The Role of Patient Education in Total Knee Arthroplasty: a new methodology for developing countries: a randomized controlled trial

Background: The illiteracy index is high in public hospitals of developing countries,. We established a method in which patients are instructed before total knee arthroplasty (TKA) in a differentiated way without the necessity of reading any self-orientation. Methods: We developed a multidisciplinary approach to improve patient education in TKA comprising of a differentiated orientation conducted by an orthopedic surgeon, a nurse and a physiotherapist. It consists of standardized lectures regarding on pre, intra and post-operative issues in a randomized controlled trial of 79 consecutive patients undergoing primary TKA. Thirty-four patients received the standard education (control group) and 45 patients received the differentiated education (intervention group). The patients were evaluated during at least six months. Results: After a 6-month follow-up period, the Short Form Health Survey (SF-36), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the visual analogue pain scale (VAS) and knee range-of-motion (ROM) improved significantly in both groups. Range-of-motion was better in the intervention group (mean and SD - 106.9 ± 5.7 versus 92.5 ± 12.1 degrees, p = 0.02). Moreover, walk ability (more than 400 meters) was better in the intervention group compared with the control group (97.4% versus 72.4%, p = 0.003). In the intervention and control groups, respectively, 10.5% and 31% of patients reported the need for some walking devices (p = 0.03). Conclusions: A differentiated educational program with a multidisciplinary team had a positive impact on functional outcomes, improving ROM and walk ability of patients undergoing TKA in a short-term evaluation.

A new educational method before total knee arthroplasty to be applied in developing countries: a randomized controlled trial

Background In developing countries, the illiteracy index is high in public hospitals. We describe a method in which patients are instructed before total knee arthroplasty (TKA) in a differentiated way without the necessity of reading any self-orientation. Methods To improve patient education before TKA we developed a multidisciplinary method in which an orthopedic surgeon, a nurse and a physiotherapist give the patients a differentiated orientation with specific lectures regarding the pre, intra and post-operative issues in a prospective case-control study of 79 consecutive patients undergoing primary TKA. Twenty-nine patients received the standard verbal education (control group) and 38 patients received the differentiated education (intervention group). The patients were evaluated during at least six months. Results After a 6-month follow-up period, SF-36 and WOMAC forms, VAS and range of motion improved significantly in both groups. ROM was better in the intervention group (mean and SD − 106.9 ± 5.7 versus 92.5 ± 12.1 degrees, p = 0.02). Moreover, walk ability (more than 400 meters) was improved in the intervention group compared with control group (97.4% versus 72.4%, p = 0.003). In the intervention and control groups, respectively, 10.5% and 31% of patients reported the need of some walking device (p = 0.03). Conclusions A differentiated educational program with a multidisciplinary team had a positive impact on functional outcomes, improving ROM and walk ability of patients undergoing TKA in a short-term evaluation.

What Is The Role Of Design And Architecture In Slip, Trip, And Fall Accidents?

The paper and presentation addresses how much comparative negligence is contributed by bad architectural choices and environmental design, as compared to humans not being aware or “unconscious” of their surrounding environment. What is the role of the environment versus behavior? The architectural design process has critical steps in developing design criteria, but human factors and ergonomics are not typically given priority over aesthetics. Egress paths of travel are addressed typically in terms of accessibility and fire resistance, but not in terms of walk-ability, safety, including slip and trip resistance. Various national and state codes, as well as standards of care define what safe paths of travel should be, yet in 2007, more than 21,700 Americans died as a result of falls and more than 7.9 million were injured. Falls are the leading cause of injury related deaths among adults 73 year and older, and 2nd leading cause of death of persons 60-72. Over 275,000 occupational injuries were caused by slips, trips and falls in 2008 (Scott, National Safety Council, 2009). The consequences of a person suffering injures from a fall accident are ten times more likely than being a victim from a fire (National Safety Council 2017). Recommendations are made for improved architectural awareness and understanding of the human factors and ergonomics in the prevention of slip, trip, and fall accidents.

Ecological Urbanism in the Tropics Studies on the Sustainable Dimensions of Malay Traditional Urban Centers

Many of the present eco-cities are designed and planned with an emphasis on high technology and infrastructure yet the meaning of sustainability itself implies a balance between past and present. Past urban configurations that rise from earlier traditional socio-cultural structures reflect sustainable principles localised to climate and ecology. The aim of this study is to reconstruct urban morphologies be-fore the advent of the automobile in order to analyse and characterise urban forms that are aligned with ecological criteria such as walk-ability, permeability and shade. Three traditional urban center or ‘cores’ in tropical Malaysia which had reigned during the early colo-nial era yet still related sultanate-based polities are mapped in terms of morphologies and these urban ‘core’ configurations were esti-mated and composed according to historical documents and evidences . These urban patterns are then discussed with regards to the present principles and criteria of green urbanism. The reconstructed and mapped urban cores are discussed in relation to green urban-ism principles and criteria, namely, based on global sustainable standards namely the LEED ND (Leadership in Energy and Environ-mental Design) version 4 neighbourhood rating system. The findings from this study suggest the contextualization of sustainable criteria according to climate and postulate the differences between traditional urban morphologies that can further regionalism principles of current green urbanism and further contextualise key principles in international standards on urbanism.

Selling New Neighborhoods as Good for Walking: Issues for Measuring Self-Selection

Background:Self-selection—whether individuals inclined to walk more seek to live in walkable environments—must be accounted for when studying built environment influences on walking. The way neighborhoods are marketed to future residents has the potential to sway residential location choice, and may consequently affect measures of self-selection related to location preferences. We assessed how walking opportunities are promoted to potential buyers, by examining walkability attributes in marketing materials for housing developments.Methods:A content analysis of marketing materials for 32 new housing developments in Perth, Australia was undertaken, to assess how walking was promoted in the text and pictures. Housing developments designed to be pedestrian-friendly (LDs) were compared with conventional developments (CDs).Results:Compared with CDs, LD marketing materials had significantly more references to ‘public transport,’ ‘small home sites,’ ‘walkable parks/open space,’ ‘ease of cycling,’ ‘safe environment,’ and ‘boardwalks.’ Other walk-ability attributes approached significance.Conclusion:Findings suggest the way neighborhoods are marketed may contribute to self-reported reasons for choosing particular neighborhoods, especially when attributes are not present at the time of purchase. The marketing of housing developments may be an important factor to consider when measuring self-selection, and its influence on the built environment and walking relationship.