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Effective teamwork is essential in almost every job, and can even mean life, death, or disability in some jobs. Intraoperative neurophysiological monitoring (IONM) is a career in which effective teamwork and accurate communication are of utmost importance, yet it comes with a unique set of challenges in which to achieve those goals. Operating rooms can be very stressful environments, even if a surgical neurophysiologist (SNP) works in the same hospital every day. Often an SNP is required to travel from hospital to hospital and work with different teams each day. In addition, communication with the IONM oversight professional (IONM-P) can be challenging by nature of the telemedicine model which is becoming the most commonly applied IONM model in the United States. It is unfortunate that such critical skills are assumed and are rarely formally trained. In this article, we present evidence-based recommendations for establishing effective team function. We also provide several tools designed to help create effective and efficient teams. Teams cannot function at their best without outstanding communication, so improving teamwork also means improving communication. This article also provides several techniques for excellent communication, regardless of the situation or context. [ABSTRACT FROM AUTHOR]

Intraoperative neurophysiological monitoring (IONM) is shown to be useful in surgeries when the nervous system is at risk. Its success in part relies upon proper setup of often dozens of electrodes correctly placed and secured upon patients and inserted in specific stimulating and recording receptacles. Given the complicated setups and the demanding operating room environment, errors in setup are bound to occur. These have led to false negatives associated with new patient morbidities including, at times, paralysis. No studies quantify the prevalence of these types of setup errors. Approximately 800,000 operations annually utilize intraoperative neuromonitoring in the US alone, so even a small percentage of errors suggests clinical significance. In addition, these types of errors hinder the overall effectiveness of IONM and may result in lower reported sensitivities and lower cost-effectiveness of this important service. We sought to discover through a prospective study and verification through chart review the prevalence of “electrode-swap” errors (when recording and/or stimulating electrodes are incorrectly placed on the patient or in the IONM equipment during setup) across all procedures monitored. We found recording and/or stimulating electrode set up errors in 24 of 454 cases (5.3%). These data and examples of how errors were discovered intraoperatively are reported. We also offer techniques to help reduce this error rate. This study demonstrates a significant potential avoidable error in IONM diagnostic utility, patient outcome, and sensitivity/specificity of alert criteria. The value of identifying and correcting these errors is consequential, multifaceted, and far-reaching. [ABSTRACT FROM AUTHOR]

Spider silks have outstanding potential as biomaterials due to their sought‐after mechanical properties and low immunogenicity. The toughest spider silk is aciniform silk, which is used by spiders to wrap prey and produce egg sacs. A variety of recombinant aciniform silk constructs are now been developed, including hybrid silks with domains from multiple spider silk proteins fused together. In this study, an engineered aciniform silk construct, termed NBSilk, fused both N‐ and C‐terminally to heptapeptide motifs that bind the neurotrophic factor and nerve growth factor‐β (NGF) is introduced. NBSilk is shown to be amenable to casting into robust films that remain intact while sequestering and maintaining bioactive NGF at the film surface for at least 7 days. These films support cell survival while enhancing differentiation and neurite density and outgrowth in neuron‐like PC12 cells, with elevation of signaling through both the mitogen‐activated protein kinase (MAPK) and protein kinase B (AKT) signaling pathways. Strikingly, preloading of NBSilk films with NGF enhances neuritogenesis even over conditions where cells are grown with NGF supplementation in the culture medium. NBSilk scaffolds, thus, warrant future development and evaluation as biomaterials for nerve regeneration. [ABSTRACT FROM AUTHOR]