Bionic Advancements in the Medical Field Article Review

Pages: 15 (4660 words)  ·  Bibliography Sources: 0  ·  File: .docx  ·  Level: College Junior  ·  Topic: Medical / Medicine  ·  Written: September 25, 2018

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[. . .] Parallel structure robots have higher positional accuracy and higher stiffness. The authors also discuss how robots could be involved in image-guided therapies, if their ability to recognize images was able to be drastically improved. As a result of these unique challenges, there’s been a more rapid development of technology as a way of making up for these complexities and to give these robots a wider scope of procedures they can complete. Once some of these roadblocks are overcome, it seems very likely that medical robotics will ultimately take off, as there are certain requirements of surgery that robots can very easily perform. Medical robotics can be optimized and adjusted and programmed to engage in tasks that assist the clinician or surgeon so that the operations are safe and minimally invasive.

Hebl JR, Dilger JA, Byer DE, Kopp SL, Stevens SR, Pagnano MW, Hanssen AD, Horlocker TT. 2008. A pre-emptive multimodal pathway featuring peripheral nerve block improves perioperative outcomes after major orthopedic surgery. Reg Anesth Pain Med 33:510- 517.

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Hebl and colleagues were well aware of the post-operative agony that patients experienced after undergoing serious orthopedic surgery. The authors concluded that the manner in which the analgesia was managed could have tremendous impact on the overall rehabilitation experience. Hence, the authors sought to determine which analgesic practice was best for minimizing the pain of patients going through hip and knee surgery, examining both outcomes during and after surgery. Hebl and associates assembled a sample size of one hundred patients who had already experienced such a surgery. Patients were matched to 1:1 controls regarding specific surgical methods and analgesic strategies, along with other traits selected (such as age, sex, surgeon, surgery, etc.). However, the main outcome that the authors were interested in was how long the patient had to stay in the hospital. Other outcomes variables were things like how much mobility their joints had and when they were able to be discharged. Of this participant size, the authors found that those who received the Mayo Clinic TJRA protocol for pain management were in the hospital for shorter periods of time (3.8 days v 5.0 days; P .001), and were eligible for discharge sooner. These participants also recorded lower levels of pain and lower rates of wanting opioids. There were negative impacts, such as urine retention and irritable bowels. However, given how marked the positive effects were, one could conclude that it is perhaps better to initiate them within a “multimodal analgesic regimen” that has a focus on a “peripheral nerve block.”

Holzapfel BM, Reichert JC, Schantz JT, Gbureck U, Rackwitz L, Noth U, Jakob F, Rudert M, Groll J, Hutmacher DW. 2013. How smart do biomaterials need to be? A translational science and clinical point of view. Adv Drug Deliv Rev 65:581- 603.

Holzapel and associates make the incisive argument that while need has driven so much of the innovation in orthopedic implant technology, in part this progress was motivated by the very grave issues of appropriate body integration and ideal body mechanics. Hence there has (and continues to be) an intense fervor over finding ways to help biopolymers, ceramics and metal evolve. Holzapel and colleagues have put together a cohesive review on the articles that address the most pertinent issues in connection with biomaterials and to give their opinion on the business and future of these implants and devices from a scientific and clinical perspective. Holzapel and associates are able to use their vast knowledge and experience in pinpointing and selecting the strides and innovations that will really make a difference in the future. For example, the authors discuss tailored biomaterials necessities and in situ guided tissue regeneration in situations that are less than straightforward. They are able to make the distinction that when such biomaterials are harnessed in a health body who still needs to engage in realistic tissue regeneration, these biomaterials don’t need to contain a host of smart traits: they just need to integrate into the body and not thwart any of the regeneration that is trying to occur. Holzapel and colleagues make this incisive distinction, while also adding that such materials can be adjusted to provoke aspects of the regenerative journey (such as the development of stem cells) in order to bolster certain needs in the patient. This is an example of precisely the type of feedback Holzapel and colleagues have accumulated on a very nuanced and exciting subject.

Jones EL, Wainwright TW, Foster JD, Smith JRA, Middleton RG, Francis NK. 2014. A systematic review of a patient reported outcomes and patient experience in enhanced recovery after orthopaedic surgery. Ann R Coll Surg Engl 96:89-94.

Jones and colleagues closely examine a specific and new phenomena within the realm of orthopedic surgery: enhanced recovery after surgery (ERAS). This is a clinical method of fat-tracking the patient through recovering to get them back to a higher level of mobility faster and to resume their life outside the hospital sooner. Hence, Jones and colleagues endeavored to study the research done on the use of orthopedic ERAS across a full spectrum, in order to determine if ERAS really were as effective as they are marketed. Jones and associates pinpointed the best research studies using a host of databases (Embase™, MEDLINE®, AMED, CINAHL®) along with the Cochrane Library and the British Nursing Index. The team used key subject words that would connect directly to the patient response and opinions of ERAS and the impact that this method had on their lives and health. The team attempted to be both as broad and as exact as possible, so that they could pare down their findings to the most relevant group of studies at the end. The team found just under 600 relevant abstracts and eight individual papers that fulfilled the specificities they set for inclusion. And just over 2,200 patients who were receiving some form of orthopedic surgery were included. This review showed a range in response when it came to the influence of ERAS. In some studies patient satisfaction and quality of life scores went up, in others there was just a scarcity of information. However, based on all the research collected, one can conclude that ERAS don’t have a adverse impact on patients.

Long PH. 2008. Medical devices in orthopedic applications. Toxicol Pathol 36:85-91.

Long’s article acknowledges how orthopedic medical devices have been tremendously transformative in giving people movement and a better way of life for decades, while minimizing the amount of discomfort they suffering from injuries or aging joints. Their success and the good that they have done has turned this sector into a billion dollar industry. While there has been copious research done on the up and coming materials to use streamline the industry and take it into the future, as Long points out, there really are just a few substances (metals, polymers, ceramics) that rule this industry. Long’s article essentially offers a cohesive review of these materials, focusing on the potentially negative impacts of some of them. Long discusses how metals are ideal as they are resistant to corrosion, offer intense strength, extreme durability, offer the user a high level of integration with the human body. Many polymers are also great as they are able to slide just like the joints of the human body, are bale to endure strong impacts, are resistant to fatigue and integrate with strong compatibility with the human body. Likewise, ceramics are resistant to oxidation and are very rigid and have low elements of friction and some ceramics have a regimented surface degradation. However, Long does discuss the negative aspects of these implants and the adverse events they can cause for the patients, such as loosening, stress shielding, wear and tear and infections. Other issues such as manufacturing glitches, toxicity with the human body, and general irritation can also create problems for users. These problems should motivate science and research to find the most ideal type and to continue to test and fine-tune potential products.

Lyndon JA, Boyd BJ, Birbilis N. 2014. Metallic implant drug/device combinations for controlled drug release in orthopaedic applications. J Control Release 179:63-75.

Lyndon and colleagues stress the heightened importance that metallic drug/device combinations have received in recent times. The reason for this increased attention is in part because of their effectiveness, and in part because of their potential. Drug/device pairings like these generally are used when the implant is permanent and metal based (stainless steel or titanium). The implant is then given an thin layer of a polymer or ceramic mix that is able to extract material from one another through meshing with it. Lyndon and associates also examine the other types of drug elution that occur from the implant, such as ones based on the type of material the implant is composed… [END OF PREVIEW] . . . READ MORE

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