[Treatment effect of an urban acute psychiatric clinic: a prospective cohort study]. / Behandeleffect van een grootstedelijke acute opnamekliniek: een prospectief cohortonderzoek.

BACKGROUND: A clinical admission is a frightening event, especially in a crisis situation, and above all when it comes with legal measures. The effectiveness of an acute crisis admission has been demonstrated in a Cochrane review, but cohort studies of a clinic setting are not yet available. AIM: To assess and determine the treatment effects after a crisis admission in a metropolitan acute psychiatric clinic of patients with severe mental illness (SMI patients). METHOD: In the context of routine outcome monitoring, the 12 HoNOS scores at admission and discharge (pre- and post-measurements) were rated by clinicians. The data of 1423 patients were analyzed by a statistician. RESULTS: The crisis admissions have a substantial positive clinical effect: 76 percent of the patients improved, 16 percent was stable and 10 percent worsened (effect size ES = 1.2). The patients improved most in regard to psychotic problems, aggressiveness and social problems. This applies equally to patients who have been admitted voluntarily, as well as to patients with a legal measure. The admission duration of patients is two months, except for patients with compulsory treatment (seclusion, sedation, forced medication). In this case the treatment duration prolongs to three months. CONCLUSION: Acute short-term clinical admission is an effective part of the clinical and outpatient treatment chain for patients with severe mental illness (SMI). A substantial treatment effect is achieved by the crisis admission. These findings are an important addition to the Cochrane review.

Halting targeted and collateral damage to red blood cells by the complement system.

The complement system is an important defense mechanism against pathogens; however, in certain pathologies, the system also attacks human cells, such as red blood cells (RBCs). In paroxysmal nocturnal hemoglobinuria (PNH), RBCs lack certain complement regulators which sensitize them to complement-mediated lysis, while in autoimmune hemolytic anemia (AIHA), antibodies against RBCs may initiate complement-mediated hemolysis. In recent years, complement inhibition has improved treatment prospects for these patients, with eculizumab now the standard of care for PNH patients. Current complement inhibitors are however not sufficient for all patients, and they come with high costs, patient burden, and increased infection risk. This review gives an overview of the underlying pathophysiology of complement-mediated hemolysis in PNH and AIHA, the role of therapeutic complement inhibition nowadays, and the high number of complement inhibitors currently under investigation, as for almost every complement protein, an inhibitor is being developed. The focus lies with novel therapeutics that inhibit complement activity specifically in the pathway that causes pathology or those that reduce costs or patient burden through novel administration routes.

The effect of a preoperative warm-up with a custom-made Nintendo video game on the performance of laparoscopic surgeons.

BACKGROUND: It has previously been shown that short, pre-operative practice with a simulator, box trainer, or certain video games can temporarily improve one's basic laparoscopic skills; the so-called warm-up effect. In this experiment, we tested the hypothesis that Underground video game made for training basic laparoscopic skills, can also be used for a pre-operative warm-up. MATERIALS AND METHODS: 29 laparoscopic experts were randomized into two different groups, which were tested on two different days. Group 1 (n = 16) did a laparoscopic skill baseline measurement using the FLS peg transfer test and the Top Gun cobra rope drill on day 1, and did the same tests on day 2 after a 15 min session with the Underground game. Group 2 (n = 13) did the same, but started with the video game, followed by baseline measurement on day 2. This way, each participant served as its own control. Video recordings of both tasks were later analyzed by two blinded reviewers. RESULTS: On day 1, group 2 was 14.33 % (P = 0.037) faster in completing the peg transfer test. A trend toward better cobra rope scores is also seen. When comparing the average improvement between both days, group 1--which used the game as a warm-up on day 2--showed a 19.61 % improvement in cobra rope score, compared to a 0.77 % score decrease in group 2 (P = 0.002). CONCLUSIONS: This study shows that the Underground video game can be used as a pre-operative warm-up in an experimental setting.

Construct and concurrent validity of a Nintendo Wii video game made for training basic laparoscopic skills.

BACKGROUND: Virtual reality (VR) laparoscopic simulators have been around for more than 10 years and have proven to be cost- and time-effective in laparoscopic skills training. However, most simulators are, in our experience, considered less interesting by residents and are often poorly accessible. Consequently, these devices are rarely used in actual training. In an effort to make a low-cost and more attractive simulator, a custom-made Nintendo Wii game was developed. This game could ultimately be used to train the same basic skills as VR laparoscopic simulators ought to. Before such a video game can be implemented into a surgical training program, it has to be validated according to international standards. METHODS: The main goal of this study was to test construct and concurrent validity of the controls of a prototype of the game. In this study, the basic laparoscopic skills of experts (surgeons, urologists, and gynecologists, n = 15) were compared to those of complete novices (internists, n = 15) using the Wii Laparoscopy (construct validity). Scores were also compared to the Fundamentals of Laparoscopy (FLS) Peg Transfer test, an already established assessment method for measuring basic laparoscopic skills (concurrent validity). RESULTS: Results showed that experts were 111 % faster (P = 0.001) on the Wii Laparoscopy task than novices. Also, scores of the FLS Peg Transfer test and the Wii Laparoscopy showed a significant, high correlation (r = 0.812, P < 0.001). CONCLUSIONS: The prototype setup of the Wii Laparoscopy possesses solid construct and concurrent validity.