To assess patient satisfaction with the use of Portable Video Media (PVM) for the purpose of taking informed consent for common urological outpatient procedures performed under local anaesthesia. MethodsPatients undergoing the following procedures were approached for recruitment: flexible cystoscopy with or without biopsy, transrectal ultrasound-guided prostate biopsy or flexible cystoscopy with insertion or removal of a ureteric stent. Audio-visual media were developed for each procedure, with each script translated from English into isiXhosa and Afrikaans.The study involved a cross-over for each patient between Standard Verbal Consent (SVC) and PVM consent, with each patient randomised to start with SVC or PVM consent. Each of these consent-arms were assessed via a questionnaire. Results60 patients completed participation, with PVM as the first exposure for 28 patients and 32 patients receiving SVC as their first arm of the study.When comparing the overall satisfaction between SVC and PVM consent (the total scores out of 18 for the questionnaire), patients scored significantly higher for PVM consent (M = 16.3 ± 2.4) compared to SVC (M = 15.4 ± 2.9) (p = 0.002). 92% of the total patient sample preferred PVM consent. 6 ConclusionPVM proved superior to SVC in improving satisfaction in the consent process for common outpatient urological procedures performed under local anaesthesia.

Selective non-operative management for penetrating injuries to the kidney is widely accepted. The management of a retained projectile within the kidney remains unclear. We present a case of bilateral renal gunshot wound (GSW) which was managed non-operatively. The patient presented with a peculiar complication of renal colic due to a migrated projectile 5 months post injury. Retained projectiles within the renal collecting system have a risk for stone formation and migration.

The splash and spray and tidal zones are generally assumed to be the most severe marine exposure environments with respect to steel reinforcement corrosion in concrete structures. However, it has been observed in several aged marine structures along the Southern African coastlines, that there is usually relatively insignificant reinforcement corrosion damage in the tidal zone, despite very high (above-threshold) chloride contents. To develop a full understanding of the severity of marine exposure conditions with regard to the actual deterioration, it is imperative that other factors that directly affect corrosion, such as oxygen availability at the steel surface (which is influenced by concrete quality, cover thickness and moisture condition), are carefully considered. The laboratory experimental work in the study presented in this paper comprised of different cover depths (10, 20 and 30 mm) and w/b ratios (0.5 and 0.8) and simulated marine tidal, splash and submerged environments. The results show that for any give exposure environment, the relative influence of each of the various factors considered should be considered in conjunction with the other factors; this finding can be generalized to include all relevant factors that can affect corrosion in a given exposure environment including ambient temperature. For example, a cover depth of 30 mm in the tidal zone with a simulated intertidal duration of 6 h effectively resulted in similar corrosion behavior to that in the submerged zone. The paper concludes that engineers should consider these factors when applying standard exposure classes in the design for durability of marine structures.

BackgroundMoore et al.1 reported that nurse led initiatives can reconfigure care, making it more responsive to individual needs, increasing patient satisfaction and reducing hospital visits. Nurse-led telephone follow up clinics post surgery have evidence of patient satisfaction and reduction in post-op complications,2 but this is not a routine intervention post thoracic surgery. Prior to establishing our clinic, patients were discharged after thoracic surgery with a surgical outpatient appointment at 6 weeks and no routine community follow up. These patients had often undergone complicated surgery, and been discharged with chest drains or on strong opioids.MethodsAll patients discharged after surgery were contacted by telephone up to a maximum of a week after discharge with a further follow up call 2 weeks later if needed. A protocol of open questions was used to identify post-op difficulties at an early stage, facilitate referral to community teams, improve patient experience and provide additional information.Results and conclusion29 patients were contacted over a 6 month period, following discharge after thoracic surgery; VATs, lobectomy, sleeve/wedge resection, pneumonectomy and pleurectomy. Each call lasted up to 20 min, equating to a maximum 10 h of nurse time.Telephone clinic highlighted a number of medical issues that required intervention and prevented GP and hospital appointments/admissions. Commonly reported symptoms included pain, shortness of breath, fatigue, constipation, weight loss and inability to sleep. In most cases simple advice and reassurance could be given. In 3 cases, medication was organised (antibiotics, laxatives, analgesia). A referral to the GP or community services was organised in 4 cases. Patient satisfaction was high however further evaluation over a longer period is needed. Additional study is necessary to explore the cost implications and the monetary value of avoiding admissions.References1 Moore S, Corner J, Haviland J, et al. Nurse led follow up and conventional medical follow up in management of patients with lung cancer: randomised trial. BMJ 2002;325:11452 Young JM, Butow PN, Walsh J, et al. Multicenter randomized trial of centralized nurse-led telephone-based care coordination to improve outcomes after surgical resection for colorectal cancer: The CONNECT intervention. J Clin Oncol. 2013;31:3585–91