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PubMed2002

Anatomic landmarks and time management during retroperitoneoscopic radical nephrectomy.

BACKGROUND AND PURPOSE: Retroperitoneoscopy has not been widely considered the preferred approach to laparoscopic radical nephrectomy for cancer, in part because the retroperitoneal anatomic landmarks have not been well defined. The aim of this study is to provide prospective, objective data on retroperitoneoscopic radical nephrectomy with regard to anatomic landmarks and time management of the sequential operative steps. MATERIALS AND METHODS: A uniform database was devised to record predetermined intraoperative parameters prospectively in 18 consecutive retroperitoneoscopic radical nephrectomies. RESULTS: A three- or four-port technique was employed to perform 10 left and 8 right retroperitoneoscopic radical nephrectomies. Initial balloon dilation was routinely performed outside of and posterior to Gerota's fascia. The anatomic landmarks visible immediately on initial insertion of the laparoscope were: psoas muscle in 18 cases (100%), Gerota's fascia in 18 (100%), peritoneal reflection in 15 (83%), ureter and/or gonadal vein in 11 (61%), and renal artery pulsations in 10 (56%). Aortic pulsations were seen in 9 of 10 left (90%) and the inferior vena cava in 2 of 8 right (25%) radical nephrectomies. The mean surgical time was 203 +/- 52.9 minutes (range 105-290 minutes). The sequential operative steps and their individual time breakdowns were: port placement 12 +/- 3.9 minutes, hilar dissection 63 +/- 29.1 minutes, adrenal mobilization 49 +/- 12.1 minutes, specimen mobilization 19 +/- 20.8 minutes, and specimen entrapment and exit 23 +/- 18.2 minutes. When the initial balloon dilation resulted in visibility of four or more anatomic landmarks, the hilar dissection time was significantly shorter (P < 0.001). CONCLUSIONS: Proper development of the retroperitoneal space and identification of adequate anatomic landmarks is important during retroperitoneoscopy. This timed analysis of the sequential operative steps of retroperitoneoscopic radical nephrectomy has served as an important self-assessment tool for us in improving our surgical technique. As a result, our surgical time for retroperitoneoscopic radical nephrectomy has decreased from the earlier 4- to 5-hour range to the current 2- to 3-hour range.

Aged↗
PubMed1976

A time-management study of 25 patients with penetrating wounds of the chest and abdomen.

The present study prospectively reviewed the time management aspects of 25 patients with penetrating wounds of the chest or abdomen. Each diagnostic procedure or treatment carried out on each patient was recorded to the nearest minute after his arrival in the emergency department. This generated median elapsed times for procedures which could be compared (4+ minutes for starting an IV, 9 minutes for insertion of CVP, 31 minutes for insertion of a chest tube). Two of the 25 patients died; 20 were admitted of whom 8 required immediate surgery. Some preocedures carried out in the accident room were done indiscriminately and for questionable reasons. The tendency was to do as much as possible to "cover" the patient. Some redundancy in the acutely ill patient is desirable but the overtreatment in some cases may have reflected inexperience of some of the physicians. Delay in using radiography and defects in professional coverage appeared to be the most serious errors. Independent monitoring of the functioning of the accident room appears to be an affective means of self-evaluation.

Abdominal Injuries↗
PubMed2000

Total time and efficient time management: in search of optimal learning and retention via study-test-rest presentation programs.

Bugelski's total time hypothesis (TTH) assumes that a constant time X is needed to learn Y regardless of how time X is programmed, with no possibility of optimization. Izawa's study-test-rest (STR) hypothesis assumes that optimization in learning and retention is possible. Examined were the effects of varied study (S) and test (T) presentation programs on learning and retention, with total time held constant. Participants learned a list of 12 paired associates under three presentation program types. In S + T list repetitions, each pair was presented once per S cycle and tested once per T cycle; both S and T were repeated in list form. In S + T item repetitions, each pair was repeated 1-6 times before the next pair in the list was presented on both S and T cycles. For S/T alternations, the entire list of pairs was studied and then each pair was tested, with S and T cycles alternating. Under each program type, there were four presentation rates. Item repetition led to more learning than list repetition when the presentation rate was very fast. Learning and retention were greatest with the intermediate S/T alternation program. These findings supported Izawa's STR hypothesis but strongly contradicted TTH.

Attitude↗
PubMed2006

Care managers' time use: differences between community mental health and older people's services in the United Kingdom.

Since the community care reforms of the early 1990s, care management in the United Kingdom has become the usual means of arranging services for even the most straightforward of social care needs. This paper presents data from a diary study of care managers' time use, from a sample of social services commissioning organizations representing the most common forms of care management practiced in England at the end of the 20th century. It compares the working practices of care managers in community mental health service settings to the practices of those situated in older people's services. Evidence is provided to suggest that while the former follow a more clinical model of care management, those working with older people take an almost exclusively administrative approach to their work. In addition, the multidisciplinary nature of mental health service teams appears to facilitate a more integrated health and social care approach to care management compared to the approach to older people's services. Further enquiry is needed as to the comparative effectiveness of these different modes of working in each service setting.

Adolescent↗
PubMed2000

[Time management: realities for parents living with children with motor deficiencies].

A quantitative study involving 244 families from three health and social service regions of Quebec was undertaken to explore how families function. Fourteen families agreed to participate in the qualitative part of this study. Twenty-eight parents participated through an in-depth interview. During the interviews, the impact of the presence of a child with a motor disability on the parents' use of time was discussed. An analysis of the themes and categories highlighted the different aspects of the impact of a handicapped child on the parents' use of time in relation to the four spheres of life. In fact, the parents that were interviewed indicated that the presence of their child greatly influenced the time they had available for their personal, conjugal and family life as well as for doing any paid work. In general, mothers devoted more time than fathers to the care of the child. This situation has a direct impact on the way the mothers manage their time. Based on an analysis of the respondents' comments, the author recommends to offer support to the parents in order to assist them with time management.

Activities of Daily Living↗
PubMed1990

Management time: who's got the monkey?

In any organization, the manager's bosses, peers, and subordinates--in return for their active support--impose some requirements, just as he imposes upon them some of his own where they are drawing upon his support. These demands on him constitute so much of the manager's time that successful leadership hinges on his ability to control this "monkey-on-the-back" input effectively.

Humans↗
PubMed2005

Managing time: an interpretative phenomenological analysis of patients' and physiotherapists' perceptions of adherence to therapeutic exercise for low back pain.

PURPOSE: Physiotherapy for low back pain (LBP) includes exercise therapy. Unfortunately adherence is problematic. This study explores patients' and physiotherapists' perceptions of exercise adherence. METHOD: Nine LBP patients and eight physiotherapists were interviewed. Interpretative Phenomenological Analysis (IPA) was used to explore transcript data. RESULTS: The main theme 'managing time', reveals how pressure on time reflects society's view of time as a commodity. Theme components include 'the bargaining process': physiotherapists spend time listening, exploring patient beliefs, but modify patients' expectations of quick cures with the need to own their back care. 'Reviewing the future' identifies fears about long-term disability, highlighting the importance of recovery time knowledge. CONCLUSIONS: Interpreting participants' stories illustrates how investing in routine exercise could help re-interpret LBP as part of everyday life.

Adult↗
PubMed1991

It's time to manage your time.

A simple, three-part process is described for the working nurse to identify the activities of each day, order the activities by importance, and then redesign their work day for better time management. The article also describes how to be sure that the employer's values are in sync with the nurse's.

Adaptation, Psychological↗
PubMedDate not supplied

Time management.

Explore the source record for details and available documents.

Goals↗
PubMed1983

Myelomeningocele newborn management: time for parental decision.

We retrospectively reviewed a process whereby parents were afforded additional time to decide the initial managements of their newborn with myelomeningocele. Of 110 newborn referrals, 52 (47%) had early surgery within the first 48 hours, 32 (29%) had delayed surgery between 3-7 days, 12 (11%) had late surgery from 7 days to 10 months, and 14 (13%) had no surgery, per parental request. There were no significant differences among the early, delayed or late surgery groups in mortality where 92%, 94% and 100% respectively were alive at 10 months, or the morbidity of worsening paralysis, ventriculitis or developmental delay. Our data suggest, therefore that there is no urgency or emergency for surgical intervention in the initial management of newborns with myelomeningocele. Rather, there is time to fully discuss issues with parents and obtain a better-informed consent for or against surgical management.

Decision Making↗