What ' s known on the subject? and What does the study add?In a previous randomized controlled trial, barbed polyglyconate suture for vesicourethral anastomosis was associated with more frequent cystogram leaks, longer mean catheterization times and greater suture costs per case.In the current randomized controlled trial, we show that barbed polyglyconate suture is associated with decreased anastomosis time, decreased need to readjust suture tension, cost reduction, and equal continence and early/late urinary complication rates. OBJECTIVE• To examine the effectiveness of barbed polyglyconate suture (V-Loc 180; Covidien, Mansfi eld, MA, USA) compared with standard monofi lament for posterior reconstruction (PR) and vesico-urethral anastomosis (VUA) during robot-assisted radical prostatectomy (RARP). PATIENTS AND METHODS• A prospective randomized controlled trial was conducted in 70 consecutive RARP cases by a single surgeon (K.C.Z.).• Standard VUA was performed using three 4-0 poliglecaprone 25 (Monocryl; Ethicon Endosurgery, Cincinnati, OH, USA) sutures secured with absorbable suture clips (LapraTy, Ethicon; one single 6-inch [ 15.2 cm ] for PR and two attached 6-inch [ 15.2 cm ] for VUA).• Barbed suture VUA was performed using two 3-0 6-inch (15.2 cm) barbed polyglyconate sutures.• Time to complete the suture set-up by the nursing team, anastomosis time and need to adjust suture tension were recorded. Suture-related complications, validated-questionnaire continence and cost were also examined. RESULTS• Compared with a conventional reconstruction technique, there was a signifi cant reduction in mean nurse set-up time (31 vs. 294 s; P < 0.01) and reconstruction time (13.1 vs. 20.8 min; P < 0.01) for the barbed suture technique.• Need to readjust suture tension or to place additional suture clips for watertight closure was greater in the standard monofi lament group than in the barbed suture group (6% vs. 24%; P = 0.03).• A cost reduction was recorded at our institution (48.05 vs. 70.25 $CAN) with the barbed suture technique.• With a mean follow-up of 6.2 months, no delayed anastomotic leak or bladder neck contracture was observed in either group.• Pad-free continence outcomes for the monofi lament suture vs the barbed suture groups at 1 (64 vs. 69%, P = 0.6), 3 (76 vs. 81%, P = 0.5) and 6 months (88 vs. 92%, P = 0.7) were similar. CONCLUSIONS• Compared with standard monofi lament suture, the unidirectional barbed polyglyconate suture appears to provide safe, effi cient and cost-effective PR and VUA during RARP.• Use of the interlocked barbed polyglyconate suture technique prevents slippage, precluding the need for assistance, knot-tying and constant reassessment of anastomosis integrity.

Purpose: Our purpose was to describe the safety and feasibility of a running posterior reconstruction (PR) integrated with continuous vesicourethral anastomosis (VUA) using a novel self-cinching unidirectional barbed suture in robot-assisted radical prostatectomy (RARP). Methods: Between March and October 2010, 30 consecutive patients with organ-confined prostate cancer underwent RARP by an experienced single surgeon (KCZ). Upon completion of radical prostatectomy, urinary reconstruction was carried out using 2 knotless, interlocked 6-inches 3-0 V-Loc-180 suture. The left tail of the suture was initially used for PR (starting at 5-o'clock and ran to re-approximate the retrotrigonal layer to the rectoure-thralis) followed by left-sided VUA (from 6-to 12-o'clock), while the right-sided suture completed the right-sided VUA. Assurance of watertight closure with an intraoperative 300 cc saline visual cystogram was performed in all cases prior to case completion. Perioperative outcomes and 30-day complications were recorded. Results: All anastamoses were performed without assistance and without knot tying. Median time for nurse setup and urinary reconstruction was 40 seconds (interquartile range [IQR] 25-60) and 14.6 min (IQR 10-18), respectively. The need to readjust suture tension or place Lapra-Ty clips (Ethicon Endo-Surgery, Cincinnati, OH) to establish watertight closure was observed in 2 cases (7%). No patient had clinical urinary leak and there was no urinary retention after catheter removal on mean postoperative day 5 (IQR 4-6). Conclusions: Our clinical experience with a novel technique using the interlocked V-Loc suture during RARP for both PR and anas-tomosis appears to be safe and efficient. Using the barbed suture prevents slippage and eliminates the need for bedside assistance to maintain suture tension or knot tying, thus assuring watertight tissue closure. Résumé Objectif : Notre but était de décrire l'innocuité et la faisabilité d'une reconstruction postérieure (RP) intégrée à une anastomose vésico-urétrale continue à l'aide de la nouvelle technique de suture avec fils barbelés unidirectionnels et ancrage automatique après prostatectomie radicale assistée par robot (PRAR). Méthodologie : Entre mars et octobre 2010, 30 patients consécutifs atteints d'un cancer de la prostate confiné à la glande ont subi une PRAR effectuée par un chirurgien expérimenté (KCZ). Après la prostatectomie radicale, une reconstruction urinaire a été entreprise à l'aide de 2 sutures 3-0 de 6 pouces sans noeud par le dispositif V-Loc 180. L'extension gauche de la suture a d'abord été utilisée pour la PR (en commençant à 5 heures et en poursuivant pour rapprocher la couche rétrotrigonale du muscle recto-urétral) et suivie d'une anatostomose vésico-urétrale du côté gauche (de 6 à 12 heures), alors que la partie droite de la suture a permis de termi-ner l'anastomose vésico-urétrale droite. Une fermeture hermétique par cystogramme visuel intraopératoire avec 300 mL de solution salée dans tous les cas a été réalisée avant la fin de l...

Purpose: Our purpose was to describe the safety and feasibility of a running posterior reconstruction (PR) integrated with continuous vesicourethral anastomosis (VUA) using a novel self-cinching unidirectional barbed suture in robot-assisted radical prostatectomy (RARP). Methods: Between March and October 2010, 30 consecutive patients with organ-confined prostate cancer underwent RARP by an experienced single surgeon (KCZ). Upon completion of radical prostatectomy, urinary reconstruction was carried out using 2 knotless, interlocked 6-inches 3-0 V-Loc-180 suture. The left tail of the suture was initially used for PR (starting at 5-o'clock and ran to re-approximate the retrotrigonal layer to the rectourethralis) followed by left-sided VUA (from 6-to 12-o'clock), while the right-sided suture completed the right-sided VUA. Assurance of watertight closure with an intraoperative 300 cc saline visual cystogram was performed in all cases prior to case completion. Perioperative outcomes and 30-day complications were recorded. Results: All anastamoses were performed without assistance and without knot tying. Median time for nurse setup and urinary reconstruction was 40 seconds (interquartile range [IQR] 25-60) and 14.6 min (IQR 10-18), respectively. The need to readjust suture tension or place Lapra-Ty clips (Ethicon Endo-Surgery, Cincinnati, OH) to establish watertight closure was observed in 2 cases (7%). No patient had clinical urinary leak and there was no urinary retention after catheter removal on mean postoperative day 5 (IQR 4-6). Conclusions: Our clinical experience with a novel technique using the interlocked V-Loc suture during RARP for both PR and anastomosis appears to be safe and efficient. Using the barbed suture prevents slippage and eliminates the need for bedside assistance to maintain suture tension or knot tying, thus assuring watertight tissue closure. RésuméObjectif : Notre but était de décrire l'innocuité et la faisabilité d'une reconstruction postérieure (RP) intégrée à une anastomose vésico-urétrale continue à l'aide de la nouvelle technique de suture avec fils barbelés unidirectionnels et ancrage automatique après prostatectomie radicale assistée par robot (PRAR). Méthodologie : Entre mars et octobre 2010, 30 patients consécutifs atteints d'un cancer de la prostate confiné à la glande ont subi une PRAR effectuée par un chirurgien expérimenté (KCZ). Après la prostatectomie radicale, une reconstruction urinaire a été entreprise à l'aide de 2 sutures 3-0 de 6 pouces sans noeud par le dispositif V-Loc 180. L'extension gauche de la suture a d'abord été utilisée pour la PR (en commençant à 5 heures et en poursuivant pour rapprocher la couche rétrotrigonale du muscle recto-urétral) et suivie d'une anatostomose vésico-urétrale du côté gauche (de 6 à 12 heures), alors que la partie droite de la suture a permis de terminer l'anastomose vésico-urétrale droite. Une fermeture hermétique par cystogramme visuel intraopératoire avec 300 mL de solution salée dans tous les cas a été réalisée avant la fin ...

Introduction In addition to shifting and expanding clinical responsibilities, rapidly evolving information and guidelines during the COVID-19 pandemic has made it difficult for health care workers (HCW) to synthesise and translate COVID-19 information into practice. This study evaluated whether a COVID-19-specific telemedicine education program (ECHO COVID) would impact health care workers’ self-efficacy and satisfaction in the management of patients with COVID-19. Methods A prospective mixed methods parallel-design study was conducted among ECHO COVID participants using pre-post questionnaires and a focus group discussion. Questionnaire results were examined for changes in health care workers’ self-efficacy and satisfaction. Focus group discussion data were analysed to explore health care workers’ experience in ECHO COVID and the context of their practice during the COVID-19 pandemic. Results 239 health care workers registered in ECHO COVID and 114 (47.7%) completed questionnaires and attended at least one ECHO COVID session. Median self-efficacy scores increased from 5 (IQR 4–6) to 6 (IQR 6–6) ( p < 0.0001), independent of profession, years in practice, age group, or practice environment. Participants were highly satisfied with ECHO COVID sessions with a median score of 4 (IQR 4–5). Focus group discussion data indicated that health care workers gained knowledge through ECHO COVID and revealed facilitators for ECHO COVID program success, including the transition to virtual care, the practicability of knowledge provided, and a ‘perspective from the trenches.’ Discussion This study demonstrated that a telemedicine education program aimed to support health care workers in managing patients with COVID-19 had a positive impact on health care workers’ self-efficacy and satisfaction. This impact was specifically mediated by the ECHO COVID program.

No abstract

The effect of 2 weeks oral digoxin administration on respiratory muscle performance (RMP) in 14 patients with chronic obstructive lung disease (COPD) was investigated in a randomized double-blind placebo-controlled cross-over study. All patients were ambulatory with severe air flow obstruction. FEV₁/FVC was 0.44 ± (SD)0.11, FEV₁ was 0.88 ± (SD)0.35 liter/s RMP was assessed by measuring maximal inspiratory pressure (Pι_max), maximal expiratory pressure (PE_max), and maximal voluntary ventilation. Although these parameters were significantly reduced in the COPD patients, 2 weeks of digoxin administration (with serum levels in the therapeutic range) did not alter any parameter of RMP or spirometry. We conclude that digoxin has no effect on RMP or spirometry in ambulatory patients with severe COPD

No abstract

No abstract