The impact of pastors' spiritual practices on burnout.

This qualitative study addressed two research questions (a) what spiritual practices contribute to pastors' emotional and spiritual well-being?, and (b) what factors contribute to pastoral burnout? Based on an inductive analysis of eight pastoral interviews, the study revealed that these spiritual leaders engage in specific spiritual disciplines that contribute to their sense of well-being. The implications of this study prompt further research into the relationship between leaders' spiritual practices and burnout.

Arthrodesis of the equine proximal interphalangeal joint: a mechanical comparison of 2 parallel 5.5 mm cortical screws and 3 parallel 5.5 mm cortical screws.

OBJECTIVE: To compare the biomechanical characteristics and mode of failure of 2 techniques using parallel 5.5 mm screws for pastern joint arthrodesis in horses. STUDY DESIGN: Randomized block design, for horse (1-5), method of fixation (two 5.5 mm screws versus three 5.5 mm screws), side (right, left), and end (front, hind). Constructs were tested to failure in 3-point bending. SAMPLE POPULATION: Twenty limbs (5 cadavers). METHODS: A combined aiming device was used to facilitate screw placement. Two parallel 5.5 mm screws were inserted in lag fashion in 1 limb of a pair, and three 5.5 mm screws were inserted in the contralateral limb. Constructs were then tested in 3-point bending in a dorsal-to-palmar (plantar) direction using a materials testing machine at a loading rate of 19 mm/s. Maximal bending moment at failure and stiffness were obtained from bending moment-angular deformation curves. RESULTS: There was no significant difference between two and three 5.5 mm screw constructs for bending moment and stiffness (P<.05). All constructs ultimately failed by bone fracture or screw bending. For proximal interphalangeal (PIP) joint arthrodesis constructs loaded in 3-point bending, no significant effect of treatment, side, or end on maximal bending moment or stiffness was detected. CONCLUSIONS: Two 5.5 mm cortical screws inserted in parallel should provide a surgically simpler and equally strong PIP joint arthrodesis compared with three 5.5 mm cortical screws. CLINICAL RELEVANCE: Two 5.5 mm cortical screws inserted in parallel for PIP joint arthrodesis should perform similarly under conditions used in this study, as three 5.5 mm screws inserted in a similar manner, when loaded under bending.

Cadaveric-donor organ recovery at a hospital-independent facility.

BACKGROUND: Of the many logistic issues addressed throughout the cadaveric organ donation process, timely access to the operating theater for surgical recovery of organs and tissues can be one of the most problematic. Delay in recovery adds to cost, risks organ viability, and compounds donor family anguish with compromise to donation consent. METHODS: From March 1 to November 30, 2001, 25 cadaveric donors were selected and successfully transferred from local donor critical care units to an off-site facility, which was constructed, equipped, and staffed to allow surgical recovery of organs and tissues. Assessment of the recovery process and outcome results was compared to 42 consecutive, hospital-based, organ recoveries within the Mid-American Transplant Services (MTS) organ procurement organization region. RESULTS: Twenty-five MTS-facility and 42 hospital organ recoveries were successfully conducted with no technical losses and satisfactory function in all 206 transplanted organs. From the MTS donor group, 7 hearts, 4 lungs, 21 livers, 28 kidneys, and 5 pancreases were successfully transplanted. Statistically significant in the MTS group was higher donor age (44.1 vs. 30.2 years), shorter total donor management time (539 vs. 718 min), reduced delay in start of surgery (25 vs. 77 min), shorter cold ischemia time for recovered pancreases (355 vs. 630 min), and reduced mean cost per donor ($10,636 vs. $12,918). There was no significant difference in race, gender, cause of death, vasopressor requirements, organs per donor recovered (3.12 vs. 3.62) or transplanted (2.60 vs. 3.36), rate of tissue recoveries (68% vs. 67%), total operating room time (207 vs. 200 min.), or cold ischemia time (excluding pancreas). CONCLUSIONS: Cadaveric-donor multiorgan and tissue recovery at this hospital-independent facility was successfully accomplished in a manner indistinguishable from conventional hospital organ and tissue recovery. The intended objectives of improved access to the operating theater were realized along with the added benefit of significant cost savings and convenience to hospital personnel and surgical recovery teams.