Ariel - Volume () Number 1

Copyright 1986 Arie

Effects of Patient Aggression on Pediatric Healthcare Workers

Healthcare workers are injured at high rates, even those who work in pediatric settings. The source of these injuries may be overexertion, slips/trips/falls, or needle sticks, but one source of injuries that has not been studied as extensively is patient aggression. Our study looked at possible effects of experiencing “patient behavioral events” (or PBEs), which are defined as physical aggression toward an employee, whether or not there was an intention to harm. Surveys of employees at three children’s hospitals across the U.S. showed that increased frequency of PBEs is associated with decreased well-being and worse job/organization attitudes. One key finding from this study is that the same negative effects were shown when the frequency of witnessing or hearing about PBEs was higher, which suggests that one need not be the target of the aggression to experience negative effects. If this causal path holds in future research, it would mean that PBEs have ripple effects in the unit, beyond just the person who is targeted by the patient aggression. Ongoing data analyses will examine whether there are any mitigating factors that might reduce the harm caused by PBEs

Recording active basilar membrane tuning characteristics using distortion-product otoacoustic emissions

The objective of this study was to describe ways in which properties of human cochlear travelling waves may be manifested in characteristics of distortion-product otoacoustic emissions (DPOAEs). Four young adults served as subjects. DPOAE magnitude was studied for various frequency-ratio and intensity relationships of the primary stimuli. Results revealed complex relationships between stimulus level (L) and frequency ratios (f). The optimal f2/f1 ratios were highly dependent upon differences between L1 and L2. Maximum distortion product amplitudes were encountered when L2 was smaller than L1 for several stimulus conditions and when f2/f1 ratios were approximately 1.20 (range = 1.05 to 1.25). These observations replicate and extend the findings of prior investigations regarding the optimal parameters associated with the production of DPOAEs, and also provide evidence of the complex, nonlinear events leading to the creation of DPOAEs

Ultrasonographic diagnosis and minimally invasive treatment of a patent urachus associated with a patent omphalomesenteric duct in a newborn

Rational: Patent urachus (PU) is due to an incomplete obliteration of the urachus, whereas patent omphalomesenteric duct (POMD) is due to an incomplete obliteration of the vitelline duct. These anomalies are very rarely associated with one another. We describe a case of a newborn with a PU associated with a POMD, who was diagnosed by an abdominal ultrasound (US) and laparoscopy, and managed with a minimally invasive excision. Patient concern: A 28-day-old male neonate was referred to our hospital to investigate a delay in umbilical healing, with blood-mucinous material spillage for 3 weeks prior to the referral. The baby had no symptoms and was in good general health. Diagnosis: After a thorough cleaning of the umbilical stump, a clear granuloma with a suspected fistula was evident under the seat of the ligature of the stump. An abdominal US examination revealed the formation of a full communication, starting below the umbilical stump and developing along the anterior abdominal wall that connected with the bladder dome. The US also revealed a tubular formation containing air, which was compatible with POMD, in the deepest portion of the same umbilical stump. Considering these findings, the rare diagnosis of a PU associated with a POMD duct was suspected. Interventions: The child was then hospitalized for an elective laparoscopy that confirmed the US picture, and a minimally invasive excision was performed. Outcome: The postoperative course was favorable and uneventful. Lessons: Our case underlines the importance of evaluating all persisting umbilical lesions without delay when conventional pharmacological therapies fail. Using a US as the first approach is valuable and should be supported by laparoscopy to confirm the diagnosis; a minimally invasive excision of the remnants appears to be an effective therapeutic approach

Management of puncture wounds in the foot.

Puncture wounds may be relatively innocuous, or they can lead to devastating sequelae. The authors reflect their combined experiences in treating these maladies and review recommended treatment protocol. Various radiographic, clinical, and histologic characteristics of puncture wounds are presented