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Purpose – Intravenous leiomyomatosis (IVL) is a very rare subtype of leiomyoma, involving the right obstruction of the heart, and is an unusual cause of outflow tract obstruction. The IVL grows from the vessel’s smooth muscle, protruding into the vessel’s lumen, and can expand to the right atrium and even beyond causing death due to blood flow obstruction into the right atrium and even to pulmonary artery.

Design/Methodology/Approach – We present a 33-year-old Indonesian woman with cardiopulmonary symptoms predominantly, and marked by an intravascular leiomyoma extending from inferior vena cava (IVC) to right chamber atrium, with the chief complaint being easily fatigued since seven months.

Findings – Echocardiography observations found a mass in the right atrium and the IVC that caused dynamics obstructed in tricuspid valve, right atrium and ventricle were dilated, no left ventricular (LV) hypertrophy, normal LV and right ventricular (RV) functions, and no valve abnormality except the tricuspid valve gradient being 21 mmHg with mild regurgitation. Venography resulted in a mobile tumor mass in IVC mouth which partially flew into the right atrium, and partially blocked the IVC mouth. Tumor size was 6.4 cm × 4.8 cm. Abdominal multislice computed tomography resulted in a residual soft tissue mass (leiomyoma) along the IVC extended to the right atrium. The tumor mass size in the IVC and the right atrium was bigger compared to tumor mass on July 2008. The correct diagnosis was established during surgery; therefore a two-stage resection was done.

Originality/Value – Surgical resection is the best treatment for intracardiac extension of intravenous leiomyoma. To remove the ilio-caval portion, iliac venotomy was recommended for the tumor in both stages of the surgeries.

There is a growing consensus within the NHS of the importance of obtaining feedback from patients in order to improve the quality of health care; consequently, many patient satisfaction surveys are now undertaken. However, much research is based on provider‐held assumptions about service quality. This study focuses on patient satisfaction with coronary bypass surgery, starting with the concerns expressed by patients and using these as a basis for evaluating different aspects of care. The paired comparison technique was employed to produce a ranked list of aspects of care that were perceived to be in greatest need of improvement. Some difficulties were encountered in administering the ranking technique to patients in a highly specialized health‐care setting; however, results were obtained and validated for follow‐up patients. The item of most concern to these patients was a lack of sensitivity about when patients felt ready for discharge.

The results of introducing a new licensed local anaesthetic drug, ropivacaine, into routine practice were evaluated by measuring the efficacy and adverse effects of patient controlled epidural analgesia (PCEA), using ropivacaine 2mg/ml (R), or the mixtures in current use: fentanyl 5 (μg/ml with bupivacaine 1mg/ml (BF5) and fentanyl 10 (μg/ml) with bupivacaine 1mg/ml (BF10). All patients were nursed on general wards after surgery. For two months, 102 consecutive patients were studied. Pain scores at rest were significantly better in the fentanyl and bupivacaine groups, (mean rank R: 35.5, BF5: 22.7, BF10: 26.9, P<0.05). There was a significant correlation between patient controlled boluses and pain at rest and (p < 0.001), and pain on moving (p < 0.001). Nausea and vomiting was worse in the BF10 (p < 0.05). Older patients demanded less analgesia (p < 0.001). Postoperatively BF5 provided better pain relief with trends demonstrating fewer side‐effects and complications than BF10 or R. We now use fentanyl 5 (μg/ml and bupivacaine 1mg/ml as our standard epidural infusion mixture.

The sustainability of the Japanese healthcare system is in question because the government has had a huge fiscal debt. Despite an enormous effort to cut the deficit, our healthcare expenditure is increasing every year because of the rapidly aging population. One of the solutions for this problem is to improve the productivity of healthcare. The purpose of this paper is to determine the factors that change surgeons’ productivity in one year.

The authors collected data of all surgical procedures performed at Teikyo University Hospital from April 1 through September 30 in 2014 and 2015, and computed the surgeons’ Malmquist index (MI), efficiency change (EC) and technical change (TC) using non-radial and non-oriented Malmquist model under the constant returns-to-scale assumptions. The authors then divided the surgeons into two groups; one whose productivity progressed and the other whose productivity regressed. These two groups were compared to identify factors that may influence their MI.

The only significant difference between the two groups was ECs (p < 0.0001). The other factors, such as TC, experience, surgical volume, emergency cases, surgical specialty, academic ranks, medical schools and gender, were not significantly different between the two groups.

EC is a major determinant of surgeons’ productivity change. The best way to improve surgeons’ productivity may be to enhance their efficiency regardless of their surgical volume and personal backgrounds.

Robotic surgery is limited by the lack of haptic feedback to the surgeon. The addition of tactile information may enable surgeons to feel tissue characteristics, appropriately tension sutures, and identify pathologic conditions. Tactile feedback may also enable expansion of minimally invasive surgery to other surgical procedures and decrease the learning curve associated with robotic surgery. This paper aims to explore a system to provide tactile feedback.

A pneumatic balloon‐based system has been developed to provide tactile feedback to the fingers of the surgeon during robotic surgery. The system features a polydimethyl siloxane actuator with a thin‐film silicone balloon membrane and a compact pneumatic control system. The 1.0 × 1.8 × 0.4 cm actuators designed for the da Vinci system feature a 3 × 2 array of 3 mm inflatable balloons.

The low‐profile pneumatic system and actuator have been mounted directly onto the da Vinci surgical system. Human perceptual tests have indicated that pneumatic balloon‐based tactile input is an effective means to provide tactile information to the fingers of the surgeon.

Application of a complete tactile feedback system is limited by current force sensing technologies.

The actuators have been designed such that they can be mounted directly onto the hand controls of the da Vinci robotic system, and are scalable such that they can be applied to various robotic applications.

This paper aims to review the latest applications in terms of three-dimensional printed (3DP) metal implants in orthopedics, and, importantly, the design of 3DP metal implants through a series of cases operated at The Second Hospital of Jilin University were presented.

This paper is available to practitioners who are use 3DP implants in orthopedics. This review began with the deficiency of traditional prostheses and basic concepts of 3DP implants. Then, representative 3DP clinical cases were summarized and compared, and the experiences using customized prostheses and directions for future potential development are also shown.

The results obtained from the follow-up of clinical applications of 3DP implants show that the 3D designed and printed metal implants could exhibit good bone defect matching, quick and safe joint functional rehabilitation as well as saving time in surgery, which achieved high patient satisfaction collectively.

Single center experiences of 3DP metal implants design were shared and the detailed technical points between various regions were compared and analyzed. In conclusion, the 3DP technology is infusive and will present huge potential to reform future orthopedic practice.

Overall equipment effectiveness (OEE) is a performance indicator that is been used to measure manufacturing productivity. The purpose of this paper is to propose the operating room effectiveness for hospital operating rooms (ORs), adapted from the OEE, to measure performance and identify losses based on lean health-care principles.

The present study is an exploratory, descriptive and applied research work. Literature review, documents of the hospital, observation and interviews with employees of a large university hospital in southern Brazil were analyzed to organize the proposed effectiveness indicator. After that, historical data of the ORs was collected and the usefulness of the indicator was analyzed. The indicator was applied for 10 months and validated with an expert committee from the hospital.

The present study describes an adaptation of a performance indicator to ORs of hospitals, allowing to classify its types of operational losses in a lean health-care context. The application of this indicator and the development of improvement actions to a university hospital, resulted in operational efficiency gains of 12 per cent and estimated annual savings of US$400,000.

ORs are a critical service for hospitals. This paper presents a new way to measure the performance of ORs and identify their main types of wastes. It also shows how to implement it and the potential gains of its application. The main research limitations are related to technical analysis of care data from doctors and nurses involved.

This paper fulfills the need to study how ORs performance can be measured and its operational wastes can be identified. In addition, this paper classifies the planning, performance and quality related losses, which can be used by researchers and practitioners to improve the performance of operation rooms.

The purpose of this study is to explore the potential contribution of the metaverse to improve training and development as a function of human resource development (HRD) perspective. The authors explore the benefits and challenges of the metaverse and introduce cases of companies using the metaverse in training.

A narrative literature review was conducted to collect information on the metaverse in training. The authors reviewed peer- and non-peer-reviewed articles, book chapters, white papers, corporate websites and blogs and business magazines.

A total of 75 articles were reviewed, including 14 cases, which were summarized to demonstrate how companies are applying metaverse technology in training contexts. For a more in-depth review, three cases were selected and summarized in terms of context, process and outcomes.

The metaverse is an emergent topic in HRD. It has the potential to revolutionize the functions of training and development through the combination of advanced technologies, including virtual reality, augmented reality and mixed reality. This article is the foundational attempt to provide a comprehensive summary of existing literature and case studies that highlight the potential of the metaverse in training within the context of HRD.

Aims to investigate the structural relationships between out‐patient satisfaction and service quality dimensions under a South Korea health care system where patients have substantial freedom in choosing their medical service providers and to further study the causal relationship between service quality and satisfaction between out‐patient subgroups obtained on the basis of gender, age and types of services received.

After assessing the construct validity of the service quality dimensions based on confirmatory factor analysis, a path model specifying the relationships between service quality dimensions and patient satisfaction was estimated. The next analysis was a series of multi‐sample analyses. A multigroup LISREL analysis was used to test the invariance of structural paths between service quality dimensions and patient satisfaction.

Results indicated that the general causal relationship between service quality and patient satisfaction was well supported in the South Korean health‐care delivery system. An examination of the estimated path coefficients showed that the pattern of relationships between service quality and patient satisfaction was similar across the gender, age, and service type subgroups. Results also revealed that the level of satisfaction, on the other hand, was not the same for subgroups when divided by age and the types of services received.

Since the majority of the past studies have been geographically concentrated in the countries in North America and Western Europe, the findings of this study expand understanding of the relationships between service quality and patient satisfaction.

In Japan, health-care systems have long been supported by physicians' long working hours. To solve this problem, there is an urgent need to improve the working environment for physicians while practicing patient-centered medicine and controlling health-care costs. This paper aims to examine the effect of task shifting to nurses and discuss its usefulness from the perspective of health-care value co-creation.

This paper analyzes task shifting to nurses in acute care hospitals in Japan as a solution for the shortage of anesthesiologists. The authors discuss how the value was created from the perspective of the health-care ecosystem, with conceptual consideration of the value co-creation mechanism through patient-centered practices.

The study showed that task shifting initiatives in Japan can improve the motivation of nurses through human resource development while maintaining high quality. The study also suggested that task shifting from physicians to nurses may contribute to improving net income and maintaining the health-care system.

The findings are highly reproducible and can be immediately applied to initiatives at other medical institutions in Japan. Furthermore, it is suggested that these findings might provide some perspective on the realignment of fragmented healthcare in the USA.

It was confirmed in practical terms that micro-level initiatives have an impact on the macro level as well. In addition, the academic presentation of the concept has contributed to the deepening of value research.