A protocol on the effects of interactive digital assistance on engagement and perceived quality of care of surgery patients and self-efficacy and workload of staff.

Introduction: The workforce shortage in the healthcare context is a growing issue that exerts detrimental effects on employees (e.g., higher workload) and patients (e.g., suboptimal patient care). Since traditional approaches alone may not be enough to solve this problem, there is a need for complementary innovative digital health solutions, such as socially assistive robots. Hence, the proposed study aims to investigate the effects of gamified nursing education and physiotherapy delivered by a socially assistive robot on patient- (engagement, perceived quality of care) and employee-related outcomes (perceived self-efficacy, workload). Methods and analysis: Approximately 90 vascular and thoracic surgery patients will receive either standard care or standard care with additional robot interactions over the course of 3-5 days. Additionally, approximately 34 nursing and physiotherapeutic employees will fill out self-report questionnaires after weeks of not using a social robot and weeks of using a social robot. The main hypotheses will be tested with mixed-design analyses of variance and paired-samples t-tests. Discussion: While the proposed study has some limitations, the results will provide high-quality and comprehensive evidence on the effectiveness of socially assistive robots in healthcare. Ethics and dissemination: The study was approved by the Medical Ethics Commission of the University Medical Center and registered in the ISRCTN registry (ISRCTN96689284). The study findings will be summarized in international peer-reviewed scientific journals and meetings and communicated to relevant stakeholders.

A randomized controlled trial for evaluating the impact of integrating a computerized clinical decision support system and a socially assistive humanoid robot into grand rounds during pre/post-operative care.

Although clinical decision support systems (CDSSs) are increasingly emphasized as one of the possible levers for improving care, they are still not widely used due to different barriers, such as doubts about systems' performance, their complexity and poor design, practitioners' lack of time to use them, poor computer skills, reluctance to use them in front of patients, and deficient integration into existing workflows. While several studies on CDSS exist, there is a need for additional high-quality studies using large samples and examining the differences between outcomes following a decision based on CDSS support and those following decisions without this kind of information. Even less is known about the effectiveness of a CDSS that is delivered during a grand round routine and with the help of socially assistive humanoid robots (SAHRs). In this study, 200 patients will be randomized into a Control Group (i.e. standard care) and an Intervention Group (i.e. standard care and novel CDSS delivered via a SAHR). Health care quality and Quality of Life measures will be compared between the two groups. Additionally, approximately 22 clinicians, who are also active researchers at the University Clinical Center Maribor, will evaluate the acceptability and clinical usability of the system. The results of the proposed study will provide high-quality evidence on the effectiveness of CDSS systems and SAHR in the grand round routine.

Comparison of the Standard vs. Thoracoscopic Extrapleural Modification of the Nuss Procedure-Two Centers' Experiences.

Pectus excavatum is the most common congenital anterior chest wall deformity, with an incidence of 1:400 to 1:1000. Surgical strategy has evolved with the revolutionary idea of Donald Nuss, who was a pioneer in the operative correction of this deformity using minimally invasive surgery. The aim of this paper is to compare the preliminary results of pectus excavatum repair in two University Centers with a moderate number of patients using the standard Nuss procedure and its modification, the extrapleural thoracoscopic approach. The statistical analysis showed no significant difference for the patient's age (14.52 ± 3.70 vs. 14.57 ± 1.86; p = 0.95) and the CT Haller index (4.17 ± 1.58 vs. 3.78 ± 0.95; p = 0.32). A statistically significant difference was noted for the duration of a pectus bar implant (2.16 ± 0.24 vs. 2.48 ± 0.68; p = 0.03) between the Maribor and Novi Sad Center. We report 14 complications (28%), including dislocation of the pectus bar (10%), pleural effusion (8%), wound inflammation (6%), pericarditis (2%) and an allergic reaction to the pectus bar (2%). Standard and thoracoscopic extrapleural Nuss procedures are both safe and effective procedures used to correct a pectus excavatum deformity. The choice of surgical procedure should be made according to a surgeon's reliability in performing a particular procedure. Our study found no advantages of one procedure over the other.

Giant solitary fibrous tumour of the pleura. Case report and review of the literature.

BACKGROUND: Solitary fibrous tumours of the pleura (SFTP) are rare tumours. They are mostly benign. Only around 12% of them are malign ant. In the initial stage they are mostly asymptomatic and by growing they cause chest pain, irritating cough and dyspnoea on account of the pressure created on the surrounding structures. Rare giant tumours have compression symptoms on the mediastinal structures. The condition requires tiered diagnostic radiology. Preoperative biopsy is not successful in most cases. The therapy of choice is radical surgical tumour removal. Malignant or non-radically removed benign solitary fibrous tumours of the pleura additionally require neoadjuvant therapy. CASE REPORT: A 68-year old patient was hospitalized for giant solitary fibrous tumour of the pleura in the right pleural cavity. With its expansive growth the tumour caused the shift of the mediastinum by compressing the lower vena cava, right cardiac auricle as well as the intermediate and lower lobe bronchus. Due to cardiac inflow obstruction and right lung collapse, the patient's life was endangered with signs of cardio-respiratory failure. After preoperative diagnostic radiology, the tumour was surgically removed. Postoperatively, the patient's condition improved. No disease recurrence was diagnosed after a year. CONCLUSIONS: Giant solitary fibrous tumour of the pleura may cause serious and life-threatening conditions by causing compression of the pleural cavity with its expansive growth. Early diagnosis of the condition enables less aggressive as well as video-assisted thoracic surgery in patients with significantly better state of health. Large tumour surgeries in cardio-respiratory affected patients are highly risk-associated procedures.

What have we learned from surgical treatment of gastric adenocarcinoma? A comparison of two periods.

In January 1992, a standardized and more radical surgical approach in gastric cancer treatment and a standardized pathohistological workup of specimens was introduced at our institution. The aim of our retrospectively designed study was to compare the results of two consecutive groups of altogether 348 patients who underwent a total or subtotal gastrectomy for gastric cancer (period A: 162 patients operated between 1992 and 1996; period B: 186 patients operated between 1997 and 2000). The two groups of patients were comparable in age, sex, their general condition, and the proportion of potentially curable (R0) resections. There was a significant difference between the groups with regard to tumor site (fewer distal and more proximal stomach tumors in period B), type of operation (more total gastrectomies in period B), extent of lymphadenectomy (more D2 and D3 in period B), average number of affected lymph nodes (higher in period B), average number of examined nodes (higher in period B), and in UICC stage (less stage II in period B). UICC classification was impossible in 19 patients overall, but there were fewer non-classified patients in period B. The incidence of surgical complications (15.6% vs. 18.7%) and average hospital stay (14.72 days vs. 14.70 days) was not significantly different in the two groups. The drop in overall mortality rate (potentially curable and non-curable resections) in period B almost reached statistical significance (period A: 8%, period B: 6.5%; p = 0.57). The 5-year survival for all R0 resected patients (279) in 9 years was 31%. The median survival was significantly longer in period B (941 days) than in period A (570 days) for R0 and non-curable (R2) resections together (p=0.0132) as well as for R0 resections alone (period A: 844 days, period B: 1176 days; p = 0.0127). Comparison of the two consecutive groups of patients shows that after a defined period of systematic surgical work our results improved, reflected in the higher number of extracted lymph nodes, the higher number of total gastrectomies, and the longer median survival in the second period.