|
| ||
|
|
||
Bladder Incontinence (bladder + incontinence)
Selected AbstractsIncontinence: prevalence, management, staff knowledge and professional practice environment in rehabilitation unitsINTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING, Issue 1 2009Geraldine McCarthy MSc Background., Bladder and bowel incontinence is a major health care problem, which adversely affects the lives of many individuals living at home or in health service facilities. Current approaches to continence care emphasize comfort, safety and reduction of risk, rather than detailed individualized assessment and management. The literature illustrates a gap between evidence and actual practice and emphasizes the context of care as being a key element for successful implementation of evidence based practice. Aims., To identify prevalence of bowel and bladder incontinence and its management, investigate continence knowledge and describe the professional practice environment within a rehabilitation unit for older people. Method., An integrated evaluation of continence prevalence, staff knowledge and the work environment was adopted. Results., Findings revealed a high incidence of incontinence (60% urinary, 3% faecal, 37% mixed) a lack of specific continence assessment and specific rationale for treatment decisions or continuation of care. The focus was on continence containment rather than on proactive management. Staff demonstrated a reasonable knowledge of incontinence causation and treatment as measured by the staff knowledge audit. The evaluation of the work environment indicated a low to moderate perception of control over practice (2.39), autonomy in practice (2.87), nurse doctor relationship (2.67) and organizational support (2.67). [source] Prevalence of vision, hearing, and combined vision and hearing impairments in patients with hip fracturesJOURNAL OF CLINICAL NURSING, Issue 21 2009Else Vengnes Grue Aims and objectives., To examine the prevalence of hearing and vision impairments in 65+ year-old patients with hip fractures. Background., Many older people believe sensory problems are inevitable and thus avoid medical assessment and assistance. Furthermore, health professionals often overlook sensory problems, though it is known that sensory impairments can increase the risk of falling and sustaining hip fractures. Design., A prospective, observational study. Methods., We admitted 544 consecutive patients to an orthogeriatric ward from October 2004,July 2006; 332 were screened for study inclusion with the Resident Assessment Instrument for Acute Care (InterRAI-AC) and a questionnaire (KAS-Screen). We conducted patient interviews, objective assessments, explored hospital records and interviewed the family and staff. Impairments were defined as problems with seeing, reading regular print or hearing normal speech. Results., Sixteen per cent of the patients had no sensory impairments, 15·4% had vision impairments, 38·6% had hearing impairments and 30·1% had combined sensory impairments. Among the impaired, 80·6% were female, the mean age was 84·3 years (SD 6·8), 79·9% were living alone, 48·0% had cognitive impairments, 89·6% had impaired activities of daily living, 70·6% had impaired instrument activities in daily living, 51·0% had bladder incontinence and 26·.8% were underweight. Comorbidity and polypharmacy were common. Delirium was detected in 17·9% on day three after surgery. Results showed the prevalence of combined sensory impairments was: 32·8% none; 52·2% moderate/severe; and 15·1% severe. Conclusion., Patients with hip fractures frequently have hearing, vision and combined impairments. Relevance to clinical practice., We recommend routine screening for sensory impairments in patients with hip fractures. Most sensory problems can be treated or relieved with environmental adjustments. Patients should be encouraged to seek treatment and training for adapting to sensory deficiencies. This approach may reduce the number of falls and improve the ability to sustain independent living. [source] Deinstitutionalization in Ontario, Canada: Understanding Who Moved WhenJOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES, Issue 3 2010Lynn Martin Abstract The results of deinstitutionalization are well known, but less information is available on the process of deinstitutionalization itself. This study sought to understand the process of deinstitutionalization in Ontario by examining the timing of individuals' transitions to the community and the characteristics of individuals who experienced a change in the timing of their move. Data used were based on census information collected between 2005 and 2008 using the interRAI Intellectual Disability assessment instrument on all persons residing in Ontario's specialized institutions. Analyses of characteristics at baseline by the anticipated transition year revealed the existence of significant differences between the groups. Comparisons of anticipated and actual transition years revealed that about 40% of individuals experienced a change in their transition year. Age, bladder incontinence, and number of medical diagnoses were associated with increased likelihood of moving earlier than anticipated, whereas family contact, presence of a strong and supportive relationship with family, psychiatric diagnoses, destructive behavior, and aggression were associated with higher likelihood of moving later. Careful attention to characteristics and level of need was paid at the onset of the deinstitutionalization planning process; however, the timing of transitions to the community was not "set in stone." In the future, studies should not only examine the individual's outcomes and quality of life in the community, but also should seek to qualitatively describe the individual's and family's experiences of the transition process. This type of information is invaluable for other jurisdictions in which deinstitutionalization is planned or under way. [source] Catheter Tip Granuloma Associated with Sacral Region Intrathecal Drug AdministrationNEUROMODULATION, Issue 4 2003Fernandez Julius MD Abstract Spinal cord compression from catheter tip granulomatous masses following intrathecal drug administration may produce devastating permanent neurologic deficits. Some authors have advocated intrathecal catheter placement below the conus medullaris to avoid the possibility of spinal cord involvement. Multiple cases of catheter tip granulomas in the thoracolumbar region have been reported. We present a unique case of a sacral region catheter tip inflammatory mass producing permanent neurologic deficits. A 71-year-old white male with a diagnosis of failed back surgery syndrome was referred to the senior author for evaluation. After more extensive conservative therapy, including spinal cord stimulation, failed to yield adequate pain relief, he was offered implantation of an intrathecal pump for opioid administration. Excellent pain relief was achieved in the postoperative period; however, three years after implantation, he presented with progressive saddle anesthesia and bowel/bladder incontinence. Magnetic resonance imaging demonstrated a space occupying lesion associated with the catheter tip. The patient underwent emergent second level complete sacral laminectomy with partial resection of an intradural extra-axial mass and removal of intrathecal catheter. At discharge, the patient had no restoration of neurologic function. Histologic examination of the mass confirmed a sterile inflammatory mass. It has been suggested that intrathecal catheters be placed below the conus medullaris to avoid the possibility of spinal cord involvement. We present an unusual case documenting devastating permanent neurologic deficits from a catheter tip granuloma in the sacral region. [source] | ||||||||||