A pictographic guide for decision making in surgery for pelvic bone sarcoma.

Pelvic bone sarcoma surgery is challenging due to complex anatomy, proximity to major neurovascular structures, and, more importantly, the potential for complications. Decision-making is vital in offering patients the best oncological and functional outcomes after surgery. Multidisciplinary teams involved from the stage of diagnosis and treatment planning, followed by surgery by experienced teams have proven to be beneficial. Tumour-free margin clearance is essential, and surgical planning must be tailored to achieve the same. The choice of reconstruction needs to be decided based on the amount of bone resected and the available expertise and resources. Lesions isolated only to PI or PIII region may not need reconstruction. Though pedestal cups and Custom-made prosthesis are useful in reconstruction after periacetabular tumour resections, hip transposition surgery is also widely practiced by surgeons with favourable outcomes particularly after neo-adjuvant radiotherapy/proton beam therapy. Navigation has shown promise in achieving tumour-negative margins and disease-free progression particularly in chondrosarcoma. A flap-based approach can be considered for hindquarter amputations; however, patients need to be counseled regarding the complications following this surgery. This article, with proposed flowcharts, is aimed at providing practicing surgeons with a guide toward decision-making while planning pelvic bone sarcoma surgery.

Intraoperative glioblastoma surgery-current challenges and clinical trials: An update.

Surgical excision is an important part of the multimodal therapy strategy for patients with glioblastoma, a very aggressive and invasive brain tumor. While major advances in surgical methods and technology have been accomplished, numerous hurdles remain in the field of glioblastoma surgery. The purpose of this literature review is to offer a thorough overview of the current challenges in glioblastoma surgery. We reviewed the difficulties associated with tumor identification and visualization, resection extent, neurological function preservation, tumor margin evaluation, and inclusion of sophisticated imaging and navigation technology. Understanding and resolving these challenges is critical in order to improve surgical results and, ultimately, patient survival.

A Community-Based Cervical Cancer Education and Navigation Program for Korean American Women.

In the United States (US), rates of cervical cancer screening among Asian American women (notably Korean American women) lag far behind other populations. Thus, guided by the Health Belief Model, we developed a multi-component intervention to enhance Korean American women's knowledge and beliefs about screening and to increase screening uptake. The intervention group (N=341) received a culturally-relevant cancer education program and navigation services. The control group (N=335) received a similar program on cervical cancer risk and screening, along with information about free/low-cost screening sites. Women's knowledge and beliefs were measured at baseline and post-program, and screening behavior was assessed at 12-months post-program. It was hypothesized that the intervention would lead to positive changes in health beliefs and knowledge about cervical cancer and screening, which were then evaluated as potential mediators of the intervention on screening behavior. From pre- to post-program, the intervention group reported significantly greater increases in knowledge (p<0.01) and perceived risk (p=0.02) and significantly greater decreases in perceived barriers (p<0.001) compared to the control group. However, changes in knowledge and health beliefs did not mediate intervention effects on screening behavior. Use of navigation services was associated with greater odds of obtaining screening (OR=3.15, 95% CI=2.28-4.01, p<0.001) and attenuated the significant effect of group assignment (intervention vs. control) on screening behavior to non-significance. In conclusion, although our intervention program was effective in improving women's knowledge and beliefs about screening, delivery of navigation services was the critical component in increasing cervical cancer screening rates in this underserved population.

Use of a Skin-Fixed Dynamic Reference Frame in Spinal Trauma Surgery: A Case Report.

Intraoperative CT navigation has revolutionized spinal surgery by enhancing precision, particularly in pedicle screw placement. However, the traditional use of bone-fixed dynamic reference frames (DRFs) often necessitates placement on spinous processes, complicating percutaneous pedicle screw (PPS) insertion and requiring additional incisions. This case report presents a novel approach utilizing a skin-fixed DRF in spinal trauma surgery. A 26-year-old female sustained lower limb paralysis, sensory impairment, and bladder-rectal dysfunction after a 15 m fall, resulting in an L1 fracture-dislocation (American Spinal Injury Association score C, Thoracolumbar AOSpine Injury Score score 13). The radiological assessment confirmed dural sac compression. An emergency damage control surgery was conducted using a skin-fixed DRF, secured with sutures and tape near the PPS insertion site. Intraoperative CT navigation guided the insertion of PPS from T11 to L3. The procedure lasted 141 minutes with an estimated blood loss of 256 mL. Postoperative CT verified accurate screw placement. At six months postoperatively, the patient exhibited significant motor recovery and regained independent ambulation. The skin-fixed DRF technique minimizes surgical complexity, obviates the need for additional incisions, and mitigates the challenges associated with bone-fixed DRFs during PPS procedures. This method demonstrates potential as a minimally invasive and effective surgical technique in spinal trauma cases.

Barriers to identifying and addressing health-related social needs in cancer care: Patient and patient navigator perspectives.

BACKGROUND: The study aimed to gain insight into the experiences of patients with cancer and survivors regarding the integration of social needs assessment into their care, while also gathering perspectives from patient navigators on the barriers to obtaining and utilizing social needs information during cancer care, which taken together may influence cancer care policies. By comparing the perspectives of patients and navigators, the study sought to inform best practices for integrating, identifying, and addressing social needs to improve patient experiences and outcomes. METHODS: We conducted qualitative interviews and self-report surveys involving patients with cancer, providers, and patient navigators or care coordinators, seeking their insights and firsthand experiences related to health-related social needs in cancer care. Interviews were transcribed, separated into memos of main themes based on deductive coding, and further analyzed for new emergent themes using inductive coding. RESULTS: The present analysis focuses solely on the perspectives of 20 patient navigators and 21 patients. Qualitative analyses revealed two overarching themes: Theme 1: Personal and health system-related factors may create barriers for patients to disclose health-related social needs information during cancer care; and Theme 2: When social needs are identified, it is best practice to acknowledge and address social needs through referrals, resources, timely follow-up, and continued care coordination. Key barriers include individual beliefs and attitudes, concerns regarding privacy and sensitivity of questions, uncertainties about the outcomes of disclosing information, and patient-provider relationships and trust. CONCLUSION: Drawing upon the perspectives of patients and patient navigators provided valuable insight into the challenges associated with acquiring information on social needs. Their viewpoints presented feasible solutions to overcome barriers through early acknowledgment of patient needs, timely resource provision, and maintaining consistent follow-up actions. Additionally, it enhanced understanding of the pivotal role patient navigators play in oncology, serving as crucial links between screening for health-related social needs and addressing individual patient requirements. POLICY SUMMARY: The policies and policy improvements our paper seeks to impact include: inequalities in cancer care and health-related social needs of cancer.

A Self-Developed Mobility Augmented Reality System Versus Conventional X-rays for Spine Positioning in Intraspinal Tumor Surgery: A Case-Control Study.

OBJECTIVE: To evaluate the efficacy of a self-developed mobile augmented reality navigation system (MARNS) in guiding spinal level positioning during intraspinal tumor surgery based on a dual-error theory. METHODS: This retrospective study enrolled patients diagnosed with intraspinal tumors admitted to Fujian Provincial Hospital between May and November 2023. The participants were divided into conventional x-rays and self-developed MARNS groups according to the localization methods they received. Position time, length of intraoperative incision variation, and location accuracy were systematically compared. RESULTS: A total of 41 patients (19 males) with intraspinal tumors were included, and MARNS was applied to 21 patients. MARNS achieved successful lesion localization in all patients with an error of 0.38±0.12 cm. Compared to x-rays, MARNS significantly reduced positioning time (129.00±13.03 seconds vs. 365.00±60.43 seconds, p<0.001) and length of intraoperative incision variation (0.14 cm vs. 0.67 cm, p=0.009). CONCLUSION: The self-developed MARNS, based on augmented reality technology for lesion visualization and perpendicular projection, offers a radiation-free complement to conventional x-rays.

Minimal perception: enabling autonomy in resource-constrained robots.

The rapidly increasing capabilities of autonomous mobile robots promise to make them ubiquitous in the coming decade. These robots will continue to enhance efficiency and safety in novel applications such as disaster management, environmental monitoring, bridge inspection, and agricultural inspection. To operate autonomously without constant human intervention, even in remote or hazardous areas, robots must sense, process, and interpret environmental data using only onboard sensing and computation. This capability is made possible by advancements in perception algorithms, allowing these robots to rely primarily on their perception capabilities for navigation tasks. However, tiny robot autonomy is hindered mainly by sensors, memory, and computing due to size, area, weight, and power constraints. The bottleneck in these robots lies in the real-time perception in resource-constrained robots. To enable autonomy in robots of sizes that are less than 100 mm in body length, we draw inspiration from tiny organisms such as insects and hummingbirds, known for their sophisticated perception, navigation, and survival abilities despite their minimal sensor and neural system. This work aims to provide insights into designing a compact and efficient minimal perception framework for tiny autonomous robots from higher cognitive to lower sensor levels.

Three-Dimensional Holographic-Guided Robotic Lung Segmentectomy for Deep Pulmonary Nodules: Technique and Initial Results.

Background: Diagnosis and treatment of small and isolated lung nodules remain challenging issues. Purpose: The aim of this article is to report the technique of real-time navigation using holographic reconstruction technology combined with a robot assisted thoracic surgery (RATS) platform for lung resection in patients with small deep nodules.Research Design: The pre-surgery 3D planning was based on the chest CT scan. The reconstruction was uploaded to a head-mounted display for real-time navigation during mini invasive robot assisted surgery performed with an open console platform. We evaluated this technique with the success rate of diagnosis, the operative time and the post-operative course.Study Sample: This technique was performed in 6 patients (4 female, mean age 65 years) to date.Results: The precision of the head-mounted display based localization system was effective in all cases without the need of open conversion. The mean diameter of the nodules was 8 mm (6-9). The diagnosis was a lung cancer (n = 5) and tuberculoma (n = 1). The mean operative time was 125 min (100-145). The mean hospital stay was 2.5 days (1-3).Conclusions: In conclusion, the intraoperative navigation using the 3D holographic assistance was an helpful tool for mini invasive RATS lung segmentectomy without the need of preoperative localization.

Intraoperative Navigation in Reverse Shoulder Arthroplasty: Advantages and Future Prospects.

Intraoperative navigation is a novel technology that can provide real-time feedback to the surgeon during implantation and enhance the accuracy and precision of glenoid component positioning. Applications of intraoperative navigation systems have demonstrated increased precision in baseplate version and inclination, as well as improved baseplate screw placement, with fewer screws used and greater purchase length achieved when compared to standard instrumentation. Early clinical studies have shown favorable results, with significantly improved patient-reported and clinical outcomes and decreased complications. The implementation of intraoperative navigation is associated with a short learning curve and a minimal increase in operative time. Nevertheless, further research is necessary to substantiate the clinical benefit of navigation and evaluate its economic cost-effectiveness and impact on implant survival. Augmented reality and robotic-assisted surgery are additional emerging technologies that, while novel, hold the potential to further advance the field of shoulder arthroplasty.

Accuracy of Cervical Pedicle Screw Insertion With and Without a Navigation-Linked High-Speed Drill: A Retrospective Clinical Study.

INTRODUCTION: Cervical pedicle screw (CPS) fixation provides high stability but poses a risk of nerve and vascular injury. Although useful for reducing CPS deviation rates, navigation systems cannot completely eliminate deviation. This study aimed to compare two methods for creating insertion paths, one using a navigation-linked high-speed drill (NAVI drill) and the other using conventional manual probing. METHODS: Our study comprised 104 patients with 509 CPSs at the C3-6 level who were treated at our institution between 2017 and 2023. CPS deviations were graded according to the Neo classification system, and the deviation direction (medial, lateral, cranial, or caudal) was assessed. Complications associated with CPS deviation were also investigated. We compared cases that used the NAVI drill (Group M) with those that used manual probing (Group N). RESULTS: Group M included 45 cases (252 screws), and Group N included 59 cases (257 screws). The CPS deviation rate was grade 1 or higher in 14.7% and 17.1% of cases in Groups M and N, respectively (p = 0.469). It was grade 2 or higher in 1.2% and 4.3% of cases in Groups M and N, respectively (p = 0.222). The medial, lateral, caudal, and cranial deviation direction rates were 56.8%, 2.7%, 40.5%, and 0% in Group M and 13.6%, 72.7%, 11.4%, and 2.3% in Group N, respectively (p < 0.001). In one case in Group N, a grade 3 lateral deviation resulted in vertebral artery injury (VAI). CONCLUSIONS: The use of the NAVI drill was associated with a slightly lower, albeit insignificant, CPS deviation rate. However, it significantly lowered the proportion of lateral deviations. Therefore, the NAVI drill is a useful tool for preventing VAI.

Novel use of dynamic navigation for guiding a piezoelectric device during window osteotomy for maxillary sinus floor elevation in complex clinical scenarios.

In patients with severe atrophy of the posterior maxilla requiring lateral maxillary sinus floor elevation (MSFE), the window location and size are commonly designed according to the future implants and anatomical conditions. A window osteotomy becomes challenging when there is an extended edentulous space in the maxilla with no reference from the natural dentition, or when the surgical site involves anatomical variations, for example in the course of a large vessel or a sinus septum. Through preoperative planning and real-time visualization, the application of dynamic navigation allows an accurate location, optimal dimension, and customized shape during lateral window osteotomy. This article introduces a digital protocol for ensuring an accurate and safe window osteotomy for MSFE in complex clinical scenarios, by integrating dynamic navigation and a piezoelectric device.

Pulmonary endoscopy - central to an interventional pulmonology program.

INTRODUCTION: Pulmonary endoscopy occupies a central role in Interventional Pulmonology and is frequently the mainstay of diagnosis of respiratory disease, in particular lung malignancy. Older techniques such as rigid bronchoscopy maintain an important role in central airway obstruction. Renewed interest in the peripheral pulmonary nodule is driving major advances in technologies to increase the diagnostic accuracy and advance new potential endoscopic therapeutic options. AREAS COVERED: This paper describes the role of pulmonary endoscopy, in particular ultrasound in the diagnosis and staging of lung malignancy. We will explore the recent expansion of ultrasound to include endoscopic ultrasound - bronchoscopy (EUS-B) and combined ultrasound (CUS) techniques. We will discuss in detail the advances in the workup of the peripheral pulmonary nodule.We performed a non-systematic, narrative review of the literature to summarize the evidence regarding the indications, diagnostic yield, and safety of current bronchoscopic sampling techniques. EXPERT OPINION: EBUS/EUS-B has revolutionized the diagnosis and staging of thoracic malignancy resulting in more accurate assessment of the mediastinum compared to mediastinoscopy alone, thus reducing the rate of futile thoracotomies. Although major advances in the assessment of the peripheral pulmonary nodule have been made, the role of endoscopy in this area requires further clarification and investigation.

Clinical Feasibility of Vascular Navigation System During Laparoscopic Gastrectomy for Gastric Cancer: A Retrospective Comparison With Propensity-Score Matching.

PURPOSE: The usability of a new surgical navigation system that provides patient-specific vascular information for robotic gastrectomy in gastric cancer remains unexplored for laparoscopic gastrectomy owing to differences in surgical environments. This study aimed to evaluate the applicability and safety of this navigation system in laparoscopic gastrectomy and to compare the post-operative outcomes between procedures with and without its use. MATERIALS AND METHODS: Between June 2022 and July 2023, 38 patients across 2 institutions underwent laparoscopic gastrectomy using a navigation system (navigation group). The technical feasibility, safety, and accuracy of detecting variations in vascular anatomy were measured. The perioperative outcomes were compared with 114 patients who underwent laparoscopic gastrectomy without a navigation system (non-navigation group) using 1:3 propensity score matching during the same study period. RESULTS: In all patients in the navigation group, no adverse events associated with the navigation system occurred during surgery in any patient in the navigation group. No accidental vessel injuries necessitate auxiliary procedures. All vessels encountered during the gastrectomy were successfully reconstructed and visualized. Patient demographics and operative data were comparable between the 2 groups. The navigation group exhibited a significantly lower overall complication rate (10.5%) than the non-navigation group (26.3%, P=0.043). Notably, pancreas-related complications were absent in the navigation group but occurred in eight cases in the non-navigation group (7.0%, P=0.093), although the difference was not statistically significant. CONCLUSIONS: The patient-specific surgical navigation system demonstrated clinical feasibility and safety for laparoscopic gastrectomy for gastric cancer, potentially reducing complication rates compared with laparoscopic gastrectomy without its use.

Semi-Quantitative Assessment of Surgical Navigation Accuracy During Endoscopic Sinus Surgery in a Real-World Environment.

INTRODUCTION: Although surgical navigation is commonly used in rhinologic surgery, data on real world performance are sparse because of difficulties in collecting measurements for target registration error (TRE). Despite publications showing submillimeter TRE, surgeons do report TRE of >3 mm. We describe a novel method for assessing TRE during surgery and report findings with this technique. METHODS: The TruDi navigation system (Acclarent, Irving, CA) was registered using a contour-based protocol. The surgeon estimated target registration error (e-TRE) at up to 8 points (anatomic regions of interest [ROI]) during endoscopic sinus surgery (ESS). System logs were used to simulate the localization for quantitative assessment of TRE (q-TRE). RESULTS: We performed 98 localizations in 20 patients. The ROI in the sinuses were ethmoid (33 sites), maxillary (28 sites), frontal (17 sites), and sphenoid (22 sites). For localizations, mean qTRE and eTRE were 0.93 and 0.84 mm (P = .56). Notably, 80% of qTRE and 81% of eTRE were 1 mm or less. Mean qTRE and eTRE were less for attending-performed registrations at the maxillary, frontal and sphenoid. CONCLUSION: Surgical navigation accuracy, as measured by qTRE and eTRE, approaches 1 mm or better at all sinus sites in a real-world setting for 80% of localizations. The qTRE method provides a unique approach for assessing TRE. Surgeons underestimate TRE (overstate navigation accuracy), but this difference does not seem to be statistically significant. Registration performed by trainees yields higher TRE than registration performed by attendings. These data may be used to guide navigation optimization.

A novel technique for C1-C2 posterior screw insertion using patient-specific guides created by CT-based 3D printing.

C1-C2 fixation has been developed for the rigid fusion of atlantoaxial instability. C1 lateral mass screw (C1 LMS)-C2 pedicle screw fixation is used more frequently due to its rigid fixation and high bone fusion rate. However, C1 screw placement is relatively unsafe even with recently developed image-based navigation systems. Patient-specific screw guide templates (PSGT) were developed to improve the accuracy and safety of C1 screw placement. Herein, we investigated the outcomes of the C1-C2 posterior fixation technique using PSGT. This was a retrospective study of six patients who underwent posterior cervical spinal fusion using the PSGT between January 2022 and April 2023. Operative time, estimated blood loss, intraoperative radiation dose, surgical cost, and screw placement accuracy were evaluated and compared with those achieved with preoperative CT-based navigation (navigation group, n = 15). Screw accuracy was assessed using Neo's classification. PSGT showed good results, although the differences were not statistically significant (operation time: 104.3 ± 9.7 min vs 116.4 ± 20.8 min; estimated blood loss: 56.7 ± 72.4 mL vs 123.2 ± 162.3 mL; and radiation dose: 1.8 ± 1.2 mSv vs 2.6 ± 0.8 mSv, respectively). PSGT was particularly better in terms of the accuracy of C1 LMS (PSGT: 100%, navigation: 83.3%). The deviation at the entry point was minimal, and the difference between the sagittal and transversal angles from the preoperative plan was small. We investigated the clinical efficacy of using the PSGT for C1-C2 posterior fixation. PSGT improved the accuracy of C1 LMS insertion.

Accuracy of robotic arm-assisted versus computed tomography-based navigation in total hip arthroplasty using the direct anterior approach: a retrospective study.

BACKGROUND: A robotic arm-assisted and a computed tomography (CT)- based navigation system have been reported to improve the accuracy of component positioning in total hip arthroplasty (THA). However, no study has compared robotic arm-assisted THA (rTHA) to CT-based navigated THA (nTHA) concerning accuracy of cup placement and acetabular fractures using the direct anterior approach (DAA). This study aimed to compare the accuracy of cup placement and the presence of intraoperative acetabular fractures between rTHA and nTHA using DAA in the supine position. METHODS: We retrospectively investigated 209 hips of 188 patients who underwent rTHA or nTHA using DAA (rTHA using the Mako system: 85 hips of 79 patients; nTHA: 124 hips of 109 patients). After propensity score matching for age and sex, each group consisted of 73 hips. We evaluated clinical and radiographic outcomes, comparing postoperative cup orientation and position, measured using a three-dimensional templating software, to preoperative CT planning. Additionally, we investigated the prevalence of occult acetabular fracture. RESULTS: Clinical outcomes were not significantly different between the groups at 1 year postoperatively. The mean absolute error of cup orientation was significantly smaller in the rTHA group than in nTHA (inclination: 1.4° ± 1.2° vs. 2.7° ± 2.2°, respectively; p = 0.0001, anteversion: 1.5° ± 1.3° vs. 2.2° ± 1.7°, respectively; p = 0.007). The cases within an absolute error of 5 degrees in both RI and RA were significantly higher in the rTHA (97.3%) than in nTHA group (82.2%) (p = 0.003). The absolute error of the cup position was not significantly different between the two groups. The prevalence of occult acetabular fracture did not differ significantly between the two groups (rTHA: n = 0 [0%] vs. nTHA: n = 1 [1.4%]). CONCLUSION: Cup placement using DAA in the supine position in rTHA was more accurate with fewer outliers compared to nTHA. Therefore, rTHA performed via DAA in a supine position would be useful for accurate cup placement.

Self-navigated subspace reconstruction for real-time MR imaging of the vocal tract.

PURPOSE: Real-time MRI offers a continuous and dynamic view of the object being imaged. Researchers have applied real-time MRI to speech production, which allows for the visualization of the vocal tract during speech. METHODS: This study proposed applying self-navigated subspace reconstruction for real-time vocal tract imaging. We performed experiments on a clinical 3 T MRI using standard RF coils and rapid acquisition. Additionally, 1000 frames were compressed during reconstruction to a few principal components, and iterative low-rank approximation was performed on compressed k-space, in conjunction with the orthogonal basis estimation for the subspace. RESULTS: The simulation study involving a 32-time acceleration showed that the proposed method produced a reasonably small root mean square error (RMSE) of 0.159, compared to 0.278 for sliding window reconstruction, 0.2527 for SToRM and 0.294 for low-rank reconstruction. The study also presented in vivo images of a typical sagittal image with a temporal resolution of 7 ms/frame or 21 ms/frame for the three-slice scan. CONCLUSION: Our study presented a subspace reconstruction technique that does not require a navigator echo, which can be used for real-time MRI, particularly in speech imaging applications.

Magnetic navigation-assisted colonoscopic enteral tube placement in swine (with video): a preliminary study.

BACKGROUND: Colonoscopic enteral tube placement using current methods has some shortcomings, such as the complexity of the procedure and tube dislodgement. The magnetic navigation technique (MNT) has been proven effective for nasoenteral feeding tube placement, and is associated with reduced cost and time to initiation of nutrition. This study attempted to develop a novel method for enteral tube placement using MNT. METHODS: The MNT device consisted of an external magnet and a 12 Fr tube with a magnet at the end. Ten swine were used, and bowel cleansing was routinely performed before colonoscopy. Intravenous anesthesia with propofol and ketamine was administered. A colonoscopic enteral tube was placed using the MNT. The position of the end of the enteral tube was determined by radiography, and angiography was performed to check for colonic perforations. Colonoscopy was used to detect intestinal mucosal damage after tube removal. RESULTS: MNT-assisted colonoscopic enteral tube placement was successfully completed in all pigs. The median operating time was 30 (26-47) min. No colon perforation was detected on colonography after enteral tube placement, and no colonic mucosal bleeding or injury was detected after the removal of the enteral tube. CONCLUSIONS: MNT-assisted colonoscopic enteral tube placement is feasible and safe in swine and may represent a valuable method for microbial therapy, colonic drainage, and host-microbiota interaction research in the future.

A clinical study on robot navigationassisted intramedullary nail treatment for humeral shaft fractures.

BACKGROUND: The purpose of this study was to evaluate the advantages of robot navigation system-assisted intramedullary nail treatment for humeral shaft fractures and compare it's efficacy with that of traditional surgical intramedullary nail treatment. MATERIALS AND METHODS: This was a retrospective analysis of patients with humeral shaft fractures who received intramedullary nail treatment at our centre from March 2020 to September 2022. The analysis was divided into a robot group and a traditional surgical group on the basis of whether the surgery involved a robot navigation system. We compared the baseline data (age, sex, cause of injury, fracture AO classification, and time of injury-induced surgery), intraoperative conditions (surgery time, length of main nail insertion incision, postoperative fluoroscopy frequency, intraoperative bleeding), fracture healing time, and shoulder joint function at 1 year postsurgery (ASES score and Constant-Murley score) between the two groups of patients. RESULTS: There was no statistically significant difference in the baseline data or average fracture healing time between the two groups of patients. However, the robotic group had significantly shorter surgical times, longer main nail incisions, fewer intraoperative fluoroscopies, and less intraoperative blood loss than did the traditional surgery group (P < 0.001). CONCLUSION: Robot navigation system-assisted intramedullary nail fixation for humeral shaft fractures is a reasonable and effective surgical plan. It can help surgeons determine the insertion point and proximal opening direction faster and more easily, shorten the surgical time, reduce bleeding, avoid more intraoperative fluoroscopy, and enable patients to achieve better shoulder functional outcomes.

Healthcare system navigation difficulties among informal caregivers of older adults: a logistic regression analysis of social capital, caregiving support and utilization factors.

BACKGROUND: Informal caregivers of older adults play a vital role in improving the degree to which older adults access community and healthcare services in a seamless and timely manner. They are fulfilling important navigation and support roles for their older care recipients. However, there is still little knowledge of the most significant facilitators and barriers to effective and efficient system navigation among caregivers. This paper aims to fill these knowledge gaps through investigation of the key factors (i.e., social capital/cohesion, caregiving supports, and utilization factors) affecting navigation difficulties faced by informal caregivers of older adults. METHODS: The Behavioural-Ecological Framework of Healthcare Access and Navigation (BEAN) model is used to frame the study. Using the General Social Survey on Caregiving and Care Receiving 2018, we analyzed 2,733 informal caregivers whose primary care recipients were aged 65 or older. Hierarchical logistic regression was conducted to identify the relationship between system navigation difficulties among informal caregivers and four sequentially ordered blocks of predictors: (1) sociodemographic (2), social capital/cohesion (3), caregiving supports, and (4) healthcare demand. RESULTS: The fully adjusted model showed that the probability of reporting navigation difficulties was lower for caregivers with social capital/cohesion compared to those without social capital/cohesion. In comparison, the probability of reporting navigation difficulties was higher among caregivers with caregiving support and among caregivers whose care receivers use a higher amount of health service use. Several sociodemographic covariates were also identified. CONCLUSION: Our findings support certain aspects of the BEAN model. This study extends our understanding of potential facilitators and barriers that informal caregivers of older adults face while navigating complex community and health systems. There is a need to implement coordinated schemes and health policies especially for older adults with mental/neurological issues to address the challenges of their caregivers given the specific vulnerability identified in this study. The need for further research using different approaches to examine the disproportionate impact of COVID-19 on caregivers' system navigation experience is crucial.