Specialist Medical Staff Research Articles

Frailty in Hemodialysis Patient

Abstract Background Frailty has been defined as a state of increased vulnerability to stressors as a consequence of degeneration in multiple systems. There remain two schools of thought with regard to frailty: one which sees frailty as a physical phenotype characterized by sarcopenia and another that views frailty as an accumulation of deficits across a variety of domains. Aim of the Work The aim of this study was to assess the prevalence of frailty among dialysis population. Patients and Methods This cross section study carried out in Hemodialysis Unit of the Nasr City Health Insurance Hospital between October 2020 and July 2021. The total number of the study was 325 hemodialysis patients, 25 were excluded from the study, thus the enrolled final number became 300 hemodialysis patients on maintenance hemodialysis therapy for at least 6 months. Results The mean age of the patients was 45.57±11.79 years (range 25-65 years) 50% of them were under 45 years of age. 258 (86%) of patients were males and 42 (14%) females, with male to female ratio about 6.14:1. 37 patients (12.3%) has positive HCV, while the results also show that none of the HBV and HIV of the study group. 10 patients (3.3%) of vulnerable, 89 (29.7%) patients at mild frailty, table also clarified that, 126 (42.0%) patients at moderat4e frailty, furthermore, 75 (25%) patients at severe frailty in Edmonton frail scale. There was significant positive association between frailty and age with p-value <0.001. Males more affected by frailty than females. Conclusion The differences in the frailty prevalence among CKD patients could be caused by the different definitions of frailty that each study adopted. It is important to prevent early-onset disability in end-stage renal disease, which may be accelerated by frailty in this patient population, which includes individuals who already carry a high risk of morbidity and mortality. We adopted the Edmonton Frail Scale (EFS) based on self-report, it is very simple to administer and can be carried out by hemodialysis nursing staff after minimal training, without the need for specialist medical staff, in less than 15 min. Its association with poor short-term outcome highlights its utility in detecting frail patients, but because it is a multi-domain test, it also gives health professionals information about which areas of frailty are affected. This would allow specialists to administer specific, more complex scales to detect deficits in independence for basic and instrumental activities of daily life, cognition, emotional status, and social support. Our findings allow us to recommend the inclusion of the frailty comprehensive assessment of patients starting the dialysis program to timely identification of frailty syndrome.

The Role of Saliva in Examining for SARS-CoV-2

SARS-CoV-2 causes COVID-19 (Corona Virus Infection Disease-19), an infectious disease (Severe Acute Respiratory Syndrome Corona Virus-2)virus which was first confirmed on December 2, Wuhan, China, in 2019 and very quickly world-wide. World Health Organization (WHO) declared it on March 11th, 2020,fever, cough, and breathing difficulties are all common symptoms. The gold standard for diagnosing SARS-CoV-2 infection is the real-time reverse transcription polymerase chain reaction (rRT-PCR)by detecting viral RNA using nasopharyngeal swabs and other respiratory specimens. However, this process necessitates the use of specialist medical staff, centralized laboratory facilities, and a lengthy period of time for results to be obtained. Besides that, the possibility of virus transmission is not negligiblefor procedure's operator. Due to this reason, several investigations have shown that other bodily fluids, like as saliva, could be used to identify SARS-CoV-2. Saliva is used as a diagnostic sample has many advantages: it is easy to collect samples by the patient themselves with a fairly comfortable procedure, does not require health personnel with special expertise to manage it, and reduces the risk of transmitting the virus to the operator. Currently, there are several alternative tests for SARS-CoV-2 which have simpler and more efficient procedures, such as antigen based rapid diagnostic tests, antibody based rapid diagnostics, and RT LAMP tests. This examination is suitable for screening and mass examination, but cannot be used as a primary diagnostic tool because the sensitivity and specificity are not as high as rRT-PCR.

Health care model for people living in nursing homes based on integrated care

PurposeOlder people living in nursing homes have complex care needs and frequently need specialists’ advice and support that can be challenging to deliver in a rural setting. The aim of this paper is to describe a model of integrated care in a rural area supported by a nurse case manager.Design/methodology/approachA real-world evidence study of people living in Ribes de Freser nursing home, was conducted between specific timeframes in 2019 and 2022, comparing the casemix and outcomes of a traditional care model with the integrated interdisciplinary model.FindingsThe integrated care model led to a significant reduction in transfers to the emergency department, hospitalisations, outpatient medical visits and a reduction in the number of medicines. In addition, the number of residents receiving end-of-life care at the nursing home showed a substantial increase.Originality/valueThis case study contributes valuable evidence supporting the implementation of an integrated model of nurse case manager support in nursing homes, particularly in the rural contexts, where access to specialist medical staff may be limited. The findings highlight the potential benefits of person-centred integrated care for older adults, addressing their complex needs and improving end-of-life care in nursing home settings.

516 The Livingston Nexobrid Pain Protocol - Further Experience in 80 Patients

Abstract Introduction Our unit has employed Nexobrid in the debridement of burns. It is a painful process yet there is no formal analgesia protocol in the literature. The team in Livingston developed a successful bedside pain protocol which is fast acting, long lasting and has a quick recovery time. It is administered by the Acute Pain Team nurses and reduces the need for invasive techniques and specialist medical staff. Method A Fentanyl based Patient Controlled Analgesia (PCA) protocol with clinician administered boluses is used in this unit. Patients’ pain scores were documented throughout the procedure, as well as their perception of their worst pain and their overall satisfaction with the treatment. All patients undergoing enzymatic debridement outwith the ITU environment utilised this protocol. Results Eighty patients undergoing Nexobrid burns debridement were included in this study. The PCA ran for around 4 hours. Pain was most severe on removal of the enzyme however after bolus analgesia, the mean score at this point was 3/10. Patient satisfaction with the treatment was reported as “very satisfied” or “satisfied” in 95% of cases. No complications were reported. Conclusions Addressing the significant psychological element of the pain response was an important role of the Pain Nurses in preparing patients for the debridement process. The analgesia protocol is safe, easy to administer and remains well tolerated, providing a high level of patient satisfaction and low rate of complications in the enzymatic debridement of burns. The role of the Pain Nurse in this protocol is important.

Factors associated with participation in cardiac rehabilitation in patients with acute myocardial infarction: A systematic review and meta-analysis.

Cardiac rehabilitation (CR) is effective in reducing morbidity and mortality in patients with acute myocardial infarction (AMI), but the participation rate is low and its influencing factors vary. Our study aimed to systematically review the literature and investigate the participation rates and influencing factors of CR in patients with AMI. We searched 10 databases, including PubMed, Web of Science, Cochrane Library, and so forth. A systematic review and meta-analysis were conducted on the studies on the factors affecting CR participation in AMI. The Q tests and the I2 tests were used to assess heterogeneity between studies. The combined effect size and odds ratio (OR) and their respective 95% confidence interval (CI) for CR participation rate and its influences are expressed, respectively. Stata 17.0 software was used for statistical analysis. We included 14 studies with 114 542 participants. Current evidence indicates a CR participation rate of 34% (95% CI: 21%-46%) in patients with AMI. The pooled OR values and CI of each influencing factor are as follows: over 60 years old (OR = 0.865; 95% CI: 0.772-0.969), male (OR = 1.690; 95% CI: 1.276-2.239), college education or above (OR = 2.526; 95% CI: 1.117-5.711), ST-segment elevation myocardial infarction (OR = 4.257; 95% CI: 2.004-9.045), decrease in left ventricular ejection fraction (OR = 0.918; 95% CI: 0.868-0.971), higher economic level (OR = 1.282; 95% CI: 1.108-1.483), history of coronary heart disease(OR = 0.667; 95% CI: 0.509-0.875), smoking (OR = 0.665; 95% CI: 0.550-0.805), combined hypertension (OR = 0.638; 95% CI: 0.562-0.723), and combined hyperlipidemia (OR = 0.577; 95% CI: 0.512-0.651). The overall participation rate of CR in AMI patients is low, and various factors affect the participation rate. Specialist medical staff are needed to further promote CR rehabilitation concepts and scientific knowledge, and take appropriate measures to address the influencing factors to increase CR utilization and improve patient prognosis.

Kwalifikacje zawodowe – personel medyczny w permanentnym rozwoju

One of the duties of medical staff is to improve professional qualifications and supplement knowledge. Especially in times that are referred to as the 3N: instability, discontinuity, unpredictability, and the transformations experienced by the economy and society are referred to as the fourth industrial revolution. The article aims to present these issues in relation to medical personnel in professional groups of doctors, nurses and midwives employed in medical entities. The obligation to improve professional qualifications and supplement knowledge stems from a number of generally applicable laws as well as regulations in force at a given employer, and its importance is important due to the nature of the activities performed by medical personnel, i.e. saving the health and life of patients. The employment of specialist medical staff is also a condition for healthcare entities to participate in competition procedures in order to conclude contracts for the provision of health services. Therefore, raising and supplementing qualifications by medical personnel should also be in the interest of managers of medical entities.

Classification of medical specialty for text medical report based on natural language processing and deep learning

Natural language processing (NLP) is a part of artificial intelligence algorithms that focus on designing and building applications and systems in a way that allows interaction between computers and natural languages ​​developed for human use. NLP has been used in several areas within artificial intelligence and data processing applications such as social media applications and medical applications and translation applications. The medical field is one of the richest in terms of big data, which has not been well invested so far. one of these unused data was the text medical reports. Natural Language Processing analysis is an effective way of examining medical reports and social media data to improve treatments and patient services. by training a computer to make a decision instead of a human, as soon as possible from the decisions of specialist doctors or medical staff working in health institutions to diagnose diseases or Prescribe treatment to the patient. The data of each patient is stored in the form of medical reports mostly as a text document file and kept within the hospital data. Hospitals suffer from a scarcity of medical and nursing staff, in addition to the high cost of hiring medical staff.

CoviDetNet: A new COVID-19 diagnostic system based on deep features of chest x-ray.

COVID‐19 has emerged as a global pandemic affecting the world, and its adverse effects on society still continue. So far, about 243.57 million people have been diagnosed with COVID‐19, of which about 4.94 million have died. In this study, a new model, called COVIDetNet, is proposed for automated COVID‐19 detection. A lightweight CNN architecture trained instead of the popular and pretrained convolution neural network (CNN) models such as VGG16, VGG19, AlexNet, ResNet50, ResNet100, and MobileNetV2 from scratch with chest x‐ray (CXR) images was designed. A new feature set was created by concatenating the features of all layers of the designed CNN architecture. Then, the most efficient features chosen among the features concatenating with the Relief feature selection algorithm were classified using the support vector machine (SVM) method. The experimental works were carried out on a public COVID‐19 CXR database. Experimental results demonstrated 99.24% accuracy, 99.60% specificity, 99.39% sensitivity, 99.04% precision, and an F1 score of 99.21%. Also, in comparison to AlexNet and VGG16 models, the deep feature extraction durations were reduced by approximately 6‐fold and 38‐fold, respectively. The COVIDetNet model provided a higher accuracy score than state‐of‐the‐art models when compared to multi‐class research studies. Overall, the proposed model will be beneficial for specialist medical staff to detect COVID‐19 cases, as it provides faster and higher accuracy than existing CXR‐based approaches.

Using Explainable Artificial Intelligence Models (ML) to Predict Suspected Diagnoses as Clinical Decision Support.

The complexity of emergency cases and the number of emergency patients have increased dramatically. Due to a reduced or even missing specialist medical staff in the emergency departments (EDs), medical knowledge is often used without professional supervision for the diagnosis. The result is a failure in diagnosis and treatment, even death in the worst case. Secondary: high expenditure of time and high costs. Using accurate patient data from the German national registry of the medical emergency departments (AKTIN-registry, Home - Notaufnahmeregister (aktin.org)), the most 20 frequent diagnoses were selected for creating explainable artificial intelligence (XAI) models as part of the ENSURE project (ENSURE (umg.eu)). 137.152 samples and 51 features (vital signs and symptoms) were analyzed. The XAI models achieved a mean area under the curve (AUC) one-vs-rest of 0.98 for logistic regression (LR) and 0.99 for the random forest (RF), and predictive accuracies of 0.927 (LR) and 0.99 (RF). Based on its grade of explainability and performance, the best model will be incorporated into a portable CDSS to improve diagnoses and outcomes of ED treatment and reduce cost. The CDSS will be tested in a clinical pilot study at EDs of selected hospitals in Germany.

Research on the Attitudes of Breast Specialist Medical Staff Towards the Implementation of Breast Cancer Decision-Making Aids

Background: The participation of patients in treatment and nursing decision-making has been advocated by many medical staff. This is not only to attach importance to the wishes of patients, but also to the needs of social development. The purpose of this research was to investigate the attitudes of Chinese breast cancer medical staff towards the implementation of breast cancer decision-making aids.Methods: A cross-sectional study was conducted among 420 doctors and nurses in the Department of Breast Surgery. We used a questionnaire designed by investigators. Data was collected from February 2021 to September 2021. IBM SPSS Version 22 was used to analyze the collected data.Results: Overall, 420 valid questionnaires were returned from 220 doctors and 200 nurses. Response rate was 85.19%. The results showed that 77.14% of the medical staff supported the promotion of breast cancer decision-making aids, and 85.71%（360/420）agreed that patients should be the main participants in high-quality clinical decision-making. Also, 95.24%（400/420）believed that patients should know the reasons for making treatment decisions, and agreed that the positive effects of patient decision-making aids were positively correlated with high education (r education=0.317, P=0.001). There were statistically significant differences in the attitudes of medical staff with different working years (X2=9.432, P=0.024), educational background (X2=42.918, P<0.001) and shared decision education (X2=11.932, P=0.008) on whether to promote decision-making aids. Conclusion: At this stage, breast medical staff have a positive attitude towards using breast cancer decision aids for joint decision-making.

Sexual violence: 10 years of case studies in a hospital in Northern Italy.

Background: In the past twenty years, the fight against sexual violence has become a common goal of the entire European Union, due to a greater socio-cultural awareness of the population and the need to create guidelines for common action. Italian Law no. 66 of February 15, 1996, regarding the “Rules against sexual violence” which, with the appropriate amendments, is still in force today, defines 3 types of sexual offenses through the articles 609 of the Penal Code.Design and Methods: This study analyzes the cases relating to one of the hospitals in Northern Italy, during the decade January 2010 - December 2019, relating to suspected/reported cases of sexual violence, group sexual violence and sexual acts with minors. This study was carried out by acquiring information relating to subjects who had been victims of a sexual crime through the analysis of the consultations drawn up by specialist medical staff in the submentioned hospital. These consultations are defined by specific medical protocols that must be activated every time a victim of a suspected sexual offense comes into the Emergency Room (ER). The data were processed with descriptive analyzes, the qualitative variables were synthesized with absolute and percentage frequencies, while the quantitative variables with mean and interpolation of the data, to identify a trend line. In order to hypothesize the possible future trend of the phenomenon, data were collected relating to the type of crime according to the Penal Code, gender and age of the victim. This article also outlines future directions for improving research.Results: Our data shows that females, of any age, are the most affected in all sexual crimes, often share home with their aggressor, usually a man, and in most cases, they come to the medical observation without any lesion on their body.Conclusions: In order to provide a global vision of the situation and of the diffusion throughout the territory, studies like this one could be carried out in various Italian provinces. Besides, we hope that the high degree of commitment on the part of society and institutions in combating sexual violence, through information campaigns and incitements to report, will lead in a few years to a reduction in the number of victims of repeated violence (especially in family contexts) and, consequently, also in the total number of acts of violence that comes to the attention of the healthcare facilities. Finally, primary prevention of sexual violence must begin early because a substantial portion is experienced at a young age. It will be necessary to prevent these forms of violence with strategies that address known risk factors for perpetration (e.g., low family support, high poverty, low parental education, absent or single parenting, parental substance abuse, domestic violence, low caregiver warmth), by changing social norms and behaviors and by identifying protective factors that could be strengthened. Significance for public health The study presented is relevant because it analyzes the ways in which the italian public health daily faces the burdensome problem of sexual violence, in all the forms identified by Italian law, highlighting the characteristics of this crime that involves any gender and age. This article aims to be the starting point for the dissemination of these studies, which cannot be sectoral, in all the provinces of Italy, to highlight the critical issues and to reinforce the process of identification and reporting of these cases.

PECULIARITIES OF THE SYSTEM OF FAMILY MEDICINE IN HUNGARY

The purpose of the study: study of the existing system of family medicine in Hungary.Materials and methods. The bibliosemantic method, the method of structural-logical analysis, and the data of the statistical industry reporting of Hungary.Results. In 1992, in Hungary, the system of district doctors was replaced by the system of family doctors. Most of them (about 80%) are in private practice and work under contract with local governments. They receive payment from the National Health Insurance Fund according to the patient register. Local governments employ the remainder (about 21%) of GPs on fixed wage rates.In 2021, Government Resolution 53/2021 was adopted. (II. 9) on the creation of communities of family doctors. According to the resolution, 1,000 of the existing 6,500 family practice communities should be created. The family practice community includes: a family doctor, a pediatrician, a dentist, a psychologist, a nutritionist, a physical therapy specialist, and junior and senior medical staff. Communities may be amalgamated, integrated or a consortium of shared practice. By the beginning of 2022, 422 consortia of family medicine practice communities have already been created. It was established that the efficiency of providing primary medical care at the place of residence has increased, and the income of medical workers has increased by 50%.Conclusions. The implemented model of family medicine and its reformation at the current stage (creation of territorial collective communities of family doctors) in Hungary can be a valuable, practically-oriented example for Ukraine.

Admission triage tool for adult intensive care unit admission in Hong Kong during the COVID-19 outbreak.

Intensive care is expensive, and the numbers of intensive care unit (ICU) beds and trained specialist medical staff able to provide services in Hong Kong are limited. The most recent increase in coronavirus disease 2019 (COVID-19) infections over July to August 2020 resulted in more than 100 new cases per day for a prolonged period. The increased numbers of critically ill patients requiring ICU admission posed a capacity challenge to ICUs across the territory, and it may be reasonably anticipated that should a substantially larger outbreak occur, ICU services will be overwhelmed. Therefore, a transparent and fair prioritisation process for decisions regarding patient ICU admission is urgently required. This triage tool is built on the foundation of the existing guidelines and framework for admission, discharge, and triage that inform routine clinical practice in Hospital Authority ICUs, with the aim of achieving the greatest benefit for the greatest number of patients from the available ICU resources. This COVID-19 Crisis Triage Tool is expected to provide structured guidance to frontline doctors on how to make triage decisions should ICU resources become overwhelmed by patients requiring ICU care, particularly during the current COVID-19 pandemic. The triage tool takes the form of a detailed decision aid algorithm based on a combination of established prognostic scores, and it should increase objectivity and transparency in triage decision making and enhance decision-making consistency between doctors within and across ICUs in Hong Kong. However, it remains an aid rather than a complete substitute for the carefully considered judgement of an experienced intensive care clinician.

Legislative lacunas in holding persons responsible for driving vehicles under the influence of alcohol

A general review of the legal framework for holding persons administratively responsible for driving vehicles under the influence of alcohol has been carried out. Lacunas in the current legislation on holding persons responsible for driving vehicles under the influence of alcohol have been identified. Thus, there is nowadays virtually no practice of drawing up re-ports on administrative offenses for transferring control of a vehicle to a person who is in a state of alcohol intoxication. The legislative alternative presupposing the police inspecting a vehicle on the scene using specialist equipment or medical staff examining the driver of that vehicle leads, in certain cases, to the closure of the administrative offense proceedings in the actual absence of the administrative offense case to answer. The relevant judicial practice has been analyzed. The distinctive features of the use by the police of specialist equipment, by means of which the drivers of vehicles are detected to have signs of alcohol intoxication, have been highlighted. Opposing views have been given on the issue of classifying certain equipment, currently used by the police officers, as specialist. Proposals regarding amendments to the respective regulations have been formulated. In particular, this is the establishment of the lower and upper limits of administrative penalties; taking disciplinary action against respective persons for failure to appear in court for hearing an administrative offense case, as well as conducting internal reviews in case the court recognizes the fact of unlawful drawing up of the report on an administrative offense; the expansion of the list of documents that must be carried by the driver of a motor vehicle, etc.

Early detection of breast cancer using mammography images and software engineering process

The breast cancer has affected a wide region of women as a particular case. Therefore, different researchers have focused on the early detection of this disease to overcome it in efficient way. In this paper, an early breast cancer detection system has been proposed based on mammography images. The proposed system adopts deep-learning technique to increase the accuracy of detection. The convolutional neural network (CNN) model is considered for preparing the datasets of training and test. It is important to note that the software engineering process model has been adopted in constructing the proposed algorithm. This is to increase the reliably, flexibility and extendibility of the system. The user interfaces of the system are designed as a website used at country side general purpose (GP) health centers for early detection to the disease under lacking in specialist medical staff. The obtained results show the efficiency of the proposed system in terms of accuracy up to more than 90% and decrease the efforts of medical staff as well as helping the patients. As a conclusion, the proposed system can help patients by early detecting the breast cancer at far places from hospital and referring them to nearest specialist center.

A review of the atomoRapid HIV self-testing device: an acceptable and easy alternative to facilitate HIV testing

ABSTRACT Introduction:HIV testing is the gateway to both HIV prevention and treatment, and increased HIV testing and linkage to services is vital for an effective HIV response. HIV testing has progressed significantly from a lengthy laboratory process conducted by specialist medical staff to rapid point of care testing performed by trained lay staff. Despite HIV testing services being widely available, testing rates remain suboptimal among young people and men. Alternative delivery strategies that complement conventional testing services are needed to reach these priority groups. Areas covered:This article reviewed the AtomoRapid HIV self-testing (HIVST) device as an innovative alternative to conventional testing. Expert commentary:HIVST complements traditional HIV testing options and can be used to overcome major barriers to testing by catering for testing outside of conventional settings and by allowing individuals to test themselves privately, and at their own discretion and frequency. We conclude that the high sensitivity, specificity, acceptability, usability, and fidelity of this device makes it an appropriate option for the enhancement of HIV testing strategies for harder to reach populations, such as young people and men.

Effect of clinical pharmacist intervention on clinical rational use of antineoplastic drugs

Objective To explore the effect of clinical pharmacist on clinical rational use of antineoplastic drugs after participating in treatment group. Methods Retrospective research was used.According to whether there was a clinical pharmacist directly or indirectly involved in, all medical teams of the oncology department were divided into intervention group, advisory group and control group in our hospital.Intervention group was the medical team that had a specialist clinical pharmacist who could intervene irrational use of antineoplastic drug in the treatment on the spot.Advisory group was in the same area with the intervention group, and didn't have a specialist clinical pharmacist, but used to communicate with clinical pharmacist and take his medication advice, where clinical pharmacist indirectly involved in treatment.The control group was the medical group in the other area without clinical pharmacists of oncology department.The control group one and two were with the most beds among the control group.Randomly selected lung cancer, breast cancer, esophageal cancer, gastric cancer, colorectal cancer, gynecological cancer, liver/gallbladder/pancreatic cancer and other tumors patients from intervention group, advisory group, control group one and control group two, from January 2015 to December 2015, 10 copies of each case, 80 copies of each group.And antineoplastic drugs were commented specially.The information such as sex, age, clinical diagnosis, irrational antineoplastic drug use, adverse reaction and unexpected events and hospitalization time were recorded. Results The rate of irrational antineoplastic drug use of the intervention group (41.25%) was lower than the advisory group(80%), and was significantly lower than two control groups(147.50%, 161.25%), advisory group was also lower than two control groups, but no significant differences between the two control groups(χ2=0.193, P>0.05). Irrational chemotherapy, inappropriate usage and dosage and inappropriate indications were prominent problems in intervention group and advisory group.In addition, there were more improper solvent and contraindicated or adverse interaction problems in two control groups.Adverse events and incidence of unexpected events in intervention group (46.25%, 12.50%) were significantly lower than those in two control groups[(73.75%, 22.50%), (23.75%, 18.75%)]. Furthermore, the length of stay of intervention group patients was shortest in four groups (F=8.766, P<0.05). Conclusion By participating in the treatment group, clinical pharmacists can discover the irrational drug use and security risks in treatment, can provide medication guidance, consultation, publicity and other pharmaceutical service for specialist medical staff and patients.They will be more and more prominent in the treatment of cancer. Key words: Clinical pharmacist; Intervention; Antineoplastic drugs; Rational drug use

Oral anticancer medicines in acute oncology; recognition by non-specialist clinicians and risk reduction measures

ObjectiveThis study investigated the awareness of non-oncology specialist medical staff about commonly used oral anticancer medicines (OAMs).MethodsInterviews conducted with a range of non-oncology specialist doctors.ResultsThe recognition of OAMs was poor...

ATPS-53SURGICAL THERAPY FOR CEREBRAL VENTRICLE TUMOR IN INFANTS

BACKGROUND: Surgical treatment for infant ventricle tumors is a tough procedure. We summarize the clinical information, surgical experience and perioperative therapy for 14 patients. METHODS: The patients contained 8 males, 6 females and were treated from 2010-1 to 2014-12. The age ranged from 4 to 24 months with an average of 11.5 months. We used the approach of trigone area for 3 cases, interhemispheric transcallosal for 5 cases, and sub-occipital medline for 6 cases. RESULTS: Resection extent: 10 total resection (including 2 subtotal resection), 4 partial resection. Pathology categories: 5 choroid plexus papilomas (CPP), 1 choroid plexus carcinoma,1 mature teratoma, 1 anaplastic CPP, 3 anaplastic ependymoma (WHO III), 1 ependymoma (WHO I-II ), 1 glioma, 1 medulloblastoma. PROGNOSIS: 7 cases survive (4 cases survive with different complications); 5 infants died (all died for abandoning treatment); 1 case was lost. Overall, the prognosis is poor. CONCLUSIONS: 1. Infant cerebral ventricle tumors are often large before symptoms come up. Tumor's proximity to important brain regions makes it difficult for total resection. 2. Infants have a small blood volume and poor tolerance to operation, since great blood loss usually occurs intraoperation. Time-consuming operations, such as those for total resection, require a great deal of time under anaesthesia and blood loss. It's preferable to choose a stage operation when severe blood loss occurs. 3. Acute resection is a better choice to relieve hydrocephalus rather than drainage. 4. Close contact of qualified, specialist medical staff is necessary. Intensive care and nutritional support are important for postoperation therapy.

POST TRANSPLANT MEDICINE EDUCATION—A COLLABORATIVE APPROACH

PurposeWe have developed a collaborative post transplant teaching programto enable our children and young people to gain confidence and independence in managing their chronic medication.MethodDescription of our program development.ResultsIt is...