Antecedents and Outcomes of Intimate Co-creation: A Qualitative Inquiry

This qualitative research study aims at re-conceptualizing intimate co-creation on the basis of a qualitative data analysis. Hence, along with a latest conceptualization, theory of intimation co-creation has been empirically examined in this study. Based on the qualitative research approach of interpretive phenomenological analysis, qualitative data obtained from eight in-depth interviews was transcribed and coded in QDA Miner Lite software for analysis. Results found that five emerging themes represent the phenomenon of intimate co-creation. Furthermore, the contribution of this study was that a new research framework on intimate co-creation has been developed in which antecedents and potential outcomes of intimate co-creation have been identified. Propositions have been given as well to elaborate the relationship of antecedents and outcomes of intimate co-creation for future research direction

Where you end and I begin: A new scale development on intimate co-creation

Purpose: Built upon the theories of psychological ownership, personal intimacies, and interpersonal relationship; the concept of intimate co-creation was conceptually theorized in the recent management literature. Intimate co-creation typically occurs at the dyadic level often for the creative task engagements and has a spillover effect on groups and teams. However, there is no measurement scale on intimate co-creation available in the management literature. Methodology: The current study has addressed this literature gap by developing a new measurement scale on intimate co-creation. Best practices for new measurement scale development as available in the management literature were followed. A qualitative study was conducted first to determine the dimensional structure of intimate co-creation and an initial pool of 72 items. Scale development experts’ review of the measurement scale, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA) abetted in finalizing a 14 items measurement scale with four dimensions of intimate co-creation. Findings: This new measurement scale development is a milestone for further empirical research on intimate co-creation as it is the first-ever measurement scale on intimate co-creation. Conclusion: This is the first-ever measurement scale on intimate co-creation that is available for future researchers to empirically validate the concept of intimate co-creatio

Impact of Compulsory Citizenship Behavior on Employee Performance: A Mediating Role of Perceived Insider Status and Moderating Role of Psychological Hardiness

The current study investigates the relationship between compulsory citizenship behavior (CCB) and employee performance (EP) through the underlying mechanism of perceived insider status (PIS) and the moderating effect of psychological hardiness (PH). For this purpose, data were collected through a non-probability convenience sampling technique in three-time lags from 376 employees working in hotels located in Pakistan. The results support the effect of compulsory citizenship behavior on employee performance, directly and indirectly, through the perceived insider status of employees. Results also support the moderating role of psychological Hardiness weakening the negative relationship between CCB and perceived insider status

Increasing the Implication of Endoscopy to a Wide Spectrum of Intraventricular Lesions: A Review of Our Experience

Introduction: Though traditional microsurgical techniques are the gold standard for intraventricular tumor resection, the morbidity and invasiveness of microsurgical approaches to the ventricular system have galvanized interest in neuroendoscopic resection. We present a case series to share our experience with endoscopic management of intraventricular lesion.Materials and Methods: 17 patients, both male and female, from 5 to 50 years of age were endoscopically operated during 1.5 years. Intraventricular lesions < 4cm, mildly vascular and soft in consistency were included. The average operative time was 90 minutes and the average hospital stay was 4 ± 1.5 days. Follow up was done at 2 weeks, 6weeks and at 6 months.Results: Out of 12 males and 5 females there were 6 colloid cysts, 3 supra sellar arachnoid cysts, 5 intraventri-cular tumors and 3 pineal tumors. Complete resection of lesion was achieved in 4 out of 6 patients with colloid cyst (66.6%). Size of supra sellar arachnoid cyst reduced along with improvement of hydrocephalus in all 3 patients (100%) Positive tumor biopsy was possible in 100% of cases. Adjuvant endoscopic third ventriculostomy was performed in 9 (52.9%). Septostomy was done in 1 (5.9%). Post op Ventriculoperitoneal shunt was required in 4 (23.5%) cases. There was no peri or post operative mortality.Conclusion: With proper patient selection endoscopic surgery can yield results at par with microsurgery with added benefits of minimum patient discomfort, shorter hospital stay and improved cosmetic results

The Role of Intracranial Pressure (ICP) Monitoring in Severe Traumatic Brain Injury (TBI)

The management of patients with severe head injury is a prodigious task for any neurosurgical team. After the initial life support, the management plan of patient with traumatic brain injury rest on the findings of a cranial CT scan. The treatment options of TBI differ with severity of trauma. Osmotic diuretics in the acute phase can be helpful. Hyperventilation is a method to be used in conjunction with other options in certain situations. Normal values of intra cranial pressure (ICP) vary with age, being 10 to 15 mm Hg in an adult. Intra cranial pressure (ICP) values of 20 to 30 mm Hg shows mild intracranial hypertension, while sustained intra cranial pressure (ICP) values more than 40 mm Hg indicate life threatening malignant intracranial hypertension which should be lowered immediately. Measuring the intra cranial pressure of severe traumatic brain injury patients is now mandatory as it allows an effective and control way of lowering the raised ICP with very good outcome results.Objective: To adjust the ICP lowering mechanics according to the reading obtained via the ICP monitor in patients after severe head injury so as to minimize the need of ventilatory support and decrease the patients’ stay at hospital.1. To measure the value of ICP by using ICP monitoring in severe head injuries (GCS score below or equal to 8).2. To assess the outcome of the conservative measures in patients in whom ICP was monitored, on the basis of Glasgow Outcome Scale.Study Design: Prospective descriptive study.Setting: Department of Neurosurgery, Lahore General Hospital, Lahore.Duration of Study: One year from July 2012 to July 2013.Material and Methods: Thirty patients of traumatic brain injury were included in this study. ICP monitoring was done via Integra intra parenchymal Camino bolt and Integra ICP monitors.Results: Out of 30 patients, there were 21 (70%) male patients and 9 (30%) female patients.The male to female ratio was 2.33:1. In 20 (67%) patients the ICP ranged from 25-34 mmHg. There were 10 (33%) patients having ICP of 35 – 50 mm Hg. The mean intracranial pressure was 29.5 ± 6.96. The Glasgow coma scale of our patients was such that there were2 (6.6%) patients had GCS 5. In GCS 6 there were 20 (66%) patients. There were 3 (10%) patients who had a GCS of 7. In GCS 8 there were 5 (16.6) patients. The ventilation duration was 5 – 15 days. The frequency of hospital stay in our patients 10-30 days. There were 2 (7%) patients of Glasgow outcome scale of grade – I. In grade – II, there were 3 (10%) patients, no patient in Glasgow outcome scale grade – III. There were 10 (33%) patients in grade – IV while 15 (50%) patient were in grade – V. In the follow up cases, after 1 month, there were no patient in grade – I. There were 3 (10%) patients of GOS grade – II, in grade – III there were 4 (13%) patients, there were 8 (27%) patients grade – IV. 15 (50%) patients of grade – V. After 3 month, there was 1 (3%) patient in grade – I. There were 2 (7%) patients of GOS grade – II, in grade – III there were 2 (7%) patients, there were 10 (33%) patients grade – IV. 15 (50%) patients of grade – V.Conclusion: It is concluded that ICP monitoring is useful for improving the outcome of traumatic brain injury patients. Most of the patients were in young age. Majority of the patients had a low Glasgow coma scales. In our study most of the patients were male. In this study there is short duration of ventilation in patients and a short hospital stay in patients of TBI in which ICP is monitored and addressed promptly

Traumatic Subdural Empyema – A Rare Neurosurgical Emergency: Case Report and Review of Literature

Subdural empyema is a neurosurgical emergency with potentially overwhelming complications. The prognosis is harmfully affected when early diagnosis is not made. Recent advancement in the imaging techniques, especially contrast enhanced CT Scans and MRI Scans, have improved the precision of radiological diagnosis of this condition, along with reduction in the mortality rate. Regardless of this, there may still be an impediment in diag-nosis, partly due to the subtleness of early radiological signs, especially on non-contrast CT Scan. We present a case report which illustrates some of the radiological manifestations, complications, potential pitfalls in diagnosis and treatment of traumatic subdural empyema.Conclusion: Patient of severe head injury not improving with pharmacotherapy should get a repeat C.T Scan vault to look for delayed hematomas or empyema. Urgent diagnosis and prompt evacuation along with proper anti-biotic therapy can improve the survival of patient having traumatic subdural empyema

Early Versus Late Tracheotomy in Patients with Severe Head Injury

Objective: A majority of patients with severe head injury whether treated conservatively or being operated, need ventilatory support and require endotracheal intubation. There has been a great discussion regarding the timing of tracheostomy. In this study we observed our admitted patients with severe head injury and noted the role of early tracheostomy in the outcome of these patients.Material and Method: This study included 50 cases of severe head injury presenting in the emergency department of Neurosurgery, Lahore General Hospital, Lahore.Study Duration: The study duration was two years from October 2010 to October 2012.Study Design: Prospective and analytic study.Results: A total of 50 patients with no sex predilection, ages ranging from 10 years to 60 years were included in this study. The patients were divided into 2 groups. Group A, having 25 patients who underwent tracheostomy earlier and Group B, having 25 patients in whom tracheostomy was done late. According to the timing of tracheostomy, patients were classified as early group A (? 7 days; N = 25) or late group B (> 7 days; N = 25). The average time of the tracheostomy procedure was 5.5 ± 1.8 (SD) days in the early group and 11.0 ± 4.3 days in the late group. There were no significant differences between the groups in terms of age, proportion of female sex, GCS, Injury Severity Score, or need for blood transfusion. However, patients in the early group had a significantly shorter stay in the ICU than patients in the late group (19.76 ± 4.4 vs. 28.9 ± 5.6 days; P = 0.0000001). There was no difference between the groups in ventilator days (15.7 ± 6.0 vs. 20.0 ± 16.0 days; p = 0.57) data not shown. There were significant differences between the groups regarding overall mortality 4% vs. 24%; p = 0.041332. Similarly, significant recovery (p = 0.04) was observed in early tracheostomy patients when compared with group B. Conclusion: Early tracheostomy was beneficial, resulting in a shorter ICU stay and decreasing the overall mortality

Dysembryoplastic Neuroepithelial Tumour (DNET): A Rare Brain Pathology Presenting with Intractable Seizures

Dysembryoplastic neuroepithelial tumour (DNET) is a benign glioneuronal tumour often related with intractable localization – related seizures in both in paediatric age group as well as young adults. However, a small number appear to have the potential for malignant transformation. Total surgical removal without any adjuvant therapy is the gold standard treatment. We report a case in which DNET appeared in a 13 year old male. Cranial CT scan showed a discoid lesion with peripheral enhancement in right parietal lobe. Micro-decompression of the tumour was done. On histopathology, the tumour revealed features of WHO grade I dysembryoplastic neuroepithelial tumour

Midline Depressed Fractures of the Skull

Objective: To evaluate the results of management of middle depressed fracture skull.Depressed skull fracture is a common neuro-traumatic emergency. The commonest causes in our society are fall from height and road traffic accident. The frequency of depressed fractures is that it occurs in 75% in fronto-parietal region, 10%1 in temporal region, while in occipital is 5% and in others is 10%. In time surgical manage-ment gives excellent results and leads to minimize the sequel of this condition. Most of the causes can be pre-vented just by adopting preventive measures. The condition can be treated in periphery hospital as well, if trained personals are available. Midline depress fracture are rare. Depressed fracture over venous sinuses requires special handling. Surgical elevation involves massive blood loss. Most of them are treated conservatively.Material and Methods: We conducted a 4 years study in the department of Neurosurgery, Lahore General Hospital from 2009 to 2013.Results: We included 30 patients of mid line depressed fractures in which 20 were treated by surgical elevation and 10 by conservative management. Follow of 3 months to 1 year. In a total of 3750 patients who presented in the emergency department, 540 (14.4%) patients were operated for depressed skull fractures in which midline depressed fractures were 20 (4%). There were 20 patients in whom the anterior 1/3rd of superior sagittal sinus was involved, in 6 patients the middle 1/3rd of superior sagittal sinus was involved while in only 4 patients the posterior 1/3rd of superior sagittal sinus was involved. We paid special attention to these midline fractures involv-ing the venous sinuses. In 4 of our patient we encountered severe blood loss as the depressed fragment was being plugged in sinus tear. In 12 patients we carefully elevated the depressed fractures and gained control over the venous sinus as soon as possible with the help of spongiston and packing technique. In 8 patients the fracture site was not contaminated with foreign material, there was no cosmetic issue and no focal deficit found, they were managed by scalp debridement along thorough irrigation and primary closure. Out of operated 20 patients only two patients presented with mild wound infection but it settled down with proper antibiotic therapy. In the con-servative group out of 10 patients 2 patients developed epileptic seizure after 3 months and 7 months of trauma and they were managed by giving antiepileptic drugs.Conclusion: In our study we concluded that elevation of depressed fracture over SSS can be attempted whenever patients clinical condition warrant. Elevation of the bone along with debridement of the wound resulted in rapid and dramatic resolution of signs and symptoms of raised ICP and venous hypertension. The study also showed an improvement in the cosmesis and reduction in the overall wound infection rate

Endonasal Endoscopic Repair of Cerebrospinal Fluid Leaks

Objective: To assess the outcome of Endonasal Endoscopic Repair of Cerebrospinal Fluid LeaksMethods and Materials: This study was conducted from July 2013 to October 2014 at the department of Neurosurgery, PGMI, Lahore General Hospital, Lahore. A total of 20 patients were included in this study of both gender (male and female) and in the age range of 15 – 65 years. All the patients undergone Endonasal Endoscopic with the use of a Karl Stortz rigid endoscope of 0º and 30º with a 4mm diameter. All of them were followed up for recurrence of CSF leak and any postoperative complication.Results: Out of 20 patients, there were 08 (40%) males and 12 (60%) female patients. Their age ranged from 15 – 65 years. The maximum numbers of patients were in their third and fourth decade of life. The cause of CSF leak was spontaneous in 11(55%), iatrogenic in 5 (25%) and traumatic in 4 (20%) of cases. In 13 (65%) patients, CSF rhinorrhea was from right nostril and in 7 (35%) patients left side was affected. Endonasal Endoscopic CSF repair was done in all patients and was successful in 18 (90%) of patients. Two patients (10%) presented with recurrence of CSF leak in which one was successfully re-operated endoscopically and other undergone transcranial approach. Overall the success rate was 95% in our study. Only one patient complicates with meningitis postoperatively which was resolved with antibiotics.Conclusion: The repair of the CSF rhinorrhea by Endonasal Endoscopic surgery is minimal invasive, safe, effective and is a valid alternative to the cranial approach. Abbreviations: CSF: Cerebrospinal Fluid. MRI: Magnetic Resonance Imaging