In spite of the global implementation of standardized surgical safety checklists and evidence-based practices, general surgery remains associated with a high residual risk of preventable ...perioperative complications and adverse events. This study was designed to validate the hypothesis that a new "Trigger Tool" represents a sensitive predictor of adverse events in general surgery.
An observational multicenter validation study was performed among 31 hospitals in Spain. The previously described "Trigger Tool" based on 40 specific triggers was applied to validate the predictive power of predicting adverse events in the perioperative care of surgical patients. A prediction model was used by means of a binary logistic regression analysis.
The prevalence of adverse events among a total of 1,132 surgical cases included in this study was 31.53%. The "Trigger Tool" had a sensitivity and specificity of 86.27% and 79.55% respectively for predicting these adverse events. A total of 12 selected triggers of overall 40 triggers were identified for optimizing the predictive power of the "Trigger Tool".
The "Trigger Tool" has a high predictive capacity for predicting adverse events in surgical procedures. We recommend a revision of the original 40 triggers to 12 selected triggers to optimize the predictive power of this tool, which will have to be validated in future studies.
Full text
Available for:
IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Catheter-associated urinary tract infections (CAUTIs) are the most common nosocomial acquired infections, with high resistance rates. CAUTIs are a potentially severe complication in hospitalized ...patients and imply higher costs. Our aim was to analyze the characteristics of CAUTIs in our Urology department.
Between November 2011 and October 2013, a prospective observational study was carried out analyzing the incidence of healthcare-associated urinary tract infections in patients admitted to the urology ward with an indwelling urinary catheter. Furthermore, we evaluated associated risks factors and comorbidities such as urinary catheter at the time of admission or urological surgery during the hospitalization. We also presented our results regarding the microbiological characteristics and patterns of resistance to antibiotics in patients with CAUTI admitted in our service.
The incidence of CAUTI was 8.2% (189/2283 patients who had urinary catheter). Mean age was 67.4±14.26 years, 90.2% underwent a surgical procedure (p<0.001), 14.8% had a urinary stone (p=0.058) and 46% had a urinary catheter before admission (p<0.001). The most commonly isolated pathogens were Escherichia coli (22.6%), Enterococcus (21.9%) and Pseudomonas aeruginosa (13.9%). E.coli showed resistance rates of 41.9% for quinolones, 33.3% of them produced extended spectrum Β-lactamase (ESBL). P.aeruginosa showed resistance rates of 42.1% for quinolones and 21.1% for carbapenems.
Healthcare-associated CAUTI in patients hospitalized in a urology ward are related to risks factors such as having a urinary catheter before admission and undergoing a surgical procedure. Moreover, CAUTIs have higher incidence of pathogens with antibiotic resistances and non-common pathogens such as Enterococcus spp.
To determine the effectiveness and safety of saturation biopsies for prostate cancer detection of and to identify predictive variables for cancer.
We conducted a retrospective transversal study in ...which we analyzed 144 saturation biopsies (January '06 - July '09).
at least two sets of biopsies without evidence of malignancy and Prostate Specific Antigen (PSA)levels >10 ng/ml or PSA kinetics suggestive of malignancy (rate >0.75 ng/ml/year)and patients with atypia in a previous biopsy.The variables analyzed were: age, abnormal digital rectal examination (DRE), total PSA, free/total PSA ratio, prostate volume, PSA density, previous histopathology, number of cylinders obtained and complications. Statistical analysis was performed using the Chi-square test, Student's t-test and logistic regression.
Mean age was 66 years (SD ± 6.4), mean total PSA 14.4 ng/ml (SD ± 12.6), mean free/total PSA ratio 0.09 (SD ± 0.09), mean prostate volume 61.6 cc (SD ± 27.4), mean PSA density 0.27 (SD ± 0.26) and mean number of cylinders obtained 30.45 (SD ± 3.8). We diagnosed 32% of the patients with prostatic adenocarcinoma. We observed PSA density was higher in the prostate cancer group, 0.39 (SD ± 0.36), compared to 0.21 (SD ± 0.18) in patients without cancer (p=0.003). Adenocarcinoma was found in 58% of the biopsies in patients with suspicious DRE, compared to 28% with normal DRE (p=0.009). Mean prostate volume in the prostate cancer group was 52.5 (SD ± 24.7)compared to 66.0 (SD ± 27.7)in the group without cancer (p=0.006). In the multivariate analysis, the PSA density (p=0.02; 95% CI 1.36 - 37.36) was the only variable that independently predicted the presence of adenocarcinoma. No statistically significant differences were found in either univariate or multivariate analysis for the remaining variables analyzed. The incidence of complications was similar to that described in the literature for other series.
Saturation biopsy is safe and effective for detection of prostate cancer. PSA density was the only factor that was shown to be independent predictive variable for tumor diagnosis.
To determine the impact of implementing a joint action protocol on prostatic disease on the referrals to Urology from Primary Care in a health care area.
We drafted a protocol for managing patients ...consulting for clinical signs and symptoms associated to benign prostatic hyperplasia (BPH) and to test PSA in asymptomatic males. At the same time, three e-mail addresses were opened for consultations generated from Primary Care, and joint sessions were carried out in the primary health care centers. We measured the impact of the protocol by assessing the adequacy of prostatic disease referrals to Urology, as well as by determining the course of the total number of referrals in three peripheral specialized health care centers (PSHCC).
From January 2011, a better compliance to the referrals to Urology protocol for prostatic disease has been produced, going from 47% (assessment prior to implementing the protocol) to 64%. These results are especially good when we consider referrals associated to PSA, which went from a compliance of 33% to 84%. Regarding the course of the referrals to Urology, the referral rate (referrals per 1000 inhabitants) has decreased by 15% (from 13,8 to 11,7).
The collaboration between Urology and Primary health care, by means of implementing joint protocols, and also by establishing new communication channels (e-mail, joint sessions), achieves a better adequacy of patients referred for prostatic disease, as well as a reduction in the total number of referrals.
Introduction & ObjectivesKidney transplant (KT) is the best treatment for end-stage chronic kidney disease, with higher survival rates, better quality of life and lower economic burden than dialysis. ...Due to the large amount of people awaiting a KT there is a great organ shortage, which has led to investigate new sources of grafts. Donation after cardiac death (DCD) has emerged in the last two decades to increase the donor pool, classically composed by donation after brain death (DBD). Uncontrolled DCD (uDCD) is popular in scarce countries; these kidneys have a higher ischemic risk due to longer cold ischemia time, which can be related to a higher rate of postoperative complications, especially affecting the urinary reconstruction. Our aim is to compare the incidence of postoperative complications of uDCD transplants (with normothermic preservation prior to organ procurement) versus DBD transplants.
METHODSWe carried out a retrospective review of 300 KT (150 uDCD with normothermic perfusion and 150 DBD) performed in our centre between 2007 and 2012 on recipients under 60 years old. We collected preoperative features, surgical technique, graft characteristics and postoperative complications. These complications were also stratified according to time of onset (early –during the first 90 postoperative days– versus late –after the 90th postoperative day–) and severity (based on Clavien-Dindo classification). Data were analysed using Stata v12.0 for Windows.(Table is included in full-text article.)(Table is included in full-text article.)
RESULTSBaseline characteristics were comparable, with a median follow-up of 53.6 months. Total postoperative complication rate was 77.7%. Comparative incidence of complications is presented in Table 1 and stratification is presented in Table 2.
CONCLUSIONSUncontrolled DCD kidneys under normothermic preservation have a rate of postoperative complications comparable to that of DBD kidneys, with no differences in time of onset or severity. We therefore believe that postoperative complications are not an obstacle when it comes to use DCD kidneys as a source of grafts to fight against organ shortage.
INTRODUCTION AND OBJECTIVESKidney transplantation is the best treatment for end-stage chronic kidney disease, with multiple advantages over dialysis. Because of the large quantity of people awaiting ...a kidney transplant there is an important organ shortage, which has led to investigate new sources of grafts. Donation after cardiac death (DCD) has emerged in the last two decades to increase the donor pool, classically composed by donation after brain death (DBD). Uncontrolled DCD is popular in not many countries, because of ethical issues among others; moreover, these kidneys have a higher ischemic risk due to longer cold ischemia time. In this series, we compare the survival of uncontrolled DCD transplants related to DBD transplants.
METHODSWe carried out a retrospective review of 300 kidney transplants (150 uncontrolled DCD with normothermic perfusion and 150 DBD) performed in our centre between 2007 and 2012 on recipients under 60 years old. We collected preoperative features, surgical technique, graft characteristics (cold ischemia time) and postoperative events. We estimated crude survival and death-censored and primary non function-censored survival with Kaplan Meier curves, using Stata v12.0 for Windows.
RESULTSBoth groups were comparable regarding baseline characteristics, with a median follow-up of 53.6 months (interquartile range 35.3-70.5), and a median age of 43 years for donors and 46 for recipients. Crude survival (Figure 1) at 1, 5 and 10 years was 93.3%, 90.9% and 88.5% for DBD kidneys and 91.1%, 83.6% and 81.6% for uncontrolled DCD grafts, with no statistically significant difference (p=0,100). Primary non function and death censored survival (Figure 2) at 1, 5 and 10 years was 95.6%, 93% and 88.7% for DBD grafts and 97%, 88.9% and 86.9% for DCD grafts..(Figure is included in full-text article.)(Figure is included in full-text article.)
CONCLUSIONSUncontrolled DCD kidneys under normothermic preservation have similar survival as DBD grafts. Hence, they can be considered as a valuable source to increase the donor pool so as to minimize the current organ shortage.
Testicular tumour diagnosis and its management are widely known by urologists, although there are some exceptional diagnoses with rare clinical profiles. We report the unusual case of a young man ...presenting neuropsychiatric symptoms with no evidence of neurological disease and increased serum anti-Ma2 antibodies, which are associated with germ cell tumours. Our patient was finally diagnosed with a likely left testicular tumour, an orchidectomy was performed and the symptoms disappeared. Only four cases with a similar clinical background and evolution have been reported in the literature.
Full text
Available for:
NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
PDF
