Orihuela and Smith [139] found a recurrence rate of 80% among patients who did not receive supplemental BCG versus a recurrence rate of 16.6% among those who did. However, an update of their series could not ultimately demonstrate a survival advantage with the addition of adjuvant BCG [111]. Rastinehad et al. [122] retrospectively studied 133 renal units treated by percutaneous resection for UTTCC. Eighty‐nine renal units treated primarily by percutaneous resection were then analyzed. Fifty renal units received adjuvant BCG therapy two weeks after endoscopic management for a total of six courses. Recurrence was defined as a positive biopsy result after the third‐look nephroscopy. Overall median follow‐up was 40.8 months. There was no statistical …show more content…
There was no statistical significance demonstrated between any of the treated and nontreated groups. The authors concluded that there is no overall oncologic benefit in the administration of adjuvant BCG with regard to disease recurrence, interval to recurrence, and progression of disease in the treatment of UTTCC. The latest analysis of this retrospective series from Smith’s group included 141 patients with median follow‐up of 66 months [143]. Nephroureterectomy was avoided in 87% of patients. Recurrence occurred in 37% of low‐grade UTTCC patients and 63% of high‐grade UTTCC patients, with a median time to recurrence of 71.4 versus 36.4 months, respectively. On multivariate analysis, grade was the only predictor of recurrence (HR 2.12, P = 0.018). Disease in one patient recurred after 116 months of surveillance, emphasizing the importance of long‐term follow‐up after endoscopic management of UTTCC. Similar to their previous analysis, BCG and mitomycin did not protect against recurrence, progression to nephroureterectomy, or death over resection alone
...gnosis depends on the cause of the kidney stones and the response to preventive therapies.
Mcgrogan, A., Franssen, C. F. and De Vries, C. S. 2011. The incidence of primary glomerulonephritis worldwide: a systematic review of the literature. Nephrology Dialysis Transplantation, 26 (2), pp. 414-430.
. G. Toys is a leading supplier of high quality dolls that are manufactured in two plants within Illinois, one in Chicago, one in Springfield. These dolls are sold in retailors throughout the United States and have an established, loyal customer base due to their high quality and popularity (Campbell & Kulp, 2004). In the last few years, due to rising production costs, their most popular doll, Geoffrey, has seen a decrease in profit margin. In this evaluation we plan to address G.G. Toys existing cost system and offer recommendations on whether management should change the costing system in both the Chicago and Springfield plant. We will calculate the costs of the Geoffrey doll, the specialty branded doll #106 and the cradles using the cost
2013). Inappropriate use of urinary catheter in patients as stated by the CDC includes patients with incontinence, obtaining urine for culture, or other diagnostic tests when the patient can voluntarily void, and prolonged use after surgery without proper indications. Strategies used focused on initiating restrictions on catheter placement. Development of protocols that restrict catheter placement can serve as a constant reminder for providers about the correct use of catheters and provide alternatives to indwelling catheter use (Meddings et al. 2013). Alternatives to indwelling catheter includes condom catheter, or intermittent straight catheterization. One of the protocols used in this study are urinary retention protocols. This protocol integrates the use of a portable bladder ultrasound to verify urinary retention prior to catheterization. In addition, it recommends using intermittent catheterization to solve temporary issues rather than using indwelling catheters. Indwelling catheters are usually in for a longer period. As a result of that, patients are more at risk of developing infections. Use of portable bladder ultrasound will help to prevent unnecessary use of indwelling catheters; therefore, preventing
Different studies had different result numbers or different percentage reduction rates which was primarily based on their indifferences in regards to study design utilized and sample size. As evidenced by research results (Magers, June 2013) and (Welden, 2013), these showed a reduction of urinary catheter days resulted in reduced CAUTI rates. Though different outcome results between the different research studies, they all strongly significantly supported the notion that a nurse-driven protocol to assess and evaluate the appropriateness and use of urethral catheter compared with a no protocol is essential to help in the reduction of CAUTIs. Interpreting these results, (Meddings et al., 2013) showed a drop greater than 52% in CAUTIs and a decrease in catheterization by 37%. The study results from the six scholarly research study articles showed nearly similar or corresponding outcomes. The results were significant enough to support the PICO question. In general, though the difference in sample size, the results still strongly supported excellent outcomes when a nurse-driven protocol is used to evaluate the necessity of continued urethral catheter use. (Chen et al., 2013, para.
The scientific name of a kidney infection is known as pyelonephritis. There are two types of pyelonephritis infections, acute and chronic. Acute pyelonephritis is sudden and limited and can be cured/treated using antibiotics. However, if it is a chronic infection, it is long-lasting and occurs due to birth defects; it can lead to scarring in the kidneys, as well. Kidney infections can occur in both men and women. Although, according to Chih-Yen’s study of chronic infection, “Females (36.1%, 60/166) were more prone to have upper UTIs than males (11.8%, 13/110)” (Chih-Yeh, 2014; Chih-Yeh et al., 2014). In addition, age is not an important number due to the presence of Escherichia coli present in everyone’s body. It is dependent on time and health of an individual for the infection to present itself. Moreover, a study on children and adolescent transplantation concluded that, “UTI was uncommon in children after the first month of transplantation. Two significant risk factors for UTI were female gender and neurogenic bladder in this transplant population” (Fallahzadeh, 2011; Fallahzadeh et al., 2011). From the peer-reviewed papers, it is clear that females are more prone to UTI infection, overall, than
As such techniques were not used in this study, I defined a recurrent urinary tract infection as the presence of 2 10,000 col/ml of a single bacteria and one or more urinary symptoms occurring at least two weeks after the initial infection. This may lead to some misclassification of outcome; however, as long as the classification is not associated with the exposure(s) of interest the resulting measures of association should be biased toward the null hypothesis of no difference. The associations between hypothesized risk factors and repeat UTI were studied using multilevel contingency tables, with both stratification and multivariate techniques to control for confounding.3 I calculated six-month cumulative incidences of UTI, risk ratios (RR), and Mantel-Haenszel summary RRs. Exact 95 percent confidence intervals (CI) were calculated around each RR using the method of Gart.4 A three-level symptoms scale, (0 = no hematuria or urgency, 1 = urgency alone, 2 = hematuria and urgency) was developed and used both as a dependent and
“The Nephrology Nursing Journal” was initially published in 1974, and is a refereed clinical and scientific resource that provides current information on a wide variety of subjects to facilitate the practice of professional nephrology nursing (ANNA, 2015). Its purpose is to disseminate information on the latest advances in research, practice, and education to nephrology nurses to positively influence the quality of care they provide (ANNA, 2015). It is designed to meet the educational and information needs of nephrology nurses in a variety of roles at all levels of practice, while also serving as a source of knowledge for non-nephrology nurses. (ANNA, 2015). Its content expands the knowledge base for nephrology nurses, stimulates professional growth, guides research-based practice, presents new technological developments, and provides a forum for review of critical issues promoting the advancement of nephrology nursing practice (ANNA, 2015).
The cycling industry has growth in the last couple decades in becoming a successful business. In the last decade four companies have standed out in the cycling business
After further multidisciplinary team meetings with the involvement of John the treatment option of automated peritoneal dialysis was implemented (NSF 2004). Once the Tenchkoff catheter had been inserted, education and training completed John was ready for discharge home.
This article describes the choices for treatment: hemodialysis, peritoneal dialysis, and kidney transplantation. It gives the pros and cons of each. It also discusses diet and paying for treatment. It gives tips for working with your doctor, nurses, and others who make up your health care team. It provides a list of groups that offer information and services to kidney patients. It also lists magazines, books, and brochures that you can read for more information about treatment.
In rare cases when a patient does not respond to drug treatment or diet and lifestyle changes, surgery may be necessary. Doctors will remove part or all of the colon in attempt to stop the condition. Surgeries for UC are generally successful but significantly decrease quality of life because the patient has to deal with frequent stools due to the absence of a colon.
Shipping companies does not have or does not follow the standards set in the Safety Management System and MRM
P&G’s purpose is to provide branded products and services of superior quality and value that improve the lives of the world’s consumers. P&G values their employees through leadership, ownership, integrity, passion for winning, and trust. P&G entices and recruits best people in the world, builds their organization by promoting and rewarding from within, and believes that their employees will always be the most important asset. P&G has many principles such as (1) showing respect to all individuals, (2) valuing differences, (3) inspiring and enabling employees to achieve high expectations, standards, and challenging goals, (4) valuing personal mastery, (5) believing that all individuals can and want to contribute to their fullest potential, (6)
Chronic Kidney Disease. Mayo Foundation for Medical Education and Research, 2014. Web. 20 May 2014.