Conformity Influence Meeting Evolving Consumer Experience in Recommender Systems

The purpose of this article is to compare transrectal ultrasound (TRUS) biopsy accuracies of operators with different levels of prostate MRI experience using cognitive registration versus MRI-TRUS fusion to assess the preferred method of TRUS prostate biopsy for MRI-identified lesions. SUBJECTS AND METHODS; One hundred patients from a prospective prostate MRI-TRUS fusion biopsy study were reviewed to identify all patients with clinically significant prostate adenocarcinoma (PCA) detected on MRI-targeted biopsy. Twenty-five PCA tumors were incorporated into a validated TRUS prostate biopsy simulator. Three prostate biopsy experts, each with different levels of experience in prostate MRI and MRI-TRUS fusion biopsy, performed a total of 225 simulated targeted biopsies on the MRI lesions as well as regional biopsy targets. Simulated biopsies performed using cognitive registration with 2D TRUS and 3D TRUS were compared with biopsies performed under MRI-TRUS fusion. Two-dimensional and 3D TRUS sampled only 48% and 45% of clinically significant PCA MRI lesions, respectively, compared with 100% with MRI-TRUS fusion. Lesion sampling accuracy did not statistically significantly vary according to operator experience or tumor volume. MRI-TRUS fusion-naïve operators showed consistent errors in targeting of the apex, midgland, and anterior targets, suggesting that there is biased error in cognitive registration. The MRI-TRUS fusion expert correctly targeted the prostate apex; however, his midgland and anterior mistargeting was similar to that of the less-experienced operators. MRI-targeted TRUS-guided prostate biopsy using cognitive registration appears to be inferior to MRI-TRUS fusion, with fewer than 50% of clinically significant PCA lesions successfully sampled. No statistically significant difference in biopsy accuracy was seen according to operator experience with prostate MRI or MRI-TRUS fusion.

Recent reports indicate that there is a trend toward the use of models and simulators to teach basic orthopaedic operative skills. We describe a high-fidelity model for teaching basic orthopaedic fracture manipulation. A model of a distal radial fracture was developed and validated by orthopaedic surgeons with different levels of experience, who examined and manipulated the model and then completed a structured questionnaire. The participants mostly agreed (designated as 4 in the questionnaire) that the model performed well on the degree to which the manipulation represented real life. The participants agreed (designated as 5 in the questionnaire) that the model scored high on the appearance and feel of the fracture and its ability to be used as a teaching tool. There was no difference between perceptions of participants with regard to different levels of occupational experience or model use. We believe that this model could be used to teach the skill of closed reduction of a distal radial fracture in the preclinical setting.

Veterinary professionals experience higher psychological distress and lower wellbeing compared with the general population. Identifying workplace stressors is key to understanding and alleviating these difficulties. Identify the severity of workplace stressors in veterinary professions across different levels of professional experience. A cross-sectional quantitative design was utilised via administration of a veterinary stressor questionnaire that measured the severity of 93 generic and veterinary-specific workplace stressors. A total of 658 participants reported stressor severity score. Factor analysis revealed four main stressor categories: workload and job demands, client relations stress, performance and accountability, patient care challenges. An inverse relationship was found between experience level and stressor severity scores. Furthermore, the most severe stressors varied as a function of career stage. Stressor severity tends to decrease with increasing experience levels. Stressors can be categorised by theme and unique stressor profiles can be derived for practitioners according to experience level. This knowledge can assist in the design and delivery of workplace support initiatives. Identify key stressors across different levels of experience is important in focusing efforts to support people in the workplace.

BackgroundThe clinical outcome of hip resurfacing (HR) as a demanding surgical technique associated with a substantial learning curve depends on the position of the femoral component. The aim of the study was to investigate the effects of the level of surgical experience on computer-assisted imageless navigation concerning precision of femoral component positioning, notching, and oversizing rate, as well as operative time.MethodsThree surgeons with different levels of experience in both HR and computer-assisted surgery (CAS) prepared the femoral heads of 54 synthetic femurs using the DuromTM Hip Resurfacing (Zimmer, Warsaw, IN, USA) system. Each surgeon prepared a total of 18 proximal femurs using the Navitrack® system (ORTHOsoft Inc., Montreal, Canada) or the conventional free-hand DuromTM K-wire positioning jig. The differences between planned and postoperative stem shaft angle (SSA) and anteversion angle in standardized x-rays were measured and the operative time, not including the time for calibrating the CAS-system, was documented. Notching was evaluated by the three surgeons in a randomized manner. Oversizing was determined by the difference of the preoperative determined cap and the cap size advised by the CAS-system.ResultsCAS significantly reduced the overall mean deviation between planned and postoperative SSA in comparison with the conventional procedure (mean ± SD, 1 ± 1.7° vs. 7.4 ± 4.4°, P <0.01) regardless of the surgeon’s level of experience. The incidence of either varus or valgus SSA deviations exceeding 5° were 1/27 for CAS and 15/27 for the conventional method, respectively (P <0.001), corresponding to a reduction by 97%. Using CAS, the rate of notching was reduced by 100%.ConclusionsThe accuracy of femoral HR component orientation is significantly increased by use of CAS regardless of the surgeon’s level of experience in our preclinical study. Thus, imageless computer-assisted navigation can be a valuable tool to improve implant positioning in HR for surgeons at any stage of their learning curve.

Reliability and reproducibility analysis of the AOSpine Sacral Fractures Classification System by spinal and pelvic surgeons

Ring liner and burn-out temperature affect the clinical time required to fit a cast post

Humans differ in how they perceive, assess, and measure animal behaviour. This is problematic because strong observer bias can reduce statistical power, accuracy of scientific inference, and in the worst cases, lead to spurious results. Unfortunately, reports and studies of measurement reliability in animal behaviour studies are rare. Here, we investigated two aspects of measurement reliability in working dogs: inter‐observer agreement and criterion validity (comparing novice ratings with those given by experts). Here, we extend for the first time a powerful framework used in human psychological studies to investigate three potential aspects of (dis)agreement in nonhuman animal behaviour research: (a) that some behaviours are easier to observe than others; (b) that some subjects are easier to observe than others; and (c) that observers with different levels of experience with the subject animal give the same or different ratings. We found that novice observers with the same level of experience agreed upon measures of a wide range of behaviours. We found no evidence that age of the dogs affected agreement between these same novice observers. However, when observers with different levels of experience (i.e., novices vs. a working dog expert) assessed the same dogs, agreement appeared to be strongly affected by the measurement instrument used to assess behaviour. Given that animal behaviour research often utilizes different observers with different levels of experience, our results suggest that further tests of how different observers may measure behaviour in different ways are needed across a wider variety of organisms and measurement instruments.

Laparoscopic and robotic surgery is a challenge to the surgeon's hand–eye coordination ability, which requires constant practice. Traditional mentor training is gradually shifting to simulation training based on various models. Laparoscopic and robotic bilioenteric anastomosis is an important and difficult operation in hepatobiliary surgery. We constructed and optimized the reusable modular 3D-printed models of choledochal cyst. The aim of this study was to verify the ability of this optimized model to distinguish between surgeons with different levels of proficiency and the benefits of repeated practice. A total of 12 surgeons with different levels participated in the study. Operation completion time and OSATS score were recorded. The model was validated by Likert scale. Surgeons were shown the steps and contents before performing laparoscopic or robotic bilioenteric anastomosis using the model. Surgeons with different levels of experience showed different levels when performing laparoscopic bilioenteric anastomosis on this model. Repeated training can significantly shorten the time of laparoscopic bilioenteric anastomosis and improve the operation scores of surgeons with different levels of experience. At the same time, preliminary results have shown that the performance of surgeons on the domestic robotic platform was basically consistent with their laparoscopic skills. This model may distinguish surgeons with different levels of experience and may improve surgical skills through repeated practice. It is worth noting that in order to draw more reliable conclusions, more subjects should be collected and more experiments should be done in the future.

BackgroundBox trainer systems have been developed that include advanced skills such as suturing. There is still a need for a portable, cheap training and testing system for basic laparoscopic techniques that can be used across different specialties before performing supervised surgery on patients. The aim of this study was to establish validity evidence for the Training and Assessment of Basic Laparoscopic Techniques (TABLT) test, a tablet‐based training system.MethodsLaparoscopic surgeons and trainees were recruited from departments of general surgery, gynaecology and urology. Participants included novice, intermediate and experienced surgeons. All participants performed the TABLT test. Performance scores were calculated based on time taken and errors made. Evidence of validity was explored using a contemporary framework of validity.ResultsSome 60 individuals participated. The TABLT was shown to be reliable, with an intraclass correlation coefficient of 0·99 (P < 0·001). ANOVA showed a difference between the groups with different level of experience (P < 0·001). The Bonferroni correction was used to confirm this finding. A Pearson's r value of 0·73 (P < 0·001) signified a good positive correlation between the level of laparoscopic experience and performance score. A reasonable pass–fail standard was established using contrasting groups methods.ConclusionTABLT can be used for the assessment of basic laparoscopic skills and can help novice surgical trainees in different specialties gain basic laparoscopic competencies.

BackgroundRobotic neurointerventions have demonstrated promising initial clinical results. Claims of enhanced precision during robotic navigation have been reported, but objective quantification of such precision is limited. Precision during intracranial navigation...

The purpose of this study was to examine the removal of the epithelium in the periodontal pocket using a diode (980 nm) laser in comparison with the conventional techniques in an animal experimental model. The goal of periodontal therapy is to reduce the bacterial deposits in the pockets and to enhance the clinical attachment. Different surgical techniques have been used in the past, which control the epithelial migration and promote the connective tissue formation. The buccal pockets of the posterior teeth in 10 freshly sacrificed adult pigs were scaled by three different examiners (with different levels of experience in periodontal surgery) using conventional curettes. The lingual pockets were treated using a diode (980 nm) laser. The laser was used in a continuous wave (c. w.) mode with two different power settings (2 and 4 Watts) with a 300-microm-thick glass fiber. The instrumentation period revealed 15 sec in all of the sites. Soft tissue biopsies of the instrumented sites were removed and examined histologically. In all of the lased sections, no epithelial remnants were found. The laser with a low power was able to remove the thin pocket epithelium in the same way regardless of the level of surgical experience of the examiner. A high-power setting presented significant damage to the underlying connective tissues. The sites, which were instrumented with the conventional curettes, demonstrated significant epithelial remnants in all of the tissues regardless of the level of periodontal surgical experience. The histological findings presented in this study showed that instrumentation of the soft periodontal tissues with a diode laser (980 nm) leads to a complete epithelial removal in comparison to conventional treatment methods with hand instruments (independent of the clinician's experience).

Introduction:The introspective experience of cancer patients using mistletoe therapy has received little scientific interest, although it is crucial for a holistic understanding of this therapy. This study contributes to patient-centered research and treatment by documenting the subjective experiences of individuals undergoing mistletoe therapy.Methods:In this qualitative, explorative study, 20 outpatients with a history of various cancer types were recruited from Arlesheim Hospital (Arlesheim, Switzerland). All patients received subcutaneous mistletoe therapy for at least 2 years (median 7.5 years). Data was collected through 2 semi-structured, in-depth interviews per patient. Qualitative content analysis was applied to examine the data. The individual experience of mistletoe therapy was analyzed in relation to 6 predefined levels of human experience: physical, vital, emotional, mental, spiritual and social. In addition, 3 further aspects, considered as cross-dimensional perspectives, emerged out of the material: warmth, immune strengthening, and general wellbeing.Results:Data analysis revealed considerable heterogeneity among patients’ experiences with mistletoe therapy. The importance of specific aspects became apparent, such as increased vitality to manage daily life, greater emotional and mental stability, warmth as a multidimensional phenomenon, feelings of safety and protection through mistletoe therapy, heightened self-awareness and improved self-care, as well as sensations of spiritual connectedness.Conclusions:Prior to this study it had not been shown that cancer patients using mistletoe therapy do have observations on different levels of experience. These results may lead to a deeper understanding of patients receiving mistletoe therapy, enabling them to be supported in a more holistic way both during mistletoe treatment and on their life path. Further investigations into the effects of mistletoe therapy on the emotional, mental, and spiritual level are warranted.

The implant design and the surgical technique are important parameters that can be modified to improve the implant primary stability. The aim of this study was to evaluate the role of the apical part of an implant on the implant stability of implants placed in Type II dense bone by novice and experienced clinicians. Implants with a progressive thread design (3.5 mm diameter, 11 mm length) were used. A total of 80 osteotomies were prepared in dense bone samples (quality Type II) by two clinicians with different levels of experience (novice and experienced) under the same surgical protocol. Two experimental groups were prepared. In the test group (apical stability), 40 implants were inserted with only 3 mm of the apical portion of the implant within the bone and without lateral contact between the residual implant length and the osteotomy walls. In the control group (full implant stability), 40 implants were inserted with full contact between the osteotomy walls and the implant surface. The stability of both groups (test and control) was evaluated using a resonance frequency analysis (RFA) (implant stability quotient [ISQ] values). Statistical comparisons between the groups were performed using the Kruskal-Wallis test with Dunn post-test for multiple comparisons. The results did not show statistically significant differences (P > 0.05) in terms of primary stability between implants placed by novice or experienced clinicians in dense bone. The control group showed significantly higher ISQ values compared with the test group (P < 0.001). The apical implant stability contributed to ≈ 30% and 43% of the entire implant stability for novice and experienced clinicians, respectively. The apical portion of an implant plays a fundamental role in the entire implant stability and is independent on the clinician's experience. However, precise implant site preparation to guarantee apical implant anchorage is recommended.

To construct a nomogram based on sonogram features and radiomics features to differentiate granulomatous lobular mastitis (GLM) from invasive breast cancer (IBC). A retrospective collection of 213 GLMs and 472 IBCs from three centers was divided into a training set, an internal validation set, and an external validation set. A radiomics model was built based on radiomics features, and the RAD score of the lesion was calculated. The sonogram radiomics model was constructed using ultrasound features and RAD scores. Finally, the diagnostic efficacy of the three sonographers with different levels of experience before and after combining the RAD score was assessed in the external validation set. The RAD score, lesion diameter, orientation, echogenicity, and tubular extension showed significant differences in GLM and IBC (p < 0.05). The sonogram radiomics model based on these factors achieved optimal performance, and its area under the curve (AUC) was 0.907, 0.872, and 0.888 in the training, internal, and external validation sets, respectively. The AUCs before and after combining the RAD scores were 0.714, 0.750, and 0.830 and 0.834, 0.853, and 0.878, respectively, for sonographers with different levels of experience. The diagnostic efficacy was comparable for all sonographers when combined with the RAD score (p > 0.05). Radiomics features effectively enhance the ability of sonographers to discriminate between GLM and IBC and reduce interobserver variation. The nomogram combining ultrasound features and radiomics features show promising diagnostic efficacy and can be used to identify GLM and IBC in a noninvasive approach.

Degeneration of the acromioclavicular joint (AC) often causes impaired shoulder function and pain. Its infiltration results in reportedly beneficial short-term effects. Misplacement of infiltrations is observed in high numbers. A previous study showed high accuracy of infiltrations of one surgeon comparing conventional palpation technique to ultrasound guidance. This study evaluates if ultrasound-guided AC joint infiltration is feasible for therapists of different levels of experience and if the accuracy can be increased. One hundred and twenty AC joints of 60 cadavers were enrolled into a prospective, randomized observer-blinded study. Six therapists of three different levels of experience infiltrated 20 AC joints each. Half of them were infiltrated after palpation of the joint space, half of them were ultrasound-guided infiltrated. Controls were performed pre- and post-infiltration by an independent radiologist. In total, accurate infiltration was observed in 70%. In 25%, misplacement of the infiltration was recorded in the palpation-, in 2% in the ultrasound- and in 3% in both groups. The difference between the two groups was significant (P = 0.009). Ultrasound-guided infiltration to the AC joint is significantly more accurate than conventional palpation technique. This method is simple, efficient and can be applied by therapists of all levels of experience.