Impact of Telemedicine Tools on Record Keeping and Compliance in Haemophilia Care.

BACKGROUND: Record keeping is integral to home treatment for haemophilia. Issues with paper diaries include questionable compliance, data validity and quality. Implementation of electronic diaries (e-diaries) in haemophilia patients could improve documentation of home treatment. AIM: This article evaluates the effects of an e-diary, Haemoassist, on recording and patient compliance with therapy. PATIENTS AND METHODS: An explorative study was used to assess the sequential use of paper diaries and e-diaries by 99 patients with severe haemophilia A or B and 1 with severe factor VII deficiency. Median age was 41 years. Information was obtained from paper records for 3 years preceding the introduction of an electronic record system and the first 6 to 12 months of Haemoassist use. Data from the 3-year period were averaged. Missing data for rounded 12 months of e-diary use were extrapolated to correspond to a full year. RESULTS: Enhancement of 23% in record delivery was observed for the period of Haemoassist use (p = 0.013). Twenty-one percent increase in patients' compliance for data reporting (from 65% 35 to 86% 22, p = 0.003) and 16% increase for documentation of bleedings (from 68 to 84% of patients, p = 0.01) were detected. Compliance to prescribed therapy of patients for the whole studied period improved by 6% (from 82% ± 29 to 88% ± 25, p = 0.05). Major advances were demonstrated predominantly in the age groups of between 13 and 20 and 21 and 40 years. CONCLUSION: e-Diaries' use enables improved recording of information about patients' home treatment and bleeding episodes. Enhanced compliance with therapy may be a further benefit.

Overall survival in carcinoma of the penis--a single institution study.

PURPOSE: This retrospective study was performed to evaluate the overall survival (OS) and to identify some prognostic factors and their influence on the survival of patients with squamous cell carcinoma of the penis (SCCP). PATIENTS AND METHODS: Fifty-nine patients with SCCP, treated at the Clinic of Urology, Medical University, Plovdiv, between 1980 and 2005, were studied. The patients' OS was estimated by the Kaplan-Meier life table method. Log-rank test was used to compare cumulative survival functions between different groups of patients. RESULTS: During a mean follow-up period of 7.06+/-0.97 years (range 2 months-26 years; median 4 years) 37 (62.71%) patients died (SCCP progression 29, intercurrent illness 7, other cause 1), giving a mean survival time of 12.56 years )95% confidence interval [CI] = 9.46-15.67; median 14 years). The 5-year OS was 62.19%. The main adverse prognostic factors significantly affecting the OS were: age (p= 0.0199), pathological (p) T stage (p= 0.0001), pN status (p= 0.0046) and pN stage (p= 0.0001). CONCLUSION: The prognostic factors identified in this study are of great importance for the clinical practice, especially for decision making over the treatment strategy involving primary tumor and regional lymph nodes.

Penile cancer--surgical treatment of the primary tumor.

OBJECTIVE: To present our experience in the surgical treatment of primary tumor in penile cancer based on the accepted oncologic principles and indications for the existing surgical methods of treatment. MATERIAL AND METHODS: A retrospective analysis of 54 patients with histologically proven malignant penile cancer treated surgically at the Urology department of MHAT "St George", Plovdiv between 1975 and April 2001. RESULTS: Fifty patients were treated with 53 operations performed. Penile amputations were significantly more than penile-preserving operations. DISCUSSION: Differentiation and tumor stage are paramount in the choice of surgical strategy for penile cancer.

[The C-reactive protein level of patients after the extracorporeal lithotripsy of urinary calculi]. / Nivo na C-reaktivniia protein pri bolni sled ELPK.

Within 24 to 48 hours of sustaining a variety of severe clinical conditions, such as general bacterial infection, tissue necrosis, acute rheumatism, myocardial infarction, active pulmonary tuberculosis and neoplastic processes, the serum level of C-reactive protein may show a considerable increase. It may also serve as a criterion for the evolution of the disease, and for the effect of the therapy in course. The task undertaken is to use the serum level of C-reactive protein as a criterion for evaluating the extent of renal parenchyma damage following extracorporeal lithotripsy of urinary calculi (ELUC). Proceeding from the results of the study, it is assumed that ELUC is a nontraumatic operative intervention for the renal parenchyma. In case of extreme increase in C-reactive protein level, a higher incidence rate of post-ELUC complications may be anticipated.