Percutaneous antegrade management of large proximal ureteral stones using non-papillary puncture

Objective:To evaluate the feasibility and the safety of medial non-papillary percutaneous nephrolithotomy(npPCNL)for the management of large proximal ureteral stones.Methods:We evaluated prospectively collected data of 37 patients with large proximal ureteral stones more than 1.5 cm in diameter treated by prone npPCNL.Depending on stone size,in-toto stone removal or lithotripsy using the Lithoclast®Trilogy(EMS Medical,Nyon,Switzerland)was performed.Perioperative parameters including operative time(from start of puncture to the skin suturing),stone extraction time(from the first insertion of the nephroscope to the extraction of all stone fragments),and the stone-free rate were evaluated.Results:Twenty-one males and 16 females underwent npPCNL for the management of large upper ureteral calculi.The median age and stone size of treated patients were 58(interquartile range[IQR]:51-69)years and 19.3(IQR:18.0-22.0)mm,respectively.The median operative time and stone extraction time were 25(IQR:21-29)min and 8(IQR:7-10)min,respectively.One case(2.7%)of postoperative bleeding and two cases(5.4%)of prolonged fever were managed conservatively.The stone-free rate at a 1-month follow-up was 94.6%.Conclusion:The npPCNL provides a straight route to the ureteropelvic junction and proximal ureter.Approaching from a dilated portion of the ureter under low irrigation pressure with larger diameter instruments results in effective and safe stone extraction within a few minutes.

A Qualitative Assessment of People-Centeredness of Inpatient Tuberculosis Treatment Services in Armenia

Background: People-centered tuberculosis (TB) care promotes treatment adherence and outcomes. TB patients’ and families’ health education and protection of their rights are among the core components of people-centered care. We aimed to assess the level of people-centeredness of TB care as a proxy to quality in the largest inpatient unit of the National Pulmonology Center (NPC) in Armenia. Methods: We conducted a qualitative study by interviewing clinical and administrative staff, TB patients, and family members to learn their experiences about patient and family education and rights (PFE&R) protection practices focusing on two Joint Commission International (JCI) Standards for Hospital Accreditation. Mixed-conventional inductive and directed deductive content approach guided the analysis of data. Results: The study revealed various gaps in the provided services. According to the TB physicians and nurses, they routinely educated patients and families and took actions to protect their rights. However, practices reported by TB providers varied across clinical departments and professionals and did not meet the recommendations of the JCI standards. The document review revealed that no written policies or procedures existed in the NPC inpatient unit to guide the implementation of PFE&R. Lastly, patients’ inconsistent experiences were also indicative of the lack of standardization and issues with PFE&R implementation. Conclusion: Bridging the gap between existing and recommended practices by establishing and enforcing new people-centered policies and procedures is a pledge for improving operations and patients’ experiences with a potential nationwide impact in Armenia.

Family-Based Tuberculosis Counseling Supports Directly Observed Therapy in Armenia: A Pilot Project

Objectives: Non-adherence to tuberculosis (TB) treatment causes development of multi-drug resistance (MDR). In Armenia, about 47% of previously-treated TB patients develop MDR-TB. This pilot intervention intended to explore the feasibility and effectiveness of a family-based-counseling (FBC) that included a psychological component in terms of improved adherence of TB patients to treatment and reduced stigma of TB. Methods: Overall, 136 regular TB patients (55) and their family members (81) participated in a single 90-minute interactive counseling session conducted in each household by the team of professional psychologist and TB nurse. To evaluate FBC effectiveness, we administered baseline and follow-up surveys to 52 TB patients and their 57 family members in 2012 and compared treatment outcomes of the study participants with the national data for 2011 and 2013. Results: We found that the intervention substantially improved the mean knowledge score of TB patients (from 19.2 to 21.6, p Conclusion: The evaluation showed that a low-cost one-time family–based educational intervention with a psychological component can be effective in improving treatment outcomes of TB patients.