A preliminary functional brain study on amputees.

The purpose of this study was to verify whether brain activation could be used to modulate the movements of an artificial limb. This approach was begun 20 years ago with the fitting of prostheses immediately following lower-limb amputations. We studied 9 unilateral amputees and 9 control participants using functional MRI, electroneuromyography, gait laboratory, and neuropsychological assessments. The results demonstrated that brain activation is analogous when participants in the control group are asked to mentally move a foot, compared with amputees who are asked to move a nonexistent foot. The brain has not been damaged and maintains its areas of command. This can be applied in rehabilitation.

Decision-making theory and HIV disease.

AIDS: AIDS treatment is sophisticated and complex, requiring difficult decisions about when to begin treatment, how aggressively to treat the infection, and which alternative therapies to pursue. Health care professionals need to be able to calculate risks and to help patients weigh their treatment options. Ideally, clinicians should present all options and discuss why they advocate some and not others. Unconventional treatments should also receive attention, because a patient may lend more credibility to options he or she believes is being purposefully concealed. Treatment decisions can be turned into a formula by estimating the good or bad value of each possible outcome of an action, multiplying that figure by the outcome's probability, and adding up the products from all the outcomes. Even if the person does not wish to base a decision on the formula, they have at least given careful consideration to all the issues. Creating a record of the decision-making process can also help ease regret caused by hindsight or outcome bias.^ieng

A randomized, double-blind pilot study examining the use of intravenous ondansetron in the prevention of postoperative nausea and vomiting in female inpatients.

STUDY OBJECTIVE: To compare the efficacy and safety profiles of intravenous (IV) ondansetron (two 8 mg doses 8 hours apart) and a placebo when used in the prevention of postoperative nausea and emesis (vomiting or retching). DESIGN: Randomized, double-blind, placebo-controlled, parallel, multicenter pilot study. SETTING: Four university hospitals in the United States. PATIENTS: Two hundred seven women scheduled to undergo inpatient surgical procedures during general anesthesia. INTERVENTIONS: Patients were randomized to receive, in a double-blind fashion, either two 8 mg doses of IV ondansetron or a placebo. The first study drug dose was administered before induction of anesthesia; the second dose was given 8 hours later. Each study drug dose was admixed with normal saline to 20 ml and administered IV over 2 to 5 minutes. Vital signs were monitored immediately before and 1 minute after completion of the study drug infusion. MEASUREMENTS AND MAIN RESULTS: For the 24-hour period following operation, 60% of the patients who received ondansetron and 26% of the patients who received the placebo were emesis-free (p < 0.001). Subanalyses based on patients' previous history of general anesthesia indicated that ondansetron was superior to the placebo in preventing emesis regardless of history [66% vs. 33% in patients who had never had general anesthesia or had had no nausea or emesis following previous anesthesia (p = 0.001) and 50% vs. 17% in patients who had nausea or emesis following previous anesthesia (p = 0.005)]. Ondansetron also was superior to the placebo for the prevention of nausea over the 24-hour study period regardless of anesthesia history. Ondansetron was generally well tolerated. The adverse event, vital sign, and clinical laboratory test profiles were similar to those for the placebo. No patient who received ondansetron had untoward changes in central nervous system function, including sedation. CONCLUSIONS: Prophylactic IV ondansetron appears to be safe and causes a significant reduction in the frequency and severity of postoperative nausea and emesis.