A consensus statement on when to start clean intermittent self-catheterization: An untapped resource?

BACKGROUND: Clean intermittent self-catheterisation (CISC or ISC) is used by patients/carers to empty the bladder if needed. Sometimes the urethral lumen leading out of the bladder is blocked; sometimes, the bladder (detrusor) muscle itself or the autonomic motor nerves innervating the bladder are damaged, resulting in a failure of the detrusor muscle to work, leading to a failure of the bladder being able to empty adequately. Prior consensus as to the indications and timing of CISC has yet to be provided. This article aims to provide a multidisciplinary consensus view on this subject. CONCLUSION: It is evident that every patient needs to be considered individually, bearing in mind the symptoms and investigations to be considered. We emphasise the importance of considering the term Bladder Voiding Efficiency (BVE). One group of patients who might find CISC helpful are those with a neurological disorder; these include spinal injury patients, multiple sclerosis, Parkinson's, and a condition called cauda equina. Sometimes bladder problems are treated with anticholinergics, and others may be treated with Botox. These may cause the bladder not to empty at all, which is good for leaks but needs self-catheterisation to empty the bladder. In the past, hospitals used a permanent catheter called an 'indwelling' or a 'suprapubic' catheter. These can have side effects, including infections, stones, and pain. For CISC, disposable catheters are the best option for patients as they come in different sizes and styles to provide individualised care. In conclusion, we would like hospitals to consider each patient separately and not use a general 'one-size-fits-all' bladder function for these patients.

Understanding the challenges faced by men learning to live with clean intermittent self-catheterisation.

Clean intermittent self-catheterisation (CISC) is considered the preferred option to an indwelling catheter for emptying the bladder in people with a range of voiding dysfunctions. CISC has a lower risk of complications and urinary tract infections. This narrative review of previous qualitative research explores the quality-of-life impacts and highlights the challenges that men face. It will provide nurses who teach CISC with some useful insights into the male experience and the issues of concordance and adherence. This will help to better inform and guide clinical practice in this specialist area of nursing practice.

An exploration of men's experiences of learning intermittent self-catheterisation with a silicone catheter.

Intermittent self-catheterisation (ISC) is the method of choice for men with lower urinary tract symptoms who need to drain retained urine from the bladder. It is preferred to using an indwelling urinary catheter as it has lower risks of complications and catheter-associated urinary tract infection. Learning ISC can be challenging for men initially but, with the support of knowledgeable nurses experienced in teaching ISC, the technique can be learned, accepted and normalised, improving symptom control and quality of life. This paper discusses the results of a survey exploring men's experiences of learning ISC with the Hydrosil Go™ (C.R. Bard Inc-now part of Becton, Dickinson and Company) silicone catheter and to highlight issues important to men when learning and living with ISC. The survey collected data from four countries: UK, France, Netherlands and Italy. It aims to help nurses who teach ISC and inform them to discuss what matters to men when learning and living with ISC.

The female experience of ISC with a silicone catheter.

Intermittent self-catheterisation (ISC) is a safe and effective treatment in the management of neuropathic bladder, voiding dysfunction and urinary incontinence in women. ISC has been shown to improve quality of life when used appropriately. It provides freedom for individuals who require bladder drainage as they can choose where and when to catheterise to empty the bladder. ISC requires minimum equipment, is a more discreet solution than an indwelling catheter and is relatively easy to teach in one patient visit. There are a range of different ISC catheters available on prescription. Many have been designed specifically for women and patient choice regarding product selection is an important consideration. This article describes a UK patient-satisfaction survey evaluating the female patient's perspective of learning ISC using a silicone intermittent catheter called HydroSil Go™ that is manufactured by C.R. Bard, Inc.

The male experience of ISC with a silicone catheter.

Since its introduction in the 1970s, intermittent self-catheterisation (ISC) has become more common and should be considered the method of choice for draining retained urine. The realisation for male patients that they require catheterisation can be associated with a significant physical and psychological burden (Shaw and Logan, 2013). This article describes a UK multi-centre patient satisfaction survey evaluating the features of a male ISC silicone catheter. The survey was aimed at determining patient preferences and perceptions of learning ISC with the intermittent catheter to evaluate if a silicone catheter is acceptable and user friendly. This information is intended to be used to expand the knowledge base around catheter selection and help guide nurses who offer a choice of catheters when teaching ISC to patients.

Role of caspases in cytokine-induced barrier breakdown in human brain endothelial cells.

During neuroinflammation, cytokines such as TNF-α and IFN-γ secreted by activated leukocytes and/or CNS resident cells have been shown to alter the phenotype and function of brain endothelial cells (BECs) leading to blood-brain barrier breakdown. In this study, we show that the human BEC line hCMEC/D3 expresses the receptors for TNF-α, TNF receptor 1 and TNF receptor 2, and for IFN-γ. BEC activation with TNF-α alone or in combination with IFN-γ induced endothelial leakage of paracellular tracers. At high cytokine concentrations (10 and 100 ng/ml), this effect was associated with caspase-3/7 activation and apoptotic cell death as evidenced by annexin V staining and DNA fragmentation (TUNEL) assays. In addition, inhibition of JNK and protein kinase C activation at these doses partially prevented activation of caspase-3/7, although only JNK inhibition was partially able to prevent the increase in BEC paracellular permeability induced by cytokines. By contrast, lower cytokine concentrations (1 ng/ml) also led to effector caspase activation, increased paracellular flux, and redistribution of zonula occludens-1 and VE-cadherin but failed to induce apoptosis. Under these conditions, specific caspase-3 and caspase-9, but not caspase-8, inhibitors partially blocked cytokine-induced disruption of tight and adherens junctions and BEC paracellular permeability. Our results suggest that the concentration of cytokines in the CNS endothelial microenvironment determines the extent of caspase-mediated barrier permeability changes, which may be generalized as a result of apoptosis or more subtle as a result of alterations in the organization of junctional complex molecules.

Adenovirus vector vaccination induces expansion of memory CD4 T cells with a mucosal homing phenotype that are readily susceptible to HIV-1.

In the recently halted HIV type 1 (HIV-1) vaccine STEP trial, individuals that were seropositive for adenovirus serotype 5 (Ad5) showed increased rates of HIV-1 infection on vaccination with an Ad5 vaccine. We propose that this was due to activation and expansion of Ad5-specific mucosal-homing memory CD4 T cells. To test this hypothesis, Ad5 and Ad11 antibody titers were measured in 20 healthy volunteers. Dendritic cells (DCs) from these individuals were pulsed with replication defective Ad5 or Ad11 and co-cultured with autologous lymphocytes. Cytokine profiles, proliferative capacity, mucosal migration potential, and susceptibility to HIV infection of the adenovirus-stimulated memory CD4 T cells were measured. Stimulation of T cells from healthy Ad5-seropositive but Ad11-seronegative individuals with Ad5, or serologically distinct Ad11 vectors induced preferential expansion of adenovirus memory CD4 T cells expressing alpha(4)beta(7) integrins and CCR9, indicating a mucosal-homing phenotype. CD4 T-cell proliferation and IFN-gamma production in response to Ad stimulation correlated with Ad5 antibody titers. However, Ad5 serostatus did not correlate with total cytokine production upon challenge with Ad5 or Ad11. Expanded Ad5 and Ad11 memory CD4 T cells showed an increase in CCR5 expression and higher susceptibility to infection by R5 tropic HIV-1. This suggests that adenoviral-based vaccination against HIV-1 in individuals with preexisting immunity against Ad5 results in preferential expansion of HIV-susceptible activated CD4 T cells that home to mucosal tissues, increases the number of virus targets, and leads to a higher susceptibility to HIV acquisition.

An overview of male intermittent self-catheterisation.

Since the early 1970s intermittent self-catheterisation (ISC) has become increasingly popular and is now considered the method of choice for draining retained urine from the bladder and to treat urethral strictures in men. It is the preferred option for this kind of bladder dysfunction management instead of an indwelling urinary catheter. Learning ISC can be a challenging time for men, but with the support of knowledgeable experienced nurses in teaching ISC it can be successfully achieved. This article outlines the anatomy of the male urinary tract, offers practical tips for nurses who teach it, and highlights issues important to men when learning and living with ISC.

Toilet privacy in hospital.

Good practice in toilet management and continence promotion can help hospital patients to maintain their dignity. This article reports on an audit that highlighted the issues important to patients and nurses in terms of improving privacy and dignity for inpatients using the toilet.

Addressing ketamine bladder syndrome.

The rise in ketamine misuse means more health professionals will need to diagnose, refer and treat ketamine bladder syndrome. Prevention and raising awareness of the problem among multidisciplinary teams will help limit damage to the bladder as well as making treatment and management more effective.

Improved glycaemia during the Covid-19 pandemic lockdown is sustained post-lockdown and during the "Eat Out to Help Out" Government Scheme, in adults with Type 1 diabetes in the United Kingdom.

AIMS: The majority of studies report that the Covid-19 pandemic lockdown did not have a detrimental effect on glycaemia. We sought to explore the impact of lockdown on glycaemia and whether this is sustained following easing of restrictions. METHODS: Retrospective, observational analysis in adults and children with type 1 diabetes attending a UK specialist centre, using real-time or intermittently scanned continuous glucose monitoring. Data from the following 28-day time periods were collected: (i) pre-lockdown; (ii) during lockdown; (iii) immediately after lockdown; and (iv) a month following relaxation of restrictions (coinciding with Government-subsidised restaurant food). Data were analysed for times in glycaemic ranges and are expressed as median (IQR). RESULTS: 145 adults aged 35.5 (25.8-51.3) years with diabetes duration of 19.0 (7.0-29.0) years on multiple daily injections of insulin (60%) and continuous insulin infusion (40%) were included. In adults, % time in range (70-180mg/dL) increased during lockdown (60.2 (45.2-69.3)%) compared to pre-lockdown (56.7 (43.5-65.3)%; p<0.001). This was maintained in the post-lockdown time periods. Similarly, % time above range (>180mg/dL) reduced in lockdown compared to pre-lockdown (p = 0.01), which was sustained thereafter. In children, no significant changes to glycaemia were observed during lockdown. In multivariable analysis, a greater increase in %TIR 3.9-10mmol/L (70-180mg/dL) during lockdown was associated with higher levels of deprivation (coefficient: 4.208, 95% CI 0.588 to 7.828; p = 0.02). CONCLUSIONS: Glycaemia in adults improved during lockdown, with people from more deprived areas most likely to benefit. This effect was sustained after easing of restrictions, with government-subsidised restaurant eating having no adverse impact on glycaemia.

Constructing identifiable composite faces: The importance of cognitive alignment of interview and construction procedure.

We investigated the impact of congruency between the witness interview and method used to construct a composite face. Experiment 1, using a typical feature-by-feature composite method, revealed that aligning cognitive processes during interview and face construction enhanced the effectiveness of composites compared with composites produced following unaligned (incongruent) procedures. Experiment 2 revealed that incorporating character judgments in the witness interview substantially enhanced identification of feature-based composites when constructing the central (internal) features first, suggesting that such judgments focus attention on this region of the face. Experiment 3 explored alignment of processes using an approach based on an evolutionary algorithm, a method requiring witnesses to create a composite by selecting from arrays based on the eye-region. A combination of character judgments, first for the whole face and then for the eye region, led to best-identified composites. Overall, results indicate that more effective composites are produced when both interview and construction procedures are aligned cognitively. Results are discussed with relevance to the theory of transfer-appropriate processing (Morris, Bransford, & Franks, 1977). (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Effect of clean intermittent self-catheterization on quality of life: a qualitative study.

AIM: This paper is a report of a study to describe the experience of people carrying out clean intermittent self-catheterization and the impact on their quality of life. BACKGROUND: Clean intermittent self-catheterization is a recommended treatment for people experiencing urinary voiding difficulties. The majority of the literature to date has focused on biomedical issues such as complication rates and use of different catheters. METHOD: A qualitative approach was used based on grounded theory. Fifteen users (eight men and seven women) of intermittent self-catheterization took part in semi-structured interviews during 2006. Ages ranged from 33 to 81 years (median 65 years). Reasons for self-catheterization included multiple sclerosis, urethral stricture and high residual volumes. Thematic analysis was used to develop hypotheses about the causes and consequences of the core category 'quality of life'. FINDINGS: The core category consisted of two subcategories of positive and negative impacts. Positive impacts were related to improvement in lower urinary tract symptoms, whereas the negative impacts resulted from the practical difficulties encountered, and the psychological and cultural context of worry and stigma. The factors influencing variations in quality of life impacts were sex, lifestyle, frequency and duration of carrying out self-catheterization, technical difficulties, type of catheter, co-morbidities and individual predispositions. CONCLUSION: The model has the potential to help professionals to identify the factors likely to influence response to clean intermittent self-catheterization, and could be used as a tool to help identify those who may have difficulty complying with the treatment or to aid advice-giving on situations that may cause difficulties.

Patients' experiences of learning clean intermittent self-catheterization: a qualitative study.

AIM: This paper is a report of a study to explore the experiences of learning to carry out clean intermittent self-catheterization and user views of service provision. BACKGROUND: This treatment imposes a variety of challenges to users, both physical and emotional. Safety, infection rates and complications have been investigated, but the practicalities of learning and performing self-catheterization have not been addressed. What is currently known about the topic from a user perspective is based on audit, small projects or anecdotal reports provided by continence advisers. METHOD: In-depth interviews were carried out in 2006 with eight men and seven women, aged 33-81 years (median 65), and carrying out self-catheterization for a variety of reasons. A grounded theory framework was used. FINDINGS: Themes identified were psychological issues, physical problems and service interaction. The communication skills of nurses helped facilitate the learning experience. In conjunction with nurses' skills, a friendly relaxed approach alleviated embarrassment and anxiety, thus facilitating information exchange and retention of information. CONCLUSION: Adequate information and thorough instruction by healthcare professionals helps empower people to take control and master the treatment, with potential contribution to ongoing compliance and long-term urinary tract health. Development of a policy supporting evidence-based care and a consistent teaching programme is highly recommended for use where this treatment is regularly employed.

Designing a catheter skills training programme.

Karen Logan describes how a team of continence advisers designed and implemented a training programme that allows local nurses to meet the national occupational standards and competencies in catheterisation and catheter care.

Immunohistochemical localization of angiotensin II receptor types 1 and 2 in the mesenteric artery from spontaneously hypertensive rats.

Angiotensin II plays a crucial role in the control of blood pressure, acting at AT1 or AT2 receptors, and can act as a potent vasoconstrictor of the peripheral vasculature inducing hypertrophy, hyperplasia, or both, in resistance arteries. The aim of the present study was to investigate whether the pattern of distribution of angiotensin AT1 and AT2 receptors on mesenteric artery sections differs in spontaneously hypertensive rats (SHR) versus their respective controls (Wistar-Kyoto [WKY] rats). Immunohistochemistry using anti-AT1 or anti-AT2 antibodies was performed on perfused-fixed/paraffin-embedded mesenteric arteries from SHR and WKY rats. 3,3'-Diaminobenzidine tetrahydrochloride (DAB; activated by hydrogen peroxide) staining revealed distinct AT1 and AT2 labeling of all artery layers (adventitia, media and intima) from WKY rats, whereas in SHR an abundant AT1 labeling was found in both intima and adventitia and a sparser labeling in the media. There was a vast reduction of AT2 labeling throughout all layers. These results suggest a crucial role for AT2 receptors in the pathogenesis of hypertension.

Diabetes in pregnancy and infant adiposity: systematic review and meta-analysis.

OBJECTIVE: Maternal glycaemia and anthropometry-derived newborn adiposity are strongly correlated. The children of mothers with diabetes are at greater risk of adverse metabolic health, and increased adiposity is a plausible mediator. We undertook a systematic review and meta-analysis to compare adiposity in infants of diabetic mothers (IDM) and infants of mothers without diabetes (NIDM). DESIGN: We identified observational studies reporting adiposity in IDM and NIDM. We searched references, traced forward citations and contacted authors for additional data. We considered all body composition techniques and compared fat mass, fat-free mass, body fat % and skinfold thickness. We used random effects meta-analyses and performed subgroup analyses by maternal diabetes type (type 1, type 2 and gestational) and infant sex. We examined the influence of pre-pregnancy body mass index (BMI) and conducted sensitivity analyses. RESULTS: We included data from 35 papers and over 24 000 infants. IDM have greater fat mass than NIDM (mean difference (95% CI)): 83 g (49 to 117). Fat mass is greater in infants of mothers with gestational diabetes: 62 g (29 to 94) and type 1 diabetes: 268 g (139 to 397). Insufficient studies reported data for type 2 diabetes separately. Compared with NIDM, fat mass was greater in IDM boys: 87 g (30 to 145), but not significantly different in IDM girls: 42 g (-33 to 116). There was no attenuation after adjustment for maternal BMI. CONCLUSIONS: IDM have significantly greater adiposity in comparison with NIDM. These findings are justification for studies to determine whether measures to reduce infant adiposity will improve later health.

Development of Early Adiposity in Infants of Mothers With Gestational Diabetes Mellitus.

OBJECTIVE: Infants born to mothers with gestational diabetes mellitus (GDM) are at greater risk of later adverse metabolic health. We examined plausible candidate mediators, adipose tissue (AT) quantity and distribution and intrahepatocellular lipid (IHCL) content, comparing infants of mothers with GDM and without GDM (control group) over the first 3 postnatal months. RESEARCH DESIGN AND METHODS: We conducted a prospective longitudinal study using MRI and spectroscopy to quantify whole-body and regional AT volumes, and IHCL content, within 2 weeks and 8-12 weeks after birth. We adjusted for infant size and sex and maternal prepregnancy BMI. Values are reported as the mean difference (95% CI). RESULTS: We recruited 86 infants (GDM group 42 infants; control group 44 infants). Mothers with GDM had good pregnancy glycemic control. Infants were predominantly breast-fed up to the time of the second assessment (GDM group 71%; control group 74%). Total AT volumes were similar in the GDM group compared with the control group at a median age of 11 days (-28 cm(3) [95% CI -121, 65], P = 0.55), but were greater in the GDM group at a median age of 10 weeks (247 cm(3) [56, 439], P = 0.01). After adjustment for size, the GDM group had significantly greater total AT volume at 10 weeks than control group infants (16.0% [6.0, 27.1], P = 0.002). AT distribution and IHCL content were not significantly different at either time point. CONCLUSIONS: Adiposity in GDM infants is amplified in early infancy, despite good maternal glycemic control and predominant breast-feeding, suggesting a potential causal pathway to later adverse metabolic health. Reduction in postnatal adiposity may be a therapeutic target to reduce later health risks.