SEARCH · PubMed Health

Results for “DEXTERITY”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 469 records · Page 26Linked to original sources

PubMed1998

Objective evaluation of a laparoscopic surgical skill program for residents and senior surgeons.

BACKGROUND: Laparoscopic surgery adapts poorly to apprenticeship models for general surgical training. Standardized skill acquisition and validation programs, targeted performance goals, and a supervised, enforced, skill-based curriculum that readily can be shared between trainee and instructor must replace the observation and incremental skill-acquisition model used in an open surgical environment. The Yale Laparoscopic Skills and Suturing Program was used to develop a data bank for objective evaluation of dexterity and suturing skills for laparoscopic surgical training. The current study compares trainee and senior surgeon performance in this standardized training program. OBJECTIVE: To compare objectively evaluated laparoscopic surgical skills and suturing capability of senior surgeons and of residents after they have completed the same standardized training regimen. METHODS: Two hundred ninety-one trained surgeons performed 8730 standardized laparoscopic dexterity drills and 2910 intracorporeal suturing exercises in the Yale Laparoscopic Skills and Suturing Program. Their performance was supervised by an instructor who recorded performance and timing of the tasks in a 2 1/2-day program. Ninety-nine residents performed the same drills and exercises the same number of times and followed the same technique for intracorporeal suturing. Percentile graphs were prepared for each type of drill and suturing exercise to allow comparison of levels of achievement among different training groups. RESULTS: The performance of the residents was the same as that of trained surgeons for the rope pass drill and the suturing exercise. Residents in comparison with trained surgeons performed the triangle transfer drill faster and the new cup drop drill and old cup drop drill more slowly. There was no significant difference in performance between male and female residents. CONCLUSION: Basic skills relevant to laparoscopic performance can be acquired with a high level of competence in a brief course unrelated to prior surgical experience, sex, or age.

Adult↗

PubMed1996

Effect of puncture resistant surgical gloves, finger guards, and glove liners on cutaneous sensibility and surgical psychomotor skills.

New puncture and cut resistant hand protection systems have been developed to enhance the barrier to cuts and needle puncture injuries during surgical procedures. It is important, however, that these new hand protection systems do not reduce tactile sensitivity or dexterity during surgery. Consequently, it was the purpose of this report to compare the cutaneous sensibility and dexterity of physicians' hands covered by these new puncture and cut resistant hand protection systems to that of the standard surgical latex glove. The hide (Medak) portion of the Life Liner and the polyethylene (Spectra) portion of the FingGuard, which offered the greatest resistance to needle puncture, were associated with the greatest reduction in cutaneous sensibility, as determined by moving and static two-point discrimination, aesthesiometer pressure sensation, and discrimination of suture size and configuration. In addition, the physicians believed that the puncture and cut resistant Life Liner glove liner markedly interfered with their handling of surgical instruments. The ultimate benefit of these puncture and cut resistant hand protection systems must be determined in well-controlled clinical trials.

Discrimination, Psychological↗

PubMedDate not supplied

Perforation rate using a single pair of orthopedic gloves vs. a double pair of gloves in obstetric cases.

Our purpose was to determine the perforation rate for a single pair of orthopedic gloves vs. a double pair of regular gloves in obstetric cases. Faculty, residents, medical students, and surgical technicians were assigned randomly to use either double gloves or single orthopedic gloves. After each procedure, the gloves were examined by filling with water, occluding the cuff, and observing for streams of water. The perforation rate for the double gloves (both inner and outer glove at the same location) was 7% (12/169), similar to the 7% (12/172) for single orthopedic gloves (P < 0.9). After adjusting for procedure type there was no association between the type of gloves and perforation rate. Fifty-four percent of all perforations were not recognized intraoperatively. Of those individuals with glove perforations, 4/24 (17%) observed blood on the hand at the end of the procedure. Double-gloved users complained more frequently than single-gloved users of loss of dexterity (77/169, 46%, 95% CI 38-53%) vs. (6/172, 3.5%, 95% CI 0.7-6%) (P < 0.001) and numbness (12/169, 7%, 95% CI 3.2-11%) vs (1/172 0.6%, 95% CI 0.55-1.7%) (P < 0.005). Although the use of a single pair of orthopedic gloves is more costly than a double pair of regular gloves ($78 vs. $15 per box), it is as safe and as effective as a double pair of gloves in maintaining a sterile barrier. The primary advantage of a single pair of orthopedic gloves is that surgical dexterity is minimally compromised when compared to double gloves.

Equipment Failure↗

PubMed1980

Neurophysiological and psychological picture of solvent poisoning.

Neurophysiological and psychological tests were administered to 107 patients--48 men and 59 women--with a diagnosis of solvent poisoning after longstanding (mean 9.6 years for males and mean 7.6 years for females) occupational exposure. Electroencephalography (EEG) and a wide psychological test battery were applied in all cases, and electroneurographic measurements were performed in 77 subjects. Sixty-five percent of the patients showed an abnormal EEG, and excessive beta activity, not induced by drugs, was found in 54% of patients. At least one abnormally slow nerve conduction velocity (CV) was found in 48 out of 77 patients. The scores of Wechsler Adult Intelligence Scale (WAIS) subtests Digit Span (DSp) and Digit Symbol (DSy) among the men and scores of Similarities (Sim), Digit Symbol (DSy), Picture Completion (PC), and Block Design (BD) among the women were statistically significantly lower than in the Finnish standardization sample. Long duration of exposure was related to poor performance in the Santa Ana Dexterity test in both sexes, to poor visual memory among the men and to poor visuoconstructive intellectual tasks among the women. The background frequency in the EEG showed a correlation to the DSp test of WAIS and some relationship emerged also between the former and the BD, the Symmetry Drawing test, the Santa Ana Dexterity test, and the Mira test. Focal slow wave abnormalities were related to inaccurate hand movements in the psychomotor Mira test. Neurophysiological and psychological tests seem to reflect partly different aspects of neurologic effects and their combined use helps in the evaluation of hazards of solvent exposure.

Adult↗

PubMed2004

Meissner corpuscles and somatosensory acuity: the prehensile appendages of primates and elephants.

Meissner corpuscles (MCs) are specialized mechanoreceptors located exclusively in the papillae of glabrous skin. They are confined largely to cutaneous pads of the extremities and respond to transient, phasic, or vibratory stimuli. Though absent in most eutherian taxa, MCs are reported in all primates studied, being most developed in modern humans. The location of MCs between the internal ridges of the epidermis indicates they are well situated to detect friction or deformation at the external surface. Accordingly, MCs are hypothesized to provide primates generally with an enhanced tactile perception. However, the selective pressures favoring greater somatosensory acuity in primates are seldom considered. Interestingly, primate digital dexterity varies greatly. In general, dexterity improves with the extent to which foraging requires food manipulation or textural evaluation. This observation implies that MC density could vary accordingly. Here we report on the density of MCs in five anthropoid taxa selected to represent diverse dietary regimes. Results show that greater MC density correlates with the extent to which primates are frugivorous; however, locomotor and/or phylogenetic effects cannot be discounted.

Adaptation, Physiological↗

PubMed2004

A crossover trial of custom-made and commercially available wrist splints in adults with inflammatory arthritis.

OBJECTIVE: To compare the effect of 3 wrist splints (2 prefabricated commercial splints and 1 custom made) on perceived wrist pain, hand function, and perceived upper extremity function in adults with inflammatory arthritis. METHODS: Subjects (n = 45, mean age 49 years, mean disease duration 8.6 years) were randomly assigned to treatment order in a 3-phase crossover trial. Splints were worn for 4 weeks, separated by 1-week washouts. Outcomes were assessed at baseline, after each splint phase and washout period, and at 6 months' followup using a pain visual analog scale (VAS), the Arthritis Hand Function Test, and McMaster-Toronto Arthritis Patient Function Preference questionnaire. Data were analyzed with multivariate analyses of variance (MANOVAs), t-tests, and chi-square tests. RESULTS: There did not appear to be order or carryover effects. MANOVA indicated that wrist splints significantly reduced pain (P = 0.007). The custom leather splint was most effective in reducing pain, from 4.1 cm to 2.8 cm on the VAS (P = 0.001). All splints improved hand strength, and the commercial Rolyan splint provided significantly stronger grip than the Anatech commercial splint (P = 0.04). In contrast to previous studies, splints did not compromise dexterity. There were several significant differences among splints, depending on the outcome measure. Improvements were maintained at 6 months. CONCLUSION: After 4 weeks' use, wrist splints reduce pain, improve strength, and do not compromise dexterity. Similar improvements were achieved with the custom leather splint and Rolyan commercial splint, which were superior to the Anatech commercial splint.

Adult↗

PubMed2004

Content comparison of occupation-based instruments in adult rheumatology and musculoskeletal rehabilitation based on the International Classification of Functioning, Disability and Health.

OBJECTIVE: To compare the content of clinical, occupation-based instruments that are used in adult rheumatology and musculoskeletal rehabilitation in occupational therapy based on the International Classification of Functioning, Disability and Health (ICF). METHODS: Clinical instruments of occupational performance and occupation in adult rehabilitation and rheumatology were identified in a literature search. All items of these instruments were linked to the ICF categories according to 10 linking rules. On the basis of the linking, the content of these instruments was compared and the relationship between the capacity and performance component explored. RESULTS: The following 7 instruments were identified: the Canadian Occupational Performance Measure, the Assessment of Motor and Process Skills, the Sequential Occupational Dexterity Assessment, the Jebson Taylor Hand Function Test, the Moberg Picking Up Test, the Button Test, and the Functional Dexterity Test. The items of the 7 instruments were linked to 53 different ICF categories. Five items could not be linked to the ICF. The areas covered by the 7 occupation-based instruments differ importantly: The main focus of all 7 instruments is on the ICF component activities and participation. Body functions are covered by 2 instruments. Two instruments were linked to 1 single ICF category only. CONCLUSION: Clinicians and researchers who need to select an occupation-based instrument must be aware of the areas that are covered by this instrument and the potential areas that are not covered at all.

Activities of Daily Living↗

PubMed1989

The development and evaluation of a clinical test of surgical resident proficiency.

The two purposes of this study were to develop a clinical test of surgical resident proficiency and to compare this clinical test with currently applied methods of resident evaluation. Appendicitis is a common surgical disease, and its accurate diagnosis depends largely on clinical acumen. Ten third-year surgical residents prospectively evaluated 107 patients admitted because of suspected appendicitis. After taking a history, performing a physical examination, and reviewing laboratory data, these residents were asked to state, as a percentage, the likelihood that each patient had appendicitis. Sixty-three patients had appendicitis documented by pathologic inspection after appendectomy. Forty-four patients did not have appendicitis, as was determined by operation (17) or by in-house observation and resolution of abdominal pain (27). These outcomes were used to calculate a diagnostic ability score (DAS) for each resident. Residents were evaluated by standard methods including in-service examinations and monthly evaluations by the attending staff. Residents were also evaluated by nonstandard, but potentially useful, neuropsychologic and psychologic tests, including the trail making test, the Ravens progressive matrices test, the paced auditory serial addition test (PASAT), the grooved pegboard test of manual dexterity, and the profile of mood states (POMS) psychologic questionnaire. Cumulative scores were calculated and compared by multiple regression with coefficient variance analysis. The correlation (R2) of DAS with standard evaluation techniques was as follows: In-service (0.055), faculty (0.508), trails (-0.293), Ravens (0.028), PASAT (0.251), dexterity (0.432), POMS (0.381). We found that (1) the DAS is a discriminating clinical test; (2) the DAS correlates with subjective faculty evaluation; and (3) the DAS does not correlate with in-service examination scores. We conclude that faculty evaluation remains the best currently applied test of surgical resident clinical proficiency as measured by the DAS.

Adult↗

PubMed1985

Pitfalls in the diagnosis of tricuspid atresia: report of a new angiocardiographic sign.

Two patients with the classical clinical, angiographic, and echocardiographic signs of tricuspid atresia are reported, where the correct diagnoses were made at operation; one child had cor triatriatum dexter, the other child total anomalous systemic venous drainage to the left atrium. The literature on cor triatriatum dexter and total anomalous systemic venous drainage is discussed and a new angiographic sign for the differentiation from tricuspid atresia is reported: nonopacification of the right atrial appendage with right atrial angiocardiography.

Angiocardiography↗

PubMed2005

Motor coordination difficulties in a municipality group and in a clinical sample of poor readers.

The purpose of the study was to investigate incidence, severity and types of motor problems in two groups of poor readers compared to good reading controls. A group of children with severe dyslexia referred to specialist evaluation, a teacher selected municipality sample comprising the 5% poorest readers, and a control group consisting of the 5% best readers were all assessed applying a norm-based, standardized measure by Henderson and Sugden 1992; (The Movement Assessment Battery for Children. Kent: The Psychological Corporation). The three groups were compared with regard to total motor impairment scores as well as motor function within the areas of manual dexterity, ball-skills and balance. More than 50% of the children in both groups of poor readers showed definite motor coordination difficulties at or below the 5th centile, for which motor intervention is recommended. Children in both groups showed difficulties within the sub-area of manual dexterity in particular and also performed significantly worse than controls within the sub-area of balance, but not in ball-skills. The high incidence of motor coordination problems in the two groups of poor readers indicates that all children with reading difficulties should be screened for possible motor difficulties.

Child↗

PubMed1980

Promotion of hematopoietic stem cell differentiation in vitro by a soluble mediator, allogeneic effect factor.

This study was designed to investigate the effects of allogenic effect factor (AEF), a soluble mediator derived from short-term mixed lymphocyte cultures (MLC) of in vitro alloantigen-primed T cells, on cultures of murine bone marrow cells. Cultures established under suboptimal conditions namely, in the absence of a pre-established adherent cell layer as required in conventional Dexter-type cultures--declined and lost their stem cell activity rapidly. In contrast, supplementation of these cultures, at initiation and thereafter, with AEF, but not with T cell growth factor (TCGF), induced cell growth and proliferation for several weeks. Such AEF-supplemented cultures exhibited cellular heterogeneity and stem cell activity for significantly longer periods than the control cultures. Even in conventional Dexter cultures, established under optimal conditions, AEF had a beneficial effect on cellular growth and proliferation and myeloid progenitor cell (CFU-C) activity. Furthermore, cell capable of synergizing with suboptimal numbers of mature T cells in con A-induced mitogenic responses, shown by others to be pre-T cells, were detected in the AEF-supplemented cultures for several weeks.

Animals↗

PubMed2007

Effects of unilateral subthalamic and pallidal deep brain stimulation on fine motor functions in Parkinson's disease.

Deep brain stimulation (DBS) is an effective treatment for selected patients with disabling Parkinson's disease (PD). The two main targets are the subthalamic nucleus (STN) and the globus pallidus internus (GPi), although it has not been established whether stimulation at one target is superior to the other. This prospective randomized study assessed the effects of unilateral DBS of the STN versus GPi on fine motor skills in 33 patients with advanced PD. Stimulation of either the STN (18 subjects) or GPi (15 subjects) in the off medication state significantly improved movement time and dexterity, but had little or no effect on reaction time. Overall, the extent of improvement did not differ between the two targets. The degree of improvement in movement time, but not dexterity, was correlated with the extent of preoperative medication responsiveness. Our findings suggest that DBS of the STN or GPi results in a similar improvement in hand movements at short-term follow-up. Preoperative medication responsiveness predicts improvement in some but not other motor tasks.

Adult↗

PubMed1995

Tenascin-C induction in Whitlock-Witte culture: a relevant role of the thiol moiety in lymphoid-lineage differentiation.

The extracellular matrix (ECM) glycoprotein tenascin-C is expressed in a temporally and spatially restricted pattern during embryogenesis and carcinogenesis in association with stromal-epithelial interactions. First, we investigated the production of tenascin-C and other ECM glycoproteins in the established in vitro model system specific for the lymphoid-lineage hemopoiesis, i.e., the Whitlock-Witte (W-W) culture system. In murine primary long-term bone marrow cultures, tenascin-C was produced constitutively and was expressed significantly in higher amounts in this system than in the other established in vitro model system specific for the myeloid-lineage hemopoiesis, i.e., the Dexter culture system. 2-Mercaptoethanol (2-ME), a component of the W-W system, induced the secretion of tenascin-C and upregulated the expression of its mRNA. Furthermore, the reduced glutathione, which, like 2-ME, contains a thiol moiety, induced tenascin-C glycoprotein and its mRNA. By contrast, hydrocortisone (HC), a component of the Dexter system, inhibited the secretion of ECM glycoproteins. 2-ME and TGF-beta 1, the latter of which is known as an inducer of ECM glycoproteins, had an additive effect on the induction of tenascin-C when they were simultaneously added to the W-W system. The TGF-beta receptor binding analysis demonstrated that this induction by 2-ME was not mediated by the cell-surface TGF-beta receptors, suggesting that it was regulated independently of TGF-beta 1. Then, the role of thiol compounds in the lymphoid-lineage differentiation was examined. The omission of 2-ME from the W-W system completely eliminated its ability to support the lymphoid-lineage differentiation. Glutathione, which, unlike 2-ME, does not passively permeate through the plasma membrane, did not support the development of a lymphoid lineage. These results indicate that 2-ME, essential for the lymphoid-lineage differentiation in the W-W culture system, is a potent inducer of tenascin-C expression in vitro.

Animals↗

PubMed1985

Morphologic analysis of long-term bone marrow cultures that support B-lymphopoiesis or myelopoiesis.

A comparative morphological analysis of the Whitlock-Witte long-term B-cell culture and the predominantly myeloid Dexter long-term bone marrow culture demonstrates that similarities and differences exist between the two systems. Cells from the long-term B-cell cultures have a characteristic lymphoid morphology, whereas those from the Dexter cultures are predominantly granulocytes and macrophages along with a few undifferentiated blast cells. A multilayered stromal cell layer is a common feature of both systems. Scanning electron micrographs show the cells in this layer to be large, irregularly shaped and flattened. The data further indicate that there are unique features in the relationship between developing B cells and stromal cells in the long-term B-cell cultures. Large, mononuclear cells are present that have numerous membrane infoldings within which numerous lymphoid cells lie. The relationship of these cells to macrophages and epithelial/reticular cells is discussed.

Animals↗

PubMed1984

Effect of loprazolam and of triazolam on psychological functions.

Twelve poor sleepers of mean age 52 years performed 2 h of laboratory tests three times on 1 day during each week of nightly intake of loprazolam 0.5 mg, loprazolam 1 mg, triazolam 0.5 mg, or continued placebos. Only in the mornings did loprazolam 1 mg cause impairment in manual dexterity and card-sorting, and triazolam 0.5 mg in manual dexterity. Using difference from baseline, withdrawal of either drug after 3 weeks was associated with poorer subjective quality of sleep than following continuing placebos. The rate of spontaneous complaints (including accidents) associated with the drugs was as informative as formal testing.

Adult↗

PubMed1980

Increasing hand efficiency at cold temperatures by training hand vasodilation with a classical conditioning-biofeedback overlap design.

The prolonged exposure of hands to cold environments leads to substantial cold pain and severe deterioration of manual dexterity, finger dexterity, hand strength, and tactile sensitivity. This study taught volunteers to warm their hands at -14 degrees Celsius and measured the hand efficiency effects. The subjects were six male and female nonsmoking volunteers. All research was conducted in a cold chamber during the warm summer months to eliminate seasonal factors. A combined multiple-baseline/ABA single-subject design with multiple replications was used. Each subject's hand performance was obtained for both hands in warm and in cold conditions. One hand was trained and both hands were retested in the cold. The second hand was trained and both hands were retested in the cold. Finally, the subject inhibited warming while in the cold (treatment removal) and both hands were tested again. The treatment itself used biofeedback instrumentation to extend and enlarge previously classically conditioned vasodilative episodes. The procedure was found to be effective for bringing about temperature changes in the cold. Large treatment effects were found on all hand efficiency measures. The results suggest wide implications for the workplace, for theory, and for future research.

Acclimatization↗

PubMedDate not supplied

Distal upper extremity function following proximal humeral resection and reconstruction for tumors: contralateral comparison.

BACKGROUND: Most functional analyses after limb salvage operations about the shoulder have focused on proximal function with the assumption that distal function is largely unaffected. This analysis examines distal function objectively. METHODS: Objective laboratory data regarding distal upper extremity strength after reconstructive procedures for tumors near the shoulder joint was collected over a 16-year period. Thirty-two patients were able to participate fully in the data collection at an average most recent follow-up duration of > 3.5 years. RESULTS: Statistically significant reductions on the involved side compared with the uninvolved side in grip, forearm pronation, forearm supination, elbow flexion, and elbow extension strength were documented (p < 0.05). The magnitude of reduction in strength diminishes distally, with the greatest effect in this group of patients being observed in elbow extension, followed by elbow flexion, forearm supination, and forearm pronation. Grip strength consistently showed the least amount of strength reduction compared with the uninvolved side, even within resection and reconstruction groups. Subjective patient rating of dexterity was no less than 3 of 5. Ninety percent of patients rated their dexterity 4 of 5 (52%) or 5 of 5 (38%). CONCLUSIONS: Despite the insistence of "normal" function in the distal upper extremity after limb salvage procedures, complete normality is not maintained. However, the degree of maintenance of distal function appears to be high, especially for grip strength and forearm pronation strength, and patient satisfaction is acceptable.

Adolescent↗

PubMed1999

Effects of chronic median nerve compression at the wrist on sensation and manual skills.

The aim of this study was to analyse the functional impairments caused by chronic median nerve compression at the wrist on hand sensation and manual skill. Hand function was assessed in 11 patients (8 women and 3 men) with severe carpal tunnel syndrome (CTS) and compared with that of an age- and sex-matched control group. Apart from CTS, the subjects were healthy and the electrodiagnostic examination was normal. The pressure and vibration detection thresholds of the index finger were partially impaired and statistically different (P<0.05) when compared with controls, suggesting a reduction of tactile acuity in the territory of the median nerve. The thermal thresholds were identical in both groups, suggesting that the small-diameter fibres were not affected. When a small object was lifted and positioned in space, the coordination between the grip force and the vertical lifting force did not seem to be affected in our patients. They were able to modify their grip force according to the friction between the fingertips and the object, i.e. the more slippery the object, the higher the grip force. The unimanual Purdue Pegboard subtest results suggest that digital dexterity was also not significantly perturbed in our sample of CTS patients when compared with controls. Despite the severe abnormalities of median nerve conduction, our results suggest that chronic median nerve compression occurring in CTS induces partial impairment of tactile sensibility with minor impact on grasp force regulation and digital dexterity.

Carpal Tunnel Syndrome↗