825 research outputs found
Organised care of acute stroke at Groote Schuur Hospital : a controlled trial
No full textIncludes bibliographical references.Background and purpose: Groote Schuur Hospital (GSH) admits about 570 stroke patients annually. These patients about occupy 10% of acute medical beds. Recent investigations have demonstrated that stroke services are poorly organised Although "Organised stroke care" has been shown to improve outcomes, this has not been demonstrated locally. This study was undertaken to determine whether stroke unit care within a general medical ward improves outcomes. Study design and sampling: The study was a prospective non-randomised controlled trial, with systematic allocation by admission day. of all acute stroke admissions to the Department of Medicine from 1 January to 15 May 1996. Intervention: There were three comparison groups: in the Stroke Intervention Ward, the intervention was implemented by the author; in the Guidelines Ward, the manner in which the intervention can be set up and implemented was provided in the form of a Guidelines Booklet and in the Control Ward, stroke patients received routine care. The intervention consisted of (i) geographic/spatial unity and allocation of a designated nurse; (ii) use of a Stroke Clerking Pro forma and (iii) a multidisciplinary Team Care Plan and Post Intake Stroke Ward Round. Results: 58 patients were admitted to the Stroke Intervention Ward, 40 patients were admitted to the Guidelines Ward and 91 were admitted to the 2 Control Wards. The groups had similar baseline characteristics, except for the percentage of patients continent on admission. There were no significant differences in the Modified Barthel Index prior to admission, at discharge or at follow-up. There were no significant differences in the principal outcome measures (death, dependency, death or dependency, institutionalisation and death or institutionalisation) between the comparison groups. The median [inter-quartile range] length of hospital stay in days was significantly reduced in the Stroke Intervention Ward (6.5[5-9]) compared to the Guidelines Ward (9[7-14]) and the Control Wards (8[5-12]). The referral rates to Professionals Allied to Medicine were significantly increased in the Stroke Intervention Ward, except for referrals to the Community Liaison Sister. The referral rates to rehabilitation resources on discharge were significantly increased in the Stroke Intervention Ward, except for referrals to physiotherapy. Conclusions: Organised Stroke Care is feasible in our setting and results in improved utilisation of resources without increasing length of stay. However, principle outcome measures were not significantly altered in this study
Groote Eyelandt (Groote), NT, 1993 (P609), radiometric line data, AWAGS levelled
No full textMaintenance and Update Frequency: notPlannedStatement: This Groote Eyelandt (Groote), NT, 1993 (P609), radiometric line data, AWAGS levelled is an airborne-derived radiometric data for the Groote Eyelandt, NT, 1993. The data was acquired under the project No. 609 for the geological survey of NT. A total of 16092 line-kilometres of data at a line spacing of 500m were acquired during this survey. To constrain long wavelengths in the data, an independent data set, the Australia-wide Airborne Geophysical Survey (AWAGS) airborne magnetic data, was used to control the base levels of the survey data (Milligan et al., 2009). This survey data is essentially levelled to AWAGS. Noise-adjusted singular value decomposition (NASVD) has been applied to the data. NASVD is a spectral component analysis procedure for the removal of noise from gamma-ray spectra. Details of the specifications of individual airborne surveys can be found in the Fourteenth Edition of the Index of Airborne Geophysical Surveys (Percival, 2014). This Index is also available online at http://pid.geoscience.gov.au/dataset/79134.
References:
Milligan, P.R., Minty, B.R.S., Richardson, M. & Franklin, R., 2009. The Australia-wide Airborne Geophysical Survey accurate continental magnetic coverage. Preview, No. 138, p. 1-128,
Percival, P.J., 2014. Index of airborne geophysical surveys (Fourteenth Edition).The radiometric, or gamma-ray spectrometric method, measures the natural variations in the gamma-rays detected near the Earth's surface as the result of the natural radioactive decay of potassium (K), uranium (U) and thorium (Th). The data collected are processed via standard methods to ensure the response recorded is that due only to the rocks in the ground. The results produce datasets that can be interpreted to reveal the geological structure of the sub-surface. The processed data is checked for quality by GA geophysicists to ensure that the final data released by GA are fit-for-purpose.<br/> This Groote Eyelandt (Groote), NT, 1993 (P609), radiometric line data, AWAGS levelled were acquired in 1993 by the NT Government, and consisted of 16092 line-kilometres of data at 500m line spacing and 100m terrain clearance. To constrain long wavelengths in the data, an independent data set, the Australia-wide Airborne Geophysical Survey (AWAGS) airborne magnetic data, was used to control the base levels of the survey data. This survey data is essentially levelled to AWAGS
Evidence synthesis of health policy and systems research in rehabilitation: a protocol for Cochrane overviews of systematic reviews on delivery, governance, financial arrangements, and implementation strategies
No full textCochrane Rehabilitation and the World Health Organization (WHO) Rehabilitation Program are collaborating to produce four Cochrane overviews of systematic reviews that synthesize the current evidence from health policy and systems research (HPSR) in rehabilitation. They will focus on the four pillars of HPSR identified by the Cochrane Effective Practice and Organization of Care (EPOC) taxonomy: delivery arrangements, financial arrangements, governance arrangements, and implementation strategies. The protocol describes why HPSR is currently needed in rehabilitation, provides detailed information on the four EPOC pillars in interaction with rehabilitation and reports the Cochrane methods that will be followed to produce the overviews. 1. Del Furia MJ, Minozzi S, Arienti C, Battel I, Capodaglio P, Côté P, Décary S, De Groote W, Duttine A, Frontera WR, Gimigliano F, Kiekens C, Mudau Q, Ryan R, Sabariego C, Negrini S. Delivery arrangements for rehabilitation services in health systems: an overview of systematic reviews. 2. Gimigliano F, Arienti C, Butzback OK, Capodaglio P, Côté P, Décary S, Del Furia MJ, De Groote W, Duttine A, Frontera WR, Iolascon G, Kiekens C, Liguori S, Minozzi S, Mudau Q, Negrini S, Paoletta M, Ryan R, Sabariego C, Moretti A. Financial arrangements for rehabilitation services in health systems: an overview of systematic reviews. 3. Atkinson-Graham M, Mior S, Bakaa N, Konstantinidis T, Wong J, Arienti C, Capodaglio P, Décary S, De Groote W, Del Furia MJ, Duttine A, Frontera WR, Kiekens C, Minozzi S, Gimigliano F, Mudau Q, Negrini S, Ryan R, Sabariego C, Côté P. Governance arrangements for rehabilitation services in health systems: an overview of systematic reviews. 4. Touhami D, Ryan R, Engeda EH, Arienti C, Capodaglio P, Côté P, Décary S, Del Furia MJ, De Groote W, Duttine A, Frontera WR, Gimigliano F, Kiekens C, Minozzi S, Mudau Q, Negrini S, Sabariego C. Implementation strategies for rehabilitation services in health systems: an overview of systematic reviews. The protocol is largely common to all four overviews. The individual parts of each overview can be identified by the sub-titles delivery arrangements, financial arrangements, governance arrangements, and implementation strategies for overviews 1 to 4
Robotic Urologic Surgery: How to Make an Effective Robotic Program—A European Perspective
No full text
Robot-assisted surgery
No full textOver the last two decades the introduction of novel technologies substantially changed the practice in most surgical disciplines. With the advent of robotic surgery, the approach to patients with surgical indications has dramatically changed. The number of robotic procedures performed per year is rapidly increasing all over the world and more and more centers are equipping with this technology. The availability of new technologies is constantly affecting the field of minimally invasive surgery. Many of these innovations have been integrated within recent robotic surgical systems leading to numerous benefit for the surgeon and patients. New generation robotic systems are equipped with innovative technological refinements in order to improve vision, dexterity and assist the surgeon during the operation (virtual reality). Many companies are engaged in designing new robotic systems in order to propose an alternative to the well-established DaVinci platform. Tactile feedback, image-guided surgery and single site surgery are all hot topics for the next generation robotic surgeons. At the same time the costs either because this technology is expensive or because their introduction leads to an expansion in the types and numbers of patients treated should be considered to best allocate investments in the healthcare system
Robotic urologic surgery: How to make an effective robotic program—a European perspective
No full textOver the last decade the introduction of novel technologies substantially changed our approach to patients with urologic pathologies. Worldwide the number of robotic procedures performed per year is rapidly increasing. In current literature the relevance of robotic surgical training is progressively increasing although it is not easy to define and validate standardized paths for surgeons that are approaching for the first time to robotic surgery. In this context, the European Association of Urology Robotic Urology Section (ERUS) made several efforts in order to develop and validate an educational program for surgeons starting their robotic career
A Novel Approach for Apical Dissection During Robot-assisted Radical Prostatectomy: The “Collar” Technique
No full textBackground: Apical dissection in robot-assisted radical prostatectomy (RARP) affects not only cancer control, but also continence recovery. Objective: To describe a novel approach for apical dissection, the collar technique, to reduce apical positive surgical margins (PSMs). Design, setting, and participants: A total of 189 consecutive patients (81 in the control group, 108 in the collar technique group) underwent RARP at a single center. Primary outcome: rates of apical PSMs; secondary outcome: urinary continence. Intervention: The urethral sphincter complex is incised 2–3 mm distally to the apex, to stay farther from it and reduce PSMs; the underlying smooth muscle is exposed and incised closer to the apex to preserve the maximal length of the lissosphincter. Outcome measurements and statistical analysis: Mann–Whitney U and chi-square tests compared median and proportions between the two groups, respectively. Univariate logistic regression tested the association between technique employed and risk of apical PSMs. Results and limitations: Fourteen patients (7.4%) revealed apical PSMs (9.9% in the control group, 5.6% in the collar group; p = 0.7). When the collar technique was used, significantly lower rates of apical PSMs occurred in pT2 disease (0% vs 7.1%; p = 0.03). In case of apical tumor at preoperative magnetic resonance imaging (MRI; n = 43), the collar technique determined significantly lower overall (9.7% vs 42%) and apical (3.2% vs 42%) PSMs (all p ≤ 0.02). Continence recovery in the collar and control groups was similar. When preoperative MRI showed an apical tumor, the collar technique had a significantly lower risk of apical PSMs (odds ratio: 0.05, p = 0.009). Conclusions: The collar technique reduces the rates of apical PSMs in case of apical tumor, preserving the length of the lissosphincter. Patient summary: We describe a novel approach for apical dissection during robot-assisted radical prostatectomy. Our technique reduces the rates of apical surgical margins in case of apical tumor at preoperative magnetic resonance imaging and leads to optimal continence recovery. The proposed novel technique for apical dissection in the course of robotic prostatectomy allows reduction of the rates of apical surgical margins in case of apical tumor at preoperative magnetic resonance imaging and helps achieve optimal continence recovery
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