Managing recurrent urinary catheter encrustation

Recurrent blockage of the urinary catheter is a common problem in around 40–50% of long-term catheterized patients, leading to problems which are distressing to patients and costly to health services in both time and resources. Blockage is frequently caused by the build-up of mineral deposits on the catheter surface following precipitation from the urine under alkaline conditions. The presence of urea-splitting bacteria in the urine promotes a strongly alkaline urine and their adhesion to the catheter as a biofilm makes them extremely difficult to remove. This article addresses strategies for early identification of potential ‘blockers’; proactive approaches to care; and the evidence for use of catheter maintenance solutions. </jats:p

The Critical Decision Vortex: Lessons From the Emergency Room

The dominant model of decision making, rational decision making, is increasingly challenged by research on intuitive decision making and emotion. This article contributes to the debate by articulating a model of how rational decision making, intuitive decision making, and emotion influence each other: the critical decision vortex. The critical decision vortex emerges from a discussion between an emergency room (ER) doctor and a management scholar. The experience of the doctor diagnosing and treating patients in the ER provides the background for a reflection on decision making in critical conditions. One of the main findings of this collaborative effort is that to be effective, ER doctors, like managers, need to remain centered in the critical decision vortex; they need to attend equally to their analytical conclusions, the intuitive hunches that come from their experience, and remain open and attentive to their emotions