Exfoliation rates of urothelial cells following bladder irrigation were studied in patients with long-term indwelling catheters and chronic urinary tract infections (UTI). The irrigations were associated with an increased shedding of urothelial cells. Ultrastructural studies of these cells demonstrated increased disruption when compared with those obtained from normal subjects without catheters or chronic infection. The findings suggest that bladder irrigation further damages the already disrupted urothelium, which may in turn increase the predisposition of the bladder to the recurrent infections, commonly associated with patients who have indwelling urinary catheters. Bladder irrigation methods and the indications for their use require reassessment.
Stroke is the most common cause of adult neurological disability in the UK. This article describes the reasons for the establishment of the UK Forum for Stroke Training and the Stroke-Specific Education Framework. It illustrates how these initiatives can be used to access a range of endorsed, stroke-specific courses to develop excellence in stroke care and multidisciplinary teamwork, as demanded by the Department of Health's National Stroke Strategy.
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