The effect of intravenous tranexamic acid on blood loss and early post-operative pain in total shoulder arthroplasty.

AIMS: The purpose of the present study was to evaluate the impact of intravenous tranexamic acid on the reduction of blood loss, transfusion rate, and early post-operative clinical outcome in total shoulder arthroplasty. PATIENTS AND METHODS: A randomised, placebo-controlled trial which included 54 patients undergoing unilateral primary stemless anatomical or stemmed reverse total shoulder arthroplasty was undertaken. Patients received either 100 ml saline (placebo, n = 27), or 100 ml saline together with 1000 mg of tranexamic acid (TXA, n = 27) intravenously prior to skin incision and during wound closure. Peri-operative blood loss via an intra-articular drain was recorded and total blood loss was calculated. The post-operative transfusion rate was documented. Assessment of early clinical parameters included the visual analogue scale for pain (VAS), documentation of haematoma formation and adverse events. RESULTS: Mean peri-operative blood drainage (placebo: 170 ml versus TXA: 50 ml, p = 0.001) and calculated mean total blood loss (placebo: 1248.2 ml versus TXA: 871.0 ml, p = 0.009) were significantly lower in the TXA group. No transfusions were necessary during the study period in either group. Mean VAS for pain significantly decreased from pre-operative (VAS 7) to the early post-operative period (VAS 1.7, p < 0.001). Significant differences regarding mean post-operative pain between placebo (VAS 2.0) and TXA (VAS 1.3) were detected (p = 0.05). The occurrence of haematomas was significantly more frequent in the placebo (59.3%, n = 16) than in the TXA group (25.9%, n = 6, p = 0.027). Whereas only mild haematomas developed in the TXA group, in the placebo group a total of 22.2% (n = 6) developed either moderate or severe haematomas. No adverse events associated with administration of TXA occurred. CONCLUSION: Intravenous administration of TXA successfully reduced mean peri-operative blood drainage, total estimated blood loss, pain during the first post-operative days, and haematoma formation in total shoulder arthroplasty. Cite this article: Bone Joint J 2017;99-B:1073-9.

Crying in hospitals: a survey of doctors', nurses' and medical students' experience and attitudes.

OBJECTIVE: To investigate doctors', nurses' and medical students' experiences with, and attitudes of health care personnel towards, crying in hospitals. DESIGN: Descriptive, cross-sectional study, using self-report questionnaires. SETTING AND PARTICIPANTS: The sample comprised 52 doctors (response rate, 33%) and 103 nurses (response rate, 58%) from three Sydney metropolitan general hospitals, and 101 sixth-year medical students (response rate, 99%). RESULTS: Crying was frequent in hospitals; 57% of doctors, 76% of nurses and 31% of medical students had cried at work in the hospital at least once, and women cried significantly more often than men. Being a nurse significantly increased, whereas being a medical student significantly decreased, the likelihood of crying. Medical students reported the highest percentage of negative social consequences of their own crying (e.g., being ridiculed or screamed at). The main reason for all respondents' crying was identification and bonding with suffering and dying patients or their families. The respondents generally viewed crying by patients as a healthy response, and they were empathetic towards the crying patient. About one-third of the respondents were interested in (or would consider) using psychological help to explore their own emotional reactions to crying. CONCLUSION: Despite its limited sample, this study suggests that the topic of "crying" should be included in medical training, and that support be provided for medical staff who are distressed by crying behaviour in hospitals.

[Therapy relevant aspects of anatomy, pathophysiology and diagnosis of urinary incontinence in women]. / Therapierelevante Aspekte der Anatomie, Pathophysiologie und Diagnostik der weiblichen Harninkontinenz.

Many aspects of the pathogenesis of urinary incontinence are poorly understood. Most studies show good results for physical therapy for instance for pelvic floor exercises and biofeedback. Unfortunately most of these studies lack an objective diagnostic and neurophysiological assessment. This could be one reason for the strongly divergent therapeutical success rates reported (30 to 90%). We recommend the use of objective parameters, for instance the PAD test with standardized bladder volume and a neurophysiological and short urodynamic assessment as well as subjective parameters [satisfaction with the outcome of treatment measured with the VAS (visual analog scale), documentation of the changes in ADL (activities of daily living)] in future therapeutical studies. A more precise assessment of the pathological cause of the impairment will help to develop optimal therapeutic procedures. Because of poor documentation in the past the analysis of therapeutic failures and the decision if mono-or complex physiotherapy is more appropriate has not been possible. This aspect will become even more important as the cost-effectiveness of treatments becomes a more important issue.

[Personality markers in patients with Sudeck's disease. A psychoanalytic study]. / Persönlichkeitsmerkmale bei Patienten mit M. Sudeck. Eine tiefenpsychologische Untersuchung.

We examined 22 patients suffering from reflex sympathetic dystrophy with psychoanalytic interviews. In all 22 patients we found a common psychological structure corresponding to Balint's basic fault (Balint, 1970). For people with this structure the accident that preceded the reflex sympathetic dystrophy and the following pain, immobilisation and need to help are promoting the patient's regression in a specific way ending in the developing of reflex sympathetic dystrophy. The dispair of the patients about their reflex sympathetic dystrophy expresses unsolved fears of early childhood.

[The psychosocial care of cancer radiology patients--the requirement, subjective need and acceptance]. / Psychosoziale Betreuung radioonkologischer Patienten--Bedarf, subjektives Bedürfnis und Akzeptanz.

The topic of the investigation was the discrepancy between the documented objective need for psychosocial support of cancer patients on the one hand, and of the patient's little subjective needs on the other, the latter resulting in only low acceptance of care offered. In an empiric study the attitude of 38 radio-oncological patients (29 female, nine male) toward psychosocial support was investigated. The study revealed a tendency, independent of sex, that may be described as a social retreat (e.g. emphasis on personal independence, desire not to burden anybody, to hold back own interests and feelings, to be of help rather to others). We interpret this attitude as a specific reaction of coping with the problem, attempting at self-stabilisation.