Through the Looking Glass: A Scoping Review of Cinema and Video Therapy

Background: Cinematherapy and video treatments are artistic therapeutic techniques by which the individuals are exposed to their psycho-physical difficulties through the stories of the characters on the screen who are coping with the same issues that the patients are. Although these techniques are increasingly common within modern art therapies, there are neither comprehensive classifications of the different approaches nor agreement on their effectiveness. We performed a scoping review, describing different methodological approaches and outcome measures in cinematherapy and video treatments.Methodology: We searched articles in PubMed, PsycINFO and Google Scholar. We included: (i) articles in which subjects were treated for their difficulties with videos or films, (ii) articles written in English. Review articles and papers describing a research protocol without data collection were not included.Results: We analyzed 38 studies. Thirty-six reported a positive effect of the treatment. Seven studies used classical cinematherapy, adopting a qualitative approach to measure the therapy outcome. Thirty-one studies used different video treatments, 8 of which were defined as randomized controlled trials with specific objective therapy outcomes. Studies were mainly focused on behavioral and psychological difficulties in Autism Spectrum Disorders and Schizophrenia.Conclusion: Studies using video treatments more often rely upon structured experimental designs; on the contrary, those who used classical cinematherapy produced descriptive results. A more standardized methodological approach in terms of experimental design, procedure, and objective outcome measure is needed to provide evidence on the effectiveness of these techniques, promoting its application in the clinical field.

Facial Feminization Surgery Review: Diagnosis, Preoperative Planning, Surgical Techniques, and Outcomes

Facial Feminization Surgery (FFS) broadly encompasses a series of surgical procedures offered by craniomaxillofacial surgeons designed to modify facial features and transform both skeletal and soft tissues to create a more feminine appearance. Techniques, initially pioneered by Dr. Douglas Ousterhout, have been modified to include preoperative virtual planning and evolving aesthetic preferences. Computed Tomography (CT) imaging assists with morphologic typing of the brow, supraorbital, chin, and lateral mandible regions. Advancements in instrumentation increase the efficiency and accuracy of FFS procedures. More recently, trends in transgender acceptance have led to improved insurance authorization for FFS procedures. Objective outcome studies have shown success in achieving goals of (1) minimizing mis-gendering in public (appropriately identifying trans-women as female) and (2) reduction in dysphoric feelings (improved patient satisfaction).

P.060 Immunoglobulin Use For Neuromuscular Conditions: Updating British Columbia Provincial Guidelines Through Focused Literature Review

Background: Immune-mediated neuromuscular conditions often cause significant disability and may require ongoing immunomodulating therapies such as immunoglobulin (Ig). Ig use in several neuromuscular conditions such as Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) is supported by robust evidence, however Ig is increasingly used for other disorders. In British Columbia (BC), Ig use has increased annually; last year, expenditure exceeded 51 million dollars, 35% relating to neurological disease. Within the context of the pandemic, Ig supply is at risk of shortages. Methods: A focused literature review was conducted of CIDP, Guillain-Barré Syndrome (GBS), Multifocal Motor Neuropathy (MMN), Myasthenia Gravis (MG), and other neuromuscular conditions to compare BC Ig guidelines with international best practices. Provincial recommendations for Ig use were updated accordingly. Results: Evidence-based practices include acute and chronic Ig use in CIDP and MMN, and acute or relapse-related treatment in GBS and MG. Ig may be beneficial in other treatment-refractory inflammatory disorders such as Lambert-Eaton Myasthenic Syndrome and vasculitic neuropathy. Objective outcome measures can optimize patient care and ensure appropriate resource utilization. Conclusions: Updated BC guidelines emphasize using established diagnostic criteria, objective outcome measures and minimum effective Ig doses for neuromuscular conditions. Periodic literature reviews on Ig use allow guidelines to remain evidence-based.

Using smartphone-based accelerometers to gauge postoperative outcomes in patients with NPH: Implications for ambulatory monitoring

Background: The surgical treatment of normal pressure hydrocephalus (NPH) with shunting remains controversial due to the difficulty in distinguishing such pathology from other neurological conditions that can present similarly. Thus, patients with suspected NPH should be carefully selected for surgical intervention. Historically, clinical improvement has been measured by the use of functional grades, alleviation of symptoms, and/or patient/family-member reported surveys. Such outcome analysis can be subjective, and there is difficulty in quantifying cognition. Thus, a push for a more quantifiable and objective investigation is warranted, especially for patients with idiopathic NPH (INPH), for which the final diagnosis is confirmed with postoperative clinical improvement. We aimed to use Apple Health (Apple Inc., Cupertino, CA) data to approximate physical activity levels before and after shunt placement for NPH as an objective outcome measurement. The patients were contacted and verbally consented to export Apple Health activity data. The patient’s physical activity data were then analyzed. A chart review from the patient’s EMR was performed to understand and better correlate recovery. Case Description: Our first patient had short-term improvements in activity levels when compared to his preoperative activity. The patient’s activity level subsequently decreased at 6 months and onward. This decline was simultaneous to new-onset lumbar pain. Our second patient experienced sustained improvements in activity levels for 12 months after his operation. His mobility data were in congruence with his subjectively reported improvement in clinical symptoms. He subsequently experienced a late-decline that began at 48-months. His late deterioration was likely confounded by exogenous factors such as further neurodegenerative diseases coupled with old age. Conclusion: The use of objective activity data offers a number of key benefits in the analysis of shunted patients with NPH/INPH. In this distinctive patient population, detailed functional outcome analysis is imperative because the long-term prognosis can be affected by comorbid factors or life expectancy. The benefits from using smartphone-based accelerometers for objective outcome metrics are abundant and such an application can serve as a clinical aid to better optimize surgical and recovery care.

Neural correlates of extrinsic and intrinsic outcome processing during learning in individuals with TBI: a Pilot Investigation

Objective: Outcome processing, the ability to learn from feedback, is an important component of adaptive behavior and rehabilitation. Evidence from healthy adults implicates the striatum and dopamine in outcome processing. Animal research shows that damage to dopaminergic pathways in the brain can lead to a disruption of dopamine tone and transmission. Such evidence thus suggests that persons with TBI experience deficits in outcome processing. However, no research has directly investigated outcome processing and associated neural mechanisms in TBI. Here, we examine outcome processing in individuals with TBI during learning. Given that TBI negatively impacts striatal and dopaminergic systems, we hypothesize that individuals with TBI exhibit deficits in learning from outcomes. Methods: To test this hypothesis, individuals with moderate-to-severe TBI and healthy adults were presented with a declarative paired-associate word learning task. Outcomes indicating performance accuracy were presented immediately during task performance and in the form of either monetary or performance-based feedback. Two types of feedback provided the opportunity to test whether extrinsic and intrinsic motivational aspects of outcome presentation play a role during learning and outcome processing. Results: Our results show that individuals with TBI exhibited impaired learning from feedback compared to healthy participants. Additionally, individuals with TBI exhibited increased activation in the striatum during outcome processing. Conclusions: The results of this study suggest that outcome processing and learning from immediate outcomes is impaired in individuals with TBI and might be related to inefficient use of neural resources during task performance as reflected by increased activation of the striatum.

Long term oral azithromycin versus functional endoscopic sinus surgery in patients suffering from chronic rhinosinusitis: a comparative study

<p class="abstract"><strong>Background: </strong>Chronic rhinosinusitis (CRS) is defined as inflammation of the nasal cavity and paranasal sinuses. Azithromycin, a macrolide antibiotic, a well-established class of anti-bacterial agents, which also have anti-inflammatory properties. The present study was designed to compare the role of azithromycin with surgical management in patients with chronic-rhinosinusitis.</p><p class="abstract"><strong>Methods: </strong>The study population included 60 adult patients with symptomatic CRS refractory to 3 weeks of medical therapy. The patients were divided in two groups with 30 patients in each group. One group of patients received oral Azithromycin as main treatment for 12 weeks while the other group of patients underwent sinonasal surgery. Symptom scoring and endoscopic scoring were done previous to the treatment and at 1 month and 3-month follow-ups.</p><p class="abstract"><strong>Results:</strong> A good subjective as well as objective outcome in terms of symptom improvement was obtained with in patients with chronic rhinosinusitis with Surgical intervention as compared to those patients who received long term oral Azithromycin.</p><p class="abstract"><strong>Conclusions: </strong>We advocate that patients suffering from chronic sinonasal disease should be initially targeted with maximal medical therapy using an oral macrolide for at least 3 months. After this patient should be assessed and surgery considered in those cases refractory to medical therapy.</p>

Review of Quantitative Imaging for Objective Assessment of Fat Grafting Outcomes in Breast Surgery

This article presents a comprehensive review of the use of quantitative measurements based on breast images to assess fat retention, breast aesthetics, and fat necrosis after autologous fat grafting. Breast volume measured from MRI and 3-dimensional surface images is widely used as a measure of fat retention. Breast aesthetics are assessed from a combination of anthropometric (distance and contour) measurements on breast surface images. Examination of radiologic images (ultrasonography, mammography, and MRI) is utilized to assess fat necrosis. The article discusses implementation guidelines for objective outcome assessment to support robust quantification and enable investigations of fat grafting efficacy. Level of Evidence: 4

Motion Smoothness Metrics for Cannulation Skill Assessment: What Factors Matter?

Medical training simulators have the potential to provide remote and automated assessment of skill vital for medical training. Consequently, there is a need to develop “smart” training devices with robust metrics that can quantify clinical skills for effective training and self-assessment. Recently, metrics that quantify motion smoothness such as log dimensionless jerk (LDLJ) and spectral arc length (SPARC) are increasingly being applied in medical simulators. However, two key questions remain about the efficacy of such metrics: how do these metrics relate to clinical skill, and how to best compute these metrics from sensor data and relate them with similar metrics? This study addresses these questions in the context of hemodialysis cannulation by enrolling 52 clinicians who performed cannulation in a simulated arteriovenous (AV) fistula. For clinical skill, results demonstrate that the objective outcome metric flash ratio (FR), developed to measure the quality of task completion, outperformed traditional skill indicator metrics (years of experience and global rating sheet scores). For computing motion smoothness metrics for skill assessment, we observed that the lowest amount of smoothing could result in unreliable metrics. Furthermore, the relative efficacy of motion smoothness metrics when compared with other process metrics in correlating with skill was similar for FR, the most accurate measure of skill. These results provide guidance for the computation and use of motion-based metrics for clinical skill assessment, including utilizing objective outcome metrics as ideal measures for quantifying skill.