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1.
Acad Med ; 95(3): 435-441, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31651436

RESUMO

PURPOSE: Catheter-associated urinary tract infection (CAUTI) is a priority quality metric for hospitals. The impact of placement of indwelling urinary catheter (IUC) by medical students on CAUTI rates is not well known. This study examined the impact of a simulation-based medical student education curriculum on CAUTI rates at an academic medical center. METHOD: Patient characteristics, procedural data, and outcome data from all operating room IUC insertions from June 2011 through December 2016 at the Northwestern University Feinberg School of Medicine were analyzed using a multivariable model to evaluate associations between CAUTI and inserting provider. Infection data before and after implementation of a simulation-based IUC competency course for medical students were compared. RESULTS: A total of 57,328 IUC insertions were recorded during the study period. Medical students inserted 12.6% (7,239) of IUCs. Medical students had the lowest overall rate of CAUTI among all providers during the study period (medical students: 0.05%, resident/fellows: 0.2%, attending physicians: 0.3%, advanced practice clinicians: 0.1%, nurses: 0.2%; P = .003). Further, medical student IUC placement was not associated with increased odds of CAUTI in multivariable analysis (odds ratio, 0.411; 95% confidence interval: 0.122, 1.382; P = .15). Implementation of a simulation-based curriculum for IUC insertion resulted in complete elimination of CAUTI in patients catheterized by medical students (0 in 3,471). CONCLUSIONS: IUC insertion can be safely performed by medical students in the operating room. Simulation-based skills curricula for medical students can be effectively implemented and achieve clinically relevant improvements in patient outcomes.


Assuntos
Cateteres de Demora/efeitos adversos , Cateteres de Demora/estatística & dados numéricos , Salas Cirúrgicas/estatística & dados numéricos , Treinamento por Simulação/métodos , Estudantes de Medicina/estatística & dados numéricos , Cateterismo Urinário/estatística & dados numéricos , Infecções Urinárias/etiologia , Centros Médicos Acadêmicos/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Chicago , Currículo , Educação Médica/organização & administração , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cateterismo Urinário/efeitos adversos , Adulto Jovem
2.
J Matern Fetal Neonatal Med ; 33(1): 68-72, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29886771

RESUMO

Purpose: We conducted a prospective randomized controlled trial to compare postoperative urinary catheter removal 2 versus 12 h after elective cesarean section in terms of irritative symptoms, first void time, incidence of urinary tract infection, postoperative mobilization time, and hospitalization time.Methods: A total of 134 women admitted to Duzce University Hospital for primary or recurrent elective cesarean section were randomized into two groups. A total of 62 women were enrolled in the early group, with indwelling catheter removal 2 h after cesarean section; 74 women were enrolled in the delayed group, with catheter removal 12 h after the cesarean section. The groups were prospectively compared in terms of irritative urinary symptoms, bacteriuria, hematuria, length of hospital stay, and mobilization time.Results: Urinary frequency (p = .04), microscopic hematuria incidence (p = .04), postoperative mobilization time (p = .01), and length of hospital stay (p = .009) were significantly lower in the early group than in the delayed group. There were no significant differences in terms of bacteruria, urinary retention, dysuria, and first postoperative voiding time.Conclusions: Early removal of urinary catheters after elective cesarean section is associated with reduced mobilization time and hospital stay.


Assuntos
Cateteres de Demora , Cesárea , Remoção de Dispositivo/métodos , Cateterismo Urinário , Cateteres Urinários/efeitos adversos , Adulto , Infecções Relacionadas a Cateter/epidemiologia , Cateteres de Demora/efeitos adversos , Cateteres de Demora/estatística & dados numéricos , Cesárea/efeitos adversos , Cesárea/instrumentação , Cesárea/métodos , Cesárea/estatística & dados numéricos , Remoção de Dispositivo/efeitos adversos , Remoção de Dispositivo/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Procedimentos Cirúrgicos Eletivos/instrumentação , Procedimentos Cirúrgicos Eletivos/métodos , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Paridade/fisiologia , Cuidados Pós-Operatórios/efeitos adversos , Cuidados Pós-Operatórios/métodos , Cuidados Pós-Operatórios/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Gravidez , Fatores de Tempo , Resultado do Tratamento , Turquia/epidemiologia , Cateterismo Urinário/efeitos adversos , Cateterismo Urinário/estatística & dados numéricos , Cateteres Urinários/estatística & dados numéricos , Retenção Urinária/epidemiologia , Retenção Urinária/etiologia , Infecções Urinárias/epidemiologia , Infecções Urinárias/etiologia , Adulto Jovem
3.
J Clin Nurs ; 28(23-24): 4572-4581, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31469471

RESUMO

AIMS AND OBJECTIVES: To identify the point prevalence of indwelling urinary catheters (IDCs) in adult inpatients in acute care hospitals, and to describe the indications for IDC insertion based on patient age, gender, specialty and hospital. BACKGROUND: Catheter-associated urinary tract infections (CAUTIs) are preventable healthcare-associated infections. IDC duration is the strongest predictor of CAUTI, and little is known about characteristics of patients who receive an IDC. DESIGN: Two single-day point prevalence surveys collected baseline patient data as part of a larger pre-post control-intervention study. METHODS: Surveys were conducted at four acute care hospitals in NSW, Australia, for all adult patients. Data collection included IDC presence, insertion details and urine culture collection. Point prevalence data were linked with electronically extracted patient demographic data. This study is presented in line with STROBE checklist (See Supplementary File 1). RESULT: Data from 1,630 patients were analysed, with 196 patients (12%) identified as having an IDC on the survey dates. IDC prevalence rates were higher in males (13%) than in females (11%). Critical care had the highest rate of patients with IDCs (42%). Urine cultures were collected in 70 patients with an IDC (43%). CONCLUSIONS: Findings indicated similar rates of IDC use in males and females, and there was no significant difference in age between patients with or without an IDC. However, indication for IDC varied by patient age and gender. High rates of urine culture collection may represent routine collection. RELEVANCE TO CLINICAL PRACTICE: IDC use is found across genders, all age groups and specialties. Nurses should be aware that any of their patients may have an IDC and be particularly aware of certain indications based on patient age and gender. Routine urine culture collection is not advised, and instead, nurses should be guided by clinical decision-making tools.


Assuntos
Infecções Relacionadas a Cateter/epidemiologia , Cateteres de Demora/efeitos adversos , Cateterismo Urinário/estatística & dados numéricos , Infecções Urinárias/epidemiologia , Idoso , Estudos de Casos e Controles , Infecções Relacionadas a Cateter/enfermagem , Infecção Hospitalar/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , New South Wales/epidemiologia , Inquéritos e Questionários , Fatores de Tempo , Cateterismo Urinário/enfermagem , Cateteres Urinários , Infecções Urinárias/enfermagem
4.
Infect Control Hosp Epidemiol ; 40(9): 979-982, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31232260

RESUMO

BACKGROUND: The device standardized infection ratio (SIR) is used to compare unit and hospital performance for different publicly reported infections. Interventions to reduce unnecessary device use may select a higher-risk population, leading to a paradoxical increase in SIR for some high-performing facilities. The standardized utilization ratio (SUR) adjusts for device use for different units and facilities. METHODS: We calculated the device SIR (calculated based on actual device days) and population SIR (defined as Σ observed events divided by Σ predicted events based on predicted device days), adjusting for the facility SUR for both central-line-associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) in 84 hospitals from a single system for calendar years 2016 and 2017. RESULTS: The central-line SUR was 1.02 for 801,172 central-line days, with a device SIR of 0.76 and a population SIR of 0.78, a 1.6% relative increase. On the other hand, the urinary catheter SUR was 0.90 for 757,504 urinary catheter days, with a device SIR of 0.84 and a population SIR of 0.76, a 10.0% relative decrease. The cumulative attributable difference for CAUTI to a target SIR of 1 was -135.4 for the device SIR compared to -203.66 for the population SIR, a 50.8% increase in prevented events. CONCLUSION: Population SIR accounts for predicted device utilization; thus, it is an attractive metric with which to address overall risk of infection or harm to a patient population. It also reduces the risk of selection bias that may impact the device SIR with interventions to reduce device use.


Assuntos
Infecções Relacionadas a Cateter/epidemiologia , Cateteres Venosos Centrais/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Cateterismo Urinário/estatística & dados numéricos , Infecções Urinárias/epidemiologia , Infecções Relacionadas a Cateter/microbiologia , Cateteres Venosos Centrais/microbiologia , Infecção Hospitalar/epidemiologia , Humanos , Infecções Urinárias/microbiologia
5.
Medicine (Baltimore) ; 98(23): e15958, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31169723

RESUMO

BACKGROUND: Thoracic epidural analgesia is associated with a high rate of postoperative urine retention (POUR). Auriculotherapy can reduce visceral dysfunction and can be helpful in anesthesiology and pain control. The aim of this study was to test the efficacy of preoperative auriculotherapy to decrease the occurrence of POUR. METHODS: This single-center, double-blinded, 2-arm randomized study was performed between January 2015 and May 2016 in a tertiary care university hospital. Male patients scheduled for an elective lung surgical procedure under combined general anesthesia and thoracic epidural analgesia were included. Auriculotherapy (A group) was performed once the patient was under general anesthesia with 5 semi-permanent needles inserted in both ears at the "Shen Men" "bladder", "pelvic parasympathetic", "anterior hypothalamus", and "frontal lobe" points. Five small round patches of adhesive pads were positioned bilaterally at the same points in the control group (C group). The main outcome measure was the requirement for bladder catheterization during the day and the first night following surgery. RESULTS: Fifty-three patients were randomized and 25 analyzed in each group. Requirement for bladder catheterization was different between groups: 24 C group patients (96%) and 18 A group patients (72%) (P = .049, Fisher exact test; Odds Ratio = 0.11 [0.01-0.95]. The number of patients needed to treat with auriculotherapy to avoid 1 case of bladder catheterization was 4. No adverse effect was observed due to auriculotherapy. CONCLUSION: This study demonstrates that auriculotherapy is a safe and useful technique reducing POUR in thoracotomy patients benefiting from thoracic epidural analgesia. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT02290054 (November 13, 2014).


Assuntos
Analgesia Epidural/efeitos adversos , Auriculoterapia/métodos , Complicações Pós-Operatórias/prevenção & controle , Toracotomia/efeitos adversos , Retenção Urinária/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Método Duplo-Cego , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Vértebras Torácicas , Toracotomia/métodos , Resultado do Tratamento , Bexiga Urinária/fisiopatologia , Bexiga Urinária/cirurgia , Cateterismo Urinário/estatística & dados numéricos , Retenção Urinária/etiologia , Retenção Urinária/terapia , Adulto Jovem
6.
Infect Control Hosp Epidemiol ; 40(6): 681-685, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30915925

RESUMO

Catheter-associated urinary tract infection (CAUTI) has long been considered a preventable healthcare-associated infection. Many federal agencies, the Centers for Medicare and Medicaid Services (CMS), and public and private healthcare organizations have implemented strategies aimed at preventing CAUTIs. To monitor progress in CAUTI prevention, the National Healthcare Safety Network (NHSN) CAUTI metric has been adopted nationally as the primary outcome measure and has been refined over the past decades. However, this surveillance metric may underestimate infectious and noninfectious catheter harm. We suggest evolving to more inclusive performance metrics to better reflect quality improvement efforts underway in hospitals. The standardized device utilization ratio (SUR) provides a good surrogate for preventable catheter harm. On the other hand, a population-based metric that combines both standardized infection ratio (SIR) and SUR would address both infectious and noninfectious harm, while adjusting for population risk. Finally, electronically captured catheter-associated bacteriuria may contribute essential information on local testing stewardship.


Assuntos
Infecções Relacionadas a Cateter/prevenção & controle , Infecção Hospitalar/prevenção & controle , Controle de Infecções/normas , Cateterismo Urinário/efeitos adversos , Infecções Urinárias/prevenção & controle , Hospitais , Humanos , Avaliação de Resultados em Cuidados de Saúde , Estados Unidos , Cateterismo Urinário/estatística & dados numéricos
7.
Obstet Gynecol ; 133(4): 675-682, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30870290

RESUMO

OBJECTIVE: To estimate whether the urinary force of stream method is noninferior to a standard fill voiding trial for rate of catheterization within 6 weeks after apical prolapse surgery in those discharged without a catheter. METHODS: A noninferiority randomized controlled trial was conducted in postoperative women comparing force of stream with standard fill voiding trials after vaginal, abdominal, or laparoscopic-robotic apical pelvic organ prolapse (POP) surgery. Before discharge, women in both groups were backfilled with 300 mL normal saline. Successful voiding criteria in the force of stream group was subjective force of stream of at least 50 using a visual analog scale; reporting less than 50 prompted a bladder scan. Successful voiding was defined as a postvoid residual volume of less than 500 mL. For the standard fill voiding trial group, voiding two thirds of the instilled amount indicated success. The primary outcome was the rate of catheterization within the 6-week postoperative period after surgical repair of apical prolapse among those discharged without a urinary catheter. Secondary endpoints included trial of void failure rates. A sample size of 59 patients per group who passed trial of void at discharge was needed to achieve 80% power using a noninferiority margin (delta of 10%). Total enrollment of 169 patients was necessary to account for an estimated 30% trial of void failure rate. RESULTS: From April 2016 and April 2017, 184 patients were enrolled (six enrolled before the trial registration date), with the first patient enrolled on April 1, 2016. One hundred seventy-four patients were randomized (86 in the force of stream group and 88 in the standard fill voiding trial group). No differences were observed in demographic or perioperative characteristics, except for stage 2 apical prolapse (52% in the force of stream group vs 36% in the standard fill voiding trial group). For the primary outcome, similar rates were found in those patients who passed their trial of void but subsequently needed catheterization for voiding dysfunction (force of stream 2.8% [2/71] vs standard fill voiding trial 3.1% [2/64]; difference -0.3%, 95% CI -8.69% to 8.08%). The incidence of trial of void failures at discharge was similar (force of stream 17.4% [15/86] vs standard fill voiding trial 26.4% [23/87]; risk ratio 0.65, 95% CI 0.37-1.18, P=nonsignificant). CONCLUSION: Force of stream was noninferior to standard fill voiding trial when comparing the rate of catheter insertion during the 6-week postoperative period after apical POP surgery in those discharged without a catheter. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT02753920.


Assuntos
Prolapso de Órgão Pélvico/cirurgia , Cateterismo Urinário/estatística & dados numéricos , Transtornos Urinários/diagnóstico , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/terapia , Slings Suburetrais/efeitos adversos , Cateterismo Urinário/efeitos adversos , Infecções Urinárias/epidemiologia , Infecções Urinárias/etiologia , Micção , Transtornos Urinários/terapia , Urina , Procedimentos Cirúrgicos Urogenitais/efeitos adversos
8.
Surg Endosc ; 33(9): 3008-3013, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30406386

RESUMO

BACKGROUND: Postoperative urinary retention (POUR) is a complication of laparoscopic inguinal hernia repair (LIHR). Previous research has identified predictive factors of POUR, such as age and history of benign prostatic hyperplasia (BPH). There is currently limited work on preventative measures. We hypothesize dexamethasone, a steroid, reduces POUR rates following LIHR due to its mechanism. METHODS: Consecutive patients (n = 979) undergoing LIHR from 2009 to 2017 at a single institution were selected from a prospectively managed database. All procedures were performed by four general surgeons. Only male patients were selected, as the majority of POUR occurs in males. Patients were retroactively chart reviewed and divided into two groups, dexamethasone use (n = 623) and no dexamethasone use (n = 356). Perioperative factors were compared between groups with Chi-square and independent samples t tests. Univariable and multivariable logistic regression analysis was used to assess whether dexamethasone use was associated with POUR. A subgroup analysis was performed on the dexamethasone group to determine any dose-dependent effects. RESULTS: We found a significant difference in POUR between the dexamethasone group and no dexamethasone group (3.7% vs. 9.8%, p = 0.0001). Patients in the dexamethasone group had a shorter length of stay, and were less likely to have BPH or a Foley placed (all p < 0.05). Age and BMI were similar between groups. Multivariable analysis showed that the use of dexamethasone was associated with a reduced risk of POUR (OR 0.52, 95% CI 0.2-0.97, p = 0.0386), while controlling for factors such as age and BPH. A subgroup analysis examined the effect of dexamethasone per unit (mg) increase. There was no significant association between dexamethasone dose and POUR rates (OR 1.07, 95% CI 0.82-1.38, p = 0.6241). CONCLUSIONS: Patients who received dexamethasone showed a lower rate of POUR regardless of dose. These results suggest dexamethasone can be administered to reduce POUR in males undergoing LIHR.


Assuntos
Dexametasona/uso terapêutico , Hérnia Inguinal/cirurgia , Herniorrafia/efeitos adversos , Laparoscopia/efeitos adversos , Complicações Pós-Operatórias , Hiperplasia Prostática/complicações , Cateterismo Urinário/estatística & dados numéricos , Adulto , Glucocorticoides/uso terapêutico , Hérnia Inguinal/complicações , Herniorrafia/métodos , Humanos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/terapia , Estudos Retrospectivos , Retenção Urinária/etiologia , Retenção Urinária/prevenção & controle , Retenção Urinária/terapia
9.
BMJ Qual Saf ; 28(1): 56-66, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30100564

RESUMO

BACKGROUND: Indwelling urinary catheters are commonly used for patients undergoing general and orthopaedic surgery. Despite infectious and non-infectious harms of urinary catheters, there is limited guidance available to surgery teams regarding appropriate perioperative catheter use. OBJECTIVE: Using the RAND Corporation/University of California Los Angeles (RAND/UCLA) Appropriateness Method, we assessed the appropriateness of indwelling urinary catheter placement and different timings of catheter removal for routine general and orthopaedic surgery procedures. METHODS: Two multidisciplinary panels consisting of 13 and 11 members (physicians and nurses) for general and orthopaedic surgery, respectively, reviewed the available literature regarding the impact of different perioperative catheter use strategies. Using a standardised, multiround rating process, the panels independently rated clinical scenarios (91 general surgery, 36 orthopaedic surgery) for urinary catheter placement and postoperative duration of use as appropriate (ie, benefits outweigh risks), inappropriate or of uncertain appropriateness. RESULTS: Appropriateness of catheter use varied by procedure, accounting for procedure-specific risks as well as expected procedure time and intravenous fluids. Procedural appropriateness ratings for catheters were summarised for clinical use into three groups: (1) can perform surgery without catheter; (2) use intraoperatively only, ideally remove before leaving the operating room; and (3) use intraoperatively and keep catheter until postoperative days 1-4. Specific recommendations were provided by procedure, with postoperative day 1 being appropriate for catheter removal for first voiding trial for many procedures. CONCLUSION: We defined the appropriateness of indwelling urinary catheter use during and after common general and orthopaedic surgical procedures. These ratings may help reduce catheter-associated complications for patients undergoing these procedures.


Assuntos
Cirurgia Geral , Procedimentos Ortopédicos , Assistência Perioperatória , Cateterismo Urinário , Feminino , Guias como Assunto , Humanos , Masculino , Auditoria Médica , Michigan , Procedimentos Desnecessários , Cateterismo Urinário/estatística & dados numéricos
10.
Int Urogynecol J ; 30(11): 1897-1902, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-30483852

RESUMO

INTRODUCTION AND HYPOTHESIS: There is a distinct lack of literature on postoperative management after anterior colporrhaphy (AC). Our traditional postoperative protocol consisted of 24 h of indwelling catheterisation followed by 24 h of self-intermittent catheterisation. We hypothesised that a new protocol consisting of only 24 h of indwelling catheterisation might produce better results without additional complications. METHODS: From April 2014 to July 2017, all candidates for AC were randomised to catheter removal 24 or 48 h after surgery. The primary outcome was the postoperative urinary retention (POUR) rate. Secondary outcomes included: asymptomatic bacteriuria (AB), urinary tract infection (UTI) and postoperative pain after 24 h. RESULTS: A total of 79 patients were recruited. Thirty-seven and 40 patients were randomised to follow the 48-h protocol and the 24-h protocol respectively. There were no significant differences in relation to the POUR rate: 3 patients (8.1%) vs 1 (2.5%) in the 48-h vs the 24-h group respectively (p = 0.346). The UTI rate was 2 (8.1%) vs 0 patients respectively (p = 0.139) and the postoperative AB rate was 3 (9.1%) vs 0 patients (p = 0.106). In the postoperative pain evaluation, the visual analogue scale score was significantly higher in the 48 h group (0.35 vs 0.13, p = 0.02). CONCLUSIONS: According to our results, reducing the catheterisation from 48 to 24 h after AC does not increase the risk of POUR and decreases the rate of UTI, AB and postoperative pain. This new postoperative management protocol of pelvic floor surgery would improve postoperative outcomes and shorten the stay in hospital.


Assuntos
Cuidados Pós-Operatórios/métodos , Cateterismo Urinário/estatística & dados numéricos , Prolapso Uterino/cirurgia , Vagina/cirurgia , Idoso , Cateteres de Demora , Feminino , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Prospectivos , Fatores de Tempo
11.
Arch Pediatr ; 26(1): 16-20, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30554850

RESUMO

INTRODUCTION: Since April 2015, the French Society of Pediatrics has encouraged suprapubic aspiration (SA) and urethral catheterization (UC) for urine collection in non-toilet-trained children suspected of having urinary tract infections (UTIs) and has tried to reduce the use of urine bag (UB). OBJECTIVE: To analyze the medical practices concerning urine collection methods used for non-toilet-trained children in pediatric emergency departments in France. METHODS: We conducted a descriptive medical practice study in October 2017. All members of the French Society of Pediatric Nephrology received two questionnaires about urine collection methods used for non-toilet-trained children, distinguishing between male and female patients, and about the corresponding analgesic protocols used in their pediatric emergency departments. RESULTS: In total, 26 centers completed questionnaires concerning female patients. UC was performed in cases of fever associated with urinary tract malformations in 14 of 26 centers (54%). UB was used in cases of fever of unknown origin lasting for more than 48h in 17 of 26 centers (65%), in cases of fever associated with UTI symptoms in 14 of 26 centers (54%), and in cases of fever in infants under 3 months of age in 16 of 26 centers (61%). The questionnaires concerning male patients were completed by 30 centers. UB was the initially used urine collection method in all situations with, respectively, 22 of 30 (73%), 27 of 30 (90%), 23 of 30 (77%), and 22 of 30 (73%) centers. The analgesic protocol for urine collection is not well established in France. CONCLUSION: UC for urine collection in pediatric emergency departments in France is underused despite the national recommendations and the greater diagnostic power of this method compared with UB.


Assuntos
Padrões de Prática Médica/estatística & dados numéricos , Urinálise/estatística & dados numéricos , Infecções Urinárias/diagnóstico , Coleta de Urina/métodos , Analgésicos/administração & dosagem , Pré-Escolar , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , França , Humanos , Lactente , Masculino , Dor/epidemiologia , Dor/etiologia , Inquéritos e Questionários , Treinamento no Uso de Toaletes , Cateterismo Urinário/estatística & dados numéricos , Coleta de Urina/estatística & dados numéricos
12.
Int Urogynecol J ; 30(5): 779-787, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30145671

RESUMO

INTRODUCTION AND HYPOTHESIS: Catheter-associated urinary tract infections (UTI) are the most common health-care-related infections. We aimed to compare the UTI rate among women undergoing urogynecological procedures with a silver-alloy suprapubic catheter (SPC) and a standard SPC, and identify the risk factors predisposing patients to UTI. METHODS: Patients who were to undergo placement of an SPC as part of pelvic organ prolapse surgery were enrolled between 1 August 2011 and 30 August 2017, and randomized to either standard SPC or silver-alloy SPC. Follow-up was performed at a postoperative visit or via a phone call at 6 weeks. The primary outcome was UTI. RESULTS: Of the 288 patients who were randomized, 127 with standard SPC and 137 with silver-alloy SPC were included in the analysis. Twenty-nine out of 123 women with standard SPC (23.6%) and 24 out of 131 (18.3%) with silver-alloy SPC were diagnosed with UTI within 6 weeks postoperatively (p = 0.30). In univariate analysis, non-white race (odds ratio [OR] 5.36, 95% CI 1.16-24.73) and diabetes (OR 2.80, 95% CI 1.26-6.23) were associated with increased risk of UTI. On multivariate analysis, only diabetes remained an independent risk factor. Comparisons between groups were evaluated using two-sample t test for age, Chi-squared tests for diabetes, and Wilcoxon rank sum test for all other variables. CONCLUSION: There was only a 5% difference in 6-week UTI rates between those who received standard vs silver-alloy SPC; the study was not powered to detect such a small difference. Diabetes was identified as a risk factor for SPC-associated UTI in women undergoing pelvic reconstructive surgeries.


Assuntos
Infecções Relacionadas a Cateter/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Cateterismo Urinário/instrumentação , Infecções Urinárias/epidemiologia , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Prolapso de Órgão Pélvico/cirurgia , Fatores de Risco , Compostos de Prata/uso terapêutico , Cateterismo Urinário/efeitos adversos , Cateterismo Urinário/estatística & dados numéricos , Cateteres Urinários , Infecções Urinárias/etiologia
13.
J Matern Fetal Neonatal Med ; 32(19): 3168-3175, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29642724

RESUMO

Objective: It is unclear that whether Foley catheter with simultaneous oxytocin could improve the efficacy of induction outcome. Method: To conduct a meta-analysis of randomized controlled trial (RCT) studies to evaluate the effect of Foley catheter with simultaneous oxytocin on labor induction. PubMed, Embase, and other databases were searched from their inception to July 2017. We included all RCTs comparing Foley catheter with simultaneous oxytocin (i.e. intervention group) with Foley catheter followed by oxytocin (i.e. control group) in the three kinds of women (nulliparas and multiparas/only nulliparas/only multiparas). We estimate summarized relative risk (RR) and 95% confidence intervals (CIs) for dichotomous outcomes, standard mean difference for continuous outcomes. Fixed- and random-effects models were used, depending on heterogeneity. Results: After application of our inclusion and exclusion criteria, six RCTs with a total of 1133 participants were identified. We found that only nulliparas had significant RR of delivery within 24 h (RR = 1.32, 95% CI: 1.12, 1.55, I2 = 46.5%). Meanwhile, there was no statistically significant difference between intervention and control groups in vaginal delivery in 24 h, cesarean delivery, time to delivery, and Apgar score at 5 min less than 7. Foley catheter with simultaneous oxytocin did not increase the risk of side effects, included chorioamnionitis, postpartum hemorrhage, uterine hyperstimulation, and neonatal intensive care unit admission. Conclusion: The results seem to support the use of oxytocin to a Foley catheter at the initiation of labor induction, as it might lead to increases the rate of delivery within 24 h in nulliparas.


Assuntos
Trabalho de Parto Induzido , Ocitocina/administração & dosagem , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Cateterismo Urinário/métodos , Adulto , Esquema de Medicação , Feminino , Idade Gestacional , Humanos , Trabalho de Parto Induzido/efeitos adversos , Trabalho de Parto Induzido/métodos , Trabalho de Parto Induzido/estatística & dados numéricos , Idade Materna , Ocitocina/efeitos adversos , Gravidez , Cateterismo Urinário/efeitos adversos , Cateterismo Urinário/estatística & dados numéricos
14.
Int Urogynecol J ; 30(2): 301-305, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29600405

RESUMO

INTRODUCTION AND HYPOTHESIS: The objective was to compare postoperative urinary retention using the Babcock and Kelly clamps for retropubic midurethral sling (RPS) tensioning. METHODS: This was a retrospective cohort of isolated RPS procedures from December 2010 through April 2016 by five fellowship-trained surgeons at two institutions. Slings were tensioned with a Babcock clamp by grasping a 3-mm midline fold of mesh (RPS-B) or a Kelly clamp as a spacer between the sling and suburethral tissue (RPS-K). Assessment of urinary retention included the primary outcome of postoperative catheterization and several secondary outcomes, including discharge home with a catheter, within 1 year of surgery. Analysis of covariance was used to compute the mean difference in duration of catheterization and log-binomial regression was used to calculate risk ratios (RR) and 95% confidence intervals (CI). RESULTS: We included 240 patients. The RPS-B group had a lower body mass index and was more likely to be menopausal, have had pelvic organ prolapse surgery, and have a lower maximum urethral closure pressure than the RPS-K group. The mean duration of catheterization was similar, as demonstrated by the crude (0.21 days [-0.30-0.71]) and BMI-adjusted (0.07 days [-0.41-0.55]) mean difference in duration of catheterization. The incidence of postoperative OAB symptoms was comparable between the groups (BMI-adjusted RR: 0.95 (0.80-1.1)), and the incidence of revision did not differ (p = 0.7). CONCLUSIONS: The Babcock and Kelly clamp tensioning techniques appear comparable, with a low incidence of prolonged postoperative catheterization. Most catheters were removed on the day of the surgery. It is reasonable to tension retropubic midurethral slings with either method.


Assuntos
Complicações Pós-Operatórias/epidemiologia , Slings Suburetrais/efeitos adversos , Instrumentos Cirúrgicos/efeitos adversos , Cateterismo Urinário/estatística & dados numéricos , Transtornos Urinários/epidemiologia , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Razão de Chances , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Período Pós-Operatório , Análise de Regressão , Estudos Retrospectivos , Resultado do Tratamento , Transtornos Urinários/etiologia , Transtornos Urinários/terapia
15.
J Perianesth Nurs ; 34(2): 394-402, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30337198

RESUMO

PURPOSE: Few strategies exist regarding decreasing catheter-associated urinary tract infections (CAUTIs) in the outpatient urologic oncology population discharged with an indwelling urinary catheter (IUC). DESIGN: A quality improvement methodology using a premeasurement-postmeasurement structure was used to study the impact of process interventions on reducing CAUTIs. METHODS: Creation of IUC outpatient materials, an "IUC Removal Form," and bundling IUC supplies were translated to an outpatient and perioperative setting to reduce CAUTIs. FINDINGS: The CAUTI rate in urologic surgical patients requiring an IUC at discharge decreased from 12.5% to 8%. Preoperative IUC education increased from 0% to 100%. The average number of days the IUC was present was unchanged. The average postanesthesia care unit length of stay decreased from 1.98 to 1.32 hours, saving the organization $11,880.00. IUC removal appointments at discharge increased from 4% to 33% (P = .0146). CONCLUSIONS: Implementation of consistent patient education and improved process for IUC removal reduced CAUTIs in this population.


Assuntos
Infecções Relacionadas a Cateter/prevenção & controle , Educação de Pacientes como Assunto/métodos , Infecções Urinárias/prevenção & controle , Neoplasias Urológicas/cirurgia , Idoso , Infecções Relacionadas a Cateter/epidemiologia , Cateteres de Demora/efeitos adversos , Remoção de Dispositivo/estatística & dados numéricos , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Cuidados Pré-Operatórios/métodos , Melhoria de Qualidade , Cateterismo Urinário/estatística & dados numéricos , Cateteres Urinários , Infecções Urinárias/epidemiologia
16.
Prog Urol ; 29(1): 36-44, 2019 Jan.
Artigo em Francês | MEDLINE | ID: mdl-30344105

RESUMO

INTRODUCTION AND OBJECTIVES: The periurethral adjustable balloons (PUAB) Pro-ACT™ are less invasive technique to treat non-severe forms of post-radical prostatectomy urinary incontinence (pRP-UI), like sub-urethral trans-obturator male sling. Few data of efficiency are available for their use in second line treatment after male sling failure. OBJECTIVE: To evaluate the efficiency of PUAB Pro-ACT™ (Uromedica, Inc., MN, USA) in the second line treatment for non-severe pRP-UI after male sling failure. MATERIALS AND METHODS: Single center retrospective study of patients treated with male sling (17 Advance™, 1 TOMS™) between 2009 and 2015. The continence results were evaluated by the number of pad per day and the quality of life assessment by the I-QOL questionnaire. The "cure" was defined as no pad and "improved" as decreased more than 50 % of pads use. RESULTS: Eighteen patients were included with median follow-up of 21.5 [14-44] months. Two patients (11.1 %) had a past history of pelvic radiotherapy. The median pads per day used was 2 [1-3] after male sling insertion and before Pro-ACT™ device insertion. After Pro-ACT™ device insertion, the median pads per day used was 0 [0-1], with 77.7 % of patients cured and 22.2 % improved. The median quality of life score I-QOL, was 52.2 [23.3-62.6] and 83 [31.8-97.7], respectively before and after Pro-ACT™ device insertion (P<0.001). Nine (60 %) patients rated their incontinence severity as mild, four (26.6 %) as middle and two (13.3 %) as severe, after balloon insertion. The median volume of adjustment was 3 [2-6] mL. CONCLUSIONS: The PUAB Pro-ACT™ have a significant efficiency for use after male sling failure and can be used in second line therapy. LEVEL OF EVIDENCE: 3.


Assuntos
Falha de Equipamento/estatística & dados numéricos , Prostatectomia/efeitos adversos , Implantação de Prótese/estatística & dados numéricos , Slings Suburetrais/efeitos adversos , Incontinência Urinária por Estresse/etiologia , Incontinência Urinária por Estresse/terapia , Idoso , Idoso de 80 Anos ou mais , França/epidemiologia , Humanos , Masculino , Complicações Pós-Operatórias/cirurgia , Desenho de Prótese , Reoperação/instrumentação , Reoperação/métodos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Slings Suburetrais/estatística & dados numéricos , Resultado do Tratamento , Cateterismo Urinário/efeitos adversos , Cateterismo Urinário/instrumentação , Cateterismo Urinário/métodos , Cateterismo Urinário/estatística & dados numéricos
17.
J Matern Fetal Neonatal Med ; 32(20): 3470-3472, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29656689

RESUMO

Objective: We performed a retrospective case-control study of vaginal delivery at term without epidural anesthesia to identify clinical predictions of postpartum urinary retention (PUR). Methods: We reviewed the obstetric records of all singleton vaginal deliveries at Japanese Red Cross, Katsushika Maternity Hospital form January 2016 through December 2017. Results: There were 58 women (2.4%) complicated by PUR and 2391 women without PUR. A multivariate analysis revealed nulliparity, instrumental delivery, and episiotomy as independent risk factors for PUR (nulliparity: adjusted OR 2.39, 95%CI 1.2-4.8, p = 0.01; instrumental delivery: 3.53, 95%CI 1.9-6.7, p < .01, episiotomy: adjusted OR 1.96, 95%CI 1.0-3.8, p = .04). While, urination (or urethral catheterization) within 1 hour before delivery revealed as independent prevention factor for PUR (adjusted OR 0.54, 95%CI 0.30-0.99, p = .048). Conclusions: The risk factors identified in our institute seemed to approximately similar to those observed in the institutes capable of performing epidural anesthesia. In addition, urination just before delivery seemed to be an independent prevention factor for PUR.


Assuntos
Anestesia Obstétrica , Parto Obstétrico/efeitos adversos , Transtornos Puerperais/etiologia , Nascimento a Termo , Retenção Urinária/etiologia , Adulto , Anestesia Epidural , Anestesia Obstétrica/efeitos adversos , Anestesia Obstétrica/métodos , Estudos de Casos e Controles , Parto Obstétrico/métodos , Episiotomia/efeitos adversos , Episiotomia/estatística & dados numéricos , Feminino , Humanos , Japão/epidemiologia , Gravidez , Transtornos Puerperais/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Cateterismo Urinário/efeitos adversos , Cateterismo Urinário/estatística & dados numéricos , Retenção Urinária/epidemiologia , Vagina
18.
Am J Crit Care ; 27(5): 354-361, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30173167

RESUMO

BACKGROUND: Older adults account for more than half of all admissions to intensive care units; most remain alive at 1 year, but with long-term sequelae. OBJECTIVE: To explore geriatric-focused practices and associated outcomes in older intensive care survivors. METHODS: In a 1-year, retrospective, cohort study of patients admitted to the medical intensive care unit and subsequently transferred to the medicine service, adherence to geriatric-focused practices and associated clinical outcomes during intensive care were determined. RESULTS: A total of 179 patients (mean age, 80.5 years) met inclusion criteria. Nonadherence to geriatric-focused practices, including nothing by mouth (P = .004), exposure to benzodiazepines (P = .007), and use of restraints (P < .001), were associated with longer stay in the intensive care unit. Nothing by mouth (P = .002) and restraint use (P = .003) were significantly associated with longer hospital stays. Bladder catheters were associated with hospital-acquired pressure injuries (odds ratio, 8.9; 95% CI, 1.2-67.9) and discharge to rehabilitation (odds ratio, 8.9; 95% CI, 1.2-67.9). Nothing by mouth (odds ratio, 3.2; 95% CI, 1.2-8.0) and restraints (odds ratio, 2.8; 95% CI, 1.4-5.8) were also associated with an increase in 30-day readmission. Although 95% of the patients were assessed at least once by using the Confusion Assessment Method for the Intensive Care Unit (overall 2334 assessments documented), only 3.4% had an assessment that indicated delirium; 54.6% of these assessments were inaccurate. CONCLUSION: Although initiatives have increased awareness of the challenges, implementation of geriatric-focused practices in intensive care is inconsistent.


Assuntos
Medicina Baseada em Evidências , Fidelidade a Diretrizes , Unidades de Terapia Intensiva , Sobreviventes , Idoso de 80 Anos ou mais , Analgésicos Opioides/administração & dosagem , Benzodiazepinas/administração & dosagem , Cateteres de Demora/estatística & dados numéricos , Estudos de Coortes , Delírio/diagnóstico , Documentação/estatística & dados numéricos , Uso de Medicamentos/estatística & dados numéricos , Feminino , Avaliação Geriátrica , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Cidade de Nova Iorque , Readmissão do Paciente/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Psicotrópicos/administração & dosagem , Restrição Física/estatística & dados numéricos , Estudos Retrospectivos , Cateterismo Urinário/estatística & dados numéricos
19.
BMC Health Serv Res ; 18(1): 642, 2018 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-30115051

RESUMO

BACKGROUND: Urinary catheters are a common medical intervention, yet they can also be associated with harmful adverse events such as infection, urinary tract trauma, delirium and patient discomfort. The purpose of this study was to describe the use of the SafetyLEAP program to drive improvement efforts, and specifically to reduce the use of urinary catheters on general internal medicine wards. METHODS: A pre and post intervention study using the SafetyLEAP program was performed with urinary catheter prevalence as the primary outcome on two general internal medicine wards in a large academic health sciences center. RESULTS: A total of n = 534 patients (n = 283 from ward #1; and n = 252 from ward #2) were included in the initial audit and feedback portion of the study and 1601 patients (n = 824 pre-intervention and n = 777 post-intervention were included in the planned quality improvement portion of the study). A total of 379 patients during the quality improvement intervention had a urinary catheter. Overall, the adherence to the SafetyLEAP program was 97.4% on both general internal medicine wards. The daily catheter point prevalence decreased from 22 to 13%. After the implementation of the program, the urinary catheter utilization ratio (defined as urinary catheter days/patient days) declined from 0.14 to 0.12. Catheter-associated urinary tract infections (CAUTI) were unchanged. CONCLUSION: The SafetyLEAP program can help provide a systematic approach to the detection, and reduction of safety incidents. Future studies should aim at refining and implementing this intervention broadly.


Assuntos
Centros Médicos Acadêmicos , Medicina Interna , Quartos de Pacientes , Procedimentos Desnecessários/estatística & dados numéricos , Cateterismo Urinário/estatística & dados numéricos , Idoso , Canadá , Infecções Relacionadas a Cateter/epidemiologia , Infecção Hospitalar/epidemiologia , Feminino , Humanos , Masculino , Segurança do Paciente , Melhoria de Qualidade , Infecções Urinárias/terapia
20.
J Pediatr Surg ; 53(10): 2032-2035, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29983187

RESUMO

BACKGROUND: Patient-controlled analgesia (PCA) is often used in children with perforated appendicitis. To prevent urinary retention, some providers also routinely place Foley catheters. This study examines the necessity of this practice. METHODS: We retrospectively reviewed all children (≤18 years old) with perforated appendicitis and postoperative PCA from 7/2015 to 6/2016 at two academic children's hospitals. Urinary retention was defined as the inability to spontaneously void requiring straight catheterization or placement of a Foley catheter. RESULTS: Of 313 patients who underwent appendectomy for perforated appendicitis (Hospital 1: 175, Hospital 2: 138), 129 patients received an intraoperative Foley (Hospital 1: 22 [13%], Hospital 2: 107 [78%], p < 0.001). Age, gender, and BMI were similar between those with an intraoperative Foley and those without. There were no urinary tract infections in either group. Urinary retention rate in patients with an intraoperative Foley following removal on the inpatient unit (n = 3, 2%) and patients without an intraoperative Foley (n = 10, 5%) did not reach significance (p = 0.25). On univariate analysis, demographics, intraoperative findings, PCA specifics, postoperative abscess formation, and postoperative length of stay, were not significant risk factors for urinary retention. CONCLUSIONS: The risk of urinary retention in this population is low despite the use of PCA. Children with perforated appendicitis do not require routine Foley catheter placement to prevent urinary retention. LEVEL OF EVIDENCE: II.


Assuntos
Analgesia Controlada pelo Paciente , Apendicite , Complicações Pós-Operatórias/epidemiologia , Cateterismo Urinário/estatística & dados numéricos , Apendicectomia/efeitos adversos , Apendicite/epidemiologia , Apendicite/cirurgia , Criança , Feminino , Humanos , Masculino , Estudos Retrospectivos , Fatores de Risco , Retenção Urinária/prevenção & controle
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