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This study investigated Tingey, Lambert, Burlingame, and Hansen's (1996) extension of Jacobson, Follette and Revenstorf's (1984) proposal for assessing clinical significance. Seventy (N = 70) outpatients with/without Cluster C personality disorders treated with a brief psychodynamic intervention (BDI) were included in the study. Results showed that 33% of patients demonstrated clinically significant change on the Global Severity Index. Patients who improved reported more perceived subjective change, greater satisfaction with the treatment, and greater improvement on the Social Adjustment Scale than patients who did not improve (60%) or deteriorated (7%). Further analyses showed that clinical significance achieved in a four session ultra-brief therapy is associated with patient characteristics such as co-morbid personality disorders, level of defensive functioning, and specific interpersonal problems. Results were maintained at 3 month and 6 month follow-ups. Findings are discussed in reference to Howard's suggestions on remoralization and remission. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to investigate the effect of a reduction in the prescribed post-operative ibuprofen dosage on frequency of post-tonsillectomy bleeding., Methods: A quality improvement study was conducted at a single tertiary care pediatric hospital with patients weighing >40 kg undergoing tonsillectomy. The intervention was limiting the post-operative ibuprofen dosage to a maximum of 400 mg per dose. Data was collected on all patients returning to the hospital with bleeding after tonsillectomy. The primary outcome was the rate of post-tonsillectomy bleeding. Statistical analysis was conducted using nonparametric comparisons and a run chart., Results: A total of 199 tonsillectomy patients >40 kg were included in the study. There were 119 (59.8 %) females and 80 (40.2 %) males total. The pre-intervention group had a total of 56 patients while the post-intervention group had a total of 143 patients. There was no statistical difference in age, weight, or sex between the pre- and post-intervention groups (p > .05). The post-tonsillectomy hemorrhage rate was 11/56 (19.6 %) before the intervention, and 11/143 (7.7 %) after the intervention (p = .016). Children who experienced a bleeding event were significantly older (mean 15.9 years, 95 % CI 14.5-17.3) than those who did not (13.5 years, 95 % CI 12.9-14.1; p = .011). The run chart revealed that the intervention resulted in a nonrandom decrease in rate of post-tonsillectomy bleeding., Conclusions: Post-tonsillectomy bleeding rate decreased with a ceiling post-operative ibuprofen dose of 400 mg/dose in this quality improvement study. Further research is warranted., Competing Interests: Declaration of competing interest None., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objective: To assess financial toxicity experienced by caregivers of children with long-term tracheostomies., Methods: Cross-sectional survey study with comparison group conducted at a tertiary pediatric hospital and outpatient clinic. Pediatric (<18 years) patients with tracheostomies for ≥12 months were recruited for the study. Patients who underwent tympanostomy tube placement or adenotonsillectomy were recruited as controls. Eligible patients' caregivers were contacted to fill out a questionnaire including the validated Comprehensive Score for Financial Toxicity survey., Results: Surveys were completed for 72 patients, including 31 in the study group (mean age, 6.58 years, 95% confidence interval [CI], 4.85-8.30 years) and 41 controls (mean age, 6.42 years, 95% CI, 5.15-10.52 years) ( P  = .864). The mean duration of tracheostomy was 3.98 years (95% CI, 2.91-5.05 years). The mean household income and education level were lower in the study group than in the control group. Caregivers of the study group were more likely to have public health insurance or be uninsured. Caregivers of study patients reported greater financial toxicity, with a lower mean Comprehensive Score for Financial Toxicity (18.23 [95% CI, 15.20-21.25]) than caregivers of controls (34.27 [95% CI, 32.05-36.49]; P  < .001). Linear regression analysis showed that survey scores were lower for caregivers who employed home nursing care ( P  < .001)., Conclusion: Caregivers of pediatric patients requiring long-term tracheostomies experience greater financial toxicity than caregivers of pediatric patients who have typical otolaryngologic surgery., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: A small proportion of children with otitis media develop acute mastoiditis, which has the potential to spread intracranially and result in significant morbidity and mortality. The aim of this study was to evaluate the incidence and management of complications related to pediatric acute mastoiditis using a national database., Study Design: Retrospective review of 2016 Kids' Inpatient Database, part of the Healthcare Cost and Utilization Project., Setting: Academic, community, general, and pediatric specialty hospitals in the United States., Methods: International Classification of Diseases, Tenth Revision, Clinical Modification code H70.XXX was used to retrieve records for children admitted with a diagnosis of mastoiditis. Data included patient demographics, intracranial infections, procedures (middle ear drainage, mastoidectomy, and intracranial drainage), length of stay (LOS), and total charges., Results: In total, 2061 children aged ≤21 years were identified with a diagnosis of acute mastoiditis. Complications included subperiosteal abscess (6.90%), intracranial thrombophlebitis/thrombosis (5.30%), intracranial abscess (3.90%), otitic hydrocephalus (1.20%), encephalitis (0.90%), subperiosteal abscess with intracranial complication (0.60%), petrositis (0.60%), and meningitis (0.30%). Children with intracranial abscesses were more likely ( P < .001) to undergo myringotomy ± ventilation tube insertion (63.7%), mastoidectomy (53.8%), mastoidectomy with ventilation tube or myringotomy (42.5%), intracranial drainage procedure (36.3%), or all 3 key procedures (15.0%). Children with any type of intracranial complication had a significantly longer LOS ( P < .001) and higher total charges ( P < .001). Both a diagnosis of bacterial meningitis and undergoing an intracranial drainage procedure ( P < .001) contributed significantly to LOS and total charges., Conclusion: Patients with intracranial complications are more likely to undergo surgical procedures; however, there is still wide variability in practice patterns, illustrating that controversies in the management of otitis media complications persist.

Objective: The aim of this work was to assess the cost-effectiveness of the fetal fibronectin (fFN) test at 48 h after admission for threatened preterm delivery to promote early discharge., Study Design: Before-and-after study to calculate the incremental cost-effectiveness ratio (ICER). Patients were enrolled 48 h after admission in a tertiary care centre for threatened preterm delivery between 24 +0 and 34 +6 weeks. fFN testing was performed. During the first period, physician was blinded to fFN test and discharge occurred after apparent reduced symptomatology at physician's discretion. During the second period, fFN test was revealed to physician and discharge was immediately proposed to negative test patients. The costs considered in this analysis were the direct medical costs from the hospital perspective: costs of hospitalisation, treatment, and imaging procedures. The efficacy criterion selected was the number of deliveries at 7 and at 14 days after admission for threatened preterm delivery., Results: The study included 178 pregnant patient, 99 during the first period (July 2008-October 2009) and 79 during the second (March 2010-February 2012). The lengths of hospital stays were shorter during the second period, with more than 50% of women discharged home between 48 and 72 h (p < 0.0001) resulting in a cost-saving of 76 051 euros. The number of deliveries at 7 and at 14 days was similar between the two periods., Conclusion: The fFN test at 48 h after admission supported early discharge and was safe and cost-effective., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: One fifth of drivers convicted of drink-driving for the first time will be convicted again for the same offence in subsequent years. Lecture-based educational programmes are believed to reduce recidivism. Little is known about the modalities of enhancing the benefits of such programs., Methods: This parallel randomised controlled trial measured the effects of the duration of lectures and the presence of a close relative 'in class' on rates of recidivism during the ten years following an initial drink-driving conviction. Of 1588 drivers in the Canton of Geneva convicted of a first-time offence with a blood alcohol concentration (BAC) of between 0.80 and 2.49g/kg from May 2001 to February 2004, 727 agreed to participate and were randomly assigned to either a seven-hour series of lectures, a four-hour series with a friend or close relative, or a brief two-hour lecture. Time until recidivism was retrieved from a national registry that contains details of recidivism that took place up to ten years after the first offence., Results: Significant effects of briefer lectures over the standard day-long series of lectures were observed only during the most influential time period with regards to recidivism levels-the two years following the intervention. Replacing the usual one-day series of lectures by briefer two-hour lectures would reduce, by 25% (CI95%; 3-44%), the risk of recidivism., Conclusion: This study does not support policymakers' decision to rely on a seven-hour series of lectures to decrease DUI recidivism. The advantages of shorter lectures over no lecture still need to be evaluated., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Nephrology emergencies are not the most frequent in the emergency room but they often generate some diagnostic and therapeutic problems. Most common renal emergencies are due most often to acute renal failure whatever the cause, electrolytes disturbances, hypertensive crisis and less frequently intoxications or acute decompensation of chronic kidney diseases. The goal of this paper is to review some of these clinical situations both in the diagnostic and therapeutic perspective but essentially to discuss when the nephrologist should be called in the emergency room so that the coordination of care is optimal for the patients.

Benckiser's haemorrhage is a serious obstetrical complication, following a vasa previa rupture. Incidence of vasa previa is estimated between 1/1150 and 1/5000 pregnancies. This case report illustrates the consequences of a suspected vasa previa rupture. There is no French recommendation of how to treat vasa previa. Different methods of prevention are described and examined thanks to a literature review., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Objectives: To describe perinatal and pediatric outcome after selective feticide for complicated monochorionic twin pregnancy., Patients and Methods: We reviewed all consecutive cases of umbilical cord occlusion performed for complicated monochorionic twin pregnancy over a 16-year period. Pediatric follow-up was based on medical records and updated by phone calls to the parents., Results: Thirty procedures were performed. Indications were: twin-to-twin transfusion syndrome (TTTS) progressing despite serial amniodrainage (n=12) ; twin reversed arterial perfusion (n=9) ; selective growth restriction (n=5) ; severe discordant structural anomalies (n=4). Mean gestational age at procedure was 21.8±3.1gestational weeks (GW) and 31.8±4.8 GW at birth. Overall survival rate was 87%, i.e. 83%, 100%, 60% and 100% for each indication, respectively. Mean pediatric follow-up was 5years (range: 6months to 15years). Medical charts and parents declared normal development in 88% of surviving children, i.e. 67%, 100%, 100%, and 100% for each indication. Cross-comparison between the four groups revealed that in the TTTS group, gestational age at procedure was more advanced (P=0.01) while delivery was slightly earlier (P=0.1), and pediatric development was poorer (P=0.02)., Discussion and Conclusion: Pediatric outcome after selective feticide appeared to be poorer for TTTS progressing despite serial amniodrainage than for other indications., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)