Subject(s)
Analgesia, Epidural , Analgesia , Nurses , Humans , Pain , Pain Management/methods , Catheters , Pain, PostoperativeABSTRACT
The COVID-19 pandemic had a tremendous impact on healthcare systems around the world. This study aims to research the course of surgical treatment in urology during the pandemic in 2020, evaluate the volume of deferred treatment in urology in Poland, and indicate groups of patients that are especially vulnerable to a delay in the delivery of healthcare services. The National Health Found statistics (NHF) database was searched for information on procedures completed in urology departments from 2015 to 2020. Changes in hospital discharges of adults from 2019 to 2021 were investigated using monthly reports of NHF on patient billing groups. Statistics of PSA, testosterone, and creatinine testing were extracted from NHF reports. Annual changes in the number of surgeries were calculated. Then, the estimation of the expected quantity of procedures without the occurrence of the pandemic was performed using linear regression based on data from 2015 to 2020. The estimation was assumed reliable at R2 > 0.8. The difference between collected and estimated data was analysed. In 2020, the volume of radical prostatectomies, cystectomies, and kidney surgeries noted downturns following lockdowns in March and November. All analysed procedures, except radical cystectomy, noted a reduction in the entire year. The declines reached -34% in shockwave lithotripsy, -13% in ureterorenoscopic lithotripsy, -22% in cystolithotripsy, -28% in percutaneous lithotripsy, -12% in transurethral resection of a bladder tumour (TURBT), -31% in transurethral resection of the prostate, -15% in nephrectomy and kidney tumorectomy, and -10% in radical prostatectomy. Among the analysed procedures, only radical cystectomy rates increased 5%. Prostate-specific antigen and creatinine tests fell -17%, and testosterone testing was down -18%. In conclusion, the patients most vulnerable to delayed treatment due to the post-pandemic backlog are those requiring TURBT, kidney cancer operations, and radical prostatectomies. Solving backlogs in urology should prioritise cancer patients and thus requires improved access to cystoscopy, TURBT, diagnoses and surgery of prostate and kidney tumours. Addressing the needs of patients suffering from benign diseases demands appropriate measures to increase the surgical productivity of urology departments.
Subject(s)
COVID-19 , Kidney Neoplasms , Transurethral Resection of Prostate , Urology , Male , Adult , Humans , COVID-19/epidemiology , Pandemics , Poland/epidemiology , Creatinine , Time-to-Treatment , Communicable Disease Control , TestosteroneABSTRACT
The goal of this study was to determine whether patterns of expression profiles of p73 isoforms and of p53 mutational status are useful combinatorial biomarkers for predicting outcome in a gynecological cancer cohort. This is the first such study using matched tumor/normal tissue pairs from each patient. The median follow-up was over two years. The expression of all 5 N-terminal isoforms (TAp73, DeltaNp73, DeltaN'p73, Ex2p73 and Ex2/3p73) was measured by real-time RT-PCR and p53 status was analyzed by immunohistochemistry. TAp73, DeltaNp73 and DeltaN'p73 were significantly upregulated in tumors. Surprisingly, their range of overexpression was age-dependent, with the highest differences delta (tumor-normal) in the youngest age group. Correction of this age effect was important in further survival correlations. We used all 6 variables (five p73 isoform levels plus p53 status) as input into a principal component analysis with Varimax rotation (VrPCA) to filter out noise from non-disease related individual variability of p73 levels. Rationally selected and individually weighted principal components from each patient were then used to train a support vector machine (SVM) algorithm to predict clinical outcome. This SVM algorithm was able to predict correct outcome in 30 of the 35 patients. We use here a mathematical tool for pattern recognition that has been commonly used in e.g. microarray data mining and apply it for the first time in a prognostic model. We find that PCA/SVM is able to test a clinical hypothesis with robust statistics and show that p73 expression profiles and p53 status are useful prognostic biomarkers that differentiate patients with good vs. poor prognosis with gynecological cancers.
Subject(s)
DNA-Binding Proteins/metabolism , Endometrial Neoplasms/diagnosis , Nuclear Proteins/metabolism , Ovarian Neoplasms/diagnosis , Tumor Suppressor Protein p53/analysis , Tumor Suppressor Proteins/metabolism , Age Factors , DNA-Binding Proteins/genetics , Endometrial Neoplasms/metabolism , Endometrial Neoplasms/pathology , Female , Humans , Intracellular Signaling Peptides and Proteins , Nuclear Proteins/genetics , Ovarian Neoplasms/metabolism , Ovarian Neoplasms/pathology , Prognosis , Protein Isoforms/analysis , Protein Isoforms/genetics , Protein Isoforms/metabolism , Proteins/analysis , Proteins/metabolism , RNA, Messenger/analysis , RNA, Messenger/metabolism , Tumor Protein p73 , Tumor Suppressor Proteins/genetics , Up-RegulationABSTRACT
OBJECTIVES: To review the advances in the diagnosis, evaluation, staging, and treatment of cervical cancer that have been made in the past 10 years, and identify the work that still needs to be done. DATA SOURCES: Journal and review articles, book chapters, and research studies. CONCLUSIONS: Although cervical cancer has a preinvasive component and should be easily preventable, it has not been eradicated. Issues that prevent access to health care need to be addressed. IMPLICATIONS FOR NURSING PRACTICE: Nurses now have a more extended role in screening patients and educating them regarding the importance of preventive care. As new treatments are developed, the nurse is the one who will monitor the patient for side effects and assist with minimizing them. When all treatments fail in advanced disease, the nurse will assist the patient to deal with end-of-life issues and symptom control.
