Does Bone Wax Induce a Chronic Inflammatory Articular Reaction?

Background  

Bone wax is used to control femoral neck bleeding during open femoroacetabular impingement (FAI) surgery. Despite its widespread use, only a few case reports and small case series describe side effects after extraarticular use. It is unclear whether intraarticular use of bone wax leads to such complications. However, during revision FAI surgery, we have observed various degrees of articular inflammatory reactions.     

Femoral Bone Is Preserved Using Cemented Polished Stems in Young Patients

Background  

Techniques that ensure femoral bone preservation after primary THA are important in younger patients who are likely to undergo revision surgery.     

Comparing two anesthesia information management system user interfaces: a usability evaluation

Introduction

Anesthesia information management systems (AIMS) have been developed by multiple vendors and are deployed in thousands of operating rooms around the world, yet not much is known about measuring and improving AIMS usability. We developed a methodology for evaluating AIMS usability in a low-fidelity simulated clinical environment and used it to compare an existing user interface with a revised version. We hypothesized that the revised user interface would be more useable.

Methods

In a low-fidelity simulated clinical environment, twenty anesthesia providers documented essential anesthetic information for the start of the case using both an existing and a revised user interface. Participants had not used the revised user interface previously and completed a brief training exercise prior to the study task. All participants completed a workload assessment and a satisfaction survey. All sessions were recorded. Multiple usability metrics were measured. The primary outcome was documentation accuracy. Secondary outcomes were perceived workload, number of documentation steps, number of user interactions, and documentation time. The interfaces were compared and design problems were identified by analyzing recorded sessions and survey results.

Results

Use of the revised user interface was shown to improve documentation accuracy from 85.1% to 92.4%, a difference of 7.3% (95% confidence interval [CI] for the difference 1.8 to 12.7). The revised user interface decreased the number of user interactions by 6.5 for intravenous documentation (95% CI 2.9 to 10.1) and by 16.1 for airway documentation (95% CI 11.1 to 21.1). The revised user interface required 3.8 fewer documentation steps (95% CI 2.3 to 5.4). Airway documentation time was reduced by 30.5 seconds with the revised workflow (95% CI 8.5 to 52.4). There were no significant time differences noted in intravenous documentation or in total task time. No difference in perceived workload was found between the user interfaces. Two user interface design problems were identified in the revised user interface.

Discussion

The usability of anesthesia information management systems can be evaluated using a low-fidelity simulated clinical environment. User testing of the revised user interface showed improvement in some usability metrics and highlighted areas for further revision. Vendors of AIMS and those who use them should consider adopting methods to evaluate and improve AIMS usability.     

Guidelines to the Practice of Anesthesia Revised Edition 2012

OVERVIEW: The Guidelines to the Practice of Anesthesia Revised Edition 2012 (the guidelines) were prepared by the Canadian Anesthesiologists' Society (CAS), which reserves the right to determine their publication and distribution. Because the guidelines are subject to revision, updated versions are published annually. Whereas previous versions of the guidelines appeared as special supplements to the Canadian Journal of Anesthesia (the Journal), this edition of the guidelines is published within the Journal. This allows for improved archiving and online access to complement the printed version--a new offering for CAS members and Journal subscribers. The Guidelines to the Practice of Anesthesia Revised Edition 2012 supersedes all previously published versions of this document. Although the CAS encourages Canadian anesthesiologists to adhere to its practice guidelines to ensure high-quality patient care, the society cannot guarantee any specific patient outcome. Each anesthesiologist should exercise his or her own professional judgement in determining the proper course of action for any patient's circumstances. The CAS assumes no responsibility or liability for any error or omission arising from the use of any information contained in its Guidelines to the Practice of Anesthesia.     

Mullerian cyst of the uterus misdiagnosed as ovarian cyst on pelvic sonography

Mullerian cyst of the uterus, also known as endosalpingiosis, is rare and often can be misdiagnosed as adnexal cyst on pelvic sonography. A 47‐year‐old woman was referred for an incidental finding of a right adnexal mass on pelvic sonography, suspected to be an ovarian cyst. During laparoscopy, a pedunculated cystic mass arising from the right anterior uterine wall was seen. The mass was resected laparoscopically and histologic examination showed a benign Mullerian cyst of the uterus. Diagnosis of Mullerian cyst of the uterus can be challenging. However, with increased awareness, preoperative diagnosis of this condition should be possible sonographically. © 2013 Wiley Periodicals, Inc. J Clin Ultrasound 42 :183–184, 2014     

Intrapancreatic gastric duplication cyst—a rare cause of chronic abdominal pain in childhood

We report a rare case of a gastric duplication cyst in the tail of the pancreas in a child presenting with chronic abdominal pain which was cured by excision of the cyst and adjacent pancreas. This case report highlights the role of sonography as an excellent imaging tool for depiction of the bowel wall and, hence, in aiding diagnosis even when clinical picture and findings of other modalities are nonspecific. © 2013 Wiley Periodicals, Inc. J Clin Ultrasound 42 :42–44, 2014