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Scruggs-Wodkowski E, Kidder I, Meddings J, Patel PK. Urinary Catheter-Associated Infections. Infect Dis Clin North Am 2024:S0891-5520(24)00057-6. [PMID: 39261137 DOI: 10.1016/j.idc.2024.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2024]
Abstract
Catheter-associated urinary tract infections (CAUTIs) are common and costly hospital-acquired infections, yet they are largely preventable. The greatest modifiable risk factor for developing a CAUTI is duration of catheterization, including initial indwelling catheter placement when it may not otherwise be necessary. Alternatives to indwelling urinary catheters, including intermittent straight catheterization and the use of external catheters, should be considered in applicable patients. If an indwelling urinary catheter is required, aseptic insertion technique and maintenance should be performed. Through the use of collaborative, multidisciplinary intervention efforts, CAUTI rates can be successfully reduced.
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Affiliation(s)
- Elizabeth Scruggs-Wodkowski
- Division of Infectious Diseases, Department of Internal Medicine, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA; Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Medical School, University Hospital South F4012A, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
| | - Ian Kidder
- Division of Infectious Diseases, Department of Internal Medicine, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA; Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Medical School, University Hospital South F4012A, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Jennifer Meddings
- Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48109, USA; Division of General Pediatrics, Department of Pediatrics, University of Michigan Medical School, East Medical Campus, 4260 Plymouth Road, Room F224, Ann Arbor, MI 48109, USA; Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI 48109, USA; Department of Medicine, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA
| | - Payal K Patel
- Division of Infectious Diseases, Intermountain Medical Center, 5171 South Cottonwood Street, Suite 350, Murray, UT 84107, USA
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Chrouser K, Fowler KE, Mann JD, Quinn M, Ameling J, Hendren S, Krapohl G, Skolarus TA, Bernstein SJ, Meddings J. Urinary Retention Evaluation and Catheterization Algorithm for Adult Inpatients. JAMA Netw Open 2024; 7:e2422281. [PMID: 39012634 PMCID: PMC11252892 DOI: 10.1001/jamanetworkopen.2024.22281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 05/15/2024] [Indexed: 07/17/2024] Open
Abstract
Importance Acute urinary retention (UR) is common, yet variations in diagnosis and management can lead to inappropriate catheterization and harm. Objective To develop an algorithm for screening and management of UR among adult inpatients. Design, Setting, and Participants In this mixed-methods study using the RAND/UCLA Appropriateness Method and qualitative interviews, an 11-member multidisciplinary expert panel of nurses and physicians from across the US used a formal multi-round process from March to May 2015 to rate 107 clinical scenarios involving diagnosis and management of adult UR in postoperative and medical inpatients. The panel ratings informed the first algorithm draft. Semistructured interviews were conducted from October 2020 to May 2021 with 33 frontline clinicians-nurses and surgeons from 5 Michigan hospitals-to gather feedback and inform algorithm refinements. Main Outcomes and Measures Panelists categorized scenarios assessing when to use bladder scanners, catheterization at various scanned bladder volumes, and choice of catheterization modalities as appropriate, inappropriate, or uncertain. Next, qualitative methods were used to understand the perceived need, usability, and potential algorithm uses. Results The 11-member expert panel (10 men and 1 woman) used the RAND/UCLA Appropriateness Method to develop a UR algorithm including the following: (1) bladder scanners were preferred over catheterization for UR diagnosis in symptomatic patients or starting as soon as 3 hours since last void if asymptomatic, (2) bladder scanner volumes appropriate to prompt catheterization were 300 mL or greater in symptomatic patients and 500 mL or greater in asymptomatic patients, and (3) intermittent was preferred to indwelling catheterization for managing lower bladder volumes. Interview findings were organized into 3 domains (perceived need, feedback on algorithm, and implementation suggestions). The 33 frontline clinicians (9 men and 24 women) who reviewed the algorithm reported that an evidence-based protocol (1) was needed and could be helpful to clinicians, (2) should be simple and graphically appealing to improve rapid clinician review, and (3) should be integrated within the electronic medical record and prominently displayed in hospital units to increase awareness. The draft algorithm was iteratively refined based on stakeholder feedback. Conclusions and Relevance In this study using a systematic, multidisciplinary, evidence- and expert opinion-based approach, a UR evaluation and catheterization algorithm was developed to improve patient safety by increasing appropriate use of bladder scanners and catheterization. This algorithm addresses the need for practical guidance to manage UR among adult inpatients.
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Affiliation(s)
- Kristin Chrouser
- Department of Urology, University of Michigan, Ann Arbor
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Karen E. Fowler
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Jason D. Mann
- Division of Geriatrics, Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Martha Quinn
- School of Public Health, University of Michigan, Ann Arbor
| | - Jessica Ameling
- Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Samantha Hendren
- Department of Surgery, University of Michigan, Ann Arbor
- Michigan Surgical Quality Collaborative, Ann Arbor
| | - Greta Krapohl
- Michigan Surgical Quality Collaborative, Ann Arbor
- Veterans Health Administration National Center for Patient Safety, Ann Arbor, Michigan
| | - Ted A. Skolarus
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- Department of Surgery, University of Chicago, Chicago, Illinois
| | - Steven J. Bernstein
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Jennifer Meddings
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor
- Division of General Pediatrics, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor
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Wang L, Hummel R, Singh P. Reducing urinary tract infection rates in post-operative surgical patients: A quality improvement intervention. J Healthc Qual Res 2024; 39:233-240. [PMID: 38811301 DOI: 10.1016/j.jhqr.2024.04.005] [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] [Revised: 03/18/2024] [Accepted: 04/24/2024] [Indexed: 05/31/2024]
Abstract
INTRODUCTION AND OBJECTIVES The Scarborough Health Network joined the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) in fiscal year 2017-2018 with interest in tracking surgical outcomes in General and Vascular Surgery patients. Results of the ACS NSQIP program revealed poor outcomes in 30-day urinary tract infection (UTI) rates in this population group. Results were in the lowest quartile compared to peer hospitals. To improve patient care, SHN initiated a multi-pronged quality improvement plan (QIP). METHODS The QIP focused on several improvements: (1) clarify the current state and conduct a root cause analysis, (2) determine a plan to encourage early removal of catheters in post-surgical patients, (3) enhance team communication in the pre-operative, operative and post-operative care environments, and (4) improve education around UTI prevention and treatment. RESULTS This study demonstrates the success of the quality improvement plan to improve a peri-operative complication in surgical patients. By 2019, SHN saw a significant decrease in UTI rates, and became a top decile performer in ACS NSQIP. CONCLUSIONS This study demonstrates the feasibility and success of implementing a quality improvement project, and its methods can be adapted at other hospital sites to improve patient care.
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Affiliation(s)
- L Wang
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - R Hummel
- Montefiore Medical Center, Canada
| | - P Singh
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada; Scarborough Health Network, Scarborough, Ontario, Canada.
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Winberg M, Hälleberg Nyman M, Fjordkvist E, Eldh AC, Joelsson-Alm E. Adherence to evidence-based guidelines for prevention of urinary retention in hip surgery patients: a multicentre observational study. Int J Qual Health Care 2024; 36:mzae045. [PMID: 38804913 PMCID: PMC11155696 DOI: 10.1093/intqhc/mzae045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 03/01/2024] [Accepted: 05/27/2024] [Indexed: 05/29/2024] Open
Abstract
Urinary retention is a healthcare complication putting patients at risk of unnecessary suffering and harm. Orthopaedic patients are known to face an increased such risk, calling for evidence-based preoperative assessment and corresponding measures to prevent bladder problems. The aim of this study was to evaluate healthcare professionals' adherence to risk assessment guidelines for urinary retention in hip surgery patients. This was an observational study from January 2021 to April 2021 with a descriptive and comparative design, triangulating three data sources: (I) Medical records for 1382 hip surgery patients across 17 hospitals in Sweden were reviewed for preoperative risk assessments for urinary retention and voiding-related variables at discharge; (II) The patients completed a survey regarding postoperative lower urinary tract symptoms, and; (III) data were extracted from a national quality registry regarding type of surgery, preoperative physical status, and perioperative urinary complications. Group differences were analysed with Chi-square/Fisher's exact test, t-test, Wilcoxon rank-sum test, or Mann-Whitney U-test. Logistic regression was used to analyse variables associated with completed risk assessments for urinary retention. Of all study participants, 23.4% (n = 323) had a preoperative documented risk assessment of urinary retention. Whether a risk assessment was performed was significantly associated with acute surgery [odds ratio (OR) 3.56, 95% confidence interval (CI) 2.48-5.12] and undergoing surgery at an academic hospital (OR 4.59, 95% CI 2.68-7.85). Acute patients were more often affected by urinary retention and had bladder issues and/or an indwelling catheter at discharge. More than every tenth patient (11. 9%, n = 53) completing the survey experienced intensified bladder problems after their hip surgery. The study shows a lack of adherence to risk assessment for urinary retention according to evidence-based guidelines, which negatively affects quality of care and patient safety.
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Affiliation(s)
- Madeleine Winberg
- Faculty of Medicine and Health Sciences, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping SE-581 83, Sweden
| | - Maria Hälleberg Nyman
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro SE-701 82, Sweden
- Department of Orthopaedics, Faculty of Medicine and Health, Örebro University, Örebro SE-701 82, Sweden
- Faculty of Medicine and Health, University Health Care Research Center, Örebro SE-702 82, Sweden
| | - Erika Fjordkvist
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro SE-701 82, Sweden
- Department of Orthopaedics, Faculty of Medicine and Health, Örebro University, Örebro SE-701 82, Sweden
| | - Ann Catrine Eldh
- Faculty of Medicine and Health Sciences, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping SE-581 83, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Box 564, SE-751 22, Uppsala, Sweden
| | - Eva Joelsson-Alm
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm SE-118 83, Sweden
- Department of Anaesthesia and Intensive Care, Södersjukhuset, Stockholm SE-118 83, Sweden
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Budin JS, Waters TL, Collins LK, Cole MW, Winter JE, Delvadia BP, Iloanya MC, Sherman WF. Incontinence Is an Independent Risk Factor for Total Hip and Knee Arthroplasty. Arthroplast Today 2024; 27:101355. [PMID: 38516503 PMCID: PMC10951425 DOI: 10.1016/j.artd.2024.101355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 12/18/2023] [Accepted: 02/14/2024] [Indexed: 03/23/2024] Open
Abstract
Background Urinary incontinence has been linked to worse postoperative pain, decreased physical function, and reduced quality of life in patients following total joint arthroplasty. The purpose of this study was to analyze whether incontinence is associated with increased postoperative medical and joint complications following primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). Methods A retrospective cohort study was conducted using a national insurance database. Thirty-two thousand eight hundred eleven patients with incontinence who underwent primary THA were identified and matched 1:4 with 129,073 patients without incontinence. Ninety-one thousand nine hundred thirty-five patients with incontinence who underwent primary TKA were matched 1:4 with 367,285 patients without incontinence. Medical and joint complication rates at 90 days and 2 years, respectively, were then compared for patient cohorts using multivariable logistic regressions. Results Patients who underwent primary THA with incontinence had statistically higher rates of dislocation, periprosthetic fracture, aseptic revisions, and overall joint complications compared to controls. Patients who underwent primary TKA with incontinence had higher rates of mechanical failure, aseptic revision, and all-cause revision compared to controls. Conclusions This study demonstrated an association between patients with incontinence and higher rates of dislocation, periprosthetic fractures, aseptic revisions, and overall joint complications following primary THA compared to controls. Patients with incontinence experience higher rates of mechanical failure, aseptic revision, and all-cause revision following TKA compared to controls. As such, perioperative management of urinary incontinence may help mitigate the risk of postoperative complications.
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Affiliation(s)
- Jacob S. Budin
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA
| | - Timothy L. Waters
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA
| | - Lacee K. Collins
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA
| | - Matthew W. Cole
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA
| | - Julianna E. Winter
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA
| | - Bela P. Delvadia
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA
| | - Michael C. Iloanya
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA
| | - William F. Sherman
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA
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Hendren S, Ameling J, Rocker C, Sulich C, Greene MT, Meddings J. Validation of measures for perioperative urinary catheter use, urinary retention, and urinary catheter-related trauma in surgical patients. Am J Surg 2024; 228:199-205. [PMID: 37798151 PMCID: PMC10922583 DOI: 10.1016/j.amjsurg.2023.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/12/2023] [Accepted: 09/19/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND The effects of non-infectious urinary catheter-related complications such as measurements of indwelling urinary catheter overuse, catheter-related trauma, and urinary retention are not well understood. METHODS This was a retrospective cohort study of 200 patients undergoing general surgery operations. Variables to measure urinary catheter use, trauma, and retention were developed, then surgical cases were abstracted. Inter- and intra-rater reliability were calculated for measure validation. RESULTS 129 of 200 (65%) had an indwelling urinary catheter placed at the time of surgery. 32 patients (16%) had urinary retention, and variation was observed in the treatment of urinary retention. 12 patients (6%) had urinary trauma. Rater reliability was high (>90% agreement for all) for the dichotomous outcomes of urinary catheter use, urinary catheter-related trauma, and urinary retention. CONCLUSIONS This study suggests a persistent high rate of catheter use, significant rates of urinary retention and trauma, and variation in the management of retention.
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Affiliation(s)
- Samantha Hendren
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
| | - Jessica Ameling
- Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Cheryl Rocker
- Michigan Surgical Quality Collaborative, Ann Arbor, MI, USA.
| | - Catherine Sulich
- Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - M Todd Greene
- Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA; Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA.
| | - Jennifer Meddings
- Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA; Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA; Division of General Pediatrics, Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, MI, USA.
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7
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Baldwin M. Should urinary catheters be avoided in patients with total joint arthroplasty? JAAPA 2023; 36:1-4. [PMID: 37668486 DOI: 10.1097/01.jaa.0000977632.34077.4d] [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: 09/06/2023]
Abstract
ABSTRACT Patients undergoing total joint arthroplasty typically have indwelling urinary catheters placed preoperatively to decompress the bladder, assess urinary output, and prevent postoperative urinary retention. However, catheterization is associated with several complications and increased hospital length of stay, and research supports eliminating routine placement of urinary catheters in most patients undergoing elective joint arthroplasty and certain general surgeries lasting no more than 2 hours.
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Affiliation(s)
- Michael Baldwin
- Michael Baldwin is the advanced practice provider supervisor at the University of California San Diego Health, Department of Orthopedic Surgery, in San Diego, Calif., and developed the blueprint and curriculum for Loma Linda (Calif.) University's inaugural PA residency in orthopedic surgery. He is a former orthopedic hospitalist at Bon Secours Mercy Health System in Richmond, Va., and adjunct faculty of musculoskeletal medicine at South University's Richmond campus. The author has disclosed no potential conflicts of interest, financial or otherwise
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Huang SY, Panuccio A, Mohabbatizadeh B, Chu M, Leung A, Carre AL. Omitting Foley Catheter Use in Mastectomy Patients With or Without Immediate Reconstruction. Ann Plast Surg 2023; 90:547-550. [PMID: 37311310 DOI: 10.1097/sap.0000000000003556] [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: 06/15/2023]
Abstract
BACKGROUND Foley catheter placement is often advised in surgeries anticipated to exceed 3 hours; however, this time cutoff does not take into account the type of surgery. Complications from Foley catheter placement include urinary tract infections and genitourinary trauma that may be costly to healthcare systems. Our objective was to determine whether mastectomy with or without reconstruction can be done without Foley use, without an increase in urinary retention risk. METHODS One hundred eighty-seven patients who underwent unilateral or bilateral mastectomies with or without reconstruction in 2020 and 2021 were reviewed. Chart review included intraoperative fluids given, estimated blood loss, lymph node dissection, and duration of procedure. RESULTS After excluding patients with case duration under 180 minutes, 145 remained. Ninety-four patients did not have a Foley and 51 patients had an intraoperative Foley. None of the patients without a Foley experienced postoperative urinary retention, including 3 patients who also underwent lymphatic microsurgical preventive healing approach. Eighty-six percent of patients were discharged on the day of surgery. Patients with or without a Foley did not differ significantly in terms of race, rate of axillary lymph node dissection, body mass index, rate of same-day discharge, presence of hypertension or diabetes, estimated blood loss, or age. CONCLUSIONS Patients undergoing unilateral and bilateral mastectomies with or without reconstruction or lymphatic microsurgical preventive healing approach may avoid Foley catheter placement without increased risk of urinary retention, even if the case is anticipated to exceed 3 hours. Advantages include elimination of catheter-associated urinary tract infections and their associated hospital costs, as well as avoiding genitourinary trauma.
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Affiliation(s)
- Siu-Yuan Huang
- From the Department of General Surgery, Kaiser Permanente Los Angeles Medical Center
| | - Alexandria Panuccio
- From the Department of General Surgery, Kaiser Permanente Los Angeles Medical Center
| | - Borna Mohabbatizadeh
- From the Department of General Surgery, Kaiser Permanente Los Angeles Medical Center
| | - Michael Chu
- Department of Plastic Surgery, Kaiser Permanente West Los Angeles Medical Center
| | - Anna Leung
- From the Department of General Surgery, Kaiser Permanente Los Angeles Medical Center
| | - Antoine L Carre
- Department of Plastic Surgery, City of Hope, Los Angeles, CA
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Zhang YF, Li XY, Liu XY, Zhang Y, Gong LR, Shi J, Du SH, He SM, Li C, Li YT, Li N, Liu SS, Wu Y, Xie ZL, Pei ZC, Yu JB. Transcutaneous Electrical Acupoints Stimulation Improves Spontaneous Voiding Recovery After Laparoscopic Cholecystectomy: A Randomized Clinical Trial. World J Surg 2023; 47:1153-1162. [PMID: 36745198 DOI: 10.1007/s00268-023-06924-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2023] [Indexed: 02/07/2023]
Abstract
BACKGROUND Facilitating the recurrence of spontaneous voiding is considered to be a way to prevent urinary retention after surgery, which is of great importance in cholecystectomy. This study aimed to assess the effect of transcutaneous electrical acupoint stimulation (TEAS) on spontaneous voiding recovery after laparoscopic cholecystectom. METHODS Participants who underwent elective laparoscopic cholecystectomy were randomly assigned to either the TEAS group or the sham group. Active TEAS or sham TEAS at specific acupuncture points was conducted intraoperatively and postoperatively. The primary outcome was the recovery speed of spontaneous voiding ability after surgery and secondary outcomes included postoperative urinary retention (POUR), voiding dysfunction, pain, anxiety and depression, and early recovery after surgery. RESULTS A total of 1,948 participants were recruited and randomized to TEAS (n = 975) or sham (n = 973) between August 2018 and June 2020. TEAS shortens the time delay of the first spontaneous voiding after laparoscopic cholecystectomy (5.6 h [IQR, 3.7-8.1 h] in the TEAS group vs 7.0 h [IQR, 4.7-9.7 h] in the sham group) (p < 0.001). The TEAS group experienced less POUR (p = 0.020), less voiding difficulty (p < 0.001), less anxiety and depression (p < 0.001), reduced pain (p = 0.007), and earlier ambulation (p = 0.01) than the sham group. CONCLUSIONS Our results showed that TEAS is an effective approach to accelerate the recovery of spontaneous voiding and reduce POUR which facilitates recovery for patients after laparoscopic cholecystectomy.
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Affiliation(s)
- Yan-Fang Zhang
- Department of Anesthesiology and Critical Care Medicine, Tianjin Nankai Hospital, Tianjin Medical University, 6 Changjiang Road, Tianjin, People's Republic of China
| | - Xiang-Yun Li
- Department of Anesthesiology and Critical Care Medicine, Tianjin Nankai Hospital, Tianjin Medical University, 6 Changjiang Road, Tianjin, People's Republic of China
| | - Xiu-Yun Liu
- Department of Biomedical Engineering, College of Precision Instruments and Optoelectronics Engineering, Tianjin University, Tianjin, China
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, People's Republic of China
| | - Yuan Zhang
- Department of Anesthesiology and Critical Care Medicine, Tianjin Nankai Hospital, Tianjin Medical University, 6 Changjiang Road, Tianjin, People's Republic of China
| | - Li-Rong Gong
- Department of Anesthesiology and Critical Care Medicine, Tianjin Nankai Hospital, Tianjin Medical University, 6 Changjiang Road, Tianjin, People's Republic of China
| | - Jia Shi
- Department of Anesthesiology and Critical Care Medicine, Tianjin Nankai Hospital, Tianjin Medical University, 6 Changjiang Road, Tianjin, People's Republic of China
| | - Shi-Han Du
- Department of Anesthesiology and Critical Care Medicine, Tianjin Nankai Hospital, Tianjin Medical University, 6 Changjiang Road, Tianjin, People's Republic of China
| | - Si-Meng He
- Department of Anesthesiology and Critical Care Medicine, Tianjin Nankai Hospital, Tianjin Medical University, 6 Changjiang Road, Tianjin, People's Republic of China
| | - Cui Li
- Department of Anesthesiology and Critical Care Medicine, Tianjin Nankai Hospital, Tianjin Medical University, 6 Changjiang Road, Tianjin, People's Republic of China
| | - Yu-Ting Li
- Department of Anesthesiology and Critical Care Medicine, Tianjin Nankai Hospital, Tianjin Medical University, 6 Changjiang Road, Tianjin, People's Republic of China
| | - Na Li
- Department of Anesthesiology and Critical Care Medicine, Tianjin Nankai Hospital, Tianjin Medical University, 6 Changjiang Road, Tianjin, People's Republic of China
| | - Sha-Sha Liu
- Department of Anesthesiology and Critical Care Medicine, Tianjin Nankai Hospital, Tianjin Medical University, 6 Changjiang Road, Tianjin, People's Republic of China
| | - Ya Wu
- Department of Anesthesiology and Critical Care Medicine, Tianjin Nankai Hospital, Tianjin Medical University, 6 Changjiang Road, Tianjin, People's Republic of China
| | - Zi-Lei Xie
- Department of Anesthesiology and Critical Care Medicine, Tianjin Nankai Hospital, Tianjin Medical University, 6 Changjiang Road, Tianjin, People's Republic of China
| | - Zheng-Cun Pei
- Department of Biomedical Engineering, College of Precision Instruments and Optoelectronics Engineering, Tianjin University, Tianjin, China
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, People's Republic of China
| | - Jian-Bo Yu
- Department of Anesthesiology and Critical Care Medicine, Tianjin Nankai Hospital, Tianjin Medical University, 6 Changjiang Road, Tianjin, People's Republic of China.
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Frödin M, Nellgård B, Rogmark C, Gillespie BM, Wikström E, Andersson AE. A co-created nurse-driven catheterisation protocol can reduce bladder distension in acute hip fracture patients - results from a longitudinal observational study. BMC Nurs 2022; 21:276. [PMID: 36224550 PMCID: PMC9559039 DOI: 10.1186/s12912-022-01057-z] [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: 03/29/2022] [Accepted: 09/30/2022] [Indexed: 11/10/2022] Open
Abstract
Background Urinary retention is common in elderly patients undergoing acute hip fracture surgery. Avoiding overfilling the urinary bladder is important to avoid detrusor muscle damage and associated motility problems. The aim of this study was to analyse associations between the co-creation of a nurse-driven urinary catheterisation protocol and the incidence of bladder distension in patients undergoing hip fracture surgery. Methods This is a single-centre implementation intervention with a retrospective longitudinal observation design, using five measures points, spanning from June 2015 to March 2020. The intervention was theory driven and the participants, together with the facilitators and researcher, co-created a nurse-driven urinary catheterisation protocol. Data were retrieved from the hip fracture register. Uni- and multivariable logistic regressions were used for analyses of changes in bladder distension and urinary volume of ≥500 ml over the years. Results A total of 3078 patients were included over a five-year period. The implementation intervention was associated with a reduction in the proportion of patients with bladder distension of 31.5% (95% confidence interval 26.0–37.0), from year 1 to year 5. The multivariable analysis indicated a 39% yearly reduction in bladder distension, OR 0.61 (95% confidence interval 0.57–0.64, p < 0001). There was a reduction in the proportion of patients with a bladder volume of ≥500 ml of 42.8% (95% confidence interval 36.2–49.4), from year 1 to year 5. The multivariable analysis found a 41% yearly reduction in patients with a bladder volume of ≥500 ml, OR 0.59 (95% confidence interval 0.55–0.64, p < 0.0001). The intervention was associated with improved documentation of both catheter indications and removal plans. Conclusion The use of predefined catheter indications and a tighter bladder scanning schedule were associated with a reduction in the incidence of both bladder distension and urine volume ≥ 500 ml in hip fracture patients. Registered nurses can play an active role in the facilitation of timely and appropriate catheter treatment in patients with hip fractures. Trial registration Clinical Trial Registry ISRCTN 17022695 registered retrospectively on 23 December 2021, in the end of the study, after data collection. Supplementary Information The online version contains supplementary material available at 10.1186/s12912-022-01057-z.
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Affiliation(s)
- Maria Frödin
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska University Hospital, Ortopedoperation 1, Göteborgsvägen 31, SE-431 80, Gothenburg, Sweden.
| | - Bengt Nellgård
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska University Hospital, Ortopedoperation 1, Göteborgsvägen 31, SE-431 80, Gothenburg, Sweden
| | - Cecilia Rogmark
- Skane University Hospital, Department of Orthopaedics Malmö, Lund University, Lund, Sweden.,The Swedish Arthroplasty Register, Registercentrum VGR, Gothenburg, Sweden
| | - Brigid M Gillespie
- NMHRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute, Queensland, Griffith University, Brisbane, Australia.,Gold Coast University Hospital and Health Service, Southport, Australia
| | - Ewa Wikström
- School of Business, Economics and Law, Department of Business Administration, University of Gothenburg, Gothenburg, Sweden
| | - Annette Erichsen Andersson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska University Hospital, Ortopedoperation 1, Göteborgsvägen 31, SE-431 80, Gothenburg, Sweden
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11
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Nollen JM, Pijnappel L, Schoones JW, Peul WC, Van Furth WR, Brunsveld-Reinders AH. Impact of early postoperative indwelling urinary catheter removal: A systematic review. J Clin Nurs 2022; 32:2155-2177. [PMID: 35676776 DOI: 10.1111/jocn.16393] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 03/11/2022] [Accepted: 05/16/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Indwelling urinary catheters (IDUCs) are associated with complications and early removal is therefore essential. Currently, it is unknown what the effect of a specific removal time is and what the consequences of this removal time are. RESEARCH QUESTION To present an overview of the available evidence to determine the effects of three postoperative IDUC removal times (after a certain number of hours, at a specific time of day and flexible removal time) on the development of complications in hospital. METHODS PubMed, Medline, Embase, Emcare and Cochrane Central Register of Controlled Trials were searched till 6 June, 2021. Studies were included that described the effect of the removal time in relation to re-catheterisation, urinary tract infections (UTIs), ambulation time, time of first voiding and hospital stay. The quality of the studies was assessed with the Newcastle-Ottawa Scale and the Cochrane Effective Practice and Organisation of Care. A narrative descriptive analysis was performed. PRISMA guidelines were followed in reporting this review. RESULTS Twenty studies were included from which 18 compared removal after a number of hours, 1 reported on a specific removal time and 1 reported on both topics. The results were contradicting regarding the hypothesis that later removal increases the incidence of UTIs. Earlier removal does not lead to a higher re-catheterisation rate while immediate removal is beneficial for reducing the time to first ambulation and shortening the hospital stay. Studies reporting on specific removal times did not find differences in outcomes. No study addressed flexible removal time. CONCLUSIONS There is inconclusive evidence that earlier removal results in less UTIs, despite the incidence of UTIs increasing if the IDUC is removed ≥24 h. Immediate or after 1-2 day(s) removal does not lead to higher re-catheterisation rates while immediate removal results in earlier ambulation and shorter length of hospital stay. IMPLICATIONS OF KEY FINDINGS Nurses should focus on early IDUC removal while being aware of urinary retention.
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Affiliation(s)
- Jeanne-Marie Nollen
- Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Laury Pijnappel
- Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan W Schoones
- Walaeus Library, Leiden University Medical Center, Leiden, The Netherlands
| | - Wilco C Peul
- Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Wouter R Van Furth
- Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
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12
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Acosta J. Development and pilot test of criteria defining best practices for organizational sexual assault prevention. Prev Med Rep 2022; 26:101723. [PMID: 35198360 PMCID: PMC8844897 DOI: 10.1016/j.pmedr.2022.101723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 01/24/2022] [Accepted: 01/29/2022] [Indexed: 11/18/2022] Open
Abstract
Sexual violence affects millions of Americans, and approximately one out of every three women and one out of every four men have experienced sexual violence during their lifetime. While prevention efforts have focused on implementing specific programmatic approaches, there has been relatively little focus on developing comprehensive and effective approaches to reduce sexual assault prevention across an organization. This study describes the development of the Prevention Evaluation Framework, an assessment targeting organizational best practices for comprehensive sexual assault prevention across multiple domains including human resources, collaborative relationships and infrastructure, use of evidence-informed approaches, quality implementation and continuous evaluation of programs/policies. Using the structured RAND/University of California, Los Angeles appropriateness method to develop the assessment, we conducted a literature review and solicited expert feedback about what a comprehensive organizational approach to sexual assault prevention should entail. We then pilot tested the assessment with 3 United States military service academies; and continued to improve and adapt the assessment to a range of organizations with input from 6 Department of Defense headquarters organizations, and 9 universities across the country. Given the nascent state of the evidence about what makes an effective organizational approach to sexual assault prevention, the assessment reflects one way of promoting quality in this evolving field. The consistency between the experts’ ratings and the literature, and the relevance of the items across organizations suggest that the assessment provides important guidance to inform the development of comprehensive organizational approaches to sexual assault prevention and to the evaluation of ongoing efforts.
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13
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Porche K, Maciel CB, Lucke-Wold B, Robicsek SA, Chalouhi N, Brennan M, Busl KM. Preoperative prediction of postoperative urinary retention in lumbar surgery: a comparison of regression to multilayer neural network. J Neurosurg Spine 2022; 36:32-41. [PMID: 34507288 PMCID: PMC9608355 DOI: 10.3171/2021.3.spine21189] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/09/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Postoperative urinary retention (POUR) is a common complication after spine surgery and is associated with prolongation of hospital stay, increased hospital cost, increased rate of urinary tract infection, bladder overdistention, and autonomic dysregulation. POUR incidence following spine surgery ranges between 5.6% and 38%; no reliable prediction tool to identify those at higher risk is available, and that constitutes an important gap in the literature. The objective of this study was to develop and validate a preoperative risk model to predict the occurrence of POUR following routine elective spine surgery. METHODS The authors conducted a retrospective chart review of consecutive adults who underwent lumbar spine surgery between June 1, 2017, and June 1, 2019. Patient characteristics, preexisting ICD-10 codes, preoperative pain and opioid use, preoperative alpha-1 blocker use, details of surgical planning, development of POUR, and management strategies were abstracted from electronic medical records. A binomial logistic model and a multilayer perceptron (MLP) were optimized using training and validation sets. The models' performance was then evaluated on model-naïve patients (not a part of either cohort). The models were then stacked to take advantage of each model's strengths and to avoid their weaknesses. Four additional models were developed from previously published models adjusted to include only relevant factors (i.e., factors known preoperatively and applied to the lumbar spine). RESULTS Overall, 891 patients were included in the cohort, with a mean of 59.6 ± 15.5 years of age, 52.7% male, BMI 30.4 ± 6.4, American Society of Anesthesiologists class 2.8 ± 0.6, and a mean of 5.6 ± 5.7 comorbidities. The rate of POUR was found to be 25.9%. The two models were comparable, with an area under the curve (AUC) of 0.737 for the regression model and 0.735 for the neural network. By combining the two models, an AUC of 0.753 was achieved. With a regression model probability cutoff of 0.24 and a neural network cutoff of 0.23, maximal sensitivity and specificity were achieved, with specificity 68.2%, sensitivity 72.9%, negative predictive value 88.2%, and positive predictive value 43.4%. Both models individually outperformed previously published models (AUC 0.516-0.645) when applied to the current data set. CONCLUSIONS This predictive model can be a powerful preoperative tool in predicting patients who will be likely to develop POUR. By using a combination of regression and neural network modeling, good sensitivity, specificity, and NPV are achieved.
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Affiliation(s)
- Ken Porche
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - Carolina B. Maciel
- Departments of Neurology and Neurosurgery, University of Florida, Gainesville, Florida
| | - Brandon Lucke-Wold
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - Steven A. Robicsek
- Department of Anesthesiology, University of Florida, Gainesville, Florida
| | - Nohra Chalouhi
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - Meghan Brennan
- Department of Anesthesiology, University of Florida, Gainesville, Florida
| | - Katharina M. Busl
- Departments of Neurology and Neurosurgery, University of Florida, Gainesville, Florida
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14
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Need for routine preoperative insertion of indwelling urinary catheter prior to endovascular repair of abdominal aortic aneurysm. Ann Vasc Surg 2021; 82:96-103. [PMID: 34954377 DOI: 10.1016/j.avsg.2021.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/01/2021] [Accepted: 12/13/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Evaluate outcomes following urinary catheter (UC) vs. no urinary catheter (NUC) insertion in elective endovascular repair (EVAR) of abdominal aortic aneurysm (AAA). METHODS Retrospective record review of all elective EVAR at a university affiliated medical center over a 5-year period. Statistical analysis included Chi Sq, Independent Student T Test. RESULTS Six surgeons performed 272 elective EVAR. Three surgeons preferred selective insertion of indwelling UC, such that 86 (32%) EVAR were completed without indwelling urinary catheters (NUC). Differences between NUC vs. UC included; male: (86% vs. 70%; P= 0.004), CAD: (45% vs.33%; p= .046), conscious sedation: (36% vs. 8%; P < 0.001), bilateral percutaneous EVAR (PEVAR): (100% vs. 90%; P= 0.01), within ProglideTM IFU guidelines (87% vs 75%; P= .05), major adverse operative event (MAOE): (3.5% vs. 10%; P= 0.05) and mean operative time (185 ± 73 vs. 140 ± 37; P < 0.001). Intra-operative catheterization was never required among NUC. Postoperative adverse urinary events (AUE) were more common among UC (11.4% vs. 8.1%; P= 0.41); with longer times to straight catheterization/reinsertion (1575 ± 987 vs 522 ± 269 minutes; P= 0.015) and lower likelihood of eligibility for same day discharge (SDD); (41% vs.59%; P= 0.008). Ineligibility for SDD was due to AUE in 18% of UC patients. CONCLUSION Selective preoperative UC insertion should be considered for EVAR, with particular consideration to no preoperative catheterization in men meeting Proglide IFU. Adverse urinary events occurred less frequently among NUC and were identified/ treated earlier. Moreover, AUEs were the most common reason for potential SDD ineligibility among UC patients. Selective policies may facilitate SDD.
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15
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Crain NA, Goharderakhshan RZ, Reddy NC, Apfel AM, Navarro RA. The Role of Intraoperative Urinary Catheters on Postoperative Urinary Retention after Total Joint Arthroplasty: A Multi-Hospital Retrospective Study on 9,580 Patients. THE ARCHIVES OF BONE AND JOINT SURGERY 2021; 9:480-486. [PMID: 34692929 DOI: 10.22038/abjs.2020.49205.2441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 12/02/2020] [Indexed: 12/27/2022]
Abstract
Background Urinary catheters (UC) are used by some surgeons during total joint arthroplasty (TJA). This study investigated the impact of intraoperative urinary catheters on postoperative urinary retention (POUR) following TJA cases. Methods We conducted a retrospective comparative study across 11 medical centers on 9,580 TJA patients. Visits to urgent care or the emergency department within 7 and 30 postoperative days were reviewed. Medical records over a 12-month period for all patients older than 18 years old were used to gather demographic and surgical data as well as the incidence of urinary tract infection (UTI). Chi-squared tests (RStudio) were used to determine statistical significance against P-Values (P) < 0.05. Results 13 (0.14%) patients returned within 7 days for POUR. POUR was more common in males [10 (0.3%) vs. 3 (0.1%) females, (P = 0.01)]. There was no difference in POUR when comparing total hip and knee arthroplasty procedures [0.16% vs. 0.12%, (P = 0.60)]. Of all operations, 25% had intraoperative UC use. There was no difference in POUR between the UC and no UC groups [0.21 vs. 0.11%, (P = 0.26)]. However, there was an increase in UTI in UC vs. no UC use within 7 postoperative days [0.92 vs. 0.43%, (P = 0.005)] and 30 postoperative days [2.60 vs. 1.50 %, (P < 0.001)]. Conclusion In our study, there was no difference in POUR rates between the intraoperative UC vs. no UC groups. Therefore, the use of intraoperative UC may not decrease the rate of POUR following TJA procedures. Additionally, UTI risk was higher in the UC group which may be attributable to other factors, especially when comparing female vs. male patients.
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Affiliation(s)
- Nikhil A Crain
- Department of Orthopedics, South Bay Medical Center, Kaiser Permanente Southern California Medical Group, Harbor City, CA, USA.,2196 Gaston Street, Winston-Salem, NC, USA
| | - Reza Z Goharderakhshan
- Department of Urology, South Bay Medical Center, Kaiser Permanente Southern California Medical Group, Harbor City, CA, USA
| | - Nithin C Reddy
- Department of Orthopedics, San Diego Medical Center, Kaiser Permanente Southern California Medical Group, San Diego, CA, USA
| | - Allison M Apfel
- Department of Orthopedics, South Bay Medical Center, Kaiser Permanente Southern California Medical Group, Harbor City, CA, USA
| | - Ronald A Navarro
- Department of Orthopedics, South Bay Medical Center, Kaiser Permanente Southern California Medical Group, Harbor City, CA, USA
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16
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Adherence to evidence-based guidelines for indwelling urinary catheter management: A cross-sectional study. Collegian 2021. [DOI: 10.1016/j.colegn.2021.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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17
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Lorenzi C, Duffy CC. Incorporating Human Factors in Perioperative Nursing to Reduce Errors. AORN J 2021; 114:380-386. [PMID: 34586659 DOI: 10.1002/aorn.13516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 04/07/2021] [Indexed: 11/10/2022]
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18
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Crigger C, Kuzbel J, Al-Omar O. Choosing the Right Catheter for Pediatric Procedures: Patient Considerations and Preference. Res Rep Urol 2021; 13:185-195. [PMID: 33954151 PMCID: PMC8092428 DOI: 10.2147/rru.s282654] [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: 01/16/2021] [Accepted: 03/30/2021] [Indexed: 11/23/2022] Open
Abstract
Determining the need for bladder decompression and urinary diversion in the perioperative pediatric surgical patient can cause a clinical conundrum for the surgical team. Add in the several different types of urinary diversion devices possible, and the various materials associated therein and the process can suddenly seem unnecessarily daunting given the lack of concise recommendations and broad consensus. The decision to divert urine, though seemingly trivial, is associated with inherent risks. Managing and mitigating certain risks are best approached through proper education, selection, and technique. We provide a broad overview of pediatric catheter selection, indications, and pitfalls to streamline the process so that energy and attention can best be focused on the planned intervention at hand.
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Affiliation(s)
- Chad Crigger
- Department of Urology, Division of Pediatric Urology, West Virginia University, Morgantown, WV, 26506, USA
| | - Jake Kuzbel
- Department of Urology, Division of Pediatric Urology, West Virginia University, Morgantown, WV, 26506, USA
| | - Osama Al-Omar
- Department of Urology, Division of Pediatric Urology, West Virginia University, Morgantown, WV, 26506, USA
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19
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Prezioso G, Perrone S, Biasucci G, Pisi G, Fainardi V, Strisciuglio C, Marzano FN, Moretti S, Pisani F, Tchana B, Argentiero A, Neglia C, Caffarelli C, Bertolini P, Bersini MT, Canali A, Voccia E, Squarcia A, Ghi T, Verrotti C, Frusca T, Cecchi R, Giordano G, Colasanti F, Roccia I, Palanza P, Esposito S. Management of Infants with Brief Resolved Unexplained Events (BRUE) and Apparent Life-Threatening Events (ALTE): A RAND/UCLA Appropriateness Approach. Life (Basel) 2021; 11:171. [PMID: 33671771 PMCID: PMC7926945 DOI: 10.3390/life11020171] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 02/17/2021] [Accepted: 02/18/2021] [Indexed: 12/15/2022] Open
Abstract
Unexpected events of breath, tone, and skin color change in infants are a cause of considerable distress to the caregiver and there is still debate on their appropriate management. The aim of this study is to survey the trend in prevention, decision-making, and management of brief resolved unexplained events (BRUE)/apparent life-threatening events (ALTE) and to develop a shared protocol among hospitals and primary care pediatricians regarding hospital admission criteria, work-up and post-discharge monitoring of patients with BRUE/ALTE. For the study purpose, a panel of 54 experts was selected to achieve consensus using the RAND/UCLA appropriateness method. Twelve scenarios were developed: one addressed to primary prevention of ALTE and BRUE, and 11 focused on hospital management of BRUE and ALTE. For each scenario, participants were asked to rank each option from '1' (extremely inappropriate) to '9' (extremely appropriate). Results derived from panel meeting and discussion showed several points of agreement but also disagreement with different opinion emerged and the need of focused education on some areas. However, by combining previous recommendations with expert opinion, the application of the RAND/UCLA appropriateness permitted us to drive pediatricians to reasoned and informed decisions in term of evaluation, treatment and follow-up of infants with BRUE/ALTE, reducing inappropriate exams and hospitalisation and highlighting priorities for educational interventions.
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Affiliation(s)
- Giovanni Prezioso
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (G.P.); (G.P.); (V.F.); (F.P.); (A.A.); (C.N.); (C.C.)
| | - Serafina Perrone
- Unit of Neonatology, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.P.); (S.M.); (F.C.); (I.R.)
| | - Giacomo Biasucci
- Pediatrics and Neonatology Unit, Guglielmo da Saliceto Hospital, 29122 Piacenza, Italy;
| | - Giovanna Pisi
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (G.P.); (G.P.); (V.F.); (F.P.); (A.A.); (C.N.); (C.C.)
| | - Valentina Fainardi
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (G.P.); (G.P.); (V.F.); (F.P.); (A.A.); (C.N.); (C.C.)
| | - Caterina Strisciuglio
- Department of Woman, Child and General and Specialistic Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Francesco Nonnis Marzano
- Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, 43126 Parma, Italy;
| | - Sabrina Moretti
- Unit of Neonatology, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.P.); (S.M.); (F.C.); (I.R.)
| | - Francesco Pisani
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (G.P.); (G.P.); (V.F.); (F.P.); (A.A.); (C.N.); (C.C.)
| | | | - Alberto Argentiero
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (G.P.); (G.P.); (V.F.); (F.P.); (A.A.); (C.N.); (C.C.)
| | - Cosimo Neglia
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (G.P.); (G.P.); (V.F.); (F.P.); (A.A.); (C.N.); (C.C.)
| | - Carlo Caffarelli
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (G.P.); (G.P.); (V.F.); (F.P.); (A.A.); (C.N.); (C.C.)
| | | | - Maria Teresa Bersini
- Primary Care Pediatrics, AUSL of Parma, 43126 Parma, Italy; (M.T.B.); (A.C.); (E.V.)
| | - Andrea Canali
- Primary Care Pediatrics, AUSL of Parma, 43126 Parma, Italy; (M.T.B.); (A.C.); (E.V.)
| | - Emanuele Voccia
- Primary Care Pediatrics, AUSL of Parma, 43126 Parma, Italy; (M.T.B.); (A.C.); (E.V.)
| | - Antonella Squarcia
- Unit of Neuropsychiatry of Children and Adolescents, AUSL Parma, 43126 Parma, Italy;
| | - Tullio Ghi
- Obstetrics and Gynaecology Unit, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (T.G.); (T.F.)
| | | | - Tiziana Frusca
- Obstetrics and Gynaecology Unit, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (T.G.); (T.F.)
| | - Rossana Cecchi
- Legal Medicine Section, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy;
| | - Giovanna Giordano
- Pathology Unit, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy;
| | - Filomena Colasanti
- Unit of Neonatology, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.P.); (S.M.); (F.C.); (I.R.)
| | - Ilenia Roccia
- Unit of Neonatology, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.P.); (S.M.); (F.C.); (I.R.)
| | - Paola Palanza
- Unit of Neuroscience, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy;
| | - Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (G.P.); (G.P.); (V.F.); (F.P.); (A.A.); (C.N.); (C.C.)
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Kauffman JD, Danielson PD, Chandler NM. Risk factors and associated morbidity of urinary tract infections in pediatric surgical patients: A NSQIP pediatric analysis. J Pediatr Surg 2020; 55:715-720. [PMID: 31126686 DOI: 10.1016/j.jpedsurg.2019.04.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/17/2019] [Accepted: 04/29/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The purpose of this study is to examine the incidence, risk factors, and morbidity of postoperative urinary tract infections (UTI) in pediatric surgical patients. METHODS All patients in the 2012-2016 American College of Surgeons National Surgical Quality Improvement Program Pediatric database were included. Demographics, comorbidities, and 30-day outcomes were assessed. Multivariable logistic regression was used to estimate the independent effects of patient and procedure characteristics on the risk for UTI and to estimate the effects of UTI on the risk for readmission and reoperation. RESULTS Of 369,176 patients, 1964 (0.5%) developed a postoperative UTI. Those undergoing urological and neurosurgical procedures were at greatest risk. Diabetes, ventilator dependence, and dependence on nutritional support each increased the odds of developing a UTI by more than 60% (P < 0.01). On multivariable analysis, UTI was an independent risk factor for unplanned readmission (OR, 4.93; 95% CI, 4.39-5.54; P < 0.001) and reoperation (OR, 1.21; 95% CI, 1.01-1.45; P = 0.041). CONCLUSION Urinary tract infection is an uncommon but not inconsequential complication following surgery in the pediatric population and is associated with increased risk of readmission and reoperation. The identification of risk factors for postoperative UTI provides the opportunity for targeted surveillance and patient-specific interventions to prevent UTIs in children at greatest risk. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Jeremy D Kauffman
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA.
| | - Paul D Danielson
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA.
| | - Nicole M Chandler
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA.
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21
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Using appropriateness criteria to identify opportunities to improve perioperative urinary catheter use. Am J Surg 2020; 220:706-713. [PMID: 32008720 DOI: 10.1016/j.amjsurg.2020.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND The Michigan Appropriate Perioperative (MAP) criteria provide guidance regarding urinary catheter use. For Category A (e.g., laparoscopic cholecystectomy), B (e.g., hemicolectomy), and C (e.g., abdominoperineal resection) procedures, recommendations are to avoid catheter, remove POD 0 or 1, and remove POD 1-4, respectively. We applied MAP criteria to statewide registry data to identify improvement targets. METHODS Retrospective cohort study of risk-adjusted catheter use and duration for appendectomy, cholecystectomy, and colorectal resections in 2014-2015 from 64 Michigan hospitals. RESULTS 5.5% of 13,032 Category A cases used urinary catheters, including 26.9% of open appendectomies. 94.5% of 1,624 Category B cases used catheters (31.2% remained after POD 1). 98.3% of 700 Category C cases used catheters (4.6% remained POD5+). Variation in duration of use persisted after risk adjustment. CONCLUSIONS Perioperative urinary catheter use was appropriate for most simple abdominal procedures, but duration of use varied in all categories.
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22
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Lee Y, McKechnie T, Springer JE, Doumouras AG, Hong D, Eskicioglu C. Optimal timing of urinary catheter removal following pelvic colorectal surgery: a systematic review and meta-analysis. Int J Colorectal Dis 2019; 34:2011-2021. [PMID: 31707560 DOI: 10.1007/s00384-019-03404-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/11/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE Acute urinary retention (AUR) is a common postoperative complication in colorectal surgery. In pelvic colorectal operations, the optimal duration for postoperative urinary catheter use is controversial. This systematic review and meta-analysis aims to compare early (POD 1), intermediate (POD 3), and late (POD 5) urinary catheter removal. METHODS Medline, EMBASE, CENTRAL, and PubMed databases were searched. Articles were eligible for inclusion if they compared patients with urinary catheter removal on POD 1 or earlier to patients with urinary catheter removal on POD 2 or later in major pelvic colorectal surgeries. The primary outcome was rate of postoperative AUR. The secondary outcome was rates of postoperative urinary tract infection (UTI). RESULTS From 691 relevant citations, five studies with 928 patients were included. Comparison of urinary catheter removal on POD 1 versus POD 3 demonstrated no significant difference in rate of urinary retention (RR 1.36, 95%CI 0.83-2.21, P = 0.22); however, compared to POD 5, rates of AUR were significantly higher (RR 2.58, 95%CI 1.51-4.40, P = 0.0005). Rates of UTI were not significantly different between POD 1 and POD 3 urinary catheter removal (RR 0.40, 95%CI 0.05-3.71, P = 0.45), but removal on POD 5 significantly increased risk of UTI compared to POD 1 (RR 0.50, 95%CI 0.31-0.81, P = 0.005). CONCLUSION Risk of AUR can be minimized with late postoperative urinary catheter removal compared to early removal, but at the cost of increased risk of UTI. Patient-specific factors should be taken into consideration when deciding upon optimal duration of postoperative urinary catheterization.
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Affiliation(s)
- Yung Lee
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Tyler McKechnie
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Jeremy E Springer
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Aristithes G Doumouras
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- Division of General Surgery, Department of Surgery, St. Joseph Healthcare, Hamilton, Ontario, Canada
| | - Dennis Hong
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- Division of General Surgery, Department of Surgery, St. Joseph Healthcare, Hamilton, Ontario, Canada
| | - Cagla Eskicioglu
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
- Division of General Surgery, Department of Surgery, St. Joseph Healthcare, Hamilton, Ontario, Canada.
- Division of General Surgery Department of Surgery, St. Joseph's Healthcare, McMaster University, 50 Charlton Avenue East, Hamilton, Ontario, L8N 4A6, Canada.
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Postoperative Urinary Retention After Bariatric Surgery: An Institutional Analysis. J Surg Res 2019; 243:83-89. [DOI: 10.1016/j.jss.2019.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/23/2019] [Accepted: 05/01/2019] [Indexed: 01/02/2023]
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Meddings J, Manojlovich M, Fowler KE, Ameling JM, Greene L, Collier S, Bhatt J, Saint S. A Tiered Approach for Preventing Catheter-Associated Urinary Tract Infection. Ann Intern Med 2019; 171:S30-S37. [PMID: 31569226 DOI: 10.7326/m18-3471] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Jennifer Meddings
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (J.M., S.S.)
| | | | - Karen E Fowler
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (K.E.F.)
| | | | - Linda Greene
- University of Rochester Highland Hospital, Rochester, New York (L.G.)
| | - Sue Collier
- Health Research & Educational Trust, American Hospital Association, Chicago, Illinois (S.C., J.B.)
| | - Jay Bhatt
- Health Research & Educational Trust, American Hospital Association, Chicago, Illinois (S.C., J.B.)
| | - Sanjay Saint
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (J.M., S.S.)
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Meddings J, Manojlovich M, Ameling JM, Olmsted RN, Rolle AJ, Greene MT, Ratz D, Snyder A, Saint S. Quantitative Results of a National Intervention to Prevent Hospital-Acquired Catheter-Associated Urinary Tract Infection: A Pre-Post Observational Study. Ann Intern Med 2019; 171:S38-S44. [PMID: 31569231 DOI: 10.7326/m18-3534] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Many hospitals struggle to prevent catheter-associated urinary tract infection (CAUTI). OBJECTIVE To evaluate the effect of a multimodal initiative on CAUTI in hospitals with high burden of health care-associated infection (HAI). DESIGN Prospective, national, nonrandomized, clustered, externally facilitated, pre-post observational quality improvement initiative, for 3 cohorts active between November 2016 and May 2018. SETTING Acute care, long-term acute care, and critical access hospitals, including intensive care and non-intensive care wards. PARTICIPANTS Target hospitals had a high burden of Clostridioides difficile infection plus central line-associated bloodstream infection, CAUTI, or hospital-onset methicillin-resistant Staphylococcus aureus bloodstream infection, defined as cumulative attributable differences above the first tertile in the Targeted Assessment for Prevention (TAP) strategy. Some additional nonrecruited hospitals also joined. INTERVENTION Multimodal intervention, including Practice Change Assessment tool to identify infection prevention and control (IPC) and HAI prevention gaps; Web-based, on-demand modules involving onboarding, foundational IPC practices, HAI-specific 2-tiered approach to prioritize and implement interventions, and TAP resources; monthly webinars; state partner-led in-person meetings; and feedback. State partners made site visits to at least 50% of their enrolled hospitals, to support self-assessments and coach. MEASUREMENTS Rates of CAUTI and urinary catheter device utilization ratio. RESULTS Of 387 participating hospitals from 23 states and the District of Columbia, 361 provided CAUTI data. Over the study period, the unadjusted CAUTI rate was low and relatively stable, decreasing slightly from 1.12 to 1.04 CAUTIs per 1000 catheter-days. Catheter utilization decreased from 21.46 to 19.83 catheter-days per 100 patient-days from the pre- to the postintervention period. LIMITATIONS The intervention period was brief, with no assessment of fidelity. Baseline CAUTI rates were low. Patient characteristics were not assessed. CONCLUSION This multimodal intervention yielded no substantial improvements in CAUTI or urinary catheter utilization. PRIMARY FUNDING SOURCE Centers for Disease Control and Prevention.
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Affiliation(s)
- Jennifer Meddings
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (J.M., M.T.G., S.S.)
| | | | - Jessica M Ameling
- University of Michigan Medical School, Ann Arbor, Michigan (J.M.A., A.S.)
| | - Russell N Olmsted
- Integrated Clinical Services Team, Trinity Health, Livonia, Michigan (R.N.O.)
| | - Andrew J Rolle
- Health Research & Educational Trust, American Hospital Association, Chicago, Illinois (A.J.R.)
| | - M Todd Greene
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (J.M., M.T.G., S.S.)
| | - David Ratz
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (D.R.)
| | - Ashley Snyder
- University of Michigan Medical School, Ann Arbor, Michigan (J.M.A., A.S.)
| | - Sanjay Saint
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (J.M., M.T.G., S.S.)
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