What is operative? Conceptualizing neuralgia: Neuroma, compression neuropathy, painful hyperalgesia, and phantom nerve pain

Neuralgia, or nerve pain, is a common presenting complaint for the hand surgeon. When the nerve at play is easily localized, and the cause of the pain is clear (eg, carpal tunnel syndrome), the patient may be easily treated with excellent results. However, in more complex cases, the underlying pathophysiology and cause of neuralgia can be more difficult to interpret; if incorrectly managed, this leads to frustration for both the patient and surgeon. Here we offer a way to conceptualize neuralgia into 4 categories-compression neuropathy, neuroma, painful hyperalgesia, and phantom nerve pain-and offer an illustrative clinical vignette and strategies for optimal management of each. Further, we delineate the reasons why compression neuropathy and neuroma are amenable to surgery, while painful hyperalgesia and phantom nerve pain are not

“You understand that whole big situation they’re in”: interpretative phenomenological analysis of peer-assisted learning

Abstract Background Peer-assisted learning (PAL) increasingly features within medical school curricula. While there is evidence of its effectiveness, less is known about how it promotes learning. Cognitive and social congruence between peer-tutor and student have been described as important concepts underpinning teaching and learning in PAL. We employed interpretative phenomenological analysis for an in-depth exploration of how medical students experience PAL sessions. Methods We conducted the study at The University of Manchester within a near-peer scheme aimed at developing clinical skills within clinical clerkship students. We conducted individual interviews with three peer tutors and five students. We undertook interpretive phenomenological analysis of interview transcripts. We subsequently synthesised an account of the study participants’ lived experiences of PAL sessions from individual personal accounts to explore how medical students experience peer-assisted learning. This analysis was then used to complement and critique a priori educational theory regarding the mechanisms underlying PAL. Results Students experienced PAL sessions as a safe and egalitarian environment, which shaped the type and style of learning that took place. This was facilitated by close relationships with peer-tutors, with whom they shared a strong sense of camaraderie and shared purpose. Peer-tutors felt able to understand their students’ wider sociocultural context, which was the most important factor underpinning both the PAL environment and tutor-student relationship. Participants contrasted this relative safety, camaraderie and shared purpose of PAL with teaching led by more senior tutors in clinical settings. Conclusions This study provides a rich description of the important factors that characterise medical students’ experiences of PAL sessions. Participants felt a strong sense of support in PAL sessions that took into account their wider sociocultural context. Multiple factors interplayed to create a learning environment and tutor-student relationship that existed in contrast to teaching led by more senior, clinical tutors. The insight generated via IPA complemented existing theory and raised new lines of enquiry to better understand how the peer relationship fosters learning in PAL at medical school. We make recommendations to use insights from PAL for faculty and curriculum development

Exploring the Relationship Between Eye Movements and Electrocardiogram Interpretation Accuracy

Interpretation of electrocardiograms (ECGs) is a complex task involving visual inspection. This paper aims to improve understanding of how practitioners perceive ECGs, and determine whether visual behaviour can indicate differences in interpretation accuracy. A group of healthcare practitioners (n = 31) who interpret ECGs as part of their clinical role were shown 11 commonly encountered ECGs on a computer screen. The participants’ eye movement data were recorded as they viewed the ECGs and attempted interpretation. The Jensen-Shannon distance was computed for the distance between two Markov chains, constructed from the transition matrices (visual shifts from and to ECG leads) of the correct and incorrect interpretation groups for each ECG. A permutation test was then used to compare this distance against 10,000 randomly shuffled groups made up of the same participants. The results demonstrated a statistically significant (α  0.05) result in 5 of the 11 stimuli demonstrating that the gaze shift between the ECG leads is different between the groups making correct and incorrect interpretations and therefore a factor in interpretation accuracy. The results shed further light on the relationship between visual behaviour and ECG interpretation accuracy, providing information that can be used to improve both human and automated interpretation approaches

The lion’s share. An experimental analysis of polygamy in Northern Nigeria

Using samples of polygamous and non-polygamous households from villages in rural areas south of Kano, Northern Nigeria we test basic theories of household behaviour. Husbands and wives play two variants of a voluntary contributions game in which endowments are private knowledge, but contributions are public. In one variant, the common pool is split equally. In the other treatment the husband allocates the pool (and wives are forewarned of this). Most partners keep back at least half of their endowment from the common pool, but we find no evidence that polygynous households are less efficient than their monogamous counterparts. We also reject a strong form of Bergstrom’s model of polygyny in which all wives receive an equal allocation. In our case, senior wives often receive more from their husbands, no matter what their contribution. Thus the return to contributions is higher for senior wives compared to their junior counterparts. When they control the allocation, polygynous men receive a higher payoff than their monogamous counterparts. We speculate on the implications of this pattern of investment and reward for the sustainability of polygynous institutions