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Rosenthal VD, Yin R, Jin Z, Perez V, Kis MA, Abdulaziz-Alkhawaja S, Valderrama-Beltran SL, Gomez K, Rodas CMH, El-Sisi A, Sahu S, Kharbanda M, Rodrigues C, Myatra SN, Chawla R, Sandhu K, Mehta Y, Rajhans P, Arjun R, Tai CW, Bhakta A, Mat Nor MB, Aguirre-Avalos G, Sassoe-Gonzalez A, Bat-Erdene I, Acharya SP, Aguilar-de-Moros D, Carreazo NY, Duszynska W, Hlinkova S, Yildizdas D, Kılıc EK, Dursun O, Odek C, Deniz SSO, Guclu E, Koksal I, Medeiros EA, Petrov MM, Tao L, Salgado E, Dueñas L, Daboor MA, Raka L, Omar AA, Ikram A, Horhat-Florin G, Memish ZA, Brown EC. Examining the impact of a 9-component bundle and the INICC multidimensional approach on catheter-associated urinary tract infection rates in 32 countries across Asia, Eastern Europe, Latin America, and the Middle East. Am J Infect Control 2024:S0196-6553(24)00105-6. [PMID: 38437883 DOI: 10.1016/j.ajic.2024.02.017] [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: 01/19/2024] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND Catheter-Associated Urinary Tract Infections (CAUTIs) frequently occur in the intensive care unit (ICU) and are correlated with a significant burden. METHODS We implemented a strategy involving a 9-element bundle, education, surveillance of CAUTI rates and clinical outcomes, monitoring compliance with bundle components, feedback of CAUTI rates and performance feedback. This was executed in 299 ICUs across 32 low- and middle-income countries. The dependent variable was CAUTI per 1,000 UC days, assessed at baseline and throughout the intervention, in the second month, third month, 4 to 15 months, 16 to 27 months, and 28 to 39 months. Comparisons were made using a 2-sample t test, and the exposure-outcome relationship was explored using a generalized linear mixed model with a Poisson distribution. RESULTS Over the course of 978,364 patient days, 150,258 patients utilized 652,053 UC-days. The rates of CAUTI per 1,000 UC days were measured. The rates decreased from 14.89 during the baseline period to 5.51 in the second month (risk ratio [RR] = 0.37; 95% confidence interval [CI] = 0.34-0.39; P < .001), 3.79 in the third month (RR = 0.25; 95% CI = 0.23-0.28; P < .001), 2.98 in the 4 to 15 months (RR = 0.21; 95% CI = 0.18-0.22; P < .001), 1.86 in the 16 to 27 months (RR = 0.12; 95% CI = 0.11-0.14; P < .001), and 1.71 in the 28 to 39 months (RR = 0.11; 95% CI = 0.09-0.13; P < .001). CONCLUSIONS Our intervention, without substantial costs or additional staffing, achieved an 89% reduction in CAUTI incidence in ICUs across 32 countries, demonstrating feasibility in ICUs of low- and middle-income countries.
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Affiliation(s)
- Victor D Rosenthal
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA; Department of Infection Control, INICC Foundation, International Nosocomial Infection Control Consortium, Miami, USA.
| | - Ruijie Yin
- Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, USA
| | - Zhilin Jin
- Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, USA
| | - Valentina Perez
- Department of Biological Sciences, Florida International University, Miami, USA
| | - Matthew A Kis
- Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, USA
| | | | - Sandra L Valderrama-Beltran
- Department of Infection Control, Pontificia Universidad Javeriana Hospital Universitario San Ignacio, Bogota, Colombia
| | - Katherine Gomez
- Department of Infection Control, Clinica Sebastian de Belalcazar, Cali, Colombia
| | - Claudia M H Rodas
- Department of Infection Control, Fundacion Hospital San Jose De Buga, Guadalajara de Buga, Colombia
| | - Amal El-Sisi
- Department of Pediatric Cardiac ICU, Cairo University Specialized Pediatric Hospital, Cairo, Egypt
| | - Suneeta Sahu
- Department of Critical Care, Apollo Hospital Bhubaneswar, Bhubaneswar, India
| | | | - Camilla Rodrigues
- Department of Infection Control, Pd Hinduja National Hospital And Medical Research Centre, Mumbai, India
| | - Sheila N Myatra
- Department of Critical Care, Tata Memorial Hospital Homi Bhabha National Institute, Mumbai, India
| | - Rajesh Chawla
- Department of Critical Care, Indraprastha Apollo Hospital Delhi, New Delhi, India
| | - Kavita Sandhu
- Department of Critical Care, Max Super Speciality Hospital Saket Delhi, New Delhi, India
| | - Yatin Mehta
- Department of Critical Care, Medanta The Medicity, New Delhi, India
| | - Prasad Rajhans
- Department of Critical Care, Deenanath Mangeshkar Hospital And Research Center Erandwane Pune, Pune, India
| | - Rajalakshmi Arjun
- Department of Critical Care, Kerala Institute Of Med Sciences Thiruvananthapuram, Thiruvananthapuram, India
| | - Chian-Wern Tai
- Department of Critical Care, Universiti Kebangsaan Malaysia Specialist Children's Hospital, Kuala Lumpur, Malaysia
| | - Arpita Bhakta
- Department of Critical Care, University Malaya Medical Centre Pediatric Intensive Care, Kuala Lampur, Malaysia
| | - Mohd-Basri Mat Nor
- Department of Critical Care, International Islamic University Malaysia Department of Anesthesia and Critical Care, Kuantan, Malaysia
| | - Guadalupe Aguirre-Avalos
- Department of Critical Care, Hospital Civil De Guadalajara Fray Antonio Alcalde Terapia Intensiva, Guadalajara, Mexico
| | - Alejandro Sassoe-Gonzalez
- Department of Infection Control, Hospital Regional de Alta Especialidad de Ixtapaluca, Ixtapaluca, Mexico
| | - Ider Bat-Erdene
- Department for Quality and Safety, Intermed Hospital, Ulaanbaatar, Mongolia
| | - Subhash P Acharya
- Department of Infection Control, Grande International Hospital, Kathamandu, Nepal
| | - Daisy Aguilar-de-Moros
- Department of Infection Control, Hospital del Nino Dr Jose Renan Esquivel de Panama, Panama, Panama
| | - Nilton Yhuri Carreazo
- Department of Infection Control, Universidad Peruana de Ciencias Aplicadas Hospital de Emergencias Pediatricas, Lima, Peru
| | - Wieslawa Duszynska
- Department of Anesthesiology and Intensive Therapy, Wroclaw Medical University, Wroclaw, Poland
| | - Sona Hlinkova
- Department of Critical Care, Catholic University In Ruzomberok, Faculty of Health, Central Military Hospital SNP Ruzomberok, Ruzomberok, Slovakia
| | - Dincer Yildizdas
- Department of Pediatric Intensive Care, Balcali Hospital, Adana, Turkey
| | - Esra K Kılıc
- Department of Critical Care, Ankara Training And Research Hospital, Ankara, Turkey
| | - Oguz Dursun
- Department of Critical Care, Akdeniz University Medical School, Antalya, Turkey
| | - Caglar Odek
- Department of Critical Care, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Suna S O Deniz
- Department of Critical Care, Pamukkale University Hospital, Denizli, Turkey
| | - Ertugrul Guclu
- Department of Critical Care, Sakarya University Training And Research Hospital, Sakarya, Turkey
| | - Iftihar Koksal
- Department of Critical Care, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Eduardo A Medeiros
- Department of Infection Control, Hospital Sao Paulo, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Michael M Petrov
- Department of Microbiology, Faculty of Pharmacy, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Lili Tao
- Department of Pneumonology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Estuardo Salgado
- Department of Infection Control, Hospital Marie Curie, Quito, Ecuador
| | - Lourdes Dueñas
- Department of Critical Care, Hospital Nacional de Niños Benjamin Bloom, San Salvador, El Salvador
| | - Mohammad A Daboor
- Department of Infection Control, King Hussein Cancer Center, Amman, Jordan
| | - Lul Raka
- Department of Public Health, National Institute For Public Health, Prishtina, Kosovo
| | - Abeer A Omar
- Department of Infection Control, Infection Control Directorate. Ministry of Health, Kuwait City, Kuwait
| | - Aamer Ikram
- Department of Critical Care, Armed Forces Institute of Urology, Rawalpindi, Pakistan
| | - George Horhat-Florin
- Department of Critical Care, University of Medicine and Pharmacy Victor Babes Timisoara Emergency Clinical County Hospital Romania,Timisoara, Romania
| | - Ziad A Memish
- Department of Infection Control, King Saud Medical City, Ministry of Health, Ryhad, Saudi Arabia
| | - Eric C Brown
- Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, USA
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O'Connor E, Nic An Riogh A, Karavitakis M, Monagas S, Nambiar A. Diagnosis and Non-Surgical Management of Urinary Incontinence - A Literature Review with Recommendations for Practice. Int J Gen Med 2021; 14:4555-4565. [PMID: 34429640 PMCID: PMC8378928 DOI: 10.2147/ijgm.s289314] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/03/2021] [Indexed: 02/06/2023] Open
Abstract
Urinary incontinence (UI) is a bothersome symptom with population studies suggesting a prevalence of 13.1% in women and 5.4% in men. While a significant cohort of patients with this complaint may ultimately require surgical management to achieve complete continence, a number of non-surgical measures exist to improve symptoms and quality of life. A range of guidelines exist on this topic, including those published by the European Association of Urology (EAU), the International Continence Society (ICS), the American Urological Association (AUA) and the UK's National Institute for Health and Care Excellence (NICE). The aim of our study is to provide an overview of the initial assessment of patients with UI including history taking, examination and basic investigations. Our review outlines non-surgical management strategies for UI, including conservative measures, behavioral and physical therapies and drug treatment. We shall also examine the above guidelines and present a narrative overview of the literature surrounding the diagnosis and non-surgical management of urinary incontinence.
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Affiliation(s)
- Eabhann O'Connor
- Department of Urology, Beaumont University Hospital, Dublin, Ireland
| | | | - Markos Karavitakis
- Department of Urology, University General Hospital of Heraklion, University of Crete, Irakleio, Greece
| | - Serenella Monagas
- Department of Urology, San Agustín University Hospital, Avilés, Spain
| | - Arjun Nambiar
- Department of Urology, Freeman Hospital, Newcastle-upon-Tyne, UK
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Prevalence and predictors of continence containment products and catheter use in an acute hospital: A cross-sectional study. Geriatr Nurs 2021; 42:433-439. [PMID: 33684628 DOI: 10.1016/j.gerinurse.2021.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 02/10/2021] [Accepted: 02/12/2021] [Indexed: 01/02/2023]
Abstract
Although incontinence is common in hospital, the prevalence and predictors of continence aid use (continence wear and catheters) are poorly described. A one-day cross-sectional study was conducted in a large university hospital assessing consecutive inpatients (≥55) for their pre-admission and current use of continence aids. Barthel Index, Clinical Frailty Scale and Charlson Co-morbidity scores were recorded. Appropriateness was defined by local guidelines. 355 inpatients, median age 75±17 years, were included; 53% were male. Continence aid use was high; prevalence was 46% increasing to 58% for those ≥75. All-in-one pads were the most common, an overall prevalence of 31%. Older age, lower Barthel and higher frailty scores were associated with continence aid use in multivariate analysis. Inappropriate use of aids was high at 45% with older age being the only independent predictor. Continence aids are often used inappropriately during hospitalisation by older patients. Concerted efforts are required to address this issue.
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Clean Intermittent Self-Catheterization as a Treatment Modality for Urinary Retention: Perceptions of Urologists. Int Neurourol J 2017; 21:189-196. [PMID: 28954460 PMCID: PMC5636956 DOI: 10.5213/inj.1734824.412] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 03/21/2017] [Indexed: 11/16/2022] Open
Abstract
Purpose Clean intermittent self-catheterization (CISC) is now considered the gold standard for the management of urinary retention. In the literature, several articles on patients’ perspectives on CISC and adherence to this technique have been published. No studies have yet explored the points of view of professional caregivers, such as nurses and doctors. The aim of this study was to explore the opinions of urologists about CISC and to evaluate the need for dedicated nurses specialized in CISC through a self-administered questionnaire. Methods A questionnaire was developed to explore the opinions of professional caregivers about self-catheterization and to evaluate the need to provide nurses with specialized education in CISC. Questionnaires were sent to 244 urologists through email. We received 101 completed questionnaires. The response rate was 41.4%. Results Hand function, the presence or absence of tremor, and visual acuity were rated as the most important determinants for proposing CISC to a patient. Twenty-five percent of the urologists reported that financial remuneration would give them a greater incentive to propose CISC. The lack of dedicated nurses was reported by half of the urologists as a factor preventing them from proposing CISC. A meaningful number of urologists thought that patients perceive CISC as invasive and unpleasant. Although most urologists would choose CISC as a treatment option for themselves, almost 1 urologist out of 5 would prefer a permanent catheter. Conclusions This questionnaire gave valuable insights into urologists’ perceptions of CISC, and could serve as the basis for a subsequent broader international study. Further research should also focus on the opinions of nurses and other caregivers involved in incontinence management. Apart from financial remuneration, it is also clear that ensuring sufficient expertise and time for high-quality CISC care is important. This could be a potential role for dedicated nurses.
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Gutmanis I, Hay M, Shadd J, Byrne J, McCallum S, Bishop K, Whitfield P, Faulds C. Understanding bladder management on a palliative care unit: a grounded theory study. Int J Palliat Nurs 2017; 23:144-151. [PMID: 28345475 DOI: 10.12968/ijpn.2017.23.3.144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Research regarding factors associated with nursing-initiated changes to bladder management at end-of-life is sparse. OBJECTIVES To explore the process of Palliative Care Unit (PCU) nurses' approach to bladder management changes. METHODS Nursing staff from one PCU in London, Canada were interviewed regarding bladder management care practices. A constructivist grounded theory was generated. RESULTS Four interconnected themes emerged: humanity (compassionate support of patients); journey (making the most of a finite timeline); health condition (illness, functional decline); and context (orders, policies, supplies). These overlapping themes must be considered in light of ongoing changes which prompt recycling through the framework. While bladder management necessitates shared decision-making and individualised care, nurses' phronetic experience may serve to detect the presence of change and the need to consider other alternatives. CONCLUSION End-of-life bladder management requires nurses to continually reconsider the significance of humanity, journey, health condition and context in light of ongoing changes.
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Affiliation(s)
- Iris Gutmanis
- Associate Scientist, Lawson Health Research Institute in London, ON Canada
| | - Melissa Hay
- PhD Candidate, Health and Rehabilitation Sciences, Western University in London, ON Canada
| | - Joshua Shadd
- Assistant Professor, Department of Family Medicine, McMaster University, Hamilton, ON in London, ON Canada
| | - Janette Byrne
- Palliative Pain and Symptom Management Consultation Program, St Joseph's Health Care in London, ON Canada
| | - Sarah McCallum
- Forensic Rehabilitation Unit, St Joseph's Health Care in London, ON Canada
| | - Kristen Bishop
- PhD Candidate, Health and Rehabilitation Sciences, Western University in London, ON Canada
| | - Patricia Whitfield
- Palliative Pain and Symptom Management Consultation Program, St. Joseph's Health Care in London, ON Canada
| | - Cathy Faulds
- Family Physician and Practicing in Palliative Care, Adjunct Professor, Department of Family Medicine, Western University in London, ON Canada
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6
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Ostaszkiewicz J, O'Connell B, Dunning T. Residents' perspectives on urinary incontinence: a review of literature. Scand J Caring Sci 2011; 26:761-72. [PMID: 22150795 DOI: 10.1111/j.1471-6712.2011.00959.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Individuals in residential aged care facilities experience urinary incontinence more than any other single population. Despite these factors, the impact of the condition on their quality of life, their perspectives of living with the condition, and their preferences for care have received little research attention. AIM To provide a descriptive overview of research about; the impact of urinary incontinence on residents' quality of life; residents' perspectives of having urinary incontinence; and their preferences for continence care'. DESIGN A descriptive review of literature. METHOD A broad search was undertaken for qualitative and quantitative research that evaluated residents' quality of life related to urinary incontinence; their perspectives on having urinary incontinence, and their preferences for managing it. Data were displayed in tabular format, summarized, and described. RESULTS Ten studies were identified and reviewed (six qualitative and four quantitative). They reveal many residents' value having independent bowel and bladder function, but believe that incontinence in inevitable and intractable. Some adopt self management strategies, however considerable barriers hinder their ability to maintain continence and manage incontinence. Residents often have low expectations, and hence decline further evaluation and treatment. Some express satisfaction with continence care even if this care is not consistent with their preferences. Little is known about how cognitively impaired residents perceive their condition. However some individuals with cognitive impairment respond with acute anxiety when carers' attempt to provide continence care. CONCLUSION Residents' perspectives on incontinence and preferences for continence care relate to low expectations for improvement. Such misconceptions should be addressed and residents and their family members should be given a range of options from which to choose. As urinary incontinence impacts on residents' quality of life, it is also important that continence care is delivered in a participative and sensitive way.
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Affiliation(s)
- Joan Ostaszkiewicz
- School of Nursing and Midwifery, Deakin University, Melbourne, Victoria, Australia.
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Nishizawa O, Ishizuka O, Okamura K, Gotoh M, Hasegawa T, Hirao Y. Guidelines for management of urinary incontinence. Int J Urol 2008; 15:857-74. [DOI: 10.1111/j.1442-2042.2008.02117.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Urinary tract infection (UTI), with its diverse clinical syndromes and affected host groups, remains one of the most common but widely misunderstood and challenging infectious diseases encountered in clinical practice. Antimicrobial resistance is a leading concern, with few oral options available to treat infections caused by Gram-negative organisms resistant to trimethoprim-sulfamethoxazole and fluoroquinolones, especially for patients with upper tract disease. Efforts should be made not to detect or treat asymptomatic bacteriuria and funguria; to ensure an appropriate duration of therapy for symptomatic infections; and to limit the use of broad-spectrum agents, especially fluoroquinolones, if narrower spectrum agents are available. Further research is needed regarding rapid diagnosis of UTI, accurate presumptive identification of patients with resistant pathogens, and development of new antimicrobials for drug-resistant UTI.
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Affiliation(s)
- Dimitri M Drekonja
- Minneapolis Veterans Affairs Medical Center, Infectious Diseases (111F), 1 Veterans Drive, Minneapolis, MN 55417, USA.
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Pfisterer MHD, Johnson TM, Jenetzky E, Hauer K, Oster P. Geriatric Patients' Preferences for Treatment of Urinary Incontinence: A Study of Hospitalized, Cognitively Competent Adults Aged 80 and Older. J Am Geriatr Soc 2007; 55:2016-22. [DOI: 10.1111/j.1532-5415.2007.01457.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Morris AR, Ho MT, Lapsley H, Walsh J, Gonski P, Moore KH. Costs of managing urinary and faecal incontinence in a sub-acute care facility: a "bottom-up" approach. Neurourol Urodyn 2005; 24:56-62. [PMID: 15573385 DOI: 10.1002/nau.20079] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS To measure accurately the direct costs of managing urinary and faecal incontinence in the sub-acute care setting. MATERIALS AND METHODS Prospective observational study was undertaken in two sub-acute care units in a metropolitan hospital. A consecutive series of 29 consecutive patients with urinary and/or faecal incontinence, who were in-patients in a geriatric rehabilitation or sub-acute neurologic unit underwent routine timed voiding protocol, as per usual care. Face-to-face bedside recordings of all incontinence care, with detailed cost analysis, were undertaken. RESULTS A total of 3,621 occasions of continence care were costed. The median time per 24 hr spent caring for incontinence per patient was 109 min (interquartile range 88-140). Isolated urinary incontinence episodes occurred in 28 patients (96.5%), mixed urinary/faecal incontinence episodes observed in 79.3%, and episodes of pure faecal incontinence were seen in 62%. The median costs of incontinence care in the sub-acute setting was $49AU per 24 hr, the major share ($41) spent on staff wages. The incontinence tasks of toileting assistance, pad changes, bed changes and catheter care were spread evenly across the three 8 hr shifts of duty. CONCLUSIONS As our population demographics include an increasingly greater portion of the elderly, for whom long term institutional care is becoming relatively more scarce, provision of care in the sub-acute unit that may allow rehabilitation and return to home warrants scrutiny. This is the first study that delineates the costs of managing urinary and faecal incontinence in the sub-acute care setting. Such costs are substantial and place a heavy burden upon night-time carers.
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Affiliation(s)
- Alastair R Morris
- The Pelvic Floor Unit, St George Hospital, University of New South Wales, NSW, Australia
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Dromerick AW, Edwards DF. Relation of postvoid residual to urinary tract infection during stroke rehabilitation11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated. Arch Phys Med Rehabil 2003; 84:1369-72. [PMID: 13680576 DOI: 10.1016/s0003-9993(03)00201-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To examine (1) risk factors for urinary tract infection (UTI) during stroke rehabilitation and (2) the relation of postvoid residual (PVR) to the frequency of UTI. DESIGN Prospective case series. SETTING Academic specialty stroke rehabilitation service. PARTICIPANTS One hundred one consecutive admissions for stroke rehabilitation. INTERVENTIONS Not applicable. Main outcome measure Presence or absence of UTI. RESULTS Previously undiagnosed UTI was found in 28 of 101 subjects. Two or more PVR determinations of 150mL or more were an independent risk factor for UTI. In multivariate analysis, factors associated with increased risk of UTI included only use of beta-blockers and 2 peak PVR determinations of 150mL or more. Single determinations were not significant. CONCLUSION The optimal PVR for initiating bladder catheterization during stroke rehabilitation remains unknown, but the risk of UTI increases only when 2 or more ultrasound PVR readings are more than 150mL.
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Affiliation(s)
- Alexander W Dromerick
- Division of Rehabilitation, Department of Neurology and Program in Occupational Therapy, Washington University, St Louis, MO 63108, USA.
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Brown JS, Nyberg LM, Kusek JW, Burgio KL, Diokno AC, Foldspang A, Fultz NH, Herzog AR, Hunskaar S, Milsom I, Nygaard I, Subak LL, Thom DH. Proceedings of the National Institute of Diabetes and Digestive and Kidney Diseases International Symposium on Epidemiologic Issues in Urinary Incontinence in Women. Am J Obstet Gynecol 2003; 188:S77-88. [PMID: 12825024 DOI: 10.1067/mob.2003.353] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The Epidemiologic Issues in Urinary Incontinence: Current Databases and Future Collaborations Symposium included an international group of 29 investigators from 10 countries. The purpose of the symposium was to discuss the current understanding and knowledge gaps of prevalence, incidence, associated risk factors, and treatment outcomes for incontinence in women. During the symposium, investigators identified existing large databases and ongoing studies that provide substantive information on specific incontinence research questions. The investigators were able to form an international collaborative research working group and identify potential collaborative projects to further research on the epidemiology of urinary incontinence and bladder dysfunction.
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Affiliation(s)
- Jeanette S Brown
- Department of Obstetrics/Gynecology & Reproductive Services, University of California San Francisco, 94115, USA.
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Use and Management of Chronic Urinary Catheters in Long-Term Care: Much Controversy, Little Consensus. J Am Med Dir Assoc 2003. [DOI: 10.1016/s1525-8610(04)70309-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Systematic Review of the Effectiveness of Urinary Continence Products. J Wound Ostomy Continence Nurs 2002. [DOI: 10.1097/00152192-200205000-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gammack JK. Use and Management of Chronic Urinary Catheters in Long-Term Care: Much Controversy, Little Consensus. J Am Med Dir Assoc 2002. [DOI: 10.1016/s1525-8610(04)70459-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Johnson TM, Ouslander JG, Uman GC, Schnelle JF. Urinary incontinence treatment preferences in long-term care. J Am Geriatr Soc 2001; 49:710-8. [PMID: 11454108 DOI: 10.1046/j.1532-5415.2001.49146.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To elicit preferences for different urinary incontinence (UI) treatments in long-term care (LTC) from groups likely to serve as proxy decision makers for LTC residents. DESIGN A descriptive, comparative study of preference for UI treatments of frail older adults, family members of nursing home (NH) residents, and LTC nursing staff. Surveys were mailed to families and self-administered by staff. Older adults were interviewed. SETTING Four LTC facilities and two residential-care facilities in Los Angeles. PARTICIPANTS Four hundred and three family members of incontinent NH residents were mailed surveys. Sixty-six nursing staff caring for these incontinent residents and 79 older adult residents of care facilities (nine cognitively intact NH respondents and 70 residential care residents) answered surveys. MEASUREMENTS Preference rankings between seven paired combinations of five different UI treatments were measured on an 11-point visual analog scale, with the verbal anchors "definitely prefer" this treatment, "probably prefer" this treatment, and "uncertain." Respondents gave open-ended comments as well. RESULTS Forty-two percent of family members (171/ 403) returned the mailed survey. Of all respondents, 85% "definitely" or "probably" preferred diapers, and 77% "definitely" or "probably" preferred prompted voiding (PV) to indwelling catheterization. Respondent groups occasionally differed significantly in their preferences. In choosing between treatment pairs using a visual analogue scale, nurses preferred PV to diapers significantly more than did older adults or families (both of whom preferred diapers) (F (2,295) = 13.11, P < .0001). Older adults, compared with family and nurse respondents, showed a significantly stronger preference for medications over diapers (F (2,296) = 41.54, P < .0001). In open-ended responses, older adults stated that they would choose a UI treatment based in part upon criteria of feeling dry, being natural, not causing embarrassment, being easy, and not resulting in dependence. Nurses said that they would base their choice of UI treatment upon increasing self-esteem and avoiding infection. CONCLUSIONS Although there was wide variation within and between groups about preferred UI treatment, most respondents preferred noninvasive strategies (diapers and PV) to invasive strategies (indwelling catheters and electrical stimulation). Older adults preferred to a greater degree medications and electrical stimulation, therapies directed at the underlying cause of UI. Despite data documenting that diapering is a less time intensive way to manage UI and that toileting programs are difficult to maintain in LTC, nurses viewed PV as "natural" and strongly preferred it to diapering. Several family members and older adults viewed PV as "embarrassing" and "fostering dependence." These data highlight the need to elicit preferences for UI treatment among LTC residents and their families.
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Affiliation(s)
- T M Johnson
- Atlanta VA Rehabilitation Research and Development Center, Decatur, Georgia 30033, USA
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Shirran E, Brazzelli M. Absorbent products for the containment of urinary and/or faecal incontinence in adults. Cochrane Database Syst Rev 2000:CD001406. [PMID: 10796783 DOI: 10.1002/14651858.cd001406] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Incontinence is a distressing condition with significant medical, social and economic implications. People suffering from incontinence, who cannot be successfully cured, depend, almost exclusively, on the use of containment products to manage their symptoms. OBJECTIVES Many people with incontinence cannot be cured and so depend on symptomatic management. The objective was to assess the effects of different types of absorbent product for the containment of urinary and/or faecal incontinence. SEARCH STRATEGY We searched the Cochrane Incontinence Group trials register (March 1999), Embase (to January 1999), Cinahl (to January 1999), HealthSTAR (to January 1999) and the reference lists of relevant articles. We contacted investigators in the field to locate studies. Date of the most recent searches: March 1999. SELECTION CRITERIA Types of studies All randomised or quasi-randomised trials of absorbent products for the containment of urinary and/or faecal incontinence. Types of participants All adults with urinary and/or faecal incontinence were eligible. The intention was to subdivide participants by severity of underlying incontinence, level of mobility and gender, but this proved not to be feasible. Types of intervention Absorbent products (bodyworns, underpads, and different fabric types for disposable products), for any severity of incontinence. DATA COLLECTION AND ANALYSIS Trials were evaluated for subject relevance and methodological quality using a standard methodological quality assessment form. If applicable, data on relevant outcomes were then abstracted using a standardised data abstraction form. MAIN RESULTS Five studies with a total of 345 participants met the selection criteria. Two studies compared disposable with non-disposable bodyworns, one disposable with non-disposable underpads, two fluff pulp with superabsorbent polymers, and one bodyworns with underpads. Data presented on effects were available for few outcomes and were subject to potential bias. REVIEWER'S CONCLUSIONS The data were too few and of insufficient quality to provide a firm basis for practice. Disposable products may be more effective than non-disposable products in decreasing the incidence of skin problems and superabsorbent products may perform better than fluff pulp products. However, based on the available evidence, these conclusions can only be tentative.
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Affiliation(s)
- E Shirran
- Health Services Research Unit, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, UK, AB25 2ZD.
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Saint S, Lipsky BA, Baker PD, McDonald LL, Ossenkop K. Urinary catheters: what type do men and their nurses prefer? J Am Geriatr Soc 1999; 47:1453-7. [PMID: 10591242 DOI: 10.1111/j.1532-5415.1999.tb01567.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Urinary catheters are used frequently, but the relative risks and benefits of different types of devices are not clear. We sought to determine the beliefs of both older male patients and nursing staff about the relative merits and problems of condom and indwelling catheters. DESIGN Patient and nurse survey using convenience sampling. SETTING A University-affiliated Veterans Affairs medical center. PARTICIPANTS Men hospitalized on medical, rehabilitation and nursing home units using either an indwelling or a condom catheter were invited to participate as were all members of the nursing staff on these units. Of 116 eligible patients, 104 were interviewed (response rate = 90%). Of 107 eligible nursing staff members, 99 completed the questionnaires (response rate = 92%). INTERVENTION AND MEASUREMENTS Consenting patients were interviewed personally about their urinary catheter. The nursing staff were asked to complete a self-administered questionnaire. RESULTS Patients were mostly older and predominantly hospitalized on the medical service. Compared with those using an indwelling catheter, patients using a condom catheter were more likely to believe that their catheter was comfortable (86 vs 58%, P = .04) and less likely to believe it was painful (14 vs 48%, P = .008) or to restrict their activity (24 vs 61%, P = .002). The nursing staff had a mean of 13 years nursing experience, and the majority worked in the nursing home unit. Most of the nursing staff respondents believed that condom catheters were less painful and restrictive for patients and were easier to apply, but they also believed that they fell off and leaked more often and required more nursing time. CONCLUSIONS Both patients and nursing staff prefer condom to indwelling catheters for patient comfort, but they recognize that dislodgment and leaking are major drawbacks of condom catheters. A more secure condom catheter would greatly improve the management of male incontinence.
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Affiliation(s)
- S Saint
- Department of Medicine, University of Michigan Health System, Health Services Research and Development, Ann Arbor Veterans Affairs Medical Center, 48109-0376, USA.
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Abstract
It seems likely, and indeed inevitable, that medical device usage will continue its rapid increase over the next 10 to 20 years and beyond. For surgeons, these new inventions will come in many forms but should take into account biocompatibility and resistance to encrustations and to microorganisms. This review focuses on research under way at present in vitro and in vivo on materials and coatings, use of bioelectrics, use of artificial organs and tissues, application of indigenous bacteria, and other alternative device management techniques, which could well become part of clinical practice in the future. By necessity, some of these citations are speculative, but supporting documentation for their inclusion is presented.
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Affiliation(s)
- G Reid
- Department of Microbiology and Immunology, The University of Western Ontario, London, Canada.
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Brown JA, Elliott DS, Barrett DM. Postprostatectomy urinary incontinence: a comparison of the cost of conservative versus surgical management. Urology 1998; 51:715-20. [PMID: 9610584 DOI: 10.1016/s0090-4295(98)00123-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Post-radical prostatectomy stress incontinence occurs in up to 20% of patients. Postprostatectomy incontinence is initially treated with undergarments, pads, or drip collectors. Patients with persistent leakage are often treated with a transurethral bulking agent (Contigen) or placement of an artificial genitourinary sphincter (AGUS). We have compared the direct costs of each treatment at our institution over 10 years. METHODS The Mayo Clinic estimating office provided the Medicare and non-Medicare charges for patients receiving both collagen injection (outpatient) and AGUS placement (2-day hospitalization) during August 1995. The Mayo Store provided the current price of all undergarments, pads, and drip collectors carried. Two local grocery stores provided the cost of Depends undergarments. RESULTS The following items were the least expensive carried at the Mayo Clinic Store: Entrust undergarments, Active Style pads, and Conveen drip collectors at $0.99, $0.52, $1.05 each, respectively. The average cost of Depends undergarments was $0.52 each. The cost of wearing 5 of the least expensive undergarments or pads per day for 10 years is $9497. The average estimated Medicare and non-Medicare cost for outpatient (general anesthesia) collagen injection is $4300 and $5625, respectively. The average Medicare and non-Medicare cost for AGUS placement is $15,400 and $20,300, respectively. Factoring in our current 22.4% reoperation rate, the average per patient Medicare and non-Medicare cost for AGUS placement is $18,850 and $24,847, respectively. CONCLUSIONS The cost of the AGUS placement compares favorably with the cost of transurethral collagen injection (under general anesthesia) in patients requiring several (more than three) collagen injection treatments or requiring the continued use of undergarments after collagen injection. Whereas the cost of transurethral collagen injection, when effective, compares favorably with conservative treatment, AGUS placement is significantly more expensive than conservative management for almost all patients except the exceedingly rare patient wearing more than 9 undergarments or pads per day. When the psychosocial benefit of urinary continence is considered, however, transurethral injection of collagen or AGUS placement often becomes the preferred treatment.
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Affiliation(s)
- J A Brown
- Division of Urology, David Grant Medical Center, Travis Air Force Base, California, USA
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Abstract
This paper outlines the role of quality audit within the framework of quality assurance, presenting the concurrent and retrospective approaches available. The literature survey provides a review of the limited audit tools available and their application to continence services and care delivery, as well as attempts to produce tools from national and local standard setting. Audit is part of a process; it can involve staff, patients and their relatives and the team of professionals providing care, as well as focusing on organizational and management levels. In an era of market delivery of services there is a need to justify why audit is important to continence advisors and managers. Effectiveness, efficiency and economics may drive the National Health Service, but quality assurance, which includes standards and audit tools, offers the means to ensure the quality of continence services and care to patients and auditing is also required in the purchaser/provider contracts for patient services. An overview and progress to date of published and other a projects in auditing continence care and service is presented. By outlining and highlighting the audit of continence service delivery and care as a basis on which to build quality assurance programmes, it is hoped that this knowledge will be shared through the setting up of a central auditing clearing project.
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Reid G, Tieszer C, Lam D. Influence of lactobacilli on the adhesion of Staphylococcus aureus and Candida albicans to fibers and epithelial cells. JOURNAL OF INDUSTRIAL MICROBIOLOGY 1995; 15:248-53. [PMID: 8519484 DOI: 10.1007/bf01569832] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The ability of organisms to adhere to and form biofilms on fibrous materials is believed to be an important initiating step in the induction of several diseases, such as toxic shock syndrome. Using an in vitro assay, a moderately hydrophobic strain of Staphylococcus aureus (water contact angle 35 degrees) and a hydrophilic Candida albicans (shown by a hexadecane test) were highly adherent to commercial diaper fibers. The lumen side of the diaper was porous and the fibers were very hydrophobic (> 140 degrees), but the internal section was very hydrophilic (0 degrees), presumably for lus strains was present. Surfaces precoated with lactobacilli inhibited staphylococcal adhesion by 26-97%, and candida by 0-67%. When the lactobacilli were used to challenge adherent pathogens, there was 99% displacement of the S. aureus and up to 91% displacement of C. albicans. Hydrophobic L. acidophilus 76 (54 degrees) and T-13 (80 degrees) were the most effective of five Lactobacillus isolates tested at interference by precoating. The moderately hydrophilic L. casei var rhamnosus GR-1 (33 degrees) was the most effective at displacing the yeast. Experiments with uroepithelial cells also showed that the lactobacilli could significantly interfere with the adhesion of both pathogens to the cells. The results demonstrate the rapidity with which two pathogens adhered to fibers and epithelial cells, and raised the possibility that members of the normal female urogenital flora might interfere with infections caused by these organisms.
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Affiliation(s)
- G Reid
- Department of Microbiology and Immunology, University of Western Ontario, London, Canada
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Briggs A, Sculpher M. Sensitivity analysis in economic evaluation: a review of published studies. HEALTH ECONOMICS 1995; 4:355-371. [PMID: 8563834 DOI: 10.1002/hec.4730040502] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
A structured methodological review of journal articles published in 1992 was undertaken to determine whether recently published economic evaluation studies deal systematically and comprehensively with uncertainty. Ninety three journal articles were identified from a range of searches including a computerised search of the MEDLINE CD-Rom database. Articles were reviewed to determine how they had handled uncertainty in: a) data sources; b) generalisability; c) extrapolation; and d) analytic method. Articles were subsequently assessed to determine how they had represented this uncertainty in terms of the overall results of their analysis. Finally, studies were rated on the basis of their overall performance with respect to dealing systematically and comprehensively with uncertainty. Despite the numerous books and articles devoted to the appropriate methods to be employed by analysts conducting economic evaluation, 22 (24%) studies failed to consider uncertainty at all and 35 (38%) studies employed sensitivity analysis in a manner judged as inadequate. In all, 36 (39%) studies were judged to have given at least an adequate account of uncertainty with 13 (14%) of those judged to have provided a good account of uncertainty. Such disappointing results may reflect a general lack of detail in much of the methods literature concerning how sensitivity analysis should be applied and how results should be presented. Journal editors and readers of economic evaluation articles should acquaint themselves with the methods for handling uncertainty in order that they can critically evaluate the extent to which authors have allowed for uncertainties inherent in their analysis.
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Affiliation(s)
- A Briggs
- Health Economics Research Group, Brunel University, UK
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Zimakoff JD, Pontoppidan B, Larsen SO, Poulsen KB, Stickler DJ. The management of urinary catheters: compliance of practice in Danish hospitals, nursing homes and home care to national guidelines. SCANDINAVIAN JOURNAL OF UROLOGY AND NEPHROLOGY 1995; 29:299-309. [PMID: 8578273 DOI: 10.3109/00365599509180580] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The compliance of practice to national guidelines on urethral catheter care has been examined. Questionnaires on the practices used with patients under their care were sent to 1350 nursing staff. Replies were received from 1153 individuals, 692 from hospitals, 345 from nursing homes and 116 from home care. While national guidelines stress the importance of maintaining a closed urine drainage system, the results revealed that 25.4% of respondents opened the drainage system to collect samples of urine for analysis, 57.9% to perform bladder washouts and 76% to change urine bags. 26% of respondents reported that they collected urine samples for routine bacteriological surveillance, a procedure considered unnecessary in the guidelines. 83% of staff reported that they washed their hands after emptying urine bags. Staff awareness of written guidelines for various aspects of catheter care ranged from 25-68% in hospitals, 27-45% in nursing homes and 7-17% in home care. A marginal costs analysis was performed to estimate the economic consequences of non-compliance to the national guidelines.
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Affiliation(s)
- J D Zimakoff
- National Centre For Hospital Hygiene, Copenhagen, Denmark
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Stewart CI, McMurdo ME. Closing the loop in an audit of urinary incontinence. Scott Med J 1995; 40:21-2. [PMID: 7604238 DOI: 10.1177/003693309504000109] [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: 01/26/2023]
Abstract
Urinary incontinence (UI) fulfils the criteria for an indicator condition of quality of care. A records review audit in 1992 indicated that the minimum standards for history taking, physical examination and investigation of UI were not being met, so this was repeated in 1993 after full discussion with staff. 40% of the 368 patients studied met the definition of UI. In Assessment and Rehabilitation wards 57% met the standard for history (60% in the previous audit), 24% for examination (50% previously), and 86% for investigation (100% previously). As previously results were worse on Continuing Care wards, where minimum standards were being met in only 17% for history, 14% for examination and 47% for investigation. However, management planning had improved with care plans for 71% of incontinent patients in Assessment and Rehabilitation wards and 97% in Continuing Care wards. Our repeat audit has highlighted the difficulties inherent in encouraging health professionals to alter practice to correct apparent deficiencies.
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Affiliation(s)
- C I Stewart
- Department of Medicine for the Elderly, Royal Victoria Hospital, Dundee
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Detsky AS. Using cost-effectiveness analysis for formulary decision making: from theory into practice. PHARMACOECONOMICS 1994; 6:281-288. [PMID: 10147465 DOI: 10.2165/00019053-199406040-00002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The growth of expenditures on healthcare and pharmaceutical products is a concern to third-party payers because of the absence of market discipline (price signals that consumers face). Cost-effectiveness analysis is a method that allows third-party payers to systematically make judgements about the 'value for money' of these products. It moves beyond simple unit price comparisons of alternate interventions/products to consider the full stream of relevant cost and benefits. As formulary committees begin to adopt the systematic use of cost-effectiveness analyses to inform the debate, the exercise will move from an academic to a more practical application. This transition will require several important changes including defining the purpose of cost-effectiveness analysis, measurement of outcomes and data, format of reports, and contractual arrangements between the pharmaceutical industry and analysts. As more 'real world' experience is gained in the practical application of cost-effectiveness analysis, the quality of data will improve as will its value as an aid to decision making.
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Affiliation(s)
- A S Detsky
- Departments of Health Administration and Medicine, University of Toronto, Ontario, Canada
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Reid G. Applications from bacterial adhesion and biofilm studies in relation to urogenital tissues and biomaterials: a review. JOURNAL OF INDUSTRIAL MICROBIOLOGY 1994; 13:90-6. [PMID: 7765341 DOI: 10.1007/bf01584104] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The urogenital tract, particularly of the adult female, is the habitat for many species of microorganisms. These populations are in a state of flux, are susceptible to disruption by antibiotics and spermicides, and are exposed to many different biomaterial substrata. Infections of the genital area and bladder are common, and are invariably initiated by microbial adhesion to surfaces. This review examines the actual and potential applications to industry and to patients emerging from the study of bacterial adhesion to surfaces.
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Affiliation(s)
- G Reid
- Department of Microbiology and Immunology, University of Western Ontario, Canada
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