Major Study Shows Dissatisfaction Following Robotic Prostatectomy

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A major study of patient satisfaction and regret following open prostatectomy and robot-assisted laparoscopic prostatectomy provides some important lessons for surgeons.*
The research, recently published in the European Journal of Urology, shows 19 per cent of patients regretted their treatment choice and patients who had robot-assisted surgery were most likely to be dissatisfied.

The authors suggest the regret is “possibly because of higher expectation of an ‘innovative procedure'”.

Their conclusion is one for all urological surgeons to note. “We suggest that urologists carefully portray the risks and benefits of new technologies during preoperative counselling to minimise regret and maximise satisfaction.”

In recent years, the treatment of prostate cancer has been a rapidly developing field, providing patients with a wide range of different choices.

Brachytherapy and HIFU offer non-surgical options and for those who want surgery, there are open, laparoscopic and nerve-sparring options, depending upon your diagnosis and treatment provider.

At the same time, patients are becoming increasingly proactive, using the internet to research and consider the different options themselves, as well as the traditional consultation with the urologist.

Increased choice is without doubt a positive benefit for patients, but as urology centres – both private and NHS – seek to attract patients, we have a responsibility to carefully counsel them about the advantages and disadvantages of treatments.
There is a distinctive risk when a procedure is perceived to be new and especially “innovative”. The media will always be interested in the next “pioneering operation”, particularly one which involves robots.

A newspaper article will tend to portray the new procedure as an immaculate solution, which corrects all the risk and disadvantages of other procedures.
As surgeons, we have a responsibility to provide patients with a more sober and informative picture, acknowledging limitations as well as benefits.

The patient satisfaction study was based on the responses of 400 men who had undergone retropubic radical prostatectomy (RRP) or robot-assisted laparoscopic radical prostatectomy between 2000 and 2007 in the US.

The report’s authors also examined patients urinary domain scores, hormonal domain scores and found scores were independently linked with regret.

It is still early days for robotic surgery in the UK. In prostate cancer surgery, there are currently six Da Vinci robotic machines in the UK, compared with 350 in America.

There is no current evidence that robotic surgery provides better outcomes for patients, in terms of urinary symptoms, post operative sexual function or post-operative risks and complications.
It seems certain that robotic surgery will increase within the UK during the next decade, with NHS and private centres purchasing the Da Vinci machines.

This will provide even more choice for patients, which is in principle, a positive development.

It is however vital that patients are given accurate and comprehensive information to enable them to make an informed choice, rather than simply being over-sold a new product.

SAP C_TCRM20_60 study guide

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Study Abroad Education Programs

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Study abroad programs become the first choice when it comes to pursuing higher education. The advancement of technology and increasing liberalization have also elevated education abroad as a viable option for many. However, what has made these programs popular among the students of developing countries and other hitherto marginalized sections of the population is the availability of numerous study abroad scholarships and International fellowships.

Over the years, USA seems to have captured the imagination of the youth who wish to pursue higher education abroad. Canada, United Kingdom, Australia, Germany, New Zealand and Singapore are some other places that have witnessed tremendous flow of International students. India and China are two other countries that are attracting a growing number of foreign students at present.

However, taking the decision to go abroad for studies is not an easy one as it involves considerable expenses. But with numerous education loans and scholarships around, it has become much easier today. Most of the countries that seek to attract students from other countries offer scholarships on a wide variety of study abroad programs that may include courses in medicine, engineering, arts and humanities, science, management, law, fashion design & technologies, and various other courses. For example, if you are willing to study in USA, you can think of applying for Fulbright Scholarships, Marshall Scholarships, AFLSE Scholarships, Miss America Scholarships and so on. In order to qualify for certain scholarships you may have to fulfill certain criteria like merit, need, ethnicity etc.

For specific information on a country’s study abroad programs, it is always helpful to visit the local office of the country’s embassy or the office of the High Commission. Moreover, certain countries has also opened office specifically to cater to the needs of the International students. Certain good educational websites also provide information about the study abroad programs that are available in a country and other related information. Another option to take the right decision is to go for professional help and visit an experienced education consultant.

Best Ab Exercises According to Study

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Study Searches for Best Ab Exercises

In a study conducted by the Biomechanics Lab at the San Diego State University, thirteen common abdominal exercises were measured using an electromyography. This specialized equipment measures the activity in the abdominal muscles during the performance of the exercise.

What does all this mean? Well each abdominal exercise was analyzed for the effectiveness in the rectus abdominus and oblique muscles to determine the best ab exercises.

Thirty healthy men and women ranging in age from 20 to 45 participated in this study. Each person was allowed to practice the abdominal exercise before doing 10 to 12 reps of each exercise. The data was gathered and analyzed.

Best Ab Exercises

If you are like many people who thought the traditional crunch was the best abdominal exercise then the results of this study will surprise you. Rather than being one of the best abdominal exercises, the traditional crunch actually ranked in the bottom three.

The top 3 ab exercises for overall effectiveness and for the most effective in the rectus abdominus muscle were the bicycle crunch, captains chair and the exercise ball crunch. The most effective in the oblique muscles ranking number 1 3 respectively were the captains chair, bicycle crunch and the reverse crunch.

Worst Ab Exercises

Although this study only included 13 ab exercises and all the exercises showed some effectiveness, these three showed the least activity and effectiveness in the rectus abdominus and oblique muscles. These three are the traditional crunch coming in at number 11, the exercise tubing pull at number 12 and last was the ab rocker.

Just because these 3 came in at the bottom does not mean you should remove them from your list of abdominal exercises. However, if you are looking to purchase abdominal exercise equipment you may want to consider some more effective than the ab rocker in order to get your moneys worth.

Effective Ab Exercise Routine

To get the most out of your abdominal exercises and flatten your stomach you want to make sure you are working all the abdominal muscles. The ab muscles include the rectus abdominus, internal and external obliques and the transverse abdominus muscle.

Most abdominal exercises target the rectus abdominus and oblique muscles but it is critical you also include exercises that work the transverse abdominus muscle. This muscle acts as a griddle to help tighten and hold in your stomach.

To get the most out of your abdominal exercises try including several different ab exercises so that you work all the muscles. Exercises like the bicycle crunch work all the ab muscles, including the transverse abdominus. Make your abdominal exercise routine varied and fun. Add new and different ab exercises each time to ensure you are hitting all the muscles and toning all areas.

A Short Take On The Gmat Online Study

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GMAT is the acronym of the Graduate Management Admission Test is one of the most significant international MBA entrance tests. Since the GMAT score is accepted in the B schools of about eighty English speaking countries including USA with the offering of 1500 management courses. The GMAT score remains valid for five years. Depending on the recent question paper trend and type of questions, a student can get some comprehensive idea on GMAT syllabus. As officially there is nothing called a compact GMAT syllabus, this is the best method to get some comprehensive idea on the GMAT syllabus. If a person chooses to go through the GMAT test papers of the last five to ten years, it will be a greatly enlightening experience. There are four subjects which a person needs to study thoroughly as a part of the GMAT preparation which are- quaint, reasoning, language and analytical section. The time allotted to every section is really short, and the number of questions provided for answering the questions may seem insufficient. Joining a MBA coaching centre may show some significant way to success but it is the student who needs to make it happen. These days, GMAT online preparation is a choice for many candidates.Since there is no age barrier for writing GMAT, fresh graduates often prefer to gather some substantial corporate exposure. Therefore, attending the regular GMAT preparation classes becomes a great hurdle for them. Though night and week end classes offer relief to some, a large section remains in the dark. In this situation, different online GMAT preparation programmes can help a person to a great deal. Since there is no adjustments a person need to make from the busy schedule, the person can study the materials in the convenient time. Weekend preparation is hugely necessary for the people having a regular job. As the lectures of the online GMAT preparation class are provided through Videos, it will not be a big deal to follow the lectures. A student can put forward any query related to the study any time. The doubts and queries will be entertained by the expert faculties. Different short cut methods will be taught as well which are indispensable for completing the paper within the given time.Regular practice is completely necessary to get acquainted well with the type of problems that one needs to face in the quantitative section. This subject needs at least one hour regularly. Other sections require regular study time as well. No matter whether a person has assigned for a GMAT online preparation or a regular course, there are some books and materials which are extremely necessary for the GMAT preparation. Writing mock tests in regular interval is absolutely necessary for the better preparation. A person should select the course materials in accordance to the score the student has targeted for. There is no positive outcome in crowding up the brain with excessive study materials. A proper balance should be maintained in order to achieve the targeted GMAT percentile.

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Jgls – The Best Place To Study Law In India

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No great idea in its beginning can ever be within the law. How can it be within the law? The law is stationary. The law is fixed. The law is a chariot wheel which binds us all regardless of conditions or place or time. ” Emma Goldman in her book Anarchism and other essays define law as statutory but stationary.

No doubt, the study of law is amongst the most tedious yet coveted courses in India asserted by the fact; we have the world”s largest constitution. The national law school is the first preference of the students who wish to study law in India. We have seen great lawyers in the country and witnessed a long list of lawyers turning into politicos. Youngsters from across the country look forward to get best practical knowledge while he/she study law in India, because court room is entirely different from the books that one needs to mug up before being called a proficient and efficient lawyer. In India, to attract employers’ attention, national law schools are throwing out decades of tradition by replacing textbook courses with classes that teach more practical skills.

What makes the study of law in India a renowned and prosperous avenue for students? Answer might be many but a few personalities in Indian judiciary never fail to impress and fascinate students to learn and follow the prodigy of these great lawyers of our country. The first that comes in the countdown of great lawyers is Mr. Nariman, better known as the wise man of the Bar. His stature allows him to be blunt in court. He lets his displeasure be known when a judge fails to understand a point “” “No, no, that’s not what I mean.”Nariman, 81, has aged yet bold and skeptical about everything he doesn”t sympathizes to. His voice has turned metallic over the years, but it still booms in the biggest courtroom of all “” the chief justice of India”s, with its 40-feet high ceiling.

Another personality that makes it look really is Sorabjee. He loves to be referred to as the former Attorney General, for it brought him great glory. As AG, he successfully defended India against Pakistan in the Atlantique downing case in an international court. The study of law in India is not easy but these gentlemen”s make a daunting note of that and make the youngsters believe if you can go through the avid books and all the court room sessions a blissful life awaits you.

These individuals in some part of their lives have been a part of best law institutes in the India i.e national law school. This makes it evident that study law in India and that too in these institutes might not be easy but it”s the quality education in these institutes that transforms an individual into a successful legal instructor or lawyer.

Modern Family Review Education & Growth

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I always think one of the most appealing things of The United States is that US parents are far more open in education. Instead of just talking to their children unilaterally, they pay more attention to the conversation between they and their children.

It isn’t just for fun to watch US TV shows. Sometimes it is like a kind of experience. Placing myself into the episodes, and feeling some of their education and inspiration that I have never had. Maybe it could make up some of the deficiency in my childhood. But just maybe…

Like other situation comedies, Modern Family can not escape from common family routine such as trivial home matters, couples conflicts, children growing problems and discords between daughter and stepmother. And although there are fights and conflicts, but every one in the big family loves each other, that the final ending of every episode is always happy.

Even if the editors keep creating topics, making up scenarios, we can always see through these pieces of facts the American educational culture and daily life. And I am always touched by the episodes and can’t help thinking how it could be if my parents had treated me like these…

Little Manny ridiculed by his classmates at school. His old stepfather knew that himself was not good at persuasion, so he called his son Mitchell to see meteor showers with him and Manny and try to persuade Manny by the way. Although teased by Manny, Mitchell sat down and told Manny that he had also been ridiculed by others as a child. Sometimes it is very strange that we hated to be isolated at childhood, but almost over one night, suddenly every one wanted to be different. Mitchell did not pretend to be profound, but said the homely words. This really deserves further thought.

I remember in one episode of Friends, Phoebe said that he doesn’t believe Darwin’s evolution theory. As a paleontologist, Ross felt that he had to persuade Phoebe. But Phoebe said, however, I know the theory of evolution makes sense, but why do I have to believe? Even if there is so much evidence and so many people who believe in it, but is it certainly right? Then Ross scratched his head, didn’t speak any longer, and packed up and left. I think this conveys determination of anti-authority and not blindly following the majority. Althouth this power is quite small and no body support it, but I still stick to my opinion.

College Education Courses Online – What You Should Know

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Education online is a growing field of opportunity for those who are unable to complete a traditional course of college education. Reasons are varied for people being unable to complete normal college information, but may include financial and time constraints.Online college courses tend to cost less than campus courses, but more importantly when receiving your education online you can still work. Holding down a full time job may be essential to some at the same time as studying because they are not only having to pay for their college education but also their course books and day to day living costs. An online college education has a greater flexibility in how you manage your time and so gives you a better chance to still hold a full time job or fulfill other responsibilities. There may also be people who want to further their college education but do not have the time for traditional courses because they work full time, or are raising children and do not want to put them in daycare whilst they attend to their course requirements. For them attending online college courses gives them the flexibility to study after work, or when the children are napping or have gone to bed. Even if you are studying for your degree through a traditional campus institution, there may be courses that are available online, that will give you a little more freedom to perhaps take extra college courses in one semester and less in another if you need to play catch up or else make a semester easier because of upcoming commitments. Many, if not all colleges will now provide course information and education materials online. This is not to allow people to skip classes, or to enable them to sleep through lectures but rather as a support to the education that they are receiving. Courses are available in many areas of study including such areas as computer science and programming, foreign languages, theoretical sciences, the arts-almost everything that a traditional college can offer education in.Other than the requirements for payment for your courses there may be educational prerequisites too. You will also need to purchase the course materials and will need a computer with internet access for the online access to classes. Occasionally a telephone may be needed, to call into a class and listen to a live lecture, or to participate in a seminar or other discussion.Exams may be held online, but there is also likely to be a requirement at some point through the course, for you to sit an exam under normal exam conditions, on campus. There are other times that you may be required to be on campus too and this should be born in mind when considering which course you which to do, because if you sign up for a college a thousand miles away you may struggle when the dean wants to hold interviews to confirm that it really was you that took the course and exam.

Memory and Education Games

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Are you tying to find useful entertaining activities? Well, maybe its` time you gave Joya memory games and other educational games a try. Why not have fun, while training your memory at the same time? If this is starting to sound like a good idea to you, you should probably know that there are different types of memory and educational games. The differences can be pretty significant, as they provide fun activities for different ages, and even for different interests. The great thing about these games is that they can get quite personal. Because there is such a large variety online, every individual can choose their games according to their personal preferences. There are different levels you can choose to play. If you feel like a little challenge, you can simply take on a high level memory game, while if you just feel like relaxing, you can choose a lower one.
These sorts of games are great family activities, as they are really easy to access and play. As a parent, if you want to get your children involved, you can simply choose a lower level educational game and help them build up. After all, children learn everything a lot faster when new information is presented in the form of fun activities. Also, it is these sorts of family games that will allow you to spend some quality time with your children. Children will also enjoy that quality time spent with their parents, and they will develop a comfortable feeling about learning together with your parents. Many children are reticent when it comes to parents and homework. They hate asking their parents for help, as they feel uncomfortable for not handling it themselves. However, memory and educational games family time can make that feeling vanish in just a few minutes. Children love showing their parents that they are good at something. This is why, this sort of games will help them blossom.