Predictors of severely compromised renal function to aid decision-making for placement of a percutaneous nephrostomy tube(s) or ureteral stent(s) in gynecologic oncology patients

11611 Background: The decision to discontinue anti-cancer therapies in oncology patients is a complex one and may occur in several unique ways. We sought to understand the processes of therapy discontinuation in a gynecologic oncology population and to discern possible changes in the distribution of these processes after implementation of a palliative care (PC) quality improvement project. Methods: Women with incurable gynecologic malignancies seen in the outpatient setting at an academic center were identified with the recommendation for ‘goals of care’ discussion within 3 visits following identification. Processes of discontinuing chemotherapy for this population were assessed and categorized into 1 of 4 categories: definitive outpatient decision, definitive inpatient decision, interruption by hospitalization, treatment holiday, and “no decision.” Retrospective chart review identified a similar cohort of women prior to the implementation of our PC intervention. Univariate analyses were conducted to determine associations between characteristics and binary outcome of definitive outpatient decision versus all other decision processes. Results: 90/102 (88%) pre-intervention subjects and 83/157 (53%) post-intervention subjects had died at time of analysis. Of the total deceased cohort, 59/173 (34%) made a definitive decision to stop therapy in the outpatient setting. After implementation of the PC initiative, there was a trend towards fewer women identified as having made “no decision” (18.1% vs 30%). Those who made a definitive outpatient decision were less likely to die within 30 days of hospitalization than those who did not (OR 0.16 [95% CI 0.07,0.390], p < 0.0001). Conclusions: Discontinuation of therapy is a nuanced concept in gynecologic oncology patients that can be stratified into several processes. While our data demonstrates a possible increase in active decision-making with the PC initiative, a majority of patients near the end of life still did not make definitive therapy cessation decisions. This reveals an urgent need for the development of initiatives to enhance patient engagement and shared decision making for women near the end of life.

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Percutaneous Nephrostomy in Gynecologic Oncology Patients

The Journal of Urology ◽

10.1016/s0022-5347(17)40856-1 ◽

1989 ◽

Vol 141 (2) ◽

pp. 472-473

Author(s):

J.T. Soper ◽

T.M. Blaszczyk ◽

E. Oke ◽

D. Clarke-Pearson ◽

W.T. Creasman

Keyword(s):

Gynecologic Oncology ◽

Percutaneous Nephrostomy ◽

Oncology Patients

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Percutaneous nephrostomy in gynecologic oncology patients

American Journal of Obstetrics and Gynecology ◽

10.1016/0002-9378(88)90237-2 ◽

1988 ◽

Vol 158 (5) ◽

pp. 1126-1131 ◽

Cited By ~ 22

Author(s):

John T. Soper ◽

Theodore M. Blaszczyk ◽

Edward Oke ◽

Daniel Clarke-Pearson ◽

William T. Creasman

Keyword(s):

Gynecologic Oncology ◽

Percutaneous Nephrostomy ◽

Oncology Patients

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Functional Outcomes After Percutaneous Nephrostomy in Hydronephrotic Kidneys in Adult Population

Bangladesh Journal of Urology ◽

10.3329/bju.v21i2.49880 ◽

2020 ◽

Vol 21 (2) ◽

pp. 93-97

Author(s):

Md Muazzam Hossan ◽

Md Fazal Naser ◽

Md Rokonuzzaman Khan ◽

Md Amirul Islam ◽

Md Golam Kabir

Keyword(s):

Renal Function ◽

Specific Gravity ◽

Adult Population ◽

Percutaneous Nephrostomy ◽

Repeated Measure ◽

Functional Improvement ◽

Nephrostomy Tube ◽

College Hospital ◽

Split Renal Function ◽

Hospital Patients

Objective: To evaluate the results of renal function after percutaneous nephrostomy in hydronephrotic kidneys in adult population. Methods: This study was performed on 57 patients of more than 18 years of age with hydronephrosis due to PUJ obstruction and split renal function <10% at the Department of Urology, Dhaka Medical College Hospital. Patients with concomitant pathologies like stone, pyonephrosis and VUJ obstruction were excluded from the study. Their evaluation included split renal function (SRF),glomerular filtration rate (GFR),specific gravity of urine draining through nephrostomy tube,volume of urine through nephrostomy tube. Statistical analysis was performed by SPSS version 13 and the test statistics used to analyse the data were descriptive statistics and Repeated measure ANOVA. Results: Mean age of the patients was 33.4+13.0 years, mean SRF increased from 6.2% at baseline to 18.6% after 6 weeks of PCN (p < 0.001), mean GFR increased from 6.2 ml/min/1.73 sq-meter at baseline to 18.6 ml/min/1.73 sq-meter at the end of week 6,mean specific gravity of urine significantly increased from 1.009 at baseline to 1.019 after 6 weeks, volume of urine at 2nd week was 316 ml/ 24 hours and nearly 363 ml/ 24 hours after 6 weeks of PCN (p < 0.001).GFR and SRF improved in 78.95% case Conclusions: Most of the poorly functioning hydronephrotic kidneys showed functional improvement following PCN and hence not all such kidneys should be removed without subjecting them to a trial of PCN. Bangladesh Journal of Urology, Vol. 21, No. 2, July 2018 p.93-97

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Awareness and Decision Making in Professional Ethics

European Psychologist ◽

10.1027//1016-9040.5.1.19 ◽

2000 ◽

Vol 5 (1) ◽

pp. 19-27 ◽

Cited By ~ 2

Author(s):

Ronny Swain

Keyword(s):

Decision Making ◽

Professional Ethics ◽

Ethical Decision Making ◽

Code Of Ethics ◽

Professional Autonomy ◽

Ethical Awareness ◽

Ethical Decisions ◽

The Right ◽

Aid Decision

The paper describes the development of the 1998 revision of the Psychological Society of Ireland's Code of Professional Ethics. The Code incorporates the European Meta-Code of Ethics and an ethical decision-making procedure borrowed from the Canadian Psychological Association. An example using the procedure is presented. To aid decision making, a classification of different kinds of stakeholder (i.e., interested party) affected by ethical decisions is offered. The author contends (1) that psychologists should assert the right, which is an important aspect of professional autonomy, to make discretionary judgments, (2) that to be justified in doing so they need to educate themselves in sound and deliberative judgment, and (3) that the process is facilitated by a code such as the Irish one, which emphasizes ethical awareness and decision making. The need for awareness and judgment is underlined by the variability in the ethical codes of different organizations and different European states: in such a context, codes should be used as broad yardsticks, rather than precise templates.

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Outcome of Percutaneous Nephrostomy in Children With Ureteropelvic Junction Obstruction

Bangladesh Journal of Urology ◽

10.3329/bju.v20i2.49654 ◽

2020 ◽

Vol 20 (2) ◽

pp. 61-64

Author(s):

Mohammad Mahfuzur Rahman Chowdhury ◽

Rifat Zaman ◽

Md Amanur Rasul ◽

Akm Shahadat Hossain ◽

Shafiqul Alam Chowdhury ◽

...

Keyword(s):

Renal Function ◽

Low Dose ◽

Ureteropelvic Junction Obstruction ◽

Percutaneous Nephrostomy ◽

Ureteropelvic Junction ◽

College Hospital ◽

Medical College ◽

Split Renal Function

Introduction and objectives: Congenital ureteropelvic junction obstruction (UPJO) is the most common cause of hydronephrosis. Management protocols are based on the presence of symptoms and when the patient is asymptomatic the function of the affected kidney determines the line of treatment. Percutaneous nephrostomy (PCN) became a widely accepted procedure in children in the 1990s. The aim of the study was to evaluate the results of performing percutaneous nephrostomy (PCN) in all patients with UPJO and split renal function (SRF) of less than 10% in the affected kidney, because the management of such cases is still under debate. Methods:This prospective clinical trial was carried out at Dhaka Medical College Hospital from January 2014 to December 2016. Eighteen consecutive patients who underwent PCN for the treatment of unilateral UPJO were evaluated prospectively. In these children, ultrasonography was used for puncture and catheter insertion. Local anesthesia with sedation or general anesthesia was used for puncture. Pig tail catheters were employed. The PCN remained in situ for at least 4 weeks, during which patients received low-dose cephalosporin prophylaxis. Repeat renography was done after 4 weeks. When there was no significant improvement in split renal function (10% or greater) and PCN drainage (greater than 200 ml per day) then nephrectomies were performed otherwise pyeloplasties were performed. The patients were followed up after pyeloplasty with renograms at 3 months and 6 months post operatively. Results: All the patients had severe hydronephrosis during diagnosis and 14 patients with unilateral UPJO were improved after PCN drainage and underwent pyeloplasty. The rest four patients that did not show improvement in the SRF and total volume of urine output underwent nephrectomy. In the patients with unilateral UPJO who improved after PCN drainage, the SRF was increased to 26.4% ±8.6% (mean± SD) after four weeks and pyeloplasty was performed. At three and six months follow-up, SRF value was 29.2% ±8.5% and 30.8.2% ±8.8% respectively. Conclusion: Before planning of nephrectomy in poorly functioning kidneys (SRF < 10%) due to congenital UPJO, PCN drainage should be done to asses improvement of renal function. Bangladesh Journal of Urology, Vol. 20, No. 2, July 2017 p.61-64

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