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The purpose of this paper is to present a surgical robot for spinal fusion and its control framework that provides higher operation accuracy, greater flexibility of robot position control, and improved ergonomics.

A human‐guided robot for the spinal fusion surgery has been developed with a dexterous end‐effector that is capable of high‐speed drilling for cortical layer gimleting and tele‐operated insertion of screws into the vertebrae. The end‐effector is position‐controlled by a five degrees‐of‐freedom robot body that has a kinematically closed structure to withstand strong reaction force occurring in the surgery. The robot also allows the surgeon to control cooperatively the position and orientation of the end‐effector in order to provide maximum flexibility in exploiting his or her expertise. Also incorporated for improved safety is a “drill‐by‐wire” mechanism wherein a screw is tele‐drilled by the surgeon in a mechanically decoupled master/slave system. Finally, a torque‐rendering algorithm that adds synthetic open‐loop high‐frequency components on feedback torque increases the realism of tele‐drilling in the screw‐by‐wire mechanism.

Experimental results indicated that this assistive robot for spinal fusion performs drilling tasks within the static regulation errors less than 0.1 μm for position control and less than 0.05° for orientation control. The users of the tele‐drilling reported subjectively that they experienced torque feedback similar to that of direct screw insertion.

Although the robotic surgery system itself has been developed, integration with surgery planning and tracking systems is ongoing. Thus, the screw insertion accuracy of a whole surgery system with the assistive robot is to be investigated in the near future.

The paper arguably pioneers the dexterous end‐effector appropriately designed for spinal fusion, the cooperative robot position‐control algorithm, the screw‐by‐wire mechanism for indirect screw insertion, and the torque‐rendering algorithm for more realistic torque feedback. In particular, the system has the potential of circumventing the screw‐loosening problem, a common defect in the conventional surgeon‐operated or robot‐assisted spinal fusion surgery.

The purpose of this paper is to investigate the phenomenon of the digital do-it-yourself (DiDIY) in the medical domain. In particular, the main contribution of the paper is the analysis and discussion of a questionnaire-based user study focused on 3D printing (3DP) technology, which was conducted among clinicians of one of the most important research hospital group in Lombardy, Italy.

A general reflection on the notion of knowledge artifacts (KAs) and on the use of 3DP in medicine is followed by the research questions and by a more detailed analysis of the specialist literature on the usage of 3DP technology for diagnostic, training and surgical planning activities for clinicians and patients. The questionnaire-based user study design is then emerging from the conceptual framework for DiDIY in healthcare. To help focus on the main actors and assets composing the 3DP innovation roles in healthcare, the authors model: the DiDIY-er as the main initiator of the practice innovation; the available technology allowing the envisioning of new practices; the specific activities gaining benefits from the innovative techniques introduced; and the knowledge community continuously supporting and evolving knowledge practices.

The authors discuss the results of the user study in the light of the four main components of our DiDIY framework and on the notion of KA. There are differences between high expertise, or senior, medical doctors (MDs) and relatively lower expertise MDs, or younger MDs, regarding the willing to acquire 3DP competences; those who have seen other colleagues using 3DP are significantly more in favor of 3DP adoption in medical practices, and those who wish to acquire 3DP competence and do-by-themselves are significantly more interested in the making of custom-made patient-specific tools, such as cutting guides and templates; there are many recurrent themes regarding how 3DP usage and application may improve medical practice. In each of the free-text questions, there were comments regarding the impact of 3DP on medical knowledge practices, such as surgical rehearsal, surgery, pathology comprehension, patient-physician communication and teaching.

The 3DP adoption in healthcare is seen favorably and advocated by most of the respondents. In this domain, 3DP objects can be considered KAs legitimately. They can support knowledgeable practices, promote knowledge sharing and circulation in the healthcare community, as well as contribute to their improvement by the introduction of a new DiDIY mindset in the everyday work of MDs.

This research examines the effects of obesity, gender, and specialty on the social influence of physicians. Recent research in other areas of social science indicates that the effects of gender are declining, but the effects of the obesity physical appearance dimension linger. For physicians, just the opposite seems to be the case. More significant gender effects than obesity effects were found. Some specialties also interact with gender and obesity. Moreover, the research describes an innovative use of morphing to manipulate and isolate the obesity stimulus.

The potential implications of the three-dimensional printing (3DP) technology are growing enormously in the various health-care sectors, including surgical planning, manufacturing of patient-specific implants and developing anatomical models. Although a wide range of thermoplastic polymers are available as 3DP feedstock, yet obtaining biocompatible and structurally integrated biomedical devices is still challenging owing to various technical issues.

Polyether ether ketone (PEEK) is an organic and biocompatible compound material that is recently being used to fabricate complex design geometries and patient-specific implants through 3DP. However, the thermal and rheological features of PEEK make it difficult to process through the 3DP technologies, for instance, fused filament fabrication. The present review paper presents a state-of-the-art literature review of the 3DP of PEEK for potential biomedical applications. In particular, a special emphasis has been given on the existing technical hurdles and possible technological and processing solutions for improving the printability of PEEK.

The reviewed literature highlighted that there exist numerous scientific and technical means which can be adopted for improving the quality features of the 3D-printed PEEK-based biomedical structures. The discussed technological innovations will help the 3DP system to enhance the layer adhesion strength, structural stability, as well as enable the printing of high-performance thermoplastics.

The content of the present manuscript will motivate young scholars and senior scientists to work in exploring high-performance thermoplastics for 3DP applications.

This paper aims to explore how the integrated thinking of a chief executive officer (CEO) impacts the management’s orchestration of the six capitals to create value in an organization.

Following a case study approach, data was gathered on two business organizations in Sri Lanka through interviews, focus group discussions and documentary analyzes. Thematic and cross-case analyzes were used in analyzing the data based on an analytical framework that was developed using systems and resource orchestration theories.

The study finds that the integrated thinking perspective of the CEO determines which capitals to embrace in the pursuit of value creation by an organization. A broader perspective on the integrated thinking of the CEO can lead to a sustainable perspective for value creation focusing on integrated corporate responsibility. On the contrary, a constrained perspective of integrated thinking can lead to a business case perspective for value creation that focuses mainly on the key areas of responsibility extended for operational efficiency. These different perspectives result in differences in value creation in organizations over time.

The capitals embraced in the integrated thinking perspective of a CEO should be translated into objectives, strategies and performance measurement and implemented at every level of the company to create value. This perspective of a CEO can be institutionalized through the adoption of accredited management systems. To foster value creation, managers should use a variety of information technology platforms and internal networks.

This is one of the first studies that explore how the perception of integrated thinking of the CEO impacts value creation in an organization through a combination of resource orchestration and systems thinking theory lenses.

The purpose of this paper is to discover best practices for selling stem cell based biologics and ensuring proper sales force alignment in the biomedical device industry.

This research is based on an immersion into the industry as well as several formal, semi-structured interviews and dozens of informal interviews of surgeons, medical staff and medical device salespersons and managers. Data were also collected and analyzed from wipricepoint.org. The factors analyzed were the number of discharges, average charge per procedure, median age, male/female patient ratio and total hospital charges per year.

Secondary data can augment primary data collection to determine the most lucrative markets for salespersons to target their efforts. In addition, the data when combined with sales force specific data can help optimize sales force alignment. Insights into the industry are also given such as how to overcome objections to the use of stem cell based biologics for spinal surgeries.

Much of the findings are specific to only one industry (medical device sales). However, we do present a generalized process for analyzing a key source of secondary data that could be beneficial to any hospital-serving industry.

Within the medical equipment industries, approximately 58 per cent of sales territories were either too large or too small (Zoltners and Lorimer, 2000). This paper shows how secondary data sources can be obtained and analyzed to better focus sales force effort.

Procedures can be categorized as certain surgeries based on their necessity and outcomes while others are classified as uncertain surgeries based on these areas. To account for this variance, policies such as the Affordable Care Act (ACA) call for health care providers to engage in shared decision making (SDM) with patients to ensure they are informed of treatment options and asked their preferences. Yet, gender may influence the decision-making process. Thus, this project examines the decision process and how gender impacts patients’ participation in decisions to undergo certain surgeries compared to uncertain surgeries.

This research project analyzed data from the National Survey of Medical Decisions 2006–2007 which surveyed the medical decisions of US residents 40 and older.

First, the data reveals that women felt more informed having uncertain surgeries compared to men. Second, patients were less likely asked their preference for surgery when undergoing certain surgeries compared to uncertain surgeries. Third, compared to men, women having uncertain surgeries were less likely to make the final decision to have surgery, compared to sharing the final decision with health care providers.

Due to the sample size, this project could not perform three-way interactions between gender, race, and surgery type.

Gender influences the level patients feel informed having uncertain surgeries. Though policy calls for SDM, health care providers are less likely to ask patients their preference for surgery regarding certain surgeries, relative to uncertain surgeries. Gender impacts the final decision-making process regarding whether patients should have uncertain surgeries.

The current industry standard rigid spinal implants suffer fatigue failures due to bending and torsion loads. The purpose of this program was to design novel prototype flexible titanium alloy spinal implant rod with machined features, and then apply the laser shock peening (LSP) process to restore the fatigue strength debit due to these features.

A flexible prototype rod was designed with flat section at the center of the rod. The flat section was laser shock peened. Static compression tests were conducted as per American Society of Testing Materials standards for three‐ and four‐point bending tests and “vertebrectomy” constructs. Finite element models were developed to aid in the design of LSP and also to guide the experiments.

The test results indicated a ∼3X improvement in flexibility and a reduction in fatigue load ratio, defined as applied load divided by the yield load; from 72 to 68 percent. This rod was LSP's on the flat sections, and tested again. The results indicated an increase in the fatigue load ratio from 68 to 75 percent without any further change in flexibility.

It has been demonstrated successfully that the current industry rigid spinal implant rod can be modified for flexibility and laser shock peened to increase fatigue strength. This enhancement will enable the use of the implant for longer periods and higher loads; and for surgical processes with and without fusion. This technology can be readily applied to all metals that are certified for human implant applications; thus can be implemented with minimal clinical trials.

Clinical specialist physiotherapy (CSP)-led musculoskeletal triage clinics have been established in the UK as a means of managing patients referred for outpatient orthopaedic consultation. The purpose of this paper is to determine if a CSP could allocate patients into distinct diagnostic triage categories in line with national and international guidelines. A second aim was to describe the CSPs clinical decision making.

A review of 100 spinal patients, consecutively referred between February and April 2013 to a CSP spinal triage clinic was undertaken. Patient demographics (age, gender, employment status), clinical diagnosis and diagnostic triage categories selected for each patient were recorded. Subsequently, if clinical triage led to further investigation or a consultant opinion then the onward management pathway was followed to calculate conversion to consultant surgical intervention.

In total, 69 per cent of patients were independently managed by the CSP and discharged back to the General Practitioner or on to therapy. In total, 30 per cent of patients (n=30) were referred for consultant opinion, of these 12 underwent intervention. This represents a conversion rate to consultant intervention of 40 per cent.

Findings suggest that a significant number of spinal patients referred for an orthopaedic consultation may be managed independently by a CSP. Referral for consultant review was deemed appropriate in terms of conversion to intervention, advice on further imaging, referral to other medical disciplines and patient counselling. This study suggests that CSPs can manage a significant number of patients with spinal conditions whilst providing high-quality referrals to surgical colleagues. This audit provides a novel insight into practitioner behaviour that supports the development of advanced practice for non-medical clinicians.

This paper aims to provide an overview of applications of medical rapid prototyping (MRP)-assisted customized surgical guides (CSGs) and shows the potential of this technology in complex surgeries. This review paper also reports two case studies from open literature where MRP-assisted CSGs have been successfully used in complex surgeries.

Key publications from the past two decades have been reviewed.

This study concludes that the use of MRP-assisted CSGs improves the accuracy of surgery. Additionally, MRP-assisted CSGs make the surgery much faster, accurate and cheaper than any other technique. The outcome based on literature review and two case studies strongly suggested that MRP-assisted CSGs might become part of a standard protocol in the medical sector to operate the various complex surgeries, in the near future.

Advanced technologies like radiology, image processing, virtual surgical planning (VSP), computer-aided design (CAD) and MRP made it possible to fabricate the CSGs. MRP-assisted CSGs can easily transfer the VSP into the actual surgery.

This paper is beneficial to study the development and applications of MRP-assisted CSGs in complex surgeries.