Benefits of simulation for ultrasound-guided midline placement training: MC-in-Sim pilot study.

INTRODUCTION: Ultrasound-guided placement of Midlines catheters (MCs) is a standard procedure with many benefits for patients. Even if there are some guidelines worldwide, this invasive technique is still taught at the patient's bed and relies on mentoring in many care centers. The performance of this care by novice practitioners raises ethical and quality of care issues mainly because of its risk of complications. This study aimed to propose and assess a simulation-based learning method for the placement of MCs in novice practitioners. METHODS: A single-center prospective observational study was conducted with anesthesia residents who had no prior experience of Midline placement. Two workshops were planned. The first one consisted of a theoretical training and a simulated practical phase. The second workshop included an assessment of theoretical memorization, a practical exercise and adherence to the training program. RESULTS: The median score of the theoretical memorization was 14.6 (interquartile range [IQR]: 13.5-15.8). The MCs placement time was significantly higher (Med: 12.23 min; IQR: 12.21-12.80) for novice practitioners who did not successfully complete solo MCs placement in simulation versus novice practitioners who successfully completed solo MCs placement in simulation 6.66 min (IQR: 5.92-8.93) (p = 0.002). The number of attempts was significantly higher (p = 0.034) for the novice practitioners who did not successfully complete solo MCs placement in simulation with 67% having performed three punctures, against 0% for the novice practitioners who successfully completed solo MCs placement in simulation. All novice practitioners found this training model efficient for learning how to place MCs and considered it allows for reproducibility in care situations. CONCLUSION: This ultrasound-guided MCs training on simulation is an agile and fast alternative to traditional bedside training for anesthesia novice practitioners.

Neural mechanisms of odour imagery induced by non-figurative visual cues.

Odour imagery, the ability to experience smell when an appropriate stimulus is absent, has widely been documented as being particularly difficult. However, previous studies have shown the beneficial effect of visual cues (e.g., pictures or words) to facilitate performance in numerous tasks of olfactory nature. Therefore, the use of visual cues to evoke odours seems relevant. In this study, our interest is directed towards non-figurative coloured arrangements, which result from a patented technology and aim at chromatically representing any smell from its chemical composition and sensory description. The aim of this study was to characterise the neural mechanisms of odour imagery facilitated by these non-figurative coloured arrangements. Using functional magnetic resonance imaging, we recorded and compared hemodynamic responses during odour imagery facilitated by non-figurative coloured arrangements and pictures. Our findings reveal that the use of non-figurative coloured arrangements during odour imagery solicits olfactory and non-olfactory brain regions (orbitofrontal cortex, insula, hippocampus, thalamus, dorsolateral prefrontal cortex and supplementary motor area), which are mainly involved in olfactory processing and multimodal integration. Moreover, very similar cortical activity was found between the use of non-figurative coloured arrangements and pictures during odour imagery, with increased activity in the supplementary motor area during the use of coloured arrangements only. Overall, non-figurative coloured arrangements could become a robust tool to visually evoke odours without requiring prior familiarity with the depicted odour. Future studies should use psychometric measures to determine the relationships between brain activation, odour imagery ability and vividness of the generated odour images.

Case Report: Atonic PNES Capture in fMRI.

Psychogenic Non-Epileptic Seizures (PNES) are a misunderstood and disabling pathology, characterized by a paroxysmal occurrence of clinical signs without the epileptic activity. Resting-state functional MRI (fMRI) studies in patients with PNES have shown abnormal functional connectivity of the resting-state networks, especially in the limbic and motor systems, and in the precuneus. However, the transient nature of PNES episodes prevents us from elucidating the underlying mechanisms of seizures. Here, we report the case of a patient who presented an atonic episode of PNES during a 3T fMRI session. The patient is a 23-year-old woman, suffering from post-traumatic stress disorder, with no neurological comorbidities. The preprocessing of the fMRI images involved realignment, co-registration, segmentation, normalization, denoising (PhysIO toolbox), and smoothing. The time boundary of the seizure was defined according to the patient's reports, and the seizure period was contrasted with the resting state period before the seizure. A whole-brain analysis showed significant activations (left inferior temporal gyrus, left temporo-occipital junction) and deactivations (right precuneus, right superior parietal lobule, right postcentral gyrus, bilateral lingual gyri, inferior occipital gyri, and cerebellar lobules; right insula in a sub-thresholded analysis). Activations and deactivations occurred in four cerebral networks: emotional processing, agency, self-perception, and dissociation. To our knowledge, this report is the first published case of functional MRI during PNES. These results could confirm the emotional and dissociative hypothesis of the physiopathology of PNES and highlight future targets for neuromodulation.

French Vividness of Olfactory Imagery Questionnaire: A Potential Tool for Diagnosing Olfactory Loss by Assessing Olfactory Imagery?

Several studies have shown a significant relationship between smelling and olfactory imagery abilities. The primary aim of the present study was to validate a French version of the Vividness of Olfactory Imagery Questionnaire (VOIQ). The secondary aim was to investigate its capability to differentiate individuals with smell loss from healthy individuals. After having elaborated a French translation of the VOIQ (fVOIQ), we evaluated olfactory imagery abilities of 387 French participants who anonymously self-completed the fVOIQ: 121 pathologic individuals (hyposmic and anosmic), 244 normosmic individuals (healthy non-expert), and 22 fragrance experts. Significant split-half reliability as expressed by Spearman correlation coefficients for the global sample, as well as for each group separately, indicated the excellent internal consistency of the fVOIQ. Moreover, results revealed a significant effect of the smelling ability group on fVOIQ score, suggesting that daily olfactory stimulation is fundamental to maintaining the ability to create a vivid image and that severe loss of smell may result in progressive impairment of olfactory imagery. Our fVOIQ and the original English version seemingly have similarly high benefit in differentiating experts and normosmic individuals based on their olfactory imagery ability. Moreover, the fVOIQ seems capable of differentiating individuals with loss of smell from healthy individuals. These findings demonstrate the reliability and validity of the fVOIQ, and its capability to differentiate individuals' smelling ability according to their olfactory imagery ability.