Percutaneous Cholecystostomy for Acute Cholecystitis During Spaceflight.

Introduction: Acute calculous cholecystitis is a common surgical emergency and cholecystectomy is the gold-standard treatment. However, alternative drainage modalities such as percutaneous cholecystostomy tube (PCT) placement have been proposed for poor surgical candidates or in remote environments, such as space. We reviewed the literature to assess the theoretical utility of PCT to treat acute cholecystitis during long-duration spaceflight or on the Moon or Mars.

Long Round-Trip Time Delay Effects on Performance of a Simulated Appendectomy Task.

No current astronauts have surgical training, and medical capabilities for future missions do not account for it. We sought to determine the effect of communication delays and text-based communication on emergency medicine physician (EMP) performance of a simulated surgical procedure and the ideal training paradigm for remote surgery. In this study, 12 EMPs performed an appendectomy on a virtual reality laparoscopic simulator after tutorial.

A Novel 3D-Printed Gravity-Independent Air-Eliminating Filter for Rapid Intravenous Infusions.

The absence of a consistent downward G vector can make separation of gases from liquids challenging, such as in field medicine without stable upright equipment or during spaceflight. This limits the use of medical equipment and procedures like administration of intravenous (IV) fluids in microgravity and can make field medicine hazardous. Administering IV fluids and medications in microgravity requires a technique to separate air from the liquid phase.

Effects of whole-body vibration or resistive-vibration exercise on blood clotting and related biomarkers: a systematic review.

Whole-body vibration (WBV) and resistive vibration exercise (RVE) are utilized as countermeasures against bone loss, muscle wasting, and physical deconditioning. The safety of the interventions, in terms of the risk of inducing undesired blood clotting and venous thrombosis, is not clear. We therefore performed the present systematic review of the available scientific literature on the issue.

A 3D-Printed Portable Sterilizer to Be Used During Surgical Procedures in Spaceflight.

During spaceflight, it is important to consider the mechanisms by which surgeries and medical procedures can be safely and efficiently conducted. Instruments used to carry out these processes need to be sterilized. Thus, we have designed and tested a three-dimensional-printed (3D-printed) portable sterilizer that implements far ultraviolet-C (Far UV-C) light radiation to disinfect bacteria and microorganisms from surgical instruments.

Characteristics of acute sexual assault care in New England emergency departments.

Objective: Interventions such as written protocols and sexual assault nurse examiner programs improve outcomes for patients who have experienced acute sexual assault. How widely and in what ways such interventions have been implemented is largely unknown. We sought to characterize the current state of acute sexual assault care in New England.

Impact of Telemedicine on Extended Focused Assessment With Sonography for Trauma Performance and Workload by Critical Care Transport Personnel.

Introduction: There are currently no reports on whether telementoring for extended focused assessment with sonography for trauma (eFAST) improves critical care transport providers' performance in prehospital settings. Our objective was to determine the impact of teleguidance on eFAST performance and quantify workload experience.

Methods: Eight trauma injury modules were selected on simulated patients.

Pathophysiology, risk, diagnosis, and management of venous thrombosis in space: where are we now?

The recent incidental discovery of an asymptomatic venous thrombosis (VT) in the internal jugular vein of an astronaut on the International Space Station prompted a necessary, immediate response from the space medicine community. The European Space Agency formed a topical team to review the pathophysiology, risk and clinical presentation of venous thrombosis and the evaluation of its prevention, diagnosis, mitigation, and management strategies in spaceflight. In this article, we discuss the findings of the ESA VT Topical Team over its 2-year term, report the key gaps as we see them in the above areas which are hindering understanding VT in space.

Prophylactic Splenectomy and Hyposplenism in Spaceflight.

There is debate whether astronauts traveling to space should undergo a prophylactic splenectomy prior to long duration spaceflight. Risks to the spleen during flight include radiation and trauma. However, splenectomy also carries significant risks.

Spatial Volume Necessary to Perform Open Appendectomy in a Spacecraft.

With the increase in crewed commercial spaceflight and expeditions to the Moon and Mars, the risk of critical surgical problems and need for procedures increases. Appendicitis and appendectomy are the most common surgical pathology and procedure performed, respectively. The habitable volume of current spacecraft ranges from 4 m³ (Soyuz) to 425 m³ (International Space Station).

Feasibility and Acceptance of a Teletrauma Surgery Consult Service to Rural and Community Hospitals: A Pilot Study.

Background: Many trauma patients currently transferred from rural and community hospitals (RCH) to Level I trauma centers (LITC) for trauma surgery evaluation may instead be appropriate for immediate discharge or admission to the local facility after evaluation by a trauma and acute care surgery (TACS) surgeon. Unnecessary use of resources occurs with current practice. We aimed to demonstrate the feasibility and acceptance of a teletrauma surgery consultation service between LITC and RCH.

American Helicopter Emergency Medical Service Pilots Report to Work Despite High Rates of Sleepiness.

Objective: Previous studies on helicopter emergency medical service (HEMS) pilots found a positive correlation among fatigue, nodding off in flight, and accidents. We sought to quantify the amount of sleepiness in HEMS pilots using the Epworth Sleepiness Scale (ESS).

Methods: An anonymous survey was sent via the National EMS Pilots Association emergency medical services listserv including demographics, the ESS, and subjective effects of fatigue on flying.

Search for Venous Endothelial Biomarkers Heralding Venous Thromboembolism in Space: A Qualitative Systematic Review of Terrestrial Studies.

The recent discovery of a venous thrombosis in the internal jugular vein of an astronaut has highlighted the need to predict the risk of venous thromboembolism in otherwise healthy individuals (VTE) in space. Virchow's triad defines the three classic risk factors for VTE: blood stasis, hypercoagulability, and endothelial disruption/dysfunction. Among these risk factors, venous endothelial disruption/dysfunction remains incompletely understood, making it difficult to accurately predict risk, set up relevant prophylactic measures and initiate timely treatment of VTE, especially in an extreme environment.

Impact of Time Delay on Simulated Operative Video Telementoring: A Pilot Study.

As NASA and private spaceflight companies push forward with plans for missions to cis-lunar and interplanetary space, the risk of surgical emergency increases. At latencies above 500 ms, telesurgery is not likely to be successful, so near-real-time telementoring is a more viable option. We examined the effect of a 700-ms time delay on the performance of first year surgical residents on a simulated task requiring significant feedback from a mentor in a pilot study.

Decrease in Trauma Admissions with COVID-19 Pandemic.

Introduction: The COVID-19 pandemic has led to social distancing and decreased travel in the United States. The impact of these interventions on trauma and emergency general surgery patient volume has not yet been described.

Methods: We compared trauma admissions and emergency general surgery (EGS) cases between February 1-April 14 from 2017-2020 in five two-week time periods.

Critical Care Transport Time Differences Between Ground, Helicopter VFR, and Helicopter IFR Transports.

In helicopter critical care and emergency medical services (HEMS) transportation, organizations aim for efficiency of the dispatch process. Most HEMS organizations do not provide transport under instrument flight rules (IFR), due to equipment and training cost. Boston MedFlight (BMF) provides IFR HEMS transport.

Lack of Routine Healthcare among Resident Physicians in New England.

Background: Although physician health promotes retention to the profession and encourages higher-quality patient care, residents can face challenges seeking routine medical care. Erratic working hours, time constraints, easy access to informal health consultation, and a culture of self-reliance can deter help-seeking behavior. Despite national focus on physician burnout and efforts to promote wellness, little is known about the self-care habits of residents.

Use of Learning Teams to Improve the Educational Environment of General Surgery Residency.

Objective: Recent surgical education literature has focused on means of improving structured educational experience in residency, particularly in the context of limited working hours. In addition, prior studies have illustrated a void in training regarding leadership. Learning teams have been adopted in several medical schools with an aim to improve the educational experience.

Abdominal insufflation for laparoscopy increases intracranial and intrathoracic pressure in human subjects.

Background: Laparoscopy has emerged as an alternative to laparotomy in select trauma patients. In animal models, increasing abdominal pressure is associated with an increase in intrathoracic and intracranial pressures. We conducted a prospective trial of human subjects who underwent laparoscopic-assisted ventriculoperitoneal shunt placement (lap VPS) with intraoperative measurement of intrathoracic, intracranial and cerebral perfusion pressures.

Decrease in junior resident case volume after 2011 ACGME work hours.

Objective: To determine how the new 2011 Accreditation Council for Graduate Medical Education work hours affected case volume across postgraduate year (PGY) levels of surgical trainees.

Design: Retrospective review of Accreditation Council for Graduate Medical Education case logs of surgical residents at Beth Israel Deaconess Medical Center from 2006 to 2013.

Setting: Tertiary care center.

Effect of abdominal insufflation for laparoscopy on intracranial pressure.

Importance: Increased abdominal pressure may have a negative effect on intracranial pressure (ICP). Human data on the effects of laparoscopy on ICP are lacking. We retrospectively reviewed laparoscopic operations for ventriculoperitoneal shunt placement to determine the effect of insufflation on ICP.

Effects of the new Accreditation Council for Graduate Medical Education work hour rules on surgical interns: a prospective study in a community teaching hospital.

Background: On July 1, 2011, the Accreditation Council for Graduate Medical Education (ACGME) eliminated 30-hour call in an attempt to improve resident wakefulness. We surveyed interns on the Newton Wellesley Hospital (NWH) surgery service before and after the transition from Q4 overnight call to a night float schedule.

Methods: For 15 weeks, interns completed weekly surveys including the Epworth Sleepiness Scale (ESS).

Visual display angles of conventional and a remotely piloted aircraft.

Introduction: Instrument display separation and proximity are important human factor elements used in the design and grouping of aircraft instrument displays. To assess display proximity in practical operations, the viewing visual angles of various displays in several conventional aircraft and in a remotely piloted vehicle were assessed.

Methods: The horizontal and vertical instrument display visual angles from the pilot's eye position were measured in 12 different types of conventional aircraft, and in the ground control station (GCS) of a remotely piloted aircraft (RPA).