Prevalence and Predisposing Factors for Recurrence after Hallux Valgus Surgery: A Systematic Review and Meta-Analysis

Recurrence is a frequent and undesirable outcome after hallux valgus (HV) surgery. However, the prevalence of HV recurrence and the pre- and postoperatory factors associated with it have not been adequately studied. This study aimed to quantify the prevalence rate of HV recurrence and to analyze its predisposing factors. MEDLINE and EMBASE databases were systematically searched for observational studies including individuals undergoing HV surgical correction. The random-effects restricted maximum likelihood model was used to estimate the pooled effect size (correlation coefficient (r)). Twenty-three studies were included, yielding a total of 2914 individuals. Pooled prevalence of HV recurrence was 24.86% (95% confidence interval (CI), 19.15 to 30.57, I2 = 91.92%, p = 0.00). Preoperative HV angle (HVA) (r = 0.29; 95% CI, 0.14 to 0.43) and preoperative intermetatarsal angle (IMA) (r = 0.13; 95% CI, 0.00 to 0.27) showed a moderate positive relationship with recurrence. Postoperative HVA (r = 0.57; 95% CI, 0.21 to 0.94) and sesamoid position (r = 0.46; 95% CI, 0.31 to 0.60) showed strong relationships with recurrence. In conclusion, preoperative HVA, IMA, and postoperative HVA and sesamoid position are significant risk factors for HV recurrence, and the association of these factors with recurrence is affected by age.

Moral orientations in psychology: contrasting theoretical perspectives

BackgroundThe relational development systems (RDS) metamodel embodies a newly recognized scientific paradigm that stands in contrast to the nature-nurture split. It suggests that the bidirectional relationship between an organism and its environment must be the central focus of scientific inquiry.Main bodyRDS theorists suggest scientists have a moral obligation to benefit human kind. However, the potential for interventions that appear efficacious to simultaneously instigate an undesirable outcome suggests that moral clarity might not always exist in scientific practice. Contrasting RDS perspectives with life history theory highlights a pertaining disparity in approaches.ConclusionWhile the RDS metamodel posits many premises necessary to contemporary research, it may not yet be pragmatic to impose moral obligation on the sciences.

Undesirable Postoperative Anesthesia Outcomes at Two National Referral Hospitals: A Cross-Sectional Study in Eritrea

Background. Postoperative undesirable anesthesia outcomes are common among patients undergoing surgery. They may affect body systems and lead into more serious postoperative problems. This research is conducted in the Eritrean National Referral Hospitals with the aim of assessing the prevalence of undesirable anesthesia outcomes during the postoperative period. Method. A cross-sectional study design was applied on 470 patients who underwent different types of surgeries within a three-month period. Patients were interviewed 24 hours after operation (POD 1) using the Leiden Perioperative care Patient Satisfaction questionnaire (LPPSq). This study reports one component of a large study conducted. The dimension “Discomfort and needs” of the LPPSq was considered, and the measurements of that dimension are presented in this report. Items of the dimension were standardized and measured using a five-point Likert scale from “Not at all” to “Extremely.” Multivariable logistic regression was used to look for the association of the outcomes with the types of surgery and types of anesthesia using SPSS (Version 22). Results. The prevalence were computed in two manners, prevalence of those with ‘at least a little bit’ outcomes, which was computed to see the total occurrence of these outcomes, and prevalence of those having ‘more than moderate’ outcomes to see the severe experience of these outcomes. Prevalence of the predominant undesirable outcome, postoperative pain, for ‘at least a little bit’ and ‘more than moderate’ were 82.6% and 43.6%, respectively. The rest of the postoperative undesirable outcomes were less frequently reported. Conclusion. Postoperative pain was found to be the most prevalent undesirable outcome. Enhancement of proper assessment and management of postoperative pain through the development and implementation of specific pain management modalities is needed.

Root-Cause Analysis

A root-cause analysis is used to identify the initiating, or root, of a causal chain that leads to an observed undesirable outcome. It is useful in helping managers to focus their problem-solving efforts on providing remedies to issues that actually prevent the undesirable outcome from recurring. Failure to identify the root cause of a problem often leads to time spent on removing causal factors, which can alleviate the symptoms of a problem yet may not prevent recurrence with full certainty. This chapter discusses the underlying theory, core idea, depiction, process, insight or value created, and risks and limitations of root-cause analysis. The chapter also discusses the illustration of the DISH Network and applies the steps of root-cause analysis to this case.

Stress and Exploitative Decision-Making

Every day, we encounter situations in which we must decide whether to continue what we are doing or move on to a potentially better option (e.g., going to the same place as last year for vacation or traveling somewhere new; staying in a secure but unsatisfying job or embarking on a new career path). These types of decisions are examples of the explore/exploit problem. Exploration is defined as choosing an option about which we have less information, whereas exploitation is sticking with an option about which we know more. The decisions people ultimately make in these situations depend upon their past experiences, which create expectations about the type and likelihood of rewards and punishments that a given environment will yield. For example, if an individual perceives that the world has been harsh and unfair, she might expect that any choice she makes will lead to an undesirable outcome. This individual may therefore be more likely to exploit a familiar, but nonoptimal, option than to explore an alternative path. Lenow et al. (2017) argue that stress is one factor that leads to perceptions of an environment being harsh, and therefore hypothesized that stress would facilitate tendencies to exploit rather than explore.

Myopia drives reckless behavior in the face of over-taxation

Governments use taxes to discourage undesired behaviors and encourage desired ones. One target of such interventions is reckless behavior, for instance, texting while driving, which in most cases is harmless but sometimes leads to catastrophic outcomes. Past research has demonstrated how interventions can backfire when the tax on one reckless behavior is set too high while other less attractive reckless actions remain untaxed. In the context of experience-based decisions, this undesirable outcome arises from people behaving as if they underweighed rare events, which according to a popular theoretical account can result from basing decisions on a small, random sample of past experiences. Here, we reevaluate the adverse effect of overtaxation using an alternative account focused on recency. We show that a reinforcement-learning model that weighs recently observed outcomes stronger than than those observed in the past can provide an equally good account of people's behavior. Furthermore, we show that there exist two groups of individuals who show qualitatively distinct patterns of behavior in response to the experience of catastrophic outcomes. We conclude that targeted interventions tailored at a small group of myopic individuals who disregard catastrophic outcomes soon after they have been experienced can be as effective as an omnibus intervention based on taxation.

Effect of Preoperative Nebulized Ketamine on Incidence and Severity of Postoperative Sore Throat in Patient Undergoing General Anaesthesia with Endotracheal Intubation

Introduction Postoperative sore throat (POST) has a reported incidence of up to 62% following general anaesthesia. POST was rated by patients as the eighth most undesirable outcome in the postoperative period. The objective of this study was to compare the incidence and severity of postoperative sore throat after saline and ketamine nebulization in patients undergoing general anaesthesia with endotracheal intubation. MethodsThe study was prospective double blinded randomized controlled trial . One hundred patients belonging to American Society of Anesthesiologists physical status I–II undergoing surgery under general anaesthesia with endotracheal intubation were randomized into two groups; group Saline (S) received nebulization with 5 ml of normal saline and group Ketamine (K) received nebulization with 1 ml of ketamine of concentration 50 mg/ml mixed with 4 ml saline. POST was assessed at zero hour, two hour, four hour, six hour, eight hour and 24 hour. ResultsThe overall incidence of POST was 28%. Twenty two (44%) patients in group S and six (12%) patients in group K had postoperative sore throat at some point of the study. The POST was significantly reduced in group K at zero hour 3(6%), two hour 3(6%), four hour 4(8%), six hour 5(10%) and eight hour 3(6%) with p value <0.05 . The severity of POST was also significantly decreased in group K at zero hour, two hour, four hour, six hour, eight hour with p value <0.05. ConclusionPreoperative nebulization with ketamine reduces the incidence and severity of POST after general anaesthesia with endotracheal intubation.

The Utility of Choice-Enhancing Language in Emergency Preparedness Messages: An Application of Psychological Reactance Theory

ABSTRACT Objective: This study uses psychological reactance theory as a framework for designing effective emergency preparedness messages. Psychological reactance is the motivational state that occurs when individuals perceive their freedom to be threatened. From the standpoint of persuasive message design, reactance is an undesirable outcome that should be avoided whenever possible. Methods: Participants (N = 174) were randomly assigned to view 1 of 2 emergency preparedness messages (choice-enhancing language [“the choice is yours”] vs choice-restricting language [“you must”]) in a between-subjects-posttest-only online survey experiment. Results: Structural equation modeling revealed that choice-restricting language resulted in greater freedom threat and subsequent reactance. Reactance resulted in a diminished attitude and subsequent intention to prepare an emergency kit. Conclusion: Public health practitioners would benefit from the inclusion of choice-enhancing language in their public communications, alongside the exclusion of choice-restricting language. Pretesting of messages is recommended to avoid eliciting reactance and subsequent boomerang effects.

Undesirable Perioperative Anesthesia Outcomes at Two National Referral Hospitals, a cross sectional study in Eritrea

Background: Perioperative undesirable anesthesia outcomes are common among patients undergoing surgery. They may affect body systems and lead into more serious intraoperative and postoperative problems. This research is conducted in the Eritrean National Referral Hospitals with the aim of assessing the prevalence of undesirable anesthesia outcomes during the perioperative period. Method: A cross sectional study design was applied on 470 patient who underwent different types of surgeries with in a three month period. Patients were interviewed 24 hours after operation using the Leiden preoperative care patient satisfaction questionnaire (LPPSq). This study reports one component of a large study conducted. The dimension “Discomfort and needs” of the LPPSq was considered and the measurement of that dimension are presented in this report. Items of the dimension were standardized and measured using a five point Likert scale from “Not at all” to “Extremely”. Multivariable logistic regression was used to look for the association of the outcomes with the types of surgery and types of anesthesia using SPSS (Version 22). Statistical significance level was set at p< 0.05. Results: The prevalence of undesirable anesthesia outcomes were computed in two manners; prevalence of those with ‘at least a little bit’ outcomes which was computed to see the total occurrence of these outcomes and prevalence of those having ‘more than moderate’ outcomes to see the severe experience of these outcomes. Prevalence of the predominant undesirable outcome, post-operative pain, for ‘at least a little bit’ and ‘more than moderate’ were 82.6% and 43.6% respectively. The rest post-operative undesirable outcomes were less frequently reported. Conclusion: Postoperative pain was found to be the most prevalent undesirable outcome. Enhancement of the proper assessment and management of postoperative pain through the development and implementation of specific pain management modalities is needed. Local guidelines should also be available in these settings for the treatment of acute postoperative pain or other outcomes. Keywords: Leiden preoperative care patient satisfaction questionnaire (LPPSq), Perioperative care, Surgery, Undesirable anesthesia outcomes.