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Article
Publication date: 8 December 2017

Mohammadreza Dehghani, Majid Mohammadi Moghadam and Pourya Torabi

Removing the bone flap is a compulsory step in open skull surgeries and is very cumbersome and time-consuming. Exerting large forces during the milling and cutting of the skull…

Abstract

Purpose

Removing the bone flap is a compulsory step in open skull surgeries and is very cumbersome and time-consuming. Exerting large forces during the milling and cutting of the skull renders the surgeon exhausted and consequently increases probable errors in further task of manipulating the sensitive brain tissue. This paper aims to present the development of a robotic system capable of perforating and cutting the required bone flap without restraining the surgeon.

Design/methodology/approach

For the purpose of optimization, the target workspace is estimated by 3D modeling of the sample skull and bone flaps of targeted surgeries. The optimization considers kinematic performance matrices and the extracted workspace requirements by assigning scores to each possible design and finally selects the design with highest score.

Findings

The design utilizes a parallel remote center of motion mechanism. Coordinating the remote center of motion (RCM) of the mechanism with the center of a sphere which circumscribes the skull, the milling tool is always nearly perpendicular to the skull bone. The paper presents the concept design, optimization criteria and finally the optimal design of the robot and the fabricated prototype. Tests indicate that the prototype is able to sweep the target workspace and to exert the required forces for bone milling.

Originality value

The workspace requirements of the craniotomy/craniectomy surgeries are investigated and converted into one quantitative target workspace. An optimized design for a surgical robot is developed which satisfies the workspace requirements of the targeted surgeries.

Details

Industrial Robot: An International Journal, vol. 45 no. 1
Type: Research Article
ISSN: 0143-991X

Keywords

Article
Publication date: 2 May 2017

Grand Roman Joldes, Peter Teakle, Adam Wittek and Karol Miller

This paper aims to investigate the application of adaptive integration in element-free Galerkin methods for solving problems in structural and solid mechanics to obtain accurate…

Abstract

Purpose

This paper aims to investigate the application of adaptive integration in element-free Galerkin methods for solving problems in structural and solid mechanics to obtain accurate reference solutions.

Design/methodology/approach

An adaptive quadrature algorithm which allows user control over integration accuracy, previously developed for integrating boundary value problems, is adapted to elasticity problems. The algorithm allows the development of a convergence study procedure that takes into account both integration and discretisation errors. The convergence procedure is demonstrated using an elasticity problem which has an analytical solution and is then applied to accurately solve a soft-tissue extension problem involving large deformations.

Findings

The developed convergence procedure, based on the presented adaptive integration scheme, allows the computation of accurate reference solutions for challenging problems which do not have an analytical or finite element solution.

Originality/value

This paper investigates the application of adaptive quadrature to solid mechanics problems in engineering analysis using the element-free Galerkin method to obtain accurate reference solutions. The proposed convergence procedure allows the user to independently examine and control the contribution of integration and discretisation errors to the overall solution error. This allows the computation of reference solutions for very challenging problems which do not have an analytical or even a finite element solution (such as very large deformation problems).

Details

Engineering Computations, vol. 34 no. 3
Type: Research Article
ISSN: 0264-4401

Keywords

Article
Publication date: 23 May 2011

Colin Pritchard, Malcolm Cox, Lesley Foulkes and Kenneth Lindsay

Successive governments have called for greater “empowerment” of the patient, reflected in the chief medical officer's call for more patient‐related outcome measures (PROM). This…

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Abstract

Purpose

Successive governments have called for greater “empowerment” of the patient, reflected in the chief medical officer's call for more patient‐related outcome measures (PROM). This paper aims to bring together three‐linked studies.

Design/methodology/approach

First study: in 1999, the neurosurgical patient was seen as “expert” to identify PROM outcomes, based upon a patient and carer‐designed self‐administered postal questionnaire in a regional two‐year retrospective survey of subarachnoid haemorrhage (SAH) patients with a 77 per cent response rate, designated treatment‐as‐usual (TAU) cohort (n=142).Second study: in the same region, following the implementing of the specialist neuro‐vascular nurse (SNVN), the SNVN recommendation was evaluated in a two‐year prospective study (n=184) that provided family‐specific psychosocial support and a continuity of care linking hospital and community; the response rate was 87 per cent. Third study: A re‐analysis of the national SAH study (n=2,380), by projecting the TAU and SNVN results onto clinically matched patients within the National cohort to estimate the potential “savings” if all 34 neurosurgical units had an SNVN type service.

Findings

First study: respondents identified many psychosocial and fiscal problems but recommended a SNVN to reduce these difficulties. Second study: the TAU and SNVN patient's were a close clinical match and using the TAU as a control group, it was found that there were major psychosocial and fiscal benefits for SNVN patients and carers, who more speedily re‐established their lives.Third study: it was estimated that this would have produced major financial benefits, e.g. 4,165 fewer bed occupancy days, saving £2.5million; reduced time‐off work for patients and carers, saving £8.1million; and, after deducting cost of a national SNVN service, a combined saving for the service and families of an estimated £9.83 million p.a. Thus, addressing PROM outcomes, through an integrated psychosocial service in neurosurgery was cost‐effective, benefited families, the service, and the wider economy and should be a factor when considering pressurised departmental budgets.

Originality/value

Overall, what the two regional studies and the re‐analysis of the national study showed was that there are benefits from treating the “patient as expert” and taking on board their agendas. There is a need for a more integrated approach to treatment and care that is of value to the service, patients, families and the wider economy.

Details

Social Care and Neurodisability, vol. 2 no. 2
Type: Research Article
ISSN: 2042-0919

Keywords

Article
Publication date: 24 May 2022

Arezoo Monfared, Nahid Dehghan Nayeri, Nazila Javadi-Pashaki and Fateme Jafaraghaee

This study aimed to analyze and define the concept of readiness for hospital discharge (RHD) in patients with myocardial infarction (MI).

Abstract

Purpose

This study aimed to analyze and define the concept of readiness for hospital discharge (RHD) in patients with myocardial infarction (MI).

Design/methodology/approach

Walker and Avant's approach was used for concept analysis. Electronic text searches were performed using valid databases with “readiness for hospital discharge” and “MI” keywords. The research included quantitative and qualitative studies related to RHD published between 1997 and 2021 in English and Persian. Out of 103 obtained articles, 29 met the inclusion criteria.

Findings

In the analysis, the authors identified stable physical state, desirable individual and social conditions, psychological stability, adequate support, adequate information and knowledge, and multidisciplinary care as the attributes of the determinants of RHD. Antecedents were divided into two categories, including preadmission conditions (economic and social, etc.) and postadmission conditions (disease severity and patient health needs, etc). The consequences were also identified as both positive (e.g. self-care) and side effects (e.g. reduced readmission).

Originality/value

The results showed that the concept of RHD in MI patients is a complex and multidimensional condition that applies to all patients on discharge. It is critical for the care team to pay attention to its attributes and scopes in the process of preparing the patient for discharge. It is also suggested that the concept be used as a nursing diagnosis on the North American Nursing Diagnosis Association (NANDA) list. The Association provides nurses with an up-to-date list of nursing diagnoses.

Details

Qualitative Research Journal, vol. 22 no. 3
Type: Research Article
ISSN: 1443-9883

Keywords

Article
Publication date: 30 September 2019

Pataravit Rukskul, Waraporn Suvannapruk and Jintamai Suwanprateeb

The purpose of this study is to evaluate the intra- and post-operative performance and safety of direct three dimensional printing (3DP) porous polyethylene implants in cranial…

Abstract

Purpose

The purpose of this study is to evaluate the intra- and post-operative performance and safety of direct three dimensional printing (3DP) porous polyethylene implants in cranial reconstruction.

Design/methodology/approach

Prefabricated porous polyethylene implants were prepared by direct 3DP, and cranioplasty implantation was performed. Postoperative aesthetics, patient satisfaction, firmness of the implant, reactions to the implant and 3D computed tomography (CT) scanning were assessed after 2, 6, 12 and 24 months postoperatively.

Findings

No complications after surgery were encountered. Excellent aesthetic results were obtained in all cases, and all the patients were satisfied with the reconstruction outcome. Bone density structure was found to ingrowth into these direct 3DP porous polyethylene implants and the content increased with increasing follow-up times.

Research limitations/implications

This study was a pilot study conducted in a single group and evaluated in a short-term period. The bone formation and ingrowth were indirectly assessed by 3D CT evaluation.

Originality/value

This work reported the use and evaluation of direct 3DP porous polyethylene in middle- to large-sized cranial reconstructions. It evidently showed the bonding of implants to surrounding tissues which would result in the long-term stability and infection resistance of the implant.

Details

Rapid Prototyping Journal, vol. 26 no. 2
Type: Research Article
ISSN: 1355-2546

Keywords

Book part
Publication date: 21 August 2017

Jill Taft-Kaufman

This study focuses upon the importance of group narrative work by ill and injured individuals who are participants/listeners/viewers in the reciprocity of testifying and…

Abstract

This study focuses upon the importance of group narrative work by ill and injured individuals who are participants/listeners/viewers in the reciprocity of testifying and witnessing one another’s stories. Their creative collaboration addresses a transformation of self that is engendered by illness and injury. An emphasis on narrative within a group setting offers tools to validate individual autonomy, build collective strength, and assist those in the group to gather momentum for the journeys that await each of them. The rationale and exercises described serve to complement and enhance traditional modes of healing.

Open Access
Book part
Publication date: 30 April 2019

S. J. Oswald A. J. Mascarenhas

This focal chapter deals with the understanding of important ethical theories used in executive moral reasoning such as teleology, deontology, distributive justice and corrective…

Abstract

Executive Summary

This focal chapter deals with the understanding of important ethical theories used in executive moral reasoning such as teleology, deontology, distributive justice and corrective justice, virtue ethics versus ethics of trust, from the perspectives of intrinsic versus instrumental good, moral worth versus moral obligation, and moral conscience versus moral justification. Ethical and moral reasoning will power executives to identify, explore, and resolve corporate moral dilemma, especially in the wake of emerging gray market areas where good and evil, right or wrong, just or unjust, and truth and falsehood cannot be easily distinguished. We focus on developing corporate skills of awareness of ethical values and moral imperatives in current otherwise highly commoditized and turbulent human, market, and corporate situations. The challenges of morality are multifaceted and diverse. Professionals usually have self-discipline and self-regulation abilities, ego strength, and social skills. Morality in the professions is not concerned with the issues of rudimentary socialization; rather, the issues involve deciding between conflicting values, where each value represents something good in itself. There are problems in both knowing what is right, good, true, and just on the one hand, and on the other hand, in doing what is right and avoiding wrong, doing good and avoiding evil, and being fair and just while avoiding being unfair and unjust. Several contemporary cases will illustrate the challenging dimensions of ethical and moral reasoning, moral judgment and moral justification embedded in executive decision processes, and corporate growth and profitability ventures.

Details

Corporate Ethics for Turbulent Markets
Type: Book
ISBN: 978-1-78756-192-2

Article
Publication date: 2 September 2013

Lihong Zhou and Miguel Baptista Nunes

The purpose of this paper is to present and discuss the process of doing qualitative inductive research in China, drawing its conclusions from a grounded theory study. To be more…

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Abstract

Purpose

The purpose of this paper is to present and discuss the process of doing qualitative inductive research in China, drawing its conclusions from a grounded theory study. To be more specific, this paper reflects on the process of approaching interviewees, guaranteeing their participation, conducting the interviews and encouraging responses in the context of Chinese culture.

Design/methodology/approach

The discussion in the paper uses Hofstede's cultural dimensions as a tool in the interpretation and understanding of both the behaviour and the preconceptions of the interview participants involved in a research project focused on exploring and explaining barriers and enablers to knowledge sharing between traditional and Western healthcare professionals in China. The context for the study was a public hospital in the province of Hubei in Central China. A total of 49 semi-structured interviews were carried out and analysed.

Findings

Despite the grounded theory methodology being applicable in different cultural contexts, the culture itself may present challenges and barriers at both the data collection and analysis stages. These cultural problems may hinder interaction with informants, misunderstanding of responses and behaviours, and thus significantly impair the research validity and reliability.

Practical implications

The paper provides advice and recommendations to researchers aiming at doing this type of study in China.

Originality/value

The paper is of interest to inductive researchers, in particular those using grounded theory, as it describes and discusses the actual application of the methodology in a non-Western context. The paper is also of interest to any researchers intending to undertake participative research in China.

Article
Publication date: 2 June 2021

André Luiz Jardini, Éder Sócrates Najar Lopes, Laís Pellizzer Gabriel, Davi Calderoni, Rubens Maciel Filho and Paulo Kharmandayan

This study aims to assess the design, manufacturing and surgical implantation of three-dimensional (3D) customized implants, including surgical preoperative planning, surgery and…

Abstract

Purpose

This study aims to assess the design, manufacturing and surgical implantation of three-dimensional (3D) customized implants, including surgical preoperative planning, surgery and postoperative results, for cranioplasty along with zygomatic and orbital floor implants using additive manufacturing (AM) technics for a 23-year-old female who suffered from severe craniomaxillofacial trauma.

Design/methodology/approach

The skull biomodel was produced in polyamide while implants were made of Ti-6Al-4V alloy by AM.

Findings

The method enabled perfectly fitting implants and anatomical conformance with the craniomaxillofacial defect, providing complete healing for the patient. Surgical planning using a customized 3D polyamide biomodel was effective. This proved to be a powerful tool for medical planning and manufacturing of customized implants, as complete healing and good craniofacial aesthetic results were observed.

Originality/value

Satisfactory surgical procedures, regarding surgery time reduction and good craniofacial aesthetic results, were achieved. Furthermore, the 3D titanium customized implants represented a favorable alternative for the repair of craniomaxillofacial defects.

Details

Rapid Prototyping Journal, vol. 27 no. 5
Type: Research Article
ISSN: 1355-2546

Keywords

Article
Publication date: 1 June 2000

Kennedy Nyabuti Ondimu

Kenya has seen a gradual decline in the quality of health services particularly those in the public sector. This has adversely affected health status of vulnerable groups…

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Abstract

Kenya has seen a gradual decline in the quality of health services particularly those in the public sector. This has adversely affected health status of vulnerable groups including the poor, children and pregnant women. This article discusses research findings on the quality of obstetric care offered by both public and private sector facilities in the Nyanza province. It found that public sector health facilities are under staffed, lack essential drugs and equipment and are unable to offer even basic therapeutic and diagnostic services. Local people have lost confidence in the facilities and only use them when in absolute danger. Sometimes this may be late, leading to severe complications. The article recommends more personnel be trained and posted to rural areas, a reliable supply of drugs and the purchase of necessary equipment for public health facilities. Meanwhile, the private sector should be encouraged to charge less for essential services like maternity care.

Details

International Journal of Health Care Quality Assurance, vol. 13 no. 3
Type: Research Article
ISSN: 0952-6862

Keywords

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