1,721,204 research outputs found
Alien Registration- Murphy, Catherine (Fairfield, Somerset County)
Full text linkhttps://digitalmaine.com/alien_docs/9391/thumbnail.jp
Why do clinicians place indwelling urinary catheters with patients in acute medical care?
No full textBackground: Indwelling urinary catheters (IUCs) placed for short-term use in hospital frequently become long-term catheters, increasing the potential for infections, trauma and other complications. Current research has focused on the prompt removal of IUCs in place, with no published review of interventions to reduce the initial placement. Furthermore, little is known about why clinicians place IUCs in acute medical care. Without this knowledge, the effectiveness of strategies aimed at reducing IUC use is likely to be sub-optimal.Aim: To understand why clinicians decide to place IUCs in acute medical care. Methods: (1) A systematic review of interventions to minimise the initial placement of urinary catheters in acute care. (2) A qualitative study in the A&E department and acute medical wards of a 1200+ bed hospital. Clinicians who made the decision to place an IUC were asked to participate in a retrospective think aloud interview describing how they came to the decision, later participating in a semi-structured interview to discuss their wider experiences of making the decision to place an IUC. A purposive sample and thematic analysis were used. Results: (1) Eight (six uncontrolled) studies met the inclusion criteria for the systematic review, using a variety of interventions including clinician education and introduction of guidelines to reduce IUC use. Although seven demonstrated a reduction in the initial use of IUCs post-intervention (relative risk 0.19 – 0.86), the impact of individual interventions was unclear. Notably, each study provided a list of reasons considered to provide justifications for IUC use, with substantial variation between the lists. (2) 30 retrospective think aloud interviews and 20 semi-structured interviews were undertaken. Clinicians were influenced by cues taken from three groups; individual beliefs (e.g. on the clinical indication or IUC-associated risks), patient factors (e.g. age or gender) and organisational factors (e.g. resources or policy). Many spectrums of belief were found (e.g. varying opinions on using IUCs to protect skin from urinary incontinence). Conclusions: This work establishes that understanding of interventions to reduce the initial placement of IUCs is poor and there is a lack of agreement on when the benefits of IUC use outweigh the risks. Clinical reasoning in this area is frequently inconsistent and IUC placement decisions vary widely, indicating that there is considerable scope for a reduction in use
CURA Operations and Communications. Tentative Recommendations.
Full text linkCenter for Urban and Regional Affairs, University of Minnesota.Drury, Edward J.; Murphy, Catherine. (1975). CURA Operations and Communications. Tentative Recommendations.. Retrieved from the University Digital Conservancy, https://hdl.handle.net/11299/205758
Interventions 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
“It's easier to stick a tube in”: a qualitative study to understand clinicians’ individual decisions to place urinary catheters in acute medical care
No full textBackground Indwelling urinary catheters (IUCs) placed in acute care are a leading cause of healthcare-associated urinary tract infection. Despite initiatives to minimise the placement of IUCs, levels of inappropriate use are still considered unacceptable. IUC practice is difficult to change, and factors influencing clinicians’ decisions need to be better understood. Objective To explore why clinicians decide to place IUCs in acute medical care. Methods We conducted a qualitative study in the emergency department and acute medical wards of a 1200+ bed hospital, undertaking 30 retrospective think aloud and 20 semistructured interviews with nurses and physicians who made the decision to place an IUC. A purposive sample and thematic analysis were used. Results Opinions on when an IUC was warranted varied considerably. Inconsistency in decision-making was caused by differing beliefs on when an IUC was appropriate for each clinical indication. Numerous patient and non-patient factors, including clinical setting, resources, patient age and gender and staff workload, also impacted on each decision. Assessing when the benefit of an IUC outweighed the risk could be problematic due to conflicting goals. Conclusions These findings help to explain why clinicians sometimes deviate from IUC best practice guidance and resist interventions to modify practice. In order to engage nurses and physicians in change, interventions to reduce IUC use should acknowledge and respond to the complexity and lack of clarity often faced by clinicians making the decision to place an IUC. However, it is equally important that inconsistencies in IUC-related beliefs are recognised, investigated and, where appropriate, challenged.</p
Lean and agile: configuring future dermatology services
No full textPredicting the configuration of future dermatology services to meet the needs of patients requires intelligent workforce planning and appropriate modelling. In the current economic climate, the future service and workforce must be 'lean and agile'. This paper explains this concept and suggests areas to focus on within the specialty with regard to future service configuration
A systematic review of interventions to minimise the initial use of indwelling urinary catheters in acute care
No full textIntermittent catheter techniques, strategies and designs for managing long‐term bladder conditions
No full textBackgroundIntermittent catheterisation (IC) is a commonly recommended procedure for people with incomplete bladder emptying. Frequent complications are urinary tract infection (UTI), urethral trauma and discomfort during catheter use. Despite the many designs of intermittent catheter, including different lengths, materials and coatings, it is unclear which catheter techniques, strategies or designs affect the incidence of UTI and other complications, measures of satisfaction/quality of life and cost‐effectiveness.This is an update of a Cochrane Review first published in 2007. ObjectivesTo assess the clinical and cost‐effectiveness of different catheterisation techniques, strategies and catheter designs, and their impact, on UTI and other complications, and measures of satisfaction/quality of life among adults and children whose long‐term bladder condition is managed by intermittent catheterisation.Search methodsWe searched the Cochrane Incontinence Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE In‐Process, MEDLINE Epub Ahead of Print, CINAHL, ClinicalTrials.gov, WHO ICTRP and handsearching of journals and conference proceedings (searched 12 April 2021), the reference lists of relevant articles and conference proceedings, and we attempted to contact other investigators for unpublished data or for clarification.Selection criteriaRandomised controlled trials (RCTs) or randomised cross‐over trials comparing at least two different catheterisation techniques, strategies or catheter designs.Data collection and analysisAs per standard Cochrane methodological procedures, two review authors independently extracted data, assessed risk of bias and assessed the certainty of evidence using GRADE. Outcomes included the number of people with symptomatic urinary tract infections, complications such as urethral trauma/bleeding, comfort and ease of use of catheters, participant satisfaction and preference, quality of life measures and economic outcomes.Main resultsWe included 23 trials (1339 randomised participants), including twelve RCTs and eleven cross‐over trials. Most were small (fewer than 60 participants completed), although three trials had more than 100 participants. Length of follow‐up ranged from one month to 12 months and there was considerable variation in definitions of UTI. Most of the data from cross‐over trials were not presented in a useable form for this review.Risk of bias was unclear in many domains due to insufficient information in the trial reports and several trials were judged to have a high risk of performance bias due to lack of blinding and a high risk of attrition bias. The certainty of evidence was downgraded for risk of bias, and imprecision due to low numbers of participants. Aseptic versus clean techniqueWe are uncertain if there is any difference between aseptic and clean techniques in the risk of symptomatic UTI because the evidence is low‐certainty and the 95% confidence interval (CI) is consistent with possible benefit and possible harm (RR 1.20 95% CI 0.54 to 2.66; one study; 36 participants). We identified no data relating to the risk of adverse events comparing aseptic and clean techniques or participant satisfaction or preference. Single‐use (sterile) catheter versus multiple‐use (clean)We are uncertain if there is any difference between single‐use and multiple‐use catheters in terms of the risk of symptomatic UTI because the certainty of evidence is low and the 95% CI is consistent with possible benefit and possible harm (RR 0.98, 95% CI 0.55, 1.74; two studies; 97 participants). One study comparing single‐use catheters to multiple‐use catheters reported zero adverse events in either group; no other adverse event data were reported for this comparison. We identified no data for participant satisfaction or preference.Hydrophilic‐coated catheters versus uncoated cathetersWe are uncertain if there is any difference between hydrophilic and uncoated catheters in terms of the number of people with symptomatic UTI because the certainty of evidence is low and the 95% CI is consistent with possible benefit and possible harm (RR 0.89, 95% CI 0.69 to 1.14; two studies; 98 participants). Uncoated catheters probably slightly reduce the risk of urethral trauma and bleeding compared to hydrophilic‐coated catheters (RR 1.37, 95% CI 1.01 to 1.87; moderate‐certainty evidence). The evidence is uncertain if hydrophilic‐coated catheters compared with uncoated catheters has any effect on participant satisfaction measured on a 0‐10 scale (MD 0.7 higher, 95% CI 0.19 to 1.21; very low‐certainty evidence; one study; 114 participants). Due to the paucity of data, we could not assess the certainty of evidence relating to participant preference (one cross‐over trial of 29 participants reported greater preference for a hydrophilic‐coated catheter (19/29) compared to an uncoated catheter (10/29)). Authors' conclusionsDespite a total of 23 trials, the paucity of useable data and uncertainty of the evidence means that it remains unclear whether the incidence of UTI or other complications is affected by use of aseptic or clean technique, single (sterile) or multiple‐use (clean) catheters, coated or uncoated catheters or different catheter lengths. The current research evidence is uncertain and design and reporting issues are significant. More well‐designed trials are needed. Such trials should include analysis of cost‐effectiveness because there are likely to be substantial differences associated with the use of different catheterisation techniques and strategies, and catheter designs
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