Correlation Between Paramedic Disaster Triage Accuracy in Screen-Based Simulations and Immersive Simulations

Background: Disaster triage is an infrequent, high-stakes skill set used by emergency medical services (EMS) personnel. Screen-based simulation (SBS) provides easy access to asynchronous disaster triage education. However, it is unclear if the performance during a SBS correlates with immersive simulation performance. Methods: This was a nested cohort study within a randomized controlled trial (RCT). The RCT compared triage accuracy of paramedics and emergency medical technicians (EMTs) who completed an immersive simulation of a school shooting, interacted with an SBS for 13 weeks, and then completed the immersive simulation again. The participants were divided into two groups: those exposed vs. those not exposed to 60?Seconds to Survival^© (60S), a disaster triage SBS. The aim of the study was to measure the correlation between SBS triage accuracy and immersive simulation triage accuracy. Improvements in triage accuracy were compared among participants in the nested study before and after interacting with 60S, and with improvements in triage accuracy in a previous study in which immersive simulations were used as an educational intervention. Results: Thirty-nine participants completed the SBS; 26 (67%) completed at least three game plays and were included in the evaluation of outcomes of interest. The mean number of plays was 8.5 (SD =7.4). Subjects correctly triaged 12.4% more patients in the immersive simulation at study completion (73.1% before, 85.8% after, P?=?0.004). There was no correlation between the amount of improvement in overall SBS triage accuracy, instances of overtriage (P?=?0.101), instances of undertriage (P?=?0.523), and improvement in the second immersive simulation. A comparison of the pooled data from a previous immersive simulation study with the nested cohort data showed similar improvement in triage accuracy (P?=?0.079). Conclusions: SBS education was associated with a significant increase in triage accuracy in an immersive simulation, although triage accuracy demonstrated in the SBS did not correlate with the performance in the immersive simulation. This improvement in accuracy was similar to the improvement seen when immersive simulation was used as the educational intervention in a previous study.     

Validity and reliability of 2-dimensional trunk,hip, and knee frontal plane kinematics during single-leg squat,drop jump,and single-leg hop in females with patellofemoral pain

ObjectivesTo investigate validity and between-session reliability of frontal plane trunk, hip, and knee kinematics during three functional tasks in females with patellofemoral pain (PFP).DesignObservational.SettingResearch Laboratory.Participants20 females with PFP (22.7 ± 3.2 years, 69.9 ± 9.2 kg, 167.7 ± 9.6 cm).Main outcome measuresTrunk, hip, and knee frontal plane peak angles during the single leg squat (SLS), drop vertical jump (DVJ), and single leg hop (SLH) kinematics were evaluated using 2-dimensional (2D) and 3-dimensional (3D) motion capture. Participants returned to the lab one week later and competed a second 2D analysis of the functional tasks. Concurrent validity was assessed by evaluating relationship between 2D and 3D frontal plane kinematics with Pearson correlations. Between-session reliability was assessed by evaluating 2D kinematics with intraclass correlation coefficients by a single assessor.ResultsModerate to strong correlations (r = 0.55–0.76, p < .05) were found for frontal plane hip kinematics during all three tasks and the trunk during the SLH. Frontal plane kinematics demonstrated good to excellent test-retest reliability for each of the three tasks, (ICC _(2,1) = 0.70–0.90).Conclusion2D hip joint angles during the three functional tasks were the only valid frontal plane angles. Trunk, hip, and knee 2D frontal plane kinematics ranged between good-excellent reliability.     

The effects of exergames on anxiety levels: A systematic review and meta-analysis

There are currently many different approaches to performing exergames and there is still no consensus as to whether exergames are able to reduce anxiety levels, as well as whether exergames provide greater reductions on anxiety levels when added to traditional forms of clinical interventions. Therefore, the aim of the present systematic review and meta-analysis was to access data from studies that evaluated the effects of exergames on anxiety levels in humans. PubMed, Scopus and Cochrane databases were searched up to 22 February 2019. Inclusion criteria were acute and chronic (short-term and long-term interventions) studies which evaluated the effects of exergames in anxiety levels as primary or secondary aim. Of the 1342 studies found, 17 and 10 were included in qualitative analyses and meta-analyses, respectively. The within-group analysis found that exergames (standardized mean difference [SMD]: −0.57 [95% Confidence interval (CI): −0.86 to −0.28], P < .001) and usual care (SMD: −0.21 [95% CI: −0.34 to −0.08], P = .002) resulted in significant improvements on anxiety levels. However, the between-group meta-analysis on the effects of control interventions vs exergames (SMD: 0.02 [95% CI: −0.55 to 0.60], P = .939) found no significant difference between groups in anxiety levels reductions. There was also no significant difference (SMD: −0.04 [95% CI: −0.32 to 0.25], P = .805) between usual care vs exergames plus usual care interventions in anxiety levels reductions. Although exergames demonstrated within-group improvements in anxiety levels across different clinical populations, it was not greater than the effects from non-exercise interventions. Also, given the paucity of studies, small sample sizes, different research designs, and different population investigated, the existing evidence is insufficient to support the advantages of usual care supplemented by exergame intervention over usual care standalone in anxiety levels reduction.     

Non‐epileptic myoclonic attacks in infancy: three cases

Since the first cases of abnormal paroxystic movements in normal infants were described, the importance of accurate characterization of this medical condition has been increasingly confirmed in the literature. Non‐epileptic attacks mimic epileptic paroxysms in clinical presentation, but they have a typically benign course and are unresponsive to pharmacological treatment. An evident feature of the syndrome is its extreme variability in clinical manifestation. Here, we describe three normal infants with two similar forms of non‐epileptic paroxysms. Electroclinical manifestations and profile of evolution were investigated. Ictal video‐EEG polygraphic recordings were obtained for each patient. The increasing number of such reported clinical cases in the literature may contribute to high quality systematic reviews and the development of useful guidelines in the future. The clinical heterogeneity of non‐epileptic attacks, together with the relative rarity of the condition, may make differential diagnosis with epileptic attacks very challenging. [Published with video sequences]     

Predictors of Recording an Event During Prolonged Inpatient Video Electroencephalogram Monitoring in Children

BackgroundDistinguishing between seizures and nonepileptic events is a key challenge in pediatric neurology. The diagnostic gold standard is prolonged inpatient video electroencephalogram monitoring. However, little is known about preadmission characteristics that are predictive of recording an event during such monitoring.MethodsThis is a retrospective chart review of children undergoing prolonged inpatient video electroencephalogram monitoring between 2009 and 2012 at a tertiary referral center for the purpose of distinguishing between seizures and nonepileptic events. Demographic information, medical history, event characteristics, and inpatient monitoring course were abstracted.ResultsTwo-hundred thirteen children were identified. The median recording duration was 25 hours (interquartile range 22.4-48.5), and median time to event of interest (among those with an event recorded) was 4.5 hours (interquartile range 1.4-18.8). An event of interest was recorded in 66% of patients. At the event level, 20% of recorded events were associated with an electroencephalogram correlate, which refers to a change in the pattern seen on the electroencephalogram during a seizure. At the patient level, 112 (79.4%) with events recorded had only nonepileptic events recorded, 25 (17.7%) had only seizures recorded, and 4 (2.8%) had both recorded. Recording an event was predicted by the presence of intellectual disability (P = 0.001), greater preadmission event frequency (P < 0.001), and shorter latency since most recent event (P < 0.001).ConclusionsProlonged inpatient electroencephalogram monitoring captured an event of interest in two-thirds of patients, with most of these events captured within less than four and a half hours of recording onset. Several factors predict a greater yield with prolonged inpatient video electroencephalogram monitoring—including event frequency, latency since the most recent event, and the presence of intellectual disability—and can be used to counsel patients regarding this study for the purpose of event capture in the context of shared decision making.     

Improving disease knowledge of primary sclerosing cholangitis patients and their relatives with a 3-dimensional education video

ObjectivePrimary sclerosing cholangitis is a severe liver disease. Liver transplantation is the only curative therapeutic option. The unpredictable disease course causes much uncertainty and anxiety among patients and relatives. Improved disease knowledge may result in better health outcomes. In PSC, there is lack of high quality patient education materials. The aim of this study was to evaluate the ability of a 3-dimensional education video to improve PSC knowledge in patients and relatives.MethodsA digital survey containing questions about PSC, anxiety and satisfaction was sent prior to, directly after, and one week after watching the video. Both European and American patients and relatives were included.ResultsA total of 278 participants (224 patients and 54 relatives) were included. PSC knowledge score increased from 53 % to 74 % directly after and 70 % one week after the video. The STAI anxiety score decreased after the video (-0,8, p = 0,007). Younger age and lower baseline knowledge were independent predictors of knowledge improvement.ConclusionDisease knowledge improved after watching the video and this was sustained one week later. Generally, patients were very enthusiastic about the video.Practice implications3D education videos can be useful to increase disease knowledge in a severe disease such as PSC.     

Physiological and Brain Activity After a Combined Cognitive Behavioral Treatment Plus Video Game Therapy for Emotional Regulation in Bulimia Nervosa: A Case Report

Background

PlayMancer is a video game designed to increase emotional regulation and reduce general impulsive behaviors, by training to decrease arousal and improve decision-making and planning. We have previously demonstrated the usefulness of PlayMancer in reducing impulsivity and improving emotional regulation in bulimia nervosa (BN) patients. However, whether these improvements are actually translated into brain changes remains unclear.

Objective

The aim of this case study was to report on a 28-year-old Spanish woman with BN, and to examine changes in physiological variables and brain activity after a combined treatment of video game therapy (VGT) and cognitive behavioral therapy (CBT).

Methods

Ten VGT sessions were carried out on a weekly basis. Anxiety, physiological, and impulsivity measurements were recorded. The patient was scanned in a 1.5-T magnetic resonance scanner, prior to and after the 10-week VGT/CBT combined treatment, using two paradigms: (1) an emotional face-matching task, and (2) a multi-source interference task (MSIT).

Results

Upon completing the treatment, a decrease in average heart rate was observed. The functional magnetic resonance imaging (fMRI) results indicated a post-treatment reduction in reaction time along with high accuracy. The patient engaged areas typically active in healthy controls, although the cluster extension of the active areas decreased after the combined treatment.

Conclusions

These results suggest a global improvement in emotional regulation and impulsivity control after the VGT therapy in BN, demonstrated by both physiological and neural changes. These promising results suggest that a combined treatment of CBT and VGT might lead to functional cerebral changes that ultimately translate into better cognitive and emotional performances.