Developing an Educational Framework for Urological Nursing: Using a World Café approach to gain an emerging international understanding of issues,challenges and responses

A series of three World Café events centred on the topic of developing an Educational Framework for Urological Nursing [EFUN] were held by the British Association of Urological Nurses [BAUN], the European Association of Urology Nurses [EAUN] and the Australian and New Zealand Urological Nursing Society [ANZUNS] between 2017 and 2019. About 376 urology nurses participated in these “conversations that matter” and generated 1047 individual response items that were grouped into themes to assist the three associations to take the creation of an EFUN to the next level. Areas explored centred on four aspects: what any agreed educational framework for urology nursing should contain; the academic level at which education should be provided; who should be recruited as collaborators on writing an educational framework and, lastly, just how any emergent framework should be used. Analysis of the conversational data indicate that there exists within the urological nursing community a collective wisdom regarding their educational needs and how these needs should be met.     

The patient with an implantable cardioverter defibrillator

Electrophysiologic technology developed over the past 20 years has improved the life expectancy of patients who have survived sudden cardiac death events. Use of an implantable cardioverter defibrillator (ICD) continues to increase as more indications for the device are researched. Patients with ICDs will be cared for in the postanesthesia care unit following cardiac and noncardiac surgery and require PACU nurses to be knowledgeable about this advanced and changing technology as well as provide for emotional and psychological needs.     

Validation of a simplified technique for using the POPQ pelvic organ prolapse classification system

Our objective was to determine the inter-examiner agreement of a simplified pelvic organ prolapse quantification (POPQ) exam and to assess its correlation with the standard POPQ exam. This study consists of two parts; both were preformed in a prospective, randomized, blinded fashion on women presenting with complaints attributed to pelvic organ support defects. The first study was done to determine the inter-examiner reliability of a simplified POPQ exam. The simplified POPQ exam is based on the POPQ with similar ordinal staging but with only four points measured instead of nine. Forty-eight women underwent exams by five different investigators. The order of exams was randomized and the examiners were blinded to the results of each other’s findings. The results of these two exams were compared using weighted kappa statistics. The second part of the study was done to determine the inter-system agreement between the simplified vs standard POPQ exam. A group of 49 women were examined by four different investigators: one using the simplified and the other using standard POPQ exams. The order of the exams was randomized and the examiners were blinded to the results of each other’s exam. Kendall’s tau-b statistics were used to determine the inter-system agreement. For the inter-examiner reliability of the POPQ exam, the average age was 60±13 years. The weighted kappa statistics for the inter-examiner reliability of the simplified prolapse classification system were 0.86 for the overall stage, 0.89 and 0.86 for the anterior and posterior vaginal walls, respectively, 0.82 for the apex/cuff, and 0.72 for the cervix. All demonstrate significant agreement. For the inter-system association between the simplified POPQ and standard POPQ, the average age was 61±15 year. The Kendall’s tau-b value for overall stage was 0.90, 0.83, and 0.87 for the anterior and posterior walls respectively, and 0.78 for the cuff/apex and 0.98 for the cervix. There is good inter-examiner agreement of a simplified POPQ classification system and it appears to have good inter-system association with the POPQ.IUGA Standardization of Terminology Committee members: Robert Freeman MD (chairman), Steven Swift, Eckhard Petri MD, Richard J. Scotti MD, and Peter Dwyer MD.     

Receptionists, appointment systems and continuity of care.

The influence of receptionists on continuity of care in four group practices was examined. Twenty two receptionists were observed making 543 appointments and afterwards were interviewed about their personal priority for continuity of care. One of the practices ran a personal list system. It was found that the personal list practice attracted more requests for a specific doctor and time which were then more difficult to satisfy. Most receptionists thought it was important that patients should see the same doctor but their influence seemed to be small compared with that of the doctor as expressed in practice policies. Marked variation in demand for individual doctors was seen in two of the practices without a personal list system.     

The reaction of skin to primers used in the "single-step" bonding systems

A large number of direct bonding systems have been introduced for use by dentists and dental hygienists. Although these agents are used for direct bonding of brackets to enamel, contact with skin, oral mucosa, and gingiva is not uncommon. These products have wide clinical use, but their biocompatibility characteristics have not been extensively investigated. The present study was undertaken to determine the effects of the primer component of Mono-Lok (Rocky Mountain) and the primer component of Control (Lancer Pacific) on skin. Three adult Macaca mulatta monkeys were used in the study. The skin on their backs was shaved and the primer component of Control, primer component of Mono-Lok, and saline solution were applied at different sites every 3 days for up to four applications. The skin was examined clinically and, 5 days after the last application, a biopsy was performed for histologic evaluation. The skin in contact with the primer component of Mono-Lok exhibited pronounced inflammatory changes and was characterized by swelling, vesiculation, and ulceration. Histologic observations confirmed these findings by showing a marked inflammatory cellular response characterized by eosinophils. In contrast to these findings, the skin in contact with the primer component of Control or saline solution exhibited normal architecture. Histologic observations supported this appearance and showed minimal inflammatory cell infiltration. These results show that there are differences in the biocompatibility of direct bonding systems and that further studies are needed to clarify their long-term effects on patients and dental personnel.