EEG-EMG Zeitschrift fur Elektroenzephalographie, Elektromyographie und verwandte Gebiete最新文献

Objective: In surgery, dysfunctional teamwork is perpetuated by a 'silo' mentality modelled by students. Interprofessional education using high-fidelity simulation-based training (SBT) may counteract such modelling. We sought to determine whether SBT of interprofessional student teams (1) changes long-term teamwork attitudes and (2) is an effective form of team training.

Design: A quasiexperimental, pre/postintervention comparison design was employed at an academic health sciences institution. High-fidelity simulation-based training of 42 interprofessional teams of third year surgery clerkship medical students and senior undergraduate nursing students was undertaken using a two-scenario format with immediate after action debriefing. Pre/postintervention TeamSTEPPS Teamwork Attitudes questionnaires (5 subscales, 30 items, Likert type) were given to the medical student and undergraduate nursing student classes. Pre/postsession Readiness for Inter-Professional Learning (RIPL; 19 items, Likert type) surveys and postscenario participant-rated and observer-rated Teamwork Assessment Scales (3 subscales, 11 items, Likert type) were given during each training session. Mean TeamSTEPPS Teamwork Attitudes Questionnaire, RIPL and Teamwork Assessment Scales scores were calculated; matched pre/postscore differences and trained versus non-trained TeamSTEPPS Teamwork Attitudes Questionnaire scores were compared using paired t-test or analysis of variance.

Results: Both student groups had 10 significantly improved RIPL items as well as TeamSTEPPS Teamwork Attitudes Questionnaire (TTAQ) mutual support subscales. Medical students had a significantly improved TTAQ team structure subscale. Over a simulation-based training session, each observer-rated Teamwork Assessment Scales subscale and two self-rated Teamwork Assessment Scales subscales significantly improved. Trained students had significantly higher TTAQ team structure subscales than non-trained students.

Conclusions: Interprofessional education using high-fidelity simulation-based training of students is effective at teaching teamwork, changing interprofessional attitudes and improving long-term teamwork attitudes.

Several authors have presented evidence for a strict relation between regional cerebral blood flow and EEG. Therefore the EEG can serve as an adequate physiological parameter when monitoring cerebral function in the operating room. However, to exploit the inherent information as far as possible, both multichannel EEG and somatosensory evoked potentials should be recorded simultaneously. In the present article we describe a monitoring system which is capable to handle this task under the conditions of an operating room. In the first step some numerically simple algorithms are applied to detect gross artifacts. In the subsequent processing stage an analysis procedure is performed which is robust with respect to the remaining more subtile artifacts. In addition the raw signals are continually displayed on a monitor to allow for a visual evaluation of the EEG. The results of a trend analysis procedure are presented on the same graphical display by means of a compact topographical scheme. The system has been running under routine conditions for approximately two years now.

The results from a topographic analysis of the early median nerve SEPs allowed to design a method for recording and analysing the SEPs in the routine laboratory. The detailed analysis of the topography of 50 normal subjects revealed: 1. An inter- and intraindividual variability of the location of the maximal amplitudes, 2. A significantly longer latency of the cortical potentials after left side stimulation, 3. A significantly higher amplitude of N20 after left side stimulation and 4. A significantly higher amplitude of the later potentials P25 and N30 after right side stimulation. It was shown that a 4-channel recording from the neck at C7 with a Fz-reference as well as from stimulus contralateral F3, CP3 and P3 or F4, CP4 and P4 with an stimulus contralateral earlobe reference provides all necessary parameters in comparison to an 20-channel recording. The definition of normal values has to take into account these results. Absolute maximum values were taken instead of the standard deviation because all amplitude values were proven to be not distributed normally. In 7 out of 30 MCA-stroke patients pathological SEP amplitudes were obtained using the 4-channel montage, whereas the 1-channel recording from CP3 and CP4 with a Fz-reference revealed normal amplitudes.

The multiple sleep latency test (MSLT) has proved to be a useful diagnostical tool for patients complaining of excessive daytime sleepiness (EDS). The intention of the present study was to investigate the structure of MSLT naps and in particular sleep spindle and k-complex density in three different groups of EDS patients. MSLT was performed at 8 a.m., 10 a.m. 12 a.m., 2. p.m. and 4 p.m.. Each recording lasted 20 minutes and was not stopped even if sleep occurred before 20 min. Sleep was scored visually. Spindle and k-complex density was determined per minute of S2 sleep. Statistical analysis used ANOVA. Each of the three groups consisted of 15 patients. Diagnosis of narcolepsy, sleep apnea, of EDS due to a psychiatric disorder has been confirmed subsequently. There were 5 female and 10 male narcoleptics (mean age: 43.9 +/- 10.9 years), 2 female and 13 male obstructive sleep apnea patients (mean age: 53.9 +/- 10.9 years) and 7 female and 8 male patients complaining of EDS, in whom a psychiatric disorder was diagnosed (mean age: 38.8 +/- 13.8 years). Narcoleptics sent more than half of the recording time of 100 min asleep (52.9%). Apnea patients slept 41.3% and psychogenic EDS patients 22.7%. The proportion of sleep stages 1 and 2 in narcoleptics (S2/S1 = 1:1) was clearly different from the other two (apnea patients: S2/S1 = 4:1; psychogenic EDS patients: S2/S1 = 3:1). 18.5% of the naps contained stage REM and during the afternoon naps 0.9% of S3 in the narcoleptics. Neither REM nor S3 was observed in the others.(ABSTRACT TRUNCATED AT 250 WORDS)

The discharge frequency of primary muscle spindle afferents of the tibial anterior muscle of the cat was determined under a ramp-and-hold stretch of the host muscle. The rate of ramp stretch was increased stepwise from 1 to 100 mm/s. Its amplitude was kept constant and was 7 mm. The initial length of the host muscle was enhanced in steps of 3 mm to reach a maximal augmentation of the muscle length by 12 mm. At each discharge pattern obtained under a rate of ramp stretch of 10 mm/s the slow receptor adaptation was established. The slow receptor adaptation is the difference between the discharge frequency occurring at the beginning of static phase of a ramp-and-hold stretch, the static maximum, and at the end of the third second of static phase, the static value (Fig. 1). The amplitude of the slow receptor adaptation was plotted against the amplitude of static maximum (Fig. 2). The diagram showed two groups of Ia fibres. One of the two groups had a slow receptor adaptation of high amplitudes. Its primary afferents will be called bag1 Ia fibres. The other group had a slow receptor adaptation of low amplitudes. Its primary afferents will be named bag2-chain Ia fibres. Furthermore, the dynamic response and the static value were determined at the discharge patterns of the two groups of spindle fibres. The dynamic response of the bag1 Ia fibres was with p < 0.0001 significantly higher in its mean amplitude than that one of the bag2-chain Ia fibres (Fig. 4a).(ABSTRACT TRUNCATED AT 250 WORDS)

Retrospective analysis of trigeminal nerve evoked potentials in 40 consecutive patients, most of them with traumatic nerve lesions, showed that in 12 cases no trigeminal nerve SEP were obtainable, and 11 of the remaining 28 patients had normal trigeminal nerve SEP. Therefore the jaw-opening reflex was investigated as a potential tool for electrophysiologic analysis of facial sensory disturbances. The jaw-opening reflex was investigated in 60 healthy subjects (31 female, 29 male) aged 23-82 years. It was elicited by electrical 0.1 ms square wave pulses delivered to the lower and upper lips and to the infraorbital region on either side at a rate below 1 per 5s. The EMG responses were recorded from the bilateral masseter and temporalis muscles at a moderate voluntary activation. Under these conditions, the jaw-opening reflex reveals itself as two inhibitory pauses of the ongoing EMG on both sides, the onset latency of the first EMG-suppression being 10-15 ms, and of the second 35-50 ms. Particular attention was paid to the stimulus strength at threshold (TR) to evoke the jaw-opening reflex. We found that the jaw-opening reflex was constantly evoked by weak stimuli applied to the 2nd and 3rd trigeminal branches. Bilateral reflex responses with unilateral stimulation were a regular finding. The reflex responses increase with increasing stimulus strength (Fig. 1). Moderate to forcible activation of the jaw closing muscles is a prerequisite for optimum recordings of the jaw-opening reflex (Fig. 2).(ABSTRACT TRUNCATED AT 250 WORDS)

According to our experiences (parietal) sleep spindles often show a periodical appearance. Successive sleep spindles in series have a distance of about four seconds. In 95% the duration of such series of sleep spindles is not longer than 40 s, so that there appears no more than ten successive periodical sleep spindles. In the present study ten subjects aged between 57 and 77 years were given Placebo and 7.5 mg Zopiclone. Under the effect of verum we found a doubling of sleep spindle series. However, the distance between the periodical spindles and the length of the spindle series remained unchanged. The variance in the ability to generate sleep spindle series was very high across subjects. One subject for example produced only one sleep spindle series in the Placebo-night (three under verum) and another subject on the other hand 95 (under verum 130). The results of the present study well corresponding to the results of a former investigation comparing Placebo, Pentobarbital, Methaqualon, Carbromal, Flunitrazepam, Triazolam and Lormetazepam.

Electromyographic and mechanographic investigations in patients with muscular hypotonia, which is, for instance, a side-effect after stereotactic treatment of tremor syndromes, permit the presumption that in this sensomotor open-loop situation the decreased muscular resistance to stretching during isometric contraction (initial stiffness) is caused by changes of muscular innervation pattern. Probably, the innervation pattern during tonic activity is changed by a shift of a more tonic motoneurone behaviour to motoneurone activities with predominantly phasic characteristics. In 17 controls and 4 patients with muscular hypotonia caused by stereotactic lesions of VIM area (treatment of tremor syndromes) the EMG of right and left side forearm flexors (especially the activity of the M. biceps brachii) was investigated by a sophisticated, topographically oriented 16-channel-surface-EMG-technique ("EMG-Mapping") during slight isometric contraction. EMG-Maps of forearm flexors (especially of M. biceps brachii) in patients with centrally evoked muscular hypotonia demonstrate that in these open-loop conditions the motor control is changed. For this the reason could be a shift of the activated motor units from a predominantly static to a more phasic functional behaviour. The latest results on muscular activation processes in cats support this presumption.

Horizontal smooth pursuit eye movements were quantitatively evaluated in forty patients with various neurological diseases (chronic alcoholism, acusticusneurinom and multiple sclerosis) as well as in twenty-four healthy subjects. Different frequency sinusoidal targets with an amplitude of 20 degrees were used. The quantitative analysis was possible after calculating the pursuit value as the difference between the saccadic part and the maximal amplitude of the recorded eye movement. Maximal and minimal P-values of 0.5, 0.7 and 0.9 Hz were chosen in the discriminant analyses. It is suggested that these parameters are very helpful in distinguishing between the groups of patients and the group of subjects.

Unlabelled: From 8 men and 12 women with a slow posterior rhythm on the one hand and from 7 male and 5 female healthy volunteers with a regular alpha-EEG on the other closed-eye-EEGs were registered at 8:00 a.m., 12:00 noon, 4:00 p.m., and 8:00 p.m. and recorded on tape for computer processing. Simultaneously each time the body temperature was measured.

Results: In 11 of the 20 patients the slow posterior rhythm shows a right-sided accentuation, in 6 a left-sided. Besides the activity of all frequency-bands favours occipital and occipital-central the right hemisphere. The control group shows only an insignificant right-sided accentuation of alpha-power and alpha-peak-power. The alpha-peak-frequency of the 20 patients is slower than in the controls, the body temperature on the contrary is higher. The physiological circadian shift of the alpha-peak-frequency and of the body temperature does not come up to a similar extent as in the controls. Striking slight is the circadian shift of the frequency of the slow posterior rhythm. Furthermore the day-time related shifts of the alpha-power and of the beta-power take other courses than in the controls. And the maxima of the alpha-power and of the alpha-peak-power are mostly located parietal instead of occipital. All in all the slow posterior rhythm seems to be connected with far-reaching peculiarities of the cerebral function.