A systematic review of procedural modalities in the treatment of notalgia paresthetica

BACKGROUND

Notalgia paresthetica (NP) is a rare condition characterized by localized pain and pruritus of the upper back, associated with a distinct area of hyperpigmentation. Given the lack of standardized treatment and the uncertain efficacy of available options, applying procedural methods is of growing interest in treating NP.

AIMS

We sought to comprehensively evaluate the role of procedural treatments for NP.

METHODS

We systematically searched PubMed/Medline, Ovid Embase, and Web of Science until November 14th, 2023. We also performed a citation search to detect all relevant studies. Original clinical studies published in the English language were included.

RESULTS

Out of 243 articles, sixteen studies have reported various procedural modalities, with or without pharmacological components, in treating NP. Pharmacological procedures, including injections of botulinum toxin, lidocaine, and corticosteroids, led to a level of improvement in case reports and case series. However, botulinum toxin did not show acceptable results in a clinical trial. Moreover, non-pharmacological procedures were as follows: physical therapy, exercise therapy, kinesiotherapy, acupuncture and dry needling, electrical muscle stimulation, surgical decompression, and phototherapy. These treatments result in significant symptom control in refractory cases. Physical therapy can be considered a first-line choice or an alternative in refractory cases.

CONCLUSION

Procedural modalities are critical in the multidisciplinary approach to NP, especially for patients who are refractory to topical and oral treatments. Procedural modalities include a spectrum of options that can be applied based on the disease's symptoms and severity.

Effect of Acupressure on Procedural Pain in Children: A Systematic Review

PURPOSE

Acupressure is a complementary treatment method performed using fingers and hands to maintain the body's energy balance by stimulating acupuncture points. In recent studies, acupressure has been widely used for minimally invasive procedural (venous assess, intravenous (IV) cannulation, intramuscular injection, heel lancing) pain management in children. This study aims to systematically review the studies that evaluate the effectiveness of acupressure on minimally invasive procedural pain in children.

DESIGN

This study is a systematic review of literature.

METHODS

Studies were obtained by screening literature on this topic using the databases PubMed, EBSCO, Scopus, Google Scholar and Cochrane Central Register of Controlled Trials. The keywords "Acupressure," "Child," "Pain," and "Procedural" were used when screening the literature. The studies selected were those published from January 1, 2000 to January 1, 2022 that met the inclusion and exclusion criteria. The PRISMA checklist was used when performing this systematic review. The Oxford Center for Evidence-Based Medicine Levels of Evidence Working Group (2011) table was used to assess the level of evidence. The procedures for this systematic review were preregistered in the PROSPERO (CRD42022320155) database.

FINDINGS

Of the 12,624 records identified, 10 nursing studies that met the research selection criteria were included in the advanced analysis. These papers were further reviewed for their study design, adequacy of randomization and concealment of allocation, blinding of participants, interventions, and outcome measurements.

CONCLUSIONS

Acupressure has been shown to be effective in relieving minimally invasive procedural pain in children. This review begins to establish a credible evidence base for the use of acupressure in minimally invasive procedural pain relief in pediatric age groups. The implication for nurses includes incorporating acupressure into their practice as an alternative therapy for children who suffer from minimally invasive procedural pain.

Intervention strategies for white noise alleviating procedural pain in newborns: A systematic review

AIMS AND OBJECTIVE

To systematically evaluate the current intervention strategies of white noise alleviating procedural pain in newborns.

METHODS

This review was conducted following the PRISMA guideline. Seventeen databases National Guideline Clearinghouse, up to date, Clinical Evidence, BMJ best practice, Cochrane library, OVID, PubMed, Medline, EMBASE, Web of Science, CHINHAL, Medlive, China Biology Medicine disc, Chinese Clinical Trial Registry, China National Knowledge Infrastructure, China Science and Technology Journal Database, Wanfang Data Knowledge Service Platform were employed, and the studies about pain-relieving with white noise in newborns published before June 2022 was included. Quality of studies was evaluated by using the Cochrane Handbook for Systematic Reviews of Interventions.

RESULTS

18 studies were included, with sample sizes ranging from 32-296 cases. Intervention indices included duration, distance, volume, music type and outcome measure. Duration varies from study to study, from 5 min before to 5 min after the procedures. The distance was controlled at 10-60 cm, volume was controlled at 45-60 dB and music type was selected from Orhan Osman's album "Kolic" in most studies. Outcome measures included physiological indicators, neurophysiological indicators, behavioural indicators and pain score. Differences in duration leading to different white noise effects was found, but no studies have shown whether there is an effect of different volume, distance or music type.

CONCLUSIONS

Based on this review, we recommend the following intervention strategies: the duration is set from 1 min before to 3 min after the procedures, the distance is decided according to the actual clinical situation, the volume is controlled at 45-55 dB (55 dB is optimal), the music type is selected to simulate intrauterine sounds, and outcome measures can choose physiological indicators, neurophysiological indictors, behavioural indicators and pain score depending on specific department and population. It is important to further explore the best intervention strategies.

RELEVANCE TO CLINICAL PRACTICE

In addition to providing a set of intervention strategies, this review could be used as evidence for relieving procedural pain in newborns.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution. Data were obtained from others' literature.

Being a Fair Neighbor-Towards a Psychometric Inventory to Assess Fairness-Related Perceptions of Airports by Residents-Development and Validation of the Aircraft Noise-Related Fairness Inventory (fAIR-In)

Aircraft noise causes a variety of negative health consequences, and annoyance is a central factor mediating stress-related health risks. Non-acoustic factors play an important role in the experience of annoyance where the aspect of fairness is assumed to be a vital component. This paper describes the development of the Aircraft Noise-related Fairness Inventory (fAIR-In) and examines its factorial validity, construct validity and predictive validity. The development of the questionnaire included expert consultations, statements from airport residents and a large-scale online survey around three German airports (N = 1367). Its items cover distributive, procedural, informational and interpersonal fairness. Via mailshot, almost 100,000 flyers were sent out in more (>55 dB(A) L_den)- and less (≤55 dB(A) L_den)-aircraft-noise-exposed areas around Cologne-Bonn, Dusseldorf and Dortmund Airport. Thirty-two items were carefully selected considering reliability, theoretical importance and factor loading calculated via exploratory factor analysis (EFA), with all facets achieving high internal consistency (α = 0.89 to 0.92). The factorial validity, analyzed via a confirmatory factor analysis (CFA), revealed that viewing distributive, procedural, informational and interpersonal fairness as distinct factors produced a better fit to the data than other categorizations with fewer factors. The fAIR-In shows adequate results in terms of construct validity and excellent results in terms of the predictive validity of annoyance by aircraft noise (r = -0.53 to r = -0.68), acceptance of airports and air traffic (r = 0.46 to r = 0.59) and willingness to protest (r = -0.28 to r = -0.46). The fAIR-In provides airport managers with a reliable, valid and easy-to-use tool to design, monitor and evaluate efforts to improve the neighborliness between an airport and its residents.

Multisensory stimulation as a non-pharmacological intervention for neonates undergoing painful procedures: A scoping review

AIM

The aim of this review is to identify available evidence on MSS practices as a pain-relieving intervention among neonates undergoing a repetitive painful procedure.

METHODS

Searches were performed in the following databases: PubMed/ MEDLINE, SCOPUS, CINAHL, and the physiotherapy evidence database (PEDro). A total of eight studies were identified, among them; studies related to MSS in relieving neonatal procedural pain were conducted only in three countries only.

RESULTS

Data collected from the identified studies were extracted by two independent reviewers, and were synthesized quantitatively, and qualitatively. Eight studies involving six hundred and eighty-six neonates in three countries were identified in the search. Among them, six were randomized controlled trials, and two were observational studies. The study results highlighted that implementation of MSS as a non-pharmacological pain-relieving intervention follows a similar protocol among the reviewed articles, but varies by who administers MSS (Physiotherapists/ Nurses/Mothers) in neonates undergoing repetitive painful procedures.

INTERPRETATION

Standardized MSS protocol should be followed globally along with its implementation for reducing procedural pain among neonates and also to promote good clinical practice in neonatal intensive care unit (NICU) settings. Future research could determine the effects of standardized MSS protocol either with or without other non-pharmacological interventions among neonates undergoing painful procedures.

Distracting Through Procedural Pain and Distress Using Virtual Reality and Guided Imagery in Pediatric, Adolescent, and Young Adult Patients: Randomized Controlled Trial

BACKGROUND

Children with acute and chronic illness undergo frequent, painful, and distressing procedures.

OBJECTIVE

This randomized controlled trial was used to evaluate the effectiveness of guided imagery (GI) versus virtual reality (VR) on the procedural pain and state anxiety of children and young adults undergoing unsedated procedures. We explored the role of trait anxiety and pain catastrophizing in intervention response.

METHODS

Children and young adults were recruited from the hematology, oncology, and blood and marrow transplant clinics at a children's hospital. Each study participant completed the GI and VR intervention during separate but consecutive unsedated procedures. Self-report measures of pain and anxiety were completed before and after the procedures.

RESULTS

A total of 50 participants (median age 13 years) completed both interventions. GI and VR performed similarly in the management of procedural pain. Those with high pain catastrophizing reported experiencing less nervousness about pain during procedures that used VR than those using GI. State anxiety declined pre- to postprocedure in both interventions; however, the decrease reached the level of significance during the VR intervention only. Those with high trait anxiety had less pain during GI.

CONCLUSIONS

In our sample, VR worked as well as GI to manage the pain and distress associated with common procedures experienced by children with acute or chronic illnesses. Children who are primed for pain based on beliefs about pain or because of their history of chronic pain had a better response to VR. GI was a better intervention for those with high trait anxiety.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04892160; https://clinicaltrials.gov/ct2/show/NCT04892160.

Assessment and Management of Pain in Preterm Infants: A Practice Update

Infants born preterm are at a high risk for repeated pain exposure in early life. Despite valid tools to assess pain in non-verbal infants and effective interventions to reduce pain associated with medical procedures required as part of their care, many infants receive little to no pain-relieving interventions. Moreover, parents remain significantly underutilized in provision of pain-relieving interventions, despite the known benefit of their involvement. This narrative review provides an overview of the consequences of early exposure to untreated pain in preterm infants, recommendations for a standardized approach to pain assessment in preterm infants, effectiveness of non-pharmacologic and pharmacologic pain-relieving interventions, and suggestions for greater active engagement of parents in the pain care for their preterm infant.

Cross-sectional study of pediatric pain prevalence, assessment, and treatment at a Canadian tertiary hospital

Background

Painful experiences are common among hospitalized children. Long-term negative biopsychosocial consequences of undertreated pain are recognized.

Aims

The study benchmarks pain prevalence, assessment, and treatment as first steps to improve pain care in a Canadian tertiary hospital.

Methods

Single-day audits were undertaken on the pediatric ward (PW), pediatric emergency department (ED), and maternal services (MS). Participants (child or caregiver proxy) reported hospital pain experiences in the preceding 24 h; medical records were reviewed for assessment and treatment.

Results

Among 84 participants, pain prevalence ranged from 75% to 88%; mean pain intensity ranged from 5.7 to 6.5/10. Prevalence of moderate to severe pain was 78% on PW, 65% in ED, and 55% on MS; needle pokes were the most frequent cause of worst pain. Documentation of pain assessment varied by setting (PW, 93%; ED, 13%; MS, 0%). Documented maximum pain scores were significantly lower compared to participant report (mean difference 4.5/10, SD 3.1, P < 0.0001). A total 29% (6/21) of infants with heel lance or injection received breastfeeding or sucrose, and 29% (7/24) of participants receiving other needle procedures had documented or reported topical lidocaine use. All participants on MS underwent needle procedures.

Conclusions

Pain is experienced commonly by infants and children in PW, ED, and MS. Pain assessment documentation is not routine and underestimates participant report. Evidence-based pain management strategies are underutilized. An institution-wide quality improvement approach is required to address pain care. Pain assessment and needle pain prevention and treatment should be prioritized in these pediatric acute care and newborn care settings.

Aircraft Noise Distribution as a Fairness Dilemma-A Review of Aircraft Noise through the Lens of Social Justice Research

Aircraft noise exposure is a health risk and there is evidence that noise annoyance partly mediates the association between noise exposure and stress-related health risks. Thus, approaches to reduce annoyance may be beneficial for health. Annoyance is influenced by manifold non-acoustic factors and perceiving a fair and trustful relationship between the airport and its residents may be one of them. The distribution of aircraft noise exposure can be regarded as a fairness dilemma: while residents living near an airport may seem to have some advantages, the majority of residents living under certain flight routes or in their immediate proximity suffer from the disadvantages of the airport, especially the noise. Moreover, a dilemma exists between the airport’s beneficial economic impact for a region and the physical and psychological integrity of residents. Aircraft noise exposure through the lens of social justice research can help to improve our understanding of noise annoyance. Research indicates that the fairness perceptions of the parties involved can be enhanced by (a) improving individual cost–benefit ratios, (b) providing a fair procedure for deciding upon the noise distribution, and (c) implementing fair social interaction with residents. Based on the review of evidence from social justice research, we derive recommendations on how fairness aspects can be integrated into aircraft noise management with the purpose of improving the relationship between the airport and its residents, to reduce annoyance, and to enhance the acceptance of local aviation and the airport as a neighbor.

Spontaneous Background and Procedure-Related Microscopic Findings and Common Artifacts in Ocular Tissues of Laboratory Animals in Ocular Studies

Identification of test article-related microscopic findings in ocular toxicology studies requires a working knowledge of the artifacts and procedure-related or background findings commonly encountered in such studies. The objective of this article is to provide a mini-atlas of the artifacts and procedure-related or spontaneous background findings commonly observed in ocular tissues from animals in toxicology studies of ocular drug candidates. Artifacts in the eye are often related to collection or fixation procedures and include swelling and vacuolation of lens fibers, separation of the neuroretina from the retinal pigment epithelium (RPE), and vacuolation of the optic nerve. Common in-life procedure-related findings include intravitreal injection needle tracks in the sclera and ciliary body pars plana and foci of RPE hypertrophy and/or hyperpigmentation at subretinal injection sites. Common background findings include corneal mineralization, uveal mononuclear cell infiltrates, and peripheral displacement of photoreceptor nuclei in the retina. A few uncommon spontaneous background findings that may be confused with test article-related findings, such as bilateral optic atrophy in macaques, are also included.

The Relationship between Just World Beliefs and Life Satisfaction

An important and often unexplored factor shaping life satisfaction is one’s perception of the world as a “just” place. The “just world hypothesis” is predicated on the idea that the world works as a place where people get what they merit, an idea that often serves as a means for people to rationalize injustices. The research addressing just world beliefs has expanded into a four-factor model that categorizes just world beliefs for self and others into subcategories of distributive and procedural justice. Distributive justice involves evaluations of the fairness of outcomes, allocations, or distribution of resources, while procedural concerns evaluations of the fairness of decision processes, rules, or interpersonal treatment. This study explored the relationship between the four just world beliefs subscales and overall satisfaction with life and examined their associations with demographic variables including ethnicity, age, gender, religion, and social class. The relationships of demographic factors with justice beliefs and life satisfaction generally yielded very small effect sizes. However, respondents who identified themselves as middle and upper class reported higher levels of life satisfaction than those who identified themselves as lower class, with a medium effect size. Consistent with the results of earlier research, regressing life satisfaction on the four justice beliefs subscales indicated that the two self-subscales (distributive and procedural) were significantly predictive of life satisfaction, but the two other subscales (distributive and procedural) were not.

Comparative Efficacy of Hidrocystoma Treatments: A Systematic Review

INTRODUCTION

Although various treatment options for hidrocystomas have been described, the comparative efficacy of these treatments is poorly understood.

METHODS

We conducted a systematic review of all articles describing the treatment of hidrocystomas. Treatment modalities were categorized as destructive surgical procedures, skin-directed therapies, systemic medical therapies, general measures, or combined. Patient and tumor characteristics, as well as response rate, recurrence rate, and adverse effects, were extracted from each article.

RESULTS

A total of 94 articles involving 192 patients and 255 unique treatment events were included in the final analysis. Destructive surgical procedures had an overall response rate and recurrence rate of 92.9% and 10.8%, respectively. Skin-directed therapies had an overall response rate of 72.6%. The overall response rate to systemic medical therapies was 71.4%. Solitary hidrocystomas were primarily treated with destructive surgical procedures, including excision, which was associated with a 4.7% recurrence rate. Multiple hidrocystomas were successfully treated with a variety of therapies, including destructive surgical procedures and skin-directed therapies requiring ongoing or repeated therapy.

CONCLUSIONS

Excision has the highest efficacy for solitary hidrocystomas. A number of therapies have shown efficacy for multiple hidrocystomas, including lasers, intracystic trichloroacetic acid, intracystic hypertonic glucose, topical and oral anticholinergics, and botulinum toxin. Aluminum chloride is associated with a low response rate. Larger comparative studies are needed to further evaluate the optimal treatments for solitary and multiple hidrocystomas.

Impact of procedural multimedia instructions for pH BRAVO testing on patient comprehension: a prospective randomized study

The positive impact on patient comprehension and improved procedural outcomes when multimedia is utilized to convey instructions preprocedurally has been previously shown for gastrointestinal procedures such as colonoscopy. However, in gastroesophageal reflux testing (GERD), we continue to utilize verbal and written instructions to establish this diagnosis when we use BRAVO pH testing. This is arguably a more complex procedure involving stopping medications, placement of a device, and maintaining an accurate diary for the duration of the testing. We hypothesize that by utilizing multimedia to relay complex textual information, patients will have improved comprehension of periprocedural instructions thereby improving data entry and satisfaction of expectations during the procedure. Prospective randomized study of 120 patients undergoing endoscopic placement of the BRAVO pH monitoring capsule for evaluation of GERD receive either written preoperative instructions (control) or written plus video instructions (video group). A composite comprehension score was calculated using procedure-specific parameters of data entry over the 48-hour monitoring period. Patient satisfaction was evaluated on the basis of a five-point Likert scale. Extent of patient satisfaction was defined by the fulfillment of patient expectations. Exclusion criteria included patients who did not have access to the video or did not complete follow-up. Seventy-eight patients completed all follow-up evaluations. The video group (n = 44) had a significantly higher mean comprehension score when compared to the control group (n = 34) (9.6 ± 1.4 vs. 7.4 ± 2.0, P = 0.01). Overall satisfaction with instructions was significantly higher in the intervention group (91% vs. 47%, p 0.01). We detected no significant difference in comprehension or satisfaction scores in subgroup analyses of the video group comparing patients <65 and ≥65 years of age and by education level. Compared to standard written instructions, video instructions improved patient comprehension based on data evaluation, and satisfaction. Therefore, clinicians should consider incorporation of multimedia instructions to enhance patient periprocedural expectations and understanding of reflux pH testing using the BRAVO procedure.

The Pediatric Procedural Holistic Comfort Assessment: A Feasibility Study

INTRODUCTION

Holistic comfort is an essential component of pediatric procedural care. However, a main gap in the literature is the ability to measure this. In this study, researchers report the feasibility of implementing a newly developed psychosocial measurement instrument in clinical practice.

METHOD

This mixed methods study was guided by Kolcaba's holistic comfort theory. Descriptive and inferential statistics and a qualitative descriptive approach to cognitive interviewing were used. Children aged 4 to 8 years (n = 16) experiencing a nonurgent needle procedure and registered nurses (n = 14) who administered the instrument were recruited.

RESULTS

Eight qualitative themes of feasibility and comprehensibility were identified. Perspectives of children and nurses were not significantly associated with any demographic variable. The Pediatric Procedural Holistic Comfort Assessment is a feasible instrument to implement but will benefit from minor revisions.

DISCUSSION

This study has implications for nursing practice, research methodology, and future research. The Pediatric Procedural Holistic Comfort Assessment can be successfully implemented by nurses in health care settings.

Procedural Memory Following Moderate-Severe Traumatic Brain Injury: Group Performance and Individual Differences on the Rotary Pursuit Task

The impact of traumatic brain injury (TBI) on procedural memory has received significantly less attention than declarative memory. Although to date studies on procedural memory have yielded mixed findings, many rehabilitation protocols (e.g., errorless learning) rely on the procedural memory system, and assume that it is relatively intact. The aim of the current study was to determine whether individuals with TBI are impaired on a task of procedural memory as a group, and to examine the presence of individual differences in performance. We administered to a sample of 36 individuals with moderate-severe TBI and 40 healthy comparisons (HCs) the rotary pursuit task, and then examined their rate of learning, as well as their retention of learning. Our analyses revealed that while individuals with TBI spent a significantly shorter amount of time on target as a group, they did not retain significantly less procedural learning, and as a group their rate of learning was not different from HCs. However, there were high individual differences in both groups, indicating that some individuals might not be able to take advantage of treatment methods designed to leverage intact procedural memory system. Future work is needed to better assess and characterize procedural memory in individuals with TBI across a larger battery of tasks in experimental and clinical setting as memory and learning status may predict rehabilitation success.

Reduction of Pain during Flexible Cystoscopy: A Systematic Review and Meta-Analysis

PURPOSE

The BCAN (Bladder Cancer Advocacy Network) Patient Survey Network identified pain during intravesical procedures as a research priority for patients. Although intraurethral lidocaine is the standard of care in this setting, evidence of its use is equivocal. We systematically reviewed studies of interventions to reduce discomfort during cystoscopy and intravesical therapy of bladder cancer. We performed a meta-analysis of interventions using available randomized, controlled trials.

MATERIALS AND METHODS

Search terms derived from the key questions were incorporated into the literature search constructed by a research librarian and the English medical literature from 1990 to 2017 was accessed. The initial search yielded 626 potential studies and the final review incorporated 62. We combined 12 trials into a meta-analysis with a random effects model of the efficacy of intraurethral lidocaine vs plain lubricant to reduce pain during flexible cystoscopy as measured on a 10-point visual analogue scale.

RESULTS

Data from 12 randomized controlled trials in a total of 1,549 patients were included in the final intraurethral lidocaine meta-analysis. The standardized mean difference between visual analogue scale pain scores in patients who underwent flexible cystoscopy with intraurethral lidocaine and plain lubricant was -0.22 (95% CI -0.39--0.05). Evidence was insufficient to evaluate other interventions to mitigate the discomfort of invasive bladder procedures.

CONCLUSIONS

Intraurethral lidocaine provides statistically significant pain reduction in men who undergo flexible cystoscopy, particularly with a longer dwell time. The evidence was insufficient for other tested interventions. A prospective study is needed to further clarify interventions to decrease patient discomfort during cystoscopy and other intravesical procedures in a diverse population.

Misconduct Within the "Four Walls": Does Organizational Justice Matter in Explaining Prison Officers' Misconduct and Job Stress?

Primarily, this article examines the role of organizational justice in understanding prison officers' behavior. The authors surveyed 169 correctional officers across five correctional facilities in Ghana to explore the role of three organizational justice dimensions in prison misconduct and job stress. Results from the negative binomial and ordinal logistic analyses revealed the significant contributions of two dimensions of organizational justice in explaining misconduct and stress among officers. Officers who had higher perceptions of distributive fairness and interaction in the organization had lower odds of receiving misconduct-related complaints. Also, greater interaction was found to be associated with reduced job stress among prison officers. In addition, several officers' characteristics were found to predict the number of times officers received misconduct complaints.

Propofol-Ketamine vs. Propofol-Fentanyl Combinations in Patients Undergoing Closed Reduction: A Randomized, Double-blind, Clinical Trial

INTRODUCTION

Painful surgical procedures require adequate sedation and analgesia. A vast array of medications can be used for Procedural Sedation and Analgesia (PSA) in Emergency Departments (EDs).

OBJECTIVE

The present study was conducted to compare Propofol-Ketamine (PK) and Propofol-Fentanyl (PF) compounds in patients undergoing closed reduction in EDs.

METHODS

This randomized, double-blind, clinical trial was conducted on 110 consecutive patients who required sedation for closed reduction. The patients were randomly divided into two groups of equal sizes. The PK group received an intravenous bolus of 1 mg/kg of propofol plus 0.5 mg/kg of ketamine, and the PF group received an intravenous bolus of 1 mg/kg of propofol plus 1 µg/kg of fentanyl. The analgesic effect and success rate were the primary outcomes under study.

RESULTS

The PK group achieved more effective analgesia at the end of the experiment. The success rate was almost the same in both groups Shivering (p=0.005) and a drop in oxygen saturation to below 92% (p=0.048) were two side effects that were more prevalent in the FK group. The mean recovery time was significantly shorter in the PK group (p<0.001). The patients in the PK group were more satisfied.

CONCLUSION

In comparison with the PF compound, the use of KP leads to better pain relief and greater patient satisfaction and shorter sedation time in PSA.

The effect of cathodal transcranial direct current stimulation during rapid eye-movement sleep on neutral and emotional memory

Sleep-dependent memory consolidation has been extensively studied. Neutral declarative memories and serial reaction time task (SRTT) performance can benefit from slow-wave activity, characterized by less than 1 Hz frequency cortical slow oscillations (SO). Emotional memories can benefit from theta activity, characterized by 4-8 Hz frequency cortical oscillations. Applying transcranial direct current stimulation (tDCS) during sleep entrains specific frequencies to alter sleep architecture. When applying cathodal tDCS (CtDCS), neural inhibition or excitation may depend on the waveform at the applied frequency. A double dissociation was predicted, with CtDCS at SO frequency improving neutral declarative memory and SRTT performance, and theta frequency CtDCS inhibiting negative emotional memory. Participants completed three CtDCS conditions (Theta: 5 Hz, SO: 0.75 Hz and control: sham) and completed an SRTT and word recognition task pre- and post-sleep, comprising emotional and neutral words to assess memory. In line with predictions, CtDCS improved neutral declarative memory when applied at SO frequency. When applied at theta frequency, no negative emotional word memory impairment was found but a positive association was found between post-stimulation theta power and emotional word recognition. SRTT performance was also not altered by either CtDCS frequency. Future studies should investigate overnight theta CtDCS and examine the effects of CtDCS during and after stimulation.

Effect of Music on Outpatient Urological Procedures: A Systematic Review and Meta-Analysis from the European Association of Urology Section of Uro-Technology

PURPOSE

Music is a practical, inexpensive and harmless analgesic and anxiolytic. An increasing number of original studies have been performed to investigate its potential application in urology. Our aim was to identify the effect of music on outpatient based urological procedures.

MATERIALS AND METHODS

We systematically reviewed the effect of using music during all reported outpatient urology procedures, including transrectal ultrasound guided prostate biopsy, shock wave lithotripsy, urodynamic studies, percutaneous nephrostomy tube placement and cystoscopy. Data were included on all randomized trials from 1980 to 2017 and no language restrictions were applied.

RESULTS

Included in analysis were 16 randomized studies in which 972 of 1,950 patients (49.8%) were exposed to music during an outpatient procedure. The procedures included transrectal ultrasound guided prostate biopsy in 4 studies in a total of 286 patients, shock wave lithotripsy in 6 studies in a total of 1,023, cystoscopy in 3 studies in a total of 331, urodynamics in 2 studies in a total of 210 and percutaneous nephrostomy in 1 study in a total of 100. All studies incorporated a visual analog score to measure pain. Anxiety was measured by STAI (State-Trait Anxiety Inventory) in 13 studies and by a visual analog scale in 2. While 14 of the 16 studies showed a reduction in self-reported pain, a reduction in anxiety was seen in 14. When using music, overall procedural satisfaction was better in 9 studies and patient willingness to repeat the procedure was also higher in 7. Our meta-analysis revealed a significant reduction in visual analog scale and STAI findings across all studies (p <0.001).

CONCLUSIONS

Our systematic review demonstrated a beneficial effect of music on urological outpatient procedures. Music seemed to decrease anxiety and pain. It might serve as a useful adjunct to increase procedural satisfaction and patient willingness to undergo the procedure again.

Memory Reactivation Enables Long-Term Prevention of Interference

The ability of the human brain to successively learn or perform two competing tasks constitutes a major challenge in daily function. Indeed, exposing the brain to two different competing memories within a short temporal offset can induce interference, resulting in deteriorated performance in at least one of the learned memories [1-4]. Although previous studies have investigated online interference and its effects on performance [5-13], whether the human brain can enable long-term prevention of future interference is unknown. To address this question, we utilized the memory reactivation-reconsolidation framework [2, 12] stemming from studies at the synaptic level [14-17], according to which reactivation of a memory enables its update. In a set of experiments, using the motor sequence learning task [18] we report that a unique pairing of reactivating the original memory (right hand) in synchrony with novel memory trials (left hand) prevented future interference between the two memories. Strikingly, these effects were long-term and observed a month following reactivation. Further experiments showed that preventing future interference was not due to practice per se, but rather specifically depended on a limited time window induced by reactivation of the original memory. These results suggest a mechanism according to which memory reactivation enables long-term prevention of interference, possibly by creating an updated memory trace integrating original and novel memories during the reconsolidation time window. The opportunity to induce a long-term preventive effect on memories may enable the utilization of strategies optimizing normal human learning, as well as recovery following neurological insults.

Tissue-engineering acellular scaffolds-The significant influence of physical and procedural decellularization factors

The importance of decellularized medical products has significantly increased during the last years. In this paper, we evaluated the effects of selected physical and procedural decellularization (DC) factors with the aim to systematically assess their influence on DC results. 72 porcine aortic walls (AW) were divided into three groups and exposed to a DC solution for 4 h and 8 h, either continuously or in repeated cycles. The AW were rocked (90bpm), whirled (10 l/min), sonicated (120W, 45 kHz) or exposed to a combination of these treatments, followed by 10 washing cycles. Defining successful DC as removal of nuclei while keeping an intact extracellular matrix (ECM), we equalized the efficiency to the penetration depth (PD), obtained by DAPI fluorescence and H&E staining. Additionally, we performed scanning electron microscopy (SEM), Pentachrome and Picrosirius-Red staining. Results showed that significantly higher DC depths are achieved on outer compared to inner surfaces (61 ± 7%; p < 0.001). Furthermore, the PD showed a high time dependency for all samples. Compared to continuous rocking, we achieved a significant increase in the DC efficiency through cyclic treatments ( ∼ 43%), whirling ( ∼ 19%) and sonication ( ∼ 49%). The combined treatment supported these results. In all procedures, a skeletonized but intact Collagen fibrous network was obtained as confirmed by SEM analysis. In conclusion, we systematically identified essential factors to significantly enhance DC procedures. We highly recommend considering these factors in future DC protocols. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 153-162, 2018.

Rise of serum troponin levels following uncomplicated elective percutaneous coronary interventions in patients without clinical and procedural signs suggestive of myocardial necrosis

INTRODUCTION

The new definition of periprocedural myocardial infarction (type 4a MI) excludes patients without angina and electrocardiographic or echocardiographic changes suggestive of myocardial ischemia even though significant serum troponin elevations occur following percutaneous coronary intervention (PCI).

AIM

To evaluate the incidence and predictors of serum troponin rise following elective PCI in patients without clinical and procedural signs suggestive of myocardial necrosis by using a high-sensitivite troponin assay (hsTnT).

MATERIAL AND METHODS

Three hundred and four patients (mean age: 60.8 ±8.8 years, 204 male) undergoing elective PCI were enrolled. Patients with periprocedural angina, electrocardiographic or echocardiographic signs indicating myocardial ischemia or a visible procedural complication such as dissection or side branch occlusion were excluded. Mild-moderate periprocedural myocardial injury (PMI) and severe PMI were defined as post-PCI (12 h later) elevation of serum hsTnT concentrations to the range of 14-70 ng/l and > 70 ng/l, respectively.

RESULTS

The median pre-procedural hsTnT level was 9.7 ng/l (interquartile range: 7.1-12.2 ng/l). Serum hsTnT concentration elevated (p < 0.001) to 19.4 ng/l (IQR: 12.0-38.8 ng/l) 12 h after PCI. Mild-moderate PMI and severe PMI were detected in 49.3% and 12.2% of patients, respectively. Post-procedural hsTnT levels were significantly higher in multivessel PCI, overlapping stenting, predilatation and postdilatation subgroups. In addition, post-procedural hsTnT levels were correlated (r = 0.340; p < 0.001) with the stent lengths.

CONCLUSIONS

High-sensitivite troponin measurements indicate a high incidence of PMI even though no clinical or procedural signs suggestive of myocardial ischemia exist. Multivessel PCI, overlapping stenting, predilatation, postdilatation and longer stent length are associated with PMI following elective PCI.

Adverse events and outcomes of procedural sedation and analgesia in major trauma patients

Context:

Trauma patients requiring procedural sedation and analgesia (PSA) may have increased risk of adverse events (AEs) and poor outcomes.

Aims:

To determine the incidence of AEs in adult major trauma patients who received PSA and to evaluate their postprocedural outcomes.

Settings and Design:

Retrospective analysis of adult patients (age >16) who received PSA between 2006 and 2014 at a Canadian academic tertiary care center.

Materials and Methods:

We compared the incidence of PSA-related AEs in trauma patients with nontrauma patients. Postprocedural outcomes including Intensive Care Unit admission, length of hospital stay, and mortality were compared between trauma patients who did or did not receive PSA.

Statistical Analysis Used:

Descriptive statistics and multivariable logistic regression.

Results:

Overall, 4324 patients received PSA during their procedure, of which 101 were trauma patients (107 procedures). The majority (77%) of these 101 trauma patients were male, relatively healthy (78% with American Society of Anesthesiologists Physical Status [ASA-PS] 1), and most (85%) of the 107 procedures were orthopedic manipulations. PSA-related AEs were experienced by 45.5% of the trauma group and 45.9% of the nontrauma group. In the trauma group, the most common AEs were tachypnea (23%) and hypotension (20%). After controlling for age, gender, and ASA-PS, trauma patients were more likely than nontrauma patients to develop hypotension (odds ratio 1.79; 95% confidence interval 1.11-2.89).

Conclusion:

Although trauma patients were more likely than nontrauma patients to develop hypotension during PSA, their outcomes were not worse compared to trauma patients who did not have PSA.

Saline Flush Test: Can Bedside Sonography Replace Conventional Radiography for Confirmation of Above-the-Diaphragm Central Venous Catheter Placement?

OBJECTIVES

Resuscitation often requires rapid vascular access via central venous catheters. Chest radiography is the reference standard to confirm central venous catheter placement and exclude complications. However, radiographs are often untimely. The purpose of this study was to determine whether dynamic sonographic visualization of a saline flush in the right side of the heart after central venous catheter placement could serve as a more rapid confirmatory study for above-the-diaphragm catheter placement.

METHODS

A consecutive prospective enrollment study was conducted in the emergency departments of 2 major tertiary care centers. Adult patients of the study investigators who required an above-the-diaphragm central venous catheter were enrolled during the study period. Patients had a catheter placed with sonographic guidance. After placement of the catheter, thoracic sonography was performed. The times for visualization of the saline flush in the right ventricle and sonographic exclusion of ipsilateral pneumothorax were recorded. Chest radiography was performed per standard practice.

RESULTS

Eighty-one patients were enrolled; 13 were excluded. The mean catheter confirmation time by sonography was 8.80 minutes (95% confidence interval, 7.46-10.14 minutes). The mean catheter confirmation time by chest radiograph availability for viewing was 45.78 minutes (95% confidence interval, 37.03-54.54 minutes). Mean sonographic confirmation occurred 36.98 minutes sooner than radiography (P< .001). No discrepancy existed between sonographic and radiographic confirmation.

CONCLUSIONS

Confirmation of central venous catheter placement by dynamic sonographic visualization of a saline flush with exclusion of pneumothorax is an accurate, safe, and more efficient method than confirmation by chest radiography. It allows the central line to be used immediately, expediting patient care.

Social incentives improve deliberative but not procedural learning in older adults

Age-related deficits are seen across tasks where learning depends on asocial feedback processing, however plasticity has been observed in some of the same tasks in social contexts suggesting a novel way to attenuate deficits. Socioemotional selectivity theory suggests this plasticity is due to a deliberative motivational shift toward achieving well-being with age (positivity effect) that reverses when executive processes are limited (negativity effect). The present study examined the interaction of feedback valence (positive, negative) and social salience (emotional face feedback – happy; angry, asocial point feedback – gain; loss) on learning in a deliberative task that challenges executive processes and a procedural task that does not. We predict that angry face feedback will improve learning in a deliberative task when executive function is challenged. We tested two competing hypotheses regarding the interactive effects of deliberative emotional biases on automatic feedback processing: (1) If deliberative emotion regulation and automatic feedback are interactive we expect happy face feedback to improve learning and angry face feedback to impair learning in older adults because cognitive control is available. (2) If deliberative emotion regulation and automatic feedback are not interactive we predict that emotional face feedback will not improve procedural learning regardless of valence. Results demonstrate that older adults show persistent deficits relative to younger adults during procedural category learning suggesting that deliberative emotional biases do not interact with automatic feedback processing. Interestingly, a subgroup of older adults identified as potentially using deliberative strategies tended to learn as well as younger adults with angry relative to happy feedback, matching the pattern observed in the deliberative task. Results suggest that deliberative emotional biases can improve deliberative learning, but have no effect on procedural learning.

Double dissociation between the contributions of the septal and temporal hippocampus to spatial learning: the role of prior experience

The mammalian hippocampus is anatomically heterogeneous along its longitudinal axis, and there is evidence that distinct functions are executed by different septotemporal subregions. The best documented example is the dependency of spatial learning on the septal, but not the temporal, hippocampus. Here, we carried out a watermaze memory task in rats with partial lesions of the septal or temporal hippocampus made either before or after training. We then studied memory retention, reversal, and new spatial learning in a novel environment. This resulted in the surprising finding that spatial learning in a new environment is dependent on the temporal hippocampus in rats with preoperative experience of a different pool. Rats with septal hippocampal lesions made after learning not only retained the focused search strategy that was acquired during preoperative training, but were also capable of rapid spatial learning in a second pool. This demonstrates that once spatial information has been acquired in one context, related new learning in a different context can be mediated by the temporal hippocampus, a result that challenges the widely held view that spatial memory is an exclusive function of the septal hippocampus.

Overnight Sleep Enhances Hippocampus-Dependent Aspects of Spatial Memory

STUDY OBJECTIVES

Several studies have now demonstrated that spatial information is processed during sleep, and that posttraining sleep is beneficial for human navigation. However, it remains unclear whether the effects of sleep are primarily due to consolidation of cognitive maps, or alternatively, whether sleep might also affect nonhippocampal aspects of navigation (e.g., speed of motion) involved in moving through a virtual environment.

DESIGN

Participants were trained on a virtual maze navigation task (VMT) and then given a memory test following either a day of wakefulness or a night of sleep. Subjects reported to the laboratory for training at either 10:00am or 10:00pm, depending on randomly assigned condition, and were tested 11 h later. Overnight subjects slept in the laboratory with polysomnography.

SETTING

A hospital-based academic sleep laboratory.

PATIENTS OR PARTICIPANTS

Thirty healthy college student volunteers.

INTERVENTIONS

N/A.

MEASUREMENTS AND RESULTS

Point-by-point position data were collected from the VMT. Analysis of the movement data revealed a sleep-dependent improvement in maze completion time (P < 0.001) due to improved spatial understanding of the maze layout, which led to a shortening of path from start to finish (P = 0.01) rather than faster exploration speed through the maze (P = 0.7).

CONCLUSIONS

We found that overnight sleep benefitted performance, not because subjects moved faster through the maze, but because they were more accurate in navigating to the goal. These findings suggest that sleep enhances participants' knowledge of the spatial layout of the maze, contributing to the consolidation of hippocampus-dependent spatial information.

CITATION

Nguyen ND; Tucker MA; Stickgold R; Wamsley EJ. Overnight sleep enhances hippocampus-dependent aspects of spatial memory. SLEEP 2013;36(7):1051-1057.

Memory before and after sleep in patients with moderate obstructive sleep apnea

OBJECTIVE

The aim of this study was to investigate the effects of obstructive sleep apnea (OSA) on procedural and declarative memory encoding in the evening prior to sleep, on memory consolidation during subsequent sleep, and on retrieval in the morning after sleep.

METHODS

Memory performance (procedural mirror-tracing task, declarative visual and verbal memory task) and general neuropsychological performance were assessed before and after one night of polysomnographic monitoring in 15 patients with moderate OSA and 20 age-, sex-, and IQ-matched healthy subjects.

RESULTS

Encoding levels prior to sleep were similar across groups for all tasks. Conventional analyses of averaged mirror tracing performance suggested a significantly reduced overnight improvement in OSA patients. Single trial analyses, however, revealed that this effect was due to significantly flattened learning curves in the evening and morning session in OSA patients. OSA patients showed a significantly lower verbal retention rate and a non-significantly reduced visual retention rate after sleep compared to healthy subjects. Polysomnography revealed a significantly reduced REM density, increased frequency of micro-arousals, elevated apnea-hypopnea index, and subjectively disturbed sleep quality in OSA patients compared to healthy subjects.

CONCLUSIONS

The results suggest that moderate OSA is associated with a significant impairment of procedural and verbal declarative memory. Future work is needed to further determine the contribution of structural or functional alterations in brain circuits relevant for memory, and to test whether OSA treatment improves or normalizes the observed deficits in learning.

Parallel striatal and hippocampal systems for landmarks and boundaries in spatial memory

How the memory systems centered on the hippocampus and dorsal striatum interact to support behavior remains controversial. We used functional MRI while people learned the locations of objects by collecting and replacing them over multiple trials within a virtual environment comprising a landmark, a circular boundary, and distant cues for orientation. The relative location of landmark and boundary was occasionally changed, with specific objects paired with one or other cue, allowing dissociation of learning and performance relative to either cue. Right posterior hippocampal activation reflected learning and remembering of boundary-related locations, whereas right dorsal striatal activation reflected learning and remembering of landmark-related locations. Within the right hippocampus, anterior processing of environmental change (spatial novelty) was dissociated from posterior processing of location. Behavioral studies show that landmark-related learning obeys associative reinforcement, whereas boundary-related learning is incidental [Doeller CF, Burgess N (2008) Proc Natl Acad Sci USA 105:5909-5914]. The distinct incidental hippocampal processing of boundaries is suggestive of a "geometric module" or "cognitive map" and may explain the hippocampal support of incidental/observational learning in "declarative" or "episodic" memory versus the striatal support of trial-and-error learning in "procedural" memory. Finally, the hippocampal and striatal systems appear to combine "bottom-up," simply influencing behavior proportional to their activations, without direct interaction, with "top-down" ventromedial prefrontal involvement when both are similarly active.