Surgical Education in the 21st Century

Surgical education has evolved drastically since the 19th century. Previously education of surgical residents was limited to on job clinical training following the “see one, do one, teach one” model with knowledge gleaned from textbooks and journals. Presently a growing emphasis has been placed on both patient safety and resident well-being leading to a development of novel training paradigms. The textbook, while remaining a core source of knowledge, is now only one of many resources available to residents. Many residencies have their libraries online, making learning possible almost anywhere, even without physical books in hand. Most programs now incorporate education days where a structured curriculum allows for standardized education; this makes it less likely that residents miss out on mandatory concepts. The 2020 Covid-19 pandemic has led to further evolution of this model, making the classroom virtual yet interactive. Technology has allowed for residents to train on surgical simulators, so that laparoscopic and robotic skills may be practiced before application on a live patient. Altogether residents are afforded multiple ways to learn due to greater availability of time, structured educational modules, and technology.

Identification of Neuregulin 1 as Predictor Outcome in Intracranial Astrocytoma

BACKGROUND: Astrocytoma is the most common primary brain tumor. The combination of adhesion molecules, proteases, and cytokines that regulate their expression likely underlies tumor progression. The cytokine of neuregulin 1 (NRG1) has a role in progression and invasion of tumor cells by activating signal after binding its receptor. AIM: To identification NRG1 expression with characteristic of intracranial astrocytoma patient is the purpose of this study. METHODS: This study uses analytic method with retrospective study. It analyzed the association between NRG1 expressions in astrocytoma patients. The study included 32 samples which were admitted to Haji Adam Malik Hospital Medan from September 2016 to August 2018. RESULTS: There was no significant association between NRG1 expression with age (p = 0.853) and gender (p = 0.565) of astrocytoma patients, while there was a significant association between NRG1 expression with cell proliferation (p = 0.00), WHO grading of astrocytoma (p = 0.00), and outcomes (p = 0.023). According to this study, the most common results are strong NRG1 expression has many cells proliferation in 10 (31.1%) patients, strong NRG1 expression with Grade IV astrocytoma found in 7 (21.9%) patients, and moderate NRG1 expression in live patient found in 7 (21.9%) patient. CONCLUSION: There is significant association between NRG1 expression and cell proliferation, WHO grading of astrocytoma, and outcomes.

Mobile Environment for Developing User Situation Awareness (MEDUSA): Training for Healthcare Professionals

This paper describes the development of a mobile phone application (MEDUSA) for training situation awareness. MEDUSA was developed as a cost efficient form of on demand training to supplement other more costly, traditional forms of training such as simulation labs and live patient rounds. Users care for a simulated patient and are tested using a version of the Situation Awareness Global Assessment Technique (SAGAT). Users receive feedback on how many SAGAT queries they answered correctly and are provided tips on how to improve SA. Initial usability testing demonstrated strong support for the program among a sample of nursing students. Continued efforts are on-going in the design and testing of a teaching portal that allows trainers to easily create their own scenarios.

Comparing Three Music Therapy Interventions for Anxiety and Relaxation in Youth With Amplified Pain

Research in pediatric hospitals has shown that active music engagement, preferred music listening, and music-assisted relaxation can decrease anxiety and increase relaxation responses. However, there is little research on the use of music therapy with pediatric chronic pain conditions such as amplified pain syndromes. The purpose of the current study was to examine the effects of 3 specific music therapy interventions (active music engagement, live patient-selected music, and music-assisted relaxation) on anxiety and relaxation levels in youth (ages 10–18) participating in a 40 hr per week hospital-based intensive interdisciplinary pain treatment program. A sample of 48 patients participated in this study which utilized a 3-period, 3-treatment cross-over design with 3 interventions delivered in a quasi-randomized order determined by when the patients started the treatment program. State anxiety was measured via the state form of the State-Trait Inventory for Cognitive and Somatic Anxiety for Children and relaxation scores were assessed with a Visual Analog Scale. Statistically significant changes were found in anxiety and relaxation outcomes across all interventions provided. Results suggest that music therapy services (using active music engagement, live patient-selected music, and music-assisted relaxation) may be an effective modality to decrease anxiety and increase relaxation levels in pediatric patients with amplified pain syndromes.

Quantification of Aerosol Particle Concentrations During Endoscopic Sinonasal Surgery in the Operating Room

Background Recent indirect evidence of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) transmission during endoscopic endonasal procedures has highlighted the dearth of knowledge surrounding aerosol generation with these procedures. As we adapt to function in the era of Coronavirus Disease 2019 (COVID-19) a better understanding of how surgical techniques generate potentially infectious aerosolized particles will enhance the safety of operating room (OR) staff and learners. Objective To provide greater understanding of possible SARS-CoV-2 exposure risk during endonasal surgeries by quantifying increases in airborne particle concentrations during endoscopic sinonasal surgery. Methods Aerosol concentrations were measured during live-patient endoscopic endonasal surgeries in ORs with an optical particle sizer. Measurements were taken throughout the procedure at six time points: 1) before patient entered the OR, 2) before pre-incision timeout during OR setup, 3) during cold instrumentation with suction, 4) during microdebrider use, 5) during drill use and, 6) at the end of the case prior to extubation. Measurements were taken at three different OR position: surgeon, circulating nurse, and anesthesia provider. Results Significant increases in airborne particle concentration were measured at the surgeon position with both the microdebrider (p = 0.001) and drill (p = 0.001), but not for cold instrumentation with suction (p = 0.340). Particle concentration did not significantly increase at the anesthesia position or the circulator position with any form of instrumentation. Overall, the surgeon position had a mean increase in particle concentration of 2445 particles/ft3 (95% CI 881 to 3955; p = 0.001) during drill use and 1825 particles/ft3 (95% CI 641 to 3009; p = 0.001) during microdebrider use. Conclusion Drilling and microdebrider use during endonasal surgery in a standard operating room is associated with a significant increase in airborne particle concentrations. Fortunately, this increase in aerosol concentration is localized to the area of the operating surgeon, with no detectable increase in aerosol particles at other OR positions.