Web-based clinical pathway for reducing practice variations in radical prostatectomy.

BACKGROUND: A clinical pathway support system on the Internet (CPSSI) has been designed for creating and implementing a web-based clinical pathway for radical prostatectomy. This investigation assessed the effects of the web-based clinical pathway for radical prostatectomy on practice variations. METHODS: From June 2002 to Jun 2003, 22 consecutive patients with localized prostate cancer who underwent radical prostatectomy were treated according to the web-based clinical pathway. The treatment results were compared with an identically sized sample of patients treated during the year before implementing the web-based clinical pathway. Variations before and following the implementation of the web-based clinical pathway for radical prostatectomy were also assessed. The CPSSI automatically measured pathway variations and length of hospital stay. RESULTS: After implementing the web-based clinical pathway, the average hospital stay was reduced significantly (p=0.0001). The mean number of variations also differed markedly (p=0.0002). CONCLUSION: This study concludes that the CPSSI-based clinical pathway support system may provide a good tool for creating and implementing a web-based clinical pathway. After implementing the web-based clinical pathway for radical prostatectomy, practice variations and length of stay were reduced considerably. Moreover, automatically assessing the effects of web-based clinical pathway implementation can enhance the quality of patient care.

Synchronous primary carcinomas of the bladder and prostate.

AIM: To determine the incidence of adenocarcinoma of the prostate for patients undergoing radical cystoprostatectomy for bladder cancer in Taiwan. METHODS: A total of 248 patients in Taiwan who were histologically confirmed for transitional cell carcinoma of the bladder underwent cystoprostatectomy. Histopathologic evaluation of the prostate specimens sectioned at 5 mm intervals was performed. RESULTS: Of the 248 patients, 10 (4.03%) were found to have prostate cancer. Of the 10 cases of unsuspected prostate cancer, eight proved to be at stage T1 or T2, and two at T3 and T4, respectively. This rate of incidentally found prostate cancer amongst our bladder cancer patients appeared to be lower than that found in bladder cancer patients in similar studies in USA. CONCLUSION: Although the incidence of incidental prostate cancer in patients in Taiwan with bladder cancer is not high compared with that in Western countries, we suggest that digital rectal examination and prostate-specific antigen (PSA) are important screening tools for men with bladder cancer, especially for those aged 60 years and older in Taiwan.