ABSTRACT
INTRODUCTION: There is an increasing volume of urology referrals for urinary catheterization (UC). The aim of this study was to determine the confidence and knowledge among healthcare staff on UC. We also assessed their satisfaction with training and support received during catheter education and clinical practice. METHODS: This was a mixed-methods model using an anonymous, online survey circulated among all hospital staff. Weekly reminders were sent, quantitative data was obtained from closed-ended questions, and thematic analysis was performed for qualitative, open-ended questions. RESULTS: The response rate was 26% (n=90/350), from a heterogenous group of doctors and nurses from various specialties and grades in the hospital and community frequently dealing with UC. There was decreasing confidence levels in female UC (54%, n=47/87), three-way catheters (33%, n=29/89), and managing suprapubic catheters (25%, n=21/85). Female UC was reported as the most difficult of catheter insertions (35%, n=31/90). Although 83% (n=74/89) of respondents received catheter education, 53% (n=48/90) felt this was insufficient for clinical practice. Fifty-one percent (n=45/89) believed more support with UC in clinical practice was required and 64% (n=57/89) recommended changes in catheter education. The most common theme identified was the need for ongoing education and more practical supervision in clinical practice. CONCLUSIONS: Catheter training should focus on different types of catheters and management of difficult catheter scenarios. Standardizing safe catheter education during undergraduate training and including this as a part of regular annual or biannual mandatory training for healthcare staff involved in dealing with catheters in clinical practice would be the way forward.
ABSTRACT
BACKGROUND: In 2006, a county-wide survey of general practitioners (GPs) in the United Kingdom (UK) identified a reluctance to refer younger men with abnormal prostate specific antigen (PSA) levels. Younger men have the most to gain from early-detection of prostate cancer (PCa), which remains a national government priority in the UK and around the world. We sought to assess changes in perception of abnormal PSA-values amongst UK GPs over the past 10 years. MATERIALS AND METHODS: A total of 500 self-administered paper questionnaires were distributed to individually named GPs. One hundred and forty two responded (28.4%), representing a patient population of â¼600,000. A series of visual analogue questions assessed referral thresholds and understanding of risk factors related to the development of PCa. RESULTS: GPs with a median of 23-years experience responded. Although mean PSA threshold for referral to urology did fall between 2006 and 2016 in both the 45-year (5.42 ng/mL vs. 4.61 ng/mL P = 0.0003) and 55-year (5.81 ng/mL vs. 5.30 ng/mL P = 0.0164) age groups, the median referral values were unchanged. Significantly, referral thresholds quoted for younger men (<65 years) were considerably higher than recommended UK maximum PSA-levels. Using case-based scenarios, practitioners appeared more likely to refer older men with abnormal PSA values, with GPs reporting an average 56.2% likelihood of referring an asymptomatic 55-year-old with elevated age-adjusted PSA of 4.6 ng/mL. A total of 95.1% recognised a family history of PCa to be a potential risk factor but other at-risk categories were not so clearly understood. CONCLUSION: Awareness of abnormal PSA values in UK primary care is improving, but continues to lag behind the evidence. Strategies to disseminate knowledge of maximum PSA-values to GPs should focus especially on those for younger patients.
ABSTRACT
INTRODUCTION: The aim of this study was to identify patients with advanced urological cancer who may benefit from specialist palliative care and to quantify the number of these patients, characterize their problems and to see if their needs were being met. METHODS: The study was divided into two parts over 4-month periods centred on a hospital trust in the UK with a catchment population of 850,000. Urology in-patients were observed prospectively and out-patients were observed retrospectively. Patients were included if they had unresectable, locally advanced or metastatic urological cancer. Patients with prostate cancer were included if they had advanced disease with hormone relapse, defined as three successive rises in PSA. RESULTS: 881 admissions to the urology ward were reviewed. A total of 24 patients with terminal malignancy had 27 admissions. Two patients died during their admission. The average length of stay was 16.6 days. Only 5 patients underwent surgical intervention. The majority of patients had general systemic symptoms of advanced malignancy. 2,482 out-patient visits were reviewed where 69 patients with terminal malignancy received 82 outpatient consultations, representing approximately 10% of all cancer visits. Seventy-five percent of the patients had specific problems or were generally unwell as a result of their disease and would have benefited from specialist palliative care. The remaining 25% were well at the time of their visit, but potential psychosocial problems arising from coping with advancing terminal disease were not addressed. CONCLUSION: Patients requiring palliative care place a heavy burden on in- and out-patient services. There is a case for a palliative care physician to be closely involved in urological cancer teams. Urologists need to be trained in palliative care, as this comprises a significant volume of their work.
