Single Intervention Research Articles

Code-ICH: A New Paradigm for Emergency Intervention.

Intracerebral hemorrhage (ICH) is the most devastating type of stroke, causing widespread disability and mortality. Unfortunately, the acute care of ICH has lagged behind that of ischemic stroke. There is an increasing body of evidence supporting the importance of early interventions including aggressive control of blood pressure and reversal of anticoagulation in the initial minutes to hours of presentation. This review highlights scientific evidence behind a new paradigm to care for these patients called Code-ICH. While numerous trials aimed at decreasing hematoma expansion through single interventions had failed to show statistically significant effects on primary outcomes, time-sensitive, multifaceted, bundled care approaches have recently shown substantial promise in improving functional outcomes in patients with ICH. The concept of Code-ICH can serve as a structural platform for the practice of acute care neurology to continuously measure its performance, reflect on best practices, advance care, and address disparities.

Amino Acid Infusion for Perioperative Functional Renal Protection: A Meta-analysis

ObjectiveAcute kidney injury (AKI) is a common perioperative complication. To date, no single intervention has been proven effective for AKI prevention in this setting. However, intravenous amino acids (AA) administration may recruit renal functional reserve and, thereby, attenuate the perioperative loss of glomerular filtration rate. Accordingly, we performed a meta-analysis to assess the efficacy of AA infusion for perioperative renal functional protection. MethodsWe performed a meta-analysis of controlled studies in perioperative patients (P) evaluating intravenous AA infusion (I) versus any comparator (C). The primary outcome was AKI at longest follow-up (O). We performed a random effects meta-analysis on the relative risk (RR) scale to assess the effect of AA infusion. We used a Bayesian approach to estimate the probability of benefit (RR<1) for the primary outcome. Secondary outcomes included renal-replacement therapy, serum creatinine, and estimated glomerular filtration rate. Tertiary outcomes included mechanical ventilation duration, intensive care unit and hospital length of stay and mortality. (PROSPERO: CRD42024547225). ResultsWe identified 15 studies (14 RCTs and one prospective before-after study) reporting at least one outcome of interest (4,544 patients), with six studies (4,084 patients) reporting the primary outcome. AKI occurred 504/2,041 (24.7%) in AA patients vs 614/2,041 (30.1%) in controls (RR=0.66; 95% CI, 0.47 to 0.94; I2=50%; p=0.02), which corresponded to a 99.1% probability of AKI reduction with AA. Moreover, coherent with such findings, AA reduced serum creatinine, and hospital length of stay, and increased eGFR. ConclusionsThis meta-analysis suggests that AA administration likely reduces the perioperative incidence of AKI.

“Attentive to their drawing”: A pilot study of the implications of a single session mindfulness-based art therapy intervention on early childhood assistants

Early childhood assistants (ECA) often cope with job-related stressors and experience burnout. This study examined the implications for ECAs of a single session mindfulness-based art therapy (SSMBAT) intervention that combined mindfulness with drawing and photography in a group setting. In this qualitative study, a convenience sample of 16 ECA volunteers were recruited after they had taken part in the SSMBAT as part of an ECA training program. Semi-structured interviews were conducted to explore their experiences during the SSMBAT. The questions focused on mindfulness, understanding and practice, and its possible contribution to personal or professional life. The thematic analysis revealed that mindfulness practices in the workshop elicited an impact in the sensory, emotional, cognitive and metacognitive, and behavioral domains. Components of the workshop, such as mindfulness sitting and walking meditations, artmaking and group sharing were seen as contributing to professional and self-development, working with children, teamwork with peers, and communication with the children’s parents. The results underscore the theoretical as well as the practical value of SSMBAT. They contribute to the scant literature on the wellbeing of ECA and efforts to support them.

Replication study: Investigating the effects of maximal anaerobic fatigue on dynamic postural control using the Y-Balance Test

ObjectivesThe aim of this study was to replicate the study titled “Investigating the effects of maximal anaerobic fatigue on dynamic postural control using the Y-Balance Test” by Johnston et al. (2018) as part of a large replication project. This study aimed to determine the effects of maximal anaerobic fatigue on dynamic postural control using the Y-Balance Test, with a specific focus on anterior reach distance. DesignA single session intervention. MethodsForty male and female university students (age: 22 ± 3 years, height: 171.88 ± 8.96 cm, mass: 76.20 ± 14.31 kg) partaking in competitive sport, completed a Y-Balance Test protocol at 20, 10, and 0 min before a modified 60 s Wingate fatiguing protocol. Post-fatigue assessments were completed at 0, 10, and 20 min after the Wingate test. Replication outcomes included significance, direction, and effect size comparison using a z-test. ResultsA one-way repeated measures ANOVA showed a significant effect for maximal anaerobic fatigue on normalised anterior reach direction (F1.82, 69.03 = 7.16, p = 0.002, ηp2 = 0.159; 95 % CI: 0.025, 0.320). Therefore, we replicated the original findings for anterior reach distance in terms of statistical significance (F = 3.818, p = 0.025, ηp2 = 0.376; 95 % CI: 0.00, 0.62). The replication and original effect size estimates for anterior reach direction were compared using a z-test and were deemed compatible (z = 1.65, p = 0.05). ConclusionsOverall, we replicated the original study findings for the effect of maximal anaerobic fatigue on anterior reach distance in a Y-Balance Test.

Immediate effect of extracorporeal shockwave therapy in patients with chronic non-specific low back pain: A randomised placebo-controlled triple-blind trial

Objective To compare the immediate effects of shockwave therapy using two different tips in patients with chronic non-specific low back pain. Design Randomised placebo-controlled study with three intervention groups. Setting The patients recruited for this study were sent for physiotherapy treatment at primary care between May and July 2022. Participants Eighty-one patients with chronic non-specific low back pain aged 18–80 years with pain for ≥3 months and pain intensity ≥3 were randomly recruited for the study. Intervention The patients received a single intervention of radial shockwave therapy with 2000 discharges at 100 mJ energy and 5 Hz frequency using concave or convex tips or placebo treatment. Main measures The primary outcome was pain intensity immediately post-intervention. The secondary outcomes were pressure pain threshold, temporal summation of pain, and functional performance. Data were collected at baseline and post-intervention. Results The post-intervention pain intensity in the concave tip group is an average of two points lower (95% CI = −3.6, −0.4; p < 0.01) than that in the placebo group. The post-intervention pressure pain threshold for the concave tip group was an average of 62.8 kPa higher (95% CI = 0.4, 125.1; p < 0.05) than for the convex tip group and 76.4 kPa higher (95% CI = 14, 138.7; p < 0.01) than in the placebo group. Conclusion The concave tip shockwave therapy is effective in reducing pain and local hyperalgesia in patients with chronic non-specific low back pain.

Potential outcomes and decision-theoretic foundations for statistical causality: Response to Richardson and Robins

Abstract I thank Thomas Richardson and James Robins for their discussion of my article, and discuss the similarities and differences between their approach to causal modelling, based on single world intervention graphs, and my own decision-theoretic approach.

Effect of occupational therapy on the occurrence of delirium in critically ill patients: a systematic review and meta-analysis.

Delirium poses a major challenge to global health care, yet there is currently a dearth of single effective interventions or medications. Particularly, addressing delirium induced by critical illness is a complex process. Occupational therapy is considered to have a high potential for use in the prevention of delirium, as it involves both cognitive training and training in ADL. To comprehensively analyze the effect of occupational therapy on delirium prevention, we evaluated the effects of occupational therapy vs. standard non-pharmacological prevention on incidence and duration of delirium, clinical outcomes and rehabilitation outcomes in critically ill patients. The data sources, including PubMed/Medline, Web of Science, EMBASE, and Cochrane Library, were comprehensively searched from their inception until 15 October 2023. Following the PICOS principle, a systematic screening of literature was conducted to identify relevant studies. Subsequently, the quality assessment was performed to evaluate the risk of bias in the included literature. Finally, outcome measures from each study were extracted and comprehensive analysis was conducted using Review Manager 5.4. A total of four clinical trials met the selection criteria. The pooled analysis indicated no significant difference in the incidence and duration of delirium between the OT group and standard non-pharmacological interventions. A comprehensive analysis of clinical outcomes revealed that OT did not significantly reduce the length of hospital stay or ICU stay. Meanwhile, there was no significant difference in mortality rates between the two groups. It is noteworthy that although grip strength levels did not exhibit significant improvement following OT intervention, there were obvious enhancements observed in ADL and MMSE scores. Although occupational therapy may not be the most effective in preventing delirium, it has been shown to significantly improve ADL and cognitive function among critically ill patients. Therefore, we contend that occupational therapy is a valuable component of a comprehensive multidisciplinary approach to managing delirium. In the future, high-quality researches are warranted to optimize the implementation of occupational therapy interventions for delirium prevention and further enhance their benefits for patients.

Inclusion of harm outcomes in core outcome sets requires careful consideration

ObjectivesThe objective of this study was to determine the proportion of all published core outcome set (COS) studies that include an adverse event or harm outcome, to determine the proportion of individual vs pooled harms, and to investigate characteristics that influence their inclusion. MethodsWe examined the extent to which a sample of 100 published COS studies (from January 2021 to January 2023) include both pooled and individual harms in the final COS. One investigator extracted the information from the COS studies, which was cross-checked against previous COS investigational research, and where possible verified with COS authors or a pharmacologist. Using Qualtrics™, we conducted a personalized online survey of developers of the 100 COS to ask them about the importance, their experiences, and methodological approaches for dealing with harms within their COS development studies. ResultsOne hundred COS were identified from 91 separate COS studies, the majority of which considered most of the minimum standards for development. Two-thirds (65%) of the COS included at least 1 harm outcome. In total, 1104 core outcomes were identified across the 100 COS, of which 184 (17%) were harm outcomes (154 individual vs 56 pooled). Individual harms were more likely to be included in a final COS if they were developed for single treatment interventions (50%) compared to those being developed for multitreatment modalities (39%). Some COS developers adopted outcome frameworks as part of their COS development process to facilitate the inclusion of harm outcomes in their final COS. A third (33%) of respondents felt that harm outcomes should be included in all COS but over half (56%) thought this would be dependent on some aspect of the scope of the COS and improved methodology and awareness of how to deal with harm outcomes in the COS development process. ConclusionHarm outcomes are already included in many COS either as individual or pooled harms. It is evident that there are some challenges with regards to both the methodology and necessity to include harms within a COS (pooled or individual. COS developers should carefully consider the need to include important harms outcomes in relation to the scope of the COS that they are developing.

Biomechanical Profile after Dry Needling in Mixed Martial Arts.

The purpose of this study was to compare the effects of dry needling (DN) intervention on the responses of muscle tone, stiffness, and elasticity, as well as power, pressure pain thresholds, and blood perfusion of the flexor carpi radialis muscle in mixed martial arts (MMA) athletes. Thirty-two trained/developmental men MMA fighters (25.5±4.5 years; 24.5±3 body mass index) participated in a randomized crossover study. Participants underwent a single intervention, receiving both DN and placebo. Laser Doppler flowmetry measured blood perfusion, while a myotonometer assessed the mechanical characteristics of muscle tone, stiffness, and elasticity of the flexor carpi radialis muscle. Pressure pain thresholds (PPT) were measured using an algometer, and maximal forearm muscle force was measured using a hand dynamometer. Outcomes were assessed at baseline, immediately after, and 24 hours and 48 hours post-intervention. A two-way repeated-measures ANOVA revealed significant Intervention*Time interaction for all outcomes: perfusion unit (p<0.001), muscle tone (p<0.001), stiffness (p<0.001), elasticity (p<0.001), PPT (p<0.001) and maximal forearm muscle force (p<0.001). The current study suggests that a single session of DN enhances muscle recovery, increases muscle strength, and improved PPT in MMA athletes. These positive adaptations appear to last up to 48 hours in some variables.

Palliative Care Coordination Interventions for Caregivers of Community-Dwelling Individuals with Dementia: An Integrative Review.

Alzheimer's disease is a serious illness with a protracted caregiving experience; however, care coordination interventions often lack the inclusion of palliative care. The purpose of this integrative review is to identify and synthesize existing care coordination interventions that include palliative care for individuals with dementia and their caregivers living in community settings. The Whittemore and Knafl framework guided the review, with data analysis guided by the SELFIE framework domains. Study quality was assessed using the Mixed Methods Appraisal Tool, while the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines informed reporting results. Nine care coordination interventions involving family caregivers across eighteen publications were identified. Only a single intervention explicitly mentioned palliative care, while the remaining interventions included traditional palliative care components such as advance care planning, symptom management, and emotional support. Many of the identified interventions lacked theoretical grounding and were studied in non-representative, homogeneous samples. Further research is needed to understand the lived experiences of people with dementia and their caregivers to alleviate care coordination burden.

Immediate effects of ultrasound therapy on pain and plantar pressure in individuals with subacute ankle sprains: a randomized controlled trial

IntroductionDespite the fact that ultrasound (US) therapy is not advised for acute ankle sprains, its therapeutic effects may be beneficial for other stages of ankle sprains, such as a subacute ankle sprain. There is, however, a lack of evidence regarding the effects of US on pain relief and functional improvement in subacute ankle sprains. Therefore, this study aimed to determine the immediate effects of US on pain and plantar pressure in individuals with unilateral subacute ankle sprains.MethodsFifty-four participants with unilateral subacute ankle sprains (aged 16–55 years) were recruited and randomly allocated into a treatment group (&lt;i&gt;n&lt;/i&gt; = 27) and a control group (&lt;i&gt;n&lt;/i&gt; = 27). The treatment and control groups received a single intervention session of US and an ineffectual US, respectively. Pain intensity during weight-bearing and static and dynamic plantar pressures were assessed before and after receiving the intervention.ResultsIn both groups, pain intensity was statistically reduced (&lt;i&gt;p&lt;/i&gt; &lt; 0.05) and clinically relevant. Although the maximum plantar pressure in the hindfoot during static conditions was statistically higher in the control group (&lt;i&gt;p&lt;/i&gt; = 0.024), the values were still lower than MDC95.ConclusionsA single treatment of US could clinically reduce pain, but it had no effect on altering plantar pressure in individuals with unilateral subacute ankle sprains.

Short-term effects of 448 kilohertz radiofrequency stimulation on plantar fascia measured by quantitative ultrasound elastography and thermography on active healthy subjects: an open controlled clinical trial

Objective: This study is an open clinical trial. The aim of this study was to show the changes that occur in the viscoelastic properties of the plantar fascia (twenty healthy volunteers) measured by SEL and the changes in the plantar fascia temperature measured by thermography after the application of a 448 kHz capacitive resistive monopolar radiofrequency (CRMR) in active healthy subjects immediately after treatment and at the 1-week follow-up. Methods: Furthermore, to analyze if an intervention with 448 kHz CRMR in the plantar fascia of the dominant lower limb produces a thermal response in the plantar fascia of the non-dominant lower limb. The final objective was to analyze the level of association between the viscoelastic properties of the PF and the temperature before and after the intervention with 448 kHz CRMR. Results: Our results showed that a temperature change, which was measured by thermography, occurred in the plantar fascia after a single intervention (T0-T1) and at the 1-week follow up (T1-T2). Conclusion: However, no changes were found in the viscoelastic properties of the plantar fascia after the intervention or at the 1-week follow up. This is the first study to investigate changes in both plantar fascia viscoelastic properties and in plantar fascia temperature after a radiofrequency intervention.

Stakeholders’ views of the Baby Friendly Initiative implementation and impact: a mixed methods study

BackgroundThe Baby Friendly Hospital Initiative (BFHI) was launched in 1991 as an intervention to support healthy infant feeding practices, but its global coverage remains around 10%. This study aimed to explore stakeholders’ views of the Baby Friendly Initiative (BFI) programme, the barriers and facilitators to accreditation and its perceived impact.MethodsA mixed methods approach was used. An online survey was distributed through numerous professional networks from September 2020 to November 2020. Quantitative data were analyzed using descriptive statistics, with simple content analysis undertaken on open-ended responses. Individual semi-structured interviews were also undertaken and analyzed using inductive thematic analysis.ResultsA total of 322 respondents completed the survey in part or in full, mainly from the United Kingdom. Fifteen key stakeholders and two maternity service users undertook interviews. Respondents were from various professional backgrounds and currently worked in different roles including direct care of women and their families, public health, education and those responsible for purchasing health services. Survey respondents viewed the BFI to have the greatest impact on breastfeeding initiation, duration, and infant health outcomes. Three overall themes were identified. The first was “BFI as an agent for change”. Most participants perceived the need to implement the whole package, but views were mixed regarding its impact and the accreditation process. Secondly, BFI was regarded as only “one part of a jigsaw”, with no single intervention viewed as adequate to address the complex cultural context and social and health inequities that impact breastfeeding. Finally, “cultural change and education” around breastfeeding were viewed as essential for women, staff and society.ConclusionsThe BFI is not a magic bullet intervention. To create a more supportive breastfeeding environment within society a holistic approach is required. This includes social and cultural changes, increased education ideally starting at school age, and advancing positive messaging around breastfeeding within the media, as well as fully banning breastmilk substitute advertising. Although the BFI comprises a whole package, few survey respondents rated all aspects as equally important. Additional evidence for the effectiveness of each element and the importance of the whole package need to be established and communicated.

Multisensory stimulation for promoting development and preventing morbidity in preterm infants.

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of multisensory stimulation compared to any single sensory intervention or standard care for physical and neurological development in preterm infants.

Effect of skill-based educational training for ambulance personnel on neonatal transportfor newborn care in coastal South India - a single arm intervention study.

Education of '108' ambulance personnel involved in transporting neonates may improve outcomes. We assessed i) perceptions/practices of '108' ambulance personnel for transporting neonates, ii) clinical parameters of transported neonates at arrival, and iii) outcomes such as survival/mortality and NICU stay (before and after skill-based educational intervention). We conducted a single-arm intervention study (pre-and post) over 18 months. We assessed the perceptions and practices of 77 ambulance personnel on neonatal transport pre- versus post-intervention. Checklists assessed ambulance equipment availability/usage in both phases. We compared clinical parameters and outcomes of transported neonates between the pre-intervention (n=62) and post-intervention (n=53) phases. We analyzed data using SPSS version 25. Post-intervention, there was a significant reduction in the levels of hypothermia (p < 0.001), hypoglycemia (p=0.010), and prolonged capillary refill time (p=0.042), along with improvement in the use of intravenous fluids (p <0.001), a reduction in the positivity of umbilical swab growth (p=0.002) and in the duration of NICU stay (p = 0.001), significant improvement (p < 0.001) in the perceptions/practices of ambulance personnel towards neonatal transport. There was an improvement in the ambulance equipment availability/usage post-intervention. The perceptions and practices of the '108' ambulance towards transporting neonates had significantly improved post-educational intervention. Further, a significant decrease in hypothermia, hypoglycemia, and duration of NICU stay was seen in neonates transported post-intervention.

Clinical outcomes of the Burnett "snake" maneuver shunt modification for ischemic priapism.

Major ischemic priapism (IP) is defined as a persistent penile erection for >4hours. IP may cause serious complications, especially if prompt resolution is not achieved. Therefore, selecting the most effective and usable shunt technique is crucial in IP cases that are refractory to medical therapy. To compare the effectiveness and complication risks of distal corporoglanular shunt procedures with and without the Burnett "snake" maneuver. We conducted a retrospective study of patients who presented with IP and underwent surgical treatment at our institution between 2005 and 2021. The patients were categorized into 2 groups: group 1 (n = 26) underwent distal shunt + Burnett snake maneuver, and group 2 (n = 56) underwent distal shunt-only. Clinical history, parameters of IP, details of medical and surgical treatments, and follow-up information were evaluated. Outcomes included differences in IP resolution and recurrence, functional erections, and complications between corporoglanular shunt procedures with and without the Burnett snake maneuver. In group 1, 24 of 26 patients (92.3%) experienced priapism resolution with a single surgical intervention, while this outcome was observed in 30 of 56 patients (53.6%) in group 2 (P < .001). Notably, priapism recurrence was significantly lower in group 1, occurring in 1 of 24 patients (4.2%), as opposed to 8 of 30 patients (26.6%) in group 2 (P < .001). Of the patients with documented sexual function status at follow-up, functional erections (capable of penetration with or without phosphodiesterase 5 inhibitors) were noted in 6 of 14 patients (42.8%) in group 1 and 13 of 26 patients (50%) in group 2 (P = .66). This study provides valuable insights regarding technical aspects of distal shunt procedures with and without the Burnett snake maneuver for treating major IP episodes. These results can help surgeons with clinical decision making for patients who present with IP. Limitations include the single-site retrospective design with potential selection bias, inaccuracies in medical record data, challenges in controlling confounding variables, and the lack of validated questionnaire scores for erectile function evaluation. Our study demonstrates that modifying distal shunt procedures using the Burnett snake maneuver significantly improves priapism resolution and effectively prevents further priapism episodes without introducing additional complications or erectile function loss, thereby distinguishing it from distal shunt-only procedures.

An optimal control vaccine model of COVID-19 with cost-effective analysis

This study presents a comprehensive COVID-19 vaccination model, integrating breakthrough transmission, and evaluates its efficacy through various analytical techniques. To assess secondary infections, four effective reproduction rates are computed corresponding to different disease states. The sensitivity analysis of the reproduction rates is conducted using the PRCC to identify influential compartments and parameters. The model is extended to incorporate five time-dependent control interventions to reduce infected compartments, with optimisation performed using the Pontryagin maximum principle. A cost-effectiveness analysis of these strategies is conducted using the average cost-effectiveness ratio. Analysis shows that the model does not undergo backward bifurcation, meaning a stable disease-free equilibrium cannot coexist with a stable endemic equilibrium. The findings show that strict adherence to standard operating procedures is the most effective single intervention. In contrast, a combined approach incorporating all five control interventions is the most effective in averting infections with the lowest ACER.

Nicotinamide N-methyltransferase inhibition mimics and boosts exercise-mediated improvements in muscle function in aged mice

Human hallmarks of sarcopenia include muscle weakness and a blunted response to exercise. Nicotinamide N-methyltransferase inhibitors (NNMTis) increase strength and promote the regenerative capacity of aged muscle, thus offering a promising treatment for sarcopenia. Since human hallmarks of sarcopenia are recapitulated in aged (24-month-old) mice, we treated mice from 22 to 24 months of age with NNMTi, intensive exercise, or a combination of both, and compared skeletal muscle adaptations, including grip strength, longitudinal running capacity, plantarflexor peak torque, fatigue, and muscle mass, fiber type, cross-sectional area, and intramyocellular lipid (IMCL) content. Exhaustive proteome and metabolome analyses were completed to identify the molecular mechanisms underlying the measured changes in skeletal muscle pathophysiology. Remarkably, NNMTi-treated aged sedentary mice showed ~ 40% greater grip strength than sedentary controls, while aged exercised mice only showed a 20% increase relative to controls. Importantly, the grip strength improvements resulting from NNMTi treatment and exercise were additive, with NNMTi-treated exercised mice developing a 60% increase in grip strength relative to sedentary controls. NNMTi treatment also promoted quantifiable improvements in IMCL content and, in combination with exercise, significantly increased gastrocnemius fiber CSA. Detailed skeletal muscle proteome and metabolome analyses revealed unique molecular mechanisms associated with NNMTi treatment and distinct molecular mechanisms and cellular processes arising from a combination of NNMTi and exercise relative to those given a single intervention. These studies suggest that NNMTi-based drugs, either alone or combined with exercise, will be beneficial in treating sarcopenia and a wide range of age-related myopathies.

Effectiveness of rehabilitation interventions in adults with asthma: a systematic review and meta-analysis.

To evaluate the effectiveness of pulmonary rehabilitation (PR) programs and other rehabilitation interventions in adults with asthma. Systematic review and meta-analysis. MEDLINE (PubMed), EMBASE, Cumulative Index to Nursing & Allied Health Literature and CENTRAL were searched from inception to 31 May 2023. PROSPERO registration number: CRD42022331440. Thirty-six randomised controlled trials (RCTs) were analysed, and only 26 were pooled in the meta-analysis due to the heterogeneity of comparisons and outcomes across the studies. Pulmonary rehabilitation, compared with education associated with breathing exercises, may result in little to no difference in the Asthma Quality of Life Questionnaire (AQLQ) (mean difference 0.01 score, 95% confidence interval -0.48 to 0.50, 163 participants, three studies, low certainty). Our findings show that pulmonary rehabilitation, compared with education associated with breathing exercises, may result in little to no difference in the impact of asthma on health-related quality of life. Overall, the certainty of evidence was low or very low preventing any firm conclusion on the effects of single or combined rehabilitation interventions.

Enhancing Botulinum Toxin Injection Precision: The Efficacy of a Single Cadaveric Ultrasound Training Intervention for Improved Anatomical Localization.

Ultrasound guidance can enhance existing landmark-based injection methods, even through a brief and single exposure during a cadaveric training course. A total of twelve participants were enrolled in this training program, comprising nine physical medicine and rehabilitation specialists, one pediatrician, and two physician assistants. For each participant, one upper-limb muscle and one lower-limb muscle were randomly chosen from the preselected muscle group. Subsequently, participants were tasked with injecting both of their chosen cadaveric muscles with 1 mL of acrylic paint using a manual needle palpation technique, relying solely on their knowledge of anatomic landmarks. Participants then underwent a personalized, one-to-one ultrasound teaching session, lasting approximately five minutes, conducted by two highly experienced instructors. Following this instructive phase, participants were tasked with a second round of injections, targeting the same two muscles in the lower and upper limbs. However, this time, the injections were performed using anatomical landmarks and ultrasound guidance. To facilitate differentiation from the initial injections, a distinct color of acrylic paint was employed. When employing the anatomical landmark-based approach, the overall success rate for injections was 67%, with 16 out of 24 targeted muscles accurately injected. With the incorporation of ultrasound guidance, the success rate was 92%, precisely targeting 22 out of the 24 muscles under examination. There was an improvement in injection accuracy achievable through the integration of ultrasound guidance, even with minimal training exposure. Our single cadaveric ultra-sound training program contributes valuable insights to the utilization of ultrasound for anatomy training to help optimize the targeting of BoNT-A.