[The nurse practitioner as responsible clinician: opportunities and challenges].

Background: The Compulsory Mental Health Care Act in the Netherlands (CMHCA) came into effect in 2020. Mental health nurse practitioners have since been allowed to be ‘responsible clinician’ However, there seems to be diversity in the implementation of the role in practice.

Aim: To investigate the state of affairs regarding the role of the mental health nurse practitioners as ‘responsible clinician’ within the CMHCA and reflecting on this topic.

Physician Payment Incentives and Active Surveillance in Low-Risk Prostate Cancer.

Importance: Active surveillance in men with less aggressive prostate cancer is inconsistently used despite clinical guidelines. Renumeration generally favors treatment over conservative management and may contribute to the variable adoption of active surveillance, which suggests that value-based payment incentives may promote guideline-concordant care.

Objective: To describe the adoption of active surveillance in low-risk prostate cancer, following the initiation of a novel payment incentive sponsored by a commercial payer to support its use.

The use of nephron-sparing intervention does not appear to be compromised after a period of active surveillance for patients with cT1 renal masses.

Introduction And Objective: It remains unknown whether the use of nephron sparing intervention (NSI) is impacted with delayed intervention after a period of active surveillance (AS) compared with immediate intervention for patients with clinically localized renal masses ≤7cm (cT1RMs). We hypothesized that the proportion of patients undergoing NSI is similar among patients undergoing immediate and delayed intervention for cT1RMs.

Methods: We retrospective reviewed the prospectively maintained Michigan Urological Surgery Improvement Collaborative (MUSIC) registry for patients undergoing intervention for cT1RMs from 05/2017 to 09/2023.

Renal Mass Biopsy Is Associated With Fewer Radical Nephrectomies for Benign or Indolent Disease, Particularly for T1b Renal Masses.

Introduction: How renal mass biopsy (RMB) impacts patient management with T1 renal masses (T1RMs) is unclear. We explore the association between RMB and utilization of active surveillance (AS), nephron-sparing interventions, and radical nephrectomy (RN).

Methods: Data were analyzed retrospectively using the MUSIC-KIDNEY (Michigan Urological Surgery Improvement Collaborative Kidney Mass: Identifying and Defining Necessary Evaluation and Therapy) registry.

The Impact of the COVID-19 Pandemic on the Cost of the Urology Application Process.

Objective: To review the self-reported costs of urology residency applications from 2019 to 2023 and examine the impact of Society of Academic Urologists (SAU) policy changes made during the COVID-19 pandemic on these costs.

Methods: Data from the Texas Seeking Transparency in Applications to Residency (STAR) survey were used to evaluate costs incurred by fourth-year urology residency applicants from U.S.

Surgeon Skill and Perioperative Outcomes in Robot-Assisted Partial Nephrectomy.

Importance: Technical skill in complex surgical procedures may affect clinical outcomes, and there is growing interest in understanding the clinical implications of surgeon proficiency levels.

Objectives: To determine whether surgeon scores representing technical skills of robot-assisted kidney surgery are associated with patient outcomes.

Design, Setting, And Participants: This quality improvement study included 10 urological surgeons participating in a surgical collaborative in Michigan from July 2021 to September 2022.

A Prospective Observational Study of Posterior Tibial Nerve Stimulation in Multiple Sclerosis.

Introduction And Hypothesis: The objective was to examine the outcomes of posterior tibial nerve stimulation (PTNS) on bladder, bowel, and sexual health-related quality of life among a cohort of patients with multiple sclerosis (MS) with refractory lower urinary tract symptoms (LUTS).

Methods: Patients with MS and refractory LUTS were recruited for a prospective, observational study using PTNS to treat their symptoms. Patients underwent 12 weekly 30-min PTNS sessions and bladder, bowel, and sexual symptoms were evaluated at baseline, 3, 12, and 24 months with voiding diaries, visual analog scales (VAS), and validated patient-reported questionnaires, including the American Urological Association Symptom Score (AUA-SS), Neurogenic Bladder Symptom Score (NBSS), Michigan Incontinence Symptom Index (M-ISI), Health Status Questionnaire, Sexual Satisfaction Scale, and Bowel Control Scale.

Conversion to Radical Nephrectomy From Robotic Partial Nephrectomy Is Most Commonly Due to Anatomic and Oncologic Complexity.

Purpose: Partial nephrectomy is standard-of-care treatment for small renal masses. As utilization of partial nephrectomy increases and includes larger and complex tumors, the risk of conversion to radical nephrectomy likely increases. We evaluated incidence and reason for conversion to radical nephrectomy in patients scheduled for partial nephrectomy by surgeons participating in MUSIC (the Michigan Urologic Surgery Improvement Collaborative).

Antisperm Antibody Levels After Vasectomy Reversal Are Not Associated With Pregnancy Rates or Method of Conception.

Objective: To examine the relationship between antisperm antibody (ASA), pregnancy rates, and method of conception following vasectomy reversal, given that before and after vasectomy reversal, patients wonder if ASAs will prevent them from achieving pregnancy and American Urological Association vasectomy guidelines call for additional research to answer this question.

Methods: We performed retrospective chart review and phone interview of patients who underwent vasectomy reversal at our institution from 1/1/2000 to 12/31/2018. We excluded patients who underwent vasectomy reversal for pain, or without postoperative semen analysis with ASA.

Poor Glycemic Control Increases Dental Risk in a Sri Lankan Population.

The aim of our study was to investigate the impact of diabetes-related factors on the dental disease outcomes of diabetes patients in Trincomalee, Sri Lanka. Dental data were collected from 80 type-2-diabetic individuals. A dental risk score was calculated based on the frequency of dental outcomes observed and categorized as low risk (≤3 dental outcomes) and high risk (>3 dental outcomes).

Practice-Level Variation in Opioid-Free Discharge Following Surgery for T1 Renal Masses: A MUSIC-KIDNEY Analysis.

Introduction: Opioid prescription following surgery has played a role in the current opioid epidemic. We evaluated practice-level variation in opioid prescribing following surgery for cT1 renal masses and examined the relationships between opioid-free discharge and postoperative emergency department (ED) visits and readmissions.

Methods: We retrospectively examined all T1 renal mass (RM) patients with data regarding postoperative opioid prescriptions within the Michigan Urological Surgery Improvement Collaborative-Kidney Mass: Identifying and Defining Necessary Evaluation and Therapy (MUSIC-KIDNEY) registry from April 2021 to March 2023.

Does Urologist-level Utilization of Active Surveillance for Low-risk Prostate Cancer Correspond with Utilization of Active Surveillance for Small Renal Masses?

Active surveillance (AS) for prostate cancer (CaP) or small renal masses (SRMs) helps in limiting the overtreatment of indolent malignancies. Implementation of AS for these conditions varies substantially across individual urologists. We examined the Michigan Urological Surgery Improvement Collaborative (MUSIC) registry to assess for correlation of AS between patients with low-risk CaP and patients with SRM managed by individual urologists.

Testicular catch-up growth in the non-operative management of the adolescent varicocele.

Introduction: Adolescent varicocele is a common urologic condition with a spectrum of outcomes, leading to variations in management. Testicular hypotrophy is a common indication for surgery Routine monitoring may be an appropriate form of management for many adolescents with testicular hypotrophy, as studies have shown that a large proportion of these patients may experience catch-up growth of the ipsilateral testis. Furthermore, there are few longitudinal studies which have correlated patient specific factors to catch-up growth.

Initial Management of Indeterminate Renal Lesions in a Statewide Collaborative: A MUSIC-KIDNEY Analysis.

Purpose: Renal masses can be characterized as "indeterminate" due to lack of differentiating imaging characteristics. Optimal management of indeterminate renal lesions remains nebulous and poorly defined. We assess management of indeterminate renal lesions within the MUSIC-KIDNEY (Michigan Urological Surgery Improvement Collaborative-Kidney mass: Identifying and Defining Necessary Evaluation and therapY) collaborative.

Age, race, insurance type, and digital divide index are associated with video visit completion for patients seen for oncologic care in a large hospital system during the COVID-19 pandemic.

Introduction: The COVID-19 pandemic drove rapid adoption of telehealth across oncologic specialties. This revealed barriers to telehealth access and telehealth-related disparities. We explored disparities in telehealth access in patients with cancer accessing oncologic care.

Cystic renal-epithelial derived induced pluripotent stem cells from polycystic kidney disease patients.

Autosomal-dominant polycystic kidney disease (ADPKD) is the most common inherited kidney disease, leading to kidney failure in most patients. In approximately 85% of cases, the disease is caused by mutations in PKD1. How dysregulation of PKD1 leads to cyst formation on a molecular level is unknown.

[Working with hearing impairment: an integrated approach].

Patients with hearing impairment are more likely to encounter health problems and difficulties at work than their colleagues with normal hearing. This is often not realised by either patients or professionals. In this article we describe three cases that illustrate how working conditions can influence the health of workers with hearing loss.

A process evaluation of implementing a vocational enablement protocol for employees with hearing difficulties in clinical practice.

Objective: A multidisciplinary vocational rehabilitation programme, the Vocational Enablement Protocol (VEP) was developed to address the specific needs of employees with hearing difficulties. In the current study we evaluated the process of implementing the VEP in audiologic care among employees with hearing impairment.

Design: In conjunction with a randomized controlled trial, we collected and analysed data on seven process parameters: recruitment, reach, fidelity, dose delivered, dose received and implemented, satisfaction, and perceived benefit.

Year-round grazing to counteract effects of atmospheric nitrogen deposition may aggravate these effects.

Excessive nitrogen input in natural ecosystems is a major threat to biodiversity. A coastal dune area near Amsterdam in the Netherlands suffers from high atmospheric nitrogen deposition affecting sensitive habitats such as fixed coastal dunes with herbaceous vegetation ('grey dunes'). To mitigate its effect year round grazing was applied from 2007 until 2012.

Iron-rich dune grasslands: relations between soil organic matter and sorption of Fe and P.

Effects of high atmospheric nitrogen-deposition partly depend on availability of phosphate. Lime-poor, but iron-rich dune grasslands are supposedly protected from grass-encroachment, due to P-fixation in iron phosphate. However, in iron-rich Dutch hinterdunes, dunes have low, but dry former beach plains high grass-encroachment.

Clinical and cytogenetic analyses in uveal melanoma.

Purpose: Uveal melanoma is one of the most frequently occurring primary intraocular malignancies in the Western world. Cytogenetically these tumors are characterized by typical chromosomal losses and gains, such as loss of 1p, 3, and 6q and gain of 6p and 8q. Whereas most studies focus on known aberrations, in this one, cytogenetic changes were characterized and correlated with clinical and histopathologic parameters.

Concurrent loss of chromosome arm 1p and chromosome 3 predicts a decreased disease-free survival in uveal melanoma patients.

Purpose: Uveal melanoma is a highly malignant disease with a mortality rate of 50% at 10 to 15 years. Previous studies have shown that chromosomal changes are associated with decreased survival of the patient. However, in these studies the small number of tumors analyzed did not allow robust statistical analysis.