Search

Lisa Goudman,1–3 Jorne Laton,4 Raf Brouns,4,5 Guy Nagels,4–6 Eva Huysmans,2,3,7,8 Ronald Buyl,7,9 Kelly Ickmans,2,3,10 Jo Nijs,2,3,10 Maarten Moens,1,2,4,11 1Department of Neurosurgery, Universitair Ziekenhuis Brussel, 2Pain in Motion International Research Group, 3Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, 4Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), 5Department of Neurology, Universitair Ziekenhuis Brussel, 6National MS Center, 7Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, 8Interuniversity Centre for Health Economics Research (I-CHER), 9Department of Biostatistics and Medical Informatics, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, 10Department of Physical Medicine and Physiotherapy, 11Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium Abstract: The goal of this study was to capture the electroencephalographic signature of experimentally induced pain and pain-modulating mechanisms after painful peripheral electrical stimulation to determine one or a selected group of electrodes at a specific time point with a specific frequency range. In the first experiment, ten healthy participants were exposed to stimulation of the right median nerve while registering brain activity using 32-channel electroencephalography. Electrical stimulations were organized in four blocks of 20 stimuli with four intensities – 100%, 120%, 140%, and 160% – of the electrical pain threshold. In the second experiment, 15 healthy participants received electrical stimulation on the dominant median nerve before and during the application of a second painful stimulus. Raw data were converted into the time–frequency domain by applying a continuous wavelet transform. Separated domain information was extracted by calculating Parafac models. The results demonstrated that it is possible to capture a reproducible cortical neural response after painful electrical stimulation, more specifically at 250 milliseconds poststimulus, at the midline electrodes Cz and FCz with predominant δ-oscillations. The signature of the top-down nociceptive inhibitory mechanisms is δ-activity at 235 ms poststimulus at the prefrontal electrodes. This study presents a methodology to overcome the a priori determination of the regions of interest to analyze the brain response after painful electrical stimulation. Keywords: electroencephalography, Parafac model, painful electrical stimulation, conditioned pain modulation

In Belgium, it is mandatory to report Shiga toxin-producing Escherichia coli (STEC) infections to the health inspection authorities. To facilitate the decision making regarding infection control measures, information about the risk factors for the development of the haemolytic uremic syndrome (HUS) can be helpful. We performed statistical analyses on a dataset of 411 Belgian STEC strains. Demographic and clinical patient characteristics as well as phenotypical and genotypical STEC strain characteristics were taken into account. Multivariate logistic regression models indicated that age categories ⩽5, 6-12 and ⩾75; the stx2 gene; and the eae gene were significant HUS development risk determinants. The stx2a subtype had the highest risk (OR 29.6, 95% CI 7.0-125.1), while all stx1 subtypes encompassed a significant lower risk (OR 0.3, 95% CI 0.1-0.5). Presence of the stx1 gene without stx2 encompassed a lower risk than the combined presence of stx1 and stx2, or stx2 solely. Based on these results, we propose a new virulence typing algorithm that will enable the National Reference Centre to provide the physicians and health inspection authorities with a risk classification for the development of HUS. We believe this will contribute to a more efficient STEC infection control management in Belgium. [ABSTRACT FROM AUTHOR]

Objectives: EBP (evidence-based practice) is becoming the standard paradigm in modern healthcare. Therefore different healthcare providers have the need for easily accessible evidence-based information. The Internet creates new opportunities to fill the gaps in education that are experienced by healthcare workers. Contributing to solutions and filling in the needs in the above-mentioned scope, the University of Brussels initiated a European project called MedSkills in 2004.Methods: MedSkills' main goal was to create a copyright-free reference work containing valuable evidence-based information on medical skills for all levels of healthcare professionals (paramedics, nurses and physicians, teachers of medical skills and students).Results: We succeeded in designing and creating a framework to suit the requirements of different users, in 'cellular', 'organ', 'body' and 'best treatment' content maps. A wiki tool was installed to allow the project to be built and in order to maintain itself.Conclusions: This multi-professional and international initiative, unique in its kind aims at contributing to a gold standard for European healthcare, via the creation of a freely available, consistent and updatable evidence-based teaching environment. [ABSTRACT FROM AUTHOR]

Introduction: Psychological factors and changes in sensory system play a role in low back pain (LBP). Psychological factors are examined by questionnaires and the sensory system by quantitative sensory testing (QST). Questionnaires Start Back screening Tool (SBT) and Central Sensitization Inventory (CSI) subgroup patients into risk respectively severity levels. The aim of this study was investigating the linear trend across the risk and severity levels based on the SBT and CSI for various psychological factors and sensitivity changes in the sensory system. Methods: Participants with LBP were recruited. Demographic information was taken, psychological questionnaires were filled in. Comprehensive QST was taken and linear contrast analysis was conducted in this cross-sectional study. Results: Psychological variables (e.g. kinesiophobia, catastrophizing) show significant positive linear trends across the risk levels of the SBT (p < 0.001) and severity levels of the CSI. Several QST-measurements show significant linear trends between the risk and severity levels based on the SBT (e.g. heat pain thresholdlow leg, p = 0.005) and CSI (e.g. pressure pain thresholdL4, p = 0.012). Discussion: Psychological factors increase as risk and severity levels increase. As the risk and/or severity levels increase some responsiveness of nociceptive neurons increased measured by pressure pain thresholds and heat pain thresholds. Temporal summation and conditioned pain modulation show no significant linear trends. Process evaluation: Recruiting people with LBP in primary care was challenging. Patients do not have often time to participate in research. It is helpful to actively approach different physiotherapists and to recruit participant in one's own working environment. [ABSTRACT FROM AUTHOR]

Introduction: Current perioperative education for patients undergoing lumbar surgery is only limited effective in preventing unfavorable outcome. Perioperative pain neuroscience education (PPNE) is a recently introduced intervention that aims to inform such patients about what to expect from their recovery, to improve maladaptive pain cognitions, and to reconceptualize pain. As such, this study aims to evaluate the effectiveness of PPNE on quality of life at 6 weeks post-surgery in at-risk patients undergoing surgery for lumbar radiculopathy. Methods: Following screening, 108 at-risk patients (i.e., having chronic pain = 6 months, and maladaptive degrees of kinesiophobia and pain catastrophizing) undergoing surgery for lumbar radiculopathy will be randomized into an experimental (PPNE) or control (perioperative biomedical education) group. Intervention includes a pre-and postoperative in-person session with a physiotherapist, and access to an educational web application. The primary outcome measure is quality of life which will be assessed at 1 week pre-surgery, and 6 weeks, 6 months and 1 year post-surgery. Results: The central hypothesis describes that due to the effect of PPNE these patients, despite their risk profile for unfavorable outcome, will have good surgical outcome with improvements in quality of life. Discussion: Findings will provide insight in the effectiveness of PPNE as a preventive measure for unfavorable surgical outcome and will be valuable for all clinicians working with such at-risk patients. Process evaluation: Though recruitment for this study has recently started, the process has been slow. As such, updated recruitment strategies are needed to help overcome current barriers. [ABSTRACT FROM AUTHOR]

Introduction: The benefits of perioperative pain neuroscience education (PPNE) for people undergoing surgery for lumbar radiculopathy have recently been established. 1,2 However so far, not much is known about which factors influence PPNE's treatment success. Therefore, this study aims to assess the potential influence of preoperative pain intensity, pain cognitions and sensory function on the PPNE treatment effect for postoperative quality of life 1 year following surgery for lumbar radiculopathy. Methods: This study is a secondary analysis of a randomized controlled trial in which 120 patients were randomized to receive either PPNE or perioperative biomedical education (PBE).3 Quality of life was assessed using the Short Form 36-item Health Survey (SF-36) at baseline (1 week pre-surgery), and 6 weeks, 6 months and 1 year post-surgery. Linear mixed models will be built for the SF-36 Physical component, SF-36 Mental component, and SF-6D utility scores using the following independent variables: treatment (PPNE versus PBE), time, and baseline scores for back pain intensity, leg pain intensity, pain catastrophizing, kinesiophobia, hypervigilance, and measures of quantitative sensory testing (i.e., electrical pain threshold, temporal summation, and conditioned pain modulation). Results: It is hypothesized that patients who report unfavorable scores for these preoperative factors will show a larger treatment effect of PPNE on postoperative quality of life. Discussion: Findings will provide novel insight into the potential moderating effect of preoperative factors on treatment outcome following PPNE in people undergoing surgery for lumbar radiculopathy. Process evaluation: Analysis for this study is underway and results are expected in Spring 2022. [ABSTRACT FROM AUTHOR]