Layanan Pemakai Yang Sempurna Dilihat dari Beberapa Aspek

Produk utama perpustakaan adalah bagaimana mengakses informasi. Ketika mahasiswa dan staff universitas menelusur informasi sering menggunakan layanan dari perpustakaan mereka sendiri. Pilihan untuk menggunakan perpustakaan, tergantung pada mutu dari layanan jasa yang ditawarkan. Ketika pemakai mempunyai persepsi yang negatif dari apa yang perpustakaan tawarkan, maka pemakai akan mencari layanan yang lain seperti perpustakaan lain, dari teman rekan kerja, toko buku, internet, atau mengarah ke layanan online yang menjadi saingan perpustakaan, untuk memenuhi kebutuhan informasi yang mereka inginkan. Munculah kompetisi (1)atau bahkan ketidakpuasan dengan jasa yang ditawarkan sehingga dapat menyebabkan stagnasi atau kemunduran jumlah pemakai. Sebagai con toh, suatu ketika pelanggan menerima layanan jasa yang cepat yang berupa suatu dokumen yang dipesan secara elektronis dari suatu penyalur dokumen online komersil, kemudian pemakai tersebut pernah sekali tidak dipenuhi kebutuhannya untuk meminjam dokumen antar perpustakaan (Inter library Loan) setelah lebih dari dua minggu kondisi demikian menimbulkan persepsi yang kurang baik. Hal ini merupakan suatu layanan informasi yang betul-betul dibutuhkan oleh kelompok pemakai utama walaupun berbeda-beda bidang studinya. Tetapi perlu ditekankan bahwa sistem informasi dirancang dengan baik dan sesuai bagi profit pemakai, dan sistem informasi bekerja sesuai dengan standard tinggi. Perpustakaan menawarkan dan memperkenalkan ke pengguna secara jelas dan nyaman pemakaian sistem ini

Three-Dimensional-Printed Drill Guides for Occipitothoracic Fusion in a Pediatric Patient With Occipitocervical Instability

BACKGROUND: Pediatric occipitothoracic fusion can be challenging because of small size pedicles and thin occipital bone. Three-dimensional (3D) printing technology can help with accurate screw insertion but has not been described for occipital keel plate positioning so far. OBJECTIVE: To describe the novel use of 3D technology to position occipital keel plates during pediatric occipitothoracic fixation. METHODS: A young boy with segmental spinal dysgenesis presented with asymmetrical pyramidal paresis in all limbs. Developmental abnormities of the cervical spine caused a thinned spinal cord, and because of progressive spinal cord compression, surgical intervention by means of occipitothoracic fixation was indicated at the age of 3 yr. Because of the small-size pedicles and thin occipital bone, the pedicle screws and occipital plates were planned meticulously using 3D virtual surgical planning technology. The rods were virtually bent in order to properly align with the planned screws. By means of 3D-printed guides, the surgical plan was transferred to the operating theater. For the occipital bone, a novel guide concept was developed, aiming for screw positions at maximal bone thickness. RESULTS: The postoperative course was uneventful, and radiographs showed good cervical alignment. After superimposing the virtual plan with the intraoperative acquired computed tomography, it was confirmed that the occipital plate positions matched the virtual plan and that pedicle screws were accurately inserted without signs of breach. CONCLUSION: The use of 3D technology has greatly facilitated the performance of the occipitothoracic fixation and could, in the future, contribute to safer pediatric spinal fixation procedures

Effectiveness of antiepileptic prophylaxis used with supratentorial craniotomies: a meta-analysis

Thirty publications on the effectiveness of prophylactic antiepileptic drugs (AEDs) with supratentorial craniotomies were reviewed (1980–1995). After a first selection, six controlled studies remained (11 publications). These six were evaluated according to previously defined methodological criteria. The criteria were divided into three main categories: (1) internal validity, (2) proper and relevant outcome-measures and (3) analysis. In this way a maximum of 145 points could be obtained for each study. Three studies were considered to be of satisfactory methodological quality (≥55% of 145 points) and the odds ratios were calculated as a measure of association between treatment and occurrence of convulsions. The odds ratios of these three studies were statistically pooled using the Mantel-Haenszel Estimator. From this test it appeared that prophylactically used AEDs showed a tendency to prevent postoperative convulsions, but this effect was certainly not statistically significant (P = 0.1 one-tailed). Points of attention concerning possible future investigations are stressed

Anterior or posterior approach in the surgical treatment of cervical radiculopathy; neurosurgeons' preference in the Netherlands

Objectives: Several surgical techniques are available for the treatment of cervical degenerative disease. For resolving cervical nerve root compression, anterior cervical discectomy with fusion (ACDF) or posterior cervical foraminotomy (PCF) can be applied. Amongst neurosurgeons, there seems to be a tendency to prefer ACDF, even though there are some advantages in favor of PCF. The objective of present study is to evaluate which factors determine the choice for an anterior or posterior surgical approach in patients with cervical radiculopathy based on foraminal pathology. Methods: A web-based survey was sent to all 133 neurosurgeons in the Netherlands. The study followed a mixed methods cross-sectional design. The first part of the survey focused on general perceived (dis)advantages of ACDF and PCF. The second part concerned questions about the choice between the two procedures. Furthermore, it was analyzed if exposure during training, amount of performed surgeries, assumed reoperation and complication rates influenced the choice of procedure by conducting Chi-square tests with post-hoc analysis. Results: A total of 56 neurosurgeons responded (42%). An overall preference for ACDF was observed, even when differentiating for a pure disc prolapse, a spondylotic or a combined stenosis of the neuroforamen. The most relative important factors for motivating the preference for either ACDF or PCF were: the assumed best decompression of the nerve root (18%), congruence with current literature (16%), exposure during residency (12%), personal comfort (11%) and experience (11%) with the technique. Conclusion: In this survey, there was an overall preference for ACDF above PCF for the surgical treatment of a foraminal cervical radiculopathy. In addition to subjective factors as "experience" and "comfort", the respondents often motivated their choice as "the best one according to literature". As there is currently no evidence about the superiority of any of the procedures in literature, this assumption is remarkable

Three-Dimensional Planning and Use of Individualized Osteotomy-Guiding Templates for Surgical Correction of Kyphoscoliosis:A Technical Case Report

OBJECTIVE: We have described the use of 3-dimensional (3D) virtual planning and 3D printed patient-specific osteotomy templates in the surgical correction of a complex spinal deformity. Pedicle subtraction osteotomies (PSOs) for the correction of severe spinal deformities are technically demanding procedures with a risk of major complications. In particular, operations of the severely deformed spine call for new, more precise, methods of surgical planning. The new 3D technology could result in new possibilities for the surgical planning of spinal deformities. METHODS: We present the case of severe congenital kyphoscoliosis in a young girl with skeletal dysplasia. A closing wedge-extended PSO was 3D virtual planned using medical computer design software. After the optimal 3D-wedge procedure was planned, individualized osteotomy-guiding templates were designed for translation of the planned PSO to the surgical procedure. During surgery, the PSO was performed using the osteotomy templates. Successful correction of the kyphoscoliosis was realized. RESULTS: The kyphosis was successfully reduced using a wedge-shaped extended PSO using preoperative 3D virtual planning, assisted by 3D-printed individualized osteotomy-guiding templates. CONCLUSIONS: In addition to direct translation of the planned PSO for surgery, the 3D planning also facilitated a detailed preoperative evaluation, greater insight into the case-specific anatomy, and accurate planning of the required correction

Long-term clinical outcome after anterior cervical discectomy with polymethylmethacrylate (PMMA) as intervertebral spacer:A propensity score matched analysis

Background: For single-level cervical degenerative disorders, an anterior cervical discectomy (ACD) is often performed with interposition of an intervertebral spacer. Most surgeons prefer a cage or arthroplasty, although superiority in comparison with other types of spacers, or leaving out a spacer, still has never been proven. Polymethylmethacrylate (PMMA) is a cost-friendly spacer with reported clinical outcome similar to other spacers. Therefore, the aim of this study was to assess long-term clinical outcome of ACD with PMMA as a spacer compared with ACD with a cage or without a spacer. Methods: A retrospective cohort study among patients with cervical degenerative disorders requiring a single-level ACD was performed in two hospitals in the Netherlands. Subgroups were made for PMMA, cage and no spacer. The primary outcome measure was the Neck Disability Index, secondary outcome measures were complication and reoperation rates, quality of life, workability and the need of additional treatments (e.g. physiotherapy, selective nerve root block, spinal cord stimulation). A 1:1 propensity score matching was performed that adjusted for age, gender, body mass index, comorbidities, duration and type of symptoms, and level of surgery. Results: A total of 241 patients were included in the study, with a median follow-up of 9.4 years. Propensity score matching revealed no statistically significant differences in all clinical outcome parameters between all subgroups. Complications, reoperations and the need for additional treatments were similarly distributed as well. A sensitivity analysis in which multiple PMMA patients were implemented (1: many matching) demonstrated equal results. Conclusions: No differences in long-term clinical outcome were demonstrated between ACD with PMMA compared to ACD with cage, or without any intervertebral spacer. Complication and reoperation rates were equal among the matched cohorts. In conclusion, PMMA is an effective, safe and cost-friendly alternative with equal long-term clinical outcome compared to other surgical techniques for cervical degenerative disorders