Role of antibiotics during change over from continuous bladder drainage to intermittent clean catheterization in patients with spinal cord injury

INTRODUCTION: Neurogenic bladder dysfunction is a great challenge in patients with traumatic or non-traumatic spinal cord injuries (SCI). The neurological level of injury and the completeness of the spinal cord lesion are the two main factors deciding the type of bladder dysfunction, with the bladder evacuation function varying between detrusor over-activity and no detrusor activity. Bladder dysfunction continues to affect the quality of life of individuals with SCI many years following the initial trauma. Neurogenic bladder can result in multiple complications including urinary tract infections, calculi, hydronephrosis and renal failure.Prior to the 1970s, renal disease was the leading cause of mortality in chronic SCI. In the mid-1970s, Lapides et al. reported on the effectiveness of intermittent clean catheterisation (ICC) in those with SCI to improve continence and allow storage at low pressures. Since the advent of these programs, the prevalence of renal disease has decreased dramatically. The survival rates in spinal cord injury patients have improved over the last few decades and a better enhanced urinary tract management has doubtlessly played a major role in this process. AIM OF THE STUDY: To test the hypothesis that the initiation of intermittent clean catheterization (ICC) under antibiotic cover is not superior to the initiation of ICC without antibiotic cover in long term catheterized spinal cord injury patients. MATERIALS AND METHODS: A total of 32 subjects with spinal cord injury participated in a randomized controlled trial of either antibiotic prophylaxis or no antibiotic medication during the initiation of intermittent clean catheterisation(ICC). Urine culture and sensitivity, routine urine examination, Urine dip stick test and Gram stain were used for analysing symptomatic urinary tract infections according to modified CDC criteria. All subjects were observed for symptomatic UTI for one week time. Chi-Square test and T test were used for the statistical analysis. RESULTS: Of the total 32 subjects, febrile urinary tract infection occurred in one case each in both antibiotic and non antibiotic groups during a period of one week. Nitrofurantoin (NFN) was used in 81% of the intervention group with NFN alone in 56%. Chi-Square test done showed no significant difference in the occurrence of symptomatic UTI between the 2 study groups (Fisher's Exact Test with exact Significance 1.00). CONCLUSION: There was no statistically significant difference in the incidence of symptomatic urinary tract infection in the antibiotic and non-antibiotic groups after the initiation of ICC. Hence the study suggests that it may not be necessary to use antibiotic cover during initiation of intermittent clean catheterisation in spinal cord injury patients. However the study was limited by a small sample size and short duration of follow up

Strategy in a Digital World

Organizations are increasingly adopting digital strategies and investing heavily in digital technologies and initiatives. However, to date, there does not appear to be a clear understanding of digital strategies and their purpose, which forms the motivation for this research. This research-in-progress study aims to address this research gap by exploring 1) the various conceptions of digital strategy, and 2) the way in which digital strategies differ from conventional strategies. We interviewed three senior executives and employed thematic analysis to analyse the interview data, which resulted in the construction of ten themes that were grouped under three theoretical constructs. We then explored the applicability of the six dimensions of strategy proposed by Hax (1990) in the digital context and proposed two additional dimensions. The contribution of this study is to provide a deeper understanding of digital strategy to support further academic research and provide guidance to practitioners

Spinning-Up the Envelope Before Entering a Common Envelope Phase

We calculate the orbital evolution of binary systems where the primary star is an evolved red giant branch (RGB) star, while the secondary star is a low-mass main sequence (MS) star or a brown dwarf. The evolution starts with a tidal interaction causes the secondary to spiral-in. Than either a common envelope (CE) is formed in a very short time, or alternatively the system reaches synchronization and the spiraling-in process substantially slows down. Some of the latter systems later enter a CE phase. We find that for a large range of system parameters, binary systems reach stable synchronized orbits before the onset of a CE phase. Such stable synchronized orbits allow the RGB star to lose mass prior to the onset of the CE phase. Even after the secondary enters the giant envelope, the rotational velocity is high enough to cause an enhanced mass-loss rate. Our results imply that it is crucial to include the pre-CE evolution when studying the outcome of the CE phase. We find that many more systems survive the CE phase than would be the case if these preceding spin-up and mass-loss phases had not been taken into account. Although we have made the calculations for RGB stars, the results have implications for other evolved stars that interact with close companions.Comment: New Astronomy, in pres

Nurses and challenges faced as clinical educators: a survey of a group of nurses in Cameroon

BACKGROUND: Clinical teaching is an important component of clinical education. In nursing, clinical teaching is ensured by clinical nurse educators (CNEs). This study aimed at describing the major challenges faced by CNEs in Cameroon. METHODS: In a qualitative study, supplemented with quantitative methods, CNEs were enrolled from three health districts to represent their frequency in Cameroon’s health delivery system. RESULTS: A total of 56 CNEs participated in the study, of whom, as many as 58.9% acknowledged always facing challenges in clinical teaching and supervision. The major challenges identified were the lack of opportunities to update knowledge and skills, students’ lack of preparedness and the CNEs not being prepared for clinical teaching. CNEs attributed these challenges in major part to the lack of incentives and poor health policies. CONCLUSION: CNEs in Cameroon do indeed face major challenges which are of diverse origins and could adversely affect teaching in clinical setting

Promising to Try

We maintain that in many contexts promising to try is expressive of responsibility as a promiser. This morally significant application of promising to try speaks in favor of the view that responsible promisers favor evidentialism about promises. Contra Berislav Marusˇic´, we contend that responsible promisers typically withdraw from promising to act and instead promise to try, in circumstances in which they recognize that there is a significant chance that they will not succeed

Development of antigen-specific ELISA for circulating autoantibodies to extracellular matrix protein 1 in lichen sclerosus

Lichen sclerosus is a common, acquired chronic inflammatory skin disease of unknown etiology, although circulating autoantibodies to the glycoprotein extracellular matrix protein 1 (ECM1) have been detected in most patients’ sera. We have examined the nature of ECM1 epitopes in lichen sclerosus sera, developed an ELISA system for serologic diagnosis, and assessed clinicopathological correlation between ELISA titer and disease. Epitope-mapping studies revealed that lichen sclerosus sera most frequently recognized the distal second tandem repeat domain and carboxyl-terminus of ECM1. We analyzed serum autoantibody reactivity against this immunodominant epitope in 413 individuals (95 subjects with lichen sclerosus, 161 normal control subjects, and 157 subjects with other autoimmune basement membrane or sclerosing diseases). The ELISA assay was highly sensitive; 76 of 95 lichen sclerosus patients (80.0%) exhibited IgG reactivity. It was also highly specific (93.7%) in discriminating between lichen sclerosus and other disease/control sera. Higher anti-ECM1 titers also correlated with more longstanding and refractory disease and cases complicated by squamous cell carcinoma. Furthermore, passive transfer of affinity-purified patient IgG reproduced some histologic and immunopathologic features of lichen sclerosus skin. This new ELISA is valuable for the accurate detection and quantification of anti-ECM1 autoantibodies. Moreover, the values may have clinical significance in patients with lichen sclerosus