Role of IPAA for Crohn's Disease

Proctocolectomy and creation of an ileal pouch-anal anastomosis (IPAA), first described by Parks and Nicholls, is the preferred and most commonly performed surgical procedure for patients requiring resection of the entire large intestine provided they demonstrate good sphincter function and lack risk factors for postoperative complications or dysfunction. The operation was initially developed for patients with ulcerative colitis or familial adenomatous polyposis to preserve the normal route of defecation and avoid the need for a permanent stoma while ensuring acceptable functional results and satisfactory patient-reported quality of life

The QED Structure of the Photon

Measurements of the QED structure of the photon based on the reaction ee --> ee \gamma(*)(P^2)\gamma*(Q^2) --> ee mumu are discussed. This review is an update of the discussion of the results on the QED structure of the photon presented in Refs.[1], and covers the published measurements of the photon structure functions F_2, F_A nd F_B and of the differential cross-section dsig/dx for the exchange of two virtual photons.Comment: Invited talk given at the 7th International Workshop on Deep Inelastic Scattering and QCD, April 19 to 23, 1999, Zeuthen, to appear in the proceedings. 8pages 4 figure

Haalbaarheid mobiel slachthuis en uitsnijderij = Feasibility of mobile slaughter and cutting carcasses

To develop selling of local products and biologic meat a mobile unit for slaughter farm animals with a permanent cutting and selling room at the farm can be useful

Emergency upscaling of video consultation during the COVID-19 pandemic:Contrasting user experience with data insights from the electronic health record in a large academic hospital

BackgroundVideo consultation (VC) has been scaled up at our academic centre attempting to facilitate and accommodate patient-provider interaction in times of social distancing during the recent and ongoing COVID-19 pandemic.ObjectivesThis study evaluates qualitative outcomes with data insights from the electronic health record, to contrast satisfaction outcomes with the actual use of VC.MethodsHealthcare providers and patients using VC during the COVID-19 pandemic at a large academic centre in the Netherlands were surveyed for user satisfaction and experiences with VC. In addition, quantitative technical assessment was performed using data related to VC from the EHR record.ResultsIn total, 1,027/4,443 patients and 87/166 healthcare providers completed their online questionnaire. Users rated the use of VC during a pandemic with an average score of 8.3/10 and 7.6/10 respectively. Both groups believed the use of VC was a good solution to continue the provision of healthcare during this pandemic. The use of VC increased from 92 in March 2020 to 837 in April 2020.ConclusionThis study strongly signals that VC is an important modality in futureproofing outpatient care during and beyond pandemic times. Further development in end-user technology is needed for EHR integrated VC solutions. Guidelines needs to be developed advising both patients and healthcare providers. Such guidelines should not solely focus on technical implementation and troubleshooting, but must also consider important aspects such as digital health literacy, patient and provider authentication, privacy and ethics

Cost-effectiveness of sigmoid resection with primary anastomosis or end colostomy for perforated diverticulitis: an analysis of the randomized Ladies trial

Background: Several studies have been published favouring sigmoidectomy with primary anastomosis over Hartmann's procedure for perforated diverticulitis with purulent or faecal peritonitis (Hinchey grade III or IV), but cost-related outcomes were rarely reported. The present study aimed to evaluate costs and cost-effectiveness within the DIVA arm of the Ladies trial. Methods: This was a cost-effectiveness analysis of the DIVA arm of the multicentre randomized Ladies trial, comparing primary anastomosis over Hartmann's procedure for Hinchey grade III or IV diverticulitis. During 12-month follow-up, data on resource use, indirect costs (Short Form Health and Labour Questionnaire) and quality of life (EuroQol Five Dimensions) were collected prospectively, and analysed according to the modified intention-to-treat principle. Main outcomes were incremental cost-effectiveness (ICER) and cost–utility (ICUR) ratios, expressed as the ratio of incremental costs and the incremental probability of being stoma-free or incremental quality-adjusted life-years respectively. Results: Overall, 130 patients were included, of whom 64 were allocated to primary anastomosis (46 and 18 with Hinchey III and IV disease respectively) and 66 to Hartmann's procedure (46 and 20 respectively). Overall mean costs per patient were lower for primary anastomosis (€20 544, 95 per cent c.i. 19 569 to 21 519) than Hartmann's procedure (€28 670, 26 636 to 30 704), with a mean difference of €–8126 (–14 660 to –1592). The ICER was €–39 094 (95 per cent bias-corrected and accelerated (BCa) c.i. –1213 to –116), indicating primary anastomosis to be more cost-effective. The ICUR was €–101 435 (BCa c.i. –1 113 264 to 251 840). Conclusion: Primary anastomosis is more cost-effective than Hartmann's procedure for perforated diverticulitis with purulent or faecal peritonitis

Comparison of segmentation software packages for in-hospital 3D print workflow

Purpose: In-hospital three-dimensional (3D) printing of patient-specific pathologies is increasingly being used in daily care. However, the efficiency of the current conversion from image to print is often obstructed due to limitations associated with segmentation software. Therefore, there is a need for comparison of several clinically available tools. A comparative study has been conducted to compare segmentation performance of Philips IntelliSpace Portal(®) (PISP), Mimics Innovation Suite (MIS), and DICOM to PRINT(®) (D2P). Approach: These tools were compared with respect to segmentation time and 3D mesh quality. The dataset consisted of three computed tomography (CT)-scans of acetabular fractures (ACs), three CT-scans of tibia plateau fractures (TPs), and three CTA-scans of abdominal aortic aneurysms (AAAs). Independent-samples [Formula: see text]-tests were performed to compare the measured segmentation times. Furthermore, 3D mesh quality was assessed and compared according to representativeness and usability for the surgeon. Results: Statistically significant differences in segmentation time were found between PISP and MIS with respect to the segmentation of ACs ([Formula: see text]) and AAAs ([Formula: see text]). Furthermore, statistically significant differences in segmentation time were found between PISP and D2P for segmentations of AAAs ([Formula: see text]). There were no statistically significant differences in segmentation time for TPs. The accumulated mesh quality scores were highest for segmentations performed in MIS, followed by D2P. Conclusion: Based on segmentation time and mesh quality, MIS and D2P are capable of enhancing the in-hospital 3D print workflow. However, they should be integrated with the picture archiving and communication system to truly improve the workflow. In addition, these software packages are not open source and additional costs must be incurred