[Show abstract][Hide abstract] ABSTRACT: Background:
Urolithiasis is a common disease with high prevalence and recurrence. Its incidence varies in different geographic locations, and there are evidences that meteorological factors also affect urinary stone formation. The aim of this study is to analyze the effects of climate parameters on the numbers of shockwave treatments for urinary stones in our hospital, in order to understand the effects of these parameters on the prevalence of urolithiasis in northern Taiwan.
We retrospectively reviewed the records of extracorporeal shockwave lithotripsy (ESWL) performed in our hospital from December 2006 to November 2011. Repeated ESWL performed in the same patient within 1 month was excluded, and we only counted as one ESWL in our study. Climate data of the corresponding months were collected from Central Weather Bureau. The available monthly meteorological data included highest, lowest, and average temperatures, humidity, rainfall, total rain days, sunshine hours, average atmospheric pressure, and wind speed.
Monthly ESWL number was positively correlated to temperature (r = 0.696), sunshine hours (r = 0.515), and wind speed (r = 0.369), while it was negatively correlated to humidity (r = -0.441) and atmospheric pressure (r = -0.568). Average monthly temperature had the strongest correlation to ESWL number (r2 = 0.484). Monthly rainfall and rain days were not significantly correlated to ESWL number. To investigate the climate parameters together, we introduced these correlated factors into the multivariate linear regression model which demonstrated only temperature (ß = 1.438, 95% CI: 3.703-9.144, p < 0.001) and atmospheric pressure (ß = 0.803, 95% CI: 0.790-5.428, p = 0.010) to be independently related to monthly ESWL number.
Temperature and atmospheric pressure are associated with monthly ESWL number. Ambient temperature is the most important climate factor affecting the prevalence of urolithiasis in northern Taiwan.
[Show abstract][Hide abstract] ABSTRACT: To identify the changes and associated factors in decisional conflict and regret in patients with localised prostate cancer up to six months postprimary treatment.
Various treatments of differing qualities can be used for patients with localised prostate cancer; these treatments may cause conflicts in treatment decision-making and post-treatment regret.
A quantitative longitudinal study.
A total of 48 patients were recruited from a 3700-bed medical centre in northern Taiwan and assessed at pretreatment and one and six months post-treatment. Demographic characteristics, clinical information and results from the psychosocial adjustment to illness scale, decisional conflict scale and decision regret scale were collected. Data were analysed based on the generalised estimating equations models.
The overall decisional conflict substantially improved over time. However, the feeling of being less informed was high and did not improve considerably during the study period. Education level, decision preferences and psychosocial adjustment were associated with decisional conflict and influenced decision-making. The feeling of ineffective decision-making and decisional regret was low, post-treatment. Psychosocial adjustment was associated with effective decision-making and decisional regret.
In patients with localised prostate cancer, decisional conflict reduced considerably up to six months post-treatment. Moreover, the patients were satisfied with their treatment decision-making and believed that they had made the correct choice up to six months post-treatment. However, patients may have experienced feelings of being less informed pre- and post-treatment, particularly those with lower education levels, a preference for passive roles, or inferior psychosocial adjustment. Consequently, health professionals must provide adequate medical information and psychosocial intervention to help patients in the decision-making process.
Nurses and healthcare providers must provide localised prostate cancer patients with adequate information and psychosocial intervention to reduce decisional conflict.
No preview · Article · Dec 2013 · Journal of Clinical Nursing
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Psychosocial strategies are commonly used to alleviate anxiety and depression in patients with prostate cancer. However, previous studies have shown inconsistent results. OBJECTIVES: This study examined the effects of psychosocial strategies on anxiety and depression in prostate cancer patients. DATA SOURCES AND REVIEW METHODS: A systematic literature review was conducted using 4 English databases (Pubmed, Cochrane Central Register of Controlled Trials, Cinahl, and PsycInfo) and 2 Chinese databases (Wanfang data and Chinese Electronic Periodical Service) with predetermined keyword searches. We first evaluated 8144 titles and/or abstracts. Fourteen studies that met the inclusion criteria were selected. The criteria for study inclusion were as follows: (1) randomized controlled trial design; (2) control group received usual or standard care; (3) focus on testing psychosocial strategies to improve anxiety and depression symptoms; and (4) studies conducted with prostate cancer patients at any stage of the disease. RESULTS: The quality of the studies was assessed using the Jadad scoring system. Only 35.7% of studies were regarded as high quality. The majority of studies (85.7%) delivered informational and educational or cognitive-behavioral interventions. The results show that psychosocial strategies have a substantial effect on reducing anxiety 3 months after intervention (standard mean difference -1.13, p<0.0001) and have a short-term effect on depression symptoms (immediately after intervention: standard mean difference -0.43, p<0.001; 3 months after intervention: standard mean difference -0.78, p=0.04). CONCLUSION: The results indicate that psychosocial strategies were more effective in reducing anxiety and depression compared with routine care, although the effect was not sustainable. However, high-quality methodologies, longer follow-up designs, and innovative psychosocial strategies are suggested for further study.
No preview · Article · Feb 2013 · International journal of nursing studies
[Show abstract][Hide abstract] ABSTRACT: Objective
Redundant prepuce and phimosis are known risk factors for balanoposthitis. It is usually caused by retrograde infection and is related to the preputial bacterial flora. We investigated differences in the preputial bacterial flora between patients with balanoposthitis and physiological phimosis.Materials and Methods
Fifty-six male children were included in the study. Fifteen patients presented to the emergency room or outpatient department with balanoposthitis. Forty-one patients with physiological phimosis received a circumcision. Preputial swab cultures were done. Differences in age, body weight, and preputial flora between these two groups of patients were compared.ResultsPatients with balanoposthitis in this study were significantly younger. Common uropathogens were predominant in patients with balanoposthitis, whereas in patients with physiological phimosis, the main isolates were enteric flora other than common uropathogens. Patients with a body weight higher than the 50th percentile of the normal growth curve had a lower risk of balanoposthitis (odds ratio = 0.212).Conclusions
The preputial bacterial flora in patients with physiological phimosis may change from enteric flora to common uropathogens which are predominant in patients with balanoposthitis. Furthermore, patients at a younger age and with a lighter body weight also had increased susceptibility to balanoposthitis.
[Show abstract][Hide abstract] ABSTRACT: We report the outcomes of temporary vesicostomy- assisted anastomotic urethroplasty in patients with recurrent obliterated posterior urethral stricture.
A review of the medical records identified 12 men (mean age 35.8 years) who had undergone anastomotic urethroplasty for recurrent obliterated posterior stricture. Preoperative evaluation of the urethral defect included a simultaneous retrograde urethrogram and cystogram. The mean estimated preoperative radiographic length of the urethral disruption was 4.25 cm. All patients underwent 1-stage bulboprostatic anastomotic repair which was assisted by an intraoperative temporary vesicostomy.
The initial objective success rate was 83%. The mean follow-up was 22 months. Voiding cystourethrography performed postoperatively demonstrated a wide, patent anastomosis in all but two cases. Urethroscopy performed 1 month after surgery revealed a patent anastomosis with normal urethral mucosa in all but two patients. The mean peak flow rate at the last follow-up visit was 16.3 ml/s. Two patients developed an anastomotic stricture 6 weeks after surgery that was successfully treated by direct visual internal urethrotomy. Finally, all patients had a patent urethra after salvage treatment postoperatively.
An open 1-stage temporary vesicostomy- assisted urethroplasty for recurrent obliterated posterior urethral stricture provides satisfactory outcomes and minimal morbidities.
[Show abstract][Hide abstract] ABSTRACT: Benign prostatic hyperplasia is a common disease affecting older males. As obesity becomes an increasing problem worldwide, its role in prostatic hypertrophy has been discussed recently. The purpose of this study is to evaluate the relationship between waist circumferences and prostatic hyperplasia in Taiwan.
There were 539 men enrolled in the study who had health examinations at the Healthcare Center of Chang Gung Memorial Hospital; 53 were excluded because of history of conditions affecting prostatic volume. Their anthropometry was measured and serum prostate-specific antigen (PSA) levels as well as lipid profiles were analyzed. Prostate volume was measured by transrectal ultrasonography performed by experienced urologists.
The mean prostate volume was 26.43 mL, whereas mean body mass index (BMI) was 25.27 kg/m(2) and mean waist circumference (WC) was 90.81 cm. By age-adjusted logistic regression, PSA > 4 ng/mL, WC ≥ 90 cm, and BMI > 24 kg/m(2) are associated with increased risk of developing prostatic hyperplasia; only WC ≥ 90 cm can be validated by multiple logistic regression. Further analysis of obesity patterns showed that abdominal overweight/obesity places patients at increased risk independently rather than high WC or high BMI alone.
Study results showed that waist circumference ≥ 90 cm is an independent risk factor of prostatic hyperplasia in Taiwan. Men with abdominal overweight/obesity (WC ≥ 90 cm and BMI > 24 kg/m(2)) have a twofold risk of developing prostatic hyperplasia.
No preview · Article · Oct 2011 · Asian Journal of Surgery
[Show abstract][Hide abstract] ABSTRACT: We report on refinements of a technique for preputial covering to prevent complications of redundant prepuce, possibly caused by inadequate surgery for buried penis.
From July 2006 to July 2008, 20 consecutive patients (mean age 4.3 years) underwent surgery for buried penis. The surgical techniques consisted of complete unfurling of the penile shaft, fixation of the penile base skin to Buck's fascia and 1 pedicle flap for skin coverage. Our method for preputial covering is novel in that we create a unique 1-flap covering for the ventral skin defect. Patients were monitored postoperatively at 2 weeks, 1 month and 3 months.
All patients had good or excellent outcomes, with fewer postoperative complications. Two patients developed subcutaneous hematomas that resolved in 2 weeks with conservative treatment. The mean increase in length of penile projection after surgery was 1.7 cm, a statistically significant difference. All patients had good cosmetic results, with increased visualization of the penile shaft.
The preputial covering technique we devised avoided postoperative bulky prepuce caused by residual redundant prepuce. Repeat surgery was also unnecessary for our patients. Furthermore, parents judged the cosmetic results as excellent.
No preview · Article · Feb 2010 · Urologia Internationalis
[Show abstract][Hide abstract] ABSTRACT: The number of cadaver donors is far beyond demand. The use of marginal donors may increase the number of organs available for transplantation.
We expanded our criteria for cadaver donors to include those with active infections. From January 2004 through August 2005, there were 25 cadaveric transplantations in our center. Infected donors accounted for 13 transplants and the remaining 12 that were not infected were used as the control subjects. Blood and infected locus cultures were performed before transplantation and the recipients were treated accordingly.
There were no statistically significant differences between post-transplantation creatinine levels of the kidneys from infected and non-infected donors at 1 month (1.50 +/- 0.61 vs 2.21 +/- 0.77, p = 0.235) and 3 months (1.33 +/- 0.57 vs 2.31 +/- 0.92, p = 0.311) after transplantation. There were no differences in final creatinine levels (1.25 +/- 0.39 vs 1.81 +/- 0.89, p = 0.077), urinalysis white blood cell count (11.62 +/- 26.64 vs 1.91 +/- 3.30, p = 0.102) and blood white cell count (7677 +/- 1890 vs 8636 +/- 2390, p = 0.635). None of the recipients in the infected donor group developed systemic infections or complications. Graft and patient survival rates were both 100%.
Our results seem to suggest that kidneys procured from infected donors might be suitable for transplantation without transmission of the infective organism. Nevertheless, prophylactic antibiotics, close monitoring for possible infection and great care are warranted to prevent related complications. However, longer follow-up periods are needed.
Full-text · Article · Jan 2009 · Chang Gung medical journal
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to investigate the participatory experience in the treatment related decision-making process of patients receiving radical prostatectomy or high-dosage brachytherapy for localized prostate cancer. Between March 2005 and May 2005, ten patients diagnosed with localized prostate cancer were recruited by purposive sampling at a medical center outpatient department and ward and included in this study, based on a qualitative study design. Semi-structured, guided interviews were employed to collect data. Data were analyzed by content analysis. Results showed that the decision-making experience of these localized prostate cancer patients included the items of greatest concern to patients as well as addressed the factors that made treatment decision-making difficult. Findings may be referenced by medical personnel when they are charged to select optimal treatment options for patients with prostate cancer.
No preview · Article · Mar 2007 · Hu li za zhi The journal of nursing
[Show abstract][Hide abstract] ABSTRACT: Laparoscopic adrenalectomy (LA) had become the preferred operation for management of adrenal neoplasm. We conducted this cohort study to evaluate the outcome of laparoscopic and open adrenalectomy (OA).
A total of 67 patients with complete medical records were included in this study. Thirty patients underwent OA and the other 37 patients received LA. The intraoperative and perioperative data analyses focused on surgery time, blood loss, pain scale rating, resumption of oral feeding, hospital stay, complications and convalescence.
LA was completed in all 37 patients without conversion to OA or mortality. The surgery times (203.4 vs. 192.9, p = 0.776) were similar for both OA and LA groups. There was less blood loss in the LA group (355.0 vs. 104.0, p = 0.021). The postoperative pain scale rating was lower in the LA group (5.6 vs. 4.5 p = 0.035) as was analgesia demand (57.4 vs. 3.7, p < 0.001). Oral feeding resumed earlier in the LA group (91.7 vs. 16.4, p < 0.001) and these patients had a shorter postoperative hospital stay (8.4 vs. 3.9, p < 0.001). The complication rate in both groups was similar. In the LA group, patients with primary aldosteronism had shorter surgery times and less blood loss than patients with other tumor types (p < 0.05).
LA results in good surgical outcome without increased risks. We suggest that LA should be the preferred choice for management of adrenal neoplasms. We also suggest that surgeons inexperienced in LA consider beginning with a case of primary hyperaldosteronism.
Preview · Article · Nov 2005 · Chang Gung medical journal