Monday, October 1, 2007

Therapist Caught In The Act Stealing From Patients

Police in Utah County say they caught a physical therapist - who has a history of drug problems - stealing medication from a client's car while she was inside getting treatment.
Detectives arrested James C. Nackos, 35, on suspicion of burglary, theft and illegal possession of prescription drugs. On Thursday he remained in the Utah County jail without bail.
Nackos is a physical therapist at a Provo clinic. One of Nackos' clients had noticed when she finished her appointments and returned to her car it appeared someone rummaged her purse, said Lt. Rich Ferguson of the Utah County major crimes task force.
The woman's family, armed with a video camera, decided to watch her car while she attended her next appointment, he said. The family members recorded a man who appeared to be Nackos using her keys to enter the car and going through her purse, Ferguson said.
The family reported the burglary to police, and Detective Dan Forster planned a similar sting. On Tuesday, the woman arrived for an appointment again.
Ferguson said the client was inside about 20 minutes when Nackos came outside with her keys and entered the car, taking prescription medication from her purse.
"He's pretty hasty about it," Ferguson said. "He's out of the car pretty quick and we took him down at that time."
It appears Nackos

would occupy the client by having her operate a therapy machine, then he would take her car keys, he said.
"We're pretty curious if there's other victims," Ferguson said.
Nackos pleaded in abeyance in October 2005 to two felony counts of altering a prescription. The convictions were to be voided after 24 months if Nackos did not violate laws. Failing to meet that term puts Nackos at risk of going to prison for as much as five years on each count, but there was no indication Thursday of whether prosecutors or 4th District Court in Provo were planning to take action.
Nackos has had a license to practice physical therapy since 2002, according to the Utah Division of Professional Licensing. State laws list felony convictions or drug crimes as grounds for discipline against professional license holders. Professional Licensing said it has no record of any enforcement proceedings against Nackos, though it's not clear if Professional Licensing was aware of the convictions.
"It certainly is grounds for investigation," said Scott Ward, physical therapy division chairman at the University of Utah and the president of the American Physical Therapy Association. Ward said he was not familiar with the Nackos case.

Hydroxyapatite-Coated Tibial Implants Compared with Cemented Tibial Fixation in Primary Total Knee Arthroplasty

A Randomized Trial of Outcomes at Five Years

L.A. Beaupré, PhD, PT1, M. al-Yamani, MD1, J.R. Huckell, BSc, MDCM, FRCS(C)1 and D.W.C. Johnston, MD, FRCS(C)1

1 University of Alberta, Capital Health, 1F1.52 WMC, 8440-112 Street, Edmonton, AB T6G 2B7, Canada. E-mail address for L.A. Beaupré:

Investigation performed at Capital Health, Edmonton, Alberta, Canada

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from Stryker Canada, Inc. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Background: Although excellent long-term results have been reported with cemented tibial fixation, cementless fixation as a means to improve the longevity of total knee prostheses continues to be of interest to clinicians. The purpose of this study was to compare outcomes between cementless tibial fixation with hydroxyapatite and cemented tibial fixation in the first five years following primary total knee arthroplasty.

Methods: We performed a prospective, randomized clinical trial that included eighty-one patients with noninflammatory knee arthritis who underwent primary total knee arthroplasty when they were less than seventy years of age. The subjects were randomized at the time of surgery to be treated with either cementless tibial fixation with hydroxyapatite or cemented tibial fixation. Evaluations were performed preoperatively and at six months, one year, and five years postoperatively by a physical therapist who was blinded to group allocation. Self-reported pain and function, the primary outcomes, were measured with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the RAND 36-Item Health Survey (RAND-36). Complications and revision rates were determined through a review of hospital records and at each patient evaluation. The Knee Society radiographic score was used to evaluate plain radiographs at each assessment.

Results: Seventy subjects (86%) completed the five-year assessment. Slightly more pain was reported in the hydroxyapatite group at six months as measured with both the WOMAC and the RAND-36, a difference that disappeared by one year postoperatively. No differences were seen in function, radiographic findings, or complications. No subject required revision of the tibial prosthesis during the study.

Conclusions: At five years postoperatively, there is no difference between cementless tibial fixation with hydroxyapatite and cemented tibial fixation in terms of self-reported pain, function, health-related quality of life, postoperative complications, or radiographic scores.

Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.

Helping Patients Walk Again

Hamburg, Penn. -- For stroke patients or people living with multiple sclerosis or cerebral palsy, one of the most difficult, but very common, side effects of their condition is paralysis of part of the body. But now, a new device is giving some patients their life back.

For Lorrie Hemerly, a short walk with her husband, Jeff, is reason to celebrate. Just a few months ago, it was impossible to keep up. Multiple sclerosis had rendered her right leg nearly useless.

"It was one of my first questions when they told me I had MS. Was I going to wind up in a wheelchair?" Hemerly says.

But now, physical therapists are using a new wireless, computer-controlled device to help people with central nervous system disorders. Hemerly suffers from what is known as "Foot Drop." She's not able to raise her toes while she's walking.

That's where the "NESS" L-300 comes in. "NESS" stands for neuromuscular-electrical-stimulation-system. The NESS has three parts -- a sensor inside the user's shoe with a transmitter that is clipped onto the heel, the brace at the knee, and a small, hand-held control unit.

When Hemerly steps down on her heel, the transmitter sends a wireless signal to her brace. Then, two electrodes send a timed, electrical pulse to the nerves that control the paralyzed foot.

"That is the one that you're stimulating during what's called the 'swing phase,' when you want the leg to be able to go up and through without issue," says Kathy Slezak, physical therapist at Good Shepherd Rehabilitation Network in Allentown, Penn.

Hemerly can control the "NESS." When she's tired, her foot starts to drag, so she can increase the electrical stimulation.

But the biggest benefit? Hemerly says the device has greatly increased her stability. This first-time grandma said she couldn't hold little McKenzie and walk at the same time. Now, that's changed.

"It gives you a little bit more confidence now. You can do a bit more," Hemerly says.

Patients say they can feel the electrical charge going into their leg, but it's not painful, and they get used to it quickly. Physical therapists say they've had the most success with patients who have paralysis on only one side of the body. Good Shepherd Rehabilitation Network is the only in-patient Beta testing site for the technology in the United States.