BIO3011 Research Methods In Biology

Question:

Discuss the topic of the project management aspects of the anterior surgery approach in adolescence treatment for idiopathic colic.

Answer:

Introduction

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Scoliosis is defined by The Scoliosis Research Society to be the lateral curvature in the spine in the coronal plan.

The radiograph of the spine taken from a standing position will show this deformity.

The Cobb angle, which is the angle between the most inclined vertebral columns end-plates, measures the degree and shape of the curve. Weinstein et. al. (2013).

Adolescent idiopathic scoliosis manifests itself as a curvature at the lumbar, and thoracic spinal spines.

AIS is a condition where there is a persistent lateral curl of more 10 degrees between the lumbar or thoracic spines, when held upright.

It’s a complex, 3-dimensional deformity that is caused by spine rotation and other plane curvatures.

Scoliotic deformities are most commonly treated with surgery. They are likely to worsen over time.

AIS surgery should be considered for adolescents whose spinal curve has Cobb angle values greater than 45deg-50deg. (Konieczny Senyurt & Krauspe (2013)

The surgery aims to correct deformities, achieve solid fusion, and improve cosmetic appearance.

This stops the progression of curves.

The spine is used as a structural framework to cement the components using a bone paste.

For fusion stability reinforcement, wires, rods and metal screws are used.

Fusion surgery can be done in an anterior or posterior manner.

Comparison of 2 Methods

Posterior approach-This involves a straight cut along the midline.

It is commonly used to treat curvature problems.

It requires a simple exposure.

It takes up less space.

Neurovascular compromise has negligible risk (Charosky et. al., 2012).

There is a violation of the posterior muscles.

The vertebral column’s sagittal plane provides good control.

Due to lack or inadequate soft tissue coverages, high infections rates are common in this approach (Yilmaz et. al. 2012).

It addresses the deformity of coronal planes thoroughly, and the hump can be well controlled.

Preadolescents are more at risk for Crankshaft phenomenon (curve becomes worse).

The thoracic and pulmonary cages are not affected.

Hypokyphosis (normal, outward curvature change) is not always corrected at the thoracic area of the spine.

Anterior approach- This involves making a straightincision at the front of your spine.

It is usually used to treat a single deformity of the thoracic or lumbar spine.

Crankshaft phenomenon effectively prevented

Use of a single cable, or rod, can cause screw pullout and rod breakage (Yagi, Patel & Boachie–Adjei (2015)).

It is capable of correcting thoracic hypokyphosis.

Because of its recent development, the spine is at high risk for non-union or permanent failure in healing.

It provides a complete disc space evacuation that increases fusion surface area (Choudhry Ahmad & Verma (2016)).

Use of anterior instruments within the lumbar spinal area without an interbody device can increase the risks of lumbar Hypolordosis.

It allows the insertion and stabilization of larger spinal implants.

An incision too large can lead to weakening of the chest muscles and poor lung function.

Anterior approaches are becoming more popular among surgeons for treating curvature problems in the spine.

The procedure involves a thoracotomy (Cho et. al. 2014).

The 1970s saw the rise in popularity of anterior spinal instrumentation for lumbar adolescent idiopathic scoliosis and thoracolumbar adolescent scoliosis (AIS).

Due to its ability to avoid the Crankshaft phenomenon this approach is preferred by surgeons.

For a successful outcome, the whole procedure can take several hours (Helenius 2013).

First, a person who is undergoing anterior spinal fusion surgery must be sedated. Then, general anesthesia will be administered.

The person is rolled on his side, so that the operating face is facing up.

This is the lateral decubitus posture (Ialenti, et al. 2013, 2013).

These steps are followed during this approach.

The incisions are made initially on either the left or right sides, above the abdomen or chest wall depending on the location of the curve defect in the spine.

Next, the lung is deflated. Then, a rib is removed to reach the exact spine.

In the case of curves in the lumbar, thoraco-lumbar spines (Tao et. al. 2012), a detachment is performed of the diaphragm.

It is possible to remove the disc material between the vertebrae, where the curve is.

This disc material removal increases the curve’s flexibility.

This increases the surface area available for spinal fusion (Sudo, et al. 2013, 2013).

The next step is instrumentation for spine correction.

After the screws have been placed at the correct vertebral levels, attachments with one or two rods at each level are made.

To correct the spinal deformity, rotate and compress simultaneously.

The roughened bone between the vertebral bodies can be seen.

In the space between the vertebral body’s bones, a bone substitute or a bone transplant is placed.

This promotes fusion.

The source of the bone transplant may be an allograft bone or a removed rib.

The final step is closing the incision.

A chest tube is inserted through the chest side for chest cavity surgeries.

This is used to expand the lings in the aftermath of surgery (Hasler 2013).

Proponents of the anterior approach argue that it provides better correction levels for the lumbar or thoracolumbar curves. They also claim that it is faster to recover, causes less pain, and requires less fusions.

Because of the significant improvement in spinal flexibility and the saving of one vertebra, the anterior approach is preferable for surgeries that are restricted to the lumbar area.

Additionally, anterior approaches have been shown to be more effective in correcting curve and rib hump.

It is more effective in determining pulmonary function and radiographic outcomes.

Because of these advantages, the anterior approach is a better option for treating adolescent with idiopathic spinesis than the posterior.

Management Theory

Surgery is generally required in severe cases.

While the costs of scoliosis treatment and surgery vary from region to region, they can be very expensive.

These general costs do NOT include any additional costs for rehabilitation, revision surgeries, or treatment for unforeseen complications.

New managerial approaches are required in order to meet healthcare challenges (Yoder Wise, 2014).

In this context of healthcare, there are many organizational theories that can help improve the health outcomes of patients who have undergone anterior surgical approaches.

The Bureaucratic Theory should be the first option.

This is one of oldest theories of management still in use.

This management theory is used by all types of institutions and organizations.

This management involves the presence of a few people at higher levels of hierarchy who have the right to make decisions. (Tummers & Bekkers (2014)

For the efficient execution of tasks, a network of middle and lower management is responsible.

These managers have very limited authority.

The highest levels are given orders in a manner similar to the military.

Figure 2 illustrates how the authority and responsibility lines are established and how duties are distributed.

The theory works by placing individuals in positions that best suit their technical skills.

In this model, it is crucial to adhere to the procedures.

As demonstrated by numerous studies, this theory has been proven to be effective in creating stability and predictability through consistent management approaches and consistent decision making.

This theory is supported by other studies that show professionals have control over the administrative structures of their organizations.

Evidence of the dominance by professional bureaucratic management in healthcare organizations is provided by the existence of parallel administrative and profession hierarchies that play a role clarifying responsibilities as well as operating procedures (Gittell Godfrey & Thistlethwaite (2013)).

Its closed-system approach and inherent focus on internal issues make this theory problematic.

While this theory can be applied across healthcare systems, it is based on the assumption that there is no external environment or influence other than static.

The importance of the human resource/relation theory is paramount.

A closed system perspective is used here to keep in line with the previous theory.

This theory, according to studies, highlights the contribution of creative potential towards improvement of an organization when it is supported by adequate management resources.

Jiang and colleagues (2012) identify motivation and individual involvement as crucial features of this theory.

It has proven effective in encouraging harmony and supporting the development of organisations (Figure 3).

This theory encourages interpersonal collaboration and communication skills that maximize individual contributions and motivate people (Kramar (2014)).

Its profound impact on healthcare professionals has been demonstrated (S.Y.

It encourages higher entry-level education as well as continuous professional development. This ultimately creates positive patient outcomes (Alfes and al., 2013).

The model predicts stability, however.

In complex healthcare settings, the framework cannot be used alone.

Another model is patient-centered leadership.

Many healthcare organizations are now adopting a patient-centered approach to management because of a shift in attitudes towards patient care and the healthcare business environment.

Figure 4: Top managers are often more comfortable with certain systems than others (Figure 5).

However, the best care is delivered when the organization is tailored to the patient’s needs (Cipolle Strand & Morley (2012)).

This theory promotes excellence in medical services and best financial results.

The framework has been shown to be used by top managers to foster collaboration between interdisciplinary approaches, departments, and medical services in ways that aren’t typical of bureaucratic management. (Hudon et. al. 2012).

The Institutional theory is a way to explain how organizations thrive in an external environment that is conducive to their success.

According to this theory, key stakeholders can help organizations gain legitimacy by adopting values and norms that reflect the beliefs of their stakeholders (Thornton Ocasio & Lounsbury (2015)).

Research shows that the healthcare system’s functioning has been affected by expectations and socialization pressures from professionals such as management consultants and professional bodies for decades (Horisch. et. al., 2014.).

All of the above theories play a part in the improvement of the healthcare industry.

Methodology

Management strategies

You can reduce hospitalization costs, or the length of stay by using a variety of approaches.

The consumer-directed health plan, which includes a health savings account and health reimbursement arrangements, focuses on making employees better healthcare consumers.

To persuade employees to make healthier choices, management strategies will be employed.

The healthcare staff will receive adequate training and tools to help them understand the costs of the surgery.

They will be motivated to reduce their treatment costs by offering incentives. This will help achieve desired results.

Effective communication strategies will allow participants to engage in healthy behavior (Knapp Vangelisti, Caughlin and Caughlin (2014)).

Other options include the use of consume-directed health design (Fischer, 2015).

This will encourage healthcare consumerism and lower costs.

A health savings account that is linked to high-deductible plans can also be very effective.

A patient’s recovery depends on their ability to manage pain.

McQuay et. al. (2013) will initiate a pain control policy.

A pain control policy will be initiated by professionals. They will also discuss the topic with patients.

These providers will learn about the management of cohesive-pain.

It will be possible to avoid delays in medication delivery following surgery by using efficient human resources coordination.

Hospital stays can be cut by keeping track of average daily admissions and managing elective admissions.

The incision may come into contact with water within the first 2 weeks.

The patient will be off opioids and narcotics. A switch to a weaker pain medication such as acetaminophen can aid in rapid healing.

To assess the effectiveness of the fusion and surgical healing, X-rays are taken approximately 6 weeks following surgery.

The administration of physical therapy to the patients may also help improve surgical healing.

Data Collection

Data collection is done by administering the Scoliosis Research Society-30 (30) outcome questionnaire to all 30 patients at each stage of their treatment.

This questionnaire measures the health-related QoL (HRQoL), in patients with adolescent idiopathic scoliosis who had either undergone anterior approach surgery (Carrico Meves & Avanzi (2012)).

Comparisons between the patient and control group will be made on self-image, pain and mental health scores, as well as total scores for function, self-image and satisfaction.

SPSS 21 version will be used for analysis and evaluation of the responses.

This is the Work That Has Been Done So Far

The questionnaire is now complete.

It was sent to all those who will be undergoing anterior scoliosis surgery.

In the questionnaire, they were asked to indicate their willingness to undergo the surgery.

They have been protected in every way possible.

The questionnaire will be sent again to respondents after surgery.

The next semester’s plan will include a follow up in which responses from participants will be taken for a 4-month follow-up.

The SPSS 21 statistical program will analyze the data.

Simulation modeling will assist in decision-making regarding the anterior approach to adolescentiopathic scoliosis.

This study will enable us to compare fusion rates in patients with AIS.

The analysis will also help to identify major neurological or vascular complications after surgical intervention.

Additionally, the data will reveal financial information, current activity, medication management, patient satisfaction, and will allow for a deeper understanding of management frameworks that are needed to reduce hospital stays, lower healthcare costs and manage pain.

Conclusion

Scoliosis, also known as the three-dimensional deformity or deviation of the spinal axis, is therefore a condition called scoliosis.

The scoliosis is most common in adolescents aged 10 and above.

It can lead to an idiopathic lateral structural curve.

Cobb method is used to measure the angle.

It is possible to diagnose the condition by using a longitudinal radiograph which shows the spine rotating in a radial direction.

Surgery is considered the preferred option for all patients with skeletally maturing spines that have a 40-degree scoliosis. It can also be used for those patients who have a painful or progressive curve of their spines greater than 45 degrees.

Crankshaft phenomenon refers to an anterior growth of skeletally undeveloped patients following posterior spine fusion surgery.

It usually manifests as an increase in rib-hump in post-surgical patients.

To prevent this, anterior fusion surgery can be performed.

Anterior surgery is a painless procedure that allows for spinal fusion without any side effects, and can also restore truncal balance and cosmesis.

The progress report made use of several management theories that could be used throughout the healthcare system to ensure efficient service delivery.

These management frameworks can help improve patient outcomes, decrease hospital stay, and lower treatment costs.

These management frameworks will be helpful in pain management, as well as increasing healing ability after the surgery.

Based on a questionnaire, the data will be collected.

The questionnaire responses can be used to help manage patients with adolescent Idiopathic Scoliosis.

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