Surveying patients about their experience with a urinary catheter

About 15–20% of hospital inpatients are catheterized, and it has been estimated that in an average sized hospital 10–15 patients will die each year from catheter‐related sepsis. Reducing catheterization rates or indwell times has been shown to reduce associated sepsis. This study examined patient experience of catheterization; the rationale for the study was to broaden understanding of catheter impact as part of a wider quality improvement agenda. Fifty patients completed a detailed catheter‐experience patient questionnaire. The patients were all inpatients from 17 wards across a range of specialties. Data were sought on demographics, catheter status, experience and their knowledge of and involvement in the catheter care. Fifty percent gender split. Median catheter time was 5 d (range 2 h to long term). Median age 72 years (range 22–92). Thirty‐four percent (n = 17) of patients did not have the process and options discussed before catheterization. Eighteen percent did not know why they were catheterized. Patients experienced leaking (32%), ‘pain’ (26%), inconvenience (26%), embarrassment (24%), blocking (24%) with 8% finding their catheters ‘restrictive’. Fourteen percent felt they could have coped without the catheter. Urinary catheters have a profound and often negative effect on the inpatient experience. This information can help support and empower colleagues to push for less urinary catheter use in the non‐urological inpatient population and start to better understand the patient experience.     

In the case of prostate cancer patients,are there advantages in cancer nurse‐led follow‐up?

The role of cancer nurse specialist (CNS) has expanded reflecting rapid changes in the field of prostate cancer diagnostics, treatments and improved survival outcomes. Extended roles such as CNS‐led follow‐up are aimed at helping men and their families to cope better with the impact of the disease. Aim of this study is to compare medical with CNS‐led follow‐up by assessing the patient experience, quality of life and emotional wellbeing. Primary sources of research articles were searched on selected databases: MEDLINE (1995 to September 2015), EMBASE (1995 to September 2015) and CINAHL (1995 to September 2015). The Cochrane Collaboration Assessment of Bias Collaboration's tool was used and 10 of 11 studies were selected for data extraction. The process of meta‐analysis was supported by the use of RevMen software version 5·1.7. Although there is some indication that the CNS‐led follow‐up is better, there is no statistically significant difference between medical and CNS‐led follow‐up. This review has found no statistically significant difference between medical and CNS‐led follow‐up. Therefore, it is proposed that CNS can offer a safe and effective follow‐up for people with cancer, including men with prostate cancers.     

Neoadjuvant Chemotherapy and Surgery for Esophageal Adenocarcinoma: Prognostic Value of Circumferential Resection Margin and Stratification of N1 Category

Background  In the UK, it is standard practice to treat esophageal adenocarcinoma with neoadjuvant chemotherapy (no radiation) and surgery. We examined the prognostic value of the status of the circumferential resection margin (CRM) and stratification of the N1 category into 1–4 nodes or ≥5 nodes. Methods  Between 2000 and 2006, 105 patients with radiologically staged T3, T4 or N1 esophageal adenocarcinoma had preoperative chemotherapy. One hundred and one patients had an Ivor Lewis operation with two-field lymphadenectomy, three had a transhiatal operation and one had a three-incision operation. CRM was assessed by painting the specimen with India ink and transverse sections at 5–10 mm intervals. The CRM was considered positive (CRM+) if malignant cells were within 1 mm of the inked margin. Results  There were 87 men. The median age was 61 years (range 37–81 years). Median lymph node yield was 28 (4–77); 86 patients (83%) had ≥18 nodes. Seventy-four patients (70%) had N1 disease, with 1–4 involved nodes in 41 patients (39%) and ≥5 nodes in 33 patients (31%). The CRM was positive in 38 patients (36%). On multivariate analysis, nodal metastasis [N0 versus N1; hazard ratio (HR) 3.3, 3-year survival 80% versus 40%; P = 0.004], CRM status (CRM– versus CRM+: HR 2.6, 3-year survival 64% versus 26%; P = 0.002) and vascular invasion (V0 versus V1: HR 2.2, 3-year survival 67% versus 39%; P = 0.014) retained independently significant prognostic value. N1 patients with 1–4 nodes had longer survival than those with ≥5 nodes (56% versus 21%; P < 0.001). Conclusions  CRM involvement and stratification of the N1 category are independent prognostic factors after multimodal therapy for esophageal adenocarcinoma.