Minced skin grafts for chronic wounds compared to conventional mesh grafts.

Background and Aims: Skin grafting is the single most effective method to close a chronic wound. The current standard of care is to use meshed split thickness skin grafts. This entails the use of surgical instruments that need to be autoclaved and to have a power source, which usually requires an OR facility. The minced skin technique uses single use, presterilized instruments and the procedure can be done under local anesthesia, by a wound care practitioner, in a wound clinic, a physician's office or even at the bedside. The current study was designed to determine if the results from micrografting were non inferior to conventional mesh grafting. Methods: In a prospective non inferiority study, 26 chronic ulcers were treated with micrografting (MSG) and 24 with conventional mesh grafts 1:3 (control group-CG) in a total of 21 patients, 10 male and 11 female. The donor site areas in the MSG group were predetermined to 2.5 × 5 cm and the mesh grafts expansion was set at 1:3. Results: In the first weeks postoperatively, micrograft healing initially lagged behind the conventional mesh grafts but at 60 days after grafting, all MSG wounds were healed. The MSG wounds had better pigmentation, less itching, and less scarring. The micrografting procedure was easy to learn and expeditious to perform. The MSG mean expansion was 9.1 compared to three times (CG). Conclusion: The MSG procedure is not inferior to conventional mesh grafting, requires smaller donor sites, and can be done with single use instruments, under local anesthesia, with early discharge.

"Studying cognitive reappraisal as an antidote to the effect of negative emotions on medical residents' learning: a randomized experiment".

BACKGROUND: Medical trainees often encounter situations that trigger emotional reactions which may hinder learning. Evidence of this effect on medical trainees is scarce and whether it could be counteracted is unclear. This study investigated the effect of negative emotions on medical residents' learning and whether cognitive reappraisal counteracts it. METHODS: Ninety-nine medical residents participated in a three-phase experiment consisting of: (1) watching a video, either a neutral or an emotion-induction version, the latter either followed by cognitive reappraisal or not (2) learning: all participants studied the same medical text; study-time and cognitive engagement were measured; (3) test: a recall-test measured learning. Data was analysed using Chi-square test and one-way ANOVA. RESULTS: Study time significantly varied between conditions (p = 0.002). The two emotional conditions spent similar time, both significantly less than the neutral condition. The difference in test scores failed to reach significance level (p = 0.053). While the emotional conditions performed similarly, their scores tended to be lower than those of the neutral condition. CONCLUSION: Negative emotions can adversely affect medical residents' learning. The effect of emotions was not counteracted by cognitive reappraisal, which has been successfully employed to regulate emotions in other domains. Further research to examine emotion regulation strategies appropriate for medical education is much needed.

Balance disturbances in asthmatic patients.

OBJECTIVE: The aim of this study was to investigate balance control in asthmatic patients. METHODS: Thirty subjects with controlled persistent asthma were compared with 30 non-asthmatic subjects who were matched by age and sex. Individuals who had received psychiatric treatment, demonstrated chronic musculoskeletal pain, had limited joint movements, or showed vestibular or other equilibrium disorders were excluded from both the groups to avoid biomechanical bias in the dynamic posturography. Balance control was evaluated with the subject standing still on a force platform under four different sensory test conditions. These conditions combined the subject's eyes being opened or closed with a fixed or mobile force platform. A mobile platform provides a somatosensory perturbation, and when associated with the eyes closed condition, only vestibular information is available to moderate balance control. Sensory manipulation provides a more sensitive condition to differentiate postural control between populations or pathologies. Data were sampled at 100 Hz in three 20-second trials and four postural conditions were assessed. The center of pressure (CoP) displacement values were used to calculate area and velocity in the medial-lateral and forward-backward directions. A two-factor analysis of variance with repeated measurements was applied to the data. RESULTS: In comparison to the control group, the asthma group demonstrated a greater area of CoP displacement in conditions using the mobile force platform (with eyes opened or closed) and a higher velocity in forward-backward direction on the mobile platform with the eyes closed. CONCLUSION: Asthmatic individuals presented a greater area for the CoP displacement under somatosensory perturbations and a higher velocity in the forward-backward direction when vestibular information only was made available. Our data suggest that balance needs to be evaluated in asthmatic patients.

Effects of aerobic training on psychosocial morbidity and symptoms in patients with asthma: a randomized clinical trial.

BACKGROUND: Asthma symptoms reduce patients' daily activities, impair their health-related quality of life (HRQoL), and increase their reports of anxiety and depression, all of which seem to be related to a decrease in asthma control. Aerobic exercise training is known to improve aerobic fitness and reduce dyspnea in asthmatics; however, its effect in reducing psychologic distress and symptoms remains poorly understood. We evaluated the role of an aerobic training program in improving HRQoL (primary aim) and reducing psychologic distress and asthma symptoms (secondary aims) for patients with moderate or severe persistent asthma. METHODS: A total of 101 patients were randomly assigned to either a control group or an aerobic training group and studied during the period between medical consultations. Control group patients (educational program plus breathing exercises) (n = 51) and training group patients (educational program plus breathing exercises plus aerobic training) (n = 50) were followed twice a week during a 3-month period. HRQoL and levels of anxiety and depression were quantified before and after treatment. Asthma symptoms were evaluated monthly. RESULTS: At 3 months, the domains (physical limitations, frequency of symptoms, and psychosocial) and total scores of HRQoL significantly improved only in the training group patients (P < .001); the number of asthma-symptom-free days and anxiety and depression levels also significantly improved in this group (P < .001). In addition, a linear relationship between improvement in aerobic capacity and the days without asthma symptoms was observed (r = 0.47; P < .01). CONCLUSIONS: Our results suggest that aerobic training can play an important role in the clinical management of patients with persistent asthma. Further, they may be especially useful for patients with higher degrees of psychosocial distress. TRIAL REGISTRATION: clinicaltrials.gov; Identifier: NCT-00989365.