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Quantifying the performance level of surgeons with digital virtual reality (VR) simulators can help ensure that quality requirements in healthcare are met. In order to better understand integration amongst quality principles, practices and technologies in the adoption and diffusion of VR simulators, the authors applied a technological innovation system (TIS) framework. The purpose of this study is to understand how the adoption and diffusion of VR surgical simulators in a Swedish healthcare context is influenced by various system factors.

In this study, single-case holistic design based on innovation system theory was used to analyse the adoption of digital quality technologies related to surgical performance in Swedish hospitals. The case employs a mixed methods approach triangulating data longitudinally from published documents and expert interviews.

Adoption of digital technologies regarding surgical performance is restricted by system factors relating to inconsistent normative and regulatory requirements for quantified performance criteria to judge surgical expertise. Addressing these systems' weaknesses with evidence-based training programmes can have a significant impact on the further development of the innovation system and can ultimately affect healthcare reliability and quality.

This paper explores quality management (QM) challenges in the context of digital transformation in healthcare. The paper attempts to fill the gap for TIS studies in a healthcare context and highlight the role of innovation function strength along the value chain and in relation to technology cycles to increase the understanding of adoption of digital technologies relating to surgical performance.

This study aims to investigate the potential of using polymer multi-material additive manufacturing (MMAM) to produce miniature hydraulic piston actuators combining rigid structures and flexible seals. Such actuators offer great potential for medical robots in X-ray and magnetic resonance environments, where conventional piston actuators cannot be used because of safety issues caused by metal components.

Hydraulic pistons with two different integrated flexible seal shapes are designed and manufactured using MMAM. Design 1 features a ring-shaped seal made from a flexible material that is printed on the surface of the rigid piston shaft. Design 2 appears identical from the outside, yet an axial opening in the piston shaft is added to enable self-reinforced sealing as fluid pressure increases. For both designs, samples with three different outer diameters are fabricated leading to a total of six different piston versions. The pistons are then evaluated regarding leakage, friction and durability.

Measurement results show that the friction force for Design 2 is lower than that of Design 1, making Design 2 more suitable for the intended application. None of the versions of Design 2 shows leakage for pressures up to 1.5 MPa. For Design 1, leak-tightness varies with the outer diameter, yet none of the versions is consistently leak-tight at 1.5 MPa. Furthermore, the results show that prolonged exposure to water decreases the durability of the flexible material significantly. The durability the authors observe may, however, be sufficient for short-term or single-use devices.

The authors investigate a novel design approach for hydraulic piston actuators based on MMAM. These actuators are of particular interest for patient-specific medical devices used in radiological interventions, where metal-free components are required to safely operate in X-ray and magnetic resonance environments. This study may serve as a basis for the development of new actuators, as it shows a feasible solution, yet pointing out critical aspects such as the influence of small geometry changes or material performance changes caused by water absorption.

Biodegradable polymers are widely used in personalized medical devices or scaffolds for tissue engineering. The manufacturing process should be finished with sterilization procedure. However, it is not clear how the different sterilization methods have an impact on the mechanical strength of the three-dimensional (3D)-printed parts, such as bone models or personalized mechanical devices. This paper aims to present the results of mechanical testing of polylactide-based bone models before and after sterilization.

Polylactide specimens prepared in fused filament fabrication technology were sterilized with different sterilization methods: ultraviolet (UV) and ethylene oxide. Mechanical properties were determined by testing tensile strength, Young’s modulus and toughness.

The tensile strength of material after sterilization was significantly higher after ethylene oxide sterilization compared to the UV sterilization, but in both sterilization methods, the specimens characterized lower tensile strength and Young’s modulus when compared to the control. In comparison of toughness results, there was no statistically significant differences. The findings are particularly significant in the perspective of using individual implants, bone grafts and dental guides.

Although fused filament fabrication (FFF) 3D printing devices equipped with UV light sterilization options are available, experimental results of the effect of selected sterilization methods on the mechanical strength of additively manufactured parts have not been described. This paper completes the present state of the art on the problem of sterilization of FFF parts from biodegradable materials.

The teaching and learning of anatomy has experienced a significant paradigm shift. The present study assessed the level of knowledge in anatomy in medical postgraduate students and explored the impact of interventions in the form of anatomical videos on knowledge obtained. An awareness of the importance of human anatomy for clinical skills was created to ensure a certain level of competence be achieved by the end of the anatomy course.

Postgraduate medical students were recruited from various specialties on voluntary basis. The first step was to conduct a preliminary screening exam to determine the level of anatomical knowledge. The students were then divided into two groups at random, one of which received no intervention (the control group), and the other of which watched the videos with content that was pertinent to the practical demonstrations (intervention). To assess the effects of the video intervention, a post-test was administered to all students.

Both spot tests (SPOTs) and short answer question (SAQ) components for scores of all the regions from the intervention groups were comparable to the scores obtained by the post-test control group, although the findings were not significant (p > 0.05). However, the intervention group from the abdomen (ABD) region did perform significantly better (p < 0.05) than the screening test score.

The results of the research study imply that interventions like anatomical videos can bridge the postgraduate trainee’s anatomy knowledge gap in a practical method which will immensely help in increasing their knowledge.

Left atrial appendage occlusion (LAAO) is a structural interventional cardiology procedure that offers several possibilities for the application of additive manufacturing technologies. The literature shows a growing interest in the use of 3D-printed models for LAAO procedure planning and occlusion device choice. This study aims to describe a full workflow to create a 3D-printed LAA model for LAAO procedure planning.

The workflow starts with the patient’s computed tomography diagnostic image selection. Segmentation in a commercial software provides initial geometrical models in standard tessellation language (STL) format that are then preprocessed for print in dedicated software. Models are printed using a commercial stereolithography machine and postprocessing is performed.

Models produced with the described workflow have been used at the Careggi Hospital of Florence as LAAO auxiliary planning tool in 10 cases of interest, demonstrating a good correlation with state-of-the-art software for device selection and improving the surgeon’s understanding of patient anatomy and device positioning.

3D-printed models for the LAAO planning are already described in the literature. The novelty of the article lies in the detailed description of a robust workflow for the creation of these models. The robustness of the method is demonstrated by the coherent results obtained for the 10 different cases studied.

Coronary artery disease (CAD) is reported as one of the most common sources of death all over the world. The presence of stenosis (plaque) in the coronary arteries results in the restriction of blood supply, leading to myocardial infarction. The current study investigates the influence of multi stenosis on hemodynamic properties in a patient-specific left coronary artery.

A three-dimensional model of the patient-specific left coronary artery was reconstructed based on computed tomography (CT) scan images using MIMICS-20 software. The diseased model of the left coronary artery was investigated, having the narrowing of 90% and 70% of area stenosis (AS) at the left anterior descending (LAD) and left circumflex (LCX), respectively.

The results indicate that the upstream region of stenosis experiences very high pressure for 90% AS during the systolic period of the cardiac cycle. The pressure drops maximum as the flow travels into the stenotic zone, and the high flow velocities were observed across the 90% AS. The higher wall shear stresses occur at the stenosis region, and it increases with the increase in the flow rate. It is found that the maximum wall shear stress across 90% AS is at the highest risk for rupture. A recirculation region immediately after the stenosis results in the further development of stenosis.

The current study provides evidence that there is a strong effect of multi-stenosis on the blood flow in the left coronary artery.

Process facilitation as part of a complex intervention for changing or improving practices within workplaces is becoming a common work method. The aim of this study was to investigate what characterizes the process-facilitating role in a complex intervention.

The present study focuses on a complex work environment intervention targeting eight organizational units (workplaces) in the Swedish healthcare sector. The study applies a mixed-method approach and has been carried out in two steps. First, a qualitative process evaluation was performed. Secondly, an evaluation was conducted to see to what extent these identified conditions and mechanisms affected the quantitative intervention effect in term of sickness absence.

The analysis shows that the facilitating role consisted of three overlapping and partially iterative phases. These phases involved different activities for the facilitating role. Depending on how the facilitating role and the intervention were designed, various supporting conditions were found to significantly affect the outcome of the intervention measured as the total sickness absence.

It is concluded that the facilitation is not static or fixed during the change process. Instead, the facilitation role develops and emerges through the process of support during the different implementation phases.

The facilitative role of performing support is based on a combination of support role activities and expert role activities. The support role focuses on support activities, while the expert role includes capacity building through knowledge- and legitimacy-oriented activities.

This study contributes to earlier research by developing a methodological approach for carrying out process facilitation in complex interventions.

This study examines the osteoconductive and healing capabilities of locally implanted synthetic hydroxyapatite (sHAp) derived from eggshells in the central incisor sockets of rats.

Toxicity experiments were conducted in vitro and in vivo, to testify the safety dosage of sHAp. Around 24 mature male Sprague–Dawley (SD) rats had their upper central incisors extracted. The rats were placed into three groups of eight rats each: Group 1: the sockets of extracted central incisors were left unfilled (control), Group 2: filled up with commercially available hydroxyapatite (HAp) and Group 3: implanted with sHAp locally retrieved from eggshells. After extraction, four rats from each group were sacrificed at 2nd and 4th weeks. Maxillary tissue sections were obtained and stained with hematoxylin and eosin (H&E) and Masson’s trichome (MT) staining. Anti-osteocalcin (OCN) and proliferating cell nuclear antigen (PCNA) were used primary antibodies for immunohistochemistry (IHC) special labeling.

The results showed that the locally implanted sHAp was non-toxic and safe in cell lines (human osteoblast and fibroblast) and animals. Histological analysis of H&E, MT and IHC showed that the sockets treated with locally implanted sHAp from eggshells were filled with new bone tissue of comparable thickness to other groups.

This unique technique uses locally implanted eggshell-derived sHAp with osteoconductive characteristics. In an in vivo model, sHAps increased OCN and PCNA expression to improve bone repair.