45 research outputs found
Boalele lipicioase : două prelegeri pentru popor
No full textBoalele lipicioase : două prelegeri pentru popor / de Iulian Chitul. - Sibiiu : Editura "Asociaţiunii", 1914. - 58 p. ; 17 cm. - (Biblioteca poporală a "Asociaţiunii" ; Nr.40
Defining the best practices and guidelines for building successful multicultural teams
No full text“When in Rome do as the Romans do” – this hundreds years old proverb is still very actual today. Even more, nowadays you don’t even have to go to Rome to feel cultural differences. The communication technology have changed the world economy, thousands of people work now for multinational companies, interacting daily not just with a culture, but possibly with as much as 5 or 6 different ones. Some teams even work in different geographical locations communicating exclusively by electronic means. Today’s managers just have to deal with culture whether they like it or not, but the whole employee-manager relationship may be turned upside down on another side of the globe. So what should we do and what do we do about it? Ho do we manage effectively? These are the questions that this study aims to answer at. The main research objects of this study are rather small software engineering teams and companies that are working in cross-cultural environment, but do have little or no special company policies and other formal ways to manage cultural differences. Yet we found out that managers develop there own understanding of cultural issues and are practicing different methods to deal with [email protected]; [email protected]
Laparoscopic anatomical landmarks in oncological dissection for low rectal cancers – a video vignette
No full textHow to do a laparoscopic high left colectomy with complete mesocolic excision and central vascular ligation for splenic flexure cancer
No full text
Liver Elastography Methods for Diagnosis of De Novo and Recurrent Hepatocellular Carcinoma
No full textHepatocellular carcinoma (HCC), a common consequence of chronic liver disease, ranks among the most prevalent cancers globally and contributes significantly to cancer-related mortality. Liver fibrosis is intimately associated with hepatic function and the likelihood of future HCC occurrence. Despite the fact that liver biopsy continues to be the gold standard for diagnosing fibrosis, its utility is hindered by cost and invasiveness, along with patient unease, procedural rejection, and potential adverse effects. Liver elastography has become a leading noninvasive means of assessing tissue stiffness with considerable diagnostic precision. Malignant tumors generally exhibit higher cellularity in comparison to benign ones, resulting in increased stiffness. Elastography techniques capitalize on alterations in tissue elasticity stemming from specific pathological or physiological processes. Technological innovations, such as advanced ultrasound imaging and artificial intelligence (AI)-integrated systems, are paving the way for enhanced diagnostic accuracy and risk prediction. Recent research underscores the potential of elastography in managing HCC patients, presenting novel clinical applications, including prediction of HCC development, differentiation between malignant and benign liver lesions, evaluating treatment response, and forecasting recurrence post-treatment, though certain findings remain contentious. Therefore, this review aims to sum up the latest advancements in liver elastography for HCC patients, outlining its applications while addressing existing limitations and avenues for future progress
Protective ileostomy creation after anterior resection of the rectum (PICARR): a decision-making exploring international survey
No full text: In our previous survey of experts, surgeon's decision-making process (DMP) about protective ileostomy (PI) creation after anterior resection was investigated. Based on our previous data, a multiple choice questionnaire has been developed. The aim is to perform a quantitative analysis of the results obtained from an international survey and to describe the clinical practice worldwide. Ten questions were related to participants' demographics and, 20 questions (of which 17 Likert scale questions) investigated the DMP regarding PI creation. To evaluate the tendency of the answers in the Likert-type questions, the mean of the answers obtained was compared with the mean point of the Likert scale. The survey was completed by 1019 physicians. Neoadjuvant chemoradiotherapy and distance of the anastomosis from the anal verge ≤ 10 cm were each considered alone sufficient to justify creation of a PI, with statistically significant differences in comparison to the mean point of the scales in (p = < 0.0001 in both cases). Total Mesorectal Excision alone was not considered a factor sufficient to create a PI (p = 0.416). Most of the participants agree to define their approach to create a PI "tailored" to patients' risk factors (p = < 0.0001) and "influenced by my experience" in case of patients with low/moderate risk of anastomotic leakage (p = < 0.0001). This study provides useful insights on the worldwide clinical practice regarding creation of PI following anterior resection. Given the lack of standardization and evidence-based guidelines, this analysis may be helpful to assist surgeons' practice
Splenectomy through the laparoscopic approach and how I do it
No full textScopul lucrării. Studierea cazurilor de splenectomie prin abord laparoscopic și clasic în vederea stabilirii cauzalității tip procedurăincidente
perioperatorii și demonstrării superiorității abordului laparoscopic.
Materiale și metode. Au fost selectate cazurile de splenectomie efectuate prin abord clasic și laparoscopic în Clinica de Chirurgie
Colțea, perioada 01.01.2019-31.12.2022. Am revăzut filmările intraoperatorii, am evaluat factorii generali și locali asociați abordului
chirurgical preferat.
Rezultate. Au fost selectate 29 de cazuri, vârsta medie 54.8 ani, 72.4% femei, 27.6% barbati, 55.2% (16) cu multiple comorbidități:
antecedente chirurgicale majore, insuficiența cardiacă, asmul bronșic sever etc. Cazurile au fost împărțite în 2 grupe: Gr. I- cu abord
laparoscopic 34.5% (10), Gr. II- cu abord clasic 65.5% (19). Incidența comorbidităților a fost de 10% (1) în Gr.I, cu dimensiunea medie
a splinei de 13.2 cm (min 8.5 cm, max 21 cm) și 84.2 % (16) în Gr.II cu dimensiunea medie a splinei de 20.4 cm (min 10 cm, max 34
cm). Doar în Gr.II au fost înregistrate sângerări intraoperatorii în 78.9% (15), iar in 15.8% (3) au fost complicații postoperatorii. Pacienții
din Gr.I au avut o perioadă de spitalizare postoperatorie medie de 4 zile, iar cei din Gr. II de 7 zile și au fost externați cu o evoluție
postoperatorie favorabilă.
Concluzie. Abordul laparoscopic are aceleași indicații ca abordul clasic conform EAES, cu avantajul complicațiilor perioperatorii mult
reduse și o spitalizare postoperatorie mai mică comparativ cu abordul clasic, iar în cazul echipelor experimentate este posibil abordul
laparoscopic inclusiv la pacienții cu splenomegalii masive (>20cm), care poate fi asistat manual.Aim of study. Study of cases of splenectomy by laparoscopic and classic approach in order to establish causality type procedureperioperative
incidents and demonstrate the superiority of the laparoscopic approach.
Materials and methods. The cases of splenectomy performed by classical and laparoscopic approach in the Colțea Surgery Clinic,
period 01.01.2019-31.12.2022, were selected. We reviewed intraoperative films, assessed general and local factors associated with
the preferred surgical approach.
Results. 29 cases were selected, average age 54.8 years, 72.4% women, 27.6% men, 55.2% (16) with multiple comorbidities: major
surgical antecedents, heart failure, severe bronchial asthma, etc. The cases were divided into 2 groups: Gr. I- with laparoscopic approach 34.5% (10), Gr. II- with classic approach 65.5% (19). The incidence of comorbidities was 10% (1) in Gr.I, with mean spleen
size of 13.2 cm (min 8.5 cm, max 21 cm) and 84.2% (16) in Gr.II with mean spleen size of 20.4 cm (min 10 cm, max 34 cm). Only in
Gr.II, intraoperative bleeding was recorded in 78.9% (15), and in 15.8% (3) there were postoperative complications. The patients in Gr.
I had an average postoperative hospitalization period of 4 days, and those in Gr. II of 7 days, and were discharged with a favorable
postoperative evolution.
Conclusions. The laparoscopic approach has the same indications as the classic one according to EAES, with the advantage
of reduced perioperative complications and a shorter postoperative hospitalization, and in the case of experienced teams, the
laparoscopic approach is possible, including patients with massive splenomegaly (>20cm), being manually assisted
Evaluation of a Quality Improvement Intervention To Reduce Anastomotic Leak Following Right Colectomy (eagle): Pragmatic, Batched Stepped-Wedge, Cluster-Randomized Trial in 64 Countries
No full textMagill, Laura/0000-0003-2498-8407; Chitul, Andrei/0000-0001-5991-3443; Taha, Mohamed Hassan Ali Ahmed/0000-0001-6503-2239; Soria Aledo, Victoriano/0000-0003-0159-4034; Fiume, Diego/0000-0001-9483-4783; Yonekura, Hiroshi/0000-0003-0523-2997; yadev, IP/0000-0002-5086-6246; ALVAREZ PADILLA, FRANCISCO EMILIANO/0009-0000-8197-3274; Maurya, Ajeet/0000-0002-5845-7236; Mutlu, Arda Ulas/0000-0001-7499-7155; Marino, Fabio/0000-0002-7535-436X; Fernandez-Hevia, Maria/0000-0002-2147-1317; Espin-Basany, Eloy/0000-0002-9139-4548; Rashed, Amier Mohamed/0009-0003-3671-2042; Atanasov, Boyko/0000-0003-3000-681X; Ibrahimli, Arturan/0000-0002-5527-4434; Alvarez-Bautista, Francisco Emmanuel/0000-0003-2645-832X; Elshami, Mohamedraed/0000-0002-9977-0923; Theodoropoulos, Charalampos/0000-0002-7393-1987; Abdou, Khaled/0000-0001-9777-080X; SANLI, AHMET NECATI/0000-0002-1483-8176; Ferrario, Luca/0000-0002-3652-3255; Garcia Botello, Stephanie Anne/0000-0001-6921-4902; Lule, Herman/0000-0002-0647-9716; Colak, Elif/0000-0002-1893-6427; Rey Valcarcel, Cristina/0000-0001-9762-9742; Pantoja Pachajoa, Diana Alejandra/0000-0002-3968-4206; Balaban, Vladimir/0000-0002-7226-4641; Tidjane, Anisse/0000-0002-3264-2441; Duzgun, Ozgul/0000-0001-7214-2276; JIMENEZ-GOMEZ, LUIS MIGUEL/0000-0003-1390-0473; Mastriale, Francesco/0000-0003-3586-2826; Fleres, Francesco/0000-0002-1092-8975; Garzali, Ibrahim Umar/0000-0002-9797-851X; Isik, Ozgen/0000-0002-9541-5035; Paniagua Garcia-Senorans, Marta/0000-0003-2402-4106; Marson, Fernando Augusto Lima/0000-0003-4955-4234; Stijns, Jasper/0000-0002-5256-6167; Mourad, Mohamed/0000-0003-4714-7192; Zayakov, Georgi/0000-0002-8796-8350; Glasbey, James/0000-0001-7688-5018; Arabadzhiev, Angel/0000-0003-2186-3799; KOSTEK, MEHMET/0000-0001-7259-2461; Blanca, Ana/0000-0002-4360-4352; Bozbiyik, Osman/0000-0002-1827-2720; Pizanias, Michail/0000-0002-5270-3555; Waqar, Usama/0000-0002-9447-5810; Karamanliev, Martin/0000-0001-5166-0752; Mariani, Nicolo Maria/0000-0003-4360-187X; Burlov, Nikita/0000-0003-3407-4406; Shudrak, Anatolii/0000-0003-2760-8780; Quintanilha, Rui/0000-0002-5367-4872; KARA, YASIN/0000-0002-9723-1774; , Mikael/0000-0002-5189-2251; Biswas, Jyotirmoy/0000-0001-9357-0448; Garcia Florez, Luis Joaquin/0000-0003-1231-9126; Waledziak, Maciej/0000-0003-4311-9995; Bayhan, Zulfu/0000-0002-7587-7267; Manatakis, Dimitrios K./0000-0002-1263-8488; Sulen, Nina/0000-0002-2012-8090; Sena, Giuseppe/0000-0001-9793-3250; Isaacs Beron, Reinaldo/0000-0002-3539-9985; Minaya Bravo, Ana Maria/0000-0002-7982-5499; Baili, Efstratia/0000-0001-8745-2269; Garcia Urena, Miguel Angel/0000-0002-7356-6211; Gallo, Gaetano/0000-0003-1066-4671; Chowdhury, Sharfuddin/0000-0002-3794-4158; Gribnev, Petar/0000-0001-9459-7095; Palomba, Giuseppe/0000-0003-3954-5166; Bedzhanyan, Arkady/0000-0002-4377-0035; Litvin, Andrey/0000-0002-9330-6513; Baelum, Jens Kristian/0000-0003-0135-2430; fakhradiyev, ildar/0000-0003-0528-3874; Azhar, Najia/0000-0001-6709-4441; Shahu, Juliana/0000-0003-1908-6601; Resendiz Aguilar, Hogla Aridai/0000-0002-3416-2775; Douba, Zain/0000-0001-9662-9492; CHISTHI, MEER/0000-0003-2794-0062; Bisgin, Tayfun/0000-0001-7040-4228; FENNER LYRA JUNIOR, HUMBERTO/0000-0001-8649-802X; Valdes-Hernandez, Javier/0000-0002-0837-8986; Zimmerman, David/0000-0002-0393-9350; Kulimbet, Mukhtar/0000-0003-4399-700X; Triantafyllou, Alexandra/0000-0001-8232-2203; Mantoglu, Baris/0000-0002-2161-3629; Romano, Francesco Maria/0000-0002-9491-748X; Castaldi, Antonio/0000-0003-3084-7942; Bhangu, Aneel/0000-0001-5999-4618; Slavchev, Mihail/0000-0003-4412-7604; Dhar, Puneet/0000-0003-3141-5447; Hamdan, Fatma/0000-0002-0276-1343; Biondo, Santino Antonio/0000-0002-4720-3345; GONULLU, Emre/0000-0001-6391-4414; Perivoliotis, Konstantinos/0000-0002-6622-5734; Tokidis, Evripidis/0000-0001-8594-0007; Negoi, Ionut/0000-0002-6950-9599; Pellino, Gianluca/0000-0002-8322-6421; Elmore, Ugo/0000-0001-9652-1502; Kashchenko, Victor/0000-0002-4958-5850; El Sorogy, Mohamed/0000-0002-5922-3917; Kovacevic, Bojan/0000-0001-6595-337X; Sokolov, Manol/0000-0002-2608-333X; Ulasi, Ikechukwu/0000-0001-7387-2713; Manigrasso, Michele/0000-0001-8204-7942; Metwally, Islam Hany/0000-0002-5981-9614; Bains, Lovenish/0000-0002-8627-0452; Mazzeo, Carmelo/0000-0001-9893-7480; Drozdov, Evgeniy/0000-0003-4157-9744; Perra, Teresa/0000-0001-7032-1289; Akin, Emrah/0000-0003-0224-3834; Ekwesianya, Andrew Chiagozie/0000-0001-5064-681X; Akay, Omer/0000-0002-0824-2077; Jakhar, Subham/0000-0002-1980-3175; Li, Elizabeth/0000-0001-5961-2894; Bintintan, Vasile/0000-0002-1435-6791; BALALIS, DIMITRIOS/0000-0001-8879-2804; Abd-erRazik, Mohammad/0000-0002-8498-9957; Poskus, Tomas/0000-0002-6931-6041; Selvaggi, Lucio/0000-0001-6920-3103; MANDI, DRAGA-MARIA/0000-0002-5070-217X; Curro, Giuseppe/0000-0001-9566-1378; Beznosenko, Andriy/0000-0003-2293-3488; De Deken, Julie/0000-0002-7788-0881; Sarakatsianou, Chamaidi/0000-0002-9509-581X; Ciftci, Ahmet Burak/0000-0002-1814-4008; Egwuonwu, Ochonma Amobi/0000-0001-5978-6392; ozgen, utku/0000-0002-6481-1473; /0000-0003-4645-6655; Dushimova, Zaure/0000-0003-0791-4246; Hamza, Amr/0000-0001-6520-3595; Altintoprak, Fatih/0000-0002-3939-8293; Shehta, Ahmed/0000-0002-9184-8597; Belev, Nikolay/0000-0001-9248-8194; Ballah, Abubakar/0000-0002-7988-5993; Munoz, Jose/0000-0001-9529-6980Background: Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods: The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results: A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion: Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov).ESCP; National Institutes of Health Research (NIHR) [NIHR133364] Funding Source: National Institutes of Health Research (NIHR)The EAGLE study was funded by the ESCP. Ethicon provided an unrestricted educational grant to the ESCP which was used in supporting the development of the online education materials. The NIHR Global Health Research Unit on Global Surgery (NIHR133364) provided support, notably in accessing and supporting collaborating teams in low-and middle-income countries. The funders had no role in the design, set-up, running or analysis of this study, or writing of this report. The views expressed are those of the authors and not necessarily those of the ESCP, Ethicon, or NIHR
