Monitoring and alleviating the effects of pressure related injuries for spinal surgery–a need for improvement?

The development of pressure injuries (PIs) is a common complication arising during surgery. Monitoring and alleviating PIs is currently not possible during lengthy spinal and orthopaedic surgeries, especially if a patient requires x-rays. We interviewed surgical staff to gain an understanding of attitudes regarding current methods and approaches for the management of PIs to allow the development of new devices based on staff feedback. Interviewees provided insights regarding the possible design of a new device used to monitor and alleviate pressure injuries in a surgical environment. From the interviews we derived key themes, including current devices/systems, current risk assessment/scales, and design considerations. As a result, we identified critical design requirements and an appropriate product design specification. Background: Complications can arise when perioperative staff are monitoring a patient’s health status during surgery, including the development of pressure injuries (PIs). It is important to reduce the incidence rates of developing PIs intraoperatively, and thereby mitigate both increased costs and negative impacts to patients and care providers. Current pressure relief supports offer limited monitoring abilities throughout the perioperative environment. Aim: The aim of this study is to establish clear design requirements and a product design specification that enables a new closed-loop product solution to be developed with real-time pressure monitoring during surgery. Method: We conducted semi-structured interviews with nine different clinical staff members involved in the perioperative environment. We conducted the interviews over a two-week period with two major teaching hospitals within the East Midlands, UK. Questions focused on healthcare professionals’ perceptions of current methods and their approaches to managing PIs. We recorded and transcribed participants’ data using NVivo software. Conclusion: The interview data identified a need for an improved method to manage and monitor PIs. We established that the incorporation of live feedback to reduce the prevalence of PIs is a critical design priority. Based on the interviews, we developed design criteria and a product design specification (PDS). Interview transcripts suggest a new device design should focus on a novel radiolucent pressure redistribution solution capable of reducing PIs intraoperatively while incorporating live feedback

A review of the surgical conversion rate and independent management of spinal extended scope practitioners in a secondary care setting

INTRODUCTION Spinal orthopaedic triage aims to reduce unnecessary referrals to surgical consultants, thereby reducing waiting times to be seen by a surgeon and to surgical intervention. This paper presents an evaluation of a spinal orthopaedic triage service in the third largest spinal unit in the UK. METHODS A retrospective service evaluation spanning 2012 to 2014 was undertaken by members of the extended scope practitioner (ESP) team to evaluate the ESPs’ ability to manage patient care independently and triage surgical referrals appropriately. Data collected included rates of independent management, referral rates for surgical consideration and conversion to surgery. Patient satisfaction rates were evaluated retrospectively from questionnaires given to 5% of discharged patients. RESULTS A total of 2,651 patients were seen. The vast majority (92%) of all referrals seen by ESPs were managed independently. Only 8% required either a discussion with a surgeon to confirm management or for surgical review. Of the latter, 81% were considered to be suitable surgical referrals. A 99% satisfaction rate was reported by discharged patients. CONCLUSIONS ESP services in a specialist spinal service are effective in managing spinal conditions conservatively and identifying surgical candidates appropriately. Further research is needed to confirm ESPs’ diagnostic accuracy, patient outcomes and cost effectiveness

Does surgical site infection influence neurological outcome and survival in patients undergoing surgery for metastatic spinal cord compression?

Purpose: Most of the literature on infection after surgery for spinal metastases focuses on incidence and risk factors for surgical site infection (SSI). To the best of our knowledge, there is no report on the influence of infection on neurological outcome and survival in patients undergoing emergent surgery for metastatic spinal cord compression (MSCC).Methods: Our aim was to establish if SSIs adversely affected the neurological outcome and survival in patients with MSCC. We reviewed 318 consecutive patients admitted for surgical intervention for MSCC from October 2005 to October 2012. Morbidity (neurological outcome, length of hospital stay and additional procedures) and survival rates were analysed.Results: During this study period, the incidence of infection was 29/318 (9.1%). The median length of stay in hospital in the infected group was 25 days compared to 13 days in the non-infected group (p = 0.001). Twenty out of the 29 (69%) infected patients underwent an additional procedure (29 procedures in total) compared to 9/289 (3%) non-infected patients (p = 0.001). There was no statistical difference between the two groups with regard to neurological outcome (p = 0.37) but the survival rate was statistically different between the two groups [infected group: median survival 131 days (19–1558) vs. non-infected group: 258 days (5–2696; p = 0.03)].Conclusion: Surgical site infection increased the morbidity with considerably longer hospital stay and requirement for additionalprocedures. Although there was no difference in neurological outcome, the infected group of patients had a significantlyshorter survival

A randomised sham controlled trial of vertebroplasty for painful acute osteoporotic vertebral fractures (VERTOS IV)

<p>Abstract</p> <p>Background</p> <p>The standard care in patients with a painful osteoporotic vertebral compression fracture (VCF) is conservative therapy. Percutaneous vertebroplasty (PV), a minimally invasive technique, is a new treatment option. Recent randomized controlled trials (RCT) provide conflicting results: two sham-controlled studies showed no benefit of PV while an unmasked but controlled RCT (VERTOS II) found effective pain relief at acceptable costs. The objective of this study is to compare pain relief after PV with a sham intervention in selected patients with an acute osteoporotic VCF using the same strict inclusion criteria as in VERTOS II. Secondary outcome measures are back pain related disability and quality of life.</p> <p>Methods</p> <p>The VERTOS IV study is a prospective, multicenter RCT with pain relief as primary endpoint. Patients with a painful osteoporotic VCF with bone edema on MR imaging, local back pain for 6 weeks or less, osteopenia and aged 50 years or older, after obtaining informed consent, are included and randomized for PV or a sham intervention. In total 180 patients will be enrolled. Follow-up is at regular intervals during a 1-year period with a standard Visual Analogue Scale (VAS) score for pain and pain medication. Necessary additional therapies and complications are recorded.</p> <p>Discussion</p> <p>The VERTOS IV study is a methodologically sound RCT designed to assess pain relief after PV compared to a sham intervention in patients with an acute osteoporotic VCF selected on strict inclusion criteria.</p> <p>Trial registration</p> <p>This study is registered at ClinicalTrials.gov., <a href="http://www.clinicaltrials.gov/ct2/show/NCT01200277">NCT01200277</a>.</p

Regional differentiation of felid vertebral column evolution: a study of 3D shape trajectories

Recent advances in geometric morphometrics provide improved techniques for extraction of biological information from shape and have greatly contributed to the study of ecomorphology and morphological evolution. However, the vertebral column remains an under-studied structure due in part to a concentration on skull and limb research, but most importantly because of the difficulties in analysing the shape of a structure composed of multiple articulating discrete units (i.e. vertebrae). Here, we have applied a variety of geometric morphometric analyses to three-dimensional landmarks collected on 19 presacral vertebrae to investigate the influence of potential ecological and functional drivers, such as size, locomotion and prey size specialisation, on regional morphology of the vertebral column in the mammalian family Felidae. In particular, we have here provided a novel application of a method—phenotypic trajectory analysis (PTA)—that allows for shape analysis of a contiguous sequence of vertebrae as functionally linked osteological structures. Our results showed that ecological factors influence the shape of the vertebral column heterogeneously and that distinct vertebral sections may be under different selection pressures. While anterior presacral vertebrae may either have evolved under stronger phylogenetic constraints or are ecologically conservative, posterior presacral vertebrae, specifically in the post-T10 region, show significant differentiation among ecomorphs. Additionally, our PTA results demonstrated that functional vertebral regions differ among felid ecomorphs mainly in the relative covariation of vertebral shape variables (i.e. direction of trajectories, rather than in trajectory size) and, therefore, that ecological divergence among felid species is reflected by morphological changes in vertebral column shape