Robotic-assisted total knee arthroplasty with the OMNIBot platform: a review of the principles of use and outcomes.

INTRODUCTION: Technology that enables the orthopaedic surgeon to deliver a surgical plan with precision and reproducibility continues to evolve. Robotic TKA represents the next phase of technological development in knee arthroplasty. Multiple propriety robotic platforms are now available for use in TKA, and one such system is the OMNIBotics platform. We conducted a review of this system, reporting its history and principles of use, published outcomes and our own personal experience performing OMNI robotic-assisted TKAs. MATERIALS AND METHODS: A literature review was conducted using the PRISMA guidelines. Thirteen papers were included for the final review. RESULTS: The OMNIBot is an accurate and consistent delivery tool in TKA surgery and compares favourably to instrumented, navigation-assisted and patient-specific cutting guides. The OMNIBot has been shown to be a reliable tool for delivering different alignment philosophies as well as planning and achieving tibio-femoral coronal balancing. The utility of the system is increased when the robot is used in conjunction with a soft-tissue tensioning device-the BalanceBot. Data regarding PROM's are limited, however results to date show reliable outcomes. Survival analysis of RATKA using the OMNIBot is limited to one study which reported 99.26% survivorship at 3 years. We report our own outcomes using the OMNIBot, having performed 766 TKA's using the OMNIBot, since 2014 with 99.48% survivorship at 6 year follow-up. CONCLUSION: The OMNIBot platform is an imageless, passive robotic system available since 2007, with over 30,000 TKA's being performed with its assistance. It has a small physical footprint, is relatively inexpensive and time efficient. Our review demonstrates a high level of precision of the surgical planning, with a modestly improved accuracy compared to conventional and navigation technology. Published outcomes are limited, however demonstrate good short-term PROM's and survivorship data that compare favourably to other robotic TKA cohorts.

Methodological issues in health human resource planning: cataloguing assumptions and controlling for variables in needs-based modelling.

Health Human Resource Planning (HHRP) models approximate future nursing requirements based on a variety of factors specific to the model being employed. There is an urgent need to develop a better understanding of the sources of bias in statistical modelling in order to ensure that we are guided by accurate and robust formulae. This paper addresses these issues as they apply in the context of needs-based HHRP research for nursing by presenting a review and discussion of the relevant literature as it relates to: (1) the testing of assumptions, (2) avoiding ecological and atomistic fallacies, (3) how need is directly or indirectly related to health care, and (4) alternatives to aggregate analysis for assessing the relationship between health needs and utilization of nursing services. The paper concludes that multilevel modelling is useful for the simulation analysis of individuals and their ecologies, and that small area variation modelling holds promise for assessing the relationship between health needs and utilization of nursing services.

Nova Scotia high school students' interactions with physicians for sexual health information and services.

PURPOSE: To support a community effort to establish a health service in a Nova Scotia high school, adolescents' sexual behaviours and use of physicians for sexual health services were assessed. METHODS: A self-completion survey asked students about sexual behaviours, use of physician services and barriers to use of those services. RESULTS: Only 8.7% of male and 37.9% of female students with family physicians had discussed with the physician whether they were sexually experienced (p < 0.0001). More females had discussed sexual activity when the physician was female than when the physician was male (43.7% vs. 35.1%; p < 0.05). More sexually experienced females who had not discussed this behaviour with their physicians identified specific issues as barriers to discussion. CONCLUSIONS: Female physicians discuss sexual activity more with their adolescent female patients than do male physicians. The results support the need to provide health services in addition to those of physicians to meet the sexual health needs of adolescents.

Forecasting models for human resources in health care.

This article is a review of the approaches published between 1996 and 1999 that have been used to forecast human resource requirements for nursing. Much of the work to date generally does not consider the complex factors that influence health human resources (HHR). They also do not consider the effect of HHR decisions on population health, provider outcomes such as stress, and the cost of a decision made. Supply and demand approaches have dominated. Forecasting is limited, too, by the availability of reliable and valid data bases for examining supply and use of nursing personnel across sectors. Three models--needs based, utilization based, and effective demand based--provide substantially different estimates of future HHR need. The methods of analysis employed for forecasting range from descriptive to predictive and are borrowed from demography, epidemiology, economics, and industrial engineering. Simulation models offer the most promise for the future. The forecasting methods described have demonstrated their accuracy and usefulness for specific situations, but none has proven accurate for long-term forecasting or for estimating needs for large geographical areas or populations.

Telephone support for Canadian nurses in HIV/AIDS care.

An assessment study was conducted with Canadian nurses (N = 177) in HIV/AIDS care to determine how social support influences the relationship between job stress and health (job satisfaction and burnout). The assessment study revealed that social support and coping both moderate the effects of these stressors on nurses' health and functioning outcomes (i.e., job satisfaction and burnout). Accordingly, the follow-up study tested the effectiveness of an intervention designed to enhance social support, promote the use of certain coping strategies for managing occupational stress, and prevent burnout in nurses. Telephone support groups, co-led by an expert facilitator and an expert AIDS nurse, were tested in a demonstration project for nurses in HIV/AIDS care (n = 30). The nurse participants reported that the intervention enhanced their coping, confidence, relationships, client care, and connections to the HIV/AIDS nursing community.

Health human resource planning in home care: how to approach it--that is the question.

In her paper, MacAdam refers to future challenges in health human resources for the home-care sector. This paper builds on her comments and discusses conceptual and practical approaches to future planning of health human resources. Necessary national data requirements are identified for this type of planning. The authors point out the limitations of traditional supply-side modelling and describe a new framework linking population health needs to outcomes that builds upon earlier conceptual work in needs-based, utilization-based and effective demand-based models.

Nursing students with disabilities.

Nursing is a self-licensing profession with an ever-increasing responsibility to develop and sustain public trust. Thus, there is a need for nurses not only to be accountable and trustworthy but to be perceived by the public as accountable and trustworthy. Recognizing the special need for trust in caregivers, the Faculty of Health Professions at Dalhousie University has recently instituted a policy enabling its schools to suspend or terminate a student from a program based on the student's professional unsuitability. Unsuitability could include a type of conduct (criminal behavior, substance abuse or unethical behavior) or a health impairment that affects the student's ability to meet performance requirements. The challenge for the health profession schools, including Nursing, is to develop specific guidelines for implementing the policy. Guidelines on performance requirements for students with disabilities will be particularly difficult to define.