Phencyclidine-like catalepsy induced by the excitatory amino acid antagonist DL-2-amino-5-phosphonovalerate

This study presents experimental evidence for the mediation of a behavioral effect of phencyclidine-like drugs by inhibition of neurotransmission at excitatory synapses utilizing N-methyl-aspartate (NMA) receptors by showing that -2-amino-5-phosphonovalerate, a selective NMA antagonist, produces phencyclidine-like catalepsy in pigeons. This finding suggests the possibility that other behavioral actions of phencyclidine-like substances may be mediated in a similar fashion.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/26248/1/0000328.pd

Messvorrichtung zum Vermessen des Biegeverhaltens einer Probe

Bei einer Messvorrichtung soll eine genauere Erfassung vom Biegeverhalten von länglichen Proben ermöglich werden. Dies wird mit einer Vorrichtung und einem Verfahren erreicht, bei welchen eine längliche Probe in zwei Halterungen befestigt wird, welche momentarm oder idealerweise momentfrei drehbar gelagert und relativ zueinander aufeinander zubewegbar sind, wobei die Erfassung der Kenngrößen mithilfe von Sensoren erreicht wird

Using Video Analysis to Understand the Technical Variation of Robot-Assisted Radical Prostatectomy (RARP) in a Statewide Surgical Collaborative

Introduction & Objectives: Video assessment is an emerging tool for understanding variation in surgical technique. Despite widespread adoption, patient outcomes after RARP may be linked to technical aspects of the procedure. In an effort to refine surgical approaches and improve outcomes, we sought to understand technical variation for the steps of RARP in a surgical collaborative. Materials & Methods: The Michigan Urological Surgery Improvement Collaborative (MUSIC) is a statewide quality improvement collaborative consisting of 260 urologists from 44 diverse community and academic practices, with the aim of improving prostate cancer care. Surgeons were invited to submit representative complete videos of nerve-sparing RARP to the MUSIC coordinating center. The duration and variation in the tasks performed during each part were captured. Results: The anterior approach was used by 65%, with the remainder using a posterior approach for the seminal vesicle (SV) dissection. Data obtained from video analysis identified variation in time to complete different steps (Figure 1): bladder takedown (2-24 mins), endopelvic fascia dissection (4-11 mins), dorsal venous complex (DVC) control (2-10 mins), bladder neck dissection (7- 30 mins), SV dissection (9 -32 mins), nerve-sparing and pedicle control (8-33 mins), apical dissection (4-17 mins), and anastomosis (17-44 mins). Seven different permutations involving suture, staples and electrocautery for dividing and controlling the DVC were used. Management of the pedicle and nerve-sparing was performed using hem-o-lok clips (75%), Enseal tissue sealer (20%), and titanium clips (5%). Prior to anastomosis, only 25% undertook a posterior reconstruction. A non-barbed (vs. barbed) running suture (60%) was the main method when completing the anastomosis, overall 30% placed a urethral suspension stitch. At the end, 50% of surgeons performed a bladder leak test with 11/20 surgeons placing drains regardless of the result. Two surgeons utilized suprapubic tubes for bladder drainage (vs urethral catheter). Conclusions: RARP technique is not uniform. Video analysis identified variation in (1) time to complete each step (2) methods for DVC control, (3) nerve-sparing technique, and (4) performance of the urethrovesical anastomosis. Future efforts linking differences in technique with clinical outcomes may provide objective evidence to support best practices. (figure presented)

Prospective monitoring of imaging guideline adherence by physicians in a surgical collaborative: comparison of statistical process control methods for detecting outlying performance

Abstract Background Systematic, automated methods for monitoring physician performance are necessary if outlying behavior is to be detected promptly and acted on. In the Michigan Urological Surgery Improvement Collaborative (MUSIC), we evaluated several statistical process control (SPC) methods to determine the sensitivity and ease of interpretation for assessing adherence to imaging guidelines for patients with newly diagnosed prostate cancer. Methods Following dissemination of imaging guidelines within the Michigan Urological Surgery Improvement Collaborative (MUSIC) for men with newly diagnosed prostate cancer, MUSIC set a target of imaging < 10% of patients for which bone scan is not indicated. We compared four SPC methods using Monte Carlo simulation: p-chart, weighted binomial CUSUM, Bernoulli cumulative sum (CUSUM), and exponentially weighted moving average (EWMA). We simulated non-indicated bone scan rates ranging from 5.9% (within target) to 11.4% (above target) for a representative MUSIC practice. Sensitivity was determined using the average run length (ARL), the time taken to signal a change. We then plotted actual non-indicated bone scan rates for a representative MUSIC practice using each SPC method to qualitatively assess graphical interpretation. Results EWMA had the lowest ARL and was able to detect changes significantly earlier than the other SPC methodologies (p < 0.001). The p-chart had the highest ARL and thus detected changes slowest (p < 0.001). EWMA and p-charts were easier to interpret graphically than CUSUM methods due to their ability to display historical imaging rates. Conclusions SPC methods can be used to provide informative and timely feedback regarding adherence to healthcare performance target rates in quality improvement collaboratives. We found the EWMA method most suited for detecting changes in imaging utilization.http://deepblue.lib.umich.edu/bitstream/2027.42/173603/1/12911_2020_Article_1126.pd

Using video review to understand the technical variation of robot-assisted radical prostatectomy in a statewide surgical collaborative.

PURPOSE: Video assessment is an emerging tool for understanding surgical technique. Patient outcomes after robot-assisted radical prostatectomy (RARP) may be linked to technical aspects of the procedure. In an effort to refine surgical approaches and improve outcomes, we sought to understand technical variation for the key steps of RARP in a surgical collaborative. METHODS: The Michigan Urological Surgery Improvement Collaborative (MUSIC) is a statewide quality improvement collaborative with the aim of improving prostate cancer care. MUSIC surgeons were invited to submit representative complete videos of nerve-sparing RARP for blinded analysis. We also analyzed peri-operative outcomes from these surgeons in the registry. RESULTS: Surgical video data from 20 unique surgeons identified many variations in technique and time to complete different steps. Common to all surgeons was a transperitoneal approach and a running urethrovesical anastomosis. Prior to anastomosis, 25% surgeons undertook a posterior reconstruction and 30% employed urethral suspension. 65% surgeons approached the seminal vesicle anteriorly. For control of the dorsal vein complex, suture ligation was used in 60%, and vascular stapler was 15%. The majority (80%) of surgeons employed clips for managing pedicles. In examining patient outcomes for surgeons, peri-operative outcomes were not correlated with surgeon\u27s operative time; however, surgeons with an EBL \u3e 400 ml had significant difference among the five different techniques employed. CONCLUSIONS: Despite the worldwide popularity of RARP, the operation is still far from standardized. Correlating variation in technique with clinical outcomes may help provide objective data to support best practices with the goal to improve patient outcomes

Evaluation of Patient- and Surgeon-Specific Variations in Patient-Reported Urinary Outcomes 3 Months After Radical Prostatectomy From a Statewide Improvement Collaborative

Importance: Understanding variation in patient-reported outcomes following radical prostatectomy may inform efforts to reduce morbidity after this procedure. Objective: To describe patient-reported urinary outcomes following radical prostatectomy in the diverse practice settings of a statewide quality improvement program and to explore whether surgeon-specific variations in observed outcomes persist after accounting for patient-level factors. Design, Setting, and Participants: This prospective population-based cohort study included 4582 men in the Michigan Urological Surgery Improvement Collaborative who underwent radical prostatectomy as primary management of localized prostate cancer between April 2014 and July 2018 and who agreed to complete validated questionnaires prior to surgery and at 3, 6, and 12 months after surgery. Data were analyzed from 2019 to June 2019. Exposures: Radical prostatectomy. Main Outcomes and Measures: Patient- and surgeon-level analyses of patient-reported urinary function 3 months after radical prostatectomy. Outcomes were measured using validated questionnaires with results standardized using previously published methods. Urinary function survey scores are reported on a scale from 0 to 100 with good function established as a score of 74 or higher. Results: For the 4582 men undergoing radical prostatectomy within the Michigan Urological Surgery Improvement Collaborative who agreed to complete surveys, mean (SD) age was 63.3 (7.1) years. Survey response rates varied: 3791 of 4582 (83%) responded at baseline, 3282 of 4137 (79%) at 3 months, 2975 of 3770 (79%) at 6 months, and 2213 of 2882 (77%) at 12 months. Mean (SD) urinary function scores were 88.5 (14.3) at baseline, 53.6 (27.5) at 3 months, 68.0 (25.1) at 6 months, and 73.7 (23.0) at 12 months. Regression analysis demonstrated that older age, lower baseline urinary function score, body mass index (calculated as weight in kilograms divided by height in meters squared) of 30 or higher, clinical stage T2 or higher, and lack of bilateral nerve-sparing surgery were associated with a lower probability of reporting good urinary function 3 months after surgery. When evaluating patients with good baseline function, the rate at which individual surgeons\u27 patients reported good urinary function 3 months after surgery varied broadly (0% to 54.5%; P \u3c .001). Patients receiving surgery from top-performing surgeons were more likely to report good 3-month function. This finding persisted after accounting for patient risk factors. Conclusions and Relevance: In this study, patient- and surgeon-level urinary outcomes following prostatectomy varied substantially. Documenting surgeon-specific variations after accounting for patient factors may facilitate identification of surgical factors associated with superior outcomes

Prostate Cancer with Peritoneal Carcinomatosis: A robotic-assisted radical prostatectomy-based Case Series

OBJECTIVE: To aid in the diagnosis and treatment of patients with metastatic tumor seeding, an exceedingly phenomenon following minimally invasive urological surgery, additional case reports are needed. MATERIALS AND METHODS: We report our experience with patients determined to have peritoneal carcinomatosis following robotic-assisted radical prostatectomy (RARP) and provide a descriptive summary of these unique cases. RESULTS: Five cases of peritoneal carcinomatosis were identified, all of which occurred relatively late - between 8-13 years - following RARP. Four of the five cases had T3 disease at the time of prostatectomy. CONCLUSIONS: Certain clinical factors, such as advanced pathologic stage at the time of prostatectomy, may predict risk for carcinomatosis following RARP. Additionally, next generation imaging modalities, such as PSMA PET, may aid in identifying these metastases and are likely to identify increasing numbers of these patients as next generation imaging becomes more widely available. Continued documentation and classification of this atypical presentation are needed to improve our understanding and management of this phenomenon

Keck Adaptive Optics Current and Future Roles as an ELT Pathfinder

International audienceKeck Adaptive Optics Current and Future Roles as an ELT Pathfinde

Keck Adaptive Optics Current and Future Roles as an ELT Pathfinder

International audienceKeck Adaptive Optics Current and Future Roles as an ELT Pathfinde