Postoperative Remote Automated Monitoring: Need for and State of the Science

Worldwide, more than 230 million adults have major noncardiac surgery each year. Although surgery can improve quality and duration of life, it can also precipitate major complications. Moreover, a substantial proportion of deaths occur after discharge. Current systems for monitoring patients postoperatively, on surgical wards and after transition to home, are inadequate. On the surgical ward, vital signs evaluation usually occurs only every 4-8 hours. Reduced in-hospital ward monitoring, followed by no vital signs monitoring at home, leads to thousands of cases of undetected/delayed detection of hemodynamic compromise. In this article we review work to date on postoperative remote automated monitoring on surgical wards and strategy for advancing this field. Key considerations for overcoming current barriers to implementing remote automated monitoring in Canada are also presented.     

Insomnia does not affect heart rate changes when young adults watch humorous films: An exploratory study

Emotional reactivity in insomnia is affected both subjectively and on a physiological level for negative emotional material, but little is known about reactions to positive stimuli. We here investigated whether in younger adult insomnia patients, presentation of short humorous films would lead to heart rate decreases during and after film viewing, as compared to heart rate changes when falling asleep. Investigating 20 participants with DSM‐5‐diagnosed insomnia and 18 participants without insomnia, we found that heart rate decreased when falling asleep, increased when watching humorous films and returned to normal values afterwards for all participants. Film‐related heart rate increases were strongly related to humour ratings of the films. No differences were found between those with and without insomnia on subjective ratings of the films, film‐related heart rate changes or when falling asleep. We conclude that the experience of positive daily life stimuli in younger adults is not affected by insomnia in our study, despite insomnia having a known more profound effect on negative stimuli. Future studies exploring insomnia‐related autonomous nervous system responses combining different neurophysiological modalities should confirm our findings.     

Improving greater trochanteric reattachment with a novel cable plate system

Cable-grip systems are commonly used for greater trochanteric reattachment because they have provided the best fixation performance to date, even though they have a rather high complication rate. A novel reattachment system is proposed with the aim of improving fixation stability. It consists of a Y-shaped fixation plate combined with locking screws and superelastic cables to reduce cable loosening and limit greater trochanter movement.The novel system is compared with a commercially available reattachment system in terms of greater trochanter movement and cable tensions under different greater trochanteric abductor application angles.A factorial design of experiments was used including four independent variables: plate system, cable type, abductor application angle, and femur model. The test procedure included 50 cycles of simultaneous application of an abductor force on the greater trochanter and a hip force on the femoral head.The novel plate reduces the movements of a greater trochanter fragment within a single loading cycle up to 26%. Permanent degradation of the fixation (accumulated movement based on 50-cycle testing) is reduced up to 46%. The use of superelastic cables reduces tension loosening up to 24%. However this last improvement did not result in a significant reduction of the grater trochanter movement.The novel plate and cables present advantages over the commercially available greater trochanter reattachment system. The plate reduces movements generated by the hip abductor. The superelastic cables reduce cable loosening during cycling. Both of these positive effects could decrease the risks related to grater trochanter non-union.     

Material differentiation in forensic radiology with single-source dual-energy computed tomography

The goal of this study was to investigate the use of dual-energy computed tomography (CT) in differentiating frequently encountered foreign material on CT images using a standard single-source CT scanner. We scanned 20 different, forensically relevant materials at two X-Ray energy levels (80 and 130 kVp) on CT. CT values were measured in each object at both energy levels. Intraclass correlation coefficient (ICC) was used to determine intra-reader reliability. Analysis of variance (ANOVA) was performed to assess significance levels between X-Ray attenuation at 80 and 130 kVp. T test was used to investigate significance levels between mean HU values of individual object pairings at single energy levels of 80 and 130 kVp, respectively. ANOVA revealed that the difference in attenuation between beam energies of 80 kVp compared to 130 kVp was statistically significant (p < 0.005) for all materials except brass and lead. ICC was excellent at 80 kVp (0.999, p < 0.001) and at 130 kVp (0.998, p < 0.001). T test showed that using single energy levels of 80 and 130 kVp respectively 181/190 objects pairs could be differentiated from one another based on HU measurements. Using the combined information from both energy levels, 189/190 object pairs could be differentiated. Scanning with different energy levels is a simple way to apply dual-energy technique on a regular single-energy CT and improves the ability to differentiate foreign bodies with CT, based on their attenuation values.     

Effectiveness of Exercise Programs in Ankylosing Spondylitis: A Meta-Analysis of Randomized Controlled Trials

Objective

To assess the effectiveness of exercise programs on disease activity and function in ankylosing spondylitis (AS) by a systematic review and meta-analysis of randomized controlled trials (RCTs).