Evolution of robotics in surgery and implementing a perioperative robotics nurse specialist role

Use of robotics is expanding rapidly in the medical arena. Not only are a growing number of facilities purchasing robotic systems, but the number of surgeons using them also is increasing, which creates many challenges (eg, cost, training, safety). The evolution of robotics in surgery is presented within the context of virtual reality, telepresence, telemanipulation, and passive (ie, master-slave) robotic surgical systems. A new perioperative nursing role, the robotics nurse specialist, was developed and implemented at one facility. The need for a robotics nurse specialist and how this role can help the entire surgical team promote positive patient and facility outcomes also is discussed.     

The evolution of robotics in surgery and implementing a perioperative robotics nurse specialist role

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USE OF ROBOTICS is expanding rapidly in the medical arena. Not only are a growing number of facilities purchasing robotic systems, but the number of surgeons using them also is increasing, which creates many challenges (eg, cost, training, safety).

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THE EVOLUTION of robotics in surgery is presented within the context of virtual reality, telepresence, telemanipulation, and passive (ie, master-slave) robotic surgical systems.

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A NEW PERIOPERATIVE NURSING ROLE, the robotics nurse specialist, was developed and implemented at one facility. The need for a robotics nurse specialist and how this role can help the entire surgical team promote positive patient and facility outcomes also is discussed. AORN J 83 (March 2006) 630-650.

     

Risk analysis and safety assessment in surgical robotics: a case study on a biopsy robot.

One of the most important issues in medical robotics is safety and integration into the clinical workflow. If a robot is not safe and its use is complicated by difficult handling and complex user interfaces physicians would not use a robotic system during clinical patient trials, whatever the other advantages are. However, there are only few publications on this topic, in particular on risk management in developing a robotic prototype (for clinical trials). In this paper risk management and the safety of using robot-assisted surgery equipment are discussed and demonstrated exemplarily in the process of developing a prototype biopsy robot.     

Iterative processes: a review of semi-supervised machine learning in rehabilitation science

Abstract

Purpose: To define semi-supervised machine learning (SSML) and explore current and potential applications of this analytic strategy in rehabilitation research.

Method: We conducted a scoping review using PubMed, GoogleScholar and Medline. Studies were included if they: (1) described a semi-supervised approach to apply machine learning algorithms during data analysis and (2) examined constructs encompassed by the International Classification of Functioning, Disability and Health (ICF). The first two authors reviewed identified articles and recorded study and participant characteristics. The ICF domain used in each study was also identified.

Results: After combining information from the eight studies, we established that SSML was a feasible approach for analysis of complex data in rehabilitation research. We also determined that semi-supervised approaches may be more accurate than supervised machine learning approaches.

Conclusions: A semi-supervised approach to machine learning has potential to enhance our understanding of complex data sets in rehabilitation science. SSML mirrors the iterative process of rehabilitation, making this approach ideal for calibrating devices, classifying activities or identifying just-in-time interventions. Rehabilitation scientists who are interested in conducting SSML should collaborate with data scientists to advance the application of this approach within our field.

• Implications for rehabilitation

• Semi-supervised machine learning applications may be a feasible approach for analyses of complex data sets in rehabilitation research.

• Semi-supervised machine learning approaches uses a combination of labelled and unlabelled data to produce accurate predictive models, thereby requiring less user-input data than other machine learning approaches (i.e., supervised, unsupervised), reducing resource cost and user-burden.

• Semi-supervised machine learning is an iterative process that, when applied to rehabilitation assessment and outcomes, could produce accurate personalized models for treatment.

• Rehabilitation researchers and data scientists should collaborate to implement semi-supervised machine learning approaches in rehabilitation research, optimizing the power of large datasets that are becoming more readily available within the field (e.g., EEG signals, sensors, smarthomes).

     

Blended learning in ethics education: a survey of nursing students

Nurses are experiencing new ethical issues as a result of global developments and changes in health care. With health care becoming increasingly sophisticated, and countries facing challenges of graying population, ethical issues involved in health care are bound to expand in quantity and in depth. Blended learning rather as a combination of multiple delivery media designed to promote meaningful learning. Specifically, this study was focused on two questions: (1) the students' satisfaction and attitudes as members of a scenario-based learning process in a blended learning environment; (2) the relationship between students' satisfaction ratings of nursing ethics course and their attitudes in the blended learning environment. In total, 99 senior undergraduate nursing students currently studying at a public nursing college in Taiwan were invited to participate in this study. A cross-sectional survey design was adopted in this study. The participants were asked to fill out two Likert-scale questionnaire surveys: CAAS (Case Analysis Attitude Scale), and BLSS (Blended Learning Satisfaction Scale). The results showed what students felt about their blended learning experiences - mostly items ranged from 3.27-3.76 (the highest score is 5). Another self-assessment of scenario analysis instrument revealed the mean scores ranged from 2.87-4.19. Nearly 57.8% of the participants rated the course 'extremely helpful' or 'very helpful.' This study showed statistically significant correlations (r=0.43) between students' satisfaction with blended learning and case analysis attitudes. In addition, results testified to a potential of the blended learning model proposed in this study to bridge the gap between students and instructors and the one between students and their peers, which are typical of blended learning, and to create meaningful learning by employing blended pedagogical consideration in the course design. The use of scenario instruction enables students to develop critical analysis and problem solving skills through active learning and social exchange of ideas.     

Prefrontal involvement in imitation learning of hand actions: effects of practice and expertise

In this event-related fMRI study, we demonstrate the effects of a single session of practising configural hand actions (guitar chords) on cortical activations during observation, motor preparation and imitative execution. During the observation of non-practised actions, the mirror neuron system (MNS), consisting of inferior parietal and ventral premotor areas, was more strongly activated than for the practised actions. This finding indicates a strong role of the MNS in the early stages of imitation learning. In addition, the left dorsolateral prefrontal cortex (DLPFC) was selectively involved during observation and motor preparation of the non-practised chords. This finding confirms Buccino et al.'s [Buccino, G., Vogt, S., Ritzl, A., Fink, G.R., Zilles, K., Freund, H.-J., Rizzolatti, G., 2004a. Neural circuits underlying imitation learning of hand actions: an event-related fMRI study. Neuron 42, 323-334] model of imitation learning: for actions that are not yet part of the observer's motor repertoire, DLPFC engages in operations of selection and combination of existing, elementary representations in the MNS. The pattern of prefrontal activations further supports Shallice's [Shallice, T., 2004. The fractionation of supervisory control. In: Gazzaniga, M.S. (Ed.), The Cognitive Neurosciences, Third edition. MIT Press, Cambridge, MA, pp. 943-956] proposal of a dominant role of the left DLPFC in modulating lower level systems and of a dominant role of the right DLPFC in monitoring operations.     

Indicators of choking risk in adults with learning disabilities: a questionnaire survey and interview study

Purpose. Feeding and swallowing impairments are key predictors of increased morbidity and mortality in adults with learning disabilities. This postal survey and interview study sought to identify risk factors in adults with learning disabilities who have histories of choking. Method. A total of 2000 questionnaires were sent to carers of all adults with learning disabilities registered as service users by three local health authorities. (A 'service user' may be using any specialist learning disability health or social care facility with day, residential or therapeutic services). Of the 674 service users for whom surveys were returned, 47 were living in hospital, 396 were living in residential or group homes and 208 were living with relatives, or in their own homes. Eighteen subjects who had reported serious or repeated episodes of choking were interviewed in depth in their residences or workplaces. Responses were subjected to frequency analyses. Personal characteristics were analysed. Choking patterns were differentiated by food texture. Results. A total of 34% of questionnaires on 674 service users were returned; 42% of respondents reported one or more choking episodes. There was a significantly greater occurrence of choking among people with more severe learning disability, with Down syndrome, people who had an incomplete dentition or were taking a greater number of psychotropic drugs. Antisocial eating habits learnt in institutional settings presented an additional choking hazard for some individuals. Conclusion. Choking is a serious hazard for many adults with learning disabilities. This study establishes many of the characteristics associated with swallowing problems in this population. Clinicians and carers should benefit from awareness of these predictors, leading to better management of eating behaviours and habits. A choking and swallowing risk assessment should be included in routine health assessments of adults with learning disability, paying especial attention to the condition of a person's teeth; possible side effects from prescribed medication, and abnormal eating behaviour.     

The actions and role of calcium entry blockers in hypertension: cardiac considerations

The calcium antagonists, although initially restricted to the treatment of angina pectoris, are now finding widespread application as safe and effective therapy for hypertension. These drugs reduce systemic vascular resistance and thus address the usual primary physiologic defect in high blood pressure. Reduction of blood pressure with these agents appears to lead to the concomitant reduction of hypertension-induced ventricular hypertrophy and improvement of ventricular function. Unlike other vasodilators, calcium antagonists do not secondarily lead to sodium retention or stimulation of the renin-angiotensin-aldosterone and sympathoadrenal systems. They are effective in the treatment of angina pectoris and may inhibit the onset or progression of atherosclerosis. As calcium antagonists primarily block voltage-operated, as opposed to receptor-operated, sarcolemmal calcium channels, they may be rationally and effectively combined with agents such as converting enzyme inhibitors and adrenergic antagonists. Calcium antagonists have important interactions with drugs relevant to the treatment of cardiac disease. The combination of verapamil and beta blockers or disopyramide and diltiazem with amiodarone should be avoided; caution is advised in the concomitant use of calcium antagonists and digoxin or the major antiarrhythmic agents.     

Phospholipids and their inhibitors: a critical evaluation of their role in the treatment of sepsis.

OBJECTIVE: The clinical condition sepsis and its sequelae are caused by numerous mediators that are released by various cell types. The purpose of this review is to describe the results of various studies performed with agents that either inhibited or stimulated the synthesis of, or affected the receptor-binding characteristics of a specific class of these mediators, the phospholipids. DESIGN: Antagonists to platelet-activating factor and thromboxane A2 receptors, monoclonal antibodies to phospholipase A2, agents which increased levels of prostaglandins, and cyclooxygenase, lipoxygenase, and other specific pathway inhibitors, which block the production of leukotrienes and thromboxane A2, were used in the studies described to affect the physiologic correlates of sepsis animal models and human studies. DATA SOURCES: The matters discussed in this paper come from a wide variety of sources, including many broad-based clinical studies of humans with inflammatory disease. Many animal studies are discussed, along with some in vitro cell culture studies and work in molecular genetics. STUDY SELECTION: This article reviews a subject that is rapidly evolving, with frequent discoveries. Thus, much of the article discusses research in basic science, particularly the use of experimental drugs in animals. Clinical studies are generally of large numbers of patients showing overt signs of sepsis. DATA EXTRACTION: Most cited literature was found in reputable, peer review journals, including such major basic science journals as Science, and clinical journals such as the Journal of the American Medical Association, New England Journal of Medicine, and Critical Care Medicine. DATA SYNTHESIS: Occasionally, contradictions do occur in the results of various studies. These contradictions are discussed in this review, and may often be due to the use of different protocols and definitions of the various clinical states. CONCLUSIONS: Increases of some mediators, such as platelet-activating factor, thromboxane A2, and the leukotrienes are associated with animal models of sepsis and seem to have a negative effect on the course of sepsis. Antagonists and blockers of these mediators increased survival in these studies. More research is needed to identify how these mediators of inflammation are associated with sepsis, and what the effects of blocking their actions will have on sepsis.     

Postoperative pain therapy: a survey of patients' expectations and their experiences.

For 2 months elective surgical patients (n = 259) were asked preoperatively about their expectations of pain and pain relief. At both 24 and 72 h after their surgery they were asked about their pain and pain control. The analgesics they received were monitored for the first 72 h. The survey revealed that patients do not have the necessary knowledge about pain relief to contribute effectively in their own pain management. Analgesics administered intermittently were generally effective when given, however, the dosing interval was too long for the agents used resulting in frequent reports of poor pain relief. We conclude that patients need better education on postoperative pain control therapy. Medical staff could prescribe, and nursing staff administer, analgesics more effectively.     

Family members' experiences of their role in a hospital: a pilot study

The purpose of the study is to explore the experiences of family members in their role of relative in a situation where a next of kin has been admitted to hospital. The questionnaire was used in data collection. The data reported here are form a pilot study. The sample consisted of 70 family members of patients receiving treatment on the neurological wards. It was found that family members spent a lot of time at their relative's bedside, most of them up to several hours a day. The daily routines of families and way of life were alos very much affected. The most important way in which the hospital supported families was to keep them informed about the patient's care and treatment. However, this was not possible without an active interest and involvement on the part of family members themselves. There were obvious problems and shortcomings in terms of family orientation: only one thrid of the family members felt that the nursing staff were seriously interested in the family's well-being, and only one quarter had been told what they could do in hospital. About half of the family members needed to meet nurses to get support from nurses and over one third from doctors. The oldest respondents and women needed more help than did others. Men preferred to turn to doctors rather than nurses for help. In general family members had good experiences of visiting their relavtie in hospital. They believed that they were expected and that they were of help to their relative. Over half of the family members said they were actively involved in caring for their relative. Only four per cent of the family members reported bad experiences of their visits to hospital, in spite of the obviours shortcomings in family nursing. For this reason it is important that nurses facilitate the involvement and integration of relatives in the process of nursing.     

Experiences of and actions towards worries among ambulance nurses in their professional life: a critical incident study

Nurses working in the ambulance service are frequently exposed to situations in which they have to take sole responsibility for sick or injured patients, many of which can be emotionally trying. The purpose of this study was therefore to describe critical incidents in which ambulance nurses experience worry in their professional life and the actions they take in order to prevent and cope with it. The sample consisted of 13 male and 12 female nurses working in ambulance services in three small to medium-sized counties in the south of Sweden. The data were collected by means of interviews and analysed according to Critical Incident Technique (CIT). The result showed that nurses worried about specific emergency situations as well as situations related to their working environment. Worry was alleviated by their own actions or with help from others. It was also shown that, with increasing experience, came a responsibility to be able to cope with all kinds of situations. This responsibility was experienced as worrying. However, if the nurse felt confident in their colleague, the worry could ease. It was concluded that the worry experienced by ambulance nurses in specific emergency situations requires flexibility on the part of the ambulance service. Nurses must be given the opportunity to address their worries in the way that is most appropriate for each individual.