Good Treatment Quality Research Articles

Influence of specialization on primary success and complication rate in ERCP. Proposal to improve the quality of ERCP

Endoscopic retrograde cholangiopancreatography [ERCP] is a complex procedure with a flat learning curve. It is associated with the risk of serious complications such as pancreatitis, bleeding, cholangitis and perforation. Endosonography should therefore also be offered for the precise indication of the higher-risk ERCP. Numerous factors influence the success of ERCP. In addition to structured training for the initial acquisition of skills and a minimum number of ERCPs of varying degrees of difficulty, maintaining a good quality of ERCP also requires a regular minimum number of examinations performed per year. There is extensive evidence that shows a significant correlation between ERCP volumes and primary success rates, lower lengths of hospital stay, fewer unwanted readmissions and fewer complications. The cut-offs for differentiating between high-volume and low-volume centers were chosen inconsistently in the studies, with the highest evidence for a cut-off value of 200 ERCPs/year. The question of specialization in ERCP has been given a relevance by the current developments in german hospital reform. Here, a minimum number of ERCPs should be defined for groups of different specialization. However, a minimum number alone will not be able to achieve good treatment quality. In terms of high-quality patient care, it is necessary to offer ERCPs in specialized gastroenterology center, which, in addition to a sufficient number of ERCPs for training and to maintain competence, offer an on-call service and complementary procedures such as EUS and which are embedded in appropriately accessible clinics that have the necessary resources for complication management.

Transforming the Management of Articular Fractures in the Foot: A Critical Examination of Current Methods and Future Directions: A Review.

This study provides a comprehensive examination of the current methodologies and potential strategies for the treatment of articular fractures of the foot. In the field of orthopedic healthcare, these fractures present a significant challenge due to their complex nature and the fact that they affect the routines of patients. The motivation behind this study is based on two main concepts. The first one is represented by the use of emerging medical technologies and personalized medicine to bring a significant transformation in the management of foot fractures and give a better quality of treatment that is accepted by the patient. However, because there are inequities in the availability of the necessary medical care and equipment, as well as uneven incorporation in clinical settings, new technologies cannot be used to treat these types of fractures. Regarding the second concept behind this study, it is indicated that although current treatment methods are essential, they have a number of shortcomings when it comes to properly addressing these types of injuries. An approach is needed that takes into account the biomechanical points of view and the particularities of each patient. This approach could be applied in all hospital settings. Through this study, we want to highlight the progress made in recent years in surgical techniques such as 3D printing, minimally invasive surgery (MIS), and biological products. However, in the application of this new discovery, new obstacles have been discovered that prevent the efficient treatment of these types of injuries. This study examines the effectiveness and limitations of current treatments, as well as how differences in healthcare, such as available equipment, training of medical staff, and technological advances, affect patient outcomes in everyday life. This research wishes to emphasize that continuous innovation, interdisciplinary collaboration, and the use of an optimal approach that is appropriate for each patient, are essential. This study aims to provide new insights and useful recommendations for future research and clinical practice. The main role of this research is to improve the quality of life of patients and increase the standards of care in this complex field, which is in permanent evolution.

Comparative Evaluation of Single Rotary File System and Sequential Multi-file Rotary Systems on Time for Biomechanical Preparation and Obturation Quality in Single-visit Pulpectomy Protocol: A Double-blind Randomized Clinical Trial.

Single-visit pulpectomy (SVP) protocol with rotary files is highly recommended for the treatment of teeth with irreversible pulpitis. Various rotary endodontic files specially designed for use in the pediatric population are available. The aim is to clinically assess the parameters related to the time required for biomechanical preparation (TBMP) and quality of filling using a single file system vs a sequential multi-file system in infected primary mandibular molars. A total of 45 infected primary molars were allocated to three groups (two experimental groups (n = 15) and a control group. The first experimental group was instrumented using NiTi K-Flex files, the second group with a single file rotary system with variably variable (VV) taper, and the third with a sequential multi-file system with constant taper. Biomechanical preparation time was recorded and standardized digital radiograph (RVG) were taken pre- and postinstrumentation. The data recorded was sent for statistical analysis. There is a substantial reduction of TBMP in primary molars using single file VV taper and multi-sequential file constant taper. Obturation time for all three file systems was comparable and there were no differences between the three file systems used (p > 0.05). Multi-sequential file constant taper files showed a higher probability of optimal obturations and minimal voids followed by NiTi "K-Flex" files and single file system but the difference was nonsignificant (p > 0.05). However, using a rotary in primary teeth results in better canal shape, and less TBMP leading to a better quality of treatment in less time. Shetty B, Singh R, Patil V, et al. Comparative Evaluation of Single Rotary File System and Sequential Multi-file Rotary Systems on Time for Biomechanical Preparation and Obturation Quality in Single-visit Pulpectomy Protocol: A Double-blind Randomized Clinical Trial. Int J Clin Pediatr Dent 2023;16(S-3):S247-S252.

Selection of a viable blockchain service provider for data management within the internet of medical things: An MCDM approach to Indian healthcare

Health 4.0 is gaining significant attention globally to support better treatment and care for people. Digital technologies such as the IoMT “(”Internet of Medical Things“”) and blockchain substantially promote quality health services. Literature shows that embedding blockchain in IoMT is an effective way to attain secure and quality healthcare. Selecting a viable blockchain service provider (BSP) becomes a complex task and can be considered an MCDM “(”Multi-Criteria Decision-Making“”) problem. Earlier studies on BSP selection indicate that complex expressions cannot be well-modelled and methodical estimation of decision parameters by capturing hesitation and interaction of entities is not adequately explored. Driven by the issues, authors put forward a novel MCDM framework with (i) a double hierarchy linguistic structure for data collection in natural expressions; (ii) regret measure for experts' reliability calculation; (iii) a weighted CRITIC approach for criteria weight determination, and (iv) CRADIS-Copeland algorithm for ranking BSPs. Finally, a case example from Recent Indian healthcare is exemplified to demonstrate the framework's applicability. Recently, the Indian healthcare sector launched initiatives/plans as part of Health 4.0 to promote data management for a better quality of treatment by seeking support from digital technologies such as IoMT and blockchains to ensure data privacy and improved customer experience. Sensitivity analysis and comparison with extant methods infer that (i) BC1, BC5, and BC3 are the top three BSPs for the considered problem; (ii) criteria such as privacy aspects, intercommunication capability, global accessibility, and total cost constitute 58% importance in the supposed decision problem; (iii) developed model reduces human intervention/biases; (iv) developed model is robust to weight alteration and yields unique rank orders with both personalised and cumulative ordering of BSPs; and (v) proposed model produces broader rank values that aid in effective backup planning.

Environmental Impact of Nephrological Activity: How to Register, Evaluate and Audit?

While medical health professionals are trained to detect, treat, and comfort, they are not trained to consider the environmental impact of the services they provide. Healthcare contributes significantly to resource depletion and greenhouse gas emissions. Not only are healthcare institutions, whose mission is to protect and promote health, major polluters that use large amounts of energy and water, but the production, transport, use and disposal of medications and other medical consumables also leave considerable carbon footprints. In nephrology practice, dialysis programs have a particularly large carbon footprint with recurrent, per capita, resource consumption and waste generation profiles that are disproportionately high compared to other medical therapies. A close relationship between renal healthcare professionals and manufacturers is fundamental for the development of sustainable ecofriendly technologies, devices, and machines. Such collaboration is essential to reduce the environmental burden of renal therapies and maintain good quality of treatment. Renal units should register and evaluate their environmental performance and make an initial diagnosis of their environmental processes, to provide locally adapted recommendations for areas of additional improvement through environmental management programs. Regular auditing of these programs must be also performed aiming at continuous improvement with the setting of increasingly ambitious goals for reducing environmental burden of nephrology.

Privacy Preserving Attribute-Focused Anonymization Scheme for Healthcare Data Publishing

Advancements in Industry 4.0 brought tremendous improvements in the healthcare sector, such as better quality of treatment, enhanced communication, remote monitoring, and reduced cost. Sharing healthcare data with healthcare providers is crucial for harnessing the benefits of such improvements. In general, healthcare data holds sensitive information about individuals. Hence, sharing such data is challenging because of various security and privacy issues. According to privacy regulations and ethical requirements, it is essential to preserve the privacy of patients before sharing data for medical research. State-of-the-art literature on privacy preserving studies either uses cryptographic approaches to protect the privacy or uses anonymizing techniques regardless of the type of attributes, this results in poor protection and data utility. In this paper, we propose an attribute-focused privacy preserving data publishing scheme. The proposed scheme is two-fold, comprising a fixed-interval approach to protect numerical attributes and an improved l-diverse slicing approach to protect the categorical and sensitive attributes. In the fixed-interval approach, the original values of the healthcare data are replaced with an equivalent computed value. The improved l-diverse slicing approach partitions the data both horizontally and vertically to avoid privacy leaks. Extensive experiments with real-world datasets are conducted to evaluate the performance of the proposed scheme. The classification models built on anonymized dataset yields approximately 13% better accuracy than benchmarked algorithms. Experimental analyses show that the average information loss which is measured by normalized certainty penalty (NCP) is reduced by 12% compared to similar approaches. The attribute focused scheme not only provides data utility but also prevents the data from membership disclosures, attribute disclosures, and identity disclosures.

Prevention of Work-Related Musculoskeletal Disorders in Physiotherapist - A Review

Introduction: Healthcare professionals, especially those with in direct contact of patient are at the highest risk of work-related musculoskeletal disorders (WMSDs), physical therapists being one of them. Aim: Our aim was to review current knowledge relating to the prevalence, risk factors and prevention of WMSDs among physiotherapists. Method: Google Scholar and PubMed were searched for terms relating to WMSDs in Physiotherapists from inception to 2021. Result: The prevalence of WMSDs among Physiotherapist was high, with the lower back as the most frequently affected followed most often by the neck, upper back and shoulders. Knee joint was commonly affected joint in lower extremity. Multiple risk factors have been found responsible for WMSDs in physiotherapist and some of them are modifiable. Conclusion: Implementing preventive strategies for WMSDs in early stage of a physiotherapist’s career may help to prevent WMSDs and maintain good quality of treatment for patients. Keywords: Pain, Musculoskeletal disorders, Ergonomics, Prevention.

Patients’ Satisfaction Regarding The Dental Treatment Provided by Educational Dental School in Majmaah University

Introduction: Patient satisfaction with health care is considered to be one of the main objectives of quality ‎care. The satisfaction of the patients has been investigated in different colleges of dentistry in ‎many countries. Assessment of the patients’ feedback could help in promoting best quality of ‎treatment. Aims & Objective. The objective of this study is to determine patients’ satisfaction regarding the quality ‎of treatment at dental clinics of the College of Dentistry at Majmaah University.‎ Material & Method: Self-administrated questionnaire was distributed to patients attending to dental clinics. It was ‎composed of twenty-four closed questions measuring patient satisfaction regarding the dental ‎care provided. This questionnaire had three main themes. First, was the reason why patients chose ‎the dental school and the purpose of the visit. Second, was based on the ease of getting an ‎appointment and staff behavior. Third was related to student/doctor communication and attitude. ‎ Results: A total of 442 questionnaires were collected. Response rate was 88.4% as 442 out of 500 ‎questionnaires were returned. The most of the patients were male (68.1%) whereas female were ‎‎(31.9%). A total of 424 (95.9%) of the participants agreed that it was easy to get an ‎appointment in the dental clinics and a total of 278 (62.9%) were very satisfied with the ‎performance of the reception. Regarding to the treatment Majority of the participant were ‎satisfied with the treatment provider, 295(66.7%) very satisfied.‎ Conclusions: The results of the study reported that dental clinics in the college of dentistry in ‎Majmaah university has been successful in achieving participant’s satisfaction regarding the ‎services, staff, treatment and patient–dentist interaction. Key words: Dental care, Education, patient satisfaction

Appointment Length with Patients in Medical Consultations in Bangladesh: A Hospital-Based Cross-Sectional Study.

In medical consultations, the length of the visit has a significant impact on the quality of care. It is significantly associated with a better quality of treatment and better health outcomes. In this study, we analyzed doctors’ consultation length with patients and associated factors in Bangladesh. A cross-sectional survey was conducted among the patients (N = 763) who visited the doctors in six district/upazila (sub-district) hospitals in the Chittagong Hill Tracts (CHT) area. Linear regression analyses were performed to identify the determining factors associated with the length of doctors’ appointments with patients. Data were analyzed using IBM SPSS version 24.0. Among the patients, 319 (41.8%) were female and 688 (90.2%) lived in rural/suburban areas. This study revealed that the average length of medical consultations was 9.10 min. Additionally, our findings illustrated that doctors’ patient-centered communication behavior (β = 0.23, p < 0.001) appeared to be the strongest predictor of longer visit length. It was also found that patients’ higher education level (β = 0.10, p = 0.006), having adequate knowledge about the health problem (β = 0.13, p < 0.001), follow-up visits (β = 0.13, p < 0.001), and the presence of female doctors (β = 0.19, p < 0.001) were significantly associated with longer interview times between doctors and patients in primary care settings. Given that doctors’ patient-centered communication behavior appears to play the most important role, this study suggests that practicing professionalism in medical consultations, developing effective communication skills and increasing awareness of sociodemographic discrepancies are important to ensure longer appointment lengths and better health outcomes of patients, regardless their sociodemographic and socioeconomic status.

Survey on the Orthodontic Awareness in MGM Campus, Navi Mumbai, Maharashtra, India

ABSTRACT Introduction Awareness is the state or ability to perceive, to feel, or to be conscious. The decision to go for an orthodontic treatment is influenced by the desire to look attractive, to overcome social pressure, and to enhance self-esteem. The aim of the present survey was to assess the awareness of orthodontics in MGM Campus, Navi Mumbai. Materials and methods This study was carried out through an online questionnaire of 22 questions which was distributed through various channels, such as personal e-mails and communication through the phone to students of MGM Campus, Navi Mumbai fitting the inclusion criteria. The sample size of 285 represented a population of students in the age group of 18–24 years. The questionnaire was made accessible to the participants for 2 months. Results Results showed that nearly 78% of the subjects had visited a dentist before while 40% were unaware of the role of an orthodontist, indicating a general lack of awareness of the difference between a general dentist and an orthodontist. The majority of the subjects were able to notice people with irregular teeth around them and 79.6% of the subjects noticed improper positioning of their teeth by themselves, thus indicating that people were conscious about the crowding seen within their dentition. More than 80% of the subjects believed that maintaining oral hygiene is difficult with the presence of crowded teeth, oral habits can have deleterious effects on teeth, and for an esthetic facial appearance, teeth should be well aligned. Nearly 50% of the participants were simply unaware that orthodontic treatment could be performed after the age of 40 years as well. Majority were aware of the various types of braces and &gt;60% of the subjects knew that ceramic and lingual braces are more expensive as compared to traditional metal braces. A lack of awareness about invisible braces options was seen in &gt;60% of the participants. Diet restrictions for better orthodontic results were known to majority of the participants. Nearly 90% of the subjects knew that special care has to be taken of oral hygiene during the orthodontic treatment. Extraction protocol for better treatment results and disadvantages, such as pain and ulcerations, either was known to &gt;80% of the subjects. More than 70% were aware that orthodontic treatment is usually of longer duration as compared to other types of dental treatment. Nearly 46% of the subjects were unaware of the frequency of orthodontic appointments. Only 66% knew that it is necessary to wear retainers after the completion of treatment. More than 50% felt that self-consciousness would majorly influence their decision to go for orthodontic treatment. Nearly 60% felt that social life is not adversely affected by braces. Conclusion There was less awareness in young adults, about various orthodontic treatment options and in general about orthodontic treatment, hence there is a need to create awareness about the same, which will help us provide a better quality of treatment. How to cite this article Vajifaker PJ, Mhatre AC, Joshi D. Survey on the Orthodontic Awareness in MGM Campus, Navi Mumbai, Maharashtra, India. J Contemp Dent 2019;9(3):101–108.

Pregnancy-Associated Breast Cancer: A Realistic Approach.

The number of cancers diagnosed during pregnancy is on the rise, and breast cancer is the most common malignancy. Presently, there are very limited resources and no clear guidelines for managing this peculiar patient population both worldwide and in India. The objective of this study was to find out the incidence of pregnancy-associated breast cancer (PABC) in a tertiary care referral centre and to compare the epidemiological, diagnostic and prognostic factors as well as maternal and foetal outcomes with the most recent literature worldwide. We conducted a retrospective descriptive study of women diagnosed with breast cancer in pregnancy and post-partum period at a tertiary care centre in southern India during the period of 10years (total number of breast cancer patients were 10). We studied the diagnostic and prognostic factors as well as maternal and foetal outcome in patients diagnosed with breast cancer for the first time in pregnancy. Overall incidence of PABC was found to be 0.6% (n = 10). Mean age at the time of presentation was 30.7 ± 4years. All cases suspected clinically or on imaging (USG) were confirmed with FNAC, excision biopsy or Trucut biopsy. Out of 10 patients, 70% (n = 7) had an advanced-stage disease on diagnosis. Histopathology suggested 90% (n = 9) had invasive ductal carcinoma and 55.5% (n = 5) had a triple negative receptor status. 20% (n = 2) of our patients had opted for a breast conservation surgery (BCS), and 70% (n = 7) of our patients underwent modified radical mastectomy with neoadjuvant or adjuvant chemotherapy/radiotherapy. One patient had a second trimester MTP in view of stage 4 disease. 77.7% (n = 7) of the nine patients who continued pregnancy underwent LSCS, out of which 57.4% (n = 4) were elective, and MRM was done concurrently with LSCS in 50% (n = 2) of the elective LSCS. The mean birth weight of the 9 neonates was 2.2 ± 0.5kg. Intrauterine growth retardation was seen in 22.2% (n = 2) neonates. 33.3% (n = 3) of the neonates required NICU support, and one baby expired on post-natal day 16. With the increasing number of elderly primigravida amongst the urban population, a clear understanding of PABC is becoming more important. A multidisciplinary team approach shall help the clinician not only in reducing the heavy burden of patient responsibility but more importantly, in guaranteeing better quality of treatment, avoiding unnecessary delays in providing interventions and providing adequate treatment.

Service providing scenario of urban primary health care services delivery project working in selected municipality

Background: The urbanization and urban growth is going through very rapid in Bangladesh. This growth is being fuelled by rising incomes due to rapid expansion of commerce and industry. The rapid and incessant growth of urbanization on Kushtia district is creating continuous pressure on urban health care services. Urban poor people are also a vital factor for promoting urban primary health care services delivery project (UPHCSDP) to provide health care facilities.Methods: A cross sectional survey was carried out among 576 patients in 3 selected urban primary health care centres in Kushtia Municipality with a major concentration of people residing in urban areas. Data were collected using questionnaires regarding type of care or treatment patients demanded and type of care they received from the clinic.Results: Study results showed that total of 46.5% of the subjects demanded maternal and obstetric health services and 8.6% demanded child health diagnosis and care. It was found that a total of 22.0% of the subjects received physical diagnosis from the centres. About 7.1% clients received advice or suggestions and 8.0% received normal delivery service from the centres.Conclusions: The result shows that these clinics provide a lot of health care services to the clients especially on maternal and child health care delivery system. These services are provided to the patient with less or free of cost. Study exhibited that the overall health care services of health care centres are good. The clients come to these centres for the good quality of treatment.

Comparison between the Effectiveness of Rotary and Manual Instrumentation in Primary Teeth: A Systematic Review.

ABSTRACTAimTo develop a scientifically current and evidence based protocol on the efficacy of rotary and hand root canal instrumentation in primary teeth.Materials and methodsPrevious randomized control trials were used for the current review. Hand search and online search engines of PUBMED and Google Scholar were used to search English language articles with human subjects published up to December 2016.ResultsAfter screening of the abstracts and articles, based on the inclusion and exclusion criteria a total of 13 articles were included in the systematic review.ConclusionRotary instrumentation shows equivalent cleaning efficiency than hand files depending on the system of instrumentation and techniques used. However, use of rotary in primary teeth leads to improved shaping of canals providing better quality of treatment in less time.How to cite this articlePanchal V, Jeevanandan G, et al. Comparison between the Effectiveness of Rotary and Manual Instrumentation in Primary Teeth: A Systematic Review. Int J Clin Pediatr Dent 2019;12(4):340–346.

REGIONAL IMMUNO- AND NO – THERAPY IN COMPEX TREATMENT OF EPITHELIAL COCCYGEAL WAY IN ABSCESS STAGE

There were analyzed the results of 61 patients, age from 17 to 32, with epithelial coccyeal way in abscess stage who had been treated by method of precipitated radical treatment. The observed group consisted of 39 persons: 33 men, 6 women, in treatment of post-operative wound there was used the oxygenated nitrogen and regional lymphatic introduction of antibiotics and immunophan. In the comparative group (22) the post-operative wound was treated by ultrasound, the similar drugs were introduced by intramuscular method. The better quality of treatment was marked in the observed group.

Variation in the Quality of Treated Wastewater by Local Sand Filter: The Case of the Algerian Sahara Sand

In urban areas, population growth generates significant amounts of wastewater that is treated in sewage treatment plants specialize or reject directly controlling interest in the natural environment. Many scientists are looking into the issue to try to find solutions to clean water and make it drinkable. We are interested in the technique of sand filtration (in the region southwest of Algeria), as an essential phase for the treatment of wastewater, such methods are known to be well suited to rural areas, since they have a good quality of treatment, a relatively simple operation and low maintenance. The method is based on the following principle: a slow filtration, water passes under a constant hydraulic load (30 cm water) the filter bed (60 cm of sand), the hydraulic load is kept constant during the experiment. A physicochemical analysis is performed on the water sample before and after filtration, the filter bed to give us a discount of around 50% in the levels of contaminant parameters such as NTK, Ammonium, Nitrate, and Nitrite. The reduction of BOD, COD and suspended solids is about 90%. It was observed a significant increase in the potassium from 33.19 mg/l to 99.89 mg/l.

Managing infertility with the follitropin alfa prefilled pen injector - patient considerations.

Gonadotropin treatment has been used in fertility treatment since the 1930s. First, preparations coming from animals were injected, then, gonadotropins prepared from the pituitary glands of human cadavers. A great step was achieved with the introduction of human menopausal gonadotropin extracted from the urine of postmenopausal women. When cases of Creutzfeld-Jacob disease were recognized after the use of human pituitary-derived hormone injections, urinary gonadotropins were increasingly purified and then produced by the use of recombinant DNA technology. Recombinant gonadotropins were characterized by the extreme high specificity and the nearly 100% purity. This allows for follitropin alfa, the first recombinant-human follicle stimulating hormone (r-hFSH) approved, to be quantified and filled by mass, with a small variance of only ±2% and no more with a bioassay with a variance of 45%. With recombinant preparations, it is also possible to cover the tremendous growing demand for gonadotropins. Ovarian stimulation has become a self-injecting procedure for the patients. Accurate and easy-to-use injection devices which minimize pain, difficulty, and stress are essential for patient compliance. So, two pen injectors adapted from the well-known insulin pen were introduced in fertility treatment, one as a multiple-use device rechargeable with premixed, prefilled cartridges with r-hFSH (follitropin β) and the other a disposable, prefilled drug delivery system with a liquid formulation of follitropin alfa filled by mass. The efficacy in comparison to the quite more cumbersome handling with ampoules and syringes has been proven very quickly. In several studies, it has been shown that patients had a preference to the prefilled follitropin alfa pen due to the faster preparation and were more confident of accurate dosing. The follitropin alfa (filled by mass [FbM]) prefilled pen is a move toward better quality of treatment and also better quality of life for the women within the stressful period of fertility treatment.

When the Conservative Treatment in High-Risk Non-Muscle Invasive Bladder Cancer Patients should be Abandoned

Despite the good quality of treatment expected with optimized transurethral resection (TUR) and adjuvant Bacillus Galmette-Guérin (BCG) regimen, many high-risk non-muscle invasive bladder cancer (NMIBC) patients recur and progress. According to the EORTC Tables of risk, cases with a score of 10-17 and those with a score of 7-23 should be considered as being at high risk of recurrence and progression, respectively. AUA and NCCN consider all T1 stage tumors, high grade Ta and CIS at high risk of recurrence and progression. Long-term follow-up shows that T1, G3 patients treated with BCG will suffer from up to 45% and 17% rate of recurrence and progression, respectively. Consequently, EAU, AUA and NCCN Guidelines for bladder cancer recommend radical cystectomy as a first treatment option for those patients who failed after two cycles of adjuvant BCG. However, to date, there is no definitive evidence that in this special subgroup of patients an early radical cystectomy is better than any additional salvage strategy, in terms of oncologic outcome. On the other hand, it is well accepted that radical cystectomy is burdened with consistent reduction of overall post-operative quality of life. The reluctance of patient to accept (and of surgeon to recommend) this major extirpative surgery may explain the reduced disease-free survival rate, well documented when radical cystectomy has been extremely delayed. Defining the criteria for the selection of BCG-failure patients for whom any conservative procedure should be definitively abandoned in favor of a timely radical cystectomy has become of critical importance. Recently, clinical, laboratory and pathologic acquisitions allowed the development of more accurate predictive factors for tumor progression in NMIBC. Among these factors, clinical type of BCG-failure, morphology and tumor growth patterns, pathologic sub-staging and immunohistochemistry will play a paramount role in decision-making with these patients in routine practice.

When the conservative treatment in high-risk non-muscle invasive bladder cancer patients should be abandoned

Despite the good quality of treatment expected with optimized transurethral resection (TUR) and adjuvant Bacillus Calmette-Guérin (BCG) regimen, many high-risk non-muscle invasive bladder cancer (NMIBC) patients recur and progress. According to the EORTC Tables of risk, cases with a score of 10-17 and those with a score of 7-23 should be considered as being at high risk of recurrence and progression, respectively. AUA and NCCN consider all T1 stage tumors, high grade Ta and CIS at high risk of recurrence and progression. Long-term follow-up shows that T1,G3 patients treated with BCG will suffer from up to 45% and 17% rate of recurrence and progression, respectively. Consequently, EAU, AUA and NCCN Guidelines for bladder cancer recommend radical cystectomy as a first treatment option for those patients who failed after two cycles of adjuvant BCG. However, to date, there is no definitive evidence that in this special subgroup of patients an early radical cystectomy is better than any additional salvage strategy, in terms of oncologic outcome. On the other hand, it is well accepted that radical cystectomy is burdened with consistent reduction of overall post-operative quality of life. The reluctance of patient to accept (and of surgeon to recommend) this major extirpative surgery may explain the reduced disease-free survival rate, well documented when radical cystectomy has been extremely delayed. Defining the criteria for the selection of BCG-failure patients for whom any conservative procedure should be definitively abandoned in favor of a timely radical cystectomy has become of critical importance. Recently, clinical, laboratory and pathologic acquisitions allowed the development of more accurate predictive factors for tumor progression in NMIBC. Among these factors, clinical type of BCG-failure, morphology and tumor growth patterns, pathologic sub-staging and immunohistochemistry will play a paramount role in decision-making with these patients in routine practice.

Why do experts on ectodermal dysplasia (ED) meet again?

Hypohidrotic ectodermal dysplasia was first described in the mid 19th century by John Thurnam. In 1875, Charles Darwin described the signs and symptoms in a four-generation family, “the ten men from Scinde”, explaining X-linked inheritance at the same time when Gregor Mendel mapped the laws of inheritance. The typical clinical expression in boys with X-linked hypohidrotic ED makes this syndrome easy to recognize, although usually not in the newborn, where the vulnerability for overheating is at its peak. Still a majority of these boys seems to be diagnosed by dentists, either when no teeth erupt on time or when the first teeth show up in an unusual position and with an aberrant form. In many of the other >190 different ED forms, there are even greater difficulties in getting to a diagnosis. In recent years, the internet has had an enormous impact on access to information. The successful initiative of Mary Kaye Richter, who thirty years ago started the first support group in the US, has had many followers, and today the International ED network (IEDN) covers four continents. However, individuals and families with ED suffer the same difficulties that are typical for all rare disorders in search for physicians and dentists who can help, treat and give advice for good quality of treatment to assure a good quality of life. Recent research has led to a better understanding of symptoms not only in ectodermally derived tissues, but also in tissues of mesenchymal origin. The last decade has seen a veritable eruption of new knowledge, not only in the genetic field, but also in diagnostics and treatment. The most spectacular scientific contribution was when X-linked hypohidrotic ED as the first heritable disease was shown to be permanently corrected by treatment with the missing protein. Now we are following the application of these findings from mice to men. This also calls for estimations of prevalence, ethical considerations, more research and hope for a better future for individuals with ED.

Children's Surgical Forum report

The Children's Surgical Forum (CSF) will launch its new report in mid-July. In the seven years since the CSF published its first report, Children's Surgery: A First Class Service, the surgical landscape has changed almost beyond recognition and there are major threats to the standards of surgical care for children. While it may no longer be possible to treat children in the ways to which the population is accustomed, there must be networks of care in place that maintain the best quality of treatment for them. It is against this background that the CSF has brought thinking on the organisation and delivery of surgical care to the young up to date.