Non‐medical prescribing in prostate cancer care: a case study reflection

There are approximately 54 000 nurse and midwife prescribers across the United Kingdom (UK), with 19 000 nurse independent and supplementary prescribers. Prostate cancer specialist nurses are ideally suited to implement advanced levels of practice in non‐medical prescribing, but little has been detailed in the literature about the prescribing practice in this clinical context. This paper set out to critically review evidence‐based recommendations for Prostate Cancer Specialist Nurses using a case study reflection to contextualize the role of non‐medical prescribing. A structured literature review was conducted in a range of electronic databases (DARE, Cochrane, MEDLINE, BNI, PsychINFO, EMBASE and CIHAHL), and a grey literature search in google, to identify studies employing a qualitative and/or quantitative methods. National (UK) and European clinical guidelines and legislative frameworks were also included. Methodological evaluation was conducted and evidence‐based recommendations were integrated into a narrative synthesis. A multidisciplinary and proactive approach to the management of men with metastatic prostate cancer ensures safe and effective prescribing practice, and optimizes supportive care delivery. A reflective case study has illuminated the key features necessary to maximize the success of non‐medical prescribing in prostate cancer care and captures the importance of good working relationships. While different practice models will emerge, the Prostate Cancer Model of Consultation may facilitate a structured framework for safe practice, embedded in effective communication strategies. Non‐medical prescribers must be committed to continual professional development, and prescribe safely within individual competencies and scope of professional practice. There is a pressing need for further research to evaluate prescribing practices with a particular focus on the nature of influencing factors on prescribing decisions, cost‐effectiveness and a more detailed understanding of how team working and inter‐team referral affects prescribing decisions between the Multidisciplinary Team (MDT) members.     

Targets not only drive forward service change but influence change in practice

The aim of this article is to illustrate and discuss how a change in service delivery and nursing role influenced the need for further changes in the interventions between the urology unit and the patient. This highlighted the fact that there were varying styles and means of disseminating results and especially when informing patients of what could be potentially confusing biopsy results such as those which have revealed high‐grade prostatic intraepithelial neoplasia. Some practices could lead to the patients being confused or worried, as they have not been afforded pure choice according to their individual wishes. After reviewing the literature, and explaining the histological diagnosis that is high‐grade intraepithelial prostatic neoplasia, an information leaflet has been developed that can be given to patients receiving such results, thus ensuring patients are all given standard written information minimizing inter‐clinician variations. The changing role of the clinical nurse specialist within the urological team will be discussed, as well as the service delivery changes that took place within that team which led to the need to challenge existing practices that have continued throughout the years.     

The psychosocial dimensions of fatigue in men treated for prostate cancer

Prostate cancer is one of the most prevalent forms of cancer in men worldwide. Cancer‐related fatigue (CRF) is the most frequently reported side effect of all cancer treatments and occurs in up to 74% of men treated for prostate cancer, particularly those receiving combined hormone and radiation therapies. Patients report the devastating impact of CRF on their quality of life and psychosocial functioning, affecting work, social, emotional and cognitive performance. It can manifest during treatment and persist long after its completion. A diagnosis of CRF is achieved once all other treatable factors such as anaemia or anxiety and depression have been managed, but does not alleviate the fatigue. The Functional Assessment of Cancer Therapy‐Fatigue (FACT‐F) is a brief and easily administered valid and reliable tool recommended for the assessment of CRF. Non‐pharmacological interventions such as activity‐based programs and psychosocial interventions including prostate cancer specific education and cognitive behavioural therapy have shown benefits in reducing levels of CRF. A multidisciplinary approach to the management of CRF in prostate cancer patients is advocated. The NICE four‐tier model of psychological support can be used as a framework to assist nurses and other health care professionals to alleviate the psychosocial burden of CRF. More research studies using a solid methodological foundation are required in men with prostate cancer to provide robust evidence which can be applied in practice.     

前列腺低回声灶和PSAD对前列腺癌的诊断价值

术前经直肠超声检出前列腺低回声灶65例,范围0.5-2.0cm^2,84.61%位于移行区,病检证实前列腺癌（PCa)35例（53.84%),前列腺上皮内瘤（PIN）13例（20%）。结节增生17例（26.15%)。以PSA10ng/ml和PSAD0.1为界值,对PCa和PIN的敏感性是52%和85%A,特异性90%和56%,阳性预测值90%和71%,本研究提示,前列腺弱回声灶和PSAD较单一指标能提高对前列腺癌的检出率。     

A service evaluation describing a nurse‐led prostate cancer service in NHS,Ayrshire and Arran

From 1999, the NHS Ayrshire and Arran Health Board implemented an innovative nurse‐led collaborative care model for the management of patients with prostate cancer (PC). This article describes the model and presents the results of a local evaluation to assess its impact. The evaluation comprised a retrospective audit of the service against national standards for PC management, undertaken in 2012. Seventy‐one patients, who were under the care of the service during June 2008, were included. Patient and staff satisfaction were also assessed using questionnaires distributed to 75 patients undergoing outpatient or telephone reviews during April 2012 and 7 one‐to‐one semi‐structured staff interviews. The patient audit showed good compliance with standards relating to selection of appropriate PC treatments according to tumour stage and grade; radiotherapy dosing and referral‐to‐treatment times. Areas requiring improvement were the documentation of patients' risk and performance status and provision of verbal and written information to patients and carers. Seventy‐three per cent of the patient questionnaires were returned, with 96% of respondents rating their overall care as ‘excellent’ or ‘very good’. Staff satisfaction was also high and interviewees described many benefits of the service for patients, hospital staff, GPs and the NHS/health board. Negative responses related mainly to demand/capacity issues. Overall, the evaluation showed good compliance with many national standards and high levels of patient and staff satisfaction. This suggests that with trained and competent nursing staff and collaborative multidisciplinary team working, safe and appropriate care can be achieved for more complex, as well as very stable PC patients.     

Prostate cancer with bone metastasis: an overview of pain assessment and management

The challenges of assessing and assisting men with chronic progressive metastatic bone pain secondary to prostate cancer can be immense. All patients have a right to have their pain assessed and relieved by knowledgeable health professionals, yet many urology outpatient clinic nurses come from a surgical background and have limited skills and knowledge in this area. This article aims to enhance the knowledge of urology nurses, by critically analysing and discussing components of current pain management practice, for men with painful bone metastasis. To this end, the pathophysiology of metastatic bone pain is briefly outlined followed by pain definitions from literature and information pertaining to assessment of bone pain. Barriers to effective pain assessment are identified, along with a brief discussion on the impact of factors like fatigue, anxiety and depression on pain. A review is undertaken of selected pharmacological and non‐pharmacological strategies for the management of bone pain, as reported in published literature. Knowledge of the WHO analgesic ladder for cancer pain and the actions of pain‐relieving medications and their adjuncts will better equip nurses to educate patients regarding their effective use. Insights gained into potentially effective non‐pharmacological strategies for the reduction of the experience of pain should prompt nurses to investigate what modalities are on offer at their place of work and within their local community. Written resources can then be created to share this information with patients if they are not already in existence.     

经直肠前列腺超声造影靶向活检诊断前列腺癌的可行性研究

目的评价超声造影对前列腺癌(PCa)的诊断价值,探讨PCa靶向活检(TB)的可行性。方法对164例前列腺特异度抗原(PSA)水平≥4ng/ml患者,在接受前列腺活检前行前臂静脉注射声诺维2.4ml (29.5μg),经直肠超声(TRUS)前列腺超声造影(CEUS)检查,评估CEUS的声像图表现。对92例CEUS显示前列腺异常灌注区行TB;并对260例PSA≥4ng/ml患者行前列腺系统活检(SB),然后对TB和SB的病理结果进行对比分析。结果 92例CEUS显示前列腺异常灌注区的患者于TRUS引导下行TB,平均每位患者取活检标本12.6条,病理诊断PCa阳性率66.3%(61/92),未见癌细胞33.7%(31/92);SB病理诊断PCa 19.6%(51/260),未见癌细胞199例76.5%(199/260),TB对PCa检出率明显高于SB的19.6%(优势比=3.3,P=0.002 7)。CEUS提示PCa的声像图表现多种多样:强对比增强、快速对比增强、血管灌注异常和低对比增强。结论 TRUS引导下CEUS靶向活检,可提高组织材料的质量,使患者避免不必要的穿刺,减少穿刺次数,从而提高PCa的诊断率,超声造影TB和SB结合,可以获得PCa较高的检出率,有较高的临床应用价值。     

Extending the nursing role in Emergency Departments: Challenges for Australia

As nursing has developed as a profession there has been a continual evolution of the scope of practice in which nurses work. Emergency nursing practice is an example where recently there has been a rapid expansion in the nature and scope of practice. This change in practice has largely resulted from increasing public demand on emergency departments, medical and nursing shortages and governmental pressure to reduced emergency department waiting times and patient length of stay.There have been a number of models worldwide in which the expansion of the Emergency Nurses role has occurred. Recently in New South Wales the Clinical Initiative Nurse role has been developed as an advanced practice role with the objective of initiating treatment based on advanced clinical assessment and to assist emergency departments to meet benchmarks and key performance indicators (KPIs). The scope of practice of this new role did not extend to that of a Nurse Practitioner who is able to discharge patients, prescribe medication and provide medical referral.The variation in advance practice nursing roles in Australia and worldwide has contributed to confusion and uncertainty. The aim of this paper is to explore the various advanced practice roles that may be encountered in emergency nursing practice and examine some of the advantages and limitations to the implementation of these roles.     

Nurse practitioners: a contract for change and excellence in nursing

The role of the Nurse Practitioner has been in existence in a variety of contexts and within a broad range of the scope of their practice throughout the world for a number of years. Many nurses work at this advanced level of clinical practice without the acknowledgement f the very important and responsible role that they play within the healthcare setting. Although the United States and United Kingdom have recognised the role of the advanced Nurse Practitioner for a number of years, there still exists confusion and disagreement as to their scope of practice. There is uncertainty and anxiety as to where the role boundaries between nursing and medical and allied health professionals begin and end. The role of the Nurse Practitioner in Australia has not been without its problems in the developmental stage of its creation. New South Wales finally achieved recognition of the role this year after a decade of negotiation. This has culminated in the acceptance for the development of 40 Nurse Practitioner positions across the State. The first of these was accepted in the Far West Area Health Service in May 2001. The Far West Area Health Service created a five-year plan, which addresses the development of nurses preparing for authorisation, the creation of Nurse Practitioner positions in the remote communities, the creation of clinical guidelines to support advanced practice and the evaluation process for both the positions and the nurses. The objective of this approach is to ensure effective implementation of these advanced nursing positions in the remote communities of New South Wales. The Nurse Practitioner role needs to respond to the individual, the family and the community, utilising advanced clinical skills and remaining responsive to the changes in health care within a primary health care framework, which is essential for combating the complex health care issues in remote areas (NSW Health 2000).     

Strategic directions and actions for advanced practice nursing in China

There is a need and opportunity for China to develop education and practice innovations given that advance practice nurses (APNs) improve health care and outcomes. The China Medical Board (CMB) China Nursing Network (CCNN) began planning for an Advanced Nursing Practice Program for education and career development that will facilitate CCNN's contributions to meeting national nursing policy priorities. This paper presents the discussion, recommendations and action plans developed at the inaugural planning meeting on June 26, 2015 at Fudan University in Shanghai. The recommendations are: Develop standards for advanced nursing practice; Develop Master's level curricula based on the standards; Commence pilot projects across a number of University affiliated hospitals; and Prepare clinical tutors and faculty. The strategic directions and actions are: Develop a clinical career ladder system; Expand the nursing role from hospital to community; and Build a specialty nurse accreditation system.     

Coffee,Chaos, and Competence: A Day in the Life of a Radiology Nurse

The role of a radiology nurse is not clearly understood by patients or nursing colleagues. Following a radiology float nurse through a day in a complex radiology practice in a Magnet-designated facility illustrates how a radiology nurse must incorporate specialty education and training, clinical competence, and a professional nursing practice model to provide quality patient care.     

Nurse-led flexible cystoscopy: the UK experience informs a New Zealand nurse specialist's training

Flexible cystoscopy utilizes a fibre‐optic scope with a light source to examine the internal surfaces of the bladder and urethra. The procedure is undertaken to investigate and diagnose the cause of lower urinary tract symptoms. It is also used extensively to detect the recurrence of bladder tumours in people diagnosed with transitional cell carcinoma of the bladder and kidney. In the UK, the advent of flexible cystoscopy clinics undertaken by appropriately trained and supervised nurses has been one way of improving provision of a flexible cystoscopy service. Information from published literature informed the decision to establish a nurse‐led flexible cystoscopy clinic at one large District Health Board in New Zealand. This article reviews the current body of knowledge on nurse‐led flexible cystoscopy, focusing on the education and training required to prepare nurses for independent cystoscopy practice. Literature findings are discussed, along with the observations of a urology nurse specialist undertaking flexible cystoscopy training in New Zealand and anecdotal evidence from visits with nurse cystoscopists in England during 2006. Carefully designed research studies published in literature have a key role to play in augmenting the body of evidence around this relatively new area of nursing practice, and as such should be strongly encouraged in both countries. It is recommended that nurse cystoscopy training and competencies are standardized and adopted internationally in order to increase the transferability of findings from research on the clinical outcomes of nurses performing nurse‐led flexible cystoscopy.     

尿液DD3mRNA定量检测在前列腺癌诊断中的价值

目的探讨前列腺按摩后尿沉渣中DD3mRNA含量在前列腺癌诊断中应用价值。方法收集前列腺癌(Pca)患者18例、良性前列腺增生(BPH)33例,在前列腺穿刺活检前收集前列腺按摩后的尿液,离心取细胞沉淀物,用荧光实时定量RT- PCR方法检测DD3 mRNA和PSAmRNA含量,以PSAmRNA作为管家基因校正尿沉渣中的前列腺细胞,以DD3mRNA/PSAmR- NA比值表示尿DD3mRNA含量。用ROC曲线对DD3mRNA诊断PCa的性能进行分析,并与血清tPSA进行了比较,同时探讨了尿DD3mRNA阳性率与临床分期和病理分级的关系。结果Pca患者尿DD3mRNA表达量明显高于BPH患者,差异具有统计学意义(P<0.05)。ROC曲线分析结果显示,ROC-AUC=0.716(95%CI:0.572～0.861)。当截断值为0.118时,DD3mRNA的灵敏性、特异性、准确性、阳性预测值、阴性预测值、阳性似然比、阴性似然比分别为67.0%、78.8%、77.4%、63. 2%、83.9%、3.41和0.35。若血清tPSA分别以4ng/ml和10ng/ml为截断值时,灵敏度分别为100%和94.4%,特异度分别为15.25和57.6%。DD3mRNA的阳性率与临床分期和病理分级无关。结论DD3mRNA的特异性明显高于血清PSA,尿液DD3mRNA的检测可减少不必要的前列腺穿刺,作为PCa的一种非损伤性诊断方法具有良好的应用前景。     

经直肠超声检查和前列腺移行区特异抗原密度在前列腺癌穿刺活检中的作用

目的分析经直肠超声(TRUS)和前列腺移行区特异抗原密度(PSA-TZ)在前列腺癌穿刺活检中的作用,探讨个体化经直肠前列腺穿刺方案的可行性。方法依据TRUS结合PSA-TZ选择穿刺点,对64例可疑前列腺癌(PCA)患者,行经直肠前列腺穿刺活检。结果45例PSA-TZ≥0.35ng/ml.cm3,穿刺病理阳性41例,前列腺癌的检出率为91.1%,其中TRUS发现可疑病灶(TRUS+)35例均证实为癌。19例PSA-TZ&lt;0.35ng/ml.cm3,穿刺病理阳性3例,前列腺癌的检出率15.8%,TRUS(+)5例,其中2例证实为癌。此两组患者前列腺癌的检出率差异显著(P&lt;0.01)。结论当PSA-TZ≥0.35ng/ml.cm3,同时TRUS发现可疑病灶,建议行病灶穿刺;当PSA-TZ≥0.35ng/ml.cm3而TRUS阴性,宜行10点穿刺;若PSA-TZ&lt;0.35ng/ml.cm3,TRUS阳性,则行包括病灶在内的6点穿刺。     

我国护理硕士专业学位研究生与专科护士并轨培养可行性探讨

目的 探讨科学、系统、合理、可执行的我国护理硕士专业学位研究生和专科护士并轨培养的思路及可行性,为从根本上全面提高我国专科护士的学历水平及护理硕士专业学位研究生的专业技能提供参考。方法 对我国护理硕士专业学位研究生及专科护士培养进行了现状分析,然后阐明了两者并轨的可行性及必要性,接着从招生对象、培养学制、导师制度、课程设置、临床护理实践、考试与考核、学位授予及专科护士资格认证共7个方面探讨了并轨培养的具体思路设想,最后提出了相应的对策及建议。结果 护理硕士专业学位研究生教育和专科护士并轨培养可行,可考虑在合理衔接研究生教育与专科护士培训两者间的差异基础上加强政府、护理院校、医疗机构三者间的交流协作,构建并完善规范化、标准化的培养体系。结论 与专科护士培训并轨的护理硕士专业学位培养模式符合我国护理专业化、高层次化发展的需求,是我国护理实践发展的必然趋势,两者并轨对于专业学位研究生综合素质的培养及护理学科的可持续发展具有重要意义。     

耻骨后前列腺癌根治手术中尿控功能和性功能保护的手术技巧

目的探讨在耻骨后前列腺癌根治术中尿控功能和性功能保护的手术技巧和疗效。方法 2001年8月2010年1月,行耻骨后前列腺癌根治术21例,其中2例经腹腔镜。所有患者均早期控制缝扎背静脉复合体,并妥善处理前列腺尖和尿道。21例通过保护控尿神经、尿道横纹括约肌,保护了尿控功能;17例通过保留神经血管束技术（12例保留双侧,5例保留一侧）保护性功能。结果手术均成功完成,无围手术期严重并发症。2周拔出尿管后,排尿通畅,无尿道狭窄。术后3、12个月内恢复尿控能力患者分别为6、13例,持续性轻-中度尿失禁2例。21例患者中,术前勃起功能正常;术中保留神经血管束17例,术后3、12个月内勃起功能恢复分别为2、8例,4例勃起功能减弱,3例不能勃起。术后病理报告均为前列腺癌,未侵及精囊、膀胱颈、双侧淋巴结阴性。后尿道切缘阳性1例。术后6、24、54个月各有1例出现生化复发。结论手术精细解剖并注意技巧,可有效保护尿控功能和性功能,并达到肿瘤根治的疗效。     

耻骨后前列腺癌根治术中尿控功能和性功能保护的手术技巧

目的探讨在耻骨后前列腺癌根治术中尿控功能和性功能保护的手术技巧和疗效。方法 2001年8月2010年1月,行耻骨后前列腺癌根治术21例,其中2例经腹腔镜施行。均早期控制缝扎背静脉复合体,并妥善处理前列腺尖和尿道。21例通过保护控尿神经、保护尿道横纹括约肌等措施,保护尿控功能;17例通过保留神经血管束技术（12例保留双侧,5例仅保留一侧）保护性功能。结果手术均成功完成,无围术期严重并发症。2周拔出尿管后,排尿通畅,无尿道狭窄。手术后3、12个月内恢复尿控能力分别为：6例、13例,持续性轻-中度尿失禁2例。21例中,手术前勃起功能正常,并于手术中保留神经血管束17例,手术后3、12个月内勃起功能恢复分别为：2、8例,4例勃起功能减弱,3例不能勃起。手术后病理报告均为前列腺腺癌,未侵及精囊.膀胱颈,双侧淋巴结阴性。后尿道切缘阳性1例。手术后6、24、54个月各有1例出现生化复发。结论精细解剖并注意手术技巧,可有效保护性功能和尿控功能,并达到肿瘤根治的疗效。     

团体认知干预联合个性化营养护理对前列腺癌手术患者的影响

目的:探讨团体认知干预联合个性化营养护理对前列腺癌手术患者的影响。方法:将118例前列腺癌手术患者随机分为常规组和联合组各59例,常规组行个性化营养护理,联合组行团体认知干预联合个性化营养护理,比较两组护理效果。结果:联合组患者干预后焦虑自评量表(SAS)、抑郁自评量表(SDS)、生活质量评分及免疫功能均优于常规组(P<0.05)。结论:团体认知干预联合个性化营养护理能有效改善前列腺癌手术患者的不良情绪和生活质量,提高患者术后免疫功能。