A Prospective, Randomized Controlled, Single-Blinded Study to Assess the Effect of a 33-Gauge Needle Versus a 34-Gauge Needle on Pain Experienced During Injection of Local Anesthetic on the Face.

BACKGROUND: Most pain experienced by patients during Mohs micrographic surgery is associated with the initial injection. Previous studies have shown that a smaller gauge needle (33-gauge vs 30-gauge) is associated with less patient-reported pain. OBJECTIVES: To evaluate patient-reported pain levels following injection with a 33-gauge versus a 34-gauge needle.  Methods: During this prospective, randomized, controlled, single-blinded study, 480 patients were randomized into a 33-gauge versus a 34-gauge needle group. Pain levels following needle insertion were recorded using the validated numerical rating scale (VNRS)-11 scale.  Results: Injection of local anesthetic with a 34-gauge needle is associated with significantly less pain compared to a 33-gauge needle across all subgroups (P=0.007, average pain level 0.49 [34-gauge group] vs 0.79 [33-gauge group] rated on a 0-10 pain scale). Females, first-time Mohs patients, patients under age 65, patients with basal cell carcinoma, and those with tumor locations on the nose experienced the most pain reduction with the use of a 34-gauge needle.  Limitations: This was a single-blinded study; thus, the injector was able to see which needle was being used. This knowledge could have subconsciously affected the angle, speed, or force used to insert the needle. CONCLUSIONS: Injections with a 33-gauge and a 34-gauge needle are both tolerated well and associated with minimal pain. While the pain reduction associated with using a 34-gauge needle is statistically significant, the use of a 34-gauge needle may be most clinically relevant for certain patient subgroups. J Drugs Dermatol. 2023;22(11): doi:10.36849/JDD.7689.

I'm Lovin' It: How Fast Food Advertising Influences Meat-Eating Preferences.

Overconsumption of red and processed meat is associated with a multitude of negative health outcomes. Previous research shows exposure to advertising messaging can influence dietary behaviors but research on the influence of meat advertising on diet, specifically, is scant. Theoretically informed by the Reasoned Action Approach, the present experiment randomly assigned participants to view a version of a print McDonald's advertisement that included meat imagery (a Big Mac), non-meat imagery (French fries), or no food (just the McDonalds' logo and slogan), which acted as a control. An online survey in the United States included 514 U.S. adults (Mage = 51 years). Participants exposed to meat imagery compared to the non-meat imagery reported a higher desire to eat meat. The meat imagery and control conditions were also significantly associated with increased cognitive accessibility of meat concepts, compared to when respondents were shown the no-meat condition. Desire to eat meat, but not the cognitive accessibility of meat concepts, was significantly associated with attitude, normative pressure, and perceived behavioral control for avoiding eating meat one day per week; these constructs predicted intention and willingness to avoid meat. Results indicate that exposure to meat imagery in advertising does have the potential to influence meat consumption behavior and also has implications for the use of meat imagery in persuasive messaging for public health campaigns.

Lidocaine Infusions for Pain Management in Pediatrics.

Lidocaine is an amino amide with a well-established role as a local anesthetic agent. Systemic intravenous administration expands its clinical use to include acute and chronic pain circumstances, such as postoperative pain, neuropathic pain, postherpetic neuralgia, hyperalgesia, visceral pain, and centrally mediated pain. For refractory pain that has not responded to conventional therapy or if further escalation of treatment is prevented by contraindications or side effects to standard therapies, a continuous infusion of lidocaine may be considered as a single intervention or as a sequence of infusions. Here, we review and evaluate published data reflecting the use of lidocaine continuous infusions for pain management in the pediatric population.

Comparison of provider satisfaction with specialty pharmacy services in integrated health-system and external practice models: A multisite survey.

PURPOSE: The purpose of this study is to obtain insight into providers' satisfaction with services offered by health-system integrated specialty pharmacies and to determine whether providers' perceptions of services offered under an integrated model differ from perceptions of external specialty pharmacy services. METHODS: A multi-site, cross-sectional, online survey of specialty clinic healthcare providers at 10 academic health systems with integrated specialty pharmacies was conducted. The questionnaire was developed by members of the Vizient Specialty Pharmacy Outcomes and Benchmarking Workgroup and was pretested at 3 pilot sites prior to dissemination. Prescribers of specialty medications within each institution were identified and sent an email invitation to participate in the study that included a link to the anonymous questionnaire. Respondents were asked to rate their agreement with 10 statements regarding quality of services of integrated and external specialty pharmacies on a 5-point scale (1 = strongly disagree, 5 = strongly agree). An analysis to determine differences in providers' overall satisfaction with the integrated and external specialty pharmacy practice models, as well as differences in satisfaction scores for each of the 10 statements, was performed using paired-samples t tests. RESULTS: The mean (SD) score for overall satisfaction with integrated specialty pharmacies was significantly higher than the score for satisfaction with external specialty pharmacies: 4.72 (0.58) vs 2.97 (1.20); 95% confidence interval, 1.64-1.87; P < 0.001. Provider ratings of the integrated specialty pharmacy model were also higher for all 10 items evaluating the quality of services (P < 0.05 for all comparisons). CONCLUSION: The study results confirm that the health-system integrated specialty pharmacy practice model promotes high rates of provider satisfaction with services and perceived benefits.

Distinct Representational Structure and Localization for Visual Encoding and Recall during Visual Imagery.

During memory recall and visual imagery, reinstatement is thought to occur as an echoing of the neural patterns during encoding. However, the precise information in these recall traces is relatively unknown, with previous work primarily investigating either broad distinctions or specific images, rarely bridging these levels of information. Using ultra-high-field (7T) functional magnetic resonance imaging with an item-based visual recall task, we conducted an in-depth comparison of encoding and recall along a spectrum of granularity, from coarse (scenes, objects) to mid (e.g., natural, manmade scenes) to fine (e.g., living room, cupcake) levels. In the scanner, participants viewed a trial-unique item, and after a distractor task, visually imagined the initial item. During encoding, we observed decodable information at all levels of granularity in category-selective visual cortex. In contrast, information during recall was primarily at the coarse level with fine-level information in some areas; there was no evidence of mid-level information. A closer look revealed segregation between voxels showing the strongest effects during encoding and those during recall, and peaks of encoding-recall similarity extended anterior to category-selective cortex. Collectively, these results suggest visual recall is not merely a reactivation of encoding patterns, displaying a different representational structure and localization from encoding, despite some overlap.

Preconception Care for the Patient and Family.

Preconception counseling is essential for women of childbearing age and family members who have decided to conceive because the level of well health of the mother and unborn child are affected by decisions and actions of the mother before and during pregnancy. Proactively planning pregnancy includes scheduling a preconception counseling consultation with a provider. Understanding physical, psychological, and emotional needs promotes healthy pregnancy outcomes for mother and baby. This article offers a reflective and holistic perspective of how health care providers frame, prioritize, and engage with the patient and family during the preconception consultation.

A chelating dendritic ligand capped quantum dot: preparation, surface passivation, bioconjugation and specific DNA detection.

Herein we report the synthesis of a new chelating dendritic ligand (CDL) and its use in the preparation a compact, stable and water-soluble quantum dot (QD), and further development of specific DNA sensor. The CDL, which contains a chelative dihydrolipoic acid moiety for strong QD surface anchoring and four dendritic carboxylic acid groups, provides a stable, compact and entangled hydrophilic coating around the QD that significantly increases the stability of the resulting water-soluble QD. A CDL-capped CdSe/ZnS core/shell QD (CDL-QD) has stronger fluorescence than that capped by a monodendate single-chain thiol, 3-mercapto-propionic acid (MPA-QD). In addition, the fluorescence of the CDL-QD can be enhanced by 2.5-fold by treatments with Zn2+ or S2- ions, presumably due to effective passivation of the surface defects. This level of fluorescence enhancement obtained for the CDL-QD is much greater than that for the MPA-QD. Further, by coupling a short single-stranded DNA target to the QD via the CDL carboxylic acid group, a functional QD-DNA conjugate that can resist non-specific adsorption and hybridize quickly to its complementary DNA probe has been obtained. This functional QD-DNA conjugate is suitable for specific quantification of short, labelled complementary probes at the low DNA probe:QD copy numbers via a QD-sensitised dye fluorescence resonance energy transfer (FRET) response with 500 pM sensitivity on a conventional fluorimeter.

Registered computed tomography images as an alternative to postimplantation magnetic resonance imaging in the assessment of subthalamic electrode placement.

Magnetic resonance imaging (MRI) after implantation of electrodes in the subthalamic nuclei is currently performed at a number of sites, but a recent adverse incident and changes in MRI technology may heighten safety concerns. In this report, it is demonstrated that given whole-head image data, registration of postimplantation computed tomography to preimplantation MRI can enable verification of the position of electrodes to an accuracy of 2 mm. This registration technique can remove the need for potentially risky postoperative MRI.