Nocturnal bladder emptying and Quality of Life in patients with spinal cord injury.

BACKGROUND: Little is known about the relationship between sleep disruption due to nocturnal bladder emptying and Quality of Life in patients with spinal cord injury. AIM: The aim of this study was to evaluate the possible influence of number of nocturnal bladder emptying, bladder emptying method and nocturnal incontinence on the Quality of Life of patients with spinal cord injury. DESIGN: The design of this paper is a cross-sectional descriptive study. SETTING: The setting is in- and outpatient. POPULATION: Seventy-nine patients aged between 18 and 77 years with SCI in a first rehabilitation period or follow-up. METHODS: Patients were asked to complete Short Form-36 and Incontinence Quality of Life questionnaires and a medical information form. Independent samples t-tests and ANOVA were used to compare scores between groups. RESULTS: The response rate was 71 out of 79 (89%; 51 males and 20 females). 16 paraplegic and 4 tetraplegic patients were chronic, 29 paraplegic and 22 tetraplegic patients were in rehabilitation therapy or had finished this treatment recently. The paraplegic group had a significantly better Short Form-36 total score and emotional function score, while the tetraplegic group had a significantly better Incontinence Quality of Life total score and avoidance and limiting behavior score. The paraplegic patients with 0-1 nocturnal bladder emptying had better Short Form-36-derived Quality of Life than those with ≥2 emptying. Quality of Life score was not associated with gender, leg oedema, incontinence, or acute/chronic group. Incontinence Quality of Life score was significantly better for patients with incomplete spinal cord injury. Fully completed questionnaires were returned by 36 patients; at least 1 item was missing for 35 participants. CONCLUSIONS: General Short Form-36-derived Quality of Life was better for the paraplegic population. Incontinence-related Quality of Life was better in tetraplegic patients, most of whom used suprapubic catheterization. Paraplegic patients had compromised sleep and Quality of Life when the patient had to wake up two or more times at night to empty the bladder by voiding or intermittent catheterization. The high number of incomplete responders indicates the shortcomings of Quality-of-Life questionnaires for wheelchair-bound patients with spinal cord injury. CLINICAL REHABILITATION IMPACT: The use of suprapubic catheterization should be considered to improve Quality of Life for tetraplegic patients. For paraplegic patients, we must focus urological policy on aiming to reduce the number of nighttime bladder emptying to one or none.

How to modify the risk-taking behaviour of emergency medical services drivers?

High speed and an aggressive style of driving are major risk factors for serious traffic accidents. Consequently, frontline emergency medical services vehicles have an increased collision risk. We report on two studies designed to modify the risk-taking behaviour of emergency medical services drivers. In the first study, we compared the travel intervals for a second tier unit using two different types of vehicles. We found that the replacement of a sports estate by an ambulance, which can be considered more or less as a change from a speedy and aggressive style of driving to a cautious style of driving with respect for the speed limits, resulted in an increase of the travel interval of only 10-20%. In the second study we found that the installation of a 'black box' in an emergency medical services vehicle, combined with well-defined guidelines for the drivers and a close monitoring system, provides fair but still not optimal results with regard to maximum speed and the occurrence of harsh braking events. Despite some limitations in the study designs, we conclude that for second tier units only a small amount of time is gained by high speed and an aggressive style of driving. Furthermore, we are convinced that a 'black box' is a good tool to modify the risk-taking behaviour of emergency medical services drivers.