Introduction of a dedicated colic clinic reduces referral to treatment times in patients managed expectantly with acute ureteric colic: a quality improvement project.

Ureteric colic constitutes a large proportion of acute hospital attendances, across the UK, putting pressure on urological services. The British Association of Urological Surgeons (BAUS) guidelines indicate that for patients managed expectantly, a clinic review should be undertaken within 4 weeks of presentation. This quality improvement project reports the benefit of a dedicated virtual colic clinic to facilitate an efficient care pathway and reduce patient waiting times. A retrospective cycle analysed patients referred from the emergency department (ED) with uncomplicated acute ureteric colic (excluding those admitted for immediate intervention) over 2 months in 2019. A further cycle was carried out 12 months later following the introduction of a new dedicated virtual colic clinic with updated ED referral guidance. The mean time from ED referral to urology clinic review fell from 7.5 to 3.5 weeks. The percentage of patients reviewed in clinic within 4 weeks increased from 25% to 82%. The mean time from referral to intervention including shockwave lithotripsy and primary ureteroscopy fell from 15 to 5 weeks. The introduction of a virtual colic clinic improved the time to definitive management of ureteric stones for patients managed expectantly as per BAUS guidelines. This has reduced waiting times for both clinic review and stone treatment which has enhanced patient experience within our service.

Experiences of registered nurses supporting nursing students during clinical placement using a facility-based model: A mixed methods study.

BACKGROUND: An ageing workforce and increased vacancies has seen a steady growth in nursing student enrolments. This has created a need to re-think how to optimise existing clinical placement opportunities while ensuring quality student experiences and staff satisfaction in their support role. OBJECTIVES: To provide insights into the experiences and satisfaction levels of Registered Nurses who supported nursing students during clinical placement using a facility-based model. DESIGN: A quasi-experimental design. SETTINGS: Three wards in an acute care facility and Primary and Community Health within the Southwest of Sydney, New South Wales, Australia. PARTICIPANTS: Participants included Registered Nurses/Midwives, Facility-based liaison support staff, and Nurse Managers. INTERVENTION: Within the 24/7 facility-based model, each nursing student was allocated to one Registered Nurse for the duration of the clinical placement period. The pair was rostered to complete the same day, evening, night, and weekend shifts. METHODS: A cross-sectional survey related to staff satisfaction was administered to participants at two time points: (a) prior to the commencement of the intervention (baseline survey); and (b) at the completion of the intervention. Following the intervention participants were invited to a focus group or an individual interview. RESULTS: There were no statistically significant changes in the levels of staff satisfaction from baseline to post-intervention; with personal fulfilment scoring the highest and workload the lowest. Staff who worked in the Primary and Community Health settings were less satisfied with this model of student support. Overall, most participants reported high personal satisfaction, professional growth and development opportunities yet acknowledged this came at a cost, with an increased workload. CONCLUSIONS: Participants were satisfied with the facility-based model in supporting student learning on clinical placement. The model is fit for purpose however it does need to be tailored to the contextual needs of nurses working in Primary and Community settings.

Frequency of Adverse Events Following Q Fever Immunisation in Young Adults.

Q fever is a zoonosis of concern in many countries. Vaccination is the most effective means of prevention, and since 1989, Australia has had a licensed Q fever vaccine, Q-VAX®. This vaccine was also used in the Netherlands in 2011 following the largest recorded Q fever outbreak globally. There is a paucity of available data regarding adverse events following immunisation (AEFI) for young adult females. Such data are important for informing future vaccination recommendations both within Australia and internationally. This study collected Q fever vaccine (Q-VAX®) AEFI data in veterinary and animal science students at Australian universities. Students were enrolled at the time of vaccination and were emailed a link to an online AEFI survey one week later. Of the 60% (499/827) that responded, 85% were female and the median age was 18 years. Local injection site reactions (ISRs) occurred in 98% (95%; CI 96⁻99%) of respondents, of which 30% (95% CI 24⁻32%) were severe. Systemic AEFI occurred in 60% (95%; CI 55⁻64%) of respondents within the seven days following immunisation. Medical attention was sought by 19/499 (3.8%) respondents, of whom one sought treatment at a hospital emergency department. Females were more likely than males to experience any local ISR (odds ratio [OR] 9.3; 95% CI 2.5⁻33.8; p < 0.001), ISRs of greater severity (OR 2.5; 95% CI 1.5⁻4.2; p < 0.001), and any systemic AEFI (OR 1.9; 95% CI 1.1⁻3.1; p = 0.016). These safety data suggest that a high frequency of adverse events following immunisation should be expected in young adults, particularly females. However, the consequences of Q fever disease are potentially far more debilitating.

Synthesis and Characterization of Renewable Polyester Coil Coatings from Biomass-Derived Isosorbide, FDCA, 1,5-Pentanediol, Succinic Acid, and 1,3-Propanediol.

Biomass-derived polyester coatings for coil applications have been successfully developed and characterized. The coatings were constituted by carbohydrate-derived monomers, namely 2,5-furan dicarboxylic acid, isosorbide, succinic acid, 1,3-propanediol, and 1,5-pentanediol, the latter having previously been used as a plasticizer rather than a structural building unit. The effect of isosorbide on the coatings is widely studied. The inclusion of these monomers diversified the mechanical properties of the coatings, and showed an improved performance against common petrochemical derived coatings. This research study provides a range of fully bio-derived polyester coil coatings with tunable properties of industrial interest, highlighting the importance of renewable polymers towards a successful bioeconomy.

Distress Among Locally Advanced Breast Cancer Patients from Diagnosis to Follow-Up: A Critical Review of Literature.

OBJECTIVE: This critical review used a systematic approach to explore the prevalence of distress among locally advanced breast cancer (LABC) patients along their treatment journey. This review explored the domains of distress (psychosocial, physical and/or practical) that are significant to this patient population and determined indications for psychosocial support throughout the patients' treatment. METHODS: Electronic databases including CINAHL, EmBase, Medline PsycInfo, and gray literature were searched from the year 2000 to 2016, to produce relevant literature. A critical review was conducted on 73 articles meeting the inclusion and exclusion criteria. A narrative synopsis was used to summarize the findings under key themes. RESULTS: The results indicate that 16/73 studies assessed for distress in all three domains of distress throughout the treatment course. A meta-analysis was not possible due to the methodological heterogeneity of the articles, the variation of assessment tools used, timing in which the assessments were done, and the different treatment modalities. Distress was prevalent from the time of diagnosis, through treatment, and into survivorship. Sexuality, body image, age, financial difficulty, family/social support, and informational needs were common themes that emerged among the LABC population in these studies. CONCLUSIONS: Comprehensive assessments incorporating all three domains of distress with the appropriate tools will assist health care professionals throughout the complicated treatment trajectory of LABC patients in taking a more proactive approach in assisting patients' concerns and preventing undue or increase in psychological distress during or after active treatment. This will encourage effective patient-centered communication and supportive care referrals for a better patient experience.

Survey of owner motivations and veterinary input of owners feeding diets containing raw animal products.

BACKGROUND: The practice of feeding of diets containing raw animal products (RAP) to pets (dogs and cats) is discouraged by veterinary organizations and governmental public health organizations. Nevertheless, the practice of feeding RAP to pets is increasing in popularity. Pet owner motivations for feeding RAP diets to pets have not been explored and the benefits of RAP diets remain largely anecdotal. We hypothesized that pet owners feeding RAP diets would not rely on veterinary advice in choosing their pet's diet. We also hypothesized that these owners would have lower levels of trust in veterinary advice with respect to nutrition relative to pet owners not feeding RAP. METHODS: An anonymous web-based survey was developed to identify pet owner motivations for feeding RAP diets, and to characterize the veterinarian-client relationships of individuals feeding RAP diets. RESULTS: There were 2,337 respondents and 2,171 completed surveys. Of survey respondents, 804 reported feeding RAP at the time of the survey. While 20% of pet owners feeding RAP relied on online resources to determine what or how much RAP to feed, only 9% reported consulting with a veterinarian in making decisions about feeding RAP. Pet owners feeding RAP reported lower levels of trust in veterinary advice both 'in general' and 'with respect to nutrition' than pet owners not feeding RAP. Most pet owners reported that a discussion regarding their pet's nutrition does not occur at every veterinary appointment. DISCUSSION: Pet owners feeding a RAP diet have lower trust in veterinary advice than pet owners not feeding a RAP diet. Owners feeding RAP are more reliant on online resources than their own veterinarian in deciding what and how much RAP to feed. Pet owners perceive that nutrition is not discussed at most veterinary appointments. Therefore, there is room for improvement in the veterinarian-client communication with regards to nutrition.

Evaluation of a Web-based decision aid for people considering the APOE genetic test for Alzheimer risk.

PURPOSE: With the increasing interest in apolipoprotein E (APOE) genetic testing to estimate the risk of developing late-onset Alzheimer disease, new educational tools are needed to help people make the best decision for themselves about whether to undergo this test. This study evaluated an online tool to assist in this decision process. METHODS: A prototype decision aid was studied in a two-part survey that collected data from participants before and after they examined the decision aid. Both surveys had multiple-choice options and opportunities for open-ended responses, yielding quantitative and qualitative information. The responses before and after use of the aid were compared for each participant. RESULTS: A total of 1,262 individuals completed both surveys. The overall effectiveness of the decision aid was shown by three measures: 94% found the decision aid very helpful or somewhat helpful; general knowledge was increased; and some people changed their minds about APOE genetic testing, with 35% shifting to a higher likelihood of undergoing the test and 20% to a lower likelihood. Suggestions for improvements were noted and incorporated into the online tool. CONCLUSION: This decision aid can provide useful educational assistance to many individuals as they consider APOE genetic testing as well as facilitate further discussions with their health-care providers.Genet Med advance online publication 03 November 2016.

Children view own-age faces qualitatively differently to other-age faces.

Like most own-group biases in face recognition, the own-age bias (OAB) is thought to be based either on perceptual expertise or socio-cognitive motivational mechanisms [Wolff, N., Kemter, K., Schweinberger, S. R., & Wiese, H. (2013). What drives social in-group biases in face recognition memory? ERP evidence from the own-gender bias. Social Cognitive and Affective Neuroscience. doi:10.1093/scan/nst024]. The present study employed a recognition paradigm with eye-tracking in order to assess whether participants actively viewed faces of their own-age differently to that of other-age faces. The results indicated a significant OAB (superior recognition for own-age relative to other-age faces), provided that they were upright, indicative of expertise being employed for the recognition of own-age faces. However, the eye-tracking results indicate that viewing other-age faces was qualitatively different to the viewing of own-age faces, with more nose fixations for other-age faces. These results are interpreted as supporting the socio-cognitive model of the OAB.

The use of protocol in breaking bad news: evidence and ethos.

This article discusses health professionals use of protocol in the breaking of bad news, focusing particularly on the well-known SPIKES framework. The evidence of impact on the patient experience is examined and recommendations are made for further outcome-based research. Existing evidence suggests that the model as commonly interpreted may not fully meet the needs of patients or reflect the clinical experience of breaking bad news for some professionals and further guidance may be needed to support them in their practice. The ethos of the step-wise protocol is debated, questioning whether it helps or hinders individualised care and the formation of a genuine relationship between patient and professional. Finally, recommendations for practice are offered.

Radiation Therapy Students' Knowledge, Attitudes, and Beliefs about Palliative and End-of-Life Care for Cancer Patients.

BACKGROUND AND PURPOSE: Although radiation therapy students are highly interested in providing palliative and end-of-life care (PEOLC), students often lack understanding of what palliative care is and express a lack of confidence when interacting with palliative patients. This study examined radiation therapy students' existing knowledge, attitudes, and beliefs toward PEOLC for cancer patients and how professional and personal experiences influenced those factors. METHODS: This study used a cross-sectional online questionnaire. After informed consent, data were collected from a sample of students in an undergraduate radiation therapy program in Canada. Questions were both quantitative and qualitative in nature. Responses were comprised of Likert scales and true or false responses, a case study-based vignette and several short open-ended questions. RESULTS: Sixty-one students completed the questionnaire; the response rate was 42%. Responses indicate students had an incomplete understanding of PEOLC principles despite reporting positive views and interest in the topic. Professional and personal experiences improved students' knowledge regarding the role of PEOLC and attitudes and beliefs became more positive with increased real-life experiences. CONCLUSIONS: Experiential learning influences students' knowledge, attitudes, and beliefs about PEOLC. To better prepare students for their future professional roles, it is necessary for radiation therapy undergraduate programs to include PEOLC educational initiatives in its curricula. These initiatives should emphasize holistic care to prepare students to be competent radiation therapists who can address patients' complex PEOLC needs.

Repeat retroperitoneal lymph-node dissection after chemotherapy for metastatic testicular germ cell tumour.

OBJECTIVES: To examine the operative findings, histopathology and clinical outcome of patients undergoing repeat retroperitoneal lymph node dissection (RPLND) after initial chemotherapy and RPLND (PC-RPLND) for metastatic testicular germ cell tumour (GCT), as a small proportion relapse or have residual disease after incomplete resection in the lung, retrocrural or pelvic nodes, and retroperitoneum. PATIENTS AND METHODS: Between September 1992 and May 2006, 359 patients had PC-RPLND under the care of one surgeon, 54 of which were repeat procedures. We compared the long-term outcome between those having primary and those having repeat PC-RPLND. RESULTS: The median (range) time from original to repeat surgery was 2.4 (0.25-26.5) years, and the median follow-up after the repeat procedure was 5.8 (0.08-12.9) years. There was no difference in survival between patients requiring only one PC-RPLND and those having a repeat procedure (P = 0.592). The most frequent sites of recurrent disease were: behind the great vessels/para-aortic areas (38, 46%), in the suprahilar region (18, 18%), in the retrocrural area (16, 19%), in the pelvic nodes (10, 12%) and in the lung (one, 1%). The most common pathological findings in the repeat PC-RPLNDs were differentiated teratoma (19, 35%), malignant teratoma undifferentiated (nine, 17%), adenocarcinoma (eight, 15%) and necrotic tissue (five, 9.2%). CONCLUSION: Although a small proportion of patients with metastatic GCT might require repeat PC-RPLND, there is no difference in survival between this group and those having one PC-RPLND. However, to avoid cancer recurrence and reoperation, it is crucial that the first PC-RPLND is careful and complete, preferably done in a centre with expertise in this procedure.

Patient perceptions of factors influencing adherence to medication following kidney transplant.

Research has shown that most patients with end-stage kidney failure prefer treatment by transplantation. This entails taking immunosuppressant drugs daily throughout the life of the kidney. Failure to do so causes transplant rejection and a return to dialysis, or sometimes even death. Up to 50% of transplanted patients report failing to take their medication as prescribed. This qualitative study used focus groups to explore patients' lived experience in relation to medication adherence. Data were analysed using thematic analysis. The main themes to emerge were: fear of kidney failure, loyalty to the renal team and donors, health beliefs, forgetting and side-effects. Reasons for adherence were to avoid kidney failure and to acknowledge their gratitude to the renal team and donors. Participants suggested that non-adherence was largely due to forgetting.

Living with a kidney transplant: a qualitative investigation of quality of life.

Research has shown that transplantation improves quality of life for patients with end stage renal disease (ESRD), although it does not return to pre-kidney failure levels. This study used focus groups to explore the experience of living with a transplanted kidney. The data were analysed, using thematic analysis, and the following themes were identified: medicalization; fear; gratitude; and coping. These may necessitate constant vigilance, reduced spontaneity and preoccupation with self-care to maintain the kidney's health; being treated differently from others; pressure not to let themselves and others down; and the urge to increase their knowledge about their condition. It was found that these themes pervade the lives of the recipients and that the psychosocial effects of transplantation are long-lasting.

Laparoscopic hysterectomy with or without pelvic lymphadenectomy or sampling in a high-risk series of patients with endometrial cancer.

BACKGROUND: The purpose of the study was to determine the outcome of all patients with endometrial adenocarcinoma cancer treated by laparoscopic hysterectomy at our institution, many of whom were high-risk for surgery. METHODS: Data was collected by a retrospective search of the case notes and Electronic Patient Records of the thirty eight patients who underwent laparoscopic hysterectomy for endometrial cancer at our institutions. RESULTS: The median body mass index was 30 (range 19-67). Comorbidities were present in 76% (29 patients); 40% (15 patients) had a single comorbid condition, whilst 18% (7 patients) had two, and a further 18% (7 patients) had more than two. Lymphadenectomy was performed in 45% (17 patients), and lymph node sampling in 21% (8 patients). Median operating time was 210 minutes (range 70-360 minutes). Median estimated blood loss was 200 ml (range 50-1000 ml). There were no intraoperative complications. Post-operative complications were seen in 21% (2 major, 6 minor). Blood transfusion was required in 5% (2 patients). The median stay was 4 post-operative nights (range 1-25 nights). In those patients undergoing lymphadenectomy, the mean number of nodes taken was fifteen (range 8-26 nodes). The pathological staging was FIGO stage I 76% (29 patients), stage II 8% (3 patients), stage III 16% (6 patients). The pathological grade was G1 31% (16 patients), G2 45% (17 patients), G3 24% (8 patients). CONCLUSION: Laparoscopic hysterectomy can be safely carried out in patients at high risk for surgery, with no compromise in terms of outcomes, whilst providing all the benefits inherent in minimal access surgery.

Bone formation in the urinary tract: case report.

A case of osseous metaplasia of the ureter presenting as a small upper-ureteral calculus is reported. This rare phenomenon may represent an unusual nucleus for stone formation in the urinary tract. The etiology of this condition is uncertain; we speculate that trauma to the ureter may stimulate osseous metaplasia.