RESUMEN
From a public health perspective, nasal surgery accounts for many unused opioids. Patients undergoing septorhinoplasty require few opioids, and efforts to eliminate this need may benefit both patients and the public. METHODS: A multimodal analgesic protocol consisting of 15 components encompassing all phases of care was implemented for 42 patients. RESULTS: Median age and BMI were 34 years and 23, respectively. Most were women (79%), White (79%), primary surgeries (62%), and self-pay (52%). Comorbid conditions were present in 74% of the patients, with anxiety (33%) and depression (21%) being the most common. Septoplasties (67%) and osteotomies (45%) were common. The median operative time was 70 minutes. No patients required opioids in recovery, and median time in recovery was 63 minutes. Ten (24%) patients required an opioid prescription after discharge. In those patients, median time to requirement was 27 hours (range 3-81), and median total requirement was 20 mg morphine equivalents (range 7.5-85). Protocol compliance inversely correlated to opioid use (P = 0.007). Compliance with local and regional anesthetic (20% versus 63%, P = 0.030) as well as ketorolac (70% versus 100%, P = 0.011) was lower in patients who required opioids. Patients who required opioids were less likely to be administered a beta blocker (0% versus 34%, P = 0.041). Pain scores were higher in opioid users on postoperative days 1-5 (P < 0.05). No complications occurred in those requiring opioids, and satisfaction rates were equivalent between groups. CONCLUSION: This protocol allowed us to safely omit opioid prescriptions in 76% of patients following septorhinoplasty, without adverse effects on outcomes or patient satisfaction.
RESUMEN
Recent instances of corporate misconduct and examples of blatant leader self-serving behavior have rekindled interest in leader personality traits as antecedents of negative leader behavior. The current research builds upon that work, and examines the relationship between leader psychopathy and leader self-serving behavior. Moreover, we investigate whether follower self-esteem affects the occurrence of self-serving behavior in leaders with psychopathic tendencies. We predict that self-serving behaviors by psychopathic leaders are more likely to occur in the interaction with followers low in self-esteem. We first conducted an experimental study (N = 156), in which we manipulated follower self-esteem, measured leader psychopathy, and assessed their combined effect on leader self-serving behavior using an ultimatum game. We then conducted a multi-source field study (N = 124 leader-follower dyads) using questionnaires to assess leader psychopathy, follower self-esteem, and perceived leader self-serving behavior. Across both studies, we found that leader psychopathy was positively related to their self-serving behavior, but only when followers had low rather than high self-esteem. As expected, our studies showed that the degree to which (perceived) psychopathic traits of leaders are reflected in their behavior depends on the characteristics of their followers. Apparently, the behavioral expression of negative leader traits is not only a matter of the trait strength, but instead is the result of the interplay between leader and follower in a certain context.
RESUMEN
We present the first case of traveler's diarrhea resulting in breast implant infection. An otherwise healthy 34-year-old female underwent breast augmentation. Five months later, while vacationing in Cancun, Mexico, she developed abdominal pain and diarrhea that progressed to include fevers and chills. Her symptoms persisted until she returned to the United States, at which point her primary care physician evaluated her on the fourth day of her illness. An abdominal CT scan was unremarkable; however, a complete metabolic panel demonstrated elevated transaminases. Her symptoms soon resolved without treatment. Fourteen days after symptom resolution, the patient developed right breast pain. She was evaluated in the surgical clinic where the breast was tender to palpation, swollen and without erythema. An ultrasound demonstrated a small amount of homogenous fluid surrounding the implant. She was prescribed amoxicillin-clavulanate 875-125 mg BID; however, she presented three days later with worsening pain, swelling and new erythema. She was taken to the operating room, where the abscess was incised, drained and the implant removed. Cultures grew Salmonella serogroup C. Patients should be counseled regarding the potential for hematogenous seeding of the breast cavity and implant following severe illness and bacteremia. It may be reasonable to provide patients with breast implants who are traveling to areas at high-risk for traveler's diarrhea or areas with limited medical resources with an antibiotic to take if moderate to severe symptoms of traveler's diarrhea were to develop while away.
RESUMEN
The popular media has repeatedly pointed to pride as one of the key factors motivating leaders to behave unethically. However, given the devastating consequences that leader unethical behavior may have, a more scientific account of the role of pride is warranted. The present study differentiates between authentic and hubristic pride and assesses its impact on leader ethical behavior, while taking into consideration the extent to which leaders find it important to their self-concept to be a moral person. In two experiments we found that with higher levels of moral identity, authentically proud leaders are more likely to engage in ethical behavior than hubristically proud leaders, and that this effect is mediated by leaders' motivation to act selflessly. A field survey among organizational leaders corroborated that moral identity may bring the positive effect of authentic pride and the negative effect of hubristic pride on leader ethical behavior to the forefront.
RESUMEN
How do people react to indifference when they see it in others? In 5 studies we examined how people may respond to it as a cue to disengage when they lack sufficient commitment to a goal or task themselves. Across the studies, participants were either exposed to cues implying an absence of motivation or not, after which their own goal-directed motivation was assessed. Results indicated that participants were likely to behaviorally assimilate indifference when it was directed toward a relevant goal (Studies 1 and 3) and they were not very committed to the goal (Studies 2a-b, 3, 5). Corresponding self-report data suggested that exposure to indifference generally discouraged and obstructed goal pursuit in the participants' minds (Studies 4-5). However, participants overcame the indifference when their commitment to the goal was chronically high or experimentally heightened, with the corresponding self-report data suggesting a process of increased monitoring and counteraction. In these studies, we also distinguished goal commitment from goal accessibility: Whereas a manipulation of goal commitment seemed to facilitate overcoming indifference (Study 5), a manipulation of goal accessibility did not (Study 4). In sum, a potentially insidious feature of indifference may be that people assimilate it not because they want to but because it exploits their preexisting doubts about the goal or their general openness to disengaging from it.