Outcomes of robotic-assisted radical prostatectomy for patients in two extreme age-groups (< 50 years vs > 65 years).

BACKGROUND AND AIMS: To assess the outcomes of robotic radical prostatectomy in two different age subgroups of pre-operatively potent patients: younger than 50 years and older than 65 years. METHODS: We included in the present study a number of 202 patients with prostate cancer divided into two groups: 99 patients older than 65 years (group 1) and 103 patients younger than 50 years (group 2). RESULTS: More than half of the younger patients were low-risk vs 57% of the older patients who were high-risk. Overall positive surgical margins rate was 21.2% in group 1 vs 12.1% in group 2. The early biochemical recurrence at 6 months after radical prostatectomy was 4% in group 1 vs 11.6% in group 2. The continence rate at 6 months was similar between the two groups and was not correlated with the patients' age (p=0.72), nerve-sparing (p=0.3 for group 1, p=0.92 for group 2) or pathological staging (overall p=0.81, p=0.89 in group 1 and p=0.63 in group 2). We observed a significantly higher rate of potency for patients in group 2 (91.5% vs 47.2%, p<0.0001). The most important factor associated with the regain of potency at 6 months after the procedure was the age of the patient (p<0.0001), independently of the type of nerve-sparing performed. CONCLUSIONS: Age seems to be the most important predictor of the regain of potency after robotic radical prostatectomy. Patients should be counseled accordingly in order to have realistic expectations about the functional results after robotic-assisted surgery.

Serum metabolomics can predict the outcome of first systematic transrectal prostate biopsy in patients with PSA <10 ng/ml.

AIM: To assess the predictive value of metabolomic analysis for the presence of prostate cancer (PCa) at first systematic biopsy. PATIENTS & METHODS: Ninety serum samples from patients with suspicion for PCa were included. Targeted and nontargeted metabolomic analysis was performed. RESULTS: Six metabolites were combined into a predictive score. A cutoff value of 0.528 for the metabolomic score showed a good accuracy for the prediction of PCa at biopsy (Area under the curve (AUC): 0.779; p < 0.001). These results were validated in a subgroup of patients, showing similar accuracy (p = 0.1). For patients with prostate specific antigen (PSA) less than 10 ng/ml, the score showed a Se 80.95%, Sp 64.52% for the detection of PCa at biopsy. CONCLUSION: Metabolomic analysis can predict the outcome of the first systematic biopsy.

Developing a European urban health indicator system: results of EURO-URHIS 1.

Introduction: More than half of the world's population now live in cities, including over 70% in Europe. Cities bring opportunities but can be unhealthy places to live. The poorest urban dwellers live in the worst environments and are at the greatest risk of poor health outcomes. EURO-URHIS 1 set out to compile a cross-EU inventory of member states use of measures of urban health in order to support policymakers and improve public health policy. Following a literature review to define terms and find an appropriate model to guide urban health research, EURO-URHIS Urban Areas in all EU member states except Luxembourg, as well as Croatia, Turkey, Macedonia, Iceland and Norway, were defined and selected in collaboration with project partners. Following piloting of the survey tool, a the EURO-URHIS 45 data collection tool was sent out to contacts in all countries with identified EUA's, asking for data on 45 Urban Health Indicators (UHI) and 10 other indicators. 60 questionnaires were received from 30 countries, giving information on local health indicator availability, definitions and sources. Telephone interviews were also conducted with 14 respondents about their knowledge of sources of urban health data and barriers or problems experienced when collecting the data. Most participants had little problem identifying the sources of data, though some found that data was not always routinely recorded and was held by diverse sources or not at local level. Some participants found the data collection instrument to not be user-friendly and with UHI definitions that were sometimes unclear. However, the work has demonstrated that urban health and its measurement is of major relevance and importance for Public Health across Europe. The current study has constructed an initial system of European UHIs to meet the objectives of the project, but has also clearly demonstrated that further development work is required. The importance and value of examining UHIs has been confirmed, and the scene has been set for further studies on this topic.

Comparison between a multi-pavilion hospital and a single pavilion hospital.

BACKGROUND AND AIM: Defining and measuring hospital efficiency is a hard task, in spite of the agreement that hospitals need to be efficient. Thus, while research might focus on the relationship between costs and outcomes, measurements differ significantly across studies. The aim of the present study is to compare a multi-pavilion hospital with a single hospital from Cluj-Napoca, Romania. METHODS: Statistical and financial (effective expenses, salaries, drugs, materials, reagents, food) indicators were used to compare two hospitals from Cluj-Napoca: the Adults' Clinical Hospital in Cluj-Napoca, and the Rehabilitation Hospital from Cluj-Napoca respectively. Data related to these indicators were collected at each hospital level, between 2004 and 2010. RESULTS: When investigating the expenses on medicine, data showed the two hospitals had similar values in 2004, 13.09% and 14.43% for the multi-pavilion hospital and single hospital, respectively. After 2004, the expenses started to drop simultaneously, being around 11% in 2006 and 2007 for both hospitals. The mortality rate was significantly different for the two hospitals. The multi-pavilion had a much higher mortality rate, when compared to the single hospital. From 2004 until 2007 a steady increase was observed for the multi-pavilion hospital, from 1.09 to 2.57 respectively. CONCLUSION: The significant differences found between the two hospitals look being unavoidable, as long as they seem to stem from the hospitals' ownership, their addressability and their targeted diseases and associated procedures.

Cost-Efficiency Analysis of a Multi-Pavilion Hospital in Cluj County.

BACKGROUND AND AIM: Multi-hospital health systems have become the most popular administrative structure in healthcare, leading to both opportunities and challenges for hospital administrators. In government-funded healthcare systems, there is a balance between costs and the provision of health services. The aim of the present study is to assess the efficiency in terms of costs of a multi-pavilion hospital from Cluj County, Romania. METHODS: The institution analyzed in this article is the Adults' Clinical Hospital in Cluj-Napoca. A descriptive retrospective study collected data from January 2004 to December 2010. A set of indicators were compiled, divided into three main categories: personnel, statistics, and financial. RESULTS: Twenty-one financial indicators were investigated. Heterogeneity between different years was observed for the continuous hospitalization indicator and the wage budget indicator. The highest variability was observed between the budget and expenses indicators, while a smaller variability was observed at the average costs per patient. The costs per patient have increased at all pavilions in the studied time frame, the higher costs being at the Internal Medicine and Surgery pavilions: 10,203 RON in 2010 (1 euro ~ 4.4 RON). CONCLUSION: The pavilions included in the Adults' Clinical Hospital Cluj-Napoca have different expenses patterns, as each pavilion is focused on different specialties. Each pavilion serves different target groups, requiring different procedures. This in turn results in different expense patterns across each pavilion.

G.I.S. Surveillance of Chronic Non-occupational Exposure to Heavy Metals as Oncogenic Risk.

INTRODUCTION: The potential oncogenic effect of some heavy metals in people occupationally and non-occupationally exposed to such heavy metals is already well demonstrated. This study seeks to clarify the potential role of these heavy metals in the living environment, in this case in non-occupational multifactorial aetiology of malignancies in the inhabitants of areas with increased prevalent environmental levels of heavy metals. METHODS: Using a multidisciplinary approach throughout a complex epidemiological study, we investigated the potential oncogenic role of non-occupational environmental exposure to some heavy metals [chrome (Cr), nickel (Ni), copper (Cu), zinc (Zn), cadmium (Cd), lead (Pb) and arsenic (As)-in soil, drinking water, and food, as significant components of the environment] in populations living in areas with different environmental levels (high vs. low) of the above-mentioned heavy metals. The exposures were evaluated by identifying the exposed populations, the critical elements of the ecosystems, and as according to the means of identifying the types of exposure. The results were interpreted both epidemiologically (causal inference, statistical significance, mathematical modelling) and by using a GIS approach, which enabled indirect surveillance of oncogenic risks in each population. RESULTS: The exposure to the investigated heavy metals provides significant risk factors of cancer in exposed populations, in both urban and rural areas [ χ2 test (p < 0.05)]. The GIS approach enables indirect surveillance of oncogenic risk in populations. CONCLUSIONS: The role of non-occupational environmental exposure to some heavy metals in daily life is among the more significant oncogenic risk factors in exposed populations. The statistically significant associations between environmental exposure to such heavy metals and frequency of neoplasia in exposed populations become obvious when demonstrated on maps using the GIS system. Environmental surveillance of heavy metals pollution using GIS should be identified as an important element of surveillance, early detection, and control of neoplastic risks in populations, at the level of a single locality, but even on a wider geographical scale.

Rabies surveillance in the rural population of Cluj County, Romania.

INTRODUCTION: The rabies virus causes an acute encephalomyelitis that progresses to coma and death within 10 days of the onset of the disease. Taking into account the fatality of the disease and the absence of a specific treatment, preventive methods are of the outmost importance. The purpose of this study was to assess the exposure of the rural population from Cluj County, Romania, to rabies risk factors. METHODS: Data regarding the exposure of the rural population from Cluj County to rabies risk factors were collected from the Vaccination Center registry at the Infectious Diseases Teaching Hospital in Cluj-Napoca. The information was treated confidentially. The data obtained were collected using an Access 2000 database and was analyzed using Epi Info. Information regarding the general population was available from the 2002 General Population and Housing Census. RESULTS: Cluj County reported 1008 cases of human exposure to potentially rabid animals between April 1998 and December 2004. The relative contributions of the major groups of aggressor animals were as follows: 882 dogs (81.55%), 51 cats (5.06%), 30 foxes (2.98%), 28 horses (2.78%), 19 rats (1.89%), and 58 other animals (5.74%). Post-exposure prophylaxis with antirabies serum immune globulin was prescribed in 9% of the cases (n = 90). Vaccine was recommended in 72% of the cases (n = 726). Two hundred and eighty-three patients out of 726 (38.98%) underwent complete vaccine prophylaxis. Diagnoses in animals suspected of having rabies were made by direct immunofluorescent antibody staining of rabies viral antigen in brain material. The number of animals that tested positive for rabies during the period April 1998 to December 2004 was 49. More than 77% (n = 38) were wild animals. The relative contributions of the major groups of animals were as follows: 33 foxes (67.35%), 7 dogs (14.29%), 2 wolves (4.08%) and 7 other animals (14.29%). CONCLUSIONS: The fatal risk of rabies in human beings, and the persistence of the virus in this geographic area, makes legitimate the recommendation of prophylactic procedures for persons exposed to potentially rabid animals.