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A pneumatic tourniquet is often used during ankle fracture surgery to reduce bleeding and enhance the visibility of the surgical field. Tourniquet use causes both mechanical and ischemic pain. The main purpose of this study was to evaluate the effect of tourniquet time on postoperative opioid consumption after ankle fracture surgery.

Background: Many children with neurodevelopmental disorders such as autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD) or developmental language disorder (DLD) have difficulty recognizing and understanding emotions. However, the reasons for these difficulties are currently not well understood. Aims: To compare the emotion recognition skills of children with neurodevelopmental disorders as well as those children's skills with the skills of their typically developing (TD) age peers. Also, to identify the role of underlying factors in predicting emotion recognition skills. Methods & Procedures: The 6-10-year-old children (n = 50) who participated in the study had either ASD, ADHD or DLD and difficulties recognizing emotions from face and/or in voice. TD age peers (n = 106) served as controls. Children's skills were tested using six forced-choice tasks with emotional nonsense words, meaningful emotional sentences, the FEFA 2 test, photographs, video clips and a task in which facial expressions and tones of voice had to be matched. Expressive vocabulary, rapid serial naming, auditory and visual working memory and Theory of Mind skills were explored as possible explanatory factors of the emotion recognition difficulties of the diagnosed children. Outcomes & Results: Children with ASD, ADHD or DLD did not significantly differ from each other in their linguistic or cognitive skills. Moreover, there were only minor differences between children with these diagnoses in recognizing facial expressions and emotional tone of voice and matching the two. The only significant difference was that children with ADHD recognized facial expressions in photographs better than children with DLD. The participants with diagnoses scored significantly lower than the controls in all but one emotion recognition tasks presented. According to the linear regression analysis, first-order Theory of Mind skills predicted the delay relative to typical development in the recognition of facial expressions in the FEFA 2 test, and expressive vocabulary and working memory skills together predicted the delay in the recognition of emotions in the matching task. Conclusions & Implications: Children with ASD, ADHD or DLD showed very similar emotion recognition skills and were also found to be significantly delayed in their development of these skills. Some predictive factors related to linguistic and cognitive skills were found for these difficulties. Information about impaired emotion recognition and underlying linguistic and cognitive skills helps to select intervention procedures. Without this information, therapy might unnecessarily focus on only symptoms.

Children with neurodevelopmental disorders often have social–emotional difficulties. Serious games can be used to support their social–emotional learning. This study investigated if 6–10‐year‐old children with autism spectrum condition, attention deficit hyperactivity disorder and developmental language disorder would improve their emotion discrimination skills by playing a serious game. Intervention (n = 30) and control groups (n = 20), comprising children with neurodevelopmental disorders, and a group of typically developing (TD) age peers (n = 106), completed six emotion discrimination tasks. ABA research design was applied in this study. Prior to the game intervention, children with neurodevelopmental disorders were significantly delayed in relation to their TD age peers in all tasks. After playing the game for two months, the children in the intervention group had significantly improved their emotion discrimination skills in four tasks, whereas the control group had significantly advanced in only one task without practice. Intervention gains were maintained at the one‐month follow‐up. Parents reported that the children in the intervention group somewhat improved their emotion recognition and behavioural skills in daily life in comparison to the control group. Implications for practice are discussed. Practitioner notesWhat is already known about this topic Children with neurodevelopmental disorders often exhibit various social–emotional symptoms.Within the field of social–emotional learning, many serious games have a narrow focus on specific skills, and they often only provide possibilities for observing target behaviours, not actual skill training.There are mixed results on the efficacy of game‐based interventions targeted at improving social–emotional skills.What this paper adds The Emotion Detectives game used in this study offers a well‐designed learning environment that provides adaptive learning and feedback systems.The participating children's social–emotional skills were assessed with versatile methods and via triangulation.Intervention with the Emotion Detectives game helped to decrease some emotion and behavioural symptoms of the players.Implications for practice This study provides information about the efficacy of a web‐based game that is freely available for supporting children's social–emotional learning.Improvements in emotion discrimination and recognition, as well as behavioural skills, can be gained by playing serious games.For optimal intervention outcomes, multimodal training should be utilized in serious games targeting social–emotional learning. [ABSTRACT FROM AUTHOR]

A pneumatic tourniquet is often used during ankle fracture surgery to reduce bleeding and enhance the visibility of the surgical field. Tourniquet use causes both mechanical and ischemic pain. The main purpose of this study was to evaluate the effect of tourniquet time on postoperative opioid consumption after ankle fracture surgery. We retrospectively reviewed the files of 586 adult patients with surgically treated ankle fractures during the years 2014–2016. We evaluated post hoc the effect of tourniquet time on postoperative opioid consumption during the first 24 h after surgery. The patients were divided into quartiles by the tourniquet time (4–43 min; 44–58 min; 59–82 min; and ≥83 min). Multivariable linear regression analysis was used to evaluate the results. Tourniquets were used in 486 patients. The use of a tourniquet was associated with an increase in the total postoperative opioid consumption by 5.1 mg (95 % CI 1.6–8.5; p=0.004) during the first 24 postoperative hours. The tourniquet time over 83 min was associated with an increase in the mean postoperative oxycodone consumption by 5.4 mg (95 % CI 1.2 to 9.7; p=0.012) compared to patients with tourniquet time of 4–43 min The use of a tourniquet and prolonged tourniquet time were associated with higher postoperative opioid consumption during the 24 h postoperative follow-up after surgical ankle fracture fixation. The need for ethical approval and informed consent was waived by the Institutional Review Board of Northern Ostrobothnia Health District because of the retrospective nature of the study. [ABSTRACT FROM AUTHOR]

Background: The rate of incisional hernia after closure of a temporary loop ileostomy is significant. Synthetic meshes are still commonly avoided in contaminated wounds. The Preloop trial was a multicentre RCT designed to evaluate the benefits of synthetic mesh in incisional hernia prevention, and its safety for use in a contaminated surgical site compared with biological mesh. Methods: Study patients who underwent closure of a loop ileostomy after anterior resection for rectal cancer were assigned to receive either retrorectus synthetic or biological mesh to prevent incisional hernia. The primary outcomes were surgical-site infections within 30 days, and clinical or radiological incisional hernia incidence at 10 months. Secondary outcomes were reoperation rate, operating time, duration of hospital stay, other complications within 30 days of surgery, 5-year quality of life measured by RAND-36, and incisional hernia incidence within 5 years of follow-up. Results: Between November 2018 and September 2021, 102 patients were randomised, of whom 97 received the intended allocation. At 10-month follow-up, 90 patients had undergone clinical evaluation and 88 radiological evaluation. One patient in each group (2 per cent) had a clinical diagnosis of incisional hernia (P = 0.950) and one further patient in each group had a CT-confirmed incisional hernia (P = 0.949). The number of other complications, reoperation rate, operating time, and duration of hospital stay did not differ between the study groups. Conclusion: Synthetic mesh appeared comparable to biological mesh in efficacy and safety for incisional hernia prevention at the time of loop ileostomy closure. Registration number: NCT03445936 (http://www.clinicaltrials.gov). Preloop was a prospective, randomized, controlled, multicentre feasibility trial to show that synthetic mesh is non-inferior in incisional hernia prevention, safe for use in a contaminated surgical site, and a comparable alternative to biological mesh. One patient in each study group (2 per cent) had clinical suspicion of incisional hernia (P = 0.950). Two other patients, one in each group, had a CT-confirmed incisional hernia (P = 0.949). Synthetic mesh is equally effective and safe for incisional hernia prevention at contaminated surgical sites, and is comparable to biological mesh. [ABSTRACT FROM AUTHOR]