Patients' perceptions of quality of care delivery by urology residents: A nationwide study

Objective To present the results of a nationwide survey among urological patients to evaluate their perception of the quality of care provided by residents. Methods An anonymous survey was distributed to patients who were referred to 22 Italian academic institutions. The survey aimed to investigate the professional figure of the urology resident as perceived by the patient. Results A total of 2587 patients were enrolled in this study. In all, 51.6% of patients were able to correctly identify a urology resident; however, almost 40% of respondents discriminated residents from fully trained urologists based exclusively on their young age. Overall, 98.2% patients rated the service provided by the resident as at least sufficient. Urology trainees were considered by more than 50% of the patients interviewed to have good communication skills, expertise and willingness. Overall, patients showed an excellent willingness to be managed by urology residents. The percentage of patients not available for this purpose showed an increasing trend that directly correlated with the difficulty of the procedure. Approximately 5-10% of patients were not willing to be managed by residents for simple procedures such as clinical visits, cystoscopy or sonography, and up to a third of patients were not prepared to undergo any surgical procedure performed by residents during steps in major surgery, even if the residents were adequately tutored. Conclusions Our data showed that patients have a good willingness to be managed by residents during their training, especially for medium- to low-difficulty procedures. Furthermore, the majority of patients interviewed rated the residents' care delivery as sufficient. Urology trainees were considered to have good communication skills, expertise and willingness

FIRST RESULTS FROM OEDOTENSIOMETRIC TESTS

An oedotensiometer was used to examine to examine the behaviour of sieved sample of a swelling soil (a vertisol) as well as of the same soils treated with solution of Na+ + Ca2+ to simulate the soil changes from excessive irrigation with brackish water. The oedometer test consisted in an infiltration of water from below through a ceramic porous plate at a feeding pressure of +10 cm water and successive drainage under a depression mostly of -112 cm of water. The rate of water entry as well as the swelling rate of the sample were monitored. Preliminary considerations regards the domains in which the shrinkage curve of a swelling soil is subdivided and make hypothesis on the swelling process expected when the infiltration from below of the sample is applied. The results support the hypothesis that when the water pressure is applied some water enters rather rapidly in the larger structural pores and is followed later by the swelling in the smaller pores, responsible for the basic domain. This first conclusion demonstrates that the assumption of a simultaneous movement of solid and liquid components in the sample, which is the base of most theoretical developments for swelling soils, cannot be accepted for the tested samples. Some cases with water clogging on the sample surface confirm a late final swelling of the soil and permitted to evaluate the hydraulic conductivity of the swollen soil. These manifestations are more evident in sodicated soils. The loading of the sample reduces the swelling of the sample and seems to reduce its permeability. The reduction of the feeding water pressure further reduces the sample swelling. The draining process from saturated soil sample shows that most of the process occurs in the large pores of the structural domain. This gives the possibility to evaluate the water diffusivity coefficient for the structural domain of the sample. In draining the soil with the highest sodication there was a variation of soil volume practically equal to the water lost, demonstrating that in this case the shrinking state of the soil was in the basic domain and the soil was in a biphasic condition (no air phase in the wetted soil part). This was the only case in which material coordinate arguments could be applied and the soil completely obeys to swelling properties in quasi equilibrium conditions

Heme Oxigenase-1 (HO-1) and Oxidative Stress in Rat Heart

Low oxygen tension (hypoxia) is a potent regulator of diverse biological processes. Mammalian cells respond to hypoxia in part by increased expression of several genes that encode for tissue-specific and ubiquitous proteins. The aim of this study was to evaluate the effects of chronic exposure to low tension of oxygen (hypoxia) on the induction of heme-oxygenase-1 (HO-1) as an oxidative stress model. Adult male Wistar rats were used and subdivided randomly in two groups: A:(n=10) maintained in normoxic conditions and B: (n=10) maintained in hypoxic conditions. The animal of both groups were sacrificed after 14 days. Group A showed an evident non-specific reaction. Group B presented an increased positively of HO-1 immunoreaction. This data was confirmed by western blot analysis of protein and by the study of mRNA through rtPCR. These results suggest that myocardial adaptive response to hypoxia involves up-regulation of HO-1 in cardiac cells, indicating that this enzyme may participate in regulating vascular tone via CO and thereby contributing to the pathophysiologically important defense mechanism of the heart

Nonmuscular Invasive Urothelial Carcinoma of the Bladder in Pediatric and Young Adult Patients: Age-related Outcomes

Objective: To report 2 pediatric urology referral centers' experience on transitional cell carcinoma of the bladder (TCCB) in patients younger than 30 years, focusing on age-related prognostic factors. Materials and Methods: Patients younger than 30 years affected by TCCB from January 1999 to December 2011 were investigated. Spearman's rank test and Kruskal-Wallis test were adopted for statistical analysis. Results: Eighteen patients were identified (8 females, 10 males) and stratified by age at presentation: 5 in group A (12 years old and younger), 7 in group B (13-19 years), and 6 in group C (20-29 years). Females were predominant in groups A and B, whereas males were predominant in group C. Pathological grading revealed low-grade papillary urothelial carcinoma in 7, papillary urothelial neoplasm of low malignant potential in 7, and high-grade urothelial papillary carcinoma in 4 patients. At a mean follow-up of 6.5 years, recurrence was observed in 2 cases. Statistical analysis showed a positive correlation between age and grading. There was no statistical significance based on gender. Staging was significant between the age groups; older patients had more advanced tumors. Conclusion: TCCB is rarely observed in the first 3 decades of life. The prognosis is good in early-age presentation. Sex distribution, pathological grading, and prognosis were found different according to age. Patients younger than 19 years behave in a more favorable manner than those older, and should be followed up like adults

Larval development in the feather star Antedon mediterranea

Echinoderms have been used often as experimental models in developmental biology and evolutionary biology studies. Numerous data on echinoid and asteroid development are available, whereas little is known about crinoid larval biology. This contribution focussed on the life cycle of the Mediterranean feather star Antedon mediterranea. Light and electron microscopy were used to characterize, in detail, the morphology and behaviour of the main larval stages. Similarities and differences with respect to what is already known for other crinoids, and echinoderm species, were explored. In view of the importance of serotonin during settlement and morphogenesis, analyses of the distribution of this molecule were carried out on swimming larvae. Immunolabelling results suggested a role for serotonin in A. mediterranea development, underlining the ancestral importance of this conserved neurotransmitter in deuterostome evolution

Magnetic Resonance and Ultrasound Image Fusion Supported Transperineal Prostate Biopsy Using the Ginsburg Protocol: Technique, Learning Points, and Biopsy Results

Background: Prostate biopsy supported by transperineal image fusion has recently been developed as a new method to the improve accuracy of prostate cancer detection. Objective: To describe the Ginsburg protocol for transperineal prostate biopsy supported by multiparametric magnetic resonance imaging (mpMRI) and transrectal ultrasound (TRUS) image fusion, provide learning points for its application, and report biopsy results. The article is supplemented by a Surgery in Motion video. Design, setting, and participants: This single-centre retrospective outcome study included 534 patients from March 2012 to October 2015. A total of 107 had no previous prostate biopsy, 295 had benign TRUS-guided biopsies, and 159 were on active surveillance for low-risk cancer. Surgical procedure: A Likert scale reported mpMRI for suspicion of cancer from 1 (no suspicion) to 5 (cancer highly likely). Transperineal biopsies were obtained under general anaesthesia using BiopSee fusion software (Medcom, Darmstadt, Germany). All patients had systematic biopsies, two cores from each of 12 anatomic sectors. Likert 3-5 lesions were targeted with a further two cores per lesion. Outcome measurements and statistical analysis: Any cancer and Gleason score 7-10 cancer on biopsy were noted. Descriptive statistics and positive predictive values (PPVs) and negative predictive values (NPVs) were calculated. Results and limitations: The detection rate of Gleason score 7-10 cancer was similar across clinical groups. Likert scale 3-5 MRI lesions were reported in 378 (71%) of the patients. Cancer was detected in 249 (66%) and Gleason score 7-10 cancer was noted in 157 (42%) of these patients. PPV for detecting 7-10 cancer was 0.15 for Likert score 3, 0.43 for score 4, and 0.63 for score 5. NPV of Likert 1-2 findings was 0.87 for Gleason score 7-10 and 0.97 for Gleason score ≥4+3=7 cancer. Limitations include lack of data on complications. Conclusions: Transperineal prostate biopsy supported by MRI/TRUS image fusion using the Ginsburg protocol yielded high detection rates of Gleason score 7-10 cancer. Because the NPV for excluding Gleason score 7-10 cancer was very high, prostate biopsies may not be needed for all men with elevated prostate-specific antigen values and nonsuspicious mpMRI. Patient summary: We present our technique to sample (biopsy) the prostate by the transperineal route (the area between the scrotum and the anus) to detect prostate cancer using a fusion of magnetic resonance and ultrasound images to guide the sampling

Urology Residency Training in Italy: Results of the First National Survey

BACKGROUND: Numerous surveys have been performed to determine the competence and the confidence of residents. However, there is no data available on the condition of Italian residents in urology. OBJECTIVE: To investigate the status of training among Italian residents in urology regarding scientific activity and surgical exposure. DESIGN, SETTING, AND PARTICIPANTS: A web-based survey that included 445 residents from all of the 25 Italian Residency Programmes was conducted between September 2015 and November 2015. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The main outcomes were represented by scientific activity, involvement in surgical procedures, and overall satisfaction. RESULTS AND LIMITATIONS: In total, 324 out of 445 (72.8%) residents completed the survey. Overall, 104 (32%) residents had not published any scientific manuscripts, 148 (46%) published 645, 38 (12%) 6410, 26 (8%) 6415, four (1%) 6420, and four (1%) >20 manuscripts, respectively. We did not observe any differences when residents were stratified by sex (p=0.5). Stent positioning (45.7%), extracorporeal shock wave lithotripsy (30.9%), transurethral resection of bladder tumor (33.0%), hydrocelectomy (24.7%), varicocelectomy (17%), ureterolithotripsy (14.5%), and orchiectomy (12.3%) were the surgical procedures more frequently performed by residents. Overall, 272 residents (84%) expressed a good satisfaction for urology specialty, while 178 (54.9%) expressed a good satisfaction for their own residency programme. We observed a statistically decreased trend for good satisfaction for urology specialty according to the postgraduate year (p=0.02). CONCLUSIONS: Italian Urology Residency Programmes feature some heavy limitations regarding scientific activity and surgical exposure. Nonetheless, satisfaction rate for urology specialty remains high. Further improvements in Residency Programmes should be made in order to align our schools to others that are actually more challenging. PATIENT SUMMARY: In this web-based survey, Italian residents in urology showed limited scientific productivity and low involvement in surgical procedures. Satisfaction for urology specialty remains high, demonstrating continuous interest in this field of study from residents

Urology Residency Training in Italy: Results of the First National Survey

Background: Numerous surveys have been performed to determine the competence and the confidence of residents. However, there is no data available on the condition of Italian residents in urology. Objective: To investigate the status of training among Italian residents in urology regarding scientific activity and surgical exposure. Design, setting, and participants: A web-based survey that included 445 residents from all of the 25 Italian Residency Programmes was conducted between September 2015 and November 2015. Outcome measurements and statistical analysis: The main outcomes were represented by scientific activity, involvement in surgical procedures, and overall satisfaction. Results and limitations: In total, 324 out of 445 (72.8%) residents completed the survey. Overall, 104 (32%) residents had not published any scientific manuscripts, 148 (46%) published ≤5, 38 (12%) ≤10, 26 (8%) ≤15, four (1%) ≤20, and four (1%) >20 manuscripts, respectively. We did not observe any differences when residents were stratified by sex (p = 0.5). Stent positioning (45.7%), extracorporeal shock wave lithotripsy (30.9%), transurethral resection of bladder tumor (33.0%), hydrocelectomy (24.7%), varicocelectomy (17%), ureterolithotripsy (14.5%), and orchiectomy (12.3%) were the surgical procedures more frequently performed by residents. Overall, 272 residents (84%) expressed a good satisfaction for urology specialty, while 178 (54.9%) expressed a good satisfaction for their own residency programme. We observed a statistically decreased trend for good satisfaction for urology specialty according to the postgraduate year (p = 0.02). Conclusions: Italian Urology Residency Programmes feature some heavy limitations regarding scientific activity and surgical exposure. Nonetheless, satisfaction rate for urology specialty remains high. Further improvements in Residency Programmes should be made in order to align our schools to others that are actually more challenging. Patient summary: In this web-based survey, Italian residents in urology showed limited scientific productivity and low involvement in surgical procedures. Satisfaction for urology specialty remains high, demonstrating continuous interest in this field of study from residents. Italian Residency Programs in urology shows some limitation regarding scientific productivity and surgical activity. Resident involvement in many urological procedures still remains low and there is a risk in providing the near future urologists with no expertise

Management of patients with atopic dermatitis undergoing systemic therapy during COVID‐19 pandemic in Italy: Data from the DA‐COVID‐19 registry

Background Few and small studies have described the management of immunomodulant/immunosuppressive therapies or phototherapy in atopic dermatitis (AD) patients during coronavirus disease 2019 (COVID-19) pandemic.Methods A national registry, named DA-COVID-19 and involving 35 Italian dermatology units, was established in order to evaluate the impact of COVID-19 pandemic on the management of adult AD patients treated with systemic immunomodulant/immunosuppressive medications or phototherapy. Demographic and clinical data were obtained at different timepoints by teledermatology during COVID-19 pandemic, when regular visits were not allowed due to sanitary restrictions. Disease severity was assessed by both physician- and patient-reported assessment scores evaluating itch intensity, sleep disturbances, and AD severity.Results A total of 1831 patients were included, with 1580/1831 (86.3%) continuing therapy during pandemic. Most patients were treated with dupilumab (86.1%, 1576/1831) that was interrupted in only 9.9% (156/1576) of cases, while systemic immunosuppressive compounds were more frequently withdrawn. Treatment interruption was due to decision of the patient, general practitioner, or dermatologist in 39.9% (114/286), 5.6% (16/286), and 30.1% (86/286) of cases, respectively. Fear of increased susceptibility to SARS-CoV-2 infection (24.8%, 71/286) was one of the main causes of interruption. Sixteen patients (0.9%) resulted positive to SARS-CoV-2 infection; 3 of them (0.2%) were hospitalized but no cases of COVID-related death occurred.Conclusions Most AD patients continued systemic treatments during COVID pandemic and lockdown period, without high impact on disease control, particularly dupilumab-treated patients