Drainage after total thyroidectomy or lobectomy for benign thyroidal disorders

Objective: This prospective randomized clinical trial was conducted to evaluate the necessity of drainage after total thyroidectomy or lobectomy for benign thyroidal disorders. Methods: A total of 116 patients who underwent total thyroidectomy or lobectomy for benign thyroidal disorders were randomly allocated to be drained or not. Operative and postoperative outcomes including operating time, postoperative pain assessed by visual analogue scale (VAS), total amount of intramuscular analgesic administration, hospital stay, complications, necessity for re-operation and satisfaction of patients were all assessed. Results: The mean operating time was similar between two groups (the drained and non-drained groups). The mean VAS score was found to be significantly low in the non-drained group patients in postoperative day (POD) 0 and POD 1. The mean amount of intramuscular analgesic requirement was significantly less in the non-drained group. One case of hematoma, two cases of seroma and three cases of transient hypoparathyroidism occurred in the non-drained group, whereas one case of hematoma, two cases of seroma, two cases of wound infections and two cases of transient hypoparathyroidism occurred in the drained group. No patient needed re-operation for any complication. The mean hospital stay was significantly shorter and the satisfaction of patients was superior in the non-drained group. Conclusion: These findings suggest that postoperative complications cannot be prevented by using drains after total thyroidectomy or lobectomy for benign thyroid disorders. Furthermore, the use of drains may increase postoperative pain and the analgesic requirement, and prolong the hospital stay. In the light of these findings, the routine use of drains might not be necessary after thyroid surgery for benign disorders.     

X祖父

在那辆干净但年月已久的雪佛兰轿车里,我夹坐在两位表姐妹中间,在用布料和塑料制成的座位上不停地被抛上抛下。祖父牢牢地抓紧驾驶盘并把车停在一间     

Adolescent sexual offender recidivism: success of specialized treatment and implications for risk prediction

OBJECTIVE: To evaluate the success of specialized community-based treatment for reducing adolescent sexual reoffending and explore the predictive utility of variables assessed regarding sexual and nonsexual recidivism. METHOD: Recidivism data (criminal charges) were collected for 58 offenders participating in at least 12 months of specialized treatment at the SAFE-T Program. Data were also collected for a comparison group of 90 adolescents who received only an assessment (n = 46), refused treatment (n = 17), or dropped out before 12 months (n = 27). Follow-up interval ranged from 2 to 10 years (M = 6.23, SD = 2.02). Offenders completed a battery of psychological tests to provide standardized data regarding social, sexual, and family functioning. RESULTS: Recidivism rates for sexual, violent nonsexual, and nonviolent offenses for treated adolescents were 5.17%, 18.9%, and 20.7%, respectively. The Comparison group had significantly higher rates of sexual (17.8%), violent nonsexual (32.2%), and nonviolent (50%) recidivism. Sexual recidivism was predicted by sexual interest in children. Nonsexual recidivism was related to factors commonly predictive of general delinquency such as history of previous offenses, low self-esteem, and antisocial personality. CONCLUSIONS: Results support the efficacy of treatment for adolescent sexual offenders and are consistent with the notion that sexual recidivism is predicted by unique factors unrelated to general (nonsexual) reoffending.     

“The Pleasure of Reading”

Reading books will not only enrich our life, but also broaden (1) our horizon.In addition, it will add(2) grace to our life. Thus, it is the favourite pastime of men     

Abusive head trauma in Maine infants: medical,child protective,and law enforcement analysis

OBJECTIVE: To collect and compare the results of medical, child protective, and law enforcement evaluation of a sample of Maine children who were victims of abusive head trauma (AHT) in order to describe the clinical and evaluative characteristics as they relate to victims, families and perpetrators of such trauma and to improve the professional response to AHT in Maine.METHOD: Retrospective chart review of medical, child protective, and law enforcement records of all AHT victims admitted to two tertiary care hospitals in Maine or seen by the state medical examiner from 1991 to 1994.RESULTS: Nineteen children (age range 2 weeks to 17 months) were identified as victims of AHT (out of a total of 94 head trauma admissions) accounting for 20 hospitalizations during the study period. There was a history of prior injury in 30%, history of prior medical evaluations for possibly abuse related problems in 65%, while, on presentation, 75% had evidence or history of prior injury. The hospitals notified child protective services (CPS) in all 20 cases and correctly identified abuse in 18 (90%). Parental risk factors for abuse identified in CPS records included substance abuse (53%), domestic violence (42%), criminal history (32%), unrealistic expectations (42%), and attachment problems (32%). However, risk factors were inadequately assessed in 53% of homes. Law enforcement identified a likely perpetrator in 79% of cases and in the majority the identified suspect was the father. In the 15 cases where a perpetrator was identified by law enforcement, that person was alone with the child at symptom onset in 14 (93%).CONCLUSIONS: The medical response, at least at the inpatient level, was generally well done with regard to suspicion and reporting. Cases are possibly being missed at the outpatient level. Child protective risk assessment was limited overall yet in a third of the homes where AHT occurred, few if any risk factors were present to aid in identification and prevention. Law enforcement results suggest that a primary suspect for AHT is the caretaker alone with the child at the time of symptom onset.     

Evidence for the role of higher order reasoning processes in cue competition and other learning phenomena

When people judge the contingency between a target cue and an outcome, they also take into account the contingency between the outcome and other cues with which the target cue co-occurred. Several authors have argued that such cue competition effects are due to higher order reasoning processes. We review the evidence that supports this hypothesis and discuss whether higher order reasoning might also play a role in other learning phenomena.     

Special needs of the deaf dying patient

Hospice and hospital personnel who give care to dying patients should be prepared for situations in which a client or family member is hearing impaired. What are the specific concerns of a hearing impaired client? How are needs for meaningful conversation and expression of feelings compromised by the care giver's awkwardness? This article provides practical suggestions for meeting needs of hearing impaired clients with serious illnesses.     

Initiations of social interactions by young hearing impaired preschoolers

This study examined strategies for initiating social interactions with peers, among 4 children with hearing impairment, aged 33 to 36 months, attending a special early education center or a regular kindergarten. The study investigated initiation type (related to partner's hearing status) and rates of initiation success/failure vis-a-vis hearing and deaf partners. Results revealed (a) more initiations in the regular program than in the special program; (b) in the special program, much more successful initiations toward children with hearing impairment than toward hearing children; (c) vocalization as the most frequent strategy used with both hearing and hearing-impaired partners; and (d) referential decisions about their initiations even among young children with hearing impairment (made by changing frequencies of various strategies according to partner's hearing status). The discussion addressed implications regarding integration of children with hearing impairment into regular educational settings.     

The gap between guidelines, practice, and knowledge in interpreting services for deaf students

In this article, we examine the literature on educational interpreting for information related to optimal interpreting in school settings. this literature review is coupled with an examination of 15 guidelines for educational interpreters in school districts and programs for the deaf and hard of hearing across the United States. With this information, we then explore discrepancies between what guidelines recommend, what actually occurs in classrooms, and what research on the process of interpreting has found on the basis of three major areas of concern: the production of the message by the interpreter, the reception of the message by the student, and additional responsibilities required of interpreters working in school programs.