Concordance analysis of ultrasonographic diagnoses by urology nurses.

OBJECTIVES: To check the degree of concordance in renal ultrasound examination between two nurses and one experienced urologist with the aim of testing nurses' competence performing renal ultrasound. METHODS: The echographic aspect of both kidneys (normal or abnormal) was evaluated. Every abnormal finding resulted in the automatic classification of the kidney as 'abnormal'. The agreement between observers was tested using the Kappa concordance index. RESULTS: Eventually, 75 and 45 consecutive examinations performed by the urologist and nurse MM, and the urologist and nurse NJ, respectively, were evaluable. Overall, the study tested 120 patients. Prevalence of 'abnormal' kidneys was intermediate (28-36%). The overall agreement percentage exceeded 88% (88,8-92%). Kappa coefficient was always 0.7. CONCLUSIONS: Urological ultrasound examination by qualified well-trained nurses provides records very similar to those delivered by an experienced urologist.

Analisis de concordancia de los diagnosticos ecográficos del personal de enfermeria urologica / Concordance analysis of ultrasonographic diagnoses by Urology nurses

OBJETIVO: Evaluar el grado de concordancia en el diagnóstico ecográfico entre dos enfermeras y un urólogo experimentado en esa técnica, como medio de validar la competencia de las enfermeras para la exploración ecográfica urológica. MÉTODOS: Se valoró el aspecto de los riñones (normales o anormales). Todo hallazgo fuera de la normalidad supuso la automática clasificación del órgano como ‘anormal’. Acto seguido se determinó el grado de acuerdo entre los observadores y el índice de concordancia kappa. RESULTADOS: Resultaron evaluables 75 y 45 exploraciones consecutivas llevadas a cabo conjuntamente por el urólogo y la enfermera MM, y por el urólogo y la enfermera NJ, respectivamente. En definitiva, el estudio tuvo lugar sobre 120 pacientes; todos autorizaron la doble exploración. La prevalencia de riñones ‘anormales’ resultó intermedia (28-36% de la exploraciones). El porcentaje de acuerdos fue superior al 88% (88,8-92%). En todas las cuestiones analizadas (aspecto del riñón derecho y del riñón izquierdo), el coeficiente kappa resultó igual o superior a 0,7. CONCLUSIONES: La exploración ecográfica por enfermeras bien formadas y entrenadas proporciona registros superponibles a los obtenidos por un urólogo experimentado(AU)

OBJECTIVES: To check the degree of concordance in renal ultrasound examination between two nurses and one experienced urologist with the aim of testing nurses’ competence performing renal ultrasound. METHODS: The echographic aspect of both kidneys (normal or abnormal) was evaluated. Every abnormal finding resulted in the automatic classification of the kidney as ‘abnormal’. The agreement between observers was tested using the Kappa concordance index. RESULTS: Eventually, 75 and 45 consecutive examinations performed by the urologist and nurse MM, and the urologist and nurse NJ, respectively, were evaluable. Overall, the study tested 120 patients. Prevalence of ‘abnormal’ kidneys was intermediate (28-36%). The overallagreement percentage exceeded 88% (88,8-92%). Kappa coefficient was always 0.7. CONCLUSIONS: Urological ultrasound examination by qualified well-trained nurses provides records very similar to those delivered by an experienced urologist(AU)

Quality perception in the outpatient area of an Urology department. Can we improve it?

OBJECTIVES: To test patient's satisfaction after consultation in the outpatient area of the Urology Department in a public hospital using a structured interview. METHODS: We used the Comunidad Autónoma de Madrid (CAM) standard interview form modified to include three questions related to the implementation of a 'one-visit'policy and nurses' empowerment. Patients' opinions were gathered with respect to waiting times in the waiting room, facilities, and staff kindness and professionalism. Sample size was estimated in 386 patients. The effect of every predictive factor on the overall satisfaction was tested using the chi square test. To define the effect of every variable in presence of the rest of covariates a logistic regression model was used. RESULTS: Participation reached 65.5%. Overall, 86.4% of the patients were satisfied. Irrespectively of the professional and personal style, the quality perception was homogeneous (p=ns). Multivariate analysis couldn't disclose any independent predictive variable. Only the perception in the item 'overall time available for the consultation' approached statistical significance (p=0.08), with patients scoring high in this variable getting the highest overall satisfaction scores. CONCLUSIONS: There was no personal or professional style particularly related with patient satisfaction. Nevertheless, there is a slight trend towards a higher satisfaction when patients feel enough time has been spent in their consultation. The new organizational resources (one-visit clinic and nurses' empowerment) are both welcome but are not clearly related to patient satisfaction.

Calidad percibida en el area de consultas de un servicio de urologia / Quality perception in the outpatient area of an Urology department. Can we improve it?

OBJETIVO: Establecer el grado de satisfacción de los pacientes tras su visita al área de consultas de un servicio de urología de un hospital público nacional. MÉTODOS: Se utilizó el modelo de encuesta autoaplicado de la Comunidad Autónoma de Madrid (CAM) modificado para recoger tres preguntas relacionadas con la implantación de un modelo de visita única, y con la participación directa de la enfermería en el proceso de producción. Se recogieron las opiniones de los pacientes en relación al tiempo de espera, instalaciones, amabilidad y profesionalidad de los profesionales, y tiempo dedicado a la entrevista. Para el análisis del efecto de cada uno de los factores predictivos sobre el grado de satisfacción, se empleó el test de la chi cuadrado. Para valorar el efecto de las variables predictivas en presencia del resto de covariables se utilizó un modelo de regresión logística. RESULTADOS: La participación fue del 65,5%. Globalmente, el 86,4% de los pacientes manifestaron encontrarse satisfechos con la atención recibida. Con independencia de los estilos profesionales de médicos y enfermeras, la percepción de la calidad fue homogénea (p=ns). En el análisis multivariante no fue posible identificar ninguna variable predictiva independiente. Sólo el tiempo dedicado a la entrevista con el paciente se aproximó a la significación estadística (p=0,08), de modo que, a mayor percepción en esta categoría, mayor probabilidad de satisfacción global. CONCLUSIONES: Ningún estilo profesional (sensación de profesionalidad) ni personal (sensación de amabilidad) se asocia a un mayor grado de satisfacción. Sin embargo, parece existir una tendencia hacia una mayor satisfacción cuando el paciente percibe que se le ha dedicado suficiente tiempo. Las nuevas formas de atención (visita única e implicación de la enfermería) son bienvenidas por los usuarios de un servicio de urología, pero no determinan mayor satisfacción entre los usuarios(AU)

OBJECTIVES: To test patient`s satisfaction after consultation in the outpatient area of the Urology Department in a public hospital using a structured interview. METHODS: We used the Comunidad Autónoma de Madrid (CAM) standard interview form modified to include three questions related to the implementation of ‘one-visit’ policy and nurses’ empowerment. Patients’ opinions were gathered with respect to waiting times in the waiting room, facilities, and staff kindness and professionalism. Sample size was estimated in 386 patients. The effect of every predictive factor on the overall satisfaction was tested using the chi square test. To define the effect of every variable in presence of the rest of covariates a logistic regression model was used. RESULTS: Participation reached 65.5%. Overall, 86.4% of the patients were satisfied. Irrespectively of the professional and personal style, the quality perception was homogeneous (p=ns). Multivariate analysis couldn’t disclose any independent predictive variable. Only the perception in the item ‘overall time available for the consultation’ approached statistical significance (p=0.08), with patients scoring high in this variable getting the highest overall satisfaction scores. CONCLUSIONS: There was no personal or professional style particularly related with patient satisfaction. Nevertheless, there is a slight trend towards a higher satisfaction when patients feel enough time has been spent in their consultation. The new organizational resources (one-visit clinic and nurses’ empowerment) are both welcome but are not clearly related to patient satisfaction(AU)

The one-stop clinic as the standard of out-patient care in a hospital urology department.

PURPOSE: To evaluate the performance of a 'one-stop' clinic in terms of proportion of discharges or inclusion in surgical waiting lists. MATERIALS AND METHODS: All patients were referred from primary care facilities (population 220,646) and from different departments in the hospital. Eight senior urologists, two registered nurses and two nurse attendants participated in the experience. Prior to the start of the project, referral protocols had been agreed with the primary care physicians involved. Compliance with the protocols was periodically tested. Eventually 5537 first visits (January-December 2009) where evaluable. RESULTS: Overall, the 'one-stop' format proved feasible in 74.2% of the patients (4108/5537). Patients, who successfully used the 'one-stop' format, were significantly younger than those who required additional consultations (43 vs 50 years old, respectively, Student 's t test < 0.001). For obvious reasons the 'one-stop' format was universally possible in male sterilization and penile phimosis patients. Similarly, the 'one-stop' policy was applied in most consultations due to male sexual dysfunction (75%) and urinary tract infection (73%). Other health problems, such as haematuria (62%) and renal colic (46%), required more than one visit so that care of the patient reverted to the traditional, outpatient care model. CONCLUSION: A 'one-stop' philosophy is feasible for a number of procedures in a urological outpatient clinic. The costs to implement such an approach would be limited to managerial expenditure.

The one-stop clinic as the standard of out-patient care in a hospital urology department

PURPOSE: To evaluate the performance of a 'one-stop' clinic in terms of proportion of discharges or inclusion in surgical waiting lists. MATERIALS AND METHODS: All patients were referred from primary care facilities (population 220.646) and from different departments in the hospital. Eight senior urologists, two registered nurses and two nurse attendants participated in the experience. Prior to the start of the project, referral protocols had been agreed with the primary care physicians involved. Compliance with the protocols was periodically tested. Eventually 5537 first visits (January-December 2009) where evaluable. RESULTS: Overall, the 'one-stop' format proved feasible in 74.2 percent of the patients (4108/5537). Patients, who successfully used the 'one-stop' format, were significantly younger than those who required additional consultations (43 vs 50 years old, respectively, Student's t test < 0.001). For obvious reasons the 'one-stop' format was universally possible in male sterilization and penile phimosis patients. Similarly, the 'one-stop' policy was applied in most consultations due to male sexual dysfunction (75 percent) and urinary tract infection (73 percent). Other health problems, such as haematuria (62 percent) and renal colic (46 percent), required more than one visit so that care of the patient reverted to the traditional, outpatient care model. CONCLUSION: A 'one-stop' philosophy is feasible for a number of procedures in a urological outpatient clinic. The costs to implement such an approach would be limited to managerial expenditure.

Adverse events and readmissions after day-case urological surgery.

OBJECTIVE: The literature lacks of studies on postoperative outcomes after urological ambulatory surgery. Our study aims to identify parameters associated with postoperative complications within 30 days after ambulatory urological surgery. MATERIALS AND METHODS: Adjusted and unadjusted comparisons between clinical features and postoperative outcome (complicated and uncomplicated). RESULTS: Postoperative course was complicated in 5% of the patients. Discharge schedule was not completed in 1.1% while unplanned visits resulted in admission in 0.5%. Multivariate analyses could only confirm the independent effect of type of anesthesia and diagnosis-related group (DRG) relative weight. CONCLUSIONS: Ambulatory urological surgery can be safe in terms of postoperative complications. In the present study surgery under general anesthesia, or a higher DRG relative weight procedure, increased the risk of complications compared to surgery under regional or local anesthesia or lower DRG relative weight operations. Patients scheduled for general anesthesia or undergoing complex urological procedures should be warned about an increased risk of postoperative incidents and/or readmission.

Adverse events and readmissions after day-case urological surgery

OBJECTIVE: The literature lacks of studies on postoperative outcomes after urological ambulatory surgery. Our study aims to identify parameters associated with postoperative complications within 30 days after ambulatory urological surgery. MATERIALS AND METHODS: Adjusted and unadjusted comparisons between clinical features and postoperative outcome (complicated and uncomplicated). RESULTS: Postoperative course was complicated in 5 percent of the patients. Discharge schedule was not completed in 1.1 percent while unplanned visits resulted in admission in 0.5 percent. Multivariate analyses could only confirm the independent effect of type of anesthesia and diagnosis-related group (DRG) relative weight. CONCLUSIONS: Ambulatory urological surgery can be safe in terms of postoperative complications. In the present study surgery under general anesthesia, or a higher DRG relative weight procedure, increased the risk of complications compared to surgery under regional or local anesthesia or lower DRG relative weight operations. Patients scheduled for general anesthesia or undergoing complex urological procedures should be warned about an increased risk of postoperative incidents and/or readmission.

Effects of escin on indinavir crystallization time in the urine of patients with HIV-I infection: a multicenter, randomized, open-label, controlled, four-period crossover trial.

BACKGROUND: The combination of indinavir, a protease inhibitor, and reverse-transcriptase inhibitors is widely used in the treatment of HIV-1 infection. However, precipitation of indinavir crystals in the renal tubular lumen due to the drug's aqueous insolubility may result in characteristic symptoms of flank pain or classic renal colic. An in vitro study has shown that addition of escin to synthetic urine containing indinavir delayed the crystallization time of indinavir. OBJECTIVE: This study examined the efficacy and tolerability of the addition of escin to highly active antiretroviral therapy containing indinavir to delay the crystallization time of indinavir in urine. METHODS: This was a multicenter, randomized, open-label, controlled, 4-period crossover trial in which each period lasted 4 weeks. HIV-1-infected adults receiving treatment with indinavir plus 2 nucleoside analogue reverse-transcriptase inhibitors in whom plasma viral loads had been undetectable (HIV-1 RNA <200 copies/mL) for at least 6 months were randomly assigned to 1 of 2 groups based on the timing of the initiation of escin. Group I received escin during the second and third treatment periods, and group II received escin during the first and fourth treatment periods. The primary end point was the in vitro crystallization time of indinavir in 24-hour urine specimens, determined at the end of each 4-week period. Tolerability was assessed based on the number of patients with a rebound in plasma viral load and on the numbers of clinically and biologically relevant adverse events (including those requiring discontinuation of treatment). Clinical and laboratory evaluations were performed throughout each 4-week period. RESULTS: Fifty HIV-1-infected patients were enrolled, 47 were randomized to treatment (40 [85.1%] men, 7 [14.9%] women; median [interquartile range] age, 36 [34-45] years), and 30 completed the study. Urine pH and plasma and urine indinavir concentrations were unaffected by the addition of escin to antiretroviral treatment. The mean time to the onset of crystallization was 14.7 minutes with escin (95% Cl, 11.8-17.5) and 9.9 minutes without it (95% Cl, 6.7-13.1). Therefore, the addition of escin increased the mean crystallization time by 5.5 minutes (95% Cl, 1.5-9.5; P = 0.008), representing the overall capacity of study treatment to inhibit indinavir crystallization in the urine. Three of 47 patients had mild gastrointestinal symptoms associated with escin treatment. No episodes of nephrolithiasis were recorded during the study or after the completion of study treatment. CONCLUSION: The results of this prospective clinical trial of the effect of escin on indinavir crystallization time support the possibility that indinavir-associated nephrolithiasis may be prevented by means other than overhydration. Further research is needed in greater numbers of patients over longer follow-up times.

Valor pronóstico de la expresión inmunohistoquímica de la proteína p53 en el cáncer de mama / Prognostic value of immunohistochemical expression of p53 protein in breast cancer

Planteamiento: En este artículo se valora la influencia pronóstica de la expresión imnu-nohistoquírnica de la proteína p53 en el cáncer de mama. Material y métodos: Hemos estudiado 100 casos de carcinoma de mama tratados con mastectomía, en los que investigamos la relación entre la expresión inmunohistoquímica de la proteína p53 y la supervivencia libre de enfermedad y supervivencia global con un seguimiento medio de 52 meses. Resultados: El 25 por ciento de los tumores presentaron inmunotinción nuclear para proteína p53. En el análisis univariante, los casos p53-positivos mostraron una menor supervivencia libre de enfermedad y supervivencia global comparados con los p53-negativos. En el análisis multivariante, la expresión de proteína p53 se asoció de forma independiente con una menor supervivencia libre de enferme-dad y supervivencia global. Conclusiones: La expresión inmunohistoquímica de proteína p53 se ha comportado como un factor independiente de mal pronóstico en el cáncer de mama (AU)

Pérdida de heterocigosidad en la región 9p21 como mecanismo de inactivación del gen supresor p16 / Loss of heterozygosity (LOH) on 9p21 as mechanism of inactivation of the p16 tumor suppresor gene

OBJETIVO: El objetivo de este trabajo es estudiar la LOH en la región 9p21 (locus D9S1747) en una población de pacientes con carcinoma renal mediante el análisis de los polimorfismos de microsatélites. MÉTODO: Hemos estudiado una serie de 40 pacientes diagnosticados de carcinoma renal esporádico, analizando la LOH en 9p21 mediante el análisis de polimorfismos de microsatélites. RESULTADOS: El 23,7 por ciento de los pacientes presentaba LOH en 9p21, no relacionándose esta alteración genética con ninguna de las características tumorales estudiadas. CONCLUSIONES: - En nuestra serie de pacientes el 23,7 por ciento presentaba LOH en la región 9p21 - El 26,9 por ciento de los carcinomas de células renales convencionales presentaban LOH, el 25 por ciento de los carcinomas papilares y el 25 por ciento de los carcinomas de túbulos de Bellini, el resto de los tipos histológicos no presentaban LOH (AU)

Metilación de las islas 5'CpG del gen supresor p16/CDKN2/MTS1 en carcinoma renal / Methylation of 5' CpG island of the tumor suppresor gene p16/CDKN2/MTS-1 in renal carcinoma

OBJETIVO: El carcinoma renal constituye el 2 por ciento de todos los cánceres humanos. En la actualidad se considera el cáncer como el resultado de una acumulación de alteraciones genéticas que afectan a diversos genes con distintas funciones celulares. Estudios genéticos han demostrado la existencia de un gen supresor en el brazo corto del cromosoma 9, en la región 9p21. A este gen se la ha denominado p16 y codifica las proteínas p16 y p19. Una de las formas de inactivación de este gen sin pérdida de material genético es la metilación en secuencias específicas CpG, en la región promotora del gen. MÉTODO: Se estudió una serie de 40 pacientes diagnosticados de carcinoma renal esporádico. Se analizó el estado de metilación del gen p16 mediante el análisis de los polimorfismos de microsatélites en tejido tumoral y en tejido sano del mismo paciente. RESULTADOS: El porcentaje de pacientes con el gen p16 metilado fue del 20 por ciento. Se relacionó esta alteración genética con las características tumorales, y con ninguna de estas variables se demostró asociación, resultando variables independientes. CONCLUSIÓN: El proceso de tumorogénesis requiere la acumulación de alteraciones genéticas en protoncogenes y genes supresores de tumores. Nuestro estudio sugiere que la alteración del gen supresor p16 a través de la hipermetilación de la región promotora del gen, aunque su incidencia sea baja, puede contribuir al desarrollo del cáncer renal (AU)