AimTo evaluate whether performing ventral hernia repairs using the Ethicon Physiomesh™ Open Flexible Composite Mesh Device in conjunction with the Ethicon Securestrap® Open Absorbable Strap Fixation Device reduces surgical time and surgeon stress levels, compared with traditional surgical repair methods.MethodsTo repair a simulated ventral incisional hernia, two surgeries were performed by eight experienced surgeons using a live porcine model. One procedure involved traditional suture methods and a flat mesh, and the other procedure involved a mechanical fixation device and a skirted flexible composite mesh. A Surgery Task Load Index questionnaire was administered before and after the procedure to establish the surgeons’ perceived stress levels, and saliva samples were collected before, during, and after the surgical procedures to assess the biologically expressed stress (cortisol and salivary alpha amylase) levels.ResultsFor mechanical fixation using the Ethicon Physiomesh Open Flexible Composite Mesh Device in conjunction with the Ethicon Securestrap Open Absorbable Strap Fixation Device, surgeons reported a 46.2% reduction in perceived workload stress. There was also a lower physiological reactivity to the intraoperative experience and the total surgical procedure time was reduced by 60.3%.ConclusionsThis study provides preliminary findings suggesting that the combined use of a mechanical fixation device and a skirted flexible composite mesh in an open intraperitoneal onlay mesh repair has the potential to reduce surgeon stress. Additional studies are needed to determine whether a reduction in stress is observed in a clinical setting and, if so, confirm that this results in improved clinical outcomes.
Existing methods for eliciting health state preferences vary considerably in approach, but have in common an aim to 'uncover' preferences by asking survey respondents to evaluate a sub-set of states, then using their responses to infer the relative importance of specific dimensions and levels. An alternative approach is to ask people to construct their own personal utility functions (PUFs) by directly asking them about the relative importance of dimensions, levels and interactions between them. We developed an innovative questionnaire designed to elicit PUFs from the general public via computer-assisted face-to-face interviews. We piloted the questionnaire with a convenience sample of n= 30 health outcomes professionals. The aims of this paper are to report the pilot results and discuss the feasibility of the PUF approach in valuing EQ-5D. MethOds: The approach is grounded in utility theory, and informed by swing-weighting techniques. 30 interviews were conducted in 2015 by a member of the study team. Respondents were encouraged to reflect on their answers and to change any previous responses. The approach is based on the premise that individuals construct their preferences in response to stated preference tasks. Results: Overall, pain/discomfort and anxiety/depression are the highest ranked dimensions and mobility is the lowest ranked dimension. High levels of internal consistency were observed. The ratings for intermediate improvements in each dimension show heterogeneity, both within and between participants. The validation exercise results demonstrate that the PUF algorithm works as intended. The task to identify the individual's location of dead within the descriptive system worked well. 20% of participants indicated that no EQ-5D health states are worse than dead. The data allow the reporting of individual respondents' PUFs. cOnclusiOns: The results of the pilot suggest the PUF approach is likely to be feasible and has potential to yield meaningful, well-informed preference data from respondents.
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