Doktora başvuru ikilemi: Poliklinik hastalarında veri güvenilirliğinin irdelenmesi

The aim of the study is to investigate the nature of outpatient-based visits to speciality care physicians in outpatient departments of a teaching hospital. A questionnaire which was in a sense “an after-visit summary” that contained patient age, gender and doctor’s major office contact reason was developed. Physicians from different medical disciplines completed the questionnaire on randomly selected visits. Data was analysed statistically by descriptive analysis and cross tabulation. 1184 adult patients were analysed; 587 [49.6 (%)] of them were visited by medicine specialists, and 597 [50.4 (%)] by surgeons. Among all adult admissions, first patients comprised less than half of the workload, 40.8 (%) in surgery and 43.5 (%) in medicine. There was a significant difference between the number of patient contacts in medical and surgical specialities in terms of major visit categories. Compared to first visit, numbers of established patients, office consultation and reporting were significantly higher, whereas number of prehospitalizations was significantly lower in medicine than surgery. As shown in the study, per capita doctors’ visit data is not very reliable, nor is it uniform in OECD database, disabling the comparison between countries.Bu çalışmanın amacı, bir eğitim araştırma hastanesinin farklı polikliniklerine başvuran ayaktan hastaların başvuru nedenlerini incelemektir. Araştırmamızda farklı polikliniklerden hekimler tarafından doldurulan, hastanın yaşı, cinsiyeti ve başvuru nedenini içeren; bir bakıma “muayene sonrası özeti” olan bir çizelge geliştirilmiştir. Hekimler çizelgeyi rastgele seçilen muayeneler arasından tamamlamışlardır. Elde edilen verilerden çapraz tablolar oluşturulmuş ve tanımlayıcı istatistik ile analiz edilmiştir. 1184 yetişkin hasta analiz edilmiş olup; 587'si (%49,6) dahili klinikleri, 597'si (%50,4) cerrahi klinikleri hekimlerince muayene edilmiştir. Tüm yetişkin başvuruları arasındaki hastaların yarısından azı hem dahili [40,84 (%)] hem de cerrahi [43,55 (%)] polikliniklerde ilk kez hekime başvuru yapan hastalardır. Dahili ve cerrahi polikliniklere yapılan hasta başvuru nedenleri arasında önemli bir farklılık bulunmaktadır. İlk muayeneleri kıyasladığımızda dahili branşlarda, takipli hasta sayısı, konsültasyon ve rapor yazdırma sayıları cerrahi branşlara göre önemli ölçüde daha yüksekken, hastaneye yatış öncesi yapılan muayene sayısı cerrahi branşlara göre önemli ölçüde daha düşük çıkmıştır. Çalışmada gösterildiği gibi, doktor başına düşen muayene verileri güvenilir olmamakla birlikte OECD veri tabanında bu konuda tam bir tanım birliği bulunmamaktadır, bu da ülkeler arasındaki karşılaştırma yapılmasını engellemektedir

Effect of the COVID-19 Pandemic on Radical Prostatectomy: A Turkish Multicenter Study

Objective: The present study examines the effects of the coronavirus disease 2019 pandemic on radical prostatectomy performed as part of localized prostate cancer treatment in Turkey. Material and methods: A retrospective analysis was made of the data of 176 patients from 8 centers in Turkey who underwent radical prostatectomy due to localized prostate cancer over the 2 years spanning March 1, 2019, to February 28, 2021. Within this timeframe, March 1, 2019, to February 28, 2020, was denoted the 1-year pre-coronavirus disease 2019 period, while March 1, 2020, to February 28, 2021, was denoted the 1-year coronavirus disease 2019 period. An analysis was made of whether there was a difference in the number of radical prostatectomies performed for prostate cancer, the time from biopsy to operation, and the biopsy and radical prostatectomy pathology between the 2 periods. Results: It was found that the number of radical prostatectomies performed for localized prostate cancer during the coronavirus disease 2019 pandemic was statistically and highly significantly fewer than in the pre-coronavirus disease 2019 period (P < .001). The patients diagnosed with Gleason 3 + 3 (low risk) prostate cancer were statistically significantly fewer in number in the coronavirus disease 2019 period (P < .001). The pathological Gleason score was upgrading than the biopsy Gleason score in all patients who underwent in both periods (P < .001). When the periods were compared, the pathological involvement determined by lymph node dissection performed during radical prostatectomy was found to be decreased in the coronavirus disease 2019 period, although the difference was not statistically significant (P = .051). Conclusion: As with many diseases, the diagnosis and treatment of prostate cancer have been adversely affected by the coronavirus disease 2019 pandemic. © 2022, AVES. All rights reserved

Is There Any Correlation Between De Ritis Ratio and Prostate Cancer in Males Who Underwent Transrectal Prostate Biopsy?

Objective:This study aims to evaluate the diagnostic value of the De Ritis ratio (DRR) in predicting prostate cancer (PCa) and clinically significant prostate cancer (csPCa) in biopsy-naive patients with suspected PCa.Method:We retrospectively reviewed medical records of 282 male patients who underwent transrectal ultrasound-guided prostate needle biopsy (PNB) between January 2015 and July 2019. Demographic and clinical characteristics of the patients including digital rectal examination findings, preoperative prostate-specific antigene (PSA), aspartate aminotransferase levels, alanine aminotransferase levels, prostate volume, comorbidities and pathological findings of the PNB specimens were noted in detail for each patient. The study cohort was divided into two groups according to the histopathological results of PNB specimens (group 1: patients with benign histopathology, group 2: patients with PCa). The receiver operating characteristic (ROC) curve analysis was conducted to evaluate the diagnostic performance of PSA, PSA density and DRR in predicting PCa.Results:The median age of the participants was 64 (59-69) years. While 71.6% (n=202) of the participants were in group 1, 28.4% (n=80) of them were in group 2. The median DRR value of group 1 was 1.08 (range: 0.89-1.32), and the median DRR value of group 2 was determined as 1.19 (range: 0.95-1.56), and the median DRR value of group 2 was found to be statistically significantly higher than that of group 1 (p=0.013). Statistically significant but a weak positive correlation was observed between PCa in PNB specimens and DRR (r=0.149, p=0.012), while there was no statistically significant correlation between csPCa in PNB specimens and DRR (r=0.002, p=0.983). The ROC curve analysis showed that the cut-off value of DRR for the presence of PCa in PNB specimens was 1.125 and the area under curve was 0.595 (95% confidence interval=0.518-0.672, p=0.013) for the presence of PCa in PNB specimens.Conclusion:This study suggests that DRR had restricted diagnostic importance in predicting PCa in biopsy-naive patients who underwent transrectal PNB

Doctors’ Visit Dilemma: Exploring The Reliability of The Data in An Outpatient Department

The aim of the study is to investigate the nature of outpatient-based visits to speciality care physicians in outpatient departments of a teaching hospital. A questionnaire which was in a sense “an after-visit summary” that contained patient age, gender and doctor’s major office contact reason was developed. Physicians from different medical disciplines completed the questionnaire on randomly selected visits. Data was analysed statistically by descriptive analysis and cross tabulation. 1184 adult patients were analysed; 587 [49.6 (%)] of them were visited by medicine specialists, and 597 [50.4 (%)] by surgeons. Among all adult admissions, first patients comprised less than half of the workload, 40.8 (%) in surgery and 43.5 (%) in medicine. There was a significant difference between the number of patient contacts in medical and surgical specialities in terms of major visit categories. Compared to first visit, numbers of established patients, office consultation and reporting were significantly higher, whereas number of prehospitalizations was significantly lower in medicine than surgery. As shown in the study, per capita doctors’ visit data is not very reliable, nor is it uniform in OECD database, disabling the comparison between countries

A new robot for flexible ureteroscopy: Development and early clinical results (IDEAL stage 1-2b)

WOS: 000344694300032PubMed ID: 25059998Background: An improved armamentarium has had a significant impact on the emerging role of flexible ureteroscopy (FURS) for the management of nephrolithiasis; however, FURS still represents a challenging technique. Objective: To examine a robotic device designed for FURS for its impact on ergonomics and outcome of the procedure based on the IDEAL (idea, development, evaluation, assessment, long-term study) framework. Design, setting, and participants: Roboflex Avicenna consists of a surgeon's console and a manipulator for the flexible ureterorenoscope. Following experimental evaluation of the prototype (IDEAL stage 1) and receipt of ethical approval, seven surgeons treated 81 patients (mean age: 42 yr [range: 6-68]) with renal calculi (mean volume: 1296 +/- 544 mm(3) [range: 432-3100 mm(3)]) in an observational study (IDEAL stage 2). Surgical procedure: Robotic FURS was performed with the Roboflex Avicenna robotic device. Outcome measurements and statistical analysis: Numerical data were analysed with the Mann-Whitney test, and categorical variables were analysed using the chi-square test or Fisher exact test. P values <0.05 were considered statistically significant. Results and limitations: Mean robot docking time was 59.6 +/- 45 s. Mean operative time was 74 min (range: 40-182). Mean fragmentation speed was 29.1 +/- 6.1 mm(3)/min. Ergonomics based on a validated questionnaire showed significant advantage for robotic FURS (total score: 5.6 vs 31.3; p < 0.01). A 10/12F-access sheath was used in 72 patients. Two cases required secondary FURS, one because of malfunction of the flexible digital ureteroscope and another because of larger residual fragments. In the remaining 79 cases, complete stone disintegration was accomplished. Conclusions: Roboflex Avicenna provides a suitable and safe platform for robotic FURS with significant improvement of ergonomics. Future studies should evaluate its impact on the clinical outcome of FURS. Patient summary: Robotic flexible ureteroscopy (FURS) was performed with the Roboflex Avicenna robotic device. Results showed that Roboflex Avicenna provides a suitable and safe platform for robotic FURS with significant improvement of ergonomics