Gastrointestinal robot-assisted surgery. A current perspective.

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Lunca, Sorinel; Bouras, George; Stanescu, Alexandru Calin

2005-12-01

Minimally invasive techniques have revolutionized operative surgery. Computer aided surgery and robotic surgical systems strive to improve further on currently available minimally invasive surgery and open new horizons. Only several centers are currently using surgical robots and publishing data. In gastrointestinal surgery, robotic surgery is applied to a wide range of procedures, but is still in its infancy. Cholecystectomy, Nissen fundoplication and Heller myotomy are among the most frequently performed operations. The ZEUS (Computer Motion, Goleta, CA) and the da Vinci (Intuitive Surgical, Mountain View, CA) surgical systems are today the most advanced robotic systems used in gastrointestinal surgery. Most studies reported that robotic gastrointestinal surgery is feasible and safe, provides improved dexterity, better visualization, reduced fatigue and high levels of precision when compared to conventional laparoscopic surgery. Its main drawbacks are the absence of force feedback and extremely high costs. At this moment there are no reports to clearly demonstrate the superiority of robotics over conventional laparoscopic surgery. Further research and more prospective randomized trials are needed to better define the optimal application of this new technology in gastrointestinal surgery.

Overview of Facial Plastic Surgery and Current Developments

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Chuang, Jessica; Barnes, Christian; Wong, Brian J. F.

2016-01-01

Facial plastic surgery is a multidisciplinary specialty largely driven by otolaryngology but includes oral maxillary surgery, dermatology, ophthalmology, and plastic surgery. It encompasses both reconstructive and cosmetic components. The scope of practice for facial plastic surgeons in the United States may include rhinoplasty, browlifts, blepharoplasty, facelifts, microvascular reconstruction of the head and neck, craniomaxillofacial trauma reconstruction, and correction of defects in the face after skin cancer resection. Facial plastic surgery also encompasses the use of injectable fillers, neural modulators (e.g., BOTOX Cosmetic, Allergan Pharmaceuticals, Westport, Ireland), lasers, and other devices aimed at rejuvenating skin. Facial plastic surgery is a constantly evolving field with continuing innovative advances in surgical techniques and cosmetic adjunctive technologies. This article aims to give an overview of the various procedures that encompass the field of facial plastic surgery and to highlight the recent advances and trends in procedures and surgical techniques. PMID:28824978

Current rates of publication for podium and poster presentations at the american society for surgery of the hand annual meetings.

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Abzug, Joshua M; Osterman, Meredith; Rivlin, Michael; Paryavi, Ebrahim; Osterman, A Lee

2014-09-01

Research projects are presented at the Annual Meetings of the American Society for Surgery of the Hand (ASSH). It is unknown how many achieve publication in peer-reviewed journals. We sought to determine current rates of publication of podium and poster presentations. All ASSH podium and poster presentations from 2000 to 2005 were reviewed, and an Internet-based search using PubMed and Google was conducted to determine whether the presented studies had been published. Times to publication and journal names were recorded. Data were analyzed with descriptive statistics. Fisher's exact test was conducted to compare current trends with previous trends. Of 1127 podium and poster presentations reviewed, 46% were published in peer-reviewed journals. Forty-seven percent of published presentations (242 presentations) were in Journal of Hand Surgery, and 11% (59 presentations) were in Journal of Bone and Joint Surgery. Forty-five percent of presentations were published within 2 years and 66% within 3 years. The publication rate for podium presentations was significantly higher than that previously reported for Journal of Hand Surgery, at 54% compared with 44% (P=0.004). Currently, fewer than half of the studies presented at Annual Meetings of the ASSH achieve publication in peer-reviewed journals. Presentations are most likely to be published within 3 years, and almost half are published in Journal of Hand Surgery.

Current trends in nursing theories.

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Im, Eun-Ok; Chang, Sun Ju

2012-06-01

To explore current trends in nursing theories through an integrated literature review. The literature related to nursing theories during the past 10 years was searched through multiple databases and reviewed to determine themes reflecting current trends in nursing theories. The trends can be categorized into six themes: (a) foci on specifics; (b) coexistence of various types of theories; (c) close links to research; (d) international collaborative works; (e) integration to practice; and (f) selective evolution. We need to make our continuous efforts to link research and practice to theories, to identify specifics of our theories, to develop diverse types of theories, and to conduct international collaborative works. Our paper gives implications for future theoretical development in diverse clinical areas of nursing research and practice. © 2012 Sigma Theta Tau International.

Neuroimaging in refractory epilepsy. Current practice and evolving trends

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Ramli, N. [Department of Biomedical Imaging, University Malaya Research Imaging Centre (Malaysia); Rahmat, K., E-mail: katt_xr2000@yahoo.com [Department of Biomedical Imaging, University Malaya Research Imaging Centre (Malaysia); Lim, K.S.; Tan, C.T. [Neurology Unit, Department of Medicine, University Malaya, Kuala Lumpur (Malaysia)

2015-09-15

Highlights: • Neuroimaging is imperative in diagnostic work up and therapeutic assessment of refractory epilepsy. • Identification of epileptogenic zone on EEG, MRI and functional imaging improves the success of surgery. • High performance MRI greatly enhanced metabolic information and elucidate brain functions. • Optimisation of epilepsy protocols in structural and functional MRI are presented in this article. - Abstract: Identification of the epileptogenic zone is of paramount importance in refractory epilepsy as the success of surgical treatment depends on complete resection of the epileptogenic zone. Imaging plays an important role in the locating and defining anatomic epileptogenic abnormalities in patients with medically refractory epilepsy. The aim of this article is to present an overview of the current MRI sequences used in epilepsy imaging with special emphasis of lesion seen in our practices. Optimisation of epilepsy imaging protocols are addressed and current trends in functional MRI sequences including MR spectroscopy, diffusion tensor imaging and fusion MR with PET and SPECT are discussed.

Neuroimaging in refractory epilepsy. Current practice and evolving trends

International Nuclear Information System (INIS)

Ramli, N.; Rahmat, K.; Lim, K.S.; Tan, C.T.

2015-01-01

Highlights: • Neuroimaging is imperative in diagnostic work up and therapeutic assessment of refractory epilepsy. • Identification of epileptogenic zone on EEG, MRI and functional imaging improves the success of surgery. • High performance MRI greatly enhanced metabolic information and elucidate brain functions. • Optimisation of epilepsy protocols in structural and functional MRI are presented in this article. - Abstract: Identification of the epileptogenic zone is of paramount importance in refractory epilepsy as the success of surgical treatment depends on complete resection of the epileptogenic zone. Imaging plays an important role in the locating and defining anatomic epileptogenic abnormalities in patients with medically refractory epilepsy. The aim of this article is to present an overview of the current MRI sequences used in epilepsy imaging with special emphasis of lesion seen in our practices. Optimisation of epilepsy imaging protocols are addressed and current trends in functional MRI sequences including MR spectroscopy, diffusion tensor imaging and fusion MR with PET and SPECT are discussed

Refractive surgery trends and practice style changes in Germany over a 3-year period.

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Schmack, Ingo; Auffarth, Gerd U; Epstein, Daniel; Holzer, Mike P

2010-03-01

To study the current practice styles and preferences of refractive surgeons in Germany. In February 2008, a seven-item questionnaire regarding the practice of refractive surgery was mailed to 282 members of the German Society of Intra-ocular Lens Implantation, Interventional, and Refractive Surgery (DGII) and the Commission of Refractive Surgery (KRC). Most questions were identical to our 2005 German refractive surgery survey. All data were analyzed in a masked fashion. The response rate was 42.2%. The majority (68%) of respondents reported that they perform refractive surgery in laser centers (exclusively or partially) followed by general hospitals (19.4%) and universities (12.6%). Although LASIK was the predominant type of refractive surgery performed (80.6%), other refractive procedures included refractive lens exchange (60.2%), photorefractive keratectomy (47.6%), phakic intraocular lens implants (45.6%), laser-assisted subepithelial keratectomy (36.9%), epithelial laser in situ keratomileusis (15.5%), intracorneal rings (5.8%), and limbal relaxing incisions (2.9%). The volume of refractive surgery procedures and the preferred type of excimer laser systems, microkeratomes, and diagnostic devices varied at different institutions. Most respondents performed either wavefront-guided custom ablation or wavefront-optimized ablation (63.1%) compared with conventional excimer laser correction (36.9%). Refractive surgery practice styles and preferences in Germany are comparable to trends in other European countries. Although LASIK is the most commonly performed refractive procedure, the numbers of various surface ablation techniques and refractive intraocular lens procedures are increasing. Copyright 2010, SLACK Incorporated.

Current Rates of Publication for Podium and Poster Presentations at the American Society for Surgery of the Hand Annual Meetings

Directory of Open Access Journals (Sweden)

Joshua M. Abzug

2014-09-01

Full Text Available Background:  Research projects are presented at the Annual Meetings of the American Society for Surgery of the Hand (ASSH. It is unknown how many achieve publication in peer-reviewed journals. We sought to determine current rates of publication of podium and poster presentations.   Methods:  All ASSH podium and poster presentations from 2000 to 2005 were reviewed, and an Internet-based search using PubMed and Google was conducted to determine whether the presented studies had been published. Times to publication and journal names were recorded. Data were analyzed with descriptive statistics. Fisher’s exact test was conducted to compare current trends with previous trends. Results:  Of 1127 podium and poster presentations reviewed, 46% were published in peer-reviewed journals. Forty-seven percent of published presentations (242 presentations were in Journal of Hand Surgery , and 11% (59 entations were in Journal of Bone and Joint Surgery . Forty-five percent of presentations were published within 2 years and 66% within 3 years. The publication rate for podium presentations was significantly higher than that previously reported for Journal of Hand Surgery, at 54% compared with 44% (P=0.004.  Conclusions:  Currently, fewer than half of the studies presented at Annual Meetings of the ASSH achieve publication in peer-eviewed journals. Presentations are most likely to be published within 3 years, and almost half are published in Journal of Hand Surgery .

The Canadian general surgery resident: defining current challenges for surgical leadership.

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Tomlinson, Corey; Labossière, Joseph; Rommens, Kenton; Birch, Daniel W

2012-08-01

Surgery training programs in Canada and the United States have recognized the need to modify current models of training and education. The shifting demographic of surgery trainees, lifestyle issues and an increased trend toward subspecialization are the major influences. To guide these important educational initiatives, a contemporary profile of Canadian general surgery residents and their impressions of training in Canada is required. We developed and distributed a questionnaire to residents in each Canadian general surgery training program, and residents responded during dedicated teaching time. In all, 186 surveys were returned for analysis (62% response rate). The average age of Canadian general surgery residents is 30 years, 38% are women, 41% are married, 18% have dependants younger than 18 years and 41% plan to add to or start a family during residency. Most (87%) residents plan to pursue postgraduate education. On completion of training, 74% of residents plan to stay in Canada and 49% want to practice in an academic setting. Almost half (42%) of residents identify a poor balance between work and personal life during residency. Forty-seven percent of respondents have appropriate access to mentorship, whereas 37% describe suitable access to career guidance and 40% identify the availability of appropriate social supports. Just over half (54%) believe the stress level during residency is manageable. This survey provides a profile of contemporary Canadian general surgery residents. Important challenges within the residency system are identified. Program directors and chairs of surgery are encouraged to recognize these challenges and intervene where appropriate.

Current Trends In Educational Technology: Implication On ...

African Journals Online (AJOL)

This paper presents the current trends in educational technology and the implication on educational managers in Nigeria. The current trends in the field of educational technology are centred on the influence of information and communication technology on the development of educational management. Various challenges ...

Temporal trend of carpal tunnel release surgery: a population-based time series analysis.

Directory of Open Access Journals (Sweden)

Naif Fnais

Full Text Available BACKGROUND: Carpal tunnel release (CTR is among the most common hand surgeries, although little is known about its pattern. In this study, we aimed to investigate temporal trends, age and gender variation and current practice patterns in CTR surgeries. METHODS: We conducted a population-based time series analysis among over 13 million residents of Ontario, who underwent operative management for carpal tunnel syndrome (CTS from April 1, 1992 to March 31, 2010 using administrative claims data. RESULTS: The primary analysis revealed a fairly stable procedure rate of approximately 10 patients per 10,000 population per year receiving CTRs without any significant, consistent temporal trend (p = 0.94. Secondary analyses revealed different trends in procedure rates according to age. The annual procedure rate among those age >75 years increased from 22 per 10,000 population at the beginning of the study period to over 26 patients per 10,000 population (p<0.01 by the end of the study period. CTR surgical procedures were approximately two-fold more common among females relative to males (64.9% vs. 35.1 respectively; p<0.01. Lastly, CTR procedures are increasingly being conducted in the outpatient setting while procedures in the inpatient setting have been declining steadily - the proportion of procedures performed in the outpatient setting increased from 13% to over 30% by 2010 (p<0.01. CONCLUSION: Overall, CTR surgical-procedures are conducted at a rate of approximately 10 patients per 10,000 population annually with significant variation with respect to age and gender. CTR surgical procedures in ambulatory-care facilities may soon outpace procedure rates in the in-hospital setting.

24th Current Trends in Computational Chemistry

Science.gov (United States)

2017-05-17

Corps of Engineers Army Research Office Conference on Current Trends in Computational Chemistry 2016 NOVEMBER 11-12, 2016 JACKSON, MS... Chemistry and Biochemistry Jackson, MS 39217 U.S.A. Tel: 6019793723 E-mail: shonda@icnanotox.org Richard Alo Dean College of Science, Engineering ...Report: 24th Current Trends in Computational Chemistry The views, opinions and/or findings contained in this report are those of the author(s) and should

Current perspectives in robotic assisted surgery.

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Binet, Aurélien; Ballouhey, Quentin; Chaussy, Yann; de Lambert, Guénolée; Braïk, Karim; Villemagne, Thierry; Becmeur, François; Fourcade, Laurent; Lardy, Hubert

2018-02-23

From classical surgery to Robotic Assisted Surgery, there is a long way allowed by Minimal Invasive Surgery' improvements. The last three decades have witnessed a prodigious development of minimally invasive surgery (MIS) and especially in the field of laparoscopic pediatric surgery but there are several limitations in the use of conventional laparoscopic surgery and Robotic Assisted Surgery was developed to relieve these drawbacks. This new technology enables today the performance of a wide variety of procedures in children with a minimally invasive approach. As for all new technologies, an objective evaluation is essential with the need to respond to several questions: Is the technology feasible? Is the technology safe? Is the technology efficient? Does it bring about benefits compared with current technology? What are the procedures derived from most benefits of robotic assistance? How to assume the transition from open surgery to Minimal Invasive access for RAS? In the first part of this article, the authors give details about technical concerns and then describe the implementation process with its organization, pitfalls, successes, and issues from human resources and financial standpoints. The learning curve is then described and a special focus on small children weighing less than 15 Kg is developed. Finally, the concept of evaluation of this emerging technology is evocated and financial concerns are developed.

Microsurgical reconstruction of the head and neck region: Current concepts of maxillofacial surgery units worldwide.

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Kansy, Katinka; Mueller, Andreas Albert; Mücke, Thomas; Koersgen, Friederike; Wolff, Klaus Dietrich; Zeilhofer, Hans-Florian; Hölzle, Frank; Pradel, Winnie; Schneider, Matthias; Kolk, Andreas; Smeets, Ralf; Acero, Julio; Haers, Piet; Ghali, G E; Hoffmann, Jürgen

2015-10-01

Microvascular surgery following tumor resection has become an important field of oral maxillofacial surgery (OMFS). Following the surveys on current reconstructive practice in German-speaking countries and Europe, this paper presents the third phase of the project when the survey was conducted globally. The DOESAK questionnaire has been developed via a multicenter approach with maxillofacial surgeons from 19 different hospitals in Germany, Austria and Switzerland. It was distributed in three different phases to a growing number of maxillofacial units in German-speaking clinics, over Europe and then worldwide. Thirty-eight units from Germany, Austria and Switzerland, 65 remaining European OMFS-departments and 226 units worldwide responded to the survey. There is wide agreement on the most commonly used flaps, intraoperative rapid sections and a trend towards primary bony reconstruction. No uniform concepts can be identified concerning osteosynthesis of bone transplants, microsurgical techniques, administration of supportive medication and postoperative monitoring protocols. Microsurgical reconstruction is the gold standard for the majority of oncologic cases in Europe, but worldwide, only every second unit has access to this technique. The DOESAK questionnaire has proven to be a valid and well accepted tool for gathering information about current practice in reconstructive OMFS surgery. The questionnaire has been able to demonstrate similarities, differences and global inequalities. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

[Trends in thyroid surgery at the Instituto Nacional de la Nutrición Salvador Zubirán].

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Herrera, M F; López, C M; Saldaña, J; Pérez, B; Rivera, R; González, O; Angeles, A; Letayf, V

1995-01-01

The diagnosis and treatment of thyroid disease has significantly changed with time. With the aim of analysing changes in thyroid surgery in our institution, a representative sample of patients from the first three years in four decades (1960-1992) were comparatively analysed. In the sixties, the diagnosis of thyroid cancer was made during surgery; by contrast, this diagnosis was correctly done by fine needle aspiration (FNA) in most patients of the last decade. Thyroid lobectomy, infrequently used in the treatment of differentiated thyroid carcinoma in earlier times, has now been abandoned and currently most patients undergo total or near-total thyroidectomy. Complications such as hypoparathyroidism and recurrent laryngeal nerve paralysis have importantly decreased with time and were not seen in the last decade. A trend toward an earlier diagnosis of thyroid carcinoma was also observed. In summary, the number of thyroidectomies for benign diseases has been importantly reduced by the use of FNA with the proportional increment of surgery for malignant disease.

Google Trends as a Resource for Informing Plastic Surgery Marketing Decisions.

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Ward, Brittany; Ward, Max; Paskhover, Boris

2018-04-01

Celebrities have long influenced the medical decisions of the general population. By analyzing Google search data using Google Trends, we measured the impact of highly publicized plastic surgery-related events on the interest level of the general population in specific search terms. Additionally, we investigated seasonal and geographic trends around interest in rhinoplasties, which is information that physicians and small surgical centers can use to optimize marketing decisions. Google Trends was used to access search data histories for three separate areas of interest: Kylie Jenner and lip fillers, Joan Rivers and plastic surgery, and rhinoplasty, which were then analyzed using two-tailed, two-sample equal variance t-tests. The average interest level in fillers increased by 30.31 points after Kylie Jenner announced that she received Juvéderm lip injections. The interest level in plastic surgery was decreased by 21.3% the month after Joan Rivers' death. Between January 2004 and May 2017, the average interest level for rhinoplasty was significantly different in January/December (67.91 ± 20.68) and June/July (70.12 ± 18.89) from the remaining calendar months (63.58 ± 19.67). Los Angeles, New York City, and Miami showed consistently high interest levels throughout the time period, while Tulsa, OK, showed a major interest increase between 2015 to 2016 of 65 points. A noticeable impact was observed in both celebrity cases on search term volume, and a seasonal effect is apparent for rhinoplasty searches. As many surgeons already employ aggressive Internet marketing strategies, understanding and utilizing these trends could help optimize their investments, increase social engagement, and increase practice awareness by potential patients. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www

Robotic technology in surgery: current status in 2008.

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Murphy, Declan G; Hall, Rohan; Tong, Raymond; Goel, Rajiv; Costello, Anthony J

2008-12-01

There is increasing patient and surgeon interest in robotic-assisted surgery, particularly with the proliferation of da Vinci surgical systems (Intuitive Surgical, Sunnyvale, CA, USA) throughout the world. There is much debate over the usefulness and cost-effectiveness of these systems. The currently available robotic surgical technology is described. Published data relating to the da Vinci system are reviewed and the current status of surgical robotics within Australia and New Zealand is assessed. The first da Vinci system in Australia and New Zealand was installed in 2003. Four systems had been installed by 2006 and seven systems are currently in use. Most of these are based in private hospitals. Technical advantages of this system include 3-D vision, enhanced dexterity and improved ergonomics when compared with standard laparoscopic surgery. Most procedures currently carried out are urological, with cardiac, gynaecological and general surgeons also using this system. The number of patients undergoing robotic-assisted surgery in Australia and New Zealand has increased fivefold in the past 4 years. The most common procedure carried out is robotic-assisted laparoscopic radical prostatectomy. Published data suggest that robotic-assisted surgery is feasible and safe although the installation and recurring costs remain high. There is increasing acceptance of robotic-assisted surgery, especially for urological procedures. The da Vinci surgical system is becoming more widely available in Australia and New Zealand. Other surgical specialties will probably use this technology. Significant costs are associated with robotic technology and it is not yet widely available to public patients.

Trends in Accreditation Council for Graduate Medical Education Accreditation for Subspecialty Fellowship Training in Plastic Surgery.

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Silvestre, Jason; Serletti, Joseph M; Chang, Benjamin

2018-05-01

The purposes of this study were to (1) determine the proportion of plastic surgery residents pursuing subspecialty training relative to other surgical specialties, and (2) analyze trends in Accreditation Council for Graduate Medical Education accreditation of plastic surgery subspecialty fellowship programs. The American Medical Association provided data on career intentions of surgical chief residents graduating from 2014 to 2016. The percentage of residents pursuing fellowship training was compared by specialty. Trends in the proportion of accredited fellowship programs in craniofacial surgery, hand surgery, and microsurgery were analyzed. The percentage of accredited programs was compared between subspecialties with added-certification options (hand surgery) and subspecialties without added-certification options (craniofacial surgery and microsurgery). Most integrated and independent plastic surgery residents pursued fellowship training (61.8 percent versus 49.6 percent; p = 0.014). Differences existed by specialty from a high in orthopedic surgery (90.8 percent) to a low in colon and rectal surgery (3.2 percent). From 2005 to 2015, the percentage of accredited craniofacial fellowship programs increased, but was not significant (from 27.8 percent to 33.3 percent; p = 0.386). For hand surgery, the proportion of accredited programs that were plastic surgery (p = 0.755) and orthopedic surgery (p = 0.253) was stable, whereas general surgery decreased (p = 0.010). Subspecialty areas with added-certification options had more accredited fellowships than those without (100 percent versus 19.2 percent; p < 0.001). There has been slow adoption of accreditation among plastic surgery subspecialty fellowships, but added-certification options appear to be highly correlated.

Evolving Practice Trends of Aortic Root Surgery in North America.

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Caceres, Manuel; Ma, Yicheng; Rankin, J Scott; Saha-Chaudhuri, Paramita; Gammie, James S; Suri, Rakesh M; Thourani, Vinod H; Englum, Brian R; Esmailian, Fardad; Czer, Lawrence S; Puskas, John D; Svensson, Lars G

2014-08-19

Aortic-valve sparing (AVS) techniques have emerged as alternatives to composite graft-valve replacement (CVR) for treatment of aortic root aneurysm. This study analyzed recent practice trends of aortic root surgery using the Society of Thoracic Surgeons database. From January 2000 through June 2011, 31,747, Overall patients received AVS (n=3,585/31,747; 11.3%) or CVR (n=28,162/31,747; 88.7%). A High-Risk Subgroup was defined as: age >75 years, endocarditis, aortic stenosis, dialysis, multi-valve surgery, valve reoperation, or emergency/salvage status, and high-risk patients were less likely to receive AVS (n=20,356/31,747 [64.1%]; 6% AVS; unadjusted operative mortality 10.5% AVS and 11.7% CVR). The remaining patients comprised a Low-Risk Subgroup, in which AVS was more common (n=11,388/31,747 [35.9%]; 21% AVS; unadjusted operative mortality 1.4% AVS and 3.1% CVR). Procedural changes over 3 equal time periods (P1-P2-P3) were evaluated by Cochran-Armitage trends analysis. Compared to AVS, Overall CVR patients had worse baseline risk profiles and higher unadjusted operative mortality. In High-Risk patients, AVS mortality was comparable to CVR (10.5% vs 11.7%, p=0.19), but AVS mortality was lower in the Low-Risk group (1.4% vs 3%, pAVS percentages and trend p-values were: High-Risk (6%/6%/7%, p=0.26) and Low-Risk (12%/21%/25%, pAVS increased over time in Low-Risk patients while bioprostheses increased in CVR. Favorable outcomes support the trend toward further expansion of AVS. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Readability Trends of Online Information by the American Academy of Otolaryngology-Head and Neck Surgery Foundation.

Science.gov (United States)

Wong, Kevin; Levi, Jessica R

2017-01-01

Objective Previous studies have shown that patient education materials published by the American Academy of Otolaryngology-Head and Neck Surgery Foundation may be too difficult for the average reader to understand. The purpose of this study was to determine if current educational materials show improvements in readability. Study Design Cross-sectional analysis. Setting The Patient Health Information section of the American Academy of Otolaryngology-Head and Neck Surgery Foundation website. Subjects and Methods All patient education articles were extracted in plain text. Webpage navigation, references, author information, appointment information, acknowledgments, and disclaimers were removed. Follow-up editing was also performed to remove paragraph breaks, colons, semicolons, numbers, percentages, and bullets. Readability grade was calculated with the Flesch-Kincaid Grade Level, Flesch Reading Ease, Gunning-Fog Index, Coleman-Liau Index, Automated Readability Index, and Simple Measure of Gobbledygook. Intra- and interobserver reliability were assessed. Results A total of 126 articles from 7 topics were analyzed. Readability levels across all 6 tools showed that the difficulty of patient education materials exceeded the abilities of an average American. As compared with previous studies, current educational materials by the American Academy of Otolaryngology-Head and Neck Surgery Foundation have shown a decrease in difficulty. Intra- and interobserver reliability were both excellent, with intraclass coefficients of 0.99 and 0.96, respectively. Conclusion Improvements in readability is an encouraging finding and one that is consistent with recent trends toward improved health literacy. Nevertheless, online patient educational material is still too difficult for the average reader. Revisions may be necessary for current materials to benefit a larger readership.

Robotic general surgery: current practice, evidence, and perspective.

Science.gov (United States)

Jung, M; Morel, P; Buehler, L; Buchs, N C; Hagen, M E

2015-04-01

Robotic technology commenced to be adopted for the field of general surgery in the 1990s. Since then, the da Vinci surgical system (Intuitive Surgical Inc, Sunnyvale, CA, USA) has remained by far the most commonly used system in this domain. The da Vinci surgical system is a master-slave machine that offers three-dimensional vision, articulated instruments with seven degrees of freedom, and additional software features such as motion scaling and tremor filtration. The specific design allows hand-eye alignment with intuitive control of the minimally invasive instruments. As such, robotic surgery appears technologically superior when compared with laparoscopy by overcoming some of the technical limitations that are imposed on the surgeon by the conventional approach. This article reviews the current literature and the perspective of robotic general surgery. While robotics has been applied to a wide range of general surgery procedures, its precise role in this field remains a subject of further research. Until now, only limited clinical evidence that could establish the use of robotics as the gold standard for procedures of general surgery has been created. While surgical robotics is still in its infancy with multiple novel systems currently under development and clinical trials in progress, the opportunities for this technology appear endless, and robotics should have a lasting impact to the field of general surgery.

Laparoscopic major hepatectomies: current trends and indications. A comparison with the open technique.

Science.gov (United States)

Ratti, Francesca; Cipriani, Federica; Ariotti, Riccardo; Giannone, Fabio; Paganelli, Michele; Aldrighetti, Luca

2015-06-01

Diffusion of laparoscopic major hepatectomies is experiencing a steady increasing trend, although slower compared to minor resections. The aim of this single-center study is to discuss current trends and indications in the application of minimally invasive techniques to major hepatic resections. Preoperative patients and disease characteristics of 49 laparoscopic major hepatectomies (LPS group), performed between 2005 and 2015, were compared with 585 open hepatectomies (Open group) to analyze differences in patients recruitment. Factors which were found to be differently distributed between groups were used as covariates in a propensity score-based case-matched analysis with a 1:3 ratio between LPS group and 147 patients from the Open group (constituting Open-mat group). Short-term outcome was analyzed in matched groups. ASA score, previous abdominal surgery, previous interventional procedures, indication, lesion size and associated procedures were significantly different between the LPS and the Open group. Short-term outcome analysis revealed that blood loss (200 vs 350 mL, p = 0.044) and time for functional recovery (3 vs 4 days, p = 0.05) were reduced in the LPS compared to the Open-mat group, in spite of longer length of surgery (260 vs 170 min, p = 0.041) and comparable oncological adequacy. Even though data on technical feasibility of laparoscopic major resections and their benefits in terms of blood loss and functional recovery support the diffusion of minimally invasive approach, the limit of the technique is still represented by the reduced pool of suitable candidates.

Current economic trends in equine practice.

Science.gov (United States)

Clark, Andrew R

2009-12-01

Current economic trends in equine practice are trends of weakness. Most practices, after a decade of double-digit growth, have migrated to survival mode within a few months. Understanding that all regions and disciplines are affected differently, using the Porter five forces model, we can identify changes that must be made in our business models first to survive and then to position ourselves to prosper when the recession ends. If we are to avoid long-term damage to our practices, we must use cost control and work efficiency in addition to price concessions.

Current Trends in and Indications for Endoscopy-Assisted Breast Surgery for Breast Cancer: Results from a Six-Year Study Conducted by the Taiwan Endoscopic Breast Surgery Cooperative Group

Science.gov (United States)

Lai, Hung-Wen; Chen, Shou-Tung; Chen, Dar-Ren; Chen, Shu-Ling; Chang, Tsai-Wang; Kuo, Shou-Jen; Kuo, Yao-Lung; Hung, Chin-Sheng

2016-01-01

Background Endoscopy-assisted breast surgery (EABS) performed through minimal axillary and/or periareolar incisions is a possible alternative to open surgery for certain patients with breast cancer. In this study, we report the early results of an EABS program in Taiwan. Methods The medical records of patients who underwent EABS for breast cancer during the period May 2009 to December 2014 were collected from the Taiwan Endoscopic Breast Surgery Cooperative Group database. Data on clinicopathologic characteristics, type of surgery, method of breast reconstruction, complications and recurrence were analyzed to determine the effectiveness and oncologic safety of EABS in Taiwan. Results A total of 315 EABS procedures were performed in 292 patients with breast cancer, including 23 (7.8%) patients with bilateral disease. The number of breast cancer patients who underwent EABS increased initially from 2009 to 2012 and then stabilized during the period 2012–2014. The most commonly performed EABS was endoscopy-assisted total mastectomy (EATM) (85.4%) followed by endoscopy-assisted partial mastectomy (EAPM) (14.6%). Approximately 74% of the EATM procedures involved breast reconstruction, with the most common types of reconstruction being implant insertion and autologous pedicled TRAM flap surgery. During the six-year study period, there was an increasing trend in the performance of EABS for the management of breast cancer when total mastectomy was indicated. The positive surgical margin rate was 1.9%. Overall, the rate of complications associated with EABS was 15.2% and all were minor and wound-related. During a median follow-up of 26.8 (3.3–68.6) months, there were 3 (1%) cases of local recurrence, 1 (0.3%) case of distant metastasis and 1 (0.3%) death. Conclusion The preliminary results from the EABS program in Taiwan show that EABS is a safe procedure and results in acceptable cosmetic outcome. These findings could help to promote this under-used surgical technique

Gender trends in authorship in oral and maxillofacial surgery literature: A 30-year analysis.

Science.gov (United States)

Nkenke, Emeka; Seemann, Rudolf; Vairaktaris, Elefterios; Schaller, Hans-Günter; Rohde, Maximilian; Stelzle, Florian; Knipfer, Christian

2015-07-01

The aim of the present study was to perform a bibliometric analysis of the gender distribution of first and senior authorships in important oral and maxillofacial journals over the 30-year period from 1980 to 2010. Articles published in three representative oral and maxillofacial surgery journals were selected. The years 1980, 1990, 2000, and 2010 were chosen as representative points in time for article selection. Original research, case reports, technical notes, and reviews were included in the analysis. Case reports and technical notes were pooled in one group. For each article, the gender of the first author as well as that of the senior author was determined, based on the inspection of their first name. The type of article was determined and the country of origin of the article was documented. A total 1412 articles were subjected to the data analysis. A significant increase in female authorship in oral and maxillofacial surgery could be identified over the chosen 30-year period. However, the number of publications by male authors was still significantly higher at all points of time, exceeding those of female authors by at least 3.8 fold in 2010. As there is a trend towards feminization of medicine and dentistry, the results of the present study may serve as the basis for further analysis of the current situation, and the identification of necessary actions to accelerate the closure of the gender gap in publishing in oral and maxillofacial surgery. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Trends in oral drug bioavailability following bariatric surgery: examining the variable extent of impact on exposure of different drug classes.

Science.gov (United States)

Darwich, Adam S; Henderson, Kathryn; Burgin, Angela; Ward, Nicola; Whittam, Janet; Ammori, Basil J; Ashcroft, Darren M; Rostami-Hodjegan, Amin

2012-11-01

Changes to oral drug bioavailability have been observed post bariatric surgery. However, the magnitude and the direction of changes have not been assessed systematically to provide insights into the parameters governing the observed trends. Understanding these can help with dose adjustments. Analysis of drug characteristics based on a biopharmaceutical classification system is not adequate to explain observed trends in altered oral drug bioavailability following bariatric surgery, although the findings suggest solubility to play an important role. To identify the most commonly prescribed drugs in a bariatric surgery population and to assess existing evidence regarding trends in oral drug bioavailability post bariatric surgery. A retrospective audit was undertaken to document commonly prescribed drugs amongst patients undergoing bariatric surgery in an NHS hospital in the UK and to assess practice for drug administration following bariatric surgery. The available literature was examined for trends relating to drug permeability and solubility with regards to the Biopharmaceutics Classification System (BCS) and main route of elimination. No significant difference in the 'post/pre surgery oral drug exposure ratio' (ppR) was apparent between BCS class I to IV drugs, with regards to dose number (Do) or main route of elimination. Drugs classified as 'solubility limited' displayed an overall reduction as compared with 'freely soluble' compounds, as well as an unaltered and increased ppR. Clinical studies establishing guidelines for commonly prescribed drugs, and the monitoring of drugs exhibiting a narrow therapeutic window or without a readily assessed clinical endpoint, are warranted. Using mechanistically based pharmacokinetic modelling for simulating the multivariate nature of changes in drug exposure may serve as a useful tool in the further understanding of postoperative trends in oral drug exposure and in developing practical clinical guidance. © 2012 The Authors

Robotic bariatric surgery: A general review of the current status.

Science.gov (United States)

Jung, Minoa K; Hagen, Monika E; Buchs, Nicolas C; Buehler, Leo H; Morel, Philippe

2017-12-01

While conventional laparoscopy is the gold standard for almost all bariatric procedures, robotic assistance holds promise for facilitating complex surgeries and improving clinical outcomes. Since the report of the first robotic-assisted bariatric procedure in 1999, numerous publications, including those reporting comparative trials and meta-analyses across bariatric procedures with a focus on robotic assistance, can be found. This article reviews the current literature and portrays the perspectives of robotic bariatric surgery. While there are substantial reports on robotic bariatric surgery currently in publication, most studies suffer from low levels of evidence. As such, although robotics technology is without a doubt superior to conventional laparoscopy, the precise role of robotics in bariatric surgery is not yet clear. Copyright © 2017 John Wiley & Sons, Ltd.

Anesthesia for day-care surgeries: Current perspectives

Directory of Open Access Journals (Sweden)

Sukhminder Jit Singh Bajwa

2017-01-01

Full Text Available Day-care surgery has become a popular modality of surgical intervention throughout the globe. Numerous factors including the economic and financial issues are driving this therapeutic modality to a widespread acceptance among surgeons and anesthesiologists. Advancements in anesthesia and surgical techniques as well as availability of newer drugs are largely responsible for the progress of day-care surgeries. Numerous challenges are still faced by anesthesiologists and surgeons in carrying out day-care surgeries, especially in spite of these advancements, at resource-limited setups. The first right step in successfully delivering the day-care surgical services includes proper selection of the patients. The preanesthetic evaluation is highly essential in determining the suitability of the patient for day-care anesthesia and surgery as well as the formulation of various anesthetic plans and strategies. The current review is intended to highlight inherent challenges and probable solutions to them for this rapidly progressing anesthesia.

Bariatric surgery and the changing current scope of general surgery practice: implications for general surgery residency training.

Science.gov (United States)

Mostaedi, Rouzbeh; Ali, Mohamed R; Pierce, Jonathan L; Scherer, Lynette A; Galante, Joseph M

2015-02-01

The scope of general surgery practice has evolved tremendously in the last 20 years. However, clinical experience in general surgery residency training has undergone relatively little change. To evaluate the current scope of academic general surgery and its implications on surgical residency. The University HealthSystem Consortium and Association of American Medical Colleges established the Faculty Practice Solution Center (FPSC) to characterize physician productivity. The FPSC is a benchmarking tool for academic medical centers created from revenue data collected from more than 90,000 physicians who practice at 95 institutions across the United States. The FPSC database was queried to evaluate the annual mean procedure frequency per surgeon (PFS) in each calendar year from 2006 through 2011. The associated work relative value units (wRVUs) were also examined to measure physician effort and skill. During the 6-year period, 146 distinct Current Procedural Terminology codes were among the top 100 procedures, and 16 of these procedures ranked in the top 10 procedures in at least 1 year. The top 10 procedures accounted for more than half (range, 52.5%-57.2%) of the total 100 PFS evaluated for each year. Laparoscopic Roux-en-Y gastric bypass was consistently among the top 10 procedures in each year (PFS, 18.2-24.6). The other most frequently performed procedures included laparoscopic cholecystectomy (PFS, 30.3-43.5), upper gastrointestinal tract endoscopy (PFS, 26.5-34.3), mastectomy (PFS, 16.5-35.0), inguinal hernia repair (PFS, 15.5-22.1), and abdominal wall hernia repair (PFS, 21.6-26.1). In all years, laparoscopic Roux-en-Y gastric bypass generated the highest number of wRVUs (wRVUs, 491.0-618.2), and laparoscopic cholecystectomy was regularly the next highest (wRVUs, 335.8-498.7). A significant proportion of academic general surgery is composed of bariatric surgery, yet surgical training does not sufficiently emphasize the necessary exposure to technical expertise

Medical telerobotic systems: current status and future trends.

Science.gov (United States)

Avgousti, Sotiris; Christoforou, Eftychios G; Panayides, Andreas S; Voskarides, Sotos; Novales, Cyril; Nouaille, Laurence; Pattichis, Constantinos S; Vieyres, Pierre

2016-08-12

Teleoperated medical robotic systems allow procedures such as surgeries, treatments, and diagnoses to be conducted across short or long distances while utilizing wired and/or wireless communication networks. This study presents a systematic review of the relevant literature between the years 2004 and 2015, focusing on medical teleoperated robotic systems which have witnessed tremendous growth over the examined period. A thorough insight of telerobotics systems discussing design concepts, enabling technologies (namely robotic manipulation, telecommunications, and vision systems), and potential applications in clinical practice is provided, while existing limitations and future trends are also highlighted. A representative paradigm of the short-distance case is the da Vinci Surgical System which is described in order to highlight relevant issues. The long-distance telerobotics concept is exemplified through a case study on diagnostic ultrasound scanning. Moreover, the present review provides a classification into short- and long-distance telerobotic systems, depending on the distance from which they are operated. Telerobotic systems are further categorized with respect to their application field. For the reviewed systems are also examined their engineering characteristics and the employed robotics technology. The current status of the field, its significance, the potential, as well as the challenges that lie ahead are thoroughly discussed.

Current integrated cardiothoracic surgery residents: a Thoracic Surgery Residents Association survey.

Science.gov (United States)

Tchantchaleishvili, Vakhtang; LaPar, Damien J; Stephens, Elizabeth H; Berfield, Kathleen S; Odell, David D; DeNino, Walter F

2015-03-01

After approval by the Thoracic Surgery Residency Review Committee in 2007, 6-year integrated cardiothoracic surgery (I-6) residency programs have gained in popularity. We sought to assess and objectively quantify the level of satisfaction I-6 residents have with their training and to identify areas of improvement for future curriculum development. A completely anonymous, electronic survey was created by the Thoracic Surgery Residents Association that asked the responders to provide demographic information, specialty interest, and lifestyle priorities, and to rate their experience and satisfaction with I-6 residency. The survey was distributed nationwide to all residents in I-6 programs approved by the Accreditation Council for Graduate Medical Education. Of a total of 88 eligible I-6 residents, 49 completed the survey (55.7%). Career choice satisfaction was high (75.5%), as was overall satisfaction with integrated training (83.7%). The majority (77.6%) were interested in cardiac surgery. Overall, the responders reported sufficient time for life outside of the hospital (57.1%), but experienced conflicts between work obligations and personal life at least sometimes (75.5%). Early exposure to cardiothoracic surgery was reported as the dominant advantage of the I-6 model, whereas variable curriculum structure and unclear expectations along with poor integration with general surgery training ranked highest among perceived disadvantages. Current I-6 residents are largely satisfied with the integrated training model and report a reasonable work/life balance. The focused nature of training is the primary perceived advantage of the integrated pathway. Curriculum variability and poor integration with general surgery training are identified by residents as primary areas of concern. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Metastatic Spine Tumor Epidemiology: Comparison of Trends in Surgery Across Two Decades and Three Continents.

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Wright, Ernest; Ricciardi, Federico; Arts, Mark; Buchowski, Jacob M; Chung, Chun Kee; Coppes, Maarten; Crockard, Alan; Depreitere, Bart; Fehlings, Michael; Kawahara, Norio; Lee, Chong Suh; Leung, Yee; Martin-Benlloch, Antonio; Massicotte, Eric; Mazel, Christian; Oner, Cumhur; Peul, Wilco; Quraishi, Nasir; Tokuhashi, Yasuaki; Tomita, Katsuro; Ulbricht, Christian; Verlaan, Jorrit-Jan; Wang, Mike; Choi, David

2018-03-20

Indications for surgery for symptomatic spinal metastases have become better defined in recent years, and suitable outcome measures have been established against a changing backdrop of patient characteristics, tumor behavior, and oncologic treatments. Nonetheless, variations still exist in the local management of patients with spinal metastases. In this study, we aimed to review global trends and habits in the surgical treatment of symptomatic spinal metastases, and to examine how these have changed over the last 25 years. In this cohort study of consecutive patients undergoing surgery for symptomatic spinal metastases, data were collected using a secure Internet database from 22 centers across 3 continents. All patients were invited to participate in the study, except those unable or unwilling to give consent. There was a higher incidence of colonic, liver, and lung carcinoma metastases in Asian countries, and more frequent presentation of breast, prostate, melanoma metastases in the West. Trends in surgical technique were broadly similar across the centers. Overall survival rates after surgery were 53% at 1 year, 31% at 2 years, and 10% at 5 years after surgery (standard error 0.013 for all). Survival improved over successive time periods, with longer survival in patients who underwent surgery in 2011-2016 compared with those who underwent surgery in earlier time periods. Surgical habits have been fairly consistent among countries worldwide and over time. However, patient survival has improved in later years, perhaps due to medical advances in the treatment of cancer, improved patient selection, and operating earlier in the course of disease. Copyright © 2018 Elsevier Inc. All rights reserved.

Trends in pediatric epilepsy surgery.

Science.gov (United States)

Shah, Ritesh; Botre, Abhijit; Udani, Vrajesh

2015-03-01

Epilepsy surgery has become an accepted treatment for drug resistant epilepsy in infants and children. It has gained ground in India over the last decade. Certain epilepsy surgically remediable syndromes have been delineated and should be offered surgery earlier rather than later, especially if cognitive/behavioral development is being compromised. Advances in imaging, particularly in MRI has helped identify surgical candidates. Pre-surgical evaluation includes clinical assessment, structural and functional imaging, inter-ictal EEG, simultaneous video -EEG, with analysis of seizure semiology and ictal EEG and other optional investigations like neuropsychology and other newer imaging techniques. If data are concordant resective surgery is offered, keeping in mind preservation of eloquent cortical areas subserving motor, language and visual functions. In case of discordant data or non-lesional MRI, invasive EEG maybe useful using a two-stage approach. With multi-focal / generalized disease, palliative surgery like corpus callosotomy and vagal nerve stimulation maybe useful. A good outcome is seen in about 2/3rd of patients undergoing resective surgery with a low morbidity and mortality. This review outlines important learning aspects of pediatric epilepsy surgery for the general pediatrician.

Current Status of Single-incision Laparoscopic Surgery

DEFF Research Database (Denmark)

Ahmed, Irfan; Ciancio, Fabio; Ferrara, Vincenzo

2012-01-01

Recent advances in minimally invasive surgery have centered on reducing the number of incisions required, which has led to the development of the single-incision laparoscopic technique. A panel of European single-incision laparoscopy experts met to discuss the current status of, and the future...

Comprehensive management of pressure ulcers in spinal cord injury: Current concepts and future trends

Science.gov (United States)

Kruger, Erwin A.; Pires, Marilyn; Ngann, Yvette; Sterling, Michelle; Rubayi, Salah

2013-01-01

Pressure ulcers in spinal cord injury represent a challenging problem for patients, their caregivers, and their physicians. They often lead to recurrent hospitalizations, multiple surgeries, and potentially devastating complications. They present a significant cost to the healthcare system, they require a multidisciplinary team approach to manage well, and outcomes directly depend on patients' education, prevention, and compliance with conservative and surgical protocols. With so many factors involved in the successful treatment of pressure ulcers, an update on their comprehensive management in spinal cord injury is warranted. Current concepts of local wound care, surgical options, as well as future trends from the latest wound healing research are reviewed to aid medical professionals in treating patients with this difficult problem. PMID:24090179

Impact of the Economic Downturn on Elective Cervical Spine Surgery in the United States: A National Trend Analysis, 2003-2013.

Science.gov (United States)

Bernstein, David N; Jain, Amit; Brodell, David; Li, Yue; Rubery, Paul T; Mesfin, Addisu

2016-12-01

To analyze overall trends of elective cervical spine surgery in the United States from 2003 to 2013 with the goal of determining whether the economic downturn had an impact. Codes from the International Classification of Diseases, Ninth Revision, Clinical Modification were used to identify elective cervical spine surgery procedures in the Nationwide Inpatient Sample from 2003 to 2013. National Health Expenditure, gross domestic product, and S&P 500 Index were used as measures of economic performance. The economic downturn was defined as 2008-2009. Confidence intervals were determined using subgroup analysis techniques. Linear regressions were completed to determine the association between surgery trends and economic conditions. From 2003 to 2013, posterior cervical fusions saw a 102.7% increase. During the same time frame, there was a 7.4% and 14.7% decrease in the number of anterior cervical diskectomy and fusions (ACDFs) and posterior decompressions, respectively. The trend of elective cervical spine surgeries per 100,000 persons in the U.S. population may have been affected by the economic downturn from 2008 to 2009 (-0.03% growth). The percentage of procedures paid for by private insurance decreased from 2003 to 2013 for all ACDFs, posterior cervical fusions, and posterior decompressions. The linear regression coefficients (β) and R 2 values between the number of surgeries and each of the macroeconomic factors analyzed were not statistically significant. The overall elective cervical spine surgery trend was not likely impacted by the economic downturn. Posterior cervical fusions grew significantly from 2003 to 2013, whereas ACDFs and posterior decompressions decreased. Copyright © 2016 Elsevier Inc. All rights reserved.

Impact of the Economic Downturn on Elective Lumbar Spine Surgery in the United States: A National Trend Analysis, 2003 to 2013.

Science.gov (United States)

Bernstein, David N; Brodell, David; Li, Yue; Rubery, Paul T; Mesfin, Addisu

2017-05-01

Retrospective database analysis. The impact of the 2008-2009 economic downtown on elective lumbar spine surgery is unknown. Our objective was to investigate the effect of the economic downturn on the overall trends of elective lumbar spine surgery in the United States. The Nationwide Inpatient Sample (NIS) was used in conjunction with US Census and macroeconomic data to determine historical trends. The economic downturn was defined as 2008 to 2009. Codes from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), were used in order to identify appropriate procedures. Confidence intervals were determined using subgroup analysis techniques. From 2003 to 2012, there was a 19.8% and 26.1% decrease in the number of lumbar discectomies and laminectomies, respectively. Over the same time period, there was a 56.4% increase in the number of lumbar spinal fusions. The trend of elective lumbar spine surgeries per 100 000 persons in the US population remained consistent from 2008 to 2009. The number of procedures decreased by 4.5% from 2010 to 2011, 7.6% from 2011 to 2012, and 3.1% from 2012 to 2013. The R 2 value between the number of surgeries and the S&P 500 Index was statistically significant ( P ≤ .05). The economic downturn did not affect elective lumbar fusions, which increased in total from 2003 to 2013. The relationship between the S&P 500 Index and surgical trends suggests that during recessions, individuals may utilize other means, such as insurance, to cover procedural costs and reduce out-of-pocket expenditures, accounting for no impact of the economic downturn on surgical trends. These findings can assist multiple stakeholders in better understanding the interconnectedness of macroeconomics, policy, and elective lumbar spine surgery trends.

Virtual Universities: Current Models and Future Trends.

Science.gov (United States)

Guri-Rosenblit, Sarah

2001-01-01

Describes current models of distance education (single-mode distance teaching universities, dual- and mixed-mode universities, extension services, consortia-type ventures, and new technology-based universities), including their merits and problems. Discusses future trends in potential student constituencies, faculty roles, forms of knowledge…

Digital library research : current developments and trends

OpenAIRE

Shiri, Ali

2003-01-01

This column gives an overview of current trends in digital library research under the following headings: digital library architecture, systems, tools and technologies; digital content and collections; metadata; interoperability; standards; knowledge organisation systems; users and usability; legal, organisational, economic, and social issues in digital libraries.

Robotic surgery for rectal cancer: A systematic review of current practice

Science.gov (United States)

Mak, Tony Wing Chung; Lee, Janet Fung Yee; Futaba, Kaori; Hon, Sophie Sok Fei; Ngo, Dennis Kwok Yu; Ng, Simon Siu Man

2014-01-01

AIM: To give a comprehensive review of current literature on robotic rectal cancer surgery. METHODS: A systematic review of current literature via PubMed and Embase search engines was performed to identify relevant articles from january 2007 to november 2013. The keywords used were: “robotic surgery”, “surgical robotics”, “laparoscopic computer-assisted surgery”, “colectomy” and “rectal resection”. RESULTS: After the initial screen of 380 articles, 20 papers were selected for review. A total of 1062 patients (male 64.0%) with a mean age of 61.1 years and body mass index of 24.9 kg/m2 were included in the review. Out of 1062 robotic-assisted operations, 831 (78.2%) anterior and low anterior resections, 132 (12.4%) intersphincteric resection with coloanal anastomosis, 98 (9.3%) abdominoperineal resections and 1 (0.1%) Hartmann’s operation were included in the review. Robotic rectal surgery was associated with longer operative time but with comparable oncological results and anastomotic leak rate when compared with laparoscopic rectal surgery. CONCLUSION: Robotic colorectal surgery has continued to evolve to its current state with promising results; feasible surgical option with low conversion rate and comparable short-term oncological results. The challenges faced with robotic surgery are for more high quality studies to justify its cost. PMID:24936229

Current status and future options for trauma and emergency surgery in Turkey.

Science.gov (United States)

Taviloğlu, Korhan; Ertekin, Cemalettin

2008-01-01

The number of trauma victims in Turkey is expected to increase as a consequence of the increasing vehicular traffic, potential for earthquakes, and risk of terrorist attacks. The Turkish Association for Trauma and Emergency Surgery monitors trauma cases, publishes a quarterly journal, organizes trauma courses and seminars for various health personnel nationwide. It is also extending efforts to improve in-hospital care by establishing trauma and emergency surgery fellowships and trauma and emergency surgery centers nationwide, which is run by General Surgeons currently. Turkey faces the same dilemma as the rest of the developed world regarding the future of trauma surgeons in the current era of nonoperative trauma management. We suggest that the field of trauma and emergency surgery be redefined to include emergency general surgery and cavitary trauma.

Tool Sequence Trends in Minimally Invasive Surgery: Statistical Analysis and Implications for Predictive Control of Multifunction Instruments

Directory of Open Access Journals (Sweden)

Carl A. Nelson

2012-01-01

Full Text Available This paper presents an analysis of 67 minimally invasive surgical procedures covering 11 different procedure types to determine patterns of tool use. A new graph-theoretic approach was taken to organize and analyze the data. Through grouping surgeries by type, trends of common tool changes were identified. Using the concept of signal/noise ratio, these trends were found to be statistically strong. The tool-use trends were used to generate tool placement patterns for modular (multi-tool, cartridge-type surgical tool systems, and the same 67 surgeries were numerically simulated to determine the optimality of these tool arrangements. The results indicate that aggregated tool-use data (by procedure type can be employed to predict tool-use sequences with good accuracy, and also indicate the potential for artificial intelligence as a means of preoperative and/or intraoperative planning. Furthermore, this suggests that the use of multifunction surgical tools can be optimized to streamline surgical workflow.

Current trends in pedicle screw stimulation techniques: lumbosacral, thoracic, and cervical levels.

Science.gov (United States)

Isley, Michael R; Zhang, Xiao-Feng; Balzer, Jeffrey R; Leppanen, Ronald E

2012-06-01

Unequivocally, pedicle screw instrumentation has evolved as a primary construct for the treatment of both common and complex spinal disorders. However an inevitable and potentially major complication associated with this type of surgery is misplacement of a pedicle screw(s) which may result in neural and vascular complications, as well as impair the biomechanical stability of the spinal instrumentation resulting in loss of fixation. In light of these potential surgical complications, critical reviews of outcome data for treatment of chronic, low-back pain using pedicle screw instrumentation concluded that "pedicle screw fixation improves radiographically demonstrated fusion rates;" however the expense and complication rates for such constructs are considerable in light of the clinical benefit (Resnick et al. 2005a). Currently, neuromonitoring using free-run and evoked (triggered) electromyography (EMG) is widely used and advocated for safer and more accurate placement of pedicle screws during open instrumentation procedures, and more recently, guiding percutaneous placement (minimally invasive) where the pedicle cannot be easily inspected visually. The latter technique, evoked or triggered EMG when applied to pedicle screw instrumentation surgeries, has been referred to as the pedicle screw stimulation technique. As concluded in the Position Statement by the American Society of Neurophysiological Monitoring (ASNM), multimodality neuromonitoring using free-run EMG and the pedicle screw stimulation technique was considered a practice option and not yet a standard of care (Leppanen 2005). Subsequently, the American Association of Neurological Surgeons/Congress of Neurological Surgeons (AANS/CNS) Joint Section on Disorders of the Spine and Peripheral Nerves published their "Guidelines for the Performance of Fusion Procedures for Degenerative Disease of the Lumbar Spine" (Heary 2005, Resnick et al. 2005a, Resnick et al. 2005b). It was concluded that the "primary

Current trends in ion implantation

International Nuclear Information System (INIS)

Gwilliam, R.M.

2001-01-01

As semiconductor device dimensions continue to shrink, the drive beyond 250 nm is creating significant problems for the device processor. In particular, trends toward shallower-junctions, lower thermal budgets and simplified processing steps present severe challenges to ion implantation. In parallel with greater control of the implant process goes the need for a better understanding of the physical processes involved during implantation and subsequent activation annealing. For instance, the need for an understanding of dopant-defect interaction is paramount as defects mediate a number of technologically important phenomena such as transient enhanced diffusion and impurity gettering. This paper will outline the current trends in the ion implantation and some of the challenges it faces in the next decade, as described in the semiconductor roadmap. It will highlight some recent positron annihilation work that has made a contribution to addressing one of these challenges, namely the need for tighter control of implant uniformity and dose. Additionally, some vacancy-mediated processes are described with the implication that these may provide areas in which positron annihilation spectroscopy could make a significant contribution. (orig.)

Recent national trends in the use of adolescent inpatient bariatric surgery: 2000 through 2009.

Science.gov (United States)

Kelleher, Deirdre C; Merrill, Chaya T; Cottrell, Linda T; Nadler, Evan P; Burd, Randall S

2013-02-01

To determine the current rate of inpatient bariatric surgical procedures among adolescents and to analyze national trends of use from 2000 to 2009. Retrospective cross-sectional study. Discharge data obtained from the Healthcare Cost and Utilization Project Kids' Inpatient Database, 2000 through 2009. Adolescents (defined herein as individuals aged 10-19 years) undergoing inpatient bariatric procedures. Inpatient bariatric surgery. The primary outcome measure was the national population-based bariatric procedure rate. The secondary outcome measures were trends in procedure rates and type, demographics, complication rate, length of stay, and hospital charges from 2000 through 2009. The inpatient bariatric procedure rate increased from 0.8 per 100 000 in 2000 to 2.3 per 100 000 in 2003 (328 vs 987 procedures) but did not change significantly in 2006 (2.2 per 100 000) or 2009 (2.4 per 100 000), with 925 vs 1009 procedures. The use of laparoscopic adjustable gastric banding approached one-third (32.1%) of all procedures by 2009. The cohort was predominantly female and older than 17 years. The prevalence of comorbidities increased from 2003 (49.3%) to 2009 (58.6%) (P = .002), while the complication rate remained low and the in-hospital length of stay decreased by approximately 1 day (P bariatric procedures among adolescents has plateaued since 2003. The predominant procedure type has changed to minimally invasive techniques, including laparoscopic adjustable gastric banding and laparoscopic Roux-en-Y gastric bypass. Trends show low complication rates and decreasing length of stay, despite increasing comorbid conditions among patients.

Trends and Predictors of National Institutes of Health Funding to Plastic Surgery Residency Programs.

Science.gov (United States)

Silvestre, Jason; Abbatematteo, Joseph M; Chang, Benjamin; Serletti, Joseph M

2017-12-01

Recent studies have demonstrated low levels of National Institutes of Health funding for surgical research. The authors compared the funding in plastic surgery with the funding for other surgical specialties. A query of National Institutes of Health grants awarded to departments of surgical specialties was performed using the National Institutes of Health RePORTER database (2008 to 2016). Trends in funding were compared by specialty and adjusted for the number of active physicians in each specialty. Plastic surgery residency program characteristics were correlated with funding procurement. Eight hundred eighty-nine faculty at 94 plastic surgery residency programs were queried. Forty-eight investigators (5.4 percent) at 23 programs (24.4 percent) had National Institutes of Health funding. From 2008 to 2016, a total of $84,142,138 was awarded through 81 grants. Funding supported translational (44.6 percent), clinical (26.4 percent), basic science (27.2 percent), and educational (1.7 percent) research. In 2016, plastic surgery received the least amount of National Institutes of Health funding per active physician ($1,530) relative to orthopedic surgery ($3124), obstetrics and gynecology ($3885), urology ($5943), otolaryngology ($9999), general surgery ($11,649), ophthalmology ($11,933), and neurologic surgery ($20,874). Plastic surgery residency program characteristics associated with National Institutes of Health funding were high ranking and had more than 10 clinical faculty (p < 0.05). Plastic surgery receives the least National Institutes of Health funding among the surgical specialties. Departments and divisions of plastic surgery should support investigators applying for research grants to increase future National Institutes of Health funding.

Current trends in methods for neutron diffusion calculations

International Nuclear Information System (INIS)

Adams, C.H.

1977-01-01

Current work and trends in the application of neutron diffusion theory to reactor design and analysis are reviewed. Specific topics covered include finite-difference methods, synthesis methods, nodal calculations, finite-elements and perturbation theory

Current Trends in Associate Degree Nursing Programs.

Science.gov (United States)

Blackstone, Elaine Grant

This study was designed to ascertain current trends in associate degree nursing programs and to discover innovative ideas and techniques which could be applied to the existing program at Miami-Dade Community College (Florida). Data was compiled from interviews with representatives of ten associate degree nursing programs in six states. Information…

Current status of cerebral glioma surgery in China.

Science.gov (United States)

Wu, Jin-song; Zhang, Jie; Zhuang, Dong-xiao; Yao, Cheng-jun; Qiu, Tian-ming; Lu, Jun-feng; Zhu, Feng-ping; Mao, Ying; Zhou, Liang-fu

2011-09-01

The treatment of gliomas is highly individualized. Surgery for gliomas is essentially for histological diagnosis, to alleviate mass effect, and most importantly, to favor longer survival expectancy. During the past two decades, many surgical techniques and adjuvants have been applied to glioma surgery in China, which lead to a rapid development in the field of cerebral glioma surgery. This article broadly and critically reviewed the existing studies on cerebral glioma surgery and to portrait the current status of glioma surgery in China. A literature search was conducted covering major innovative surgical techniques and adjuvants for glioma surgery in China. The following databases were searched: the Pubmed (January 1995 to date); China Knowledge Resource Integrated Database (January 1995 to date) and VIP Database for Chinese Technical Periodicals (January 1995 to date). A selection criterion was established to exclude duplicates and irrelevant studies. The outcome measures were extracted from included studies. A total of 3307 articles were initially searched. After excluded by abstracts and full texts, 69 studies conducted in the mainland of China were included and went through further analysis. The philosophy of surgical strategies for cerebral gliomas in China is undergoing tremendous change. Nowadays Chinese neurosurgeons pay more attention to the postoperative neurofunctional status of the patients. The aim of the glioma surgery is not only the more extensive tumor resection but also the maximal safety of intervention. The well balance of longer overall survival and higher quality of life should be judged with respect to each individual patient.

Current trends in nuclear material transportation

International Nuclear Information System (INIS)

Ravenscroft, Norman; Oshinowo, Franchone

1997-01-01

The business of radioactive material transportation has evolved considerably in the past 40 years. Current practices reflect extensive international experience in handling radioactive cargo within a mature and tested regulatory framework. Nevertheless, new developments continue to have an impact on how shipments of nuclear material are planned and carried out. Entities involved in the transport of radioactive materials must keep abreast of these developments and work together to find innovative solutions to ensure that safe, smooth transport activities may continue. Several recent trends in the regulatory environment and political atmosphere require attention. There are four key trends that we'll be examining today: 1) the reduction in the pool of available commercial carriers; 2) routing restrictions; 3) package validation issues; and 4) increasing political sensitivities. Careful planning and cooperative measures are necessary to alleviate problems in each of these areas. (author)

Glaucoma treatment trends: a review.

Science.gov (United States)

Conlon, Ronan; Saheb, Hady; Ahmed, Iqbal Ike K

2017-02-01

Glaucoma is one of the most common causes of blindness worldwide, and its prevalence is increasing. The aim of the present review is to describe the current medical and surgical treatment trends in the management of open-angle glaucoma. There has been an increase in the availability of glaucoma medications and the use of laser trabeculoplasty over the past decade, with a subsequent decrease in invasive incisional surgery. In addition, a new class of glaucoma procedures, termed microinvasive glaucoma surgery, has emerged, which aims to fill the gap between conservative medical management and more invasive surgery. Copyright © 2017 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

Current Trends in Higher Education Technology: Simulation

Science.gov (United States)

Damewood, Andrea M.

2016-01-01

This paper is focused on how technology in use changes over time, and the current trend of simulation technology as a supported classroom technology. Simulation-based training as a learning tool is discussed within the context of adult learning theories, as is the technology used and how today's higher education technology administrators support…

Trends in utilization and outcomes of bariatric surgery in obese people with and without type 2 diabetes in Spain (2001-2010).

Science.gov (United States)

Lopez-de-Andres, Ana; Jiménez-García, Rodrigo; Hernández-Barrera, Valentin; Gil-de-Miguel, Angel; Jiménez-Trujillo, M Isabel; Carrasco-Garrido, Pilar

2013-03-01

Bariatric surgery is associated with a significant improvement in glucose control and even diabetes remission. There are no studies investigating national trends in the use of bariatric surgery in people with type 2 diabetes. We examine trends in the use of bariatric surgery in patients with and without type 2 diabetes between 2001 and 2010 in Spain. We identified patients who underwent bariatric surgery using national hospital discharge data. Discharges were grouped by diabetes status. Incidence of discharges due to bariatric surgery were calculated and stratified by diabetes status, procedure and year. We calculated length of stay (LOS) and in-hospital mortality (IHM). From 2001 to 2010 13,038 bariatric surgery procedures were performed. Over the study period 23.6% (n=3080) of all patients undergoing bariatric procedure had DM as a co-diagnosis. This prevalence increased from 17.3% in 2001 to 25.5% in 2010. LOS and IHM were similar among patients with and without type 2 diabetes. The proportion of subjects with type 2 diabetes among bariatric surgery patient has increased over time, in part due to an increase in the use of laparoscopic techniques. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Prevailing Trends in Haptic Feedback Simulation for Minimally Invasive Surgery.

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Pinzon, David; Byrns, Simon; Zheng, Bin

2016-08-01

Background The amount of direct hand-tool-tissue interaction and feedback in minimally invasive surgery varies from being attenuated in laparoscopy to being completely absent in robotic minimally invasive surgery. The role of haptic feedback during surgical skill acquisition and its emphasis in training have been a constant source of controversy. This review discusses the major developments in haptic simulation as they relate to surgical performance and the current research questions that remain unanswered. Search Strategy An in-depth review of the literature was performed using PubMed. Results A total of 198 abstracts were returned based on our search criteria. Three major areas of research were identified, including advancements in 1 of the 4 components of haptic systems, evaluating the effectiveness of haptic integration in simulators, and improvements to haptic feedback in robotic surgery. Conclusions Force feedback is the best method for tissue identification in minimally invasive surgery and haptic feedback provides the greatest benefit to surgical novices in the early stages of their training. New technology has improved our ability to capture, playback and enhance to utility of haptic cues in simulated surgery. Future research should focus on deciphering how haptic training in surgical education can increase performance, safety, and improve training efficiency. © The Author(s) 2016.

The trend of quality of publications in endodontic surgery: a 10-year systematic survey of the literature.

Science.gov (United States)

Del Fabbro, Massimo; Corbella, Stefano; Tsesis, Igor; Taschieri, Silvio

2015-03-01

The aims of the present systematic literature analysis were to evaluate, over a 10-year period, the trend of the proportion of RCT, SR, MA published on endodontic surgery, and to investigate if the impact factor (IF) of the main endodontic Journals correlates with the proportion of RCT, SR, MA they publish. An electronic search of the RCT, SR and MA published on the topic "endodontic surgery" from 2001 to 2010 was performed on Medline and Cochrane CENTRAL database using specific search terms combined with Boolean operators. Endodontic Journals impact factor was retrieved by the Thomson Scientific database. The proportion of each study type over the total number of articles on endodontic surgery published per year was estimated. The correlation between the number of high-evidence level studies published on the main endodontic Journals and the IF of such Journals per year was estimated. From a total of 900 articles published in 2001-2010 on endodontic surgery, there were 114 studies of high evidence level. A significant increase of the proportion of either RCT, SR and MA over the years was found. A modest to unclear correlation was found between the Journal IF and the number of high-evidence articles published. There is a positive trend over the years among researchers in performing studies of good quality in endodontic surgery. The impact factor of endodontic Journals is not consistently influenced by publication of high-evidence level articles. Copyright © 2015 Elsevier Inc. All rights reserved.

Social media in plastic surgery practices: emerging trends in North America.

Science.gov (United States)

Wheeler, Chad K; Said, Hakim; Prucz, Roni; Rodrich, Rod J; Mathes, David W

2011-05-01

Social media is a common term for web-based applications that offer a way to disseminate information to a targeted audience in real time. In the current market, many businesses are utilizing it to communicate with clients. Although the field of plastic surgery is constantly changing in response to innovative technologies introduced into the specialty, the utilization of social media in plastic surgery practices is currently unclear. The authors evaluate the current attitudes and practices of aesthetic surgeons to emerging social media technology and compare these to attitudes about more traditional modes of communication. A 19-question web-based survey was disseminated by e-mail to all board-certified or board-eligible American plastic surgeons (n = 4817). Respondents were asked to answer questions on three topics: (1) their use of social media in their personal and professional lives, (2) their various forms of practice marketing, and (3) their demographic information. There were 1000 responses (20.8%). Results showed that 28.2% of respondents used social media in their practice, while 46.7% used it in their personal life. Most plastic surgeons managed their social media themselves or through a staff member. The majority of respondents who used social media in their practice claimed that their efforts were directed toward patient referrals. The typical plastic surgery practice that used social media was a solo practice in a large city with a focus on cosmetic surgery. Local competition of plastic surgeons did not correlate with social media use. Most plastic surgeons (88%) advertised, but the form of marketing varied. The most common forms included websites, print, and search engine optimization, but other modalities, such as television, radio, and billboards, were still utilized. Social media represents a new avenue that many plastic surgeons are utilizing, although with trepidation. As social media becomes commonplace in society, its role in plastic surgery

Beard transplants and facial hair trends: Why men are motivated to have surgery

OpenAIRE

Zucchelli, F.

2017-01-01

Over the past few years, an increasing number of men have received surgery to enhance or restore facial hair. This came at a time when beards re-entered mainstream fashion. Drawing on the research literature, this article explores the apparent link between facial hair fashion and rates of beard transplants, and considers deeper-seated psychological explanations for the trend, including perceptions of masculinity, social dominance, age and attractiveness. The question of whether beard transpla...

Current trends in chloroplast genome research | Khan | African ...

African Journals Online (AJOL)

comprise of DOGMA for annotation, SCAN-SE, ARAGON and PREP suit for RNA analyses and CG viewer for circular map construction/comparative analysis. Faster algorithms for gene-order based phylogenetic reconstruction and bootstrap analysis have attracted the attention of research community. Current trends in ...

Current trends in context-aware applications

Directory of Open Access Journals (Sweden)

Andrea Loayza

2013-12-01

Full Text Available (Received: 2013/10/07 - Accepted: 2013/12/10Context-aware applications adapt their behavior and settings according to the environment conditions and to the user preferences. This state-of-the-art survey identifies the current trends related to the technics and tools for the development of this kind of software, as well as the areas of interest of the scientific community on the subject. It stands out the research on multimodal interfaces, localization, activity detection, interruptions control, predictive and wellbeing applications.

Current status of natural orifice trans-endoscopic surgery (NOTES and laparoendoscopic single site surgery (LESS in urologic surgery

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Rafael E. Sanchez-Salas

2010-08-01

Full Text Available Laparoendoscopic single site surgery (LESS and natural orifice transluminal endoscopic surgery (NOTES represent novel approaches in urological surgery. To perform a review of the literature in order describe the current status of LESS and NOTES in Urology. References for this manuscript were obtained by performing a review of the available literature in PubMed from 01-01-02 to 15-05-09. Search terms included single port, single site, NOTES, LESS and single incision. A total of 412 manuscripts were initially identified. Out of these, 64 manuscripts were selected based in their urological content. The manuscript features subheadings for experimental and clinical studies, as NOTES-LESS is a new surgical technique and its future evolution will probably rely in initial verified feasibility. A subheading for reviews presents information regarding common language and consensus for the techniques. The issue of complications published in clinical series and the future needs of NOTES-LESS, are also presented.

Laparoscopic surgery in colorectal cancer

International Nuclear Information System (INIS)

Bressler Hernandez, Norlan; Martinez Perez, Elliot; Fernandez Rodriguez, Leopoldo; Torres Core, Ramiro

2011-01-01

In the current age of minimally invasive surgery, laparoscopic surgery for colon cancer has been established as oncologically equivalent to conventional open surgery. The advantages of laparoscopic surgery have translated into smaller incisions and shorter recovery. Since the advent of laparoscopy, surgeons have been fueled to develop less invasive operative methods as feasible alternatives to traditional procedures. As techniques evolved and technology advanced, laparoscopy became more widely accepted and is now more commonly used in many institutions. Recently, a trend toward less invasive surgery, driven by patient and surgeon alike, has been a major objective for many institutions because of the ability of laparoscopic surgery to reduce postoperative pain, achieve a quicker recovery time, and improve cosmetic outcomes. Although still evolving, traditional laparoscopy has served as a foundation for even further refinements in the minimally invasive approach and as a result, more advanced equipment and newer techniques have arisen

Current Trends in Higher Education Learning and Teaching

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Singh, R. J.

2012-01-01

Current trends in higher education learning and teaching focuses on the use of technology, integrated learning through "blended learning" and writing for academic purposes. This introductory article initiates the debate around the context of South African higher education teaching and learning. It does so by contextualizing the South…

Current status of pediatric minimal access surgery at Sultan Qaboos ...

African Journals Online (AJOL)

Keywords: current status, laparoscopy, minimal access surgery, thoracoscopy. Departments of ... Materials and methods ... procedures, the open technique was used for the creation ... operated for bilateral inguinal herniotomy had recurrence.

Current Trends in Aerospace Engineering Education on Taiwan.

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Hsieh, Sheng-Jii

A proposal for current trends in Aerospace Engineering Education on Taiwan has been drawn from the suggestions made after a national conference of "Workshop on Aerospace Engineering Education Reform." This workshop was held in January 18-20, 1998, at the Institute of Aeronautics and Astronautics, National Cheng Kung University, Tainan,…

Cobalt 60 gamma irradiation current status, trends and insights

International Nuclear Information System (INIS)

Corley, John T.

1998-01-01

This paper discusses the current status, trends and insights into the continued, safe use of cobalt 60 gamma irradiation. Also presented are some of the many initiatives undertaken at MDS Nordion. Topics covered include our investment for the future supply of raw materials and the latest news from source production. Briefly presented are the tasks associated with the safe transport of cobalt 60 around the world. Discussed is cobalt 60 usage at the customer site; more specifically maintaining source integrity, source utilization and irradiator design trends. Highlighted are industry trends for North America, Europe and the rest of the world. Finally presented are the challenges and opportunities for the industry. Stressed in the paper is the need to work together

Current trends in Bayesian methodology with applications

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Upadhyay, Satyanshu K; Dey, Dipak K; Loganathan, Appaia

2015-01-01

Collecting Bayesian material scattered throughout the literature, Current Trends in Bayesian Methodology with Applications examines the latest methodological and applied aspects of Bayesian statistics. The book covers biostatistics, econometrics, reliability and risk analysis, spatial statistics, image analysis, shape analysis, Bayesian computation, clustering, uncertainty assessment, high-energy astrophysics, neural networking, fuzzy information, objective Bayesian methodologies, empirical Bayes methods, small area estimation, and many more topics.Each chapter is self-contained and focuses on

Trends in the exchange current for hydrogen evolution

DEFF Research Database (Denmark)

Nørskov, Jens Kehlet; Bligaard, Thomas; Logadottir, Ashildur

2005-01-01

A density functional theory database of hydrogen chemisorption energies on close packed surfaces of a number of transition and noble metals is presented. The bond energies are used to understand the trends in the exchange current for hydrogen evolution. A volcano curve is obtained when measured...... exchange currents are plotted as a function of the calculated hydrogen adsorption energies and a simple kinetic model is developed to understand the origin of the volcano. The volcano curve is also consistent with Pt being the most efficient electrocatalyst for hydrogen evolution. (c) 2005...

Natural orifice translumenal endoscopic surgery (NOTES) for innovation in hepatobiliary and pancreatic surgery: preface.

Science.gov (United States)

Sugimoto, Maki

2009-01-01

Natural orifice translumenal endoscopic surgery (NOTES) has captured the interest of interventional endoscopists and may represent the next stage of evolution of minimally invasive surgery. It provides the potential for performance of incisionless operations. It is gaining momentum both in the animal laboratory and in human case reports. Developments in the field of NOTES have led to the formation of the Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR) in 2006. In this special issue, the current trends in NOTES in the field of hepatobiliary and pancreatic surgery are featured, including NOTES cholecystectomy, hepatectomy splenectomy, pancreatic necrosectomy, and the future of NOTES. In this issue, we discuss the potential benefits of these procedures in hepatobiliary and pancreatic surgery. We have just started the evaluation process for this new technology. The concept of NOTES is becoming established and is enormously advantageous for the patient. Both the surgeon and gastroenterologist should contribute to developing NOTES in making use of their specialties.

Minimally invasive glaucoma surgery: current status and future prospects

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Richter GM

2016-01-01

Full Text Available Grace M Richter,1,2 Anne L Coleman11UCLA Stein Eye Institute, Department of Ophthalmology, University of California, Los Angeles, CA, USA; 2USC Eye Institute, Department of Ophthalmology, Keck School of Medicine of University of Southern California, Los Angeles, CA, USAAbstract: Minimally invasive glaucoma surgery aims to provide a medication-sparing, conjunctival-sparing, ab interno approach to intraocular pressure reduction for patients with mild-to-moderate glaucoma that is safer than traditional incisional glaucoma surgery. The current approaches include: increasing trabecular outflow (Trabectome, iStent, Hydrus stent, gonioscopy-assisted transluminal trabeculotomy, excimer laser trabeculotomy; suprachoroidal shunts (Cypass micro-stent; reducing aqueous production (endocyclophotocoagulation; and subconjunctival filtration (XEN gel stent. The data on each surgical procedure for each of these approaches are reviewed in this article, patient selection pearls learned to date are discussed, and expectations for the future are examined. Keywords: MIGS, microincisional glaucoma surgery, trabecular stent, Schlemm’s canal, suprachoroidal shunt, ab interno

Current Technology Trends for School Library Media Specialists

OpenAIRE

Leticia Ekhaml; Joan Hubbard

2003-01-01

An overview of some of the current technology trends used in classroom instruction and school library media centers in provided in this article such as the use of handheld electronic organizers, CD recorders, digital video cameras, and interactive whiteboards. The article offers some suggestions or ideas on how to acquire new technologies to school library media centers that are low in budgetary funds.

Five Aspects of Current Trends in German Library Science

Science.gov (United States)

Steierwald, Ulrike

2006-01-01

The specialisation Library Science at the Hochschule Darmstadt/University of Applied Science Darmstadt is the newest academic program in Germany for the higher education of librarians. Five current trends in library science in Germany reflect the new "Darmstadt Model": (1) The delimitation of a specific professional field…

Current Trends in Neonatal Tracheostomy.

Science.gov (United States)

Isaiah, Amal; Moyer, Kelly; Pereira, Kevin D

2016-08-01

The indications for neonatal tracheostomy may have changed with current noninvasive respiratory therapies compared with previous decades. To study the current trends in neonatal tracheostomy and identify the primary indication for the procedure and risk factors for failed extubation. This retrospective medical record review included 47 neonates who underwent tracheostomy from January 1, 2009, to December 31, 2013, at the University of Maryland Children's Hospital. Group 1 included infants undergoing tracheostomy for the primary indication of upper airway obstruction; group 2, infants with primary pulmonary disease. Data on weight, gestational age, comorbid conditions, congenital abnormalities, complications, outcomes, and indications for tracheostomy were compared statistically between groups. Differences in gestational age, birth weight, and age at tracheostomy. Among the 47 infants included in the study (30 boys; 17 girls, mean [SD] age, 113 [73] days), 31 (66%) demonstrated anatomical causes of airway obstruction, and 16 (34%) had significant pulmonary disease. Among infants with anatomical causes, subglottic stenosis represented the largest group (11 of 31 [35%]). The mean age at the time of tracheostomy was significantly lower in the group with airway obstruction (98.9 vs 146.9 days; difference, 48 [95% CI, 4.8-91.2] days; P = .04). No procedure-related morbidity or mortality was encountered. Anatomical upper airway obstruction may be returning as the most common indication for a neonatal tracheostomy, thereby supporting the belief that current respiratory therapies have lowered the burden of chronic lung disease and the need for prolonged ventilatory care.

Fifty Years of Innovation in Plastic Surgery

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Richard M Kwasnicki

2016-03-01

Full Text Available BackgroundInnovation has molded the current landscape of plastic surgery. However, documentation of this process only exists scattered throughout the literature as individual articles. The few attempts made to profile innovation in plastic surgery have been narrative, and therefore qualitative and inherently biased. Through the implementation of a novel innovation metric, this work aims to identify and characterise the most prevalent innovations in plastic surgery over the last 50 years.MethodsPatents and publications related to plastic surgery (1960 to 2010 were retrieved from patent and MEDLINE databases, respectively. The most active patent codes were identified and grouped into technology areas, which were subsequently plotted graphically against publication data. Expert-derived technologies outside of the top performing patents areas were additionally explored.ResultsBetween 1960 and 2010, 4,651 patents and 43,118 publications related to plastic surgery were identified. The most active patent codes were grouped under reconstructive prostheses, implants, instruments, non-invasive techniques, and tissue engineering. Of these areas and other expert-derived technologies, those currently undergoing growth include surgical instruments, implants, non-invasive practices, transplantation and breast surgery. Innovations related to microvascular surgery, liposuction, tissue engineering, lasers and prostheses have all plateaued.ConclusionsThe application of a novel metric for evaluating innovation quantitatively outlines the natural history of technologies fundamental to the evolution of plastic surgery. Analysis of current innovation trends provides some insight into which technology domains are the most active.

Labour Markets Trends, Financial Globalization and the current crisis in Developing Countries

NARCIS (Netherlands)

R.E. van der Hoeven (Rolph)

2010-01-01

textabstractThe current wave of globalization has profound labour market effects, accentuated, in many cases, by the current financial and economic crisis. This paper reviews general labour market trends and country examples, arguing that the current globalization process makes labour’s position

Current Technology Trends for School Library Media Specialists

Directory of Open Access Journals (Sweden)

Leticia Ekhaml

2003-03-01

Full Text Available An overview of some of the current technology trends used in classroom instruction and school library media centers in provided in this article such as the use of handheld electronic organizers, CD recorders, digital video cameras, and interactive whiteboards. The article offers some suggestions or ideas on how to acquire new technologies to school library media centers that are low in budgetary funds.

Organizational Development of Russian SMEs: Current trends

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Emil Velinov

2016-12-01

Full Text Available The research paper sheds a light on Russian SMEs transition and specifically on their current development and evolution. The paper attempts to explain what are the main drivers and antecedents on SMEs during the period 2010-2015. Along with it, it is applied detailed analysis of Russian SMEs in terms of key performance indicators, turnover and volume of sales. Further, are given potential developments and trends within SMEs in Russia. The paper draws attention to socio-economic and political factors influencing SMEs development.

Current role of mesh in vaginal prolapse surgery.

Science.gov (United States)

Richter, Lee A; Carter, Charelle; Gutman, Robert E

2014-10-01

This report summarizes the latest literature on transvaginal mesh (TVM) for the treatment of pelvic organ prolapse, with a focus on indications for use and management of complications. We describe trends in TVM by reviewing the recent literature and summarizing national meeting presentations. Vaginal mesh complications are most often managed surgically, and the majority of patients experiencing mesh-related pain have symptom improvement after intervention. New efforts will focus on identifying variables associated with success after intervention for mesh-related complications, to aid reconstructive pelvic surgeons in outcome prediction and patient counselling. Although the use of TVM has plateaued in recent years, we are seeing an exponential rise in synthetic mesh implant removal. Reconstructive pelvic surgeons advising patients with TVM complications should report that surgical intervention is often necessary, improvement rates of pain-related symptoms after surgery are high, and up to a third may require multiple interventions.

Current controversies in colorectal surgery: the way to resolve uncertainty and move forward

DEFF Research Database (Denmark)

Rosenberg, J; Fischer, A; Haglind, E

2012-01-01

for low rectal cancer, robotic surgery for various colorectal procedures, laparoscopic lavage without resection for Hinchey Stage III perforated sigmoid diverticulitis, and the use of the single port technique for laparoscopic surgery. Before general implementation the new modalities should ideally......The are currently a number of unsolved clinical questions in colorectal surgery with new surgical principles being introduced without proper scientific high-level evidence. These include complete mesocolic excision with central ligation for colonic cancer, extralevator abdominoperineal excision...

Declining Otolaryngology Resident Training Experience in Tracheostomies: Case Log Trends from 2005 to 2015.

Science.gov (United States)

Lesko, David; Showmaker, Jason; Ukatu, Ceisha; Wu, Qiwei; Chang, C W David

2017-06-01

Objective To evaluate recent tracheostomy surgical experience among otolaryngology residents and general surgery residents. Study Design Retrospective database review. Setting Accreditation Council for Graduate Medical Education otolaryngology and general surgery programs. Subjects and Methods Accreditation Council for Graduate Medical Education case log data from 2005 to 2015 for resident graduates in otolaryngology and general surgery were used to obtain mean graduate tracheostomy numbers, mean graduate composite case numbers, and number of graduating residents. Market share for each specialty was estimated through the derived metric of nationwide total tracheostomy graduate experience, calculated by multiplying the number of graduating residents by the mean number of graduate tracheostomies. Linear regression analysis was used to calculate trends. Multiple linear regression analysis was used for pairwise comparison of trends. Results From 2005 to 2015, mean graduate tracheostomy numbers for otolaryngology residents declined 2.3% per year, while those for general surgery residents increased 1.8% per year. Accounting for changes in number of resident graduates, market share of tracheostomy decreased 1.0% per year for otolaryngology and increased 3.0% per year for general surgery. Mean graduate composite case numbers increased significantly by 1.8% and 1.0% per year for otolaryngology and general surgery residents, respectively. Conclusion Tracheostomy case volume in otolaryngology residency has decreased steadily in comparison with general surgery residency. However, current otolaryngology graduates have more experience in tracheostomy when compared with general surgery graduates. While otolaryngology residents have excellent exposure to tracheostomy, otolaryngology programs should be made aware of this declining trend as well as changing procedural trends, which may affect training needs.

Deep-vein thrombosis prophylaxis in foot and ankle surgery: what is the current state of practice?

Science.gov (United States)

Shah, Kalpesh; Thevendran, Gowreeson; Younger, Alastair; Pinney, Stephen J

2015-04-01

When contemplating thromboprophylaxis for patients undergoing elective foot and ankle surgery the potential for complications secondary to venous thromboembolism (VTE) must be balanced against the cost, risk, and effectiveness of prophylactic treatment. The incidence of pulmonary embolism (PE) following foot and ankle surgery is considerably lower than after hip or knee surgery. The purpose of this study was to assess current trends in practice regarding VTE prophylaxis among expert orthopaedic foot and ankle surgeons. An e-mail-based survey of active AOFAS (American Orthopaedic Foot and Ankle Society) committee members was conducted (n = 100). Surgeons were questioned as to their use, type, and duration of thromboprophylaxis following elective ankle fusion surgery. Scenarios included the following: (1) A 50-year-old woman with no risk factors; (2) a 50-year-old woman with a history of PE; and (3) a 35-year-old woman actively using birth control pills (BCPs). The response rate for the survey was 80% (80/100). Replies regarding the use of thromboprophylaxis were as follows: (1) in the absence of risk factors, 57% of respondents (45/80) answered, "No prophylaxis required"; (2) for the scenario in which the patient had experienced a previous PE, 97.5% of respondents (78/80) answered, "Yes" to prophylaxis use; (3) for the scenario in which the patient was on BCP, 61.3% of respondents (49/80) stated that they would give some type of thromboprophylaxis. The most commonly recommended methods of prophylaxis were aspirin, 49% (24/49), and low-molecular-weight heparin, 47% (23/49). The recommended length of time for thromboprophylaxis varied widely, from 1 day to more than 6 weeks. . There remains wide variation in the practice of deep-vein thrombosis thromboprophylaxis within the foot and ankle community. Because risks for foot and ankle patients differ from those in the well-studied areas of hip and knee, specific guidelines are needed for foot and ankle surgery. Level V

Current Trends in Foreign Trade Theory and Policy

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Zdzisław W. Puślecki

2017-12-01

Full Text Available In this research work, Author focus on the current analysis trends in foreign trade theory and policy. Accordance with the foreign trade policy theory further trade liberalisation and improved framework policies would increase trade and promote growth. It must be emphasized that openness to trade is associated with higher incomes and growth and there is the need for new approaches to trade cooperation in light of the forces that are currently re-shaping international business. What indicates the importance and innovativeness of the research is the presentation of the new models of the foreign trade policy and trade interests. First of all, it must underline that in the new theoretical terms in demand for trade policy very important is factor specificity. The low specificity of factors means that factor returns are equalized throughout a region’s economy. On the other hand, some factors are stuck in their present uses; therefore, factor returns are not equalized throughout a region’s economy but are industry specific. The main objective of the research task is to give a comprehensive analysis of current trends in foreign trade theory and policy and in particular models of foreign trade policy, trade interests indicated by export orientation and import sensitivity, foreign trade policy in different types of authoritarian regimes, protectionist pressures in different political system, the level of protectionist pressures, the tendencies to bilateralism in the foreign trade policy. It should be stressed that free trade in itself is not responsible for economic growth, but more significant are the determining macroeconomic stability and increasing investment.

Counseling in Malaysia: History, Current Status, and Future Trends

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See, Ching Mey; Ng, Kok-Mun

2010-01-01

This article presents an overview of the history of counseling in Malaysia, provides an update of its current status, and discusses some anticipated future trends for the profession in light of recent developments in the country. Counseling in Malaysia began with school guidance in the 1960s and has now achieved recognition as a profession in…

Trends in day surgery in the Netherlands

NARCIS (Netherlands)

Wasowicz-Kemps, D.K.

2008-01-01

Hospital care has been subject to important changes during the last century. In stead of treating patients with various diseases with bed rest, medical care has shifted from in hospital to an ambulatory or outpatient setting as much as possible. Admission time after surgery shortened and day surgery

Cardiovascular disease mortality in the Americas: current trends and disparities.

Science.gov (United States)

de Fatima Marinho de Souza, Maria; Gawryszewski, Vilma Pinheiro; Orduñez, Pedro; Sanhueza, Antonio; Espinal, Marcos A

2012-08-01

To describe the current situation and trends in mortality due to cardiovascular disease (CVD) in the Americas and explore their association with economic indicators. This time series study analysed mortality data from 21 countries in the region of the Americas from 2000 to the latest available year. Age-adjusted death rates, annual variation in death rates. Regression analysis was used to estimate the annual variation and the association between age-adjusted rates and country income. Currently, CVD comprised 33.7% of all deaths in the Americas. Rates were higher in Guyana (292/100 000), Trinidad and Tobago (289/100 000) and Venezuela (246/100 000), and lower in Canada (108/100 000), Puerto Rico (121/100 000) and Chile (125/100 000). Male rates were higher than female rates in all countries. The trend analysis showed that CVD death rates in the Americas declined -19% overall (-20% among women and -18% among men). Most countries had a significant annual decline, except Guatemala, Guyana, Suriname, Paraguay and Panama. The largest annual declines were observed in Canada (-4.8%), the USA (-3.9%) and Puerto Rico (-3.6%). Minor declines were in Mexico (-0.8%) and Cuba (-1.1%). Compared with high-income countries the difference between the median of death rates in lower middle-income countries was 56.7% higher and between upper middle-income countries was 20.6% higher. CVD death rates have been decreasing in most countries in the Americas. Considerable disparities still remain in the current rates and trends.

Current trends in plant breeding

International Nuclear Information System (INIS)

Jalani, B.S.; Rajanaidu, N.

2000-01-01

The current world population is 6 billion and it is likely to reach 7 billion in 2010 and 8 billion 2025. Sufficient food must be produced for the ever increasing human population. The available suitable land for intensive agriculture is limited. We have to produce more food from less land, pesticide, labour and water resources. Hence, increase in crop productivity are essential to feed the world in the next century. Plant breeding provides the avenue to increase the food production to feed the growing world population. Development of a cultivar involves (I) Construction of a genetic model (II) creating a gene pool (III) selection among plants and (IV) testing the selected genotypes for adaptation to the biotic and abiotic environments (Frey, 1999). This paper discusses the trends in plant breeding using the oil palm as a model. It covers (i) genetic resources (ii) physiological traits (III) exploitation of genotype x environment interaction (IV) oil palm clones, and (v) biotechnology application. (Author)

AMS-11 in Rome, 2008: Past achievements, current and future trends

International Nuclear Information System (INIS)

Fink, David

2010-01-01

The volume of scientific work and achievements of the international Accelerator Mass Spectrometry community over the past 30 years is presented by quantifying the annual increases in past AMS conference participation, trends in technical developments and applications, the rate of growth of new AMS facilities, sample throughput, publications and general scientific impact. Also a brief summary with some highlights of the International AMS-11 Rome Conference is presented with some flavour of current trends and future directions in AMS.

Trends in Perinatal Care and Implications for Frontline Nurse Leaders.

Science.gov (United States)

Crenshaw, Jeannette T; Adams, Ellise D; Amis, Debby

2016-01-01

The perinatal trends presented in this article are based on recent topics from conferences, journals, the media, as well as from input from perinatal nurses. Trends in patient care are influenced by evidence known for decades, new research, emerging and innovative concepts in healthcare, patient and family preferences, and the media. Trends discussed in this article are rethinking the due date, birth outside the hospital setting, obstetric hospitalists as birth attendants, nitrous oxide for pain in childbirth, hydrotherapy and waterbirth in the hospital setting, delayed cord clamping, disrupters of an optimal infant microbiome, skin-to-skin care during cesarean surgery, and breast-sleeping and the breast-feeding dyad. In addition, the authors developed implications for perinatal nurses related to each trend. The goal is to stimulate reflection on evidence that supports or does not support current practice and to stimulate future research by discussing some of the current trends that may influence the care that perinatal nurses provide during the birthing year.

Variable Operative Experience in Hand Surgery for Plastic Surgery Residents.

Science.gov (United States)

Silvestre, Jason; Lin, Ines C; Levin, Lawrence Scott; Chang, Benjamin

Efforts to standardize hand surgery training during plastic surgery residency remain challenging. We analyze the variability of operative hand experience at U.S. plastic surgery residency programs. Operative case logs of chief residents in accredited U.S. plastic surgery residency programs were analyzed (2011-2015). Trends in fold differences of hand surgery case volume between the 10th and 90th percentiles of residents were assessed graphically. Percentile data were used to calculate the number of residents achieving case minimums in hand surgery for 2015. Case logs from 818 plastic surgery residents were analyzed of which a minority were from integrated (35.7%) versus independent/combined (64.3%) residents. Trend analysis of fold differences in case volume demonstrated decreasing variability among procedure categories over time. By 2015, fold differences for hand reconstruction, tendon cases, nerve cases, arthroplasty/arthrodesis, amputation, arterial repair, Dupuytren release, and neoplasm cases were below 10-fold. Congenital deformity cases among independent/combined residents was the sole category that exceeded 10-fold by 2015. Percentile data suggested that approximately 10% of independent/combined residents did not meet case minimums for arterial repair and congenital deformity in 2015. Variable operative experience during plastic surgery residency may limit adequate exposure to hand surgery for certain residents. Future studies should establish empiric case minimums for plastic surgery residents to ensure hand surgery competency upon graduation. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

A Study of Current Trends and Issues Related to Technical/Engineering Design Graphics.

Science.gov (United States)

Clark, Aaron C.; Scales Alice

2000-01-01

Presents results from a survey of engineering design graphics educators who responded to questions related to current trends and issues in the profession of graphics education. Concludes that there is a clear trend in institutions towards the teaching of constraint-based modeling and computer-aided manufacturing. (Author/YDS)

Current trends in molecular diagnostics of chronic myeloid leukemia.

Science.gov (United States)

Vinhas, Raquel; Cordeiro, Milton; Pedrosa, Pedro; Fernandes, Alexandra R; Baptista, Pedro V

2017-08-01

Nearly 1.5 million people worldwide suffer from chronic myeloid leukemia (CML), characterized by the genetic translocation t(9;22)(q34;q11.2), involving the fusion of the Abelson oncogene (ABL1) with the breakpoint cluster region (BCR) gene. Early onset diagnosis coupled to current therapeutics allow for a treatment success rate of 90, which has focused research on the development of novel diagnostics approaches. In this review, we present a critical perspective on current strategies for CML diagnostics, comparing to gold standard methodologies and with an eye on the future trends on nanotheranostics.

Current trends of tropical fruit waste utilization.

Science.gov (United States)

Cheok, Choon Yoong; Mohd Adzahan, Noranizan; Abdul Rahman, Russly; Zainal Abedin, Nur Hanani; Hussain, Norhayati; Sulaiman, Rabiha; Chong, Gun Hean

2018-02-11

Recent rapid growth of the world's population has increased food demands. This phenomenon poses a great challenge for food manufacturers in maximizing the existing food or plant resources. Nowadays, the recovery of health benefit bioactive compounds from fruit wastes is a research trend not only to help minimize the waste burden, but also to meet the intensive demand from the public for phenolic compounds which are believed to have protective effects against chronic diseases. This review is focused on polyphenolic compounds recovery from tropical fruit wastes and its current trend of utilization. The tropical fruit wastes include in discussion are durian (Durio zibethinus), mangosteen (Garcinia mangostana L.), rambutan (Nephelium lappaceum), mango (Mangifera indica L.), jackfruit (Artocarpus heterophyllus), papaya (Carica papaya), passion fruit (Passiflora edulis), dragon fruit (Hylocereus spp), and pineapple (Ananas comosus). Highlights of bioactive compounds in different parts of a tropical fruit are targeted primarily for food industries as pragmatic references to create novel innovative health enhancement food products. This information is intended to inspire further research ideas in areas that are still under-explored and for food processing manufacturers who would like to minimize wastes as the norm of present day industry (design) objective.

Educational Research in Mainland China: Current Situation and Developmental Trends

Science.gov (United States)

Sun, Miantao

2011-01-01

The influence of Confucian culture in Chinese Mainland China is reflected in the current situation and contextual trends of educational research content of educational thought of Confucianism, educational issues grounded on theoretical views of Confucianism, and the influence of the inclusiveness of Confucianism. In terms of research method, the…

Impact of Medical Tourism on Cosmetic Surgery in the United States

Science.gov (United States)

Franzblau, Lauren E.

2013-01-01

Summary: Developing countries have been attracting more international patients by building state-of-the-art facilities and offering sought-after healthcare services at a fraction of the cost of the US healthcare system. These price differentials matter most for elective procedures, including cosmetic surgeries, which are paid for out of pocket. It is unclear how this rise in medical tourism will affect the practice of plastic surgery, which encompasses a uniquely large number of elective procedures. By examining trends in the globalization of the cosmetic surgery market, we can better understand the current situation and what plastic surgeons in the United States can expect. In this article, we explore both domestic and foreign factors that affect surgical tourism and the current state of this industry. We also discuss how it may affect the practice of cosmetic surgery within the United States. PMID:25289258

Impact of medical tourism on cosmetic surgery in the United States.

Science.gov (United States)

Franzblau, Lauren E; Chung, Kevin C

2013-10-01

Developing countries have been attracting more international patients by building state-of-the-art facilities and offering sought-after healthcare services at a fraction of the cost of the US healthcare system. These price differentials matter most for elective procedures, including cosmetic surgeries, which are paid for out of pocket. It is unclear how this rise in medical tourism will affect the practice of plastic surgery, which encompasses a uniquely large number of elective procedures. By examining trends in the globalization of the cosmetic surgery market, we can better understand the current situation and what plastic surgeons in the United States can expect. In this article, we explore both domestic and foreign factors that affect surgical tourism and the current state of this industry. We also discuss how it may affect the practice of cosmetic surgery within the United States.

Current Trends in European Quality Assurance. ENQA Workshop Report 8

Science.gov (United States)

Bozo, Dhurata; Damian, Radu; Gonzalez, Cecilia de la Rosa; Helle, Emmi; Imoda, Franco; Kohler, Alexander; Papazoglou, Vassilios J.; Dalmau, Gemma Rauret; Shopov, Todor

2009-01-01

The present report is a product of two ENQA (European Association for Quality Assurance in Higher Education) seminars, held in 2007, on current trends in European Quality Assurance. The first seminar, hosted by the Bulgarian National Evaluation and Accreditation Agency (NEAA), examined the situation in South-Eastern Europe. The second seminar…

West Virginia Women Business Owners: Current Study and Trends Report.

Science.gov (United States)

Holup, Linda L.; FitzGerald, Kathleen M.

This report profiles current West Virginia women business owners and notes significant trends in the last eight years. It highlights a subgroup of women business owners, specifically low income, single women with children. These survey areas are discussed: industry sector, type of ownership, reasons for going/not going into business, planning…

Cataract surgery in patients with pseudoexfoliation syndrome: current updates

Directory of Open Access Journals (Sweden)

Fontana L

2017-07-01

Full Text Available Luigi Fontana, Marco Coassin, Alfonso Iovieno, Antonio Moramarco, Luca Cimino Ophthalmology Unit, Arcispedale Santa Maria Nuova – IRCCS, Reggio Emilia, Italy Abstract: Pseudoexfoliation is a ubiquitous syndrome of multifactorial origin affecting elderly people by increasing the risk of cataract and secondary glaucoma development. Despite modern techniques and technologies for cataract surgery, pseudoexfoliation syndrome represents a challenge for surgeons because of the increased weakness of the zonular apparatus and limited pupil dilation. Due to the inherent difficulties during surgery, the risk of vitreous loss in these patients is several times higher than in cataract patients without pseudoexfoliation. Using currently available surgical devices (ophthalmic viscosurgical device, iris retractors and ring dilators, capsular tension ring, etc., the risk of intraoperative complications may be much reduced, allowing the surgeon to handle difficult cases with greater confidence and safety. This review analyzes the methodologic approach to the patient with zonular laxity with the aim of providing useful advices to limit the risks of intraoperative and postoperative complications. From the preoperative planning, to the intraoperative management of the small pupil and phacodonesis, and to the postoperative correction of capsule phimosis and intraocular lens dislocation, a step approach to the surgical management of pseudoexfoliation patients is illustrated. Keywords: pseudoexfoliation syndrome, cataract surgery, zonular laxity, intraocular lens implant, complications

Current Status of Nephron-Sparing Surgery (NSS) in the Management of Renal Tumours.

Science.gov (United States)

Venkatramani, Vivek; Swain, Sanjaya; Satyanarayana, Ramgopal; Parekh, Dipen J

2017-06-01

Nephron-sparing surgery has emerged as the surgical treatment of choice for small renal masses over the past two decades, replacing the traditional teaching of radical nephrectomy for renal cell carcinoma. With time, there has been an evolution in the techniques and indications for partial nephrectomy. This review summarizes the current status of nephron-sparing surgery for renal carcinoma and also deals with the future of this procedure.

Bariatric surgery and nonalcoholic fatty liver disease: current and potential future treatments

Directory of Open Access Journals (Sweden)

Akira eSasaki

2014-10-01

Full Text Available Nonalcoholic fatty liver disease (NAFLD and nonalcoholic steatohepatitis (NASH are increasingly common cause of chronic liver disease worldwide. The diagnosis of NASH is challenging as most affected patients are symptom-free and the role of routine screening is not clearly established. Most patients with severe obesity who undergo bariatric surgery have NAFLD, which is associated insulin resistance, type 2 diabetes mellitus (T2DM, hypertension, and obesity-related dyslipidemia. The effective treatment for NAFLD is weight reduction through lifestyle modifications, antiobesity medication, or bariatric surgery. Among these treatments, bariatric surgery is the most reliable method for achieving substantial, sustained weight loss. This procedure is safe when performed by a skilled surgeon, and the benefits include reduced weight, improved quality of life, decreased obesity-related comorbidities, and increased life expectancy. Further research is urgently needed to determine the best use of bariatric surgery with NAFLD patients at high risk of developing liver cirrhosis and its role in modulating complications of NAFLD, such as T2DM and cardiovascular disease. The current evidence suggests that bariatric surgery for patients with severe obesity decreases the grade of steatosis, hepatic inflammation, and fibrosis. However, further long-term studies are required to confirm the true effects before recommending bariatric surgery as a potential treatment for nonalcoholic steatohepatitis.

Surgical adhesives in ophthalmology: history and current trends.

Science.gov (United States)

Guhan, Samantha; Peng, Si-Liang; Janbatian, Hrag; Saadeh, Stephanie; Greenstein, Stephen; Al Bahrani, Faisal; Fadlallah, Ali; Yeh, Tsai-Chu; Melki, Samir A

2018-03-26

Tissue adhesives are gaining popularity in ophthalmology, as they could potentially reduce the complications associated with current surgical methods. An ideal tissue adhesive should have superior tensile strength, be non-toxic and anti-inflammatory, improve efficiency and be cost-effective. Both synthetic and biological glues are available. The primary synthetic glues include cyanoacrylate and the recently introduced polyethylene glycol (PEG) derivatives, while most biological glues are composed of fibrin. Cyanoacrylate has a high tensile strength, but rapidly polymerises upon contact with any fluid and has been associated with histotoxicity. Fibrin induces less toxic and inflammatory reactions, and its polymerisation time can be controlled. Tensile strength studies have shown that fibrin is not as strong as cyanoacrylate. While more research is needed, PEG variants currently appear to have the most promise. These glues are non-toxic, strong and time-effective. Through MEDLINE and internet searches, this paper presents a systematic review of the current applications of surgical adhesives to corneal, glaucoma, retinal, cataract and strabismus surgeries. Our review suggests that surgical adhesives have promise to reduce problems in current ophthalmic surgical procedures. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Research on Current Trends and Developments in Library Automation Systems.

Science.gov (United States)

Clyde, Laurel A.

A research project was undertaken in 1992 in order to identify, describe, and analyze current trends and developments in library automation systems and library software. The starting point is work conducted in 1988/1989 that formed the foundation of the book "Computer Software for School Libraries: A Directory." A 1992 survey of software…

Computers in nuclear medicine - current trends and future directions

International Nuclear Information System (INIS)

Anon.

1994-01-01

Previously, a decision to purchase computing equipment for nuclear medicine usually required evaluation of the 'local' needs. With the advent of Pacs and state of the art computer techniques for image acquisition and manipulation, purchase and subsequent application is to become much more complex. Some of the current trends and future possibilities which may influence the choice and operation of computers within and outside the nuclear medicine environment is discussed. (author)

Management of infantile hemangiomas: Current trends

Directory of Open Access Journals (Sweden)

Gomathy Sethuraman

2014-01-01

Full Text Available Infantile hemangiomas (IH are common vascular tumours. IH have a characteristic natural course. They proliferate rapidly during the early infantile period followed by a period of gradual regression over several years. Most of the uncomplicated IH undergo spontaneous involution, with a small proportion of cases requiring intervention. These are children with IH in life-threatening locations, local complications like haemorrhage, ulceration and necrosis and functional or cosmetic disfigurements. Systemic corticosteroids have been the first line of treatment for many years. Recently, non-selective beta-blockers, such as oral propranalol and topical timolol, have emerged as promising and safer therapies. Other treatment options include interferon α and vincristine which are reserved for life-threatening haemangiomas that are unresponsive to conventional therapy. This review mainly focuses on the current trends and evidence-based approach in the management of IH.

Robotic surgery for rectal cancer: current immediate clinical and oncological outcomes.

Science.gov (United States)

Araujo, Sergio Eduardo Alonso; Seid, Victor Edmond; Klajner, Sidney

2014-10-21

Laparoscopic rectal surgery continues to be a challenging operation associated to a steep learning curve. Robotic surgical systems have dramatically changed minimally invasive surgery. Three-dimensional, magnified and stable view, articulated instruments, and reduction of physiologic tremors leading to superior dexterity and ergonomics. Therefore, robotic platforms could potentially address limitations of laparoscopic rectal surgery. It was aimed at reviewing current literature on short-term clinical and oncological (pathological) outcomes after robotic rectal cancer surgery in comparison with laparoscopic surgery. A systematic review was performed for the period 2002 to 2014. A total of 1776 patients with rectal cancer underwent minimally invasive robotic treatment in 32 studies. After robotic and laparoscopic approach to oncologic rectal surgery, respectively, mean operating time varied from 192-385 min, and from 158-297 min; mean estimated blood loss was between 33 and 283 mL, and between 127 and 300 mL; mean length of stay varied from 4-10 d; and from 6-15 d. Conversion after robotic rectal surgery varied from 0% to 9.4%, and from 0 to 22% after laparoscopy. There was no difference between robotic (0%-41.3%) and laparoscopic (5.5%-29.3%) surgery regarding morbidity and anastomotic complications (respectively, 0%-13.5%, and 0%-11.1%). Regarding immediate oncologic outcomes, respectively among robotic and laparoscopic cases, positive circumferential margins varied from 0% to 7.5%, and from 0% to 8.8%; the mean number of retrieved lymph nodes was between 10 and 20, and between 11 and 21; and the mean distal resection margin was from 0.8 to 4.7 cm, and from 1.9 to 4.5 cm. Robotic rectal cancer surgery is being undertaken by experienced surgeons. However, the quality of the assembled evidence does not support definite conclusions about most studies variables. Robotic rectal cancer surgery is associated to increased costs and operating time. It also seems to be

Impact of Medical Tourism on Cosmetic Surgery in the United States

Directory of Open Access Journals (Sweden)

Lauren E. Franzblau, BS

2013-10-01

Full Text Available Summary: Developing countries have been attracting more international patients by building state-of-the-art facilities and offering sought-after healthcare services at a fraction of the cost of the US healthcare system. These price differentials matter most for elective procedures, including cosmetic surgeries, which are paid for out of pocket. It is unclear how this rise in medical tourism will affect the practice of plastic surgery, which encompasses a uniquely large number of elective procedures. By examining trends in the globalization of the cosmetic surgery market, we can better understand the current situation and what plastic surgeons in the United States can expect. In this article, we explore both domestic and foreign factors that affect surgical tourism and the current state of this industry. We also discuss how it may affect the practice of cosmetic surgery within the United States.

CURRENT TRENDS FOR DEVELOPMENT AND IMPROVEMENT OF THE ORGANIZATIONAL STRUCTURES IN MANAGEMENT

Directory of Open Access Journals (Sweden)

Angel Doraliyski

2017-03-01

Full Text Available One of the key components of the management system is the organizational structure of management. This report presents the current trends of development and improvement of organizational structures of management. The semantics of the term "organizational structure" used in the report is clarified. Key aspects of structural policy of organizations are discussed, as well as the introduction of flexible organizational forms. The main directions for analysis of organizational policy of organizations are also mentioned. It is stressed that the analysis of current trends for the future development of organizational structures of management should be an integral component of the management policy of every organization. The trends are flexibility and adaptability of the organizational structure, rational proportion between centralization and decentralization, an appropriate balance between the rights, duties and responsibilities, reducing regulations, rules and other normative documents. A recommendetaion is made that organizational governance structures must be adapted constantly in accordance with changes in the overall management system, as they are one of its main components.

CURRENT TRENDS IN HOSPITALITY INDUSTRY

Directory of Open Access Journals (Sweden)

Ivica Batinić

2013-10-01

Full Text Available Hospitality industry is a complex product-service economic activity which besides accommodation, food and beverages offers a variety of complementary and ancillary services in order to meet modern needs, demands and desires of tourists consumers. Contemporary needs, demands and desires of tourists consumers (increased need for security and preservation of health; emphasis on ecology and healthy food; pure nature stay; growing demand for adventure activities and excitement; convention facilities and incentive offerings; visits to towns, big sports, cultural, religious, business events; new travel motivation have led to the emergence of new trends in hospitality offering design. Wellness and spa hotels, boutique hotels, all inclusive hotels, slow-food restaurants, and wine and lounge bars are just some of the main trends, and successful hoteliers and caterers will examine each of the trends and devise development politics in accordance with the new requirements and global market needs.

International Medical Graduates in the US Physician Workforce and Graduate Medical Education: Current and Historical Trends.

Science.gov (United States)

Ahmed, Awad A; Hwang, Wei-Ting; Thomas, Charles R; Deville, Curtiland

2018-04-01

Data show that international medical graduates (IMGs), both US and foreign born, are more likely to enter primary care specialties and practice in underserved areas. Comprehensive assessments of representation trends for IMGs in the US physician workforce are limited. We reported current and historical representation trends for IMGs in the graduate medical education (GME) training pool and US practicing physician workforce. We compared representation for the total GME and active practicing physician pools with the 20 largest residency specialties. A 2-sided test was used for comparison, with P  < .001 considered significant. To assess significant increases in IMG GME trainee representation for the total pool and each of the specialties from 1990-2015, the slope was estimated using simple linear regression. IMGs showed significantly greater representation among active practicing physicians in 4 specialties: internal medicine (39%), neurology (31%), psychiatry (30%), and pediatrics (25%). IMGs in GME showed significantly greater representation in 5 specialties: pathology (39%), internal medicine (39%), neurology (36%), family medicine (32%), and psychiatry (31%; all P  < .001). Over the past quarter century, IMG representation in GME has increased by 0.2% per year in the total GME pool, and 1.1% per year for family medicine, 0.5% for obstetrics and gynecology and general surgery, and 0.3% for internal medicine. IMGs make up nearly a quarter of the total GME pool and practicing physician workforce, with a disproportionate share, and larger increases over our study period in certain specialties.

Adolescent bariatric surgery: review on nutrition considerations.

Science.gov (United States)

Nogueira, Isadora; Hrovat, Kathleen

2014-12-01

The prevalence of obesity in adolescents has dramatically increased over the past 3 decades in the United States. Weight loss surgery is becoming a viable treatment option for obese adolescents. The number of surgeries being performed yearly is rising, and this trend is likely to continue. Adolescent patients present a unique challenge to clinicians. There are currently best-practice recommendations and evidence-based nutrition guidelines for the treatment of the adolescent bariatric patient. A review of the current literature was performed to discuss bariatric surgery and nutrition for the adolescent patient. Studies show that most adolescents with obesity will become obese adults, thus increasing their risk of developing serious and debilitating health conditions. It is recommended that the candidates for surgery be referred to a practice that has a multidisciplinary team experienced in meeting the distinct physical and psychological needs of adolescents. Specific nutrition concerns for the adolescent bariatric patient include preoperative educational pathway, postoperative dietary progression, female reproduction, compliance with vitamin/supplementation recommendations, laboratory tests, and long-term monitoring. The medical literature has reported positive outcomes of bariatric surgery in adolescents with severe obesity. Before surgery is offered as an option, unique factors to adolescents must be addressed. The multidisciplinary clinical team must consider the adolescents' cognitive, social, and emotional development when considering their candidacy for surgery. As the number of adolescent bariatric surgery programs increases, continued research and long-term outcome data need to be collected and shared to base future treatment decisions. © 2014 American Society for Parenteral and Enteral Nutrition.

Image-guided surgery and therapy: current status and future directions

Science.gov (United States)

Peters, Terence M.

2001-05-01

Image-guided surgery and therapy is assuming an increasingly important role, particularly considering the current emphasis on minimally-invasive surgical procedures. Volumetric CT and MR images have been used now for some time in conjunction with stereotactic frames, to guide many neurosurgical procedures. With the development of systems that permit surgical instruments to be tracked in space, image-guided surgery now includes the use of frame-less procedures, and the application of the technology has spread beyond neurosurgery to include orthopedic applications and therapy of various soft-tissue organs such as the breast, prostate and heart. Since tracking systems allow image- guided surgery to be undertaken without frames, a great deal of effort has been spent on image-to-image and image-to- patient registration techniques, and upon the means of combining real-time intra-operative images with images acquired pre-operatively. As image-guided surgery systems have become increasingly sophisticated, the greatest challenges to their successful adoption in the operating room of the future relate to the interface between the user and the system. To date, little effort has been expended to ensure that the human factors issues relating to the use of such equipment in the operating room have been adequately addressed. Such systems will only be employed routinely in the OR when they are designed to be intuitive, unobtrusive, and provide simple access to the source of the images.

Modern trends in oesophageal surgery | Bremner | South African ...

African Journals Online (AJOL)

... oesophageal disease, advances in instrumentation and the surge of molecular biological interests. The recent explosion of bariatric surgery in the USA has also opened new dimensions for investigation of the effects of bariatric procedures on oesophageal function. South African Journal of Surgery Vol.43(1) 2005: 13-16 ...

Corporate Social responsibility in the petrochemical industry: Exploring current trends in social and environmental disclosure

OpenAIRE

Lei, Juan

2006-01-01

Current trends indicate that we are entering a new phase of corporate responsibility reporting that more emphasis is paid on social responsibility, but significant variation still remains in the maturity of reporting content and styles in industries, and even in the same industry. This study explores the current trend of corporate social and environmental reporting in petrochemical industry. It offers a detailed review of the development of corporate social responsibility reporting, and of th...

Minimal invasive single-site surgery in colorectal procedures: Current state of the art

Directory of Open Access Journals (Sweden)

Diana Michele

2011-01-01

Full Text Available Background: Minimally invasive single-site (MISS surgery has recently been applied to colorectal surgery. We aimed to assess the current state of the art and the adequacy of preliminary oncological results. Methods: We performed a systematic review of the literature using Pubmed, Medline, SCOPUS and Web of Science databases. Keywords used were "Single Port" or "Single-Incision" or "LaparoEndoscopic Single Site" or "SILS™" and "Colon" or "Colorectal" and "Surgery". Results: Twenty-nine articles on colorectal MISS surgery have been published from July 2008 to July 2010, presenting data on 149 patients. One study reported analgesic requirement. The final incision length ranged from 2.5 to 8 cm. Only two studies reported fascial incision length. There were two port site hernias in a series of 13 patients (15.38%. Two "fully laparoscopic" MISS procedures with preparation and achievement of the anastomosis completely intracorporeally are reported. Future site of ileostomy was used as the sole access for the procedures in three studies. Lymph node harvesting, resection margins and length of specimen were sufficient in oncological cases. Conclusions: MISS colorectal surgery is a challenging procedure that seems to be safe and feasible, but the existing clinical evidence is limited. In selected cases, and especially when an ileostomy is planned, colorectal surgery may be an ideal indication for MISS surgery leading to a no-scar surgery. Despite preliminary oncological results showing the feasibility of MISS surgery, we want to stress the need to standardize the technique and carefully evaluate its application in oncosurgery under ethical committee control.

Laparoscopic surgery in colorectal cancer; Cirugia laparoscopica en cancer colorrectal

Energy Technology Data Exchange (ETDEWEB)

Bressler Hernandez, Norlan; Martinez Perez, Elliot; Fernandez Rodriguez, Leopoldo; Torres Core, Ramiro, E-mail: bcimeq@infomed.sld.cu [Centro de Investigaciones Medico Quirurgicas, La Habana (Cuba)

2011-07-01

In the current age of minimally invasive surgery, laparoscopic surgery for colon cancer has been established as oncologically equivalent to conventional open surgery. The advantages of laparoscopic surgery have translated into smaller incisions and shorter recovery. Since the advent of laparoscopy, surgeons have been fueled to develop less invasive operative methods as feasible alternatives to traditional procedures. As techniques evolved and technology advanced, laparoscopy became more widely accepted and is now more commonly used in many institutions. Recently, a trend toward less invasive surgery, driven by patient and surgeon alike, has been a major objective for many institutions because of the ability of laparoscopic surgery to reduce postoperative pain, achieve a quicker recovery time, and improve cosmetic outcomes. Although still evolving, traditional laparoscopy has served as a foundation for even further refinements in the minimally invasive approach and as a result, more advanced equipment and newer techniques have arisen.

Perspectives of stem cell use in reconstructive maxillofacial surgery

Directory of Open Access Journals (Sweden)

Mikhail G. Semyonov

2016-12-01

Full Text Available The discovery of stem cells is one of the greatest achievements of molecular and cell biology, and associated research has confirmed the possibility of self-renewal and differentiation into specialized tissue stem cells. The use of cellular technologies is an important trend in modern medicine. The aim of this article is to briefly review current findings on the use of stem cells in cardiology, endocrinology, neurology, traumatology, and maxillofacial surgery. All data were retrieved from experimental and clinical studies using various cell technologies. The material is part of ongoing maxillofacial surgery research to investigate the possible use of stem cells in reconstructive maxillofacial surgery for jaw bone pathologies in children. Present tissue engineering methods provide some opportunities for solving difficult clinical problems in oral and maxillofacial surgery. Despite some international achievements of effective application of IC in various diseases, clinical use in reconstructive surgery requires further investigation.

Trend, Risk Factors, and Costs of Clostridium difficile Infections in Vascular Surgery.

Science.gov (United States)

Egorova, Natalia N; Siracuse, Jeffrey J; McKinsey, James F; Nowygrod, Roman

2015-01-01

Starting in December 2013, the Hospital Inpatient Quality Reporting Program included Clostridium difficile infection (CDI) rates as a new publically reported quality measure. Our goal was to review the trend, hospital variability in CDI rates, and associated risk factors and costs in vascular surgery. The rates of CDI after major vascular procedures including aortic abdominal aneurysm (AAA) repair, carotid endarterectomy or stenting, lower extremity revascularization (LER), and LE amputation were identified using Nationwide Inpatient Sample database for 2000-2011. Risk factors associated with CDI were analyzed with hierarchical multivariate logistic regression. Extra costs, length of stay (LOS), and mortality were assessed for propensity-matched hospitalizations with and without CDI. During the study period, the rates of CDI after vascular procedures had increased by 74% from 0.6 in 2000 to 1.05% in 2011, whereas the case fatality rate was stable at 9-11%. In 2011, the highest rates were after ruptured aortic abdominal aneurysm (rAAA) repair (3.3%), followed by lower extremity amputations (2.3%) and elective open AAA (1.3%). The rates of CDI increased after all vascular procedures during the 12 years. The highest increase was after endovascular LER (151.8%) and open rAAA repair (135.7%). In 2011, patients who had experienced CDI had median LOS of 15 days (interquartile range, 9-25 days) compared with 8.3 days for matched patients without CDI, in-hospital mortality 9.1% (compared with 5.0%), and $13,471 extra cost per hospitalization. The estimated cost associated with CDI in vascular surgery in the United States was ∼$98 million in 2011. Hospital rates of CDI varied from 0 to 50% with 3.5% of hospitals having infection rates ≥5%. Factors associated with CDI included multiple chronic conditions, female gender, surgery type, emergent and weekend hospitalizations, hospital transfers, and urban locations. Despite potential reduction of infection rates as evidenced

The current state and trends of the development of universities in Ukraine

Directory of Open Access Journals (Sweden)

O.B. Morhulets

2015-09-01

Full Text Available Education is the basis of social, political, economic, spiritual, and cultural development. Therefore, the study of the current state and trends of the development of Ukrainian universities is a significant factor of social and economic progress of the country.The paper reflects the general state of universities in Ukraine, in particular, the trends in dynamics: the number of students in terms of entry/graduation, sources of financing, education fields; the number of universities in the context of accreditation, types and forms of ownership; the number of outbound Ukrainian and inbound foreign students; quantitative and qualitative characteristics of teaching staff; spending on higher education and the cost of funding per student compared with other countries. The purpose of the study is the assessment of economic activity of higher educational establishments in Ukraine, the identification of problems and tendencies of their development in the context of national transformational processes in education and formation of the society of knowledge. The methodical base used in the study is analysis and synthesis, methods of comparison and generalization, extrapolation, index and graphical methods. The practical value of the study is based on the results of a thorough analysis of university activities. Such results reveal the current state and trends of the development of universities under conditions of higher education transformation in Ukraine and its integration into the European educational area. The results of research improve understanding of the state and problems of the universities and provide the foundations for further research in the field of the national education system development and for improving of the quality of young professionals’ training. The trends of the university development indicate that the reorganization of higher education which is being currently taken place, already results in the emergence of new competencies of

Current practice of antiplatelet and anticoagulation management in post-cardiac surgery patients: a national audit.

Science.gov (United States)

Hosmane, Sharath; Birla, Rashmi; Marchbank, Adrian

2012-04-01

The Audit and Guidelines Committee of the European Association for Cardio-Thoracic Surgery recently published a guideline on antiplatelet and anticoagulation management in cardiac surgery. We aimed to assess the awareness of the current guideline and adherence to it in the National Health Service through this National Audit. We designed a questionnaire consisting of nine questions covering various aspects of antiplatelet and anticoagulation management in post-cardiac surgery patients. A telephonic survey of the on-call cardiothoracic registrars in all the cardiothoracic centres across the UK was performed. All 37 National Health Service hospitals in the UK with 242 consultants providing adult cardiac surgical service were contacted. Twenty (54%) hospitals had a unit protocol for antiplatelet and anticoagulation management in post-cardiac surgery. Only 23 (62.2%) registrars were aware of current European Association for Cardio-Thoracic Surgery guidelines. Antiplatelet therapy is variable in the cardiac surgical units across the country. Low-dose aspirin is commonly used despite the recommendation of 150-300 mg. The loading dose of aspirin within 24 h as recommended by the guideline is followed only by 60.7% of surgeons. There was not much deviation from the guideline with respect to the anticoagulation therapy.

Current trends in the global tourism industry: evidence from the United States

Directory of Open Access Journals (Sweden)

Nejdet Delener

2010-10-01

Full Text Available Tourism is one of the largest U.S. industries, serving millions of international and domestic tourists yearly. Tourists visit the U.S. to see natural wonders, cities, historic landmarks, and entertainment venues. Americans seek similar attractions as well as recreation and vacation areas. Tourism competes in the global market, so it is important to understand current trends in the U.S. travel industry. Therefore, this article offers insight into important trends and suggests strategies for policy makers involved in the travel and tourism industry.

Orthopedic Surgery among Patients with Rheumatoid Arthritis: A Population-based study to Identify Risk factors, Sex differences, and Time trends.

Science.gov (United States)

Richter, Michael; Crowson, Cynthia S; Matteson, Eric L; Makol, Ashima

2017-12-20

To identify risk factors for large joint (LJS) versus small joint surgery (SJS) in rheumatoid arthritis (RA) and evaluate trends in surgery rates over time. A retrospective medical record review was performed of all orthopedic surgeries following first fulfillment of 1987 ACR criteria for adult-onset RA among residents of Olmsted County, Minnesota, USA in 1980-2013. Risk factors were examined using Cox models adjusted for age, sex and calendar year of RA incidence. Trends in incidence of joint surgeries were examined using Poisson regression models. A total of 1077 patients with RA (mean age 56 years, 69% female, 66% seropositive) were followed for a median of 10.7 years during which 112 (90 women) underwent at least one SJS and 204 (141 women) underwent at least one LJS. Risk factors included advanced age, rheumatoid factor and anti-CCP antibody positivity for both SJS and LJS, and BMI≥30 kg/m 2 for LJS. Risk factors for SJS and LJS at any time during follow-up included the presence of radiographic erosions, large joint swelling, and methotrexate use. SJS rates decreased by calendar year of incidence (hazard ratio 0.53; p=0.001), with significant decline in SJS after 1995. The cumulative incidence of SJS was higher in women than men (p=0.008). In recent years, there has been a significant decline in rates of SJS but not LJS in patients with RA. The incidence of SJS is higher among women. Traditional RA risk factors are strong predictors for SJS and LJS. Increasing age and obesity are predictive of LJS. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Survey Exploring Views of Scientists on Current Trends in Chemistry Education

Science.gov (United States)

Vamvakeros, Xenofon; Pavlatou, Evangelia A.; Spyrellis, Nicolas

2010-01-01

A survey exploring the views of scientists, chemists and chemical engineers, on current trends in Chemistry Education was conducted in Greece. Their opinions were investigated using a questionnaire focusing on curricula (the content and process of chemistry teaching and learning), as well as on the respondents' general educational beliefs and…

Disability in the Classroom: Current Trends and Impacts on Music Education

Science.gov (United States)

Abramo, Joseph

2012-01-01

This article covers current trends in disability rights and raises questions about how society's views of disability influence the music education of students in need of special education services. Brief overviews of the disability-rights movement in the United States and of federal laws pertaining to disabilities and education are included. Next,…

Oil development in China: Current status and future trends

International Nuclear Information System (INIS)

Ma Linwei; Fu Feng; Li Zheng; Liu Pei

2012-01-01

The future of oil has become an important topic of the discussion of energy policy in China. This paper attempts to present a full picture of the current status and future trends of China’s oil development through system analysis. First, we map a Sankey diagram of China’s oil flow to reveal the physical pattern of China’s oil supply and consumption. Then, we present the historical and ongoing trends of China’s oil flow from key aspects such as oil demand, oil resource availability, technology improvement, and policy adjustment. Based on these understandings, we design three scenarios of China’s oil demand in 2030, and analyze policy implications for oil saving, automotive energy development, and energy security. From the analysis, we draw some conclusions for policy decisions, such as to control the total oil consumption to avoid energy security risks, to enhance oil saving in all sectors with road transportation as the emphasis, and to increase the investment on oil production and refining to secure oil supply and reduce emissions. - Highlights: ► A Sankey Diagram to reveal the physical pattern of China’s oil supply and consumption. ► Present the ongoing trends of China’s oil development. ► Discuss important policy issues such as oil saving, energy security, and emissions reduction.

In vivo microrobots for natural orifice transluminal surgery. Current status and future perspectives.

Science.gov (United States)

Forgione, A

2009-06-01

The possibility to operate inside the peritoneal cavity through small holes performed in hollow organs that is presented by Natural Orifice Transluminal Endoscopic Surgery (NOTES) represents a major paradigm shift in general surgery. While this new approach seems very appealing from patients' perspectives because it eliminates completely abdominal wall aggression and promises to reduce postoperative pain, it is very challenging for surgeons because of the major constraints imposed by both the mode of access and the limited technology currently available. For this reason NOTES applications at the present time are performed by only a few surgeons and mainly to perform non-complex procedures. While new devices are under development, many of them are trying mainly to simply improve current endoscopic platforms and seem not to offer breakthrough solutions. The numerous challenges introduced by natural orifice approaches require a radical shift in the conception of new technologies in order to make this emerging operative access safe and reproducible. The convergence of several enabling technologies in the field of miniaturization, communication and micro-mechatronics brings the possibility to realize on a large scale the revolutionary concept of miniature in vivo co-operative robots. These robots provide vision and task assistance without the constraints of the entry incision and have been shown in experimental settings to possess many qualities that could be ideal to partner with Natural Orifice Surgery. This article explores the current status of microrobotics as well as presents potential future scenarios of their applications in NOTES.

Time trends in prostate cancer surgery: data from an Internet-based multicentre database.

Science.gov (United States)

Schostak, Martin; Baumunk, Daniel; Jagota, Anita; Klopf, Christian; Winter, Alexander; Schäfers, Sebastian; Kössler, Robert; Brennecke, Volker; Fischer, Tom; Hagel, Susanne; Höchel, Steffen; Jäkel, Dierk; Lehsnau, Mike; Krege, Susanne; Rüffert, Bernd; Pretzer, Jana; Becht, Eduard; Zegenhagen, Thomas; Miller, Kurt; Weikert, Steffen

2012-02-01

To report our experience with an Internet-based multicentre database that enables tumour documentation, as well as the collection of quality-related parameters and follow-up data, in surgically treated patients with prostate cancer. The system was used to assess the quality of prostate cancer surgery and to analyze possible time-dependent trends in the quality of care. An Internet-based database system enabled a standardized collection of treatment data and clinical findings from the participating urological centres for the years 2005-2009. An analysis was performed aiming to evaluate relevant patient characteristics (age, pathological tumour stage, preoperative International Index of Erectile Function-5 score), intra-operative parameters (operating time, percentage of nerve-sparing operations, complication rate, transfusion rate, number of resected lymph nodes) and postoperative parameters (hospitalization time, re-operation rate, catheter indwelling time). Mean values were calculated and compared for each annual cohort from 2005 to 2008. The overall survival rate was also calculated for a subgroup of the Berlin patients. A total of 914, 1120, 1434 and 1750 patients submitted to radical prostatectomy in 2005, 2006, 2007 and 2008 were documented in the database. The mean age at the time of surgery remained constant (66 years) during the study period. More than half the patients already had erectile dysfunction before surgery (median International Index of Erectile Function-5 score of 19-20). During the observation period, there was a decrease in the percentage of pT2 tumours (1% in 2005; 64% in 2008) and a slight increase in the percentage of patients with lymph node metastases (8% in 2005; 10% in 2008). No time trend was found for the operating time (142-155 min) or the percentage of nerve-sparing operations (72-78% in patients without erectile dysfunction). A decreasing frequency was observed for the parameters: blood transfusions (1.9% in 2005; 0.5% in 2008

Comparison of cardiothoracic surgery training in USA and Germany.

Science.gov (United States)

Tchantchaleishvili, Vakhtang; Mokashi, Suyog A; Rajab, Taufiek K; Bolman, R Morton; Chen, Frederick Y; Schmitto, Jan D

2010-11-26

Training of cardiothoracic surgeons in Europe and the United States has expanded to incorporate new operative techniques and requirements. The purpose of this study was to compare the current structure of training programs in the United States and Germany. We thoroughly reviewed the existing literature with particular focus on the curriculum, salary, board certification and quality of life for cardiothoracic trainees. The United States of America and the Federal Republic of Germany each have different cardiothoracic surgery training programs with specific strengths and weaknesses which are compared and presented in this publication. The future of cardiothoracic surgery training will become affected by technological, demographic, economic and supply factors. Given current trends in training programs, creating an efficient training system would allow trainees to compete and grow in this constantly changing environment.

Health Information System Role-Based Access Control Current Security Trends and Challenges.

Science.gov (United States)

de Carvalho Junior, Marcelo Antonio; Bandiera-Paiva, Paulo

2018-01-01

This article objective is to highlight implementation characteristics, concerns, or limitations over role-based access control (RBAC) use on health information system (HIS) using industry-focused literature review of current publishing for that purpose. Based on the findings, assessment for indication of RBAC is obsolete considering HIS authorization control needs. We have selected articles related to our investigation theme "RBAC trends and limitations" in 4 different sources related to health informatics or to the engineering technical field. To do so, we have applied the following search query string: "Role-Based Access Control" OR "RBAC" AND "Health information System" OR "EHR" AND "Trends" OR "Challenges" OR "Security" OR "Authorization" OR "Attacks" OR "Permission Assignment" OR "Permission Relation" OR "Permission Mapping" OR "Constraint". We followed PRISMA applicable flow and general methodology used on software engineering for systematic review. 20 articles were selected after applying inclusion and exclusion criteria resulting contributions from 10 different countries. 17 articles advocate RBAC adaptations. The main security trends and limitations mapped were related to emergency access, grant delegation, and interdomain access control. Several publishing proposed RBAC adaptations and enhancements in order to cope current HIS use characteristics. Most of the existent RBAC studies are not related to health informatics industry though. There is no clear indication of RBAC obsolescence for HIS use.

Robotic-Assisted Procedures in Pediatric Surgery: A Critical Appraisal of the Current Best Evidence in Comparison to Conventional Minimally Invasive Surgery.

Science.gov (United States)

Friedmacher, Florian; Till, Holger

2015-11-01

In recent years, the use of robotic-assisted surgery (RAS) has expanded within pediatric surgery. Although increasing numbers of pediatric RAS case-series have been published, the level of evidence remains unclear, with authors mainly focusing on the comparison with open surgery rather than the corresponding laparoscopic approach. The aim of this study was to critically appraise the published literature comparing pediatric RAS with conventional minimally invasive surgery (MIS) in order to evaluate the current best level of evidence. A systematic literature-based search for studies comparing pediatric RAS with corresponding MIS procedures was performed using multiple electronic databases and sources. The level of evidence was determined using the Oxford Centre for Evidence-based Medicine (OCEBM) criteria. A total of 20 studies met defined inclusion criteria, reporting on five different procedures: fundoplication (n=8), pyeloplasty (n=8), nephrectomy (n=2), gastric banding (n=1), and sleeve gastrectomy (n=1). Included publications comprised 5 systematic reviews and 15 cohort/case-control studies (OCEBM Level 3 and 4, respectively). No studies of OCEBM Level 1 or 2 were identified. Limited evidence indicated reduced operative time (pyeloplasty) and shorter hospital stay (fundoplication) for pediatric RAS, whereas disadvantages were longer operative time (fundoplication, nephrectomy, gastric banding, and sleeve gastrectomy) and higher total costs (fundoplication and sleeve gastrectomy). There were no differences reported for complications, success rates, or short-term outcomes between pediatric RAS and conventional MIS in these procedures. Inconsistency was found in study design and follow-up with large clinical heterogeneity. The best available evidence for pediatric RAS is currently OCEBM Level 3, relating only to fundoplication and pyeloplasty. Therefore, higher-quality studies and comparative data for other RAS procedures in pediatric surgery are required.

[Current status and changes of metabolic and bariatric surgery in China].

Science.gov (United States)

Liu, Jingang

2017-04-25

Through continuous development, metabolic and bariatric surgery (MBS) has become widely recognized in academic and medical circles. In China, the volume of MBS operations has increased year by year. Therapeutic goals of MBS have evolved from treating obesity to treating Type 2 diabetes mellitus, and further to treating a series of obesity-associated metabolic diseases (including conditions in the endocrine system, circulatory system, respiratory system, reproductive system, and etc). Surgical approach of MBS has also been evolving continuously. Currently the common surgical procedures include laparoscopic Roux-en-Y gastric bypass (LRYGB), laparoscopic sleeve gastrectomy (LSG), laparoscopic adjustable gastric banding (LAGB) and bilio-pancreatic diversion with duodenal switch (BPD-DS). All surgical procedures have pros and cons, and the choice of surgical procedures should be based on the conditions of patients, the surgeon's technical ability, and benefits and operative risks. With the development of MBS, the proportions of different surgical procedures also changed in China. In recent five years, the proportion of AGB has decreased continuously and LAGB is no longer a common procedure. The proportion of LSG has increased rapidly, rising from 9% in 2010 to 55% in 2015. The proportion of RYGB has increased from 57% to 64% between 2010 and 2013, and remained at 45% afterwards. Since 2010, most MBS operations are laparoscopic surgery. 3D Laparoscopic surgery, laparoendoscopic single-site surgery and da Vinci Robotic Surgery have also been introduced in MBS. This review discusses the status quo and changes of MBS in china, as well as the new technology in MBS, aiming to strengthen the information and comprehension of MBS in china.

Current approach to diagnosis and treatment of delirium after cardiac surgery

Science.gov (United States)

Evans, Adam S.; Weiner, Menachem M.; Arora, Rakesh C.; Chung, Insung; Deshpande, Ranjit; Varghese, Robin; Augoustides, John; Ramakrishna, Harish

2016-01-01

Delirium after cardiac surgery remains a common occurrence that results in significant short- and long-term morbidity and mortality. It continues to be underdiagnosed given its complex presentation and multifactorial etiology; however, its prevalence is increasing given the aging cardiac surgical population. This review highlights the perioperative risk factors, tools to assist in diagnosing delirium, and current pharmacological and nonpharmacological therapy options. PMID:27052077

Food and Health Some Current Issues and Future Trends

OpenAIRE

Gormley, T. R. (Thomas Ronan)

1991-01-01

This paper deals with some of the many current issues and future trends in the area of food, diet and health in Europe. A complete coverage would be impossible in a short article in view of the extent and complexity of the food system and its major interaction with health. It is also important to stress at the outset that food/diet is only one component of health and other factors such as environment, overall lifestyle and genetics also play a major role. The genetic dimension is of particula...

Current Trends in High-Level Synthesis of Asynchronous Circuits

DEFF Research Database (Denmark)

Sparsø, Jens

2009-01-01

This paper is a survey paper presenting what the author sees as two major and promising trends in the current research in CAD-tools and design-methods for asynchronous circuits. One branch of research builds on top of existing asynchronous CAD-tools that perform syntax directed translation, e...... a conventional synchronous circuit as the starting point, and then adds some form of handshake-based flow-control. One approach keeps the global clock and implements discrete-time asynchronous operation. Another approach substitutes the clocked registers by asynchronous handshake-registers, thus creating truly...

The current waste generation and management trends in South Africa: A Review

CSIR Research Space (South Africa)

Nkosi, N

2013-04-01

Full Text Available This paper, a continuation and expansion of the work of Muzenda et al, 2012 [1] looks at the current waste generation and management trends in South Africa. The waste tyre problem in South Africa is also briefly discussed. Solid waste management...

Current technological trends in development of NPP systems

International Nuclear Information System (INIS)

Florescu, Gheorghe; Panaitescu, Valeriu

2010-01-01

The recent nuclear research issues look for new technologies and continuous progress in finding different and efficient solutions for sustained and upraising energy demand. The trend of increasing energy consumption and occurring of new and large consumers, especially from Asian countries, imposes finding of new means for clean, large scale and sustained energy production. NPPs availability was continuously monitored and improved; at the same time the safety of the nuclear energy production was under surveillance. The present development of the new technologies, the discoveries of new materials and development of efficient technological processes offer the opportunities for their appropriate implementation and use in the NPP system configurations and functioning/operation. The new technologies and scientific discoveries, and also the international cooperation, offer the opportunities to mitigate the actual barriers in order to cumulate and use advanced energy production, to find new energy sources and to build improved, reliable and safe power plants. The monitoring systems, intelligent sensors and SSCs, nanotechnologies and new/intelligent materials constitute the main ways for improvement of the NPP systems configuration and processes. The paper presents: - The state of the art in the level of the currently applied technologies for nuclear power systems development; - The actual technological limits that need to be over passed for improving the NPP systems ; - The main systems that need improvement and reconfiguration for development of currently operating NPPs as well as raising the operation efficiency, availability and total safety; - The actual energy production issues; - The key arguments in sustaining the R and D new NPP systems development; - Future trends in NPP development; - The limitations in industrial processes knowledge and use. Appropriate R and D in the field of NPP systems have specific characteristics that were considered in paper completion

Current approaches to journal club by general surgery programs within the Southwestern surgical congress.

Science.gov (United States)

Shifflette, Vanessa; Mitchell, Chris; Mangram, Alicia; Dunn, Ernest

2012-01-01

Journal club (JC) is a well-recognized education tool for many postgraduate medical education programs. Journal club helps residents learn critical analytic skills and keep up to date with current medical practices. To our knowledge, there is minimal evidence in the current literature detailing modern JC practices of general surgery training programs. Our study attempts to define how general surgery residency programs are implementing JC in their training process. We distributed by mail a 14-question survey to general surgery program directors within the Southwestern Surgical Congress. These surveys were redistributed 1 month after the initial attempt. The responses were collected and analyzed. Survey questions aimed to define JC practice characteristics, such as where JC is held, when JC is held, who directs JC, what journals are used, the perceived importance of JC, and average attendance. The surveys were sent to 32 program directors (PDs), which included 26 university and 6 community-based programs. We received responses from 26 (81%) PDs. Ninety-two percent of the programs have a consistent journal club (JC). Most JCs meet monthly (64%) or weekly (16%). The meeting places ranged from conference rooms (60%), faculty homes (20%), restaurants (8%), or in the hospital (12%). The meeting times were divided between morning (29%), midday (29%), and evening (42%). Most JCs lasted between 1 and 2 hours (88%), reviewed 1-4 articles (88%), and are attended by more than 60% of residents routinely (75%). Half of the programs (50%) had 3-4 faculty members present during discussion; 29% of the programs had only 1-2 faculty present. The articles were selected from more than 10 different journals. Seventy-five percent of the programs used the American Journal of Surgery and Annals of Surgery to find articles; only 13% of the programs used evidence-based reviews in surgery. PDs believe JC is very beneficial (42%), moderately beneficial (42%), or only fairly beneficial (16

[Materials/Biomaterials in Clinical Practice - a Short Review and Current Trends].

Science.gov (United States)

Bolle, T; Meyer, F; Walcher, F; Lohmann, C; Jockenhövel, S; Gries, T; Hoffmann, W

2017-04-01

Biomaterials play a major role in interventional medicine and surgery. However, the development of biomaterials is still in its early phases in spite of the huge progress made within the last decades. On the one hand, this is because our knowledge of the molecular and cellular processes associated with biomaterials is still increasing exponentially. On the other hand, a wide variety of advanced materials with highly interesting properties is being developed currently. This review provides a short introduction into the variety of materials in use as well as their application in interventional medicine and surgery. Also the importance of biomaterials for tissue engineering in the field of regenerative medicine and the functionalisation of biomaterials, including sterilisation methods are discussed. For the future, an even broader interdisciplinary scientific collaboration is necessary in order to develop novel biomaterials and facilitate their translation into clinical practice. Georg Thieme Verlag KG Stuttgart · New York.

A Review of Current Clinical Applications of Three-Dimensional Printing in Spine Surgery.

Science.gov (United States)

Cho, Woojin; Job, Alan Varkey; Chen, Jing; Baek, Jung Hwan

2018-02-01

Three-dimensional (3D) printing is a transformative technology with a potentially wide range of applications in the field of orthopaedic spine surgery. This article aims to review the current applications, limitations, and future developments of 3D printing technology in orthopaedic spine surgery. Current preoperative applications of 3D printing include construction of complex 3D anatomic models for improved visual understanding, preoperative surgical planning, and surgical simulations for resident education. Intraoperatively, 3D printers have been successfully used in surgical guidance systems and in the creation of patient specific implantable devices. Furthermore, 3D printing is revolutionizing the field of regenerative medicine and tissue engineering, allowing construction of biocompatible scaffolds suitable for cell growth and vasculature. Advances in printing technology and evidence of positive clinical outcomes are needed before there is an expansion of 3D printing applied to the clinical setting.

World petrochemical outlook: Is the current weakness a trend or an aberration?

International Nuclear Information System (INIS)

Baggett, P.E.

1995-01-01

While the focus of this conference is methanol, a review of the general petrochemical industry might be enlightening and valuable to understanding the methanol market. Methanol is certainly a commodity with similarities to hydrocarbons such as gasoline and similarities to base petrochemicals such as ethylene. Methanol stands with one foot in the fuels market via MTBE and the other in the chemicals business for acetic acid and formaldehyde, among many others. Is the world petrochemical market moving into a new trend of weak prices and profits or is the strong growth seen in 1994 and 1995 continuing and the current situation an aberration? In order to determine whether the current market is a trend or aberration, the author looks at issues that he believes caused the current situation and then considers where the world's economies and petrochemical markets are heading. The issues discussed are: unusually high price increase in a short period; inventory increase/decrease because of price changes; reduction in demand caused by high prices; increase in capacity caused by high prices; changes in growth of world economies; and political/economic issues in China

Views of surgery program directors on the current ACGME and proposed IOM duty-hour standards.

Science.gov (United States)

Willis, Ross E; Coverdill, James E; Mellinger, John D; Collins, J Craig; Potts, John R; Dent, Daniel L

2009-01-01

The purpose of this study was to survey the experiences of surgery program directors with the current Accreditation Council for Graduate Medical Education (ACGME) duty-hour standards and views of the Institute of Medicine (IOM) proposed duty-hour recommendations. A total of 118 program directors (47.6% of all surgery programs in the US) responded to the survey. Results showed that the current duty-hour standards have hindered clinical education opportunities by reducing or eliminating rotations on many services, didactic teaching conferences, and clinical bedside teaching opportunities. Additionally, patient safety has been compromised by frequent hand offs of care. Most IOM recommendations were perceived as extremely difficult or impossible to implement, with the exception of the moonlighting recommendation. The results indicated that adopting the IOM recommendations is not feasible given current workforce limitations, and most program directors supported maintaining the current duty-hour standards until such time as there is evidence-based outcomes research to direct change. The conclusion was that the current ACGME duty-hour standards have reduced teaching opportunities and narrowed the scope of training.

Foot Surgery

Science.gov (United States)

... coding trends along with compliance guidelines and practice marketing materials, APMA has you covered whether you are ... crutches after the surgery or in a cast. Fusions: Fusions are usually performed to treat arthritic or ...

Current interest in careers in surgery and cardiothoracic surgery from the millennial generation.

Science.gov (United States)

Ghannam, Michael; Zhao, Lili; Reddy, Rishindra M

2014-01-01

Interest in cardiothoracic surgery (CTS) as a career has decreased over the past decade. Anecdotal evidence suggests that many surgeons develop an interest in CTS before medical school and even before college. This study evaluates the interest of high-school students at a magnet high school, with regard to careers in medicine, in surgery, and in CTS. A survey assessing career interests and values was conducted among junior and senior high-school students. Students were given a 1-hour presentation by a cardiothoracic (CT) surgeon on the postgraduate training process and then completed a postpresentation survey. A magnet math and science high school, the Kalamazoo Area Mathematics and Science Center. Of 128 students, 117 (91% response rate) completed the survey. Overall, 38% of students reported having a high interest in medicine; of this group, 58% reported a high interest in surgery and 36% reported having a high interest in CTS. Men were more likely than women were to have a high interest in surgery and CTS (p < 0.001). Students with at least 1 family member as a physician vs those without were more likely to be interested in medicine, surgery, and CTS and also have a higher level of concern for postgraduation debt (p < 0.01). Women were more likely than men were to have a high level of concern about postgraduation debt (p = 0.018). After a presentation by a CT surgeon, students showed no changes in interest in medicine careers but did report an increased level of knowledge about the process of becoming a CT surgeon, going from 31% to 72%. There exists a large interest in both surgery and CTS at the high-school level, but there may be a need for more active outreach to maintain and foster their interest in surgery and CTS through undergraduate and medical school. Copyright © 2014 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Evolution and Current Trends in Liquid and Supercritical Fluid Chromatography

OpenAIRE

Fekete, Szabolcs; Grand-Guillaume-Perrenoud, Alexandre; Guillarme, Davy

2014-01-01

The current trend in high performance liquid chromatography (HPLC) tends toward the achievement of higher separation efficiency and shorter analysis time. Indeed, better performance in LC has become increasingly important in recent years mainly driven by the challenges of either analyzing more complex samples or increasing the numbers of samples per time unit. In the recent development of particle technology, the use of fully porous sub-2 m particles and sub-3 m shell particles have received ...

Current status of validation for robotic surgery simulators - a systematic review.

Science.gov (United States)

Abboudi, Hamid; Khan, Mohammed S; Aboumarzouk, Omar; Guru, Khurshid A; Challacombe, Ben; Dasgupta, Prokar; Ahmed, Kamran

2013-02-01

To analyse studies validating the effectiveness of robotic surgery simulators. The MEDLINE(®), EMBASE(®) and PsycINFO(®) databases were systematically searched until September 2011. References from retrieved articles were reviewed to broaden the search. The simulator name, training tasks, participant level, training duration and evaluation scoring were extracted from each study. We also extracted data on feasibility, validity, cost-effectiveness, reliability and educational impact. We identified 19 studies investigating simulation options in robotic surgery. There are five different robotic surgery simulation platforms available on the market. In all, 11 studies sought opinion and compared performance between two different groups; 'expert' and 'novice'. Experts ranged in experience from 21-2200 robotic cases. The novice groups consisted of participants with no prior experience on a robotic platform and were often medical students or junior doctors. The Mimic dV-Trainer(®), ProMIS(®), SimSurgery Educational Platform(®) (SEP) and Intuitive systems have shown face, content and construct validity. The Robotic Surgical SimulatorTM system has only been face and content validated. All of the simulators except SEP have shown educational impact. Feasibility and cost-effectiveness of simulation systems was not evaluated in any trial. Virtual reality simulators were shown to be effective training tools for junior trainees. Simulation training holds the greatest potential to be used as an adjunct to traditional training methods to equip the next generation of robotic surgeons with the skills required to operate safely. However, current simulation models have only been validated in small studies. There is no evidence to suggest one type of simulator provides more effective training than any other. More research is needed to validate simulated environments further and investigate the effectiveness of animal and cadaveric training in robotic surgery. © 2012 BJU

Depressive Symptoms in Bariatric Surgery Patients with Multiple Sclerosis.

Science.gov (United States)

Fisher, Carolyn J; Heinberg, Leslie J; Lapin, Brittany; Aminian, Ali; Sullivan, Amy B

2018-04-01

Bariatric surgery has been shown to be a safe and effective intervention for patients with comorbid obesity and multiple sclerosis (MS); however, this sub-population may be at heightened risk for pre- and postoperative depressive symptoms. This current exploratory study aims to describe the prevalence and nature of depressive symptoms in a sample of patients with MS who undergo bariatric surgery. Medical records were retrospectively reviewed to identify patients who received bariatric surgery and had a diagnosis of MS (n = 31) and a control sample of non-surgical MS patients with severe obesity (n = 828). Longitudinal outcome measures included the Patient Health Questionnaire-9 (PHQ-9) and Multiple Sclerosis Performance Scale (MSPS). There were no significant differences in PHQ-9 total and item scores between groups at baseline. PHQ-9 scores significantly improved at years 1 (p bariatric surgery when compared to non-surgical controls. Higher BMI (p = 0.03) and worse overall quality of life (p bariatric group. When compared to controls, the bariatric group demonstrated improved MSPS scores on a trend level 1 year post-surgery (p = 0.08). Consistent with the literature on more general bariatric surgery populations, current findings highlight the possible early benefits of bariatric surgery for reducing depressive symptoms in this population when compared to controls. Importantly, results should be viewed as preliminary and additional research is needed to examine bariatric surgery and associations with depressive symptoms and performance in the MS population.

3D Printing: current use in facial plastic and reconstructive surgery.

Science.gov (United States)

Hsieh, Tsung-Yen; Dedhia, Raj; Cervenka, Brian; Tollefson, Travis T

2017-08-01

To review the use of three-dimensional (3D) printing in facial plastic and reconstructive surgery, with a focus on current uses in surgical training, surgical planning, clinical outcomes, and biomedical research. To evaluate the limitations and future implications of 3D printing in facial plastic and reconstructive surgery. Studies reviewed demonstrated 3D printing applications in surgical planning including accurate anatomic biomodels, surgical cutting guides in reconstruction, and patient-specific implants fabrication. 3D printing technology also offers access to well tolerated, reproducible, and high-fidelity/patient-specific models for surgical training. Emerging research in 3D biomaterial printing have led to the development of biocompatible scaffolds with potential for tissue regeneration in reconstruction cases involving significant tissue absence or loss. Major limitations of utilizing 3D printing technology include time and cost, which may be offset by decreased operating times and collaboration between departments to diffuse in-house printing costs SUMMARY: The current state of the literature shows promising results, but has not yet been validated by large studies or randomized controlled trials. Ultimately, further research and advancements in 3D printing technology should be supported as there is potential to improve resident training, patient care, and surgical outcomes.

Computational approaches to analogical reasoning current trends

CERN Document Server

Richard, Gilles

2014-01-01

Analogical reasoning is known as a powerful mode for drawing plausible conclusions and solving problems. It has been the topic of a huge number of works by philosophers, anthropologists, linguists, psychologists, and computer scientists. As such, it has been early studied in artificial intelligence, with a particular renewal of interest in the last decade. The present volume provides a structured view of current research trends on computational approaches to analogical reasoning. It starts with an overview of the field, with an extensive bibliography. The 14 collected contributions cover a large scope of issues. First, the use of analogical proportions and analogies is explained and discussed in various natural language processing problems, as well as in automated deduction. Then, different formal frameworks for handling analogies are presented, dealing with case-based reasoning, heuristic-driven theory projection, commonsense reasoning about incomplete rule bases, logical proportions induced by similarity an...

Comparison of cardiothoracic surgery training in usa and germany

Directory of Open Access Journals (Sweden)

Chen Frederick Y

2010-11-01

Full Text Available Abstract Background Training of cardiothoracic surgeons in Europe and the United States has expanded to incorporate new operative techniques and requirements. The purpose of this study was to compare the current structure of training programs in the United States and Germany. Methods We thoroughly reviewed the existing literature with particular focus on the curriculum, salary, board certification and quality of life for cardiothoracic trainees. Results The United States of America and the Federal Republic of Germany each have different cardiothoracic surgery training programs with specific strengths and weaknesses which are compared and presented in this publication. Conclusions The future of cardiothoracic surgery training will become affected by technological, demographic, economic and supply factors. Given current trends in training programs, creating an efficient training system would allow trainees to compete and grow in this constantly changing environment.

Systematic review of 3D printing in spinal surgery: the current state of play.

Science.gov (United States)

Wilcox, Ben; Mobbs, Ralph J; Wu, Ai-Min; Phan, Kevin

2017-09-01

Three-dimensional printing (3DP), also known as "Additive Manufacturing", is a rapidly growing industry, particularly in the area of spinal surgery. Given the complex anatomy of the spine and delicate nature of surrounding structures, 3DP has the potential to aid surgical planning and procedural accuracy. We perform a systematic review of current literature on the applications of 3DP in spinal surgery. Six electronic databases were searched for original published studies reporting cases or outcomes for 3DP surgical models, guides or implants for spinal surgery. The findings of these studies were synthesized and summarized. These searches returned a combined 2,411 articles. Of these, 54 were included in this review. 3DP is currently used for surgical planning, intra-operative surgical guides, customised prostheses as well as "Off-the-Shelf" implants. The technology has the potential for enhanced implant properties, as well as decreased surgical time and better patient outcomes. The majority of the data thus far is from low-quality studies with inherent biases linked with the excitement of a new field. As the body of literature continues to expand, larger scale studies to evaluate advantages and disadvantages, and longer-term follow up will enhance our knowledge of the effect 3DP has in spinal surgery. In addition, issues such as financial impact, time to design and print, materials selection and bio-printing will evolve as this rapidly expanding field matures.

Current state of virtual reality simulation in robotic surgery training: a review.

Science.gov (United States)

Bric, Justin D; Lumbard, Derek C; Frelich, Matthew J; Gould, Jon C

2016-06-01

Worldwide, the annual number of robotic surgical procedures continues to increase. Robotic surgical skills are unique from those used in either open or laparoscopic surgery. The acquisition of a basic robotic surgical skill set may be best accomplished in the simulation laboratory. We sought to review the current literature pertaining to the use of virtual reality (VR) simulation in the acquisition of robotic surgical skills on the da Vinci Surgical System. A PubMed search was conducted between December 2014 and January 2015 utilizing the following keywords: virtual reality, robotic surgery, da Vinci, da Vinci skills simulator, SimSurgery Educational Platform, Mimic dV-Trainer, and Robotic Surgery Simulator. Articles were included if they were published between 2007 and 2015, utilized VR simulation for the da Vinci Surgical System, and utilized a commercially available VR platform. The initial search criteria returned 227 published articles. After all inclusion and exclusion criteria were applied, a total of 47 peer-reviewed manuscripts were included in the final review. There are many benefits to utilizing VR simulation for robotic skills acquisition. Four commercially available simulators have been demonstrated to be capable of assessing robotic skill. Three of the four simulators demonstrate the ability of a VR training curriculum to improve basic robotic skills, with proficiency-based training being the most effective training style. The skills obtained on a VR training curriculum are comparable with those obtained on dry laboratory simulation. The future of VR simulation includes utilization in assessment for re-credentialing purposes, advanced procedural-based training, and as a warm-up tool prior to surgery.

Changing trend in emergency surgery for perforated duodenal ulcer

International Nuclear Information System (INIS)

Gurteyik, E.

2003-01-01

Objective: To evaluate changes in the emergency surgery of the duodenal ulcer. Subjects and Methods: Hospital records of 523 surgically treated patients, with duodenal ulcer perforation, during the period of 25 years 91975-1999) in the same surgical department, was retrospectively analysed. Changing aspects of emergency surgery of peptic ulcer disease, in the recent period, were determined in respect to number of operations per year and in the choice of operative methods. Results: The average number of patients and emergency operations per year was 21. No significant change was observed during the study period. Elective operations gradually decreased in the last ten years, and none was performed in the last 4 years. On the other hand, 226 emergency interventions for duodenal ulcer perforation were performed in the last ten years and 84 interventions in the last 4 years. Definitive anti-ulcer surgery was performed in 42% of patients between 1985 and 1994. Simple closure of the perforation plus treatment with proton pump inhibitors and with anti-Helicobacter pylori medication was the method in 80% during the last year. Conclusion: Emergency surgery for perforated duodenal ulcer preserves its steady rate despite disappearance of elective operations after tremendous progress in medical control of peptic ulcer disease. There is an obvious return from definitive anti-ulcer surgery to simple closure of the perforation followed by antisecretory and antibacterial medications in the recent years. (author)

Mechanics of Biological Tissues and Biomaterials: Current Trends

Directory of Open Access Journals (Sweden)

Amir A. Zadpoor

2015-07-01

Full Text Available Investigation of the mechanical behavior of biological tissues and biomaterials has been an active area of research for several decades. However, in recent years, the enthusiasm in understanding the mechanical behavior of biological tissues and biomaterials has increased significantly due to the development of novel biomaterials for new fields of application, along with the emergence of advanced computational techniques. The current Special Issue is a collection of studies that address various topics within the general theme of “mechanics of biomaterials”. This editorial aims to present the context within which the studies of this Special Issue could be better understood. I, therefore, try to identify some of the most important research trends in the study of the mechanical behavior of biological tissues and biomaterials.

CURRENT TRENDS OF ROMANIAN RURAL FAMILY

Directory of Open Access Journals (Sweden)

Adina IORGA

2013-01-01

Full Text Available The profound changes experienced by the Romanian society had a profound social impact on the structure and functions of the rural family. The paper aims to highlight the main trends recorded using a number of indicators: ruralization rate, birth rate, infant mortality rate, percentage of children born outside marriage, fertility rate, percentage of population aged 65 and over. Statistics from censuses and statistical yearbooks were processed to identify the trends of the Romanian rural family: changes in reproductive behavior, increased aging, declining birth rates.

[Strategies to ensure careers of young academics in plastic surgery - analysis of the current situation and future perspectives].

Science.gov (United States)

Horch, R E; Vogt, P M; Schaller, H E; Stark, G B; Lehnhardt, M; Kneser, U; Giunta, R E

2013-08-01

Recruitment problems in surgical disciplines have become an increasingly debated topic. On the one hand current career prospects appear to be less attractive than those were seen for the previous generation. On the other hand the demands for a so-called "work-life balance" have changed and the proportion of female students and colleagues in medicine has risen and will continue to increase. Although Plastic Surgery currently seems to be less affected by these problems than other surgical disciplines, securing a qualified supply of young academics in Plastic Surgery is a prerequisite for the further development of this discipline. The traditional model of mentoring is discussed and the role of coaching in a sense of helping the mentorees examine what they are doing in the light of their intentions and goals is reflected. The present article tries to analyze the current status of academic Plastic Surgery from the viewpoint of German university senior surgeons in academic plastic surgery, and aims to highlight the specific prospects for young academics against the backdrop of an often one-sided and superficial perception of this profession. © Georg Thieme Verlag KG Stuttgart · New York.

Trends in refractive surgery at an academic center: 2007-2009

OpenAIRE

Kuo, Irene C

2011-01-01

Abstract Background The United States officially entered a recession in December 2007, and it officially exited the recession in December 2009, according to the National Bureau of Economic Research. Since the economy may affect not only the volume of excimer laser refractive surgery, but also the clinical characteristics of patients undergoing surgery, our goal was to compare the characteristics of patients completing excimer laser refractive surgery and the types of procedures performed in t...

Robot-assisted vitreoretinal surgery: current perspectives.

Science.gov (United States)

Roizenblatt, Marina; Edwards, Thomas L; Gehlbach, Peter L

2018-01-01

Vitreoretinal microsurgery is among the most technically challenging of the minimally invasive surgical techniques. Exceptional precision is required to operate on micron scale targets presented by the retina while also maneuvering in a tightly constrained and fragile workspace. These challenges are compounded by inherent limitations of the unassisted human hand with regard to dexterity, tremor and precision in positioning instruments. The limited human ability to visually resolve targets on the single-digit micron scale is a further limitation. The inherent attributes of robotic approaches therefore, provide logical, strategic and promising solutions to the numerous challenges associated with retinal microsurgery. Robotic retinal surgery is a rapidly emerging technology that has witnessed an exponential growth in capabilities and applications over the last decade. There is now a worldwide movement toward evaluating robotic systems in an expanding number of clinical applications. Coincident with this expanding application is growth in the number of laboratories committed to "robotic medicine". Recent technological advances in conventional retina surgery have also led to tremendous progress in the surgeon's capabilities, enhanced outcomes, a reduction of patient discomfort, limited hospitalization and improved safety. The emergence of robotic technology into this rapidly advancing domain is expected to further enhance important aspects of the retinal surgery experience for the patients, surgeons and society.

Current Trends in Malaysian Higher Education and the Effect on Education Policy and Practice: An Overview

Science.gov (United States)

Grapragasem, Selvaraj; Krishnan, Anbalagan; Mansor, Azlin Norhaini

2014-01-01

Malaysia has evolved from a production-based to knowledge-based economy in order to stay relevant and compete in the global marketplace. Thus, the purpose of this article is to discuss current trends in Malaysian higher education and how these affect education policies and practices. Four main trends are discussed in this study: Globalization,…

Bibliometric trend analyses of plastic surgery research

NARCIS (Netherlands)

Loonen, M.P.J.

2007-01-01

The present thesis was designed to evaluate the qualitative and quantitative aspects of plastic surgery research by means of a bibliometric citation analysis of plastic surgical presentations and publications. Citations to such published work provides an indication of the impact and the relevance of

Is outpatient brain tumor surgery feasible in India?

Science.gov (United States)

Turel, Mazda K; Bernstein, Mark

2016-01-01

The current trend in all fields of surgery is towards less invasive procedures with shorter hospital stays. The reasons for this change include convenience to patients, optimal resource utilization, and cost saving. Technological advances in neurosurgery, aided by improvements in anesthesia, have resulted in surgery that is faster, simpler, and safer with excellent perioperative recovery. As a result of improved outcomes, some centers are performing brain tumor surgery on an outpatient basis, wherein patients arrive at the hospital the morning of their procedure and leave the hospital the same evening, thus avoiding an overnight stay in the hospital. In addition to the medical benefits of the outpatient procedure, its impact on patient satisfaction is substantial. The economic benefits are extremely favorable for the patient, physician, as well as the hospital. In high volume centers, a day surgery program can exist alongside those for elective and emergency surgeries, providing another pathway for patient care. However, due to skepticism surrounding the medicolegal aspects, and how radical the concept at first sounds, these procedures have not gained widespread popularity. We provide an overview of outpatient brain tumor surgery in the western world, discussing the socioeconomic, medicolegal, and ethical issues related to its adaptability in a developing nation.

Audiovisual quality assessment in communications applications: Current status, trends and challenges

DEFF Research Database (Denmark)

Korhonen, Jari

2010-01-01

Audiovisual quality assessment is one of the major challenges in multimedia communications. Traditionally, algorithm-based (objective) assessment methods have focused primarily on the compression artifacts. However, compression is only one of the numerous factors influencing the perception...... addressed in practical quality metrics is the co-impact of audio and video qualities. This paper provides an overview of the current trends and challenges in objective audiovisual quality assessment, with emphasis on communication applications...

Geographic Trends in the Plastic Surgery Match.

Science.gov (United States)

Silvestre, Jason; Lin, Ines C; Serletti, Joseph M; Chang, Benjamin

2016-01-01

The integrated plastic surgery match is among the most competitive residency matches in recent years. Although previous studies have correlated applicant characteristics with successful match outcomes, none have comprehensively investigated the role of geography in the match. This study elucidates regional biases in the match. Plastic surgery residents who matched during 2011-2015 were eligible for study inclusion. Names of residents were obtained from official residency program websites and cross-referenced with data obtained from the Student Doctor Network. For each resident, region of residency program and medical school were compared. From 67 programs, 622 residents were identified. Most graduated from US medical schools (97.9%). A total of 94 residents matched at a home institution (15.1%). Half of the residents matched in the same region as their medical school (48.9%). Programs in the South matched the greatest number of residents from the same region (60.8%), whereas West programs matched the least (30.8%, p < 0.001). No regional differences existed regarding residents matching at their home institution (p = 0.268). More women matched at West programs (43.1%) versus East programs (30.6%, p < 0.05). A significant number of residents matched at their home institution. Roughly, half matched at a program in the same region as their medical school. Whether this regional phenomenon stems from applicant or program factors remains unknown. Yet, given the limited number of interviews and the high costs of interviewing, applicants and programs can use these data to help optimize the match process. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Trends in Mediation Analysis in Nursing Research: Improving Current Practice.

Science.gov (United States)

Hertzog, Melody

2018-06-01

The purpose of this study was to describe common approaches used by nursing researchers to test mediation models and evaluate them within the context of current methodological advances. MEDLINE was used to locate studies testing a mediation model and published from 2004 to 2015 in nursing journals. Design (experimental/correlation, cross-sectional/longitudinal, model complexity) and analysis (method, inclusion of test of mediated effect, violations/discussion of assumptions, sample size/power) characteristics were coded for 456 studies. General trends were identified using descriptive statistics. Consistent with findings of reviews in other disciplines, evidence was found that nursing researchers may not be aware of the strong assumptions and serious limitations of their analyses. Suggestions for strengthening the rigor of such studies and an overview of current methods for testing more complex models, including longitudinal mediation processes, are presented.

Cosmetic surgery volume and its correlation with the major US stock market indices.

Science.gov (United States)

Gordon, Chad R; Pryor, Landon; Afifi, Ahmed M; Benedetto, Paul X; Langevin, C J; Papay, Francis; Yetman, Randall; Zins, James E

2010-01-01

As a consumer-driven industry, cosmetic plastic surgery is subject to ebbs and flows as the economy changes. There have been many predictions about the short, intermediate, and long-term impact on cosmetic plastic surgery as a result of difficulties in the current economic climate, but no studies published in the literature have quantified a direct correlation. The authors investigate a possible correlation between cosmetic surgery volume and the economic trends of the three major US stock market indices. A volume analysis for the time period from January 1992 to October 2008 was performed (n = 7360 patients, n = 8205 procedures). Four cosmetic procedures-forehead lift (FL), rhytidectomy (Rh), breast augmentation (BA), and liposuction (Li)-were chosen; breast reduction (BRd), breast reconstruction (BRc), and carpal tunnel release (CTR) were selected for comparison. Case volumes for each procedure and fiscal quarter were compared to the trends of the S&P 500, Dow Jones (DOW), and NASDAQ (NASD) indices. Pearson correlation statistics were used to evaluate a relationship between the market index trends and surgical volume. P values indices. FL (n =312) only correlated to the NASD (P = .021) and did not reach significance with the S&P 500 (P = .077) or DOW (P = .14). BRd and BRc demonstrated a direct correlation to two of the three stock market indices, whereas CTR showed an inverse (ie, negative) correlation to two of the three indices. This study, to our knowledge, is the first to suggest a direct correlation of four cosmetic and two reconstructive plastic surgery procedures to the three major US stock market indices and further emphasizes the importance of a broad-based plastic surgery practice in times of economic recession.

Current trends in radiation protection in Egypt. Vol. 1

International Nuclear Information System (INIS)

Gomma, M.A.

1996-01-01

The treatise presents the development of radiation protection in egypt over the past four decades. The contents will include a historical synopsis, and the current state of art regarding competent authorities, the hierarchy involved, and the respective responsibilities. The recent publications of the international trends in radiation protection are also mentioned. The efforts made towards the implementation of the new recommendations on radiation protection, and updating of the radiation protection legislations are also discussed. The 1994 international safety standards, and the collective opinion of the committee on radiation protection and public health (CRPPH) of the organization for economic Co-operation and development of the Nuclear energy agency OECD/NEA are also summarized

Current trends in radiation protection in Egypt. Vol. 1

Energy Technology Data Exchange (ETDEWEB)

Gomma, M A [Atomic Energy Authority, Cairo (Egypt)

1996-03-01

The treatise presents the development of radiation protection in egypt over the past four decades. The contents will include a historical synopsis, and the current state of art regarding competent authorities, the hierarchy involved, and the respective responsibilities. The recent publications of the international trends in radiation protection are also mentioned. The efforts made towards the implementation of the new recommendations on radiation protection, and updating of the radiation protection legislations are also discussed. The 1994 international safety standards, and the collective opinion of the committee on radiation protection and public health (CRPPH) of the organization for economic Co-operation and development of the Nuclear energy agency OECD/NEA are also summarized.

CURRENT TRENDS IN INTERNATIONAL BUSINESS

Directory of Open Access Journals (Sweden)

Evgeny V. Ryabinin

2015-01-01

Full Text Available The methodological bases of researchof international business are stated in the article. The great attention is focused on analysis of main trends in development of international. The comparison of competitiveness to of most used forms ofinternational business, as well as identified the main problems and barriers of theinternational business structures.

Psychological assessment for bariatric surgery: current practices.

Science.gov (United States)

Flores, Carolina Aita

2014-01-01

The prevalence of obesity on a global scale has alarmed health institutions, the general population and professionals involved in its treatment. Bariatric surgery has emerged as an effective and lasting alternative for weight reduction and improved general health. In this context and as part of a multidisciplinary team, psychologists are responsible for the preoperative psychological assessment of bariatric candidates. To investigate how psychological assessments are occurring, including the identification of utilized resources; factors that are addressed; the duration of the process; existing protocols; and to evaluate the importance of this practice. A systematic review of national and international literature, through PubMed and Scielo's databases, using "psychological assessment", "obesity" and "surgery", as keywords. There is an agreement about the main factors that should be investigated during the preoperative assessment, as well as the main contraindications for the surgical procedure. The importance of the psychological assessment is well established in the field of bariatric surgery. However, this area needs a standard protocol to guide the mental health professionals that deal with bariatric patients.

Overview of robotic colorectal surgery: Current and future practical developments

Science.gov (United States)

Roy, Sudipta; Evans, Charles

2016-01-01

Minimal access surgery has revolutionised colorectal surgery by offering reduced morbidity and mortality over open surgery, while maintaining oncological and functional outcomes with the disadvantage of additional practical challenges. Robotic surgery aids the surgeon in overcoming these challenges. Uptake of robotic assistance has been relatively slow, mainly because of the high initial and ongoing costs of equipment but also because of limited evidence of improved patient outcomes. Advances in robotic colorectal surgery will aim to widen the scope of minimal access surgery to allow larger and more complex surgery through smaller access and natural orifices and also to make the technology more economical, allowing wider dispersal and uptake of robotic technology. Advances in robotic endoscopy will yield self-advancing endoscopes and a widening role for capsule endoscopy including the development of motile and steerable capsules able to deliver localised drug therapy and insufflation as well as being recharged from an extracorporeal power source to allow great longevity. Ultimately robotic technology may advance to the point where many conventional surgical interventions are no longer required. With respect to nanotechnology, surgery may eventually become obsolete. PMID:26981188

eHealth in Saudi Arabia: Current Trends, Challenges and Recommendations.

Science.gov (United States)

Alsulame, Khaled; Khalifa, Mohamed; Househ, Mowafa

2015-01-01

The purpose of this study is to explore the current status of eHealth in Saudi Arabia from the perspective of health informatics professionals. We used a case study approach and analyzed participant data using thematic analysis. The study took place between July and August 2013. Data collection included interviews with nine senior health information professionals in Saudi Arabia. The findings describe participant views on current eHealth trends in Saudi Arabia and show differences among Saudi healthcare organizations in terms of eHealth adoption. Participants also describe the challenges relating to organizational and cultural issues, end user attitudes towards eHealth projects, and the lack of specialized human resources to implement eHealth systems. Two main recommendations made by the participants were to form a new national body for eHealth and to develop a unified plan for the implementation of Saudi eHealth initiatives.

Trends in isolated lumbar spinal stenosis surgery among working US adults aged 40-64 years, 2010-2014.

Science.gov (United States)

Raad, Micheal; Donaldson, Callum J; El Dafrawy, Mostafa H; Sciubba, Daniel M; Riley, Lee H; Neuman, Brian J; Kebaish, Khaled M; Skolasky, Richard L

2018-05-25

OBJECTIVE Recommendations for the surgical treatment of isolated lumbar spinal stenosis (LSS) (i.e., in the absence of concomitant scoliosis or spondylolisthesis) are unclear. The aims of this study were to investigate trends in the surgical treatment of isolated LSS in US adults and determine implications for outcomes. METHODS The authors analyzed inpatient and outpatient claims from the Truven Health Analytics MarketScan Commercial Claims and Encounters Database for 20,279 patients aged 40-64 years who underwent surgery for LSS between 2010 and 2014. Only patients with continuous 12-month insurance coverage after surgery were included. The rates of decompression with arthrodesis versus decompression only and of simple (1- or 2-level, single-approach) versus complex (> 2-level or combined-approach) arthrodesis were analyzed by year and geographic region. These trends were further analyzed with respect to complications, length of hospital stay, payments made to the hospital, and patient discharge status. Statistical significance was set at p < 0.05. RESULTS The proportion of patients who underwent decompression with arthrodesis compared with decompression only increased significantly and linearly from 2010 to 2014 (OR 1.08; 95% CI 1.06-1.10). Arthrodesis was more likely to be complex rather than simple with each subsequent year (OR 1.4; 95% CI 1.33-1.49). This trend was accompanied by an increased likelihood of postoperative complications (OR 1.11; 95% CI 1.02-1.21), higher costs (payments increased by a mean of US$1633 per year; 95% CI 1327-1939), and greater likelihood of being discharged to a skilled nursing facility as opposed to home (OR 1.11; 95% CI 1.03-1.20). The South and Midwest regions of the US had the highest proportions of patients undergoing arthrodesis (48% and 42%, respectively). The mean length of hospital stay did not change significantly (p = 0.324). CONCLUSIONS From 2010 to 2014, the proportion of adults undergoing decompression with

Current Evidence for Clinical Efficacy of Platelet Rich Plasma in Aesthetic Surgery: A Systematic Review.

Science.gov (United States)

Frautschi, Russell S; Hashem, Ahmed M; Halasa, Brianna; Cakmakoglu, Cagri; Zins, James E

2017-03-01

Platelet rich plasma (PRP) has attracted attention in a number of surgical fields due to a wide variety of potential clinical benefits. Yet PRP has not gained wide popularity in aesthetic surgery as a result of uncertainty surrounding objective clinical evidence. We aim to describe the current applications, define preparation and activation, explore effectiveness, and propose a classification system to facilitate comparisons across studies. A comprehensive review of the literature regarding the use of platelet rich plasma in aesthetic surgery was performed. Data gathered included: PRP application, study type, subject number, centrifugation, anticoagulation, activation, PRP composition, and outcomes. Thirty-eight reports were identified. Applications included injection into aging skin (29%), scalp alopecia (26%), lipofilling (21%), fractional laser (13%), and facial surgery (11%). The majority of studies (53%) were case series without controls. Leucocytes were sparsely defined (32%). The concentration of injected and/or baseline platelets was rarely clarified (18%). The mechanism of activation was described in 27 studies (71%), while anticoagulation was uncommonly elucidated (47%). While most studies (95%) claim effectiveness, objective measures were only utilized in 17 studies (47%). Current studies produce context-dependent results with a lack of consistent reporting of PRP preparation, composition, and activation in aesthetic applications, making meaningful meta-analysis unrealistic. Thus the method of PRP preparation warrants increased attention. We recommend a set of descriptors, FIT PAAW (described below), to produce scientifically grounded conclusions, facilitating a clearer understanding of the situations in which PRP is effective. 4 © 2016 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com

The 50 Most Cited Papers in Craniofacial Anomalies and Craniofacial Surgery.

Science.gov (United States)

Mahon, Nicola A; Joyce, Cormac W; Thomas, Sangeetha; Concannon, Elizabeth; Murray, Dylan

2015-09-01

Citation analysis is a recognized scientometric method of classifying cited articles according to the frequency of which they have been referenced. The total number of citations an article receives is considered to reflect it's significance among it's peers. Until now, a bibliometric analysis has never been performed in the specialty of craniofacial anomalies and craniofacial surgery. This citation analysis generates an extensive list of the 50 most influential papers in this developing field. Journals specializing in craniofacial surgery, maxillofacial surgery, plastic surgery, neurosurgery, genetics and pediatrics were searched to demonstrate which articles have cultivated the specialty within the past 55 years. The results show an intriguing compilation of papers which outline the fundamental knowledge of craniofacial anomalies and the developments of surgical techniques to manage these patients. This citation analysis provides a summation of the current most popular trends in craniofacial literature. These esteemed papers aid to direct our decision making today within this specialty.

Perspectives on...Special Collections at ARL Libraries and K-12 Outreach: Current Trends

Science.gov (United States)

Visser, Michelle

2006-01-01

This article examines the results of a survey sent to Association of Research Libraries (ARL) Special Collections requesting information on outreach to K-12 students. Over half of the respondents work with K-12 and many of those who currently do not are planning to. New pressures and changing philosophies contribute to this trend.

Aesthetic journeys: a review of cosmetic surgery tourism.

Science.gov (United States)

Terence Pereira, Ryan; Malone, Carmel M; Flaherty, Gerard T

2018-06-01

Medical tourism has witnessed significant growth in recent years. The emerging trend towards international travel for cosmetic surgical interventions has not previously been reviewed. The current review aims to critically address the scale and impact of cosmetic surgical tourism and to delineate the complication profile of this form of medical tourism. Articles published in the English language on the PubMed database that were relevant to surgical tourism and the complications of elective surgical procedures abroad were examined. Reference lists of articles identified were further scrutinized. The search terms used included combinations of 'surgery abroad', 'cosmetic surgery abroad', 'cosmetic surgery tourism', 'cosmetic surgery complications' and 'aesthetic tourism'. This article critically reviews the epidemiology of cosmetic surgical tourism and its associated economic factors. Surgical complications of selected procedures, including perioperative complications, are described. The implications for travel medicine practice are considered and recommendations for further research are proposed. This narrative literature review focuses on the issues affecting travellers who obtain cosmetic surgical treatment overseas. There is a lack of focus in the travel medicine literature on the non-surgery-related morbidity of this special group of travellers. Original research exploring the motivation and pre-travel preparation, including the psychological counselling, of cosmetic surgical tourists is indicated.

Current research topics and trends in the software architecture community : ICSA 2017 Workshops summary

NARCIS (Netherlands)

Malavolta, Ivano; Capilla, Rafael

2017-01-01

This summary reports the workshops accepted in the 1st International Conference on Software Architecture (ICSA 2017), held by Chalmers University at Gothenburg (Sweden). We gather the description of current and new research trends in different software architecture topics to provide a wide view to

Trends in Orbital Decompression Techniques of Surveyed American Society of Ophthalmic Plastic and Reconstructive Surgery Members.

Science.gov (United States)

Reich, Shani S; Null, Robert C; Timoney, Peter J; Sokol, Jason A

To assess current members of the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) regarding preference in surgical techniques for orbital decompression in Graves' disease. A 10-question web-based, anonymous survey was distributed to oculoplastic surgeons utilizing the ASOPRS listserv. The questions addressed the number of years of experience performing orbital decompression surgery, preferred surgical techniques, and whether orbital decompression was performed in collaboration with an ENT surgeon. Ninety ASOPRS members participated in the study. Most that completed the survey have performed orbital decompression surgery for >15 years. The majority of responders preferred a combined approach of floor and medial wall decompression or balanced lateral and medial wall decompression; only a minority selected a technique limited to 1 wall. Those surgeons who perform fat decompression were more likely to operate in collaboration with ENT. Most surgeons rarely remove the orbital strut, citing risk of worsening diplopia or orbital dystopia except in cases of optic nerve compression or severe proptosis. The most common reason given for performing orbital decompression was exposure keratopathy. The majority of surgeons perform the surgery without ENT involvement, and number of years of experience did not correlate significantly with collaboration with ENT. The majority of surveyed ASOPRS surgeons prefer a combined wall approach over single wall approach to initial orbital decompression. Despite the technological advances made in the field of modern endoscopic surgery, no single approach has been adopted by the ASOPRS community as the gold standard.

Current and future trends in cloud CRM

OpenAIRE

Nemček, Sebastian

2011-01-01

The diploma thesis is committed to mapping CRM applications available in cloud and trends within. The goal is to describe what CRM is, how it evolved into Cloud CRM, analyze main differences between the two approaches and analyze trends that can be observed in CRM market and CRM applications. This is coupled with description of the most common CRM solutions and products available both on-premises as well as on-demand. In the first part, the thesis introduces theory behind Customer Relationshi...

Prognostic trend in advanced implant surgery.

Science.gov (United States)

Demitri, V; Polini, F; Robiony, M; Politi, M

2002-03-01

Implant surgery in association with bone grafting is generally considered less predictive than primary implant surgery. Many reports have been published about implant rehabilitation with bone grafts in atrophic patients. Most of these papers showed a lower implant success rate than primary implantology. The aim of this study is to verify if it's possible to warrant similar results between the two types of implantology, if such procedures are performed following effective protocols and criteria. From 1995 to 1999, 43 severely atrophic edentulous patients were treated in our Clinic with 63 autologous bone grafts and delayed implantology; 45 patients were treated with traditional implantology. 284 fixtures were positioned. The success rate in grafted implantology versus traditional implantology was compared for every maxillary and mandibular region. Furthermore, success rate in implantology of the anterior maxilla versus the poster maxilla in grafted patients was compared. The statistical considerations were performed with c2 test (p<0.05). The statistical analysis evidenced not significative difference in the implant success rate between grafted and not grafted patients in the anterior (p=0.23) and in the posterior maxilla (p=0.35). There was not significative difference in the implant success rate between grafted and not grafted patients in the anterior mandible (p=0.54) and in the posterior mandible (p=0.54). There was not significative difference in the implant success rate between the anterior and posterior grafted maxilla (p=0.21). The results obtained show that if close surgical protocol is performed it is possible to obtain no prognostic difference between the two METHODS.

Current State of Laparoscopic Colonic Surgery in Austria: A National Survey.

Science.gov (United States)

Klugsberger, Bettina; Haas, Dietmar; Oppelt, Peter; Neuner, Ludwig; Shamiyeh, Andreas

2015-12-01

Several studies have demonstrated that laparoscopic colonic resection has significant benefits in comparison with open approaches in patients with benign and malignant disease. The proportion of colonic and rectal resections conducted laparoscopically in Austria is not currently known; the aim of this study was to evaluate the current status of laparoscopic colonic surgery in Austria. A questionnaire was distributed to all general surgical departments in Austria. In collaboration with IMAS, an Austrian market research institute, an online survey was used to identify laparoscopic and open colorectal resections performed in 2013. The results were compared with data from the National Hospital Morbidity Database (NHMD), in which administrative in-patient data were also collected from all general surgical departments in Austria in 2013. Fifty-three of 99 surgical departments in Austria responded (53.5%); 4335 colonic and rectal resections were carried out in the participating departments, representing 50.5% of all NHMD-recorded colorectal resections (n = 8576) in Austria in 2013. Of these 4335 colonic and rectal resections, 2597 (59.9%) were carried out using an open approach, 1674 (38.6%) were laparoscopic, and an exact classification was not available for 64 (1.5%). Among the NHMD-recorded colonic and rectal resections, 6342 (73.9%) were carried out with an open approach, and 2234 (26.1%) were laparoscopic. The proportion of colorectal resections that are carried out laparoscopically is low (26.1%). Technical challenges and a learning curve with a significant number of cases may be reasons for the slow adoption of laparoscopic colonic surgery.

Rehabilitation strategies for partially edentulous-prosthodontic principles and current trends.

Science.gov (United States)

D'Souza, Dsj; Dua, Parag

2011-07-01

The prosthetic considerations for treatment of partially edentulous patients involve evaluation of important aspects such as presence of certain functional or skeletal deficits, orientation of the occlusal plane, free-way space, size and location of edentulous areas, number, strategic location and quality of the likely abutment teeth, vertical dimension, and the type of occlusion. A comprehensive evaluation, multidisciplinary approach and a sequential treatment plan, worked out in harmony with the patient's perceptions are important factors to ensure a successful outcome. This article discusses the principles, current trends and importance of clinical decisions in designing a treatment strategy when confronted with complex situations of partial edentulism.

Radiation sterilization of medical products- current trends and future prospects

International Nuclear Information System (INIS)

Sharma, G.

1997-01-01

In medical practice use of sterile pharmaceuticals and single use disposable medical devices is steadily increasing. Sterile pharmaceuticals like injections and ophthalmic ointments are required for therapy. Medical devices are employed for diagnostic, drug administration or corrective purposes, and as implants for temporary, short term or long term residence in the human system. All these products are made available in sterile form by treating them to a suitable process of sterilization i.e. dry/wet heat, ethylene oxide (EtO) gas or ionizing radiation. In this paper current trends and future prospects of radiation sterilization of medical products are given in detail. 9 refs., 7 tabs

Computer aided surgery. Current status and future directions

International Nuclear Information System (INIS)

Sato, Yoshinobu

2006-01-01

This review describes topics in the title in the order of 3D model reconstruction and therapeutic planning based on images before surgery; registration of the actual images in virtual physical space of the patient who is under surgical operation, to the preoperative ones with use of 3D-position sensor, ultrasonics, endoscopy and X-diaphanoscopy; and their accuracy analysis. Images before surgery usually obtained with CT and MR are reconstructed in 3D for the purpose of therapeutic planning by segmentation of the target organ/site, surrounding organs, bones and blood vessels. Navigation system at the surgery functions to make the images obtained before and during operation to be integrated for their registration and displaying. Usually, the optical marker and camera both equipped in the endoscope, and position sensor (tracker) are used for integration in the operation coordinate system. For this, the actual pictures at liver operation are given. For accuracy analysis there is a theory of target registration error, which has been established on FDA demands. In future, development of technology concerned in this field like that of robot, bio-dynamics, biomaterials, sensor and high performance computing together with 4D document of surgery for feed-back to technology are desirable for the systematic growing of this surgical technology. (T.I.)

The value of haptic feedback in conventional and robot-assisted minimal invasive surgery and virtual reality training: a current review.

Science.gov (United States)

van der Meijden, O A J; Schijven, M P

2009-06-01

Virtual reality (VR) as surgical training tool has become a state-of-the-art technique in training and teaching skills for minimally invasive surgery (MIS). Although intuitively appealing, the true benefits of haptic (VR training) platforms are unknown. Many questions about haptic feedback in the different areas of surgical skills (training) need to be answered before adding costly haptic feedback in VR simulation for MIS training. This study was designed to review the current status and value of haptic feedback in conventional and robot-assisted MIS and training by using virtual reality simulation. A systematic review of the literature was undertaken using PubMed and MEDLINE. The following search terms were used: Haptic feedback OR Haptics OR Force feedback AND/OR Minimal Invasive Surgery AND/OR Minimal Access Surgery AND/OR Robotics AND/OR Robotic Surgery AND/OR Endoscopic Surgery AND/OR Virtual Reality AND/OR Simulation OR Surgical Training/Education. The results were assessed according to level of evidence as reflected by the Oxford Centre of Evidence-based Medicine Levels of Evidence. In the current literature, no firm consensus exists on the importance of haptic feedback in performing minimally invasive surgery. Although the majority of the results show positive assessment of the benefits of force feedback, results are ambivalent and not unanimous on the subject. Benefits are least disputed when related to surgery using robotics, because there is no haptic feedback in currently used robotics. The addition of haptics is believed to reduce surgical errors resulting from a lack of it, especially in knot tying. Little research has been performed in the area of robot-assisted endoscopic surgical training, but results seem promising. Concerning VR training, results indicate that haptic feedback is important during the early phase of psychomotor skill acquisition.

Current Trends in the Nuclear Power Global Market

Directory of Open Access Journals (Sweden)

Mariya Mikhailovna Osetskaya

2018-03-01

Full Text Available The review of the nuclear energy technologies market, namely the main processes of the initial and final stages of the nuclear fuel cycle (NTC was shown. The authors reveal key players in the markets of natural uranium mining, conversion, enrichment, fabrication of nuclear fuel, direct disposal, and reprocessing as well as determine their market shares. The article shows the fundamental factors influencing the development trends of the global nuclear power market such as: units’ commissioning in China, India, the Republic of Korea and other countries, the restart of the Japanese nuclear power plants, growth of uranium supplies long-term contracting planned for the period up to 2025, volatility of world prices of the NFC initial and final stages, political, economic and environmental reasons for the nuclear power generation choice. The article presents the results of analyses of Russian and world prices on the NFC initial and final stages main processes’ allowing to draw a conclusion about the current competitiveness of Russian nuclear energy technologies

Modern Trends in the Surgical Management of Paget's Disease.

Science.gov (United States)

Wong, Stephanie M; Freedman, Rachel A; Stamell, Emily; Sagara, Yasuaki; Brock, Jane E; Desantis, Stephen D; Golshan, Mehra

2015-10-01

We examined the incidence and modern national trends in the management of Paget's disease (PD), including the use of breast-conserving surgery (BCS), mastectomy, axillary surgery, and receipt of radiotherapy. Using surveillance, epidemiology and end results (SEER) data, we identified 2631 patients diagnosed with PD during 2000-2011. Of these patients, 185 (7%) had PD of the nipple only, 953 (36.2%) had PD with ductal carcinoma in situ (PD-DCIS), and 1493 (56.7%) had PD with invasive ductal carcinoma (PD-IDC). Trends in age-adjusted incidence, primary surgery, sentinel lymph node biopsy (SLNB), and axillary lymph node dissection were examined. Multivariable logistic regression was used to evaluate factors associated with receipt of BCS and radiotherapy. A decrease in the age-adjusted incidence of PD occurred from 2000 to 2011 (-4.3% per year, p modern trends in local therapy suggest that BCS, SLNB, and adjuvant radiotherapy remain underutilized.

Current status and future perspectives in laparoendoscopic single-site and natural orifice transluminal endoscopic urological surgery.

Science.gov (United States)

Autorino, Riccardo; Stein, Robert J; Lima, Estevão; Damiano, Rocco; Khanna, Rakesh; Haber, Georges-Pascal; White, Michael A; Kaouk, Jihad H

2010-05-01

Objective of this study is to provide an evidence-based analysis of the current status and future perspectives of scarless urological surgery. A PubMed search has been performed for all relevant urological literature regarding natural orifice transluminal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS). In addition, experience with LESS and NOTES at our own institution has been considered. All clinical and investigative reports for LESS and NOTES procedures in the urological literature have been considered. A wide variety of clinical procedures in urology have been successfully completed by using LESS techniques. Thus far, experience with NOTES has largely been investigational, although early clinical reports are emerging. Further development of instrumentation and platforms is necessary for both techniques to become more widely adopted throughout the urological community.

Pneumonia after Major Cancer Surgery: Temporal Trends and Patterns of Care

Directory of Open Access Journals (Sweden)

Vincent Q. Trinh

2016-01-01

Full Text Available Rationale. Pneumonia is a leading cause of postoperative complication. Objective. To examine trends, factors, and mortality of postoperative pneumonia following major cancer surgery (MCS. Methods. From 1999 to 2009, patients undergoing major forms of MCS were identified using the Nationwide Inpatient Sample (NIS, a Healthcare Cost and Utilization Project (HCUP subset, resulting in weighted 2,508,916 patients. Measurements. Determinants were examined using logistic regression analysis adjusted for clustering using generalized estimating equations. Results. From 1999 to 2009, 87,867 patients experienced pneumonia following MCS and prevalence increased by 29.7%. The estimated annual percent change (EAPC of mortality after MCS was −2.4% (95% CI: −2.9 to −2.0, P<0.001; the EAPC of mortality associated with pneumonia after MCS was −2.2% (95% CI: −3.6 to 0.9, P=0.01. Characteristics associated with higher odds of pneumonia included older age, male, comorbidities, nonprivate insurance, lower income, hospital volume, urban, Northeast region, and nonteaching status. Pneumonia conferred a 6.3-fold higher odd of mortality. Conclusions. Increasing prevalence of pneumonia after MCS, associated with stable mortality rates, may result from either increased diagnosis or more stringent coding. We identified characteristics associated with pneumonia after MCS which could help identify at-risk patients in order to reduce pneumonia after MCS, as it greatly increases the odds of mortality.

Current trends in degradation assesment on metallic materials of industrial components

International Nuclear Information System (INIS)

Herrera Palma, Victoria

2007-01-01

To needs to assess objectively a structural integrity analysis in nuclear and termal power-, oil- and chemical- industry system, represents a large challenge for engineer and researches related to Materials Science, equipment manufactures or users. These systems share many of their problems with regards to aging mechanism of components metallic materials, high replacement costs and increasing requirements on efficiency and safety. This paper makes an attempt to give an overview of the current trends on material damage and residual life assessment for installation of power-, oil- and chemical industry. Some of the currently existing ideas on components inspection, as an activity for damage detection are shown. A summary on mechanism of material damage and experimental techniques for their characterization is also presented. Finally, some analytical methods with wide appliance in materials damage evaluation and residual life assesment of components are described

Soft-tissue sarcomas. Current aspects of diagnosis and therapy

International Nuclear Information System (INIS)

Hohenberger, P.

1996-01-01

The decisive factor for promising therapy of soft-tissue sarcomas is primary therapy provided in an experienced tumour unit. This centre must offer the entire spectrum of surgery (vascular, reconstruction and orthopaedic surgery) leading into an interdisciplinary treatment regimen. Initially, MRI would appear to be sufficient for diagnosis. On the other hand, the presence of an experienced pathologist conversant with all means of cytogenetic tumour classification is essential. For interdisciplinary therapy, a radiotherapist with hyperthermia equipment, nuclear medicine specialists and medical oncologists are indispensable. All personnel must be familiar with the special problems associated with sarcomas. The current trend is indeed toward a select number of centres where such skills are focused. (orig.) [de

The development and current status of 131I treatment for hyperthyroidism

International Nuclear Information System (INIS)

Wang Chunmei; Wang Xuemei

2010-01-01

Hyperthyroidism is an autoimmune diseasein which excessive amounts of thyroid hormones circulate in the blood. The treatments for hyperthyroidism mainly include antithyroid drugs, 131 I treatment, and surgery. 131 I had been verified as an effective, safe, simple method to treat adult and children hyperthyroidism. Current research trends of 131 I treatment mainly are problems of 131 I treatment of hyperthyroidism and its long-term security. (authors)

Current Trends in Adolescent Substance Use in Jamaica

Directory of Open Access Journals (Sweden)

U Atkinson

2015-03-01

Full Text Available Objective: National secondary school-based drug surveys facilitate the identification and understanding of patterns of substance use among adolescents, associated risk and protective factors which exist and inform prevention and treatment interventions and policies which are appropriate for resource constrained settings. This paper analyses current trends as well as reviews trends from the last National School Survey conducted by the National Council on Drug Abuse in 2006. Method: The study utilized a survey design that included a representative sample of secondary school students. Data were collected from 3365 students from 38 schools across the island. The study made specific reference to the prevalence of alcohol, tobacco cigarette, marijuana and inhalant use among secondary school students. Results: The most widely used substances among the sample were alcohol, tobacco cigarettes, marijuana and solvents/inhalants. A large number of students (64% reported a lifetime prevalence of alcohol use. Alcohol use was also the highest for one-year (44% and one-month (33.6% use. While lifetime use of tobacco cigarette was higher than marijuana, one-year and one-month use of marijuana was higher than that of tobacco cigarette. There has been a slight increase in the age of initiation for alcohol, tobacco cigarette and marijuana use. There has also been a significant decrease (approximately 50% in lifetime, past year and past month prevalence of inhalant use since the 2006 secondary school survey. Conclusions: Alcohol continues to be the substance most widely used by Jamaican adolescents, followed by tobacco, marijuana and inhalants. Though the average age of first use has slightly increased for all substances, prevalence remains a concern. As such, innovative school-based interventions are required to assist in reducing substance use among Jamaican adolescents.

Ambulatory surgery for the patient with breast cancer: current perspectives

Directory of Open Access Journals (Sweden)

Pek CH

2016-08-01

Full Text Available Chong Han Pek,1 John Tey,2 Ern Yu Tan1 1Department of General Surgery, 2Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore, Singapore Abstract: Ambulatory breast cancer surgery is well accepted and is the standard of care at many tertiary centers. Rather than being hospitalized after surgery, patients are discharged on the day of surgery or within 23 hours. Such early discharge does not adversely affect patient outcomes and has the added benefits of better psychological adjustment for the patient, economic savings, and a more efficient utilization of health care resources. The minimal care needed post-discharge also means that the caregiver is not unduly burdened. Unplanned conversions to inpatient admission and readmission rates are low. Wound complications are infrequent and no issues with drain care have been reported. Because the period of postoperative observation is short and monitoring is not as intensive, ambulatory surgery is only suitable for low-risk procedures such as breast cancer surgery and in patients without serious comorbidities, where the likelihood of major perioperative events is low. Optimal management of pain, nausea, and vomiting is essential to ensure a quick recovery and return to normal function. Regional anesthesia such as the thoracic paravertebral block has been employed to improve pain control during the surgery and in the immediate postoperative period. The block provides excellent pain relief and reduces the need for opiates, which also consequently reduces the incidence of nausea and vomiting. The increasing popularity of total intravenous anesthesia with propofol has also helped reduce the incidence of nausea and vomiting in the postoperative period. Ambulatory surgery can be safely carried out in centers where there is a well-designed workflow to ensure proper patient selection, counseling, and education, and where patients and caregivers have easy access to

A short review on a complication of lumbar spine surgery: CSF leak.

Science.gov (United States)

Menon, Sajesh K; Onyia, Chiazor U

2015-12-01

Cerebrospinal fluid (CSF) leak is a common complication of surgery involving the lumbar spine. Over the past decades, there has been significant advancement in understanding the basis, management and techniques of treatment for post-operative CSF leak following lumbar spine surgery. In this article, we review previous work in the literature on the various factors and technical errors during or after lumbar spine surgery that may lead to this feared complication, the available options of management with focus on the various techniques employed, the outcomes and also to highlight on the current trends. We also discuss the presentation, factors contributing to its development, basic concepts and practical aspects of the management with emphasis on the different techniques of treatment. Different outcomes following various techniques of managing post-operative CSF leak after lumbar spine surgery have been well described in the literature. However, there is currently no most ideal technique among the available options. The choice of which technique to be applied in each case is dependent on each surgeon's cumulative experience as well as a clear understanding of the contributory underlying factors in each patient, the nature and site of the leak, the available facilities and equipment. Copyright © 2015 Elsevier B.V. All rights reserved.

Current robotic curricula for surgery residents: A need for additional cognitive and psychomotor focus.

Science.gov (United States)

Green, Courtney A; Chern, Hueylan; O'Sullivan, Patricia S

2018-02-01

Current robot surgery curricula developed by industry were designed for expert surgeons. We sought to identify the robotic curricula that currently exist in general surgery residencies and describe their components. We identified 12 residency programs with robotic curricula. Using a structured coding form to identify themes including sequence, duration, emphasis and assessment, we generated a descriptive summary. Curricula followed a similar sequence: learners started with online modules and simulation exercises, followed by bedside experience during R2-R3 training years, and then operative opportunities on the console in the final years of training. Consistent portions of the curricula reflect a device-dependent training paradigm; they defined the sequence of instruction. Most curricula lacked specifics on duration and content of training activities. None clearly described cognitive or psychomotor skills needed by residents and none required a proficiency assessment before graduation. Resident-specific robotic curricula remain grounded in initial industrial efforts to train experienced surgeons, are non-specific regarding the type and nature of hands on experience, and do not include discussion of operative technique and surgical concepts. Copyright © 2017 Elsevier Inc. All rights reserved.

Current Trends in Nuclear and Radiation Sensing

International Nuclear Information System (INIS)

McHugh, Harold R.; Quam, William

2009-01-01

This paper provides a brief overview of radiation detector history, a summary of the present state of the art, and some speculation on future developments in this field. Trends in the development of radiation detectors over the years are analyzed. Rapid progress in detection technology was experienced between WWII and the 1970s. Since then, fewer dramatic improvements have been seen. The authors speculate about the reasons for this trend and where the technology might take us in the next 20 years. Requirements for radiation detection equipment have changed drastically since 9/11; this demand is likely to accelerate detector development in the near future

Special Issue: Current Trends in Research in Accounting Finance and Management Control

OpenAIRE

Lassala, Carlos; Ripoll Feliu, Vicente

2017-01-01

On January 27, 2016, an agreement was signed with OmniaScience to select articles to be published in the journal Intangible Capital, in a special issue titled "Current Trends in Research in Accounting, Finance and Management Control." The agreement was reached within the framework of three events at the University of Valencia, from June 27 to 30, 2016: XXI Workshop on Accounting and Management Control. “Memorial Raymond Konopka”, X Iberoamerican Congress of Management Accounting, III  Int...

Implications of current resident work-hour guidelines on the future practice of surgery in Canada.

Science.gov (United States)

Maruscak, Adam A; VanderBeek, Laura; Ott, Michael C; Kelly, Stephen; Forbes, Thomas L

2012-01-01

Work-hour restrictions have had a profound impact on surgical training. However, little is known of how work-hour restrictions may affect the future practice patterns of current surgical residents. The purpose of this study is to compare the anticipated career practice patterns of surgical residents who are training within an environment of work-hour restrictions with the current practice of faculty surgeons. An electronic survey was sent to all surgery residents and faculty at 2 Canadian university-affiliated medical centers. The survey consisted of questions regarding expected (residents) or current (faculty) practice patterns. A total of 149 residents and 125 faculty members completed the survey (50.3% and 52.3% response rates, respectively). A greater proportion of males were in the faculty cohort than in the resident group (77.6% vs 62.4%, p = 0.0003). More faculty than residents believed that work-hour restrictions have a negative impact on both residency education (40.8% vs 20.8%, p = 0.008) and preparation for a surgical career (56.8% vs 19.5%, p implications and might require larger surgical groups and reconsideration of resource allocation. Copyright © 2012 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

The trend of the research and development for the upgrade of the high current energy system

International Nuclear Information System (INIS)

2010-01-01

The high current energy technology ranges from a basic technology of the electric power field to a state-of-the-art technology and has been used extremely variously. In addition, as the energy technology advances, the expansion of applied field, such as the nuclear fusion and the exhaust thing processing, etc., requires a further upgrade of the large current technology. In this report, the trend of the research and development for the upgrade of the high current energy technology are summarized. In the following, the elemental technology including arc/plasma phenomena and the pulse power system is described in Chapter 2. In Chapter 3, the trend of the research and development for the upgrade of various equipments and devices such as the nuclear fusion development, the superconducting applications of SMES and the maglev transportation system, and the arc application of the exhaust processing for a medical waste, the radio active waste and a detrimental gas and the next generation lithography system. In Chapter 4, the analysis and the measurement technology of the arc phenomenon and the standardization of current shunt, etc are described. We hope this research report can contribute to the promotion of technical exchanges in different fields, and offer guidelines for future development in this high current energy technology. (author)

Current research trends and perspectives on materials-based hydrogen storage solutions: A critical review

CSIR Research Space (South Africa)

Ren, Jianwei

2016-01-01

Full Text Available BrunauereEmmetteTeller (BET) surface areas and larger pore volumes . . . . 00 Tailoring reaction enthalpies... consumption. Re-produced ] with permission. this article in press as: Ren J, et al., Current research trends view, International Journal of Hydrogen Energy (2016), htcountries to think about energy security. Fossil fuels will one day be inevitably used up...

Medical Robots: Current Systems and Research Directions

Directory of Open Access Journals (Sweden)

Ryan A. Beasley

2012-01-01

Full Text Available First used medically in 1985, robots now make an impact in laparoscopy, neurosurgery, orthopedic surgery, emergency response, and various other medical disciplines. This paper provides a review of medical robot history and surveys the capabilities of current medical robot systems, primarily focusing on commercially available systems while covering a few prominent research projects. By examining robotic systems across time and disciplines, trends are discernible that imply future capabilities of medical robots, for example, increased usage of intraoperative images, improved robot arm design, and haptic feedback to guide the surgeon.

Current trends in free software research

OpenAIRE

Navarro Bosch, Ramon; Vila Marta, Sebastià

2009-01-01

This report analyzes how scientific research is studying free software. We find which research is being done on free software by looking into scientific journals and conferences publications. The data thus obtained is analized and the most salient trends related to free software discovered. We also reviewed the main works published in each free software research area.

Recent Trends in Veteran Unemployment as Measured in the Current Population Survey and the American Community Survey

National Research Council Canada - National Science Library

Savych, Bogdan; Klerman, Jacob A; Loughran, David S

2008-01-01

This technical report explores recent trends in the unemployment of recent veterans as estimated from two nationally representative surveys, the Current Population Survey "CPS" and the American Community Survey "ACS...

Current and emerging basic science concepts in bone biology: implications in craniofacial surgery.

Science.gov (United States)

Oppenheimer, Adam J; Mesa, John; Buchman, Steven R

2012-01-01

Ongoing research in bone biology has brought cutting-edge technologies into everyday use in craniofacial surgery. Nonetheless, when osseous defects of the craniomaxillofacial skeleton are encountered, autogenous bone grafting remains the criterion standard for reconstruction. Accordingly, the core principles of bone graft physiology continue to be of paramount importance. Bone grafts, however, are not a panacea; donor site morbidity and operative risk are among the limitations of autologous bone graft harvest. Bone graft survival is impaired when irradiation, contamination, and impaired vascularity are encountered. Although the dura can induce calvarial ossification in children younger than 2 years, the repair of critical-size defects in the pediatric population may be hindered by inadequate bone graft donor volume. The novel and emerging field of bone tissue engineering holds great promise as a limitless source of autogenous bone. Three core constituents of bone tissue engineering have been established: scaffolds, signals, and cells. Blood supply is the sine qua non of these components, which are used both individually and concertedly in regenerative craniofacial surgery. The discerning craniofacial surgeon must determine the proper use for these bone graft alternatives, while understanding their concomitant risks. This article presents a review of contemporary and emerging concepts in bone biology and their implications in craniofacial surgery. Current practices, areas of controversy, and near-term future applications are emphasized.

Current market trends in hospital/physician integration.

Science.gov (United States)

Bauman, Randy R

2009-01-01

This article explores recent trends that are dramatically changing the landscape of typical hospital/physician integration models and provides the reader with useful insights to better evaluate this dynamically changing marketplace.

Patient centric approach for clinical trials: Current trend and new opportunities.

Science.gov (United States)

Sharma, Neha Shankar

2015-01-01

The clinical research industry today is undergoing a major facelift. Companies are continuously looking to adopt and implement effective and innovative ways to accelerate drug launches in the market. Companies today are more open and do not view patients as mere "subjects" who generate data, - but as informed collaborators whose participation is "core" to the overall success of trials leading to the emergence of the concept of "patient-centric trials." This paper is intended to highlight the current trends and new opportunities that can be seen in industry -indicative of crucial role patients today play in their own health care using technology, social media and self education.

Patient centric approach for clinical trials: Current trend and new opportunities

Directory of Open Access Journals (Sweden)

Neha Shankar Sharma

2015-01-01

Full Text Available The clinical research industry today is undergoing a major facelift. Companies are continuously looking to adopt and implement effective and innovative ways to accelerate drug launches in the market. Companies today are more open and do not view patients as mere "subjects" who generate data, - but as informed collaborators whose participation is "core" to the overall success of trials leading to the emergence of the concept of "patient-centric trials." This paper is intended to highlight the current trends and new opportunities that can be seen in industry -indicative of crucial role patients today play in their own health care using technology, social media and self education.

Current trend of robotics application in medical

International Nuclear Information System (INIS)

Olanrewaju, O A; Faieza, A A; Syakirah, K

2013-01-01

The applications of robotics in recent years has emerged beyond the field of manufacturing or industrial robots itself. Robotics applications are now widely used in medical, transport, underwater, entertainment and military sector. In medical field, these applications should be emphasized in view of the increasing challenges due to the variety of findings in the field of medicine which requires new inventions to ease work process. The objective of this review paper is to study and presents the past and on-going research in medical robotics with emphasis on rehabilitation (assistive care) and surgery robotics which are certainly the two main practical fields where robots application are commonly used presently. The study found that, rehabilitation and surgery robotics applications grow extensively with the finding of new invention, as well as research that is being undertaken and to be undertaken. The importance of medical robot in medical industry is intended to offer positive outcomes to assist human business through a complicated task that involves a long period, accuracy, focus and other routines that cannot be accomplished by human ability alone.

Trends in Utilization of Vocal Fold Injection Procedures.

Science.gov (United States)

Rosow, David E

2015-11-01

Office-based vocal fold injections have become increasingly popular over the past 15 years. Examination of trends in procedure coding for vocal fold injections in the United States from 2000 to 2012 was undertaken to see if they reflect this shift. The US Part B Medicare claims database was queried from 2000 through 2012 for multiple Current Procedural Terminology codes. Over the period studied, the number of nonoperative laryngoscopic injections (31513, 31570) and operative medialization laryngoplasties (31588) remained constant. Operative vocal fold injection (31571) demonstrated marked linear growth over the 12-year study period, from 744 procedures in 2000 to 4788 in 2012-an increase >640%. The dramatic increased incidence in the use of code 31571 reflects an increasing share of vocal fold injections being performed in the operating room and not in an office setting, running counter to the prevailing trend toward awake, office-based injection procedures. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.

Current Trends in Communication Graduate Degrees: Survey of Communications, Advertising, PR, and IMC Graduate Programs

Science.gov (United States)

Quesenberry, Keith A.; Coolsen, Michael K.; Wilkerson, Kristen

2015-01-01

A survey of 61 master's degree advertising programs reveals significant trends in program titles, curriculum design, course delivery, and students served. The results provide insight for current and planned master's degree programs as research predicts a continued increase in demand for master's education over the next decade. Survey results are…

Current status of indications for surgery in peptic ulcer disease.

Science.gov (United States)

Jamieson, G G

2000-03-01

The eradication of Helicobacter pylori in patients with peptic ulcer disease has greatly diminished the need for antiulcer surgery. However, in societies where such drug therapy is considered too expensive and because occasional patients remain refractory to optimal medical therapy, elective surgery for duodenal ulcer disease is still carried out. If the required expertise is available, it can be undertaken laparoscopically. The advent of endoscopic therapies such as heater probe therapy and injection sclerotherapy has also greatly diminished the need for emergency surgery in bleeding peptic ulcer disease. Once again, however, when such therapy fails surgery is still indicated. Even with perforated peptic ulcer disease the role of surgery has receded somewhat, but here not because of changes in drug therapy. Nonoperative management of perforation is indicated in fit patients if the diagnosis is in doubt, in any patient when surgical facilities are unavailable (e.g., remote geographic areas, on board ship), or when a patient is extremely ill either because of co-morbidity or late presentation of the disease. Operation should be considered in all patients when the perforation is established to be unsealed, particularly after

Current Trends in Science | Overview | Publications | Indian ...

Indian Academy of Sciences (India)

Emerging trends at the interface of Chemistry and Biology: Applications to the design of human therapeutics ... Interplay between multiple length and time scales in complex chemical systems ... A tutorial introduction to financial engineering.

Internet marketing of bariatric surgery: contemporary trends in the medicalization of obesity.

Science.gov (United States)

Salant, Talya; Santry, Heena P

2006-05-01

In the context of political, economic, and scientific anxiety around the 'epidemic' rise in obesity in the US, the social and historical forces engendering the medicalization of obesity have been widely discussed. However, the recent growth of bariatric-weight loss-surgery and the expanding presence of advertising for bariatric surgery on the Internet suggest the possible emergence of new loci and languages of medicalization. We sought to identify the nature and extent to which web advertising of bariatric surgery contributes to the medicalization of obesity by examining the design and textual content of 100 bariatric surgery center websites. We found that websites, through strategic use of text and images, consistently describe obesity as a serious disease that requires professional ascertainment and supervision, entails substantial individual suffering, and is remedied through the transformative yet low risk effects of bariatric surgery. In the process, social normalcy and risk reduction come to replace physical criteria as the basis for determining health. Further, websites draw upon contradictory discourses of medicalization; that is, they insist upon 'external' (e.g. genetics, environment) causes of obesity to legitimize surgical intervention while implicating individual behaviors in surgical failure. From this, we suggest that the economic and professional motivations underlying website advertisements for bariatric surgery may result in confusing messages being sent to prospective patients as well as the perpetuation of gendered notions of obesity and the entrenchment of health disparities.

[Bariatric surgery in Denmark.

DEFF Research Database (Denmark)

Funch-Jensen, P.; Iversen, M.G.; Kehlet, H.

2008-01-01

INTRODUCTION: In 2005 the National Board of Health (NBH) published guidelines on bariatric surgery in Denmark. The aim of the present study was to shed light on the national bariatric effort in relation to these guidelines. MATERIAL AND METHODS: The analysis is based on extraction of the following......, a tendency which was attributable to the activities of one of the private clinics. CONCLUSION: The frequency with which bariatric surgery is performed follows a strongly increasing trend and the procedures are only performed at the public departments selected by the National Board of Health...

The evolution of spinal surgery in the west of Ireland, 2005-2013.

LENUS (Irish Health Repository)

O’Sullivan, M D

2016-04-01

The aim of this study was to determine the changes in both the short and long term, in the trends within the practice of spinal surgery in Galway University Hospitals (GUH) over a seven year period, January 2005 – January 2013. The absolute number of spinal surgery cases has increased from 147 in 2005, to 257 cases by 2013. Multiple level spine surgery accounts for 51% (131) of all cases by 2013, which is an increase from 31% (45) in 2005. On analysis of the trends within spinal surgery during the study period, a statistically significant (p<0.05) increase in all aspects of spinal surgery was noted, with the exception of surgeries for single level, lumbar and infection pathology respectively. The average waiting time for lumbar decompression and instrumentation climbed for an average of 1.3 months in 2008 to 12.1 months by 2012.The volume and complexity of spinal surgery has increased during the study period, in the West of Ireland.

Current trends in medical English education and the Japan College of Rheumatology International School.

Science.gov (United States)

Jego, Eric Hajime; Amengual, Olga

2017-11-01

In light of the present revolution happening in medical education in Japan as medical schools implement new curricula to conform to global standards, there is a growing demand for more internationalization and higher quality practical medical English education. In response, many institutions including governmental organizations, universities and academic associations are moving ahead with new initiatives to adapt to these changing demands. This paper reviews the current trends and innovations in medical English education in Japan. This paper also describes one initiative by the Japan College of Rheumatology (JCR) known as the JCR International School held yearly in Karuizawa. By examining recent trends and innovations in medical English education in Japan, the most relevant and applicable can be elucidated to illuminate a path forward for improved medical English education within the JCR.

Trends of Heller myotomy hospitalizations for achalasia in the United States, 1993-2005: effect of surgery volume on perioperative outcomes.

Science.gov (United States)

Wang, Y Richard; Dempsey, Daniel T; Friedenberg, Frank K; Richter, Joel E

2008-10-01

Achalasia is a rare chronic disorder of esophageal motor function. Single-center reports suggest that there has been greater use of laparoscopic Heller myotomy for achalasia in the United States since its introduction in 1992. We aimed to study the trends of Heller myotomy and the relationship between surgery volume and perioperative outcomes. The Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS) is a 20% stratified sample of all hospitalizations in the United States. It was used to study the macro-trends of Heller myotomy hospitalizations during 1993-2005. We also used the NIS 2003-2005 micro-data to study the perioperative outcomes of Heller myotomy hospitalizations, using other achalasia and laparoscopic cholecystectomy hospitalizations as control groups. The generalized linear model with repeated observations from the same unit was used to adjust for multiple hospitalizations from the same hospital. The national estimate of Heller myotomy hospitalizations increased from 728 to 2,255 during 1993-2005, while its mean length of stay decreased from 9.9 to 4.3 days. Of the 1,117 Heller myotomy hospitalizations in the NIS 2003-2005, 10 (0.9%) had the diagnosis of esophageal perforation at discharge. Length of stay was negatively correlated with a hospital's number of Heller myotomy per year (correlation coefficient -0.171, P Heller myotomy per year was negatively associated with length of stay (coefficient -0.215 to -0.119, both P Heller myotomy for achalasia was associated with greater use of surgery and shorter length of stay. A larger volume of Heller myotomy in a hospital was associated with better perioperative outcomes in terms of shorter length of stay and lower total charges.

Laparoscopic colorectal surgery: Current status and implementation of the latest technological innovations.

Science.gov (United States)

Pascual, Marta; Salvans, Silvia; Pera, Miguel

2016-01-14

The introduction of laparoscopy is an example of surgical innovation with a rapid implementation in many areas of surgery. A large number of controlled studies and meta-analyses have shown that laparoscopic colorectal surgery is associated with the same benefits than other minimally invasive procedures, including lesser pain, earlier recovery of bowel transit and shorter hospital stay. On the other hand, despite initial concerns about oncological safety, well-designed prospective randomized multicentre trials have demonstrated that oncological outcomes of laparoscopy and open surgery are similar. Although the use of laparoscopy in colorectal surgery has increased in recent years, the percentages of patients treated with surgery using minimally invasive techniques are still reduced and there are also substantial differences among centres. It has been argued that the limiting factor for the use of laparoscopic procedures is the number of surgeons with adequate skills to perform a laparoscopic colectomy rather than the tumour of patients' characteristics. In this regard, future efforts to increase the use of laparoscopic techniques in colorectal surgery will necessarily require more efforts in teaching surgeons. We here present a review of recent controversies of the use of laparoscopy in colorectal surgery, such as in rectal cancer operations, the possibility of reproducing complete mesocolon excision, and the benefits of intra-corporeal anastomosis after right hemicolectomy. We also describe the results of latest innovations such as single incision laparoscopic surgery, robotic surgery and natural orifice transluminal endoscopic surgery for colon and rectal diseases.

Current trends in gamma radiation detection for radiological emergency response

Science.gov (United States)

Mukhopadhyay, Sanjoy; Guss, Paul; Maurer, Richard

2011-09-01

Passive and active detection of gamma rays from shielded radioactive materials, including special nuclear materials, is an important task for any radiological emergency response organization. This article reports on the current trends and status of gamma radiation detection objectives and measurement techniques as applied to nonproliferation and radiological emergencies. In recent years, since the establishment of the Domestic Nuclear Detection Office by the Department of Homeland Security, a tremendous amount of progress has been made in detection materials (scintillators, semiconductors), imaging techniques (Compton imaging, use of active masking and hybrid imaging), data acquisition systems with digital signal processing, field programmable gate arrays and embedded isotopic analysis software (viz. gamma detector response and analysis software [GADRAS]1), fast template matching, and data fusion (merging radiological data with geo-referenced maps, digital imagery to provide better situational awareness). In this stride to progress, a significant amount of inter-disciplinary research and development has taken place-techniques and spin-offs from medical science (such as x-ray radiography and tomography), materials engineering (systematic planned studies on scintillators to optimize several qualities of a good scintillator, nanoparticle applications, quantum dots, and photonic crystals, just to name a few). No trend analysis of radiation detection systems would be complete without mentioning the unprecedented strategic position taken by the National Nuclear Security Administration (NNSA) to deter, detect, and interdict illicit trafficking in nuclear and other radioactive materials across international borders and through the global maritime transportation-the so-called second line of defense.

Assessment of open operative vascular surgical experience among general surgery residents.

Science.gov (United States)

Krafcik, Brianna M; Sachs, Teviah E; Farber, Alik; Eslami, Mohammad H; Kalish, Jeffrey A; Shah, Nishant K; Peacock, Matthew R; Siracuse, Jeffrey J

2016-04-01

General surgeons have traditionally performed open vascular operations. However, endovascular interventions, vascular residencies, and work-hour limitations may have had an impact on open vascular surgery training among general surgery residents. We evaluated the temporal trend of open vascular operations performed by general surgery residents to assess any changes that have occurred. The Accreditation Council for Graduate Medical Education's database was used to evaluate graduating general surgery residents' cases from 1999 to 2013. Mean and median case volumes were analyzed for carotid endarterectomy, open aortoiliac aneurysm repair, and lower extremity bypass. Significance of temporal trends were identified using the R(2) test. The average number of carotid endarterectomies performed by general surgery residents decreased from 23.1 ± 14 (11.6 ± 9 chief, 11.4 + 10 junior) cases per resident in 1999 to 10.7 ± 9 (3.4 ± 5 chief, 7.3 ± 6 junior) in 2012 (R(2) = 0.98). Similarly, elective open aortoiliac aneurysm repairs decreased from 7.4 ± 5 (4 ± 4 chief, 3.4 ± 4 junior) in 1999 to 1.3 ± 2 (0.4 ± 1 chief, 0.8 ± 1 junior) in 2012 (R(2) = 0.98). The number of lower extremity bypasses decreased from 21 ± 12 (9.5 ± 7 chief, 11.8 ± 9 junior) in 1999 to 7.6 ± 2.6 (2.4 ± 1.3 chief, 5.2 + 1.8 junior) in 2012 (R(2) = 0.94). Infrapopliteal bypasses decreased from 8.1 ± 3.8 (3.5 ± 2.2 chief, 4.5 ± 2.9 junior) in 2001 to 3 ± 2.2 (1 ± 1.6 chief, 2 ± 1.6 junior) in 2012 (R(2) = 0.94). General surgery resident exposure to open vascular surgery has significantly decreased. Current and future graduates may not have adequate exposure to open vascular operations to be safely credentialed to perform these procedures in future practice without advanced vascular surgical training. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Using a clinical protocol for orthognathic surgery and assessing a 3-dimensional virtual approach: current therapy.

Science.gov (United States)

Quevedo, Luis A; Ruiz, Jessica V; Quevedo, Cristobal A

2011-03-01

Oral and maxillofacial surgeons who perform orthognathic surgery face major changes in their practices, and these challenges will increase in the near future, because the extraordinary advances in technology applied to our profession are not only amazing but are becoming the standard of care as they promote improved outcomes for our patients. Orthognathic surgery is one of the favorite areas of practicing within the scope of practice of an oral and maxillofacial surgeon. Our own practice in orthognathic surgery has completed over 1,000 surgeries of this type. Success is directly related to the consistency and capability of the surgical-orthodontic team to achieve predictable, stable results, and our hypothesis is that a successful result is directly related to the way we take our records and perform diagnosis and treatment planning following basic general principles. Now that we have the opportunity to plan and treat 3-dimensional (3D) problems with 3D technology, we should enter into this new era with appropriate standards to ensure better results, instead of simply enjoying these new tools, which will clearly show not only us but everyone what we do when we perform orthognathic surgery. Appropriate principles need to be taken into account when implementing this new technology. In other words, new technology is welcome, but we do not have to reinvent the wheel. The purpose of this article is to review the current protocol that we use for orthognathic surgery and compare it with published protocols that incorporate new 3D and virtual technology. This report also describes our approach to this new technology. Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Mechanisms and management of dry eye in cataract surgery patients.

Science.gov (United States)

Sutu, Christine; Fukuoka, Hideki; Afshari, Natalie A

2016-01-01

To provide a summary of the mechanisms that may cause dry eye after cataract surgery and discuss available and upcoming treatment modalities. Development or worsening of dry eye symptoms after cataract surgery is multifactorial with corneal nerve transection, inflammation, goblet cell loss, and meibomian gland dysfunction commonly cited as underlying disorders. With increasing awareness of the prevalence of dry eye disease, current surgical techniques are being analyzed for their contribution to the issue. Although many classic interventions, such as artificial tears and anti-inflammatory drops, remain first-line treatment options, they may not adequately address abnormalities of the tear film. The trend has been to create new drugs and technologies that target meibomian gland deficiencies and restore goblet cell numbers. Therapy for postoperative dry eye symptoms should be determined based on symptom severity and which underlying cause is most prominent at a given time. Patients with high-level risk factors for dry eye should be evaluated preoperatively to determine whether they have preexisting dry eye disease or if they are susceptible to developing disease after surgery.

Is it time to include point-of-care ultrasound in general surgery training? A review to stimulate discussion.

Science.gov (United States)

Mollenkopf, Maximilian; Tait, Noel

2013-12-01

Point-of-care ultrasound scanning or POCUS is a focused ultrasound (US) scan, performed by non-imaging clinicians during physical examination, an invasive procedure or surgery. As this technology becomes cheaper, smaller and easier to use, its scope for use by surgeons grows, a trend that may generate a gap between use and training. Opportunities for enhanced general surgery skill sets may be reduced unless consideration is given to inclusion of POCUS in general surgery training. To stimulate discussion regarding inclusion of POCUS in the general surgery curriculum; to resource this discussion with an overview of current trends and issues around POCUS; and to discuss concerns and controversies that may arise if POCUS was adopted into general surgery training. A literature search was performed using PUBMED, MEDLINE, Google and Google Scholar, using the terms 'ultrasound', 'point-of-care-ultrasound', 'bedside ultrasound', 'portable ultrasound' and 'hand-held ultrasound'. Literature, references and non-literature resources found were reviewed for relevance to US education in general surgery. Increasingly, medical students are graduating with basic POCUS skills. Specialty-specific uses of POCUS are proliferating. Training and assessment resources are not keeping up, in accessibility or standardization. A learned surgical college led training and accreditation process would require aligned education in anatomy and US technology and collaboration with the specialist imaging community to ensure appropriate standards are clarified and met. Research is also required into how general surgery trainees can best achieve and maintain POCUS competence. © 2013 Royal Australasian College of Surgeons.

Surgical specialty procedures in rural surgery practices: implications for rural surgery training.

Science.gov (United States)

Sticca, Robert P; Mullin, Brady C; Harris, Joel D; Hosford, Clint C

2012-12-01

Specialty procedures constitute one eighth of rural surgery practice. Currently, general surgeons intending to practice in rural hospitals may not get adequate training for specialty procedures, which they will be expected to perform. Better definition of these procedures will help guide rural surgery training. Current Procedural Terminology codes for all surgical procedures for 81% of North Dakota and South Dakota rural surgeons were entered into the Dakota Database for Rural Surgery. Specialty procedures were analyzed and compared with the Surgical Council on Resident Education curriculum to determine whether general surgery training is adequate preparation for rural surgery practice. The Dakota Database for Rural Surgery included 46,052 procedures, of which 5,666 (12.3%) were specialty procedures. Highest volume specialty categories included vascular, obstetrics and gynecology, orthopedics, cardiothoracic, urology, and otolaryngology. Common procedures in cardiothoracic and vascular surgery are taught in general surgical residency, while common procedures in obstetrics and gynecology, orthopedics, urology, and otolaryngology are usually not taught in general surgery training. Optimal training for rural surgery practice should include experience in specialty procedures in obstetrics and gynecology, orthopedics, urology, and otolaryngology. Copyright © 2012 Elsevier Inc. All rights reserved.

Suicide: current trends.

Science.gov (United States)

Bailey, Rahn K; Patel, Tejas C; Avenido, Jaymie; Patel, Milapkumar; Jaleel, Mohammad; Barker, Narviar C; Khan, Jahanzeb Ali; Ali, Shahid; Jabeen, Shagufta

2011-07-01

Suicide is the act of a human being intentionally causing his or her own death. More than 1 million people commit suicide every year. It is the 13th leading cause of death worldwide, with China, India, and Japan accounting for almost half of all suicides. In less than 50 years, the rate of suicide among Sri Lankans has risen from a modest level to one of the highest in the world (118 per 100,000). Suicide is a major preventable cause of premature death. It is influenced by psychosocial, cultural, and environmental risk factors. The impact of suicide can be devastating for all concerned. It is common in people who are living with chronic mental illness. Individuals with severe clinical depression and alcohol use disorders are at highest risk if untreated. On an interpersonal level, friends and families of suicide victims require social support. On a national level, governments need to recognize the causes of suicide and protect those most vulnerable. If governments commit to defining national responses to prevent suicide, significant progress can be made. On a global scale, research and health organizations can identify global trends and encourage the sharing of information in effective prevention activities. In September 2010, World Suicide Prevention Day, with a theme of "Many faces, many places: suicide prevention across the world," encouraged public awareness worldwide to unite in commitment and action to promote understanding about suicide and removal of stigmatization'. There is compelling evidence that adequate prevention and awareness can reduce suicide rates.

Trends in refractive surgery at an academic center: 2007-2009

Directory of Open Access Journals (Sweden)

Kuo Irene C

2011-05-01

Full Text Available Abstract Background The United States officially entered a recession in December 2007, and it officially exited the recession in December 2009, according to the National Bureau of Economic Research. Since the economy may affect not only the volume of excimer laser refractive surgery, but also the clinical characteristics of patients undergoing surgery, our goal was to compare the characteristics of patients completing excimer laser refractive surgery and the types of procedures performed in the summer quarter in 2007 and the same quarter in 2009 at an academic center. A secondary goal was to determine whether the volume of astigmatism- or presbyopia-correcting intraocular lenses (IOLs has concurrently changed because like laser refractive surgery, these "premium" IOLs involve out-of-pocket costs for patients. Methods Retrospective case series. Medical records were reviewed for all patients completing surgery at the Wilmer Laser Vision Center in the summer quarter of 2007 and the summer quarter of 2009. Outcome measures were the proportions of treated refractive errors, the proportion of photorefractive keratectomy (PRK vs. laser-assisted in-situ keratomileusis (LASIK, and the mean age of patients in each quarter. Chi-square test was used to compare the proportions of treated refractive errors and the proportions of procedures; two-tailed t-test to compare the mean age of patients; and two-tailed z-test to compare proportions of grouped refractive errors in 2007 vs. 2009; alpha = 0.05 for all tests. Refractive errors were grouped by the spherical equivalent of the manifest refraction and were considered "low myopia" for 6 diopters (D of myopia or less, "high myopia" for more than 6 D, and "hyperopia" for any hyperopia. Billing data were reviewed to obtain the volume of premium IOLs. Results Volume of laser refractive procedures decreased by at least 30%. The distribution of proportions of treated refractive errors did not change (p = 0.10. The

Trends in refractive surgery at an academic center: 2007-2009.

Science.gov (United States)

Kuo, Irene C

2011-05-14

The United States officially entered a recession in December 2007, and it officially exited the recession in December 2009, according to the National Bureau of Economic Research. Since the economy may affect not only the volume of excimer laser refractive surgery, but also the clinical characteristics of patients undergoing surgery, our goal was to compare the characteristics of patients completing excimer laser refractive surgery and the types of procedures performed in the summer quarter in 2007 and the same quarter in 2009 at an academic center. A secondary goal was to determine whether the volume of astigmatism- or presbyopia-correcting intraocular lenses (IOLs) has concurrently changed because like laser refractive surgery, these "premium" IOLs involve out-of-pocket costs for patients. Retrospective case series. Medical records were reviewed for all patients completing surgery at the Wilmer Laser Vision Center in the summer quarter of 2007 and the summer quarter of 2009. Outcome measures were the proportions of treated refractive errors, the proportion of photorefractive keratectomy (PRK) vs. laser-assisted in-situ keratomileusis (LASIK), and the mean age of patients in each quarter. Chi-square test was used to compare the proportions of treated refractive errors and the proportions of procedures; two-tailed t-test to compare the mean age of patients; and two-tailed z-test to compare proportions of grouped refractive errors in 2007 vs. 2009; alpha = 0.05 for all tests. Refractive errors were grouped by the spherical equivalent of the manifest refraction and were considered "low myopia" for 6 diopters (D) of myopia or less, "high myopia" for more than 6 D, and "hyperopia" for any hyperopia. Billing data were reviewed to obtain the volume of premium IOLs. Volume of laser refractive procedures decreased by at least 30%. The distribution of proportions of treated refractive errors did not change (p = 0.10). The proportion of high myopes, however, decreased (p = 0

Socioeconomic factors and mortality in emergency general surgery: trends over a 20-year period.

Science.gov (United States)

Armenia, Sarah J; Pentakota, Sri Ram; Merchant, Aziz M

2017-05-15

Socioeconomic factors such as race, insurance, and income quartiles have been identified as independent risk factors in emergency general surgery (EGS), but this impact has not been studied over time. We sought to identify trends in disparities in EGS-related operative mortality over a 20-y period. The National Inpatient Sample was used to identify patient encounters coded for EGS in 1993, 2003, and 2013. Logistic regression models were used to examine the adjusted relationship between race, primary payer status, and median income quartiles and in-hospital mortality after adjusting for patients' age, gender, Elixhauser comorbidity score, and hospital region, size, and location-cum-teaching status. We identified 391,040 patient encounters. In 1993, Black race was associated with higher odds of in-hospital mortality (odds ratio [95% confidence interval]: 1.35 [1.20-1.53]) than White race, although this difference dissipated in subsequent years. Medicare, Medicaid, and underinsured patients had a higher odds of mortality than those with private insurance for the entire 20-y period; only the disparity in the underinsured decreased over time (1993, 1.63 [1.35-1.98]; 2013, 1.41 [1.20-1.67]). In 2003 (1.23 [1.10-1.38]) and 2013 (1.23 [1.11-1.37]), patients from the lowest income quartile were more likely to die after EGS than patients from the highest income quartile. Socioeconomic disparities in EGS-related operative morality followed inconsistent trends. Over time, while gaps in in-hospital mortality among Blacks and Whites have narrowed, disparities among patients belonging to lowest income quartile have worsened. Medicare and Medicaid beneficiaries continued to experience higher odds of in-hospital mortality relative to those with private insurance. Copyright © 2017 Elsevier Inc. All rights reserved.

The Austrian breast implant register: recent trends in implant-based breast surgery.

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Wurzer, Paul; Rappl, Thomas; Friedl, Herwig; Kamolz, Lars-Peter; Spendel, Stephan; Hoflehner, Helmut; Parvizi, Daryousch

2014-12-01

Due to the fact that the number of breast implant surgeries for cosmetic and medical purposes is rising yearly, a discussion about the quality of service for both patients and physicians is more important than ever. To this end, we reviewed the Austrian Breast Implant Register with one specific question in mind: What are the trends? In the statistical analysis of the Austrian Breast Implant Register, we were able to identify 13,112 registered breast implants between 2004 and 2012. The whole dataset was then divided into medical and cosmetic groups. We focused on device size, surface characteristics, filling material, device placement and incision site. All factors were considered for all examined years. In summary, the most used device had a textured surface (97 %) and silicone gel as the filling material (93 %). The mean size of implants for the cosmetic group was 240 cc, placement was submuscular (58 %) and the incision site was inframammary (67 %). In the medical group, the mean size was 250 cc. Yearly registrations had their peak in 2008 (1,898 registered devices); from this year on, registrations decreased annually. A slight trend away from subglandular placement in the cosmetic group was noted. Also, the usage of implants with polyurethane surface characteristics has increased since 2008. The smooth surface implants had a peak usage in 2006 and their usage decreased steadily from then on whereas the textured surface was steady over the years. Keeping the problems related to the quality of breast implants in mind, we could recommend an obligatory national register. Organisations of surgeons and governments should develop and establish these registers. Furthermore, an all-encompassing international register should be established by the European Union and the American FDA (Food and Drug Administration); this might be useful in comparing the individual country registers and also would help in delivering "evidence based" medicine in cosmetic and medical procedures

Present trends in the detection of myocardial viability using nuclear cardiology tests

International Nuclear Information System (INIS)

Peix Gonzalez, Amalia; Garcia Barreto, David

1999-01-01

The myocardial viability diagnosis is important for those who will undergo myocardial revascularization whether by surgery or coronary angioplasty. Our purpose is to present some of the present trends in the detection of myocardial viability using nuclear cardiology tests. Emphasis is made on the estimation of radiopharmaceutical uptake and the use of vasodilators in perfusion scintigraphy mainly with technetium-labeled compounds. Also, the current possibilities for a myocardial metabolism study using single-photon emission-computed tomography as well as some clinical implications of myocardial viability are set forth

Clinical negligence claims in pediatric surgery in England: pattern and trends.

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Thyoka, Mandela

2015-02-01

We hypothesized that there has been an increase in the number of successful litigation claims in pediatric surgery in England. Our aim was to report the incidence, causes, and costs of clinical negligence claims against the National Health Service (NHS) in relation to pediatric surgery. We queried the NHS Litigation Authority (NHSLA) on litigation claims among children undergoing pediatric surgery in England (2004-2012). We decided a priori to only examine closed cases (decision and payment made). Data included year of claim, year of payment of claim, payment per claim, paid-to-closed ratio, and severity of outcome of clinical incident. Out of 112 clinical negligence claims in pediatric surgery, 93 (83%) were finalized-73 (65%) were settled and damages paid to the claimant and 20 (18%) were closed with no payment, and 19 (17%) remain open. The median payment was £13,537 (600-500,000) and median total cost borne by NHSLA was £31,445 (600-730,202). Claims were lodged at a median interval of 2 (0-13) years from time of occurrence with 55 (75%) cases being settled within the 3 years of being received. The commonest reasons for claims were postoperative complications (n=20, 28%), delayed treatment (n=16, 22%), and/or diagnosis (n=14, 19%). Out of 73, 17 (23%) closed claims resulted in case fatality. Conclusion: Two-thirds of all claims in pediatric surgery resulted in payment to claimant, and the commonest reasons for claims were postoperative complications, delayed treatment, and/or diagnosis. Nearly a quarter of successful claims were in cases where negligence resulted in case fatality. Pediatric surgeons should be aware of common diagnostic and treatment shortfalls as high-risk areas of increased susceptibility to clinical negligence claims. Georg Thieme Verlag KG Stuttgart · New York.

Positive surgical margins in nephron-sparing surgery; the great unknown

Directory of Open Access Journals (Sweden)

Dan Spinu

2018-04-01

Full Text Available There is a currently a general trend towards organ-preserving surgery, and urology is no exception. Specifically, nephron-sparing surgery (NSS has gained general acceptance for T1a renal cell carcinoma (guidelines recommendations. Moreover T1b, T2 and even T3 stage tumors have been included on the nephron sparing list at some centers. An unresolved issue is that of positive surgical margins (PSM, not only their detection but also the implications for follow up and treatment. This paper highlights data available on risk factors for PSM, their clinical relevance, and possible therapeutic consequences. From the surgeon’s viewpoint, NSS is a daring and risky surgical procedure. Urological guidelines stress the importance of NSS, and thus the trend is moving in that direction. Unresolved, however, is the problem of PSM. Trifecta, MIC, and pentafecta are applicable concepts which attempt to define the optimal endpoint of NSS, but further elaboration is necessary. Specifically, research needs to focus less on the concept of definitive margins and more on their identification and avoidance. Although some studies suggest that PSMs do not influence overall survival rate, the basic idea of preserving tissue that is not cancerous leads to further medical, social, and psychological considerations.

Proceedings of the BRNS-AEACI first symposium on current trends in analytical chemistry: book of abstracts

International Nuclear Information System (INIS)

Reddy, A.V.R.

2015-01-01

The symposium was very useful for the scientists on various aspects of current trends in analytical chemistry like separation science, speciation, nuclear analytical techniques, thermo analytical techniques, electro analytical techniques, spectrochemical and microscopic techniques, environmental studies, geochemical studies, chemical metrology, analytical instrumentation. Papers relevant to INIS are indexed separately

Robotic liver surgery

Science.gov (United States)

Leung, Universe

2014-01-01

Robotic surgery is an evolving technology that has been successfully applied to a number of surgical specialties, but its use in liver surgery has so far been limited. In this review article we discuss the challenges of minimally invasive liver surgery, the pros and cons of robotics, the evolution of medical robots, and the potentials in applying this technology to liver surgery. The current data in the literature are also presented. PMID:25392840

Current status of robotic bariatric surgery: a systematic review

Science.gov (United States)

2013-01-01

Background Bariatric surgery is an effective treatment to obtain weight loss in severely obese patients. The feasibility and safety of bariatric robotic surgery is the topic of this review. Methods A search was performed on PubMed, Cochrane Central Register of Controlled Trials, BioMed Central, and Web of Science. Results Twenty-two studies were included. Anastomotic leak rate was 8.51% in biliopancreatic diversion. 30-day reoperation rate was 1.14% in Roux-en-Y gastric bypass and 1.16% in sleeve gastrectomy. Major complication rate in Roux-en-Y gastric bypass resulted higher than in sleeve gastrectomy ( 4,26% vs. 1,2%). The mean hospital stay was longer in Roux-en-Y gastric bypass (range 2.6-7.4 days). Conclusions The major limitation of our analysis is due to the small number and the low quality of the studies, the small sample size, heterogeneity of the enrolled patients and the lack of data from metabolic and bariatric outcomes. Despite the use of the robot, the majority of these cases are completed with stapled anastomosis. The assumption that robotic surgery is superior in complex cases is not supported by the available present evidence. The major strength of the robotic surgery is strongly facilitating some of the surgical steps (gastro-jejunostomy and jejunojejunostomy anastomosis in the robotic Roux-en-Y gastric bypass or the vertical gastric resection in the robotic sleeve gastrectomy). PMID:24199869

LIFELONG LEARNING THROUGH SECOND LIFE: CURRENT TRENDS, POTENTIALS AND LIMITATIONS

Directory of Open Access Journals (Sweden)

Nil GOKSEL-CANBEK

2011-08-01

Full Text Available Lifelong Learning (LLL has been a remarkable response to people-centered educational demand of 21st century. In order to provide effective formal, non-formal, and informal learning, immersive educational activities undertaken throughout life should be aimed to create a learning society in which people can experience individual and collective learning with no constrains of time or location. The concept of lifelong learning within the context of distance immersive education encompasses diverse 3D activities. The three dimensional, Web-based structured activities supported by distance learning technologies can be viewed as interactive tools which foster LLL. In this perspective, Second Life (SL can be regarded as one of the learning simulation milieus that allow learners to participate in various educational LLL activities in individual or group forms. The following paper examines how SL, taking advantage of its simulative nature and the possibility for creative interaction among participants, which are also common in games, allows the learners to participate in immersive constructivist learning activities. The article will also touch on the current uses of SL as a tool for LLL, as well as its potentials for further development according to the current trends in adult education. Further, the authors will discuss its limitations and will make suggestions towards a more complete pedagogical use.

Information Technology in New Zealand: Review of Emerging Social Trends, Current Issues, and Policies

OpenAIRE

Erturk, Emre; Fail, Derwyn

2015-01-01

This paper discusses the general state of information technology in New Zealand society, current issues, and policies. It is a qualitative study that reviews recent scholarly articles, periodicals, and surveys in order to create an understanding of some of the information technology issues and trends in New Zealand. After reviewing previous research, it assesses the potential existence and nature of a 'digital divide' in New Zealand society whilst also evaluating possible strategic responses ...

Social media use and impact on plastic surgery practice.

Science.gov (United States)

Vardanian, Andrew J; Kusnezov, Nicholas; Im, Daniel D; Lee, James C; Jarrahy, Reza

2013-05-01

Social media platforms have revolutionized the way human beings communicate, yet there is little evidence describing how the plastic surgery community has adopted social media. In this article, the authors evaluate current trends in social media use by practicing plastic surgeons. An anonymous survey on the use of social media was distributed to members of the American Society of Plastic Surgeons. Prevalent patterns of social media implementation were elucidated. One-half of respondents were regular social media users. Reasons for using social media included the beliefs that incorporation of social media into medical practice is inevitable (56.7 percent), that they are an effective marketing tool (52.1 percent), and that they provide a forum for patient education (49 percent). Surgeons with a primarily aesthetic surgery practice were more likely to use social media. Most respondents (64.6 percent) stated that social media had no effect on their practice, whereas 33.8 percent reported a positive impact and 1.5 percent reported a negative impact. This study depicts current patterns of social media use by plastic surgeons, including motivations driving its implementation and impressions on its impact. Many feel that social media are an effective marketing tool that generates increased exposure and referrals. A small number of surgeons have experienced negative repercussions from social media involvement. Our study reveals the presence of a void. There is a definite interest among those surveyed in developing best practice standards and oversight to ensure ethical use of social media platforms throughout the plastic surgery community. Continuing discussion regarding these matters should be ongoing as our experience with social media in plastic surgery evolves.

Impact of novel techniques on minimally invasive adrenal surgery: trends and outcomes from a contemporary international large series in urology.

Science.gov (United States)

Pavan, Nicola; Autorino, Riccardo; Lee, Hak; Porpiglia, Francesco; Sun, Yinghao; Greco, Francesco; Jeff Chueh, S; Han, Deok Hyun; Cindolo, Luca; Ferro, Matteo; Chen, Xiang; Branco, Anibal; Fornara, Paolo; Liao, Chun-Hou; Miyajima, Akira; Kyriazis, Iason; Puglisi, Marco; Fiori, Cristian; Yang, Bo; Fei, Guo; Altieri, Vincenzo; Jeong, Byong Chang; Berardinelli, Francesco; Schips, Luigi; De Cobelli, Ottavio; Chen, Zhi; Haber, Georges-Pascal; He, Yao; Oya, Mototsugu; Liatsikos, Evangelos; Brandao, Luis; Challacombe, Benjamin; Kaouk, Jihad; Darweesh, Ithaar

2016-10-01

To evaluate contemporary international trends in the implementation of minimally invasive adrenalectomy and to assess contemporary outcomes of different minimally invasive techniques performed at urologic centers worldwide. A retrospective multinational multicenter study of patients who underwent minimally invasive adrenalectomy from 2008 to 2013 at 14 urology institutions worldwide was included in the analysis. Cases were categorized based on the minimally invasive adrenalectomy technique: conventional laparoscopy (CL), robot-assisted laparoscopy (RAL), laparoendoscopic single-site surgery (LESS), and mini-laparoscopy (ML). The rates of the four treatment modalities were determined according to the year of surgery, and a regression analysis was performed for trends in all surgical modalities. Overall, a total of 737 adrenalectomies were performed across participating institutions and included in this analysis: 337 CL (46 % of cases), 57 ML (8 %), 263 LESS (36 %), and 80 RA (11 %). Overall, 204 (28 %) operations were performed with a retroperitoneal approach. The overall number of adrenalectomies increased from 2008 to 2013 (p = 0.05). A transperitoneal approach was preferred in all but the ML group (p Asia and South America reported the highest rate in LESS procedures, and RAL was adopted to larger extent in the USA. LESS had the fastest increase in utilization at 6 %/year. The rate of RAL procedures increased at slower rates (2.2 %/year), similar to ML (1.7 %/year). Limitations of this study are the retrospective design and the lack of a cost analysis. Several minimally invasive surgical techniques for the management of adrenal masses are successfully implemented in urology institutions worldwide. CL and LESS seem to represent the most commonly adopted techniques, whereas ML and RAL are growing at a slower rate. All the MIS techniques can be safely and effectively performed for a variety of adrenal disease.

Analysis of current trends on the Czech food market with a focus on a healthy lifestyle.

OpenAIRE

Bartůňková, Eva

2013-01-01

The thesis of this work is to map current trends on the Czech food market with focus on a healthy lifestyle. In particular, it focuses on foodstuff labelling and GDA labels. The paper begins by surveying the development of the healthy lifestyle trend, as well as the activities of the Federation of the Food and Drink Industries of the Czech Republic involved in a healthy lifestyle; furthermore, the work elaborates on segmentation of the consumer and evaluation of a healthy lifestyle, obesity a...

Transgender Surgery in Denmark From 1994 to 2015

DEFF Research Database (Denmark)

Aydin, Dogu; Buk, Liv Johanne; Partoft, Søren

2016-01-01

INTRODUCTION: Gender dysphoria is a mismatch between a person's biological sex and gender identity. The best treatment is believed to be hormonal therapy and gender-confirming surgery that will transition the individual toward the desired gender. Treatment in Denmark is covered by public health...... identity disorders from January 1994 through March 2015. Patients were excluded from the study if they were pseudohermaphrodites or if their gender was not reported. MAIN OUTCOME MEASURES: Gender distribution, age trends, and surgeries performed for Danish patients who underwent gender-confirming surgery...... care, and gender-confirming surgery in Denmark is centralized at a single-center with few specialized plastic surgeons conducting top surgery (mastectomy or breast augmentation) and bottom surgery (vaginoplasty or phalloplasty and metoidioplasty). AIMS: To report the first nationwide single...

Cataract surgery practices in the United States Veterans Health Administration.

Science.gov (United States)

Havnaer, Annika G; Greenberg, Paul B; Cockerham, Glenn C; Clark, Melissa A; Chomsky, Amy

2017-04-01

To describe current cataract surgery practices within the United States Veterans Health Administration (VHA). Veterans Health Administration hospitals in the U.S. Retrospective data analysis. An initial e-mail containing a link to an anonymous 32-question survey of cataract surgery practices was sent to participants in May 2016. Two reminder e-mails were sent to nonresponders 1 week and 2 weeks after the initial survey was sent; the remaining nonresponders were called twice over a 2-week period. The data were analyzed using descriptive statistics. The response rate was 75% (67/89). Cataract surgeons routinely ordered preoperative testing in 29 (45%) of 65 sections and preoperative consultations in 26 (39%) of 66 sections. In 22 (33%) of 66 sections, cataract surgeons administered intracameral antibiotics. In 61 (92%) of 66 sections, cataract surgeons used toric intraocular lenses (IOLs). In 20 (30%) of 66 sections, cataract surgeons used multifocal IOLs. Cataract surgeons in 6 (9%) of 66 sections performed femtosecond laser-assisted cataract surgery. In 6 (9%) of 66 sections, cataract surgeons performed immediate sequential bilateral cataract surgery. Forty-nine (74%) ophthalmology chiefs reported a high level of satisfaction with Veterans Affairs ophthalmology. The survey results indicate that in cataract surgery in the VHA, routine preoperative testing is commonly performed and emerging practices, such as femtosecond laser-assisted cataract surgery and immediate sequential bilateral cataract surgery, have limited roles. The results of this survey could benchmark future trends in U.S. cataract surgery practices, especially in teaching hospital settings. Copyright © 2017 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Making Current Trends in School Design Feasible.

Science.gov (United States)

North Carolina State Dept. of Public Instruction, Raleigh. Div. of School Support.

This report describes new and innovative approaches to school facilities as they relate to their communities by exploring the trends towards smaller schools, presenting the pros and cons of smaller schools, and examining the solutions and strategies in smart growth planning. The report addresses the following questions: if school leaders,…

Current trends in electrochemical sensing and biosensing of DNA methylation.

Science.gov (United States)

Krejcova, Ludmila; Richtera, Lukas; Hynek, David; Labuda, Jan; Adam, Vojtech

2017-11-15

DNA methylation plays an important role in physiological and pathological processes. Several genetic diseases and most malignancies tend to be associated with aberrant DNA methylation. Among other analytical methods, electrochemical approaches have been successfully employed for characterisation of DNA methylation patterns that are essential for the diagnosis and treatment of particular diseases. This article discusses current trends in the electrochemical sensing and biosensing of DNA methylation. Particularly, it provides an overview of applied electrode materials, electrode modifications and biorecognition elements applications with an emphasis on strategies that form the core DNA methylation detection approaches. The three main strategies as (i) bisulfite treatment, (ii) cleavage by restriction endonucleases, and (iii) immuno/affinity reaction were described in greater detail. Additionally, the availability of the reviewed platforms for early cancer diagnosis and the approval of methylation inhibitors for anticancer therapy were discussed. Copyright © 2017 Elsevier B.V. All rights reserved.

[Current status of thoracoscopic surgery for thoracic and lumbar spine. Part 2: treatment of the thoracic disc hernia, spinal deformities, spinal tumors, infections and miscellaneous].

Science.gov (United States)

Verdú-López, Francisco; Beisse, Rudolf

2014-01-01

Thoracoscopic surgery or video-assisted thoracic surgery (VATS) of the thoracic and lumbar spine has evolved greatly since it appeared less than 20 years ago. It is currently used in a large number of processes and injuries. The aim of this article, in its two parts, is to review the current status of VATS of the thoracic and lumbar spine in its entire spectrum. After reviewing the current literature, we developed each of the large groups of indications where VATS takes place, one by one. This second part reviews and discusses the management, treatment and specific thoracoscopic technique in thoracic disc herniation, spinal deformities, tumour pathology, infections of the spine and other possible indications for VATS. Thoracoscopic surgery is in many cases an alternative to conventional open surgery. The transdiaphragmatic approach has made endoscopic treatment of many thoracolumbar junction processes possible, thus widening the spectrum of therapeutic indications. These include the treatment of spinal deformities, spinal tumours, infections and other pathological processes, as well as the reconstruction of injured spinal segments and decompression of the spinal canal if lesion placement is favourable to antero-lateral approach. Good clinical results of thoracoscopic surgery are supported by growing experience reflected in a large number of articles. The degree of complications in thoracoscopic surgery is comparable to open surgery, with benefits in regard to morbidity of the approach and subsequent patient recovery. Copyright © 2012 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

New Clinical and Research Trends in Lower Extremity Management for Ambulatory Children with Cerebral Palsy

Science.gov (United States)

Damiano, Diane L.; Alter, Katharine E.; Chambers, Henry

2010-01-01

Synopsis Cerebral palsy is the most prevalent physical disability in childhood and includes a group of disorders with varying manifestations and levels of capability in individuals given this diagnosis. This chapter will focus on current and future intervention strategies for improving mobility and participation over the lifespan for ambulatory children with cerebral palsy (CP). The provision and integration of physical therapy, medical and orthopedic surgery management focused primarily on the lower extremities will be discussed here. Some of the newer trends are: more intense and task-related exercise strategies, greater precision in tone identification and management, and a shift towards musculoskeletal surgery that focuses more on promoting dynamic bony alignment and less on releasing or lengthening tendons. Advances in basic and clinical science and technology development are changing existing paradigms and offering renewed hope for improved functioning for children with CP who are currently facing a lifelong disability with unique challenges at each stage in life. PMID:19643348

Trends in statistical methods in articles published in Archives of Plastic Surgery between 2012 and 2017.

Science.gov (United States)

Han, Kyunghwa; Jung, Inkyung

2018-05-01

This review article presents an assessment of trends in statistical methods and an evaluation of their appropriateness in articles published in the Archives of Plastic Surgery (APS) from 2012 to 2017. We reviewed 388 original articles published in APS between 2012 and 2017. We categorized the articles that used statistical methods according to the type of statistical method, the number of statistical methods, and the type of statistical software used. We checked whether there were errors in the description of statistical methods and results. A total of 230 articles (59.3%) published in APS between 2012 and 2017 used one or more statistical method. Within these articles, there were 261 applications of statistical methods with continuous or ordinal outcomes, and 139 applications of statistical methods with categorical outcome. The Pearson chi-square test (17.4%) and the Mann-Whitney U test (14.4%) were the most frequently used methods. Errors in describing statistical methods and results were found in 133 of the 230 articles (57.8%). Inadequate description of P-values was the most common error (39.1%). Among the 230 articles that used statistical methods, 71.7% provided details about the statistical software programs used for the analyses. SPSS was predominantly used in the articles that presented statistical analyses. We found that the use of statistical methods in APS has increased over the last 6 years. It seems that researchers have been paying more attention to the proper use of statistics in recent years. It is expected that these positive trends will continue in APS.

Trends in a changing vascular practice environment for members of the Society for Vascular Surgery

Science.gov (United States)

Matthews, Mika A. B.; Satiani, Bhagwan; Lohr, Joann M.

2013-01-01

Objective To survey the Society for Vascular Surgery (SVS) membership with regard to practice trends related to work effort, employment status, practice ownership, endovascular cases, and anticipated changes in practice in the near future. Methods A survey questionnaire was developed to gather information about member demographics and practice, hours worked, full-time (FT) or part-time status, employment status, practice ownership, competition for referrals, proportion of endovascular vs open procedures, and anticipated changes in practice in the next 3 years. We used SurveyMonkey and distributed the survey to all active vascular surgeon (VS) members of the SVS. Results The response rate was 207 of 2230 (10.7%). Two thirds were in private practice, and 21% were in solo practice. Twenty-four percent were employed by hospitals/health systems. Those VS under the age of 50 years were more likely to exclusively practice vascular surgery compared with VS over the age of 50 years (P = .0003). Sixty-eight of the physicians (32.7%) were between 50 and 59 years old, 186 (90.3%) were men, 192 (92.8%) worked FT (>36 hours of patient care per week), and almost two thirds worked >60 hours per week. Those in physician-owned practices worked >40 hours of patient care per week more often than did FT employed VS (P = .012). Younger VS (age 50% of their workload being endovascular compared with older VS (age ≥50 years; P 40 hours of patient care per week than are FT employed VS. Longitudinal surveys of SVS members are imperative to help tailor educational, training, and practice management offerings, guide governmental activities, advocate for issues important to members, improve branding initiatives, and sponsor workforce analyses. PMID:23254185

Research on the Current Telecommuting Trends in United States and European Union Markets

Directory of Open Access Journals (Sweden)

Catalina Georgiana PICU

2016-12-01

Full Text Available In the context of globalization and due to the accelerated progress made in information and communication technology, more and more companies offer their employees the option of telecommuting. For the past twenty years, telecommuting has been on an asceding trend, an incresing number of people embracing the ability to work from home, using a computer and internet connection to communicate for their jobs. The goal of the paper is to explain the overall notion of telecommuting and to analyze the current trends in the United States and European Union markets. Another objective is to assess the advantages and disadvantages of telecommuting and the important role played by this concept within the striving purpose of corporations to achieve their strategic targets. The study is based upon specialized literature reviews regarding the emergence of telecommuting and the role it plays in organizations. A comparative analysis was conducted by the authors on two regional markets, United States and the European Union, in order to assess the trend in telecommuting and the factors that influence it. The outcome of the research shows that although the benefits of telecommuting are numerous, it does not come without challenges, both being applicable for both the employer, as well as for the employee. The research results of this study can be used by organizations when considering to offer their employees flexible work opportunities which can positively influence the long term business performance.

Trend of Changes in Serum Albumin and Its Relation with Sex, Age, and BMI Following Laparoscopic Mini-gastric Bypass Surgery in Morbid Obese Cases.

Science.gov (United States)

Karimi, Mehrdad; Kabir, Ali; Nejatifar, Masoumeh; Pazouki, Abdolreza

2018-03-01

The aim of this study is to investigate the pattern of changes in serum albumin level after mini-gastric bypass (MGB) and its association with gender, age, and body mass index (BMI) of the patients. This cohort study was conducted on 196 morbidly obese patients undergoing MGB followed for 1 year. The data on BMI, serum albumin level, demographic, anthropometric, biochemical variables and comorbidities were gathered before and after (3, 6, and 12 months) surgery. The trend of changes in BMI and serum albumin of the patients was investigated by repeated measures tests using general linear model (GLM) and generalized estimating equations (GEE) approaches. The mean age, baseline median BMI, and albumin of the patients were 41.34 ± 11.03 years, 44.54 kg/m 2 , and 4.00 g/dl, respectively. There was a chronologically significant trend of decline in BMI (P age grouping and baseline serum albumin level (P = 0.017 and 0.001, respectively). This trend had fluctuations in patients older than 40 years with baseline serum albumin level of 3.50-3.90 g/dl. For patients with any age and baseline serum albumin level of 4.00-4.90 g/dl, this trend was stable in all periods of follow-up. MGB is an effective technique to lose weight. The trend of changes in serum albumin level was affected by its baseline levels and age.

Does robotics improve minimally invasive rectal surgery? Functional and oncological implications.

Science.gov (United States)

Guerra, Francesco; Pesi, Benedetta; Amore Bonapasta, Stefano; Perna, Federico; Di Marino, Michele; Annecchiarico, Mario; Coratti, Andrea

2016-02-01

Robot-assisted surgery has been reported to be a safe and effective alternative to conventional laparoscopy for the treatment of rectal cancer in a minimally invasive manner. Nevertheless, substantial data concerning functional outcomes and long-term oncological adequacy is still lacking. We aimed to assess the current role of robotics in rectal surgery focusing on patients' functional and oncological outcomes. A comprehensive review was conducted to search articles published in English up to 11 September 2015 concerning functional and/or oncological outcomes of patients who received robot-assisted rectal surgery. All relevant papers were evaluated on functional implications such as postoperative sexual and urinary dysfunction and oncological outcomes. Robotics showed a general trend towards lower rates of sexual and urinary postoperative dysfunction and earlier recovery compared with laparoscopy. The rates of 3-year local recurrence, disease-free survival and overall survival of robotic-assisted rectal surgery compared favourably with those of laparoscopy. This study fails to provide solid evidence to draw definitive conclusions on whether robotic systems could be useful in ameliorating the outcomes of minimally invasive surgery for rectal cancer. However, the available data suggest potential advantages over conventional laparoscopy with reference to functional outcomes. © 2016 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.

Contemporary indications for transsphenoidal pituitary surgery.

Science.gov (United States)

Miller, Brandon A; Ioachimescu, Adriana G; Oyesiku, Nelson M

2014-12-01

To analyze current indications for transsphenoidal pituitary surgery. The current literature regarding transsphenoidal surgery for all subtypes of pituitary adenomas and other sellar lesions was examined. Alternate approaches for pituitary surgery were also reviewed. Transsphenoidal surgery continues to be the mainstay of surgical treatment for pituitary tumors, and has good outcomes in experienced hands. Pre- and postoperative management of pituitary tumors remains an important part of the treatment of patients with pituitary tumors. Even as medical and surgical treatment for pituitary tumors evolves, transsphenoidal surgery remains a mainstay of treatment. Outcomes after transshenoidal surgery have improved over time. Neurosurgeons must be aware of the indications, risks and alternatives to transsphenoidal pituitary surgery. Copyright © 2014 Elsevier Inc. All rights reserved.

Gamma knife surgery for craniopharyngioma

International Nuclear Information System (INIS)

Prasad, D.; Steiner, M.; Steiner, L.

1995-01-01

We present our results of Gamma Knife surgery for craniopharyngioma in nine patients. The current status of surgery, radiation therapy, intracavitary instillation of radionuclides and Gamma Knife surgery in the management of craniopharyngiomas is discussed. (author)

Racial and Ethnic Diversity of U.S. Plastic Surgery Trainees.

Science.gov (United States)

Silvestre, Jason; Serletti, Joseph M; Chang, Benjamin

Increased diversity of U.S. physicians can improve patient communication and mitigate health disparities for racial minorities. This study analyzes trends in racial and ethnic diversity of plastic surgery residents. Demographic data of surgical residents, medical students, and integrated plastic surgery residency applicants were obtained from the Association of American Medical Colleges. Data for college students and the general population were obtained from the U.S. Census for comparison with plastic surgery. Interspecialty differences and temporal trends in racial composition were analyzed with chi-square tests. From 1995 to 2014, Asian and Hispanic plastic surgery residents increased nearly 3-fold (7.4%-21.7%, p < 0.001) and 2-fold (4.6%-7.9%, p < 0.001), respectively. African American plastic surgery residents did not increase significantly (3.0%-3.5%, p = 0.129). Relative to the U.S. population, Hispanics (range: 0.1-0.5-fold) and African Americans (range: 0.1-0.4-fold) were underrepresented, whereas Asians (range: 2.2-5.3-fold) were overrepresented in plastic surgery. A "bottleneck" existed in the pipeline of African American and Hispanic plastic surgery residents. Significant differences in racial composition existed between plastic surgery and other surgical disciplines, which varied over time. The percentage of Hispanic (10.6% vs 7.0%, p = 0.402) and African American (6.4% vs 2.1%, p < 0.001) plastic surgery residency applicants exceeded those in residency. Hispanics and African Americans are underrepresented in plastic surgery residency relative to whites and Asians. This study underscores the need for greater initiatives to increase diversity in plastic surgery residency. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Current status of cardiovascular surgery in Japan 2013 and 2014: A report based on the Japan Cardiovascular Surgery Database. 2: Congenital heart surgery.

Science.gov (United States)

Hirata, Yasutaka; Hirahara, Norimichi; Murakami, Arata; Motomura, Noboru; Miyata, Hiroaki; Takamoto, Shinichi

2018-01-01

We analyzed the mortality and morbidity of congenital heart surgery in Japan using the Japan Cardiovascular Surgery Database (JCVSD). Data regarding congenital heart surgery performed between January 2013 and December 2014 were obtained from JCVSD. The 20 most frequent procedures were selected and the mortality rates and major morbidities were analyzed. The mortality rates of atrial septal defect repair and ventricular septal defect repair were less than 1%, and the mortality rates of tetralogy of Fallot repair, complete atrioventricular septal defect repair, bidirectional Glenn, and total cavopulmonary connection were less than 2%. The mortality rates of the Norwood procedure and total anomalous pulmonary venous connection repair were more than 10%. The rates of unplanned reoperation, pacemaker implantation, chylothorax, deep sternal infection, phrenic nerve injury, and neurological deficit were shown for each procedure. Using JCVSD, the national data for congenital heart surgery, including postoperative complications, were analyzed. Further improvements of the database and feedback for clinical practice are required.

Review: Current trends in coral transplantation – an approach to preserve biodiversity

Directory of Open Access Journals (Sweden)

ABDELNABY ORABI

2013-04-01

Full Text Available Ammar MSA,El-Gammal F, Nassar M, Belal A, Farag W, El-Mesiry G, El-Haddad K, Orabi A, Abdelreheem A, Shaaban A. 2013. Review: Current trends in coral transplantation – an approach to preserve biodiversity. Biodiversitas 14: 43-53. The increasing rates of coral mortality associated with the rise in stress factors and the lack of adequate recovery worldwide have urged recent calls for actions by the scientific, conservation, and reef management communities. This work reviews the current trends in coral transplantation. Transplantation of coral colonies or fragments, whether from aqua-, mariculture or harvesting from a healthy colony, has been the most frequently recommended action for increasing coral abundance on damaged or degraded reefs and for conserving listed or “at-risk” species. Phytoplanktons are important for providing transplanted corals with complex organic compounds through photosynthesis. Artificial surfaces like concrete blocks, wrecks or other purpose-designed structures can be introduced for larval settlement. New surfaces can also be created through electrolysis. Molecular biological tools can be used to select sites for rehabilitation by asexual recruits. Surface chemistry and possible inputs of toxic leachate from artificial substrates are considered as important factors affecting natural recruitment. Transplants should be carefully maintained , revisited and reattached at least weekly in the first month and at least fortnightly in the next three months. Studies on survivorship and the reproductive ability of transplanted coral fragments are important for coral reef restoration. A coral nursery may be considered as a pool for local species that supplies reef-managers with unlimited coral colonies for sustainable management. Transplanting corals for making artificial reefs can be useful for increasing biodiversity, providing tourist diving, fishing and surfing; creating new artisanal and commercial fishing opportunities

Current and future trends in marine image annotation software

Science.gov (United States)

Gomes-Pereira, Jose Nuno; Auger, Vincent; Beisiegel, Kolja; Benjamin, Robert; Bergmann, Melanie; Bowden, David; Buhl-Mortensen, Pal; De Leo, Fabio C.; Dionísio, Gisela; Durden, Jennifer M.; Edwards, Luke; Friedman, Ariell; Greinert, Jens; Jacobsen-Stout, Nancy; Lerner, Steve; Leslie, Murray; Nattkemper, Tim W.; Sameoto, Jessica A.; Schoening, Timm; Schouten, Ronald; Seager, James; Singh, Hanumant; Soubigou, Olivier; Tojeira, Inês; van den Beld, Inge; Dias, Frederico; Tempera, Fernando; Santos, Ricardo S.

2016-12-01

. Integration into available MIAS is currently limited to semi-automated processes of pixel recognition through computer-vision modules that compile expert-based knowledge. Important topics aiding the choice of a specific software are outlined, the ideal software is discussed and future trends are presented.

Development of a Pilot Telehealth Bariatric Surgery Support Group

Science.gov (United States)

Schofield, Carin K.

2013-01-01

The prevalence of obesity in the United States continues to grow. Bariatric surgery is becoming more common and accepted in the treatment of obesity. Clinical candidates for bariatric surgery should have a BMI > 40 kg/m[superscript 2] alone, or a BMI > 35 kg/m[superscript 2] plus one comorbidity. A trend is emerging in the literature showing…

Acromioclavicular dislocation: treatment and rehabilitation. Current perspectives and trends among Brazilian orthopedists☆

Science.gov (United States)

Arliani, Gustavo Gonçalves; Utino, Artur Yudi; Nishimura, Eduardo Misao; Terra, Bernardo Barcellos; Belangero, Paulo Santoro; Astur, Diego Costa

2015-01-01

Objective To evaluate the approaches and procedures used by Brazilian orthopedic surgeons in treatment and rehabilitation of acromioclavicular dislocation of the shoulder. Methods A questionnaire comprising eight closed questions that addressed topics relating to treatment and rehabilitation of acromioclavicular dislocation was applied to Brazilian orthopedic surgeons over the three days of the 45th Brazilian Congress of Orthopedics and Traumatology, in 2013. Results A total of 122 surgeons completely filled out the questionnaire and formed part of the sample analyzed. Most of them came from the southeastern region of the country. In this sample, 67% of the participants would choose surgical treatment for patients with grade 3 acromioclavicular dislocation. Regarding the preferred technique for surgical treatment of acute acromioclavicular dislocation, a majority of the surgeons used subcoracoid ligature with acromioclavicular fixation and transfer of the coracoacromial ligament (25.4%). Regarding complications found after surgery had been performed, 43.4% and 32.8% of the participants, respectively, stated that residual deformity of the operated joint and pain were the complications most seen during the postoperative period. Conclusions Although there was no consensus regarding the treatment and rehabilitation of acromioclavicular dislocation, evolution had occurred in some of the topics analyzed in this questionnaire applied to Brazilian orthopedists. However, further controlled prospective studies are needed in order to evaluate the clinical and scientific benefit of these trends. PMID:26535196

Acromioclavicular dislocation: treatment and rehabilitation. Current perspectives and trends among Brazilian orthopedists.

Science.gov (United States)

Arliani, Gustavo Gonçalves; Utino, Artur Yudi; Nishimura, Eduardo Misao; Terra, Bernardo Barcellos; Belangero, Paulo Santoro; Astur, Diego Costa

2015-01-01

To evaluate the approaches and procedures used by Brazilian orthopedic surgeons in treatment and rehabilitation of acromioclavicular dislocation of the shoulder. A questionnaire comprising eight closed questions that addressed topics relating to treatment and rehabilitation of acromioclavicular dislocation was applied to Brazilian orthopedic surgeons over the three days of the 45th Brazilian Congress of Orthopedics and Traumatology, in 2013. A total of 122 surgeons completely filled out the questionnaire and formed part of the sample analyzed. Most of them came from the southeastern region of the country. In this sample, 67% of the participants would choose surgical treatment for patients with grade 3 acromioclavicular dislocation. Regarding the preferred technique for surgical treatment of acute acromioclavicular dislocation, a majority of the surgeons used subcoracoid ligature with acromioclavicular fixation and transfer of the coracoacromial ligament (25.4%). Regarding complications found after surgery had been performed, 43.4% and 32.8% of the participants, respectively, stated that residual deformity of the operated joint and pain were the complications most seen during the postoperative period. Although there was no consensus regarding the treatment and rehabilitation of acromioclavicular dislocation, evolution had occurred in some of the topics analyzed in this questionnaire applied to Brazilian orthopedists. However, further controlled prospective studies are needed in order to evaluate the clinical and scientific benefit of these trends.

0 + 5 Vascular Surgery Residents' Operative Experience in General Surgery: An Analysis of Operative Logs from 12 Integrated Programs.

Science.gov (United States)

Smith, Brigitte K; Kang, P Chulhi; McAninch, Chris; Leverson, Glen; Sullivan, Sarah; Mitchell, Erica L

2016-01-01

Integrated (0 + 5) vascular surgery (VS) residency programs must include 24 months of training in core general surgery. The Accreditation Council for Graduate Medical Education currently does not require specific case numbers in general surgery for 0 + 5 trainees; however, program directors have structured this time to optimize operative experience. The aim of this study is to determine the case volume and type of cases that VS residents are exposed to during their core surgery training. Accreditation council for graduate medical education operative logs for current 0 + 5 VS residents were obtained and retrospectively reviewed to determine general surgery case volume and distribution between open and laparoscopic cases performed. Standard statistical methods were applied. A total of 12 integrated VS residency programs provided operative case logs for current residents. A total of 41 integrated VS residents in clinical years 2 through 5. During the postgraduate year-1 training year, residents participated in significantly more open than laparoscopic general surgery cases (p surgery cases are hernia repair (20%), skin and soft tissue (7.4%), and breast (6.3%). Residents in programs with core surgery over 3 years participated in significantly more general surgery operations compared with residents in programs with core surgery spread out over 4 years (p = 0.035). 0 + 5 VS residents perform significantly more open operations than laparoscopic operations during their core surgery training. The majority of these operations are minor, nonabdominal procedures. The 0 + 5 VS residency program general surgery operative training requirements should be reevaluated and case minimums defined. The general surgery training component of 0 + 5 VS residencies may need to be restructured to meet the needs of current and future trainees. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Current trends and controversies in the management of patients with splenic flexure tumours

Directory of Open Access Journals (Sweden)

Chan DS

2013-03-01

Full Text Available Aim: There exists a variation in practice in the management of tumours around the splenic flexure. We aim to determine the current opinion regarding the management of these tumours. Methods: An anonymised 10-part online questionnaire was sent to all members of the Association of Coloproctology of Great Britain and Ireland (ACPGBI. Results: The response rate was 24% (111/464 with approximately half of respondents performing laparoscopic surgery. Electively, an extended right hemicolectomy is the preferred option by 63% of respondents followed by left hemicolectomy (23% and segmental resection (14%. The upper sigmoid and rectosigmoid is the preferred site of anastomosis by 90% and 10% of respondents respectively. There were no significant differences in the type of operations performed by surgeons who practice laparoscopic or open surgery (p=0.10. A hand-sewn end-to-end anastomosis is most commonly performed (51% followed by a stapled side-to-side (36% and a stapled end-to-end (13% technique. Extended right hemicolectomy is also the preferred option in obstructing tumours. Of surgeons who perform segmental resections, 27% perform an on-table lavage and 9% perform a defunctioning stoma. Internal herniation following laparoscopic resection was only reported by a handful of surgeons. Conclusion: Opinion and practice in the management of patients with tumours around the splenic flexure are divided. Further trials are indicated to determine the best practice.

Recent Advances in Pancreatic Cancer Surgery of Relevance to the Practicing Pathologist

NARCIS (Netherlands)

van Rijssen, Lennart B.; Rombouts, Steffi J. E.; Walma, Marieke S.; Vogel, Jantien A.; Tol, Johanna A.; Molenaar, Isaac Q.; van Eijck, Casper H. J.; Verheij, Joanne; van de Vijver, Marc J.; Busch, Olivier R. C.; Besselink, Marc G. H.

2016-01-01

Recent advances in pancreatic surgery have the potential to improve outcomes for patients with pancreatic cancer. We address 3 new, trending topics in pancreatic surgery that are of relevance to the pathologist. First, increasing awareness of the prognostic impact of intraoperatively detected

Higher success rate with transcranial electrical stimulation of motor-evoked potentials using constant-voltage stimulation compared with constant-current stimulation in patients undergoing spinal surgery.

Science.gov (United States)

Shigematsu, Hideki; Kawaguchi, Masahiko; Hayashi, Hironobu; Takatani, Tsunenori; Iwata, Eiichiro; Tanaka, Masato; Okuda, Akinori; Morimoto, Yasuhiko; Masuda, Keisuke; Tanaka, Yuu; Tanaka, Yasuhito

2017-10-01

During spine surgery, the spinal cord is electrophysiologically monitored via transcranial electrical stimulation of motor-evoked potentials (TES-MEPs) to prevent injury. Transcranial electrical stimulation of motor-evoked potential involves the use of either constant-current or constant-voltage stimulation; however, there are few comparative data available regarding their ability to adequately elicit compound motor action potentials. We hypothesized that the success rates of TES-MEP recordings would be similar between constant-current and constant-voltage stimulations in patients undergoing spine surgery. The objective of this study was to compare the success rates of TES-MEP recordings between constant-current and constant-voltage stimulation. This is a prospective, within-subject study. Data from 100 patients undergoing spinal surgery at the cervical, thoracic, or lumbar level were analyzed. The success rates of the TES-MEP recordings from each muscle were examined. Transcranial electrical stimulation with constant-current and constant-voltage stimulations at the C3 and C4 electrode positions (international "10-20" system) was applied to each patient. Compound muscle action potentials were bilaterally recorded from the abductor pollicis brevis (APB), deltoid (Del), abductor hallucis (AH), tibialis anterior (TA), gastrocnemius (GC), and quadriceps (Quad) muscles. The success rates of the TES-MEP recordings from the right Del, right APB, bilateral Quad, right TA, right GC, and bilateral AH muscles were significantly higher using constant-voltage stimulation than those using constant-current stimulation. The overall success rates with constant-voltage and constant-current stimulations were 86.3% and 68.8%, respectively (risk ratio 1.25 [95% confidence interval: 1.20-1.31]). The success rates of TES-MEP recordings were higher using constant-voltage stimulation compared with constant-current stimulation in patients undergoing spinal surgery. Copyright © 2017

CALL FOR PAPERS: Special issue on Current Trends in Integrability and Nonlinear Phenomena Special issue on Current Trends in Integrability and Nonlinear Phenomena

Science.gov (United States)

Gómez-Ullate, D.; Lombardo, S.; Mañas, M.; Mazzocco, M.; Nijhoff, F.; Sommacal, M.

2009-12-01

may be found at www.iop.org/Journals/jphysa. Contributions to the special issue should if possible be submitted electronically by web upload at www.iop.org/Journals/jphysa, or by email to jphysa@iop.org, quoting 'JPhysA Special Issue: Current Trends in Integrability and Nonlinear Phenomena' Submissions should ideally be in standard LaTeX form. Please see the website for further information on electronic submissions. Authors unable to submit electronically may send hard-copy contributions to: Publishing Administrators, Journal of Physics A, IOP Publishing, Dirac House, Temple Back, Bristol BS1 6BE, UK. Please quote 'JPhysA Special Issue—Current Trends in Integrability and Nonlinear Phenomena'. All contributions should be accompanied by a read-me file or covering letter giving the postal and e-mail addresses for correspondence. The Publishing Office should be notified of any subsequent change of address. This special issue will be published in the paper and online version of the journal.

Current Status and Trend of Internet and E-Commerce Market in Korea

Institute of Scientific and Technical Information of China (English)

LEE Hongjoo; KIM Jongwoo; PARK Sungjoo

2004-01-01

After the remarkable increase of Internet users and broadband Internet subscribers at the end of the 20th century, the size of Korean Internet and e-commerce market steadily increased but the growth rate has been either stagnant or decreased. Trends of Korean Internet and e-commerce market are summarized in this paper the trends on Internet usage are introduced. Trends of online games, blogs and wireless Internet are introduced. The trends of Korean Internet market may have implications for China and Japan.

The Longitudinal Trend of Cardiac Surgery in Korea from 2003 to 2013

Directory of Open Access Journals (Sweden)

Kyeong Soo Lee

2016-12-01

Full Text Available Background: The purpose of this study was to investigate longitudinal changes of the utilization of operational and surgical medical care inside and outside a metropolitan area over 10 years, analyzing the residential areas of patients and the locations of medical facilities for major cardiovascular surgery. Methods: Data analysis was conducted by classifying the addresses of patients and the locations of medical care facilities of metropolitan cities and provinces, using data from the National Health Insurance Corporation from January 2003 to December 2013. Results: There is serious concentration of major heart surgery to medical facilities in Seoul; this problem has not improved over time. There were differences in percentages of surgical procedures performed in the metropolitan areas according to major diseases. In the case of Busan and Daegu provinces, at least 50% of the patients underwent surgery in medical facilities in the city, but there are other regions where the percentage is less than 50%. In the case of provinces, the percentage of surgical procedures performed in medical facilities in Seoul or nearby metropolitan cities is very high. Conclusion: Policies to strengthen the regional capabilities of heart surgery and to secure human resources are required to mitigate the concentration of patients in the capital area. Many regional multi-centers must be designated to minimize unnecessary competition among regional university hospitals and activate a win-win partnership model for medical services.

Current status and future trends of medical physics in Mexico

Science.gov (United States)

Azorin Nieto, J.

2015-01-01

Medical Physics is an area that applies the principles of physics to medicine, particularly in the prevention, diagnosis and treatment of diseases using ionizing and nonionizing radiation. The main attractive of medical physics is that it has a direct impact on the quality and safety of medical care in humans; this social component with direct implications for the population is of high value for Mexico. This paper describes the concepts of medical physics, trends and the current status of this discipline as a profession, which is directly related to the efforts of clinical research. It is also described what is, in my opinion, the future of medical physics in Mexico, emphasizing the fact that this field requires a substantial boost from universities and hospitals to recruit highly qualified young medical physicists and the support from government agencies such as Secretaria de Salud, Instituto Mexicano del Seguro Social and Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado through clinical research projects that allow the necessary evolution of medical physics into the hospital setting.

Current status and future trends of medical physics in Mexico

International Nuclear Information System (INIS)

Nieto, J Azorin

2015-01-01

Medical Physics is an area that applies the principles of physics to medicine, particularly in the prevention, diagnosis and treatment of diseases using ionizing and nonionizing radiation. The main attractive of medical physics is that it has a direct impact on the quality and safety of medical care in humans; this social component with direct implications for the population is of high value for Mexico. This paper describes the concepts of medical physics, trends and the current status of this discipline as a profession, which is directly related to the efforts of clinical research. It is also described what is, in my opinion, the future of medical physics in Mexico, emphasizing the fact that this field requires a substantial boost from universities and hospitals to recruit highly qualified young medical physicists and the support from government agencies such as Secretaria de Salud, Instituto Mexicano del Seguro Social and Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado through clinical research projects that allow the necessary evolution of medical physics into the hospital setting

Current Trends in Internet Usage and Cyber Crimes against Youth

Directory of Open Access Journals (Sweden)

Divya Bansal

2011-06-01

Full Text Available Based on a written survey, this paper examines the current trends in internet use and cyber crime against youth for a given set of demographic conditions and presents suggestions for related safety measures and precautions. A written survey of young internet users aged between 10 and 17 years was conducted in the schools of Chandigarh, India. It showed that nearly 84 percent of the youth surveyed have internet connectivity at their homes. Seventy percent of the youth surveyed use the internet for social networking, the majority of whom share photographs, videos and personal information online. Fifteen percent of the youth reported online harassment, and approximately 30 percent reported online interaction with unknown people. According to the youth surveyed, the parents or guardians of more than 90 percent know about their browsing habits. In most cases parents or guardians had talked to their children about internet safety and possible threats. Schools and parents/guardians should ensure that the children are aware of internet dangers, including the dangers of sharing personal information and trusting unknown people online, and regulate their browsing activities.

Type 2 Diabetes Mellitus: A Review of Current Trends

Directory of Open Access Journals (Sweden)

Abdulfatai B. Olokoba

2012-07-01

Full Text Available Type 2 diabetes mellitus (DM is a chronic metabolic disorder in which prevalence has been increasing steadily all over the world. As a result of this trend, it is fast becoming an epidemic in some countries of the world with the number of people affected expected to double in the next decade due to increase in ageing population, thereby adding to the already existing burden for healthcare providers, especially in poorly developed countries. This review is based on a search of Medline, the Cochrane Database of Systemic Reviews, and citation lists of relevant publications. Subject heading and key words used include type 2 diabetes mellitus, prevalence, current diagnosis, and current treatment. Only articles in English were included. Screening and diagnosis is still based on World Health Organization (WHO and American Diabetes Association (ADA criteria which include both clinical and laboratory parameters. No cure has yet been found for the disease; however, treatment modalities include lifestyle modifications, treatment of obesity, oral hypoglycemic agents, and insulin sensitizers like metformin, a biguanide that reduces insulin resistance, is still the recommended first line medication especially for obese patients. Other effective medications include non-sulfonylurea secretagogues, thiazolidinediones, alpha glucosidase inhibitors, and insulin. Recent research into the pathophysiology of type 2 DM has led to the introduction of new medications like glucagon-like peptide 1 analogoues: dipeptidyl peptidase-IV inhibitors, inhibitors of the sodium-glucose cotransporter 2 and 11ß-hydroxysteroid dehydrogenase 1, insulin-releasing glucokinase activators and pancreatic-G-protein-coupled fatty-acid-receptor agonists, glucagon-receptor antagonists, metabolic inhibitors of hepatic glucose output and quick-release bromocriptine. Inhaled insulin was licensed for use in 2006 but has been withdrawn from the market because of low patronage.

Current role of endovascular therapy in Marfan patients with previous aortic surgery

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Ibrahim Akin

2008-02-01

Full Text Available Ibrahim Akin, Stephan Kische, Tim C Rehders, Tushar Chatterjee, Henrik Schneider, Thomas Körber, Christoph A Nienaber, Hüseyin InceDepartment of Medicine, Division of Cardiology at the University Hospital Rostock, Rostock School of Medicine, Ernst-Heydemann-Str. 6, 18057 Rostock, GermanyAbstract: The Marfan syndrome is a heritable disorder of the connective tissue which affects the cardiovascular, ocular, and skeletal system. The cardiovascular manifestation with aortic root dilatation, aortic valve regurgitation, and aortic dissection has a prevalence of 60% to 90% and determines the premature death of these patients. Thirty-four percent of the patients with Marfan syndrome will have serious cardiovascular complications requiring surgery in the first 10 years after diagnosis. Before aortic surgery became available, the majority of the patients died by the age of 32 years. Introduction in the aortic surgery techniques caused an increase of the 10 year survival rate up to 97%. The purpose of this article is to give an overview about the feasibility and outcome of stent-graft placement in the descending thoracic aorta in Marfan patients with previous aortic surgery.Keywords: Marfan syndrome, aortic dissection, root replacement, stent-graft, previous aortic surgery

The Impact of Bariatric Surgery on Psychological Health

OpenAIRE

Kubik, Jeremy F.; Gill, Richdeep S.; Laffin, Michael; Karmali, Shahzeer

2013-01-01

Obesity is associated with a relatively high prevalence of psychopathological conditions, which may have a significant negative impact on the quality of life. Bariatric surgery is an effective intervention in the morbidly obese to achieve marked weight loss and improve physical comorbidities, yet its impact on psychological health has yet to be determined. A review of the literature identified a trend suggesting improvements in psychological health after bariatric surgery. Majority of mental ...

Review on the current trends in tongue diagnosis systems.

Science.gov (United States)

Jung, Chang Jin; Jeon, Young Ju; Kim, Jong Yeol; Kim, Keun Ho

2012-12-01

Tongue diagnosis is an essential process to noninvasively assess the condition of a patient's internal organs in traditional medicine. To obtain quantitative and objective diagnostic results, image acquisition and analysis devices called tongue diagnosis systems (TDSs) are required. These systems consist of hardware including cameras, light sources, and a ColorChecker, and software for color correction, segmentation of tongue region, and tongue classification. To improve the performance of TDSs, various types TDSs have been developed. Hyperspectral imaging TDSs have been suggested to acquire more information than a two-dimensional (2D) image with visible light waves, as it allows collection of data from multiple bands. Three-dimensional (3D) imaging TDSs have been suggested to provide 3D geometry. In the near future, mobile devices like the smart phone will offer applications for assessment of health condition using tongue images. Various technologies for the TDS have respective unique advantages and specificities according to the application and diagnostic environment, but this variation may cause inconsistent diagnoses in practical clinical applications. In this manuscript, we reviewed the current trends in TDSs for the standardization of systems. In conclusion, the standardization of TDSs can supply the general public and oriental medical doctors with convenient, prompt, and accurate information with diagnostic results for assessing the health condition.

Current use of navigation system in ACL surgery: a historical review.

Science.gov (United States)

Zaffagnini, S; Urrizola, F; Signorelli, C; Grassi, A; Di Sarsina, T Roberti; Lucidi, G A; Marcheggiani Muccioli, G M; Bonanzinga, T; Marcacci, M

2016-11-01

The present review aims to analyse the available literature regarding the use of navigation systems in ACL reconstructive surgery underling the evolution during the years. A research of indexed scientific papers was performed on PubMed and Cochrane Library database. The research was performed in December 2015 with no publication year restriction. Only English-written papers and related to the terms ACL, NAVIGATION, CAOS and CAS were considered. Two reviewers independently selected only those manuscripts that presented at least the application of navigation system for ACL reconstructive surgery. One hundred and forty-six of 394 articles were finally selected. In this analysis, it was possible to review the main uses of navigation system in ACL surgery including tunnel positioning for primary and revision surgery and kinematic assessment of knee laxity before and after different surgical procedures. In the early years, until 2006, navigation system was mainly used to improve tunnel positioning, but since the last decade, this tool has been principally used for kinematics evaluation. Increased accuracy of tunnel placement was observed using navigation surgery, especially, regarding femoral, 42 of 146 articles used navigation to guide tunnel positioning. During the following years, 82 of 146 articles have used navigation system to evaluate intraoperative knee kinematic. In particular, the importance of controlling rotatory laxity to achieve better surgical outcomes has been underlined. Several applications have been described and despite the contribution of navigation systems, its potential uses and theoretical advantages, there are still controversies about its clinical benefit. The present papers summarize the most relevant studies that have used navigation system in ACL reconstruction. In particular, the analysis identified four main applications of the navigation systems during ACL reconstructive surgery have been identified: (1) technical assistance for tunnel

A national review of the frequency of minimally invasive surgery among general surgery residents: assessment of ACGME case logs during 2 decades of general surgery resident training.

Science.gov (United States)

Richards, Morgan K; McAteer, Jarod P; Drake, F Thurston; Goldin, Adam B; Khandelwal, Saurabh; Gow, Kenneth W

2015-02-01

Minimally invasive surgery (MIS) has created a shift in how many surgical diseases are treated. Examining the effect on resident operative experience provides valuable insight into trends that may be useful for restructuring the requirements of resident training. To evaluate changes in general surgery resident operative experience regarding MIS. Retrospective review of the frequency of MIS relative to open operations among general surgery residents using the Accreditation Council for Graduate Medical Education case logs for academic years 1993-1994 through 2011-2012. General surgery residency training among accredited programs in the United States. We analyzed the difference in the mean number of MIS techniques and corresponding open procedures across training periods using 2-tailed t tests with statistical significance set at P surgery has an increasingly prominent role in contemporary surgical therapy for many common diseases. The open approach, however, still predominates in all but 5 procedures. Residents today must become efficient at performing multiple techniques for a single procedure, which demands a broader skill set than in the past.

New trends in minimally invasive urological surgery: what is beyond the robot?

Science.gov (United States)

Micali, Salvatore; Pini, Giovannalberto; Teber, Dogu; Sighinolfi, Maria Chiara; De Stefani, Stefano; Bianchi, Giampaolo; Rassweiler, Jens

2013-06-01

To review the minimal-invasive development of surgical technique in urology focusing on nomenclature, history and outcomes of Laparo-Endoscopic Single-site Surgery (LESS), Natural Orifice Translumenal Endoscopic Surgery (NOTES) and Computer-Assisted Surgery (CAS). A comprehensive literature search was conducted in order to find article related to LESS, NOTES and CAS in urology. The most relevant papers over the last 10 years were selected in base to the experience from the panel of experts, journal, authorship and/or content. Seven hundred and fifty manuscripts were found. Papers on LESS describe feasibility/safety in most of the procedures with a clinical experience of more than 300 cases and five compared results to standard laparoscopy without showing significant differences. NOTES accesses have been proved their feasibility/safety in experimental study. In human, the only procedures performed are on kidney and through a hybrid-Transvaginal route. New robots overcome the main drawbacks of the DaVinci® platform. The use of CAS is increasing its popularity in urology. LESS has been applied in clinical practice, but only ongoing technical and instrumental refinement will define its future role and overall benefit. The transition to a clinical application of NOTES seems at present only possible with multiple NOTES access and transvaginal access. Robot and Soft Tissue Navigation appear to be important to improve surgical skills. We are already witness to the advantages offered by the former even if costs need to be redefined based on pending long-term results. The latter will probably upgrade the quality of surgery in a near future.

Current Rates of Publication for Podium and Poster Presentations at the American Society for Surgery of the Hand Annual Meetings

Directory of Open Access Journals (Sweden)

Joshua M. Abzug

2014-09-01

 Currently, fewer than half of the studies presented at Annual Meetings of the ASSH achieve publication in peer-eviewed journals. Presentations are most likely to be published within 3 years, and almost half are published in Journal of Hand Surgery . 

Current aspects of perioperative fluid handling in vascular surgery

NARCIS (Netherlands)

Jacob, Matthias; Chappell, Daniel; Hollmann, Markus W.

2009-01-01

Purpose of review Perioperative fluid management influences patient outcome. Vascular surgery unites various surgical procedures, mainly with a high impact on patients who often have relevant preexisting illnesses. There are only scarce data on this specialty, forcing the clinician to extrapolate

Changes in utilization and peri-operative outcomes of bariatric surgery in large U.S. hospital database, 2011-2014.

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Lu Zhang

Full Text Available With the epidemic of morbid obesity, bariatric surgery has been accepted as one of the most effective treatments of obesity.To investigate recent changes in the utilization of bariatric surgery, patients and hospital characteristics, and in-hospital complications in a nationwide hospital database in the United States.This is a secondary data analysis of the Premier Perspective database.ICD-9 codes were used to identify bariatric surgeries performed between 2011 and 2014. Descriptive statistics were computed and regression was used.A total of 74,774 bariatric procedures were identified from 436 hospitals between 2011 and 2014. During this time period, the proportion of gastric bypass (from 44.8% to 31.3%; P for trend < 0.0001 and gastric banding (from 22.8% to 5.2%; P for trend < 0.0001 decreased, while the proportion of sleeve gastrectomy (from 13.7% to 56.9%; P for trend < 0.0001 increased substantially. The proportion of bariatric surgery performed for outpatients decreased from 17.15% in 2011 to 8.11% in 2014 (P for trend < 0.0001. The majority of patients undergoing surgery were female (78.5%, white (65.6%, younger than 65 years (93.8%, and insured with managed care (53.6%. In-hospital mortality rate and length of hospital stay remained stable. The majority of surgeries were performed in high-volume (71.8% and urban (91.6% hospitals.Results based on our study sample indicated that the popularity of various bariatric surgery procedures changed significantly from 2011 to 2014. While the rates of in-hospital complications were stable, disparities in the use of bariatric surgery regarding gender, race, and insurance still exist.

Trends in Weight Regain Following Roux-en-Y Gastric Bypass (RYGB) Bariatric Surgery.

Science.gov (United States)

Cooper, Timothy C; Simmons, Elizabeth B; Webb, Kirsten; Burns, James L; Kushner, Robert F

2015-08-01

The primary purpose of this study was to assess weight loss and occurrence of weight regain among patients who underwent Roux-en-Y gastric bypass (RYGB) using categorical analysis. Study participants were selected from patients who underwent RYGB from a single institution. Participants (n = 300, mean procedure age = 45.6 ± 9.9) completed surveys for self-reported preoperative weight, current weight, and subsequent weights over postoperative years. Measured weights and confirmed procedure dates were acquired from patient medical records. Mean preoperative weight and BMI were 140.8 kg ± 32.1 and 49.7 ± 9.9, respectively, and mean years since surgery was 6.9 ± 4.9. Study subjects were mostly Caucasian (56.7 %) and female (80.3 %). Participants were stratified a priori into four cohorts based on percent of weight loss at 1 year, 35 % (n = 113). General linear model analyses were conducted to assess the effect of year one weight loss on percent weight regain. The mean weight regain for all patients was 23.4 % of maximum weight loss. Using categorical analysis, mean weight regain in the 35 % weight loss cohorts was 29.1, 21.9, 20.9, and 23.8 %, respectively. Excessive weight regain, defined as ≥25 % of total lost weight, occurred in 37 % of patients. Weight gain is a common complication following RYGB surgery. Despite the percentage of weight loss over the first year, all cohort patient groups regained on average between 21 and 29 % of lost weight. Excessive weight gain was experienced by over one third of patients. Greater initial absolute weight loss leads to more successful long-term weight outcomes.

Current Trends in Retirement: Implications for Career Counseling and Vocational Psychology

Science.gov (United States)

Lytle, Megan C.; Clancy, Megan E.; Foley, Pamela F.; Cotter, Elizabeth W.

2015-01-01

This article provides an overview of emerging trends in retirement, examines demographic trends in the labor force, and provides practical recommendations for working with older workers across cultures (e.g., women and racial/ethnic minorities, and among others). Increasingly, older workers in the United States remain in the workforce for reasons…

A BRIEF ANALYSIS OF THE TOURISM SECTOR - CURRENT TRENDS AND ISSUES IN THE BULGARIAN TOURIST BUSINESS

Directory of Open Access Journals (Sweden)

Kostadin Valkov

2016-03-01

Full Text Available Thе analysis presented in current article deepens and summarizes the results of an economic study focused on the management of human resources in the sector "Tourism". The expected changes in organizational and technological terms are taken into account. The law on tourism in the Republic of Bulgaria and the types of taxes that directly and indirectly affect those employed in tourism are considered. Leading accents are the current trends and issues that arise from the lack of skilled workers in this sector and their deficit caused by the seasonal nature of employment. Growing gray economy is concerned as a major obstacle to development of the tourism industry and its future.

Robot-assisted surgery in gynecological oncology

DEFF Research Database (Denmark)

Kristensen, Steffen E; Mosgaard, Berit J; Rosendahl, Mikkel

2017-01-01

INTRODUCTION: Robot-assisted surgery has become more widespread in gynecological oncology. The purpose of this systematic review is to present current knowledge on robot-assisted surgery, and to clarify and discuss controversies that have arisen alongside the development and deployment. MATERIAL...... was performed by screening of titles and abstracts, and by full text scrutiny. From 2001 to 2016, a total of 76 references were included. RESULTS: Robot-assisted surgery in gynecological oncology has increased, and current knowledge supports that the oncological safety is similar, compared with previous...

Review on the current trends in tongue diagnosis systems

Directory of Open Access Journals (Sweden)

Chang Jin Jung

2012-12-01

Full Text Available Tongue diagnosis is an essential process to noninvasively assess the condition of a patient's internal organs in traditional medicine. To obtain quantitative and objective diagnostic results, image acquisition and analysis devices called tongue diagnosis systems (TDSs are required. These systems consist of hardware including cameras, light sources, and a ColorChecker, and software for color correction, segmentation of tongue region, and tongue classification. To improve the performance of TDSs, various types TDSs have been developed. Hyperspectral imaging TDSs have been suggested to acquire more information than a two-dimensional (2D image with visible light waves, as it allows collection of data from multiple bands. Three-dimensional (3D imaging TDSs have been suggested to provide 3D geometry. In the near future, mobile devices like the smart phone will offer applications for assessment of health condition using tongue images. Various technologies for the TDS have respective unique advantages and specificities according to the application and diagnostic environment, but this variation may cause inconsistent diagnoses in practical clinical applications. In this manuscript, we reviewed the current trends in TDSs for the standardization of systems. In conclusion, the standardization of TDSs can supply the general public and oriental medical doctors with convenient, prompt, and accurate information with diagnostic results for assessing the health condition.

Analytical Chemistry: A retrospective view on some current trends.

Science.gov (United States)

Niessner, Reinhard

2018-04-01

In a retrospective view some current trends in Analytical Chemistry are outlined and connected to work published more than a hundred years ago in the same field. For example, gravimetric microanalysis after specific precipitation, once the sole basis for chemical analysis, has been transformed into a mass-sensitive transducer in combination with compound-specific receptors. Molecular spectroscopy, still practising the classical absorption/emission techniques for detecting elements or molecules experiences a change to Raman spectroscopy, is now allowing analysis of a multitude of additional features. Chemical sensors are now used to perform a vast number of analytical measurements. Especially paper-based devices (dipsticks, microfluidic pads) celebrate a revival as they can potentially revolutionize medicine in the developing world. Industry 4.0 will lead to a further increase of sensor applications. Preceding separation and enrichment of analytes from complicated matrices remains the backbone for a successful analysis, despite increasing attempts to avoid clean-up. Continuous separation techniques will become a key element for 24/7 production of goods with certified quality. Attempts to get instantaneous and specific chemical information by optical or electrical transduction will need highly selective receptors in large quantities. Further understanding of ligand - receptor complex structures is the key for successful generation of artificial bio-inspired receptors. © 2018 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Minimally invasive orthognathic surgery.

Science.gov (United States)

Resnick, Cory M; Kaban, Leonard B; Troulis, Maria J

2009-02-01

Minimally invasive surgery is defined as the discipline in which operative procedures are performed in novel ways to diminish the sequelae of standard surgical dissections. The goals of minimally invasive surgery are to reduce tissue trauma and to minimize bleeding, edema, and injury, thereby improving the rate and quality of healing. In orthognathic surgery, there are two minimally invasive techniques that can be used separately or in combination: (1) endoscopic exposure and (2) distraction osteogenesis. This article describes the historical developments of the fields of orthognathic surgery and minimally invasive surgery, as well as the integration of the two disciplines. Indications, techniques, and the most current outcome data for specific minimally invasive orthognathic surgical procedures are presented.

Worldwide trends in surgical techniques in the treatment of esophageal and gastroesophageal junction cancer

NARCIS (Netherlands)

Haverkamp, L.; Seesing, M. F J; Ruurda, J. P.; Boone, J.; van Hillegersberg, R.

The aim of this study was to evaluate the worldwide trends in surgical techniques for esophageal cancer surgery by comparing it to our survey from 2007. In addition, new questions were added for gastroesophageal junction (GEJ) cancer. An international survey on surgery of esophageal and GEJ cancer

What the Current System Development Trends tell us about Systems Development Methodologies: Toward explaining SSDAM, Agile and IDEF0 Methodologies

Directory of Open Access Journals (Sweden)

Abdulla F. Ally

2015-03-01

Full Text Available Systems integration, customization and component based development approach are of increasing attention. This trend facilitates the research attention to also focus on systems development methodologies. The availability of systems development tools, rapid change in technologies, evolution of mobile computing and the growth of cloud computing have necessitated a move toward systems integration and customization rather than developing systems from scratch. This tendency encourages component based development and discourages traditional systems development approach. The paper presents and evaluates SSADM, IDEF0 and Agile systems development methodologies. More specifically, it examines how they fit or not fit into the current competitive market of systems development. In the view of this perspective, it is anticipated that despite of its popularity, SSADM methodology is becoming obsolete while Agile and IDEF0 methodologies are still gaining acceptance in the current competitive market of systems development. The present study more likely enrich our understanding of the systems development methodologies concepts and draw attention regarding where the current trends in system development are heading.

Global surgery: current evidence for improving surgical care.

Science.gov (United States)

Fuller, Jennifer C; Shaye, David A

2017-08-01

The field of global surgery is undergoing rapid transformation, owing to several recent prominent reports positioning it as a cost-effective means of relieving global disease burden. The purpose of this article is to review the recent advances in the field of global surgery. Efforts to grow the global surgical workforce and procedural capacity have focused on innovative methods to increase surgeon training, enhance international collaboration, leverage technology, optimize existing health systems, and safely implement task-sharing. Computer modeling offers a novel means of informing policy to optimize timely access to care, equitably promote health and financial protection, and efficiently grow infrastructure. Tools and checklists have recently been developed to enhance data collection and ensure methodologically rigorous publications to inform planning, benchmark surgical systems, promote accurate modeling, track key health indicators, and promote safety. Creation of institutional partnerships and trainee exchanges can enrich training, stimulate commitment to humanitarian work, and promote the equal exchange of ideas and expertise. The recent body of work creates a strong foundation upon which work toward the goal of universal access to safe, affordable surgical care can be built; however, further collection and analysis of country-specific data is necessary for accurate modeling and outcomes research into the efficacy of policies such as task-sharing is greatly needed.

Depth-time interpolation of feature trends extracted from mobile microelectrode data with kernel functions.

Science.gov (United States)

Wong, Stephen; Hargreaves, Eric L; Baltuch, Gordon H; Jaggi, Jurg L; Danish, Shabbar F

2012-01-01

Microelectrode recording (MER) is necessary for precision localization of target structures such as the subthalamic nucleus during deep brain stimulation (DBS) surgery. Attempts to automate this process have produced quantitative temporal trends (feature activity vs. time) extracted from mobile MER data. Our goal was to evaluate computational methods of generating spatial profiles (feature activity vs. depth) from temporal trends that would decouple automated MER localization from the clinical procedure and enhance functional localization in DBS surgery. We evaluated two methods of interpolation (standard vs. kernel) that generated spatial profiles from temporal trends. We compared interpolated spatial profiles to true spatial profiles that were calculated with depth windows, using correlation coefficient analysis. Excellent approximation of true spatial profiles is achieved by interpolation. Kernel-interpolated spatial profiles produced superior correlation coefficient values at optimal kernel widths (r = 0.932-0.940) compared to standard interpolation (r = 0.891). The choice of kernel function and kernel width resulted in trade-offs in smoothing and resolution. Interpolation of feature activity to create spatial profiles from temporal trends is accurate and can standardize and facilitate MER functional localization of subcortical structures. The methods are computationally efficient, enhancing localization without imposing additional constraints on the MER clinical procedure during DBS surgery. Copyright © 2012 S. Karger AG, Basel.

The Effect of Current Trends in Mobile Marketing on Traditional Marketing Communications and Customer Relationship Management

OpenAIRE

Hoffmann, Kristina

2011-01-01

As consumers increasingly prefer mobile devices as their main communication and entertainment channel, it becomes more and more important for marketers as well. Mobile marketing today does not only include sending SMS and E-mail but rather is becoming a whole new interactive, rich-media marketing channel with possibilities for direct engagement with ads and brands like never before. This research attempts to provide a greater understanding about the effects of current trends in mobile mark...

Regional anesthesia techniques for ambulatory orthopedic surgery.

LENUS (Irish Health Repository)

O'Donnell, Brian D

2012-02-03

PURPOSE OF REVIEW: The purpose of this review is to present advances in the use of regional anesthetic techniques in ambulatory orthopedic surgery. New findings regarding the use of both neuraxial anesthesia and peripheral nerve block are discussed. RECENT FINDINGS: Neuraxial anesthesia: The use of short-acting local anesthetic agents such as mepivacaine, 2-chloroprocaine, and articaine permits rapid onset intrathecal anesthesia with early recovery profiles. Advantages and limitations of these agents are discussed.Peripheral nerve block: Peripheral nerve blocks in limb surgery have the potential to transform this patient cohort into a truly ambulatory, self-caring group. Recent trends and evidence regarding the benefits of regional anesthesia techniques are presented.Continuous perineural catheters permit extension of improved perioperative analgesia into the ambulatory home setting. The role and reported safety of continuous catheters are discussed. SUMMARY: In summary, shorter acting, neuraxial, local anesthetic agents, specific to the expected duration of surgery, may provide superior recovery profiles in the ambulatory setting. A trend towards more peripheral and selective nerve blocks exists. The infrapatellar block is a promising technique to provide analgesia following knee arthroscopy. Improved analgesia seen in the perioperative period can be safely and effectively extended to the postoperative period with the use of perineural catheters.

Trends analysis of surgical procedures for cervical degenerative disc disease and myelopathy in patients with tobacco use disorder.

Science.gov (United States)

Grisdela, Phillip; Buser, Zorica; D'Oro, Anthony; Paholpak, Permsak; Liu, John C; Wang, Jeffrey C

2017-09-01

This study defined the incidence and trends of surgeries performed for patients with cervical disc degeneration with and without tobacco use disorder (TUD). This study utilized the Humana Inc. database between 2007 and 2013 to identify patients with cervical disc degeneration with or without myelopathy. International Classification of Diseases, ninth revision (ICD-9) and Current Procedural Terminology (CPT) codes determined the initial diagnosis of disc degeneration, myelopathy status and TUD, whether patients received surgery, and TUD status at surgery. The prevalence of disc degeneration with myelopathy increased by 32.8% between 2007 and 2013, while disc disease with myelopathy and TUD increased by 91.6%. For patients without myelopathy, the prevalence of disc degeneration alone increased by 65.4%, and disc degeneration with myelopathy increased by 148.7%. Of myelopathy patients, 1717 (6.4%) had TUD and 1024 (59.6%) received surgery, compared to 6508 patients without TUD (26.1%). For patients without myelopathy, 11,337 (3.5%) had TUD and 787 (6.9%) underwent surgery, compared to 9716 patients (3%) without TUD. Of surgical patients, 781 (76.3%) with myelopathy and TUD still had a TUD diagnosis at surgery, and 542 (68.9%) of patients without myelopathy still had a TUD diagnosis at surgery. The prevalence of degenerative disc disease and TUD has increased more than disc disease alone. Patients with TUD were more likely to get surgery, and to have surgeries earlier than patients without TUD. Patients with TUD at the time of the diagnosis of their disc degeneration likely still had a TUD diagnosis at the time of surgery.

[Is the structure of surgical clinics in Germany changing? A current investigation into the structure of surgical clinics in the Federal Republic of Germany].

Science.gov (United States)

Lob, G; Lob, T; Bauer, H; Niethard, F; Polonius, J; Siebert, H

2009-04-01

Medical developments have led to extensive specialization in the field of surgery. This has already been reflected for many years in altered structure and organization forms of surgical clinics. Indispensable quality standards, statutory general conditions, increasing competition in service providers and health insurance with transparency of the service procedure all intensify this trend. The aim of this investigation was, therefore, to determine how far this differentiation of service supply in the field of surgery is also reflected in the area and in surgical departments and clinics of basic and routine supply. To achieve this, all available published information on the structure and organization of surgical clinics in the Federal Republic of Germany was classified according to current departmentalization into "undivided" or general/visceral surgery facilities compared to orthopedic/trauma surgery departments.

Pacemaker Dependency after Cardiac Surgery: A Systematic Review of Current Evidence.

Science.gov (United States)

Steyers, Curtis M; Khera, Rohan; Bhave, Prashant

2015-01-01

Severe postoperative conduction disturbances requiring permanent pacemaker implantation frequently occur following cardiac surgery. Little is known about the long-term pacing requirements and risk factors for pacemaker dependency in this population. We performed a systematic review of the literature addressing rates and predictors of pacemaker dependency in patients requiring permanent pacemaker implantation after cardiac surgery. Using a comprehensive search of the Medline, Web of Science and EMBASE databases, studies were selected for review based on predetermined inclusion and exclusion criteria. A total of 8 studies addressing the endpoint of pacemaker-dependency were identified, while 3 studies were found that addressed the recovery of atrioventricular (AV) conduction endpoint. There were 10 unique studies with a total of 780 patients. Mean follow-up ranged from 6-72 months. Pacemaker dependency rates ranged from 32%-91% and recovery of AV conduction ranged from 16%-42%. There was significant heterogeneity with respect to the definition of pacemaker dependency. Several patient and procedure-specific variables were found to be independently associated with pacemaker dependency, but these were not consistent between studies. Pacemaker dependency following cardiac surgery occurs with variable frequency. While individual studies have identified various perioperative risk factors for pacemaker dependency and non-resolution of AV conduction disease, results have been inconsistent. Well-conducted studies using a uniform definition of pacemaker dependency might identify patients who will benefit most from early permanent pacemaker implantation after cardiac surgery.

Increasing Utilization Of Pediatric Epilepsy Surgery In The United States Between 1997 and 2009

Science.gov (United States)

Pestana Knight, Elia M.; Schiltz, Nicholas K.; Bakaki, Paul M.; Koroukian, Siran M.; Lhatoo, Samden D.; Kaiboriboon, Kitti

2014-01-01

SUMMARY OBJECTIVE To examine national trends of pediatric epilepsy surgery usage in the United States between 1997 and 2009. METHODS We performed a serial cross-sectional study of pediatric epilepsy surgery using triennial data from the Kids’ Inpatient Database from 1997 to 2009. The rates of epilepsy surgery for lobectomies, partial lobectomies, and hemispherectomies in each study year were calculated based on the number of prevalent epilepsy cases in the corresponding year. The age-race-sex adjusted rates of surgeries were also estimated. Mann-Kendall trend test was used to test for changes in the rates of surgeries over time. Multivariable regression analysis was also performed to estimate the effect of time, age, race, and sex on the annual incidence of epilepsy surgery. RESULTS The rates of pediatric epilepsy surgery significantly increased from 0.85 epilepsy surgeries per 1,000 children with epilepsy in 1997 to 1.44 epilepsy surgeries per 1,000 children with epilepsy in 2009. An increment in the rates of epilepsy surgeries was noted across all age groups, in boys and girls, all races, and all payer types. The rate of increase was lowest in blacks and in children with public insurance. The overall number of surgical cases for each study year was lower than 35% of children who were expected to have surgery, based on the estimates from the Connecticut Study of Epilepsy. SIGNIFICANCE In contrast to adults, pediatric epilepsy surgery numbers have increased significantly in the past decade. However, epilepsy surgery remains an underutilized treatment for children with epilepsy. In addition, black children and those with public insurance continue to face disparities in the receipt of epilepsy surgery. PMID:25630252

Current trends in local antibacterial therapy of periprosthetic infection and osteomyelitis

Directory of Open Access Journals (Sweden)

S. A. Bozhkova

2015-01-01

Full Text Available The rational use of antibiotics in the treatment of orthopedic infection still presents a significant problem. Local antibiotic delivery systems enable to achieve effective concentrations of drugs in the focus of bone infection without the development of toxicity. It is the important accompaniment to systemic antibiotics in the treatment of periprosthetic infection and osteomyelitis. The data collected through the PubMed and eLIBRARY databases (http://www.ncbi.nlm. nih.gov/pubmed, 1995-2015; http://elibrary.ru, 2005-2015 years present the information about bone substitutes used for local antibiotic therapy in scientific investigations and in clinical practice. The information is submitted in accordance with the groups of materials: cements based on polymethylmethacrylate, bone grafts, demineralized bone matrix, bioceramics, natural and synthetic polymers, combined antibiotic delivery systems. The majority of these materials have only been studied experimentally and only a limited range of them is registered for use in clinical practice. Informing orthopedic surgeons about current methods of local antibiotic use is the key to the development of a modern integrated approach to the therapy of infectious complications after orthopedic surgery.

Sustainable Biomaterials: Current Trends, Challenges and Applications.

Science.gov (United States)

Kumar Gupta, Girish; De, Sudipta; Franco, Ana; Balu, Alina Mariana; Luque, Rafael

2015-12-30

Biomaterials and sustainable resources are two complementary terms supporting the development of new sustainable emerging processes. In this context, many interdisciplinary approaches including biomass waste valorization and proper usage of green technologies, etc., were brought forward to tackle future challenges pertaining to declining fossil resources, energy conservation, and related environmental issues. The implementation of these approaches impels its potential effect on the economy of particular countries and also reduces unnecessary overburden on the environment. This contribution aims to provide an overview of some of the most recent trends, challenges, and applications in the field of biomaterials derived from sustainable resources.

Sustainable Biomaterials: Current Trends, Challenges and Applications

Directory of Open Access Journals (Sweden)

Girish Kumar Gupta

2015-12-01

Full Text Available Biomaterials and sustainable resources are two complementary terms supporting the development of new sustainable emerging processes. In this context, many interdisciplinary approaches including biomass waste valorization and proper usage of green technologies, etc., were brought forward to tackle future challenges pertaining to declining fossil resources, energy conservation, and related environmental issues. The implementation of these approaches impels its potential effect on the economy of particular countries and also reduces unnecessary overburden on the environment. This contribution aims to provide an overview of some of the most recent trends, challenges, and applications in the field of biomaterials derived from sustainable resources.

Improving Quality in Colorectal Surgery

NARCIS (Netherlands)

J.C. Slieker (Juliette)

2014-01-01

markdownabstract__Abstract__ Colorectal surgery is an important aspect of our current health system, due to the high incidence of colorectal cancer combined with an ageing population, improved long-term outcomes after colorectal surgery, and the perfectioning of the operative and postoperative

Annals of African Surgery

African Journals Online (AJOL)

The goal of the Annals of African Surgery is to provide a medium for the exchange of current information between surgeons in the African region. The journal embraces surgery in all its aspects; basic science, clinical research, experimental research, surgical education. It will assist surgeons in the region to keep abreast of ...

Critical analysis of the literature investigating urogenital function preservation following robotic rectal cancer surgery

Institute of Scientific and Technical Information of China (English)

Sofoklis; Panteleimonitis; Jamil; Ahmed; Mick; Harper; Amjad; Parvaiz

2016-01-01

AIM To analyses the current literature regarding the urogenital functional outcomes of patients receiving robotic rectal cancer surgery. METHODS A comprehensive literature search of electronic databases was performed in October 2015. The following search terms were applied: 'rectal cancer' or 'colorectal cancer' and robot* or 'da Vinci' and sexual or urolog* or urinary or erect* or ejaculat* or impot* or incontinence. All original studies examining the urological and/or sexual outcomes of male and/or female patients receiving robotic rectal cancer surgery were included. Reference lists of all retrieved articles were manually searched for further relevant articles. Abstracts were independently searched by two authors. RESULTS Fifteen original studies fulfilled the inclusion criteria. A total of 1338 patients were included; 818 received robotic, 498 laparoscopic and 22 open rectal cancer surgery. Only 726(54%) patients had their urogenital function assessed via means of validated functional questionnaires. From the included studies, three found that robotic rectal cancer surgery leads to quicker recovery of male urological function and five of male sexual function as compared to laparoscopic surgery. It is unclear whether robotic surgery offers favourable urogenital outcomes in the long run for males. In female patients only two studies assessed urological and threesexual function independently to that of males. In these studies there was no difference identified between patients receiving robotic and laparoscopic rectal cancer surgery. However, in females the presented evidence was very limited making it impossible to draw any substantial conclusions. CONCLUSION There seems to be a trend towards earlier recovery of male urogenital function following robotic surgery. To evaluate this further, larger well designed studies are required.

Critical analysis of the literature investigating urogenital function preservation following robotic rectal cancer surgery

Institute of Scientific and Technical Information of China (English)

Sofoklis; Panteleimonitis[1,2; Jamil; Ahmed[1; Mick; Harper[2; Amjad; Parvaiz[1,2

2016-01-01

AIM To analyses the current literature regarding the urogenital functional outcomes of patients receiving robotic rectal cancer surgery.METHODS A comprehensive literature search of electronic databases was performed in October 2015. The following search terms were applied: “rectal cancer” or “colorectal cancer” and robot* or “da Vinci” and sexual or urolog* or urinary or erect* or ejaculat* or impot* or incontinence.All original studies examining the urological and/or sexual outcomes of male and/or female patients receiving robotic rectal cancer surgery were included. Reference lists of all retrieved articles were manually searched for further relevant articles. Abstracts were independently searched by two authors.RESULTS Fifteen original studies fulfilled the inclusion criteria.A total of 1338 patients were included; 818 received robotic, 498 laparoscopic and 22 open rectal cancer surgery. Only 726 (54%) patients had their urogenital function assessed via means of validated functional questionnaires. From the included studies, three found that robotic rectal cancer surgery leads to quicker recovery of male urological function and five of male sexual function as compared to laparoscopic surgery.It is unclear whether robotic surgery offers favourable urogenital outcomes in the long run for males. In female patients only two studies assessed urological and three sexual function independently to that of males. In these studies there was no difference identified between patients receiving robotic and laparoscopic rectal cancer surgery. However, in females the presented evidence was very limited making it impossible to draw any substantial conclusions.CONCLUSION There seems to be a trend towards earlier recovery of male urogenital function following robotic surgery. To evaluate this further, larger well designed studies are required.

Current Practices and Barriers to the Integration of Oncoplastic Breast Surgery: A Canadian Perspective.

Science.gov (United States)

Maxwell, Jessica; Roberts, Amanda; Cil, Tulin; Somogyi, Ron; Osman, Fahima

2016-10-01

Despite the safety and popularity of oncoplastic surgery, there is limited data examining utilization and barriers associated with its incorporation into practice. This study examines the use of oncoplastic techniques in breast conserving surgery and determines the barriers associated with their implementation. A 13-item survey was mailed to all registered general surgeons in Ontario, Canada. The survey assessed surgeon demographics, utilization of specific oncoplastic techniques, and perceived barriers. A total of 234 survey responses were received, representing a response rate of 32.2 % (234 of 725). Of the respondents, 166 surgeons (70.9 %) reported a practice volume of at least 25 % breast surgery. Comparison was made between general surgeons performing oncoplastic breast surgery (N = 79) and those who did not use these techniques (N = 87). Surgeon gender, years in practice, fellowship training, and access to plastic surgery were similar across groups. Both groups rated the importance of breast cosmesis similarly. General surgeons with a practice volume involving >50 % breast surgery were more likely to use oncoplastic techniques (OR 8.82, p < .001) and involve plastic surgeons in breast conserving surgery (OR 2.21, p = .02). For surgeons not performing oncoplastic surgery, a lack of training and access to plastic surgeons were identified as significant barriers. For those using oncoplastic techniques, the absence of specific billing codes was identified as a limiting factor. Lack of training, access to plastic surgeons, and absence of appropriate reimbursement for these cases are significant barriers to the adoption of oncoplastic techniques.

Innovations in surgery simulation: a review of past, current and future techniques.

Science.gov (United States)

Badash, Ido; Burtt, Karen; Solorzano, Carlos A; Carey, Joseph N

2016-12-01

As a result of recent work-hours limitations and concerns for patient safety, innovations in extraclinical surgical simulation have become a desired part of residency education. Current simulation models, including cadaveric, animal, bench-top, virtual reality (VR) and robotic simulators are increasingly used in surgical training programs. Advances in telesurgery, three-dimensional (3D) printing, and the incorporation of patient-specific anatomy are paving the way for simulators to become integral components of medical training in the future. Evidence from the literature highlights the benefits of including simulations in surgical training; skills acquired through simulations translate into improvements in operating room performance. Moreover, simulations are rapidly incorporating new medical technologies and offer increasingly high-fidelity recreations of procedures. As a result, both novice and expert surgeons are able to benefit from their use. As dedicated, structured curricula are developed that incorporate simulations into daily resident training, simulated surgeries will strengthen the surgeon's skill set, decrease hospital costs, and improve patient outcomes.

Current use of imaging and electromagnetic source localization procedures in epilepsy surgery centers across Europe.

Science.gov (United States)

Mouthaan, Brian E; Rados, Matea; Barsi, Péter; Boon, Paul; Carmichael, David W; Carrette, Evelien; Craiu, Dana; Cross, J Helen; Diehl, Beate; Dimova, Petia; Fabo, Daniel; Francione, Stefano; Gaskin, Vladislav; Gil-Nagel, Antonio; Grigoreva, Elena; Guekht, Alla; Hirsch, Edouard; Hecimovic, Hrvoje; Helmstaedter, Christoph; Jung, Julien; Kalviainen, Reetta; Kelemen, Anna; Kimiskidis, Vasilios; Kobulashvili, Teia; Krsek, Pavel; Kuchukhidze, Giorgi; Larsson, Pål G; Leitinger, Markus; Lossius, Morten I; Luzin, Roman; Malmgren, Kristina; Mameniskiene, Ruta; Marusic, Petr; Metin, Baris; Özkara, Cigdem; Pecina, Hrvoje; Quesada, Carlos M; Rugg-Gunn, Fergus; Rydenhag, Bertil; Ryvlin, Philippe; Scholly, Julia; Seeck, Margitta; Staack, Anke M; Steinhoff, Bernhard J; Stepanov, Valentin; Tarta-Arsene, Oana; Trinka, Eugen; Uzan, Mustafa; Vogt, Viola L; Vos, Sjoerd B; Vulliémoz, Serge; Huiskamp, Geertjan; Leijten, Frans S S; Van Eijsden, Pieter; Braun, Kees P J

2016-05-01

In 2014 the European Union-funded E-PILEPSY project was launched to improve awareness of, and accessibility to, epilepsy surgery across Europe. We aimed to investigate the current use of neuroimaging, electromagnetic source localization, and imaging postprocessing procedures in participating centers. A survey on the clinical use of imaging, electromagnetic source localization, and postprocessing methods in epilepsy surgery candidates was distributed among the 25 centers of the consortium. A descriptive analysis was performed, and results were compared to existing guidelines and recommendations. Response rate was 96%. Standard epilepsy magnetic resonance imaging (MRI) protocols are acquired at 3 Tesla by 15 centers and at 1.5 Tesla by 9 centers. Three centers perform 3T MRI only if indicated. Twenty-six different MRI sequences were reported. Six centers follow all guideline-recommended MRI sequences with the proposed slice orientation and slice thickness or voxel size. Additional sequences are used by 22 centers. MRI postprocessing methods are used in 16 centers. Interictal positron emission tomography (PET) is available in 22 centers; all using 18F-fluorodeoxyglucose (FDG). Seventeen centers perform PET postprocessing. Single-photon emission computed tomography (SPECT) is used by 19 centers, of which 15 perform postprocessing. Four centers perform neither PET nor SPECT in children. Seven centers apply magnetoencephalography (MEG) source localization, and nine apply electroencephalography (EEG) source localization. Fourteen combinations of inverse methods and volume conduction models are used. We report a large variation in the presurgical diagnostic workup among epilepsy surgery centers across Europe. This diversity underscores the need for high-quality systematic reviews, evidence-based recommendations, and harmonization of available diagnostic presurgical methods. Wiley Periodicals, Inc. © 2016 International League Against Epilepsy.

Current research and development trends in floristic geography

OpenAIRE

Hang Sun; Tao Deng; Yongsheng Chen; Zhuo Zhou

2017-01-01

This paper summarizes the research status, existing issues, and trends in floristic geography. There is now a wealth of research accumulation on floristic investigations, distribution types of genera, floristic regions, and regional floristic analysis. It is also noted that most of these studies utilize simple statistical analyses, comparative studies, traditional methods, and single subjects, to provide a basic understanding and description of the floristic phenomenon, which is lacking spati...

Social media in vascular surgery.

Science.gov (United States)

Indes, Jeffrey E; Gates, Lindsay; Mitchell, Erica L; Muhs, Bart E

2013-04-01

There has been a tremendous growth in the use of social media to expand the visibility of various specialties in medicine. The purpose of this paper is to describe the latest updates on some current applications of social media in the practice of vascular surgery as well as existing limitations of use. This investigation demonstrates that the use of social networking sites appears to have a positive impact on vascular practice, as is evident through the incorporation of this technology at the Cleveland Clinic and by the Society for Vascular Surgery into their approach to patient care and physician communication. Overall, integration of social networking technology has current and future potential to be used to promote goals, patient awareness, recruitment for clinical trials, and professionalism within the specialty of vascular surgery. Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

Do Modic changes have an impact on clinical outcome in lumbar spine surgery?

DEFF Research Database (Denmark)

Laustsen, Aske Foldbjerg; Bech-Azeddine, Rachid

2016-01-01

= 607), 1 fusion versus discectomy (n = 91), 3 fusion surgery (n = 454), and 4 total disc replacement (TDR, n = 500). A trend toward less improvement in low back pain or Oswestry Disability Index score was found in the discectomy studies, and a trend toward increased improvement was demonstrated...

Robotic-assisted surgery in ophthalmology.

Science.gov (United States)

de Smet, Marc D; Naus, Gerrit J L; Faridpooya, Koorosh; Mura, Marco

2018-05-01

Provide an overview of the current landscape of robotics in ophthalmology, including the pros and cons of system designs, the clinical development path, and the likely future direction of the field. Robots designed for eye surgery should meet certain basic requirements. Three designs are currently being developed: smart surgical tools such as the steady hand, comanipulation devices and telemanipulators using either a fixed or virtual remote center of motion. Successful human intraocular surgery is being performed using the Preceyes surgical system. Another telemanipulation robot, the da Vinci Surgical System, has been used to perform a pterygium repair in humans and was successful in ex-vivo corneal surgery despite its nonophthalmic design. Apart from Preceyes' BV research platform, none of the currently eye-specific systems has reached a commercial stage. Systems are likely to evolve from robotic assistance during specific procedural steps to semiautonomous surgery, as smart sensors are introduced to enhance the basic functionalities of robotic systems. Robotics is still in its infancy in ophthalmology but is rapidly reaching a stage wherein it will be introduced into everyday ophthalmic practice. It will most likely be introduced first for demanding vitreo-retinal procedures, followed by anterior segment applications.

Current trends in the implementation of IAEA safeguards

International Nuclear Information System (INIS)

Adamson, A.; Bychkov, V.

1993-01-01

A practical goal, embodying the principle that a minimum amount of material is required in order to manufacture a nuclear explosive device, is that safeguards activities should enable the timely detection of the diversion of a significant quantity of nuclear material. It is important to note that the safeguards activities are not restricted to the International Atomic Energy Agency (the agency) but impose obligations on both state (and consequently on facility operators) and the agency. The beneficiaries are member states of the world community which have enhanced confidence in the competence and probity of states with safeguards agreements. Neither safeguards nor the nuclear industry have remained stationary. As new techniques have been developed, they have found applications, and as new challenges were encountered, the system has responded, for example, through improved measurements; through new or improved techniques for the operator, state or agency; and through new regulations. This paper details approaches, procedures and techniques developed for new complex nuclear facilities. Trends toward increase efficiency and effectiveness, and developments leading to more automated analysis and collection of data and the development of nondestructive assay methods are examined. Also important are trends in the presentation of safeguards results to the states and the general public

Primary energy use for heating in the Swedish building sector-Current trends and proposed target

International Nuclear Information System (INIS)

Johansson, P.; Nylander, A.; Johnsson, F.

2007-01-01

One goal of the Swedish energy policy is to reduce the amount of electricity used for heating in the building sector. This means to reduce the primary energy used for heating which in this paper is analyzed in the context of various heating technologies and CO 2 emissions. The analysis is applied to a region in Sweden (southern Sweden) for which detailed information on the energy infrastructure (the capital stock of the buildings and heating systems together with geographical variations in heat intensity) is available from a previous work [Johansson, P., Nylander, A., Johnsson, F., 2005. Electricity dependency and CO 2 emissions from heating in the Swedish building sector-current trends in conflict with governmental policy? Energy policy] and which is large enough to be assumed representative for Sweden as a whole. The detailed mapping of the energy infrastructure allows a good estimate on the rate at which the energy system can be expected to be replaced with respect to economical lifetime of the capital stock (the year 2025 in this case). Two scenarios are investigated; a target scenario for which energy savings are employed (e.g. improving climate shell in buildings) and oil and most of the electricity used for heating purposes are phased out and a second for which the current trend in the heating market continues. In the target scenario it is shown that although only applying commercially competitive heating technologies, it is possible to achieve a 47% reduction in primary energy use for heating with a 34% decrease in heat demand together with significant reduction in CO 2 emissions. However, the scenario which continues the current trends on the heating market instead yields an increase (of about 10%) in primary energy use (reduction in conversion efficiency) of the heating system of the region over the period studied, in spite of a slight decrease in heat demand (9%, mainly due to energy efficiency measures) as well as in CO 2 emissions. In light of the

Intraoperative Image Guidance in Neurosurgery: Development, Current Indications, and Future Trends

International Nuclear Information System (INIS)

Schulz, Ch.; Mauer, U.M.; Waldeck, S.

2012-01-01

Introduction. As minimally invasive surgery becomes the standard of care in neurosurgery, it is imperative that surgeons become skilled in the use of image-guided techniques. The development of image-guided neurosurgery represents a substantial improvement in the microsurgical treatment of tumors, vascular malformations, and other intracranial lesions. Objective. There have been numerous advances in neurosurgery which have aided the neurosurgeon to achieve accurate removal of pathological tissue with minimal disruption of surrounding healthy neuronal matter including the development of microsurgical, endoscopic, and endovascular techniques. Neuro navigation systems and intraoperative imaging should improve success in cranial neurosurgery. Additional functional imaging modalities such as PET, SPECT, DTI (for fiber tracking), and fMRI can now be used in order to reduce neurological deficits resulting from surgery; however the positive long-term effect remains questionable for many indications. Method. Pub Med database search using the search term “image guided neurosurgery.” More than 1400 articles were published during the last 25 years. The abstracts were scanned for prospective comparative trials. Results and Conclusion. 14 comparative trials are published. To date significant data amount show advantages in intraoperative accuracy influencing the perioperative morbidity and long-term outcome only for cerebral glioma surgery.

Current trends in Irish perinatal mortality.

LENUS (Irish Health Repository)

Mahony, R

2010-06-01

This was a retrospective review of normally formed perinatal deaths among 176,620 births at the National Maternity Hospital (1984-2007). Prelabor stillbirths were categorised by presumed cause of death including unexplained, intrauterine growth retardation (IUGR), placental abruption, red cell alloimmunisation (RCA) and deaths related to prematurity. Peripartum deaths included intrapartum and first week neonatal deaths. The post-mortem rate, initially almost 100%, fell to 60%. Data were analysed using the Mantel-Haenszel chi square test for trends. In the study period there was a significant reduction in the PNM, largely because of a fall in death related to prematurity, term peripartum death, death at 42 weeks or greater, placental abruption, death related to IUGR and RCA (P < 0.01). Overall the unexplained still birth rate was unchanged throughout the study period (p = 0.8) despite a highly significant (p < 0.001) increase in obstetric intervention particularly induction of labor and caesarean section.

Research trend in thermally stimulated current method for development of materials and devices in Japan

Science.gov (United States)

Iwamoto, Mitsumasa; Taguchi, Dai

2018-03-01

Thermally stimulated current (TSC) measurement is widely used in a variety of research fields, i.e., physics, electronics, electrical engineering, chemistry, ceramics, and biology. TSC is short-circuit current that flows owing to the displacement of charges in samples during heating. TSC measurement is very simple, but TSC curves give very important information on charge behaviors. In the 1970s, TSC measurement contributed greatly to the development of electrical insulation engineering, semiconductor device technology, and so forth. Accordingly, the TSC experimental technique and its analytical method advanced. Over the past decades, many new molecules and advanced functional materials have been discovered and developed. Along with this, TSC measurement has attracted much attention in industries and academic laboratories as a way of characterizing newly discovered materials and devices. In this review, we report the latest research trend in the TSC method for the development of materials and devices in Japan.

Accreditation Council for Graduate Medical Education (ACGME) Surgery Resident Operative Logs: The Last Quarter Century.

Science.gov (United States)

Drake, Frederick Thurston; Aarabi, Shahram; Garland, Brandon T; Huntington, Ciara R; McAteer, Jarod P; Richards, Morgan K; Zern, Nicole Kansier; Gow, Kenneth W

2017-05-01

To describe secular trends in operative experience for surgical trainees across an extended period using the most comprehensive data available, the Accreditation Council for Graduate Medical Education (ACGME) case logs. Some experts have expressed concern that current trainees are inadequately prepared for independent practice. One frequently mentioned factor is whether duty hours' restrictions (DHR) implemented in 2003 and 2004 contributed by reducing time spent in the operating room. A dataset was generated from annual ACGME reports. Operative volume for total major cases (TMC), defined categories, and four index laparoscopic procedures was evaluated. TMC dropped after implementation of DHR but rebounded after a transition period (949 vs 946 cases, P = nonsignificance). Abdominal cases increased from 22% of overall cases to 31%. Alimentary cases increased from 21% to 26%. Trauma and vascular surgery substantially decreased. For trauma, this drop took place well before DHR. The decrease in vascular surgery also began before DHR but continued afterward as well: 148 cases/resident in the late 1990s to 107 currently. Although total operative volume rebounded after implementation of DHR, diversity of operative experienced narrowed. The combined increase in alimentary and abdominal cases is nearly 13%, over a half-year's worth of operating in 5-year training programs. Bedrock general surgery cases-trauma, vascular, pediatrics, and breast-decreased. Laparoscopic operations have steadily increased. If the competence of current graduates has, in fact, diminished. Our analysis suggests that operative volume is not the problem. Rather, changing disease processes, subspecialization, reductions in resident autonomy, and technical innovation challenge how today's general surgeons are trained.

How to set up a robotic-assisted laparoscopic surgery center and training of staff.

Science.gov (United States)

Lenihan, John P

2017-11-01

The use of computers to assist surgeons in the operating room has been an inevitable evolution in the modern practice of surgery. Robotic-assisted surgery has been evolving now for over two decades and has finally matured into a technology that has caused a monumental shift in the way gynecologic surgeries are performed. Prior to robotics, the only minimally invasive options for most Gynecologic (GYN) procedures including hysterectomies were either vaginal or laparoscopic approaches. However, even with over 100 years of vaginal surgery experience and more than 20 years of laparoscopic advancements, most gynecologic surgeries in the United States were still performed through an open incision. However, this changed in 2005 when the FDA approved the da Vinci Surgical Robotic System tm for use in gynecologic surgery. Over the last decade, the trend for gynecologic surgeries has now dramatically shifted to less open and more minimally invasive procedures. Robotic-assisted surgeries now include not only hysterectomy but also most all other commonly performed gynecologic procedures including myomectomies, pelvic support procedures, and reproductive surgeries. This success, however, has not been without controversies, particularly around costs and complications. The evolution of computers to assist surgeons and make minimally invasive procedures more common is clearly a trend that is not going away. It is now incumbent on surgeons, hospitals, and medical societies to determine the most cost-efficient and productive use for this technology. This process is best accomplished by developing a Robotics Program in each hospital that utilizes robotic surgery. Copyright © 2017. Published by Elsevier Ltd.

Vestibular schwannomas in the modern era: epidemiology, treatment trends, and disparities in management.

Science.gov (United States)

Babu, Ranjith; Sharma, Richa; Bagley, Jacob H; Hatef, Jeffrey; Friedman, Allan H; Adamson, Cory

2013-07-01

There are a variety of treatment options for the management of vestibular schwannomas (VSs), including microsurgical resection, radiotherapy, and observation. Although the choice of treatment is dependent on various patient factors, physician bias has been shown to significantly affect treatment choice for VS. In this study the authors describe the current epidemiology of VS and treatment trends in the US in the modern era. They also illustrate patient and tumor characteristics and elucidate their effect on tumor management. Patients diagnosed with VS were identified through the Surveillance, Epidemiology, and End Results database, spanning the years 2004-2009. Age-adjusted incidence rates were calculated and adjusted using the 2000 US standard population. The chi-square and Student t-tests were used to evaluate differences between patient and tumor characteristics. Multivariate logistic regression was performed to determine the effects of various patient and tumor characteristics on the choice of tumor treatment. A total of 6225 patients with VSs treated between 2004 and 2009 were identified. The overall incidence rate was 1.2 per 100,000 population per year. The median age of patients with VS was 55 years, with the majority of patients being Caucasian (83.16%). Of all patients, 3053 (49.04%) received surgery only, with 1466 (23.55%) receiving radiotherapy alone. Both surgery and radiation were only used in 123 patients (1.98%), with 1504 patients not undergoing any treatment (24.16%). Increasing age correlated with decreased use of surgery (OR 0.95, 95% CI 0.95-0.96; pmanagement (OR 1.04, 95% CI 1.04-1.05; pmanaged conservatively despite presenting with larger tumors. Further studies are needed to elucidate the reasons for treatment disparities and investigate the nationwide trend of resection for the treatment of small VSs.

Current trends in treatment of obesity in Karachi and possibilities of cost minimization.

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Hussain, Mirza Izhar; Naqvi, Baqir Shyum

2015-03-01

Our study finds out drug usage trends in over weight and obese patients without any compelling indications in Karachi, looks for deviations of current practices from evidence based antihypertensive therapeutic guidelines and identifies not only cost minimization opportunities but also communication strategies to improve patients' awareness and compliance to achieve therapeutic goal. In present study two sets were used. Randomized stratified independent surveys were conducted in hospital doctors and family physicians (general practitioners), using pretested questionnaires. Sample size was 100. Statistical analysis was conducted on Statistical Package for Social Science (SPSS). Opportunities of cost minimization were also analyzed. One the basis of doctors' feedback, preference is given to non-pharmacologic management of obesity. Mass media campaign and media usage were recommended to increase patients awareness and patients' education along with strengthening family support systems was recommended for better compliance of the patients to doctor's advice. Local therapeutic guidelines for weight reduction were not found. Feedbacks showed that global therapeutic guidelines were followed by the doctors practicing in the community and hospitals in Karachi. However, high price branded drugs were used instead of low priced generic therapeutic equivalents. Patient's education is required for better awareness and improving patients' compliance. The doctors found preferring brand leaders instead of low cost options. This trend increases cost of therapy by 0.59 to 4.17 times. Therefore, there are great opportunities for cost minimization by using evidence-based clinically effective and safe medicines.

Errors and complications in laparoscopic surgery

Directory of Open Access Journals (Sweden)

Liviu Drăghici

2017-05-01

Full Text Available Background. In laparoscopic surgery errors are unavoidable and require proper acknowledgment to reduce the risk of intraoperative and accurately assess the appropriate therapeutic approach. Fortunately, their frequency is low and cannot overshadow the benefits of laparoscopic surgery. Materials and Methods. We made an epidemiological investigation in General Surgery Department of Emergency Clinical Hospital "St. John" Bucharest, analyzing 20 years of experience in laparoscopic surgery, during 1994-2014. We wanted to identify evolution trends in complications of laparoscopic surgery, analyzing the dynamic of errors occurred in all patients with laparoscopic procedures. Results. We recorded 26847 laparoscopic interventions with a total of 427 intra-or postoperative complications that required 160 conversions and 267 reinterventions to resolve inconsistencies. The average frequency of occurrence of complications was 15.9‰ (15.9 of 1,000 cases. In the period under review it was a good momentum of laparoscopic procedures in our department. Number of minimally invasive interventions increased almost 10 times, from 266 cases operated laparoscopically in 1995 to 2638 cases in 2008. Annual growth of the number of laparoscopic procedures has surpassed the number of complications. Conclusions. Laborious work of laparoscopic surgery and a specialized centre with well-trained team of surgeons provide premises for a good performance even in the assimilation of new and difficult procedures.

Achilles tenotomy as an office procedure and current practising trends among New Zealand orthopaedic surgeons.

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Agius, Lewis; Wickham, Angus; Walker, Cameron; Knudsen, Joshua

2018-05-18

Percutaneous Achilles tenotomy (PAT) is performed during the final phase of casting with Ponseti method. Several settings have been proposed as venues for this procedure, however it is increasingly being performed in theatre under a general anaesthetic (GA). General anaesthesia, however, is expensive and not without risks. The purpose of the present study was to compare results of outpatient releases to theatre releases, and assess current practising trends among orthopaedic surgeons. Retrospective comparison of patients with idiopathic clubfoot managed by Ponseti method who had Achilles tenotomy performed in outpatient clinic and in theatre. Surveys were sent to all POSNZ members to determine current practising trends in New Zealand. Parental satisfaction surveys were performed. Comparative cost analysis was performed using hospital billing information. The current study includes 64 idiopathic congenital clubfeet (19 bilateral cases). PAT was performed on 26 clubfeet under local anaesthetic in an outpatient setting, and 33 clubfeet under GA in a theatre setting. There was no significant difference for post-operative complications, or recurrence (p=0.67). Those in theatre group were exposed to a greater number of general anaesthetics before the age of four. Among practising New Zealand paediatric orthopaedic surgeons, 77.78% perform this in theatre under general anaesthesia, while only 22.22% perform PAT in outpatient clinic. The main barriers included concerns regarding pain control, concerns regarding incomplete release, concerns regarding distress to family and concerns regarding sterility. Parental satisfaction surveys found pain management to be excellent. Financial data was analysed and indicative costs were $6,061 NZD per procedure in theatre, compared to $378 NZD per procedure in clinic. PAT performed in a clinic setting is both safe and efficacious with results comparative to that performed in theatre. There was no difference in post

Current and Future Trends in Game-Based Learning

Directory of Open Access Journals (Sweden)

Carlos Vaz de Carvalho

2014-05-01

Full Text Available The first number of the second volume of the EAI Transactions on Serious Games focuses on the results presented on the European Conference on Game-Based Learning. This event, already on the 8th edition, has set standards in terms of presentation of research and practice and in the pointing out of new and future trends in the development of Game-Based Learning. As such, we are quite thrilled to be able to report them here.

Augmented reality technology for preoperative planning and intraoperative navigation during hepatobiliary surgery: A review of current methods.

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Tang, Rui; Ma, Long-Fei; Rong, Zhi-Xia; Li, Mo-Dan; Zeng, Jian-Ping; Wang, Xue-Dong; Liao, Hong-En; Dong, Jia-Hong

2018-04-01

Augmented reality (AR) technology is used to reconstruct three-dimensional (3D) images of hepatic and biliary structures from computed tomography and magnetic resonance imaging data, and to superimpose the virtual images onto a view of the surgical field. In liver surgery, these superimposed virtual images help the surgeon to visualize intrahepatic structures and therefore, to operate precisely and to improve clinical outcomes. The keywords "augmented reality", "liver", "laparoscopic" and "hepatectomy" were used for searching publications in the PubMed database. The primary source of literatures was from peer-reviewed journals up to December 2016. Additional articles were identified by manual search of references found in the key articles. In general, AR technology mainly includes 3D reconstruction, display, registration as well as tracking techniques and has recently been adopted gradually for liver surgeries including laparoscopy and laparotomy with video-based AR assisted laparoscopic resection as the main technical application. By applying AR technology, blood vessels and tumor structures in the liver can be displayed during surgery, which permits precise navigation during complex surgical procedures. Liver transformation and registration errors during surgery were the main factors that limit the application of AR technology. With recent advances, AR technologies have the potential to improve hepatobiliary surgical procedures. However, additional clinical studies will be required to evaluate AR as a tool for reducing postoperative morbidity and mortality and for the improvement of long-term clinical outcomes. Future research is needed in the fusion of multiple imaging modalities, improving biomechanical liver modeling, and enhancing image data processing and tracking technologies to increase the accuracy of current AR methods. Copyright © 2018 First Affiliated Hospital, Zhejiang University School of Medicine in China. Published by Elsevier B.V. All rights

Optimal surgical approach to thymic malignancies: New trends challenging old dogmas.

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Ruffini, Enrico; Filosso, Pier Luigi; Guerrera, Francesco; Lausi, Paolo; Lyberis, Paraskevas; Oliaro, Alberto

2018-04-01

Until recently, the surgical approach to thymic tumors has remained basically unchanged. The collaborative effort led by ITMIG with the collaboration of regional and society-based interest groups (ESTS, JART) produced an enthusiastic surge of interest in testing the new technological advances in thoracic surgery and many historical dogmas in thymic surgery have been questioned and challenged. The present review addresses the new trends in the optimal surgical management of thymic tumors based on the review of the current literature. 1. Minimally-invasive techniques (MIT) including video-assisted thoracic surgery (VATS) and robotic-assisted thoracic Surgery (RATS) are now to be considered the standard of care in early-stage thymic tumors. MIT are no inferior to open approaches in terms of postoperative complications, loco-regional recurrence rates and survival. MIT are associated with a shorter length of stay, reduced intraoperative blood loss and better cosmetic results. 2. The adoption of the ITMIG/IASLC TNM staging system for thymic tumors requires a paradigm shift among thoracic surgeons to include regional lymphadenectomy according to the IASLC/ITMIG nodal map in the surgical management of thymic tumors. 3. A limited thymectomy instead of total thymectomy along with the removal of the thymic tumor in nonmyasthenic Stage I-II tumors has been proposed by some authors, although the results are not uniform. Until more mature data is available, adherence to the current guidelines recommending total thymectomy in addition to thymomectomy is always indicated. 4. In locally-advanced Stage IVa patients with pleural involvement, major pleural resections, including pleurectomy/decortication or extrapleural pneumonectomy are indicated, provided a complete resection of the pleural deposits is anticipated, usually in a multidisciplinary setting, with excellent long-term results. The incorporation of these new concepts and techniques in the surgical armamentarium of the

Landscape of current and emerging cell therapy clinical trials in the UK: current status, comparison to global trends and future perspectives.

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Bisson, Isabelle; Green, Emma; Sharpe, Michaela; Herbert, Chris; Hyllner, Johan; Mount, Natalie

2015-01-01

Cell Therapy Clinical Trial and Preclinical Research databases have been established by the Cell Therapy Catapult to document current and future cell therapy clinical trials in the UK. We identified 41 ongoing trials in April 2014, an increase of seven trials from April 2013. In addition, we identified 45 late-stage preclinical research projects. The majority of the clinical trials are early phase, primarily led by academic groups. The leading therapeutic areas are cancer, cardiology and neurology. The trends in the UK are also seen globally. As the field matures, more later phase and commercial studies will emerge and the challenges will likely evolve into how to manufacture sufficient cell quantities, manage complex logistics for multi-center trials and control cost.

Metabolic surgery: quo vadis?

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Ramos-Leví, Ana M; Rubio Herrera, Miguel A

2014-01-01

The impact of bariatric surgery beyond its effect on weight loss has entailed a change in the way of regarding it. The term metabolic surgery has become more popular to designate those interventions that aim at resolving diseases that have been traditionally considered as of exclusive medical management, such as type 2 diabetes mellitus (T2D). Recommendations for metabolic surgery have been largely addressed and discussed in worldwide meetings, but no definitive consensus has been reached yet. Rates of diabetes remission after metabolic surgery have been one of the most debated hot topics, with heterogeneity being a current concern. This review aims to identify and clarify controversies regarding metabolic surgery, by focusing on a critical analysis of T2D remission rates achieved with different bariatric procedures, and using different criteria for its definition. Indications for metabolic surgery for patients with T2D who are not morbidly obese are also discussed. Copyright © 2013 SEEN. Published by Elsevier Espana. All rights reserved.

Radiopharmaceuticals - current state and trends

International Nuclear Information System (INIS)

Muenze, R.

1981-07-01

The current state as well as the tendencies of modern radiopharmaceutical development and application is reviewed. After an evaluation of the fundamental preconditions of decay characteristics and pharmaceutical properties the problems concerning sup(99m)Tc-radiopharmaceuticals, metabolizable compounds and the use of specific biological interactions are discussed. (author)

Perception versus reality: elucidating motivation and expectations of current fellowship council minimally invasive surgery fellows.

Science.gov (United States)

Watkins, Jeffrey R; Pryor, Aurora D; Truitt, Michael S; Jeyarajah, D Rohan

2018-04-17

The aim of our study is to determine minimally invasive trainee motivation and expectations for their respective fellowship. Minimally Invasive Surgery (MIS) is one of the largest non-ACGME post-residency training pathways though little is known concerning the process of residents choosing MIS as a fellowship focus. As general surgery evolves, it is important to understand resident motivation in order to better prepare them for a surgical career. A survey invitation was sent to current trainees in the Minimally Invasive and related pathways through the Fellowship Council. The participants were asked to complete a web-based questionnaire detailing demographics, experiences preparing for fellowship, motivation in choosing an MIS fellowship, and expectations for surgical practice after fellowship. Sixty-seven MIS trainees responded to the survey out of 151 invitations (44%). The Fellowship Council website, mentors, and other fellows were cited as the most helpful source of information when applying for fellowship. Trainees were active in surgical societies as residents, with 78% having membership in the ACS and 60% in SAGES. When deciding to pursue MIS as a fellowship, the desire to increase laparoscopic training was the most important factor. The least important reasons cited were lack of laparoendoscopic training in residency and desire to learn robotic surgery. The majority of trainees believed their laparoscopic skill set was above that of their residency cohort (81%). The most desired post-fellowship employment model is hospital employee (46%) followed by private practice (27%). Most fellows plan on marketing themselves as MIS surgeons (90%) or General Surgeons (78%) when in practice. Residents who choose MIS as a fellowship have a strong exposure to laparoscopy and want to become specialists in their field. Mentors and surgical societies including ACS and SAGES play a vital role in preparing residents for fellowship and practice.

Motor/Prefrontal Transcranial Direct Current Stimulation (tDCS) Following Lumbar Surgery Reduces Postoperative Analgesia Use.

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Glaser, John; Reeves, Scott T; Stoll, William David; Epperson, Thomas I; Hilbert, Megan; Madan, Alok; George, Mark S; Borckardt, Jeffrey J

2016-05-01

Randomized, controlled pilot trial. The present study is the first randomized, double-blind, sham-controlled pilot clinical trial of transcranial direct current stimulation (tDCS) for pain and patient-controlled analgesia (PCA) opioid usage among patients receiving spine surgery. Lumbar spinal surgeries are common, and while pain is often a complaint that precedes surgical intervention, the procedures themselves are associated with considerable postoperative pain lasting days to weeks. Adequate postoperative pain control is an important factor in determining recovery and new analgesic strategies are needed that can be used adjunctively to existing strategies potentially to reduce reliance on opioid analgesia. Several novel brain stimulation technologies including tDCS are beginning to demonstrate promise as treatments for a variety of pain conditions. Twenty-seven patients undergoing lumbar spine procedures at Medical University of South Carolina were randomly assigned to receive four 20-minute sessions of real or sham tDCS during their postsurgical hospital stay. Patient-administered hydromorphone usage was tracked along with numeric rating scale pain ratings. The effect of tDCS on the slope of the cumulative PCA curve was significant (P tDCS was associated with a 23% reduction in PCA usage. In the real tDCS group a 31% reduction was observed in pain-at-its-least ratings from admission to discharge (P = 0.027), but no other changes in numeric rating scale pain ratings were significant in either group. The present pilot trial is the first study to demonstrate an opioid sparing effect of tDCS after spine surgical procedures. Although this was a small pilot trial in a heterogeneous sample of spinal surgery patients, a moderate effect-size was observed for tDCS, suggesting that future work in this area is warranted. 2.

Assessment and E-Learning: Current Issues and Future Trends

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Cowie, Neil; Sakui, Keiko

2015-01-01

This paper describes different ways in which digital technology can be used for language learning. It then identifies some key trends connecting assessment and technology in language learning and higher education: the use of automated systems to enhance traditional assessment practices; the use of Web 2.0 tools to facilitate new assessment…

Current State and Future Perspectives of Energy Sources for Totally Implantable Cardiac Devices.

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Bleszynski, Peter A; Luc, Jessica G Y; Schade, Peter; PhilLips, Steven J; Tchantchaleishvili, Vakhtang

There is a large population of patients with end-stage congestive heart failure who cannot be treated by means of conventional cardiac surgery, cardiac transplantation, or chronic catecholamine infusions. Implantable cardiac devices, many designated as destination therapy, have revolutionized patient care and outcomes, although infection and complications related to external power sources or routine battery exchange remain a substantial risk. Complications from repeat battery replacement, power failure, and infections ultimately endanger the original objectives of implantable biomedical device therapy - eliminating the intended patient autonomy, affecting patient quality of life and survival. We sought to review the limitations of current cardiac biomedical device energy sources and discuss the current state and trends of future potential energy sources in pursuit of a lifelong fully implantable biomedical device.

Current Trends in Discharge Disposition and Post-discharge Care After Total Joint Arthroplasty.

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Tarity, T David; Swall, Marion M

2017-09-01

The purpose of this manuscript is to review published literature over the last 5 years to assess recent trends and influencing factors regarding discharge disposition and post-discharge care following total joint arthroplasty. We evaluated instruments proposed to predict a patient's discharge disposition and summarize reports investigating the safety in sending more patients home by reviewing complications and readmission rates. Current literature supports decreased length of hospital stay and increased discharge to home with cost savings and stable readmission rates. Surgeons with defined clinical pathways and those who shape patient expectations may more effectively control costs than those without defined pathways. Further research is needed analyzing best practices in care coordination, managing patient expectations, and cost-effective analysis of home discharge while at the same time ensuring patient outcomes are optimized following total joint arthroplasty.

Ischaemic heart disease deaths in Brazil: current trends, regional disparities and future projections.

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Baena, Cristina P; Chowdhury, Rajiv; Schio, Nicolle Amboni; Sabbag, Ary Elias; Guarita-Souza, Luiz Cesar; Olandoski, Marcia; Franco, Oscar H; Faria-Neto, José Rocha

2013-09-01

To quantify the trend of ischaemic heart disease (IHD) deaths in Brazil during the last decade (2000-2010) for various population characteristics and to forecast the upcoming mortality trends across regions in Brazil until the year 2015. Nationwide comparative observational study. The population studied encompassed all adult residents (≥ 20 years) living in five Brazilian regions between 2000 and 2010. Demographic, economic and mortality data were obtained from Brazilian National Mortality Data System and National Applied Economics Research Institute. Subnotified deaths were redistributed proportionally to IHD deaths. Age-standardised mortality rates (ASMRs) per 100 000 inhabitants, by sex and region, were calculated employing a standard Brazilian population and constructing multivariate regression models to quantify and to project temporal trends. Absolute numbers of death due to IHD and region-specific death rates in Brazil by age and sex. During the study period, 627 786 men and 452 690 women died due to IHD in Brazil. ASMR trends across all regions for men and women converged, driven by a declining trend in the South and Southeast and an opposite incline in the North and Northeast (p < 0.05). Future projections demonstrated potential widening of the observed North-South gap in coming years. The IHD death trend in Brazil has changed from a decline to a stagnant state. However, a significant discrepancy in mortality trends exists between the northern and southern regions, which is likely to widen further. Reappraisal of the public health policies tailored to populations with diverse socioeconomic structures is urgently required.

Current trends in immunosuppressive therapies for renal transplant recipients.

Science.gov (United States)

Lee, Ruth-Ann; Gabardi, Steven

2012-11-15

Current trends in immunosuppressive therapies for renal transplant recipients are reviewed. The common premise for immunosuppressive therapies in renal transplantation is to use multiple agents to work on different immunologic targets. The use of a multidrug regimen allows for pharmacologic activity at several key steps in the T-cell replication process and lower dosages of each individual agent, thereby producing fewer drug-related toxicities. In general, there are three stages of clinical immunosuppression: induction therapy, maintenance therapy, and treatment of an established acute rejection episode. Only immunosuppressive therapies used for maintenance therapy are discussed in detail in this review. The most common maintenance immunosuppressive agents can be divided into five classes: (1) the calcineurin inhibitors (CNIs) (cyclosporine and tacrolimus), (2) costimulation blockers (belatacept), (3) mammalian target of rapamycin inhibitors (sirolimus and everolimus), (4) antiproliferatives (azathioprine and mycophenolic acid derivatives), and (5) corticosteroids. Immunosuppressive regimens vary among transplantation centers but most often include a CNI and an adjuvant agent, with or without corticosteroids. Selection of appropriate immunosuppressive regimens should be patient specific, taking into account the medications' pharmacologic properties, adverse-event profile, and potential drug-drug interactions, as well as the patient's preexisting diseases, risk of rejection, and medication regimen. Advancements in transplant immunosuppression have resulted in a significant reduction in acute cellular rejection and a modest increase in long-term patient and graft survival. Because the optimal immunosuppression regimen is still unknown, immunosuppressant use should be influenced by institutional preference and tailored to the immunologic risk of the patient and adverse-effect profile of the drug.

Current status of surgery for benign disorders of the esophagus

NARCIS (Netherlands)

Draaisma, Werner Adriaan

2006-01-01

This thesis aimed at exploring new techniques for the surgical treatment of benign disorders of the esophagus. Specifically, studies were performed on surgery for gastroesophageal reflux disease and large (type II-IV) hiatal hernia. The chapters presented in this thesis involve studies that have

Positron computed tomography: current state, clinical results and future trends

International Nuclear Information System (INIS)

Schelbert, H.R.; Phelps, M.E.; Kuhl, D.E.

1980-01-01

An overview is presented of positron computed tomography: its advantages over single photon emission tomography, its use in metabolic studies of the heart and chemical investigation of the brain, and future trends

Employment and satisfaction trends among general surgery residents from a community hospital.

Science.gov (United States)

Cyr-Taro, Amy E; Kotwall, Cyrus A; Menon, Rema P; Hamann, M Sue; Nakayama, Don K

2008-01-01

Physician satisfaction is an important and timely issue in health care. A paucity of literature addresses this question among general surgeons. To review employment patterns and job satisfaction among general surgery residents from a single university-affiliated institution. All general surgery residents graduating from 1986 to 2006, inclusive, were mailed an Institutional Review Board-approved survey, which was then returned anonymously. Information on demographics, fellowship training, practice characteristics, job satisfaction and change, and perceived shortcomings in residency training was collected. A total of 31 of 34 surveys were returned (91%). Most of those surveyed were male (94%) and Caucasian (87%). Sixty-one percent of residents applied for a fellowship, and all but 1 were successful in obtaining their chosen fellowship. The most frequent fellowship chosen was plastic surgery, followed by minimally invasive surgery. Seventy-one percent of residents who applied for fellowship felt that the program improved their competitiveness for a fellowship. Most of the sample is in private practice, and of those, 44% are in groups with more than 4 partners. Ninety percent work less than 80 hours per week. Only 27% practice in small towns (population job. Twenty-three percent agreed that they had difficulty finding their first job, and 30% had fewer job offers than expected. Thirty-five percent of the graduates have changed jobs: 29% of the residents have changed jobs once, and 6% have changed jobs at least twice since completing training. Reasons for leaving a job included colleague issues (82%), financial issues (82%), inadequate referrals (64%), excessive trauma (64%), and marriage or family reasons (55% and 55%, respectively). One half to three fourths of the graduates wished they had more teaching on postresidency business and financial issues, review of contracts, and suggestions for a timeline for finding a job. Although general surgical residencies prepare

[Nutritional screening before surgery for esophageal cancer - current status and evaluation results].

Science.gov (United States)

Shimakawa, Takeshi; Asaka, Shinich; Sagawa, Masano; Shimazaki, Asako; Yamaguchi, Kentaro; Usui, Takebumi; Yokomizo, Hajime; Shiozawa, Shunichi; Yoshimatsu, Kazuhiko; Katsube, Takao; Naritaka, Yoshihiko

2014-10-01

The incidence of postoperative complications and mortality are usually higher in patients with preoperative malnutrition. Malnutrition often preexists, particularly in patients undergoing surgery for esophageal cancer, which is substantially invasive. It is therefore important to understand the nutritional condition of patients and actively control perioperative nutrition.Our hospital has been providing nutritional status screening for patients before resection of esophageal cancer, and we report the current status and evaluation results in this article.This screening included 158 patients requiring radical resection of esophageal cancer.Age, comorbidity with diabetes, body mass index(BMI), serum albumin(Alb), Onodera's prognostic nutritional index(PNI), and Glasgow prognostic score(GPS)were used as nutritional indicators to stratify patients for analysis.Evaluation parameters included the incidence of postoperative complications(any complication, pulmonary complications, psychiatric disorder, and anastomotic leakage)and rates of long-term postoperative hospitalization.The analysis indicated that age, BMI, serum Alb, PNI, and GPS are useful for predicting the onset of postoperative complications and prolonged postoperative hospitalization.For such patients, more active nutritional control should be provided.

Robotics in Colorectal Surgery

Science.gov (United States)

Weaver, Allison; Steele, Scott

2016-01-01

Over the past few decades, robotic surgery has developed from a futuristic dream to a real, widely used technology. Today, robotic platforms are used for a range of procedures and have added a new facet to the development and implementation of minimally invasive surgeries. The potential advantages are enormous, but the current progress is impeded by high costs and limited technology. However, recent advances in haptic feedback systems and single-port surgical techniques demonstrate a clear role for robotics and are likely to improve surgical outcomes. Although robotic surgeries have become the gold standard for a number of procedures, the research in colorectal surgery is not definitive and more work needs to be done to prove its safety and efficacy to both surgeons and patients. PMID:27746895

Positron Computed Tomography: Current State, Clinical Results and Future Trends

Science.gov (United States)

Schelbert, H. R.; Phelps, M. E.; Kuhl, D. E.

1980-09-01

An overview is presented of positron computed tomography: its advantages over single photon emission tomography, its use in metabolic studies of the heart and chemical investigation of the brain, and future trends. (ACR)

Positron computed tomography: current state, clinical results and future trends

Energy Technology Data Exchange (ETDEWEB)

Schelbert, H.R.; Phelps, M.E.; Kuhl, D.E.

1980-09-01

An overview is presented of positron computed tomography: its advantages over single photon emission tomography, its use in metabolic studies of the heart and chemical investigation of the brain, and future trends. (ACR)

Interior Design Trends in Libraries.

Science.gov (United States)

Sager, Don, Ed.

2000-01-01

Four contributing authors discuss perspectives on current trends in library interior design. Articles include: "Trends in Library Furnishings: A Manufacturer's Perspective" (Andrea Johnson); "Libraries, Architecture, and Light: The Architect's Perspective" (Rick McCarthy); "The Library Administrator's Perspective" (Chadwick Raymond); and "The…

[Advocating standardization and customization of corneal refractive surgery in Chinese domestic situation].

Science.gov (United States)

Zhang, F J; Song, Y Z

2016-07-01

With the improvement and application of excimer laser and femtosecond laser equipment in clinical ophthalmology, the diversified strategies for corneal refractive surgery candidates have been provided. Based on the trend of " all-laser treatment", it is very necessary to take the domestic situation into consideration when a standard and customized choice is made according to the indications of each specific surgical type. The characteristics and limitations of various surgeries are elucidated and commented here in order to provide some reasonable treatment options for refractive surgery. (Chin J Ophthalmol, 2016, 52: 481-485).

Management of mydriasis and pain in cataract and intraocular lens surgery: review of current medications and future directions

Directory of Open Access Journals (Sweden)

Grob SR

2014-07-01

Full Text Available Seanna R Grob,1–3 Luis A Gonzalez-Gonzalez,1–3 Mary K Daly1,2,4 1Department of Ophthalmology, Veterans Administration Boston Healthcare System, Boston, MA, USA; 2Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; 3Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; 4Department of Ophthalmology, Boston University School of Medicine, Boston, MA, USA Abstract: The maintenance of mydriasis and the control of postoperative pain and ­inflammation are critical to the safety and success of cataract and intraocular lens replacement surgery. Appropriate mydriasis is usually achieved by topical and/or intracameral administration of anticholinergic agents, sympathomimetic agents, or both, with the most commonly used being cyclopentolate, tropicamide, and phenylephrine. Ocular inflammation is common after cataract surgery. Topical steroids and nonsteroidal anti-inflammatory drugs are widely used because they have been proved effective to control postsurgical inflammation and decrease pain. Topical nonsteroidal anti-inflammatory drugs have also been shown to help maintain dilation. However, use of multiple preoperative drops for pupil dilation, inflammation, and pain control have been shown to be time consuming, resulting in delays to the operating room, and they cause dissatisfaction among perioperative personnel; their use can also be associated with systemic side effects. Therefore, ophthalmologists have been in search of new options to streamline this process. This article will review the current medications commonly used for intraoperative mydriasis, as well as pain and inflammation control. In addition, a new combination of ketorolac, an anti-inflammatory agent, and phenylephrine, a mydriatic agent has recently been designed to maintain intraoperative mydriasis and to reduce postoperative pain and irritation from intraocular lens replacement surgery. Two Phase III clinical trials evaluating this

Metal-enhanced luminescence: Current trend and future perspectives- A review

International Nuclear Information System (INIS)

Ranjan, Rajeev; Esimbekova, Elena N.; Kirillova, Maria A.; Kratasyuk, Valentina A.

2017-01-01

Optically enhanced biosensing strategies are prerequisites for developing miniature and highly sensitive multiplexed analytical platforms. Such smart biosensing systems are highly promising for use in the fields of biomedicine and environmental monitoring. Optical signal enhancement during bioassays is attributed to the complex opto-electronic interactions of incoming photonic signals at the nanomaterial interface. Research on the use of metals other than gold and silver for such purposes tends to extend the spectral window to observe luminescence enhancement effects. Such manifold increase in luminescence may be explained by the principles of plasmon coupling, directional emission led high collection efficiency, Rayleigh scattering and related opto-electronic events. The present review begins with a mechanistic description of important phenomena associated with metal-induced luminescence enhancement, particularly focusing on the origin of metal-enhanced luminescence. This review further analyses the hybrid nanostructure capabilities responsible for maintaining unique opto-electronic properties during bio-functionalisation. Current research trends in this area, future scope of this field for designing useful bioassays and concluding remarks are then discussed. - Highlights: • Nanomaterials significantly differ from their bulk counterparts. • Strong and pronounced photophysical effects at the metal surface provide opportunities for designing novel biosensors. • Metal-enhanced luminescence increases the quantum yield of luminescent reactions. • Under optimal conditions, plasmon coupling enhances the optical effects at the nanometal surface.

Metal-enhanced luminescence: Current trend and future perspectives- A review

Energy Technology Data Exchange (ETDEWEB)

Ranjan, Rajeev [Laboratory of Bioluminescent Biotechnologies, Department of Biophysics, Institute of Fundamental Biology and Biotechnology, Siberian Federal University, 79 Svobodny Prospect, Krasnoyarsk 660041 (Russian Federation); Esimbekova, Elena N., E-mail: esimbekova@yandex.ru [Laboratory of Bioluminescent Biotechnologies, Department of Biophysics, Institute of Fundamental Biology and Biotechnology, Siberian Federal University, 79 Svobodny Prospect, Krasnoyarsk 660041 (Russian Federation); Institute of Biophysics SB RAS, Federal Research Center “Krasnoyarsk Science Center SB RAS”, Akademgorodok 50/50, Krasnoyarsk 660036 (Russian Federation); Kirillova, Maria A. [Laboratory of Bioluminescent Biotechnologies, Department of Biophysics, Institute of Fundamental Biology and Biotechnology, Siberian Federal University, 79 Svobodny Prospect, Krasnoyarsk 660041 (Russian Federation); Kratasyuk, Valentina A. [Laboratory of Bioluminescent Biotechnologies, Department of Biophysics, Institute of Fundamental Biology and Biotechnology, Siberian Federal University, 79 Svobodny Prospect, Krasnoyarsk 660041 (Russian Federation); Institute of Biophysics SB RAS, Federal Research Center “Krasnoyarsk Science Center SB RAS”, Akademgorodok 50/50, Krasnoyarsk 660036 (Russian Federation)

2017-06-08

Optically enhanced biosensing strategies are prerequisites for developing miniature and highly sensitive multiplexed analytical platforms. Such smart biosensing systems are highly promising for use in the fields of biomedicine and environmental monitoring. Optical signal enhancement during bioassays is attributed to the complex opto-electronic interactions of incoming photonic signals at the nanomaterial interface. Research on the use of metals other than gold and silver for such purposes tends to extend the spectral window to observe luminescence enhancement effects. Such manifold increase in luminescence may be explained by the principles of plasmon coupling, directional emission led high collection efficiency, Rayleigh scattering and related opto-electronic events. The present review begins with a mechanistic description of important phenomena associated with metal-induced luminescence enhancement, particularly focusing on the origin of metal-enhanced luminescence. This review further analyses the hybrid nanostructure capabilities responsible for maintaining unique opto-electronic properties during bio-functionalisation. Current research trends in this area, future scope of this field for designing useful bioassays and concluding remarks are then discussed. - Highlights: • Nanomaterials significantly differ from their bulk counterparts. • Strong and pronounced photophysical effects at the metal surface provide opportunities for designing novel biosensors. • Metal-enhanced luminescence increases the quantum yield of luminescent reactions. • Under optimal conditions, plasmon coupling enhances the optical effects at the nanometal surface.

Current Trends in Sustainability of Bitcoins and Related Blockchain Technology

Directory of Open Access Journals (Sweden)

Pasquale Giungato

2017-11-01

Full Text Available Bitcoin is a digital currency based on a peer-to-peer payment system managed by an open source software and characterized by lower transaction costs, greater security and scalability than fiat money and no need of a central bank. Despite criticisms about illegal uses and social consequences, it is attracting the interest of the scientific community. The purpose of this work is to define and evaluate the current trends of the literature concerned with the sustainability of bitcoin, considering the environmental impacts, social issues and economic aspects. From the analysis it emerges that the transition of the whole monetary system in the new cryptocurrency will result in an unacceptable amount of energy consumed to mine new bitcoins and to maintain the entire virtual monetary system, and probably bitcoin will remain a niche currency. Blockchain, which is the base for a distributed and democratically-sustained public ledger of the transactions, could foster new and challenging opportunities. Sharing the framework of medical data, energy generation and distribution in micro-grids at the citizen level, block-stack and new state-driven cryptocurrencies, may benefit from the wide spread of blockchain-based transactions. Under the perspective of its being a driver of social change, bitcoins and related blockchain technologies may overcome the issues highlighted by numerous detractors.

Surveys on surgery theory

CERN Document Server

Cappell, Sylvain; Rosenberg, Jonathan

2014-01-01

Surgery theory, the basis for the classification theory of manifolds, is now about forty years old. The sixtieth birthday (on December 14, 1996) of C.T.C. Wall, a leading member of the subject''s founding generation, led the editors of this volume to reflect on the extraordinary accomplishments of surgery theory as well as its current enormously varied interactions with algebra, analysis, and geometry. Workers in many of these areas have often lamented the lack of a single source surveying surgery theory and its applications. Because no one person could write such a survey, the editors ask

Racial disparities in smoking knowledge among current smokers: data from the health information national trends surveys.

Science.gov (United States)

Reimer, Rachel Ann; Gerrard, Meg; Gibbons, Frederick X

2010-10-01

Although African-Americans (Blacks) smoke fewer cigarettes per day than European-Americans (Whites), there is ample evidence that Blacks are more susceptible to smoking-related health consequences. A variety of behavioural, social and biological factors have been linked to this increased risk. There has been little research, however, on racial differences in smoking-related knowledge and perceived risk of lung cancer. The primary goal of the current study was to evaluate beliefs and knowledge that contribute to race disparities in lung cancer risk among current smokers. Data from two separate nationally representative surveys (the Health Information National Trends surveys 2003 and 2005) were analysed. Logistic and hierarchical regressions were conducted; gender, age, education level, annual household income and amount of smoking were included as covariates. In both studies, Black smokers were significantly more likely to endorse inaccurate statements than were White smokers, and did not estimate their lung cancer risk to be significantly higher than Whites. Results highlight an important racial disparity in public health knowledge among current smokers.

Laparoscopy is safe among patients with congestive heart failure undergoing general surgery procedures.

Science.gov (United States)

Speicher, Paul J; Ganapathi, Asvin M; Englum, Brian R; Vaslef, Steven N

2014-08-01

Over the past 2 decades, laparoscopy has been established as a superior technique in many general surgery procedures. Few studies, however, have examined the impact of the use of a laparoscopic approach in patients with symptomatic congestive heart failure (CHF). Because pneumoperitoneum has known effects on cardiopulmonary physiology, patients with CHF may be at increased risk. This study examines current trends in approaches to patients with CHF and effects on perioperative outcomes. The 2005-2011 National Surgical Quality Improvement Program Participant User File was used to identify patients who underwent the following general surgery procedures: Appendectomy, segmental colectomy, small bowel resection, ventral hernia repair, and splenectomy. Included for analysis were those with newly diagnosed CHF or chronic CHF with new signs or symptoms. Trends of use of laparoscopy were assessed across procedure types. The primary endpoint was 30-day mortality. The independent effect of laparoscopy in CHF was estimated with a multiple logistic regression model. A total of 265,198 patients were included for analysis, of whom 2,219 were identified as having new or recently worsened CHF. Of these patients, there were 1,300 (58.6%) colectomies, 486 (21.9%) small bowel resections, 216 (9.7%) ventral hernia repairs, 141 (6.4%) appendectomies, and 76 (3.4%) splenectomies. Laparoscopy was used less frequently in patients with CHF compared with their non-CHF counterparts, particularly for nonelective procedures. Baseline characteristics were similar for laparoscopy versus open procedures with the notable exception of urgent/emergent case status (36.4% vs 71.3%; P surgery procedures, particularly in urgent/emergent cases. Despite these patterns and apparent preferences, laparoscopy seems to offer a safe alternative in appropriately selected patients. Because morbidity and mortality were considerable regardless of approach, further understanding of appropriate management in this

Robotic laparoendoscopic single-site surgery: From present to future

Directory of Open Access Journals (Sweden)

Ayhan Verit

2012-01-01

Full Text Available The continued effort of improving cosmesis and reducing morbidity in urologic surgery has given rise to novel alternatives to traditional minimally invasive techniques: Laparoendoscopic Single-site Surgery (LESS and Natural Orifice Transluminal Endoscopic Surgery (NOTES. Despite the development of specialized access devices and instruments, the performance of complex procedures using LESS has been challenging due to loss of triangulation and instrument clashing. A robotic interface may represent the key factor in overcoming the critical restrictions related to NOTES and LESS. Although encouraging, current clinical evidence related to R-LESS remains limited as the current da Vinci® robotic platform has not been specifically designed for LESS. Robotic innovations are imminent and are likely to govern major changes to the current landscape of scarless surgery.

Trends in computer hardware and software.

Science.gov (United States)

Frankenfeld, F M

1993-04-01

Previously identified and current trends in the development of computer systems and in the use of computers for health care applications are reviewed. Trends identified in a 1982 article were increasing miniaturization and archival ability, increasing software costs, increasing software independence, user empowerment through new software technologies, shorter computer-system life cycles, and more rapid development and support of pharmaceutical services. Most of these trends continue today. Current trends in hardware and software include the increasing use of reduced instruction-set computing, migration to the UNIX operating system, the development of large software libraries, microprocessor-based smart terminals that allow remote validation of data, speech synthesis and recognition, application generators, fourth-generation languages, computer-aided software engineering, object-oriented technologies, and artificial intelligence. Current trends specific to pharmacy and hospitals are the withdrawal of vendors of hospital information systems from the pharmacy market, improved linkage of information systems within hospitals, and increased regulation by government. The computer industry and its products continue to undergo dynamic change. Software development continues to lag behind hardware, and its high cost is offsetting the savings provided by hardware.

Global development and current evidence of uniportal thoracoscopic surgery

Science.gov (United States)

Tu, Cheng-Che

2016-01-01

In the era of video-assisted thoracoscopic surgery (VATS), uniportal and single incision thoracoscopic surgeries are gaining popularity. The spectrum of uniportal VATS indications is now almost equal to that of conventional VATS. For example, successful uniportal sleeve lobectomy, rib segmental resection, and management of intraoperative bleeding have all been reported. According to published data in the English-language literature, more than 9,545 uniportal VATS have been performed to date, including 1,293 lobectomies, 1,024 procedures for pneumothorax, and 6,845 sympathectomies. Of the 192 articles discussing this topic, 35 were conducted in Spain, and there were an increasing number of publications from China, Korea, and other Asian countries. There were 41 technical and review articles, all of which provided an excellent foundation of surgical concept and skill learning. The benefits of uniportal VATS include better surgical geometry and cosmetics. Regarding postoperative outcomes, thirteen out of the 15 articles reviewed showed that uniportal VATS has similar or superior outcomes to conventional VATS. Most studies demonstrated that uniportal VATS produced less postoperative pain and paresthesia. In conclusion, uniportal VATS can produce excellent operative outcome, which is becoming a mature surgical approach in thoracic disease, supported by fast-accumulating and abundant experience. PMID:27014479

Residency Training in Robotic General Surgery: A Survey of Program Directors.

Science.gov (United States)

George, Lea C; O'Neill, Rebecca; Merchant, Aziz M

2018-01-01

Robotic surgery continues to expand in minimally invasive surgery; however, the literature is insufficient to understand the current training process for general surgery residents. Therefore, the objectives of this study were to identify the current approach to and perspectives on robotic surgery training. An electronic survey was distributed to general surgery program directors identified by the Accreditation Council for Graduate Medical Education website. Multiple choice and open-ended questions regarding current practices and opinions on robotic surgery training in general surgery residency programs were used. 20 program directors were surveyed, a majority being from medium-sized programs (4-7 graduating residents per year). Most respondents (73.68%) had a formal robotic surgery curriculum at their institution, with 63.16% incorporating simulation training. Approximately half of the respondents believe that more time should be dedicated to robotic surgery training (52.63%), with simulation training prior to console use (84.21%). About two-thirds of the respondents (63.16%) believe that a formal robotic surgery curriculum should be established as a part of general surgery residency, with more than half believing that exposure should occur in postgraduate year one (55%). A formal robotics curriculum with simulation training and early surgical exposure for general surgery residents should be given consideration in surgical residency training.

Black Truffle Harvesting in Spanish Forests: Trends, Current Policies and Practices, and Implications on its Sustainability

Science.gov (United States)

Garcia-Barreda, Sergi; Forcadell, Ricardo; Sánchez, Sergio; Martín-Santafé, María; Marco, Pedro; Camarero, J. Julio; Reyna, Santiago

2018-04-01

The European black truffle is a mycorrhizal fungus native to Spanish Mediterranean forests. In most Spanish regions it was originally commercially harvested in the second half of the 20th century. Experts agree that wild truffle yields suffered a sharp decline during the 1970s and 1980s. However, official statistics for Spanish harvest are scarce and seemingly conflicting, and little attention has been paid to the regime for the exploitation of truffle-producing forests and its implications on the sustainability of this resource. Trends in harvest from 1969 to 2013 and current harvesting practices were analyzed as a case study, taking into account that Spain is a major truffle producer worldwide, but at the same time truffles have only recently been exploited. The available statistical sources, which include an increasing proportion of cultivated truffles since the mid-1990s, were explored, with estimates from Truffle Harvesters Federation showing higher consistency. Statistical sources were then compared with proxies for wild harvest (rents from truffle leases in public forests) to corroborate time trends in wild harvesting. Results suggest that black truffle production is recovering in recent years thanks to plantations, whereas wild harvest is still declining. The implications of Spanish legal and institutional framework on sustainability of wild truffle use are reviewed. In the current scenario, the decline of wild harvest is likely to continue and eventually make commercial harvesting economically unattractive, thus aggravating sustainability issues. Strengthening of property rights, rationalization of harvesting pressure, forest planning and involvement of public stakeholders are proposed as corrective measures.

Recent advances in femtosecond laser-assisted cataract surgery

Directory of Open Access Journals (Sweden)

Zhao-Jie Chu

2013-07-01

Full Text Available Perfect vision and fewer complications is our goal in cataract surgery, femtosecond laser-assisted cataract surgery hold the promise. Applications of femtosecond laser technology for capsulotomy, nuclear fragmentation and corneal incision in cataract surgery bring a new level of accuracy, reproducibility and predictability over the current cataract surgery. The femtosecond laser produces capsulotomies that are more precise, accurate, reproducible, and stronger than those created with the conventional manual technique, and further helps maintain proper positioning of the IOL. Femtosecond laser in nuclear fragmentation lead to a lower effective phacoemulsification time, and the corneal incision is more stable. But currently there are some complications and a clear learning curve associated with the use of femtosecond lasers for cataract surgery. The long-term safety and visual outcomes still need further investigation.

Archives: Annals of Pediatric Surgery

African Journals Online (AJOL)

Items 1 - 32 of 32 ... Archives: Annals of Pediatric Surgery. Journal Home > Archives: Annals of Pediatric Surgery. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register · Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives. 1 - 32 of 32 Items ...

Virtual reality and laparoscopic surgery.

Science.gov (United States)

Coleman, J; Nduka, C C; Darzi, A

1994-12-01

The nature of laparoscopic surgery makes it likely to benefit from current and future developments in virtual reality and telepresence technology. High-definition screens, three-dimensional sensory feedback and remote dextrous manipulation will be the next major developments in laparoscopic surgery. Simulators may be used in surgical training and in the evaluation of surgical capability.

Automating Trend Analysis for Spacecraft Constellations

Science.gov (United States)

Davis, George; Cooter, Miranda; Updike, Clark; Carey, Everett; Mackey, Jennifer; Rykowski, Timothy; Powers, Edward I. (Technical Monitor)

2001-01-01

Spacecraft trend analysis is a vital mission operations function performed by satellite controllers and engineers, who perform detailed analyses of engineering telemetry data to diagnose subsystem faults and to detect trends that may potentially lead to degraded subsystem performance or failure in the future. It is this latter function that is of greatest importance, for careful trending can often predict or detect events that may lead to a spacecraft's entry into safe-hold. Early prediction and detection of such events could result in the avoidance of, or rapid return to service from, spacecraft safing, which not only results in reduced recovery costs but also in a higher overall level of service for the satellite system. Contemporary spacecraft trending activities are manually intensive and are primarily performed diagnostically after a fault occurs, rather than proactively to predict its occurrence. They also tend to rely on information systems and software that are oudated when compared to current technologies. When coupled with the fact that flight operations teams often have limited resources, proactive trending opportunities are limited, and detailed trend analysis is often reserved for critical responses to safe holds or other on-orbit events such as maneuvers. While the contemporary trend analysis approach has sufficed for current single-spacecraft operations, it will be unfeasible for NASA's planned and proposed space science constellations. Missions such as the Dynamics, Reconnection and Configuration Observatory (DRACO), for example, are planning to launch as many as 100 'nanospacecraft' to form a homogenous constellation. A simple extrapolation of resources and manpower based on single-spacecraft operations suggests that trending for such a large spacecraft fleet will be unmanageable, unwieldy, and cost-prohibitive. It is therefore imperative that an approach to automating the spacecraft trend analysis function be studied, developed, and applied to

[Evolution of ideas and techniques, and future prospects in epilepsy surgery].

Science.gov (United States)

Mathon, B; Bédos-Ulvin, L; Baulac, M; Dupont, S; Navarro, V; Carpentier, A; Cornu, P; Clemenceau, S

2015-02-01

The aim of this article was to review and evaluate the published literature related to the outcome of epilepsy surgery, while placing it in an historical perspective, and to describe the future prospects in this field. Temporal lobe surgery achieves seizure freedom in about 70% of cases. Seizure outcome is similar in the pediatric population. Extratemporal resections impart good results to 40% to 60% of patients, with a better prognosis in the case of frontal lobe surgery. Pediatric hemispherotomy leads to seizure control in about 80% of children. Radiosurgery used as a treatment for temporal mesial epilepsy has an outcome quite similar to that obtained with surgical resection, but provides a neuropsychological advantage. Radiosurgery is also effective in 60% of children treated for seizures related to hypothalamic hamartoma. Regarding palliative surgery, callosotomy and multiple subpial transections show satisfactory outcomes in over 60% of cases. Neuromodulation techniques (vagus nerve stimulation and bilateral stimulation of the anterior nucleus of the thalamus) allow a 50% reduction of seizures in half of patients. Transcranial magnetic stimulation combined with electroencephalography seems a promising technique because of its diagnostic, prognostic and therapeutic applications. Transcranial ultrasound stimulation, which can reversibly control neuronal activity, is also under consideration. Concerning neuromodulation, trigeminal nerve stimulation may become an alternative to vagus nerve stimulation; while other targets of deep brain stimulation are being evaluated. Also, the possibility of coupling SEEG seizure focus detection with concomitant laser or radiofrequency focus destruction is under development. Constant evolution of epilepsy surgery has improved patient outcomes over time. Current research and development axes suggest the continuation of this trend and a reduction of the invasiveness of surgical procedures. Copyright © 2014 Elsevier Masson SAS. All

Everyday, everywhere: alcohol marketing and social media--current trends.

Science.gov (United States)

Nicholls, James

2012-01-01

To provide a snapshot content analysis of social media marketing among leading alcohol brands in the UK, and to outline the implications for both regulatory policies and further research. Using screengrab technology, the complete Facebook walls and Twitter timelines for 12 leading UK alcohol brands in November 2011 were captured and archived. A total of 701 brand-authored posts were identified and categorized using a thematic coding frame. Key strategic trends were identified and analysed in the light of contextual research into recent developments in marketing practice within the alcohol industry. A number of dominating trends were identified. These included the use of real-world tie-ins, interactive games, competitions and time-specific suggestions to drink. These methods reflect a strategy of branded conversation-stimulus which is favoured by social media marketing agencies. A number of distinct marketing methods are deployed by alcohol brands when using social media. These may undermine policies which seek to change social norms around drinking, especially the normalization of daily consumption. Social media marketing also raises questions regarding the efficacy of reactive regulatory frameworks. Further research into both the nature and impact of alcohol marketing on social media is needed.

Carbon footprint and cost-effectiveness of cataract surgery.

Science.gov (United States)

Venkatesh, Rengaraj; van Landingham, Suzanne W; Khodifad, Ashish M; Haripriya, Aravind; Thiel, Cassandra L; Ramulu, Pradeep; Robin, Alan L

2016-01-01

This article raises awareness about the cost-effectiveness and carbon footprint of various cataract surgery techniques, comparing their relative carbon emissions and expenses: manual small-incision cataract surgery (MSICS), phacoemulsification, and femtosecond laser-assisted cataract surgery. As the most commonly performed surgical procedure worldwide, cataract surgery contributes significantly to global climate change. The carbon footprint of a single phacoemulsification cataract surgery is estimated to be comparable to that of a typical person's life for 1 week. Phacoemulsification has been estimated to be between 1.4 and 4.7 times more expensive than MSICS; however, given the lower degree of postoperative astigmatism and other potential complications, phacoemulsification may still be preferable to MSICS in relatively resource-rich settings requiring high levels of visual function. Limited data are currently available regarding the environmental and financial impact of femtosecond laser-assisted cataract surgery; however, in its current form, it appears to be the least cost-effective option. Cataract surgery has a high value to patients. The relative environmental impact and cost of different types of cataract surgery should be considered as this treatment becomes even more broadly available globally and as new technologies are developed and implemented.

Carotid and coronary disease management prior to open and endovascular aortic surgery. What are the current guidelines?

Science.gov (United States)

Thompson, J P

2014-04-01

Several bodies produce broadly concurring and updated guidelines for the evaluation and treatment of cardiovascular disease in both surgical and non-surgical patients. Recent developments include revised recommendations on preoperative stress testing, referral for possible coronary revascularization and medical management. It is recognized that non-invasive cardiac tests are relatively poor at predicting perioperative risk, and "prophylactic" coronary revascularization has a limited role. The planned aortic intervention (open or endovascular repair) also influences preoperative management. Patients presenting for elective abdominal aortic aneurysm (AAA) repair should only be referred for cardiological testing if they have active symptoms of coronary artery disease (CAD), known CAD and poor functional exercise capacity, or multiple risk factors for CAD. Coronary revascularization before AAA surgery should be limited to patients with established indications, so cardiac stress testing should only be performed if it would change management i.e. the patient is a candidate for and would benefit from coronary revascularization. When endovascular aortic repair is planned, it is reasonable to proceed to surgery without further cardiac stress testing or evaluation unless otherwise indicated. All non-emergency patients require medical optimization, but perioperative beta blockade benefits only certain patients. Some of the data informing recent guidelines have been questioned and some guidelines are being revised. Current guidelines do not specifically address the management of patients with known or suspected carotid artery disease who may require aortic surgery. For these patients, an individualized approach is required. This review considers recent guidelines. Algorithms for investigation and management based on their recommendations are included.

Laparoendoscopic single-site surgery in gynaecology: A new frontier in minimally invasive surgery

Directory of Open Access Journals (Sweden)

Fader Amanda

2011-01-01

Full Text Available Review Objective: To review the recent developments and published literature on laparoendoscopic single-site (LESS surgery in gynaecology. Recent Findings: Minimally invasive surgery has become a standard of care for the treatment of many benign and malignant gynaecological conditions. Recent advances in conventional laparoscopy and robotic-assisted surgery have favorably impacted the entire spectrum of gynaecological surgery. With the goal of improving morbidity and cosmesis, continued efforts towards refinement of laparoscopic techniques have lead to minimization of size and number of ports required for these procedures. LESS surgery is a recently proposed surgical term used to describe various techniques that aim at performing laparoscopic surgery through a single, small-skin incision concealed within the umbilicus. In the last 5 years, there has been a surge in the developments in surgical technology and techniques for LESS surgery, which have resulted in a significant increase in utilisation of LESS across many surgical subspecialties. Recently published outcomes data demonstrate feasibility, safety and reproducibility for LESS in gynaecology. The contemporary LESS literature, extent of gynaecological procedures utilising these techniques and limitations of current technology will be reviewed in this manuscript. Conclusions: LESS surgery represents the newest frontier in minimally invasive surgery. Comparative data and prospective trials are necessary in order to determine the clinical impact of LESS in treatment of gynaecological conditions.

Penile surgery and reconstruction.

Science.gov (United States)

Perovic, Sava V; Djordjevic, Miroslav L J; Kekic, Zoran K; Djakovic, Nenad G

2002-05-01

This review will highlight recent advances in the field of penile reconstructive surgery in the paediatric and adult population. It is based on the work published during the year 2001. Besides the anatomical and histological studies of the penis, major contributions have been described in congenital and acquired penile anomalies. Also, a few new techniques and modifications of old procedures are described in order to improve the final functional and aesthetic outcome. The techniques for penile enlargement present a trend in the new millennium, but are still at the stage of investigation.

The Aesthetic Surgery Literature: Do Plastic Surgeons Remain at the Cutting Edge?

Science.gov (United States)

Dolan, Roisin T; Zins, James E; Morrison, Colin M

2016-07-01

The aesthetic surgery arena has become a competitive marketplace. Recognition as an authority in aesthetic surgery remains a powerful marketing tool for plastic surgeons, but have significant inroads been made by other specialties? The aims of this study were to analyze publication trends relating to the top five most commonly performed aesthetic surgical procedures, and to assess the origins (i.e., source specialty, authorship, institutions, and countries) of published aesthetic surgical research. Based on the seventeenth annual multispecialty data set provided by the American Society for Aesthetic Plastic Surgery, the top five most commonly performed aesthetic surgical procedures were selected. A temporal analysis of publication and citation rates, source institution and country, publishing journal, funding agency trends, and level of evidence was undertaken from 1970 to 2013. Using the search criteria, 7762 articles were identified. There was an 8.8-fold increase in publication volume when the first decade (n = 375) was compared with the last decade (n = 3326). Over the past four decades, 52.2 percent of publications (n = 4053 of 7762) originated from plastic surgery research institutions, with varying contributions from other specialties. Competition was greatest in relation to authorship of blepharoplasty- and rhinoplasty-related publications. Although plastic surgeons continue to maintain a center-stage presence in terms of authorship of aesthetic surgical literature, significant contributions are now made by other specialties. Plastic surgeons must continue to foster high-quality, peer-reviewed research and innovations to maintain their visibility as leaders in the aesthetic surgery literature and sustain a competitive advantage in aesthetic surgery practice.

Trends in Surgical Practices for Lateral Epicondylitis Among Newly Trained Orthopaedic Surgeons.

Science.gov (United States)

Wang, Dean; Degen, Ryan M; Camp, Christopher L; McGraw, Michael H; Altchek, David W; Dines, Joshua S

2017-10-01

Much controversy exists regarding the optimal surgical intervention for lateral epicondylitis because of a multitude of options available and the lack of comparative studies. Knowledge of the current practice trends would help guide the design of comparative studies needed to determine which surgical technique results in the best outcome. To review the latest practice trends for the surgical treatment of lateral epicondylitis among newly trained surgeons in the United States utilizing the American Board of Orthopaedic Surgery (ABOS) database. Cross-sectional study; Level of evidence, 3. The ABOS database was utilized to identify surgical cases for lateral epicondylitis submitted by Part II board certification examination candidates from 2004 through 2013. Inclusion criteria were predetermined using a combination of International Classification of Diseases, Ninth Revision (ICD-9) and Current Procedural Terminology (CPT) codes. Cases were organized by open and arthroscopic treatment groups and by fellowship training and were analyzed to determine differences in surgical techniques, complication rates, and concomitant procedures. In total, 1150 surgeons submitted 2106 surgical cases for the treatment of lateral epicondylitis. The number of surgical cases for lateral epicondylitis performed per 10,000 submitted cases significantly decreased from 26.7 in 2004 to 21.1 in 2013 ( P = .002). Among all cases, 92.2% were open and 7.8% were arthroscopic, with no change in the incidence of arthroscopic surgeries over the study period. Shoulder and elbow (18.1%) and sports medicine (11.4%) surgeons were more likely to perform surgery arthroscopically compared with hand surgeons (6.1%) ( P < .001). There was no difference in overall self-reported complication rates between open (4.4%) and arthroscopic (5.5%) procedures ( P = .666). Percutaneous tenotomy, debridement only, and debridement with tendon repair comprised 6.4%, 46.3%, and 47.3% of open treatment, respectively. Sports

Residency Training in Robotic General Surgery: A Survey of Program Directors

Directory of Open Access Journals (Sweden)

Lea C. George

2018-01-01

Full Text Available Objective. Robotic surgery continues to expand in minimally invasive surgery; however, the literature is insufficient to understand the current training process for general surgery residents. Therefore, the objectives of this study were to identify the current approach to and perspectives on robotic surgery training. Methods. An electronic survey was distributed to general surgery program directors identified by the Accreditation Council for Graduate Medical Education website. Multiple choice and open-ended questions regarding current practices and opinions on robotic surgery training in general surgery residency programs were used. Results. 20 program directors were surveyed, a majority being from medium-sized programs (4–7 graduating residents per year. Most respondents (73.68% had a formal robotic surgery curriculum at their institution, with 63.16% incorporating simulation training. Approximately half of the respondents believe that more time should be dedicated to robotic surgery training (52.63%, with simulation training prior to console use (84.21%. About two-thirds of the respondents (63.16% believe that a formal robotic surgery curriculum should be established as a part of general surgery residency, with more than half believing that exposure should occur in postgraduate year one (55%. Conclusion. A formal robotics curriculum with simulation training and early surgical exposure for general surgery residents should be given consideration in surgical residency training.

The Impact of Bariatric Surgery on Psychological Health

Directory of Open Access Journals (Sweden)

Jeremy F. Kubik

2013-01-01

Full Text Available Obesity is associated with a relatively high prevalence of psychopathological conditions, which may have a significant negative impact on the quality of life. Bariatric surgery is an effective intervention in the morbidly obese to achieve marked weight loss and improve physical comorbidities, yet its impact on psychological health has yet to be determined. A review of the literature identified a trend suggesting improvements in psychological health after bariatric surgery. Majority of mental health gain is likely attributed to weight loss and resultant gains in body image, self-esteem, and self-concept; however, other important factors contributing to postoperative mental health include a patient’s sense of taking control of his/her life and support from health care staff. Preoperative psychological health also plays an important role. In addition, the literature suggests similar benefit in the obese pediatric population. However, not all patients report psychological benefits after bariatric surgery. Some patients continue to struggle with weight loss, maintenance and regain, and resulting body image dissatisfaction. Severe preoperative psychopathology and patient expectation that life will dramatically change after surgery can also negatively impact psychological health after surgery. The health care team must address these issues in the perioperative period to maximize mental health gains after surgery.

The impact of bariatric surgery on psychological health.

Science.gov (United States)

Kubik, Jeremy F; Gill, Richdeep S; Laffin, Michael; Karmali, Shahzeer

2013-01-01

Obesity is associated with a relatively high prevalence of psychopathological conditions, which may have a significant negative impact on the quality of life. Bariatric surgery is an effective intervention in the morbidly obese to achieve marked weight loss and improve physical comorbidities, yet its impact on psychological health has yet to be determined. A review of the literature identified a trend suggesting improvements in psychological health after bariatric surgery. Majority of mental health gain is likely attributed to weight loss and resultant gains in body image, self-esteem, and self-concept; however, other important factors contributing to postoperative mental health include a patient's sense of taking control of his/her life and support from health care staff. Preoperative psychological health also plays an important role. In addition, the literature suggests similar benefit in the obese pediatric population. However, not all patients report psychological benefits after bariatric surgery. Some patients continue to struggle with weight loss, maintenance and regain, and resulting body image dissatisfaction. Severe preoperative psychopathology and patient expectation that life will dramatically change after surgery can also negatively impact psychological health after surgery. The health care team must address these issues in the perioperative period to maximize mental health gains after surgery.

Robotics in General Surgery

OpenAIRE

Wall, James; Chandra, Venita; Krummel, Thomas

2008-01-01

In summary, robotics has made a significant contribution to General Surgery in the past 20 years. In its infancy, surgical robotics has seen a shift from early systems that assisted the surgeon to current teleoperator systems that can enhance surgical skills. Telepresence and augmented reality surgery are being realized, while research and development into miniaturization and automation is rapidly moving forward. The future of surgical robotics is bright. Researchers are working to address th...

Rectal cancer surgery: volume-outcome analysis.

LENUS (Irish Health Repository)

Nugent, Emmeline

2010-12-01

There is strong evidence supporting the importance of the volume-outcome relationship with respect to lung and pancreatic cancers. This relationship for rectal cancer surgery however remains unclear. We review the currently available literature to assess the evidence base for volume outcome in relation to rectal cancer surgery.

Current status of food irradiation in the world. Trend in Asia

International Nuclear Information System (INIS)

Kume, Tamikazu

2002-01-01

This review describes the current status of food irradiation in the world and particularly, its trends in Asia, based on the report of the economic scale investigation on the irradiation in United States and Japan (2001) and on the information of 12th International Meeting on Radiation Processing in France in 2001 and on personal communications. International Consultative Group on Food Irradiation promotes its activities of irradiation globally and 46 countries are affiliated. Food irradiation is allowed in 52 countries. In 1999, 257,000 t of food is irradiated in the world, of which 1/3 is due to spice. The facilities for the irradiation have such sources as 60 Co and 137 Cs γ-rays, electron beam of <10 MeV and X-ray with <5 MeV. Detection methods of irradiated foods are summarized by the project of Analytical Detection Methods for Irradiation Treatment of Foods. The US is the most advanced country in the irradiation and, in Japan, only irradiation of potato is permitted. The detailed present status is also described of Bangladesh, China (the irradiation is most widely conducted in the world), India, Indonesia, Korea, Malaysia, Thailand and Vietnam. Recently Australia and New Zealand have started the irradiation. (K.H.)

The evolution of robotic general surgery.

Science.gov (United States)

Wilson, E B

2009-01-01

Surgical robotics in general surgery has a relatively short but very interesting evolution. Just as minimally invasive and laparoscopic techniques have radically changed general surgery and fractionated it into subspecialization, robotic technology is likely to repeat the process of fractionation even further. Though it appears that robotics is growing more quickly in other specialties, the changes digital platforms are causing in the general surgical arena are likely to permanently alter general surgery. This review examines the evolution of robotics in minimally invasive general surgery looking forward to a time where robotics platforms will be fundamental to elective general surgery. Learning curves and adoption techniques are explored. Foregut, hepatobiliary, endocrine, colorectal, and bariatric surgery will be examined as growth areas for robotics, as well as revealing the current uses of this technology.

History of cervical spine surgery: from nihilism to advanced reconstructive surgery.

Science.gov (United States)

Dweik, A; Van den Brande, E; Kossmann, T; Maas, A I R

2013-11-01

Review of literature. To review and analyze the evolution of cervical spine surgery from ancient times to current practice. The aim is to present an accessible overview, primarily intended for a broad readership. Descriptive literature review and analysis of the development of cervical spine surgery from the prehistoric era until today. The first evidence for surgical treatment of spinal disorders dates back to approximately 1500 BC. Conservative approaches to treatment have been the hallmark for thousands of years, but over the past 50 years progress has been rapid. We illustrate how nations have added elements to this complex subject and how knowledge has surpassed borders and language barriers. Transferral of knowledge occurred from Babylon (Bagdad) to Old Egypt, to the Greek and Roman empires and finally via the Middle East (Bagdad and Damascus) back to Europe. Recent advances in the field of anesthesia, imaging and spinal instrumentation have changed long-standing nihilism in the treatment of cervical spine pathologies to the current practice of advanced reconstructive surgery of the cervical spine. A critical approach to the evaluation of benefits and complications of these advanced surgical techniques for treatment of cervical spine disorders is required. Advances in surgery now permit full mechanical reconstruction of the cervical spine. However, despite substantial experimental progress, spinal cord repair and restoration of lost functions remain a challenge. Modern surgeons are still looking for the best way to manage spine disorders.

Gender trends in dental practice patterns. A review of current U.S. literature.

Science.gov (United States)

Dolan, T A

1991-01-01

This paper reviews three recent reports of national gender trends in dental practice patterns. Although the three independent cross-sectional studies were conducted at different points in time, used different sampling strategies, and used similar but independent survey instruments, findings were consistent across studies. In summary: Women dentists are less likely to be married and have fewer children. Women are more likely to assume child rearing and household responsibilities. Women are less likely to be practice owners. Women worked slightly fewer hours per week and weeks per year, and were more likely to take a leave of absence for illness or child rearing. However, women dentists demonstrate a far greater professional work commitment than was previously reported in the literature. Women earn significantly less income from the practice of dentistry, even after controlling for age, practice ownership, hours worked per week, and other personal characteristics. The most current "Gender Wage Gap" estimates range from 57.7% for specialists to 75.4% for general practitioners (8). delta.

Bone Metabolism after Bariatric Surgery

Science.gov (United States)

Yu, Elaine W.

2014-01-01

Bariatric surgery is a popular and effective treatment for severe obesity, but may have negative effects on the skeleton. This review summarizes changes in bone density and bone metabolism from animal and clinical studies of bariatric surgery, with specific attention to Roux-en-Y gastric bypass (RYGB), adjustable gastric banding (AGB), and sleeve gastrectomy (SG). Skeletal imaging artifacts from obesity and weight loss are also considered. Despite challenges in bone density imaging, the preponderance of evidence suggests that bariatric surgery procedures have negative skeletal effects that persist beyond the first year of surgery, and that these effects vary by surgical type. The long-term clinical implications and current clinical recommendations are presented. Further study is required to determine mechanisms of bone loss after bariatric surgery. Although early studies focused on calcium/vitamin D metabolism and mechanical unloading of the skeleton, it seems likely that surgically-induced changes in the hormonal and metabolic profile may be responsible for the skeletal phenotypes observed after bariatric surgery. PMID:24677277

An Untargeted Metabolomics Approach to Characterize Short-Term and Long-Term Metabolic Changes after Bariatric Surgery.

Directory of Open Access Journals (Sweden)

Sophie H Narath

Full Text Available Bariatric surgery is currently one of the most effective treatments for obesity and leads to significant weight reduction, improved cardiovascular risk factors and overall survival in treated patients. To date, most studies focused on short-term effects of bariatric surgery on the metabolic profile and found high variation in the individual responses to surgery. The aim of this study was to identify relevant metabolic changes not only shortly after bariatric surgery (Roux-en-Y gastric bypass but also up to one year after the intervention by using untargeted metabolomics. 132 serum samples taken from 44 patients before surgery, after hospital discharge (1-3 weeks after surgery and at a 1-year follow-up during a prospective study (NCT01271062 performed at two study centers (Austria and Switzerland. The samples included 24 patients with type 2 diabetes at baseline, thereof 9 with diabetes remission after one year. The samples were analyzed by using liquid chromatography coupled to high resolution mass spectrometry (LC-HRMS, HILIC-QExactive. Raw data was processed with XCMS and drift-corrected through quantile regression based on quality controls. 177 relevant metabolic features were selected through Random Forests and univariate testing and 36 metabolites were identified. Identified metabolites included trimethylamine-N-oxide, alanine, phenylalanine and indoxyl-sulfate which are known markers for cardiovascular risk. In addition we found a significant decrease in alanine after one year in the group of patients with diabetes remission relative to non-remission. Our analysis highlights the importance of assessing multiple points in time in subjects undergoing bariatric surgery to enable the identification of biomarkers for treatment response, cardiovascular benefit and diabetes remission. Key-findings include different trend pattern over time for various metabolites and demonstrated that short term changes should not necessarily be used to identify

Planned combined radiotherapy and surgery

International Nuclear Information System (INIS)

Silverman, C.L.; Marks, J.E.

1987-01-01

Though the planned combined use of surgery and radiation has been shown to be beneficial for other tumors, the authors feel that the present evidence is far from persuasive in demonstrating a definite superiority of combined therapy over surgery or radiation alone for advanced laryngeal tumors. The actuarial or disease-free survival rates for patients treated with combined therapy have not been significantly increased over those obtained with a single modality in any randomized, well-controlled study, although the trend is toward improved local regional control. Many of the retrospective studies are probably flawed by selection bias; the patients selected for combined treatment generally have more advanced cancers and represent a worse prognostic group. It is clear from this review that the positive value of irradiation for advanced transglottic and supraglottic tumors needs to be documented by a controlled study that compares surgery alone with salvage radiation at time of recurrence to surgery plus adjuvant radiation. The authors feel that such a study is needed to put to rest the present controversy before they can advocate a course of treatment that is expensive, time-consuming, and difficult for the patients to tolerate owing to severe acute side effects and potentially morbid late effects (xerostomia, necrosis) that can greatly lessen the quality of life for these patients

Prevalence, correlates, and trends in tobacco use and cessation among current, former, and never adult marijuana users with a history of tobacco use, 2005-2014.

Science.gov (United States)

Schauer, Gillian L; King, Brian A; McAfee, Timothy A

2017-10-01

Approximately 70% of current (past 30-day) adult marijuana users are current tobacco users, which may complicate tobacco cessation. We assessed prevalence and trends in tobacco cessation among adult ever tobacco users, by marijuana use status. Data came from the National Survey on Drug Use and Health, a cross-sectional, nationally representative, household survey of U.S. civilians. Analyses included current, former, and never marijuana users aged≥18 reporting ever tobacco use (cigarette, cigar, chew/snuff). We computed weighted estimates (2013-2014) of current tobacco use, recent tobacco cessation (quit 30days to 12months), and sustained tobacco cessation (quit>12months) and adjusted trends in tobacco use and cessation (2005-2014) by marijuana use status. We also assessed the association between marijuana and tobacco use status. In 2013-2014, among current adult marijuana users reporting ever tobacco use, 69.1% were current tobacco users (vs. 38.5% of former marijuana users, pusers, pusers, pusers, pusers, pusers, pusers who ever used tobacco had double the prevalence (vs. never-marijuana users) of current tobacco use, and significantly lower sustained abstinence. Interventions addressing tobacco cessation in the context of use of marijuana and other substances may be warranted. Copyright © 2017 Elsevier Ltd. All rights reserved.

Current Technologies and its Trends of Machine Vision in the Field of Security and Disaster Prevention

Science.gov (United States)

Hashimoto, Manabu; Fujino, Yozo

Image sensing technologies are expected as useful and effective way to suppress damages by criminals and disasters in highly safe and relieved society. In this paper, we describe current important subjects, required functions, technical trends, and a couple of real examples of developed system. As for the video surveillance, recognition of human trajectory and human behavior using image processing techniques are introduced with real examples about the violence detection for elevators. In the field of facility monitoring technologies as civil engineering, useful machine vision applications such as automatic detection of concrete cracks on walls of a building or recognition of crowded people on bridge for effective guidance in emergency are shown.

Anesthesia for ambulatory anorectal surgery.

Science.gov (United States)

Gudaityte, Jūrate; Marchertiene, Irena; Pavalkis, Dainius

2004-01-01

The prevalence of minor anorectal diseases is 4-5% of adult Western population. Operations are performed on ambulatory or 24-hour stay basis. Requirements for ambulatory anesthesia are: rapid onset and recovery, ability to provide quick adjustments during maintenance, lack of intraoperative and postoperative side effects, and cost-effectiveness. Anorectal surgery requires deep levels of anesthesia. The aim is achieved with 1) regional blocks alone or in combination with monitored anesthesia care or 2) deep general anesthesia, usually with muscle relaxants and tracheal intubation. Modern general anesthetics provide smooth, quickly adjustable anesthesia and are a good choice for ambulatory surgery. Popular regional methods are: spinal anesthesia, caudal blockade, posterior perineal blockade and local anesthesia. The trend in regional anesthesia is lowering the dose of local anesthetic, providing selective segmental block. Adjuvants potentiating analgesia are recommended. Postoperative period may be complicated by: 1) severe pain, 2) urinary retention due to common nerve supply, and 3) surgical bleeding. Complications may lead to hospital admission. In conclusion, novel general anesthetics are recommended for ambulatory anorectal surgery. Further studies to determine an optimal dose and method are needed in the group of regional anesthesia.

Annals of African Surgery: Editorial Policies

African Journals Online (AJOL)

Focus and Scope. The goal of the Annals of African Surgery is to provide a medium for the exchange of current information between surgeons in the African region. The journal embraces surgery in all its aspects; basic science, clinical research, experimental research, surgical education. It will assist surgeons in the region ...

Current aspects in reconstructive surgery for nasal cavity and paranasal sinus cancer

Science.gov (United States)

Shtin, V. I.; Novikov, V. A.; Gjunter, V. E.; Choinzonov, E. L.; Ryabova, A. I.; Sirkashev, V. A.; Surkova, P. V.; Vasilev, R. V.; Menkova, E. N.

2017-09-01

Tumors of the nasal cavity and paranasal sinuses present a challenge to treat them. A combination of surgery and radiation therapy can improve treatment outcomes in 49-56% [1, 2] of the patients with locally advanced nasal cavity and paranasal sinus cancer. The midface reconstruction poses a formidable challenge to the reconstructive surgeon due to the region's complex skeletal and soft-tissue anatomy. The rehabilitation program including the reconstruction of the resected orbital walls using the porous and mesh implants from titanium nickelid (TiNi) was developed at the Cancer Research institute jointly with the Research Institute of Medical Materials. The technique was proven effective, allowing the natural position of the eye and visual function to be preserved in 90% [1-3] of the patients. A long period of reparative processes and risk of developing inflammation in the implant area, as well as the need to decrease length of surgery, contributed to the development of a novel approach to repairing the midface bone structures using the implant based on the microporous wire and TiNi mesh. Eighteen patients with nasal cavity and paranasal sinus cancer were treated using the combined thin implants. The novel technique allowed the time of the implant installation to be reduced to 5-10 min. The structure of the implant contributed to prevention of inflammatory processes in 97% [1, 2] of cases. Thus, the natural position of the eyeball and visual function were preserved in 100% [1, 3, 4] of patients. The use of the TiNi implants in reconstructive surgery for patients with nasal cavity and paranasal sinus cancer led to reduced time of surgery and rehabilitation, increased level of social adaptation of patients and improved cosmetic and functional results.

Unused Opioid Pills After Outpatient Shoulder Surgeries Given Current Perioperative Prescribing Habits.

Science.gov (United States)

Kumar, Kanupriya; Gulotta, Lawrence V; Dines, Joshua S; Allen, Answorth A; Cheng, Jennifer; Fields, Kara G; YaDeau, Jacques T; Wu, Christopher L

2017-03-01

In the past 16 years, the number of prescription opioids sold in the United States, as well as deaths from prescription opioids, has nearly quadrupled. However, the overall amount of pain reported by patients has not changed significantly. Specific information about opioid prescriptions in the perioperative period is lacking. Of the studies that have been published, investigators have shown that the majority of patients have unused postoperative opioid pills. Moreover, patients appear to lack information about disposal of unused opioid pills. To compare the number of pills prescribed versus the numbers left unused after outpatient shoulder surgeries at an orthopaedic surgery institution. Case series; Level of evidence, 4. In this prospective, observational study, 100 patients (age >18 years) undergoing outpatient shoulder surgery (rotator cuff repair, labral repair, stabilization/Bankart repair, debridement) were enrolled. Follow-ups were conducted via surveys on postoperative days (PODs) 7, 14, 28, and 90. The primary outcome was the number of unused pills from the originally prescribed medication. For all procedure types, the median (Q1, Q3) number of prescribed pills was 60 (40, 80). On POD 90, patients reported a median (Q1, Q3) of 13 (0, 32) unused pills; patients who underwent rotator cuff repairs had the lowest number of pills remaining (median [Q1, Q3], 0 [0, 16]), whereas patients who had stabilization/Bankart repairs had the highest number of unused pills (median [Q1, Q3], 37 [29, 50]). Patient satisfaction with pain management ranged from an average of 70% to 90%. Only 25 patients received instructions or education about opioid disposal. Most outpatient shoulder surgery patients who underwent certain operations were prescribed more opioid analgesics than they consumed. Patient education regarding the disposal of opioids was lacking.

Proceeding of 27th domestic symposium on trends in aging management and current status of aging degradation studies in nuclear power plants

International Nuclear Information System (INIS)

2000-11-01

As the 27th domestic symposium of Atomic Energy Research Committee, the Japan Welding Engineering Society, the symposium was held titled as 'Trends of aging managements and current status of aging effect studies in nuclear power plants'. Six speakers gave lectures titled as 'Present status of research on mechanism and prediction method of neutron irradiation embrittlement of pressure vessel steels', 'Present status of research on mechanism and prediction method of environmentally assisted cracking in the LWR environments', 'Domestic and overseas trends of aging management of the LWR plants', 'Trends of prediction/evaluation, inspection/monitoring and repair/replacement technologies for aging of the LWR plants', 'Present status of research on mechanism and prediction method of high cycle thermal fatigue due to the thermal fluid-structure interaction in the LWR environments' and Present status of research on very high cycle fatigue of structural materials'. (T. Tanaka)

Innovations in Bariatric Surgery.

Science.gov (United States)

Zhu, Catherine; Pryor, Aurora D

2015-11-01

Surgery has consistently been demonstrated to be the most effective long-term therapy for the treatment of obesity. However, despite excellent outcomes with current procedures, most patients with obesity- and weight-related comorbidities who meet criteria for surgical treatment choose not to pursue surgery out of fear of operative risks and complications or concerns about high costs. Novel minimally invasive procedures and devices may offer alternative solutions for patients who are hesitant to pursue standard surgical approaches. These procedures may be used for primary treatment of obesity, early intervention for patients approaching morbid obesity, temporary management prior to bariatric surgery, or revision of bypass surgery associated with weight regain. Novel bariatric procedures can in general be divided into four categories: endoluminal space-occupying devices, gastric suturing and restrictive devices, absorption-limiting devices, and neural-hormonal modulating devices. Many of these are only approved as short-term interventions, but these devices may be effective for patients desiring low-risk procedures or a transient effect. We will see the expansion of indications and alternatives for metabolic surgery as these techniques gain approval.

[Flexible endoscope in thoracic surgery: CITES or cVATS?].

Science.gov (United States)

Assouad, J; Fénane, H; Masmoudi, H; Giol, M; Karsenti, A; Gounant, V; Grunenwald, D

2013-10-01

Early pain and persistent parietal disorders remains a major unresolved problem in thoracic surgery. Thoracotomy and the use of multiple ports in most Video Assisted Thoracic Surgery (VATS) procedures are the major cause of this persistent pain. For the last decade, a few publications describing the use of either single incision VATS and cervical thoracic approaches have been reported without significant results in comparison with current used techniques. Intercostals compression during surgery and early after by intercostals chest tube placement, are probably the major cause of postoperative pain. Flexible endoscope is currently used in several surgeries and will take more and more importance in our daily use in thoracic surgery. Instrument flexibility allows its use through minimally invasive approaches and offers a very interesting intra-thoracic navigation. We describe here the first use in France of a flexible endoscope in thoracic surgery through a single cervical incision to perform simultaneous exploration and biopsies of the mediastinum and right pleura using the original approach of Cervical Incision Thoracic Endoscopic Surgery (CITES). Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Elective surgery cancelation on day of surgery: An endless dilemma

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A Fayed

2016-01-01

Full Text Available Background: Cancelation of surgery is a constant agonizing dilemma for nearly all healthcare services that has been intensively investigated to find out its roots, consequences, and possible solutions. The rates of cancelation of surgery vary between centers and more so among surgical specialties with numerous reasons standing behind this phenomenon. Patients and Methods: In the current study, analysis of monthly cancelation rates from January 2009 to December 2012, and assessment of establishing new operating rooms (ORs using statistical process control charts was conducted. A detailed review of a total of 1813 cases canceled on the day of surgery from January to December 2012, to examine the various reasons of cancelation among surgical specialties. Results: The average cancelation rate was 11.1%, which dropped to 9.0% after launching of new theaters. Four reasons explained about 80% of cancelations; Patients "no show" was the leading cause of cancelation (27%. One-fourth of cancelations (24.3% were due to the need for further optimization, and the third most prominent cause of cancelation was a lack of OR time (19.5%. Unavailability of staff/equipment/implants accounted for only 0.7% of cancelations. The "no show" was the most common cause of cancelation among all surgical specialties ranging from 21% for plastic surgery to 32% in ophthalmic surgeries. Conclusion: It was confirmed that there is a unique profile of cancelation of surgery problem for every institute, an extension of infrastructure may not be the only solution. Control charts helped to enhance the general picture and are functional in monitoring and evaluating changes in the cancelation of surgery.

Institutional Repositories at Small Institutions in America: Some Current Trends

Science.gov (United States)

Nykanen, Melissa

2011-01-01

The research reported in this article was undertaken to determine the level of implementation of institutional repositories (IRs) at small institutions enrolling fewer than 10,000 students. The study analyzed quantitative and qualitative data from IRs at a number of small institutions with the aim of observing relevant patterns and trends that may…

Current Evidence regarding Prophylactic Antibiotics in Head and Neck and Maxillofacial Surgery

Science.gov (United States)

2014-01-01

Antibiotic prophylaxis is commonly used to decrease the rate of infections in head and neck surgery. The aim of this paper is to present the available evidence regarding the application of antibiotic prophylaxis in surgical procedures of the head and neck region in healthy patients. A systemic literature review based on Medline and Embase databases was performed. All reviews and meta-analyses based on RCTs in English from 2000 to 2013 were included. Eight out of 532 studies fulfilled all requirements. Within those, only seven different operative procedures were analyzed. Evidence exists for the beneficial use of prophylactic antibiotics for tympanostomy, orthognathic surgery, and operative tooth extractions. Unfortunately, little high-level evidence exists regarding the use of prophylactic antibiotics in head and neck surgery. In numerous cases, no clear benefit of antibiotic prophylaxis has been shown, particularly considering their potential adverse side effects. Antibiotics are often given unnecessarily and are administered too late and for too long. Furthermore, little research has been performed on the large number of routine cases in the above-mentioned areas of specialization within the last few years, although questions arising with respect to the treatment of high-risk patients or of specific infections are discussed on a broad base. PMID:25110703

Investments of Banks in Securities: the Essence and Development Trends under Current Conditions

Directory of Open Access Journals (Sweden)

Ekaterina Vladimirovna Mazikova

2015-12-01

Full Text Available The implementation of modern banking activities involves the realization of investments. Investment is a complex discussion economic category, characterized by a number of features. The types and forms of investment are manifold and can be transformed with account of the state of the economy and the level of development of industrial relations. The faster growth of the financial sector in the economy has stipulated the development of financial investment. Banks as financial and lending institutions actively make financial investments in securities. Banks’ investment in securities pursues a number of purposes which determine the selection of securities for investment and their quality. The article identified the targets of bank investments in securities and their development trends under current conditions on the basis of the analysis of the actual data for 2010–2014. Negative revaluation and the actual decrease in the value of corporate securities of Russian issuers reduce their commercial appeal. Banks refuse to speculate on the stock market in favor of the securities that ensure liquidity. Banks’ investments aim to purchasing securities from the Lombard List of the Bank of Russia in order to obtain loans and participate in the repo transactions. Thus, during the analyzed period, banks’ investments in securities transformed from systemically important assets that generate substantial profit into the mechanism that provides liquidity. It should be noted that a significant part of investment resources of Russian banks services the debt obligations of Russia’s Government. The article also identified a trend of banks’ increasing investment in the participation portfolios of subsidiaries and associated joint stock companies. The official data of the Central Bank of the Russian Federation (Bank of Russia [15], and the Federal State Statistics Service [14] were used as the information base for the study

E-LEARNING: CURRENT STATE, TRENDS AND FUTURE PROSPECTS

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Г А Краснова

2017-12-01

Full Text Available The article is devoted to the main trends of development of e-learning in formal and non-formal education in different countries. The article discusses the main quantitative and qualitative characteristics of the market of e-learning education. The authors define main reasons the development of e-learning education in higher education. The authors note that the demand for e-learning by various groups of users will push the education authorities and educational institutions to develop different forms of e-learning and implement new business models of universities. In most universities in Europe and the United States adopted or will be adopted for the institutional strategy of development of e-learning.

Tianshuishi space breeding current situation and developing trend

International Nuclear Information System (INIS)

Wang Fuquan; Song Jianrong; Zhang Zhongping; Guo Zhenfang

2012-01-01

Tianshuishi is located in Xi'an to lanzhou among two big cities, the five space launch, has vegetables, food, grasses, flowers, rape, melon and fruit, Chinese traditional medicine, amount of 8 categories of crops, such as the 22 new material after carrying the ground breeding work. Only vegetables on identified 23 aerospace new varieties. After ten years of space breeding, summarizes the present situation of Tianshuishi space breeding, development experience, characteristic, trends, and puts forward the development space breeding Tianshuishi organization and breeding of talent from the matching policy and grow up incentive mechanism, strengthen the cooperation and all over the country, establishing fiscal policy support from the aspects such as advice. (authors)

A review of medical robotics for minimally invasive soft tissue surgery.

Science.gov (United States)

Dogangil, G; Davies, B L; Rodriguez y Baena, F

2010-01-01

This paper provides an overview of recent trends and developments in medical robotics for minimally invasive soft tissue surgery, with a view to highlight some of the issues posed and solutions proposed in the literature. The paper includes a thorough review of the literature, which focuses on soft tissue surgical robots developed and published in the last five years (between 2004 and 2008) in indexed journals and conference proceedings. Only surgical systems were considered; imaging and diagnostic devices were excluded from the review. The systems included in this paper are classified according to the following surgical specialties: neurosurgery; eye surgery and ear, nose, and throat (ENT); general, thoracic, and cardiac surgery; gastrointestinal and colorectal surgery; and urologic surgery. The systems are also cross-classified according to their engineering design and robotics technology, which is included in tabular form at the end of the paper. The review concludes with an overview of the field, along with some statistical considerations about the size, geographical spread, and impact of medical robotics for soft tissue surgery today.

Taking NOTES: translumenal flexible endoscopy and endoscopic surgery.

Science.gov (United States)

Willingham, Field F; Brugge, William R

2007-09-01

To review the current state of natural orifice surgery and examine the concerns, challenges, and opportunities presented by translumenal research. Translumenal endoscopic procedures have been the focus of extensive research. Researchers have reported natural orifice translumenal endoscopic surgery in a swine model in several areas involving the abdominal cavity. Diagnostic procedures have included endoscopic peritoneoscopy, liver biopsy, lymphadenectomy, and abdominal exploration. Several gynecologic procedures including tubal ligation, oophorectomy, and partial hysterectomy have been demonstrated using current commercial endoscopes. Gastrointestinal surgical procedures, including gastrojejunostomy, cholecystectomy, splenectomy, and distal pancreatectomy have been performed successfully via transgastric and/or transcolonic approaches. There have been no studies of natural orifice translumenal endoscopic surgery procedures published in humans. While fundamental questions about the emerging technology have not been scrutinized, limitations of the large animal model will pose a challenge to the development of large randomized trials. While natural orifice translumenal endoscopic surgery may represent a paradigm shift and may offer significant benefits to patients, rigorous testing of the techniques is lacking and current data have been drawn from case series.

More green infrastructure is required to maintain ecosystem services under current trends in land-use change in Europe.

Science.gov (United States)

Maes, Joachim; Barbosa, Ana; Baranzelli, Claudia; Zulian, Grazia; Batista E Silva, Filipe; Vandecasteele, Ine; Hiederer, Roland; Liquete, Camino; Paracchini, Maria Luisa; Mubareka, Sarah; Jacobs-Crisioni, Chris; Castillo, Carolina Perpiña; Lavalle, Carlo

Green infrastructure (GI), a network of nature, semi-natural areas and green space, delivers essential ecosystem services which underpin human well-being and quality of life. Maintaining ecosystem services through the development of GI is therefore increasingly recognized by policies as a strategy to cope with potentially changing conditions in the future. This paper assessed how current trends of land-use change have an impact on the aggregated provision of eight ecosystem services at the regional scale of the European Union, measured by the Total Ecosystem Services Index (TESI8). Moreover, the paper reports how further implementation of GI across Europe can help maintain ecosystem services at baseline levels. Current demographic, economic and agricultural trends, which affect land use, were derived from the so called Reference Scenario. This scenario is established by the European Commission to assess the impact of energy and climate policy up to 2050. Under the Reference Scenario, economic growth, coupled with the total population, stimulates increasing urban and industrial expansion. TESI8 is expected to decrease across Europe between 0 and 5 % by 2020 and between 10 and 15 % by 2050 relative to the base year 2010. Based on regression analysis, we estimated that every additional percent increase of the proportion of artificial land needs to be compensated with an increase of 2.2 % of land that qualifies as green infrastructure in order to maintain ecosystem services at 2010 levels.

Gender reassignment surgery: an overview.

Science.gov (United States)

Selvaggi, Gennaro; Bellringer, James

2011-05-01

Gender reassignment (which includes psychotherapy, hormonal therapy and surgery) has been demonstrated as the most effective treatment for patients affected by gender dysphoria (or gender identity disorder), in which patients do not recognize their gender (sexual identity) as matching their genetic and sexual characteristics. Gender reassignment surgery is a series of complex surgical procedures (genital and nongenital) performed for the treatment of gender dysphoria. Genital procedures performed for gender dysphoria, such as vaginoplasty, clitorolabioplasty, penectomy and orchidectomy in male-to-female transsexuals, and penile and scrotal reconstruction in female-to-male transsexuals, are the core procedures in gender reassignment surgery. Nongenital procedures, such as breast enlargement, mastectomy, facial feminization surgery, voice surgery, and other masculinization and feminization procedures complete the surgical treatment available. The World Professional Association for Transgender Health currently publishes and reviews guidelines and standards of care for patients affected by gender dysphoria, such as eligibility criteria for surgery. This article presents an overview of the genital and nongenital procedures available for both male-to-female and female-to-male gender reassignment.

Current Status of Surgical Planning for Orthognathic Surgery: Traditional Methods versus 3D Surgical Planning

Directory of Open Access Journals (Sweden)

Jeffrey A. Hammoudeh, MD, DDS

2015-02-01

Conclusions: It is our opinion that virtual model surgery will displace and replace traditional model surgery as it will become cost and time effective in both the private and academic setting for practitioners providing orthognathic surgical care in cleft and noncleft patients.

FROM COMPLEX EVOLVING TO SIMPLE: CURRENT REVISIONAL AND ENDOSCOPIC PROCEDURES FOLLOWING BARIATRIC SURGERY.

Science.gov (United States)

Zorron, Ricardo; Galvão-Neto, Manoel Passos; Campos, Josemberg; Branco, Alcides José; Sampaio, José; Junghans, Tido; Bothe, Claudia; Benzing, Christian; Krenzien, Felix

Roux-en-Y gastric bypass (RYGB) is a standard therapy in bariatric surgery. Sleeve gastrectomy and gastric banding, although with good results in the literature, are showing higher rates of treatment failure to reduce obesity-associated morbidity and body weight. Other problems after bariatric may occur, as band erosion, gastroesophageal reflux disease and might be refractory to medication. Therefore, a laparoscopic conversion to a RYGB can be an effective alternative, as long as specific indications for revision are fulfilled. The objective of this study was to analyse own and literature data on revisional bariatric procedures to evaluate best alternatives to current practice. Institutional experience and systematic review from the literature on revisional bariatric surgery. Endoscopic procedures are recently applied to ameliorate failure and complications of bariatric procedures. Therapy failure following RYGB occurs in up to 20%. Transoral outlet reduction is currently an alternative method to reduce the gastrojejunal anastomosis. The diameter and volume of sleeve gastrectomy can enlarge as well, which can be reduced by endoscopic full-thickness sutures longitudinally. Dumping syndrome and severe hypoglycemic episodes (neuroglycopenia) can be present in patients following RYGB. The hypoglycemic episodes have to be evaluated and usually can be treated conventionally. To avoid partial pancreatectomy or conversion to normal anatomy, a new laparoscopic approach with remnant gastric resection and jejunal interposition can be applied in non-responders alternatively. Hypoglycemic episodes are ameliorated while weight loss is sustained. Revisional and endoscopic procedures following bariatric surgery in patients with collateral symptomatic or treatment failure can be applied. Conventional non-surgical approaches should have been applied intensively before a revisional surgery will be indicated. Former complex surgical revisional procedures are evolving to less

Bariatric surgery in individuals with liver cirrhosis: A narrative review

Directory of Open Access Journals (Sweden)

Everton Cazzo

Full Text Available Summary Introduction: Bariatric surgery has become the gold standard treatment for morbid obesity, but there is no consensus regarding its safety and efficacy among individuals with chronic liver diseases. Objective: To critically evaluate the existing evidence on literature about bariatric surgery in individuals with liver cirrhosis. Method: Narrative review performed by means of an online search in the MEDLINE and LILACS databases. Results: Bariatric surgery is safe and effective in individuals with chronic liver disease without clinical decompensation or significant portal hypertension. Individuals with severe liver function impairment present significantly higher surgical morbidity and mortality. Among candidates to liver transplantation, surgery may be performed before, after and even during transplantation, and there is a predominant trend to perform it after. Vertical sleeve gastrectomy seems to be the most adequate technique in this group of subjects. Conclusion: Bariatric surgery is safe and effective in individuals with compensated cirrhosis without significant portal hypertension, but presents higher morbidity. Among candidates to liver transplantation and/or individuals with severe portal hypertension, morbidity and mortality are significantly higher.

The effects of conventional extracorporeal circulation versus miniaturized extracorporeal circulation on microcirculation during cardiopulmonary bypass-assisted coronary artery bypass graft surgery

NARCIS (Netherlands)

Yuruk, Koray; Bezemer, Rick; Euser, Mariska; Milstein, Dan M. J.; de Geus, Hilde H. R.; Scholten, Evert W.; de Mol, Bas A. J. M.; Ince, Can

2012-01-01

OBJECTIVES: To reduce the complications associated with cardiopulmonary bypass (CPB) during cardiac surgery, many modifications have been made to conventional extracorporeal circulation systems. This trend has led to the development of miniaturized extracorporeal circulation systems. Cardiac surgery

Serum endocan levels before and after surgery on low-grade gliomas.

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Tanriverdi, Taner; Kemerdere, Rahsan; Inal, Berrin B; Yuksel, Odhan; Emre, Humeyra O; Ahmedov, Merdin; Baran, Oguz; Ates, Seda

2017-01-01

Endocan has been shown to be a marker for several cancers and may show degree of malignancy. The aim of this study is to assess serum levels of endocan before and after surgery on low-grade gliomas (LGGs). Endocan was assayed by commercially available enzyme-linked immunosorbent assay (ELISA) kits in a total of 19 patients and 12 controls. Serial serum samples were obtained before and after surgery (1 st day, 1 st week, and 1 st month of surgery). Control samples were collected from cord blood during cesarean section. The results were compared with control brain tissues. Controls showed significantly lower serum endocan levels compared to before and after surgery ( P < 0.05). There is a trend of increase in mean serum levels from before surgery and during the very early period after surgery (during first week); however, in the first month, mean serum levels became lower. Endocan, a vital molecule for angiogenesis, is highly expressed before and after surgery in LGGs, but long-term data is needed. Furthermore, future studies should include high-grade gliomas to discuss whether endocan is associated with recurrence and response to treatment.

Bariatric Surgery Coverage: a Comprehensive Budget Impact Analysis from a Payer Perspective.

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Palli, Swetha R; Rizzo, John A; Heidrich, Natalie

2018-06-01

The objective of this study was to estimate a payer's budget impact of bariatric surgery coverage under (1) unrestricted, (2) budget-restricted ($500,000/year), and (3) quantity-restricted (100/year) medical benefit plan scenarios versus non-coverage in general and type 2 diabetes mellitus (T2DM) populations over a 10-year period. Using recently published literature and health technology assessment reports, the model evaluated a hypothetical payer population of 100,000 members under current real-world trends: BMI-defined obesity groups (31.3% normal/underweight, 33% overweight, 20.4% obese, 9% severely obese and 6.3% morbidly obese), T2DM prevalence (6.7-27.5%; 100% for the T2DM model), surgery type (LAGB, BPD/DS, VSG, and RYGB), and differential outcomes (T2DM resolution, costs, and reoperation and complications rates). Assuming a surgery election rate of 1.42% among eligible candidates with a 3% discount rate and 10% annual surgery turnover rate, the model calculated the incremental cost per-member-per-month (PMPM) by estimating the difference in total non-T2DM and T2DM-related expected costs and savings. One-way (± 25%) sensitivity analysis was performed. The impact of covering bariatric surgery under multiple scenarios for a general (or T2DM) population ranged from an additional $0.3 to $3.6 (T2DM: $0.3 to $10.5) PMPM in year 1. Incremental costs diminished over time, breaking even between years 5 and 9 (T2DM: 5-6), and by year 10, cost savings were estimated to be between $1.5 and $4.8 (T2DM: $1.2 and $31.8). Providing bariatric surgery coverage may have a modest short-term budget impact increase but would lead to long-term net cost savings in a general population model. The cost savings were much more pronounced in the T2DM model.

Transfusion medicine and solid organ transplant - Update and review of some current issues.

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Sarkar, R S; Philip, J; Yadav, Pramod

2013-04-01

Transfusion medicine holds a place of prime importance in organ transplant surgeries. There is a huge demand of organs worldwide with long waiting periods before the organ is available for transplant. Currently the dependency on ABO and HLA matching has decreased considerably with the use of modern immunosuppressant drugs and transplant techniques. The greatest advance in clinical implementation of ABO-incompatible transplants came about through desensitization and isoagglutinin elimination techniques with immunoadsorption and anti-CD20 antibodies becoming the norm, and spleenectomy fading out. The implications and practices of transfusion medicine in organ transplant are also undergoing drastic changes. The practice of infusion of one unit of donor's blood preoperatively for immunomodulation is no longer practiced. Use of leuco-reduced products has shown decreasing trends of alloimmunization and graft rejection in cases of multiple surgeries related to organ transplants. Worldwide donor and recipient registry programmes are being setup and existing ones are being upgraded. Such a registry system has been opened in India for kidney transplant cases very recently. Due to such registry programmes the dependency on siblings and directed donations have decreased considerably. This review deals with some of the current issues contributing to the successful outcome of mismatched transplants and the changing concepts of transfusion medicine related to it.

Stellate Ganglion Block, Compared With Xenon Light Irradiation, Is a More Effective Treatment of Neurosensory Deficits Resulting From Orthognathic Surgery, as Measured by Current Perception Threshold.

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Nogami, Kentaro; Taniguchi, Shogo

2015-07-01

The aim of this study was to evaluate the relative effectiveness of stellate ganglion blockade (SGB) versus xenon light irradiation (XLI) for the treatment of neurosensory deficits resulting from orthognathic surgery as determined by a comparison of prospective measurements of electrical current perception thresholds (CPTs) and ranged CPTs (R-CPTs). CPT and R-CPT in the mental foramen area were measured during electrical stimulation at 98 different sites on the body in patients who had undergone orthognathic surgery. After surgery, patients were assigned to the SGB group or the XLI group. CPT and R-CPT of the 2 groups were measured at stimulation frequencies of 2,000, 250, and 5 Hz before surgery, 1 week after surgery, and after 10 treatment sessions. Furthermore, the influence of surgical factors, such as genioplasty and a surgically exposed inferior alveolar nerve (IAN), was examined in the 2 groups. Patients' CPT and R-CPT values indicated a considerable amount of sensory disturbance in most cases after surgery. The change in magnitude of all CPT and R-CPT values for the SGB group decreased considerably compared with that for the XLI group after treatment. There was no correlation between CPT or R-CPT values and surgical factors (eg, genioplasty and exposure of the IAN). SGB of the IAN could be an effective method for treating neurosensory deficits after orthognathic surgery on the IAN. Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Current status of cardiovascular surgery in Japan, 2013 and 2014: A report based on the Japan Cardiovascular Surgery Database (JCVSD). 1: Mission and history of JCVSD.

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Takamoto, Shinichi; Motomura, Noboru; Miyata, Hiroaki; Tsukihara, Hiroyuki

2018-01-01

The Japan Cardiovascular Surgery Database (JCVSD) was created in 2000 with the support of the Society of Thoracic Surgeons (STS). The STS database content was translated to Japanese using the same disease criteria and in 2001, data entry for adult cardiac surgeries was initiated online using the University Hospital Medical Information Network (UMIN). In 2008, data entry for congenital heart surgeries was initiated in the congenital section of JCVSD and preoperative expected mortality (JapanSCORE) in adult cardiovascular surgeries was first calculated using the risk model of JCVSD. The Japan Surgical Board system merged with JCVSD in 2011, and all cardiovascular surgical data were registered in the JCVSD from 2012 onward. The reports resulting from the data analyses of the JCVSD will encourage further improvements in the quality of cardiovascular surgeries, patient safety, and medical care in Japan.

A Panoramic Wireless Endoscope System Design for the Application of Minimally Invasive Surgery

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Chun-Hsiang Peng

2014-05-01

Full Text Available Minimally Invasive Surgery (MIS is the current trend in surgery. Compared to traditional surgery, MIS can substantially decrease recovery time and expenses needed by patients after surgeries, reduce pain during surgical procedures, and is highly regarded by physicians and patients. An endoscope is widely used in the diagnosis and treatments of various medical disciplines, such as hysteroscopy, laparoscopy, and colonoscopy, and have been adopted by many branches of medicine. However, the limited image field of MIS is often the most difficult obstacles faced by surgeons and medical students, especially to less experienced physicians and difficult surgical procedures; the limited field of view of endoscopic imaging does not provide a whole picture of the surgery area, making the procedures difficult and full of uncertainty. In light of this problem, we proposed a "Panoramic Wireless Endoscope System design", hoping to provide physicians with a wide field of view of the endoscopic image. We combine images captured from two parallel-mounted endoscope lenses into a single, wide-angle image, giving physicians a wider field of view and easier access to the surgical area. In addition, we developed a wireless transmission system so the image can be transmitted to various display platforms, eliminating the needs for excessive cabling on surgical tools and enable physicians to better operate on the patient. Finally, our system allows surgical assistants a better view of the operation process, and enables other physicians and nurses to remotely observe the process. Our experiment results have shown that we can increase the image to 152% of its original size. We used the PandaBoard ES platform with an ARM9 processor and 1G of onboard RAM, and continuously implementing animal trials to verify the reliability of our system.

Specialization and the Current Practices of General Surgeons

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Decker, Marquita R; Dodgion, Christopher M; Kwok, Alvin C; Hu, Yue-Yung; Havlena, Jeff A; Jiang, Wei; Lipsitz, Stuart R; Kent, K Craig; Greenberg, Caprice C

2014-01-01

Background The impact of specialization on the practice of general surgery has not been characterized. Our goal was to assess general surgeons’ operative practices to inform surgical education and workforce planning. Study Design We examined the practices of general surgeons identified in the 2008 State Inpatient and Ambulatory Surgery Databases of the Healthcare Cost and Utilization Project (HCUP) for three US states. Operations were identified using ICD-9 and CPT codes linked to encrypted physician identifiers. For each surgeon, total operative volume and the percentage of practice comprised of their most common operation were calculated. Correlation was measured between general surgeons’ case volume and the number of other specialists in a health service area. Results There were 1,075 general surgeons who performed 240,510 operations in 2008. The mean operative volume for each surgeon was 224 annual procedures. General surgeons performed an average of 23 different types of operations. For the majority of general surgeons, their most common procedure comprised no more than 30% of total practice. The most common operations, ranked by the frequency that they appeared as general surgeons’ top procedure, included: cholecystectomy, colonoscopy, endoscopy, and skin excision. The proportion of general surgery practice comprised of endoscopic procedures inversely correlated with the number of gastroenterologists in the health service area (Rho = - 0.50, p = 0.005). Conclusions Despite trends toward specialization, the current practices of general surgeons remain heterogeneous. This indicates a continued demand for broad-based surgical education to allow future surgeons to tailor their practices to their environment. PMID:24210145

Electronic commerce in China:current status, development strategies, and new trends

Institute of Scientific and Technical Information of China (English)

Xiang Junyong; Jing Linbo

2014-01-01

After years of development in China's electronic commerce sector,there has been a drastic increase not only in the number of electronic commerce enterprises and online shoppers,but also in electronic commerce market turnover in China.During this process,the Chinese government has played a key role in establishing legislation and market disciplines for the electronic commerce market.This paper explores policy regarding electronic commerce development in China and analyzes new trends in China's electronic commerce,including the rise of mobile commerce,social commerce,and cross-border electronic commerce,and the booming industries of internet financing and Big Data.This paper aims to provide a better understanding of the development,uniqueness,and trends of electronic commerce in China.In addition,this paper also provides policymakers in China and other developing countries with policy suggestions regarding electronic commerce.

Infection management following ambulatory surgery

Directory of Open Access Journals (Sweden)

Chin AB

2015-10-01

Full Text Available Anne B Chin, Elizabeth C Wick Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA Abstract: Surgical site infections (SSIs are frequent postoperative complications that are linked to measures of surgical quality and payment determinations. As surgical procedures are increasingly performed in the ambulatory setting, management of SSIs must transition with this trend. Prevention of SSIs should include optimization of patient comorbidities, aggressive infection control policies including appropriate skin decontamination, maintenance of normothermia, and appropriate antibiotic prophylaxis. Systems must also be set in place to provide adequate surveillance for identification of SSIs when they do occur as well as provide direct feedback to surgeons regarding SSI rates. This may require utilization of claims-based surveillance. Patient education and close follow-up with the clinical team are essential for early identification and management of SSIs. Therapy should remain focused on source control and appropriate antibiotic therapy. Keywords: ambulatory surgery, SSI, infection

Surgery without papilla incision: tunneling flap procedures in plastic periodontal and implant surgery.

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Zuhr, Otto; Rebele, Stephan F; Cheung, Stefani L; Hürzeler, Markus B

2018-06-01

Diverse clinical advancements, together with some relevant technical innovations, have led to an increase in popularity of tunneling flap procedures in plastic periodontal and implant surgery in the recent past. This trend is further promoted by the fact that these techniques have lately been introduced to a considerably expanded range of indications. While originally described for the treatment of gingival recession-type defects, tunneling flap procedures may now be applied successfully in a variety of clinical situations in which augmentation of the soft tissues is indicated in the esthetic zone. Potential clinical scenarios include surgical thickening of thin buccal gingiva or peri-implant mucosa, alveolar ridge/socket preservation and implant second-stage surgery, as well as soft-tissue ridge augmentation or pontic site development. In this way, tunneling flap procedures developed from a technique, originally merely intended for surgical root coverage, into a capacious surgical conception in plastic periodontal and implant surgery. The purpose of this article is to provide a comprehensive overview on tunneling flap procedures, to introduce the successive development of the approach along with underlying ideas on surgical wound healing and to present contemporary clinical scenarios in step-by-step photograph-illustrated sequences, which aim to provide clinicians with guidance to help them integrate tunneling flap procedures into their daily clinical routine. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

The use of the digital smile design concept as an auxiliary tool in periodontal plastic surgery.

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Santos, Felipe Rychuv; Kamarowski, Stephanie Felice; Lopez, Camilo Andres Villabona; Storrer, Carmen Lucia Mueller; Neto, Alexandre Teixeira; Deliberador, Tatiana Miranda

2017-01-01

Periodontal surgery associated with prior waxing, mock-up, and the use of digital tools to design the smile is the current trend of reverse planning in periodontal plastic surgery. The objective of this study is to report a surgical resolution of the gummy smile using a prior esthetic design with the use of digital tools. A digital smile design and mock-up were used for performing gingival recontouring surgery. The relationship between the facial and dental measures and the incisal plane with the horizontal facial plane of reference were evaluated. The relative dental height x width was measured, and the dental contour drawing was inserted. Complementary lines are drawn such as the gingival zenith, joining lines of the gingival and incisal battlements. The periodontal esthetic was improved according to the established design digital smile pattern. These results demonstrate the importance of surgical techniques and are well accepted by patients and are easy to perform for the professional. When properly planned, they provide the desired expectations. Periodontal Surgical procedures associated with the design digital smile facilitate the communication between the patient and the professional. It is, therefore, essential to demonstrate the reverse planning of the smile and periodontal parameters with approval by the patient to solve the esthetic problem.

[Vitreoretinal outpatient surgery: clinical and financial considerations].

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Creuzot-Garcher, C; Aubé, H; Candé, F; Dupont, G; Guillaubey, A; Malvitte, L; Arnavielle, S; Bron, A

2008-11-01

Vitreoretinal surgery has benefited from great advances opening the opportunity for outpatient management. We report on the 6-month experience of outpatient surgery for vitreoretinal diseases. From November 2007 to April 2008, 270 patients benefited from a vitreoretinal surgery, with 173 retinal detachments, 63 epiretinal membranes, and 34 other procedures. Only 8.5% (n=23) of the patients had to stay at the hospital one or two nights. The main reasons were the distance from the hospital and surgery on a single-eye patient. The questionnaire given after the surgery showed that almost all the patients were satisfied with the outpatient setting. In contrast, the financial results showed a loss of income of around 400,000 euros due to the low level of payment of outpatient surgery in France by the national health insurance system. Vitreoretinal surgery can be achieved in outpatient surgery with an improvement in the information given to the patients and the overall organization of the hospitalization. However, the current income provided with vitreoretinal outpatient surgery is highly disadvantageous in France, preventing this method from being generalized.

Epilepsy surgery: Recommendations for India

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Chandra P

2010-01-01

Full Text Available The following article recommends guidelines for epilepsy surgery for India. This article reviews the indications, the various surgical options available and the outcome of surgery for drug resistant epilepsy based on current evidence. Epilepsy surgery is a well-established option for patients who have been diagnosed to have drug resistant epilepsy (DRE (on at least two appropriate, adequate anti-epileptic drugs (AEDs (either in monotherapy or in combination with continuing seizures, where the presurgical work-up has shown concordance of structural imaging (magnetic resonance imaging and electrical mapping data (electroencephalography (EEG, video EEG. There may be a requirement of functional imaging techniques in a certain number of DRE like positron emission tomography (PET, single photon emission tomography, (SPECT. Invasive monitoring should be restricted to a few when all noninvasive investigations are inconclusive, there is a dual pathology or there is a discordance of noninvasive data. The types of surgery could be curative (resective surgeries: amygdalo hippocampectomy, lesionectomy and multilobar resections; functional surgeries: hemispherotomy and palliative (multiple subpial transaction, corpus callosotomy, vagal nerve stimulation. Epilepsy surgery in indicated cases has a success range from 50 to 86% in achieving seizure freedom as compared with < 5% success rate with AEDs only in persons with DRE. Centers performing surgery should be categorized into Level I and Level II.

Strategies to enhance biologically active-secondary metabolites in cell cultures of Artemisia - current trends.

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Ali, Mohammad; Abbasi, Bilal Haider; Ahmad, Nisar; Khan, Haji; Ali, Gul Shad

2017-11-01

The genus Artemisia has been utilized worldwide due to its immense potential for protection against various diseases, especially malaria. Artemisia absinthium, previously renowned for its utilization in the popular beverage absinthe, is gaining resurgence due to its extensive pharmacological activities. Like A. annua, this species exhibits strong biological activities like antimalarial, anticancer and antioxidant. Although artemisinin was found to be the major metabolite for its antimalarial effects, several flavonoids and terpenoids are considered to possess biological activities when used alone and also to synergistically boost the bioavailability of artemisinin. However, due to the limited quantities of these metabolites in wild plants, in vitro cultures were established and strategies have been adopted to enhance medicinally important secondary metabolites in these cultures. This review elaborates on the traditional medicinal uses of Artemisia species and explains current trends to establish cell cultures of A. annua and A. absinthium for enhanced production of medicinally important secondary metabolites.

Metacognition fundaments, applications, and trends a profile of the current state-of-the-art

CERN Document Server

2015-01-01

This book is devoted to the Metacognition arena. It highlights works that show relevant analysis, reviews, theoretical, and methodological proposals, as well as studies, approaches, applications, and tools that shape current state, define trends and inspire future research. As a result of the revision process fourteen manuscripts were accepted and organized into five parts as follows: ·     Conceptual: contains conceptual works oriented to: (1) review models of strategy instruction and tailor a hybrid strategy; (2) unveil second-order judgments and define a method to assess metacognitive judgments; (3) introduces a conceptual model to describe the metacognitive activity as an autopoietic system. ·     Framework: offers three works concerned with: (4) stimulate metacognitive skills and self-regulatory functions; (5) evaluate metacognitive skills and self-regulated learning at problem solving; (6) deal with executive management metacognition and strategic knowledge metacognition. ·     Studies: r...

ANALYSIS OF CURRENT STATE AND FUTURE TRENDS OF AUTO PARTS MANUFACTURING SECTOR IN ROMANIA

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DANIELA MIHAI

2012-10-01

Full Text Available In the economy of any country, the auto parts manufacturing sector holds an important percentage in the national automotive industry. The dynamics of sales within it can vary significantly on short term, depending on the automotive market trend. This is also the case of the current situation in Romania, where the effect of the regressive automotive sales evolution will propagate, most probably, with a significant delay for the companies involved in production and trade of auto parts (for both first-assembly manufacture and car maintenance and repair. The statistical data indicate that even though the total volume of vehicles delivered decreased with 7.4% in 2011 as compared to 2010, the total turnover of the companies in the automotive industry increased with 7.8%. The apparent paradox is explained in the present article through the particularities of the demand for spare parts intended for the rolling stock in operation and through the effective organization of the distribution system.

[Current Situation of Antibiotic Prophylaxis in Obesity and Metabolic Surgery - Data Analysis from the Study for Quality Assurance in Operative Treatment of Obesity in Germany].

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Stroh, C; Wilhelm, B; Weiner, R; Ludwig, K; Benedix, F; Knoll, C; Lippert, H; Manger, T; Adipositas, Kompetenznetz

2016-02-01

Since January 2005, the situation of metabolic and obesity surgery in Germany has been constantly evaluated by the German Bariatric Surgery Registry (GBSR). Data registration is performed using an internet online database with prospective data collection. All registered data were analysed in cooperation with the Institute of Quality Assurance at the Otto-von-Guericke University Magdeburg. Data collection includes primary and revision/redo-procedures. A main focus of the current study is the analysis of data regarding the perioperative management, in particular, administration of antibiotics. Since 2005 a significant increase of primary bariatric procedures has been reported. For evaluation of the antibiotic regimen 12 296 primary operations including 684 balloons (BIB), 2950 gastric bandings (GB), 5115 Roux-en-Y-gastric bypasses (RYGBP), 120 Scopinaro's biliopancreatic diversions (BPD), 164 duodenal switches (DS), 3125 sleeve gastrectomies (SG) and 138 other procedures were analysed. In total 77.3 % of the patients with primary procedures received perioperative antibiotics. Patients without concomitant comorbidities received antibiotics significantly less often compared to those with comorbidities. Wound infection rates were comparable for patients who underwent either gastric banding or sleeve gastrectomy. Surgery has been accepted step by step as a treatment for morbid obesity and its comorbidities in Germany during the last few years. There is only little experience in the literature regarding antibiotic therapy as well as prophylaxis in bariatric surgery. Based on the results of the current study we recommend rather the selective than the routine use of antibiotics depending on different parameters, e.g., operative time, preoperative BMI and concomitant comorbidities. Georg Thieme Verlag KG Stuttgart · New York.

CURRENT TRENDS AND PROSPECTS OF THE RUSSIAN PHARMACEUTICAL INDUSTRY AND THE FOREIGN EXPERIENCE

Directory of Open Access Journals (Sweden)

Z. A. Mamedyarov

2017-01-01

Full Text Available Purpose: the purpose of this article is to study the current state of the pharmaceutical industry in Russia, to identify trends in Russian pharmaceutical market, and to provide preliminary analysis of the state support policy for pharmaceuticals in Russia, focusing on the federal target program "Pharma-2020".Methods: the study is based on a quantitative study of the characteristics and trends of the Russian pharmaceutical market. The emphasis was put on the period 2008–2017. The volume of the market, the structure of imports and exports are considered, and expenditures under the federal program "Pharma-2020" are studied. A qualitative comparative comparison with the tendencies of the global development of the industry is conducted and recommendations are made on further stimulating the growth of the pharma industry in Russia.Results: in the past 5 years, the pharmaceutical industry in Russia did receive special attention from the government, significant funds have been allocated for to support domestic producers, and import substitution policies have been launched. Financial results of the industry show slight improvement in a number of indicators: the market share of domestic medicines is growing, the generics production increased, production standards became tighter controlled. Nevertheless, Russia remains on the periphery of the world pharmaceutical science, import retains two thirds of the market share by value, while innovative novel drugs are now launched primarily by MNEs from the US and the EU.Conclusions and relevance: the challenges and development factors of Russia's pharmaceutical industry identified in this research require effective regulatory tools. First of all, it is necessary to reduce the gap between Russia and the developed countries in the R&D standards and their market implementation. Statistical data has showed the progress in the production of drugs from the VED list (Vital and Essential Drugs, but it is necessary to

The value of comparative research in major day surgery.

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Llop-Gironés, Alba; Vergara-Duarte, Montse; Sánchez, Josep Anton; Tarafa, Gemma; Benach, Joan

2017-05-19

To measure time trends in major day surgery rates according to hospital ownership and other hospital characteristics among the providers of the public healthcare network of Catalonia, Spain. Data from the Statistics of Health Establishments providing Inpatient Care. A generalized linear mixed model with Gaussian response and random intercept and random slopes. The greatest growth in the rate of major day surgery was observed among private for-profit hospitals: 42.9 (SD: 22.5) in 2009 versus 2.7 (SD: 6.7) in 1996. These hospitals exhibited a significant increase in major day surgery compared to public hospitals (coefficient 2; p-value <0.01) CONCLUSIONS: The comparative evaluation of hospital performance is a decisive tool to ensure that public resources are used as rationally and efficiently as possible. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

The climb to break the glass ceiling in surgery: trends in women progressing from medical school to surgical training and academic leadership from 1994 to 2015.

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Abelson, Jonathan S; Chartrand, Genevieve; Moo, Tracy-Ann; Moore, Maureen; Yeo, Heather

2016-10-01

There have been many efforts to increase the number of women surgeons. We provide an update of women surgeon representation along the pathway to surgical academia. Data was extracted from Association of American Medical Colleges FACTS and Faculty Administrative Management Online User System as well as GME annual reports starting in 1994 until the last year available for each. The proportion of graduating women medical students has increased on average .5% per year from 1994 to 2014. Women general surgery trainees have more than doubled in number over the same period but represented 38.3% of all general surgery trainees in 2014. Women Full Professors increased on average .3% from 1994 to 2015 but still make up less than 10% of all Full Professors. Despite improvements over the past 20 years, there are still large gender gaps in surgery for trainees and academic leadership. At the current rate of increase, women Full Professors will not achieve gender parity until in 2136. Copyright © 2016 Elsevier Inc. All rights reserved.

Medical Management of Uveitis ? Current Trends

OpenAIRE

Babu, Kalpana; Mahendradas, Padmamalini

2013-01-01

Uveitis is a challenging disease to treat. Corticosteroids have been used in the treatment of uveitis for many years. Immunosuppressives are gaining momentum in recent years in the treatment of uveitis. In this article we present an overview of current treatment of uveitis and the major breakthroughs and advances in drugs and ocular drug delivery systems in the treatment of uveitis.

Hypertrophic scars and keloids in surgery: current concepts.

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Song, Colin

2014-09-01

Hypertrophic scars and keloids remain a challenge in surgery. We appreciate that our understanding of the process at cellular and molecular level, profound as it is, when it comes to the clinical evidence much is left to be desired. Although the bench to bedside conundrum remains, the science of translational research calls for an even higher level of cooperation between the scientist and the clinician for the impetus to succeed.The clinicians alerted us to the possible theories in the pathogenesis of keloid formation, inter alia, the ischemia theory, mast cell theory, immune theory, transforming growth factor β interaction, mechanical theory, and the melanocyte stimulating hormone theory. All of the above presupposed a stimulus that would result in an uncontrolled upregulation of collagen and extracellular matrix expression in the pathogenesis of the keloid. This bedside to bench initiative, as in true science, realized more ponderables than possibilities.By the same token, research into the epidermal-mesenchymal signaling, molecular biology, genomics, and stem cell research holds much promise in the bench top arena. To assess efficacy, many scar assessment scores exist in the literature. The clinical measurement of scar maturity can aid in determining end points for therapeutics. Tissue oxygen tension and color assessment of scars by standardized photography proved to be useful.In surgery, the use of dermal substitutes holds some promise as we surmise that quality scars that arise from dermal elements, molecular and enzyme behavior, and balance. Although a systematic review shows some benefit for earlier closure and healing of wounds, no such review exists at this point in time for the use of dermal substitutes in scars.Adipose-derived stem cell, as it pertains to scars, will hopefully realize the potential of skin regeneration rather than by repair in which we are familiar with as well as the undesirable scarring as a result of healing through the inflammatory

Internal limiting membrane flap transposition for surgical repair of macular holes in primary surgery and in persistent macular holes.

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Leisser, Christoph; Hirnschall, Nino; Döller, Birgit; Varsits, Ralph; Ullrich, Marlies; Kefer, Katharina; Findl, Oliver

2018-03-01

Classical or temporal internal limiting membrane (ILM) flap transposition with air or gas tamponade are current trends with the potential to improve surgical results, especially in cases with large macular holes. A prospective case series included patients with idiopathic macular holes or persistent macular holes after 23-G pars plana vitrectomy (PPV) and ILM peeling with gas tamponade. In all patients, 23-G PPV and ILM peeling with ILM flap transposition with gas tamponade and postoperative face-down position was performed. In 7 of 9 eyes, temporal ILM flap transposition combined with pedicle ILM flap could be successfully performed and macular holes were closed in all eyes after surgery. The remaining 2 eyes were converted to pedicle ILM flap transposition with macular hole closure after surgery. Three eyes were scheduled as pedicle ILM flap transposition due to previous ILM peeling. In 2 of these eyes, the macular hole could be closed with pedicle ILM flap transposition. In 3 eyes, free ILM flap transposition was performed and in 2 of these eyes macular hole could be closed after surgery, whereas in 1 eye a second surgery, performed as pedicle ILM flap transposition, was performed and led to successful macular hole closure. Use of ILM flaps in surgical repair of macular hole surgery is a new option of treatment with excellent results independent of the diameter of macular holes. For patients with persistent macular holes, pedicle ILM flap transposition or free ILM flap transposition are surgical options.

Metabolic Surgery

DEFF Research Database (Denmark)

Pareek, Manan; Schauer, Philip R; Kaplan, Lee M

2018-01-01

The alarming rise in the worldwide prevalence of obesity is paralleled by an increasing burden of type 2 diabetes mellitus. Metabolic surgery is the most effective means of obtaining substantial and durable weight loss in individuals with obesity. Randomized trials have recently shown...... the superiority of surgery over medical treatment alone in achieving improved glycemic control, as well as a reduction in cardiovascular risk factors. The mechanisms seem to extend beyond the magnitude of weight loss alone and include improvements in incretin profiles, insulin secretion, and insulin sensitivity....... Moreover, observational data suggest that the reduction in cardiovascular risk factors translates to better patient outcomes. This review describes commonly used metabolic surgical procedures and their current indications and summarizes the evidence related to weight loss and glycemic outcomes. It further...

[Thromboelastography and its use in cardiac surgery].

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Ak, Koray; Atalan, Nazan; Tekeli, Atike; Işbir, Selim; Civelek, Ali; Emekli, Nesrin; Arsan, Sinan

2008-04-01

Thromboelastography is an alternative method to conventional coagulation tests for the general evaluation of hemostatic system. Cardiac surgery with cardiopulmonary bypass is accomplished by complex alterations of hemostasis, including acquired dysfunction of platelets, consumption coagulopathy and increased fibrinolysis. Despite major advances in blood conservation methods and perioperative care of the patients, transfusion rates in cardiac surgery remain high. Thromboelastography has an ability to assess almost all components of haemostatic system globally. Currently, thromboelastography is used with standard coagulation tests to decrease the microvascular bleeding and homologous blood transfusion in cardiac surgery with cardiopulmonary bypass. In this review, we aimed to discuss thromboelastography technology and its usage in cardiac surgery.

Robotics in general surgery: an evidence-based review.

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Baek, Se-Jin; Kim, Seon-Hahn

2014-05-01

Since its introduction, robotic surgery has been rapidly adopted to the extent that it has already assumed an important position in the field of general surgery. This rapid progress is quantitative as well as qualitative. In this review, we focus on the relatively common procedures to which robotic surgery has been applied in several fields of general surgery, including gastric, colorectal, hepato-biliary-pancreatic, and endocrine surgery, and we discuss the results to date and future possibilities. In addition, the advantages and limitations of the current robotic system are reviewed, and the advanced technologies and instruments to be applied in the near future are introduced. Such progress is expected to facilitate the widespread introduction of robotic surgery in additional fields and to solve existing problems.

The impact of marketing language on patient preference for robot-assisted surgery.

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Dixon, Peter R; Grant, Robert C; Urbach, David R

2015-02-01

Robot-assisted surgery is gaining momentum as a new trend in minimally invasive surgery. With limited evidence supporting its use in place of the far less expensive conventional laparoscopic surgery, it has been suggested that marketing pressure is partly responsible for its widespread adoption. The impact of phrases that promote the novelty of robot-assisted surgery on patient decision making has not been investigated. We conducted a discrete choice experiment to elicit preference of partial colectomy technique for a hypothetical diagnosis of colon cancer. A convenience sample of 38 participants in an ambulatory general surgery clinic consented to participate. Each participant made 2 treatment decisions between robot-assisted surgery and conventional laparoscopic surgery, with robot-assisted surgery described as "innovative" and "state-of-the-art" in one of the decisions (marketing frame), and by a disclosure of the uncertainty of available evidence in the other (evidence-based frame). The magnitude of the framing effect was large with 12 of 38 subjects (31.6%, P = .005) selecting robot-assisted surgery in the marketing frame and not the evidence-based frame. This is the first study to our knowledge to demonstrate that words that highlight novelty have an important influence on patient preference for robot-assisted surgery and that use of more neutral language can mitigate this effect. © The Author(s) 2014.

Impact of cataract surgery in reducing visual impairment: a review.

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Khandekar, Rajiv; Sudhan, Anand; Jain, B K; Deshpande, Madan; Dole, Kuldeep; Shah, Mahul; Shah, Shreya

2015-01-01

The aim was to assess the impact of cataract surgeries in reducing visual disabilities and factors influencing it at three institutes of India. A retrospective chart review was performed in 2013. Data of 4 years were collected on gender, age, residence, presenting a vision in each eye, eye that underwent surgery, type of surgery and the amount the patient paid out of pocket for surgery. Visual impairment was categorized as; absolute blindness (no perception of light); blind (visual impairment (SVI) (visual impairment (6/18-6/60) and; normal vision (≥6/12). Statistically analysis was performed to evaluate the association between visual disabilities and demographics or other possible barriers. The trend of visual impairment over time was also evaluated. We compared the data of 2011 to data available about cataract cases from institutions between 2002 and 2009. There were 108,238 cataract cases (50.6% were female) that underwent cataract surgery at the three institutions. In 2011, 71,615 (66.2%) cases underwent surgery. There were 45,336 (41.9%) with presenting vision visual disability. The goal of improving vision related quality of life for cataract patients during the early stages of visual impairment that is common in industrialized countries seems to be non-attainable in the rural India.

Cervical bracing practices after degenerative cervical surgery: a survey of cervical spine research society members.

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Lunardini, David J; Krag, Martin H; Mauser, Nathan S; Lee, Joon Y; Donaldson, William H; Kang, James D

2018-05-21

Context: Prior studies have shown common use of post-operative bracing, despite advances in modern day instrumentation rigidity and little evidence of brace effectiveness. To document current practice patterns of brace use after degenerative cervical spine surgeries among members of the Cervical Spine Research Society (CSRS), to evaluate trends, and to identify areas of further study. A questionnaire survey METHODS: A 10 question survey was sent to members of the Cervical Spine Research Society to document current routine bracing practices after various common degenerative cervical spine surgical scenarios, including fusion and non-fusion procedures. The overall bracing rate was 67%. This included 8.4% who used a hard collar in each scenario. Twenty-two percent of surgeons never used a hard collar, while 34% never used a soft collar, and 3.6% (3 respondents) did not use a brace in any surgical scenario. Bracing frequency for specific surgical scenarios varied from 39% after foraminotomy to 88% after multi-level corpectomy with anterior & posterior fixation. After one, two and three level anterior cervical discectomy & fusion (ACDF), bracing rates were 58%, 65% and 76% for an average of 3.3, 4.3 and 5.3 weeks, respectively. After single level corpectomy, 77% braced for an average of 6.2 weeks. After laminectomy and fusion, 72% braced for an average of 5.4 weeks. Significant variation persists among surgeons on the type and length of post-operative brace usage after cervical spine surgeries. Overall rates of bracing have not changed significantly with time. Given the lack evidence in the literature to support bracing, reconsidering use of a brace after certain surgeries may be warranted. Copyright © 2018. Published by Elsevier Inc.

Training in breast surgery in Spain.

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Miguelena, José M; Domínguez Cunchillos, Fernando

2016-01-01

Breast surgery is a key part of training and competency in general surgery in Spain and is a "frontier area" that can be efficiently managed by general surgeons and gynecologists. The main objective of the training process consists of the surgical treatment of breast cancer, including conservative surgery, oncoplastic and reconstructive techniques. This article analyses the current status of breast surgery training in Spain and schematically proposes potential targets of the different training programs, to improve access and training for surgeons and residents in this area, taking into account the RD 639/2014 and European regulation. The priority is to specify the level of training that should be achieved, in relation to the group of professionals involved, considering their area of competency: surgery resident, educational programs, and surgeons with special dedication to this area. Copyright © 2016 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

Trends in Mobile Application Development

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Holzer, Adrian; Ondrus, Jan