Objective:To evaluate the efficacy and user satisfaction of the MAIA^(TM)telemedicine platform for postoperative telemonitoring and telerehabilitation in patients undergoing robot-assisted radical prostatectomy(RARP)....Objective:To evaluate the efficacy and user satisfaction of the MAIA^(TM)telemedicine platform for postoperative telemonitoring and telerehabilitation in patients undergoing robot-assisted radical prostatectomy(RARP).Methods:Patients undergoing RARP(from April 2022 to January 2023)were divided into Group A,following the standard rehabilitation protocol,and Group B using the MAIA^(TM)platform for the first 30-day post-intervention period.Perioperative,pathological,and functional variables(continence and potency rates,assessed via validated questionnaires)were collected and telerehabilitation protocol’s adherence was monitored.The telerehabilitation system included an online platform for medical providers and a patient application,facilitating data acquisition,management,treatment planning,and monitoring.Patient and provider satisfactionwere evaluated using the visual analogue scale score and validated telemedicine satisfaction questionnaire.Results:Totally,227 patients were enrolled.No differences in perioperative or pathological variables were found.Group B had higher potency recovery rates than Group A(p=0.031);the potency recovery rates at 1 month and 3 months for Group B were 45%and 57%,respectively,and in Group A were 34%and 48%,respectively.At the multivariate analysis,MAIA^(TM)use and the nerve-sparing(NS)were independent predictors of erectile function at both 1 month(MAIA^(TM)use:odd ratio[OR]2.03,95%confidence interval[CI]1.13-3.63,p=0.018;NS:OR 2.08,95%CI 1.06-4.12,p=0.034)and 3 months(MAIA^(TM)use:OR 1.89,95%CI 1.07-3.34,p=0.028;NS:OR 1.90;95%CI 1.02-3.54,p=0.044).Adherencemonitoring revealed 4.6%of patients in Group B reported exercise issues due to pelvic pain onset and 10%did not take oral phosphodiesterase 5-inhibitors due to myalgia.All those patients restarted the rehabilitation program after televisit to address the causing problem,allowing restarting of a rehabilitation program.Patients reported high satisfaction with the MAIA^(TM)platform use(mean visual analogue scale score:88.7).Conclusion:The MAIA^(TM)telemedicine platform seems to have a role in optimizing early potency recovery after RARP.Patient and provider satisfaction levels were high,emphasizing the user-friendliness of the platform.展开更多
Objective:The aim of the study was to evaluate three-dimensional virtual models(3DVMs)usefulness in the intraoperative assistance of minimally-invasive partial nephrectomy in highly complex renal tumors.Methods:At our...Objective:The aim of the study was to evaluate three-dimensional virtual models(3DVMs)usefulness in the intraoperative assistance of minimally-invasive partial nephrectomy in highly complex renal tumors.Methods:At our institution cT1-2N0M0 all renal masses with Preoperative Aspects and Dimensions Used for an Anatomical classification score≥10 treated with minimally-invasive partial nephrectomy were considered for the present study.For inclusion a baseline contrast-enhanced computed tomography in order to obtain 3DVMs,the baseline and postoperative serum creatinine as well as estimated glomerular filtration rate values were needed.These patients,in which 3DVMs were used to assist the surgeon in the planning and intraoperative guidance,were then compared with a control group of patients who underwent minimally-invasive partial nephrectomy with the same renal function assessments,but without 3DVMs.Multivariable logistic regression models were used to predict the margin,ischemia,and complication score achievement.Results:Overall,79 patients met the inclusion criteria and were compared with 143 complex renal masses without 3DVM assistance.The 3DVM group showed better postoperative outcomes in terms of baseline-weighted differential estimated glomerular filtration rate(-17.7%vs.-22.2%,p=0.03),postoperative complications(16.5%vs.23.1%,p=0.03),and major complications(Clavien Dindo>III,2.5%vs.5.6%,p=0.03).At multivariable logistic regression 3DVM assistance independently predicted higher rates of successful partial nephrectomy(odds ratio:1.42,p=0.03).Conclusion:3DVMs represent a useful tool to plan a tailored surgical approach in case of surgically complex masses.They can be used in different ways,matching the surgeon's needs from the planning phase to the demolitive and reconstructive phase,leading towards maximum safety and efficacy outcomes.展开更多
To the best of our knowledge no multicenter studies have been published using standardized semi-quantitative evaluation of [123I]FP-CIT scan (DAT-SPECT). The aims of this study were: 1) to cross-compare semi-quantitat...To the best of our knowledge no multicenter studies have been published using standardized semi-quantitative evaluation of [123I]FP-CIT scan (DAT-SPECT). The aims of this study were: 1) to cross-compare semi-quantitative software-assisted evaluations of DAT-SPECTs performed in three centers with different equipments;2) to assess the accuracy of semi-quantitative evaluations of DAT-SPECT and 3) to identify the threshold with the best accuracy, sensitivity and specificity in a patient population with suspected parkinsonian syndrome. Materials and Methods: Two hundred twenty patients (mean age at the time of SPECT acquisition, 67.4 ± 9.5 yy) acquired in three centers (Ospedale San Luigi Gonzaga;Ospedale San Giovanni Battista Molinette;Ospedale Mauriziano Umberto I) were included. All of them underwent DAT-SPECT from January 2006 to July 2010. All exams were analyzed with the freely available software BASGAN and semi-quantitative data were used to predict disease. In particular, analyses were based on the values from the most deteriorated putamen and caudate, normalized for age and corrected for equipment. ROC analysis was performed and area under the curve (AUC) was estimated. Results: Analysis showed high AUCs (0.898, 0.864, 0.900 and 0.891 for each center and for the multicenter setting, respectively) confirming the very good accuracies reached. The best cut-off were 0.72 and 0.82 for putamen and caudate respectively. These thresholds allowed sensitivities and specificities in each center and in the multicenter setting of 76% and 96%, 91% and 82%, 93% and 90%, 86% and 89% respectively. No significant differences were observed between sensibility and specificity in each center. Conclusion: A unique threshold useful for all centers with high and similar sensitivities and specificities is possible after correction for age and equipments. The high accuracy reached in this multicenter trial by the semi-quantitative analysis seems similar to accuracies from qualitative analysis in other multicenter studies.展开更多
文摘Objective:To evaluate the efficacy and user satisfaction of the MAIA^(TM)telemedicine platform for postoperative telemonitoring and telerehabilitation in patients undergoing robot-assisted radical prostatectomy(RARP).Methods:Patients undergoing RARP(from April 2022 to January 2023)were divided into Group A,following the standard rehabilitation protocol,and Group B using the MAIA^(TM)platform for the first 30-day post-intervention period.Perioperative,pathological,and functional variables(continence and potency rates,assessed via validated questionnaires)were collected and telerehabilitation protocol’s adherence was monitored.The telerehabilitation system included an online platform for medical providers and a patient application,facilitating data acquisition,management,treatment planning,and monitoring.Patient and provider satisfactionwere evaluated using the visual analogue scale score and validated telemedicine satisfaction questionnaire.Results:Totally,227 patients were enrolled.No differences in perioperative or pathological variables were found.Group B had higher potency recovery rates than Group A(p=0.031);the potency recovery rates at 1 month and 3 months for Group B were 45%and 57%,respectively,and in Group A were 34%and 48%,respectively.At the multivariate analysis,MAIA^(TM)use and the nerve-sparing(NS)were independent predictors of erectile function at both 1 month(MAIA^(TM)use:odd ratio[OR]2.03,95%confidence interval[CI]1.13-3.63,p=0.018;NS:OR 2.08,95%CI 1.06-4.12,p=0.034)and 3 months(MAIA^(TM)use:OR 1.89,95%CI 1.07-3.34,p=0.028;NS:OR 1.90;95%CI 1.02-3.54,p=0.044).Adherencemonitoring revealed 4.6%of patients in Group B reported exercise issues due to pelvic pain onset and 10%did not take oral phosphodiesterase 5-inhibitors due to myalgia.All those patients restarted the rehabilitation program after televisit to address the causing problem,allowing restarting of a rehabilitation program.Patients reported high satisfaction with the MAIA^(TM)platform use(mean visual analogue scale score:88.7).Conclusion:The MAIA^(TM)telemedicine platform seems to have a role in optimizing early potency recovery after RARP.Patient and provider satisfaction levels were high,emphasizing the user-friendliness of the platform.
文摘Objective:The aim of the study was to evaluate three-dimensional virtual models(3DVMs)usefulness in the intraoperative assistance of minimally-invasive partial nephrectomy in highly complex renal tumors.Methods:At our institution cT1-2N0M0 all renal masses with Preoperative Aspects and Dimensions Used for an Anatomical classification score≥10 treated with minimally-invasive partial nephrectomy were considered for the present study.For inclusion a baseline contrast-enhanced computed tomography in order to obtain 3DVMs,the baseline and postoperative serum creatinine as well as estimated glomerular filtration rate values were needed.These patients,in which 3DVMs were used to assist the surgeon in the planning and intraoperative guidance,were then compared with a control group of patients who underwent minimally-invasive partial nephrectomy with the same renal function assessments,but without 3DVMs.Multivariable logistic regression models were used to predict the margin,ischemia,and complication score achievement.Results:Overall,79 patients met the inclusion criteria and were compared with 143 complex renal masses without 3DVM assistance.The 3DVM group showed better postoperative outcomes in terms of baseline-weighted differential estimated glomerular filtration rate(-17.7%vs.-22.2%,p=0.03),postoperative complications(16.5%vs.23.1%,p=0.03),and major complications(Clavien Dindo>III,2.5%vs.5.6%,p=0.03).At multivariable logistic regression 3DVM assistance independently predicted higher rates of successful partial nephrectomy(odds ratio:1.42,p=0.03).Conclusion:3DVMs represent a useful tool to plan a tailored surgical approach in case of surgically complex masses.They can be used in different ways,matching the surgeon's needs from the planning phase to the demolitive and reconstructive phase,leading towards maximum safety and efficacy outcomes.
文摘To the best of our knowledge no multicenter studies have been published using standardized semi-quantitative evaluation of [123I]FP-CIT scan (DAT-SPECT). The aims of this study were: 1) to cross-compare semi-quantitative software-assisted evaluations of DAT-SPECTs performed in three centers with different equipments;2) to assess the accuracy of semi-quantitative evaluations of DAT-SPECT and 3) to identify the threshold with the best accuracy, sensitivity and specificity in a patient population with suspected parkinsonian syndrome. Materials and Methods: Two hundred twenty patients (mean age at the time of SPECT acquisition, 67.4 ± 9.5 yy) acquired in three centers (Ospedale San Luigi Gonzaga;Ospedale San Giovanni Battista Molinette;Ospedale Mauriziano Umberto I) were included. All of them underwent DAT-SPECT from January 2006 to July 2010. All exams were analyzed with the freely available software BASGAN and semi-quantitative data were used to predict disease. In particular, analyses were based on the values from the most deteriorated putamen and caudate, normalized for age and corrected for equipment. ROC analysis was performed and area under the curve (AUC) was estimated. Results: Analysis showed high AUCs (0.898, 0.864, 0.900 and 0.891 for each center and for the multicenter setting, respectively) confirming the very good accuracies reached. The best cut-off were 0.72 and 0.82 for putamen and caudate respectively. These thresholds allowed sensitivities and specificities in each center and in the multicenter setting of 76% and 96%, 91% and 82%, 93% and 90%, 86% and 89% respectively. No significant differences were observed between sensibility and specificity in each center. Conclusion: A unique threshold useful for all centers with high and similar sensitivities and specificities is possible after correction for age and equipments. The high accuracy reached in this multicenter trial by the semi-quantitative analysis seems similar to accuracies from qualitative analysis in other multicenter studies.
