PeerJ Preprints: Surgery and Surgical Specialtieshttps://peerj.com/preprints/index.atom?journal=peerj&subject=7000Surgery and Surgical Specialties articles published in PeerJ PreprintsSchedule feasibility and workflow for additive manufacturing of titanium plates for cranioplasty reconstruction in canine skull tumorshttps://peerj.com/preprints/277072019-05-062019-05-06Jordan JamesMichelle L OblakAlex zur LindenFiona MK JamesMatt ParkesJohn Phillips
Additive manufacturing has allowed for the creation of a patient-specific custom solution that can resolve many of the limitations previously reported for canine cranioplasty. The purpose of this pilot study was to determine the schedule feasibility and workflow in manufacturing patient-specific titanium implants for canines undergoing cranioplasty immediately following craniectomy. Computed tomography scans from patients with tumors of the skull were considered and 3 cases were selected. Images were imported into OsiriX MD image processing software and tumor margins were determined based on agreement between a board-certified veterinary radiologist and veterinary surgical oncologist. Virtual surgical planning was performed and a 5mm bone margin was selected. A defect was created to simulate the intraoperative defect. Stereolithography format files of the skulls were imported into Renishaw Additive-manufacture for Design-led Efficient Patient Treatment (ADEPT) software. In collaboration with medical solution center, Additive Design in Surgical Solutions (ADEISS), a custom titanium plate was designed with the input of an applications engineer and veterinary surgical oncologist. Plates were printed in titanium and postprocessed at ADEISS. Total planning time was approximately 2 hours with a manufacturing time of 2 weeks. Based on the findings of this study, with access to an advanced 3D metal printing medical solution center that can provide advanced software and printing, patient-specific additive manufactured titanium implants can be planned, created, processed, shipped and sterilized for patient use within a 3-week turnaround.
Additive manufacturing has allowed for the creation of a patient-specific custom solution that can resolve many of the limitations previously reported for canine cranioplasty. The purpose of this pilot study was to determine the schedule feasibility and workflow in manufacturing patient-specific titanium implants for canines undergoing cranioplasty immediately following craniectomy. Computed tomography scans from patients with tumors of the skull were considered and 3 cases were selected. Images were imported into OsiriX MD image processing software and tumor margins were determined based on agreement between a board-certified veterinary radiologist and veterinary surgical oncologist. Virtual surgical planning was performed and a 5mm bone margin was selected. A defect was created to simulate the intraoperative defect. Stereolithography format files of the skulls were imported into Renishaw Additive-manufacture for Design-led Efficient Patient Treatment (ADEPT) software. In collaboration with medical solution center, Additive Design in Surgical Solutions (ADEISS), a custom titanium plate was designed with the input of an applications engineer and veterinary surgical oncologist. Plates were printed in titanium and postprocessed at ADEISS. Total planning time was approximately 2 hours with a manufacturing time of 2 weeks. Based on the findings of this study, with access to an advanced 3D metal printing medical solution center that can provide advanced software and printing, patient-specific additive manufactured titanium implants can be planned, created, processed, shipped and sterilized for patient use within a 3-week turnaround.Nintendo Da Vinci: Implementing a novel control system to improve performance in robotic assisted surgery – A pilot studyhttps://peerj.com/preprints/276372019-04-052019-04-05Ibrahim S Al-Akash
Complications of robotic-assisted surgery are on the rise, partly due to surgeons not receiving proper training. Using the current Da Vinci (DV) surgical system, 150-3,000 surgeries must be performed to achieve proficiency. To improve performance, a new system was developed using Nintendo Joycon (NJ) controls. The system was tested using NJ and the DV control systems, with two users (gamer and doctor), in a simulated skills assessment in 2-dimensional (2D) and 3-dimensional (3D) modes. The simulation completion time and error count were used to calculate a Fundamentals of Robotic Surgery Skills Assessment (FRS) score. The results indicate the task time, error, FRS scores, and learning rates had improved significantly (p<0.05). The risk ratios indicate the Da Vinci control system increases the risk of error significantly (p<0.05). Based on the data collected in this study, implementing a Nintendo Joycon control system improves task time by 83% for the doctor and by 88% for the gamer, reduces error by 73% for the doctor and by 82% for the gamer, improves FRS score by 72% for the doctor and by 46% for the gamer, and accelerates the learning rate by 84% for the doctor and by 86% for the gamer. The data collected indicates that implementing a Nintendo Joycon control system will significantly improve surgical performance by accelerating the learning rate and reducing error.
Complications of robotic-assisted surgery are on the rise, partly due to surgeons not receiving proper training. Using the current Da Vinci (DV) surgical system, 150-3,000 surgeries must be performed to achieve proficiency. To improve performance, a new system was developed using Nintendo Joycon (NJ) controls. The system was tested using NJ and the DV control systems, with two users (gamer and doctor), in a simulated skills assessment in 2-dimensional (2D) and 3-dimensional (3D) modes. The simulation completion time and error count were used to calculate a Fundamentals of Robotic Surgery Skills Assessment (FRS) score. The results indicate the task time, error, FRS scores, and learning rates had improved significantly (p<0.05). The risk ratios indicate the Da Vinci control system increases the risk of error significantly (p<0.05). Based on the data collected in this study, implementing a Nintendo Joycon control system improves task time by 83% for the doctor and by 88% for the gamer, reduces error by 73% for the doctor and by 82% for the gamer, improves FRS score by 72% for the doctor and by 46% for the gamer, and accelerates the learning rate by 84% for the doctor and by 86% for the gamer. The data collected indicates that implementing a Nintendo Joycon control system will significantly improve surgical performance by accelerating the learning rate and reducing error.A protocol for a survey of patient perceptions about outpatient joint replacement surgery (The RAAPID survey)https://peerj.com/preprints/274642019-01-032019-01-03Taylor WoolnoughKim MaddenAnthony AdiliVickas KhannaJustin deBeerMitchell WinemakerThomas WoodDaniel Tushinski
Background: Total knee arthroplasty (TKA) and total hip arthroplasty (THA), are the second and third most common surgical procedures performed in Canada, accounting for more than 600,000 acute care bed days and over $1 billion CAD in healthcare spending. The demand for these procedures, both in Canada and internationally, is only expected to increase. Same-day discharge has been demonstrated to be safe and effective in properly selected patients and has the potential to greatly decrease the cost of THA and TKA, collectively referred to as total joint arthroplasty (TJA). The existing literature focuses on implementing outpatient TJA from the physician’s perspective. However, patient opinions do not always align with physician opinions. To date, only one study has explored patients’ perspectives regarding outpatient TJA; many questions remain unanswered. To effectively implement or expand outpatient joint replacement programs, detailed exploration of the patient perspective is necessary.
Methods: This study is a multicentre cross-sectional survey to primarily determine the proportion of patients who are open to outpatient TJA. Adult patients scheduled for primary TJA surgery or those who have received TJA surgery in the past year will be included in the survey. The secondary objectives of this survey are to determine patient characteristics associated with openness to outpatient TJA, describe patient concerns regarding outpatient TJA, and identify potential methods to increase patient comfort with outpatient TJA.
Discussion: Resource expenditure and clinical practice are increasingly guided by subjective patient outcomes, especially in the area of joint replacement. With the current focus on cost-efficiency in healthcare, there is increasing interest in outpatient TJA. By exploring how patients perceive outpatient TJA, this study may serve to guide the development of educational resources and programs to enhance and support outpatient TJA. Addressing concerns identified by patients in an evidence-based manner has the potential to improve patient satisfaction and outcomes in the growing trend of outpatient TJA.
Background: Total knee arthroplasty (TKA) and total hip arthroplasty (THA), are the second and third most common surgical procedures performed in Canada, accounting for more than 600,000 acute care bed days and over $1 billion CAD in healthcare spending. The demand for these procedures, both in Canada and internationally, is only expected to increase. Same-day discharge has been demonstrated to be safe and effective in properly selected patients and has the potential to greatly decrease the cost of THA and TKA, collectively referred to as total joint arthroplasty (TJA). The existing literature focuses on implementing outpatient TJA from the physician’s perspective. However, patient opinions do not always align with physician opinions. To date, only one study has explored patients’ perspectives regarding outpatient TJA; many questions remain unanswered. To effectively implement or expand outpatient joint replacement programs, detailed exploration of the patient perspective is necessary.Methods: This study is a multicentre cross-sectional survey to primarily determine the proportion of patients who are open to outpatient TJA. Adult patients scheduled for primary TJA surgery or those who have received TJA surgery in the past year will be included in the survey. The secondary objectives of this survey are to determine patient characteristics associated with openness to outpatient TJA, describe patient concerns regarding outpatient TJA, and identify potential methods to increase patient comfort with outpatient TJA.Discussion: Resource expenditure and clinical practice are increasingly guided by subjective patient outcomes, especially in the area of joint replacement. With the current focus on cost-efficiency in healthcare, there is increasing interest in outpatient TJA. By exploring how patients perceive outpatient TJA, this study may serve to guide the development of educational resources and programs to enhance and support outpatient TJA. Addressing concerns identified by patients in an evidence-based manner has the potential to improve patient satisfaction and outcomes in the growing trend of outpatient TJA.Trochanteric pain in patients undergoing total hip arthroplasty: A protocol for a systematic reviewhttps://peerj.com/preprints/272932018-10-222018-10-22Daniel AxelrodKim MaddenLaura BanfieldMitchell WinemakerJustin deBeerThomas Wood
Background: Total hip arthroplasty (THA) is one of the most common surgical procedures. Although THA surgeries are typically very successful, between 3% and 17% of all patients experience trochanteric pain after surgery. Unfortunately, there remains little high quality and reproducible evidence surrounding this disorder, especially following total hip replacement. The objectives of this review are to describe, among pre-operative or post-operative primary THA patients the prevalence, treatments, prognosis, risk factors, and diagnostic methods available for trochanteric pain.
Methods: This is a protocol for a descriptive systematic review of trochanteric pain among THA patients. We will include studies of all study designs, with the exception of non-systematic reviews and expert opinion, with no date limits. We will search Medline, Embase, CINAHL, and the Cochrane Library using the Ovid search interface. We will also search the reference lists of included studies for possible missed studies. We will use the systematic review management software Rayyan to assist with study screening. Two reviewers will independently review studies for inclusion and extract data into a study-specific database.
Discussion: This study will add to the literature by comprehensively and systematically evaluating the available literature on trochanteric pain after THA. Previous studies have been conducted on the topic but they were not comprehensive or did not review the literature systematically. Additionally, our study will critically evaluate the methodological quality of the included studies, adding an evidence-based component to the review. This review will help orthopaedic surgeons better care for patients with trochanteric pain after THA, and will identify knowledge gaps for future research.
Registration: This protocol will be registered on PROSPERO
Background: Total hip arthroplasty (THA) is one of the most common surgical procedures. Although THA surgeries are typically very successful, between 3% and 17% of all patients experience trochanteric pain after surgery. Unfortunately, there remains little high quality and reproducible evidence surrounding this disorder, especially following total hip replacement. The objectives of this review are to describe, among pre-operative or post-operative primary THA patients the prevalence, treatments, prognosis, risk factors, and diagnostic methods available for trochanteric pain.Methods: This is a protocol for a descriptive systematic review of trochanteric pain among THA patients. We will include studies of all study designs, with the exception of non-systematic reviews and expert opinion, with no date limits. We will search Medline, Embase, CINAHL, and the Cochrane Library using the Ovid search interface. We will also search the reference lists of included studies for possible missed studies. We will use the systematic review management software Rayyan to assist with study screening. Two reviewers will independently review studies for inclusion and extract data into a study-specific database.Discussion: This study will add to the literature by comprehensively and systematically evaluating the available literature on trochanteric pain after THA. Previous studies have been conducted on the topic but they were not comprehensive or did not review the literature systematically. Additionally, our study will critically evaluate the methodological quality of the included studies, adding an evidence-based component to the review. This review will help orthopaedic surgeons better care for patients with trochanteric pain after THA, and will identify knowledge gaps for future research.Registration: This protocol will be registered on PROSPEROThe effect of postoperative oral antibiotic therapy on the incidence of postoperative endophthalmitis after phacoemulsification surgery in dogs. 320 eyes (1997-2006)https://peerj.com/preprints/270912018-08-042018-08-04Amanda T. CorrDaniel A. Ward
Purpose. To assess the effectiveness of postoperative administration of oral antibiotics at reducing the incidence of endophthalmitis following phacoemulsification cataract extraction in dogs.
Methods. Medical records of the University of Tennessee College of Veterinary Medicine were reviewed for cases having undergone phacoemulsification and divided according to whether or not they had received oral antibiotics postoperatively. Records were then evaluated for a diagnosis of endophthalmitis and incidence rates between the group receiving postoperative oral antibiotics and the group not receiving postoperative oral antibiotics were compared.
Results. A total of 185 patients (320 eyes) were identified by the search. 113 patients (197 eyes) were treated with oral antibiotics postoperatively. 72 patients (123 eyes) were not treated with oral antibiotics postoperatively. Two cases of endophthalmitis were identified, with 1 in each group (P>0.05, Fisher’s exact test).
Conclusions. The overall incidence of endophthalmitis in this study was 0.63%. The rate of postphacoemulsification endophthalmitis was unaffected by the postoperative administration of oral antibiotics.
Purpose. To assess the effectiveness of postoperative administration of oral antibiotics at reducing the incidence of endophthalmitis following phacoemulsification cataract extraction in dogs.Methods. Medical records of the University of Tennessee College of Veterinary Medicine were reviewed for cases having undergone phacoemulsification and divided according to whether or not they had received oral antibiotics postoperatively. Records were then evaluated for a diagnosis of endophthalmitis and incidence rates between the group receiving postoperative oral antibiotics and the group not receiving postoperative oral antibiotics were compared.Results. A total of 185 patients (320 eyes) were identified by the search. 113 patients (197 eyes) were treated with oral antibiotics postoperatively. 72 patients (123 eyes) were not treated with oral antibiotics postoperatively. Two cases of endophthalmitis were identified, with 1 in each group (P>0.05, Fisher’s exact test).Conclusions. The overall incidence of endophthalmitis in this study was 0.63%. The rate of postphacoemulsification endophthalmitis was unaffected by the postoperative administration of oral antibiotics.The laryngeal tie-forward procedure to alleviate aspiration of feed caused by hypoplasia of the soft palate of an adult marehttps://peerj.com/preprints/266382018-03-072018-03-07José R CastroJim Schumacher
Background
An adult mare, presented to the University of Tennessee’s Veterinary MedicalCenter because of chronic, persistent coughing and abnormal respiratory noise,was found, during endoscopic examination of its nasopharynx and larynx, to havehypoplasia of the caudal fourth of its soft palate and an aryepiglottic fold entrapment.The mare had developed chronic discharge of feed from the nares after the aryepiglotticfold entrapment was relieved with a laser, using endoscopic guidance.
Methods
The mare received a laryngeal tie forward procedure to ameliorate discharge of feedfrom the nares by decreasing the gap between the apex of the epiglottis and thesoft palate.
Results
The distance between the epiglottis and the soft palate appeared to have beenreduced during endoscopic examination of the nasopharynx, and the horse nolonger experienced discharge of feed from the nares or persistent coughing. Thehorse continued to produce abnormal respiratory noise but was able to be usedfor trail riding.
Discussion
The tie-forward procedure should be considered as a treatment to ameliorate signs of hypoplastic soft palate in horses, if the palatal defect is short.
BackgroundAn adult mare, presented to the University of Tennessee’s Veterinary MedicalCenter because of chronic, persistent coughing and abnormal respiratory noise,was found, during endoscopic examination of its nasopharynx and larynx, to havehypoplasia of the caudal fourth of its soft palate and an aryepiglottic fold entrapment.The mare had developed chronic discharge of feed from the nares after the aryepiglotticfold entrapment was relieved with a laser, using endoscopic guidance.MethodsThe mare received a laryngeal tie forward procedure to ameliorate discharge of feedfrom the nares by decreasing the gap between the apex of the epiglottis and thesoft palate.ResultsThe distance between the epiglottis and the soft palate appeared to have beenreduced during endoscopic examination of the nasopharynx, and the horse nolonger experienced discharge of feed from the nares or persistent coughing. Thehorse continued to produce abnormal respiratory noise but was able to be usedfor trail riding.DiscussionThe tie-forward procedure should be considered as a treatment to ameliorate signs of hypoplastic soft palate in horses, if the palatal defect is short.Robotic Olympics: A novel robotic surgical training experience for residents in an obstetrics and gynecology residency programhttps://peerj.com/preprints/35102018-01-072018-01-07Malte RenzEric LibermanBrian DanielsSara IsaniDennis Y KuoNicole Nevadunsky
Background: Resident experience and opinions regarding robotic surgical training as part of the formal obstetrics and gynecology curriculum has not been reported.
Objective: To evaluate residents’ experience with the newly introduced Robotic Olympics and a robotic surgical trainings curriculum in general, especially in correlation with future career goals.
Methods: All residents of the Obstetrics and Gynecology Residency Program at the Montefiore Medical Center, who participated in the Robotic Olympics 2014, a team-based simulation competition, completed a de-identified pre- and post-Olympics survey.
Results: For the participating 31 residents, the mean number of bedside-assistant robotic and console cases was 8 (0-50) and 4 (0-30), respectively. Both were positively associated with postgraduate level. The majority of residents (89%) reported that they were best trained in open surgery. Only 52% anticipated using robotic surgery in their future practice. Anticipated use of the robot and interest in robotic training were correlated with surgical subspecialty career goals. 100% of residents aspiring a career in gynecologic oncology and none interested in maternofetal medicine anticipated future use of robotic surgery. However, all residents desired the Robotic Olympics to be integral part of resident education.
Conclusions: The majority of residents welcomed the addition of the Robotic Olympics to the robotic-surgical curriculum. However, the residents’ interest in robotic surgical training in general was disparate and correlated with the anticipated use of the robot in the residents’ future career. This data suggests the need for directed robotic surgical training for residents interested in surgical sub-specialties to focus resources early on.
Background: Resident experience and opinions regarding robotic surgical training as part of the formal obstetrics and gynecology curriculum has not been reported.Objective: To evaluate residents’ experience with the newly introduced Robotic Olympics and a robotic surgical trainings curriculum in general, especially in correlation with future career goals.Methods: All residents of the Obstetrics and Gynecology Residency Program at the Montefiore Medical Center, who participated in the Robotic Olympics 2014, a team-based simulation competition, completed a de-identified pre- and post-Olympics survey.Results: For the participating 31 residents, the mean number of bedside-assistant robotic and console cases was 8 (0-50) and 4 (0-30), respectively. Both were positively associated with postgraduate level. The majority of residents (89%) reported that they were best trained in open surgery. Only 52% anticipated using robotic surgery in their future practice. Anticipated use of the robot and interest in robotic training were correlated with surgical subspecialty career goals. 100% of residents aspiring a career in gynecologic oncology and none interested in maternofetal medicine anticipated future use of robotic surgery. However, all residents desired the Robotic Olympics to be integral part of resident education.Conclusions: The majority of residents welcomed the addition of the Robotic Olympics to the robotic-surgical curriculum. However, the residents’ interest in robotic surgical training in general was disparate and correlated with the anticipated use of the robot in the residents’ future career. This data suggests the need for directed robotic surgical training for residents interested in surgical sub-specialties to focus resources early on.Cross-institutional evaluation of a mastoidectomy assessment instrumenthttps://peerj.com/preprints/29542017-10-022017-10-02Thomas KerwinBrad HittleDon StredneyPaul De BoeckGregory Wiet
Objective: The objective of this work is to obtain validity evidence for an evaluation instrument used to assess the performance level of a mastoidectomy. The instrument has been previously described and had been formulated by a multi-institutional consortium.
Design: Mastoidectomies were performed on a virtual temporal bone system and then rated by experts using a previously described 15 element task-based checklist. Based on the results, a second, similar checklist was created and a second round of rating was performed.
Setting: Twelve otolaryngological surgical training programs in the United States.
Participants: 65 mastoidectomy performances were evaluated coming from 37 individuals with a variety of temporal bone dissection experience, from medical students to attending physicians. Raters were attending surgeons from 12 different institutions.
Results: Intraclass correlation (ICC) scores varied greatly between items in the checklist with some being low and some being high. Percentage agreement scores were similar to previous rating instruments. There is strong evidence that a high score on the task-based checklist is necessary for a rater to consider a mastoidectomy to be performed at the level of an expert but a high score is not a sufficient condition.
Conclusions: Rewording of the instrument items to focus on safety does not result in increased reliability of the instrument. The strong result of the Necessary Condition Analysis suggests that going beyond simple correlation measures can give extra insight into grading results. Additionally, we suggest using a multiple point scale instead of a binary pass/fail question combined with descriptive mastery levels.
Objective: The objective of this work is to obtain validity evidence for an evaluation instrument used to assess the performance level of a mastoidectomy. The instrument has been previously described and had been formulated by a multi-institutional consortium.Design: Mastoidectomies were performed on a virtual temporal bone system and then rated by experts using a previously described 15 element task-based checklist. Based on the results, a second, similar checklist was created and a second round of rating was performed.Setting: Twelve otolaryngological surgical training programs in the United States.Participants: 65 mastoidectomy performances were evaluated coming from 37 individuals with a variety of temporal bone dissection experience, from medical students to attending physicians. Raters were attending surgeons from 12 different institutions.Results: Intraclass correlation (ICC) scores varied greatly between items in the checklist with some being low and some being high. Percentage agreement scores were similar to previous rating instruments. There is strong evidence that a high score on the task-based checklist is necessary for a rater to consider a mastoidectomy to be performed at the level of an expert but a high score is not a sufficient condition.Conclusions: Rewording of the instrument items to focus on safety does not result in increased reliability of the instrument. The strong result of the Necessary Condition Analysis suggests that going beyond simple correlation measures can give extra insight into grading results. Additionally, we suggest using a multiple point scale instead of a binary pass/fail question combined with descriptive mastery levels.The effects of allogenic stem cells in a murine model of hind limb diabetic ischemic tissuehttps://peerj.com/preprints/30752017-07-072017-07-07Jesús Álvarez GarcíaSoledad García Gómez-HerasLuis Riera del MoralCarlota LargoDamián García-OlmoMariano García-Arranz
Background: Diabetes is one of the major risk factors for peripheral arterial disease. In patients in whom surgery cannot be performed, cell therapy may be an alternative treatment. Since time is crucial for these patients, we propose the use of allogenic mesenchymal cells. Methods: We obtained mesenchymal cells derived from the fat tissue of a healthy Sprague-Dawley rat. Previous diabetic induction with streptozotocin in 40 male Sprague-Dawley rats, ligation plus left iliac and femoral artery sections were performed as a previously described model of ischemia. After 10 days of follow-up, macroscopic and histo-pathological analysis was performed to evaluate angiogenic and inflammatory parameters in the repair of the injured limb. All samples were evaluated by the same blind researcher. Statistical analysis was performed using the SPSS v.11.5 program (p <0.05). Results: Seventy percent of the rats treated with streptozotocin met the criteria for diabetes. Macroscopically, cell-treated rats presented better general and lower ischemic clinical status, and histologically, a better trend towards angiogenesis, greater infiltration of type 2 macrophages and a shortening of the inflammatory process. However, only the inflammatory variables were statistically significant. No immunological reaction was observed with the use of allogeneic cells. Discussion: The application of allogeneic ASCs in a hind limb ischemic model in diabetic animals shows no rejection reactions and a reduction in inflammatory parameters in favor of better repair of damaged tissue. These results are consistent with other lines of research in allogeneic cell therapy. This approach might be a safe, effective treatment option that makes it feasible to avoid the time involved in the process of isolation, expansion and production of the use of autologous cells.
Background: Diabetes is one of the major risk factors for peripheral arterial disease. In patients in whom surgery cannot be performed, cell therapy may be an alternative treatment. Since time is crucial for these patients, we propose the use of allogenic mesenchymal cells. Methods: We obtained mesenchymal cells derived from the fat tissue of a healthy Sprague-Dawley rat. Previous diabetic induction with streptozotocin in 40 male Sprague-Dawley rats, ligation plus left iliac and femoral artery sections were performed as a previously described model of ischemia. After 10 days of follow-up, macroscopic and histo-pathological analysis was performed to evaluate angiogenic and inflammatory parameters in the repair of the injured limb. All samples were evaluated by the same blind researcher. Statistical analysis was performed using the SPSS v.11.5 program (p <0.05). Results: Seventy percent of the rats treated with streptozotocin met the criteria for diabetes. Macroscopically, cell-treated rats presented better general and lower ischemic clinical status, and histologically, a better trend towards angiogenesis, greater infiltration of type 2 macrophages and a shortening of the inflammatory process. However, only the inflammatory variables were statistically significant. No immunological reaction was observed with the use of allogeneic cells. Discussion: The application of allogeneic ASCs in a hind limb ischemic model in diabetic animals shows no rejection reactions and a reduction in inflammatory parameters in favor of better repair of damaged tissue. These results are consistent with other lines of research in allogeneic cell therapy. This approach might be a safe, effective treatment option that makes it feasible to avoid the time involved in the process of isolation, expansion and production of the use of autologous cells.Multi-institutional development of a mastoidectomy performance evaluation instrumenthttps://peerj.com/preprints/29312017-04-182017-04-18Thomas KerwinBrad HittleDon StredneyPaul De BoeckGregory Wiet
A method for rating surgical performance of a mastoidectomy procedure that is shown to apply universally across teaching institutions has not yet been devised. This work describes the development of a rating instrument created from a multi-institutional consortium. Using a participatory design and a modified Delphi approach, a multi-institutional group of expert otologists constructed a 15 element task-based checklist for evaluating mastoidectomy performance. This instrument was further refined into a 14 element checklist focusing on the concept of safety after using it to rate a large and varied population of performances. By using 14 experts from 12 different institutions and a literature review, individual metrics were identified, rated as to the level of importance and operationally defined to create a rating scale for mastoidectomy performance. Initial use of the rating scale showed modest rater agreement. The operational definitions of individual metrics were modified to emphasize “safe” as opposed to “proper” technique. A second rating instrument was developed based on this feedback. Using a consensus building approach with multiple rounds of communication between experts is a feasible way to construct a rating instrument for mastoidectomy. Expert opinion alone using a Delphi method provides face and content validity evidence, however, this is not sufficient to develop a universally acceptable rating instrument. A continued process of development and experimentation to demonstrate evidence for reliability and validity making use of a large population of raters and performances is necessary to achieve universal acceptance.
A method for rating surgical performance of a mastoidectomy procedure that is shown to apply universally across teaching institutions has not yet been devised. This work describes the development of a rating instrument created from a multi-institutional consortium. Using a participatory design and a modified Delphi approach, a multi-institutional group of expert otologists constructed a 15 element task-based checklist for evaluating mastoidectomy performance. This instrument was further refined into a 14 element checklist focusing on the concept of safety after using it to rate a large and varied population of performances. By using 14 experts from 12 different institutions and a literature review, individual metrics were identified, rated as to the level of importance and operationally defined to create a rating scale for mastoidectomy performance. Initial use of the rating scale showed modest rater agreement. The operational definitions of individual metrics were modified to emphasize “safe” as opposed to “proper” technique. A second rating instrument was developed based on this feedback. Using a consensus building approach with multiple rounds of communication between experts is a feasible way to construct a rating instrument for mastoidectomy. Expert opinion alone using a Delphi method provides face and content validity evidence, however, this is not sufficient to develop a universally acceptable rating instrument. A continued process of development and experimentation to demonstrate evidence for reliability and validity making use of a large population of raters and performances is necessary to achieve universal acceptance.