Presence Of Incontinence Research Articles

Vliv episiotomie na výskyt močové inkontinence u žen 2-5 let po porodu

Cíl: Cílem práce bylo zjistit vliv episiotomie na výskyt močové inkontinence u žen. Získané výsledky jsme porovnávali s ženami, které během porodu utrpěly spontánní ruptury hráze I. a II. stupně a skupinou žen bez porodního poranění hráze. Metodika: Výzkumný soubor tvořilo 211 žen, které byly 2-5 let po spontánním termínovém porodu. Data byla získávána pomocí dotazníku International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Výsledky: Nebyly zjištěny rozdíly ve výskytu močové inkontinence mezi ženami s epiziotomií a ženami se spontánními rupturami hráze nebo bez porodního poranění hráze. Výskyt močové inkontinence ovlivňuje BMI ženy, parita a přítomnost problémů s únikem moče již před porodem. Závěr: Nebylo prokázáno, že by epiziotomie zvyšovala nebo snižovala výskyt močové inkontinence u žen 2-5 let po porodu.

The Impact of Autonomic Dysfunction on Survival in Patients with Dementia with Lewy Bodies and Parkinson's Disease with Dementia

IntroductionAutonomic dysfunction is a well-known feature in neurodegenerative dementias, especially common in α-synucleinopathies like dementia with Lewy bodies and Parkinson's disease with dementia. The most common symptoms are orthostatic hypotension, incontinence and constipation, but its relevance in clinical practice is poorly understood. There are no earlier studies addressing the influence of autonomic dysfunction on clinical course and survival. The aim of this study was to investigate the frequency of the three most common features of autonomic dysfunction and analyze how it affects survival.MethodsThirty patients with dementia with Lewy bodies and Parkinson's disease with dementia were included in this prospective, longitudinal follow-up study. Presence of incontinence and constipation was recorded at baseline. Blood pressure was measured at baseline, after 3 months and after 6 months according to standardized procedures, with 5 measurements during 10 minutes after rising. Orthostatic hypotension was defined using consensus definitions and persistent orthostatic hypotension was defined as 5 or more measurements with orthostatic hypotension. Difference in survival was analyzed 36 months after baseline.ResultsThere was a high frequency of persistent orthostatic blood pressure (50%), constipation (30%) and incontinence (30%). Patients with persistent orthostatic hypotension had a significantly shorter survival compared to those with no or non-persistent orthostatic hypotension (Log rank x2 = 4.47, p = 0.034). Patients with constipation and/or urinary incontinence, in addition to persistent orthostatic hypotension, had a poorer prognosis compared to those with isolated persistent orthostatic hypotension or no orthostatic hypotension (Log rank x2 = 6.370, p = 0.041).DiscussionAccording to our findings, the identification of autonomic dysfunction seems to be of great importance in clinical practice, not only to avoid falls and other complications, but also as a possible predictor of survival.

Protection of continence in pregnancy, labor and postpartum periods

Urinary incontinence (UI) is a common problem among women. Pregnancy and labor are the major risk factors for UI among young and middle‐aged women. In some studies, the presence of incontinence before and during pregnancy has been shown to be an independent risk factor for urinary and anal incontinence after delivery and beyond. Recently, the need and consequences of many routine interventions applied during each delivery are questioned on an evidence‐based basis. Episiotomy and interventions (forceps, fundal pressure) at the second phase of delivery result in pelvic floor injury by perineal trauma. Similar interventions during delivery pose a risk for urinary and fecal incontinence. Therefore, episiotomy should be avoided as much as possible during delivery, and spontaneous and non‐interventional labor opportunities should be created.Pelvic floor muscle training (PFMT) is often advised as a conservative management method in UI during pregnancy. Investigations suggest that women with stress, urge or mixed UI should be advised to perform PFMT that is part of the conservative management program. There is some evidence in primiparous women that PFMT may prevent UI on the late weeks of pregnancy and the postpartum period. When postpartum pelvic floor exercises are applied along with feedback, they induce a decrease in postpartum incontinence. Furthermore, motivation and the initiative in reminding women regarding kegel exercises were not found to be effective in the postpartum prevention of UI. Postpartum pelvic floor exercises were not found to be consistent with decreased incidence of fecal incontinence. Multidisciplinary approaches are needed to inform women about the risk of postpartum UI.

Addressing incontinence for people with dementia living at home: a documentary analysis of local English community nursing service continence policies and clinical guidance

To establish whether the problems and issues experienced by people with dementia living at home and their carers were addressed in the clinical guidance for continence management for community nursing services in England. Internationally, the numbers of people with dementia are rising. Managing incontinence is a significant issue as the presence of incontinence is one of the triggers for people with dementia to move their residence to a care home. People with dementia living at home and their family carers report difficulties in accessing knowledgeable professionals and acceptable continence products. A review by documentary analysis of clinical policies and guidance from a sample of community nursing services in all Strategic Health Authority regions of England. A sample of clinical policy and guidance documents for continence assessment and management from up to four community nursing services in each of the ten Strategic Health Authority regions in England was sought. Documentary analysis was undertaken on the relevance of the documents identified for people with dementia living at home. Ninety-eight documents from 38 local community nursing services spread across ten Strategic Health Authority areas were obtained and analysed. Only in the documents of three services were nurses offered detailed guidance about the management of incontinence for people with dementia at home. In the documentation of only one service were people with dementia identified as a special case which warranted the provision of additional continence products. Clinical guidance on continence assessment and management for community nurses in many parts of England does not address the specific needs of people with dementia living at home or their carers. Nurses working in community settings and those providing clinical leadership in continence care should review their clinical guidance and policies to ensure relevance for people with dementia living at home and their family carers.

A Midurethral Sling to Reduce Incontinence after Vaginal Prolapse Repair

BackgroundWomen without stress urinary incontinence undergoing vaginal surgery for pelvic-organ prolapse are at risk for postoperative urinary incontinence. A midurethral sling may be placed at the time of prolapse repair to reduce this risk.MethodsWe performed a multicenter trial involving women without symptoms of stress incontinence and with anterior prolapse (of stage 2 or higher on a Pelvic Organ Prolapse Quantification system examination) who were planning to undergo vaginal prolapse surgery. Women were randomly assigned to receive either a midurethral sling or sham incisions during surgery. One primary end point was urinary incontinence or treatment for this condition at 3 months. The second primary end point was the presence of incontinence at 12 months, allowing for subsequent treatment for incontinence.ResultsOf the 337 women who underwent randomization, 327 (97%) completed follow-up at 1 year. At 3 months, the rate of urinary incontinence (or treatment) was 23.6% in the sling group and 49.4% in the sham group (P<0.001). At 12 months, urinary incontinence (allowing for subsequent treatment of incontinence) was present in 27.3% and 43.0% of patients in the sling and sham groups, respectively (P=0.002). The number needed to treat with a sling to prevent one case of urinary incontinence at 12 months was 6.3. The rate of bladder perforation was higher in the sling group than in the sham group (6.7% vs. 0%), as were rates of urinary tract infection (31.0% vs. 18.3%), major bleeding complications (3.1% vs. 0%), and incomplete bladder emptying 6 weeks after surgery (3.7% vs. 0%) (P≤0.05 for all comparisons).ConclusionsA prophylactic midurethral sling inserted during vaginal prolapse surgery resulted in a lower rate of urinary incontinence at 3 and 12 months but higher rates of adverse events. (Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Institutes of Health Office of Research on Women's Health; OPUS ClinicalTrials.gov number, NCT00460434.)

A Comparative Trial: The Safety and Clinical Efficacy of PEG 3350 and Liquid Paraffin in Management of Chronic Functional Constipation in Children

Background: Constipation is one of the most common problems in the pediatric age group. In the vast majority, chronic constipation is idiopathic or functional. In addition to education and behavioral changes, disimpaction and maintenance treatment with medications are the main pillars of successful outcome. The medications are variably effective and have potential side effects. Objectives: The current clinical trial was designed to evaluate clinical efficacy of polyethylene glycol (PEG) 3350 and liquid paraffin in chronic functional constipation. Besides, subjects were followed carefully for the side effects. Material and Methods: This study was involved 110 children suffering from chronic functional constipation. They were placed into two different groups, randomly. Each group was treated with PEG 3350 or liquid paraffin. The clinical efficacy and side effects were monitored. Results: After disimpaction with bisacodyl suppositories or combined with Mineral oil enemas in hard fecal impaction, maintenance therapy with PEG 3350 or liquid paraffin was started. The treatment duration and efficacies were not different between the two groups. Furthermore, serious adverse drug reaction was not observed. The family history of constipation and presence of incontinence were two worse prognostic factors. Conclusion: No difference was observed between PEG 3350 and liquid paraffin in chronic functional constipation in children in terms of their efficacies. They are safe and effective medications in this age group.

Long-Term Urinary Bladder Function Following Unilateral Refluxing Low Loop Cutaneous Ureterostomy

PurposeUnilateral low loop cutaneous ureterostomy (LLCU) has been offered as the preferred method of temporary urinary diversion in cases of massively dilated and refluxing ureters. We sought to explore whether LLCU is effective in preserving urinary bladder function in the long term.Materials and MethodsThe charts of all patients who had undergone temporary unilateral LLCU as newborns in the presence of massive vesico-ureteric reflux were retrospectively reviewed. Demographic data, follow-up length, and presence of incontinence were recorded. Patients were interviewed regarding lower urinary tract symptoms (LUTS), and their urination patterns were recorded by using uroflow and post-void residual (PVR) measurements.ResultsBetween 1972 and 2003, a total of 24 patients underwent unilateral LLCU in the presence of massively refluxing ureters. Eight patients were included in the final analysis. The median age at diversion was 12 days, the median time to closure was 22.5 months, and the median follow-up was 12.5 years. Urinary bladders showed normal contour, normal capacities, and minimal PVRs in most cases. None of the patients required augmentation cystoplasty. One patient suffered from urinary leakage and few demonstrated minimal LUTS.ConclusionsUnilateral refluxing LLCU is an effective method of urinary diversion that preserves urinary bladder function for the long term. Larger studies are required to confirm this finding.

Do vascular risk factors contribute to the prevalence of pressure ulcer in veterans with spinal cord injury?

Objective: The overall goal of this observational study was to determine whether modifiable vascular risk factors contribute to the prevalence of pressure ulcers (PrU) in veterans with traumatic spinal cord injury (SCI).Background: Given the increasingly limited financial resources in hospitals and clinics, identifying risk factors associated with the development of PrU in persons with SCI will be a major step in reducing the cost of care for these individuals, and may improve their quality of life.Method: We retrospectively reviewed the electronic charts of 87 veterans with SCI who are being followed regularly in our SCI clinic and are enrolled in the SCI registry. The data collected included the basic demographics, presence of modifiable vascular risk factors such as hypertension, diabetes mellitus, hyperlipidemia, and current smoking; presence of incontinence and depression; and results from blood drawn for hemoglobin level, blood urea nitrogen, creatinine, and albumin levels and lipid profile on veteran's initial enrollment. Local Institution Review Board approval was obtained for the protocol.Results: Of the 87 veterans with SCI, 27 had PrU. Comparisons between those with and without PrU found no significant differences for the demographic variables of age, gender, age of SCI onset, or SCI duration, but there was a trend for the groups to differ in ethnicity (P = 0.05). Similarly, the presence of modifiable vascular risk factors including hypertension, diabetes mellitus, hyperlipidemia, and current smoking did not differ between those with and without PrU. There were 36 pressure ulcer sites observed in 27 people. The proportion of pressure ulcer sites (of the 36) significantly differed by SCI severity based on the American Spinal Injury Association (ASIA) score (P < 0.0001).Conclusion: This study suggests that the presence of PrU was influenced by the severity of the SCI without any contribution from modifiable vascular risk factors.

Do the self-concept and quality of life decrease in CP patients? Focussing on the predictors of self-concept and quality of life

Purpose. To find out if the quality of life (QOL) and self-concept of the children with cerebral palsy (CP) was different from that of children without disability, to investigate predictive variables that could affect self-concept and QOL.Methods. A total of 40 children with CP and 46 age-matched peers were included. The baseline characteristics including sex, type of CP, the level of disability according to Gross Motor Function Classification System (GMFCS) were recorded. Education levels of both children and parents, demographic features of parents, features of living area, usage of devices and associated impairments were filled out. Self-concept was measured using Piers–Harris Self-concept (PH) Scale. Quality of life was measured by Pediatric Quality of Life Inventory 4.0 (PedsQL). The physical and psychosocial health subscale scores of PedsQL (P-PedsQL and PS-PedsQL) were recorded.Results. Significant differences in mean scores favouring the control group were found for PH scale, PedsQL scale (p < 0.001). P-PedsQL and PS-PedsQL of the CP group were lower than the control group (p < 0.001). PS-PedsQL report was significant predictor of self-concept. The presence of incontinence and GMFCS level were significant predictors of PedsQL and PPedsQL, respectively.Conclusion. Self-concept and QOL of the CP children were lower than the children without CP. Presence of incontinence, self-concept rating and GMFCS level were important to predict domains of QOL.

Do Incontinence, Breathing Difficulties, and Gastrointestinal Symptoms Increase the Risk of Future Back Pain?

Cross-sectional studies have suggested a relationship between respiratory disorders, incontinence, gastrointestinal symptoms, and back pain. However, longitudinal data are lacking. This study aimed to evaluate whether these disorders increase risk for the development of back pain. A total of 2943 younger, 2298 mid-age, and 2258 older women from the Australian Longitudinal Study on Women's Health who reported no back pain during the preceding 12 months were followed for 4, 2, and 3 years, respectively. Crude and adjusted associations between the development of back pain and changes in the presence of incontinence, breathing difficulty, and gastrointestinal symptoms were assessed with logistic regression. Women with preexisting incontinence (prevalence ratios [PR]: 1.26 to 1.46) and gastrointestinal symptoms (PR: 1.24 to 1.44) and women who developed breathing problems (PR: 1.63 to 2.11) were more likely to develop back pain than women without such problems. Menstrual pain and allergy were also associated with back pain development. Consistent with predictions from physiological data, this study provides novel evidence that the presence and/or development of incontinence, respiratory problems, and gastrointestinal symptoms are associated with the development of back pain. This highlights the importance of comorbidities and suggests opportunities for future preventative interventions. This study demonstrates that women with incontinence, respiratory disorders, and gastrointestinal symptoms have increased risk for the development of back pain. Evidence of compromised control of the spine in people with incontinence and respiratory disorders and the potential for viscerosomatic hyperalgesia in people with gastrointestinal symptoms may provide physiological explanations for these findings.

Prevalence of Urinary Incontinence in Women With Osteoporosis

ObjectiveTo investigate the prevalence and frequency of urinary incontinence in women presenting to a specialist osteoporosis clinic. MethodsParticipants included 412 female patients aged 22 to 94 years (mean 62 years) presenting to a hospital-based specialist multidisciplinary osteoporosis clinic over one year. The presence or absence of urinary incontinence, urgency without leakage, type of symptoms (stress, urge, mixed) and frequency of urinary incontinence were recorded. ResultsSixty-seven percent of patients (277/412) reported some symptoms of urinary incontinence, 23% reported no symptoms and 10% reported urgency without any leakage. Of those who reported some urinary incontinence, 51% reported symptoms of stress incontinence, urgency, and urge incontinence. Almost 40% of all patients (163/412) and 59% of those with any urinary incontinence (163/277) reported leakage at least once per week. ConclusionThe prevalence of at least weekly urinary incontinence in this population is much higher than that reported in studies of other older adult female populations. There is also a high prevalence of incontinence accompanied by urgency in women with osteoporosis. Based on these results and because urinary incontinence can limit a woman’s ability to be physically active and increase the risk of falls and fractures, screening for incontinence should be a routine part of osteoporosis management. Clinicians seeing patients for osteoporosis should consider the presence of incontinence when prescribing exercise for bone health and fall prevention.

870 STRESS URINARY INCONTINENCE AFTER RADICAL PROSTATECTOMY: LONG TERM EFFECTS OF ENDOSCOPIC INJECTION WITH DEXTRANOMER/HYLAURONIC ACID COPOLYMER

INTRODUCTION AND OBJECTIVES: After radical prostatectomy due to prostate cancer a remarcably number of patients suffer of stress urinary incontinence (SIU). Dextranomer/hyaluronic acid copolymer (Deflux) is a substance which is easy to applicate, with a good biocompatibility and no tendency to migrate. In a retrospective study 21 patients in our department were injected for mild to moderarte stress incontinence after radical prostatectomy. Urethral injection of bulking agents as a minimal invasive treatment option for SUI was controlled for its efficacy and time of duration. METHODS: Between October 2003 and September 2007 21 male patients with mild to moderate SUI postoperative after radical prostatectomy were treated with endoscopic injection of Deflux. Injection site was in the anastomotic area. Prospectively all patients were interviewed by telephone. The endpoint of the study was the presence of incontinence and the number of pads per day respectively. Incontinence was defined as “the complaint of involuntary leakage on effort or exertion, or on sneezing or coughing” according the definition of the International Continence Society (ICS) 2002. RESULTS: Operating time was 14 min (5 31min). Before injection a suprapubic catheter was inserted. Mean injected volume was 3.2 ml (2,5 4.5 ml). Mean hospital stay was 1,1 days (1 3 days). One patient had a hematuria from the suprapubic catheter which was treated conservatively. No other complications were reported. After a median follow-up of 30.7 months (8 55 months) all patients were interviewed by telephone. Before therapy all 21 patients had mean 3,3 (1-10) Pads/ day, In the long term follow up two patients of the 21 patients (9,5%) didn`t need any pads and were defined as continent. 19 patients (90,5%) showed no improvement post injection. In these patients the mean number of pads before and postoperatively didn`t change significantly (p > 0, 3). Meanwhile in 7 of these patients artifical devices were implanted (5 pts artificial sphincter, suburethral slings in 2 pts). CONCLUSIONS: The injection of Dextranomer/hyaluronic acid copolymer (Deflux) for SUI in patients after radical prostatectomy is a minimal invasive treatment option with a low complication rate. In the long term follow up the success rate of this technique was found to be 9,5%. The costs for the amount of used substance were dependent to the injected volume high. Only in selected cases endoscopic injection can be advised as treatment option.

Home care nurses' ratings of appropriateness of wound treatments and wound healing

Purpose: The purpose of this study was to examine nurses' ratings of appropriateness of wound treatments and wound healing for patients in home care in relation to patient demographic and visit variables. Design: A cross-sectional design was used. Setting and subjects: Data were collected about patients with wounds by 281 nurses from 13 home care agencies located throughout lower Michigan. Patients with wounds (n = 881) ranged in age from 21 to 100 years. They included 492 women and 383 men who were white (72.4%) or African-American (26%). Instruments: The Community Wound Assessment Tool was developed for the study and was used to obtain demographic and wound data. The demographic section contained information about the patient's age, sex, reason for the visit, length of visit, and time the case was opened. The wound section included the wound type, treatments, presence of incontinence, nutritional supplementation, and adverse home environmental factors. Nurses rated wounds as healing or not healing. Wound treatments were rated as all appropriate, some appropriate/inappropriate, and all inappropriate. Methods: Nurses were systematically selected from each agency and collected data about each patient visited on one occasion. Main outcome measurements: The main outcome measurements were the relationship of patient demographic variables and visit variables to the appropriateness of wound treatments and wound healing. Results: The nurses' rating of wound treatments as appropriate was significantly related to younger patient age and a shorter time for the case to be open. Wound healing was initially associated with younger patient age, continence of urine or stool, shorter home visits, shorter time for the case to be open, and fewer reasons for the visit. When wound healing was controlled for the type of wound in path analysis, the patient's age was no longer significant and incontinence appeared to impair healing of nonsurgical wounds. The appropriateness of the wound treatments was significantly related to wound healing. Conclusions: Nurses' ratings of appropriateness of wound treatments and healing are significantly related to factors that affect length of service and complexity of care for the home care patient with a wound. Decisions nurses make about wound treatments and healing are important for the patient as well as for the agency. (J WOCN:2002;29:20-8.)

Home Care Nursesʼ Ratings of Appropriateness of Wound Treatments and Wound Healing

In Brief Purpose The purpose of this study was to examine nurses' ratings of appropriateness of wound treatments and wound healing for patients in home care in relation to patient demographic and visit variables. Design A cross-sectional design was used. Setting and subjects Data were collected about patients with wounds by 281 nurses from 13 home care agencies located throughout lower Michigan. Patients with wounds (n = 881) ranged in age from 21 to 100 years. They included 492 women and 383 men who were white (72.4%) or African-American (26%). Instruments The Community Wound Assessment Tool was developed for the study and was used to obtain demographic and wound data. The demographic section contained information about the patient's age, sex, reason for the visit, length of visit, and time the case was opened. The wound section included the wound type, treatments, presence of incontinence, nutritional supplementation, and adverse home environmental factors. Nurses rated wounds as healing or not healing. Wound treatments were rated as all appropriate, some appropriate/inappropriate, and all inappropriate. Methods Nurses were systematically selected from each agency and collected data about each patient visited on one occasion. Main outcome measurements The main outcome measurements were the relationship of patient demographic variables and visit variables to the appropriateness of wound treatments and wound healing. Results The nurses' rating of wound treatments as appropriate was significantly related to younger patient age and a shorter time for the case to be open. Wound healing was initially associated with younger patient age, continence of urine or stool, shorter home visits, shorter time for the case to be open, and fewer reasons for the visit. When wound healing was controlled for the type of wound in path analysis, the patient's age was no longer significant and incontinence appeared to impair healing of nonsurgical wounds. The appropriateness of the wound treatments was significantly related to wound healing. Conclusions Nurses' ratings of appropriateness of wound treatments and healing are significantly related to factors that affect length of service and complexity of care for the home care patient with a wound. Decisions nurses make about wound treatments and healing are important for the patient as well as for the agency. This research study set out to examine nurses' ratings of the appropriateness of wound treatments and wound healing for patients in home care.

Expectativas del tratamiento de la incontinencia urinaria vistas desde una población de ancianos

To determine the attitudes of community-dwelling elderly patients about the possibilities for cure of urinary incontinence. Cross-sectional study. A specific questionnaire on urinary incontinence and the Barthel Index Modified by Shah. Basic Health Zone of Cabra (Córdoba, Spain). A random age-stratified sample of 793 patients selected from a total of 5139 persons > or = 65 years of age. Home interview on urinary incontinence (presence, characteristics, patient attitude regarding possibilities for cure). Forty-eight percent of elderly persons felt that incontinence could be cured, 21% thought that it could be improved, 9% stated that nothing could be done about it and the remaining 22% had no opinion. A significant association was found between the type of response and age, sex, state of health as perceived by the subject and level of self-care. The presence of incontinence did not influence the nature of the responses given by patients about the possibilities for successful treatment of incontinence. Our elderly persons were not aware of the possibilities for treatment of incontinence, a fact that may have a negative impact on sufferers seeking help for this remediable problem.

Hospital services for stroke care. A European Perspective. European Study of Stroke Care.

Stroke is a common cause of mortality and morbidity in Europe and a major consumer of healthcare costs. However, outcomes from stroke vary significantly across Europe, raising the issue of the extent to which the delivery of care varies across Europe. A multicenter, multinational study collected data on hospital admission for stroke. These included patient baseline characteristics, clinical status, and use of inpatient services. Initial results examined inpatient services in nine hospitals in six countries. Statistically significant differences existed between hospitals in key processes of care, most notably in the areas of (1) mean length of stay (11 to 39 days) and median length of stay (8 to 21 days), (2) percentage of admissions receiving brain imaging (30% to 98%) and neurosurgery (0% to 31%), and (3) percentage of admissions with an identified "need" who received physiotherapy (44% to 90%) and occupational (0% to 65%) and speech (0% to 59%) therapy. Although there were significant hospital differences (P < .001) in the case mix of admissions in terms of level of consciousness, presence of incontinence, prestroke Rankin Scale score, and age, these did not explain the differences in care across sites. There is geographic inequity across Europe in the care a stroke patient can expect to receive. Ongoing analysis will examine the link between European variations in service use and outcomes, in terms of mortality, handicap, and functional ability, as a means of indicating which patterns of care are the most effective.

Nurses?? Attitudes Toward Older Persons on Their Use of Physical Restraints

This descriptive study explores the relationship between acute care nurses' attitudes toward older persons, their attitudes toward the use of physical restraints, and their actual use of physical restraints. Restraint use by 52 nurses employed in a hospital setting was assessed for a 1-week period. Three weeks later, two attitude questionnaires were administered to the same group of nurses. Although the incidence of restraint use was low (< 5%), results indicated that nurses with negative attitudes toward older persons were likely to favor the use of restraints with older persons (p = .006). Negative attitudes, however, were not related to the actual use of physical restraints. Factors such as the number of older persons (p = .02) and confused patients (p = .01) in the nurse's assignment, the unit census (p = .00), patient age (p = .00), mental status (p = .00), and the presence of incontinence (p = .00) were significantly related to restraint use. These findings suggest that strategies other than changing nurses' attitudes may be more effective in reducing restraint use.

Handicaps associated with incontinence: implications for management.

The aim was to explore the relationship between dementia, impairment of mobility, and incontinence and the implications for management. The study was a survey of a sample population drawn from a general practice register. A large general practice serving the entire population of Melton Mowbray, Leicestershire, UK. Of 1329 persons aged 75 or over, 1203 (90%) took part in the survey. Of non-responders, refusers accounted for 5%, deaths 4%, and failure to trace 1%. 12% of the population complained of incontinence. No more than 24% of these cases were demented. Dementia and isolated locomotor problems were significantly associated with presence of incontinence, but 31% of cases were completely free of either problem. A minimum estimate of 56% of cases of incontinence were considered to be due to local physical disorders of the bladder. A search for local disorders causing incontinence is important, and more attention should be paid to the management of locomotor problems and possibly depression in the relief of incontinence.

Products to treat decubitus ulcers

Pressure ulcers are a significant health care problem all across the world due to their associated high mortality and morbidity rates and high health care costs. The prevalence of pressure ulcers serves as one of the most important indicators of the quality of nursing care.This study aims to determine the prevalence of pressure ulcers and patient-related risk factors in inpatients receiving treatment in the province of Erzurum, located in the eastern part of Turkey.This is a cross-sectional study.which included 832 inpatients hospitalized for at least 24 h after admission in five hospitals in the province of Erzurum. All of the study patients were 18 years of age or older and agreed to participate in the research. Patients hospitalized in the obstetric, emergency, and pediatric clinics were excluded from the study (due to the low probability of pressure ulcers in these clinics).For the collection of data, the “Introductory Information Form” was used to learn the socio-demographic and clinical characteristics of the patients, and the “Braden Risk Assessment Scale” was used to determine the risk of pressure ulcers. The stage of the pressure ulcers of the patients was determined according to the classification of the National Pressure Ulcer Advisory Panel (NPUAP).Since the study was planned as a point prevalence study, research data were gathered by the researchers and interviewers on a single day designated for each hospital during the first week of October 2016.Among the patients included in the study, 53.1% were male, mean age was 56.62 ± 17.95, 57.2% were treated in internal clinics, and the mean hospital stay was 9.02 ± 13.36 days. In terms of the patients' risk of pressure ulcers, it was determined that 28% were at risk. The overall prevalence of pressure ulcers was calculated to be 12.7% (for stages I-IV), with the overall prevalence decreasing by 6.7% when the patients with stage-I were excluded. Furthermore, it was found that 48.3% of the pressure ulcers were stage-I, and that the sacral region (37.3%) was the most affected region. According to the logistic regression analysis conducted to determine the factors, along with their weights, that affect the development of pressure ulcers, the age of the patient, the duration of the hospital stay, the presence of incontinence, albumin level problems, and a Braden score below 17 were found to have an impact (p < 0.05).In this study, the prevalence of pressure ulcers was calculated to be 12.7%, with the highest prevalence found in intensive care clinics (35.3%). The age of the patient, the duration of the hospital stays, the presence of incontinence, albumin level problems, and a Braden score below 17 were found to be effective in the development of pressure ulcers.

Anorectal motility after surgery for spina bifida.

Anorectal motility was studied in 93 children (aged 15 days to 16 1/2 years) who had undergone surgery for myelocele or meningomyelocele, and 80 controls, matched for age and sex. Mean resting pressure in the anal canal of patients was markedly decreased, particularly in the presence of incontinence, and unstable. The recording of a rectoanal inhibitory reflex both in the upper anal canal and at the anal margin was associated with the presence of fecal incontinence and motor disorders of the lower extremities. Patients could be divided into four groups according to manometric pattern: 1) those with normal recordings (incontinence in 63 per cent), 2) those with spontaneous intermittent relaxations of the upper anal canal and simultaneous rectal contractions (incontinence in 91 per cent), 3) those with normal manometry except for unstable upper anal canal pressure (incontinence in 92 per cent), and 4) those with absence of the rectoanal inhibitory reflex and hypotonic anal canal (patients too young to appraise continence, all under 2 years).