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Baxter CM, Matthews CL, Zamarripa C, Johnston JR, Lane R, Chung A, Palladino K, Kip PL, Zapf RL, Wagester S, Snyder GM. Implementation of an external female urinary catheter strategy on prevention of skin breakdown in acute care: A quality improvement study. J Clin Nurs 2024. [PMID: 38979896 DOI: 10.1111/jocn.17356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 05/17/2024] [Accepted: 06/24/2024] [Indexed: 07/10/2024]
Abstract
AIM(S) To evaluate the incidence of skin-related complications attributable to incontinence-associated dermatitis (IAD) using an external female urinary catheter device strategy for urinary incontinent (UI) patients in acute care. DESIGN Multicenter quality improvement study. METHODS Randomized allocation of two commercially available external female urinary catheter devices was used in hospitalized UI female patients. Daily nursing skin assessments were documented in the electronic health record before, during and after external catheter device application. Methods and results were reported following SQUIRE guidelines. RESULTS Three hundred and eighty-one patients from 57 inpatient care units were included in the analysis. Both catheter devices were associated with an overall low risk (5 %) of new or worsening skin breakdown. CONCLUSION The overall benefit of external catheters is most persuasive for skin integrity, rather than infection prevention. IMPACT Significant negative outcomes are associated with UI patients. External female urinary catheters are a non-invasive alternative strategy to reduce exposure of regional skin to urine contamination and IAD-related skin complications. Use of external female urinary catheters in hospitalized UI female patients offers low risk (5%) of new or worsening overall skin breakdown. PATIENT CONTRIBUTION Hospitalized UI female patients were screened for external catheter device eligibility by the bedside nurse. The quality improvement review committee waved consent because the intervention was considered standard care.
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Affiliation(s)
- Carla M Baxter
- Quality, Safety, and Innovation, Wolff Center-UPMC, Pittsburgh, Pennsylvania, USA
| | - Carol L Matthews
- Wound Care, UPMC Presbyterian/Shadyside, Pittsburgh, Pennsylvania, USA
| | - Cecilia Zamarripa
- Wound Care, UPMC Presbyterian/Shadyside, Pittsburgh, Pennsylvania, USA
| | | | - Robin Lane
- Supply Chain Management, UPMC, Pittsburgh, Pennsylvania, USA
| | - Ashley Chung
- Quality, Safety, and Innovation, Wolff Center-UPMC, Pittsburgh, Pennsylvania, USA
| | - Katie Palladino
- Infection Prevention and Control, UPMC Mercy, Pittsburgh, Pennsylvania, USA
| | - Paula L Kip
- Quality, Safety, and Innovation, Wolff Center-UPMC, Pittsburgh, Pennsylvania, USA
| | - Rachel L Zapf
- Quality, Safety, and Innovation, Wolff Center-UPMC, Pittsburgh, Pennsylvania, USA
| | - Suzanne Wagester
- Quality, Safety, and Innovation, Wolff Center-UPMC, Pittsburgh, Pennsylvania, USA
| | - Graham M Snyder
- Infection Prevention and Control, UPMC Presbyterian, Pittsburgh, Pennsylvania, USA
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Boyd B, Guaderrama N, Zhuang Z, Tovar S, Whitcomb E. Treatment of Stress Urinary Incontinence: Does Race Matter? UROGYNECOLOGY (PHILADELPHIA, PA.) 2024:02273501-990000000-00224. [PMID: 38710019 DOI: 10.1097/spv.0000000000001525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
IMPORTANCE The importance of this study was to examine treatment patterns and surgical complications for stress urinary incontinence (SUI). OBJECTIVES The aim of this study was to describe the treatment of SUI and associated complications in a racially and ethnically diverse population. STUDY DESIGN This was a retrospective cohort study of patients with a new diagnosis of SUI. We identified patients who received treatment with a pessary, pelvic floor physical therapy, or surgery. Surgical complications were abstracted. Logistic regression was used to examine the association between race/ethnicity and treatment, as well as surgical complications. RESULTS A total of 67,187 patients with a new diagnosis of SUI were included. The population was predominately Hispanic (47.5%) followed by White, Asian, Black, Native Hawaiian/Pacific Islander, and American Indian/Alaska Native. Comparing no treatment to any treatment, all racial/ethnic groups, except American Indian/Alaska Native, had decreased odds of receiving treatment compared with White women. Hispanic and Native Hawaiian/Pacific Islander women had increased odds of referral for pelvic floor physical therapy compared with White women. All racial/ethnic groups, except for American Indian/Alaska Native women, had decreased odds of receiving a sling procedure compared with White women. When these racial/ethnic minority groups did receive treatment, it was more likely to be conservative treatment compared with White women. There were no significant differences in individual surgical complications. CONCLUSIONS Racial minority women were 20-50% less likely to undergo a sling procedure, commonly posited as the gold standard surgical treatment. Racial minority women were 40-100% more likely to receive conservative management and 20-50% less likely to receive any treatment compared with White women.
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Affiliation(s)
| | - Noelani Guaderrama
- Division of Female Pelvic Medicine and Reconstructive Surgery, Southern California Permanente Medical Group, Irvine, CA
| | - Zimin Zhuang
- Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA
| | - Stephanie Tovar
- Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA
| | - Emily Whitcomb
- Division of Female Pelvic Medicine and Reconstructive Surgery, Southern California Permanente Medical Group, Irvine, CA
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Charette M, Pacheco-Brousseau L, Poitras S, Ashton R, McLean L. Management of urinary incontinence in females by primary care providers: a systematic review. BJU Int 2024; 133:498-512. [PMID: 38037509 DOI: 10.1111/bju.16234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
OBJECTIVE To describe primary care provider (PCP) practices for the assessment and management of females with urinary incontinence (UI), and appraise these practices relative to recommendations made in high-quality clinical guidelines. METHODS Studies were searched in four databases (MEDLINE, EMBASE, CINAHL, Web of Science) from their respective inception dates to 6 March 2023. All studies describing UI evaluation and management practices used by PCPs for female patients were eligible. Two reviewers independently selected studies assessed their quality and extracted data. A narrative synthesis of included studies was performed to describe practices. Relevant evaluation and management practices were then compared to recommendations that were consistent across current high-quality UI guidelines. Pharmacotherapy, referrals, and follow-ups were reported descriptively only. RESULTS A total of 3475 articles were retrieved and, among those, 31 were included in the review. The majority reported a poor-moderate adherence to performing a pelvic examination (reported adherence range: 23-76%; based on eight studies), abdominal examination (0-87%; three studies), pelvic floor muscle assessment (9-36%; two studies), and bladder diary (0-92%; nine studies), while there was high adherence to urine analysis (40-97%; nine studies). For the conservative management of UI, studies revealed a poor-moderate adherence to recommendations for pelvic floor muscle training (5-82%; nine studies), bladder training (2-53%; eight studies) and lifestyle interventions (1-71%; six studies). Regarding pharmacotherapy, PCPs predominantly prescribed antimuscarinics (2-46%; nine studies) and oestrogen (2-77%; seven studies). Lastly, PCPs referred those reporting UI to medical specialists (5-37%; 14 studies). Referrals were generally made <30 days after diagnosis with urologists being the most sought out professional to assess and treat UI. CONCLUSION This review revealed poor-moderate adherence to clinical practice guideline recommendations. While these findings reflect high variability in reporting, the key message is that most aspects of patient care for female UI provided by PCPs needs to improve.
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Affiliation(s)
- Marylène Charette
- Population Health, Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Lissa Pacheco-Brousseau
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Stéphane Poitras
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Rosalind Ashton
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Rideau Friel Medical Centre, Ottawa, Ontario, Canada
| | - Linda McLean
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
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Weinstein MM, Dunivan GC, Guaderrama NM, Richter HE. A Motion-based Device Urinary Incontinence Treatment: A Longitudinal Analysis at 18 and 24 Months. Int Urogynecol J 2024; 35:803-810. [PMID: 38252280 PMCID: PMC11052829 DOI: 10.1007/s00192-023-05721-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/14/2023] [Indexed: 01/23/2024]
Abstract
INTRODUCTION AND HYPOTHESIS There are sparse data regarding the long-term efficacy of pelvic floor muscle training (PFMT) for the treatment of urinary incontinence (UI). The objective of this study was to evaluate the impact of an 8-week PFMT program guided by a motion-based intravaginal device versus a standard home program over 24 months. METHODS Between October 2020 and March 2021, a total of 363 women with stress or stress-predominant mixed UI were randomized and completed an 8-week PFMT program using a motion-based intravaginal device (intervention group) or a home program following written/video instructions (control group). Participants were not asked to continue training after the 8-week program. At 18 and 24 months' follow-up, the Urogenital Distress Inventory, short-form (UDI-6) and Patient Global Impression of Improvement (PGI-I) were collected. In the original trial, a total of 139 participants in each arm were needed to detect a 0.3 effect size (alpha = 0.05, power 0.8, one-tailed t test) in the difference in UDI-6 scores. RESULTS A total of 231 participants returned 24-month data. Mean age at 24 months was 51.7 ± 14.5 years, and mean BMI was 31.8 ± 7.4 kg/m2. Mean change in UDI-6 scores from baseline to 24 months was greater in the intervention group than the control group (-21.1 ± 24.5 vs -14.8 ± 19.4, p = 0.04). Reported improvement using PGI-I was greater in the intervention group than in the control group at 24 months (35% vs 22%, p = 0.03, OR 1.95(95% CI 1.08, 3.57). CONCLUSIONS Pelvic floor muscle training guided by a motion-based prescription intravaginal device yielded durable and significantly greater UI symptom improvement than a standard home program, even in the absence of continued therapy.
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Affiliation(s)
- Milena M Weinstein
- Department of Obstetrics, Gynecology and Reproductive Biology, Division of Female Pelvic Medicine and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Gena C Dunivan
- University of Alabama at Birmingham, Birmingham, AL, USA
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Klein AJ, Eisenhauer C, Mollard E, Shade MY, Alappattu M. Methodologies Used in Studies of Self-Management Interventions for Urinary Incontinence in Adult Women: An Integrative Review. West J Nurs Res 2023; 45:1150-1164. [PMID: 37902161 DOI: 10.1177/01939459231208418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
BACKGROUND Urinary incontinence (UI) affects approximately 60% of women in the United States and negatively impacts self-esteem, sexual function, participation in social activities, and quality of life (QOL). Self-management interventions show promise for improving UI symptoms and QOL. Previous reviews of UI self-management studies have focused on outcomes for older women. However, the literature lacks a synthesis of methodologies of these studies. PURPOSE The purpose of this integrative review was to synthesize and evaluate methodologies used in studies of self-management interventions for UI in adult women. METHODS Using an integrative review approach, a search of PubMed, CINAHL, and Embase was conducted yielding 1404 results, 23 of which met inclusion criteria. Data abstracted from each article included author(s), year of publication, study design and purpose, sample, country and setting, measures of UI symptoms, and intervention description. RESULTS Findings showed methodological differences, particularly in design, assessment of UI subtypes, measures of UI symptoms, and intervention components. Multicomponent self-management interventions were used in 18 studies and 1 component used in 5 studies. Education, pelvic floor muscle exercises, and bladder training were the intervention components most frequently used, either alone or in combination; however, intervention components were not consistently aligned with the UI subtypes. Analysis of ethical matters revealed areas for improvement, specifically in reporting privacy and confidentiality and in methods to obtain informed consent. CONCLUSIONS Results highlight opportunities to improve the rigor of methodologies used in studies of self-management interventions for UI in adult women.
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Affiliation(s)
- Abbey Jo Klein
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Elizabeth Mollard
- College of Nursing, University of Nebraska Medical Center, Lincoln, NE, USA
| | - Marcia Y Shade
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
| | - Meryl Alappattu
- College of Public Health and Health Professional, University of Florida, Gainesville, FL, USA
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Bonasia K, Clancy A, Stairs J. Prevalence and risk factors for urinary incontinence up to 2 years postpartum: a cross-sectional population-based study. Int Urogynecol J 2023; 34:2467-2472. [PMID: 37199742 DOI: 10.1007/s00192-023-05571-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/26/2023] [Indexed: 05/19/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Urinary incontinence (UI) is common in the postpartum period; however, most studies focus on the early postpartum period and assess prevalence at only one or two time points. We hypothesized that UI would be prevalent across the first 2 years postpartum. Our secondary objective was to evaluate risk factors for postpartum UI among a nationally representative, contemporary sample. METHODS This cross-sectional, population-based study used National Health and Nutrition Examination Survey (2011-2018) data for parous women within 24 months following delivery. Prevalence of UI, UI subtypes, and severity were estimated. Multivariate logistic regression was used to estimate adjusted odds (aOR) of UI for exposures of interest. RESULTS Among 560 postpartum women, prevalence of any UI was 43.5%. Stress UI was most common (28.7%), and most women (82.8%) experienced mild symptoms. There was no significant change in prevalence of UI across the 24 months following delivery (R2 = 0.004). Individuals with postpartum UI tended to be older (30.3 ± 0.5 versus 28.8 ± 0.5 years) and had higher BMI (31.1 ± 0.6 versus 28.9 ± 0.6). In multivariate analysis, odds of postpartum UI were higher for women who had had a prior vaginal delivery (aOR 2.0, 95% CI: 1.3-3.3), prior delivery of a baby weighing 9 lb (4 kg) or more (aOR 2.5, 95% CI: 1.3-4.8), or who reported current smoking (aOR 1.5, 95% CI: 1.0-2.3). CONCLUSIONS During the first 2 years postpartum 43.5% of women report UI, with relatively stable prevalence over this period. This high prevalence supports screening for UI after delivery regardless of risk factors.
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Affiliation(s)
- Kyra Bonasia
- Department of Obstetrics and Gynecology, The Ottawa Hospital, Ottawa, Canada
| | - Aisling Clancy
- Department of Obstetrics and Gynecology, The Ottawa Hospital, Ottawa, Canada
| | - Jocelyn Stairs
- Department of Obstetrics and Gynecology, Dalhousie University, 5980 University Avenue, P.O. Box 9700, Halifax, NS, 5850B3K 6R8, Canada.
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