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PubMed2006

Predictors for the development of elevated anti-heparin/platelet factor 4 antibody titers in patients undergoing cardiac catheterization.

A substantial proportion of patients who undergo cardiac catheterization develop antibodies directed against the heparin/platelet factor 4 (PF4) complex after the procedure, which have been implicated in the pathogenesis of heparin-induced thrombocytopenia. This study attempted to identify factors that predicted the development of these antibodies in a prospective cohort study. Antiheparin/PF4 antibody titers were measured at baseline and again 5 +/- 2 days after cardiac catheterization by enzyme-linked immunosorbent assay. A total of 311 patients who underwent cardiac catheterization were included in the analysis. Of these, 25 (8.0%) developed positive antibody levels after catheterization. Patients who had positive antibody test results after catheterization had significantly greater baseline antiheparin/PF4 antibody titers compared with those whose titers remained low (optical density 0.227 vs 0.158, p < 0.001). In a logistic regression model, greater baseline antibody titers, a history of heparin exposure, and a lower platelet count at enrollment were the strongest predictors of conversion to positive antiheparin/PF4 antibody titers after cardiac catheterization. It is possible to identify patients at high risk for developing elevated titers of antiheparin/PF4 antibodies on the basis of their baseline clinical characteristics.

Antibodies↗

PubMed2005

Effects of cornual catheterization on uterotubal histology and function.

OBJECTIVE: To assess histologic damage and functional impairment following coaxial tubal catheterization. DESIGN: Prospective randomized controlled study. SETTING: Research laboratory. PATIENT(S): Ninety-two female New Zealand rabbits. INTERVENTION(S): Tubal cannulation and mating. MAIN OUTCOME MEASURE(S): Rabbits randomized for placement of unilateral catheter and guide wire (group 1), unilateral catheter and guide wire plus falloposcope (group 2), and catheterization as in group 1 or 2 but using a cage catheter (groups 3 and 4, respectively). A fifth group consisted of rabbits with tubal perforations. Rabbits were killed at 2 or 4 weeks after catheterization or after mating. The sixth group consisted of only control rabbits. RESULT(S): Only one catheterized tube in groups 1 and 3 showed inflammation, fibrosis, or edema. None of the tubes manifested ciliary loss. Serosal tubal adhesions were identified in two tubes in group 1, in one in group 3, in three tubes in group 5, and one in the control group. The nidation index in control and nonperforated catheterized tubes ranged from 72%-95% (not significant). Nidation index in tubes unintentionally perforated was 81%. CONCLUSION(S): Catheterization of the uterotubal junction and fallopian tube in rabbits does not cause long-term tubal damage or impair tubal function.

Animals↗

PubMed1999

Effect of transradial access on quality of life and cost of cardiac catheterization: A randomized comparison.

BACKGROUND: Transradial access is a recently developed alternative for diagnostic cardiac catheterization. Its effects on quality of life after the procedure, patient preference, and cost are unknown. METHODS AND RESULTS: We performed a randomized single-center trial in which 99 patients underwent transfemoral and 101 underwent transradial diagnostic cardiac catheterization. Quality of life was measured with the SF-36 and visual analog scales at baseline, 1 day, and 1 week. Patients were examined at 1 day and at 1 week after for complications. Costs were measured prospectively. One patient in the femoral group and 2 in the radial group crossed over to the alternative access site. There were no major access site complications. One patient in the transfemoral group had a minor stroke. Transradial catheterization significantly reduced median length of stay (3.6 vs 10.4 hours, P <.0001). Over the first day after the procedure, measures of bodily pain, back pain, and walking ability favored the transradial group (P <.05 for all comparisons). Over the week after the procedure, changes in role limitations caused by physical health, bodily pain, and back pain favored the transradial group (P <.05 for all comparisons). There was a strong patient preference for transradial catheterization as well (P <. 0001). Transradial catheterization led to significant reductions in bed, pharmacy, and total hospital costs ($2010 vs $2299, P <.0001). CONCLUSIONS: Among patients undergoing diagnostic cardiac catheterization, transradial access leads to improved quality of life after the procedure, is strongly preferred by patients, and reduces hospital costs.

Cardiac Catheterization↗

PubMed2001

Age and the utilization of cardiac catheterization following uncomplicated first acute myocardial infarction treated with thrombolytic therapy (The Second National Registry of Myocardial Infarction [NRMI-2]).

Considerable data indicates that patients <50 years of age have lower morbidity and mortality after acute myocardial infarction (AMI) than older patients. It has been demonstrated that use of routine cardiac catheterization and revascularization in younger patients with AMI and successful thrombolysis does not confer benefit compared with a more conservative approach. Despite this, it has been our impression that cardiac catheterization is frequently employed in younger patients with AMI. Patients with uncomplicated initial AMI treated with thrombolytic therapy in the Second National Registry of Myocardial Infarction (NRMI-2) between June 1994 and April 1998 were identified. Patients were categorized into 4 age strata for purposes of analysis. A total of 61,232 cases met our inclusion criteria. Cardiac catheterization was performed during hospitalization in 78% of patients after an uncomplicated initial AMI. Age was inversely associated with receipt of cardiac catheterization: 85% of those < or =49 years old underwent catheterization compared with 63% of those > or =70 years old. Regression analysis revealed that use of catheterization was 2.9 times greater (95% confidence intervals 2.7 to 3.2) in patients < or =49 years old compared with those > or =70 years old. Geographic location and payor status also strongly influenced utilization of this procedure. In conclusion, routine coronary angiography after uncomplicated AMI is extensively utilized in all age groups, particularly in those <50 years of age. The efficacy and cost effectiveness of this strategy in these patients has not yet been determined in clinical trials.

Age Factors↗

PubMed2003

Diagnostic and therapeutic value of selective salpingography and tubal catheterization in an unselected infertile population.

OBJECTIVE: To present diagnostic findings and fertility outcome after selective salpingography and tubal catheterization in an unselected infertile population. DESIGN: Cohort study. SETTING: Tertiary reproductive medicine unit. PATIENT(S): One hundred ten consecutive infertile women. No exclusion criteria were applied. Follow-up ranged from 16 to 54 months. INTERVENTION(S): Selective salpingography and tubal catheterization under fluoroscopic guidance as the primary test for the assessment of the fallopian tubes. MAIN OUTCOME MEASURE(S): Incidence of tubal disease at selective salpingography, therapeutic effectiveness of tubal catheterization, and fertility outcome after the procedure. RESULT(S): Tubal disease was present in 31.4% of the tubes examined. Of tubes proximally blocked at selective salpingography, 52.1% were found to be normal after tubal catheterization. Proximal tubal blockage (bilateral or unilateral) was detected in 34.8% of women. This was reduced to 5.5% after tubal catheterization. Spontaneous conceptions occurred in 21.9% of the women. In total, 36.2% conceived without IVF or ICSI. CONCLUSION(S): Selective salpingography and tubal catheterization can be useful as a primary tubal assessment tool in the investigation of infertility. In cases of proximal tubal blockage, an effective see-and-treat approach can be adopted. More research into the possible therapeutic benefits of the procedure is justified.

Adult↗

PubMed2004

EUS-guided portal vein catheterization and pressure measurement in an animal model: a pilot study of feasibility.

BACKGROUND: The extrahepatic portal vein is inaccessible to direct catheterization. METHODS: Because EUS can readily image the portal vein, the feasibility of EUS-guided portal vein catheterization by using a 22-gauge needle was studied in 7 normal pigs and 14 pigs in which portal hypertension was induced (7/14 anticoagulated). RESULTS: Catheterization was not possible by EUS or transhepatic methods in, respectively, 3 and 5 animals. One anticoagulated animal had a small amount of periduodenal bleeding as a result of EUS catheterization. The mean normal portal vein pressure (1 standard deviation) as determined by EUS and transhepatic methods was, respectively, 20.3 (4) mm Hg and 20.4 (2) mm Hg. Injection of polyvinyl alcohol particles increased the portal vein pressure by 10.2 (11.59) mm Hg. There was a close correlation under all conditions between the mean portal vein pressures obtained by EUS and transhepatic catheterization (r=0.91). CONCLUSIONS: EUS-guided portal vein catheterization appears to be feasible in an animal model and provides accurate pressure measurements.

Animals↗

PubMed1978

Cardiac catheterization in the neonate. A comparison of three techniques.

This study evaluated three methods of catheter entry for cardiac catheterization in neonates less than one week of age. Eighty-five neonates underwent venous catheterization through the umbilical vein, 77 by saphenous or femoral cutdown, and 31 by femoral percutaneous entry. Of these 194 neonates, 128 also had an aortic catheter introduced via the umbilical artery. Umbilical vein catheterizations took an average of 115 minutes, 30 minutes shorter than either of the other techniques. Fatal complications following catheterization occurred in 10 of the 194 neonates (5%) three of these were related to catheterization technique. Diagnostic cardiac catheterization and balloon atrial septostomy may be performed most quickly by way of the umbilical vessels. Percutaneous entry of the femoral vein in this series carried the lowest complication rate; cutdown entry resulted in the highest complication rate.

Cardiac Catheterization↗

PubMed2003

How to manage acute urethral false passage due to intermittent catheterization in spinal cord injured patients who refused insertion of an indwelling catheter.

PURPOSE: Acute urethral false passage is an important complication of clean intermittent catheterization in spinal cord injured patients. Temporary urethral stenting with an indwelling catheter is generally an excellent conventional therapeutic option to treat patients with acute false passage. However, how can acute false passage be managed in a patient who refuses insertion of an indwelling catheter? MATERIALS AND METHODS: For 3 years 5 male patients with acute urethral false passage due to catheterization refused urethral stenting because indwelling catheter insertion would prevent sexual intercourse. We placed a nitinol prostatic stent successfully in the false urethral passage in all 5 patients. The stents were left in place for 3 to 6 months. RESULTS: The stent migrated in 1 patient and it was replaced. During a retention period of 3 to 6 months all patients continued clean intermittent catheterization without any difficulty and achieved sexual intercourse. On urethral cystoscopy we observed that all false passages disappeared without a gross tissue reaction. The stents were then removed without any complications. During a mean followup of 11.8 months (range 4 to 25) none of these patients had another false passage. All continued to perform clean intermittent catheterization without any further difficulty. CONCLUSIONS: Temporary placement of a removable endourethral stent is a safe and effective method for managing acute urethral false passage in patients on clean intermittent catheterization who refuse insertion of an indwelling catheter. This approach makes further clean intermittent catheterization possible and improves patient quality of life.

Acute Disease↗

PubMed1984

Clean intermittent catheterization in the management of the neurogenic bladder in children.

Clean intermittent catheterization has been successful in the management of urinary incontinence and upper tract changes associated with a neurogenic bladder. The results of clean intermittent catheterization controlling urinary incontinence, ureteral reflux, upper tract dilatation and urinary infection in 84 children with a neurogenic bladder were evaluated for up to 3 years of followup. Of the children 41 (49 per cent) were totally incontinent and 14 (17 per cent) were slightly damp. Preexisting ureteral reflux deteriorated in 25 per cent of the patients, ceased in 35 per cent and was unchanged in 40 per cent, while pre-existing upper tract dilatation improved in 12.5 per cent and was unchanged in 87.5 per cent. On clean intermittent catheterization and antibacterial medication 90 per cent of the children had sterile urine and 7.5 per cent had 10(5) or more colonies per ml. Complications occurred on 54 occasions but were minor in nature and were corrected easily. Half of the parents, schools and children found clean intermittent catheterization very acceptable or acceptable but a quarter of the parents and patients found it unacceptable or slightly unacceptable, or were undecided. Initial management of urinary complications associated with neurogenic bladder in children has changed to the clean intermittent catheterization program, with greatly improved results compared to Credé's expression of the bladder, an indwelling urethral catheter or urinary diversion. However, the clean intermittent catheterization regimen was not effective completely, not without complications and not accepted completely by parents, schools and children.

Adolescent↗

PubMed1983

Intermittent clean catheterization: an alternative to diversion in continent transplant recipients with lower urinary tract dysfunction.

A total of 3 renal transplant recipients who were candidates for urinary diversion underwent successful transplantation using a planned program of intermittent clean catheterization. The urinary tract dysfunction was caused by a lower motor neuron neurogenic bladder, prune belly syndrome and myelodysplasia. The patients remain dry between catheterizations and maintain serum creatinine levels of 1.1, 0.8 and 0.5 mg. per cent, respectively, with a followup of 6 to 25 months. There has been only 1 urinary tract infection during 42 patient-months at risk while on self-catheterization. Pre-transplant urologic evaluation and patient education are mandatory. The ideal candidate for intermittent clean catheterization is a patient with a low pressure bladder that fails to empty and who is continent between catheterizations. Intermittent clean catheterization is a safe and effective alternative to diversion in continent transplant recipients with lower urinary tract dysfunction.

Adult↗

PubMed1982

Clean intermittent catheterization for spinal cord injury patients.

Charts were reviewed retrospectively for 65 patients with traumatic spinal cord injury discharged from the hospital between 1972 and 1977 on clean intermittent catheterization for management of neurogenic bladders. While 54 patients were still using clean intermittent catheterization 9 had discontinued its use and 2 were lost to followup. Complete urologic followup records were available for 28 long-term clean intermittent catheterization users, with an average followup of 3.7 years. Complications seen in this group included nephrolithiasis-3 cases, cystolithiasis--3, epididymitis--4 and urinary tract infection--12. No patient had hydronephrosis or radiographic pyelonephritis. Clean intermittent catheterization appears to be a safe and satisfactory alternative for long-term management of the neurogenic bladder of selected spinal cord injury patients, since the incidence of serious renal complications is low. Factors that should be considered before long-term clean intermittent catheterization is recommended include type of neurogenic bladder, prognosis for recovery, incontinence despite medication, history of urethral trauma, host resistance, physical independence in self-catheterization, compliance and patient preference.

Female↗

PubMed1999

Role of chronic catheterization in the development of bladder cancer in patients with spinal cord injury.

OBJECTIVES: Patients with spinal cord injury (SCI) and chronic indwelling catheters are known to be at increased risk of bladder malignancy. "Decatheterization" by clean intermittent catheterization, external condom catheterization, or spontaneous voiding is thought to reduce the risk by decreasing the chronic mucosal irritation and rate of infection. We examined two Department of Veterans Affairs (DVA) data bases to test this theory. METHODS: A population-based retrospective analysis of invasive treatments for carcinoma of the bladder in all DVA hospitals was conducted using computerized inpatient files from fiscal years 1988 to 1992. RESULTS: One hundred thirty patients with bladder malignancy were identified from a pool of 33,565 patients with SCI (0.39%). All 130 patients underwent either radical cystectomy (n = 63, 48%) or transurethral resection of bladder tumor (n = 67, 52%). The 30-day perioperative mortality and overall 5-year survival rates were 2 (1.5%) and 49 (38%) of 130, respectively. Of the 130 patients analyzed, 42 (32%) had adequate data available regarding tumor pathologic findings and method of bladder management for analysis. The average age at diagnosis was 57.3 years. The histologic finding was transitional cell carcinoma in 23 (55%), squamous cell carcinoma in 14 (33%), and adenocarcinoma in 4 (10%) of 42. Bladder management was an indwelling urethral catheter in 18 (43%), suprapubic catheter in 8 (19%), clean intermittent catheterization in 8 (19%), and condom catheter in 6 (14%) of 42 patients. Squamous cell carcinoma was more common in patients with indwelling urethral catheters and suprapubic tubes (11 of 26, 42%) than in those using clean intermittent catheterization, condom catheterization, or spontaneous voiding (3 of 16, 19%). CONCLUSIONS: Bladder cancer was diagnosed in approximately 0.39% of this large SCI population during a 5-year period. Most cancers (55%) were transitional cell carcinomas. Squamous cell carcinoma was more common in patients with SCI and indwelling catheters than those without chronic catheterization. These data continue to suggest that avoidance of indwelling catheters, when feasible, is the preferred method of bladder management in patients with SCI.

Adenocarcinoma↗

PubMed2003

A prospective study on incidence and risk factors of arteriovenous fistulae following transfemoral cardiac catheterization.

BACKGROUND: A potentially harmful complication of cardiac catheterization is the arteriovenous fistula. Precise knowledge of possible factors predisposing for acquisition of iatrogenic AV-fistulae could enable cardiologists to perform a risk stratification for cardiac patients prior to catheterization. METHODS: Over a period of 2 years, 10,271 consecutive patients who underwent cardiac catheterization were included in this study. Auscultation of a new femoral bruit was followed by a duplex scan to confirm the suspected diagnosis of an AVF. Every patient was investigated on the day after catheterization. RESULTS: The incidence of iatrogenic AVF was 0.86%. A multivariate regression analysis revealed five significant and independent risk factors: (1) procedural heparin dosage >or=12,500 IU (Odds Ratio (OR)=2.88), (2) coumadin therapy (OR=2.34), (3) puncture of the left groin (OR=2.21), (4) arterial hypertension (OR=1.86) and (5) female gender (OR=1.84). Coronary angioplasty (instead of diagnostic procedure), size and number of sheaths, age and body mass index did not significantly affect the incidence of AVF. CONCLUSIONS: The overall incidence of AV-fistulae following cardiac catheterization approximates 1%. Determination of significant risk factors will facilitate identification of patients at risk for iatrogenic arteriovenous fistulae prior to cardiac catheterization and thus help to develop strategies to reduce the incidence of AV-fistulae.

Aged↗

PubMed1986

A comparison of the supraclavicular approach and the infraclavicular approach for subclavian vein catheterization.

Five hundred emergency department patients requiring subclavian vein catheterization were randomized prospectively into one of two groups, supraclavicular or infraclavicular. If catheterization was unsuccessful in a few attempts using the randomized approach, catheterization with the alternate approach was attempted. Two catheters were available for use, a short, 8-French introducer and a long, 16-gauge catheter. There were 38 failures (15.5%) among 245 patients in the supraclavicular group, with one malposition and five complications. There were 51 failures (20.0%) among 255 patients in the infraclavicular group, with 21 malpositions and 13 complications. No differences were significant except that of malpositions (P less than .01). The combination of infraclavicular approach and 16-gauge catheter accounted for 21 of 22 malpositions. When catheterization by the randomized approach failed, catheterization by the alternate approach was successful in all but seven cases, resulting in an overall success rate of 98.6%. Analysis of this series suggests that both the infraclavicular and supraclavicular approaches to subclavian vein catheterization are acceptable alternatives, with little difference in success rate or complications. Using an alternate approach if the initial approach was unsuccessful produced a high overall success rate and a low overall complication rate. A physician who is familiar with both approaches will be more successful at placing central venous catheters safely.

Adolescent↗

PubMed1999

Management of chylothorax by percutaneous catheterization and embolization of the thoracic duct: prospective trial.

PURPOSE: To prospectively assess the efficacy of percutaneous transabdominal thoracic duct catheterization and embolization in the management of patients with high-output chylothoracic effusions. MATERIALS AND METHODS: Eleven consecutive patients (four women and seven men; mean age, 53 years) were referred with chylothorax secondary to esophagectomy (n = 4), lobectomy (n = 1), lung transplant (n = 1), coronary artery bypass (n = 1), aortic graft (n = 2), lymphangioleiomyomatosis (n = 1), and gunshot wound (n = 1). Two patients were brought by ambulance and referred back to their hospital on the same day. Pedal lymphography was used to opacify the cisterna chyli or major retroperitoneal lymphatic trunks. When patent, these were punctured under local anesthesia with a fine needle and the thoracic duct was catheterized over a microguide wire with use of a 3-F catheter; the duct was embolized with platinum coils. Patients were followed up for decrease in thoracic drainage output and morbidity. RESULTS: There were no retroperitoneal ducts suitable for catheterization in six patients because of previous abdominal surgery, trauma, or lymphangioleiomyomatosis; the thoracic duct was successfully catheterized in five patients, a 45% technical success rate. Thoracic duct embolization was performed in four patients, with cure of effusion in two. In the other two patients, one with lymphangioleiomyomatosis and the other with nonchylous pleural fluid, continued effusion was successfully treated by means of pleurodesis. Of two patients with previous thoracic duct ligation, one was found to have the duct incompletely tied. The authors were surprised to find that previous major abdominal surgery, chronic aortic dissection, and lymphangioleiomyomatosis could obliterate major retroperitoneal lymphatic ducts and the cisterna chyli. Percutaneous study of the thoracic duct with aqueous contrast medium was more sensitive than lymphography with iodinated oil. There was no morbidity. CONCLUSIONS: Catheterization of the thoracic duct was possible in all patients who had patent major retroperitoneal lymphatic trunks. Thoracic duct embolization was curative in patients with demonstrable duct leakage. Previous abdominal surgery, aortic dissection, and lymphangioleiomyomatosis can lead to silent occlusion of retroperitoneal lymphatic trunks. Percutaneous thoracic duct catheterization and embolization is safe and can replace surgical ligation in some patients.

Adult↗

PubMed2001

Pulmonary artery systolic pressures estimated by echocardiogram vs cardiac catheterization in patients awaiting lung transplantation.

BACKGROUND: At many lung transplant centers, right heart catheterization and transthoracic echocardiogram are part of the routine pre-transplant evaluation to measure pulmonary pressures. Because decisions regarding single vs bilateral lung transplant procedures and the need for cardiopulmonary bypass are often made based on pulmonary artery systolic pressures, we sought to examine the relationship between estimated and measured pulmonary artery systolic pressures using echocardiogram and catheterization, respectively. METHODS: We retrospectively reviewed all patients in our program who had measured pulmonary hypertension (n = 57). Patients with both echocardiogram-estimated and catheterization-measured pulmonary artery systolic pressures performed within 2 weeks of each other were included (n = 19). We analyzed results for correlation and linear regression in the entire group and in the patients with primary pulmonary hypertension (n = 8) and pulmonary fibrosis (n = 8). RESULTS: In patients with primary pulmonary hypertension, pulmonary artery systolic pressure was 94 +/- 27 and 95 +/- 15 mm Hg by echocardiogram and catheterization, respectively, with r(2) = 0.11; in patients with pulmonary fibrosis, 57 +/- 23 and 58 +/- 12 mm Hg with r(2) = 0.22; and in the whole group, 76 +/- 29 and 75 +/- 23 mm Hg with r(2) = 0.50. Thirty-two additional patients had mean pulmonary artery systolic pressure = 48 +/- 16 mm Hg by catheterization but either had no evidence of tricuspid regurgitation by echocardiogram (n = 22) or the pulmonary artery systolic pressure could not be measured (n = 10). CONCLUSIONS: In patients with pulmonary hypertension awaiting transplant, pulmonary artery systolic pressures estimated by echocardiogram correspond but do not serve as an accurate predictive model of pulmonary artery systolic pressures measured by catheterization. Technical limitations of the echocardiogram in this patient population often preclude estimating pulmonary artery systolic pressure.

Adult↗

PubMed1997

Physical predictors of infection in patients treated with clean intermittent catheterization: a prospective 7-year study.

OBJECTIVE: To study urinary tract complications in patients treated using long-term clean intermittent catheterization (CIC), and to evaluate the physical factors which might be implicated in these complications. PATIENTS AND METHODS: During 1995, 170 patients (84 men and 86 women, mean age 56.9 years) with a mean duration of use of CIC for 8.8 years were assessed for complications related to CIC. The same patients had participated in a thorough follow-up study during 1988-9 and were examined again using questionnaires and the analysis of urine samples. CIC was practised by two-thirds of the patients because they had neurogenic bladder dysfunction and for non-neurogenic dysfunction in the remainder. RESULTS: In this prevalence study, 111 patients (65%) had no signs of clinical urinary tract infection (UTI), while 10 patients (6%) had pronounced symptoms. The remaining 29% had only minor signs of UTI. There were three predictive factors of clinical UTI: women reported more infections than men, the patients most affected by UTI in the present study were those suffering UTI during the 1988-9 study and patients with UTI had the highest mean catheterization volume now, and the highest increase in mean catheterization volume from 1989 to 1995. Bacteriuria was found in 61% of the urine samples, with Escherichia coli the dominant species among women and Gram-positive cocci among men. Patients who did not use anti-infective agents had a 31% rate of sterile urine while the corresponding value among those using antibiotics was 54%. The frequency of catheterization was the only variable predictive of bacteriuria apart from the use of antibiotics. CONCLUSION: This study confirms previous reports showing CIC to be an excellent procedure for minimizing urinary tract complications and supports the current recommendations, e.g., restricting the use of antibiotics in patients using CIC and ensuring that they catheterize sufficiently often to ensure that the mean volume of each catheterization is kept to < 400 mL in adults.

Adult↗

PubMed2000

Rectal examination and urethral catheterization by medical students and house officers: taught but not used.

OBJECTIVE: To assess the acquisition of skills in digital rectal examination (DRE) and urethral catheterization by medical students and house officers associated with a UK medical school, and to determine their confidence in these techniques. Subjects and methods Questionnaires were sent to all final-year medical students at Oxford Medical School immediately before their final examinations. Similar questionnaires were sent to all pre-registration house officers who had graduated from Oxford in the previous year. RESULTS: Responses were received from 71% of the students and 84% of the graduates; 88% of the students and 94% of the graduates had been taught how to perform a DRE as a medical student, but 42% of medical students had performed fewer than five DREs before qualification. Their findings were rarely checked by a doctor. Of the students, 44% had never felt a clinically malignant prostate gland and 41% were 'not at all confident' in their ability to give an opinion based on their findings on a DRE. House officers performed DRE regularly (53% >/= 50 DREs) but rarely received additional instruction, and exposure to pathology remained limited. House officers' findings on DRE were rarely confirmed by a more senior doctor. Most respondents had been taught how to perform male urethral catheterization as a medical student (92% of students, 89% of house officers) but 48% of students had performed fewer than two catheterizations on qualification and 68% of house officers had received no additional instruction; however, 69% of house officers were 'very confident' in their ability to perform male urethral catheterization. CONCLUSIONS: The DRE is a critical skill in assessing the prostate; students conduct few DREs, lack confidence and are exposed to minimal pathology. Legitimate concerns over students carrying out intimate examinations may be mitigating against the acquisition of skills. Possible solutions are explored. House officers perform DREs regularly, but with no additional instruction they may continue to lack confidence. Students lack experience in male urethral catheterization and rarely receive postgraduate instruction. House officers' confidence in their ability to perform male urethral catheterization may be misplaced.

Attitude of Health Personnel↗