Impact of Dexamethasone on Length of Stay and Early Pain Control in Direct Anterior Approach Total Hip Arthroplasty With Neuraxial Anesthesia

BackgroundDexamethasone has been shown to reduce postoperative pain and opioid consumption for total joint arthroplasty patients; however, its impact on patients who received neuraxial anesthesia (NA) is not well described. We examined the impact of perioperative dexamethasone on outcomes for patients undergoing direct anterior approach total hip arthroplasty (THA) under NA.MethodsA retrospective review was conducted for 376 THA patients from a single institution. Univariate analysis was used to compare postoperative outcomes for 164 THA patients receiving dexamethasone compared to 212 who did not receive dexamethasone.ResultsNo differences in age, gender, body mass index, or American Society of Anesthesiologists (ASA) Score were observed between the groups. Patients receiving perioperative dexamethasone reported statistically significantly lower postanesthesia care unit (PACU) pain numeric rating scale (Dexamethasone 1.6 vs No dexamethasone 2.3, P = .014) and received lower PACU morphine milligram equivalents (MME) (Dexamethasone 8.57 vs No dexamethasone 11.44, P < .001). Patients receiving dexamethasone had significantly shorter LOS (Dexamethasone 29.40 vs No dexamethasone 35.26 hrs., P < .001).ConclusionPerioperative dexamethasone is associated with decreased postoperative pain and narcotic consumption, and shorter length of stay for patients undergoing primary direct anterior approach THA with NA.     

Can Met Expectations Moderate the Relationship Between Pain/Function and Satisfaction in Total Knee Arthroplasty?

BackgroundApproximately 20% of patients are dissatisfied with their total knee arthroplasty (TKA) at 1-year post-surgery. Met expectations have been found by some to significantly predict satisfaction. The role of met expectations in determining patient satisfaction has not been exhaustively explored. The primary aim of this study is to evaluate if met expectations moderate the relationship between pain and function variables and satisfaction.MethodsPatients who underwent primary TKA for osteoarthritis were included in the study (n = 304). Patient-reported outcomes at pre-surgery and 1-year post-surgery were collected. The Knee Society Score (KSS) satisfaction subscale was used as the dependent variable. Candidate independent variables included the following: demographics, KSS, Knee injury and Osteoarthritis Outcome Score (KOOS), 12-Item Short Form Health Survey (SF-12), Hospital Anxiety and Depression Scale, Pain Catastrophizing Scale, Self-Administered Comorbidity Questionnaire, and University of California Los Angeles activity score. Separate linear regression models were created to test interactions for KSS met expectations with pain and KSS met expectations with function.ResultsSignificant predictors of satisfaction were KSS symptoms (pain), KOOS activities of daily living (function), KSS met expectations, KOOS pre-surgery activities of daily living, body mass index, and SF-12 general health. A significant interaction between met expectations and pain was found (P = .043) and the met expectations and function interaction approached significance (P = .086). For both interactions, as met expectations increased, pain and function predicted satisfaction less strongly.ConclusionMet expectations were found to moderate the relationship between pain and satisfaction. There may be more value in improving pain for patients with low met expectations.Level of evidenceLevel IV.     

Why adolescents delay with presentation to hospital with acute testicular pain: A qualitative study

Background/purposeAdolescents have poor outcomes following testicular torsion directly attributable to delay from onset of symptoms to presentation to hospital. The aim of this study was to investigate the barriers to urgent presentation in young men.MethodsSemistructured interviews were undertaken with young men (11–19 years), using a topic guide exploring issues surrounding testicular pain and health. Thematic analysis was undertaken using a framework approach.ResultsTwenty-seven adolescents were recruited, data saturation was reached at sixteen participants, and median age was 13.5 years (range 11–18). The process by which an adolescent gets to hospital with testicular pain is slow. They must recognize the problem and alert their parents, who then use a ‘watch and wait’ policy to assess need for medical review, often leaving it ‘a day’ or overnight. Adolescent males do not engage with healthcare services independently of their parents. Additional factors preventing early presentation include: absence of knowledge about testicular pathology from adolescents and their parents; concern from the young people about raising a false alarm and family concerns about burdening healthcare services.ConclusionsRecommendations include designing a testicular health education campaign for young men and educating parents regarding the medical conditions where a ‘watch and wait’ policy may be harmful to their child.Level of evidenceVI     

Epilepsy and the GABA-hypothesis a brief review and some examples

A brief review is given with regard to the GABAergic alterations in experimental and genetic models of epilepsy and human epilepsy, illustrating, among others, that agents exist, both convulsants and anticonvulsants, that are capable of interacting with GABA's synthesis, storage, extraneuronal release, presynaptic reuptake, postsynaptic destruction and activation. The so-called "GABA-hypothesis" of epilepsy implies that a reduction of GABA-ergic inhibition results in epilepsy while an enhancement of GABAergic inhibition results in an antiepileptic effect. The examples presented, in support of the "GABA-hypothesis", concern the effects of some exogenous [pentylenetetrazol (PTZ) and methyl 6,7-dimethoxy-4-ethyl-beta-carboline-3-carboxylate (DMCM)] and some endogenous convulsants on the postsynaptic GABAA receptor. The studied endogenous convulsants were the guanidino compounds which are known to increase in uremia and hyperargininemia. PTZ and DMCM dose-dependently reduced GABA responses on mouse neurons in cell culture. The benzodiazepine receptor antagonist CGS 9896 antagonized the DMCM- but not the PTZ-induced inhibition of GABA-responses. The guanidino compounds guanidine, methylguanidine, creatinine, guanidinosuccinic acid (increased in uremia) and arginine, homoarginine, alpha-keto-delta-guanidinovaleric acid and argininic acid (increased in hyperargininemia) decreased both GABA- and GLY-responses. The guanidino compounds were equally potent in decreasing GABA- and GLY-responses and CGS 9896 did not antagonize the guanidino compound-induced inhibition of GABA responses. The presented results indicate that the studied convulsants inhibit GABAergic inhibition through interaction with distinct sites at the postsynaptic GABAA receptor. The demonstrated effect might, in agreement with the "GABA-hypothesis", underlie the epileptogenicity of these compounds in animal models and might have pathophysiological importance in uremia and hyperargininemia.     

Sampling clinicians' activities using electronic pagers

Pager-based activity sampling (PAS) is described as a cost-effective and unobtrusive method for sampling residents' activities in clinical settings. A sample program evaluation is presented using residents in an urban children's hospital resident-training program. The purposes of the program evaluation were: (a) to establish a behavioral baseline that would help clinical faculty understand how residents were using their time, and (b) to determine whether alterations in the way residents were assigned within the hospital resulted in desired changes to time spent. The primary rationale for changing resident-assignment policies were: (a) to decrease the time residents were spending in transit between various locations within the hospital, and (b) to increase the time spent by residents in educational activities and in direct contact with patients and their families. This PAS application demonstrates that the technique can produce statistically supportable conclusions, at minimal cost, without unduly disrupting either the residents or their patients. PAS is compared with other time-sampling methods, its limitations are discussed, and suggestions for future applications are provided.     

Sample size for cohort studies in pharmacoepidemiology

OBJECT: Cohort studies in pharmacoepidemiology can result in a unique type of study, where subjects have complex types of exposure to drugs (with periods of non-exposure as well). The object of this paper is to explain how to calculate the sample size of such a study. METHOD: It is assumed that adverse events follow Poisson distributions in the two study groups. The null hypothesis is that the two groups have equal rates of disease. Formulae are provided to calculate the sample size required to significantly reject the null hypothesis. Sample size is given as the number of events, rather than the number of subjects entered. In a Poisson study, it is the ratio of the amount of person-years exposure in the two groups that is important to calculate sample size, rather than the actual amounts of exposure (or number of subjects in the study). Some examples are included.     

Competencies and problems reported by parents of Greek and American children,ages 6–11

This study compared parent-reported competencies and behavioral/emotional problems in demographically-matched samples of Greek and American children, ages 6–11. Parents of 356 children of each nationality completed the Child Behavior Checklist (CBCL). Competence scores were higher for American children, except on Academic Competence, where scores were higher for Greek children. Greek scores were significantly higher than American scores on the Withdrawn, Anxious/Depressed, Attention Problems, Delinquent Behavior, Aggressive Behavior, Internalizing, Externalizing, and Total Problem scales. On the Anxious/Depressed syndrome, nationality accounted for 14% of the variance. There were few main effects for sex and age and fewer interactions. The higher problem scores in the Greek sample were partly due to the tendency of Greek parents to use extreme item scores. When items were scored present v. absent, Greek scores were higher only on Withdrawn, Anxious/Depressed, Internalizing, and Total Problems, while American scores were higher on Somatic Complaints and Thought Problems. Nationality differences in rates of referral for mental health services and sample differences in exclusion criteria for prior mental health services may have contributed to differences in problem scores. Results are compared to findings from other cross-cultural studies.

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Zusammenfassung Diese Studie vergleicht die Fähigkeiten und Verhaltens- bzw. emotionalen Auffälligkeiten in demographisch parallelisierten Stichproben von griechischen und amerikanischen Kindern im Alter von 6-11 Jahren. Die Eltern von 356 Kindern der beiden Nationalitäten füllten die Child Behavior Checklist (CBCL) aus. Die Kompetenzwerte waren bei den amerikanischen Kindern mit Ausnahme der akademischen Fähigkeiten höher. Die griechischen Werte waren signifikant höher als die amerikanischen im Hinblick auf die Skalen Zurückhaltung, ängstlich/depressiv, Aufmerksamkeitsstörungen, delinquentes Verhalten, aggressives Verhalten, Internalisation, Externalisation und Gesamtauffälligkeiten. Im Hinblick auf das ängstlich/depressive Syndrom war die Nationalität für 14% der Varianz verantwortlich. Nur vereinzelt wurden Haupteffekte im Hinblick auf Geschlecht und Alter und eine geringere Anzahl Interaktionen festgestellt. Die höheren Problemwerte in der griechischen Stichprobe waren teilweise durch die Tendenz der griechischen Eltern bedingt, extreme Werte anzukreuzen. Bei den Items, die als vorhanden bzw. nicht vorhanden gewertet werden mußten, waren die griechischen Werte nur bei den Skalen Zurückhaltung, ängstlich/depressiv, Internalisation und Gesamtprobleme höher, während amerikanische Werte für die Skalen körperliche Beschwerden und Denkstörungen höher lagen. Nationalitätsunterschiede der Zuweisungsraten zu psychosozialen Diensten und Stichprobenunterschieden im Hinblick auf die Ausschlußkriterien für vorangegangene Inanspruchnahme psychosozialer Dienste könnten zu den unterschiedlichen Problemwerten beigetragen haben. Die Ergebnisse werden verglichen mit anderen transkulturellen Studien.

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Résumé Cette étude a comparé les compétences et les problèmes de comportement et affectifs rapportés par les parents d'un échantillon d'enfants grecs et américains âgés de 6 à 11 ans appariés démographiquement. Les parents de 356 enfants de chaque nationalité ont rempli la Child Behavior Checklist (CBCL). Les scores de compétence étaient plus élevés pour les enfants américains excepté pour la compétence scolaire pour laquelle les scores étaient plus élevés chez les enfants grecs. Les scores grecs étaient significativement plus hauts que les scores américains quant au retrait, l'anxiété-dépression, les problèmes d'attention, le comportement délinquant, le comportement agressif, les échelles d'internalisation, d'externalisation et de problèmes totaux. Pour le syndrome anxiodépressif, la nationalité intervenait pour une variance de 14%. Il y avait peu d'effets principaux en ce qui concerne le sexe et l'âge. Les scores de problèmes les plus élevés dans les échantillons grecs étaient en partie dûs à la tendance des parents grecs à utiliser des items extrêmes. Quand les items étaient cotés présents versus absents, les scores grecs étaient plus élevés seulement en ce qui concerne le retrait, l'anxiété-dépression, l'internalisation et les problèmes totaux tandis que les scores américains étaient plus hauts en ce qui concerne les plaintes somatiques et les problèmes de pensée. Les différences de nationalité en ce qui concerne les taux de référence à des services de santé mentale et les différences des échantillons dans les critères d'exclusion pour l'utilisation antérieure de services de santé mentale, peuvent avoir contribué aux différences dans les scores de problèmes. Les résultats sont comparés aux autres études transculturelles.

     

The effects of d-cycloserine and MK-801 on the performance of rats in two spatial learning and memory tasks

The present study was undertaken to investigate the effects of modulation of the (NMDA) receptor on learning and memory. Thus, the performance of rats treated with d-cycloserine, a partial agonist at the glycine recognition site of the NMDA receptor complex, and MK-801, a noncompetitive NMDA receptor antagonist, either alone or concurrently were assessed in radial arm maze and water maze tasks. Administration of MK-801 (0.1 mg/kg, i.p.) impaired acquisition in the water maze (increased escape latency and distance) and working memory in the radial arm maze (increased re-entries) in rats. Moreover, in the radial arm maze, MK-801 disrupted locomotion (increased latencies and decreased arm entries per minute) and impaired the acquisition of reference memory (increased number of errors) performance of rats. d-Cycloserine (0.03, 0.3, 1.0, 3.0, 10 mg/kg, i.p.) had no effects on acquisition or memory performance of control or MK-801-treated rats in either of these tasks. However, d-cycloserine (0.03, 0.3, 3.0 mg/kg) reversed the MK-801-induced disruption in locomotion. Furthermore, 3.0 mg/kg d-cycloserine increased behavioral activity and also decreased the time needed to complete the task in control animals. To conclude, our results suggest that the consequences of NMDA receptor modulation on learning and memory processes and sensorimotor functions may be functionally different or have distinct anatomical locations.     

Cancer coverage in mass-circulating Canadian women's magazines

Mass media can inform health beliefs and shape cancer control behaviours. This study surveyed cancer coverage in 309 issues of Canadian women's magazines for the period 1991-1997. Magazines were selected if 1996 revenue > $10 million and circulation > 500,000; Canadian Living, Chatelaine, Flare and Homemaker's met these criteria. The volume of cancer coverage varied significantly by year and by magazine. However, coverage of specific cancers did not reflect their contribution as a cause of cancer death in Canadian women. The percentage of articles on lung cancer was lower and on breast cancer was higher than the percentage of deaths due to these cancers. All magazines had decreased coverage of lung cancer in 1997 compared to 1991. National cancer resource agencies and research initiatives on breast cancer were infrequently mentioned. These results argue for greater partnerships between the media and health educators to enhance balanced dissemination of cancer control information to Canadian women.