ObjectivesTo determine if portable video media (PVM) improves patient's knowledge and satisfaction acquired during the consent process for cystoscopy and insertion of a ureteric stent compared to standard verbal communication (SVC), as informed consent is a crucial component of patient care and PVM is an emerging technology that may help improve the consent process.
Patients and MethodsIn this multi-centre randomised controlled crossover trial, patients requiring cystoscopy and stent insertion were recruited from two major teaching hospitals in Australia over a 15-month period (July 2014-December 2015. Patient information delivery was via PVM and SVC. The PVM consisted of an audio-visual presentation with cartoon animation presented on an iPad. Patient satisfaction was assessed using the validated Client Satisfaction Questionnaire 8 (CSQ-8; maximum score 32) and knowledge was tested using a true/false questionnaire (maximum score 28). Questionnaires were completed after first intervention and after crossover. Scores were analysed using the independent samples t-test and Wilcoxon signed-rank test for the crossover analysis.
ResultsIn all, 88 patients were recruited. A significant 3.1 point (15.5%) increase in understanding was demonstrable favouring the use of PVM (P < 0.001). There was no difference in patient satisfaction between the groups as judged by the CSQ-8. A significant 3.6 point (17.8%) increase in knowledge score was seen when the SVC group were crossed over to the PVM arm. A total of 80.7% of patients preferred PVM and 19.3% preferred SVC. Limitations include the lack of a validated questionnaire to test knowledge acquired from the interventions.
ConclusionsThis study demonstrates patients' preference towards PVM in the urological consent process of cystoscopy and ureteric stent insertion. PVM improves patient's understanding compared with SVC and is a more effective means of content delivery to patients in terms of overall preference and knowledge gained during the consent process.
The Australian experience of Fellowship trained surgeons performing LRP demonstrates favourable peri-operative, oncological and functional outcomes in comparison to published data for open, laparoscopic and robotic assisted radical prostatectomy. In our Australian centres, LRP remains an acceptable minimally invasive surgical treatment for prostate cancer despite the increasing use of robotic assisted surgery.
A 72-year-old-female was referred to our urology clinic with a 3-month history of dysuria, intermittent right flank pain, measured fevers and the computerized tomography finding of a dilated right renal collecting system with abnormal wall thickening (Fig. 1). Prior to her referral, she had undergone an outpatient gastroscopy and colonoscopy to investigate these symptoms, which found no abnormality and she had completed a course of trimethoprim prescribed by a primary care physician. Her medical history included osteoarthritis and hypertension and her physical examination was unremarkable. She was prescribed an appropriate antibiotic for a resistant Enterococcus isolated from a recent urine culture and was booked for cystoscopy, retrograde pyelography and flexible pyeloscopy.A cystoscopy was performed 3 weeks after clinic review and demonstrated several small erythematous patches on the bladder wall. Retrograde pyelography revealed multiple filling defects in the right renal collecting system from the mid-ureter to the renal pelvis ( Fig. 2) with no abnormalities on the left. Ureteroscopy of the right ureter was grossly abnormal, with cream-colored pseudomembranous change from the mid-ureter to the renal pelvis and areas of near total occlusion. Multiple biopsies of the abnormal ureteric material and erythematous bladder patches were collected, and a 4.8F multi-length ureteric stent was placed.A high fever (39.8°C) was recorded late on post-operative day 1. Cultures were performed, a chest radiograph was unremarkable and a full blood count revealed neutropenia (0.8 × 10 9 /L, reference range 2-7.5 × 10 9 /L). Further history revealed that she had experienced drenching night sweats and fevers periodically for several months, and had a complicated recent travel history including Morocco, China, Cambodia, Thailand, Laos, Chile and Mexico. She had migrated to Australia 50 years previously from a rural area in Chile.
Physical activity improves mental health. Building on previous work promoting cycling in the general community, we trialled an innovative cycling program for mental health service consumers in the former Sydney South West Area Health Service.
The poor physical health of people with a mental illness is well documented. Increasing consumer's physical health is difficult and the literature surrounding the issue is limited. One study found that outside activity significantly improves self esteem and mood.
Background
International estimates of the laparoscopic radical prostatectomy (LRP) learning curve extend to as many as 1000 cases, but is unknown for Fellowship‐trained Australian surgeons.
Methods
Prospectively collected data from nine Australian surgeons who performed 2943 consecutive LRP cases was retrospectively reviewed. Their combined initial 100 cases (F100, n = 900) were compared to their second 100 cases (S100, n = 782) with two of nine surgeons completing fewer than 200 cases.
Results
The mean age (61.1 versus 61.1 years) and prostate specific antigen (7.4 versus 7.8 ng/mL) were similar between F100 and S100. D'Amico's high‐, intermediate‐ and low‐risk cases were 15, 59 and 26% for the F100 versus 20, 59 and 21% for the S100, respectively. Blood transfusions (2.4 versus 0.8%), mean blood loss (413 versus 378 mL), mean operating time (193 versus 163 min) and length of stay (2.7 versus 2.4 days) were all lower in the S100. Histopathology was organ confined (pT2) in 76% of F100 and 71% of S100. Positive surgical margin (PSM) rate was 18.4% in F100 versus 17.5% in the S100 (P = 0.62). F100 and S100 PSM rates by pathological stage were similar with pT2 PSM 12.2 versus 9.5% (P = 0.13), pT3a PSM 34.8 versus 40.5% (P = 0.29) and pT3b PSM 52.9 versus 36.4% (P = 0.14).
Conclusion
There was no significant improvement in PSM rate between F100 and S100 cases. Perioperative outcomes were acceptable in F100 and further improved with experience in S100. Mentoring can minimize the LRP learning curve, and it remains a valid minimally invasive surgical treatment for prostate cancer in Australia even in early practice.
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