Search results for: centralisation

Authors: Jemini Vyas, Oluwatobi Adeyoe, Jenny Branagan, Chandran Tanabalan, John Beatty, Aakash Pai

Abstract:

Introduction: The development of robotic surgery has accelerated centralisation to tertiary centres, where robotic radical prostatectomy (RP) is offered. The purpose of concentrating treatment in high volume specialist centres is to improve the quality of care and patient outcomes. The aim of this study was to assess the impact on clinical outcomes of centralisation for locally diagnosed patients undergoing RP. Methods: Clinical outcomes for 169 consecutive laparoscopic & open RP pre-centralisation were retrospectively compared with 50 consecutive robotic RP conducted over a similar period post-centralisation. Preoperative risk stratification and time to surgery were collected. Perioperative outcomes, including length of stay (LOS) and complications, were collated. Post-operative outcomes, including erectile dysfunction (ED), biochemical recurrence (BCR), and urinary continence, were assessed. Results: Preoperative risk stratification showed no difference between the two groups. The median time from diagnosis to treatment was similar between the two groups (pre-centralisation, 121 days, post-centralisation, 117 days). The mean length of stay (pre-centralisation, 2.1 days, post-centralisation, 1.6 days) showed no significant difference (p=0.073). Proportion of overall complications (pre-centralisation, 11.4%, post-centralisation, 8.7%) and complications, above Clavien-Dindo 2, were similar between the two groups (pre-centralisation1.2%, post-centralisation 2.2%). Post operative functional parameters, including continence and ED, were comparable. Five-year BCR free rate was 78% for the pre-centralisation group and 79% for the post centralisation group. Conclusion: For our cohort of patients, clinical outcomes have remained static during centralisation. It is imperative that centralisation is accompanied by increased capacity, streamlining of pathways, and training to ensure that improved quality of care is achieved. Our institution has newly acquired a robot, and prospectively studying this data may support the reversal of centralisation for RP surgery.

Keywords: prostate, cancer, prostatectomy, clinical

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Authors: Jemini Vyas, Oluwatobi Adeyoe, Jenny Branagan, Chandran Tanabalan, Aakash Pai

Abstract:

Introduction: Radical prostatectomy and radiotherapy are both viable options for the treatment of localised prostate cancer. Over the years medicine has evolved towards a patient-centred approach. Patient decision-making is not motivated by clinical outcomes alone. Geographical location and ease of access to treating clinician are contributory factors. With the development of robotic surgery, prostatectomy has been centralised into tertiary centres. This has impacted on the distances that patients and their families are expected to travel. Methods: A single centre retrospective study was undertaken over a five-year period. All patients with localised prostate cancer, undergoing radical radiotherapy or prostatectomy were collected pre-centralisation. This was compared to the total number undergoing these treatments post centralisation. Results: Pre-centralisation, both radiotherapy and prostatectomy groups had to travel a median of less than five miles for treatment. Post-centralisation of pelvic surgery, prostatectomy patients had to travel a median of more than 40 miles, whilst travel distance for the radiotherapy group was unchanged. In the post centralisation cohort, there was a 63% decline in the number of patients undergoing radical prostatectomy per month from a mean of 5.1 to 1.9. The radical radiotherapy group had a concurrent 41% increase in patient numbers with a mean increase from 13.3 to 18.8 patients per month. Conclusion: Choice of radical treatment in localised prostate cancer is based on multiple factors. This study infers that local availability can influence choice of radical treatment. It is imperative that efforts are made to maintain accessibility to all viable options for prostate cancer patients, so that patient choice is not compromised.

Keywords: prostate, prostatectomy, radiotherapy, centralisation

Procedia PDF Downloads 67

Authors: P. Panwalkar, K. Veravalli, M. Tofighi, A. Mofidi

Abstract:

Introduction: Anterior femoral perforation or distal anterior nail position is a known complication of femoral nailing specifically in pertrochantric fractures fixed with cephalomedullary nail. This has been attributed to wrong entry point for the femoral nail, nail with large radius of curvature or malreduced fracture. Left alone anterior perforation of femur or abutment of nail on anterior femur will result in pain and risk stress riser at distal femur and periprosthetic fracture. There have been multiple techniques described to avert or correct this problem ranging from using different nail, entry point change, poller screw to deflect the nail position, use of shorter nail or use of curved guidewire or change of nail to ensure a nail with large radius of curvature Methods: We present this technique which we have used in order to centralise the femoral nail either when the nail has been put anteriorly or when the guide wire has been inserted too anteriorly prior to the insertion of the nail. This technique requires the use of femoral reduction spool from the nailing set. This technique was used by eight trainees of different level of experience under supervision. Results: This technique was easily reproducible without any learning curve without a need for opening of fracture site or change in the entry point with three different femoral nailing sets in twenty-five cases. The process took less than 10 minutes even when revising a malpositioned femoral nail. Conclusion: Our technique of using femoral reduction spool is easily reproducible and repeatable technique for avoidance of non-centralised femoral nail insertion and distal anterior perforation of femoral nail.

Keywords: femoral fracture, nailing, malposition, surgery

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Authors: Joy Debski

Abstract:

Due to the varying degrees of the problem posed by global warming, environmental sustainability dominates international discourse. International initiatives' aims and expectations have proven particularly challenging to put into practice in developing nations. To reduce human exploitation of the environment, stricter measures are urgently needed. However, putting them into practice has proven more difficult. Relatively recent information from the Climate Accountability Institute and academic researchers shows that fossil fuel companies are major contributors to the climate crisis. Host communities in oil and gas-producing areas, particularly in developing nations, have grown hostile toward both oil and gas companies and government policies. It is now essential that the three main stakeholders—government, the oil and gas sector, and host communities—cooperate to achieve the shared objective of environmental sustainability. This research, therefore, advocates a governance system for Nigeria that facilitates the achieving the goal of environmental sustainability. This objective is achieved by the research's examination of the main institutional framework for environmental sustainability, evaluation of the strategies used by major oil companies to increase stakeholder engagement in environmental sustainability, and examination of the involvement of host communities in environmental sustainability. The study reveals that while environmental sustainability is important to the identified stakeholders, it's challenging to accomplish without an informed synergy. Hence the research advocates the centralisation of CSR through a CSR commission for environmental sustainability. The commission’s mandate is to facilitate, partner with, and endorse companies. The commission is strongly advised to incorporate host community liaison offices into the process of negotiating contracts with oil and gas firms, as well as to play a facilitative role in helping firms adhere to both domestic and international regulations. The recommendations can benefit Nigerian policymakers in enhancing their unsuccessful efforts to pass CSR legislation. Through the research-proposed CSR department, which has competent training and stakeholder engagement strategies, oil and gas companies can enhance and centralise their goals for environmental sustainability. Finally, the CSR Commission's expertise would give host communities more leverage when negotiating their memorandum of understanding with oil and gas companies.

Keywords: environmental sustainability, corporate social responsibility, CSR, oil and gas, nigeria

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Authors: Ali Alahmari

Abstract:

Saudi Arabia is facing increasing challenges in managing urban drainage, due to a combination of factors including climate change and urban expansion. Traditional drainage systems are unable to cope with demand, resulting in flooding and damage to property. Consequently, new ways of dealing with this issue need to be found and Sustainable Urban Drainage Systems (SUDS) appear to be a possible solution. This paper suggests that knowledge is a central issue in the adoption of Sustainable Urban Drainage approaches, as revealed through qualitative research with representative officials and professionals from key government departments and organisations in Riyadh. Semi-structured interviews were conducted with twenty-six participants. The interviews explored the challenges of adopting sustainable drainage approaches, and grounded theory analysis was used to examine the role of knowledge. However, a number of barriers have been identified with regard to the adoption of sustainable drainage approaches, such as the marginal status of sustainability in drainage decisions; lack of technical standards for other unconventional drainage solutions, and lack of consideration by decision makers of contributions from environmental and geographical studies. Due to centralisation, decision-making processes are complex and time-consuming, resulting in the discouragement of the adoption of new knowledge and approaches. Stakeholders with knowledge of sustainable approaches are often excluded from the hierarchical system of urban planning and drainage management. In addition, the multiplicity of actors involved in the implementation of the drainage system, as well as the different technical standards involved, often causes problems around coordination and cooperation. Although those with procedural and explicit knowledge have revealed a range of opportunities, such as a significant increase in government support for rainwater drainage in urban areas, they also identified a number of obstacles. These are mainly related to the lack of specialists in sustainable approaches, and a reluctance to involve external experts. Therefore, recommendations for overcoming some of these challenges are presented, which include enhancing the decision-making process through applying decentralisation and promoting awareness of sustainability through establishing educational and outreach programmes. This may serve to increase knowledge and facilitate the adoption of sustainable drainage approaches to promote sustainable development in the context of Saudi Arabia.

Keywords: climate change, decision-making processes, new knowledge and approaches, resistance to change, Saudi Arabia, SUDS, urban expansion

Procedia PDF Downloads 118