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Shoulder pain is among the early postlaparoscopic symptoms related to carbon dioxide used for pneumoperitoneum, which remains in the abdominal cavity. Therefore, incentive spirometry (IS) is a novel technique to alleviate this pain following laparoscopic cholecystectomy (LC). The present study was designed to investigate if the use of IS after LC would relieve shoulder tip pain, and determine the amount of postoperative opioid analgesics utilized.

This randomized clinical trial was conducted on patients who were clinically diagnosed with cholecystitis, and underwent LC. Accordingly, group I patients (n=42) received IS (including 10 deep breaths with a spirometer in sitting or semisitting positions) in full consciousness every 2 hours starting at 2 hours after surgery, but group II patients (n=42) did not have respiratory physiotherapy. The postoperative shoulder pain after the surgery was further evaluated by a numerical rating scale (NRS).

At 4, 8, 12, 24, and 48 hours following LC, the NRS pain scores significantly reduced in group I compared with group II. In addition, the results of the repeated measures analysis of variance indicated significantly lower NRS pain scores within the first 48 hours after LC in group I compared with group II. Consequently, the study findings showed a significantly higher percentage of cases in group II, requiring postoperative analgesics, in comparison with group I.

IS decreased the severity of shoulder tip pain after LC with no complications. check details Thus, IS may be considered as a viable alternative to other laparoscopic interventions. However, still further studies are necessary to evaluate its efficacy compared with other techniques.

IS decreased the severity of shoulder tip pain after LC with no complications. Thus, IS may be considered as a viable alternative to other laparoscopic interventions. However, still further studies are necessary to evaluate its efficacy compared with other techniques.

Patients treated nonsurgically for complicated diverticulitis are managed by antibiotics. However, there are no recommendations concerning their duration. We aimed to determine the impact of the duration of antibiotic therapy on the risk of failure of nonsurgical treatment of complicated acute diverticulitis.

This was a single-center retrospective study of patients with computer tomography (CT)-diagnosed complicated diverticulitis between January 2015 and April 2020. Treatment failure was defined as early recurrence and/or a persistent abscess by control CT.

In total, 148 patients fulfilled the inclusion criteria [87 men (58.8%), mean age 55±15 y]. The diverticulitis was classified as Hinchey I in 41.9%, Hinchey II in 9.5%, and pericolic free air in 48.6% of cases. The median abscess size was 2.9±1.7 cm. The median duration of antibiotic treatment was 10±4.2 days. The median follow-up was 64±60 months. The rate of failure was 12.8%. In univariate analysis, treatment >10 days (P=0.015) and an abscess >3 cm (P=0.032) were associated with a risk of treatment failure. In multivariate analysis, only the diameter of the abscess remained associated with a risk of failure (odds ratio 1.6, 95% confidence interval 1.09-2.4, P=0.01).

This study suggests that there is no need to extend the duration of antibiotic treatment beyond 10 days in nonsurgically treated complicated acute diverticulitis.

This study suggests that there is no need to extend the duration of antibiotic treatment beyond 10 days in nonsurgically treated complicated acute diverticulitis.

This prospective longitudinal study assesses the reciprocal relationship between physical activity, including sport participation, and depressive and anxiety symptoms, conceptualized as emotional distress, over time.

Boys and girls are from the Quebec Longitudinal Study of Child Development birth cohort (N = 1428). Trajectories of emotional distress symptoms from ages 6 to 10 years, assessed by teachers, were generated using latent class analysis. Multinomial logistic regression analyses examined sport participation at age 5 years, measured by parents, as a predictor of emotional distress trajectory outcomes. Analyses of covariance compared physical activity, measured by children at age 12 years, across different trajectories of emotional distress.

We identified 3 emotional distress trajectories "low" (77%), "increasing" (12%), and "declining" (11%). Boys who never participated in sport at age 5 years were more likely to be in the "increasing" (adjusted odds ratio [OR] = 1.63, 95% confidence interval [Cphysical activity for health promotion.

The aim of this study was to describe the disclosure process in children with perinatally acquired HIV infection (PHIV+) and its impact on their emotional well-being and adherence to antiretroviral therapy (ART) in South Africa.

This prospective cohort study followed PHIV+ children aged 7 to 13 years attending counseling over 18 months. Standardized disclosure tools were used by a counselor with both child and caregiver present. Assessments included the Child Behavior Checklist (CBCL), Vineland Adaptive Behavior Scale (VABS), Child Depression Inventory (CDI), and Revised Children's Manifest Anxiety Scale (RCMAS). Adherence to ART was recorded through pharmacy pill returns. Changes over time and their differences from baseline were assessed by linear mixed models.

Thirty children with median age 10 years (interquartile range [IQR] 9.0-11.0) were enrolled. The median time to disclosure was 48 weeks (IQR 48.0-54.6). There was a significant decrease from baseline (p < 0.0001) and over time (p = 0.0037) ioutcome on children with PHIV+.

Developmental delay occurs frequently in sickle cell disease (SCD). Psychosocial and biomedical factors contribute to delays, but most studies have not examined the timing of risk factors and developmental delay. We examined sociodemographic and biomedical factors to evaluate whether risks of developmental delay differed across 2 developmental periods.

We examined Ages and Stages Questionnaire, second edition (ASQ-2), outcomes in 2-year-olds (n = 100) and 4-year-olds (n = 101) with SCD. ASQ-2 data were obtained from routine developmental screenings administered as part of health care between 2009 and 2016 at a single hematology clinic. Medical record reviews were used to identify sociodemographic and biomedical factors associated with positive screenings for developmental delay.

Two-year-olds with positive ASQ-2 screenings (n = 32; 32%) were less likely to have private health insurance or to have been in formal daycare and more likely to have a severe SCD genotype. Four-year-olds with positive screenings (n = 40; 40%) were more likely to have a severe SCD genotype or an abnormal transcranial Doppler ultrasound (TCD) examination indicating high stroke risk. The strength of the association between positive screenings and insurance status, severe genotypes, and TCD examinations differed across the 2 age groups. Domain-level outcomes on the ASQ-2 also differed across the 2 age groups.

The cross-sectional data indicate biomedical and psychosocial risks are related to developmental delay, but the association with specific risk factors differs across age.

The cross-sectional data indicate biomedical and psychosocial risks are related to developmental delay, but the association with specific risk factors differs across age.

This study examined the transition to adult health care for individuals with spina bifida (SB) and explored demographic and relational associations with transition status.

Young adults with SB (18-30; n = 326) were recruited to complete an anonymous, online survey. Frequencies of reported experiences, behaviors, and satisfaction with the transition to adult health care were examined. Nonparametric tests and exploratory hierarchical regressions were used to examine demographic and relational factors with physicians between those (1) who had and had not yet transitioned and (2) who did and did not return to pediatric care.

Most of the sample reported having transitioned to adult health care, with three-quarters reporting that their primary physician is an adult primary care doctor. Individuals who had transitioned were more likely to be younger (p = 0.01) and to not have a shunt (p = 0.003). Beyond the effect of age and shunt status, relational factors with pediatric providers were not associated with transition (p > 0.1). After transition, over one-third reported returning to a pediatric provider. Those who did not return to pediatric care were more likely to have myelomeningocele, be a full-time student, and to not have a shunt (p < 0.001). Beyond the effect of age and shunt status, lower ratings of communication with adult providers were associated with a return to pediatric care (p = 0.04).

The results highlight the need for additional research about barriers and facilitators to the transition to adult health care to target interventions that support this critical milestone in young adults with SB.

The results highlight the need for additional research about barriers and facilitators to the transition to adult health care to target interventions that support this critical milestone in young adults with SB.

Trauma teams are often faced with patients on antithrombotic drugs, which is challenging when bleeding occurs. We sought to compare the effects of different antithrombotic medications on head injury severity and hypothesized that antithrombotic reversal would not improve mortality in severe TBI patients.

An EAST-sponsored prospective, multi-centered, observational study of 15 trauma centers was performed. Patient demographics, injury burden, comorbidities, antithrombotic agents, and reversal attempts were collected. Outcomes of interest were head injury severity and in-hospital mortality.

Analysis was performed on 2793 patients. The majority of patients were on aspirin (ASA, 46.1%). Patients on a platelet chemoreceptor blocker (P2Y12) had the highest mean injury severity score (ISS, 9.1 ± 8.1). Patients taking P2Y12 inhibitors ± ASA, and ASA + warfarin had the highest head AIS mean (1.2 ± 1.6). On risk adjusted analysis, warfarin + ASA was associated with a higher head AIS (OR 2.43; 95% CI 1.34-4.42) afsk.

Level II; prognostic.

prospective observation.

prospective observation.

With health care expenditures continuing to increase rapidly, the need to understand and provide value has become more important than ever. In order to determine the value of care, the ability to accurately measure cost is essential. The acute care surgeon leader is an integral part of driving improvement by engaging in value increasing discussions. Different approaches to quantifying cost exist depending on the purpose of the analysis and available resources. Cost analysis methods range from detailed microcosting and time-driven activity-based costing to less complex gross and expenditure-based approaches. An overview of these methods and a practical approach to costing based on the needs of the acute care surgeon leader is presented.Study TypeRegular Review.

With health care expenditures continuing to increase rapidly, the need to understand and provide value has become more important than ever. In order to determine the value of care, the ability to accurately measure cost is essential. The acute care surgeon leader is an integral part of driving improvement by engaging in value increasing discussions.