Students' satisfaction and continued intention toward e-learning: a theory-based study.

Coronavirus disease (COVID-19) has forced the urgent lockdown of schools and colleges worldwide. To ensure the continuity of education a shift from traditional teaching to e-learning was required. This study aims to identify factors that affect students' satisfaction and continued intention towards e-learning. A questionnaire was distributed to medical and dental students (second to sixth year) from different universities in Saudi Arabia. The study synthesizes the expectation-confirmation theory (ECT) and the theory of planned behavior (TPB) to predict students' satisfaction and intention to continue using e-learning using a validated self-administered questionnaire. We used the structural equation model to analyze the results and assess the study's hypotheses. A total of 870 completed questionnaires were received (67% response rate). The results showed that students were at a moderate level of satisfaction (median = 3.5). According to the ECT, both perceived usefulness and confirmation significantly influenced students' satisfaction (ß = -.69 and ß = .82, respectively). Satisfaction was the strongest predictor of students' continued intention (ß = 1.95). Among the TPB constructs, perceived behavioral control (ß = .51), attitudes (ß = .39), and subjective norms (ß = .36) had a significant positive influence on their intention to use e-learning. The results suggest efforts to increase students' satisfaction and intention with e-learning should be directed to adopting easy and useful e-learning platforms. In addition, training and motivating students to continue e-learning and increasing their confidence to ensure the effective and efficient use of such teaching modalities.

Safety of a 'swing room' surgery model at a high-volume hip and knee arthroplasty centre.

AIMS: The practice of overlapping surgery has been increasing in the delivery of orthopaedic surgery, aiming to provide efficient, high-quality care. However, there are concerns about the safety of this practice. The purpose of this study was to examine the safety and efficacy of a model of partially overlapping surgery that we termed 'swing room' in the practice of primary total hip (THA) and knee arthroplasty (TKA). METHODS: A retrospective review of prospectively collected data was carried out on patients who underwent primary THA and TKA between 2006 and 2017 in two academic centres. Cases were stratified as partially overlapping (swing room), in which the surgeon is in one operating room (OR) while the next patient is being prepared in another, or nonoverlapping surgery. The demographic details of the patients which were collected included operating time, length of stay (LOS), postoperative complications within six weeks of the procedure, unplanned hospital readmissions, and unplanned reoperations. Fisher's exact, Wilcoxon rank-sum tests, chi-squared tests, and logistic regression analysis were used for statistical analysis. RESULTS: A total of 12,225 cases performed at our institution were included in the study, of which 10,596 (86.6%) were partially overlapping (swing room) and 1,629 (13.3%) were nonoverlapping. There was no significant difference in the mean age, sex, body mass index (BMI), side, and LOS between the two groups. The mean operating time was significantly shorter in the swing room group (58.2 minutes) compared with the nonoverlapping group (62.8 minutes; p < 0.001). There was no significant difference in the rates of complications, readmission and reoperations (p = 0.801 and p = 0.300, respectively) after adjusting for baseline American Society of Anesthesiologists scores. CONCLUSION: The new 'swing room' model yields similar short-term outcomes without an increase in complication rates compared with routine single OR surgery in patients undergoing primary THA or TKA. Cite this article: Bone Joint J 2020;102-B(7 Supple B):112-115.

Relationship of Preoperative Patient-Reported Outcome Measures (PROMs) to Postoperative Success in End-Stage Ankle Arthritis.

BACKGROUND: Ankle osteoarthritis is a significant cause of pain and disability. Despite the effectiveness of treatments, a subset of patients remains with persistent pain and functional limitations. The purpose of this study was to use preoperative patient-reported outcome measures to predict which ankle osteoarthritis patients would be most likely to experience postoperative improvements in functional outcomes. METHODS: A retrospective analysis of prospectively collected data was used to evaluate 427 patients with end-stage ankle arthritis with 5-year follow-up. Demographics, comorbidities, Ankle Osteoarthritis Scale (AOS), Ankle Arthritis Score (AAS), and the physical and mental component scores of the Short Form-36 (SF-36 Physical Components Score [PCS] and Mental Components Score [MCS]) were collected. The minimal clinically important difference (MCID) was then calculated. Receiver operating characteristic (ROC) analysis was used to choose the optimal threshold values of preoperative patient-reported outcome measure and assess the prediction performance. RESULTS: Patients who scored worst at preoperative baseline made the greatest gains in function and pain relief, and they had a high chance of achieving MCID following surgical treatment. ROC curves demonstrated that preoperative AOS, AAS, and SF-36 PCS and MCS scores were predictive of postoperative improvements in physical and mental function. Patients with preoperative AOS score above 45.7 had an 83% probability of achieving an MCID (AUC = 0.67). Similarly, patients with a preoperative AAS score above 25.7 had a 78% probability of achieving an MCID (AUC = 0.63). Patients with a preoperative SF-36 PCS score below 31 had a 62% probability of achieving an MCID (AUC = 0.64). Patients with a preoperative SF-36 MCS below 52.7 had a 47% probability of achieving an MCID (AUC = 0.89). MCIDs for AOS, AAS, SF3-36 PCS, and SF-36 MCS score changes were 12.4, 10.0, 6.43, and 8.1, respectively. CONCLUSION: Preoperative patient-reported outcomes measures could predict postoperative improvement in ankle arthritis patients. The results of this study may be used to facilitate discussion between physicians and patients regarding the expected benefit of surgery. LEVEL OF EVIDENCE: Level III, prognostic comparative study.

Computed Navigation Guidance for Ankle Replacement in the Setting of Ankle Deformity.

Total ankle replacement (TAR) has evolved over the past decade as a treatment for end-stage ankle arthritis with improved survivorship. Despite the improving outcomes, ankle deformity represents a challenge to the foot and ankle surgeon with increased risk of implant failure. The use of preoperative computer-assisted guidance has led to better understanding the 3-dimensional ankle anatomy and associated deformities and allows for reproducible, anatomic placement of the TAR components.

Preoperative Computed Tomography Myelography Parameters as Predictors of Outcome in Patients With Degenerative Cervical Myelopathy: Results of a Systematic Review.

STUDY DESIGN: Systematic review. OBJECTIVES: To determine the preoperative computed tomography (CT) myelogram imaging parameters in patients diagnosed with degenerative cervical myelopathy (DCM) that correlate with severity of DCM and predict postoperative patients' functional outcome. METHODS: An electronic database search was performed using Ovid Medline and Embase. CT myelogram studies investigating the correlation between imaging characteristics and DCM severity or postoperative outcomes were included. Two independent reviewers performed citation screening, selection, qualitative assessment, and data extraction using an objective and blinded protocol. RESULTS: A total of 5 studies (402 patients) were included in this review and investigated the role of preoperative CT myelogram parameters in predicting the functional outcome after surgical treatment of DCM. All studies were retrospective cohort studies. CT myelogram characteristics included the transverse area of the spinal cord at maximum level of compression, spinal canal narrowing, number of blocks, spinal canal diameter, and flattening ratio. There is low evidence suggesting that patients with a preoperative transverse area of the spinal cord >30 mm2 at the level of maximum compression have better postoperative recovery and outcome. We found no studies investigating the correlation between preoperative CT myelogram parameters and DCM severity. CONCLUSIONS: Patients with greater transverse area of spinal cord at the level of maximum compression on the preoperative CT myelogram are more likely to have better neurological outcome after surgery. There is insufficient evidence to suggest that any of the other CT myelogram parameters investigated are predictors of postoperative outcomes in patients with DCM.