World journal of urology
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Comparative effectiveness research (CER) has come to remain at the forefront of political and scientific debates of health care. The aim of this article is to describe the attributes of CER and implications to the field of urology. ⋯ Several topics of urologic care have already been identified in the first quartile of CER priorities, and many others need to be added. Following the proposed research, designs for CER should be done while abiding by robust methodology, maintaining transparency, and effectively translating research into clinical practice.
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World journal of urology · Feb 2011
ReviewHealth care reform in 2010: transforming the delivery system to improve quality of care.
Although the American health care system is the most expensive in the world, it delivers inconsistent (and sometimes poor) quality of care. Recent health care legislation contains several delivery system reforms that will attempt to address these issues. We review these programs and discuss the implications for practicing urologists. ⋯ Although the recent health care legislation broadens coverage for millions of Americans, there are limited data demonstrating the effectiveness of the cost-containment and quality-improvement mechanisms established by this law. Results from recently initiated pilot programs will emerge over the coming years, and it remains to be seen how health care costs and quality will be affected.
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World journal of urology · Dec 2010
Randomized Controlled TrialThe efficacy of periprostatic local anaesthetic infiltration in transrectal ultrasound biopsy of prostate: a prospective randomised control study.
It is still uncertain as to which form of anaesthesia is the optimum. We conducted a study to identify the best location and optimum volume of anaesthetic agent in order to achieve best pain relief and cooperation from our patients. We also assessed the need for local anaesthetic gel for probe lubrication and if the number of cores during biopsy makes a difference in the pain score. ⋯ We suggest that a 10 cc 1% Lignocaine infiltration at the apical region of the prostate be used to obtain best pain relief during this procedure. Plain lubricant jelly is sufficient for probe insertion. There is no need to alter the anaesthetic requirement if number of cores is increased.
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World journal of urology · Apr 2010
Perioperative analgesia strategies in fast-track pediatric surgery of the kidney and renal pelvis: lessons learned.
Effective analgesia is essential for the success of fast-track (FT) pediatric surgery. Aim of the study was to achieve an optimal analgesia protocol for a comfortable postoperative course and early mobilization in children undergoing urological procedures. ⋯ The modified analgesia protocol FT II leads to earlier and more effective pain reduction, lower use of opioids and fewer side effects than the previously used protocol FT I. Hence, modification of analgesia in pediatric urology is essential.
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World journal of urology · Feb 2010
Comparative StudyPenile block is associated with less urinary retention than caudal anesthesia in distal hypospadia repair in children.
Caudal anesthesia (CA) is widely recommended due to excellent analgesia in distal hypospadia repairs, but its potential side effect on urinary retention interferes with patient comfort. To objective is to determine the impact of CA versus penile block (PB) on postoperative micturition. ⋯ In our series, children undergoing distal hypospadia repair experienced significantly less impaired micturition when using penile block instead of caudal anesthesia. We recommend penile block as the first choice perioperative analgesia, when spontaneous postoperative micturition must be guaranteed.