Healthcare practitioners and robotic-assisted rehabilitation: understanding needs and barriers

Backgrounds: In recent years, numerous robotic devices, together with allied technologies, have been developed to support rehabilitation, both in research settings and industry. Although robotic-assisted rehabilitation and related technologies hold significant promise for supporting healthcare practitioners and enhancing patient care, their use in clinical practice remains limited. One of the motivations could be that final users’ needs have not been given due consideration so far. As a matter of fact, understanding user needs and perceptions is crucial for designing these technological devices and for creating new organizational models within hospitals aiming to establish and maintain robotics-assisted rehabilitation gyms. Methods: We developed and distributed an online survey to the Italian community of healthcare practitioners working in rehabilitation, to depict the current landscape of robotic-assisted rehabilitation and to understand their opinions and demands across various domains and diseases. The questionnaire is divided into two main parts. The first section pertains to the respondents' demographics and professional experience. The second part includes questions about eight different categories of rehabilitative devices. For each category, practitioners can indicate whether they use a device in their practice, their perceptions, and any perceived barriers. Additionally, they can fill out a System Usability Scale for a specific device in that category. Results: We collected answers from 423 Italian rehabilitation professionals, including various clinical roles, that revealed significant insights into the use of robotics in rehabilitation. Gender distribution shows a high prevalence of female professionals. 40% of respondents reported being unfamiliar with any robotics devices. Advanced treadmills are the most known and used robots. Generally, usage and experience with devices are associated with positive attitudes towards robotics-assisted rehabilitation. Lack of financial resources and scientific evidence, as well as lack of opportunities and training, are the most reported barriers. Conclusions: Despite a general positivity towards technology, there is a substantial lack of awareness about rehabilitation devices among professionals. The survey highlights the need for enhanced training and education on robotics in rehabilitation programs. Additionally, the limited focus on home rehabilitation is noted. The study emphasizes the importance of verifying both the effectiveness and economic sustainability of robotic devices in clinical practice

Combined antiretroviral therapy reduces hyperimmunoglobulinemia in HIV-1 infected children

Objective: To evaluate the effect of combined antiretroviral therapy on serum immunoglobulin (Ig) levels in HIV-1 perinatally infected children. Methods: Data from 1250 children recorded by the Italian Register for HIV Infection in Children from 1985 to 2002 were analysed. Since Ig levels physiologically vary with age, differences at different age periods were evaluated as differences in z-scores calculated using means and standard deviations of normal population for each age period. Combined antiretroviral therapy has become widespread in Italy since 1996, thus differences in Ig z-scores between the periods 1985-1995 and 1996-2002 were analysed. Data according to type of therapeutic regimen were also analysed. Results: Between the two periods 1985-1995 and 1996-2002, significant (P < 0.0001) decreases in IgG (6.29 ± 4.72 versus 4.44 ± 4.33), IgM (9.25 ± 13.32 versus 5.61 ± 7.93), and IgA (10.25 ± 15.68 versus 6.48 ± 11.56) z-scores, together with a parallel significant (P < 0.0001) increase in CD4 T-lymphocyte percentages, were found. These decreases were confirmed regardless of whether the children were receiving intravenous Ig or not. Ig z-scores were significantly higher in children receiving mono-therapy than in those receiving double-combined therapy (IgC, P < 0.0001; IgM, P = 0.003; IgA, P = 0.031) and in the latter children than in those receiving three or more drugs (P < 0.0001 for all z-scores). Ig z-scores correlated inversely with CD4 T-lymphocyte percentages and, directly, with viral loads. Conclusions: Our data show that in HIV-1 infected children combined antiretroviral therapy leads to reduction of hyperimmunoglobulinemia which parallels restoration of CD4 T-lymphocyte percentage and viral load decrease, which it turn probably reflects improved B-lymphocyte functions. © 2004 Lippincott Williams & Wilkins

Good prenatal detection rate of major birth defects in HIV-infected pregnant women in Italy

What's already known about this topic? Exposure to antiretroviral treatment in pregnancy does not seem to increase the risk of birth defects, but there is no information on the rate of prenatal detection of such defects. What does this study adds? We provide for the first time, in a national case series, information about prenatal detection rate in women with HIV (51.6% for any major defect, 66.7% for chromosomal abnormalities, and 85% for severe structural defect

Ventilation and outcomes following robotic-assisted abdominal surgery: an international, multicentre observational study

Background: International data on the epidemiology, ventilation practice, and outcomes in patients undergoing abdominal robotic-assisted surgery (RAS) are lacking. The aim of the study was to assess the incidence of postoperative pulmonary complications (PPCs), and to describe ventilator management after abdominal RAS. Methods: This was an international, multicentre, prospective study in 34 centres in nine countries. Patients ≥18 yr of age undergoing abdominal RAS were enrolled between April 2017 and March 2019. The Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score was used to stratify for higher risk of PPCs (≥26). The primary outcome was the incidence of PPCs. Secondary endpoints included the preoperative risk for PPCs and ventilator management. Results: Of 1167 subjects screened, 905 abdominal RAS patients were included. Overall, 590 (65.2%) patients were at increased risk for PPCs. Meanwhile, 172 (19%) patients sustained PPCs, which occurred more frequently in 132 (22.4%) patients at increased risk, compared with 40 (12.7%) patients at lower risk of PPCs (absolute risk difference: 12.2% [95% confidence intervals (CI), 6.8–17.6%]; P&lt;0.001). Plateau and driving pressures were higher in patients at increased risk, compared with patients at low risk of PPCs, but no ventilatory variables were independently associated with increased occurrence of PPCs. Development of PPCs was associated with a longer hospital stay. Conclusions: One in five patients developed one or more PPCs (chiefly unplanned oxygen requirement), which was associated with a longer hospital stay. No ventilatory variables were independently associated with PPCs. Clinical trial registration: NCT02989415

Investigating determinants of yawning in the domestic (Equus caballus) and Przewalski (Equus ferus przewalskii) horses

International audienceYawning is rare in herbivores which therefore may be an interesting group to disentangle the potential function(s) of yawning behaviour. Horses provide the opportunity to compare not only animals living in different conditions but also wild versus domestic species. Here, we tested three hypotheses by observing both domestic and Przewalski horses living in semi-natural conditions: (i) that domestic horses may show an elevated rate of yawning as a result of the domestication process (or as a result of life conditions), (ii) that individuals experiencing a higher level of social stress would yawn more than individuals with lower social stress and (iii) that males would yawn more often than females. The study involved 19 Przewalski horses (PHs) and 16 domestic horses (DHs) of different breeds living in large outdoor enclosures. The results showed that there was no difference between the PH and DH in yawning frequency (YF). PHs exhibited much higher levels of social interactions than DHs. There was a positive correlation between yawning frequency and aggressive behaviours in PHs, especially males, supporting the idea that yawning may be associated with more excitatory/stressful social situations. A correlation was found between yawning frequency and affiliative behaviours in DHs, which supports the potential relationship between yawning and social context. Finally, the entire males, but not castrated males, showed much higher levels of yawning than females in both species. The intensity (rather than the valence) of the interaction may be important in triggering yawning, which could therefore be a displacement activity that helps reduce tension

A crying baby: not simply infant colic

Hypertrophic pyloric stenosis is a relatively common condition, but atypical presentations can present a diagnostic challenge. We describe the case of a 9-week-old Latin male infant who presented with a 2-day history of intermittent crying and poor feeding. He was suspected to have intussusception but was affected by and successfully treated for hypertrophic pyloric stenosis. Diagnostic tools of atypical HPS cases are discussed