Artificial neural networks in urolithiasis

PURPOSE OF REVIEW: The management of urolithiasis is a clinical challenge worldwide which may result in difficulty in diagnosis, treatment and prevention of recurrence. Artificial neural networks (ANNs) are well described adjuncts to many aspects of clinical urological practice. We review literature published in on-line Medline-citable English language journals to assess whether ANNs are useful in clinician-led decision-making processes in urolithiasis. RECENT FINDINGS: Studies have examined the role of ANNs in prediction of stone presence and composition, spontaneous passage, clearance and regrowth after treatment. These reports suggest that ANNs can identify important predictive variables and accurately predict treatment outcome. SUMMARY: Although well described in general urological practice, there is comparatively little research into the role of ANNs in urolithiasis. Initial results appear promising; however, further prospective studies are necessary to determine if this mode of analysis is superior to standard statistical predictive methods.     

Nanotechnology and its relevance to the urologist

OBJECTIVES: We review important aspects of nanotechnology, and discuss the wide range of research and clinical applications of nanomedicine in the field of urology. There is particular emphasis on key clinical and pre-clinical studies to provide an update on recent and potential applications in the care of urological patients. METHODS: A directed Medline literature review of nanotechnology was performed. Important publications that have shaped our understanding of nanotechnology were selected for review and were augmented by manual searches of reference lists. RESULTS: Nanotechnology is the study, design, creation, synthesis, manipulation, and application of functional materials, devices, and systems through control of matter at the nanometer scale. Studies demonstrate a number of important concepts. These include nanovectors, nanotubes, and nanosensors for targeted drug delivery; nanowires and nanocantilever arrays for early detection of precancerous and malignant lesions; and nanopores for DNA sequencing. These advances will lead to significant applications relevant to the diagnosis, management, and treatment of all urological conditions. CONCLUSIONS: This review is designed for the urologist to provide an overview and update on nanotechnology and its applications in the field of urology. In the future, it is widely expected that nanotechnology and nanomedicine will have a significant impact on urological research and clinical practice, allowing urologists to intervene at the cellular and molecular level. With structured, safe implementation, nanotechnologies have the potential to revolutionise urological practice in our lifetime.     

Design und Reporting klinischer Forschung

At one hand, scientific quality of a clinical research project is determined by its design and planning process. Hereunto, statistical methods and concepts of clinical epidemiology give essential input. On the other hand, reporting guidelines provide advice on how to report research methods and findings and are equally relevant to assure the perceived scientific quality. They are mostly ignored by authors, editors, reviewers, and readers. Bad reporting undermines the usability of reported findings and misleads clinicians, researchers, policymakers and, ultimately, patients. A good practice of reporting produces ready to use evidence. It relies on statistical methods and concepts of clinical epidemiology. Results of statistical analyses will be presented to be used in new analyses and simulations which feed systematic reviews or clinical decision models. Therefore, reporting is not only the presentation of a story which is finished. It is also a tool to change the future.     

Statistical inference in facial plastic surgery: perspectives and alternatives

Facial plastic surgeons often must make decisions with imperfect information. Statistical inference is fundamentally the practice of using data to draw conclusions about uncertain phenomena. It is important, therefore, that facial plastic surgeons engaged both in clinical practice and in research have an understanding of statistical concepts to conduct research with results that are meaningful, to assess the validity of published research, and to adopt the most effective techniques and treatments. The purpose of this article is to provide an overview of classical statistical methods that are encountered frequently in facial plastic surgery research, discuss issues of interpretation of results, and introduce an alternative paradigm for conducting statistical inference.     

Urinary tract infections: what's new?

PURPOSE: This review provides practicing urologists with important basic information about urinary tract infections (UTIs) that can be applied to everyday clinical problems. MATERIALS AND METHODS: A review is presented of provocative and controversial concepts in the current literature. RESULTS: Bacterial virulence mechanisms are critical for overcoming the normal host defenses. Increasing antimicrobial resistance of uropathogens has led to reconsideration of traditional treatment recommendations in many areas. For effective patient management the first issue is to define complicating urological factors. Managing complicated urinary tract infections, particularly in urology, is determined by clinical experience to define the pertinent anatomy and to determine the optimal interventions. New clinical data are summarized on UTIs in long-term care patients, behavioral risks for UTI in healthy women and anatomical differences associated with an increased risk for UTI. The rationale is presented for UTI prophylaxis using cranberry juice, immunization and bacterial interference. Current treatment trends for UTI include empiric therapy (without urine culture and sensitivity testing), short-course therapy, patient-administered (self-start) therapy and outpatient therapy for uncomplicated pyelonephritis. CONCLUSIONS: Recommendations for treating patients with UTIs have changed based on basic science and clinical experience.     

A basic introduction to statistics for the orthopaedic surgeon

Orthopaedic surgeons should review the orthopaedic literature in order to keep pace with the latest insights and practices. A good understanding of basic statistical principles is of crucial importance to the ability to read articles critically, to interpret results and to arrive at correct conclusions. This paper explains some of the key concepts in statistics, including hypothesis testing, Type I and Type II errors, testing of normality, sample size and p values.     

Statistics as support tool and not as a decision tool

The use of statistics in medical articles has risen a lot during the last decades, however it is used in a thoughtless manner in many instances. Today, Statistics is the only tool that allows the medical researcher to obtain results and benefits from those studies the relationships of which can not be interpreted from a determinist perspective, because it is a branch of applied mathematics objective of which is to manage and quantify the uncertainty of the available information, to support decision taking. The objective of this article is to review the basic statistical concepts that every doctor should know to be able to perform and/or detect quality research, as well as to underline the most frequent errors committed when interpreting statistical results. We review the general concepts about data synthesis and differentiation of the different types of measurements, hypothesis testing and errors that can be committed doing it, the real meaning of the "p" value, differentiation between statistically significant and clinically relevant results, the importance of confidence intervals as a measure of significance and clinical relevance, the confusion generated between two concepts that are different as standard deviation and standard error, and the criteria that govern the selection of the adequate statistical tests to evaluate relationships between variables.     

Basic epidemiologic and statistical methods in clinical research.

Various study designs and approaches to statistical analysis in clinical research have their own underlying rationales and limitations for interpretation. This information is presented in an intuitive and accessible manner, relying minimally on basic algebra. Epidemiologic concepts of study design and interpretation, bias and confounding, hypothesis testing, and sample size and power are explained. Statistical tests and their appropriate applications are discussed for mean comparisons (t tests and ANOVA), percentages (chi-square), survival analysis, and correlation and regression. Applicable nonparametric tests are also introduced.     

Surgical trainees and trauma emergencies

An accident and emergency (A&E) training has been suggested as an essential part of the basic surgical training. The A&E curriculum should be divided into three sections: a critical curriculum, a core curriculum and a comprehensive curriculum. For instance, the critical curriculum contains topics that provide the opportunity to translate the ABCDE principles of trauma management into practice. Furthermore, a post in the A&E department provides the surgical trainee with significant exposure to the management of the polytrauma patient and to the management of other acute general surgical, urological and orthopaedic conditions. By presenting better educational programs and by reducing the non-medical tasks a trainee has to deal with, the education of surgical trainees during A&E attachment can be improved.     

Are most randomised trials in anaesthesia and critical care wrong? An analysis using Bayes’ theorem

False findings are an inevitable consequence of statistical testing. In this article, I use Bayes’ theorem to estimate the false positive and false negative risks for randomised controlled trials related to our speciality. For small trials in peri-operative medicine, the false positive risk appears to be at least 50%. For trials reporting weakly significant p values, the risk is even higher. By contrast, large, multicentre trials in critical care appear to have a high false negative risk. These findings suggest much of the evidence that underpins our clinical practice is likely to be wrong.     

The evidence-based pathway for peri-operative management of open and robotically assisted laparoscopic radical prostatectomy

OBJECTIVE: To assess reports supporting the novel and comprehensive evidence-based pathway for radical prostatectomy (RP), as collaborative-care pathways have helped to optimize management of patients treated with RP and such clinical pathways provide an ideal framework for constructing an original evidence-based pathway for the complete peri-operative care of these patients. PATIENTS AND METHODS: We searched for articles on Medline via PubMed to identify reports describing consensus opinions on appropriate aspects of the peri-operative management of patients treated with RP, specifically seeking to discern information on preoperative antibiotic regimen, peri-operative laboratory testing, use of beta-blockers for those at cardiac risk, pulmonary treatment, deep venous thrombosis prophylaxis, diet advancement, pain management, anti-emetic use, bowel regimen, and catheter removal after RP. RESULTS: Available reports were used to substantiate each variable of our collaborative-care pathway for RP. When available, meta-analyses were used to provide a broad review of the recognized clinical research. Otherwise, many controlled studies and retrospective reviews were relied upon to provide evidence to construct a framework for clinical decision-making. CONCLUSIONS: This is the first pathway for the peri-operative management of major urological procedure that is well integrated into current literature. The critical aspects of clinical decision-making in the patient treated with RP were validated by the available research.     

Outcome after polytrauma

Background and aims: Outcome refers to the different facets of consequences resulting from an event or intervention. These consequences may be relevant for an individual patient, but also for society. There is a growing recognition that clinical research needs to define and focus on the outcomes of medical care. Outcome research should help health care professionals to better evaluate the effectiveness of specific interventions or a therapeutic concept. This broader base of evidence should then benefit the patients. Methods: The literature was reviewed with respect to concepts of outcome research as well as results of outcome research after major trauma. Results: Measuring outcome might be relevant for research purposes as well as in daily surgical practice. In the past, clinical research in trauma care has tended to focus on survival. Mortality rates are not out, complication rates are not out, but their value is limited and restricted to given scenarios with high mortality rates. New outcomes have to be added: such a functional status, emotional health, social interaction, cognitive function, degree of disability and other indicators of health. Conclusion: Despite differences in injury pattern and severity of injury, there is strong evidence from the literature that the quality of life is significantly impaired after major trauma. This is true for functional outcome as well as for psycho-social outcome in up to 70% of patients. Received: 22 February 1998     

A proposed guideline for the urological management of patients with spinal cord injury

OBJECTIVE

To develop a guideline for the urological management of patients with spinal cord injury (SCI).

METHODS

The existing practice in the UK was evaluated by a series of expert meetings. Previous publications on the subject were evaluated, and the information synthesized to produce a proposed guideline.

RESULTS

The literature review showed limited good‐quality data. As a result of the process a series of research questions was produced, the answers to which would allow a guideline to be established based on good‐quality evidence. In the absence of high‐quality evidence, the guideline was constructed using expert opinion. Urological care is described in the immediate, intermediate and long‐term phases after SCI.

CONCLUSION

The urological consequences of SCI can be devastating. Urological care is an important part of the holistic care of these patients, and should be delivered from SCI centres through a network of qualified clinicians.     

Wound care evidence,knowledge and education amongst nurses: a semi‐systematic literature review

The aims of this study were to determine the knowledge and skills of nurses involved in wound care, to provide a critical overview of the current evidence base underpinning wound care and to determine the extent of utilisation of existing evidence by nurses involved in the management of wounds in practice. A semi‐systematic review of the literature was undertaken on Cinahl, Medline Science Direct and Cochrane using the search terms: wound, tissue viability, education, nurse, with limitations set for dates between 2009 and 2017 and English language. Shortfalls were found in the evidence base underpinning wound care and in links between evidence and practice, prevalence of ritualistic practice and in structured education at pre‐ and post‐registration levels. The evidence underpinning wound care practice should be further developed, including the conduction of independent studies and research of qualitative design to obtain rich data on both patient and clinician experiences of all aspects of wound management. More structured wound care education programmes, both at pre‐registration/undergraduate and professional development levels, should be established.     

Tissue engineering and stem cells: Basic principles and applications in urology

To overcome problems of damaged urinary tract tissues and complications of current procedures, tissue engineering (TE) techniques and stem cell (SC) research have achieved great progress. Although diversity of techniques is used, urologists should know the basics. We carried out a literature review regarding the basic principles and applications of TE and SC technologies in the genitourinary tract. We carried out MEDLINE/PubMed searches for English articles until March 2010 using a combination of the following keywords: bladder, erectile dysfunction, kidney, prostate, Peyronie's disease, stem cells, stress urinary incontinence, testis, tissue engineering, ureter, urethra and urinary tract. Retrieved abstracts were checked, and full versions of relevant articles were obtained. Scientists have achieved great advances in basic science research. This is obvious by the tremendous increase in the number of publications. We divided this review in two topics; the first discusses basic science principles of TE and SC, whereas the second part delineates current clinical applications and advances in urological literature. TE and SC applications represent an alternative resource for treating complicated urological diseases. Despite the paucity of clinical trials, the promising results of animal models and continuous work represents the hope of treating various urological disorders with this technology.     

Statistical fallacies in orthopedic research

Background:

A large number of statistical fallacies occur in medical research literature. These are mostly inadvertent and occur due to lack of understanding of the statistical concepts and terminologies. Many researchers do not fully appreciate the consequence of such fallacies on the credibility of their report.

Materials and Methods:

This article provides a general review of the issues that could give rise to statistical fallacies with focus on orthopedic research. Some of this is based on real-life literature and some is based on the actual experiences of the author in dealing with medical research over the past three decades. The text is in teaching mode rather than research mode.

Results:

Statistical fallacies occur due to inadequate sample that is used for generalized conclusion; incomparable groups presented as comparable; mixing of two or more distinct groups that in fact require separate consideration; misuse of percentages, means and graphs; incomplete reporting that suppresses facts; ignoring reality and depending instead on oversimplification; forgetting baseline values that affect the outcome; misuse of computer packages and use of black-box approach; misuse of P-values that compromises conclusions; confusing correlation with cause-effect; and interpreting statistical significance as medical significance.

Conclusion:

Mere awareness of the situations where statistical fallacies can occur may be adequate for researchers to sit up and take note while trying to provide a credible report.     

Inadequate statistical power of negative clinical trials in urological literature

PURPOSE: Negative studies provide valuable information. However, conducting studies with inadequate power is unethical and an inefficient use of resources. The purpose of this study was to determine the prevalence of negative studies with inadequate power in urological literature. MATERIALS AND METHODS: The Journal of Urology, Urology and BJU International (formerly British Journal of Urology) from 1982 to 2002 were searched using the Ovid MEDLINE database. All clinical trials that contained the phrase "no difference" were identified. Data necessary for power calculation were extracted from applicable studies. RESULTS: Of the 417 articles identified in the MEDLINE search, 127 were negative studies that contained enough information to be analyzed. There were 70 (55%) articles from The Journal of Urology, 35 (28%) from BJU International and 22 (17%) from Urology. Of the studies that used continuous variables 65% had adequate power (greater than 80%) to detect a 50% difference between groups and 32% had adequate power to detect a 25% difference. Of the studies that used dichotomous variables only 33% had adequate power to detect a 50% difference between groups and 23% had adequate power to detect a 25% difference. Levels of adequate power in negative studies did not improve over time (p = 0.258). CONCLUSIONS: Many negative studies in urological literature are inconclusive because they lack adequate power to detect even large differences between groups. Inadequately powered studies often result in false conclusions that alter clinical behavior and deter further research. Therefore, it is imperative to consider power when interpreting literature. When designing future investigations power calculations should be performed to ensure sufficient patient recruitment to attain clinically meaningful results.     

The role of randomized controlled trials in evidence-based urology

Purpose

To review the current and future role of randomized controlled trials (RCTs) in urology.

Methods

A review of the urological literature was performed to assess the current role of RCTs in urology. These findings were put in context of current practice, and methodologic limitations of observational study design were discussed.

Results

Several RCTs have improved treatment of urology patients. However, overall, few studies in the urologic literature convey high-level evidence. RCTs represent the only study design that can assess causality, thus are the only means to significantly advance knowledge about therapy and improve patient care. Increased incidence and improved quality of RCTs may be achieved through education, community outreach, and better access to research infrastructure.

Conclusions

RCTs have significantly improved urologic practice. RCTs are superior to observational studies because of decreased risk of bias and confounding. To further advance clinical practice, clinical trials must play a predominant role and should be embraced by the urology community.