Accuracy and trending ability of the fourth-generation FloTrac/Vigileo System™ in patients undergoing abdominal aortic aneurysm surgery

Abstract

Purpose

The fourth-generation FloTrac/Vigileo™ improved its algorithm to follow changes in systemic vascular resistance index (SVRI). This revision may improve the accuracy and trending ability of CI even in patients who undergo abdominal aortic aneurysm (AAA) surgery which cause drastic change of SVRI by aortic clamping. The purpose of this study is to elucidate the accuracy and trending ability of the fourth-generation FloTrac/Vigileo™ in patients with AAA surgery by comparing the FloTrac/Vigileo™-derived CI (CI_FT) with that measured by three-dimensional echocardiography (CI_3D).

Methods

Twenty-six patients undergoing elective AAA surgery were included in this study. CI_FT and CI3_D were determined simultaneously in eight points including before and after aortic clamp. We used CI_3D as the reference method.

Results

In the Bland–Altman analysis, CI_FT had a wide limit of agreement with CI_3D showing a percentage error of 46.7%. Subgroup analysis showed that the percentage error between CO_3D and CO_FT was 56.3% in patients with cardiac index < 2.5 L/min/m² and 28.4% in patients with cardiac index ≥ 2.5 L/min/m². SVRI was significantly higher in patients with cardiac index < 2.5 L/min/m² (1703 ± 330 vs. 2757 ± 798; p < 0.001). The tracking ability of fourth generation of FloTrac/Vigileo™ after aortic clamp was not clinically acceptable (26.9%).

Conclusions

The degree of accuracy of the fourth-generation FloTrac/Vigileo™ in patients with AAA surgery was not acceptable. The tracking ability of the fourth-generation FloTrac/Vigileo™ after aortic clamp was below the acceptable limit.

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Correction to: A Systematic Review of Community Health Workers’ Role in Occupational Safety and Health Research

Abstract

The original version of this article unfortunately contained a mistake in the affiliation of co-author Ashley M. Bush.

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Frequency of awake bruxism behaviours in the natural environment. A 7‐day, multiple‐point observation of real‐time report in healthy young adults

Journal of Oral Rehabilitation, EarlyView.


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Surveillance of Drug-Resistant Tuberculosis in Spain (2001–2015)

Microbial Drug Resistance, Ahead of Print.


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Rapid Determination of Resistance to Antibiotic Inhibitors of Protein Synthesis in Staphylococcus aureus Through In Situ Evaluation of DNase Activity

Microbial Drug Resistance, Ahead of Print.


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S16-2. Strategy in anesthetic management for intraoperative neuromonitoring

The development of postoperative functional dysfunction can have an impact on the length of hospital stay, total medical costs, and necessity of dependency. To maintain functional integrity, neuromonitoring including motor evoked potential (MEP), sensory evoked potential, and visual evoked potential, has been conducted during the operation. Anesthetic management is usually based on the maintenance of MEP, which is most susceptible to suppression by anesthetic agents. MEP is indicated for craniotomy, spine surgery and aortic surgery, in which the technique for stimulation and recording can vary on types of surgery.

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O-1-13. Diagnosis of lumbar radiculopathy using magnetospinography

We previously reported noninvasive visualization of neural activities in the lumbar spine using magnetospinography (MSG). We report here MSG findings of a patient with lumbar radiculopathy.

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MedStar slalom

MedStar replaced training diagrams with drone flyovers of the driving course to better demonstrate how to navigate a complicated driving scenario.

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MedStar AJody Stevens Banana Microphone

To keep the students' attention, MedStar incorporated some entertaining videos.

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MedStar: Clearing Intersection, OV does not stop

MedStar has traditionally used the CEVO program. They began augmenting this training with several real-life scenarios captured on camera to show true outcomes of both bad and good driving habits, like this crew clearing an intersection.

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SAGES Mini Med School: inspiring high school students through exposure to the field of surgery

Abstract

Objective

The SAGES Mini Med School (SMMS) was designed to expose high school students to the field of surgery through mentoring, knowledge transfer, and hands-on experience with simulation. The objective of this paper is to profile the evolutionary development, performance metrics, and satisfaction queries of this innovative effort.

Methods

Sixty-one high school students, grades 9–12, took part in the (SMMS) program during the 2015 SAGES Annual Congress. The students completed a surgical skills lab session where they attempted tasks associated with the development of open surgical and laparoscopic skills. The lab included a warm-up with the validated Super Monkey Ball video game, Top Gun Pea Drop task, FLS Peg Transfer task, open knot tying station, and open instrument tie station.

Results

The following are the results of the surgical skills lab. For the Super Monkey Ball task, 60 students participated with an average score of 73.0 s (SD = 53.9; range 59.1–87.0; median = 74). Sixty students participated in the Surgeons Knot and Pea Drop tasks with average times of 26.6 s (SD = 19.3; range 21.7–31.6; median = 21.0) and 113.8 s (SD = 65.9; range 96.6–131.0; median = 101.0), respectively. Sixty students participated in the Instrument Tie and 56 students participated in the Peg Transfer stations with average times of 51.7 s (SD = 34.5; range 42.8–60.6; median = 39.5) and 173.1 s (SD = 25.0; range 166.4–179.8; median = 180.0), respectively. 51 (83.6%) agreed that the Mini Med School made them more likely to consider a career in medicine. When asked if the program made them more likely to consider a career in surgery 42 (68.8%) agreed. All 61 respondents (100%) said that they would recommend the program to others.

Conclusions

The SMMS program showed that the students had an excellent aptitude for the performance of validated surgical subtasks with high satisfaction, and increased consideration of a career in medicine/surgery. Long-term studies are needed to evaluate the impact on workforce recruitment.

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Long-term oncologic outcomes after laparoscopic versus open rectal cancer resection: a high-quality population-based analysis in a Southern German district

Abstract

Background

An increasing number of rectal carcinoma resections in Germany and worldwide are performed laparoscopically. The recently published COLOR II trial demonstrated the oncologic safety of this surgical approach. It remains unclear whether these findings can be transferred to clinical practice.

Patients and methods

This population-based retrospective cohort study aimed to evaluate 5-year overall, relative, disease-free, and local recurrence-free survival of rectal cancer patients treated by open surgery and laparoscopy. Data from a southern German region of 1.1 million inhabitants were collected by an official clinical cancer registry. All primary non-metastatic rectal adenocarcinoma cases with surgery between 2004 and 2013 were eligible for inclusion. To compare survival rates, Kaplan–Meier analyses, relative survival models, and multivariate Cox regression were applied; a sensitivity analysis assessed bias by exclusion.

Results

Finally, 1507 patients with a median follow-up time of 7.1 years were included. Of these patients, 28.4% underwent laparoscopic procedures, with an increasing rate over time. Patients with tumors of the upper or middle rectum, younger patients, and patients of specialized colorectal cancer centers were more likely to undergo laparoscopy. After 5 years, 80.4% of laparoscopy patients were still alive, compared to 68.6% in the open group (p < 0.001). Moreover, laparoscopy was associated with superior local recurrence-free survival rates. This advantage was also significant in multivariate analysis (HR 0.70, 95% CI 0.52–0.92).

Conclusion

Laparoscopic rectal cancer surgery can be considered safe in daily clinical practice. This should be confirmed by future studies outside the setting of randomized trials.

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Feasibility of adapting the fundamentals of laparoscopic surgery trainer box to endoscopic skills training tool

Abstract

Background

The fundamentals of laparoscopic surgery (FLS) training box is a validated tool, already accessible to surgical trainees to hone their laparoscopic skills. We aim to investigate the feasibility of adapting the FLS box for the practice and assessment of endoscopic skills. This would allow for a highly available, reusable, low-cost, mechanical trainer.

Methods

The design and development process was based on a user-centered design, which is a combination of the design thinking method and cognitive task analysis. The process comprises four phases: empathy, cognitive, prototyping/adaptation, and end user testing. The underlying idea was to utilize as many of the existing components of FLS training to maintain simplicity and cost effectiveness while allowing for the practice of clinically relevant endoscopic skills. A sample size of 18 participants was calculated to be sufficient to detect performance differences between experts and trainees using a two tailed t test with alpha set at 0.05, standard deviation of 5.5, and a power of 80%.

Results

Adaptation to the FLS box included two fundamental attachments: a front panel with an insertion point for an endoscope and a shaft which provides additional support and limits movement of the scope. The panel also allows for mounting of retroflexion tasks. Six endoscopic tasks inspired by FLS were designed (two of which utilize existing FLS components). Pilot testing with 38 participants showed high user's satisfaction and demonstrated that the trainer was robust and reliable. Task performance times was able to discriminate between trainees and experts for all six tasks.

Conclusions

A mechanical, reusable, low-cost adaptation of the FLS training box for endoscopic skills is feasible and has high user satisfaction. Preliminary testing shows that the simulator is able to discriminate between trainees and experts. Following further validation, this adaptation may act as a supplement to the FES program.

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Intergenerational Mobility and Goal-Striving Stress Among Black Americans: The Roles of Ethnicity and Nativity Status

Abstract

Goal-striving stress refers to the psychological consequences of seeking but failing to reach upward mobility and is more common among low-income and people of color. Intergenerational mobility—or improved socioeconomic standing relative to one's parents—may be an important predictor of goal-striving stress for Blacks. We used the National Survey of American Life to investigate the association between intergenerational mobility and goal-striving stress among U.S.-born African Americans, U.S.-born Caribbean Blacks, and foreign-born Caribbean Blacks. Intergenerational mobility was associated with lower goal-striving stress and U.S.-born African Americans and Caribbean Blacks reported lower goal-striving stress than foreign-born Caribbean Blacks. Goal-striving stress was relatively high among foreign-born Blacks, regardless of level of intergenerational mobility attained. Goal-striving is an important stressor for foreign-born Caribbean Blacks, regardless of their level of educational success. Given increasing Black migration, future studies should disaggregate the Black racial category based on ethnicity and nativity.

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Archives of Physical Medicine and Rehabilitation Supplements

Publication date: April 2018
Source:Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 4





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Response to Letter to the Editor regarding “Effects of respiratory training on heart rate variability and baroreflex sensitivity in individuals with chronic spinal cord injury”

Publication date: April 2018
Source:Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 4
Author(s): Bonnie E. Legg Ditterline, Sevda C. Asian, David C. Randall, Susan J. Harkema, Camilo Castillo, Alexander V. Ovechkin




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Editorial Board

Publication date: April 2018
Source:Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 4





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Table of Contents

Publication date: April 2018
Source:Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 4





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Editors' Selections From This Issue: Volume 99 / Number 4 / April 2018

Publication date: April 2018
Source:Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 4





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Masthead

Publication date: April 2018
Source:Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 4





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Correction

Publication date: April 2018
Source:Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 4





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Prediction of Falls in Subjects Suffering From Parkinson Disease, Multiple Sclerosis, and Stroke

Publication date: April 2018
Source:Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 4
Author(s): Ettore Beghi, Elisa Gervasoni, Elisabetta Pupillo, Elisa Bianchi, Angelo Montesano, Irene Aprile, Michela Agostini, Marco Rovaris, Davide Cattaneo
ObjectiveTo compare the risk of falls and fall predictors in patients with Parkinson disease (PD), multiple sclerosis (MS), and stroke using the same study design.DesignMulticenter prospective cohort study.SettingInstitutions for physical therapy and rehabilitation.ParticipantsPatients (N=299) with PD (n=94), MS (n=111), and stroke (n=94) seen for rehabilitation.InterventionsNot applicable.Main Outcome MeasuresFunctional scales were applied to investigate balance, disability, daily performance, self-confidence with balance, and social integration. Patients were followed for 6 months. Telephone interviews were organized at 2, 4, and 6 months to record falls and fall-related injuries. Incidence ratios, Kaplan-Meier survival curves, and Cox proportional hazards models were used.ResultsOf the 299 patients enrolled, 259 had complete follow-up. One hundred and twenty-two patients (47.1%) fell at least once; 82 (31.7%) were recurrent fallers and 44 (17.0%) suffered injuries; and 16%, 32%, and 40% fell at 2, 4, and 6 months. Risk of falls was associated with disease type (PD, MS, and stroke in decreasing order) and confidence with balance (Activities-specific Balance Confidence [ABC] scale). Recurrent fallers were 7%, 15%, and 24% at 2, 4, and 6 months. The risk of recurrent falls was associated with disease type, high educational level, and ABC score. Injured fallers were 3%, 8%, and 12% at 2, 4, and 6 months. The only predictor of falls with injuries was disease type (PD).ConclusionsPD, MS, and stroke carry a high risk of falls. Other predictors include perceived balance confidence and high educational level.



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Effects of Respiratory Training on Heart Rate Variability and Baroreflex Sensitivity in Individuals with Chronic Spinal Cord Injury

Publication date: April 2018
Source:Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 4
Author(s): Cameron M. Gee, Christopher R. West




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Correction

Publication date: April 2018
Source:Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 4





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Correction

Publication date: April 2018
Source:Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 4





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Return to Play After Injuries: A Survey on the Helpfulness of Various Forms of Assistance in the Shared Decision-Making Process in Semiprofessional Athletes in Germany

Publication date: April 2018
Source:Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 4
Author(s): Daniel Niederer, Jan Wilke, Lutz Vogt, Winfried Banzer
ObjectiveTo assess how different decision-guiding factors, such as health- and performance-related stakeholders, as well as evidence-based guidelines, support the process-oriented final positive return-to-play (RTP) decision of head coaches responsible for semiprofessional sport teams.DesignCross-sectional survey.SettingTeam sport.ParticipantsA survey consisting of questions on the importance of different decision-guiding factors used when making the RTP decision after injuries was administered to and completed by head coaches (N=238) of semiprofessional players' teams.InterventionsNot applicable.Main Outcome MeasuresWith respect to helpfulness in the RTP decision-making process, the coaches rated both the importance of the opinions of physicians, physiotherapists, strength and conditioning coaches, and the athletes themselves, and the importance of the general and injury-specific RTP guidelines.ResultsOur survey revealed that the head coaches rely on physicians and physiotherapists to a large extent, to the athletes and to themselves to a medium extent, and to strength and conditioning coaches and RTP guidelines to a small but still relevant extent. The coaches' efforts to seek a shared decision-making process in RTP are, hence, partially evident.ConclusionsA multitude of actuators intervene when making the RTP decision. The professionalization of the RTP process in semiprofessional sports includes the athletes themselves, the head coaches, the (external) physicians, the (external) physiotherapists, and the strength and conditioning coaches based on general RTP decision-making models and specific criteria related to injury type, sports type, level, and playing position. The development of awareness and implementation strategies of RTP models should be subject to further research.



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Accuracy of Ultrasonography for the Diagnosis of Carpal Tunnel Syndrome: A Systematic Review and Meta-Analysis

Publication date: April 2018
Source:Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 4
Author(s): Ana Torres-Costoso, Vicente Martínez-Vizcaíno, Celia Álvarez-Bueno, Asunción Ferri-Morales, Iván Cavero-Redondo
ObjectiveTo evaluate the accuracy of inlet and outlet ultrasonography measurements for the diagnosis of carpal tunnel syndrome (CTS).Data SourcesMEDLINE, EMBASE, the Cochrane Library, and the Web of Science databases were systematically searched from inception to February 2017.Study SelectionObservational studies comparing the diagnostic accuracy of inlet and outlet ultrasonography measurements were selected.Data ExtractionRandom-effects models for the diagnostic odds ratio (dOR) values computed by Moses' constant for a linear model and 95% confidence intervals (CIs) were used to calculate the accuracy of the test. Hierarchical summary receiver operating characteristic curves were used to summarize overall test performance.Data SynthesisTwenty-eight published studies were included in the meta-analysis. The pooled dOR values for the diagnosis of CTS were 31.11 (95% CI, 20.42–47.40) for inlet-level and 16.94 (95% CI, 7.58–37.86) for outlet-level measurements. The 95% confidence region for the point that summarizes overall test performance of the included studies occurred where the cutoffs ranged from 9.0 to 12.6mm² for inlet-level measurements and from 9.5 to 10.0mm² for outlet-level measurements.ConclusionsBoth ultrasonography measurements for the diagnosis of CTS showed sufficient accuracy for their use in clinical settings, although the overall accuracy was slightly higher for inlet-level than for outlet-level measurements. The addition of outlet and inlet measurements does not increase the accuracy for the diagnosis. Therefore, the inlet-level ultrasonography measurement appears to be an appropriate method for the diagnosis of CTS.



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Treadmill locomotion of the mouse lemur ( Microcebus murinus ); kinematic parameters during symmetrical and asymmetrical gaits

Abstract

The gaits of the adult grey mouse lemur Microcebus murinus were studied during treadmill locomotion over a large range of velocities. The locomotion sequences were analysed to determine the gait and the various spatiotemporal gait parameters of the limbs. We found that velocity adjustments are accounted for differently by stride frequency and stride length depending on whether the animal showed a symmetrical or an asymmetrical gait. When using symmetrical gaits the increase in velocity is associated with a constant contribution of the stride length and stride frequency; the increase of the stride frequency being always lower. When using asymmetrical gaits, the increase in velocity is mainly assured by an increase in the stride length which tends to decrease with increasing velocity. A reduction in both stance time and swing time contributed to the increase in stride frequency for both gaits, though with a major contribution from the decrease in stance time. The pattern of locomotion obtained in a normal young adult mouse lemurs can be used as a template for studying locomotor control deficits during aging or in different environments such as arboreal ones which likely modify the kinematics of locomotion.

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Editorial Board

Experimental Physiology, Volume 103, Issue 4, Page 617-619, 1 April 2018.


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Gene editing and gene regulation with CRISPR

Experimental Physiology, Volume 103, Issue 4, Page 437-438, 1 April 2018.


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Corrigendum

The Journal of Physiology, Volume 596, Issue 7, Page 1311-1311, 1 April 2018.


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Issue Information

The Journal of Physiology, Volume 596, Issue 7, Page 1105-1106, 1 April 2018.


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The Who, What, Why and When of Gynaecological Referrals for Refugee Women

Abstract

Refugees have health needs relating to unstable living situations and poor access to care. We examined the nature of health problems requiring gynaecological referrals for refugee women in Toronto. A retrospective cohort design was used to examine gynaecologic referrals of women at a refugee clinic between December, 2011 and June, 2016. The primary outcome measure was the indications for gynaecological referral. 125 out of 1040 women received a gynaecologic referral for 131 unique concerns. The most common referrals were for abnormal uterine bleeding and cervical dysplasia. Fibroids were prevalent amongst African patients, while referrals for LARCs/sterilization were absent from Middle Eastern patients. 26% of patients referred had a sexual violence history. Refugee women exhibit gynaecologic needs similar to the broader population. Needs vary by geographic origins. As global conflicts shift, so too will this population's needs. High rates of sexual violence history reflect the need for further understanding and intervention.

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Determination of the occlusal vertical dimension in edentulous patients using lateral cephalograms

Journal of Oral Rehabilitation, EarlyView.


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Transcutaneous electrical stimulation on the anterior neck region: The impact of pulse duration and frequency on maximum amplitude tolerance and perceived discomfort

Journal of Oral Rehabilitation, EarlyView.


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Brain‐heart interaction in perseverative cognition

Psychophysiology, EarlyView.


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Prevalence of Nutritional Deficiencies Among Populations of Newly Arriving Government Assisted Refugee Children to Kitchener/Waterloo, Ontario, Canada

Abstract

This study examined the variation among ethnic populations in prevalence of anemia, vitamin D and B12 deficiencies among refugee children. A retrospective chart review of 388 government assisted refugee children ≤ 16 years of age, seen at the Refugee Health Clinic in Kitchener, Canada from January 2009 to December 2014 was conducted. Vitamin D levels were only collected until December 1st 2010 (116 children). 15.7% were anemic (25% < 5 years, 8.7% 5–11 years, and 18.3% 12–16 years old) with Somali children having the lowest hemoglobin levels compared to those from Iraq, Afghanistan and Myanmar. 53.5% were vitamin D deficient (25(OH)D < 50 nmol/L), seen most commonly in Iraqis and Afghans. 11.2% had vitamin B12 levels < 150 pmol/L. Providers' knowledge of prevalence of nutritional deficiencies related to region of origin, can guide appropriate screening and treatment options to promote longer term cognitive, physical and developmental health.

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