1,721,016 research outputs found
Emphysematous pyelonephritis: time for a management plan with an evidence-based approach
Get PDFIntroduction: emphysematous
pyelonephritis (EPN) is a life-threatening necrotising kidney
infection, but there is no consensus on the best management.Methods: we
systematically reviewed previous articles published from 1980 to 2013
that included studies reporting on EPN, and applying the Cochrane
guidelines, we conducted a meta-analysis of the results.Results: in all, 32 studies were included, with results for 628 patients (mean age 56.6 years,
range 33.8–79.9). There were 462 women, outnumbering men by 3:1.
Diabetes was present in 85% of the cases. Fevers and rigor (74.7%),
pyuria (78.2%) and pain (70.4%) were the most common symptoms. Shock was
associated with 54.4% of deaths while obstructive uropathy was
associated with 15.1% of deaths. Computed tomography was diagnostic in
all the cases. Percutaneous drainage (PCD) and medical management (MM)
alone were associated with a significantly lower mortality rate than was
emergency nephrectomy (EN), with an odds ratio (95% confidence
interval) for PCD vs. EN of 3.13 (1.89–5.16; P < 0.001), for EN vs. MM of 2.84 (1.62–4.99; P = 0.001), and of 0.91 (0.53–1.56; P = 0.73,
i.e., no difference) for PCD vs. MM. Open drainage also had a
significantly lower mortality rate than EN, with a ratio of 0.12
(0.02–0.91; P < 0.04).Conclusion: the
overall mortality rate was ≈18%; shock was associated with a high
mortality rate and therefore should be managed aggressively. PCD and MM
were associated with significantly higher survival rates than EN, and
therefore EN should only be considered if the patient does not improve
despite other treatments
Laparoscopic partial nephrectomy in obese patients: a systematic review and meta-analysis
No full textWhat's known on the subject? And What does the study add? The literature yielded only four studies on the subject; however, no clear outcome can be taken from individual studies. This review adds a meta-analysis of these four studies to make the patient cohort larger and to allow for a greater understanding of the procedure in this select group of patients. • To compare the safety and efficacy of laparoscopic partial nephrectomy (LPN) in obese and non-obese patients. • We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1966 to November 2011), EMBASE (1980 to November 2011), CINAHL, Clinicaltrials.gov, Google Scholar, reference lists of articles and abstracts from conference proceedings without language restriction for studies comparing LPN in obese and non-obese patients. • Four observational cohort studies were included for 256 obese patients compared with 403 non-obese patients who underwent LPN. • There was no difference in operative duration (mean difference [MD] 5.64, 95% confidence interval [CI]-3.80 to 15.09), warm ischaemic time (MD -1.04, 95% CI -2.68 to 0.59), estimated blood loss (MD 53.73, 95% CI 0.72-106.74) or hospital stay (MD -0.04, 95% CI -0.30 to 0.22). • There was no difference in complications in total (odds ratio [OR] 1.02, 95% CI 0.70-1.49), intraoperative complications (OR 0.68, 95% CI 0.30-1.53), or postoperative complications (OR 1.15, 95% CI 0.75-1.77). • The obese group had significantly more Clavien grade III complications (OR 3.95, 95% CI 1.36-11.42), despite the low absolute incidence, with 4.3% (11/256) in the obese group vs 1.5% (6/403) in the non-obese group. • Experienced laparoscopic surgeons can safely and efficiently perform PN for obese patients with comparable results to those of non-obese patients. • The likelihood of major (Clavien Classification ≥ III) complications is higher for the obese patient.</p
Testosterone Measurement in Patients with Prostate Cancer
No full textContext: Serum testosterone measurement has no widely accepted place in the management of patients with prostate cancer (PCa). However, several potential clinical applications of serum testosterone determination can be envisaged. Objective: To review the role of testosterone and the androgen axis in the natural history of PCa and evaluate the evidence for the clinical application of serum testosterone measurement in patient screening, diagnosis, and management. Evidence acquisition: A Medline search retrieved original research and review articles relating to the androgen axis in PCa and the use of testosterone measurement for (1) assessing PCa risk in the general population, (2) adding to the specificity of prostate-specific antigen (PSA) testing, (3) determining tumour aggressiveness, (4) assessing the efficacy of androgen-deprivation therapy (ADT), and (5) optimising the scheduling of intermittent ADT. Relevant data were reviewed during a roundtable discussion, and consensus recommendations were agreed. Evidence synthesis: A body of data implicates the androgen axis in PCa throughout its natural history. Based on current evidence, serum testosterone measurement cannot be recommended for determining PCa risk, increasing specificity of PSA testing, or assessing tumour aggressiveness. In contrast, for patients receiving ADT, there is a clear rationale for serum testosterone monitoring to ensure that castration levels are achieved. Practical recommendations for testosterone measurement during ADT are outlined. If PSA is rising while on ADT, castration levels of serum testosterone must be demonstrated before hormonal independence can be assumed. Serum testosterone levels might be considered an additional trigger for therapy reinitiation in intermittent ADT schedules. Finally, future prospective studies should further evaluate the potential relevance of testosterone measurement as an independent assessment of prognosis and treatment decision in different disease stages. Conclusions: As a therapeutic target, serum testosterone levels should be monitored to verify response to ADT and confirm suspected castration independence. (C) 2010 European Association of Urology. Published by Elsevier B. V. All rights reserved
Robotic versus laparoscopic partial nephrectomy: a systematic review and meta-analysis
No full textContex: centres
worldwide have been performing partial nephrectomies laparoscopically
for greater than a decade. With the increasing use of robotics, many
centres have reported their early experiences using it for
nephron-sparing surgery.Objective: to review published literature comparing robotic partial nephrectomy (RPN) with laparoscopic partial nephrectomy (LPN).Evidence acquisition: an
online systematic review of the literature according to Cochrane
guidelines was conducted from 2000 to 2012 including studies comparing
RPN and LPN. All studies comparing RPN with LPN were included. The
outcome measures were the patient demographics, tumour size, operating
time, warm ischaemic time, blood loss, transfusion rates, length of
hospital stay, conversion rates, and complications. A meta-analysis of
the results was conducted. For continuous data, a Mantel-Haenszel
chi-square test was used; for dichotomous data, an inverse variance was
used. Each was expressed as a risk ratio with a 95% confidence interval p < 0.05 considered significant.Evidence synthesis: a total of 717 patients were included, 313 patients in the robotic group
and 404 patients in the laparoscopic group (seven studies). There was no
significant difference between the two groups in any of the demographic
parameters except for age (age: p = 0.006; sex: p = 0.54; laterality: p = 0.05; tumour size: p = 0.62, tumour location: p = 57; or confirmed malignant final pathology: p = 0.79). There was no difference between the two groups regarding operative times (p = 0.58), estimated blood loss (p = 0.76), or conversion rates (p = 0.84). The RPN group had significantly less warm ischaemic time than the LPN group (p = 0.0008). There was no difference regarding postoperative length of hospital stay (p = 0.37), complications (p = 0.86), or positive margins (p = 0.93).Conclusions: in
early experience, RPN appears to be a feasible and safe alternative to
its laparoscopic counterpart with decreased warm ischaemia times noted
Androgen-Deprivation Therapy in Prostate Cancer: A European Expert Panel Review
No full textContext: Androgen-deprivation therapy (ADT) is the mainstay of treatment for metastatic prostate cancer and is also recommended in association with external-beam radiation therapy (EBRT) for patients with high-risk disease. Objective: Our aim was to make recommendations regarding optimal timing of ADT, target serum testosterone levels, intermittent ADT delivery, and quality of life (QoL) during ADT. Evidence acquisition: This review contains recommendations from a European expert panel held in May 2009. Evidence synthesis: There is ongoing debate over whether ADT should be initiated at diagnosis or delayed until biochemical or symptomatic progression. Immediate ADT is recommended for metastatic disease to defer symptom development and reduce serious complications. In node-positive disease or high-risk nonmetastatic disease unfit for curative therapy, immediate ADT is also an option. Furthermore, there is a clear benefit of adjuvant ADT in association with EBRT in patients with high-risk disease. Some retrospective evidence also supports adjuvant ADT use following radical prostatectomy for high-risk localised disease. In cases of biochemical relapse after definitive local therapy, early ADT may benefit patients with poor prognostic factors. For patients on ADT, the traditional <50 ng/dl target for serum testosterone levels should be considered outdated. It is now clear that a <20 ng/dl threshold better reflects the outcome of bilateral orchidectomy, which is considered the standard of reference in ADT. Recent data demonstrate a clinical benefit of testosterone reduction to more stringent targets than the historical <50 ng/dl threshold. In addition, emerging evidence suggests that intermittent scheduling of ADT can reduce adverse events and improve QoL without compromising survival, but further data are needed to guide its clinical use. Finally, adverse events of ADT may affect QoL and must be discussed with patients. Conclusions: Based on current evidence, the panel made several recommendations for the clinical implementation of ADT. (C) 2010 European Association of Urology. Published by Elsevier B. V. All rights reserved
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe 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
Get PDF“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
Get PDFWe 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
Get PDFWe 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
- …
