Objective: While instructional videos are commonly used in surgical education, there is a paucity of data on home laparoscopic box trainers. This pilot study evaluated impacts of augmenting instructional videos with these devices. Design: This was a randomized controlled pilot study evaluating laparoscopic surgical performance on the LapSim virtual surgical simulator before and after a 2 week curriculum of instructional videos alone (n = 8, 47.1%) vs videos plus a home laparoscopic box trainer (n = 9, 52.9%). The LapSim recorded mistake number, time, and instrument path length to complete each task. Participants completed surveys about their perceptions of surgery before and after the course. Participants: Preclinical medical students were recruited. Those with extensive surgical experience or did not complete the course were excluded. Results: For the box trainer group vs the videos alone group: mean change in mistakes was −10.0 (standard deviation [SD]:17.1) vs +.5 (SD:21.59) ( P = .28); mean change in time was −433.24 (SD:304.67) seconds vs −366.16 (SD:240.10) seconds ( P = .62); mean change in instrument path length was −4.27 (SD:4.38) meters vs −3.19 (SD:4.86) meters ( P = .64). The box trainer group ranked “I feel as though surgery comes naturally” 1.58 points higher (95% confidence interval [CI]: .85, 2.32; P < .01) and “I am worried about being skilled at surgery” 1.26 points lower (95% CI: 2.29, −.24; P = .02) upon completing the study. The videos alone group reported no significant changes in survey responses. Conclusion: Home laparoscopic box trainers can generate confidence and reduce anxiety regarding surgical fields. This study provides a framework for future larger scale works.

Introduction. Heart rate variability (HRV) is considered a marker of autonomic nervous system (ANS) function and a biomarker of interest in evaluating nervous system function following traumatic brain injury. This study validates prior research with larger sample sizes and proposes a model for establishing baseline HRV reactivity in healthy participants. Methods. Sixty-two healthy collegiate athletes were recruited for this study. Following informed consent, they were evaluated supine using the Elite HRV CorSense monitor and platform to record low frequency/high frequency (LF/HF) ratio and root means square of successive differences (RMSSD) over 5 min. A bag of ice was placed on their face, then RMSSD and LF/HF ratio were collected over three successive 1-min intervals. Results. RMSSD was elevated at 1 and 2 min (+47.4 ms, p < .0001; +16.5 ms, p = .014) following face cooling and fell to baseline at 3 min (+4.6 ms, p = .52). LF/HF ratio decreased following face cooling at 2 and 3 min (change from rest %: 2 min, −33%, p = .007; 3 min, −50%, p = < .0001). Conclusion. The Elite HRV platform can detect an elevation in RMSSD in the first minute following face cooling with a return to baseline in the second and third minutes. It can also detect a consistent decrease in LF/HF following face cooling.

ObjectiveUse biofeedback measures to manage a patient's long term recovery from concussion.BackgroundSports-related mild traumatic brain injury (MTBI) is estimated to affect 3.8 million people in the United States. Identifying quantitative measures of recovery has become a point of interest in treatment. Heart Rate Variability (HRV), the average fluctuation in the interval between heartbeats, shows promise as a noninvasive biomarker.Design/MethodsCase report following cardiovascular recovery of a 15 year old cross country runner 4 months post-injury. Average heart rate and maximum heart rate per training session were collected from the patient's smart device.ResultsA 15-year-old Caucasian male cross-country runner hit the back of his head during a soccer game suffering an MTBI. The patient rested from the activity for 1 week then returned to training. Two months after the injury the patient complained of persistent shortness of breath, fatigue, and increased heart rate while running. According to the patient, his average BPM while running prior to the injury was in the 160s. The patient's smart device post-concussion reports a spike into the 180s. 3 months post-concussion the patient was instructed to keep his heart rate below 170 during training. In the following month, the patient's condition improved gradually with a return to baseline activity.ConclusionsHRV is a promising point of investigation for the management of post-concussive symptoms. Further research is necessary to elucidate the long term effects of concussion on heart rate variability.