Clinical decision making in prostate cancer care-evaluation of EAU-guidelines use and novel decision support software.

Keeping up to date with the latest clinical advances in prostate cancer can be challenging. We investigated the impact of guideline use on quality of treatment decisions as well as the impact of a novel, CE-certified clinical decision support tool (Siemens AIPC software) on the amount of time clinicians spend on decision-making in a multicenter setting. Ten urologists assessed ten clinical cases (screening and localized prostate cancer) in three settings: without support, using a digital version of the EAU guidelines, and with the AIPC tool, resulting in 300 clinical decisions. Comparison involved time spent, decision correct- and completeness. Using AIPC compared to digital guidelines led to a significant reduction of expenditure of time at a per case level (3.57 min and 0:14 min, p < 0.01) and for overall time per urologist (39.45 min and 02:20 min, p < 0.01). Decision options without guidelines support, online guideline usage and usage of AIPC were complete in 61%, 80% and 100%, respectively (p < 0.01). Decision making without guidelines support, online guideline usage and usage of AIPC was correct including all options in 28%, 66% and 100%, respectively (p < 0.01).Clinical decision support systems have the potential to reduces decision-making time and to enhance decision quality.

Three-dimensional ultrasound and three-dimensional power Doppler in the assessment of ovarian tumors.

OBJECTIVE: To determine preoperative method that predicts nature of ovarian tumors. METHODS: Fifty patients with complex pelvic masses assessed preoperatively with two-dimensional ultrasound (2DUS), two-dimensional power Doppler (2DPD), three-dimensional ultrasound (3DUS), three-dimensional power Doppler (3DPD), color Doppler. RESULTS: All patients underwent exploration, 19 (38%) had benign tumors, 31 (62%) had ovarian cancer. 2DUS identified 29 cases suspicious for malignancy giving sensitivity, specificity, PPV and accuracy of 80%, 78%, 86%, and 80%. 2DUS with 2DPD identified 28 suspicious cases giving sensitivity, specificity, PPV and accuracy of 80%, 84%, 89%, and 82%. 3DUS identified 31 suspicious cases including 28 cancers giving sensitivity, specificity, PPV and accuracy of 90%, 84%, 90%, and 88%. 3DUS with 3DPD, identified 34 suspicious cases including all 31 cancers giving sensitivity, specificity, PPV and accuracy of 100%, 84%, 91%, and 94%. Color Doppler RI of 0.48 identified 28 cases of 31 cancers giving sensitivity of 90%. CONCLUSION: Evaluation by 3DUS with 3DPD improves diagnostic accuracy of ovarian tumors.

Role of Chlamydia trachomatis and herpes simplex virus in cervicitis and female infertility.

A population of infertile women attending the infertility clinic of Ain Shams university hospital were studied with the purpose of assessing the possible role of C. trachomatis and Herpes simplex virus as factors related to their infertility and coexisting Cervicitis. A control group of fertile women was also examined. C. trachomatis antigen detected by ELISA was found in 2 patients with tubal obstruction and one patient with infertility with normal tube and 3 patients of Control group. The difference between the 3 groups is statistically insignificant. No Cases were recorded positive for Herpes simplex virus infection. C. trachomatis antibodies titer was statistically significant between the 3 groups at titer 1/16, 1/64, 1/256. This study suggests the possibility that high titer of IgG antibody, may serve as a marker of deeply seated infection of C. trachomatis.

Prophylactic intravenous metronidazole in cesarean section.

Prophylactic chemotherapy was given to 100 patients who underwent cesarean section. Ampicillin was given to 50 patients and I.V. metronidazole to the other 50 (in a single dose of 500 mg to 20 and in 3 doses to 30 patients). The overall febrile morbidity was 20%. Metronidazole was superior in reducing febrile morbidity and wound sepsis, compared to ampicillin (P less than 0.05). This study supports the concept of prophylactic chemotherapy being beneficial to the obstetric patient. A single dose of 500 mg I.V. is satisfactory for prophylactic use in cesarean section.