Does the Identification of a Minimum Number of Cases Correlate With Better Adherence to International Guidelines Regarding the Treatment of Penile Cancer? Survey Results of the European PROspective Penile Cancer Study (E-PROPS)

BackgroundPenile cancer represents a rare malignant disease, whereby a small caseload is associated with the risk of inadequate treatment expertise. Thus, we hypothesized that strict guideline adherence might be considered a potential surrogate for treatment quality. This study investigated the influence of the annual hospital caseload on guideline adherence regarding treatment recommendations for penile cancer.MethodsIn a 2018 survey study, 681 urologists from 45 hospitals in four European countries were queried about six hypothetical case scenarios (CS): local treatment of the primary tumor pTis (CS1) and pT1b (CS2); lymph node surgery inguinal (CS3) and pelvic (CS4); and chemotherapy neoadjuvant (CS5) and adjuvant (CS6). Only the responses from 206 head and senior physicians, as decision makers, were evaluated. The answers were assessed based on the applicable European Association of Urology (EAU) guidelines regarding their correctness. The real hospital caseload was analyzed based on multivariate logistic regression models regarding its effect on guideline adherence.ResultsThe median annual hospital caseload was 6 (interquartile range (IQR) 3–9). Recommendations for CS1–6 were correct in 79%, 66%, 39%, 27%, 28%, and 28%, respectively. The probability of a guideline-adherent recommendation increased with each patient treated per year in a clinic for CS1, CS2, CS3, and CS6 by 16%, 7.8%, 7.2%, and 9.5%, respectively (each p < 0.05); CS4 and CS5 were not influenced by caseload. A caseload threshold with a higher guideline adherence for all endpoints could not be perceived. The type of hospital care (academic vs. non-academic) did not affect guideline adherence in any scenario.ConclusionsGuideline adherence for most treatment recommendations increases with growing annual penile cancer caseload. Thus, the results of our study call for a stronger centralization of diagnosis and treatment strategies regarding penile cancer.

International experience in organization of teaching practice in teacher training and some recommendations

Given the strict guideline and significant innovation from the Laos Government, there are certain limitations in teacher training in Laos. This paper focuses on selected internationally published works on training teaching skills for prospective teachers (pre-service teachers) with document analysis method on articles and books of authors outside Laos. Subsequently, some recommendations to help innovate the pre-service teacher training process in Laos would be proposed in order to contribute to the development of teachers’ pedagogical competencies. It is suggested that the time allowance for pedagogical practice in high schools with the guidance of expert teachers, possibly through lesson planning and micro-teaching be increased. It is also necessary to pay more attention to equip teacher trainees with skills in using information technology and software in teaching (in particular pre-service mathematics teachers).

Contemporary hemodynamic monitoring, fluid responsiveness, volume optimization, and endpoints of resuscitation: an AAST critical care committee clinical consensus

This article, on hemodynamic monitoring, fluid responsiveness, volume assessment, and endpoints of resuscitation, is part of a compendium of guidelines provided by the AAST (American Association for the Surgery of Trauma) critical care committee. The intention of these guidelines is to inform practitioners with practical clinical guidance. To do this effectively and contemporarily, expert consensus via the critical care committee was obtained. Strict guideline methodology such a GRADE (Grading of Recommendations Assessment, Development and Evaluation) was purposefully NOT used so as not to limit the possible clinical guidance. The critical care committee foresees this methodology as practically valuable to the bedside clinician.

Prescribing pattern of antibiotics in AL-Elwia Pediatric Teaching Hospital, Baghdad, 2016.

Background: Antibiotics are among the most commonly used medicine, in both community and hospital setting, all over the world especially in countries where no strict guideline to regulate their use. In Iraq, only a few studies conducted to describe the antibiotic prescription pattern in general hospitalsand even less in pediatric hospital. Objective: To describe the patterns for antibiotics used in Elwia pediatric teaching hospital in Baghdad, Iraq Type of the study: Descriptive cross sectional study. .Methodology: The study was conducted at AL-Elwia Pediatric Teaching Hospitalduring the year 2016. A random sample from all the prescriptions sheets, of patients consulting outpatient clinic or admitted to different departments were studied for different parameters in different departments of the hospital. Results:A total number of 9440 prescriptions, were collected and analyzed.The age group 1-5 years was the most common group consulting the hospital followed by those below 6 months of age. About 51% of all patients were males. The study revealedthat 87.56% of all patients consulting the hospital were received antibiotics. The highest rate of antibiotic used was in inpatient department (99.9%) followed by NNCU (92.11%). Amoxicillin was the most preferred antibiotics by pediatrician in outpatient, inpatient and ER department. Conclusion: The results of this study indicate that there is, in general, overuse of antibiotics in all hospital departments when compared with other developing countries.

Generating standard 20° involute pinions with increased fillet strength by using 25° rack cutters with non-standard module

According to all prevailing standards for gear design, a strict guideline is that the individual gears of a gear pair must be of the same module and pressure angle in order to mesh properly and the compatibility of the remaining geometrical parameters is determined under this assumption. However, in this article, the fundamental meshing principles of a generating rack and pinion are reinterpreted, and a more insightful form of the compatibility equations for involute gears is presented. In this context, stronger tooth forms with thicker root fillets can be produced using 25° rack cutters and still be able to mesh with standard 20° involute gears indiscriminately. The increased strength of pinions of the proposed design versus their standard counterparts is verified with finite element analysis.