Factors affecting continuation of clean intermittent catheterisation in people with multiple sclerosis: results of the COSMOS mixed-methods study

Background:  Clean intermittent catheterisation (CIC) is often recommended for people with multiple sclerosis (MS).  Objective:  To determine the variables that affect continuation or discontinuation of the use of CIC.  Methods:  A three-part mixed-method study (prospective longitudinal cohort (n = 56), longitudinal qualitative interviews (n = 20) and retrospective survey (n = 456)) was undertaken, which identified the variables that influenced CIC continuation/discontinuation. The potential explanatory variables investigated in each study were the individual’s age, gender, social circumstances, number of urinary tract infections, bladder symptoms, presence of co-morbidity, stage of multiple sclerosis and years since diagnosis, as well as CIC teaching method and intensity.  Results:  For some people with MS the prospect of undertaking CIC is difficult and may take a period of time to accept before beginning the process of using CIC. Ongoing support from clinicians, support at home and a perceived improvement in symptoms such as nocturia were positive predictors of continuation. In many cases, the development of a urinary tract infection during the early stages of CIC use had a significant detrimental impact on continuation.  Conclusion:  Procedures for reducing the incidence of urinary tract infection during the learning period (i.e. when being taught and becoming competent) should be considered, as well as the development of a tool to aid identification of a person’s readiness to try CIC

Systematic review of new medics’ clinical task experience by country

OBJECTIVES: There is a need for research which informs on the overall size and significance of clinical skills deficits among new medics, globally. There is also the need for a meta-review of the similarities and differences between countries in the clinical skills deficits of new medics. DESIGN: A systematic review of published literature produced 68 articles from Google/Scholar, of which 9 met the inclusion criteria (quantitative clinical skills data about new medical doctors). PARTICIPANTS: 1329 new medical doctors (e.g., foundation year-1s, interns, PGY1s). SETTING: Ten countries/regions. MAIN OUTCOME MEASURES: 123 data points and representation of a broad range of clinical procedures. RESULTS: The average rate of inexperience with a wide range of clinical procedures was 35.92% (lower CI 30.84%, upper CI 40.99%). The preliminary meta-analysis showed that the overall deficit in experience is significantly different from 0 in all countries. Focusing on a smaller selection of clinical skills such as catheterisation, IV cannulation, nasogastric tubing and venepuncture, the average rate of inexperience was 26.75% (lower CI 18.55%, upper CI 35.54%) and also significant. England presented the lowest average deficit (9.15%), followed by New Zealand (18.33%), then South Africa (19.53%), Egypt, Kuwait, Gulf Cooperation Council countries and Ireland (21.07%), after which was Nigeria (37.99%), then USA (38.5%), and Iran (44.75%). CONCLUSION: A meta-analysis is needed to include data not yet in the public domain from more countries. These results provide some support for the UK General Medical Council’s clear, detailed curriculum, which has been heralded by other countries as good practice

Restorative proctocolectomy with ileal pouch reservoir in ulcerative colitis : the first series from Malta

Seventy five to eighty percent of patients with ulcerative colitis are more or less satisfactorily treated medically. Surgery cures the disease, but because proper surgical therapy has until recently necessitated a permanent ileostomy, physicians and patients are understandably reluctant to agree to definitive surgical treatment until absolutely necessary.peer-reviewe

Continuous low-dose antibiotic prophylaxis to prevent urinary tract infection in adults who perform clean intermittent self-catheterisation: the AnTIC RCT

Peer reviewedPublisher PD

Endovascular management of massive post-partum haemorrhage in abnormal placental implantation deliveries

Objectives: To retrospectively evaluate safety and efficacy of pelvic artery embolisation (PAE) in post-partum haemorrhage (PPH) in abnormal placental implantation (API) deliveries. Methods: From January 2009 to November 2013, 12 patients with API and intractable intraoperative PPH underwent PAE after caesarean delivery to control a haemorrhage (in four of these cases after hysterectomy). Arterial access was obtained prior to the delivery; PAE was performed in the obstetrics operating room by an interventional radiologist that was present with an interventional radiology (IR) team during the delivery. Results: PAE was successful in preventing bleeding and avoid hysterectomy in four cases (group A). Uterine atony and disseminated intravascular coagulation caused failure of PAE requiring hysterectomy in four patients (group B). PAE prevented bleeding post-hysterectomy in the remaining four cases (group C). Technical success (cessation of contrast extravasation on angiography or occlusion of the selected artery) was 100 %. Maternal and foetal mortality and morbidity were 0 %. Conclusions: PAE is a minimal invasive technique that may help to prevent hysterectomy and control PPH in API pregnancies without complications. Embolisation should be performed on an emergency basis. For such cases, an IR team on standby in the obstetrics theatre may be useful to prevent hysterectomy, blood loss and limit morbidity. Key Points: • Endovascular treatment is a validated technique in post-partum haemorrhage. • Abnormal placental implantation is a risk factor for post-partum haemorrhage. • We propose an interventional radiologist standby in the delivery room. © 2015, European Society of Radiology

Policies for replacing long-term indwelling urinary catheters in adults

We would also like to thank the foll owing Cochrane Incontinence editorial base staff members for their help and support with this re-view: Cathryn Glazener, Sheila Wallace, Mandy Fader, Peter Her-bison and Suzanne Macdonald. The review authors are grateful to Toby Lasseron for his advice. The review authors are thankful to Dr Beverly Priefer for responding to our query about Priefer 1982. Policies for replacing long‐term indwelling urinary catheters in adults, Protocol, Fergus PM Cooper, Cameron Edwin Alexander, Sanjay Sinha, Muhammad Imran Omar; https://doi.org/10.1002/14651858.CD011115; 14 May 2014Peer reviewedPublisher PD

Feasibility and performance of a device for automatic self-detection of symptomatic acute coronary artery occlusion in outpatients with coronary artery disease : a multicentre observational study

Background Time delay between onset of symptoms and seeking medical attention is a major determinant of mortality and morbidity in patients with acute coronary artery occlusion. Response time might be reduced by reliable self-detection. We aimed to formally assess the proof-of-concept and accuracy of self-detection of acute coronary artery occlusion by patients during daily life situations and during the very early stages of acute coronary artery occlusion. Methods In this multicentre, observational study, we tested the operational feasibility, specificity, and sensitivity of our RELF method, a three-lead detection system with an automatic algorithm built into a mobile handheld device, for detection of acute coronary artery occlusion. Patients were recruited continuously by physician referrals from three Belgian hospitals until the desired sample size was achieved, had been discharged with planned elective percutaneous coronary intervention, and were able to use a smartphone; they were asked to perform random ambulatory selfrecordings for at least 1 week. A similar self-recording was made before percutaneous coronary intervention and at 60 s of balloon occlusion. Patients were clinically followed up until 1 month after discharge. We quantitatively assessed the operational feasibility with an automated dichotomous quality check of self-recordings. Performance was assessed by analysing the receiver operator characteristics of the ST difference vector magnitude. This trial is registered with ClinicalTrials.gov, number NCT02983396. Findings From Nov 18, 2016, to April 25, 2018, we enrolled 64 patients into the study, of whom 59 (92%) were eligible for self-applications. 58 (91%) of 64 (95% CI 81.0-95.6) patients were able to perform ambulatory self-recordings. Of all 5011 self-recordings, 4567 (91%) were automatically classified as successful within 1 min. In 65 balloon occlusions, 63 index tests at 60 s of occlusion in 55 patients were available. The mean specificity of daily life recordings was 0.96 (0.95-0.97). The mean false positive rate during daily life conditions was 4.19% (95% CI 3.29-5.10). The sensitivity for the target conditions was 0.87 (55 of 63; 95% CI 0.77-0.93) for acute coronary artery occlusion, 0.95 (54 of 57; 0.86-0.98) for acute coronary artery occlusion with electrocardiogram (ECG) changes, and 1.00 (35 of 35) for acute coronary artery occlusion with ECG changes and ST-segment elevation myocardial infarction criteria (STEMI). The index test was more sensitive to detect a 60 s balloon occlusion than the STEMI criteria on 12-lead ECG (87% vs 56%; p<0.0001). The proportion of total variation in study estimates due to heterogeneity between patients (I-2) was low (12.6%). The area under the receiver operator characteristics curve was 0.973 (95% CI 0.956-0.990) for acute coronary artery occlusion at different cutoff values of the magnitude of the ST difference vector. No patients died during the study. Interpretation Self-recording with our RELF device is feasible for most patients with coronary artery disease. The sensitivity and specificity for automatic detection of the earliest phase of acute coronary artery occlusion support the concept of our RELF device for patient empowerment to reduce delay and increase Survival without overloading emergency services. Copyright (C) 2019 The Author(s). Published by Elsevier Ltd