Ability to control directional lip‐closing force during voluntary lip pursing in healthy young adults

Abstract

Background

It is considered important to evaluate the ability to control lip‐closing force (LCF).

Objective

This study aimed to investigate the ability to control directional LCF.

Methods

The experimental system included an apparatus developed to measure LCF during lip pursing in eight directions (upper, lower, right, left and the four directions in between) and a display showing the exerted LCF and a target value in each direction in real time. Twenty subjects (10 males and 10 females) were instructed to maintain the LCF at a specific target value using visual feedback. Based on our preliminary experiments, the target value was set as 50% of the maximum LCF, and the range was set at the target value ± 8%. The accuracy rate was defined as the ratio of the matched time, in which the subject was able to keep the LCF in the target range, to the total 3 seconds.

Results

The accuracy rate of males was higher than in females in the lower, lower left, and lower right directions. The accuracy rate of the directional LCF differed significantly depending on the direction. In assessing the accuracy rate for each directional LCF, the rates of upper and lower directional LCF were significantly higher than that of oblique directional LCF. No significant relationship was observed between the accuracy rate and the maximum LCF except for one direction in male subjects.

Conclusions

Our findings suggest that the ability to control directional LCF is affected by sex and the force direction.

This article is protected by copyright. All rights reserved.

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Society for Neuroscience in Anesthesiology & Critical Care (SNACC) Neuroanesthesiology Education Milestones for Resident Education

Background: The Accreditation Council for Graduate Medical Education (ACGME) has introduced competency-based assessments (milestones) for resident education. However, the existing milestones for Anesthesiology are not specific to Neuroanesthesiology. The Society for Neuroscience in Anesthesiology & Critical Care (SNACC) commissioned a task force to adapt the ACGME anesthesiology milestones for use in Neuroanesthesiology training, and to provide recommendations for implementing milestones. Methods: A 7-member expert task force supported by an advisory committee developed the initial milestones by consensus. Written permission was given by the ACGME. The milestones were refined following 3-month pilot use in 14 departments across the United States and inputs from SNACC members. Final milestones were approved by the SNACC Board of Directors. Results: Twelve Neuroanesthesiology-specific milestones in 5 major ACGME domains are recommended; these were identified as most pertinent to this subspecialty rotation. These pertain to patient care (7 milestones), medical knowledge (2 milestones), practice-based learning and improvement (1 milestone), and interpersonal and communication skills (2 milestones). Each milestone was described in detail, with clear outline of expectations at various levels of training. Conclusions: The SNACC Neuroanesthesiology milestones provide a framework for reviewing resident performance and are expected to facilitate improved use of ACGME milestones during Neuroanesthesiology subspecialty training. The task force recommends that the target should be to accomplish level 4 or higher milestones by the end of residency training. Individual programs should decide the implications of a resident not meeting the expected milestones. The authors have no funding or conflicts of interest to disclose. Address correspondence to: Deepak Sharma, MD, DM, Departments of Anesthesiology & Pain Medicine and Neurological Surgery, Division of Neuroanesthesiology & Perioperative Neurosciences, University of Washington, Seattle, WA, P.O. Box #359724, 325, 9th Ave., Seattle, WA 98104 (e-mail: dsharma@uw.edu). Received December 15, 2018 Accepted January 7, 2019 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved

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Cerebrospinal Fluid Glucose and Lactate Levels After Subarachnoid Hemorrhage: A Multicenter Retrospective Study

Background: In patients with subarachnoid hemorrhage (SAH), abnormalities in glucose and lactate metabolism have been described using cerebral microdialysis. Glucose and lactate concentrations in cerebrospinal fluid (CSF) are more easily accessible, but scarce data are available in this setting. The aim of this study is to assess the relationship of CSF glucose and lactate with blood concentrations and with unfavorable neurological outcome after SAH. Methods: A retrospective cohort study was conducted in 5 European University intensive care units. Patients aged 18 years and above who were admitted after a nontraumatic SAH over a 4-year period (2011 to 2014) were included if they had an external ventricular drain placed, daily analysis of CSF including glucose (±lactate) concentrations for 1 to 4 consecutive days, and concomitant analysis of glucose and lactate concentrations in the arterial blood. Results: A total of 144 patients were included in the final analysis (median age: 58 [49 to 66] y; male sex: 77/144). Median time from admission to external ventricular drain placement was 1 (0 to 3) day; median Glasgow Coma Scale on admission was 10 (7 to 13), and CT-scan Fisher scale was 4. A total of 81 (56%) patients had unfavorable neurological outcome at 3 months (Glasgow Outcome Scale ≤3). There was a weak correlation between blood and CSF glucose (r2=0.07, P=0.007), and between blood and CSF lactate levels (r2=0.58, P

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International Multicenter Survey of Perioperative Management of External Ventricular Drains: Results of the EVD Aware Study

Introduction: The perioperative management of patients with external ventricular drains (EVDs) is not well defined, and adherence to published management guidelines unknown. This study investigates practice, patterns, and variability in the perioperative management of patients with EVDs. Methods: A 31-question survey was sent to 1830 anesthesiologists from 27 institutions in North America, Europe, and Asia. A perioperative EVD Guideline Adherence Score was calculated for the preoperative, transport and intraoperative periods. Differences in management practices between neuroanesthesiologists and non-neuroanesthesiologists, and factors affecting EVD guideline adherence, were examined using bivariate significance tests and linear regression. Results: Among a sample of 599 anesthesiologists (survey response rate, 32.7%), compared with non-neuroanesthesiologists, neuroanesthesiologists were more likely to include baseline neurological examination (P=0.023), hourly cerebrospinal fluid output (P=0.006) and color (P

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Glucose and Lactate Concentrations in Cerebrospinal Fluid After Traumatic Brain Injury

Background: Studies in which brain metabolism has been monitored using microdialysis have indicated decreases in cerebral glucose concentration and increases in lactate concentration in patients with traumatic brain injury (TBI). However, few data are available on glucose and lactate concentrations in the cerebrospinal fluid (CSF) of TBI patients. This study investigates the relationship between CSF glucose and lactate concentrations and outcomes after TBI. Methods: Consecutive adult (>18 y) TBI patients were admitted to our 35-bed medicosurgical between 2011 and 2014 and were included in the study if they met the following inclusion criteria: presence of an external ventricular drain (EVD) for intracranial pressure monitoring, daily analysis of CSF glucose and lactate concentrations for 4 consecutive days, and concomitant measurements of blood glucose/lactate concentrations. Neurological outcome was assessed at 3 months using the extended Glasgow Outcome Scale (GOS), and unfavorable outcome defined as a GOS 1 to 4. Results: Of 151 TBI patients who had an EVD, 56 met the inclusion criteria. Most EVDs were placed on the day of intensive care unit admission, and maintained for 10 (interquartile range: 6 to 14) days. On day 1, there was a weak but significant correlation between blood and CSF glucose concentrations (R2=0.07, P=0.04), and a greater correlation between blood and CSF lactate (R2=0.32, P

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Intubating Laryngeal Mask Airway-assisted Flexible Bronchoscopic Intubation is Associated With Reduced Cervical Spine Motion When Compared With C-MAC Video Laryngoscopy-guided Intubation: A Prospective Randomized Cross Over Trial

Background: In the evolving research into cervical spine mechanics during airway intervention, new devices are being constantly added to the armamentarium of anesthesiologists. In this study we compared cervical spine movement during orotracheal intubation using an intubating laryngeal mask airway (LMA Fastrach) assisted flexible bronchoscope or video laryngoscope. Materials and Methods: In total, 40 consenting patients without history of abnormalities of cervical spine and planned for elective neuroradiologic interventions in the angiography suite were enrolled in this randomized crossover trial. Every patient was subjected to LMA Fastrach-guided flexible bronchoscopic as well as video laryngoscopy guided intubation. Cervical spine motion at the occipital bone, C1-C5 vertebrae, the occiput-C1, C1-C2, C2-C3 and C4-C5 junctions was investigated using continuous fluoroscopy during intubation. The primary outcome of the study was combined craniocervical motion from occiput to C5 between the 2 intubation techniques. Results: There was less (62%) combined craniocervical movement from occiput to C5 during the LMA Fastrach-flexible bronchoscopy-guided technique as compared with video laryngoscopy-guided intubation (17.55±14.23 vs. 28.95±11.58 degrees, respectively; P

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Floor and ceiling effects of the World Health Organization Disability Assessment Schedule 2.0 among patients with chronic musculoskeletal pain

The aim of this study was to investigate the floor and ceiling effects of 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS). This was a cross-sectional survey study at a university's physical and rehabilitation medicine outpatient clinic of 1988 patients with chronic musculoskeletal pain. Floor and ceiling effects were calculated as relative frequencies of the lowest or the highest possible scores for each item. The probit plotting method was used to detect the non-normality of distribution of the total score graphically. A significant floor effect of 15–79% was observed in all 12 WHODAS 2.0 items. A substantial floor effect for total score was also detected graphically. No ceiling effects were observed. In this study, a significant floor effect was found for all WHODAS 2.0 items among patients with chronic musculoskeletal pain associated with mild or no disability. Correspondence to Niina Katajapuu, MSc, Turku University of Applied Sciences, Joukahaisenkatu 3, 20520 Turku, Finland Tel: +358 442 747 978; e-mail: niina.katajapuu@turkuamk.fi Received December 12, 2018 Accepted January 23, 2019 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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