Development of a Two Port Laparoscopic Appendectomy Technique at a Rural Hospital

Background. Laparoscopic appendectomy (LA) is most commonly performed using two 5-mm and one 10/12-mm ports. Various attempts to reduce the number and size of ports have been made and new technologies such as single port LA have been introduced. Appendix and mesoappendix are usually divided with a stapler or energy device with electrocautery, clips, and endoloop being cheaper options.Patients and Methods. This study includes 51 consecutive LAs performed at a rural hospital. Patients were divided into 4 groups: group 1 was the standard technique group (n=12), group 2 served as a “try-out” (n=12), group 3 served as feasibility group (n=12), and group 4 was the final patient cohort in which the optimized technique was preferably used (n=15).Results. Median age of the study cohort was 35.4 (range: 6.2-80.6) years, and 55% of patients were male. Whereas in G1 all patients had standard port placement (10/12-mm, 2x5-mm), in an increasing number of patients in G2-4 only two 5-mm ports and the 2.3-mm Teleflex minigrasper were inserted. Usage of staplers and/or energy devices was reduced from 100% in G1 to 20% in G4, and in the majority of cases both the appendix and the vascular pedicle were secured with an endoloop. The new technique did not add time to the procedure or total OR time. No stump-leaks or surgical site infections were encountered in this series, and there were no conversions to open surgery. Cost savings when not using a stapler or energy device are approximately 400$ per case; the minigrasper added approximately 200$ to the case.Discussion. LA with use of two ports and a portless needle grasper is feasible in the majority of cases and was associated with high patient satisfaction and excellent cosmetic results. Avoiding energy devices and staplers is cost saving; the endoloop securely controls appendix and mesoappendix.

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ACADEMIA’S ROLE TO DRIVE CHANGE IN THE ORTHOTICS AND PROSTHETICS PROFESSION

Canadian Prosthetics & Orthotics Journal ◽

10.33137/cpoj.v4i2.36673 ◽

2021 ◽

Vol 4 (2) ◽

Author(s):

Géza Kogler ◽

Christopher Hovorka

Keyword(s):

Technology Use ◽

Clinical Training ◽

Clinical Decision Making ◽

New Technologies ◽

Clinical Care ◽

Clinical Decision ◽

The United States ◽

Academic Program ◽

Number Of Patients ◽

Curricular Emphasis

This position paper outlines the important role of academia in shaping the orthotics and prosthetics (O&P) profession and preparing for its future. In the United States, most healthcare professions including O&P are under intense pressure to provide cost effective treatments and quantifiable health outcomes. Pivotal changes are needed in the way O&P services are provided to remain competitive. This will require the integration of new technologies and data driven processes that have the potential to streamline workflows, reduce errors and inform new methods of clinical care and device manufacturing. Academia can lead this change, starting with a restructuring in academic program curricula that will enable the next generation of professionals to cope with multiple demands such as the provision of services for an increasing number of patients by a relatively small workforce of certified practitioners delivering these services at a reduced cost, with the expectation of significant, meaningful, and measurable value. Key curricular changes will require replacing traditional labor-intensive and inefficient fabrication methods with the integration of newer technologies (i.e., digital shape capture, digital modeling/rectification and additive manufacturing). Improving manufacturing efficiencies will allow greater curricular emphasis on clinical training and education – an area that has traditionally been underemphasized. Providing more curricular emphasis on holistic patient care approaches that utilize systematic and evidence-based methods in patient assessment, treatment planning, dosage of O&P technology use, and measurement of patient outcomes is imminent. Strengthening O&P professionals’ clinical decision-making skills and decreasing labor-intensive technical fabrication aspects of the curriculum will be critical in moving toward a digital and technology-centric practice model that will enable future practitioners to adapt and survive. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/36673/28349 How To Cite: Kogler GF, Hovorka CF. Academia’s role to drive change in the orthotics and prosthetics profession. Canadian Prosthetics & Orthotics Journal. 2021; Volume 4, Issue 2, No.21. https://doi.org/10.33137/cpoj.v4i2.36673 Corresponding Author: Géza F. KoglerOrthotics and Prosthetics Unit, Kennesaw State University.E-Mail: [email protected] ID: https://orcid.org/0000-0003-0212-5520

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Extending the “Reach” of the Short-Scar Facelift with Energy Devices—An Early Report

Facial Plastic Surgery ◽

10.1055/s-0041-1724102 ◽

2021 ◽

Vol 37 (02) ◽

pp. 259-266

Author(s):

Fred G. Fedok

Keyword(s):

New Technologies ◽

Early Report ◽

Subcutaneous Fat ◽

Facial Rejuvenation ◽

Skin Tightening ◽

Energy Devices ◽

Age Related ◽

Facial Attributes ◽

Facial Changes ◽

Short Scar

AbstractFacial rejuvenation has become more popular. A wider breadth of the patient population is seeking procedures to preserve their youthful facial attributes and to remedy age-related deleterious changes. Along with this increasing interest in facial rejuvenation is also the expressed desire for any interventions to be relatively low risk, with limited recovery, and with achievable positive results. Many new technologies have become available in an attempt to improve age-related facial changes. The radiofrequency (RF)-based technologies are largely directed toward skin tightening and toward reducing and remodeling subcutaneous fat. It can be contemplated that the combination of RF-based technology with limited surgical procedures may extend the patient selection for less invasive procedures while improving potential results. This is a report of the combination of radiofrequency technologies—percutaneous and transcutaneous—with short scar face techniques in facial rejuvenation.

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Early Transient Hypoglycemia and Test Performance in At-Risk Newborns

American Journal of Perinatology ◽

10.1055/s-0041-1732380 ◽

2021 ◽

Author(s):

Nahed O. ElHassan ◽

Eric W. Schaefer ◽

Basilia Gonzalez ◽

Thomas Nienaber ◽

Luc P. Brion ◽

...

Keyword(s):

Risk Factors ◽

At Risk ◽

Academic Performance ◽

Glucose Concentration ◽

Achievement Tests ◽

Large For Gestational Age ◽

Study Cohort ◽

Perinatal Factors ◽

Number Of Patients ◽

The Impact

Objective This study aimed to evaluate if early (within the first 3 hours after birth) transient neonatal hypoglycemia (TNH) is associated with poor academic performance in infants at-risk for hypoglycemia. Study Design This was a retrospective cohort study of at risk-infants (late preterm infants, small and large for gestational age infants, and infants of diabetic mothers [IDMs]) who were born in 1998 and 1999 at the University of Arkansas for Medical Sciences and had ≥1 recorded glucose concentration. The outcome measure was proficiency on 4th grade literacy and mathematics achievement tests. Three glucose concentration cutoffs for defining hypoglycemia (<35, <40, and <45 mg/dL) were investigated. Logistic regression models were developed to examine the association between early TNH and achievement test proficiency based on perinatal factors. Results Among 726 infants, 472 had one, 233 had two, and 21 had three risk factor(s). Early TNH (glucose concentration <35, <40, and <45 mg/dL) was observed in 6.3, 11.6, and 20.5% of the study cohort, respectively. Irrespective of the cutoff used, the frequency of early TNH (number of patients with early TNH in a risk category divided by the total number of patients in that category) was significantly greater among infants with multiple risk factors. After controlling for perinatal factors, early TNH (cutoffs <35 and <40 mg/dL) was significantly associated with decreased probability of proficiency in literacy but not mathematics. Despite that early TNH was more common in IDMs and infants with three risk factors, the category or number of risk factors did not impact academic proficiency. Conclusion Early TNH (<35 and <40 mg/dL) was associated with lower adjusted probability of proficiency on 4th grade literacy achievement tests in at-risk infants. The impact of early TNH on academic performance was similar irrespective of category or number of risk factors. Key Points

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KNOWLEDGE ON PREVENTION OF SURGICAL SITE INFECTION AMONG MEDICAL STAFF IN SON TAY GENERAL HOSPITAL, 2021

Tạp chí Y học Cộng đồng ◽

10.52163/jcm.v62i5.139 ◽

2021 ◽

Vol 62 (5) ◽

Author(s):

Tran Quynh Anh ◽

Bui Van Tung ◽

Nguyen Tuan Tai ◽

Chu Van Thang ◽

Dang Duc Hoan ◽

...

Keyword(s):

Surgical Site Infection ◽

General Hospital ◽

Medical Staff ◽

Surgical Site Infections ◽

Cross Sectional Study ◽

Site Infection ◽

Cross Sectional ◽

Ongoing Training ◽

Number Of Patients ◽

Objective Description

Objective: Description of knowledge on prevention of surgical site infections (SSIs) among medical staff in Son Tay general hospital, 2021 and some related factors.Method: A cross-sectional study was conducted on 151 medical staff.Results: The rate of medical staff with fully knowledge of SSI prevention is 36.42%, in which the rate of doctors is 38.3% and of nurses is 35.58%. Age group ≥30 (OR=2.82; 95%CI: 1.12 – 7.13);Department of Surgery (OR=13.61; 95%CI: 5.14 – 35.98); working year ≥10 (OR=2.54; 95%CI: 1.26 – 5.11) and number of patients cared for/day <8 (OR=3.43; 95%CI: 1.26 – 9 ,34) are factorsrelated to the knowledge of medical staff about regarding SSIs.Conclusion: The medical staff’s knowledge of surgical site infection prevention is suboptimal; relevant factors should be considered when conducting ongoing training in the prevention of surgical site infections in hospitals.

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Laparoscopic Resection of Advanced Colorectal Cancer in a Patient with Lumboperitoneal Shunt

Case Reports in Surgery ◽

10.1155/2018/6826079 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4

Author(s):

Toru Imagami ◽

Satoru Takayama ◽

Yohei Maeda ◽

Ryohei Matsui ◽

Masaki Sakamoto ◽

...

Keyword(s):

Laparoscopic Surgery ◽

Colorectal Resection ◽

Laparoscopic Resection ◽

Advanced Colorectal Cancer ◽

Surgical Site Infections ◽

Right Hemicolectomy ◽

Csf Shunt ◽

Negative Effects ◽

Number Of Patients ◽

Laparoscopic Right Hemicolectomy

A 78-year-old woman with lumboperitoneal (LP) shunt was diagnosed with advanced cancer of the ascending colon. Laparoscopic right hemicolectomy was performed without manipulating the catheter. The patient’s postoperative course was uneventful, with no shunt-related complications or neurological deficit. The number of patients with cerebrospinal fluid (CSF) shunt who require abdominal surgery has been increasing. There are only few studies on laparoscopic surgery for patients with LP shunt, and the safety of pneumoperitoneum in the CSF shunt remains controversial. Consistent with other studies, we considered that pneumoperitoneum with a pressure of 10 mmHg has few negative effects. Our recommendations are as follows: (1) during colorectal resection, laparoscopic surgery can be performed without routine manipulation of the shunt catheter; (2) altering the location of the port is necessary to prevent both damage to the shunt tube during surgery and wound infection postoperatively; and (3) laparoscopic surgery is superior to laparotomy because it is associated with reduced surgical site infections and postoperative adhesions. However, laparoscopy should be performed at least 3 months after the construction of CSF shunt.

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Outcome after conservatively managed intracapsular fractures of the femoral neck

Annals of The Royal College of Surgeons of England ◽

10.1308/003588415x14181254788809 ◽

2015 ◽

Vol 97 (4) ◽

pp. 279-282 ◽

Cited By ~ 12

Author(s):

LS Moulton ◽

NL Green ◽

T Sudahar ◽

NK Makwana ◽

JP Whittaker

Keyword(s):

Hip Fracture ◽

Femoral Neck ◽

Mortality Data ◽

Study Cohort ◽

Infection Pressure ◽

Number Of Patients ◽

Admission Status ◽

American Society ◽

One Year ◽

The Uk

Introduction In 2012, 2.6% of hip-fracture patients in the UK were treated conservatively. There is little data on outcome for these patients. However, one study demonstrated that though 30-day mortality is higher, mortality over the rest of the year is comparable with that in surgical groups. Therefore, we assessed conservatively managed patients in our unit. Methods Patients with intracapsular fractures of the femoral neck treated by conservative means between 2010 and 2012 inclusive were identified. Data were collected: American Society of Anaesthesiologists (ASA) grade, Nottingham Hip Fracture Score (NHFS), mobility, mortality (30 days and one year) and pain levels. Results Thirty-two patients formed the study cohort. Mean age was 85.6 years. Median ASA grade was 4. Mortality at 30 days and one year was 31.3% and 56.3%, respectively. There was one case of pneumonia and one of infection. Pressure sores or venous thromboembolism were not documented. Three patients underwent surgery once their health improved. In general, mobility was decreased, but 30.8% of patients could mobilise with two aids or a frame. Only two cases had ongoing problems with pain. Conclusions Our data are similar to those published previously. Our patients were likely to have higher mortality data due to selection bias. Thirty-day mortality was significantly higher than the national average, but patients surviving 30 days had a prevalence of mortality similar to those managed by surgical means. Despite mobility decreasing from the pre-admission status, a considerable number of patients were free of pain and could mobilise. These data suggest that conservative management of intracapsular fractures of the femoral neck can produce acceptable results.

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2025 Nuclear Code: The Vision for the Future of ASME Nuclear Codes and Standards

Volume 1B: Codes and Standards ◽

10.1115/pvp2018-84031 ◽

2018 ◽

Author(s):

Dale E. Matthews ◽

Ralph S. Hill ◽

Charles W. Bruny

Keyword(s):

Nuclear Power ◽

Power Plants ◽

New Technologies ◽

Fusion Energy ◽

Life Cycle Management ◽

Economic Benefits ◽

Plant Design ◽

Element Analysis ◽

Energy Devices ◽

The Future

ASME Nuclear Codes and Standards are used worldwide in the construction, inspection, and repair of commercial nuclear power plants. As the industry looks to the future of nuclear power and some of the new plant designs under development, there will be some significant departures from the current light water reactor (LWR) technology. Some examples are gas-cooled and liquid metal-cooled high temperature reactors (HTRs), small modular reactors (SMRs), and fusion energy devices that are currently under development. Many of these designs will have different safety challenges from the current LWR fleet. Variations of the current LWR technology are also expected to remain in use for the foreseeable future. Worldwide, many LWRs are planned or are already under construction. However, technology for construction of these plants has advanced considerably since most of the current construction codes were written. As a result, many modern design and fabrication methods available today, which provide both safety and economic benefits, cannot be fully utilized since they are not addressed by Code rules. For ASME Nuclear Codes and Standards to maintain and enhance their position as the worldwide leader in the nuclear power industry, they will need to be modernized to address these items. Accordingly, the ASME Nuclear Codes and Standards organizations have initiated the “2025 Nuclear Code” initiative. The purpose of this initiative is to modernize all aspects of ASME’s Nuclear Codes and Standards to adopt new technologies in plant design, construction, and life cycle management. Examples include modernized finite element analysis and fatigue rules, and incorporation of probabilistic and risk-informed methodology. This paper will present the vision for the 2025 ASME Nuclear Codes and Standards and will discuss some of the key elements that are being considered.

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Stretchable/flexible silver nanowire electrodes for energy device applications

Nanoscale ◽

10.1039/c9nr04193a ◽

2019 ◽

Vol 11 (43) ◽

pp. 20356-20378 ◽

Cited By ~ 19

Author(s):

Jinwook Jung ◽

Hyunmin Cho ◽

Recep Yuksel ◽

Dongkwan Kim ◽

Habeom Lee ◽

...

Keyword(s):

Silver Nanowires ◽

Silver Nanowire ◽

Energy Device ◽

Energy Devices ◽

Device Applications

This review focuses on the silver nanowires (Ag NWs) based stretchable and flexible energy devices for self-sustainable devices.

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Novel Cardiac-Specific Biomarkers and the Cardiovascular Continuum

Biomarker Insights ◽

10.4137/bmi.s9536 ◽

2012 ◽

Vol 7 ◽

pp. BMI.S9536 ◽

Cited By ~ 23

Author(s):

Efstathios Vassiliadis ◽

Natasha Barascuk ◽

Athanasios Didangelos ◽

Morten A Karsdal

Keyword(s):

Cardiovascular Disease ◽

Biochemical Markers ◽

New Technologies ◽

Troponin I ◽

Tissue Remodelling ◽

Holistic View ◽

Tissue Specific ◽

Number Of Patients ◽

Cardiovascular Continuum

The concept of the cardiovascular continuum, introduced during the early 1990s, created a holistic view of the chain of events connecting cardiovascular-related risk factors with the progressive development of pathological-related tissue remodelling and ultimately, heart failure and death. Understanding of the tissue-specific changes, and new technologies developed over the last 25–30 years, enabled tissue remodelling events to be monitored in vivo and cardiovascular disease to be diagnosed more reliably than before. The tangible product of this evolution was the introduction of a number of biochemical markers such as troponin I and T, which are now commonly used in clinics to measure myocardial damage. However, biomarkers that can detect specific earlier stages of the cardiovascular continuum have yet to be generated and utilised. The majority of the existing markers are useful only in the end stages of the disease where few successful intervention options exist. Since a large number of patients experience a transient underlying developing pathology long before the signs or symptoms of cardiovascular disease become apparent, the requirement for new markers that can describe the early tissue-specific, matrix remodelling process which ultimately leads to disease is evident. This review highlights the importance of relating cardiac biochemical markers with specific time points along the cardiovascular continuum, especially during the early transient phase of pathology progression where none of the existing markers aid diagnosis.

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