BACKGROUND: Malignant and paramalignant pleural effusions are important complications of many malignancies. The two main management options debated in the literature are: 1) insertion of an indwelling pleural catheter (IPC) to achieve chronic drainage of the effusion, or 2) hospitalization with tube thoracostomy and subsequent chemical pleurodesis (CP) with talc or doxycycline to prevent fluid reaccumulation. We aimed to describe a large series of patients with malignant pleural effusions managed with an IPC, identify and validate factors identified in the literature as predictors of spontaneous pleurodesis in the IPC group and compare the group managed with IPC to patients managed with CP. METHODS: We designed a retrospective cohort study comparing patients with malignant and paramalignant pleural effusions managed either with CP between March 1, 2003 and February 28, 2006 or IPC insertion between May 1, 2006 and April 1, 2009. The CP group was identified through the prescription of talc or doxycycline and the IPC group from the IPC clinic database. Data were collected from paper and electronic records and from the Government of Ontario. RESULTS: We identified 193 consecutive patients with an ECOG performance status of less than 4 (ECOG less than 4 means that the patient is not completely disabled and confined to bed or chair) having undergone IPC insertion and 168 who were managed with CP. None of the variables we tested were significant predictors of spontaneous pleurodesis in the IPC group. Pleural effusion control rates at 6 months were higher in the IPC group than in the CP group (52.7% vs 34.0%, p<0.01) but the rate of freedom from pleural effusion at 180 days and catheter removal at 90 days was not significantly different (25.8% in the IPC group and 34.0% in the CP group p=0.14). Patients in the IPC group had a significantly longer median survival (148 days measured from the date of catheter insertion vs 133 days in the CP group, log-rank p<0.05). CONCLUSION: We found an intriguing possible survival benefit favouring management of malignant or paramalignant effusions with an IPC. Given possible biases due to the design of this study and uncertain explanatory mechanism, this needs to be confirmed in a randomized controlled trial. Quality of life, an important measure of success for these palliative procedures, should also be measured.

No description available.

Bakgrund Behandling med kvarliggande urinkateter är en vanlig behandlingsmetod inom hälso- och sjukvården som kan vara indicerat vid olika former av blåsdysfunktion. Egenvård är ett sätt för patienten att kunna bibehålla en vardag och förebygga komplikationer. Bristfällig kunskap och stöd från hälso- och sjukvårdspersonal är dock förekommande och påverkar patienternas upplevelser av behandlingen. Att sjuksköterskor besitter rätt kompetens är därför viktigt för korrekt omhändertagande av patienter under behandling med kvarliggande urinkateter. Syfte Syftet var att beskriva vuxna patienters upplevelser vid behandling med kvarliggande urinkateter. Metod Denna icke-systematiska litteraturöversikt bestod av 16 vetenskapliga originalartiklar, av både kvalitativ och kvantitativ metodansats, som hittades via systematiska databassökningar i PubMed och CINAHL samt manuella sökningar. Valda artiklar kvalitetsgranskades i fulltext enligt Sophiahemmet Högskolas bedömningsunderlag och en integrerad dataanalys gjordes för att analysera och sammanställa resultatet med hjälp av två huvudkategorier och sju underkategorier som identifierades under studien. Resultat Utifrån den integrerade dataanalysen identifierades två huvudkategorier; att leva med kvarliggande urinkateter och vårdrelationens betydelse. För att ingående kunna beskriva patienters upplevelse av behandling med kvarliggande urinkateter identifierades sju underkategorier; anpassning till behandlingen, underlättande aspekter, upplevda begräsningar i dagligt liv, sexualitet, kroppsuppfattning och självbild, upplevda komplikationer, agerande från hälso- och sjukvårdspersonal samt behov av individuellt anpassad information och utbildning. Slutsats Studien identifierade positiva och negativa upplevelser hos patienter med kvarliggande urinkateter samt samband mellan upplevelser och behandlingslängd. Vikten av välfungerande egenvård och personcentrerad omvårdad samt förståelse och kunskap hos hälso- och sjukvårdspersonal identifierades som avgörande aspekter i studien. Studiens resultat kan bidra till förbättrad kunskap och förståelse hos sjukvårdspersonal för att förbättra patientupplevelserna kring behandling med kvarliggande urinkateter. / Background Treatment with indwelling urinary catheter is a commonly used treatment method in health care that may be indicated for bladder dysfunction. Self-care is a way for patients to be able to maintain everyday life and prevent complications. However, inadequate knowledge and support from health care professionals is common and affects patients’ experiences. Proper skills from the nurses are important to enable correct care of patients with an indwelling urinary catheter. Aim The aim was to describe the experiences of adult patients during treatment with indwelling urinary catheters. Method This non-systematic literature review consisted of 16 original scientific articles, of both qualitative and quantitative method, which was found through systematic database searches in PubMed and CINAHL as well as manual searches. The selected articles were quality-reviewed in full text according to Sophiahemmet University's framework and an integrated data analysis was done to analyze and compile the results by two main- and seven subcategories that were identified through this study. Results Based on the integrated data analysis, two main categories were identified: living with an indwelling urinary catheter and the importance of the health care relationship. In order to be able to thoroughly describe patients' experiences of treatment with indwelling urinary catheters seven subcategories were identified; adaptation to the treatment, facilitating aspects, perceived limitations in daily life, sexuality, body image and self-image, perceived complications, actions of healthcare professionals and the need for individually adapted information and education. Conclusions Patients’ experiences, both positive and negative, were identified as well as the relationship between experiences and the treatment’s duration. The importance of a well-functioning self-care as well as the understanding and knowledge of the health care professionals was identified. The result of this study can contribute to improve understanding and knowledge among healthcare professionals to improve patients’ experiences of treatment with indwelling urinary catheters.

No description available.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第23764号 / 医博第4810号 / 新制||医||1056(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 長尾 美紀, 教授 佐藤 俊哉, 教授 永井 洋士 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Bakgrund: Urinvägsinfektioner är en av de vanligaste vårdrelaterade infektionerna inom svensk sjukvård. Varje år drabbas 65 000 personer av en vårdrelaterad infektion, av dessa är 14 % urinvägsrelaterad. Detta medför onödigt lidande för patienten, men ger också upphov till förlängda vårdtider och ökade kostnader för hälso- och sjukvården. Syfte: Syftet var att beskriva hur sjuksköterskan kan arbeta preventivt för att minska förekomsten av vårdrelaterade urinvägsinfektioner. Metod: Studiens design var en litteraturöversikt innehållande 15 vetenskapliga artiklar, varav 13 stycken var kvantitativa och två stycken var kvalitativa. Datainsamlingen har skett via sökningar i databaserna PubMed och Cinahl, valda artiklar granskades med granskningsmallar och sammanställdes sedan i resultatet. Resultat: Resultatet visade att ett förebyggande arbete kring rutiner vid kateterisering innebar minskade risker för att drabbas av urinvägsinfektioner. Utbildning och ökad medvetenhet kring hygien visade sig ha en positiv effekt både hos patienter och bland personal. Det påvisades även ett positivt samband med ett ökat vätskeintag samt kosttillskott i form av tranbärskapslar. Slutsats: För att minska vårdrelaterade urinvägsinfektioner krävs det att sjuksköterskan har en följsamhet i det förebyggande arbetet. Utbildning bland personal och patienter, större medvetenhet kring basala hygienrutiner och korrekt rutiner vid kateterisering har en stor betydelse i det preventiva arbetet. / Background: Urinary tract infection is one of the most common nosocomial infections in Swedish health care. Each year, 65 000 people suffer from a nosocomial infection, of which 14 % are urinary tract related. This problem causes unnecessary suffering for the patient, prolonged waiting times and increased costs for health care. Aim: The aim of this study was to describe how nurses could prevent nosocomial urinary tract infections. Methods: This was a literature review based on 15 articles. Of these, 13 studies had a quantitative approach and two studies had a qualitative approach. The data collection has been done by searching in the databases PubMed and Cinahl. Chosen articles were reviewed by using reviewing templates, analyzed and were compiled in the result. Results: The result showed that proactive work regarding routines when catheterize amounted to less risks for patients suffering from urinary tract infections. Education and increased awareness around hygiene turned out to have a positive effect on patients in decreasing urinary tract infections and on staff behavior. There was also a positive correlation between an increased fluid intake and cranberry capsules as a supplement. Conclusion: To reduce nosocomial urinary tract infections it is required that the nurse is involved in the proactive work. Education for staff and patients, greater awareness around basic hygiene routines and correct routines when catheterizing has a big impact on the proactive work.

Made available in DSpace on 2016-06-02T19:48:17Z (GMT). No. of bitstreams: 1 3504.pdf: 1063832 bytes, checksum: 03554173f6a31d037b2307cd0b5dc065 (MD5) Previous issue date: 2011-02-17 / Financiadora de Estudos e Projetos / Vesical catheterization is one of the most frequently performed invasive interventions in the hospital and its indications are of fundamental importance for the patients that need it. Their insertion, maintenance and withdrawal are under responsibility of nursing team. However, the use of an indwelling catheter can result in complications. In this context, nursing plays a critical role, since most of the complications are likely to be prevented through specific interventions. This study aimed to identify the evidences available in the literature on the risks of injury to the low urinary tract due the use of indwelling catheters and to examine how the risk of injury by the use of indwelling catheters can be approached through the Nursing Diagnosis of the North American Nursing Diagnosis Association - International (NANDA-I). From an integrative literature review, 32 studies were included, 22 were selected from PubMed, 4 in LILACS, 3 in The Cochrane Library and 3 in CINAHL. The predominant studies identified were case studies and actualizations. About the year of publication, 46.9% were published in the interval from 2000 to 2009. About the main investigator 62.5% were physicians ant it was noted a predominance of articles published in journals of urology. Complications identified were grouped into three categories: injuries, complications secondary to injuries and others. From this identification, the factors that contribute to the development of lesions were identified making it possible to perform a fundamental analysis for the identification of risk factors for low urinary tract injury due the use of indwelling catheters. The results revealed an absence in NANDA-I of a nursing diagnosis that portray the human response on the vulnerability of people undergoing the use of indwelling catheters, and it was suggested, based on Scroggins (2010), that a new nursing diagnosis, Risk of injury to the lower urinary tract can be considered to inclusion as a nursing diagnosis. It is expected that the recognition of risk factors relating to this type of injury can contribute to increase the effectiveness in the development of nursing care plans. / O cateterismo vesical de demora é uma das intervenções invasivas mais frequentemente realizadas no ambiente hospitalar e suas indicações são de fundamental importância para os clientes que necessitam desse dispositivo. Sua inserção, manutenção e retirada são de responsabilidade da enfermagem. No entanto, o uso de um cateter vesical de demora pode resultar em complicações. Nesse contexto, a Enfermagem assume papel fundamental, já que grande parte das complicações são passíveis de serem evitadas através de intervenções específicas. Este estudo teve como objetivos identificar as evidências disponíveis na literatura sobre os riscos de lesão no trato urinário inferior pelo uso do cateter vesical de demora e analisar de que forma a situação de risco de lesão pelo uso do cateter vesical de demora pode ser abordada entre os Diagnósticos de Enfermagem- DE da North American Nursing Diagnosis Association International (NANDA-I). . A partir de uma revisão integrativa da literatura, foram incluídos 32 estudos, sendo 22 selecionados na PubMed, 4 na LILACS, 3 na Biblioteca Cochrane e 3 na CINAHL. Em relação ao delineamento dos estudos, predominaram estudos de caso e atualizações. No que diz respeito ao ano de publicação, 46,9% foram publicados no intervalo de 2000 a 2009. Quanto ao pesquisador principal 62,5% eram profissionais da área médica, notando-se um predomínio de artigos publicados em revistas de urologia. As complicações identificadas foram agrupadas em 3 categorias: lesões, complicações secundárias a lesões e outras. A partir dessa identificação, os fatores contribuintes para o desenvolvimento das lesões também foram identificados, o que possibilitou uma análise fundamental para o levantamento de fatores de risco de lesão no trato urinário pelo uso do cateter vesical de demora. Diante dos resultados encontrados e da ausência, na classificação da NANDA-I, de um diagnóstico de enfermagem que retrate a resposta humana relativa à vulnerabilidade das pessoas que fazem uso do cateter vesical de demora, foi sugerida a inclusão de um novo diagnóstico de enfermagem levando-se em consideração as diretrizes apresentadas por Scroggins (2010), qual seja, Risco de lesão do trato urinário inferior. Espera-se que a partir do reconhecimento dos fatores de riscos relacionados a este tipo de lesão seja possível uma maior efetividade na elaboração de planos de cuidados de enfermagem.

Bakgrund: Det förekommer att personer är beroende av en kvarliggande urinkateter för att kunna miktera. Den urinuppsamlingspåsen som kopplas till urinkatetern kan se olika ut. En vanlig komplikation är kateterassocierad urinvägsinfektion vilket kan leda till döden. För att undvika komplikationer ska sjuksköterskan informera personerna om egenvård av urinkatetern.  Syfte: Syftet var att beskriva vuxna personers upplevelser av att leva med en kvarliggande urinrörskateter eller en suprapubiskateter i vardagen. Metod: Litteraturöversikten som genomfördes utgick från 12 artiklar med kvalitativ design där resultaten utgår från ett patientperspektiv. Data samlades in från 2 olika databaser. Fribergs analysmetod för kvalitativa artiklar användes.   Resultat: I resultatet framkom tre huvudteman; förändrad självbild, känslan av okunskap och känslor kopplade till komplikationer. Åtta subtema identifierades; acceptansen av urinkatetern och urinuppsamlingspåsen, påverkan på det sexuella samlivet, behovet av planering, osäkerheten till behovet av urinkatetern, behovet av information, oro för flödeshinder, oro för infektioner och smärta.  Slutsats: Urinkatetern kan upplevas som besvärlig eller som en lättsamhet beroende på om den orsakar problem om den löser problemen i vardagen. Urinuppsamlingspåsen upplevs som en begränsning i vardagen och mycket planering behövs när personen ska lämna hemmet. Det finns en känsla av okunskap då personen inte fått tillräckligt med information om urinkatetern. / Background: It occurs that some people are in need of an indwelling urinary catheter to micturate. The urine-collection bag that is connected to the urinary catheter has different appearances.  A common complication is a catheter associated urinary tract infection that can lead to death. The nurse should inform the person about self-care of the urinary catheter, to avoid complications.   Aim: The aim was to describe adult peoples’ experiences of living with an indwelling urinary catheter or a suprapubic catheter in the daily life.  Method: This literature review has its origin within 12 articles with a qualitative design where the results were written from the patients' perspective. Data was collected from two different databases. The method of Friberg was used to analyse the data.  Results: The results were based on three major themes; altered self-image, the feeling of ignorance and feelings related to complications. Eight sub themes were identified; acceptance of the urinary catheter and the urine-collection bag, impact on the sexual intercourse, the need of planning, the uncertainty of the needs for the urinary catheter, the need for information, worries for blockage, worries for infections and pain.  Conclusion: The urinary catheter can be experienced as difficulty or as a lightness depending on if it causes troubles or solves problems in the daily life. The urine collection bag experiences as a limitation in daily life and much planning is needed when the person should leave the home. A feeling of ignorance occurs when the person has not received enough information about the urinary catheter.

In the United States, many hospitalized patients with indwelling urinary catheters acquire catheter-associated urinary tract infections (CAUTI) during their hospital stay. CAUTI negatively affects peoples' health and quality of life and causes a financial burden to individuals and the nation. The purpose of this quantitative cross-sectional study was to explore the relationship between gender, age, and hospital types and CAUTI incidence in New York and North Carolina over a 3-year period. The theoretical framework of choice was the Donabedian model. Simple logistic regression and hierarchical multivariable logistic regression analysis were performed on archival data that was requested from Healthcare Cost and Utilization Project (HCUP) agency. According to the findings, males (n = 61,040) were at a higher risk of developing CAUTI compared to female (n = 66,792) (p < .001) in New York and North Carolina between 2012 and 2014. The odds of getting CAUTI were much higher among age > = 45 compared to the < 17 years. These findings fit in with previous literature identifying age and gender as having a significant relationship with CAUTI occurrence. The outcomes in this study may guide the formulation of policies that are age-appropriate, gender-specific, and facility-tailored to reduce the incidence of CAUTI.

Bakgrund: En kateterrelaterad urinvägsinfektion är en vanlig vårdrelaterad infektion som drabbar patienter i olika åldrar och medför lidande, förlängda vårdtider samt ökade vårdkostnader. Risken ökar med långvarig kateteranvändning, ålder och andra försämrade hälsotillstånd. Sjuksköterskor har en viktig roll i att förebygga och hantera kateterrelaterade urinvägsinfektioner genom evidensbaserad omvårdnad.  Syfte: Syftet med studien var att undersöka hur sjuksköterskan kan förebygga kateterrelaterad urinvägsinfektion. Metod: En allmän litteraturstudie av tidigare forskning gjordes genom granskning av fem kvalitativa, tolv kvantitativa och en mixad metod-studie. Resultat: Fem kategorier identifierades: arbetsplatsen och samarbetets påverkan, kunskapen hos sjuksköterskor, material och tillvägagångsätt vid kateterisering, sjuksköterskors arbetsrutiner med katetrar och förebyggande åtgärder vid kateteranvändning. Resultatet visade att kunskap bland vårdpersonal och patienter behöver öka samt att valet av kateter kan minska risken att få en kateterrelaterad urinvägsinfektion. Flera olika förebyggande åtgärder identifierades, som specifika riktlinjer för hur katetern ska skötas samt användning av checklistor och bedömningsverktyg för att minska felaktigt användande av kateter. Konklusion: För att förebygga kateterrelaterad urinvägsinfektion krävs förbättrad säkerhetskultur, samarbete, trivsel på arbetsplatsen, utbildning, material och evidensbaserade riktlinjer. / Background: A catheter-associated urinary tract infection is a common healthcare-associated infection that affects patients of different ages, causing suffering, prolonged hospital stays, and increased healthcare costs. The risk increases with prolonged catheter use, age, and other health conditions. Nurses play a crucial role in preventing and managing catheter-associated urinary tract infections through evidence-based care. Aim: The aim of the study was to investigate how the nurse can prevent catheter-associated urinary tract infection. Method: A general literature review of previous research, including five qualitative, twelve quantitative, and one mixed-method study, was conducted to compile current knowledge on preventive measures. Results: Five categories were identified: workplace and collaboration impact, nurses' knowledge, materials and approaches in catheterization, nurses' catheter care routines, and nurses' and patients' impact during catheter use. The results showed that knowledge among healthcare staff and patients’ needs to increase, and the choice of catheter can reduce the risk of catheter-associated urinary tract infections. Preventive measures such as specific guidelines for catheter care and the use of checklists and assessment tools to reduce improper catheter use. Conclusion:Preventing catheter-associated urinary tract infections requires improved safety culture, collaboration, workplace satisfaction, education, materials, and evidence-based guidelines.