'Sorry I meant the patient's left side': impact of distraction on right/left discrimination

Context Medical students can have difficulty in distinguishing left from right. Many infamous medical errors have occurred when a procedure has been performed on the wrong side, such as in the removal of the wrong kidney. Clinicians encounter many distractions during their work. There is limited information on how these affect performance. 
Objectives Using a neuropsychological paradigm, we aim to elucidate the impacts of different types of distraction on left–right (LR) discrimination ability. 
Methods Medical students were recruited to a study with four arms: (i) control arm (no distraction); (ii) auditory distraction arm (continuous ambient ward noise); (iii) cognitive distraction arm (interruptions with clinical cognitive tasks), and (iv) auditory and cognitive distraction arm. Participants’ LR discrimination ability was measured using the validated Bergen Left–Right Discrimination Test (BLRDT). Multivariate analysis of variance was used to analyse the impacts of the different forms of distraction on participants’ performance on the BLRDT. Additional analyses looked at effects of demographics on performance and correlated participants’ self-perceived LR discrimination ability and their actual performance. 
Results A total of 234 students were recruited. Cognitive distraction had a greater negative impact on BLRDT performance than auditory distraction. Combined auditory and cognitive distraction had a negative impact on performance, but only in the most difficult LR task was this negative impact found to be significantly greater than that of cognitive distraction alone. There was a significant medium-sized correlation between perceived LR discrimination ability and actual overall BLRDT performance. 
Conclusions
Distraction has a significant impact on performance and multifaceted approaches are required to reduce LR errors. Educationally, greater emphasis on the linking of theory and clinical application is required to support patient safety and human factor training in medical school curricula. Distraction has the potential to impair an individual's ability to make accurate LR decisions and students should be trained from undergraduate level to be mindful of this.

3-T direct MR arthrography of the wrist: value of finger trap distraction to assess intrinsic ligament and triangular fibrocartilage complex tears.

PURPOSE: To determine the value of applying finger trap distraction during direct MR arthrography of the wrist to assess intrinsic ligament and triangular fibrocartilage complex (TFCC) tears. MATERIALS AND METHODS: Twenty consecutive patients were prospectively investigated by three-compartment wrist MR arthrography. Imaging was performed with 3-T scanners using a three-dimensional isotropic (0.4 mm) T1-weighted gradient-recalled echo sequence, with and without finger trap distraction (4 kg). In a blind and independent fashion, two musculoskeletal radiologists measured the width of the scapholunate (SL), lunotriquetral (LT) and ulna-TFC (UTFC) joint spaces. They evaluated the amount of contrast medium within these spaces using a four-point scale, and assessed SL, LT and TFCC tears, as well as the disruption of Gilula's carpal arcs. RESULTS: With finger trap distraction, both readers found a significant increase in width of the SL space (mean Δ = +0.1mm, p ≤ 0.040), and noticed more contrast medium therein (p ≤ 0.035). In contrast, the differences in width of the LT (mean Δ = +0.1 mm, p ≥ 0.057) and UTFC (mean Δ = 0mm, p ≥ 0.728) spaces, as well as the amount of contrast material within these spaces were not statistically significant (p = 0.607 and ≥ 0.157, respectively). Both readers detected more SL (Δ = +1, p = 0.157) and LT (Δ = +2, p = 0.223) tears, although statistical significance was not reached, and Gilula's carpal arcs were more frequently disrupted during finger trap distraction (Δ = +5, p = 0.025). CONCLUSION: The application of finger trap distraction during direct wrist MR arthrography may enhance both detection and characterisation of SL and LT ligament tears by widening the SL space and increasing the amount of contrast within the SL and LT joint spaces.

Nouveautés dans l'ostéogenèse imparfaite: de la recherche à la prise en charge multidisciplinaire [News in osteogenesis imperfecta: from research to clinical management]

Osteogenesis imperfecta (OI) is a rare genetic disease. Today we are able to propose an adapted and efficient management to the patients with this rare disorder (and their families) thanks to a strong collaboration of clinicians and researchers. Recent knowledge regarding the genetics of OI permits an accurate diagnosis of the specific type of OI and its own molecular mechanism, a genetic counseling for family planning and prenatal diagnosis, and in addition more targeted therapeutic options. A specific support with re-education for patients with OI is necessary and efficient. To optimize patient care, a multidisciplinary consultation is proposed at the CHUV, moreover a web site is available for patients, families and therapists: www.infomaladiesrares.ch

Arrêt du conseil d'Etat qui ordonne que des 500000 liv. d'augmentations de gages créées par édit d'octobre 1710 distraction sera faite de 797 l. 6 s. 1 d. pour être distribués aux offices de conseillers-secrétaires de S. M. et autres officiers des chancelleries établies près les parlements, cours supérieures et présidiaux du royaume en exécution de l'Edit du mois d'oct. 1704

[Acte. 1711-10-20. Versailles]

Effect of osteogenesis imperfecta on orthodontic tooth movement in a mouse model

Thesis written in co-mentorship with director: Nelly Huynh; co-directors: Frank Rauch and Jean-Marc Retrouvey; collaborators: Clarice Nishio, Duy-Dat Vu and Nathalie Alos

Reverberant auditory environments: the effects of multiple echoes on distraction by 'irrelevant' speech

Two experiments examine the effect on an immediate recall test of simulating a reverberant auditory environment in which auditory distracters in the form of speech are played to the participants (the 'irrelevant sound effect'). An echo-intensive environment simulated by the addition of reverberation to the speech reduced the extent of 'changes in state' in the irrelevant speech stream by smoothing the profile of the waveform. In both experiments, the reverberant auditory environment produced significantly smaller irrelevant sound distraction effects than an echo-free environment. Results are interpreted in terms of changing-state hypothesis, which states that acoustic content of irrelevant sound, rather than phonology or semantics, determines the extent of the irrelevant sound effect (ISE). Copyright (C) 2007 John Wiley & Sons, Ltd.

Auditory distraction from low-intensity noise: a review of the consequences for learning and workplace environments

The 'irrelevant sound effect' in short-term memory is commonly believed to entail a number of direct consequences for cognitive performance in the office and other workplaces (e.g. S. P. Banbury, S. Tremblay, W. J. Macken, & D. M. Jones, 2001). It may also help to identify what types of sound are most suitable as auditory warning signals. However, the conclusions drawn are based primarily upon evidence from a single task (serial recall) and a single population (young adults). This evidence is reconsidered from the standpoint of different worker populations confronted with common workplace tasks and auditory environments. Recommendations are put forward for factors to be considered when assessing the impact of auditory distraction in the workplace. Copyright (c) 2005 John Wiley & Sons, Ltd.

Analyzing the meaning of background speech is obligatory, distraction by meaning is not

The effects of background English and Welsh speech on memory for visually-presented English words were contrasted amongst monolingual English speakers and bilingual Welsh-English speakers. Equivalent disruption to the English language task was observed amongst Welsh-speaking bilinguals from both English and Welsh speech, but English-speaking monolinguals displayed less disruption from the Welsh speech. An effect of the meaning of the background speech was therefore apparent amongst bilinguals even when the focal memory task was presented in a different language from the distracting speech. A second experiment tested only English-speaking monolinguals, using English as background speech, but varied the demands of the focal task. Participants were asked either to count the number of vowels in words visually presented for future recall, or to rate them for pleasantness, before subsequently being asked to recall the words. Greater disruption to recall was observed from meaningful background speech when participants initially rated the words for pleasantness than when they initially counted the vowels within the words. These results show that background speech is automatically analyzed for meaning, but whether the meaning of the background speech causes distraction is critically dependent upon the nature of the focal task. The data underscore the need to consider not only the nature of office noise, but also the demands and content of the work task when assessing the effects of office noise on work performance.

Lexical access across languages: a multinomial model of auditory distraction

Recall in many types of verbal memory task is reliably disrupted by the presence of auditory distracters, with verbal distracters frequently proving the most disruptive (Beaman, 2005). A multinomial processing tree model (Schweickert, 1993) is applied to the effects on free recall of background speech from a known or an unknown language. The model reproduces the free recall curve and the impact on memory of verbal distracters for which a lexical entry exists (i.e., verbal items from a known language). The effects of semantic relatedness of distracters within a language is found to depend upon a redintegrative factor thought to reflect the contribution of the speech-production system. The differential impacts of known and unknown languages cannot be accounted for in this way, but the same effects of distraction are observed amongst bilinguals, regardless of distracter-language.

Auditory distraction eliminates retrieval induced forgetting: implications for the processing of unattended sound

The Retrieval-Induced Forgetting (RIF) paradigm includes three phases: (a) study/encoding of category exemplars, (b) practicing retrieval of a sub-set of those category exemplars, and (c) recall of all exemplars. At the final recall phase, recall of items that belong to the same categories as those items that undergo retrieval-practice, but that do not undergo retrieval-practice, is impaired. The received view is that this is because retrieval of target category-exemplars (e.g., ‘Tiger’ in the category Four-legged animal) requires inhibition of non-target category-exemplars (e.g., ‘Dog’ and ‘Lion’) that compete for retrieval. Here, we used the RIF paradigm to investigate whether ignoring auditory items during the retrieval-practice phase modulates the inhibitory process. In two experiments, RIF was present when retrieval-practice was conducted in quiet and when conducted in the presence of spoken words that belonged to a category other than that of the items that were targets for retrieval-practice. In contrast, RIF was abolished when words that either were identical to the retrieval-practice words or were only semantically related to the retrieval-practice words were presented as background speech. The results suggest that the act of ignoring speech can reduce inhibition of the non-practiced category-exemplars, thereby eliminating RIF, but only when the spoken words are competitors for retrieval (i.e., belong to the same semantic category as the to-be-retrieved items).

Memory as discrimination: what distraction reveals

Recalling information involves the process of discriminating between relevant and irrelevant information stored in memory. Not infrequently, the relevant information needs to be selected from amongst a series of related possibilities. This is likely to be particularly problematic when the irrelevant possibilities are not only temporally or contextually appropriate but also overlap semantically with the target or targets. Here, we investigate the extent to which purely perceptual features which discriminate between irrelevant and target material can be used to overcome the negative impact of contextual and semantic relatedness. Adopting a distraction paradigm, it is demonstrated that when distracters are interleaved with targets presented either visually (Experiment 1) or auditorily (Experiment 2), a within-modality semantic distraction effect occurs; semantically-related distracters impact upon recall more than unrelated distracters. In the semantically-related condition, the number of intrusions in recall is reduced whilst the number of correctly recalled targets is simultaneously increased by the presence of perceptual cues to relevance (color features in Experiment 1 or speaker’s gender in Experiment 2). However, as demonstrated in Experiment 3, even presenting semantically-related distracters in a language and a sensory modality (spoken Welsh) distinct from that of the targets (visual English) is insufficient to eliminate false recalls completely, or to restore correct recall to levels seen with unrelated distracters . Together, the study shows how semantic and non-semantic discriminability shape patterns of both erroneous and correct recall.