Ten steps for proper peripheral nerve handling during inguinal hernia surgery.

INTRODUCTION: Post-inguinal pain after a hernia surgery is prevalent and can be quite frustrating for the surgeon and patient alike. There are several sources for possible post-operative inguinal pain after a successful hernia repair; however, in the setting where a recurrent inguinal hernia is not present, it is likely related to the nerves in the inguinal canal or pelvis. Chronic inguinal groin pain after hernia repairs have been reported in a high percentage of patients following inguinal hernia surgery despite being one of the most common procedures performed annually in the USA and worldwide. MATERIALS AND METHODS: We present ten of the basic concepts utilized by peripheral nerve surgeons to limit nerve injury, which can easily be applied to open inguinal hernia surgery with or without mesh, starting with the firm understanding of the inguinal anatomy to addressing the nerves, meticulous placement of the mesh and the active revision of the surrounding structures and nerve position before closure. CONCLUSIONS: Understanding the proper handling of the inguinal nerves during hernia surgery can decrease the incidence of post-operative chronic pain by employing microsurgical concepts to day-to-day surgical procedures and prevent complications in an extensive set of patients.

Does complexity relate to compensation? A comparison of relative value units in initial versus recurrent inguinal hernia repair.

PURPOSE: Work relative value units (wRVUs) can be used as a compensation model based on the effort required for providing a service and helps to determine adequate compensation for physicians. Thus, more complex surgical procedures that require greater technical skills and time should yield greater compensation. There are limited data comparing wRVUs and operative times within common general surgery procedures such as inguinal hernia repair. This study aims to compare mean operative times and wRVUs per minute between primary and recurrent inguinal hernia repairs, the latter being considered as a more difficult procedure to perform. METHODS: A retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was performed to identify all patients undergoing primary inguinal hernia repair and recurrent inguinal hernia repair by general surgeons over a 6-year period (2012-2017). Calculation and comparison of mean operative times, wRVUs, and wRVU per minute were performed. RESULTS: A total of 134,391 patients were included in the analysis. 121,235 underwent primary inguinal repair and 13,156 patients underwent repair of recurrent inguinal hernia. Patients were distributed within open/reducible, open/incarcerated and laparoscopy groups. Mean operative time and RVUs were greater for recurrent inguinal procedures (p < 0.0001). Consistently, RVU per minute was also found to be higher for recurrent procedures within the different groups analyzed. CONCLUSION: Appropriately, general surgeons are reimbursed at a higher rate per minute in recurrent cases, regardless of the technique used.

A Novel Rubric to Evaluate Wearable Cameras for Assessment of Interrater Reliability.

Research has reported on traditional methods of assessing interrater reliability but, currently, no such standard protocol exists for selection of alternative methods of assessing interrater reliability, such as wearable video cameras. The professions of occupational therapy and occupational science take a unique ecological perspective when evaluating individuals, which focuses on the naturalistic perspective of an individual, ideally resulting in optimal performance. Given current advancements in technology, wearable, low-cost, unobtrusive, first-person view digital video cameras are readily available for use in research. The researchers generated an original rubric for critiquing cameras, then trialed four cameras for use in a future interrater reliability study. This standardized protocol fills a gap in the field and can be used by future researchers searching for a standardized method of camera selection.

A Longitudinal Examination of Mothers' Depression and PTSD Symptoms as Impacted by Partner-Abusive Men's Harm to Their Children.

Intimate partner violence (IPV) is a serious and widespread form of gender-based violence that disproportionately affects women. It is well established that IPV victimization contributes to depression and posttraumatic stress disorder (PTSD), and that many partner-abusive men continue to perpetuate abuse even after their relationship with the victim ends. In addition, when men harm their partners, they are more likely to harm their children, and evidence suggests that this harm continues post-separation. However, scant research has been conducted on men's harm to their children as an extension of IPV perpetration, with even less known about the mental health impact this form of abuse has on mothers. For this longitudinal cohort study, 40 partner-abused mothers who had separated, or were planning to separate, from an abusive partner with whom they shared children were recruited. Women were interviewed 4 times over 1 year. Results confirmed that, in addition to men's physical abuse perpetration relating to subsequent increases in mothers' depression and PTSD symptoms over time, their harm to the children predicted both mothers' depression and PTSD symptoms as well.

Patterns of women's aggression against partners and others: broadening our understanding of violence.

Research on women's aggression typically focuses on relational aggression. However, the study of violence must include multiple forms of violence such as aggression against partners and non-partner others, while also considering victimization experiences by partners and non-partners. The focus of this study is the multiple experiences of violence (perpetration and victimization) of women who are incarcerated. Incarcerated women are likely to experience higher rates of both than women in community settings, but most will be released in a brief period of time. Using a random sample (N = 580) we conducted cluster analyses to identify five patterns of women's aggression. Clusters varied depending on the target/s of aggression (i.e., partner and/or others), and type of aggression (i.e., physical and/or intimidation). Multinomial logistic regression was performed to determine the relationship between women's membership in a perpetration cluster and their victimization. Victimization history was related to an increased risk of perpetrating aggression, and varied depending on the target and type of aggression. Our findings provide support that research and interventions addressing women's use of aggression must also address their victimization history. Furthermore, results indicate that for some women, aggression towards partners and others is related. Future research should investigate multiple forms of aggression.

Collaborative teaching: school implementation and connections with outcomes among students with disabilities.

Collaborative teaching is a widely used method of including and supporting students with disabilities to provide all students equal access to education. Yet, there is a dearth of research on its implementation and outcomes, and the few existing studies are limited to academic and testing outcomes. This study assesses the degree to which schools are implementing co-teaching practices and the relation between co-teaching and student psychosocial outcomes using a mixed method design. Data from 12 schools, which included 16 school leaders and staff, 13 teachers, and 56 students with disabilities, were examined. Schools achieved 0-75% of the co-teaching best-practices criteria, with the majority achieving 25%-50% of the criteria. Higher levels of teacher-reported co-teaching were related to higher levels of student-reported school belonging, school satisfaction, and self-efficacy for new experiences. The benefits and challenges of co-teaching, as well as implications for intervention and research are addressed.

Post-Separation Abuse of Women and their Children: Boundary-setting and Family Court Utilization among Victimized Mothers.

Continued abuse of themselves and their children is a concern for many mothers leaving intimate partner violence (IPV) perpetrating husbands. This research examines women's responses to abuse committed by ex-husbands with whom they had undergone custody disputes. In-depth, qualitative interviews were conducted with 19 mothers who had divorced IPV-perpetrating husbands between one and three years prior. Participants were located through publicly available family court divorce records and interviews were examined using analytic induction. Women's strategies to protect themselves and their children from abuse involved setting boundaries to govern their interactions with ex-husbands. Mothers often turned to family court for assistance in setting boundaries to keep children safe, but found that family court did not respond in ways they believed protected their children. Conversely, when women turned to the justice system for restraining orders or called the police for help against IPV, they generally found the justice system responsive.

Abused Mothers' Safety Concerns and Court Mediators' Custody Recommendations.

This study adds to research on family court's response to custody in the context of intimate partner abuse (IPA). Mediation is often used to assist family court with custody negotiation; however, debate exists in the field regarding its use when IPA exists. The following study examines experiences with court mediation among a sample of victimized mothers who divorced abusive husbands. Mixed-method data were collected from 19 women. Findings demonstrate that abuse is rarely considered in custody recommendations, as most court mediators prefer joint custody. Implications for the ongoing debate, as well as future directions for research, are discussed.

Secondary Victimization of Abused Mothers by Family Court Mediators.

Family court often assists divorcing parties in establishing custody arrangements. Mediation is commonly used for custody negotiation; however, its applicability for cases involving intimate partner abuse (IPA) is debated. This study was designed to gain an in-depth understanding of abused mothers' court mediation experiences and how those experiences impact future court help-seeking when the fathers of their children have been abusive to them. Most women experienced secondary victimization during mediation, which had a negative impact on their willingness to use the court in the future. Policy recommendations include screening for IPA, providing separate mediation sessions, and improving court mediators' training.

Gestational trophoblastic tumor in pregnancy: a case report and review of the literature.

A case of gestational trophoblastic tumor (GTT) concurrent with an intrauterine pregnancy is reported in a 21-year-old gravida 2 para 0 (0010) who presented with dyspnea, orthopnea, headache, and blurring of vision at 33 weeks age of gestation. She had a history of hydatidiform mole for which curettage was done. Chest radiograph showed pulmonary metastases, with pleural effusion on both lungs. Serum beta subunit of human chorionic gonadotropin was abnormally elevated for age of gestation. Due to worsening maternal pulmonary condition, the patient underwent primary, low segment cesarean section and was subsequently started on multidrug chemotherapy. This is the first reported case of GTT in pregnancy in the Philippines in which both the mother and the infant survived. Several hypotheses regarding its origin, its diagnosis, and its management and prognosis are presented. This case report emphasizes the importance of early diagnosis and treatment to improve the prognosis of both the mother and the infant.

Localized cecal zygomycosis following renal transplantation.

Zygomycosis occurs as an opportunistic infection following organ transplantation and immunosuppressive therapy. Gastrointestinal zygomycosis is an exceedingly rare and usually fatal presentation of this infection. We discuss the case of a renal transplant recipient who survived cecal perforation from zygomycosis. The successful treatment consisted of aggressive surgical resection, intensive course of antifungal therapy, and rapid withdrawal of anti-rejection medications.