The robotic future of minimally invasive cytoreduction and hyperthermic intraperitoneal chemotherapy for peritoneal surface malignancies.

Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) has been increasingly utilized for peritoneal surface malignancies. This has been commonly utilized for a variety of neoplasms, but, especially mucinous neoplasms of the appendix, ovarian cancer, gastric cancer, colorectal cancer and mesothelioma. Traditionally, CRS/HIPEC has been performed as an open, extensive operation associated with prolonged hospitalization. However, when the peritoneal carcinomatosis index (PCI) is small (<10), minimally invasive approaches can be considered. Such less invasive approaches may be associated with improved postoperative recovery, less complications while preserving oncologic outcomes. The robotic platform offers distinct advantages over laparoscopy with superior visualization and ergonomics which account for its increased utilization in oncologic surgery. Herein, we review available data on minimally invasive approaches to CRS/HIPEC procedures, focusing on patient selection and comparative studies to open CRS/HIPEC. We summarize the existing initial studies on robotically assisted CRS/HIPEC and provide technical insights about our approach to robotically assisted CRS/HIPEC. Current data suggests that treatment of peritoneal surface malignancies with minimally invasive CRS/HIPEC is feasible in selected cases and is associated with improved postoperative recovery. The robotically assisted platform for CRS/HIPEC deserves further investigation and may improve outcomes after this procedure in the future for carefully selected patients with low PCI.

Women Leading Healthy Change: A Reciprocal Learning Experience for Women in the Sex Trade and Medical Students.

Introduction: Service learning can teach medical students about the social determinants of health and prepare them to better serve marginalized populations, while people in the sex trade can serve as effective educators for their peers and health professions trainees. However, service-learning projects involving medical students and people in the sex trade are currently rare. Methods: We modified a curriculum from an author's prior institution to provide a unique service-learning experience for medical students and peer health education for women in the sex trade in a new city and new context. Medical students partnered with a local community organization to implement a 10-week course on physical and mental health for women in the sex trade. Coled by a medical student and a woman who had utilized the community partner's services, the course's instructional methods included in-class demonstrations, group discussion, games, and worksheets. Results: Ten women participated in the course, and six medical students facilitated its implementation. The participants demonstrated increased knowledge in physical and mental health topics and reported being more comfortable speaking with health care providers. The coleaders developed skills and confidence to pursue additional leadership opportunities. The medical student coleader gained a better understanding of addiction and was more prepared to work with patients with substance use disorders. Discussion: This mutual learning experience was a valuable health education opportunity for a local underserved community and helped medical students understand the barriers women in the sex trade face when seeking health care and how physicians can better meet their needs.

Making Abortion Safer in Rwanda: Operationalization of the Penal Code of 2012 to Expand Legal Exemptions and Challenges.

Penal code was revised in Rwanda in 2012 allowing legal termination of pregnancy resulting from rape, incest, forced marriage, or on medical grounds. An evaluation was conducted to assess women's access to abortion services as part of an ongoing program to operationalize the new exemptions for legal abortion. Data was collected from eight district hospitals; seven gender-based violence (GBV) centers and six intermediate courts. Three focus group discussions and 22 in-depth interviews were conducted with key informants. At hospitals, of the 2,644 uterine evacuation records (July 2012-June 2014), and 312 monitoring cases (August-December 2014), majority of all uterine evacuations (97% and 85% respectively, for the two periods) were for obstetric conditions, and induced abortion on medical grounds accounted for 2% vs. 15% respectively. Medical abortion was the prominent method of uterine evacuation. At the GBV centers, 3,763 records were identified retrospectively; 273 women were pregnant. Since the legal reform there was only one abortion for a pregnancy resulting from rape. Abortion stigma and court order requirement are major barriers to access services. The operationalization program has made significant contributions to make abortion safer in Rwanda but this evaluation demonstrates that further work is required to reach the goal of providing safe abortion services to all eligible women. Addressing abortion stigma at the community, organizational and structural levels; further strengthening of service provision; and streamlining legal requirements to protect particularly young women from sexual violence and making abortion a realistic option for GBV victims are some of the important next steps.

Prevalencia y factores asociados con síntomas depresivos en estudiantes de ciencias de la salud de una Universidad privada de Lima, Perú 2010 / Prevalence and asociated factors WITH depresive symptoms in Health Sciences students from a private university in Lima, Peru 2010

Introducción. Los síntomas depresivos en estudiantes de ciencias de la salud son comunes y podrían ser potencialmente perjudiciales. Objetivos. Determinar la prevalencia de síntomas depresivos y sus factores asociados en los estudiantes de la Facultad de Ciencias de la Salud de la Universidad Peruana de Ciencias Aplicadas, Lima (Perú), junio 2010. Materiales y métodos. Estudio analítico transversal; se realizó una encuesta previo consentimiento informado a 590/869 estudiantes. Para medir la variable de respuesta (síntomas depresivos) se usó la escala de Zung abreviada. Se empleó la regresión logística múltiple para evaluar los factores asociados, considerando un nivel de significancia de p<0,05. Resultados. La edad media fue 18,97 ± 2,45 años; 71,1 por ciento fueron mujeres; 19,6 por ciento fueron migrantes y 62,5 por ciento fueron de la carrera de medicina. La prevalencia de síntomas depresivos fue 31,2 por ciento en la población y de 33,6 por ciento en estudiantes de medicina. No se encontró asociación en el análisis bivariado con el sexo, carrera de estudio, si ha repetido cursos, si vive solo o si es migrante (p>0,05). En el análisis multivariado, se encontró asociación con la inconformidad de su rendimiento académico (OR=2,13; IC95 por ciento:1,47-3,08), inconformidad con la situación económica actual (OR=1,93; IC95 por ciento:1,24-2,99) y vivir con un familiar externo a la familia nuclear (OR=1,62; IC95 por ciento:1,07-2,45). Conclusión. Existe una alta prevalencia de síntomas depresivos en la población estudiada, especialmente en los alumnos de la carrera de medicina, siendo la inconformidad con el rendimiento académico, con su economía y vivir con un familiar externo a la familia nuclear, factores asociados que podrían tomarse en cuenta para trabajar programas preventivos.

Introduction. Depressive symptoms in health sciences students are common, these might be potentially detrimental. Objectives. To determine the prevalence of depressive symptoms and its associated factors in students from the Health Sciences Faculty of the Universidad Peruana de Ciencias Aplicadas in Lima (Peru), June 2010. Materials and methods. Cross-sectional analytic study; a pre-consented survey was applied to the population 590/869 students. Zung’s abbreviated scale was used to measure depressive symptoms. To evaluate de associated factors, logistic regression was used, p<0.05 was considered statistically significant. Results. The mean age was 18.97 ± 2.45 years and 71.1 percent were women, 19.6 percent were migrants and 62.5 percent were medical students. The prevalence of depressive symptoms was 31.2 percent in the whole population and in medical students was 33.6 percent. Depressive symptoms were not associated in bivariate analysis with sex, career, having failed a course, living alone or being a migrant (p>0.05). In the multivariate analysis, significant statistical association was found between depressive symptoms and dissatisfaction with the own academic performance (OR=2.13 CI95 percent1.47-3.08), dissatisfaction with the current economic status (OR=1.93 CI95 percent1.24-2.99) and living with a relative external to the nuclear family (OR=1.62 CI95 percent1.07-2.45). Conclusion. A high prevalence of depressive symptoms was found, especially in medical students; being dissatisfaction with academic performance, economic status and living with a relative external to the nuclear family associated factors that could be taken into account in order to build preventive programs.

[Prevalence and associated factors with depressive symptoms in Health Sciences students from a private university in Lima, Peru 2010]. / Prevalencia y factores asociados con síntomas depresivos en estudiantes de ciencias de la salud de una Universidad privada de Lima, Perú 2010.

INTRODUCTION: Depressive symptoms in health sciences students are common, these might be potentially detrimental. OBJECTIVES: To determine the prevalence of depressive symptoms and its associated factors in students from the Health Sciences Faculty of the Universidad Peruana de Ciencias Aplicadas in Lima (Peru), June 2010. MATERIALS AND METHODS: Cross-sectional analytic study; a pre-consented survey was applied to the population 590/869 students. Zung's abbreviated scale was used to measure depressive symptoms. To evaluate de associated factors, logistic regression was used, p<0.05 was considered statistically significant. RESULTS: The mean age was 18.97 ± 2.45 years and 71.1% were women, 19.6% were migrants and 62.5% were medical students. The prevalence of depressive symptoms was 31.2% in the whole population and in medical students was 33.6%. Depressive symptoms were not associated in bivariate analysis with sex, career, having failed a course, living alone or being a migrant (p>0.05). In the multivariate analysis, significant statistical association was found between depressive symptoms and dissatisfaction with the own academic performance (OR=2.13 CI95%1.47-3.08), dissatisfaction with the current economic status (OR=1.93 CI95%1.24-2.99) and living with a relative external to the nuclear family (OR=1.62 CI95%1.07-2.45). CONCLUSION: A high prevalence of depressive symptoms was found, especially in medical students; being dissatisfaction with academic performance, economic status and living with a relative external to the nuclear family associated factors that could be taken into account in order to build preventive programs.

Making abortion safer in Rwanda: operationalization of the Penal Code of 2012 to expand legal exemptions and challenges

Penal code was revised in Rwanda in 2012 allowing legal termination of pregnancy resulting from rape, incest, forced marriage, or on medical grounds. An evaluation was conducted to assess women's access to abortion services as part of an ongoing program to operationalize the new exemptions for legal abortion. Data was collected from eight district hospitals; seven gender-based violence (GBV) centers and six intermediate courts. Three focus group discussions and 22 in-depth interviews were conducted with key informants. At hospitals, of the 2,644 uterine evacuation records (July 2012-June 2014), and 312 monitoring cases (August-December 2014), majority of all uterine evacuations (97% and 85% respectively, for the two periods) were for obstetric conditions, and induced abortion on medical grounds accounted for 2% vs. 15% respectively. Medical abortion was the prominent method of uterine evacuation. At the GBV centers, 3,763 records were identified retrospectively; 273 women were pregnant. Since the legal reform there was only one abortion for a pregnancy resulting from rape. Abortion stigma and court order requirement are major barriers to access services. The operationalization program has made significant contributions to make abortion safer in Rwanda but this evaluation demonstrates that further work is required to reach the goal of providing safe abortion services to all eligible women. Addressing abortion stigma at the community, organizational and structural levels; further strengthening of service provision; and streamlining legal requirements to protect particularly young women from sexual violence and making abortion a realistic option for GBV victims are some of the important next steps