Group Of Operators Research Articles

The role of laparoscopy in the treatment of perforated gastro-duodenal ulcers

Introduction:The incidence of peptic ulcer disease decreased due to proton pump inhibitors and Helicobacter pylori eradication. Bleeding from peptic ulcer decreased, as well, although perforation did not decrease and it is permanently between 2–10%. This is a potential surgical emergency, the mortality can reach up to 25% and the morbidity 50%, respectively. Urgent surgical intervention in the right time can improve the results.Aim:To compare the morbidity, mortality, the length of hospital stay and duration of operating time in open and laparoscopic repair of perforated peptic ulcer.Results:A cohort of 55 patients were operated on with perforated peptic ulcer from 01.01.2017 to 30.06.2019 31 open (51.36%) and 24 laparoscopic (43.63%) operations were performed from which 4 (16.6%) needed conversion to open approach. The average age of 23 men and 8 women were 56.3 and 70.3 years respectively in the open operations group, while 13 men and 11 women with average age of 49.7 and 53.7 years was in the laparoscopic operations group. Within 30 days the number of complications were 5 in the open and 2 in the laparoscopic group (p= 0.45). The average duration of operation was 51.95 minutes (30–85) in the open and 63.41 minutes (25–110) in the laparoscopic group (p= 0.13). 6 from the open group with average age of 74.3 years and 2 from the laparoscopic group with average age of 68.5 years died within 30 days (p= 0.44). The average length of stay was 7.13 (5–16) days in the open and 6.19 (4–13) days in the laparoscopic group (p= 0.24). The average size of the perforation was 7.4 mm (3–20) in the open and 5.3 mm (3–10) in the laparoscopic group (p= 0.14). Free air was seen in the abdominal cavity in 25 cases (80%) of the open and in 11 cases (54%) of the laparoscopic group.Conclusion:Early diagnosis, prompt supportive care and antibiotic treatment and urgent surgical intervention are essential to improve outcomes. The standard operation is the simple suture with pedicled omental flap which can be performed by either open or laparoscopic surgical repair. Laparoscopic method spreads slowly, the learning curve is longer and it needs more expertise but the morbidity is lower than that of the open surgery. The morbidity does not increase after conversion according to the literature so if there is no contraindication and there is enough expertise it should be suggested as the first choice.

Operative intervention for recurrence of adrenocortical carcinoma: A single-center experience

IntroductionAdrenocortical carcinoma is a rare endocrine malignancy with a high recurrence rate. The aim of this study was to evaluate the role of surgery for patients with local or distant recurrent adrenocortical carcinoma and to attempt to identify prognostic features related to survival benefit in patients undergoing resection of recurrence. MethodsThe data of 47 patients with recurrent adrenocortical carcinoma in West China Hospital, Sichuan, China, between 2009 and 2019 were retrospectively collected. These patients were divided into 2 groups according to whether resection of recurrence was performed. The correlation between overall survival after recurrence and reoperation was evaluated. Kaplan-Meier and univariate/multivariate Cox regression methods were used to identify any prognostic factors. ResultsIncluded in our study were 21 patients who underwent reoperation and 26 patients who underwent nonoperative treatments were. The operation group had a better median overall survival after recurrence than the nonoperation group (19 months versus 6.5 months; P = .007). In the operated group, disease-free interval >12 months (P = .002), complete resection of recurrent adrenocortical carcinoma (P = .041), and R0 resection of the primary tumor (P = .005) were associated with prolonged survival after recurrence. ConclusionsReoperation plays an important role in the management of selected patients with recurrent adrenocortical carcinoma. Disease-free interval, preoperative evaluation for complete resection, and R0 resection of the primary tumor are important prognostic characteristics for the resection of recurrent adrenocortical carcinoma. The overall survival after recurrence was significantly improved for patients who had a disease-free interval >12 months, and initial R0 resection or complete resection of recurrent adrenocortical carcinoma is feasible.

Effect of Ultramicro Superparamagnetic Iron Oxide Nanoparticles on Cerebral Infarction in Mice.

To investigate the effect of Feraheme (ferumoxytol) intravenous injection on cerebral infarction volume and inflammatory response in mice with permanent middle cerebral artery occlusion. We randomly divided 30 CS7BL6J mice into sham operated group, normal saline control group, and Feraheme group with 10 mice in each group. The model of permanent occlusion of right middle cerebral artery was made via the modified suture method in the normal saline control group and the Feraheme group. After 24 h of establishment the model, the tail vein was injected with 18 mg/kg Feraheme in the sham operation group and Feraheme group, and the normal saline control group was injected with an equal volume of normal saline. Neurobehavioral scores were obtained 24 h (before injection of Feraheme or normal saline) and 48 h (before MRI) after the model was established. The volume of cerebral infarction was calculated according to T2 weighted imaging. Orbital blood was collected after nodal scanning to detect serum TNF-α, IL-1β, and IL-6 levels. Then, the brain tissues of mice were killed for HE staining and IBAL immunohistochemical staining. No significant differences in cerebral infarction volume and neurological function were observed between the normal saline control group and Feraheme group. The levels of TNF-α, IL-1β and IL-6 in the normal saline control group and Feraheme group were significantly higher than those in the sham operation group (P < 0.05), but there were no significant differences between the normal saline control group and Feraheme group. We showed that intravenous injection of 18 mg/kg Feraheme 24 h after cerebral ischemia does not affect the infarct volume and inflammatory response, suggesting that the dose of Feraheme can be used for molecular imaging studies of inflammatory response after cerebral ischemia.

Public Trust and Acceptance for Concepts of Remotely Operated Urban Air Mobility Transportation

There is building interest within industry and government to enable Urban Air Mobility (i.e., air-taxies). One concept envisions remotely piloted aircraft, yet it is unclear how this will impact public trust and acceptance. Method: Two hundred participants read vignettes describing remotely-piloted UAM operations and then responded to a series of questionnaires. The study employed a one-way between-subjects design manipulating five levels of Pilot-in-Command Distance: Onboard Pilot; Remote Control Pilot; Dedicated Remote Operator; Remote Operator; System Manager. Results: The Remote Control Pilot group indicated they would be less likely than the Onboard Pilot group to use UAM, based on the mediating effect of trust in the automation. The Remote Control Pilot and Remote Operator groups indicated they would be less likely to use UAM than the Onboard Pilot group, based on the mediating effect of trust in the remote pilot/operator. Conclusion: Trust in UAM automation and remote pilots/operators will likely affect public acceptance of UAM.

Nurses' knowledge, skills and personal attributes for competent health education practice: An instrument development and psychometric validation study.

To develop and psychometrically test the Nurse Health Education Competence Instrument for assessing nurses' knowledge, skills and personal attributes concerning competent health education practice. A psychometric instrument development and validation study. A four-step approach was used: Step 1) operational definition based on an up-to-date concept analysis and experts' judgement; step 2) item generation and content validation by expert panel and target population; step 3) item analysis based on acceptability, internal consistency and face validity; and step 4) psychometric evaluation based on construct validity, criterion validity, internal consistency and stability, conducted from January -February 2019 with 458 hospital-care nurses. The operational framework and expert groups showed good content validity, resulting in the first version. From the initial 88-item pool, 58 items were retained after item analysis. Exploratory factor analysis revealed three scales concerning the cognitive (three-factor solution with 23 items), psychomotor (two-factor solution with 26 items) and affective-attitudinal (one-factor solution with nine items) competency domains, which respectively accounted for 58%, 53% and 54% of the variance. Known-group study demonstrated significant differences by years working in the service and training received in health education, providing evidence for the measure's sensitivity. The three scales correlated positively with the criterion variable. Overall Cronbach alphas for the cognitive, psychomotor and affective-attitudinal scales were 0.95, 0.95 and 0.90, respectively. Intraclass correlation coefficients were >0.70. The newly developed Nurse Health Education Competence Instrument is an original and tested self-reporting psychometric tool, being the first to identify nurses' knowledge, skills and attributes necessary for planning and assessing health education practice competency. The instrument permits measurable insights into nurses' perceptions regarding their health education competence and related educational needs. This study provides a valid and specific learning tool that is appropriate to use both in clinical practice and in nursing education programmes.

Ultrasound grading of thyroid nodules using the BTA U-scoring guidelines - Is there evidence of intra-and interobserver variability?

U-score ultrasound classification (graded U1-U5) is widely used to grade thyroid nodules based on benign and malignant sonographic features. It is well established that ultrasound is an operator-dependent imaging modality and thus more susceptible to subjective variances between operators when using imaging-based scoring systems. We aimed to assess whether there is any intra- or interobserver variability when U-scoring thyroid nodules and whether previous thyroid ultrasound experience has an effect on this variability. A total of 14 ultrasound operators were identified (five experienced thyroid operators, five with intermediate experience and four with no experience) and were asked to U-score images from 20 thyroid cases shown as a single projection, with and without Doppler flow. The cases were subsequently rescored by the 14 operators after six weeks. The first and second round U-scores for the three operator groups were then analysed using Fleiss' kappa to assess interobserver variability and Cochran's Q test to determine any intraobserver variability. We found no significant interobserver variability on combined assessment of all operators with fair agreement in round 1 (Fleiss' kappa = 0.30, p <0.0001) and slight agreement in round 2 (Fleiss' kappa = 0.19, p < 0.0001). Cochran's Q test revealed no significant intraobserver variability in all 14 operators between round 1 and round 2 (all p>0.05). We found no statistically significant inter- or intraobserver variability in the U-scoring of thyroid nodules between all participants reinforcing the validity of this scoring method in clinical practice, allaying concerns regarding potential subjective biases in reporting.

Polyhomomorphisms of locally compact groups

Let and be locally compact groups with fixed two-sided invariant Haar measures. A polyhomomorphism is a closed subgroup with fixed Haar measure, whose marginals on and are dominated by the Haar measures on and . A polyhomomorphism can be regarded as a multi-valued map sending points to sets equipped with ‘uniform’ measures. For two polyhomomorphisms and there is a well-defined product . The set of polyhomomorphisms is a metrizable compact space with respect to the Chabauty-Bourbaki topology and the product is separately continuous. A polyhomomorphism determines a canonical operator , which is a partial isometry up to a scalar factor. For example, we consider locally compact linear spaces over finite fields and examine the closures of groups of linear operators in semigroups of polyhomomorphisms. Bibliography: 40 titles.

Carotid Endarterectomy with Modified Eversion Technique: Results of a Single Center

Carotid endarterectomy (CEA) has a wide range of approaches based on personal expertise and preference. We evaluated our outcome with CEA with modified eversion technique (meCEA) under local anesthesia and whether the surgeon's experience could influence it. at our Institution, 837 patients underwent CEA across 8years. Although the surgicaltechnique was standardized, 2 groups were considered further: meCEA performed by a single Senior Operator (Group A) and meCEA performed by 4 young Consultants (Group B). A selective shunting policy was needed in 5.1%, together with general anesthesia. Overall operative time was 63.9±15.1minutes (61.4±12.5 and 66±16.9minutes in Group A and Group B respectively; P<0.001) and cross-clamp time 19.3±2.9minutes (19.0±3.2 vs. 19.5±2.8, P=0.009). At 30days, 0.7% TIA and 0.8% strokes were recorded. No differences (p=N.S.) between the 2 study groups in terms of postoperative neurological complications, with postoperative ipsilateral strokes always<1%. At a median imaging follow-up of 22.5months, the overall percentage of restenosis was 3.7%, with no difference between the 2 groups (P=0.954). Twenty-two patients (2.6%) underwent reintervention for significant restenosis, and none of them had an ipsilateral stroke or TIA. Freedom from reintervention for restenosis at 24months was 97.9% in Group A and 95.9% in Group B, with no between-group difference (P=0.14). At the median survival follow-up of 37months, the overall survival rate at 24months was 97.9%in Group A, and 97.9% in Group B, with no between-group difference (P=0.070). In our experience, CEA with a modified technique is safe and achieves comparable outcomes to those of other established techniques. The reported short cross-clamp time, also in less experienced hands, is an additional strength.

Omitting radiotherapy is safe in breast cancer patients\u2009\u2265\u200970\xa0years old after breast-conserving surgery without axillary lymph node operation

To verify whether omitting radiotherapy from breast cancer treatment for patients ≥ 70 years old following breast-conserving surgery (BCS) without axillary lymph node dissection is safe. Previous studies have shown that omitting breast radiotherapy after BCS and axillary lymph node dissection is safe for elderly breast cancer patients. We aimed to evaluate the safety of BCS without axillary surgery or breast radiotherapy (BCSNR) in elderly patients with breast cancer and clinically negative axillary lymph nodes. We performed a retrospective analysis of 481 patients with breast cancer, aged ≥ 70 years, between 2010 and 2016. Of these, 302 patients underwent BCSNR and 179 underwent other, larger scope operations. Local recurrence rate, ipsilateral breast tumor recurrence (IBTR) rate, distant metastasis rate, breast-related death, disease-free survival (DFS), and overall survival (OS) were compared between the two groups. After a median follow-up of 60 months, no significant differences in local recurrence, distant metastasis rate, breast-related death, and DFS were noted. The OS was similar (P = 0.56) between the BCSNR group (91.7%) and other operations group (93.0%). The IBTR rate was considered low in both groups, however resulted greater (P = 0.005) in the BCSNR group (5.3%) than in other operations group (1.6%). BCSNR did not affect the survival of elderly patients with breast cancer with clinically negative axillary lymph nodes. IBTR was infrequent in both groups; however, there was a significant difference between the two groups. BCSNR is a feasible treatment modality for patients with breast cancer ≥ 70 years old with clinically negative axillary lymph nodes.

Project for Universal Management of Airways - part 1: concept and methods.

SummaryMultiple professional groups and societies worldwide have produced airway management guidelines. These are typically targeted at the process of tracheal intubation by a particular provider group in a restricted category of patients and reflect practice preferences in a particular geographical region. The existence of multiple distinct guidelines for some (but not other) closely related circumstances, increases complexity and may obscure the underlying principles that are common to all of them. This has the potential to increase cognitive load; promote the grouping of ideas in silos; impair teamwork; and ultimately compromise patient care. Development of a single set of airway management guidelines that can be applied across and beyond these domains may improve implementation; promote standardisation; and facilitate collaboration between airway practitioners from diverse backgrounds. A global multidisciplinary group of both airway operators and assistants was assembled. Over a 3‐year period, a review of the existing airway guidelines and multiple reviews of the primary literature were combined with a structured process for determining expert consensus. Any discrepancies between these were analysed and reconciled. Where evidence in the literature was lacking, recommendations were made by expert consensus. Using the above process, a set of evidence‐based airway management guidelines was developed in consultation with airway practitioners from a broad spectrum of disciplines and geographical locations. While consistent with the recommendations of the existing English language guidelines, these universal guidelines also incorporate the most recent concepts in airway management as well as statements on areas not widely addressed by the existing guidelines. The recommendations will be published in four parts that respectively address: airway evaluation; airway strategy; airway rescue and communication of airway outcomes. Together, these universal guidelines will provide a single, comprehensive approach to airway management that can be consistently applied by airway practitioners globally, independent of their clinical background or the circumstances in which airway management occurs.

Prevalence of arrhythmias on the long term of adult patients with partial anomalous pulmonary venous connection treated surgically and conservatively: data from the SACHER registry and a French center

Abstract Introduction Partial anomalous pulmonary venous connection (PAPVC) is a rare congenital heart disease, characterized by one or some but not all pulmonary veins anomalously connected to the right atrium or a systemic vein. PAPVC is either an isolated shunt lesion or associated with an atrial septal defect (ASD). This study compares the arrhythmic outcome of patients treated surgically with those clinically monitored. Method Clinical, surgical, imaging and invasive data of PAPVC patients were retrospectively reviewed from 7 centers from the Swiss Adult Congenital HEart disease Registry (SACHER) and one French center. Results A total of 168 patients with PAPVC were identified. Most (77%) patients underwent surgery, while the remaining (23%) ones were treated conservatively with clinical monitoring. The operated group (OG) had a significantly higher number of associated ASD (N=106, 82%) (p&amp;lt;0.001) and a higher number of anomalous pulmonary veins leading to a mean Qp:Qs at 2.5±1.2 before surgery (table). Moreover, the majority of patients in the OG had cardiac symptoms (N=78, 60%) and were diagnosed at a significantly younger age (table). Mean age at operation was 27±20 years. Age did not differ at latest follow-up (table). Holter recordings revealed a higher prevalence of arrhythmia in the OG (p=0.031), mainly of supraventricular tachyarrhythmias (table). The occurrence of ventricular non-sustained tachycardia and of bradyarrhythmia did not statistically differ between groups. Patients in the OG required more often medical treatment for arrhythmias: 12 (9%) needed electrophysiological study in the OG and none in the NOG (p=0.057). The amount of patients requiring a pacemaker implantation in the OG (11%) was significantly higher than that of NOG (0%) (p=0.039). Conclusion Patients after PAPVC repair present with a significant higher burden of arrhythmia than conservatively treated patients, either due to a larger shunt pre-operatively and/or as a late complication of the corrective surgery itself. Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Unrestricted grant from Actelion, Switzerland

Long-term outcome of adult patients with partial anomalous pulmonary venous connection treated surgically and conservatively: data from the SACHER registry and a French center

Abstract Introduction Partial anomalous pulmonary venous connection (PAPVC) is a rare congenital heart disease, which is characterized by one or some but not all pulmonary veins anomalously connected to the right atrium or a systemic vein. PAPVC is either an isolated shunt lesion or associated with an atrial septal defect (ASD). The only curative treatment is surgery, however the indication for surgery can be challenging. This study compares the outcome of patients treated surgically with those clinically monitored. Method Clinical, surgical, imaging and invasive data were retrospectively reviewed from 7 centers from the Swiss Adult Congenital HEart Registry (SACHER) and a French center. Results A total of 168 patients with partial anomalous pulmonary venous connection were identified. The majority (77%) of patients underwent surgery and the remaining (23%) were treated conservatively with clinical monitoring. The operated group (OG) had a significantly higher proportion of associated ASD (N=106, 82%) (p&amp;lt;0.001) and a higher prevalence of anomalous pulmonary veins leading to a mean Qp:Qs at 2.5±1.2 before surgery. Latest follow-up was 12 years after surgery. Mean age was 40±17 years. Patients in the non-operated group (NOG) were significantly more dyspneic than the OG (p=0.002). However, the need for medical treatment did not differ between groups: 58% of the NOG and 48% in the OG (p=0.203). Right ventricular (RV) ejection fraction did not differ between groups despite a significantly larger RV end-diastolic volume and a higher Qp:Qs on cardiac magnetic resonance (CMR) in the NOG (table). On echocardiography, the NOG showed a significantly better right ventricular longitudinal function and a higher systolic pulmonary artery pressure than the OG (table). The prevalence of significant valvulopathies did not differ between groups (table). Both groups had normal exercise capacity and with no differences between groups (table). Eighteen (14%) OG patients required a re-intervention either for residual shunt and/or stenosis of the pulmonary veins, superior and inferior vena cava. Conclusion PAPVC patients after surgical correction, show a favorable outcome in terms of imaging parameters and exercise capacity, however, a significant number presents with symptoms. PAPVC patients treated conservatively with small left to right shunting, have similar outcome justifying a conservative approach. Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Unrestricted grant from Actelion, Switzerland

Spectral identities and smoothing estimates for evolution operators

Smoothing (and decay) spacetime estimates are discussed for evolution groups of self-adjoint operators in an abstract setting. The basic assumption is the existence (and weak continuity) of the spectral density in a functional setting. Spectral identities for the time evolution of such operators are derived, enabling results concerning “best constants” for smoothing estimates. When combined with suitable “comparison principles” (analogous to those established in [39]), they yield smoothing estimates for classes of functions of the operators. An important contribution of this study involves the comparison of the spectral density of an operator $H$ and its perturbation $H+V.$ It entails a derivation of global spacetime estimates for $H+V$ on the basis of analogous estimates for $H.$ A number of applications are given, including smoothing estimates for fractional Laplacians, Stark Hamiltonians and Schrödinger operators with potentials.

Profile of Steroid Hormones and sex Hormone-Binding Globulin of Elite Soldiers

Background: Military police training should characterize the necessary abilities to conduct their activities with excellence. Biochemical parameters have a significant role in the performance of individuals and, therefore, are of crucial importance when trying to improve the teamwork of police officers, particularly for special operations groups. Hence, the use of laboratory analysis in activities that cause great physiological stress is of paramount importance. Objectives: The present study aimed to evaluate the profile of steroid hormones and the sex hormone-binding-globulin of soldiers belonging to a special operations force. Methods: In this cross-sectional study, blood samples of 75 volunteers collected after 12 hours of fasting are analyzed. Data were analyzed using descriptive statistics (i.e., mean and standard deviation) and compared to the reference values for each biomarker, referencing each individual in their age group. Results: Most of the participants presented adequate concentrations for their respective ages in relation to the data analyzed. Even the inclusion of individuals from different age groups did not change the good results found in the group. Conclusions: The positive results found in such a heterogeneous group with respect to age group can be attributed to an extremely rigorous selection process and a training program that elevates them to the rank of elite soldiers of the military police.

Analysis of visualization index using technique of simultaneous laparoscopic operations

Fatigue is a temporary decrease in the efficiency of an organism or organ due to intensive or long-term work, which is manifested in a decrease in quantitative and qualitative indicators of work and deterioration of coordination of work functions. Groups of simultaneous operations (411 patients) and group of single operations (746 patients) were formed. In both groups these changes were insignificant in most cases (except for marginal values in obese patients III, there were 6 such cases in the first group and8 inthe second), corrections of the port administration scheme were performed when performing vertical gastrectomy in both groups. After the calculation, the average deviations were1.2 cmin the first group and1.4 cmin the second. When using a laparoscope with a viewing angle of 0 o, the approach distance of the laparoscope with its own method of access on average during normal surgery is (6.92 ± 0.306) cm and is slightly smaller than standard methods, the average value of the studied parameter in the control group is - (6.98 ± 0.258) cm (p &lt;0.001). Visualisation during simultaneous laparoscopic operations using our developed technique was on the level with single laparoscopic operation, performed classically.

Сукупність основних принципів визначення раціонального складу сил і засобів для маскування та імітації військових об’єктів від технічних засобів повітряної розвідки та наведення зброї противника

Подальший розвиток теорії захисту військових об’єктів від технічних засобів повітряної розвідки та наведення зброї (ТЗПР) противника, особливо визначення завдань цього процесу в операціях (бойових діях) та оцінювання ефективності їх виконання, неможливі без формулювання відповідних принципів визначення раціонального складу сил і засобів для маскування та імітації військових об’єктів від ТЗРНЗ противника. У статті сформульовано основні принципи визначення раціонального складу сил і засобів для маскування та імітації військових об’єктів від ТЗПР противника, які ґрунтуються на загальних принципах створення оперативно-стратегічних (оперативних) угруповань військ (сил), встановлених закономірностях подальшого розвитку сил захисту військових об’єктів від засобів повітряного нападу противника, особливостях застосування сил і засобів маскування в сучасних операціях (бойових діях), розкрито їх зміст, проведено класифікацію та систематизацію.

Training the trainees: a pilot study of inter-observer discrepancy and learning curve in the maternal foetal unit of a tertiary centre

Our study aims to present the preliminary findings of an ongoing prospective cohort study that assesses the trainees’ ability to perform foetal biometry during the third trimester of pregnancy. Sixty-three women with third-trimester singleton pregnancies were included. A biometry scan was performed byboth residents and a foetal medicine specialist in the Third department of Obstetrics and Gynaecology of Attikon University Hospital. For each case, the ultrasonographic measurements of the two operator groups were compared. The mean difference of the resident group compared to the specialist group was: for the biparietal diameter +1.3 mm (CI 95%, range −10.6 to +13,3, ±1.96 SD), for the occipitofrontal diameter −2.6 mm (CI 95%, range −31.5 to +26.2), for the anterior-posterior abdominal diameter −2.6 mm (CI 95%, range −17.9 to +12.8), for the transverse abdominal diameter −0.7 mm (CI 95%, range −17.1 to +15.7) and for the femur length −1.1 mm (CI 95%, range −11.7 to +9.6). We observed that, among all biometric parameters, the most accurate -based on the specialist group were the head circumference measurements. The highest discrepancy was noted for the abdominal assessment. Given that foetal biometry is of utmost importance in obstetrical clinical evaluation and management, a study that highlights the weaknesses of residents in this field could open new horizons in optimising the learning procedure. Impact statement What is already known on this subject? After review of the literature, we found only a few studies on inter- and intra-observer discrepancy in foetal biometry measurements among specialists. What the results of this study add? To our knowledge, our study is the first to evaluate residents' capacity of performing a biometry scan, by comparing their measurements to those of MFM specialists. What the implications are of these findings to clinical practice and/or further research? The need for constant evaluation of residents is indisputable. Our study could help to improve their ultrasound skills by giving emphasis on residents' weaknesses. With further research on this subject, a standard system of evaluation could be formed and determine the duration and type of training required for each resident.

Perspectives of Platform Operators, Content Producers, and Information Receivers toward Health and Fitness Apps

The interactive mechanism among platform operators, content producers, and information receivers is increasingly complex in human–computer symbiosis. The purpose of this study is to identify the interactive value among platform operators, content producers, and information receivers with regard to information through the health and fitness apps by adopting an advanced Analytic Hierarchy Process (AHP) method derived from professional perspectives of app users and operators, key opinion leaders, scholars, and officers. The AHP method was allocated weightings to the evaluation criteria from the twelve panelists from three groups of platform operators, content producers, and information receivers. After focus group interviews were conducted, four dimensions and twelve sub-dimensions of the initial health and fitness apps were obtained as follows: Content category: Monitoring, exercise, journaling, and sleeping; (2) User reviews: Fuctionality, interactivity, and criticism; (3) Content updates: New feature, correctness, and new language; (4) Platform terms: Privacy, accuracy, ownership, and right of use. The study integrated the panelists’ opinions toward health and fitness apps and analyzed the weight of each indicator according to their importance by Power Choice V2.5. The results revealed that the weights of dimensions of health and fitness apps were sorted by content category, user review, platform terms, and content update, as well as that the weights of the top six sub-dimensions were followed: monitoring, exercise, functionality, interactivity, privacy, and accuracy. Content producers suggested increasing the popularity of their products by adding new features, whereas information receivers preferred to correct problems. Content producers and information receivers graded platform terms as less essential, whereas platform operators rated platform terms higher. This study can contribute to assisting the health and fitness industry and the overall strategic operative process by identifying how the effectiveness in the procedures, estimative process, and cost-down can enhance competitiveness to further improve users experience and satisfaction.

SIMULTANEOUS LAPAROSCOPIC CHOLECYSTECTOMY AND CRURORAPHY WITH TOUPET FUNDOPLICATION

Summary. Aim of work: to determine and compare the level of visualization, comfort, safety and effectiveness of simultaneous technique of laparoscopic surgery of gallstone disease and concomitant hiatal hernia and standard «baseball diamond» technique of laparoscopic surgery of only hiatal hernia.&#x0D; Materials and methods: the study was performed based on data developed in MISU VRCH. 359 patients were treated and divided on two groups, of which the group №1 — patients who underwent simultaneous laparoscopic cholecystectomy and cruroraphy with Toupet fundoplication (n=155), and group №2 — patients who underwent only laparoscopic crurography with with Toupet fundoplication. The level of visualization, comfort, frequency of «fencing», duration of operation, length of hospital stay, complication frequency were determined. The method with the null hypothesis, Pearson’s analysis, Mann-Whitney method were used.&#x0D; The results of the study: the approach distance of the laparoscope was (8,11 ± 0,917) and (8,71 ± 0,256) cm for 30°-optics while (6,55 ± 0,491) and (6,66 ± 0,485) cm for 0°-optics in two groups, respectively. The frequency of fencing was just about 4 episodes in both groups and did not differ statistically significantly. The frequency of the need to change the viewing area` and the frequency of the need to change the position of the instruments did not differ statistically significantly in both groups. The operation time was longer in the group of simultaneous operations by 10 % or 4,24 minutes. The level of complications was comparable in both groups, no correlation was found. The length of hospital stay was (3,64 ± 0,71) days (2-8 days) versus (3,58 ± 0,67) days (2-8 days) for both groups, respectively (p = 0.967).

Reconhecimento emocional da criança de cinco a sete anos em acolhimento institucional

O objetivo deste estudo foi verificar o reconhecimento emocional da criança de cinco a sete anos em acolhimento institucional. Trata-se de uma pesquisa qualitativa exploratória, realizada a partir do método de estudo de caso. A coleta de dados ocorreu entre outubro e novembro de 2016, em um Centro de Acolhimento Municipal de um município do sudoeste do Paraná, mediante realização de grupos operativos, em que foram utilizados, como instrumentos de coleta: histórias infantis, carinhas emotivas e desenhos. Evidenciou-se a dificuldade de reconhecimento emocional da criança de cinco a sete anos em acolhimento institucional, sendo que, as mesmas, descrevem as emoções de forma superficial, evidenciando suas dificuldades na associação das emoções com acontecimentos reais de suas vidas, indicando dificuldade de reconhecimento das emoções como próprias. No entanto, ressalta-se que, prevaleceu interesse e identificação das crianças participantes do estudo, com histórias que abordavam emoções negativas (tristeza, raiva e medo). Esse achado foi reforçado durante a elaboração dos desenhos, as crianças reforçaram maior afinidade com as emoções negativas, uma vez que, projetaram majoritariamente, em seus desenhos, figuras que expressavam sentimentos negativos. Este trabalho busca contribuir para os serviços de acolhimento infantil e demais profissionais para a necessidade de criação de momentos de expressão e reconhecimento emocional a fim de proporcionar maior acolhimento aos sofrimentos infantis e possibilidades de re-significações dessas como espaços de promoção de saúde mental infantil.