Developing an Inpatient Relationship Centered Communication Curriculum (I-RCCC) rounding framework for surgical teams.

BACKGROUND: Morning rounds by an acute care surgery (ACS) service at a level one trauma center are uniquely demanding, given the fast pace, high acuity, and increased patient volume. These demands notwithstanding, communication remains integral to the success of surgical teams. Yet there are limited published curricula that address trauma inpatient communication needs. Observations at our institution confirmed that the surgical team lacked a shared mental model for communication. We hypothesized that creating a relationship-centered rounding conceptual framework model would enhance the provider-patient experience. STUDY DESIGN: A mixed-methods approach was used for this study. A multi-pronged needs assessment was conducted. Provider communion items for Press Ganey and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys were used to measure patients' expressed needs. Faculty with experience in relationship-centered communication observed morning rounds and documented demonstrated behaviors. A five-hour workshop was designed based on the identified needs. A pre-and post-course Assessment and course evaluation were conducted. Provider-related patient satisfaction items were measured six months before the course and six months after the workshop. RESULTS: Needs assessment revealed a lack of a shared communication framework and a lack of leadership skills for senior trauma residents. Barriers included: time constraints, patient load, and interruptions during rounds. The curriculum was very well received. The self-reflected behaviors that demonstrated the most dramatic change between the pre and post-workshop surveys were: I listened without interrupting; I spoke clearly and at a moderate pace; I repeated key points; and I checked that the patient understood. All these changed from being performed by 50% of respondents "about half of the time" to 100% of them "always". Press Ganey top box likelihood to recommend (LTR) and provider-related top box items showed a trend towards improvement after implementing the training with a percentage difference of up to 20%. CONCLUSION: The Inpatient Relationship Centered Communication Curriculum (I-RCCC) targeting senior residents and Nurse Practitioners (NP) was feasible, practical, and well-received by participants. There was a trend of an increase in LTRs and provider-specific patient satisfaction items. This curriculum will be refined based on the study results and potentially scalable to other surgical specialties.

Distributed representation of visual objects by single neurons in the human brain.

It remains unclear how single neurons in the human brain represent whole-object visual stimuli. While recordings in both human and nonhuman primates have shown distributed representations of objects (many neurons encoding multiple objects), recordings of single neurons in the human medial temporal lobe, taken as subjects' discriminated objects during multiple presentations, have shown gnostic representations (single neurons encoding one object). Because some studies suggest that repeated viewing may enhance neural selectivity for objects, we had human subjects discriminate objects in a single, more naturalistic viewing session. We found that, across 432 well isolated neurons recorded in the hippocampus and amygdala, the average fraction of objects encoded was 26%. We also found that more neurons encoded several objects versus only one object in the hippocampus (28 vs 18%, p < 0.001) and in the amygdala (30 vs 19%, p < 0.001). Thus, during realistic viewing experiences, typical neurons in the human medial temporal lobe code for a considerable range of objects, across multiple semantic categories.

A statistical method for predicting seizure onset zones from human single-neuron recordings.

OBJECTIVE: Clinicians often use depth-electrode recordings to localize human epileptogenic foci. To advance the diagnostic value of these recordings, we applied logistic regression models to single-neuron recordings from depth-electrode microwires to predict seizure onset zones (SOZs). APPROACH: We collected data from 17 epilepsy patients at the Barrow Neurological Institute and developed logistic regression models to calculate the odds of observing SOZs in the hippocampus, amygdala and ventromedial prefrontal cortex, based on statistics such as the burst interspike interval (ISI). MAIN RESULTS: Analysis of these models showed that, for a single-unit increase in burst ISI ratio, the left hippocampus was approximately 12 times more likely to contain a SOZ; and the right amygdala, 14.5 times more likely. Our models were most accurate for the hippocampus bilaterally (at 85% average sensitivity), and performance was comparable with current diagnostics such as electroencephalography. SIGNIFICANCE: Logistic regression models can be combined with single-neuron recording to predict likely SOZs in epilepsy patients being evaluated for resective surgery, providing an automated source of clinically useful information.

Motor imagery may incorporate trial-to-trial error.

The authors tested for 1/f noise in motor imagery (MI). Participants pointed and imagined pointing to a single target (Experiment 1), to targets of varied size (Experiment 2), and switched between pointing and grasping (Experiment 3). Experiment 1 showed comparable patterns of serial correlation in actual and imagined movement. Experiment 2 suggested increased correlation for MI and performance with increased task difficulty, perhaps reflecting adaptation to a more complex environment. Experiment 3 suggested a parallel decrease in correlation with task switching, perhaps reflecting discontinuity of mental set. Although present results do not conclusively reveal 1/f fluctuation, the emergent patterns suggest that MI could incorporate trial-to-trial error across a range of constraints.

Target dimension affects 1/f noise in aiming.

The present study tested for 1/f noise to examine how timing and target constraints affect cognitive processes in aiming. Participants pointed to targets of varied height and width at preferred speed (Experiment 1) and as quickly as possible (Experiment 2). Results show greater intensity of 1/f noise, or long-range correlation in variability, at preferred speed and with increased accuracy demands perpendicular to the target (i.e., related to height). Prior research suggests that increased 1/f noise in movement reflects increased coordination of processes at different timescales (e.g., planning and control), particularly when there is more time to complete the movement. Previous studies also suggest that target height constraints promote more reliance on both predictive and reactive control, as more time is spent during initial aiming and adjustment. Thus, present results expand on what we know about aiming movements in two ways: (a) by further suggesting a non-orthogonal relation between planning (coarse aiming) and control (fine tuning) that is time dependent; and (b) by demonstrating that such an integration of processes, reflected in distinct patterns of 1/f noise, may be modulated by multiple environmental characteristics (i.e., target shape).

Sensory and perceptual interactions in weight perception.

In four experiments, a multidimensional signal detection analysis was used to determine the influence of length, diameter, and mass on haptically perceived heaviness with and without vision. This analysis allowed us to test for sensory and perceptual interactions between mass and size. As in previous research, sensory interactions were apparent in all four experiments. A novel result was the appearance of perceptual interactions that became more prominent when diameter varied and when vision was allowed. Discussion focuses on how vision and the modalities of touch (i.e., haptic and dynamic) might influence which interactions appear in the data.

Using 1/f noise to examine planning and control in a discrete aiming task.

The present study used 1/f noise to examine how spatial, physical, and timing constraints affect planning and control processes in aiming. Participants moved objects of different masses to different distances at preferred speed (Experiment 1) and as quickly as possible (Experiment 2). Power spectral density, standardized dispersion, rescaled range, and an autoregressive fractionally integrated moving average (ARFIMA) model selection procedure were used to quantify 1/f noise. Measures from all four analyses were in reasonable agreement, with more ARFIMA (long-range) models selected at peak velocity in Experiment 1 and fewer selected at peak velocity in Experiment 2. There also was a nonsignificant trend where, at preferred speed, of those participants who showed 1/f noise, more tended to show 1/f noise at peak velocity, when planning and control would overlap most. This trend disappeared for fast movements, where planning and control would have less time to overlap. Summing short-range processes at different timescales can produce 1/f-like noise. As planning is a slower-moving process and control faster, present results suggest that, with enough time for both planning and control, 1/f noise in aiming may arise from a similar summation of processes. Potential limitations of time series length in the present task are discussed.