Prospective observational study of peripheral intravenous cannula utilisation and frequency of intravenous fluid delivery in the emergency department—Convenience or necessity?

Background Peripheral Intravenous Cannulas (PIVCs) are frequently utilised in the Emergency Department (ED) for delivery of medication and phlebotomy. They are associated with complications and have an associated cost to departmental resources. A growing body of international research suggests many of the PIVCs inserted in the ED are unnecessary.Methods The objective of this study was to determine the rates of PIVC insertion and use. This was a prospective observational study conducted in one UK ED and one Italian ED. Adult ED patients with non-immediate triage categories were included over a period of three weeks in the UK ED in August 2016 and two weeks in the Italian ED in March and August 2017. Episodes of PIVC insertion and data on PIVC utilisation in adults were recorded. PIVC use was classified as necessary, unnecessary or unused. The proportion of unnecessary and unused PIVCs was calculated. PIVCs were defined as unnecessary if they were either used for phlebotomy only, or solely for IV fluids in patients that could have potentially been hydrated orally (determined against a priori defined criteria). PIVC classified as unused were not used for any purpose.Results A total of 1,618 patients were included amongst which 977 PIVCs were inserted. Of the 977 PIVCs, 413 (42%) were necessary, 536 (55%) were unnecessary, and 28 (3%) were unused. Of the unnecessary PIVCs, 473 (48%) were used solely for phlebotomy and 63 (6%) were used for IV fluids in patients that could drink.Conclusions More than half of PIVCs placed in the ED were unnecessary in this study. This suggests that clinical decision making about the benefits and risks of PIVC insertion is not being performed on an individual basis

Neck emergency due to parathyroid adenoma bleeding: a case report

<p>Abstract</p> <p>Introduction</p> <p>The spontaneous rupture of a parathyroid adenoma accompanied by extracapsular hemorrhage is a rare, potentially fatal, condition and is a cervicomediastinal surgical emergency.</p> <p>Case presentation</p> <p>This report describes an atypical two-step spontaneous rupture of an asymptomatic parathyroid adenoma in a 56-year-old Caucasian woman who presented with a painful mass in the right side of her neck.</p> <p>Conclusion</p> <p>Based on this case report and similar cases reported in the medical literature, a diagnosis of extracapsular parathyroid hemorrhage should be considered when a non-traumatic sudden neck swelling coexists with hypercalcemia and regional ecchymosis.</p

Exploring leaders' strategies for managing negative emotions of sales people

The aim of this thesis is to explore the practice of leader strategies to manage and influence employees' emotions and its implications. Emotion has emerged as a key field in organisational behaviour, particularly pertaining to leadership. Managing followers' emotions is critical for leaders since employees' emotions are directly related to job performance. Most studies focus on measuring the high level relationship between the constructs of emotions and leadership and there is little research on how leaders deliberately manage the emotions of their followers.This qualitative study explores sales leaders' practices for managing followers' negative emotions through a case study method using semi-structured interviews and critical incident technique. 32 sales leaders are interviewed from one of the top logistics companies; 89 critical incidents are identified where these leaders were challenged with managing their followers' emotions.The findings of this research show that leaders consider changing employees' negative emotions a key function of leadership. The critical incidents demonstrate that leaders face both business and personal problems. Dealing with business situations requires strategies that involve more changing the problem or its meaning, while personal situations require strategies for reducing the intensity of the emotions.The findings also demonstrate that the existing models of emotion regulation do not cover all of the strategies that leaders use to effectively manage followers' emotions. Therefore, a proposed comprehensive set of strategies that leaders can use is presented together with contextual factors that leaders should consider when managing followers' negative emotions, including the use of short-intermediate strategies and person focused strategies.This study is among the first to qualitatively explore how leaders actually manage followers' negative emotions. A recommended set of strategies is presented to help leaders regulate and deal with negative or dysfunctional emotions. The findings provide clarification on what strategies leaders can use and how this practice can be improved.The aim of this thesis is to explore the practice of leader strategies to manage and influence employees' emotions and its implications. Emotion has emerged as a key field in organisational behaviour, particularly pertaining to leadership. Managing followers' emotions is critical for leaders since employees' emotions are directly related to job performance. Most studies focus on measuring the high level relationship between the constructs of emotions and leadership and there is little research on how leaders deliberately manage the emotions of their followers.This qualitative study explores sales leaders' practices for managing followers' negative emotions through a case study method using semi-structured interviews and critical incident technique. 32 sales leaders are interviewed from one of the top logistics companies; 89 critical incidents are identified where these leaders were challenged with managing their followers' emotions.The findings of this research show that leaders consider changing employees' negative emotions a key function of leadership. The critical incidents demonstrate that leaders face both business and personal problems. Dealing with business situations requires strategies that involve more changing the problem or its meaning, while personal situations require strategies for reducing the intensity of the emotions.The findings also demonstrate that the existing models of emotion regulation do not cover all of the strategies that leaders use to effectively manage followers' emotions. Therefore, a proposed comprehensive set of strategies that leaders can use is presented together with contextual factors that leaders should consider when managing followers' negative emotions, including the use of short-intermediate strategies and person focused strategies.This study is among the first to qualitatively explore how leaders actually manage followers' negative emotions. A recommended set of strategies is presented to help leaders regulate and deal with negative or dysfunctional emotions. The findings provide clarification on what strategies leaders can use and how this practice can be improved

Evaluation of Constipation

The evaluation of the chronically constipated patient is multifaceted and challenging. Many clinicians define constipation according to the latest Rome III diagnostic criteria for functional gastrointestinal disorders. Female sex, older age, low fiber diet, a sedentary life style, malnutrition, polypharmacy, and a lower socioeconomic status have all been identified as risk factors for functional constipation. In elderly patients, it is important to rule out a colonic malignancy as the cause of constipation. The initial evaluation of the constipated patient includes a detailed history to elicit symptoms distinguishing slow transit constipation from obstructive defecation. Slow transit and obstructive defecation are the two major subtypes of functional constipation. In addition, the clinician should identify any secondary causes of constipation. The office examination of the constipated patient includes an abdominal, perineal, and a rectal exam. Many patients improve with lifestyle modification. When dietary interventions and lifestyle modifications fail, many diagnostic studies are available to further evaluate the constipated patient. Sitzmark transit study, nuclear scintigraphic defecography, electromyography, anorectal manometry, balloon expulsion test, paradoxical puborectalis contraction, cinedefecography, and dynamic magnetic resonance imaging defecography have all been used to diagnose the underlying causes of functional constipation

Peristaltic Motion of Non-Newtonian Fluid with Heat and Mass Transfer through a Porous Medium in Channel under Uniform Magnetic Field

This paper is devoted to the study of the peristaltic motion of non-Newtonian fluid with heat and mass transfer through a porous medium in the channel under the effect of magnetic field. A modified Casson non-Newtonian constitutive model is employed for the transport fluid. A perturbation series’ method of solution of the stream function is discussed. The effects of various parameters of interest such as the magnetic parameter, Casson parameter, and permeability parameter on the velocity, pressure rise, temperature, and concentration are discussed and illustrated graphically through a set of figures

Comparaison des indicateurs bactériologiques et parasitologiques dans l'évaluation du risque sanitaire lors de l'utilisation par aspersion d'eaux résiduaires traitées ou d'eaux superficielles

Confrontés aux problèmes sanitaires posés par l'utilisation d'eaux résiduaires traitées pour leur utilisation très particulière dans l'irrigation par aéroaspersion de culture de maïs sélection, les auteurs ont comparé les qualités bactériologiques et parasitologiques des eaux traitées qui sont soumises à des normes et des eaux superficielles qui ne le sont pas. Ils concluent à la nécessité d'affiner les normes selon les pays et d'élaborer une réglementation prenant en compte la qualité des eaux superficielles

New 5,5'-disubstituted BINAP derivatives: Syntheses and pressure and electronic effects in Rh asymmetric hydrogenation.

International audienc

2,2'-Bis-[bis(4-substituted-phenyl)phosphino]-1,1'-binaphthyl derivatives in Rh(I)-catalyzed hydrogenation of acetamidoacrylic acid derivatives: Electronic affects.

International audienc