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Elgg / Städtchen und Umgebung, Switzerland

Krapf D.,Kantonsspital Aarau AG | Kaipel M.,Barmherzige Bruder Hospital | Majewski M.,Universitaetsspital Basel Orthopaedie

Acute Achilles tendon ruptures are common sports injuries; however, treatment remains a clinical challenge. Studies show a superior effect of early mobilization and full weight bearing on tendon healing and clinical outcome; however, few data exist on structural and biomechanical characteristics in the early healing phase. This study investigated the histological and biomechanical characteristics of early mobilization and full weight bearing in an Achilles tendon rupture model. Eighty rats underwent dissection of a hindpaw Achilles tendon; 40 rats were treated conservatively and 40 underwent open repair of the transected Achilles tendon by suturing. Early mobilization and full weight bearing were allowed in both groups. At 1, 2, 4, and 8 weeks after tenotomy, tensile strength, stiffness, thickness, tissue characteristics (histological analysis), and length were determined. Dissected Achilles tendons healed in all animals during full weight-bearing early mobilization. One and 2 weeks after tenotomy, rats in the operative group showed increased tensile strength and stiffness compared with the nonoperative group. Repair-site diameters were increased at 1, 2, and 8 weeks after tenotomy. Tendon length was decreased in the operative group throughout observation, whereas the nonoperative group showed increased structural characteristics on the cellular level and a more homogeneous collagen distribution. Surgical treatment of dissected rat Achilles tendons showed superior biomechanical characteristics within the first 2 weeks. Conservative treatment resulted in superior histological findings but significant lengthening of the tendon in the early healing phase (weeks 1-8). Source

Schwappach D.L.B.,Swiss Patient Safety Foundation | Schwappach D.L.B.,University of Bern | Wernli M.,Kantonsspital Aarau AG
Quality and Safety in Health Care

Objectives To assess chemotherapy patients' perceptions of safety and their attitudes towards participating in error-prevention strategies. Design Semistructured interviews were conducted with 30 chemotherapy patients at baseline. Follow-up interviews were conducted 9 weeks later. Setting A community hospital in Switzerland. Results Though patients had experienced errors in their care, they were only moderately worried about safety, risk of errors and the potential for harm. At follow-up, worries about safety had increased, and patients reported a higher degree of vigilance. Participants unequivocally agreed that patients can make contributions to their safety, and many patients were prepared to get involved. Patients described engaging in their safety as a learning process and highlighted the importance of being proactive, asking questions and communicating any observations of deviations from routines. Commonly recommended error-prevention strategies were rated as highly effective. Instruction by nurses was central for patients, but the underlying reasons varied. There was no indication that patients perceive participation in safety actions as eroding trust in their providers. Conclusions Patients are prepared to engage in their safety, but the encouragement by staff is vital. Involvement of patients with cancer in medication administration safety needs to acknowledge patients' conceptions of these activities and their varying abilities at different stages in the treatment process. Source

Schwappach D.L.B.,Swiss Patient Safety Foundation | Schwappach D.L.B.,University of Bern | Wernli M.,Kantonsspital Aarau AG

Background. Patients can make contributions to the safety of chemotherapy administration but little is known about their motivations to participate in safetyenhancing strategies. The theory of planned behavior was applied to analyze attitudes, norms, behavioral control, and chemotherapy patients' intentions to participate in medical error prevention. Methods. A quantitative, cross-sectional survey study among chemotherapy patients treated at the oncology/ hematology department of a large regional hospital was conducted. Confirmatory factor analysis and structural equation modeling were used to investigate the relationship between patients' responses to measures of attitudes, norms, and behavioral control and their intentions. Results. Four hundred seventy-nine patients completed the survey (52% response rate). Attitudes, perceived behavioral control, and subjective norms explained 62% of the variance in intentions to engage in error monitoring and reporting. Perceived behavioral control (β =0.476), norms relating to patients' relatives (β = 0.343), and instrumental attitudes (β = 0.281) were the strongest (direct) predictors of patients' intentions. Experiential attitudes had the smallest effect on intentions (β = 0.178). Subjective norms relating to expectations attributed to oncology staff had strong direct and indirect effects on patients' intentions (total effect, 0.382). Conclusions. Patients acknowledge the benefit of error monitoring and reporting and anticipate positive outcomes of involvement, but their valuations of the process of engaging in error prevention are less positive. Behavioral control and perceptions of staff approval are central for patients. Involvement of cancer patients in safety requires oncologists to address their patients' normative and control beliefs through education and proactive approval of patient engagement. © AlphaMed Press. Source

Schmoelz W.,Innsbruck Medical University | Disch A.C.,Charite - Medical University of Berlin | Huber J.F.,Kantonsspital Aarau AG
European Spine Journal

With the growing incidence of vertebral compression fractures in elderly patients having a fair overall health condition, minimal-invasive treatment techniques are getting in focus of surgical therapy. Cement augmentation is widely performed and its complications and mechanical limitations are well described. Implants avoiding the side effects of cement augmentation while reaching the same level of stability would be desirable. The primary and secondary stability of a new augmentation method with self-locking hexagonal metal implants were investigated and compared with the performance of established augmentation options. 18 fresh-frozen human spinal specimens (Th12-L2/L3-L5) were tested with pure moments of 7.5 Nm in a six-degree-of-freedom spine simulator to investigate primary and secondary stability of three augmentation techniques: (1) vertebroplasty, (2) PMMA filled cavity and (3) hexagonal metal implants. An increasing three-step cyclic loading model was included. Elastic displacement and height loss under loading did not show significant differences between the three test groups. Investigation of primary and secondary stability evenly demonstrated comparable results for all techniques indicating an insufficiency to stabilise the fracture with higher load cycles. The newly introduced method for augmentation with the metal implant Spine Pearls achieved comparable results to bone cement based techniques in a biomechanical in vitro study. Midterm and longterm reduction preservation and ingrowth of the implants have to be proven in further studies. © 2010 Springer-Verlag. Source

Fathi A.R.,U.S. National Institutes of Health | Fathi A.R.,Kantonsspital Aarau AG | Pluta R.M.,U.S. National Institutes of Health | Bakhtian K.D.,U.S. National Institutes of Health | And 3 more authors.
Journal of Neurosurgery

Object. Subarachnoid hemorrhage (SAH)-induced vasospasm is a significant underlying cause of aneurysm rupture- related morbidity and death. While long-term intravenous infusion of sodium nitrite (NaNO 2) can prevent cerebral vasospasm after SAH, it is not known if the intravenous administration of this compound can reverse established SAH-induced vasospasm. To determine if the intravenous infusion of NaNO 2 can reverse established vasospasm, the authors infused primates with the compound after SAH-induced vasospasm was established. Methods. Subarachnoid hemorrhage-induced vasospasm was created in 14 cynomolgus macaques via subarachnoid implantation of a 5-ml blood clot. On Day 7 after clot implantation, animals were randomized to either control (saline infusion, 5 monkeys) or treatment groups (intravenous NaNO 2 infusion at 300 μg/kg/hr for 3 hours [7 monkeys] or 8 hours [2 monkeys]). Arteriographic vessel diameter was blindly analyzed to determine the degree of vasospasm before, during, and after treatment. Nitric oxide metabolites (nitrite, nitrate, and S-nitrosothiols) were measured in whole blood and CSF. Results. Moderate-to-severe vasospasm was present in all animals before treatment (control, 36.2% ± 8.8% [mean ± SD]; treatment, 45.5% ± 12.5%; p = 0.9). While saline infusion did not reduce vasospasm, NaNO 2 infusion significantly reduced the degree of vasospasm (26.9% ± 7.6%; p = 0.008). Reversal of the vasospasm lasted more than 2 hours after cessation of the infusion and could be maintained with a prolonged infusion. Nitrite (peak value, 3.7 ± 2.1 μmol/L), nitrate (18.2 ± 5.3 μmol/L), and S-nitrosothiols (33.4 ± 11.4 nmol/L) increased significantly in whole blood, and nitrite increased significantly in CSF. Conclusions. These findings indicate that the intravenous infusion of NaNO 2 can reverse SAH-induced vasospasm in primates. Further, these findings indicate that a similar treatment paradigm could be useful in reversing cerebral vasospasm after aneurysmal SAH. Source

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