SuSiPed: An initial step towards a universal, low-cost, 3D-printable platform for pediatric minimal-invasive surgery training.

BACKGROUND: Training platforms such as the Fundamentals of Laparoscopic Surgery have become an integral part of postgraduate adult general surgical education. So far, however, there is no such universal tool for pediatric minimal-invasive surgery (MIS). We therefore designed and validated a novel 3D printable pediatric MIS simulation program. METHODS: The SuSiPed (Surgical Simulation in Pediatrics) curriculum consists of 6 MIS training modules: camera guidance, shell transfer, figure cutting, cyst resection, single interrupted suturing, and slipknot suturing. All modules can be 3D printed, and thus manufactured in a low-cost, sustainable and reproducible fashion. Instructional videos for the participants for each module were created. For validation, a group of medical students and surgical residents were compared to a group of pediatric surgical specialists with experience in MIS. All participants performed the entire SuSiPed curriculum 3 times, measuring time to task completion and technical mistakes. The results of the last attempt were compared using Welch's T-test. RESULTS: There were 25 participants in the novice group and 5 in expert group. Times to task completion were lower in the expert group for all modules except camera guidance. Errors were significantly more frequent during slipknot suturing in the novice group, while there were no difference in the other modules. CONCLUSION: Our novel training platform showed good construct validity for 5 out of 6 modules, while scores of camera navigation was not associated with prior experience. The SuSiPed platform is useful for pediatric minimal-invasive surgery training and evaluation, even in low-resource countries where expensive simulators are not affordable. LEVEL OF EVIDENCE: Level III, Validation Study.

A Microanalysis of Mood and Self-Reported Functionality in Stroke Patients Using Ecological Momentary Assessment.

Post-stroke depression has been repeatedly associated with the degree of functional and cognitive impairment. The present study aimed to conduct a microanalysis on this association and examined the association between mood and self-reported functionality in 20 stroke patients (6 females, age: M = 59.9, SD = 5.2) using ecological momentary assessments (EMA), a structured diary method capturing moment-to-moment variations. Mood and self-reported functionality were recorded via a smartphone-app eight times a day for seven consecutive days during inpatient rehabilitation care. The patients answered on average to 73.2% of the received prompts. Variability in patients' responses was caused by differences both between and within patients. Multilevel regression analyses revealed that mood and self-reported functionality were significantly associated at the same point in time, but only patients' mood predicted their self-reported functionality at the next assessment point in time-lagged analyses. These results remained stable after controlling for between-person differences as patients' age, staff-ratings of their awareness of illness, and their degree of functional independence. Patients' mood appeared to affect their future ratings of their functionality but not the other way around.

Should children be vaccinated against COVID-19?

Whether all children under 12 years of age should be vaccinated against COVID-19 remains an ongoing debate. The relatively low risk posed by acute COVID-19 in children, and uncertainty about the relative harms from vaccination and disease mean that the balance of risk and benefit of vaccination in this age group is more complex. One of the key arguments for vaccinating healthy children is to protect them from long-term consequences. Other considerations include population-level factors, such as reducing community transmission, vaccine supply, cost, and the avoidance of quarantine, school closures and other lockdown measures. The emergence of new variants of concern necessitates continual re-evaluation of the risks and benefits. In this review, we do not argue for or against vaccinating children against COVID-19 but rather outline the points to consider and highlight the complexity of policy decisions on COVID-19 vaccination in this age group.