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Competing Interests: The authors declare no conflicts of interest.

Competing Interests: The authors declare no conflicts of interest.

Competing Interests: The authors declare no conflicts of interest.

Advanced health assessment (AHA) serves as the foundational course in advanced practice nurse education in which students apply clinical decision-making skills to gather appropriate subjective and objective data and to begin to formulate diagnostic hypotheses. Summative objective structured clinical exams (OSCEs) have been used in AHA courses to evaluate students' clinical competence. After implementing summative OSCEs in AHA, we found that students struggled with evaluations requiring critical thinking skills and subsequently designed a teaching tool to address this gap. An Episodic Tool was created for the six main body systems with a chief complaint and three age and gender combinations. In small groups, students used the tool to identify pertinent history and physical exam components for a specific age and gender. A faculty-facilitated group discussion followed. A pre/post design was used in this quality improvement project to compare OSCE and oral clinical exam (OCE) scores. OCEs were used in 2020 due to COVID-19 limitations. There was a statistically significant increase of 7 % in the mean OCE/OSCE scores after implementation of the tool (p < .001). Qualitative feedback from students and faculty suggested the tool effectively enhanced students' critical thinking and clinical decision-making skills and promoted consistency across course sections., Competing Interests: Declaration of competing interest None., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Introduction: The aim of this research project was to test an incremental bipolar radiofrequency generator with open and laparoscopic inline electrode probe for partial renal resection without vascular clamping., Material and Methods: Sixteen polar resections with clamping and six without were performed in four pigs in the acute phase. Three pigs underwent laparoscopic polar resection and were live housed for ten days and reoperated to verify the presence of hematic and urinary collection and the condition of the renal edge. Five pigs underwent laparoscopic polar resection without clamping, and two of these were live housed and reoperated after ten days., Results: Polar renal resection by our system (LaparoNewPro) turned out to be effective and safe, without cardio-respiratory complications or damage to the remaining parenchyma. Coagulation of the renal parenchyma before resection is effective and safe; at the reoperation, no complications were observed. The laparoscopic version of the probe is ergonomic and safe, with effective coagulation and a small amount of smoke produced. No complications occurred in the housed animals. No damage, local or to residual parenchyma, or thrombosis of the renal vessels were found., Conclusions: LaparoNewPro is able to deliver coagulation of the resection line effectively and independently of clamping of the vessels both in the open and laparoscopic approaches. Coagulation times are short, the automatism of the generator is reliable, and the open and laparoscopic probes are ergonomic.

Background: The aim of this research project was the realization of an incremental bipolar radiofrequency generator with inline 4-electrode probe for partial renal resection without clamping of the vessels., Methods: The experimentation was carried out across two phases: the preliminary realization of a specific generator and an inline multielectrode probe for open surgery (Phase 1); system testing on 27 bench kidneys for a total of 47 partial resection (Phase 2). The parameters evaluated were: power level, generator automatisms, parenchymal coagulation times, needle caliber, thickness of the coagulated tissue "slice", charring, ergonomy, feasibility of the application of "bolster" stitches., Results: The analysis of the results referred to the homogeneity and thickness of coagulation, energy supply times with reference to the power level and caliber of the needles. The optimal results were obtained by using needles of 1.5 mm caliber at power level 5, and with coagulation times of 54 seconds for the first insertion and 30 seconds for the second., Conclusions: The experimentation demonstrated that the apparatus, consisting of a generator named "LaparoNewPro" and fitted with a dedicated probe for open surgery, is able to carry out a coagulation of the line of resection of the renal parenchyma in a homogeneous manner, in short times, without tissue charring, and with the possibility of stitching both on coagulated tissue and the caliceal system. The generator automatism based on the flow of the current supplied by each electrode is reliable, and the cessation of energy supply coincides with optimal coagulation.