Optimising the use of virtual and conventional simulation: a clinical and economic analysis

AbstractBackground and purpose: Currently, optimal use of virtual simulation for all treatment sites is not entirely clear. This study presents data to identify specific patient groups for whom conventional simulation may be completely eliminated and replaced by virtual simulation.Sampling and method: Two hundred and sixty patients were recruited from four treatment sites (head and neck, breast, pelvis, and thorax). Patients were randomly assigned to be treated using the usual treatment process involving conventional simulation, or a treatment process differing only in the replacement of conventional plan verification with virtual verification. Data were collected on set-up accuracy at verification, and the number of unsatisfactory verifications requiring a return to the conventional simulator. A micro-economic costing analysis was also undertaken, whereby data for each treatment process episode were also collected: number and grade of staff present, and the time for each treatment episode.Results: The study shows no statistically significant difference in the number of returns to the conventional simulator for each site and study arm. Image registration data show similar quality of verification for each study arm. The micro-costing data show no statistical difference between the virtual and conventional simulation processes.Conclusions: At our institution, virtual simulation including virtual verification for the sites investigated presents no disadvantage compared to conventional simulation.

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Cost Analysis of Dialysis Modalities in Italy

Health Services Management Research ◽

10.1177/095148480101400102 ◽

2001 ◽

Vol 14 (1) ◽

pp. 9-17 ◽

Cited By ~ 4

Author(s):

F. Tediosi ◽

G. Bertolini ◽

F. Parazzini ◽

G. Mecca ◽

L. Garattini

Keyword(s):

Cost Analysis ◽

Specific Patient ◽

Rational Allocation ◽

Italian National Health Service ◽

Related Quality ◽

Health Related ◽

Italian National Health ◽

Patient Groups ◽

The Cost

This study analyses management and costs of dialysis in the Italian National Health Service (NHS). Information on efficacy and health-related quality of life (HRQOL) based on the existing literature also is presented. The clinical differences between the dialysis modalities seem to be related to their appropriateness to specific patient groups. Efficacy rates are similar and the only differences are in complications and HRQOL. Traditional haemodialysis (THD) can be done by Italian patients in dialysis centres or in hospital. High-flux haemodialysis (HFHD) is generally only done in hospital. Peritoneal dialysis (PD) is usually done at home. The cost analysis was performed on a sample of Italian dialysis centres and hospitals, according to the full cost method. As expected, HFHD was more expensive than THD and PD, but no marked differences emerged among the different HFHD modalities. THD modalities in dialysis centres were less costly than in hospitals. Automated PD (APD) was much more expensive (almost twice) than continuous ambulatory PD (CAPD), the cheapest method in absolute terms. This study confirms that dialysis is costly and that it is very difficult to assess the cost-effectiveness of the different approaches. Although this study has limits, it should provide sufficient analytical information to local healthcare managers for more rational allocation of financial resources to dialysis services.

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Composting of cow manure and rice straw with cow urine and its influence on compost quality

Journal of Vietnamese Environment ◽

10.13141/jve.vol9.no2.pp61-66 ◽

2018 ◽

Vol 9 (2) ◽

pp. 61-66 ◽

Cited By ~ 1

Author(s):

Thanh Phong Nguyen ◽

Thi Ngoc Quynh Nguyen

Keyword(s):

Rice Straw ◽

Cow Manure ◽

Compost Quality ◽

Composting Process ◽

Plastic Foil ◽

Significant Difference ◽

Cow Urine ◽

Phosphorous Content ◽

Set Up

The aim of this study was to assess the effect of composting process of cow manure and rice straw with application of cow urine and to evaluate the quality of composting products. There were two treatment piles, in which one pile was applied with cow urine every week and another pile without urine application. Each pile was set up by one tone cow manure and 500kg rice straw. The piles were half-covered by plastic foil to protect from rain and turned one a week. The composting duration lasted 8 weeks. The parameters such as temperature, pH, DM, density and nitrogen were monitored and observed during the 8-week period. The results showed that there was a significant difference in temperature, compost quality and duration between two piles with and without cow urine application. The application of cow urine increased significant nitrogen and phosphorous content and shortened the composting process. This study recommends that cow urine should be applied for composting process of cow manure and rice straw in order to increase the quality of compost. The final product was in the range of matured compost level and can be used directly for agriculture crop. Mục tiêu của nghiên cứu nhằm đánh giá ảnh hưởng đến chất lượng phân compost của việc bổ sung nước tiểu vào trong quá trình ủ phân từ nguyên liệu phân bò và rơm rạ. Thí nghiệm được thực hiện trên hai đống ủ phân, một đống ủ được bổ sung nước tiểu bò hàng tuần và một đống ủ không bổ sung nước tiểu bò như là một nghiệm thức đối chứng. Mỗi đống ủ được trộn 1 tấn phân bò và 500kg rơm. Đống ủ phân được đậy kín một nửa phía trên nhằm ngăn cản ảnh hưởng của mưa và được đảo trộn một lần mỗi tuần. Quá trình thí nghiệm được tiến hành trong 8 tuần. Các chỉ tiêu như nhiệt độ, pH, DM, mật độ và chất dinh dưỡng Nitơ và Phốt Pho được quan trắc trong thời gian ủ. Kết quả cho thấy có sự khác biệt đáng kể giữa hai đống phân ủ đối với các chỉ tiêu như nhiệt độ, chất lượng phân compost và thời gian ủ. Đống ủ phân có bổ sung nước tiểu có hàm lượng Nitơ và Phốt pho cao hơn và thời gian ủ ngắn hơn. Kết quả nghiên cứu khuyến cáo nên bổ sung nước tiểu bò cho quá trình ủ phân compost nhằm tăng hàm lượng chất dinh dưỡng cho sản phẩm phân compost. Sản phẩm sau quá trình ủ đạt mức độ phân hữu cơ và có thể sử dụng cho cây trồng.

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Reference radiologic measurements for the assessment of tibial pilon fractures

Journal of Musculoskeletal Surgery and Research ◽

10.25259/jmsr_121_2021 ◽

2022 ◽

Vol 0 ◽

pp. 1-6

Author(s):

Daniele Gianoli ◽

Alexander Joeris ◽

Christoph Sommer

Keyword(s):

Normal Weight ◽

Lateral Malleolus ◽

Radiological Parameters ◽

Tibial Pilon ◽

Large Patient ◽

Significant Difference ◽

Radiological Control ◽

Patient Groups ◽

Pilon Fractures

Objectives: The management of pilon fractures is a challenge and the outcome depends on multiple factors, one of which is the quality of reduction. In the literature, there is no assessment of anatomical reduction in pilon fractures. We also lack standard radiological parameters in large patient groups to measure the reduction. The main aim of this analysis was to define normal standard radiological values and identify potential specific types of ankle joint morphology (morphotypes) that might deserve special attention intraoperatively. Methods: We analyzed data of 103 healthy contralateral ankles collected within an observational and prospective multicenter study about tibial pilon fractures. We divided the patients according to their height into two groups, measured 11 radiological parameters, and compared them with each other and the literature. In addition, using cluster analysis, we could identify three morphotypes. Results: There is a statistically significant difference between the two groups in the lengths of three parameters: Mortise width, medial clear space, and length of the lateral malleolus, but not in the angles. The three morphotypes differ only in body mass index and the length of the lateral malleolus. Conclusion: Reference values from the literature are insufficient to assess a reduction after open reduction and internal fixation of tibial pilon fractures because they depend on the height. This does not apply to angles because they are independent of height. For clinical practice, a radiological control of the contralateral healthy ankle gives the best information about the reduction quality and should always be done, especially in normal weight males.

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State of advance care planning research: A descriptive overview of systematic reviews

Palliative & Supportive Care ◽

10.1017/s1478951518000500 ◽

2018 ◽

Vol 17 (2) ◽

pp. 234-244 ◽

Cited By ~ 5

Author(s):

Geronimo Jimenez ◽

Woan Shin Tan ◽

Amrit K. Virk ◽

Chan Kee Low ◽

Josip Car ◽

...

Keyword(s):

Advance Care Planning ◽

Systematic Reviews ◽

Care Planning ◽

Specific Patient ◽

Cochrane Reviews ◽

Overview Of Systematic Reviews ◽

Patient Groups ◽

Advance Care ◽

State Of Research

AbstractObjectiveTo provide an overview of the current state of research of advance care planning (ACP), highlighting most studied topics, publication time, quality of studies and reported outcomes, and to identify gaps to improve ACP receptivity, utilization, implementation, and outcomes.MethodCochrane methodology for conducting overviews of systematic reviews. Study quality was assessed using a modified version of the Assessing the Methodological Quality of Systematic Reviews tool. The following databases were searched from inception to April 2017: MEDLINE, EBM Reviews, Cochrane Reviews, CINAHL, Global Health, PsycINFO, and EMBASE. Searches were supplemented with gray literature and manual searches.ResultEighty systematic reviews, covering 1,662 single articles, show that ACP-related research focuses on nine main topics: (1) ACP as part of end-of-life or palliative care interventions, (2) care decision-making; (3) communication strategies; (4) factors influencing ACP implementation; (5) ACP for specific patient groups, (6) ACP effectiveness; (7) ACP experiences; (8) ACP cost; and (9) ACP outcome measures. The majority of this research was published since 2014, its quality ranges from moderate to low, and reports on documentation, concordance, preferences, and resource utilization outcomes.Significance of resultsDespite the surge of ACP research, there are major knowledge gaps about ACP initiation, timeliness, optimal content, and impact because of the low quality and fragmentation of the available evidence. Research has mostly focused on discrete aspects within ACP instead of using a holistic evaluative approach that takes into account its intricate working mechanisms, the effects of systems and contexts, and the impacts on multilevel stakeholders. Higher quality studies and innovative interventions are needed to develop effective ACP programs and address research gaps.

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Quality of life and functional outcome after single-radius and multi-radius total knee arthroplasty

Journal of Orthopaedic Surgery ◽

10.1177/2309499018792417 ◽

2018 ◽

Vol 26 (3) ◽

pp. 230949901879241 ◽

Cited By ~ 2

Author(s):

Merrill Lee ◽

Jerry Yongqiang Chen ◽

Hao Ying ◽

Pang Hee Nee ◽

Darren Keng Jin Tay ◽

...

Keyword(s):

Quality Of Life ◽

Total Knee Arthroplasty ◽

Functional Outcome ◽

Knee Arthroplasty ◽

T Test ◽

Significant Difference ◽

Patient Groups ◽

Total Knee ◽

Single Radius

Purpose: The main objective of this study was to compare quality of life and functional outcome in patients who have undergone a single-radius (SR) or multi-radius (MR) total knee arthroplasty (TKA). The secondary objective was to observe changes in knee range of movement (ROM) and standardized knee scores (KSCs) in these patients. The hypothesis was that there would be no statistically significant difference between the two patient groups in quality of life and functional outcome. Methods: One hundred three SR TKAs were performed by a single surgeon between August 2008 and December 2012. A propensity score matching algorithm was used to select 103 MR TKAs performed during the same period. Preoperative and postoperative variables such as standardized knee and quality of life scores were captured prospectively and then analyzed via both the Student’s t-test and paired t-test to look for statistically significant differences between the SR and MR patient groups. Results: At 2 years postoperatively, there was no statistically significant difference between the SR and MR patient populations in knee extension, Oxford Knee Score, Knee Society Clinical Rating Scores, and the Physical Component Summary of the Short Form 36 Health Survey (SF-36). There was a statistically significant difference between the two patient groups in postoperative knee flexion in favor of the MR design ( p = 0.011). Conclusion: While an SR femoral implant design has several theoretical biomechanical advantages, postoperative standardized KSCs and quality of life scores in this single-surgeon series do not show a clear advantage of one design over the other. Level of evidence: III.

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Automated Morphometric Analysis of the Femur on Large Anatomical Databases with Highly Accurate Correspondence Detection

Open Medicine Journal ◽

10.2174/1874220301401010015 ◽

2014 ◽

Vol 1 (1) ◽

pp. 15-22 ◽

Cited By ~ 16

Author(s):

Manuel Schröder ◽

Heiko Gottschling ◽

Nils Reimers ◽

Matthias Hauschild ◽

Rainer Burgkart

Keyword(s):

Medical Applications ◽

Detailed Knowledge ◽

Morphometric Measurements ◽

Data Set ◽

Specific Patient ◽

Novel Approach ◽

Patient Groups ◽

Ct Segmentation ◽

Correspondence Mapping

For a variety of medical applications, detailed knowledge on the statistical distribution of morphometric characteristics among specific patient groups is required. We present a novel approach for performing automated morphometric measurements on the surface of anatomical bone samples obtained from CT segmentation. The system developed supports various types of measurements (distances, angles, radii) on several kinds of features (points, lines, planes or circles), which are performed automatically for every bone sample in a given data set. The desired features can be specified by the user in two ways, either by marking them on a standardized template that is mapped to all samples via a correspondence mapping, or by hierarchically building new features from existing features. The system was implemented and tested on a database containing about 1200 segmented femur. The quality of the automated matching was assessed through a study comparing the performance of the system with results obtained from manual labeling by medical experts. It was found that the deviation between the two methods was generally less than 2mm.

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The REALISE score: a new statistically validated scoring system to assess the severity of anal fissures

Techniques in Coloproctology ◽

10.1007/s10151-021-02459-y ◽

2021 ◽

Author(s):

A. Picciariello ◽

P. Lobascio ◽

L. Spazzafumo ◽

M. Rinaldi ◽

R. Dibra ◽

...

Keyword(s):

Quality Of Life ◽

Anal Fissure ◽

Scoring System ◽

Obstructed Defecation ◽

Control Group ◽

Tertiary Centre ◽

Significant Difference ◽

Highly Correlated ◽

Set Up

Abstract Background Anal fissure (AF) is a common, painful disease that strongly affects patients’ quality of life, however, no scoring system to assess the severity of AF is available in the literature. The aim of this study was to set up and validate a reliable scoring system to quantify the severity of AF, to be used in prospective trials comparing the efficacy and the outcomes of surgical or medical treatments. Methods The study was conducted on patients with acute or chronic AF and a control group in a tertiary centre for coloproctology in June 2020–September 2020. Two researchers independently carried out a structured interviewer-led questionnaire at two different time points (T1/T2). The questionnaire consisted of five items selected according to the most commonly reported symptoms for AF: the item pain, was scored from 0 to 10 using a visual analogue scale, and quality of life, duration of pain, use of painkillers, and bleeding were scored from 1 to 5 using Likert-scale questions. The scoRing systEm for AnaL fIsSurE (REALISE) score was the sum of the points. Patients with AF and a control group of patients with haemorrhoids, anal fistula, or obstructed defecation syndrome entered the study. Main outcome measures were reliability, inter-/intraobserver agreement, and repeatability. Results One hundred and fifty well-matched patients (75 with AF and 75 controls) were enrolled. A significant difference was found between the mean REALISE score for patients with AF and controls (p < 0.001). The two REALISE scores were highly correlated (r = 0.99). The coefficient of repeatability was 1.45 in T1 and 1.18 in T2. Conclusions The REALISE score may have an important role in the assessment and management of AF, in grading the severity of AF and comparing results of different treatments.

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The effectiveness of different treatment methods in isolated telangiectasia and reticular vein treatment: A single-center prospective randomized study

Phlebology The Journal of Venous Disease ◽

10.1177/02683555211030739 ◽

2021 ◽

pp. 026835552110307

Author(s):

Ufuk Aydın ◽

Mesut Engin ◽

Tamer Türk ◽

Yusuf Ata

Keyword(s):

Medical Treatment ◽

Randomized Study ◽

Significant Difference ◽

Patient Groups ◽

Group 3 ◽

The Mean ◽

Group 2 ◽

Reticular Veins ◽

Group 1

Background There are opinions that telangiectasis and reticular veins are asymptomatic and constitute a cosmetic problem only. However, it has been proven that telangiectasis and reticular veins also affect the quality of life and are symptomatic. Methods Ninety consecutive female patients who were admitted to our outpatient clinic and did not have insufficiency in deep, superficial and perforating veins were included in this study. All participants were divided into three groups as the compression group (Group 1), medical treatment group (Group 2), and sclerotherapy group (Group 3). The initial complaint severities of all patients were noted. Except for patient compliance assessment, baseline, 1st month (T1), 3rd month (T2) and 6th month (T3) evaluation records were kept in all three groups. Results The study began with a total of 90 patients, 30 patients in each group. The mean ages of Groups 1, 2 and 3 were 39.73 ± 8.51 years, 39.30 ± 8.67 years, and 40.77 ± 9.45 years, respectively. The rates of decrease in pain, itching, restless leg, and muscle cramps were similar among the patient groups at all times (P > 0.05). The rate of reduction in swelling was similar between the groups at T1 and T2 (P > 0.05), while there was a significant difference between the groups at T3 (P = 0.009). The groups significantly differed in terms of appearance concern at all times (P = 0.002 for T1, P < 0.001 for T2 and T3). Conclusion We showed that symptoms such as swelling and heaviness in leg can be improved with medical treatment, but the patient's cosmetic satisfaction can increase with sclerotherapy.

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Onco-Cardiology: Consensus Paper of the German Cardiac Society, the German Society for Pediatric Cardiology and Congenital Heart Defects and the German Society for Hematology and Medical Oncology

Clinical Research in Cardiology ◽

10.1007/s00392-020-01636-7 ◽

2020 ◽

Vol 109 (10) ◽

pp. 1197-1222 ◽

Cited By ~ 14

Author(s):

Tienush Rassaf ◽

◽

Matthias Totzeck ◽

Johannes Backs ◽

Carsten Bokemeyer ◽

...

Keyword(s):

Side Effects ◽

Heart Defects ◽

German Society ◽

Tumour Therapy ◽

Specific Patient ◽

Treatment Groups ◽

Consensus Paper ◽

Patient Groups ◽

Therapy Strategies

Abstract The acute and long-lasting side effects of modern multimodal tumour therapy significantly impair quality of life and survival of patients afflicted with malignancies. The key components of this therapy include radiotherapy, conventional chemotherapy, immunotherapy and targeted therapies. In addition to established tumour therapy strategies, up to 30 new therapies are approved each year with only incompletely characterised side effects. This consensus paper discusses the risk factors that contribute to the development of a potentially adverse reaction to tumour therapy and, in addition, defines specific side effect profiles for different treatment groups. The focus is on novel therapeutics and recommendations for the surveillance and treatment of specific patient groups.

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