Efficacy of organo-selenium-incorporated urinary catheter tubing for in vitro growth inhibition of E. coli, K. pneumoniae, P. aeruginosa, and H. influenzae.

PURPOSE: Catheter-associated urinary tract infections are of significant medical burden in cost, morbidity, and mortality. Experimental selenium-coated medical devices have demonstrated non-toxic in vitro and in vivo antimicrobial activity. While antimicrobial-coated catheters have shown efficacy in preventing CAUTIs, selenium has not been tested in this context. The purpose of this in vitro study is to evaluate selenium-incorporated urinary catheters for inhibition of uropathogenic bacterial growth and biofilm formation. METHODS: Urinary catheters incorporated with 1% organo-selenium and standard (uncoated) catheters were incubated in vitro with E. coli, K. pneumoniae, P. aeruginosa, H. influenzae, and combinations of these bacteria. Growth was evaluated by colony-forming unit count and visualized with confocal laser and scanning electron microscopy. Organo-selenium catheter material integrity was also tested by soaking the tubing in phosphate-buffered saline for 12 weeks at 37 °C. RESULTS: Organo-selenium-incorporated catheters demonstrated total reduction (100%) of in vitro bacterial growth and biofilm formation for E. coli, K. pneumoniae, H. influenzae, and a combination of these species when compared to control. P. aeruginosa growth was inhibited by approximately 4 logs (99.99%). Complete inhibition of E. coli growth was maintained after long-term phosphate-buffered saline soaking. CONCLUSION: The results demonstrate that organo-selenium was stably incorporated into catheter tubing and inhibited bacterial attachment, growth, and biofilm formation for multiple uropathogenic organisms. Furthermore, long-term soaking of organo-selenium tubing in phosphate-buffered saline did not show any decline in bacterial growth inhibition or biofilm formation. These findings suggest that organo-selenium-incorporated catheters may be advantageous in preventing catheter-associated urinary tract infections and warrant further in vivo and clinical evaluation.

Use of Antimicrobial-Coated Catheters in Preventing Catheter-Associated Urinary Tract Infections and Bacteriuria: A Meta-Analysis for Clinicians.

INTRODUCTION: Catheter-associated urinary tract infections comprise a significant burden to the health care system and are of major concern for indwelling catheter use. Catheter coatings have been studied for their potential to reduce risk of infection. The purpose of this meta-analysis is to determine the efficacy of coated catheters across clinical studies in preventing these common nosocomial infections. METHODS: Searches were conducted on PubMed Central® and ScienceDirect using the terms "catheter," "urinary tract infection" and "coated" or "antimicrobial." Articles included were prospective randomized clinical studies of coated (experimental) vs uncoated (control) catheters published in English between the years 2000 and 2020. Results from included studies were analyzed using Fisher's exact test and conditional logistic regression. RESULTS: Fifteen studies met the inclusion criteria. Tested urinary catheter coatings include silver, silver salt, nitrofurazone and metal-alloy. Conditional logistic regression (p <0.001) shows statistically significant negative association between coated catheter use and the incidence of catheter-associated urinary tract infections. The odds ratio of 0.80 and 95% confidence interval (0.74, 0.88) support protective effect of catheter coatings. CONCLUSIONS: Meta-analysis demonstrates a negative association of coated catheter and incidence of catheter-associated urinary tract infections, supporting that antimicrobial catheter coatings decreases incidence of infection across studies. Further clinical research is recommended to determine the potential for catheter coating adoption in clinical practice to reduce catheter-associated urinary tract infection risk and incidence.

Review of New Implantable Tibial Nerve Stimulators in Comparison to Established Third Line Treatment Modalities for Nonneurogenic Overactive Bladder.

INTRODUCTION: New technologies are currently evolving in the treatment of overactive bladder syndrome, giving physicians and patients additional options when conservative care fails to resolve symptoms. The purpose of this review is to compare the prospective clinical data of the new small implantable devices stimulating the tibial nerve to recent prospective clinical studies of sacral nerve stimulation, percutaneous tibial nerve stimulation and botulinum toxin injection, which are currently the most established third line treatment modalities in overactive bladder syndrome. METHODS: A literature search on PubMed®/MEDLINE® was performed for new technologies in neuromodulation to improve overactive bladder syndrome. Additionally, a search was performed for all currently established third line treatment options for comparison of treatment results. The reported prospective clinical data were statistically compared using Fisher's exact test. RESULTS: Two new small implantable devices that stimulate the tibial nerve have been reported over the recent years, BlueWind RENOVA™ and eCoin™. These new implantable devices that stimulate the tibial nerve show very comparable 3-month and 6-month clinical success rates regarding reduction of urinary incontinence episodes when compared to well-established treatment options such as sacral nerve stimulation, percutaneous tibial nerve stimulation and botulinum toxin injections. CONCLUSIONS: The 2 new small implantable devices stimulating the tibial nerve, BlueWind RENOVA and eCoin, show promising clinical results. Both devices are currently undergoing U.S. Food and Drug Administration approval and 1-year followup data should soon be available. Still more clinical data with larger patient cohorts and multicenter studies are necessary to verify the therapeutic efficacy of these new small implantable devices. If confirmed these new small implantable neuromodulation devices may become well-established in the treatment of patients with overactive bladder syndrome.

Why patients should arrive late: The impact of arrival time on patient satisfaction in an academic clinic.

INTRODUCTION: When considering quality improvement of healthcare practices, patient flow, wait time, and satisfaction are important factors to monitor. Patient wait time can affect satisfaction with the care received, and it can be dependent on many different factors. The purpose of this study was to investigate the impact of patients' arrival times to his/her appointment (early vs. on time vs. late) on patients' wait times and satisfaction. METHODS: 171 patients in an otolaryngology outpatient clinic completed surveys that asked them to record wait times in various areas of the clinic and to provide a satisfaction level for these wait times. Statistical analysis tested for any significant differences in wait time and satisfaction for patients that arrived early, on time, or late. RESULTS: Late, on time, and early arriving patients spent 18.2, 30.7, and 38.8min in the waiting room, respectively. Late, on time, and early arriving patients had a total visit length of 57.4, 68.6, and 81.9min, respectively. There was a significant difference with total time spent in the clinic (p=0.0034) and for overall satisfaction with the total length of the visit (p=0.0202) between late and early arriving patients. CONCLUSIONS: This study indicates patients arriving late had shorter wait times and, not surprisingly, were more satisfied with the visit. The study provides evidence that patients view their wait as starting when they arrive to the clinic and not the actual time of the appointment. It questions the traditional scheduling systems that many clinics still use and proposes that there may be "out-of-the-box" approaches that positively impact patient satisfaction.

A Cost-Benefit Analysis of Medical Scribes and Electronic Medical Record System in an Academic Urology Clinic.

INTRODUCTION: Electronic medical records have introduced an additional level of complexity to the patient-provider encounter and medical scribes may offer a solution. We examined how a medical scribe system could support an academic urology clinic. To assess the financial feasibility of this model, we analyzed the additional costs associated with adding medical scribes and we discuss the potential benefits of this system. METHODS: We measured total patient wait and interaction times with staff, and estimated the additional staff required to maintain an increased patient load if medical scribes were introduced. We then calculated the average revenue per patient during the most recent 9 months of data to estimate the minimum increase in the number of patient visits needed to offset the additional staffing needs. RESULTS: Mean ± SD total wait time was 23 minutes 28 seconds ± 13 minutes 4 seconds. Average monthly expenses would increase by $17,452.50 for 6 additional staff members, including 1 nursing assistant, 1 patient service specialist, 1 nurse and 3 scribes. There was an average of 666 monthly office visits and average net revenue to the department was $107.78 per patient visit. The increase in the number of patient visits required to break even would be 162 additional patients per month, representing a 24.3% increase. Additional downstream revenue was considered. CONCLUSIONS: A medical scribe system in the example of an academic urology clinic setting could increase patient flow and decrease the burden on medical providers by reducing computer charting. This model is only financially prudent if the increased expenses are offset by additional revenue from increased patient visits.