Journal articles on the topic 'Operative plans'
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Hague, Christina, Marianne Aznar, Lei Dong, Alireza Fotouhi-Ghiam, Lip Wai Lee, Taoran Li, Alexander Lin, et al. "Inter-fraction robustness of intensity-modulated proton therapy in the post-operative treatment of oropharyngeal and oral cavity squamous cell carcinomas." British Journal of Radiology 93, no. 1107 (March 2020): 20190638. http://dx.doi.org/10.1259/bjr.20190638.
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Objective: To evaluate dosimetric consequences of inter-fraction setup variation and anatomical changes in patients receiving multifield optimised (MFO) intensity modulated proton therapy for post-operative oropharyngeal (OPC) and oral cavity (OCC) cancers. Methods: Six patients receiving MFO for post-operative OPC and OCC were evaluated. Plans were robustly optimised to clinical target volumes (CTVs) using 3 mm setup and 3.5% range uncertainty. Weekly online cone beam CT (CBCT) were performed. Planning CT was deformed to the CBCT to create virtual CTs (vCTs) on which the planned dose was recalculated. vCT plan robustness was evaluated using a setup uncertainty of 1.5 mm and range uncertainty of 3.5%. Target coverage, D95%, and hotspots, D0.03cc, were evaluated for each uncertainty along with the vCT-calculated nominal plan. Mean dose to organs at risk (OARs) for the vCT-calculated nominal plan and relative % change in weight from baseline were evaluated. Results: Robustly optimised plans in post-operative OPC and OCC patients are robust against inter-fraction setup variations and range uncertainty. D0.03cc in the vCT-calculated nominal plans were clinically acceptable across all plans. Across all patients D95% in the vCT-calculated nominal treatment plan was at least 100% of the prescribed dose. No patients lost ≥10% weight from baseline. Mean dose to the OARs and max dose to the spinal cord remained within tolerance. Conclusion: MFO plans in post-operative OPC and OCC patients are robust to inter-fraction uncertainties in setup and range when evaluated over multiple CT scans without compromising OAR mean dose. Advances in knowledge: This is the first paper to evaluate inter-fraction MFO plan robustness in post-operative head and neck treatment.
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Akhtari, Mani, Denley Ming Kee Yuan, Eugene C. Endres, Bao Minh Tran, and Todd A. Swanson. "Effect of incorporation of preoperative CT scan on bladder doses and irradiated volume in postprostatectomy radiation therapy (pPRT)." Journal of Clinical Oncology 35, no. 6_suppl (February 20, 2017): e561-e561. http://dx.doi.org/10.1200/jco.2017.35.6_suppl.e561.
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e561 Background: pPRT increases local control, biochemical progression free survival, and even overall survival in patients with adverse features undergoing prostatectomy. The Radiation Therapy Oncology Group (RTOG) consensus definition of the clinical target volume (CTV) in 2010 was based on patterns of failure and anatomy without consideration of pre-operative imaging. This results in large volumes of bladder in the treatment field. Our study evaluates whether incorporation of pre-operative prostate volume can reduce the post-operative CTV and minimize dose to adjacent normal tissue. Methods: We reviewed records of all patients with available pre-operative pelvic CT scans treated at our institution with pPRT. The pre-operative CT scan was fused to the simulation CT. Post-operative CTV (CTV1) was delineated based on RTOG guidelines. A separate CTV (CTV2) was constructed, based on the intact prostate and proximal seminal vesicles. Plans were constructed for each CTV and doses to rectum, bladder, and penile bulb calculated, as well as concordance between the two CTVs and planning target volumes (PTVs). Paired student’s t-test was used to calculate difference between doses in the two different plans. Results: 10 patients’ plans were analyzed. Dosimetric parameters are shown in table 1. Volume of the bladder receiving 65 Gy or higher (V65) was significantly higher in CTV1. As would be expected, there were no significant differences in dose to either the rectum or penile bulb. Additionally, there was on average only 39% overlap between the CTVs and 60% between the PTVs in the two plans. Conclusions: Utilization of the pre-operative pelvic CT scan can aid in more accurate delineation of the CTV/PTV in prostate bed radiation therapy and decrease the bladder dose. As many patients at risk for pPRT have had this imaging performed preoperatively, in accordance with guidelines, incorporation of this data appears prudent. These findings need to be validated in a larger cohort. [Table: see text]
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Perlow, Haley, Rahul Prasad, Michael Siedow, Yevgeniya Gokun, Joseph McElroy, Jennifer Matsui, Catherine Cadieux, et al. "RADT-31. 68GA-DOTATATE PET VERSUS MRI-BASED TREATMENT PLANNING FOR POST-OPERATIVE AND INTACT MENINGIOMA: A DOSIMETRIC ANALYSIS." Neuro-Oncology 24, Supplement_7 (November 1, 2022): vii56. http://dx.doi.org/10.1093/neuonc/noac209.221.
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Abstract Background Nearly all meningiomas express somatostatin receptor 1/2 (SSTR1/SSTR2); therefore, SSTR ligands such as 68Ga-DOTATATE can be utilized for meningioma radiotherapy treatment planning. Incorporation of 68Ga-DOTATATE PET assists with target delineation and may reduce the dose to organs-at-risk (OARs). We hypothesize that 68Ga-DOTATATE PET-based treatment plans will reduce dose to OARs when compared to MRI-based plans. METHODS All treatment plans were rendered on computed tomography (CT) planning datasets, using RapidArc and 6MV photon energy. Two arcs were positioned on the coplanar axis with alternated collimator settings of 0 and 90 degrees to promote MLC sparing with a third unique vertex arc chosen independently to spare normal brain tissue and associated organs at risk (OAR). For MRI structures, a 1 cm expansion from the gross tumor volume (GTV) created a clinical treatment volume (CTV)60. A 2 cm expansion created a CTV54. For PET structures, a 1 cm expansion from the GTV created a CTV60. A 3 mm isotropic expansion created planning treatment volumes (PTVs). Plans were optimized such that Dmax to brainstem remained limited to 60Gy or less and Dmax to optic structures was limited to 54Gy or less. RESULTS 18 meningioma patients were included (9 post-operative, 9 intact). The mean PTV volume using MRI was 258 ccs (306 ccs for post-operative, 210 ccs for intact), and the mean PTV volume using PET was 60 ccs (97 ccs for post-operative, 91 ccs for intact). The mean radiation dose to both optic nerves, the optic chiasm, both hippocampi, and the brainstem was reduced favoring PET-based treatment plans for both post-operative and intact patients. CONCLUSION Our study shows that incorporation of 68Ga-DOTATATE PET can reduce dose to OARs for post-operative and intact patients, and this difference may translate to reduced toxicity. 68Ga-DOTATATE PET guided radiation treatments are worthy of future prospective investigation.
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Ou-Yang, David, Evalina L. Burger, and Christopher J. Kleck. "Pre-Operative Planning in Complex Deformities and Use of Patient-Specific UNiD™ Instrumentation." Global Spine Journal 12, no. 2_suppl (April 2022): 40S—44S. http://dx.doi.org/10.1177/21925682211055096.
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Study Design Review of current literature and authors experience. Objective Pre-operative planning is an integral part of complex spine surgery. With the advent of computer-assisted planning, multiple surgical plans can be evaluated utilizing alignment parameters, and the best plan for individual patients selected. However, the ability to evaluate and measure surgical correction goals intraoperatively are still limited. The use of patient-specific UNiD rods, created based on pre-operative plans, provided an initial tool for implementation of pre-operative plans in the operative setting. Methods A literature review for the use of patient-specific UNiD rods in thoracolumbar spine complex surgery was performed. The articles were selected and reviewed for the initial experience/outcomes of these techniques. Further, the initial experience of the authors at The University of Colorado is described. Results The use of UNiD patient-specific rods, in combination with pre-operative planning has been shown to provide a higher rate of patients with spinopelvic alignment parameters within currently accepted ranges. This includes improvement of sagittal vertical axis (SVA) < 50 mm and pelvic incidence (PI)–lumbar lordosis (LL) = ± 10°. Multiple authors have shown improvement in pelvic tilt to age adjusted values but note continued difficulties in obtaining correction goals. Conclusions The use of pre-operative planning software and UNiD patient-specific rods has been shown to improve surgeon’s ability to achieve spinopelvic alignment parameters, specifically SVA and PI-LL, along with other possible benefits. Further research is needed regarding long-term value of the technology.
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Sólyom, Barbara. "Digitális esélyegyenlőség – Az eMultiCoop Szociális Szövetkezet." Információs Társadalom 17, no. 2 (October 24, 2017): 78. http://dx.doi.org/10.22503/inftars.xvii.2017.2.6.
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Jelen esettanulmány a digitális esélyegyenlőtlenség mérséklésére irányuló kezdeményezések munkájába kíván betekintést engedni a Nógrád megyei Szécsény térségében működő eMultiCoop Szociális Szövetkezet tevékenységén keresztül. Tanulmányunkban bemutatjuk a Szövetkezet létrejöttét és működését, főbb jellemzőit és jövőbeli terveit. Empirikus kutatásunk során meglévő szervezeti dokumentumok, mélyinterjúk és egy fókuszcsoport segítségével igyekeztünk választ találni kérdéseinkre.
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Digital equality – eMultiCoop Social Co-operative
This case study describes the initiative to mitigate digital inequality. The eMultiCoop Social Co-operative in the Szécsény region of Nógrád County is striving to achieve this goal. In our study we present the establishment and operation of the Co-operative, its main characteristics, and future plans. In our empirical research we sought the answers to our questions using organizational documents, interviews and a focus group.
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Mićo Klepo, Vladimir Mikuličić, and Zdenko Šimić. "POWER PLANT MODEL WITH ENVIRONMENTAL CONDITIONS INCLUDED IN THE ELECTRIC POWER SYSTEM RELIABILITY AND AVAILABILITY MODEL." Journal of Energy - Energija 58, no. 1 (September 15, 2022): 26–55. http://dx.doi.org/10.37798/2009581291.
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This work presents the results of the theoretical-methodological elaboration of the model by virtue of which the generating units are included in the models for calculation of reliability and availability of the electric power system in the operative plans of its operation. The operation, that is, the operative features of these generating units, and therewith also their reliability and availability, are influenced by the state of the environment, mostly by adverse weather conditions. The generating units model with environmental conditions included also introduces into the calculation of indicators of the electric power system reliability and availability, along with the time dependence, the dependence on the environmental conditions which the unit is exposed to during duration of the period of such conditions.
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Sierts, M., E. Seravalli, E. Brand, M. Maspero, S. David, M. E. P. Philippens, E. H. J. Voormolen, and J. J. C. Verhoeff. "RADT-08. DOSIMETRIC FEASIBILITY OF DIRECT POST-OPERATIVE MRI-LINAC-BASED STEREOTACTIC RADIOSURGERY FOR RESECTION CAVITIES OF BRAIN METASTASES." Neuro-Oncology 24, Supplement_7 (November 1, 2022): vii50. http://dx.doi.org/10.1093/neuonc/noac209.198.
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Abstract Background Post-operative stereotactic radiosurgery (SRS) of patients with brain metastases with single resection cavities is typically planned on a post-recovery MRI, 4-6 weeks after resection. However, meanwhile the intracranial metastasis may (re-)grow, and postponing adjuvant systemic treatment increases chance on extracranial progression as well. Anticipating direct post-operative SRS to minimize this interval would enable rapid start of systemic therapy. In this study, we considered treatment with MRI-Linac (MRL) SRS, because of the possibility to execute the post-operative MRI and SRS treatment combined on the MRL instead of on two separate systems, improving logistics and increasing patient comfort. However, it is unclear whether MRL-based SRS may be feasible from a dosimetric perspective. This study aims to shed light on the dosimetric feasibility of MRL-based SRS. METHODS We simulated MRL treatments including thirteen patients with resectable single brain metastases treated with single fraction CT-Linac (CTL) SRS. We therefore contoured direct post-operative gross tumor volumes (GTV) and compared them to post-recovery MRI GTV. Next, we compared a non-coplanar VMAT technique for CTL (ncVMAT) to a coplanar IMRT technique for MRL (cIMRT), creating three plans per patient: a ncVMAT plan and a cIMRT plan for the direct post-operative GTV, and a post-recovery ncVMAT plan as current clinical standard. RESULTSCompared to GTVs defined on direct post-operative MRI, on post-recovery MRI 15.5% of cavities shrunk by > 2cc, and 46% expanded by > 2cc. Although direct post-operative ncVMAT plans had lower median gradient index and higher median V3Gy of the skin, they were clinically acceptable according to clinical guidelines. CONCLUSION Although slightly inferior to non-coplanar CTL plans, direct post-operative MRL-based SRS for resection cavities of brain metastases is dosimetrically acceptable, at the trade-off between increased patient comfort and logistics. Additionally, MRL-based SRS enables substantially earlier start with adjuvant systemic therapies, thereby maximizing tumor control.
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Henrioud, J. M., and A. Bourjault. "Computer Aided Assembly Process Planning." Proceedings of the Institution of Mechanical Engineers, Part B: Journal of Engineering Manufacture 206, no. 1 (February 1992): 61–66. http://dx.doi.org/10.1243/pime_proc_1992_206_056_02.
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A method allowing a systematic generation of assembly plans for mechanical products is presented. It involves a product modelling that includes non-assembly relevant features like labelling, checking, etc. Assembly plans are represented by assembly trees and are produced through interactive software written in PROLOG. An analysis of assembly constraints is also presented with a distinction between operative constraints dealing with the feasibility of the operations involved in the different assembly plans and the strategic constraints dealing with the global structure of the plans. An automatic transformation of the resulting assembly plans into one or several precedence graphs is given as well as a generalization of the classic precedence graphs in precedence hypergraphs able to represent disjunctive precedence conditions.
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Karki, Bir Bahadur. "Strategic Planning in Co-operative Sector: A Study on Dairy." Journal of Nepalese Business Studies 2, no. 1 (April 2, 2007): 72–80. http://dx.doi.org/10.3126/jnbs.v2i1.57.
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Dairy co-operatives are found everywhere in both developed and developing countries. In developing countries, it is one of the income sources of their rural economy whereas in developed countries it takes as a sustainable business. These countries face different types of problems. Developing countries focus on increase in production volume of milk and milk product, and developed countries do on enhancement of milk product, brand, and merger of dairy co-operatives. Dairy cooperatives have been getting various opportunities as well as facing different challenges. They are going to formulate different types of strategic planning to cope with these challenges and to get success. Strategic plans of dairy cooperatives in developing countries are, generally to increase production volume of buffalo milk, bring about the internal improvement in cooperative societies, reduce cost of production, provide quality service to consumer through skill, trained and educated manpower, and e-commerce. Strategic plan of developed countries is quite different from that of developing countries. Their strategic plans are to merge different dairy cooperative societies / institutions into a dairy cooperative, and compete in the global market with quality of products.
Journal of Nepalese Business Studies Vol.2(1) 2005 pp.72-80
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Maples, Mark F. "Habitat Conservation Plans." Texas A&M Journal of Property Law 1, no. 2 (December 2013): 245–65. http://dx.doi.org/10.37419/jpl.v1.i2.5.
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Both sides of the debate have strong reasons for disliking section 10. After a brief discussion of HCPs and their history in Part II, this Comment will evaluate the best arguments from both landowners and preservationists in Parts III and V. Parts IV and VI will discuss case history supporting both sides. Part VII will then discuss the philosophy of eco-pragmatism and recommend that resourcists and landowners should adopt some of its principles regarding adaptive management and HCPs. Within this Section, the Author will argue that the advantages to pragmatism in constitutional law that Daniel Farber submitted in 1988 are perfectly suited to the conflicts presented by modern HCPs, and it is essential for landowners to understand this. Further, the ESA must be revised to make HCPs less complicated and more cost-effective for landowners, so that it will be reasonable for them to develop operative plans. HCPs are really the only viable option we have for addressing the needs of vastly different competing interests. These tools for conservation must be embraced and strengthened, so they can successfully and efficiently preserve species.
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Dixon, Jennifer E., Neil J. Ericksen, Janet L. Crawford, and Philip Berke. "Planning under a Co-operative Mandate: New Plans for New Zealand." Journal of Environmental Planning and Management 40, no. 5 (September 1997): 603–14. http://dx.doi.org/10.1080/09640569711967.
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Selmi, H., and H. Osmani. "Improving the detail of post-operative plans in general surgical patients." International Journal of Surgery 23 (November 2015): S44. http://dx.doi.org/10.1016/j.ijsu.2015.07.172.
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Cho, Young Jae, In Seok Park, Jungbin Kim, Hyun Jin Cho, Geum Hee Gwak, Keun Ho Yang, Byung Noe Bae, and Ki Hwan Kim. "Factors Predicting the Need for Early Surgical Intervention for Small Bowel Obstruction." Annals of Coloproctology 36, no. 4 (August 31, 2020): 223–28. http://dx.doi.org/10.3393/ac.2019.09.30.
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Purpose: Small bowel obstruction (SBO) is a common disease that requires hospitalization. The most common cause of SBO is postoperative adhesion. Delayed timing of operations in patients who need surgical intervention results in mortality or morbidity. A number of studies on SBO have established criteria for emergency surgery. However, few objective clinical parameters are available for screening patients who need a delayed operation. Therefore, we analyzed factors that affect the clinical course of SBO to select appropriate therapeutic plans for reducing the risk of complications in these patients.Methods: We investigated the clinical characteristics of patients admitted to the surgery department of our hospital between January 1, 2015, and December 31, 2016, who were diagnosed with SBO. Patients were divided into an operative treatment group (n = 12) and a conservative treatment group (n = 96). We compared clinical characteristics between the 2 groups.Results: The operative treatment group underwent more operations before SBO than the conservative treatment group (P = 0.007). Initial leukocyte counts (P = 0.004) and C-reactive protein (CRP) levels (P = 0.028) were elevated in the operative group. Body mass index (BMI) was lower in the operative group (P = 0.013).Conclusion: The number of operations before SBO, leukocyte counts, CRP levels, and BMI were useful parameters for selecting patients who needed an urgent operation for SBO.
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Schooneveldt, Gerben, Hana Dobšíček Trefná, Mikael Persson, Theo M. de Reijke, Klas Blomgren, H. Petra Kok, and Hans Crezee. "Hyperthermia Treatment Planning Including Convective Flow in Cerebrospinal Fluid for Brain Tumour Hyperthermia Treatment Using a Novel Dedicated Paediatric Brain Applicator." Cancers 11, no. 8 (August 15, 2019): 1183. http://dx.doi.org/10.3390/cancers11081183.
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Hyperthermia therapy (40–44 °C) is a promising option to increase efficacy of radiotherapy/chemotherapy for brain tumours, in particular paediatric brain tumours. The Chalmers Hyperthermia Helmet is developed for this purpose. Hyperthermia treatment planning is required for treatment optimisation, but current planning systems do not involve a physically correct model of cerebrospinal fluid (CSF). This study investigates the necessity of fluid modelling for treatment planning. We made treatments plans using the Helmet for both pre-operative and post-operative cases, comparing temperature distributions predicted with three CSF models: a convective “fluid” model, a non-convective “solid” CSF model, and CSF models with increased effective thermal conductivity (“high-k”). Treatment plans were evaluated by T90, T50 and T10 target temperatures and treatment-limiting hot spots. Adequate heating is possible with the helmet. In the pre-operative case, treatment plan quality was comparable for all three models. In the post-operative case, the high-k models were more accurate than the solid model. Predictions to within ±1 °C were obtained by a 10–20-fold increased effective thermal conductivity. Accurate modelling of the temperature in CSF requires fluid dynamics, but modelling CSF as a solid with enhanced effective thermal conductivity might be a practical alternative for a convective fluid model for many applications.
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Soon, David SC, Yit J. Leang, and Charles HC Pilgrim. "Operative versus non-operative management of blunt pancreatic trauma: A systematic review." Trauma 21, no. 4 (September 10, 2018): 252–58. http://dx.doi.org/10.1177/1460408618788111.
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Introduction Motor vehicle crashes are common causes of blunt abdominal trauma in the 21st century. While splenic trauma occurs very frequently and thus there is a well-established treatment paradigm, traumatic pancreatic injuries are relatively infrequent, occurring in only 3–5% of traumas. This low incidence means physicians have reduced experience with this condition and there is still ongoing debate with regards to the best practice in managing pancreatic trauma. During severe trauma, the pancreas can be injured as a consequence of blunt and penetrating injury. This has an estimated mortality rate ranging from 9 to 34%. Methods A systematic review was performed using three scientific databases: Embase, Medline and Cochrane and in-line with the PRISMA statement. We included only articles published in English, available as full text and describing only adults. Keywords included: pancrea*, trauma, blunt, operative management and non-operative management. Results Three studies were found that directly compared operative versus non-operative management in blunt pancreatic trauma. Length of stay, mortality and rate of re-intervention were lower in the non-operative group compared to the operative group. However, the average grade of pancreatic injury was lower in the non-operative group compared to the operative group. Discussion Our results revealed that patients who undergo non-operative management tend to have lower grade of injuries and patients with higher grade of injury tend to be managed in an operative fashion. This could be likely due to the fact that higher grade of pancreatic injuries is often accompanied by other injuries such as hollow viscus injury and therefore require operative intervention. Conclusion Non-operative management is a safe approach for low-grade blunt pancreatic trauma without ductal injuries. However, more evidence is required to improve our understanding and treatment plans. We suggest a large international multicentre study combining data from multiple international trauma centres to collect adequate data.
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Haklar, Uğur, Ertuğrul Ulusoy, and Tayfun Şimşek. "Radiological Comparison and Functional Outcomes of Robotic Assisted Medial Unicompartmental Knee Arthroplasty with Metal-Backed Onlay Tibial Components." Orthopaedic Journal of Sports Medicine 5, no. 2_suppl2 (February 1, 2017): 2325967117S0010. http://dx.doi.org/10.1177/2325967117s00101.
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Robotic surgery studies have been increasing considering operative advantages on reducing error and improving functional success in partial knee arthroplasty. We have been curious whether planning and application of knee implants assisted robotically correspond to their radiological outcomes. Moreover, we were also curious about functional outcomes. Methods: Data were prospectively collected in 42 patients (62 knees) who underwent MAKOplasty, robotic assisted unicondylar medial knee arthroplasty, between June 2013 – December 2015 For evaluation of components’ accuracy, intra-operative robotic analyses were compared with post-operative radiographic alignment. Statistical analysis was done on these values using paired T-Test. Additionally in our clinic with an average follow-up time of 22 months. Clinical outcomes were evaluated with American Knee Society Scoring (AKSS) System. Results: Difference between intra-operative robotic plans and post-operative radiographs was evaluated for the flexion angle of the femoral component, posterior slope of the tibial component and the varus angle of the tibial component. A novel method is used to evaluate the varus angle of the tibial component. All of the errors are <=0.5°, approximately 86% of the errors are <=0.3° while 18% of errors are zero. No significant difference was observed statistically (paired t-test, p<0.05). Post-operatively all 42 patients had excellent knee scores (mean, 99.67) and functional scores (mean, 99.04) on AKSS while pre-operatively 2 were scored fair, 40 were score poor, and functionally 14 were scored fair and 28 were scored poor. Conclusion: The difference between robotic plans and radiographic outcomes was statistically not significant where metal-backed onlay tibial components were used.
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Campero, Alvaro, Guillermo Román, Matías Baldoncini, and Juan F. Villalonga. "Supracerebellar-Infratrochlear Approach for Midbrain Cavernoma: 3-Dimensional Operative Video." Operative Neurosurgery 19, no. 2 (December 7, 2019): E151. http://dx.doi.org/10.1093/ons/opz386.
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Abstract Gravity retraction is an underutilized adjunct in neurosurgery. Gravity is gentler than retractor blades; it does not cause brain edema or injury, and it tends to open natural subarachnoidal plans to deep lesions.1-3 A good example of this is the supracerebellar infratrochlear approach4-7 in semisitting position for resection to a midbrain cavernous malformation. This approach was selected because the cavernous malformation was 1 mm under the lateral mesencephalic sulcus. The procedure was developed with the use of transesophageal ultrasound and physiological neuromonitoring. We present a 3-dimensional video of this surgery with all the tricks and details used in the procedure. The patient consented to the procedure and to publication of the photos and surgical video.
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Meek, T., R. Clyburn, Z. Fritz, D. Pitcher, A. Ruck Keene, and P. J. Young. "Implementing advance care plans in the peri‐operative period, including plans for cardiopulmonary resuscitation: Association of Anaesthetists clinical practice guideline." Anaesthesia 77, no. 4 (February 15, 2022): 456–62. http://dx.doi.org/10.1111/anae.15653.
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Banga, R., S. Mirza, SA Douglas, and KP Gibbin. "Do trainees follow up their operative cases? An audit of myringoplasty follow-up." Bulletin of the Royal College of Surgeons of England 88, no. 5 (May 1, 2006): 171–73. http://dx.doi.org/10.1308/147363506x106161.
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With the reduction in working hours brought on by Calmanisation and the European Working Time Directive there has been a simultaneous reduction in the number of hours of training received by SpRs. There are also plans to further shorten higher surgical training in the near future. In light of these facts it is important to identify any areas that can maximise training opportunities and learning. There are several papers evaluating training in the theatre and outpatient setting but very few of these include detailed information on the level of follow-up of SpRs' operative cases.
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LoPresti, Melissa, Bradley Daniels, Edward P. Buchanan, Laura Monson, and Sandi Lam. "Virtual surgical planning and 3D printing in repeat calvarial vault reconstruction for craniosynostosis: technical note." Journal of Neurosurgery: Pediatrics 19, no. 4 (April 2017): 490–94. http://dx.doi.org/10.3171/2016.10.peds16301.
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Repeat surgery for restenosis after initial nonsyndromic craniosynostosis intervention is sometimes needed. Calvarial vault reconstruction through a healed surgical bed adds a level of intraoperative complexity and may benefit from preoperative and intraoperative definitions of biometric and aesthetic norms. Computer-assisted design and manufacturing using 3D imaging allows the precise formulation of operative plans in anticipation of surgical intervention. 3D printing turns virtual plans into anatomical replicas, templates, or customized implants by using a variety of materials. The authors present a technical note illustrating the use of this technology: a repeat calvarial vault reconstruction that was planned and executed using computer-assisted design and 3D printed intraoperative guides.
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Woo, S., C. Freeman, A. Desrochers, K. Rans, B. E. Chwyl, N. Parker, and B. J. Debenham. "Comparison of Primary Radiation Therapy Plans to Post-Operative Radiation Therapy Plans in Patients with Stage III or IV Oropharyngeal Cancer." International Journal of Radiation Oncology*Biology*Physics 99, no. 2 (October 2017): E332—E333. http://dx.doi.org/10.1016/j.ijrobp.2017.06.1395.
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El Shafie, Rami, Eric Tonndorf-Martini, Daniela Schmitt, Dorothea Weber, Aylin Celik, Thorsten Dresel, Denise Bernhardt, et al. "Pre-Operative Versus Post-Operative Radiosurgery of Brain Metastases—Volumetric and Dosimetric Impact of Treatment Sequence and Margin Concept." Cancers 11, no. 3 (March 1, 2019): 294. http://dx.doi.org/10.3390/cancers11030294.
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Background: Pre-operative radiosurgery (SRS) preceding the resection of brain metastases promises to circumvent limitations of post-operative cavity SRS. It minimizes uncertainties regarding delineation and safety margins and could reduce dose exposure of the healthy brain (HB). Methods: We performed a systematic treatment plan comparison on 24 patients who received post-operative radiosurgery of the resection cavity at our institution. Comparative treatment plans were calculated for hypofractionated stereotactic radiotherapy (7 × 5 Gray (Gy)) in a hypothetical pre-operative (pre-op) and two post-operative scenarios, either with (extended field, post-op-E) or without the surgical tract (involved field, post-op-I). Detailed volumetric comparison of the resulting target volumes was performed, as well as dosimetric comparison focusing on targets and the HB. Results: The resection cavity was significantly smaller and different in morphology from the pre-operative lesion, yielding a low Dice Similarity Coefficient (DSC) of 53% (p = 0.019). Post-op-I and post-op-E targets showed high similarity (DSC = 93%), and including the surgical tract moderately enlarged resulting median target size (18.58 ccm vs. 22.89 ccm, p < 0.001). Dosimetric analysis favored the pre-operative treatment setting since it significantly decreased relevant dose exposure of the HB (Median volume receiving 28 Gy: 6.79 vs. 10.79 for pre-op vs. post-op-E, p < 0.001). Dosimetrically, pre-operative SRS is a promising alternative to post-operative cavity irradiation that could furthermore offer practical benefits regarding delineation and treatment planning. Comparative trials are required to evaluate potential clinical advantages of this approach.
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Beria, Paolo, Alberto Bertolin, and Raffaele Grimaldi. "Integration between Transport Models and Cost-Benefit Analysis to Support Decision-Making Practices: Two Applications in Northern Italy." Advances in Operations Research 2018 (2018): 1–16. http://dx.doi.org/10.1155/2018/2806062.
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Decisions on transport plans and projects involve relevant public investments and may also determine radical changes in users’ costs. Unfortunately, it is not rare that—especially at the strategic planning stage—decisions on alternative projects or scenarios are made on a qualitative basis or, at best, by setting some indicators and verifying how much they reach the politically decided targets (e.g., “increasing the use of bicycles by 10%”). In order to reduce subjectivity, a more quantitative and comprehensive approach to the evaluation is needed. A Cost-Benefit Analysis is a tool commonly used to assess public expenditure, but its application to mobility plans introduces further practical and theoretical complexities. In this paper, we will thus try to contribute to the topic of the assessment of both sustainable mobility transport plans and infrastructure projects by presenting the operative application of a CBA methodology that is, at the same time, theoretically coherent and rich in outputs to support the decision-maker. Moreover, we will discuss the possible use of GIS software in order to provide to the decision-makers a clear and immediate “picture” of the effects on the network linked to different scenarios. The structure is as follows. Firstly, we discuss the complexities involved in the evaluation of plans with respect to a single infrastructure. Secondly, we introduce the available approaches for the assessment of consumer surplus, namely, the Rule of Half and the logsum function method, which allow the perfect integration between CBA and transport models. Thirdly, we present, through some operative case studies, the methodologies applied to the assessment and the network effects visualization of the urban mobility plan and new infrastructures. Finally, we underline how we can make the results more understandable to politicians, policy-makers, stakeholders, and citizens and in general improve the transparency and the awareness of the choices.
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Selmi, H., and H. Habib. "An audit to improve the quality of post-operative plans for orthopaedic trauma patients." International Journal of Surgery 55 (July 2018): S81—S82. http://dx.doi.org/10.1016/j.ijsu.2018.05.384.
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Ledesma González, Oswaldo, and Juan Israel García Cruz. "LOS PLANES DE MODERNIZACIÓN, MEJORA E INCREMENTO DE LA COMPETITIVIDAD DE PRIMERA GENERACIÓN DE CANARIAS: UNA APROXIMACIÓN ANALÍTICA DESCRIPTIVA." Cuadernos de Turismo, no. 48 (December 10, 2021): 95–122. http://dx.doi.org/10.6018/turismo.492681.
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Dentro de la política turística en Canarias, los Planes de Modernización, Mejora e Incremento de la Competitividad se posicionaron como un instrumento fundamental para la renovación de las áreas turísticas. Planteado como un híbrido entre un plan estratégico y un instrumento de ordenación urbanística, su regulación insta a la concreción de un modelo turístico para el ámbito de actuación sobre el que interviene. No obstante, al menos los de primera generación, centrarían la renovación en la intervención física, dejando al resto de operativas en un segundo plano. El presente trabajo tiene tres objetivos: exponer las características generales de los planes; realizar una clasificación de los planes en función del momento de elaboración y aprobación, considerando el marco normativo vigente en cada momento; y realizar un estudio pormenorizado de los planes de primera generación, como caso práctico con mayor recorrido, a fin de evidenciar el peso que la operativa urbanística ha tenido en ellos en detrimento de otras operativas. Within the tourism policy in the Canary Islands, the Plans for Modernization, Improvement and Increase of the Competitiveness were positioned as a fundamental instrument for the renovation of tourist areas. Posed as a hybrid between a strategic plan and an urban planning instrument, its regulation urges the concretion of a tourism model for the field of action on which it intervenes. However, at least the first generation, would focus the renovation on physical intervention, leaving the rest of operations in the background. The present work has three objectives: expose the general characteristics of the plans; make a classification of the plans according to the time of elaboration and approval, considering the regulatory framework in force at each moment; and carry out a detailed study of the first generation plans, as a longer case study, in order to demonstrate the weight that the urban planning operation has had on them to the detriment of others operation.
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Ling, Ted Chen-Tai, Jerry Monroe Slater, Rachel Mifflin, Prashanth Nookala, Roger Grove, Anh Ly, Baldev Patyal, Jerry D. Slater, and Gary Yang. "A comparison of proton and photon radiotherapy in reducing cardiac exposure for patients receiving radiation therapy for distal and esophagogastric junction cancer." Journal of Clinical Oncology 32, no. 3_suppl (January 20, 2014): 167. http://dx.doi.org/10.1200/jco.2014.32.3_suppl.167.
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167 Background: Recent studies indicate that radiation exposure to heart may have a greater impact on perioperative cardiac morbidities than do other clinical factors. The purpose of this study is to investigate dose distributions of proton and photon treatment plans in patients (pts) with distal and esophagogastric junction (GEJ) carcinoma, focusing specifically on dose reduction to cardiac structures. Methods: Ten pts between 2010 and 2013 were included in this study. Three separate plans were generated for each patient: 3D proton plan, 3D photon plan, and Intensity modulated radiotherapy (IMRT) photon plan. The clinical target volume (CTV) consisted of the pre-operative extent of tumor plus a 10mm manual expansion in all directions. The planning target volume (PTV) was generated by a further expansion on the CTV ranging from 10-15mm. A dose of 50.4Gy given in 28 fractions was delivered to the PTV. All plans were optimized to allow 90% isodose coverage of at least 95% of the PTV. Dose-volume histograms were calculated and analyzed in order to compare plans between the three modalities. ANOVA and two-tailed paired t-tests were performed for all data parameters. Results: The 3D proton plans showed decreased dose to partial volumes of the entire heart, arteries, valves, atria, and ventricles in comparison to both the IMRT and 3D photon plans (see Table). The IMRT plans showed decreased dose delivered to the LAD artery, pericardium, and atria in comparison to the 3D photon plans (see Table). Conclusions: For pts receiving radiation therapy for distal esophageal and GEJ cancer, proton plans are technically feasible with adequate coverage while resulting in lower dose to cardiac structures. This may result in decreased cardiac toxicity and less complications in a multimodality setting. [Table: see text]
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Danielsson, PhD, Erna. "The value of crisis plans." Journal of Emergency Management 18, no. 4 (July 1, 2020): 281–93. http://dx.doi.org/10.5055/jem.2020.0474.
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Objective: This case study elaborates on the theme of crisis planning and addresses the question of the value of crisis plans and for whom. Method: This study is based on the data collected during a water pollution incident and consists of interviews, notes, and observations at a Municipal Council, County Administrative Board, and County Council in Sweden.Result: Merton’s concept of manifest and latent function offers a new understanding in the discussion of crisis plans. The result is then related to how known the place, task, and situation are to them. The manifest function implies that preparing crisis plans are supposed to direct officials in how to act when a crisis occurs. However, the plan was not made by or intended for the operative personnel who handled the water pollution crisis. Rather, this study shows that the personnel acted on the basis of their professional knowledge and earlier experiences when handling the crisis, and their knowledge can be related to the context of the crisis, and how known the place, task, and situation are to them.Conclusion: This research adds to the knowledge of the use of crisis plans. It shows that the importance of having a crisis plan is related to how known the situation and the place is to those handling the crisis, and if the task to be done is known to them. Knowing the place and task helps the personnel to improvise in an unknown situation, and the crisis plan is not used. The value of a crisis plan arises when the task is unknown.
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Yirmibesoglu, Eda, David V. Fried, Mark Kostich, Julian Rosenman, William Shockley, Mark Weissler, Adam Zanation, and Bhishamjit Chera. "Dosimetric evaluation of an ipsilateral intensity modulated radiotherapy beam arrangement for parotid malignancies." Radiology and Oncology 47, no. 4 (December 1, 2013): 411–18. http://dx.doi.org/10.2478/raon-2013-0010.
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Abstract Background. We conducted a dosimetric comparison of an ipsilateral beam arrangement for intensity modulated radiotherapy (IMRT) with off-axis beams. Patients and methods. Six patients who received post-operative radiotherapy (RT) for parotid malignancies were used in this dosimetric study. Four treatment plans were created for each CT data set (24 plans): 1) ipsilateral 4-field off-axis IMRT (4fld-OA), 2) conventional wedge pair (WP), 3) 7 field co-planar IMRT (7fld), and 4) ipsilateral co-planar 4-field quartet IMRT (4fld-CP). Dose, volume statistics for the planning target volumes (PTVs) and planning risk volumes (PRVs) were compared for the four treatment techniques. Results. Wedge pair plans inadequately covered the deep aspect of the PTV. The 7-field IMRT plans delivered the largest low dose volumes to normal tissues. Mean dose to the contralateral parotid was highest for 7 field IMRT. Mean dose to the contralateral submandibular gland was highest for 7 field IMRT and WP. 7 field IMRT plans had the highest dose to the oral cavity. The mean doses to the brainstem, spinal cord, ipsilateral temporal lobe, cerrebellum and ipsilateral cochlea were similar among the four techniques. Conclusions. For postoperative treatment of the parotid bed, 4-field ipsilateral IMRT techniques provided excellent coverage while maximally sparing the contralateral parotid gland and submandibular gland.
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Barrett, A. R. W., B. L. Davies, M. P. S. F. Gomes, S. J. Harris, J. Henckel, M. Jakopec, V. Kannan, F. M. Rodriguez y Baena, and J. P. Cobb. "Computer-assisted hip resurfacing surgery using the Acrobot® Navigation System." Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine 221, no. 7 (July 1, 2007): 773–85. http://dx.doi.org/10.1243/09544119jeim283.
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The authors have previously reported on the laboratory development of the Acrobot® Navigation System for accurate computer-assisted hip resurfacing surgery. This paper describes the findings of using the system in the clinical setting and including the improvements that have been made to expedite the procedure. The aim of the present system is to allow accurate planning of the procedure and precise placement of the prosthesis in accordance with the plan, with a zero intraoperative time penalty in comparison to the standard non-navigated technique. At present the navigation system is undergoing final clinical evaluation prior to a clinical study designed to demonstrate the accuracy of outcome compared with the conventional technique. While full results are not yet available, this paper describes the techniques that will be used to evaluate accuracy by comparing pre-operative computed tomography (CT)-based plans with post-operative CT scans. Example qualitative clinical results are included based on visual comparison of the plan with post-operative X-rays.
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Wilson, Nathan M., Frank R. Arko, and Charles A. Taylor. "Predicting changes in blood flow in patient-specific operative plans for treating aortoiliac occlusive disease." Computer Aided Surgery 10, no. 4 (January 2005): 257–77. http://dx.doi.org/10.3109/10929080500230445.
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Wilson, Nathan, Frank Arko, and Charles Taylor. "Predicting changes in blood flow in patient-specific operative plans for treating aortoiliac occlusive disease." Computer Aided Surgery 10, no. 4 (July 1, 2005): 257–77. http://dx.doi.org/10.1080/10929080500230445.
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Gas, Becca L., Monali Mohan, Apram Jyot, EeeLN H. Buckarma, and David R. Farley. "Does scripting operative plans in advance lead to better preparedness of trainees? A pilot study." American Journal of Surgery 213, no. 3 (March 2017): 526–29. http://dx.doi.org/10.1016/j.amjsurg.2016.11.011.
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Kheir, E., I. Charopoulos, R. Dimitriou, A. Ghoz, Z. Dahabreh, and PV Giannoudis. "The Health Economics of Ankle Fracture Fixation." Bulletin of the Royal College of Surgeons of England 94, no. 4 (April 1, 2012): 1–5. http://dx.doi.org/10.1308/147363512x13189526440717.
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In the current climate of modernisation of the NHS, attention has been given to improving the efficiency and efficacy of the service provided across the different disciplines without an overspend of the allocated budget. Implementation of the cost-saving plans is also encouraged owing to the ever-increasing financial burden on the NHS, obviously without compromising patient safety and the standard of care provided. In this context, the cost of operative procedures has been given a lot of attention.
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Pokaliuk V. M. "PRACTICAL TRAINING OF PERSONAL OF REGULAR SUBDIVISIONS OF STRUCTURAL UNITS OF OPERATIVE AND RESCUE SERVICE OF CIVIL PROTECTION OF UKRAINE." World Science 3, no. 3(55) (March 31, 2020): 31–33. http://dx.doi.org/10.31435/rsglobal_ws/31032020/6988.
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The article describes the contents of the concepts of independent training and official training of the personnel of the units of the Operative and Rescue Service of Civil Protection of Ukraine, describes the practical component of their professional training directly in the units. It is established that the main types of occupations in the system of official training are lectures, seminars, practical classes, tactical-special trainings, control and testing classes. Types of practical training of rescuers are characterized: practical workout of training exercises (exercises and standards on special physical training), working out and correction of documents of operative response (plans, cards), operative-tactical study of service area and objects, solving tactical tasks, night test tactical tasks training, fire and emergency management, tactical training.At the same time, there is a contradiction between the increased level of requirements for the preparedness of rescuers in modern conditions and the traditional system of their professional training, which does not take into account changes in the extension and complication of professional tasks.
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Salata, Stefano, Sıla Özkavaf-Şenalp, and Koray Velibeyoğlu. "Integrating Ecosystem Vulnerability in the Environmental Regulation Plan of Izmir (Turkey)—What Are the Limits and Potentialities?" Urban Science 6, no. 1 (March 8, 2022): 19. http://dx.doi.org/10.3390/urbansci6010019.
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The land-use regulatory framework in Turkey is composed of several hierarchical plans. The Environmental Regulation Plan pursues comprehensive planning management, which ranges between 1/100,000 and 1/25,000 and defines the framework for local master plans. Unfortunately, there is scarce knowledge of how these plans effectively protect the environment. Besides, these plans have poor consideration of socio-economic dynamics and the ecosystem vulnerability, while evaluating the actual conflicts or synergies within the localization of ecological conservation and settlement expansion areas. In this work, an ecosystem-based geodatabase was created for the western Izmir area (Turkey). The dataset has been created by employing a supervised classification sampling of Sentinel-2 images acquired on 28 March 2021, while accessing ONDA-DIAS services to L2C products. Then, the InVEST software was used to map the Habitat Quality and the Habitat Decay, while the ArcMap raster analysis tool was employed to generate the Normalized Difference Vegetation Index. The results were used to classify the ecosystem vulnerability of the western metropolitan area of Izmir and then superimposed to the Environmental Regulation Plan of the city of Izmir (2021), thus evaluating synergies and conflicts. Although integration of the ecosystem services approach into spatial planning is lacking in the planning practice of Turkey, the paper provides an operative methodology to integrate ecosystem evaluation in environmental planning as a basic strategy to support sustainable development.
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Cross, Michael, Gail Lebovic, James Stubbs, Joe Ross, Scott Jones, and Thad Beck. "Identifying the surgical cavity following oncoplastic breast surgery." Journal of Clinical Oncology 32, no. 26_suppl (September 10, 2014): 81. http://dx.doi.org/10.1200/jco.2014.32.26_suppl.81.
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81 Background: Oncoplastic surgery (OPS) has improved outcomes for partial mastectomy. However, tissue rearrangement poses challenges in the post-operative management of these patients. In most cases, these patients will require post-operative radiotherapy. Accurately visualizing the surgical cavity can be particularly troublesome in patients who have oncoplastic closure of the resection cavity. Recent advances have made it feasible to perform external beam radiation using advanced methods, but these are not commonly used for breast cancer. This is due to the difficulty in identifying the exact area of the surgical site. In this series of patients, a novel method for marking the surgical site when using oncoplastic techniques was evaluated. Methods: 65 patients had a 3-D tissue marker implanted at the time of lumpectomy. All patients were candidates for partial mastectomy and local breast reconstruction using OPS. Post-operative treatment plans for radiation and/or adjuvant chemotherapy were completed. Patients were evaluated with standard breast imaging methods for treatment planning. Results: The marker was easily identified and clearly delineated within the lumpectomy cavity. It provided 3-D characterization of the borders surrounding the cavity, and was easily distinguished from seroma and other tissue changes. Respiratory motion was easily tracked using the device making it possible to use IMRT and accelerated protocols. Use of the marker resulted in treatment volumes that were reduced by an average of 50% when compared to standard methods. In appropriate patients when the marker facilitated an accelerated protocol, total treatment time was decreased to 5-7 days. No complications were reported, and overall patient outcomes were excellent. Conclusions: This novel 3-D marker was consistently visualized without difficulty, was readily incorporated into standard practices and had appreciable benefits when designing optimal treatment plans. Its unique features were helpful in all cases, but particularly useful when using oncoplastic techniques to reconstruct the breast with local tissue flaps.
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Rautio, T., J. Perälä, H. Wiik, K. Haukipuro, and T. Juvonen. "Influence of Preoperative Duplex Ultrasonography on the Operative Procedure for Primary Varicose Vein Surgery." Phlebology: The Journal of Venous Disease 16, no. 4 (December 2001): 149–53. http://dx.doi.org/10.1177/026835550101600405.
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Objective: To evaluate the impact of duplex ultrasonography on the treatment plan of patients with uncomplicated primary varicose veins. Methods: Forty-nine consecutive patients (62 legs) with primary uncomplicated varicose veins were examined clinically and with hand-held Doppler (HHD) and duplex ultrasonography in an outpatient clinic on the same day. The plans for subsequent treatment were recorded separately after the two ultrasound examinations. Results: The accuracy of the HHD examination was 0.71 in the saphenofemoral junction (SFJ) and long saphenous vein (LSV trunk). In fifty-six limbs (90%) duplex scanning did not affect the surgical treatment of the patients. Conclusions: Most operations on primary varicose veins can be performed on the basis of clinical and HHD examinations by an experienced surgeon. Duplex ultrasonography can be used selectively in the patients with suspected saphenopopliteal junction (SPJ) reflux or equivocal HHD findings.
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Şenkesen, Ö., H. Küçücük, E. O. Göksel, E. Tezcanli, Z. Özen, S. Küçücük, G. Kemikler, R. Dişçi, and I. Aslay. "PO-1894 Comparison of Intra Operative and Post Implant Plans for Low Dose Rate Prostate Brachytherapy." Radiotherapy and Oncology 161 (August 2021): S1613—S1614. http://dx.doi.org/10.1016/s0167-8140(21)08345-6.
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Bleeker, Margot, Karin Goudschaal, Arjan Bel, Jan-Jakob Sonke, Maarten C. C. M. Hulshof, and Astrid van der Horst. "Feasibility of cone beam CT-guided library of plans strategy in pre-operative gastric cancer radiotherapy." Radiotherapy and Oncology 149 (August 2020): 49–54. http://dx.doi.org/10.1016/j.radonc.2020.04.057.
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Jain, P. K., N. K. Mehta, and P. C. Pandey. "Automatic cut planning in an operative process planning system." Proceedings of the Institution of Mechanical Engineers, Part B: Journal of Engineering Manufacture 212, no. 2 (February 1, 1998): 129–40. http://dx.doi.org/10.1243/0954405981515554.
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The present paper discusses a knowledge-based interactive CAPP system for symmetrical turned parts. In this system, which is modular in structure, special emphasis has been laid on geometric reasoning and cut planning—two aspects which have received little attention in the CAPP systems reported in published literature. The present paper deals mainly with the description of the cut planning module of UOR_PLAN. The task of cut planning in UOR_PLAN is divided into two subtasks—macro cut planning and micro cut planning. Macro cut planning deals with the identification of pockets of unwanted metal. As a first step a mesh of nodal points is generated by taking into account the geometry of the part profile and the shape of the blank. Next, by rule-based successive elimination of nodal points from the mesh, pockets of unwanted metal for a given operation sequence are identified. This process is repeated for all possible sequences. The distinguishing feature of this technique is that it identifies the machinable volumes automatically without the preparation of an incidence/precedence matrix. A further breakup of machinable volumes is dealt with in micro cut planning. In phase one of micro cut planning, each machinable volume is divided into a number of rough cuts of equal depth by leaving a suitable finishing allowance. Optimum machining parameters (depth of cut, feed rate, cutting speed and number of passes) are selected by applying the sequential unconstrained minimization technique (SUMT). The best of the cut plans is selected on the basis of minimum production time. Phase two of the micro cut planning deals with the removal of the finishing allowance and has been discussed in an earlier paper.
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Slater, Jerry Monroe, Ted Chen-Tai Ling, Prashanth Nookala, Rachel Mifflin, Roger Grove, Anh Ly, Baldev Patyal, Jerry D. Slater, and Gary Yang. "A treatment planning evaluation of protons versus IMRT in pancreatic cancer: A comparative study." Journal of Clinical Oncology 32, no. 3_suppl (January 20, 2014): 369. http://dx.doi.org/10.1200/jco.2014.32.3_suppl.369.
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369 Background: The purpose of this study is to investigate dose distributions of proton and intensity-modulated radiation therapy (IMRT) photon treatment plans in patients with resected pancreatic adenocarcinoma, focusing specifically on dose reduction to the kidney, liver, and small bowel as organs at risk. Methods: Ten patients with pancreatic head adenocarcinoma underwent Whipple procedure between 2010 and 2013 were included in this study. Most of the patients had locally advanced disease (T3-4N1). All patients were simulated with contrast-enhanced CT imaging. The clinical target volume (CTV) consisted of the pre-operative extent of tumor plus a 10 mm manual expansion in all directions. The planning target volume (PTV) was generated by a further expansion on the CTV ranging from 10-15 mm. A dose of 50.4 Gy given in 28 fractions was delivered to the PTV. All plans were optimized to allow 95% isodose coverage of at least 95% of the PTV. Dose-volume histograms, conformity index (CI), uniformity index (UI), homogeneity index (HI), were calculated and analyzed in order to compare plans between the two modalities. The OAR being evaluated in this study are the kidneys, liver, small bowel, and spinal cord. To determine statistical significance, ANOVA and two-tailed paired t-tests were performed for all data parameters. Results: The proton plans resulted in a lower mean kidney dose (3.17 Gy vs. 9.59 Gy, p=0.039), a lower dose delivered to 1/3 of the liver, D1/3, (0.25 Gy vs. 4.56 Gy, p=0.003), and a lower mean liver dose (1.83 Gy vs. 5.24 Gy, p=0.021). See table for a summary of the results. Conclusions: For patients receiving postoperative radiotherapy for pancreatic cancer, the proton plans are technically feasible and dosimetrically appealing with superior organ at risk sparing compared to IMRT photon treatment plans.[Table: see text]
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Maggio, Dominic, Tamir T. Ailon, Justin S. Smith, Christopher I. Shaffrey, Virginie Lafage, Frank Schwab, Regis W. Haid, et al. "Assessment of impact of standing long-cassette radiographs on surgical planning for lumbar pathology: an international survey of spine surgeons." Journal of Neurosurgery: Spine 23, no. 5 (November 2015): 581–88. http://dx.doi.org/10.3171/2015.1.spine14833.
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OBJECT The associations among global spinal alignment, patient-reported disability, and surgical outcomes have increasingly gained attention. The assessment of global spinal alignment requires standing long-cassette anteroposterior and lateral radiographs; however, spine surgeons routinely rely only on short-segment imaging when evaluating seemingly isolated lumbar pathology. This may prohibit adequate surgical planning and may predispose surgeons to not recognize associated pathology in the thoracic spine and sagittal spinopelvic malalignment. The authors used a case-based survey questionnaire to evaluate if including long-cassette radiographs led to changes to respondents' operative plans as compared with their chosen plan when cases contained standard imaging of the involved lumbar spine only. METHODS A case-based survey was distributed to AOSpine International members that consisted of 15 cases of lumbar spine pathology and lumbar imaging only. The same 15 cases were then shuffled and presented a second time with additional long-cassette radiographs. Each case required participants to select a single operative plan with 5 choices ranging from least to most extensive. The cases included 5 “control” cases with normal global spinal alignment and 10 “test” cases with significant sagittal and/or coronal malalignment. Mean scores were determined for each question with higher scores representing more invasive and/or extensive operative plans. RESULTS Of 712 spine surgeons who started the survey, 316 (44%) completed the entire series, including 68% of surgeons with spine fellowship training and representation from more than 40 countries. For test cases, but not for control cases, there were significantly higher average surgical invasiveness scores for cases presented with long-cassette radiographs (4.2) as compared with those cases with lumbar imaging only (3.4; p = 0.002). The addition of long-cassette radiographs resulted in 82.1% of respondents recommending instrumentation up to the thoracic spine, a 23.2% increase as compared with the same cases presented with lumbar imaging only (p = 0.008). CONCLUSIONS This study demonstrates the importance of maintaining a low threshold for performing standing long-cassette imaging when assessing seemingly isolated lumbar pathology. Such imaging is necessary for the assessment of spinopelvic and global spinal alignment, which can be important in operative planning. Deformity, particularly positive sagittal malalignment, may go undetected unless one maintains a high index of suspicion and obtains long-cassette radiographs. It is recommended that spine surgeons recognize the prevalence and importance of such deformity when contemplating operative intervention.
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Bithal, Parmod. "Anaesthetic considerations for evoked potentials monitoring." Journal of Neuroanaesthesiology and Critical Care 01, no. 01 (April 2014): 002–12. http://dx.doi.org/10.4103/2348-0548.124832.
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AbstractIntra-operative neurophysiologic monitoring (IONM) under anaesthesia has achieved popularity because it helps prevent/ minimize neurologic morbidity from surgical manipulations of various neurologic structures. Neurologic functions in an anaesthetised patient can be monitored either by electroencephalography (EEG) or by evoked potentials. Whereas, EEG is difficult to analyse, evoked potentials, in contrast, are easy to interpret, they are either present or absent, delayed or not delayed, with normal or abnormal wave. The goal of IONM is to identify changes in nervous system function prior to irreversible damage. Many factors need consideration when selecting an anaesthetic regimen for intra-operative monitoring of evoked potentials. The very pathophysiological condition or the potential risks of the contemplated surgical procedure, which require evoked potentials monitoring, may place constraints on anaesthetic management as well. With the availability of numerous anaesthetic techniques, an appropriate plan for managing both anaesthesia and IONM in a patient should be organised. It is extremely essential not to alter the pharmacological state of the patient to avoid any changes in the recording of evoked responses. While an anaesthesiologist may alter plans for a patient in order to facilitate IONM, monitoring team too, sometimes may be required to modify plans for monitoring when a particular anaesthetic agent or technique is strongly indicated or contraindicated. At times, compromise may be required between an anaesthesia technique and a monitoring technique. To serve patients’ best interest, it is critical to have a team approach and good communication among the neurophysiologist, anaesthesiologist and surgeon.
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Simaan, Nabil, Rusell H. Taylor, and Howie Choset. "Intelligent Surgical Robots with Situational Awareness." Mechanical Engineering 137, no. 09 (September 1, 2015): S3—S6. http://dx.doi.org/10.1115/1.2015-sep-6.
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This article discusses various challenges and puts forth the concepts of intelligent surgical robots and complementary situational awareness (CSA) as a means for achieving new surgical systems with unprecedented capabilities in terms of safety, ease of operation, and exact execution of pre-operative surgical plans. Situational awareness is defined in accordance with by the three stages of sensory acquisition, sensory comprehension, and projection. A robotic system with CSA assists the user not only in manipulation, but also in forming the situational awareness regarding the task at hand by using perception resources beyond the capabilities of the user. In the future, it is expected that CSA systems will increasingly be embedded within a larger framework of Computer-Integrated Interventional Medicine, in which patient-specific information such as images, lab results, and genomics are combined with general knowledge to model and diagnose the patients’ condition and to develop an optimized treatment plan.
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Vasconcelos, S. C., A. E. M. Santos, K. N. Maranhão, A. V. Lordão, Z. F. D. Carvalho, S. A. Almeida, J. C. Neves, and M. J. J. Alves. "Nursing care to the person with mental disorder: Experience report." European Psychiatry 41, S1 (April 2017): S605. http://dx.doi.org/10.1016/j.eurpsy.2017.01.949.
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IntroductionThe formation of nursing professionals requires a dynamic teaching that provides the acquisition of skills and abilities to execute care, management, teaching and research activities. In this perspective, the operative groups are a teaching and nursing care strategy, performed by a knowledge exchange and collective interventions.AimsDiscuss the experience in nursing care to the person with mental disorder.MethodsIt is about a fourth year undergraduate nursing students’ experience report. The activities were developed at a center of psychosocial attention in João Pessoa, Paraíba, Brazil. Once a week, four operative group sessions were held under the theme “men's health”. In the first session were agreed norms of behavior and activities plans on which the participants chose the subjects.ResultsThe operative group provided a friendly environment to exchange knowledge, in which the contents where addressed from the participant's acquirements and experiences. There was a good group interaction. The students conducted the activities under the teacher and monitor's supervision.ConclusionThis report provided experiences that contributed to the students’ teaching-learning process as well as for understanding the nurse's insertion in the care scenario and the use of soft technologies to an efficient care to the person with mental disorder. The students also noticed the operative group's impact in the user's lives though sentences such as “It was fun”, “I won gifts”, “liked it”, “I learned”.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Blount, Jeffrey P., Amber S. Gordon, Paul M. Foreman, and John H. Grant. "Multidisciplinary staged surgical management of bifrontal meningoencephalocele with long-term follow-up." Journal of Neurosurgery: Pediatrics 11, no. 4 (April 2013): 478–84. http://dx.doi.org/10.3171/2012.11.peds12330.
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The authors report on an infant with a bifrontal encephalocele that was associated with multisuture craniosynostosis, spasticity, and a progressively severe epilepsy. They describe the initial presentation, genetic screening results, staged multidisciplinary operative plans, clinical course, complications, and long-term surgical and developmental follow-up. To their knowledge, the comprehensive surgical management of this type of complicated congenital cranial anomaly has not been previously described. Surgical management was staged and multidisciplinary and required careful attention to all 3 components of the condition: 1) hydrocephalus, 2) frontal meningoencephalocele, and 3) epilepsy.
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Lower, Anna, and Agnieszka Szumilas. "Parking Policy as a Tool of Sustainable Mobility-Parking Standards in Poland vs. European Experiences." Sustainability 13, no. 20 (October 14, 2021): 11330. http://dx.doi.org/10.3390/su132011330.
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Contemporary cities generally lack the balance between the development of the spatial structure and the communication possibilities of the inhabitants. The high motorisation rate in Poland, as well as in other European countries, and the preferred choice of individual means of transportation have both contributed to a significant increase in congestion over the last 10 years. The aim of this research was to try to establish to what extent a consciously conducted parking policy can help control the mobility of inhabitants of selected Polish cities. The starting point for the analysis was the availability of parking spaces in residential areas, introduced as an imposed indicator in the operative planning documents. As part of the research, the authors of this paper analyzed the legal provisions of the operative Local Spatial Development Plans (MPZP) concerning the parking function for housing estates five of the biggest cities in Poland. The results were confronted with data on selected European cities. Nearly 550 planning documents from the years 2000–2019 and parking standards operating in individual countries were cataloged and analyzed. The research results show that for 20 years Polish cities have mainly been using the possibility of determining the minimum rate of parking spaces. Regulations attempting to limit the number of cars are incidental. However, this is a necessary direction of legislative changes.
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Taylor, Peter Mark, Andrew Olleveant, John Spink, Mike Osborne, and Ali Onder. "Co-Operative Planning Approach: A South-West Atlantic Frontier Exploration Area." International Oil Spill Conference Proceedings 1999, no. 1 (March 1, 1999): 165–68. http://dx.doi.org/10.7901/2169-3358-1999-1-165.
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ABSTRACT Oil industry alliances bring benefits in various fields, including emergency planning. The benefits will include consistency in oil spill response plans and procedures, plus potential cost savings. Government, organisations and groups involved will appreciate a single and comprehensive consultative process. Time and money will be saved, plan formats will be consistent and there will be less scope for confusion. Partnership building will be stronger and more effective. This paper will use a case study of cooperative oil spill contingency planning in the south-west Atlantic to illustrate these points. The Falkland Islands archipelago lies in the south-west Atlantic, approximately 400 km east of the tip of the South American mainland. In 1996 the Falkland Islands Government (FIG) undertook its first round of oil exploration licensing and awarded acreage. Four of the successful operating companies formed the Falklands Operators Sharing Agreement (FOSA). This co-operation extended to a number of areas, including a joint approach to oil spill contingency planning. Oil Spill Response Limited (OSRL) worked with FOSA to produce a generic oil spill contingency plan, to function for all the companies and differ only in its emergency contact section. The contingency planning process closely followed the guidelines promulgated by the International Petroleum Industry Environmental Conservation Association (IPIECA, 1991) and the International Maritime Organization (IMO, 1995). A key factor was liaison with groups on the Islands and interfacing with the new Falkland Islands national oil spill contingency plan, which this paper will introduce.
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R.D., Holland, James R.A., Coates S., Clements M., and Nijkamp H. "OILED WILDLIFE RESPONSE - THE ROLE OF AN OIL INDUSTRY SPILL RESPONSE CO-OPERATIVE." International Oil Spill Conference Proceedings 2008, no. 1 (May 1, 2008): 977–79. http://dx.doi.org/10.7901/2169-3358-2008-1-977.
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ABSTRACT During an oil spill, public attention is focussed on animal welfare and care, primarily channelled through powerful media imagery and comment. Traditionally, animal welfare organisations are tasked to provide the manpower and resources to manage the rehabilitation and response effort, with Government and industry providing financial and administrative support on an ad hoc basis as the incident dictates. A novel response model has now been developed between the oil industry'S international response group, Oil Spill Response and East Asia Response Ltd (OSRL/EARL), and the wildlife response community. OSRL/EARL working in co-operation with the independent Sea Alarm Foundation (SAF) have collectively addressed oiled wildlife response issues and married their individual strengths, capabilities and resources to bring a new approach to oiled wildlife response. Preparedness and response activities to oiled wildlife will be enhanced and improved globally via the establishment of a database of Country Wildlife Response Profiles, a pool of specialist experts for wildlife response, equipment stockpiles at an aviation secure base and development of wildlife response plans in co-operation with recognised international groups. This poster details how these activities will benefit oiled wildlife response globally.
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Popa, Florina, Oana Rosca, Alexandru Georgescu, and Claudio Cannistra. "Reconstruction of the abdominal wall in anatomical plans. Pre and post – operative keys in repairing “cold’’ incisional hernias." Medicine and Pharmacy Reports 89, no. 1 (February 2, 2016): 117–21. http://dx.doi.org/10.15386/cjmed-572.
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Background and aims. The clinical results of the vertical "vest-over-pants" Mayo repair were evaluated, and the risk factors for incisional hernia recurrence were studied. The purpose of this study is to point out the importance of reducing pre and post operative risk factors in the incisional hernia repair process in order to achieve a physiologically normal abdominal wall.Methods. Twenty patients diagnosed with incisional hernia underwent an abdominal reconstruction procedure using the Mayo (Paletot) technique at Bichat Claude Bernard Hospital between 2005 and 2015. All procedures were performed by a single surgeon and all patients were pre-operatively prepared, identifying all coexisting conditions and treating them accordingly before undergoing surgery.Results. All patients underwent at least one surgical operation before the hernia repair procedure and a quarter had experienced at least three, prior to this one. Nine patients had a body mass index of >30 kg/m2. Additional risk factors and comorbidities included obesity in 45%, diabetes mellitus in 10%, smoking in 55%, and high blood pressure in 40%.Hernia defect width was from 3 cm (25% F) to 15 cm (5% M) of which nine patients (45%) had a 10 cm defect. Most of the patients had an average hospitalization of 7 days. The patients were carefully monitored and were called on periodic consultations after 3, 6, and 12 months from the moment of the procedure. Patient feedback regarding hernia recurrence and complaints about the scar were noted. Physical examination is essential in determining the hernia recurrence therefore the scar was examined for any abnormalities that may have occurred, which was defined as any palpable or detected fascial defect located within seven centimeters of the hernia repair. Post-operative complications: seroma formation, wound hematoma, superficial and deep wound infection, recurrences and chronic pain were followed and no complications were registered during the follow-up period.Conclusions. Reducing the risk factors to a minimum prior to surgery will increase the success of the incisional hernia repair and generate a positive impact on the patient’s quality of life. The lofty goal of significant weight loss prior to elective hernia has shown to be the key factor in using the Mayo technique for incisional hernia repair. This study demonstrates that the Mayo repair technique is a suitable and trustworthy alternative for repairing incisional hernias with very good results. It’s costs are minimal and it can be easily reproduced, even by less experienced surgeons.