Nurses’ advice regarding sterile or clean urinary drainage bags for individuals with a long-term Indwelling urinary catheter

PURPOSE: The purpose of this study was to identify, compare, and explore advice nurses give to community-dwelling long-term indwelling catheter users on the use of sterile or clean urinary drainage bags, and to obtain information that would inform the design of a larger-scale international survey.


SUBJECTS AND SETTINGS: A survey was targeted to nurse members of the International Continence Society (n = 130). Respondents (n = 28; 21.5%) included nurses from Australia, Canada, Belgium, Switzerland, the United Kingdom, and the United States, who specialized in managing incontinence.


METHODS: The project was conducted as a descriptive, exploratory pilot study. Respondents completed an online anonymous survey that was distributed by the International Continence Society. The survey instrument was designed by the investigators and comprised 14 questions with both fixed and open-ended response options.


RESULTS: Most respondents in this survey advised indwelling catheter users to reuse their catheter bags (n = 15; 68%). Factors that influenced advice included concerns about the cost of catheter bags, an evaluation of the individual's infection risk, local and national policies, evidence-based guidelines, users' living arrangements, and their ability to clean the bags. Advice on decontamination methods varied; however, the most commonly recommended cleaning agent was water and vinegar, followed by a sterilizing or bleach solution or dishwashing detergent.


CONCLUSION: Nurses play a key role in educating and supporting indwelling catheter users. Results of this study highlight variability in the advice nurses give to community-dwelling long-term indwelling catheter users about sterile or clean urinary drainage bags. This variability requires further investigation and affirms the need for a larger-scale study that draws on a broader sample of nurses.

Clinical evaluation of long-term users of two contact lens care preservative systems

Purpose: To clinically evaluate long-term users of two different contact lens care preservative systems and to investigate whether prolonged use is associated with an increase in the prevalence of dry eye.

Methods: Eighty-nine wearers of group IV hydrogel or silicone hydrogel lenses participated in this one-visit, investigator-masked study. Subjects were required to have consistently used a polyhexamethylene biguanide (PHMB) or polyquaternium-1 (PQT) based solution for 2 years. Consistent use was defined as 80% for the past 2 years and 100% for the past year. Clinical assessments included: average and comfortable wear time; overall and end-of-day comfort; signs of dryness, discomfort, burning or stinging, grittiness or scratchiness and visual changes; non-invasive and fluorescein break-up-time; pre-ocular tear film lipids, tear meniscus height, Schirmer and fluorescein clearance tests; limbal and bulbar hyperemia; palpebral roughness; corneal and conjunctival staining; lens front surface wetting; and lens film deposits.

Results: Significantly more grittiness or scratchiness was reported by subjects using a PHMB-containing system (67% vs. 44%; P = 0.02). Palpebral roughness and hyperemia were significantly greater in the PHMB group wearing group IV lenses (P = 0.01 and P = 0.05, respectively). Corneal staining was significantly higher in the PHMB users in all four peripheral sectors (P < 0.01). Nasal and temporal conjunctival staining was also significantly higher for users of PHMB-containing systems (P < 0.05). Front surface lens wettability was significantly better for group IV PQT users compared to PHMB users (P = 0.008), with 84% vs. 72%, respectively, with lenses graded by the investigator as having good or excellent wettability. Significantly higher levels of lens front surface film deposits were noted with PHMB users (P = 0.007), with 58% of group IV lenses treated with PHMB compared with 38% of group IV lenses treated with PQT showing some lens front surface film deposition. No significant differences between the two preservative system groups were noted for the range of dry eye evaluations nor the remaining clinical assessments.

Conclusions: Differences in both ocular and lens characteristic were observed between long-term users of two preservative systems used in many contact lens multi-purpose solutions. The findings from this study did not support the hypothesis that prolonged use of PHMB-containing solutions leads to dry eye. Additional studies including a larger sample size and perhaps longer use of the systems could help to further elucidate differences in clinical performance between systems.

1H-NMR and mass spectrometric characterization of the metabolic response of juvenile Atlantic salmon (Salmo salar) to long-term handling stress

Stressors of various kinds constantly affect fish both in the wild and in culture, examples being acute water temperature and quality changes, predation, handling, and confinement. Known physiological responses of fish to stress such as increases in plasma cortisol and glucose levels, are considered to be adaptive, allowing the animal to cope in the short term. Prolonged exposure to stressors however, has the potential to affect growth, immune function, and survival. Nonetheless, little is known about the mechanisms underlying the long-term stress response. We have investigated the metabolic response of juvenile Atlantic salmon (Salmo salar) to long-term handling stress by analyzing fish plasma via ¹H nuclear magnetic resonance spectroscopy and ultra high performance liquid chromatography–mass spectrometry (UPLC–MS), and comparing results with controls. Analysis of NMR data indicated a difference in the metabolic profiles of control and stressed fish after 1 week of stress with a maximum difference observed after 2 weeks. These differences were associated with stress-induced increases in phosphatidyl choline, lactate, carbohydrates, alanine, valine and trimethylamine-N-oxide, and decreases in low density lipoprotein, very low density lipoprotein, and lipid. UPLC-MS data showed differences at week 2, associated with another set of compounds, tentatively identified on the basis of their mass/charge. Overall the results provided a multi-faceted view of the response of fish to long-term handling stress, indicating that the metabolic disparity between the control and stress groups increased to week 2, but declined by weeks 3 and 4, and revealed several new molecular indicators of long-term stress.

Establishment and development of a seabird colony : long-term trends in phenology, breeding success, recruitment, breeding density and demography

Few studies document long-term colony-level metrics from colony establishment to maturity (equilibrium) and few test predictions of general models of colony development. We describe long-term trends in a colony of Australasian Gannets (Morus serrator) which has been monitored from an early stage in its development. The colony at Pope’s Eye, within Port Phillip Bay, Victoria, Australia was established in 1984 on an artificial structure and the first nest count (25 nests) was conducted in the same year. The colony was then studied for 15 of 19 years between 1988 and 2006–2007. During the study, 2,516 eggs were recorded, resulting in 1,694 chicks hatching (67 % of eggs), of which 1,310 (77 % of those hatched) fledged. At least 184 (14 %) of fledged offspring returned to Pope’s Eye as breeding adults. Since establishment, the number and density of nests increased (number of nests increased 8.8 % annually), with density increasing at varying rates in different areas of the colony. Early recruitment involved birds from a nearby colony, but within 5 years post establishment the first natal recruits were breeding at Pope’s Eye and thereafter natal recruitment was the main source of new breeding adults (totalling 81.4 % of all recruits). Age of recruitment varied throughout the study, though not systematically, and there was no difference between the sexes. The pattern of rapid initial growth is typical of patterns reported for other seabird colonies. However, as the colony (and birds within it) aged, there was no increase in breeding success and egg laying did not become earlier, as was expected from general models of colony development.

The ideal Ileal-Pouch design : a long-term randomized control trial of J- vs W-pouch construction

BACKGROUND: The IPAA has become established as the preferred technique for restoring intestinal continuity postproctocolectomy. The ideal pouch design has not been established. W-pouches may give better functional results owing to increased volume, whereas the J-pouch’s advantage is its straightforward construction. We report short- and long-term results of an randomized control trial designed to establish the ideal pouch.

DESIGN: Ninety-four patients were randomly assigned to J- and W-pouches (49:45) and assessed at 1 and 8.7 years postoperatively. Assessment was questionnaire based and designed to assess pouch function and patient quality of life.

RESULTS: Eighty-five percent of patients were followed up at 1 year, and 68% were followed up at 8.7 years. At 1 year, there was a significant difference in 24-hour bowel movement frequency J- vs W-pouches 7 vs 5(p < 0.001) and in daytime frequency J- vs W-pouches 6 vs 4 (p < 0.001), with no difference in nocturnal function. At 9-year follow-up, function had equilibrated between the 2 groups: 24-hour bowel movement frequency J- vs W-pouches 6.5 vs 6 (p = 0.36), daytime frequency 5.5 vs 5 (p = 0.233), and nocturnal function 1 vs 1 (p = 0.987). Mean operating time of J- and W-pouches was 195 and 215 minutes (p < 0.05). All other parameters, pad usage, urgency, incontinence, and quality of life, did not differ significantly between groups.

CONCLUSION: These data demonstrate that the theoretical functional advantage conferred on the W-pouch by its greater volume exists only in the short term and is of little consequence to patients’ long-term quality of life. This advantage is attenuated as the pouches mature, resulting in no disparity in pouch function. This, combined with the more consistent, efficient, and easily taught construction of the J-pouch, should conclusively establish it as the optimum ileal-pouch design.