from the repository of Utrecht University: "OBJECTIVES: Antipsychotic drugs are frequently prescribed to elderly patients, but they are associated with serious adverse effects. The objective of the current study was to investigate the association between use of antipsychotics by elderly women and the risk of urinary tract infections (UTIs). COHORT STUDY SETTING: Dispensing data were obtained from the PHARMO Database Network for the period 1998-2008. PARTICIPANTS: Ambulatory Dutch women (≥65 years) with current and past use of antipsychotics. MEASUREMENTS: Incidence rates of UTIs, as defined by use of nitrofurantoin, was calculated within and outside the period of exposure to antipsychotic drugs. Cox proportional hazard regression analysis with Andersen-Gill extension for recurrent events was used to calculate crude and adjusted hazard ratios (HRs). RESULTS: During the study period, 18,541 women with a first prescription of an antipsychotic were identified. Current use of antipsychotics was associated with an increased risk of UTI compared to past use: HR, adjusted for age and history of UTIs, 1.33, 95% CI 1.27-1.39. A strong temporal relationship was found: the risk of being treated for a UTI was higher in the first week after the start of the treatment (adjusted HR 3.03, 95% CI 2.63-3.50) and decreased after 3 months (adjusted HR 1.22, 95% CI 1.17-1.28). Cumulative exposure was not associated with an increased risk of UTIs. There was no difference in effect between conventional and atypical antipsychotics. CONCLUSION: Our results show an increased risk of uncomplicated UTIs during antipsychotic use in older female patients, especially in the first week of treatment."
LINK
BACKGROUND: Urinary and (peripheral and central) intravenous catheters are widely used in hospitalized patients. However, up to 56% of the catheters do not have an appropriate indication and some serious complications with the use of these catheters can occur. The main objective of our quality improvement project is to reduce the use of catheters without an appropriate indication by 25-50%, and to evaluate the affecting factors of our de-implementation strategy.METHODS: In a multicenter, prospective interrupted time series analysis, several interventions to avoid inappropriate use of catheters will be conducted in seven hospitals in the Netherlands. Firstly, we will define a list of appropriate indications for urinary and (peripheral and central) intravenous catheters, which will restrict the use of catheters and urge catheter removal when the indication is no longer appropriate. Secondly, after the baseline measurements, the intervention will take place, which consists of a kick-off meeting, including a competitive feedback report of the baseline measurements, and education of healthcare workers and patients. Additional strategies based on the baseline data and local conditions are optional. The primary endpoint is the percentage of catheters with an inappropriate indication on the day of data collection before and after the de-implementation strategy. Secondary endpoints are catheter-related infections or other complications, catheter re-insertion rate, length of hospital (and ICU) stay and mortality. In addition, the cost-effectiveness of the de-implementation strategy will be calculated.DISCUSSION: This study aims to reduce the use of urinary and intravenous catheters with an inappropriate indication, and as a result reduce the catheter-related complications. If (cost-) effective it provides a tool for a nationwide approach to reduce catheter-related infections and other complications.TRIAL REGISTRATION: Dutch trial registry: NTR6015 . Registered 9 August 2016.
Objectives : To systematically review the literature regarding the reliability and validity of assessment methods available in primary care for bladder outlet obstruction or benign prostatic obstruction in men with lower urinary tract symptoms (LUTS). Design : Systematic review with best evidence synthesis. Setting : Primary care. Participants : Men with LUTS due to bladder outlet obstruction or benign prostatic obstruction. Review methods: PubMed, Ebsco/CINAHL and Embase databases were searched for studies on the validity and reliability of assessment methods for bladder outlet obstruction and benign prostatic obstruction in primary care. Methodological quality was assessed with the COSMIN checklist. Studies with poor methodology were excluded from the best evidence synthesis. Results : Of the 5644 studies identified, 61 were scored with the COSMIN checklist, 37 studies were included in the best evidence synthesis, 18 evaluated bladder outlet obstruction and 17 benign prostatic obstruction, 2 evaluated both. Overall, reliability was poorly evaluated. Transrectal and transabdominal ultrasound showed moderate to good validity to evaluate bladder outlet obstruction. Measured prostate volume with these ultrasound methods, to identify benign prostatic obstruction, showed moderate to good accuracy, supported by a moderate to high level of evidence. Uroflowmetry for bladder outlet obstruction showed poor to moderate diagnostic accuracy, depending on used cut-off values. Questionnaires were supported by high-quality evidence, although correlations and diagnostic accuracy were poor to moderate compared with criterion tests. Other methods were supported by low level evidence. Conclusion :Clinicians in primary care can incorporate transabdominal and transrectal ultrasound or uroflowmetry in the evaluation of men with LUTS but should not solely rely on these methods as the diagnostic accuracy is insufficient and reliability remains insufficiently researched. Low-to-moderate levels of evidence for most assessment methods were due to methodological shortcomings and inconsistency in the studies. This highlights the need for better study designs in this domain.
MULTIFILE
To optimize patient care, it is vital to prevent infections in healthcare facilities. In this respect, the increasing prevalence of antibiotic-resistant bacterial strains threatens public healthcare. Current gold standard techniques are based on classical microbiological assays that are time consuming and need complex expensive lab environments. This limits their use for high throughput bacterial screening to perform optimal hygiene control. The infection prevention workers in hospitals and elderly nursing homes underline the urgency of a point-of-care tool that is able to detect bacterial loads on-site in a fast, precise and reliable manner while remaining with the available budgets. The aim of this proposal titled SURFSCAN is to develop a novel point-of-care tool for bacterial load screening on various surfaces throughout the daily routine of professionals in healthcare facilities. Given the expertise of the consortium partners, the point-of-care tool will be based on a biomimetic sensor combining surface imprinted polymers (SIPs), that act as synthetic bacterial receptors, with a thermal read-out strategy for detection. The functionality and performance of this biomimetic sensor has been shown in lab conditions and published in peer reviewed journals. Within this proposal, key elements will be optimized to translate the proof of principle concept into a complete clinical prototype for on-site application. These elements are essential for final implementation of the device as a screening and assessment tool for scanning bacterial loads on surfaces by hospital professionals. The research project offers a unique collaboration among different end-users (hospitals and SMEs), and knowledge institutions (Zuyd University of Applied Sciences, Fontys University of Applied Sciences and Maastricht Science Programme, IDEE-Maastricht University), which guarantees transfer of fundamental knowledge to the market and end-user needs.
