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Morbidity and mortality (M&M) conferences are prevalent in all fields of medicine. Historically, they arose out a desire to improve medical care. Nevertheless, the goals of M&M conferences are often poorly defined, at odds with one another, and do not support a just culture. We differentiate among the various possible goals of an M&M and review the literature for strategies that have been shown to achieve these goals. Based on the literature, we outline an ideal M&M structure within the context of just culture: The process starts with robust adverse event and near miss reporting, followed by careful case selection, excluding cases solely attributable to individual error. Prior to the M&M, the case should be openly discussed with involved members and should be reviewed using a selected framework. The goal of the M&M should be selected and clearly defined, and the presentation format and rules of conduct should all conform to the selected presentation goal. The audience should ideally be multidisciplinary and multispecialty. The M&M should conclude with concrete tasks and assigned follow-up. The entire process should be conducted in a peer review protected format within an environment promoting psychological safety. We conclude with future directions for M&Ms.

Background: Clinicians are increasingly adopting telemedicine in an effort to expand patient access and efficiently deliver care. The degree of health disparities among patients receiving otolaryngologic telemedical care is unclear.Aims: We performed a retrospective cross-sectional study to explore disparities in telemedicine delivery.Methods: We evaluated otolaryngology clinical visits from January 2019 to November 2022. We obtained patient demographics and visit characteristics (e.g., subspecialty, telemedicine vs in-person). Our primary outcome was demographic characteristics of otolaryngology patients who received telemedicine vs in-person care during the study timeframe.Results: A total of 231,384 otolaryngology clinical visits were reviewed, of which 26,895 (11.6%) were telemedicine visits. Rhinology (36.5%) and facial plastics (28.4%) subspecialties performed the most telemedicine visits. On multivariate analysis, individuals who identified as Asian, non-English speaking, and with Medicare insurance were statistically significantly less likely to use telemedicine than in-person services.Conclusion: Our findings suggest that expanding telemedicine care may not improve access for all populations, and socioeconomic factors are important considerations to ensure patients are receiving equally accessible care. Futures studies are warranted to understand how these disparities may impact health outcomes and patient satisfaction with care.

Emergency manuals (EMs) are context-relevant sets of crisis checklists or cognitive aids designed to enable professional teams to deliver optimal care during critical events. Evidence from simulation and other high-risk industries have proven that use of these types of checklists can significantly improve event management and decrease omissions of key steps. However, simply printing and placing tools in operating rooms (ORs) is unlikely to be effective. Howinterventions are implemented influences whether clinicians actually change practice and whether patient care is affected. This article provides an in-depth description of a rigorous implementation plan with three goals: (1) place EMs in every anesthetizing location, (2) create interprofessional engagement, and (3) demonstrate that a majority of anesthesia clinicians would use the new tool in some way within the first year.

An emergency manual (EM) is a set of evidence-based crisis checklists, or cognitive aids, that can improve team performance. EMs are used in other safety-critical industries, and health care simulation studies have shown their efficacy, but use in clinical settings is nascent. A case study was conducted on the use of an EM during one intraoperative crisis, which entailed the assessment of the impact of the EM's use on teamwork and patient care and the identification of lessons for effectively using EMs during future clinical crises.

Handovers around the time of surgery are common, yet complex and error prone. Interventions aimed at improving handovers have shown increased provider satisfaction and teamwork, improved efficiency, and improved communication and have been shown to reduce errors and improve clinical outcomes in some studies. Common recommendations in the literature include a standardized institutional process that allows flexibility among different units and settings, the completion of urgent tasks before information transfer, the presence of all members of the team for the duration of the handover, a structured conversation that uses a cognitive aid, and education in team skills and communication.

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Coordination compounds of the polypyridines, 2,2 ' -bipyridine (bipy) and 1,10-penanthroline (phen) have offered renewed interest on account of their manifold applications and from the point of view of understanding their structure-reactivity relationships.1 Iron(II) reacts with them to form tris-complexes possessing spin-paired ground states. Cyanide ion greatly enhances the rate of displacement of bipy or phen to form the Schilt class of compounds. Fe(bipy)2(CN)2 and Fe(phen)2(CN)2. They display varying colours in solution depending upon the nature of the solvent and react reversibly with acids to form diprotonated species.2 Magnetic circular dichroism studies have been reported to describe their lowest electronic excitation.3

The Pd(II) and Pt(II) complexes with two dibasic tridentate ligands viz. o-vanillin thiosemicarbazone and o-vanillin-4-phenylthiosemicarbazone, have been synthesized and characterized on the basis of their elemental analysis, magnetic susceptibility, conductance, ir and electronic spectral and thermogravimetric data. The presence of chlorine atom in the coordination sphere imparts a square planar geometry to these complexes having the general formula [M (L) Cl]. The mixed ligand complexes of the type [M (L) py. H2O] have also been prepared employing pyridine as an additional heterocyclic base. The complexes are square pyramidal and the presence of chlorine, water molecules is revealed by the study of their thermograms supported by the presence of relevant bands in their ir spectra. Suitable structures have been assigned to these binary and ternary complexes.

Ten lanthanide complexes (Ln=La, Ce, Pr, Nd, Sm, Gd, Eu and Dy) with the title ligands have been synthesised and characterised. The structure of these complexes are assigned on the basis of IR spectra, magnetic and thermal analysis data. The IR spectra indicate that o-vanillin paraanisidine (oVPA) is a bidentate ligand coordinating through azomethine N and phenolic O whereas o-vanillin salicyloylhydrazone (oVSH) is tridentate possessing ketonic O as an additional donor site. Involvement of anions (Cl-, Ac-) in coordination is explored. Electronic spectra indicate weak covalent nature of metal ligand bond and various parameters β, b½, η and δ have been evaluated.

The three isonicotinoyl hydrazone Schiff bases viz. anisaldehyde isonicotinoyl hydrazone(AINH), 2-furaldehyde isonicotinoyl hydrazone(FINH), 2-thi ophenealdehyde isonicotinoyl hydrazone(TINH) have been synthesized and characterized on the basis of their elemental analysis, magnetic susceptibility, IR, electronic and nmr spectral studies. The ternary complexes of Ni(II) and Cu(II) with these hydrazones and neutral bidentate base phen and bipy are octahedral and the presence of acetate and/ or water molecule is revealed by the study of their IR spectra, force constants and thermal degradation pattern. Suitable structures have been assigned to these ternary complexes.

Lanthanum(III), cerium(III), praseodymium(III), neodymium(III), samarium(III) and europium(III) form complexes in 1:1, 1:2 and 1:3 stoichiometric ratios with the ligands 2-thiophenealdehyde salicyloylhydrazone(tash) and indole-3-aldehyde semicarbazone(iasc). The complexes have been characterised on the basis of elemental analyses, spectral, magnetic and thermal data. tash is a tetradentate ligand forming complexes upto maximum coordination number of twelve for the lanthanide ion whereas the iasc behaves as bidentate and the other coordination sites are occupied by aqua/or acido ions. The spectral parameters bonding (b½), covalency angular overlap(λ), Sinha's covalency (δ), have been calculated and indicate partial covalent bonding developing between the lanthanide metal and ligand in these complexes. Higher μRT values for Sm(III) and Eu(III) complexes along with structural characteristics of the lanthanide complexes are discussed.

Novel copper(II) and nickel(II) complexes having the molecular formula [ML2X2].2H2O, (L = 4 - methyl-2-pentanone thiosemicarbazone or 4-methyl-2-pentanone semicarbazone and X = Cl-, CH3COO- or ½ SO42-) were synthesised and characterised on the basis of elemental analyses, molar conductance and IR spectral studies. The IR data indicate that both ligands are neutral bidentate, coordinating through the azomethine nitrogen and ketonic oxygen in the semicarbazone and thionic sulfur in the thiosemicarbazone. The low molar conductance values suggest the complexes to be non-electrolytes and the involvement of anions in the coordination. An octahedral geometry has been proposed for all these new bisligated complexes.

Six new mixed ligand complexes of copper(II) with tridentate o-vanillin thiosemicarbazone (o-VTSC) or o-vanillin-4-phenylthiosemicarbazone (o-VPTSC) and a heterocyclic base bipy, phen or py have been synthesized and characterized. The chelating behaviour of the ligands and the gemoetry of the complexes are discussed in the light of spectroscopic, thermal, conductance and magnetic studies.

Octahedral Metal(II) complexes of tridentate hydrazones have been prepared from the chelating ligands 2-pyridinecarboxaldehyde-p-chlorobenzoylhydrazone (PCCBH) and 2-pyridinecarboxaldehyde-salicyloylhydrazone (PCSH). The ligands were obtained by treating pyridine-2-carboxaldehyde with the appropriate hydrazide.

Polymeric coordination complexes of the type (ML.2H2O)n, where M(II) - Mn, Fe, Ni, Cu or Zn and L = N1-(4-chlorophenyl)-N4-(3,5-dinitrobenzoyl)thiosemicarbazide have been synthesised and characterised by microanalytical, I. R., magnetic, D. R. S. and thermal analysis. The IR spectra indicate tetradentate ligand coordination through the enolic oxygen, thioenolic sulphur and the nitrogen atom of the C?N group. The metal ion is the bridging unit between the donor sites of the ligand molecule, and it is likely that a polymeric chain grows through consecutive ligand-metal links.

Spectral properties of Schiff base complexes involving diamines and aldehydes are widely studied1,2. Platinum (II) complexes of protonated diamines have been synthesised and are reported to possess antitumour activity.1 In recent years, there has been considerable interest in the study of structural properties of metal complexes of quadridentate nature. Synthesis of some novel binuclear metal complexes, containing both square planar and tetrahedral metal ions has been Investigated by MacDermott.4 They are formed by the reaction of coordinated diamines with an α-hydroxyketone. Other studies involving diamines include the isolation of thorium (IV) and uranium (VI) complexes with tetradentate Schiff bases derived from substituted salicylaldehyde and 1,2-ethanediamine or o-phenylenediamine.5 The X-ray crystal structure reveal that the 8-coordi-nated complex molecules have a slightly distorted dodecahedral geometry.

Three Schiff bases derived from 2,3-indolinedione (isatin) viz. isatinsemicarbazone (iscH), isatin thiosemicarbazone (itscH) and isatin-4-phenylthiosemi-carbazone (iptscH) were prepared. All the ligands are tridentate (ONO-, ONS-donor). The metal(II) complexes formed with Co, Ni, Cu, Zn and Cd, in 1:2 stoichio-metric ratio are octahedral and do not contain water molecules. From the results of chemical analysis, magnetic susceptibility measurements employing varying currents, ir, diffuse reflectance spectral and thermal studies, the coordinating properties of the ligands and structures of the complexes have been discussed.

New Schiff base chelating ligands were prepared by reacting equimolar quantities of 2-pyridinecarboxaldehyde and thiosemicarbazide (PTSC) or 4-phenylthiosemicarbazide (PPTSC) in ethanolic medium. Their subsequent reaction with metal salts in 2:1 molar ratio gave complexes that were characterised by elemental analysis, i.r. and diffuse reflectance spectra, and by magnetic and thermal studies. Structures of the complexes are proposed.

Summary Mixed ligand complexes of copper(II), zinc(II), nickel(II) and cobalt(II) ions involving 1,10-phenanthroline (phen) as primary and 3,5-dinitrosalicylic acid (dnsa), 5-nitrosalicylic acid (nsa), 5-chlorosalicylic acid (csa) and 3,5-dibromosalicylic acid (dbsa) as secondary ligands in solution have been investigated potentiometrically [25°, µ = 0.1 M [NaClO4], medium 50% v: v aqueous ethanol]. The stability order of mixed ligand complexes with respect to the metal ions obeys the natural order: cobalt(II) < nickel(II) < copper(II) > zinc(II). The stabilities of the heterometal chelates have been compared with the corresponding homometal chelates of the secondary ligands and have been interpreted in terms of metal-ligand p effects and coulombic interactions between various ligand anion species present.

Cobalt(II), nickel (II) and copper (II) complexes of o-vanillin and isovanillin salicyloylhydrazones have been synthesised. These compounds were characterised by elemental analyses, IR, magnetic, thermal and diffuse reflectance spectra. The salicyloylhydrazones have been further characterised by 1H NMR. Force constants of the major bonds, M-O and M-N have also been calculated.

The synthesis and characterization of two Schiff base hydrazone ligands isatin isonicotinic acid hydrazone (HIINH) and vanillin isonicotinic acid hydrazone (VINH) and their metal complexes with various salts of Cu(II) and Ni(II) are reported. The complexes have the compositions [M(IINH)X] or [M(VINH)2X2], where X=C1, NO3 or ½SO4, which contain 4- or 6-coordinated metals. The complexation of the former ligand occurs in the deprotonated diol form of the ligand, via the azomethine nitrogen and the carbonyl oxygen. All complexes were characterized by elemental analysis, m. p., molar conductance measurements and infrared and electronic spectral data.

Summary Vanadium(V) reacts with 7-amino-1-naphthol-3,6-disulphonic acid (2 R-acid) in the ratio 2:1, forming a red coloured chelate having maximum absorbance at 470 nm. The composition of the chelate has been found by the continuous variations and the mole ratio methods. The system obeys Beer's law between a range of 1.72 to 30.9 p. p. m. of vanadium and the sensitivity is 0.17µg/cm2 at pH 2.0, The reagent is found to be fairly selective for vanadium.

Summary A spectrophotometric method for the determination of palladium is described using 4-(2-pyridylazo)-resorcinol as reagent. The method involves the formation of two red coloured chelates of palladium-PAR at pH 4.0 and 10.5 respectively. The colour reactions have sensitivity of 0.0085µg cm-2 and 0.0071µg cm-2 for logI0/I= 0.001. The effects of pH, time, order of addition of reagents, temperature etc. have been investigated. The composition of the complexes (metal:reagent) have been confirmed by two methods as 1:1 (at pH 4.0) and 3:2 (at pH 10.5).

Summary Complexometric determinations of praseodymium, neodymium and samarium as representative members of the rare earths with Alizarin Red S, Thoron, and Murexide as ohelatochrome indicators have been investigated. The studies include the determination of optimum pH range, concentration range and other conditions required for the analysis of these metals.

A new series of complexes with the tridentate dibasic Schiff base ligand o-vanillin isonicotinoyl hydrazone (o-VINH) were prepared and characterized by i.r., 1H n.m.r. and electronic spectral studies, magnetic susceptibility measurements and t.g.a. The disappearance of low field signals due to OH, NH protons at 10.23 and 9.31 p.p.m. and downfield shift of the -CH=N proton signal at 8.17 p.p.m. in the n.m.r. spectrum confirms the involvement of these groups in coordination. Both t.g.a. and i.r. spectral data show evidence for one molecule of coordinated H2O. These results taken in conjunction with electronic spectral data allow assignation of tetrahedral geometry for manganese(II), nickel(II) and palladium(II) complexes but a square planar configuration to cobalt(II), copper(II) amd zinc(II) complexes.

Five- and six-membered rings result from the chelation of nickel(II) by the dibasic tridentate Schiff base ligand, o-vanillin thiosemicarbazone(o-VTSC), a new chelate prepared and characterized. The structural results are discussed in the light of spectroscopic and other data.

Summary Isolation of coloured metal complexes of anisaldehyde thiosemicarbazone (HATSC) and anisaldehyde-4-phenylthiosemicarbazone (HAPTSC) of general formula [M(ATSC)2] and [M(APTSC)2]·2H2O are described. The room-temperature magnetic moment, i.r. and u.v. spectra, ligand field parameters and thermal characteristics are reported. The complexation occurs through deportonated thiol form of thiosemicarbazone and its azomethine nitrogen to yield 4- and 6-coordinate complexes.