Time Of Placement Research Articles

Patient Outcomes After Penile Prosthesis Placement with Concomitant Non-Reconstructive Urologic Procedures.

There is substantial literature demonstrating minimal to no increased risk of three-piece penile prosthesis (PP) complications for patients undergoing placement with concomitant reconstructive urologic procedures. However, there is a paucity of research investigating outcomes for patients suffering from erectile dysfunction (ED) who undergo concomitant non-reconstructive urologic procedures at the time of PP placement. We performed a retrospective review of patients undergoing PP placement and a second non-reconstructive urologic procedure performed concomitantly at our institution between January 2007 and July 2021. This was compared to a control cohort of 127 patients who underwent PP placement only. Outcomes of interest were complications and device infections. Comparative statistics were used to compare the two groups, and the Kaplan-Meier method was used to estimate the rate of complications and infections over time. We identified 44 patients who underwent concomitant surgery and 127 patients who underwent single surgery only. The types of concomitant surgeries were as follows: 23 endoscopic (52.3%), 9 penile (20.5%), 10 scrotal (22.7%), 1 hardware placement (2.3%), and 1 oncologic (2.3%). Hypertension was the only comorbidity that was more prevalent in the concomitant group (65.9% vs. 43.8%, P < 0.01). Patients undergoing concomitant surgery had similar complication (4.6% vs. 3.6%, P=0.79) and device infection (2.3% vs. 0.7%, P=0.43) rates as the single surgery group. In the largest study of its kind, we observed that patients undergoing concomitant non-reconstructive urologic procedures at the time of PP placement are not at an increased risk of adverse events.

The Use of Different Types of Supraglottic Airway Devices by Medics on a Manikin with Night Vision Goggles: A Pilot Study.

Under normal conditions, the use of a supraglottic airway device (SAD) is safe and effective. There are situations in military environments in which such devices must be used in the dark (e.g., to conceal the team's position). The aim of our study was to evaluate the use of different SADs using night vision goggles (NVG) on a manikin. A group of 53 medically trained soldiers (paramedics, emergency medical technicians [EMTs] and Combat First Responders Bravo) was given a brief demonstration of how to place three different types of SAD in a manikin's airway. This was followed by randomized use in ambient light and then, after the room was darkened, with NVG. Differences in terms of placement success, placement time, and observed usage problems were compared. Attempt success rates were >91% for all SADs used both in ambient light and with NVG. Median placement times differed significantly between ambient light and NVG (ambient light/NVG: i-gel, 7.2/15.1s; standard laryngeal mask airway [LMA], 15.4/21.5s; laryngeal tube [LT], 13.4/24.3s). In the direct comparison of the various SADs, the i-gel laryngeal mask airway was placed significantly faster than a standard LMA (P<.0001) and the LT (P<.0001). Our study proves that the use of NVG has a measurable impact on the speed of placement but does not prolong placement to a clinically significant extent on a manikin. In addition, there was no significant difference in the placement success for each SAD in ambient light or with NVG. Furthermore, all participants were able to read the size information on the various SADs when wearing NVG and were thus able to make a proper size selection. It would, however, make use easier if additional size markings were added. SADs can be applied quickly and safely on the manikin even when NVG are worn. Differences in the use of the various types of SAD are not relevant from a clinical perspective. Using NVG while placing a SAD seems to be safe for the patient and might increase safety for the care provider in tactical situations by maintaining concealment in dark environments.

Three-dimensional volumetric CT image fusion and trans-abdominal US: Adjunct guidance to portal vein cannulation for TIPS

PurposeTo describe portal vein cannulation under adjunct guidance for transjugular intrahepatic portosystemic shunts (TIPS). MethodsMedical records of 86 patients who underwent TIPS, including conventional TIPS, 3D volumetric CT image fusion (CT-fluoroscopy image fusion)-guided TIPS, and transabdominal ultrasound (US)-guided TIPS at our institute from March 2016 to June 2024 were reviewed. Baseline characteristics, clinical outcomes, and procedural data were analyzed. ResultsTechnical success was achieved in 35 conventional TIPS patients (92.11 %), 20 CT-fluoroscopy image fusion-guided TIPS patients (95.24 %), and 26 transabdominal US-guided TIPS patients (96.30 %). Among patients who underwent a successful procedure, the procedural time and contrast usage were lower in the CT-fluoroscopy image fusion-guided and trans-abdominal US-guided TIPS groups than in the conventional group. There was a statistical significance in the cumulative fluoroscopic time between CT-fluoroscopy image fusion-guided TIPS and conventional TIPS groups (43.19 ± 14.92 vs 63.05 ± 30.33 min, p = 0.012). No immediate experienced complications were observed. Furthermore, the incidence of post-procedural complications among the three groups was not statistically different during follow-up. ConclusionsCT-fluoroscopy image fusion and trans-abdominal US-guided portal vein cannulation are feasible, safe, and effective adjunct methods for patients undergoing TIPS. These methods provide shorter procedural time and lower contrast usage for TIPS placement.

Abstract TP149: Development and Implementation of an Algorithm for Early Percutaneous Endoscopic Gastrostomy (PEG) Tube Placement in Acute Stroke Patients

Background: Dysphagia is a common complication of stroke and often leads to the need for modified diets and alternate feeding routes. Length of stay (LOS) for stroke patients requiring percutaneous endoscopic gastrostomy (PEG) tubes is often longer than those who can eat by mouth. The decision to place a PEG is multifactorial and multidisciplinary, involving speech-language pathologist (SLP), dietary, and neurology input, as well as goals of care. Despite this complex decision-making process, there are few existing algorithms to guide the need and timing for PEG placement. Hypothesis: Use of a PEG algorithm will result in timelier PEG placement and shorter LOS for acute stroke patients requiring artificial nutrition. Methods: A multidisciplinary team, including physicians, nurses, registered dieticians, and SLPs designed an evidenced based algorithm to guide PEG placement. Based on assessment and individual patient factors, possible algorithm pathways included dysphagia treatment and/or calorie count by nursing and dieticians to guide decision-making for PEG placement. A retrospective study was conducted in the inpatient setting of a comprehensive stroke center. Data included 68 acute ischemic and hemorrhagic stroke patients admitted to the Neurology and Neurosurgery services from 1/1/2023-2/29/24. Only those patients who were identified as being at risk for significant oropharyngeal dysphagia, aspiration pneumonia, and/or malnutrition were included in the study. Data collected included age, diet recommendation, and initial National Institutes of Health Stroke Scale Score with a focus on length of time from PEG recommendation to PEG placement and LOS. Statistical analysis was completed via t-test. Results: Comparing algorithm (n=30) and non-algorithm (n=38) groups, there was an average decrease of 3.86 days from PEG recommendation to placement in the algorithm group. Although this was not statistically significant (p=0.211), this resulted in decreased LOS from 24.2 to 20.0 days and hospital savings of ~ $7,720 per patient. Conclusions: Implementation of a multidisciplinary PEG algorithm resulted in reduced time from PEG recommendation to placement and shorter LOS. This novel process helped to guide decision-making for timelier PEG placement. Ongoing studies will be powered to assess overall impact on LOS, costs, outcomes, and complications.

Abstract 71: Relationship Between Timing of Carotid Artery Stent Placement and One Month Rate of Stroke and or Death: Analysis of The National Vascular Quality Initiative

Abstract 71: Relationship Between Timing of Carotid Artery Stent Placement and One Month Rate of Stroke and or Death: Analysis of The National Vascular Quality Initiative

Abstract 39: Timing of Intracranial Stent Placement and One month Stroke and/or Death Rates in Patients with High Grade Symptomatic Intracranial Stenosis: Pooled Analysis of SAMMPRIS and VISSIT Trials

Abstract 39: Timing of Intracranial Stent Placement and One month Stroke and/or Death Rates in Patients with High Grade Symptomatic Intracranial Stenosis: Pooled Analysis of SAMMPRIS and VISSIT Trials

Revisiting Colonic Obstruction Criteria and Optimal Timing for SEMS Placement in Colon Cancer

Revisiting Colonic Obstruction Criteria and Optimal Timing for SEMS Placement in Colon Cancer

Abstract WP32: Impact of External Ventricular Drain Placement Timing on Rerupture and Outcomes in Aneurysmal Subarachnoid Hemorrhage

Abstract WP32: Impact of External Ventricular Drain Placement Timing on Rerupture and Outcomes in Aneurysmal Subarachnoid Hemorrhage

Comparative Accuracy of dCAIS and Freehand Techniques for Immediate Implant Placement in the Maxillary Aesthetic Zone: An In Vitro Study

ObjectiveTo evaluate the accuracy of immediate implant placement in fresh extraction sockets in the maxillary aesthetic zone using a dynamic computer-assisted implant surgery system (dCAIS), with the evaluation of possible deviations versus freehand placement. MethodsA total of 18 implants were placed by an experienced surgeon in fresh extraction sockets of anterior teeth in 6 maxillary models. Nine implants were placed using the dCAIS system and 9 implants were placed using the conventional freehand technique. The following outcome parameters were measured and compared: positional deviation at entry, apex point and angular deviations between planned and placed implant position. Surgery time was measured for each procedure. Descriptive and statistical analyses were performed on all outcome parameters. ResultsGlobal entry deviations were not significantly different between the two techniques (p=0.078). dCAIS resulted in significantly more accurate implant placement in terms of global apex deviation with values of 1.28±0.36 mm and angular deviations with values of 1.29±0.64°, compared to 2.06±0.60 mm and 5.05±2.54° with freehand placement (p<0.001). The dental implant placement time was approximately three times longer when using dCAIS (10.99 ± 3.43 min) versus freehand (3.25± 0.63 min) (p < 0.001). ConclusionsdCAIS achieved more precise immediate implant placement in terms of apex deviation and angulation than freehand placement, but increased the surgery time. Clinical significancedCAIS provides greater accuracy in the placement of immediate implants in the maxillary aesthetic zone following prosthetic-driven digital planning compared to freehand surgery.

AI Powered Student Assistant ChatBot

The increasing number of questions in the admission process of engineering and polytechnic colleges under the Department of Technical Education, is making it impossible for institutions to manage queries using traditional methods. To enhance communication and provide relevant information, centrally developed AI-enabled chatbots can be used to act as virtual assistants. The chatbot will automatically answer questions related to admissions, eligibility, fees, scholarships, courses, hostel facilities, and placement times. The chatbot, available 24/7, will reduce the workload of employees, enhance user experience, and provide insights to improve services. With machine learning, the system can adapt and improve its performance based on user interaction and provide accurate and relevant information. Chatbots not only improve response time but also eliminate the need for human intervention in solving many problems. In addition, the design of the education system will ensure the dissemination of information in every school, equality and accuracy. Thanks to natural language processing, which allows multilingual support, chatbots will make the inquiry process more efficient and effective by providing access to a wider audience, thus allowing students and participants to make their own decisions. Key Words: AI-powered chatbot, 24/7 virtual assistant, Admission inquiries, Automationn, Multilingual support

P-832. The Skip Phenomenon in Patients with Staphylococcus lugdunensis Bloodstream Infection

Abstract Background Staphylococcus lugdunensis (SL) is a coagulase-negative staphylococcus with virulence comparable to that of Staphylococcus aureus. The “skip phenomenon” (SP) is a pattern where blood cultures are intermittently negative before final clearance of bloodstream infection (BSI). SP is well-documented in S. aureus bacteremia but has not been described previously in SL. In this report, we present a cohort with SL BSI and describe its prevalence and their clinical features and outcomes. Methods We conducted a retrospective review of patients with blood cultures positive for SL in samples referred to the Mayo Clinic reference lab between June 2012 and June 2022. We assessed clinical characteristics, including time to positivity, prevalence of the skip phenomenon (defined by a positive culture after 24 hours of negative cultures), patient demographics including Charlson Comorbidity Index, mortality and length of hospital stay. Results We identified 55 patients with SL BSI and 33 of them had enough laboratory data to determine the prevalence of the skip phenomenon. SP was present in 5 of 33 (15.2%) patients. For all patients with SL BSI, the median age was 67 years (interquartile range [IQR] 61-79); mean CCI in the group with SP was 5.6 (standard deviation 2) and those without SP was 5.9 (standard deviation 2.7); median duration of bacteremia was 3 days (IQR 1-4); median hospital length of stay was 14 days (IQR 8-20); and 1-year mortality was 45%. Oxacillin susceptibility was present in 33 of 34 cases. Conclusion A total of 15% of patient cases with SL BSI demonstrated the SP. Recognition of the SP in patients with SL BSI is important as this may impact duration of antibiotic therapy and timing of long-term cardiovascular device placement. Disclosures Larry M. Baddour, MD, UpToDate, Inc.: Royalty payments (authorship duties).

Patient satisfaction with radio-frequency identification (RFID) tag localization compared with wire localization for nonpalpable breast lesions: the RFID trial

BackgroundMost breast cancers are detected at an early stage in which case conservative surgery is indicated. An accurate preoperative localization technique is essential for conservative surgery of non-palpable breast lesions. Currently, the gold standard technique is wire localization (WL). However, this technique has well-known drawbacks. Several wire-free techniques have been developed to overcome these drawbacks; one technique is localisation by Radiofrequency Identification (RFID). The purpose of this clinical trial was to assess the superiority of RFID tags (HOLOGIC) in terms of patient satisfaction, over wire localization of non-palpable breast lesions.MethodsThis was a single-centre, prospective, controlled and non-interventional trial. Patients were followed from their inclusion at the time of the preoperative consultation to the postoperative consultation, one month after surgery. Data on anxiety and satisfaction was collected from patients and clinicians using questionnaires, and clinical data was collected from the medical files. The primary outcome was the patients’ satisfaction scores, assessed using a visual analogue scale.ResultsEighty patients were sequentially enrolled in two groups: the wire group (n = 40) and the RFID group (n = 40). One patient from the RFID group was excluded from the analysis because of a substantial migration during deployment. On a 10-point Visual Analogue Scale, the patients’ median satisfaction score was 9.8 (IQR = 1.32) for the wire group and 10 (IQR = 0.07) for the RFID group (p < 0.001). A reduction in pain between device insertion and surgery was observed in the RFID group (p = 0.009). The median placement time was shorter in the RFID group (15 min, IQR = 6) than in the wire group (20 min, IQR = 30) (p = 0.01).ConclusionOur results show a statistically significant difference in median patient satisfaction score with the localization of non-palpable breast cancer lesions using RFID tags compared to the use of the WL. Although our results did not show clinically significant outcomes in terms of satisfaction, RFID tags are a reliable alternative to WL and simplify the organization of patients’ healthcare trajectories.Trial registrationClinicalTrials.gov ID; NCT04750889 registered on February 11, 2021. https://clinicaltrials.gov/ct2/show/NCT04750889?term=rfid&draw=2&rank=1

Integrated Optical and Magnetic Navigation for Simplified Percutaneous Transforaminal Endoscopic Lumbar Discectomy: A Novel Approach.

This study aims to evaluate the clinical benefits of the integrated optical and magnetic surgical navigation system in assisting transforaminal endoscopic lumbar discectomy (TELD) for the treatment of lumbar disc herniation (LDH). A retrospective analysis was conducted on patients who underwent TELD for LDH at our hospital from November 2022 to December 2023. Patients treated with the integrated optical and magnetic surgical navigation system were defined as the navigation-guided transforaminal endoscopic lumbar discectomy (Ng-TELD) group (30 cases), while those treated with the conventional X-ray fluoroscopy method were defined as the control group (31 cases). Record and compare baseline characteristics, surgical parameters, efficacy indicators, and adverse events between the two patient groups. The average follow-up duration for the 61 patients was 11.8 months. Postoperatively, both groups exhibited significant relief from back and leg pain, which continued to improve over time. At the final follow-up, patients' lumbar function and quality of life had significantly improved compared to preoperative levels (P < 0.05). The Ng-TELD group had significantly shorter total operation time (58.43±12.37 vs. 83.23 ± 25.90 min), catheter placement time (5.83 ± 1.09 vs. 15.94 ± 3.00 min), decompression time (47.17 ± 11.98 vs. 67.29 ± 24.23 min), and fewer intraoperative fluoroscopies (3.20 ± 1.45 vs. 16.58 ± 4.25) compared to the control group (P < 0.05). There were no significant differences between the groups in terms of efficacy evaluation indicators and hospital stay. At the final follow-up, the excellent and good rate of surgical outcomes assessed by the MacNab criteria was 98.4%, and the overall adverse event rate was 8.2%, with no statistically significant differences between the groups (P > 0.05). This study demonstrates that the integrated optical and magnetic surgical navigation system can reduce the complexity of TELD, shorten operation time, and minimize radiation exposure for the surgeon, highlighting its promising clinical potential.

Real-time ultrasound-guided thoracic epidural placement: Illustrating the techniques and reporting on prospective observational study.

This study aimed to assess the feasibility of real-time ultrasound-guided thoracic epidural placement. A prospective observational study was conducted in 20 patients undergoing elective abdominal and thoracic surgery. The procedure, performed with patients in a lateral position, involved three sequential steps: (1) identification of the interlaminar gap, (2) advancement of the Touhy needle, and (3) identification of the epidural space. Success was defined as the catheter insertion with achieving sensory blockade. The estimated and actual epidural depth, thoracic epidural placement success rate and procedural time were recorded. The average age and body mass index were 62.1 ± 8.9 years and 22.4 ± 4.4 kg/m2. Thoracic epidural placement was successful in 18 patients (90%, 95% confidence interval: 77-100), and at first attempt in 12 of those (66.7%). The thoracic epidural placement times and total procedural time were 5 (4-6.75) min and 19.5 ± 5.4 min, respectively. The correlation between ultrasound-estimated epidural depth and actual depth was 0.81. Ultrasound guidance enhances thoracic epidural success rates and reduces attempts and skin punctures.

Comparison of perioperative outcomes of robot-assisted radical prostatectomy among the da Vinci, hinotori, and Hugo robot-assisted surgery systems.

In recent times, innovative surgical robotics have emerged and gained widespread adoption. This study aimed to compare the perioperative outcomes associated with robot-assisted radical prostatectomy (RARP) using three different robotic surgical systems: da Vinci surgical system (DVSS), hinotori surgical robot system (HSRS), and Hugo robot-assisted surgery system (HRASS). Our study involved a retrospective analysis of clinical data from 149 individuals who received RARP from 2022 to 2024, utilizing the DVSS (n = 81), HSRS (n = 52), and HRASS (n = 16). We compared patient characteristics and perioperative outcomes, including complications, console time, and time to console start (i.e., port placement and docking time) among these groups. The Fisher's exact test was used to test categorical variables and Kruskal-Wallis test were used to test continuous variables. Linear model was used to measure the learning rate. The DVSS, HSRS, and HRASS significantly differed in terms of the median operative time (348, 343, 279min, respectively, p < 0.001); median port placement time (25, 23, 22min, respectively, p = 0.136); and median docking time (7, 13, 15min, respectively, p < 0.001). The time to console was shorter with DVSS than with the HSRS and HRASS (p = 0.024). The incidence of perioperative complications was comparable across all three groups, with no statistically significant variations. Compared to other systems, the DVSS showed superior efficiency in both docking and transitioning to console surgery. Although surgeon bias cannot be ruled out in this study, RARP could be safely performed in clinical practice using any of these three models.

S8 Navigation system combined with an ultrasonic osteotome for three-dimensional real-time dynamic visualization decompression to reduce postoperative neurological deterioration in thoracic ossification of the ligamentum flavum.

Posterior laminectomy is a standard treatment for thoracic ossification of the ligamentum flavum (TOLF), but it often leads to neurological deterioration during surgery. This study aimed to reduce iatrogenic neurological deterioration by using an S8 navigation system combined with an ultrasonic osteotome for three-dimensional real-time dynamic visualization decompression. A retrospective analysis was conducted on patients who underwent laminectomy and internal fixation for TOLF in our centre from January 2016 to January 2023. Patients were divided into a visualization group (S8 navigation + ultrasonic bone scalpel) and a control group (ultrasonic bone scalpel) based on the use of three-dimensional real-time dynamic visualization decompression technology. Intraoperative multimodal neuroelectrophysiological monitoring (IONM) was used to collect somatosensory evoked potential and motor evoked potential data. We compared the incidence of intraoperative neurological deterioration indicated by IONM alarms between the two groups. Neurological and motor functions were assessed via the American Spinal Injury Association (ASIA) classification system and the modified Japanese Orthopaedic Association (m-JOA) score for thoracic myelopathy. Follow-ups were conducted at 1, 3, 6, and 12months postsurgery, and the data from both groups were compared. Other clinical indicators included decompression time per laminectomy segment, intraoperative blood loss, intraoperative dural ossification, hospitalization duration, and drainage tube placement time. We also analysed intraoperative and postoperative complications. A total of 91 patients with thoracic ossification of the ligamentum flavum were included, with a follow-up period of 12-18months. The visualization group consisted of 41 patients, and the control group included 50 patients. The incidence of neurological deterioration indicated by IONM in the visualization group (9.8%) was significantly lower than that in the control group (30.0%) (P = 0.014). The immediate postoperative ASIA grade change value ≤ - 1 was lower in the visualization group (9.8%) than in the control group (34.0%) (P = 0.006); A similar trend was observed at the 12month follow-up (2.4% vs. 20.0%, P = 0.022). The m-JOA scores at 1, 3, 6, and 12months postsurgery were higher in the visualization group than in the control group (P < 0.05). The visualization group also had shorter lamina decompression times per segment and less intraoperative blood loss (P < 0.05). The incidence of nondural ossification cerebrospinal fluid leakage was lower in the visualization group (2.4%) than in the control group (18.0%) (P = 0.018). Additionally, nerve root injury was lower in the visualization group (0%) than in the control group (10.0%) (P = 0.037). Postoperative CT scans revealed no ossification residue in the visualization group, whereas 7 cases (14.0%) were observed in the control group (P = 0.013). The S8 navigation system combined with an ultrasonic osteotome for three-dimensional real-time dynamic visualization decompression significantly reduces the incidence of intraoperative neurological deterioration, improves postoperative motor function recovery, and reduces decompression time per vertebral segment, intraoperative bleeding, and complications such as cerebrospinal fluid leakage. This technology is safe and reliable and offers a promising option for spinal surgeons in treating thoracic ossification of the ligamentum flavum.

Application of elbow skin fold extension line in extreme elbow flexion in ulnar Kirschner wire insertion of extended supracondylar humeral fractures in children

To discuss the elbow skin fold extension line in Kirschner wire internal fixation of extended supracondylar humeral fractures in children. The clinical data of 58 children with extended supracondylar fractures of the humerus who met the selection criteria between August 2021 and July 2024 were retrospectively analyzed. In 28 cases, needle placement of medial epicondyle of humerus was performed with the assistance of the elbow skin fold extension line (study group), and 30 cases were assisted by routine touch of the medial epicondyle of the humerus (control group). There was no significant difference in baseline data such as gender, age, side, cause of injury, Gartland type, Kirschner wire configuration, and time from injury to operation between the two groups ( P>0.05). The closed reduction rate, total operation time, time of medial humeral condyle pin placement, fluoroscopy times during medial pin placement, rate of one-time determination of medial entry point, ulnar nerve injury incidence, and fracture healing time were recorded and compared between the two groups. At the same time, the closed reduction rate of patients with the time from injury to operation ≤24 hours and >24 hours was compared. The elbow function was evaluated by Mayo elbow function score. The closed reduction rate of the study group was significantly higher than that of the control group ( P<0.05). Among all patients, the closed reduction rate of patients with the time from injury to operation ≤24 hours [73.3% (22/30)] was significantly higher than that of patients >24 hours [42.9% (12/28)] ( χ 2=5.545, P=0.019). The total operation time, medial needle placement time, and fluoroscopy times in the study group were significantly less than those in the control group, and the one-time determination rate of medial needle entry point in the study group was significantly higher than that in the control group ( P<0.05). There were 4 cases of ulnar nerve injury in the control group, and no ulnar nerve injury in the study group, but there was no significant difference in the incidence of ulnar nerve injury between the two groups ( P>0.05). All patients were followed up 6-12 months (mean, 8 months). There was no bone nonunion in both groups, and the fracture healing time of the study group was significantly shorter than that of the control group ( P<0.05). Volkmann ischemic contracture, heterotopic ossification, myositis ossificans, and premature epiphyseal closure were not observed after operation. No complications such as loosening or fracture of Kirschner wire occurred. At last follow-up, the Mayo elbow joint function score was used to evaluate function, and there was no significant difference between the two groups ( P>0.05). In the treatment of extended supracondylar fractures of the humerus in children, the elbow skin fold extension line can help to quickly locate the medial epicondyle of the humerus, quickly insert Kirschner wire, and reduce the operation time and trauma.

The ongoing impact of COVID-19 on the clinical education of Australian medical radiation science students.

The COVID-19 pandemic has had a significant and ongoing impact on health care, particularly for medical radiation science (MRS) professionals. There exist many studies that describe the negative effects of clinical placement restrictions and access to universities on the well-being of all health professional students during the pandemic. There also exists evidence of changes to MRS student teaching and impacts to students and academic clinical educators; however, there exists a paucity of research that investigates how changes have affected the performance of students within the clinical environment and entering the workforce. This study surveyed workplace MRS clinical educators within Australia to gather their perspectives regarding the impact of COVID-19 on student clinical education. A descriptive study comprising an online structured survey of 44 questions was provided to Medical Imaging and Radiation Therapy Clinical Educators across Australia. A total of 55 survey responses were received. Of note, respondents described heavy reductions to student intake capacity, losses of clinical placement time, a noted theory-practice gap and possibility of sites 'failing to fail' students. Negative impacts to all domains of MRPBA professional capabilities, as well as a perceived unpreparedness to meet the MRPBA capabilities were described. There was general agreement that graduating students will require supportive periods upon entry into the profession. This study highlights the considerable impact of changes to the education and training of MRS students in response to COVID-19. The results pose a real concern for a generation of MRS students affected by the COVID-19 pandemic.

3D-printed drill guide versus fluoroscopic-guided free-hand technique for pedicle screw insertion in the upper cervical spine: a systematic review and meta-analysis.

3D-printed (3DP) drill guides have demonstrated significant potential to accurately guide pedicle screw insertion in spinal surgery. However, their role in the upper cervical spine is not well established. This review aimed to compare the efficacy and safety of 3DP drill guides to the conventional fluoroscopic-guided free-hand technique for pedicle screw insertion in the upper cervical spine. A comprehensive literature search was conducted across five databases (Medline, Scopus, CENTRAL, Web of Science, and Embase). The meta-analysis compared the accuracy of pedicle screw placement, screw placement time, operative time, blood loss, fluoroscopy usage, and post-operative JOA and VAS scores between the two approaches. Seven studies were included in the review, encompassing 386 patients and 1,512 screws. The meta-analysis demonstrated that 3DP drill guides increased the rate of perfect screw insertion (OR: 4.34, P < 0.00001) and lowered the incidence of moderate (OR: 0.26, P < 0.00001) and poor (OR: 0.09, P < 0.00001) screw insertion compared to the free-hand technique. Additionally, operative time (MD: -36.07, P < 0.00001), blood loss (MD: -83.82, P < 0.00001), and fluoroscopy usage (MD: -3.47, P < 0.0001) was significantly reduced in the 3DP cohort. No significant difference was detected in screw placement time (MD: -2.65, P = 0.07), or post-operative JOA (MD: 0.17, P = 0.47), and VAS (MD: -0.09, P = 0.19) scores between the two cohorts. The review demonstrated that 3DP drill guides are a safe and effective tool to assist pedicle screw fixation in the upper cervical spine.

Influence of buccal mucosa width/height ratio, emergence profile and buccal bone width on peri-implant tissues: a prospective one-year study

BackgroundThe stability of soft and hard tissues surrounding the implant is not only a matter of aesthetics, but also affects the long-term stability of the implant. The present study was to explore the influence of buccal mucosa width/height (W/H) ratio, emergence profile and buccal bone width on peri-implant soft and hard tissue changes in the posterior region.MethodsFifty-eight posterior implant restoration cases were recruited in this study. Evaluations were performed at the time of restoration placement (T0), and 1 year later (T1). Buccal mucosa width (BMW), buccal bone width (BBW), implant buccal inclination angle, and emergence angle were evaluated. The variables that may affect buccal mucosa recession (MR) as well as vertical bone loss (VBL) were analyzed.ResultsThe BMW at baseline was 2.93 ± 1.01 mm. The BBW at baseline was 1.50 ± 0.82 mm. The buccal mucosa W/H ratio at 1 year (1.23 ± 0.38) was significantly lower than that at baseline (1.42 ± 0.45). Buccal MR was − 0.22 ± 0.47 mm while VBL was 0.81 ± 0.80 mm. The correlation between MR and initial BMW (r=-0.381), initial W/H ratio (r=-0.422), BBW (r=-0.290) was statistically significant. The correlation between VBL and initial BMW (r=-0.421), initial W/H ratio (r=-0.305), implant buccal inclination angle (r = 0.507), BBW (r=-0.556) was statistically significant.ConclusionsWithin the scope of this study, implant sites in the posterior region presenting a thin BMW, a thin BBW, and a small W/H ratio are more prone to exhibit buccal mucosa recession and vertical bone loss.