Research Spotlight

Huddleston, P. (2020). “Measuring Unlicensed Assistive Personnel Perceptions of a Healthy Work Environment in Acute Care Settings, Part 4.” J Nurs Adm 50(10): 526-532.

Full text of this article.

BACKGROUND: Survey items on the Healthy Work Environment Scale (HWES) for Unlicensed Assistive Personnel (UAP) were developed using statements from a qualitative research study conducted in a large urban healthcare system. PURPOSE: The purposes of this research study were to develop items on the HWES for UAP, to assess the validity and reliability of this tool, and to describe the UAP perceptions of a healthy work environment (HWE) using a nonexperimental descriptive design. METHODS: This research study has 2 separate phases. In phase 1, the UAP assigned each item to 1 of the 8 characteristics of an HWE to assess face validity. The 2nd step in this phase was to have the 10 content experts rate each survey item based on its relevancy to measuring an HWE using a 4-point Likert scale ranging from “not relevant” to “very relevant” to determine content validity by calculating a scale content validity and item content validity indices. Based on the results, there were no items deleted from the survey. In phase 2, principal component analysis assessed the validity of the tool, a Cronbach’s α served as the test for reliability, and the UAP perceptions of an HWE were measured. RESULTS: Samples included 45 content experts for phase 1 and 406 for phase 2. Principal component analysis revealed 49 items comprising 6 components. Internal consistency was 0.976 for all items. Based on the findings, the HWES for UAP demonstrated strong psychometric properties to measure an HWE in acute care settings.

Ding, W., Chen, H., Xiang, Y., Liao, J., Qi, X., Wang, X. and Huang, J.H. (2020). “Revision Surgery Technique in the Treatment of Refractory Subcutaneous Cerebrospinal Fluid Collection Combined with Intracranial Infection Following Posterior Fossa Surgery.” Cureus 12(9): e10610.

Full text of this article.

Objective Cerebrospinal fluid (CSF) leakage remains the most common and serious complication following posterior fossa surgery. Persistent subcutaneous CSF collections can cause wound dehiscence and predispose patients to intracranial infection. Management with conservative treatment fails in up to 40% of patients, and revision surgery remains the last resort. We hereby introduce a novel surgical technique using muscle graft or pedicled trapezius muscle flaps to repair dura and skull base defect for the treatment of subcutaneous CSF collections refractory to conservative management. Methods A retrospective chart review was conducted for six patients who presented to our institution from 2012 to 2020, with subcutaneous CSF collections following posterior fossa surgeries and had undergone revision surgeries after unsuccessful management with conservative treatments. Patient demographics, etiologies, culture results, revision procedures, follow-ups, and recurrences of fluid collections were collected. Results Of these six patients, two underwent repair of dura and skull base defect with pedicled trapezius muscle flaps, and four had arachnoid fistula repaired with autologous muscle graft. All six patients fully recovered. CSF leakage and subcutaneous fluid collections were resolved. No recurrences occurred upon the last follow-ups. Conclusion A revision surgery using muscle graft or pedicled trapezius muscle flaps to repair the dura and skull base defect is effective at treating persistent cerebrospinal fluid leakage and subcutaneous fluid collection refractory to conservative treatment.

High, R., Zhang, Y., Virani, S., Eggleston, K., Kuehl, T.J., Bird, E.T. and Danford, J.M. (2020). “Pilot Trial of Midstream Urine Collection Device Versus Transurethral Catheter in Women With Lower Urinary Tract Symptoms: Practicality of Use in a Clinical Setting, Patient Preferences, and Comparison of Laboratory Findings.” Female Pelvic Med Reconstr Surg Sep 30. [Epub ahead of print.].

Full text of this article.

OBJECTIVES: This study aimed to evaluate successful use of a midstream urine collection device in women with lower urinary tract symptoms and to assess specimen contamination. METHODS: Nonpregnant women 18 years or older without use of antibiotics in the last 4 weeks were recruited. After using the midstream urine collection device to obtain a specimen in a private restroom, a paired specimen was obtained by transurethral catheterization. Patients completed preference questionnaires. Culture organisms and microscopic urinalysis of paired specimens (device vs catheterized) were compared using the McNemar χ test. Bivariate analysis was performed. RESULTS: Successful use was demonstrated in 54 (77%) of 70. Reasons for failure included inadequate specimen volume and improper device use. Older median age (50 vs 72 years, P = 0.0003) and history of diabetes (7% vs 27%, P = 0.037) were associated with failed use. Organisms were discordant in 21 (41%) of 51 paired urine culture specimens. The device detected 7 (88%) of 8 uropathogens. There were no detectable differences in microscopic urinalysis. CONCLUSIONS: The midstream urine collection device could increase comfort, and many patients prefer it to transurethral catheterization. With proper patient selection and instructions for use, this device could increase satisfaction. Further studies are needed to assess contamination rates with this device.

Lane, G.I., Smith, A.L., Stambakio, H., Lin, G., Al Hussein Alawamlh, O., Anger, J.T., Brandes, E.R., Carmel, M.E., Chung, D.E., Cox, L., DeLong, J., Elliott, C.S., Eltahawy, E., Aparecido França, W., Gousse, A., Gupta, P., Hagedorn, J.C., High, R.A., Khan, A., Kowalik, C., Lee, R.K., Lee, U.J., Lucioni, A., MacDonald, S., Malaeb, B., McKay, S., Padmanabhan, P., Powell, C.R., Sajadi, K.P., Sutherland, S.E., Theva, D., Vollstedt, A., Welk, B., Zheng, Y. and Cameron, A.P. (2020). “Treatment of urethral stricture disease in women: A multi-institutional collaborative project from the SUFU research network.” Neurourol Urodyn 39(8): 2433-2441.

Full text of this article.

AIM: Female urethral stricture disease is rare and has several surgical approaches including endoscopic dilations (ENDO), urethroplasty with local vaginal tissue flap (ULT) or urethroplasty with free graft (UFG). This study aims to describe the contemporary management of female urethral stricture disease and to evaluate the outcomes of these three surgical approaches. METHODS: This is a multi-institutional, retrospective cohort study evaluating operative treatment for female urethral stricture. Surgeries were grouped into three categories: ENDO, ULT, and UFG. Time from surgery to stricture recurrence by surgery type was analyzed using a Kaplan-Meier time to event analysis. To adjust for confounders, a Cox proportional hazard model was fit for time to stricture recurrence. RESULTS: Two-hundred and ten patients met the inclusion criteria across 23 sites. Overall, 64% (n = 115/180) of women remained recurrence free at median follow-up of 14.6 months (IQR, 3-37). In unadjusted analysis, recurrence-free rates differed between surgery categories with 68% ENDO, 77% UFG and 83% ULT patients being recurrence free at 12 months. In the Cox model, recurrence rates also differed between surgery categories; women undergoing ULT and UFG having had 66% and 49% less risk of recurrence, respectively, compared to those undergoing ENDO. When comparing ULT to UFG directly, there was no significant difference of recurrence. CONCLUSION: This retrospective multi-institutional study of female urethral stricture demonstrates that patients undergoing endoscopic management have a higher risk of recurrence compared to those undergoing either urethroplasty with local flap or free graft

High, R.A., Winkelman, W., Panza, J., Sanderson, D.J., Yuen, H., Halder, G.E., Shaver, C., Bird, E.T., Rogers, R.G. and Danford, J.M. (2020). “Sacral neuromodulation for symptomatic chronic urinary retention in females: do age and comorbidities make a difference?” Int Urogynecol J.

Full text of this article.

OBJECTIVES: To evaluate if age and medical comorbidities are associated with progression to implantation of sacral neuromodulation devices in women with symptomatic chronic urinary retention. METHODS: This multisite retrospective cohort included women with symptomatic chronic urinary retention who had a trial phase of sacral neuromodulation. The primary outcome was progression to implantation. Post-implantation outcomes were assessed as stable response versus decreased efficacy. A sub-analysis of catheter-reliant (intermittent-self catheterization or indwelling) patients was performed. Age was analyzed by 10-year units (decades of age). Multivariate logistic regression determined odds ratios for outcomes of implantation and for post-implantation stable response. RESULTS: Implantation occurred in 86% (243/284) women across six academic institutions. Most patients (160/243, 66%) were catheter reliant at the time of trial phase. Increased decade of age was associated with reduced implantation in all women [OR 0.54 (95% CI 0.42, 0.70)] and in the subgroup of catheter-reliant women [OR 0.52 (95% CI 0.37, 0.73)]. Post-implantation stable response occurred in 68% (193/243) of women at median follow-up of 2 years (range 0.3-15 years). Medical comorbidities present at the time of trials did not impact progression to implantation or post-implantation success. CONCLUSIONS: Increasing decade of age is associated with reduced implantation in women with symptomatic chronic urinary retention. There is no age cutoff at which outcomes change. Post-implantation stable response was not associated with age or medical comorbidities.