The RoboCOS Study : Development of an international core outcome set for the comprehensive evaluation of patient, surgeon, organisational and population level impacts of robotic assisted surgery

ACKNOWLEDGEMENTS We would like to thank sincerely all those who contributed to the interviews, the focus group, the Delphi survey and the consensus meeting, and Paul Manson (Health Services Research Unit, University of Aberdeen) for helping to retrieve full text copies of reports identified by the literature search. We also thank HSRU (Health Services Research Unit) at University of Aberdeen for providing support for this work. Funding: The study was funded from NHS Grampian Endowment Fund and the University of Aberdeen. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Copyright: © 2023 Robertson et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Peer reviewedPublisher PD

Improving simulation training in orthopaedics

The way surgical trainees acquire technical skills is changing in modern surgical training programmes: simulation is proposed as a key part of those changes. Arthroscopy is a surgical technique that is increasing in both incidence and technical complexity; where simulation is becoming common, but evidence is limited. Real-world performance improvements can be measured following simulation training in other fields, but equivalent measures of intra-operative performance are inadequate. Thus, although surgical simulation is popular and improves simulated performance, there is little objective evidence that it improves intra-operative performance. The original contribution of this thesis is to objectively demonstrate the transfer of simulation training into improved intra-operative technical skills. To achieve this, a systematic literature review investigated the quantitative metrics currently used to measure arthroscopic performance, identifying wireless motion analysis as a potential method to assess performance intra-operatively. Motion analysis is a recognised objective method to measure surgical activity which correlates with surgical experience, so wireless motion analysis was validated against a wired motion analysis method commonly used in simulation but not feasible for intra-operative use. Wireless motion analysis metrics were further validated with a simulated arthroscopy list: this environment allowed deliberate practice of arthroscopic sub-skills with proximate feedback for independent practice. This simulated arthroscopy list with wireless motion analysis was used in two randomised studies: the penultimate study of this thesis investigated the impact of simulated practice on the arthroscopic learning curve and showed that performance improved rapidly with independent practice but was not modified by feedback, while the final study investigated additional simulation practice during early surgical training, and objectively demonstrated that additional simulation training improved intra-operative performance compared to traditional training alone. This thesis is the first to objectively show that simulation affects intra-operative behaviour. It sets the groundwork for further investigations into efficient, cost-effective simulation and the impact of simulation training on patient outcomes.</p

Spite and the scale of competition in Pseudomonas aeruginosa

This work was funded by the European Research Council and the Leverhulme Trust (A.B.), the Natural Environment Research Council (R.F.I. and A.B.), and Balliol College and the Royal Society (A.G.).Scale of competition has been shown to be an important factor in shaping the evolution of social interactions. Although many theoretical and experimental studies have examined its effect on altruistic cooperation, relatively little research effort has been focused on spiteful behaviors-actions that harm both the actor and the recipient. In this study, we expand on existing theory by investigating the importance of the global frequency of spiteful alleles, and we determine experimentally how the scale of competition affects selection for spite in the bacterial pathogen Pseudomonas aeruginosa under high and intermediate spatial relatedness. Consistent with our theoretical results, we found in our experiments that spiteful genotypes are more favored under local (rather than global) competition and intermediate (rather than high) spatial relatedness, conditions that have been shown to select against indiscriminate altruism.Publisher PDFPeer reviewe

Improving simulation training in orthopaedics

The way surgical trainees acquire technical skills is changing in modern surgical training programmes: simulation is proposed as a key part of those changes. Arthroscopy is a surgical technique that is increasing in both incidence and technical complexity; where simulation is becoming common, but evidence is limited. Real-world performance improvements can be measured following simulation training in other fields, but equivalent measures of intra-operative performance are inadequate. Thus, although surgical simulation is popular and improves simulated performance, there is little objective evidence that it improves intra-operative performance. The original contribution of this thesis is to objectively demonstrate the transfer of simulation training into improved intra-operative technical skills. To achieve this, a systematic literature review investigated the quantitative metrics currently used to measure arthroscopic performance, identifying wireless motion analysis as a potential method to assess performance intra-operatively. Motion analysis is a recognised objective method to measure surgical activity which correlates with surgical experience, so wireless motion analysis was validated against a wired motion analysis method commonly used in simulation but not feasible for intra-operative use. Wireless motion analysis metrics were further validated with a simulated arthroscopy list: this environment allowed deliberate practice of arthroscopic sub-skills with proximate feedback for independent practice. This simulated arthroscopy list with wireless motion analysis was used in two randomised studies: the penultimate study of this thesis investigated the impact of simulated practice on the arthroscopic learning curve and showed that performance improved rapidly with independent practice but was not modified by feedback, while the final study investigated additional simulation practice during early surgical training, and objectively demonstrated that additional simulation training improved intra-operative performance compared to traditional training alone. This thesis is the first to objectively show that simulation affects intra-operative behaviour. It sets the groundwork for further investigations into efficient, cost-effective simulation and the impact of simulation training on patient outcomes.</p

Data from: Spite and the scale of competition in Pseudomonas aeruginosa

Scale of competition has been shown to be an important factor in shaping the evolution of the social interactions. Although many theoretical and experimental studies have examined its impact upon altruistic cooperation, relatively little research effort has been focused upon spiteful behaviours: actions that harm both the actor and recipient. In this study, we expand upon the existing theory by investigating the importance of global frequency of spiteful alleles, and we determine experimentally how scale of competition affects selection for spite in the bacterial pathogen Pseudomonas aeruginosa, under high and intermediate spatial relatedness. Consistent with our theoretical results, we find in our experiments that spiteful genotypes are more favoured under local (rather than global) competition and intermediate (rather than high) spatial relatedness; conditions that have been shown to select against indiscriminate altruism

Change in frequency of bacteriocin producers in response to the scale of competition and spatial relatedness

Results from manipulating scale of competition and and spatial relatedness. Colonies were picked randomly from plates and used to inoculate the subsequent transfer. These results score the number of producing (p) and sensitive (c) colonies used to inoculate the subsequent tubes of media

Invasion of bacteriocin producer and an isogenic non producing mutant that does not produce under a range of different starting frequencies

Colony counts for competition assays between bacteriocin producing, non-producing, and sensitive strains, with relative fitness calculations. Competitions include both direct (in the same tube) and indirect (separate tubes) data

Validating the accuracy of a novel virtual reality platform for determining implant orientation in simulated primary total hip replacement

Introduction Accurate acetabular cup and femoral stem component orientation are critical for optimising patient outcomes, reducing complications and increasing component longevity following total hip replacement (THR). This study aimed to determine the accuracy of a novel virtual reality (VR) platform in assessing component orientation in a simulated THR model. Methods The VR platform (HTC Vive Pro® system hardware) was compared against the validated Vicon® optical motion capture (MoCap) system. An acetabular cup and femoral stem were manually implanted across a range of orientations into pelvic and femur sawbones, respectively. Simultaneous readings of the acetabular cup operative anteversion (OA) and inclination (OI) and femoral stem alignment (FSA) and neck anteversion (FNA) were obtained from the VR and MoCap systems. Statistical analysis was performed using Pearson product-moment correlation coefficient (PPMCC) (Pearson’s r) and linear regression (R 2 ). Results A total of 55 readings were obtained for the acetabular cup and 68 for the femoral stem model. The mean average differences in OA, OI, FSA and FNA between the systems were 3.44°, −0.01°, 0.01° and −0.04°, respectively. Strong positive correlations were demonstrated between both systems in OA, OI, FSA and FNA, with Pearson’s r = 0.92, 0.94, 0.99 and 0.99, and adjusted R 2  = 0.82, 0.9, 0.98 and 0.98, respectively. Conclusion The novel VR platform is highly accurate and reliable in determining both acetabular cup and femoral stem component orientations in simulated THR models. This adaptable and cost-effective digital tracking platform may be modified for use in a range of simulated surgical training and educational purposes, particularly in orthopaedic surgery