The overlooked outcome measure for spinal cord injury: use of assistive devices

Although several outcome measures are used to assess various areas of interest regarding spinal cord injuries (SCIs), little is known about the frequency of their use, and the ways in which they transform shared knowledge into implemented practices. Herein, 800 professionals from the International Spinal Cord Society, especially trained for caring in patients with SCI, were invited to respond to an Internet survey collecting information on the use of standardized measures in daily clinical practices. We asked both clinicians and researchers with different areas of interest about their use of functional outcome measures, and, in particular, which scales they habitually use to assess various aspects of clinical practice and rehabilitation. We selected a set of rating scales, which were validated for measuring SCIs (http://www.scireproject.com/outcome-measures). The results show that the areas of interest assessed by most of the participants were neurological status, upper limb, lower limb gait, pain, spasticity, self-care, and daily living. The most widely used rating scales were the spinal cord independence measure, the functional independence measure and the International Standards for Neurological Classification of Spinal Cord Injury. Instead, the majority of respondents did not evaluate the use of assistive technology. Despite the availability of several outcome scales, the practice of evaluating SCIs with standardized measures for assistive technologies and wheelchair mobility is still not widespread, even though it is a high priority in the rehabilitation of SCI patients. The results emphasize the need for a more thorough knowledge and use of outcome scales, thus improving the quality of assistive device evaluation

Assessing positive and negative experiences: validation of a new measure of well-being in an Italian population

The aim of this study is to explore the psychometric properties of an affect scale, the Scale of Positive and Negative Experience (SPANE), in an Italian-speaking population. The results of this study demonstrate that the Italian version of the SPANE has psychometric properties similar to those shown by the original and previous versions, and it presents satisfactory reliability and factorial validity. The results of the Confirmatory Factor Analysis support the expected two-factor structure, positive and negative feeling, which characterized the previous versions. As expected, measures of negative affect, anxiety, negative future expectances, and depression correlated positively with the negative experiences SPANE subscale, and negatively with the positive experiences SPANE subscale. Results of this study demonstrate that the Italian version of the SPANE has psychometric properties similar to those shown by the original and previous versions, and it presents satisfactory reliability and factorial validity. The use of this instrument provides clinically useful information about a person’s overall emotional experience and it is an indicator of well-being. Although further studies are required to confirm the psychometric characteristics of the scale, the SPANE Italian version is expected to improve theoretical and empirical research on the well-being of the Italian population.Lo scopo del presente studio è quello di esplorare le proprietà psicometriche di uno strumento di misurazione dell’affetto, la Scala di Esperienze Positive e Negative (SPANE), all’interno di una popolazione italiana. Gli esiti dell’analisi fattoriale confermativa com- provano l’attesa struttura a due fattori, sentimenti positivi e negativi. Le correlazioni con altre dimensioni (per es., ansia, depressione, affetto, aspettative future) confermano i risultati ottenuti con le precedenti versioni della scala: affetto negativo, ansia, depressione e aspettative futu- re negative correlano positivamente con la subscala di esperienze negative e negativamente con la subscala di esperienze positive dello SPA- NE. In conclusione, i risultati del nostro studio dimostrano che la versione italiana dello SPANE presenta caratteristiche psicometriche simili a quelle mostrate dalla versione orginale e da successive validazioni dello strumento in altre lingue. La scala presenta, inoltre, affidabilità e va- lidità fattoriale. Lo SPANE è un indice utile dal punto di vista clinico che può fornire informazioni rilevanti circa l’esperienza emotiva e il be- nessere della persona. Nonostante ulteriori studi siano necessari per confermare le caratteristiche psicometriche della scala, la presente vali- dazione della versione italiana dello SPANE può contribuire ad ampliare la ricerca nell’ambito del benessere in una popolazione Italiana.CIBERobn i san initiate of the ISCIII. Red de Excelencia PROMOSAN (PSI2014-56303-REDT): Investigación en procesos, mecanismos y tratamientos psicológicos para la promoción de la salud mental. Ministerio de Economía y Competitividad (Spain), (Plan Nacional I+D+I. PSI2013-41783-R)

Assessing Future Expectations and the Two-Dimensional Model of Affect in an Italian Population

Future-directed thinking has been described as part of two underlying systems that integrate dimensions of affect, motivational systems, orientation to the future, and future expectations, which are initiated at the cognitive, affective, biological, behavioral, and motivational levels. The main aim of the present study is to test the two underlying frameworks model and explore future expectations in a general Italian-speaking population (N=345). Therefore, the second aim of the present paper is to confirm the factorial structure of the Subjective Probability Task (SPT; MacLeod et al., 1996), a questionnaire designed to assess specific positive and negative orientations towards the future. Results showed that the SPT has good psychometric properties and it is a reliable instrument to assess future-directed thinking. Moreover, our findings confirmed the role of future expectancies as cognitive correlates of depression and anxiety. Differently from previous studies (Clark and Watson, 1991; MacLeod et al., 1996), our results did not confirm that depression was characterized by low positive affect. We believe this paper contributes to the understanding of future expectancies and their relation with anxiety and depression, and will help to expand the availability of an instrument to assess future directed thinking

Embodying functionally relevant action sounds in patients with spinal cord injury

Growing evidence indicates that perceptual-motor codes may be associated with and influenced by actual bodily states. Following a spinal cord injury (SCI), for example, individuals exhibit reduced visual sensitivity to biological motion. However, a dearth of direct evidence exists about whether profound alterations in sensorimotor traffic between the body and brain influence audio-motor representations. We tested 20 wheelchair-bound individuals with lower skeletal-level SCI who were unable to feel and move their lower limbs, but have retained upper limb function. In a two-choice, matching-to-sample auditory discrimination task, the participants were asked to determine which of two action sounds matched a sample action sound presented previously. We tested aural discrimination ability using sounds that arose from wheelchair, upper limb, lower limb, and animal actions. Our results indicate that an inability to move the lower limbs did not lead to impairment in the discrimination of lower limb-related action sounds in SCI patients. Importantly, patients with SCI discriminated wheelchair sounds more quickly than individuals with comparable auditory experience (i.e. physical therapists) and inexperienced, able-bodied subjects. Audio-motor associations appear to be modified and enhanced to incorporate external salient tools that now represent extensions of their body schemas

Digital image enhancement may improve sensitivity of cholesteatoma detection during endoscopic ear surgery.

OBJECTIVES This study investigates the possible benefits and limitations of the digital image enhancement systems provided by Storz Professional Image Enhancement System (SPIES) during endoscopic ear surgery (EES) for cholesteatoma. An increased detection of cholesteatoma residuals during the final steps of endoscopic surgery using DIE technology was hypothesized. DESIGN Cross-sectional study. SETTING Tertiary referral hospital. METHODS A total of 10 questionnaires of 18 intraoperative pictures with equal numbers of cholesteatoma and non-cholesteatoma images, each presented in three different image-enhancing modalities (Clara, Spectra A, Spectra B), were generated. Fifty-one experienced ear surgeons participated to the survey and were randomly assigned to a questionnaire and completed it at two time points. The experts were asked to rate for each picture whether cholesteatoma was present or not. The answers were compared with the histopathological reports. RESULTS Clara showed the highest accuracy in cholesteatoma detection, followed by Spectra A and lastly Spectra B. In contrast, Spectra B showed the highest sensitivity and Clara the highest specificity, while Spectra A was placed in the middle for both values. Using the Spectra B modality, most responses agreed across the two time points. Ear surgeons assessed the usefulness, as well as preference among image modalities for cholesteatoma surgery, in the following order: Clara, Spectra B, Spectra A. CONCLUSION Digital enhancement technologies are applicable to EES. After complete cholesteatoma removal, Spectra B showed the highest sensitivity in the detection of cholesteatoma residuals as compared with Clara and Spectra A. Thus, Spectra B may be recommended to avoid missing any cholesteatoma residuals during EES

“Lo bueno dura poco”: disminuir las emociones positivas influye en nuestros niveles de optimismo

xxA pesar del creciente interés en la comprensión de las estrategias de regulación emocional (RE) de las emociones positivas y su relación con la salud mental, la relación entre los diferentes estilos de respuesta al afecto positivo y estilos cognitivos como el optimismo aún no se ha probado empíricamente. El objetivo del presente estudio fue evaluar el efecto de las estrategias para regular emociones positivas (evaluadas por el cuestionario Response to Positive Affect -RPA) sobre el optimismo, y la posible mediación del afecto positivo en esta relación. 250 participantes completaron el cuestionario RPA, medidas de optimismo y afecto positivo, y realizaron un procedimiento de inducción emocional aplicado a través de Internet. Los resultados muestran que el afecto positivo no media la relación entre las estrategias de regulación emocional y los niveles de optimismo. No obstante, disminuir las emociones positivas (“dampening”) fue la única estrategia que predijo los niveles de optimismo después de la inducción. Se señala la necesidad de nuevos estudios con el fin de mejorar la comprensión de los mecanismos implicados en la regulación y el optimismo.

Determinants of Caregiver Burden in Early-Onset Dementia

Caregivers of patients with early-onset dementia (EOD) experience high levels of burden, which is known to be affected by caregivers’ psychological features as well as by patients’ and caregivers’ demographical and social variables. Although potential clinical, demographical, and social determinants have been separately examined, it is not known how they reciprocally interact. Methods: Ninety- two consecutive patient-caregiver dyads were recruited from the Cognitive Neurology Clinics of Modena, Northern Italy. Caregivers were asked to fill in questionnaires regarding their burden, psychological distress, and family economic status. Data were analyzed with multivariable regression models and then entered in a mediation model. Results: Caregiver burden was positively related to female caregiver sex, spousal relationship to the patient, severity of patient’s behavioral symptoms, diagnostic delay, and financial distress of the family. It was negatively related to disease duration, patient’s education, region of birth, caregiver age, number of caregiver’s days off work, number of offspring, and caregiver perception of patient’s quality of life. While the effect of caregiver age, diagnostic delay, and of proxies of family or social network directly impacted on caregiver’s burden, the effect of patient’s disease duration, being a wife caregiver, financial distress, and number of caregiver’s days off work was entirely mediated by the level of caregiver psychological distress. Conclusions: Both direct actions (such as increasing social networks and shortening diagnostic delay) and indirect actions aimed at reducing psychological distress (such as increasing the number of caregiver’s days off work and financial support) should be planned to reduce caregiver’s burden

Assessment of a novel patient-specific 3D printed multi-material simulator for endoscopic sinus surgery

Background: Three-dimensional (3D) printing is an emerging tool in the creation of anatomical models for surgical training. Its use in endoscopic sinus surgery (ESS) has been limited because of the difficulty in replicating the anatomical details. Aim: To describe the development of a patient-specific 3D printed multi-material simulator for use in ESS, and to validate it as a training tool among a group of residents and experts in ear-nose-throat (ENT) surgery. Methods: Advanced material jetting 3D printing technology was used to produce both soft tissues and bony structures of the simulator to increase anatomical realism and tactile feedback of the model. A total of 3 ENT residents and 9 ENT specialists were recruited to perform both non-destructive tasks and ESS steps on the model. The anatomical fidelity and the usefulness of the simulator in ESS training were evaluated through specific questionnaires. Results: The tasks were accomplished by 100% of participants and the survey showed overall high scores both for anatomy fidelity and usefulness in training. Dacryocystorhinostomy, medial antrostomy, and turbinectomy were rated as accurately replicable on the simulator by 75% of participants. Positive scores were obtained also for ethmoidectomy and DRAF procedures, while the replication of sphenoidotomy received neutral ratings by half of the participants. Conclusion: This study demonstrates that a 3D printed multi-material model of the sino-nasal anatomy can be generated with a high level of anatomical accuracy and haptic response. This technology has the potential to be useful in surgical training as an alternative or complementary tool to cadaveric dissection

Topographic Anatomy of the Medial Labyrinthine Wall: Implications for the Transcanal Endoscopic Approach to the Internal Auditory Canal.

Hypothesis To characterize transcanal endoscopic landmarks of the medial labyrinthine wall and correlate these with anatomical features of the fundus of the internal auditory canal (IAC). Background The transcanal transpromontorial approach (TTA) enables minimally invasive access to the IAC. The establishment of a landmark-based dissection technique for the approach is crucial to avoid injury to the facial nerve. Methods Twenty temporal bones were dissected endoscopically through the TTA. Furthermore, high-resolution computed tomography (CT) scans from ten adult normal temporal bones were analyzed and three-dimensionally reconstructed. Results A stepwise dissection technique for the TTA was demonstrated depending on a newly described landmark used in the identification of the facial nerve. The proposed landmark, which was named the intervestibulocochlear crest (IVCC), is an integrated part of the otic capsule. It can be differentiated after the excision of the lateral labyrinthine wall as a laterally based bony pyramid between the cochlea and the vestibule. Its medially directed apex blends with the central part of the falcifrom crest and points to the distal part of the meatal facial nerve. The IVCC is best detected on axial CT images at the level of the tympanic facial nerve. The union between the IVCC and the falciform crest appears radiologically as a short stem or mini-martini glass. Conclusion The proposed IVCC is a novel landmark with a consistent relationship to the IAC fundus and the facial nerve. It may be utilized in conjunction with the falciform crest to identify the facial nerve during minimally invasive transcanal surgeries. METHODS Twenty temporal bones were dissected endoscopically through the TTA. Furthermore, high-resolution computed tomography (CT) scans from ten adult normal temporal bones were analyzed and three-dimensionally reconstructed. RESULTS A stepwise dissection technique for the TTA was demonstrated depending on a newly described landmark used in the identification of the facial nerve. The proposed landmark, which was named the intervestibulocochlear crest (IVCC), is an integrated part of the otic capsule. It can be differentiated after the excision of the lateral labyrinthine wall as a laterally based bony pyramid between the cochlea and the vestibule. Its medially directed apex blends with the central part of the falcifrom crest and points to the distal part of the meatal facial nerve. The IVCC is best detected on axial CT images at the level of the tympanic facial nerve. The union between the IVCC and the falciform crest appears radiologically as a short stem or mini-martini glass. CONCLUSION The proposed IVCC is a novel landmark with a consistent relationship to the IAC fundus and the facial nerve. It may be utilized in conjunction with the falciform crest to identify the facial nerve during minimally invasive transcanal surgeries

Surgical Training on Ex Vivo Ovine Model in Otolaryngology Head and Neck Surgery: A Comprehensive Review.

Background: Nowadays, head and neck surgical approaches need an increased level of anatomical knowledge and practical skills; therefore, the related learning curve is both flat and long. On such procedures, surgeons must decrease operating time as much as possible to reduce the time of general anesthesia and related stress factors for patients. Consequently, little time can be dedicated for training skills of students and young residents in the operating theater. Fresh human cadavers offer the most obvious surrogate for living patients, but they have several limitations, such as cost, availability, and local regulations. Recently, the feasibility of using ex vivo animal models, in particular ovine ones, have been considered as high-fidelity alternatives to cadaveric specimens. Methods: This comprehensive review explores all of head and neck otolaryngology applications with this sample. We analyzed studies about ear surgery, orbital procedures, parotid gland and facial nerve reanimation, open laryngeal and tracheal surgery, microlaryngoscopy procedures, laryngotracheal stenosis treatment, and diagnostic/operative pediatric endoscopy. For each different procedure, we underline the main applications, similarities, and limitations to human procedures so as to improve the knowledge of this model as a useful tool for surgical training. Results: An ovine model is easily available and relatively inexpensive, it has no limitations associated with religious or animal ethical issues, and it is reliable for head and neck surgery due to similar consistencies tissues and neurovascular structures with respect to humans. However, some other issues should be considered, such as differences about some anatomical features, the risk of zoonotic diseases, and the absence of bleeding during training. Conclusion: This comprehensive review highlights the potentials of an ex vivo ovine model and aims to stimulate the scientific and academic community to further develop it for other applications in surgical education