Theatres without borders: a systematic review of the use of intraoperative telemedicine in low- and middle-income countries (LMICs)

Objective: This systematic review aims to provide a summary of the use of real-time telementoring, telesurgical consultation and telesurgery in surgical procedures in patients in low/middle-income countries (LMICs). Design: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and the Cochrane Collaboration published guidelines. Data sources: EMBASE, MEDLINE, Cochrane, PubMed and Google Scholar were searched for original articles and case reports that discussed telementoring, telesurgery or telesurgical consultation in countries defined as low-income or middle-income (as per the World Banks’s 2021–2022 classifications) from inception to August 2021. Eligibility criteria for selecting studies: All original articles and case reports were included if they reported the use of telemedicine, telesurgery or telesurgical consultation in procedures conducted on patients in LMICs. Results: There were 12 studies which discussed the use of telementoring in 55 patients in LMICs and included a variety of surgical specialities. There was one study that discussed the use of telesurgical consultation in 15 patients in LMICs and one study that discussed the use of telesurgery in one patient. Conclusion: The presence of intraoperative telemedicine in LMICs represents a principal move towards improving access to specialist surgical care for patients in resource-poor settings. Not only do several studies demonstrate that it facilitates training and educational opportunities, but it remains a relatively frugal and efficient method of doing so, through empowering local surgeons in LMICs towards offering optimal care while remaining in their respective communities

Faculty Experiences Using Synchronous Videoconference Technology to Assess Student Psychomotor Performance

Introduction: Psychomotor skills are an essential aspect of physical therapy (PT) education. Recent studies supported using videoconference technology (VCT) for psychomotor instruction, but research on the use of VCT for psychomotor assessments is limited. Determining the usefulness of VCT for psychomotor exams is vital to establishing best pedagogical practices. The purpose of this basic qualitative study was to explore the faculty experience using synchronous VCT to assess PT students’ psychomotor skills. Methods: The conceptual framework for this study was the unified theory of acceptance and use of technology (UTAUT). The research question guided the investigation into how PT educators described the psychomotor skill assessment of students using VCT, related to the four constructs of UTAUT: performance expectancy, effort expectancy, social influence, and facilitating conditions. Purposive sampling was used to collect qualitative data via online semistructured interviews of 15 U.S. PT professors. Results: Data were analyzed using emergent coding and thematic analysis. Key findings were that faculty participants perceived that the use of VCT to assess psychomotor skills was a feasible alternative modality to face-to-face practicals. The use of VCT did not sacrifice achieving good learning outcomes. Faculty identified VCT assessment benefits as convenience, adaptability, and skill acquisition and recognized the challenges of a static camera angle and connectivity and resource issues. Discussion: This study may foster positive social change by informing PT educators of the value of using VCT for psychomotor assessments, which provided additional educational opportunities, exposed students to telehealth, promoted acceptance of online learning, and improved accessibility for individuals in rural locations

Faculty Experiences Using Synchronous Videoconference Technology to Assess Student Psychomotor Performance

Psychomotor skills are an essential aspect of physical therapy (PT) education. Recent studies supported using videoconference technology (VCT) for psychomotor instruction, but research on the use of VCT for psychomotor assessments is limited. Determining VCT’s usefulness for psychomotor exams is vital to establish best pedagogical practices. The purpose of this basic qualitative study was to explore the faculty experience using synchronous VCT to assess PT student’s psychomotor skills. The conceptual framework for this study was the unified theory of acceptance and use of technology (UTAUT). The research question investigated how PT educators described the psychomotor skill assessment of students using VCT, related to the four constructs of UTAUT: performance expectancy, effort expectancy, social influence, and facilitating conditions. Purposive sampling was used to collect qualitative data via online semistructured interviews of 15 U.S. physical therapy professors. Data were analyzed using emergent coding and thematic analysis. Key findings were that faculty participants perceived the use of VCT to assess psychomotor skills as a feasible alternative modality to face-to-face practicals. The use of VCT did not sacrifice achieving good learning outcomes. Faculty identified VCT assessment benefits as convenience, adaptability, and skill acquisition and recognized the challenges of a static camera angle and connectivity and resource issues. This study may foster positive social change by informing PT educators of the value of using VCT for psychomotor assessments, which provided additional educational opportunities, exposed students to telehealth, promoted acceptance of online learning, and improved accessibility for individuals in rural locations

Clamp-assisted retractor advancement for lower eyelid involutional entropion

Scientific Poster 144PURPOSE: To describe a novel approach to internal repair of lower lid entropion using the Putterman clamp. METHODS: Retrospective, consecutive case series of patients with entropion who underwent retractor advancement using the clamp. RESULTS: Seven eyes of 6 patients (average age: 80; 4 women and 2 men) were analyzed. Complete resolution was achieved in 5 of the 6 patients (83.3%). The 1 patient with recurrence had 2 previous entropion surgeries on each eye over the past 4 years; there was lid laxity, and horizontal tightening was needed. No severe adverse events occurred in the patients. CONCLUSION: Clamp-assisted lower lid retractor advancement offers a safe and effective, minimally invasive approach to involutional entropion. Further study is needed to assess its role in recurrent entropion.postprin

Fragility Fracture Nursing

This open access book aims to provide a comprehensive but practical overview of the knowledge required for the assessment and management of the older adult with or at risk of fragility fracture. It considers this from the perspectives of all of the settings in which this group of patients receive nursing care. Globally, a fragility fracture is estimated to occur every 3 seconds. This amounts to 25 000 fractures per day or 9 million per year. The financial costs are reported to be: 32 billion EUR per year in Europe and 20 billon USD in the United States. As the population of China ages, the cost of hip fracture care there is likely to reach 1.25 billion USD by 2020 and 265 billion by 2050 (International Osteoporosis Foundation 2016). Consequently, the need for nursing for patients with fragility fracture across the world is immense. Fragility fracture is one of the foremost challenges for health care providers, and the impact of each one of those expected 9 million hip fractures is significant pain, disability, reduced quality of life, loss of independence and decreased life expectancy. There is a need for coordinated, multi-disciplinary models of care for secondary fracture prevention based on the increasing evidence that such models make a difference. There is also a need to promote and facilitate high quality, evidence-based effective care to those who suffer a fragility fracture with a focus on the best outcomes for recovery, rehabilitation and secondary prevention of further fracture. The care community has to understand better the experience of fragility fracture from the perspective of the patient so that direct improvements in care can be based on the perspectives of the users. This book supports these needs by providing a comprehensive approach to nursing practice in fragility fracture care. ; Provides a comprehensive discussion of nursing the frail older person with a fragility fracture across Europe Based on a two-day workshop of like-minded specialist and advanced nurses from over 20 countries Acts as the course text/reader for a Europe-wide education programme in all relevant settings (Emergency Department, Fracture Clinic, Trauma Unit, Orthopaedic Ward, Rehabilitation setting) Open Acces

Yale Medicine : Alumni Bulletin of the School of Medicine, Spring 2011- Spring 2013

This volume contains Yale Medicine: alumni bulletin of the School of Medicine, v.45 through v.47 (Spring 2011-Spring 2013). Prepared in cooperation with the alumni and development offices at the School of Medicine. Earlier volumes are called Yale School of Medicine alumni bulletins, dating from v.1 (1953) through v.13 (1965). Digitized with funding from the Arcadia fund, 2017.https://elischolar.library.yale.edu/yale_med_alumni_newsletters/1025/thumbnail.jp

Yale Medicine : Alumni Bulletin of the School of Medicine, Fall 1990- Summer 1992

This volume contains Yale medicine: alumni bulletin of the School of Medicine, v.25 (Fall 1990) through v.26 (Summer 1992). Prepared in cooperation with the alumni and development offices at the School of Medicine. Earlier volumes are called Yale School of Medicine alumni bulletins, dating from v.1 (1953) through v.13 (1965). Digitized with funding from the Arcadia fund, 2017.https://elischolar.library.yale.edu/yale_med_alumni_newsletters/1010/thumbnail.jp

The Prevalence of Termination Variations of the Basilar Artery:A Systematic Review and Meta-Analysis

Purpose: Understanding the vascular anatomical variations of the termination pattern of the basilar artery is crucial for both neurosurgical and interventional radiological procedures. Recent evidence indicates that variant bifurcation patterns of the basilar artery, differing from the classical textbook descrip- tion, are increasingly encountered. This study aims to provide a comprehensive summary of the prevalence of termination anomalies related to the basilar artery.Methods: This systematic review included human cadaveric and imaging studies on basilar artery termination patterns. PubMed, Ovid MEDLINE, and Scopus databases were system- atically searched in accordance with PRISMA guidelines, us- ing the terms “(basilar OR vertebrobasilar OR (posterior AND circulation)) AND (anatomy OR termination OR trifurcation OR quadfurcation OR pentafurcation OR hexafurcation OR nonfurcation OR variation OR variant)”. A meta-analysis of proportions was conducted to assess the prevalence of each variation using a random intercept logistic regression model, following logit transformation of the proportions.Results: From 845 initial hits, 4 articles were eligible for the quantitative analysis. The estimated pooled proportions of bifurcation, trifurcation, quadfurcation, pentafurcation, hexa- furcation, and non-furcation in the artery, under the random effects model, were 62.22% (95%CI [34.48%; 83.75%]), 6.08% (95%CI [2.60%; 13.58%]), 5.27% (95%CI [2.17%; 12.27%]),2.06% (95%CI [0.96%; 4.35%]), 0.49% (95%CI [0.08%; 2.90%]), and 0.10% (95%CI [0.0%; 17.07%]), respectively. Heterogeneity analysis revealed significant variability among the studies (I2 up to 93.6%, p&lt;0.0001).Conclusion: More than one-third of basilar artery termi- nations exhibit anatomical variations other than bifurcation. Trifurcation and quadfurcation are the most commonly re- ported variations, each accounting for over 5% of cases. These variations might carry significant implications for regional neurosurgical and interventional radiological procedures.<br/

A Rare Presentation of Infantile Mediastinal Mature Cystic Teratoma Leading to Progressive Respiratory Failure - A Case Series

Purpose: Teratoma is a congenital tumour arising from one or more of the three germ cell layers in the embryo, with an incidence of 1.2-14.2 cases per 100,000 people per year. Mature cystic teratomas contain bone, cartilage, hair, nails, and cystic fluid filled spaces. Extragonadal teratomas are uncommon, and are usually detected incidentally in adults. Here, we report three cases of infantile mediastinal mature cystic teratomas presenting with impending acute respiratory failure.Methods: Three previously healthy infants (two were boys) aged 5-6 months presented with worsening respiratory tract infection and impending respiratory failure despite medical management. A chest radiograph revealed a large anterior mediastinal mass. CECT chest demonstrated the mediasti- nal tumour suggestive of Teratoma with a mediastinal shift, cardiac and tracheal compression. None of them had features of local infiltration. It was decided to proceed with surgical excision after multidisciplinary discussions. Mediastinum was approached with muscle sparing posterolateral thoracotomy in two patients. And the other child underwent right anterolat- eral thoracotomy. Excision of the tumour relieved the airway obstruction and mediastinal shift.Results: The symptoms improved rapidly following the tumour excision, and they were gradually weaned off from respiratory support. They received ITU care and recovered un- eventfully with no surgical complications. The histology of the excised tumours confirmed mature cystic teratoma.Conclusion: Mature cystic teratoma may rarely present in infancy with progressive respiratory failure, hence clinicians should have a high degree of suspicion. Complete excision is possible in most cases where there is a clear plane of dissection with the lesion and the surrounding structures with excellent clinical outcomes. Both anterolateral and posterolateral thora- cotomy approaches could be used to access the mediastinum.<br/