Applying the Exoscope to Lacrimal Surgery: Preliminary Experience

ORL ◽  
2021 ◽  
pp. 1-6
Author(s):  
Francesca Pirola ◽  
Armando De Virgilio ◽  
Alessandra Di Maria ◽  
Elena Russo ◽  
Matteo Di Bari ◽  
...  
Keyword(s):  
New Technology ◽  
Surgical Team ◽  
Scrub Nurse ◽  
Team Members ◽  
Ethical Committee Approval ◽  
Secondary Endpoints ◽  
Surgical Field

Purpose: The aim of the study was to investigate the role of the exoscope as an assisting tool in endoscopic dacryocystorhinostomy (e-DCR). Materials and Methods: In this observational retrospective study, the application of the VITOM® exoscope was studied in a group of 21 patients undergoing mono- or bilateral DCR. The primary endpoint was to evaluate resolution of symptoms (epiphora/dacryocystitis) at the 6-month follow-up and time for surgery. Qualitative features of the exoscope (intraoperative view of the surgical field) and comparison with the typical setting for DCR were analyzed as secondary endpoints. A questionnaire was administered to surgical team members (ENT surgeon, ophthalmologist, and scrub nurse) to evaluate the perceived quality of this new technology (12 items valued as “good” = 2, “acceptable” = 1, and “not acceptable” = 0). A questionnaire score of 24 out of 24 was valued as “completely approved,” score 20–23 as “moderately approved,” and score ≤19 as “weakly approved.” Patients were divided into 3 consecutive groups, and questionnaire scores by each team member were analyzed for tendencies. Statistical analysis was performed to test significance at p < 0.05. Local Ethical Committee approval was obtained. Results: No significant differences were found between exoscope-set DCR and classic setting for concerned patient outcomes (failure rate: 3.2 vs. 3.8%, respectively, p = 0.896) and mean time for surgery (20’ vs. 23’, respectively, p = 0.091). The exoscope was valued by surgical team members as “completely approved” in 55.5% of cases, “moderately approved” in 39.7%, and “weakly approved” in 4.8%. Questionnaire scores by the ENT, ophthalmologist, and scrub nurse showed an average increase in the 3 consecutive groups (p = 0.119, p = 0.024, and p < 0.001, respectively). Conclusions: The exoscope is a new tool that may support e-DCR. It has no effects on symptom outcomes (epiphora/dacryocystitis) and time for surgery compared to classic DCR. Based on self-perception, this new technology was accepted by all team members.

Can Innovative Technologies Overcome HbA1c Disparity for African-American Youth with Type 1 Diabetes?

2021 ◽  
pp. 193229682110213
Author(s):  
Stuart Chalew ◽  
Alan M. Delamater ◽  
Sonja Washington ◽  
Jayalakshmi Bhat ◽  
Diane Franz ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Racial Disparity ◽  
Diabetes Management ◽  
New Technology ◽  
African American Youth ◽  
Glucose Monitoring ◽  
Supportive Role

Achieving normal or near-normal glycemic control as reflected by HbA1c levels in patients with type 1 diabetes (T1D) is important for preventing the development and progression of chronic complications. Despite delineation and dissemination of HbA1c management targets and advances in insulin pharmacology, insulin delivery systems, and glucose monitoring, the majority of children with T1D do not achieve HbA1c goals. In particular, African Americans are more likely not to reach HbA1c goals and have persistently higher HbA1c than Non-Hispanic Whites. Availability of pumps and other technology has not eliminated the disparity in HbA1c. Multiple factors play a role in the persisting racial disparity in HbA1c outcome. The carefully designed application and deployment of new technology to help the patient/family and facilitate the supportive role of the diabetes management team may be able to overcome racial disparity in glycemic outcome and improve patient quality of life.

The Heartguard: A Humanitarian Pediatric Cardiac Surgery Program in Rural China

2021 ◽  
Author(s):  
Xun E. Zhang ◽  
Zhi Geng ◽  
Jun Shao ◽  
Hao Yao ◽  
Lu Wang ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Endovascular Procedures ◽  
Rural China ◽  
Surgical Team ◽  
Physical And Mental Health ◽  
Team Members ◽  
Financial Difficulties ◽  
The Government ◽  
Receive Treatment

Abstract Background Congenital heart disease (CHD) accounts for the most common birth defects in China, pressuring both the physical and mental health in children. The inaccessibility of CHD children in rural China due to financial difficulties is demanding inputs from both the government and society. The Heartguard project is a program developed to improve the delivery of CHD care in rural China. Methods The Heartguard project partners with county hospitals and performs CHD screening to diagnose patients with CHD in rural China. Diagnosed children with CHD who are unable to afford therapy will subsequently receive treatment sponsored by the financial partners. All patients are followed up by the local partner and visiting surgical team members. Results More than 10,000 children across 9 provinces underwent CHD screening. A total of 240 (accounting for an incidence of 2.4%) was treated by the program, of which 226 patients were managed invasively, the other 14 patients conservatively. Open surgery was performed in 162 patients, while endovascular procedures were applied in another 64. No mortality or significant complications occurred during the transfer. There was no perioperative or late death. Conclusion This humanitarian cardiac surgery program is able to promote accessibility of care for CHD children in rural China. The quality of life of these patients can be improved with continuous input from the society.

scholarly journals Impact of Surgical Table Orientation on Flow Disruptions and Movement Patterns during Pediatric Outpatient Surgeries

2021 ◽  
Vol 18 (15) ◽  
pp. 8114
Author(s):  
Anjali Joseph ◽  
David Neyens ◽  
Sahar Mihandoust ◽  
Kevin Taaffe ◽  
David Allison ◽  
...  
Keyword(s):  
Ambulatory Surgery ◽  
Surgical Team ◽  
Scrub Nurse ◽  
Work Zones ◽  
Convenience Sample ◽  
Operational Strategies ◽  
Team Members ◽  
Video Recordings ◽  
Safety Risks ◽  
Flow Disruptions

(1) Background: The surgical table within a typical ambulatory surgery operating room is frequently rotated and placed in different orientations to facilitate surgery or in response to surgeon preferences. However, different surgical table orientations can impact access to different work zones, areas and equipment in the OR, potentially impacting workflow of surgical team members and creating patient safety risks; (2) Methods: This quantitative observational study used a convenience sample of 38 video recordings of the intraoperative phase of pediatric outpatient surgeries to study the impacts of surgical table orientation on flow disruptions (FDs), number of contacts between team members and distance traveled; (3) Results: This study found that the orientation of the surgical table significantly influenced staff workflow and movement in the OR with an angled surgical table orientation being least disruptive to surgical work. The anesthesia provider, scrub nurse and circulating nurse experienced more FDs compared to the surgeon; (4) Conclusions: The orientation of the surgical table matters, and clinicians and architects must consider different design and operational strategies to support optimal table orientation in the OR.

scholarly journals Immune Checkpoints Expression in Chronic Lung Allograft Rejection

2021 ◽  
Vol 12 ◽  
Author(s):  
Ilaria Righi ◽  
Valentina Vaira ◽  
Letizia Corinna Morlacchi ◽  
Giorgio Alberto Croci ◽  
Valeria Rossetti ◽  
...  
Keyword(s):  
T Lymphocytes ◽  
Bronchiolitis Obliterans Syndrome ◽  
Immune Checkpoints ◽  
Hla Antibodies ◽  
Restrictive Allograft Syndrome ◽  
And Function ◽  
Shed Light

Chronic lung allograft dysfunction (CLAD) is the main cause of poor survival and low quality of life of lung transplanted patients. Several studies have addressed the role of dendritic cells, macrophages, T cells, donor specific as well as anti-HLA antibodies, and interleukins in CLAD, but the expression and function of immune checkpoint molecules has not yet been analyzed, especially in the two CLAD subtypes: BOS (bronchiolitis obliterans syndrome) and RAS (restrictive allograft syndrome). To shed light on this topic, we conducted an observational study on eight consecutive grafts explanted from patients who received lung re-transplantation for CLAD. The expression of a panel of immune molecules (PD1/CD279, PDL1/CD274, CTLA4/CD152, CD4, CD8, hFoxp3, TIGIT, TOX, B-Cell-Specific Activator Protein) was analyzed by immunohistochemistry in these grafts and in six control lungs. Results showed that RAS compared to BOS grafts were characterized by 1) the inversion of the CD4/CD8 ratio; 2) a higher percentage of T lymphocytes expressing the PD-1, PD-L1, and CTLA4 checkpoint molecules; and 3) a significant reduction of exhausted PD-1-expressing T lymphocytes (PD-1pos/TOXpos) and of exhausted Treg (PD-1pos/FOXP3pos) T lymphocytes. Results herein, although being based on a limited number of cases, suggest a role for checkpoint molecules in the development of graft rejection and offer a possible immunological explanation for the worst prognosis of RAS. Our data, which will need to be validated in ampler cohorts of patients, raise the possibility that the evaluation of immune checkpoints during follow-up offers a prognostic advantage in monitoring the onset of rejection, and suggest that the use of compounds that modulate the function of checkpoint molecules could be evaluated in the management of chronic rejection in LTx patients.

scholarly journals Peran Supervisi Kepala Madrasah dalam Meningkatkan Mutu Pendidikan di MTs Negeri Kulon Progo

2020 ◽  
Vol 4 (2) ◽  
pp. 211-220
Author(s):  
Legiman
Keyword(s):  
Quality Improvement ◽  
Learning Objectives ◽  
Learning Activities ◽  
Quality Of Education ◽  
Factors Affecting ◽  
Qualitative Descriptive ◽  
Education Personnel

This research aims to determine the role of the head of Madrasah in improving the quality of education in MTs Negeri 4 Kulon Progo, and to help improve the competency of teachers in the learning activities with a real, measurable, controlled, directional program to achieve learning objectives. This research uses qualitative descriptive methods with data collection through observation, interviews and documentation. The results of this research are: 1) supervision of the head of the district of the state of the principal of the school 4 Kulon Progo includes education, managerial, administrator, supervisor, leader, innovator, and motivator; 2) The role of quality improvement is done by increasing the professionalism of teachers by giving opportunities to teachers; 3) Factors affecting the implementation of the head of the Madrasah include: the planning, implementation and follow-up that is carried out continuously to the teachers and education personnel.

scholarly journals Understanding coaching efficacy in education through activity systems: privileging the nuances of provision

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Rachel M. Lofthouse ◽  
Anthea Rose ◽  
Ruth Whiteside
Keyword(s):  
Activity Systems ◽  
Content Type ◽  
Coaching Efficacy ◽  
Range Of Functions ◽  
Cultural Historical Activity ◽  
The Individual ◽  
Specific Challenge

PurposeThe research demonstrates the role of activity systems based in Cultural Historical Activity Theory as a means of analysing characteristics and efficacy of specific provisions of coaching in education.Design/methodology/approachThree examples of coaching in education were selected, involving 51 schools in England. The three examples were re-analysed using activity systems. This drew on existing evaluation evidence, gathered through interviews, questionnaires, focus groups and recordings of coaching.FindingsIn each example, the object of the coaching was to address a specific challenge to secure the desired quality of education. Using activity systems it is possible to demonstrate that coaching has a range of functions (both intended and consequential). The individual examples illustrate the potential of coaching to support change in complex and diverse education settings.Research limitations/implicationsThe use of existing data from evaluations means that direct comparisons between examples are not made. While data were collected throughout the duration of each coaching programme no follow-up data was available.Practical implicationsThe analysis of the examples of coaching using activity systems provides evidence of the efficacy of specific coaching provision in achieving individually defined objectives related to sustaining and improving specific educational practices.Originality/valueThe research offers insights into how coaching in education might be better tuned to the specific needs of contexts and the challenges experienced by the individuals working in them. In addition, it demonstrates the value of activity systems as an analytical tool to make sense of coaching efficacy.

Glioma patient-reported outcomes: patients and clinicians

2021 ◽  
pp. bmjspcare-2020-002699
Author(s):  
Marthe Peeters ◽  
Germaine Ottenheijm ◽  
Paul Bienfait ◽  
Daniëlle Eekers ◽  
Anja Gijtenbeek ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Patient Reported Outcomes ◽  
Successful Implementation ◽  
Nurse Specialist ◽  
Patient Reported ◽  
Semistructured Interviews ◽  
Routine Assessment

IntroductionRoutine assessment of patient-reported outcomes (PROs) in oncology has shown to improve the quality of the delivered care and to prolong survival. However, for successful implementation of routine assessment of PROs, more knowledge on their usability in clinical practice is needed.ObjectiveThis study aimed to cross-sectionally assess the perspective of patients and clinicians on the practicality of routinely measuring PROs in clinical practice for glioma patients.MethodsSemistructured interviews were conducted evaluating the role of healthcare professionals (HCP) in discussing results of PRO measures (PROMs), and the preferred topics, methods and frequency of PRO assessment. Glioma patients, their proxies and HCPs involved in the treatment of glioma patients from eight centres in the Netherlands were included.ResultsTwenty-four patients, 16 proxies and 35 HCPs were interviewed. The majority of patients, proxies and HCPs (92%, 81% and 80%, respectively) were willing to discuss PRO results during consultations. Although HCPs prefer that results are discussed with the nurse specialist, only one-third of patients/proxies agreed. Functioning of daily life was considered important in all three groups. Most participants indicated that discussion of PROM results should take place during standard follow-up visits, and completed at home about 1 week in advance. On group level, there was no preference for administration of questionnaires on paper or digitally. Lastly, all centres had staff available to send questionnaires on paper.ConclusionThis study shows that routine assessment of PROs is desired by patients, proxies and HCP’s in neuro-oncological care in Dutch hospitals.

Exploring the scope of homoeopathy in combating the unfortunate consequences of post-COVID-19 survivors based on non-COVID conditions: a narrative review

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Ashish Kumar Dixit ◽  
Nibha Giri ◽  
Shishir Singh
Keyword(s):  
Chronic Fatigue ◽  
Cardiac Insufficiency ◽  
Medical Database ◽  
Fatigue Syndrome ◽  
Tract Infections ◽  
The Impact

Abstract Objectives The long-term consequences of COVID-19 survivors care and post-coronavirus infection are not yet well understood. The review aims to see whether homoeopathy can help COVID-19 survivors recover from its consequences and improve their quality of life. Content A systematic search of published articles for post-COVID sequelae and the impact of Homoeopathy were conducted. For the literature search, the major electronic bio-medical database PubMed/MEDLINE was used. In addition, supplementary searches were conducted through the references of those published articles. Summary A total of 113 records were identified of which 61 studies included for this review. Homoeopathy is effective in the treatment of mental disorders including anxiety and depressive disorder (ADD), some research studies have found, although systematic reviews disagree. Likewise, some medical societies denounce homoeopathy for pain management; other literature shows that it can be used to treat pain effectively. Homoeopathy can aid in the treatment of cardiovascular diseases, as Crataegus, a homoeopathic medication, was found to be just as effective as a standard angiotensin-converting enzyme (ACE) inhibitor and diuretic treatment for minor cardiac insufficiency. The outcomes for Chronic Fatigue Syndrome (CFS), Influenza, and Acute Respiratory Tract Infections (ARTIs) are also promising. Outlook Based on the results of homoeopathy in non-COVID conditions, it can be thought of in the management of post-COVID-19 outcomes. Consequently, we propose that while investigating post-COVID-19 patient rehabilitation, homoeopathic management may be included as part of the follow-up route and as much data as possible in the context of homoeopathy should be collected, so that in future, the role of homoeopathy in dealing with it can be better demonstrated.

Nursing in Integrative Medicine and Nurses’ Engagement in Caring-Healing

2012 ◽  
pp. 235-239
Author(s):  
Chiyoko Inomata ◽  
Shin’ichi Nitta
Keyword(s):  
Music Therapy ◽  
Neurodegenerative Diseases ◽  
Integrative Medicine ◽  
Collaborative Work ◽  
Care Providers ◽  
Team Members ◽  
Healing Environment ◽  
Therapy Sessions

In 2008, the authors’ team started an ongoing project to administer music therapy sessions for patients with neurodegenerative diseases. Studies were made conducted from the “caring” perspective to evaluate the effects of music therapy on the mental health of the patients (Inomata, 2008a, Inomata 2008b) and on the role of nurses in integrative medicine (Inomata, 2008c). On the basis of the findings from these studies, music therapy programs were designed and conducted to meet the different needs of various neurodegenerative diseases. This project was the first ever reported music therapy initiative undertaken as a multi-disciplinary collaborative work and in partnership with a patients’ group (Saji, 2010). The findings from four years of running the project are summarized as follows: (1) Music therapy helped maintain/improve the QOL(Quality of Life) level of neurodegenerative disease patients, which would otherwise deteriorate with the progress of symptoms; (2) There was an improvement in the patients’ psychological and spiritual health as exemplified by the expansion of consciousness and rebuilding of relationships; (3) The project increased the feeling of partnership among the multi-disciplinary team members; (4) Care providers shared values such as self-belief and respect for both the self and others; (5) Caring for patients’ emotional side by being compassionate and staying with them and/or listening to them resulted in a stronger care provider-patient bond; (6) Nurses were engaged in the building a healing environment as “healers,” and the patients found more hope in everyday life.

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