The Death of a Newborn Twin: An Analysis of Parental Bereavement

The emotional responses of eight families who lost a singleton newborn were compared with those of eight families who lost a twin. The mean gestational age of the babies in both groups was 31 weeks. At a mean time of 15 months following their loss, parents were sent a questionnaire which requested that they report their responses during the first six weeks following their baby's death and their present response to this experience. Embedded in the questionnaire was a 20-item depression symptom inventory. Analysis of variance indicated that although mothers experienced significantly more depressive symptoms than fathers (F = 59.48, P = .001) and that all symptoms had diminished greatly over time (F = 6.02, P = .032), there was no significant difference between the parents who had lost a twin and those who had lost a singleton. However, family, friends, and hospital staff frequently ignored or downplayed the death of the twin assuming that the grief of the parents would be minimal because of the surviving twin. Results of this study indicate that the presence of a living twin in no way lessens the grieving process and that a conscious effort needs to be made to allow parents to express openly their feelings of loss when a twin dies.

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The impact of COVID-19 infection on hip fracture 30-day mortality

Trauma ◽

10.1177/1460408620949725 ◽

2021 ◽

pp. 146040862094972

Author(s):

Ahmed Fadulelmola ◽

Rob Gregory ◽

Gavin Gordon ◽

Fiona Smith ◽

Andrew Jennings

Keyword(s):

Hip Fracture ◽

Hip Fractures ◽

Hospital Admissions ◽

The Elderly ◽

Primary Outcome Measure ◽

Time To Death ◽

Significant Difference ◽

The Mean ◽

The Impact ◽

Mean Time

Introduction: A novel virus, SARS-CoV-2, has caused a fatal global pandemic which particularly affects the elderly and those with comorbidities. Hip fractures affect elderly populations, necessitate hospital admissions and place this group at particular risk from COVID-19 infection. This study investigates the effect of COVID-19 infection on 30-day hip fracture mortality. Method: Data related to 75 adult hip fractures admitted to two units during March and April 2020 were reviewed. The mean age was 83.5 years (range 65–98 years), and most (53, 70.7%) were women. The primary outcome measure was 30-day mortality associated with COVID-19 infection. Results: The COVID-19 infection rate was 26.7% (20 patients), with a significant difference in the 30-day mortality rate in the COVID-19-positive group (10/20, 50%) compared to the COVID-19-negative group (4/55, 7.3%), with mean time to death of 19.8 days (95% confidence interval: 17.0–22.5). The mean time from admission to surgery was 43.1 h and 38.3 h, in COVID-19-positive and COVID-19-negative groups, respectively. All COVID-19-positive patients had shown symptoms of fever and cough, and all 10 cases who died were hypoxic. Seven (35%) cases had radiological lung findings consistent of viral pneumonitis which resulted in mortality (70% of mortality). 30% ( n = 6) contracted the COVID-19 infection in the community, and 70% ( n = 14) developed symptoms after hospital admission. Conclusion: Hip fractures associated with COVID-19 infection have a high 30-day mortality. COVID-19 testing and chest X-ray for patients presenting with hip fractures help in early planning of high-risk surgeries and allow counselling of the patients and family using realistic prognosis.

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Adaptors and Innovators: Selection versus Induction

Psychological Reports ◽

10.2466/pr0.1991.68.3c.1283 ◽

1991 ◽

Vol 68 (3_suppl) ◽

pp. 1283-1290 ◽

Cited By ~ 12

Author(s):

P. A. Holland ◽

I. Bowskill ◽

A. Bailey

Keyword(s):

Cognitive Style ◽

Past Research ◽

Significant Shift ◽

Occupational Groups ◽

Significant Difference ◽

The Mean ◽

New Entrants ◽

Innovative Cognitive Style ◽

Over Time ◽

Established Group

The hypothesis that predictable differences would exist between the mean cognitive style of new entrants and those of the longer serving “established” employees in certain departments while not in others was tested. Data from 99 employees from four departments of a large British pharmaceuticals company who completed the Kirton Adaption-Innovation Inventory provided results broadly in line with the expectations of adaption-innovation theory and past research. The mean innovative cognitive style of new entrants to adaptive departments regressed towards the mean of the establishment and the occupational mean over time. In departments where there was no initial significant difference between the mean cognitive style of the new entrants and the established group, no significant shift was shown over time. Implications of these findings are suggested. The data also indicated norms for two occupational groups where previously they did not exist.

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Complex Regional Pain Syndrome: Current Practice Management and Referral Trends in a Closed Healthcare System

Osteology ◽

10.3390/osteology1010004 ◽

2020 ◽

Vol 1 (1) ◽

pp. 39-47

Author(s):

Connor Zale ◽

Joshua Hansen ◽

Paul Ryan

Keyword(s):

Pain Management ◽

Pain Score ◽

Complex Regional Pain Syndrome ◽

Healthcare System ◽

Pain Syndrome ◽

Occupational Outcomes ◽

Mean Delay ◽

Significant Difference ◽

The Mean ◽

Over Time

Background: Complex regional pain syndrome (CRPS) is a neurologic condition that can present with severe pain and dysfunction. Delay in treatment adversely affects outcomes. The purpose of this study is to evaluate patient outcomes as they relate to the time from diagnosis to pain management referral once the diagnosis of CRPS has been made in a closed healthcare system. Methods: A retrospective record review from a closed healthcare system was utilized for CRPS cases from 2010–2019. Demographics, injury pattern, surgeries, pain score, treatment modalities, occupational outcomes, and time to pain management referral were recorded. Results: There were 26 cases of CRPS that met inclusion criteria. The mean time from diagnosis to treatment was 55 days. 16/26 (61.5%) were medically discharged from the military. 23/26 (88.5%) were unable to return to full duty due to CRPS. There was no significant difference in the reported pain scores over time regardless of treatment (p = 0.76). A linear regression demonstrated a significantly higher Visual Analog Scale Pain Score (VAS) over time in patients that were medically discharged (p = 0.022). Conclusions: The mean delay in referral to the pain service was 55 days. The majority of patients (88.5%) did not return to full duty secondary to the diagnosis of CRPS, and 61.5% of patients required medical separation from active duty. Due to the negative impact that the diagnosis of CRPS has on occupational outcomes with a mean delay in referral of 55 days, clinics and providers should set up referral criteria and establish early pain pathways for patients diagnosed with CRPS.

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Assessment of necessity of neuronavigation in localization of calvarial extra-axial lesions in the setting of limited resources

Chinese Neurosurgical Journal ◽

10.1186/s41016-021-00253-1 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Hussein Soffar ◽

Mohamed F. Alsawy

Keyword(s):

Conventional Method ◽

Linear Measurement ◽

Limited Resources ◽

Linear Measurements ◽

Surgical Interventions ◽

Localization Method ◽

Mean Error ◽

Significant Difference ◽

The Mean ◽

Mean Time

Abstract Background Neuronavigation is a very beneficial tool in modern neurosurgical practice. However, the neuronavigation is not available in most of the hospitals in our country raising the question about its importance in localizing the calvarial extra-axial lesions and to what extent it is safe to operate without it. Methods We studied twenty patients with calvarial extra-axial lesions who underwent surgical interventions. All lesions were preoperatively located with both neuronavigation and the usual linear measurements. Both methods were compared regarding the time consumed to localize the tumor and the accuracy of each method to anticipate the actual center of the tumor. Results The mean error of distance between the planned center of the tumor and the actual was 6.50 ± 1.762 mm in conventional method, whereas the error was 3.85 ± 1.309 mm in IGS method. Much more time was consumed during the neuronavigation method including booting, registration, and positioning. A statistically significant difference was found between the mean time passed in the conventional method and IGS method (2.05 ± 0.826, 24.90 ± 1.334, respectively), P-value < 0.001. Conclusion In the setting of limited resources, the linear measurement localization method seems to have an accepted accuracy in the localization of calvarial extra-axial lesions and it saves more time than neuronavigation method.

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Evaluating the Effect of Three-Dimensional Visualization on Force Application and Performance Time during Robotics-Assisted Mitral Valve Repair

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0b013e3182a3200e ◽

2013 ◽

Vol 8 (3) ◽

pp. 199-205 ◽

Cited By ~ 2

Author(s):

Maria E. Currie ◽

Ana Luisa Trejos ◽

Reiza Rayman ◽

Michael W.A. Chu ◽

Rajni Patel ◽

...

Keyword(s):

Cardiac Surgery ◽

Mitral Valve ◽

Haptic Feedback ◽

3D Visualization ◽

Three Dimensional ◽

Test Bed ◽

Mitral Valve Annuloplasty ◽

Significant Difference ◽

The Mean ◽

Mean Time

Objective The purpose of this study was to determine the effect of three-dimensional (3D) binocular, stereoscopic, and two-dimensional (2D) monocular visualization on robotics-assisted mitral valve annuloplasty versus conventional techniques in an ex vivo animal model. In addition, we sought to determine whether these effects were consistent between novices and experts in robotics-assisted cardiac surgery. Methods A cardiac surgery test-bed was constructed to measure forces applied during mitral valve annuloplasty. Sutures were passed through the porcine mitral valve annulus by the participants with different levels of experience in robotics-assisted surgery and tied in place using both robotics-assisted and conventional surgery techniques. Results The mean time for both the experts and the novices using 3D visualization was significantly less than that required using 2D vision (P < 0.001). However, there was no significant difference in the maximum force applied by the novices to the mitral valve during suturing (P = 0.7) and suture tying (P = 0.6) using either 2D or 3D visualization. The mean time required and forces applied by both the experts and the novices were significantly less using the conventional surgical technique than when using the robotic system with either 2D or 3D vision (P < 0.001). Conclusions Despite high-quality binocular images, both the experts and the novices applied significantly more force to the cardiac tissue during 3D robotics-assisted mitral valve annuloplasty than during conventional open mitral valve annuloplasty. This finding suggests that 3D visualization does not fully compensate for the absence of haptic feedback in robotics-assisted cardiac surgery.

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Comparison of stapler and handsewn anastomosis techniques in creating an ileal conduit following radical cystectomy

10.31083/jomh.2021.107 ◽

2021 ◽

pp. 1

Keyword(s):

Postoperative Complications ◽

Ileal Conduit ◽

Perioperative Complications ◽

Movement Time ◽

Oral Intake ◽

Total Cost ◽

Handsewn Anastomosis ◽

Significant Difference ◽

The Mean ◽

Mean Time

Background and objective: Ileal conduit for urinary diversion can be completed using either end-to-end handsewn or stapled anastomosis. This study aimed to compare stepled and handsewn anastomosis methods in terms of complications, hospitalization and cost. Materials and methods: Forty-three patients were included in the hand-sewn and 44 patients in the stapler group. After creating an ileal conduit, continuity of the loop was achieved either with handsewn or stapler method. Patients' demographic data, time to onset of bowel movement, time to transit to oral intake, time to removal of the drain, perioperative and postoperative complications, mortality and total costs were retrospectively recorded and compared between the two groups. Results: There was no statistically significant difference between the groups in terms of the mean to the onset of bowel movements (p = 0.51) and the mean time to transit to oral intake (p = 0.23). The mean time to removal of the drain was significantly lower in the stapler group (p = 0.023). Perioperative complications were seen in eight patients in the handsewn group, while none of the patients in the stapler group developed perioperative complication (p = 0.003). Postoperative complications were similar between both groups (p = 0.75). The duration of hospitalization was statistically significantly lower in the stapler group (p = 0.004) and the mean total cost was statistically significantly more advantageous (p < 0.001). Conclusion: No significant difference was found between stapler and handsewn anastomosis techniques in terms of postoperative complications. On the other hand, hospitalization and total cost were in favour of stapler technique, showing that this technique can be used safely.

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Tear Rates of the Ipsilateral ACL Graft and the Contralateral Native ACL Are Similar following ACL Reconstruction

The Journal of Knee Surgery ◽

10.1055/s-0040-1713861 ◽

2020 ◽

Author(s):

Nadia Nastassia Ifran ◽

Ying Ren Mok ◽

Lingaraj Krishna

Keyword(s):

Acl Reconstruction ◽

Medical Records ◽

Cruciate Ligament ◽

Acl Graft ◽

Increased Risk ◽

Significant Difference ◽

The Mean ◽

Anterior Cruciate ◽

Mean Time

AbstractThe aim of the study is to compare the tear rates of ipsilateral anterior cruciate ligament (ACL) grafts and the contralateral native ACL as well as to investigate the correlation of gender, age at time of surgery, and body mass index (BMI) with the occurrence of these injuries. The medical records of 751 patients who underwent ACL reconstruction surgery with follow-up periods of 2 to 7 years were retrospectively analyzed. Survival analyses of ipsilateral ACL grafts and contralateral native ACL were performed. Univariate and multivariate logistic regression analyses were performed to identify risk factors that were associated with these injuries. The tear rates of the ipsilateral ACL graft and contralateral ACL were 5.86 and 6.66%, respectively with no significant difference between groups (p = 0.998). The mean time of tears of the ipsilateral ACL and contralateral ACL was also similar (p = 0.977) at 2.64 and 2.78 years, respectively after surgery. Both the odds of sustaining an ipsilateral ACL graft and contralateral ACL tear were also significantly decreased by 0.10 (p = 0.003) and 0.14 (p = 0.000), respectively, for every 1-year increase in age at which the reconstruction was performed. However, graft type, gender, and BMI were not associated with an increased risk of these injuries. There was no difference between tear rates of ipsilateral ACL graft and contralateral ACL following ACL reconstruction. Patients who undergo ACL reconstruction at a young age are at an increased risk of both ipsilateral graft and contralateral ACL rupture after an ACL reconstruction. Patients who are young and more likely to return to competitive sports should be counselled of the risks and advised to not neglect the rehabilitation of the contralateral knee during the immediate and back to sports period of recovery. This is a Level III, retrospective cohort study.

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The Majority of Inpatient Short Synacthen Tests Are Performed Incorrectly, Due to Imprecise Timing, Incorrect Sampling and Failure to Interrupt Steroid Administration

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.197 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A98-A99

Author(s):

Aonghus McCarthy ◽

Susan McKenna ◽

Keira Hall ◽

Aileen Niland ◽

Gerard P Boran ◽

...

Keyword(s):

Hospital Staff ◽

Repeat Testing ◽

Steroid Administration ◽

Synacthen Test ◽

The Mean ◽

Short Synacthen Test ◽

Mean Time ◽

Sample Window ◽

Serum Acth ◽

Interpretation Of Results

Abstract Introduction: The short synacthen test (SST) is commonly used to assess adrenal function. Accurate timing and appropriate holding of exogenous steroids are essential to ensure correct interpretation of results. Aims & Methods: We reviewed all SSTs performed on inpatients in our hospital over a 1-year period, in order to determine accuracy of testing. Results: 42 patients (Male 15, Female 27), with mean age 68 years (range 43–90), underwent SST. The majority (39/42; 93%) of tests were requested by internal medicine physicians. The indications for testing were; suspected adrenal insufficiency (18), HPA axis suppression (9), fatigue (7), hyponatremia (5), suspected pituitary disease (2) and vomiting (1). 7 (44%) of the 16 patients taking steroids did not have medication appropriately held. 31 (74%) patients did not have serum ACTH measured prior to the test. 28 (66%) tests were not started at the correct time. Only 10 (24%) of the 30 minute samples were completed within the 25-35min sample window. The mean time between the 0min and 30min samples was 42mins (median 62mins; range 0-209mins). 12 (29%) tests involved an unnecessary 60min sample. 8 (19%) tests had no interpretation of results documented in the medical notes. 4 (10%) patients underwent repeat testing, necessitated by an incorrect first test. Discussion: The vast majority of inpatient SSTs (33/42;79%) were performed suboptimally, with the most common errors pertaining to incorrect timing of the test, inaccurate sampling and inappropriate pre-test steroid administration. Considering these errors, some results may have been interpreted incorrectly. Repeat tests were recognised as required in 10% of patients, with associated inconvenience, cost and discomfort. Improved training and guidelines for performing SSTs should be available to hospital staff to ensure more accurate application of the test.

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Comparison between isobaric levobupivacaine 0.5% and hyperbaric bupivacaine 0.5% in spinal anesthesia in lower limb surgeries and lower abdominal surgeries in adult patients

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20210417 ◽

2021 ◽

Vol 9 (2) ◽

pp. 418

Author(s):

Preeti Parashar ◽

Anisha Singh ◽

Manoj Kumar Sharma ◽

Dipak L. Raval

Keyword(s):

Blood Pressure ◽

Lower Limb ◽

Motor Block ◽

Total Duration ◽

Sensory Block ◽

Hyperbaric Bupivacaine ◽

Significant Difference ◽

The Mean ◽

Group B ◽

Mean Time

Background: The aim of our study was to compare sensory and motor block characteristics and hemodynamic changes following intrathecal hyperbaric bupivacaine (0.5%) and isobaric levobupivacaine (0.5%) in elective lower limb and lower abdominal surgeries.Methods: 60 patients of either sex, aged 18-60 years, ASA grade I or II scheduled for elective lower abdominal and lower limb surgeries were randomized into two groups, group B (n=30) and group L (n=30) and received either 3 ml of intrathecal hyperbaric bupivacaine or isobaric levobupivacaine intrathecally.Results: The mean time of onset of sensory block at shin of tibia in both the groups was comparable i.e. levobupivacaine (1.19±0.2 minutes) and bupivacaine (1.1+0.2 minutes). The mean time for total duration of sensory block was 211.1±8.2 minutes in group L, while 193.13±13.7 minutes in group B. Time for total duration of motor block in group L was 198.76±8.428 minutes and in group B was 182.6±13.989 minutes. Statistically significant difference was observed in total duration of sensory and motor block in both levobupivaciane and bupivacaine group (p<0.0001). Patients in group L were hemodynamically more stable with significantly less decrease in pulse rate, systolic blood pressure and diastolic blood pressure as compared to group B.Conclusions: We observed that 0.5% isobaric levobupivacaine provided better hemodynamic stability, longer duration of sensory and motor block as compared to bupivacaine.

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Effect of Oxytocin on the Body Weight of Male Rabbits

AL-MUKHTAR JOURNAL OF SCIENCES ◽

10.54172/mjsc.v36i4.369 ◽

2021 ◽

Vol 36 (4) ◽

pp. 263-272

Author(s):

Areej A. Mohammed ◽

Aisha F. Bonaama ◽

Souad A. M. Moftah ◽

Ameerah T. Ramadhan ◽

Abdulsalam M. A. Bolhaj ◽

...

Keyword(s):

Dose Group ◽

The Body ◽

Control Group ◽

High Dose ◽

Significant Difference ◽

The Mean ◽

Time Spent Feeding ◽

Mean Time ◽

Different Doses ◽

Food Consumed

This study was carried out to investigate the effect of two different doses of oxytocin on weight. Adult male rabbits (15) were weighed and provided with food twice daily for 3 weeks to determine the amount of food consumed daily and the time spent feeding by each rabbit. After 3 weeks the rabbits were weighed and divided randomly into 3groups: the control group, the low dose group, and the high dose group. The animals were injected daily for 3 weeks. During that time the amount of food consumed and the time spent feeding in both periods were determined. After the end of the treatment period the rabbits were weighed, and sacrificed. The results of this study showed that before treatment the rabbits consumed more food in the evening period than they did in the afternoon period. The mean time spent feeding in the evening period was slightly higher than that spent in the afternoon period; however, this difference was not statistically significant. After treatment, there was still significant difference between the means of the consumed food in the afternoon and the evening period for the control group. The mean amounts of food consumed in both periods by the treated groups were slightly reduced, but this reduction was not statistically significant. Furthermore, the mean time spent feeding in the evening period was slightly higher than that of the afternoon period for the 3 groups; however, these differences were not significant. The mean weight of the control group was slightly increased after treatment with the hormone; and the mean weights of the treated groups were slightly reduced after treatment. However, changes in body weighs were not statistically significant.

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