METHODS: This was a cross-sectional survey conducted during the 15th Family Medicine Scientific Conference in June 2011 using the Warr-Cook-Wall scales. The questionnaires included demography and work-related items and were self-distributed and returned at the end of the conference. Independent risk factors were identified using multiple linear regressions.
RESULTS: A total of 149 conference participants completed the survey, with a response rate of 33.1%. They were mainly females (85.2%), Malay (83.2%), and married (83.9%) in almost equal proportions of practice location (urban 57.8% and rural 42.2%). Majority of them were working at community-based health clinics (74.0%) and in public sectors (94.4%). The respondents were mainly doctors (91.4%). The mean age of the participants was 39.1 years (SD 8.0), with a mean duration of service of 9 years (SD 6.9). Family medicine specialty (FMSt) residents had lower job satisfaction (B = -8.0, 95% CI -14.61 to -1.40, p = 0.02). Family medicine specialists (FMSs) had higher satisfaction with working conditions (B = 1.95, 95% CI 0.50 to 3.41, p = 0.01). A male worker had on average 2.8 (95% CI -4.7 to -0.9, p = 0.005) lower points in the total intrinsic job motivation scale. There was a positive relationship between the duration of working and job motivation (B = 0.10, 95% CI 0.004 to 0.2, p = 0.04).
CONCLUSION: FMSt residents might have the least job satisfaction, but FMSs were generally satisfied with their working conditions regardless of the location of their clinics. Men and those who were novice in primary healthcare may need more support for motivation.
METHOD: This is a descriptive study based on data from the Audit of Diabetes Control and Management (ADCM) registry. This audit assessed the treatment and standard of control of hypertension in diabetic patients aged 18 years and above. Data were analysed using STATA version 9.
RESULTS: From a total of 20 646 cases, about two third of them, 13 417 (65%) were reported to have hypertension. 19 484 (94.4%) had their blood pressure (BP) recorded and out of these, 11 414 (58.5%) were found to have BP >130/80 mmHg. 13 601 cases (65.9%) of the total sample were on antihypertensive drugs. 64.1% of those on antihypertensive drugs were prescribed angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers. 14.2% were on more than two types of antihypertensive drugs. Older patients and those with longer duration of DM were less likely to achieve the target BP of ≤130/80. In general, about 40% of diabetic cases registered in the ADCM project had their hypertension well controlled.
METHODS: This study retrospectively analyzed patients who underwent RIRS for renal stones from January 2018 to August 2021 within the multicentric FLEXOR registry. Demographics, stone characteristics, perioperative findings, results and complications were analyzed and compared between gender groups.
RESULTS: A total of 6669 patients were included, 66.1% were male and 33.9% were female. Stone characteristics was comparable between groups. Female patients had significant higher fever and positive urine culture rates (12% vs. 8% and 37% vs. 34%). Also, females had a slight longer hospital stay (3.8 vs. 3.5 days; P
METHODS: A number of 6579 patients from the TOWER group registry were divided into pre-stented (group 1) and non-pre-stented groups (group 2). Patients aged ≥18 years old, with normal calyceal anatomy were enrolled. Patients with ureteric stones, anomalous kidneys, bilateral stones, planned for ECIRS were excluded.
RESULTS: Patients are homogeneously distributed in both groups (3112 vs. 3467). The predominant indication for pre-stenting was symptom relief. Overall stone size was comparable, whilst group 1 had a significantly more multiple (1419 vs. 1283, P<0.001) and lower-pole (LP) stones (1503 vs. 1411, P<0.001). The mean operative time for group 2 was significantly longer (68.17 vs. 58.92, P<0.001). Stone size, LP stones, age, recurrence and multiple stones are contributing factors for residual fragments at the multivariable analysis. The incidence of postoperative day 1 fever and sepsis was significantly higher in group 2, indicating that pre-stenting is associated with a lower risk of post-RIRS infection and a lower overall complications rate (13.62% vs. 15.89%) (P<0.001).
CONCLUSIONS: RIRS without pre-stenting can be considered safe without significant morbidity. Multiple, lower-pole and large stone is a significant contributor towards residual fragments. Patients who were not pre-stented had significantly higher but low-grade complications, especially for lower pole and large volume stones. While we do not advocate routine pre-stenting, a tailored approach for these patients should include proper counselling regarding pre-stenting.
PURPOSE: To develop a series of recommendations for the contemporary management management of staghorn calculi and to provide a clinical framework for urologists treating patients with these complex stones.
METHODS: A comprehensive literature search for articles published in English between 01/01/1976 and 31/12/2022 in the PubMed, OVID, Embase and Medline database is performed. A series of recommendations are developed and individually graded following the review of literature and panel discussion.
RESULTS: The definition, pathogenesis, pathophysiology, preoperative evaluation, intraoperative treatment strategies and procedural advice, early postoperative management, follow up and prevention of stone recurrence are summarized in the present document.
CONCLUSION: A series of recommendations regarding the management of staghorn calculi, along with related commentary and supporting documentation offered in the present guideline is intended to provide a clinical framework for the practicing urologists in the management of staghorn calculi.
OBJECTIVE: To develop recommendations for RIRS on the basis of existing data and expert consensus.
DESIGN, SETTING, AND PARTICIPANTS: A protocol-driven, three-phase study was conducted by the European Association of Urology Section of Urolithiasis (EULIS) and the International Alliance of Urolithiasis (IAU). The process included: (1) a nonsystematic review of the literature to define domains for discussion; (2) a two-round modified Delphi survey involving experts in this field; and (3) an additional group meeting and third-round survey involving 64 senior representative members to formulate the final conclusions.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The results from each previous round were returned to the participants for re-evaluation of their decisions during the next round. The agreement threshold was set at 70%.
RESULTS AND LIMITATIONS: The panel included 209 participants who developed 29 consensus statements on the following topics of interest: (1) perioperative infection management; (2) perioperative antithrombotic therapy; (3) fundamentals of the operative technique; and (4) standardized outcome reporting. Although this consensus can be considered as a useful reference for more clinically oriented daily practice, we also acknowledge that a higher level of evidence from further clinical trials is needed.
CONCLUSIONS: The consensus statements aim to guide and standardize clinical practice and research on RIRS and to recommend standardized outcome reporting.
PATIENT SUMMARY: An international consensus on the best practice for minimally invasive surgery for kidney stones was organized and developed by two international societies. It is anticipated that this consensus will provide further guidance to urologists and may help to improve clinical outcomes for patients.