BackgroundRobot-assisted minimal access surgery (MAS) reduces blood loss, recovery time, intraoperative and postoperative complications and pain. However, uptake of robotic MAS remains low, suggesting there are barriers to its use. To overcome these barriers, a new surgical robot system, Versius, was developed based on the needs and feedback of surgeons and surgical teams.MethodsThe surgical robot prototype was designed based on observations in the operating room (OR) and previous interviews with surgeons. Formative studies with surgeons and surgical teams were used to refine the prototype design, resulting in modifications to all components, including the arms, instruments, handgrips and surgeon console. Proof-of-concept cadaver studies were used to further optimize its design by assessing its usability during surgical procedures.ResultsFeedback led to the development of a novel, mobile design with independent arm carts and surgical console, linked by supported serial or parallel connections, providing maximum flexibility in the OR. Instrument tips were developed based on surgeons’ preferred designs and wristed at the tip providing seven degrees of freedom within the patient. Multiple handgrip designs were assessed by surgeons; of these, a ‘game controller’ design was rated most popular and usable. An open surgical console design allowing multiple working positions was rated highest by surgeons and the surgical teams.ConclusionsThis surgical robot system has been developed using feedback from end users throughout the design process and aims to minimize barriers to robotic MAS uptake. Additionally, these studies demonstrate system success in the surgical procedures it was designed for. The studies reported here, and further studies of the Versius Surgical System, are intended to align with IDEAL (Idea, Development, Exploration, Assessment, Long-term study) Framework guidance.
There is a higher incidence of mental health problems amongst people with intellectual disabilities. Family members and support staff who provide support to people with intellectual disabilities with mental health difficulties are more likely to experience increased stress. In the mainstream mental health literature it has been demonstrated that psycho-educational family interventions have a positive impact on the person with mental health difficulties and on the family members who support them. This article uses a case study to illustrate the implementation of a family intervention with the support system around someone with intellectual disabilities, autism and chronic mental health difficulties. Following intervention the family member reported a marked decrease in levels of strain. Both the family and team members reported improvement in functioning within the support system.
Accessible summaryThis article looks at a simplified version of a widely used assessment tool called Clinical Outcomes in Routine Evaluation -Outcome Measure (CORE-OM).• The main reason for carrying out this piece of research was to help people with a learning disability understand a simplified version of CORE-OM, and help them tell people how distressed they were feeling. • People with learning disabilities helped us test out the measure in different ways to see if it worked properly. • We found one particular way worked really well, but we will have to check this out with more people to make sure. • The people we tested found the simplified CORE-OM very helpful; they also made some suggestions on how to make it better. We are enthusiastic about developing this, so other people with a learning disability can use the measure in the future. SummaryThere are few reliable self-report measures suitable for people with a learning disability in reporting psychological distress. This study examines the modification of the Clinical Outcomes in Routine Evaluation -Outcome Measure (CORE-OM), exploring its reliability, using two different presentation styles. One style included a sequencing task then use of a visual histogram scale to facilitate rating; the other prompted participants to indicate presence or absence of symptoms before using the histogram. The study was conducted on a small sample of people with mental health problems who have a mild learning disability. The modified CORE-OM was found to have an excellent test-retest correlation with the group who completed the sequencing task, then the histogram scale, but the other group produced less favourable results. The preliminary results are encouraging, highlighting the need to conduct a larger study after further modifications of the measure.
People with learning disabilities are an ageing and increasing population and have been the subject of policy initiatives by the four countries of the UK, detailing the range of supports that need to be in place for this group. The evidence base of their mental health needs is growing and with it the need to ensure the full range of psychotherapies available to the general population are made available to people with learning disabilities. Cognitive Behaviour Therapy (CBT) is now a widely accepted and effective form of psychotherapy for many mental health problems and the evidence base is growing on the effectiveness with the learning disability population; however, the model needs to be applied differently for this group to take account of their cognitive impairment and support needs. Registered Nurses in Learning Disabilities are well placed to apply this approach within their clinical practice; however, there is an absence of leadership and direction in the development of CBT for this group of clinicians. There is a need to support education and practice development to contribute to addressing the emotional needs of people with learning disabilities. Action is required to support education to prepare Registered Nurses in Learning Disabilities to practice CBT and to contribute to the ongoing development of research in this area of clinical practice.
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