Measurement of three-joint-finger motions: reality or fancy? A three-dimensional anatomical approach

Various anatomical publications have reported two-dimensional studies with flexion/extension or abduction/adduction motion analysis, but longitudinal axial rotations (LAR) of three-joint fingers have rarely been mentioned. The aim of our study was to determine the maximal passive motions of three-joint-fingers and to measure the passive LAR of phalanges during a flexion/extension movement. A protocol of anatomical dissection was carried out with 22 fresh-frozen limbs from 11 human cadavers free from any visible pathology. The sample consisted of six females and five males with a mean age of 75.7 years (range 65-94 years). Passive motions of fingers excluding the thumb were analyzed with a wire circling technique. Extreme flexion/extension angles and adduction/abduction laxities were measured for each joint. LAR angles of distal bony segment position were evaluated in comparison with the proximal bony segment position in extreme flexion or extension. The results were recorded for the joints of each three-joint-finger. No difference was statistically related to sex or right/left-sided criteria ( p>0.05). Passive LARs were measured in spite of an aggressive anatomical protocol. A small database was set up. LARs were an important third type of motion. They should be analyzed during a routine clinical examination of patients' hands as well as flexion/extension or abduction/adduction motions.     

Infundibular dilation: an anatomical variant or a pre-aneurysm? Advantages of assessment with three-dimensional rotational angiography

Purpose  

Whether an infundibular dilation (ID) is an anatomical variant or a pre-aneurysm has not been clearly determined. The aim of the present study was to evaluate the anatomical change of IDs by use of three-dimensional rotational angiography (3DRA) with volume rendering (VR).     

Critical care: Are we customer friendly?

Objective:Assessing and enhancing family satisfaction are imperative for the provision of comprehensive intensive care. There is a paucity of Indian data exploring family''s perception of Intensive Care Unit (ICU) patients. We wanted to explore family satisfaction and whether it differed in families of patients admitted under intensivists and nonintensivists in our semi-open ICU.Methodology:We surveyed family members of 200 consecutive patients, between March and September 2009 who were in ICU for >3 days. An internationally validated family satisfaction survey was adapted and was administered to a family member, on day 4 of the patient''s stay. The survey consisted of 15 questions in five categories - patient care, medical counseling, staff interaction, visiting hours, and facilities and was set to a Likert scale of 1–4. Mean, median, and proportions were computed to describe answers for each question and category.Results:A total of 515 patients were admitted during the study period, of which 200 patients stayed in the ICU >3 days. One family member each of the 200 patients completed the survey with 100% response rate. Families reported the greatest satisfaction with patient care (94.5%) and least satisfaction with visiting hours (60.5%). Chi-square tests performed for each of the five categories revealed no significant difference between satisfaction scores of intensivists and nonintensivists'' patients.Conclusion:Family members of ICU patients were satisfied with current care and communication, irrespective of whether they were admitted under intensivists or nonintensivists. Family members preferred open visiting hours policy than a time limited one.     

Noninvasive ventilation: Are we overdoing it?

Background:

Use of noninvasive ventilation (NIV) outside guideline recommendations is common. We audited use of NIV in our tertiary care critical care unit (CCU) to evaluate appropriateness of use and patient outcomes when used outside level I recommendations.

Materials and Methods:

Prospective observational study of all patients requiring NIV. Clinical parameters and arterial blood gases were recorded at initiation of NIV and 2 h later (or earlier if clinically warranted). NIV titration and decision to intubate were left to the discretion of treating intensivist. Patients were categorized into two groups: Group 1: Those with level I indications for use of NIV and group 2: All other levels of indications. Patients were followed until hospital discharge.

Results:

From January 2010 to June 2010, 1120 patients were admitted to the CCU. Of these 106 patients required NIV support with 40.6% (n = 43/106) being in group 1 and 59.4% (n = 63/106) in group 2. Of these 35.8% patients (38/106) failed NIV and required endotracheal intubation. NIV failure rates (41.27% vs. 27.91%; P = 0.02) and mortality (30.6% vs. 18.6%; P = 0.03) were significantly higher in group 2 patients. In a logistic regression analysis Acute Physiology and Chronic Health Evaluation (APACHE) II score (P = 0.02), time on NIV before intubation (P = 0.001) and baseline PaCO₂ levels (P = 0.01) were strongly associated with mortality.

Conclusion:

Noninvasive ventilation failure and mortality rates were significantly higher when used outside level I recommendations. APACHE II score, baseline PaCO₂ and duration on NIV prior to intubation were predictors of increased mortality.     

The neuropsychology of sentence processing: Where do we stand?

In the early 1980s, sentence comprehension deficits were attributed to a loss of syntactic knowledge in agrammatic Broca's aphasics and to a short-term memory deficit in conduction aphasics. Findings in the remainder of the decade called both of these claims into question and presented general difficulties for the group study approach. Results from case studies support the representational independence of syntactic and semantic information but the interaction of these knowledge sources during processing. Working memory is still considered to provide critical constraints on sentence comprehension, but the capacity involved appears to be largely independent of the phonological storage involved in word list recall. Current computational approaches to sentence comprehension provide the means of accounting for the interaction of multiple sources of information and working memory requirements, but have yet to be tested against neuropsychological findings.     

The measurement of cardiac markers: where should we focus?

Cardiac markers are presently a hot topic, with active debate on their use. They now have a major role for cost-effective management of acute chest pain and suspected acute coronary syndrome. The laboratory has a pivotal role in proper selection and interpretation of available markers, depending on the creation of evidence-based knowledge about test utilization and sources of variation. This article reviews this knowledge in the field of biomarkers determination and summarizes the major analytic and clinical issues, with reference to various recent recommendations of laboratory medicine and cardiology expert groups.     

Are we teaching sufficient anatomy at medical school? The opinions of newly qualified doctors

In recent decades wide-ranging changes have occurred in medical school curricula. Time spent studying gross anatomy has declined amidst controversy as to how, what, and when teaching is best delivered. This reduced emphasis has led to concerns amongst clinicians that a new generation of doctors are leaving medical school with insufficient anatomical knowledge. Previous studies have established that medical students value their anatomy teaching during medical school. None have sought to establish views on the sufficiency of this teaching. We investigate the opinions of newly qualified doctors at a UK medical school and relate these opinions to career intentions and academic performance in the setting of a traditional dissection and prosection-based course. Overall nearly half of respondents believe they received insufficient anatomy teaching. A substantial proportion called for the integration of anatomy teaching throughout the medical school course. Trainees intent on pursuing a surgical career were more likely to believe anatomy teaching was insufficient than those pursuing a nonsurgical career; however, overall there was no statistical difference in relation to the mean for any individual career group. This study adds to the current debates in anatomical sciences education, indicating that overall, regardless of career intentions, new doctors perceive the need for greater emphasis on anatomical teaching.     

Peer-review for selection of oral presentations for conferences: Are we reliable?

IntroductionAlthough peer-review for journal submission, grant-applications and conference submissions has been called ‘a counter- stone of science’, and even ‘the gold standard for evaluating scientific merit’, publications on this topic remain scares.Research that has investigated peer-review reveals several issues and criticisms concerning bias, poor quality review, unreliability and inefficiency. The most important weakness of the peer review process is the inconsistency between reviewers leading to inadequate inter-rater reliability.Aim of the paperTo report the reliability of ratings for a large international conference and to suggest possible solutions to overcome the problem.MethodsIn 2016 during the International Conference on Communication in Healthcare, organized by EACH: International Association for Communication in Healthcare, a calibration exercise was proposed and feedback was reported back to the participants of the exercise.ResultsMost abstracts, as well as most peer-reviewers, receive and give scores around the median. Contrary to the general assumption that there are high and low scorers, in this group only 3 peer-reviewers could be identified with a high mean, while 7 has a low mean score. Only 2 reviewers gave only high ratings (4 and 5). Of the eight abstracts included in this exercise, only one abstract received a high mean score and one a low mean score. Nevertheless, both these abstracts received both low and high scores; all other abstracts received all possible scores.DiscussionPeer-review of submissions for conferences are, in accordance with the literature, unreliable. New and creative methods will be needed to give the participants of a conference what they really deserve: a more reliable selection of the best abstracts.Practice implicationsMore raters per abstract improves the inter-rater reliability; training of reviewers could be helpful; providing feedback to reviewers can lead to less inter-rater disagreement; fostering negative peer-review (rejecting the inappropriate submissions) rather than a positive (accepting the best) could be fruitful for selecting abstracts for conferences.     

Do we see what we think we see? The complexities of morphological assessment

Reliable pathological interpretation is vital to so many aspects of tissue‐based research as well as being central to patient care. Understanding the complex processes involved in decision‐making is the starting point to improve both diagnostic reproducibility and the definition of diagnostic groups that underpin our experiments. Unfortunately, there is a paucity of research in this field and it is encouraging to see The Journal of Pathology publishing work in this area. This review attempts to highlight the opportunities that exist in this field and the technologies that are now available to support this type of research. Key amongst these are the use of decision analysis tools such as inference networks, and virtual microscopy that allows us to simulate diagnostic decision‐making. These tools have roles, not only in studying the subtleties of diagnostic decision‐making, but also in delivering new methods of training and proficiency testing. Research which helps us to better understand what we see, why we see it, and standardizing interpretative reasoning in pathological classification is essential for improving the wide range of activities that pathologists support, including clinical diagnosis, teaching, training, and experimental research. Copyright © 2009 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.