Step Of Procedure Research Articles

Don't be nasty: A phenomenological study of newly licensed nurses and workplace bullying

BackgroundBullying behaviors whether verbal, emotional, or physical impact nurses in several ways. AimThe purpose of this study was to describe how newly licensed nurses managed the bullying behaviors they experienced. MethodsA qualitative descriptive design was used with 24 newly licensed nurses. Interviews followed an open-ended, semi-structured interview guide. Colaizzi's procedural steps for phenomenological analysis were used to analyze the transcript data. ResultsSix themes emerged from the qualitative data: The Bullying, The Perception of the Event, How Bullying Affected Them, How They Dealt with Bullying, How They Wished Bullying Had Been Managed, and What the School Should Do. ConclusionsOrganizational support, in the form of policies and procedures, could reduce bullying behaviors and improve nurse efficiency. Additionally, nursing schools can incorporate education about bullying into their curricula to both better prepare new nurses and break the cycle of bullying among nurses.

Regulative raumordnungsbezogene Optionen für eine Beschleunigung (nicht nur) der Energiewende: Ebenen, Verfahrensschritte und Bindungswirkungen

The urgency of the energy transition is in conflict with delaying effects and options that are not optimally used in the complex, multi-stage German planning system. This also applies to the law and procedures of spatial planning, as well as the interaction of spatial planning with construction planning and sectoral law. Here, fundamental reform options have not yet been exhausted, despite many current legislative projects. Some procedural steps and options for legislative deviations can be eliminated altogether, the interaction of planning and decision-making levels can be made more effective, and subject-related certain hierarchical levels in the planning system could be omitted on a topic-specific basis. Based on a brief analysis of the initial situation for spatial planning, this paper first provides corresponding general considerations on such far-reaching acceleration options and their consequences. This is followed by the presentation of numerous specific spatial planning-related optimisation options.

Introduction to the novel model of preoperative Multi - Domain Risk Stratification (pMDRS).

Preoperative risk stratification is an important step in surgical procedures. The current scoring systems do not predict accurate overall surgical outcomes in complex comorbid patients. The novel model of preoperative multi-domain risk stratification is described in this article, which categorises patients in to three risk groups, aiming to modify the risk for optimal surgical outcomes.

An analysis on the effect of body tissues and surgical tools on workflow recognition in first person surgical videos.

Analysis of operative fields is expected to aid in estimating procedural workflow and evaluating surgeons' procedural skills by considering the temporal transitions during the progression of the surgery. This study aims to propose an automatic recognition system for the procedural workflow by employing machine learning techniques to identify and distinguish elements in the operative field, including body tissues such as fat, muscle, and dermis, along with surgical tools. We conducted annotations on approximately 908 first-person-view images of breast surgery to facilitate segmentation. The annotated images were used to train a pixel-level classifier based on Mask R-CNN. To assess the impact on procedural workflow recognition, we annotated an additional 43,007 images. The network, structured on the Transformer architecture, was then trained with surgical images incorporating masks for body tissues and surgical tools. The instance segmentation of each body tissue in the segmentation phase provided insights into the trend of area transitions for each tissue. Simultaneously, the spatial features of the surgical tools were effectively captured. In regard to the accuracy of procedural workflow recognition, accounting for body tissues led to an average improvement of 3 % over the baseline. Furthermore, the inclusion of surgical tools yielded an additional increase in accuracy by 4 % compared to the baseline. In this study, we revealed the contribution of the temporal transition of the body tissues and surgical tools spatial features to recognize procedural workflow in first-person-view surgical videos. Body tissues, especially in open surgery, can be a crucial element. This study suggests that further improvements can be achieved by accurately identifying surgical tools specific to each procedural workflow step.

The Project-Based Learning Model for Javanese Language in Kurikulum Merdeka

The purpose of this research is to present the implementation of a project-based learning model in Javanese language subjects. Descriptive qualitative method is used as the procedural steps in this research. Data in the research are collected through interview techniques, observations, and documentation. The data analysis technique used is Miles and Huberman's, which involves the steps of 1) data collection, 2) data reduction, 3) data presentation, and 4) data conclusion. Informants include the school principal, teachers, and students. The results of this research show that the project-based learning model is implemented for the wayang (traditional Javanese puppet) material. The findings indicate that the Project-Based Learning Model is very suitable as an alternative Javanese language learning model in the Merdeka Curriculum. This Project-Based Learning Model for Javanese language is implemented by preparing students of class VII F, arranging activity schedules, supervising the implementation, assessing students, and conducting evaluations.

Production of reverse transcriptase from Moloney murine Leukemia virus in Escherichia coli expression system

Reverse transcriptase (RT) is one of the most important enzymes used in molecular biology applications, enabling the conversion of RNA into complementary DNA (cDNA) that is used in reverse transcription-polymerase chain reaction (RT-PCR). The high demand of RT enzymes in biotechnological applications making the production optimization of RT is crucial for meeting the growing demand in industrial settings. Conventionally, the expression of recombinant RT is T7-induced promoter using IPTG in Escherichia coli expression systems, which is not cost-efficient. Here, we successfully made an alternative procedure for RT expression from Moloney murine leukemia virus (M-MLV) using autoinduction method in chemically defined medium. The optimization of carbon source composition (glucose, lactose, and glycerol) was analyzed using Response Surface Methodology (RSM). M-MLV RT was purified for further investigation on its activity. A total of 32.8 mg/L purified M-MLV RT was successfully obtained when glucose, glycerol, and lactose were present at concentration of 0.06%, 0.9%, and 0.5% respectively, making a 3.9-fold improvement in protein yield. In addition, the protein was produced in its active form by displaying 7462.50 U/mg of specific activity. This study provides the first step of small-scale procedures of M-MLV RT production that make it a cost-effective and industrially applicable strategy.

A New Procedure-Based Assessment of Operative Skills in Gastric Bypass Surgery, Evaluated by Video Fragment Rating

PurposeFeedback on technical and procedural skills is essential during the training of residents and fellows. The aim of this study was to assess the performance of a newly created instrument for the assessment of operative skills using laparoscopic Roux-en-Y gastric bypass (LRYGB) video fragments.Materials and MethodsA new procedure-based assessment (PBA) was created by combining LRYGB key steps with a 5-point independence scale. LRYGB performed by residents and surgeons with different levels of expertise were video recorded. Fragments of the pouch creation, gastro-jejunostomy and jejunojejunostomy, were review by 12 expert bariatric surgeons and the operative skills assessed with the PBA, Objective Structured Assessment of Technical Skill (OSATS), and the Bariatric OSATS (BOSATS). The PBA was compared to the OSATS and BOSATS. Mean scores for all items of the different assessments were summarized and compared using a T-test.ResultsThe scores of the procedural steps were combined and compared for all levels. The mean scores for beginner, intermediate, and expert level were 2.71, 3.70, and 3.90 for the PBA; for the OSATS 1.84, 2.86, and 3.44; and for the BOSATS 2.78, 3.56, and 4.19. Each of these assessments differentiated between the three skill levels (all p < 0.05).ConclusionThe PBA discriminates well between different levels of operative skills. Similar patterns were found for the OSATS and BOSATS, showing that the randomly selected video fragments are representative samples for assessing skill level. Future research will demonstrate whether these results can be extrapolated to clinical training, and which scores allow for procedure certification.Graphical

Implantation accuracy of novel polyimide stereotactic electroencephalographic depth electrodes-a human cadaveric study.

Stereoelectroencephalography (sEEG) is a minimally invasive procedure that uses depth electrodes stereotactically implanted into brain structures to map the origin and propagation of seizures in epileptic patients. Implantation accuracy of sEEG electrodes plays a critical role in the safety and efficacy of the procedure. This study used human cadaver heads, simulating clinical practice, to evaluate (1) neurosurgeon's ability to implant a new thin-film polyimide sEEG electrode according to the instructions for use (IFU), and (2) implantation accuracy. Four neurosurgeons (users) implanted 24 sEEG electrodes into two cadaver heads with the aid of the ROSA robotic system. Usability was evaluated using a questionnaire that assessed completion of all procedure steps per IFU and user errors. For implantation accuracy evaluation, planned electrode trajectories were compared with post-implantation trajectories after fusion of pre- and postoperative computer tomography (CT) images. Implantation accuracy was quantified using the Euclidean distance for entry point error (EPE) and target point error (TPE). All sEEG electrodes were successfully placed following the IFU without user errors, and post-implant survey of users showed favorable handling characteristics. The EPE was 1.28 ± 0.86 mm and TPE was 1.61 ± 0.89 mm. Long trajectories (>50 mm) had significantly larger EPEs and TPEs than short trajectories (<50 mm), and no differences were found between orthogonal and oblique trajectories. Accuracies were similar or superior to those reported in the literature when using similar experimental conditions, and in the same range as those reported in patients. The results demonstrate that newly developed polyimide sEEG electrodes can be implanted as accurately as similar devices in the marker without user errors when following the IFU in a simulated clinical environment. The human cadaver ex-vivo test system provided a realistic test system, owing to the size, anatomy and similarity of tissue composition to that of the live human brain.

Procedure-specific simulation for vaginal surgery training: Arandomized controlled trial.

Vaginal surgery has a superior outcome profile compared with other surgical routes, yet skills are declining because of low case volumes. Graduating residents' confidence and preparedness for vaginal surgery has plummeted in the past decade. The objective of the present study was to investigate whether procedure-specific simulation skills, vs usual training, result in improved operative competence. We completed a randomized controlled trial of didactic and procedural training via low fidelity vaginal surgery models for anterior repair, posterior repair (PR), vaginal hysterectomy (VH), recruiting novice gynecology residents at three academic centers. We evaluated performance via global rating scale (GRS) in the real operating room and for corresponding procedures by attending surgeon blinded to group. Prespecified secondary outcomes included procedural steps knowledge, overall performance, satisfaction, self-confidence and intraoperative parameters. A priori sample size estimated 50 residents (20% absolute difference in GRS score, 25% SD, 80% power, alpha 0.05). gov: Registration no. NCT05887570. We randomized 83 residents to intervention or control and 55 completed the trial (2011-23). Baseline characteristics were similar, except for more fourth-year control residents. After adjustment of confounders (age, level, baseline knowledge), GRS scores showed significant differences overall (mean difference 8.2; 95% confidence interval [CI]: 0.2-16.1; p = 0.044) and for VH (mean difference 12.0; 95% CI: 1.8-22.3; p = 0.02). The intervention group had significantly higher procedural steps knowledge and self-confidence for VH and/or PR (p < 0.05, adjusted analysis). Estimated blood loss, operative time and complications were similar between groups. Compared to usual training, procedure-specific didactic and low fidelity simulation modules for vaginal surgery resulted in significant improvements in operative performance and several other skill parameters.

A procedural step analysis of radiation exposure in fenestrated endovascular aortic repair

ObjectiveRadiation exposure during complex endovascular aortic repair may be associated with tangible adverse effects in patients and operators. This study aimed to identify the steps of highest radiation exposure during fenestrated endovascular aortic repair (FEVAR) and to investigate potential intraoperative factors affecting radiation exposure. MethodsProspective data of 31 consecutive patients managed exclusively with four-fenestration endografts between March 1, 2020, and July 1, 2022 were retrospectively analyzed. Leveraging the conformity of the applied technique, every FEVAR operation was considered a combination of six overall stages composed of 28 standardized steps. Intraoperative parameters, including air kerma, dose area product, fluoroscopy time, and number of digital subtraction angiographies (DSAs) and average angulations were collected and analyzed for each step. ResultsThe mean procedure duration and fluoroscopy time was 140 minutes (standard deviation [SD], 32 minutes), and 40 minutes (SD, 9.1 minutes), respectively. The mean air kerma was 814 mGy (SD, 498 mGy), and the mean dose area product was 66.8 Gy cm2 (SD, 33 Gy cm2). The percentage of air kerma of the entire procedure was distributed throughout the following procedure stages: preparation (13.9%), main body (9.6%), target vessel cannulation (27.8%), stent deployment (29.1%), distal aortoiliac grafting (14.3%), and completion (5.3%). DSAs represented 23.0% of the total air kerma. Target vessel cannulation and stent deployment presented the highest mean lateral angulation (67 and 63 degrees, respectively). Using linear regression, each minute of continuous fluoroscopy added 18.9 mGy of air kerma (95% confidence interval, 17.6-20.2 mGy), and each DSA series added 21.1 mGy of air kerma (95% confidence interval, 17.9-24.3 mGy). Body mass index and lateral angulation were significantly associated with increased air kerma (P < .001). ConclusionsCannulation of target vessels and bridging stent deployment are the steps requiring the highest radiation exposure during FEVAR cases. Optimized operator protection during these steps is mandatory.

Evaluation of the quality and content of YouTube videos as an educational resource in developing patients’ inhaler use skills

Background YouTube has educational videos on inhalers. However, their content and quality are not adequately known. Objectives This study investigated the quality and content of educational YouTube videos on inhalers. Methods This descriptive study analyzed 178 YouTube videos on inhalers between May and July 2022. Two researchers independently evaluated the videos. The Global Quality Score (GQS), Journal of American Medical Association (JAMA) Benchmark Criteria, and Inhaler Application Checklist (IAC) were used to assess the quality and content of the videos. Spearman’s correlation, Kruskal–Wallis, Mann–Whitney U, ANOVA, and Post hoc analysis Bonferroni test were used for data analysis. Results The videos had a mean GQS score of 3.70 ± 1.24, and JAMA score of 2.22 ± 0.60. A negative correlation was between the quality score of the videos and views, likes, comments, duration, and likes/views (respectively; r = −0.237 p < 0.005, r = −0.217 p < 0.003, r = −0.220 p < 0.005, r = −0.147, p < 0.005). The videos narrated by nurses and doctors had significantly higher mean JAMA and GQS scores than others (p = 0.001). The videos missed some procedural steps [gargling (29.1%), adding no more than five ml of medication and device cleaning (41.9%), and exhaling through the nose (37.5%)]. Videos uploaded by individual missed significantly more procedural steps than professional organizations (p < 0.05). Conclusions YouTube videos about inhaler techniques have a moderate level of quality. Videos uploaded by doctors and nurses as content narrators were of higher quality. The videos missed some procedural steps. Individual video uploaders had higher missed procedural steps. Counseling should be provided to patients regarding the reliability of online information.

Virtual reality cricothyrotomy - a case-control study on gamification in emergency education

BackgroundCricothyrotomy is an invasive and rare emergency intervention to secure the airway in a “cannot intubate, cannot ventilate” situation. This leads to lack of routine. Cricothyrotomy is performed only hesitantly. Therefore, we aim to improve teaching by including a virtual reality (VR) cricothyrotomy as a learning tool.MethodsWe programmed the VR cricothyrotomy in the C# programming language on the open-source Unity platform. We could include 149 students that we randomly assigned to either a study group (VR cricothyrotomy) or control group (educational video). We asked the study group to subjectively rate the VR cricothyrotomy. To evaluate our intervention (VR cricothyrotomy) we took the time participants needed to perform a cricothyrotomy on a plastic model of a trachea and evaluated the correct procedural steps.ResultsThe majority of students that performed the VR simulation agreed that they improved in speed (81%) and procedural steps (92%). All participants completed the cricothyrotomy in 47s ± 16s and reached a total score of 8.7 ± 0.7 of 9 possible points. We saw no significant difference in time needed to perform a cricothyrotomy between study and control group (p > 0.05). However, the total score of correct procedural steps was significantly higher in the study group than in the control group (p < 0.05).ConclusionsVirtual reality is an innovative learning tool to improve teaching of emergency procedures. The VR cricothyrotomy subjectively and objectively improved correct procedural steps. Digitized education fills an educational gap between pure haptic experience and theoretical knowledge. This is of great value when focusing on extension of factual knowledge.Trial registrationDRKS00031736, registered on the 20th April 2023.

Risks of Drone Use in Light of Literature Studies.

This article aims to present the results of a bibliometric analysis of relevant literature and discuss the main research streams related to the topic of risks in drone applications. The methodology of the conducted research consisted of five procedural steps, including the planning of the research, conducting a systematic review of the literature, proposing a classification framework corresponding to contemporary research trends related to the risk of drone applications, and compiling the characteristics of the publications assigned to each of the highlighted thematic groups. This systematic literature review used the PRISMA method. A total of 257 documents comprising articles and conference proceedings were analysed. On this basis, eight thematic categories related to the use of drones and the risks associated with their operation were distinguished. Due to the high content within two of these categories, a further division into subcategories was proposed to illustrate the research topics better. The conducted investigation made it possible to identify the current research trends related to the risk of drone use and pointed out the existing research gaps, both in the area of risk assessment methodology and in its application areas. The results obtained from the analysis can provide interesting material for both industry and academia.

Impact of prosthesis oversizing on clinical outcomes of transcatheter aortic valve implantation using a self-expandable Evolut R valve

BackgroundTranscatheter Aortic Valve Implantation (TAVI) has a growing target population after being indicated even in low-surgical-risk patients with severe symptomatic aortic stenosis. However, postoperative outcomes can be compromised due to para-valvular leakage (PVL). A lot of procedural steps have been investigated to decrease this partially avoidable operational hazard. Oversizing is a main technique to decrease the PVL, despite being itself a risky step. Many studies have been conducted to identify the optimum degree of oversizing. However, studies about oversizing by more than 20% are scarce. We aimed to evaluate the safety and efficacy of oversizing equal to or more than 20%.Results209 patients who underwent TAVI using the self-expandable valve Evolut R were initially included. 66 patients were excluded because of the baseline conduction disturbance and lack of sufficient data, so 143 patients, 60 females and 83 males, were enrolled in our study as two groups based on the degree of oversizing: Group A included 97 patients with an oversizing index (OI) of less than 20%, and Group B included 46 patients with an OI of 20% or more. We conducted a new technique for more accurate measuring of the OI in the context of the implantation depth, and our patients were categorized using this technique. Our findings have met our primary end point in terms of the safety and efficacy of oversizing by 20% or more. There was no significant difference between both groups in terms of new-onset conduction disturbance (NOCD), with zero cases of annular rupture or coronary encroachment. In terms of efficacy, The incidence of significant PVL (grade 2 or more) in group B was less than in group A (P value 0.007). The ROC curve found that the minimum depth of implantation-derived oversizing (DIDO) to predict no significant PVL was less than 17%.ConclusionProsthesis oversizing by 20% using the self-expandable Evolut R valve is safe and effective, with no significant effect on the conduction system, coronary encroachment, or annular injury, and warrants a greater reduction in the incidence of significant PVL.

The Extraction of Chitin from Indonesian Shells and its Potential as Zinc Ion Batteries Supporting Material

&lt;p&gt;Indonesia is an archipelagic country that has a very wide water area. One of the results of aquaculture in Indonesia is shrimp. Shrimp production results based on data from the Ministry of Maritime Affairs and Fisheries in 2022 amounted to 8,3 tons. This makes Indonesia one of the largest shrimp-exporting countries in Southeast Asia. The part of the shrimp that is often consumed by the public is the meat. So that the heads, tails, and shells that have been peeled are often discarded. Shrimp waste besides being able to pollute the environment can also disturb the comfort of local residents, so efforts are needed to overcome it. Shrimp shell contains 27.6% minerals, 34.9% protein, and 18.1% chitin. The chitin content in shrimp shells can be processed into materials for zinc-ion batteries, namely into chitosan which has non-toxic properties and can be used as polymer electrolytes that have good conductivity values through the deacetylation process. The main ingredient used is shrimp shell powder from shrimp waste that has been cleaned and dried. In this study, there are three steps of procedures, namely the deproteination method using NaOH base solution, demineralization using HCl acid solution, and testing for the presence of chitin with the Van Wesslink color reaction. In this experiment, the yields obtained were 0.38, 0.1, 0.12, dan 0.47-gram chitin/gram shrimp shell. The big difference in the yield produced is due to the different types of shrimp waste used.&lt;/p&gt;

Conscientious objection and barriers to abortion within a specific regional context - an expert interview study.

While most countries that allow abortion on women's request also grant physicians a right to conscientious objection (CO), this has proven to constitute a potential barrier to abortion access. Conscientious objection is regarded as an understudied phenomenon the effects of which have not yet been examined in Germany. Based on expert interviews, this study aims to exemplarily reconstruct the processes of abortion in a mid-sized city in Germany, and to identify potential effects of conscientious objection. Five semi-structured interviews with experts from all instances involved have been conducted in April 2020. The experts gave an insight into the medical care structures with regard to abortion procedures, the application and manifestations of conscientious objection in medical practice, and its impact on the care of pregnant women. A content analysis of the transcribed interviews was performed. Both the procedural processes and the effects of conscientious objection are reported to differ significantly between early abortions performed before the 12th week of pregnancy and late abortions performed at the second and third trimester. Conscientious objection shows structural consequences as it is experienced to further reduce the number of possible providers, especially for early abortions. On the individual level of the doctor-patient relationship, the experts confirmed the neutrality and patient-orientation of the vast majority of doctors. Still, it is especially late abortions that seem to be vulnerable to barriers imposed by conscientious objection in individual medical encounters. Our findings indicate that conscientious objection possibly imposes barriers to both early and late abortion provision and especially in the last procedural steps, which from an ethical point of view is especially problematic. To oblige hospitals to partake in abortion provision in Germany has the potential to prevent negative impacts of conscientious objection on women's rights on an individual as well as on a structural level.

Reliabilty of recording occlusal contacts by using intraoral scanner and articulating paper - A prospective study

ObjectiveThe recording of occlusal contacts is a pivotal step in many dental procedures, yet the lack of a standardized method could introduce clinical errors. The aim of this study was to compare the occlusal contacts recorded using a intraoral scanner to the contacts recorded using articulating paper. As a secondary outcome, the subjective clinical assessment made using the two methods was compared between different observers. MethodsTwenty-eight records were analysed for this study. Digital scan and intraoral photos of the coloured marks impressed by articulating paper were taken at the same time point for every patient. Using a standardized occlusal template, two operators recorded the number of occlusal contacts for every tooth provided by the two techniques. Then, 11 clinicians analysed the collected records and answered questions about the quality of the occlusions observed. ResultsThe statistical analysis showed significant differences between the number of contacts recorded by digital scan and those recorded by the photographed articulation marks, except in the case of the upper central incisors and first premolars. The Kappa Fleiss showed slight and fair agreement between clinicians when judging the occlusions. ConclusionThe occlusal contacts recorded using the intraoral scanner and those recorded with the articulating paper did not match, and overall the clinicians showed low agreement when rating the recorded data. Clinical significanceDespite of the great clinical importance of occlusal contact there is a lack of a precise method for recording and collecting occlusal contacts.

Brachytherapy Workflow Practices: Analysis of Different Workflow Scenarios in Patients With Cervical Cancer and Impact on IGBT Implementation-An IAEA Study.

The workflow of brachytherapy (BT) is an essential aspect of treatment to consider in image-guided brachytherapy (IGBT). It has an overarching effect influencing patient throughput and the number of cancer treatments that can be performed as it occupies equipment, space, and personnel. There is limited research addressing this issue. Under the International Atomic Energy Agency's Coordinated Research Activity titled IGBT for cervix cancer: An implementation study, our study analyzes various scenarios in the clinical workflow of BT delivery for cervical cancer. It aims to determine the extent to which these scenarios allow the routine implementation of IGBT. With this information, current barriers and individualized adaptations to efficient workflows can be identified to enhance the global application of IGBT, leading to better cervical cancer treatment. A web-based poll of questions regarding practices in BT workflow was presented to 62 participants from low-, lower middle-, upper middle-, and high-income countries (19 countries). This study highlighted diversity in BT practices across countries, income levels, and regions. It identified variations in workflow, patient throughput, and resource availability, which can have implications for the efficiency and quality of BT treatments. Scenario A, utilizing multiple locations for the steps of the BT procedure, was the most commonly used. The availability of resources, such as imaging devices and trained personnel, varied among the participating centers and remained challenging for IGBT implementation and sustainability. The design of the BT facility plays a vital role in improving efficiency, with a dedicated BT suite contributing to an efficient workflow but limiting patient throughput, especially for high-volume centers. Although IGBT is effective, its implementation requires consideration of various logistical challenges and should be individualized.

From Total Skepticism to a Well-balanced Approach: International Experience in Applying Remote Justice

The article analyzes the current international experience of remote justice during and after the COVID-19 pandemic. It identifies the main disadvantages of remote hearings that led to the reluctance to make active use of video conferencing prior to the threat of the coronavirus. The paper examines the widespread use of remote hearings during the active phase of the pandemic, looking in particular at the legal, administrative and organisational measures taken to ensure the capacity of judicial systems to administer justice at a distance. The article also examines evaluations of remote court hearings and their impact on justice outcomes conducted in Anglo-Saxon and Western European jurisdictions, highlighting the benefits and positive feedback from remote participation. In particular, these benefits include facilitating access to justice; increasing the efficiency of court proceedings; meeting deadlines; and reducing costs and time for parties and their representatives. Less obvious benefits include reducing public anxiety and concern; improving work-life balance, in particular by helping women lawyers to combine work and childcare; avoiding unwanted conflict between parties in court buildings; helping to protect the environment by reducing travel and air travel; and improving access to hearings for disabled parties and lawyers. The article demonstrates that remote justice contributes to ensuring the effectiveness of the right to legal protection, provided that there is a robust legal framework, the necessary procedural steps, and adequate technical equipment and Internet connection. With this in mind, the article provides arguments in favour of a balanced use of remote justice on an ongoing basis, i.e. use in certain court processes or at certain stages of the court process, when remote participation can contribute to ensuring access to justice or increasing its efficiency. The appropriateness of the use of remote justice and its compatibility with the guarantees of a fair trial must be determined and justified by the judge in each specific case on the basis of a comprehensive assessment of the circumstances of the case, its complexity and the capabilities of the parties to the proceedings. General conclusions are drawn regarding the types of cases or stages that are more suitable for video hearings, and the need for further improvement of remote justice practices to meet the requirements of fairness, transparency, equality, and accountability.

Immediate implants” an elegance in anterior maxilla: Case report

Esthetics and psychological distress are the propounding factors which comes into effect when somebody losses the anterior teeth. The compensation of it is of long-drawn-out and demands for an immediate regimen. In these circumstances, it’s the immediate implants placement which offers a simple choice for replacing the lost tooth immediately and hence it is currently considered as a golden treatment modality for replacing a missing tooth. The added benefits of it are less time consuming, involves few steps of surgical procedures and minimal bone resorption as it helps in preserving the vitality of bone receptors immediately after extraction thereby helps in gaining high rates of success of dental implants placed. Here in this article, we are reporting a successful case of immediate implant placed at maxillary anterior canine region which rendered a complete satisfaction to the patient and as well as professionally.