A survey of 554 peripheral intravenous catheters: infection, duration of cannulation and documentation issues

The purpose of this survey was to improve nursing care of patients with peripheral intravenous catheters (PVCs), focusing on duration of cannulation. The survey was conducted in 20 general wards recording data on the duration of cannulation, site-infection, dating of PVC dressing and documentation in nursing notes. Nursing staff were interviewed on duration of the PVC and a documentation form was introduced during the survey.

A total of 554 PVCs in 397 patients were surveyed. Duration of cannulation ranged from one to ten days, with 402 (73%) of PVCs removed by day three. The site-infection rate was 28 (5%) with no cases of blood stream infection. Most site infection (20 of 28 (71%)) occurred within the first three days.

The duration of cannulation, from interview, was known by nurses in 416 (75%) of cases and documented in 208 (40%) of cases. Eighteen months after its introduction, the PVC documentation form was in use in 19 of 20 wards for 60 (76%) PVCs.

While the infection rate was low and nurses were generally aware of the duration of cannulation, inadequate documentation by nursing and medical staff was a cause for concern. Information on PVCs should be included in standard documentation on all wards and in relevant departments to assist nurses and others in the provision of quality care to patients.

Review : Functional Neuroimaging of Memory

Cognitive neuroscientists have acquired powerful new tools for studying the functional neuroanatomy of the human brain. Traditional methods such as lesion analysis have been supplemented with electrical and mag netic field recording techniques that can measure the informational transactions of the brain in the scale of milliseconds and neuroimaging techniques that can provide structural details of the brain to a fraction of a millimeter. The most powerful new methods have been functional imaging techniques in which brain activity engendered by a sensory, motor, or cognitive task causes an increase in local blood flow and metabolism that can be imaged with high resolution. This article reviews recent progress in functional neuroimaging, with special emphasis on understanding the neural substrates of memory. The Neuroscientist 1:155-163, 1995

Electrophysiological correlates of face-evoked person knowledge

Face recognition includes identifying a face as perceptually familiar and recollecting biographical information, or person-knowledge, associated with the face. The majority of studies examining the neural basis of face recognition have confounded these stages by comparing brain responses evoked by novel and perceptually familiar famous faces. Here, we recorded EEG in two tasks in which subjects viewed two sets of faces that were equally perceptually familiar, but which had differing levels of associated person-knowledge. Our results dissociated the effects of person-knowledge from perceptual familiarity. Faces with associated biographical information elicited a larger ∼600ms centroparietal positivity in both a passive viewing task in which subjects viewed faces without explicitly responding, and an active question-answering task in which subjects indicated whether or not they knew particular facts about the faces. In the question task only, person-knowledge was associated with a negative ERP difference over right posterior scalp over the 170-450ms interval which appeared again at long latency (>900ms).

Reactivation during encoding supports the later discrimination of similar episodic memories

Episodic memory is characterized by remembering events as unique combinations of features. Even when some features of events overlap, we are later often able to discriminate among them. Here we ask whether hippocampally mediated reactivation of an earlier event when a similar one occurs supports subsequent memory that two similar but not identical events occurred (mnemonic discrimination). In two experiments, participants viewed objects (Experiment 1) or scenes (Experiment 2) during functional MRI (fMRI). After scanning, participants had to remember whether repeated items had been identical or similar. In Experiment 2, representational similarity between the 1st and 2nd presentation predicted participants' ability to remember that the presentations were different, suggesting that the first item was reactivated while viewing the second. A similar but weaker result was found in Experiment 1 that did not survive correction for multiple comparisons. Furthermore, both experiments yielded evidence that the hippocampus was involved in reactivation; hippocampal pattern similarity (and, in Experiment 2, hippocampal activity during the 2nd presentation) correlated with pattern similarity in several regions of visual cortex. These results provide the first fMRI evidence that hippocampally mediated reactivation contributes to the later memory that two similar, but different events occurred. © 2016 Wiley Periodicals, Inc.

Agreement and equation between Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) in an old age psychiatry outpatient clinic population

Introduction

Both MMSE and MoCA are two widely used cognitive screening test. Comparison of the two tests has been done in specific populations (Parkinson) but not in general elderly psychiatric populations. In research, equating methodologies has been used to compare results among studies that use different scales, which measure the same construct.

Aims

To explore their level of agreement within a particular clinical setting.

Objectives

(a) To find MoCA and MMSE agreement. (b) To derive a conversion formula between the two scales and test it in a random population of similar setting.

Methods

Prospective study of consecutive community dwelling older patients who attend outpatient clinic or day hospital. Both tests were administered from the same researcher the same day in random order.

Results

The total sample (n = 135) was randomly divided in two. One from where the equating rule derived (n = 70) and a second (n = 65) in which the derived conversion was tested. Agreement of the two scales (Pearson's r) was 0.86 (P < 0.001), and Lin's Concordance Correlation Coefficient (CCC) was 0.57 (95% CI 0.45–0.66). In the second sample, we convert the MoCA scores to MMSE scores according to equating rule from the first sample and after we examined the agreement between the converted MMSE scores and the originals. The Pearson's r was 0.89 (n = 65, P < 0.001) and the CCC 0.88 (95% CI 0.82–0.92).

Conclusions

Although the two scales overlap considerably, the agreement is modest. The conversion rule derived showed promising accuracy in this population but need further testing in other populations.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

“Reflective Learning” In Psychiatric Education: Does It Have Any Merit?

Introduction

Nowadays “reflection” and “reflective practice” is nearly in every curriculum for psychiatric training. Trainees are asked to keep reflection diaries, journals, and participate in “reflection workshops”.

Aims

To prove that reflection on or in action does not lead to learning.

Methods

Using epistemological notation.

Results/proofs

Because sciences including psychiatry are approximate, evolving and inexact, the classical definition of propositional knowledge becomes: A knows that p if:

– (a’) A believes that p is an approximate true;

– (b’) p is approximate truth;

– (c’) A has reason to claim that p is a better approximation than its rivals on available evidence.

Condition (c’) implies that A is not possible at the same time to have two mutually contradictive approximate truths.

In reflective learning we need to add two more conditions:

– (d’) A knows the outcome of p;

– (e’) A is satisfied in believing that p.

In cases of reflection in-action, the (e’) remains even the outcome is not favourable. Similarly, in reflection on-action the condition (e’) remains unchanged since this happened in the past. This leads to controversy. Is p better or worse approximation of truth than its’ rival p’? However, p has passed rigorous and different scientific tests and has proved scientifically superior to its rival p’. Therefore subject A cannot change his knowledge despite the unfavourable outcome, but A can tests further the p. Within the former reflecting learning does not occur, within the latter “critical thinking” occurred.

Conclusions

Reflection does not lead to learning but critical thinking does.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Family functioning and individual psychopathology in a non-clinical general population

Introduction

A family “constructs” an identity of its own derived from their assumptions about relationships and the social environment they live in. This identity transcends the individual while at the same time encourages individual differentiation. Family functioning is influenced from different factors like social context, qualitative characteristics, and from individual's medical or psychiatric condition.

Aims and objectives

To examined the effects of sociodemographic factors and individual psychopathology on the function of family in a non-clinical sample.

Methods

Cross-sectional study of participants and their families. The follow data collected:

Results

The sample constituted of 151 families, (453 individuals), in 48 families, 2 family members participated, in 56 families, 3 members participated, in 46 families 4 members participated and 1 family had 5 members participating. One hundred ninety-four (42.8%) were children and 259 (57.2%) were parents. The mean age of the children was 23.62 (SD: 6.35) and 68 (35%) were males. Mean age of the parents was 51.4 (SD: 8.2) and 117 (45.2%) were males. SCL-90 identified 183 participants as caseness. Multilevel analysis showed that individual psychopathology (caseness) was the only statistical significant factor for family dysfunctioning.

Conclusion

There is strong association between family dysfunction and psychopathology of a member. Dysfunctional families need further psychiatric evaluation of the members. Cause-effect cannot be concluded from this cross-sectional study.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Implementation Of Health Of The Nation Outcome Scale (HoNOS) In Outpatient Clinic, Sligo Mental Health Services: Feasibility And Agreement With Global Assessment Of Functioning Scale

Introduction

Outcome measurements in mental health services is beneficial in allowing healthcare providers in determining the effectiveness of their treatment plan. Health of the Nation Outcome Scale (HoNOS) and Global Assessment of Functioning (GAF) are two well-established instruments to measure patients’ outcome.

Aims and objectives

To measure the correlation of these two scales, and the feasibility of HoNOS.

Methods

Prospective longitudinal study of psychiatric outpatients attending a clinic in Sligo. Patients were assessed using HoNOS and GAF by trained doctors during the consultation. Feedback from doctors using HoNOS during the research was taken as a measure for feasibility.

Results

Total of 441 HoNOS and 237 GAF completed on 280 patients (53.2% female, mean age 46.23; SD = 14.89). The correlation between HoNOS and GAF was (r = –0.696, P < 0.001). In reassessment, we found significant reduction in HoNOS score when comparing the first assessment with the second (t = 4.590, df = 110, P < 0.01) and the third (t = 2.876, df = 37, P < 0.01). Using a linear mixed-effects model, it was found that patients with diagnosis of schizophrenia, mood affective disorder, neurotic disorder, personality disorder and younger in age are more likely to improve during the follow-up compared to those with organic mental disorders, alcohol related problems and older age.

Conclusions

HoNOS is a feasible scale and can be potentially used as an outcome measurement in the mental health services. Can help in deciding better management plan for patient and improvement of the service. HoNOs can also be used for comparison of outcomes between services in national and international level.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Task influences pattern discriminability for faces and bodies in ventral occipitotemporal cortex

Our prior research showed that faces and bodies activate overlapping regions of the ventral occipitotemporal cortex (VOTC). However, faces and bodies were nonetheless discriminable in these same overlapping regions when their spatial patterns of activity were classified using multivoxel pattern analysis (MVPA). Here we investigated whether these spatial patterns and their time courses were influenced by different categorization tasks. Participants viewed pictures of faces or headless bodies depicting a happy or fearful emotion. In one task, they categorized the picture as a face or a body regardless of emotion. In the other task, they categorized the emotion regardless of whether it was depicted by a face or body. Using a classifier trained on independent data, we found higher face-body classification accuracy for the emotion categorization task. The classifier was applied to each post-stimulus time-point to characterize the temporal course of classification. Accuracy initially rose equivalently above chance for both tasks, but then increased over a longer duration when participants categorized emotions. Thus, the temporal course of pattern differences between faces and bodies in VOTC was modulated by the behavioral goal of the observer, suggesting the top-down modulatory effect of task context on the category-selectivity activity in the VOTC.

The Function Biomedical Informatics Research Network Data Repository

The Function Biomedical Informatics Research Network (FBIRN) developed methods and tools for conducting multi-scanner functional magnetic resonance imaging (fMRI) studies. Method and tool development were based on two major goals: 1) to assess the major sources of variation in fMRI studies conducted across scanners, including instrumentation, acquisition protocols, challenge tasks, and analysis methods, and 2) to provide a distributed network infrastructure and an associated federated database to host and query large, multi-site, fMRI and clinical data sets. In the process of achieving these goals the FBIRN test bed generated several multi-scanner brain imaging data sets to be shared with the wider scientific community via the BIRN Data Repository (BDR). The FBIRN Phase 1 data set consists of a traveling subject study of 5 healthy subjects, each scanned on 10 different 1.5 to 4 T scanners. The FBIRN Phase 2 and Phase 3 data sets consist of subjects with schizophrenia or schizoaffective disorder along with healthy comparison subjects scanned at multiple sites. In this paper, we provide concise descriptions of FBIRN's multi-scanner brain imaging data sets and details about the BIRN Data Repository instance of the Human Imaging Database (HID) used to publicly share the data.

Neural regions discriminating contextual information as conveyed through the learned preferences of others

The human brain consists of a network of regions that are engaged when one observes the movements of others. Observing unexpected movements, as defined by the context, often elicits greater activity, particularly in the right posterior superior temporal sulcus (pSTS). This implies that observers use contextual information to form expectations about an agent's goal and subsequent movements. The current study sought to identify regions that support the formation of these context-dependent expectations, with the pSTS being one candidate, given the consistent contextual modulation of its activity. We presented participants with fictitious individuals who had emotion-dependent food preferences, and instructed participants to indicate which food they expected each individual to choose based on the individual's current emotional state. Each individual's preference and emotional state therefore created a context that informed the observer's expectation of the individual's choice. Multi-voxel pattern analysis (MVPA) was used to assess if these different contexts could be discriminated in the pSTS and elsewhere in the brain. No evidence for context discrimination was found in the pSTS. Context discrimination was found instead a network of other brain regions including the anterior medial prefrontal cortex (amPFC), bilateral parietal cortex, left middle temporal gyrus (L MTG) and left anterior temporal lobe (L ATL), which have been previously associated with context processing, and semantic and memory retrieval. All together, these regions possibly support the formation of context-dependent expectations of an agent's goal.

Electrophysiological Correlates of Refreshing: Event-related Potentials Associated with Directing Reflective Attention to Face, Scene, or Word Representations

Refreshing is the component cognitive process of directing reflective attention to one of several active mental representations. Previous studies using fMRI suggested that refresh tasks involve a component process of initiating refreshing as well as the top-down modulation of representational regions central to refreshing. However, those studies were limited by fMRI's low temporal resolution. In this study, we used EEG to examine the time course of refreshing on the scale of milliseconds rather than seconds. ERP analyses showed that a typical refresh task does have a distinct electrophysiological response as compared to a control condition and includes at least two main temporal components: an earlier (∼400 msec) positive peak reminiscent of a P3 response and a later (∼800-1400 msec) sustained positivity over several sites reminiscent of the late directing attention positivity. Overall, the evoked potentials for refreshing representations from three different visual categories (faces, scenes, words) were similar, but multivariate pattern analysis showed that some category information was nonetheless present in the EEG signal. When related to previous fMRI studies, these results are consistent with a two-phase model, with the first phase dominated by frontal control signals involved in initiating refreshing and the second by the top-down modulation of posterior perceptual cortical areas that constitutes refreshing a representation. This study also lays the foundation for future studies of the neural correlates of reflective attention at a finer temporal resolution than is possible using fMRI.

An investigation into the removal of Salmonella and enteric indicator bacteria from the separated liquid fraction of raw or anaerobically digested pig manure using novel on-farm woodchip biofilters

The objective was to investigate the removal of Salmonella and enteric indicator bacteria from the liquid fraction of raw and anaerobically digested (AD) pig manure in woodchip biofilters over a 14 week (98 day) period. Antibiotic susceptible Salmonella Infantis was detected in one influent material (liquid fraction of raw manure) on two occasions but was not found in the effluent at any time point. Furthermore, mean coliform reductions of 56% were observed in the biofilters treating the liquid fraction of raw manure. However, a mean increase of 228% was found in those treating the liquid from AD manure, despite the fact that the microbial challenge to these biofilters was lower. In addition, relatively high coliform counts were still present in the effluent from both biofilter treatments, especially in the systems treating the liquid fraction of AD manure. However, findings for Escherichia coli and Enterococcus were more promising, with reductions observed for both treatments (10 and 18.5% for E. coli and 71 and 87% for Enterococcus). Moreover, E. coli and Enterococcus were at, or just above, the limit of detection in the final effluents. Overall, although, there are no microbial limits for discharge or washwaters, the woodchip filter effluent would appear safe for discharge to waterways or use on-farm as regards Salmonella, E. coli and Enterococcus but not coliform. In conclusion, woodchip biofilters offer potential as a low-cost sustainable novel treatment option for the removal of pathogens from the liquid fraction of pig manure.

Amygdala-prefrontal cortex functional connectivity during threat-induced anxiety and goal distraction

BACKGROUND

Anxiety produced by environmental threats can impair goal-directed processing and is associated with a range of psychiatric disorders, particularly when aversive events occur unpredictably. The prefrontal cortex (PFC) is thought to implement controls that minimize performance disruptions from threat-induced anxiety and goal distraction by modulating activity in regions involved in threat detection, such as the amygdala. The inferior frontal gyrus (IFG), orbitofrontal cortex (OFC), and ventromedial PFC (vmPFC) have been linked to the regulation of anxiety during threat exposure. We developed a paradigm to determine if threat-induced anxiety would enhance functional connectivity between the amygdala and IFG, OFC, and vmPFC.

METHODS

Healthy adults performed a computer-gaming style task involving capturing prey and evading predators to optimize monetary rewards while exposed to the threat of unpredictable shock. Psychophysiological recording (n = 26) and functional magnetic resonance imaging scanning (n = 17) were collected during the task in separate cohorts. Task-specific changes in functional connectivity with the amygdala were examined using psychophysiological interaction analysis.

RESULTS

Threat exposure resulted in greater arousal measured by increased skin conductance but did not influence performance (i.e., monetary losses or rewards). Greater functional connectivity between the right amygdala and bilateral IFG, OFC, vmPFC, anterior cingulate cortex, and frontopolar cortex was associated with threat exposure.

CONCLUSIONS

Exposure to unpredictable threat modulates amygdala-PFC functional connectivity that may help maintain performance when experiencing anxiety induced by threat. Our paradigm is well-suited to explore the neural underpinnings of the anxiety response to unpredictable threat in patients with various anxiety disorders.

Functional Heterogeneity and Convergence in the Right Temporoparietal Junction

The right temporoparietal junction (rTPJ) is engaged by tasks that manipulate biological motion processing, Theory of Mind attributions, and attention reorienting. The proximity of activations elicited by these tasks raises the question of whether these tasks share common cognitive component processes that are subserved by common neural substrates. Here, we used high-resolution whole-brain functional magnetic resonance imaging in a within-subjects design to determine whether these tasks activate common regions of the rTPJ. Each participant was presented with the 3 tasks in the same imaging session. In a whole-brain analysis, we found that only the right and left TPJs were activated by all 3 tasks. Multivoxel pattern analysis revealed that the regions of overlap could still discriminate the 3 tasks. Notably, we found significant cross-task classification in the right TPJ, which suggests a shared neural process between the 3 tasks. Taken together, these results support prior studies that have indicated functional heterogeneity within the rTPJ but also suggest a convergence of function within a region of overlap. These results also call for further investigation into the nature of the function subserved in this overlap region.

Face, eye, and body selective responses in fusiform gyrus and adjacent cortex: an intracranial EEG study

Functional MRI (fMRI) studies have investigated the degree to which processing of whole faces, face-parts, and bodies are differentially localized within the fusiform gyrus and adjacent ventral occipitotemporal cortex. While some studies have emphasized the spatial differentiation of processing into discrete areas, others have emphasized the overlap of processing and the importance of distributed patterns of activity. Intracranial EEG (iEEG) recorded from subdural electrodes provides excellent temporal and spatial resolution of local neural activity, and thus provides an alternative method to fMRI for studying differences and commonalities in face and body processing. In this study we recorded iEEG from 12 patients while they viewed images of novel faces, isolated eyes, headless bodies, and flowers. Event-related potential analysis identified 69 occipitotemporal sites at which there was a face-, eye-, or body-selective response when contrasted to flowers. However, when comparing faces, eyes, and bodies to each other at these sites, we identified only 3 face-specific, 13 eye-specific, and 1 body-specific electrodes. Thus, at the majority of sites, faces, eyes, and bodies evoked similar responses. However, we identified ten locations at which the amplitude of the responses spatially varied across adjacent electrodes, indicating that the configuration of current sources and sinks were different for faces, eyes, and bodies. Our results also demonstrate that eye-sensitive regions are more abundant and more purely selective than face- or body-sensitive regions, particularly in lateral occipitotemporal cortex.

Discriminable spatial patterns of activation for faces and bodies in the fusiform gyrus

Functional neuroimaging studies consistently report that the visual perception of faces and bodies strongly activates regions within ventral occipitotemporal cortex (VOTC) and, in particular, within the mid-lateral fusiform gyrus. One unresolved issue is the degree to which faces and bodies activate discrete or overlapping cortical regions within this region. Here, we examined VOTC activity to faces and bodies at high spatial resolution, using univariate and multivariate analysis approaches sensitive to differences in both the strength and spatial pattern of activation. Faces and bodies evoked substantially overlapping activations in the fusiform gyrus when each was compared to the control category of houses. No discrete regions of activation for faces and bodies in the fusiform gyrus survived a direct statistical comparison using standard univariate statistics. However, multi-voxel pattern analysis differentiated faces and bodies in regions where univariate analysis found no significant difference in the strength of activation. Using a whole-brain multivariate searchlight approach, we also found that extensive regions in VOTC beyond those defined as fusiform face and body areas using standard criteria where the spatial pattern of activation discriminated faces and bodies. These findings provide insights into the spatial distribution of face- and body-specific activations in VOTC and the identification of functionally specialized regions.

Perceived animacy influences the processing of human-like surface features in the fusiform gyrus

While decades of research have demonstrated that a region of the right fusiform gyrus (FG) responds selectively to faces, a second line of research suggests that the FG responds to a range of animacy cues, including biological motion and goal-directed actions, even in the absence of faces or other human-like surface features. These findings raise the question of whether the FG is indeed sensitive to faces or to the more abstract category of animate agents. The current study uses fMRI to examine whether the FG responds to all faces in a category-specific way or whether the FG is especially sensitive to the faces of animate agents. Animate agents are defined here as intentional agents with the capacity for rational goal-directed actions. Specifically, we examine how the FG responds to an entity that looks like an animate agent but that lacks the capacity for goal-directed rational action. Region-of-interest analyses reveal that the FG activates more strongly to the animate compared with the inanimate entity, even though the surface features of both animate and inanimate entities were identical. These results suggest that the FG does not respond to all faces in a category-specific way, and is instead especially sensitive to whether an entity is animate.

A multi-scanner study of subcortical brain volume abnormalities in schizophrenia

Schizophrenia patients show significant subcortical brain abnormalities. We examined these abnormalities using automated image analysis software and provide effect size estimates for prospective multi-scanner schizophrenia studies. Subcortical and intracranial volumes were obtained using FreeSurfer 5.0.0 from high-resolution structural imaging scans from 186 schizophrenia patients (mean age±S.D.=38.9±11.6, 78% males) and 176 demographically similar controls (mean age±S.D.=37.5±11.2, 72% males). Scans were acquired from seven 3-Tesla scanners. Univariate mixed model regression analyses compared between-group volume differences. Weighted mean effect sizes (and number of subjects needed for 80% power at α=0.05) were computed based on the individual single site studies as well as on the overall multi-site study. Schizophrenia patients have significantly smaller intracranial, amygdala, and hippocampus volumes and larger lateral ventricle, putamen and pallidum volumes compared with healthy volunteers. Weighted mean effect sizes based on single site studies were generally larger than effect sizes computed based on analysis of the overall multi-site sample. Prospectively collected structural imaging data can be combined across sites to increase statistical power for meaningful group comparisons. Even when using similar scan protocols at each scanner, some between-site variance remains. The multi-scanner effect sizes provided by this study should help in the design of future multi-scanner schizophrenia imaging studies.