First Year Of Experience Research Articles

PE025 - Robot-assisted radical prostatectomy with the On Demand Dexter™ Robotic System: first year of experience

PE025 - Robot-assisted radical prostatectomy with the On Demand Dexter™ Robotic System: first year of experience

Agrochemical Conditions of Loamy Haplic Luvisol at Sour Cherry Orchard after 6-Year Treatments by Nitrogen and Potassium Fertilizers

In a field experiment in a cherry orchard, the effect of annual application of urea and potassium sulfate on the most important agrochemical properties of the soil in the root zone was evaluated. The soil of the garden is medium-loamy agro-gray with initially favorable parameters: pHKCl 5.8, humus content – 3.58–4.57%. Fertilizers have been applied since 2017 1 time a year in early spring according to the scheme: 1 – control (without fertilizers), 2 – N30K40, 3 – N60K80, 4 – N90K120, 5 – N120K160. Soil samples were taken from soil layers 0–20, 20–40 and 40–60 cm in 2017 (the first year of experience) and in 2022 (after 6 years of fertilization). The annual application of fertilizers for 6 years led to a significant increase (by 1.4–2.2 times) in the availability of exchangeable potassium in the soil layer of 0–20 cm with a constant humus content in the entire root zone. At the same time, an increase in acidity and loss of calcium occurred in the upper layers of the soil under the influence of fertilizers in doses of N60K80 or more. For the period 2018–2022, the highest total yield of Turgenevka cherry trees was noted when applying fertilizers N60K80 and N120K160 (35.5 and 36.5 t/ha, respectively), but this increase was insignificant compared to the control (29.3 t/ha). Thus, an agro-gray medium loamy soil with favorable agrochemical characteristics can ensure the growth and fruiting of cherry trees without the use of fertilizers for 8 years after planting and at the same time the level of soil fertility remains stable.

A promise kept? The first years of experience of the Appeal Panel of the SRB

Abstract Within the institutional architecture for financial supervision within the EU, courts coexist with quasi-courts, i. e., review bodies like the ESAs Joint Board of Appeal, the SSM’s Administrative Board of Review (ABoR) and the SRB’s Appeal Panel. This has parallels e. g. US Administrative Law Judges (ALJs). Some argue that this flight away from courts is justified because administrative law and procedure are more flexible. Yet administrative mechanisms are deceptively simple. This paper offers a cautionary tale about the complexities of all quasi-judicial arrangements and their competing and complementary role with courts and presents an analysis of the European framework from both a functional and a comparative perspective.

Initiation of a pediatric cardiac surgery program in 2020

The goal of this study is to describe the preparation and the first year of experience of the pediatric cardiac surgery program at our institution, where such a program was not available before 2020. The project was initiated by the university hospital, in collaboration with the Regional Health Agency. Transborder staff training and significant investments were supported by the Interreg program. A multidisciplinary team was built, which started the pediatric ECMO program in the pediatric intensive care unit prior to the surgical program and set up a parallel program dedicated to the neurodevelopmental follow-up of operated infants. Importantly, a progressive upscale was devised: only children with a weight > 5 kg requiring low or moderate-complexity surgeries were operated on during the first year. From October 2020 to December 2021, 77 children were operated on, including 64 in the new pediatric cardiac surgery program. Repeated waves of COVID-19 made the start of the program difficult by restricting access to the operating room. The age of the 64 patients of the new program was 6.2 years old (1.7–9.5). Cardiopulmonary bypass cases represented 47 (74.6%) of all cases. In addition to low-complexity surgeries, procedures such as tetralogy of Fallot repair ( n = 6) and bilateral cavopulmonary connection ( n = 4) were performed. There were no early or late deaths postcardiotomy. Intensive care and hospital stays were 3 (2–7) and 6 (5–11) days, respectively. Our pediatric cardiac surgery program achieved very satisfactory outcomes in selected patients, despite difficulties related to the current pandemic. Institutional support, meticulous planning and excellent team cohesion were keys for successful initiation of our program.

Endoscopic transsphenoidal surgery for non-functioning pituitary adenoma: Learning curve and surgical results in a prospective series during initial experience.

BackgroundTo report the initial experience of surgery for non-functioning pituitary adenoma (NFPA) from a neurosurgeon in a dedicated residency training endoscopic transsphenoidal (ETS) program, and detail the surgical and clinical outcomes during this period.MethodsA prospective series of all patients operated for NFPA, using an ETS approach, during the three first years of experience of a newly board-certified neurosurgeon was analysed. Clinical, radiological and peri-operative data were collected. Extent of resection (EOR) was determined by formal volumetric analysis. Impact of the learning curve and predictive factors of gross total resection (GTR) were determined.ResultsFifty-three patients with NFPA were included in this prospective cohort which was divided in two periods of time (“First period”: 30 first cases, and “second period”: 23 following cases). Baseline characteristics of the patients in the two periods were similar. Overall occurrence of complication was 22% and was not significantly different in the two periods of time. No patient had severe neurological complication. Gross total resection was achieved in 70% of patients. Mean Extent of resection was 96%. In a multiple linear regression model, a higher EOR was positively correlated with experience (p = 0.018) and negatively correlated with Knosp Score equal to 4 (p < 0.001). Predictive factors for GTR were Higher Knosp grade (p = 0,01), higher pre-operative volume (p = 0.03), and second period of time (p = 0.01).ConclusionNFPA surgery can be safe and efficient during the learning period. Dedicated intensive learning, careful patient selection and multidisciplinary work are key to shorten the learning curve and achieve satisfactory results.

American Board of Physical Medicine and Rehabilitation Diplomate Customization Choices on the Longitudinal Assessment for Physical Medicine and Rehabilitation: A First-Year Experience.

The American Board of Physical Medicine and Rehabilitation began administering the longitudinal assessment for physical medicine and rehabilitation for continuing certification in 2020. The longitudinal assessment for physical medicine and rehabilitation digitally delivers quarterly short assessments of content and repeats missed items to facilitate learning as well as serve as a summative certification assessment. With a goal of offering content relevant to an individual's practice and learning needs, diplomates choose how to customize the domains or topic areas of their question content on an annual basis. This report describes the first year of experience with customization of longitudinal assessment for physical medicine and rehabilitation. The American Board of Physical Medicine and Rehabilitation diplomate customization data are grouped and compared in a variety of ways to ascertain whether there are differences in customization choices. While customization choices were similar across several domains, significant differences were seen when comparing groups with specific areas of practice or subspecialty certification. Smaller differences were also seen when comparing question domain allocation choice between sexes, age groups, and practice setting. The results from this first full year of experience confirm an alignment of this innovative assessment approach to individual physician practice, a significant step in improving the relevance of continuing certification overall for participating physicians.

ECHO project in atopic dermatitis in Argentina: An innovative strategy to reach underserved areas with up to date knowledge, first year of experience

BackgroundThe ECHO® (Extension for Community Healthcare Outcomes) project is a model of distance medical education developed in the United States to support health professionals in the management of patients with complex diseases. Since 2019, it has been implemented in atopic dermatitis (AD) in Argentina. The program consists of the periodic presentation of clinical cases by videoconference, virtual classes, and a permanently available open chat between professionals in charge of patients with AD and a group of experts. ObjectiveThe objective of this study was to analyze the impact of the ECHO Project AD on the medical knowledge and medical skills of Argentinian health professionals when treating patients with AD. MethodsA survey was carried out among the participants in order to evaluate the impact of the program on the care of patients with AD. ResultsECHO Project AD revealed a significant improvement in the management of patients with AD. The program contributed to the interpretation and use of severity scores, use of phototherapy, and management and prescription of both classic and innovative topical and systemic treatments. Study limitationsThe reduced number of participants and the short period of time. The answers of the survey may be biased by the enthusiasm of the participants. ConclusionsThe ECHO project is an educational tool that enhances the medical skills of doctors and institutions, in which a climate of a partnership comes first and the participants look forward to learning from experiences, successes, and mistakes from one another, producing a scientific hub in constant evolution.

1545. Three Site Testing for Sexually Transmitted Infections for People Living with HIV in One Southeastern Ryan White HIV/AIDS Program Clinic: First Year of Experience

BackgroundFor comprehensive care, it is recommended that people living with HIV who are sexually active have annual multisite testing for gonorrhea and chlamydia. Appropriate testing is defined by testing at all sites of sexual exposure (urogenital, pharyngeal, rectal). In the first year of 3 site testing at our HIV clinic, we aimed to describe (1) the rate of appropriate sexually transmitted infection (STI) testing, (2) the factors associated with STI diagnosis, and (3) the percentage of extragenital STIs that would have been missed with only urogenital testing.MethodsParticipants were > 14 years old with > 1 in-person medical visit at the Ryan White HIV/AIDS Program clinic in 2019. We collected demographics, reported sexual activity, and STI test dates and results. Controlling for number of sites tested, a log-binomial model was used to estimate the association of different characteristics with an STI diagnosis.ResultsFor this cohort (n=857; Table 1), 44% reported sexual activity, 34% reported no sexual activity and 22% had no sexual activity information recorded. Of 1185 STI tests performed for 491 participants, 51 STIs were diagnosed in 33 participants. One STI was diagnosed for a female (0.7%). Overall, 68% (253/375) received appropriate urogenital testing, 63% (85/134) received appropriate pharyngeal testing and 69% (72/105) received appropriate rectal testing. For male participants with > 1 STI test (n=347), Hispanic ethnicity was associated with an STI diagnosis (Table 2). Of those with concurrent extragenital and urogenital tests, 96% of people with an STI (n=26) were positive at only an extragenital site.Table 1: Study Participants’ Characteristics Table 2: Factors Associated with Being Diagnosed With a Sexually Transmitted Infection for Men Living With HIV: Frequencies and Results of Univariable and Multivariable Log-binomial Model ConclusionNearly a quarter of participants had no sexual activity information recorded in the year, which is an area for improvement. Despite newly adopting 3 site testing, appropriate extragenital and urogenital testing rates were similar and were high compared with national averages. There was no obvious clinician/patient bias against extragenital testing. Hispanic male participants’ higher STI diagnosis rate may point to more condomless sex in this population. Based on the identification of many infections exclusively at extragenital sites, we likely missed STIs previously. This highlights the importance of 3 site testing availability and testing at all appropriate sites.DisclosuresKathleen A. McManus, MD, MSCR, Gilead Sciences, Inc (Research Grant or Support, Shareholder)

A Preferred Vendor Model Reduces the Costs of Sports Medicine Surgery

To report on our institution's first year of experience with a preferred vendor program for implants and disposables for sports medicine surgery. Cost and utilization data for implants and disposables were analyzed for knee and shoulder sports medicine surgeries performed during the 2-year period including the 12 months preceding the start of the contract (contract year 0 [CY0] and the first 12 months of the contract period (CY1). The costs of grafts and biological therapies were excluded. Utilization of the preferred vendor's products, operative time, and per-case costs were compared between the 2 time periods and adjusted for patient factors and case mix. Utilization of the preferred vendor's shavers (0% to 94%, P < .001) and radiofrequency ablation wands (0% to 91%, P < .001) increased significantly in CY1 (n= 5,068 cases) compared with CY0 (n= 5,409 cases), with a small but significant increase in use of the preferred vendor's implants (64% to 67%, P= .023). There was no significant difference in mean operative time between CY0 and CY1 (P= .485). Mean total per-case implant and disposable costs decreased by 12% (P < .001) in CY1 versus CY0. Our institution was able to reduce the costs of sports medicine surgery with the implementation of a preferred single-vendor program for implants and disposables. This program had widespread surgeon adoption and did not have any detrimental effect on operating room efficiency. III, retrospective comparative study.

Multidisciplinary Management of Tethered Spinal Cord Syndrome in Children: Operationalizing an Outpatient Patient-Centered Workflow.

IntroductionMultidisciplinary care for patients with tethered spinal cord syndrome (TCS) is valuable in ensuring comprehensive evaluation, timely follow-up, optimal functional outcome, and patient-centered care. The family-centered focus aims to minimize patient and parental burdens associated with care coordination. We present our first-year institutional experience in operationalizing a multidisciplinary, patient-centered, pediatric tethered cord clinic (TCC) to manage routine, long-term surgical follow-up for children with non-myelomeningocele-related tethered spinal cords.MethodsTCC is composed of three surgical services: orthopedic surgery, neurosurgery, urology. A retrospective chart review of patients seen in the TCC from January 2019 to January 2020 was conducted. Patients enrolled in the clinic were intended for long-term follow-up. Demographic and outcome variables were collected.ResultsFifty-nine patients were seen in TCC. Types of tethered spinal cords amongst these patients were the following: fatty filum (62.7%), dermal sinus tract (15.2%), meningocele manqué (8.4%), lipomyelomeningocele (6.7%), low lying conus medullaris (5.1%), and sacral arachnoid cyst (1.7%). Age at diagnosis was 1.31 ± 2.21 (median: 0.25 years) and at follow-up was 9.0 ± 5.18 years (median: 8 years). A total of 50.9% of patients were female, and 93.2% had a prior untethering procedure. Of all patients, 6.8% have no surgical intervention and continue to be monitored conservatively for evidence of decline. All three services evaluated 84.8% of patients during the same clinic session, while 15.3% of patients were seen by two of the services, and 20.3% of patients were able to schedule related imaging or diagnostic testing during the same visit.ConclusionWe describe successful implementation of a multidisciplinary pediatric TCC and document the first year of experience. The TCC streamlines care, decreases burden on families, and reduces those lost to follow-up. Complex disease pathologies, even when clinically stable, require long-term follow-up with multiple subspecialties and benefit from multidisciplinary clinics.

The first year of experience with an extracorporeal resuscitation program for refractory in-hospital cardiac arrest

The first year of experience with an extracorporeal resuscitation program for refractory in-hospital cardiac arrest

Law and practice of financial appeal bodies (ESAs’ Board of Appeal, SRB Appeal Panel): A view from the inside

This paper offers some lessons drawn from the first years of experience of both the joint Board of Appeal (BoA) of the European Supervisory Authorities and the Appeal Panel (AP) of the Single Resolution Board.The paper outlines their institutional design and the main substantive and procedural issues that have arisen in the cases so far decided by both bodies. It offers a view “from the inside”, which shows not only the certainties of appeal bodies, but also their many challenges. The paper also discusses design strengths and weaknesses of the current EU adjudicatory system of public law disputes in the Banking Union and the Capital Markets Union, bearing in mind the importance of independent review, and the Vaassen criteria for “courts”. The paper concludes by offering preliminary stocktaking and reflections on a possible way forward to enhance the complementary (and supporting) role of financial appeal bodies to the EU courts.

A new modular external fixator: A retrospective review

The Dolphix is a new external fixation system consisting of relatively few components. Its modular nature allows for a variety of possible configurations, making it useful for the treatment of many types of fractures. The fixator can be adjusted after it is placed in order to improve either patient comfort or fracture reduction, and the device can be removed at the bedside under light sedation with no need for additional instrumentation. During the first year of experience with this device at our level I trauma center, fixator times have been relatively short and there have been no equipment failures or pin-tract problems. The Dolphix is a reasonable alternative to some of the more complex and costly external fixation systems currently available.

Diseño y pilotaje del METEnf: Modelo de Evaluación de los factores de Transferencia de la formación de los nuevos profesionales en Enfermería

BackgroundDuring the first months in the labour market, many nursing professionals face barriers that might influence the application of their training received during their degree. AimTo describe the design and validation of the Model for evaluating Training Transferability factors of new Nursing professionals (METEnf) during their first year of experience in the labour market. MethodThe model was based on a literature review and focus group in order to create the questionnaire items. The METEnf content validity was tested using expert groups. Its psychometric qualities were evaluated with a sample of 33 nursing professionals, which was also used as a pilot test. ResultsThe questionnaire showed a good internal consistency, which started its validation process. The results also indicated that nursing professionals are highly motivated to learn during their first year of being employed. Nonetheless, they considered that the training received in their degree, as well as the presence of a mentor hinder their possibilities to transfer what they have learned into their nursing activities. ConclusionsThis study shows the possibilities of using the METEnf tool to evaluate the factors that influence the training transferability of new nursing professionals, even though there is a need to intervene in training, as well as the mentor figure, in order to facilitate this process.

MASK (Mobile Airways Sentinel Network), a mobile App with ARIA's comprehensive solution in Spanish-speaking countries

Although there are high quality clinical guidelines about allergic rhinitis, many patients receive deficient treatment, partly due to the high level of self-medication. MASK (Mobile Airways Sentinel Network) is an integral part of a project against chronic diseases which it is focused on active and healthy aging and is supported by the European Union. It forms the third phase of ARIA (Allergic Rhinitis and its Impact on Asthma) in which, through a mobile app on a smart device, the purpose is to guide patients in the control of their multimorbidity, allergic rhinitis or conjunctivitis, or asthma. The "Allergy Diary" app by MACVIA-ARIA is free and it is available for Android and iOS; on it, patients indicate how unpleasant the symptoms are on a daily basis through five screens with an analogous visual scale; two more screens were recently added (sleep affectation). With the app, it is also possible to download the information of the "Allergy Diary" on the physician's computer through a QR code at the moment of the medical consultation. In this article, we review the first year of experience in Spain, Mexico and Argentina, where the Spanish version is used.

Providing Medical Assistance in Dying Within a Home Palliative Care Program in Toronto, Canada: An Observational Study of the First Year of Experience

Abstract Background: Medical Assistance in Dying (MAiD) was legalized in Canada in June 2016. There are no documented experiences of MAiD provision within a home palliative care program. The majori...

Providing Medical Assistance in Dying within a Home Palliative Care Program in Toronto, Canada: An Observational Study of the First Year of Experience.

Medical Assistance in Dying (MAiD) was legalized in Canada in June 2016. There are no documented experiences of MAiD provision within a home palliative care program. The majority of palliative care physicians in Canada object to MAiD. As one of the largest home-based palliative care providers in Canada, the Temmy Latner Centre for Palliative Care (TLCPC) developed processes to implement MAiD provision within a home palliative care team with diverse attitudes toward MAiD. To demonstrate the feasibility of providing MAiD within a home palliative care setting and describe the population that received MAiD in the first year of legalization. A retrospective chart review identified patients who received or were assessed for MAiD and had a known outcome between June 17, 2016 and June 30, 2017. Patients receiving home-based palliative care. Data extracted included age, gender, primary diagnosis, length of time receiving home-based palliative care, and final clinical outcome. Of the 45 patients who were assessed for MAiD, 27 (60%) received MAiD and 18 (40%) did not. The mean age was 74 (range 20-95), 24 (53%) were male, and 33 (73%) had cancer as a primary diagnosis. These 27 patients represent 1.2% of our total patient population during this time period. MAiD was accessed by 1.2% of the patients within a home palliative care center in the first year of legalization. Patient demographics were consistent with those documented elsewhere. The TLCPC process accommodates the diverse viewpoints of clinicians and emphasizes continuity of palliative care provision.

Abstract 173: Reducing the Burden of Low Risk Chest Pain Admissions; Role of the Expedited Outpatient Stress Testing Quality Improvement Initiative

Background: Chest pain is a frequent cause for emergency department (ED) presentation and is associated with significant costs. A pathway for expedited outpatient stress testing and follow-up for low risk chest pain patients in the ED was established in our institution. We present patients’ demographics and evaluate the efficacy, safety and overall performance of this quality improvement (QI) initiative. Methods: All patients referred to the program were retrospectively identified from the first year of experience. Rates of MACE and readmissions were determined at both 30 and 60 days of follow-up. Average time to testing and clinic assessment were measured. Rates of Cardiology consultations and admissions for chest pain were determined before and after program implementation. Results and discussion: A total of 425 patients were identified who were referred to the program. Forty patients were excluded from analysis as they failed to attend or declined testing, were inappropriately referred, or were lost to follow-up. Patient characteristics, outcome data, and adverse events are shown in table 1. A rate of over 75% stress testing within 5 days of ED visit and 68% of clinic visit within 6 weeks of a positive test was observed. Trends towards a reduction in admissions and consultations occurred in the year following program implementation(Figure 1). Conclusion: This local program for rapid out-patient testing for low risk chest pain patients in the ED is feasible, safe, and effective. Lack of patient adherence to follow-up is a concern with this out-patient approach. Improving time to stress testing and clinic waiting times have been identified as institutional priorities on the basis of this QI project.

Un « Massive Open Online Course » (MOOC) sur des travaux pratiques en histologie : un objectif, un outil, un public varié ! Retour sur une première expérience

A goal! The MOOC entitled "Introduction to Histology, A Human Tissue Exploration" correspond to our vision of the practice of General Histology, which is based on the ability to diagnose 5 families of biological tissues. Ultimately, participants must be able to recognize the different types of cells and all the surrounding elements in order to understand how they organize themselves to form tissues with specific functions. A tool! This know-how is based on reasoning from observations of microscopic structures. Learners are therefore invited to manipulate a virtual microscope to explore biological samples on histological slides digitized. Annotations, comments, drawings or photos are associated with landmarks that enrich the study of these histological sections. A target audience! Two educational paths allow deepening the subject in a different way and thus matching the goals or motivations of each one. After a first year of experience, usage statistics and surveys of our learners show that the MOOC Histo has allowed each of them to find an interest and federate a community of motivated learners.

Descemet Membrane Endothelial Keratoplasty: Outcomes in the First Year of Experience.

We aimed to report the clinical outcomes of Descemet membrane endothelial keratoplasty in our first year of experience. Patients who underwent Descemet membrane endothelial keratoplasty at the Baskent University Faculty of Medicine, Department of Ophthalmology, between 2015 and 2016 were included in the study. Patient demographics, cause of endothelial dysfunction, best-corrected visual acuity, central corneal thickness, graft survival, follow-up duration, and intraoperative and postoperative complications were recorded. Five eyes of 5 patients (4 female, 1 male) with a mean age of 53.4 ± 12.7 years were included. Cause of endothelial dysfunction included corneal endothelial dystrophy in 3 patients, pseudophakic bullous keratopathy in 1 patient, and endothelial graft failure after previous penetrating keratoplasty in 1 patient. Pre-stripped Descemet membranes obtained from the Ankara State Hospital Eye Bank were used. Mean duration of postoperative follow-up was 7.4 ± 3.7 months. Mean preoperative Snellen best-corrected visual acuity and central corneal thickness were 0.24 ± 0.15 and 625.5 ± 97.4 μm. Mean best-corrected visual acuity increased to 0.67 ± 0.26 (P = .02) in the first month and to 0.84 ± 0.11 (P < .01) at the end of follow-up. Mean central corneal thickness decreased to 546.6 ± 28.4 μm (P = .03). Graft detachment was observed in 1 patient on the first postoperative day, and it was reattached successfully by injection of air into the anterior chamber. There were no intraoperative complications. All corneas were clear at the end of follow-up. Descemet membrane endothelial keratoplasty provides a new and exciting option for endothelial transplant and has the potential to become the primary procedure for surgical management of Fuchs endothelial dystrophy and corneal endothelial disease. Rapid visual rehabilitation with few and manageable complications and good visual outcomes are the major advantages of this procedure.