ABSTRACT
PURPOSE: Worldwide, transrectal ultrasound-guided prostate needle remains the most common method of diagnosing prostate cancer. Due to high infective complications reported, some have suggested it is now time to abandon this technique in preference of a trans-perineal approach. The aim of this study was to report on the infection rates following transrectal ultrasound-guided prostate needle biopsy in multiple Australian centres. MATERIALS AND METHODS: Data were collected from seven Australian centres across four states and territories that undertake transrectal ultrasound-guided prostate needle biopsies for the diagnosis of prostate cancer, including major metropolitan and regional centres. In four centres, the data were collected prospectively. Rates of readmissions due to infection, urosepsis resulting in intensive care admission and mortality were recorded. RESULTS: 12,240 prostate biopsies were performed in seven Australian centres between July 1998 and December 2020. There were 105 readmissions for infective complications with rates between centres ranging from 0.19 to 2.60% and an overall rate of 0.86%. Admission to intensive care with sepsis ranged from 0 to 0.23% and overall 0.03%. There was no mortality in the 12,240 cases. CONCLUSION: Infective complications following transrectal ultrasound-guided prostate needle biopsies are very low, occurring in less than 1% of 12,240 biopsies. Though this study included a combination of both prospective and retrospective data and did not offer a comparison with a trans-perineal approach, TRUS prostate biopsy is a safe means of obtaining a prostate cancer diagnosis. Further prospective studies directly comparing the techniques are required prior to abandoning TRUS based upon infectious complications.
Subject(s)
Prostate , Prostatic Neoplasms , Australia/epidemiology , Biopsy , Biopsy, Needle/adverse effects , Biopsy, Needle/methods , Humans , Male , Prospective Studies , Prostate/diagnostic imaging , Prostate/pathology , Prostatic Neoplasms/diagnosis , Prostatic Neoplasms/pathology , Retrospective Studies , Ultrasonography, InterventionalABSTRACT
This paper describes a medical model to provide in-house GP services to residents of aged-care facilities. Access to GP services for aged-care residents is decreasing, partially due to the changing demographic of the Australian GP workforce. The model we have developed is an in-house GP (AgedCare+GP) trialled in a publicly funded residential aged-care facility (RACF). The service model was based on the GP cooperative used in our after-hours general practice (AfterHours+GP). Briefly, the service model involves rostering a core group of GPs to provide weekly sessional clinics at the RACF. Financial contributions from appropriate Medicare Benefits Schedule (MBS) items for aged-care planning (including chronic conditions) provided adequate funds to operate the clinic for RACF residents. Evaluation of the service model used the number of resident transfers to the local emergency department as the primary outcome measure. There were 37 transfers of residents in the 3 months before the commencement of the AgedCare+GP and 11 transfers over a 3-month period at the end of the first year of operation; a reduction of almost 70%. This project demonstrates that AgedCare+GP is a successful model for GP service provision to RACF residents, and it also reduces the number of emergency department transfers.
Subject(s)
General Practice/methods , Health Services for the Aged/organization & administration , Homes for the Aged/organization & administration , Nursing Homes/organization & administration , Aged , Aged, 80 and over , Australia , General Practice/standards , Health Services for the Aged/standards , Homes for the Aged/standards , Humans , Nursing Homes/standards , Primary Health Care/methods , Primary Health Care/standardsABSTRACT
People with learning disabilities represent a small and vulnerable group in society who commonly encounter barriers in accessing and using health care. This article focuses on how nurses and other healthcare professionals could support these individuals to make decisions about their care. In particular, it highlights the changes in legislation, policy and practice that have occurred recently to ensure the rights of people with learning disabilities to access health care are upheld.
Subject(s)
Health Services Accessibility/legislation & jurisprudence , Intellectual Disability , Patient Advocacy , Patient Preference/legislation & jurisprudence , Community Health Nursing , England , Female , Health Policy , Health Status Disparities , Humans , Male , WalesABSTRACT
Pigeons (Columba livia), gray squirrels (Sciurus carolinensis), and undergraduates (Homo sapiens) learned discrimination tasks involving multiple mutually redundant dimensions. First, pigeons and undergraduates learned conditional discriminations between stimuli composed of three spatially separated dimensions, after first learning to discriminate the individual elements of the stimuli. When subsequently tested with stimuli in which one of the dimensions took an anomalous value, the majority of both species categorized test stimuli by their overall similarity to training stimuli. However some individuals of both species categorized them according to a single dimension. In a second set of experiments, squirrels, pigeons, and undergraduates learned go/no-go discriminations using multiple simultaneous presentations of stimuli composed of three spatially integrated, highly salient dimensions. The tendency to categorize test stimuli including anomalous dimension values unidimensionally was higher than in the first set of experiments and did not differ significantly between species. The authors conclude that unidimensional categorization of multidimensional stimuli is not diagnostic for analytic cognitive processing, and that any differences between human's and pigeons' behavior in such tasks are not due to special features of avian visual cognition.
