Cooling effects and comfort of four cooling blanket temperatures in humans with fever.

Adult patients with fever (N = 89) were randomized into four blanket temperature groups: 7.2, 12.8, 18.3, and 23.9 degrees C. With their extremities protected, subjects were given acetaminophen and placed between two cooling blankets. There were no differences in the mean time (in minutes) to cool to a body temperature of 38.9 degrees C among groups. Although there were no differences in mean time for shivering, a trend of less shivering was apparent with warmer blanket temperatures. Few patients shivered (n = 17). There were no differences in the mean time (in minutes) for afterfall among the groups. The mean amount of afterfall for the 7.2 degrees C group (1.04 degrees C, SD = 0.50) was significantly greater than the 23.9 degrees C group (0.68 degrees C, SD = 0.47). Comfort scores significantly improved with warmer blanket temperatures. Thus, warmer blanket temperatures provided similar rates of cooling as the colder temperatures, yet were perceived to be more comfortable by the patient.

The effects of patterned urge-response toileting (PURT) on urinary incontinence among nursing home residents.

OBJECTIVE: To test an individualized form of habit training for urinary incontinence (UI) among long-stay cognitively and/or physically impaired elderly nursing home residents over time. DESIGN: Randomization of subjects occurred by nursing home unit. Baseline wet checks were done hourly for one 24-hour period at 3-week intervals over 12 weeks followed by 72 hours of continuous electronic monitoring to establish precise voiding patterns for each subject. The 12-week intervention period was administered by indigenous staff after they attended a 4-hour UI educational program. Subjects were followed an additional 12 weeks to determine the extent of maintenance of the intervention among staff and subjects. SETTING: Four non-profit nursing homes; west, mid-west, east coast. PATIENTS: Consent was obtained from 154 (71%) who met primary inclusion criteria. Forty-one failed the secondary inclusion criteria leaving 113 who entered the 37-week study. Eighty-eight completed the study (experimental = 51, control = 37); all were physically and/or mentally impaired, averaged age 85, and had either urge or urge/stress UI. RESULTS: UI was significantly decreased during the 3-month period (P less than 0.001). Eighty-six percent showed improvement over baseline while one-third improved 25% or more over their baseline UI rate. The control group's UI increased during the same period of time. The volume of UI among the experimental group also decreased (P less than 0.005) while the control group's UI volume increased. CONCLUSIONS: The training program was effective in reducing UI though compliance among nursing staff averaged only 70% of the prescribed toileting times. The success of this approach is similar to other recently described behavioral programs but achieved the reduction using only regular nursing staff. This individualized approach supports the recent regulatory thrust to individualize care to promote and maintain functional abilities and autonomy.

Issues in implementing clinical research in nursing home settings.

Researchers at four nursing home sites experienced similar problems in the informed consent process when they attempted to access a frail, cognitively impaired population to conduct a collaborative, quasi-experimental two year clinical trials study on urinary incontinence. In addition, similar institutional barriers were experienced in these geographically distant and dissimilar nursing homes. The study involved working closely with indigenous licensed nursing and nurse aide staff to implement the independent variable, an individualized toileting prescription. Successful strategies used to overcome barriers in conducting the research will be described.