Reducing Grip Uncertainty During Initial Prosthetic Hand Use Improves Eye-Hand Coordination and Lowers Mental Workload

The reliance on vision to control a myoelectric prosthesis is cognitively burdensome and contributes to device abandonment. The feeling of uncertainty when gripping an object is thought to be the cause of this overreliance on vision in hand-related actions. We explored if experimentally reducing grip uncertainty alters the visuomotor control and mental workload experienced during initial prosthesis use. In a repeated measures design, twenty-one able-bodied participants took part in a pouring task across three conditions: (a) using their anatomical hand, (b) using a myoelectric prosthetic hand simulator, and (c) using a myoelectric prosthetic hand simulator with Velcro attached to reduce grip uncertainty. Performance, gaze behaviour (using mobile eye-tracking) and self-reported mental workload, was measured. Results showed that using a prosthesis (with or without Velcro) slowed task performance, impaired typical eye-hand coordination and increased mental workload compared to anatomic hand control. However, when using the prosthesis with Velcro, participants displayed better prosthesis control, more effective eye-hand coordination and reduced mental workload compared to when using the prosthesis without Velcro. These positive results indicate that reducing grip uncertainty could be a useful tool for encouraging more effective prosthesis control strategies in the early stages of prosthetic hand learning.

The corticomuscular response to experimental pain via blood flow occlusion when applied to the ipsilateral and contralateral leg during an isometric force task

Blood flow occlusion (BFO) has been previously used to investigate physiological responses to muscle ischemia, showing increased perceptual effort (RPE) and pain along with impaired neuromuscular performance. However, at present, it is unclear how BFO alters corticomuscular activities when either applied to the exercising or nonexercising musculature. The present study therefore set out to assess the corticomuscular response to these distinct BFO paradigms during an isometric contraction precision task. In a repeated measures design, fifteen participants (age = 27.00 ± 5.77) completed 15 isometric contractions across three experimental conditions; no occlusion (CNTRL), occlusion of the contralateral (i.e., nonexercising) limb (CON-OCC), and occlusion of the ipsilateral (i.e., exercising) limb (IPS-OCC). Measures of force, electroencephalographic (EEG), and electromyographic (EMG) were recorded during contractions. We observed that IPS-OCC broadly impaired force steadiness, elevated EMG of the vastus lateralis, and heightened RPE and pain. IPSI-OCC also significantly decreased corticomuscular coherence during the early phase of contraction and decreased EEG alpha activity across the sensorimotor and temporoparietal regions during the middle and late phases of contraction compared with CNTRL. By contrast, CON-OCC increased perceived levels of pain (but not RPE) and decreased EEG alpha activity across the prefrontal cortex during the middle and late phases of contraction, with no changes observed for EMG and force steadiness. Together, these findings highlight distinctive psychophysiological responses to experimental pain via BFO showing altered cortical activities (CON-OCC) and altered cortical, corticomuscular, and neuromuscular activities (IPS-OCC) when applied to the lower limbs during an isometric force precision task.

Minimally invasive laparo-thoracoscopic Ivor-Lewis esophagectomy with semi-mechanical triangular anastomosis: Short-term outcomes of 114 consecutive patients

INTRODUCTION

Several surgical teams have developed so-called minimally invasive esophagectomy techniques with the intention of decreasing post-operative complications. The goal of this report is to determine the feasibility, reproducibility, morbidity and mortality of esophagectomy and intrathoracic anastomosis via thoracoscopy.

METHODS

This retrospective series included 114 consecutive non-selected patients who underwent Lewis Santy type esophagectomy between 2016 and 2020. The procedure was performed via abdominal laparoscopy, thoracoscopy with the patient in a supine position, without selective intubation, with intra-thoracic semi-mechanical triangular esophagogastric anastomosis.

RESULTS

Mean patient age was 62.8years. Conversion from laparoscopy to laparotomy was required in three patients (2.6%); no patient required conversion from thoracoscopy to thoracotomy. A semi-mechanical triangular esophagogastric anastomosis was successfully performed in all patients. Median duration of hospital stay was 16 (8-116) days. Mortality was 2.6%; 34 patients (29.8%) had major complications, 55 (48%) had a respiratory complication. The leakage rate was 12.3%; most were type I. Only 5.2% required an additional procedure. There was no mortality.

CONCLUSION

The analysis of this consecutive series found that this operative technique was reproducible and reliable. These results need to be confirmed by other studies. Pulmonary morbidity was high and remains the main challenge in this type of surgery.

Short report presenting preliminary evidence of impaired corticomuscular coherence in an individual with Developmental Coordination Disorder

BACKGROUND

It has been suggested that developmental coordination disorder (DCD) could be caused by a 'dysconnection' in brain and skeletal muscle communication. To date no previous work has examined the integrity of this neuromuscular process in individuals with DCD.

AIMS

To conduct a feasibility study for measuring functional connectivity of the brain and muscle in an individual with DCD using corticomuscular coherence (CMC).

METHODS AND PROCEDURES

An individual with DCD and a typically developing (TD) participant completed a series of sustained 5-second voluntary isometric hand contractions (15 ± 5 % MVC) on a handheld dynamometer under both single and dual task (i.e., counting backwards) conditions. EEG, EMG and force data were collected.

OUTCOMES AND RESULTS

The participant with DCD displayed poorer force steadiness and higher mental demand compared to the TD participant and in dual task conditions. The TD participant displayed a commonly observed pattern of CMC that was highly localised over the contralateral hand area, the DCD participant displayed a less localised CMC across cortical regions.

CONCLUSIONS AND IMPLICATIONS

These findings support the feasibility of measuring CMC in DCD populations and offer some, albeit preliminary, evidence of impaired communication between the brain and muscles in these individuals.

Update on the diagnosis and management of autoimmune encephalitis

In recent years, autoimmunity has been increasingly recognised as an important cause of encephalitis. Many different antibodies are now known to target antigens on the neuronal surface, and some of these are associated with characteristic clinical presentations, although seronegative cases are also recognised. Autoimmune encephalitis may mimic other conditions, including primary psychiatric disorders, particularly early in the disease. Because early immune treatment of autoimmune encephalitis improves patient outcomes, and indeed many make a good recovery, it is important to recognise these syndromes promptly.

Combined action observation and motor imagery facilitates visuomotor adaptation in children with developmental coordination disorder

The internal modelling deficit (IMD) hypothesis suggests that motor control issues associated with Developmental Coordination Disorder (DCD) are the result of impaired predictive motor control. In this study, we examined the benefits of a combined action observation and motor imagery (AO + MI) intervention designed to alleviate deficits in internal modelling and improve eye-hand coordination during a visuomotor rotation task. Twenty children with DCD were randomly assigned to either an AO + MI group (who watched a video of a performer completing the task whilst simultaneously imagining the kinaesthetic sensations associated with action execution) or a control group (who watched unrelated videos involving no motor content). Each group then attempted to learn a 90° visuomotor rotation while measurements of completion time, eye-movement behaviour and movement kinematics were recorded. As predicted, after training, the AO + MI group exhibited quicker completion times, more target-focused eye-movement behaviour and smoother movement kinematics compared to the control group. No significant after-effects were present. These results offer further support for the IMD hypothesis and suggest that AO + MI interventions may help to alleviate such deficits and improve motor performance in children with DCD.

Liquid Chromatographic Determination of Ochratoxin A in Barley, Wheat Bran, and Rye by the AOAC/IUPAC/NMKL Method: NMKL Collaborative Study1

In an inter laboratory study of the AOAC/lnternational Union of Pure and Applied Chemistry (IUPAC)/ Nordic Committee on Food Analysis (NMKL) liquid chromatographic method for ochratoxin A (OTA), 3 spiked samples each of wheat bran and rye and 3 naturally contaminated barley samples with expected OTA contents between 2 and 9 μg/kg were analyzed by 12 European laboratories. Mean recoveries ranged from 64 to 72%. Within-laboratory standard deviations were 21,17, and 12% for wheat bran, rye, and barley, respectively. Corresponding between-laboratory standard deviations were 23-28,20-28, and 18-31%. Horwitz ratio values ranged from 0.50 to 0.77. The method was accepted as an official NMKL method for determining OTA at ≥2 μg/kg in cereals and cereal products.

Visual attention, EEG alpha power and T7-Fz connectivity are implicated in prosthetic hand control and can be optimized through gaze training

Background

Prosthetic hands impose a high cognitive burden on the user that often results in fatigue, frustration and prosthesis rejection. However, efforts to directly measure this burden are sparse and little is known about the mechanisms behind it. There is also a lack of evidence-based training interventions designed to improve prosthesis hand control and reduce the mental effort required to use them. In two experiments, we provide the first direct evaluation of this cognitive burden using measurements of EEG and eye-tracking (Experiment 1), and then explore how a novel visuomotor intervention (gaze training; GT) might alleviate it (Experiment 2).

Methods

In Experiment 1, able-bodied participants (n = 20) lifted and moved a jar, first using their anatomical hand and then using a myoelectric prosthetic hand simulator. In experiment 2, a GT group (n = 12) and a movement training (MT) group (n = 12) trained with the prosthetic hand simulator over three one hour sessions in a picking up coins task, before returning for retention, delayed retention and transfer tests. The GT group received instruction regarding how to use their eyes effectively, while the MT group received movement-related instruction typical in rehabilitation.

Results

Experiment 1 revealed that when using the prosthetic hand, participants performed worse, exhibited spatial and temporal disruptions to visual attention, and exhibited a global decrease in EEG alpha power (8-12 Hz), suggesting increased cognitive effort. Experiment 2 showed that GT was the more effective method for expediting prosthesis learning, optimising visual attention, and lowering conscious control – as indexed by reduced T7-Fz connectivity. Whilst the MT group improved performance, they did not reduce hand-focused visual attention and showed increased conscious movement control. The superior benefits of GT transferred to a more complex tea-making task.

Conclusions

These experiments quantify the visual and cortical mechanisms relating to the cognitive burden experienced during prosthetic hand control. They also evidence the efficacy of a GT intervention that alleviated this burden and promoted better learning and transfer, compared to typical rehabilitation instructions. These findings have theoretical and practical implications for prosthesis rehabilitation, the development of emerging prosthesis technologies and for the general understanding of human-tool interactions.

Electronic supplementary material

The online version of this article (10.1186/s12984-019-0524-x) contains supplementary material, which is available to authorized users.

Widening interest, widening participation: factors influencing school students' aspirations to study medicine

BACKGROUND

Under-representation of some socio-economic groups in medicine is rooted in under-representation of those groups in applications to medical school. This study aimed to explore what may deter school-age children from applying to study medicine.

METHODS

Workshops were undertaken with school students aged 16-17 years ('Year 12', n = 122 across three workshops) and 13-14 years ('Year 9', n = 295 across three workshops). Workshops used a variety of methods to identify and discuss participants' perceptions of medicine, medical school and the application process. Year 12 workshops focused on applications and medical school, while Year 9 took a broader approach reflecting their relative distance from applying. Subsequent workshops were informed by the findings of earlier ones.

RESULTS

The main finding was that potential applicants had limited knowledge about medicine and medical school in several areas. Older students would benefit from accessible information about medical degrees and application processes, access to work experience opportunities and personal contact with medical students and junior doctors, particularly those from a similar background. Younger students demonstrated a lack of awareness of the breadth of medical careers and a limited understanding of what medicine encompasses. Many Year 9 students were attracted by elements of practice which they did not associate with medicine, such as 'talking to people with mental health problems'. An exercise addressing this elicited an increase in their interest in medicine. These issues were identified by participants as being more marked for those without knowledgeable support at home or school. It was apparent that school teachers may not be equipped to fill these knowledge gaps.

CONCLUSION

Gaps in knowledge and support may reflect the importance of 'social capital' in facilitating access to medical school. Medical schools could act as hubs to introduce students to resources which are essential for widening participation. Outreach and support to schools may ensure that fundamental knowledge gaps are equitably addressed for all prospective applicants. More generally, a focus on medicine which under-emphasises aspects of medical practice involving communication may deter some students and have longer term impact on recruitment to careers including general practice and psychiatry.

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

BACKGROUND

Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world.

METHODS

This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231.

FINDINGS

Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p<0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05-2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p<0·001).

INTERPRETATION

Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication.

FUNDING

DFID-MRC-Wellcome Trust Joint Global Health Trial Development Grant, National Institute of Health Research Global Health Research Unit Grant.

Descending aortic aneurysm in Wiskott-Aldrich syndrome: options for repair

We report open surgical repair of a previously stented descending thoracic aneurysm in a patient with Wiskott-Aldrich syndrome and a platelet count <10 × 109·L−1. The same patient was described previously in a report of the first endovascular stent in this form of vasculitis. We describe the pre- and intraoperative management, and suggest a change in strategy in this setting.

Examining the Spatiotemporal Disruption to Gaze When Using a Myoelectric Prosthetic Hand

The aim of this study was to provide a detailed account of the spatial and temporal disruptions to eye-hand coordination when using a prosthetic hand during a sequential fine motor skill. Twenty-one able-bodied participants performed 15 trials of the picking up coins task derived from the Southampton Hand Assessment Procedure with their anatomic hand and with a prosthesis simulator while wearing eye-tracking equipment. Gaze behavior results revealed that when using the prosthesis, performance detriments were accompanied by significantly greater hand-focused gaze and a significantly longer time to disengage gaze from manipulations to plan upcoming movements. The study findings highlight key metrics that distinguish disruptions to eye-hand coordination that may have implications for the training of prosthesis use.

The AIDS Crisis: Review of Psychological Issues and Implications, with Special Reference to the South African Situation

AIDS represents a major challenge to the health care industry. The behavioural sciences, especially psychology, have important contributions to make to various aspects of AIDS and its prevention. This article reviews the stages in the development of AIDS, examining the psychological issues and implications at each stage. Special attention is given to the unique South African situation with respect to AIDS. The article concludes by examining the present and prospective position of psychology in SA with respect to AIDS.

[Neurofeedback in the Treatment of Anorexia Nervosa: a Case Report]

Anorexia nervosa has been related to alterations in brain activity in terms of hyperactive EEG patterns. This case report illustrates the principles and results of a five-week neurofeedback treatment in a 29-year-old woman suffering from anorexia nervosa. A neurofeedback protocol to enhance alpha activity (8 - 12 Hz) was developed and conducted additionally to the standardized treatment for eating disorders in training sessions twice a week. Pre- and post-test measurements included resting state EEG measurements and a psychological test battery. The results show improvements from pre- to post-test in eating disorder psychopathology including psychological wellbeing, emotional competence, and eating behavior traits. In addition, a decrease in theta power (4 - 7 Hz), a well-known trait marker of anorexia nervosa, was measured. However, our data should be interpreted with caution because this is a single case study. Nevertheless, this report documents the practicability and method of neurofeedback as treatment adjunct in eating disorders from the clinical perspective. Although the use of neurofeedback in the treatment of anorexia nervosa is recommended in literature, empirical studies are still lacking. Randomized controlled trials to evaluate short- and long-term effects of neurofeedback are needed.

Reliability of OperaVOX against Multidimensional Voice Program (MDVP)

OBJECTIVE

To evaluate the agreement between OperaVOX and MDVP.

DESIGN

Cross sectional reliability study.

SETTING

University teaching hospital.

METHODS

Fifty healthy volunteers and 50 voice disorder patients had supervised recordings in a quiet room using OperaVOX by the iPod's internal microphone with sampling rate of 45 kHz. A five-seconds recording of vowel/a/was used to measure fundamental frequency (F0), jitter, shimmer and noise-to-harmonic ratio (NHR). All healthy volunteers and 21 patients had a second recording. The recorded voices were also analysed using the MDVP. The inter- and intrasoftware reliability was analysed using intraclass correlation (ICC) test and Bland-Altman (BA) method. Mann-Whitney test was used to compare the acoustic parameters between healthy volunteers and patients.

RESULTS

Nine of 50 patients had severe aperiodic voice. The ICC was high with a confidence interval of >0.75 for the inter- and intrasoftware reliability except for the NHR. For the intersoftware BA analysis, excluding the severe aperiodic voice data sets, the bias (95% LOA) of F0, jitter, shimmer and NHR was 0.81 (11.32, -9.71); -0.13 (1.26, -1.52); -0.52 (1.68, -2.72); and 0.08 (0.27, -0.10). For the intrasoftware reliability, it was -1.48 (18.43, -21.39); 0.05 (1.31, -1.21); -0.01 (2.87, -2.89); and 0.005 (0.20, -0.18), respectively. Normative data from the healthy volunteers were obtained. There was a significant difference in all acoustic parameters between volunteers and patients measured by the Opera-VOX (P < 0.001) except for F0 in females (P = 0.87).

CONCLUSION

OperaVOX is comparable to MDVP and has high internal consistency for measuring the F0, jitter and shimmer of voice except for the NHR.

Advanced methods for time-varying effective connectivity estimation in memory processes

Memory processes are based on large cortical networks characterized by non-stationary properties and time scales which represent a limitation to the traditional connectivity estimation methods. The recent development of connectivity approaches able to consistently describe the temporal evolution of large dimension connectivity networks, in a fully multivariate way, represents a tool that can be used to extract novel information about the processes at the basis of memory functions. In this paper, we applied such advanced approach in combination with the use of state-of-the-art graph theory indexes, computed on the connectivity networks estimated from high density electroencephalographic (EEG) data recorded in a group of healthy adults during the Sternberg Task. The results show how this approach is able to return a characterization of the main phases of the investigated memory task which is also sensitive to the increased length of the numerical string to be memorized.

Quiet eye training facilitates visuomotor coordination in children with developmental coordination disorder

INTRODUCTION

Quiet eye training (QET) has been shown to be more effective than traditional training (TT) methods for teaching a throw and catch task to typically developing 8-10 yr old children. The current study aimed to apply the technique to children with developmental coordination disorder (DCD).

METHOD

30 children with DCD were randomly allocated into TT or QET intervention groups. The TT group were taught how to control their arm movements during the throw and catch phases, while the QET group were also taught to fixate a target location on the wall prior to the throw (quiet eye1; QE1), followed by tracking the ball prior to the catch (quiet eye2; QE2). Performance, gaze and motion analysis data were collected at pre/post-training and 6-week retention.

RESULTS

The QET group significantly increased QE durations from pre-training to delayed retention (QE1 = +247 ms, QE2 = +19%) whereas the TT group experienced a reduction (QE1 = -74 ms, QE2 = -4%). QET participants showed significant improvement in the quality of their catch attempts and increased elbow flexion at catch compared to the TT group (QET = -28°, TT = -1°).

CONCLUSION

QET changed DCD children's ability to focus on a target on the wall prior to the throw, followed by better anticipation and pursuit tracking on the ball, which in turn led to improved catching technique. QET may be an effective adjunct to traditional instructions, for therapists teaching visuomotor skills to children with DCD.

The role of epithelial mesenchymal transition and resistance to neoadjuvant therapy in locally advanced rectal cancer

AIM

Nonresponse to neoadjuvant therapy is a significant challenge for clinicians managing solid cancers. This study aimed to determine whether epithelial mesenchymal transition (EMT) was associated with nonresponse to neoadjuvant therapy in patients with locally advanced rectal cancer.

METHOD

Representative tissue specimens from the tumour-invasive front of consecutive patients undergoing resection of rectal cancer from 2009 to 2011 were used. Patients with marked regression to neoadjuvant therapy were classified as responders and the remainder were classified as nonresponders. Markers of EMT included reduced immunohistochemical expression of membranous E-cadherin, increased nuclear beta-catenin expression and tumour budding. In-situ hybridization was used to assess the expression of microRNA-200c (mir200c), an upstream master-regulator of EMT.

RESULTS

Of 103 patients undergoing resection of rectal cancer, 69 received neoadjuvant chemoradiotherapy; 65% of these were nonresponders. Reduced expression of mir200c was significantly associated with a higher T grade. Reduced membranous E-cadherin, increased nuclear beta-catenin and tumour budding individually predicted the presence of extramural vascular invasion. Reduced E-cadherin, nucleic beta-catenin, reduced expression of mir200c and tumour budding were all significantly associated with nonresponse to neoadjuvant therapy (all P < 0.001). Reduced E-cadherin and expression of mir200c were both associated with reduced cancer-specific survival (log-rank P-values 0.036 and 0.009, respectively).

CONCLUSION

Targeted biomarkers of EMT were associated with nonresponse to neoadjuvant therapy and reduced survival in advanced rectal cancer. EMT may provide a practical clinical biomarker and a novel therapeutic target to improve the proportion of patients who respond to neoadjuvant therapy.

Changes in hemodynamic signals accompanying motor imagery and motor execution of swallowing: a near-infrared spectroscopy study

In the present study we investigated hemodynamic changes in the brain in response to motor execution (ME) and motor imagery (MI) of swallowing using near-infrared spectroscopy (NIRS). Previous studies provide evidence that ME and MI of limb movements lead to comparable brain activation patterns indicating the potential value of MI for motor rehabilitation. In this context, identifying brain correlates of MI of swallowing may be potentially useful for the treatment of dysphagia. Fourteen healthy participants actively swallowed water (ME) and mentally imagined to swallow water (MI) in a randomized order while changes in concentration of oxygenated hemoglobin (oxy-Hb) and deoxygenated hemoglobin (deoxy-Hb) were assessed. MI and ME led to the strongest NIRS signal changes in the inferior frontal gyrus. During and after ME, oxy-Hb significantly increased, with a maximum peak around 15s after task onset. In contrast, oxy-Hb decreased during MI compared to a rest period probably because of motor inhibition mechanisms. Changes in deoxy-Hb were largely comparable between MI and ME, especially when participants used a kinesthetic motor imagery strategy during MI compared to no specific strategy. Hence, the present study provides new evidence concerning timing and topographical distribution of the hemodynamic response during ME and MI of swallowing.

Near-infrared spectroscopy based neurofeedback training increases specific motor imagery related cortical activation compared to sham feedback

In the present study we implemented a real-time feedback system based on multichannel near-infrared spectroscopy (NIRS). Prior studies indicated that NIRS-based neurofeedback can enhance motor imagery related cortical activation. To specify these prior results and to confirm the efficacy of NIRS-based neurofeedback, we examined changes in blood oxygenation level collected in eight training sessions. One group got real feedback about their own brain activity (N=9) and one group saw a playback of another person's feedback recording (N=8). All participants performed motor imagery of a right hand movement. Real neurofeedback induced specific and focused brain activation over left motor areas. This focal brain activation became even more specific over the eight training sessions. In contrast, sham feedback led to diffuse brain activation patterns over the whole cortex. These findings can be useful when training patients with focal brain lesions to increase activity of specific brain areas for rehabilitation purpose.

Dapsone-induced methemoglobinemia in renal transplant recipients: more prevalent than previously thought

BACKGROUND

After an outbreak of Pneumocystis pneumonia (PCP) in our nephrology unit, dapsone was used as the second-line chemoprophylactic agent. Dapsone is the most common cause of drug-induced methemoglobinemia (MHb). Its prevalence is poorly described in the renal transplant population. Because dapsone is excreted by the kidneys, we hypothesized that the rate of MHb in these patients would be higher than previously reported. We aimed to describe the demographics, risk factors, and presenting features of MHb in these renal transplant patients.

METHODS

Twenty-six transplant recipients commenced on dapsone for chemoprophylaxis against PCP from February to September 2011. All patients had normal glucose-6-phosphate dehydrogenase levels before treatment. Characteristics of patients with MHb were compared with those of the rest of the cohort to determine potential risk factors.

RESULTS

Twelve (46%) patients developed MHb (levels 6.4 ± 4.1%). Six (50%) of the patients with MHb were asymptomatic on presentation. Cases had a mean drop in hemoglobin of 19 ± 7%. MHb led to five admissions (median length of stay 5 days, range 1-10 days). MHb level showed a strong correlation with the length of stay (correlation coefficient 0.762, P = 0.002).

CONCLUSION

This is the highest reported prevalence of MHb, to our knowledge, in patients receiving dapsone, and its use led to significant hospitalization in this population. This study raises concerns about the use of dapsone as chemoprophylaxis in renal transplant recipients.

[Evaluation of the impact of prescription analgesic during the anaesthesia consultation on the incidence of postoperative pain at home in ambulatory orthopaedic surgery]

INTRODUCTION

Postoperative pain at home in ambulatory surgery is a major problem. To improve its management, the French society of anaesthesia emphasizes the importance of writing prescriptions for analgesic during the preanaesthetic consultation. The objective of this study was to assess the impact of this prescription on the incidence of postoperative pain at home in ambulatory orthopaedic surgery.

PATIENT AND METHODS

We conducted a prospective evaluation in the ambulatory surgery unit of Rouen University Hospital. We were able to identify two periods of 1 year with implementation of a systematic prescription of analgesics during the postoperative period (P1) or during the preanaesthetic consultation (P2). The evaluation of this measurement was made by a telephone survey conducted the day after surgery. The main parameter was the incidence of postoperative pain at home defined by the occurrence of a pain greater to 3/10 on a numerical scale (FR). Secondary parameters were demographic and anaesthetic data, the incidence of moderate pain (FR ≤ 3), treatment adherence and patient satisfaction.

RESULTS

We included 638 patients and 531 were analysed: 28% of patients had an EN greater than 3 the day following surgery. There is no difference between the two periods (30% for P1 versus 27% for P2). The analysis of subgroups showed that in the general anaesthesia group, 30% of patients had an EN greater than 3 for P1 versus 18% for P2 (P<0.01). Furthermore, 55% of patients expressed moderate pain (FR ≤ 3) for P1 versus 22% for P2 (P<0.01). Moreover, 89% of patients reported having an adequate analgesic treatment. The overall observance was 64%, 53% for P1 versus 75% for P2 (P<0.01).

DISCUSSION

The systematic prescription of analgesics during the preanaesthetic consultation does not decrease the intensity of moderate to severe pain. On the other hand, this procedure seems to be positive for the people who underwent a general anaesthesia.

Sharps injuries among nurses in a Thai regional hospital: prevalence and risk factors

BACKGROUND

Sharps injuries (SIs) are one of the most serious occupational accidents among nurses due to the possible severe consequences, such as the transmission of infectious diseases and inducing of mental impairment.

OBJECTIVE

To discover the prevalence of SIs among nurses in a regional hospital in Thailand and to identify factors associated with SIs.

METHODS

A cross-sectional study was conducted in 2011. Stratified random sampling was used to select the respondents, with wards as the strata and the number of nurses selected proportional to the size of the ward nurse population. 261 self-administered questionnaires were distributed to nurses who used needles, syringes or other sharp medical equipment in their work. Data were analyzed using chi-square tests, correlation analysis and multiple logistic regression analysis.

RESULTS

The prevalence of SIs for the previous 12 months was 55.5% among the 250 nurses who returned a completed questionnaire. Of these, 91.1% were with blood. Needles (52.8%) were the main cause of SIs. The reporting rate of SIs to the hospital was 23.8%. SIs had a significant association with each of marital status, work duration, work department, attitude regarding SI prevention, and preventive management. Using multiple logistic regression analysis, attitude was found to be the strongest predictor of SIs when adjusted for other factors. Nurses who had negative attitudes towards prevention of SIs were nearly two times more likely to have SIs than those with positive attitudes (adjusted odds ratio = 1.86; 95% CI: 1.03-3.38).

CONCLUSION

The study showed a high prevalence of SIs, but a low reporting rate. This suggests the reporting system requires simplification and also should include a quick response management component. Promoting positive attitudes to SI prevention, and improving the reporting system would reduce SIs.