MDCT prior to median re-sternotomy in cardiovascular surgery: our experiences, infrequent findings and the crucial role of radiological report.

Resternotomy (RS) is a common occurrence in cardiac surgical practice. It is associated with an increased risk of injury to old conduits, cardiac structures, catastrophic hemorrhage and subsequent high morbidity and mortality rate in the operating room or during the recovery period. To mitigate this risk, we evaluated the role of multidetector CT (MDCT) in planning repeat cardiac surgery. We evaluated sternal compartment abnormalities, sternal/ascending aorta distance, pre-reoperative assessment of the aorta (wall, diameters, lumen, valve), sternal/right ventricle distance, diaphragm insertion, pericardium and cardiac chambers, sternal/innominate vein distance, connection of the grafts to the predicted median sternotomy cut, graft patency and anatomic course, possible aortic cannulation and cross-clamping sites and additional non-cardiovascular significant findings. Based on the MDCT findings, surgeons employed tailored operative strategies, including no-touch technique, clamping strategy and cardiopulmonary bypass (CPB) via peripheral cannulation assisted resternotomy. Our experience suggests that MDCT provides information which contributes to the safety of re-operative heart surgery reducing operative mortality and adverse outcomes. The radiologist must be aware of potential surgical options, including in the report any findings relevant to possible resternotomy complications.

Using the HSE stress indicator tool in a military context.

An assessment of the Health and Safety Executive's (HSE) stress indicator tool was conducted to determine whether it was suitable for use with Ministry of Defence (MoD) personnel. A total of 1031 respondents from the Army, Navy, Air Force and MoD civilians completed a questionnaire containing the HSE tool and supplementary measures of work-life balance, engagement, deployment, leave taken and hours of work. Six measures of adverse reaction to the stressors were also reported: perceptions of job stress, job stress and health, psychological strain, fatigue after work, work ability and quality of working life. The stressor scales, particularly the 'demands' and 'relationships' scales, were associated with adverse outcomes as was the work-life balance scale. The HSE tool had some validity when used with MoD personnel, but its content was too narrow. The content validity of the tool can be improved for use in a military context with the addition of a 'work-life balance' scale'. PRACTITIONER SUMMARY: The HSE stress tool was tested with a mixed sample of MoD employees. The 'Demands and "Relationships" scales were associated with adverse outcomes. An additional Work­Life Balance' scale improved the content validity, demonstrating the importance of assessing the psychometric qualities of scales when used within particular contexts to ensure validity.