Tag: nevin manimala

Int J Spine Surg. 2021 Dec;15(suppl 3):S54-S64. doi: 10.14444/8164.

ABSTRACT

BACKGROUND: From the 1990s, there has been growth in the literature demonstrating the feasibility of minimally invasive approaches for treating variety lumbar spinal disorders. There is still much work to be done in overcoming the technical challenges and explicate relative advantages of endoscopic techniques in lumbar spine surgery. In this comprehensive literature review, we discuss the history, indications, contraindications, surgical techniques, learning curves, technical tips, adverse events, and examine peer-reviewed studies addressing uniportal endoscopic interlaminar decompression in lumbar spinal surgery.

METHODS: This literature review was conducted with keywords “endoscopic,” “minimally invasive,” “uniportal endoscopic decompression,” “interlaminar decompression,” and “lumbar spinal surgery” using PubMed, Embase, ClinicalKey, and Google Scholar.

RESULTS: Review of 423 patients who underwent uniportal endoscopic interlaminar lumbar decompression showed satisfying results with 82% of patients no longer having leg pain, and 13% of patients having only occasional pain, with no significant operation-related deterioration in leg or back pain. To compare the outcomes between endoscopic and microscopic technique, a comparative review of 192 lumbar lateral recess stenosis patients demonstrated the uniportal endoscopic group had 29% shorter operation duration, 1.2% fewer perioperative complications, and significantly reduced postoperative pain (visual analog scale) over 5 days, and reduced use of pain medications. Multiple retrospective studies echoed the outcomes of endoscopic decompression surgery, showed shorter hospitalization time, lower mean dural expansion, lower increment of horizontal displacement measured, and less elevated levels of postoperative serum CPK (creatine phosphokinase) and CRP (c-reactive protein). Lastly, a systematic review and meta-analysis that enrolled 994 patients found that patients who received the full-endoscopic decompression technique showed statistically lower levels of back pain and leg pain and a 40% lower chance of having complications compared with those receiving microscopic decompression in lumbar stenosis.

CONCLUSIONS: Based on our literature review, there are multiple positive outcomes with endoscopic interlaminar lumbar decompression, which reduces operation duration, perioperative complications, and better postoperative outcomes. However, the technical challenge highlights the importance of further training and innovation in this rapidly evolving field.

PMID:34974421 | DOI:10.14444/8164

Int J Med Educ. 2021 Dec 31;12:274-299. doi: 10.5116/ijme.61b3.56ee.

ABSTRACT

OBJECTIVES: To investigate the acceptability and the effectiveness of a virtual adaptation of a well-established, mandatory, community-based pre-clinical remote area health placement in which medical students learn about the social and environmental determinants of health in remote Australia; and make recommendations to guide the delivery of future learning experiences.

METHODS: A mixed-methods convergent design was used. All 99 students, 36 placement hosts and 10 staff were invited to complete an online survey and 27(27%), 12(33%) and 10(100%), respectively, contributed data. Qualitative data were collected via semi-structured interviews from four students, four hosts and six staff. Survey data were analysed using descriptive statistics (frequency and percentage) and open-ended responses summarised to provide supporting contextual evidence. Interview transcripts were analysed and coded independently, then corroborated to identify and summarise common themes using thematic analysis.

RESULTS: Survey and interview data indicated that the virtual placement was acceptable to students and hosts and enabled students to achieve intended learning objectives. Virtual activities enabled students and hosts to develop authentic, genuine interpersonal relationships, which in turn were facilitated when hosts and students had practiced videoconferencing beforehand with good high-speed internet connections via mobile devices. Pastoral care and access to IT support were essential.

CONCLUSIONS: Virtual placements can be used in combination with and are an option for students and hosts who cannot attend/courses that cannot fund physical placements. Careful design and further research is required to ensure that virtual placements enable “head, heart and hands” learning and do not create/reinforce inequities.

PMID:34974431 | DOI:10.5116/ijme.61b3.56ee

Parkinsonism Relat Disord. 2021 Dec 18;95:23-27. doi: 10.1016/j.parkreldis.2021.12.011. Online ahead of print.

ABSTRACT

BACKGROUND: Statistically and clinically significant cognitive declines are observed in a small subset of individuals with Parkinson’s Disease (PD) following treatment with Deep Brain Stimulation (DBS).

OBJECTIVES: We examine the association between multi-domain cognitive decline (MCD) and demographic and baseline clinical variables and the incidence of serious adverse events (SAE) arising within a six-month interval following DBS for PD.

METHOD: Study participants with PD who displayed MCD at 6-month follow-up evaluation after DBS (n = 18) were contrasted with individuals with PD from the same study who did not show cognitive decline after DBS (n = 146). Logistic regression analyses were employed to assess relationship between predictors, including age (>70 years old), pre-DBS cognitive screening test performance, SAE, and MCD. MCD+ and MCD-groups were also compared on other baseline clinical and demographic variables.

RESULTS: MCD showed modest association with older age and lower baseline neurocognitive screening performance, whereas the groups did not differ on most other baseline clinical and demographic variables. SAEs during the study interval were the most robust predictor of MCD in the DBS group. A variety of SAEs were documented in study participants experiencing MCD after DBS surgery, including, but not limited to, infections and small intracranial hemorrhages.

CONCLUSIONS: Older age and lower baseline cognition measured prior to treatment are associated with MCD measured at six-months after DBS. SAE occurring following DBS surgery are also predictive of MCD. These predictors may reflect aspects of “frailty” in advanced PD. Risk factors for SAE warrant careful consideration in clinical trials.

PMID:34974395 | DOI:10.1016/j.parkreldis.2021.12.011

Soc Sci Med. 2021 Dec 21;294:114673. doi: 10.1016/j.socscimed.2021.114673. Online ahead of print.

ABSTRACT

Prior research suggests that participation in enriching early-life activities (EELAs) has long-term benefits for cognitive health and aging. This study aims to examine the life course processes underlying these associations by drawing on theoretical models from life course epidemiology. Specifically, we tested sensitive-period effects, social pathways, and selection effects as potential explanations for linkages between greater participation in EELAs and better later life cognition. We drew on data from the Wisconsin Longitudinal Study (WLS), which is among the longest-running cohort studies in the U.S. that has followed graduates (all identified as non-Hispanic White) from Wisconsin high schools since 1957. We used prospective measures of key variables, including information from high school yearbooks, with assessments of cognitive performance at ages 65 and 72. Results from multilevel modeling indicated that greater participation in cognitively oriented extracurricular activities (but not physically nor socially oriented activities) was associated with both better language/executive functioning and memory at age 65. Although the size of these associations was reduced when accounting for other cognitive resources in adolescence (childhood socioeconomic status and adolescent cognitive ability) and in midlife (adult socioeconomic status and formal group participation), there remained small, yet statistically robust, associations. We did not find robust associations between greater EELA engagement and slower rates of decline in cognition between ages 65 and 72, nor did we find evidence of gender differences. Results suggest that for this cohort of older adults, EELA participation is part of life course “protective chains,” whereby exposures to assets at one point in the life course increase the likelihood of subsequent exposures, each sequentially and in their own right, toward better later life cognition. We discuss how results support the importance of policies and practices to promote healthy cognitive development among youth for the long-term cognitive health of a rapidly aging U.S. population.

PMID:34974386 | DOI:10.1016/j.socscimed.2021.114673

Neurosurg Focus. 2022 Jan;52(1):E4. doi: 10.3171/2021.10.FOCUS21526.

ABSTRACT

OBJECTIVE: The accuracy of percutaneous pedicle screw placement has increased with the advent of robotic and surgical navigation technologies. However, the effect of robotic intraoperative screw size and trajectory templating remains unclear. The purpose of this study was to compare pedicle screw sizes and accuracy of placement using robotic navigation (RN) versus skin-based intraoperative navigation (ION) alone in minimally invasive lumbar fusion procedures.

METHODS: A retrospective cohort study was conducted using a single-institution registry of spine procedures performed over a 4-year period. Patients who underwent 1- or 2-level primary or revision minimally invasive surgery (MIS)-transforaminal lumbar interbody fusion (TLIF) with pedicle screw placement, via either robotic assistance or surgical navigation alone, were included. Demographic, surgical, and radiographic data were collected. Pedicle screw type, quantity, length, diameter, and the presence of endplate breach or facet joint violation were assessed. Statistical analysis using the Student t-test and chi-square test was performed to evaluate the differences in pedicle screw sizes and the accuracy of placement between both groups.

RESULTS: Overall, 222 patients were included, of whom 92 underwent RN and 130 underwent ION MIS-TLIF. A total of 403 and 534 pedicle screws were placed with RN and ION, respectively. The mean screw diameters were 7.25 ± 0.81 mm and 6.72 ± 0.49 mm (p < 0.001) for the RN and ION groups, respectively. The mean screw length was 48.4 ± 4.48 mm in the RN group and 45.6 ± 3.46 mm in the ION group (p < 0.001). The rates of “ideal” pedicle screws in the RN and ION groups were comparable at 88.5% and 88.4% (p = 0.969), respectively. The overall screw placement was also similar. The RN cohort had 63.7% screws rated as good and 31.4% as acceptable, while 66.1% of ION-placed screws had good placement and 28.7% had acceptable placement (p = 0.661 and p = 0.595, respectively). There was a significant reduction in high-grade breaches in the RN group (0%, n = 0) compared with the ION group (1.2%, n = 17, p = 0.05).

CONCLUSIONS: The results of this study suggest that robotic assistance allows for placement of screws with greater screw diameter and length compared with surgical navigation alone, although with similarly high accuracy. These findings have implied that robotic platforms may allow for safe placement of the “optimal screw,” maximizing construct stability and, thus, the ability to obtain a successful fusion.

PMID:34973674 | DOI:10.3171/2021.10.FOCUS21526

Neurosurg Focus. 2022 Jan;52(1):E6. doi: 10.3171/2021.10.FOCUS21523.

ABSTRACT

OBJECTIVE: In this study, the authors aimed to describe a new technique of sacroiliac joint (SIJ) fusion using a robotic navigation guidance system and to document clinical results with patient-reported visual analog scale (VAS) scores.

METHODS: Patients diagnosed with SIJ dysfunction were surgically treated using 2 hydroxyapatite (HA)-coated, threaded screws with the aid of the robotic navigation system. In a total of 36 patients, 51 SIJs were fused during the study period. Patients’ VAS scores were used to determine clinical improvement in pain. Postoperative imaging at routine intervals during the follow-up period was also performed for assessment of radiological fusion. In addition, complication events were recorded, including reoperations.

RESULTS: All 36 patients had successful fusion evidenced by both CT and clinical assessment at the final follow-up. Two patients underwent reoperation because of screw loosening. The mean preoperative VAS score was 7.2 ± 1.1, and the mean 12-month postoperative VAS score was 1.6 ± 1.46. This difference was statistically significant (p < 0.05) and demonstrated a substantial clinical improvement in pain.

CONCLUSIONS: Robotic navigation-assisted SIJ fusion using 2 HA-coated, threaded screws placed across the joint was an acceptable technique that demonstrated reliable clinical results with a significant improvement in patient-reported VAS pain scores.

PMID:34973676 | DOI:10.3171/2021.10.FOCUS21523

Asian J Psychiatr. 2021 Dec 25;69:102984. doi: 10.1016/j.ajp.2021.102984. Online ahead of print.

ABSTRACT

BACKGROUND: Occupational balance is an essential element for social participation and quality of life. However, it is difficult for patients with schizophrenia to participate in occupation and achieve occupational balance in daily life due to physical and mental symptoms.

OBJECTIVE: This study investigated the form of time use and occupational balance in a schizophrenic patient, and examined the effect of client-centered occupation-based case management.

METHODS: The research was conducted at a private center visited using one-on-one weekly client interactions for 10 weeks from September 1, 2020, and time use was analyzed using the Occupational Questionnaire (OQ) and the 2019 Life Time Survey Table of the National Statistical Office. In addition, data on work performance and satisfaction were collected using Canadian Occupational Performance Measure (COPM), and client-centered occupation-based interventions were conducted.

RESULTS: As a result of identifying the balance of work of clients, 38.46% of rest and sleep during the day, 30.77% of IADL, 17.94% of Work, 10.26% of BADL, and 2.57% of leisure. Through occupation-based case management for child care and work, which are the main goals of the client, the COPM score increased on average by 2 or more points per item, showing a positive effect.

CONCLUSION: In order to resolve the occupation imbalance of schizophrenic patients, it is necessary to closely understand the type of time use and actively intervene in client-centered occupation-based interventions.

DATA AVAILABILITY STATEMENT: Data pertinent to this report will be made available upon reasonable request to the author.

PMID:34973635 | DOI:10.1016/j.ajp.2021.102984

Neurosurg Focus. 2022 Jan;52(1):E11. doi: 10.3171/2021.10.FOCUS21499.

ABSTRACT

OBJECTIVE: The application of robots in the field of pedicle screw placement has achieved great success. However, decompressive laminectomy, a step that is just as critical as pedicle screw placement, does not have a mature robot-assisted system. To address this lack, the authors designed a collaborative spine robot system to assist with laminectomy. In this study, they aimed to investigate the reliability of this novel collaborative spinal robot system and compare it with manual laminectomy (ML).

METHODS: Thirty in vitro porcine lumbar vertebral specimens were obtained as experimental bone specimens. Robot-assisted laminectomy (RAL) was performed on the left side of the lamina (n = 30) and ML was performed on the right side (n = 30). The time required for laminectomy on one side, whether the lamina was penetrated, and the remaining thickness of the lamina were compared between the two groups.

RESULTS: The time required for laminectomy on one side was longer in the RAL group than in the ML group (median 326 seconds [IQR 133 seconds] vs 108.5 seconds [IQR 43 seconds], p < 0.001). In the RAL group, complete lamina penetration occurred twice (6.7%), while in the ML group, it occurred 9 times (30%); the difference was statistically significant (p = 0.045). There was no statistically significant difference in the remaining lamina thickness between the two groups (median 1.035 mm [IQR 0.419 mm] vs 1.084 mm [IQR 0.383 mm], p = 0.842).

CONCLUSIONS: The results of this study confirm the safety of this novel spinal robot system for laminectomy. However, its efficiency requires further improvement.

PMID:34973664 | DOI:10.3171/2021.10.FOCUS21499

Spectrochim Acta A Mol Biomol Spectrosc. 2021 Dec 23;270:120802. doi: 10.1016/j.saa.2021.120802. Online ahead of print.

ABSTRACT

Ascorbic acid has recently been extensively used due to its role in the management of COVID-19 infections by stimulating the immune system and triggering phagocytosis of the corona virus. The currently used spectrofluorometric methods for determination of ascorbic acid require using derivatizing agents or fluorescent probes and suffer from a number of limitations, including slow reaction rates, low yield, limited sensitivity, long reaction times and high temperatures. In this work, we present a highly sensitive spectrofluorometric method for determination of ascorbic acid by switching-on the fluorescence of salicylate in presence of iron (III) due to a reduction of the cation to iron (II). The addition of ascorbic acid resulted in a corresponding enhancement in the fluorescence intensity of iron (III)-salicylate complex at emission wavelength = 411 nm. The method was found linear in the range of 1-8 µg/mL with a correlation coefficient of 0.9997. The limits of detection and quantitation were 0.035 µg/mL and 0.106 µg/mL, respectively. The developed method was applied for the determination of ascorbic acid in the commercially available dosage form; Ruta C60® tablets. The obtained results were compared with those obtained by a reported liquid chromatographic method at 95% confidence interval, no statistically significant differences were found between the developed and the reported methods. Yet, the developed spectrofluorometric method was found markedly greener than the reference method, based on the analytical Eco-scale and the green analytical procedure index. This work presents a simple, rapid and sensitive method that can possibly be applied for determination of ascorbic acid in pharmaceuticals, biological fluids and food samples.

PMID:34973618 | DOI:10.1016/j.saa.2021.120802

Nurse Educ Today. 2021 Dec 24;109:105260. doi: 10.1016/j.nedt.2021.105260. Online ahead of print.

ABSTRACT

BACKGROUND: Prebriefing is the first phase of simulation; however, the literature does not adequately identify prebriefing standards and implementation strategies, providing little direction for simulation facilitators to conduct prebriefing in a manner that promotes student self-efficacy and clinical competency.

OBJECTIVES: The aim of this study was to examine the effects of the Self-Efficacy Prebriefing Model (SEPM) on nursing student self-efficacy and clinical competency.

DESIGN: An experimental design with group randomization was used to compare self-efficacy and clinical competency in nursing students who received prebriefing per the SEPM compared to a control group.

SETTING: The study was conducted in one public Midwestern university in the United States.

PARTICIPANTS: 66 senior Bachelor of Science in Nursing students enrolled in a clinical course completed the study.

METHODS: Clinical competency and self-efficacy were examined between an experimental group that received prebriefing per the SEPM and a control group that received standard prebriefing. The relationship between self-efficacy and clinical competency was examined. Clinical competency and self-efficacy were evaluated using the Creighton Competency Evaluation Instrument and Revised Clinical and Simulation General Self-Efficacy Scale.

RESULTS: The experimental group had statistically significantly higher self-efficacy (p = .001) and clinical competency (p < .001) as compared to the control group. There was no significant relationship noted between self-efficacy and clinical competency (p = .207).

CONCLUSION: The SEPM promoted nursing student self-efficacy and clinical competency in simulation. Prebriefing has an essential role in the simulation process and in promoting student outcomes.

PMID:34973554 | DOI:10.1016/j.nedt.2021.105260