Filling the gap between the OR and virtual simulation : a European study on a basic neurosurgical procedure

Aki Laakso tutkimusryhmän jäsenenä.Currently available simulators are supposed to allow young neurosurgeons to hone their technical skills in a safe environment, without causing any unnecessary harm to their patients caused by their inexperience. For this training method to be largely accepted in neurosurgery, it is necessary to prove simulation efficacy by means of large-scale clinical validation studies. We correlated and analysed the performance at a simulator and the actual operative skills of different neurosurgeons (construct validity). We conducted a study involving 92 residents and attending neurosurgeons from different European Centres; each participant had to perform a virtual task, namely the placement of an external ventricular drain (EVD) at a neurosurgical simulator (ImmersiveTouch). The number of attempts needed to reach the ventricles and the accuracy in positioning the catheter were assessed. Data suggests a positive correlation between subjects who placed more EVDs in the previous year and those who get better scores at the simulator (p = .008) (fewer attempts and better surgical accuracy). The number of attempts to reach the ventricle was also analysed; senior residents needed fewer attempts (mean = 2.26; SD = 1.11) than junior residents (mean = 3.12; SD = 1.05) (p = .007) and staff neurosurgeons (mean = 2.89, SD = 1.23). Scoring results were compared by using the Fisher's test, for the analysis of the variances, and the Student's T test. Surprisingly, having a wider surgical experience overall does not correlate with the best performance at the simulator. The performance of an EVD placement on a simulator correlates with the density of the neurosurgical experience for that specific task performed in the OR, suggesting that simulators are able to differentiate neurosurgeons according to their surgical ability. Namely this suggests that the simulation performance reflects the surgeons' consistency in placing EVDs in the last year.Peer reviewe

Social and psychological impact of the COVID-19 pandemic on UK medical and nursing students: protocol for a national medical and nursing student survey

INTRODUCTION: Healthcare students have played a significant role in the National Health Service during the COVID-19 pandemic. We captured data on the well-being of medical students during the acute phase of the pandemic with the Social and Psychological Impact of COVID-19 on medical students: a national survey Evaluation (SPICE-19) study. We will evaluate changes in mental health and well-being of medical and nursing students 1 year after SPICE-19, in a cross-sectional study, to understand the impact of the pandemic, and inform well-being policies. METHODS AND ANALYSIS: This study will be a national, multi-institution, cross-discipline study. An online 53-item survey of demographics, mental health and well-being will be used to record responses. Students studying for a medical or nursing degree at any UK universities will be eligible to participate. The survey will be advertised through the Neurology and Neurosurgery Interest Group national network. Participation is anonymous and voluntary, with relevant mental health resources made available to participants. ETHICS AND DISSEMINATION: Ethical approval was granted by the University of Oxford Central University Research Ethics Committee (R75719/RE001) on 21 May 2021. Study findings will be presented at national and international meetings, and submitted for publication in a peer-reviewed journal

Demographic and angioarchitectural features associated with seizures presentation in patients with brain arteriovenous malformations in Durban, KwaZulu-Natal, South Africa

Background: Brain arteriovenous malformations (AVMs) often present with epileptic seizures which carry standard mortality rate two to three folds higher than in the general population, yet preventative eradication of these lesions remains controversial. The aim of this study was to determine the demographic and angioarchitectural features associated with clinical presentation of seizures in patients with brain AVMs. Methods: We conducted a retrospective chart review of all consecutive patients who presented to three interventional neuroradiology hospitals, with brain AVMs in Kwazulu-Natal, South Africa, over a period of 10years. The demographic and clinical presentations were derived from patient's electronic medical records. Radiological features were determined using axial Computerized Topography (CT) or Magnetic Resonance Imaging (MRI) Scan. Angioarchitectural features were determined from Digital Subtraction Angiography (DSA). Simple and multiple logistic regression models were used to identify factors associated with the risk of seizure as initial presentation in brain AVMs. Results: The analysis identified race/ethnicity, nidus size and location as the predictors of seizure presentation. By multiple logistic regression analysis, African-black race (OR=4.7; 95%CI: 1.15–19.60), brain AVM nidus >3cm in diameter, (OR=4.4; 95%CI: 1.7−11.42) and cortical lobar location (OR=13.6; 95%CI: 2.80−65.14) were found to be significant predictors of brain AVM-associated seizures. Conclusion: Improved knowledge of specific morphological factors associated with brain AVM epilepsy could aid in the formulation of appropriate therapeutic strategies for control and/or cure of these brain AVM-associated seizures. Keywords: Angioarchitecture, Arteriovenous malformations, Brain, Demographics, Seizure

Correspondence to

Abnormal inflammatory activity returns after natalizumab cessation in multiple sclerosi