Perioperative management of upper tract urothelial carcinoma in the Nordic countries.

Background: Upper tract urothelial carcinoma (UTUC) is a rare malignancy, with typically only few new cases annually per urological department. Adherence to European association of urology (EAU) guidelines on UTUC in the Nordic countries is unknown. The objective of this survey was to examine the implementation of EAU guidelines, the perioperative management and organization of the treatment of UTUC in the Nordic countries.

Intraoperative Mitomycin C Bladder Instillation During Radical Nephroureterectomy Is Feasible and Safe.

Background: Bladder recurrence after radical treatment of upper urinary tract urothelial cancer (UTUC) is frequent, and patients are required to undergo surveillance cystoscopies following surgery. The use of intravesical adjuvant chemotherapy is an accepted method to prevent bladder recurrence, but the timing of this method is not standardized and the concept of intraoperative use is unexplored.

Objective: The objective of the study is to examine the feasibility and safety of intraoperative intravesical mitomycin C (MMC) instillation using a closed-circuit system following bladder cuff excision and bladder closure.

Perioperative management of radical cystectomy in the Nordic countries.

Radical cystectomy is performed in all of the Nordic countries, but the current practice patterns remain unclear. This study explored current perioperative care and adherence to the Early Recovery After Cystectomy (ERAC) protocol and EAU guidelines by cystectomy surgeons in the Nordic countries. The study was performed as a survey including 47 centers performing cystectomies in Norway, Sweden, Finland, Iceland and Denmark.

The Absence of Fever Is Associated With Higher Mortality and Decreased Antibiotic and IV Fluid Administration in Emergency Department Patients With Suspected Septic Shock.

Objective: This study evaluates whether emergency department septic shock patients without a fever (reported or measured) receive less IV fluids, have decreased antibiotic administration, and suffer increased in-hospital mortality.

Design: This was a secondary analysis of a prospective, observational study of patients with shock.

Setting: The study was conducted in an urban, academic emergency department.

Serum Lactate Predicts Adverse Outcomes in Emergency Department Patients With and Without Infection.

Introduction: Lactate levels are increasingly used to risk stratify emergency department (ED) patients with and without infection. Whether a serum lactate provides similar prognostic value across diseases is not fully elucidated. This study assesses the prognostic value of serum lactate in ED patients with and without infection to both report and compare relative predictive value across etiologies.

Derivation and Validation of Predictive Factors for Clinical Deterioration after Admission in Emergency Department Patients Presenting with Abnormal Vital Signs Without Shock.

Introduction: Strategies to identify high-risk emergency department (ED) patients often use markedly abnormal vital signs and serum lactate levels. Risk stratifying such patients without using the presence of shock is challenging. The objective of the study is to identify independent predictors of in-hospital adverse outcomes in ED patients with abnormal vital signs or lactate levels, but who are not in shock.

Assessing The Predictive Value of Clinical Factors Used to Determine The Presence of Sepsis Causing Shock in the Emergency Department.

Introduction: Differentiating shock etiologies is a challenging task in the Emergency Department (ED); even the strongest clinical predictors leave some diagnostic uncertainty. This study sought to establish an evidence base for using clinical covariates in the diagnostic evaluation of septic shock.

Methods: We conducted a prospective, observational study of consecutive ED patients with shock from November 11, 2012 to September 23, 2013.

The Utility of Inflammatory and Endothelial Markers to Identify Infection in Emergency Department Patients.

Background: Identifying infection in emergency department (ED) patients can be challenging. This study assesses the value that inflammatory and endothelial biomarkers add to clinical data when predicting infectious etiologies of abnormal vital signs (AVSs) in ED patients.

Methods: This study was a prospective, observational cohort study of ED patients with AVSs at an urban, academic tertiary-care hospital, identified from March 1, 2013, to April 15, 2013.