La monitorización ambulatoria de la presión arterial no siempre es necesaria

Intervention for Alleviating Clinical Inertia in the Management of Urinary Incontinence

PURPOSE

The purpose of this study was to determine whether clinical inertia exists in the care of patients with urinary incontinence and to test the effects of an educational intervention designed to alleviate inertia related to care of urinary incontinence.

DESIGN

Single-group, pretest/posttest design.

SUBJECTS AND SETTING

The sample comprised 132 participants practicing in 6 medical-surgical inpatient care units at an urban hospital in Almería, Spain; 66 (50%) were RNs, and all other participants were unlicensed assistive personnel. Most participants (87.9%) were female; their average age was 43.99 years (SD = 7.85 years).

METHODS

An educational intervention (online course) was provided. The main objective of the course was application of evidence-based knowledge for prevention and management of urinary incontinence in hospitalized patients. The course program comprised 3 didactic units: (1) introduction and evaluation of the patient with urinary incontinence, (2) care plans, and (3) instructions and rational use of absorbent products. Data collection included demographic and professional characteristics of respondents, desired results when caring for patients with incontinence, a medical record checklist, an occupational environment and satisfaction scale, and an assessment record of knowledge/skills and training activity satisfaction.

RESULTS

After comparing the pre- and posttest scores of knowledge on urinary incontinence, significant differences were found before and after the intervention (z = -14.113, P = .000). Specifically, analysis revealed differences in caring actions related to urinary incontinence (z = -14.248, P = .000) and differences in direct observation of urinary incontinence practice following the intervention (z = -14.326, P = .000).

CONCLUSIONS

Our findings indicate existence of inertia in nursing care for hospitalized patients with urinary incontinence. The educational intervention improved knowledge, observable nursing care activities related to incontinence management, and improved documentation of care.

Effects of added salt reduction on central and peripheral blood pressure

BACKGROUND

Although the effects of salt intake reduction on casual blood pressure have been extensively studied in hypertensive individuals, data on reductions of added salt on arterial stiffness in both normotensive and prehypertensive subjects are scarce.

OBJECTIVE

To evaluate the effects of progressive reduction in added salt intake (from 6 grams to 4 grams per day) on peripheral and central blood pressure and arterial stiffness in normotensive, prehypertensive and hypertensive individuals.

METHODS

This was a single-blinded clinical trial with 13 weeks of follow-up. Normotensive (≤ 130/85 mmHg), prehypertensive (≥ 130 e < 139/≥ 85 e < 90 mmHg) and stage 1 hypertensive individuals (< 139/≥ 85 and < 90 mmHg) were assessed. Casual blood pressure measurements and ambulatory blood pressure monitoring were performed using the automated OMRON 705CP device, and central blood pressure was measured using the Sphygmocor®. Twenty-four-hour urinary sodium excretion and the amounts of added salt consumed were measured. Statistically significance level was set at p < 0.05 for all analysis.

RESULTS

A total of 55 participants (18 normotensive, 15 prehypertensive and 22 hypertensive), median age 48 years (IQR:39-54) were studied. The groups were not different in age or sex. No difference was observed in blood pressure or sodium excretion levels before and after the intervention. No significant changes in arterial stiffness parameters were observed.

CONCLUSION

The progressive reduction in added salt intake during a period of 13 weeks did not cause significant reductions in peripheral and central blood pressure. (Arq Bras Cardiol. 2020; 114(3):554-561).