CONCLUSION: The preoperative three-dimensional (3D) modeling of the pituitary adenoma together with pituitary gland, optic nerves, carotid arteries, and the sphenoid sinuses was adopted for routine use in our institution for all pituitary surgery patients. It gave the surgeon a more profound orientation to the individual surgical field compared with the use of conventional 2D images only. OBJECTIVE: To demonstrate the feasibility of 3D surgical planning for pituitary adenoma surgery using readily available resources. SUBJECTS AND METHODS: The computed tomography (CT) and magnetic resonance imaging (MRI) data of 40 consecutive patients with pituitary adenoma were used to construct 3D models to be used in preoperative planning and during the surgery. A freely available, open source program (3D Slicer) downloaded to a conventional personal computer (PC) was applied. RESULTS: The authors present a brief description of the 3D reconstruction-based surgical planning workflow. In addition to the preoperative planning the 3D model was used as a 'road map' during the operation. With the 3D model the surgeon was more confident when opening the sellar wall and when evacuating the tumor from areas in contact with vital structures than when using only conventional 2D images.
The aim of the study was to assess the feasibility of and possible selection to attend in colorectal cancer screening.
During the years 1979-1980, 1 785 men and women (born in 1917-1929) were invited to a pilot screening project for colorectal cancer. The screening method used was a guaiac-based faecal occult blood test repeated once if the initial test was positive.
Compliance was 69% and the test was positive in 19% of those attending. In a record linkage with the Finnish Cancer Registry, 47 colorectal cancer cases and 24 deaths from colorectal cancer were observed by the end of 2004. In all, the particular test method was not regarded specific enough for population screening. There was, however, no difference in cancer incidence between those who complied and those who did not when compared to the general population of same age and gender.
Compliance was found high enough to make screening feasible and there was no self selection of persons with low cancer risk to attend screening.
Penetrating junctional trauma is a leading cause of preventable death on the battlefield. Similarly challenging in civilian settings, exsanguination from the vessels of the abdomen, pelvis, and groin can occur in moments. Therefore, iliac artery or abdominal aortic compression has been recommended. Based on prior research, 120 lbs (54 kg) or 140 lbs (63 kg) of compression may be required to occlude these vessels, respectively. Whether most rescuers can generate this amount of compression is unknown.
To determine how many people in a convenience sample of 44 health care professionals can compress 120 lbs and 140 lbs.
This study simulated aortic and iliac artery compression. Consent was obtained from 44 clinicians (27 female; 17 male) from two large urban hospitals in Edmonton, Alberta, Canada. Participants compressed the abdominal model, which consisted of a medical scale and a 250 ml bag of saline, covered by a folded hospital blanket and placed on the ground. In random order, participants compressed a force they believed maintainable for 20 minutes ("maintainable effort") and then a maximum force they could maintain for two minutes ("maximum effort"). Compression was also performed with a knee. Descriptive statistics were used to evaluate the data.
Compression was directly proportional to the clinician's body weight. Participants compressed a mean of 55% of their body weight with two hands at a maintainable effort, and 69% at a maximum effort. At maintainable manual effort, participants compressed a mean of 86 lbs (39 kg). Sixteen percent could compress over 120 lbs, but none over 140 lbs. At maximum effort, participants compressed a mean of 108 lbs (48 kg). Thirty-four percent could compress greater than 120 lbs and 11% could compress greater than 140 lbs. Using a single knee, participants compressed a mean weight of 80% of their body weight with no difference between maintainable and maximum effort.
This work suggests that bimanual compression following penetrating junctional trauma is feasible. However, it is difficult, and is not likely achievable or sustainable by a majority of rescuers. Manual compression (used to temporize until device application and operative rescue) requires a large body mass. To maintain 140 lbs of compression (for example during a lengthy transport), participants needed to weigh 255 lbs (115 kg). Alternatively, they needed to weigh 203 lbs (92 kg) to be successful during brief periods. Knee compression may be preferable, especially for lower-weight rescuers.
To determine the outcome and side effects of a new drug protocol to induce abortion.
An urban primary care practice.
One hundred consecutive patients who requested elective termination of pregnancies of less than 8 weeks' gestation.
Subjects received methotrexate (50 mg/m2 body surface area, administered intramuscularly) and, 3 days afterward, misoprostol (800 micrograms, given vaginally).
Number of abortions induced within 24 hours and within 10 days of misoprostol administration, number of surgical aspirations conducted because of incomplete abortion, mean amount of bleeding and pain and the number of women who, if faced with the same situation, said they would again choose a drug-induced abortion over a surgical one.
Abortion occurred within 24 hours of misoprostol administration among 48 women and within 10 days among 69 women. In total, 89 women had an abortion without surgical aspiration. Of these women, 71 said they would choose a drug-induced abortion if faced with the choice again.
Abortion induced with methotrexate and misoprostol appears to be a feasible alternative to surgical abortion and deserves further study.
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To develop and test the long-term feasibility of an interdisciplinary independent drug information service providing both written and oral drug information to physicians in an urban area of Sweden (> 400,000 inhabitants).
A drug information service was developed encouraging a cooperative approach between a department of clinical pharmacology, general practitioners (GPs), pharmacists, and Drug and Therapeutic Committees. Scientifically-based drug information was condensed and interpreted by a team and presented in both written and oral form. In one part of the area, both oral and written information was provided, while in another part of the area, only written information was distributed. Questionnaires and one prescription survey were performed to elucidate the knowledge and attitudes of the GPs regarding drug treatment of one condition (urinary tract infection, UTI, and norfloxacin were used as examples), as well as their opinion of our services.
Over a period of 10 years, 75 issues of a drug bulletin (2000 copies) were distributed. Oral producer-independent drug information, provided jointly by a GP and a pharmacist, was given on 16 occasions in each of 30 health centres (150 GPs). Around 80% of the GPs participated in the meetings. Of these GPs, 75% found the service important for their daily work. A majority of the GPs had prescribed the test drug, norfloxacin, not a first-line drug according to local recommendations, 1 year after approval. A significantly lower proportion of prescribers were observed in the area where the GPs had been provided with both written and oral information regarding recommended treatment (including first-line drugs) for uncomplicated cystitis. The approximate cost for this service in 1995 was SEK 0.685 million (USD 0.1 million); the prescribing costs of the 150 GPs were estimated at SEK 255 million per year. This means that the cost of the service per GP is only around 0.3% of normal prescribing costs.
Over a period of 10 years the information/education method described here has proven sustainable and feasible in terms of providing the information, regarding participation of the target group GPs in the oral sessions, and regarding integration of the service into the existing health care system.
Previous research has found that current smokers are less likely to have access to the Internet than nonsmokers. As access to the Internet continues to expand, does this finding remain true? Also, how many smokers are interested in Web-assisted tobacco interventions (WATIs)? These questions are important to determine the potential role that WATIs might play in promoting tobacco cessation.
The aims of the study were to determine whether smokers are less likely than nonsmokers to have access to the Internet and to establish the level of interest in WATIs among a representative sample of smokers.
A random digit dialing telephone survey was conducted of 8467 adult respondents, 18 years and older, in Ontario, Canada from September 2006 to August 2007. All respondents were asked their smoking status and whether they used the Internet (at home or work in the past 12 months; where; how often in the past 12 months). To assess the level of interest in WATIs, current daily smokers were asked whether they would be interested in a confidential program that they could access on the Internet, free of charge, that would allow them to check their smoking and compare it to other Canadians.
Smokers were marginally less likely to have used the Internet than nonsmokers (74% vs 81% in the last year), and, of those who had access to the Internet, smokers used the Internet less often than nonsmokers. Overall, 40% of smokers said they would be interested in a WATI. The number of cigarettes smoked per day was unrelated to level of interest in the WATI, but time to first cigarette after waking was. Smokers who used the Internet were more interested in the WATI than smokers who did not use the Internet (46% vs 20%).
While the difference in level of Internet use between smokers and nonsmokers was greatly reduced compared to 2002 and 2004 data, smokers still remain marginally less likely to use the Internet than nonsmokers. Overall, there was a substantial level of interest in the WATI among smokers, in particular among smokers who currently use the Internet. These results indicate that WATIs have a substantial potential audience among smokers, and, given the growing body of evidence regarding their efficacy, there is growing support that WATIs have a significant role to play in promoting tobacco cessation.
ABSTRACTOne of the keys to the success of the Canadian Longitudinal Study on Aging (CLSA) will be the leveraging of secondary data sources, particularly health care utilization (HCU) data. To examine the practical, methodological, and ethical aspects of accessing HCU data, one-on-one qualitative interviews were conducted with 53 data stewards and privacy commissioners/ombudsmen from across Canada. Study participants indicated that obtaining permission to access HCU data is generally possible; however, they noted that this will be a complex and lengthy process requiring considerable and meticulous preparatory work to ensure proper documentation and compliance with jurisdictional variations along legislative and policy lines.
The accuracy of central axis dose calculation was evaluated for 48 photon beams from 28 linear accelerators at nine centres in Finland. In addition, inter-accelerator consistency of beam data was evaluated for Varian Clinac 600 CDs and 2100 CDs, and averaged data sets were generated for output factors (OFs) and percentage depth doses (PDDs). The averaged data sets obtained were used to identify potential dosimetry reasons for local errors.
Agreement between measured and calculated doses was determined at isocentre at 10 cm depth in water for nine different sized open square and rectangular fields. Averaged OFs were determined for nominal energies of 4, 6, 10, 15 and 18 MV both at d(max) and at a 10-cm depth. In order to develop a function for the OF data, OFs for square fields were parameterised through empirical model fitting. The feasibility of a simple equivalent square collimator formula was also evaluated for the presentation of OFs for rectangular fields. Averaged PDDs were determined at a 10-cm depth.
The difference between measured and calculated doses exceeded +/-3%, +/-2% and +/-1% for 3, 6 and 35 of the investigated 48 beams, respectively. The differences were due to errors observed in both OFs and depth dose data. When the agreement between dose calculation and measurement was within +/-1%, inter-accelerator differences in OFs were within +/-1.0% at both the depth of dose maximum and at 10 cm for Clinac 600 CDs and also for 2100 CDs. Differences in PDDs were within +/-1.2%.
The importance of quality control for beam data was demonstrated by showing significant errors in measured data. For Clinac 600 and 2100 CDs, the quality control can be accurately performed by comparing local data to averaged reference data. Robust averaged data sets were obtained for 6, 15 and 18 MV beams of Clinac 2100 CDs.
Assessment of image analysis methods and computer software used in (99m) Tc-MAG3 dynamic renography is important to ensure reliable study results and ultimately the best possible care for patients. In this work, we present a national multicentre study of the quantification accuracy in (99m) Tc-MAG3 renography, utilizing virtual dynamic scintigraphic data obtained by Monte Carlo-simulated scintillation camera imaging of digital phantoms with time-varying activity distributions. Three digital phantom studies were distributed to the participating departments, and quantitative evaluation was performed with standard clinical software according to local routines. The differential renal function (DRF) and time to maximum renal activity (Tmax ) were reported by 21 of the 28 Swedish departments performing (99m) Tc-MAG3 studies as of 2012. The reported DRF estimates showed a significantly lower precision for the phantom with impaired renal uptake than for the phantom with normal uptake. The Tmax estimates showed a similar trend, but the difference was only significant for the right kidney. There was a significant bias in the measured DRF for all phantoms caused by different positions of the left and right kidney in the anterior-posterior direction. In conclusion, this study shows that virtual scintigraphic studies are applicable for quality assurance and that there is a considerable uncertainty associated with standard quantitative parameters in dynamic (99m) Tc-MAG3 renography, especially for patients with impaired renal function.
Telemedicine was introduced for weekly tumour case conferences between Sahlgrenska University Hospital and two district hospitals in Sweden. The accuracy of tele-oncology was determined using simulated telemedicine consultations, in which all the material relating to each case was presented but without the patient in person. The people attending the conference were asked to determine the tumour ('TNM') classification and treatment. The patient was then presented in person, to give the audience the opportunity to ask questions and perform a physical examination. Then a new discussion regarding the tumour classification and the treatment plan took place, and the consensus was recorded. Of the 98 consecutive patients studied in this way, 80 could be evaluated by both techniques. Of these 80, 73 (91%) had the same classification and treatment plan in the telemedicine simulation as in the subsequent face-to-face consultation. In four cases the TNM classification was changed and for three patients the treatment plan was altered. The specialists also had to state their degree of confidence in the tele-oncology decisions. When they recorded uncertainty about their decision, it was generally because they wanted to palpate the tumour. In five of the seven patients with a different outcome, the clinical evaluation was stated to be dubious or not possible. The results show that telemedicine can be used safely for the management of head and neck cancers.