Day: February 7, 2022

Categories : UrogenitalTags :

Surgical Simulations Confer Better Skills and Reduce Complications

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A surgical simulation unit used in the study. Credit: Takashige Abe.

An international trial found that while simulation-based training for ureteroscopy did not speed up surgeons general proficiency acquisition, it did increase skills in more complex surgeries, with fewer total complications and ureteric injuries. The results were published in the journal European Urology.

“To date, there have been limited data, mostly from small-scale studies conducted with medical students, assessing the transferability of surgical simulation,” said paper authors Takashige Abe, Associate Professor of Urology at Hokkaido University. The aim, he said, was to evaluate whether surgical residents undergoing additional simulation training can achieve proficiency sooner and with better patient outcomes, compared to usual operation room-based training.

The trial followed 65 participants in 10 countries for 18 months, or up to 25 procedures. A total of 32 participants received simulation-based training while 33 received conventional apprenticeship-style training. Both remained supervised by more experienced surgeons. Participants performed a total of 1140 surgeries, either semi-rigid or flexible ureteroscopy to remove ureteral or renal stones, respectively, demonstrating “mixed results” in proficiency.

“For our primary outcome measure, while we showed what might be deemed a clinically meaningful difference, it was not statistically significant,” Prof Abe said. “However, when stratified to each procedure type, there were higher rates of proficiency in the simulation-based training group when it came to the more technically challenging flexible ureteroscopy procedure.”

Prof Abe also noted that the simulation group scored higher on a standard assessment for each surgerythe other group.

“Simulation-based training led to higher overall proficiency scores than for conventional training, and fewer procedures were required to achieve proficiency in the complex form of the index procedure, with fewer serious complications overall,” Prof Abe said. “It is expected that the results of the trial will have a positive impact for advanced procedural training beyond the fields of surgery and urology in order to promote patients’ safety as well as better surgical outcomes.”

Source: University of Hokkaido

Categories : Obstetrics & GynaecologyTags :

A Small Risk of Increased Congenital Abnormalities from Opioids in Pregnancy

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Photo by William-Fortunato on Pexels

In a new study in the Canadian Medical Association Journal, researchers drawing on a provincial database report a small increased risk of congenital abnormalities in infants exposed to opioid medications in the first trimester of pregnancy.

Prescribed opioid pain medications are capable of crossing the placenta and have the potential to cause harm. In a study comparing placental crossing rates for various opioids, oxycodone, a commonly prescribed opioid for pain relief, was the fastest. About 2%–4% of foetuses are exposed to these drugs. To determine the association between opioid pain medications in early pregnancy and congenital abnormalities in infants, investigators analysed administrative health data from Ontario on almost 600 000 birth parent–infant pairs. 

Among the infants included in the study, 2% (11 903) were exposed in utero to opioid analgesics, such as codeine, oxycodone, hydromorphone, tramadol, and morphine. Analysis showed a small increased risk of major anomalies with exposure to tramadol and morphine, and of minor anomalies with exposure to codeine, hydromorphone and oxycodone. Specific congenital anomalies observed included gastrointestinal and genital anomalies, neoplasms and tumours, and ankyloglossia.

This study adds to the evidence from previous studies in Sweden and Norway and also from a recent study of pregnant US Medicaid beneficiaries that suggested a small increased risk of congenital anomalies, an important finding for a pregnant person who may be prescribed opioids for pain relief.

“Both the potential for harm or distress to the pregnant person as a consequence of foregoing treatment and the subsequent risk to the infant must be considered for effective treatment,” the authors concluded. “These findings further quantify harms associated with prenatal exposure to opioid analgesics to inform treatment choices for pain in pregnancy.”

Source: EurekAlert!

Categories : Mental HealthTags :

Abnormal Heart Reaction in Generalised Anxiety Disorder

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Photo by Joice Kelly on Unsplash

In women with generalised anxiety disorder (GAD), researchers using functional magnetic resonance imaging (fMRI) have identified an abnormal link between the heart and the prefrontal cortex.

The researchers were seeking to determine whether individuals suffering from GAD show dysfunction in the neural circuitry underlying cardiovascular arousal, and if it is associated with certain disorder-related symptoms such as anxiety and body sensation. To conduct the study, they completed a randomised clinical trial of 58 adult female participants (29 with GAD and 29 healthy controls).

During the study, they stimulated the cardiovascular system using isoproterenol, which mimics the effects of adrenaline but, unlike adrenaline, cannot cross the blood-brain-barrier to directly impact brain activity. Intravenous infusions of isoproterenol or saline were administered during fMRI, allowing them to assess whether the brains of patients with GAD differ in the processing of information received from the body, a function known as ‘interoception’. The main findings were that patients with GAD perceived their heartbeats to be more intense and had relatively higher heart rates and lower neural activity in the ventromedial prefrontal cortex. However, these were only observed during the lower of two dosages of isoproterenol: a key finding. Self-reported anxiety was higher only for those with GAD compared to healthy participants in response to either dose. 

The findings were published in JAMA Psychiatry.

Lead author Adam Teed, a postdoctoral associate at Laureat Institute of Brain Research, said “administering isoproterenol allowed us to provide causal evidence that an abnormally sensitive cardiovascular system and an abnormally insensitive frontal cortex in GAD patients lowers their ability to regulate bodily arousal. This could help to explain why they experience anxiety so frequently and in a wide variety of contexts.” The authors hope that their study prompts further research into the ventromedial prefrontal cortex as a therapeutic target for novel treatments helping individuals with GAD to regulate physiological and emotional responses to stress. 

In addition to this link, the observation of cardiovascular hypersensitivity in GAD patients was also noteworthy. This is because the DSM-5 describes autonomic symptoms such as sweating, rapid heart rate, or shortness of breath, as being less prominent in GAD than other anxiety disorders, such as panic disorder. As senior author Sahib Khalsa, MD, PhD, a psychiatrist and principal investigator at LIBR explains, “this study shows us that anxiety is not only something that happens within our brains but within our bodies as well.” 

Thus abnormal autonomic nervous system functioning is not only a factor in GAD, but it occurs in combination with abnormal functioning of certain areas of the brain. Dr Khalsa believes that this finding is the most important research outcome: “it is the interaction between our brain and body that may be essential for determining whether an innocuous situation creates a state of fear in individuals with GAD. We need to better understand how this abnormal physiological response relates to the functional impairments that commonly interfere with the daily lives of such individuals.”

Source: Laureate Institute for Brain Research