Early mortality benefit with COVID-19 convalescent plasma: a matched control study.

Convalescent plasma can provide passive immunity during viral outbreaks, but the benefit is uncertain for the treatment of novel coronavirus disease 2019 (COVID-19). Our goal is to assess the efficacy of COVID-19 convalescent plasma (CCP). In all, 526 hospitalized patients with laboratory-confirmed SARS-CoV-2 at an academic health system were analyzed. Among them, 263 patients received CCP and were compared to 263 matched controls with standard treatment. The primary outcome was 28-day mortality with a subanalysis at 7 and 14 days. No statistical difference in 28-day mortality was seen in CCP cases (25·5%) compared to controls (27%, P = 0·06). Seven-day mortality was statistically better for CCP cases (9·1%) than controls (19·8%, P < 0·001) and continued at 14 days (14·8% vs. 23·6%, P = 0·01). After 72 h, CCP transfusion resulted in transitioning from nasal cannula to room air (median 4 days vs. 1 day, P = 0·02). The length of stay was longer in CCP cases than controls (14·3 days vs. 11·4 days, P < 0·001). Patients with COVID-19 who received CCP had a decreased risk of death at 7 and 14 days, but not 28 days after transfusion. To date, this is the largest study demonstrating a mortality benefit for the use of CCP in patients with COVID-19 compared to matched controls.

Uncontrolled recurrent myasthenia gravis exacerbations secondary to chronic gabapentin use.

Gabapentin is an anticonvulsant medication that reduces synaptic transmission by decreasing presynaptic voltage-gated Ca2+ and Na+ channels. It is approved to treat focal seizures but also used to treat post-herpetic and neuropathic pain. Although uncommon, there have been three reported cases of myasthenia gravis exacerbation associated with gabapentin in the literature. We present a patient with uncontrolled recurrent myasthenia gravis exacerbations secondary to chronic gabapentin use and provide a review for the three published cases.

New onset of insomnia in hospitalized patients in general medical wards: incidence, causes, and resolution rate.

Background: Insomnia is common in hospitalized patients. However, no study has examined new onset of insomnia in patients without a prior history of insomnia. Objectives: Incidence of new onset of insomnia in inpatients, associated factors and resolution rate after 2 weeks. Method: This is a prospective observational study conducted at a community hospital. We used the Insomnia Severity Index questionnaire to screen for insomnia in all patients located in the general medical floors from day 3 to day 5 of their hospital stay. We excluded patients with a prior insomnia history. Results: Out of the 205 patients who met the inclusion criteria, 75 patients (36%) reported insomnia. Severe insomnia was present in 3% of patients. Difficulty in maintaining sleep is the most common symptom. Frequent staff disruptions due to blood draws and vital signs checks were reported by 68% as the cause of insomnia, followed by illness associated causes (64%) and sleep disruption due to noise and or brightness (23%). Patients with insomnia had more awakenings due to noise, brightness, and staff interruptions than those without insomnia (1.35 times vs. 0.9 times, p = 0.027). Patients with respiratory symptoms, cardiac monitoring, oxygen use, private rooms, and no sedative use did not have a higher insomnia risk. Patients with insomnia had significant lower satisfaction scores than patients without insomnia (4.53 vs. 4.05, p = 0.001) but did not have a different length of stay (6.18 vs. 6.19, p = 0.97). In 31% of patients with insomnia who were able to be contacted two weeks after discharge, 75% of them had insomnia resolution. Conclusion: New onset of insomnia occurred in 36% of hospitalized patients. Most common causes are staff disruption and disease symptoms. It was usually short-term and could decrease patients' satisfaction score.

Laparoscopic surgery skills evaluation: analysis based on accelerometers.

BACKGROUND AND OBJECTIVE: Technical skills assessment is considered an important part of surgical training. Subjective assessment is not appropriate for training feedback, and there is now increased demand for objective assessment of surgical performance. Economy of movement has been proposed as an excellent alternative for this purpose. The investigators describe a readily available method to evaluate surgical skills through motion analysis using accelerometers in Apple's iPod Touch device. METHODS: Two groups of individuals with different minimally invasive surgery skill levels (experts and novices) were evaluated. Each group was asked to perform a given task with an iPod Touch placed on the dominant-hand wrist. The Accelerometer Data Pro application makes it possible to obtain movement-related data detected by the accelerometers. Average acceleration and maximum acceleration for each axis (x, y, and z) were determined and compared. RESULTS: The analysis of average acceleration and maximum acceleration showed statistically significant differences between groups on both the y (P = .04, P = .03) and z (P = .04, P = .04) axes. This demonstrates the ability to distinguish between experts and novices. The analysis of the x axis showed no significant differences between groups, which could be explained by the fact that the task involves few movements on this axis. CONCLUSION: Accelerometer-based motion analysis is a useful tool to evaluate laparoscopic skill development of surgeons and should be used in training programs. Validation of this device in an in vivo setting is a research goal of the investigators' team.

Entrenamiento en cirugía robótica: validación de una escala para la evaluación objetiva de destrezas / Training in robotic surgery: validation of a scale for objective skills evaluation

Objetivo: El objetivo de este estudio consiste en determinarla capacidad de la escala GEARS (global evaluative assessment of robotic skills) para diferenciar individuos con distinto nivel de experiencia en cirugía robótica, como un parámetro fundamental para la validación de la misma. Método: Es un estudio transversal que incluye a tres grupos de individuos con diferente nivel de experiencia en cirugía robótica (expertos, intermedios, novatos), a los cuales se les asignó una tarea sobre un modelo de entrenamiento, siendo evaluados mediante la escala en estudio (GEARS), aplicada por dos evaluadores. La diferencia entre los grupos se determinó mediante el método no paramétrico de Mann Whitney y la consistencia interobservador se estudió mediante el coeficiente W de Kendall. Resultados: Se realizaron un total de 15 evaluaciones, correspondientes a 5 individuos de cada grupo. La concordancia inter-observador de la escala GEARS fue de 0,96. El puntaje obtenido al realizar la evaluación fue de 29,8±0,4; 24±2,8 y 16±3; para los expertos, intermedios y novatos respectivamente, siendo la diferen-cia entre ellos estadísticamente significativa. Todos los parámetros de la escala permiten diferenciar entre los distintos niveles de expe-riencia, con la excepción del ítem percepción de profundidad. Conclusión:Se concluye que la escala GEARS demostró ser capaz de diferenciar entre individuos con distinto nivel de experiencia en cirugía robótica, validándose como una herramienta útil en el entrenamiento y evaluación del cirujano en formación(AU)

Objective: The objective of this study is to determine the ability of the GEARS scale (global evaluative assessment of robotic skills) to differentiate individuals with different levels of experience in robotic surgery, as a fundamental validation of the same para-meter. Method: This is a cross-sectional study that included three groups of individuals with different levels of experience in robotic surgery (expert, intermediate, novice) to which they were assigned a task on a training model, and was assessed by the GEARS scale applied by two reviewers. The difference between groups was determined by a nonparametric method from Mann Whitney and the consistency between the reviewers was studied by Kendall W coefficient. Results: A total of 15 evaluations were performed to all the individuals in each group. The agreement between the reviewers of the scale GEARS was 0.96. The score of the assessment was 29.8±0.4 to experts, 24 ±2.8 to intermediates and 16 ±3 to novices,with a statistically significant difference between all of them(p<0.05). All parameters from the scale allow discriminating between different levels of experience, with exception of the depth perception item. Conclusion: We conclude that the scale GEARS was able to differentiate between individuals with different levels of experience in robotic surgery. Therefore is a validated and useful tool to evaluate surgeons in training(AU)

Colecistectomía laparoscópica por un solo puerto. Modelo ex vivo de entrenamiento / Laparoendoscopic single site surgery (less) cholecystectomy. Ex vivo training model

Objetivo: Describir un modelo ex vivo de entrenamiento para colecistectomía laparoscópica mediante abordaje por una sola incisión (LESS). Método: Se utilizó el complejo hepatobiliar ex vivo del Sus scrofa domesticus, los cuales fueron colocados en cajas negras convencionales, se tomó en cuenta si el modelo era capaz de permitir las prácticas de cada uno de los pasos del procedimiento. Se determinó el impacto de la práctica en la superación de dificultades al evaluar el desempeño de dos cirujanos en cinco sesiones consecutivas, teniendo como parámetro el tiempo empleado en completar la tarea. Resultados: En el modelo descrito es posible reproducir cada uno de los pasos de la colecistectomía laparoscópica a través de una sola incisión, permitió a los residentes la práctica y superación de dificultades propias de la técnica, lo cual se hizo evidente con la disminución del tiempo empleado. Conclusión:El modelo propuesto permite el entrenamiento del equipo quirúrgico en colecistectomía laparoscópica mediante abordaje por una sola incisión(AU)

Objective: To describe an ex vivo model for training LESS cholecystectomy. Method: The hepatobiliary complex of Sus scrofa domesticus placed in conventional "black boxes" was used. The capability of the model to allow practice of each step of the procedure was evaluated. We determined the impact of the practice in overcoming technical difficulties assessing the performance of two surgeons in five consecutive sessions, the time required to complete de task was evaluated. Results: It is possible to perform each step of LESS cholecystectomy in the proposed training model. It allows post-graduate residents practice and overcoming related difficulties.Conclusion: The proposed training model allows the practice of LESS cholecystectomy(AU)