Danny Goel - Academia.edu (original) (raw)
Papers by Danny Goel
Journal of Shoulder and Elbow Surgery, Sep 1, 2011
Operative Techniques in Orthopaedics, Mar 1, 2010
... release. Heterotopic Ossification. Hastings and Graham 61 have defined a classification schem... more ... release. Heterotopic Ossification. Hastings and Graham 61 have defined a classification scheme for heterotopic ossification (HO) around the elbow. The extent of HO can be minimal to complete ankylosis requiring surgical excision. ...
Techniques in Shoulder and Elbow Surgery, Jun 1, 2010
Journal of Shoulder and Elbow Surgery, May 1, 2012
Journal of Shoulder and Elbow Surgery, Apr 1, 2014
Scapulothoracic fusion (STF) may be an option to alleviate pain and restore function. The purpose... more Scapulothoracic fusion (STF) may be an option to alleviate pain and restore function. The purpose of this study is to report the clinical outcome of patients who underwent STF for the treatment of painful scapular winging. From 1999 through 2008, 10 patients (12 shoulders) underwent an STF for painful winging of the scapula. The mean follow-up period was 41 months (range, 8-72 months). Indications for STF included winging in association with excessive medial and/or lateral clavicular resection and facioscapulohumeral dystrophy, as well as scapular winging related to combined long thoracic and spinal accessory nerve palsy. A retrospective review was performed to evaluate the subjective shoulder value, visual analog scale score, range of motion, unions, and complications. There was a statistically significant improvement in the subjective shoulder value, visual analog scale score, range of motion, and satisfaction postoperatively. The overall complication rate was 50% (6 of 12). There were 2 persistent nonunions (2 of 12, 17%), and 50% (6 of 12) of all fusions required subsequent hardware removal because of discomfort. Complications included pleural effusion (3 of 12, 25%), hemopneumothorax (1 of 12, 8%) pulmonary embolus (1 of 12, 8%), and infection (1 of 12, 8%). With the exception of the revision nonunion, all complications resolved with no negative sequelae. STF results in improved function and pain relief. STF is associated with a high short-term complication rate with limited long-term sequelae.
American Journal of Physiology-heart and Circulatory Physiology, Oct 1, 2002
Sports Medicine and Arthroscopy Review, Sep 1, 2010
Journal of Surgical Research, Dec 1, 2021
BACKGROUND Immersive virtual reality (iVR) simulators provide accessible, low cost, realistic tra... more BACKGROUND Immersive virtual reality (iVR) simulators provide accessible, low cost, realistic training adjuncts in time and financially constrained systems. With increasing evidence and utilization of this technology by training programs, clarity on the effect of global skill training should be provided. This systematic review examines the current literature on the effectiveness of iVR for surgical skills acquisition in medical students, residents, and staff surgeons. METHODS A literature search was performed on MEDLINE, EMBASE, CENTRAL, Web of Science and PsycInfo for primary studies published between January 1, 2000 and January 26, 2021. Two reviewers independently screened titles, abstracts, and full texts, extracted data, and assessed quality and strength of evidence using the Medical Education Research Quality Instrument (MERSQI) and Cochrane methodology. Results were qualitatively synthesized, and descriptive statistics were calculated. RESULTS The literature search yielded 9650 citations, with 17 articles included for qualitative synthesis. The mean (SD) MERSQI score was 11.7 (1.9) out of 18. In total, 307 participants completed training in four disciplines. Immersive VR-trained groups performed 18% to 43% faster on procedural time to completion compared to control (pooled standardized mean difference = -0.90 [95% CI=-1.33 to -047, I2=1%, P < 0.0001]). Immersive VR trainees also demonstrated greater post-intervention scores on procedural checklists and greater implant placement accuracy compared to control. CONCLUSIONS Immersive VR incorporation into surgical training programs is supported by high-quality, albeit heterogeneous, studies demonstrating improved procedural times, task completion, and accuracy, positive user ratings, and cost-effectiveness.
Journal of Bone and Joint Surgery, American Volume, Jan 17, 2020
Journal of the American Academy of Orthopaedic Surgeons, Oct 1, 2021
Background: The COVID-19 pandemic has interrupted orthopaedic training structures for both surgeo... more Background: The COVID-19 pandemic has interrupted orthopaedic training structures for both surgeons and trainees. The concept of skill decay must be considered during inactivity of elective practice. The purpose of this study was to provide an evidence-based curriculum in association with immersive virtual reality (iVR) to prevent skill decay during periods of training cessation and beyond. Methods: A review of pertinent literature for orthopaedic surgical skill decay was performed. Early experience by faculty instructors and residency and fellowship program directors was gathered from multiple institutions with experience in virtual training methods including iVR. A proposed curriculum for cognitive and manual skill acquisition during COVID-19 was produced from qualitative narrative group opinion. Results: Skill decay can occur on the order of days to months and is dependent on the initial skill level. A novel curriculum for structured continuing medical education during and after periods of surgical disruption including e-learning, virtual meetings, and iVR simulators was produced from expert opinion and based on competency-based curriculum standards. Conclusion: Skill decay mitigation strategies should use best available evidence technologies and course structures that satisfy advanced learning concepts. The virtual curriculum including iVR simulators may provide cost-effective solutions to training.
Archives of Orthopaedic and Trauma Surgery, Jul 15, 2021
Immersive virtual reality (IVR), augmented reality and mixed reality form a spectrum of extended ... more Immersive virtual reality (IVR), augmented reality and mixed reality form a spectrum of extended reality technology integration that has gained popularity in orthopaedics recently. This review article examines the role of extended reality technologies in knee arthroplasty. Existing literature on the applications of extended reality technologies in preoperative planning and intraoperative navigation were reviewed. A sample workflow of a novel IVR simulator for improving surgical training was also provided to demonstrate its utility in educating trainees on knee arthroplasty techniques. Extended reality technologies enable the surgeon to visualise patient-specific anatomy in real-time, enhancing preoperative planning and providing intraoperative guidance. IVR technology has the potential to revolutionise modern surgical training and optimise surgical performance in a cost-efficient manner, with current evidence demonstrating favourable immediate skill acquisition and transfer. Extended reality technologies have a myriad of potential applications in orthopaedic surgery. Further research is needed to evaluate the cost-effectiveness of its incorporation into training programmes.
The Open Orthopaedics Journal, Apr 23, 2010
Journal of Bone and Joint Surgery, American Volume, Mar 21, 2012
Although the results of the Latarjet procedure have been reported previously, there is little lit... more Although the results of the Latarjet procedure have been reported previously, there is little literature regarding the early complications of this procedure. The purpose of this study was to report our experience with the Latarjet procedure for glenohumeral instability and to highlight the initial complications that may occur following this procedure. Forty-seven patients (forty-eight shoulders) underwent the Latarjet procedure for anterior glenohumeral instability between January 2005 and January 2010. All shoulders had some osseous deficiency of the anterior glenoid rim or had undergone an unsuccessful prior soft-tissue Bankart repair. The minimum duration of patient follow-up was six months. Forty-five shoulders were available for follow-up. The overall complication rate was 25% (twelve of the original forty-eight shoulders). Complications were divided into three groups: infection, recurrent glenohumeral instability, and neurologic injury. A superficial infection developed in three shoulders (6%); in all cases, the infection resolved following irrigation and debridement and administration of antibiotics for up to four weeks. Four shoulders (8%) developed recurrent glenohumeral instability; this occurred within eight months in two shoulders and at nineteen and forty-two months postoperatively in the other two. Five procedures (10%) resulted in a neurologic injury. Two of these involved the musculocutaneous nerve, one involved the radial nerve, and two involved the axillary nerve. The three musculocutaneous and radial nerve injuries involved sensory neurapraxia that resolved fully within two months. Both of the patients with axillary nerve dysfunction continued to have persistent sensory disturbances and one continued to have residual weakness that had not yet resolved fully at the time of the final follow-up. The overall complication rate of 25% is higher than that reported in the literature. Although most of these complications resolved completely, two patients continued to have residual neurologic symptoms. Patients should be informed of the risk of complications associated with the Latarjet procedure, although most of the potential complications will resolve.
Journal of Molecular and Cellular Cardiology, Jun 1, 2001
Journal of Bone and Joint Surgery, American Volume, Mar 1, 2010
Lysophosphatidylcholine (LPC) has been reported to stimulate Na(+)-H+ exchange in rat cardiomyocy... more Lysophosphatidylcholine (LPC) has been reported to stimulate Na(+)-H+ exchange in rat cardiomyocytes. This action may be important in pathological conditions like ischemic injury where LPC is generated and Na(+)-H+ exchange activation is an important determinant of cardiac damage and dysfunction. It is unclear, however, if this stimulation of Na(+)-H+ exchange by LPC occurs through a direct action on the exchanger or through stimulation of a second messenger pathway. The purpose of the present investigation was to determine if lysolipids could directly affect Na(+)-H+ exchange. Purified cardiac sarcolemmal membranes were isolated and Na(+)-H+ exchange was measured by radioisotopic methods following addition of LPC. There were no effects of LPC on Na(+)-H+ exchange at LPC concentrations of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or = 100 microM at all reaction times examined. Lysophosphatidylethanolamine (LPE), lysophosphatidylserine (LPS), lysophosphatidylinositol (LPI) and lysoplasmenylcholine (LP(E)C) also did not alter Na(+)-H- exchange at all concentrations and reaction times examined. We conclude that any stimulatory effects of lysolipids on Na(+)-H+ exchange do not occur through a direct action on the exchanger or its membrane lipid environment and must occur through a second messenger pathway.
Journal of the American Academy of Orthopaedic Surgeons, Nov 1, 2021
Case: A percutaneous pinning of a slipped capital femoral epiphysis is described after the use of... more Case: A percutaneous pinning of a slipped capital femoral epiphysis is described after the use of immersive virtual reality (iVR) training. This case report documents the first reported example of an immediate translation of surgical skill from iVR to the operating room. Conclusion: There is increasing evidence for the use of iVR in orthopaedic education. Several randomized controlled trials demonstrate improved trainee performance relative to control when measured in analogous operating room assessments. This is the first case report demonstrating direct patient care after the use of iVR. The implications of cost-effectiveness through skill transfer and patient safety are highlighted.
Journal of Shoulder and Elbow Surgery, Dec 1, 2010
Journal of Shoulder and Elbow Surgery, Sep 1, 2011
Operative Techniques in Orthopaedics, Mar 1, 2010
... release. Heterotopic Ossification. Hastings and Graham 61 have defined a classification schem... more ... release. Heterotopic Ossification. Hastings and Graham 61 have defined a classification scheme for heterotopic ossification (HO) around the elbow. The extent of HO can be minimal to complete ankylosis requiring surgical excision. ...
Techniques in Shoulder and Elbow Surgery, Jun 1, 2010
Journal of Shoulder and Elbow Surgery, May 1, 2012
Journal of Shoulder and Elbow Surgery, Apr 1, 2014
Scapulothoracic fusion (STF) may be an option to alleviate pain and restore function. The purpose... more Scapulothoracic fusion (STF) may be an option to alleviate pain and restore function. The purpose of this study is to report the clinical outcome of patients who underwent STF for the treatment of painful scapular winging. From 1999 through 2008, 10 patients (12 shoulders) underwent an STF for painful winging of the scapula. The mean follow-up period was 41 months (range, 8-72 months). Indications for STF included winging in association with excessive medial and/or lateral clavicular resection and facioscapulohumeral dystrophy, as well as scapular winging related to combined long thoracic and spinal accessory nerve palsy. A retrospective review was performed to evaluate the subjective shoulder value, visual analog scale score, range of motion, unions, and complications. There was a statistically significant improvement in the subjective shoulder value, visual analog scale score, range of motion, and satisfaction postoperatively. The overall complication rate was 50% (6 of 12). There were 2 persistent nonunions (2 of 12, 17%), and 50% (6 of 12) of all fusions required subsequent hardware removal because of discomfort. Complications included pleural effusion (3 of 12, 25%), hemopneumothorax (1 of 12, 8%) pulmonary embolus (1 of 12, 8%), and infection (1 of 12, 8%). With the exception of the revision nonunion, all complications resolved with no negative sequelae. STF results in improved function and pain relief. STF is associated with a high short-term complication rate with limited long-term sequelae.
American Journal of Physiology-heart and Circulatory Physiology, Oct 1, 2002
Sports Medicine and Arthroscopy Review, Sep 1, 2010
Journal of Surgical Research, Dec 1, 2021
BACKGROUND Immersive virtual reality (iVR) simulators provide accessible, low cost, realistic tra... more BACKGROUND Immersive virtual reality (iVR) simulators provide accessible, low cost, realistic training adjuncts in time and financially constrained systems. With increasing evidence and utilization of this technology by training programs, clarity on the effect of global skill training should be provided. This systematic review examines the current literature on the effectiveness of iVR for surgical skills acquisition in medical students, residents, and staff surgeons. METHODS A literature search was performed on MEDLINE, EMBASE, CENTRAL, Web of Science and PsycInfo for primary studies published between January 1, 2000 and January 26, 2021. Two reviewers independently screened titles, abstracts, and full texts, extracted data, and assessed quality and strength of evidence using the Medical Education Research Quality Instrument (MERSQI) and Cochrane methodology. Results were qualitatively synthesized, and descriptive statistics were calculated. RESULTS The literature search yielded 9650 citations, with 17 articles included for qualitative synthesis. The mean (SD) MERSQI score was 11.7 (1.9) out of 18. In total, 307 participants completed training in four disciplines. Immersive VR-trained groups performed 18% to 43% faster on procedural time to completion compared to control (pooled standardized mean difference = -0.90 [95% CI=-1.33 to -047, I2=1%, P < 0.0001]). Immersive VR trainees also demonstrated greater post-intervention scores on procedural checklists and greater implant placement accuracy compared to control. CONCLUSIONS Immersive VR incorporation into surgical training programs is supported by high-quality, albeit heterogeneous, studies demonstrating improved procedural times, task completion, and accuracy, positive user ratings, and cost-effectiveness.
Journal of Bone and Joint Surgery, American Volume, Jan 17, 2020
Journal of the American Academy of Orthopaedic Surgeons, Oct 1, 2021
Background: The COVID-19 pandemic has interrupted orthopaedic training structures for both surgeo... more Background: The COVID-19 pandemic has interrupted orthopaedic training structures for both surgeons and trainees. The concept of skill decay must be considered during inactivity of elective practice. The purpose of this study was to provide an evidence-based curriculum in association with immersive virtual reality (iVR) to prevent skill decay during periods of training cessation and beyond. Methods: A review of pertinent literature for orthopaedic surgical skill decay was performed. Early experience by faculty instructors and residency and fellowship program directors was gathered from multiple institutions with experience in virtual training methods including iVR. A proposed curriculum for cognitive and manual skill acquisition during COVID-19 was produced from qualitative narrative group opinion. Results: Skill decay can occur on the order of days to months and is dependent on the initial skill level. A novel curriculum for structured continuing medical education during and after periods of surgical disruption including e-learning, virtual meetings, and iVR simulators was produced from expert opinion and based on competency-based curriculum standards. Conclusion: Skill decay mitigation strategies should use best available evidence technologies and course structures that satisfy advanced learning concepts. The virtual curriculum including iVR simulators may provide cost-effective solutions to training.
Archives of Orthopaedic and Trauma Surgery, Jul 15, 2021
Immersive virtual reality (IVR), augmented reality and mixed reality form a spectrum of extended ... more Immersive virtual reality (IVR), augmented reality and mixed reality form a spectrum of extended reality technology integration that has gained popularity in orthopaedics recently. This review article examines the role of extended reality technologies in knee arthroplasty. Existing literature on the applications of extended reality technologies in preoperative planning and intraoperative navigation were reviewed. A sample workflow of a novel IVR simulator for improving surgical training was also provided to demonstrate its utility in educating trainees on knee arthroplasty techniques. Extended reality technologies enable the surgeon to visualise patient-specific anatomy in real-time, enhancing preoperative planning and providing intraoperative guidance. IVR technology has the potential to revolutionise modern surgical training and optimise surgical performance in a cost-efficient manner, with current evidence demonstrating favourable immediate skill acquisition and transfer. Extended reality technologies have a myriad of potential applications in orthopaedic surgery. Further research is needed to evaluate the cost-effectiveness of its incorporation into training programmes.
The Open Orthopaedics Journal, Apr 23, 2010
Journal of Bone and Joint Surgery, American Volume, Mar 21, 2012
Although the results of the Latarjet procedure have been reported previously, there is little lit... more Although the results of the Latarjet procedure have been reported previously, there is little literature regarding the early complications of this procedure. The purpose of this study was to report our experience with the Latarjet procedure for glenohumeral instability and to highlight the initial complications that may occur following this procedure. Forty-seven patients (forty-eight shoulders) underwent the Latarjet procedure for anterior glenohumeral instability between January 2005 and January 2010. All shoulders had some osseous deficiency of the anterior glenoid rim or had undergone an unsuccessful prior soft-tissue Bankart repair. The minimum duration of patient follow-up was six months. Forty-five shoulders were available for follow-up. The overall complication rate was 25% (twelve of the original forty-eight shoulders). Complications were divided into three groups: infection, recurrent glenohumeral instability, and neurologic injury. A superficial infection developed in three shoulders (6%); in all cases, the infection resolved following irrigation and debridement and administration of antibiotics for up to four weeks. Four shoulders (8%) developed recurrent glenohumeral instability; this occurred within eight months in two shoulders and at nineteen and forty-two months postoperatively in the other two. Five procedures (10%) resulted in a neurologic injury. Two of these involved the musculocutaneous nerve, one involved the radial nerve, and two involved the axillary nerve. The three musculocutaneous and radial nerve injuries involved sensory neurapraxia that resolved fully within two months. Both of the patients with axillary nerve dysfunction continued to have persistent sensory disturbances and one continued to have residual weakness that had not yet resolved fully at the time of the final follow-up. The overall complication rate of 25% is higher than that reported in the literature. Although most of these complications resolved completely, two patients continued to have residual neurologic symptoms. Patients should be informed of the risk of complications associated with the Latarjet procedure, although most of the potential complications will resolve.
Journal of Molecular and Cellular Cardiology, Jun 1, 2001
Journal of Bone and Joint Surgery, American Volume, Mar 1, 2010
Lysophosphatidylcholine (LPC) has been reported to stimulate Na(+)-H+ exchange in rat cardiomyocy... more Lysophosphatidylcholine (LPC) has been reported to stimulate Na(+)-H+ exchange in rat cardiomyocytes. This action may be important in pathological conditions like ischemic injury where LPC is generated and Na(+)-H+ exchange activation is an important determinant of cardiac damage and dysfunction. It is unclear, however, if this stimulation of Na(+)-H+ exchange by LPC occurs through a direct action on the exchanger or through stimulation of a second messenger pathway. The purpose of the present investigation was to determine if lysolipids could directly affect Na(+)-H+ exchange. Purified cardiac sarcolemmal membranes were isolated and Na(+)-H+ exchange was measured by radioisotopic methods following addition of LPC. There were no effects of LPC on Na(+)-H+ exchange at LPC concentrations of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or = 100 microM at all reaction times examined. Lysophosphatidylethanolamine (LPE), lysophosphatidylserine (LPS), lysophosphatidylinositol (LPI) and lysoplasmenylcholine (LP(E)C) also did not alter Na(+)-H- exchange at all concentrations and reaction times examined. We conclude that any stimulatory effects of lysolipids on Na(+)-H+ exchange do not occur through a direct action on the exchanger or its membrane lipid environment and must occur through a second messenger pathway.
Journal of the American Academy of Orthopaedic Surgeons, Nov 1, 2021
Case: A percutaneous pinning of a slipped capital femoral epiphysis is described after the use of... more Case: A percutaneous pinning of a slipped capital femoral epiphysis is described after the use of immersive virtual reality (iVR) training. This case report documents the first reported example of an immediate translation of surgical skill from iVR to the operating room. Conclusion: There is increasing evidence for the use of iVR in orthopaedic education. Several randomized controlled trials demonstrate improved trainee performance relative to control when measured in analogous operating room assessments. This is the first case report demonstrating direct patient care after the use of iVR. The implications of cost-effectiveness through skill transfer and patient safety are highlighted.
Journal of Shoulder and Elbow Surgery, Dec 1, 2010