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Zhao CC, Comiter CV, Elliott CS. Perspectives on technology: Single-use catheters - evidence and environmental impact. BJU Int 2024; 133:638-645. [PMID: 38438065 DOI: 10.1111/bju.16313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
OBJECTIVE To explore the data comparing single- vs multi-use catheters for clean intermittent catheterisation (CIC), consider if the widespread use of single-use catheters is warranted given the cost and environmental impact, and put forth ideas for future consideration. METHODS A primary literature review was performed in PubMed over the past 50 years. Studies that performed comparative analysis of single- and multi-use catheters were included in our review. All studies that reported on primary data were narratively summarised. RESULTS A total of 11 studies were identified that reported on primary data comparing single- and multi-use catheters. There was no appreciable evidence suggesting reusable multi-use catheters were inferior to single-use catheters from an infection or usability standpoint. In addition, the environmental and monetary burden of single-use catheters is significant. CONCLUSIONS The intermittent catheter landscape in the USA has a complex past: defined by policy, shaped by industry, yet characterised by a paucity of data demonstrating superiority of single-use over multi-use catheters. We believe that the aversion to reusable catheters by many patients and healthcare professionals is unwarranted, especially given the cost and environmental impact. Moving forward, better comparative data and more sustainable practices are needed.
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Affiliation(s)
- Calvin C Zhao
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | - Craig V Comiter
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | - Christopher S Elliott
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
- Division of Urology, Santa Clara Valley Medical Center, San Jose, CA, USA
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Calderón-Juárez M, Samejima S, Rempel L, Sachdeva R, Krassioukov A. Autonomic dysreflexia in urological practice: pathophysiology, prevention and treatment considerations. World J Urol 2024; 42:80. [PMID: 38358540 DOI: 10.1007/s00345-024-04781-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/09/2024] [Indexed: 02/16/2024] Open
Abstract
PURPOSE Spinal cord injury (SCI) leads to sensorimotor impairments; however, it can also be complicated by significant autonomic dysfunction, including cardiovascular and lower urinary tract (LUT) dysfunctions. Autonomic dysreflexia (AD) is a dangerous cardiovascular complication of SCI often overlooked by healthcare professionals. AD is characterized by a sudden increase in blood pressure (BP) that can result in severe cardiovascular and cerebrovascular complications. In this review, we provide an overview on the clinical manifestations, risk factors, underlying mechanisms, and current approaches in prevention and management of AD. METHODS After conducting a literature research, we summarized relevant information regarding the clinical and pathophysiological aspects in the context of urological clinical practice CONCLUSIONS: The most common triggers of AD are those arising from LUT, such as bladder distention and urinary tract infections. Furthermore, AD is commonly observed in individuals with SCI during urological procedures, including catheterization, cystoscopy and urodynamics. Although significant progress in the clinical assessment of AD has been made in recent decades, effective approaches for its prevention and treatment are currently lacking.
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Affiliation(s)
- Martín Calderón-Juárez
- International Collaboration On Repair Discoveries, Faculty of Medicine, The University of British Columbia, 818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, The University of British Columbia, Vancouver, Canada
| | - Soshi Samejima
- International Collaboration On Repair Discoveries, Faculty of Medicine, The University of British Columbia, 818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, The University of British Columbia, Vancouver, Canada
| | - Lucas Rempel
- International Collaboration On Repair Discoveries, Faculty of Medicine, The University of British Columbia, 818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
- Faculty of Medicine, The University of British Columbia, Vancouver, Canada
| | - Rahul Sachdeva
- International Collaboration On Repair Discoveries, Faculty of Medicine, The University of British Columbia, 818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, The University of British Columbia, Vancouver, Canada
| | - Andrei Krassioukov
- International Collaboration On Repair Discoveries, Faculty of Medicine, The University of British Columbia, 818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada.
- Division of Physical Medicine and Rehabilitation, Department of Medicine, The University of British Columbia, Vancouver, Canada.
- GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, BC, Canada.
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Xing H, Dai H, Li B, Yuan X, Liu X, Cui G, Liu N, Biering-Sørensen F. Factors associated with urinary tract infection in the early phase after performing intermittent catheterization in individuals with spinal cord injury: a retrospective study. Front Med (Lausanne) 2023; 10:1257523. [PMID: 38046407 PMCID: PMC10691259 DOI: 10.3389/fmed.2023.1257523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/23/2023] [Indexed: 12/05/2023] Open
Abstract
Objectives To investigate the occurrence rate of urinary tract infections (UTIs) in the early phase after performing intermittent catheterization (IC) and to explore the possible factors associated with UTIs after performing IC among people with spinal cord injury (SCI). Setting An inpatient rehabilitation department of a teaching hospital in China. Design Retrospective chart review. Methods A retrospective chart review was carried out for traumatic and non-traumatic SCI patients after performing IC during their inpatient stay. Demographic information, comorbidity of diabetes, urine analysis results before IC, method of IC (sterile or clean), use of bladder irrigation, cessation of IC and its reasons, and UTI events were collected. Results A total of 183 adult individuals were included, of which 60 (32.8%) of them were women. The median age was 49.0 years. The median time post-injury was 2 months. The overall occurrence rate of UTI after performing IC was 1.31 (95% confidence intervals: 0.96-1.77) events per 100 days. Sixty-nine (37.7%) patients discontinued IC during hospitalization, and UTIs were the leading reason for cessation (50.7%). Female sex, use of antibiotics for infections other than UTI, and use of bladder irrigation were found to be associated with a lower occurrence rate of UTI in the early phase after performing IC, with an odds ratio of 0.38 (p = 0.019), 0.20 (p = 0.022), and 0.24 (p < 0.001), respectively. Conclusion UTI after performing IC is prevalent among people with SCI. The study indicated that antibiotic prophylaxis and routine bladder irrigation might be associated with the reduction in UTI in the early phase after performing IC. Further research is needed to provide more evidence.
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Affiliation(s)
- Huayi Xing
- Department of Rehabilitation Medicine, Peking University Third Hospital, Beijing, China
| | - Hongyue Dai
- Department of Rehabilitation Medicine, Peking University Third Hospital, Beijing, China
| | - Baohua Li
- Department of Nursing, Peking University Third Hospital, Beijing, China
| | - Xiaoning Yuan
- Department of Hospital-Acquired Infection Control, Peking University Third Hospital, Beijing, China
| | - Xiaoxuan Liu
- Department of Rehabilitation Medicine, Peking University Third Hospital, Beijing, China
| | - Guoqing Cui
- Department of Rehabilitation Medicine, Peking University Third Hospital, Beijing, China
| | - Nan Liu
- Department of Rehabilitation Medicine, Peking University Third Hospital, Beijing, China
| | - Fin Biering-Sørensen
- Clinic for Spinal Cord Injuries, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Santos-Pérez de la Blanca R, Medina-Polo J, González-Padilla D, Cano-Galán MM, Arrébola-Pajares A, Hernández-Arroyo M, Rodríguez-Antolín A. Evaluation of Quality of Life and Self-reported Complications in Patients With Clean Intermittent Catheterization: An Observational Study. J Wound Ostomy Continence Nurs 2023; 50:400-405. [PMID: 37713351 DOI: 10.1097/won.0000000000001002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
PURPOSE This study sought to determine health-related quality of life and self-reported complications associated with clean intermittent catheterization (CIC). DESIGN Observational, cross-sectional study. SUBJECTS AND SETTING The target population was patients cared for by the urology department at Hospital 12 de Octubre in Madrid, Spain, undergoing CIC for chronic urinary retention of any etiology (neurogenic bladder dysfunction, neobladder, and other). The sample comprised 50 respondents with a mean age of 49 years; a majority (66%, n = 33) were female. Participants performed an average of 4 CICs. METHODS All participants completed the ISC-Q (Intermittent Self-Catheterization Questionnaire) and a questionnaire about CIC-associated complications. Data were collected in February 2019. RESULTS A vast majority of respondents (98%, n = 49) indicated preparation for catheterization was simple, and 76% (n = 38) indicated the catheter was easy to insert. One in 5 (20%, n = 10) considered carrying catheters and supplies inconvenient, though 58% (n = 29) indicated it was easy to dispose of the catheters outside the home. Most respondents (98%, n = 49) indicated they felt self-conscious about their need to self-catheterize, and 16% (n = 8) felt that CIC created limitations when visiting friends and family. The most frequent complication was symptomatic urinary tract infections (UTIs); participants reported an average of 1.7 UTIs in the last year. Additional complications, such as epididymo-orchitis, urethral stenosis, and urethral bleeding, were reported by less than 5% (n = 2) of participants. CONCLUSIONS Participants managed by CIC for chronic urinary retention of any cause reported acceptable levels of satisfaction with the procedure. The reported incidence of complications was low, except for UTIs.
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Affiliation(s)
- Rocío Santos-Pérez de la Blanca
- Rocío Santos-Pérez de la Blanca, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- José Medina-Polo, PhD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Daniel González-Padilla, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- María Mercedes Cano-Galán, Nurse, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Ana Arrébola-Pajares, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Mario Hernández-Arroyo, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Alfredo Rodríguez-Antolín, PhD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
| | - José Medina-Polo
- Rocío Santos-Pérez de la Blanca, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- José Medina-Polo, PhD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Daniel González-Padilla, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- María Mercedes Cano-Galán, Nurse, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Ana Arrébola-Pajares, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Mario Hernández-Arroyo, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Alfredo Rodríguez-Antolín, PhD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
| | - Daniel González-Padilla
- Rocío Santos-Pérez de la Blanca, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- José Medina-Polo, PhD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Daniel González-Padilla, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- María Mercedes Cano-Galán, Nurse, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Ana Arrébola-Pajares, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Mario Hernández-Arroyo, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Alfredo Rodríguez-Antolín, PhD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
| | - María Mercedes Cano-Galán
- Rocío Santos-Pérez de la Blanca, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- José Medina-Polo, PhD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Daniel González-Padilla, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- María Mercedes Cano-Galán, Nurse, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Ana Arrébola-Pajares, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Mario Hernández-Arroyo, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Alfredo Rodríguez-Antolín, PhD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
| | - Ana Arrébola-Pajares
- Rocío Santos-Pérez de la Blanca, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- José Medina-Polo, PhD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Daniel González-Padilla, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- María Mercedes Cano-Galán, Nurse, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Ana Arrébola-Pajares, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Mario Hernández-Arroyo, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Alfredo Rodríguez-Antolín, PhD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
| | - Mario Hernández-Arroyo
- Rocío Santos-Pérez de la Blanca, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- José Medina-Polo, PhD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Daniel González-Padilla, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- María Mercedes Cano-Galán, Nurse, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Ana Arrébola-Pajares, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Mario Hernández-Arroyo, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Alfredo Rodríguez-Antolín, PhD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
| | - Alfredo Rodríguez-Antolín
- Rocío Santos-Pérez de la Blanca, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- José Medina-Polo, PhD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Daniel González-Padilla, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- María Mercedes Cano-Galán, Nurse, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Ana Arrébola-Pajares, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Mario Hernández-Arroyo, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Alfredo Rodríguez-Antolín, PhD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
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Miller T, Lange D, Kizhakkedathu JN, Yu K, Felix D, Samejima S, Shackleton C, Malik RN, Sachdeva R, Walter M, Krassioukov AV. The Microbiological Burden of Short-Term Catheter Reuse in Individuals with Spinal Cord Injury: A Prospective Study. Biomedicines 2023; 11:1929. [PMID: 37509568 PMCID: PMC10377649 DOI: 10.3390/biomedicines11071929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023] Open
Abstract
Despite the risk of developing catheter-associated urinary tract infections (CAUTI), catheter reuse is common among people with spinal cord injury (SCI). This study examined the microbiological burden and catheter surface changes associated with short-term reuse. Ten individuals with chronic SCI reused their catheters over 3 days. Urine and catheter swab cultures were collected daily for analysis. Scanning electron microscopy (SEM) and X-ray photoelectron spectroscopy (XPS) analyses were used to assess catheter surface changes. Catheter swab cultures showed no growth after 48 h (47.8%), skin flora (28.9%), mixed flora (17.8%), or bacterial growth (5.5%). Asymptomatic bacteriuria was found for most participants at baseline (n = 9) and all at follow-up (n = 10). Urine samples contained Escherichia coli (58%), Klebsiella pneumoniae (30%), Enterococcus faecalis (26%), Acinetobacter calcoaceticus-baumannii (10%), Pseudomonas aeruginosa (6%) or Proteus vulgaris (2%). Most urine cultures showed resistance to one or more antibiotics (62%). SEM images demonstrated structural damage, biofilm and/or bacteria on all reused catheter surfaces. XPS analyses also confirmed the deposition of bacterial biofilm on reused catheters. Catheter surface changes and the presence of antibiotic-resistant bacteria were evident following short-term reuse, which may increase susceptibility to CAUTI in individuals with SCI despite asymptomatic bacteriuria.
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Affiliation(s)
- Tiev Miller
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
| | - Dirk Lange
- Department of Urologic Sciences, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- The Stone Centre at Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada
| | - Jayachandran N Kizhakkedathu
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- Centre for Blood Research, Life Science Institute, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- The School of Biomedical Engineering, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
| | - Kai Yu
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- Centre for Blood Research, Life Science Institute, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
| | - Demian Felix
- Department of Urologic Sciences, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- The Stone Centre at Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada
| | - Soshi Samejima
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
| | - Claire Shackleton
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
| | - Raza N Malik
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
| | - Rahul Sachdeva
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
| | - Matthias Walter
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- Department of Urology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland
| | - Andrei V Krassioukov
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, BC V5Z 2G9, Canada
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Looby A, Davies H, Mealing S, Smith AB, Avey B, Laezza A, Crossland A, Lane EF, Ridler M, Cawson M. Time trade-off study to establish utility decrements in individuals with a spinal cord injury who perform intermittent catheterisation. J Med Econ 2023; 26:430-440. [PMID: 36892952 DOI: 10.1080/13696998.2023.2189395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
AIMS To generate utility decrements for three attributes associated with catheterisation for individuals with a spinal cord injury (SCI): the process of catheterisation, the physical impact of urinary tract infections (UTIs) and worry associated with hospitalisation. MATERIALS AND METHODS Health state vignettes comprising various levels of the three attributes were developed. Two cohorts of respondents, corresponding to people with SCIs and a sample broadly representative of the UK population, were presented with nine vignettes (three vignettes for the mild, moderate and severe health states in addition to a random set of six vignettes). It was assumed no or a nominal decrement was associated with the mild health state. Utility decrements were derived from analysing the data obtained from the online time trade-off (TTO). A proportion of the SCI cohort (n = 57) also completed the EQ-5D-5L questionnaire. RESULTS Utility decrements were generated using statistical models for the general population (n = 358), the SCI population (n = 48) and the two populations combined (merged model, n = 406). Results from the two cohorts showed minimal differences. For the merged model, SCI status was not statistically significant. All interaction terms, excluding SCI and the severe level of the physical attribute, were not statistically significant. Compared to the mild level, the greatest utility decrement calculated was the severe level of the emotional (worry) attribute (0.09, p < 0.001) for the SCI population. A significant decrement of 0.02 (p <0.001) was calculated for the moderate level of the emotional attribute for all models. The mean utility score for those with SCI having completed the EQ-5D-5L was 0.371. LIMITATIONS Modest sample size of respondents from the SCI population (n = 48). CONCLUSIONS Worry associated with hospitalisation had the greatest impact on patients' health-related quality of life (HRQoL). The catheterisation process, such as the lubrication and repositioning of the catheter, also impacted on patients' HRQoL.
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Affiliation(s)
- A Looby
- York Health Economics Consortium
| | - H Davies
- York Health Economics Consortium
| | | | | | - B Avey
- York Health Economics Consortium
| | | | | | - E F Lane
- York Health Economics Consortium
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Lauridsen SV, Averbeck MA, Krassioukov A, Vaabengaard R, Athanasiadou S. UTI assessment tool for intermittent catheter users: a way to include user perspectives and enhance quality of UTI management. BMC Nurs 2022; 21:272. [PMID: 36199133 PMCID: PMC9535847 DOI: 10.1186/s12912-022-01033-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 09/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Urinary Tract Infections (UTIs) are among the most severe complications for users of intermittent catheterisation (IC), with numerous risk factors contributing to their occurrence. The aim of this study was to develop a tool to assess UTI risk factors among IC users in a systematic way that considers the perspective of the individual user. METHODS The Design Thinking Process was used to guide the development of the content and format of the tool. The UTI Risk Factors model by Kennelly et al. was used as a basis for developing the content. Insights on the appropriate content and format were collected via the Coloplast Nurse Advisory Boards and by conducting a qualitative evidence synthesis on user perspectives and practices in relation to UTIs. RESULTS The literature search identified a total of 3544 articles, out of which 22 met the inclusion criteria. Additionally, three rounds of meetings were conducted with approximately 90 nurses from the Nurse Advisory Boards across Europe. The qualitative evidence synthesis showed that users describe their UTI symptoms in different terms and that personal needs and priorities impact their adherence and catheter selection. Furthermore, some users lack relevant and updated knowledge about IC and UTIs. The nurses described that correct UTI diagnosis is essential. They pointed that they would assess the user's general condition, adherence, technique, and catheter type as potential areas of risk factors and emphasised the importance of adequate support for users. The study resulted in the development of the UTI assessment tool for intermittent catheter users, which comprises three elements: a guide for healthcare professionals, a dialogue board, and a notepad. The tool starts with a confirmation of the UTI incidence, and then assesses risk factors via questions on health, adherence, technique, and catheter, and concludes with a support section. CONCLUSIONS The UTI assessment tool for intermittent catheter users is designed to help healthcare professionals assess UTI risk factors in a systematic way, while engaging users and taking their perspective into account. By identifying the relevant risk factors, the use of this tool has the potential to reduce the occurrence of UTIs for the individual IC user.
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Affiliation(s)
- S V Lauridsen
- Department of Urology, Copenhagen University Hospital, Copenhagen, Denmark. .,WHO-CC, Parker Institute, Copenhagen University Hospital, Frederiksberg and Bispebjerg Hospital, Frederiksberg, Denmark.
| | | | - A Krassioukov
- International Collaboration on Repair Discoveries (ICORD), Division of Physical Medicine and Rehabilitation, Department of Medicine, Faculty of Medicine, International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Endowment Lands, Canada.,G.F. Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, British Columbia, Canada
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8
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The microbiological and physical properties of catheters for intermittent catheterization: a systematic review on the impact of reuse and cleaning. Spinal Cord 2022; 60:581-593. [PMID: 35066573 DOI: 10.1038/s41393-021-00740-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/08/2021] [Accepted: 12/14/2021] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Systematic Review. OBJECTIVES To review systematically the clinical evidence of the effectiveness of various intermittent catheter cleaning methods that have been proposed as methods to prepare catheters for reuse. METHODS A keyword search in Medline, Excerpta Medica dataBASE, the Cumulative Index to Nursing and Allied Health Literature, Web of Science and Cochrane Central Register of Controlled Trials, was undertaken to identify all English, Russian and German language literature evaluating the effectiveness of various intermittent catheter cleaning methods. Studies selected for review included analytical experimental, prospective cohort and cross-sectional. Cleaning methods reviewed included heat-based sterilization, chemical cleaning solutions, mechanical abrasion, photocatalytic sterilization, and combined methods. RESULTS Overall, 12 studies were included. Heat-based sterilization and mechanical abrasion methods were either not effective or damaged the physical properties of catheters. Two studies reported evidence that their chemical cleaning methods (i.e., soaked catheters in a 70% alcohol solution for 5 min or combined approach detergent wash followed by soaking in Milton sterilizing fluid also known as the Milton method) both preserved the structural integrity of their catheters and were bactericidal. CONCLUSIONS Numerous cleaning methods resulted in the destruction of catheters. However, there are two reported cleaning methods, submersion for 5 min in 70% alcohol and the "Milton method", that eliminate bacterial colonization while leaving the physical properties of the catheters unchanged. While these cleaning methods are promising, each was published in just one study, therefore higher-powered / longitudinal studies confirming the safety and efficacy of these cleaning methods must be obtained before current clinical recommendations can be modified.
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Moshi HI, Sundelin GG, Sahlen KG, Sörlin AV. A one-year prospective study on the occurrence of traumatic spinal cord injury and clinical complications during hospitalisation in North-East Tanzania. Afr Health Sci 2021; 21:788-794. [PMID: 34795737 PMCID: PMC8568242 DOI: 10.4314/ahs.v21i2.39] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Clinical complications following spinal cord injury are a big concern as they account for increased cost of rehabilitation, poor outcomes and mortality. OBJECTIVE To describe the occurrence of traumatic spinal cord injury and associated clinical complications during hospitalisation in North-East Tanzania. METHOD Prospective data were collected from all persons with traumatic spinal cord injury from North-East Tanzania from their admission to discharge from the hospital. Neurological progress and complications were assessed routinely. Data were captured using a form that incorporated the components of the core data set of the International Spinal Cord Society and were analysed descriptively. RESULTS A total of 87 persons with traumatic spinal cord injury were admitted at the hospital with a mean age of 40.2 ± 15.8 years. There were 69 (79.3%) males, and 58 (66.6%) of the injuries resulted from falls. Spasms (41 patients, 47.1%), neuropathic pain (40 patients, 46%), and constipation (35 patients, 40.2%) were the most commonly reported complications. The annual incidence rate in the Kilimanjaro region was at least 38 cases per million. CONCLUSION The incidence of traumatic spinal cord injury in the Kilimanjaro region is relatively high. In-hospital complications are prevalent and are worth addressing for successful rehabilitation.
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Affiliation(s)
- Haleluya I Moshi
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
- Physiotherapy Department, Faculty of Rehabilitation Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Gunnevi G Sundelin
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Klas G Sahlen
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Ann Vm Sörlin
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
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10
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Thompson WR, Vanlandewijck YC. Perspectives on research conducted at the Paralympic Games. Disabil Rehabil 2020; 43:3503-3514. [DOI: 10.1080/09638288.2020.1849427] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Walter R. Thompson
- College of Education & Human Development, Georgia State University, Atlanta, GA, USA
| | - Yves C. Vanlandewijck
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Swedish School of Sport and Health Sciences (GIH), Stockholm, Sweden
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11
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Walter M, Ruiz I, Squair JW, Rios LAS, Averbeck MA, Krassioukov AV. Prevalence of self-reported complications associated with intermittent catheterization in wheelchair athletes with spinal cord injury. Spinal Cord 2020; 59:1018-1025. [PMID: 33051562 PMCID: PMC8397616 DOI: 10.1038/s41393-020-00565-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 09/22/2020] [Accepted: 10/01/2020] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVES To identify the prevalence of complications associated with intermittent catheterization in wheelchair athletes with spinal cord injury (SCI). SETTING International and national sporting events. METHODS A total 130 competitive wheelchair athletes living with SCI completed a self-reported questionnaire during international or national sporting events. The questionnaire collected information regarding demographics, injury characteristics, method of bladder emptying, and complications related to intermittent catheterization. RESULTS Overall, 84% (109/130) of wheelchair athletes used intermittent catheterization. Within this group, 77% of athletes (84/109) experienced at least one complication associated with intermittent catheterization. Twenty-seven percent (29/109) sustained urethral injuries and 63% (69/109) had at least one episode of urinary tract infection during the last 12 months. Almost one-fourth of male athletes (22/95, 23%) had a history of inflammation / infection of genital organs associated with intermittent catheterization. CONCLUSIONS Here we report a high prevalence of self-reported complications associated with intermittent catheterization in wheelchair athletes with SCI. Considering their potential impact on lower urinary tract function, athletic performance, and health, further studies are needed to assess the role of preventative strategies to reduce complications related to intermittent catheterization in wheelchair athletes with SCI. SPONSORSHIP Coloplast Brazil and Instituto Lado a Lado pela Vida (a nongovernmental, nonprofit organization based in São Paulo) and Wellspect provided funding for this study.
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Affiliation(s)
- Matthias Walter
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, British Columbia (BC), Canada.,Department of Urology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Ian Ruiz
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, British Columbia (BC), Canada
| | - Jordan W Squair
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, British Columbia (BC), Canada
| | - Luis A S Rios
- Department of Urology, IAMSPE Hospital, São Paulo, Brazil.,Videourodynamic Unit, Albert Einstein Hospital, São Paulo, Brazil
| | - Marcio A Averbeck
- Department of Urology, Moinhos de Vento Hospital, Porto Alegre, Brazil
| | - Andrei V Krassioukov
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, British Columbia (BC), Canada. .,Division of Physical Medicine and Rehabilitation, Faculty of Medicine, UBC, Vancouver, BC, Canada. .,G.F. Strong Rehabilitation Centre, Vancouver, BC, Canada.
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12
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Orlandin L, Nardi A, Costa RRDO, Mazzo A. Difficulties of patients and caregivers in performing clean intermittent catheterization: scoping review. ESTIMA 2020. [DOI: 10.30886/estima.v18.907_in] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective: To identify the main difficulties reported by patients and caregivers in the use of clean intermittent catheterization described in the scientific literature. Methods: Scoping review with studies published in Portuguese, English or Spanish, without date limit, in electronic databases and digital libraries, using descriptors and keywords. Results: 790 studies were identified, including 34 studies published between 1984 and 2019. The main difficulties reported in performing clean intermittent catheterization were related to catheter insertion, pain, discomfort, urethral trauma, public bathrooms with inadequate facilities, physical difficulties and lack of access to necessary inputs. Conclusion: The studies analyzed show the difficulties that patients who use clean intermittent catheterization and their caregivers face on a daily basis, which are related to intrinsic and extrinsic, institutional and governmental factors and can decrease satisfaction and adherence to rehabilitation programs bladder, with an impact on the quality of life of patients and their caregivers. Therefore, it highlights the need for health education for the proper teaching of performing clean intermittent catheterization, emphasizing the importance of the nurse’s role in this process.
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Affiliation(s)
- Leonardo Orlandin
- Universidade de São Paulo – Escola de Enfermagem de Ribeirão Preto – Programa de Pós-Graduação em Enfermagem Fundamental – Ribeirão Preto (SP), Brasil
| | - Aguinaldo Nardi
- Universidade de São Paulo – Faculdade de Odontologia de Bauru – Curso de Medicina – Bauru (SP), Brasil.o
| | | | - Alessandra Mazzo
- Universidade de São Paulo – Faculdade de Odontologia de Bauru – Curso de Medicina – Bauru (SP), Brasil.o
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13
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Orlandin L, Nardi A, Costa RRDO, Mazzo A. Dificuldades de pacientes e cuidadores na realização do cateterismo intermitente limpo: revisão de escopo. ESTIMA 2020. [DOI: 10.30886/estima.v18.907_pt] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Objetivo: Identificar as principais dificuldades relatadas pelos pacientes e cuidadores no uso do cateterismo intermitente limpo descritas na literatura científica. Métodos: Revisão de escopo com estudos publicados em português, inglês ou espanhol, sem limite de data, em base de dados eletrônicas e bibliotecas digitais, utilizando descritores e palavras-chave. Resultados: Foram identificados 790 estudos, sendo incluídos 34 estudos publicados entre 1984 e 2019. As principais dificuldades relatadas na realização do cateterismo intermitente limpo foram referentes a inserção do cateter, dor, desconforto, trauma uretral, banheiros públicos com instalações inadequadas, dificuldades físicas e falta de acesso aos insumos necessários. Conclusão: Os estudos analisados evidenciam as dificuldades que os pacientes usuários do cateterismo intermitente limpo e seus cuidadores enfrentam no dia a dia, que estão relacionadas à fatores intrínsecos e extrínsecos, institucionais e governamentais e podem diminuir a satisfação e a aderência aos programas de reabilitação vesical, com impacto na qualidade de vida dos pacientes e seus cuidadores. Portanto destaca-se a necessidade de educação em saúde para o adequado ensino da realização do cateterismo intermitente limpo, enfatizando a importância do papel do enfermeiro nesse processo.
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Affiliation(s)
- Leonardo Orlandin
- Universidade de São Paulo – Escola de Enfermagem de Ribeirão Preto – Programa de Pós-Graduação em Enfermagem Fundamental – Ribeirão Preto (SP), Brasil
| | - Aguinaldo Nardi
- Universidade de São Paulo – Faculdade de Odontologia de Bauru – Curso de Medicina – Bauru (SP), Brasil.o
| | | | - Alessandra Mazzo
- Universidade de São Paulo – Faculdade de Odontologia de Bauru – Curso de Medicina – Bauru (SP), Brasil.o
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14
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Hollander K, Kluge S, Glöer F, Riepenhof H, Zech A, Junge A. Epidemiology of injuries during the Wheelchair Basketball World Championships 2018: A prospective cohort study. Scand J Med Sci Sports 2019; 30:199-207. [DOI: 10.1111/sms.13558] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 08/19/2019] [Accepted: 09/17/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Karsten Hollander
- Department of Sports and Rehabilitation Medicine BG Trauma Hospital of Hamburg Hamburg Germany
- Spaulding National Running Center Harvard Medical School Cambridge MA USA
| | - Sascha Kluge
- Department of Sports and Rehabilitation Medicine BG Trauma Hospital of Hamburg Hamburg Germany
| | - Franziska Glöer
- Department of Sports and Exercise Medicine Institute of Human Movement Science, University of Hamburg Hamburg Germany
| | - Helge Riepenhof
- Department of Sports and Rehabilitation Medicine BG Trauma Hospital of Hamburg Hamburg Germany
| | - Astrid Zech
- Institute of Sport Science Friedrich Schiller University Jena Jena Germany
| | - Astrid Junge
- Medical School Hamburg Hamburg Germany
- Schulthess Klinik and Swiss Concussion Center Zürich Switzerland
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15
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Walter M, Christison K, Wyndaele JJJM, Kennelly M, Kessler TM, Noonan VK, Fallah N, Krassioukov AV. Response to Elliot and Crew (doi: 10.1089/neu.2018.5697) Response to Christison et al. (doi: 10.1089/neu.2017.5413): Intermittent Catheterization: The Devil Is in the Details. J Neurotrauma 2019; 36:1678-1679. [PMID: 30520680 DOI: 10.1089/neu.2018.6289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Matthias Walter
- 1 International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine (FoM), University of British Columbia, Vancouver, British Columbia, Canada
| | - Kathleen Christison
- 1 International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine (FoM), University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Michael Kennelly
- 3 Department of Urology, Carolinas Medical Center, Charlotte, North Carolina
| | - Thomas M Kessler
- 4 Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | | | - Nader Fallah
- 5 Rick Hansen Institute, Vancouver, British Columbia, Canada.,6 Division of Neurology, and Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrei V Krassioukov
- 1 International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine (FoM), University of British Columbia, Vancouver, British Columbia, Canada.,7 Division of Physical Medicine and Rehabilitation, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,8 G.F. Strong Rehabilitation Centre, Vancouver, British Columbia, Canada
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16
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Kennelly M, Thiruchelvam N, Averbeck MA, Konstatinidis C, Chartier-Kastler E, Trøjgaard P, Vaabengaard R, Krassioukov A, Jakobsen BP. Adult Neurogenic Lower Urinary Tract Dysfunction and Intermittent Catheterisation in a Community Setting: Risk Factors Model for Urinary Tract Infections. Adv Urol 2019; 2019:2757862. [PMID: 31065264 PMCID: PMC6466920 DOI: 10.1155/2019/2757862] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 03/05/2019] [Indexed: 01/11/2023] Open
Abstract
A risk factor model for urinary tract infections in patients with adult neurogenic lower urinary tract dysfunction performing clean intermittent catheterisation was developed; it consists of four domains, namely, (1) general (systemic) conditions in the patient, (2) individual urinary tract conditions in the patient, (3) routine aspects related to the patient, and (4) factors related to intermittent catheters per se. The conceptual model primarily concerns patients with spinal cord injury, spina bifida, multiple sclerosis, or cauda equina where intermittent catheterisation is a normal part of the bladder management. On basis of several literature searches and author consensus in case of lacking evidence, the model intends to provide an overview of the risk factors involved in urinary tract infections, with specific emphasis to describe those that in daily practice can be handled and modified by the clinician and so come to the benefit of the individual catheter user in terms of fewer urinary tract infections.
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Affiliation(s)
- Michael Kennelly
- Department of Urology, Carolinas Medical Center, Charlotte, NC, USA
| | | | | | | | | | | | | | - Andrei Krassioukov
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- G.F. Strong Rehabilitation Centre, Vancouver, British Columbia, Canada
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17
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Saadat SH, Shepherd S, Van Asseldonk B, Elterman DS. Clean intermittent catheterization: Single use vs. reuse. Can Urol Assoc J 2019; 13:64-69. [PMID: 30138101 PMCID: PMC6363567 DOI: 10.5489/cuaj.5357] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Intermittent catheterization (IC) is one of the fundamental aspects of managing patients with chronic urinary retention. Although reuse of catheters has been allowed to be chosen as the first option for IC, the optimal method of IC and the type of catheter has been a long-standing debate. We conducted a literature review regarding risk of urinary tract infection (UTI) and the costs associated with different methods and catheters. METHODS A MEDLINE search via PubMed, EMBASE, and EBSCO host was conducted in March 2018. The date of publication was limited to 2014 to present/current. RESULTS Single use of catheters (hydrophilic-coated [HC] or uncoated [UC]) was considered to impose a lower risk of UTI in all studies, except in one study that included children, but did not test their dexterity to handle HC catheters. Cost-effectiveness of single-use catheters was confirmed by all studies during this period. CONCLUSIONS Reuse of catheters exposes the patient to a plethora of possible cleaning techniques and duration of catheter use. Patient adherence to cleaning method cannot be predicted and this further amplifies the risk of complications and their burden on the healthcare system. We recommend a patient-centred approach to consider HC catheters as the first option, while considering the patient's/caregiver's ability to accommodate the usage technique. Single-use UC catheters, and finally reuse of catheters are considered as next options if HC catheters are found difficult to handle (especially in children doing self-catheterization). Larger trials investigating this matter are required.
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Affiliation(s)
- Seyed Hossein Saadat
- Division of Urology, Department of Surgery, University Health Network, Toronto, ON, Canada
| | - Shaun Shepherd
- Division of Urology, Department of Surgery, University Health Network, Toronto, ON, Canada
| | | | - Dean S. Elterman
- Division of Urology, Department of Surgery, University Health Network, Toronto, ON, Canada
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18
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Dutton RA. Medical and Musculoskeletal Concerns for the Wheelchair Athlete: A Review of Preventative Strategies. Curr Sports Med Rep 2019; 18:9-16. [PMID: 30624329 DOI: 10.1249/jsr.0000000000000560] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Adaptive sports refers to organized sporting activities that are practiced by individuals with disabilities and are worthwhile to maintain physical and psychological health. As adaptive sports participation continues to rise, health care providers must have an enhanced understanding of injury and illness patterns specific to the adaptive athlete. Early recognition and prevention are important to ensure safe and successful participation in sport. The present review aims to provide a framework for diagnosis and prevention of common conditions specific to the wheelchair athlete. In particular, autonomic dysreflexia, impaired thermoregulation, urinary tract infection, and pressure injuries, as well as shoulder pain, upper-extremity entrapment neuropathies, and osteoporotic fractures will be discussed.
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Affiliation(s)
- Rebecca A Dutton
- University of New Mexico, Department of Orthopaedics and Rehabilitation
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19
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Averbeck MA, Krassioukov A, Thiruchelvam N, Madersbacher H, Bøgelund M, Igawa Y. The impact of different scenarios for intermittent bladder catheterization on health state utilities: results from an internet-based time trade-off survey. J Med Econ 2018; 21:945-952. [PMID: 29882712 DOI: 10.1080/13696998.2018.1486846] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
AIMS Intermittent catheterization (IC) is the gold standard for bladder management in patients with chronic urinary retention. Despite its medical benefits, IC users experience a negative impact on their quality of life (QoL). For health economics based decision making, this impact is normally measured using generic QoL measures (such as EQ-5D) that estimate a single utility score which can be used to calculate quality-adjusted life years (QALYs). But these generic measures may not be sensitive to all relevant aspects of QoL affected by intermittent catheters. This study used alternative methods to estimate the health state utilities associated with different scenarios: using a multiple-use catheter, one-time-use catheter, pre-lubricated one-time-use catheter and pre-lubricated one-time-use catheter with one less urinary tract infection (UTI) per year. METHODS Health state utilities were elicited through an internet-based time trade-off (TTO) survey in adult volunteers representing the general population in Canada and the UK. Health states were developed to represent the catheters based on the following four attributes: steps and time needed for IC process, pain and the frequency of UTIs. RESULTS The survey was completed by 956 respondents. One-time-use catheters, pre-lubricated one-time-use catheters and ready-to-use catheters were preferred to multiple-use catheters. The utility gains were associated with the following features: one time use (Canada: +0.013, UK: +0.021), ready to use (all: +0.017) and one less UTI/year (all: +0.011). LIMITATIONS Internet-based survey responders may have valued health states differently from the rest of the population: this might be a source of bias. CONCLUSION Steps and time needed for the IC process, pain related to IC and the frequency of UTIs have a significant impact on IC related utilities. These values could be incorporated into a cost utility analysis.
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Affiliation(s)
| | - Andrei Krassioukov
- b International Collaboration On Repair Discoveries (ICORD), Department of Medicine , University of British Columbia and G.F. Strong Rehabilitation Centre , Vancouver , BC , Canada
| | - Nikesh Thiruchelvam
- c Department of Urology, Cambridge University Hospitals NHS Trust , Cambridge , UK
| | - Helmut Madersbacher
- d Department of Neurology , Medical University Innsbruck , Innsbruck , Austria
| | | | - Yasuhiko Igawa
- f Department of Continence Medicine , The University of Tokyo , Graduate school of Medicine , Tokyo , Japan
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20
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Beauchemin L, Newman DK, Le Danseur M, Jackson A, Ritmiller M. Best practices for clean intermittent catheterization. Nursing 2018; 48:49-54. [PMID: 30134322 DOI: 10.1097/01.nurse.0000544216.23783.bc] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Lisa Beauchemin
- Lisa Beauchemin is a clinical nurse manager at Wellspect Healthcare in Waltham, N.H. Diane K. Newman is an adjunct professor of urology in surgery at the Perelman School of Medicine, University of Pennsylvania in Philadelphia, Pa. Maureen Le Danseur is a clinical nurse specialist at Sharp Memorial Hospital in San Diego, Calif. Angela Jackson is a nurse manager at the University of South Florida Department of Urology in Tampa, Fla. Michael Ritmiller is a neuro-urology physician assistant at Chesapeake Urology Associates, University of Maryland Rehabilitation and Orthopaedic Institute in Baltimore, Md
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21
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Walter M, Krassioukov AV. Autonomic Nervous System in Paralympic Athletes with Spinal Cord Injury. Phys Med Rehabil Clin N Am 2018; 29:245-266. [PMID: 29627087 DOI: 10.1016/j.pmr.2018.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Individuals sustaining a spinal cord injury (SCI) frequently suffer from sensorimotor and autonomic impairment. Damage to the autonomic nervous system results in cardiovascular, respiratory, bladder, bowel, and sexual dysfunctions, as well as temperature dysregulation. These complications not only impede quality of life, but also affect athletic performance of individuals with SCI. This article summarizes existing evidence on how damage to the spinal cord affects the autonomic nervous system and impacts the performance in athletes with SCI. Also discussed are frequently used performance-enhancing strategies, with a special focus on their legal aspect and implication on the athletes' health.
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Affiliation(s)
- Matthias Walter
- Faculty of Medicine, International Collaboration on Repair Discoveries (ICORD), University of British Columbia, 818 West 10th Avenue, Vancouver, British Columbia V5Z 1M9, Canada
| | - Andrei V Krassioukov
- Division of Physical Medicine and Rehabilitation, Department of Medicine, International Collaboration on Repair Discoveries (ICORD), Blusson Spinal Cord Centre, University of British Columbia, GF Strong Rehabilitation Centre, Vancouver Coastal Health, 818 West 10th Avenue, Vancouver, British Columbia V5Z 1M9, Canada.
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22
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Truzzi JC, Teich V, Pepe C. Can hydrophilic coated catheters be beneficial for the public healthcare system in Brazil? - A cost-effectiveness analysis in patients with spinal cord injuries. Int Braz J Urol 2018; 44:121-131. [PMID: 28792195 PMCID: PMC5815542 DOI: 10.1590/s1677-5538.ibju.2017.0221] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 07/17/2017] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Detrusor sphincter dyssynergia affects 70% to 80% of all spinal cord injury patients, resulting in increased risk of urinary tract infections (UTIs) and potential exposure to antimicrobial resistance. In Brazil, local guidelines recommend intermittent catheterization as the best method for bladder emptying, and two catheter types are available: the conventional uncoated PVC and the hydrophilic coated catheters. OBJECTIVE To evaluate the cost-effectiveness of two types of catheters for intermittent catheterization from the perspective of the Brazilian public healthcare system. MATERIALS AND METHODS A Markov model was used to evaluate cost-effectiveness in those with spinal cord injuries. A primary analysis was conducted on all possible adverse events, and a secondary analysis was performed with urinary tract infections as the only relevant parameter. The results were presented as cost per life years gained (LYG), per quality-adjusted life years (QALY) and per number of urinary tract infections (UTIs) avoided. RESULTS The base scenario of all adverse events shows a cost-effective result of hydrophilic coated catheters compared to uncoated PVC catheters at 57,432 BRL (Brazilian Reais) per LYG and 122,330 BRL per QALY. The secondary scenario showed that the use of hydrophilic coated catheters reduces the total number of UTIs, indicating that an additional cost of hydrophilic coated catheters of 31,240 BRL over a lifetime will reduce lifetime UTIs by 6%. CONCLUSIONS Despite the higher unit value, the use of hydrophilic coated catheters is a cost-effective treatment from the perspective of the Brazilian public healthcare system.
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Affiliation(s)
- José Carlos Truzzi
- Escola Paulista de Medicina, Universidade Federal de São Paulo, SP, Brasil
- Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brasil
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23
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Feasibility of a Web-Based Self-management Intervention for Intermittent Urinary Catheter Users With Spinal Cord Injury. J Wound Ostomy Continence Nurs 2017; 43:529-38. [PMID: 27488740 DOI: 10.1097/won.0000000000000256] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the feasibility of a new Web-based intermittent catheter self-management intervention. DESIGN We tested the acceptability and usability of intervention components, which included multiple Web-based materials (an online urinary diary adapted for mobile phone use and an educational booklet), 3 phone calls with a nurse, and a peer-led discussion forum. SUBJECTS AND SETTING Thirty adults with spinal cord injury using intermittent catheterization for bladder drainage were enrolled; 26 participants received the nurses' phone-based consultations. METHODS Preliminary effectiveness of new self-efficacy and self-management scales were evaluated using baseline and 3-month online surveys. Participants' perceived value of the intervention components, self-management changes, and suggestions were assessed with data from the 3-month surveys, followed by brief tape-recorded interviews. RESULTS Several catheter practices improved somewhat over 3 months. The frequency of catheterizations every 4 to 6 hours increased from 71% to 77%. Self-management of neurogenic bladder dysfunction increased significantly (P = .032); participant comments indicated that fluid intake was the biggest change. Catheter-related self-efficacy and quality-of-life scores increased but not significantly. The frequency of urinary tract infection and pain did not change significantly. For feasibility, intervention components, with the exception of the forum, were rated highly by the majority of participants for usefulness, satisfaction (desired information), and Web-based usability. CONCLUSION Further testing of this intervention is recommended in a multisite randomized clinical trial.
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Abstract
Over the past 10 years, our team has attended numerous Paralympic games and International Paralympic Committee (IPC)-sanctioned events where we have accumulated the largest data set to date from elite athletes with spinal cord injury (SCI). This empirical evidence has allowed us to address critical questions related to health and athletic performance in these incredibly medically complex individuals. Namely, does autonomic function influence performance? Can we account for this with the present sport classification? How can we prevent the doping practice of self-inducing life-threatening episodes of hypertension to improve performance (termed "boosting")? How does extremely high participation in routine upper-body wheelchair exercise impact cardiovascular and cerebrovascular disease risk? Is it possible to improve the sport classification to level the playing field between athletes with and without autonomic dysfunction? Herein, we will narratively address these questions, and provide our perspective on future directions and recommendations moving forward. Our extensive clinical experience and comprehensive dataset suggest preserved autonomic function is critical for elite performance. We will explore how an easy-to-execute test may be able to predict which individuals are most likely to develop autonomic dysfunctions that may negatively affect their health and performance. We also will evaluate the possibility that a level playing field may be even more difficult to establish than once thought, considering the importance of not only voluntary movement to performance, but also autonomic function. Finally, we also will discuss new changes in screening guidelines at Rio to assess the occurrence of boosting, which is a banned practice by the IPC.
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Affiliation(s)
- Aaron A Phillips
- 1 International Collaboration on Repair Discoveries, University of British Columbia , Vancouver, British Columbia, Canada
| | - Jordan W Squair
- 1 International Collaboration on Repair Discoveries, University of British Columbia , Vancouver, British Columbia, Canada .,2 MD/PhD Training Program, University of British Columbia , Vancouver, British Columbia, Canada
| | - Andrei V Krassioukov
- 1 International Collaboration on Repair Discoveries, University of British Columbia , Vancouver, British Columbia, Canada .,3 Department of Medicine, University of British Columbia , Vancouver, British Columbia, Canada .,4 GF Strong Rehabilitation Centre, Vancouver Health Authority, University of British Columbia , Vancouver, British Columbia, Canada
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Le Danseur M, Stutzman SE, Wilson J, Sislak I, Olson DWM. Is the CABIC Clean Intermittent Catheterization Patient Education Effective? Rehabil Nurs 2016; 43:40-45. [PMID: 27775184 DOI: 10.1002/rnj.306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
PURPOSE This study examined the effectiveness of the consensus model (Clinical Advisory Board for Intermittent Catheterization [CABIC] method) for teaching clean intermittent self-catheterization (ISC). The primary hypothesis was that the CABIC method of teaching ISC would result in higher ISC knowledge and performance scores. DESIGN Prospective, non randomized, pre-post study of an educational intervention of ISC education with nursing students. METHODS Nursing students completed a self-report pre-/posttest, education of the CABIC method, and video recording of the CABIC method using same-gendered manikins. The Le Danseur Instrument (LDI) was used to grade the video-recorded demonstration. FINDINGS Fifty participants completed three phases of the study. Paired t test showed statistically significant improvement in ISC knowledge. A mean score of 92-93 demonstrated a high level of participant education retention. CONCLUSIONS The CABIC method of teaching clean ISC is associated with improvement in generalized clean ISC knowledge and performance scores. CLINICAL RELEVANCE The CABIC method can be integrated into clinical practice as an evidence-based approach to teaching ISC.
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Peršolja M. Varna tehnika dolgotrajne intermitentne samokatetrizacije. OBZORNIK ZDRAVSTVENE NEGE 2016. [DOI: 10.14528/snr.2016.50.2.91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Uvod: Intermitentna samokatetrizacija je prednostna metoda praznjenja sečnega mehurja pri pacientih z zastojem urina. Medicinska sestra običajno pacienta nauči čiste ali aseptične tehnike samokatetrizacije. Namen prispevka je s pregledom literature ugotoviti, ali obstaja optimalna tehnika intermitentne samokatetrizacije, ki bi jo medicinske sestre priporočale pacientom.
Metode: Uporabljen je bil sistematični pregled literature v bazah podatkov: CINAHL, Medline, ProQuest, COBIB.SI in Cochrane Library. Vključena je bila literatura od prve omembe samokatetrizacije leta 1972 do leta 2016. S selekcijo prvotnih 350 virov smo glede na njihovo skladnost z namenom raziskave izbrali 67 enot literature.
Rezultati: Osemnajst referenc, izbranih z orodjem CASP, je bilo objavljenih med letoma 1992 in 2015: šest randomiziranih kliničnih in pet kohortnih raziskav ter šest sistematičnih pregledov literature in ena kritika. Ključne spremenljivke analize zbranih podatkov so bile sterilnost katetra, vrsta vlažilnega gela in higiena periuretralnega področja.
Diskusija in zaključek: Nobena tehnika intermitentne samokatetrizacije se ne izkaže kot optimalna. Ob upoštevanju značilnosti in sposobnosti pacienta je za slovenske razmere najboljša uporaba sterilnega materiala za enkratno uporabo (katetra in vlažilnega gela), higiena periuretralnega področja s sterilno solucijo in tamponi ter tehnika nedotikanja.
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Lamin E, Newman DK. Clean intermittent catheterization revisited. Int Urol Nephrol 2016; 48:931-9. [DOI: 10.1007/s11255-016-1236-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 01/29/2016] [Indexed: 12/27/2022]
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Bertschy S, Bostan C, Meyer T, Pannek J. Medical complications during pregnancy and childbirth in women with SCI in Switzerland. Spinal Cord 2015; 54:183-7. [PMID: 26620876 DOI: 10.1038/sc.2015.205] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 10/13/2015] [Accepted: 10/16/2015] [Indexed: 12/14/2022]
Abstract
STUDY DESIGN A retrospective interview study of mothers with spinal cord injuries (SCIs) who gave birth over the last 15 years. OBJECTIVES To identify the medical complications of women with SCIs during pregnancy and childbirth in Switzerland and to describe how they dealt with these complications. SETTINGS Swiss Paraplegic Research in Nottwil, the University of Lausanne and participants' homes. METHODS Data were collected by self-reported questionnaires and descriptive analysis was conducted. RESULTS Seventeen women with SCIs who gave birth to 23 children were included. Thirteen of the women were paraplegics and four were tetraplegics. All of them practiced an independent bladder management. Three women changed their bladder management techniques during pregnancy. Five women reported an increased bladder evacuation frequency during pregnancy, and six women reported a new onset or increase in incontinence. We observed no significant increase in bowel dysfunction or skin breakdown due to their pregnancies. Ten women were hospitalised during the course of their pregnancies. Aside from urinary tract infections/pyelonephritis, women were hospitalised for falls, hypertension, pneumonia, preeclampsia, pre-term labour or tachycardia. CONCLUSION The results of our study clearly demonstrated that, although medical complications are not infrequent during pregnancy in women with SCIs, pregnancy and delivery in this group of women are possible without posing intolerable risks to the mothers or the children. Urological problems seemed to be the most frequent complication during pregnancy.
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Affiliation(s)
- S Bertschy
- Swiss Paraplegic Research (SPF), Nottwil, Switzerland.,Department of Health Sciences and Health Policy, University of Lucerne and SPF, Nottwil, Switzerland
| | - C Bostan
- Swiss Paraplegic Research (SPF), Nottwil, Switzerland.,Department of Health Sciences and Health Policy, University of Lucerne and SPF, Nottwil, Switzerland
| | - T Meyer
- Hannover Medical School, Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover, Germany
| | - J Pannek
- Neuro-Urology, Swiss Paraplegic Center (SPZ), Nottwil, Switzerland
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The good, the bad and the ugly of catheterization practice among elite athletes with spinal cord injury. Spinal Cord 2015; 53:712. [DOI: 10.1038/sc.2015.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Compton S, Trease L, Cunningham C, Hughes D. Australian Institute of Sport and the Australian Paralympic Committee position statement: urinary tract infection in spinal cord injured athletes. Br J Sports Med 2015; 49:1236-40. [PMID: 25869093 DOI: 10.1136/bjsports-2014-094527] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2015] [Indexed: 12/25/2022]
Abstract
Patients with spinal cord injuries are at increased risk of developing symptomatic urinary tract infections. Current evidence-based knowledge regarding prevention and treatment of urinary tract infection in the spinal cord injured population is limited. There are currently no urinary tract infection prevention and management guidelines specifically targeted towards elite spinal cord injured athletes. This position statement represents a set of recommendations intended to provide clinical guidelines for sport and exercise medicine physicians and other healthcare providers for the prevention and treatment of urinary tract infection in spinal cord injured athletes. It has been endorsed by the Australian Institute of Sport (AIS) and the Australian Paralympic Committee (APC).
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Affiliation(s)
- Stacey Compton
- Sports Medicine, Australian Institute of Sport, Bruce, Australia
| | | | | | - David Hughes
- Sports Medicine, Australian Institute of Sport, Canberra, Australia
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