The outcome of elderly patients following removal of indwelling urinary catheter

The objectives of this study were to examine the documented indications for the insertion of the indwelling urinary catheter in elderly patients before admission to Zammit Clapp Hospital, St. Julians and St Vincent de Paule Residence, Luqa and to study the outcome after attempting removal of the indwelling urinary catheter. 64 patients from Zammit Clapp Hospital and 61 patients from St. Vincent de Paule Residence were studied. In 34 patients (24%), no clear reason for catheterisation prior to admission could be identified. In 46 patients (32 %) catheterisation was performed for severe uncontrollable incontinence. In all, 66 patients had their indwelling urinary catheter removed at some stage. Of these a total of 49 patients were continent 15 days after the removal of the catheter, 33 patients were still continent after 3 months and 29 patients remained continent after one year. With regards’ to continence rate, a poorer outcome was noted in patients with a mental score of less than 5/10, when compared to patients with a mental score of more than 5/10. Continence rates were better in patients from Zammit Clapp Hospital than in patients from St. Vincent de Paule residence. In conclusion, attempts should be made to use long term indwelling urinary catheterisation only if other measures fail. This can be achieved by proper multi-disciplinary team assessment and education of the patient or his carers. Full support from social services and provision and advice about the use of continence aids is necessary.peer-reviewe

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

The Third Person of the Trinity: How the Holy Spirit Facilitates Man\u27s Walk with God

Much of the modern church knows the Father and the Son very well as part of its common worship, practice, and conversation. However, the Holy Spirit is given little more than recognition in many circles. He is referenced, talked about, and mentioned in songs and sermons, but there is often a resistance to letting Him lead the believer and the church. It is vital that the church opens its eyes to the indwelling, personal, and powerful Spirit which the Lord has sent to them. Through a study of the role of the Holy Spirit within the Scriptures, as well as a substantial consideration of the views of the Early Church Fathers, this paper seeks to kindle a renewed appreciation for, and a reliance upon the third person of the Trinity. The overarching theme revealed through this research is the marvelous reality that the God of the universe resides within the believer. The final section delves into this reality in search of the process that results in learning to truly walk with the Holy Spirit

Coil-Assisted Retrograde Transvenous Obliteration (CARTO) for the Treatment of Portal Hypertensive Variceal Bleeding: Preliminary Results.

ObjectivesTo describe the technical feasibility, safety, and clinical outcomes of coil-assisted retrograde transvenous obliteration (CARTO) in treating portal hypertensive non-esophageal variceal hemorrhage.MethodsFrom October 2012 to December 2013, 20 patients who received CARTO for the treatment of portal hypertensive non-esophageal variceal bleeding were retrospectively evaluated. All 20 patients had at least 6-month follow-up. All patients had detachable coils placed to occlude the efferent shunt and retrograde gelfoam embolization to achieve complete thrombosis/obliteration of varices. Technical success, clinical success, rebleeding, and complications were evaluated at follow-up.ResultsA 100% technical success rate (defined as achieving complete occlusion of efferent shunt with complete thrombosis/obliteration of bleeding varices and/or stopping variceal bleeding) was demonstrated in all 20 patients. Clinical success rate (defined as no variceal rebleeding) was 100%. Follow-up computed tomography after CARTO demonstrated decrease in size with complete thrombosis and disappearance of the varices in all 20 patients. Thirteen out of the 20 had endoscopic confirmation of resolution of varices. Minor post-CARTO complications, including worsening of esophageal varices (not bleeding) and worsening of ascites/hydrothorax, were noted in 5 patients (25%). One patient passed away at 24 days after the CARTO due to systemic and portal venous thrombosis and multi-organ failure. Otherwise, no major complication was noted. No variceal rebleeding was noted in all 20 patients during mean follow-up of 384±154 days.ConclusionsCARTO appears to be a technically feasible and safe alternative to traditional balloon-occluded retrograde transvenous obliteration or transjugular intrahepatic portosystemic shunt, with excellent clinical outcomes in treating portal hypertensive non-esophageal variceal bleeding

Omnipresence, Indwelling, and the Second-Personal

The claim that God is maximally present is characteristic of all three major monotheisms. In this paper, I explore this claim with regard to Christianity. First, God’s omnipresence is a matter of God’s relations to all space at all times at once, because omnipresence is an attribute of an eternal God. In addition, God is also present with and to a person. The assumption of a human nature ensures that God is never without the ability to be present with human persons in the way mind-reading enables; and, in the indwelling of the Holy Spirit, God is present in love

The Impact of a Nurse-Driven Foley Catheter Removal Protocol on Catheter Associated Urinary Tract Rates in Critical Care Areas

Background: Indwelling urinary catheters serve a purpose in critical care; however, they can also pose a risk for patients. With increased catheter use, there is an increased risk of developing a catheter associated urinary tract infection (CAUTI). CAUTIs lead to longer length of stay for patients, antibiotic treatment, and have a financial burden to the institution. The objective of this study was to determine if a nurse driven catheter removal protocol could reduce CAUTIs in critical care units. Methods: Retrospective review of CAUTI data from the National Healthcare Safety Network (NHSN) was observed three months prior to the protocol implementation and three months post implementation. Results: There were seven CAUTIs reported prior to the protocol implementation and five post implementation. There was also an increase noted in catheter days post implantation. There was a 29% reduction in CAUTI rate (p = 0.5736). Discussion: While the rate reduction from pre to post protocol implementation was not statistically significant, we propose that given the reduction in CAUTIs, it is clinically significant. Conclusion: Implementation of catheter removal protocols could be a useful tool in CAUTI reduction. Further research would be beneficial in determining the association between the tool and CAUTI rate reduction

Risk Factors for Nosocomial Infection in the Neonatal Intensive Care Unit by the Japanese Nosocomial Infection Surveillance (JANIS)

We evaluated the infection risks in the neonatal intensive care unit (NICU) using data of NICU infection surveillance data. The subjects were 871 NICU babies, consisting of 465 boys and 406 girls, who were cared for between June 2002 and January 2003 in 7 medical institutions that employed NICU infection surveillance. Infections were defined according to the National Nosocomial Infection Surveillance (NNIS) System. Of the 58 babies with nosocomial infections, 15 had methicillin-resistant Staphylococcus aureus (MRSA) infection. Multiple logistic regression analysis demonstrated that the odds ratio for nosocomial infections was significantly related to gender, birth weight and the insertion of a central venous catheter (CVC). When the birth weight group of more than 1, 500g was regarded as the reference, the odds ratio was 2.35 in the birth weight group of 1,000-1,499g and 8.82 in the birth weight group of less than 1,000g. The odds ratio of the CVC () for nosocomial infection was 2.27. However, other devices including artificial ventilation, umbilical artery catheter, umbilical venous catheter, and urinary catheter were not significant risk factors. The incidence of MRSA infection rapidly increased from 0.3% in the birth weight group of more than 1,500g to 2.1% in the birth weight group of 1,000-1,499g, and to 11.1% in the birth weight group of less than 1,000g. When the birth weight group of more than 1,500g was regarded as the reference, multiple logistic regression analysis demonstrated that the odds ratio was 7.25 in the birth weight group of 1,000-1,499g and 42.88 in the birth weight group of less than 1,000g. These odds ratios were significantly higher than that in the reference group. However, the application of devices did not cause any significant differences in the odds ratio for MRSA infection.</p