CLASS 504 UNIT 5 ASSIGNMENT (J)
RESEARSH
Class 504
Professor: Dr. Colleen Harris.
Jorge F. Garcia. RN, BSN.
P= Patient population (who?)
I= Intervention (what?)
C= Comparison (what is the alternative?)
O= Outcome (what are you looking for?)
T= Time (what is the time frame?)
PICOT
PICOT Acronym used to formulate questions for the conduct of an evidence-based investigation.
2
Patients with Prostate Cancer(P)undergoing Robotic Prostatectomy compared to those undergoing Open Prostatectomy(C) will have better recovery (I) after 3 months postoperatively(T) ?
MY PICOT QUESTIONS
Validity: It refers to whether the results of the study were obtained through scientific methods are solid.
Reliability: How precisely the effect was estimated.
Applicability: The results obtained will help in the treatment of the patient or affected population.
Clinical key questions.
Background:
How is prostate cancer diagnosed?
How wills the recovery of patient’s prostactemy by Robotic Surgery?
Foreground:
Could you ask me does Robotic Surgery offer better recovery than Open Surgery for patients with Prostate Cancer?
What are the risks identified with the treatment options?
Foreground and Background Questions.
5
PubMed.
Databases Used
Evidence Levels
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Gardiner et al. (2012). They performed a randomized trial of robotic and open prostatectomy in newly diagnosed men with prostate cancer. The results were measured preoperatively and at 6 weeks, 3, 6, 12 and 24 months after the surgery. Its objective was to evaluate the quality of life after the robotic and open surgery, as well as the costs of both procedures for the health sector and for the patient, life expectancy. The results include the evidence to make the decision for the most effective surgical treatment for prostate cancer.
Level I Evidence
A randomized controlled study was conducted in patients diagnosed with prostate cancer, with the aim of evaluating the functional results (urinary domain, sexual function) as well as oncology, after 12 weeks postoperatively comparing the robot- asisted laparoscopic prostatectomy and open radial retropubic prostatectomy . It was concluded that both techniques produce similar functional results at 12 weeks, intraoperatively, the open procedure presented greater incidence of adverse events. Yaxley, J. W., John, W., Coughlin, G.D., Chambers, S.K., Occhipinti, S., Samaratunga, H., & Robert, A. (2016)
Level I evidence… next example
This randomized controlled trial compares laparoscopic and robot-guided surgery for patients with prostate cancer, where the results do not show a great difference in the results in terms of quality of life (urinary and sexual function), nor in postoperative surgical complications. . When we compare both procedures with open prostatectomy, they show advantages in shorter hospital stays and less use of blood transfusions.(Ilic, D., Evans, S.M., Allan, C.A., Jung, J.H., Murphy, D., Frydenberg, M. 2017)
Level I evidence… next example
Wallerstedt, A. et al (2015). They carried out a study that compared the intrahospital characteristics and the reported results of the patients after 3 months of having performed a laparoscopic retro-pubic radical-assisted radical open prostatectomy. For which they conducted a prospective controlled trial of men undergoing radical prostatectomy of 14 centers. Where robot-assisted surgery presented less perioperative bleeding, as well as a shorter hospital stay compared to open surgery, although the operation time was shorter in the open technique.
Level II Evidence
This prospective study focused on evaluating the benefits of patients with prostatectomy through robotic surgery, where they found a minimum of perioperative complications, during follow-up of patients maintained undetectable levels of PSA, good results of urinary function, was shown to be a safe technique for the patient and efficient with functional preservation. (Takehiro, S., Toshihiko, M., Shuichi M., Katsuya, H., Naoto, K., Akihisa, Y. & Atsushi, T. 2013).
Level II evidence… next example
The review of several articles and studies that were conducted was comparing and contrasting information that both patients reported and medically informed that it seems that robotic prostatectomy is a safe surgical procedure for prostate cancer patients, where 91% of them have shown levels of PSA in the first year at undetectable levels, as well as 76% of them did not use pads for urinary incontinence, also decreases the days of hospitalization, as well as blood transfusions and postoperative pain. In terms of sexual function, cancer recurrence, survival, postoperative complications, the results do not show much difference compared with open surgery, so that robotic surgery is an alternative that can be considered by these patients.
Conclusions
Gardiner et al. (2012) A randomised trial of robotic and open prostatectomy in men with localised prostate cancer. Retrieved from https:// web-b-ebscohost-com.lib.kaplan.edu/ehost/pdfviewer/pdfviewer?vid=7&sid=3ea99e87-f6f2-4ea3-aa38-a8e136e2037e%40sessionmgr104
Ilic, D., Evans, S.M., Allan, C.A., Jung, J.H., Murphy, D., Frydenberg, M. (2017) Prostatectomía radical laparoscópica y asistida por robot versus abierta para el tratamiento del cáncer de próstata localizado . Base de datos Cochrane de revisiones sistemáticas, do : 10.1002 / 14651858.CD009625.pub2.
Takehiro, S., Toshihiko, M., Shuichi M., Katsuya, H., Naoto, K., Akihisa, Y. & Atsushi, T. (2013). 6(1), 1-20. Robot-assisted radical prostatectomy: a case series of the first 100 patients -constitutional introduction and implementation on the basis of comprehensive department of minimal invasive surgery center-. BMC Research Notes. Retrieved from: https:// web-b-ebscohost-com.lib.kaplan.edu/ehost/detail/detail?vid=13&sid=783f9ef1-64bf-487b-a784-7b8296934760%40sessionmgr103&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#AN=91885890&db=a9h
Wallerstedt, A., Tyritzis, S.I., Thorsteinsdottir, T., Carlsson, S., Stranne, J., Gustafsson, O… Haglind, E. (2015). Short-term results after robot-assisted laparoscopic radical prostatectomy compared to open radical prostatectomy. Eur Urol. 67(4) 660-70. doi: 10.1016/j.eururo.2014.09.036. Epub 2014 Oct 11.
Yaxley, J. W., John, W., Coughlin, G.D., Chambers, S.K., Occhipinti, S., Samaratunga, H., & Robert, A. (2016). Articles: Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: early outcomes from a randomised controlled phase 3 study. The Lancet, 388(10049):1057-1066. doi: 10.1016/S0140-6736(16)30592-X
References