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Digital Issues

Music Matters in the OR

What's on your OR's iPod? British researchers say Fix You by Coldplay is an excellent choice, but suggest you avoid Queen's Another One Bites the Dust. The recommendations are part of an editorial published in the tongue-in-cheek holiday edition of The BMJ.

According to the editorial's authors, who really did review the literature to see what benefit music has on patient care, tunes are played during 62% to 72% of cases, with surgeons most often playing the role of room DJ. Approximately 80% of OR staff say music improves communication between team members, reduces anxiety levels, improves efficiency and enhances surgeons' performance by increasing their focus on tasks at hand.

The arts and medicine have long been intertwined, says David C Bosanquet, MD, surgical registrar at the University Hospital of Wales in Cardiff, England, who points out Apollo is the Greek god of both healing and music.

Evidence-based surgery guides everything surgical teams do, from the moment patients enter the OR to the minute they leave, he says. But what does the evidence say about music's benefits?

"It's quite clear — music is fantastically beneficial for the awake patient," says Dr. Bosanquet. "The calming effects are equivalent to pre-op analgesics, and in some cases are slightly better."

Music is free to give at the patient's request. It can be started and stopped, and has no side effects. "This is a wonder drug that we are perhaps underutilizing," says Dr. Bosanquet.

Just steer clear of Scar Tissue by the Red Hot Chili Peppers.

Daniel Cook

December 2nd E-WEEKLY

New Hope for Knees: 3D Printing and Proteins

Researchers have found a way to regenerate torn or damaged knee menisci using 3D printing and implanted recombinant human proteins.

According to their study in Science Translational Medicine, the technique has been successfully carried out in sheep, which have knees similar to those of humans. It starts with an MRI of the healthy meniscus in a patient's undamaged knee. A 3D printer then produces a scaffold (in about 30 minutes) that's essentially an exact replica, using polycaprolactone, a biodegradable polymer used in sutures.

The scaffold, when inserted into the damaged knee, is infused with connective growth factor (CTGF) and transforming growth factor β3 (TGFβ3). When released in a pre-specified order, the growth factors attract existing stem cells from the body and induce them to form meniscal tissue. Eventually, the scaffold dissolves and is absorbed. In sheep, the entire process takes about 4 to 6 weeks.

"We envision that personalized meniscus scaffolds, from initial MRI to 3D printing, could be completed within days," says study leader Jeremy Mao, DDS, PhD, of the Columbia University Medical Center in New York. The scaffolds could then be shipped to clinics and hospitals within a week.

The technique could represent a big step forward for the million or so Americans who suffer meniscus damage every year. "Some small tears can be sewn back in place, but larger tears have to be surgically removed," says Dr. Mao. "While removal helps reduce pain and swelling, it leaves the knee without the natural shock absorber between the femur and tibia, which greatly increases the risk of arthritis."

Damaged menisci can also be replaced with transplants using tissue from other body parts or cadavers, but the procedure has a low success rate and carries significant risks.

Jim Burger

Key Indicators of UTIs Following Pelvic-Floor Surgery

There may be a way to identify women at risk of developing urinary tract infection (UTI) following pelvic-floor surgery, suggests a recent study in PLOS ONE.

Researcher at the Loyola University Chicago Stritch School of Medicine looked at the relationship between urinary bacteria, antimicrobial peptides and UTI symptom severity in 54 women undergoing pelvic-floor surgery. Study participants answered questions on their symptoms and provided a catheterized urine specimen on the day of surgery, which was analyzed using advanced DNA-based detection methods.

Those at a lower risk for a post-op UTI had greater bacterial diversity, greater abundance of the Lactobacillus species and higher levels of the antimicrobial peptide β-defensin-1, the study found.

Women who undergo surgery for pelvic-organ prolapse or urinary incontinence are more likely to develop a UTI following the procedure, although clinicians have not yet had a way to determine which patients are at an increased risk.

"This study's information may help us improve UTI prevention and treatment strategies for women down the road," says study senior author Katherine Radek, PhD, an assistant professor in department of surgery at Loyola.

Kendal Gapinski

InstaPoll: Is Your Staff Receiving a Holiday Bonus This Year?

With the holidays right around the corner, we want to know if your staff is going to receive a little something extra in their paychecks this year. Tell us if your facility is going to hand out a holiday bonus in this week's InstaPoll.

Most (69%) of the 232 respondents to last week's poll say they've been pressured to cut a corner or look the other way during their surgical careers. The results:

Ever felt pressured to do something that you knew was wrong?

  • yes 69%
  • no 31%

Dan O'Connor

News & Notes

  • Preparing for terror emergencies The rash of violent rampages taking place in healthcare facilities over the past year has led the U.S. Department of Health and Human Services to compile a guide to help providers prepare for, respond to and recover from an armed-intruder emergency. The guide was produced in consultation with the Federal Emergency Management Agency and the Federal Bureau of Investigation.
  • Where waiting room magazines go The magazines in your reception area disappear at a rate of 1.32 magazines per day, or 41 a month, according to a report in The BMJ, which traditionally publishes lighthearted peer-reviewed studies each year in its Christmas issue. A New Zealand physician conducted the experiment in his practice's waiting room to find that newer magazines were more likely to go missing than older ones, and those with photos of celebrities on the cover were more likely to go home with patients and their families than newsy fare. In total, swiped magazines cost the United Kingdom's healthcare facilities an average $19.8 million a year, he calculated.
  • SSI rates vary A universal method for tracking surgical site infections in hospitals is needed, according to a study in JAMA Surgery. The authors discovered an 8% difference in infection rate data gathered by the American College of Surgeons and the CDC, with the ACS rates always higher. The findings suggest the data collection methods cannot be used interchangeably to evaluate infection control practices and determine Medicare reimbursements tied to the Hospital Value-Based Purchasing program.