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Increasing Experience (increasing + experience)
Selected AbstractsThe Radial Approach: Is This the Route to Take?JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 5 2008M.R.C.P., SUDHIR RATHORE M.D. The benefits of the transradial approach have clearly been demonstrated over the years in various studies. The reduced incidence of access site complications and early mobilization are some of the benefits making this technique popular with interventional cardiologists worldwide. With increasing experience and availability of dedicated equipment this technique is now been increasingly used for complex catheter interventions. However, there still remain some potential problems and complications with the transradial approach and it needs further research. The main purpose of this review is to highlight the benefits, complications, and potential problems with the transradial approach. [source] Transcervical chorionic villus sampling in multiple pregnancies using a biopsy forcepsPRENATAL DIAGNOSIS, Issue 3 2002Gemma Casals Abstract Objective The aim of this study was to assess the effectiveness and safety of chorionic villus sampling (CVS) performed in multiple pregnancies by means of a transcervical biopsy forceps. Methods The study included CVS performed from January 1990 to March 2000 in our Unit. The results were analysed in two consecutive periods, period A (1990,1994) and period B (1995,2000), in an attempt to assess the effect of increasing experience. Results Seventy-five samplings were performed in 39 multiple pregnancies, 38 twin sets and one triplet. A cytogenetic report was obtained in 73% of cases in period A and in 98% in period B. An abnormal karyotype was observed in 11 samples. The need for subsequent amniocentesis decreased from 38% in period A to 10% in period B. The spontaneous fetal loss rate in chromosomally and structurally normal fetuses before the 20th week decreased from 8.7% in period A to 3.3% in period B. The fetal loss rate after the 20th week was 3.3% in period B and none in period A. It must be noted that in three out of the four cases of fetal loss an amniocentesis was needed after CVS. Conclusion Our results suggest that effectiveness and safety improved with increasing experience. Transcervical chorionic villus sampling allows an earlier prenatal genetic diagnosis in multiple pregnancies and this may be particularly relevant for a safer selective termination when chosen by parents if one of the fetuses has an abnormal karyotype. Copyright © 2002 John Wiley & Sons, Ltd. [source] Compliance with routine antenatal rhesus D prophylaxis and the impact on sensitisations: observations over 14 yearsBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 7 2006IZ MacKenzie Documented routine antenatal anti-D prophylaxis was given to 90% and 81,87% of eligible women at 28 and 34 weeks of gestation, respectively, during the early 1990s and early 2000s. With increasing experience and education, a significant improvement in the timing of the first (OR 0.26, 95% CI 0.16,0.41: P < 0.0001) and second injections (OR 0.40, 95% CI 0.26,0.61: P < 0.0001) occurred during the latter period. Despite these improvements, there was no reduction in the sensitisation rate at 0.4%. However, this low rate occurred despite significant proportions of women delivering more than 42 days after the second injection. Fifteen of the 16 sensitised women had received routine antenatal prophylaxis. [source] Unexpected reduction in the incidence of birth trauma and birth asphyxia related to instrumental deliveries during the study period: was this the Hawthorne effect?BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 3 2003W.C. Leung Objective The study was originally designed to identify the risk factors that could predict those difficult instrumental deliveries resulting in birth trauma and birth asphyxia. Design A prospective study on all singleton deliveries in cephalic presentation with an attempt of instrumental delivery over a 12-month period (13 March 2000 to 12 March 2001). Setting A local teaching hospital. Sample Six hundred and seventy deliveries. Methods A codesheet was designed to record the demographic data, characteristics of first and second stages of labour and neonatal outcome. In particular, the doctor had to enter the pelvic examination findings before the attempt of instrumental delivery. Main outcome measures Birth trauma and birth asphyxia. Results There was a significant reduction in the incidence of birth trauma and birth asphyxia related to instrumental deliveries during the study period (0.6%) when compared with that (2.8%) in the pre-study period (1998 and 1999) (RR 0.27, 95% CI 0.11,0.70). There was more trial of instrumental deliveries in the operating theatre although this was not statistically significant (RR 1.19, 95% CI 0.88,1.60). The instrumental delivery rate decreased during the study period (RR 0.88, 95% CI 0.82,0.94). The caesarean section rate for no progress of labour, the incidence of direct second stage caesarean section and the incidence of failed instrumental delivery did not increase during the study period. Conclusions Apart from the merits of regular audit exercise and increasing experience of the staff, the Hawthorne effect might be the major contributing factor in the reduction of birth trauma and birth asphyxia related to instrumental deliveries during the study period. [source] Laparo-endoscopic single-site surgery: preliminary advances in renal surgeryBJU INTERNATIONAL, Issue 8 2009Sashi S. Kommu We reviewed the preliminary advances in laparo-endoscopic single-site surgery (LESS) as applied to renal surgery, and analyzed current publications based on animal models and human patients. We searched published reports in major urological meeting abstracts, Embase and Medline (1966 to 25 August 2008), with no language restrictions. Keyword searches included: ,scarless', ,scar free', ,single port/trocar/incision', ,intraumbilical', and ,transumbilical', ,natural orifice transluminal endoscopic surgery' (NOTES), ,SILS', ,OPUS' and ,LESS'. The lessons learnt from the studies using the porcine model are that further advances in instrumentation are essential to achieve optimum results, and that testing survival in animals is also necessary to further expand the NOTES and LESS techniques. Further advances in instrument technology together with increasing experience in NOTES and LESS approaches have driven the transition from porcine models to human patients. In the latter, studies show that the techniques are feasible provided that both optimal surgical technical expertise with advanced skills, and optimal instrumentation, are available. The next step towards minimal access/minimally invasive urological surgery is NOTES and LESS. It is inevitable that LESS will be extended to involve more complex and technically demanding procedures such as laparoscopic radical prostatectomy and partial nephrectomy. [source] | ||||||||||