Spread of local anesthetic during an ultrasound-guided interscalene block: does the injection site influence diffusion?

BACKGROUND: During interscalene block (ISB) placement, ultrasound guidance (USG) enables the practitioner to measure the spread of local anesthetic around the nerve trunks or roots, and to adjust the needle position in order to optimize diffusion. Moreover, USG helps determine the best injection level, i.e. the point from which diffusion gives the most complete brachial plexus block. The aim of this study was to compare C5 and C6 level injections and to determine which level allows the best diffusion. METHODS: Sixty randomized patients scheduled for shoulder surgery were divided into two groups. In group C5, injection was directed toward C5 while in group C6, the C6 nerve root was targeted. Block performance time was recorded. The onset of motor and sensory block of each nerve distribution was evaluated every 10 min over a 30-min period. RESULTS: The average time taken to perform a nerve block was 6.2+2.6 min in Group C6 and 6.0+2.1 min in Group C5 (NS). At 30 min, the number of patients with a satisfactory musculocutaneous and axillary nerve block was not notably greater in either group. By contrast, a significantly higher success rate was observed for other nerves in the C6 group as compared to the C5 group: ulnar nerve block: 93% vs. 19%, radial nerve block: 96% vs. 28%, median nerve block: 96%, vs. 69%. CONCLUSIONS: During USG ISB placement, injection below the C6 level provided the same efficiency in analgesia after shoulder surgery as an injection cranial to the C5 nerve root but a greater success rate of anesthesia in all distal nerve areas. This technique could be very interesting for trauma cases as an alternative to a supraclavicular block and offers a high success rate and is simple to perform, potentially promoting wide use and quicker learning for beginners.

[Retrospective study on six years of anaesthesia for reduction of shoulder dislocation in emergency]. / Etude rétrospective sur six années de l'anesthésie pour réduction de luxation d'épaule en urgence.

OBJECTIVE: The aim of this study was to assess the anaesthetic technique used for emergency shoulder luxation management in a university hospital. STUDY DESIGN: Retrospective observational study. PATIENTS AND METHODS: During a six-year period, all patients who were anaesthetized for shoulder luxation were included. Data were collected from administrative database and patient's files. RESULTS: Two hundred and twenty-four patients were included. Ninety-seven regional anaesthesias were performed (17 failures) and so, 144 general anaesthesias were performed. Among general anaesthesia, 89 patients were not fasten, only four rapid sequence inductions were performed. Sixteen (8%) complications occurred, all during general anaesthesia, among them one inhalation. In not fasten patients, anaesthesia was performed not in accordance with guidelines in 56% of cases of all anaesthetic technique and 96% for patient who had general anaesthesia. Accordance with guidelines was independent from the anaesthesiologist experience or the time of the anaesthesia (night/day). CONCLUSION: We must spread guidelines information to physicians because of the morbidity.

Sputtered iridium oxide films (SIROFs) for low-impedance neural stimulation and recording electrodes.

Iridium oxide films formed by electrochemical activation of iridium metal (AIROF) or by electrochemical deposition (EIROF) are being evaluated as low-impedance charge-injection coatings for neural stimulation and recording. Iridium oxide may also be deposited by reactive sputtering from iridium metal in an oxidizing plasma. The characterization of sputtered iridium oxide films (SIROFs) as coatings for nerve electrodes is reported. SIROFs were characterized by cyclic voltammetry, electrochemical impedance spectroscopy, and potential transient measurements during charge-injection. The surface morphology of the SIROF transitions from smooth to highly nodular with increasing film thickness from 80 nm to 4600 nm. Charge-injection capacities exceed 0.75 mC/cm(2) with 0.75 ms current pulses in thicker films. The SIROF was deposited on both planar and non-planar substrates and photolithographically patterned by lift-off.

Measuring religious faith in cancer patients: reliability and construct validity of the Santa Clara Strength of Religious Faith questionnaire.

Growing attention has focused on associations between religious involvement and health outcomes for cancer patients. Unfortunately, research has been hampered by lack of measures suitable for use in oncology settings. This study examined the performance of one recently developed measure, the Santa Clara Strength of Religious Faith Questionnaire (SCSORF). Initial investigations with cancer patients in a bone marrow transplant program and with non-oncology patients yielded promising results. This study provided additional information about temporal stability and convergent validity. The measure was evaluated in two well-defined samples: (1) 95 breast cancer patients, and (2) 53 healthy young adults. Most of the cancer patients had recent diagnoses and localized or regional disease. In each sample, the instrument demonstrated high test-retest reliability (r's=0.82-0.93) and internal consistency (r's=0.95-0.97). It displayed strong correlations with measures of intrinsic religiosity (r's=0.67-0.82, p<0.0001), and moderate correlations with organizational religiosity (r's=0.61-069, p<0.0001), non-organizational religiosity (r's=0.52-0.55, p<0.0001), comfort from religion (r=0.58, p<0.0001), and ratings of self as religious (r=0.58, p<0.0001). Among cancer patients, scores were significantly associated with optimism (r=0.30, p<0.01), but not with openness of family communication about cancer or perceived social support. These data build on previous findings with cancer patients, and suggest that the SCSORF may be a useful measure of religious faith in oncology settings.

Trichotillomania. An overview and guide to understanding.

Tichotillomania presents challenges to clinicians in various areas including assessment, treatment, and research. Characterized by an irresistible urge to pull out one's hair, which is preceded by tension and followed by relief or pleasure, trichotillomania can cause significant impairment and distress to those who suffer from it. Possible hypothesized causes include a biological basis for hair-pulling, as well as pulling in response to stressors in life. Several assessment techniques to measure the severity of trichotillomania exist, each of which has advantages and disadvantages in establishing a diagnosis. Because it is still a relatively poorly understood disorder, treatment options for patients reporting these behaviors are limited and generally are confined to pharmacological therapy and habit-reversal behavior therapy. Mansueto, Stemberger, Thomas, and Golomb have published a compelling comprehensive behavioral model that attempts to explain the various cues and factors in trichotillomania. It is useful to consider trichotillomania a biological, psychological, and social phenomenon requiring further research regarding the interaction of these variables in advancing the understanding of the disorder.

A multidimensional measure of religious involvement for cancer patients: the Duke Religious Index.

Despite increasing interest in the relationship between religious involvement and health outcomes for cancer patients, research has been limited by the lack of appropriate measures. Few of the many instruments available are well suited to cancer patients. The current study examined the psychometric properties of one recently developed measure, the Duke Religious Index (DRI), which assesses several aspects of religious involvement. The DRI was evaluated in two distinct samples: 104 cancer patients receiving treatment at a bone marrow transplantation program and 175 gynecology clinic patients. The instrument demonstrated good internal consistency (coefficient alphas 0.87-0.94). Moderate to high correlations with other measures of religiosity provided support for convergent validity. Modest relationships with other measures commonly used in psychosocial oncology (e.g., optimism, social support, purpose in life) indicated that the instrument provides unique information (all rs's < 0. 42). Small relationships with social desirability response bias, negative affect, and relationship cohesion further supported the divergent validity of the instrument (all rs's < 0.22). The DRI was significantly associated with demographic characteristics but not with medical variables. Findings support the value of the DRI for use in oncology settings.

Religious faith and spirituality in substance abuse recovery: determining the mental health benefits.

Recently, mental health professionals have begun examining the potential value of religious faith and spirituality in the lives of individuals suffering from a variety of acute and chronic illnesses. This study explored the relation between religious faith, spirituality, and mental health outcomes in 236 individuals recovering from substance abuse. We found that recovering individuals tend to report high levels of religious faith and religious affiliation, but choose to rate themselves as being more spiritual than religious. Results also indicate that among recovering individuals, higher levels of religious faith and spirituality were associated with a more optimistic life orientation, greater perceived social support, higher resilience to stress, and lower levels of anxiety. This represents the largest self-report study to date examining the relation between religious faith, spirituality, and mental health outcomes among individuals recovering from substance abuse.

Could the perception of fitness account for many of the mental and physical health benefits of exercise?

There is a great amount of professional confidence among researchers and clinicians alike that exercise improves both mental and physical health functioning. Interestingly, until recently, investigators had not seriously examined the possibility that some of the positive emotional results associated with exercise may occur because of psychological gains from the experience of trying to get fit or believing that one is fit rather than from an increase in aerobic physical fitness. Further, some research suggests that the perception of fitness is more closely associated with improvements in physical functioning than is aerobic physical fitness. Perhaps we have underestimated the role of our health beliefs as a useful intervention with or without resulting behavior change. Perhaps, for some health outcomes, it may be more healthful to think that you are fit than actually be fit.

Does exercise help in the treatment of psychiatric disorders?

1. Some researchers have stated that the perception of fitness and health may be a better predictor of psychological improvements than actual cardiovascular fitness. 2. It appears reasonable to encourage patients in psychotherapy to participate in a regular exercise program. 3. Adjunct treatments such as exercise may become increasingly important and helpful in the changing health care delivery and reimbursement environment where more short-term and self-help therapies are being strongly encouraged.

Measuring treatment outcome and client satisfaction among children and families.

As the delivery and reimbursement methods for mental health services change rapidly, measuring treatment outcome and client satisfaction has become critical. This article describes a case example of a treatment outcome and client satisfaction assessment program at the Children's Health Council, a private nonprofit agency affiliated with Stanford University that provides comprehensive mental health services to children and families in Palo Alto, California. Approximately 300 families receive mental health treatment per year at the agency. The simple and inexpensive program presented herein can be used and modified by other mental health professionals and agencies struggling to develop satisfactory treatment outcome and client satisfaction evaluation programs.

Preliminary predictions of athletic performance among collegiate baseball players with a biopsychosocial model.

This study investigated the association of nine biopsychosocial variables and athletic performance among 40 elite collegiate baseball players. High scores on confidence and perceived fitness and low scores on repressive denial, strength of religious faith, and sensitivity to glare were reliably associated with ratings of superior athletic performance by four coaches. Preliminary results suggest that the biopsychosocial model may prove useful in predicting athletic performance.

Are stress and coping associated with WISC-III performance among children?

This study examined the association between stress/coping variables and the newly developed Wechsler Intelligence Scale for Children--III (WISC-III) among children. Subjects included 98 children (72 males, 26 females), who ranged in age from 6 to 16 years and who were referred for multidisciplinary diagnostic testing during 1992-93. Demographic, DSM-III-R diagnostic, and testing data from the WISC-III were obtained from patient charts. Results suggest that stress and coping are associated with WISC-III performance among referred children in this archival and correlational study. Implications for future research are discussed.

The Persian Gulf War: civilian war-related stress and the influence of age, religious faith, and war attitudes.

This study examined the stress response of 86 civilian subjects at the onset of the Persian Gulf War. The Impact of Events Scale (IES) and the Symptom Checklist-90-Revised (SCL-90-R) were used to measure participants' subjective stress response and symptoms of psychological distress. Subjects also completed a demographic questionnaire that included questions that ranged from religious affiliation to approval of the war effort. The study describes war-related stress and the influence of age, religious faith, and attitudes about war on reported levels of stress. Results indicate measurable levels of war-related stress in this civilian population.

Using the biopsychosocial model to predict nocturnal penile rigidity in men with erectile dysfunction.

The purpose of this study was to examine the relative contributions of sets of descriptive, organic, and psychosocial variables to a prediction of nocturnal penile rigidity among a group of men presenting with significant erectile dysfunction. Seventy veterans referred for evaluation of their erectile dysfunction completed several standardized questionnaires and two nights of nocturnal penile rigidity monitoring (NPRM) using the snap gauge technique. Results suggest that each set of variables uniquely contributes to a prediction of NPRM. Findings support the view that a biopsychosocial approach should be used in the evaluation and treatment of erectile dysfunction.

Attitudes toward sex, arousal, and the retention of contraceptive information.

Previous research has suggested that women with a negative emotional orientation toward sexuality (i.e., erotophobia) have difficulty learning and retaining sexually relevant material such as contraceptive information. It has been hypothesized that these women become aroused by this material and that this arousal interferes with their ability to learn it. The importance of this issue led us to conduct the current study. Erotophobic and erotophilic women viewed presentations about contraception while their physiological responses were being monitored. In addition, they were tested on the information contained in the presentation before, immediately after, and again 4-6 weeks after the presentation. The results indicated that the erotophobic women knew less contraceptive information before the presentation and were more aroused by the presentation. This arousal, however, did not interfere with retention of the material. These results are discussed in terms of individual differences in reactions to sexual material and the ability to learn, retain, and use contraceptive information.

PIP: The effect of positive or negative sexual orientation and degree of arousal during learning on retention of contraceptive content was assessed using pre-testing and control subjects. 72 female subjects were classified on the basis of a Sexual Experience Survey and the Sexual Opinion Survey as erotophilic or erotophobics. To control for the effect prior knowledge, pretests on contraceptive knowledge and the anatomy of the skeletal system were administered. Physiological arousal was measured by skin resistance. Subjects viewed 5-minute slide and tape presentations on conception and contraception and on the skeletal system. Initially, erotophilic women, and those classified as effective contraceptors, performed better on tests of contraceptive knowledge, but not on knowledge of the skeletal system. After adjusting for pretest scores, there was no difference in posttest scores on these topics. Initial follow-up scores 4-6 weeks later showed no differences, although adjusted scores were higher for erotophobic women. There were no physiological differences during the pretest, but as predicted, the erotophobic women were significantly more aroused during the birth control presentation. The adjusted birth control follow-up test scores were positively correlated with arousal. Thus, the hypothesis that erotophobic women have difficulty learning sexually explicit material on contraception was not supported.