ORCID Profile
0000-0001-5975-0074
Current Organisation
Western Sydney Local Health District
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Publisher: SAGE Publications
Date: 25-04-2017
Abstract: The purpose of this study was to determine whether commonly used methods of securing an indwelling catheter decrease the force transmission along the indwelling catheter to the bladder neck in response to an externally applied force. A test apparatus was constructed to simulate key features of a catheter drainage system. A “bladder neck” was suspended from a force gauge, with an indwelling catheter inserted through it, tensioned with a urine drainage bag. The system was calibrated, and various methods of securement were tested, with the level of force transmitted to the bladder neck recorded. The methods of securement tested included: adhesive tape taped used a number of ways (including direct taping and a taped mesentery), and three commercially available devices. Some securement devices were able to completely eliminate force transmission to the bladder neck (the Flexi-Trak and Grip-Lok devices). A taped mesentery performed well reducing the transmitted force by up to 85% compared with an unsecured control. Within the limitations of this study we were able to demonstrate that some of the commonly used methods of securing indwelling catheters do work. We were also able to show that adhesive tape was still effective, although not as effective as commercially available devices.
Publisher: Springer Science and Business Media LLC
Date: 21-06-2022
DOI: 10.1186/S12894-022-01043-2
Abstract: The effects of the COVID-19 pandemic on healthcare in Australia have yet to be fully determined. There are well documented decreases in the rates of screening and diagnostic testing for many cancers in 2020, with commensurate stage migration of cancers when they are eventually detected. We aimed to determine whether there was a decrease in the rate of prostate cancer (PC) screening and testing in Australia in 2020. Data was extracted from the Department of Human Services (DHS) website for Medicare Benefits Schedule (MBS) item numbers for tests pertinent to detection of Prostate Cancer. This data is de-identified and publicly available. Data was analysed at both a national, and a state level. For 2020 nationwide the percentage change for prostate cancer testing was minor with 97% as many PSA tests, 99% as many prostate MRIs, and 105% as many prostate biopsies as the average for the preceding years. The differences were not significant (PSA tests p = 0.059 and prostate biopsies p = 0.109). The predicted values are fairly similar to both the average values for the preceding 5 years and the actual number of tests done in 2020. With exception of PSA tests in Victoria the actual number of tests performed was within the 95% Prediction Interval (performed: 167,426 predicted 171,194–196,699 p = 0.015). The current pandemic has had a widespread reach across Australia, with varying impact across each state and territory. Contrary to the trends across the world, our data suggest that during 2020 in Australia most areas remained unaffected in terms of prostate cancer testing excluding Victoria, which had statistically significant decrease in the number of PSA tests correlating with the extended lockdown that occurred in the state.
Publisher: Wiley
Date: 02-08-2017
DOI: 10.1111/ANS.14126
Abstract: Ureteric stents are indispensable tools in modern urology however, the risk of them not being followed-up once inserted poses medical and medico-legal risks. Stent registers are a common solution to mitigate this risk however, manual registers are logistically challenging, especially for busy units. Western Sydney Local Health District developed a novel Semi-Automatic Electronic Stent Register (SAESR) utilizing billing information to track stent insertions. To determine the utility of this system, an audit was conducted comparing the 6 months before the introduction of the register to the first 6 months of the register. In the first 6 months of the register, 457 stents were inserted. At the time of writing, two of these are severely delayed for removal, representing a rate of 0.4%. In the 6 months immediately preceding the introduction of the register, 497 stents were inserted, and six were either missed completely or severely delayed in their removal, representing a rate of 1.2%. A non-inferiority analysis found this to be no worse than the results achieved before the introduction of the register. The SAESR allowed us to improve upon our better than expected rate of stents lost to follow up or severely delayed. We demonstrated non-inferiority in the rate of lost or severely delayed stents, and a number of other advantages including savings in personnel costs. The semi-automatic register represents an effective way of reducing the risk associated with a common urological procedure. We believe that this methodology could be implemented elsewhere.
Publisher: SAGE Publications
Date: 28-06-2017
Abstract: To establish the comprehension of urological abbreviations by non-urologists, and evaluate the awareness of urologists to this issue. This study involved complimentary surveys to non-urologists and urologists in the same area. The non-urologist survey was distributed to three groups: medical students, junior doctors, GPs and GP trainees. It assessed the comprehension of 24 commonly used urological abbreviations. The urologists’ survey assessed the urologists’ expectations of comprehension by each of the non-urologist groups. A total of 196 non-urologists (19 medical students, 35 junior doctors and 142 GPs and GP trainees), and 11 urologists and urological trainees participated. On average the junior doctors and GPs understood approximately the same number of abbreviations (9.86 and 9.62 correct, respectively), with the medical students understanding fewer (7.89 correct). While this difference was statistically significant (F 2,193df =3.875, P=0.022), gender, number of years post-graduation and completion of a urology term were not shown to have an impact on the comprehension of urological abbreviations. Of the 24 abbreviations, nine were correctly understood by more than 50% of non-urologists. The urologists did not expect non-urologists to understand a majority of the abbreviations however, most also reported not using abbreviations routinely in communications with non-urologists. These results suggest that caution must be used when using abbreviations in communication with non-urologists as there is a high chance of the recipient not understanding the abbreviations. This is particularly pertinent given the current rollout of electronic medical records across Australia.
Publisher: Hindawi Limited
Date: 2016
DOI: 10.1155/2016/1853015
Abstract: Advances in the treatment of melanoma are resulting in patients living for extended periods after being diagnosed with metastatic disease. Metastases to the ureter are rare, but they have been described in the literature on a number of occasions. In this case report, we describe a patient with established metastatic melanoma who, whilst taking and responding to immunomodulatory therapy, was found to have an obstructive mass in the middle of his left ureter. Rather than performing either a nephroureterectomy or partial resection of the ureter, we opted to perform an endoscopic resection of the melanoma. Follow-up imaging at 12 months shows no evidence of local disease recurrence. We submit that primary endoscopic management of metastatic melanoma in the ureter is a viable alternative to a radical approach.
Publisher: Elsevier BV
Date: 12-2019
DOI: 10.1016/J.UROLOGY.2019.08.048
Abstract: To determine if differences exist in the pathological characteristics of prostate cancer occurring in younger men as compared to the disease when it occurs in older men. A retrospective cohort study was conducted on prostatectomy specimens from the prostate cancer database of a single large Australian pathology practice which services a large proportion of hospitals within 1 state. Data were extracted regarding the pathological characteristics of the cancers and a univariate analysis was conducted against 2 age cutoffs. Data were extracted for all prostatectomy specimens between 2011 and 2017 in 11,551 men. One hundred and thirty-two men were 45 years old and younger, and 545 were 50 years old and younger. Statistically significant differences were found in a number of pathological characteristics. Younger men had lower grade group disease, and within that had less adverse pathological characteristics. In particular, even after controlling for confounding in men 45 and younger, in Grade Group 2 disease there was a lower risk of extra prostatic extension (17.5% vs 34.4%, P = .003), and lymph node involvement (0% vs 0.8%, P = .006), with trends toward superiority in other domains. Our results demonstrate that prostate cancer in younger men tends to be lower grade and stage disease compared to older men. This is in contrast to persistent views within the urological community and may have an impact on disease management in younger men.
Publisher: Wiley
Date: 23-06-2023
DOI: 10.1002/BCO2.171
Abstract: The objective of this study is to present our initial experience with a novel parenchymal cl (NPC) developed to allow partial nephrectomies (PN) to be performed without whole kidney ischaemia. We compare patients who underwent PN with the NPC with those undergoing standard PNs. The NPC applies pressure only to the portion of the parenchyma containing the small renal mass (≤3.5 cm) and interrupts regional blood flow. A retrospective analysis was conducted on patients that underwent open PN within our unit. Minimum follow‐up was 12 months. Patient and disease characteristics, perioperative outcomes and renal function estimated Glomerular Filtration Rate (eGFR) were compared. Data were collected on 63 patients, of whom 33 had their procedure performed with the NPC. Demographic characteristics and comorbidity profiles were not significantly different between groups (p between 1.0 and 0.08). RENAL nephrometry scores were 5.6 in the NPC group versus 6.2 in the standard PN group ( p = 0.146). Perioperative, operative and postoperative data did not show significant differences. There was no difference in the rates of Clavien‐Dindo III or above complications between the two groups (NPC 3/33 vs. standard PN 5/30, p = 0.416). There was also no statistically significant difference to changes in renal functional at 12 months (change −5.2 and −6.4, p = 0.712). Despite the limited s le size and follow‐up, this study establishes the safety of the NPC. In the future, we intend to perform a prospective study on the laparoscopic version.
Publisher: Elsevier BV
Date: 05-2018
Publisher: Wiley
Date: 08-2021
DOI: 10.1111/AJR.12763
Abstract: To demonstrate the magnitude of the potential problem caused by the trend towards using positron emission tomography prostate‐specific membrane antigen scans on men in rural Australia. Prostate‐specific membrane antigen positron emission tomography scans have higher sensitivity to detect metastatic prostate cancer than other imaging modalities, especially at lower prostate specific antigen (PSAs). This has led to proposals that prostate‐specific membrane antigen be the gold standard to investigate men with a suspicion of prostate cancer. There is a trial underway in Australia examining the use of positron emission tomography prostate‐specific membrane antigen in pre‐biopsy men. Disparities in access to care and outcomes for prostate cancer for men in rural Australia are well documented. Incorporating positron emission tomography prostate‐specific membrane antigen into the primary diagnostic pathway for prostate cancer creates a risk of further entrenching or worsening this inequity due to the lack of positron emission tomography scanners in rural locations. As a surrogate marker for restricted access, we determined the proportion of men over 50 more than 1.5 hours from a positron emission tomography scanner, with local government areas as the unit of assessment. Of the 505 local government areas, 309 were greater than 1.5 hours from the nearest positron emission tomography scanner. Of 3 793 865 men, over 50 585 689 lived in the 309 local government areas with restricted access to a positron emission tomography scanner. Our study highlights the risk of exacerbating inequalities in prostate cancer care experienced by men in rural areas. If positron emission tomography prostate‐specific membrane antigen becomes the new gold standard, one in 6 men will face geographic barriers to access the standard of care. Future considerations of positron emission tomography prostate‐specific membrane antigen must take this into account.
No related grants have been discovered for James Macneil.