Just-in-time Training with Remote Guidance for Ultrasound-Guided Percutaneous Intervention.

BACKGROUND: Management of surgical emergencies in spaceflight will pose a challenge as the era of exploration class missions dawns, requiring increased crew autonomy at a time when training and supplies will be limited. Ultrasound-guided percutaneous intervention would allow for the management of a variety of pathologies with largely shared equipment and training. This proof-of-concept work attempts to determine the feasibility of "just-in-time" remote teaching and guidance of a sample procedure of this type.METHODS: Subjects naïve to ultrasound-guided intervention were instructed via a short video regarding the technique for placement of a percutaneous drain into a simulated abscess within a gel phantom. Subjects were then guided through the performance of the procedure via two-way audiovisual communication with an experienced remote assistant. Technical success was determined by the successful aspiration or expression of fluid from the simulated abscess following drain placement. This was then performed by and compared with staff experienced with such procedures. Time to completion and number of needle redirections required were also measured.RESULTS: All 29 subjects naïve to interventional work and the 4 experienced control subjects achieved technical success. There was a statistically significant difference in the time to completion between the two groups, with the experienced subjects averaging 2 min to completion and the inexperienced 5.8 min. There was no statistically significant difference in the number of redirections.DISCUSSION: This proof-of-concept work demonstrates high rates of technical success of percutaneous ultrasound-guided intervention in previously inexperienced personnel when provided with brief just-in-time training and live two-way audiovisual guidance.Lerner DJ, Pohlen MS, Apland RC, Parivash SN. Just-in-time training with remote guidance for ultrasound-guided percutaneous intervention. Aerosp Med Hum Perform. 2022; 93(12):882-886.

Pharmacoresistance with newer anti-epileptic drugs in mesial temporal lobe epilepsy with hippocampal sclerosis.

This study aims to evaluate the overall prognosis, prognostic factors, and efficacy of treatment in patients with mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) who have access to third generation anti-epileptic drugs but not to epilepsy surgery. Eighty-five MTLE-HS patients were retrospectively placed into a seizure-free (seizure-free for >1year) or drug-resistant group, and the two groups were compared on the basis of age, sex, age at onset of seizures, duration of epilepsy, side of lesion, handedness, EEG findings, history of CNS infection, history of febrile convulsions, history of head trauma, history of cognitive impairment, family history of seizures, number of current anti-epileptic drugs (AEDs), total number of AED trials, and presence of individual AEDs. Only 24.7% of MTLE-HS patients had achieved seizure freedom for >1 year. Poor prognosis and drug-resistance were associated with younger age at onset of seizures (p=0.002), longer duration of epilepsy (p=0.018), greater number of current AEDs (p<0.001), and greater total number of AED trials (p<0.001). In addition, regimens with newer AEDs had no greater efficacy than regimens with older AEDs. Most medically managed MTLE-HS patients do not achieve seizure freedom despite multiple AED trials, and treatment with third generation AEDs should not preclude evaluation for epilepsy surgery.