A pure microcytic bladder carcinoma synchronous to prostatic adenocarcinoma

Small cell carcinoma (SCC) or microcytic carcinoma of the urinary bladder is a rare entity comprising approximately 0.5% of all bladder tumors. Due to its rarity, no prospective studies evaluating the most effective treatment have been published in the medical literature. Several cases of bladder SCC have been presented so far. We describe our case report and we revise the recent literature. Our patient was diagnosed with pure bladder SCC and prostatic adenocarcinoma. After the initial and complete transurethral resection of the bladder tumour (TUR-BT), he underwent a thorax and mediastinum computer tomography (CT) examination to exclude primary pulmonary small cell carcinoma and a bone scan scintigraphy for staging purposes. He received a three 14-day cycles of Cisplatin-containing chemotherapeutic schema and a single dose of Luteinizing-Hormone Releasing hormone (LHRH) analogue injection after 14 days of bicalutamide administration. The patient is followed for 24 months without any signs of bladder SCC recurrence or biochemical or local relapse from prostatic adenocarcinoma

Exploring Nurses' Perceptions of Medication Error Risk Factors: Findings From a Sequential Qualitative Study

A focus group study was conducted to explore nurses' perceptions of medication administration error associated factors in two medical wards of a tertiary hospital. Nurses were invited to participate in focus group discussions. Thematic analysis was employed and identified four themes: professional practice environment related factors, person-related factors, drug-related factors, and processes and procedures. Staffing, interruptions, system failures, insufficient leadership, and patient acuity were perceived as risk factors for medication errors. The findings of this study complement the findings of an observational study which investigated medication administration errors in the same setting. Although some findings were similar, important risk factors were identified only through focus group discussions with nurses. Nurses' perceptions of factors influencing medication administration errors provide important considerations in addressing factors that contribute to errors and for improving patient safety

Urodynamic findings in children with nocturnal enuresis

Objectives: To investigate in a prospective study the role of bladder function during the Urodynamic investigation and to compare the results of Maximum Bladder Capacity (MBC), the Functional bladder capacity (FBC), the Detrusor Overactivity (DO) and the Bladder wall thickness (BWTh), in children with primary nocturnal enuresis as this is a common problem in children. Methods: The study included 100 children with monosymptomatic primary nocturnal enuresis aged 6-14 (9,1±2,19) years. Children were divided into 4 groups according to Enuresis severity: group A = 0-3/week, group B = 3-6/week, group C = every night and group D Diurnal + Nocturnal Enuresis. All children underwent urinalysis, bladder and upper urinary tract ultrasonography, uroflowmetry and water cytometry. The Maximum bladder capacity (MBC), Detrusor Overactivity (OD), bladder wall thickness (BWTh) and Functional Bladder Capacity (FBC) were measured using ultrasonography. The FBC estimated from a 4 days Feeling/Volume chart. The Urodynamic findings (MBC, OD) were compared between the FBC, BWTh and Enuresis groups according to severity groups A, B, C, D. Parameters recording became in Excel office and were imported for statistical analysis in environment SPSS ver. the 15 for windows. Analysis became at one way ANOVA and BENFERONI. Results: Instability (OD) was observed in 40 children and was recorded as follows: Group A = (3/25, 12%), Group B = 8/30 (26, 6%), Group C = 12/20 (60%) and in the children with NE + Daily symptoms 17/25 (68%). The OD was more intense in the children of B, C, D groups. The cross-correlation of findings at Pearson showed that the FBC has relation with the OD, MBC, BWTh and the age, which is statistically significant, while the OD has a statistically significant relation with the MBC. The MBC at the same comparisons appears to relate itself so much with the FBC and with BWTh having a statistically significant difference too. BWTh was found to have statistical significant difference in combination FBC OD and MBC. From the recorded prices and comparisons, the age is related only with the FBC and MBC. Conclusion: The results of this study show that the ultrasonographic measure of the BWTh and water cytometry findings on bladder function plus the Functional Bladder Capacity are characteristic in children with nocturnal enuresis. Detrusor over activity can occur in 68% of the Enuretic Children with diurnal symptoms. Obtaining a voiding and elimination diary in conjunction with a good history may be beneficial in children with monosymptomatic primary nocturnal enuresis. In addition, routine Urodynamics may be unnecessary in the evaluation of children with monosymptomatic primary nocturnal enuresis after obtaining a careful and complete history of the voiding dysfunction. Urodynamic testing may be reserved for polysymptomatic enuretics with abnormal ultrasound or those who fail to respond to first line treatment.Σκοπός: Σκοπός της έρευνας είναι η Ουροδυναμική μελέτη των παιδιών με Νυκτερινή Ενούρηση (ΝΕ) και η καταγραφή των παραμέτρων της Μεγίστης Χωρητικότητας (MBC), της Λειτουργικής χωρητικότητας (FBC), της αστάθειας του εξωστήρα (OAB), του πάχους του τοιχώματος της ουροδόχου κύστης (BWTh) και να συγκριθούν τα αποτελέσματα μεταξύ τους. Υλικό και Μέθοδος: Στη μελέτη συμπεριλήφθηκαν 100 παιδιά ηλικίας 6-14 χρόνων (9,1±2,19) με ΝΕ (58 αγόρια και 42 κορίτσια) τα οποία ταξινομήθηκαν ανάλογα με την σοβαρότητα της ΝΕ σε 4 ομάδες: α) Ήπια 0-3 φορές την εβδομάδα, β) Μέτρια 3- 6 φορές την εβδομάδα, γ) Σοβαρή κάθε βράδυ και δ) Ημερήσια ενούρηση (Η) ± ΝΕ. Όλα τα παιδιά υποβλήθηκαν σε Ουροδυναμικό έλεγχο, υπερηχοτομογραφική μέτρηση του BWTh, καταγραφή της OD, της MBC και εκτίμηση της FBC με το Ημερολόγιο ούρησης. Τα ουροδυναμικά ευρήματα (MBC, OD) συγκρίθηκαν μεταξύ των FBC, ΒWTh και ομάδων ενούρησης σύμφωνα με τις ομάδες σοβαρότητας α, β, γ, δ. Η καταγραφή των παραμέτρων έγινε σε Excel office και εισάχθηκαν για στατιστική ανάλυση σε περιβάλλον SPSS ver. 15 for windows και η ανάλυση έγινε κατά one way ANOVA και BENFERONI. Αποτελέσματα: Η αστάθεια (OD) παρατηρήθηκε σε 40 παιδιά και καταγράφηκε ως εξής: 1η ομάδα 3/25 (12%), 2η ομάδα 8/30 (26,6%), 3η ομάδα 12/20 (60%) και στα παιδιά με ΝΕ + Ημερήσια συμπτωματολογία 17/25 (68%). Η OD ήταν περισσότερο έντονη στα παιδιά της 2ης, 3ης και 4ης ομάδας. Η συσχέτιση των τιμών κατά Pearson έδειξε ότι η FBC έχει σχέση με την OD, MBC, BWTh και την ηλικία η οποία είναι στατιστικά σημαντική, ενώ η OD έχει στατιστικά σημαντική σχέση με την MBC. Η MBC φαίνεται να σχετίζεται στατιστικά σημαντικά τόσο με την FBC όσο και με το BWTh. Το BWTh διαπιστώθηκε να έχει στατιστικά σημαντική διαφορά σε σχέση με την FBC, OD και MBC. Από τις καταγεγραμμένες τιμές και συγκρίσεις η ηλικία παρατηρήθηκε να σχετίζεται μόνο με την FBC και MBC. Συμπέρασμα: Το ιστορικό μαζί με το Ημερολόγιο ούρησης μπορούν να αξιολογήσουν τις συνήθειες πλήρωσης της ουροδόχου κύστης. Η FBC και η καταμέτρηση του πάχους του τοιχώματος της ουροδόχου κύστης θέτει την πιθανή διάγνωση αστάθειας ή και άλλων διαταραχών ούρησης. Η αστάθεια ανέρχεται έως και 68% σε παιδιά με Η και ΝΕ. Το εύρημα αυτό συνιστά την συνδυασμένη φαρμακευτική αντιμετώπιση των παιδιών με ΝΕ. Η εκτίμηση όλων αυτών των παραμέτρων παρέχει τη δυνατότητα στον Ιατρό να καθορίσει την στρατηγική του ως προς την θεραπευτική αντιμετώπιση της ΝΕ στα παιδιά. Η ουροδυναμική μελέτη δεν κρίνεται απαραίτητη στα παιδιά με ΝΕ που όμως δεν παρουσιάζουν άλλες διαταραχές ούρησης. Σε παιδιά με Η και ΝΕ και άλλες συνοδές διαταραχές ούρησης καθώς και παιδιά ανθεκτικά στη θεραπεία με Δεσμοπρεσίνη ή παιδιά που υποτροπιάζουν ο ουροδυναμικός έλεγχος θεωρείται απολύτως απαραίτητος για να καταγραφούν και να τεκμηριωθούν οι λειτουργικές διαταραχές ώστε να εφαρμοστεί η καταλληλότερη θεραπεία

Hemodynamic evaluation of aneurysm sac after endovascular aneurysm repair using novel imaging technologies

Endoleak is the Achilles heel of endovascular aneurysm repair, with type II endoleak being the most prevalent but also the most controversial form in terms of management.The purpose of this research study is to evaluate the hemodynamic characteristics of type II endoleak using novel imaging technologies in order to identify high-risk type II endoleak for aneurysm sac growth and to predict their clinical consequences after diagnosis. For this purpose the following techniques were used : A. Dual-energy computed tomography, B. Perfusion imaging and C. Radiomic analysis and artificial intelligence algorithms.The study’s conclusions are encouraging, showing that functional imaging with quantitative assessment of type II endoleak is just a few steps away. The analyzed technologies represent promising diagnostic tools in the evaluation of type II endoleak after endovascular aneurysm repair that may help in patient management by indicating the need for re-intervention and also in optimizing follow-up protocols.Η ενδοδιαφυγή αποτελεί την Αχίλλειο πτέρνα της ενδαγγειακής αποκατάστασης ανευρύσματος κοιλιακής αορτής, με την ενδοδιαφυγή τύπου ΙΙ να αφορά στην συχνότερη αλλά ταυτόχρονα στην πλέον αμφιλεγόμενη μορφή της ως προς την διαχείριση.Σκοπός της παρούσας διδακτορικής διατριβής είναι να μελετήσει τα αιμοδυναμικά χαρακτηριστικά της ενδοδιαφυγής τύπου ΙΙ με την βοήθεια σύγχρονων τεχνικών ιατρικής απεικόνισης με στόχο να απομονώσει τις υψηλού κινδύνου ενδοδιαφυγές τύπου ΙΙ για αύξηση των διαστάσεων του ανευρυσματικού σάκου. Για τον σκοπό αυτό χρησιμοποιήθηκαν οι ακόλουθες τεχνικές : Α. Αξονική τομογραφία διπλής ενέργειας, Β. Απεικόνιση αιμάτωσης και Γ. Ραδιομική ανάλυση και αλγόριθμοι τεχνητής νοημοσύνης.Τα τελικά συμπεράσματα της μελέτης είναι ενθαρρυντικά και δείχνουν ότι η λειτουργική απεικόνιση με την ποσοτική αξιολόγηση της ενδοδιαφυγής τύπου ΙΙ είναι προ των πυλών. Οι τεχνικές που αναλύθηκαν αντιπροσωπεύουν πολύ υποσχόμενα διαγνωστικά εργαλεία στην αξιολόγηση των ασθενών με ενδοδιαφυγή τύπου ΙΙ μετά από ενδαγγειακή αποκατάσταση ανευρύσματος κοιλιακής αορτής που θα μπορούσαν αφενός να βοηθήσουν στην διαχείριση των ασθενών υποδεικνύοντας την ανάγκη για επανεπέμβαση και αφετέρου στην βελτιστοποίηση των πρωτοκόλλων παρακολούθησης

Missed nursing care as related to the types of ethical climate in public hospitals

Missed nursing care is defined as "any aspect of required patient care that is omitted (either in part or in whole) or delayed", (Kalisch et al. 2009, p. 1509), it can occur at any stage of the nursing process and it is influenced by factors in the care environment such as the allocation of resources (material and labor), relationships and communication, that affect nurses’ internal processes (e.g. values, beliefs, collective team norms) and guide them in deciding which nursing activity should be completed, should be missed, or should be delayed (Kalisch et al. 2009). Ethical climate in hospitals reflects the collective behavior of health care employees, acts as a reference of behavior when nurses face ethical issues and has a great impact on their decision-making process and on the quality of patient care. Victor and Cullen (1987) defined ethical climate as “the shared perceptions of what is ethically correct behavior and how ethical issues should be handled in organizations’’. Five types appear frequently in healthcare organizations which are the Caring, the Instrumental, the Rules, the Law and Codes and the Independence. Research on the relationship of the types of ethical climate with missed nursing care is limited. Since the nurses' practice environment has been linked to missed nursing care and having in mind that the ethical climate is actually a dimension of the whole working environment, as well as, the results of a previous study (Vryonides et al. 2016) that had examined this relationship in cancer care units (only), the current study further explores this relationship

Integrated Photonic Linear Frequency Discriminator Filter for 5G Phase-Modulated Microwave Photonic Links

The design, fabrication and characterization of a passive linearized field discriminator (FD) filter is presented. The FD filter is designed for silicon-on-insulator (SOI) platform using foundry process design kits (PDKs). Unlike previous FD filters; the design consists of only two MZI stages. The fabrication is performed using the SiEPIC process. Limitations in the knowledge of the exact design of the PDKs; such as waveguide paths and structure are overcome by designing the device with symmetry both in the number of PDK passive components as well as optical path lengths. Excellent agreement with the theoretical results is obtained for the linearity of the transfer function; which extends over a wide bandwidth (80 GHz). The device is tested in a system evaluation simulation for a phase modulated fiber optic link and the results are compared to that of a typical intensity modulation direct detection scheme. Performance of 8 dB in carrier to intermodulation is obtained for modulating frequencies up to 50 GHz using a complementary transfer function with balanced detection demodulation scheme

Fabrication and Performance of Passive Linear Electric Field Frequency Discriminator Filter for 5G Phase-Modulated Microwave Photonic Links

We present the circuit design, fabrication in silicon-on-insulator (SOI) platform, and measurement of a linearized electric field discriminator (FD) filter, called Sin-Sin2. This low complexity FD is intended for advanced 5G phase/frequency-modulated direct-detection (PM/FM-DD) links

The ethical dimension of nursing care rationing as it is revealed from existing qualitative research studies

The aim of this presentation is to present the results of a systematic review and a thematic synthesis of qualitative research studies that have revealed an ethical dimension of nursing care rationing. The Objectives of this thematic synthesis were to find out the deeper moral meaning of nursing care rationing (if any) by synthesizing studies that relate this phenomenon with the ethical perspectives of nursing