Robotic Surgical Training in an Academic Institution

OBJECTIVE: To detail robotic procedure development and clinical applications for mitral valve, biliary, and gastric reflux operations, and to implement a multispecialty robotic surgery training curriculum for both surgeons and surgical teams. SUMMARY BACKGROUND DATA: Remote, accurate telemanipulation of intracavitary instruments by general and cardiac surgeons is now possible. Complex technologic advancements in surgical robotics require well-designed training programs. Moreover, efficient robotic surgical procedures must be developed methodically and safely implemented clinically. METHODS: Advanced training on robotic systems provides surgeon confidence when operating in tiny intracavitary spaces. Three-dimensional vision and articulated instrument control are essential. The authors’ two da Vinci robotic systems have been dedicated to procedure development, clinical surgery, and training of surgical specialists. Their center has been the first United States site to train surgeons formally in clinical robotics. RESULTS: Established surgeons and residents have been trained using a defined robotic surgical educational curriculum. Also, 30 multispecialty teams have been trained in robotic mechanics and electronics. Initially, robotic procedures were developed experimentally and are described. In the past year the authors have performed 52 robotic-assisted clinical operations: 18 mitral valve repairs, 20 cholecystectomies, and 14 Nissen fundoplications. These respective operations required 108, 28, and 73 minutes of robotic telemanipulation to complete. Procedure times for the last half of the abdominal operations decreased significantly, as did the knot-tying time in mitral operations. There have been no deaths and few complications. One mitral patient had postoperative bleeding. CONCLUSION: Robotic surgery can be performed safely with excellent results. The authors have developed an effective curriculum for training teams in robotic surgery. After training, surgeons have applied these methods effectively and safely

The National Mental Health Policy: Implications for Public Psychiatric Services in Australia

The Health Ministers of all Australian States, Territories and the Commonwealth endorsed National Mental Health Policy in April 1992 [1]. This Policy is intended to set clear direction for the future development of mental health services within Australia. The Policy recognises the high prevalence of mental health problems and mental disorders in the Australian community and the impact of these on consumers, carers, families and society as whole. It also clearly accepts the need to address the problems confronting the promotion of mental health and the provision of mental health services

Impacts of Instrumental Versus Relational Centered Logic on Cause-Related Marketing Decision Making

The purpose of cause-related marketing is to capitalise on a firm’s social engagement initiatives to achieve a positive return on a firm’s social investment. This article discusses two strategic perspectives of cause related marketing and their impact on a firm’s decision-making regarding campaign development. The instrumental dominant logic of cause-related marketing focuses on attracting customers’ attention in order to generate sales. The relational dominant logic of cause-related marketing focuses on building relationships with the target stakeholders through the enhancement of a firm’s legitimacy. The combination of these two types of logic gives rise to four types of cause-related marketing: altruistic, commercial, social and integrative. This paper uses the qualitative method to explore a firm’s marketing decision choices regarding campaign-related decision dimensions — campaign duration, geographical scope, cause selection, and implementation strategy — for each type of cause-related marketing. The finding provides theoretical, managerial and public policy implications