Medicine is a rapidly-evolving discipline, with progress picking up pace with each passing decade. This constant evolution results in the introduction of new tools and methods, which in turn occasionally leads to paradigm shifts across the affected medical fields. The following review attempts to showcase how 3D printing has begun to reshape and improve processes across various medical specialties and where it has the potential to make a significant impact. The current state-of-the-art, as well as real-life clinical applications of 3D printing, are reflected in the perspectives of specialists practicing in the selected disciplines, with a focus on pre-procedural planning, simulation (rehearsal) of non-routine procedures, and on medical education and training. A review of the latest multidisciplinary literature on the subject offers a general summary of the advances enabled by 3D printing. Numerous advantages and applications were found, such as gaining better insight into patient-specific anatomy, better pre-operative planning, mock simulated surgeries, simulation-based training and education, development of surgical guides and other tools, patient-specific implants, bioprinted organs or structures, and counseling of patients. It was evident that pre-procedural planning and rehearsing of unusual or difficult procedures and training of medical professionals in these procedures are extremely useful and transformative.
Introduction.The COVID-19 pandemic greatly disrupted the national healthcare system in Poland, resulting in the implementation of new protocols allowing only patients with severe diagnoses to receive immediate treatment. Given that an intracranial aneurysm (IA) is regarded as one of the most severe diagnoses, we planned to assess whether the current protocol has successfully provided the standard treatment for IAs. Material and methods.Data on all IA cases treated from 2015 to 2020 was extracted from the JGP (a homogeneous group of patients) catalogue provided by the National Health Index of Poland (NFZ, Narodowy Fundusz Zdrowia). Poisson regression was used to determine the significance of the change in hospital admissions, and differences between proportions were analysed using the "N-1" Chi-squared test.Results. A total of 21,801 IA patients treated during 2015-2020 were included in this study. The overall number of hospitalisations due to IAs fell in the open surgery group, but not in the endovascular cohort. Mortality rates following IA treatment increased significantly by 21% in 2020 compared to preceding years. The demographics changed as well; the patients were significantly younger during the pandemic. Conclusions.Our findings show that the current strategy for optimal care for patients diagnosed with IAs in Poland during the pandemic is failing to maintain high quality treatment. New methods to improve the current plan should be implemented to address future crises.
(1) Background: The pandemic of COVID-19 and subsequent lockdown strategies had a profound impact on many aspects of everyday life. During this time the world faced the unprecedented crisis of healthcare disrupting timely care delivery. This study was designed to evaluate the impact of the pandemic on the acute treatment of stroke in Poland. (2) Methods: The national data on hospitalizations with stroke as a primary diagnosis were obtained from the National Health Fund of Poland. Poisson regression was used to determine the significance of the change in hospital admissions. The differences between proportions were analyzed using the “N-1” Chi-squared test. (3) Results: During the COVID-19 period, the number of hospitalizations dropped by 8.28% with a monthly nadir of 22.02 in April. On a monthly scale during 2020, the greatest decrease was 22.02%. The thrombolysis ratio was also affected, with the highest monthly drop of 15.51% in November. The overall number of in-hospital deaths did not change. (4) Conclusions: The pandemic caused a serious disruption of the acute care of stroke. There is no evidence that the quality of care was seriously compromised.
YouTube (YT) has become a popular health information reservoir. In this study, we aimed to evaluate the content and quality of YT videos as a source of patient information for meningiomas. A YT search was conducted for the following terms: “meningioma”, “meningiomas”, “meningeal tumor”, and “psammoma”. A total of 119 videos were examined by five independent raters, using validated quality criteria, including the Quality Criteria for Consumer Health Information (DISCERN), the Journal of the American Medical Association instrument (JAMA), and the Global Quality Score (GQS). The mean DISCERN score was 35.6 points, while the mean GQS and JAMA scores were 2.4 and 1.8, respectively. The majority of the videos were produced in the United States (37.82%). Moreover, 47.9% of the evaluated videos were graded as “poor” and only 9.24% were “good”. Statistically higher scores in all three scoring systems were associated with the following information: tumor localization, clinical manifestations, indications for surgery, treatment options, risks, adjuvant therapies, results, follow up, diagrams, and those that featured a doctor as the speaker. Misleading information was presented in 35 productions. Our findings show that the overall quality of YT on the topic of meningiomas is defective, and requires further improvement and evaluation.
OBJECTIVE Laminoplasty is a common treatment for cervical spondylotic myelopathy (CSM) and for ossification of the posterior longitudinal ligament (OPLL). However, approximately 21% of patients undergoing laminoplasty develop cervical kyphotic deformity (KD). Because of the high prevalence rate of KD, several studies have sought to identify predictors for this complication, but the findings remain highly inconsistent. Therefore, the authors performed a systematic review and meta-analysis to establish reliable preoperative predictors of KD. METHODS PubMed, Scopus, and Web of Science databases were used to systematically extract potential references. The first phase of screening required the studies to be written in the English language, involve patients treated for CSM and/or OPLL via laminoplasty, and report postoperative cervical KD. The second phase required the studies to provide more than 10 patients and include a control group. The mean difference (MD) and odds ratio (OR) were calculated for continuous and dichotomous parameters. Study quality was evaluated using the Newcastle-Ottawa Scale. CSM and OPLL patients were further assessed by performing subgroup analyses. RESULTS Thirteen studies comprising patients who developed cervical KD (n = 296) and no KD (n = 1254) after receiving cervical laminoplasty for CSM or OPLL were included in the meta-analysis. All studies were retrospective cohorts and were rated as high quality. In the combined univariate analysis of CSM and OPLL patients undergoing laminoplasty, statistically significant predictors for postoperative KD included age (MD 2.22, 95% CI 0.16–4.27, p = 0.03), preoperative BMI (MD 0.85, 95% CI 0.06–1.63, p = 0.04), preoperative C2–7 range of flexion (MD 10.42, 95% Cl 4.24–16.59, p = 0.0009), preoperative C2–7 range of extension (MD −4.59, 95% CI −6.34 to −2.83, p < 0.00001), and preoperative center of gravity of the head to the C7 sagittal vertical axis (MD 26.83, 95% CI 9.13–44.52, p = 0.003). Additionally, among CSM patients, males were identified as having a greater risk for postoperative KD (OR 1.73, 95% CI 1.02–2.93, p = 0.04). CONCLUSIONS The findings from this study currently provide the largest and most reliable review on preoperative predictors for cervical KD after laminoplasty. Given that several of the included studies identified optimal cutoff points for the variables that are significantly associated with KD, further investigation into the development of a preoperative risk scoring system that can accurately predict KD in the clinical setting is encouraged. PROSPERO registration no.: CRD42022299795 (https://www.crd.york.ac.uk/PROSPERO/).
Background. The coronavirus disease (COVID-19) pandemic has greatly affected the treatment of most medical conditions. In particular, the treatment of seriously ill patients had to be adjusted due to the limited availability of in-hospital procedures.Objectives. The aim of this study was to evaluate the effects of COVID-19-related changes on neurooncological surgeries in the Polish medical system. Materials and methods.Data from the period of 2010-2020 were collected from National Health Insurance database for 2 diagnosis-related groups: A11 (complex intracranial procedures) and A12 (large intra cranial procedures). The total number of procedures and diagnoses per year, trend changes and changes in procedures grouped by medical type were analyzed, including resections/biopsies, malignant/stable (nonmalignant) lesions, elective/acute procedures, and length of stay.Results. Mean yearly numbers of 7177 (standard deviation (SD) = 760) procedures and 5934 (SD = 1185) diagnoses were recorded. Both numbers were growing up to 9. 1% per year until 2018. From 2018, a 3. 1% decrease in the number of procedures was observed, with a significantly larger decrease of 10.5% observed in 2020 (p < 0.001). The number of diagnoses decreased in 2019 by 2.7%, and by 9.2% in 2020 (p = 0.706), with a statistically significant change in the annual growth rate (p = 0.044). The number of resections decreased by 11.5% in 2020 (p = 0.204), with a significant change in the annual growth rate (p < 0.001). The number of biopsies decreased by 2.5% in 2020 (p = 0.018), with the annual decrement in 2019/2020 also being significant (p = 0.004). Decreases were observed in 2019 and 2020 for the number of malignant (0.5% and 6.3%, respectively) and nonmalignant (5.4% and 12.9%, respectively) tumors (p = 0.233 and p = 0.682 for absolute values, and p = 0.008 and p = 0.004 for the annual growth rates, respectively). The number of acute procedures in 2020 further decreased by 9.8% from 5.5% decrease in 2019 (p = 0.004), and the number of elective procedures decreased by 11.8% (p = 0.009). The annual growth rates for both acute and elective procedures were statistically significant (p < 0.001 and p < 0.001). Conclusions.The decrease in the number of neuro-oncological surgeries appeared to be much lower than the 20% decrease observed for general oncological surgeries in Poland during the COVID-19 pandemic. This seems to have resulted from postponing the treatment of less critical cases (i.e., nonmalignant and elective) and focusing on the treatment of the most precarious patients.
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