Age over 65, higher BMI, and higher ASA comorbidity score were associated with longer operating and cutting times, ICU stay, and hospital length of stay. Those over 65 also had higher rates of transfusion. However, complication rates were generally similar between groups. Higher ASA score was associated with more minor and moderate systemic complications, but occurrence of local complications was similar between groups.
The RIVAL trial compared outcomes of radial versus femoral access in over 7,000 patients undergoing angiography or percutaneous coronary intervention. It found that radial access was associated with a lower risk of major vascular complications compared to femoral access, but found no differences in rates of death, myocardial infarction, stroke, or major bleeding. Radial access provided benefits regardless of operator or center volume. The study demonstrated that with experience, radial access can be performed as safely as femoral access in a variety of clinical settings.
Small AVMs that are deep or in eloquent areas are often treated with radiosurgery instead of surgery. Radiosurgery uses a single high dose of radiation and has an obliteration rate of 70-80% at 2 years. Frame-based radiosurgery requires invasive head fixation for imaging and treatment, while frameless radiosurgery with the Cyberknife does not require an invasive frame. Preliminary studies show frameless radiosurgery has obliteration rates similar to frame-based radiosurgery but is better tolerated as an outpatient procedure without head frame fixation.
The Use of Achieve Circular Mapping Catheter Significantly Reduces Procedure ...Jc Templar
Michaël Peyrol, Pascal Sbragia, Morgane Orabona, Anne-Claire Casalta, Amandine Quatre, Zinedine Zerrouk, Gilles Boccara, Maxime Guenoun, Samuel Lévy, Franck Paganelli
Department of Cardiology, Centre Hospitalier Universitaire Nord, Marseille, France
This document summarizes the results of a randomized trial comparing outcomes of PCI performed at hospitals with and without on-site cardiac surgery. It found that at 6 weeks and 9 months, rates of death, heart attack, bleeding, stroke and other complications were similar between the two hospital types. However, PCI failure and use of bare-metal stents were higher, and staged procedures and catheterization lab visits were more frequent, at hospitals without on-site surgery.
This document describes surgical techniques for using the CAPSTONE PEEK Spinal System for posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF) procedures. It discusses implant features, instrument sets, surgical steps including laminotomy, facetectomy, disc space preparation, distraction, trial insertion, interbody spacer insertion, additional fixation options, and explantation procedures. Navigation and neuromonitoring options are also covered. The techniques can be performed using open or minimally invasive approaches.
TLIF is a minimally invasive approach towards removing degenerative discs in the lumbar spine. If you or someone you know may benefit from a Transforaminal Lumbar Interbody Fusion feel free to contact us 1-8SPINECAL-1, doctor@beverlyspine.com, doctor@santamonicaspine.com or via the internet www.santamonicaspine.com or www.beverlyspine.com
The document discusses the history, indications, anatomy, and techniques of posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF). It describes how PLIF and TLIF were developed over time to improve fusion rates. Common indications for PLIF and TLIF include degenerative disc disease, spinal stenosis, instability, and spondylolisthesis. Details are provided on the anatomy of the lumbar spine and techniques for performing PLIF and TLIF, including patient positioning, pedicle screw insertion, interbody cage placement, and rod fixation.
The RIVAL trial compared outcomes of radial versus femoral access in over 7,000 patients undergoing angiography or percutaneous coronary intervention. It found that radial access was associated with a lower risk of major vascular complications compared to femoral access, but found no differences in rates of death, myocardial infarction, stroke, or major bleeding. Radial access provided benefits regardless of operator or center volume. The study demonstrated that with experience, radial access can be performed as safely as femoral access in a variety of clinical settings.
Small AVMs that are deep or in eloquent areas are often treated with radiosurgery instead of surgery. Radiosurgery uses a single high dose of radiation and has an obliteration rate of 70-80% at 2 years. Frame-based radiosurgery requires invasive head fixation for imaging and treatment, while frameless radiosurgery with the Cyberknife does not require an invasive frame. Preliminary studies show frameless radiosurgery has obliteration rates similar to frame-based radiosurgery but is better tolerated as an outpatient procedure without head frame fixation.
The Use of Achieve Circular Mapping Catheter Significantly Reduces Procedure ...Jc Templar
Michaël Peyrol, Pascal Sbragia, Morgane Orabona, Anne-Claire Casalta, Amandine Quatre, Zinedine Zerrouk, Gilles Boccara, Maxime Guenoun, Samuel Lévy, Franck Paganelli
Department of Cardiology, Centre Hospitalier Universitaire Nord, Marseille, France
This document summarizes the results of a randomized trial comparing outcomes of PCI performed at hospitals with and without on-site cardiac surgery. It found that at 6 weeks and 9 months, rates of death, heart attack, bleeding, stroke and other complications were similar between the two hospital types. However, PCI failure and use of bare-metal stents were higher, and staged procedures and catheterization lab visits were more frequent, at hospitals without on-site surgery.
This document describes surgical techniques for using the CAPSTONE PEEK Spinal System for posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF) procedures. It discusses implant features, instrument sets, surgical steps including laminotomy, facetectomy, disc space preparation, distraction, trial insertion, interbody spacer insertion, additional fixation options, and explantation procedures. Navigation and neuromonitoring options are also covered. The techniques can be performed using open or minimally invasive approaches.
TLIF is a minimally invasive approach towards removing degenerative discs in the lumbar spine. If you or someone you know may benefit from a Transforaminal Lumbar Interbody Fusion feel free to contact us 1-8SPINECAL-1, doctor@beverlyspine.com, doctor@santamonicaspine.com or via the internet www.santamonicaspine.com or www.beverlyspine.com
The document discusses the history, indications, anatomy, and techniques of posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF). It describes how PLIF and TLIF were developed over time to improve fusion rates. Common indications for PLIF and TLIF include degenerative disc disease, spinal stenosis, instability, and spondylolisthesis. Details are provided on the anatomy of the lumbar spine and techniques for performing PLIF and TLIF, including patient positioning, pedicle screw insertion, interbody cage placement, and rod fixation.
1) Lumbar interbody fusion is a spinal surgery technique that aims to eliminate painful segmental motion by forming a bony bridge between vertebrae. It involves removing the disc and placing a bone graft and/or interbody device to maintain alignment and disc height.
2) There are several approaches for lumbar interbody fusion, including anterior (ALIF, LLIF, OLIF), posterior (PLIF, TLIF), and transforaminal. Each approach has advantages and disadvantages in terms of access, fusion rates, and potential complications.
3) Anterior approaches provide a large surface area for fusion but require abdominal incisions, while posterior approaches allow indirect decompression but have a limited surgical
Religions like Judaism and Islam have dietary restrictions that affected what foods people could eat. Judaism's kosher laws only allow certain animals to be eaten that are slaughtered in a specific ritual way, and forbid mixing meat and dairy. Islam's halal dietary laws are similar, only allowing meat from animals slaughtered in the name of Allah while mentioning his name. These religious dietary codes shaped the diets of followers for centuries.
The document lists various music genres including rock/metal, Spanish guitar, jazz/blues, country/western, and pop. For each genre, there are some random letters and symbols listed with no other details provided. The document does not contain any substantial information about the different music genres.
This document summarizes new features and improvements in Jelly Bean, including enhanced accessibility, browser performance, calendar usability, face unlock speed and accuracy, international keyboard support, notification customization, settings organization, widget personalization, and updates to core Google apps like Search, Now, Play, and more.
This document summarizes the origins and operations of the "Our Bears from Bergenfield Story 2002" project, which collects and distributes teddy bears to children in Israel who have been victims of terror attacks. It began after 9/11 when a family wanted to help in some way and started by making American flag pins. Their son Sammy G suggested collecting teddy bears after being given one in the hospital. Since then over 137,000 bears have been collected and distributed to hospitals and shelters in Israel through volunteer efforts.
The document provides an autobiographical summary of a person named Kyle Roberts and his journey and goals in the music industry. It describes how he grew up in Morristown, NJ and became interested in music in college. It details how he started recording local musicians for free and eventually began charging for studio time. His goals are to work in a top recording studio, discover a mainstream artist as an A&R representative, have his own record label, and be contacted through his social media pages.
South Africa has a diverse population of over 50 million people and 11 official languages. It has a history of Dutch and British colonization and implemented an apartheid system until the 1990s. Some of its major issues include high HIV/AIDS rates and economic inequality leftover from apartheid. The country has significant mineral resources and tourism is an important industry, focused around attractions like Cape Town, wildlife parks, and beaches.
Vidbox Mexico plans to introduce automated DVD rental kiosks across Mexico, replicating the successful Redbox model in the United States. Vidbox kiosks will rent DVDs, Blu-rays, and video games through a touchscreen interface at locations where consumers already shop like grocery stores, drugstores, and fast food restaurants. With over 1,100 kiosks and growing, Redbox dominates the US rental market. Vidbox aims to establish itself as the leading brand in Mexico and capture sales from Mexico's growing middle class by strategically placing 1,600 kiosks in high traffic locations in major cities in the first year. A team of experienced professionals in business, logistics, and the
The group planned their preliminary task using mind maps and storyboards but had to change locations last minute when their original choice became unavailable. They filmed using iPads, which worked well though they had to remember to shoot in landscape. Editing in iMovie was straightforward. The completed video meets the criteria of including dialogue between two people and different shots. Overall, the process taught the importance of thorough location planning and how to produce a video with varied shots and camera movements.
This document lists and describes various technologies and online tools used in the Zootopia eTwinning project. It discusses the use of a whiteboard, webcam, laptop, Skype, Gimp, Audacity, Windows Movie Maker, PowerPoint, blogs, Twinspace, Rayuela, Prezi and various educational websites for creating puzzles, animated videos, photo presentations, music, and more. The goal was to facilitate communication and sharing of project activities between partners in Spain and Cyprus.
Crown Capital Eco Management analyzes environmental data from various sources to provide information to the public and policymakers about issues like climate change and pollution. As an independent non-profit organization, it is composed of volunteer scientists supported by agencies worldwide.
The document describes several experiments in using context changes to influence behaviors. In the first, keeping a bedroom floor clean led to feeling more accomplished and going to bed earlier. In the second, placing keys and devices in designated spots each night reduced stress. The third used an advent calendar approach with daily push-up workouts and puzzle pieces to maintain a streak and motivate the behavior. Context changes, like visual cues or incentives, made new routines easier and more rewarding to follow.
El documento describe la teoría de la inteligencia múltiple de Howard Gardner que propone que existen varios tipos de inteligencia como la espacial, musical, lingüística, matemática, corporal, interpersonal, intrapersonal y emocional. También discute la inteligencia artificial como la capacidad de razonar de agentes no vivos como computadoras y robots usando cálculos matemáticos y lógicos. Finalmente, proporciona enlaces sobre inteligencia artificial y teoría de inteligencia múltiple.
Economic evaluation. Methods for adjusting survival estimates in the presence...HTAi Bilbao 2012
This document describes a simulation study examining methods for adjusting survival estimates when patients switch or crossover between treatment groups in a randomized controlled trial. The study compares the performance of naive approaches (e.g. intention-to-treat analysis) to more complex statistical methods (e.g. rank preserving structural failure time models, inverse probability of censoring weights) under different simulation scenarios varying factors like the treatment effect size and percentage of patients who crossover. The goal is to provide evidence on which methods produce the least biased results in different situations involving treatment crossover.
1) The document describes the early experience of a single center performing TAVI procedures using both the Sapien and CoreValve prostheses between 2010-2011. 129 high-risk patients with severe aortic stenosis underwent the TAVI procedure.
2) In-hospital mortality was 10.1% overall, with lower mortality for transfemoral (5.1%) compared to transapical (25%) access. Complications included conversion to surgery, stroke, vascular issues, and renal failure.
3) At 9.9 month follow up, late mortality was 9 additional patients from non-cardiac causes. Survival was better for those with higher ejection fraction and without other comorbidities. The
1) Lumbar interbody fusion is a spinal surgery technique that aims to eliminate painful segmental motion by forming a bony bridge between vertebrae. It involves removing the disc and placing a bone graft and/or interbody device to maintain alignment and disc height.
2) There are several approaches for lumbar interbody fusion, including anterior (ALIF, LLIF, OLIF), posterior (PLIF, TLIF), and transforaminal. Each approach has advantages and disadvantages in terms of access, fusion rates, and potential complications.
3) Anterior approaches provide a large surface area for fusion but require abdominal incisions, while posterior approaches allow indirect decompression but have a limited surgical
Religions like Judaism and Islam have dietary restrictions that affected what foods people could eat. Judaism's kosher laws only allow certain animals to be eaten that are slaughtered in a specific ritual way, and forbid mixing meat and dairy. Islam's halal dietary laws are similar, only allowing meat from animals slaughtered in the name of Allah while mentioning his name. These religious dietary codes shaped the diets of followers for centuries.
The document lists various music genres including rock/metal, Spanish guitar, jazz/blues, country/western, and pop. For each genre, there are some random letters and symbols listed with no other details provided. The document does not contain any substantial information about the different music genres.
This document summarizes new features and improvements in Jelly Bean, including enhanced accessibility, browser performance, calendar usability, face unlock speed and accuracy, international keyboard support, notification customization, settings organization, widget personalization, and updates to core Google apps like Search, Now, Play, and more.
This document summarizes the origins and operations of the "Our Bears from Bergenfield Story 2002" project, which collects and distributes teddy bears to children in Israel who have been victims of terror attacks. It began after 9/11 when a family wanted to help in some way and started by making American flag pins. Their son Sammy G suggested collecting teddy bears after being given one in the hospital. Since then over 137,000 bears have been collected and distributed to hospitals and shelters in Israel through volunteer efforts.
The document provides an autobiographical summary of a person named Kyle Roberts and his journey and goals in the music industry. It describes how he grew up in Morristown, NJ and became interested in music in college. It details how he started recording local musicians for free and eventually began charging for studio time. His goals are to work in a top recording studio, discover a mainstream artist as an A&R representative, have his own record label, and be contacted through his social media pages.
South Africa has a diverse population of over 50 million people and 11 official languages. It has a history of Dutch and British colonization and implemented an apartheid system until the 1990s. Some of its major issues include high HIV/AIDS rates and economic inequality leftover from apartheid. The country has significant mineral resources and tourism is an important industry, focused around attractions like Cape Town, wildlife parks, and beaches.
Vidbox Mexico plans to introduce automated DVD rental kiosks across Mexico, replicating the successful Redbox model in the United States. Vidbox kiosks will rent DVDs, Blu-rays, and video games through a touchscreen interface at locations where consumers already shop like grocery stores, drugstores, and fast food restaurants. With over 1,100 kiosks and growing, Redbox dominates the US rental market. Vidbox aims to establish itself as the leading brand in Mexico and capture sales from Mexico's growing middle class by strategically placing 1,600 kiosks in high traffic locations in major cities in the first year. A team of experienced professionals in business, logistics, and the
The group planned their preliminary task using mind maps and storyboards but had to change locations last minute when their original choice became unavailable. They filmed using iPads, which worked well though they had to remember to shoot in landscape. Editing in iMovie was straightforward. The completed video meets the criteria of including dialogue between two people and different shots. Overall, the process taught the importance of thorough location planning and how to produce a video with varied shots and camera movements.
This document lists and describes various technologies and online tools used in the Zootopia eTwinning project. It discusses the use of a whiteboard, webcam, laptop, Skype, Gimp, Audacity, Windows Movie Maker, PowerPoint, blogs, Twinspace, Rayuela, Prezi and various educational websites for creating puzzles, animated videos, photo presentations, music, and more. The goal was to facilitate communication and sharing of project activities between partners in Spain and Cyprus.
Crown Capital Eco Management analyzes environmental data from various sources to provide information to the public and policymakers about issues like climate change and pollution. As an independent non-profit organization, it is composed of volunteer scientists supported by agencies worldwide.
The document describes several experiments in using context changes to influence behaviors. In the first, keeping a bedroom floor clean led to feeling more accomplished and going to bed earlier. In the second, placing keys and devices in designated spots each night reduced stress. The third used an advent calendar approach with daily push-up workouts and puzzle pieces to maintain a streak and motivate the behavior. Context changes, like visual cues or incentives, made new routines easier and more rewarding to follow.
El documento describe la teoría de la inteligencia múltiple de Howard Gardner que propone que existen varios tipos de inteligencia como la espacial, musical, lingüística, matemática, corporal, interpersonal, intrapersonal y emocional. También discute la inteligencia artificial como la capacidad de razonar de agentes no vivos como computadoras y robots usando cálculos matemáticos y lógicos. Finalmente, proporciona enlaces sobre inteligencia artificial y teoría de inteligencia múltiple.
Economic evaluation. Methods for adjusting survival estimates in the presence...HTAi Bilbao 2012
This document describes a simulation study examining methods for adjusting survival estimates when patients switch or crossover between treatment groups in a randomized controlled trial. The study compares the performance of naive approaches (e.g. intention-to-treat analysis) to more complex statistical methods (e.g. rank preserving structural failure time models, inverse probability of censoring weights) under different simulation scenarios varying factors like the treatment effect size and percentage of patients who crossover. The goal is to provide evidence on which methods produce the least biased results in different situations involving treatment crossover.
1) The document describes the early experience of a single center performing TAVI procedures using both the Sapien and CoreValve prostheses between 2010-2011. 129 high-risk patients with severe aortic stenosis underwent the TAVI procedure.
2) In-hospital mortality was 10.1% overall, with lower mortality for transfemoral (5.1%) compared to transapical (25%) access. Complications included conversion to surgery, stroke, vascular issues, and renal failure.
3) At 9.9 month follow up, late mortality was 9 additional patients from non-cardiac causes. Survival was better for those with higher ejection fraction and without other comorbidities. The
Impact of previous stenting on the outcome of (2)escts2012
This study examined the impact of previous coronary stenting on outcomes of subsequent CABG surgery in patients with multivessel disease. The study divided 200 patients into two groups: Group A with no previous stents, and Group B with previous stents. Group B had worse postoperative outcomes such as longer hospital stays, higher morbidity rates, and less improvement in echocardiogram measurements after surgery compared to Group A. Previous studies also found worse outcomes for patients who had undergone prior PCI compared to those without prior stenting. The presence of previous stents is associated with more severe coronary artery disease and worse clinical status preoperatively.
Using NSQIP to calculate mortality risk from NSTIsAmalia Cochran
This study (1) developed a 30-day postoperative mortality risk calculator for patients with necrotizing soft tissue infections (NSTIs) using data from the National Surgical Quality Improvement Program (NSQIP), (2) found that older age, dependence level, dialysis, higher ASA class, emergent surgery, septic shock, and low platelet count were significant predictors of mortality in the risk model, and (3) validated the model with a receiver operating characteristic (ROC) area of 0.85, indicating a strong predictive performance.
Estudio presentado por el Dr. Andre Lamy en el último ACC.2013, realizado en San Francisco, Estados Unidos, los días 9, 10 y 11 de Marzo. Más presentaciones de este evento en www.solaci.org/es/coberturas.php
The document discusses anatomical variations of the radial artery that can cause failures in transradial interventions, techniques to manage arterial spasm and loops during the procedure, and evidence that the radial approach has better outcomes than femoral especially in STEMI patients while emphasizing the need for dedicated equipment and techniques to minimize complications.
This document discusses the prevention of venous thromboembolism (VTE) in hospitalized patients. It notes that while prevention is not necessary for all patients, those at high risk include patients undergoing surgery, those with cancer or trauma, patients in the ICU or with spinal cord injuries. Studies show medical patients have a 10-20% risk of DVT, while risks are higher, 40-80%, for other groups like trauma or arthroplasty patients. Meta-analyses found anticoagulants reduced PE, fatal PE, symptomatic DVT and overall VTE compared to placebo, without increasing major bleeding risk. For stroke patients, benefits were smaller due to many asymptomatic VTE cases, so number needed to treat was higher
1) The study examined outcomes in patients with heart failure who were at high risk, finding that at 6 months their risk was approximately 3.8 times higher.
2) Baseline characteristics were similar between the eplerenone and placebo groups, including average age of 64, 72% males, mean ejection fraction of 33%, and 32% with diabetes.
3) For the primary endpoints of total mortality and cardiovascular mortality or hospitalization, eplerenone demonstrated a 15% and 13% reduced risk respectively compared to placebo.
ACE: The First Experience with Angiographic Reviewsbnolke
This document summarizes the findings from the first 10 facilities reviewed by the Accreditation for Cardiovascular Excellence (ACE) program. It found that while the majority of cases met quality standards, documentation was often inadequate, incomplete, or inconsistent. Indications for procedures and results of in-lab testing were not always clearly documented. Random case reviews, an important part of quality assurance, were not routinely performed at most facilities. The conclusions call for improved documentation in cath reports and increased use of random case reviews.
1) The document discusses optimal practice in radiation treatment for head and neck cancer in the 21st century, focusing on balancing treatment targets and sparing normal tissues using available technology and expertise.
2) It reviews treatment options and approaches for different stages of head and neck cancer, highlighting evidence that altered fractionation and chemoradiation can improve outcomes over standard radiation alone.
3) Challenges of implementing intensity-modulated radiation therapy (IMRT) for head and neck cancer are discussed, as well as examples of how IMRT can improve target coverage and tissue sparing compared to conventional techniques.
Amarelli 313 Transplantation Ii Early Graft Failure After Heart Transplant Le...Cristiano Amarelli
The document discusses a study examining risk factors for early graft failure (EGF) within 24 hours of heart transplantation. The study analyzed 317 transplant recipients and identified factors significantly associated with EGF, including male sex, redo surgery, high donor inotrope use, weight mismatch over 20%, and longer ischemic time. EGF occurred in 32 patients (10.1%) and was associated with high mortality of 52.9%.
Nurse Maude provides community nursing services in Christchurch, New Zealand. They operate a specialist wound care service from two clinics. In 2009, they began using an electronic health record (EHR) system integrated with a wound measurement tool. An audit found that while the EHR captured data on 562 patients, some data was missing due to technical and organizational issues. Recommendations included improving training, equipment, and standardizing the data collected in the EHR.
1) Epidemiological studies show a possible association between exposure to extremely low frequency magnetic fields above 0.3-0.4 μT and childhood leukemia, however selection bias and lack of biological mechanism could explain the findings.
2) While a causal relationship is still uncertain, the association persists in measurement-based studies, and magnetic fields may act as a promoter in the multi-stage process of leukemia development.
3) If the association is causal, the attributable risk is likely small due to widespread low-level exposure, but 0.4 μT should not be considered a safe threshold given survival analyses show a possible effect above this level.
The ACT Trial was a large, pragmatic randomized controlled trial that investigated whether acetylcysteine reduces the risk of contrast-induced nephropathy (CIN) in over 2,300 patients undergoing coronary angiography. The trial found no difference in the primary outcome of CIN or other clinical outcomes like mortality between patients receiving acetylcysteine or placebo. Subgroup and sensitivity analyses also found no benefit of acetylcysteine. An updated meta-analysis of high-quality trials, including the ACT Trial, similarly found no effect of acetylcysteine on reducing CIN risk. The results suggest acetylcysteine is not effective in preventing CIN and may inform updating clinical guidelines.
The ACT Trial was a large pragmatic randomized controlled trial that evaluated the effectiveness of acetylcysteine in preventing contrast-induced nephropathy in over 2,300 high-risk patients undergoing coronary angiography. The trial found no significant difference in the rates of contrast-induced nephropathy or other clinical outcomes like mortality between patients who received acetylcysteine or placebo. Subgroup and meta-analysis of previous trials confirmed these results. The conclusions indicate that acetylcysteine is not effective in reducing short-term renal or clinical risks in high-risk patients undergoing angiography.
The document discusses robotic-assisted pyeloplasty as a technique for repairing ureteropelvic junction obstruction, noting that while it has similar success rates to laparoscopic pyeloplasty it allows more urologists to perform the minimally invasive procedure due to the robot's suturing abilities, though it is less cost effective than the pure laparoscopic approach.
1) The POPE study was a randomized, double-blind trial that assessed whether the NSAID diclofenac was effective in reducing post-operative pericardial effusion volume compared to placebo.
2) 196 patients with moderate to large pericardial effusions more than 7 days after cardiac surgery were randomized to receive either diclofenac or placebo for 14 days.
3) The primary outcome of mean pericardial effusion grade decrease from baseline to end of treatment showed no significant difference between the diclofenac and placebo groups. Secondary outcomes including late tamponade rates were also similar between groups.
4) The study concluded that NSA
This document discusses the use of radiosurgery techniques like Gamma Knife and CyberKnife for treating various brain tumors and vascular malformations. It provides details on the indications, dosimetry, and outcomes of these techniques for conditions like meningiomas, acoustic schwannomas, brain metastases, arteriovenous malformations (AVMs), and craniopharyngiomas. CyberKnife is described as having sub-millimeter accuracy similar to Gamma Knife but with more conformal dose distributions and the ability to treat larger or multiple lesions in a fractionated schedule. Indian studies show high rates of tumor control and low complication rates following radiosurgery for conditions like AVMs.
This document discusses radiation therapy accidents that occurred in France between 2003-2007. It describes several cases where errors in planning, equipment use, or quality assurance led to overdoses and patient complications. Key lessons learned include ensuring safety of treatment machines and software, continuous training, independent dose verification, and adapting quality assurance for new techniques. National reforms in France since then have focused on strengthening quality assurance programs, reporting systems, safety inspections, and developing a culture of safety in radiotherapy.
Bone sarcomas are rare cancers that can be curable if treated properly. The main types are osteosarcoma, Ewing sarcoma, and chondrosarcoma. Staging involves imaging and biopsy to determine tumor size, location, and spread. Multidisciplinary teams are needed for optimal care. Chemotherapy is important for osteosarcoma and Ewing sarcoma but not usually effective for chondrosarcoma. Neoadjuvant chemotherapy followed by surgery improves outcomes for osteosarcoma over surgery alone. Short and long chemotherapy regimens appear equally effective for operable osteosarcoma. Ifosfamide added to standard regimens improves outcomes for non-metastatic and
Similar to MI-TLIF - effect of age, BMI& comorbidity - 2013-04-06 - global spine congress, hong kong (20)
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central19various
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler Community Health Nursing A Canadian Perspective, 5th Edition TEST BANK by Stamler Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Study Guide Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Studocu Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Course Hero Community Health Nursing A Canadian Perspective, 5th Edition Answers Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Course hero Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Studocu Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Study Guide Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Ebook Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Questions Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Studocu Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Stuvia
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...
MI-TLIF - effect of age, BMI& comorbidity - 2013-04-06 - global spine congress, hong kong
1. MAST/MISS TLIF
effect of Age, BMI & Comorbidity in 200 patients
Petrus Stone, Neurosurgeon, Private Practice
Bloemfontein, South Africa
2013-04-06
2. Disclosures
MAST/MISS
Teaching on behalf
of Medtronic
Sponsored
attendance/travel
Study at my own
expense
No animals were
harmed
3. Literature
OPEN surgery
Age – more
complicated
BMI – more
complicated
Comorbidity - more
complicated
MI/MAST
Age – some studies
BMI – some studies
Co-morbidity – no
comparisons
5. Objective
To what degree does
co-morbidity affect
(short term) outcome
Use of Information
Patient/procedure
selection
Resource allocation
(length of stay, High
Care nights,
transfusion,
Physicians)
6. Patients / Materials And
Methods
200 consecutive degenerative TLIF
cases since 2009-08-31
Review case notes, hospital notes
(myself; senior nurse)
Excluded 6 cases
1x conversion to open
1x aborted procedure (revision of
open TLIF; screw holes too big)
1x cancellation on table (medical
aid interference)
3 trauma thoraco-lumbar cases
Stat analysis by UFS statistician
7.
8. Descriptive Stats – The Procedures
Surgical Time
Median 3 hours (1h25-9h30) (case
no 9; 3 levels)
Levels operated / Orange River TLIF
Class
1: 56.5%
A: 39%
B-F: 15%
2: 40%
A: 24.5%
TLIF sub-classes to accommodate for extra
B-F: 15.5%
work
3: 3.5% • a – no extra work
A: 2.5% • b – 30 minutes
• c – 60 minutes
B-F: 1.0% • Etc
Medtronic : n = 181 (90.5%) Examples
• Vertebroplasty;
Navigation: n = 8 (4%) • adjacent level discectomy;
Radiation exposure: median 3.1 • Same level wide decompression/lami;
minutes • Remove instrumentation
9. Descriptive Stats – Short term Outcome
Major Duration follow up: 30-880
• threatening to life or limb days
function
• Early revision surgery Length of ICU/High Care
Moderate stay
• prolonged hospital stay or 0 nights: 14,5%
outpatient treatment required
Minor 1 night: 75.5%
• inconvenient 2 nights: 9.5%
Length of postoperative
hospital stay
Median 3.9 days (0.9 to
17.9)
Need for transfusion
3.5%
10. Significant Complications
Moderate local complications %
Moderate systemic complications %
durotomies 7.5%
superficial sepsis 1.0% respiratory (chest infection, atelectasis,
sleep apnoea) 4.5%
iatrogenic end plate damage --> extra screws 0.5%
partial L5 weakness 1 (0.5%) 0.5%
arrhythmia 0.5%
persisting dysesthetic leg pain 0.5%
plunge with PAK needle (uncomplicated) 0.5% quadriceps hematoma 0.5%
screw too deep, Hb drop 0.5%
11.0% 5.5%
Major local complications % Major systemic complications %
decompression same stay 1.0% Pulmonary embolism 1.5%
fusion extension same stay 0.5% Unexpected epileptic fit 0.5%
severe L4 nerve root damage 0.5% tachy-arythmia -> cardioversion 0.5%
2.0% 2.5%
11. Age effect
Group name Age Group 2
Subgroup names <65 >65
Fisher’s Exact Test % % p-value Sig? Worse
Transfusion required 2.41 8.82 0.0969 - • Transfusion if >70:
Durotomy/CSF leak
Local (major)
6.63
1.81
11.76 0.2918 -
2.94 0.5284 -
15.8%
Local (moderate) 9.64 17.65 0.2241 - • LOS if >70: 3.8 vs
Local (minor) 0.60 0.00 1.0000 - 3.9 vs 5.7 days
• ICU stay (hours not
Local (All: M, M, M) 12.05 20.59 0.4077 -
Systemic (major) 2.41 2.94 1.0000 -
Systemic (moderate) 4.82 8.82 0.4028 - nights) if >65
Systemic (minor) 18.07 29.41 0.1577 -
Systemic (all) 25.30 41.17 0.1415 -
Local or Systemic (major) 4.22 5.88 0.6515 - Similar
Local or Systemic (moderate) 14.46 26.47 0.1914 - • Complications
Local or Systemic (minor) 18.67 29.41 0.1577 -
• Theater, Cutting,
Significant blood loss
1 night: 75.9%; 2
1 night: 75.76%; 2
Radiation time
nights: 6.63%
ICU nights nights 24.24% 0.0005 Yes
Kruskal-Wallis Test Median Median p-value Sig?
LOS postop (days) 3.80 4.90 0.0451 Yes
Theater Time (hours) 4.10 4.30 0.4115 -
Cutting Time (hours) 3.00 3.10 0.5770 -
ICU stay (hours) 20.50 21.70 0.0020 Yes
Radiation Exposure (mins) 3.10 3.10 0.6888 -
12. BMI effect
Group name BMI BMI Group 3
Subgroup names <35 >35 <35 35-40 >40
Fisher’s Exact Test % % p-value % % % p-value
Transfusion required 3.45 3.64 1.0000 3.45 0.00 7.69 0.2114
Durotomy/CSF leak 8.28 5.45 0.7642 8.28 6.90 3.85 0.9088
Local (major) 1.38 3.64 0.3038 1.38 6.90 0.00 0.1821 Worse
• ICU nights
Local (moderate) 12.41 7.27 0.4478 12.41 10.34 3.85 0.5757
Local (minor) 0.00 1.82 0.2750 0.00 0.00 3.85 0.1300
• Theater, Cutting, RE
Local (All: M, M, M) 13.79 12.73 0.1729 13.79 17.24 7.70 0.1149
Systemic (major) 2.76 1.82 1.0000 2.76 0.00 3.85 0.6015
Systemic (moderate)
Systemic (minor)
4.83
18.62
7.27
23.64
0.4985 4.83 6.90 7.69 0.6770
0.4338 18.62 24.14 23.08 0.6583
time
Systemic (all) 26.21 32.73 0.8746 26.21 31.04 34.62 0.9190
Local or Systemic (major) 4.14 5.46 0.7084 4.14 6.90 3.85 0.8519
Local or Systemic
(moderate) 17.24 14.54 0.6623 17.24 17.24 11.54 0.9036
Similar
Local or Systemic (minor)
ICU - zero nights
18.62
17.36
25.46
7.27
0.4338 18.62 24.14 26.93 0.6583
17.36 13.79 0.00
• Complications
ICU - one night 75.69 76.36 0.0381 75.69 68.97 84.62 0.0312
6.94 17.24 15.38
• Hospital LOS
ICU - two night 6.94 16.36
ICU nights
Kruskal-Wallis Test median median p-value p-value
LOS postop (days) 3.90 4.00 0.1588 3.90 3.90 4.40 0.3392
Theater Time (hours) 4.00 4.70 0.0209 4.00 4.60 5.20 0.0245
Cutting Time (hours) 2.80 3.50 0.0163 2.80 3.20 3.80 0.0216
ICU stay (hours) 21.00 22.00 0.1765 21.00 20.40 23.00 0.1687
Radiation Exposure (mins) 3.00 3.70 0.0153 3.00 3.00 5.30 0.0012
13. Comorbidity (ASA) effect
Group name ASA score ASA_Ex_BMI
Subgroup names ASA 1 ASA 2 ASA 3 ASA 1 ASA 2 ASA 3
Fisher’s Exact Test % % % p-value % % % p-value
Transfusion required 1.89 4.55 3.39 0.8867 1.59 4.69 0.00 0.5883
Durotomy/CSF leak 9.43 7.95 5.08 0.6999 7.94 7.81 0.00 1.0000
Local (major) 0.00 2.27 3.39 0.5810 0.00 3.13 0.00 0.4221 Summary
Local (moderate) 15.09 11.36 6.78 0.3714 14.29 10.16 0.00 0.5071
Local (minor) 0.00 0.00 1.69 0.5600 0.00 0.78 0.00 1.0000
More likely
Local (All: M, M, M) 15.09 13.63 11.86 0.4548 14.29 14.07 0.00 0.6124
Systemic (major) 3.77 2.27 1.69 0.7278 3.17 2.34 0.00 0.7349 • Minor & Moderate
Systemic (moderate) 1.89 6.82 6.78 0.4513 1.59 6.25 22.22 0.0491 systemic Cx
Systemic (minor) 13.21 21.59 23.73 0.3462 11.11 22.66 44.44 0.0255 • Theater & Cutting
Systemic (all) 18.87 30.68 32.20 0.6372 15.87 31.25 66.66 0.0358
time
Local or Systemic (major) 3.77 4.54 5.08 1.0000 3.17 5.47 0.00 0.8168
Local or Systemic (moderate) 16.98 18.18 13.56 0.6589 15.88 16.41 22.22 0.7344
• ICU stay? (integar
Local or Systemic (minor) 13.21 21.59 25.42 0.3462 11.11 23.44 44.44 0.0255 nights; not hours)
ICU - zero nights 26.42 12.64 6.78 26.98 9.45 0.00
ICU - one night 66.04 81.61 76.27 0.0115 66.67 81.10 66.67 0.0034
Similar occurrence
• Local Cx
ICU - two night 7.55 5.75 16.95 6.35 9.45 33.33
Kruskal-Wallis Test median median median p-value p-value
LOS postop (days) 3.80 3.90 4.00 0.2550 3.60 4.00 4.00 0.0857 • Major Systemic Cx
Theater Time (hours) 3.60 4.20 4.70 0.0063 3.50 4.50 4.10 0.0008 • Transfusion
Cutting Time (hours) 2.60 2.90 3.50 0.0153 2.40 3.30 2.90 0.0045 • ICU nights (hours
not nights)
ICU stay (hours) 20.20 21.10 22.00 0.1933 20.20 21.10 25.20 0.0362
Radiation Exposure (mins) 2.90 3.00 3.70 0.0509 2.90 3.30 2.90 0.1182
• LOS
14. Summary
Age
>70: longer LOS (4 vs 6 days)
>70: transfusion more likely
(15 vs 2%)
>65: ICU stay (hours not
nights)
ISQ complications
BMI
Longer procedure, theater
time, irradiation time
More ICU nights
ISQ complications & LOS
Comorbidity (ASA score)
Longer procedure
ISQ complications & LOS