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Digestive Diseases (Basel, Switzerland) 2003Surgery is required in many patients with inflammatory bowel disease at some point in their disease. In patients with ulcerative colitis, surgery is potentially curative... (Review)
Review
Surgery is required in many patients with inflammatory bowel disease at some point in their disease. In patients with ulcerative colitis, surgery is potentially curative whereas recurrence of Crohn's disease following surgery is a common occurrence. As a result, the indications and surgical management of the two diseases may be quite different. Surgery is usually reserved for the management of complications or failure of medical treatment in Crohn's disease. Resection of the diseased segment is the usual procedure performed. While surgery usually results in an improvement in quality of life, recurrence of disease occurs frequently with reported rates of 5-90% at 1 year, depending on the criteria used. To date, there have been no surgical maneuvers which have been shown to decrease the risk of recurrence. Over the past few decades, several advances have been made in the surgical management of Crohn's disease: use of strictureplasty for extensive disease; use of laparoscopic techniques to perform surgery and the performance of the ileal pouch procedure in very selected patients. Significant advances in the surgical management of ulcerative colitis have been made in the past 50 years. Although there are several options available to patients, the preferred option now is the ileal pouch procedure. With technical modifications and with experience, this procedure can now be performed with a low complication rate, with good functional results and quality of life and excellent long-term outcome.
Topics: Anastomosis, Surgical; Colitis, Ulcerative; Colonic Pouches; Crohn Disease; Digestive System Surgical Procedures; Humans; Laparoscopy; Patient Selection; Prognosis; Recurrence; Risk Factors; Severity of Illness Index
PubMed: 14571114
DOI: 10.1159/000073248 -
Best Practice & Research. Clinical... Nov 2017Robotic surgery in the treatment of gynecologic diseases continues to evolve and has become accepted over the last decade. The advantages of robotic-assisted... (Review)
Review
Robotic surgery in the treatment of gynecologic diseases continues to evolve and has become accepted over the last decade. The advantages of robotic-assisted laparoscopic surgery over conventional laparoscopy are three-dimensional camera vision, superior precision and dexterity with EndoWristed instruments, elimination of operator tremor, and decreased surgeon fatigue. The drawbacks of the technology are bulkiness and lack of tactile feedback. As with other surgical platforms, the limitations of robotic surgery must be understood. Patient selection and the types of surgical procedures that can be performed through the robotic surgical platform are critical to the success of robotic surgery. First, patient selection and the indication for gynecologic disease should be considered. Discussion with the patient regarding the benefits and potential risks of robotic surgery and of complications and alternative treatments is mandatory, followed by patient's signature indicating informed consent. Appropriate preoperative evaluation-including laboratory and imaging tests-and bowel cleansing should be considered depending upon the type of robotic-assisted procedure. Unlike other surgical procedures, robotic surgery is equipment-intensive and requires an appropriate surgical suite to accommodate the patient side cart, the vision system, and the surgeon's console. Surgical personnel must be properly trained with the robotics technology. Several factors must be considered to perform a successful robotic-assisted surgery: the indication and type of surgical procedure, the surgical platform, patient position and the degree of Trendelenburg, proper port placement configuration, and appropriate instrumentation. These factors that must be considered so that patients can be appropriately prepared before and during the operation are described.
Topics: Female; Gynecologic Surgical Procedures; Humans; Intraoperative Care; Patient Selection; Preoperative Care; Robotic Surgical Procedures
PubMed: 28579145
DOI: 10.1016/j.bpobgyn.2017.04.008 -
The Orthopedic Clinics of North America Apr 2004This review summarizes past studies examining the progression of osteoarthritis (OA) of the knee that have led to the conclusion that the disease is slow, progressive,... (Review)
Review
This review summarizes past studies examining the progression of osteoarthritis (OA) of the knee that have led to the conclusion that the disease is slow, progressive, and typically limited to one tibiofemoral compartment. Treatments such as unicondylar knee arthroplasty (UKA) that address the single diseased compartment, preserving bone and soft tissue, seem appropriate. The senior author's minimally invasive surgical technique for performing UKA also is described.
Topics: Ambulatory Surgical Procedures; Arthroplasty, Replacement, Knee; Disease Progression; Humans; Minimally Invasive Surgical Procedures; Osteoarthritis, Knee; Patient Selection
PubMed: 15062706
DOI: 10.1016/j.ocl.2003.12.001 -
Statistics in Medicine Oct 2021Meta-analysis of rare event data has recently received increasing attention due to the challenging issues rare events pose to traditional meta-analytic methods. One... (Meta-Analysis)
Meta-Analysis Review
Meta-analysis of rare event data has recently received increasing attention due to the challenging issues rare events pose to traditional meta-analytic methods. One specific way to combine information and analyze rare event meta-analysis data utilizes confidence distributions (CDs). While several CD methods exist, no comparisons have been made to determine which method is best suited for homogeneous or heterogeneous meta-analyses with rare events. In this article, we review several CD methods: Fisher's classic P-value combination method, one that combines P-value functions, another that combines confidence intervals, and one that combines confidence log-likelihood functions. We compare these CD approaches, and we propose and compare variations of these methods to determine which method produces reliable results for homogeneous or heterogeneous rare event meta-analyses. We find that for homogeneous rare event data, most CD methods perform very well. On the other hand, for heterogeneous rare event data, there is a clear split in performance between some CD methods, with some performing very poorly and others performing reasonably well.
Topics: Humans; Likelihood Functions; Research Design
PubMed: 34219258
DOI: 10.1002/sim.9125 -
Paediatric Respiratory Reviews Sep 2003The technique of flexible bronchoscopy creates unique research opportunities to investigate the underlying mechanisms of respiratory disease in children, by sampling... (Review)
Review
The technique of flexible bronchoscopy creates unique research opportunities to investigate the underlying mechanisms of respiratory disease in children, by sampling directly from the airway. Bronchoscopy is, however, invasive and the ethics of performing this type of procedure for research purposes must be considered carefully at the outset. This article discusses the research applications of bronchoscopy in children, focusing on the ethical and safety issues, the types of procedure that can be performed and their application to the investigation of specific diseases. Acceptance of the use of bronchoscopy as a research tool is increasing. Future work should focus on the comparison of invasive and non-invasive techniques, the use of bronchoscopy in longitudinal and interventional studies and the development of new, highly sensitive techniques to allow us to study disease pathogenesis in greater detail. Collaboration between centres should be encouraged to maximise the use of samples obtained.
Topics: Bronchoscopy; Ethics, Medical; Humans; Research Design; Respiratory Tract Diseases
PubMed: 12880758
DOI: No ID Found -
Gastroenterology Nursing : the Official... 2001Current debate surrounds the cost-effectiveness of disposable and reusable biopsy forceps. Although a complex and arduous task, performing a cost analysis may be... (Comparative Study)
Comparative Study Review
Current debate surrounds the cost-effectiveness of disposable and reusable biopsy forceps. Although a complex and arduous task, performing a cost analysis may be necessary to determine which forcep type is more cost-effective. Costs associated with disposable biopsy forceps include their initial cost as well as storage and disposal costs. In addition to initial cost, costs associated with reusable biopsy forceps include reprocessing, maintenance, and repair costs. Estimating the number of times forceps are likely to be reused is also essential to evaluating the cost-effectiveness of reusable biopsy forceps. In general, once a reusable biopsy forcep performs a threshold number of procedures, it becomes more cost-effective than a disposable forcep. While reusable biopsy forceps may be more suitable and cost-effective for larger gastrointestinal endoscopy centers that perform many procedures per day, the convenience of disposable biopsy forceps may make them the more appropriate choice for centers that are smaller and perform only a few procedures each day. Due to significant decreases in the initial cost of disposable biopsy forceps, the cost-effectiveness of reusable biopsy forceps is waning. This article reviews the various issues associated with disposable versus reusable biopsy forceps and provides readers with guidelines for evaluating the appropriateness of both forcep designs in their unique practice setting.
Topics: Biopsy; Cost-Benefit Analysis; Disposable Equipment; Endoscopy; Equipment Design; Equipment Failure; Equipment Reuse; Equipment Safety; Guidelines as Topic; Humans; Patient Selection; Sterilization; Surgical Instruments
PubMed: 11847729
DOI: 10.1097/00001610-200103000-00004 -
Nature Clinical Practice. Rheumatology Jul 2007The identification of subgroups of patients from randomized clinical trials that are of specific interest for guiding clinical decisions can be an attractive idea;... (Review)
Review
The identification of subgroups of patients from randomized clinical trials that are of specific interest for guiding clinical decisions can be an attractive idea; however, since such trials are designed for the comparison of groups of patients, performing subgroup analyses can result in misinterpretation of the data. Such analyses must, therefore, be performed and evaluated with caution: these should be pre-planned and included in the design of a suitably powered trial. Data obtained should be analyzed using formal statistical tests of interaction on proper subgroups rather than improper subgroups of patients, the results obtained should be delineated carefully, and details of how these analyses were performed, and how the data should be interpreted, should be reported in the trial paper. The caveats associated with this approach, such as the occurrence of false positive or false negative effects, chance differences in observed effects, lack of power to perform the analysis, floor or ceiling effects, issues relating to multiple statistical testing, and over-reporting and under-reporting are discussed in this review. Subgroup analyses can, however, provide valuable, albeit predominantly exploratory, information on which to base clinical decisions if they are performed in accordance with recommendations and guidelines, and do, therefore, have a legitimate place in rheumatology clinical trials.
Topics: Data Interpretation, Statistical; Humans; Randomized Controlled Trials as Topic; Reproducibility of Results; Research Design; Rheumatology; Sample Size; Selection Bias; Sensitivity and Specificity; Treatment Outcome
PubMed: 17599075
DOI: 10.1038/ncprheum0528 -
International Journal of Surgery... 2008Day-surgery setting allows to combine patients' satisfaction to cost-saving policies that seems to be more and more important for a modern hospital management. Minimally... (Review)
Review
Day-surgery setting allows to combine patients' satisfaction to cost-saving policies that seems to be more and more important for a modern hospital management. Minimally invasive surgery seems to be the ideal surgical approach for day-case procedures since, reducing trauma to a minimal level, allows patients to return quick to a normal life with minimal nursing assistance. Extensive review of the most recent article has been performed in this article in order to define the current evidences that support the use of laparoscopic surgery in a day-case setting. Laparoscopic cholecystectomy, anti-reflux procedure and hernia repair seems to be justified according to the results of the published data. Patients' selection and hospital organization seem to be mandatory in order to obtain successful results.
Topics: Ambulatory Surgical Procedures; Decision Making; Humans; Laparoscopy; Patient Selection
PubMed: 19112057
DOI: 10.1016/j.ijsu.2008.12.012 -
Minerva Urologica E Nefrologica = the... Sep 2010The field of urology has embraced minimally invasive surgical procedures, from endoscopic to laparoscopic to robotic assisted surgery. As these surgical techniques are... (Review)
Review
The field of urology has embraced minimally invasive surgical procedures, from endoscopic to laparoscopic to robotic assisted surgery. As these surgical techniques are applied to renal cancer, the oncological outcomes need to be compared to more traditional open surgery. Laparoscopic partial nephrectomy emulates the open surgical technique and has become an alternative to open surgery at many academic centers. Still its wide spread adoption has been limited by the challenges of renal mass extirpation and renal reconstruction in a timely fashion to limit renal ischemia. The following review is designed to assist the urologic surgeon in performing a successful laparoscopic partial nephrectomy by detailing the "tips and tricks" of the procedure.
Topics: Humans; Laparoscopy; Nephrectomy; Patient Selection; Peritoneum; Retroperitoneal Space; Robotics
PubMed: 20940696
DOI: No ID Found -
Journal of Biomedical Informatics Aug 2023The imputation of missing values in multivariate time series (MTS) data is critical in ensuring data quality and producing reliable data-driven predictive models. Apart... (Review)
Review
The imputation of missing values in multivariate time series (MTS) data is critical in ensuring data quality and producing reliable data-driven predictive models. Apart from many statistical approaches, a few recent studies have proposed state-of-the-art deep learning methods to impute missing values in MTS data. However, the evaluation of these deep methods is limited to one or two data sets, low missing rates, and completely random missing value types. This survey performs six data-centric experiments to benchmark state-of-the-art deep imputation methods on five time series health data sets. Our extensive analysis reveals that no single imputation method outperforms the others on all five data sets. The imputation performance depends on data types, individual variable statistics, missing value rates, and types. Deep learning methods that jointly perform cross-sectional (across variables) and longitudinal (across time) imputations of missing values in time series data yield statistically better data quality than traditional imputation methods. Although computationally expensive, deep learning methods are practical given the current availability of high-performance computing resources, especially when data quality and sample size are of paramount importance in healthcare informatics. Our findings highlight the importance of data-centric selection of imputation methods to optimize data-driven predictive models.
Topics: Benchmarking; Research Design; Time Factors; Cross-Sectional Studies; Surveys and Questionnaires
PubMed: 37429511
DOI: 10.1016/j.jbi.2023.104440