AdventHealth Celebration

The rapid adoption of telemedicine has transformed healthcare delivery in the U.S., enhancing access and communication for surgical patients across wide geographic areas. However, a critical challenge persists: the need to define and standardize quality metrics specifically for telemedicine in surgery. Existing studies suggest that telemedicine can yield equivalent or improved outcomes compared to in-person visits. Nevertheless, literature remains limited in evaluating patient satisfaction, cost-effectiveness, and diagnostic accuracy. Through expert consensus within the American College of Surgeons Board of Governors Telehealth Pillar, we propose a structured framework for defining and implementing quality metrics for surgical telemedicine. This is based on the Donabedian model, addressing structure, process, and outcome, while also considering the distinct phases of surgical care: pre-operative, intra-operative, and post-operative. This framework identifies unique domains of telemedicine in surgical care, emphasizing hospital and organizational structure, patient and provider readiness, and policy alignment. Comparative analysis against existing AHRQ and WHO frameworks highlights gaps in surgical applicability. Finally, we propose an implementation roadmap prioritizing immediate, feasible metrics while identifying areas for future validation. Collaboration among researchers, clinicians, and policymakers will be essential to establish these metrics and ensure that telemedicine delivers on its potential to improve surgical care delivery while addressing disparities in access and outcomes.

Work-related musculoskeletal disorders are a growing concern in surgical practice, particularly in the context of robot-assisted surgery. Physical strain can significantly impact the well-being and performance of surgeons and surgical staff. This study aimed to evaluate the prevalence and severity of surgical strain among urologists using different available surgical platforms. An anonymized, web-based survey was conducted between March and October 2024 using the REDCap platform. Distributed via professional networks and social media, the survey collected data on demographics, surgical experience, platform usage, and self-reported physical discomfort. Statistical analysis included Mann-Whitney U and Chi-squared tests, with P<0.05 considered significant. A total of 427 urologists participated. Most console surgeons (up to 83% for one robotic system variant) reported some level of physical discomfort. Discomfort was also reported by 83% of open surgeons and 80% of bedside assistants, the latter of whom had the highest incidence of injury (53%) from robotic arms. A noteworthy subset of survey respondents required physiotherapy (13-15%), medical (6-11%), or surgical (2-3.8%) interventions due to physical strain. No significant differences were observed by age or sex among console users. Ergonomic strain is prevalent among urologic surgeons, regardless of surgical platform, with bedside assistants particularly vulnerable. These findings underscore the need for ergonomic training, physical conditioning, and design improvements in surgical systems to safeguard surgeon health and maintain procedural efficacy.

This paper will respond to James Sterba’s paper “An Ethics without God That is Compatible with Darwinian Evolution”. In his paper, Sterba argues that God cannot be the source of morality. Sterba maintains this position because he believes that his problem of extreme suffering entails that God cannot exist. Furthermore, Sterba argues that divine command theory has a number of serious problems confronting it. Alternatively, Sterba maintains that one can account for objective morality without appealing to God’s nature and/or commands. In response, this paper grants that Sterba presents a logically consistent account of objective morality without appealing to God’s nature and/or commands. However, this paper also cites a couple of reasons why one might think that God is still the better explanation for objective morality. This paper furthermore argues that Sterba’s objections do not demonstrate that divine command theory is false. The main thrust of this paper, though, focuses on Sterba’s argument about horrendous suffering. This paper argues that Sterba’s argument on horrendous suffering (while challenging) does not prove that a morally perfect God could not exist.

This paper aimed to evaluate the integration of Cherenkov imaging into radiation therapy practices, focusing on its utility in enhancing treatment precision, patient safety, and clinical decision-making. The research highlights its application in quality and safety verification, breast treatment, and dose visualization, confirming the absence of radiation in unintended areas and its broader clinical impact. We employed 2 commercially available Cherenkov imaging systems, BeamSite and DoseRT, integrated with Varian and Elekta linear accelerators. The methodology involved real-time imaging during radiation therapy sessions for various treatments, capturing Cherenkov light with time-gated cameras synchronized with radiation pulses. Posttreatment, images were analyzed to assess treatment accuracy, dose distribution, and any deviations from the intended plan. Cherenkov imaging consistently provided high-quality images that allowed immediate visualization of the radiation dose distribution, detection of deviations in real time, and ensured no radiation was delivered to unintended areas. The results are presented, focusing on 5 main topics: quality and patient safety verification; breast treatment applications; dose visualization for treatment verification; verification of a negative dose in areas of concern; and observations with clinical impact. It was particularly beneficial in complex scenarios like breast cancer treatments and in cases where patient positioning was challenging. The technology facilitated immediate treatment adjustments, improved patient safety, and offered insights into treatment response without adding significant time to the clinical workflow. Cherenkov imaging has shown substantial promise in enhancing radiation therapy by providing real-time, visual feedback on treatment delivery. It complements traditional verification methods by offering continuous monitoring, which can lead to fewer treatment errors and better patient outcomes. The findings suggest that Cherenkov imaging should be considered for broader clinical adoption to elevate the standard of care in radiation oncology, although further refinement of image processing and camera positioning could enhance its effectiveness.

The study aimed to identify potential candidates for adjuvant radiotherapy by stratifying patients with locally advanced prostate cancer based on their biochemical recurrence (BCR) risk. This study analyzed data from 3536 men with pT3-4 disease who achieved undetectable prostate-specific antigen (PSA) levels after robot-assisted radical prostatectomy between 2008 and 2023. Kaplan-Meier curves and log-rank tests were used to compare BCR risk across pathologic T (pT) stages. The study also evaluated associations between BCR and other adverse pathologic features, including pathologic grade group (GG), pathologic N (pN) stage, positive surgical margin, perineural invasion, lymphovascular invasion, tumor diameter, and tumor percentage involvement. A multivariable Cox regression was used to adjust for potential confounders, including age, race, Charlson Comorbidity Index, and PSA at biopsy. The median follow-up period was 60 months (interquartile range [IQR], 24-84 months), with BCR occurring in 852 patients. The patients with pT3b and pT4 disease had higher BCR risk (hazard ratio [HR], 2.54; 95% confidence interval [CI], 2.19-2.94) than those with pT3a disease (HR, 2.10; 95% CI, 1.51-2.93). In the multivariable analysis, the independent predictors for BCR were GG3-5, pT3b, lymphovascular invasion, positive surgical margin, and tumor diameter, with GG5 having the strongest prognostic significance. The combination of GG3-5 and the cumulative number of these adverse features further stratified BCR risk (p < 0.001). The study demonstrated that patients with GG5 locally advanced disease and multiple adverse pathologic features have the highest BCR risk after achieving undetectable PSA levels. These patients are potential candidates for adjuvant radiotherapy and should receive comprehensive counseling regarding its potential benefits. Prospective studies are warranted to optimize patient selection for adjuvant therapy.

The aim of this study is to analyze the impact of extranodal extension (ENE) on survival outcomes for patients with metastatic cutaneous head and neck squamous cell carcinoma (cHNSCC). The pooled hazard ratios (HRs) and the 95% confidence interval (CI) were calculated to define the impact of ENE on overall survival (OS) and disease-free survival (DFS). A total of 2076 patients (males: 84.4%) with a median age of 73.3 years were included. The incidence of ENE was 65.6% (N = 1299/1979). The median follow-up time was 38.4 months (95% CI: 21-38.4). The estimated pooled HRs were 1.31 (95% CI: 0.72-2.39; p = 0.28) and 1.80 (95% CI: 0.53-6.10; p = 0.22) for OS and DFS, respectively. ENE may not be a reliable prognostic factor in metastatic cHNSCC. Further prospective studies are needed to refine risk stratification and improve the current nodal classification system.