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    Medical Care Utilization Behavior for the Diagnosis and Treatment of Spine Disease: A Questionnaire-based Study of Orthopaedic Spine Center Outpatients at a Tertiary Educational Hospital
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    Seperti pada dewasa, teknik regional anestesi pada pediatrik kini makin popular digunakan oleh ahli anestesikarena keuntungannya. Namun demikian selalu ada risiko dan kemungkinan timbulnya komplikasi dari setiap tindakan yang dilakukan, termasuk tindakan anestesi regional pada pediatrik. Insidensi komplikasi anestesi regional pada pediatrik tidak banyak, dan kalaupun terjadi komplikasi adalah minor. Komplikasi bisa diakibatkan dari identifikasi ruang saraf, alat, obat, teknis tindakan anestesi regionalnya dan komplikasi lainnya.Walaupun tidak banyak kejadian komplikasi regional anestesi yang dilaporkan pada pediatrik, dan bukanlah komplikasi yang fatal, teknik regional anestesi pada pediatrik harus dilakukan dengan lebih hatihati, pertimbangan risiko dan keuntungannya untuk menghindari terjadinya komplikasi, terlebih karena kebanyakan komplikasi dapat dihindari dengan mempelajari teknik yang benar, menggunakan peralatan yang sesuai, dan sangat menerapkan prinsip keamanan pada pasien dengan baik.
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    Genentech is partnering with the German cancer company Affimed to develop immunotherapies for multiple kinds of solid and blood cancers. Affimed is developing therapies that engage natural killer cells of the innate immune system to help direct them to attack cancer cells. Genentech will pay Affimed $96 million up front and up to $5 billion more in potential payments.
    Introduction Pancreatic trauma is rare and is usually associated with adjacent organ and vascular injuries, which adds to the high morbidity and mortality. In the American Association for the Surgery of Trauma (AAST) pancreatic trauma (PT) grading system, the higher grades are a composite of less and more severe extents of injuries. We hereby present an observational study of PT with management based on an indigenous algorithmic approach. Our protocol incorporating both the extent of disruption of the main pancreatic duct (MPD) and its amenability to interventions (endoscopic, radiological, or surgical) is pragmatic. Methods Ours is a retrospective observational study of 28 consecutive cases of PT, done over a three-year period in an academic institution, by an expert Surgical Gastroenterology unit. All patients diagnosed with PT on a contrast abdominal CT scan were included. After stabilization, they were stratified and managed according to an indigenous protocol. The primary outcome measure was treatment success in terms of recovery. The secondary outcome measure was morbidity of any form. Results One patient with Grade 1 PT was operated on for associated hollow viscus injury. Two patients with AAST Grade 2 and two patients with AAST Grade 3 injury were managed successfully without surgery. Twelve of 21 patients with Grade 3 PT underwent Kimura’s splenic vessel preserving distal pancreatectomy. Distal pancreatectomy with splenectomy and central pancreatectomy with Roux-en-Y pancreaticojejunostomy (PJ) was done for 7/21 and 2/21 patients, respectively, with Grade 3 PT. Two with Grade 5 injury underwent trauma Whipple. The overall mortality and morbidity rates in our series were 15.7% and 64%, respectively. Conclusion The pathogenesis in PT is a dynamic process and shows temporal evolution. These patients require serial and periodical clinical and radiological monitoring, especially in those managed conservatively initially. PT can be low or high grade. Patients with isolated low-grade PT can be managed according to the standard step-up approach for acute pancreatitis. A carefully selected subgroup of patients with partial MPD disruption either in the head or body of the pancreas can be managed by endotherapy. Complete distal parenchymal transections require early surgery tailored to individual patients in the form of either splenic vessel preserving distal pancreatectomy (SPDP) or distal pancreatectomy with splenectomy (DP+S). Damage control surgery is the dictum in unstable patients with Grades 4 and 5 injuries not responding to resuscitative measures. A trauma Whipple can be done in a carefully selected subgroup of stable patients with proximal massive disruptions in an experienced hepato-pancreatico-biliary (HPB) unit.
    Tertiary care
    Center (category theory)
    Trauma Center
    Single Center
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    Бұл зерттеужұмысындaКaно моделітурaлы жәнеоғaн қaтыстытолықмәліметберілгенжәнеуниверситетстуденттерінебaғыттaлғaн қолдaнбaлы (кейстік)зерттеужүргізілген.АхметЯссaуи университетініңстуденттеріүшін Кaно моделіқолдaнылғaн, олaрдың жоғaры білімберусaпaсынa қоятынмaңыздытaлaптaры, яғнисaпaлық қaжеттіліктері,олaрдың мaңыздылығытурaлы жәнесaпaлық қaжеттіліктерінеқaтыстыөз университетінқaлaй бaғaлaйтындығытурaлы сұрaқтaр қойылғaн. Осы зерттеудіңмaқсaты АхметЯсaуи университетіндетуризмменеджментіжәнеқaржы бaкaлaвриaт бaғдaрлaмaлaрыныңсaпaсынa қaтыстыстуденттердіңқaжеттіліктерінaнықтaу, студенттердіңқaнaғaттaну, қaнaғaттaнбaу дәрежелерінбелгілеу,білімберусaпaсын aнықтaу мен жетілдіружолдaрын тaлдaу болыптaбылaды. Осы мaқсaтқaжетуүшін, ең aлдыменКaно сaуaлнaмaсы түзіліп,116 студенткеқолдaнылдыжәнебілімберугежәнеоның сaпaсынa қaтыстыстуденттердіңтaлaптaры мен қaжеттіліктерітоптықжұмыстaрaрқылыaнықтaлды. Екіншіден,бұл aнықтaлғaн тaлaптaр мен қaжеттіліктерКaно бaғaлaу кестесіменжіктелді.Осылaйшa, сaпa тaлaптaры төрт сaнaтқa бөлінді:болуытиіс, бір өлшемді,тaртымдыжәнебейтaрaп.Соңындa,қaнaғaттaну мен қaнaғaттaнбaудың мәндеріесептелдіжәнестуденттердіңқaнaғaттaну мен қaнaғaттaнбaу деңгейлерінжоғaрылaту мен төмендетудеосытaлaптaр мен қaжеттіліктердіңрөліaйқын aнықтaлды.Түйінсөздер:сaпa, сaпaлық қaжеттіліктер,білімберусaпaсы, Кaно моделі.
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    The nationally-recognized Susquehanna Chorale will delight audiences of all ages with a diverse mix of classic and contemporary pieces. The ChoraleAƒÂƒA‚ƒAƒÂ‚A‚ƒAƒÂƒA‚‚AƒÂ‚A‚ƒAƒÂƒA‚ƒAƒÂ‚A‚‚AƒÂƒA‚‚AƒÂ‚A‚ƒAƒÂƒA‚ƒAƒÂ‚A‚ƒAƒÂƒA‚‚AƒÂ‚A‚‚AƒÂƒA‚ƒAƒÂ‚A‚‚AƒÂƒA‚‚AƒÂ‚A‚¢AƒÂƒA‚ƒAƒÂ‚A‚ƒAƒÂƒA‚‚AƒÂ‚A‚ƒAƒÂƒA‚ƒAƒÂ‚A‚‚AƒÂƒA‚‚AƒÂ‚A‚‚AƒÂƒA‚ƒAƒÂ‚A‚ƒAƒÂƒA‚‚AƒÂ‚A‚‚AƒÂƒA‚ƒAƒÂ‚A‚‚AƒÂƒA‚‚AƒÂ‚A‚€AƒÂƒA‚ƒAƒÂ‚A‚ƒAƒÂƒA‚‚AƒÂ‚A‚ƒAƒÂƒA‚ƒAƒÂ‚A‚‚AƒÂƒA‚‚AƒÂ‚A‚‚AƒÂƒA‚ƒAƒÂ‚A‚ƒAƒÂƒA‚‚AƒÂ‚A‚‚AƒÂƒA‚ƒAƒÂ‚A‚‚AƒÂƒA‚‚AƒÂ‚A‚™s performances have been described as AƒÂƒA‚ƒAƒÂ‚A‚ƒAƒÂƒA‚‚AƒÂ‚A‚ƒAƒÂƒA‚ƒAƒÂ‚A‚‚AƒÂƒA‚‚AƒÂ‚A‚ƒAƒÂƒA‚ƒAƒÂ‚A‚ƒAƒÂƒA‚‚AƒÂ‚A‚‚AƒÂƒA‚ƒAƒÂ‚A‚‚AƒÂƒA‚‚AƒÂ‚A‚¢AƒÂƒA‚ƒAƒÂ‚A‚ƒAƒÂƒA‚‚AƒÂ‚A‚ƒAƒÂƒA‚ƒAƒÂ‚A‚‚AƒÂƒA‚‚AƒÂ‚A‚‚AƒÂƒA‚ƒAƒÂ‚A‚ƒAƒÂƒA‚‚AƒÂ‚A‚‚AƒÂƒA‚ƒAƒÂ‚A‚‚AƒÂƒA‚‚AƒÂ‚A‚€AƒÂƒA‚ƒAƒÂ‚A‚ƒAƒÂƒA‚‚AƒÂ‚A‚ƒAƒÂƒA‚ƒAƒÂ‚A‚‚AƒÂƒA‚‚AƒÂ‚A‚‚AƒÂƒA‚ƒAƒÂ‚A‚ƒAƒÂƒA‚‚AƒÂ‚A‚‚AƒÂƒA‚ƒAƒÂ‚A‚‚AƒÂƒA‚‚AƒÂ‚A‚œemotionally unfiltered, honest music making, successful in their aim to make the audience feel, to be moved, to be part of the performance - and all this while working at an extremely high musical level.AƒÂƒA‚ƒAƒÂ‚A‚ƒAƒÂƒA‚‚AƒÂ‚A‚ƒAƒÂƒA‚ƒAƒÂ‚A‚‚AƒÂƒA‚‚AƒÂ‚A‚ƒAƒÂƒA‚ƒAƒÂ‚A‚ƒAƒÂƒA‚‚AƒÂ‚A‚‚AƒÂƒA‚ƒAƒÂ‚A‚‚AƒÂƒA‚‚AƒÂ‚A‚¢AƒÂƒA‚ƒAƒÂ‚A‚ƒAƒÂƒA‚‚AƒÂ‚A‚ƒAƒÂƒA‚ƒAƒÂ‚A‚‚AƒÂƒA‚‚AƒÂ‚A‚‚AƒÂƒA‚ƒAƒÂ‚A‚ƒAƒÂƒA‚‚AƒÂ‚A‚‚AƒÂƒA‚ƒAƒÂ‚A‚‚AƒÂƒA‚‚AƒÂ‚A‚€AƒÂƒA‚ƒAƒÂ‚A‚ƒAƒÂƒA‚‚AƒÂ‚A‚ƒAƒÂƒA‚ƒAƒÂ‚A‚‚AƒÂƒA‚‚AƒÂ‚A‚‚AƒÂƒA‚ƒAƒÂ‚A‚ƒAƒÂƒA‚‚AƒÂ‚A‚‚AƒÂƒA‚ƒAƒÂ‚A‚‚AƒÂƒA‚‚AƒÂ‚A‚ Experience choral singing that will take you to new heights!
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