Question:
Discuss the issues of project management and the anterior surgical procedure in adolescence with idiopathic spinal problems treatment.
Answer to Question: BIO3011 Research Methods In Biology
Introduction
Scoliosis can be defined as the lateral curvature (or deformity) of the spine in the coronal plan by the Scoliosis Research Society.
This is confirmed by a radiograph taken in standing.
The Cobb angle measures the degree to the curve by measuring the angle between the least inclined end-plates on the vertebral column. (Weinstein and al., 2013).
Adolescent idiopathic scoliosis, also known as AIS, is a curvature between the lumbar spine and the thoracic.
AIS is a condition in which there is a constant lateral curvature between the lumbar (or thoracic) spine in an upright position.
It’s a complex three-dimensional deformity caused by spine rotation and multiple plane curvatures.
The most common treatment is surgery to correct the scoliotic condition, which is likely will worsen.
AIS surgery can be recommended for adolescents whose spine curves have Cobb angles greater that 45deg-50deg (Konieczny Senyurt & Krauspe 2013).
The goal of the surgery is to create a solid fuse, correct the deformity, and improve cosmetic appeal.
The curve progression can be stopped.
This technique works by using the spine as a scaffold to cement the components using bone paste on the scaffold.
Fusion stability can be reinforced with metal screws, rods, or wires.
Fusion surgery can either be performed posteriorly or anteriorly.
Comparison of 2 Methods
Posterior approach: This procedure involves incisions along the midline.
It is commonly used to treat all types of curvature defects.ADVANTAGESDISADVANTAGES
It’s a simple procedure that involves exposure. The operative field is easy to reach.
There is less disc space.
Neurovascular compromise poses negligible risks (Charosky, et al. (2012)).
There is a violation in the posterior musculature.
You can control the vertebral column well along its sagittal line.
Because of the lack or absence of soft tissue coverages, this approach can lead to high infection rates (Yilmazet al. (2012)).
It addresses the deformity on the coronal plan thoroughly, and the hump can be well controlled.
Preadolescents at higher risk for Crankshaft phenomenon (curve gets worsened).
The thoracic box is unaffected and the pulmonary functions are maintained.
Hypokyphosis is a normal outward curvature that does not always get corrected in the thoracic region.
Anterior approach: This involves making an incision in front or the spine.
It’s used for treating a single lumbar deformity or thoracic curvature.ADVANTAGESDISADVANTAGES
Crankshaft phenomenon effectively avoided
Rod breaking, or screw pullout can happen due to the use of a single rod or cable (Yagi Patel & Boachie Adjei (2015)).
It can correct hypokyphosis of the thoracic spine.
Its recent development poses a risk of non-union, or failure to heal permanently the deformed spine.
It corrects disc space and increases fusion surfaces (Choudhry Ahmad & Verma 2016).
Applying anterior instruments to the lumbar region of the spine without interbody devices can increase the chances of lumbar hyperlordosis.
It is possible to insert larger spinal implants, which leads to better stabilization.
Incisions too large in the chest can damage the chest muscles and cause poor lung function.Anterior Scoliosis Surgery
For treating spine curvature issues, the anterior approach is becoming increasingly popular.
The procedure involves a thoracotomy via the chest wall (Cho, et al. (2014)).
The 1970s saw the rise in popularity of anterior spinal instruments for lumbar idiopathic scoliosis.
This method is often preferred by surgeons because it can prevent the Crankshaft phenomenon.
The entire process can take up to several hours. (Helenius (2013)
An anterior spinal surgery involves being sedated and then receiving general anesthesia.
The person is turned to the right so that his operating side is facing upward.
This is known as the “lateral decubitus” position (Ialenti. et. al., 2013,).
The following steps can be taken during this approach:
Depending on the location of the curve in the spine, the incisions will be made on either the left side or the right.
The lung is then deflated and a rib removed to reach exactly the spine.
The diaphragm is then detached in cases of curves found in the spine’s lumbar and/or thoracolumbar (Tao, et al. (2012)).
This involves removing the disc material from between the vertebrae where there is a curve.
This allows for greater flexibility.
Additionally, the disc material is removed from the curve to increase its flexibility (Sudo. et. al., 2013,).
The next step is to instrument the spine.
The screws are inserted at the affected vertebral levels. After attachment, a single rod or double rod is used at each level.
To correct the spinal deformity, rotate and compress simultaneously.
The boney surface between the vertebral bones has been roughened.
A bone graft is used to fill the space between vertebral bodies.
This promotes fusion.
An allograft bone may be a removed bone rib or crest from pelvis.
The final step is the closure of incisions.
The chest tube can be inserted through one side of the chest cavity.
This expands the lings immediately after surgery (Hasler (2013)).
An anterior approach advocates argue that it offers better corrections for lumbar, thoracolumbar, and spinal curves. Additionally, it requires less recovery time and causes less pain.
Due to the fact that the anterior approach can be used in surgeries that limit the lumbar area, it is preferred. The anterior approach has a significant impact on spinal flexibility.
The anterior approach has historically been reported to have better results for curve corrections, rib hump, and curve corrections.
It yields better radiographic, pulmonary function outcomes.
These advantages make the anterior approach more suitable for treating adolescents with idiopathic colic.
Management Theory
Scoliosis cases that are severe will usually require surgery.
The cost of surgery for scoliosis can vary depending on where you live, but it can be very expensive.
The cost of surgery and recovery does not include costs for additional revisions, treatment of unexpected complications or costs for extra time.
Healthcare issues will require new managerial approaches (Yoder Wise (2014)
Many organizational theories can be used in healthcare. These theories will improve the outcomes for patients who undergo the anterior surgical approach.
The Bureaucratic Theory is the most popular approach.
This is one the oldest theories in management that is still being used.
This is used by organizations and institutions of all sizes.
This management involves the absence of many people at the highest levels of hierarchy who have the authority to make decisions.
It is a team of middle- and lower managers who are responsible for executing the tasks efficiently.
These people are not able to exercise much authority.
The military-like method of sending orders is used.
Figure 2 shows the formal distribution of duties and clearly establishing who has authority and what responsibility.
The theory works by placing individuals in positions that most closely match their technical expertise.
The model emphasizes the importance of following procedure.
Numerous studies have demonstrated that this theory can be used to generate a sense stability and predictability by consistent decision-making and careful management.
Other studies show that this theory can be used to control the administrative environment of the organization.
It is evident that healthcare organizations have a dominant role in professional bureaucratic administration (Gittell Godfrey & Thistlethwaite 2013).
The theory’s inherent closed system perspective and focus on the internal makes it difficult to accept.
While validating this theory across healthcare systems, the assumption of static external environments and external influences can lead to many problems.
The human resource/relation theory holds a great deal of importance.
This perspective, which is consistent with the previously mentioned theory, also adopts a closed system approach.
Research shows that this theory emphasizes creativity and the potential to improve an organization with adequate managerial support.
Jiang et.al., 2012: The theory recognizes individual participation and motivation as important features.
It has been effective in fostering harmony among people and organizations (Figure 3)
This theory emphasizes the development of interpersonal cooperation and communication skills for maximising individual contribution and motivating individuals (Kramar 2014.
Its impact on the professional and specialized healthcare workforce has been established (S.Y. D & Weiner, 2012).
It encourages high-level entry-level education, continuous professional learning among all groups, which ultimately results in positive patient outcomes. (Alfes. et. al. 2013, 2013).
However, the model also predicts stable environments.
This framework alone will not suffice in complex healthcare situations.
Another model is patient-centered business management.
Many organizations now use a patient-centered management approach in order to improve their patient care and business environment.
Figure 4 illustrates how top managers can often see certain systems as more efficient and simpler.
However, proper organization based on the needs of each patient is key to providing the best possible patient care (Cipolle Strand & Morley 2012.
This theory promotes the highest quality medical services and financial results.
Study by Hudon et.al. (2012) has shown that this framework is used by top management to foster collaboration among interdisciplinary approaches.
The Institutional Theory explains how organizations are able to thrive when they have a positive relationship with the external environment.
According to this theory, key stakeholders make an organization more credible by adopting values and norms that reflect the beliefs of those stakeholders.
According to results, expectations and socialization pressures imposed by experts like management consultants or professional organizations have governed healthcare systems’ functioning for decades (Horisch. et. al. (2014)).
These theories all play a part in improving healthcare industry.
Methodology
Management methods
To reduce hospitalizations costs and/or lengthen stays, there are several options.
Employers can be empowered to use health insurance plans that include health savings accounts and health reimbursement arrangements.
Managerial strategies will be used in order to encourage employees to make healthful choices.
Healthcare employees will be given the right tools and training to understand the cost of the surgical procedure.
Motivating them to reduce costs will motivate them and lead to desired results.
Effective communication strategies can encourage healthy behavior in participants (Knapp Vangelisti & Caughlin, 2014).
Another option is to apply consume-directed health design (Fischer (2015)).
This will encourage healthcare consumership and keep healthcare costs down.
The creation of a high-deductible health plan linked to a savings account will also be beneficial.
For a patient to recover, pain management is crucial.
McQuay, et al. (2013).
Professionals will meet with patients to discuss pain control and offer the chance for patients to voice their opinions.
This will help the providers to be more effective in managing pain.
Utilizing efficient human resource coordination will help to avoid delays in medication delivery after surgery.
It will reduce hospital stay by keeping track of all admissions and elective admissions, releasing patients as soon as possible, and initiating multidisciplinary rounding.
The incision area can come in contact water between 2 and 4 weeks following surgery.
To speed healing, patients will be weaned off opioids or narcotics. They can also switch to weaker pain medicine like acetaminophen.
Six weeks after surgery, Xrays will be taken to assess the surgical healing process and efficiency.
Surgery can also be improved by physical therapy.
Data Collection
Data collection involves administering the Scoliosis Research Society-30(SRS-30) outcome questionnaire during each patient’s preoperative, final and postoperative periods.
This questionnaire measures the quality of life (HRQoL), for patients with adolescent idiopathic scoliosis.
The patient and control groups will be compared on the basis of their individual scores and total scores for self image, pain, mental, physical, and emotional health.
SPSS 21 version will be used to evaluate and analyze the responses.
All Work Completed So Far
The questionnaire was prepared.
It has been distributed to those who are about to undergo anterior spine fusion surgery.
They were asked to complete the questionnaire to express their satisfaction with the surgery.
We have taken every precaution to respect their privacy.
The questionnaire is being sent back to them after the procedure.Future Plan
The next semester’s plan will include a followup in which responses from participants will be taken for a four-month follow up.
SPSS 21 statistical software will then analyze the data.
The simulation modeling will aid in decision making regarding the anterior approach to adolescentiopathic scoliosis.
The study will also allow us to compare fusion rate among patients who have reported AIS.
The analysis will also help to identify major neurological or vascular complications post-surgery.
In addition, the data will show information about the patient’s financial situation, current physical activity, medication management, and patient satisfaction. This will enable them to better understand the management strategies that should be implemented to decrease hospital stays, reduce healthcare costs, manage pain, increase overall satisfaction, and improve overall health.
Conclusion
Therefore, scoliosis refers to a three-dimensional deviation of the spinal column.
Adolescents with idiopathic Scoliosis occur in patients aged 10 years old and over.
It can cause an idiopathic structure lateral curve.
Cobb technique is used for measuring the angle of curvature.
This helps to determine the cause.
Surgery is recommended for all patients who have a developing 40 degree scoliosis. It also helps skeletally mature patients with painful or progressive spine curvature that exceeds 45 degrees.
Crankshaft phenomenon occurs when skeletally impaired patients experience anterior growth after a posterior-fusion surgery.
This is usually seen as an increase of rib hump in post-surgical patients.
This can be prevented by anterior fusion surgery.
Anterior surgery has the following goals: pain-free spinalfusion, restoration or truncal imbalance, improvement in cosmesis, shoulder, rib hump, and hip symmetry.
The progress report used several management strategies that can be applied across the healthcare system in order to provide efficient care.
These management frameworks are useful in improving patient outcomes, reducing hospital stay, and lowering treatment cost.
They can also be used to reduce pain and increase healing after surgery.
The questionnaire used for data collection will be used.
An analysis of questionnaire responses can help to manage adolescents with adolescentiopathic scoliosis.
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