1,720,963 research outputs found
Antimicrobial prophylaxis in TURB and TURP: time for a paradigm shift?
No full textAntimicrobial resistance is an increasing problem in healthcare and could threaten
public safety. The over- and misuse of antibiotics is an enormous problem and
created the concept of antimicrobial stewardship, which is a global initiative for a
rational antibiotic use.
Antimicrobial prophylaxis (AMP) is widely used to prevent surgical infections and
although the use of AMP is generally recognized as efficient in preventing
infectious complications, some remarks can be made in certain procedures.
Antibiotics have adverse drug reactions, allergic reactions and unnecessary
antibiotics needlessly increase hospital costs. Overuse of antibiotics is also a
reason for an increase in microbial resistance and even single-use antibiotic use
has an impact on resistance in uropathogens.
TURP or transurethral resection of the prostate is a very common urologic
procedure, which nearly every urologist performs on a regular base, in which a
hot iron loop is used to resect the inner part of an enlarged prostate.
The (inter-)national guidelines recommend AMP for every TURP procedure but
these recommendations are mostly based on obsolete or underpowered data.
Our first study was a large, prospective cohort study in which a very low infection
rate in patients undergoing TURP without AMP was observed and was published
in World Journal of Urology. Avoiding unnecessary antibiotic use is a keystone of
antimicrobial stewardship and we wanted to confirm these findings and set up a
randomized trial to confirm the safety of omitting AMP in a group of patients
undergoing TURP, in support of antimicrobial stewardship.
Our study, which is the largest RCT to date investigating the impact of AMP in
post-TURP fever, showed that omitting AMP is non-inferior in patients undergoing
TURP without a pre-operative, indwelling catheter and pyuria. This study was
published in Journal of Urology.
TURB or transurethral resection of bladder tumor is a very similar procedure to
TURP and many guidelines don’t differentiate their recommendations for this
urethrocystoscopy with manipulation-procedure. The contrast between the
frequency of the procedure and the absence of scientific evidence for AMP in TURP
is striking and was the reason for investigating this topic. The multivariable
analysis of our RCT demonstrated the safety of omitting AMP in patients
undergoing TURB without a pre-operative indwelling catheter and pre-operative,
positive urinary culture. This study was published in World Journal of Urology. These studies demonstrate the safety of omitting AMP in the majority of patients
and we hope that these findings will be implemented in the international guidelines
so a more rational approach towards AMP in TURB/P can be performed in the daily,
urologic practice.Antibiotica-resistentie is een alsmaar toenemend probleem en kan een bedreiging
vormen voor onze volksgezondheid. Door het over- en misbruik van antibiotica is
het concept van ‘antimicrobial stewardship’ ontstaan, waarbij voor een rationeel
gebruik van antibiotica gepleit wordt.
Antibiotica-profylaxie (ABP) wordt gebruikt in kader van preventie van
postoperatieve infecties en ondanks dat antibiotica-profylaxie in het algemeen
nuttig en efficiënt is, zijn er toch bepaalde kanttekeningen te plaatsen. Het gebruik
van antibiotica gaat dikwijls gepaard met storende neveneffecten, allergieën en
onnodige antibiotica jagen de ziekenhuiskosten nodeloos de hoogte in.
TURP of een transurethrale resectie van de prostaat is een erg frequente
urologische ingreep, die de meeste urologen geregeld uitvoeren. Hierbij wordt via
een hete, ijzeren lus de binnenzijde van de vergrote prostaat gereseceerd. De
(inter-) nationale richtlijnen raden aan om ABP te gebruiken bij elke TURP doch
deze zijn vaak gebaseerd op verouderde of beperkte data.
Onze eerste studie over ABP en TURP werd gepubliceerd in World Journal of
Urology en is een prospectieve, cohort studie bij meer dan 500 patiënten, waarbij
een erg lage incidentie van postoperatieve infecties geobserveerd werd. We wilden
deze bevindingen graag bevestigen via een gerandomizeerde studie aangezien
het vermijden van onnodige antibiotica een belangrijk punt binnen antimicrobial
stewardship is.
Een gerandomizeerde studie, die gepubliceerd werd in Journal of Urology, werd
aldus opgezet waarin aangetoond werd dat het weglaten van ABP bij patiënten
die een TURP ondergaan zonder preoperatieve verblijfsonde en pyurie veilig is.
TURB of een transurethrale resectie van blaastumoren is een procedure die erg
gelijkaardig is met een TURP. De meeste richtlijnen maken zelfs geen onderscheid
tussen de 2 ingrepen, hetgeen niet correct is aangezien er veel minder literatuur
beschikbaar is over ABP en TURB. Het contrast tussen de frequentie van de
ingreep en gebrek aan wetenschappelijke studies over ABP en TURB was voor ons
de aanleiding om een tweede studie te starten.
Onze TURB-studie, die gepubliceerd werd in World Journal of Urology, toonde
eveneens de veiligheid aan van het weglaten van ABP bij patiënten die een TURB
ondergaan zonder preoperatieve verblijfsonde en een positieve, preoperatieve
urinecultuur.
We hopen dat deze studieresultaten mee opgenomen zullen worden in de (inter)
nationale richtlijnen zodat een meer rationale aanpak betreffende antibioticaprofylaxie in TURB/P kan bekomen worden in de dagdagelijkse urologische
praktijk
A randomized controlled trial concerning Antimicrobial Prophylaxis (AMP) in Transurethral Resection of Bladder tumor (TURB): Another step forward in antimicrobial stewardship?
No full textA randomized trial regarding Antimicrobial Prophylaxis (AMP) in Transurethral Resection of Bladder tumor (TURB) in support of antimicrobial stewardship
No full textA randomized trial regarding antimicrobial prophylaxis (AMP) in transurethral resection of bladder tumor (TURB)
No full textPURPOSE: To determine whether omitting antimicrobial prophylaxis (AMP) in TURB is safe in patients undergoing TURB without an indwelling pre-operative catheter/nephrostomy/DJ and a negative pre-operative urinary culture. MATERIALS AND METHODS: A multi-centered randomized controlled trial (RCT) from 17-09-2017 to 31-12-2019 in 5 hospitals. Patients with a pre-operative indwelling catheter/DJ-stent or nephrostomy and a positive pre-operative urinary culture (> 104 uropathogens/mL) were excluded. Post-operative fever was defined as body temperature ≥ 38.3 °C. A non-inferiority design with a 6% noninferiority margin and null hypothesis (H0) that the infection risk is at least 6% higher in the experimental (E) than in the control (C) group; H0: C (AMP-group) - E (no AMP-group) ≥ Δ (6% noninferiority margin). A multivariable, logistic regression was performed for AMP and post-TURB fever with covariates: tumor size and (clot-) retention. The R Project® for statistical computing was used for statistical analysis and a p value of 0.05 was considered as statistically significant. RESULTS: 459 Patients were included and 202/459 (44.1%) received AMP vs 257/459 (55.9%) without AMP. Fever occurred in 6/202 [2.9%; 95% CI (1.2-6.6%)] patients with AMP vs 8/257 [3.1%; 95% CI (1.5%-6.1%)] without AMP (p = 0.44). Multivariable, logistic regression showed no significant harm in omitting AMP when controlled for (clot-)retention and tumor size (p = 0.85) and an adjusted risk difference in developing post-TURB fever of 0.0016; 95% CI [- 0.029; 0.032]. CONCLUSION: Our data suggest the safety of omitting AMP in patients undergoing TURB without an indwelling, pre-operative catheter/nephrostomy/DJ and a negative pre-operative urinary culture.status: Publishe
Antimicrobial Prophylaxis in Transurethral Resection of the Prostate: Results of a Randomized Trial
No full textPURPOSE: We sought to determine whether omitting antimicrobial prophylaxis is safe in patients undergoing transurethral resection of the prostate without preoperative pyuria and a preoperative catheter. MATERIALS AND METHODS: We conducted a multicenter randomized controlled trial from September 17, 2017 until December 31, 2019 in 5 hospitals. Patients with pyuria (>100 white blood cells/ml) and a preoperative indwelling catheter were excluded. Postoperative fever was defined as a body temperature ≥38.3C. A noninferiority design was used with a 6% noninferiority margin and null hypothesis (H0) that the infection risk is at least 6% higher in the experimental (E) than in the control (C) group; H0: C (antimicrobial prophylaxis group) - E (no antimicrobial prophylaxis group) ≥ Δ (6% noninferiority margin). A multivariable, logistic regression was performed regarding posttransurethral resection of the prostate fever and antimicrobial prophylaxis with co-variates: (clot-)retention and operating time. The R Project® for statistical computing was used and a p value of 0.05 was considered as statistically significant. RESULTS: Of the patients 474 were included for multivariable analysis and 211/474 (44.5%) received antimicrobial prophylaxis vs 263/474 (55.5%) patients without antimicrobial prophylaxis. Antibiotics were fluoroquinolones in 140/211 (66.4%), cephazolin in 58/211 (27.5%) and amikacin in 13/211 (6.2%) patients. Fever occurred in 9/211 (4.4%) patients with antimicrobial prophylaxis vs 13/263 (4.9%) without antimicrobial prophylaxis (p=0.8, risk difference 0.006 [95% CI -0.003-0.06, relative risk 1.16]). We were able to exclude a meaningful increase in harm associated with omitting antimicrobial prophylaxis (p=0.4; adjusted risk difference 0.016 [95% CI -0.02-0.05]). CONCLUSIONS: Our data demonstrate the safety of omitting antimicrobial prophylaxis in patients undergoing transurethral resection of the prostate without preoperative pyuria and a preoperative indwelling catheter.status: Publishe
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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