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1.
Aims
Create an educational program in chronic pain (EPCP).Material and methods
We used a four-step process to create the EPCP tailored to patient’s needs.Results
Five groups of patients can benefit from the program annually. Based on their own assessment, patients stated that their knowledge of chronic pain improved between 2.8 to 24%. The satisfaction with the EPCP was 8.67/10.Conclusion
Our EPCP helps patients gain and maintain the skills they need to best manage their lives with a chronic pain.2.
Aims
To describe a funded proposal for the development of an on-line evidence based educational program for the management of deteriorating patients.Background
There are international concerns regarding the management of deteriorating patients with issues around the ‘failure to rescue’. The primary response to these issues has been the development of medical emergency teams with little focus on the education of primary first responders.Design/Methods
A mixed methods triangulated convergent design.In this four phase proposal we plan to 1. examine nursing student team ability to manage deteriorating patients and based upon these findings 2. develop web based educational material, including interactive scenarios. This educational material will be tested and refined in the third Phase 3, prior to evaluation and dissemination in the final phase.Conclusion
This project aims to enhance knowledge development for the management of deteriorating patients through rigorous assessment of team performance and to produce a contemporary evidence-based online training program.3.
Barbara Domańska Oliver Stumpp Steven Poon Serkan Oray Irina Mountian Clovis Pichon 《Advances in therapy》2018,35(1):100-115
Introduction
We incorporated patient feedback from human factors studies (HFS) in the patient-centric design and validation of ava®, an electromechanical device (e-Device) for self-injecting the anti-tumor necrosis factor certolizumab pegol (CZP).Methods
Healthcare professionals, caregivers, healthy volunteers, and patients with rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, or Crohn’s disease participated in 11 formative HFS to optimize the e-Device design through intended user feedback; nine studies involved simulated injections. Formative participant questionnaire feedback was collected following e-Device prototype handling. Validation HFS (one EU study and one US study) assessed the safe and effective setup and use of the e-Device using 22 predefined critical tasks. Task outcomes were categorized as “failures” if participants did not succeed within three attempts.Results
Two hundred eighty-three participants entered formative (163) and validation (120) HFS; 260 participants performed one or more simulated e-Device self-injections. Design changes following formative HFS included alterations to buttons and the graphical user interface screen. All validation HFS participants completed critical tasks necessary for CZP dose delivery, with minimal critical task failures (12 of 572 critical tasks, 2.1%, in the EU study, and 2 of 5310 critical tasks, less than 0.1%, in the US study).Conclusion
CZP e-Device development was guided by intended user feedback through HFS, ensuring the final design addressed patients’ needs. In both validation studies, participants successfully performed all critical tasks, demonstrating safe and effective e-Device self-injections.Funding
UCB Pharma.Plain Language Summary
Plain language summary available on the journal website.4.
Background
The study was performed to reveal the effect of an individualized personal outpatient therapy program, based on a multidisciplinary assessment, on pain and health-related quality of life in patients with chronic pain.Methods
Fifty patients were prospectively evaluated before and 3 months after establishment of an individualized outpatient therapy program. Health-related quality of life, pain and pain-related disability, depression and motivation to adopt self-management of chronic pain were assessed. Therapy adherence was tested with a structured interview.Results
Only marginal improvements were observed in terms of pain and health-related quality of life. Therapy adherence varied between the different therapies.Conclusions
An individualized personal outpatient therapy program has only marginal effects on pain and health-related quality of life in patients with chronic pain.5.
Background
Those working with elderly care recipients require a good working knowledge of depression and appropriate help giving responses. While it is important for age-care staff to recognize depression in care recipients it is also critical that they know the appropriate course of action to assist a care recipient who may be depressed. This study aims to determine the knowledge of age-care staff of appropriate help giving responses, their confidence in knowing what kind of assistance to provide and their actual likelihood of providing help to potentially depressed care recipients and to examine if these measures improve following an intervention training program.Methods
One hundred and two age-care staff were surveyed on their confidence in helping age-care recipients and on their knowledge of appropriate ways to provide assistance. Staff then participated in a two hour depression awareness raising intervention. The survey was repeated immediately following the training and again six months later.Results
Staff confidence in knowing how to provide assistance increased significantly subsequent to training and remained significantly improved at the six month follow up. In addition, a significantly higher proportion of staff reported helping care recipients at the six month follow up.Conclusions
This study highlights the potential of a brief staff training program to provide a cost effective means to improve staff self-confidence and increase the likelihood of staff providing assistance to depressed care recipients.6.
Arnaud Huaulmé Kanako Harada Germain Forestier Mamoru Mitsuishi Pierre Jannin 《International journal of computer assisted radiology and surgery》2018,13(9):1419-1428
Purpose
Surgical processes are generally only studied by identifying differences in populations such as participants or level of expertise. But the similarity between this population is also important in understanding the process. We therefore proposed to study these two aspects.Methods
In this article, we show how similarities in process workflow within a population can be identified as sequential surgical signatures. To this purpose, we have proposed a pattern mining approach to identify these signatures.Validation
We validated our method with a data set composed of seventeen micro-surgical suturing tasks performed by four participants with two levels of expertise.Results
We identified sequential surgical signatures specific to each participant, shared between participants with and without the same level of expertise. These signatures are also able to perfectly define the level of expertise of the participant who performed a new micro-surgical suturing task. However, it is more complicated to determine who the participant is, and the method correctly determines this information in only 64% of cases.Conclusion
We show for the first time the concept of sequential surgical signature. This new concept has the potential to further help to understand surgical procedures and provide useful knowledge to define future CAS systems.7.
Objective
To compare the safety and estimate the response profile of olanzapine, a second-generation antipsychotic, to haloperidol in the treatment of delirium in the critical care setting.Design
Prospective randomized trialSetting
Tertiary care university affiliated critical care unit.Patients
All admissions to a medical and surgical intensive care unit with a diagnosis of delirium.Interventions
Patients were randomized to receive either enteral olanzapine or haloperidol.Measurements
Patient’s delirium severity and benzodiazepine use were monitored over 5 days after the diagnosis of delirium.Main results
Delirium Index decreased over time in both groups, as did the administered dose of benzodiazepines. Clinical improvement was similar in both treatment arms. No side effects were noted in the olanzapine group, whereas the use of haloperidol was associated with extrapyramidal side effects.Conclusions
Olanzapine is a safe alternative to haloperidol in delirious critical care patients, and may be of particular interest in patients in whom haloperidol is contraindicated.8.
Background
Existing treadmill-based locomotion training, which has been used for gait function recovery, still has limitations, such as less attentive training. Interactive treadmills (ITMs) were developed to overcome these limitations, but it has not yet been verified that ITMs can make the user pay closer attention to walk training.Methods
An experimental comparison between ITMs and conventional treadmills was conducted by measuring the level of the user’s attention using functional near-infrared spectroscopy (fNIRS). To consider the effect of task complexity on the subject’s attention, we provided two (slow and fast) speed conditions for walking on both treadmills.Results
Both the cortical activity images and oxygenated hemoglobin (oxyHb) changes showed that the level of attention to walking induced by the ITM was significantly higher than that induced by the conventional treadmill. We found that the walking speed on the ITM also affected the level of attention.Conclusion
ITM-based locomotion training would be a promising solution to the limitations of existing treadmill-based locomotion training currently used to improve gait function recovery.Trial registration
DGIST-HR-150309-03-02. Registered 01 March 2015.9.
Yaki Setty Oren Salzman 《International journal of computer assisted radiology and surgery》2016,11(12):2317-2324
Purpose
Procedure-Specific Simulations (PSS) are 3D realistic simulations that provide a platform to practice complete surgical procedures in a virtual-reality environment. While PSS have the potential to improve surgeons’ proficiency, there are no existing standards or guidelines for PSS development in a structured manner.Method
We employ a unique platform inspired by game design to develop virtual reality simulations in three dimensions of urethrovesical anastomosis during radical prostatectomy. 3D visualization is supported by a stereo vision, providing a fully realistic view of the simulation. The software can be executed for any robotic surgery platform. Specifically, we tested the simulation under windows environment on the RobotiX Mentor.Result
Using urethrovesical anastomosis during radical prostatectomy simulation as a representative example, we present a task-based methodological approach to PSS training. The methodology provides tasks in increasing levels of difficulty from a novice level of basic anatomy identification, to an expert level that permits testing new surgical approaches.Conclusion
The modular methodology presented here can be easily extended to support more complex tasks. We foresee this methodology as a tool used to integrate PSS as a complementary training process for surgical procedures.10.
Amir Elhassan Ahmed Ahmed Hamdy Awad Michelle Humeidan Viet Nguyen Elyse M. Cornett Richard D. Urman Alan David Kaye 《Current pain and headache reports》2018,22(11):74
Purpose of Review
Enhanced recovery pathways are a well-defined perioperative health care program utilizing evidence-based interventions in a protocol-like manner designed to standardize techniques including drug selection and dosing to improve results and to reduce overall costs including facilitating earlier discharge from hospitals after surgery.Recent Findings
A PubMed and World Wide Web search was performed with the following key words: enhanced recovery, surgical enhanced recovery, recovery pathways, and enhanced recovery pathways surgery.Summary
This introduction to enhanced recovery pathways reflects its 20-year history, worldwide appeal, and ever growing presence in our practices. Many clinical teams have not, as of yet, incorporated enhanced recovery pathway principles to their practices and therefore, continued evolution should include increasing outreach and formalized guidelines in the future.11.
David Black Julian Hettig Maria Luz Christian Hansen Ron Kikinis Horst Hahn 《International journal of computer assisted radiology and surgery》2017,12(9):1655-1663
Purpose
During medical needle placement using image-guided navigation systems, the clinician must concentrate on a screen. To reduce the clinician’s visual reliance on the screen, this work proposes an auditory feedback method as a stand-alone method or to support visual feedback for placing the navigated medical instrument, in this case a needle.Methods
An auditory synthesis model using pitch comparison and stereo panning parameter mapping was developed to augment or replace visual feedback for navigated needle placement. In contrast to existing approaches which augment but still require a visual display, this method allows view-free needle placement. An evaluation with 12 novice participants compared both auditory and combined audiovisual feedback against existing visual methods.Results
Using combined audiovisual display, participants show similar task completion times and report similar subjective workload and accuracy while viewing the screen less compared to using the conventional visual method. The auditory feedback leads to higher task completion times and subjective workload compared to both combined and visual feedback.Conclusion
Audiovisual feedback shows promising results and establishes a basis for applying auditory feedback as a supplement to visual information to other navigated interventions, especially those for which viewing a patient is beneficial or necessary.12.
Melissa Robinson-Reilly Penny Paliadelis Mary Cruickshank 《Supportive care in cancer》2016,24(3):1181-1187
Introduction
The evolution of venous access via peripheral cannulation, particularly in relation to the risks and the benefits of this procedure, is reported widely in the literature. However, there is limited research specific to the patient experience of undergoing venous access.Aim
The intent of this qualitative study was to understand patients’ experience of venous access, with the aim of bringing forth their voices about the experiences of repeated venous access/cannulation attempts.Methodology
This qualitative study used a hermeneutic phenomenological approach to explore the experiences of 15 participants in two rural oncology units in Australia. The participants had experienced repeated peripheral cannulation in order to receive chemotherapy. Study participants were asked to describe what it was like for them to be repeatedly cannulated. Data were collected via audiotaped individual interviews, the participants’ stories were transcribed and analysed thematically.Outcomes
Themes emerged from the participants’ stories that provided insights into their perceptions of the experience of being cannulated and the decision-making processes regarding how and where the procedure occurred. The findings suggest that a holistic approach to care was often missing causing the participants to feel vulnerable. Gaining insight into their experiences led to a greater understanding of the impact of this procedure on patients and the need to improve care through encouraging more collaborative decision-making processes between clinicians and patients.Conclusion
The implications for policy and practice focus on improving patient outcomes via procedural governance and education, with the intent of translating the findings from this research into evidence-based practice.13.
Hoang Tran Cheng Lin Fang Yu Angie Frederick Molly Mieras Lorena Baccaglini 《Supportive care in cancer》2016,24(9):3705-3713
Purpose
The purpose of this study was to examine the association between cancer survivors’ socio-demographic and clinical characteristics and aerobic fitness changes following a physical training program.Methods
We assessed the association between participant’s characteristics and aerobic fitness in the six-min walk test (6MWT) after a 12-week LIVESTRONG® at Young Men’s Christian Association (YMCA) exercise program for adults with an oncologic diagnosis using linear mixed effects models.Results
Fifty-one percent of participants had a breast cancer diagnosis and 22 % had received treatment within 1 year of enrollment. At baseline, participants who reported good/excellent health status performed better in the 6MWT than those who reported poor/fair health status (384.2 vs. 345.0 m, p = 0.035). After 12 weeks, all participants increased their average 6MWT performance by 54.2 m. After adjustment for age, gender, physical activity level, and smoking status, participants who were 60 years old or younger had a greater increase in the 6MWT score than participants older than 60 years (63.2 vs. 43.9 m, p = 0.041) while those who had never been YMCA members had a greater increase in the 6MWT compared to those who had ever been a YMCA member (62.2 vs. 40.3 m, p = 0.041).Conclusion
Overall, aerobic fitness among adults with an oncologic diagnosis increased after a 12-week exercise program, particularly among participants who were 60 years old or younger or were not YMCA members at enrollment. Participants with poorer health had lower aerobic fitness at baseline, though they had a similar positive response to the program as healthier participants. Future study designs may include randomization and an additional untreated arm.14.
15.
Background
In recent years nurses have come to play a professional role in pain management. In Germany, the publication of the national expert standards on pain management in nursing resulted in nurses being educated to be pain resource nurses; however, since education has started the continuance and commitments of specialized pain nurses in clinical practice is basically unclear. The goal of this evaluation was to identify how pain resource nurses are involved in pain management and organizational aspects in German hospitals.Method
Online survey of 374 directors of nursing services of different types of hospitals on the assignment of nursing pain experts.Results
Pain resource nurses are involved in pain management in 70.6% of the hospitals responding to the questionnaire. Their task profile depends on the hospital size and 42.2% of the hospitals have documented task profiles. Pain resource nurses are primarily involved in invasive pain management processes (37.1%) and in the management of pain in patients with complex pain problems after surgery (33.2%). Educative tasks are training of colleagues and implementation and conversion of the national expert standards. Of the hospitals 36.1% implemented the national expert standards for acute pain and 57% of the medium-sized hospitals have at least also implemented the national expert standards for chronic pain.Discussion
The study shows a first insight into the task profiles of pain resource nurses. The implementation of this special qualification is meaningful and seems to be well-recognized in the hospitals. The tasks of patient care are orientated to the spectrum of patients treated in the hospital. The tasks of education also show the importance for the education of colleagues.16.
17.
Maneesh Gupta 《Clin Pract Epidemiol Ment Health》2007,3(1):12
Background
Quetiapine causes less prolactin elevation and/or galactorrhoea than other atypical antipsychotics.Case Presentation
Ms AB had galactorrhoea and raised prolactin levels at only 100 mg of quetiapine daily.Conclusion
Low dose quetiapine can also cause galactorrhoea.18.
Joshua Verson Nicholas Dyga Nestor Agbayani Fred Serafin Louis Hondros 《International journal of emergency medicine》2018,11(1):38
Background
To design and implement a replicable disaster training curriculum for the first on-call medical student hazardous materials response team.Methods
Twenty-eight first-year medical students participated in a simulated citywide bioterrorism disaster drill. Students were notified of the Code Orange via email, a pager system, and group SMS text message. Twenty-five students participated in the drill, while the three remaining student leaders worked with the ED staff and HazMat Branch Director to ensure that all protocols were followed properly. Five groups of five students took turns donning HazMat gear, decontaminating three mannequins (an infant, a child, and an unconscious adult), and then safely removing the gear.Results
All modes of communication were received within 5 min, and all the students arrived at the ED within 20 min. The decontamination was determined to be sufficient by the team leader, Emergency Department staff, and HazMat Branch Director and was completed approximately 10 min after the entrance to the decontamination chamber.Conclusions
Current US medical school curricula lack emergency preparedness training in response to potential terrorist attacks and hazardous material exposures. Our program, while still in its early workings, not only allows students to develop critical knowledge and practical skills but also provides a unique opportunity to leverage much-needed manpower and resources during emergency situations.19.
Olga Dergachyova Xavier Morandi Pierre Jannin 《International journal of computer assisted radiology and surgery》2018,13(9):1409-1417
Purpose
Lack of annotated training data hinders automatic recognition and prediction of surgical activities necessary for situation-aware operating rooms. We propose using knowledge transfer to compensate for data deficit and improve prediction.Methods
We used two approaches to extract and transfer surgical process knowledge. First, we encoded semantic information about surgical terms using word embedding. Secondly, we passed knowledge between different clinical datasets of neurosurgical procedures using transfer learning.Results
The combination of two methods provided 22% improvement of activity prediction. We also made several pertinent observations about surgical practices based on the results of the performed transfer.Conclusion
Word embedding boosts learning process. Transfer learning was shown to be more effective than a simple combination of data, especially for less similar procedures.20.
Tjallie van der Kooi Hugo Sax Didier Pittet Jaap van Dissel Birgit van Benthem Bernhard Walder Vanessa Cartier Lauren Clack Sabine de Greeff Martin Wolkewitz Stefanie Hieke Hendriek Boshuizen Jan van de Kassteele Annemie Van den Abeele Teck Wee Boo Magda Diab-Elschahawi Uga Dumpis Camelia Ghita Susan FitzGerald Tatjana Lejko Kris Leleu Mercedes Palomar Martinez Olga Paniara Márta Patyi Paweł Schab Annibale Raglio Emese Szilágyi Mirosław Ziętkiewicz Albert W. Wu Hajo Grundmann Walter Zingg On behalf of the PROHIBIT consortium 《Intensive care medicine》2018,44(1):48-60