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Sinonasal tumours
Published in Neeraj Sethi, R. James A. England, Neil de Zoysa, Head, Neck and Thyroid Surgery, 2020
Yujay Ramakrishnan, Shahzada Ahmed
MRI with contrast (gadolinium) provides superior soft tissue detail, differentiating tumour from secretions in an opacified sinus, and demonstrates orbital and intracranial spread as well as perineural spread (in adenoid cystic carcinoma). MRI has the advantage of not being affected by dental artefact and requires no exposure to ionising radiation, but does take longer to perform. Additionally, it may not be suitable for claustrophobic patients.
Cardiovascular system
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
With cardiac gating and advanced imaging protocols, very high quality information can be obtained in a study usually lasting less than 30 minutes, though up to 60 minutes may be required for more complex investigations. Image quality may be reduced by obesity, or patient inability to repeatedly breath-hold for 5–10 seconds. Arrhythmia can be managed by pharmacological control and software programmes to overcome the effect, but highly irregular rhythms may still be problematical. Many cardiac patients have a pacemaker, which has been considered an absolute contraindication to MRI; however, many newer devices may allow access to MRI scanners. Claustrophobia may be difficult to control, but most patients can be persuaded to cope, possibly with the aid of sedation. Patients with impaired renal function may be unsuitable due to the risk of nephrogenic systemic fibrosis in reaction to IV gadolinium contrast agents.
Personal Protective Equipment (PPE): Practical and Theoretical Considerations
Published in Brian J. Lukey, James A. Romano, Salem Harry, Chemical Warfare Agents, 2019
Additional limitations incurred by an individual in PPE include a decrease in manual dexterity and communications difficulties, both in hearing, as a result of the noise created by the respirator, and by producing an almost unintelligible quality of speech. Some respirators come equipped with a voicemitter to overcome this difficulty, and although this is an improvement, much is left to be desired. Both reaction and decision times are prolonged in PPE, and errors of omission are more common. Heightened emotions in the form of anxiety, as well as a feeling of claustrophobia and isolation, frequently occur. Although many older respirators have a significant decrease in visual fields, the newer Avon series (M50 military and C50 civilian) offer vastly improved fields of vision. However, the sensations of touch, smell, and taste are also compromised. It is well documented that the accomplishment of an individual task requires more time when wearing PPE (Musa et al., 2002).
Review of the international hypnosis literature
Published in American Journal of Clinical Hypnosis, 2021
Shelagh Freedman, Ian Wickramasekera
This study evaluated the use of self-hypnosis audio recordings before an MRI examination to help with claustrophobia in high-risk patients. The 55 participants were patients with known claustrophobia, or with discomfort during previous MR examination, scheduled for an open MR scanner procedure. The 23-minute recording included background music and self-empowering direct and metaphoric suggestions, such deepened relaxation and imagining sitting on a beach chair (comfort in an enclosed space), smelling the sea air (ability to breathe easily), and being captain of a ship (having control). The hypnosis intervention was found to reduce claustrophobic events from 43% to 16%, the need of sedation from 16% to 2%, and non-sedation coping actions from 28% to 13%. A statistically significant difference in premature terminations of the procedure was not found, although it was halved. Most patients (67%) stated their preference for self-hypnosis support with future MR imaging. The authors note that myths and misinformation about hypnosis and trance are prevalent. The results show that the use of a self-hypnosis audio recording before an MRI procedure is a valuable tool and has beneficial effects, even on patients at high risk for a claustrophobic event. The recording increased comfort and reduced the need for other coping strategies. Address for reprints: Torsten Diekhoff, Department of Radiology, Charité – Universitätsmedizin Berlin Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charité Platz 1, 10117, Berlin, Germany. Email: [email protected]
Experimentally induced low back pain influences brain networks activity
Published in Journal of Motor Behavior, 2021
Rafał Gnat, Maciej Biały, Agata Dziewońska
Twenty-seven healthy volunteers were recruited in this study. Exclusion criteria included: any pain in the lower back and lower limbs area within the last 6 months, the history of lower back and lower limbs surgery, claustrophobia, any general contraindications for fMRI assessment (e.g., free metal bodies or metal implants within the body, insulin pump, etc.), the history of pregnancies and deliveries, current pregnancy and excessive body weight. Six volunteers were excluded: five due to recent LBP and one due to a history of serious knee joint trauma. In one case, previously unknown claustrophobia was revealed during the procedure. At last, 20 subjects (8 women) participated in the study. The characteristics of this group were as follows: mean age of 29.8 ± 5.43 years, mean body height of 174.9 ± 5.55 cm, and mean body mass of 72.2 ± 12.83 kg. All subjects received detailed information regarding the procedure and were free to withdraw from participation at any point. The research was approved by the local Bioethical Committee (no. 5/2011), all subjects signed written informed consent according to Helsinki Declaration before participation in this experiment.
Strategic Aeromedical Evacuation (AE): Examining Biological and Psychosocial Stress in AE Patients
Published in Military Behavioral Health, 2019
Kristie A. Morales, Cheryl A. Krause-Parello, Col Jennifer J. Hatzfeld, Capt Melissa Simpson, Erika Friedmann, John Kolassa, Col Candy Wilson
For routine AE patients, multiple stressors such as decreased partial pressure of oxygen and barometric pressure changes at higher altitudes, fluctuations in temperature, humidity, and gravitational forces, and flight related vibration, noise, and fatigue (Holleran, 2003) can negatively affect overall health. Moreover, the somewhat confining and claustrophobic environment indicative of air transport can lead to some patients experiencing increased levels of anxiety. Fears of flying and unanticipated acute separation from their units. may also contribute to greater degrees of stress and agitation. Psychological stress has also been shown to negatively impact physical wound healing (Gouin & Kiecolt-Glaser, 2011). Moreover, accumulative or increased exposure to stress-related stimuli prompts a general state of physiological arousal, activating the sympathetic nervous system (SNS) and/or the hypothalamic-pituitary-adrenal (HPA) axis to respond to physical or emotional stressors (Lehrner, Daskalakis, & Yehuda, 2016; Selye, 1956). The aforementioned allostatic response can exacerbate various maladies, resulting in adverse health outcomes for AE patients such as circulation, immune response, cognition and behavior (Nicolaides, Kyratzi, Lamprokostopoulou, Chrousos, & Charmandari, 2015).