Search results for: prior surgery
2290 Rejuvenate: Face and Body Retouching Using Image Inpainting
Authors: Hossam Abdelrahman, Sama Rostom, Reem Yassein, Yara Mohamed, Salma Salah, Nour Awny
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In today’s environment, people are becoming increasingly interested in their appearance. However, they are afraid of their unknown appearance after a plastic surgery or treatment. Accidents, burns and genetic problems such as bowing of body parts of people have a negative impact on their mental health with their appearance and this makes them feel uncomfortable and underestimated. The approach presents a revolutionary deep learning-based image inpainting method that analyses the various picture structures and corrects damaged images. In this study, A model is proposed based on the in-painting of medical images with Stable Diffusion Inpainting method. Reconstructing missing and damaged sections of an image is known as image inpainting is a key progress facilitated by deep neural networks. The system uses the input of the user of an image to indicate a problem, the system will then modify the image and output the fixed image, facilitating for the patient to see the final result.Keywords: generative adversarial network, large mask inpainting, stable diffusion inpainting, plastic surgery
Procedia PDF Downloads 682289 Psychological Capital and Intention for Self-Employment among Students in HEIs: A Multi-group Analysis Approach
Authors: Ugur Choban, Aruzhan Zhaksylyk, Assylbek Nurgabdeshov
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In recent years, there has been an increasing understanding of the value of encouraging entrepreneurial attitudes in university students. This is motivated by the belief that stimulating entrepreneurship not only promotes economic growth but also fosters innovation. This study looks at the complex link and addresses critical gaps between psychological capital and entrepreneurial intention among university students, with a specific emphasis on how contextual factors like academic support and past business experience impact this dynamic. Using a quantitative research method, data were gathered from a broad sample of 300 university students drawn from several faculties. The study used a questionnaire that included the Psychological Capital Questionnaire (PCQ) to assess psychological capital and a validated scale for entrepreneurial intention, as well as binary measures of academic support and prior entrepreneurial experience. Statistical investigations, including multigroup analyses performed with SmartPLS software, provided interesting insights into the effect of contextual factors on the relationship between psychological capital and entrepreneurial intention. The findings highlight that psychological capital had a strong favorable influence on university students' entrepreneurial inclinations. Furthermore, the study found that academic support enhances the influence of psychological capital on entrepreneurial intentions, emphasizing the significance of institutional backing in fostering entrepreneurial mindsets. Furthermore, students with prior entrepreneurial experience had a stronger propensity for entrepreneurship, showing a synergistic link between psychological capital and entrepreneurial background. These findings have both theoretical and practical implications. By explaining the mechanisms by which psychological capital promotes entrepreneurial intentions, the study contributes to the establishment of focused entrepreneurship education programs and support activities that are suited to student requirements. Policymakers may use these findings to create policies that encourage student entrepreneurship, ultimately encouraging economic development and innovation.Keywords: academic support, entrepreneurial intentions, higher education institutions, psychological capital, prior entrepreneurial experience
Procedia PDF Downloads 512288 Restoring Sagging Neck with Minimal Scar Face Lifting
Authors: Alessandro Marano
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The author describes the use of deep plane face lifting and platysmaplasty to treat sagging neck with minimal scars. Series of case study. The author uses a selective deep plane face lift with a minimal access scar that not extend behind the ear lobe, neck liposuction and platysmaplasty to restore the sagging neck; the scars are minimal and no require drainage post-op. The deep plane face lifting can achieve a good result restoring vertical vectors in aging and sagging face, neck district can be treated without cutting the skin behind the ear lobe combining the SMAS vertical suspension and platysmaplasty; surgery can be performed in local anesthesia with sedation in day surgery and fast recovery. Restoring neck sagging without extend scars behind ear lobe is possible in selected patients, procedure is fast, safe, no drainage required, patients are satisfied and healing time is fast and comfortable.Keywords: face lifting, aesthetic, face, neck, platysmaplasty, deep plane
Procedia PDF Downloads 942287 The Impact of Financial News and Press Freedom on Abnormal Returns around Earnings Announcements in Greater China
Authors: Yu-Chen Wei, Yang-Cheng Lu, I-Chi Lin
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This study examines the impacts of news sentiment and press freedom on abnormal returns during the earnings announcement in greater China including the Shanghai, Shenzhen and Taiwan stock markets. The news sentiment ratio is calculated by using the content analysis of semantic orientation. The empirical results show that news released prior to the event date may decrease the cumulative abnormal returns prior to the earnings announcement regardless of whether it is released in China or Taiwan. By contrast, companies with optimistic financial news may increase the cumulative abnormal returns during the announcement date. Furthermore, the difference in terms of press freedom is considered in greater China to compare the impact of press freedom on abnormal returns. The findings show that, the freer the press is, the more negatively significant will be the impact of news on the abnormal returns, which means that the press freedom may decrease the ability of the news to impact the abnormal returns. The intuition is that investors may receive alternative news related to each company in the market with greater press freedom, which proves the efficiency of the market and reduces the possible excess returns.Keywords: news, press freedom, Greater China, earnings announcement, abnormal returns
Procedia PDF Downloads 3912286 The Effect of Institutions on Economic Growth: An Analysis Based on Bayesian Panel Data Estimation
Authors: Mohammad Anwar, Shah Waliullah
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This study investigated panel data regression models. This paper used Bayesian and classical methods to study the impact of institutions on economic growth from data (1990-2014), especially in developing countries. Under the classical and Bayesian methodology, the two-panel data models were estimated, which are common effects and fixed effects. For the Bayesian approach, the prior information is used in this paper, and normal gamma prior is used for the panel data models. The analysis was done through WinBUGS14 software. The estimated results of the study showed that panel data models are valid models in Bayesian methodology. In the Bayesian approach, the effects of all independent variables were positively and significantly affected by the dependent variables. Based on the standard errors of all models, we must say that the fixed effect model is the best model in the Bayesian estimation of panel data models. Also, it was proved that the fixed effect model has the lowest value of standard error, as compared to other models.Keywords: Bayesian approach, common effect, fixed effect, random effect, Dynamic Random Effect Model
Procedia PDF Downloads 652285 Posterior Acetabular Fractures-Optimizing the Treatment by Enhancing Practical Skills
Authors: Olivera Lupescu, Taina Elena Avramescu, Mihail Nagea, Alexandru Dimitriu
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Acetabular fractures represent a real challenge due to their impact upon the long term function of the hip joint, and due to the risk of intra- and peri-operative complications especially that they affect young, active people. That is why treating these fractures require certain skills which must be exercised, regarding the pre-operative planning, as well as the execution of surgery.The authors retrospectively analyse 38 cases with acetabular fractures operated using the posterior approach in our hospital between 01.01.2013- 01.01.2015 for which complete medical records ensure a follow-up of 24 months, in order to establish the main causes of potential errors and to underline the methods for preventing them. This target is included in the Erasmus + project ‘Collaborative learning for enhancing practical skills for patient-focused interventions in gait rehabilitation after orthopedic surgery COR-skills’. This paper analyses the pitfalls revealed by these cases, as well as the measures necessary to enhance the practical skills of the surgeons who perform acetabular surgery. Pre-op planning matched the intra and post-operative outcome in 88% of the analyzed points, from 72% at the beginning to 94% in the last case, meaning that experience is very important in treating this injury. The main problems detected for the posterior approach were: nervous complications - 3 cases, 1 of them a complete paralysis of the sciatic nerve, which recovered 6 months after surgery, and in other 2 cases intra-articular position of the screws was demonstrated by post-operative CT scans, so secondary screw removal was necessary in these cases. We analysed this incident, too, due to lack of information about the relationship between the screws and the joint secondary to this approach. Septic complications appeared in 3 cases, 2 superficial and 1 profound (requiring implant removal). The most important problems were the reduction of the fractures and the positioning of the screws so as not to interfere with the the articular space. In posterior acetabular fractures, pre-op complex planning is important in order to achieve maximum treatment efficacy with minimum of risk; an optimal training of the surgeons insisting on the main points of potential mistakes ensure the success of the procedure, as well as a favorable outcome for the patient.Keywords: acetabular fractures, articular congruency, surgical skills, vocational training
Procedia PDF Downloads 2032284 Time Estimation of Return to Sports Based on Classification of Health Levels of Anterior Cruciate Ligament Using a Convolutional Neural Network after Reconstruction Surgery
Authors: Zeinab Jafari A., Ali Sharifnezhad B., Mohammad Razi C., Mohammad Haghpanahi D., Arash Maghsoudi
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Background and Objective: Sports-related rupture of the anterior cruciate ligament (ACL) and following injuries have been associated with various disorders, such as long-lasting changes in muscle activation patterns in athletes, which might last after ACL reconstruction (ACLR). The rupture of the ACL might result in abnormal patterns of movement execution, extending the treatment period and delaying athletes’ return to sports (RTS). As ACL injury is especially prevalent among athletes, the lengthy treatment process and athletes’ absence from sports are of great concern to athletes and coaches. Thus, estimating safe time of RTS is of crucial importance. Therefore, using a deep neural network (DNN) to classify the health levels of ACL in injured athletes, this study aimed to estimate the safe time for athletes to return to competitions. Methods: Ten athletes with ACLR and fourteen healthy controls participated in this study. Three health levels of ACL were defined: healthy, six-month post-ACLR surgery and nine-month post-ACLR surgery. Athletes with ACLR were tested six and nine months after the ACLR surgery. During the course of this study, surface electromyography (sEMG) signals were recorded from five knee muscles, namely Rectus Femoris (RF), Vastus Lateralis (VL), Vastus Medialis (VM), Biceps Femoris (BF), Semitendinosus (ST), during single-leg drop landing (SLDL) and forward hopping (SLFH) tasks. The Pseudo-Wigner-Ville distribution (PWVD) was used to produce three-dimensional (3-D) images of the energy distribution patterns of sEMG signals. Then, these 3-D images were converted to two-dimensional (2-D) images implementing the heat mapping technique, which were then fed to a deep convolutional neural network (DCNN). Results: In this study, we estimated the safe time of RTS by designing a DCNN classifier with an accuracy of 90 %, which could classify ACL into three health levels. Discussion: The findings of this study demonstrate the potential of the DCNN classification technique using sEMG signals in estimating RTS time, which will assist in evaluating the recovery process of ACLR in athletes.Keywords: anterior cruciate ligament reconstruction, return to sports, surface electromyography, deep convolutional neural network
Procedia PDF Downloads 682283 Roadmap to a Bottom-Up Approach Creating Meaningful Contributions to Surgery in Low-Income Settings
Authors: Eva Degraeuwe, Margo Vandenheede, Nicholas Rennie, Jolien Braem, Miryam Serry, Frederik Berrevoet, Piet Pattyn, Wouter Willaert, InciSioN Belgium Consortium
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Background: Worldwide, five billion people lack access to safe and affordable surgical care. An added 1.27 million surgeons, anesthesiologists, and obstetricians (SAO) are needed by 2030 to meet the target of 20 per 100,000 population and to reach the goal of the Lancet Commission on Global Surgery. A well-informed future generation exposed early on to the current challenges in global surgery (GS) is necessary to ensure a sustainable future. Methods: InciSioN, the International Student Surgical Network, is a non-profit organization by and for students, residents, and fellows in over 80 countries. InciSioN Belgium, one of the prominent national working groups, has made a vast progression and collaborated with other networks to fill the educational gap, stimulate advocacy efforts and increase interactions with the international network. This report describes a roadmap to achieve sustainable development and education within GS, with the example of InciSioN Belgium. Results: Since the establishment of the organization’s branch in 2019, it has hosted an educational workshop for first-year residents in surgery, engaging over 2500 participants, and established a recurring directing board of 15 members. In the year 2020-2021, InciSioN Ghent has organized three workshops combining educational and interactive sessions for future prime advocates and surgical candidates. InciSioN Belgium has set up a strong formal coalition with the Belgian Medical Students’ Association (BeMSA), with its own standing committee, reaching over 3000+ medical students annually. In 2021-2022, InciSioN Belgium broadened to a multidisciplinary approach, including dentistry and nursing students and graduates within workshops and research projects, leading to a member and exposure increase of 450%. This roadmap sets strategic goals and mechanisms for the GS community to achieve nationwide sustained improvements in the research and education of GS focused on future SAOs, in order to achieve the GS sustainable development goals. In the coming year, expansion is directed to a formal integration of GS into the medical curriculum and increased international advocacy whilst inspiring SAOs to integrate into GS in Belgium. Conclusion: The development and implementation of durable change for GS are necessary. The student organization InciSioN Belgium is growing and hopes to close the colossal gap in GS and inspire the growth of other branches while sharing the know-how of a student organization.Keywords: advocacy, education, global surgery, InciSioN, student network
Procedia PDF Downloads 1642282 Traumatic Brain Injury Neurosurgical Care Continuum Delays in Mulago Hospital in Kampala Uganda
Authors: Silvia D. Vaca, Benjamin J. Kuo, Joao Ricardo Nickenig Vissoci, Catherine A. Staton, Linda W. Xu, Michael Muhumuza, Hussein Ssenyonjo, John Mukasa, Joel Kiryabwire, Henry E. Rice, Gerald A. Grant, Michael M. Haglund
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Background: Patients with traumatic brain injury (TBI) can develop rapid neurological deterioration from swelling and intracranial hematomas, which can result in focal tissue ischemia, brain compression, and herniation. Moreover, delays in management increase the risk of secondary brain injury from hypoxemia and hypotension. Therefore, in TBI patients with subdural hematomas (SDHs) and epidural hematomas (EDHs), surgical intervention is both necessary and time sensitive. Significant delays are seen along the care continuum in low- and middle-income countries (LMICs) largely due to limited healthcare capacity to address the disproportional rates of TBI in Sub Saharan Africa (SSA). While many LMICs have subsidized systems to offset surgical costs, the burden of securing funds by the patients for medications, supplies, and CT diagnostics poses a significant challenge to timely surgical interventions. In Kampala Uganda, the challenge of obtaining timely CT scans is twofold: logistical and financial barriers. These bottlenecks contribute significantly to the care continuum delays and are associated with poor TBI outcomes. Objective: The objectives of this study are to 1) describe the temporal delays through a modified three delays model that fits the context of neurosurgical interventions for TBI patients in Kampala and 2) investigate the association between delays and mortality. Methods: Prospective data were collected for 563 TBI patients presenting to a tertiary hospital in Kampala from 1 June – 30 November 2016. Four time intervals were constructed along five time points: injury, hospital arrival, neurosurgical evaluation, CT results, and definitive surgery. Time interval differences among mild, moderate and severe TBI and their association with mortality were analyzed. Results: The mortality rate of all TBI patients presenting to MNRH was 9.6%, which ranged from 4.7% for mild and moderate TBI patients receiving surgery to 81.8% for severe TBI patients who failed to receive surgery. The duration from injury to surgery varied considerably across TBI severity with the largest gap seen between mild TBI (174 hours) and severe TBI (69 hours) patients. Further analysis revealed care continuum differences for interval 3 (neurosurgical evaluation to CT result) and 4 (CT result to surgery) between severe TBI patients (7 hours for interval 3 and 24 hours for interval 4) and mild TBI patients (19 hours for interval 3, and 96 hours for interval 4). These post-arrival delays were associated with mortality for mild (p=0.05) and moderate TBI (p=0.03) patients. Conclusions: To our knowledge, this is the first analysis using a modified 'three delays' framework to analyze the care continuum of TBI patients in Uganda from injury to surgery. We found significant associations between delays and mortality for mild and moderate TBI patients. As it currently stands, poorer outcomes were observed for these mild and moderate TBI patients who were managed non-operatively or failed to receive surgery while surgical services were shunted to more severely ill patients. While well intentioned, high mortality rates were still observed for the severe TBI patients managed surgically. These results suggest the need for future research to optimize triage practices, understand delay contributors, and improve pre-hospital logistical referral systems.Keywords: care continuum, global neurosurgery, Kampala Uganda, LMIC, Mulago, traumatic brain injury
Procedia PDF Downloads 2072281 Role of Endotherapy vs Surgery in the Management of Traumatic Pancreatic Injury: A Tertiary Center Experience
Authors: Thinakar Mani Balusamy, Ratnakar S. Kini, Bharat Narasimhan, Venkateswaran A. R, Pugazhendi Thangavelu, Mohammed Ali, Prem Kumar K., Kani Sheikh M., Sibi Thooran Karmegam, Radhakrishnan N., Mohammed Noufal
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Introduction: Pancreatic injury remains a complicated condition requiring an individualized case by case approach to management. In this study, we aim to analyze the varied presentations and treatment outcomes of traumatic pancreatic injury in a tertiary care center. Methods: All consecutive patients hospitalized at our center with traumatic pancreatic injury between 2013 and 2017 were included. The American Association for Surgery of Trauma (AAST) classification was used to stratify patients into five grades of severity. Outcome parameters were then analyzed based on the treatment modality employed. Results: Of the 35 patients analyzed, 26 had an underlying blunt trauma with the remaining nine presenting due to penetrating injury. Overall in-hospital mortality was 28%. 19 of these patients underwent exploratory laparotomy with the remaining 16 managed nonoperatively. Nine patients had a severe injury ( > grade 3) – of which four underwent endotherapy, three had stents placed and one underwent an endoscopic pseudocyst drainage. Among those managed nonoperatively, three underwent a radiological drainage procedure. Conclusion: Mortality rates were clearly higher in patients managed operatively. This is likely a result of significantly higher degrees of major associated non-pancreatic injuries and not just a reflection of surgical morbidity. Despite this, surgical management remains the mainstay of therapy, especially in higher grades of pancreatic injury. However we would like to emphasize that endoscopic intervention definitely remains the preferred treatment modality when the clinical setting permits. This is especially applicable in cases of main pancreatic duct injury with ascites as well as pseudocysts.Keywords: endotherapy, non-operative management, surgery, traumatic pancreatic injury
Procedia PDF Downloads 2012280 Examining Neo-colonialism and Power in Global Surgical Missions: An Historical, Practical and Ethical Analysis
Authors: Alex Knighton, Roba Khundkar, Michael Dunn
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Neo-colonialism is defined as the use of economic, political, cultural, or other pressures to control or influence other countries, especially former dependencies, and concerns have been raised about its presence in surgical missions. Surgical missions aim to rectify the huge disparity in surgical access worldwide, but their ethics must be carefully considered. This is especially in light of colonial history which affects international relations and global health today, to ensure that colonial attitudes are not influencing efforts to promote equity. This review examines the history of colonial global health, demonstrating that global health initiatives have consistently been used to benefit those providing them, and then asks whether elements of colonialism are still pervasive in surgical missions today. Data was collected from the literature using specified search terms and snowball searching, as well as from international expert web-based conferences on global surgery ethics. A thematic analysis was then conducted on this data, resulting in the identification of six themes which are identifiable in both past and present global health initiatives. These six themes are power, lack of understanding or respect, feelings of superiority, exploitation, enabling of dependency, and acceptance of poorer standards of care. An ethical analysis follows, concluding that the concerns of power and neo-colonialism in global surgery would be addressed by adopting a framework of procedural justice that promotes a refined governance process in which stakeholders are able to propose and reject decisions that affect them. The paper argues that adopting this model would address concerns of the power disparity in the field directly, as well as promoting an ethical framework to enable the other concerns of power disparity and neo-colonialism identified in the present analysis to be addressed.Keywords: medical ethics, global surgery, global health, neocolonialism, surgical missions
Procedia PDF Downloads 912279 Histopathological Examination of Lung Surgery Camel in Iran
Authors: Ali Chitgar
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Respiratory infections including diseases in camels are important not only because of the threat of animal health but also to reduce their production. Since that deal with respiratory problems and their treatment requires adequate knowledge of the existing respiratory problems, unfortunately, there is limited information about the species of camels. This study aimed to identify lung lesions camels slaughtered in a slaughterhouse more important was performed using histopathology. Respiratory camels (n = 477) was examined after the killing fully and tissue samples were placed in 10% formalin. The samples and histological sections using hematoxylin and eosin staining and color were evaluated. In this study 79.6 % (236 of 477 samples) of the samples was at least a lung lesion. Rate acute interstitial pneumonia, chronic interstitial pneumonia, bronchopneumonia, bronchiolitis, an inflammation of the pleura and 52.8 % respectively atelectasis (236 of 477 samples), 5.4 % (24 of 477 samples), 7.8 % (35 of 477 samples), 6.7 % (30 of 477 samples), 3.4 % (15 of 477 samples) and 15.2% (68 of 477 samples). The lung lesions, acute interstitial pneumonia and bronchopneumonia in autumn winter rather than spring and summer (p <0/05) and as a result, this study showed that high rates of lung lesions in the camel population. Waste higher results in cold seasons (fall and winter) shows.Keywords: camel, surgery, histopathology, breathing organ
Procedia PDF Downloads 2002278 Shifting to Electronic Operative Notes in Plastic surgery
Authors: Samar Mousa, Galini Mavromatidou, Rebecca Shirley
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Surgeons carry out numerous operations in the busy burns and plastic surgery department daily. Writing an accurate operation note with all the essential information is crucial for communication not only within the plastics team but also to the multi-disciplinary team looking after the patient, including other specialties, nurses and GPs. The Royal college of surgeons of England, in its guidelines of good surgical practice, mentioned that the surgeon should ensure that there are clear (preferably typed) operative notes for every procedure. The notes should accompany the patient into recovery and to the ward and should give sufficient detail to enable continuity of care by another doctor. The notes should include the Date and time, Elective/emergency procedure, Names of the operating surgeon and assistant, Name of the theatre anesthetist, Operative procedure carried out, Incision, Operative diagnosis, Operative findings, Any problems/complications, Any extra procedure performed and the reason why it was performed, Details of tissue removed, added or altered, Identification of any prosthesis used, including the serial numbers of prostheses and other implanted materials, Details of closure technique, Anticipated blood loss, Antibiotic prophylaxis (where applicable), DVT prophylaxis (where applicable), Detailed postoperative care instructions and Signature. Fourteen random days were chosen in December 2021 to assess the accuracy of operative notes and post-operative care. A total of 163 operative notes were examined. The average completion rates in all domains were 85.4%. An electronic operative note template was designed to cover all domains mentioned in the Royal College of surgeons' good surgical practice. It is kept in the hospital drive for all surgeons to use.Keywords: operative notes, plastic surgery, documentation, electronic
Procedia PDF Downloads 762277 A Comparative Study of Granisetron and Palonosetron in Postoperative Nausea and Vomiting Following Laparoscopic Surgery
Authors: Burra Vijitha
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A prospective randomized comparative study for the prevention of postoperative nausea and vomiting in the patients undergoing general anesthesia ,for elective laparoscopic surgeries with respect to efficacy and side effects of granisetron and palonosetron. Sixty adult patients of class ASA 1,2 of either sex in age group between 20-70 yrs,scheduled for elective laparoscopic surgeries were selected for the study.Patients were randomly divided into two groups 30 each. Group G: Granisetron group (n=30), 40µg/kg; Group P: Palonosetron group (n=30), 0.075 mg. at end of surgery before extubation group G patients 40 µg/kg of inj.granisetron and group P patients received 0.075 mg of inj.palonosetron slow iv over 30 sec.In post anesthesia care unit, episodes of nausea and vomiting experienced by each patient was recorded by direct questioning the patient .study medication was assessed in terms of incidence of nausea and vomiting during periods of 0-4 hrs,4-12 hrs,12-24 hrs,24-48hrs.our study demonstrated that complete response for those patients who received granisetron were 86.66%,80% and 66.66% ,while those received palonosetron were 100%,86.6%,90% between 0-4hrs,4-12hrs,12-24 hrs. It shows no statistically signidficant differences between the baseline values of hemodynamic variables beween two groups during study. Keywords: Granisetron, nausea, palonosetron, vomiting.Keywords: granisetron, palonosetron, nausea, vomiting
Procedia PDF Downloads 2322276 Metaverse in Future Personal Healthcare Industry: From Telemedicine to Telepresence
Authors: Mohammed Saeed Jawad
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Metaverse involves the convergence of three major technologies trends of AI, VR, and AR. Together these three technologies can provide an entirely new channel for delivering healthcare with great potential to lower costs and improve patient outcomes on a larger scale. Telepresence is the technology that allows people to be together even if they are physically apart. Medical doctors can be symbolic as interactive avatars developed to have smart conversations and medical recommendations for patients at the different stages of the treatment. Medical digital assets such as Medical IoT for real-time remote healthcare monitoring as well as the symbolic doctors’ avatars as well as the hospital and clinical physical constructions and layout can be immersed in extended realities 3D metaverse environments where doctors, nurses, and patients can interact and socialized with the related digital assets that facilitate the data analytics of the sensed and collected personal medical data with visualized interaction of the digital twin of the patient’s body as well as the medical doctors' smart conversation and consultation or even in a guided remote-surgery operation.Keywords: personal healthcare, metaverse, telemedicine, telepresence, avatar, medical consultation, remote-surgery
Procedia PDF Downloads 1302275 Design of a Mhealth Therapy Management to Maintain Therapy Outcomes after Bariatric Surgery
Authors: A. Dudek, P. Tylec, G. Torbicz, P. Duda, K. Proniewska, P. Major, M. Pedziwiatr
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Background: Conservative treatments of obesity, based only on a proper diet and physical activity, without the support of an interdisciplinary team of specialist does not bring satisfactory bariatric results. Long-term maintenance of a proper metabolic results after rapid weight loss due to bariatric surgery requires engagement from patients. Mobile health tool may offer alternative model that enhance participant engagement in keeping the therapy. Objective: We aimed to assess the influence of constant monitoring and subsequent motivational alerts in perioperative period and on post-operative effects in the bariatric patients. As well as the study was designed to identify factors conductive urge to change lifestyle after surgery. Methods: This prospective clinical control study was based on a usage of a designed prototype of bariatric mHealth system. The prepared application comprises central data management with a comprehensible interface dedicated for patients and data transfer module as a physician’s platform. Motivation system of a platform consist of motivational alerts, graphic outcome presentation, and patient communication center. Generated list of patients requiring urgent consultation and possibility of a constant contact with a specialist provide safety zone. 31 patients were enrolled in continuous monitoring program during a 6-month period along with typical follow-up visits. After one year follow-up, all patients were examined. Results: There were 20 active users of the proposed monitoring system during the entire duration of the study. After six months, 24 patients took a part in a control by telephone questionnaires. Among them, 75% confirmed that the application concept was an important element in the treatment. Active users of the application indicated as the most valuable features: motivation to continue treatment (11 users), graphical presentation of weight loss, and other parameters (7 users), the ability to contact a doctor (3 users). The three main drawbacks are technical errors (9 users), tedious questionnaires inside the application (5 users), and time-consuming tasks inside the system (2 users). Conclusions: Constant monitoring and successive motivational alerts to continue treatment is an appropriate tool in the treatment after bariatric surgery, mainly in the early post-operative period. Graphic presentation of data and continuous connection with a clinical staff seemed to be an element of motivation to continue treatment and a sense of security.Keywords: bariatric surgery, mHealth, mobile health tool, obesity
Procedia PDF Downloads 1092274 Dialysis Access Surgery for Patients in Renal Failure: A 10-Year Institutional Experience
Authors: Daniel Thompson, Muhammad Peerbux, Sophie Cerutti, Hansraj Bookun
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Introduction: Dialysis access is a key component of the care of patients with end stage renal failure. In our institution, a combined service of vascular surgeons and nephrologists are responsible for the creation and maintenance of arteriovenous fisultas (AVF), tenckhoff cathethers and Hickman/permcath lines. This poster investigates the last 10 years of dialysis access surgery conducted at St. Vincent’s Hospital Melbourne. Method: A cross-sectional retrospective analysis was conducted of patients of St. Vincent’s Hospital Melbourne (Victoria, Australia) utilising data collection from the Australasian Vascular Audit (Australian and New Zealand Society for Vascular Surgery). Descriptive demographic analysis was carried out as well as operation type, length of hospital stays, postoperative deaths and need for reoperation. Results: 2085 patients with renal failure were operated on between the years of 2011 and 2020. 1315 were male (63.1%) and 770 were female (36.9%). The mean age was 58 (SD 13.8). 92% of patients scored three or greater on the American Society of Anesthiologiests classification system. Almost half had a history of ischaemic heart disease (48.4%), more than half had a history of diabetes (64%), and a majority had hypertension (88.4%). 1784 patients had a creatinine over 150mmol/L (85.6%), the rest were on dialysis (14.4%). The most common access procedure was AVF creation, with 474 autologous AVFs and 64 prosthetic AVFs. There were 263 Tenckhoff insertions. We performed 160 cadeveric renal transplants. The most common location for AVF formation was brachiocephalic (43.88%) followed by radiocephalic (36.7%) and brachiobasilic (16.67%). Fistulas that required re-intervention were most commonly angioplastied (n=163), followed by thrombectomy (n=136). There were 107 local fistula repairs. Average length of stay was 7.6 days, (SD 12). There were 106 unplanned returns to theatre, most commonly for fistula creation, insertion of tenckhoff or permacath removal (71.7%). There were 8 deaths in the immediately postoperative period. Discussion: Access to dialysis is vital for patients with end stage kidney disease, and requires a multidisciplinary approach from both nephrologists, vascular surgeons, and allied health practitioners. Our service provides a variety of dialysis access methods, predominately fistula creation and tenckhoff insertion. Patients with renal failure are heavily comorbid, and prolonged hospital admission following surgery is a source of significant healthcare expenditure. AVFs require careful monitoring and maintenance for ongoing utility, and our data reflects a multitude of operations required to maintain usable access. The requirement for dialysis is growing worldwide and our data demonstrates a local experience in access, with preferred methods, common complications and the associated surgical interventions.Keywords: dialysis, fistula, nephrology, vascular surgery
Procedia PDF Downloads 1082273 The Role of Surgery to Remove the Primary Tumor in Patients with Metastatic Breast Cancer
Authors: A. D. Zikiryahodjaev, L. V. Bolotina, A. S. Sukhotko
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Purpose. To evaluate the expediency and timeliness of performance of surgical treatment as a component of multi-therapy treatment of patients with stage IV breast cancers. Materials and Methods. This investigation comparatively analyzed the results of complex treatment with or without surgery in patients with metastatic breast cancer. We analyzed retrospectively treatment experience of 196 patients with generalized breast cancer in the department of oncology and breast reconstructive surgery of P.A. Herzen Moscow Cancer Research Institute from 2000 to 2012. The average age was (58±1,1) years. Invasive ductul carcinoma was verified in128 patients (65,3%), invasive lobular carcinoma-33 (16,8%), complex form - 19 (9,7%). Complex palliative care involving drug and radiation therapies was performed in two patient groups. The first group includes 124 patients who underwent surgical intervention as complex treatment, the second group includes 72 patients with only medical therapy. Standard systemic therapy was given to all patients. Results. Overall, 3-and 5-year survival in fist group was 43,8 and 21%, in second - 15,1 and 9,3% respectively [p=0,00002 log-rank]. Median survival in patients with surgical treatment composed 32 months, in patients with only systemic therapy-21. The factors having influencing an influence on the prognosis and the quality of life outcomes for of patients with generalized breast cancer were are also studied: hormone-dependent tumor, Her2/neu hyper-expression, reproductive function status (age, menopause existence). Conclusion.Removing primary breast tumor in patients with generalized breast cancer improve long-term outcomes. Three- and five-year survival increased by 28,7 and 16,3% respectively, and median survival–for 11 months. These patients may benefit from resection of the breast tumor. One explanation for the effect of this resection is that reducing the tumor load influences metastatic growth.Keywords: breast cancer, combination therapy, factors of prognosis, primary tumor
Procedia PDF Downloads 4092272 Regional Anesthesia in Carotid Surgery: A Single Center Experience
Authors: Daniel Thompson, Muhammad Peerbux, Sophie Cerutti, Hansraj Riteesh Bookun
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Patients with carotid stenosis, which may be asymptomatic or symptomatic in the form of transient ischaemic attack (TIA), amaurosis fugax, or stroke, often require an endarterectomy to reduce stroke risk. Risks of this procedure include stroke, death, myocardial infarction, and cranial nerve damage. Carotid endarterectomy is most commonly performed under general anaesthetic, however, it can also be undertaken with a regional anaesthetic approach. Our tertiary centre generally performs carotid endarterectomy under regional anaesthetic. Our major tertiary hospital mostly utilises regional anaesthesia for carotid endarterectomy. We completed a cross-sectional analysis of all cases of carotid endarterectomy performed under regional anaesthesia across a 10-year period between January 2010 to March 2020 at our institution. 350 patients were included in this descriptive analysis, and demographic details for patients, indications for surgery, procedural details, length of surgery, and complications were collected. Data was cross tabulated and presented in frequency tables to describe these categorical variables. 263 of the 350 patients in the analysis were male, with a mean age of 71 ± 9. 172 patients had a history of ischaemic heart disease, 104 had diabetes mellitus, 318 had hypertension, and 17 patients had chronic kidney disease greater than Stage 3. 13.1% (46 patients) were current smokers, and the majority (63%) were ex-smokers. Most commonly, carotid endarterectomy was performed conventionally with patch arterioplasty 96% of the time (337 patients). The most common indication was TIA and stroke in 64% of patients, 18.9% were classified as asymptomatic, and 13.7% had amaurosis fugax. There were few general complications, with 9 wound complications/infections, 7 postoperative haematomas requiring return to theatre, 3 myocardial infarctions, 3 arrhythmias, 1 exacerbation of congestive heart failure, 1 chest infection, and 1 urinary tract infection. Specific complications to carotid endarterectomy included 3 strokes, 1 postoperative TIA, and 1 cerebral bleed. There were no deaths in our cohort. This analysis of a large cohort of patients from a major tertiary centre who underwent carotid endarterectomy under regional anaesthesia indicates the safety of such an approach for these patients. Regional anaesthesia holds the promise of less general respiratory and cardiac events compared to general anaesthesia, and in this vulnerable patient group, calls for comparative research between local and general anaesthesia in carotid surgery.Keywords: anaesthesia, carotid endarterectomy, stroke, carotid stenosis
Procedia PDF Downloads 1162271 Trial of Resorbable versus Non-Resorbable Sutures for Traumatic Lacerations of the Face: A Demonstration of Maxillo-Facial Trainee Led Research
Authors: R. Botrugno, S Basyuni, G. Nugent, I. Jenkyn, A. Ferro, H. Bennett, C. Hjalmarsson, J. Chu, V. Santhanam
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This trainee led randomised controlled trial (RCT) aims to assess various outcomes for resorbable versus non-resorbable sutures for traumatic lacerations to the face. Within this trial of resorbable versus non-resorbable sutures for traumatic lacerations of the face (TORNFace), patient recruitment was facilitated by trainees who were employed at an NHS University Teaching Hospital in the United Kingdom. The trainees received appropriate training prior to recruiting patients for the trial. This included the completion of a national research e-learning module and face-to-face training that was provided locally. The locally delivered training provided an understanding of the eligibility criteria for the trial and the consent process. Existing trainee skills were utilised involving clinical photography to record baseline data and delivering the intervention based on the treatment arm selected. Eligible patients who required primary closure of traumatic lacerations of the face were randomised into one of two treatment arms. These comprised of resorbable (vicryl rapide) or non-resorbable sutures (ethilon). Primarily the cosmetic outcome was assessed. Secondary outcomes included: complications rates, health care economics, and patient-reported outcomes. Remote follow-up of recruited patients utilised photographs of the facial laceration which had received the intervention. These took place at 1 week, 3 months and 6 months post-intervention. This study aims to demonstrate an example of trainee-led research within the specialty of oral and maxillofacial surgery. The available data for the randomised controlled trial will also be presented.Keywords: laceration, suture, trauma, trial
Procedia PDF Downloads 1312270 Effect of Media Reputation on Financial Performance and Abnormal Returns of Corporate Social Responsibility Winner
Authors: Yu-Chen Wei, Dan-Leng Wang
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This study examines whether the reputation from media press affect the financial performance and market abnormal returns around the announcement of corporate social responsibility (CSR) award in the Taiwan Stock Market. The differences between this study and prior literatures are that the media reputation of media coverage and net optimism are constructed by using content analyses. The empirical results show the corporation which won CSR awards could promote financial performance next year. The media coverage and net optimism related to CSR winner are higher than the non-CSR companies prior and after the CSR award is announced, and the differences are significant, but the difference would decrease when the day was closing to announcement. We propose that non-CSR companies may try to manipulate media press to increase the coverage and positive image received by investors compared to the CSR winners. The cumulative real returns and abnormal returns of CSR winners did not significantly higher than the non-CSR samples however the leading returns of CSR winners would higher after the award announcement two months. The comparisons of performances between CSR and non-CSR companies could be the consideration of portfolio management for mutual funds and investors.Keywords: corporate social responsibility, financial performance, abnormal returns, media, reputation management
Procedia PDF Downloads 4242269 Surgical Hip Dislocation of Femoroacetabular Impingement: Survivorship and Functional Outcomes at 10 Years
Authors: L. Hoade, O. O. Onafowokan, K. Anderson, G. E. Bartlett, E. D. Fern, M. R. Norton, R. G. Middleton
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Aims: Femoroacetabular impingement (FAI) was first recognised as a potential driver for hip pain at the turn of the last millennium. While there is an increasing trend towards surgical management of FAI by arthroscopic means, open surgical hip dislocation and debridement (SHD) remains the Gold Standard of care in terms of reported outcome measures. (1) Long-term functional and survivorship outcomes of SHD as a treatment for FAI are yet to be sufficiently reported in the literature. This study sets out to help address this imbalance. Methods: We undertook a retrospective review of our institutional database for all patients who underwent SHD for FAI between January 2003 and December 2008. A total of 223 patients (241 hips) were identified and underwent a ten year review with a standardised radiograph and patient-reported outcome measures questionnaire. The primary outcome measure of interest was survivorship, defined as progression to total hip arthroplasty (THA). Negative predictive factors were analysed. Secondary outcome measures of interest were survivorship to further (non-arthroplasty) surgery, functional outcomes as reflected by patient reported outcome measure scores (PROMS) scores, and whether a learning curve could be identified. Results: The final cohort consisted of 131 females and 110 males, with a mean age of 34 years. There was an overall native hip joint survival rate of 85.4% at ten years. Those who underwent a THA were significantly older at initial surgery, had radiographic evidence of preoperative osteoarthritis and pre- and post-operative acetabular undercoverage. In those whom had not progressed to THA, the average Non-arthritic Hip Score and Oxford Hip Score at ten year follow-up were 72.3% and 36/48, respectively, and 84% still deemed their surgery worthwhile. A learning curve was found to exist that was predicated on case selection rather than surgical technique. Conclusion: This is only the second study to evaluate the long-term outcomes (beyond ten years) of SHD for FAI and the first outside the originating centre. Our results suggest that, with correct patient selection, this remains an operation with worthwhile outcomes at ten years. How the results of open surgery compared to those of arthroscopy remains to be answered. While these results precede the advent of collison software modelling tools, this data helps set a benchmark for future comparison of other techniques effectiveness at the ten year mark.Keywords: femoroacetabular impingement, hip pain, surgical hip dislocation, hip debridement
Procedia PDF Downloads 772268 The Association between Prior Antibiotic Use and Subsequent Risk of Infectious Disease: A Systematic Review
Authors: Umer Malik, David Armstrong, Mark Ashworth, Alex Dregan, Veline L'Esperance, Lucy McDonnell, Mariam Molokhia, Patrick White
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Introduction: The microbiota lining epithelial surfaces is thought to play an important role in many human physiological functions including defense against pathogens and modulation of immune response. The microbiota is susceptible to disruption from external influences such as exposure to antibiotic medication. It is thought that antibiotic-induced disruption of the microbiota could predispose to pathogen overgrowth and invasion. We hypothesized that antibiotic use would be associated with increased risk of future infections. We carried out a systematic review of evidence of associations between antibiotic use and subsequent risk of community-acquired infections. Methods: We conducted a review of the literature for observational studies assessing the association between antibiotic use and subsequent community-acquired infection. Eligible studies were published before April 29th, 2016. We searched MEDLINE, EMBASE, and Web of Science and screened titles and abstracts using a predefined search strategy. Infections caused by Clostridium difficile, drug-resistant organisms and fungal organisms were excluded as their association with prior antibiotic use has been examined in previous systematic reviews. Results: Eighteen out of 21,518 retrieved studies met the inclusion criteria. The association between past antibiotic exposure and subsequent increased risk of infection was reported in 16 studies, including one study on Campylobacter jejuni infection (Odds Ratio [OR] 3.3), two on typhoid fever (ORs 5.7 and 12.2), one on Staphylococcus aureus skin infection (OR 2.9), one on invasive pneumococcal disease (OR 1.57), one on recurrent furunculosis (OR 16.6), one on recurrent boils and abscesses (Risk ratio 1.4), one on upper respiratory tract infection (OR 2.3) and urinary tract infection (OR 1.1), one on invasive Haemophilus influenzae type b (Hib) infection (OR 1.51), one on infectious mastitis (OR 5.38), one on meningitis (OR 2.04) and five on Salmonella enteric infection (ORs 1.4, 1.59, 1.9, 2.3 and 3.8). The effect size in three studies on Salmonella enteric infection was of marginal statistical significance. A further two studies on Salmonella infection did not demonstrate a statistically significant association between prior antibiotic exposure and subsequent infection. Conclusion: We have found an association between past antibiotic exposure and subsequent risk of a diverse range of infections in the community setting. Our findings provide evidence to support the hypothesis that prior antibiotic usage may predispose to future infection risk, possibly through antibiotic-induced alteration of the microbiota. The findings add further weight to calls to minimize inappropriate antibiotic prescriptions.Keywords: antibiotic, infection, risk factor, side effect
Procedia PDF Downloads 2212267 The Voice Rehabilitation Program Following Ileocolon Flap Transfer for Voice Reconstruction after Laryngectomy
Authors: Chi-Wen Huang, Hung-Chi Chen
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Total laryngectomy affects swallowing, speech functions and life quality in the head and neck cancer. Voice restoration plays an important role in social activities and communication. Several techniques have been developed for voice restoration and reported to improve the life quality. However, the rehabilitation program for voice reconstruction by using the ileocolon flap still unclear. A retrospective study was done, and the patients' data were drawn from the medical records between 2010 and 2016 who underwent voice reconstruction by ileocolon flap after laryngectomy. All of them were trained to swallow first; then, the voice rehabilitation was started. The outcome of voice was evaluated after 6 months using the 4-point scoring scale. In our result, 9.8% patients could give very clear voice so everyone could understand their speech, 61% patients could be understood well by families and friends, 20.2% patients could only talk with family, and 9% patients had difficulty to be understood. Moreover, the 57% patients did not need a second surgery, but in 43% patients voice was made clear by a second surgery. In this study, we demonstrated that the rehabilitation program after voice reconstruction with ileocolon flap for post-laryngectomy patients is important because the anatomical structure is different from the normal larynx.Keywords: post-laryngectomy, ileocolon flap, rehabilitation, voice reconstruction
Procedia PDF Downloads 1522266 Surgical Collaboration in Managing Spinal Cord Compression Due to a Pre-Vertebral Chordoma: A Case Report
Authors: Rose Virginy S. Bautista, Ida Marie Tabangay-Lim, Helen Bongalon-Amo, Jose Modesto B. Abellera
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Chordomas, particularly those of the spine and the head and neck region, represent a rare and locally aggressive group of malignancies. The complexity of these tumors -given the rarity, location, and involvement of neurovascular structures- imposes a challenge in the diagnosis and management. We herein report a case of spinal cord compression due to a prevertebral cervical chordoma. The patient presented with a gradually enlarging lateral neck mass, with progressive bilateral extremity weakness and urinary incontinence; preoperative biopsy showed chordoma. A multidisciplinary approach for the management of this case was made, involving neurosurgery, head and neck surgery, and radiation oncology services. Surgical collaboration between the two cutting services was done to have a radical excision of the tumor and spinal cord decompression. The patient was then referred for adjuvant radiation therapy. With this collaborative treatment strategy, more comprehensive and quality care could be provided to our patients.Keywords: chordoma, surgical collaboration, spinal cord compression, neurosurgery, head and neck surgery
Procedia PDF Downloads 642265 Left Posterior Pericardiotomy in the Prevention of Post-Operative Atrial Fibrillation and Cardiac Tamponade: A Retrospective Study of 2118 Isolated Coronary Artery Bypass Graft Patients
Authors: Ayeshmanthe Rathnayake, Siew Goh, Carmel Fenton, Ashutosh Hardikar
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Post-Operative Atrial Fibrillation (POAF) is the most frequent complication of cardiac surgery and is associated with reduced survival, increased rates of cognitive changes and cerebrovascular accident, heart failure, renal dysfunction, infection and length of stay, and hospital costs. Cardiac tamponade, although less common, carries high morbidity and mortality. Shed mediastinal blood in the pericardial space is a major source of intrapericardial oxidative stress and inflammation that triggers POAF. The utilisation of a left posterior pericardiotomy aims to shunt blood from the pericardium into the pleural space and have a role in the prevention of POAF as well as cardiac tamponade. 2118 patients had undergone isolated Coronary Artery Bypass Graft (CABG) at Royal Hobart Hospital from 2008-2021. They were divided into pericardiotomy vs control group. Patient baseline demographics, intraoperative data, and post-operative outcomes were reviewed retrospectively. Total incidence of new POAF and cardiac tamponade was 26.1% and 0.75%, respectively. Primary outcome of both the incidence of POAF(22.9% vs27.8%OR 0.77 p<0.05) and Cardiac Tamponade (0% vs 1.1% OR 0.85 p<0.05) were less in the pericardiotomy group.Increasing age, BMI, poor left ventricular function (EF <30%), and return to theatre were independent predictors of developing POAF. There were similar rates of return to theatre for bleeding however, no cases of tamponade in the pericardiotomy group. There were no complications attributable to left posterior pericardiotomy and the time added to the duration of surgery was minimal. Left posterior pericardiotomy is associated with a significant reduction in the incidence of POAFand cardiac tamponade and issafe and efficient.Keywords: cardiac surgery, pericardiotomy, post-operative atrial fibrillation, cardiac tamponade
Procedia PDF Downloads 862264 Postoperative Radiotherapy in Cancers of the Larynx: Experience of the Emir Abdelkader Cancer Center of Oran, about 89 Cases
Authors: Taleb Lotfi, Benarbia Maheidine, Allam Hamza, Boutira Fatima, Boukerche Abdelbaki
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Introduction and purpose of the study: This is a retrospective single-center study with an analytical aim to determine the prognostic factors for relapse in patients treated with radiotherapy after total laryngectomy with lymph node dissection for laryngeal cancer at the Emir Abdelkader cancer center in Oran (Algeria). Material and methods: During the study period from January 2014 to December 2018, eighty-nine patients (n=89) with squamous cell carcinoma of the larynx were treated with postoperative radiotherapy. Relapse-free survival was studied in the univariate analysis according to pre-treatment criteria using Kaplan-Meier survival curves. We performed a univariate analysis to identify relapse factors. Statistically significant factors have been studied in the multifactorial analysis according to the Cox model. Results and statistical analysis: The average age was 62.7 years (40-86 years). It was a squamous cell carcinoma in all cases. Postoperatively, the tumor was classified as pT3 and pT4 in 93.3% of patients. Histological lymph node involvement was found in 36 cases (40.4%), with capsule rupture in 39% of cases, while the limits of surgical excision were microscopically infiltrated in 11 patients (12.3%). Chemotherapy concomitant with radiotherapy was used in 67.4% of patients. With a median follow-up of 57 months (23 to 104 months), the probabilities of relapse-free survival and five-year overall survival are 71.2% and 72.4%, respectively. The factors correlated with a high risk of relapse were locally advanced tumor stage pT4 (p=0.001), tumor site in case of subglottic extension (p=0.0003), infiltrated surgical limits R1 (p=0.001), l lymph node involvement (p=0.002), particularly in the event of lymph node capsular rupture (p=0.0003) as well as the time between surgery and adjuvant radiotherapy (p=0.001). However, in the subgroup analysis, the major prognostic factors for disease-free survival were subglottic tumor extension (p=0.001) and time from surgery to adjuvant radiotherapy (p=0.005). Conclusion: Combined surgery and postoperative radiation therapy are effective treatment modalities in the management of laryngeal cancer. Close cooperation of the entire cervicofacial oncology team is essential, expressed during a multidisciplinary consultation meeting, with the need to respect the time between surgery and radiotherapy.Keywords: laryngeal cancer, laryngectomy, postoperative radiotherapy, survival
Procedia PDF Downloads 962263 Flexible Ureterorenoscopy as a New Possibility of Treating Nephrolithiasis in Children – Preliminary Reports
Authors: Adam Haliński, Andrzej Haliński
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Introduction: Flexible ureterorenoscopy is a surgery technique used for the treatment of the upper urinary tract. It is very often used in adult patients; however, due to the advancing miniaturization of the equipment as well as its precision, this technique has also become possible in the treatment process in children. Material and method: We would like to present 26 cases of flexible ureterorenoscopy carried out in children with nephrolithiasis of the upper urinary tract aged 6 to 17 years. The average age was 9.5 years and the children were treated in our department from June 2013 to January 2015. The first surgery in Poland took place in our Department on 06.06.2013. Because of nephrolithiasis all the children had been subjected earlier to ESWL treatment, which was unsuccessful. Results: 14 children had deposits in the lower calyx, 9 children had deposits in the middle and lower calyx and in 3 children a stone was located in the initial ureter. An efficiency of 88 % was achieved. Conclusions: Flexible ureterorenoscopy is effective and minimally invasive tool both for the diagnosis and treatment of upper urinary tract. We believe that the advancing miniaturization of the equipment and gaining experience will enable carrying out of this procedure in smaller children with high efficiency.Keywords: flexible ureterorenoscopy, urolithisis, endourology, nephrolithiasis
Procedia PDF Downloads 3742262 Comparison of the Proprioception Sense and Standing Balance in Patients with Osteoarthritis Before and After Total Knee Arthroplasty Surgery
Authors: S. Daneshi, G. Shahcheraghi, F. Ghaffarinejad
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Back ground: Osteoarthritis (OA) is the most common form of arthritis, affecting millions of people around the world during the aging process. Knee joint proprioception sense decrease with OA and Total Knee Arthroplasty (TKA) surgery may affect them. We investigated two parameters of proprioception sense (the joint position sense and kinesthesia) and standing balance in affected limbs before and after TKA, in patient with Knee OA. Methods and Materials: In this Analytic study, 10 patients who were candidate for TKA during two months in Dena Hospital of Shiraz, selected for further analysis. All of cases were female in range of 55-70 years old. Participants assessed before and two weeks after TKA using three instruments: electrogoniometer and continuous passive motion (CPM) to assess Knee joint position sense and kinesthesia in 20 and 45 degrees; and chronometer to assess duration of standing balance on affected leg with open and closed eyes. Results: To examine differences between before and after of TKA scorings Willcoxon Signed Rank and Mann-Whitney was performed which indicated no significant differences between knee joint position sense and kinesthesia in 20 and 45 degrees (P>0.05) and no significant differences between Standing Balance in a patient with knee OA before and after TKA (P>0.05). Conclusion: The study indicates that, OA can affect proprioception sense and standing balance but TKA doesn’t have any effect on these parameters. Intra articular structures such as cruciate ligaments and mines are responsible for proprioception sense in normal knee joint. Since in severe knee OA the number of mechanoreceptors in these intra articular structures decrease and their function reduce more than normal knee joint, so the anterior cruciate ligaments (ACL) become defected, thus after TKA surgery which this ligament is removed no significant change was found in proprioception sense. As a result of involving proprioception sense, muscles strength and the function of vestibular system in balance, standing balance did not show significant difference before and after TKA.Keywords: knee joint, proprioception sense, standing balance, rehabilitation sciences
Procedia PDF Downloads 3752261 The Lessons Learned from Managing Malignant Melanoma During COVID-19 in a Plastic Surgery Unit in Ireland
Authors: Amenah Dhannoon, Ciaran Martin Hurley, Laura Wrafter, Podraic J. Regan
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Introduction: The COVID-19 pandemic continues to present unprecedented challenges for healthcare systems. This has resulted in the pragmatic shift in the practice of plastic surgery units worldwide. During this period, many units reported a significant fall in urgent melanoma referrals, leading to patients presenting with advanced disease requiring more extensive surgery and inferior outcomes. Our objective was to evaluate our unit's experience with both non-invasive and invasive melanoma during the COVID-19 pandemic and characterize our experience and contrast it to that experienced by our neighbors in the UK, mainland Europe and North America. Methods: a retrospective chart review was performed on all patients diagnosed with invasive and non-invasive cutaneous melanoma between March to December of 2019 (control) compared to 2020 (COVID-19 pandemic) in a single plastic surgery unit in Ireland. Patient demographics, referral source, surgical procedures, tumour characteristics, radiological findings, oncological therapies and follow-up were recorded. All data were anonymized and stored in Microsoft Excel. Results: A total of 589 patients were included in the study. Of these, 314 (53%) with invasive melanoma, compared to 275 (47%) with the non-invasive disease. Overall, more patients were diagnosed with both invasive and non-invasive melanoma in 2020 than in 2019 (p<0.05). However, significantly longer waiting times in 2020 (64 days) compared to 2019 (28 days) (p<0.05), with the majority of the referral being from GP in 2019 (83%) compared to 61% in 2020. Positive sentinel lymph node were higher in 2019 at 56% (n=28) compared to 24% (n=22) in 2020. There was no statistically significant difference in the tutor characteristics or metastasis status. Discussion: While other countries have noticed a fall in the melanoma diagnosis. Our units experienced a higher number of disease diagnoses. This can be due to multiple reasons. In Ireland, the government reached an early agreement with the private sector to continue elective surgery on an urgent basis in private hospitals. This allowed access to local anesthetic procedures and local skin cancer cases were triaged to non-COVID-19 provider centers. Our unit also adapted a fast, effective and minimal patient contact strategy for triaging skin cancer based on telemedicine. Thirdly, a skin cancer nurse specialist maintained patient follow-ups and triaging a dedicated email service. Finally, our plastic surgery service continued to maintain a virtual complex skin cancer multidisciplinary team meeting during the pandemic, ensuring local clinical governance has adhered to each clinical case. Conclusion: Our study highlights that with the prompt efficient restructuring of services, we could reserve successful management of skin cancer even in the most devastating times. It is important to reflect on the success during the pandemic and emphasize the importance of preparation for a potentially difficult futureKeywords: malignant melanoma, skin cancer, COVID-19, triage
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