A Novel Do-It-Yourself Approach to Simulating Minimally Invasive Laparoscopic Surgery.

In 2008, the American Board of Surgery required residents to pass a laparoscopic fundamentals examination to sit for the boards. As such, minimally invasive surgery became the newest addition as a requisite skill for surgical trainees. To assist in preparing trainees for future surgery, simulation devices have been integrated into training programs to develop proficiency with laparoscopic and arthroscopic techniques. While effective, one of the biggest obstacles to accessing these devices is the thousands of dollars required for the equipment. Many commercial and do-it-yourself (DIY) iterations of low-cost, portable, laparoscopic simulators have been described to address this. While the price point ranges from 300 to 400 dollars, these DIY simulators primarily utilize webcams, iPhones, and tablet cameras in a fixed position. This presents an inherent limitation in the simulator's accuracy as current laparoscopy surgery utilizes camera motion. This study presents a novel DIY simulator that portrays a more realistic view of the operative field using camera motion and positioning, costing approximately 200 dollars. This proposed simulator uses a Universal Serial Bus (USB) endoscope with interchangeable side mirrors. We inserted an endoscope with built-in light-emitting diode (LED) lights into a seamless stainless tube for the laparoscope and attached it to a computer for configuration. To simulate the abdominal cavity, holes were drilled into a ½ torso hollow mannequin at the standard port locations for laparoscopic cholecystectomy, and rubber grommets were inserted into the drilled holes. Trocars were constructed using cross-linked polyethylene (PEX) tubing and #8 rubber stoppers. By creating a more affordable and easily constructed model, acquiring laparoscopic skills is more accessible. Simulators are becoming an essential part of medical training. Affordable simulators like ours allow trainees to develop their laparoscopic skill set at their own pace and convenience. More research into this can potentially lead to increased exposure to more accurate simulators and facilitate more accessible training for performing minimally invasive surgery in any surgical specialty.

Telemedicine Intensive Care Unit (Tele-ICU) Implementation During COVID-19: A Scoping Review.

Telemedicine intensive care unit (Tele-ICU) programs entail command centers staffed with intensivists and critical care nurses who electronically aid with and deliver real-time information to frontline clinicians. The benefits of Tele-ICU are numerous, but the barriers to it often prove insurmountable, accounting for slow adoption in rural and underserved areas where it is needed the most. Remote monitoring can quickly detect patient deterioration, while consultation provided by a remote intensivist expands the capabilities of smaller facilities. The emergence of the coronavirus disease 2019 (COVID-19) pandemic has brought about a sense of urgency, paving the way for the successful adaptation of tele-intensive care concepts. The goal of this scoping review is to map out the available published data regarding healthcare professionals' experiences with implementing Tele-ICU modalities during the COVID-19 pandemic. A primary literature search was performed on PubMed/MEDLINE and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases from October 2020 to October 2021. Of the 1,083 records screened, 19 were identified as meeting our inclusion criteria and selected for the final scoping review. Five major areas of Tele-ICU use were identified: teleconsultation, telerounding, telemonitoring, family visitation via teleconference, and changing of hospital infrastructure. A heterogeneous mix of improvised Tele-ICU platforms emerged with a common theme of interdisciplinary and family collaboration in the care of critically ill patients. Existing Tele-ICU systems were expanded, and novel programs were launched. A groundbreaking national network in the U.S. (NETCCN) will standardize the deployment of Tele-ICU and expand its reach. Future research should focus on determining accurate costs and the most reliable forms of remote communication, physician compact agreement licensure, the practical composition of Tele-ICU teams, and standardized access to the electronic health record.

Amide additives improve RDC measurements in polyacrylamide.

Residual dipolar couplings (RDCs) provide valuable NMR parameters that can be used for structural calculation and verification. Measuring RDCs requires aligning macromolecules using one of various types of alignment media. Of different alignment media options, stretched or compressed polyacrylamide gels are advantageous due to their chemical stability. However, polyacrylamide interacts with proteins and significantly broadens NMR resonances. In this study, we found that the amide-containing compounds asparagine, glutamine and propionamide improve spectral quality of proteins in polyacrylamide gel without significantly reducing the magnitude of RDC values. Moreover, we showed that propionamide is an attractive additive that increases protein solubility without interfering with protein stability, ligand binding or NMR pulse width, suggesting its potential applications for our NMR methods.