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1 – 10 of 293Bita A. Kash, Kayla M. Cline, Stephen Timmons, Rahil Roopani and Thomas R. Miller
Health care institutions in many Western countries have developed preoperative testing and assessment guidelines to improve surgical outcomes and reduce cost of surgical care. The…
Abstract
Purpose
Health care institutions in many Western countries have developed preoperative testing and assessment guidelines to improve surgical outcomes and reduce cost of surgical care. The aims of this chapter are to (1) summarize the literature on the effect of preoperative testing on clinical outcomes, efficiency, and cost; and (2) to compare preoperative testing guidelines developed in the United States, the United Kingdom, and Canada.
Design/methodology/approach
We reviewed the literature from 1975 to 2014 for studies and preoperative testing guidelines.
Findings
We identified 29 empirical studies and 8 country-specific guidelines for review. Most studies indicate that preoperative testing is overused and comes at a high cost. Guidelines are tied to payment only in one country studied. This is the most recent review of the literature on preoperative testing and assessment with a focus on quality of care, efficiency, and cost outcomes. In addition, this chapter provides an international comparison of preoperative guidelines.
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C.U. Dussa, K. Durve and K. Singhal
The purpose of this paper is to find the incidence and medical reasons for cancellations of elective orthopaedic cases following admission for an operation in a district general…
Abstract
Purpose
The purpose of this paper is to find the incidence and medical reasons for cancellations of elective orthopaedic cases following admission for an operation in a district general hospital. The paper also aims to determine the deficiencies in the local preoperative assessment protocol.
Design/methodology/approach
This is a retrospective study. The elective orthopaedic surgeries cancelled following their admission into the hospital due to medical reasons between January 2003 and December 2004, were identified. These cases were reviewed using the preoperative assessment charts and case notes. The NHS Modernisation Agency's guidelines, National Good Practice Guidance on Preoperative Assessment for Inpatient Surgery, are taken as the benchmark for comparison.
Findings
The paper finds that 44 elective orthopaedic cases were cancelled due to medical reasons. Of these patients, 64 per cent did not have a pre‐operative assessment prior to the admission for the planned surgery; 6 per cent had inadequate documentation of relevant past medical history; and 30 per cent (patients with significant medical problems) were not referred to the anaesthetist for advice although these problems were identified during the pre‐operative assessment.
Research limitations/implications
It is possible to stimulate good medical practice through audit.
Practical implications
Cancellation of an elective operation is not uncommon in hospital practice. This paper aims to highlight the possible avoidable causes for such cancellations. The paper identifies such deficiencies in the local preoperative assessment protocol and suggests remedies to improve the quality of care. These improvements and close adherence to the guidelines are important as preoperative assessment by nurse‐led clinics are being increasingly practised through out the UK.
Originality/value
The paper fulfils its aims of identifying the medical causes for cancellation of an operation and also the existing deficiencies in the preoperative assessment practice. The paper values the importance of adherence to NHS Modernising Agency's guidelines in preoperative assessment. It is useful not only to the Orthopaedic department but also to the department managers.
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Nicola Jane Spalding, Fiona Mary Poland, Sheila Gregory, Jane McCulloch, Kevin Sargen and Penny Vicary
– The purpose of this paper is to understand and develop ways to enhance patients’ experiences of preoperative education received prior to surgery for colorectal cancer.
Abstract
Purpose
The purpose of this paper is to understand and develop ways to enhance patients’ experiences of preoperative education received prior to surgery for colorectal cancer.
Design/methodology/approach
Based in the UK, three-action research cycles were undertaken to evaluate preoperative education, identify changes seen by patients and staff as likely to improve the service and to re-evaluate such changes following implementation. Data in each cycle were collected from: observations of clinic interactions; patient questionnaires; individual semi-structured interviews with multidisciplinary colorectal unit staff; longitudinal semi-structured interviews with patients and carers pre-surgery, two weeks post-surgery and 12 weeks post-surgery; patient and carer focus groups post-surgery; and existing educational material.
Findings
In total, 138 participants shared their experiences of either giving or receiving preoperative education. Findings were themed into why patients want preoperative education, and patients’ views of the educational processes.
Practical implications
Patients emphasised the need for educational provision to be fully understandable, comprehensive and client-centred using a range of communication processes. Patients emphasised the need for educational provision to be more fully understandable, comprehensive and client-centred and that important messages should be reinforced using a range of media. At a time of many uncertainties for patients’ lives, such education needed to encompass the experiences patients could expect, delivered by confident healthcare professionals.
Originality/value
Contextualising understanding and facilitating their own actions, enabled patients to regain control in circumstances particularly disruptive of bodily and other life routines. Establishing a sense of control is confirmed as important for patient's wellbeing in preparing for surgery and postoperative rehabilitation.
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Sandeep W. Dahake, Abhaykumar M. Kuthe and Mahesh B. Mawale
This study aims to find the usefulness of the customized surgical osteotomy guide (CSOG) for accurate mandibular tumor resection for boosting the accuracy of prefabricated…
Abstract
Purpose
This study aims to find the usefulness of the customized surgical osteotomy guide (CSOG) for accurate mandibular tumor resection for boosting the accuracy of prefabricated customized implant fixation in mandibular reconstructions.
Design/methodology/approach
In all, 30 diseased mandibular RP models (biomodels) were allocated for the study (for experimental group [n = 15] and for control group [n = 15]). To reconstruct the mandible with customized implant in the experimental group, CSOGs and in control group, no CSOG were used for accurate tumor resections. In control group, only preoperative virtual surgical planning (VSP) and reconstructed RP mandible model were used for the reference. Individually each patient’s preoperative mandibular reconstructions data of both the groups were superimposed to the preoperative VSP of respective patient by registering images with the non-surgical side of the mandible. In both the groups, 3D measurements were taken on the reconstructed side and compared the preoperative VSP and postoperative reconstructed mandible data. The sum of the differences between pre and postoperative data was considered as the total error. This procedure was followed for both the groups and compared the obtained error between the two groups using statistical analysis.
Findings
The use of CSOG for accurate tumor resection and exact implant fixation in mandibular reconstruction produced a smaller total error than without using CSOG.
Originality/value
The results showed that, benefits provided with the use of CSOG in mandibular reconstruction justified its use over the without using CSOG, even in free hand tumor resection using rotating burr.
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Antonella Fiorillo, Alfonso Sorrentino, Arianna Scala, Vincenzo Abbate and Giovanni Dell'aversana Orabona
The goal was to improve the quality of the hospitalization process and the management of patients, allowing the reduction of costs and the minimization of the preoperative Length…
Abstract
Purpose
The goal was to improve the quality of the hospitalization process and the management of patients, allowing the reduction of costs and the minimization of the preoperative Length of Hospital Stay (LOS).
Design/methodology/approach
The methodology used to improve the quality of the hospitalization process and patient management was Lean Thinking. Therefore, the Lean tools (Value stream map and Ishikawa diagram) were used to identify waste and inefficiencies, improving the process with the implementation of corrective actions. The data was collected through personal observations, patient interviews, brainstorming and from printed medical records of 151 patients undergoing oral cancer surgery in the period from 2006 to 2018.
Findings
The authors identified, through Value Stream Map, waste and inefficiencies during preoperative activities, consequently influencing preoperative LOS, considered the best performance indicator. The main causes were identified through the Ishikawa diagram, allowing reflection on possible solutions. The main corrective action was the introduction of the pre-hospitalization service. A comparative statistical analysis showed the significance of the solutions implemented. The average preoperative LOS decreased from 4.90 to 3.80 days (−22.40%) with a p-value of 0.001.
Originality/value
The methodology allowed to highlight the improvement of the patient hospitalization process with the introduction of the pre-hospitalization service. Therefore, by adopting the culture of continuous improvement, the flow of hospitalization was redrawn. The benefits of the solutions implemented are addressed to the patient in terms of lower LOS and greater service satisfaction and to the hospital for lower patient management costs and improved process quality. This article will be useful for those who need examples on how to apply Lean tools in healthcare.
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Sekou Singare, Qin Lian, Wei Ping Wang, Jue Wang, Yaxiong Liu, Dichen Li and Bingheng Lu
This paper aims to describe computer‐aided design and rapid prototyping (RP) systems for the preoperative planning and fabrication of custom‐made implant.
Abstract
Purpose
This paper aims to describe computer‐aided design and rapid prototyping (RP) systems for the preoperative planning and fabrication of custom‐made implant.
Design/methodology/approach
A patient with mandible defect underwent reconstruction using custom‐made implant. 3D models of the patient's skull are generated based on computed tomography image data. After evaluation of the 3D reconstructed image, it was identified that some bone fragment was moved due to the missing segment. During the implant design process, the correct position of the bone fragment was defined and the geometry of the custom‐made implant was generated based on mirror image technique and is fabricated by a RP machine. Surgical approach such as preoperative planning and simulation of surgical procedures was performed using the fabricated skull models and custom‐made implant.
Findings
Results show that the stereolithography model provided an accurate tool for preoperative, surgical simulation.
Research limitations/implications
The methods described above suffer from the expensive cost of RP technique.
Practical implications
This method allows accurate fabrication of the implant. The advantages of using this technique are that the physical model of the implant is fitted on the skull model so that the surgeon can plan and rehearse the surgery in advance and a less invasive surgical procedure and less time‐consuming reconstructive and an adequate esthetic can result.
Originality/value
The method improves the reconstructive surgery and reduces the risk of a second intervention, and the psychological stress of the patient will be eliminated.
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Hongqiang Sang, Fang Huang, Wei Lu, Rui Han and Fen Liu
The patient-side manipulator (PSM) achieves high torque capability by combining harmonic servo system with high reduction ratio and low torque motor. However, high reduction ratio…
Abstract
Purpose
The patient-side manipulator (PSM) achieves high torque capability by combining harmonic servo system with high reduction ratio and low torque motor. However, high reduction ratio can increase inertia and decrease compliance of the manipulator. To enhance the backdrivability of the minimally invasive surgical robot, this paper aims to propose a resistance torque compensation algorithm.
Design/methodology/approach
A resistance torque compensation algorithm based on dynamics and Luenberger observer is proposed. The dynamics are established, considering joint flexibility and an improved Stribeck friction model. The dynamic parameters are experimentally identified by using the least squares method. With the advantages of clear structure, simple implementation and fast solution speed, the Luenberger observer is selected to estimate the unmeasured dynamic information of PSM and realize the resistance torque compensation.
Findings
For low-speed surgical robots, the centrifugal force term in the dynamic model can be simplified to reduce computational complexity. Joint flexibility and an improved Stribeck friction model can be considered to improve the accuracy of the dynamic model. Experiment results show that parameter identification and estimated results of the Luenberger observer are accurate. The backdrivability of the PSM is enhanced in ease and smoothness.
Originality/value
This algorithm provides potential application prospects for surgical robots to maintain high torque while remaining compliant. Meanwhile, the enhanced backdrivability of the manipulator helps to improve the safety of the preoperative manual adjustment.
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Asier Muguruza Blanco, Lucas Krauel and Felip Fenollosa Artés
The use of physical 3D models has been used in the industry for a while, fulfilling the function of prototypes in the majority of cases where the designers, engineers and…
Abstract
Purpose
The use of physical 3D models has been used in the industry for a while, fulfilling the function of prototypes in the majority of cases where the designers, engineers and manufacturers optimize their designs before taking them into production. In recent years, there has been an increasing number of reports on the use of 3D models in medicine for preoperative planning. In some highly complex surgeries, the possibility of using printed models to previously perform operations can be determining in the success of the surgery. With the aim of providing new functionalities to an anatomical 3D-printed models, in this paper, a cost-effective manufacturing process has been developed. A set of tradition of traditional techniques have been combined with 3D printing to provide a maximum geometrical freedom to the process. By the use of an electroluminescent set of functional paints, the tumours and vessels of the anatomical printed model have been highlighted, providing to this models the possibility to increase its interaction with the surgeon. These set of techniques has been used to increase the value added to the reproduced element and reducing the costs of the printed model, thus making it more accessible.
Design/methodology/approach
Successfully case in where the use of a low-cost 3D-printed anatomical model was used as a tool for preoperative planning for a complex oncological surgery. The said model of a 70-year-old female patient with hepatic metastases was functionalized with the aim of increasing the interaction with the surgeons. The analysis of the construction process of the anatomical model based on the 3D printing as a tool for their use in the medical field has been made, as well as its cost.
Findings
The use of 3D printing in the construction of anatomical models as preoperative tools is relatively new; however, the functionalization of these tools by using conductive and electroluminescent materials with the aim of increasing the interaction with it by the surgeons is a novelty. And, based on the DIY principles, it offers a geographical limitlessness, reducing its cost without losing the added value.
Originality/value
The process based on 3D printing presented in this paper allows to reproduce low-cost anatomical models by following a simple sequence of steps. It can be done by people with low qualification anywhere with only access to the internet and with the local costs. The interaction of these models with the surgeon based on touch and sight is much higher, adding a very significant value it, without increasing its cost.
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Shuizhong Zou, Bo Pan, Yili Fu and Shuixiang Guo
The purpose of this paper is to propose a control algorithm to improve the backdrivability performance of minimally invasive surgical robotic arms, so that precise manual…
Abstract
Purpose
The purpose of this paper is to propose a control algorithm to improve the backdrivability performance of minimally invasive surgical robotic arms, so that precise manual manipulations of robotic arms can be performed in the preoperative operation.
Design/methodology/approach
First, the flexible-joint dynamic model of the 3-degree of freedom remote center motion (RCM) mechanisms of minimally invasive surgery (MIS) robot is derived and its dynamic parameters and friction parameters are identified. Next, the angular velocities and angular accelerations of joints are estimated in real time by the designed Kalman filter. Finally, a control algorithm based on Kalman filter is proposed to enhance the backdrivability of RCM mechanisms by compensating for the internally generated gravitational, frictional and inertial resistances experienced during the positioning and orientating.
Findings
The parameter identification for RCM mechanisms can be experimentally evaluated from comparison between the measured torques and the reconstructed torques. The accuracy and convergence of the real-time estimation of angular velocity and acceleration of the joint by the designed Kalman filter can be verified from corresponding simulation experiments. Manual adjustment experiments and animal experiments validate the effectiveness of the proposed backdrivability control algorithm.
Research limitations/implications
The backdrivability control algorithm presented in this paper is a universal method to enhance the manual operation performance of robots, which can be used not only in the medical robot preoperative manual manipulation but also in robot haptic interaction, industrial robot direct teaching and active rehabilitation training of rehabilitation robot and so on.
Originality/value
Compared with other backdrivability design methods, the proposed algorithm achieves good backdrivability for RCM mechanisms without using force sensors and accelerometers. In addition, this paper presents a new static friction compensation approach for a joint moving with very low velocity.
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Qing Han, Yanguo Qin, Yun Zou, Chenyu Wang, Haotian Bai, Tao Yu, Lanfeng Huang and Jincheng Wang
Although proximal row carpectomy, wrist arthrodesis and even total wrist arthroplasty were developed to treat wrist disease using bone and cartilage of the wrist, severe and…
Abstract
Purpose
Although proximal row carpectomy, wrist arthrodesis and even total wrist arthroplasty were developed to treat wrist disease using bone and cartilage of the wrist, severe and complicated bone defects caused by ferocious trauma and bone tumors remain a stubborn problem for surgeons. Development and application of the three-dimensional (3D) printing technology may provide possible solutions.
Design/methodology/approach
Computed tomography (CT) data of three cases with severe bone defects caused by either trauma or bone tumor were collected and converted into three-dimensional models. Prostheses were designed individually according to the residual anatomical structure of the wrist based on the models. Both the models and prostheses were produced using 3D printing technology. A preoperative design was prepared according to the models and prostheses. Then arthroplasty was performed after preoperative simulation with printed models and prostheses.
Findings
The diameter of the stem and radial medullary cavity, the direction and location of the prosthesis, and other components were checked during the preoperative design and simulation process phases. The three cases with 3D printed wrist all regained reconstruction of normal anatomy and part of the function after surgery. The average increasing Cooney score rate of Cases 2 and 3 was 133.34 ± 23.57 per cent, and that of Case 1 reached 85 per cent. The average declining rate of the Gartland and Werley Score in Cases 2 and 3 was 65.21 ± 18.89 per cent, and that of Case 1 dropped to 5 per cent in the last follow-up. The scores indicated that patients experienced pain relief and function regain. In addition, the degree of patient satisfaction improved.
Originality/value
3D printed wrist arthroplasty may provide an effective method for severe and complicated cases without sacrificing other bones. Personal customization can offer better anatomy and function than arthrodesis or other traditional surgical techniques.
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