This study was conducted to determine the frequency of increased postvoiding residual volumes (PVRV) 3 days after delivery and to examine the associated risk factors. Increased PVRV ‒ covert postpartum urinary retention, is an asymptomatic condition with possible long-term adverse effects. While early diagnosis and appropriate management can avoid long‑term complications, screening is not routinely performed. By identifying risk factors, we could define the group of patients suitable for screening. This was a prospective observational study carried out over a 3-month period at the university teaching hospital in Bratislava, Slovakia. All participants underwent ultrasound determination of PVRV while 80 ml and more on day 3 was considered pathological. A total of 429 women were included in the study. The prevalence of covert post-partum urinary retention was 9.2 %. Assisted vaginal delivery (ventouse, forceps) and episiotomy were risk factors for post-partum urinary retention (18.7 % vs 6.1 %; p = 0.0053; 52.1 % vs 35.7 %; p = 0.0483; respectively). Our observations confirmed the existence of PVRV of 80 ml and more on day 3 in almost 10% of women who had delivered at our clinic. The results of our study prove that instrumental delivery represents a considerable obstetrical-pediatric risk factor for PVRV. Our data support the need of adopting a risk-factor-based approach to PVRV screening as part of postpartum bladder care (Tab. 2, Fig. 1, Ref. 12).

Aims: To understand intrapartum and postpartum clinical practices among skilled birth attendants in low- and middle-income countries (LMICs).
 Methods: This survey, based on clinical guidelines and curricula, was administered online in French and English, from May-Oct, 2017. Summaries of respondent characteristics, knowledge, and practices were generated. Chi-square tests investigated significant disparities by region, facility type, and geography. Data were analyzed using Stata v12.
 Results: Respondents (222) were primarily midwives (61%) and OB-GYNs (15%); 56% in Africa and 39% in South-East Asia. A majority practice many recommended practices related to intrapartum/postpartum bladder care and P/OL management. Most reported using partograph to monitor labor (99%), monitoring voiding frequency for postpartum patients (95%), and utilizing UC after P/OL (94%). Findings revealed a lack ofprotocols on bladder care and P/OL management, variation in practice by region, and less access to in-service training and supplies in Africa and public facilities.
 Conclusions: Findings reveal a strong foundation for standardization in intrapartum/postpartum bladder care and P/OL management. UC after P/OL appears feasible and acceptable, meaning its systematic practice can be scaled up to prevent obstetric fistula and other sequelae of P/OL in low-resource settings. However, SBAs need protocols, in-service training, and consistent supplies, especially in Africa and public facilities.

To determine how heath regulations affect the comprehensive rehabilitation of people with spinal cord injury in two health institutions of the city of Cali- Colombia. Cross-sectional descriptive study with 53 people. The independent variable was health regulations and the dependent variable was comprehensive rehabilitation. A univariate analysis was applied. Claiming fundamental health rights before a court is a mechanism that allows people with spinal injury to access health services for comprehensive rehabilitation, of which 81% claim pain treatment, 62% spasticity, 95% neurogenic bladder care, and 93% orthotic devices or wheel chairs. Current health regulations in Colombia do not include timely mechanisms for people with spinal cord injury to have access to specific health services for comprehensive rehabilitation. It is important for interdisciplinary health teams to become familiar with regulations and provide early guidance to people with this type of injury, so that they can access the necessary healthcare services and prevent further complications such as depression or death from sepsis derived from urinary tract infections or pressure ulcers.

this article reports on a study of continence education and training for students and qualified nurses. to understand how nurses and nursing students gain their knowledge in continence education and training, to examine nurses' understanding of bladder and bowel care and to discover to what degree nurses are confident in their knowledge of bladder and bowel care. this was a qualitative enquiry and a case study methodology was used to frame the research. The data were captured through a questionnaire and group discussions. continence education comprised support through self-learning, classroom instruction, skills laboratory sessions and on the wards. Feedback from participants indicated that, although continence education enhanced learning, they thought continence education sessions were either too short or did not go into enough detail. Two key factors that limited learning in the workplace were time and work priorities. it is recommended that a combination of learning strategies is useful and valuable in developing the nurse's skills and knowledge of continence care, if time and funding are available.

BackgroundOveractive bladder (OAB) affects millions of women. It is important to assess knowledge and attitude in affected patients. The study objective was to develop surveys to assess OAB knowledge and OAB related attitude, and its association with OAB treatment status.MethodsSystematic literature review and qualitative analysis of patient and provider focus groups helped identify OAB knowledge and attitude survey items. We determined psychometric properties of the two surveys in a cross-sectional sample of 104 women, 27% of whom had received OAB treatment.ResultsThe OAB-knowledge survey consisted of 16 items and 3 condition-related concepts: perception of OAB; cause and information; and signs of OAB. The OAB-attitude survey consisted of 16 items and its concepts were treatment seeking; decision-making and effects. Both surveys demonstrated good construct validity and test-retest reliability ((≥ 0.60). In the cross-sectional validation sample, OAB-knowledge and attitude discriminated between those with different levels of ICIQ-UI scores. We observed some difference in the OAB knowledge, OAB attitude, and severity of symptoms between those treated for OAB vs. treatment naive.ConclusionsOAB knowledge and attitude surveys provide a novel tool to assess OAB domains in women. Though we did not find statistical significance in OAB knowledge and attitude scores across treatment status, they may be potentially modifiable factors that affect OAB treatment uptake and treatment compliance. Refinement of these surveys in diverse sub-populations is necessary. Our study provides effect sizes for OAB knowledge and attitude. These effect sizes can help development of fully powered trials to study the association between OAB knowledge and attitude, type and length of treatment, treatment compliance, and quality of life, leading to interventions for enhancing OAB care.

Background: Care bundles are an effective means of reducing catheter-associated urinary tract infection (CAUTI) when they are implemented with high impact interventions. Care bundle approach only works when every element of the bundle is implemented for every appropriate patient, every time and with high impact. Aim: This study aims to study the efficacy of CAUTI Care Bundle and of infection control nurse (ICN) in reducing the incidence of CAUTI in a zonal hospital. Materials and Methods: The study was with an initial baseline phase (observational) of 8 months followed by an intervention Phase of 21 months. The intervention phase was further divided into intervention Phase I (8 months) and intervention Phase II (13 months). Intervention Phase I included a multidimensional approach of education and training of health-care staff for catheter management and prevention of CAUTI and implementation of catheter care bundle. In intervention Phase II education of health-care workers and implementation of catheter care bundle was done under constant supervision and guidance of ICN. Results: We recorded a total of 834 urinary catheter days: 309 in baseline phase, 314 in intervention Phase I, and 211 in intervention Phase II. It was found that the incidence rate of CAUTI, measured as episodes per 1000 catheter days is 64.72 in baseline phase, 25.47 in intervention Phase I, and 18.95 in intervention Phase II. The catheter care bundle approach along with education of the staff reduced the CAUTI incidence by 60.64 and when the same was applied under the constant supervision of ICN for the CAUTI reduction rate was clinically significant with 70.72. Conclusions: The catheter care bundle approach along with the education of the staff reduced the CAUTI incidence by 60.64 episodes/1000 catheter days and when the same was applied under constant supervision of ICN for the CAUTI reduction rate was clinically significant with 70.72

Informal carers (carers) support palliative patients to live at home. Most palliative patients require bladder and bowel care (B&BC) at some point, but there is limited evidence about carers providing B&BC and how best to support them. To explore carers' experiences of providing B&BC to life-limited young adults. Interpretative phenomenological analysis of five interviews with purposively selected carers. One overarching theme, 'It is what it is', and three superordinate themes ('Whatever my daughter needs', 'Mum knows best', and 'Coping with caring') emerged. While B&BC could be challenging at times, it was not a major concern. Instead it engendered closeness and opportunities for carers to provide better care than they felt professionals could. This study informs how professionals should understand the support carers offer. Professionals should ensure that carer/patient dyads who wish to manage B&BC are supported to do so, and that their support needs are regularly assessed.

Gauging prognosis is a key element when facing treatment decisions in cancer care. Several prognostic tools, such as risk tables and nomograms are at hand to aid this process. In the context of patient-centered care, prognostic tools are of great interest to caregivers and -providers alike, as they can convey sizeable amounts of information and provide tailored, accurate estimates of prognosis. Given the rising number of prognostic tools in cancer care over the last two decades, and similarly, ever increasing presence of the Internet, we aimed to assess how this would translate into the availability of online tools for patient counseling. We used a modified systematic review to evaluate the web-based availability, format, and content of prognostic tools for bladder and kidney cancer care. Our search identified a total of twenty-three tools, offered by eight providers, which assessed a total of six (bladder cancer) and five (kidney cancer) different outcomes. Despite the restricted availability of online tools, we observed that the majority showed limited user-friendliness (including, for example, a statement/explanation of intended use, visualization of data, availability as application software for handheld devices). Only one tool included modifiable risk factors such as smoking behavior and body weight. Lastly, none of the tools incorporated genomic or molecular markers or treatment associated quality of life. Taken together, online tools for patient counseling in bladder and kidney cancer care are only beginning to align with the growing need in clinical reality. Further and future avenues include incorporation of health-related quality of life as well as genomic and biomarkers into prediction tools.

PD06-11 FACTORS AFFECTING DELAYS IN NEOADJUVANT CHEMOTHERAPY AND RADICAL CYSTECTOMY: AN ANALYSIS OF THE NATIONAL CANCER DATABASE COHORT

Background: Clinically silent autonomic dysfunction with bowel and bladder care, are postulated to contribute to cardiovascular disease after chronic spinal cord injury (SCI).Objective: We describe the frequency and severity of dysreflexic episodes, termed transient blood pressure elevations (T-BPE) over 48 hours in adults with cervical or high-thoracic motor-complete SCI.Setting: Tertiary SCI Rehabilitation Centre in Toronto, Canada.Participants: Individuals with chronic SCI, C1-T3 AIS A or B, >1 year post-injury, living in the community (n=19).Outcome Measures: Data were obtained via 48-hour ambulatory blood pressure (BP) and heart rate (HR) monitoring, with data captured at 10-minute intervals and a concurrent diary describing activities of daily living, and bladder/bowel routines. T-BPE were defined as a ≥ 40 mmHg elevation in systolic blood pressure (SBP) above the participant's supine baseline. Severe (≥ 60–79 mmHg) and Extreme ≥80 mmHg elevations in SBP were described.Results: Thirteen participants experienced T-BPE within the assessment period, with 7/13 experiencing “severe”, and 3/13 experiencing “extreme” SBP elevations. The median number of T-BPE was 8 (IQR = 3), and the mean ± SD SBP during T-BPE was 150 ± 16 mmHg, These T-BPE were verified as dysreflexic events using a conservative definition of a >40 mmHg increase in SBP, with a concurrent 10 bpm decrease in HR, above the 48-hour average SBP, yielding 12/19 participants with T-BPE.Conclusions: T-BPE were frequent, often with severe or extreme elevations in SBP, despite few reported symptoms. Recognition and management of these dysreflexic events associated with T-BPE are needed, which may ameliorate cardiovascular disease risk.

Peer-supported self-management to facilitate community re-entry after discharge from spinal cord injury rehabilitation: Engaging peers as change agents and research partners

Bladder care throughout the childbearing continuum is one of the essential components of midwifery care, as health of the urinary tract affects both short-term and long-term maternal wellbeing. Throughout antenatal, intrapartum and postnatal care, midwives have the opportunity to safeguard bladder function and to promote normality. As frontline practitioners during pregnancy and childbirth, midwives are ideally placed to facilitate sensitive discussions about bladder function, considering an individualised baseline for each woman's wellbeing and recognising when deviations from the normal process occur ( Strahle and Stainton, 2006 ). With a sound understanding of the physiology and anatomy underpinning bladder care, midwives can educate women about changes during pregnancy, providing reassurance and gold-standard care. A holistic midwifery consideration of both the physiological and psychosocial wellbeing of all women is paramount ( Fritel et al, 2016 ), especially when considering invasive procedures such as catheterisation and the long-term sequelae associated with bladder dysfunction.

Costs of neurogenic bladder vary widely and depend on a number of factors including severity of disease, symptomatology, patient insurance, and devices required. Recognition of how each treatment strategy will impact the patient financially could help guide selection of treatment as well as improve compliance with the chosen regimen. We have attempted to provide an overview of long term cost considerations for the neurogenic bladder patient. Armed with this information, the practitioner can better help the patient select a bladder care regimen that balances the desire to both minimize symptoms now and preserve urinary tract integrity for the future, yet still remain cost effective.

Gastrointestinal NursingVol. 13, No. 8 Centre StageSpecialist paediatric bladder and bowel care nurseClaire LindsayClaire LindsaySearch for more papers by this authorClaire LindsayPublished Online:15 Oct 2015https://doi.org/10.12968/gasn.2015.13.8.50AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article FiguresReferencesRelatedDetails 2 October 2015Volume 13Issue 8ISSN (print): 1479-5248ISSN (online): 2052-2835 Metrics History Published online 15 October 2015 Published in print 2 October 2015 Information© MA Healthcare LimitedPDF download

BackgroundYouth with spina bifida (SB) are less fit and active than other groups with childhood disability. While recent studies have shown benefits of exercise training, the increased fitness levels do not sustain or lead to increased levels of physical activity (PA) in these children. Therefore, it seems important to explore which factors are associated with participation in PA (or lack of) in youth with SB. The objective of this study is to describe both personal and environmental factors that are important for participation in physical activity as experienced by these children and their parents, in order to better develop intervention strategies to improve participation in PA in youth with SB.MethodsEleven semi-structured interviews with parents of children with SB aged 4–7 years, nine focus groups with youth with SB (n = 33, age 8–18 years) and eight focus groups with their parents (n = 31) were conducted, recorded and transcribed verbatim. Two independent researchers analyzed the data. Central themes for physical activity were constructed, using the model for Physical Activity for Persons with a Disability (PAD model) as a background scheme.ResultsData showed that youth with SB encountered both personal and environmental factors associated with participation in PA on all levels of the PAD model. Bowel and bladder care, competence in skills, sufficient fitness, medical events and self-efficacy were important personal factors. Environmental factors that were associated with physical activity included the contact with and support from other people, the use of assistive devices for mobility and care, adequate information regarding possibilities for adapted sports and accessibility of playgrounds and sports facilities.ConclusionsOur findings suggest that a variety of both personal and environmental factors were either positively or negatively associated with participation in PA. An individual approach, assessing possibilities rather than overcoming barriers within and surrounding the child may be a good starting point when setting up intervention programs to improve participation in PA. Therefore, assessment of both personal and environmental factors associated with physical activity should be standard care within multidisciplinary intervention programs aimed to encourage healthy active lifestyles in youth with SB.

Acute flaccid paralysis is an emergency and includes a variety of diagnostic possibilities. Identification of life threatening problems and emergency stabilization should precede further diagnostic evaluation. The common differential diagnoses in the post polio eradication era include Guillain Bane syndrome, acute transverse myelitis and traumatic neuritis. It is essential to rule out reversible causes such as hypokalemia and snake envenomation in the appropriate clinical setting. Stabilization of spine is imperative when trauma is suspected, and early neuroimaging is essential in any child who presents with features of myelopathy to mie out compressive lesions. Careful monitoring of respiratory muscle strength is essential especially in children who progress rapidly and early institution of mechanical ventilation is essential. Management of these children is largely supportive, and includes appropriate ventilator support, provision of early enteral nutrition, physical therapy, strict asepsis, good musing care, bowel and bladder care and psychosocial support. Immunotherapy is useful in certain patients with Guillain Bane syndrome, transverse myelitis and myasthenic crisis. Prolonged ventilation is anticipated in children with severe disease and necessitates tracheostomy to increase patient comfort and facilitate weaning from ventilation. Children who are admitted in intensive care for various disease processes may develop weakness due to critical illness related neuromuscular weakness, no effective treatment exists and management is aimed at identification of risk factors and prevention strategies.

Abstract The study was conducted on Effectiveness of self instructional module on knowledge of post operative self care for mothers undergoing elective caesarean section in selected hospitals, Mangalore. The research design was a one group pre test post test design which was a pre experimental research design. 40 mothers undergoing elective caesarean section by purposive sampling.The pretest knowledge questionnaire was administered to the mothers two days prior to caesarean section, followed by a self instructional module on post operative self care. Post test was conducted after 5 days using the same tool. The collected data were analyzed using descriptive and inferential statistics. The mean knowledge score was 14.98 whereas maximum possible score was 30. Among the 11 areas, the mean percentage knowledge score in the area of caesarean section and self care was 77.50% bladder and bowel care was 60% breast feeding was 58.40% diet was 52.50% pain management was 47.50% post operative complications and home care was 46% baby care was 44.33% early ambulation and exercise was 44% perineal hygiene was 41% wound care was 40.67% and deep breathing and coughing was 40.67%.The 't' value showed significant in the post test ('t' calculated value of pretest and post test knowledge scores = 18.000, p<0.001) which showed that self-instructional module was effective in improving the knowledge of mothers on post operative self care after caesarian section.There was significant association between the level of knowledge and demographic variables namely age parity, education, occupation, monthly income, exposure to health awareness and history of caesarean section.

Despite effective screening, cervical cancer continues to be a major public health problem among women. Radical hysterectomy represents the cornerstone in the management of localized cervical cancer especially in young women. Lower urinary tract dysfunction (LUTD) represents the most common complication after radical hysterectomy with a substantial negative impact on quality of life of survivors. Most patients with cervical cancer treated with radical hysterectomy receive postoperative bladder care at gynaecology departments and urologists are rarely confronted to patients in the post-operative phase. The etiologic factors and the natural history of LUTD following radical hysterectomy are partially elucidated. Furthermore, effective treatment remains elusive.We performed a Pubmed and Medline literature search using the keywords: radical hysterectomy, cervical cancer, and these two terms in combination with urinary dysfunction or bladder dysfunction in order to analyse the evidence on LUTD following radical hysterectomy. Emphasis will be placed on the symptoms as well as their management to prevent upper tract deterioration and to improve quality of life.

The need for competence in bladder and bowel care

Patient dignity is a significant concern among inpatient Veterans with spinal cord injuries (SCIs) because they may lack physical control over their bodies and thus rely on others for a variety of specialized needs, including mobility, personal care, wound care, bowel and bladder care, and rehabilitation, among others. This study examines the complexities of providing and negotiating dignified care in the context of interdisciplinary care teams in SCI, and the challenges Veterans with SCI face maintaining dignity in the context of limited independence. Based on a mixed methods approach that included in‐depth interviews, observations, and pile sorting at six Veterans Health Administration (VA) SCI units, the goal of this study was to explore ways in which dignity was defined, negotiated, and conferred during patient and provider interactions. Study results have immediate value to VA leadership, VA providers, and Veterans by calling attention to the ways in which the concept of patient dignity can be integrated into clinical practice on SCI units. This study provides a methodological framework to capture complex interactions among interdisciplinary care teams and patients, and offers a significant contribution to our understanding of how patient and provider interactions are conferred and negotiated.