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Introduction: Video animations are increasingly available in education but without systematic evaluation. This review aimed to collate trials of animations versus other delivery, in student or qualified healthcare practitioners. Methods: Included studies had the following features: controlled design with random or quasi-random allocation; student or qualified healthcare practitioners; comparing video animation with another format (e.g. textbook, lecture, static images); animation delivered instead of, or in addition to, another format. The primary outcome was knowledge; secondary outcomes were attitudes and cognitions, and behaviours. Multiple databases were searched from 1996-October 2022 using a defined strategy. We also undertook citation searching. Dual, independent decision-making was used for inclusion assessment, data extraction, and quality appraisal. Included studies were appraised using the Cochrane ROB2 tool. Findings were reported using narrative synthesis. Results: We included 13 studies: 11 recruited student practitioners, two recruited qualified practitioners, total n= 1068. Studies evaluated cartoon animations or 2D/3D animations. Knowledge was assessed in ten studies, showing greater knowledge from animations in eight studies. Attitudes and cognitions were assessed in five studies; animations resulted in positive outcomes in three studies, no difference in one study, and worse outcomes in one study. Behaviours were assessed in three studies, animations producing positive outcomes in two studies and there was no difference in one study. Overall risk of bias was ‘high’ in ten studies and ‘some concerns’ in three. Discussion: Overall the evidence base is small with mostly ‘high’ risk of bias. Video animations show promise in practitioner education, particularly for effects on knowledge, but bigger, better research is needed.

BackgroundThe use of patient-facing health technologies to manage long-term conditions is increasing; however, children and young people may have particular concerns or needs before deciding to use different health technologies.AimsTo identify children and young people’s reported concerns or needs in relation to using health technologies to self-manage long-term conditions.MethodsA scoping review was conducted. We searched MEDLINE, PsycINFO and CINAHL in February 2019. Searches were limited to papers published between January 2008 and February 2019. We included any health technology used to manage long-term conditions. A thematic synthesis of the data from the included studies was undertaken. We engaged children with long-term conditions (and parents) to support review design, interpretation of findings and development of recommendations.ResultsThirty-eight journal articles were included, describing concerns or needs expressed by n=970 children and/or young people aged 5–18 years. Most included studies were undertaken in high-income countries with children aged 11 years and older. Studies examined concerns with mobile applications (n=14), internet (n=9), social media (n=3), interactive online treatment programmes (n=3), telehealth (n=1), devices (n=3) or a combination (n=5). Children and young people’s main concerns were labelling and identity; accessibility; privacy and reliability; and trustworthiness of information.DiscussionThis review highlights important concerns that children and young people may have before using technology to self-manage their long-term condition. In future, research should involve children and young people throughout the development of technology, from identifying their unmet needs through to design and evaluation of interventions.

The electrical double layer (EDL), consisting of two parallel layers of opposite charges, is foundational to many interfacial phenomena and unique in atomically thin materials. An important but unanswered question is how the “transparency” of atomically thin materials to their substrates influences the formation of the EDL. Here, we report that the EDL of graphene is directly affected by the surface energy of the underlying substrates. Cyclic voltammetry and electrochemical impedance spectroscopy measurements demonstrate that graphene on hydrophobic substrates exhibits an anomalously low EDL capacitance, much lower than what was previously measured for highly oriented pyrolytic graphite, suggesting disturbance of the EDL (“disordered EDL”) formation due to the substrate-induced hydrophobicity to graphene. Similarly, electrostatic gating using EDL of graphene field-effect transistors shows much lower transconductance levels or even no gating for graphene on hydrophobic substrates, further supporting our hypothesis. Molecular dynamics simulations show that the EDL structure of graphene on a hydrophobic substrate is disordered, caused by the disruption of water dipole assemblies. Our study advances understanding of EDL in atomically thin limit.

This article discusses the challenges of visually representing pain qualities in pictogram design. An existing set of 12 pictograms designed for people with literacy problems was evaluated to understand more about misunderstandings of pictogram interpretation. Two sets of university students from different disciplines were asked to interpret the pictograms, and a novel classification system was developed to categorise answer types, as ‘location’, ‘affective’, temporal’ or ‘literal’. Several design recommendations are made as a result that will help improve the design of pain pictograms as a whole as well as guide designers of related pictogram work. We demonstrate how, through the robust classification of incorrect responses, it is possible to extract useful comprehension error patterns to inform future design.

Background: In the European Union (EU), all medicines are mandated to be provided with a patient information leaflet (PIL). Many patients express concerns about the length and complexity of some PILs, and this can be a disincentive for patients to read the PILS. In order to address this, the UK’s regulatory body (Medicine and Healthcare products Regulatory Agency [MHRA]) suggested leaflets might include a headline section—information presented prominently at the beginning of a leaflet that summarizes key safety messages about a drug. Objective: To explore the extent to which readers used a headline section in a PIL, using a form of diagnostic testing called user-testing, which examines how readers find and understand key information. Methods: The study used a cross-sectional design to user-test a PIL with a headline section in a target sample of 20 participants. Participants were provided with an exemplar PIL, and the performance of the PIL was evaluated by a questionnaire and semistructured interview. Results: The results showed that a headline section was used just over one-third of the time (39%); 90% of participants used the headline section to find information when they initially began the user-test. The qualitative findings suggested that the participants valued the presence of the headline section. Conclusion: The research suggests there does not appear to be any negative impact from including a headline section in a PIL, and it is a technique that is highly valued by the consumers of medicines information.

Background: In the European Union (EU), all medicines are mandated to be provided with a patient information leaflet (PIL). Many patients express concerns about the length and complexity of some PILs, and this can be a disincentive for patients to read the PILS. In order to address this, the UK’s regulatory body (Medicine and Healthcare products Regulatory Agency [MHRA]) suggested leaflets might include a headline section—information presented prominently at the beginning of a leaflet that summarizes key safety messages about a drug.Objective: To explore the extent to which readers used a headline section in a PIL, using a form of diagnostic testing called user-testing, which examines how readers find and understand key information.Methods: The study used a cross-sectional design to user-test a PIL with a headline section in a target sample of 20 participants. Participants were provided with an exemplar PIL, and the performance of the PIL was evaluated by a questionnaire and semistructured interview.Results: The results showed that a headline section was used just over one-third of the time (39%); 90% of participants used the headline section to find information when they initially began the user-test. The qualitative findings suggested that the participants valued the presence of the headline section.Conclusion: The research suggests there does not appear to be any negative impact from including a headline section in a PIL, and it is a technique that is highly valued by the consumers of medicines information.

Chronic pain is common and difficult for patients to communicate to health professionals. It may include neuropathic elements which require specialised treatment. A little used approach to communicating the quality of pain is through the use of images. This study aimed to test the ability of a set of 12 images depicting different sensory pain qualities to successfully communicate those qualities. Images were presented to 25 student nurses and 38 design students. Students were asked to write down words or phrases describing the quality of pain they felt was being communicated by each image. They were asked to provide as many or as few as occurred to them. The images were extremely heterogeneous in their ability to convey qualities of pain accurately. Only 2 of the 12 images were correctly interpreted by more than 70% of the sample. There was a significant difference between the two student groups, with nurses being significantly better at interpreting the images than the design students. Clearly, attention needs to be given not only to the content of images designed to depict the sensory qualities of pain but also to the differing audiences who may use them. Education, verbal ability, ethnicity and a multiplicity of other factors may influence the understanding and use of such images. Considerable work is needed to develop a set of images which is sufficiently culturally appropriate and effective for general use.

The desire for continuously gaining new knowledge in astronomy has pushed the frontier of engineering methods to deliver lighter, thinner, higher quality mirrors at an affordable cost for use in an x-ray observatory. To address these needs, we have been investigating the application of magnetic smart materials (MSMs) deposited as a thin film on mirror substrates. MSMs have some interesting properties that make the application of MSMs to mirror substrates a promising solution for making the next generation of x-ray telescopes. Due to the ability to hold a shape with an impressed permanent magnetic field, MSMs have the potential to be the method used to make light weight, affordable x-ray telescope mirrors. This paper presents the experimental setup for measuring the deformation of the magnetostrictive bimorph specimens under an applied magnetic field, and the analytical and numerical analysis of the deformation. As a first step in the development of tools to predict deflections, we deposited Terfenol-D on the glass substrates. We then made measurements that were compared with the results from the analytical and numerical analysis. The surface profiles of thin-film specimens were measured under an external magnetic field with white light interferometry (WLI). The analytical model provides good predictions of film deformation behavior under various magnetic field strengths. This work establishes a solid foundation for further research to analyze the full three-dimensional deformation behavior of magnetostrictive thin films.

Scrotal varicoceles, which are relatively common, are sometimes caused by venous flow disturbance resulting from a renal or retroperitoneal tumour. Consequently, it is common practice to perform extended renal and retroperitoneal scans following varicocele identification. The aim of this systematic review was to determine the extent of the co-association between renal or retroperitoneal tumours and scrotal varicoceles using primary research literature. We conducted a search of 11 electronic databases; hand-searched five relevant textbooks; and conducted forward- and backward-citation searches of included articles. Articles that were included were assessed for research quality and data extracted. Twenty-four articles were found, comprising 19 case reports and five case series, reporting 35 cases in total. All cases had both a varicocele and a tumour (renal, retroperitoneal or other). We found no cohort or case–control studies. In conclusion, case reports and case series are susceptible to significant publication bias and the lack of any cohort or case–control studies meant that it was not possible to establish the extent of the co-association between renal or retroperitoneal tumours and scrotal varicoceles. It was not possible to estimate the value of conducting an extended scan in patients with scrotal varicoceles. Research is needed, particularly of a cohort or case-control design and including a robust sampling method, to examine the extent of any co-association. Meanwhile, extended renal or retroperitoneal scans should be undertaken when diagnosing all varicoceles, regardless of patient age, until this research is completed.

Psychological disorders are recognized as an important and common problem after stroke but little is known about their longer-term effects on functional outcomes. We investigated the trajectory of psychological symptoms after stroke and studied their impact on physical functional recovery.

ObjectiveTo evaluate the content and presentation of websites accessed by the public for information about two non‐steroidal anti‐inflammatory drugs, ibuprofen and naproxen. To assess the accuracy and completeness of website content compared with official patient leaflets, and assess the quality of presentation of each site.

BACKGROUND Patients' ability to understand information about medication is crucial for safety and effectiveness. Rates of illiteracy worldwide indicate that written information alone cannot meet many patients' needs. Medication pictograms are an alternative, but may be culturally sensitive. Previous testing has used large pictograms, which are impractical for conventional drug information formats.OBJECTIVE To compare 2 sets of pictograms for instructions or warnings (from the US and South Africa) for understandability by adults in the UK and examine the effects of pictogram size and repeat presentation on understandability among older adults.METHODS In the first part of the study, 160 adults (aged 17–83 y) reviewed and interpreted 10 pictograms. In the second, 67 older adults (aged 65–96 y) were randomly assigned to review 10 small or large pictograms. After giving their interpretation, they were informed of the correct meaning. One week later, they were shown the same pictograms and gave their interpretation.RESULTS The pictograms for the 10 different instructions and warnings showed great variation in interpretation rates (7.5–90%), with few significant differences between the US and South African versions. Only 3 were understood by ≥85% of the population. Pictograms performed significantly better if they were larger and at the second presentation.CONCLUSIONS Pictograms have the potential to help patients understand information on drug therapy. This study shows that some existing pictograms are not easily interpreted and that testing is needed before their implementation. A reduction in their size to allow incorporation into conventional written formats may cause additional problems for patients.

Background A 45-year-old man presented with repeated awakenings at night caused by nocturnal painful erections, in sharp contrast with normal erections at other times, 2 years after surgical removal of a thoracic (Th6–7) ependymoma.Investigations Physical examination, pharmaco-sensitized penile Doppler ultrasound, spinal and brain MRI, neurophysiological work-up (tibial and perineal somatosensory-evoked potential; hand, foot and perineal sympathetic skin response assessment), polysomnography with recording of nocturnal penile tumescence.Diagnosis Sleep-related painful erections, characterized by penile pain during nocturnal erection, typically during rapid eye movement sleep, in the presence of a residual thoracic spinal cord syndrome.Management Amitriptyline, an antidepressant that suppresses rapid eye movement sleep, was ineffective. Treatments with other antidepressants, clozapine and beta-blockers were suggested, but the patient declined because of potential severe side effects.

We evaluate the efficacy and safety of tadalafil, taken as needed, in men with mild to severe erectile dysfunction (ED) and assess sexual intercourse attempt patterns.

Pudendal nerve stimulation is known to have a potential modulative effect on bladder function. However, even if its efficiency has been established for various neurogenic and non-neurogenic bladder dysfunctions, the underlying neuronal mechanism, and the involved pathways in humans remain unknown. In this prospective study we focused on the effects of pudendal nerve stimulation in complete spinal cord injured patients to identify neuromodulative processes that occur on spinal level. Twenty complete spinal male presenting with upper motor neuron lesion and neurogenic incontinence underwent pudendal nerve stimulation. Bladder, bladder neck (BN), and external urethral sphincter (EUS) pressures were continuously recorded with a three channel microtip pressure transducer catheter. Fifty six pudendal stimulations using biphasic rectangular impulses (0.2 ms, 10 Hz) with intensities up to 100 mA were applied to the dorsal penile nerve. In six patients, 18 stimulations were repeated after intravenous (i.v.) administration of 7 mg phentolamine. Mean BN and EUS pressure increased during stimulation significantly (P < 0.001). The latencies to the EUS responses range between 27 and 41 ms and those to the BN responses between 188 and 412 ms. Phentolamine decreased initial BN pressure and reduced the pressure rise during stimulation significantly (P < 0.05). Pudendal nerve stimulation evoked somatic responses in the EUS and autonomic responses in the smooth muscle sphincter controlling the BN. Longer latencies of the BN responses and the sensitivity to the α-blocking agent phentolamine suggest that sympathetic α-adrenergic fibers are involved. Somatic afferent fibers of the pudendal nerve are supposed to project on sympathetic thoracolumbar neurons to the BN and modulate their function. This neuromodulative effect works exclusively at the spinal level and appears to be at least partly responsible for BN competence and at least continence. Neurourol. Urodynam. 22:597–601, 2003. © 2003 Wiley-Liss, Inc.

The value of sacral magnetic stimulation (SMS) in neurophysiological evaluation of the sacral efferent pathways of the lower urinary tract was assessed during urodynamic examination in 10 men with chronic suprasacral spinal cord injury (SCI) and in 7 healthy volunteers. Investigated parameters included latency and amplitude of the urodynamic pressure response of the external urethral sphincter and detrusor to different stimulation strengths (50–100%) and single or repetitive (20 and 30 Hz) stimuli. Following SMS, reproducible external urethral sphincter pressure responses (mean latency, 13 ms) were recorded in all subjects. In contrast, a detrusor pressure increase was recorded only in SCI patients after repetitive SMS, with a latency of 1–2 s. This implies the appearance of a polysynaptic spinal reflex due to changes in organization of the sacral micturition reflex after SCI. The method of SMS may be helpful for the evaluation of cases in which urodynamic studies remain inconclusive. © 2002 Wiley Periodicals, Inc. Muscle Nerve 26: 486–491, 2002

Objectives— To assess the general public's interpretation of the verbal descriptors for side effect frequency recommended for use in medicine information leaflets by a European Union (EU) guideline, and to examine the extent to which differences in interpretation affect people's perception of risk and their judgments of intention to comply with the prescribed treatment.

The aim of this study was to evaluate the relaxant effect of two preparations (BOTOX® versus Dysport®) of botulinum toxin type A (BTX‐A) on the external urethral sphincter in patients with neurogenic voiding disorders. Ten male spinal cord injury patients with detrusor‐ external urethral sphincter dyssynergia (DSD) were clinically assessed before, and 4–6 weeks after, transurethral or transperineal BTX‐A injections (BOTOX® 100 U or Dysport® 250 U) into the external urethral sphincter. Patients with persistent difficulties in voiding or high post‐void residual volumes were re‐injected with the same product up to three times. All patients were urodynamically examined within 120 days of injection. In total, 30 BTX‐A injection cycles (one to three injections) were administered. Significant (P< 0.05) reductions in the DSD duration post‐injection, the time interval between the start of bladder contractions and voiding, and DSD seventy post‐treatment were observed. All patients who presented with a residual volume pre‐treatment showed a marked decrease post‐treatment. These effects lasted 6 months. Improvements in urodynamic parameters were significantly better following BOTOX® than DysporP treatment (P< 0.05), although the Dysport® dose used is now considered less potent than that of BOTOX®. Thus, injections of BTX‐A into the external urethral sphincter are a valuable treatment option for DSD in spinal cord injury patients. Treatment success appears to depend on the seventy of DSD before treatment.

Percutaneous nephrostolithotomy with or without extracorporeal shock wave lithotripsy (ESWL*) has been extensively used in the management of staghorn calculi, with stone-free rates varying from 23 to 86%. Explanations for the variability of such results include differences in stone burden, differences in percutaneous techniques and an overreliance on ESWL. The results and changing trends in the relative roles of percutaneous nephrostolithotomy and ESWL in the management of staghorn calculi at the Methodist Hospital of Indiana were examined. We reviewed 343 cases of staghorn calculi (partial and complete) with adequate followup data, which were managed with initial percutaneous nephrostolithotomy. Cases were divided into 2 groups: group 1 (252 cases) from 1984 to 1987 when access was performed by a radiologist and group 2 (91 cases) from 1988 to 1990 when access was performed by a urologist.

Subcapsular or perirenal bleeding is the most commonly experienced adverse effect directly attributable to externally applied shock waves. The first consecutive 3,620 extracorporeal shock wave lithotripsy treatments with the HM3 Dornier lithotriptor at our institution resulted in 24 hematomas in 21 patients, for an incidence of 0.66 per cent. Various factors associated with treatment were examined. The number of shock waves (up to 2,000) and voltage up to 24kv. did not correlate with the development of hematoma. Coagulation studies were normal in all patients with hematomas. There was no correlation of patient size and weight, or stone size, number or location with the occurrence rate of perinephric hematoma.

Thryistor technology has developed rapidly in Europe since its introduction, largely because about one-fifth of the electric power generated is consumed as dc power, and electric trains are so widely used.

This is the first report in the literature of an application of the rigorous symptom-context method for determining the nature of the psychological antecedents of petit mal EEG paroxysmal activity. The activity is defined by the presence of a 3 cycle/second spike and wave on the EEG which is recorded concurrently while the patient is speaking his thoughts freely during interviews. The content of the patient's speech before each petit mal episode is compared with the content of speech during non-paroxysmal periods. Three petit mal patients were examined in this way for four sessions each. (Total petit mal EEG paroxysms for patient no. 1 were 19, patient no. 2 were 25, and patient no. 3 were 55.) For the first patient, strong psychological antecedents were found before petit mal EEG paroxysms as compared with comparison periods from the same patient. These consisted of such usual negative affects as feeling depressed and blocked. For the two other patients, only a few psychological antecedents discriminated significantly and these were not of the same type across the three patients. We conclude that the patients differ in amount and type of psychological antecedents. The differences may be attributed to differences in the type of petit mal and/or differences in the psychological component to the petit mal. The differences among the patients are probably not related to the average length of the paroxysms since we have shown that the relationships with the duration were generally insignificant. The paroxysms occurred more often during the patient's silence than during the patient's speech (for two of the three patients) — talking probably requires more focused attention than silence; more focused attention or activity tends to reduce these episodes.

Analysis of our data clearly demonstrates that morbidity, secondary treatment, post-treatment manipulations, and failure of treatment increase as the stone size increases because of the increased stone fragment burden. Patients whose stone burden was less than 2 cm clearly had less morbidity. Composition of the stone may also alter the success of treatment (with cystine, calcium oxalate monohydrate, and brushite stones being resistant to treatment). However, post-treatment morbidity and complications were observed in all categories. Perirenal hematomas are unpredictable by current preoperative testing. Obstruction with pain can occur any time after treatment but usually occurs within the first 48 hours in the majority of patients. Only 1 per cent of our patients required hospitalization in another institution after discharge.