1,720,981 research outputs found
A new understanding of the Proteus mirabilis crystalline biofilm: Implications for catheter management
No full textInterventions to minimise the initial use of indwelling urinary catheters in acute care: a systematic review
No full textBackground Indwelling urinary catheters (IUC) are the primary cause of urinary tract infection in acute care. Current research aimed at reducing the use of IUCs in acute care has focused on the prompt removal of catheters already placed. This paper evaluates attempts to minimise the initial placement of IUCs.ObjectivesTo evaluate systematically the evidence of the effectiveness of interventions to minimise the initial placement of IUCs in adults in acute care.Design Studies incorporating an intervention to reduce the initial placement of IUCs in an acute care environment in patients aged 18 and over that reported on the incidence of IUC placement were included in the review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist has been used as a tool to guide the structure of the review.Data SourcesMEDLINE, CINAHL, EMBASE, National Health Service Centre for Review and Dissemination and Cochrane Library.Review Methods A systematic review to identify and synthesise research reporting on the impact on interventions to minimise the use of IUCs in acute care published up to July 2011.Results 2689 studies were scanned for eligibility. Only eight studies were found that reported any change (increase or decrease) in the level of initial placement of IUCs as a result of an intervention in acute care. Of the eight, six had an uncontrolled before-after design. Seven demonstrated a reduction in the initial use of IUCs post-intervention. There was insufficient evidence to support or rule out the effectiveness of interventions due to the small number of studies, limitations in study design and variation in clinical environments. Notably, each study listed the indications considered to be acceptable uses of an IUC and there was substantial variation between the lists of indications.Conclusions More work is needed to establish when the initial placement of an IUC is appropriate in order to better understand when IUCs are overused and inform the development of methodologically robust research on the potential of interventions to minimise the initial placement of IUCs
Understanding catheter-associated Proteus mirabilis biofilm blockage: the application of advanced microscopy techniques
No full textBiofilm development on urinary catheters promotes the appearance of viable but non-culturable (VBNC) bacteria
No full textCatheter-associated urinary tract infections have serious consequences, both for patients and in impacting on healthcare resources. Much work has been carried out to develop an antimicrobial catheter. Although such developments have shown promise under laboratory conditions, none have demonstrated a clear advantage in clinical trials.Using a range of microbiological and advanced microscopy techniques, a detailed laboratory study comparing biofilm development on silicone, hydrogel latex and silver alloy coated hydrogel latex catheters was carried out. Biofilm development by Escherichia coli, Pseudomonas aeruginosa and Proteus mirabilis on three commercially available catheters was tracked over time. Samples were examined with episcopic differential interference contrast (EDIC) microscopy, culture analysis and staining techniques to quantify viable but non-culturable (VBNC) bacteria.Both qualitative and quantitative assessment found biofilms to develop rapidly on all three materials. EDIC microscopy revealed the rough surface topography of the materials. Differences between culture counts and quantification of total and dead cells demonstrated the presence of VBNC populations, where bacteria retain viability but are not metabolically active.The use of non-culture based techniques showed the development of widespread VBNC populations. These VBNC populations were more evident on silver alloy coated hydrogel latex catheters, indicating a bacteriostatic effect at best. The laboratory tests reported here, that detect VBNC bacteria, allow more rigorous assessment of antimicrobial catheters offering an explanation for why there is often minimal benefit to patients.IMPORTANCE Several antimicrobial urinary catheter materials have been developed but, although laboratory studies may show a benefit, none have significantly improved clinical outcomes. The use of poorly designed laboratory testing and lack of consideration to the impact of VBNC populations may be responsible. While the presence of VBNC populations is becoming more widely reported, there remains a lack of understanding of the clinical impact or influence of exposure to antimicrobial products. This is the first study to investigate the impact of antimicrobial surface materials and the appearance of VBNC populations. This demonstrates how improved testing is needed prior to clinical trials uptake
Continence pad provision: meeting patients’ fundamental care needs
No full textA small-scale qualitative study found that NHS services often failed to provide suitable continence pads in sufficient numbers for people living with urinary and/or faecal incontinence at home
Catheters and incontinence after radical prostatectomy: preparing (but not scaring) men
No full textEvery year about 6000 men in the UK undergo radical prostatectomy (RP) for treatment of prostate cancer. Despite surgical advances, RP continues to be associated with significant side-effects including urinary incontinence (UI). Immediately following removal of the urinary catheter, leakage can be sudden, heavy and persistent requiring immediate recourse to continence products
The use of an occlusive penile clamp during filling cystometry in men with symptoms of stress urinary incontinence
No full textIntroduction: in severe post prostatectomy stress urinary incontinence (SUI), urodynamics may not identify crucial parameters because of inadequate bladder filling. This study describes evaluation of cystometry and pressure flow study (PFS) in men where severe SUI during attempted filling necessitated application of a penile clamp to allow filling to reach cystometric capacity.
Methods: we identified all men who had undergone prior radical prostatectomy from a database of patients attending for videourodynamic testing between 2012-2017. Symptom scores, bladder diary and free flow rate tests were retrieved. We evaluated the measurements of the subgroup of men with severe SUI for whom a Thomson-Walker compression clamp was utilised to enable full urodynamic evaluation.
Results: 166 radical prostatectomy patients were identified. In 30 (18%), severe SUI led to incomplete filling cystometry, i.e. failure to reach cystometric capacity. Following application of the penile compression clamp, it was possible to achieve further filling in each case. Applying the clamp did not alter vesical filling or impede pressure recording. These men had a lower maximum urethral closure pressure (31.6 vs 46.5cmH2O; p<0.001), volume at strong desire to void (132 vs 242mls; p=0.003) and cystometric capacity (226 with the clamp applied vs 310mls; P<0.001) when compared to the overall post prostatectomy incontinence population. Flow rates during PFS were comparable, but detrusor pressure at maximum flow was lower in the clamp group (11 vs 22cmH2O; p=0.009). Vesicoureteric reflux (VUR) was not seen in conjunction with the penile clamp use.
Conclusions: this study shows that the use of a penile clamp during urodynamics for incontinent men who have had a radical prostatectomy can optimise the test by aiding additional bladder filling in selected patients. This allows for a clearer interpretation of cystometric capacity and ability to undertake PFS. The short-term use in this context is well tolerated and does not raise any safety concerns
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