Evaluation of a clinical pathway for ‘radical laparoscopic prostatectomy’: an interrupted time series study

The aim of this study was a rigorous evaluation of a clinical pathway (CP) in patients who underwent a radical laparoscopic prostatectomy (RLP). The study was performed at a German university hospital. The Department of Urology has considerable expertise and performs more than 200 RLP per year. The CP for ‘RLP’ was developed based on the best available evidence and introduced in July 2003. It was composed of six modules, and in each module standardized recommendations for clinical examination, therapy and outcome measurement were given. An interrupted time series design with multiple linear regression models was used to measure the effects of a CP for ‘RLP’ on length of hospital stay, and durations of operation and anaesthesia before and after implementation. χ² tests were used to compare the number of patients admitted to intensive care unit, the number requiring re‐operation during admission, the number requiring transfusion(s) of blood products and 30‐d readmission rates. A total of 254 patients were analysed. A significant reduction in operation time and admission to intensive care but also a significant increase of patients readmitted to the hospital after the implementation of a CP was observed. Inconclusive results always warrant careful exploration, and measures on CP uptake should always be used to evaluate the success or failure of the implementation strategy.     

Responses and experiences after radical prostatectomy: perceptions of married couples in Switzerland

The purpose of this qualitative study was to explore the responses and experiences of a sample of Swiss men after radical prostatectomy and their intimate partners. Interviews were conducted with 10 couples and analyzed using constant comparative method. Getting a grip on it was the core process that was developed. Men focused on regaining control over their lives, urinary and erectile function while wives efforts focused on being there. The results revealed that current clinical practice of follow up at 3 months may not address the serious deficits in the patient's ability to "get a grip" on incontinence and other complications of surgery.     

Realising the potential of Q methodology in nursing research

BackgroundMixed methods research designs are becoming increasingly popular in nursing to explore complex clinical issues and to generate knowledge useful to improve the quality of nursing practice and clients’ health outcomes. Q methodology is one such research design that combines the strengths of both qualitative and quantitative approaches to examine scientifically peoples’ subjectivity towards a subject area.AimThis paper aims to provide an introduction to Q methodology and outlines the steps taken when conducting research on clinical issues.MethodsA clinical example of nurses caring for clients with a risk for aggression is used to illustrate how Q methodology was used to examine this subject area. The five sequential phases of Q-methodology integrate both approaches in a continuous interaction in a single study design, enabling researchers to explore the breadth and depth of factors that influence participants’ responses towards the topic under investigation.FindingsQ methodology is a unique mixed methods design as it does not require the researcher to spend time triangulating two or more research approaches into one single study or to conduct a qualitative and a quantitative study separately. The unique characteristics of Q methodology can be advantageous for nurses who have complex clinical workloads but also want to conduct research. Moreover, Q methodology does not require a large sample size, hence it is resource- and cost-effective.DiscussionQ methodology allows both nurse clinicians and nurse academics to explore new dimensions of staff and clients’ subjectivity which is important for the development of evidence based practice.ConclusionAdding Q methodology to the nursing research repertoire can facilitate nurse researchers to expand clinical research opportunities, to improve client care and to build capacity in early career nurse researchers.     

Management and treatment of men affected by metastatic prostate cancer: evidence‐based recommendations for practice

Currently, 250 000 men are affected by prostate cancer in the UK. Clinical guidance is crucial for nurses involved in the care delivery for men with advanced prostate cancer and for their families to maximize their quality and quantity of life. It is essential that nurses understand how prostate cancer is diagnosed, can recognize signs of disease progression, are familiar with disease management, and can educate patients and manage any symptoms appropriately and effectively. Therefore, the aim of this paper is to review current evidence‐based guidelines in relation to care delivery for men with metastatic prostate cancer in order to optimize best supportive care. A literature review was conducted in a range of electronic databases (DARE, Cochrane, MEDLINE, BNI, PsychINFO, EMBASE and CIHAHL) to identify studies employing qualitative and/or quantitative methods. National (UK) and European clinical guidelines were also reviewed. Methodological evaluation was conducted and the evidence‐based recommendations were integrated in a narrative synthesis. Supportive care is a person‐centred approach to the provision of the necessary services for those living with or affected by cancer to meet their informational, spiritual, emotional, social or physical needs during diagnosis, treatment or follow‐up phases including issues of health promotion, survivorship, palliation and bereavement. A multidisciplinary and proactive approach to the management of men with metastatic prostate cancer ensures safe and effective supportive care delivery. Nurses involved in the care delivery for this patient group need to be aware of the complex physical and psychological supportive care needs, and evidence‐based management care plans to ensure a personalized and tailored support to optimize quality of life.     

Systematic pelvic floor training for lower urinary tract symptoms post-prostatectomy: a randomized clinical trial

Because the majority of prostate cancers are diagnosed in the local or regional stages, radical prostatectomy is a treatment of choice for many patients, particularly men younger than 65 years of age. However, radical prostatectomy carries a significant risk of lower urinary tract symptoms (LUTS) and may also impair quality of life. The aim of the study was to examine the effects of systematic postoperative pelvic floor training (PFT) on LUTS intensity, LUTS distress and health‐related quality of life (HRQL) at 3, 6 and 12 months following radical prostatectomy. This randomized clinical trial was guided by the Theory of Unpleasant Symptoms. All participants (n = 126) received brief instructions for exercising pelvic floor muscles before surgery and the offer of a biofeedback evaluation session 1 month following catheter removal. The intervention group (n = 62) received an additional 4 weeks of PFT immediately following catheter removal. Intervention and control groups both reported steady declines in the intensity and distress associated with LUTS, but no between‐group differences were found. Similarly, no between‐group differences were found in impact on HRQL; however, the pattern of HRQL impact differed by group (p < 0·01) in the direction of greater impairment over time for the control group. LUTS intensity, LUTS distress and negative effects on HRQL decline for many radical prostatectomy patients over the first postoperative year; however, improvement does not occur in all patients. Further research is needed to improve our understanding of factors that influence development, resolution and management of LUTS following radical prostatectomy.     

The challenges of implementing Enhanced Recovery Programme in urology

Enhanced Recovery Programme (ERP) or fast‐track programme involves the application of evidence‐based best practice into surgery to optimize patient recovery post‐operatively. Results have been very promising especially in complex surgical procedures, where patient length of hospital stay had been significantly reduced and there has not been a significant increase in patient complication or readmission rate. These favourable outcomes are potentially cost‐effective for the health care team and hospital trust especially in the present economic climate. Within our department, we have recently implemented ERP in all patients undergoing radical cystectomy procedure since September 2009. In this paper, we discuss the elements of ERP, share our experiences and challenges in the implementation of ERP at different stages from prior‐ to post‐surgery. We concluded that the key for successful implementation of ERP is the active collaboration involving the whole health care team including the nurses, nurse specialists, doctors, surgeons and anaesthetist, to ensure every team member is accountable and contribute to the implementation process. From the nursing perspective, there is a significant role to be played especially in the pre‐ and post‐operative care of patients.     

Effect of 4 weeks of whole-body vibration training in treating stress urinary incontinence after prostate cancer surgery: a randomised controlled trial

BackgroundStress urinary incontinence is common in men after prostate cancer surgery. Rehabilitative interventions incorporate pelvic floor muscle training, biofeedback, electrical stimulation, lifestyle changes, or a combination of these strategies. However, little is known about the physiological impact of whole-body vibration for stress urinary incontinence after radical prostatectomy.ObjectiveTo investigate the effect of whole-body vibration training on stress urinary incontinence after prostate cancer surgery.DesignRandomised controlled trial.SettingTertiary university hospitals.ParticipantsSixty-one patients with mild stress urinary incontinence after radical prostatectomy.InterventionGroup 1 included 30 patients who performed pelvic floor muscle training and whole-body vibration training with a frequency and amplitude of 20 Hz/2 mm for the first two sessions and 40 Hz/4 mm for the rest of the intervention. Group 2 included 31 patients who performed pelvic floor muscle training alone. The intervention in both groups was conducted three times per week for 4 weeks.Main outcomesIncontinence Visual Analogue Scale (I-VAS) score, International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI-SF) score and 24-hour pad test result.ResultsI-VAS score, ICIQ-UI-SF score and 24-hour pad test result showed significant within-group differences at each assessment with the exception of the baseline and post-intervention I-VAS score in Group 2. For example, Group 1 I-VAS score had a median difference of 3.9 cm [95% confidence interval (CI) ?4.0 to ?3.8] from baseline to first follow-up, and a median difference of ?2.0 cm (95% CI ?2.2 to ?1.8) at 4-week follow-up. Comparisons between the groups demonstrated significant differences in favour of Group 1 after 4 weeks of intervention and at follow-up for all measured parameters.ConclusionWhole-body vibration training is an effective modality for treating patients with stress urinary incontinence after prostatectomy.
Trial registrationClinicaltrial.gov (NCT03325660).     

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.     

Relevant patient perceptions and experiences for evaluating quality of interaction with physiotherapists during outpatient rehabilitation: a qualitative study

Objective

To identify elements of the physiotherapist–patient interaction considered by patients when they evaluate the quality of care in outpatient rehabilitation settings.

Design

A qualitative study with nine focus groups, Two researchers conducted the focus groups, and a topic guide with predetermined questions was used. Each group discussion was audiotaped,, transcribed verbatim and analyzed thematically according to a modified grounded theory approach.

Setting

Three postacute ambulatory centers in Barcelona, Madrid and Seville (Spain).

Participants

Fifty-seven adults undergoing outpatient rehabilitation for musculoskeletal conditions/injuries.

Results

Patients based their evaluations of quality of care on their assessment of physiotherapists’ willingness to provide information and education, technical expertise and interpersonal manners (eg. respect, emotional support and sensitivity changes in the patient's status). Both positive and negative aspects of the physiotherapist–patient interaction emerged under all these themes, except for friendly and respectful communication.

Conclusion

This study identified which elements of the physiotherapist–patient interaction are considered by patients when evaluating the quality of care in rehabilitation outpatient settings. Further research should work to develop self-report questionnaires about patients’ experiences of the physiotherapist–patient interaction in rehabilitation services to provide empirical and quantitative evidence.