Implementation of a standardized robotic assistant surgical training curriculum.

Since 2000, robotic-assisted surgery has rapidly expanded into almost every surgical sub-specialty. Despite the popularity of robotic surgery across the United States, a national consensus for standardized training and education of robotic surgeons or surgical teams remains absent. In this quality improvement initiative, a novel, stepwise iterative Robotic Assistant Surgical Training (RAST) curriculum was developed to broaden and standardize robotic bedside assistant training. Thirteen voluntary participants, capable of fulfilling the bedside assistant role, were evaluated to determine if RAST enhanced the learner's self-perceived level of confidence and comfort in their role as bedside assistant. A pre- and post-RAST training survey and a between-stages repeated-measures survey were conducted. All learner participants reported statistically significant increases in confidence and comfort after RAST training, (p = < 0.001), and between each stage, F (2, 24 = 60.47, p < .001; [Formula: see text] = 0.834). Participant feedback regarding curriculum improvement was obtained, suggesting the desire for more training and practice, in smaller groups of 2-3 participants. One hundred percent of participants felt RAST was beneficial and that it should be implemented as standardized training during onboarding for all robotic bedside assistants. Thus, a standardized, stepwise iterative robotic bedside assistant curriculum increases learner preparedness, comfort, and confidence, safely away from the patient bedside.

Does the bracket-ligature combination affect the amount of orthodontic space closure over three months? A randomized controlled trial.

OBJECTIVE: To investigate the effect of bracket-ligature combination on the amount of orthodontic space closure over three months. DESIGN: Randomized clinical trial with three parallel groups. SETTING: A hospital orthodontic department (Chesterfield Royal Hospital, UK). PARTICIPANTS: Forty-five patients requiring upper first premolar extractions. METHODS: Informed consent was obtained and participants were randomly allocated into one of three groups: (1) conventional pre-adjusted edgewise brackets and elastomeric ligatures; (2) conventional pre-adjusted edgewise brackets and Super Slick(®) low friction elastomeric ligatures; (3) Damon 3MX(®) passive self-ligating brackets. Space closure was undertaken on 0·019×0·025-inch stainless steel archwires with nickel-titanium coil springs. Participants were recalled at four weekly intervals. Upper alginate impressions were taken at each visit (maximum three). The primary outcome measure was the mean amount of space closure in a 3-month period. RESULTS: A one-way ANOVA was undertaken [dependent variable: mean space closure (mm); independent variable: group allocation]. The amount of space closure was very similar between the three groups (1 mm per 28 days); however, there was a wide variation in the rate of space closure between individuals. The differences in the amount of space closure over three months between the three groups was very small and non-significant (P = 0·718). CONCLUSION: The hypothesis that reducing friction by modifying the bracket/ligature interface increases the rate of space closure was not supported. The major determinant of orthodontic tooth movement is probably the individual patient response.

Comparison of measurements from photographed lateral cephalograms and scanned cephalograms.

INTRODUCTION: In this study, we investigated whether a digital photograph of a lateral cephalometric radiograph can produce measurements as accurate as those from a digital image created with a flatbed scanner. METHODS: Twenty pretreatment lateral cephalograms were randomly selected from the patient files at Chesterfield Royal Hospital. Each radiograph was photographed with a digital camera and scanned with a flatbed scanner. Both images were digitized with imaging software (Dolphin, Chatsworth, Calif). Common cephalometric analyses were performed on both images, and the measurements were recorded. The paired Student t test was used to test for statistically significant differences between the measurements of the images. RESULTS: Angular measurements were not significantly different between the photographed and scanned images, but linear measurements were. CONCLUSIONS: It is acceptable to use digital photographs of cephalograms if angular measurements are primarily required. However, these images might not be acceptable if linear measurements are needed.

Surgery for atrial fibrillation.

Atrial fibrillation (AF) is the most common sustained disturbance of cardiac rhythm, affecting an estimated 2.3 million people in North America and 4.5 million people in the European Union. Although af is associated with significant morbidity, mortality, and increased health care costs, more-precise and less-invasive surgical ablation procedures have been developed. Specific cardiac sites emitting the aberrant, premature electrical signals that induce AF are ablated, which results in excellent cure rates and allows normal sinus rhythm to resume. These procedures can be performed with or without the use of cardiopulmonary bypass, through either traditional sternotomy or minimally invasive thoracotomy incisions.

Reversal of diabetes by pancreatic islet transplantation into a subcutaneous, neovascularized device.

BACKGROUND: Transplantation of pancreatic islets for the treatment of type 1 diabetes allows for physiologic glycemic control and insulin-independence when sufficient islets are implanted via the portal vein into the liver. Intrahepatic islet implantation requires specific infrastructure and expertise, and risks inherent to the procedure include bleeding, thrombosis, and elevation of portal pressure. Additionally, the relatively higher drug metabolite concentrations in the liver may contribute to the delayed loss of graft function of recent clinical trials. Identification of alternative implantation sites using biocompatible devices may be of assistance improving graft outcome. A desirable bioartificial pancreas should be easy to implant, biopsy, and retrieve, while allowing for sustained graft function. The subcutaneous (SC) site may require a minimally invasive procedure performed under local anesthesia, but its use has been hampered so far by lack of early vascularization, induction of local inflammation, and mechanical stress on the graft. METHODS: Chemically diabetic rats received syngeneic islets into the liver or SC into a novel biocompatible device consisting of a cylindrical stainless-steel mesh. The device was implanted 40 days prior to islet transplantation to allow embedding by connective tissue and neovascularization. Reversal of diabetes and glycemic control was monitored after islet transplantation. RESULTS: Syngeneic islets transplanted into a SC, neovascularized device restored euglycemia and sustained function long-term. Removal of graft-bearing devices resulted in hyperglycemia. Explanted grafts showed preserved islets and intense vascular networks. CONCLUSIONS: Ease of implantation, biocompatibility, and ability to maintain long-term graft function support the potential of our implantable device for cellular-based reparative therapies.

Disability type influences heart rate response during power wheelchair sport.

PURPOSE: The purpose of this study was to determine the influence of disability type on exercise response during power wheelchair competition. The secondary purpose was to determine the extent to which heart rate responses during competition meet cardiorespiratory fitness training intensities for the general population. METHODS: Forty-eight athletes who had cerebral palsy (CP, N = 31), spinal cord injury (SCI, N = 10), or muscular dystrophy (MD, N = 7), and were competing in the 2003 Power Soccer National Tournament, volunteered to participate. Heart rate was recorded every 5 s throughout pre-game and game conditions by Polar S610 monitors. Average heart rate (HR) values were determined for GAME and RESPONSE (change score between GAME HR and pre-game HR). The Kruskal-Wallis nonparametric test was used to determine whether a significant difference among group medians existed on the dependent measure, RESPONSE (P < 0.05). RESULTS: A significant difference on RESPONSE (P < 0.05) existed among athletes with CP (29 bpm), SCI (17 bpm), and MD (26 bpm). The median RESPONSE for athletes with CP was 12 bpm higher than athletes with SCI, and this difference was significant (P < 0.01). Further, 22 athletes with CP (71%), 5 athletes with MD (71%), and 1 athlete with SCI (10%) exceeded 55% of estimated HR(max) for at least 30 min during competition. CONCLUSION: Disability type influences the heart rate response to power wheelchair sport, and may affect the ability to sustain training intensities associated with fitness improvement.