Risk of intrafascicular spread after deliberate ex vivo intraneural injections of brachial plexus nerve roots.

Background: We investigated the intraneural spread of injected fluid in brachial plexus nerve roots, examining the potential for intrafascicular spread and identifying influencing factors.

Methods: Twelve deliberate ultrasound-guided intraneural injections were performed at the ventral rami of the brachial plexus nerve roots at their exits from the neuroforamina in six fresh, unembalmed, cryopreserved human cadavers. A 22-G, 30-degree bevel echogenic regional anaesthesia needle was used.

Life in green: Associations between greenspace availability and mental health over the lifecourse - A 40-year prospective birth cohort study.

Background: The beneficial impacts of greenspace availability on mental health are well-documented. However, longitudinal evidence using a spatial lifecourse perspective is rare, leaving the dynamics of how greenspace influences mental health across the lifecourse unclear. This study first uses prospective birth cohort data to examine the associations between greenspace availability in childhood (0-16 years) and mental health in adolescence (16 years) and between greenspace availability and mental health across adulthood (18-40 years).

Characteristics of the practice of New Zealand osteopaths who manage patients with chronic pain.

Background: Chronic pain management is challenging. Those with chronic pain present to health professionals, including osteopaths.

Methods: Secondary analysis of a cross-sectional survey of the Osteopathy Research Connect - New Zealand (ORC-NZ), a practice-based research network (PBRN).

Level 4 seizure monitoring unit admissions are associated with reduced long-term health care costs.

Objective: This study was undertaken to determine whether admission to dedicated seizure monitoring units (SMUs) result in reduced health care use (HCU).

Methods: This was a retrospective open cohort study covering the years 2010-2018 of patients residing in Alberta, Canada, who were referred to the Calgary Comprehensive Epilepsy Program and admitted to a level 4 SMU. Patients were required to have ≥3 years pre- and postadmission follow-up.

Therapeutic approaches and conceptions of practice of osteopaths in Australia - a national cross-sectional study and exploratory factor analysis of the Osteo-TAQ.

Background: Health professionals develop their own approach to patient care based on education, experience and philosophical stance. Literature suggests that this practice approach informs patient care, and clinical outcomes. The Osteopaths' Therapeutic Approaches Questionnaire (Osteo-TAQ) is a novel 36-item instrument developed from qualitative grounded theory research with osteopaths in the United Kingdom.

Peripheral nerve microanatomy: new insights into possible mechanisms for block success.

Postmortem histology and in vivo, animal-based ultra-high-definition microultrasound demonstrate a complex array of non-communicating adipose tissue compartments enclosed by fascia. Classic nerve block mechanisms and histology do not consider this tissue. Injected local anesthetic agents can occupy any of these adipose compartments, which may explain the significant differences in outcomes such as success rates, onset time, block density, duration of nerve block, and secondary continuous block failure.

Exploring the feasibility of linking historical air pollution data to the Christchurch Health and Development study: A birth cohort study in Aotearoa, New Zealand.

Spatial life course epidemiological approaches offer promise for prospectively examining the impacts of air pollution exposure on longer-term health outcomes, but existing research is limited. An essential aspect, often overlooked is the comprehensiveness of exposure data across the lifecourse. The primary objective was to meticulously reconstruct historical estimates of air pollution exposure to include prenatal exposure as well as annual exposure from birth to 10 years (1977-1987) for each cohort member.

Dreams interrupted: characteristics of REM sleep-associated seizures and status epilepticus.

Study Objectives: Seizures are rare in rapid eye movement (REM) sleep. However, seizures sometimes occur in REM sleep, and a small number of focal epilepsy patients display their maximum rate of interictal epileptiform discharges in REM sleep. We sought to systematically identify and characterize seizures in REM sleep.

Development and validation of metrics for assessment of ultrasound-guided fascial block skills.

Background: As few anaesthetists provide lumbar erector spinae block for disc surgery, there is a need to provide training to enable a randomised controlled trial investigating analgesia after painful spinal surgery (NIHR153170). The primary objective of the study was to develop and measure the construct validity of a checklist for assessment of skills in performing lumbar and thoracic erector spinae fascial plane injection using soft-embalmed Thiel cadavers.

Methods: Twenty-four UK consultant regional anaesthetists completed two iterations of a Delphi questionnaire.

Attaining expertise in regional anaesthesia training using a multifactorial approach incorporating deliberate practice.

The most effective way of delivering regional anaesthesia training and the best means of demonstrating competency have not been established. Clinical competency, based on the Dreyfus and Dreyfus lexicon, appears unachievable using current training approaches. Lessons should be taken from the worlds of music, chess, and sports.

Using Virtual Reality to teach ultrasound-guided needling skills for regional anaesthesia: A randomised controlled trial.

Study Objective: We previously designed and validated a virtual reality-based simulator to help train novices in ultrasound-guided needling skills necessary for safe and competent ultrasound-guided regional anaesthesia. This study was designed to compare the performance and error rates of novices trained by a human faculty aided with the assistance of this virtual reality simulator (virtual reality-assisted training), versus novices trained wholly by humans (conventional training).

Design, Setting, And Participants: In this single centre, randomised controlled study, we used a standardised teaching protocol, rigorous blinding, iterative training of assessors, and validated global rating scale and composite error score checklists to assess skills learning of novice participants.

The impact of area-level socioeconomic status in childhood on mental health in adolescence and adulthood: A prospective birth cohort study in Aotearoa New Zealand.

Mental health conditions pose a significant public health challenge, and low area-level socioeconomic status (SES) is a potentially important upstream determinant. Childhood exposure might have influences on later-life mental health. This study, utilises data from the Christchurch Health and Development Study birth cohort, examining the impact of area-level SES trajectories in childhood (from birth to age 16) on mental health at age 16 and from age 18-40 years.

The role of social support in reducing the long-term burden of cumulative childhood adversity on adulthood internalising disorder.

Purpose: Previous research indicates that social support is protective for the mental health outcomes of exposure to childhood adversity. However, the impact of social support as a protective factor following exposure to cumulative childhood adversity is understudied with prospective longitudinal data. The aim of this present study was to examine how social support mediates the impact of cumulative exposure to childhood adversity on internalising disorder in adulthood.

Postoperative Prophylactic Antibiotic Use in Breast Reduction Mammoplasty: A Single Centre Retrospective Cohort Study.

Breast reduction mammoplasty (BRM) is a common procedure performed by plastic surgeons treating patients with hypermastia. It is customary to give preoperative prophylactic intravenous antibiotics for BRM, followed by several days of postoperative prophylactic oral antibiotics, despite the lack of evidence of their effectiveness in preventing surgical site infections (SSIs). The purpose of this study is to determine if the addition of prophylactic postoperative antibiotics is more effective in preventing SSIs in comparison to a single dose of preoperative prophylactic antibiotics in BRM.

Craniocaudal spread and clinical translation for combined erector spinae plane block and retrolaminar block in soft embalmed cadavers: a randomised controlled equivalence study.

Background: Erector spinae plane (ESP) block spread can be unpredictable. We previously improved the spread of ESP injection by addition of retrolaminar (RL) injection. However, it is not clear whether spread at high thoracic levels is similar to spread at midthoracic levels.

Modified inverse propensity weighting method to alleviate estimation errors in the model with multiple endogenous variables.

Multiple mental health disorders affect on decisions of people. The disorders are also outcomes of other factors. Health studies commonly follow an inverse propensity weight (IPW) method to address estimation errors associated with the presence of one confounder or covariate number exceeding the recommended sample size.

Nerve block, nerve damage, and fluid injection pressure: overturning the myth.

Histological and micro-ultrasound evidence rebuffs deep-rooted views on the nature of nerve block, nerve damage, and injection pressure monitoring. We propose that the ideal position of the needle tip for nerve block is between the innermost circumneural fascial layer and outer epineurium, with local anaesthetic passing circumferentially through adipose tissue. Thin, circumferential, subepineural expansion that is invisible to the naked eye was identified using micro-ultrasound, and could account for variability of outcomes in clinical practice.

Standardizing nomenclature in regional anesthesia: an ASRA-ESRA Delphi consensus study of upper and lower limb nerve blocks.

Background: Inconsistent nomenclature and anatomical descriptions of regional anesthetic techniques hinder scientific communication and engender confusion; this in turn has implications for research, education and clinical implementation of regional anesthesia. Having produced standardized nomenclature for abdominal wall, paraspinal and chest wall regional anesthetic techniques, we aimed to similarly do so for upper and lower limb peripheral nerve blocks.

Methods: We performed a three-round Delphi international consensus study to generate standardized names and anatomical descriptions of upper and lower limb regional anesthetic techniques.

Life course development following childhood adversity: methods and findings from the Christchurch Health and Development Study.

Aim: To review research developments on childhood adversity in the Christchurch Health and Development Study (CHDS) since 2001.

Method: Narrative overview of the published work of the CHDS since 2001 in the context of research methods.

Results: The CHDS research has continued to evolve as the cohort has aged.

Excessive Smartphone Use is Associated with Depression, Anxiety, Stress, and Sleep Quality of Australian Adults.

Problematic smartphone use has been associated with poorer mental health in different population groups; however, little is known about how levels of smartphone use were associated with mental health outcomes of adults in Australia. Using data from a cross-sectional survey among Australian adults aged 18-59 years (n = 655, Mean = 24.55 [SD = 5.