Mobile application to analyse surgical experience Garcia-Estrada, Everardo; Morales-Gómez, Jesús A.; Delgado-Brito, Miriam ...
Neurocirugía (Barcelona. Internet. English ed.),
March-April 2020, 2020-03-00, Letnik:
31, Številka:
2
Journal Article
Recenzirano
To quantify the surgical experience acquired by residents in the neurosurgery specialisation programme over a 6-month period.
A total of 13 residents enrolled in the neurosurgery specialisation ...programme from February 2018 to July 2018. Over this period, the procedures residents were involved in and the role they played were documented in the Electronic Neurosurgical Register. Residents who withdrew from the specialisation programme were excluded.
A total of 530 procedures were performed during the study period. Observational learning and supervised practice are conducted primarily in the first and fifth years of residence, during which residents begin their training in emergency and elective surgeries, respectively. Residents are then able to independently perform emergency surgeries during the second and third years, and elective surgeries in the sixth year. Residents are able to instruct less experienced surgeons in the fourth year.
The Electronic Neurosurgical Register is an innovative technological tool that supports the fields of care, teaching and research. It records the exact number of patients who have undergone surgery at a particular time, providing valuable information for the proper management of resources. The data obtained can be used to identify areas of opportunity in the training of residents, facilitating the development of continuous improvement strategies in the training of competent neurosurgeons.
Cuantificar la experiencia quirúrgica obtenida por los residentes del programa de especialización en neurocirugía durante un periodo de 6 meses.
Un total de 13 residentes se registraron en el programa de especialización en neurocirugía en el periodo de febrero a julio de 2018. Durante este periodo se documentaron en el Registro Neuroquirúrgico Electrónico los procedimientos en los que cada residente participó y el rol que desempeñó. Los residentes que se retiraron del programa fueron excluidos.
Se realizaron 530 procedimientos en el periodo de estudio. El aprendizaje por observación y la práctica tutelada se realizan principalmente en el primer y quinto año de residencia, periodos durante los cuales el residente comienza su aprendizaje en el área cirugías de urgencias y electivas, respectivamente. Posteriormente es capaz de realizar cirugías de manera autónoma, en el bloque de urgencias, durante el segundo y tercer año; y en el bloque de cirugías electivas, en el sexto año. El residente es capaz de instruir a cirujanos menos experimentados en el cuarto año.
El Registro Neuroquirúrgico Electrónico es una herramienta tecnológica innovadora que apoya en los campos de asistencia, docencia e investigación. Permite conocer con exactitud la cantidad de pacientes que han sido intervenidos quirúrgicamente en un determinado momento, lo cual brinda información valiosa para el manejo adecuado de recursos. Los datos obtenidos permiten identificar áreas de oportunidad en el entrenamiento de los residentes, lo que permite el desarrollo de estrategias para la mejora continua en la formación de neurocirujanos competentes.
Acute cholecystitis in neutropenic patients Clemente-Gutiérrez, Uriel; Sánchez Morales, German Esteban; Moctezuma Velazquez, Paulina ...
Annals of hepato-biliary-pancreatic surgery,
08/2019, Letnik:
23, Številka:
3
Journal Article
Odprti dostop
The frequency of acute cholecystitis reported in neutropenic patients is between 0.4-1.65%. Clinical manifestations differ from general population as well as clinical approach, diagnosis and ...treatment. The aim of this work is to describe clinical characteristics, diagnostic approach, and outcomes of patients with hematological diseases that presented with neutropenia and fever associated with acute cholecystitis in a tertiary referral hospital.
We performed a retrospective analysis of patients with diagnosis of neutropenia and fever associated with acute cholecystitis in the period between January 2000 and January 2017. Quantitative variables were analyzed with mean and standard deviation, and qualitative variables with frequency and percentage.
During the study period, 2007 patients presented with neutropenia and fever. Twelve of them (0.59%) had associated acute cholecystitis. The most common hematologic disease among these patients was lymphoblastic leukemia. Acute acalculous cholecystitis was diagnosed in 6 cases (50%). Eleven patients (91.6%) had a severe presentation and cholecystostomy was performed in 9 (75%) cases. The main cause of mortality was septic shock (33.3%).
Treatment of acute cholecystitis in patients with neutropenia must be individualized. Cholecystostomy should be considered as a bridge therapy for an interval cholecystectomy.
We provide a separation principle for a class of non-linear time-varying systems. The only assumption we make on the state feedback control law is that it does not vanish as the states grow ...unboundedly. For the observer, we propose a design method based on the assumption that the system is transformable into a form affine in the unmeasured variable and a property of persistency of excitation. This assumption covers but is not restricted to the common observability condition that the vector field multiplying the unmeasured variable is separated from zero for all state values. Our separation principle relies on stability results for cascades systems.
In this paper, a class of time-delayed nonlinear systems with unknown parameters and unknown time-varying delays is considered. A high gain observer approach is proposed for simultaneous state ...observation and parameter identification. Sufficient conditions are obtained to ensure the boundedness of both observation and identification errors. Consequently a practical stability of the proposed observer is achieved. Moreover, an exponential stability of the observer is derived from the knowledge of time-delay. Simulation results are given to illustrate the performances of the proposed observer design under time-varying delay function and a piecewise unknown parameter.
The aim of this study was to establish safety ranges for the third vertebral artery segment (V3) for craneocervical procedures. Injury to V3 represents a potentially catastrophic complication. Its ...tortuous path and complex relationship with neighboring structures, increasing the risk. Ten male adult cadavers (20 vertebral arteries) with arterial infiltration of red latex were studied. The length, angles and anatomical measurements were obtained between the selected surgical landmarks and the portions of V3 segment. The horizontal portion has a length of 32.7 + or - 3.6 mm with an angulation of 115.1 + or - 8.3 degrees. The mean distances of the horizontal portion were: from the midline to the V3 groove of C1 posterior arch (24.7 + or - 6.3 mm); from C1 pars interarticularis to the V3 distal loop of V3 (8.9 + or - 1.4 mm). The vertical portion has a length 32.5 + or - 5.6 mm with an angulation of the proximal loop of 113.6 + or - 5.8 degrees. The mean distances between the C2 spinous process to the medial surface of the distal loop (43.8 + or - 4.2 mm); from the C1-C2 joint to the V3 vertical portion (9.5 + or - 1.5 mm); from C2 pars interarticularis to V3 in the C2 transverse foramen (6.5 + or - 3.4 mm); from C2 pars interarticularis to V3 in the C1 transverse foramen (17.5 + or - 4.5 mm). We reported four potential sites where V3 can be injured during four different surgical procedures: exposure of the posterior arch of C1, and pars interarticularis of C1 in the horizontal portion and exposure of the C1-C2 joint, and placement of C1-C2 transarticular screws one in the vertical portion. We provide measurements of redundancy and safety ranges to reduce the risk of injury to the V3 segment during craniocervical surgical procedures. KEY WORDS: Anatomy; Vertebral artery; V3 segment; Cervical spine; Spine surgery.
An adaptive interconnected observer and high order sliding mode (HOSM) control of Induction Motors (IMs) without mechanical sensors (speed sensor and load torque sensor) are proposed. The adaptive ...interconnected observer estimates fluxes, angular velocity, load torque and the stator resistance. The speed-flux control law is an original HOSM one: a sliding manifold is designed in order to ensure finite-time convergence of sliding variable and its high order time derivatives to zero in spite of uncertainties and perturbations. Stability based on Lyapunov theory is proved to guarantee the "observer-controller" stability. A contribution of the paper is the validation of the observer-controller for realistic three cases with nominal value of the external load disturbance : at low speed, at high speed, and under conditions of unobservability (low frequencies). Robustness with respect to parameters variations is proved and experimentally verified.
Fundamento: el vector del dengue se ha mantenido en la población de Camagüey en un nivel estable y en relación a las variaciones estacionales en los últimos años, a pesar de eso se observaron brotes ...epidémicos de dengue. Objetivo: identificar, actitudes, conocimientos y prácticas de la población sobre el dengue y su vector. Métodos: se realizó una investigación de tipo transversal y analítica durante el mes de octubre de 2015 en el municipio Camagüey. Se realizó una encuesta sobre actitudes, conocimientos y prácticas sobre el dengue y su vector a 270 personas. Las respuestas estuvieron basadas en la escala Likert del uno al cinco y su consistencia se evaluó con la técnica Alpha de Cronbach. Se determinaron los estadígrafos de tendencia central y dispersión, frecuencias absolutas y relativas. Para disminuir la dimensionalidad de las respuestas se realizó la técnica de componentes principales. Resultados: se encuestaron 270 personas, 144 del sexo femenino y 126 del sexo masculino con una edad promedio de 36±16 años. Los núcleos familiares estaban constituidos por 3±1 personas. No se manifestaron diferencias significativas entre las nueve áreas de salud. La promoción de salud fue adecuada, sobre todo por televisión y radio. Hubo desconocimiento de cómo controlar el vector. Las relaciones con los miembros de la campaña no son favorables, como principales riesgos se encontró la necesidad por parte de la población de guardar aguas en los hogares y la insuficiente distribución. Se reflejan actitudes favorables pero insuficiente responsabilidad social. Conclusiones: se identificaron, actitudes, conocimientos y prácticas sobre el dengue y su vector. Se evidencia la necesidad de perfeccionar el trabajo en el ámbito comunitario por parte de la población y de sus directivos.
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