The challenges encountered with developing a valid and reliable urinary continence assessment form

The purpose of this study was to develop and validate a concise continence assessment form that can be completed by patients.
A prospective, descriptive, multi-site study was conducted at three major teaching hospitals over a 6 month period utilising a repeated measure design. The study was conducted over two stages: Stage One
consisted of developing the face validity and user friendliness of the instrument; Stage Two consisted of establishing the test-retest reliability of the instrument.
This paper discusses the process and results of the instrument development project. It highlights the clinical and statistical difficulties experienced in the development of the continence assessment form.

A guideline for the nursing assessment and management of urinary retention in elderly hospitalised patients

The objective of this project was to develop a guideline for the nursing assessment and management of urinary retention in hospitalised older adults. The guideline was developed from a review of the literature and from consultation with a multidisciplinary expert panel. These experts provided feedback through a structured process known as the Delphi technique. Based on findings from both sources, a final guideline was developed which provides a framework for the nursing assessment and management of urinary retention in hospitalised older adults. This foundational work provides the basis for further research and evaluation of the management of urinary retention.

Continence prevalence and management in an acute hospital

Learning Objective 1: describe the prevalence of incontinence within an Australian acute care hospital

Learning Objective 2: describe the current management practices for incontinence with regard to patients in an acute care hospital
Introduction: In 1998 the World Health Organisation recognised the international problem of incontinence. However, incontinence remains a major problem that affects more than 3.8 million Australians. Currently, there are no Australian guidelines governing the management of continence within the acute healthcare setting. Cabrini Health sought to identify the prevalence of incontinence in the acute inpatient setting and pilot a Continence Management Program to improve patient safety and patient outcomes.

Aim: The aim of this study was to determine the prevalence of and current management practices for incontinence with regard to Cabrini Health inpatients.

Method: The sample comprised 392 inpatients across three campuses of Cabrini Health (mean age= 68.3 years). Continence prevalence was assessed using a validated Continence Point Prevalence Tool.

Results: Urinary incontinence prevalence was 14%. The resulting overall faecal incontinence prevalence was 7.4%. There were 113 (52.3%) patients who were not incontinent and were using a continence product/device. Fifteen (25.9%) patients were incontinent and were not using any form of continence product/device. There were 43 (74.1%) patients who were incontinent and were using a continence product/device. For the large majority of patients, the admission notes contained documentation of their bladder and bowel function. Specifically, 46 (11.8%) patients had no form of admission documentation relating to bowel function and 45 (11.5%) patients had no form of admission documentation regarding to bladder function.

Conclusions: This study provided baseline continence prevalence for Cabrini Health. There is a need for evidence-based guidelines to support the management of incontinent patients. These interventions will assist staff to educate patients on appropriate choice of continence products and enable patients to maintain or regain continence. Thereby, leading to improved outcomes for patients and improved risk management.

Upregulated MT1-MMP/TIMP-2 axis in the TSU-Pr1-B1/B2 model of metastatic progression in transitional cell carcinoma of the bladder

Muscle invasive transitional cell carcinoma (TCC) of the bladder is associated with a high frequency of metastasis, resulting in poor prognosis for patients presenting with this disease. Models that capture and demonstrate step-wise enhancement of elements of the human metastatic cascade on a similar genetic background are useful research tools. We have utilized the transitional cell carcinoma cell line TSU-Pr1 to develop an in vivo experimental model of bladder TCC metastasis. TSU-Pr1 cells were inoculated into the left cardiac ventricle of SCID mice and the development of bone metastases was monitored using high resolution X-ray. Tumor tissue from a single bone lesion was excised and cultured in vitro to generate the TSU-Pr1-B1 subline. This cycle was repeated with the TSU-Pr1-B1 cells to generate the successive subline TSU-Pr1-B2. DNA profiling and karyotype analysis confirmed the genetic relationship of these three cell lines. In vitro, the growth rate of these cell lines was not significantly different. However, following intracardiac inoculation TSU-Pr1, TSU-Pr1-B1 and TSU-Pr1-B2 exhibited increasing metastatic potential with a concomitant decrease in time to the onset of radiologically detectable metastatic bone lesions. Significant elevations in the levels of mRNA expression of the matrix metalloproteases (MMPs) membrane type 1-MMP (MT1-MMP), MT2-MMP and MMP-9, and their inhibitor, tissue inhibitor of metalloprotease-2 (TIMP-2), across the progressively metastatic cell lines, were detected by quantitative PCR. Given the role of MT1-MMP and TIMP-2 in MMP-2 activation, and the upregulation of MMP-9, these data suggest an important role for matrix remodeling, particularly basement membrane, in this progression. The TSU-Pr1-B1/B2 model holds promise for further identification of important molecules.

Urinary incontinence

The reasons why urinary incontinence can be regarded as a women's health issue are explored. Emancipatory action research was used to develop an understanding of women's experience of UI. A number of important issues concerning the use of emancipatory action research in the social sciences in general, and nursing in particular, are addressed.

A suite of evidence-based continence assessment tools for residential aged care

The management of incontinence in residential aged care facilities presents staff with considerable challenges. In order to support the residential aged care workforce to provide evidence-based continence care, we developed a suite of evidence-based continence assessment tools and an accompanying educational resource for use in the residential aged care sector. The tools comply with international and accreditation standards. They address urinary and faceal incontinence and other bladder and bowel symptoms. They also include a number of cues to guide staff to assess and manage residents’ continence care needs and refer as needed. An evaluation of the tools conducted in 18 residential aged care facilities across three states revealed that staff members found the tools helpful, clear, simple and user-friendly. This paper provides a description of the newly developed suite of continence assessment tools for residential aged care and the accompanying education resources, and presents staff perspectives on their clinical usefulness.

Bayesian networks and decision trees in the diagnosis of female urinary incontinence

This study compares the effectiveness of Bayesian networks versus Decision Trees in modeling the Integral Theory of Female Urinary Incontinence diagnostic algorithm. Bayesian networks and Decision Trees were developed and trained using data from 58 adult women presenting with urinary incontinence symptoms. A Bayesian Network was developed in collaboration with an expert specialist who regularly utilizes a non-automated diagnostic algorithm in clinical practice. The original Bayesian network was later refined using a more connected approach. Diagnoses determined from all automated approaches were compared with the diagnoses of a single human expert. In most cases, Bayesian networks were found to be at least as accurate as the Decision Tree approach. The refined Connected Bayesian Network was found to be more accurate than the Original Bayesian Network accurately discriminated between diagnoses despite the small sample size. In contrast, the Connected and Decision Tree approaches were less able to discriminate between diagnoses. The Original Bayesian Network was found to provide an excellent basis for graphically communicating the correlation between symptoms and laxity defects in a given anatomical zone. Performance measures in both networks indicate that Bayesian networks could provide a potentially useful tool in the management of female pelvic floor dysfunction. Before the technique can be utilized in practice, well-established learning algorithms should be applied to improve network structure. A larger training data set should also improve network accuracy, sensitivity, and specificity.