Bladder training for urinary tract symptoms in Parkinson disease: A randomized controlled trial.

OBJECTIVE: To assess the feasibility and efficacy of bladder training for troublesome lower urinary tract symptoms (LUTS) in Parkinson disease (PD). METHODS: In this single-center, single-blinded, randomized controlled trial, participants with a history of PD and LUTS were randomized to a 12-week bladder training program (BT) or conservative advice (CA). Outcome measures included a 3-day volume frequency diary, International Consultation on Incontinence Questionnaire (ICIQ)-Overactive Bladder Module, and ICIQ-Quality of Life Module. Co-primary endpoints were (1) patient perception of change and (2) change in number of urgency episodes at 12 weeks. Secondary endpoints included change in ICIQ scores, number of micturitions, and volume voided. RESULTS: Thirty-eight participants were randomized (18 to CA, 20 to BT). Both CA and BT were associated with significant improvements in volume voided, number of micturitions, symptom severity scores, and measures of quality of life (all p < 0.05). At 12 weeks, compared to CA, BT was associated with significant superiority on patient perception of improvement (p = 0.001), significantly greater reductions in number of voids in 24 hours (mean decrease 2.3 ± 0.8 voids vs 0.3 ± 0.5 [p < 0.05]), and greater reductions in interference with daily life (2.1 ± 0.8 point improvement vs 0.3 ± 0.7 point deterioration [p < 0.05]). BT was not associated with change in urgency episodes (mean change 2.4 ± 1.5 urgency episodes vs 3.5 ± 1.5 [p NS]). At 20 weeks, BT remained associated with greater improvement in interference in daily life. Loss of significance in other measures may reflect loss of power from loss to follow-up. CONCLUSION: This controlled trial demonstrated the potential benefits of BT for LUTS in PD. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that for patients with PD and LUTS, BT significantly increased patient perception of improvement but did not significantly reduce urgency episodes.

Managing urinary incontinence in adults with bronchiectasis.

BACKGROUND: Urinary incontinence has a negative impact on quality of life and often remains untreated due to low levels of self-reporting. Urinary incontinence is seen in cystic fibrosis associated bronchiectasis but little data are available for non-cystic fibrosis associated bronchiectasis. METHOD: In 2007 a new non-cystic fibrosis bronchiectasis service for patients aged 18 years and over was started within the Newcastle upon Tyne Hospitals NHS Foundation Trust. During the establishment of a new adult bronchiectasis service, patients were specifically asked about symptoms of incontinence, and if incontinence was identified then patients were referred for specialist continence assessment and management, in line with current good practice guidelines. The study relates only to those female patients who were referred to the continence service. RESULTS: In this audit 116 patients attended the bronchiectasis service from 2009-2010; 76 were female, of these 55% had urinary incontinence, describing dramatic effects on quality of life. Prior to intervention the duration of symptoms of urinary incontinence for more than 5 years was 87.5%, with 40% of patients describing symptoms of more than 10 years duration without seeking medical attention. Following intervention from the nurse consultant for continence care, 80% of patients who were referred were discharged with an improvement in symptoms of urinary incontinence. CONCLUSION: This audit highlights the importance of specifically asking about urinary incontinence when assessing patients with adult bronchiectasis.

Documented adherence to standards and guidelines: an audit.

The authors conducted a cross-sectional audit within Newcastle-upon-Tyne Hospitals NHS Foundation Trust to determine the prevalence of urethral catheterisation and documented adherence to relevant NHS standards. An on-line audit questionnaire was completed for all 80 inpatient wards within the Trust on a single day during the third week in June 2009. The tool collected data on prevalence and care requirements detailed in the Department of Health's (DH) Saving Lives High Impact Intervention 6 (2007). Data were analysed using Snap survey software. Overall, 172 of 1187 (14.5%) inpatients were catheterized and all were using a closed drainage system or catheter valve. Evidence of correct continuing catheter care was documented for 168 (98%) patients, while details of catheter insertion were identified in 153 (89%) patient records. Eight (4.5%) patients were being treated for a urinary tract infection. The authors found satisfactory adherence to basic documentation standards with regard to catheter care. This was associated with a low prevalence rate of catheterization and catheter-associated urinary infection within the Trust relative to previously published figures. Details of catheter insertion were missing from 10% of patient records, requiring further development of accessible and transferable documentation tools. Provision of relevant information to patients is also a target for development.

Best practice guidelines for the prevention and management of incontinence dermatitis.

This article outlines the causes of incontinence dermatitis and risk factors associated with this skin problem. The authors describe how simple guidance on skin care can improve patient care and use a case study to illustrate this.

The use of bowel management systems in the high-dependency setting.

In the acute care setting faecal incontinence is often associated with diarrhoea, both of which are challenging nursing problems. In this environment, it is essential that health-care professionals are able to provide good quality care, therefore, the assessment and management of faecal incontinence are fundamental elements of practice. This article examines the importance of identifying faecal incontinence within health-care settings, highlights the under-reporting of this condition and demonstrates that through careful assessment, appropriate treatment options can be used to provide optimum patient care. The article also describes the implementation of local guidelines for a bowel management system that were developed to promote best practice in patients being nursed in a high dependency health-care area.