Study DesignA retrospective study of radiographic parameters of patients who underwent lumbar spinal pedicle screw insertion.PurposeThe optimal length of pedicle screws is often determined by the lateral radiograph during minimally invasive surgery (MIS). Compared with open techniques, measuring the precise length of screws or assessing the cortical breach is challenging. This study aims to ascertain the optimal pedicle screw lengths on intraoperative lateral radiographs for L1–L5.Overview of LiteratureResearch has revealed that optimal pedicle screw length is essential to optimize fixation, especially in osteoporotic patients; however, it must be balanced against unintentional breach of the anterior cortex, risking injury to adjacent neurovascular structures as demonstrated by case reports.MethodsWe reviewed intra- and postoperative computed tomography scans of 225 patients who underwent lumbar pedicle screw insertion to ascertain which of the inserted screws were ‘optimal screws.’ The corresponding lengths of these screws were analyzed on postoperative lateral radiographs to ascertain the ideal position that a screw should attain (expressed as a percentage of the entire vertebral body length).ResultsWe reviewed 880 screws of which 771 were optimal screws. We noted a decreasing trend in average optimal percentages of insertion into the vertebral body for pedicle screws going from L1 (average=87.60%) to L5 (average=78.87%). The subgroup analysis revealed that there was an increasing percentage of screws directed in a straight trajectory from L1 to L5, compared to a medially directed trajectory.ConclusionsDuring MIS pedicle screw fixation, this study recommends that pedicle screws should not exceed 85% of the vertebral body length on the lateral view for L1, 80% for L2–L4, and 75% for L5; this will minimize the risk of anterior cortical breach yet maximize pedicle screw purchase for fixation stability.
Introduction Diabetes foot disease (DFD) contributes to poor quality of life, clinical and economic burden. Multidisciplinary diabetes foot teams provide prompt access to specialist teams thereby improving limb salvage. We present a 17-year review of an inpatient multidisciplinary clinical care path (MCCP) for DFD in Singapore. Methods This was a retrospective cohort study of patients admitted for DFD and enrolled in our MCCP to a 1700-bed university hospital from 2005 to 2021. Results There were 9279 patients admitted with DFD with a mean of 545 (±119) admissions per year. The mean age was 64 (±13.3) years, 61% were Chinese, 18% Malay and 17% Indian. There was a higher proportion of Malay (18%) and Indian (17%) patients compared to the country's ethnic composition. A third of the patients had end stage renal disease and prior contralateral minor amputation. There was a reduction in inpatient major lower extremity amputation (LEA) from 18.2% in 2005 to 5.4% in 2021 (odds ratio 0.26, 95% confidence interval 0.16-0.40, P < .001) which was the lowest since pathway inception. Mean time from admission to first surgical intervention was 2.8 days and mean time from decision for revascularization to procedure was 4.8 days. The major-to-minor amputation rate reduced from 1.09 in 2005 to 0.18 in 2021, reflecting diabetic limb salvage efforts. Mean and median length of stay (LOS) for patients in the pathway was 8.2 (±14.9) and 5 (IQR = 3) days, respectively. There was a gradual trend of increase in the mean LOS from 2005 to 2021. Inpatient mortality and readmission rate was stable at 1% and 11%. Conclusion Since the institution of a MCCP, there was a significant improvement in major LEA rate. An inpatient multidisciplinary diabetic foot care path helped to improve care for patients with DFD.
Introduction: Mentoring is a vital component of a well-rounded medical teaching environment, as evidenced by its implementation in many residency programmes. This study aims to evaluate the perceived value of mentoring by faculty and near-peer mentoring to the orthopaedic surgery resident. Methods: An online survey comprising multiple choice questions and scaled-response questions with a few open-ended questions was created and distributed to all residents, from residency years 2 to 5, within an orthopaedic residency programme in Singapore to gather their views on a tiered mentorship programme. Results: 100% of surveyed residents responded. 68.4% of junior residents had a senior resident mentor while 84.8% of all residents had a faculty mentor. Junior residents generally viewed senior resident mentors as being crucial and beneficial for training, with scores comparable to those for faculty mentors. Residents who had mentors, in particular those who had chosen their own mentors, tended to be more satisfied than their counterparts. The most desired characteristics of mentors among the residents included approachability, willingness to share, being able to give feedback and experience. 66.7% of residents felt that near-peer mentorship should be required in the residency programme but only 30.3% of them felt that it should be formalised. 78.8% of residents surveyed felt that mentorship by faculty was required. Conclusion: Residents viewed mentoring by faculty and near-peer mentoring as being beneficial and crucial to their orthopaedic residency training. We propose that an ideal mentoring programme should be tiered, allow choice of mentors and include nearpeer mentoring as a requirement but not necessarily monitored.
Little has been published on the meaning of food to palliative care patients with anorexia. Our study aims to investigate the meaning of food in palliative patients with anorexia. Fifteen patients with anorexia were recruited from the Palliative Care Unit of an acute hospital in Singapore from August 2018 to August 2021. A phenomenological methodology was employed to study the lived experience of anorexia and the meaning of food to palliative care patients. Our study findings revealed that food has social, physical, and emotional meaning in palliative care patients with anorexia. The social meaning of food was the predominant theme. Food was viewed as an important tool to bond and connect with their loved ones. It was perceived to be more important than the food itself and the taste of food was enhanced through social interactions. Food intake was related to physical strength and health status. Patients regarded eating as a way to improve their health status. Emotionally, eating was associated with positive feelings like enjoyment and freedom. Half of our participants felt that anorexia contributed to their low mood. Therefore, unlike the traditional focus of modifying the taste and quality of food in patients with anorexia, the authors recommended a focused assessment and management of the social aspect of anorexia on individual. This is important to mitigate the negative impact of anorexia, thus improving the quality of life and increasing their dignity towards the end of their lives.
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