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The aim of this study was to describe the performance of a novel Situational Awareness Scoring System (SASS) in discriminating between patients who had cardiac arrest (CA), and those who did not, in a pediatric cardiac intensive care unit (PCICU). This is a retrospective, observational-cohort study in a quaternary-care PCICU. Patients who had CA in the PCICU between January 2014 and December 2018, and patients admitted to the PCICU in 2018 who did not have CA were included. Patients with do not resuscitate or do not intubate orders, extracorporeal membrane oxygenation, ventricular assist device, and PCICU stay < 2 hours were excluded. SASS score statistics were calculated within 2-, 4-, 6-, and 8-hour time intervals counting backward from the time of CA, or end of PCICU stay in patients who did not have CA. Cross-validated discrete time logistic regression models were used to calculate area under the receiver operating characteristic (AUC) curves. Odds ratios (ORs) for CA were calculated per unit increase of the SASS score. Twenty-eight CA events were analyzed in 462 PCICU admissions from 267 patients. Maximum SASS score within 4-hour time interval before CA achieved the highest AUC of 0.91 (95% confidence interval [CI]: 0.86-0.96) compared with maximum SASS score within 2-, 6-, and 8-hour time intervals before CA of 0.88 (0.79-96), 0.90 (0.85-0.95), and 0.89 (0.83-0.95), respectively. A cutoff value of 60 for maximum SASS score within 4-hour time interval before CA resulted in 82.1 and 83.2% of sensitivity and specificity, respectively. OR for CA was 1.32 (95% CI: 1.26-1.39) for every 10 units increase in the maximum SASS score within each 4-hour time interval before CA. The maximum SASS score within various time intervals before CA achieved promising performance in discriminating patients regarding occurrence of CA., Competing Interests: Conflict of Interest The authors O.B., K.K., and S.Q.L. have a pending patent filed with the US Patent Office (Application number: 17/153,772)., (Thieme. All rights reserved.)

Study Objective: Acute aortic syndrome (AAS) is a medical emergency that requires prompt diagnosis and treatment at specialized centers. We sought to determine the frequency and etiology of false positive activation of a regional AAS network in a patient population emergently transferred for suspected AAS., Methods: We evaluated 150 consecutive patients transferred from community emergency departments directly to our Cardiac Intensive Care Unit (CICU) with a diagnosis of suspected AAS between March, 2010 and August, 2011. A final diagnosis of confirmed acute Type A, acute Type B dissection, and false positive suspicion of dissection was made in 63 (42%), 70 (46.7%) and 17 (11.3%) patients respectively., Results: Of the 17 false positive transfers, ten (58.8%) were suspected Type A dissection and seven (41.2%) were suspected Type B dissection. The initial hospital diagnosis in 15 (88.2%) patients was made by a computed tomography (CT) scan and 10 (66.6%) of these patients required repeat imaging with an ECG-synchronized CT to definitively rule out AAS. Five (29.4%) patients had prior history of open or endovascular aortic repair. Overall in-hospital mortality was 9.3%., Conclusions: The diagnosis of AAS is confirmed in most patients emergently transferred for suspected AAS. False positive activation in this setting is driven primarily by uncertainty secondary to motion-artifact of the ascending aorta and the presence of complex anatomy following prior aortic intervention. Network-wide standardization of imaging strategies, and improved sharing of imaging may further improve triage of this complex patient population.

The fast spread of laparoscopic surgery in the surgical community also required introduction of new methods of surgical education of these techniques. Training boxes applied for this reason meant a considerable help. The technique of the virtual reality introduced simulation, which is a new possibility in education. For the first time in the history of surgery we can measure medical students' or residents' dexterity and one can get acquainted with a surgical procedure in the form of "serious games". By application of the up-to-date imaging methods we can plan the movements of the surgeon's hand even before the planned operation, practice and repeating can contribute to the safety of the real procedure. Open surgical procedures can be practiced on plastic phantoms mimicking human anatomy and the use of interactive touch devices and e-learning can also contribute to practical education of surgery.

Due to the fast spread of laparoscopic cholecystectomy, surgical procedures have been changed essentially. The new techniques applied for both abdominal and thoracic procedures provided the possibility for minimally invasive access with all its advantages. Robots - originally developed for industrial applications - were retrofitted for laparoscopic procedures. The currently prevailing robot-assisted surgery is ergonomically more advantageous for the surgeon, as well as for the patient through the more precise preparative activity thanks to the regained 3D vision. The gradual decrease of costs of robotic surgical systems and development of new generations of minimally invasive devices may lead to substantial changes in routine surgical procedures.

Patients with acute aortic syndrome (AAS) often require emergent transfer for definitive therapy. The aim of this study was to evaluate the safety of transfer and the ability to optimize hemodynamics in subjects with AAS transported by an aortic network. A total of 263 consecutive patients with suspected AAS transferred to a coronary care unit from March 2010 to June 2012 were included. Transfers were accomplished by the institutional critical care transfer system using ground ambulance (n = 47), helicopter (n = 196), or fixed-wing jet (n = 20) from referring centers directly to the coronary care unit, bypassing the emergency department. The transfer mortality rate was 0%, and the in-hospital mortality rate was 9% (n = 23). Initial systolic blood pressure and heart rate at the time of arrival of the transfer team to the referring hospital were compared with those on arrival to the coronary care unit. The median transfer distance was 66 km (interquartile range 24 to 119), and the median transfer time was 87 minutes (interquartile range 67 to 114). The transfer team achieved significant reductions in systolic blood pressure (from 142 ± 29 to 132 ± 23 mm Hg) (mean difference in systolic blood pressure 10 mm Hg, 95% confidence interval 7 to 14, p <0.0001) and heart rate (from 78 ± 16 to 75 ± 16 beats/min) (mean difference in heart rate 3 beats/min, 95% confidence interval 1 to 4, p <0.0001). In conclusion, these results indicate that patients with AAS can be safely transferred to specialized centers for definitive treatment, and a well-trained critical care transfer team can actively continue to optimize medical management during transit., (Copyright © 2013 Elsevier Inc. All rights reserved.)

53 male college students and 37 male prison inmates completed a questionnaire evaluating an hypothetical rape scenario with a male perpetrator and a female victim. The college students assigned equal blame to the victim regardless of whether the assailant was a stranger or an acquaintance, but the inmates assigned more blame to the victim when the assailant was a stranger than an acquaintance. The results may be interpreted as showing a greater awareness of date or acquaintance rape among the college population than among the prison population.