Ultrasonic tool to cut human bone: Cutting speed and forces necessary for potential remote robotic arms.

Bone morphogenetic protein 2 (BMP2) is a member of a subgroup of the transforming growth factor beta superfamily and triggers various signaling events which in turn stimulate chondrogenesis, osteogenesis, angiogenesis and extracellular matrix remodeling leading to fracture healing. In this study, we quantified the concentration of BMP2 in fresh human bone grafts obtained from 40 patients undergoing hip replacement surgery. Besides the concentration, the activity of the detected BMP2 was also investigated. In this study, the concentration of BMP2 in fresh human bone grafts obtained from 40 patients undergoing hip replacement surgery was quantified. Human BMP2 enzyme-linked immunosorbent assays and bicinchoninic acid quantification was used to determine the total concentration of protein present in each sample. To determine the activity of the BMP2 found in each bone sample, alkaline phosphatase activity was measured by colorimetric assay. The amount of BMP2 seemed to vary slightly between the patients. Taking into consideration the patient's gender, we observed that male patients presented slightly more BMP2 in comparison with females. When analyzing the activity of BMP2, we observed that in female patients, the activity was slightly higher in comparison to males. This variation may be caused by a number of factors, including but not limited to gender, age, osteoporosis and previous diseases. This information shows that the osteogenic potential of different bone graft samples is not consistent. The activity of BMP2 in femur heads obtained from patients undergoing total hip replacement surgery showed significant variation according to gender and age. The measurement of bone proteins activity might be promising as a qualitative method in bone banks and should be further investigated.

Simulators provide a safe method for improving surgical skills without the associated patient risks. Advances in rapid prototyping technology have permitted the reconstruction of patient imaging into patient-specific surgical simulations that require advanced expertise, potentially continuing the learning curve. To evaluate the impact of preoperative high-fidelity patient-specific percutaneous nephrolithotomy hydrogel simulations on surgical and patient outcomes. Between 2016 and 2017, a fellowship-trained endourologist performed 20 consecutive percutaneous nephrolithotomy procedures at an academic referral center. For the first ten patients, only standard review of patient imaging was completed. For the next ten patients, patient imaging was utilized to fabricate patient-specific models including pelvicalyceal system, kidney, stone, and relevant adjacent structures from hydrogel. The models were tested to confirm anatomic accuracy and material properties similar to live tissue. Full procedural rehearsals were completed 24-48h before the real case. Surgical metrics and patient outcomes from both groups (rehearsal vs. standard) were compared. Significant improvements in mean fluoroscopy time, percutaneous needle access attempts, complications, and additional procedures were significantly lower in the rehearsal group (184.8 vs. 365.7s, p < 0.001; 1.9 vs. 3.6 attempts, p < 0.001; 1 vs. 5, p < 0.001; and 1 vs. 5, p < 0.001, respectively). There were no differences in stone free rates, mean patient age, body mass index, or stone size between the two groups. This study demonstrates that patient-specific procedural rehearsal is effective reducing the experience curve for a complex endourological procedure, resulting in improved surgical performance and patient outcomes.

Canadian Spine SocietyPresentation CPSS1: Spinal insufficiency fracture in the geriatric pediatric spinePresentation CPSS2: The clinical significance of tether breakages in anterior vertebral body growth modulation: a 2-year postoperative analysisPresentation CPSS3: Anterior vertebral body growth modulation for idiopathic scoliosis: early, mid-term and late complicationsPresentation CPSS4: Ovine model of congenital chest wall and spine deformity with alterations of respiratory mechanics: follow-up from

Machine learning (ML) holds significant promise in optimizing various aspects of total shoulder arthroplasty (TSA), potentially improving patient outcomes and enhancing surgical decision-making. The aim of this systematic review was to identify ML algorithms and evaluate their effectiveness, including those for predicting clinical outcomes and those used in image analysis. We searched the PubMed, EMBASE, and Cochrane Central Register of Controlled Trials databases for studies applying ML algorithms in TSA. The analysis focused on dataset characteristics, relevant subspecialties, specific ML algorithms used, and their performance outcomes. Following the final screening process, 25 articles satisfied the eligibility criteria for our review. Of these, 60% focused on tabular data while the remaining 40% analyzed image data. Among them, 16 studies were dedicated to developing new models and nine used transfer learning to leverage existing pretrained models. Additionally, three of these models underwent external validation to confirm their reliability and effectiveness. ML algorithms used in TSA demonstrated fair to good performance, as evidenced by the reported metrics. Integrating these models into daily clinical practice could revolutionize TSA, enhancing both surgical precision and patient outcome predictions. Despite their potential, the lack of transparency and generalizability in many current models poses a significant challenge, limiting their clinical utility. Future research should prioritize addressing these limitations to truly propel the field forward and maximize the benefits of ML in enhancing patient care.

Although numerous studies have established cognitive biases as contributors to surgical adverse events, their prevalence and impact in surgery are unknown. This review aimed to describe types of cognitive bias in surgery, their impact on surgical performance and patient outcomes, their source, and the mitigation strategies used to reduce their effect. A literature search was conducted on 9 April and 6 December 2021 using MEDLINE, Embase, PsycINFO, Scopus, Web of Science, Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews. Included studies investigated how cognitive biases affect surgery and the mitigation strategies used to combat their impact. The National Institutes of Health tools were used to assess study quality. Inductive thematic analysis was used to identify themes of cognitive bias impact on surgical performance. Thirty-nine studies were included, comprising 6514 surgeons and over 200 000 patients. Thirty-one types of cognitive bias were identified, with overconfidence, anchoring, and confirmation bias the most common. Cognitive biases differentially influenced six themes of surgical performance. For example, overconfidence bias associated with inaccurate perceptions of ability, whereas anchoring bias associated with inaccurate risk-benefit estimations and not considering alternative options. Anchoring and confirmation biases associated with actual patient harm, such as never events. No studies investigated cognitive bias source or mitigation strategies. Cognitive biases have a negative impact on surgical performance and patient outcomes across all points of surgical care. This review highlights the scarcity of research investigating the sources that give rise to cognitive biases in surgery and the mitigation strategies that target these factors.

BackgroundThermal damage during surgical procedures is a critical factor influencing patient safety and outcomes, particularly in minimally invasive laparoscopic surgeries. Advanced robotic-assisted surgical systems, such as the Anovo® Surgical System, incorporate monopolar electrosurgical tools designed to optimize precision while minimizing collateral tissue damage. This study evaluates the thermal effects of the Anovo® Hook Electrode and Curved Scissors compared to conventional off-the-shelf (OTS) tools.MethodsAn ex vivo study was conducted using 288 tissue samples from a swine model, including liver, kidney, and muscle tissues. Thermal effects during monopolar cutting and coagulation were evaluated at three power settings (low, medium, high) and durations (5, 10, 15 s). Histological analysis was performed on all samples to assess coagulation necrosis and thermal spread. Statistical equivalence testing was applied to compare the Anovo® devices with OTS tools.ResultsThe Anovo® devices achieved precise and consistent thermal effects, meeting equivalence criteria in 97.57% of samples. Histological analysis confirmed well-defined coagulation zones with no unintended necrosis beyond the treated areas. Thermal spread increased proportionally with power settings and activation durations, but remained within clinically acceptable limits. The Anovo® devices demonstrated performance comparable to, and occasionally superior to, OTS tools.ConclusionThe Anovo® Hook Electrode and Curved Scissors provide safe and effective monopolar electrosurgical performance with precise thermal effects. These findings support their use in robotic-assisted laparoscopic surgeries and highlight their potential to enhance surgical precision and patient outcomes.

This study aimed to analyze and explore the effect of Plan-Do-Check-Act (PDCA) cycle management combined with detailed management on postoperative deep venous thrombosis in patients undergoing hip replacement surgery. Patients who underwent hip replacement surgery in our hospital between November 2021 and April 2023 were recruited for the study. After screening, patients who met all the inclusion criteria were assessed for eligibility. Finally, 80 adults were enrolled. All patients were assigned into observation and control groups (1:1) according to the sequence of admission, i.e., patients admitted between November 2021 and August 2022 were the control group, and patients admitted between September 2022 and April 2023 were the observation group. The intraoperative blood loss and hospital stay in the observation group were significantly less than those in the control group (p<0.05). After the intervention, the levels of plasma prothrombin time (PT), thrombin time (TT), and thromboplastin time (APTT) in the observation group were higher than those in the control group, and the DD level was lower than that in the control group (p<0.05). There was one patient in the observation group who developed deep venous thrombosis after the operation, and the incidence was 2.50%. The rate was significantly lower than that of the control group (p<0.05). The hip joint function score of the observation group was higher than that of the control group, and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale score was lower than that of the control group (p<0.05). The incidence of adverse reactions in the observation group was significantly lower than that in the control group (p<0.05). PDCA cycle management plus detailed management in patients with hip replacement surgery yields a favorable clinical outcome, which can effectively prevent postoperative deep vein thrombosis, and improve surgical indicators and postoperative coagulation function. Also, it reduces the incidence of adverse reactions in patients and facilitates recovery. It has a beneficial impact on the prognosis of patients and deserves promotion.

Evidence based practice guidelines for the nutritional management of malnutrition in adult patients across the continuum of care

Osteonecrosis of the Femoral Head (ONFH) is a disabling disease affecting up to 30,000 people yearly in the United States alone. Diagnosis and staging of this pathology are both technically and logistically challenging, usually relying on imaging studies. Even anatomopathological studies, considered the gold standard for identifying ONFH, are not exempt from problems. In addition, the diagnosis is often made by different healthcare specialists, including orthopedic surgeons and radiologists, using different imaging modes, macroscopic features, and stages. Therefore, it is not infrequent to find disagreements between different specialists. The aim of this paper is to clarify the association and accuracy of ONFH diagnosis between healthcare professionals. To this end, femoral head specimens from patients with a diagnosis of ONFH were collected from patients undergoing hip replacement surgery. These samples were later histologically analyzed to establish an ONFH diagnosis. We found that clinico-radiological diagnosis of ONFH evidences a high degree of histological confirmation, thus showing an acceptable diagnostic accuracy. However, when the diagnoses of radiologists and orthopedic surgeons are compared with each other, there is only a moderate agreement. Our results underscore the need to develop an effective diagnosis based on a multidisciplinary approach to enhance currently limited accuracy and reliability.

The rise in health and social care costs has prompted a critical look at the way health and social care services are managed and delivered. There has been a significant change in assessing the performance and evaluating the outcomes of services. Where once only performance outcome data related to service efficiency were required, now evidence of clinical effectiveness and cost-effectiveness is demanded. When evaluating the outcomes of service delivery, it is important to measure performance outcomes (related to service efficiency), clinical outcomes (related to service effectiveness) and economic outcomes (related to cost-effectiveness). This lecture examines the interdependent relationship between performance, clinical and economic outcomes in service delivery which is underpinned by strong leadership, the application of various service improvement strategies and collaborative research between managers, clinicians, researchers and health economists, with patient and public involvement. Service improvement strategies based on practice-based and research-based evidence will be suggested to optimise performance, clinical and economic outcomes. My lecture concludes that occupational therapists should adopt these service improvement strategies and conduct clinical researches and economic evaluations to develop an efficient, effective and cost-effective service which can meet the client's needs by using allocated resources and is value for money from a commissioning perspective.

To evaluate the effects of surgeon experience, body habitus, and bony pelvic dimensions on surgeon performance and patient outcomes after robot-assisted radical prostatectomy (RARP). The pelvic dimensions of 78 RARP patients were measured on preoperative magnetic resonance imaging and computed tomography by three radiologists. Surgeon automated performance metrics (APMs [instrument motion tracking and system events data, i.e., camera movement, third-arm swap, energy use]) were obtained by a systems data recorder (Intuitive Surgical, Sunnyvale, CA, USA) during RARP. Two analyses were performed: Analysis 1, examined effects of patient characteristics, pelvic dimensions and prior surgeon RARP caseload on APMs using linear regression; Analysis 2, the effects of patient body habitus, bony pelvic measurement, and surgeon experience on short- and long-term outcomes were analysed by multivariable regression. Analysis 1 showed that while surgeon experience affected the greatest number of APMs (P<0.044), the patient's body mass index, bony pelvic dimensions, and prostate size also affected APMs during each surgical step (P<0.043, P<0.046, P<0.034, respectively). Analysis 2 showed that RARP duration was significantly affected by pelvic depth (β=13.7, P=0.039) and prostate volume (β=0.5, P=0.024). A wider and shallower pelvis was less likely to result in a positive margin (odds ratio 0.25, 95% confidence interval [CI] 0.09-0.72). On multivariate analysis, urinary continence recovery was associated with surgeon's prior RARP experience (hazard ratio [HR] 2.38, 95% CI 1.18-4.81; P=0.015), but not on pelvic dimensions (HR 1.44, 95% CI 0.95-2.17). Limited surgical workspace, due to a narrower and deeper pelvis, does affect surgeon performance and patient outcomes, most notably in longer surgery time and an increased positive margin rate.

Background Increasing evidence shows substantial variation in surgical performance measured by a (video-based) competency assessment tool (CAT). Moreover, suboptimal surgical performance has been associated with less favorable patient outcomes in complex minimal invasive procedures. It is likely this also applies for minimally invasive esophagectomy (MIE). In a previous study a CAT for MIE (MIE-CAT) was developed and validated. The present study investigated the association between surgical performance and postoperative outcomes of MIE in the Netherlands. Methods A nationwide observational video analysis study was performed. All fifteen Dutch hospitals performing MIE voluntarily submitted all patient outcomes from the 2020–2021 Dutch Upper-GI Clinical Audit registry, and two representative surgical videos from 2022. Surgical performance was assessed by 7 blinded and independent expert MIE surgeons with the MIE-CAT. Hospitals were divided into quartiles based on their performance score. Multilevel logistic regression, with clustering of patients within hospitals, was used to study associations between surgical performance and patient outcomes. Primary outcome was severe postoperative complications (Clavien-Dindo ≥3) within 30 days after surgery. Results Highest- (mean MIE-CAT 113.6, SD 5.5, n = 3) versus lowest-performance-quartile (mean 94.1, SD 5.9, n = 3) had more MIE experience (Pearson’s r = 0.74, 95%CI 0.32–0.92), larger volumes (Pearson’s r = 0.46, 95%CI -0.13-0.81) and favorable outcomes (Figure 1). Performance of highest- versus lowest-quartile was statically significantly associated with less complications (severe postoperative (RR, converted from OR, = 0.50, 95%CI 0.24–0.99), peroperative (RR = 0.21, 95%CI 0.04–0.94) and any postoperative (RR = 0.54, 95%CI 0.24–0.96)), less conversions (RR = 0.21, 95%CI 0.21–0.21) and a 11.5% absolute chance reduction of severe postoperative complications for an average patient. Increased anastomotic-phase performance was associated with less anastomotic leakage (RR = 0.14, 95%CI 0.06–0.31). Conclusion This Dutch nationwide study showed statistically significant and clinically relevant associations between surgical performance and outcomes of patients undergoing MIE. An average patient has a 11.5% absolute chance reduction of a severe postoperative complication when operated in a highest-performance quartile hospital, compared to a lowest-performance quartile hospital. These findings show that good surgical performance is an essential aspect for good clinical outcomes.

This study was to examine the relationships between nurse staffing and patient outcomes. Data for this study were obtained from the '2008 Korea National Patients Survey' conducted by the Korea Institute for Health and Social Affairs. Hospital characteristics included size, location, ownership, and physician staffing. Patient characteristics were age, gender, primary diagnosis, admission route, type of surgery, and primary payer. Nurse staffing was not significantly associated with inpatient mortality. Government and nursing policies are required to ensure adequate nurse staffing in hospitals. This study aims to objectively examine the influences of nurse staffing on patient outcomes through multilevel analysis of large-scale national data and controlling factors that affect patient outcomes patient standards. The results concluded from this study will provide evidence for the importance of the nation and medical institution's awareness on nurse staffing and adequate maintenance and management, and will contribute to the establishment of adequate government policies regarding nursing staff in the long term. The purpose of the study is to analyze the relationship between nurse staffing and surgical cerebrovascular disease patient outcomes (mortality). The concrete aims of the study are as follows: 1) Comprehend characteristics of hospitals and patients, and identify nurse staffing 2) Analyze the relationship between nurse staffing and the mortality of surgical cerebrovascular disease patients.

Study Boosts Push for Reimbursing Amyloid Imaging

Clinical pathways are being introduced by hospitals to reduce costs and control unnecessary variation in care. We studied 766 inpatients to measure the impact of a perioperative clinical pathway for patients undergoing knee replacement surgery on hospital costs. One hundred twenty patients underwent knee replacement surgery before the development of a perioperative clinical pathway, and 63 patients underwent knee replacement surgery after pathway implementation. As control groups, we contemporaneously studied 332 patients undergoing radical prostatectomy (no clinical pathway in place for these patients) and 251 patients undergoing hip replacement surgery without a clinical pathway (no clinical pathway and same surgeons as patients having knee replacement surgery). Total hospitalization costs (not charges), excluding professional fees, were computed for all patients. Mean (+/-SD) hospital costs for knee replacement surgery decreased from $21,709 +/- $5985 to $17,618 +/- $3152 after implementation of the clinical pathway. The percent decrease in hospitalization costs was 1.56-fold greater (95% confidence interval 1.02-2.28) in the knee replacement patients than in the radical prostatectomy patients and 2.02-fold greater (95% confidence interval 1.13-5.22) than in the hip replacement patients. If patient outcomes (e.g., patient satisfaction) remain constant with clinical pathways, clinical pathways may be a useful tool for incremental improvements in the cost of perioperative care. Doctors and nurses can proactively organize and record the elements of hospital care results in a clinical pathway, also known as "care pathways" or "critical pathways." We found that implementing a clinical pathway for patients undergoing knee replacement surgery reduced the hospitalization costs of this surgery.