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Hogan D, O'Kelly JA, Davis NF. Can you name that tablet? A cross-sectional study on recognition of common urology medications. Ir J Med Sci 2024:10.1007/s11845-024-03632-6. [PMID: 38430412 DOI: 10.1007/s11845-024-03632-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/12/2024] [Indexed: 03/03/2024]
Abstract
INTRODUCTION Clinicians frequently rely on patients to accurately tell them what prescription medications and doses they are taking in outpatient visits. This information is essential to monitor the efficacy of a medication and to determine any adverse interactions. This study aimed to assess urologist and urology trainee's visual recognition of common urology medications. METHODS An online survey was distributed to urologists and urology trainees in Ireland. Images of 11 commonly prescribed urological medications were presented with free text options for answering. Information was gathered on respondent's role and experience. Data was analysed using STATA version 17. RESULTS The survey had a 90% response rate from 50 distributions. Respondents' roles were consultant (31.1%), specialist registrar (33.3%), registrar (22.2%), senior house officer (11.1%) and intern (2.2%). Forty six percent had more than six years urology experience. Average rate of correct responses was 39.4% ± 23.9. The most accurate group were consultants (46.1% ± 22.1), followed by specialist registrars (41.2% ± 24.9), registrars (39.1% ± 26.8), senior house officers (21.8% ± 10.4) and interns (9.1% ± 0). The most and least recognised medications were sildenafil (Viagra©) (84.4%) and fesoterodine (Toviaz©) (11.1%), respectively. Just 28.9% of respondents had previously handled any of the medications listed. CONCLUSION Patients often do not reliably know their own medications other than to describe them or show an unpackaged tablet. Prescribing safety is paramount to ensuring patient safety and reducing the risk of adverse drug reactions. This study shows that even experienced clinicians do not recognise the medications they regularly prescribe, and decisions should not be made without accurate medication reconciliation.
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Affiliation(s)
- Donnacha Hogan
- Department of Urology, Beaumont Hospital, Dublin, Ireland.
| | - John A O'Kelly
- Department of Urology, Beaumont Hospital, Dublin, Ireland
| | - Niall F Davis
- Department of Urology, Beaumont Hospital, Dublin, Ireland
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
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O'Kelly JA, Alaya F, Davis NF, Little D, Mohan P. Peri-operative and long-term outcomes of kidney transplantation in patients with cystic fibrosis. Clin Transplant 2024; 38:e15255. [PMID: 38400672 DOI: 10.1111/ctr.15255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 01/13/2024] [Accepted: 01/23/2024] [Indexed: 02/25/2024]
Abstract
INTRODUCTION There is a lack of data regarding the peri-operative and long-term outcomes of kidney transplantation in cystic fibrosis (CF) patients. Herein, we report the peri-operative and long-term outcomes of kidney transplantation in CF patients. MATERIALS AND METHODS All CF patients who received a kidney transplant at the national kidney transplant center between 1993 and 2022 were identified. Recipients of the contralateral donor kidney were selected as a control group. Primary outcomes included 1-, 5-, and 10- year death-censored graft survival and overall survival. Secondary outcomes included peri-operative morbidity, acute graft rejection, delayed graft function (DGF), and length of stay (LOS). RESULTS Fourteen patients received a kidney transplant over the study period. Median age at transplantation was 35 (IQR 31, 40) years. The 1-, 5-, and 10-year death-censored graft survival was 92, 74, and 74% in the CF group compared to 100, 92, and 92% in the control group (p = .44). The 1-, 5-, and 10-year overall survival in the CF group was 85, 66, and 57% compared to 100, 92, and 82% in the control group (p = .036). There was no significant difference in peri-operative outcomes including LOS (10 vs. 11 days, p = .84), ICU admission (1 vs. 0 patients, p > .99), acute rejection episodes (2 vs. 1 patients, p > .99), and DGF (1 vs. 2 patients, p = .60). CONCLUSION CF patients have good long-term graft survival, however, overall survival was worse compared to a matched cohort. These data provide important information for transplant surgeons when considering suitable donor allografts in this unique patient population.
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Affiliation(s)
- John A O'Kelly
- Department of Transplant, Urology and Nephrology, Beaumont Hospital, Dublin, Ireland
| | - Fatimah Alaya
- Department of Transplant, Urology and Nephrology, Beaumont Hospital, Dublin, Ireland
| | - Niall F Davis
- Department of Transplant, Urology and Nephrology, Beaumont Hospital, Dublin, Ireland
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Dilly Little
- Department of Transplant, Urology and Nephrology, Beaumont Hospital, Dublin, Ireland
| | - Ponnusamy Mohan
- Department of Transplant, Urology and Nephrology, Beaumont Hospital, Dublin, Ireland
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O'Kelly JA, Browne E, Daly P, Keane J, Shah N, Shilling C, Cullen IM. Penile cancer in younger men-A more aggressive disease? Urol Oncol 2023; 41:329.e11-329.e15. [PMID: 37225633 DOI: 10.1016/j.urolonc.2023.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/20/2023] [Accepted: 03/28/2023] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Penile cancer (PC) in men under 45 is very rare with an incidence of 0.1 to 0.8/100,000. There is little published data on disease characteristics and outcomes of PC in younger men. Herein, we evaluate the disease characteristics and outcomes of penile cancer in younger men compared to an older cohort. METHODS This study included all men diagnosed with PC at our institution from 2016 to 2021. Primary outcomes included overall survival, cancer-specific survival, and disease-free survival. Secondary outcomes included disease characteristics and surgical management. Men aged ≤45 years (Group A) were compared with men aged >45 years (Group B) at diagnosis. RESULTS There were 90 patients treated for invasive PC over the study period. The median age at diagnosis was 64 (26-88). The mean length of follow-up was 27 (±18) months. There were 12 (13%) in Group A, and 78 (87%) patients in Group B. Group A had a worse cancer-specific survival compared to Group B (39 months vs. not reached, HR 0.1 (95%CI 0.02-0.85, P = 0.03). There was no significant difference in overall or disease-free survival between both groups. More men in Group A had lymph node metastases at the time of diagnosis (58% vs. 19%, P < 0.001). There was no significant difference in histopathological features including tumor subtype, grade, T stage, p53 status or presence of lymphovascular or perineural invasion. CONCLUSION In our study, younger men were more likely to have nodal involvement at time of diagnosis and had a worse cancer-specific survival.
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Affiliation(s)
- John A O'Kelly
- Department of Urology, University Hospital Waterford, Waterford, Republic of Ireland.
| | - Eva Browne
- Department of Urology, University Hospital Waterford, Waterford, Republic of Ireland
| | - Padraig Daly
- Department of Urology, University Hospital Waterford, Waterford, Republic of Ireland; Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - John Keane
- Department of Urology, University Hospital Waterford, Waterford, Republic of Ireland
| | - Nigam Shah
- Department of Urology, University Hospital Waterford, Waterford, Republic of Ireland
| | - Christine Shilling
- Department of Urology, University Hospital Waterford, Waterford, Republic of Ireland
| | - Ivor M Cullen
- Department of Urology, University Hospital Waterford, Waterford, Republic of Ireland; Royal College of Surgeons in Ireland, Dublin, Republic of Ireland; Department of Urology, Beaumont Hospital, Dublin, Republic of Ireland
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O'Kelly JA, Browne E, Murray P, Keane J, Daly P, Cullen IM. Distal urethral carcinoma: Contemporary management with phallus preserving techniques. Surgeon 2022; 20:e282-e287. [PMID: 35012866 DOI: 10.1016/j.surge.2021.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 08/03/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Primary urethral carcinoma is a rare clinical entity with an incidence of 1 case per million in the United Kingdom. Cancers of the distal urethra are most commonly of squamous subtype and often associated with Human Papilloma Virus infection. Penile preserving techniques are recommended in tumours of the pendulous urethra with a number of surgical approaches described. Herein, we describe the surgical management of 7 patients presenting with primary urethral carcinoma. METHODS Seven patients diagnosed with primary urethral carcinoma of the distal urethra were identified using a prospectively maintained penile cancer database at our institution from May 2017 to November 2020. RESULTS The mean age at presentation was 56.5 (33-80) years. Presenting symptoms included visible lesion, LUTS and a groin mass. Three patients had lesions located within the glanular urethra and had a distal urethrectomy and primary closure. Two patients with lesions extending proximal to the glanular urethra and into or beyond the fossa navicularis had a distal urethrectomy with a hypospadic neomeatus formation. One patient with tumour extending into the glans penis underwent distal urethrectomy and partial glansectomy with split thickness skin graft. A partial penectomy was performed for one patient with urethral tumour invading the corporal heads. Mean follow-up was 23.4 (±17.0) months. There have been no disease recurrences to date. CONCLUSION Penile preserving techniques are feasible in patients with tumours of the pendulous urethra and do not appear to compromise local control.
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Affiliation(s)
- J A O'Kelly
- Department of Urology, University Hospital Waterford, Waterford, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - E Browne
- Department of Urology, University Hospital Waterford, Waterford, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland
| | - P Murray
- Department of Urology, University Hospital Waterford, Waterford, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland
| | - J Keane
- Department of Urology, University Hospital Waterford, Waterford, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland
| | - P Daly
- Department of Urology, University Hospital Waterford, Waterford, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland
| | - I M Cullen
- Department of Urology, University Hospital Waterford, Waterford, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland; National Cancer Control Programme (NCCP), Dublin, Ireland
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O'Kelly JA, Davis NF, Ferede AA, Breen KJ, O'Kelly P, MacCraith E, Forde J, Mohan P, Power R, Smyth G, Little DM. Predictors of long-term renal allograft survival after second kidney transplantation. Clin Transplant 2020; 34:e13907. [PMID: 32416641 DOI: 10.1111/ctr.13907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 05/08/2020] [Accepted: 05/08/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Few studies investigate significant perioperative predictors for long-term renal allograft survival after second kidney transplant (SKT). We compared long-term survival following SKT with primary kidney transplant and determined predictors of renal allograft failure after SKT. METHODS Outcomes of all primary or second kidney transplant recipients at a national kidney transplant center between 1993 and 2017 were reviewed. The primary outcomes measurements were renal allograft survival for both first and second kidney transplants. Secondary outcome measurements were incidence of delayed graft function (DGF), incidence of acute rejection (AR), and predictors for renal allograft survival in SKT recipients. RESULTS In total, there were 392 SKTs and 2748 primary kidney transplants performed between 1993 and 2017. The 1-, 5-, and 10-year death-censored graft survival for deceased-donor recipients was 95.3%, 88.7%, and 78.2% for primary kidney transplant and 94.9%, 87.1%, and 74.9% for SKT (P = .0288). Survival of primary renal allograft <6 years (HR 0.6, P = .017), AR episodes (HR 1.6, P = .031), DGF (HR 2.0, P = .005), and HLA-DR MM (HR 1.7, P = .018) was independent predictors of long-term renal allograft failure after SKT. CONCLUSION These findings may provide important information on long-term survival outcomes after SKT and for identifying patients at risk for long-term renal allograft failure after SKT.
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Affiliation(s)
- John A O'Kelly
- Department of Transplant, Urology and Nephrology (TUN), National Kidney Transplant Service (NKTS), Beaumont Hospital, Dublin, Ireland
| | - Niall F Davis
- Department of Transplant, Urology and Nephrology (TUN), National Kidney Transplant Service (NKTS), Beaumont Hospital, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Atakelet A Ferede
- Department of Transplant, Urology and Nephrology (TUN), National Kidney Transplant Service (NKTS), Beaumont Hospital, Dublin, Ireland
| | - Kieran J Breen
- Department of Transplant, Urology and Nephrology (TUN), National Kidney Transplant Service (NKTS), Beaumont Hospital, Dublin, Ireland
| | - Patrick O'Kelly
- Department of Transplant, Urology and Nephrology (TUN), National Kidney Transplant Service (NKTS), Beaumont Hospital, Dublin, Ireland
| | - Eoin MacCraith
- Department of Transplant, Urology and Nephrology (TUN), National Kidney Transplant Service (NKTS), Beaumont Hospital, Dublin, Ireland
| | - James Forde
- Department of Transplant, Urology and Nephrology (TUN), National Kidney Transplant Service (NKTS), Beaumont Hospital, Dublin, Ireland
| | - Ponnusamy Mohan
- Department of Transplant, Urology and Nephrology (TUN), National Kidney Transplant Service (NKTS), Beaumont Hospital, Dublin, Ireland
| | - Richard Power
- Department of Transplant, Urology and Nephrology (TUN), National Kidney Transplant Service (NKTS), Beaumont Hospital, Dublin, Ireland
| | - Gordon Smyth
- Department of Transplant, Urology and Nephrology (TUN), National Kidney Transplant Service (NKTS), Beaumont Hospital, Dublin, Ireland
| | - Dilly M Little
- Department of Transplant, Urology and Nephrology (TUN), National Kidney Transplant Service (NKTS), Beaumont Hospital, Dublin, Ireland
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O'Kelly JA, De Marchi JA, Joyce WP. The critical view of safety in laparoscopic cholecystectomy: towards a national consensus. Ir Med J 2015; 108:26. [PMID: 25702354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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