Objective:To assess the impact of intra-operative cell salvage on outcomes in open nephrectomy.Methods:A retrospective cohort study was performed of all patients undergoing open nephrectomy for suspected malignancy fr...Objective:To assess the impact of intra-operative cell salvage on outcomes in open nephrectomy.Methods:A retrospective cohort study was performed of all patients undergoing open nephrectomy for suspected malignancy from 1 October 2013 to 1 October 2017.Patients were grouped and compared based on whether they received intra-operative cell salvage(ICS).Primary outcomes were allogeneic transfusion rates(ATRs),and if histology confirmed cancer,disease recurrence.Secondary outcomes were complications and transfusion-related cost.Results:Forty patients underwent open nephrectomy for suspected malignancy during the enrolment period.Sixteen patients received ICS while 24 did not(standard group).Compared with the standard group,ICS patients had similar median age(63.5 vs.61.0 years;p=0.83)but fewer females(19%vs.58%;p=0.013).The groups were similar in pre-operative and discharge haemoglobin,Charlson Comorbidity Index,length of hospital stay and proportion with thoracoabdominal surgical approach.The ICS group had a smaller proportion undergoing partial nephrectomy(19%vs.54%;p=0.025)and shorter median follow-up(278 vs.827 days;p=0.0005).Histology was malignant for 14 ICS and 15 standard patients.The ICS group had more frequentT2 disease(79%vs.27%;p=0.005).There were no positive margins.Both groups had similar ATRs(6%vs.4%;p=0.96),complication rates(19%vs.29%;p=0.46)and recurrence rates(18%vs.7%;p=0.40).Transfusion costs were higher amongst ICS patients(AUD$878.18 vs.$49.65 per patient).Conclusion:ICS appears safe,with low rates of recurrence and complication.Both groups had low ATRs,and therefore cost benefit for ICS was not seen.展开更多
Objective:Hyperoxaluria leads to calcium oxalate crystal formation and subsequent urolithiasis.This study aims to analyse the effect of treatment compliance in hyperoxaluria,firstly by analysis of patients with non-pr...Objective:Hyperoxaluria leads to calcium oxalate crystal formation and subsequent urolithiasis.This study aims to analyse the effect of treatment compliance in hyperoxaluria,firstly by analysis of patients with non-primary hyperoxaluria and secondly via systematic review in patients with any hyperoxaluria.Methods:In a retrospective cohort study,adults with non-primary hyperoxaluria managed with dietary counselling in 2013 were enrolled.Twenty-four-hour(24 h)urine collections initially and at 6 months were obtained.Compliance was assessed by self-reported dietary compliance and 24 h urinary volume>2 L.Patients were followed for 24 months.Primary outcomes were urinary oxalate and calcium 24 h load at 6 months,and urolithiasis-related procedural rates at 24 months.A Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)-compatible systematic review of compliance among hyperoxaluric patients was performed.Results:In the cohort study,of 19 eligible patients(4 female)with median age 52 years,10(53%)were considered compliant.Compared with the non-compliant group,these patients had significantly increased subsequent 24 h urinary volume(2250 mL vs.1600 mL;p=0.008)and lower procedural rates(10%vs.56%;p=0.033).Subsequent 24 h urinary oxalate load was nonsignificantly lower in compliant patients.Systematic review regarding compliance in hyperoxaluric patients revealed five studies.Only one utilised dietary counselling or analysed compliant vs.non-compliant patients,finding no difference.None examined the effect of compliance on procedural rates.展开更多
Objective:To systematically evaluate the spectrum of models providing dedicated resources for emergency urological patients(EUPs).Methods:A search of Cochrane,Embase,Medline and grey literature from January 1,2000 to ...Objective:To systematically evaluate the spectrum of models providing dedicated resources for emergency urological patients(EUPs).Methods:A search of Cochrane,Embase,Medline and grey literature from January 1,2000 to March 26,2019 was performed using methods pre-published on PROSPERO.Reporting followed Preferred Reporting Items for Systematic Review and meta-analysis guidelines.Eligible studies were articles or abstracts published in English describing dedicated models of care for EUPs,which reported at least one secondary outcome.Studies were excluded if they examined pathways dedicated only to single presentations,such as torsion,or outpatient solutions,such as rapid access clinics.The primary outcome was the spectrum of models.Secondary outcomes were time-to-theatre,length of stay,complications and cost.Results:Seven studies were identified,totalling 487 patients.Six studies were conference abstracts,while one study was of full-text length but published in grey literature.Four distinct models were described.These included consultant urologists allocated solely to the care of EUPs(“Acute Urological Unit”)or dedicated registrars or operating theatres(“Hybrid structures”).In some services,EUPs bypassed emergency department assessment and were referred directly to urology(“Urological Assessment Unit”)or were managed by other dedicated means.Allocating services to EUPs was associated with reduced time-to-theatre,length of stay and hospital cost,and improved supervision of junior medical staff.Conclusion:Multiple dedicated models of care exist for EUPs.Low-level evidence suggests these may improve outcomes for patients,staff and hospitals.Higher quality studies are required to explore patient outcomes and minimum requirements to establish these models.展开更多
文摘Objective:To assess the impact of intra-operative cell salvage on outcomes in open nephrectomy.Methods:A retrospective cohort study was performed of all patients undergoing open nephrectomy for suspected malignancy from 1 October 2013 to 1 October 2017.Patients were grouped and compared based on whether they received intra-operative cell salvage(ICS).Primary outcomes were allogeneic transfusion rates(ATRs),and if histology confirmed cancer,disease recurrence.Secondary outcomes were complications and transfusion-related cost.Results:Forty patients underwent open nephrectomy for suspected malignancy during the enrolment period.Sixteen patients received ICS while 24 did not(standard group).Compared with the standard group,ICS patients had similar median age(63.5 vs.61.0 years;p=0.83)but fewer females(19%vs.58%;p=0.013).The groups were similar in pre-operative and discharge haemoglobin,Charlson Comorbidity Index,length of hospital stay and proportion with thoracoabdominal surgical approach.The ICS group had a smaller proportion undergoing partial nephrectomy(19%vs.54%;p=0.025)and shorter median follow-up(278 vs.827 days;p=0.0005).Histology was malignant for 14 ICS and 15 standard patients.The ICS group had more frequentT2 disease(79%vs.27%;p=0.005).There were no positive margins.Both groups had similar ATRs(6%vs.4%;p=0.96),complication rates(19%vs.29%;p=0.46)and recurrence rates(18%vs.7%;p=0.40).Transfusion costs were higher amongst ICS patients(AUD$878.18 vs.$49.65 per patient).Conclusion:ICS appears safe,with low rates of recurrence and complication.Both groups had low ATRs,and therefore cost benefit for ICS was not seen.
文摘Objective:Hyperoxaluria leads to calcium oxalate crystal formation and subsequent urolithiasis.This study aims to analyse the effect of treatment compliance in hyperoxaluria,firstly by analysis of patients with non-primary hyperoxaluria and secondly via systematic review in patients with any hyperoxaluria.Methods:In a retrospective cohort study,adults with non-primary hyperoxaluria managed with dietary counselling in 2013 were enrolled.Twenty-four-hour(24 h)urine collections initially and at 6 months were obtained.Compliance was assessed by self-reported dietary compliance and 24 h urinary volume>2 L.Patients were followed for 24 months.Primary outcomes were urinary oxalate and calcium 24 h load at 6 months,and urolithiasis-related procedural rates at 24 months.A Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)-compatible systematic review of compliance among hyperoxaluric patients was performed.Results:In the cohort study,of 19 eligible patients(4 female)with median age 52 years,10(53%)were considered compliant.Compared with the non-compliant group,these patients had significantly increased subsequent 24 h urinary volume(2250 mL vs.1600 mL;p=0.008)and lower procedural rates(10%vs.56%;p=0.033).Subsequent 24 h urinary oxalate load was nonsignificantly lower in compliant patients.Systematic review regarding compliance in hyperoxaluric patients revealed five studies.Only one utilised dietary counselling or analysed compliant vs.non-compliant patients,finding no difference.None examined the effect of compliance on procedural rates.
基金supported by the Adelaide Graduate Centre of the University of AdelaideUniversity of Adelaide divisional scholarship(UoA2018)+1 种基金a Hospital Research Foundation post-graduate scholarship(2018/6330)a National Health and Medical Research Council post-graduate scholarship(1169487)in relation to this work.
文摘Objective:To systematically evaluate the spectrum of models providing dedicated resources for emergency urological patients(EUPs).Methods:A search of Cochrane,Embase,Medline and grey literature from January 1,2000 to March 26,2019 was performed using methods pre-published on PROSPERO.Reporting followed Preferred Reporting Items for Systematic Review and meta-analysis guidelines.Eligible studies were articles or abstracts published in English describing dedicated models of care for EUPs,which reported at least one secondary outcome.Studies were excluded if they examined pathways dedicated only to single presentations,such as torsion,or outpatient solutions,such as rapid access clinics.The primary outcome was the spectrum of models.Secondary outcomes were time-to-theatre,length of stay,complications and cost.Results:Seven studies were identified,totalling 487 patients.Six studies were conference abstracts,while one study was of full-text length but published in grey literature.Four distinct models were described.These included consultant urologists allocated solely to the care of EUPs(“Acute Urological Unit”)or dedicated registrars or operating theatres(“Hybrid structures”).In some services,EUPs bypassed emergency department assessment and were referred directly to urology(“Urological Assessment Unit”)or were managed by other dedicated means.Allocating services to EUPs was associated with reduced time-to-theatre,length of stay and hospital cost,and improved supervision of junior medical staff.Conclusion:Multiple dedicated models of care exist for EUPs.Low-level evidence suggests these may improve outcomes for patients,staff and hospitals.Higher quality studies are required to explore patient outcomes and minimum requirements to establish these models.
