Comparison of Surgical versus Conservative Management of Borderline Traumatic Extradural Hematomas Without Neurological Deficit

Objective:  To compare the outcome of surgical versus conservative treatment of traumatic extradural hematoma in the supratentorial regin. Material and Methods:  It was a prospective randomized controlled trial conducted in Departments of Neurosurgery, Allied Hospitals, Faisalabad between December 2019 to November, 2020. A total of 100 patients Supratentorial EDH; fulfilling the selection criteria were enrolled. All patients underwent clinical and radiological assessment of EDH volume by the same neurosurgical team. The patients were then divided randomly into two groups by using the lottery methods. Group A patients were conservatively managed. Group B underwent surgery. All surgeries were done by the same surgical team. Glasgow outcome scale was noted in 5 days after admission or surgery in both groups. Results:  The patients average age was 29.96 years, male to female ratio was 1.7:1. The mean volume of hematoma was 24.68 and 27.56 in group A (conservative group) and Group B (operated group) respectively. The favorable outcome was noted in all the patients and no mortality occurred in any patients. Conclusion:  Both surgical and conservative treatments are equally effective in terms of a favorable outcome and mortality occurrence in management of traumatic EDH <30ml without neurological deficit. The conservative treatment is safe and cost-effective in borderline patients

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

Background: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial

The top managers of SMEs can derive the disruptive innovation through knowledge process capabilities and creativity of subordinates

Globalization trends have been increasing all over the world and firms are overly emphasizing advanced technologies in the business world for gaining competitive advantages. While disruptive innovation is also a trigger for these firms to adapt and capture lower-end markets. This is a big challenge for the top managers of organizations to derive disruptive innovation by encouraging their subordinates for utilizing the knowledge process capabilities and creating novel ideas. The purpose of this study was to examine the relationship of knowledge process capabilities with disruptive innovation of the manufacturer and service sector small and medium enterprises. Data was collected from 194 senior managers of manufacturer and service sector SMEs in Pakistan (N = 194) and valid scales were used for measuring all constructs of this study model. SPSS and AMOS programs were used for analyzing the CFA of the measurement model and SEM of the study model. The study results indicated significant and positive relationships between knowledge process capabilities and subordinate creativity and disruptive innovation. Furthermore, subordinate creativity was completely mediated in the relationship between knowledge process capabilities and disruptive innovation. This study contributed to the literature on knowledge management and innovations. This is a cross-sectional study and can guide SMEs to adopt disruptive innovation for capturing low-end markets where lower-stream customers are demanding cheap products/services. Through practicing this study model, practitioners, researchers, and CEOs of SMEs can foster disruptive innovation

Authentic Leadership Style and Academia’s Creativity in Higher Education Institutions: Intrinsic Motivation and Mood as Mediators

<p>Using multisource data of 302 paired responses (supervisor-employee dyads), this study examined the effect of Authentic Leadership Style (ALS) on academia’s creativity with mediating role of their intrinsic motivation and mood in higher education institutions (HEIs) of Pakistan. Heads of departments (HoDs) in HEIs were asked to report their leadership style and creativity of their academic staff, whereas academia rated their intrinsic motivation and mood at work. ALS was regressed with creativity, intrinsic motivation and mood of academia to measure the direct relationships, whereas mediations were tested using bootstrapping technique. A strong infl uence of ALS on academic staff’s creativity, their intrinsic motivation and mood were found. Additionally, a partial mediating role of intrinsic motivation and mood was found between ALS and creativity of academic staff.</p

Mediation Role of Organizational Commitment in the Relationships of Organizational Politics and Job Involvement and Employee Performance

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