Development of a patient and institutional-based model for estimation of operative times for robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium

OBJECTIVES: To design a methodology to predict operative times for robot-assisted radical cystectomy (RARC) based on variation in institutional, patient, and disease characteristics to help in operating room scheduling and quality control. PATIENTS AND METHODS: The model included preoperative variables and therefore can be used for prediction of surgical times: institutional volume, age, gender, body mass index, American Society of Anesthesiologists score, history of prior surgery and radiation, clinical stage, neoadjuvant chemotherapy, type, technique of diversion, and the extent of lymph node dissection. A conditional inference tree method was used to fit a binary decision tree predicting operative time. Permutation tests were performed to determine the variables having the strongest association with surgical time. The data were split at the value of this variable resulting in the largest difference in means for the surgical time across the split. This process was repeated recursively on the resultant data sets until the permutation tests showed no significant association with operative time. RESULTS: In all, 2 134 procedures were included. The variable most strongly associated with surgical time was type of diversion, with ileal conduits being 70 min shorter (P 66 RARCs) was important, with those with a higher volume being 55 min shorter (P < 0.001). The regression tree output was in the form of box plots that show the median and ranges of surgical times according to the patient, disease, and institutional characteristics. CONCLUSION: We developed a method to estimate operative times for RARC based on patient, disease, and institutional metrics that can help operating room scheduling for RARC

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Erdosteine protects rat testis tissue from hypoxic injury by reducing apoptotic cell death

Balbay, Ege Gulec/0000-0002-1557-7019WOS: 000330777900007PubMed: 23157213The purpose of this study was to examine the effects of hypobaric hypoxia on testis morphology and the effects of erdosteine on testis tissue. Caspase-3 and hypoxia-inducible factor 1 expressions were detected by immunohistochemistry. Adult male Wistar rats were placed in a hypobaric hypoxic chamber. Rats in the erdosteine group were exposed to the same conditions and treated orally with erdosteine (20mgkg(-1) daily) at the same time from the first day of hypoxic exposure for 2weeks. The normoxia group was evaluated as the control. The hypoxia group showed decreased height of spermatogenic epithelium in some seminiferous tubules, vacuolisation in spermatogenic epithelial cells, deterioration and gaps in the basal membrane and an increase in blood vessels in the interstitial area. The erdosteine group showed amelioration of both epithelial cell vacuolisation and basal membrane deterioration. Numbers of hypoxia-inducible factor 1-immunostained Sertoli and Leydig cells were significantly higher in the hypoxia group than in the erdosteine group. The number of seminiferous tubules with caspase-3-immunostained germ cells was highest in the hypoxia group and decreased in the erdosteine and normoxia groups respectively. Based on these observations, erdosteine protects testis tissue from hypoxic injury by reducing apoptotic cell death

THE DISTRIBUTION OF FV-LEIDEN, PROTHROMBIN AND PLASMINOGEN ACTIVATOR INHIBITOR GENE MUTATIONS IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA

Balbay, Ege Gulec/0000-0002-1557-7019; Annakkaya, Ali Nihat N/0000-0002-7661-8830WOS: 000337197500011Aim: To investigate Factor V Leiden (FVL), Plasminogen Activator Inhibitor (PAI) or Prothrombin (F2L) gene polymorphisms among OSAS patients. Methods: 62 patients (35 male, 27 female) with the suspected diagnosis of OSAS were included. All patients filled out a questionnaire regarding sleep disturbance and underwent polysomnographic (PSG) examination. Genotypes were determined by a polymerase chain reaction and reverse hybridization. Results: The mean age was 51 +/- 12. 20 of the patients were not OSAS while 42 was OSAS. The distribution of FVL genotypes for 1691 GG, GA and AA is found 95 %, 5% and 0% in control group and 88.1%, 11.9% and 0% in patient groups (p:0.654) respectively. The mutant genotype was not observed for both FVL and F2L G20210A. The distribution of F2L 2021 GG, GA, AA was found 95%, 5% and 0% in control group while 97.6%, 2.4% and 0% in patient group (p:0.545) respectively. The genotype frequencies of the OSAS patients for PAT were 45.5% for wild, 45% for heterozygote, and 10% for homozygote mutant genotype in control group and 31% for wild, 47.6% for heterozygote, and 21.4% for homozygote mutant genotype in patient group (p:0.413). No significant associations with these three polymorphism were observed for OSAS and the data was shown as odds value for FVL, F2L respectively; ORFVL=2.5 (95% CI: 0.280-23.573), ORF2L =0.463 (95% CI: 0.027-7.811). Conclusion: Although FVL mutation was insignificantly high in OSAS patients, it may be an important risk factor in known hypercoagulabi

A neglected etiology of bronchiectasis: External compression due to hiatal hernia

Aim: To investigate the incidence of bronchiectasis supposed to be made by the external compression of hiatal hernia (HH) to bronchi. Materials and Methods: The thorax computed tomography (CT) scans of patients which were carried out in Duzce University Hospital between February 2014 and August 2015 were retrospectively evaluated. The repeated scans in the same patient were excluded. Results: A total of 4388 patients were included in the study. A total of 98 HH cases were detected of which 58 (59.2%) were female. The mean age was 73.30 +/- 9.14 (45-90). The rate of HH according to small, moderate and large size was 45 (45.9%), 9 (9.2%), 44 (44.9%), respectively. The rate of hiatal hernia accompanied by bronchiectasis were similar in both males and females (P = 0.078). The prevalence of bronchiectasis was significantly high in large hernias with 81.4% rate (P = 0.009). Bronchiectasis rate was 12.343 times (OR: 12.343, 95% CI: 1.479-103.027, P = 0.009) higher in the large HH group compared to small and moderate HH groups. Hiatal hernia accompanied by bronchiectasis was 88.1% anatomically near to HH. Conclusions: Thus, hiatal hernia may cause bronchiectasis due to external compression rather than lymphadenopathy or the tumor as an etiology of bronchiectasis and should be considered in the differential diagnosis.WOS:0005433981000132-s2.0-85086354682PubMed: 3252511

Which patients are able to adhere to tuberculosis treatment? A study in a rural area in the northwest part of Turkey

The purpose of this study was to investigate various factors, including demographical, socioeconomical, clinical and radiological features, of adherent and nonadherent patients with tuberculosis (TB) who were admitted to a university hospital between 1998 and 2003. One hundred and one patients (65.5%) and 53 patients (34.5%) met the criteria of adherence and nonadherence, respectively. A higher rate of adherence was observed among females than males (79.2 versus 58.4%, respectively, P = 0.012). Older patients were more nonadherent (P = 0.008). The adherence rate in non-smokers was significantly higher than that of smokers (81.4 and 52.4%, respectively, P = 0.000). Patients who underwent "family screening" were more adherent (75.7%) than those (39.5%) who did not (P = 0.000). Patients with pleurisy had higher adherence rates (81.3%), followed by patients with pulmonary TB (65.0%), while patients with extrarespiratory TB had the lowest adherence rates (45.5%) (P = 0.024). The presence of cough was significantly associated with adherence (P = 0.049). A significantly higher adherence rate was observed in patients without hemoptysis (P = 0.001). A univariate logistic regression confirmed that age, smoking, family screening, type of TB, cough and hemoptysis had significant independent effects on the adherence to treatment of TB. High-risk patients may be identified and interventions tailored to promote adherence before concluding that the patient is willfully refusing treatment