Characteristics of transformational leadership development programs: A scoping review

The effectiveness of transformational leadership (TFL) on various outcomes is well known. Accordingly, researchers have developed training programs to enhance TFL behaviours of leaders. Yet, no reviews summarizing the characteristics of TFL training programs exist. The purpose of this review was to examine the characteristics, reporting, and application of TFL-informed programs. A search of six databases yielded 4032 articles, 31 of which met the inclusion criteria. Program characteristics were analyzed using the Template for Intervention Description and Replication (TIDieR) checklist tool, while outcomes were analyzed according to the Kirkpatrick model of evaluation. The most common context for TFL program implementation was healthcare (n = 9). Programs were tailored and often delivered using group workshops and individual feedback. Studies reported variation in the dose of programs, rarely evaluated outcomes multiple times post-baseline, and typically employed Level 3a (subjective ratings of behaviour) evaluation measures. Reporting on program location, modifications, and fidelity was poor. Varying conceptualizations of TFL in different contexts lead to disparities in programs and protocols. Evaluation specialists should consider using tools like the TIDiER checklist to ensure that program characteristics are reported appropriately. Program planners should develop common approaches for planning and evaluating TFL programs to improve transparency and replicability of programs.

Investigating the influence of interaction modality on the communication patterns of spinal cord injury peer mentors

OBJECTIVES

To examine how the quality of spinal cord injury peer mentorship relationships and mentor-mentee behaviors are impacted by interaction modality.

METHODS

Using a within-subjects, repeated measures, experimental design, peer mentors (n = 8) completed two mentoring sessions with a standardized mentee in a telephone and a video chat condition. Measures of therapeutic alliance and autonomy supportiveness were administered following each session. Mentors' leadership behaviors, motivational interviewing skills, and behavior change techniques were compared across conditions. Mentors' and mentees' use of motivational interviewing skills and behavior change techniques were further analyzed using state space grids.

RESULTS

Mentors' therapeutic alliance, autonomy supportiveness, use of leadership behaviors, motivational interviewing skills, and behavior change techniques did not significantly differ across the two conditions (ps > 0.123; Cohen's d range = 0.218-0.619). State space grids analyses revealed that the dynamic structure of mentoring conversations was similar when interactions occurred through the telephone versus video chat.

CONCLUSIONS

Mentors were effective at forming positive, autonomy supportive relationships with mentees in telephone and video chat interaction conditions. Mentors also used leadership/counselling behaviors to a similar extent when interacting through these two modalities.

PRACTICE IMPLICATIONS

Organizations that provide peer mentorship can have confidence in using both telephone and video chat modalitites.

A Scoping Review of Peer Mentorship Studies for People with Disabilities: Exploring Interaction Modality and Frequency of Interaction

Given our understanding of the importance of peer mentorship for people with disabilities, research needs to begin exploring characteristics of the mentor-mentee relationship that could contribute to the observed positive outcomes. To date, no review has examined characteristics of peer mentorship (i.e. interaction modality, interaction frequency) that could impact the quality and effectiveness of this service. The primary purpose was to synthesize the peer-reviewed peer mentorship literature for people with disabilities and report on the interaction modality and frequency employed in each study. A secondary purpose was to document the results of studies that have tested relationships between the outcomes of peer mentorship and interaction modality or frequency. A scoping review was performed that involved a systematic search of MEDLINE, EMBASE, PsychINFO, CINAHL, Web of Science, and SPORTDiscus. Thirteen studies met the inclusion criteria. Articles reported five different interaction modalities; the telephone (n = 12) was the most common. Frequency of interactions was reported in nine studies with mentees reporting between 3 and 77 interactions with their mentor. Only one study attempted to analyze the mediating or moderating effects of modality and frequency on the reported outcomes. In conclusion, peer mentorship is occurring through various interaction modalities and at varying frequencies. Future research should focus on examining the impact that modality and frequency of interaction have on outcomes of peer mentorship.

Identifying the outcomes of participating in peer mentorship for adults living with spinal cord injury: a qualitative meta-synthesis

OBJECTIVE

Peer mentorship is a flagship program utilized by Canadian community-based spinal cord injury (SCI) organizations. Through connecting trained SCI peer mentors with fellow adults with SCI, these programs help adults adapt and thrive following their injury. The objective of this meta-synthesis was to work with SCI community organizations and to identify outcomes of participating in community- or rehabilitation-based peer mentorship programs using an integrated knowledge translation approach.

DESIGN

A meta-synthesis of 21 qualitative peer-reviewed studies and 66 community documents was conducted.

MAIN OUTCOME MEASURES

A total of 87 outcomes of peer mentorship were identified.

RESULTS

The outcomes of peer mentorship were grouped according to six higher-order themes: 1) Independence: enhanced self-sufficiency; 2) Personal growth: positive psychological changes; 3) Activities and participation: greater participation in activities and events; 4) Adaptation: adapting to life with disability; 5) Knowledge: obtaining new information, resources, and opportunities; and 6) Connection: developing and maintaining social relationship.

CONCLUSION

The positive nature of the identified outcomes suggests that participating in peer mentorship can promote improved health and quality of life for adults with SCI. Furthermore, the integrated knowledge translation approach helped identify outcomes that were previously not examined within SCI peer mentorship research, thus providing important insight for future research.

Co-development of a physiotherapist-delivered physical activity intervention for adults with spinal cord injury

STUDY DESIGNS

Cross-sectional survey, semi-structured interview, and randomized-controlled trial.

OBJECTIVES

Optimal spinal cord injury (SCI)-specific PA intervention strategies appropriate for the physiotherapist setting are unknown. The purpose of this paper is to describe the rigorous co-development process of a theory-based, physiotherapist-led PA intervention for people with SCI and assess its feasibility for implementation in the rehabilitation setting.

SETTING

Community.

METHODS

Co-development of the intervention included (1) a review of the literature; (2) key informant interviews with people with SCI (n = 26); (3) a national online survey of physiotherapists' barriers, needs, and preferences (n = 239); (4) a review of the evidence and recommendations for the intervention from a stakeholder expert panel (n = 13); and (5) a randomized controlled trial of intervention training and its effects on implementation determinants amongst physiotherapists (n = 20).

RESULTS

Almost 300 people with SCI and physiotherapists were engaged in the intervention development process. Optimal intervention delivery should be tailored and include (1) education on safety, PA guidelines, and behaviour change techniques, (2) referral to other peers, local programmes, and health professionals, and (3) adapted exercise prescriptions. Following intervention implementation training, physiotherapists demonstrated stronger tested and perceived knowledge, skills, resources, and confidence for promoting PA to people with SCI, ps < 0.05.

CONCLUSIONS

This development process serves as an example methodology for using theory to co-create a leisure-time physical activity behaviour change intervention tailored for people with SCI.

Using ecological momentary assessment to evaluate neuropathic pain experienced by adults with SCI: recommendations and participant perceptions

PURPOSE

Neuropathic pain is a debilitating consequence of spinal cord injury. Ecological momentary assessment can be a valuable research tool for understanding temporal fluctuations in neuropathic pain and designing effective management strategies. The objectives of this study were to (a) describe strategies necessary to adapt ecological momentary assessment to measure neuropathic pain in adults with spinal cord injury, and (b) explore participant perceptions of using ecological momentary assessment to measure pain sensations.

METHODS

End-users with spinal cord injury provided input to guide development of an ecological momentary assessment protocol. Six adults with spinal cord injury (ages 27-50 years, M = 39.33 ± 8.24) engaged in the six-day protocol and completed six daily neuropathic pain assessments. Upon finishing participants completed a semi-structured interview regarding their protocol experiences. A qualitative content analysis was used to analyze the interview data.

RESULTS

Participants reported that this specific ecological momentary assessment protocol was unobtrusive to their daily routines, and effectively captured their neuropathic pain sensations. However, participants experienced increased neuropathic pain due to the repeated nature of assessments.

CONCLUSION

Ecological momentary assessment can capture the dynamic nature of neuropathic pain experienced by persons with spinal cord injury. However, caution should be taken when designing intensive pain-related protocols to minimize pain exacerbation.IMPLICATIONS FOR REHABILITATIONNeuropathic pain affects up to 75% of people with spinal cord injury and is one of the most frequently occurring, debilitating forms of pain.Appropriate and feasible pain data collection methods are necessary to acquire a better understanding of how neuropathic pain manifests in people with spinal cord injury.Implementing ecological momentary assessment in a rehabilitation setting may help facilitate the monitoring of neuropathic pain for both rehabilitation professionals and persons with SCI.Using ecological momentary assessment may lead to a better understanding of individual temporal patterns of neuropathic pain that could inform the design of tailored neuropathic pain management techniques.

Operationalizing the reach, effectiveness, adoption, implementation, maintenance (RE-AIM) framework to evaluate the collective impact of autonomous community programs that promote health and well-being

Background

The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework is a useful tool for evaluating the impact of programs in community settings. RE-AIM has been applied to evaluate individual programs but seldom used to evaluate the collective impact of community-based, public health programming developed and delivered by multiple autonomous organizations. The purposes of this paper were to (a) demonstrate how RE-AIM can be operationalized and applied to evaluate the collective impact of similar autonomous programs that promote health and well-being and (b) provide preliminary data on the collective impact of Canadian spinal cord injury (SCI) peer mentorship programs on the delivery of peer mentorship services.

Methods

Criteria from all five RE-AIM dimensions were operationalized to evaluate multiple similar community-based programs. For this study, nine provincial organizations that serve people with SCI were recruited from across Canada. Organizations completed a structured self-report questionnaire and participated in a qualitative telephone interview to examine different elements of their peer mentorship program. Data were analyzed using summary statistics.

Results

Having multiple indicators to assess RE-AIM dimensions provided a broad evaluation of the impact of Canadian SCI peer mentorship programs. Peer mentorship programs reached 1.63% of the estimated Canadian SCI population. The majority (67%) of organizations tracked the effectiveness of peer mentorship through testimonials and reports. Setting-level adoption rates were high with 100% of organizations offering peer mentorship in community and hospital settings. On average, organizations allocated 10.4% of their operating budget and 9.8% of their staff to implement peer mentorship and 89% had maintained their programming for over 10 years. Full interpretation of the collective impact of peer mentorship programs was limited as complete data were only collected for 52% of survey questions.

Conclusions

The lack of available organizational data highlights a significant challenge when using RE-AIM to evaluate the collective impact of multiple programs that promote health and well-being. Although researchers are encouraged to use RE-AIM to evaluate the collective impact of programs delivered by different organizations, documenting limitations and providing recommendations should be done to further the understanding of how best to operationalize RE-AIM in these contexts.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-7131-4) contains supplementary material, which is available to authorized users.

Evidence-based scientific exercise guidelines for adults with spinal cord injury: an update and a new guideline

OBJECTIVES

To describe the process and outcomes of using a new evidence base to develop scientific guidelines that specify the type and minimum dose of exercise necessary to improve fitness and cardiometabolic health in adults with spinal cord injury (SCI).

SETTING

International.

METHODS

Using Appraisal of Guidelines, Research and Evaluation (AGREE) II reporting criteria, steps included (a) determining the guidelines' scope; (b) conducting a systematic review of relevant literature; (c) holding three consensus panel meetings (European, Canadian and International) to formulate the guidelines; (d) obtaining stakeholder feedback; and (e) process evaluation by an AGREE II consultant. Stakeholders were actively involved in steps (c) and (d).

RESULTS

For cardiorespiratory fitness and muscle strength benefits, adults with a SCI should engage in at least 20 min of moderate to vigorous intensity aerobic exercise 2 times per week AND 3 sets of strength exercises for each major functioning muscle group, at a moderate to vigorous intensity, 2 times per week (strong recommendation). For cardiometabolic health benefits, adults with a SCI are suggested to engage in at least 30 min of moderate to vigorous intensity aerobic exercise 3 times per week (conditional recommendation).

CONCLUSIONS

Through a systematic, rigorous, and participatory process involving international scientists and stakeholders, a new exercise guideline was formulated for cardiometabolic health benefits. A previously published SCI guideline was endorsed for achieving fitness benefits. These guidelines represent an important step toward international harmonization of exercise guidelines for adults with SCI, and a foundation for developing exercise policies and programs for people with SCI around the world.

Facial bone density: effects of aging and impact on facial rejuvenation

BACKGROUND

Facial bone aging has recently been described as primarily resulting from volume loss and morphologic changes to the orbit, midface, and mandible.

OBJECTIVE

The authors demonstrate how the facial skeleton bone mineral density (BMD) changes with age in both men and women and compare these changes to those of the axial skeleton. They also explore the aesthetic implications of such changes in bone density.

METHODS

Dual-energy X-ray absorptiometry (DXA) scans of the facial bones and lumbar spine were obtained from 60 white subjects, 30 women and 30 men. There were 10 men and 10 women in each of 3 age categories: young (20-40 years), middle (41-60 years), and old (61+ years). The following measurements were obtained: lumbar spine BMD (average BMD of L1-L4 vertebrae), maxilla BMD (the average BMD of the right and left maxilla), and mandible BMD (the average BMD of the right and left mandibular ramus).

RESULTS

The lumbar spine BMD decreased significantly for both sexes between the middle and old age groups. There was a significant decrease in the maxilla and mandible BMD for both sexes between the young and middle age groups.

CONCLUSIONS

Our results suggest that the BMD of the face changes with age, similar to the axial skeleton. This change in BMD may contribute to the appearance of the aging face and potentially affect facial rejuvenation procedures.

Aesthetic and functional satisfaction after monsplasty in the massive weight loss population

BACKGROUND

The mons region is often affected by massive weight loss (MWL), with descent of the pubic area and residual adiposity. Thinning and resuspension are often performed concomitantly with abdominal contouring procedures.

OBJECTIVES

Assess patient satisfaction, as well as functional and aesthetic results, after monsplasty in the MWL population.

METHODS

The authors identified 54 consecutive female MWL patients (≥50 lbs) who had undergone abdominal contouring and completed at least 3 months of follow-up as potential subjects. Subjects were asked to complete a Mons Satisfaction Survey, either by phone or in person. Demographic and procedural data were collected from our prospective registry. Descriptive statistics were calculated with significance set at P value <.05.

RESULTS

Thirty-one patients (57.8%) completed the survey. Average patient age was 46 ± 11.3 years. Mean maximum body mass index (BMI) was 52.0 ± 8.81 kg/m(2), mean current BMI was 31.0 ± 6.22 kg/m(2), and mean delta BMI was 20.7 ± 6.00 kg/m(2). Average pannus resection weight was 3.25 ± 2.03 kg. Visualization of the genitalia improved from 25.8% to 100% (P < .01). Patients rated the appearance of their mons as 3.18 ± 2.11 prior to surgery and 8.58 ± 1.73 after surgery (P < .001) on a scale of 1 to 10. Hygiene improved in 61.3% of patients, and sex life improved in 51.6%, with 32.3% of patients reporting increased genital sensitivity. Incontinence decreased from 22.6% to 12.9%, and 6 patients reported a change in urinary stream.

CONCLUSIONS

Monsplasty at the time of abdominal contouring yields significant improvement in patient satisfaction levels and functional scores. With proper incisional design, monsplasty can be performed safely during abdominal contouring with high patient satisfaction to improve both form and function of the pubic region.

Aging of the bony orbit: a three-dimensional computed tomographic study

BACKGROUND

Facial aging is a dynamic process involving the aging of soft tissue and bony structures. The shape, size, and volume of the bony orbit have all been shown to change with increasing age.

OBJECTIVE

In this study, we demonstrate how specific bony aspects of the orbit change with age in both male and female subjects and what impact this may have on the techniques used in facial cosmetic surgery.

METHODS

Facial bone computed tomography (CT) scans were obtained from 60 white subjects (30 female, 30 male). Our study population consisted of 10 male and 10 female subjects in each of 3 age categories. Each CT scan underwent three-dimensional (3-D) reconstruction with volume rendering. Orbital aperture width was measured as a line drawn from the posterior lacrimal crest to the frontozygomatic suture. This line was then used as the x-axis from which the distance to the superior and inferior orbital rim at nine equal increments (labeled 10 to 90) was obtained. The orbital aperture area was also measured on each 3-D model. The Student t test was used to identify any trends between age groups.

RESULTS

The orbital aperture width and area in both our male and female subjects showed a significant increase with increasing age. There was a significant increase in height of the superior orbital rim medially in both genders, suggesting that the superior orbital rim receded with age in this region. The inferior orbital rim receded significantly laterally in our female population, while our male subjects had a recession of the entire inferior orbital rim.

CONCLUSIONS

These results suggest that the bony elements of the orbit change dramatically with age, and this, coupled with soft tissue changes, can lead to the appearance of the aged eye and orbit.

Dupuytren's disease: history, diagnosis, and treatment

LEARNING OBJECTIVES

After studying this article, the participant should be able to: 1. Describe the clinical features of the disease. 2. Describe the pathoanatomical structures in Dupuytren's disease. 3. Outline the various factors associated with Dupuytren's disease. 4. Describe the modalities for surgical and nonsurgical treatment of the condition. 5. Outline recent biomolecular knowledge about the basis of Dupuytren's disease.

SUMMARY

Dupuytren's disease is characterized by nodule formation and contracture of the palmar fascia, resulting in flexion deformity of the fingers and loss of hand function. The authors review the historical background, clinical features, and current therapy of Dupuytren's disease; preview treatment innovations; and present molecular data related to Dupuytren's disease. These new findings may improve screening for Dupuytren's disease and provide a better understanding of the disease's pathogenesis.

Aging of the midface bony elements: a three-dimensional computed tomographic study

BACKGROUND

The face loses volume as the soft-tissue structures age. In this study, the authors demonstrate how specific bony aspects of the face change with age in both men and women and what impact this may have on the techniques used in facial cosmetic surgery.

METHODS

Facial bone computed tomographic scans were obtained from 60 Caucasian patients (30 women and 30 men). The authors' study population consisted of 10 male and 10 female subjects in each of three age categories. Each computed tomographic scan underwent three-dimensional reconstruction with volume rendering, and the following measurements were obtained: glabellar angle (maximal prominence of glabella to nasofrontal suture), pyriform angle (nasal bone to lateral inferior pyriform aperture), and maxillary angle (superior to inferior maxilla at the articulation of the inferior maxillary wing and alveolar arch). The pyriform aperture area was also obtained. The t test was used to identify any trends between age groups.

RESULTS

The glabellar and maxillary angle in both the male and female subjects showed a significant decrease with increasing age. The pyriform angle did not show a significant change between age groups for either sex. There was a significant increase in pyriform aperture area from the young to the middle age group for both sexes.

CONCLUSIONS

These results suggest that the bony elements of the midface change dramatically with age and, coupled with soft-tissue changes, lead to the appearance of the aged face.

Laparoscopic Repair for Recurrent Abdominal Wall Hernia After TRAM Flap Breast Reconstruction

BACKGROUND

The transverse rectus abdominis musculocutaneous (TRAM) flap is an appealing option for women choosing between various breast reconstructive techniques as it results in an autologous reconstructed breast that is soft and mimics a natural breast. Despite these benefits, there are complications with this procedure, such as pain at the donor site, longer scars, and most frequently the occurrence of abdominal wall hernia or bulge, which has been reported in up to 20%-40% of patients.

METHODS

In this case report, we share our experience with 2 patients who had multiple open hernia repairs, 5 between the 2 of them, after their TRAM flap surgery. Each of these 5 repairs was performed with a Prolene mesh overlay, but not one lasted for more than 6 months. After reviewing our patients' records and our surgical options, we decided to proceed with laparoscopic repair of their recurrent hernias.

RESULTS

The patients are now at postoperative follow-up of 12 months and 15 months, with no evidence of recurrence.

DISCUSSION

Laparoscopic surgery has many benefits, such as shorter hospitalization and decreased pain. For our patients, it also resulted in a more beneficial and longer-lasting repair. We believe that this is partly due to the mechanics of the repair, which allows the abdominal contents to buttress the mesh against the abdominal wall. In addition, we believe that this technique reinforces the posterior sheath, which may not be accomplished in an open repair. This is important as most hernias after TRAM flap surgery occur below the arcuate line. From our experience with these 2 patients, we now advocate the use of laparoscopic repair as a treatment option for those who present with recurrent abdominal wall hernia or bulge after their TRAM flap surgery and believe with more experience it will become a first-line treatment.

Blunted prefrontal cortical 18fluorodeoxyglucose positron emission tomography response to meta-chlorophenylpiperazine in impulsive aggression

BACKGROUND

Impulsive aggression is a prevalent problem and yet little is known about its neurobiology. Preclinical and human studies suggest that the orbital frontal cortex and anterior cingulate cortex play an inhibitory role in the regulation of aggression.

METHODS

Using positron emission tomography, regional metabolic activity in response to a serotonergic stimulus, meta-chlorophenylpiperazine (m-CPP), was examined in 13 subjects with impulsive aggression and 13 normal controls. The anterior cingulate and medial orbitofrontal regions were hypothesized to respond differentially to m-CPP in patients and controls. In the frontal cortex, regional metabolic glucose response to m-CPP was entered into a group (impulsive aggressive, control) x slice (dorsal, middle, orbital) x position (medial, lateral) x location (anterior, posterior) x hemisphere (right, left) mixed-factorial analysis of variance design. A separate group (impulsive aggressive, controls) x anteroposterior location (Brodmann areas 25, 24, 31, 29) x hemisphere (right, left) analysis of variance was used to examine regional glucose metabolism in the cingulate gyrus.

RESULTS

Unlike normal subjects, patients with impulsive aggression did not show activation specifically in the left anteromedial orbital cortex in response to m-CPP. The anterior cingulate, normally activated by m-CPP, was deactivated in patients; in contrast, the posterior cingulate gyrus was activated in patients and deactivated in controls.

CONCLUSIONS

The decreased activation of inhibitory regions in patients with impulsive aggression in response to a serotonergic stimulus may contribute to their difficulty in modulating aggressive impulses.

RESEARCH: Plant Community Structure in Relation to Long-Term Disturbance by Mechanized Military Maneuvers in a Semiarid Region

/ Mechanized military maneuvers are an intensive form of disturbance to plant communities in large areas throughout the world. Tracking by heavy vehicles can cause direct mortality and indirectly affect plant communities through soil compaction and by altering competitive relationships. We assessed the long-term condition of structural attributes of open woodland, grassland, and shrubland communities at Fort Carson, Colorado, in relation to levels of disturbance and soil texture. Covariate analyses were used to help separate the directional forcings by the chronic disturbance from the regenerative capacities in order to assess the relative resistance and resilience of the communities and to determine whether the continual disturbance-recovery processes balanced under current levels of utilization. All three communities responded differently to disturbance. In open woodlands, altered understory/overstory relationships were suggested by increased grass, forb, shrub, and total vegetation cover and smaller decreases in shorter than taller woody species with increasing levels of disturbance. Grassland communities generally displayed greater responses to disturbance than other communities, but temporal dynamics were often similar, indicating relatively less resistance but greater resilience of this community. Weed and exotic species increased both temporally and in relation to levels of disturbance in all three community types. Temporal trends in community-level indices of dissimilarity and diversity also indicate that rates of disturbance were greater than rates of recovery. Few variables were related to within-community differences in soil texture. While total aerial cover was temporally stable, changes in species composition and in basal cover in grasslands and shrublands suggest increasing erosion potential.

Simple technique for assuring completeness of a pyloromyotomy

A technique for assuring completeness of a pyloromyotomy is presented. I think this simple maneuver adds a sense of security to the operation and can be accomplished relatively quickly and with almost no added expense. I recommend its consideration to others.

Carotid endarterectomy: a review of surgical practice in a community hospital

That a specified number of vascular surgery procedures must be performed annually to maintain competence and that these procedures require a specialized center have been suggested repeatedly. Recent national guidelines admonish us to check our own experience with carotid surgery. In our 10-year review of 215 operations performed for carotid stenosis and/or ulceration by two surgeons in a relatively small community, the combined major morbidity/mortality rate of 2.8% compares favorably to many other series. Our experience suggests that if done judiciously, gently, and with universal shunting, the operation can be accomplished safely in the community hospital setting.

Efficiency of tube paracentesis without lavage in detecting minimal intraperitoneal bleeding

Tube paracentesis without lavage yielded a positive result in an injured child whose condition was clinically stable and who would otherwise have undoubtedly been observed briefly in the hospital and then discharged. On the basis of the positive paracentesis alone, laparotomy was performed which revealed a very minimal injury of the splenic capsule and intraperitoneal bleeding measured at less than 25 cc. The case is presented because it offers evidence in favor of the efficiency of this technique in detecting intraperitoneal bleeding. This case combined with previous experience leads us to believe this is a very useful tool in the evaluation of patients with blunt abdominal trauma.

Multiseptate gallbladder diagnosed during pregnancy.b0a

A sixth case report of multiseptate gallbladder is presented because of its rarity and because of its association in pregnancy. The anomaly has a diagnostic X-ray appearance. As reported in four previously recorded cases, no inflammation was found in our patient's specimen despite symptoms mimicking cholecystitis. Initial presentation and worsening clinical course during the patient's pregnancy lend credence to the idea that symptoms are caused not by inflammation but by pressure in the chambers, caused by relative delay in emptying. Cholecystectomy is recommended because it uniformly has relieved symptoms.