scholarly journals THE TRANSNASAL APPROACH TO SELLAR LESIONS. A NEUROSURGICAL EXPERIENCE AND PERSPECTIVE

2021 ◽  
Vol 71 (Suppl-3) ◽  
pp. S634-36
Author(s):  
Syed Sarmad Bukhari ◽  
Anisa Kalsoom ◽  
Muhammad Junaid ◽  
Maqbool Raza

The transnasal approach for pituitary lesions has been adopted increasingly by neurosurgeons for removing sellar lesions. It has made surgery in this region safer with fewer complications in experienced hands. However, the approach requires good knowledge of nasal anatomy and formal training to achieve good results since the territory is unfamiliar to most neurosurgeons. The approach has a somewhat steep learning curve. In our experience of 41 cases, we have presented here. We have discussed the history of this approach, technique and relevant complications and their avoidance.

2005 ◽  
Vol 29 (8) ◽  
pp. 312-315 ◽  
Author(s):  
Hany George El-Sayeh ◽  
Robert Waller ◽  
Simon Budd ◽  
John Holmes

This article focuses on the complex issues surrounding the need for adequate training in medical education for all clinicians. Many recent landmark papers, including guidance from the General Medical Council, have expressed the importance of formal training. Although the article points out that the majority of clinicians will probably not need to attend such courses, a few generic skills in teaching large and small groups may be of benefit to most. The authors call for the recognition of teaching duties in psychiatrist's contracts and discuss the wider implications of sound medical teaching for the recruitment and retention crisis in psychiatry.


Author(s):  
Fei Chi Chuang ◽  
Yu Min Chou ◽  
Ling Ying Wu ◽  
Tsai Hwa Yang ◽  
Wen Hsin Chen ◽  
...  

Abstract Introduction and hypothesis In addition to laparoscopic sacrocolpopexy (LS), laparoscopic pectopexy (LP) is a novel surgical method for correcting apical prolapse. The descended cervix or vaginal vault is suspended with a synthetic mesh by fixing the bilateral mesh ends to the pectineal ligaments. This study was aimed at developing a learning curve for LP and to compare it with results with LS. Methods We started laparoscopic/robotic pectopexy in our department in August 2019. This retrospective study included the initial 18 consecutive women with apical prolapse receiving LP and another group undergoing LS (21 cases) performed by the same surgeon. The medical and video records were reviewed. Results The age was older in the LP group than in the LS group (65.2 vs 53.1 years). The operation time of LP group was significantly shorter than that of the LS group (182.9 ± 27.2 vs 256.2 ± 45.5 min, p < 0.001). The turning point of the LP learning curve was observed at the 12th case. No major complications such as bladder, ureteral, bowel injury or uncontrolled bleeding occurred in either group. Postoperative low back pain and defecation symptoms occurred exclusively in the LS group. During the follow-up period (mean 7.2 months in LP, 16.2 months in LS), none of the cases had recurrent apical prolapse. Conclusions Laparoscopic pectopexy is a feasible surgical method for apical prolapse, with a shorter operation time and less postoperative discomfort than LS. LP may overcome the steep learning curve of LS because the surgical field of LP is limited to the anterior pelvis and avoids encountering the critical organs.


2021 ◽  
pp. neurintsurg-2021-017460
Author(s):  
Michael K Tso ◽  
Gary B Rajah ◽  
Rimal H Dossani ◽  
Michael J Meyer ◽  
Matthew J McPheeters ◽  
...  

BackgroundThe perception of a steep learning curve associated with transradial access has resulted in its limited adoption in neurointervention despite the demonstrated benefits, including decreased access-site complications.ObjectiveTo compare learning curves of transradial versus transfemoral diagnostic cerebral angiograms obtained by five neurovascular fellows as primary operator.MethodsThe first 100–150 consecutive transradial and transfemoral angiographic scans performed by each fellow between July 2017 and March 2020 were identified. Mean fluoroscopy time per artery injected (angiographic efficiency) was calculated as a marker of technical proficiency and compared for every 25 consecutive procedures performed (eg, 1–25, 26–50, 51–75).ResultsWe identified 1242 diagnostic angiograms, 607 transradial and 635 transfemoral. The radial cohort was older (64.3 years vs 62.3 years, p=0.01) and demonstrated better angiographic efficiency (3.4 min/vessel vs 3.7 min/vessel, p=0.03). For three fellows without previous endovascular experience, proficiency was obtained between 25 and 50 transfemoral angiograms. One fellow achieved proficiency after performing 25–50 transradial angiograms; and the two other fellows, in <25 transradial angiograms. The two fellows with previous experience had flattened learning curves for both access types. Two patients experienced transient neurologic symptoms postprocedure. Transradial angiograms were associated with significantly fewer access-site complications (3/607, 0.5% vs 22/635, 3.5%, p<0.01). Radial-to-femoral conversion occurred in 1.2% (7/607); femoral-to-radial conversion occurred in 0.3% (2/635). Over time, the proportion of transradial angiographic procedures increased.ConclusionTechnical proficiency improved significantly over time for both access types, typically requiring between 25 and 50 diagnostic angiograms to achieve asymptomatic improvement in efficiency. Reduced access-site complications and decreased fluoroscopy time were benefits associated with transradial angiography.


Author(s):  
Tehmina Khan

Accounting education has faced limitations as a highly technical and discipline-specific body of knowledge. The case presented in this chapter demonstrates and reflects on an attempt at incorporating the study of sustainability-related accounting knowledge through multiple forms of delivery and assessment. Sustainability-related material that draws from business, accounting and ethics' perspectives was included in an accounting ethics course for accounting majors at Royal Melbourne Institute of Technology (RMIT) University in Melbourne, Australia. This pedagogy has encouraged the development of students' soft skills including their emotional intelligence. Sustainability education has been found as engaging and thought provoking, albeit involving a steep learning curve for students as far as knowledge and awareness are concerned. It has allowed for the promotion of multiple and broader perspectives and education on key sustainability-related concerns, from a range of angles including ethics and accounting frameworks for sustainability as well as multidisciplinary approaches to sustainability and business.


This is the third chapter of the first section. It is a compendium of all the concepts and theorems of probability theory that are found in the problems of Bayesian estimation of a robot location and the map of its environment. It presents uncertainty as an intrinsic feature of any mobile robot that develops in a real environment. It is then discussed how uncertainty has been treated along the history of science and how probabilistic approaches have represented such a huge success in many engineering fields, including robotics. The fundamental concepts of probability theory are discussed along with some advanced topics needed in further chapters, following a learning curve as smooth and comprehensive as possible.


Author(s):  
Mitzi P. Trahan ◽  
Nan B. Adams ◽  
Susan Dupre

The growing experimentation with multi-user virtual environments for educational purposes demands rigorous examination of all aspects of these digital worlds. While their use appears to enhance and expand traditional distance learning, educators acknowledge that barriers to access remain, including a steep learning curve for orienting users to MUVE navigation and functionality. The application of Adams’s Knowledge Development Model for Virtual Learning Environments provides a framework for the design of in-world learning opportunities and activities, many of which tend to mirror pedagogical best-practices in Real Life (RL).


Author(s):  
Daniel Rolf

Teaching with technological support brings its own set of problems, some of them technical and others social in nature. Familiarity with specific technology can enhance the teacher’s, the practicing professional’s and the student’s experience, otherwise each will face a potentially steep learning curve before being able to achieve the best outcomes. We live in a time of rapid technical advancement bringing us new and ever more exciting opportunities at ever decreasing cost. In this chapter the authors will look at technologies which present opportunities in the virtuality continuum, from the ubiquitous mobile phone to more specialized augmented and mixed reality systems. They show examples from various fields of endeavor in an attempt to whet the appetite of those interested in new and innovative approaches to training and education.


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