Chair Position Research Articles

Early mobilisation and rehabilitation in Swiss intensive care units: a cross-sectional survey.

Patients in intensive care units (ICUs) are at high risk of developing physical, functional, cognitive, and mental impairments. Early mobilisation aims to improve patient outcomes and is increasingly considered the standard of care. This survey aimed to investigate the characteristics, current use and variations of early mobilisation and rehabilitation in Swiss ICUs. We conducted a cross-sectional survey among all ICU lead physicians, who provided data on their institutional characteristics, early mobilisation and rehabilitation practices, and their perceptions of the use and variation of early rehabilitation practices in Switzerland. The survey response rate was 44% (37/84). Among ICUs caring for adults (34/37), 26 were in the German-speaking region, five in the French-speaking region, and three in the Italian-speaking region. All ICUs regularly involved physiotherapy in the rehabilitation process and 50% reported having a specialised physiotherapy team. All ICUs reported performing early mobilisation, starting within the first 7 days after ICU admission. About half reported the use of a rehabilitation (45%) or early mobilisation protocol (50%). Regular, structured, interdisciplinary rounds or meetings of the ICU care team to discuss rehabilitation measures and goals for patients were stated to be held by 53%. The respondents stated that 82% of their patients received early mobilisation measures during their ICU stay. Most frequently provided mobilisation measures included passive range of motion (97%), passive chair position in bed (97%), active range of motion muscle activation and training (88%), active side to side turning (91%), sitting on the edge of the bed (94%), transfer from bed to a chair (97%), and ambulation (94%). The proportion of ICUs providing a specific early mobilisation measure, the proportion of patients receiving it, and the time dedicated to it varied across language regions, hospital types, ICU types, and ICU sizes. Almost one third of the ICU lead physicians considered early rehabilitation to be underused in their own ICU and about half considered it to be underused in Switzerland more generally. ICU lead physicians stressed lack of personnel, financial resources, and time as key causes for underuse. Moreover, they highlighted the importance of early and systematic or protocol-based rehabilitation and interprofessional approaches that are adaptive to the patients' rehabilitation needs and potential. This survey suggests that almost all ICUs in Switzerland practice some form of early mobilisation with the aim of early rehabilitation. However, the described approaches, as well as the reported use of early mobilisation measures were heterogenous across Swiss ICUs.

A Brief Review of Reverse Shoulder Arthroplasty for Rotator Cuff Arthropathy

Reverse total shoulder arthroplasty is an increasingly popular procedure performed by orthopedic surgeons. The indications have expanded over the past two decades with well documented success in the treatment of rotator cuff arthropathy. Patients with loss of rotator cuff function experience altered shoulder biomechanics that lead to superior humeral head migration, acetabulization of the acromion and progressive glenohumeral arthritis. Clinically, patients present with chronic shoulder pain, weakness and loss of range of motion that impacts activities of daily living. To address this, a reverse total shoulder can be performed. The procedure is normally done in the beach chair position utilizing the deltopectoral approach. A humeral stem with liner and glenosphere is implanted into the humerus and scapula, respectively. The procedure has shown consistent improvements in pain, strength, range-of-motion and function. Complications include dislocation, instability, fracture and infection.

Arthroscopic pectoralis minor release in the beach chair position

The scapula serves as the transition point for energy from the lower body and core through the scapulothoracic articulation to the distal upper extremity. Abnormal motion and asynchrony of the scapulothoracic articulation can disrupt this kinetic chain and lead to pain and dysfunction of the shoulder.

Assessment of Knowledge and Practice of Ergonomics among Dental Practitioners in Riyadh City in Saudi Arabia.

Aim:The present study was undertaken to assess the knowledge and practice of ergonomics among dental practitioners in Riyadh, Saudi Arabia.Methodology:A self-administered questionnaire was distributed among dental practitioners through Google Forms. Link of the questionnaire was sent through social media and e-mail. The questionnaire was focused on the awareness of ergonomics and practice of ergonomics during dental practice.Results:About 97.9% of participants are aware of different operating positions. About 71.7% of participants rate their operating procedure chair positions as good. 52.5% admit they feel numb fingers while working. Many questions were statistically significant according to educational qualification and type of practice (P < 0.050.Conclusion:Majority of the study population were aware of proper chair positions, correct operating procedures and were practicing four-handed dentistry, maintained proper back support while working, and even performed stretching exercises during clinical working hours.

Assessment of knowledge, attitude and practices towards postural management during dental practices among dental students

Introduction: Ergonomics is an applied science concerned with designing product and procedures for max efficiency and safety and concerns itself with improving the operator’s efficiency and their working environment. The aim of this study was to assess the knowledge, attitude and practices towards postural management among dental students. Materials and Methods: A study was conducted among the interns and postgraduate students. The structured, self-administered, close-ended questionnaire was designed to collect the data which consisted of four sections and comprised of 36 questions for assessing the knowledge, attitude and practices among these students towards postural management and to determine if a short chair-side lecture on postural management could improve their knowledge and attitude on this topic. A self-assessed checklist was used for evaluation of ergonomics which was filled by observing the participants in clinical setting. Results: In this study, there were a total of 30 participants between 21-30 years of age. Before giving the knowledge, around 83.3% of the participants were aware of the importance of ergonomics in clinical dentistry and after giving knowledge, 96.7% of the participants became aware of the same. Only 43.3% of the participants followed correct dental chair position before imparting the knowledge which increased to about 63.3% after that. Conclusion: The dental students maybe more prone to musculoskeletal disorders (MSD) and maintaining proper ergonomic principle in their early years of practice will prevent them from future chronic MSD.

The effects of body direction and posture on taking the perspective of a humanoid avatar in a virtual environment.

Visual perspective taking is inferring how the world looks to another person. To clarify this process, we investigated whether employing a humanoid avatar as the viewpoint would facilitate an imagined perspective shift in a virtual environment, and which factor of the avatar is effective for the facilitation effect. We used a task that involved reporting how an object looks by a simple direction judgment, either from the avatar’s position or from the position of an empty chair. We found that the humanoid avatar’s presence improved task performance. Furthermore, the avatar’s facilitation effect was observed only when the avatar was facing the visual stimulus to be judged; performance was worse when it faced backwards than when there was only an empty chair facing forwards. This suggests that the avatar does not simply attract spatial attention, but the posture of the avatar is crucial for the facilitation effect. In addition, when the directions of the head and the torso were opposite (i.e., an impossible posture), the avatar’s facilitation effect disappeared. Thus, visual perspective taking might not be facilitated by the avatar when its posture is biomechanically impossible because we cannot embody it. Finally, even when the avatar’s head of the possible posture was covered with a bucket, the facilitation effect was found with the forward-facing avatar rather than the backward-facing avatar. That is, the head/gaze direction cue, or presumably the belief that the visual stimulus to be judged can be seen by the avatar, was not required. These results suggest that explicit perspective taking is facilitated by embodiment towards humanoid avatars.

Lower trapezius transfer for massive posterosuperior rotator cuff defects.

To present the arthroscopically assisted lower trapezius transfer technique that restores shoulder external rotation and forward elevation, with low complication rates and fast recovery. Massive irreparable posterosuperior rotator cuff tears in active young patients with fatty infiltration ≥ III, osteoarthrosis Hamada ≤ 3, normal function of lower trapezius, and without glenohumeral stiffness. Absolute: Active soft tissue infection and trapezius muscle paralysis. Relative: medical comorbidities, inability to follow postoperative recommendations, advanced age, advanced degenerative changes (Hamada > 3), deltoid deficiency, and forward elevation < 60º. Beach chair position. Lower trapezius harvesting, allograft preparation, arthroscopic evaluation and rotator cuff partial repair, allograft passage, allograft intraarticular arthroscopic attachment, lower trapezius-allograft open attachment and wound closure. Avoidance of internal rotation with an external rotation brace for 6weeks. At 6weeks progressively appropriate physical therapy. Unrestricted activity at 6months. At mean follow-up of 14months, good results were reported (pain, range of motion, and Subjective Shoulder Value and Disabilities of the Arm and Shoulder and Hand scores). Long-term symptoms, Hamada 3rotator cuff arthropathy, and true pseudo paralysis were associated with negative clinical outcomes, but subscapularis pathology and teres minor fatty atrophy were not. Alow complication rate was described. Arthroscopically assisted lower trapezius transfer may restore motion and strength in external rotation. Good results with low complication rates have been reported. It has become the authors' procedure of choice in young active patients with irreparable massive rotator cuff tears.

Age-related differences in cognition and postoperative quality of recovery after beach chair position shoulder surgery

We examined the influence of age in beach chair position shoulder surgery and postoperative quality of recovery by conducting a single-site, observational, cohort study comparing younger aged (18-40 years) versus older aged (at least 60 years) patients admitted for elective shoulder surgery in the beach chair position. Endpoints were dichotomous return of function to each patient's individual preoperative baseline as assessed using the postoperative quality of recovery scale; measuring cognition, nociception, physiological, emotional, functional activities and overall perspective. We recruited 112 (41 younger and 71 older aged) patients. There was no statistical difference in cognitive recovery at day three postoperatively (primary outcome): 26/32 younger patients (81%) versus 43/60 (72%) older patients, P=0.45. Rates of recovery were age-dependent on domain and time frame (secondary outcomes), with older patients recovering faster in the nociceptive domain (P=0.02), slower in the emotional domain (P=0.02) and not different in the physiological, functional activities and overall perspective domains (all P >0.35). In conclusion, we did not show any statistically significant difference in cognitive outcomes between younger and older patients using our perioperative anaesthesia and analgesia management protocol. Irrespective of age, 70% of patients recovered by three months in all domains.

Arthroscopic Evaluation of the Long Head of the Biceps Tendon: Traditional Versus Allis Clamp Techniques.

Using a probe to retract the long head of the biceps tendon (LHBT) into the joint is common practice for visualizing the extra-articular portions during arthroscopy. However, extra-articular lesions may be missed in up to half of cases. Greater excursion of the LHBT may be achieved with an Allis clamp grasper. Our goal was to quantify portions of the extra-articular LHBT that could be visualized during shoulder arthroscopy with the Allis clamp and probe techniques. Shoulder arthroscopy was performed on 8 forequarter cadaveric specimens in the simulated beach chair position, and the most distal extent of the intra-articular LHBT was marked. The tendon was pulled into the joint with both techniques, and the additional exposed tendon portion was marked. An open approach was performed, and the locations of the 3 marks were assessed relative to total tendon length. Mean LHBT total length was 96.25 mm. Diagnostic arthroscopy allowed visualization of a mean of 21.75 mm of the intra-articular tendon (22.6% of the total length). The traditional probe technique provided visualization of 31.13 mm (32.8%). The Allis clamp technique provided visualization of 49.38 mm (52%) and increased visualization of the LHBT by 58.6% (P<.0001). A mean of 46.87 mm (48%) of the LHBT remained unvisualized. The Allis clamp technique maximizes arthroscopic visualization of extra-articular LHBT. The distal 48% eludes evaluation, but can be visualized when combined with an open technique without the need to divide the transverse humeral ligament. The Allis clamp technique facilitates additional identification of LHBT pathology that could otherwise remain hidden during shoulder arthroscopy. Because the LHBT is a major source of pain in the shoulder, this technique may improve outcomes of shoulder arthroscopy and reduce the need for revision because of remnant anterior shoulder pain. [Orthopedics. 2022;45(1):38-42.].

Tennessee Academy of Science Executive Committee Meeting Minutes, November 2021

Tennessee Academy of Science Executive Committee Meeting Minutes, November 2021

High-Efficiency Multi-Sensor System for Chair Usage Detection.

Recognizing Activities of Daily Living (ADL) or detecting falls in domestic environments require monitoring the movements and positions of a person. Several approaches use wearable devices or cameras, especially for fall detection, but they are considered intrusive by many users. To support such activities in an unobtrusive way, ambient-based solutions are available (e.g., based on PIRs, contact sensors, etc.). In this paper, we focus on the problem of sitting detection exploiting only unobtrusive sensors. In fact, sitting detection can be useful to understand the position of the user in many activities of the daily routines. While identifying sitting/lying on a sofa or bed is reasonably simple with pressure sensors, detecting whether a person is sitting on a chair is an open problem due to the natural chair position volatility. This paper proposes a reliable, not invasive and energetically sustainable system that can be used on chairs already present in the home. In particular, the proposed solution fuses the data of an accelerometer and a capacitive coupling sensor to understand if a person is sitting or not, discriminating the case of objects left on the chair. The results obtained in a real environment setting show an accuracy of 98.6% and a precision of 95%.

Gender Equity of Promoting Practices in Academic Neurosurgery in the United States

Women have historically been underrepresented in academic medicine, particularly in surgical subspecialties. This study investigated potential associations between gender and promoting practices in academic neurosurgery. Faculty data, including time from residency, professorship, specialty, and h-index, were obtained from websites of the institutions listed in the American Association of Neurological Surgeons Neurosurgical Residency Training Program Directory. Demographics, training, and appointments were compared between male and female neurosurgeons. Predictors of professorship, chair, directorship, and division leadership were identified using multivariable models. The study examined 1629 faculty members. Women were more likely to be assistant professors (P < 0.0001), while men were more likely to be full professors (P < 0.0001), hold chair positions (P= 0.007), lead subspecialty divisions (P= 0.008), and have a higher Scopus h-index (P < 0.0001). In a multivariable analysis, years from training (P < 0.001), fellowship (P= 0.009), h-index (P < 0.001), and chair/program director/division leadership position (P < 0.001) were significant positive predictors of full professorship. Holding additional advanced degrees (P= 0.010), leading a subspecialty division (P= 0.005), and having a higher h-index (P= 0.002) positively predicted chair position. However, when accounting for all other factors, gender was not a significant predictor of full professorship, division leadership, chair, or program directorship. While significantly more men hold leadership positions in U.S. academic institutions, after controlling for contributing variables, there did not appear to be an association between gender and full professorship, division leadership, chair, or program directorship in academic neurosurgery. While the field still has significant work to do to achieve gender equity, these results may serve as encouragement to women who are looking to advance their careers in academic neurosurgery.

Strings attached: Socioemotional wealth mixed gambles in the cash management choices of family firms

Family owners differ from other types of owners due to the presence of socioemotional wealth (SEW) concerns. We take a closer look at this distinctive aspect by examining the impact of family control and influence dimension of SEW on the cash management choices of family firms, conceptualizing it as a mixed gamble choice. Our empirical analysis of 195 Italian firms listed on the Milan Stock Exchange between 2003 and 2015 shows that family firms derive more value and incur lower costs than nonfamily firms when they increase their cash holdings. We then delve deeper into family firms’ cash management choices by exploring how different levels of family control and influence as well as types of board governance arrangements moderate this relationship. The empirical results indicate that the positive effects of family ownership are more pronounced under a high level of family control and influence and with separation of the board chair and CEO positions.

Characteristics of NCCN Committee Members: Opportunities for Change

The National Comprehensive Cancer Network (NCCN) guidelines are an authoritative resource in cancer management. NCCN guideline committees are composed of multi-specialty teams, representing 30 cancer institutions in the US. In spite of the critical impact of these committees, little is known about its actual members. Our study evaluates the characteristics of NCCN committee members (CMs) and assesses gender and specialty-specific variance.All NCCN management guidelines were evaluated in September 2020. Characteristics of individual CMs were obtained including specialty, gender, academic rank, disease treatment site, h-index, academic degrees, and represented institutions. Chi-square test was utilized for statistical comparisons.A total of 54 NCCN guidelines were identified, along with 1768 panel members. Median committee size was 33 (range 22-38). Medical Oncologists (MO; 47.6%), Surgical Oncologists (SO; 20.9%), and Radiation Oncologists (RO; 8.9%) comprised the largest proportion of CMs. Women accounted for 37.6% of MO, 34.2% of RO, and 22.8% of SO CMs. While women accounted for 39.3% of all CMs, among committee leaders, women constituted only 23% of chairs, and 38.1% of vice-chairs (P < 0.05). Female RO held 1 chair position (compared to 1 male RO), and 9 vice chair positions (compared to 1 male RO). Assistant and Associate professors represented 22.4% and 28.7% of CMs respectively. Full professors accounted for 40.8% of all CMs, and had a higher representation among RO (53.1%) and SO (56.3%), relative to MO (35.3%), P < 0.05. The minority of SO (0.27%) and MO (0.83%) were Instructors; there were no RO Instructors. CMs with H-index > 31 were similarly represented across oncological specialties (RO: 39.2%; MO: 40.8%; SO: 43.3%), but there was a higher prevalence of MO (17.7%) with an H-index between 0-10, in comparison to RO (7.6 %) and SO (8.4), P < 0.05. CMs held MD/MD-equivalent degrees (68.5%), MD-Master's degrees (9.9%), and non-physician degrees (7.1%). MD-PhDs accounted for 15.1% of all CMs, and were more represented among RO (31.0%) relative to MO (14.4%) and SO (7.6%), P < 0.05. Memorial Sloan Kettering (75) and MD Anderson (66) were the most represented institutions; 3 institutions had ≤8 representatives. Among the 158 RO NCCN CMs, many served on gastrointestinal (19.0%), genitourinary (12.7%), and gynecological (12.7%) committees, while few served on pediatric (0.63%), and breast (1.2%) committees. 16 (29.6%) committees had no RO members.NCCN committee members are more likely to be male, MO, full professors, and have high H-index scores. RO on committees generally exhibit high scholarship but have low representation, with almost one-third having no RO members at all. Leadership roles for female oncologists are also limited, although among RO there are more females in committee leadership roles. Increasing specialty and gender diversity on committees may allow for more balanced management perspectives.

The Leadership Landscape: Characteristics of Current Faculty in Leadership Positions in Obstetrics and Gynecology Departments

<h3>Study Objective</h3> To describe the proportion of female faculty in departmental administrative and educational leadership roles in Obstetrics and Gynecology departments. <h3>Design</h3> Cross sectional observational study. <h3>Setting</h3> Accredited Obstetrics & Gynecology residency programs. <h3>Patients or Participants</h3> 288 accredited residency programs were identified from 2019 to 2020 with 1237 individuals in leadership positions. <h3>Interventions</h3> Similar to a 2012-2013 survey by Hofler et al., residency program websites and corresponding fellowships (Maternal Fetal Medicine, Female Pelvic Medicine and Reconstructive Surgery (FPMRS), Reproductive Endocrinology and Infertility (REI), Gynecologic Oncology), departmental, and divisional websites were queried for those in administrative and educational leadership positions. Information regarding gender (as determined by surrogates of name and photographic gender expression), medical and academic degrees, academic rank, and subspecialty certification was abstracted. <h3>Measurements and Main Results</h3> Within administrative leadership roles, women comprised 29% of chairs, 46% of vice chairs, and 47% of division directors; women held significantly fewer chair positions than men (p <.001). In educational leadership, women made up 71% of medical school clerkship directors, 58% of residency directors, and 50% fellowship directors. Women were more likely to hold educational leadership positions (56% vs 40%, p<.001) while men were more likely to hold administrative leadership positions (68% vs 52%, p <.001). There was greatest gender equity within FPMRS and least gender equity in Gynecologic Oncology and REI. Female leaders were more likely to have received additional academic degrees (ex. MBA, MPH) than their male counterparts (19% vs 13%, p=.002). <h3>Conclusion</h3> Women continue to be underrepresented in administrative leadership positions. Compared to 2012-2013, there is only a 9% increase in proportion of women chairing and 10% vice chairing Obstetrics and Gynecology departments; the increase is more substantial in other positions, such as division directors (17%). Our findings demonstrate ongoing gender disparity in the highest levels of departmental leadership and the need to further improve upon diversity and gender equality within leadership roles.

Ultrasound-guided interscalene block anesthesia performed by an orthopedic surgeon: a study of 1322 cases of shoulder surgery.

BackgroundInterscalene blocks are becoming increasingly common for shoulder surgeries. This study primarily aimed to demonstrate the efficacy and complications and the secondarily to investigate the anesthesia-related time and patient satisfaction of an ultrasound-guided interscalene block performed by an orthopedic surgeon.MethodsWe retrospectively reviewed the medical records of 1322 consecutive patients (arthroscopic, 1225 cases; open, 97 cases) with a mean age of 64.2 years, who underwent shoulder surgery (arthroscopic or opensurgery) under an ultrasound-guided interscalene block performed by an orthopedic surgeon at a single institution between December 2012 and December 2019. We investigated patient satisfaction, block success rates, and complications and also compared the anesthesia-related time of an interscalene block with that of general anesthesia (428 cases, arthroscopic, 257 cases; open, 171 cases) for shoulder surgery with patients in the beach chair position during the same period. Difference between total anesthesia time and surgical time was defined as anesthesia-related time.ResultsApproximately 98.3% of patients were satisfied with an interscalene block, and the block success rate on the first attempt was 99.9%. Total complication incidence was 2.3%, with no recorded life-threatening complications. Anesthesia-related times were significantly shorter in the interscalene block group than those in the general anesthesia group (45 ± 14 min vs. 100 ± 26 min, P < .001).ConclusionAn ultrasound-guided interscalene block performed by an orthopedic surgeon for shoulder surgery is effective and safe, requires less time, and has a high patient acceptance rate, making it a feasible and alternative to the block performed by anesthesiologists.

Fifteen-year trends in participation of women in presentation and leadership positions in the Southern Association for Vascular Surgery, 2006 to 2020

ObjectiveThe implementation of integrated vascular surgery training programs was recently shown to be associated with an increase in women entering the field. However, whether this has precipitated a subsequent increase in the active participation of women in academic vascular societies remains unclear. We sought to examine the trends of academic inclusion of women vascular surgeons and surgical trainees over the past 15 years at the Southern Association for Vascular Surgery (SAVS). MethodsScientific programs for annual meetings of the SAVS, and program matriculation statistics from the Accreditation Council for Graduate Medical Education, were reviewed for the period of 2006 to 2020. Yearly rates and 3-year averages of conference and society participation and vascular surgery training program matriculation rates were calculated and compared with proportion testing. Spearman correlation testing was used to compare trends, with ρ ≥0.600 defined as a strong correlation. ResultsExamining 3-year means, the average number of women authors per SAVS abstract increased from 0.78 to 1.42 over the course of the study period (P < .001), and the overall rate of women authors steadily increased from 12.8% to 21.5% (P < .001). Although this remains less than the proportion of women matriculating into vascular surgery programs in 2019 (29.3%; P = .007), the upward trend of women entering vascular surgery overall, and particularly vascular surgery fellowship, strongly correlates with the average number of women authors on abstracts at SAVS (ρ = 0.709 and ρ = 0.737, respectively). The percentage of women presenting authors increased from 9.7% to 28.4% (P = .004), but there was no increase in the percentage of women senior authors (10.1% to 9.6%; P = .92). In the 15-year period, only one abstract of 347 (0.3%) had full authorship by women vs 35.1% with full authorship by men (P < .001). Although the increase of women matriculating into vascular surgery programs over the study period did not correlate with the increase of women in senior leadership positions (ρ < 0.600), there was an increase in the number of women in committee chair positions (0.0% to 25.9%; P = .005), which correlated strongly with increasing society membership (ρ = 0.716). Additionally, there was an increase in women holding executive council positions from 0% to 10.0% (P = .08), although this was not statistically significant. ConclusionsParticipation of women authoring and presenting papers at the SAVS has increased over the past 15 years at a rate that strongly correlates with the increasing rate of women entering vascular surgery training programs. It is important that society leadership opportunities continue to parallel this trend as we seek to further improve diversity in vascular surgery.

Arthroscopically Assisted Stabilization of Chronic Acromioclavicular Joint Instability.

For this procedure, the patient is placed in the beach chair position. After establishing standard posterior, anteroinferior, and anterolateral (transtendinous) portals, the arthroscopic preparation of the coracoid base is performed. Next, transcoracoidal-transclavicular drilling is performed, and a nitinol suture passing wire is utilized to aid the placement of the TightRope later in the procedure. The graft passage around the clavicle and the coracoid is then set up by placing 2 additional nitinol suture passing wires. Following this, coracoclavicular stabilization is performed with use of the low-profile TightRope device, after which the graft is shuttled around the clavicle and the coracoid with the help of the passing wires. After the acromial drilling, the graft is shuttled laterally transacromially and subcutaneously back to the clavicle, completing the AC cerclage. Finally, the graft ends are sewn together under tension. The deltotrapezial fascia is closed above the graft, incorporating the tendon ends into the suture. Finally, the skin can be closed. In case of chronic AC joint injuries, many surgical stabilization techniques have been described. On the one hand there are rigid stabilization techniques like the hook-plate or temporary Kirschner wire fixation. On the other hand, there are dynamic stabilization techniques like the modified Weaver-Dunn procedure or solitary synthetic coracoclavicular reconstruction with use of pulley-like devices, with or without additional AC stabilization3. As for nonsurgical alternatives, physiotherapy with periscapular stabilization and muscle strengthening may be an option4. For the treatment of chronic AC joint instability, many techniques5-9 have been described that utilized horizontal and vertical stabilization with a tendon graft combined with a synthetic pulley-like device. Usually, multiple transclavicular and transcoracoidal drill holes are utilized for the graft passage, which could weaken the bone and may result in postoperative fractures of the coracoid and clavicle10. Considering this, we present a modified technique that focuses on the optimization of the graft passage. In contrast to other aforementioned techniques, this procedure requires only 1 transcoracoidal-transclavicular tunnel for the TightRope and another transacromial tunnel for the passage of the AC cerclage. By forming a loop of the graft around the coracoid and the clavicle, the graft passage is managed without any additional coracoidal or clavicular drilling. A dedicated study investigating the specific clinical and radiographic results of our technique will be part of future research. Because the biomechanical principle of reconstruction of our technique is very similar to the technique described by Kraus et al., we refer to their clinical and radiographic results regarding the expected outcome. As shown in the chart in the video, Kraus et al. demonstrated good clinical and radiographic results with their biologic and synthetic AC-stabilization technique at a median follow-up of 24 months. The outcomes measured in that study were the Constant score, Subjective Shoulder Value, AC Joint Instability Score, and Taft score. Patients were divided into 2 groups. Group 1 included patients with failed prior conservative treatment, and group 2 included those with failed prior surgical treatment. Overall, the authors report complete dynamic posterior translation in 1 patient and partial dynamic posterior translation in 5 patients. Although there was no notable enlargement of the TightRope drill hole, the authors of that study found a significant enlargement of the clavicular graft tunnels. However, the enlargement had no clinical relevance10. Utilize a low-profile TightRope device to minimize the risk of suture irritation from knot stacks.The tendon graft should be ≥24 cm in length. If the graft is too short, perform an end-to-end anastomosis of 2 grafts.Utilize an image intensifier to ensure correct drill hole placement and avoid damage to neurovascular structures.The graft passage around the clavicle and the coracoid can be dilated by hand with the use of differently sized drill bits.Incorporate the graft into fascial closure at the end of the procedure.

Design and development of multifunctional patient bed with integrated toilet

This paper presents a new bed for bedridden patients. It has provision for using a commode by pulling it up to the bed height by a specially designed mechanism. For commode use, it has an opening in the bed. A mattress on the platform covers the commode opening. After use, the commode is pushed back to its position below the bed. Then, the commode opening gets covered. This bed also has provision for side turning of the patient. The left and right-side turning mechanisms can operate independently to allow the patient to sleep on the left or right side. It is possible to turn both sides together to avoid touching the middle part of the back to the bed surface to avoid pressure ulcers. The side turning may be simultaneously operated with the backrest. A separate mechanism is there for this purpose. In addition, the bed can be converted into a chair position and has other utilities like a washbasin, folding table, and cistern attached to it. The bed design and development are in two stages. First, a bed with a commode is designed. Later, this design is improved to add a side turning mechanism. Computer modeling, simulation, fabrication, and testing are employed to plan and check bed operations and positions. The mechanical performance of the bed is compared with the simulation results, and the errors are negligible. The bed is compared with the reported designs in the literature. It is a novel product. It will be excellent equipment for bedridden patients and caregivers.Article HighlightsPresents a new bed design for bedridden patients..The bed has the provision of a commode and a facility for the side-turning of the patient.Reduces discomfort for the patients, chances of bedsores, and efforts of the caretaker.

Fluid preloading before beach chair positioning for arthroscopic shoulder procedures: a randomized controlled trial

Background and objectivesThe Beach Chair Position (BCP) has many advantages such as less neurovascular injury and better intra-articular visualization, but it has also negative consequences, including hemodynamic instability. Although maintaining normal Mean Arterial Pressure (MAP) is important, fluid management is also a crucial concept for hemodynamic stability. The main objective of this study is whether preloading before positioning would be effective for less hemodynamic instability. MethodsThis randomized, controlled study was conducted in a single center in the Istanbul University, Istanbul Faculty of Medicine. Forty-nine patients undergoing elective arthroscopic surgery in the BCP were recruited. In the study group, crystalloid fluid at 10...mL.kg-1 of ideal body weight was administered intravenously 30...min before the BCP for preloading. The primary outcome measures were differences of hemodynamic variables as MAP, Stroke Volume (SV), Heart Rate (HR), and Cardiac Output (CO). The secondary outcome measures were Postoperative Nausea and Vomiting (PONV) rates in postoperative first day, surgical satisfaction scale, total ephedrine dose used during surgery, and total amount of fluid. ResultsThe MAP, CO, and SV measurements of the study group were higher than those of the control group in the 5th minute after the BCP (respectively, p...=...0.001, p...=...0.016, p...=...0.01). The total amount of crystalloid and surgical satisfaction scales were higher in the study group (respectively, p...=...0.016, p...=...0.001). Total amount of colloid and ephedrine dose used in the intraoperative period, and PONV rates were lower in the study group (p...=...0.003, p...=...0.018, p...=...0.019, respectively). ConclusionConsequently, preloading can be favorable approach to preserve hemodynamic stability.