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Robotic surgeries, especially in urology, have grown exponentially during the last decade. Various skills assessment tools have been developed. We reviewed the current status, the current challenges and the future needs of robotic evaluations with a focus on urological applications.According to PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) criteria 2 paired investigators screened the PubMed®, Scopus® and Web of Science® databases for all full text, English language articles published between 2006 and 2018 using the query (evaluation OR assessment) AND (robot-assisted surgery OR robotic surgery) AND (surgical performance OR surgical skill) AND training. The research design, validity and reliability of each study were ascertained and analyzed.A total of 259 studies were identified, of which 109 were included in the final analysis. We grouped the studies into 2 categories, including manual and automated assessments. Manual evaluation included global skill, procedure specific and error based assessments. For automated assessment we summarized evaluations derived from robotic instrument kinematic tracking data, systems events and surgical video data, and we explored those associations with various domains by manual evaluation. We further reviewed the current progress in automated surgical segmentation and skill evaluation with machine learning and deep learning. Concerns remain regarding efficient and effective surgeon training and credentialing.No universally accepted robotic skills assessment currently exists. The purpose of assessment (training or credentialing) may dictate whether manual or automated surgeon assessment is more suitable. Moving forward, assessment tools must be objective and efficient to facilitate the training and credentialing of competent surgeons.

INTRODUCTION AND OBJECTIVES:To propose a standardisable composite method for reporting outcomes of radical cystectomy (RC) that incorporates both peri-operative morbidity and oncologic adequacy.METHODS:From July 2010 through December 2017, 277 consecutive patients who underwent robotic radical cystectomy (RRC) for bladder cancer at our institution were prospectively analysed. IRB approval was obtained (HS-01B014). Patients who simultaneously demonstrated negative soft tissue surgical margins, =/> 16 lymph node yield, absence of major (Clavien-Dindo grade III-IV) complications at 90 days, absence of urinary diversion (UD) related long-term sequelae and absence of clinical recurrence at =/< 12 mo. were considered as having achieved the RC-pentafecta. We created a multivariable logistic regression model using age, ASA score, type of UD, NACH, pT and pN stage as covariates to measure independent factors for achieving RC-pentafecta. The internal validity of the prediction model was assessed by 1,000 bootstrap ...

To investigate whether pre-operative N-stage (nodal stage) based on FDG-PET for oesophageal cancers, correlates with final histopathology. Additionally, we assessed if N-stage differs for squamous cell cancers compared with adenocarcinomas and if neoadjuvant therapy alters these results.Our current understanding of oesophageal cancer biology means that personalisation of multimodality therapy is based on accurate clinical staging, allied with patient co morbidities and patient preference.We conducted a retrospective review of consecutive oesophagectomy cases performed over a ten year period (between 2002 and 2013) from a single tertiary centre. A total of 161 patients were identified in the study period.Overall, 103 specimens with 1402 lymph nodes were included. For both Adenocarcinomas (AC) and Squamous Cell Carcinomas (SCC), there was no significant difference between the N-stage determined by CT vs. FDG-PET (p0.05). For AC, there was statistically significant under-reporting of the N-stage by PET compared with the final histopathology (p0.01). Subgroup analysis showed that neoadjuvant therapy vs. adjuvant therapy alone did not alter the bias for under-reporting of the N-stage for adenocarcinoma by PET-CT (Bland-Altman bias 0.76 vs. bias 0.75).There is little doubt that PET-CT provides useful information in determining metastatic disease however its use in evaluating nodal burden is limited. Theoretically, this should not preclude patients from receiving definitive surgical management but the decision regarding neoadjuvant treatment based on locoregional disease may be affected.

Introduction: Our recent experiments demonstrate that demyelination enhances peripheral nerve regeneration after contusion injury in the adult rat sciatic nerve. The role of demyelination in peripheral nerve regeneration in a sciatic nerve transection model has yet to be elucidated. We hypothesize that (1) axon regeneration within a region of injury increases after experimental, immunologic demyelination, and (2) regenerated axons are partially derived from the proximal motor axons. Methods: Sciatic nerves of adult female Sprague-Dawley rats (n = 20) were injected with a demyelinating agent immediately after transection injury. The sciatic nerves were harvested 1 month (n = 5) and 2 months (n = 5) after surgery. In the control groups, the cut nerves were reapproximated without demyelination therapy. The lesion containing length of nerve was cut into 1-mm transverse blocks and processed to preserve orientation. Specimens were evaluated using structural and immunohistochemical analyses. Results: A single epineural injection of complement proteins plus antibodies to galactocerebroside resulted in demyelination followed by Schwann cell remyelination. At 1 month, remyelination was clearly shown throughout the injured sciatic nerve segment. At 2 months, there was a statistically significant increase in peripheral nerve regeneration following demyelination therapy as evidenced by total axon count, axon density, and fiber diameter. Conclusion: This study demonstrates enhanced histomorphologic nerve regeneration in the rat sciatic nerve after local delivery of experimental, immunologic demyelination following transection injury. It highlights the utility of demyelination in peripheral nerve regeneration. This therapy may be applicable for tissue-engineered constructs, cell-based systems, and nerve transfers to improve outcomes in peripheral nervous system injuries.

Background: Understanding the relationship between top management turnover and quality of care is important because turnover among top managers in nursing homes is generally high. Purposes: In this research, the direct and indirect relationships among top management turnover, the number of staff, the types of staff, and the quality indicators are examined. The top managers included in this case are both nursing home administrators and directors of nursing. Methodology/Approach: Primary data were collected from 2,840 nursing homes, and 14 quality indicators came from the Nursing Home Compare. Structural equation modeling methods were used to model direct and indirect relationships. Findings: The results show that high nursing home administrator turnover for four quality indicators are significantly associated with poor quality. These findings seem to contrast with those for director of nursing turnover, with high director of nursing turnover for three quality indicators significantly associated with better quality. Practice Implications: We identify three practice implications. First, nursing home administrators may want to be particularly vigilant to resident care in some specific areas associated with poorer quality resulting from turnover. Second, nurse aide agency staff should be used with caution. Third, higher caregiver staffing levels are generally associated with better quality of care.

The importance of teams for improving quality of care has received increased attention. We examine both the correlates of self-assessed or perceived team effectiveness and its consequences for actually making changes to improve care for people with chronic illness. STUDY SETTING AND METHODS: Data were obtained from 40 teams participating in the national evaluation of the Improving Chronic Illness Care Program. Based on current theory and literature, measures were derived of organizational culture, a focus on patient satisfaction, presence of a team champion, team composition, perceived team effectiveness, and the actual number and depth of changes made to improve chronic illness care.A focus on patient satisfaction, the presence of a team champion, and the involvement of the physicians on the team were each consistently and positively associated with greater perceived team effectiveness. Maintaining a balance among culture values of participation, achievement, openness to innovation, and adherence to rules and accountability also appeared to be important. Perceived team effectiveness, in turn, was consistently associated with both a greater number and depth of changes made to improve chronic illness care. The variables examined explain between 24 and 40% of the variance in different dimensions of perceived team effectiveness; between 13% and 26% in number of changes made; and between 20% and 42% in depth of changes made.The data suggest the importance of developing effective teams for improving the quality of care for patients with chronic illness.

Biliary complication is the Achilles' heel for live donor liver transplant. Bile leak is particularly difficult to manage as the anastomotic site was often angled acutely. We described a patient with bile leak managed by a modified rendezvous technique whereby the endoscopist and radiologist work simultaneously under fluoroscopy. Unlike the traditionally described rendezvous technique where the grasping of guidewire occurred at the duodenum, the grasping of guidewire occurred at the biloma in this modified technique. Insertion of biliary stent could then be performed over the guidewire through the duodenoscope. The bile leak resolved after keeping the biliary stents in situ for 12 months.