Background The Pain Monitoring Device (PMD) monitor (Medasense Biometrics Ltd., Ramat Gan, Israel) uses the Nociception Level (NOL) index, a multiple parameterderived index that has recently shown a good sensitivity and specificity to detect noxious stimuli. The aim of this study was to assess the latest version of the device (PMD200 TM) on variations of the NOL response after standardized tetanic stimuli to study the correlation between remifentanil doses and NOL. Methods Data from 26 patients undergoing midline laparotomy and receiving a desflurane-remifentanil-based anesthetic coupled with low thoracic epidural analgesia were analyzed. A standardized tetanic stimulus was applied to the forearm of the patients at different remifentanil infusion rates. The primary aim was to evaluate the correlation between post-tetanic stimulation NOL values from the PMD200 and remifentanil doses. The NOL index variations after experimental and clinical stimuli were also compared with heart rate (HR), mean arterial pressure (MAP), and Bispectral Index TM (BIS). Results A correlation between post-tetanic stimulation NOL values and remifentanil doses was found (r =-0.56; 95% confidence interval [CI],-0.70 to-0.44; P\0.001). The NOL discriminated noxious from non-noxious states with the maximal Youden's index value of the NOL receiver operating characteristic (ROC) curve showing a specificity of 88% (95% CI, 69.0 to 100) and sensitivity of 79.1% (95% CI, 56.2 to 95.5). The area under the NOL ROC curve (AUC, 0.9; 95% CI, 0.84 to 0.95) was significantly different from the other variables (P \ 0.001 vs HR; P \ 0.001 vs MAP; P \ 0.001 vs BIS). Conclusions The NOL value after noxious stimulus decreased with incremental remifentanil doses, showing a significant inverse correlation between the NOL index and opioid doses. The sensitivity and specificity of NOL to discriminate between noxious and non-noxious stimuli suggests its interesting potential as a monitor of nociception intensity during anesthesia.

Context Studies about the impact of global health electives on host institutions are scarce and often made from the perspective of institutions that send students. The present research examined the impact of short‐term electives in global health (STEGHs) from the under‐represented perspective of host institutions in Benin. Methods The authors conducted 30 semi‐structured interviews from a convenience sample of Beninese health care professionals who had hosted Canadian medical students. Interviewees had previously supervised STEGHs in one of the five different institutions. A subsequent qualitative thematic analysis methodology was used to compilate codes and generate themes. Results Hosting STEGH students motivated respondents to increase their medical knowledge through self‐driven learning. They perceived an improvement in the quality of their care and felt a negligible impact on patient safety. They negatively commented on the lack of clear pedagogic objectives that they could rely on. Interviewees think current STEGH partnerships do not advantage them because institutions that send students offer little support during the electives. Furthermore, sending institutions do not offer the same opportunity for local medical students or professionals to take part in such electives outside of Benin. Conclusions Although host health care professionals evaluated global health electives positively overall, specific improvements could mitigate their negative impacts and help create a more balanced partnership between sending and host institutions. Sending institutions could involve host institutions in curriculum planning. They could invest in building reciprocal elective programmes to receive students from elsewhere. Meanwhile they can maximise the transfer of relevant medical knowledge, and provide expertise, resources and support during the electives.

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