Terazosin for vesicosphincter dyssynergia in spinal cord-injured male patients

PURPOSE

Evaluation of the role of the long-acting alpha-adrenergic blocker, terazosin, in the treatment of vesicosphincter dyssynergia (VSD) in spinal cord-injured male patients.

PATIENTS AND METHODS

Sixty spinal cord-injured male patients with VSD were recruited prospectively. Their mean age was 37 years (range 15-70 years). Baseline evaluation included a thorough medical history, clinical examination, blood pressure measurement, intravenous urogram, and videourodynamics. The patients received terazosin for a 90-day period. Videourodynamic evaluation after completion of the study included cystometrogram, sphincter electromyography, maximum urethral pressure gradient (MUPG), and measurement of post voiding residual (PVR) urine volume. The findings were compared with the pretreatment values.

RESULTS

Of the 60 patients, 35 completed the study. According to response to treatment, two groups were identified: Group A = responders (N = 17; 49%) and Group B = nonresponders (N = 18, 51%). In Group A, there was a significant decrease in the maximum detrusor pressure, from a mean of 105.3 to 73.9 cm H(2)O, and in MUPG, from a mean of 84.7 to 54.1 cm H(2)O. The bladder capacity and PVR did not change significantly in either group. The time since injury was significantly longer in Group A than in Group B.

CONCLUSIONS

Terazosin in a dose of 10 mg/day was well tolerated and effective in reducing bladder outlet obstruction in many spinal cord-injured patients, as reflected by a decrease in maximum detrusor pressure and MUPG in 49% of the patients. Patients with a weak or negative response initially may respond later. Terazosin should be considered a first-line treatment of VSD prior to contemplating surgery.

A model for predicting motor urge urinary incontinence

BACKGROUND

While the historical interview has been shown to diagnose stress urinary incontinence (UI) with reasonable accuracy, it is less accurate in the diagnosis of urge or mixed UI.

OBJECTIVES

To construct an optimal model for the diagnosis of motor urge UI, and to refine this model into a simplified instrument that can be used to diagnose motor urge UI during a routine incontinence evaluation.

METHODS

A model was constructed to allow a more accurate diagnosis of motor urge UI using historical data. Initially, an optimal model was developed that used three key symptoms, age, gender, a history of neurologic disorder, obstruction diagnosed via voiding pressure study, and the urethral resistance algorithm to diagnose motor urge UI. A simplified model was then constructed using factors such as symptoms of motor urge UI, age, and gender that were readily accessible to the nurse when completing a routine UI evaluation. This simplified model was used to develop an instrument for the clinical diagnosis of motor urge UI.

RESULTS

While the agreement between clinical and urodynamic diagnosis was relatively high among patients with genuine stress UI (93% accuracy rate), it was considerably less among patients with urge and mixed UI, yielding accuracy rates of 63% and 35%, respectively. An optimal model for diagnosing motor urge UI was constructed and provided an overall accuracy rate of 91%. A simplified model was then constructed and evaluated for performance by least squares fit test. It revealed an R2 of 0.85 and an adjusted R2 of 0.84.

CONCLUSIONS

A combination of age, gender, and three key symptoms (diurnal frequency, nocturia, and symptom of urge incontinence) provide an accurate and clinically useful model for the diagnosis of motor urge UI. Additional research is recommended to test the validity and reliability of the instrument derived from this model.

Effects of Acrobat MZ and Tattoo C on Japanese medaka (Oryzias latipes) development and adult male behavior

Exposure of Japanese medaka (Oryzias latipes) embryos and adult males to sublethal concentrations of two commonly used fungicides, Acrobat MZ and Tattoo C, had varying effects on development and adult male behavior. During embryolarval assays, medaka exposed to Acrobat exhibited decreased heart rates throughout embryonic development and were smaller at hatching than controls. Differences in hatching size were not apparent with Tattoo although some decrease in heart rate was observed at higher concentrations. Tail lesions and abnormal spinal development was a problem common to embryos exposed to Acrobat. Neither time to hatch nor early growth was affected by exposure to either fungicide. Adult males that had been exposed to high concentrations of Acrobat or Tattoo over a 28-day period were less likely to approach females during behavioral trials. The absence of other behavioral effects, particularly those related to reproductive performance, may have been due to females being sexually unreceptive during behavioral trials. No other behavioral modifications were apparent for adult males exposed to either fungicide. Information about developmental and behavioral responses to sublethal concentrations of pesticides is important for establishing environmental guidelines concerning their use.

A New Module in Caring for Older Adults: Problem-Based Learning and Practice Portfolios

It is not often that educators have the chance to design a new educational program on the basis of up-to-date and locally relevant research findings. We describe the process by which we designed a new module, aimed at registered nurses who care for older adults in the community. The content of the new module was derived from an analysis of educational needs of the potential student population. The mode of delivery was strongly student-centered, using problem-based learning. Assessment was through the building up by students of a practice portfolio. This paper focuses on a description of the new module and how it relates to the findings of the educational needs analysis. The National Board for Nursing, Midwifery and Health Visiting for Scotland put out a tender in 1995 for a community research project on "Educational Provision for Evolving Roles in Community Health Care" (Nursing Times, June, 9, 1995) with the aim of piloting and evaluating an "innovative program which meets changing needs in community health care." A joint bid by Napier University and the University of Glasgow not only proposed to pilot and evaluate the educational program, but also first to develop the content of the program itself through an educational needs analysis. In this paper, we will first provide an outline of the research that underpinned the educational program. Then, we will describe how the results of the needs analysis were implemented into an innovative educational module. Finally, we will give a brief summary of the new module.

The oral health of South Asian five-year-old children in deprived areas of Dudley compared with White children of equal deprivation and fluoridation status

OBJECTIVE

To investigate the oral health of five-year-old children from South Asian ethnic groups and compare this with White children of equal deprivation and fluoridation status.

DESIGN

An epidemiological survey of five-year-old children in Dudley was carried out as part of the 1996 BASCD co-ordinated programme but with the collection of additional variables (ethnic classification and postcode of residence).

CLINICAL SETTING

The examinations were carried out in schools in Dudley, England.

PARTICIPANTS

Five hundred and fifty-four five-year-old children living in neighbourhoods with an ACORN code F (striving) and attending schools in the fluoridated part of Dudley.

MAIN OUTCOME MEASURES

Disease levels were measured using the dmft index. Caries was diagnosed at the caries into dentine (d3) threshold using a visual method without radiography or fibre-optic transillumination.

RESULTS

The prevalence of dental caries, particularly untreated caries, was higher in South Asian children. There was no difference in the intensity or pattern of disease between the two groups when comparing those children with disease experience.

CONCLUSIONS

Dental caries experience in young children continues to be associated with ethnicity once the data are controlled for deprivation and fluoridation status.

Medically complex pregnancy: a case report illustrating CNM/MD collaborative management

In contemporary society, many women with complex medical conditions are attempting fertility and becoming pregnant. The patient presents with an impressive medical complication, yet many of her key educational and psychosocial needs are typical of those for any pregnant woman. Striving for "normalcy," she may actively seek midwifery care to help her create a family-centered birth experience. Indeed, the midwife practicing with physician colleagues may have the opportunity to collaboratively manage increasingly complex cases. This article describes the case of collaborative management during pregnancy and delivery of a patient with the cardiac syndrome Wolff-Parkinson White syndrome (WPW). First diagnosed with WPW at the age of 13, the patient's condition was initially controlled with oral medication. Eventually, the patient's symptomology worsened and required repeated treatment by cardiac ablation of the accessory pathway. Illustrative of the possibilities for enhanced care of the medically complex pregnant patient via collaborative management, the discussion details not only the pertinent physiologic events but the benefits and process of care. A review of the cardiophysiology of WPW is also presented.

Anion interactions with CFTR and consequences for HCO3- transport in secretory epithelia

We have been studying CFTR channels in guinea pig pancreatic duct cells and rather surprisingly found that luminal HCO3- had a pronounced inhibitory effect on cAMP-activated CFTR chloride currents. The block produced by HCO3- was rapid, voltage-independent and occurred over a physiological range of extracellular HCO3- concentrations. I- and ClO4- were also found to inhibit CFTR currents, but both were less effective than HCO3-. Although we have not identified how HCO3- is able to block CFTR our data suggests that an external anion-binding site on the channel itself is involved. Overall, our results show that luminal HCO3- acts as a potent inhibitor of CFTR channels (and by inference CFTR-mediated secretion), under normal physiological conditions. These data have implications not only for current models of pancreatic duct cell HCO3- transport, but also for other bicarbonate-secreting tissues, such as the liver, GI tract and lungs.

Maintenance of androdioecy in the freshwater shrimp, Eulimnadia texana: estimates of inbreeding depression in two populations

Androdioecy is an uncommon form of reproduction in which males coexist with hermaphrodites. Androdioecy is thought to be difficult to evolve in species that regularly inbreed. The freshwater shrimp Eulimnadia texana has recently been described as both androdioecious and highly selfing and is thus anomalous. Inbreeding depression is one factor that may maintain males in these populations. Here we examine the extent of "late" inbreeding depression (after sexual maturity) in these clam shrimp using two tests: (1) comparing the fitness of shrimp varying in their levels of individual heterozygosity from two natural populations that differ in overall genetic diversity; and (2) specifically outcrossing and selfing shrimp from these same populations and comparing fitness of the resulting offspring. The effects of inbreeding differed within each population. In the more genetically diverse population, fecundity, size, and mortality were significantly reduced in inbred shrimp. In the less genetically diverse population, none of the fitness measures was significantly lowered in selfed shrimp. Combining estimates of early inbreeding depression from a previous study with current estimates of late inbreeding depression suggests that inbreeding depression is substantial (delta = 0.68) in the more diverse population and somewhat lower (delta = 0.50) in the less diverse population. However, given that males have higher mortality rates than hermaphrodites, neither estimate of inbreeding depression is large enough to account for the maintenance of males in either population by inbreeding depression alone. Thus, the stability of androdioecy in this system is likely only if hermaphrodites are unable to self-fertilize many of their own eggs when not mated to a male or if male mating success is generally high (or at least high when males are rare). Patterns of fitness responses in the two populations were consistent with the hypothesis that inbreeding depression is caused by partially recessive deleterious alleles, although a formal test of this hypothesis still needs to be conducted.

No evidence for association between a non-synonymous polymorphism in the gene encoding human metabotropic glutamate receptor 7 and schizophrenia

The cDNA sequence of the gene encoding human metabotropic glutamate receptor type 7 (mGluR7) contains the single nucleotide polymorphism 1536A > T [GenBank sequence X94552 (Makoff et al., 1996)]. This sequence variation is predicted to result in an amino acid change (F433Y) in the gene product and thus has the potential to affect receptor function. Since disturbances in glutamate function have been implicated in the pathophysiology of schizophrenia, we have used a novel and robust polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) assay to genotype this polymorphism in a case-control sample comprising 181 schizophrenic patients and 182 group-matched unaffected individuals. No evidence was found for association between this polymorphism and schizophrenia. We have also localised mGluR7 to chromosome 3p25-22 using radiation hybrid (RH) mapping.

Voiding dysfunction after radiation to the prostate for prostate cancer

Radiation therapy is an increasingly common treatment for prostate cancer. Although radiotherapy is generally effective, it is not free of complications. Acute adverse effects of radiation are usually mild and managed on an outpatient basis. In contrast, long-term complications, although uncommon, may be debilitating or even life-threatening, requiring more invasive treatments or hospitalization. This article will review the pathophysiology of the acute and long-term effects of radiation on the lower urinary tract and implications for WOC nursing management of patients with voiding dysfunction following radiation therapy for prostate cancer.

Endothelin-1 stimulates cardiac fibroblast proliferation through activation of protein kinase C

After myocardial ischemia, circulating levels of the mitogen endothelin-1 (ET-1) increase. The effects of ET-1 on cardiac fibroblasts are poorly characterized. Therefore we examined the influence of ET-1 on cardiac fibroblast proliferation with a view to elucidating the signal transduction mechanisms underlying this effect. ET-1 (10 n m) stimulated [(3)H]thymidine incorporation and cell proliferation in cultured neonatal rat cardiac fibroblasts, consistent with its activity as a mitogen. We examined the role of protein kinase C (PKC) on this function. Inhibition of PKC activation with either chelerythrine (1 microm) or staurosporine (1 n m) attenuated ET-1-induced increases in DNA synthesis and cell number. Downregulation of PKC by chronic pretreatment with 10 n m phorbol 12-myristate 13-acetate (PMA) also prevented ET-1-induced mitogenesis. In contrast to previous reports that cardiac fibroblast proliferation stimulated by angiotensin II acts independently of PKC, the ET-1 mediated mitogenic effect requires activation of PKC in these cells. Findings in adult rat cardiac fibroblasts were identical. In addition, we noted that concurrent treatment with the pro-inflammatory cytokine interleukin 1 beta which, like ET-1, is released after myocardial ischemia, attenuated the ET-1-induced increases in DNA synthesis and cell number. This effect was not mediated through a nitric oxide synthase pathway.

Continence for women: evaluation of AWHONN's third research utilization project

OBJECTIVE: To develop an evidence-based protocol for initial evaluation and treatment of urinary incontinence and to design procedures that would facilitate the protocol's implementation into clinical practice. DESIGN: Descriptive report of the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) Continence for Women Project. SETTING: Twenty-one public, private, and other women's health sites. Participants: Women in ambulatory care settings (N = 1474) provided demographic statistics. METHODS: The protocol was developed, sites were selected, site coordinator training was provided, data collection was facilitated by project-specific teleforms, and the overall process was evaluated by the science team. MAIN OUTCOME MEASURES: Site representation, patient representation, site coordinator feedback on the training program, and site coordinator experience during project implementation. RESULTS: The process yielded a representative mix of site and patient diversity appropriate for testing of the protocol. Site coordinators felt well-prepared to implement the protocol and experienced increased professional satisfaction because of therapeutic benefits achieved for patients and positive collaboration with physicians. CONCLUSIONS: The Continence for Women Project demonstrated the potential for developing and testing evidence-based protocols for clinical practice when the resources of an organization such as AWHONN and the research community are combined.

Screening sigmoidoscopy: a randomised trial of invitation style

OBJECTIVES

To examine uptake rates for screening sigmoidoscopy and whether offering prior consultation about sigmoidoscopic screening improves the uptake rate.

DESIGN

Patients between 50.5-60.5 years of age registered with one practice were identified and offered screening sigmoidoscopy. Patients were randomly allocated to one of two groups. The first group was sent an invitation to have screening sigmoidoscopy along with an explanatory leaflet. The second group was sent the same invitation and leaflet but with an added option to discuss the test in the first instance with their general practitioner. Response rates (regarding reply to initial invitation and subsequent attendance for screening) in the two groups were measured.

SETTING

Urban General Practice, Dundee, Scotland, UK.

RESULTS

The overall uptake rate was low at 24%. Significantly fewer people in the second group (i.e. those with the option to discuss first) replied to the initial invitation. Assessing those who did reply, there was no difference between the two groups in numbers who thereafter went on to attend for screening. Only two percent of people took up the offer to find out more about the test from their general practitioner.

CONCLUSIONS

The offer of flexible sigmoidoscopy as a screening test for colorectal cancer generates little interest in this population at present and compliance rates are low. The offer of prior consultation about the procedure with a patient's own general practitioner is not sufficient to generate interest. These results highlight potential difficulties with the introduction of a mass screening program.

Continence for women: a test of AWHONN's evidence-based protocol in clinical practice

OBJECTIVE: To test the effectiveness of an evidence-based protocol for urinary incontinence in increasing identification of women with the condition and improving their outcomes. DESIGN: Prospective formative evaluation study. SETTING: Twenty-one public, private, and other women's health care sites. PARTICIPANTS: Women in ambulatory care settings (N = 1474) provided descriptive statistics. Clinical outcomes were tested in 132 cases for whom pre- and posttreatment data were available. INTERVENTIONS: Standardized screening and baseline follow-up forms were used to minimize time burden on clinicians; bladder and pelvic floor muscle training materials were provided to clinicians for distribution. MAIN OUTCOME MEASURES: Self-reported frequency, volume, and quality of life related to incontinence and cost of self-management were used to assess protocol effectiveness. RESULTS: Frequency of incontinence episodes, estimated volume lost per episode, and the cost of self-management decreased. Quality of life improved, as reflected in decreased bother attributed to incontinence and in the number of women avoiding activities such as shopping, exercising, or travel because of incontinence. CONCLUSIONS: This simple program of pelvic floor muscle and bladder training, as it has been systematically implemented in a variety of ambulatory women's health care settings, has benefitted women's continence status. The results of this project strongly support widespread application.

Repeat sizes at CAG/CTG loci CTG18.1, ERDA1 and TGC13-7a in schizophrenia

A number of studies using the repeat expansion detection (RED) technique have suggested an association between unknown large CAG/CTG repeats and schizophrenia. The polymorphic CAG/CTG repeat loci CTG18.1 and ERDA1 have been reported to account for a high proportion (approximately 90%) of the large repeats detected by RED and may therefore be responsible for the cited association. The recently described locus TGC13-7a contains a highly polymorphic CTA/TAG and CAG/CTG composite repeat, and is thus another authentic candidate. In the present investigation, each locus was analysed for association with schizophrenia in a sample of 206 patients and 219 group-matched controls. No evidence for association of CTG18.1, ERDA1 and/or TGC13-7a with schizophrenia was found. The combined data accounted for only 54% of the CAG/CTG arrays of > 40 repeats found in our previous RED analysis.

Continence for women: evaluation of AWHONN's third research utilization project. Association of Women's Health Obstetric and Neonatal Nurses

OBJECTIVE

To develop an evidence-based protocol for initial evaluation and treatment of urinary incontinence and to design procedures that would facilitate the protocol's implementation into clinical practice.

DESIGN

Descriptive report of the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) Continence for Women Project.

SETTING

Twenty-one public, private, and other women's health sites.

PARTICIPANTS

Women in ambulatory care settings (N = 1,474) provided demographic statistics.

METHODS

The protocol was developed, sites were selected, site coordinator training was provided, data collection was facilitated by project-specific teleforms, and the overall process was evaluated by the science team.

MAIN OUTCOME MEASURES

Site representation, patient representation, site coordinator feedback on the training program, and site coordinator experience during project implementation.

RESULTS

The process yielded a representative mix of site and patient diversity appropriate for testing of the protocol. Site coordinators felt well-prepared to implement the protocol and experienced increased professional satisfaction because of therapeutic benefits achieved for patients and positive collaboration with physicians.

CONCLUSIONS

The Continence for Women Project demonstrated the potential for developing and testing evidence-based protocols for clinical practice when the resources of an organization such as AWHONN and the research community are combined.

A brief history of advanced practice nursing and its implications for WOC advanced nursing practice

Although the evolution of clinical nurse specialists and nurse practitioners during the previous several decades has led to a sense of novelty regarding advanced practice, it is important to remember that nurses have engaged in such roles for nearly 100 years. This article will review the history of advanced nursing practice, summarize current definitions of specialty and advanced practice, discuss the evolution of advanced practice and its impact on contemporary nursing, and provide a background for advanced practice considerations for the WOC nurse, which are discussed in detail in subsequent articles by Janice Beitz (pp 55-64) and Dorothy Doughty (pp 65-8) in this issue.

Continence for women: a test of AWHONN's evidence-based protocol in clinical practice. Association of Women's Health Obstetric and Neonatal Nurses

OBJECTIVE

To test the effectiveness of an evidence-based protocol for urinary incontinence in increasing identification of women with the condition and improving their outcomes.

DESIGN

Prospective formative evaluation study.

SETTING

Twenty-one public, private, and other women's health care sites.

PARTICIPANTS

Women in ambulatory care settings (N = 1,474) provided descriptive statistics. Clinical outcomes were tested in 132 cases for whom pre- and posttreatment data were available.

INTERVENTIONS

Standardized screening and baseline follow-up forms were used to minimize time burden on clinicians; bladder and pelvic floor muscle training materials were provided to clinicians for distribution.

MAIN OUTCOME MEASURES

Self-reported frequency, volume, and quality of life related to incontinence and cost of self-management were used to assess protocol effectiveness.

RESULTS

Frequency of incontinence episodes, estimated volume lost per episode, and the cost of self-management decreased. Quality of life improved, as reflected in decreased bother attributed to incontinence and in the number of women avoiding activities such as shopping, exercising, or travel because of incontinence.

CONCLUSIONS

This simple program of pelvic floor muscle and bladder training, as it has been systematically implemented in a variety of ambulatory women's health care settings, has benefited women's continence status. The results of this project strongly support widespread application.

Urinary incontinence and depression

PURPOSE

Serotonergic neuronal systems have been implicated in anxiety and depression. Because descending serotonin pathways from the brain stem inhibit bladder contractions, we postulated that depression associated with altered serotonin function may predispose to urge incontinence. We demonstrate an association between depression and idiopathic urge incontinence.

MATERIALS AND METHODS

A total of 115 consecutive incontinent patients presenting to an incontinence clinic were compared to 80 continent controls. Patients were queried for a history of depression and completed a Beck Depression Inventory (BDI). Cases were classified by history and video urodynamics as genuine stress (36), urge (44) or mixed (35) incontinence.

RESULTS

A BDI of greater than 12 and/or a history of depression was noted in 30% of incontinent patients and 17% of controls (odds ratio 2.3, 95% confidence interval 1.0 to 5.0, p = 0.044). An abnormal BDI or history of depression was revealed in 60% of patients with idiopathic urge incontinence (p<0.001). Patients with stress or urge incontinence due to neuropathology or obstruction had no greater odds of having depression than continent controls.

CONCLUSIONS

These data suggest a strong association between depression and idiopathic urinary incontinence. This link may be due to altered serotonin function and may help explain the efficacy of serotonergic based antidepressants in the treatment of urge incontinence.

CAG repeat length in the hKCa3 gene and symptom dimensions in schizophrenia

BACKGROUND

Long CAG repeats in the hKCa3 potassium channel gene have been associated with schizophrenia. We sought evidence for associations between this polymorphism and aspects of the schizophrenia phenotype.

METHODS

Associations were investigated between CAG repeat length and gender, age of illness onset, and psychotic symptom dimensions in 203 unrelated individuals with DSM-IIIR schizophrenia.

RESULTS

No association was found between CAG repeat length and gender or age of onset. Long CAG repeats were associated with higher negative symptom dimension scores.

CONCLUSIONS

This study provides preliminary evidence that genetic liability to negative symptoms in schizophrenia may be partly mediated through the hKCa3 gene.

Analysis of the capacity of extracts from normal human young and senescent fibroblasts to support DNA synthesis in vitro

Cytoplasmic extracts from early-passage (young), late-passage (senescent) normal human fibroblast (HF) cultures and immortalized human cell lines (HeLa, HT-1080, and MANCA) were analyzed for their ability to support semiconservative DNA synthesis in an in vitro SV40-ori DNA replication system. Unsupplemented extracts from the three permanent cell lines were demonstrated to be active in this system; whereas young HF extracts were observed to be minimally active, and no activity could be detected in the senescent HF extracts. The activity of these extracts was compared after supplementation with three recombinant human replication factors: (1) the catalytic subunit of DNA polymerase alpha (DNA pol-alpha-cat), (2) the three subunits of replication protein A (RPA), and (3) DNA topoisomerase I (Topo I). The addition of all three recombinant proteins is required for optimum activity in the young and senescent HF extracts; the order of the level of activity is: transformed > young HF > senescent HF. Young HF extracts supplemented with RPA alone are able to support significant replicative activity but not senescent extracts which require both RPA and DNA pol-alpha-cat for any detectable activity. The necessary requirement for these factors is confirmed by the failure of unsupplemented young and senescent extracts to activate MANCA extracts that have been immunodepleted of DNA pol-alpha-cat or RPA. Immunocytochemical studies revealed that RPA, DNA pol-alpha, PCNA, and topo I levels are higher in the immortal cell types used in these studies. In the HF cells, levels of DNA pol-alpha-cat and PCNA are higher (per mg protein) in the low-passage than in the senescent cells. By contrast, RPA levels, as determined by immunocytochemical or Western blot studies, were observed to be similar in both young and senescent cell nuclei. Taken together, these results indicate that the low to undetectable activity of young HF extracts in this system is due mainly to reduced intracellular levels of RPA, while the senescent HF extracts are relatively deficient in DNA polymerase alpha and probably some other essential replication factors, as well as RPA. Moreover, the retention of RPA in the senescent HF nuclei contributes to the low level of this factor in the cytoplasmic extracts from these cells.

Urinary function after radical prostatectomy: a comparison of the retropubic and perineal approaches

OBJECTIVES

Urinary continence is one of the most significant outcomes after radical surgery for prostate cancer. Although both retropubic and perineal approaches to radical prostatectomy are commonly used, they have not yet been compared with respect to urinary continence and voiding function in a single-institution study using a validated patient-administered instrument. This study had two primary objectives: first, to assess whether differences exist between these two procedures with respect to the overall prevalence and resolution of postoperative urinary incontinence, and second, to determine the impact of the urinary incontinence on patient lifestyle in this patient population.

METHODS

A written instrument composed of the Urinary Function Questionnaire for Men after Radical Prostatectomy, the American Urological Association (AUA) Symptom Score, and seven items querying urinary retention and urinary function bother were mailed in February 1996 to 209 men who underwent radical prostatectomy by either the perineal (43%) or retropubic (57%) approach between January 1990 and December 1995. Descriptive statistics were used to summarize the prevalence of urinary incontinence and urinary function bother as reported from this cross-sectional questionnaire. Logistic regression models were used to assess the association between reported urinary incontinence and surgical approach, AUA symptom scores, and treatment of incontinence after adjusting for possible confounders (eg, the time between surgery and questionnaire, and patient age).

RESULTS

One hundred sixty-seven men (80%) responded to the questionnaire. The median age of the participants at questionnaire administration was 68 years (range 43 to 80). Overall, 57% (95% confidence interval [CI] 50% to 63%) of the responders reported complete urinary continence at the time of the questionnaire, with a median time between surgery and the questionnaire of 2.7 years (range 0.3 to 5.4). When continence was defined as either complete dryness or minimal urinary leakage, 75% (95% CI 69% to 81%) of the responders reported being continent. In men who responded to the questionnaire within 2 years of surgery, the probability of experiencing complete urinary continence was similar between the two surgical approaches. In men who responded to the questionnaire more than 2 years after surgery, patients who had undergone perineal prostatectomy were more likely to report complete continence than those who underwent retropubic surgery. However, this observed difference disappears when continence was defined as either complete dryness or minimal urinary leakage. The major impact of urinary incontinence on patient lifestyle was observed in patients with more than just minimal leakage.

CONCLUSIONS

Radical perineal and radical retropubic prostatectomy have similar outcomes when patients with minor degrees of incontinence are grouped together with continent patients. Since the impact of a minimal degree of urinary incontinence on the patient's lifestyle after radical prostatectomy seems to be minor, currently we do not believe that postoperative continence status is a major factor in choosing one procedure over the other.

The professional socialization of diploma of higher education in nursing students (Project 2000): a longitudinal qualitative study

This paper presents a new theory of professional socialization in relation to diploma of higher education in nursing students (Project 2000). It was derived from a 3-year, grounded theory, longitudinal study exploring the effects of supernumerary status and mentorship on students undertaking practice placements. A purposive sample of 17 students was used. Ten students volunteered to be interviewed on five separate occasions throughout their course and to keep a diary to record their experiences of mentorship during their practice placements. Their diary acted as an aide memoir during their tape-recorded interviews. The other seven students participated by diary only and kept written accounts of their experiences of being supernumerary and having a mentor whilst on practice placements. Data were analysed with the aid of NUD.IST and subjected to the constant comparative method of analysis. Findings indicate that the mentor is the linchpin of the students' experience and that some students develop intuition much earlier than previous work has stated.

Electrovaporization of the prostate: initial experiences and nursing management

STUDY DESCRIPTION: Electrocautery power is increasingly used to destroy prostatic tissue as well as to control bleeding during transurethral surgery for benign prostatic hyperplasia. This study summarizes our initial experiences with the electrovaporization procedure and combines these with the published findings of others in order to provide recommendations for the nursing management of this increasingly common urologic surgical procedure.

METHODS

A retrospective review of 36 consecutive patients managed by electrovaporization of the prostate was completed. A standardized data collection form was used to evaluate the preoperative preparation, intraoperative experiences, and short-term postoperative responses to the electrovaporization procedure. These data were combined with the published experiences of others in order to provide initial insights into the nursing management of patients undergoing this procedure.

RESULTS

Patient preparation was similar to that used for transurethral resection of the prostate. No patients experienced significant intraoperative bleeding. Two subjects (7%) experienced significant but transient hematuria in the postoperative period. Five men (17%) experienced urinary retention requiring catheterization, of these three were caused by blood clots and two were attributable to pre-existing detrusor muscle weakness. Urinary tract infection occurred in eight patients (27%), three of which were accompanied by a fever. All patients reported urethral and suprapubic pain following the procedure. One subject experienced flank pain caused by an acute obstruction of a solitary ureter, and one reported bladder spasms. Significant pain requiring analgesia resolved within 5 days of the procedure in all cases.

CONCLUSIONS

The preoperative nursing management of the patient undergoing electrovaporization of prostate tissue is similar to that for transurethral resection of the prostate with the exception of patient teaching. Patient education should emphasize self-assessment for urinary retention, hematuria, and urinary tract infection. The postprocedural care initially focuses on monitoring the patient for catheter patency, hematuria, and infection. Patients and significant others should be warned that delayed hematuria and urinary retention may occur days or weeks after electrovaporization of the prostate. During the past decade, the number of alternative procedures for prostate tissue destruction has grown significantly. Each of these procedures offers potential advantages when compared to the classic transurethral resection of the prostate (TURP). While their usefulness in treating obstruction due to benign prostate enlargement has been reasonably well described (McCullough, 1998), the nursing management of patients undergoing many of these procedures has not been adequately studied or described. The purpose of this study was to summarize our initial experiences with the VaporTrode procedure and to better define the nursing management of patients undergoing this increasingly common urologic surgery.

Are ball pits the playground for potentially harmful bacteria?

Ball pits, enclosed play areas with padded floors and pits of small plastic balls, have become popular features for children at fast food restaurants. This pilot study sought to identify and confirm bacterial organisms that place children at a potential health risk in three play pits within fast food restaurants. Data for this descriptive study were randomly collected from restaurants offering play pits with multicolored, round, hollow, plastic balls within urban communities of the Tidewater region of Virginia. Specimens were collected from entrances into the ball pits as well as various areas of the bottom lining to incur a representative sample. Results indicated an increased level of normal flora as well as nonhuman flora, demonstrating that bacteria are present within the ball pits. The results question the safety of these play pits for both health care providers and parents. Nurses play a vital role in public awareness through health education. Disinfection protocol and proper handwashing are the keys to making ball pit play areas safe for children.

The community gerontological nurse: themes from a needs analysis

With the move of care into the community, the role of nurses caring for older people is changing. However, nurses may not be adequately prepared to cope with this changing role, especially if their training and experience have been primarily hospital based. This study involves an educational needs analysis of registered nurses working in the care of older people in nursing homes and clients' own homes. It is based on focus groups with registered nurses and individual interviews with other professionals, as well as group discussions with older people. The aim of this project is to provide research-based input into the design of a new community care of older people module, to be offered at Napier University, Edinburgh from February 1998. The results presented here consist of three themes or patterns that have emerged from the interview data. The specialist/generalist theme concerns issues of role definition and gerontological specialism. The social/medical theme addresses the shift towards a social model of care when nurses move into the community settings. Finally, the physical health/mental health theme represents the need for greater integration of skills and knowledge from both mental health and general health nursing in the field of community care for older people. The results indicate the need for significant attitude changes and provide a major challenge to educationalists.