Intraoperative and Postoperative Outcomes of Modified Bidirectional Intra-Umbilical versus Infra-Umbilical Incision for Direct Trocar Insertion in Gynecological Laparoscopy: A randomized controlled trial

Objectives: To describe a modified curved deep bidirectional intra-umbilical vertical incision for primary trocar insertion and prospectively compare its intraoperative and postoperative outcomes with infra-umbilical incision in gynecologic laparoscopy. Methods: Between August 2019 and March 2021, 110 patients subjected to direct trocar insertion technique for laparoscopic intervention were classified into two groups. Group A comprised 55 cases of infra-umbilical incision while a modified curved longitudinal bidirectional deep intra-umbilical incision was used in group B (55 cases). Intraoperative and postoperative assessments were performed. Results: There was statistically significant increased numbers of parity, gravidity, and previous cesarean sections; and a smaller number of infertility complaints in group B. Likewise, group B expressed a statistically significant less peri-trocar CO2 leakage (46 patients, 83.6% versus 28 patients, 50.9%) and more tightness of the primary portal entry (45 patients, 81.8% versus 30 patients, 54.5%) if compared to group A throughout the whole operation. On follow-up after one month, there was a statistically significant (p-value = 0.029) decreased OSAS and PSAS in group B (10.4 ± 4.2 and 11.8 ± 4.3) i.e., better cosmoses when compared to group A (13.3 ± 5.7 and 16.0 ± 6.8) respectively. Conclusion: Performing a modified curved deep bidirectional intra-umbilical vertical incision for insertion of primary laparoscopic trocar is a simple and fast step that results in elimination of intraoperative gas leakage and trocar slippage without the need of any additional sutures. Aesthetically, it results in a better scar with satisfactory cosmoses if compared to infra-umbilical incision. Keywords: Laparoscopy; Trocar; Entry

Feature selection of unbalanced breast cancer data using particle swarm optimization

Breast cancer is one of the significant deaths causing diseases of women around the globe. Therefore, high accuracy in cancer prediction models is vital to improving patients’ treatment quality and survivability rate. In this work, we presented a new method namely improved balancing particle swarm optimization (IBPSO) algorithm to predict the stage of breast cancer using unbalanced surveillance epidemiology and end result (USEER) data. The work contributes in two directions. First, design and implement an improved particle swarm optimization (IPSO) algorithm to avoid the local minima while reducing USEER data’s dimensionality. The improvement comes primarily through employing the cross-over ability of the genetic algorithm as a fitness function while using the correlation-based function to guide the selection task to a minimal feature subset of USEER sufficiently to describe the universe. Second, develop an improved synthetic minority over-sampling technique (ISMOTE) that avoid overfitting problem while efficiently balance USEER. ISMOTE generates the new objects based on the average of the two objects with the smallest and largest distance from the centroid object of the minority class. The experiments and analysis show that the proposed IBPSO is feasible and effective, outperforms other state-of-the-art methods; in minimizing the features with an accuracy of 98.45%

Analyse du champ de la sécurité en Suisse : vers une hypertrophie de la sécurité intérieure et autres réflexions méthodologiques

Cet article présente les résultats d’une recherche qui analyse les dynamiques contemporaines de sécurité en Suisse. Il détaille les différentes étapes mises en œuvre pour construire le champ de la sécurité en Suisse. L’analyse des prises de positions des acteurs de la sécurité, par l’analyse des menaces gérées par ces acteurs, valide la thèse de la globalisation de l’(in)sécurité dont la spécificité est l’établissement d’une sorte de continuum entre des menaces qui relèvent des champs de la sécurité intérieure et extérieure, consacrant ainsi la dé-différenciation entre les acteurs de la sécurité intérieure et extérieure, avec notamment une convergence vers les questions migratoires et la lutte contre le terrorisme. L’espace des positions du champ de la sécurité suisse est construit à partir des différents types de capitaux possédés par les individus (capital social, capital culturel, capital technologique et capital international) et permet de dégager la dimension transnationale des luttes qui structurent ce champ. L’analyse tire parti de la complémentarité des méthodes statistiques utilisées, à savoir l’analyse des correspondances multiples, l’analyse en composantes principales et l’analyse de réseau, qui sont parfaitement adaptées à une perspective relationnelle et à la construction d’espaces sociaux ou de champs.Investigating the possible emergence of a transnational field of security in Europe constitutes a very stimulating research venue for literature on critical approaches to security. However, the operationalization of such an agenda entails some challenges. Notably, time-consuming data collection and analytical processes are needed in order to fully grasp the characteristics and resources of numerous actors. Drawing on a research project funded by the Swiss National Science Foundation (SNF), the aim of this paper is double. It offers both an analysis of the contemporary dynamics of the field of security in Switzerland and a presentation of practical solutions for researchers willing to conduct empirically-oriented studies of different settings of the transnational field of security in Europe. In order to do so, this contribution stands as a methodological roadmap, presenting the various steps leading to the construction of a national social space dedicated to “security issues”. Given the significant volume of data collected in this research project, a series of statistical analysis methods are mobilized in this paper: multiple correspondence analysis (MCA), principal component analysis (PCA), and network analysis. Lastly, in summarizing the project’s results, the paper points to the growing influence of transnational security dynamics on Swiss security actors

L'espace infirmier. Visions et divisions d'une profession

S’appuyant sur plusieurs dizaines d’entretiens et près de 3000 questionnaires, les auteurs dressent un portrait totalement inédit de la profession qui rompt avec son apparente homogénéité. Ils révèlent l’existence d’un espace infirmier fortement différencié et hiérarchisé, dans lequel les différents points de vue professionnels sont étroitement liés aux positions occupées. À l’heure où la profession se trouve confrontée à des enjeux majeurs (pénurie de personnel, vieillissement de la population, rationalisation des soins, académisation des formations et développement de la recherche), ce livre constitue un outil de compréhension précieux pour tous les professionnels de santé et les étudiants. En mobilisant la théorie des champs de Pierre Bourdieu, il contribue plus largement au renouvellement de l’analyse sociologique des professions

Soziologie der Pflegefachpersonen in der Westschweiz ::die grosse Vielfalt

Eine Umfrage bei Pflegefachpersonen in der Romandie lässt erstmals ein differenziertes Bild der Berufsangehörigen zu. Das Wissen darüber gibt wertvolle Hinweise für die weitere Entwicklung der Profession, aber auch berufspolitische Strategien

Barriers, challenges and way forward for implementation of person centered care model of patient and physician consultation: a survey of patients’ perspective from Eastern Mediterranean countries

Background: Person-Centered Care (PCC) is now considered a mandatory approach in Patient-Physician consultation. The aim of the study was to identify patients’ perception regarding barriers and possible remedies for implementation of PCC in Eastern Mediterranean Region (EMR). Methods: A cross-sectional multi-country study was conducted in six countries of EMR during May 2014 to October 2014. Expert Family Physicians from each country were identified and asked to participate in the study. The Family Physicians then recruited Patients from their own clinics (\u3e18 years). Data analysis was performed on SPSS 19 and results are reported in the form of proportions, odds ratios and 95% confidence intervals. Results: A total of 234 patients were recruited, 60.6% were aged between 20 to 30 years and 36.3% of them were males. 56% of the patients preferred Person-Centered Care model for patient-physician consultation. The major barriers identified by patients in its implementing were; time constraints (73.9%, OR: 1.5; 95% CI: 0.86-2.78), doctors desire to control patient (OR: 2.6; 95% CI: 1.55-4.49), cultural and religious reasons (52.1%), increased cost (50.9%). Patients responded that increased cost related to Person-Centered Care practice would be acceptable (58.1%), if increase proved to be in the interest of better health and care outcomes (40.6%). Conclusion: Person-Centered Care (PCC) is associated with significant barriers in its implementation in Eastern Mediterranean Region. These barriers can be overcome in the interest of better health and care related outcomes

Health promotion, disease prevention and periodic health checks: perceptions and practice among family physicians in Eastern Mediterranean region

Introduction: The aim of this study was to identify the current practices and perceptions of family physicians regarding health promotion, disease prevention including periodic screening and health checks in Eastern Mediterranean Region. Methods: A multi-country cross-sectional study was conducted in six countries of EMR, from September 2014 to March 2015. Family Physicians who were currently practicing in different countries of EMR were invited to participate in the study through email. A pre-tested structured questionnaire was used for data collection. Data was entered and analyzed on SPSS 19 and logistic regression analysis was performed. Results: A total of 100 physicians’ data was included in the final analysis. The majority were female physicians (76%): 63% were 25 to 35 years of age. Approximately 53% of Family physicians always recommend periodic screening and health checks to their patients. The common screening question asked to patients in medical history was related to their blood pressure (86%). Almost all (99%) of the Family physicians believe they should conduct periodic health checks. Those who had postgraduate training in Family Medicine (OR: 0.5; 95% CI: 0.39-1.67) and attended CME sessions regularly (OR: 0.11; 95% CI: 0.01-0.93), are more likely to recommend periodic screening and health checks to their patients. Conclusion: Periodic screening and health check is an important strategy to prevent disease and maintain health. It is an underutilized practice and a great need exists for its implementation in family practice

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication