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نتیجه جستجو - surgery

تعداد مقالات یافته شده: 93
ردیف عنوان نوع
1 Educational Intervention to Strengthen Pediatric Postoperative Pain Management: A Cluster Randomized Trial
مداخله آموزشی برای تقویت مدیریت درد پس از عمل کودکان: یک آزمایش تصادفی خوشه ای-2021
Background: Pediatric postoperative pain is still undertreated. Aims: To assess whether educational intervention increases nurses’ knowledge and improves pediatric postoperative pain management.
Design: Cluster randomized controlled trial with three measurement points (baseline T1, 1 month after intervention T2, and 6 months after intervention T3). Participants/Subjects: The study was conducted in postanesthesia care units at six hospitals in Norway. Nurses working with children in the included units and children who were undergoing surgery were invited to participate in this study.
Methods: Nurses were cluster randomized by units to an intervention (n = 129) or a control group (n = 129). This allocation was blinded for participants at baseline. Data were collected using “The Pediatric Nurses’ Knowledge and Attitudes Survey Regarding Pain: Norwegian Version” (primary outcome), observations of nurses’ clinical practice, and interviews with children. The intervention included an educational day, clinical supervision, and reminders.
Results: At baseline 193 nurses completed the survey (75% response rate), 143 responded at T2, and 107 at T3. Observations of nurses’ (n = 138) clinical practice included 588 children, and 38 children were interviewed. The knowledge level increased from T1 to T3 in both groups, but there was no statistically significant difference between the groups. In the intervention group, there was an improvement between T1 and T2 in the total PNKAS-N score (70% vs. 83%), observed increase use of pain assessment tools (17% vs. 39%), and children experienced less moderate-to-severe pain.
Conclusions: No significant difference was observed between the groups after intervention, but a positive change in knowledge and practice was revealed in both groups. Additional studies are needed to explore the most potent variables to strengthen pediatric postoperative pain management.
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مقاله انگلیسی
2 Assessment of Medical Expenditure for Patients With Breast Cancer in China: Evidence From Current Curative Expenditure by System of Health Accounts 2011
ارزیابی هزینه های پزشکی برای بیماران مبتلا به سرطان پستان در چین: شواهد از هزینه های درمانی فعلی توسط سیستم حساب های بهداشتی 2011-2021
Objectives: The incidence and mortality of breast cancer have been increasing in China and bring heavy economic burdens to patients, families, and society. This study aimed to analyze the structure and influencing factors of inpatient expenditures of patients with breast cancer and put forward suggestions for insurance management.
Methods: A multistage stratified random sampling method was used to investigate 379 medical institutions and 7366 pieces of inpatient records of patients with breast cancer in Dalian in 2018. Under the framework of “System of Health Accounts 2011,” the current curative expenditure (CCE) and its distribution were calculated. The relationships between hospitalization expenditure and factors were analyzed by multiple stepwise regression and structural equation modeling.
Results: The CCE of patients with breast cancer in Dalian in 2018 was U273.38 million, accounting for 10.66% of the total expenditure on cancer. The majority of the CCE flowed to large general hospitals. The CCE was concentrated in patients aged 40 to 69 years (23.46%). The hospitalization expenditure correlated positively with length of stay, surgery, and drug expenses (rs = 0.586-0.754, P,.01) and negatively associated with age (rs = 20.074, P,.01). The length of stay mediated the relationship between surgery and hospitalization expenses for patients with breast cancer. The factors that affected the hospitalization expenditure were the drug expenses, surgery, length of stay, insurance status, and institution level.
Conclusions: The cost control for CCE of breast cancer inpatient treatment is crucial in China. Promoting hierarchical diagnosis and treatment, reducing the length of stay, and improving medical insurance depth would be effective measures to reduce the financial burden of patients.
keywords: breast cancer | current curative expenditure | hospitalization expenses | System of Health Accounts 2011
مقاله انگلیسی
3 Resident Opioid Prescribing Habits Do Not Reflect Best Practices in Post-Operative Pain Management: An Assessment of the Knowledge and Education Gap
عادت های تجویز داروهای ساکن، بهترین شیوه ها را در مدیریت درد پس از عمل منعکس نمی کنند: ارزیابی شکاف دانش و آموزش-2021
OBJECTIVE: To evaluate deficiencies in knowledge and education in opioid prescribing and to compare surgical resident opioid-prescribing practices to Opioid Prescribing Engagement Network (OPEN) procedure-specific guidelines.
DESIGN: Anonymous web-based survey distributed to all general surgery residents to evaluate prior education received and confidence in knowledge in opioid prescribing. The number of 5 milligram oxycodone tablets prescribed for common procedures was assessed and compared with OPEN for significance using Wilcoxon signed rank tests.
SETTING: General surgery residency program within large university-based tertiary medical center. PARTICIPANTS: Categorical general surgery residents of all postgraduate years.
RESULTS: Fifty-six of 72 (78%) categorical residents completed the survey. Few reported receiving formal education in opioid prescribing in medical school (32%) or residency (16%). While 82% of residents felt confident in opioid side effects, fewer felt the same with regards to opioid pharmacokinetics (36%) or proper opioid disposal (29%). Opioids prescribed varied widely with residents prescribing significantly more than recommended by OPEN in 9 of 14 procedures.
CONCLUSIONS: Tackling the evolving opioid epidemic requires a multidisciplinary approach that addresses prescribing at all steps of the process, starting with trainee education.
KEY WORDS: Opioid Epidemic | Opioid Prescribing Engagement Network | Surgical Education | Resident Education
COMPETENCIES: Patient Care, Medical Knowledge, Practice-Based Learning and Improvement
مقاله انگلیسی
4 Factors associated with knowledge towards postoperative nausea and vomiting management among health professionals in referral Hospitals of Northwest Ethiopia: A multi-center cross-sectional study
عوامل مرتبط با دانش به سوی تهوع پس از عمل و مدیریت استفراغ در میان متخصصان بهداشتی در بیمارستان های ارجاع شمال غربی اتیوپی:یک مطالعه چند منظوره مقطعی-2021
Background: Knowledge of health care professionals on postoperative nausea and vomiting (PONV) and anti- emetic prescription trends affects patient’s outcome after surgery and anesthesia and also patient and family satisfaction. Hence, knowing the knowledge status of health professionals towards PONV management is vital for the optimal care of surgical patients. Therefore, the study aimed to assess the knowledge and factors associated with PONV management among health professionals in referral hospitals of Northwest Ethiopia. Methods: An institutional based cross-sectional study was conducted on 407 health care professionals from March 1 to 30, 2019. A Simple random sampling technique was used to select the study participants. Both bivariable and multivariable logistic regression analysis were used to identify factors associated with the knowledge level of health professionals on PONV management. In the multivariable analysis, variables with a p-value <0.05 were considered statistically significant. Results: In this study, about 52.8% (95% CI: 47.9, 57.2) of the participants had good knowledge of PONV management. Being male (AOR = 1.95; 95% CI: 1.20, 3.17), Physician (AOR = 5.36; 95% CI: 2.20, 13.5), Anesthetist (AOR = 3.88; 95% CI: 1.66, 9.08), and taking training on PONV management (AOR = 5.32; 95%CI: 1.58, 17.89) were positively associated with good knowledgeable of health professionals about PONV management. Conclusion: and recommendation: More than half of health care professionals who are working in the periop- erative sites of the referral hospitals had good knowledge about the PONV management. Being male, Physician, Anesthetist and taking in-service training on PONV management were significantly affecting the knowledge level of health professionals on PONV management. Thus, providing regular in-service training on PONV manage- ment, especially for physician and anesthetist is highly recommended.
keywords: تهوع و استفراغ پس از عمل | دانش | متخصصین سلامت | اتیوپی | Postoperative nausea and vomiting | Knowledge | Health professionals | Ethiopia
مقاله انگلیسی
5 Associations of Vision Impairment and Eye Diseases With Memory Decline Over 4 Years in China and the United States
ارتباط اختلالات بینایی و بیماریهای چشمی با کاهش حافظه بیش از 4 سال در چین و ایالات متحده-2021
• PURPOSE: To examine whether vision impairment and eye diseases are independently associated with memory decline in older adults. • DESIGN: Cohort study. • METHODS: We included 8,315 participants aged 50- 94 years in China Health and Retirement Longitudinal Study (CHARLS) from China and 8,939 participants aged 50-95 years in Health and Retirement Study (HRS) from the United States in our analysis. • RESULTS: During 4.0 years’ follow-up, the composite memory decreased by 0.16 points in CHARLS. During 3.9 years’ follow-up, the composite memory decreased by 0.51 in HRS. Distance vision impairment was inversely associated with an annual change in composite memory (β [95% CI]: –0.07 [–0.12, –0.01]) and immediate memory (–0.04 [–0.07, –0.02]) in CHARLS, and the corresponding values in HRS were –0.19 (–0.34, –0.05) and –0.07 (–0.13, –0.00), respectively. Near vision impairment was inversely associated with an annual change in delayed memory in CHARLS and composite memory, immediate memory, and delayed memory in HRS. In HRS, the association between distance vision impairment and memory decline was observed in individuals aged <65 years (β [95% CI]: –0.54 [–0.78, –0.30]) but not in those aged ≥65 years (–0.01 [–0.20, 0.18]). Cataract surgery or glaucoma was not significantly associated with memory decline in either CHARLS or HRS. • CONCLUSION: Distance vision impairment was independently associated with an accelerated rate of memory decline in both China and the United States. Near vision impairment was predictive of decline in delayed memory in China and of decline in composite, immediate, and delayed memory in the United States. (Am J Ophthalmol 2021;228: 16–26. © 2021 Elsevier Inc. All rights reserved.)
مقاله انگلیسی
6 Time management: Improving the timing of post-prostatectomy radiotherapy, clinical trials, and knowledge translation
مدیریت زمان: بهبود زمان رادیوتراپی پس از پروستاتکتومی، آزمایشات بالینی و ترجمه دانش-2021
Background: Management of prostate cancer after surgery is controversial. Past studies on adjuvant radiotherapy (aRT) for higher-risk features have had conflicting results. Through the collaborative conversations of the global radiation oncology Twitter-based journal club (#RadOnc #JC), we explored this complex topic to share recent advances, better understand what the global radiation oncology community felt was important and inspire next steps. Methods: We selected the recent publication of a landmark international randomized controlled trial (RCT) comparing immediate and salvage radiotherapy for prostate cancer, RADICALS-RT, for discussion over the weekend of January 16 to 17, 2021. Coordination included open access to the article and an asynchronous portion to decrease barriers to participation, cooperation of study authors (CP, MS) who participated to share deeper insights including a live hour, and curation of related resources and tweet content through a blog post and Wakelet journal club summary. Discussion of Results: Our conversations created 2,370,104 impressions over 599 tweets with 51 participants spanning 11 countries and 5 continents. A quarter of the participants were from the US (13/51) followed by 10% from the UK (5/51). Clinical or Radiation Oncologists comprised 59% of active participants (16/27) with 62% (18/29) reporting giving aRT within the last 5 years. Discussion was interdisciplinary with three urologists (11%), three trainees (11%), and two physiotherapists (7%). Four months after the journal club its article Altmetric score had increased by 7% (214 to 229). Thematic analysis of tweet content suggested participants wanted clarification on definitions of adjuvant (aRT) and salvage radiotherapy (sRT) including indications, timing, and decision-making tools including guidelines; more interdisciplinary and cross-sectoral collaboration including with patients for study design including survivorship and meaningful outcomes; more effective knowledge translation including faster clinical trials; and more data including mature results of current trials, particular high-risk features (Gleason Group 4+, pT4b+, and margin-positive disease), implications of newer technologies such as PSMA-PET and genomic classifiers, and better explanations for practice pattern variations including underutilization of radiotherapy. This was further explored in the context of relevant literature. Conclusion: Together, this global collaborative review on the postoperative management of prostate cancer suggested a stronger signal for the uptake of early salvage radiation treatment with careful PSA monitoring, more sensitive PSA triggers, and expected access to radiotherapy. Questions still remain on potential exceptions and barriers to use. These require better decision-making tools for all practice settings, consideration of newer technologies, more pragmatic trials, and better use of social media for knowledge translation.
Keywords: Prostate radiotherapy | Adjuvant radiation | Salvage radiation | Journal club
مقاله انگلیسی
7 Deep learning-based computer vision to recognize and classify suturing gestures in robot-assisted surgery
بینایی عمیق مبتنی بر یادگیری برای تشخیص و طبقه بندی حرکات بخیه در جراحی با کمک روبات-2021
Background: Our previous work classified a taxonomy of suturing gestures during a vesicourethral anastomosis of robotic radical prostatectomy in association with tissue tears and patient outcomes. Herein, we train deep learning-based computer vision to automate the identification and classification of suturing gestures for needle driving attempts.
Methods: Using two independent raters, we manually annotated live suturing video clips to label timepoints and gestures. Identification (2,395 videos) and classification (511 videos) datasets were compiled to train computer vision models to produce 2- and 5-class label predictions, respectively. Networks were trained on inputs of raw red/blue/green pixels as well as optical flow for each frame. Each model was trained on 80/20 train/test splits.
Results: In this study, all models were able to reliably predict either the presence of a gesture (identification, area under the curve: 0.88) as well as the type of gesture (classification, area under the curve: 0.87) at significantly above chance levels. For both gesture identification and classification datasets, we observed no effect of recurrent classification model choice (long short-term memory unit versus convolutional long short-term memory unit) on performance.
Conclusion: Our results demonstrate computer vision’s ability to recognize features that not only can identify the action of suturing but also distinguish between different classifications of suturing gestures. This demonstrates the potential to utilize deep learning computer vision toward future automation of surgical skill assessment.
مقاله انگلیسی
8 Computer vision in surgery
بینایی ماشین در جراحی-2021
The fields of computer vision (CV) and artificial intelligence (AI) have undergone rapid advancements in the past decade, many of which have been applied to the analysis of intraoperative video. These advances are driven by wide-spread application of deep learning, which leverages multiple layers of neural networks to teach computers complex tasks. Prior to these advances, applications of AI in the operating room were limited by our relative inability to train computers to accurately understand images with traditional machine learning (ML) techniques. The development and refining of deep neural networks that can now accurately identify objects in images and remember past surgical events has sparked a surge in the applications of CV to analyze intraoperative video and has allowed for the accurate identification of surgical phases (steps) and instruments across a variety of procedures. In some cases, CV can even identify operative phases with accuracy similar to surgeons. Future research will likely expand on this foundation of surgical knowledge using larger video datasets and improved algorithms with greater accuracy and interpretability to create clinically useful AI models that gain widespread adoption and augment the surgeon’s ability to provide safer care for patients everywhere.
مقاله انگلیسی
9 Ocular Biometric Characteristics Measured by Swept-Source Optical Coherence Tomography in Individuals Undergoing Cataract Surgery
مشخصات بیومتریک چشم اندازه گیری شده توسط توموگرافی انسجام نوری منبع جارو در افراد تحت عمل جراحی آب مروارید-2021
PURPOSE: To study the distribution of ocular biometric parameters utilizing a swept-source optical coherence tomography (SS-OCT) biometer in adult candidates for cataract surgery.
Design: A retrospective cross-sectional study
METHODS: SETTING: A single-center analysis of consecutive eyes measured with the IOLMaster 700 SS-OCT biometer at a large tertiary medical center between February 2018 and June 2020.
RESULTS: 3836 eyes of 3836 patients were included in the study. The mean age was 72.3±12.8 years and 53% were females. The mean biometric values were: total corneal power (44.17±1.70D), total corneal astigmatism (TCA) (1.11±0.87D), mean posterior keratometry (- 5.87±0.26D), posterior corneal astigmatism (-0.26±0.15D), axial length (AL) (23.95±1.66mm), anterior chamber depth (ACD) (3.18±0.42mm), lens thickness (LT) (4.49±0.47mm); white-towhite distance (WTW) (11.92±0.44mm), central corneal thickness (CCT) (0.54 ± 0.04mm), angle alpha (0.49±0.17mm), and angle kappa (0.34±0.17mm). There were sex-related differences in all biometric parameters with the exception of LT (P=.440), angle kappa (P=.216), and corneal astigmatism (P=.103). Biometric parameters demonstrated correlations between AL, WTW distance, ACD, and LT (P<.001). Age correlated with all parameters (P<.001), with the exception of CCT and posterior keratometry. Angle alpha and angle kappa magnitudes also correlated (P<.001). The prevalence of patients with TCA ≥0.75D, 1.0D and 1.5D were 59.1%, 43.4% and22.6%,respectively.
CONCLUSIONS: Age significantly correlated with most of the biometric parameters and significant differences between sexes were noted. Furthermore, the high prevalence of TCA and relatively large angle alpha and angle kappa magnitudes were noted among subjects. These data can be relevant in planning local and national health economics.
مقاله انگلیسی
10 Automated Vision-Based Microsurgical Skill Analysis in Neurosurgery Using Deep Learning: Development and Preclinical Validation
تجزیه و تحلیل خودکار مهارتهای میکروجراحی مبتنی بر بینایی در جراحی مغز و اعصاب با استفاده از یادگیری عمیق: توسعه و اعتبار پیش بالینی-2021
- BACKGROUND/OBJECTIVE: Technical skill acquisition is an essential component of neurosurgical training. Educational theory suggests that optimal learning and improvement in performance depends on the provision of objective feedback. Therefore, the aim of this study was to develop a vision-based framework based on a novel representation of surgical tool motion and interactions capable of automated and objective assessment of microsurgical skill.
- METHODS: Videos were obtained from 1 expert, 6 intermediate, and 12 novice surgeons performing arachnoid dissection in a validated clinical model using a standard operating microscope. A mask region convolutional neural network framework was used to segment the tools present within the operative field in a recorded video frame. Tool motion analysis was achieved using novel triangulation metrics. Performance of the framework in classifying skill levels was evaluated using the area under the curve and accuracy. Objective measures of classifying the surgeons skill level were also compared using the ManneWhitney U test, and a value of P < 0.05 was considered statistically significant.
- RESULTS: The area under the curve was 0.977 and the accuracy was 84.21%. A number of differences were found, which included experts having a lower median dissector velocity (P [ 0.0004; 190.38 mse1 vs. 116.38 mse1), and a smaller inter-tool tip distance (median 46.78 vs. 75.92; P [ 0.0002) compared with novices.
- CONCLUSIONS: Automated and objective analysis of microsurgery is feasible using a mask region convolutional neural network, and a novel tool motion and interaction representation. This may support technical skills training and assessment in neurosurgery.
Key words: Artificial intelligence | Computer vision | Convolutional neural network | Mask RCNN | Microsurgery | Motion-analysis | Neurosurgery
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