Preliminary findings for preemptive analgesia with inhaled morphine: efficacy in septoplasty and septorhinoplasty cases.

OBJECTIVE: The aim of this study was to assess the efficacy of inhaled morphine for preemptive analgesia in patients who undergo septoplasty or septorhinoplasty. STUDY PLAN AND METHODS: Eighty ASA I-II patients scheduled for septoplasty or septorhinoplasty were recruited and randomly divided into 2 groups that received different treatments 10 minutes prior to induction. The preemptive analgesia group (Group P, n = 40) received 65 mug kg(-1) morphine sulphate (a 3-mL volume) via an oral nebulizer, and the control group (Group C, n = 40) received 3 mL 0.9% sodium chloride (physiological saline) via the same type of nebulizer. Blood pressure, oxygen saturation, heart rate, time to first requirement for analgesia, and occurrence of nausea/vomiting were recorded. RESULTS: There were no significant differences between Groups P and C with respect to age, body weight, sex distribution, or duration of surgery. There was also no significant difference between the group frequencies of postoperative nausea/vomiting. The time to first requirement for analgesia was significantly longer in Group P than Group C. CONCLUSION: The results of this preliminary study suggest that a single dose of inhaled morphine administered preemptively prior to septoplasty or septorhinoplasty provides effective postoperative analgesia. EBM rating: B-3b.     

Metastasis of Prostate Adenocarcinoma to Testis

Metastatic carcinoma to the testis is very rare. Metastasis of prostate adenocarcinoma to testis was detected incidentally after bilateral orchiectomy for hormonal management of metastatic prostate carcinoma. The metastatic lesion was not identified in physical examination or in macroscopic dissection of the testis after surgery. Microscopy revealed an adenocarcinoma which, given the history of the patient and a positive immunohistochemical stain for PSA, was identified as metastatic prostatic adenocarcinoma.     

Quality of dictated feedback associated with SIMPL operative assessments of pediatric surgical trainees

BackgroundSIMPL is a workplace-based operative performance assessment tool which allows for dictated feedback (DF). To better understand the value of DF, we sought to characterize the type and quality of DF generated during SIMPL evaluations.MethodsThematic analysis of DF from SIMPL assessments between June 2017 and December 2018 at a single pediatric surgery fellowship program was performed. Comments were categorized as specific, encouraging or corrective. Categories were combined to determine DF quality as effective, mediocre or ineffective.ResultsOf 781 SIMPL assessments (21 faculty, 5 trainees), 451 (57%) had DF. Most comments were encouraging (93%) and specific (65%). Only 21% were corrective, 17% had entrustment features, and 8% had an explicit learning plan. Feedback quality was deemed mediocre (45%), ineffective (33%) and effective (21%).ConclusionSIMPL dictated feedback was mostly encouraging and specific. To improve quality, feedback should incorporate learning plans as well as corrective and entrustment features.     

Evaluation of Job Strain of Family Physicians in COVID-19 Pandemic Period- An Example from Turkey

Journal of Community Health - The purpose of this study was to evaluate family physicians’ job strain during the Covid-19 pandemic and determine the effective factors. The study was carried...     

Evaluation and Comparison of Charcot’s Triad and Tokyo Guidelines for the Diagnosis of Acute Cholangitis

Reliability of Charcot’s triad has long been questioned. Tokyo Guidelines committee published Tokyo Guidelines in 2007 and 2013. The aim of this study was to retrospectively examine the patients who had been treated with the diagnosis of acute cholangitis and evaluate 2007–2013 Tokyo criteria and Charcot’s triad. The files of the patients with acute cholangitis in a referral center were examined retrospectively. All patients were classified and evaluated according to 2007 and 2013 Tokyo criteria and Charcot’s triad; and results were compared. It was detected that 51.7 % of patients who did not meet Charcot’s triad were in definitive diagnosis group of both Tokyo criteria. Kappa value was calculated as 0.404 in the analysis of consistency between two Tokyo criteria. Two patients who had features sufficient to objectively make the diagnosis of acute cholangitis failed to meet the Tokyo criteria 2007 or 2013. Charcot’s triad is not sensitive and specific enough in the diagnosis of acute cholangitis. Revision of Tokyo 2007 criteria caused a change in the diagnostic status of 15 % of the patients. It is remarkable that kappa value can hardly be considered as a sign of moderate agreement between two Tokyo guidelines. Tokyo criteria should be supported and updated.