Surgical skill acquisition with self-directed practice using computer-based video training

BACKGROUND: Computer-based video training (CBVT) provides flexible opportunities for surgical trainees to learn fundamental technical skills, but may be ineffective in self-directed practice settings because of poor trainee self-assessment. This study examined whether CBVT is effective in a self-directed learning environment among novice trainees. METHODS: Thirty novice trainees used CBVT to learn the 1-handed square knot while self-assessing their proficiency every 3 minutes. On reaching self-assessed skill proficiency, trainees were randomized to either cease practice or to complete additional practice. Performance was evaluated with computer and expert-based measures during practice and on pretests, posttests, and 1-week retention tests. RESULTS: Analyses revealed performance improvements for both groups (all P < .05), but no differences between the 2 groups (all P > .05) on all tests. CONCLUSIONS: CBVT for the 1-handed square knot is effective in a self-directed learning environment among novices. This lends support to the implementation of self-directed digital media-based learning within surgical curricula.     

Construct validity of computer-assisted assessment: quantification of movement processes during a vascular anastomosis on a live porcine model

BACKGROUND: Movement processes for 2 different suturing techniques within a single surgical task were quantified. METHODS: Junior (postgraduate years 1-2) and senior residents (postgraduate year 3 and higher) were tested on their ability to perform a vascular anastomosis on a live porcine model 1 week after a guided practice session. Two phases of 2 suturing techniques (parachute and running) were identified, and performance was evaluated during each phase using computer hand motion analysis (CHMA) and expert-based measures. RESULTS: Senior residents were more efficient on all segments based on CHMA and expert-based ratings (P < .05). CHMA showed a significant improvement in junior resident performance during each phase of the procedure (warm-up effect). The change in task difficulty during transition from parachute to running sutures was identifiable using CHMA. CONCLUSIONS: Different suturing techniques are executed using the same general motor program although specific program parameters are adjusted to suit each technique. The findings support a novel form of construct validity the for surgical assessment device, the concept of transfer of skills, and the use of computer evaluations for the assessment of technical skills embedded within complex surgical tasks.     

Electrocorticographically controlled brain-computer interfaces using motor and sensory imagery in patients with temporary subdural electrode implants. Report of four cases

Brain-computer interface (BCI) technology can offer individuals with severe motor disabilities greater independence and a higher quality of life. The BCI systems take recorded brain signals and translate them into real-time actions, for improved communication, movement, or perception. Four patient participants with a clinical need for intracranial electrocorticography (ECoG) participated in this study. The participants were trained over multiple sessions to use motor and/or auditory imagery to modulate their brain signals in order to control the movement of a computer cursor. Participants with electrodes over motor and/or sensory areas were able to achieve cursor control over 2 to 7 days of training. These findings indicate that sensory and other brain areas not previously considered ideal for ECoG-based control can provide additional channels of control that may be useful for a motor BCI.     

Complications,revision fusions,readmissions, and utilization over a 1-year period after bone morphogenetic protein use during primary cervical spine fusions

Background contextNationwide estimates examining bone morphogenetic protein (BMP) use with cervical spine fusions have been limited to perioperative outcomes.PurposeTo determine the 1-year risk of complications, cervical revision fusions, hospital readmissions, and health care services utilization.Study designA retrospective cohort study from 2002 to 2009 using a nationwide claims database.Patient sampleThere were 61,937 primary cervical spine fusions of which 1,677 received BMP.Outcome measuresComplications, revision fusions, 30-day hospital readmission, and health care utilization.MethodsData for these analyses come from the Thomson Reuters MarketScan Commercial Claims and Encounters Database 2010. Patients were aged 18 to 64 years, receiving and not receiving BMP with a primary (C2–C7) cervical spine fusion. All outcomes were defined by International Classification of Diseases, 9th edition Clinical Modification and Current Procedural and Terminology, 4th edition codes. Complications were analyzed as any complication and stratified by nervous system, wound, and dysphagia or hoarseness. Cervical revision fusions were determined in the 1-year follow-up. Hospital readmission discharge records defined 30-day hospital readmission and reason for the readmission. The utilization of at least one health care service of cervical spine imaging, epidural usage or rehabilitation service was examined. Poisson regression models were used to estimate the relative risk and 95% confidence interval (CI). Linear regression was used to determine the time to hospital readmission. Results were stratified by anterior or posterior and circumferential approaches.ResultsPatients receiving BMP were 29% more likely to have a complication (adjusted relative risk [aRR]=1.29 [95% CI, 1.14–1.46]) and a nervous system complication (aRR=1.42 [95% CI, 1.10–1.83]). Cervical revision fusions were more likely among patients receiving BMP (aRR=1.69 [95% CI, 1.35–2.13]). The risk of 30-day readmission was greater with BMP use (aRR=1.37 [95% CI, 1.07–1.73]) and readmission occurred 27.4% sooner on an average. Patients receiving BMP were more likely to receive computed tomography scans (aRR=1.34 [95% CI, 1.06–1.70]) and epidurals with anterior surgical approaches (aRR=1.29 [95% CI, 1.00–1.65]).ConclusionsThese findings question both the safety and effectiveness of off-label BMP use in primary cervical spine fusions.     

Mental health outcomes in elderly men with prostate cancer

ObjectiveTo examine the burden of mental health issues (MHI), namely anxiety, depressive disorders, and suicide, in a population-based cohort of older men with localized prostate cancer and to evaluate associations with primary treatment modality.Patients and methodsA total of 50,856 men, who were 65 years of age or older with clinically localized prostate cancer diagnosed between 1992 and 2005 and without a diagnosis of mental illness at baseline, were abstracted from the Surveillance, Epidemiology, and End Results–Medicare database. The primary outcome of interest was the development of MHI (anxiety, major depressive disorder, depressive disorder not elsewhere classified, neurotic depression, adjustment disorder with depressed mood, and suicide) after the diagnosis of prostate cancer.ResultsA total of 10,389 men (20.4%) developed MHI during the study period. Independent risk factors for MHI included age≥75 years (hazard ratio [HR] = 1.29); higher comorbidity (Charlson comorbidity index≥3, HR = 1.63); rural hospital location (HR = 1.14); being single, divorced, or widowed (HR = 1.12); later year of diagnosis (HR = 1.05); and urinary incontinence (HR = 1.47). Black race (HR = 0.79), very high-income status (HR = 0.87), and definitive treatment (radical prostatectomy [RP], HR = 0.79; radiotherapy [RT], HR= 0.85, all P<0.001) predicted a lower risk of MHI. The rates of MHI at 10 years were 29.7%, 29.0%, and 22.6% in men undergoing watchful waiting (WW), RT, and RP, respectively.ConclusionOlder men with localized prostate cancer had a significant burden of MHI. Men treated with RP or RT were at a lower risk of developing MHI, compared with those undergoing WW, with median time to development of MHI being significantly greater in those undergoing RP compared with those undergoing RT or WW.     

Sleep apnea and cervical spine pathology

Purpose

Sleep apnea is a multi-factorial disease with a variety of identified causes. With its close proximity to the upper airway, the cervical spine and its associated pathologies can produce sleep apnea symptoms in select populations. The aim of this article was to summarize the literature discussing how cervical spine pathologies may cause sleep apnea.

Methods

A search of the PubMed database for English-language literature concerning the cervical spine and its relationship with sleep apnea was conducted. Seventeen published papers were selected and reviewed.

Results

Single-lesion pathologies of the cervical spine causing sleep apnea include osteochondromas, osteophytes, and other rare pathologies. Multifocal lesions include rheumatoid arthritis of the cervical spine and endogenous cervical fusions. Furthermore, occipital–cervical misalignment pre- and post-cervical fusion surgery may predispose patients to sleep apnea.

Conclusions

Pathologies of the cervical spine present significant additional etiologies for producing obstructive sleep apnea in select patient populations. Knowledge of these entities and their pathophysiologic mechanisms is informative for the clinician in diagnosing and managing sleep apnea in certain populations.     

Overview of non-invasive factors (low level laser and low intensity pulsed ultrasound) accelerating tooth movement during orthodontic treatment

The need for orthodontic treatment is increasing all the time. As the treatment is time consuming ranging from a year to several years, any method of reducing the period of treatment and increasing the quality of the tissue will be beneficial to patients. The use of non-invasive techniques such as low level laser therapy and low intensity pulsed ultasound in accelerating orthodontic tooth movement are promising. Thus, this overview study will help to generate more understanding about the background information and the possible applications of them in daily orthodontics, depending on previous literature searching for reviews and original research articles.     

Total Knee Arthroplasty in Severe Valgus Deformity Using a Modified Technique—A 10-Year Follow-Up Study

Background

Valgus knee deformity accounts for only 10% of total knee arthroplasties (TKAs), but is frequently considered the most challenging to manage. This study provides a 10-year follow-up on a previously reported series of severe valgus knees performed using an unconstrained mobile-bearing TKA with a modified technique to validate this technique.

Quantifying the Impact of Patient-Specific Factors and Disease Severity on Clinical Decision Making in Cuff Tear Arthropathy: A Case-Based Survey

HSS Journal ® - Rotator cuff tears are a common cause of disability. Some patients with massive and irreparable tears can develop cuff tear arthropathy (CTA), which makes management more...     

The Effect of Perioperative Iron Therapy in Acute Major Non-cardiac Surgery on Allogenic Blood Transfusion and Postoperative Haemoglobin Levels: A Systematic Review and Meta-analysis

Background

Perioperative anaemia in relation to surgery is associated with adverse clinical outcomes. In an elective surgical setting, it is possible to optimize patients prior to surgery, often by iron supplementation with correction of anaemia. Possibilities for optimization prior to and during acute surgical procedures are limited. This review investigates whether iron treatment initiated perioperatively improves outcomes in patients undergoing major acute non-cardiac surgery.

Method

This systematic review was performed using PubMed, EMBASE (Ovid) and Scopus to identify current evidence on iron supplementation in acute surgery. Primary outcomes were allogenic blood transfusion (ABT) rate and changes in haemoglobin. Secondary outcomes were postoperative mortality, length of stay (LOS), and postoperative complications. Iron was administered at latest within 24 h after end of surgery.

Results

Of the 5413 studies screened, four randomized controlled trials and nine observational cohort studies were included. Ten studies included patients with hip fractures. A meta-analysis of seven studies showed a risk reduction of transfusion (OR = 0.35 CI 95% (0.20–0.63), p = 0.0004, I² = 66%). No influence on plasma haemoglobin was found. Postoperative mortality was reduced in the iron therapy group in a meta-analysis of four observational studies (OR 0.50 (CI 95% 0.26–0.96) p = 0.04). No effect was found on LOS, but a reduction in postoperative infection was seen in four studies.

Conclusions

This review examined perioperative iron therapy in acute major non-cardiac surgery. IV iron showed a lower 30-day mortality, a reduction in postoperative infections and a reduction in ABT largely due to the observational studies. The review primarily consisted of small observational studies and does not have the power to formally recommend this practice.