The management of postoperative pain in children with caudal blocks

Background: The aim of this study was to evaluate the pre-emptive analgesic effect and duration of postoperative analgesia after caudal blocks in children. Method: Forty-five children undergoing distal hypospadias surgery were assigned to group 1 (n = 23), and received caudal 0.25% bupivacaine 0.5 mg/kg and midazolam 0.05 mg/kg before the surgical incision. Group 2 (n = 22) received caudal 0.25% bupivacaine 0.5 mg/kg and midazolam 0.05 mg/kg at the end of surgery. Anaesthesia was induced with propofol and fentanyl and maintained with sevoflurane and nitrous oxide. Postoperative pain was rated on an objective paediatric pain scale. Results: The analgesic requirement was greater in the second group. Conclusion: Pre-emptive analgesia with caudal blocks may prevent the intensity and frequency of postoperative wound pain.South Afr J Anaesth Analg, 2011;17(6):376-37

Cumulant based parametric multichannel FIR system identification methods

Cataloged from PDF version of article.In this paper, ''least squares'' and recursive methods for simultaneous identification of four nonminimum phase linear, time-invariant FIR systems are presented. The methods utilize the second- and fourth-order cumulants of outputs of the four FIR systems of which the common input is an independent, identically distributed (i.i.d.) non-Gaussian process. The new methods can be extended to the general problem of simultaneous identification of three or more FIR systems by choosing the order of the utilized cumulants to be equal to the number of systems. To illustrate the effectiveness of our methods, two simulation examples are included

Benzo(a)pyrene air concentrations and emission inventory in Lombardy region, Italy

Three years of particle phase B(a)P air concentration measurements in 13 sites in Lombardy (Italy) and a detailed emission inventory at the municipal scale for the whole region were used to infer the contribution of different sources to B(a)P atmospheric levels. The analyses of the weekly and monthly profiles of B(a)P concentrations, the cluster analysis and the comparison between the B(a)P/PM10 ratios in ambient air and in the emissions allowed identifying wood burning in small residential appliances as the key source for all the sites, except for those located in Milan. The highest values of the average B(a)P concentrations were not found in the wider urban areas, where in general the highest PM10 levels were registered. Regarding the seasonal variability, a marked reduction of both B(a)P concentrations and B(a)P/PM10 ratios was observed in the summer season. The cluster analysis of PM10 and B(a)P concentrations showed that the two pollutants tend to have a separate pattern; moreover the cluster analysis of B(a)P/PM10 ratios showed that the trend of this ratio split the stations depending on their location: plain area, piedmont and valley zones, and mountain sites. The dominance of the wood combustion highlighted by the emission inventory, originating from the residential sector and from pizzerias in the city of Milan, is consistent with the findings of other studies based on a source apportionment approach or air quality modeling, although some patterns of ambient B(a)P concentrations in one site were not adequately explained by the emission sources included in the emission inventory

Pattern and Outcome of Chest Injuries at Bugando Medical Centre in Northwestern Tanzania.

Chest injuries constitute a continuing challenge to the trauma or general surgeon practicing in developing countries. This study was conducted to outline the etiological spectrum, injury patterns and short term outcome of these injuries in our setting. This was a prospective study involving chest injury patients admitted to Bugando Medical Centre over a six-month period from November 2009 to April 2010 inclusive. A total of 150 chest injury patients were studied. Males outnumbered females by a ratio of 3.8:1. Their ages ranged from 1 to 80 years (mean = 32.17 years). The majority of patients (72.7%) sustained blunt injuries. Road traffic crush was the most common cause of injuries affecting 50.7% of patients. Chest wall wounds, hemothorax and rib fractures were the most common type of injuries accounting for 30.0%, 21.3% and 20.7% respectively. Associated injuries were noted in 56.0% of patients and head/neck (33.3%) and musculoskeletal regions (26.7%) were commonly affected. The majority of patients (55.3%) were treated successfully with non-operative approach. Underwater seal drainage was performed in 39 patients (19.3%). One patient (0.7%) underwent thoracotomy due to hemopericardium. Thirty nine patients (26.0%) had complications of which wound sepsis (14.7%) and complications of long bone fractures (12.0%) were the most common complications. The mean LOS was 13.17 days and mortality rate was 3.3%. Using multivariate logistic regression analysis, associated injuries, the type of injury, trauma scores (ISS, RTS and PTS) were found to be significant predictors of the LOS (P < 0.001), whereas mortality was significantly associated with pre-morbid illness, associated injuries, trauma scores (ISS, RTS and PTS), the need for ICU admission and the presence of complications (P < 0.001). Chest injuries resulting from RTCs remain a major public health problem in this part of Tanzania. Urgent preventive measures targeting at reducing the occurrence of RTCs is necessary to reduce the incidence of chest injuries in this region

Idiopathic isolated clitoromegaly: A report of two cases

BACKGROUND: Clitoromegaly is a frequent congenital malformation, but acquired clitoral enlargement is relatively rare. METHODS: Two acquired clitoromegaly cases treated in Atatürk Training Hospital, Izmir, Turkey are presented. RESULTS: History from both patients revealed clitoromegaly over the last three years. Neither gynecological nor systemic abnormalities were detected in either patient. Karyotype analyses and hormonal tests were normal. Abdominal and gynaecological ultrasound did not show any cystic lesion or other abnormal finding. Computerized tomography scan of the adrenal glands was normal. Clitoroplasty with preservation of neurovascular pedicles was performed for the treatment of clitoromegaly. CONCLUSION: The patients were diagnosed as "idiopathic isolated" clitoromegaly. To the best of our knowledge, there has been no detailed report about idiopathic clitoromegaly in the literature

Assessing the Relative Performance of Nurses Using Data Envelopment Analysis Matrix (DEAM)

Assessing employee performance is one of the most important issue in healthcare management services. Because of their direct relationship with patients, nurses are also the most influential hospital staff who play a vital role in providing healthcare services. In this paper, a novel Data Envelopment Analysis Matrix (DEAM) approach is proposed for assessing the performance of nurses based on relative efficiency. The proposed model consists of five input variables (including type of employment, work experience, training hours, working hours and overtime hours) and eight output variables (the outputs are amount of hours each nurse spend on each of the eight activities including documentation, medical instructions, wound care and patient drainage, laboratory sampling, assessment and control care, follow-up and counseling and para-clinical measures, attendance during visiting and discharge suction) have been tested on 30 nurses from the heart department of a hospital in Iran. After determining the relative efficiency of each nurse based on the DEA model, the nurses’ performance were evaluated in a DEAM format. As results the nurses were divided into four groups; superstars, potential stars, those who are needed to be trained effectively and question marks. Finally, based on the proposed approach, we have drawn some recommendations to policy makers in order to improve and maintain the performance of each of these groups. The proposed approach provides a practical framework for hospital managers so that they can assess the relative efficiency of nurses, plan and take steps to improve the quality of healthcare delivery