HSE Management Standards and burnout dimensions among rehabilitation professionals

Background The Health & Safety Executive Indicator Tool (HSE-IT) is a standard-based questionnaire commonly used to assess work-related stress in organizations. Although the HSE-IT validity has been well documented and significant relationships have been observed between its scales and several work-related outcomes, to date there is no evidence concerning the relationships between the HSE-IT and burnout among healthcare workers.Aims To investigate the relationships between the HSE-IT subscales and burnout dimensions as measured by the Maslach Burnout Inventory (MBI) in a sample of Italian rehabilitation professionals employed in healthcare institutions.Methods An anonymous cross-sectional questionnaire was administered to a sample of Italian rehabilitation professionals including physical therapists, occupational therapists, psychiatric rehabilitation technicians and developmental psychomotor therapists. Associations between the HSE-IT and the MBI were analysed with multiple linear regression models.Results A total of 432 rehabilitation professionals completed the questionnaire and 14% of them showed high levels of burnout risk. Significant differences in the HSE-IT scores were found between workers at high risk of burnout and workers at low risk of burnout. Hierarchical regressions showed an association between the HSE-IT scales and the MBI factors: emotional exhaustion was associated with 'demands' and 'role', and both depersonalization and personal accomplishment were associated with 'control' and 'role'.Conclusions This preliminary study showed the HSE-IT subscales are sensitive to burnout risk as measured by the MBI. The association found between the HSE-IT 'demands', 'role' and 'control' subscales and the MBI dimensions is significant but small. These findings might inform targeted burnout prevention

Biodegradable polymeric micro/Nano-structures with intrinsic antifouling/antimicrobial properties: Relevance in damaged skin and other biomedical applications

Bacterial colonization ofimplanted biomedical devicesis themain cause of healthcare-associated infections, estimated to be 8.8 million per year in Europe. Many infections originate from damaged skin, which lets microorganisms exploit injuries and surgical accesses as passageways to reach the implant site and inner organs. Therefore, an effective treatment of skin damage is highly desirable for the success of many biomaterial-related surgical procedures. Due to gained resistance to antibiotics, new antibacterial treatments are becoming vital to control nosocomial infections arising as surgical and post-surgical complications. Surface coatings can avoid biofouling and bacterial colonization thanks to biomaterial inherent properties (e.g., super hydrophobicity), specifically without using drugs, which may cause bacterial resistance. The focus of this review is to highlight the emerging role of degradable polymeric micro- and nano-structures that show intrinsic antifouling and antimicrobial properties, with a special outlook towards biomedical applications dealing with skin and skin damage. The intrinsic properties owned by the biomaterials encompass three main categories: (1) physical-mechanical, (2) chemical, and (3) electrostatic. Clinical relevance in ear prostheses and breast implants is reported. Collecting and discussing the updated outcomes in this field would help the development of better performing biomaterial-based antimicrobial strategies, which are useful to prevent infections

Magnetic resonance imaging urodynamics: technique development and preliminary results

OBJECTIVES: In this preliminary study we report the development of the video urodynamic technique using magnetic resonance imaging (MRI). MATERIALS AND METHODS: We studied 6 women with genuine stress urinary incontinence, diagnosed by history and physical examination. Urodynamic examination was performed on multichannel equipment with the patient in the supine position. Coughing and Valsalva maneuvers were performed at volumes of 150, 250 and 350 mL. Simultaneously, MRI was carried out by using 1.5 T GE Signa CV/i high-speed scanner with real time fluoroscopic imaging possibilities. Fluoroscopic imaging was accomplished in the corresponding planes with T2-weighted single shot fast spin echo sequences at a speed of about 1 frame per second. Both studies were recorded and synchronized, resulting in a single video urodynamic examination. RESULTS: Dynamic MRI with cine-loop reconstruction of 1 image per second demonstrated the movement of all compartment of the relaxed pelvis during straining with the concomitant registration of abdominal and intravesical pressures. In 5 patients, urinary leakage was demonstrated during straining and the Valsalva leak point pressure (VLPP) was determined as the vesical pressure at leak subtracted from baseline bladder pressure. Mean VLPP was 72.6 cm H2O (ranging from 43 to 122 cm H2O). CONCLUSIONS: The concept of MRI video urodynamics is feasible. In a clinical perspective, practical aspects represent a barrier to daily use and it should be recommended for research purposes.Federal University of São Paulo Department of UrologyUNIFESP, Department of UrologySciEL

Pudendal nerve latency time in normal women via intravaginal stimulation

INTRODUCTION & OBJECTIVES: Studies of motor conduction for the efferent functional assessment of the pudendal nerve in women with pelvic dysfunctions have been conducted through researching distal motor latency times. The transrectal approach has been the classic approach for this electrophysiological examination. The objective of the present study is to verify the viability of the transvaginal approach in performing the exam, to establish normal values for this method and to analyze the influence of age, stature and parity in the latency value of normal women. MATERIALS AND METHODS: A total of 23 volunteers without genitourinary pathologies participated in this study. In each, pudendal motor latency was investigated through the transvaginal approach, which was chosen due to patient s higher tolerance levels. RESULTS: The motor response represented by registering the M-wave was obtained in all volunteers on the right side (100%) and in 13 volunteers on the left side (56.5%). The mean motor latency obtained in the right and left was respectively: 1.99 ± 0.41 and 1.92 ± 0.48 milliseconds (ms). There was no difference between the sides (p = 0.66). Latency did not correlate with age, stature or obstetric history. The results obtained in the present study were in agreement with those found by other researchers using the transrectal approach. CONCLUSION: The vaginal approach represents an alternative for pudendal nerve distal motor latency time, with similar results to those achieved through the transrectal approach. Normative values obtained herein might serve as a comparative basis for subsequent physiopathological studies.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM) Departments of Urology and NeurologyUNIFESP, EPM, Departments of Urology and NeurologySciEL

Automatic hand phantom map generation and detection using decomposition support vector machines

Background: There is a need for providing sensory feedback for myoelectric prosthesis users. Providing tactile feedback can improve object manipulation abilities, enhance the perceptual embodiment of myoelectric prostheses and help reduce phantom limb pain. Many amputees have referred sensation from their missing hand on their residual limbs (phantom maps). This skin area can serve as a target for providing amputees with non-invasive tactile sensory feedback. One of the challenges of providing sensory feedback on the phantom map is to define the accurate boundary of each phantom digit because the phantom map distribution varies from person to person. Methods: In this paper, automatic phantom map detection methods based on four decomposition support vector machine algorithms and three sampling methods are proposed, complemented by fuzzy logic and active learning strategies. The algorithms and methods are tested on two databases: the first one includes 400 generated phantom maps, whereby the phantom map generation algorithm was based on our observation of the phantom maps to ensure smooth phantom digit edges, variety, and representativeness. The second database includes five reported phantom map images and transformations thereof. The accuracy and training/ classification time of each algorithm using a dense stimulation array (with 100 $$\times$$ × 100 actuators) and two coarse stimulation arrays (with 3 $$\times$$ × 5 and 4 $$\times$$ × 6 actuators) are presented and compared. Results: Both generated and reported phantom map images share the same trends. Majority-pooling sampling effectively increases the training size, albeit introducing some noise, and thus produces the smallest error rates among the three proposed sampling methods. For different decomposition architectures, one-vs-one reduces unclassified regions and in general has higher classification accuracy than the other architectures. By introducing fuzzy logic to bias the penalty parameter, the influence of pooling-induced noise is reduced. Moreover, active learning with different strategies was also tested and shown to improve the accuracy by introducing more representative training samples. Overall, dense arrays employing one-vs-one fuzzy support vector machines with majority-pooling sampling have the smallest average absolute error rate (8.78% for generated phantom maps and 11.5% for reported and transformed phantom map images). The detection accuracy of coarse arrays was found to be significantly lower than for dense array. Conclusions: The results demonstrate the effectiveness of support vector machines using a dense array in detecting refined phantom map shapes, whereas coarse arrays are unsuitable for this task. We therefore propose a two-step approach, using first a non-wearable dense array to detect an accurate phantom map shape, then to apply a wearable coarse stimulation array customized according to the detection results. The proposed methodology can be used as a tool for helping haptic feedback designers and for tracking the evolvement of phantom maps

Testing for the myth of cognitive reserve. Are the static and dynamic cognitive reserve indexes a representation of different reserve warehouses?

Background: Cognitive reserve (CR) explains the individual resilience to neurodegeneration. Years of formal education express the static measure of reserve (sCR). A dynamic aspect of CR (dCR) has been recently proposed. Objective: The aim of the study was to compare sCR and dCR indexes, respectively, to detect brain abnormalities in Alzheimer's disease (AD) patients. Methods: 117 individuals [39 AD, 40 amnestic mild cognitive impairment (aMCI), 38 healthy subjects (HS)] underwent neuropsychological evaluation and a 3T-MRI. T1-weighted volumes were used for manual segmentation of the hippocampus and of the parahippocampal cortices. Years of formal education were used as an index of sCR. Partial Least Square analysis was used to decompose the variance of individual MMSE scores, considered as a dCR index. In aMCI and AD patients, the brain abnormalities have been assessed comparing individuals with high and low levels of sCR and dCR in turn. Moreover, we investigated the effect of the different CR indexes in mediating the relationship between changes in brain volumes and memory performances. Results: sCR and dCR indexes classified differently individuals having high or low levels of CR. Smaller hippocampal and parahippocampal volumes in high dCR patients were found. The sCR and dCR indexes mediated significantly the relationship between brain abnormalities and memory in patients. Conclusions: CR mediated the relationship between brain and memory dysfunctions. We hypothesized that sCR and dCR indexes are a representation of different warehouses of reserve not operating in parallel but forming a complex system, in which crystalized cognitive abilities and actual cognitive efficiency interact with brain atrophy impacting on memory

Experimental Assessment of Cuff Pressures on the Walls of a Trachea-Like Model Using Force Sensing Resistors: Insights for Patient Management in Intensive Care Unit Settings

The COVID-19 outbreak has increased the incidence of tracheal lesions in patients who underwent invasive mechanical ventilation. We measured the pressure exerted by the cuff on the walls of a test bench mimicking the laryngotracheal tract. The test bench was designed to acquire the pressure exerted by endotracheal tube cuffs inflated inside an artificial model of a human trachea. The experimental protocol consisted of measuring pressure values before and after applying a maneuver on two types of endotracheal tubes placed in two mock-ups resembling two different sized tracheal tracts. Increasing pressure values were used to inflate the cuff and the pressures were recorded in two different body positions. The recorded pressure increased proportionally to the input pressure. Moreover, the pressure values measured when using the non-armored (NA) tube were usually higher than those recorded when using the armored (A) tube. A periodic check of the cuff pressure upon changing the body position and/or when performing maneuvers on the tube appears to be necessary to prevent a pressure increase on the tracheal wall. In addition, in our model, the cuff of the A tube gave a more stable output pressure on the tracheal wall than that of the NA tube

Bone-Anchored Hearing Aids Fitted According to NAL and DSL Procedures in Adults with Mixed Hearing Loss

BACKGROUND: Bone-anchored hearing aids represent a valid alternative for patients with conductive/mixed hearing loss who cannot use hearing aids. To date, these devices have given good audiological results, thanks to various fitting prescription programs (i.e., National Acoustic Laboratories and Desired Sensation Level). The aim of this study is to compare 2 types of fitting algorithms (National Acoustic Laboratories and Desired Sensation Level) implemented for bone-anchored hearing devices. METHODS: We retrospectively enrolled 10 patients followed at our operative unit, suffering from bilateral symmetrical mixed hearing loss and who underwent bone-anchored hearing aid implantation. All patients experienced each prescriptive procedure, National Acoustic Laboratories and Desired Sensation Level, for 7 months (on average), and they were subjected to audiological tests and questionnaires to evaluate the best program. RESULTS: National Acoustic Laboratories and Desired Sensation Level prescriptions yielded similar results. Desired Sensation Level allowed less amplification of the low frequencies than the National Acoustic Laboratories prescription, and these differences were the only statistically significant. Desired Sensation Level allowed better disyllabic word and sentence recognition scores only in quiet and not in noisy conditions. The subjective questionnaires showed similar results. At the end of the trial sessions, more patients (60%) definitively chose the Desired Sensation Level program for their device. These patients were those with a worse hearing threshold. CONCLUSION: The 2 prescriptive programs allowed similar results although patients with a worse threshold seem to prefer the DSL program. This is the first evaluation of the 2 prescriptive programs, National Acoustic Laboratories versus Desired Sensation Level, for bone conduction devices available in the literature. Further studies are needed to confirm this initial finding