ABSTRACT
OBJECTIVE: To compare empiric single-dose gentamicin versus culture-specific oral antibiotics as prophylaxis before cystometrogram and/or cystogram. Comparisons with regards to infection, patient preference, and cost were made. DESIGN: Prospective randomized control trial. SETTING: Inpatient and outpatient rehabilitation hospital. PATIENTS: Seventy received oral antibiotics and 72 received intramuscular gentamicin. INTERVENTION: Cystometrograms and/or cystograms were performed. MAIN OUTCOME MEASURE: Patient interviewed and chart reviewed for infection. Convenience and comfort were rated by patient. RESULTS: Oral antibiotics and gentamicin have similar efficacy. Patients rated the gentamicin more convenient (p < .001) and comfortable (p < .01) than oral antibiotics. Gentamicin is less expensive. CONCLUSION: Gentamicin should be used as the method of choice for cystometrogram/cystogram prophylaxis.
Subject(s)
Antibiotic Prophylaxis , Bacterial Infections/prevention & control , Gentamicins/administration & dosage , Urography/methods , Administration, Oral , Adult , Aged , Aged, 80 and over , Antibiotic Prophylaxis/adverse effects , Antibiotic Prophylaxis/economics , Bacterial Infections/etiology , Chi-Square Distribution , Consumer Behavior , Cost-Benefit Analysis , Female , Gentamicins/adverse effects , Gentamicins/economics , Humans , Injections, Intramuscular , Male , Middle Aged , Prospective Studies , Urography/adverse effectsABSTRACT
Although the literature has indicated that incontinence can be successfully treated with nonsurgical methods in the able-bodied population, there has been little research performed in the disabled population. Fifty-four patients with various disabilities were treated with pelvic muscle exercises, using biofeedback in conjunction with adjustments in their bowel program, caffeine intake, fluid intake, toileting schedules, transfer training, and medications. The average number of incontinent episodes before intervention was 3.6 per day, which was reduced to 0.8 per day after interventions (p < .001). The characteristics associated with treatment success and failure were evaluated and are discussed in this article, In addition, the change in amplitude and duration of the pelvic muscle surface electromyograph were analyzed. A statistical trend (p = .07) was discovered between an increase in amplitude and a positive outcome. There was a statistical association between increased pelvic floor contraction duration and a good or excellent outcome (p < .05). In conclusion, a behavioral approach to treatment of urinary incontinence is efficacious in the disabled population who can volitionally void and can voluntarily contract their pelvic muscles.
Subject(s)
Behavior Therapy , Disabled Persons , Urinary Incontinence/therapy , Adult , Aged , Aged, 80 and over , Biofeedback, Psychology , Electromyography , Female , Humans , Male , Middle Aged , Muscle, Smooth/physiology , Pelvic Floor , Treatment OutcomeABSTRACT
The development and implementation of case management within rehabilitation care settings are a major priority and strategic initiative for the 1990s. Within this setting, the special needs of an individual with spinal cord injury, managed within a comprehensive system of care, provide a framework for a case management construct. These needs extend over the individual's lifetime from the onset of the injury. Lifetime case management by expert rehabilitation practitioners addresses, anticipates, and manages the outcome and variances of care delivery and the individual response to a comprehensive system of care. This article describes the system of lifetime case management, the continuum of special care needs, and the role of the nurse clinician as an expert practitioner and lifetime case manager.
Subject(s)
Models, Organizational , Patient Care Planning , Progressive Patient Care/organization & administration , Spinal Cord Injuries/rehabilitation , Comprehensive Health Care/organization & administration , Hospitals, University , Humans , Managed Care Programs , Philadelphia , Rehabilitation Centers , Spinal Cord Injuries/economicsABSTRACT
The incidence and effect of pressure sores on the disabled and elderly population have created a challenge to physicians and health care professionals, from emergency departments to rehabilitation units, and in the community. If not prevented, the morbidity and mortality of patients and the direct and indirect costs to both patients and the health care system are radically increased. In this article we define the impact on our health care system of pressure sores, provide an overview of a multifaceted approach to their prevention and management, and introduce successful behavioral and educational approaches for patients with chronic, recurrent sores. A coordinated approach with patients as informed participants and their care givers enhances the chances for success.
