Management of "De Novo" Carpal Tunnel Syndrome in Pregnancy: A Narrative Review.

Carpal tunnel syndrome is a common entrapment neuropathy that can occur in the upper limbs during pregnancy. However, it is often undervalued and underdiagnosed because the symptoms can be mistaken for regular changes during pregnancy. Delay or absence of diagnosis and treatment can lead to permanent nerve damage, which can affect a woman's quality of life during and after pregnancy. Although the treatment protocols are well established for carpal tunnel syndrome in patients from the general population, there is a different situation among pregnant and postpartum women that requires a preventive and personalized approach to manage this pathology. Unfortunately, the range of available treatment options is limited due to the pregnant woman's physiological status and influenced by the high possibility of the complete resolution of this pathology in the postpartum period without any treatment. To limit the possibility of unfavorable evolution of this syndrome during pregnancy, an early diagnosis and personalized approach are mandatory in each case involving a multidisciplinary team of general practitioners, obstetricians, hand surgeons, rehabilitation physicians, physiotherapists, and occupational therapists.

Contribution to the Personalized Management of the Nosocomial Infections: A New Paradigm Regarding the Influence of the Community Microbial Environment on the Incidence of the Healthcare-Associated Infections (HAI) in Emergency Hospital Surgical Departments.

Background: The management of acute surgical pathology implies not only the diagnosis-treatment sequence but also an important preventive component. In the surgical hospital department, wound infection is one of the most frequent complications which must be managed both in a preventive and a personalized manner. To achieve this goal, several factors of negative local evolution, contributing to the slowdown of the healing processes, such as the colonization and contamination of the wounds, need to be emphasized and controlled from the first moment. In this context, knowing the bacteriological status at admission ensures the distinction between the colonization and infection processes and could help to manage in an efficient way the fight against bacterial pathogen infections from the beginning. Methods: A prospective study was performed for 21 months on 973 patients hospitalized as emergencies in the Plastic and Reconstructive Surgery Department within the Emergency University County Hospital of Brasov, Romania. We analyzed the bacteriological profile of the patients from admission to discharge and the bidirectional and cyclic microorganism dynamics both in the hospital and the community microbial environment. Results: Of the 973 samples collected at admission, 702 were positive, with 17 bacterial species and one fungal, with a predominance of Gram-positive cocci at 74,85%. The most frequently isolated strains were Staphylococcus species (86.51% of the Gram-positive/64.7% of the total isolated strains), while Klebsiella at 8.16% and Pseudomonas aeruginosa species at 5.63% were mainly emphasized in the case of Gram-negative bacilli. Two to seven pathogens were introduced after admission, suggesting that the community microbial environment is in a process of evolution and enrichment with hospital pathogens. Conclusions: The high level of positive bacteriological samples and the complex associations of the pathogens found at the admission bacteriological screening sustain the new idea that the pathogenic microorganisms existing in the community microbial environment have started to increasingly influence the hospital microbial environment, in contrast with the previous consideration, which emphasized only the unidirectional relationship between hospital infections and the changing bacteriological characteristics of the community environment. This modified paradigm must become the basis of a new personalized approach to the management of nosocomial infections.

Predictive Factors of the Burnout Syndrome Occurrence in the Healthcare Workers During the COVID-19 Pandemic.

The coronavirus disease 2019 (COVID-19) pandemic is probably the most critical epidemiological situation that human civilization has faced in the last few decades. In this context, of all the professional categories involved in the management of patients with COVID-19 are the most likely to develop burnout syndrome. The main objective of this study is to analyze specific predictive factors of the occurrence and development of the burnout syndrome in the healthcare workers involved in the diagnosis and treatment of patients with COVID-19. The study focused on determining factors of the occurrence, development and maintaining the specific burnout syndrome related to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic infection. The study was conducted on a sample of 959 participants, medical personnel from all the public medical entities in Romania(including 5 hospitals): 122 male and 755 female (82 participants did not declare their gender), with a mean age of 42.29 years (SD = 9.97). The sample included 219 doctors, 477 nurses, 214 auxiliary medical personnel and 49 other types of hospital workers. A cross-sectional design was used. Three predictors of the burnout syndrome were identified: Work conditions, Fear of the consequences (including death) determined by the COVID-19 and Need for emotional support. Meaning of work had a moderating role. Several moderated mediation models were tested. The indirect relationship of Work conditions with burnout via Fear of infection was statistically significant; in addition, the indirect effect of Work conditions on burnout through both fear of infection and need for support was statistically significant. The moderation analysis showed that Meaning of work buffer the relationship between Work conditions and Fear of infection. The variance explained by the model including the moderator (30%) was higher than the variance explained by Model 1 (27%), showing that adding the moderating effect of Meaning of work to the relationship of Work conditions with burnout was relevant. The results could be used to design specific interventions to reduce the occurrence of the burnout syndrome in healthcare workers, the implementation of a strategy to motivate employees by highlighting and recognizing the high significance of the work of those in the frontline of the fight against COVID-19.

Original targeted therapy for the management of the burnout syndrome in nurses: an innovative approach and a new opportunity in the context of predictive, preventive and personalized medicine.

BACKGROUND: Currently considered an occupational disease, the burnout syndrome affects 13-27% of the active population in multiple occupational sectors of the modern world. OBJECTIVES: Considering the burnout syndrome from the new perspective of the predictive, preventive, personalized medicine concept as a pathological entity with a predictable appearance and evolution which allows a preventive approach and a personalized therapy, the main objective of the study is to highlight the possibility of psychotherapeutic interventions for producing measurable psychological changes in order to decrease the burnout level of hospital nurses. METHOD: The research design is experimental, the independent variable being the participation or non-participation of nurses in psychotherapeutic sessions where specific classical psychodrama techniques are originally used. Nurses previously identified with medium or high levels of burnout participated in the clinical study, split into two groups: the experimental one, with 150-min weekly sessions, and the control one, without any intervention. Pre- and post-intervention questionnaires were administered to the members of both groups. RESULTS: The statistical analysis of the differences between pre- and post-intervention revealed (a) the decrease of the levels of personal burnout and of burnout generated by the working conditions and (b) the decrease of the depression and of anxiety on four dimensions (self-awareness, ergic tension, veiled and general anxiety). CONCLUSIONS: The classical psychodrama method can be an effective solution in the prophylaxis and treatment of the burnout syndrome. The multidisciplinary approach according to the PPPM concept including changes of the environmental factors within the professional framework associated with stress control programmes can be promising solutions for the management of this syndrome.

The role of the personality traits and work characteristics in the prediction of the burnout syndrome among nurses-a new approach within predictive, preventive, and personalized medicine concept.

BACKGROUND: The burnout syndrome is characterized by emotional exhaustion, depersonalization, and lack of personal accomplishment. It was identified in some professional categories, the most often being affected those in public health services. OBJECTIVES: This study mainly aims to identify and analyze the value of the personality traits and work characteristics as predictive factors for the occurrence of the burnout syndrome in nurses, under the new approach of predictive, preventive, and personalized medicine. METHOD: A total of 192 nurses were included in the study. The NEO-Five-Factor Inventory, the Copenhagen Burnout Inventory, and the Inventory of Nursing Work Characteristics were administered to all of the participants. RESULTS: Some personality traits proved to be predictive factors for the occurrence of the burnout syndrome. Neuroticism, negative self-esteem, and negative emotionality predict burnout vulnerability. The negative correlations between sociability and the burnout dimensions show that the positive affectivity of the extraverted individuals and the strong positive orientation of the extraverts towards others are protective factors against burnout. There are also significant associations between certain personality traits and nursing work characteristics (work overload, the existence of problems in the department, and satisfaction in the professional and family life), which could be defined, also, as predictive factors for burnout. CONCLUSIONS: This study confirms the influence of the Big Five personality traits and nursing work characteristics as predictive factors of the burnout occurrence, opening real possibilities to perform a targeted prevention and provide personalized interventions as organizational services.

Automated detection and segmentation of large lesions in CT colonography.

Computerized tomographic colonography is a minimally invasive technique for the detection of colorectal polyps and carcinoma. Computer-aided diagnosis (CAD) schemes are designed to help radiologists locating colorectal lesions in an efficient and accurate manner. Large lesions are often initially detected as multiple small objects, due to which such lesions may be missed or misclassified by CAD systems. We propose a novel method for automated detection and segmentation of all large lesions, i.e., large polyps as well as carcinoma. Our detection algorithm is incorporated in a classical CAD system. Candidate detection comprises preselection based on a local measure for protrusion and clustering based on geodesic distance. The generated clusters are further segmented and analyzed. The segmentation algorithm is a thresholding operation in which the threshold is adaptively selected. The segmentation provides a size measurement that is used to compute the likelihood of a cluster to be a large lesion. The large lesion detection algorithm was evaluated on data from 35 patients having 41 large lesions (19 of which malignant) confirmed by optical colonoscopy. At five false positive (FP) per scan, the classical system achieved a sensitivity of 78%, while the system augmented with the large lesion detector achieved 83% sensitivity. For malignant lesions, the performance at five FP/scan was increased from 79% to 95%. The good results on malignant lesions demonstrate that the proposed algorithm may provide relevant additional information for the clinical decision process.

Comparison of texture features based on Gabor filters.

Texture features that are based on the local power spectrum obtained by a bank of Gabor filters are compared. The features differ in the type of nonlinear post-processing which is applied to the local power spectrum. The following features are considered: Gabor energy, complex moments, and grating cell operator features. The capability of the corresponding operators to produce distinct feature vector clusters for different textures is compared using two methods: the Fisher (1923) criterion and the classification result comparison. Both methods give consistent results. The grating cell operator gives the best discrimination and segmentation results. The texture detection capabilities of the operators and their robustness to nontexture features are also compared. The grating cell operator is the only one that selectively responds only to texture and does not give false response to nontexture features such as object contours.