Recommendations for blood sampling in emergency departments from the European Society for Emergency Medicine (EUSEM), European Society for Emergency Nursing (EuSEN), and European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) Working Group for the Preanalytical Phase. Executive summary.

AIM: Blood Sampling Guidelines have been developed to target European emergency medicine-related professionals involved in the blood sampling process (e.g. physicians, nurses, phlebotomists working in the ED), as well as laboratory physicians and other related professionals. The guidelines population focus on adult patients. The development of these blood sampling guidelines for the ED setting is based on the collaboration of three European scientific societies that have a role to play in the preanalytical phase process: EuSEN, EFLM, and EUSEM. The elaboration of the questions was done using the PICO procedure, literature search and appraisal was based on the GRADE methodology. The final recommendations were reviewed by an international multidisciplinary external review group. RESULTS: The document includes the elaborated recommendations for the selected sixteen questions. Three in pre-sampling, eight regarding sampling, three post-sampling, and two focus on quality assurance. In general, the quality of the evidence is very low, and the strength of the recommendation in all the questions has been rated as weak. The working group in four questions elaborate the recommendations, based mainly on group experience, rating as good practice. CONCLUSIONS: The multidisciplinary working group was considered one of the major contributors to this guideline. The lack of quality information highlights the need for research in this area of the patient care process. The peculiarities of the emergency medical areas need specific considerations to minimise the possibility of errors in the preanalytical phase.

Women and intimate partner violence: Prevalence of hospital visits and nature of injuries in the Icelandic population.

Aims: The purpose of this study was to analyse the prevalence of hospital visits and nature of injuries caused by intimate partner violence (IPV) against women and associated costs. Methods: All visits to Landspitali National University Hospital by women 18 years or older subjected to IPV, inflicted by a current or former male partner during 2005-2014, were observed and analysed. Information was obtained on number, date and time of visits and admissions, place of occurrence, patients' and perpetrators' age and relationship, number of perpetrators, medical diagnosis, aetiology, injury severity and cost. Results: The number of new hospital visits due to IPV was 1454, of which 92.6% were to the Emergency Department. The average age of the women was 34 years and 3.2% were admitted. According to the Injury Severity Score, physical injuries were mostly minor (92.4%) and mainly located on the upper body (64.3%) - namely, face, head and neck (37.1%) and upper limbs (27.2%). The majority of injuries were superficial (76.2%) and punching (29.7%), shoving (17.8%), kicking (10.5%) and attempted strangulation (9.8%) were the most common types of aetiology. Repeated new visits were 37.8%. The total cost for the hospital relating to IPV was €783,330. Conclusions: The total number of new visits resulting from IPV was 1454, and prevalence was 1.69 per 1000 women in the capital area over the research period. The majority of women were shown to have minor physical injuries of a superficial nature, located on the upper body. Although a low percentage of women were admitted, the associated cost for visits and admissions was substantial.

Associations between intraoperative factors and surgeons' self-assessed operative satisfaction.

BACKGROUND: Little is known concerning what may influence surgeon satisfaction with a surgical procedure and its associations with intraoperative factors. The objective was to explore the relationships between surgeons' self-assessed satisfaction with performed radical prostatectomies and intraoperative factors such as technical difficulties and intraoperative complications as reported by the surgeon subsequent to the operation. METHODS: We utilized prospectively collected data from the controlled LAPPRO trial where 4003 patients with prostate cancer underwent open (ORP) or robot-assisted laparoscopic (RALP) radical prostatectomy. Patients were included from fourteen centers in Sweden during 2008-2011. Surgeon satisfaction was assessed by questionnaires at the end of each operation. Intraoperative factors included time for the surgical procedure as well as difficulties and complications in various steps of the operation. To model surgeon satisfaction, a mixed effect logistic regression was used. Results were presented as odds ratios (OR) with 95% confidence intervals (CI). RESULTS: The surgeons were satisfied in 2905 (81%) and dissatisfied in 702 (19%) of the surgical procedures. Surgeon satisfaction was not statistically associated with type of surgical technique (ORP vs. RALP) (OR 1.36, CI 0.76; 2.43). Intraoperative factors such as technical difficulties or complications, for example, suturing of the anastomosis was negatively associated with surgeon satisfaction (OR 0.24, CI 0.19; 0.30). CONCLUSIONS: Our data indicate that technical difficulties and/or intraoperative complications were associated with a surgeon's level of satisfaction with an operation.

Suicide rates in Iceland before and after the 2008 Global Recession: a nationwide population-based study.

BACKGROUND: Economic downturns have been associated with increased suicide rates. The 2008 global financial crisis varied across countries but hit Iceland relatively hard. We aimed to study potential changes in suicide rates in Iceland during this major economic transition. METHODS: Data were retrieved on all suicides in Iceland during 2002-14. The study period was divided into a pre-collapse period (2002-08) and a post-collapse period (2008-14). Poisson regression models were used to estimate the association between pre-to-post economic collapse and suicide rates, expressed as risk ratios (RR) with 95% confidence intervals (CIs). Analyses were stratified by age and sex. RESULTS: A total of 470 suicides were recorded during the study period. The mean age at death was 45 years and 75% were males. The overall suicide rates per 100 000 were 13.3 pre-collapse and 15 post-collapse revealing no overall differences in pre-to-post collapse (RR 1.12; CI 0.94-1.35). This was true for both men and women (RR 1.18; CI 0.96-1.46 and RR 0.96; CI 0.67-1.38, respectively). An increase in the unemployment rate was not associated with the overall suicide rate (RR 1.07; CI 0.86-1.33), and neither were changes in gross domestic product (RR 1.29; CI 0.94-1.79) or balance of trade (RR 1.08; CI 0.96-1.22). CONCLUSION: The economic collapse and rising unemployment rates in Iceland did not result in an overall increase in suicide rates. A strong welfare system and investing in social protection during the economic crisis may have mitigated suicide risk.

Social constraints and psychological well-being after prostate cancer: A follow-up at 12 and 24 months after surgery.

OBJECTIVE: Studies indicate that social constraints (barriers to emotional expression) may be a risk factor for psychological morbidity. We aimed to investigate the association between prostate cancer-related social constraints and psychological well-being following prostate cancer surgery. METHODS: In a group of 3478 partnered patients, participating in the Laparoscopic Prostatectomy Robot Open trial, a prospective multicenter comparative study of robot-assisted laparoscopic and retropubic radical prostatectomy for prostate cancer, we used log-binomial regression analysis to investigate the links between prostate cancer-related social constraints at 3 months after surgery and psychological well-being at 12 and 24 months. RESULTS: A total of 1086 and 1093 men reported low well-being at 12 and 24 months, respectively. Prostate cancer-related social constraints by partner predicted low psychological well-being at 12 months (adjusted RR: 1.4; 95% CI, 1.1-1.9) and by others (adjusted RR: 1.9; 95% CI, 1.1-3.5). Intrusive thoughts mediated the association. CONCLUSIONS: Negative responses from the social environment, especially from partner to talking about the prostate cancer experience affected patients' psychological well-being 2 years after radical prostatectomy. Results emphasize the importance of helping patients mobilize psychosocial resources within their social network, especially among those with a lack of quality psychosocial support.

Thinking about one's own death after prostate-cancer diagnosis.

BACKGROUND: Prostate-cancer diagnosis increases the risk for psychiatric morbidity and suicide. Thoughts about one's own death could indicate need for psychiatric care among men with localized prostate cancer. We studied the prevalence and predictors of thoughts about own death among men with prostate cancer. METHODS: Of the 3930 men in the prospective, multi-centre LAPPRO-trial, having radical prostatectomy, 3154 (80%) answered two study-specific questionnaires, before and three months after surgery. Multivariable prognostic models were built with stepwise regression and Bayesian Model Averaging. RESULTS: After surgery 46% had thoughts about their own death. Extra-prostatic tumor-growth [Adjusted Odds-Ratio 2.06, 95% Confidence Interval 1.66-2.56], university education [OR 1.66, CI 1.35-2.05], uncertainty [OR 2.20, CI 1.73-2.82], low control [OR 2.21, CI 1.68-2.91], loneliness [OR 1.75, CI 1.30-2.35], being a burden [OR 1.59, CI 1.23-2.07], and crying [OR 1.55, CI 1.23-1.96] before surgery predicted thoughts about one's own death after surgery. CONCLUSIONS: We identified predictors for thoughts about one's own death after prostate cancer diagnosis and surgery. These factors may facilitate the identification of psychiatric morbidity and those who might benefit from psychosocial support already during primary treatment.

Care-related predictors for negative intrusive thoughts after prostate cancer diagnosis-data from the prospective LAPPRO trial.

OBJECTIVE: Negative intrusive thoughts about one's prostate cancer have been associated with depressive mood and impaired quality of life among prostate cancer patients. However, little is known about possible predictors for negative intrusive thoughts among this group. We aimed to identify health- and care-related predictors for such thoughts among a population of men newly diagnosed with prostate cancer and undergoing radical prostatectomy. METHODS: In the LAPPRO-trial, 3154 men (80%) answered study-specific questionnaires at admission and 3 months after surgery. Questions concerned socio-demographics, health, uncertainty, preparedness for symptoms, and the outcome-negative intrusive thoughts. Associations between variables were analyzed by log-binominal and multivariable approach. RESULTS: The strongest predictor of negative intrusive thoughts at admission to surgery was uncertainty of cure, followed by binge drinking, poor physical health, antidepressant medication, not being prepared for urinary symptoms, age under 55, and physical pain. Reporting it not probable to obtain urinary symptoms after surgery lowered the odds. Negative intrusive thoughts before surgery were the strongest predictor for such thoughts 3 months later followed by uncertainty of cure, physical pain, younger age, living alone, and poor self-reported physical health. CONCLUSIONS: Our findings showed an association of preoperative uncertainty of cure as well as low preparedness for well-known surgery-induced symptoms with higher occurrence of negative intrusive thoughts about prostate cancer. Future studies should examine if interventions designed to have healthcare professionals inform patients about their upcoming prostatectomy reduce patients' negative intrusive thoughts and thereby, improve their psychological well-being.

How badly did it hit? Self-assessed emotional shock upon prostate cancer diagnosis and psychological well-being: a follow-up at 3, 12, and 24 months after surgery.

BACKGROUND: We were interested in examining if there was a link between self-assessed emotional shock by prostate cancer diagnosis and psychological well-being at 3, 12, and 24 months after surgery. MATERIAL AND METHODS: Information was derived from patients participating in the LAPAroscopic Prostatectomy Robot Open (LAPPRO) trial, Sweden. We analyzed the association between self-assessed emotional shock upon diagnosis and psychological well-being by calculating odds ratios (ORs). RESULTS: A total of 2426 patients (75%) reported self-assessed emotional shock by the prostate cancer diagnosis. Median age of study participants was 63. There was an association between emotional shock and low psychological well-being after surgery: adjusted OR 1.7: (95% confidence interval [CI]), 1.4-2.1 at 3 months; adjusted OR 1.3: CI, 1.1-1.7 at 12 months, and adjusted OR 1.4: CI, 1.1-1.8 at 24 months. Among self-assessed emotionally shocked patients, low self-esteem, anxiety, and having no one to confide in were factors more strongly related with low psychological well-being over time. CONCLUSION: Experiencing self-assessed emotional shock by prostate cancer diagnosis may be associated with low psychological well-being for up to two years after surgery. Future research may address this high rate of self-assessed emotional shock after diagnosis with the aim to intervene to avoid this negative experience to become drawn out.

Suicide attempts and self-harm during a dramatic national economic transition: a population-based study in Iceland.

Background: Macroeconomic downturns have been associated with increased suicide rates. This study examined potential changes in suicide attempts and self-harm in Iceland during a period of major economic transition (2003-12). Methods: Data were retrieved from the National University Hospital in Reykjavik (population size: 204.725), containing all ICD-10 diagnoses connected to potential suicidal behaviour. Poisson regression models were used to compare attendance rates before and after the 2008 economic collapse. Results: During the study period, a total of 4537 attendances of 2816 individuals were recorded due to suicide attempts or self-harm. We noted a significant change in total attendance rates among men, characterized by an annual increase in attendance rate pre-collapse of 1.83 per 100.000 inhabitants and a decrease of 3.06 per 100.000 inhabitants post-collapse ( P = 0.0067). Such pattern was not observed among women. When restricting to first attendances only, we found a reduced incidence post-crisis among both men (RR: 0.85; 0.76-0.96) and women (RR: 0.86; 0.79-0.92). We further found 1% increase in unemployment rate and balance of trade to be associated with reduced attendance rates among men (RR: 0.84; 0.76-0.93 and RR: 0.81; 0.75-0.88, respectively) but not among women. Conclusion: These data suggest no overall increase in attendance rates due to suicide attempts or self-harm following the 2008 Icelandic economic collapse. In fact, a high-point in self-harm and suicide attempts was observed among men at the height of the economic boom and a decrease in new attendances among both men and women after the economic collapse.

Oncological and functional outcomes 1 year after radical prostatectomy for very-low-risk prostate cancer: results from the prospective LAPPRO trial.

OBJECTIVES: To analyse oncological and functional outcomes 12 months after treatment of very-low-risk prostate cancer with radical prostatectomy in men who could have been candidates for active surveillance. PATIENTS AND METHODS: We conducted a prospective study of all men with very-low-risk prostate cancer who underwent radical prostatectomy at one of 14 participating centres. Validated patient questionnaires were collected at baseline and after 12 months by independent healthcare researchers. Biochemical recurrence (BCR) was defined as prostate-specific antigen (PSA) ≥0.25 ng/mL or treatment with salvage radiotherapy or with hormones. Urinary continence was defined as <1 pad changed per 24 h. Erectile function was defined as ability to achieve erection hard enough for penetration more than half of the time after sexual stimulation. Changes in tumour grade and stage were obtained from pathology reports. We report descriptive frequencies and proportions of men who had each outcome in various subgroups. Fisher's exact test was used to assess differences between the age groups. RESULTS: Of the 4003 men in the LAPPRO cohort, 338 men fulfilled the preoperative national criteria for very-low-risk prostate cancer. Adverse pathology outcomes included upgrading, defined as pT3 or postoperative Gleason sum ≥7, which was present in 35% of the men (115/333) and positive surgical margins, which were present in 16% of the men (54/329). Only 2.1% of the men (7/329) had a PSA concentration >0.1 ng/mL 6-12 weeks postoperatively. Erectile function and urinary continence were observed in 44% (98/222) and 84% of the men (264/315), respectively, 12 months postoperatively. The proportion of men achieving the trifecta, defined as preoperative potent and continent men who remained potent and continent with no BCR, was 38% (84/221 men) at 12 months. CONCLUSIONS: Our prospective study of men with very-low-risk prostate cancer undergoing open or robot-assisted radical prostatectomy showed that there were favourable oncological outcomes in approximately two-thirds. Approximately 40% did not have surgically induced urinary incontinence or erectile dysfunction 12 months postoperatively. These results provide additional support for the use of active surveillance in men with very-low-risk prostate cancer; however, the number of men with risk of upgrading and upstaging is not negligible. Improved stratification is still urgently needed.

Preparedness for side effects and bother in symptomatic men after radical prostatectomy in a prospective, non-randomized trial, LAPPRO.

BACKGROUND: Many clinicians believe that preparedness before surgery for possible post-surgery side effects reduces the level of bother experienced from urinary incontinence and decreased sexual health after surgery. There are no published studies evaluating this belief. Therefore, we aimed to study the level of preparedness before radical prostatectomy and the level of bother experienced from urinary incontinence and decreased sexual health after surgery. MATERIAL AND METHODS: We prospectively collected data from a non-selected group of men undergoing radical prostatectomy in 14 centers between 2008 and 2011. Before surgery, we asked about preparedness for surgery-induced urinary problems and decreased sexual health. One year after surgery, we asked about bother caused by urinary incontinence and erectile dysfunction. As a measure of the association between preparedness and bothersomeness we modeled odds ratios (ORs) by means of logistic regression. RESULTS: Altogether 1372 men had urinary incontinence one year after surgery as well as had no urinary leakage or a small urinary dribble before surgery. Among these men, low preparedness was associated with bother resulting from urinary incontinence [OR 2.84; 95% confidence interval (CI) 1.59-5.10]. In a separate analysis of 1657 men we found a strong association between preparedness for decreased sexual health and experiencing bother from erectile dysfunction (OR 5.92; 95% CI 3.32-10.55). CONCLUSION: In this large-sized prospective trial, we found that preparedness before surgery for urinary problems or sexual side effects decreases bother from urinary incontinence and erectile dysfunction one year after surgery.

Thromboembolic complications in 3,544 patients undergoing radical prostatectomy with or without lymph node dissection.

PURPOSE: Lymph node dissection in patients with prostate cancer may increase complications. An association of lymph node dissection with thromboembolic events was suggested. We compared the incidence and investigated predictors of deep venous thrombosis and pulmonary embolism among other complications in patients who did or did not undergo lymph node dissection during open and robot-assisted laparoscopic radical prostatectomy. MATERIALS AND METHODS: Included in study were 3,544 patients between 2008 and 2011. The cohort was derived from LAPPRO, a multicenter, prospective, controlled trial. Data on adverse events were extracted from patient completed questionnaires. Our primary study outcome was the prevalence of deep venous thrombosis and/or pulmonary embolism. Secondary outcomes were other types of 90-day adverse events and causes of hospital readmission. RESULTS: Lymph node dissection was performed in 547 patients (15.4%). It was associated with eightfold and sixfold greater risk of deep venous thrombosis and pulmonary embolism events compared to that in patients without lymph node dissection (RR 7.80, 95% CI 3.51-17.32 and 6.29, 95% CI 2.11-18.73, respectively). Factors predictive of thromboembolic events included a history of thrombosis, pT4 stage and Gleason score 8 or greater. Open radical prostatectomy and lymph node dissection carried a higher risk of deep venous thrombosis and/or pulmonary embolism than robot-assisted laparoscopic radical prostatectomy (RR 12.67, 95% CI 5.05-31.77 vs 7.52, 95% CI 2.84-19.88). In patients without lymph node dissection open radical prostatectomy increased the thromboembolic risk 3.8-fold (95% CI 1.42-9.99) compared to robot-assisted laparoscopic radical prostatectomy. Lymph node dissection induced more wound, respiratory, cardiovascular and neuromusculoskeletal events. It also caused more readmissions than no lymph node dissection (14.6% vs 6.3%). CONCLUSIONS: Among other adverse events we found that lymph node dissection during radical prostatectomy increased the incidence of deep venous thrombosis and pulmonary embolism. Open surgery increased the risks more than robot-assisted surgery. This was most prominent in patients who were not treated with lymph node dissection.

Worry about one's own children, psychological well-being, and interest in psychosocial intervention.

BACKGROUND: This study investigated the association between worrying about own children and low psychological well-being during the year that follows breast cancer. METHODS: In an observational population-based study, we collected data from 313 women operated for breast cancer at Sahlgrenska University Hospital in Gothenburg, Sweden. RESULTS: Worrying about one's own children (3-7 on a 1-7 visual digital scale) was, among other variables, significantly associated with low psychological well-being 1 year after breast cancer surgery (relative risk 2.63; 95% CI 1.77-3.90; posterior probability value 98.8%). CONCLUSIONS: In this group of women operated for breast cancer, we found an association between worrying about one's own children and low psychological well-being. In a healthcare system where resources are scarce, it becomes imperative to identify to whom resources should be directed. Therefore, we may consider prioritizing psychological interventions for mothers with younger children and develop effective means to communicate about issues related to the children to increase chances of an effective, successful rehabilitation.

Intrusive thoughts and quality of life among men with prostate cancer before and three months after surgery.

BACKGROUND: Sudden, unwelcome and repetitive thoughts about a traumatic event--intrusive thoughts--could relate to how men assess their quality of life after prostate-cancer diagnosis. We aimed to study the prevalence of intrusive thoughts about prostate cancer and their association with quality-of-life outcomes before and after radical prostatectomy. METHODS: During the first year of the LAPPRO-trial, 971 men scheduled for radical prostatectomy were prospectively included from 14 urological centers in Sweden. Of those, 833 men responded to two consecutive study-specific questionnaires before and three months after surgery (participation rate 86%). The association of intrusive thoughts with three quality-of-life outcomes, i.e. self-assessed quality of life, depressive mood and waking up with anxiety was estimated by prevalence ratios that were calculated, together with a 95% confidence interval, at the same time-point as well as over time. Fisher's exact-test was used to analyze differences between respondents and non-respondents. Wilcoxon signed-ranks and Cochran-Armitage trend tests were used for analysis of change over time. To validate new questions on intrusive thoughts, written answers to open-ended questions were read and analyzed by qualitative content analysis. RESULTS: Before surgery, 603 men (73%) reported negative intrusive thoughts about their cancer at some time in the past month and 593 men (59%) reported such thoughts three months after surgery. Comparing those reporting intrusive thoughts at least weekly or once a week before surgery with those who did not, the prevalence ratio (95% confidence interval), three months after surgery, for waking up in the middle of the night with anxiety was 3.9 (2.7 to 5.5), for depressed mood 1.8 (1.6 to 2.1) and for impaired self-assessed quality of life 1.3 (1.2 to 1.5). CONCLUSION: The prevalence of negative intrusive thoughts about prostate cancer at the time of surgery associates with studied quality-of-life outcomes three months later. TRIAL REGISTRATION: Current Controlled Trials, ISRCTN06393679.

Women's intimate partner violence versus community violence: Comparing injuries as presented in Iceland's largest emergency department.

BACKGROUND: Intimate partner violence (IPV) is a widespread, often unidentified and hidden public health problem, which has serious consequences. The purpose of this study was to describe and compare the clinical characteristics of women's violence inflicted physical injuries, as presented at Iceland's largest Emergency Department (ED). Three groups were created based on registered reason of injury: (1) IPV, (2) community violence (CV) with a history of IPV (HIPV), and (3) CV with no history of IPV. METHODS: Data was collected retrospectively by using the Nomesco classification system of external causes of injuries. Participants were adult women, residing in the capital area, visiting the ED during 2005-2019. RESULTS: IPV inflicted ED visits declined by 45% during the research period and CV visits declined by 61%. Women in the IPV group had the highest prevalence of repeated new ED visits per 1000 women in the capital area. The majority of IPV occurred in residential areas (86.4%), inflicted by a current partner (54.7%), and included only one perpetrator (95.3%). Women involved in CV were most likely to visit the ED on weekends (p = 0.003) and IPV women were most likely to visit between 08:00 and 16:00 (p < 0.001). Superficial injuries were the most common type of injury among all groups and IPV women were twice as likely (7.1%) to have injuries on their neck than CV women (3.5%). IPV women were most likely to be admitted (3.0%). CONCLUSION: Time of ED visit, number of perpetrators and location of assault can be indicators of IPV inflicted injuries, as opposed to otherwise inflicted injuries. Repeated visits, superficial injuries and neck injuries might also be an indicator of IPV, however wounds and sprains and injuries on head and upper limbs are more likely to be non-IPV inflicted.

LAPPRO: a prospective multicentre comparative study of robot-assisted laparoscopic and retropubic radical prostatectomy for prostate cancer.

OBJECTIVE: This study describes the study design and procedures for a prospective, non-randomized trial comparing open retropubic and robot-assisted laparoscopic radical prostatectomy regarding functional and oncological outcomes. MATERIAL AND METHODS: The aim was to achieve a detailed prospective registration of symptoms experienced by patients using validated questionnaires in addition to documentation of surgical details, clinical examinations, medical facts and resource use. Four patient questionnaires and six case-report forms were especially designed to collect data before, during and after surgery with a follow-up time of 2 years. The primary endpoint is urinary leakage 1 year after surgery. Secondary endpoints include erectile dysfunction, oncological outcome, quality of life and cost-effectiveness at 3, 12 and 24 months after surgery. RESULTS: The study started in September 2008 with accrual continuing to October 2011. Twelve urological departments in Sweden well established in performing radical prostatectomy are participating. Personal contact with the participating departments and patients was established to ascertain a high response rate. To reach 80% statistical power to detect a difference of 5 absolute per cent in incidence of urinary leakage, 700 men in the retropubic group and 1400 in the robotic group are needed. CONCLUSIONS: The Swedish healthcare context is well suited to performing multicentre long-term prospective clinical trials. The similar care protocols and congruent specialist training are particularly favourable. The LAPPRO trial aims to compare the two surgical techniques in aspects of short- and long-term functional and oncological outcome, cost effectiveness and quality of life, supplying new knowledge to support future decisions in treatment strategies for prostate cancer.

Patients in need of comprehensive geriatric assessment: The utility of the InterRAI emergency department screener.

INTRODUCTION: The interRAI Emergency Department-Screener (ED-screener) is a risk stratification instrument incorporating functional and social aspects to identify older adults in EDs. The aim was to assess the construct validity and utility of the ED-screener in comparison with more established instruments. METHODS: The ED-screener, Triage Risk Screening Tool (TRST) and Identification of Seniors at Risk (ISAR) were administered to older ED-patients. Construct validity was assessed by correlation with TRST and ISAR. The ED-screener scores that corresponded to the established cut-offs for ISAR and TRST were assessed with linear regression. The sensitivity and specificity of the ED-screener for mortality at 4-months were calculated. RESULTS: Two hundred patients were included (mean age 78.5 years, 44% male). Majority (85%) lived at home, 43% lived alone and 53% received home care. The scores of 3.02 and 3.01 on ED-screener corresponded to the cut-off score of 2 on the other instruments. The correlation of the ED-screener with ISAR and TRST was 0.56 and 0.41 respectively. A score of 3 on the ED-screener was 100% sensitive and 28% specific for 4-month mortality. CONCLUSION: These findings provide support for the construct validity of the ED-screener and its ability to predict outcomes in its intended setting.

Vesicourethral Anastomotic Stenosis After Open or Robot-assisted Laparoscopic Retropubic Prostatectomy-Results from the Laparoscopic Prostatectomy Robot Open Trial.

BACKGROUND: Vesicourethral anastomotic stenosis is a well-known late complication after open radical retropubic prostatectomy (RRP) with previously reported incidences of 2.7-15%. There are few reports of the incidence after robot-assisted laparoscopic radical prostatectomy (RALP) compared with RRP. OBJECTIVE: The aim was to compare the risk of developing symptomatic stenosis after RRP and RALP, and to explore potential risk factors and the influence of stenosis on the risk of urinary incontinence. DESIGN, SETTING, AND PARTICIPANTS: Between 2008 and 2011, 4003 men were included in a prospective trial comparing RRP and RALP at 14 Swedish centres. Clinical data and patient questionnaires were collected before, during, and after surgery. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Stenosis was identified by either patients' reports in questionnaires or case report forms. The primary endpoint is reported as unadjusted as well as adjusted relative risks (RRs), calculated with log-binomial regression models. Data on incontinence were analysed by means of a log-binomial regression model, with stenosis as an independent and incontinence as a dependent variable. RESULTS AND LIMITATIONS: Symptomatic stenosis developed in 1.9% of 3706 evaluable men within 24 mo. The risk was 2.2 times higher after RRP than after RALP (RR 2.21, 95% confidence interval [CI] 1.38-3.53). Overall, urinary incontinence was twice as common in patients who had stenosis (RR 2.01, 95% CI 1.43-2.64). CONCLUSIONS: This large prospective study found an overall low rate of vesicourethral anastomotic stenosis after radical prostatectomy, but the rate was significantly lower after robot-assisted prostatectomy. The risk of stenosis seems to be associated with the number of sutures/takes in the anastomosis, but this was statistically significant only in the RALP group. PATIENT SUMMARY: We investigated the risk of developing vesicourethral anastomotic stenosis after open and robot-assisted radical prostatectomy. We found that the risk was generally lower than previously reported and lower after robot-assisted radical prostatectomy than after radical retropubic prostatectomy. Urinary incontinence was twice as common in patients with stenosis.

Do negative intrusive thoughts at diagnosis predict impaired quality of life, depressed mood and waking up with anxiety 3, 12 and 24 months after radical prostatectomy? - a longitudinal study.

Objective: To evaluate the effect of intrusive thoughts at diagnosis on quality of life, depressed mood and waking up with anxiety up to two years after radical prostatectomy.Method: The Laparoscopic Prostatectomy Robot Open (LAPPRO) trial was a prospective, longitudinal multicenter study of 4003 patients undergoing radical prostatectomy. Questionnaire data were collected preoperatively, at 3, 12 and 24 months after surgery.Results: The group of patients with intrusive thoughts at diagnosis had a statistically significant higher postoperative prevalence of impaired quality of life, depressed mood and waking up with anxiety as compared with the group of patients with no or minor intrusive thoughts. The highest risk increase for impaired QoL, depressed mood and waking up with anxiety ≥1/week was at 12, 3 and 3 months, respectively, where the three outcomes increased by 38% (RR: 1.38; 95%CI: 1.27-1.49)), 136% (RR: 2.36; 95%CI: 1.74-3.19)) and 165% (RR: 2.65; 95%CI: 2.22-3.17)), respectively.Conclusions: The demonstrated link between intrusive thoughts and quality of life, depressed mood and waking up with anxiety deliver is further evidence to the idea that intrusive thoughts has potential as an endpoint for assessing and predicting psychological distress among men with prostate cancer diagnosis.Trial registration number: ISRCTN06393679 (www.isrctn.com). Date of registration: 07/02/2008. Retrospectively registered.

Quality of Life After Open Radical Prostatectomy Compared with Robot-assisted Radical Prostatectomy.

BACKGROUND: Surgery for prostate cancer has a large impact on quality of life (QoL). OBJECTIVE: To evaluate predictors for the level of self-assessed QoL at 3 mo, 12 mo, and 24 mo after robot-assisted laparoscopic (RALP) and open radical prostatectomy (ORP). DESIGN, SETTING, AND PARTICIPANTS: The LAParoscopic Prostatectomy Robot Open study, a prospective, controlled, nonrandomised trial of more than 4000 men who underwent radical prostatectomy at 14 centres. Here we report on QoL issues after RALP and ORP. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary outcome was self-assessed QoL preoperatively and at 3 mo, 12 mo, and 24 mo postoperatively. A direct validated question of self-assessed QoL on a seven-digit visual scale was used. Differences in QoL were analysed using logistic regression, with adjustment for confounders. RESULTS AND LIMITATIONS: QoL did not differ between RALP and ORP postoperatively. Men undergoing ORP had a preoperatively significantly lower level of self-assessed QoL in a multivariable analysis compared with men undergoing RALP (odds ratio: 1.21, 95% confidence interval: 1.02-1.43), that disappeared when adjusted for preoperative preparedness for incontinence, erectile dysfunction, and certainty of being cured (odds ratio: 1.18, 95% confidence interval: 0.99-1.40). Incontinence and erectile dysfunction increased the risk for poor QoL at 3 mo, 12 mo, and 24 mo postoperatively. Biochemical recurrence did not affect QoL. A limitation of the study is the nonrandomised design. CONCLUSIONS: QoL at 3 mo, 12 mo, and 24 mo after RALP or ORP did not differ significantly between the two techniques. Poor QoL was associated with postoperative incontinence and erectile dysfunction but not with early cancer relapse, which was related to thoughts of death and waking up at night with worry. PATIENT SUMMARY: We did not find any difference in quality of life at 3 mo, 12 mo, and 24 mo when open and robot-assisted surgery for prostate cancer were compared. Postoperative incontinence and erectile dysfunction were associated with poor quality of life.