Evolution of pediatric urology at sindh institute of urology and transplantation.
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ABSTRACT:
SUBMITTER: Sultan S
PROVIDER: S-EPMC4157550 | biostudies-literature | 2014
REPOSITORIES: biostudies-literature
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Evolution of pediatric urology at sindh institute of urology and transplantation.
Frontiers in pediatrics 20140908
Sindh Institute of Urology and Transplantation was started in 1972 as an eight bedded department of genitourinary surgery in a government hospital by its pioneer and present director Syed Adib ul Hassan Rizvi. Responding to the socioeconomic dynamics and the needs of the patient population the facility grew into the largest tertiary care Urology, Nephrology, and Transplant center of south Asia. One of the salient components has been the evolution of the Department of Pediatric Urology, which in ...[more]
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Project description:Tissue engineering is defined as the combination of biomaterials and bioengineering principles together with cell transplantation or directed growth of host cells to develop a biological replacement tissue or organ that can be a substitute for normal tissue both in structure and function. Despite early promising preclinical studies, clinical translation of tissue engineering in pediatric urology into humans has been unsuccessful both for cell-seeded and acellular scaffolds. This can be ascribed to various factors, including the use of only non-diseased models that inaccurately describe the structural and functional modifications of diseased tissue. The paper addresses potential future strategies to overcome the limitations experienced in clinical applications so far. This includes the use of stem cells of various origins (mesenchymal stem cells, hematopoietic stem/progenitor cells, urine-derived stem cells, and progenitor cells of the urothelium) as well as the need for a deeper understanding of signaling pathways and directing tissue ingrowth and differentiation through the concept of dynamic reciprocity. The development of smart scaffolds that release trophic factors in a set and timely manner will probably improve regeneration. Modulation of innate immune response as a major contributor to tissue regeneration outcome is also addressed. It is unlikely that only one of these strategies alone will lead to clinically applicable tissue engineering strategies in pediatric urology. In the meanwhile, the fundamental new insights into regenerative processes already obtained in the attempts of tissue engineering of the lower urogenital tract remain our greatest gain.
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Project description:ObjectiveTo describe and evaluate economic analyses or economic evaluations in pediatric urologic literature, including study types such as cost-effectiveness analysis, which are increasingly common in the medical literature.MethodsWe performed a systematic literature review of the MEDLINE, EMBASE, and Cochrane databases (1990-2011) to identify economic analyses of pediatric urologic topics. Studies were evaluated using published quality metrics. We examined the analysis type, data sources, perspective, methodology, sensitivity analyses, and the reporting of methods, results, limitations, and conclusions.ResultsWe identified 2945 nonduplicated studies, 60 of which met inclusion criteria. Economic analyses of pediatric urologic topics increased in number during the study period, from 1 study (2%) in 1990 to 7 (12%) in 2010 (P <.0001 for trend). The most common types of analyses were cost-effectiveness and cost-minimization (22 each, 37%), typically performed from the payer perspective (26 [43%]). Although 44 (73%) correctly identified the analysis type, only 21 (35%) correctly identified the study perspective. Optimal data sources were used in 7 studies (11%). Appropriate inflationary discounting was used in 17 of 53 (32%). Sensitivity analyses were not reported in 31 of 53 (58%). The descriptions of study methods were adequate in 43 studies (72%), assumptions were adequately reported in 42 (70%), and 37 (62%) adequately discussed limitations.ConclusionAlthough economic analyses are increasing in the pediatric urologic literature, there is a need for standardization in methods and reporting. Future investigations should attempt to follow standardized reporting guidelines and should pay particular attention to reporting of methods and results, including a comprehensive discussion of limitations.
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Project description:Long-term complications after hematopoietic cell transplantation (HCT) have been studied in detail. Although virtually every organ system can be adversely affected after HCT, the underlying pathophysiology of these late effects remain incompletely understood. This article describes our current understanding of the pathophysiology of late effects involving the gastrointestinal, renal, cardiac, and pulmonary systems, and discusses post-HCT metabolic syndrome studies. Underlying diseases, pretransplantation exposures, transplantation conditioning regimens, graft-versus-host disease, and other treatments contribute to these problems. Because organ systems are interdependent, long-term complications with similar pathophysiologic mechanisms often involve multiple organ systems. Current data suggest that post-HCT organ complications result from cellular damage that leads to a cascade of complex events. The interplay between inflammatory processes and dysregulated cellular repair likely contributes to end-organ fibrosis and dysfunction. Although many long-term problems cannot be prevented, appropriate monitoring can enable detection and organ-preserving medical management at earlier stages. Current management strategies are aimed at minimizing symptoms and optimizing function. There remain significant gaps in our knowledge of the pathophysiology of therapy-related organ toxicities disease after HCT. These gaps can be addressed by closely examining disease biology and identifying those patients at greatest risk for adverse outcomes. In addition, strategies are needed for targeted disease prevention and health promotion efforts for individuals deemed at high risk because of their genetic makeup or specific exposure profile.
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Project description:IntroductionIn the last 120 years, the field of pediatric urology has seen an exponential growth. In this time, there has not been a comprehensive review of top cited articles within the field.ObjectivesWe aim to identify and categorize the top 100 most cited peer-reviewed articles in pediatric urology using citation analysis.Study designWe searched for articles in the Web of Science™ Core Collection between 1900 and 2020 using terms specific to pediatric urology. We identified relevant pediatric urology articles and selected the top 100 most cited articles. We analysed trends over time for topics and categories and we evaluated the relatedness of these articles using citation analysis software.ResultsThe top 100 most cited articles in pediatric urology were published between 1958 and 2016 in 26 countries, across 181 institutions, and in 46 journals. The median number of citations per article was 268 (IQR 225.75-394.25). Clinical manuscripts were the most common among the top 100 cited articles (n = 64) and the most common topic was genital conditions (e.g., penile, inguinal, or testis but not including hypospadias) (n = 19; 16.5%; total citations = 6591). When using bibliometric software to analyse relatedness among the top 100 articles based on citation of one another, we identified 11 clusters of 3 or more articles which corresponded to topics like those we defined a priori (Summary Figure). We found that a greater proportion of articles describing surgical techniques were published prior to 1987 (n = 6, 38%) as compared to after 1987 (n = 11, 13%), while the proportion of basic science articles has increased.DiscussionThis is the first study to analyse the most cited articles in pediatric urology. There was a lower median citation per article and fewer prospective studies in this list compared to other urologic sub-specialties. Similar to other clinical specialties, the focus has moved from describing and comparing operative techniques to exploring mechanisms of disease. This study is limited by using a single parameter (citation rate) and a single citation database.ConclusionThe list of top 100 most cited articles in pediatric urology is an important resource for clinicians and trainees to understand the body of knowledge and trajectory of this field. It charts the evolution of the field and highlights areas of potential investigation. This objective approach to literature review can facilitate future research and education efforts.
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Project description:Background: Although many children with diseases of the kidneys and the urinary tract may not tolerate long journeys, the number of facilities that provide specialized care for these patients is limited. Therefore, the geographical accessibility of the required health services is critical especially in this patient group. We have analyzed the geographical accessibility of pediatric inpatient and nephro-urology services in Germany, Ireland, and the United Kingdom (UK). Methods: This study introduces a model to compare countries or regions regarding the geographical accessibility of their health services. We calculated the geodesic distances, travel distances, and travel time by car from evenly distributed random points to the nearest facilities that provide pediatric inpatient or nephro-urology outpatient services (pediatric inpatient ward, urology clinic, nephrology clinic, hemodialysis unit). The results were weighted by population density. We compared the three countries with regard to the accessibility of the named services. Results: Weighted median travel times from the random points to the nearest pediatric inpatient ward are < 30 min in all countries. Weighted travel times to the nearest point of pediatric service are shortest in the UK (median <50 min) and longest in Ireland (median <90 min), regardless of the type of service (p < 0.0001). Non-weighted travel times to the nearest pediatric inpatient ward and hemodialysis unit, however, are shorter in Germany than in the UK (p < 0.0001). Conclusions: There is a surprising disparity between the travel times to the nearest facility with pediatric nephro-urology service in these three industrialized European countries. Reasons may be differences in the geographical distribution of the population, the focus of the health care system, and a different degree of clinical networking.
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Project description:IntroductionWe sought to evaluate laser access and practice variability for pediatric ureteroscopy (URS) across the Societies of Pediatric Urology (SPU) to identify opportunities and barriers for future technology promulgation and evidence dissemination.MethodsA 25-question survey was sent electronically to members of the SPU. The questionnaire assessed surgeon and hospital characteristics, treatment preferences based on an index case, and information about available laser units. Descriptive and comparative statistical analyses were performed to assess patterns of care and laser accessibility across the SPU.ResultsA total of 105 of 711 (15%) recipients responded. Seventy-seven respondents (73%) reported laser ownership, which was associated with greater after-hours laser access (87% vs. 13%, p<0.01). Fifty-eight individuals provided additional laser specifications, of whom 21 (36%) used a high-powered laser unit (>60 W). Standard-power lasers were used more frequently in free-standing children's hospitals, as compared to those working within a larger hospital complex (75% vs. 50%, p=0.049). Variation existed in treatment preferences with respect to dusting (33, 34%), fragmentation (18, 19%), or a hybrid approach (46 respondents, 48%). Stone clearance was the most important consideration irrespective of treatment choice.ConclusionsVariability in surgical preferences and accessibility to laser units exist across pediatric urologists who perform URS. Laser ownership and access to newer technologies vary across practices and may influence treatment options. Understanding access to laser technology will be important when considering opportunities for surgical optimization to improve patient outcomes through future studies.
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Project description:INTRODUCTION:The surgical comorbidity assessment is important for patient risk stratification, counseling, and research. In adults, risk assessment indices, such as the Charlson Co-morbidity Score (CCS) or Van Walraven Index (VWI), are well established. In pediatrics, however, risk assessment indices are scarce. Recently, a pediatric-specific risk assessment index, the Rhee index, was developed to discriminate mortality for pediatric general surgery patients. Currently, there is no validated risk assessment tool in pediatric urology. OBJECTIVE:We compared the performance of the CCS, VWI, and Rhee Index in discriminating postoperative complications and readmissions to the emergency room/inpatient unit after pediatric urological procedures. METHODS:We analyzed the Nationwide Readmissions Database (NRD), State Inpatient Databases (SID), and State Emergency Department Databases (SEDD). We included patients (<18 years) who underwent the following urological procedures: ureteroneocystostomy, ureteroureterostomy, radical/partial nephrectomy, pyeloplasty, appendicovesicostomy, enterocystoplasty, vesicostomy, and bladder neck sling. Complications were identified based on definitions in the National Surgical Quality Improvement Program (NSQIP). Thirty-day emergency room admission and inpatient readmissions were extracted. Comorbidity scores were calculated using each of the three indices. We compared the performance of each index in discriminate primarily postoperative complications in the NRD and both admission types in the SID/SEDD by constructing a receiver operating characteristics (ROC). AUCs were compared using the Delong method. This protocol was reviewed by our Institutional Review Board and deemed to be exempt. RESULTS:We identified a total of 8006 patients in NRD and 6236 patients in SID/SEDD. The Rhee index had the best performance for discriminating postoperative complications (AUC = 0.67, 95% CI 0.64-0.70) compared to CCS (AUC = 0.62, 95% CI 0.60-0.65) and VWI (AUC = 0.62, 95% CI 0.59-0.65); p < 0.01. The CCS had the best performance for discriminating 30-day inpatient readmissions (AUC = 0.63, 95% CI 0.61-0.66) than VWI (AUC = 0.54, 95% CI 0.52-0.57), and Rhee Index (AUC = 0.56, 95% CI 0.54-0.59); p < 0.0001. All three indices had similarly poor discrimination for 30-day ER admissions: CCS (AUC = 0.52), VWI (AUC = 0.51), and Rhee Index (AUC = 0.50); p = 0.5 (see Table). DISCUSSION:The Rhee Index had the best performance for discriminating postoperative complications, while the CCS was superior for discriminating inpatient readmissions among the three indices. Limitations to our study include inpatient-only procedures, inability to identify complications managed in clinics, omission of secondary operations, accounting for parental anxiety, and the generalizability of SID. CONCLUSIONS:The three comorbidity indices evaluated are poor discriminators for postoperative complications, 30-day inpatient readmissions or 30-day ER admissions. A new index is needed for pediatric urology patients.
| S-EPMC6026475 | biostudies-literature
Project description:BackgroundPediatric urological diseases pose serious threats to children's physical and mental health. The COVID-19 pandemic has resulted in poor pediatric outcomes for cryptorchidism, hypospadias, and testicular torsion. Presently, many people tend to seek health information via social media platforms. This study aims to quantitatively assess the quality of videos as an information source for pediatric urology in mainland China.MethodsIn this cross-sectional study, a search was performed on social media platforms (Tiktok, Bilibili, and Weibo) with the search terms "cryptorchidism", "hypospadias", and "testicular torsion". The first 30 results with any search term listed by relevance were selected in each platform. Video features (duration, number of likes, comments, and shares) and video sources were collected. Each video included in the study was assessed using DISCERN, Journal of the American Medical Association (JAMA) Benchmark Criteria, and Hexagonal Radar Schema. A correlation analysis was performed considering video features, video source, DISCERN scores and JAMA scores.ResultsA total of 152 videos were included and analyzed. The majority of videos were from physicians (65.8%). According to the DISCERN classification, most videos were rated as "very poor" (48.0%) and "poor" (36.8%). The mean DISCERN and JAMA scores were 36.56 and 2.68, respectively. The duration of videos uploaded by physicians was the shortest (P < 0.001). The video source had no relevance to numbers of "likes", "comments", "shares", DISCERN scores, and JAMA scores (all P-values > 0.05). Other than video duration (P < 0.001), there was no statistically significant difference between groups for any of the recorded or calculated video data (all P values > 0.05). Hexagonal Radar Charts showed the severe imbalance and deficiency of video information. In general, Tiktok videos with the shortest duration received the most numbers of "likes", "comments", and "shares", whereas the overall quality of videos on Weibo was relatively high.ConclusionsDespite most of the videos on social media platforms being uploaded by medical authors, the overall quality was poor. The misleading, inaccurate and incomplete information may pose a health risk to the viewers, especially during the COVID-19 pandemic. Much effort needs to be undertaken to improve the quality of health-related videos regarding pediatric urology.
| S-EPMC9240759 | biostudies-literature