Comparing the effect of Metoclopramide and Ketamine as a preemptive analgesia on postoperative pain

زمینه و هدف: جهت کنترل و یا کمک به کاهش درد پس از عمل جراحی از داروها و روشهای مختلف استفاده می شود. آنالژزی پیشگیرانه (Preemptive Analgesia) یکی از روشهایی است که در آن قبل از شروع جراحی از تزریق داروهای ضد درد نظیر مخدرها، کتامین و... استفاده می شود. در برخی از تحقیقات از متوکلوپرامید وریدی جهت کاهش درد پس از عمل جراحی استفاده شده است. این مطالعه با هدف بررسی تاثیر مقایسه ای تزریق داخل وریدی دو داروی کتامین و متوکلوپرامید نیم ساعت قبل از القای بیهوشی بر روی درد و میزان مصرف مخدر پس از جراحی انجام شد. روش بررسی: در این مطالعه کارآزمایی بالینی دو سویه کور تعداد 86 بیمار کلاس 1 و 2 بیهوشی کاندیدای عمل جراحی شکم تحت بیهوشی عمومی، به صورت در دسترس انتخاب و بطور تصادفی ساده به دو گروه تقسیم شدند. در گروه اول متوکلوپرامید (mg 10) و در گروه دوم کتامین (mg/kg 3/0) نیم ساعت قبل از القای بیهوشی به صورت داخل وریدی تزریق شد. نمره درد، میزان مصرف مخدر در ریکاوری و 24 ساعت اول پس از عمل جراحی، طول مدت اقامت در ریکاوری، زمان خروج لوله تراشه و عوارض مختلف از قبیل تهوع، استفراغ، بیقراری، عوارض روانی و...ارزیابی و ثبت گردید. اطلاعات با استفاده از آزمون های آماری کای اسکوار، t و آنالیز واریانس مشاهدات تکرار شده تجزیه و تحلیل گردید. یافته ها: میانگین نمره درد (VAS) در 24 ساعت اول پس از عمل جراحی در گروه متوکلوپرامید 04/3±98/3 و در گروه کتامین 32/3±93/5 بود (05/0

Effects of improvisation techniques in leadership development

Studies show that improvisation in leadership decision making is on the rise, and it transpires in organizations 75-90% of the time, yet very little research has explored this skillset. No other leadership skillset that is applied two thirds of the time has ever been so underdeveloped. The purpose of this study was to assess the effects of a pilot workshop applying a Holistic Improvisational Leadership Model as developed by the researcher and based on the latest improvisation research. The study employed a mixed methods design to gather qualitative and quantitative data for a descriptive evaluation of the pilot training workshop. Nonproportional quota sampling and triangulation were used to maximize cross verification and validity of the data. This study explored the skills leaders acquired and applied during, immediately after, 1 month after the workshop, and in 3 months. The study was pilot-tested on 6 different groups and a total of 67 leaders from various regions, industries and organizations. Primary findings revealed that participants gained the highest benefits in working with others and their ability to lead. Executive and educational leaders gained the awareness that 79% of their decisions at work were made spontaneously as opposed to 71% for all leaders. 100% of executives and senior leaders indicated acquiring more effective listening skills. Moreover, the concept of competent risks and celebrating failure appeared to have the most transformational impact on the participants\u27 sense of self, willingness to take risks, and acquire new skills. The workshop seemed to bring participants\u27 stress level down to an optimal level and enhance mindfulness. Ultimately, it was concluded the study\u27s workshop was most effective as a continuous 3.5 hours. Learning to improvise experientially includes a process of unlearning old routines of decision making and re-learning more effective skills. Hence, the researcher recommends follow-up learning sessions to complete the cycle of learning. Utilizing grounded theory, the findings from the study led to the revision of Tabaee\u27s Holistic Improvisational Leadership Model. The researcher recommends following the model by teaching the competencies not only to leaders but to all employees for achieving OPTIMAL strategy and performance for the organization

Fellowship training:a qualitative study of scope and purpose across one department of medicine

BACKGROUND: Fellowship training follows certification in a primary specialty or subspecialty and focusses on distinct and advanced clinical and/or academic skills. This phase of medical education is growing in prevalence, but has been an "invisible phase of postgraduate training" lacking standards for education and accreditation, as well as funding. We aimed to explore fellowship programs and examine the reasons to host and participate in fellowship training, seeking to inform the future development of fellowship education. METHODS: During the 2013-14 academic year, we conducted interviews and focus groups to examine the current status of fellowship training from the perspectives of division heads, fellowship directors and current fellows at the Department of Medicine, University of Ottawa, Canada. Descriptive statistics were used to depict the prevailing status of fellowship training. A process of data reduction, data analysis and conclusions/verifications was performed to analyse the quantitative data. RESULTS: We interviewed 16 division heads (94%), 15 fellowship directors (63%) and 8 fellows (21%). We identified three distinct types of fellowships. Individualized fellowships focus on the career goals of the trainee and/or the recruitment goals of the division. Clinical fellowships focus on the attainment of clinical expertise over and above the competencies of residency. Research fellowships focus on research productivity. Participants identified a variety of reasons to offer fellowships: improve academic productivity; improve clinical productivity; share/develop enhanced clinical expertise; recruit future faculty members/attain an academic position; enhance the reputation of the division/department/trainee; and enhance the scholarly environment. CONCLUSIONS: Fellowships serve a variety of purposes which benefit both individual trainees as well as the academic enterprise. Fellowships can be categorized within a distinct taxonomy: individualized; clinical; and research. Each type of fellowship may serve a variety of purposes, and each may need distinct support and resources. Further research is needed to catalogue the operational requirements for hosting and undertaking fellowship training, and establish recommendations for educational and administrative policy and processes in this new phase of postgraduate education

Pharmacotherapy for Dravet Syndrome: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials.

BACKGROUND Dravet syndrome (DS) is a severe developmental and epileptic encephalopathy characterized by drug-resistant, lifelong seizures. The management of seizures in DS has changed in recent years with the approval of new antiseizure medications (ASMs). OBJECTIVE The aim of this study was to estimate the comparative efficacy and tolerability of the ASMs for the treatment of seizures associated with DS using a network meta-analysis (NMA). METHODS Studies were identified by conducting a systematic search (week 4, January 2023) of the MEDLINE (accessed by PubMed), EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and US National Institutes of Health Clinical Trials Registry ( http://www. CLINICALTRIALS gov ) databases. Any randomized, controlled, double- or single-blinded, parallel-group study comparing at least one ASM therapy against placebo, another ASM, or a different dose of the same ASM in participants with a diagnosis of DS was identified. The efficacy outcomes were the proportions of participants with ≥ 50% (seizure response) and 100% reduction (seizure freedom) in baseline convulsive seizure frequency during the maintenance period. The tolerability outcomes included the proportions of patients who withdrew from treatment for any reason and who experienced at least one adverse event (AE). Effect sizes were estimated by network meta-analyses within a frequentist framework. RESULTS Eight placebo-controlled trials were included, and the active add-on treatments were stiripentol (n = 2), pharmaceutical-grade cannabidiol (n = 3), fenfluramine hydrochloride (n = 2), and soticlestat (n = 1). The studies recruited 680 participants, of whom 409 were randomized to active treatments (stiripentol = 33, pharmaceutical-grade cannabidiol = 228, fenfluramine hydrochloride = 122, and soticlestat = 26) and 271 to placebo. Pharmaceutical-grade cannabidiol was associated with a lower rate of seizure response than fenfluramine hydrochloride (odds ratio [OR] 0.20, 95% confidence interval [CI] 0.07-0.54), and stiripentol was associated with a higher seizure response rate than pharmaceutical-grade cannabidiol (OR 14.07, 95% CI 2.57-76.87). No statistically significant differences emerged across the different ASMs for the seizure freedom outcome. Stiripentol was associated with a lower probability of drug discontinuation for any reason than pharmaceutical-grade cannabidiol (OR 0.45, 95% CI 0.04-5.69), and pharmaceutical-grade cannabidiol was associated with a lower proportion of participants experiencing any AE than fenfluramine hydrochloride (OR 0.22, 95% CI 0.06-0.78). Stiripentol had a higher risk of AE occurrence than pharmaceutical-grade cannabidiol (OR 75.72, 95% CI 3.59-1598.58). The study found high-quality evidence of efficacy and tolerability of the four ASMs in the treatment of convulsive seizures in DS. CONCLUSIONS There exists first-class evidence that documents the efficacy and tolerability of stiripentol, pharmaceutical-grade cannabidiol, fenfluramine hydrochloride, and soticlestat for the treatment of seizures associated with DS, and allows discussion about the expected outcomes regarding seizure frequency reduction and tolerability profiles

The relationship between coping styles and psychological adaptation in the recovery process: Patients with coronary heart disease

Background: The relationship between coping styles and psychological adaptation during the recovery process was investigated in a sample of coronary heart disease (CHD) patients. Methods: One hundred and fifty patients from Shahid Rajaee Heart Center, Tehran, Iran, were included in this study at intake and forty five patients (27 men, 18 women) participated in the follow-up study. All participants were asked to complete the Tehran Coping Styles Scale (TCSS) and Mental Health Inventory (MHI). The Recovery Process Questionnaire (RPQ) was completed using each patient�s medical file and clinical examinations by cardiologists. Styles of coping with stress were categorized as problem-focused, positive emotional-focused and negative emotional-focused. Psychological adaptation included psychological well-being and psychological distress. Results: Objective recovery status showed no significant correlation with either coping styles or psychological adaptation. Perceived recovery revealed a significant positive association with negative emotional-focused coping (p<0.05), but no significant correlation with other coping and psychological adaptation variables. Perceived recovery revealed a significant negative association with psychological distress (p<0.05), but showed no significant correlation with psychological well-being. Conclusions: Perceived recovery in CHD patients is positively influenced by negative emotional-focused coping styles. Results and implications are discussed specifically in terms of the possible reasons for the positive relationship between perceived recovery and negative emotional-focused coping. © 2008, Tehran University of Medical Sciences. All rights reserved

Pulmonary artery banding in the current era: Is it still useful?

Background: The objective of this study was to assess the results of the pulmonary artery (PA) banding in patients with congenital heart defects (CHD) and pulmonary hypertension (PH) in the current era. Methods: We analyzed data from 305 patients who underwent PA banding between April 2005 and April 2010 at our centre. All patients were approached through a left thoracotomy. Twenty percent of patients underwent PA banding based on Trusler's rule (Group 1), 55 of them underwent PA banding based on PA pressure measurement (Group 2), and the rest of them (25) based on surgeon experience (Group 3). The follow-up period was 39 ± 20 month and 75 of patients (230 cases) had definitive repair at mean interval 23 ± 10 months. Results: The rate of anatomically and functionally effectiveness of PA banding in all groups was high (97 and 92, respectively). There were no significant differences in anatomically and functionally efficacy rate between all groups (P=0.77, P=0.728, respectively). There was PA bifurcation stenosis in six cases (2), and pulmonary valve injury in one case (0.3). The mortality rate in PA banding was 2 and in definitive repair was 3. Conclusions:We believe that PA banding still plays a role in management of patients with CHD, particularly for infants with medical problems such as sepsis, low body weight, intracranial hemorrhage and associated non cardiac anomalies. PA banding can be done safely with low morbidity and mortality

Efficacy and Safety of Fenfluramine in Epilepsy: A Systematic Review and Meta-analysis

Introduction: Fenfluramine (FFA) is an amphetamine derivative that promotes the release and blocks the neuronal reuptake of serotonin. Initially introduced as an appetite suppressant, FFA also showed antiseizure properties. This systematic review aimed to assess the efficacy and safety of FFA for the treatment of seizures in patients with epilepsy. Methods: We systematically searched (in week 3 of June 2022) MEDLINE, the Cochrane Central Register of Controlled Trials, and the US National Institutes of Health Clinical Trials Registry. Randomized, double- or single-blinded, placebo-controlled studies of FFA in patients with epilepsy and uncontrolled seizures were identified. Efficacy outcomes included the proportions of patients with ≥ 50% and 100% reductions in baseline seizure frequency during the treatment period. Tolerability outcomes included the proportions of patients who withdrew from treatment for any reason and suffered adverse events (AEs). The risk of bias in the included studies was assessed according to the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions. The risk ratio (RR) along with the 95% confidence interval (CI) were estimated for each outcome. Results: Three trials were identified and a total of 469 Dravet syndrome (DS) and Lennox–Gastaut syndrome (LGS) subjects were randomized. All three trials were judged to be at low risk of biases. In patients with DS, the RRs for ≥ 50% and 100% reductions in convulsive seizure frequency for the FFA group compared to placebo were 5.61 (95% CI 2.73–11.54) and 4.71 (95% CI 0.57–39.30), respectively. In patients with LGS, the corresponding RRs for ≥ 50% and 100% reductions in drop seizure frequency were 2.58 (95% CI 1.33–5.02) and 0.50 (95% CI 0.031–7.81), respectively. The drug was withdrawn for any reason in 10.1% and 5.8% of patients receiving FFA and placebo, respectively (RR 1.79, 95% CI 0.89–3.59). Treatment discontinuation due to AEs occurred in 5.4% and 1.2% of FFA- and placebo-treated patients, respectively (RR 3.63, 95% CI 0.93–14.16). Decreased appetite, diarrhoea, fatigue, and weight loss were AEs associated with FFA treatment. Conclusion: Fenfluramine reduces the frequency of seizures in patients with DS and LGS. Decreased appetite, diarrhoea, fatigue, and weight loss are non-cardiovascular AEs associated with FFA

Modified Blalock-Taussig shunt and giant perigraft reaction

This is a case of a modified Blalock-Taussig shunt, which was complicated by perigraft transudative, fibrinous fluid accumulation and recurrence after surgical intervention. Follow-up and expectant management of the patient was successful. Our experience regarding this complication is presented