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Journal of Gynecologic Oncology Nov 2018We aimed to propose a set of quality indicators (QIs) based on the clinical guidelines for cervical cancer treatment published by The Japan Society of Gynecologic...
OBJECTIVE
We aimed to propose a set of quality indicators (QIs) based on the clinical guidelines for cervical cancer treatment published by The Japan Society of Gynecologic Oncology, and to assess adherence to standard-of-care as an index of the quality of care for cervical cancer in Japan.
METHODS
A panel of clinical experts devised the QIs using a modified Delphi method. Adherence to each QI was evaluated using data from a hospital-based cancer registry of patients diagnosed in 2013, and linked with insurance claims data, between October 1, 2012, and December 31, 2014. All patients who received first-line treatment at the participating facility were included. The QI scores were communicated to participating hospitals, and additional data about the reasons for non-adherence were collected.
RESULTS
In total, 297 hospitals participated, and the care provided to 15,163 cervical cancer patients was examined using 10 measurable QIs. The adherence rate ranged from 50.0% for 'cystoscope or proctoscope for stage IVA' to 98.8% for 'chemotherapy using platinum for stage IVB'. Despite the variation in care, hospitals reported clinically valid reasons for more than half of the non-adherent cases. Clinically valid reasons accounted for 75%, 90.9%, 73.4%, 44.5%, and 88.1% of presented non-adherent cases respectively.
CONCLUSION
Our study revealed variations in pattern of care as well as an adherence to standards-of-care across Japan. Further assessment of the causes of variation and non-adherence can help identify areas where improvements are needed in patient care.
Topics: Adenocarcinoma; Adult; Aged; Carcinoma, Squamous Cell; Female; Guideline Adherence; Hospitals; Humans; Japan; Middle Aged; Practice Guidelines as Topic; Quality of Health Care; Registries; Uterine Cervical Neoplasms
PubMed: 30207093
DOI: 10.3802/jgo.2018.29.e83 -
Fortschritte Der Medizin Sep 1973
Topics: Endoscopes; Esophagoscopes; Fiber Optic Technology; Gastrointestinal Diseases; Gastroscopes; Humans; Proctoscopes
PubMed: 4742017
DOI: No ID Found -
Meditsinskaia Tekhnika 1972
Topics: Microscopy; Proctoscopes
PubMed: 4649537
DOI: No ID Found -
Therapie Der Gegenwart Feb 1969
Topics: Humans; Methods; Proctoscopes; Rectal Diseases; Sigmoidoscopes
PubMed: 5792514
DOI: No ID Found -
Langenbecks Archiv Fur Chirurgie.... 1991The system for TEM consists of a rectoscope of 40 mm diameter, stereoscopic optics and up to four surgical instruments for simultaneous application. Operation is...
The system for TEM consists of a rectoscope of 40 mm diameter, stereoscopic optics and up to four surgical instruments for simultaneous application. Operation is performed under automatic gas distension. Since 1983 we have operated upon 332 patients, 280 of whom were analyzed in a prospective clinical trial. The complication rate was below 10%, mortality 0.3% and the recurrence rate ot the adenomas 4%. Compared to the conventional surgical procedures, postoperative pain is significantly lower and hospital stay and rehabilitation time are shorter.
Topics: Equipment Design; Humans; Polyps; Proctoscopes; Rectal Neoplasms; Rectum; Suture Techniques
PubMed: 1793941
DOI: No ID Found -
Surgical Laparoscopy, Endoscopy &... Aug 2016Transanal endoscopic surgery (TES) can be technically difficult due to the constraints of operating through a narrow proctoscope channel. In this study, we compared the... (Comparative Study)
Comparative Study
BACKGROUND
Transanal endoscopic surgery (TES) can be technically difficult due to the constraints of operating through a narrow proctoscope channel. In this study, we compared the performance of surgical novices using instruments with and without articulating shafts to perform a simulated TES task.
METHODS
Medical students each performed 10 repetitions of the Fundamentals of Laparoscopic Surgery circle-cut task. Participants were randomized into 3 groups: 2 performed the task through a TES proctoscope using scissors with either a rigid (TES-R) or articulating (TES-A) shaft. The third group performed the task laparoscopically (LAP).
RESULTS
A total of 31 medical students participated. The LAP group had a faster mean task time than both the TES-R and TES-A groups (LAP 201±120 s vs. TES-R 362±212 s and TES-A 405±212 s, both P <0.001). The TES-R group made more errors (ie, deviation from a perfect circle) than both the other groups. The TES-R group adjusted the proctoscope position during more repetitions than the TES-A group.
CONCLUSIONS
Students had faster task times when operating laparoscopically than through a TES protoscope. Task times were similar between the TES groups using scissors with articulating and rigid shafts; however, use of the articulating instruments resulted in fewer errors and less need to adjust proctoscope position.
Topics: Clinical Competence; Education, Medical, Graduate; Humans; Laparoscopy; Learning Curve; Operative Time; Proctoscopy; Simulation Training; Students, Medical
PubMed: 27380616
DOI: 10.1097/SLE.0000000000000300 -
Der Chirurg; Zeitschrift Fur Alle... May 1996Diagnostic and pathomorphological findings support the notion that external and internal rectal prolapse with and without solitary rectal ulcer are merely different... (Review)
Review
Diagnostic and pathomorphological findings support the notion that external and internal rectal prolapse with and without solitary rectal ulcer are merely different stages of one and the same disease. In view of the fact that, in the last resort, the aetiology of this disease remains largely unknown, the differential approach to therapeutic decision-making makes it necessary to give careful consideration to the individual situation of the patient, age, sex, case history and current findings. Although considerably in excess of 100 different surgical techniques have been reported for the treatment of rectal prolapse, only very few have finally been accepted in practice. In very old and high-risk patients, extra-abdominal corrective procedures (Delorme's procedure, peri-anal rectosigmoidal resection) performed under spinal or peridural anaesthesia, are given preference, despite the fact that the recurrence rate and the rate of persistent incontinence is higher than that seen with transabdominal techniques. In the case of younger patients and older patients unburdened by risk factors, the trans-abdominal procedures offer better functional results and lower recurrence rates. Here, anterior and posterior rectopexy and resection of the sigmoid with rectopexy are the most widely practiced procedures. With the further development of minimal invasive surgery, laparoscopic techniques are now also available, with the aid of which anterior and posterior rectopexy and intracorporeal sigmoid resection can be performed safely and reliably. These techniques will very likely further encourage the trend towards transabdominal procedures for the correction of rectal prolapse. These operative procedures may also be indicated in selected cases, in whom conservative treatment of intussusception and/or solitary rectal ulcer has failed.
Topics: Adult; Aged; Aged, 80 and over; Anastomosis, Surgical; Female; Humans; Laparoscopes; Laparoscopy; Male; Middle Aged; Postoperative Complications; Proctoscopes; Proctoscopy; Rectal Prolapse; Rectum; Recurrence; Risk Factors; Surgical Equipment; Surgical Instruments; Treatment Outcome
PubMed: 8777876
DOI: No ID Found -
World Neurosurgery May 2023To compare the SimSpine (indigenously developed, low-cost model) and EasyGO! (Karl Storz, Tuttlingen, Germany) systems for simulation of endoscopic discectomy. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To compare the SimSpine (indigenously developed, low-cost model) and EasyGO! (Karl Storz, Tuttlingen, Germany) systems for simulation of endoscopic discectomy.
METHODS
Twelve neurosurgery residents, 6 in postgraduate years 1-4 or equivalent (junior) and 6 in postgraduate years 5-6 or equivalent (senior), were randomly allocated (1:1) to either EasyGO! or SimSpine endoscopic visualization systems for endoscopic lumbar discectomy simulation on the same physical simulator. After the first exercise, the participants switched over to the other system, and the exercise was repeated. Time taken to dock the system, time to reach annulus, time required for task completion, dural violation, and volume of disc material removed were used for calculating objective efficiency score. Subjective scoring (Neurosurgery Education and Training School [NETS] criteria) was performed by 4 blinded mentors based on recorded video on 2 separate occasions 2 weeks apart. Cumulative score was calculated based on efficiency and Neurosurgery Education and Training School scores.
RESULTS
Performance metrics were similar across the 2 platforms, regardless of participant seniority (P > 0.05). Time to reach disc space and discectomy time improved for both EasyGO! (P = 0.07 and P = 0.03, respectively) and SimSpine (P = 0.01 and P = 0.04, respectively) between first and second exercises. Efficiency and cumulative scores were better (P = 0.04 and P = 0.03 respectively) when EasyGO! was used as the first device compared with SimSpine.
CONCLUSIONS
SimSpine is a cost-effective viable alternative to EasyGO for endoscopic lumbar discectomy simulation-based training.
Topics: Humans; Clinical Competence; Cost-Benefit Analysis; Endoscopy; Endoscopy, Gastrointestinal; Internship and Residency; Neurosurgery; Neurosurgical Procedures; Simulation Training; Spinal Diseases
PubMed: 36889639
DOI: 10.1016/j.wneu.2023.02.133 -
Colorectal Disease : the Official... Nov 2004The aim of the study was to analyse the outcome of restorative proctocolectomy carried out by laparoscopic surgery.
OBJECTIVE
The aim of the study was to analyse the outcome of restorative proctocolectomy carried out by laparoscopic surgery.
METHODS
A prospectively collected electronic database of all colorectal laparoscopic procedures performed between April 2001 and July 2003 has been used to identify surgical outcomes in 14 consecutive patients who have undergone laparoscopic RPC.
RESULTS
Fourteen patients (5 male), median BMI 24 kg/m(2) have undergone restorative laparoscopic proctocolectomy over a two year period: 13 (ulcerative colitis, one with cancer) and 1 (FAP). The median operation time was 260 min; time has not decreased with experience. There were no intra-operative surgical complications or deaths. Patient controlled analgesia continued for a median of 36 h. The median time to diet was 48 h and median hospital stay 7 days; three patients required nasogastric aspiration for delayed gastric emptying. Eighteen regional lymph nodes were retrieved local to the carcinoma. There was one anastomotic leak. All covering stomas were closed by 6 months (12 by eight weeks). All 14 patients are fully continent, able to suppress urgency and have a median pouch frequency of 4/24 h. None admit to having problems with potency, orgasm sensation, ejaculation, micturition. One lady reports dysparunia. All are highly satisfied with functional outcome and cosmesis.
CONCLUSION
We are encouraged to continue to offer our patients the option of a laparoscopic resection.
Topics: Adult; Aged; Aged, 80 and over; Colitis, Ulcerative; Colonic Pouches; Colorectal Neoplasms; Female; Follow-Up Studies; Humans; Male; Middle Aged; Minimally Invasive Surgical Procedures; Patient Satisfaction; Postoperative Complications; Proctocolectomy, Restorative; Proctoscopes; Proctoscopy; Prospective Studies; Quality of Life; Registries; Risk Assessment; Treatment Outcome
PubMed: 15521936
DOI: 10.1111/j.1463-1318.2004.00713.x -
Tidsskrift For Den Norske Laegeforening... Nov 2007Rectal tumors up to 25 cm from the anal verge may be resected by transanal endoscopic microsurgery (TEM). TEM is suitable for resection of benign adenomas, but can also... (Review)
Review
BACKGROUND
Rectal tumors up to 25 cm from the anal verge may be resected by transanal endoscopic microsurgery (TEM). TEM is suitable for resection of benign adenomas, but can also be used for selected malignant tumours.
MATERIAL AND METHODS
Based on review of the literature and our own experience with 150 procedures, we present a review of the method and indications for TEM.
RESULTS
TEM is a safe and suitable method for resection of rectal adenomas that cannot be radically removed by endoscopic methods. TEM offers lower recurrence rates and less morbidity than traditional treatment. Large tumours and involvement of the microscopical resection margin disposes for recurrence. Selected malignant tumours (like small carcinoid tumours and early stage [Tis, T1] adencarcinomas) with higer moderate differentiation may be resected by TEM with the same oncological result as open surgery.
INTERPRETATION
Tumours can be resected in the entire rectum with TEM. TEM is especially suitable to resect benign adenomas, and may also have a place as primary treatment of selected malignant tumours in Norway. Depending on selection criteria and combination with radiotherapy, the method may be suitable for 30 - 110 patients/year with rectal cancer in Norway.
Topics: Adenocarcinoma; Adenoma; Humans; Microsurgery; Neoplasm Recurrence, Local; Postoperative Complications; Proctoscopes; Proctoscopy; Rectal Neoplasms
PubMed: 18026244
DOI: No ID Found