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Patel R, Desai C, Acharya R, Raveshia D, Shah S, Panesar H, Patel N, Singh R. Five historical innovations that have shaped modern urological surgery. J Perioper Pract 2024; 34:154-163. [PMID: 38149615 DOI: 10.1177/17504589231214388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
Throughout history, many innovations have contributed to the development of modern urological surgery, improving patient outcomes and expanding the range of treatment options available to patients. This article explores five key historical innovations that have shaped modern urological surgery: External shockwave lithotripsy, transurethral resection of prostate, cystoscope, perioperative prostate-specific antigen and robotic surgery. The selection of innovations for inclusion in this article was meticulously determined through expert consensus and an extensive literature review. We will review the development, impact and significance of each innovation, highlighting their contributions to the field of urological surgery and their ongoing relevance in contemporary and perioperative practice.
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Affiliation(s)
- Ravi Patel
- Department of Trauma and Orthopaedics, Shrewsbury and Telford Trust, The Princess Royal Hospital, Apley Castle, Telford, UK
- Department of Trauma and Orthopaedics, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK
| | - Chaitya Desai
- Department of Urology, Walsall Manor Hospital, Walsall Healthcare NHS Trust, Walsall, UK
| | - Radhika Acharya
- Department of Intensive Care, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Dimit Raveshia
- Department of General Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Saumil Shah
- Department of Otolaryngology, The Princess Royal Hospital, Apley Castle, Telford, UK
| | - Harrypal Panesar
- Department of Otolaryngology, The Princess Royal Hospital, Apley Castle, Telford, UK
| | | | - Rohit Singh
- Department of Trauma and Orthopaedics, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK
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Gandhi DA, Colón-Sanchez K, Ellsworth P. Correlation between surgical booking by a PA and surgical procedure performed. JAAPA 2024; 37:37-41. [PMID: 38349074 DOI: 10.1097/01.jaa.0000997704.21391.cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
OBJECTIVE This study evaluated the concordance between clinical evaluation and diagnosis by a physician associate/assistant (PA) and the preoperative and intraoperative evaluations by a pediatric urologic surgeon. METHODS A retrospective chart review was performed for patients independently evaluated and scheduled for surgery by a single PA between 2017 and 2020. Concordance was measured by comparing the PA's office note with the surgeon's preoperative note and operative report. RESULTS Of the 242 patients scheduled for surgery, 11 underwent an operative report procedure change and 11 others underwent a preoperative note procedure change. Concordance increased from 89.09% in 2017 to 92.31% in 2020; this was not statistically significant ( P = .230). Urologic conditions evaluated demonstrated an increase in the variety and complexity of conditions. CONCLUSIONS A supervisory/collaborative model involving a well-trained PA yields excellent outcomes in terms of concordance with surgical scheduling and procedure performed.
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Affiliation(s)
- Deep A Gandhi
- Deep A. Gandhi is a student in the University of Central Florida's College of Medicine in Orlando, Fla. At Nemours Children's Hospital, Florida in Orlando, Kaity Colón-Sanchez practices in urology and Pamela Ellsworth is chief of the Division of Pediatric Urology. The authors have disclosed no potential conflicts of interest, financial or otherwise
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3
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Grota T, Betihavas V, Burston A, Jacob E. Impact of nurse-surgeons on patient-centred outcomes: A systematic review. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2022; 4:100086. [PMID: 38745634 PMCID: PMC11080547 DOI: 10.1016/j.ijnsa.2022.100086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 06/17/2022] [Accepted: 06/29/2022] [Indexed: 11/21/2022] Open
Abstract
Background Nurse-surgeons have been performing surgeries for decades. Yet, their impact on perioperative clinical outcomes has not been explored in detail. Objective To investigate the impact of nurse-surgeons on patient-centred outcomes. Design Systematic review. Method The Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram and checklist for systematic reviews were used as the screening and reporting guideline. CINAHL, Cochrane Library, MEDLINE, and PubMed databases were searched for articles that fit the review's eligibility criteria. A combination of Medical Subject Headings, keywords and filters for each database were used. Following screening and full text review, the Mixed Methods Appraisal Tool was used for quality assessment and the Grading of Recommendations, Assessment, Development and Evaluations framework for certainty and confidence assessment. Narrative synthesis was used to report the findings due to the design heterogeneity of the included studies. Results Forty-eight (n = 48) patient-centred outcomes were identified from 25 included studies. These outcomes were grouped into four categories: patient satisfaction and experience; waiting list; perioperative complications; and quality of surgical care. Patient satisfaction and experience was rated high to very high in 16 studies; none reported patient dissatisfaction. Waiting lists improved in eight studies. Perioperative complications were none to very low in nine studies. Mortality rates in the nurse-surgeon group were better than the physician group in three studies. The quality of care in the performance of surgeries by nurse-surgeons was either similar or better than physicians in ten studies. Conclusions Nurse-surgeons performed safe, satisfactory, and high-quality surgeries with minimal perioperative complications similar to physicians. The use of nurse-surgeons has significantly reduced waiting lists regardless of surgical speciality. Policies around nurse-surgeon practice needs to be developed at national and international levels to streamline the delivery of much needed surgical services amidst the coronavirus pandemic in the areas of cancer diagnostic surgeries, emergency surgeries, minor surgeries, and remote and rural health.
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Affiliation(s)
- Tenber Grota
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, NSW 2060, Australia
| | - Vasiliki Betihavas
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, NSW 2060, Australia
| | - Adam Burston
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, QLD 4032, Australia
| | - Elisabeth Jacob
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, NSW 2060, Australia
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Georgiades F, Silva ANS, Purohit K, King S, Torpey N, Saeb-Parsy K, Pettigrew GJ, Rouhani FJ. Outpatient ureteric stent removal following kidney transplantation. Br J Surg 2021; 109:152-154. [PMID: 34435203 PMCID: PMC10364773 DOI: 10.1093/bjs/znab223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 05/18/2021] [Indexed: 11/13/2022]
Abstract
Lay Summary
During a kidney transplant, a plastic tube (stent) is placed in the ureter, connecting the new kidney to the bladder, in order to keep the new join open during the initial phase of transplantation. The stent is then removed after a few weeks via a camera procedure (cystoscopy), as it is no longer needed. The present study compared performing this in the operating theatre or in clinic for transplanted patients using a new single-use type of camera with an integrated grasper system. The results have shown that it is safe and cost-effective to do this in clinic, despite patients being susceptible to infection after transplantation.
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Affiliation(s)
- F Georgiades
- Department of Surgery, University of Cambridge, and Cambridge National Institute for Health Research Biomedical Research Centre, Cambridge, UK
| | - A N S Silva
- Department of Surgery, University of Cambridge, and Cambridge National Institute for Health Research Biomedical Research Centre, Cambridge, UK
| | - K Purohit
- Department of Surgery, University of Cambridge, and Cambridge National Institute for Health Research Biomedical Research Centre, Cambridge, UK
| | - S King
- Transplant Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - N Torpey
- Transplant Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - K Saeb-Parsy
- Department of Surgery, University of Cambridge, and Cambridge National Institute for Health Research Biomedical Research Centre, Cambridge, UK
| | - G J Pettigrew
- Department of Surgery, University of Cambridge, and Cambridge National Institute for Health Research Biomedical Research Centre, Cambridge, UK
| | - F J Rouhani
- Department of Surgery, University of Cambridge, and Cambridge National Institute for Health Research Biomedical Research Centre, Cambridge, UK
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Supportive Care Needs of Patients on Surveillance and Treatment for Non-Muscle-Invasive Bladder Cancer. Semin Oncol Nurs 2021; 37:151105. [PMID: 33431233 DOI: 10.1016/j.soncn.2020.151105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE This literature review provides an overview of non-muscle-invasive bladder cancer diagnosis (NMIBC), treatment, and surveillance. Existing evidence is reviewed to identify the NMIBC patient pathway, highlight its effect on quality of life, and identify supportive care needs of this patient group. A framework to guide nurses in the care of this underserved population is proposed. DATA SOURCES Electronic databases including CINAHL, Medline, PsychInfo, Cochrane, and Google Scholar were searched. CONCLUSION NMIBC is a chronic disease with high recurrence and progression rates with most patients requiring invasive treatment and burdensome surveillance schedules with frequent hospital visits. Treatment-related side effects may interrupt therapy and possibly result in its discontinuation. Patients' quality of life can be negatively affected at various stages of the cancer trajectory. Specialist nurses provide holistic care throughout all stages of the patient journey to optimize supportive care, information provision, and delivery of appropriate treatment and surveillance protocols. NMIBC research is historically underfunded with a paucity of evidence identifying the supportive care needs of this population. Further research is urgently required to fill the gaps identified. IMPLICATIONS FOR NURSING PRACTICE This timely paper raises the profile of unmet supportive care needs in an underserved research cancer population. Suggestions are proposed to improve the quality of nursing care through standardized practices and the development and integration of patient pathways. Evidence of the effect of NMIBC on family members or carers is absent from the literature. Future research implications and directions are proposed.
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Raman V, Triggol A, Cudrnak T, Konstantinos P. Safety of nurse-led intravitreal injection of dexamethasone (Ozurdex) implant service. Audit of first 1000 cases. Eye (Lond) 2020; 35:388-392. [PMID: 32728227 DOI: 10.1038/s41433-020-1114-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/07/2020] [Accepted: 07/16/2020] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To assess the safety of nurse-led services of intravitreal injection of dexamethasone implant. METHODS An audit of intravitreal injection of dexamethasone implant service in our unit revealed a significant delay in the delivery of injection from the time a clinical decision was made. The limiting factors were an inadequate number of injectors and limited capacity. The constraint in capacity was addressed by moving the service from the theatre to the cleanroom in the outpatients setting. Two senior nurse practitioners in the existing pool of injectors, experienced in intravitreal anti-VEGF injection, were trained to deliver the intravitreal dexamethasone implant service. A safety audit was carried out after they had completed 1000 cases. RESULTS The nurse practitioners administered 1006 injections from February 2017 to October 2019. There was no case of endophthalmitis (0%) or other visually significant complications like retinal detachment, vitreous haemorrhage, hypotony or iatrogenic cataract. One patient had incomplete scleral penetration of the implant, but this resolved without any sequelae. The waiting time to inject the implant nearly halved from 29.5 to 15 days in the nurse-led service. A patient satisfaction survey was overwhelmingly positive, with the majority advocating for the continuation of the nurse-led service. CONCLUSION The current cohort of experienced nurses providing anti-VEGF injections can be trained under supervision to inject the intravitreal dexamethasone implant (Ozurdex). This is safe, additionally effective in streamlining the service and reducing the waiting time for delivery of the steroid implant.
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Affiliation(s)
- Vasant Raman
- Royal Eye Infirmary, University hospitals of Plymouth NHS Trust, Derriford, Plymouth, PL6 8DH, UK.
| | - Alison Triggol
- Royal Eye Infirmary, University hospitals of Plymouth NHS Trust, Derriford, Plymouth, PL6 8DH, UK
| | - Tomas Cudrnak
- Royal Eye Infirmary, University hospitals of Plymouth NHS Trust, Derriford, Plymouth, PL6 8DH, UK
| | - Papadedes Konstantinos
- Royal Eye Infirmary, University hospitals of Plymouth NHS Trust, Derriford, Plymouth, PL6 8DH, UK
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Drudge-Coates L, Khati V, Ballesteros R, Martyn-Hemphill C, Brown C, Green J, Challacombe B, Muir G. A nurse practitioner model for the assessment of suspected prostate cancer referrals is safe, cost and time efficient. Ecancermedicalscience 2019; 13:994. [PMID: 32010218 PMCID: PMC6974368 DOI: 10.3332/ecancer.2019.994] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Indexed: 12/21/2022] Open
Abstract
Purpose To evaluate the outcomes from a Urology Nurse Practitioner (UNP)-led service for the initial assessment and diagnostic decision making and for suspected prostate cancer referrals. Methods Using a modified Delphi analysis approach, a panel of Urological Prostate Cancer specialists were asked to review the UNP management plans of a convenience sample of 60 randomly selected patient cases – between June 2012 and June 2015. The panel was required to establish consensus or identify divergence of clinical practice, based on five key statements. In addition, cost analysis, waiting time and patient satisfaction evaluation were made regarding the nurse-led service. Results In 87% (52/60 cases), consensus was reached by the panel that the UNP management plan was entirely appropriate and in only two cases was there discordance, where the panel felt that the management plan by the UNP was inappropriate with errors potentially and significantly affecting the patient. Over the 3 years, a modest cost saving of £11,500.38 was realised, which due to increased referrals has now realised in 1 year (2017/18) a saving of £11,335.50. Compared to the previous physician-led service, waiting times for patient appointment fell by 52% over the 3-year period; 57/63 (90%) patients reported being satisfied with seeing a UNP instead of a doctor for their first appointment; 60/63 (95%) reported that, following the initial hospital visit with the UNP, they had a clear understanding of what the next steps were in their assessment. Overall, 54/63 (86%) were ‘very satisfied’ with the UNP-led service. Conclusion Our study demonstrates that a UNP approach to the assessment and management of suspected prostate cancer referrals provides an effective approach to care in an ever-demanding healthcare arena. Through a supported training programme, urology nurses can deliver a high standard of service.
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Affiliation(s)
| | - Vitra Khati
- Department of Urology, King's College Hospital NHS Foundation Trust, SE5 9RS London, UK
| | - Randolph Ballesteros
- Department of Urology, King's College Hospital NHS Foundation Trust, SE5 9RS London, UK
| | | | - Christian Brown
- Department of Urology, King's College Hospital NHS Foundation Trust, SE5 9RS London, UK
| | - James Green
- Department of Urology, Barts Health NHS Trust, London EC1A 7BE, UK
| | - Ben Challacombe
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London SE1 9RT, UK
| | - Gordon Muir
- Department of Urology, King's College Hospital NHS Foundation Trust, SE5 9RS London, UK
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Beller H, Lobo JM, Horton BJ, Sims T, Corey T, Tyson T, Schenkman NS, Krupski TL, Jones RA. Adapting nurse-led cystoscopy experience to the United States: Tele-cystoscopy a possible compromise? INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2019. [DOI: 10.1111/ijun.12197] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Haerin Beller
- Department of Urology; University of Virginia Healthcare System; Charlottesville Virginia
| | - Jennifer M. Lobo
- Public Health Sciences; University of Virginia Healthcare System; Charlottesville Virginia
| | - Bethany J. Horton
- Public Health Sciences; University of Virginia Healthcare System; Charlottesville Virginia
| | - Terran Sims
- Department of Urology; University of Virginia Healthcare System; Charlottesville Virginia
| | - Thomas Corey
- Center for Telehealth; University of Virginia; Charlottesville Virginia
| | | | - Noah S. Schenkman
- Department of Urology; University of Virginia Healthcare System; Charlottesville Virginia
| | - Tracey L. Krupski
- Department of Urology; University of Virginia Healthcare System; Charlottesville Virginia
| | - Randy A. Jones
- School of Nursing; University of Virginia; Charlottesville Virginia
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Quallich S, Frey A, Østergren PB, Madsen SS. An innovative nurse‐led cystoscopy clinic in Denmark. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2019. [DOI: 10.1111/ijun.12181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Susanne Quallich
- Department of Urology, Michigan MedicineUniversity of Michigan, 3875 Taubman Center Ann Arbor Michigan
| | - Anders Frey
- The Department of UrologyThe University Hospital of Southwestern Denmark Esbjerg Denmark
| | | | - Søren Sorensen Madsen
- The Department of UrologyThe University Hospital of Southwestern Denmark Esbjerg Denmark
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Mc Conkey RW, Hahessy S. Developing the advanced nursing practice role in non-muscle invasive bladder cancer surveillance in Ireland. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2018. [DOI: 10.1111/ijun.12168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Robert W. Mc Conkey
- Advanced Nurse Practitioner candidate in Urology; Galway University Hospital; Galway Ireland
| | - Sinead Hahessy
- School of Nursing and Midwifery; National University of Ireland; Galway
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Langston JP, Orcutt VL, Smith AB, Schultz H, Hornberger B, Deal AB, Doran TJ, McKibben MJ, Kirby EW, Nielsen ME, Gonzalez CM, Pruthi RS. Advanced Practice Providers in U.S. Urology: A National Survey of Demographics and Clinical Roles. UROLOGY PRACTICE 2017; 4:418-424. [PMID: 37592684 DOI: 10.1016/j.urpr.2016.09.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Projections suggest a significant shortage of urologists coupled with an increasing burden of urological disease due to an aging population. To meet this need, urologists have increasingly partnered with advanced practice providers. However, to this point the advanced practice provider workforce has not been comprehensively evaluated. Understanding the impact of advanced practice providers on the urology workforce is essential to maximize collaborative care as we strive for value and quality in evolving delivery models. METHODS A 29-item, web based survey was administered to advanced practice providers identified by the AUA (American Urological Association), UAPA (Urological Association of Physician Assistants) and SUNA (Society of Urologic Nurses and Associates), querying many aspects of their practice. RESULTS A total of 296 advanced practice providers completed the survey. Advanced practice nurses comprised 62% of respondents while physician assistants comprised the remaining 38%. More than two-thirds of the respondents were female and median age was 46 years. Only 6% reported having participated in formal postgraduate urological training. Advanced practice providers were evenly divided between institutional and private practice settings, and overwhelmingly in urban or suburban environments. The majority of advanced practice providers practice in the ambulatory setting (74%) and characterize their practice as general urology (72%). Overall 81% reported performing procedures independently, with 63% performing some procedures considered to be of moderate or high complexity. CONCLUSIONS Advanced practice providers are active in the provision of urological care in many roles, including complex procedures. Given future workforce needs, advanced practice providers will likely assume additional responsibilities. As roles shift we must ensure we have the necessary educational and training opportunities to equip this vital part of our workforce.
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Affiliation(s)
- Joshua P Langston
- Department of Urology, Eastern Virginia Medical School, and Urology of Virginia PLLC, Norfolk, Virginia
| | - Venetia L Orcutt
- Department of Physician Assistant Studies, School of Health Professions, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Angela B Smith
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Heather Schultz
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Brad Hornberger
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Allison B Deal
- Lineberger Comprehensive Cancer Center, Cancer Outcomes Research Group, Biostatistics and Clinical Data Management, Chapel Hill, North Carolina
| | - Todd J Doran
- Department of Family and Preventive Medicine, Physician Associate Program, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - Maxim J McKibben
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - E Will Kirby
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Matthew E Nielsen
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Chris M Gonzalez
- Department of Urology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Raj S Pruthi
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Langston JP, Duszak R, Orcutt VL, Schultz H, Hornberger B, Jenkins LC, Hemingway J, Hughes DR, Pruthi RS, Nielsen ME. The Expanding Role of Advanced Practice Providers in Urologic Procedural Care. Urology 2017; 106:70-75. [DOI: 10.1016/j.urology.2017.03.047] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 03/09/2017] [Accepted: 03/18/2017] [Indexed: 01/13/2023]
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Shields M. Nurse Practitioner Cystoscopy: A Review of the Literature and Implications for Practice. J Dr Nurs Pract 2016; 9:45-50. [PMID: 32751002 DOI: 10.1891/2380-9418.9.1.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Bladder cancer is one of the most common and most expensive malignancies worldwide, requiring periodic cystoscopy in most cases. Access to urologists within the United States is impaired by decreasing number of physicians in this specialty. Nurse-led cystoscopy services have been established in the United Kingdom and Australia and found to provide equivalent services while improving patient satisfaction and access to care. Nurse practitioner cystoscopy should be evaluated as a potential method to improve patient access to specialized urologic care in the United States. This article will review the literature on nurse practitioner cystoscopy and the legal and ethical implications of this practice.
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Sapre N, Hayes E, Bugeja P, Corcoran NM, Costello AJ, Anderson PD. Streamlining the assessment of haematuria: 3-year outcomes of a dedicated haematuria clinic. ANZ J Surg 2014; 85:334-8. [PMID: 24989960 DOI: 10.1111/ans.12742] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Urgent assessment of haematuria is critical to exclude malignancy. The objective of this study is to report the outcomes of the first 3 years of a dedicated haematuria clinic at the Royal Melbourne Hospital, a Victorian tertiary hospital. METHODS All patients assessed in the haematuria clinic from April 2010 to April 2013 were included in the analysis. Outcomes were recorded prospectively and analysed retrospectively. RESULTS A total of 643 patients were seen in the haematuria clinic with non-visible (170, 26%) and visible haematuria (463, 72%) during this time period, all within 28 days of referral being triaged. Sixty-five (10%) patients were diagnosed with urothelial carcinoma, 63 with lower tract disease and two with upper tract urothelial carcinoma and another five (1%) patients with other tumours. Thirty out of 63 (48%) of the bladder urothelial carcinomas were invasive or high-grade. Two hundred and sixty-seven (42%) patients were discharged from the clinic after a single point of contact. One hundred and fifty-three (24%) patients were referred for further definitive management of suspected pathology. Two hundred and twenty-three (34%) patients were referred to outpatients clinic for further investigations. Urothelial carcinoma was diagnosed more often in males, older patients and patients with visible haematuria. CONCLUSION The Royal Melbourne Hospital haematuria clinic has served as an effective tool for rapid, streamlined assessment of patients presenting with haematuria. Follow-up of investigations by nurses and moving towards a 'one-stop' approach are helping to further decrease the number of patients requiring a second clinic visit.
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Affiliation(s)
- Nikhil Sapre
- Department of Urology, Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Surgery, The University of Melbourne, Parkville, Victoria, Australia
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