ORCID Profile
0000-0001-7848-9537
Current Organisation
Fiona Stanley Hospital
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Publisher: Wiley
Date: 30-07-2021
DOI: 10.1111/BJU.15552
Abstract: To determine whether the addition of inhaled methoxyflurane to periprostatic infiltration of local anaesthetic (PILA) during transrectal ultrasonography‐guided prostate biopsies (TRUSBs) improved pain and other aspects of the experience. We conducted a multicentre, placebo‐controlled, double‐blind, randomized phase 3 trial, involving 420 men undergoing their first TRUSB. The intervention was PILA plus a patient‐controlled device containing either 3 mL methoxyflurane, or 3 mL 0.9% saline plus one drop of methoxyflurane to preserve blinding. The primary outcome was the pain score (0–10) reported by the participant after 15 min. Secondary outcomes included ratings of other aspects of the biopsy experience, willingness to undergo future biopsies, urologists’ ratings, biopsy completion, and adverse events. The mean (SE) pain scores 15 min after TRUSB were 2.51 (0.22) in those assigned methoxyflurane vs 2.82 (0.22) for placebo (difference 0.31, 95% confidence interval [CI] −0.75 to 0.14 P = 0.18). Methoxyflurane was associated with better scores for discomfort (difference −0.48, 95% CI −0.92 to −0.03 P = 0.035, adjusted [adj.] P = 0.076), whole experience (difference −0.50, 95% CI −0.92 to −0.08 P = 0.021, adj. P = 0.053), and willingness to undergo repeat biopsies (odds ratio 1.67, 95% CI 1.12–2.49 P = 0.01) than placebo. Methoxyflurane resulted in higher scores for drowsiness (difference +1.64, 95% CI 1.21–2.07 P 0.001, adj. P 0.001) and dizziness (difference +1.78, 95% CI 1.31–2.24 P 0.001, adj. P 0.001) than placebo. There was no significant difference in the number of ≥ grade 3 adverse events. We found no evidence that methoxyflurane improved pain scores at 15 min, however, improvements were seen in patient‐reported discomfort, overall experience, and willingness to undergo repeat biopsies.
Publisher: Hindawi Limited
Date: 26-07-2021
DOI: 10.1111/ECC.13493
Publisher: Wiley
Date: 25-09-2021
DOI: 10.1111/ANS.16329
Publisher: Wiley
Date: 03-2023
DOI: 10.1111/ANS.18292
Abstract: For patients undergoing radical cystectomy with pelvic lymph node dissection for urothelial cancer, a lymph node count of at least 16 is associated with improved cancer‐specific and overall survival. Lymph node yield is presumed to relate directly to extent of dissection and surgical quality, however limited studies have reviewed the impact of the pathological assessment process of lymph nodes on lymph node yield. A retrospective assessment of 139 patients who had radical cystectomy for urothelial cancer between March 2015 and July 2021 from Fiona Stanley Hospital (Perth, Australia) by a single surgeon was assessed. A change in pathological assessment process from assessment of only palpable lymph nodes to microscopic assessment of the entire submitted specimens occurred in August 2018. Patients were ided into two groups accordingly and other relevant demographic and pathological data was recorded. The impact of pathological processing technique on lymph node yield was assessed using the Student T test and logistical regression was used to assess the impact of other demographic variables. The mean lymph node yield was 16.2 nodes (IQR 12–23) in 54 patients in the pre‐process change group compared to 22.4 nodes (IQR 15–28.4) in 85 patients in the post‐process change group ( P 0.0001). 53.7% had 16 or more nodes in the pre‐process change group compared to 71.3% in the post‐process change group ( P = 0.04). Age, BMI, and gender were not significant predictors of lymph node yield. The current study demonstrates that the microscopic assessment of all lymph node tissue detects significantly more lymph nodes than only examining palpably abnormal tissue. Pathologic assessment protocols should be standardized to this technique to ensure the utility of lymph node yield as a quality metric.
Publisher: Wiley
Date: 24-11-2021
DOI: 10.1111/ANS.16439
No related grants have been discovered for Cynthia Hawks.