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Willder S, Kelsey E, O'Connor E, Grills R. Expanding urological services into regional Australia and reducing interhospital transfers: how the nurse practitioner can help. ANZ J Surg 2024. [PMID: 38619216 DOI: 10.1111/ans.18993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 09/25/2023] [Accepted: 03/07/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND A visiting urology service has been in existence at Hamilton Base Hospital, Western Victoria, over the past 25 years, serving an unmet need. A Urology Nurse Practitioner (UNP) provides the care and management of urology patients working in close association with visiting urologists. We aim to assess the impact of the UNP's role in the delivery of regional urological care. METHODS A retrospective analysis of medical records identified all clinical interventions by the UNP between January 2016 and December 2019. Each encounter was graded according to a clinical severity scale from grade 1 to 5 and assessed for UNP management of patients and the prevention of interhospital transfers. RESULTS One hundred eighty-four patients with 654 individual assessments were identified for inclusion and classified according to the adapted clinical severity scale. Most interventions for category 3 and 4 patients related to major bleeding, catheter difficulties, and haemodynamic instability. A total of 19 patients whose urological issues would typically require interhospital transfer were able to be managed locally. CONCLUSIONS Transferring an acute patient from a regional to a tertiary hospital for specialist care is often necessary but not ideal for the patient and their family. The presence of a dedicated UNP in a regional centre is important for patient care and has an important role in preventing unnecessary transfers. This is a vital component of a visiting urological service to a rural community.
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Affiliation(s)
- S Willder
- Depatment of Surgery, Western District Health Service, Hamilton, Victoria, Australia
| | - E Kelsey
- Department of Urological Surgery, Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia
| | - E O'Connor
- Department of Urological Surgery, Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia
| | - R Grills
- Depatment of Surgery, Western District Health Service, Hamilton, Victoria, Australia
- Department of Urological Surgery, Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia
- Department of Surgery, School of Medicine, Deakin University, Geelong, Victoria, Australia
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Wynn J, Kelsey E, McLeod K. Treatment of the infected sacral nerve stimulator: A scoping review. Neurourol Urodyn 2024; 43:579-594. [PMID: 38318878 DOI: 10.1002/nau.25411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/13/2024] [Accepted: 01/24/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Sacral nerve stimulators (SNSs) are a widely accepted, efficacious surgical option to treat patients who have failed conservative management for overactive bladder, nonobstructive urinary retention, fecal incontinence, or pelvic pain. As with all implanted devices, there are associated risks for surgical site and implant infections. There are currently no clear published data or guidelines regarding treating such infections. AIMS We present a scoping review aiming to examine the existing literature on the treatment approaches of infected SNSs. METHODS A scoping review was conducted using Preferred Reporting Items for Systematic Review and Meta-Analysis. The search strategy focused on "sacral modulation," and "infection," and "explantation," and conservative management methods such as "antibiotics." A search was conducted on medical databases, and a grey literature search was performed. RESULTS Thirty articles were included for data extraction. Articles were published between 2006 and 2022. Outcomes were reported for 7446 patients. Two hundred and seventy-four infection events were reported, giving an overall 3.7% infection rate. Most infection events were treated with explantation, although there is some discussion on the role of conservative management using oral and intravenous antibiotics in the literature. Articles also discussed considerations for future reimplantation after explantation of SNS. CONCLUSIONS There are currently no treatment protocols in the literature to help guide whether a patient is suited to conservative or surgical management. There is future scope for developing treatment algorithms to guide clinicians for optimal treatment of infected sacral neuromodulation devices.
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Affiliation(s)
- Jessica Wynn
- Department of Urology, University Hospital Geelong, Barwon Health, Geelong, Australia
| | - Ellen Kelsey
- Department of Urology, University Hospital Geelong, Barwon Health, Geelong, Australia
| | - Kathryn McLeod
- Department of Urology, University Hospital Geelong, Barwon Health, Geelong, Australia
- Faculty of Health, Deakin University School of Medicine, Geelong, Australia
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Kelsey E, Wynn J, Holmes A, McLeod K. Anatomical location and number of injection sites of intravesical OnabotulinumtoxinA for females with refractory idiopathic overactive bladder: A scoping review. Neurourol Urodyn 2024; 43:553-564. [PMID: 38225733 DOI: 10.1002/nau.25392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/06/2023] [Accepted: 01/03/2024] [Indexed: 01/17/2024]
Abstract
AIMS The negative impact on quality of life and the economic-related burden to the patient and the health care system associated with idiopathic overactive bladder (iOAB) is well-documented. Intradetrusor OnabotulinumtoxinA (BTN/A) injections are a well-used treatment modality for the management of overactive detrusor refractory to medical management, with well-documented efficacy and safety profiles. There is currently no best practice guideline for the administration of BTN/A for this procedure and historically the trigone of the bladder has been excluded from the injection paradigm given the risk of vesicoureteral reflux (VUR). METHODS A scoping review methodology was employed to assess available literature to evaluate current techniques used. There is emerging literature that the inclusion of the trigone may increase the efficacy of the procedure, while maintaining a similar adverse effect profile. Similar results could also be obtained by decreasing the number of injection sites. A scoping review was completed with systematic methodology using the Preferred Systematic Reviews and Meta Analyses extension for Scoping Review checklist. The search strategy looked to evaluate BTN/A and number of injection sites and the inclusion of the trigone in female patients with iOAB. Studies with male or neurogenic bladder only were excluded. Mixed studies were included. A specialist research librarian was engaged, with supervision from a functional urologist using a combination of MeSH and natural language terms. Two investigators independently reviewed the titles and abstracts. RESULTS Twelve articles were included and were published between 2005 and 2021. There was no evidence of VUR in any of the results. All but one study reported similar if not improved efficacy of trigone-inclusion. Lower number of injection sites had similar efficacy profiles to higher numbers of intradetrusor injections. CONCLUSIONS Further high-quality randomized control trials of trigone inclusion and reduction of injection sites are required. It is hoped that with further exploration of intraoperative methods for BTN/A injections, the development of universally accepted guidelines may optimize management and experiences for patients with iOAB.
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Affiliation(s)
- Ellen Kelsey
- Department of Urological Surgery, Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia
| | - Jessica Wynn
- Department of Urological Surgery, Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia
| | - Angela Holmes
- Department of Urological Surgery, Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia
| | - Kathryn McLeod
- Department of Urological Surgery, Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia
- Department of Surgery, Deakin University, Geelong, Victoria, Australia
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Kelsey E, Holmes A, Tissot S, Campbell P, McLeod K. Management of recurrent localised bladder amyloid, has methotrexate helped? Urol Case Rep 2023; 51:102577. [PMID: 37811541 PMCID: PMC10551828 DOI: 10.1016/j.eucr.2023.102577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 09/26/2023] [Indexed: 10/10/2023] Open
Abstract
Background Amyloidosis of the bladder is a benign condition which can present with a multitude of symptoms including bladder mass, irritative voiding symptoms and haematuria. Case presentation We report on the investigation and management of a patient with recurrent localised amyloidosis of the bladder, which appears to have been managed fortuitously by concurrent methotrexate prescribed for another indication. Conclusion We provide further assessment and management with a focus on the possible benefit of methotrexate for management of localised bladder amyloidosis.
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Affiliation(s)
- E. Kelsey
- Department of Urology, University Hospital Geelong, Barwon Health, Australia
| | - A. Holmes
- Department of Urology, University Hospital Geelong, Barwon Health, Australia
| | - S. Tissot
- Department of Urology, University Hospital Geelong, Barwon Health, Australia
| | - P. Campbell
- Department of Haematology, University Hospital Geelong, Barwon Health, Australia
- Deakin University School of Medicine, Australia
| | - K. McLeod
- Department of Urology, University Hospital Geelong, Barwon Health, Australia
- Deakin University School of Medicine, Australia
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Holmes A, Kelsey E, Wombwell A, Molesworth C, McLeod K. Are we underestimating urinary retention following intravesical onabotulinumtoxinA in women with overactive bladder and a history of prior pelvic surgery? Neurourol Urodyn 2023; 42:106-112. [PMID: 36183370 PMCID: PMC10092604 DOI: 10.1002/nau.25054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 08/25/2022] [Accepted: 08/31/2022] [Indexed: 01/03/2023]
Abstract
AIMS This study's purpose is to review the rates of urinary retention requiring intermittent catheterization (IC) post intravesical OnabotulinumtoxinA (BTN/A) injection for idiopathic overactive bladder from a single practicing specialist urological surgeon. METHODS We performed a retrospective review of a single Australian urologist to identify the rate of intermittent catheterization in our clinical setting. Logistic regression was used to assess associations between requirement of IC and risk factors for urinary retention. RESULTS Ninety-four patients were included after inclusion and exclusion criteria were applied and the average age was 69.7 years (SD 17.2) and all participants were female. Thirty-six percent (n = 34) of patients required IC. Of patients requiring IC, 32% had a prior urethral sling, 35% had prior vaginal prolapse surgery, and 29% had a preoperative urinary tract infection (UTI). There was strong evidence of univariate associations between IC and prior sling (odds ratio [OR]: 5.26, 95% confidence interval [CI]: 1.64-16.55, p = 0.005), preoperative UTI (OR: 4.25, 95% CI: 1.31-13.08, p = 0.016) and prior vaginal prolapse surgery (OR: 4.91, 95% CI: 1.64-14.72, p = 0.005). Evidence that prior sling patients were more likely to require IC remained strong in a multivariable model (OR: 7.35, 95% CI: 1.59-34.11, p = 0.011). CONCLUSION Prior urethral sling surgery, prior vaginal prolapse surgery, and positive preoperative UTI, despite treatment, were found to be associated with a higher rate of initiation of intermittent catheterization. The rate of IC initiation of 36% was higher than reported in prior clinical trials.
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Affiliation(s)
- Angela Holmes
- Department of Urological Surgery, Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia
| | - Ellen Kelsey
- Department of Urological Surgery, Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia
| | - Amy Wombwell
- Department of Urological Surgery, Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia
| | | | - Kathryn McLeod
- Department of Urological Surgery, Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia.,Department of Surgery, School of Medicine, Deakin University, Geelong, Victoria, Australia
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Figueiroa S, Steffy M, Dourney A, Barber A, Delmerico P, Kelsey E, Park H, Taylor M, Wallace K. Sepsis, Malnutrition, and Hospital Readmission Risk. J Acad Nutr Diet 2021. [DOI: 10.1016/j.jand.2021.06.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Roberts-Gray C, Solomon T, Gottlieb N, Kelsey E. Heart Partners: a strategy for promoting effective diffusion of school health promotion programs. J Sch Health 1998; 68:106-110. [PMID: 9608451 DOI: 10.1111/j.1746-1561.1998.tb03493.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Heart Partners uses a straightforward, interpersonal approach to increase acceptance and use of innovations in school health promotion. In accord with the linkage model of innovation diffusion, developers of a new program or technology (i.e., resource system) simply designate and train selected members to be recruiters and allies of individual advocates at the campus-level (i.e., user system). Linkage is supported by supplying advocates and allies with guidelines and materials that encourage ongoing, interactive, interpersonal partnerships to promote effective implementation of the new technology at the school. Empirical assessment of this simple strategy implemented by the Texas Affiliate of the American Heart Association showed a twofold to fourfold increase in actual use and reach of school health promotion packages, with an average reported volunteer time of less than three hours per month.
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Affiliation(s)
- C Roberts-Gray
- Dept. of Kinesiology and Health Education, University of Texas at Austin 78712, USA
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Morris JD, Kelsey E, Martin RA. Comparison of WISC-R performance of urban and rural special education students. Psychol Rep 1980; 46:671-7. [PMID: 7384368 DOI: 10.2466/pr0.1980.46.2.671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The relationship between WISC-R subtest profiles and geographic environment (urban or rural) for 178 special education (Learning Disabled and Educable Mentally Handicapped) students (54 females and 124 males; 114 Negroes and 64 Caucasians), ranging in age from 6 yr., 3 mo. to 15 yr., was explored in relation to the children's race and specific type of disability. Urban children performed significantly better than rural children on all subtests except Coding. Moreover, the mean WISC-R profiles differed significantly in shape for the urban and rural children. There was a significant discrepancy in verbal and performance scores for rural children but not urban children. Extensions to a previous comparison of the WISC-R performance of urban and rural children in the standardization sample (Kaufman & Doppelt, 1976) are discussed.
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