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1.
Bone Joint J ; 102-B(1): 5-10, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31888369

RESUMO

AIMS: Intraoperative 3D navigation (ION) allows high accuracy to be achieved in spinal surgery, but poor workflow has prevented its widespread uptake. The technical demands on ION when used in patients with adolescent idiopathic scoliosis (AIS) are higher than for other more established indications. Lean principles have been applied to industry and to health care with good effects. While ensuring optimal accuracy of instrumentation and safety, the implementation of ION and its associated productivity was evaluated in this study for AIS surgery in order to enhance the workflow of this technique. The aim was to optimize the use of ION by the application of lean principles in AIS surgery. METHODS: A total of 20 consecutive patients with AIS were treated with ION corrective spinal surgery. Both qualitative and quantitative analysis was performed with real-time modifications. Operating time, scan time, dose length product (measure of CT radiation exposure), use of fluoroscopy, the influence of the reference frame, blood loss, and neuromonitoring were assessed. RESULTS: The greatest gains in productivity were in avoiding repeat intraoperative scans (a mean of 248 minutes for patients who had two scans, and a mean 180 minutes for those who had a single scan). Optimizing accuracy was the biggest factor influencing this, which was reliant on incremental changes to the operating setup and technique. CONCLUSION: The application of lean principles to the introduction of ION for AIS surgery helps assimilate this method into the environment of the operating theatre. Data and stakeholder analysis identified a reproducible technique for using ION for AIS surgery, reducing operating time, and radiation exposure. Cite this article: Bone Joint J. 2020;102-B(1):5-10.


Assuntos
Neuronavegação/métodos , Escoliose/cirurgia , Adolescente , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Parafusos Ósseos/estatística & dados numéricos , Desenho de Equipamento , Feminino , Fluoroscopia/estatística & dados numéricos , Humanos , Cuidados Intraoperatórios/métodos , Masculino , Bloqueadores Neuromusculares/administração & dosagem , Neuronavegação/instrumentação , Duração da Cirurgia , Posicionamento do Paciente , Doses de Radiação , Resultado do Tratamento
2.
Eur Spine J ; 25(3): 919-27, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26582167

RESUMO

PURPOSE: Our purpose was to analyse the presentation, management and clinical outcome of patients treated operatively and non-operatively for Copenhagen Disease (CD). METHODS: We performed a retrospective analysis of 10 patients (n = 10) with CD, with a mean follow-up time of 14.7 years. Seven patients underwent non-operative treatment and three patients were treated operatively. Clinical presentation and radiological findings were analysed. Health-related quality of life (HRQOL) outcome measures utilized included Oswestry Disability Index (ODI), Short Form 12 Health Survey (SF-12) and visual analogue scale (VAS). RESULTS: Patients tended to present with back pain. No significant difference was detected in functional scores at time of diagnosis and when compared to last follow-up. ODI improved from 20.0 to 18.4 (p = 0.839), PCS component of SF-12 from 44.5 to 45.9 (p = 0.719), MCS component of SF-12 from 45.7 to 46.9 (p = 0.840) and VAS score remained at 2.8 (p = 1.000). There was no significant difference in functional scores when comparing operative and non-operative treatment groups. CONCLUSION: CD is likely to remain stable with time or slightly improve after treatment according to functional outcomes tests. Progression of the kyphosis can be halted at different degrees with operative and non-operative treatments although it does not correlate with changes in symptomatology.


Assuntos
Dor nas Costas/etiologia , Cifose/terapia , Anormalidades Múltiplas , Adolescente , Criança , Pré-Escolar , Avaliação da Deficiência , Feminino , Seguimentos , Humanos , Lactente , Cifose/diagnóstico por imagem , Masculino , Qualidade de Vida , Radiografia , Estudos Retrospectivos , Fusão Vertebral , Escala Visual Analógica
3.
Eur Spine J ; 25(3): 801-6, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26063055

RESUMO

PURPOSE: There are very few reported cases of compartment syndrome of the leg following spinal surgery via a posterior approach. An association between compartment syndrome and muscle over-activity via nerve stimulation during evoked potential monitoring was first suggested in 2003. No further reports have suggested this link. We present a multicentre retrospective review of a series of five patients who developed compartment syndrome of the leg following spinal surgery via a posterior approach, whilst un-paralysed and with combined sensory (SSEP)/motor evoked potential (MEP) monitoring with an aim of highlighting this possible causative factor. METHODS: All data were collected contemporaneously and retrospective analysis was performed. We then arranged for a multidisciplinary review of the cases including surgeons, anaesthetists, radiologists, neurophysiologists and theatre and ward nursing staff. Finally, the literature was reviewed. RESULTS: All patients were operated on by three different surgeons, on different operating tables/mattresses in the prone position. The common factors were un-paralysed patients having motor/sensory monitoring, mechanical calf pumps and total intravenous anaesthesia. Three patients underwent surgical decompression of their compartments and two were treated expectantly. Three patients had confirmed intra-compartmental changes on MRI consistent with compartment syndrome and one had intra-compartmental pressure monitoring which confirmed the diagnosis. CONCLUSIONS: Previous cases in the literature have related to mal-positioning on the Jackson table or use of the knee-chest position for surgery. This was not the case for our patients; therefore, we suspect an association between overactive muscle stimulation and muscle necrosis. Further experimental studies investigating this link are required.


Assuntos
Síndromes Compartimentais/etiologia , Monitorização Intraoperatória/efeitos adversos , Coluna Vertebral/cirurgia , Adolescente , Anestesia Geral , Condrossarcoma/cirurgia , Potencial Evocado Motor/fisiologia , Potenciais Somatossensoriais Evocados/fisiologia , Feminino , Humanos , Perna (Membro) , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória/métodos , Músculo Esquelético/patologia , Necrose , Procedimentos Neurocirúrgicos/efeitos adversos , Posicionamento do Paciente , Decúbito Ventral , Estudos Retrospectivos , Escoliose/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Adulto Jovem
4.
J Med Internet Res ; 17(3): e64, 2015 Mar 23.
Artigo em Inglês | MEDLINE | ID: mdl-25831125

RESUMO

BACKGROUND: The global burden of disease is increasingly dominated by non-communicable diseases.These diseases are less amenable to curative and preventative interventions than communicable disease. This presents a challenge to medical practice and medical research, both of which are experiencing diminishing returns from increasing investment. OBJECTIVE: Our aim was to (1) review how medical knowledge is generated, and its limitations, (2) assess the potential for emerging technologies and ideas to improve medical research, and (3) suggest solutions and recommendations to increase medical research efficiency on non-communicable diseases. METHODS: We undertook an unsystematic review of peer-reviewed literature and technology websites. RESULTS: Our review generated the following conclusions and recommendations. (1) Medical knowledge continues to be generated in a reductionist paradigm. This oversimplifies our models of disease, rendering them ineffective to sufficiently understand the complex nature of non-communicable diseases. (2) Some of these failings may be overcome by adopting a "Systems Medicine" paradigm, where the human body is modeled as a complex adaptive system. That is, a system with multiple components and levels interacting in complex ways, wherein disease emerges from slow changes to the system set-up. Pursuing systems medicine research will require larger datasets. (3) Increased data sharing between researchers, patients, and clinicians could provide this unmet need for data. The recent emergence of electronic health care records (EHR) could potentially facilitate this in real-time and at a global level. (4) Efforts should continue to aggregate anonymous EHR data into large interoperable data silos and release this to researchers. However, international collaboration, data linkage, and obtaining additional information from patients will remain challenging. (5) Efforts should also continue towards "Medicine 2.0". Patients should be given access to their personal EHR data. Subsequently, online communities can give researchers the opportunity to ask patients for direct access to the patient's EHR data and request additional study-specific information. However, selection bias towards patients who use Web 2.0 technology may be difficult to overcome. CONCLUSIONS: Systems medicine, when combined with large-scale data sharing, has the potential to raise our understanding of non-communicable diseases, foster personalized medicine, and make substantial progress towards halting, curing, and preventing non-communicable diseases. Large-scale data amalgamation remains a core challenge and needs to be supported. A synthesis of "Medicine 2.0" and "Systems Science" concepts into "Systems Medicine 2.0" could take decades to materialize but holds much promise.


Assuntos
Pesquisa Biomédica , Registros Eletrônicos de Saúde , Necessidades e Demandas de Serviços de Saúde , Conhecimento , Humanos , Internet , Publicações
5.
Spine J ; 15(4): e19-23, 2015 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-25485486

RESUMO

BACKGROUND CONTEXT: Copenhagen syndrome, or progressive noninfectious anterior vertebral fusion, is a rare disorder of unknown etiology that usually presents with thoracolumbar kyphosis in childhood. There have been no long-term reports on outcome in children with multiple affected levels with longitudinal imaging from infancy to adulthood. PURPOSE: The purpose of this study was to report the long-term outcome of nonoperative management of a child with Copenhagen syndrome affecting 19 vertebral levels. STUDY DESIGN: This study is a case report. METHODS: The study included longitudinal clinical and radiological follow-ups. RESULTS: A 1-year-old female presented with thoracolumbar kyphosis. Plain radiographs and magnetic resonance imaging demonstrated kyphosis associated with anterior disc space narrowing plus T11-T12 and L2-L3 vertebral end-plate abnormalities. Initial treatment with a plaster jacket followed by brace failed to prevent progressive vertebral involvement and kyphosis during childhood. At skeletal maturity, no further levels became involved, and progression was halted. In total, 19 levels showed anterior fusion. CONCLUSIONS: This case describes the long-term outcome of nonoperative management for progressive noninfectious anterior vertebral fusion affecting multiple levels. Extensive vertebral involvement does not always require surgical intervention. There is a need for future research on the prognostic indicators for progression and long-term outcome.


Assuntos
Cifose/diagnóstico , Feminino , Humanos , Lactente , Cifose/congênito , Cifose/diagnóstico por imagem , Vértebras Lombares/anormalidades , Radiografia , Síndrome , Vértebras Torácicas/anormalidades
6.
Paediatr Anaesth ; 24(4): 372-6, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24417703

RESUMO

BACKGROUND: Unplanned admissions to intensive care after surgery are a recommended clinical indicator of patient safety in the perioperative period and are validated to reflect both surgical and anesthesia-related complications. OBJECTIVES: To determine the rate and reasons for unplanned admissions to high dependency (HDU) and pediatric intensive care (PICU) following noncardiac surgery. METHODS: Data, including diagnosis, operation, and history of presenting complaint, were retrieved from electronic HDU and PICU data and hospital records for a 5-year period. All cases were individually reviewed by two pediatric anesthetists to identify unplanned admissions along with their urgency, source, and cause. RESULTS: During the study period, 53,876 procedures were performed resulting in 319 unplanned admissions to HDU/PICU, a rate of 0.6%. Of these, 108 (34%) were related to complications of anesthesia. The rate of unplanned admission to HDU/PICU secondary to a complication of anesthesia was therefore 0.2%. Emergency procedures and procedures involving a shared airway were particular risk factors for admission. CONCLUSION: The rate of unplanned admission to HDU/PICU is low and is comparable to previously published data. The high number of admissions following procedures involving a shared airway may represent patient-related factors and the case mix at this hospital. However, such a finding has prompted a combined ENT and anesthetic review of the care pathway for children with problems following airway instrumentation.


Assuntos
Cuidados Pós-Operatórios/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Anestesia/efeitos adversos , Criança , Cuidados Críticos/estatística & dados numéricos , Serviços Médicos de Emergência , Feminino , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Masculino , Admissão do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco
8.
Conf Proc IEEE Eng Med Biol Soc ; 2013: 2491-4, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24110232

RESUMO

This paper presents an assistive patient mobile system for hospital environments, which focuses on transferring the patient without nursing help. The system is a combination of an advanced hospital bed and an autonomous navigating robot. This intelligent bed can track the robot and routinely navigates and communicates with the bed. The work centralizes in building a structure, hardware design and robot detection and tracking algorithms by using laser range finder. The assistive patient mobile system has been tested and the real experiments are shown with a high performance of reliability and practicality. The accuracy of the method proposed in this paper is 91% for the targeted testing object with the error rate of classification by 6%. Additionally, a comparison between our method and a related one is also described including the comparison of results.


Assuntos
Leitos , Movimentação e Reposicionamento de Pacientes/instrumentação , Robótica , Inteligência Artificial , Hospitais , Humanos , Reprodutibilidade dos Testes
9.
Ann Hum Biol ; 40(4): 318-23, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23837829

RESUMO

PURPOSE: To examine the relationship between physical activity and energy demands in children and adolescents with highly active lifestyles. METHODS: Physical activity patterns of 30 rural Kenyan children and adolescents (14 ± 1 years, mean ± SD) with median body mass index (BMI) z-score = -1.06 [-3.29-0.67] median [range] were assessed by accelerometry over 1 week. Daily energy expenditure (DEE), activity-induced energy expenditure (AEE) and physical activity level (PAL) were simultaneously determined using doubly-labelled water (DLW). Active commuting to school was assessed by global positioning system. RESULTS: Mean DEE, AEE and PAL were 12.2 ± 3.4, 5.7 ± 3.0 MJ/day and 2.3 ± 0.6, respectively. A model combining body mass, average accelerometer counts per minute and time in light activities predicted 45% of the variance in DEE (p < 0.05) with a standard error of DEE estimate of 2.7 MJ/day. Furthermore, AEE accounted for ∼47% of DEE. Distance to school was not related to variation in DEE, AEE or PAL and there was no association between active commuting and adiposity. CONCLUSION: High physical activity levels were associated with much higher levels of energy expenditure than observed in Western societies. These results oppose the concept of physical activity being stable and constrained in humans.


Assuntos
Metabolismo Energético , Atividade Motora , Acelerometria , Adolescente , Índice de Massa Corporal , Criança , Feminino , Humanos , Quênia , Masculino , População Rural
10.
PLoS One ; 8(6): e66552, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23805234

RESUMO

The relative importance of genetic and socio-cultural influences contributing to the success of east Africans in endurance athletics remains unknown in part because the pre-training phenotype of this population remains incompletely assessed. Here cardiopulmonary fitness, physical activity levels, distance travelled to school and daily energy expenditure in 15 habitually active male (13.9±1.6 years) and 15 habitually active female (13.9±1.2) adolescents from a rural Nandi primary school are assessed. Aerobic capacity ([Formula: see text]) was evaluated during two maximal discontinuous incremental exercise tests; physical activity using accelerometry combined with a global positioning system; and energy expenditure using the doubly labelled water method. The [Formula: see text] of the male and female adolescents were 73.9±5.7 ml(.) kg(-1.) min(-1) and 61.5±6.3 ml(.) kg(-1.) min(-1), respectively. Total time spent in sedentary, light, moderate and vigorous physical activities per day was 406±63 min (50% of total monitored time), 244±56 min (30%), 75±18 min (9%) and 82±30 min (10%). Average total daily distance travelled to and from school was 7.5±3.0 km (0.8-13.4 km). Mean daily energy expenditure, activity-induced energy expenditure and physical activity level was 12.2±3.4 MJ(.) day(-1), 5.4±3.0 MJ(.) day(-1) and 2.2±0.6. 70.6% of the variation in [Formula: see text] was explained by sex (partial R(2) = 54.7%) and body mass index (partial R(2) = 15.9%). Energy expenditure and physical activity variables did not predict variation in [Formula: see text] once sex had been accounted for. The highly active and energy-demanding lifestyle of rural Kenyan adolescents may account for their exceptional aerobic fitness and collectively prime them for later training and athletic success.


Assuntos
Metabolismo Energético/fisiologia , Capacidade Inspiratória/fisiologia , Resistência Física/fisiologia , Adolescente , Feminino , Humanos , Quênia/etnologia , Masculino
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