Étude rétrospective de la qualité de la chirurgie oncologique pédiatrique dans un centre académique suisse

Introduction : Il essentiel pour les patients, mais aussi pour l'utilisation appropriée des ressources médicales et financières, que les centres pédiatriques oncologiques de moindre envergure répondent de manière adéquate aux normes de soins et atteignent des résultats comparables à ceux des grands centres. Étant donné que l'impact économique des soins de santé est devenu un important modulateur des décisions politiques, il est urgent que les institutions abordent le sujet de la qualité en chirurgie pédiatrique oncologique, et fournissent des éléments pour appuyer ou modifier les lignes directrices existantes Patients et méthode : Par cette étude monocentrique rétrospective de 13 ans, nous avons analysé la qualité de la chirurgie pédiatrique de tumeurs abdominales ou thoraciques du Département Médico-Chirurgical du CHUV pratiquée sur 48 enfants. Afin d'y parvenir, nous avons choisi et analysé deux indicateurs de la qualité de ces soins. Le premier est la conformité de la pratique de ce service, avec les directives des protocoles de traitements internationaux. Le second paramètre étudié est la mesure du taux d'événements indésirables liés à la chirurgie du cancer observés dans notre population de patients. Résultats : La conformité avec les protocoles de traitement est très élevée avec un taux de 96%. L'incidence des événements indésirables liés à la chirurgie est de 34 patients sur 48 (66%). Les complications graves sont rares, avec 85% ne nécessitant pas plus qu'un traitement médical simple. Aucune mortalité chirurgicale n'a été identifiée. Conclusion : Nos données suggèrent que la planification méticuleuse de la chirurgie et l'exécution de celle-ci par des chirurgiens dédiés à l'oncologie pédiatrique, ainsi qu'une étroite collaboration avec des oncologues pédiatres sont des conditions essentielles à la qualité des soins apportés à ces patients. Dans ces conditions, même un centre d'oncologie pédiatrique de moindre envergure peut répondre aux normes établies par les grands centres internationaux

Étude rétrospective de la qualité de la chirurgie oncologique pédiatrique dans un centre académique suisse

Introduction : Il essentiel pour les patients, mais aussi pour l'utilisation appropriée des ressources médicales et financières, que les centres pédiatriques oncologiques de moindre envergure répondent de manière adéquate aux normes de soins et atteignent des résultats comparables à ceux des grands centres. Étant donné que l'impact économique des soins de santé est devenu un important modulateur des décisions politiques, il est urgent que les institutions abordent le sujet de la qualité en chirurgie pédiatrique oncologique, et fournissent des éléments pour appuyer ou modifier les lignes directrices existantes Patients et méthode : Par cette étude monocentrique rétrospective de 13 ans, nous avons analysé la qualité de la chirurgie pédiatrique de tumeurs abdominales ou thoraciques du Département Médico-Chirurgical du CHUV pratiquée sur 48 enfants. Afin d'y parvenir, nous avons choisi et analysé deux indicateurs de la qualité de ces soins. Le premier est la conformité de la pratique de ce service, avec les directives des protocoles de traitements internationaux. Le second paramètre étudié est la mesure du taux d'événements indésirables liés à la chirurgie du cancer observés dans notre population de patients. Résultats : La conformité avec les protocoles de traitement est très élevée avec un taux de 96%. L'incidence des événements indésirables liés à la chirurgie est de 34 patients sur 48 (66%). Les complications graves sont rares, avec 85% ne nécessitant pas plus qu'un traitement médical simple. Aucune mortalité chirurgicale n'a été identifiée. Conclusion : Nos données suggèrent que la planification méticuleuse de la chirurgie et l'exécution de celle-ci par des chirurgiens dédiés à l'oncologie pédiatrique, ainsi qu'une étroite collaboration avec des oncologues pédiatres sont des conditions essentielles à la qualité des soins apportés à ces patients. Dans ces conditions, même un centre d'oncologie pédiatrique de moindre envergure peut répondre aux normes établies par les grands centres internationaux

Morphodynamic responses of salt marshes to sea-level rise: upland expansion, drainage evolution, and biological feedbacks

Accelerating sea-level rise (SLR) poses an imminent threat to salt marshes, which sit within meters of mean sea level. In order to assess marsh vulnerability to SLR, we must first understand the fundamental processes governing marsh response to SLR. The objective of this dissertation work is to examine how marsh sedimentation and erosion affect the morphological development of marshes as sea level rises, over a broad range of spatial and temporal scales. At the smallest scale, the effects of bioturbation by Sesarma reticulatum crabs on sediment erodibility are examined using a laboratory flume. Measurements of surface elevation, erosion, and turbidity show that S. reticulatum bioturbation repackages formerly compacted sediment and deposits it above the surface, decreasing the threshold velocity for erosion and increasing eroded volume. S. reticulatum-induced sediment erosion can have broader impacts on creek development and marsh morphology. S. reticulatum has facilitated drainage network expansion in salt marshes at Sapelo Island, GA and Cape Romain, SC in response to local SLR. Burrowing by this crab directly adjacent to tidal creeks at these locations leads to rapid headward growth. The effects of site-specific conditions on creek expansion are examined through comparison of sediment properties, surface elevations, and historical rates of creek growth at each site. Results suggest that while similar processes are occurring at both locations, the higher elevation of the marsh in GA leads to greater shear strength and a larger volume of material to be eroded by creeks. These combined effects have led to slower creek growth compared to SC. At the largest spatial scale, and projecting forward over a 100-year period, a model for marsh response to SLR at the Great Marsh in Massachusetts is developed. This model takes into account limitations imposed by both low sediment availability and steep topography in the surrounding uplands. Results indicate that while the marsh may persist for several decades, it undergoes a dramatic shift in ecology and hydrology. As the rate of SLR accelerates, marsh loss increases due to the lack of sediment available for accretion and the physical barriers to migration presented by surrounding topography

Aging in Urbanity

As the number of Americans over the age of fifty continues to rise, there are growing concerns over the quality of health care facilities and their availability and affordability. There are those who prefer the idea of growing older in a sprawling, suburban landscape, surrounded by nature, and history has proven this to be a normative response to retirement living. Yet, there could be other ways of introducing this type of living in a more accessible, lively and urban environment. There are many different options of living for younger generations and families, so the potential for providing similar options for the aging population is a practical solution. Instead of separating the elderly population in their own cloister, invovling them in the community by location and opportunity, can provide a healthy interaction with people of varying social and ethnic demographics. Positioning them in a more urban and exciting setting can potentially influence a more positive and hopeful outlook on their own futures. History has, unfortunately, placed the aging population apart from the hub of community interaction, and subsequently segregated their ability to continue to be involved and influential upon society. My thesis will explore the expansion of the retirement community into the urban fabric, and the physical, mental and societal implications that the design could positively accentuate

Measurements of three-dimensional glenoid erosion when planning the prosthetic replacement of osteoarthritic shoulders.

The three-dimensional (3D) correction of glenoid erosion is critical to the long-term success of total shoulder replacement (TSR). In order to characterise the 3D morphology of eroded glenoid surfaces, we looked for a set of morphological parameters useful for TSR planning. We defined a scapular coordinates system based on non-eroded bony landmarks. The maximum glenoid version was measured and specified in 3D by its orientation angle. Medialisation was considered relative to the spino-glenoid notch. We analysed regular CT scans of 19 normal (N) and 86 osteoarthritic (OA) scapulae. When the maximum version of OA shoulders was higher than 10°, the orientation was not only posterior, but extended in postero-superior (35%), postero-inferior (6%) and anterior sectors (4%). The medialisation of the glenoid was higher in OA than normal shoulders. The orientation angle of maximum version appeared as a critical parameter to specify the glenoid shape in 3D. It will be very useful in planning the best position for the glenoid in TSR

Detection of the movement of the humerus during daily activity

A new ambulatory technique for qualitative and quantitative movement analysis of the humerus is presented. 3D gyroscopes attached on the humerus were used to recognize the movement of the arm and to classify it as flexion, abduction and internal/external rotations. The method was first validated in a laboratory setting and then tested on 31 healthy volunteer subjects while carrying the ambulatory system during 8h of their daily life. For each recording, the periods of sitting, standing and walking during daily activity were detected using an inertial sensor attached on the chest. During each period of daily activity the type of arm movement (flexion, abduction, internal/external rotation) its velocity and frequency (number of movement/hour) were estimated. The results showed that during the whole daily activity and for each activity (i.e. walking, sitting and walking) the frequency of internal/external rotation was significantly higher while the frequency of abduction was the lowest (P<0.009). In spite of higher number of flexion, abduction and internal/external rotation in the dominant arm, we have not observed in our population a significant difference with the non-dominant arm, implying that in healthy subjects the arm dominance does not lie considerably on the number of movements. As expected, the frequency of the movement increased from sitting to standing and from standing to walking, while we provide a quantitative value of this change during daily activity. This study provides preliminary evidence that this system is a useful tool for objectively assessing upper-limb activity during daily activity. The results obtained with the healthy population could be used as control data to evaluate arm movement of patients with shoulder diseases during daily activit

Agenesis of the long head of the biceps brachii tendon: ignored variations of the anatomy and the next tendon to disappear?

Bilateral agenesis of the long head of the biceps brachial tendon (LHB) is a very rare variation of the anatomy. We report a case of an 18-year-old man with bilateral agenesis of the long head of the biceps brachii tendon. We present initial findings, radiographical examinations and the follow-up of an unusual entity. Diagnosis of agenesis of the LHB can be challenging especially in cases of traumatic shoulder pain. It is not a very known entity because of its rareness. However, it could be associated with other congenital anomalies. The absence of the LHB is easily ignored in the diagnostic process. Clinical examination should be a pitfall, radiological examination is helpful to confirm the suspicion of LHB absence. MRI is often the first choice, although ultrasonography is cheaper and much easier to access and it is an excellent tool to visualise this anatomic variation with empty or shallow intertubercular groove

Use of Dynamic Risk Instruments to Assess Sexual Violence Risk in a Community-Supervised Sample of Men with Sexual Offense Convictions

The present study examined the predictive validity and psychometric properties of several actuarial risk measures developed to estimate likelihood of sexual recidivism, and one protective factor measure developed to assess protective factors related to desistance from sexual offending. Each of Static-99R (Helmus et al., 2012), Violence Risk Scale - Sexual Offense Version (VRS-SO; Wong et al., 2003-2017), STABLE-2007 (Hanson et al., 2007), Sex Offender Treatment Intervention Progress Scale (SOTIPS; McGrath et al., 2012), and Structured Assessment of Protective Factors for Violence Risk- Sexual Offence version (SAPROF-SO; Willis et al., 2017-2020) was rated based on file information of 200 community-supervised men with sexual offense convictions who were court mandated to receive assessments (and often treatment) at an outpatient forensic clinic in Edmonton, Alberta. Recidivism information was available for 172 men; mean follow-up time was 8.6 years. Nine percent of the sample was charged or convicted of a new sexual offense, 18.5% for any new violent (including sexual) charge or conviction, and 33% for any new charge or conviction. Predictive validity for all tools was obtained with respect to sexual, violent (including sexual), and general recidivism. All measures significantly predicted sexual (AUC = .65- .72) recidivism and dynamic measures were sometimes incremental to static measures in the prediction of sexual recidivism, depending on the pairing of predictors. An exploration of the structural properties of the VRS-SO dynamic items revealed a three-factor solution isomorphic to previous research (Olver et al., 2007; Olver & Eher, 2019). Further discrimination and calibration findings will be discussed, including implications for assessment and treatment of men convicted of sexual offenses

The logistics of voucher management: The underreported component in family planning voucher discussions

Background: The purpose of health care vouchers or coupons is to receive a health service in exchange which is fully or partially subsidized, such as any treatment offered for communicable disease; for immunization; antenatal care-/postnatal care-related maternal health services; a family planning (FP) service; or to get a health commodity like a medicine. Vouchers are targeted for a group of people who can benefit the most such as on the basis of poverty ranking, marginalized or living in rural areas. According to the World Health Organization, voucher schemes in the area of sexual and reproductive health are considered of high value if they are implemented to address the issues of contraceptive commodity or service unavailability or to address the barriers to access such services through contracting out health services, for example, through social franchising (SF). FP vouchers can substantially expand contraceptive access and choice and empower the underserved populations. Literature cites voucher\u27s effectiveness in better targeting, increasing use, and improving program outcomes in FP programs; however, there is little research or explanation of how voucher management is done in practice.Discussion: The paper attempts to describe various components of voucher management system and its functioning using example of a voucher program in Pakistan. There are challenges such as high upfront cost, targeting the appropriate clients, validation of vouchers, and quality assurance, but these can be managed with better preparation at the planning and design stage. Strong monitoring and evaluation are integral to successful implementation of the voucher program. Also, voucher interventions that are targeted and adopt a pro-poor strategy have been found to improve access to care within poor and marginalized populations. Such programs have the capacity to bridge health inequities in developing nations. Targeted voucher schemes such as those which are designed as pro-poor or pro-rural are known to reduce barriers to access for those living with poverty or for the ones considered as marginalized population. Hence, such interventions have the capacity to fulfill the gaps in health inequities, especially, in low- and/or middle-income countries.Conclusion: Voucher programs should report the voucher logistics and management to build a larger evidence base of best practices. All voucher schemes must be designed, implemented, and evaluated on the basis of set objectives through addressing the local context. But any voucher implementing organization also conducting the in-house voucher management simultaneously may be considered as a weakness in program design, in turn providing rationale for either failure or success of that particular voucher intervention. Therefore, separating implementation and management of a voucher initiative can lead to enhanced transparency, improved accountability, allow for independent validation of services, and facilitate compliance for payments