Improvement In Overall Score Research Articles

Management of mild Cervical Spondylotic Myelopathy

Introduction: Most of the elderly individuals with cervical spondylotic myelopathy (CSM) suffer from a progressive, and irreversible spinal cord dysfunction and pain. The incidence is rising in tandem with the ageing population. Due to its debilitating effects on a person's physical, mental, and social aspects, it is quickly becoming a public health issue. Therefore, the primary objective is to diagnose the condition in its milder form, prevent its progression, and treat the symptoms aggressively. This article discusses the management of mild CSM, including our experiences, difficulties, current state of knowledge, and potential future developments. Methodology: From the patients presenting with neck pain in the OPD, those with mild CSM according to modified Japanese Orthopedic Association (mJOA) scoring system were selected. Their disabilities were studies with commonly used scoring systems like Nurick grading, Neck Disability Index (NDI), and quality of life with SF-36v2. Only the degenerative cases were included, and other pathologies were excluded. Classical cervical disc prolapse with radiculopathy was also not included. Conservative management was initiated in all these patients and followed up for the improvement or deterioration. Results: With the above selection criteria, 235 patients with mild CSM were included in the studies. There were 186 males and 49 females with ages ranging from 42 to 78 years. The clinical profiles were studied. The major signs and symptoms were neck pain, disturbed dexterity of hands, imbalance on walking and exaggerated reflexes. The impairments were stratified and found that the average mJOA score was 16.2, Nurick score was 2.8 and NDI was 33.6. The quality of life was judged using SF-36v2 and was 39.7. The patients were monitored for three, six, twelve, and twenty-four months with conservative care. The follow up was very poor and only 46 out of the total 235 patients could be followed up to two years. Thus the result obtained could not derive any significant information. The symptoms like pain significantly reduced and there was improvement in overall scores including the quality of life. There were no case of deterioration during the conservative treatment. Thus, there was no discernible advancement that called for surgery. Conclusion: Mild CSM is a common, under diagnosed and usually ignored entity which affects big portion of elderly population. It specifically impacts the mental and social aspects that impairs one's quality of life, as well as the functional and emotional aspects. They are initially being treated conservatively and closely monitored for signs of worsening and advancement. Most of the patients respond to conservative treatment but those having risk factors for progression and bad prognosis, should remain vigilant of any features of deterioration. The treatment plan must be timely modified if a patient's clinical condition deteriorates preventing life-long sufferings.

Home-based transitional cardiac telerehabilitation in older adults post coronary artery bypass grafting: A randomized controlled trial

This randomized controlled trial evaluated the effectiveness of a 12-week home-based transitional cardiac telerehabilitation (Hb-T-CTR) program on health-related quality-of-life and therapeutic self-care in older adults’ post-Coronary Artery Bypass Grafting (CABG). The intervention group (n = 57) underwent Hb-T-CTR, incorporating preoperative counseling, postoperative education, a culturally adapted video, home visits, and telephone counseling, while the control group (n = 61) received standard care. Using the Coronary Revascularization Outcome Questionnaire and the Sidani Doran Therapeutic Self-Care Measure, data were collected at three time points. Results showed significant improvements in overall scores for both health-related quality of life (t1=3.386, P = 0.001; t2=4.224, P < 0.001) and therapeutic self-care (t1=7.104, P < 0.001; t2=4.242, P < 0.001) in the intervention group compared to controls. This telehealth approach provides convenient and accessible rehabilitation services for older adults’ post-CABG and highlights the importance of integrating Hb-T-CTR into routine care for personalized rehabilitation. This study underscores the potential of telehealth tools in overcoming barriers and enhancing patient-centered interventions.

The Efficacy of Onion Extract on the Prevention or Treatment of Scars: A Systemic Review.

Scars are common and debilitating outcomes of burn injury, with no current consensus regarding the gold standard in scar management. Non-invasive interventions such as silicone gels are popular adjuvant treatments due to ease of application. Onion extract (OE) has been proposed as a potential scar treatment modality due to its anti-microbial and anti-inflammatory properties. A systematic search of the literature was conducted using PubMed, Scopus, and Cochrane for articles published between January 2000 and December 2021. Inclusion criteria were studies: (a) involved OE gel or OE treatment, and (b) those assessing scar prevention or treatment outcomes. Patient and physician reported scar outcomes after treatment and adverse effects were recorded. A total of 21 articles were included in the final review. Five studies found statistically significant improvements in overall scores and individual VSS components in the OE treatment group compared to the silicone groups. Several studies found combined treatment of OE with other topical treatment modalities such as triamcinolone or silicone gel produced significant improvements in scar symptoms. In this review, reported adverse effects were minimal, often consisting of self-resolving pruritus, irritation, and erythema. This review supports OE's potential utility in scar prevention and treatment. Most studies reported minimal adverse events with OE application and significant benefits in specific scar characteristics. Further research is needed to investigate scar outcomes after treatment with OE with larger sample sizes and a follow up period greater than a year.

MFE‐MVSNet: Multi‐scale feature enhancement multi‐view stereo with bi‐directional connections

AbstractRecent advancements in deep learning have significantly improved performance in the multi‐view stereo (MVS) domain, yet achieving a balance between reconstruction efficiency and quality remains challenging for learning‐based MVS methods. To address this, we introduce MFE‐MVSNet, designed for more effective and precise depth estimation. Our model incorporates a pyramid feature extraction network, featuring efficient multi‐scale attention and multi‐scale feature enhancement modules. These components capture pixel‐level pairwise relationships and semantic features with long‐range contextual information, enhancing feature representation. Additionally, we propose a lightweight 3D UNet regularization network based on depthwise separable convolutions to reduce computational costs. This network employs bi‐directional skip connections, establishing a fluid relationship between encoders and decoders and enabling cyclic reuse of building blocks without adding learnable parameters. By integrating these methods, MFE‐MVSNet effectively balances reconstruction quality and efficiency. Extensive qualitative and quantitative experiments on the DTU dataset validate our model's competitiveness, demonstrating approximately 33% and 12% relative improvements in overall score compared to MVSNet and CasMVSNet, respectively. Compared to other MVS networks, our approach more effectively balances reconstruction quality with efficiency.

Validation of a modified Care and Comfort Score and responsiveness to hip surgery in children with cerebral palsy in Gross Motor Function Classification System levels IV and V.

The purpose of this study was to assess the reliability and responsiveness to hip surgery of a four-point modified Care and Comfort Hypertonicity Questionnaire (mCCHQ) scoring tool in children with cerebral palsy (CP) in Gross Motor Function Classification System (GMFCS) levels IV and V. This was a population-based cohort study in children with CP from a national surveillance programme. Reliability was assessed from 20 caregivers who completed the mCCHQ questionnaire on two occasions three weeks apart. Test-retest reliability of the mCCHQ was calculated, and responsiveness before and after surgery for a displaced hip was evaluated in a cohort of children. Test-retest reliability for the overall mCCHQ score was good (intraclass correlation coefficient 0.78), and no dimension demonstrated poor reliability. The surgical intervention cohort comprised ten children who had preoperative and postoperative mCCHQ scores at a minimum of six months postoperatively. The mCCHQ tool demonstrated a significant improvement in overall score from preoperative assessment to six-month postoperative follow-up assessment (p < 0.001). The mCCHQ demonstrated responsiveness to intervention and good test-retest reliability. The mCCHQ is proposed as an outcome tool for use within a national surveillance programme for children with CP.

Virtual Reality in Preoperative Planning of Complex Cranial Surgery

Changing paradigms of neurosurgical training and limited operative exposure during the residency period have made it necessary to evaluate newer technologies for training. Virtual reality (VR) technology provides three-dimensional reconstruction of routine imaging, along with the ability to see as well as interact. The application of VR technology in operative planning, which is an important part of neurosurgical training, has been incompletely studied so far. Sixteen final-year residents, post-M.Ch. (magister chirurgiae) residents, and fellows were included as study participants. They were divided into 2 groups based on their seniority for further analysis. Five complex cranial cases were selected and a multiple-choice question-based test was prepared by the authors, with 5 questions for each of the cases. The pretest score was determined based on performance on the test after participants accessed routine preoperative imaging. The posttest score was calculated after use of the VR system (ImmersiveTouch VR System, ImmersiveTouch Inc.). Analysis was performed by the investigators, who were blinded to the identity of the participant. Subanalysis based on the type of case and type of question was performed. Feedback was obtained from each participant regarding VR use. There was an overall improvement in scores from pretest to posttest, which was also noted in the analysis based on the participants' seniority. This improvement was noted to be more for the vascular cases (15.89%) compared with the tumor cases (7.84%). Participants also fared better in questions related to surgical anatomy and surgical approach, compared with questions based on the diagnosis. There was overall positive feedback from participants regarding VR use, and most participants wanted VR to become a routine part of operative planning. Our study shows that there is improvement in understanding of surgical aspects after use of this VR system.

Does the implementation of pay-for-performance indicators improve the quality of healthcare? First results in France.

Pay-for-performance (P4P) models are intended to promote quality of care in both hospitals and primary care settings. They are considered as a means of changing medical practices, particularly in primary care. The first objective of this study was to assess how performance indicators changed over time, measured through "Remuneration on Public Health Objectives" (ROSP) scores, between 2017 and 2020 in a large French region (Grand Est region), and to compare this evolution in the rural vs. urban areas of the region. The second objective was to focus on the area with the least improvement in ROSP scores and to investigate whether the scores and the available sociodemographic characteristics of the area were associated. First, we measured the evolution over time of P4P indicators (i.e., ROSP scores) obtained from the regional health insurance system, for GP practices in the Grand Est region between 2017 and 2020. We then compared the scores between the Aube Department and the rest of the region (urban areas). To address the second objective, we focused on the area found to have the least improvement in indicators to investigate whether there was a relationship between ROSP score and sociodemographic characteristics. More than 40,000 scores were collected. We observed an overall improvement in scores over the study period. The urban area (Grand Est region minus the Aube) scored better than the rural area (Aube) for chronic disease management [median 0.91 (0.84-0.95) vs. 0.90(0.79-0.94), p < 0.001] and prevention [median 0.36 (0.22-0.45) vs. 0.33 (0.17-0.43), p < 0.001], but not for efficiency, where the rural area (Aube) performed better [median 0.67(0.56-0.74) vs. 0.69 (0.57-0.75 in the rest of the Grand Est region, p = 0.004]. In the rural area, we found no significant association between ROSP scores and sociodemographic characteristics, except for extreme rurality in some sub-areas. At the regional level, the overall improvement in scores observed between 2017 and 2020 suggests that the implementation of ROSP indicators have improved the quality of care, particularly in urban areas. These results also suggest that efforts should be focused on rural areas, which already had the lowest scores at the start of the P4P program.

A Novel Mock Oral Curriculum for Senior Surgery Residents: Results of a Pilot Study.

The oral general surgery certifying examination (CE) is required for board certification. A curriculum was designed to improve CE passage rates at an academic residency program. Limited literature exists that evaluates a long-term mock oral curriculum for senior residents. This study aims to evaluate the impact of this curriculum on essential elements for clinical practice and CE preparedness. The curriculum consisted of weekly meetings with postgraduate year four and postgraduate year five residents (n=10). Two residents were selected for a video-recorded board-style mock examination with a faculty examiner and peer audience. Each attendee completed a standard evaluation form that assessed score, anxiety, confidence, and medical knowledge. Blood pressure, pulse, and unused time were assessed. A postcurriculum survey was conducted. Medical knowledge had the greatest correlation with overall scores (R2=0.733). Positive correlations were seen between confidence and case number for faculty, self, and peer scores (R2=0.671, R2=0.566, and R2=0.729, respectively). There was a positive correlation between confidence and medical knowledge (R2=0.575). There was a significant difference between the overall score of nontachycardic versus tachycardic residents (P=0.00994). Residents demonstrated increasing confidence as they progressed through the curriculum by self-reported and objective measures. Residents demonstrated improvements in overall scores. Future directions will examine results of the 2-y curriculum experience and CE passage rates to verify that a standardized, structured, weekly, longitudinal curriculum is beneficial for CE preparedness and clinical practice.

Effects of Sleep Deprivation, Non-Dominant Hand Employment, Caffeine and Alcohol Intake During Surgical Performance: Lessons Learned From the Retina Eyesi Virtual Reality Surgical Simulator.

PurposeDetermine whether real-life surgical experience correlates with scores on a retina virtual simulator and the effects of various challenges on surgical performance.MethodsThe study was performed using the Eyesi Surgical Simulator, a virtual reality retina surgical simulator. Residents, fellows, and retina staff were assessed on surgical simulations to determine surgical skills. Participants were assigned baseline scores on speed, efficiency of movement, and ability to avoid retinal damage. After receiving their baseline scores, participants were challenged to use their non-dominant hand or to use the simulator after sleep deprivation or the intake of caffeine or alcohol.ResultsAt baseline, junior residents had an average score of 943; senior residents, 1045; retina fellows, 1153; and surgical retina staff, 1161. A 12.5% overall improvement in scores was achieved when comparing baseline 1 to baseline 2; a major improvement was recorded in residents (14.5%) compared with fellows and retina staff (9.97%). A statistically significant difference was observed between residents and fellows (P = 0.027), as well as between residents and retina staff (P = 0.04). A significant decrease in performance (15.7%) was observed when the non-dominant hand was used (P = 0.043). Performance after sleep deprivation and alcohol intake decreased, but not with a statistically significant difference (P = 0.6 and P = 0.5, respectively). A trend toward increasing performance was observed after caffeine intake (6.1%; P = 0.06).ConclusionsThe retina virtual simulator is a novel teaching tool for retinal surgery. A significant association was observed between real surgical experience and the retina surgery virtual simulator results based on surgical experience.Translational RelevanceAn association between real surgical experience and retina surgery virtual simulator results was demonstrated. A complete training program with a cut-off threshold score should be validated for retina training programs.

Two years of physically active mathematics lessons enhance cognitive function and gross motor skills in primary school children

Physically active lessons have been shown to enhance academic achievement. However, the effects on cognitive function and gross motor skill development remain unknown. The present study examined how the incorporation of physical activity bouts within Mathematics lessons affects cognitive function and gross motor skill development across 2 years in primary school children. Eighty-two children (6.6 ± 0.3 y) were allocated to an intervention (n = 36; completing 8 h/wk of physically active lessons) or control (n = 46) group. A battery of cognitive function tests was completed, alongside the TGMD-3 to assess gross motor skills. Physically active Mathematics lessons led to greater improvements across all measures of cognition, when compared to the control group (digit span forwards, p < 0.001, d = 1.5; digit span backwards, p = 0.017, d = 1.0; free word recall: p < 0.001, d = 1.3; selective visual attention: p < 0.001, d = 0.3; verbal fluency: p < 0.001, d = 0.9; arithmetic: p < 0.001, d = 1.8). Furthermore, the intervention group demonstrated greater improvements in overall score on the TGMD-3 (p < 0.001, d = 1.7), as well as the locomotion (p < 0.001, d = 1.1) and object control (p < 0.001, d = 1.5) sub-scales. The physically active Mathematics lessons intervention appears to offer synergistic benefits in relation to cognitive and motor development, which are critical for optimal development in the early years.

Study of the impact of the ARCH model of parenting on the psychosocial well-being of children and their parents during the COVID-19 pandemic

Introduction: The COVID-19 pandemic and its associated lockdowns have affected the development of children negatively. The ARCH model is a parent-administered, home-based, psychological intervention model to improve the psychosocial well-being of children and their families. The model acts as a set of guidelines and a list of activity modules for parent-child interactions that will promote and enhance the child’s social skills and psychological health. Objective: The objective of the study was to study the effectiveness of a novel innovative psychological model and parenting strategy for promoting the psychosocial well-being of children. Materials and Methods: This is an open prospective single-arm study in a tertiary care hospital with pre-and post-intervention design. Patients aged 3–18 years visiting the outpatient department, admitted to the pediatric ward as well as their parents, and siblings, were enrolled in the study. Data were collected by self-reported questionnaires. The intervention was administered and 1–2 months later we checked for any changes in the psychosocial well-being scores. Results: Fifty participants were enrolled and eight were lost to follow-up. Statistical analysis showed an insignificant difference in the Ryff psychosocial well-being pre-intervention score (208.5±15.1) and post-intervention scores (208.4±14.8) (p=0.847) for parents. KIDSCREEN questionnaire score showed a significant improvement in “social service and peers” subcategory, between pre-intervention score (128.83±17.18) and post-intervention score (131.29±16.60) with a Z score=2.09 (p&lt;0.05). KIDSCREEN questionnaire score also showed improvement in overall score in pre-intervention score (578.64±440.39) and post-intervention score (584.40±444.19) with a Z score=1.66 (p&lt;0.05). Conclusion: Our study found that while the intervention did not have a major impact on the psychosocial well-being of the parents, there was a significant difference effected on the psychosocial well-being of the children.

Effectiveness of a Three‐Drawing Strategy for Self‐Assessment and Metacognitive Awareness of Anatomical Knowledge

Anatomy is often taken as a pre‐health prerequisite early in students’ undergraduate career. Universities accept students with varying backgrounds and study skills, so it is imperative for students to approach scientific rigorous subjects in an efficient manner. Anatomy is a visual science where drawing may help students with knowledge retention and retrieval. Prior research in active learning shows improved retention by drawing histological tissue (Balemans et al., 2015) and benefits of multiple iterations of drawing anatomical structures (Backhouse et al., 2016). Multiple drawings studies with initial free recall for metacognitive awareness have not been published. In this research, active learning through drawing is explored in a three‐drawing approach with consideration for metacognitive application and self‐assessment. A previous pilot study with a small group of undergraduate anatomy students indicated the effectiveness of this drawing strategy. This current study expands on the pilot, by utilizing the three‐drawing strategy in a large‐enrollment, undergraduate anatomy class.A three‐drawing template was provided to a 5‐credit hour undergraduate Basic Human Anatomy course (ANAT‐A215) during a face‐to‐face active learning session in a flipped classroom (480 students with 1 lecture and 12 lab sections). Lecture content was presented asynchronously via lecture recordings and face‐to‐face lecture instruction provided interactive activities, two of which were dedicated to the drawing activities of this study. Upon completion, students were provided with the opportunity for 2 points extra credit for drawing submissions. Drawing 1, “What you think you know,” was completed by free recall without any references. Drawing 2, “What you see,” had students observe, analyze, and draw the structures into the template based off a Human Anatomy textbook image. Drawing 3, “What you learned,” involved free recall drawing without any resources immediately after drawing 2. A scoring rubric with a range of 0‐15 points was used to compare anatomical accuracies with shape, structure proportion, orientation, and drawing and labelling of both bone/muscle features across drawing 1 and drawing 3. The first author led the interactive drawing sessions and developed both the three‐drawing activity and scoring rubric.Results suggest that students tend to fall into three groups. In the first group, students do not improve (as may be expected) in their drawings. In the second group, students have a strong initial grasp of the anatomical structures capturing appropriate shape, labelling, and features from the initial drawing 1 and demonstrate marginal improvement in drawing 3. The third group show great improvement comparing drawing 1 to drawing 3; drawing 1 might not show recall of the structures nor features labelled and improvement in drawing 3 includes structure shapes, features, and labelling of muscle/bone. In a broad scope, an overall improvement in scores is seen for most students—particularly in structure shape, recall of structures, and labelling of features. These results suggest the use of a three‐drawing learning strategy in anatomy is beneficial to student learning and self‐assessment. Using this approach, students can assess their perceived knowledge vs. learned content ultimately encouraging self‐regulation, content engagement, and self‐assessment for reflection on areas that might need further improvement.

Are Online Synchronous Team-Based-Learning (TBL) pedagogy effective?: Perspectives from a study on medical students in Oman.

Introduction: Team-based learning (TBL) is a highly structured, instructive, and student-focused pedagogy used by medical educators to foster the students’ learning. The present study aimed to qualitatively explore the students’ perception of the effectiveness of online synchronous TBL pedagogical strategy in promoting learning outcomes. Methods: A cross-over interventional study was conducted on MD4 year medical students, using four modified TBL sessions on common immunological diseases on four different dates. 139 participants were divided into 4 groups [35 each in A, B, C, & 34 in D]. For TBL session 1, Group A and group B were the study and control groups, respectively. For the second session on different topics, the groups were reversed with group B and group A as the study and control groups, respectively. The same was followed for groups C and D. The means and standard deviations of the pre-test and post-test scores were compared after calculating the improvement in scores from pre- to post-tests. Repeated measures ANOVA suitably coded in SPSS for cross-over design was used to find out confounding by sequence of interventions with a p-value of <0.05 signifying the significance. Students’ feedback on online TBL sessions was collected through a predesigned questionnaire on a 3-point Likert scale. The data were analyzed using SPSS version 22 and expressed as number and percentage. Results: The post-test scores of the students who participated in the TBL session were significantly higher when compared to the self-study (SS) arm. The overall improvement in scores was 4.98 (1.4) in TBL group, whereas in the SS arm it was only 2.29 (1.51). The new method was found far superior to the self-study method regardless of being applied before or after the comparison mode of self-study (P<0.0001). The scores of the self-study was marginally better when offered first rather than after a TBL session, indicating the negative effect of cross-over on SS mode (P=0.024). The overall response of our students toward the effectiveness of online TBL pedagogy was overwhelmingly positive in terms of an opinion survey which had a Cronbach’s alpha of 0.932. The majority (>80%) perceived TBL as an enjoyable active session that promoted their active participation and engagement through student-led discussions. Many stated that TBL enhanced their critical thinking, problem-solving ability, communication skills, and knowledge. Conclusion: TBL is an instructive and highly structured teaching-learning strategy, welcomed by the majority of our participants. Online TBL sessions are effective in fostering the students’ learning and can be used confidently when needed.

A STUDY TO EVALUATE THE SAFETY OF ARIPIPRAZOLE IN TREATMENT OF SCHIZOPHRENIA

Objectives: Aripiprazole is recommended in a dose of 10 and 15 mg/day, with a dose ranging between 10 and 30 mg/day in the treatment of schizophrenia. The primary objective of the study is to evaluate the safety profile of Aripiprazole in low dose of 15 mg versus high dose of 30 mg in the treatment of Schizophrenia. Methods: A total of 60 patients (not on treatment) between age 18-60 years of either gender who meet the diagnostic criteria as per DSM-IV classification for schizophrenia and schizoaffective disorder. All patients were randomly divided into two groups on single-blind study criteria. Group-I: Aripiprazole 15 mg once a day, morning dose for 6 weeks. Group-II: Aripiprazole 30 mg once a day, morning dose for 6 weeks. The ESRS includes 12 questionnaire items; each item is rated on a 7-point scale. Efficacy assessment included at baseline and at 6 weeks end study scoring on PANSS, EPRS, and CGI. Results: The total number of patients showed the ESRS (total symptoms) in group-I was 09 patients (35%) out of 26 and in group II, 13 patients (59%) out of total 22 showed the ESRS (total symptoms). In both the groups aripiprazole showed the comparable efficacy by improving overall symptoms in the number of patients. In group I, 20 patients have shown the improvement in overall scores of all scales. In group II, 16 patients have shown the improvement in overall scores in different scales. Conclusions: Aripiprazole is effective in schizophrenia and schizoaffective disorders, doses of 15 mg are equally effective as doses of 30 mg, side effects like EPS are more with higher doses of Aripiprazole.

Teaching plain language to medical students: improving communication with disadvantaged patients

BackgroundLow health literacy underpins health inequality and leads to poor adherence to medical care and higher risk of adverse events and rehospitalization. Communication in plain language, therefore, is an essential skill for health professionals to acquire. Most medical education communication skill programs focus on verbal communication, while written communication training is scarce.ETGAR is a student delivered service for vulnerable patients after hospital discharge in which, amongst other duties, students ‘translate’ the medical discharge letters into plain language and share them with patients at a home visit. This study ascertains how this plain language training impacted on students’ written communication skills using a tool designed for purpose.MethodsStudents, in pairs, wrote three plain language discharge letters over the course of a year for patients whom they encountered in hospital. The students handed over and shared the letters with the patients during a post-discharge home visit. Structured feedback from course instructors was given for each letter. An assessment tool was developed to evaluate students’ ability to tell the hospitalization narrative using plain and clear language. First and last letters were blindly evaluated for the entire cohort (74 letters; 87 students).ResultsStudents scored higher in all assessment categories in the third letters, with significant improvement in overall score 3.5 ± 0.8 vs 4.1 ± 0.6 Z = -3.43, p = 0.001. The assessment tool’s reliability was high α = 0.797, it successfully differentiated between plain language categories, and its score was not affected by letter length or patient’s medical condition.ConclusionsPlain language discharge letters written for real patients in the context of experience-based learning improved in quality, providing students with skills to work effectively in an environment where poor health literacy is prevalent. ETGAR may serve as a model for learning written communication skills during clinical years, using the assessment tool for formative or summative evaluation.

Acquisition of Basic Micro-Neurosurgical Skills Using Cavitron Ultrasonic Aspirator in Low-Cost Readily Available Models: The Egg Model

Attainment of micro-neurosurgical skills is a challenge in teaching hospitals throughout training. Models that mimic the workflow as well as haptics are time-consuming, expensive, and unsuitable to serve as a routine platform. Our objective was to present a model and a set of tasks, based on a hard-boiled egg, microscope, and a Cavitron ultrasonic aspirator (CUSA; Integra Lifesciences Corp., Tullamore, Ireland), which is cheap, easy to setup and can be used for training microsurgery and CUSA skills, required for removal of deep-seated tumors. The goal was to remove the egg yolk from within a hard-boiled egg, representing an intrinsic brain tumor, surrounded by the egg's white, representing adjacent brain tissue, while preserving it. Assessment was based on the yolk's exposure, completeness of removal, and collateral damage and task completion duration, with repeated trials (n= 4), for validation purposes, for 6 operators with different experience levels. Improvement in overall score (mean of 47.5 ± 19 in the first trial vs. 80.0 ± 12 in the fourth trial, P < 0.01), and task duration completion (mean initial duration of 21:25 ± 4:52 minutes to 15:30 ± 5:17 minutes, P < 0.01) was observed. Parameters gradually improved on repeated attempts, and experience level of the operators correlated with scores. The egg model is an easy-to-handle, cheap model that enables the acquisition of basic micro-neurosurgical skills and basic workflow required for removing of intrinsic brain tumors. This study has validated and defined reproducible tasks that can be scored, correlated with performance. This model can be incorporated into a resident's routine and potentially provide an accessible training platform for neurosurgical trainees.

Preliminary Report From the Pelvic Floor Disorders Consortium: Large-Scale Data Collection Through Quality Improvement Initiatives to Provide Data on Functional Outcomes After Rectal Prolapse Repair.

The surgical management of rectal prolapse is constantly evolving, yet numerous clinical trials and meta-analyses studying operative approaches have failed to make meaningful conclusions. The purpose of this study was to report on preliminary data captured during a large-scale quality improvement initiative to measure and improve function in patients undergoing rectal prolapse repair. This was a retrospective analysis of prospectively collected surgical quality improvement data. This study was conducted at 14 tertiary centers specializing in pelvic floor disorders from 2017 to 2019. A total of 181 consecutive patients undergoing external rectal prolapse repair were included. Preoperative and 3-month postoperative Wexner incontinence score and Altomare obstructed defecation score were measured. The cohort included 112 patients undergoing abdominal surgery (71 suture rectopexy/56% minimally invasive, 41 ventral rectopexy/93% minimally invasive). Those offered perineal approaches (n = 68) were older (median age, 75 vs 62 y; p < 0.01) and had more comorbidities (ASA 3-4: 51% vs 24%; p < 0.01) but also reported higher preintervention rates of fecal incontinence (Wexner 11.4 ± 6.4 vs 8.6 ± 5.8; p < 0.01). Patients undergoing perineal procedures had similar incremental improvements in function after surgery as patients undergoing abdominal repair (change in Wexner, -2.6 ± 6.4 vs -3.1 ± 5.6, p = 0.6; change in Altomare, -2.9 ± 4.6 vs -2.7 ± 4.9, p = 0.8). Similarly, patients undergoing posterior suture rectopexy and ventral mesh rectopexy had similar incremental improvements in overall scores; however, patients undergoing ventral mesh rectopexy had a higher decrease in the need to use pads after surgery. The study was limited by its retrospective data analysis and 3-month follow-up. Functional outcomes improved in all of the patients undergoing prolapse surgery. Larger cohorts are necessary to show superiority among surgical procedures. Quality improvement methods may allow for systematic yet practical acquisition of information and data analysis. We call for the creation of a robust database to benefit this patient population. See Video Abstract at http://links.lww.com/DCR/B581. ANTECEDENTES:El tratamiento quirúrgico del prolapso rectal está evolucionando constantemente, sin embargo, numerosos estudios clínicos y metaanálisis que evalúan los tratamientos quirúrgicos no han logrado demostrar conclusiones significativas.OBJETIVO:Reportar datos preliminares obtenidos a gran escala durante una iniciativa de mejoramiento de la calidad para medir y mejorar la función en pacientes sometidos a reparación de prolapso rectal.DISEÑO:Análisis retrospectivo de datos recolectados prospectivamente de mejoramiento de la calidad quirúrgica.ENTORNO CLINICO:Este estudio se realizó en 14 centros terciarios especializados en trastornos del piso pélvico del 2017 al 2019.PACIENTES:Un total de 181 pacientes consecutivos sometidos a reparación de prolapso rectal externo.PRINCIPALES MEDIDAS DE VALORACION:Escala de incontinencia de Wexner y de defecación obstruida de Altomare preoperatoria y tres meses postoperatoria.RESULTADOS:El cohorte incluyó 112 pacientes sometidos a cirugía abdominal (71 rectopexia con sutura / 56% minimally invasive, 41 rectopexia ventral / 93% minimally invasive). Aquellos a los que se les realizaron abordajes perineales (n = 68) eran mayores (edad media de 75 vs. 62, p <0,01) y tenían mayorcomorbilidades (ASA 3-4: 51% vs. 24%, p <0,01), además reportaron una mayor tasa de incontinencia fecal previo a la intervención (Wexner 11,4 ± 6,4 vs. 8,6 +/- 5,8, p <0,01). Posterior a la cirugía, los pacientes sometidos a procedimientos perineales tuvieron mejoría progresiva en la función similar que los pacientes sometidos a reparación abdominal (cambio en Wexner -2,6 ± 6,4 vs. -3,1 ± 5,6, p = 0,6; cambio en Altomare -2,9 ± 4,6 vs. -2,7 ± 4,9, p = 0,8). De manera similar, los pacientes con rectopexia posterior con sutura y rectopexia ventral con malla tuvieron mejoría progresiva similares en las escalas generales; no obstante, pacientes con rectopexia ventral con malla tuvieron una mayor disminución en la necesidad de usar paños protectores después de la cirugía.LIMITACIONES:Análisis de datos retrospectivo y seguimiento de tres meses.CONCLUSIONES:Los resultados funcionales mejoraron en todos los pacientes sometidos a cirugía de prolapso. Se necesitan cohortes más grandes para demostrar superioridad entre los procedimientos quirúrgicos. Métodos de mejoramiento de la calidad pueden permitir la adquisición sistemática, pero práctica de información y análisis de datos. Hacemos un llamado para la creación de una base de datos sólida para beneficiar a esta población de pacientes. Consulte Video Resumen en http://links.lww.com/DCR/B581. (Traducción- Dr Francisco M. Abarca-Rendon).

Effects of repetitive transcranial magnetic stimulation in the treatment of attention-deficit hyperactivity disorser: A case study

IntroductionAlthough there are very effective treatment approaches for Attention Deficit Hyperactivity Disorder (ADHD) available, the clinical management has its limits making new treatment modalities a necessity. Evidence suggests that low frequency repetitive transcranial magnetic stimulation (rTMS), improves hyperactivity, impulsivity, and attention deficit of individuals with ADHD.ObjectivesThe aim of this case study is to present the effectiveness of rTMS on hyperactivity, impulsivity, and attention deficit of an individual with ADHD.MethodsThis is a case study of a 22 year old male diagnosed with ADHD. The protocol applied was 2 weeks of daily rTMS sessions. This involved repetitive TMS to the right dorsomedial prefrontal cortex (10 Hz, 3.000 pulses, 120% motor threshold) to treat attention deficit, hyperactivity and impulsivity. Assessments were conducted using Adult ADHD Questionnaires, the Jasper and Goldberg questionnaire and WHO self- reported scale at baseline, 1 month and up to 3 months follow up.ResultsThe patient showed overall improvement in scores in both ADHD scales with scores dropping more than 50 % in both scales from pre treatment to 3 months follow up. No side effects were recorded during therapyConclusionsOur findings suggest that the use of rTMS therapy in individuals with ADHD, is an efficacious and safe therapeutic treatment option.

Use of repetitive transcranial magnetic stimulation in an adolescent with autism spectrum disorder and comorbid major depression disorder with anxiety symptoms: A case study

IntroductionPsychiatric comorbidities, including depressive and anxiety disorders, are common in individuals with autism spectrum disorder (ASD). Use of conventional therapies for treating depression and anxiety are of limited efficacy in individuals with ASD making treatment a challenging field. Repetitive Transcranial Magnetic Stimulation (rTMS) is a safe and efficacious technique in major depressive disorder, and a similar approach could yield therapeutic benefits in ASD.ObjectivesThe aim of this case study is to present the effectiveness of rTMS in a 17 year old patient diagnosed with ASD and comorbid major depression disorder with anxiety symptoms.MethodsThis is a case study of a male adolescent aged 17, diagnosed with ASD and comorbid major depression disorder with anxiety symptoms, suicidal ideation and aggressive behavior. The protocol applied was 4 weeks of daily rTMS sessions. This involved rTMS to the left dorsomedial prefrontal cortex (10 Hz, 3.000 pulses/120% motor threshold) to treat depressive symptoms and to the right (50Hz, 600 pulses/ 120%motor threshold) to treat anxiety symptoms. Assessments were conducted using the BDI, PHQ-9 and GAD-7 scales at baseline and one month follow up. Suicidal ideation and aggressive behavior were assessed by a clinician at same intervals.ResultsPatient showed overall improvement in scores both in depression and anxiety scales. Suicidal Ideation and aggressive behavior showed significant reduction. No side effects were recorded during therapy.ConclusionsOur findings suggest that the use of rTMS therapy in adolescents in the autistic spectrum and comorbid major depression disorder and anxiety symptoms is an efficacious and safe therapeutic treatment option.

Effectiveness of “OralDETECT”: a Repetitive Test-enhanced, Corrective Feedback Method Competency Assessment Tool for Early Detection of Oral Cancer

Early diagnosis of oral cancer results in less aggressive treatment and improves the quality of life and overall 5-year survival rate. Well-trained dental professionals can play a crucial role in the early detection of oral cancers. The present study aims to determine the effectiveness of the training program "OralDETECT", a spaced repetitive, test-enhanced learning tool with a corrective feedback mechanism for early detection of oral cancer. Thirty-two dentists and 259 dental students from three Malaysian dental schools were involved in this study. All participants were trained and calibrated to recognize oral potentially malignant disorders (OPMD) and oral cancer using "OralDETECT", which is comprised of a series of pre-test, lecture, post-tests and review sessions. The percentage of correct answers (scores) for each test given by the participants was calculated and analysed using a paired t test. It was found that the overall percentage of diagnostic accuracy for both dental professionals and student groups increased to above 80% from the pre-tests to the final post-tests. There was a significant improvement in overall scores between the pre-tests and all three post-tests for the dental professional groups and the student groups. The diagnostic accuracy for individual OPMD and lesions suspicious of oral cancer also increased to above 80% for both groups. The results of our study demonstrate that the "OralDETECT" is an efficient and effective competency tool which can be used to train dental professionals and students for the early detection of OPMD and oral cancer.