Cwbr Author Interview: Thunder At The Gates: The Black Civil War Regiments That Redeemed America

Interview with Douglas Egerton, author of Thunder at the Gates: The Black Civil War Regiments That Redeemed America Interviewed by Tom Barber Civil War Book Review (CWBR): Today the Civil War Book Review is pleased to speak with Douglas Egerton, Professor of History at Le Moyne College and...

Forging Freedom: Black Women and the Pursuit of Liberty in Antebellum Charleston.

Forging New Ground in Antebellum Charleston Sophie Mauncaut, once enslaved in French Saint Domingue, arrived in South Carolina with her owner, Josephine Catreuille. Toward the end of her life, Catreulle freed Mauncaut. That was not uncommon, since slaveholding women tended to liberate fa...

The Ordeal of the Reunion: A New History of Reconstruction

A Wider View of Reconstruction For too many Americans, the Reconstruction era is an afterthought, or worse yet, a confusing postscript to four years of Civil War that provided considerable clarity. No serious scholar would today deny the centrality of slavery and its extension as the cause...

The Field of Blood: Violence in Congress and the Road to Civil War

Talented historians can shed new light on familiar stories, sometimes by bringing additional data into the narrative, and some by enlarging the scope and context. In The Field of Blood, Joanne Freeman, the author of an earlier study on political violence, Affairs of Honor, does both. Historians, for example, have devoted numerous books and articles to Congressman Preston Brooks’ brutal caning of Senator Charles Sumner. But it was a revelation, to this reviewer, at least, that the affair led to eight duels or challenges, as the mayhem on the Senate floor rippled across the capital, or that Congressman Laurence Keitt, who kept others from interfering during Brooks’ assault, was himself targeted for political violence. As Republicans became determined to protect themselves, both on the streets of Washington and in their chambers, Pennsylvania Congressman Galusha Grow was among those who had grown weary of violence-prone slaveholders. After Grow issued an objection from the Democratic side of the chamber, a tipsy Keitt shouted that Grow should file his objection from his own side of the House. Grow responded that it was a free hall, prompting Keitt to grab the Pennsylvanian by the throat. Grow knocked Keitt’s hand away and then punched him hard enough to knock him to the floor. Congressmen from both parties raced toward the melee, overturning desks and unsheathing weapons as they ran. Southerners had long been “under the delusion that Northern men would not fight,” a triumphant Grow laughed (240). Now they knew better

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Effects of fluoxetine on functional outcomes after acute stroke (FOCUS): a pragmatic, double-blind, randomised, controlled trial

Background Results of small trials indicate that fluoxetine might improve functional outcomes after stroke. The FOCUS trial aimed to provide a precise estimate of these effects. Methods FOCUS was a pragmatic, multicentre, parallel group, double-blind, randomised, placebo-controlled trial done at 103 hospitals in the UK. Patients were eligible if they were aged 18 years or older, had a clinical stroke diagnosis, were enrolled and randomly assigned between 2 days and 15 days after onset, and had focal neurological deficits. Patients were randomly allocated fluoxetine 20 mg or matching placebo orally once daily for 6 months via a web-based system by use of a minimisation algorithm. The primary outcome was functional status, measured with the modified Rankin Scale (mRS), at 6 months. Patients, carers, health-care staff, and the trial team were masked to treatment allocation. Functional status was assessed at 6 months and 12 months after randomisation. Patients were analysed according to their treatment allocation. This trial is registered with the ISRCTN registry, number ISRCTN83290762. Findings Between Sept 10, 2012, and March 31, 2017, 3127 patients were recruited. 1564 patients were allocated fluoxetine and 1563 allocated placebo. mRS data at 6 months were available for 1553 (99·3%) patients in each treatment group. The distribution across mRS categories at 6 months was similar in the fluoxetine and placebo groups (common odds ratio adjusted for minimisation variables 0·951 [95% CI 0·839–1·079]; p=0·439). Patients allocated fluoxetine were less likely than those allocated placebo to develop new depression by 6 months (210 [13·43%] patients vs 269 [17·21%]; difference 3·78% [95% CI 1·26–6·30]; p=0·0033), but they had more bone fractures (45 [2·88%] vs 23 [1·47%]; difference 1·41% [95% CI 0·38–2·43]; p=0·0070). There were no significant differences in any other event at 6 or 12 months. Interpretation Fluoxetine 20 mg given daily for 6 months after acute stroke does not seem to improve functional outcomes. Although the treatment reduced the occurrence of depression, it increased the frequency of bone fractures. These results do not support the routine use of fluoxetine either for the prevention of post-stroke depression or to promote recovery of function. Funding UK Stroke Association and NIHR Health Technology Assessment Programme