Peri-operative complications in pediatric and adolescent shoulder arthroscopy

Background

Shoulder arthroscopy is not common in the pediatric and adolescent population, but the frequency may be on the rise. The purpose of the study was to determine the incidence of acute complications of arthroscopic shoulder surgery in children and adolescents.

Methods

A retrospective, cross-sectional review was performed identifying patients aged 18 years or less who underwent an arthroscopic shoulder procedure from 1997 to 2009 at Institution 1 and 2007 to 2010 at Institution 2. Exclusion criteria included open procedures and missing records. Demographic and surgical data were collected, including intra-operative and post-operative complications during the first 6 months. The complications were divided into minor (no secondary treatment) and major (secondary treatment rendered).

Results

Two hundred children, mean age 15.9 years, met criteria and 73 % were boys. All procedures were performed under general anesthesia, but 51 % included inter-scalene regional anesthesia. There were 16 (8.0 %) total complications recorded. Major complications occurred in five (2.5 %) patients, including two tendinitis/bursitis requiring injections, one broken pain pump catheter requiring an accessory incision to retrieve, one pain control readmission, and one laceration of the cephalic vein requiring ligation. Minor complications occurred in 11 (5.5 %) patients, including allergic reactions, transient dysesthesias, headaches, bronchitis, syncope, transient hypotension, and uvula swelling.

Conclusion

Although we found no seriously deleterious outcomes, it is important to recognize that an additional service was rendered for 2.5 % of children undergoing shoulder arthroscopy. The events that did occur may be preventable and this study should serve as a baseline to improve quality and safety of shoulder arthroscopy in the pediatric population.     

Nursing students with disabilities

Nursing is a self-licensing profession with an ever-increasing responsibility to develop and sustain public trust. Thus, there is a need for nurses not only to be accountable and trustworthy but to be perceived by the public as accountable and trustworthy. Recognizing the special need for trust in caregivers, the Faculty of Health Professions at Dalhousie University has recently instituted a policy enabling its schools to suspend or terminate a student from a program based on the student's professional unsuitability. Unsuitability could include a type of conduct (criminal behavior, substance abuse or unethical behavior) or a health impairment that affects the student's ability to meet performance requirements. The challenge for the health profession schools, including Nursing, is to develop specific guidelines for implementing the policy. Guidelines on performance requirements for students with disabilities will be particularly difficult to define.     

Polycythemia vera. Physical separation of normal and neoplastic committed granulocyte-macrophage progenitors.

In previous studies of two patients with polycythemia vera (PV) who were heterozygous at the X-linked locus for glucose-6-phosphate dehydrogenase (G6PD), only A type enzyme was found in nonlymphoid blood cells. However, some erythroid and granulocytic colonies grown in vitro were type B and therefore arose from presumably normal progenitors. One patient had enough type B colonies (8%) that studies of the physical characteristics of normal and PV clonal colony-forming cells could be undertaken. When marrow cells were separated by velocity sedimentation at unit gravity, most PV clonal granulocyte-macrophage progenitors (CFU-C) (type A G6PD) sedimented between 6.4 and 7.2 mm/h, whereas most residual normal, type B CFU-C sedimented less than or equal to 5.9 mm/h (P = 0.04)., When blood cells were separated over a discontinuous buoyant density gradient, PV clonal CFU-C equilibrated at densities < 1.065 g/ml, whereas residual normal CFU-C were found greater than or equal to 1.065 g/ml (P < 0.01). PV clonal and residual normal erythroid burst-forming progenitors were not separable by either method. Thus PV clonal CFU-C are larger and less dense cells than are residual normal CFU-C.     

Physician and nurse satisfaction with an Electronic Medical Record system

Electronic Medical Records (EMRs) are intended to support clinical activity, improve efficiency, and reduce error. Reluctance to use EMRs may exist among clinicians. The purpose of this study was to assess physician and nurse satisfaction with an Emergency Department (ED) EMR. We surveyed Emergency Medicine (EM) physicians and nurses at a large urban teaching hospital after implementation of an Emergency Department EMR. The questionnaire assessed: 1) computer background and experience; 2) perceptions regarding EMR use; and 3) concerns about impact upon quality of patient care. The clinicians find the EMR easy to use and are generally satisfied with the impact on their work. However, they report that the EMR has no positive impact on patient care. They report confusion in following the sequence of screens, and are concerned with the amount of time it takes to use the EMR and the confidentiality of patient information. Similar results were found between physicians and nurses. Nurses, but not physicians, report that they are able to finish work much faster than before implementation (p < 0.05). We were unable to correlate computer background and experience with satisfaction with an EMR. This survey suggests that EM physicians and nurses favor the use of an EMR and suggests opportunities for EMR enhancement.