Student characteristics associated with interpersonal skills in medical consultations.

BACKGROUND: The quality of medical care depends on effective physician-patient communication. Interpersonal skills can be improved through teaching, but the determinants are poorly understood. We therefore assessed the factors associated with the interpersonal skills of medical students during simulated medical consultations. METHODS: We conducted a cross-sectional study of fourth-year medical students participating in simulated consultations with standardized patients. Each video-recorded medical consultation was independently assessed by two raters, using a cross-cultural adaptation of the Four Habits Coding Scheme (4-HCS) into French. We then collected information on demographics and education-related characteristics. The relationship between the overall 4-HCS score and student characteristics was modeled using univariable and multivariable linear regression. RESULTS: Our analytical sample included 165 medical students for analysis. The factors significantly associated with 4-HCS score were gender (ß = - 4.8, p = 0.011) and completion of an international clinical placement (ß = 6.2, p = 0.002) or a research laboratory clerkship (ß = 6.5, p = 0.005). Education-related characteristics, multiple-choice examinations in the first to third preclinical years, and number of medicine or surgery clerkships were not significantly associated with 4-HCS score. CONCLUSIONS: Undergraduate students with higher level of interpersonal skills during video-recorded medical consultations with standardized patients are more likely to be female, to have completed international clinical placement as part of the ERASMUS exchange program or research laboratory clerkship.

Make Gestures to Learn: Reproducing Gestures Improves the Learning of Anatomical Knowledge More than Just Seeing Gestures.

Manual gestures can facilitate problem solving but also language or conceptual learning. Both seeing and making the gestures during learning seem to be beneficial. However, the stronger activation of the motor system in the second case should provide supplementary cues to consolidate and re-enact the mental traces created during learning. We tested this hypothesis in the context of anatomy learning by naïve adult participants. Anatomy is a challenging topic to learn and is of specific interest for research on embodied learning, as the learning content can be directly linked to learners' body. Two groups of participants were asked to look at a video lecture on the forearm anatomy. The video included a model making gestures related to the content of the lecture. Both groups see the gestures but only one also imitate the model. Tests of knowledge were run just after learning and few days later. The results revealed that imitating gestures improves the recall of structures names and their localization on a diagram. This effect was however significant only in long-term assessments. This suggests that: (1) the integration of motor actions and knowledge may require sleep; (2) a specific activation of the motor system during learning may improve the consolidation and/or the retrieval of memories.

Brain-shift compensation using intraoperative ultrasound and constraint-based biomechanical simulation.

PURPOSE: During brain tumor surgery, planning and guidance are based on preoperative images which do not account for brain-shift. However, this deformation is a major source of error in image-guided neurosurgery and affects the accuracy of the procedure. In this paper, we present a constraint-based biomechanical simulation method to compensate for craniotomy-induced brain-shift that integrates the deformations of the blood vessels and cortical surface, using a single intraoperative ultrasound acquisition. METHODS: Prior to surgery, a patient-specific biomechanical model is built from preoperative images, accounting for the vascular tree in the tumor region and brain soft tissues. Intraoperatively, a navigated ultrasound acquisition is performed directly in contact with the organ. Doppler and B-mode images are recorded simultaneously, enabling the extraction of the blood vessels and probe footprint, respectively. A constraint-based simulation is then executed to register the pre- and intraoperative vascular trees as well as the cortical surface with the probe footprint. Finally, preoperative images are updated to provide the surgeon with images corresponding to the current brain shape for navigation. RESULTS: The robustness of our method is first assessed using sparse and noisy synthetic data. In addition, quantitative results for five clinical cases are provided, first using landmarks set on blood vessels, then based on anatomical structures delineated in medical images. The average distances between paired vessels landmarks ranged from 3.51 to 7.32 (in mm) before compensation. With our method, on average 67% of the brain-shift is corrected (range [1.26; 2.33]) against 57% using one of the closest existing works (range [1.71; 2.84]). Finally, our method is proven to be fully compatible with a surgical workflow in terms of execution times and user interactions. CONCLUSION: In this paper, a new constraint-based biomechanical simulation method is proposed to compensate for craniotomy-induced brain-shift. While being efficient to correct this deformation, the method is fully integrable in a clinical process.

Does continuous wound infiltration enhance baseline intravenous multimodal analgesia after posterior spinal fusion surgery? A randomized, double-blinded, placebo-controlled study.

PURPOSE: There has been a growing interest in continuous local anaesthetic wound infiltration as a non-opioid technique for postoperative pain relief. The impact of this modality on baseline analgesia after spinal fusion surgery has however been inconclusive. We tested whether continuous wound infiltration with ropivacaine can enhance postoperative analgesia compared to a baseline intravenous multimodal analgesia protocol after spinal fusion surgery. METHODS: In this randomized, double-blinded, placebo-controlled study, a multiholed 19-gauge catheter was placed at the end of the surgical procedure through the wound to permit the continuous administration (8 ml/h) of ropivacaine 0.2 % (ropivacaine group; n = 19 patients) or saline (control group; n = 20 patients) during the first 48 postoperative hours (H48). Both groups received intraoperative low-dose ketamine, a combination of acetaminophen, non-steroidal anti-inflammatory drug, and nefopam over the same postoperative period, and morphine delivered by a patient-controlled analgesia (PCA) device. RESULTS: Morphine consumption was comparable between the two groups both at H48, 38 mg (26:52) (median, 25th:75th percentile) (control group) versus 43 mg (19:74) (ropivacaine group), and at H24, 18 mg (16:22) versus 22 mg (9:35) respectively. Pain scores at rest and during mobilization, quality of postoperative sleep, and morphine-related side effects were comparable between the two groups at H24 and H48. CONCLUSION: Our findings indicate that no additional analgesia was provided with continuous wound infiltration of ropivacaine compared to a baseline intravenous multimodal analgesia protocol after spinal fusion surgery. TRIAL REGISTRATION: Clinicaltrials.gov #NCT01743794.

The precerebellar linear nucleus in the mouse defined by connections, immunohistochemistry, and gene expression.

The linear nucleus (Li) is a prominent cell group in the caudal hindbrain, which was first described in a study of cerebellar afferents in the rat by [Watson, C.R.R., Switzer, R.C. III, 1978. Trigeminal projections to cerebellar tactile areas in the rat origin mainly from N. interpolaris and N. principalis. Neurosci. Lett. 10, 77-82.]. It was named for its elongated appearance in transverse sections. Since this original description in the rat, reference to the nucleus seems to have been largely absent from experimental studies of mammalian precerebellar nuclei. We therefore set out to define the cytoarchitecture, cerebellar connections, and molecular characteristics of Li in the mouse. In coronal Nissl sections at the level of the rostral inferior olive, it consists of two parallel bands of cells joined at their dorsal apex by a further band of cells, making the shape of the Greek capital letter pi. Our three-dimensional reconstruction demonstrated that the nucleus is continuous with the lateral reticular nucleus (LRt) and that the ambiguus nucleus sits inside the arch of Li. Cerebellar horseradish peroxidase injections confirmed that the cells of Li project to cerebellum. We have shown that Li cells express Atoh1 and Wnt1 lineage markers that are known to label the rhombic lip derived precerebellar nuclei. We have examined the relationship of Li cells to a number of molecular markers, and have found that many of the cells express a nonphosphorylated epitope in neurofilament H (SMI 32), a feature they share with the LRt. The mouse Li therefore appears to be a rostrodorsal extension of the LRt.

Long-term control of vestibular schwannoma after a translabyrinthine complete removal.

OBJECTIVE: The goal of this study was to determine the rate of recurrent vestibular schwannoma after a total removal via the translabyrinthine approach. PATIENTS: Between 1973 and 1995, 346 patients were operated on by a translabyrinthine approach. Ninety-one patients were included in a retrospective study for follow-up of 5 years or longer. RESULTS: The mean follow-up period for magnetic resonance imaging (MRI) examination was obtained after mean of 11 years in 91 patients. None of the 91 patients experienced a recurrent vestibular schwannoma on MRI. CONCLUSION: The translabyrinthine approach is a safe procedure for total definitive removal of a vestibular schwannoma and permitted the absence of tumoral recurrence in our series of 91 patients. A single gadolinium-enhanced MRI scan 5 years after surgery is advised in case of total removal. In case of any doubt about the quality of the tumoral removal, a proposed MRI follow-up schedule within 2 years and 5 years of surgery is an initial baseline pattern, and possibly thereafter repeated MRI examinations on clinical grounds.

Intraoperative and postoperative gamma detection of somatostatin receptors in bone-invasive en plaque meningiomas.

OBJECTIVE: Scintigraphy with a radiolabeled somatostatin analog ((111)In-diethylenetriaminepenta-acetic acid octreotide) detects the somatostatin receptors that are found in vitro in all meningiomas. Previous studies have proved the benefit of radioimmunoguided surgery, with a hand-held gamma probe, for the assessment and removal of neuroendocrine tumors. We conducted a study to determine whether intraoperative radiodetection of somatostatin receptors is feasible and could increase the probability of complete meningioma resection, especially for bone-invasive en plaque meningiomas, which are difficult to control surgically. METHODS: Eighteen patients with en plaque sphenoid wing and cranial convexity meningiomas were studied by preoperative and postoperative somatostatin receptor scintigraphy. In 10 of them, intraoperative radiodetection with a hand-held gamma probe was performed 24 hours after the intravenous administration of (111)In-diethylenetriaminepenta-acetic acid octreotide. This procedure was combined with a computer-aided navigation system. RESULTS: All preoperative scintigrams were positive. Intraoperative gamma probe detection was achieved for the invaded bone, dura, and periorbit of sphenoid wing meningiomas. The average tumor/nontumor count ratio was 2:1, with a maximum of 12:1, thus allowing precise detection capable of defining the tumor margins. In three cases of sphenoid wing meningiomas, postoperative scintigrams were helpful for the determination of recurrences that magnetic resonance imaging failed to detect. CONCLUSION: These preliminary data show that intraoperative radiodetection of somatostatin receptors with a hand-held gamma probe is feasible and may be helpful to guide the surgical removal of bone-invasive en plaque meningiomas. Preoperative and postoperative scintigraphy may be useful for the management and follow-up of patients with these tumors.