Pedicle screw insertion: robotic assistance versus conventional C-arm fluoroscopy.

Bone-mounted robotic guidance for pedicle screw placement has been recently introduced, aiming at increasing accuracy. The aim of this prospective study was to compare this novel approach with the conventional fluoroscopy assisted freehand technique (not the two- or three-dimensional fluoroscopy-based navigation). Two groups were compared: 11 patients, constituting the robotical group, were instrumented with 64 pedicle screws; 23 other patients, constituting the fluoroscopic group, were also instrumented with 64 pedicle screws. Screw position was assessed by two independent observers on postoperative CT-scans using the Rampersaud A to D classification. No neurological complications were noted. Grade A (totally within pedicle margins) accounted for 79% of the screws in the robotically assisted and for 83% of the screws in the fluoroscopic group respectively (p = 0.8). Grade C and D screws, considered as misplacements, accounted for 4.7% of all robotically inserted screws and 7.8% of the fluoroscopically inserted screws (p = 0.71). The current study did not allow to state that robotically assisted screw placement supersedes the conventional fluoroscopy assisted technique, although the literature is more optimistic about the former.

Consensus summary statement of the International Multidisciplinary Consensus Conference on Multimodality Monitoring in Neurocritical Care : A statement for healthcare professionals from the Neurocritical Care Society and the European Society of Intensive Care Medicine.

Neurocritical care depends, in part, on careful patient monitoring but as yet there are little data on what processes are the most important to monitor, how these should be monitored, and whether monitoring these processes is cost-effective and impacts outcome. At the same time, bioinformatics is a rapidly emerging field in critical care but as yet there is little agreement or standardization on what information is important and how it should be displayed and analyzed. The Neurocritical Care Society in collaboration with the European Society of Intensive Care Medicine, the Society for Critical Care Medicine, and the Latin America Brain Injury Consortium organized an international, multidisciplinary consensus conference to begin to address these needs. International experts from neurosurgery, neurocritical care, neurology, critical care, neuroanesthesiology, nursing, pharmacy, and informatics were recruited on the basis of their research, publication record, and expertise. They undertook a systematic literature review to develop recommendations about specific topics on physiologic processes important to the care of patients with disorders that require neurocritical care. This review does not make recommendations about treatment, imaging, and intraoperative monitoring. A multidisciplinary jury, selected for their expertise in clinical investigation and development of practice guidelines, guided this process. The GRADE system was used to develop recommendations based on literature review, discussion, integrating the literature with the participants' collective experience, and critical review by an impartial jury. Emphasis was placed on the principle that recommendations should be based on both data quality and on trade-offs and translation into clinical practice. Strong consideration was given to providing pragmatic guidance and recommendations for bedside neuromonitoring, even in the absence of high quality data.

Les proches des personnes souffrant d'une démence [Caring for the caregiver]

Les syndromes démentiels évoluent sur plusieurs années et touchent la personne dans sa globalité, altérant ses fonctions cognitives, son comportement et ses capacités relationnelles. Le patient perd peu à peu son indépendance. Les proches vont alors jouer un rôle essentiel auprès de lui et devront s'adapter à l'évolution de ses besoins, assumant progressivement surveillance, guidance et aide concrète. L'inestimable contribution des familles et les difficultés liées à l'exercice de ce rôle sont encore trop peu reconnues. De nombreuses études décrivent les conséquences négatives de l'aide naturelle. Toutefois les données sont moins riches quant aux déterminants de ces conséquences. Les proches ont souvent besoin d'information, de conseil et de soutien psychologique. Les programmes psychoéducatifs sont une des possibilités d'aide auprès de l'entourage de patients déments. Dementing disorders usually evolve over several years and alter cognitive performances, behavior and social abilities. Progressively, the patients lose their independence. Families will play a key role for the demented patient and have to adapt to the evolution of his or her needs. They will have to watch over, guide and help the demented proxy. The families' invaluable contribution and the numerous difficulties they encounter while they care for their demented proxy are insufficiently recognized. The deleterious consequences on the carers are currently better known than the determinants of these consequences. Families often need information, counselling and psychological support. Psycho-educational programs represent one of the possible strategies to help families and carers of patients with dementia

Improving the performance of positive selection inference by filtering unreliable alignment regions.

Errors in the inferred multiple sequence alignment may lead to false prediction of positive selection. Recently, methods for detecting unreliable alignment regions were developed and were shown to accurately identify incorrectly aligned regions. While removing unreliable alignment regions is expected to increase the accuracy of positive selection inference, such filtering may also significantly decrease the power of the test, as positively selected regions are fast evolving, and those same regions are often those that are difficult to align. Here, we used realistic simulations that mimic sequence evolution of HIV-1 genes to test the hypothesis that the performance of positive selection inference using codon models can be improved by removing unreliable alignment regions. Our study shows that the benefit of removing unreliable regions exceeds the loss of power due to the removal of some of the true positively selected sites.

Northern Ireland Firecode (PDF 2.4MB)

Northern Ireland Health Technical Memorandum 86 Part 2 Fire Risk Assessment in Healthcare Premises

Professional Estates Letters (PELs)

Professional Estates Letters (PELs)

Northern Ireland Firecode (PDF 126KB)

NIHTM 85: Fire precautions in existing healthcare premises

Northern Ireland Firecode (PDF 259KB)

Northern Ireland Health Technical Memorandum 86 Fire Risk Assessment Part 1 Community Healthcare Premises

Northern Ireland Firecode (PDF 374KB)

Health Technical Memorandum 84 Fire risk assessment in residential care premises

Northern Ireland Firecode (PDF 55KB)

Health Technical Memorandum 82 Alarm and detection systems Supplement A: Automatic fire control systems and voice alarm systems

Northern Ireland Firecode (PDF 376KB)

Health Technical Memorandum 82 Alarm and detection systems Supplement A: Automatic fire control systems and voice alarm systems

Northern Ireland Firecode (PDF 87KB)

Practice Note 10 Laboratories on Hospital Premises

Northern Ireland Firecode (PDF 119KB)

Practice Note 4 Hospital Main Kitchens