Transition from Transrectal to Transperineal MRI-Fusion Prostate Biopsy Does Not Comprise Detection Rates of Clinically Significant Prostate Cancer at a Tertiary Care Center.

BACKGROUND: A remarkable paradigm shift has emerged regarding the preferred prostate biopsy approach, favoring the transperineal (TP) over the transrectal (TR) approach due to the reduced risk of severe urinary tract infections. However, its impact on the detection of clinically significant prostate cancer (csPCa) remains unclear. MATERIALS AND METHODS: We relied on a prospectively maintained tertiary care database to identify patients who underwent either TP or TR prostate biopsy between 01/2014 and 12/2023. Of those, only patients with suspicious magnetic resonance imaging (MRI) PIRADS lesions (Likert-scale: 3,4,5) received MRI-targeted and systematic biopsies. Detection rates of csPCa (International Society of Urological Pathology [ISUP] ≥ 2) were compared between biopsy approach (TP vs. TR) according to index lesion. Subsequently, uni- and multivariable logistic regression models were applied to investigate the predictive status of the biopsy approach within each subcohort. RESULTS: Of 2063 patients, 1118 (54%) underwent combined MRI-guided and systematic prostate biopsy and were included in the final cohort. Of those, 127 (11%) and 991 (89%) underwent TP vs. TR. CsPCa rates, regardless of differences in patients' demographics and distribution of index PIRDAS lesions, did not differ statistically significantly and were 51 vs. 52%, respectively (p = 0.8). CsPCa detection rates for PIRDAS-3, PIRADS-4 and PIRADS-5 did not differ and were 24 vs. 23%, 48 vs. 51% and 72 vs. 76% for PIRADS-3, PIRADS-4 and PIRADS-5 subgroups for TP vs. TR, respectively (all p ≥ 0.9) Conclusions: The current results support the available data indicating that TP biopsy approach is comparable to transrectal biopsy approach regarding csPCa detection rates.

Initiative provides aid and education to Liberian nurses.

ABSTRACT: Recognizing the gaps in education and resources in other locations can shock nurses working in developed countries. This article discusses the origins of an international initiative born from one nurses' flight from upheaval.

Reviving a successful blunt chest wall injury protocol.

ABSTRACT: This article describes a quality improvement project that assessed nurses' knowledge and practices for patients admitted with a blunt chest wall injury and utilized interactive learning to revive the use of the protocol.

Alcohol use and binge drinking in baccalaureate nursing students: A descriptive study.

BACKGROUND: Current literature validates that drinking is a problem on many college and university campuses. While educators are aware that drinking negatively impacts learning, it is imperative that nursing educators understand why this behavior exists and recognize strategies and opportunities to mitigate drinking for students in the nursing major. PURPOSE: The purposes of this study were to understand the prevalence of and reasons for alcohol use and binge drinking in undergraduate baccalaureate nursing students in the United States and identify ways faculty may promote a healthy learning environment to decrease the incidence of alcohol use and binge drinking. METHOD: This descriptive study used a web-based survey methodology. The survey contained a demographic questionnaire, alcohol use survey, and open-ended questions to address reasons for drinking and stressors. The survey was randomly distributed to baccalaureate nursing programs throughout the United States. RESULTS: The final sample included 937 participants. Nursing students abuse alcohol for a variety of reasons including lack of understanding of binge drinking, peer pressure, dealing with mental health issues, and as a way to cope with multifaceted life stressors. Slightly over half (51%) of these participants reported drinking behavior that would be considered hazardous and 3% were in the alcohol dependent category on the alcohol use survey. CONCLUSION: These findings are consistent with social concerns about alcohol use. Nursing students yearned for help and support from faculty regarding how to handle stress and desired faculty to be role models. Faculty who form collaborative partnerships with students, foster healthy coping strategies which may promote academic success and more importantly favorable outcomes as future practicing nurses.

A little goes a long way: Strategies to support nursing staff amid COVID-19.

ABSTRACT: This article discusses the impact of staffing shortage on nurses' mental health, and outlines ways, including a successful rounder initiative, for nurse leaders and facilities to address nurses' stress and burnout.

Local anesthetic systemic toxicity: What nurses should know.

ABSTRACT: Local or regional anesthetics are becoming more common pain management options for patients, especially considering concerns regarding opioid use disorders. Though mostly safe, these interventions may carry serious risks such as local anesthetic systemic toxicity (LAST). This article discusses LAST and the importance of recognizing its signs and symptoms.

Assessing Postvoid Residual to Identify Risk for Urinary Complications Post Stroke.

BACKGROUND: After a stroke, urinary dysfunction and urinary tract infection are estimated to be approximately 20%. Increased postvoid residual (PVR) is a risk factor for urinary dysfunction and urinary tract infections. These complications can negatively impact recovery weeks after the initial hospitalization. Early identification of risks and patient education are important. PROJECT DESCRIPTION: This project was initiated for those patients admitted for a diagnosis of stroke on a 55-bed neuroscience unit in an acute care hospital. Patients were scanned after the initial void post stroke. Nurses followed a specific bladder scanning algorithm for subsequent scanning if the PVR volume was greater than 100 mL. RESULTS: Seventy-eight patients were scanned in the original phase of the project, and 41 (53%) had PVR volumes greater than 100 mL after the initial void/scan. Of those, 22 patients still had a volume of greater than 100 mL after the second void/scan, and 12 had PVR volumes greater than 100 mL after a third scan. IMPLICATIONS FOR PRACTICE: Patients admitted with stroke have demonstrated increased PVR volumes. Portable ultrasound bladder scanning is a safe, noninvasive method to measure residual urinary volumes. The use of a bladder scanning algorithm encourages nurses' autonomy in assessing and identifying patients at a higher risk for urinary complications. CONCLUSION: Identifying the risk for urinary complications post stroke can lead to early interventions that can improve recovery. This also allows for specific patient education related to preventative measures to reduce risk of urinary complications. The use of a specific bladder scanning protocol is recommended as standard practice for all patients admitted with stroke.

[Peritoneal dialysis†: what the general practitioner should know about peritoneal dialysis]. / Dialyse péritonéale†: ce que doit savoir le médecin généraliste.

Peritoneal dialysis (PD) has often been considered as a renal replacement method that is not feasible for the elderly population. Numerous recent studies have shown that this method is in fact very well, if not better tolerated by elderly patients. In Switzerland and abroad, its economic advantages have also been underlined during the past ten years. As a consequence, the use of PD is increasing, and primary care physicians are more often confronted to PD patients. Therefore, they have to be aware of some basic treatment principles, which are reviewed in this article.

La dialyse péritonéale (DP) a souvent été considérée à tort comme inadaptée à la population âgée, qui représente la majorité des patients en insuffisance rénale terminale. De nombreuses études ont montré que cette méthode est très bien, voire mieux tolérée que l'hémodialyse par les personnes âgées. Son aspect économique est de plus en plus mis en avant en Suisse et à l'étranger. Alors que la DP représentait longtemps < 10 % de la population dialysée, nous observons ces dernières années une hausse de patients traités par cette méthode. Par conséquent, le médecin traitant et l'interniste hospitalier seront plus fréquemment confrontés à ces patients. Ceci nécessite des bonnes notions de base de cette modalité comme discuté dans cet article.

Lithium-Induced Neurotoxicity: A Case Study.

BACKGROUND: In patients presenting with neurological deficits, identifying the cause can be challenging. METHODS: This case study discusses a condition that is not commonly seen. DISCUSSION: Although lithium toxicity syndrome is not as familiar as other causes of neurological issues, this should be considered for any patient who presents with unexplained neurological deficits and a history of taking this medication. CONCLUSION: If toxicity is not recognized early, the patient can be left with irreversible neurological symptoms, also known as syndrome of irreversible lithium-effectuated neurotoxicity, which impacts quality of life or can even cause death.

Cerebral Amyloid Angiopathy: A Different Kind of Stroke.

When a patient presents with stroke-type symptoms, the correct diagnosis is imperative to determine appropriate treatment. Cerebral amyloid angiopathy (CAA), a buildup of amyloid proteins on the brain artery walls, is a cause of intracerebral hemorrhage. Improved diagnostic criteria and enhanced neuroimaging have resulted in earlier detection of CAA, which will hopefully lead to better outcomes for these patients. More research is being conducted, and neuroscience nurses need to stay informed about this condition to be able to appropriately care for and educate their patients who are diagnosed with CAA.

The Effect of Listening to Music on Postoperative Pain in Adult Orthopedic Patients.

PURPOSE: Pain is a common occurrence after orthopedic surgery. Patients need additional resources to manage their pain. The purpose of this study was to determine if listening to music has a positive effect on pain scores and satisfaction in the postoperative adult orthopedic patient. There are limited studies demonstrating statistically significant decreases in postoperative pain in this group. A secondary purpose was to expose nurses on a standard medical-surgical unit to an intervention, supported by the holistic nursing model that they could use in their care. DESIGN AND METHOD: This study was a descriptive, comparative, quasi-experimental design. Patients listened to prerecorded music on individual CD players and recorded pre-post pain scores with the intervention. A satisfactory survey was completed at discharge. FINDINGS: Results demonstrated a statistically significant reduction in patients' pain scores after listening to music. Length of listening time had no effect. Patients expressed overall satisfaction, and 100% of participants would recommend this intervention to others. CONCLUSIONS: Listening to music is beneficial as an adjunct to pain medication and contributes to increased patient satisfaction. It is hoped that the information gained from this study will lead to an enhancement in the standard of care for postoperative patients.

The Importance of Educating Patients With Stroke About Vitamin D.

There is a growing body of evidence linking vitamin D to more than only bone health. Researchers are discovering connections between low vitamin D levels and increased stroke risk, higher mortality, and poorer outcomes after stroke. Nurses need to be aware of ongoing research regarding vitamin D and include information about this important vitamin with patient education, especially for older patients admitted with stroke symptoms or risks.

[Acute kidney injury in 2017 - Management in a secondary care hospital: an example of interdisciplinary collaboration]. / Insuffisance rénale aiguë en 2017 - Prise en charge dans un hôpital non universitaire : un exemple de collaboration interprofessionnelle.

Acute kidney injury (AKI) is frequent and can lead to serious complications. It is classified according to the degree of renal function impairment and classically divided into three categories: pre-renal, intrinsic and post-renal. Identification of risk factors and wise use of additional tests are crucial to the diagnosis, as there are numerous causes of AKI. Identification and specific treatment of the underlying mechanism are essential, all while protecting the kidney. Resorting to a nephrologist is systematic when there are red flags. Follow-up after resolution of AKI is important as the risk of developing a chronic kidney disease is increased.

L'insuffisance rénale aiguë (IRA) est un problème fréquemment rencontré dans la pratique clinique et grevé de complications potentiellement graves. Elle est classée selon l'importance de la diminution de la fonction rénale et divisée en trois catégories : fonctionnelle, parenchymateuse et obstructive. Une attention particulière doit être prêtée au diagnostic en identifiant les facteurs de risque et en utilisant judicieusement les examens complémentaires, tant les étiologies de l'IRA sont nombreuses. Le traitement spécifique de la cause sous-jacente est essentiel tout en limitant les agressions sur le rein. Le recours au néphrologue est systématique en présence de facteurs de gravité. Le suivi après résolution de l'IRA est important, la probabilité de survenue d'une insuffisance rénale chronique(IRC) étant augmentée.

Using Technology to Enhance Discharge Teaching and Improve Coping for Patients After Stroke.

BACKGROUND: A diagnosis of stroke is a life-changing event. Effective discharge teaching after a stroke is crucial for recovery, but the overload of information can be overwhelming for patients and caregivers. PURPOSE: The purpose of this study was to examine differences in discharge readiness and postdischarge coping in patients admitted for stroke after the use of individualized postdischarge information/education provided via a technology package (including patient online portal access, e-mail/secure messaging) compared with current standard discharge teaching methods (verbal/written instructions). METHODS: This study used a descriptive comparative design to evaluate the difference between the nonintervention group A and the intervention group B. Patients in group B received additional discharge information via secured e-mail messaging at postdischarge days 2, 6, and 10. Two validated tools, Readiness for Hospital Discharge Form and Post-Discharge Coping Difficulty Scale, were used. RESULTS: One hundred patients were recruited for the study, but the final number of complete data sets collected was 86-42 in group A and 44 in group B. There was no statistically significant difference between the groups in discharge readiness. There was a significant difference in coping scores between the 2 groups, with the technology group exhibiting higher coping. CONCLUSIONS: New technology affords new options to improve discharge readiness and contribute to positive patient coping after stroke. The researchers hope that this study will contribute to the growing body of evidence showing success using aspects of technology to enhance discharge teaching and follow-up after discharge.

Pseudobulbar Affect: What Nurses, Stroke Survivors, and Caregivers Need to Know.

Pseudobulbar affect (PBA) is a neurologic condition that can happen after a patient has had some kind of neurological insult. In this syndrome, involuntary, uncontrollable, and inappropriate emotional outbursts unrelated or out of proportion to the situation are common symptoms. This can be very frustrating and scary. Because stroke survivors and their caregivers are overloaded with information during the transition from hospital to home, information about PBA is not usually discussed. In a survey by the National Stroke Association, 53% of stroke survivors reported that they had some of the symptoms of this disorder. Even if they discussed these symptoms with their health care providers, less than half were given a diagnosis, and less than a quarter received any kind of treatment. The purpose of this article is to give nurses more information about PBA so they can share this with patients and families/significant others and encourage them to seek help if they experience these symptoms once discharged. It is hoped that increased knowledge about this condition will lead to better diagnosis and treatment and increased quality of life for stroke survivors.

Cerebral Mycotic Aneurysm and Infective Endocarditis: A Case Study.

Neurologic complications occur in 20%-40% of patients with infective endocarditis. Mycotic aneurysms are one example of these complications, and although rare, they can confound a patient's recovery and increase morbidity and mortality. This article will examine one patient's experience and the devastating effects that this complication had on his life. The information in this article will help to support neurological nurses in refining care and facilitating the best possible recovery for patients who develop this condition.