The association of early postoperative desaturation in the operating theatre with hospital discharge to a skilled nursing or long-term care facility

It is unclear which criteria should be used to define readiness for tracheal extubation in the operating theatre. We studied the effects of desaturation in the operating theatre immediately after tracheal extubation on long-term outcomes. Performing a pre-specified, retrospective analysis of 71,025 cases involving previously independent adults undergoing non-cardiac surgery, we evaluated the association between desaturation events (oxygen saturation < 90%) within 10 min of tracheal extubation and adverse discharge (to a skilled nursing facility or long-term care facility). A total of 404 (12.3%) cases with, and 5035 (7.4%) cases without, early postoperative desaturation had an adverse discharge. Early postoperative desaturation was associated with higher odds of being discharged to a nursing facility (adjusted odds ratio 1.36 (95%CI 1.20–1.54); p < 0.001). Increased duration of desaturation augmented the effect (p for trend < 0.001). Desaturation was associated with a higher risk of respiratory, renal and cardiovascular complications as well as increased duration of hospital stay, postoperative intensive care unit admission frequency and cost. Several modifiable factors were associated with desaturation including: high intra-operative long-acting opioid administration; high neostigmine dose; high intra-operative inspired oxygen concentration; and low oxygen delivery immediately before tracheal extubation. There was substantial provider variability between anaesthetists in the incidence of postoperative desaturation unexplained by patient- and procedure-related factors. Early postoperative desaturation is a potentially preventable complication associated with a higher risk of adverse discharge disposition. Anaesthetists may consider developing guidelines to define tracheal extubation readiness that contain postoperative desaturation as an adverse outcome after tracheal extubation.     

Acknowledging the use of human cadaveric tissues in research papers: Recommendations from anatomical journal editors

Research within the anatomical sciences often relies on human cadaveric tissues. Without the good will of these donors who allow us to use their bodies to push forward our anatomical knowledge, most human anatomical research would come to a standstill. However, many research papers omit an acknowledgement to the donor cadavers or, as no current standardized versions exist, use language that is extremely varied. To remedy this problem, 20 editors‐in‐chiefs from 17 anatomical journals joined together to put together official recommendations that can be used by authors when acknowledging the donor cadavers used in their studies. The goal of these recommendations is to standardize the writing approach by which donors are acknowledged in anatomical studies that use human cadaveric tissues. Such sections in anatomical papers will not only rightfully thank those who made the donation but might also encourage, motivate, and inspire future individuals to make such gifts for the betterment of the anatomical sciences and patient care.     

La place du désir dans la dysphorie de genre : une étude qualitative auprès de personnes transgenres sous traitement de réassignation sexuelle

ObjectivesThe DSM-5 defines gender dysphoria as a significant distress caused by the experience of an incongruence with regard to the person's biological sex. The diagnosis of gender dysphoria, not determined by biological, psychological and cultural elements, relies primarily on the anamnesis and the narrative of the transgender persons.MethodIndividual interviews were conducted with a sample of nine patients consulting a gender dysphoria consultation, who benefited from sexual reassignment treatments. The interviews were analyzed with the Interpretative Phenomenological Analysis (IPA).ResultsParticipants describe the development of their transgender identity as a desire to live in a body, which is culturally assigned to the opposite gender, and to be recognized by society as such. This desire – related to affects and not cognitions – is triggered by events, such as the experience of being attracted to persons with the same sex, but without feeling homosexual, or by differences experienced with same-sex peers during socialization. The desire is experienced at various stages of the development and expressed in various ways, depending on the person's biography and his way of being in and relating to the world. When the desire emerges, it is more or less easily welcomed, and at times also repressed; a consequence of this repression may be, that the body as place of this desire may be attacked. In this last situation, the dysphoric state may be caused by the impossibility to accept and to realize the emerging desire. Contextual elements, such as being forced for professional reasons to clarify the transgender issue or the encounter with a key person, move the evolution of this desire. On the contrary, negative attitudes of family members or significant others may impede gender identity formation.DiscussionThe analysis of these narratives allowed to consider the condition of transgender persons not only as dysphoria, and thus situate it in a traditional medical perspective which distinguishes between normal and pathological, but also to conceive it as a “career” towards the possible and desirable. While, the term dysphoria relates to a problematic side of the transgender condition, we consider that the perspective of a desire provide a more constructive way to conceive transgender identity.ConclusionThe challenge for the expert-psychiatrist is to grasp the different expression of this desire and to allow it to freely emerge and evolve, and to express and realize itself. The role of the psychiatrist is thus not limited to be a “gatekeeper” in the treatments of sexual reassignment, but to accompany transgender persons in their career of gender transition. As such, the psychiatrist adopts a therapeutic stance, which aims–as in other conditions–to help that desires can circulate more freely.     

Intratympanic application of triamcinolone in sudden hearing loss—radiologic anatomy in cone beam CT and its’ correlation to clinical outcome

European Archives of Oto-Rhino-Laryngology - To evaluate temporal bone cone-beam CT in patients with idiopathic sudden sensorineural hearing loss (ISSNHL) being treated with primary and secondary...