OBJECTIVE\nTo evaluate the effect of listening to music on pain, anxiety, or stress during a urodynamic study (UDS).\n\n\nMATERIALS AND METHODS\nA total of 74 female and 74 male patients who underwent UDS between March 2013 and October 2013 were prospectively randomized. The patients were divided into 2 groups according to gender (female, n = 74 vs male, n = 74) and into 2 subgroups according to whether they listened to music or not. Music group subjects played their preferred music during UDS. Before and after UDS, all subjects completed the State-Trait Anxiety Inventory (STAI) form and their degree of pain, anxiety, and satisfaction during examination were assessed by the visual analog scale (VAS, 0-10). Basic vital signs were also checked before and after the procedure.\n\n\nRESULTS\nIn the analysis of anxiety, pain, and stress scores, the mean shame, discomfort, and satisfaction scores (VAS) were significantly higher in female patients, whereas the mean score of willingness to retry the procedure was higher in male patients whether listening to music or not (P < .001). In the analysis of differences of STAI total, state anxiety, and trait anxiety, there were no statistical significances between the music group and the no-music group in either gender.\n\n\nCONCLUSION\nIn our study, music during UDS did not reduce anxiety, pain, and stress in either gender. In the analysis focusing on gender difference, female patients showed statistically higher levels of pain, anxiety, and stress scores than male patients whether listening to music or not.

Can listening to music decrease pain, anxiety and stress during a urodynamic study? A randomized prospective trial focusing on gender differences

Excessive daytime sleepiness (EDS) is a major symptom of obstructive sleep apnoea (OSA), defined as the inability to stay awake during the day. Its clinical descriptors remain elusive, and the pathogenesis is complex, with disorders such as insufficient sleep and depression commonly associated. Subjective EDS can be evaluated using the Epworth Sleepiness Scale, in which the patient reports the probability of dozing in certain situations; however, its reliability has been challenged. Objective tests such as the multiple sleep latency test or the maintenance of wakefulness test are not commonly used in patients with OSA, since they require nocturnal polysomnography, daytime testing and are expensive. Drugs for EDS are available in the United States but were discontinued in Europe some time ago. For European respiratory physicians, treatment of EDS with medication is new and they may lack experience in pharmacological treatment of EDS, while novel wake-promoting drugs have been recently developed and approved for clinical use in OSA patients in the USA and Europe. This review will discuss 1) the potential prognostic significance of EDS in OSA patients at diagnosis, 2) the prevalence and predictors of residual EDS in treated OSA patients, and 3) the evolution of therapy for EDS specifically for Europe. Drugs for EDS are available in the USA but were discontinued in Europe some time ago. For European sleep doctors, treatment of EDS with medication is new, while novel wake-promoting drugs have been developed and approved for clinical use in OSA patients. https://bit.ly/3u9y3Ln

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Investigation and management of residual sleepiness in CPAP-treated patients with obstructive sleep apnoea: the European view

During positive airway pressure (PAP) therapy for sleep apnea syndromes, the machine-detected respiratory event index (REIFLOW) is an important method for clinicians to evaluate the beneficial effects of PAP. There are concerns about the accuracy of this detection, which also confounds a related question, How common and severe are residual events on PAP?Patients with obstructive sleep apnea who underwent a split-night polysomnography were recruited prospectively. Those treated with PAP and tracked by the EncoreAnywhere system (Philips Respironics, Murrysville, PA) were analyzed. Those who stopped PAP within 1 month were excluded from this analysis. Compliance, therapy data, and waveform data were analyzed. Machine-detected vs manually scored events were compared at the first, third, sixth, and 12th month from PAP initiation. Logistic regression was used to determine factors associated with a high REIFLOW difference.One hundred and seventy-nine patients with a mean age 59.06 ± 13.97 years, median body mass index of 33.60 (29.75-38.75) kg/m2, and median baseline apnea-hypopnea index of 46.30 (31.50-65.90) events/h were included. The difference between the machine-detected REIFLOW and manually scored REIFLOW was 10.72 ± 8.43 events/h in the first month and remained stable for up to 12 months. Male sex and large leak ≥ 1.5% were more frequent in patients who had an REIFLOW difference of ≥ 5 events/h of use. A titration arousal index ≥ 15 events/h of sleep, and higher ratio of unstable to stable breathing were also associated with an REIFLOW difference ≥ 5 events/h of use.There is a substantial and sustained difference between manual and automated event estimates during PAP therapy, and some associated factors were identified.Ni Y-N, Thomas RJ. A longitudinal study of the accuracy of positive airway pressure therapy machine-detected apnea-hypopnea events. J Clin Sleep Med. 2022;18(4):1121-1134. 

https://jcsm.aasm.org/doi/pdf/10.5664/jcsm.9814

A longitudinal study of the accuracy of positive airway pressure therapy machine-detected apnea-hypopnea events

Meningitis and encephalitis are central nervous system infections with considerable morbidity and mortality. The BioFire® FilmArray® Meningitis/Encephalitis Panel (multiplex ME panel) can identify pathogens rapidly potentially aiding in targeted therapy and curtail antimicrobial exposure. This systematic review and meta-analysis synthesized the literature on the association between the multiplex ME panel and length of hospital stay (LOS), length of acyclovir therapy, and days with antibiotics. MEDLINE and EMBASE were searched. Only studies presenting novel data were retained. Random-effects meta-analyses were performed to assess the impact of the multiplex ME panel on outcomes. Of 169 retrieved publications, 13 met the criteria for inclusion. Patients tested with the multiplex ME panel had a reduction in the average LOS (mean difference [MD] [95% CI]: −1.20 days [−1.96, −0.44], n = 11 studies). Use of the multiplex ME panel was also associated with a reduction in the length of acyclovir therapy (MD [95% CI]: −1.14 days [−1.78, −0.50], n = 7 studies) and a nonsignificant reduction in the average number of days with antibiotics (MD [95% CI]: −1.01 days [−2.39, 0.37], n = 6 studies). The rapidity of pathogen identification contributes to an overall reduced LOS, reductions in the duration of empiric antiviral utilization, and a nonsignificant reduction in antibiotic therapy.

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Assessment of the Impact of a Meningitis/Encephalitis Panel on Hospital Length of Stay: A Systematic Review and Meta-Analysis

Pendahuluan: Retensi urin pasca operasi sering terjadi pada pasien, jumlahnya mencapai 30%. Bladder training merupakan  upaya untuk mengembalikan fungsi urin yang mengalami gangguan kedalam keadaan normal atau fungsi optimal neurogenik. Belum banyak literature review terbaru yang membahas terkait pengaruh bladder training terhadap inkontinensia urine pada pasien post operasi. Tujuan: Literature review ini bertujuan untuk meninjau literature terkait pengaruh bladder training terhadap inkontinensia urine pada pasien post operasi  Metode: Pencarian literature menggunakan 4 database; ProQuest, PubMed, ScienceDirect, dan Google Scholar yang diterbitkan pada tahun 2017- 2022. Bahasa artikel adalah Bahasa Indonesia dan Bahasa Inggris. Kata kunci yang dipakai dalam penelitian ini sesuai dengan Medical Subject Heading (MeSH) yaitu: “Bladder Training” AND “Urine Incontinence” AND “Post Operation Patient”. Hasil: Diperoleh sebanyak 7 artikel yang sesuai dengan kriteria inklusi literature review yang telah ditetapkan. Kesimpulan: Bladder training pada 4 penelitian terbukti berpengaruh positif pada kandung kemih pasien post operasi dan pada 3 penelitian terbukti bahwa bladder training tidak berpengaruh signifikan pada kandung kemih pasien post operasi. Saran: Diperlukan penelitian lebih lanjut terkait pengaruh bladder training pada pasien post operasi dengan menggunakan sampel yang lebih banyak untuk menghasilkan penelitian yang lebih akurat.

Pengaruh bladder training terhadap inkontinensia urin pada pasien post operasi : literature review

Rapid molecular diagnostic assays are increasingly used to guide effective antimicrobial therapy. Data on their effectiveness to decrease antimicrobial use in children have been limited and varied. We aimed to assess the impact of the implementation of the FilmArray Meningitis Encephalitis Panel (MEP) on antimicrobial use and outcomes in children. In an observational retrospective study performed at Atlantic Health System (NJ), we sought to evaluate the duration of intravenous antibiotic treatment (days of therapy (DoT)) for patients <21 years of age hospitalized and evaluated for presumptive meningitis or encephalitis before and after the introduction of the MEP. A secondary analysis was performed to determine if recovery of a respiratory pathogen influenced DoT. The median duration of antibiotic therapy prior to the implementation of the MEP was 5 DoT (interquartile range (IQR): 3–6) versus 3 DoT (IQR: 1–5) (p < 0.001) when MEP was performed. The impact was greatest on intravenous third-generation cephalosporin and ampicillin use. We found a reduction in the number of inpatient days associated with the MEP. In the regression analysis, a positive respiratory pathogen panel (RPP) was not a significant predictor of DoT (p = 0.08). Furthermore, we found no significant difference between DoT among patients with negative and positive RPP (p = 0.12). Our study supports the implementation of rapid diagnostics to decrease the utilization of antibiotic therapy among pediatric patients admitted with concerns related to meningitis or encephalitis.

Impact of a Rapid Diagnostic Meningitis/Encephalitis Panel on Antimicrobial Use and Clinical Outcomes in Children.

Study Objectives:To determine the accuracy of the apnea-hypopnea index (AHI) as measured by continuous positive airway pressure (CPAP) machines by simultaneously employing a home sleep apnea testin...

Use of the WatchPAT to detect occult residual sleep-disordered breathing in patients on CPAP for obstructive sleep apnea.

Urinary tract infections (UTIs) are common with indwelling catheter use. Our primary aim was to compare UTI rates in women sent home after surgery with continuous bladder drainage versus a urinary catheter valve. This was a non-inferiority prospective randomized controlled study between June 2016 to June 2019. Women who were being discharged home with a Foley catheter following urogynecologic surgery due to urinary retention were randomized to a continuous urinary drainage bag or a urinary catheter valve. The primary outcome of this study was post-operative UTI rates within 30 days of surgery. The secondary outcome was patient satisfaction, as determined by a Foley satisfaction questionnaire. Out of 97 women, 51 were randomized to continuous drainage and 46 to the urinary catheter valve. Comparing UTI rates, the urinary catheter valve (32.6%) was non-inferior to the continuous urinary drainage bag (33.3%). The upper bound of the 95% CI was less than the predetermined non-inferiority margin (difference 0.7%, 95% CI: −0.195, 0.180), and therefore non-inferiority criteria were met. Patients were more satisfied with the urinary catheter valve than with the continuous drainage bag (p ≤ 0.001). Use of this urinary catheter valve increased patient satisfaction without affecting the post-operative UTI rate. This easy and inexpensive device could help patients have a better catheter experience and should be considered in women being discharged home with a urinary catheter.

A urinary catheter valve is non-inferior to continuous bladder drainage with respect to post-operative UTIs: a randomized controlled trial

Evaluation of dexmedetomidine withdrawal in critically ill adults.

Objective Urodynamic testing of women is a common procedure to evaluate lower urinary tract symptoms but may cause discomfort. The objective of our study was to determine the effect of externally applied periurethral 2% lidocaine gel on pain scores after complex urodynamic testing in women. Methods This prospective, double-blinded, placebo-controlled randomized trial compared 2% lidocaine gel to water-based lubricant applied to the periurethral area before urodynamic testing in women. Discomfort was measured using a visual analog pain scale (VAS) ranging from 0 to 100. The primary outcome was the difference in VAS from baseline to 4 to 6 hours after urodynamic testing. Secondary outcomes included: VAS difference from baseline to immediately postprocedure and 24 hours after urodynamic testing; VAS scores: at baseline, immediately postprocedure, after 4-6 hours, and after 24 hours; urodynamic testing results; and any adverse events. Sixty-four women per group were needed to provide a power of 80% to detect a 10-mm difference on a 100-point VAS. Results From January 2018 to March 2019, 134 subjects were randomized, 6 subjects were excluded, which resulted in 64 subjects in both the water-based lubricant group and 2% lidocaine gel group. There was no difference in baseline demographics. There was no significant difference in the change in VAS from baseline to 4 to 6 hours after UDT (0, 0 P = 0.88). No difference in secondary outcomes was noted. Conclusions Topically applied 2% lidocaine gel does not decrease pain compared with water-based lubricant. For most women, complex urodynamic testing is not associated with any significant pain. Clinical trial registration www.ClinicalTrials.gov,-NCT03390790, "Lidocaine for Pain After Urodynamic Testing".

Stephanie Chiu

Papers

Impact of a Rapid Diagnostic Meningitis/Encephalitis Panel on Antimicrobial Use and Clinical Outcomes in Children.

Use of the WatchPAT to detect occult residual sleep-disordered breathing in patients on CPAP for obstructive sleep apnea.

A urinary catheter valve is non-inferior to continuous bladder drainage with respect to post-operative UTIs: a randomized controlled trial

Evaluation of dexmedetomidine withdrawal in critically ill adults.

Periurethral Lidocaine Does Not Decrease Pain After Urodynamic Testing in Women: A Double-Blinded Randomized Control Trial.