Stress Urinary Incontinence in Female Athletes

Objective: The purpose of this study is to educate allied health professionals and female athletes of the anatomy of the pelvic floor, and the pathology, etiology, and prevalence of stress urinary incontinence in female athletes. Background: Urinary incontinence is not a life-threatening or dangerous condition, but it is socially embarrassing, may cause the individual to remove herself from social situations, and decrease quality of life. While typically associated with parous women who had vaginal delivery, research has shown prevalence of the condition in physically active women of all ages. Stress urinary incontinence has shown to lead to withdrawal from participation in high-impact activities such as gymnastics, aerobics, and running. It may be considered a barrier for life-long athletics participation in women. Description: An in-depth introduction to the cause and origin of stress urinary incontinence including review of the female pelvic floor anatomy and prevalence of stress urinary incontinence in the female athletic population. Clinical Advantages: Athletic trainers and other allied health professionals will develop an understanding of the multiple mechanisms that cause stress urinary incontinence. Clinician competency of the dynamics and mechanism of urinary incontinence prepares the individual to learn diagnostics, prevention, pharmacological intervention, and treatment of this pathology.

Barriers to reporting child maltreatment: do emergency medical services professionals fully understand their role as mandatory reporters?

BACKGROUND: Child maltreatment is underreported in the United States and in North Carolina. In North Carolina and other states, mandatory reporting laws require various professionals to make reports, thereby helping to reduce underreporting of child maltreatment. This study aims to understand why emergency medical services (EMS) professionals may fail to report suspicions of maltreatment despite mandatory reporting policies. METHODS: A web-based, anonymous, voluntary survey of EMS professionals in North Carolina was used to assess knowledge of their agency's written protocols and potential reasons for underreporting suspicion of maltreatment (n=444). Results were based on descriptive statistics. Responses of line staff and leadership personnel were compared using chi-square analysis. RESULTS: Thirty-eight percent of respondents were unaware of their agency's written protocols regarding reporting of child maltreatment. Additionally, 25% of EMS professionals who knew of their agency's protocol incorrectly believed that the report should be filed by someone other than the person with firsthand knowledge of the suspected maltreatment. Leadership personnel generally understood reporting requirements better than did line staff. Respondents indicated that peers may fail to report maltreatment for several reasons: they believe another authority would file the report, including the hospital (52.3%) or law enforcement (27.7%); they are uncertain whether they had witnessed abuse (47.7%); and they are uncertain about what should be reported (41.4%). LIMITATIONS: This survey may not generalize to all EMS professionals in North Carolina. CONCLUSIONS: Training opportunities for EMS professionals that address proper identification and reporting of child maltreatment, as well as cross-agency information sharing, are warranted.

Exercise rehabilitation following intensive care unit discharge for recovery from critical illness: Executive summary of a Cochrane Collaboration systematic review

Skeletal muscle wasting and weakness are major complications of critical illness and underlie the profound physical and functional impairments experienced by survivors after discharge from the intensive care unit (ICU). Exercise-based rehabilitation has been shown to be beneficial when delivered during ICU admission. This review aimed to determine the effectiveness of exercise rehabilitation initiated after ICU discharge on primary outcomes of functional exercise capacity and health-related quality of life. We sought randomized controlled trials, quasi-randomized controlled trials, and controlled clinical trials comparing an exercise intervention commenced after ICU discharge vs. any other intervention or a control or ���usual care��� programme in adult survivors of critical illness. Cochrane Central Register of Controlled Trials, Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica Database, and Cumulative Index to Nursing and Allied Health Literature databases were searched up to February 2015. Dual, independent screening of results, data extraction, and quality appraisal were performed. We included six trials involving 483 patients. Overall quality of evidence for both outcomes was very low. All studies evaluated functional exercise capacity, with three reporting positive effects in favour of the intervention. Only two studies evaluated health-related quality of life and neither reported differences between intervention and control groups. Meta-analyses of data were precluded due to variation in study design, types of interventions, and selection and reporting of outcome measurements. We were unable to determine an overall effect on functional exercise capacity or health-related quality of life of interventions initiated after ICU discharge for survivors of critical illness. Findings from ongoing studies are awaited. Future studies need to address methodological aspects of study design and conduct to enhance rigour, quality, and synthesis.

An Assessment of How Nurse Practitioners Create Access to Primary Care in Canadian Residential Long-Term Care Settings

The aim of this paper is to explore the role and activities of nurse practitioners (NPs) working in long-term care (LTC) to understand concepts of access to primary care for residents. Utilizing the "FIT" framework developed by Penchanksy and Thomas, we used a directed content analysis method to analyze data from a pan-Canadian study of NPs in LTC. Individual and focus group interviews were conducted at four sites in western, central and eastern regions of Canada with 143 participants, including NPs, RNs, regulated and unregulated nursing staff, allied health professionals, physicians, administrators and directors and residents and family members. Participants emphasized how the availability and accessibility of the NP had an impact on access to primary and urgent care for residents. Understanding more about how NPs affect access in Canadian LTC will be valuable for nursing practice and healthcare planning and policy and may assist other countries in planning for the introduction of NPs in LTC settings to increase access to primary care.

Non-pharmacological interventions for cognitive impairment due to systemic cancer treatment (Review)

Background<br/><br/>It is estimated that up to 75% of cancer survivors may experience cognitive impairment as a result of cancer treatment and given the increasing size of the cancer survivor population, the number of affected people is set to rise considerably in coming years. There is a need, therefore, to identify effective, non-pharmacological interventions for maintaining cognitive function or ameliorating cognitive impairment among people with a previous cancer diagnosis.<br/>Objectives<br/><br/>To evaluate the cognitive effects, non-cognitive effects, duration and safety of non-pharmacological interventions among cancer patients targeted at maintaining cognitive function or ameliorating cognitive impairment as a result of cancer or receipt of systemic cancer treatment (i.e. chemotherapy or hormonal therapies in isolation or combination with other treatments).<br/>Search methods<br/><br/>We searched the Cochrane Centre Register of Controlled Trials (CENTRAL), MEDLINE, Embase, PUBMED, Cumulative Index of Nursing and Allied Health Literature (CINAHL) and PsycINFO databases. We also searched registries of ongoing trials and grey literature including theses, dissertations and conference proceedings. Searches were conducted for articles published from 1980 to 29 September 2015.<br/>Selection criteria<br/><br/>Randomised controlled trials (RCTs) of non-pharmacological interventions to improve cognitive impairment or to maintain cognitive functioning among survivors of adult-onset cancers who have completed systemic cancer therapy (in isolation or combination with other treatments) were eligible. Studies among individuals continuing to receive hormonal therapy were included. We excluded interventions targeted at cancer survivors with central nervous system (CNS) tumours or metastases, non-melanoma skin cancer or those who had received cranial radiation or, were from nursing or care home settings. Language restrictions were not applied.<br/>Data collection and analysis<br/><br/>Author pairs independently screened, selected, extracted data and rated the risk of bias of studies. We were unable to conduct planned meta-analyses due to heterogeneity in the type of interventions and outcomes, with the exception of compensatory strategy training interventions for which we pooled data for mental and physical well-being outcomes. We report a narrative synthesis of intervention effectiveness for other outcomes.<br/>Main results<br/><br/>Five RCTs describing six interventions (comprising a total of 235 participants) met the eligibility criteria for the review. Two trials of computer-assisted cognitive training interventions (n = 100), two of compensatory strategy training interventions (n = 95), one of meditation (n = 47) and one of physical activity intervention (n = 19) were identified. Each study focused on breast cancer survivors. All five studies were rated as having a high risk of bias. Data for our primary outcome of interest, cognitive function were not amenable to being pooled statistically. Cognitive training demonstrated beneficial effects on objectively assessed cognitive function (including processing speed, executive functions, cognitive flexibility, language, delayed- and immediate- memory), subjectively reported cognitive function and mental well-being. Compensatory strategy training demonstrated improvements on objectively assessed delayed-, immediate- and verbal-memory, self-reported cognitive function and spiritual quality of life (QoL). The meta-analyses of two RCTs (95 participants) did not show a beneficial effect from compensatory strategy training on physical well-being immediately (standardised mean difference (SMD) 0.12, 95% confidence interval (CI) -0.59 to 0.83; I2= 67%) or two months post-intervention (SMD - 0.21, 95% CI -0.89 to 0.47; I2 = 63%) or on mental well-being two months post-intervention (SMD -0.38, 95% CI -1.10 to 0.34; I2 = 67%). Lower mental well-being immediately post-intervention appeared to be observed in patients who received compensatory strategy training compared to wait-list controls (SMD -0.57, 95% CI -0.98 to -0.16; I2 = 0%). We assessed the assembled studies using GRADE for physical and mental health outcomes and this evidence was rated to be low quality and, therefore findings should be interpreted with caution. Evidence for physical activity and meditation interventions on cognitive outcomes is unclear.<br/>Authors' conclusions<br/><br/>Overall, the, albeit low-quality evidence may be interpreted to suggest that non-pharmacological interventions may have the potential to reduce the risk of, or ameliorate, cognitive impairment following systemic cancer treatment. Larger, multi-site studies including an appropriate, active attentional control group, as well as consideration of functional outcomes (e.g. activities of daily living) are required in order to come to firmer conclusions about the benefits or otherwise of this intervention approach. There is also a need to conduct research into cognitive impairment among cancer patient groups other than women with breast cancer.

Avalia����o das capacita����es de Hansen��ase: enfermeiros opini��o de m��dicos e enfermeiros das equipes de sa��de da fam��lia

MORENO,Cl��a Maria da Costa,ENDERS,Bertha Cruz, SIMPSON, Cl��lia Albino. Avalia����o das capacita����es de Hansen��ase: enfermeiros opini��o de m��dicos e enfermeiros das equipes de sa��de da fam��lia. Revista Brasileira de Enfermagem, Bras��lia, v.61,n.esp.p. 671-5.2008.

Transformer les pratiques professionnelles vis-��-vis des personnes prestataires de l���aide sociale : d��veloppement participatif et ��valuation d���une formation continue en cabinet dentaire

L���objectif de la pr��sente th��se est de g��n��rer des connaissances sur les contributions possibles d���une formation continue �� l�����volution des perspectives et pratiques des professionnels de la sant�� buccodentaire. Pr��nant une approche centr��e sur le patient, la formation vise �� sensibiliser les professionnels �� la pauvret�� et �� encourager des pratiques qui se veulent inclusives et qui tiennent compte du contexte social des patients. L�����valuation de la formation s���inscrit dans le contexte d���une recherche-action participative de d��veloppement d���outils ��ducatifs et de transfert des connaissances sur la pauvret��. Cette recherche-action aspire �� contribuer �� la lutte contre les iniquit��s sociales de sant�� et d���acc��s aux soins au Qu��bec; elle refl��te une pr��occupation pour une plus grande justice sociale ainsi qu���une prise de position pour une sant�� publique critique fond��e sur une �� science des solutions �� (Potvin, 2013). Quatre articles scientifiques, ancr��s dans une philosophie constructiviste et dans les concepts et principes de l���apprentissage transformationnel (Mezirow, 1991), constituent le c��ur de cette th��se. Le premier article pr��sente une revue critique de la litt��rature portant sur l���enseignement de l���approche de soins centr��s sur le patient. Prenant appui sur le concept d���une �� ��pist��mologie partag��e ��, des principes ��ducatifs porteurs d���une transformation de perspective �� l�����gard de la relation professionnel-patient ont ��t�� identifi��s et analys��s. Le deuxi��me article de th��se s���inscrit dans le cadre du d��veloppement participatif d���outils de formation sur la pauvret�� et illustre le processus de co-construction d���un sc��nario de court-m��trage social r��aliste portant sur la pauvret�� et l���acc��s aux soins. L���article d��crit et apporte une r��flexion, notamment sur la dimension de co-formation entre les diff��rents acteurs des milieux acad��mique, professionnel et citoyen qui ont constitu�� le collectif �� l�����coute les uns des autres. Nous y d��couvrons la force du croisement des savoirs pour g��n��rer des prises de conscience sur soi et sur ses pr��jug��s. Les outils d��velopp��s par le collectif ont ��t�� int��gr��s �� une formation continue ax��e sur la r��flexion critique et l���apprentissage transformationnel, et con��ue pour ��tre livr��e en cabinet dentaire priv��. Les deux derniers articles de th��se pr��sentent les r��sultats d���une ��tude de cas instrumentale ��valuative centr��e sur cette formation continue et visant donc �� r��pondre �� l���objectif premier de cette th��se. Le premier consiste en une analyse des transformations de perspectives et d���action au sein d���une ��quipe de 15 professionnels dentaires ayant particip�� �� la formation continue sur une p��riode de trois mois. L���article d��crit, entre autres, une plus grande ouverture, chez certains participants, sur les causes structurelles de la pauvret�� et une plus grande sensibilit�� au v��cu au quotidien des personnes prestataires de l���aide sociale. L���article comprend ��galement une exploration des effets paradoxaux dans l���apprentissage, notamment le renforcement, chez certains, de perceptions n��gatives �� l�����gard des personnes prestataires de l���aide sociale. Le quatri��me article fait ��tat de barri��res id��ologiques contraignant la transformation des pratiques professionnelles : 1) l���identification �� l���id��ologie du march�� priv�� comme v��hicule d���organisation des soins; 2) l���attachement au concept d�����galit�� dans les pratiques, au d��triment de l�����quit��; 3) la pr��dominance du mod��le biom��dical, contraignant l���adoption de pratiques centr��es sur la personne et 4) la cat��gorisation sociale des personnes prestataires de l���aide sociale. L���analyse des perceptions, mais aussi de l���exp��rience v��cue de ces barri��res d��montre comment des facteurs syst��miques et sociaux influent sur le rapport entre professionnel dentaire et personne prestataire de l���aide sociale. Les cons��quences pour la recherche, l�����ducation dentaire, le transfert des connaissances, ainsi que pour la r��gulation professionnelle et les politiques de sant�� buccodentaire, sont examin��es �� partir de cette perspective.

Using Social Worlds Theory to Explore Influences on Community Nurses��� Experiences of Providing Out of Hours Paediatric Palliative Care

Abstract Background: Paediatric oncology palliative care in the community is rare and nationally there is a lack of standardisation of out of hours nursing service provision. Objectives: This paper seeks to explore influences on the experiences of paediatric nurses providing out of hours palliative care within the family home to children with cancer. The study used social worlds theory to aid identification and demonstration of the findings. Methods: Twelve community-based palliative cases were purposively selected from children with cancer treated at one regional centre. Tape-recorded interviews were undertaken with 54 health professionals (general practitioners, community nurses and allied health professionals) involved in providing their palliative care and five facilitated case discussions completed. Data analysis followed a grounded theory approach; chronological comparative data analysis identifying generated themes. Social worlds theory was used as a framework to examine the data. Results: Nurses��� experiences are shaped by their social world and those of the nursing team,child and family and the inter-professional team providing the care. The lack of a formalised service, sub-optimal inter-professional working and impact of social worlds influence the experience of the nurse. Conclusions: Social worlds theory provided a new perspective in understanding these experiences based within a paediatric palliative care setting, knowledge that can be used to inform service provision.

Providing Palliative Care for the Child with Cancer: The Experience of GPs

Background Childhood cancers are rare and general practitioners (GPs) have limited experience in caring for these children and even less in providing their palliative care. Most families prefer that their child is cared for at home in the palliative phase of their illness, with professional support from those known to them (Chambers and Oakhill 1995, Vickers and Carlisle 2000, Craft and Killen 2007). A community based qualitative study examined the experiences of ten GPs following their involvement in the care of a child with cancer receiving palliative care within the family home. Methods Data collection was through 1:1 in-depth interviews and facilitated case discussion supported by field notes and grounded theory analysis (chronological comparative data analysis identifying generated themes). Social worlds theory was used as a framework to aid examination, and facilitate critical understanding, of the experiences of the GPs. Findings This presentation focuses on five of the findings relating to the experiences of the GP; the impact of minimal contact; lack of knowledge and experience, uncertain role, out of hours service provision and the emotional toll. Findings highlighted that GPs often have to re-establish their role at the child���s transition to palliative care. Factors hindering the GP in this process include a deficit of specialist knowledge and experience of paediatric palliative care and lack of role clarity. Conclusions/points of interest Strategies for enhancing the role of the Macmillan team in supporting GPs have been identified by this study, such as enhanced collaborative working. Findings have also provided further confirmation of the substantial variation in out of hours medical palliative care provision; with evidence that some GPs work beyond their remit in providing informal out of hours care. This presentation details the findings of one aspect (the experiences of GPs) of a wider study that explored the experiences of 54 community based health professionals (GPs, community nurses and allied health professionals) who had been involved in caring for a dying with cancer receiving palliative care at home (Neilson 2009).

Mothers��� perception of recovery and satisfaction with patent medicine dealers��� treatment of childhood febrile conditions in rural communities

Background Infant mortality in rural areas of Nigeria can be minimized if childhood febrile conditions are treated by trained health personnel, deployed to primary healthcare centres (PHCs) rather than the observed preference of mothers for patent medicine dealers (PMDs). However, health service utilization/patronage is driven by consumer satisfaction and perception of services/product value. The objective of this study was to determine ���mothers��� perception of recovery��� and ���mothers��� satisfaction��� after PMD treatment of childhood febrile conditions, as likely drivers of mothers��� health-seeking behaviour, which must be targeted to reverse the trend. Methods Ugwuogo-Nike, in Enugu, Nigeria, has many PMDs/PHCs, and was selected based on high prevalence of childhood febrile conditions. In total, 385 consenting mothers (aged 15���45 years) were consecutively recruited at PMD shops, after purchasing drugs for childhood febrile conditions, in a cross-sectional observational study using a pre-tested instrument; 33 of them (aged 21���47 years) participated in focus group discussions (FGDs). Qualitative data were thematically analysed while a quantitative study was analysed with Z score and Chi square statistics, at p < 0.05. Results Most participants in FGDs perceived that their child had delayed recovery, but were satisfied with PMDs��� treatment of childhood febrile conditions, for reasons that included politeness, caring attitude, drug availability, easy accessibility, flexibility in pricing, shorter waiting time, their God-fearing nature, and disposition as good listeners. Mothers��� satisfaction with PMDs��� treatment is significantly (p < 0.05) associated with mothers��� perception of recovery of their child (��2 = 192.94, df = 4; p < 0.0001; Cramer���s V = 0.7079). However, predicting mothers��� satisfaction with PMDs��� treatment from a knowledge of mothers��� perception of recovery shows a high accord (lambda[A from B] = 0.8727), unlike when predicting mothers��� perception of recovery based on knowledge of mothers��� satisfaction with PMDs��� treatment (lambda[A from B] = 0.4727). Conclusions Mothers��� satisfaction could be the key ���driver��� of mothers��� health-seeking behaviour and is less likely to be influenced by mothers��� perception of recovery of their child. Therefore, mothers��� negative perception of their child���s recovery may not induce proportionate decline in mothers��� health-seeking behaviour (patronage of PMDs), which might be influenced mainly by mothers��� satisfaction with the positive attributes of PMDs��� personality/practice and sets an important agenda for PHC reforms.

Avalia����o das capacita����es de Hansen��ase: enfermeiros opini��o de m��dicos e enfermeiros das equipes de sa��de da fam��lia

MORENO,Cl��a Maria da Costa,ENDERS,Bertha Cruz, SIMPSON, Cl��lia Albino. Avalia����o das capacita����es de Hansen��ase: enfermeiros opini��o de m��dicos e enfermeiros das equipes de sa��de da fam��lia. Revista Brasileira de Enfermagem, Bras��lia, v.61,n.esp.p. 671-5.2008.

Calidad de atenci��n cient��fico human��stico que presta el personal de enfermer��a y su relaci��n con el nivel de satisfacci��n del usuario del Centro de Salud Cojitambo. Azogues, 2014

Antecedentes: el tema de calidad de la atenci��n en salud hoy en d��a es clave, y urgente de conocer, entender y aplicar por el personal de salud y en particular para el profesional de Enfermer��a, para lograr la calidad en los servicios de salud es necesario el control, la evaluaci��n objetiva y sistem��tica de la atenci��n de enfermer��a ya que se han convertido en una prioridad dentro de la profesi��n, debido a que el consumidor demanda atenci��n de calidad, existiendo un mayor compromiso con la responsabilidad directa ante ��l p��blico. Objetivo: determinar la calidad de atenci��n que presta el personal de enfermer��a del centro de salud ���Cojitambo��� y su relaci��n con el nivel de satisfacci��n del usuario. Metodolog��a: se trata de un estudio descriptivo de corte transversal que permitir�� determinar la calidad de atenci��n que presta el personal de enfermer��a del centro de salud ���Cojitambo��� y su relaci��n con el nivel de satisfacci��n del usuario. Universo: para el tama��o de la muestra se considera una poblaci��n infinita con una proporci��n de insatisfacci��n del 20% con un nivel de confianza del 96% y una precisi��n del 4%. Con estos valores el tama��o de la muestra a estudiar es de 385 pacientes. Como t��cnicas se utilizar�� la entrevista, observaci��n directa e indirecta, como instrumento el formulario avalado por la Universidad T��cnica Particular de Loja en la investigaci��n realizada por el Dr. Carlos Ar��valo previa a la obtenci��n de la maestr��a en gerencias en salud para el desarrollo local, para procesar la informaci��n se utilizar�� los programas Excel, Word y SPSS, los datos ser��n analizados con estad��stica descriptiva y presentadas en tablas y gr��ficas. Uso de resultados: la presente investigaci��n pretender�� obtener datos relacionados con la medici��n de la calidad de atenci��n que brinda el personal de enfermer��a y el nivel de satisfacci��n del usuario que acude al centro de salud Cojitambo.

Perce����o dos enfermeiros sobre as compet��ncias de supervis��o cl��nica

Introdu����o: A evolu����o da ci��ncia e tecnologia, as mudan��as no seio das organiza����es de sa��de, as novas e emergentes filosofias de cuidados, exigem dos profissionais de sa��de uma participa����o ativa na forma����o dos seus pares, tendo o processo de supervis��o cl��nica uma import��ncia relevante. Objetivos: Identificar a perce����o dos enfermeiros tutores especialistas sobre as compet��ncias do supervisor cl��nico na ��rea de sa��de infantil e pediatria. M��todos: Estudo qualitativo explorat��rio descritivo, fenomenol��gico, numa amostra de dez enfermeiros tutores dos servi��os da ��rea de pediatria do Hospital Dr. N��lio Mendon��a, SESARAM. Recorremos �� entrevista semiestruturada e ��udio gravada. Efetu��mos an��lise de conte��do ao ���corpus��� de todas as entrevistas, com defini����o de subcategorias e indicadores. Resultados:. Emergiu a categoria compet��ncias do supervisor cl��nico e as subcategorias mais referenciadas foram as carater��sticas pessoais com 38% de unidade de registo e as compet��ncias profissionais (25,7%). Nos aspetos relevantes em sa��de infantil e pediatria destacaram-se tamb��m as compet��ncias pessoais e profissionais com 40,4% cada. O principal fator facilitador da supervis��o foi o ser um processo estruturado (21,6%), e o dificultador foi o deficit no relacionamento interpessoal (21,7%). No global houve mais unidades de registo relacionadas com os aspetos dificultadores. Conclus��o: Conscientes das perce����es dos supervisores numa ��rea t��o espec��fica como �� a ��rea de sa��de infantil e pediatria, pensamos que este estudo poder�� contribuir para melhorar a qualidade do processo supervisivo na enfermagem. �� necess��rio o esfor��o conjunto entre o supervisor e supervisionado, melhorando os processos mediados entre as institui����es e os atores, onde proliferam a partilha de saberes, experi��ncias e objetivos profissionais. Palavras-chave: Supervisor, Mentor, Supervisor cl��nico, Enfermagem, Supervis��o.