Laparoscopic appendectomy in the elderly: our experience

BACKGROUND: Laparoscopic appendectomy for acute appendicitis is one of the most common surgical procedures performed in the world. We aimed to compare laparoscopic and open appendectomy in the elderly in our experience. METHODS: We performed a retrospective review of elderly patients who underwent appendectomy for acute appendicitis from 1st of January 2006 to the 31st of July 2012. We analyzed 39 appendectomies in elderly patients: 20 procedures were performed using open technique (Group O) and 19 using laparoscopic technique (Group L). RESULTS: In the analysis of intraoperative variables there was no statistically significant difference. In this study there was no statistically significant difference also in peri-operative variables. CONCLUSION: Laparoscopic appendectomy is a safe and feasible technique in acute appendicitis also in the elderly

Associations between depressive symptoms and disease progression in older patients with chronic kidney disease: results of the EQUAL study

Background Depressive symptoms are associated with adverse clinical outcomes in patients with end-stage kidney disease; however, few small studies have examined this association in patients with earlier phases of chronic kidney disease (CKD). We studied associations between baseline depressive symptoms and clinical outcomes in older patients with advanced CKD and examined whether these associations differed depending on sex. Methods CKD patients (>= 65 years; estimated glomerular filtration rate <= 20 mL/min/1.73 m(2)) were included from a European multicentre prospective cohort between 2012 and 2019. Depressive symptoms were measured by the five-item Mental Health Inventory (cut-off <= 70; 0-100 scale). Cox proportional hazard analysis was used to study associations between depressive symptoms and time to dialysis initiation, all-cause mortality and these outcomes combined. A joint model was used to study the association between depressive symptoms and kidney function over time. Analyses were adjusted for potential baseline confounders. Results Overall kidney function decline in 1326 patients was -0.12 mL/min/1.73 m(2)/month. A total of 515 patients showed depressive symptoms. No significant association was found between depressive symptoms and kidney function over time (P = 0.08). Unlike women, men with depressive symptoms had an increased mortality rate compared with those without symptoms [adjusted hazard ratio 1.41 (95% confidence interval 1.03-1.93)]. Depressive symptoms were not significantly associated with a higher hazard of dialysis initiation, or with the combined outcome (i.e. dialysis initiation and all-cause mortality). Conclusions There was no significant association between depressive symptoms at baseline and decline in kidney function over time in older patients with advanced CKD. Depressive symptoms at baseline were associated with a higher mortality rate in men

Complexity reduction and kaizen events to balance manual assembly lines: an application in the field

Notwithstanding the existence of a broad research base on assembly line balancing (ALB), companies do not use the mathematical approaches developed in the literature to configure assembly lines. This article aims to fill the gap between research and application by presenting and testing in a real industrial context a methodology based on complexity reduction and kaizen events. First, the methodology supports reducing the complexity that affects real-life assembly systems in terms of the variety of, e.g. finished products, materials and parts. Next, the methodology proposes the conduction of kaizen events by using lean manufacturing tools, such as process analysis, time observation, waste identification, workstation standard documents and yamazumi charts. The methodology is successfully applied to a case study that describes its use in the confectionery process for a major chocolatier company along with the results of the application. The main contribution of this paper consists in presenting a method to manage the line balancing activity within everyday industrial realities, helping practitioners to improve and maintain the performance over time

Performance improvement of manual assembly lines in a context characterized by complexity

The researchers' difficulty at transferring the scientific knowledge to practitioners and the existence of a gap among the methods developed in literature and the real life problem are issues recognized by literature and seems that they have not been solved yet. The aim of the present work is to outline a methodology that is successfully applicable to the industrial context, i.e. that is able to both take in account of the difficulty of managing a high number of different components and materials and assure the correct line balancing to gain performance improvement of the assembly lines as well as the maintain of such better performance over time. Among the techniques presented by literature, the "kaizen assembly" is exploited to perform the line balancing and to be transferred to practitioners. As the methodology addresses a typical industrial issue, it is outlined through its application to the case of an Italian plant of a chocolatier and confectionery company, leader in the market of premium quality chocolate. In order to get such a difficult result, firstly, a methodology to reduce the complexity is proposed and applied to the case study, by identifying groups of components distinct based on commonalities in the job elements and cycle times, rather than on part-IDs. Secondly "kaizen assembly" are performed and lean manufacturing techniques are applied in order to enhance the assembly lines performance and reach a set target. This allowed the company to achieve the performance objective and to maintain changes steady over time, confirming the validity of the approach

Complexity reduction and kaizen events to balance manual assembly lines: an application in the field

Notwithstanding the existence of a broad research base on assembly line balancing (ALB), companies do not use the mathematical approaches developed in the literature to configure assembly lines. This article aims to fill the gap between research and application by presenting and testing in a real industrial context a methodology based on complexity reduction and kaizen events. First, the methodology supports reducing the complexity that affects real-life assembly systems in terms of the variety of, e.g. finished products, materials and parts. Next, the methodology proposes the conduction of kaizen events by using lean manufacturing tools, such as process analysis, time observation, waste identification, workstation standard documents and yamazumi charts. The methodology is successfully applied to a case study that describes its use in the confectionery process for a major chocolatier company along with the results of the application. The main contribution of this paper consists in presenting a method to manage the line balancing activity within everyday industrial realities, helping practitioners to improve and maintain the performance over time

Lecture notes in networks and systems

The link between Industry 4.0 (I40) and lean manufacturing has recently gained significant popularity in both academia and industry. The implementation of I40 has been proved to be beneficial for lean programs, supporting lean practices and increasing the flexibility of lean. In this context, the present paper introduces i-FAB, a learning factory developed by Università Carlo Cattaneo (LIUC) to demonstrate the benefit of the adoption of I40 technologies in a lean managed assembly system. The paper provides details on the i-FAB lean tools, I40 technologies and the training modules developed for Industrial Engineering and Management students and executive learning programs, showing empirical evidence of the benefits linked to the implementation of I40 technologies in a lean managed assembly system.11-13 November 201

Informed consent in robotic surgery: quality of information and patient perception

Obtaining a valid informed consent in the medical and surgical field is a long debated issue in the literature. In robotic surgery we believe in the necessity to follow three arrangements to make the informed consent more complete

Informed consent in robotic surgery: Quality of information and patient perception

INTRODUCTION: Obtaining a valid informed consent in the medical and surgical field is a long debated issue in the literature. In robotic surgery we believe in the necessity to follow three arrangements to make the informed consent more complete. MATERIAL AND METHODS: This study presents correlations and descriptions based on forensic medicine concepts research, literature review, and the proposal of an integration in the classic concept of informed consent. CONCLUSION: In robotic surgery we believe in the necessity to follow three arrangements to make the IC more complete. Integrate the information already present in the informed consent with data on the surgeon’s experience in RS, the number of procedures of the department and the regional map of expertises by procedure

Malfunctions of robotic system in surgery: role and responsibility of surgeon in legal point of view

Robotic surgery (RS) technology has undergone rapid growth in the surgical field since its approval. In clinical practice, failure of robotic procedures mainly results from a surgeon’s inability or to a device malfunction. We reviewed the literature to estimate the impact of this second circumstance in RS and its consequent legal implications. According to data from the literature, device malfunction is rare. We believe it is necessary to complement surgical training with a technical understanding of RS devices