Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 31
Filtrar
1.
Appl Clin Inform ; 15(1): 111-118, 2024 01.
Artigo em Inglês | MEDLINE | ID: mdl-38325408

RESUMO

BACKGROUND: Observational research has shown its potential to complement experimental research and clinical trials by secondary use of treatment data from hospital care processes. It can also be applied to better understand pediatric drug utilization for establishing safer drug therapy. Clinical documentation processes often limit data quality in pediatric medical records requiring data curation steps, which are mostly underestimated. OBJECTIVES: The objectives of this study were to transform and curate data from a departmental electronic medical record into an observational research database. We particularly aim at identifying data quality problems, illustrating reasons for such problems and describing the systematic data curation process established to create high-quality data for observational research. METHODS: Data were extracted from an electronic medical record used by four wards of a German university children's hospital from April 2012 to June 2020. A four-step data preparation, mapping, and curation process was established. Data quality of the generated dataset was firstly assessed following an established 3 × 3 Data Quality Assessment guideline and secondly by comparing a sample subset of the database with an existing gold standard. RESULTS: The generated dataset consists of 770,158 medication dispensations associated with 89,955 different drug exposures from 21,285 clinical encounters. A total of 6,840 different narrative drug therapy descriptions were mapped to 1,139 standard terms for drug exposures. Regarding the quality criterion correctness, the database was consistent and had overall a high agreement with our gold standard. CONCLUSION: Despite large amounts of freetext descriptions and contextual knowledge implicitly included in the electronic medical record, we were able to identify relevant data quality issues and to establish a semi-automated data curation process leading to a high-quality observational research database. Because of inconsistent dosage information in the original documentation this database is limited to a drug utilization database without detailed dosage information.


Assuntos
Curadoria de Dados , Registros Eletrônicos de Saúde , Humanos , Criança , Documentação , Bases de Dados Factuais , Confiabilidade dos Dados
2.
Foodborne Pathog Dis ; 21(2): 71-82, 2024 02.
Artigo em Inglês | MEDLINE | ID: mdl-38099924

RESUMO

The impact of foodborne antimicrobial resistance (AMR) on the human health burden of AMR infections is unknown. The aim of this review was to evaluate and summarize the scientific literature investigating all potential sources of human AMR infections related to food. A literature search was conducted in Embase (Ovid) and MEDLINE (Ovid) databases to identify appropriate studies published between 2010 and 2023. The results of the search were reviewed and categorized based on the primary subject matter. Key concepts from each category are described from the perspective of food safety as a public health objective. The search yielded 3457 references, 1921 remained after removal of duplicates, abstracts, editorials, comments, notes, retractions, and errata. No properly designed source attribution studies were identified, but 383 journal articles were considered relevant and were classified into eight subcategories and discussed in the context of four streams of evidence: prevalence data, epidemiological studies, outbreak investigations and human health impact estimates. There was sufficient evidence to conclude that AMR genes, whether present in pathogenic or nonpathogenic bacteria, constitute a foodborne hazard. The level of consumer risk owing to this hazard cannot be accurately estimated based on the data summarized here. Key gaps in the literature are noted.


Assuntos
Antibacterianos , Farmacorresistência Bacteriana , Humanos , Antibacterianos/farmacologia , Bactérias , Saúde Pública , Inocuidade dos Alimentos
3.
Behav Sci (Basel) ; 13(11)2023 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-37998682

RESUMO

The aim of the present work was the development and validation of a short form of the Experiences in Close Relationship Scale (ECR) in German. Three studies were conducted. In study 1, the best items for the short form were selected from the item pool of the original version based on ant colony optimization (ACO), a recently developed probabilistic approach. Data from three samples collected at a university, an online portal, and a psychosomatic clinic with a total of 1470 participants were analyzed. A 10-item solution resulted, measuring avoidance and anxiety with five items each. This solution showed a good model fit and acceptable reliability in all three samples. The two new short scales were independent of each other. In study 2, the 10-item solution was validated by correlating the new short scales with external criteria. Data from previous studies that included student, community, and clinical samples were reanalyzed. Both short scales showed expected correlations with measures of romantic relationships, personality, psychopathology, and childhood trauma, indicating convergent and discriminant validity. The significant correlations were moderate to strong. In study 3, the selected ten items alone and several content-related scales were presented online to 277 participants, most of them students. The good results in terms of model fit, reliability, and validity observed in studies 1 and 2 could be replicated here. The new short form, called ECR-G-10, allows the measurement of attachment avoidance and anxiety in an economic way in research and clinical practice.

4.
Z Psychosom Med Psychother ; 69(3): 278-292, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37815582

RESUMO

Objectives: The aim of this clinical trial was to explore whether psychodynamic-interactional therapy leads to a better outcome in the treatment of somatoform pain disorders when combined with body therapy. Methods: 30 patients diagnosed with this disorder took part in outpatient group therapies with 25 sessions. In the intervention condition, sessions based on psychodynamic-interactional and body therapy took place in weekly change, while in the control condition all sessions were based on psychodynamic-interactional therapy. Data were collected with self-report measures at the beginning and end of therapy and at the 6-months follow-up. Results: Under both conditions somatic and psychological symptoms merely remained stable from the first to the third measurement time. However, patients expressed a high level of satisfaction with the relationships in the group. Conclusions: Contrary to the assumptions, the two therapy conditions did not differ in the treatment outcome. Both conditions proved successful in providing patients with supporting interpersonal experiences.


Assuntos
Terapia Psicanalítica , Transtornos Psicofisiológicos , Humanos , Dor/psicologia , Autorrelato , Transtornos Somatoformes/diagnóstico , Transtornos Somatoformes/terapia , Transtornos Somatoformes/psicologia , Resultado do Tratamento
5.
Health Promot Int ; 38(5)2023 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-37705493

RESUMO

Recreation and sport settings (RSS) are ideal for health promotion, however, they often promote unhealthy eating. Choice architecture, a strategy to nudge consumers towards healthier options, has not been comprehensively reviewed in RSS and indicators for setting-based multi-level, multi-component healthy eating interventions in RSS are lacking. This scoping review aimed to generate healthy food environment indicators for RSS by reviewing peer-reviewed and grey literature evidence mapped onto an adapted choice architecture framework. One hundred thirty-two documents were included in a systematic search after screening. Data were extracted and coded, first, according to Canada's dietary guideline key messages, and were, second, mapped onto a choice architecture framework with eight nudging strategies (profile, portion, pricing, promotion, picks, priming, place and proximity) plus two multi-level factors (policy and people). We collated data to identify overarching guiding principles. We identified numerous indicators related to foods, water, sugary beverages, food marketing and sponsorship. There were four cross-cutting guiding principles: (i) healthy food and beverages are available, (ii) the pricing and placement of food and beverages favours healthy options, (iii) promotional messages related to food and beverages supports healthy eating and (iv) RSS are committed to supporting healthy eating and healthy food environments. The findings can be used to design nested, multipronged healthy food environment interventions. Future research is needed to test and systematically review the effectiveness of healthy eating interventions to identify the most promising indicators for setting-based health promotion in RSS.


Assuntos
Alimentos , Esportes , Humanos , Bebidas , Dieta Saudável , Política Nutricional
6.
Cell ; 186(17): 3558-3576.e17, 2023 08 17.
Artigo em Inglês | MEDLINE | ID: mdl-37562403

RESUMO

The most extreme environments are the most vulnerable to transformation under a rapidly changing climate. These ecosystems harbor some of the most specialized species, which will likely suffer the highest extinction rates. We document the steepest temperature increase (2010-2021) on record at altitudes of above 4,000 m, triggering a decline of the relictual and highly adapted moss Takakia lepidozioides. Its de-novo-sequenced genome with 27,467 protein-coding genes includes distinct adaptations to abiotic stresses and comprises the largest number of fast-evolving genes under positive selection. The uplift of the study site in the last 65 million years has resulted in life-threatening UV-B radiation and drastically reduced temperatures, and we detected several of the molecular adaptations of Takakia to these environmental changes. Surprisingly, specific morphological features likely occurred earlier than 165 mya in much warmer environments. Following nearly 400 million years of evolution and resilience, this species is now facing extinction.


Assuntos
Briófitas , Mudança Climática , Ecossistema , Aclimatação , Adaptação Fisiológica , Tibet , Briófitas/fisiologia
7.
Child Abuse Negl ; 144: 106372, 2023 10.
Artigo em Inglês | MEDLINE | ID: mdl-37499307

RESUMO

BACKGROUND: There is empirical evidence that childhood trauma is associated with symptom severity and psychosocial functioning in schizophrenia. OBJECTIVE: The present study aimed to further elucidate these associations by examining which subdomains of schizophrenic symptoms and psychosocial functioning are associated with childhood trauma. In addition, it should be tested whether the association between childhood trauma and schizophrenic symptoms is mediated by psychosocial functioning. PARTICIPANTS AND SETTING: Participants of this study were 253 inpatients of five psychiatric hospitals diagnosed with schizophrenia. Clinical interviews were conducted with these patients towards the end of therapy. METHODS: Childhood trauma was assessed with the Childhood Trauma Questionnaire (CTQ), a retrospective self-report scale. Schizophrenic symptoms were measured with the Positive and Negative Syndrome Scale (PANSS) and psychosocial functioning with the Personal and Social Performance Scale (PSP), two measures for ratings by experts. RESULTS: Most participants were affected by childhood trauma, with 91.7 % reporting at least one trauma. Childhood trauma showed small but significant correlations with positive symptoms and general psychopathology, and also with psychosocial functioning in the occupational and social area and in control over aggressive behavior. Psychosocial functioning was shown to mediate the association between childhood trauma and symptom severity, whereby full mediation was found with regard to positive symptoms and partial mediation with regard to general psychopathology. CONCLUSIONS: The findings suggest that good psychosocial functioning mitigates the negative impact of childhood trauma on illness severity in schizophrenic patients. Therapeutic interventions that promote personal and social resources are therefore useful in the treatment of schizophrenia.


Assuntos
Experiências Adversas da Infância , Esquizofrenia , Humanos , Estudos Retrospectivos , Funcionamento Psicossocial , Agressão
8.
Dtsch Arztebl Int ; 120(8): 125-132, 2023 02 24.
Artigo em Inglês | MEDLINE | ID: mdl-36633443

RESUMO

BACKGROUND: Joint Crisis Plans (JCP) and crisis cards (CC) are both instruments designed to improve the management of future psychiatric crisis situations, but they differ, for example, in terms of resource use, legal validity, and aims. International research findings for JCP are inconsistent. METHODS: From January 2018 to December 2020, a single-blinded, two-armed multicenter RCT was carried out, with assessments at T0 (baseline) and T1 (18 months later). The patients included had schizophrenia or schizoaffective disorder and were aged between 18 and 62 years. The primary outcome was the cumulative duration of inpatient treatment (voluntary/involuntary), and coercive measures comprised the secondary outcome. Trial registration: DRKS00013985. RESULTS: Of the 266 study participants, 157 completed the study. In the CC group 57.8% and in the JCP group 64.9% were admitted to psychiatric hospitals between the index treatment and T1 (p = 0.367); 8.4% of the CC group and 12.2% of the JPC group were admitted against their will (p = 0.441). The cumulative treatment duration was not significantly shorter (p = 0.631) in the JPC group (mean 42.43 days, SD = 48.60) than in the CC group (50.16 days, SD = 74.16). Thus, JPCs did not achieve the expected improvement with regard to the primary endpoint. There were also no relevant differences regarding the secondary endpoint. Major effects in favor of the JCP were observed, however, in patients' development of conficence in the treatment teams and in their active participation in the treatment procedure. CONCLUSION: Although the study showed no superiority of JCP over CC with regard to the primary and secondary outcomes, JCP should be used more frequently in routine practice as an intervention to support a participative approach to treatment.


Assuntos
Pacientes Internados , Transtornos Psicóticos , Humanos , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Intervenção em Crise/métodos , Transtornos Psicóticos/epidemiologia , Transtornos Psicóticos/terapia , Psicoterapia , Hospitalização
9.
Ann Clin Psychiatry ; 34(4): 15-22, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36282605

RESUMO

BACKGROUND: The newly developed app TellUs is a digital offering for psychiatric outpatient treatment that includes diagnostic and therapeutic tools. The aim of this study was to test the clinical efficiency and patient satisfaction of TellUs. METHODS: Sixty-four patients with depressive disorder took part in the study for 3 months. The intervention group was treated digitally with TellUs and the control group received visiting treatment (treatment as usual) during that time. RESULTS: In both groups, a significant decrease of depressive symptoms and general strain through psychological symptoms, along with an increase of quality of life in the psychological domain, was shown. Furthermore, both groups were highly satisfied with the treatment. CONCLUSIONS: TellUs was shown to be equivalent to treatment as usual in terms of clinical efficiency and patient satisfaction.


Assuntos
Transtorno Depressivo , Telemedicina , Humanos , Qualidade de Vida , Pacientes Ambulatoriais , Psicoterapia , Transtorno Depressivo/terapia , Transtorno Depressivo/psicologia
10.
Adv Nutr ; 13(6): 2666-2678, 2022 12 22.
Artigo em Inglês | MEDLINE | ID: mdl-35820042

RESUMO

Transparent reporting of nutrition research promotes rigor, reproducibility, and relevance to human nutrition. We performed a scoping review of recent articles reporting dietary folate interventions in mice as a case study to determine the reporting frequency of generic study design items (i.e., sex, strain, and age) and nutrition-specific items (i.e., base diet composition, intervention doses, duration, and exposure verification) in basic nutrition research. We identified 798 original research articles in the EMBASE, Medline, Food Science and Technology Abstracts (FSTA), Global Health, and International Pharmaceutical Abstracts (IPA) databases published between January 2009 and July 2021 in which a dietary folic acid (FA) intervention was used in mice. We identified 312 original peer-reviewed articles including 191 studies in nonpregnant and 126 in pregnant mice. Most studies reported sex (99%), strain (99%), and age (83%). The majority of studies used C57BL/6 (53%) or BALB/c (11%) mice aged 3-9 wk. Nonpregnancy studies were more likely to use only male mice (57%). Dietary FA interventions varied considerably and overlapped: deficiency (0-3 mg/kg), control (0-16 mg/kg), and supplemented (0-50 mg/kg). Only 63% of studies used an open-formula base diet with a declared FA content and 60% of studies verified FA exposure using folate status biomarkers. The duration of intervention ranged from 1 to 104 wk for nonpregnancy studies. The duration of intervention for pregnancy studies was 1-19 wk, occurring variably before pregnancy and/or during pregnancy and/or lactation. Overall, 17% of studies did not report ≥1 generic study design item(s) and 40% did not report ≥1 nutrition-specific study design item(s). The variability and frequent lack of reporting of important generic and nutrition-specific study design details in nutrition studies limit their generalizability, reproducibility, and interpretation. The use of reporting checklists for animal research would enhance reporting quality of key study design and conduct factors in animal-based nutrition research.


Assuntos
Suplementos Nutricionais , Ácido Fólico , Gravidez , Feminino , Masculino , Humanos , Camundongos , Animais , Reprodutibilidade dos Testes , Camundongos Endogâmicos C57BL , Estado Nutricional
11.
J Psychiatr Res ; 148: 121-126, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35123323

RESUMO

Schizophrenia has been shown repeatedly to be associated with a low level of psychosocial functioning. It is assumable that psychosocial functioning is related not only to current, but also to future symptom severity. To test this assumption, a follow-up study with two measurement time points with an interval of 18 months was conducted. In total, 154 inpatients from five psychiatric hospitals with a diagnosis of a schizophrenic disorder took part at both visits. Psychosocial functioning was measured with the Personal and Social Performance Scale (PSP scale) at baseline, and schizophrenic symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS) at baseline and at follow-up. Two PSP subscales, i.e. socially useful activities and control over disturbing and aggressive behavior, turned out to be significant predictors of symptom severity 18 months later. The findings reveal that personal resources in the occupational domain and in adequate interpersonal behavior can have a positive impact on the long-term course of schizophrenia.


Assuntos
Esquizofrenia , Agressão/psicologia , Seguimentos , Humanos , Escalas de Graduação Psiquiátrica , Funcionamento Psicossocial , Esquizofrenia/diagnóstico , Psicologia do Esquizofrênico
12.
Br J Clin Pharmacol ; 88(12): 5017-5033, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-34997627

RESUMO

The safety and efficacy of pharmacotherapy in children, particularly preterms, neonates and infants, is limited by a paucity of good-quality data from prospective clinical drug trials. A specific challenge is the establishment of valid biomarkers. OMICs technologies may support these efforts by complementary information about targeted and nontargeted molecules through systematic characterization and quantitation of biological samples. OMICs technologies comprise at least genomics, epigenomics, transcriptomics, proteomics, metabolomics and microbiomics in addition to the patient's phenotype. OMICs technologies are in part hypothesis-generating, allowing an in depth understanding of disease pathophysiology and pharmacological mechanisms. Application of OMICs technologies in paediatrics faces major challenges before routine adoption. First, developmental processes need to be considered, including a subdivision into specific age groups as developmental changes clearly impact OMICs data. Second, compared to the adult population, the number of patients is limited as are the type and amount of necessary biomaterial, especially in neonates and preterms. Thus, advanced trial designs and biostatistical methods, noninvasive biomarkers, innovative biobanking concepts including data and samples from healthy children, as well as analytical approaches (eg liquid biopsies) should be addressed to overcome these obstacles. The ultimate goal is to link OMICs technologies with innovative analysis tools, such as artificial intelligence at an early stage. The use of OMICs data based on a feasible approach will contribute to the identification complex phenotypes and subpopulations of patients to improve the development of medicines for children with potential economic advantages.


Assuntos
Inteligência Artificial , Pediatria , Humanos , Criança , Bancos de Espécimes Biológicos , Estudos Prospectivos , Metabolômica/métodos , Biomarcadores , Desenvolvimento de Medicamentos
14.
J Nerv Ment Dis ; 208(10): 818-821, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33002937

RESUMO

In recent times, an increasing interest in the role of childhood adversities in schizophrenia can be seen. In this study, 37 schizophrenic patients were compared with 25 individuals from the general population with regard to the quality of parental care and traumatic experiences in childhood. Two self-report scales for retrospective measurement of these variables were used that differentiate between maternal and paternal rejection, emotional warmth and control on the one hand, and trauma subtypes on the other. The schizophrenic patients scored lower regarding both parents' emotional warmth and higher regarding emotional and physical abuse and neglect. Group membership was correctly predicted with these childhood variables in 83% of cases, with the mother's emotional warmth being the best predictor. The findings underline the relevance of childhood adversities in schizophrenic diseases in adulthood, with special emphasis on the role of emotional acceptance from the primary caregiver.


Assuntos
Sobreviventes Adultos de Maus-Tratos Infantis/estatística & dados numéricos , Experiências Adversas da Infância/estatística & dados numéricos , Relações Pai-Filho , Relações Mãe-Filho/psicologia , Poder Familiar , Esquizofrenia/epidemiologia , Psicologia do Esquizofrênico , Adulto , Sobreviventes Adultos de Maus-Tratos Infantis/psicologia , Experiências Adversas da Infância/psicologia , Estudos de Casos e Controles , Feminino , Humanos , Modelos Logísticos , Masculino , Fatores de Risco , Adulto Jovem
15.
Int J Bipolar Disord ; 8(1): 10, 2020 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-32115670

RESUMO

BACKGROUND: Child maltreatment has been shown to be associated with a wide range of mental disorders, including bipolar disorders. In this 2-year follow-up study, recollections of emotional, physical and sexual abuse were related to bipolar symptoms, namely depressive, hypomanic and manic symptoms. METHODS: The sample consists of 134 students who took part at five measurement times within the 2-year period. Data were collected with self-report scales. RESULTS: The results show that recollections of abuse, particularly emotional abuse, were associated with more severe depressive symptoms; this finding, however, only applied to women. Hypomanic and manic symptoms were not associated with recollections of abuse. For hypomanic symptoms, however, a significant decrease over the 2 years was observed. CONCLUSIONS: The findings of this study suggest that recollections of abusive experiences in childhood combined with female gender increase the risk for depression, whereas hypomanic and manic states are probably better predicted by other factors, such as current life circumstances.

16.
J Cancer Res Clin Oncol ; 145(7): 1835-1843, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31006846

RESUMO

INTRODUCTION: Based on the observation of beneficial effects on cancer metabolism, microenvironment, or VEGF-signaling, several non-anticancer drugs have been discussed as useful in renal cell carcinoma (RCC). In the present study, we investigated the prognostic impact of concomitant medication in RCC and correlated comedication with cell-cycle and proliferation activity in corresponding surgical specimen. METHODS: A total of 388 patients who underwent surgery for localized RCC were included. The individual medication was evaluated according to substance classes. Tissue microarrays from corresponding tumor specimen were immunohistochemically (IHC) stained for Cyclin D1 and Ki67 and semi-quantitatively evaluated. Uni- and multivariate analyses were used to compare survival outcomes. For the comparison of IHC expression according to medication subgroups, Kruskal-Wallis analysis was performed. RESULTS: Median follow-up was 57.93 months (95% CI 53.27-69.43) and median OS accounted for 181.12 months (129.72-237.17). Univariate analysis identified pathological standard variables (T-stage > T2, Grading > G2, L1, N1, M1, sarcomatoid subtype, necrosis) as significant determinants of OS. Moreover, statin use (p = 0.009) and sartan use (p = 0.032) were significantly associated with improved OS. Multivariate analysis identified M1-stage (p < 0.001), statin and sartan use (p = 0.003 and p = 0.033, respectively) as independent prognosticators of survival. Expression of Ki67 was significantly reduced in patients with statin use (p = 0.013), while Cyclin D1 expression showed no correlation with comedication. CONCLUSIONS: Concomitant intake of statins and sartans identifies as an independent predictor of OS in RCC, and reduced Ki67 expression was significantly associated with statin use. Further evaluation of drug repurposing approaches with these substances in RCC appear warranted.


Assuntos
Carcinoma de Células Renais/patologia , Carcinoma de Células Renais/cirurgia , Neoplasias Renais/patologia , Neoplasias Renais/cirurgia , Preparações Farmacêuticas/administração & dosagem , Adolescente , Antagonistas Adrenérgicos beta/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/administração & dosagem , Ciclo Celular/efeitos dos fármacos , Proliferação de Células/efeitos dos fármacos , Diuréticos/administração & dosagem , Feminino , Humanos , Hipoglicemiantes/administração & dosagem , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Adulto Jovem
17.
Clin Lab ; 65(1)2019 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-30775903

RESUMO

BACKGROUND: Prostate specific antigen (PSA) and free PSA (fPSA) are important tools for diagnosing prostate cancer (PC). Efforts are continuously undertaken to provide more patient-centered healthcare. The application of point-of-care (POC) systems for laboratory analyses represents a step in this direction. Previous investigations on total PSA measurements using a POC system (concile® Ω100 POC reader) showed good concordance with standard laboratory measurements. For the same POC reader a novel system for fPSA was developed. In the current study, we prospectively evaluated the quality of the POC system for fPSA. METHODS: Sixty-four patients undergoing PSA measurements in our outpatient clinic between 06/2015 and 09/2015 were enrolled in the study. We measured total PSA (tPSA) and fPSA with a POC reader system (concile® Ω100) and a standard laboratory system (Siemens Immulite 2000®) and compared the respective results using linear regression analyses for PSA, fPSA, and fPSA/tPSA ratio (%fPSA). RESULTS: The coefficients of determination (r²) for fPSA and %fPSA were 0.85 (p < 0.001) and 0.82 (p < 0.001) in the subgroup with total PSA between 4 and 10 ng/mL. In the subgroup with tPSA ≤ 4 ng/mL, r² for fPSA concile® was 0.55 (p < 0.001) and 0.10 (p = 0.088) for %fPSA. In the subgroup of tPSA > 10 ng/mL the r² for fPSA and %fPSA was 0.50 (p = 0.022) and 0.50 (p = 0.022), respectively. CONCLUSIONS: The POC fPSA values correlated well with the laboratory analyses, specifically in the clinically relevant diagnostic range of tPSA 4 - 10 ng/mL. These results complement the tPSA data obtained previously and indicate the reliability of the fPSA method and the resulting %fPSA score.


Assuntos
Sistemas Automatizados de Assistência Junto ao Leito , Testes Imediatos/estatística & dados numéricos , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Testes Imediatos/normas , Neoplasias da Próstata/diagnóstico , Valores de Referência , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
18.
Eur Urol Focus ; 5(5): 906-911, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29802051

RESUMO

BACKGROUND: The number of virtual reality (VR) simulators is increasing. The aim of this prospective trial was to determine the benefit of VR cystoscopy (UC) and transurethral bladder tumor resection (TURBT) training in students. DESIGN, SETTING, AND PARTICIPANTS: Medical students without endoscopic experience (n=51, median age=25 yr, median 4th academic year) were prospectively randomized into groups A and B. After an initial VR-UC and VR-TURBT task, group A (n=25) underwent a video-based tutorial by a skilled expert. Group B (n=26) was trained using a VR training program (Uro-Trainer). Following the training, every participant performed a final VR-UC and VR-TURBT task. Performance indicators were recorded via the simulator. Data was analyzed by Mann-Whitney U test. INTERVENTION: VR cystoscopy and TURBT. RESULTS AND LIMITATIONS: No baseline and post-training differences were found for VR-UC between groups. During baseline, VR-TURBT group A showed higher inspected bladder surface than group B (56% vs 73%, p=0.03). Subgroup analysis detected differences related to sex before training (male: 31.2% decreased procedure time; 38.1% decreased resectoscope movement; p=0.02). After training, significant differences in procedure time (3.9min vs 2.7min, p=0.007), resectoscope movement (857mm vs 529mm, p=0.005), and accidental bladder injury (n=3.0 vs n=0.88, p=0.003) were found. Male participants showed reduced blood loss (males: 3.92ml vs females: 10.12ml; p=0.03) after training. CONCLUSIONS: Measuring endoscopic skills within a virtual environment can be done easily. Short training improved efficacy and safety of VR-TURBT. Nevertheless, transfer of improved VR performance into real world surgery needs further clarification. PATIENT SUMMARY: We investigated how students without endoscopic experience profit from simulation-based training. The safe environment and repeated simulations can improve the surgical training. It may be possible to enhance patient's safety and the training of surgeons in long term.


Assuntos
Internato e Residência , Treinamento por Simulação , Neoplasias da Bexiga Urinária/cirurgia , Procedimentos Cirúrgicos Urológicos/educação , Urologia/educação , Realidade Virtual , Adulto , Feminino , Humanos , Masculino , Estudos Prospectivos , Uretra , Procedimentos Cirúrgicos Urológicos/métodos , Adulto Jovem
19.
World J Urol ; 36(12): 2059-2063, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29869701

RESUMO

INTRODUCTION: Retrograde intrarenal surgery (RIRS) represents a standard option for kidney stone removal. However, RIRS is considered a cost-intensive procedure. Single-use flexible ureterorenoscopes have been introduced to improve budget predictability in RIRS. We assessed differences in physical and optical properties of single-use devices compared to standard reusable endoscopes. METHODS: In two single-use (LithoVue™, Boston Scientific; Pusen Uscope UE3011™), and one reusable ureterorenoscope (Flex-Xc™, Karl Storz), we investigated flow rates, deflection, illuminance, and intrapelvic pressure in a porcine kidney model. Subjective image quality was assessed using a standardized questionnaire. Common insertable devices were applied to investigate additional influence on physical properties. RESULTS: Significant variability in maximum flow rates was observed (Flex-Xc™: 25.8 ml/min, LithoVue™: 30.3 ml/min, Pusen™: 33.4 ml/min, p < 0.05). Insertion of a guide wire resulted in the highest reduction of flow rates in all endoscopes. Flection led to a reduction of absolute flow rates up to 9.4% (Flex-Xc™). Light intensity at 20/50 mm distance was 9090 lx/1857 lx (Flex-Xc™) and 5733 lx/1032 lx (LithoVue™) and 2160 lx/428 lx (Pusen™), respectively (p < 0.05). Subjective image quality score was highest using the Flex-Xc™ endoscope. During manipulation, maximum intrarenal pressure up to 66 mmHg (Pusen™) was measured. CONCLUSIONS: Significant differences in physical and optical properties of single-use or reusable flexible ureterorenoscopes are present, with putative influence on surgical efficacy and complications. Further comparative evaluation of single-use and reusable endoscopes in a clinical scenario is useful. Moreover, utilization of ureteral access sheaths may be considered to avoid renal damage.


Assuntos
Reutilização de Equipamento , Cálculos Renais/cirurgia , Rim/cirurgia , Ureteroscópios , Animais , Endoscópios , Suínos
20.
Eur J Surg Oncol ; 44(1): 178-184, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29108960

RESUMO

OBJECTIVE: To investigate whether the length of ileum used for ileal orthotopic neobladder (ONB) reconstruction (60 cm vs. 40 cm) after radical cystectomy (RC) for bladder cancer (BC) impacts on bowel function, postoperative complications or survival outcome. MATERIAL AND METHODS: In this retrospective study, we included 56 patients who received an ONB (Studer (S)-Pouch: 23 patients; I-Pouch: 33 patients) after RC for BC between 2003 and 2011. Preoperative comorbidities were assessed by the Charlson Comorbidity Index (CCI) and surgical complications as graded by the Clavien-Dindo classification. Changes of perioperative bowel habits were retrospectively evaluated by the validated Gastrointestinal Quality of Life Index (GIQLI). Kaplan-Meier analyses calculated survival outcomes between both ONB types. RESULTS: Preoperative CCI was comparable between S- and I-pouch patients. No significant differences were observed for 30-day major- (p = 0.33) and minor (p = 0.96) complication rates between both neobladder types. S-Pouch patients reported higher preoperative stool frequencies (S-pouch: mean 2.7; I-pouch: mean 3.4; p = 0.049) and tended to suffer from urgency (S: mean 2.9; I: mean 3.4; p = 0.059). No significant differences in postoperative bowel disorders were found between both neobladder types (S-Pouch: 15.9, IQR; I-Pouch: 16.6 IQR; p = 0.84). Furthermore, we observed no overall-, cancer specific- or recurrence free survival advantage for either of both ONB variants (p = 0.81; 0.65 and 0.78), respectively. CONCLUSION: Comorbidities, perioperative complication rates and bowel habits were similar between both ONB substitutes and did not influence survival outcomes. These stratified data suggest that the length of ileum used for ONB reconstruction (60- vs. 40 cm) does not impact per se on postoperative bowel function.


Assuntos
Cistectomia/métodos , Defecação/fisiologia , Neoplasias da Bexiga Urinária/cirurgia , Bexiga Urinária/cirurgia , Derivação Urinária/métodos , Coletores de Urina , Idoso , Feminino , Seguimentos , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Morbidade/tendências , Período Perioperatório , Período Pós-Operatório , Qualidade de Vida , Estudos Retrospectivos , Resultado do Tratamento , Bexiga Urinária/diagnóstico por imagem , Neoplasias da Bexiga Urinária/diagnóstico , Neoplasias da Bexiga Urinária/epidemiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA