Patient Satisfaction in a One‐Stop Haematuria clinic and Urology Outpatients: A Comparison of Clinics

One‐stop clinics have shown to improve the patient experience in early diagnosis of potentially life threatening conditions, although this service is less evident in Urology, where morbidity and mortality resulting from bladder cancers are increasing. This study will discuss whether or not one‐stop haematuria clinics improve patient satisfaction. A survey analysis comparing patient satisfaction for a one‐stop haematuria clinic and a traditional outpatient service was developed, based around the ‘Determinants and Components’ theory. A convenience sample of 102 haematuria patients attending either the one‐stop clinic (Route A) or an outpatient clinic within the Urology service (Route B), at an assigned National Health Service hospital, were invited to complete a ‘patient satisfaction’ questionnaire. Data were compared between clinic routes according to the patient satisfaction themes of: Time and Availability, Quality of Care, Environment, Accessibility and Convenience and Global Satisfaction. Response rate was 51%; with overall positive patient satisfaction levels for both clinics. Route A patients were most satisfied with Quality of Care; however, reported problems relating to prior information provision and appointment co‐ordination. For Route B, Availability and Time was a primary source of both satisfaction and dissatisfaction, receiving contradictory qualitative and quantitative responses respectively. Both groups rated Environment and Accessibility and Convenience highly overall, yet these were not a primary determinant of satisfaction. The majority of haematuria patients (82%), expressed a preference to attend a one‐stop clinic over several outpatient appointments. Practical recommendations for related service improvements are offered.     

Sex‐dependent activity of de novo methyltransferase 3 (Tudnmt3) in the two‐spotted mite,Tetranychus urticae Koch

DNA methylation is an epigenetic mechanism for regulating developmental and other important processes in eukaryotes. Several components of the DNA methylation machinery have been identified, such as DNA methyltransferases. However, little is known about DNA methyltransferases in chelicerates, which is the second largest arthropod group. Epigenetics are expected to have a crucial role in the metabolism and development of this group. Here, we investigated the role of DNA methyltransferase 3 in the development of Tetranychus urticae Koch. In silico analyses clearly showed that this enzyme possesses the necessary conserved motifs for the catalytic activity of de novo methylation of DNA. Real‐time PCR revealed that T. urticae de novo methyltransferase 3 (Tudnmt3) is expressed ubiquitously and throughout the life cycle of the two‐spotted spider mite. However, the pattern of Tudnmt3 expression was sex‐dependent during the adult stage. Whole in situ hybridization provided supportive evidence that Tudnmt3 is linked to the differentiation of the gonads in adult females and males. Methylation‐sensitive amplification polymorphism analyses of 119 loci showed that the status of DNA methylation is partially different between adult females and males, raising the possibility that this sex‐dependent DNA methylation pattern is mediated by different methylation activity of Tudnmt3.     

Sex hormone‐binding globulin levels are not causally related to venous thrombosis risk in women not using hormonal contraceptives

Summary. Background: Oral contraceptive use increases the risk of venous thrombosis as well as sex hormone‐binding globulin (SHBG) levels. Furthermore, increased SHBG levels are positively associated with activated protein C (APC) resistance and thrombotic risk in oral contraceptive users. Objectives: To determine whether increased SHBG levels are causally related to venous thrombosis in women not using hormonal contraceptives. Methods: Premenopausal women were selected from a case–control study on venous thrombosis, the Multiple Environmental and Genetic Assessment of risk factors for venous thrombosis (MEGA) study (23 patients; 258 controls). Women using hormonal contraceptives were excluded. First, the risk of venous thrombosis with SHBG levels above the normal reference range (70 nm ) was determined. Second, because multiple regulatory factors affect SHBG levels and residual confounding may remain, we determined six single‐nucleotide polymorphisms (SNPs) in the SHBG gene and assessed the risk of venous thrombosis in a different case–control study, the Leiden Thrombophilia Study (LETS) (20 patients; 74 controls), and in the MEGA study. Finally, the association between SHBG levels and the normalized activated partial thromboplastin time‐based APC resistance (an intermediate endpoint for venous thrombosis) was determined. Results: Elevated SHBG levels (> 70.0 nm ) were associated with venous thrombosis (odds ratio 1.92; 95% confidence interval [CI] 0.74–5.00). However, this finding can be explained by residual confounding. Two SNPs in the SHBG gene affected SHBG levels, but not venous thrombosis risk. Furthermore, SHBG levels in controls were not associated with APC resistance (SHBG level, > 70.0 vs. ≤ 70.0 nm : mean difference in normalized APC sensitivity ratio, 0.03; 95% CI ?0.05 to 0.10). Exclusion of women with FV Leiden did not materially change these results. Conclusions: Increased SHBG levels are not causally related to the risk of venous thrombosis.     

Maternal provision of non‐sex‐specific transformer messenger RNA in sex determination of the wasp Asobara tabida

In many insect species maternal provision of sex‐specifically spliced messenger RNA (mRNA) of sex determination genes is an essential component of the sex determination mechanism. In haplodiploid Hymenoptera, maternal provision in combination with genomic imprinting has been shown for the parasitoid Nasonia vitripennis, known as maternal effect genomic imprinting sex determination (MEGISD). Here, we characterize the sex determination cascade of Asobara tabida, another hymenopteran parasitoid. We show the presence of the conserved sex determination genes doublesex (dsx), transformer (tra) and transformer‐2 (tra2) orthologues in As. tabida. Of these, At‐dsx and At‐tra are sex‐specifically spliced, indicating a conserved function in sex determination. At‐tra and At‐tra2 mRNA is maternally provided to embryos but, in contrast to most studied insects, As. tabida females transmit a non‐sex‐specific splice form of At‐tra mRNA to the eggs. In this respect, As. tabida sex determination differs from the MEGISD mechanism. How the paternal genome can induce female development in the absence of maternal provision of sex‐specifically spliced mRNA remains an open question. Our study reports a hitherto unknown variant of maternal effect sex determination and accentuates the diversity of insect sex determination mechanisms.     

Therapeutic Potentials of Ecto‐Nucleoside Triphosphate Diphosphohydrolase,Ecto‐Nucleotide Pyrophosphatase/Phosphodiesterase,Ecto‐5′‐Nucleotidase,and Alkaline Phosphatase Inhibitors

The modulatory role of extracellular nucleotides and adenosine in relevance to purinergic cell signaling mechanisms has long been known and is an object of much research worldwide. These extracellular nucleotides are released by a variety of cell types either innately or as a response to patho‐physiological stress or injury. A variety of surface‐located ecto‐nucleotidases (of four major types; nucleoside triphosphate diphosphohydrolases or NTPDases, nucleotide pyrophosphatase/phosphodiesterases or NPPs, alkaline phosphatases APs or ALPs, and ecto‐5′‐nucleotidase or e5NT) are responsible for meticulously controlling the availability of these important signaling molecules (at their respective receptors) in extracellular environment and are therefore crucial for maintaining the integrity of normal cell functioning. Overexpression of many of these ubiquitous ecto‐enzymes has been implicated in a variety of disorders including cell adhesion, activation, proliferation, apoptosis, and degenerative neurological and immunological responses. Selective inhibition of these ecto‐enzymes is an area that is currently being explored with great interest and hopes remain high that development of selective ecto‐nucleotidase inhibitors will prove to have many beneficial therapeutic implications. The aim of this review is to emphasize and focus on recent developments made in the field of inhibitors of ecto‐nucleotidases and to highlight their structure activity relationships wherever possible. Most recent and significant advances in field of NTPDase, NPP, AP, and e5NT inhibitors is being discussed in detail in anticipation of providing prolific leads and relevant background for research groups interested in synthesis of selective ecto‐nucleotidase inhibitors.     

Evaluation of a nurse‐led service for follow up of patients with prostate cancer

The incidence of prostate cancer in Scotland continues to grow; men are now living with their disease which can be seen as an increased burden for the health service and in particular the Uro‐Oncology team which delivers its treatment and manage its follow up. A new model of follow up was established for men who have received treatment for prostate cancer, replacing conventional outpatient clinic. The virtual prostate cancer follow‐up clinic was set up for men who are 2 years post radiotherapy with stable prostate‐specific antigen. The aim of this follow up was to improve the patient experience of living with prostate cancer and reduce the high demand to the service. A successful bid to Macmillan allowed a nurse to be employed by the department for a 3‐year project post. The aim of this role was to develop the prostate cancer follow‐up clinic and evaluate this new way of working. Method A questionnaire was designed to obtain the views of the patients who were recipients of care and treatment from the clinical nurse specialist rather than the oncologist. The questionnaire was sent to all 302 men recruited to this new clinic. The patients were asked six questions which focused on support/communication, problems experienced and improvement. Results for 191 questionnaires were returned out of the 302 questionnaires sent, giving a 63·2% response rate. About 98% was very happy with the new service, 98·8% of patients reported being well supported by this new service. The success of this new follow‐up system will allow us to use this model for men post prostatectomy and receiving hormone suppression treatment. The role of the uro‐oncology nurse is vital to ensure that this clinic continues to be effective and give positive outcomes for patients with prostate cancer and the team involved in their journey.     

Initial experience of a community‐based prostate cancer risk assessment clinic for men of black and minority ethnicity background

We designed and implemented a community‐based prostate cancer risk assessment clinic targeting men from black and minority ethnicity (BME) background. This service had the dual aims of optimizing detection of prostate cancer within a local BME population, with a secondary goal of encouraging longer‐term engagement with primary care for follow‐up prostate‐specific antigen (PSA) testing in order to facilitate early diagnosis of future disease. “Drop‐in” clinics were set up in strategic locations and, staffed by experienced urology nurses. Risk assessment was offered in the form of a PSA test, and digital rectal examination (DRE). We targeted men of BME background aged between 45 and 75 but all attending individuals were given access to counselling and assessment as appropriate. In total, 312 men attended clinics for risk assessment. We diagnosed nine prostate cancers with histological confirmation, with a further two individuals considered to have prostate cancer based on clinical/biochemical parameters. These findings were consistent with similar previously published reports. Nurse‐led, community‐based targeted risk assessment is feasible, leads to the detection of significant numbers of prostate cancers and is well received by patients.     

One stop nurse‐led macroscopic haematuria clinic: waiting times and patient satisfaction

In 2011, a large District Health Board Hospital in New Zealand established a nurse practitioner‐led, one stop macroscopic haematuria clinic (OSMC) in an effort to improve the timeliness and quality of the investigative process offered to individuals referred with macroscopic haematuria. Patients were identified during the referrals triage process and graded to be seen at OSMC within 30 d. The OSMC process allows for completion of all basic investigations (urine microscopy and culture, urine cytology, renal tract ultrasound and flexible cystoscopy) by the end of the single clinic visit. This report outlines the OSMC process and reports on adherence to the 30‐d timeframe for the first 100 patients, along with patient satisfaction data from patients 51 to 100. The dates of referral and OSMC visits were recorded prospectively for 100 patients and analysed to determine compliance with the 30‐d timeframe. For patients 51–100, an anonymous, self‐administered questionnaire was utilized to evaluate satisfaction with pre‐appointment information, waiting times, interactions with clinicians and education. Of the first 100 patients at OSMC, 81% were seen within 30 d, with all patients rating the clinic timeframes, processes and personnel highly. While the reliability of the Haematuria Clinic Questionnaire results could have been influenced by multiple factors, the OSMC appears to offer service users timely access to diagnostic investigations with clinics timeframes, processes and personnel they rate highly. While 81% of patients were seen within 30 d, work is needed to increase compliance to 100%. This model of care could be adopted at other public hospitals.     

Endothelial invasive response in a co‐culture model with physically‐induced osteodifferentiation

Manipulation of stem cells using physicochemical stimuli has emerged as an important tool in regenerative medicine. While 2D substrates with tunable elasticity have been studied for control of stem cell differentiation, we recently developed a stratified co‐culture model of angiogenesis of human mesenchymal stem cells (hMSCs) that differentiate on a tunable polydimethylsiloxane (PDMS) substrate, thereby creating a physiologic context for elasticity‐induced differentiation. Endothelial cells (EC) were cultured on top of the hMSC construct on a collagen gel to monitor network formation. Media composition influenced EC invasion due to the conditioning media, the reduction of serum and supplemental growth factors, and the addition of recombinant growth factors. Conditioned media, recombinant growth factors and direct co‐culture were compared for endothelial cell invasive response using quantitative image analysis. As anticipated, use of recombinant vascular endothelial growth factor (VEGF) induced the deepest EC invasions while direct co‐culture caused shallow invasions compared to other conditions. However, endothelial cells displayed lumen‐like morphology, suggesting that cell‐cell interaction in the co‐culture model could mimic sprouting behaviour. In summary, an engineered suitable biochemical and physical environment facilitated endothelial cells to form 3D vessel structures onto hMSCs. These structures were plated on a stiff surface known to induce osteodifferentiation of stem cells. This low cost co‐culture system, with its minimal chemical supplementation and physically controllable matrix, could potentially model in vivo potential in engineered and pre‐vascularized bone grafts. Copyright © 2012 John Wiley & Sons, Ltd.     

Best Practice Information Sheet: The Joanna Briggs Institute Best Practice Information Sheet: Nurse‐led interventions to reduce cardiac risk factors in adults

This Best Practice Information Sheet updates and supersedes an earlier publication of the Joanna Briggs Institute in 2005. The information that is contained in this publication is based upon a systematic review of six randomized clinical trials. Additional information has been derived from a second systematic review; thus, in total, the information is derived from 22 randomized controlled trials. The original references can be sourced from the systematic reviews. Coronary heart disease (CHD) is the major cause of illness in Western society and it is becoming increasingly important to establish effective strategies in order to reduce the incidence of CHD. Nurse‐led clinics are becoming more prominent in community settings and the importance of nurse interventions in the management of CHD and risk factor reduction is recognized in terms of improved health outcomes for patients. However, the variation in outcome measures and inconsistent findings between some studies make it difficult to draw firm conclusions.