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Neurology. Clinical Practice Jun 2023To evaluate the diagnostic accuracy of the ambulatory EEG (aEEG) at detecting interictal epileptiform discharges (IEDs)/seizures compared with routine EEG (rEEG) and...
BACKGROUND AND OBJECTIVE
To evaluate the diagnostic accuracy of the ambulatory EEG (aEEG) at detecting interictal epileptiform discharges (IEDs)/seizures compared with routine EEG (rEEG) and repetitive/second rEEG in patients with a first single unprovoked seizure (FSUS). We also evaluated the association between IED/seizures on aEEG and seizure recurrence within 1 year of follow-up.
METHODS
We prospectively evaluated 100 consecutive patients with FSUS at the provincial Single Seizure Clinic. They underwent 3 sequential EEG modalities: first rEEG, second rEEG, and aEEG. Clinical epilepsy diagnosis was ascertained based on the 2014 International League Against Epilepsy definition by a neurologist/epileptologist at the clinic. An EEG-certified epileptologist/neurologist interpreted all 3 EEGs. All patients were followed up for 52 weeks until they had either second unprovoked seizure or maintained single seizure status. Accuracy measures (sensitivity, specificity, negative and positive predictive values, and likelihood ratios), receiver operating characteristic (ROC) analysis, and area under the curve (AUC) were used to evaluate the diagnostic accuracy of each EEG modality. Life tables and the Cox proportional hazard model were used to estimate the probability and association of seizure recurrence.
RESULTS
Ambulatory EEG captured IED/seizures with a sensitivity of 72%, compared with 11% for the first rEEG and 22% for the second rEEG. The diagnostic performance of the aEEG was statistically better (AUC: 0.85) compared with the first rEEG (AUC: 0.56) and second rEEG (AUC: 0.60). There were no statistically significant differences between the 3 EEG modalities regarding specificity and positive predictive value. Finally, IED/seizure on the aEEG was associated with more than 3 times the hazard of seizure recurrence.
DISCUSSION
The overall diagnostic accuracy of aEEG at capturing IED/seizures in people presenting with FSUS was higher than the first and second rEEGs. We also found that IED/seizures on the aEEG were associated with an increased risk of seizure recurrence.
CLASSIFICATION OF EVIDENCE
This study provides Class I evidence supporting that, in adults with First Single Unprovoked Seizure (FSUS), 24-h ambulatory EEG has increased sensitivity when compared with routine and repeated EEG.
PubMed: 37197370
DOI: 10.1212/CPJ.0000000000200160 -
Journal of Clinical Anesthesia Sep 2021Moderate to severe postoperative pain occurs in up to 60% of women following breast operations. Our aim was to perform a network meta-analysis and systematic review to... (Meta-Analysis)
Meta-Analysis Review
STUDY OBJECTIVE
Moderate to severe postoperative pain occurs in up to 60% of women following breast operations. Our aim was to perform a network meta-analysis and systematic review to compare the efficacy and side effects of different analgesic strategies in breast surgery.
DESIGN
Systematic review and network meta-analysis.
SETTING
Operating room, postoperative recovery room and ward.
PATIENTS
Patients scheduled for breast surgery under general anesthesia.
INTERVENTIONS
Following an extensive search of electronic databases, those who received any of the following interventions, control, local anesthetic (LA) infiltration, erector spinae plane (ESP) block, pectoralis nerve (PECS) block, paravertebral block (PVB) or serratus plane block (SPB), were included. Exclusion criteria were met if the regional anesthesia modality was not ultrasound-guided. Network plots were constructed and network league tables were produced.
MEASUREMENTS
Co-primary outcomes were the pain at rest at 0-2 h and 8-12 h. Secondary outcomes were those related to analgesia, side effects and functional status.
MAIN RESULTS
In all, 66 trials met our inclusion criteria. No differences were demonstrated between control and LA infiltration in regard to the co-primary outcomes, pain at rest at 0-2 and 8-12 h. The quality of evidence was moderate in view of the serious imprecision. With respect to pain at rest at 8-12 h, ESP block, PECS block and PVB were found to be superior to control or LA infiltration. No differences were revealed between control and LA infiltration for outcomes related to analgesia and side effects, and few differences were shown between the various regional anesthesia techniques.
CONCLUSIONS
In breast surgery, regional anesthesia modalities were preferable from an analgesic perspective to control or LA infiltration, with a clinically significant decrease in pain score and cumulative opioid consumption, and limited differences were present between regional anesthetic techniques themselves.
Topics: Anesthesia, Conduction; Breast Neoplasms; Female; Humans; Nerve Block; Network Meta-Analysis; Pain, Postoperative
PubMed: 33873002
DOI: 10.1016/j.jclinane.2021.110274 -
Dermatologic Surgery : Official... Jun 2020As the practice of dermatology becomes increasingly procedurally based, there is a concordant rise in musculoskeletal injury (MSI) risk. Dermatologic surgeons are most... (Review)
Review
BACKGROUND
As the practice of dermatology becomes increasingly procedurally based, there is a concordant rise in musculoskeletal injury (MSI) risk. Dermatologic surgeons are most susceptible and, although the majority suffer from MSI, few have received any formal ergonomics training. This stems from a lack of awareness of this troubling trend and a paucity of research and education on the ergonomics of dermatologic surgery.
OBJECTIVE
To highlight pertinent ergonomics principles and strategies from other specialties that could be translated into dermatology, and to synthesize general recommendations aimed at reducing MSI among dermatologic surgeons.
MATERIALS AND METHODS
A comprehensive search of the PubMed and Cochrane Reviews databases from 1975 to 2019 was conducted, using a combination of ergonomics-related search terms, generating 6 publications from the dermatology literature and 58 from the fields of dentistry, medicine, and select surgical subspecialties.
RESULTS
This multidisciplinary approach yielded multiple interventions that could be applied directly (i.e., adequate lighting, adjustable operating tables, and surgical seat heights) or indirectly pending further investigation into their feasibility (i.e., video displays of the surgical field to allow neutral head and neck postures).
CONCLUSION
Although much can be learned from decades of prior ergonomics research from other specialties, considerations that are unique to dermatology remain and must be addressed with specialty-specific research.
Topics: Dermatologic Surgical Procedures; Ergonomics; Humans; Musculoskeletal Diseases; Occupational Diseases; Posture; Risk Factors; Surgeons
PubMed: 31876576
DOI: 10.1097/DSS.0000000000002295 -
Progress in Brain Research 2018Acupuncture analgesia appeared relatively straightforward. A patient laid awake as the practitioner needled selected sites on the body to induce numbness for surgery....
Acupuncture analgesia appeared relatively straightforward. A patient laid awake as the practitioner needled selected sites on the body to induce numbness for surgery. Numerous reports emerging from China in the 1970s featured men and women resting on operating tables, smiling into the camera, surrounded by doctors who attended to the excised region-the esophagus, brain, gut, heart, or lungs. In the course of a decade, hundreds of news articles proclaimed acupuncture analgesia as embodying the spirit of Communist politics. While "acupuncture analgesia" was a heterogeneous practice that addressed a variety of disorders, it cohered visually in photographs of patients indifferent to their vivisected bodies, and it cohered discursively as a means for eliminating sensitivity to pain. Across these domains of representation, I argue that reports of obliterating pain with a single needle across clinical encounters collapsed the multiple temporalities of pain. Drawing on sources from an imagined community of researchers and physicians in parts of China, Singapore, Macau, Hong Kong, Britain, and the United States, this chapter explores the epistemic and ontological implications of numbness-a distinct sensation defined by the lack of sensation-in the absence of the brain.
Topics: Acupuncture Analgesia; China; History, 20th Century; Humans; Needles; Pain; Pain Management
PubMed: 30514524
DOI: 10.1016/bs.pbr.2018.10.013 -
Frontiers in Surgery 2021The operating theater is recognized to involve a high frequency of occupational blood and body fluid contacts. This study aimed to visualize the production of blood...
The operating theater is recognized to involve a high frequency of occupational blood and body fluid contacts. This study aimed to visualize the production of blood and body fluid airborne particles by surgical procedures and to investigate risks of microbial contamination of the conjunctival membranes of surgical staff during orthopedic operations. Two physicians simulated total knee arthroplasty (TKA) and total hip arthroplasty (THA) in a bio-clean theater using model bones. The generation and behaviors of airborne particles were filmed using a fine particle visualization system, and numbers of airborne particles per 2.83 L of air were counted at the height of the operating and instrument tables. Each action was repeated five times, and particle counts were evaluated statistically. Numerous airborne particles were dispersed to higher and wider areas while "cutting bones in TKA" and "striking and driving the cup component on the pelvic bone in THA" compared to other surgical procedures. The highest particle counts were detected while "cutting bones in TKA" under unidirectional laminar air flow. These results provide a clearer image of the dispersion and distribution of airborne particles and identified higher-risk surgical procedures for microbial contamination of the conjunctival membranes. Surgical staff including surgeons, nurses, anesthesiologists, and visitors, should pay attention to and take measures against occupational infection particularly in high-risk surgical situations.
PubMed: 34881285
DOI: 10.3389/fsurg.2021.754785 -
American Journal of Infection Control May 2020We review the impact of the consequences of operating room (OR) management decision making on power analyses for observational studies of surgical site infections (SSIs)... (Review)
Review
Importance of operating room case scheduling on analyses of observed reductions in surgical site infections from the purchase and installation of capital equipment in operating rooms.
BACKGROUND
We review the impact of the consequences of operating room (OR) management decision making on power analyses for observational studies of surgical site infections (SSIs) among patients receiving care in ORs with interventions versus without interventions involving physical changes to ORs. Examples include ventilation systems, bactericidal lighting, and physical alterations to ORs.
METHODS
We performed a narrative review of operating room management and surgical site infection articles. We used 10-years of operating room data to estimate parameters for use in statistical power analyses.
RESULTS
Creating pivot tables or monthly control charts of SSI per case by OR and comparing among ORs with or without intervention is not recommended. This approach has low power to detect a difference in SSI rates among the ORs with or without the intervention. The reason is that appropriate OR case scheduling decision making causes risk factors for SSI to differ among ORs, even when stratifying by surgical specialty. Such risk factors include case duration, urgency, and American Society of Anesthesiologists' Physical Status. Instead, analyze SSI controlling for the OR, where the patient had surgery, and matching patients using these variables is preferable. With α = 0.05, 600 cases per OR, 5 intervention ORs, and 5 or 1 control patients for each intervention patient, reasonable power (≅94% or 78%, respectively) can be achieved to detect reductions (3.6% to 2.4%) in the incidence of SSI between ORs with or without the intervention.
CONCLUSIONS
By using this matched cohort design, the effect of the purchase and installation of capital equipment in ORs on SSI can be evaluated meaningfully.
Topics: Appointments and Schedules; Capital Expenditures; Equipment and Supplies, Hospital; Humans; Incidence; Observational Studies as Topic; Observer Variation; Operating Rooms; Reproducibility of Results; Surgical Wound Infection
PubMed: 31640892
DOI: 10.1016/j.ajic.2019.08.017 -
Journal of Education and Health... 2023The most important part of learning happens in the clinic. To determine the differences between the real educational environment and the desirable environment, the...
BACKGROUND
The most important part of learning happens in the clinic. To determine the differences between the real educational environment and the desirable environment, the DREEM1 model is used. The present study was conducted to evaluate the clinical educational environment based on the DREEM model from the viewpoint of the OR2 students of the Lorestan University of Medical Sciences.
MATERIALS AND METHODS
The present descriptive-analytical cross-sectional study evaluated the viewpoint of 118 students of operation room (OR) technology using the DREEM (Dundee Ready Educational Environment Measure) questionnaire in the hospitals affiliated with the Lorestan University of Medical Sciences during the second semester of 2020. The DREEM questionnaire has 50 statements and is divided into five sections, which are rated on a five-point Likert scale (0-4). The data were analyzed using frequency distribution tables, mean and standard deviation indices, Mann-Whitney and Kruskal-Wallis tests. Data analysis was conducted using IBM SPSS Statistics 22.0. IBM Corp.; 2013. and the level of significance was set at 0.05.
RESULTS
The total perception of the students of the clinical educational environment was good and excellent in 73.8% of the cases and of the subscales was also good (50.8%-63.2%). There was a significant relation between the total score of students' perception of the clinical educational environment and age ( = 5.618, < 0.001), semester (χ= 43.929, df = 3, < 0.001), internship hospital (χ= 12.948, df = 6, = 0.044) and also the mean score of the subscales ( < 0.001). As the GPA3 and interest in the major increased, the mean score of total perception and its subscales also increased except for perception from the educators ( < 0.05).
CONCLUSION
According to the results, the studied students had a positive perception of the clinical educational environment. It is recommended that the scientific foundation of the educators, the physical facilities of the operating rooms, and social communication should be strengthened to improve the care, treatment, and educational services. It will be useful to use the results to improve the accreditation level of medical centers.
PubMed: 37546016
DOI: 10.4103/jehp.jehp_1861_22 -
Allergy & Rhinology (Providence, R.I.) Oct 2017Musculoskeletal injuries, such as neck and back pain, during a surgeon's career are common. However, studies on ergonomics are limited with regard to seated...
BACKGROUND
Musculoskeletal injuries, such as neck and back pain, during a surgeon's career are common. However, studies on ergonomics are limited with regard to seated otolaryngologic procedures. Key elements of an ergonomic operating environment include the height of operating tables and surgical chairs. Surgeons benefit from proper support and positioning to prevent musculoskeletal injuries and reduce occupational risk.
OBJECTIVE
The purpose of this study was to evaluate operating table and surgical seat heights, and determine whether adjustments can be made for various surgeon physiques.
METHODS
Operating tables and surgical seat dimensions were measured at local hospitals, and the information was complemented by an online search of other models.
RESULTS
Five unique operating tables and five unique surgical stools were identified, both in the local hospital and in a search on the Internet. Of available tables, the greatest range was 63.5-124.5 cm, which reaches above the maximum suggested working height of 76.2 cm. The surgical stool with the widest range was adjustable from heights of 50.8-72.4 cm. This combination of operative table and surgical stool provided the greatest range of heights.
CONCLUSION
Of the available tables and stools measured, the combination of surgical table with a range of 63.5-125.7 cm and surgical stool with a range of 50.8-72.4 cm provided the greatest versatility for diverse physician heights. In ergonomic terms, this combination may reduce physical fatigue and create a potentially safer working environment for seated surgeons.
PubMed: 29070277
DOI: 10.2500/ar.2017.8.0215 -
The Journal of Hand Surgery Sep 2014To provide an overview of available clinical evaluation tests for scaphoid fractures and to compare their diagnostic accuracies. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To provide an overview of available clinical evaluation tests for scaphoid fractures and to compare their diagnostic accuracies.
METHODS
PWe performed a systematic review of all studies assessing diagnostic characteristics of clinical evaluation in scaphoid fractures by searching MEDLINE, EMBASE, Cochrane, and CINAHL databases. Only studies on clinical testing prior to radiographic evaluation and with acceptable reference standard for occult fractures were included. Thirteen relevant articles were analyzed that described a total of 25 tests. Diagnostic characteristics of the tests were used to construct contingency tables. If possible, data were pooled and summary receiver operating characteristic curves were fitted.
RESULTS
Anatomic snuff-box tenderness (ASB, 8 studies, 1,164 patients) and longitudinal thumb compression (LTC, 8 studies, 961 patients) had sufficient data for statistical analyses. Sensitivity for ASB ranged from 0.87 to 1.00; for LTC, 0.48 to 1.00. Specificity of ASB ranged from 0.03 to 0.98; for LTC, 0.22 to 0.97. Owing to considerable heterogeneity, pooled estimate points were not calculated. Other high-sensitivity tests were scaphoid tubercle tenderness, with sensitivity and specificity ranging from 0.82 to 1.00 and 0.17 to 0.57, respectively, and painful ulnar deviation, ranging from 0.67 to 1.00 and 0.17 to 0.60, respectively. Three studies showed that combining tests increased the specificity and post-test fracture probability while maintaining high sensitivity. Quality assessment showed high or unclear risk of bias and applicability concerns in reference standard and patient selection. Twelve study designs were prospective, and 1 was retrospective.
CONCLUSIONS
Anatomical snuff box tenderness was the most sensitive clinical test. The low specificity of the clinical tests may result in a considerable number of overtreated patients. Combining tests improved the post-test fracture probability. This can be used to limit unnecessary immobilization, number of hospital visits, and use of imaging. The data presented herein may help to develop clinical prediction rules that could increase specificity without reducing sensitivity.
TYPE OF STUDY/LEVEL OF EVIDENCE
Diagnostic II.
Topics: Diagnostic Imaging; Fractures, Bone; Humans; Scaphoid Bone; Sensitivity and Specificity
PubMed: 25091335
DOI: 10.1016/j.jhsa.2014.06.004 -
Annals of Biomedical Engineering Aug 2020With the advent of Minimally Invasive Surgery (MIS), intra-operative imaging has become crucial for surgery and therapy guidance, allowing to partially compensate for... (Review)
Review
With the advent of Minimally Invasive Surgery (MIS), intra-operative imaging has become crucial for surgery and therapy guidance, allowing to partially compensate for the lack of information typical of MIS. This paper reviews the advancements in both classical (i.e. ultrasounds, X-ray, optical coherence tomography and magnetic resonance imaging) and more recent (i.e. multispectral, photoacoustic and Raman imaging) intra-operative imaging modalities. Each imaging modality was analyzed, focusing on benefits and disadvantages in terms of compatibility with the operating room, costs, acquisition time and image characteristics. Tables are included to summarize this information. New generation of hybrid surgical room and algorithms for real time/in room image processing were also investigated. Each imaging modality has its own (site- and procedure-specific) peculiarities in terms of spatial and temporal resolution, field of view and contrasted tissues. Besides the benefits that each technique offers for guidance, considerations about operators and patient risk, costs, and extra time required for surgical procedures have to be considered. The current trend is to equip surgical rooms with multimodal imaging systems, so as to integrate multiple information for real-time data extraction and computer-assisted processing. The future of surgery is to enhance surgeons eye to minimize intra- and after-surgery adverse events and provide surgeons with all possible support to objectify and optimize the care-delivery process.
Topics: Algorithms; Humans; Image Processing, Computer-Assisted; Magnetic Resonance Imaging; Minimally Invasive Surgical Procedures; Operating Rooms
PubMed: 32601951
DOI: 10.1007/s10439-020-02553-6