Objective: Stroke-related social cognitive impairment is now well established, but studies vary considerably in the nature and magnitude of the deficits reported, as well as whether there are ...potential areas of preservation. Because these discrepancies may reflect clinical heterogeneity between the contributing research participants, this study provides the first concurrent assessment of all four core social cognitive domains (theory of mind, emotion perception, social behavior, and affective empathy) in the same stroke cohort. A secondary goal was to test whether the degree of social cognitive impairment varied as a function of the tasks' ecological validity, on the basis that tasks with greater realism may provide a better indication of the implications of any stroke-related difficulties for everyday social interactions. Method: Participants included 35 people with first-time, ischemic or hemorrhagic stroke (as confirmed via MRI or CT) aged between 29 and 87 years (M = 64.69; SD = 12.92), and 35 controls matched for age, sex, and years of education. All participants completed a comprehensive social cognitive test battery as well as measures to broadly characterize neurocognitive function and well-being. Results: Relative to controls, affective empathy was selectively preserved (d = 0.02), but stroke-related deficits were identified for theory of mind (d = -0.42), emotion perception (d = -0.48), and social behavior (d = -0.59). The degree of social cognitive impairment did not vary as a function of the tasks' ecological validity. Conclusions: These data enhance understanding of stroke-related social cognitive impairment and inform the development of tailored, evidence-based rehabilitation efforts.
Key Points
Question: The primary aim of the present study was to investigate the sensitivity of four core domains of social cognitive function (theory of mind, emotion perception, social behavior, and affective empathy) to stroke. Findings: People with stroke exhibited significant difficulties with theory of mind, emotion perception, and social behavior but the capacity for affective empathy was intact. Importance: Given the critical role that social cognitive function plays in social functioning and broader well-being, these results reinforce the importance of assessing social cognition in survivors of stroke to guide rehabilitative efforts. Next Steps: Future work should examine the nature and real-world implications of social behavioral impairment in stroke survivors, and supplement self-report measures of affective empathy with proxy-rated and objective performance-based measures.
Patient’s perspective Given patient’s persistent cognitive impairment, we gained some perspective from the patient and her husband (and carer): Patient: Thank goodness it wasn’t worse than it was, in ...that I don’t need a walking stick or anything like that. Learning points The renal infarcts were silent in that there was no pain, no rise in serum creatinine, and the lactate dehydrogenase (LDH) rise could be considered non-specific. Acute renal infarction and cardioembolic stroke in a patient with atrial fibrillation and hyperthyroid-induced cardiomyopathy: a case report.
Background: New non-pharmacological treatments for improving non-motor symptoms in Parkinson's disease (PD) are urgently needed. Previous light therapies for modifying sleep behaviour lacked ...standardised protocols and were not personalised for an individual patient chronotype. We aimed to assess the efficacy of a biologically-directed light therapy in PD that targets retinal inputs to the circadian system on sleep, as well as other non-motor and motor functions. Methods: In this randomised, double-blind, parallel-group, active-controlled trial at the Queensland University of Technology, Australia, participants with mild to moderate PD were computer randomised (1:1) to receive one of two light therapies that had the same photometric luminance and visual appearance to allow blinding of investigators and participants to the intervention. One of these biologically-directed lights matched natural daylight (Day Mel), which is known to stimulate melanopsin cells. The light therapy of the other treatment arm of the study, specifically supplemented the stimulation of retinal melanopsin cells (Enhanced Mel), targeting deficits to the circadian system. Both lights were administered 30 min per day over 4-weeks and personalised to an individual patient's chronotype, while monitoring environmental light exposure with actigraphy. Co-primary endpoints were a change from baseline in mean sleep macrostructure (polysomnography, PSG) and an endocrine biomarker of circadian phase (dim light melatonin secretion onset, DLMO) at weeks 4 and 6. Participants data were analysed using an intention to treat principle. All endpoints were evaluated by applying a mixed model analysis. The trial is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12621000077864. Findings: Between February 4, 2021 and August 8, 2022, 144 participants with PD were consecutively screened, 60 enrolled and randomly assigned to a light intervention. There was no significant difference in co-primary outcomes between randomised groups overall or at any individual timepoint during follow-up. The mean (95% CI) for PSG, N3% was 24.15 (19.82–28.48) for Day Mel (n = 23) and 19.34 (15.20–23.47) for the Enhanced Mel group (n = 25) in week 4 (p = 0.12); and 21.13 (16.99–25.28) for Day Mel (n = 26) and 18.48 (14.34–22.62) for the Enhanced Mel group (n = 25) in week 6, (p = 0.37). The mean (95% CI) DLMO (decimal time) was 19.82 (19.20–20.44) for Day Mel (n = 22) and 19.44 (18.85–20.04) for the Enhanced Mel group (n = 24) in week 4 (p = 0.38); and 19.90 (19.27–20.53) for Day Mel (n = 23) and 19.04 (18.44–19.64) for the Enhanced Mel group (n = 25) in week 6 (p = 0.05). However, both the controlled daylight (Day Mel) and the enhanced melanopsin (Enhanced Mel) interventions demonstrated significant improvement in primary PSG sleep macrostructure. The restorative deep sleep phase (PSG, N3) significantly improved at week 6 in both groups model-based mean difference to baseline (95% CI): −3.87 (−6.91 to −0.83), p = 0.04. There was a phase-advance in DLMO in both groups which did not reach statistical significance between groups at any time-point. There were no safety concerns or severe adverse events related to the intervention. Interpretation: Both the controlled daylight and melanopsin booster light showed efficacy in improving measures of restorative deep sleep in people with mild to moderate PD. That there was no significant difference between the two intervention groups may be due to the early disease stage. The findings suggest that controlled indoor daylight that is personalised to the individuals’ chronotype could be effective for improving sleep in early to moderate PD, and further studies evaluating controlled daylight interventions are now required utilising this standardised approach, including in advanced PD. Funding: The Michael J Fox Foundation for Parkinson’s Research, Shake IT Up Australia, National Health and Medical Research Council, and Australian Research Council.
Introduction
Surgical instrument contamination during total joint replacement is a matter of major concern. Available recommendations suggest changing suction tips, gloves and avoiding light handle ...manipulation during the procedure. There is a paucity of data regarding surgical gown contamination. The aim of the present study was to evaluate the contamination rate of surgical gowns (SGs) during total hip arthroplasty (THA) and secondarily compare it with other orthopedic procedures.
Materials and methods
One hundred and forty surgical gowns (from 70 surgeries) were screened for bacterial contamination using thioglycolate (a high-sensitivity culture broth). The THA contamination rate was compared with those of knee and spine procedures. Controls were obtained at the beginning of every surgery and from the culture broth. The procedure’s duration and the level of training of the surgeon were evaluated as potential risk factors for contamination.
Results
Bacterial contamination was identified on 12% of surgical gowns (22% of surgical procedures). The contamination rate during THA was 4.1% (2% in primary THA and 8.3% in revisions) vs 21.67% during other surgeries (spine and knee) (OR 6.15,
p
= 0.012). There were no contaminated SGs during THAs performed in ≤ 2 h (0/33 SGs) vs 7.5% (3/40) for THAs that took ≥ 2 h (
p
= 0.25).
Conclusion
There was a high rate of SG contamination during orthopedic procedures that was higher during non-arthroplasty procedures and prolonged THAs. There were no contaminated surgical gowns in THAs under 120 min, efforts should point keeping primary THAs under this cutoff time. As a general recommendation, SGs should be changed every time there is concern about potential contamination.
Abstract Introduction We performed an agreement study of the AO and the Tronzo classifications of fractures of the trochanteric area to determine if they allow communication among practitioners with ...different levels of expertise. Material and methods Complete radiographs of 70 patients with trochanteric fractures were classified by nine evaluators (three hip sub-specialists, three orthopaedic surgery residents and three medical interns) using the AO and the Tronzo classifications. After a six-week interval, all cases were presented in a random sequence for repeat evaluation. The Kappa coefficient ( k ) was used to determine inter- and intra-observer agreement. Results Inter-observer: considering the main AO fracture types, the agreement was moderate for sub-specialists ( k = 0.60 0.50–0.70), residents ( k = 0.58 0.48–0.69) and medical interns ( k = 0.56 0.45–0.69). Using AO sub-types, all groups achieved fair agreement (sub-specialists: k = 0.31 0.25–0.38; residents: k = 0.32 0.26–0.38; medical interns: k = 0.30 0.24–0.36). For the Tronzo classification, sub-specialists ( k = 0.56 0.48–0.65) and residents ( k = 0.47 0.39–0.55) obtained moderate agreement; medical interns reached fair agreement ( k = 0.33 0.25–0.41). Intra-observer: considering the main AO fracture types, sub-specialists ( k = 0.79 0.69–0.89), residents ( k = 0.71 0.60–0.81) and medical interns ( k = 0.70 0.59–0.82) obtained substantial agreement. Considering AO sub-types, sub-specialists ( k = 0.50 0.45–0.56) and medical interns ( k = 0.54 0.48–0.69) achieved moderate agreement; residents ( k = 0.39 0.33–0.45) achieved fair agreement. Using the Tronzo classification, all groups obtained substantial agreement (sub-specialists: k = 0.66 0.58–0.74; residents: k = 0.63 0.55–0.71; medical interns: k = 0.68 0.60–0.76). Conclusion The AO classification allows an adequate communication when considering the main fracture types; the agreement within sub-types is not satisfactory. The Tronzo classification does not allow reliable communication between medical professionals.
Purpose
Deep vein thrombosis (DVT) is a common complication in hip fracture patients, associated with significant morbidity and mortality. Research has focused on postoperative DVT, with scant ...reports on preoperative prevalence. The aim of this study was to describe the prevalence of preoperative DVT in patients accessing medical care ≥ 48 h after a hip fracture.
Methods
We included elderly patients admitted ≥ 48 h after sustaining a hip fracture, between September 2015 and October 2017. Patients with a previous episode of DVT, undergoing anticoagulation therapy, with pathologic fractures or undergoing cancer treatment were excluded. Of 273 patients, 59 were admitted at least 48 h after the fracture. DVT screening by Doppler ultrasound of both lower extremities was carried upon hospital admission. We recorded age, sex, Charlson comorbidity index and ASA score, fracture type, time since injury, time from admission to surgery and total length of hospital stay.
Results
We studied 41 patients, 79 (± 10.34) years old. The delay from injury to admission was 120 h (48–696 h). Seven patients (17.1%) had a DVT upon admission. There were no significant differences between patients with and without DVT, regarding time from admission to surgery or the total length of the hospital stay.
Conclusions
The prevalence of DVT in patients admitted ≥ 48 h after a hip fracture was 17.1%. The diagnosis and management of DVT did not increase time to surgery or hospital stay. Our results suggest routine screening for DVT in patients consulting emergency services ≥ 48 h after injury.
As the population ages, patients exposed to osteoporotic fractures increase, especially hip fracture, which is the most severe and costly.
To characterize surgical practices in the management of hip ...fractures in older patients through a nationwide survey of specialized hip surgeons dedicated to the care of these patients.
A survey composed of 32 questions was formulated, including demographic factors, preoperative evaluation, definitive treatment, and postoperative management. It was sent to 140 specialists. 84 of them replied (61%), and 71 answers were included.
Eighty six percent of respondents agreed that orthogeriatric management is fundamental in the outcome of these patients, but only 73% had the collaboration of an internist or a geriatrician. Although 97% considered 72 hours or less the ideal time to perform surgery, only 52% of the respondents declared performing surgery within that timeframe, with differences between private and public system. Regarding surgical treatment, 94-98% of femoral neck fractures are treated with an arthroplasty and 98-99% of per-subtrochanteric fractures are treated with internal fixation and osteosynthesis. Osteoporosis treatment is only carried out by 51% of the respondents and with significant variation.
This survey shows that there is agreement in surgical practice between specialists treating these patients, but clear differences in preoperative optimization, treatment timeframe, and post fracture medical treatment.
Movement-compensating interactions like teleportation are commonly deployed techniques in virtual reality environments. Although practical, they tend to cause disorientation while navigating. ...Previous studies show the effectiveness of orientation-supporting tools, such as trails, in reducing such disorientation and reveal different strengths and weaknesses of individual tools. However, to date, there is a lack of a systematic comparison of those tools when teleportation is used as a movement-compensating technique, in particular under consideration of different tasks. In this paper, we compare the effects of three orientation-supporting tools, namely minimap, trail, and heatmap. We conducted a quantitative user study with 48 participants to investigate the accuracy and efficiency when executing four exploration and search tasks. As dependent variables, task performance, completion time, space coverage, amount of revisiting, retracing time, and memorability were measured. Overall, our results indicate that orientation-supporting tools improve task completion times and revisiting behavior. The trail and heatmap tools were particularly useful for speed-focused tasks, minimal revisiting, and space coverage. The minimap increased memorability and especially supported retracing tasks. These results suggest that virtual reality systems should provide orientation aid tailored to the specific tasks of the users.
Antenatal depression (AND) affects 1 in 10 fathers, potentially negatively impacting maternal mental health and well-being during and after the transition to parenthood. However, few studies have ...assessed the social predictors of paternal AND or their possible associations with maternal mental health. We analysed data from 180 couples participating in the Queensland Family Cohort longitudinal study. Both parents completed surveys measuring mental health, relationship quality, social support, and sleep quality at 24 weeks of pregnancy. Mothers also completed the same surveys 6 weeks’ postpartum. Antenatal depression, stress, and anxiety were highest among fathers reporting lower social support and higher sleep impairment. Maternal AND, stress, and anxiety were higher among mothers reporting higher physical pain and poor sleep quality. Postnatally, mothers reporting lower social support also reported higher depression, anxiety, stress, and psycho-social well-being. While there were no significant associations between AND among fathers and maternal antenatal or postnatal depression, an exploratory analysis revealed that mothers whose partners reported lower antenatal social support also reported lower postnatal social support and higher postnatal depression. Our findings highlight the importance of including data among fathers to achieve a whole family approach to well-being during the transition to parenthood.
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