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Fader M, Murphy CL, Bliss DZ, Buckley BS, Cockerell R, Cottenden AM, Kottner J, Ostaszkiewicz J. Technology for managing incontinence: What are the research priorities? Proc Inst Mech Eng H 2024; 238:688-703. [PMID: 38503718 PMCID: PMC11318214 DOI: 10.1177/09544119241233639] [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: 11/16/2023] [Accepted: 02/02/2024] [Indexed: 03/21/2024]
Abstract
Incontinence and toileting difficulties can often be successfully addressed by treating their underlying causes. However, (complete) cure is not always possible and continence products to prevent or contain unresolved leakage or to facilitate toileting are in widespread use. Many people use them successfully but identifying the product(s) most likely to meet individual needs can be challenging and the recently published Seventh International Consultation on Incontinence includes a chapter which draws on the literature to provide evidence-based recommendations to help clinicians and product users to select appropriate products. This paper is based on the same evidence, but reviewed from the different perspective of those keen to identify unmet needs and develop improved products. For each of the main continence product categories it (i) outlines the design approach and key features of what is currently available; (ii) provides a generic functional design specification; (iii) reviews how well existing products meet the requirements of their main user groups; and (iv) suggests priorities for the attention of product designers. It also flags some core scientific problems which - if successfully addressed - would likely yield benefits in multiple incontinence product contexts.
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Affiliation(s)
- Mandy Fader
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Cathy L Murphy
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Donna Z Bliss
- School of Nursing, University of Minnesota, Minneapolis, MN, USA
| | - Brian S Buckley
- Department of Surgery, University of the Philippines Manila, Philippines
| | - Rowan Cockerell
- Continence Foundation of Australia, Melbourne, VIC, Australia
| | - Alan M Cottenden
- Department Medical Physics and Biomedical Engineering, University College London, UK
| | - Jan Kottner
- Institute for Clinical Nursing Science, Charité-Universitätsmedizin Berlin, Berlin, Germany
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2
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Yates A. Penile urinary sheaths: a continence management system for men. Br J Community Nurs 2024; 29:S38-S40. [PMID: 38728167 DOI: 10.12968/bjcn.2024.29.sup5.s38] [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: 05/12/2024]
Abstract
Urinary leakage is prevalent in men. To contain and manage this leakage, men are often advised about urinary devices. However, sometimes this advice does not include penile sheaths. Penile sheaths are a good way of managing urinary leakage if an individual is suitable for sheaths. This article will explore this suitability, advantages to using a sheath, reasons why sheaths may not be suitable, and will discuss optimum fitting to ensure the sheath is a secure drainage device.
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Affiliation(s)
- Ann Yates
- Director of Continence Services, Cardiff and Vale University Health Board
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3
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Baunacke M. [Urinary incontinence after radical prostatectomy: risk factors and utilisation of care]. Aktuelle Urol 2023; 54:443-448. [PMID: 37348540 DOI: 10.1055/a-2097-3475] [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: 06/24/2023]
Abstract
Stress urinary incontinence is a relevant risk of radical prostatectomy (RP), which significantly affects patients' quality of life. The risk of developing stress urinary incontinence depends on pre-, intra- and postoperative factors. In particular, intraoperative factors regarding different surgical techniques are often focused on in order to improve continence rates. If stress urinary incontinence develops after RPE, patients affected should be treated adequately. In this respect, there are indications of healthcare insufficiencies in Germany. On the one hand, these include deficits in the use of incontinence materials. On the other hand, surgical treatment of stress urinary incontinence after RPE is insufficient.
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4
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Broom R. Pathway for post-prostatectomy urinary incontinence: impact on patient confidence and satisfaction. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:S17-S23. [PMID: 37861468 DOI: 10.12968/bjon.2023.32.sup19.s17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
BACKGROUND Between 8 and 87% of prostatectomies result in urinary incontinence, with around half of patients using incontinence pads daily at 6 months. Specialist urology continence nurses at the Norfolk and Norwich University Hospitals (NNUH) NHS Foundation Trust created a pre- and post-surgical care pathway formalising support for these patients, which involves the provision of TENA Men (Essity) male incontinence pads. AIMS This audit aimed to assess patient satisfaction with this pathway and TENA Men pads. METHODS Patients who underwent a radical prostatectomy at NNUH between 27 April and 9 November 2021 and who required continence pads were invited to fill out an online anonymous mixed-method (mainly qualitative) survey. RESULTS Of 28 respondents, 71% reported incontinence after their surgical catheter was removed. Most (89%) were satisfied with the preoperative advice. Of 19 respondents to questions on confidence and satisfaction, 16 were confident that the pads they had been prescribed were helping them to manage urinary leakage, and 16 were confident or very confident that they could manage their incontinence themselves. Generally, respondents were confident that their overall and mental health had improved, and most were confident or very confident that they had less anxiety. However, less than a quarter of respondents were 'very confident' about going out, meeting people or exercising. All but one respondent found TENA Men pads easy to fit, and the most used words in the free-text explanations of what they most liked, included 'easy', 'discreet', 'comfortable' and 'unobtrusive'. CONCLUSION The clinical pathway helped give patients undergoing radical prostatectomy confidence in their ability to manage post-surgery incontinence themselves and could be of value in other hospitals. Easy access to incontinence pads designed for the male anatomy has an important part in this.
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Affiliation(s)
- Ruth Broom
- Formerly Continence Nurse Specialist, Norfolk and Norwich University Hospitals NHS Foundation Trust
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5
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Yates A. Addressing the gender gap in urinary continence care. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:S11-S16. [PMID: 37861469 DOI: 10.12968/bjon.2023.32.sup19.s11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Urinary incontinence is a common condition that affects both men and women, and with profoundly negative effects. Prevalence figures do show that it is more common in younger women than men, but as people age the difference decreases, with research identifying that one-in-three older men have continence issues. However, even with this increase, there is little direct best practice guidance on addressing male urinary incontinence compared to that for women. Professionals seem to be unaware that men have known existing barriers to accessing health care and this would be especially true for incontinence care. There seems to be a lack of education in identifying and assessing symptoms, and little thought to appropriate management if required. This can also be true of manufacturers that provide continence management equipment. This article will look at some of these themes and highlight the gender gaps and give guidance on how professionals may address these.
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Affiliation(s)
- Ann Yates
- Director of Continence Services, Cardiff and Vale University Health Board
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6
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Latest Evidence on Post-Prostatectomy Urinary Incontinence. J Clin Med 2023; 12:jcm12031190. [PMID: 36769855 PMCID: PMC9917389 DOI: 10.3390/jcm12031190] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/28/2023] [Accepted: 01/29/2023] [Indexed: 02/05/2023] Open
Abstract
A radical prostatectomy is frequently used as the first-line treatment for men with prostate cancer. Persistent urinary incontinence after surgery is one of the most severe adverse events. We report the results of a comprehensive literature search focused on post-prostatectomy urinary incontinence (PPI), performed by a panel of experts on non-neurogenic lower urinary tract symptoms. The data on the prevalence and timing of PPI are very heterogeneous. The etiology of PPI can be multifactorial and mainly dependent on patient characteristics, lower urinary tract function or surgical issues. The medical history with a physical examination, the use of validated questionnaires with a voiding diary and pad tests are determinants in identifying the contributing factors and choosing the right treatment. Lifestyle intervention and urinary containment are the most frequently used strategies for the conservative management of PPI, while antimuscarinics, beta-3 agonists and duloxetine (off-label) are drugs indicated to manage PPI with a concomitant overactive bladder. Surgical therapies for the management of post-prostatectomy SUI include non-adjustable trans-obturator slings in men with mild-to-moderate incontinence and an artificial urinary sphincter in men with moderate-to-severe incontinence.
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7
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McLaughlin L. Addressing Gender-Related Inequality in Continence Care. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:1-16. [PMID: 36645726 DOI: 10.12968/bjon.2023.32.sup1.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Leann McLaughlin
- Uro-oncology Clinical Nurse Specialist, NHS Greater Glasgow and Clyde, UK
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8
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Broom R. Pathway for post-prostatectomy urinary incontinence: impact on patient confidence and satisfaction. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S24-S31. [PMID: 36227787 DOI: 10.12968/bjon.2022.31.18.s24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Between 8% and 87% of prostatectomies result in urinary incontinence, with around half of patients using incontinence pads daily at 6 months. Specialist urology continence nurses at the Norfolk and Norwich University Hospitals NHS Foundation Trust created a pre- and post-surgical care pathway formalising support for these patients, which involves the provision of TENA Men (Essity) male incontinence pads. AIMS This audit aimed to assess patient satisfaction with this pathway and TENA Men pads. METHODS Patients who underwent a radical prostatectomy at NNUH between 27 April and 9 November 2021 and who required continence pads were invited to fill out an online anonymous mixed-method (mainly qualitative) survey. RESULTS Of 28 respondents, 71% reported incontinence after their surgical catheter was removed. Most (89%) were satisfied with the preoperative advice. Of 19 respondents to questions on confidence and satisfaction, 16 were confident that the pads they had been prescribed were helping them to manage urinary leakage, and 16 were confident or very confident that they could manage their incontinence themselves. Generally, respondents were confident that their overall and mental health had improved, and most were confident or very confident that they had less anxiety. However, less than a quarter of respondents were 'very confident' about going out, meeting people or exercising. All but one respondent found TENA Men pads easy to fit, and the most used words in the free-text explanations of what they most included 'easy', 'discreet', 'comfortable' and 'unobtrusive'. CONCLUSION The clinical pathway helped give patients undergoing radical prostatectomy confidence in their ability to manage post-surgery incontinence themselves and could be of value in other hospitals. Easy access to incontinence pads designed for the male anatomy has an important part in this.
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Affiliation(s)
- Ruth Broom
- formerly Continence Nurse Specialist, Norfolk and Norwich University Hospitals NHS Foundation Trust
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Gacci M, Sakalis VI, Karavitakis M, Cornu JN, Gratzke C, Herrmann TRW, Kyriazis I, Malde S, Mamoulakis C, Rieken M, Schouten N, Smith EJ, Speakman MJ, Tikkinen KAO, Gravas S. European Association of Urology Guidelines on Male Urinary Incontinence. Eur Urol 2022; 82:387-398. [PMID: 35697561 DOI: 10.1016/j.eururo.2022.05.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 05/17/2022] [Indexed: 11/04/2022]
Abstract
CONTEXT Urinary incontinence (UI) is a common condition in elderly men causing a severe worsening of quality of life, and a significant cost for both patients and health systems. OBJECTIVE To report a practical, evidence-based, guideline on definitions, pathophysiology, diagnostic workup, and treatment options for men with different forms of UI. EVIDENCE ACQUISITION A comprehensive literature search, limited to studies representing high levels of evidence and published in the English language, was performed. Databases searched included Medline, EMBASE, and the Cochrane Libraries. A level of evidence and a grade of recommendation were assigned. EVIDENCE SYNTHESIS UI can be classified into stress urinary incontinence (SUI), urge urinary incontinence (UUI), and mixed urinary incontinence. A detailed description of the pathophysiology and diagnostic workup has been reported. Simple clinical interventions, behavioural and physical modifications, and pharmacological treatments comprise the initial management for all kinds of UI. Surgery for SUI includes bulking agents, male sling, and compression devices. Surgery for UUI includes bladder wall injection of botulinum toxin A, sacral nerve stimulation, and cystoplasty/urinary diversion. CONCLUSIONS This 2022 European Association of Urology guideline summary provides updated information on definition, pathophysiology, diagnosis, and treatment of male UI. PATIENT SUMMARY Male urinary incontinence comprises a broad subject area, much of which has been covered for the first time in the literature in a single manuscript. The European Association of Urology Non-neurogenic Male Lower Urinary Tract Symptoms Guideline Panel has released this new guidance, with the aim to provide updated information for urologists to be able to follow diagnostic and therapeutic indications for optimising patient care.
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Affiliation(s)
- Mauro Gacci
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
| | - Vasileios I Sakalis
- Department of Urology, Agios Pavlos General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Markos Karavitakis
- Department of Urology, University General Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece
| | - Jean-Nicolas Cornu
- Department of Urology, CHU Hôpitaux de Rouen - Hôpital Charles Nicolle, Rouen, France
| | - Christian Gratzke
- Department of Urology, University Hospital Freiburg, Freiburg, Germany
| | | | - Iason Kyriazis
- Department of Urology, General University Hospital of Patras, Patras, Greece
| | - Sachin Malde
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Charalampos Mamoulakis
- Department of Urology, University General Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece
| | | | - Natasha Schouten
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Emma J Smith
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Mark J Speakman
- Department of Urology, Taunton & Somerset Hospital, Taunton, UK
| | - Kari A O Tikkinen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Surgery, South Karelia Central Hospital, Lappeenranta, Finland
| | - Stavros Gravas
- Department of Urology, Medical School, University of Cyprus, Nicosia, Cyprus
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10
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Elliott PA, Hsiang S, Narayanan R, Bierylo J, Chang SC, Twardowski P, Wilson TG. Cryopreserved placental tissue allograft accelerates time to continence following robot-assisted radical prostatectomy. J Robot Surg 2021; 15:877-883. [PMID: 33426577 DOI: 10.1007/s11701-020-01187-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 12/24/2020] [Indexed: 10/22/2022]
Abstract
Intra-operatively placed cryopreserved placental tissue allograft (CPTA) has shown promise in expediting the recovery urinary continence (UC) following robot-assisted radical prostatectomy (RARP). In this retrospective review of a prospectively maintained single-surgeon, single-institution RARP database, we compare three groups of patients: historical controls (C; N = 183 men) that received no allograft versus two different CPTA products (total CPTA N = 162 [A1 N = 81; A2 N = 81]). The CPTA product was intra-operatively placed as an onlay over the area of the neurovascular bundles during RARP. CPTA cases had significantly faster median time to UC (A1 = 1.4 months; A2 = 1.45 months) versus controls (1.64 months), p = 0.01. On multivariable analysis, use of A1 (HR 1.55, 95% CI [1.14-2.09], p = 0.005) and use of A2 (HR 1.53, CI [1.11-2.11], p = 0.01) were significantly associated with quicker return of UC. Older age (HR 0.97, CI [0.96-0.99], p = 0.001) and non-organ-confined clinical stage (HR 0.51, CI [0.26-1.0] p = 0.05), were significantly associated with slower return of UC. In a propensity score-matched analysis of 77 CPTA patients with sufficient follow-up versus controls, there was significantly less biochemical recurrence (BCR; p = 0.01). Our study indicates that CPTA use appears to accelerate time to UC in age- and performance status-matched men undergoing RARP without increased risk of BCR.
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11
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Sattar S, Haase KR, Bradley C, Papadopoulos E, Kuster S, Santa Mina D, Tippe M, Kaur A, Campbell D, Joshua AM, Rediger C, Souied O, Alibhai S. Barriers and facilitators related to undertaking physical activities among men with prostate cancer: a scoping review. Prostate Cancer Prostatic Dis 2021; 24:1007-1027. [PMID: 34108646 DOI: 10.1038/s41391-021-00399-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/30/2021] [Accepted: 05/19/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Prostate cancer (PC) and its treatments lead to significant acute, chronic, or latent adverse effects that result in declines in patients' physical functions, quality of life and reduced sense of masculinities. Robust evidence shows that physical activity (PA) can improve many health outcomes in men with PC; however, less is known about the facilitators, preferences, and barriers to PA engagement in this population. The purpose of this scoping review is to document the nature and extent of literature related to these aspects of PA participation among men with PC. METHODS We conducted a scoping review of PA among men with PC. Databases searched included Medline, CINAHL, Embase, Rehabilitation & Sports Medicine Source, and SportDiscus from inception to June 30, 2020. Multiple reviewers were used in all screening and data abstractions. RESULTS The search yielded 2788 individual citations after duplicates were removed. Following title and abstract screening, 129 underwent full-text review, and 46 articles were included. Quantitative data related to our research question showed that structured group exercise was the most commonly reported facilitator/preference among men with PC, whereas treatment-related effects and lack of time are the most common barriers. In terms of qualitative data, the most prominent theme noted related to masculinities and gender-specific needs within the context of having PC. CONCLUSION Men with PC have unique facilitators and barriers concerning PA. More work is needed from the research and clinical practice perspectives to enable this population to engage and remain in regular PA.
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Affiliation(s)
- S Sattar
- College of Nursing, University of Saskatchewan, Regina, SK, Canada.
| | - K R Haase
- Faculty of Applied Science, School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - C Bradley
- Library, University of Regina, Regina, SK, Canada
| | - E Papadopoulos
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - S Kuster
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, SK, Canada
| | - D Santa Mina
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada
| | - M Tippe
- Patient consultant, Toronto, ON, Canada
| | - A Kaur
- College of Nursing, University of Saskatchewan, Saskatoon, SK, Canada
| | - D Campbell
- College of Nursing, University of Saskatchewan, Saskatoon, SK, Canada
| | - A M Joshua
- Department of Medical Oncology, Kinghorn Cancer Centre; Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia
| | - C Rediger
- Saskatchewan Health Authority, Regina, SK, Canada
| | - O Souied
- Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - S Alibhai
- University Health Network, Toronto, ON, Canada.,Department of Medicine, Institute of Health Policy, Management, and Evaluation, Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
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12
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Abstract
Urinary incontinence is a common condition that affects both men and women, and with profoundly negative effects. Prevalence figures do show that it is more common in younger women than men, but as people age the difference decreases, with research identifying that one in three older men have continence issues. However, even with this increase, there is little direct best practice guidance on addressing male urinary incontinence compared to that for women. Professionals seem to be unaware that men have known existing barriers to accessing health care and this would be especially true of such an embarrassing condition. There seems to be a lack of education in identifying symptoms and assessing and little thought to appropriate management if required. This can also be true of manufacturers that provide continence management equipment. This article will look at some of these themes and highlight the gender gaps and give guidance on how professionals may address these.
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Affiliation(s)
- Ann Yates
- Director of Continence Services, Cardiff and Vale University Health Board
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13
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Lee A, Mmonu NA, Thomas H, Rios N, Enriquez A, Breyer BN. Qualitative analysis of Amazon customer reviews of penile clamps for male urinary incontinence. Neurourol Urodyn 2020; 40:384-390. [PMID: 33165983 DOI: 10.1002/nau.24572] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/06/2020] [Accepted: 10/29/2020] [Indexed: 12/29/2022]
Abstract
AIMS Penile clamps offer an alternative to manage male urinary incontinence in patients who are unfit for surgery. Patient experience with penile clamps is poorly understood. Our study elucidates patient opinions on commercially available penile clamps and the factors that associate with favorable and unfavorable opinions. METHODS We collected Amazon reviews of all penile clamps marketed for male urinary incontinence from November 2011 to January 2020 and qualitatively assessed the overall sentiment towards penile clamps, key praises and key complaints. Covariates such as designated Amazon star rating were further explored for association with coding patterns. RESULTS Amazon reviews of penile clamps were found to be more positive (n = 425) in overall sentiment than negative (n = 294). The most frequent praise was effective incontinence control (n = 334) and the most frequent complaint was bad design or material (n = 166). The majority of reviews were for lower priced penile clamps, had higher Amazon star ratings, were written for Wiesner-produced clamps, and were written more recently (i.e., 2015-2020). Penile clamps with higher Amazon star ratings were more often coded positive and with a praise compared to lower rated penile clamps. CONCLUSIONS Penile clamps are seen favorably by users as an effective treatment modality for male urinary incontinence. User reviews suggest opportunities for improvement in penile clamp design. The most frequently reviewed clamp seen positively is the Wiesner Incontinence Clamp Penile Clamp whereas the most frequently reviewed clamp seen negatively is the Pacey Cuff Male Incontinence Device.
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Affiliation(s)
- Austin Lee
- Department of Urology, University of California-San Francisco, San Francisco, California, USA
| | - Nnenaya A Mmonu
- Department of Urology, University of California-San Francisco, San Francisco, California, USA
| | - Hannah Thomas
- Department of Urology, University of California-San Francisco, San Francisco, California, USA
| | - Natalie Rios
- Department of Urology, University of California-San Francisco, San Francisco, California, USA
| | - Anthony Enriquez
- Department of Urology, University of California-San Francisco, San Francisco, California, USA
| | - Benjamin N Breyer
- Department of Urology, University of California-San Francisco, San Francisco, California, USA.,Department of Biostatistics and Epidemiology, University of California-San Francisco, San Francisco, California, USA
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14
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Lemmens J, Peko Cohen L, Worsley PR, Everitt C, Broadbridge J, Gefen A, Rees RW, Drake M, Macaulay MC, Fader M, Bader DL. Magnetic resonance imaging to estimate tissue deformations during penile clamp application: A case series. JOURNAL OF CLINICAL UROLOGY 2020. [DOI: 10.1177/2051415820920511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:Penile clamps provide a means of preventing urinary incontinence in males following radical prostatectomy. In order for the devices to function, significant mechanical loads need to be applied to the penile tissues to close the urethra. However, such loads have the potential to cause damage to the vulnerable skin and underlying soft tissues. Accordingly, the study aimed to estimate the magnitudes of tissue deformations resulting from penile clamp application in three individual cases.Methods:Three individuals were recruited who currently use penile clamps to manage urinary incontinence following radical prostatectomy. Magnetic resonance images (MRI) of the penis were taken to produce a series of high contrast coronal and sagittal images both before and during the application of two commercially available clamps, modified for MRI compatibility. Tissue thickness measurements were estimated with the clamps in-situ and normalised to the unloaded baseline state.Results:The estimated magnitude of tissue deformations resulting from clamp application ranged between 68% and 84%. There were minimal differences in these deformations between the clamp designs, both of which appeared effective in closing the urethra. Local stress concentrations were observed in the tissues, which were deformed around the shape of the clamp.Conclusions:MRI enabled quantification of local tissue deformation during penile clamp application. The results revealed that clamps created large tissue deformations in all three cases, regardless of design. This information could inform the development of new clamp designs and materials to minimise the potential for tissue damage.Level of evidence:4
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Affiliation(s)
- Joe Lemmens
- School of Health Sciences, University of Southampton, UK
| | - Lea Peko Cohen
- Department of Biomedical Engineering, Tel Aviv University, Israel
| | | | | | | | - Amit Gefen
- Department of Biomedical Engineering, Tel Aviv University, Israel
| | | | - Marcus Drake
- University of Bristol, Bristol Urological Institute, UK
| | | | - Mandy Fader
- School of Health Sciences, University of Southampton, UK
| | - Dan L Bader
- School of Health Sciences, University of Southampton, UK
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15
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Murphy C, Laine C, Macaulay M, Fader M. Development and randomised controlled trial of a Continence Product Patient Decision Aid for men postradical prostatectomy. J Clin Nurs 2020; 29:2251-2259. [DOI: 10.1111/jocn.15223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 02/04/2020] [Accepted: 02/07/2020] [Indexed: 01/24/2023]
Affiliation(s)
- Catherine Murphy
- School of Health Sciences University of Southampton Southampton UK
| | - Christine Laine
- School of Health Sciences University of Southampton Southampton UK
| | | | - Mandy Fader
- School of Health Sciences University of Southampton Southampton UK
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16
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Lemmens JM, Broadbridge J, Macaulay M, Rees RW, Archer M, Drake MJ, Moore KN, Bader DL, Fader M. Tissue response to applied loading using different designs of penile compression clamps. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2019; 12:235-243. [PMID: 31303800 PMCID: PMC6603992 DOI: 10.2147/mder.s188888] [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: 09/26/2018] [Accepted: 03/22/2019] [Indexed: 12/02/2022] Open
Abstract
Background: Penile compression devices (PCD) or clamps are applied to compress the urethra and prevent urinary incontinence (UI). PCDs are more secure and less likely to leak than pads, allowing men the opportunity to participate in short-term, vigorous activities. However, they are uncomfortable, can cause pressure ulcers (PU) and affect penile blood flow. No objective assessment of tissue health has been undertaken to assess and compare different PCD designs and to provide guidance on safe use. Objective: This study was designed to evaluate existing PCDs in terms of their physiological response and potential for pressure-induced injury. Design, setting and participants: Six men with post-prostatectomy UI tested four selected PCDs at effective pressures, in a random order, in a controlled laboratory setting. Outcome measurements and statistical analysis: Using objective methods for assessing skin injury, PCDs were measured in situ for their effects on circulatory impedance, interface pressures and inflammatory response. Results and limitations: There was evidence for PCD-induced circulatory impedance in most test conditions. Interface pressures varied considerably between both PCDs and participants, with a mean value of 137.4±69.7 mmHg. In some cases, penile skin was noted to be sensitive to loading with elevated concentration of the cytokine IL-1α after 10 mins wear, indicating an inflammatory response. IL-1α levels were restored to baseline 40 mins following PCD removal. Conclusion: Skin health measures indicated tissue and blood flow compromise during the 50 mins of testing using all PCDs. Although there was an elevation in pro-inflammatory cytokines, PCDs did not cause sustained irritation and skin health measures recovered 40 mins after PCD removal. This research indicates that application of a clamp for one hour with an equal clamp free time before reapplication is likely to be safe. Longer periods are often recommended by manufacturers but have yet to be tested.
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Affiliation(s)
- Joseph Mh Lemmens
- University of Southampton, School of Health Sciences, Southampton SO17 1BJ, UK
| | - Jackie Broadbridge
- University of Southampton, School of Health Sciences, Southampton SO17 1BJ, UK
| | - Margaret Macaulay
- University of Southampton, School of Health Sciences, Southampton SO17 1BJ, UK
| | - Rowland W Rees
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
| | - Matt Archer
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
| | - Marcus J Drake
- Bristol Urological Institute, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Katherine N Moore
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada
| | - Dan L Bader
- University of Southampton, School of Health Sciences, Southampton SO17 1BJ, UK
| | - Mandy Fader
- University of Southampton, School of Health Sciences, Southampton SO17 1BJ, UK
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Miget G, Moutounaick M, Kervinio F, Teng M, Chesnel C, Charlanes A, Le Breton F, Amarenco G. [Absorbent products for urinary incontinence management]. Prog Urol 2018; 28:953-961. [PMID: 30361139 DOI: 10.1016/j.purol.2018.08.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 07/27/2018] [Accepted: 08/30/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Despite therapeutic strategies of female and male urinary incontinence (UI) are currently well defined, there is no precise indication of the real place or strategy use of absorbent products regardless of the etiology of the incontinence or the clinical context. METHODS We performed a research from the PubMed database using the following keywords: (urinary incontinence [MESH Terms]) AND absorbent pad [MeSH Terms]; allowing us to isolate 362 articles. RESULTS Many protections designs are available over-the-counter without prescription and without reimbursement in France. For "light UI", disposable insert pads are the design that seems to be the most suitable for women, compared to disposable menstrual pads, OR=0.27 [0.14, 0.52], washable pants with integral pad OR=0.12 [0.06, 0.26] or washable insert pads OR=0.05 [0.02, 0.26]. For moderate to severe UI, there is no "best universal product". There are differences between the gender and the use of a panel of protections seems the most appropriate. Both women and men prefer pull-ups to disposable insert pads, OR=0.41 [0.20, 0.87] and OR=0.39 [0.22, 0.68] respectively. In men, a preference in 70 % of subjects for urisheats is observed compared to the protections they usually use (P=0.02). The use of protections improves independence in daily OR activities=0.102 [0.046, 0.158] and quality of life related to UI OR=4.40 [1.74, 7.07] compared to patients not using protections. Despite this, their use must remain cautious because of the potential infectious urinary complications, more frequent in particular in institutional people, with 41 % of users developing at least one urinary infection over an evaluation period of 12 months vs. 11 % of non-users (P=0.001), or immuno-allergic with the "dermatitis associated incontinence" whose prevalence can reach a rate of 50 %. CONCLUSION Comparative analyzes of risk-benefit, economic costs, patient satisfaction, protections vs. other measures are lacking. It is necessary to continue the development of these products and to compare more precisely their intrinsic characteristics, to best support patients choices.
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Affiliation(s)
- G Miget
- GRC 01, GREEN - Groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne universités, AP-HP, 75020 Paris, France; Service de neuro-urologie et explorations périnéales, hôpital Tenon, AP-HP, 75020 Paris, France.
| | - M Moutounaick
- GRC 01, GREEN - Groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne universités, AP-HP, 75020 Paris, France; Service de neuro-urologie et explorations périnéales, hôpital Tenon, AP-HP, 75020 Paris, France
| | - F Kervinio
- GRC 01, GREEN - Groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne universités, AP-HP, 75020 Paris, France; Service de neuro-urologie et explorations périnéales, hôpital Tenon, AP-HP, 75020 Paris, France
| | - M Teng
- GRC 01, GREEN - Groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne universités, AP-HP, 75020 Paris, France; Service de neuro-urologie et explorations périnéales, hôpital Tenon, AP-HP, 75020 Paris, France
| | - C Chesnel
- GRC 01, GREEN - Groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne universités, AP-HP, 75020 Paris, France; Service de neuro-urologie et explorations périnéales, hôpital Tenon, AP-HP, 75020 Paris, France
| | - A Charlanes
- GRC 01, GREEN - Groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne universités, AP-HP, 75020 Paris, France; Service de neuro-urologie et explorations périnéales, hôpital Tenon, AP-HP, 75020 Paris, France
| | - F Le Breton
- GRC 01, GREEN - Groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne universités, AP-HP, 75020 Paris, France; Service de neuro-urologie et explorations périnéales, hôpital Tenon, AP-HP, 75020 Paris, France
| | - G Amarenco
- GRC 01, GREEN - Groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne universités, AP-HP, 75020 Paris, France; Service de neuro-urologie et explorations périnéales, hôpital Tenon, AP-HP, 75020 Paris, France
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18
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Jeong G, Park S. Review of urinary continence care products using sensor technology to improve effectiveness. Proc Inst Mech Eng H 2018; 233:91-99. [PMID: 30131022 DOI: 10.1177/0954411918794989] [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: 11/16/2022]
Abstract
There have been many treatment and management modalities for urinary incontinence including absorbent products and urine collecting devices, but these modalities are manual in nature, requiring significant time and effort from caregivers. Recently, the application of sensor technology for urine detection in absorbent products and urine collection devices has helped to create new modalities for urinary incontinence and to automate some of the incontinence care processes. In this article, we review the new products and devices for incontinence care which make use of urine detection sensors.
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Affiliation(s)
- Gyeonghui Jeong
- 1 College of Nursing, Seoul National University, Seoul, Republic of Korea
| | - Sangsoo Park
- 2 Department of Biomedical Engineering, College of Health Science, Eulji University, Seongnam-si, Republic of Korea
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19
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Buckley BS. User perspectives, preferences and priorities relating to products for managing bladder and bowel dysfunctions. Proc Inst Mech Eng H 2017; 233:7-18. [PMID: 29278080 DOI: 10.1177/0954411917750193] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A great many people of all ages around the world cannot fully control their bladder or bowel, or both. Either in the short or long term, they rely upon products and devices to manage the emptying of their bladders and bowels and to collect, absorb and contain leaked urine or faeces. The incontinence product market is large and growing, and ongoing developments in materials and technologies should lead to improvements in these products and devices. Engineers and designers who work in this field - or who plan to do so - need to recognise the breadth of factors that affect the effectiveness and acceptability of products. The primary functions of products for managing bladder and bowel dysfunctions are the collection and containment of urine or faeces - and the associated engineering and design challenges may be considered in terms of flow rates and volumes and methods of acquisition and containment. But products will fail if they do not take into account other factors, some of which relate less directly to these primary functions and some not at all. This article aims to highlight the product characteristics that are most important to the people who use them, and areas where user-centred innovation and development may lead to improvements.
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Affiliation(s)
- Brian S Buckley
- 1 Department of Surgery, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.,2 Urology Department, Zhongnan Hospital of Wuhan University, Wuhan, China.,3 The Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland
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20
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Levy A, Fader M, Bader D, Gefen A. Penile compression clamps: A model of the internal mechanical state of penile soft tissues. Neurourol Urodyn 2016; 36:1645-1650. [DOI: 10.1002/nau.23172] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 10/13/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Ayelet Levy
- Department of Biomedical Engineering; Tel Aviv University; Tel Aviv Israel
| | - Mandy Fader
- Faculty of Health Sciences; University of Southampton; Southampton United Kingdom
| | - Daniel Bader
- Faculty of Health Sciences; University of Southampton; Southampton United Kingdom
| | - Amit Gefen
- Department of Biomedical Engineering; Tel Aviv University; Tel Aviv Israel
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21
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Rippon M, Colegrave M, Ousey K. Incontinence-associated dermatitis: reducing adverse events. ACTA ACUST UNITED AC 2016; 25:1016-1021. [PMID: 27734729 DOI: 10.12968/bjon.2016.25.18.1016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Incontinence-associated dermatitis (IAD) is a common problem in patients with faecal and/or urinary incontinence. Urine alters the normal skin flora and increases permeability of the stratum corneum and faecal enzymes on the skin contribute to skin damage. Faecal bacteria can then penetrate the skin, increasing the risk of secondary infection. However, IAD can be prevented and healed with timely and appropriate skin cleansing and skin protection. This includes appropriate use of containment devices. This article also looks at HARTMANN incontinence pads that have been developed to absorb the fluids that cause IAD and maintain the skin's acidic pH. The acidic pH of the skin contributes to its barrier function and defence against infection. Therefore, maintaining an acidic pH will help protect the skin from damage.
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Affiliation(s)
- Mark Rippon
- Visiting Clinical Research Fellow, School of Human and Health Sciences, Institute of Skin Integrity and Infection Prevention, University of Huddersfield
| | | | - Karen Ousey
- Professor and Director for the Institute of Skin Integrity and Infection Prevention, University of Huddersfield
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22
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Faithfull S, Lemanska A, Aslet P, Bhatt N, Coe J, Drudge-Coates L, Feneley M, Glynn-Jones R, Kirby M, Langley S, McNicholas T, Newman J, Smith CC, Sahai A, Trueman E, Payne H. Integrative review on the non-invasive management of lower urinary tract symptoms in men following treatments for pelvic malignancies. Int J Clin Pract 2015; 69:1184-208. [PMID: 26292988 PMCID: PMC5042099 DOI: 10.1111/ijcp.12693] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
AIM To develop a non-invasive management strategy for men with lower urinary tract symptoms (LUTS) after treatment for pelvic cancer, that is suitable for use in a primary healthcare context. METHODS PubMed literature searches of LUTS management in this patient group were carried out, together with obtaining a consensus of management strategies from a panel of authors for the management of LUTS from across the UK. RESULTS Data from 41 articles were investigated and collated. Clinical experience was sought from authors where there was no clinical evidence. The findings discussed in this paper confirm that LUTS after the cancer treatment can significantly impair men's quality of life. While many men recover from LUTS spontaneously over time, a significant proportion require long-term management. Despite the prevalence of LUTS, there is a lack of consensus on best management. This article offers a comprehensive treatment algorithm to manage patients with LUTS following pelvic cancer treatment. CONCLUSION Based on published research literature and clinical experience, recommendations are proposed for the standardisation of management strategies employed for men with LUTS after the pelvic cancer treatment. In addition to implementing the algorithm, understanding the rationale for the type and timing of LUTS management strategies is crucial for clinicians and patients.
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Affiliation(s)
- S Faithfull
- School of Health Sciences, University of Surrey, Stag Hill, Guildford, UK
| | - A Lemanska
- School of Health Sciences, University of Surrey, Stag Hill, Guildford, UK
| | - P Aslet
- Department of Urology, Hampshire Hospitals Foundation Trust, Basingstoke, Hampshire, UK
| | - N Bhatt
- Sutton & Merton Community Services, The Royal Marsden NHS Foundation Trust, London, UK
| | - J Coe
- University College Hospital, London, UK
| | | | - M Feneley
- University College Hospital, London, UK
| | | | - M Kirby
- Faculty of Health & Human Sciences, Centre for Research in Primary & Community Care (CRIPACC), University of Hertfordshire, Hertfordshire, UK
| | - S Langley
- The Royal Surrey County Hospital, Guildford, UK
| | | | - J Newman
- Oxford University Hospital, Oxford, UK
| | - C C Smith
- School of Health and Social Care, Bournemouth University, Dorset, UK
| | - A Sahai
- Guy's and St Thomas' NHS Foundation Trust, King's Health Partners, London, UK
| | - E Trueman
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - H Payne
- University College Hospital, London, UK
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