Globally, stroke is a leading cause of mortality and disability and there are substantial economic costs for post-stroke care. Barriers to the rehabilitation of stroke survivors with disabilities in low- and middle-income countries are many. There are enormous challenges in overcoming the barriers. The socioeconomic impacts of disabilities are high. Developing and delivering cost-effective rehabilitation services to stroke survivors with disabilities are daunting challenges to low- and middle-income countries. The barriers and unmet needs for rehabilitation treatments are high. These challenges are amplified by resource constraints like infrastructural facilities for rehabilitation management, and an inadequately trained healthcare workforce in low- and middle-income countries (LMICs). Multidisciplinary team care management led by physicians, therapists, rehabilitation nurses, and community health workers need to be strengthened. Threats to the outcomes of stroke care in resource-poor settings are the non-availability of cost-effective team care at the hospital and at the community level. Long-term medical and rehabilitation care needs organizational and financial support. The future challenge is to identify what elements of organized stroke care can be implemented to make the largest gain. Simple interventions such as swallowing assessments, bowel and bladder care, mobility assessments, and consistent secondary prevention can prove to be key elements to improving post-discharge morbidity and mortality. Recognition of the importance of stroke rehabilitation by WHO and global health leaders are new opportunities for LIMCs to fight back the stroke-related disabilities. Successful rehabilitation of stroke survivors with disabilities is a paramount challenge in LIMCs. But opportunities are coming up as there is increased awareness about stroke among general people. Task shifting of the rehabilitation health workforce to caregivers at the home or community level can help augment disability-adjusted life years. Proper Caregivers Training is coming out as a good prognostic indicator in stroke survivors in low resource settings. Structured training of caregivers is essentially needed at the low resource outset in developing countries and should be emphasized in stroke rehabilitation protocol. Universal health coverage should be extended to poor stroke survivors with disability. The burden of stroke will further increase until effective stroke prevention strategies are more widely implemented. The objective of this review article is to highlight the elements of health system behavior that affect barriers and opportunities in addressing stroke survivors with disabilities. J Enam Med Col 2022; 12(3): 148−154

<b>Objectives</b> There is a risk that early neurogenic bladder and bowel dysfunction following acute spinal cord injury (SCI) may not be adequately managed on the acute hospital wards. The aim of this paper was to review optimal assessment and management of patients with neurogenic bladder and/or bowel dysfunction during acute care immediately following SCI. A secondary aim was to translate these findings into an accessible policy for clinical staff involved in the care of acute SCI patients.<br><b>Methods</b> A literature review was performed to identify the protocols and research describing the management of bladder and bowel dysfunction after acute SCI. The measures extracted were principles of practice, threshold measures and evaluation tools, and timelines of best care. Key findings relating to assessment, management and identification of the benefits of adhering to a protocol of clinical practice were summarised. Fidelity with evidence identified was evaluated, and practice gaps were recognised.<br><b>Results</b> A total of 12 papers and six guidelines for providing excellent care to patients with SCI were identified. Overall, a systematic and comprehensive assessment of bladder and bowel function and neurological impairment should be completed early following SCI. Management is best individualised to both prevent known sequelae and optimise current function and quality of life. Acute SCI bladder and bowel management pathways were developed based on evidence identified.<br><b>Conclusions</b> The study has identified that timely assessment and management of patients with spinal cord neurogenic bladder and/or bowel dysfunction during the acute phase is pivotal to optimising continence and mitigating risk of preventable harm prior to discharge to specialised spinal rehabilitation.

<b>Objectives</b> There is a risk that early neurogenic bladder and bowel dysfunction following acute spinal cord injury (SCI) may not be adequately managed on the acute hospital wards. The aim of this paper was to review optimal assessment and management of patients with neurogenic bladder and/or bowel dysfunction during acute care immediately following SCI. A secondary aim was to translate these findings into an accessible policy for clinical staff involved in the care of acute SCI patients.<br><b>Methods</b> A literature review was performed to identify the protocols and research describing the management of bladder and bowel dysfunction after acute SCI. The measures extracted were principles of practice, threshold measures and evaluation tools, and timelines of best care. Key findings relating to assessment, management and identification of the benefits of adhering to a protocol of clinical practice were summarised. Fidelity with evidence identified was evaluated, and practice gaps were recognised.<br><b>Results</b> A total of 12 papers and six guidelines for providing excellent care to patients with SCI were identified. Overall, a systematic and comprehensive assessment of bladder and bowel function and neurological impairment should be completed early following SCI. Management is best individualised to both prevent known sequelae and optimise current function and quality of life. Acute SCI bladder and bowel management pathways were developed based on evidence identified.<br><b>Conclusions</b> The study has identified that timely assessment and management of patients with spinal cord neurogenic bladder and/or bowel dysfunction during the acute phase is pivotal to optimising continence and mitigating risk of preventable harm prior to discharge to specialised spinal rehabilitation.

The short physical performance battery is associated with activities of daily living impairment at discharge in older patients with acute heart failure.

Objective: To assess the compliance of medical staff with established protocols for the management of critically ill patients in the ICU, including the assessment of pain, pressure ulcer surveillance, bowel and bladder care, and implementation of feeding protocols, as well as to evaluate the documentation practices of the medical staff.Study Design: Clinical audit.

Total Laparoscopic Hysterectomy (TLH) is pivotal in gynecological surgeries, offering advantages like decreased blood losses, faster recovery, shorter operative time and reduced hospital stays. The Comprehensive Canopy Concept: ‘The 3 Step Technique’ emerges as a three-step strategy for streamlining TLH procedures in complex cases, characterized by extensive bladder adhesions and ventrifixed uterus. As fellows under the guidance of a distinguished gynaecology laparoscopic surgeon, we recount the evolution of this approach. The first step challenges conventional norms by advocating for a posterior approach to uterine artery, dissection and ligation before bladder dissection. The second step involves meticulous dissection to create a bloodless uterovesical space creating a bladder canopy. The culmination of this technique lies in the third step, employing an anterior approach to dissect and coagulate the contralateral uterine artery. As fellows, we share our experience in adopting the Comprehensive Canopy Concept: ‘The 3 Step Technique’ emphasizing its positive impact on surgical outcomes in densely adherent bladder and patient care in cases of complex TLH. This technique not only transcends traditional approaches but also addresses persistent challenges, offering a systematic approach that ensures safety and reproducibility

Introduction: Spinal cord injury (SCI) disrupts physical, psychological, and social well-being,impacting bladder and bowel functions. Effective management through education and routinecare is crucial for improving quality of life and reducing complications. Methodology: Thestudy aimed to assess the effectiveness of a bowel and bladder care program for caregivers ofspinal cord injury (SCI) patients, utilizing a one-group pre-test-post-test design. Conducted fromFebruary to March 2021 at National Institute for Locomotor Disabilities (Divyangjan), R.G. KarMedical College and Hospital, and S.S.K.M. Medical College and Hospital (IPGME&R) inKolkata, it involved 40 caregivers selected via non-probability convenience sampling. Objectivesincluded developing and validating the program, evaluating caregivers' knowledge and practicesbefore and after its implementation, and examining the program's impact by comparing pretestand posttest scores. Tools used were an interview schedule, structured knowledge questionnaire,andobservationchecklists,withthequestionnaire'sreliabilityconfirmedat0.84. Result:Initially, 70% of caregivers scored below the median on knowledge, but post-test results showeda dramatic shift, with 90% scoring above the median. The mean post-test knowledge scoreincreased from 7.7 to 15.3, with a statistically significant difference (t(39) = 18.22, p < 0.05).Similarly, practice scores improved markedly, with 95% scoring at or below the median pre-testand 87.5% scoring above the median post-test.The mean practice score rose from 15.07 to31.32, also with significant statistical support (t(39) = 15.61, p < 0.05). Conclusion: The resultsunderscore the effectiveness of the bowel and bladder care program in enhancing caregivers'knowledge and practices, particularly in bowel care, thereby affirming the program’s impact inimprovingthe careprovided to SCIpatients

BackgroundPostoperative urinary retention (POUR), a common condition after prolapse surgery with potential serious sequelae if left untreated, lacks a clearly established optimal timing for catheter removal. This study aimed to develop and validate a predictive model for postoperative urinary retention lasting > 2 and > 4 days after prolapse surgery.MethodsWe conducted a retrospective review of 1,122 patients undergoing prolapse surgery. The dataset was divided into training and testing cohorts. POUR was defined as the need for continuous intermittent catheterization resulting from a failed spontaneous voiding trial, with passing defined as two consecutive voids ≥ 150 mL and a postvoid residual urine volume ≤ 150 mL. We performed logistic regression and the predicted model was validated using both training and testing cohorts.ResultsAmong patients, 31% and 12% experienced POUR lasting > 2 and > 4 days, respectively. Multivariable logistic model identified 6 predictors. For predicting POUR, internal validation using cross-validation approach showed good performance, with accuracy lasting > 2 (area under the curve [AUC] 0.73) and > 4 days (AUC 0.75). Split validation using pre-separated dataset also showed good performance, with accuracy lasting > 2 (AUC 0.73) and > 4 days (AUC 0.74). Calibration curves demonstrated that the model accurately predicted POUR lasting > 2 and > 4 days (from 0 to 80%).ConclusionsThe proposed prediction model can assist clinicians in personalizing postoperative bladder care for patients undergoing prolapse surgery by providing accurate individual risk estimates.

Abstract Objectives: Bladder cancer (BC) stands as the 5th most prevalent cancer in the USA, with over 83,000 new cases diagnosed in 2023. The absence of non-invasive diagnostic tools for sensitive early BC detection and treatment response monitoring poses a significant challenge. This study evaluates the clinical potential of the Bladder CARE™ Assay for early BC detection and monitoring treatment response in BC patients. Methods: Under an institutional review board-approved protocol, voided urine samples were prospectively collected from USC patients with prior BC history under surveillance/anticancer treatment, prior genitourinary manipulation. Enrollment spanned February 2019 to September 2021. Samples underwent analysis using the Bladder CARE™ Assay, a DNA methylation test for quantitative BC and upper tract urothelial carcinoma (UTUC) detection from urine. Results were reported as Bladder CARE Index (BCI) and samples were categorized as “positive” (BCI > 5), “low-positive” (2.5 < BCI < 5), or “negative” (BCI < 2.5). Correlations between BCI value and categories, and clinicopathological findings were assessed. Results: A total of 110 previously diagnosed BC patients (median age: 74; 86% male) were enrolled in this study. Within 36 months post-TURBT, 24 patients (21.8%) showed evidence of recurrence. Bladder CARE™ Assay detected all recurrences, averagely 7.35 months earlier than cystoscopy. Of 55 patients (50%) undergoing anticancer therapies (45 BCG, 4 MMC, 2 GEM, 1 9UT, 1 GEM/DOCE, 1 MMC/BCG, and 1 BCG, MMC, and GEM), 7 (12.7%) recur (non-responders) and 11 (20%) did not show evidence of recurrence by 18 months post-TURBT (responders); 18-month post-operative data was unavailable for 37 patients (67.3%), which could not be classified in responders or non-responders. Bladder CARE™ detected 85.7% of non-responders, with BCI increasing prior to positive histology (avg. BCI: 86.1). In responders, BCI remained stable in negative/low-positive range post-TURBT (avg. BCI: 2.5). In addition, data from pre- and post-TURBT assessments were available for 20 of the 110 enrolled patients. The Bladder CARE™ Assay demonstrated a decrease in BCI post-TURBT in 19 of these 20 patients (95%). Conclusions: This prospective pilot study underscores the Bladder CARE™ Assay's capacity to pre-emptively detect BC months ahead of the gold standard. Furthermore, its quantitative nature offers prognostic insight, enabling non-invasive monitoring of patient response to anticancer treatments. A larger-scale study is the next step to validating these promising findings. Citation Format: Paolo Piatti, Sia Daneshmand, Sanam Ladi Seyedian, Saum Ghodossipour, Hamed Ahmadi, Suzanne Roberts, Alireza Ghoreifi, Michael Basin, Simin Hajian, Yap Ching Chew, Jeffrey Bhasin, Benjamin Jara, Lucy Sanossian, Hooman Djaladat, Anne Shuckman, Sumeet Bhavandia, Gangning Liang. DNA methylation biomarkers for early bladder cancer detection and treatment response monitoring [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 2 (Late-Breaking, Clinical Trial, and Invited Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(7_Suppl):Abstract nr LB327.

Implementation of an overactive bladder (OAB) care pathway may affect treatment patterns and progression. This study aimed to assess the effect of OAB care pathway implementation on treatment patterns for women with OAB. This retrospective cohort study evaluated women with OAB, before (January 1, 2015-December 31, 2017) and after (January 1, 2019-December 31, 2021) care pathway initiation. Care pathway use included standardized counseling, early introduction of therapy, and close follow-up. Primary outcomes included OAB medication use, follow-up visits, third-line therapy, and time to third-line therapy. A total of 1,349 women were included: 1,194 before care pathway implementation and 155 after. Patients after implementation were more likely to have diabetes mellitus (P = 0.04) and less likely to smoke (P = 0.01). Those managed via a care pathway were more likely to use any medication or third-line therapy within 1 year after consultation (61.3% vs 25.0%; P < 0.001). This included higher proportions receiving a medication (50.3% [95% confidence interval (CI), 41.8%-57.6%] vs 23.3% [95% CI, 20.9%-25.7%]; P < 0.001) and progressing to third-line therapy (22.6% [95% CI, 15.7%-28.9%] vs 2.9% [95% CI, 2%-3.9%]; P < 0.001). Among those who underwent third-line treatment, care pathway use was associated with shorter time to third-line therapy (median, 10 days [interquartile range, 1-56 days] vs 29 days [interquartile range, 7-191 days]; P = 0.013). Those managed via a care pathway were less likely to have additional clinic visits for OAB within 1 year after initial consultation (12.3% vs 23.9%; P < 0.001). Use of an OAB care pathway was associated with higher rates of oral medication and third-line therapy yet decreased follow-up office visits. Use of an OAB care pathway may promote consistent and efficient care for women with OAB.

Overactive bladder management includes multiple therapeutic options with comparable efficacy but a range of administration modalities and side effects, creating an ideal setting for shared decision-making. This study investigates patient and physician health beliefs surrounding decision-making and expectations for overactive bladder with the aim of better understanding and ultimately improving decision-making in overactive bladder care. Patient and physician participants completed a questionnaire followed by a semi-structured interview to assess health beliefs surrounding decision making and expectations for overactive bladder treatment. The semi-structured interview guide, developed in an iterative fashion by the authors, probed qualities of overactive bladder therapies patients and physicians valued, their process of treatment selection, and their experiences with therapies. Patients (n = 20) frequently cited treatment invasiveness, efficacy, and safety as the most important qualities that influenced their decision when selecting overactive bladder therapy. Physicians (n = 12) frequently cited safety/contraindications, convenience, cost/insurance, and patient preference as the most important qualities. In our integration analysis, we identified four key themes associated with decision making in overactive bladder care: frustration with inaccessibility of overactive bladder treatments, discordant perception of patient education, diverging acceptability of expected outcomes, and lack of insight into other parties' decisional priorities and control preferences. While both patients and physicians desire to engage in a shared decision-making process when selecting therapies for overactive bladder, this process is challenged by significant divergence between patient and physician viewpoint across key domains.

Racial disparities in oncological outcomes resulting from differences in social determinants of health (SDOH) and tumour biology are well described in prostate cancer (PCa) but similar inequities exist in bladder (BCa) and renal cancers (RCCs). Precision medicine (PM) aims to provide personalized treatment based on individual patient characteristics and has the potential to reduce these inequities in GU cancers. This article aims to review the current evidence outlining racial disparities in GU cancers and explore studies demonstrating improved oncological outcomes when PM is applied to racially diverse patient populations. Evidence was obtained from Pubmed and Web of Science using keywords prostate, bladder and renal cancer, racial disparity and precision medicine. Because limited studies were found, preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were not applied but rather related articles were studied to explore existing debates, identify the current status and speculate on future applications. Evidence suggests addressing SDOH for PCa can reverse racial inequities in oncological outcomes but differences in incidence remain. Similar disparities in BCa and RCC are seen, and it would be reasonable to suggest achieving parity in SDOH for all races would do the same. Research applying a PM approach to different ethnicities is lacking although in African Americans (AAs) with metastatic castrate-resistant prostate cancer (mCRPCa) better outcomes have been shown with androgen receptor inhibitors, radium-223 and sipuleucel. Exploiting the abscopal effect with targeted radiation therapy (RT) and immunotherapy has promise but requires further study, as does defining actionable mutations in specific patient groups to tailor treatments as appropriate. For all GU cancers, the historical underrepresentation of ethnic minorities in clinical trials still exists and there is an urgent need for recruitment strategies to address this. PM is a promising development with the potential to reduce inequities in GU cancers, however, both improved understanding of race-specific tumour biology, and enhanced recruitment of minority populations into clinical trials are required. Without this, the benefits of PM will be limited.

Self bladder emptying compared with Foley catheter placement for planned cesarean delivery: a randomized controlled trial

Specialist nurses could benefit from improved knowledge and understanding of the bladder and bowel symptoms experienced by people with multiple sclerosis. This article summarises a training day run by Coloplast Professional for nurses with the aim of increasing understanding and awareness of bladder and bowel issues in people with multiple sclerosis. The training day also aimed to raise the awareness of bladder and bowel issues in multiple sclerosis teams to improve patient outcomes.

Context/Objective Urinary tract infections (UTIs) are one of the most frequent secondary complications among people with spinal cord injury (SCI). The prevention and management of UTIs is prioritized by stakeholders across Canada. The purpose of this study was to gain an in-depth understanding of the urinary bladder (bladder) management experiences of people with SCI in Alberta communities, especially how UTIs are experienced and managed. Design Convergent mixed methods parallel databases variant. Setting Communities across Alberta, Canada. Participants 39 survey participants and 19 interview participants, all with SCI. Methods One-on-one phone semi-structured interviews analyzed using thematic analysis. Quantitative surveys included demographic, multichoice, and Likert Scale questions analyzed using descriptive analysis. Both methods explored people with SCI’s experiences with bladder management and UTIs. Qualitative and quantitative results were integrated through a comparison joint display table and meta-inferences. Outcome Measures Qualitative themes and descriptive statistics further integrated as mixed core-statements. Results Bladder routine is central to daily life and maintaining bladder health, avoiding UTIs, is the priority. Several health inequities are related to (1) financial barriers dictating how bladder is managed, (2) low perceived support for appropriate bladder management, (3) low healthcare access to appropriate UTI management and (4) low providers’ capacity to support bladder management and build trust with persons with SCI. Conclusion Action is required to address identified health inequities, including improvement of financial support, like appropriate catheter coverage, decrease barriers to access appropriate care and improvement of providers’ capacity to address SCI bladder care.

A comparison of the motor effects and analgesic efficacy following lumbar plexus block combined with sciatic nerve block or epidural in dogs undergoing tibial plateau leveling osteotomy

When discussing continence care in an acute hospital setting, it can be viewed as a negative subject that is a thinly veiled jab at overstretched nurses. This article takes a fresh and holistic look at continence care, identifying factors that could be causing poor care and how technology could support a change in care. This article includes suggestions on how the data collected could be used to deliver the person-centred care outcomes that may be lacking in some environments, something that one of the authors (DP) has experienced first hand. This article describes the results of a recent trial at Ysbyty Cwm Cynon (Canon Valley Hospital), NHS Wales, which looked at how continence care technology could support positive care outcomes.

The use of highly effective multiple sclerosis (MS) disease-modifying therapies (DMTs) is rapidly increasing. Yet, little is known about their real-world risks of infections. The goals of this study were to assess the comparative risk of outpatient and serious infections across DMTs in a large, diverse, U.S. cohort and determine whether such risks are attributable to DMTs, having MS, or other factors. We conducted a retrospective cohort study of Kaiser Permanente Southern California members from 2008 through 2020 with MS and non-MS controls matched on age, sex, race, and ethnicity. MS treatments, serious (those requiring hospitalization) and outpatient infections, and covariates were collected from the electronic health record. Adjusted hazard ratios (aHR) and risk ratios (aRR) were estimated using the Cox and Poisson regression, respectively. Six thousand, six hundred and twenty-six patients with MS with 11,929 treatment episodes (2,487 rituximab, 546 natalizumab, 298 fingolimod, 4,629 interferon-beta/glatiramer acetate, IFN/GLAT, and 3,969 untreated) and 33,550 population controls were included in the analyses. The average age at treatment start ranged from 38.9 to 49.2 years, and 74% were women. Untreated (aRR = 1.39, [95% CI = 1.35-1.44]) and IFN/GLAT-treated patients with MS (aRR = 1.60, [95% CI = 1.56-1.65]) had a higher risk of outpatient infections and serious infections (aHR = 2.97, [95% CI = 2.65-3.32 and aHR = 2.31, [95% CI = 2.04-2.62], respectively) compared with controls. Rituximab (aRR = 1.19, [95% CI = 1.14-1.25]), fingolimod (aRR = 1.22, [95% CI = 1.09-1.37]), and to a lesser extent, natalizumab treatment (aRR = 1.08, [95% CI = 0.97-1.20]) were associated with an increased risk of outpatient infections compared with IFN/GLAT. Rituximab (aHR = 1.41, [95% CI = 1.09-1.84]) and natalizumab (aHR = 1.40, [95% CI = 0.96-2.04]) treatment were associated with a similar increased risk of serious infections compared with IFN/GLAT. The only treatment-specific association identified was fingolimod with outpatient herpetic infections. Higher comorbidity index, previous hospitalization for infections, and advanced disability significantly increased the risk of serious infections independent of DMTs. Hospitalization for UTI-related pseudorelapses accounted for 24%-48% of serious infections. Patients with MS have higher risks of outpatient and serious infections compared with patients without MS. The risk of outpatient infections was similarly increased by rituximab and fingolimod and serious infections by rituximab and natalizumab compared with IFN/GLAT. Steps to minimize risks include optimizing bladder care, comorbidity prevention, varicella vaccination, and considering discontinuing or avoiding DMT use in patients with advanced disability and/or previous hospitalizations for infections.

Bowel dysfunction remains a prominent priority in the rehabilitation of patients with spinal cord injuries (SCIs). However, our understanding of the factors that influence bowel-related quality of life (QoL) in this population remains limited. This study aimed to investigate the potential role of resilience, defined as an individual's capacity to cope with and adapt to adversity, as a predictor of bowel-related QoL among the patients with SCI. A cohort of adult patients with SCI who received bowel and bladder care at an outpatient clinic within a large rehabilitation hospital was identified through a prospectively collected database. Resilience was measured using the Spinal Cord Injury-Quality of Life (SCI-QOL) Resilience Short Form, whereas bowel QoL was assessed using the Irritable Bowel Syndrome-Quality of Life (IBS-QoL) questionnaire. Univariate and multivariate regression analyses were employed to identify predictors of bowel-related QoL. The examined variables included age, gender, level and completeness of injury, time since injury, hand function, resilience, and the severity of bowel dysfunction as measured using the Neurogenic Bowel Dysfunction Score (NBDS). A total of 73 patients participated in this study, with a mean age of 44.01 ± 13.43 years and comprising mostly men (n = 57, 78%). The results revealed a significant correlation between resilience scores and the total score of IBS-QoL (ρ = -0.47, p < 0.0001). The multivariate analysis demonstrated that both resilience and the severity of bowel dysfunction were significant independent predictors of bowel-related QoL, with resilience demonstrating a stronger association. Overall, this study elucidates the importance of resilience in shaping patients' perceptions of their bowel health within the SCI population. In addition to the more expected determinants of bowel-related QoL, such as the severity of bowel dysfunction, resilience emerged as a notable factor. Accordingly, integrating interventions that enhance resilience within bowel rehabilitation programs may yield improvements in patients' perceived bowel health beyond the benefits achievable through bowel function enhancement alone.

The formation of public policy relies on decisions made by the political leadership within a government. However, these decisions are usually shaped by a multitude of other factors and different stakeholders, including civil servants, professionals and citizens. Nonetheless, how is policy made and how is this translated into action? Sue Thomas highlights how a parliamentary debate in Wales is set to influence policy making in the Wales principality for the management of incontinence.