ABSTRACT
INTRODUCTION: Robot-assisted radical prostatectomy (RARP) is a standard of care primary treatment for men with clinically localized prostate cancer (CLPC). The 2010 Canadian Urological Association (CUA) consensus guideline examining surgical quality performance for radical prostatectomy suggested benchmarks for surgical performance. To date, no study has examined whether Canadian surgeons are achieving these benchmarks. We determined the proportion of University of Alberta (UA) urologic surgeons achieving the CUA surgical quality performance outcome (SQPO) benchmarks. METHODS: A retrospective quality assurance analysis of prospectively collected data from the PROstate Cancer Urosurgery Repository of Edmonton (PROCURE) was performed. Men who underwent RARP for CLPC between September 2007 and May 2018 by one of seven surgeons were analyzed. SQPO were an unadjusted pT2-R1 resection rate <25%, blood transfusion rate <10%, rectal injury rate <1%, and 90-day mortality rate <1%. Descriptive statistics were used to determine the proportion of surgeons achieving the benchmarks. RESULTS: Data were evaluable for 2821 men. Seven of seven (100%) surgeons achieved a blood transfusion rate <10%, rectal injury rate <1%, and 90-day mortality rate <1%. However, only six of seven surgeons achieved an unadjusted pT2-R1 resection rate <25%; one surgeon had an unadjusted pT2-R1 resection rate of 27.9%. Limitations include the lack of centralized pathology review for surgical margin status by a dedicated genitourinary pathologist. CONCLUSIONS: UA surgeons are achieving the CUA SQPO benchmarks for blood transfusion, rectal injury, and perioperative mortality. However, not all UA urologists are achieving a pT2-R1 resection rate <25%. Surgical quality performance initiatives designed to improve cancer control may be warranted.
ABSTRACT
OBJECTIVE: To measure the time needed to achieve changes in fraction of inspired oxygen concentration (FiO2) from the oxygen blender to the facemask during simulated neonatal resuscitation. METHOD: Two oxygen analyzers were placed at each end of the T-Piece. During simulated ventilation, the duration to achieve the set oxygen concentration at the facemask was measured. This was repeated at different gas flow rates (5 L/min, 8 L/min or 10 L/min) and different FiO2 changes (0.21 to 1.0 to 0.21, with stepwise increases and decreases in 0.05, 0.1 and 0.2 increments). RESULTS: A total of 1134 measurements (378 measurements for each flow) were recorded. Overall, the mean (± SD) time required to achieve FiO2 changes at 5 L/min, 8 L/min and 10 L/min was 36±15 s, 31±14 s and 28±14 s, respectively. CONCLUSION: There was a lag time of approximately 30 s to achieve the FiO2 at the facemask. This delay needs to be considered when making serial adjustments to FiO2 during neonatal resuscitation.
OBJECTIF: Mesurer le temps nécessaire pour modifier les concentrations de la fraction d'oxygène dans l'air inspiré (FiO2) entre le mélangeur d'oxygène et le masque au cours d'une simulation de réanimation néonatale. MÉTHODOLOGIE: Deux analyseurs d'oxygène ont été installés à chaque bout de l'insufflateur néonatal. Pendant la simulation de ventilation, les chercheurs ont mesuré le temps nécessaire pour parvenir à la concentration d'oxygène voulue au masque. Ils ont repris la mesure à divers débits de gaz (5 L/min, 8 L/min ou 10 L/min) et diverses modifications de la FiO2 (0,21 à 1,0 à 0,21, au moyen d'augmentations et de diminutions incrémentielles de 0,05, 0,1 et 0,2). RÉSULTATS: Au total, les chercheurs ont enregistré 1 134 mesures (378 mesures par débit). Dans l'ensemble, le temps moyen (± ÉT) nécessaire pour parvenir à des modifications de la FiO2 de 5 L/min, 8 L/min et 10 L/min était de 36±15 s, 31±14 s et 28±14 s, respectivement. CONCLUSION: Il y avait un décalage d'environ 30 secondes pour parvenir à une FiO2 au masque. Il faut en tenir compte lorsqu'on fait les rajustements sériels de la FiO2 pendant la réanimation néonatale.
