Trainee satisfaction in higher speciality urology training: Can we mitigate a workforce crisis?

2020 ◽  
pp. 205141582094592
Author(s):  
Tharani Mahesan ◽  
Lucy Drummond ◽  
Muddassar Hussain
Keyword(s):  
Operating Time ◽  
Common Reason ◽  
British Association ◽  
Number Of Factors ◽  
Speciality Training ◽  
Mixed Feelings ◽  
Workforce Retention ◽  
Financial Challenges ◽  
Trainee Satisfaction

Background: Over 4 years urology as a speciality has seen a 49% increase in unfilled consultant posts and long term the British Association of Urological Surgeons is predicting a shortage of up to 149 consultants over a 12-year period. Striving to keep trainees within the NHS workforce is one way of minimising those figures. We aimed to examine the challenges to workforce retention in urology higher speciality training. Methods: A 10-item survey was designed and piloted, examining the attitudes and intentions of higher speciality trainees towards their training. Results: Forty-nine higher speciality trainees completed the survey, 29 men (59%), 20 women (41%). Twenty-two (45%) were ST4 or below; 24 (49%) had considered leaving urology training, with 31 of 49 trainees (63%) citing burnout as the most common reason for this. Concerns about a shortage of colleagues and financial challenges were the second and third most common reasons. Thirty-four (69%) respondents would still apply for urology higher speciality training if they had to make the decision again. Colleagues, operating time and the ability to make an impact were all cited as enjoyable factors. Discussion: The findings of this survey clearly demonstrate mixed feelings towards urology higher training. However, the majority of trainees would still pick the speciality again, and when asked trainees were able to select a number of factors which they enjoyed. Conclusion: A workforce crisis affects everyone. While the situation may be unavoidable, we must take this opportunity to limit its impact.

Role of Closed Mitral Commissurotomy for Mitral Stenosis: Mid- and Long-term Surgical Outcome of 36 Patients

2005 ◽  
Vol 8 (1) ◽  
pp. 55 ◽  
Author(s):  
Azman Ates ◽  
Yahya �nl� ◽  
Ibrahim Yekeler ◽  
Bilgehan Erkut ◽  
Yavuz Balci ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Stenosis ◽  
Operating Time ◽  
Term Survival ◽  
Long Term Outcome ◽  
Mitral Commissurotomy ◽  
Closed Mitral Commissurotomy

Purpose: To evaluate long-term survival and valve-related complications as well as prognostic factors for mid- and long-term outcome after closed mitral commissurotomy, covering a follow-up period of 14 years. Material and Methods: Between 1989 and 2003, 36 patients (28 women and 8 men, mean age 28.8 6.1 years) underwent closed mitral commissurotomy at our institution. The majority of patients were in New York Heart Association (NYHA) functional class IIB, III, or IV. Indication for closed mitral commissurotomy was mitral stenosis. Closed mitral commissurotomy was undertaken with a Tubbs dilator in all cases. Median operating time was 2.5 hours 30 minutes. Results: After closed mitral commissurotomy, the mitral valve areas of these patients were increased substantially, from 0.9 to 2.11 cm2. No further operation after initial closed mitral commissurotomy was required in 86% of the patients (n = 31), and NYHA functional classification was improved in 94% (n = 34). Postoperative complications and operative mortality were not seen. Follow-up revealed restenosis in 8.5% (n = 3) of the patients, minimal mitral regurgitation in 22.2% (n = 8), and grade 3 mitral regurgitation in 5.5% (n = 2) patients. No early mortality occurred in closed mitral commissurotomy patients. Reoperation was essential for 5 patients following closed mitral commissurotomy; 2 procedures were open mitral commissurotomies and 3 were mitral valve replacements. No mortality occurred in these patients. Conclusions: The mitral valve area was significantly increased and the mean mitral valve gradient was reduced in patients after closed mitral commissurotomy. Closed mitral commissurotomy is a safe alternative to open mitral commissurotomy and balloon mitral commissurotomy in selected patients.

Past testate amoeba communities in landslide mountain fens (Polish Carpathians): The relationship between shell types and sediment

The Holocene ◽  
2021 ◽  
pp. 095968362199464
Author(s):  
Katarzyna Marcisz ◽  
Krzysztof Buczek ◽  
Mariusz Gałka ◽  
Włodzimierz Margielewski ◽  
Matthieu Mulot ◽  
...  
Keyword(s):  
Environmental Changes ◽  
Testate Amoebae ◽  
Mineral Matter ◽  
Testate Amoeba ◽  
Run Off ◽  
Number Of Factors ◽  
Depth To Water Table ◽  
Polish Carpathians ◽  
The Relationship

Landslide mountain fens formed in landslide depressions are dynamic environments as their development is disturbed by a number of factors, for example, landslides, slopewash, and surface run-off. These processes lead to the accumulation of mineral material and wood in peat. Disturbed peatlands are interesting archives of past environmental changes, but they may be challenging for providing biotic proxy-based quantitative reconstructions. Here we investigate long-term changes in testate amoeba communities from two landslide mountain fens – so far an overlooked habitat for testate amoeba investigations. Our results show that abundances of testate amoebae are extremely low in this type of peatlands, therefore not suitable for providing quantitative depth-to-water table reconstructions. However, frequent shifts of dominant testate amoeba species reflect dynamic lithological situation of the studied fens. We observed that high and stable mineral matter input into the peatlands was associated with high abundances of species producing agglutinated (xenosomic) as well as idiosomic shells which prevailed in the testate amoeba communities in both analyzed profiles. This is the first study that explores testate amoebae of landslide mountain fens in such detail, providing novel information about microbial communities of these ecosystems.

scholarly journals Electret Filters—From the Influence of Discharging Methods to Optimization Potential

Atmosphere ◽  
2021 ◽  
Vol 12 (1) ◽  
pp. 65
Author(s):  
Maximilian Kerner ◽  
Kilian Schmidt ◽  
Stefan Schumacher ◽  
Christof Asbach ◽  
Sergiy Antonyuk
Keyword(s):  
Fine Particles ◽  
Operating Time ◽  
Filtration Efficiency ◽  
Long Term Stability ◽  
Aerosol Filtration ◽  
Charge Decay ◽  
The One ◽  
Testing Standards ◽  
Discharge Efficiency

Electret filters are electrostatically charged nonwovens which are commonly used in aerosol filtration to remove fine particles from gases. It is known that the charge and thus also the filtration efficiency can degrade over time. Thus, many testing standards require to remove the charge by treatment with liquid isopropanol (IPA) or IPA-saturated air. However, the parameters influencing this discharge have not been completely clarified yet. The aim of this work was, on the one hand, to experimentally investigate the influence of the IPA treatment on different electret filters and, on the other hand, to show the optimization potential of electret filters with respect to efficiency and long-term stability by numerical simulations. The experiments revealed that the air permeability is a central influencing parameter. Small pores lead to a reduced discharge efficiency using liquid IPA, while both treatment methods are suitable for larger pores. The simulations showed that a homogeneous charge distribution within the filter depth is advantageous for the initial performance. In contrast, charge penetrating deeper in the filter medium delays the charge decay and thus increases the operating time, with the trade-off of a lower initial performance.

scholarly journals Minimal Invasive Surgery for Gastroesophageal Reflux Disease and Hiatus Hernia—Our Experience: A Case Series with Review of Literature

2021 ◽  
Author(s):  
Rafique Umer Harvitkar ◽  
Abhijit Joshi
Keyword(s):  
Retrospective Study ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Operating Time ◽  
Type I ◽  
Type Ii ◽  
The Mean ◽  
Gerd Symptoms

Abstract Introduction Laparoscopic fundoplication (LF) has almost completely replaced the open procedure performed for gastroesophageal reflux disease (GERD) and hiatus hernia (HH). Several studies have suggested that long-term results with surgery for GERD are better than a medical line of management. In this retrospective study, we outline our experience with LF over 10 years. Also, we analyze the factors that would help us in better patient selection, thereby positively affecting the outcomes of surgery. Patients and Methods In this retrospective study, we identified 27 patients (14 females and 13 males) operated upon by a single surgeon from 2010 to 2020 at our institution. Out of these, 25 patients (12 females and 13 males) had GERD with type I HH and 2 (both females) had type II HH without GERD. The age range was 24 to 75 years. All patients had undergone oesophago-gastro-duodenoscopy (OGD scopy). A total of 25 patients had various degrees of esophagitis. Two patients had no esophagitis. These patients were analyzed for age, sex, symptoms, preoperative evaluation, exact procedure performed (Nissen’s vs. Toupet’s vs. cruroplasty + gastropexy), morbidity/mortality, and functional outcomes. They were also reviewed to examine the length of stay, length of procedure, complications, and recurrent symptoms on follow-up. Symptoms were assessed objectively with a score for six classical GERD symptoms preoperatively and on follow-up at 1-, 4- and 6-weeks postsurgery. Further evaluation was performed after 6 months and then annually for 2 years. Results 14 females (53%) and 13 males (48%) with a diagnosis of GERD (with type I HH) and type II HH were operated upon. The mean age was 46 years (24–75 years) and the mean body mass index (BMI) was 27 (18–32). The range of duration of the preoperative symptoms was 6 months to 2 years. The average operating time dropped from 130 minutes for the first 12 cases to 90 minutes for the last 15 cases. The mean hospital stay was 3 days (range: 2–4 days). In the immediate postoperative period, 72% (n = 18) of the patients reported improvement in the GERD symptoms, while 2 (8%) patients described heartburn (grade I, mild, daily) and 1 (4%) patient described bloating (grade I, daily). A total of 5 patients (20%) reported mild dysphagia to solids in the first 2 postoperative weeks. These symptoms settled down after 2 to 5 weeks of postoperative proton-pump inhibitor (PPI) therapy and by adjusting consistency of oral feeds. There was no conversion to open, and we observed no perioperative mortality. There were no patients who underwent redo surgeries in the series. Conclusion LF is a safe and highly effective procedure for a patient with symptoms of GERD, and it gives long-term relief from the symptoms. Stringent selection criteria are necessary to optimize the results of surgery. Experience is associated with a significant reduction of operating time.

scholarly journals Vascular resection for locally advanced pancreatic ductal adenocarcinoma: analysis of long-term outcomes from a single-centre series

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Claudio F. Feo ◽  
Giulia Deiana ◽  
Chiara Ninniri ◽  
Giuseppe Cherchi ◽  
Paola Crivelli ◽  
...  
Keyword(s):  
Pancreatic Ductal Adenocarcinoma ◽  
Locally Advanced ◽  
Operating Time ◽  
Vascular Resection ◽  
Ductal Adenocarcinoma ◽  
Term Survival ◽  
Aggressive Approach ◽  
Long Term Survival ◽  
Cox Regression Analysis

Abstract Background Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy with poor prognosis. Radical surgery is the best option for cure and, nowadays, it is performed by many surgeons also in cases of vascular infiltration. Whether this aggressive approach to a locally advanced PDAC produces a survival benefit is under debate. Most data in the literature come from retrospective comparative studies; therefore, it is still unclear if such an extensive surgery for an advanced cancer is justified. Methods A retrospective review of patients with PDAC treated at our institution over a 12-year period was performed. Data concerning patients’ characteristics, operative details, postoperative course, and long-term survival were retrieved from prospective databases and analysed. Factors associated with poor survival were assessed via Cox regression analysis. Results A total of 173 patients with PDAC were included in the analysis, 41 subjects underwent pancreatectomy with vascular resection for locally advanced disease, and in 132 patients, only a pancreatic resection was undertaken. Demographics, major comorbidities, and tumour characteristics were similar between the two groups. Length of surgery (P=0.0006), intraoperative blood transfusions (P<0.0001), and overall complications (P<0.0001) were significantly higher in the vascular resection group. Length of hospital stay (P=0.684) and 90-day mortality (P=0.575) were comparable between groups. Overall median survival (P= 0.717) and survival rates at 1, 3, and 5 years (P=0.964, P=0.500, and P=0.445, respectively) did not differ significantly between groups. Age ≥70 years and postoperative complications were independent predictors of lower survival. Conclusions Our study confirms that pancreatectomy with vascular resection for a locally advanced PDAC is a complex operation associated with a significant longer operating time that may increase morbidity; however, in selected patients, R0 margins can be obtained with an acceptable long-term survival rate. Older patients are less likely to benefit from surgery.

Does robotic-assisted surgery improve outcomes of total hip arthroplasty compared to manual technique? A systematic review and meta-analysis

2021 ◽  
pp. postgradmedj-2021-141135
Author(s):  
Vishal Kumar ◽  
Sandeep Patel ◽  
Vishnu Baburaj ◽  
Rajesh Kumar Rajnish ◽  
Sameer Aggarwal
Keyword(s):  
Systematic Review ◽  
Total Hip Arthroplasty ◽  
Clinical Outcomes ◽  
Hip Arthroplasty ◽  
Meta Analysis ◽  
Operating Time ◽  
Limb Length ◽  
Robot Assisted ◽  
Total Hip

BackgroundRobot-assisted total hip arthroplasty (THA) is an emerging technology that claims to position implants with very high accuracy. However, there is currently limited data in literature on whether this improved accuracy leads to better long-term clinical outcomes. This systematic review compares the outcomes of THA done with the help of robotic assistance (RA) to those done with conventional manual techniques (MTs).MethodsFour electronic databases were searched for eligible articles that directly compared robot-assisted THA to manual THA and had data on the radiological or clinical outcomes of both. Data on various outcome parameters were collected. Meta-analysis was conducted using a random-effects model with 95% CIs.ResultsA total of 17 articles were found eligible for inclusion, and 3600 cases were analysed. Mean operating time in the RA group was significantly longer than in the MT group. RA resulted in significantly more acetabular cups being placed inside Lewinnek’s and Callanan’s safe zones (p<0.001) and had significantly reduced limb length discrepancy compared with MT. There were no statistically significant differences in the two groups in terms of incidence of perioperative complications, need for revision surgery and long-term functional outcome.ConclusionRA leads to highly accurate implant placement and leads to significantly reduced limb length discrepancies. However, the authors do not recommend robot-assisted techniques for routine THAs due to lack of adequate long-term follow-up data, prolonged surgical times and no significant differences in the rate of complications and implant survivorship compared with conventional MTs.

scholarly journals “Childhood Obesity its Factors, Complications and Impact on Overall Health in Children”

2021 ◽  
pp. 1-5
Author(s):  
Asma Saghir Khan
Keyword(s):  
Physical Activity ◽  
Childhood Obesity ◽  
Health Care Professionals ◽  
Genetic Factors ◽  
Overweight And Obesity ◽  
Family Influences ◽  
Childhood Overweight And Obesity ◽  
Number Of Factors ◽  
Obesity And Overweight

Childhood, overweight and obesity are increasingly significant problems, and ones that are likely to endure and to have long term adverse influences on the health of individuals and populations unless action is taken to reverse the trend. A number of factors have been suggested as contributing to the development of childhood obesity. These include genetic factors, decreasing levels of physical activity, increased time spent in sedentary behavior and changes in diet. In addition, lifestyle factors, including family influences, changes in society and media advertising, have been associated with the increasing incidence of obesity and overweight in childhood. To address the problem, health care professionals should incorporate appropriate screening in their child practice. Comprehensive assessment of children who are, or who are at risk of becoming, obese is also necessary

scholarly journals ESTIMATION OF VEHICLE OPERATING TIME TAKING INTO ACCOUNT THE INFLUENCE OF A NUMBER OF FACTORS

2021 ◽  
Vol 1 (37) ◽  
pp. 76-85
Author(s):  
A. Krasheninin
Keyword(s):  
Service Life ◽  
Operating Time ◽  
Material Resources ◽  
Number Of Factors ◽  
Additional Costs ◽  
Definition Of ◽  
Optimal Average ◽  
The Cost ◽  
The Impact ◽  
Standard Service

Modern vehicles operated on the railways of Ukraine have almost exhausted or exceeded their resource. The overuse of financial and material resources for their maintenance continues. The standard service life of vehicles was calculated on stable economic conditions of use of vehicles and their timely updating in process of aging. The service life of modern vehicles is determined by the influence of many factors, the disregard of which can lead to significant costs, even in compliance with the standard service life. For railway transport, these factors need modern clarification, as in operation their service life often exceeds the standard or, as for intermodal transport, the service life does not have a strict justification. Accordingly, the article analyzes the issues of assessing the impact on the service life of vehicles of the components of the cost of its maintenance and average daily mileage. It is shown that, firstly, the definition of the service life of vehicles must be linked to the cost of vehicle development, its creation, testing and production, the cost of operation and storage, as well as additional costs, and secondly , with the optimal average daily mileage, at which all the costs are minimal.

Critical Cybersecurity Threats

2021 ◽  
pp. 1973-1988
Author(s):  
Adel Ismail Al-Alawi ◽  
Sara Abdulrahman Al-Bassam ◽  
Arpita A. Mehrotra
Keyword(s):  
Qualitative Research ◽  
Data Analysis ◽  
Secondary Data ◽  
Secondary Data Analysis ◽  
Common Reason ◽  
Security Threats ◽  
Secondary Research ◽  
Its Analysis ◽  
Industry Performance

One common reason for cybercrime is the goal of damaging a business by hacking or destroying important information. Another such reason is the criminal's goal of gaining financially from the hack. This chapter analyzes Bahraini organizations' vulnerability to digital security threats. It has used qualitative research to analyze industry performance. Moreover, with the support of secondary research, it has also explored cybersecurity threats faced by such organizations. The discussion based on secondary data analysis has explored two major aspects of Bahraini organizations and the cybersecurity threats they face. Firstly, the data and finances of both sectors are at huge risk in Bahraini organizations. Secondly, one important aspect of exploration has been to identify the most frequently encountered forms of cybercrime. Its analysis reveals that the kind of cybersecurity threat that a business is most likely to face is cyberwarfare. This may affect two rival businesses while they are competing with each other. Competitors' data may be destroyed or hacked—leading to long-term losses.

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