Bladder and bowel symptoms in cervical and endometrial cancer survivors.

BACKGROUND: Previous studies likely underestimate the prevalence of bowel and bladder symptoms in gynecologic cancer survivors. We sought to estimate the prevalence of these symptoms in cervical and endometrial cancer survivors who had completed treatment 1 year previously compared with non-cancer controls, and to examine factors associated with more severe symptoms in survivors. METHODS: As part of a larger quality of life study, survivors who were 1-year posttreatment for cervical or endometrial cancer (n = 104) completed measures of bladder and bowel symptoms. An age-matched and race/ethnicity-matched sample of women with no history of cancer was recruited for comparison purposes. RESULTS: Survivors reported a higher prevalence of bladder symptoms, specifically storage and incontinence symptoms, than non-cancer controls. Prevalence rates for bowel symptoms in survivors were higher than those reported in previous studies. Greater symptom severity was associated with younger age, lower annual incomes, and less education. Other correlates included higher body mass index and history of smoking. As hypothesized, more severe symptoms were associated with radical hysterectomy and pelvic radiation. CONCLUSIONS: Bladder and bowel symptoms are more prevalent in cervical and endometrial cancer survivors than non-cancer controls. Future research should replicate these findings in a larger, prospective study.

Urinary symptoms in breast cancer: a systematic review.

A large body of research has documented the prevalence and severity of menopausal symptoms, especially vasomotor symptoms, in breast cancer survivors and their impact on quality of life. However, urinary symptoms as part of the constellation of menopausal symptoms have received relatively little attention. Thus, less is known about the prevalence and severity of urinary symptoms in breast cancer survivors. The authors of this report conducted a systematic review of studies published between 1990 and 2010 to describe the prevalence and severity of urinary symptoms in breast cancer survivors. In total, 16 eligible studies that involved >2500 women were identified. The studies varied with respect to purpose, design, and nature of the samples included; the majority used the same definition and assessment approach for urinary symptoms. Prevalence rates for symptoms ranged from 12% of women reporting burning or pain on micturition to 58% reporting difficulty with bladder control. Although, in many studies, the largest percentage of women rated symptoms as mild, 23% reported severe symptoms. Symptoms appeared to adversely affect women's quality of life. The authors concluded that there is a need for additional research assessing the natural history of urinary symptoms using consensus definitions and validated measures in diverse populations. Nevertheless, this review suggested that clinicians should screen for urinary symptoms in breast cancer survivors and should offer treatment recommendations or make referrals as appropriate.

Equivalence of temperature measurement methods in the adult hematology/oncology population.

BACKGROUND: Neutropenic patients often become febrile and require frequent temperature monitoring. Monitoring core body temperature is considered the gold standard for accuracy. Taking oral temperature is the recommended noninvasive practice when core body temperature cannot be obtained; however, neutropenic patients often, for various reasons, are unable to tolerate an oral probe. OBJECTIVES: The purpose of this article is to determine the equivalence of temperatures taken via temporal artery, axillary, and oral methods, and to determine the best alternative to the oral method in the adult hematology/oncology population. METHODS: A repeated measures equivalence design was used. A convenience sample of 40 data sets (N = 33 inpatients) was tested on a hematology/oncology inpatient unit in a National Cancer Institute-designated comprehensive cancer center in the southeastern United States. A Latin squares design was employed with three possible sequences of measurement. Demographic data were analyzed using descriptive statistics, and equivalence was tested using the two one-sided tests method. Acceptance criterion for difference between methods was set at 0.2°F from the oral method. FINDINGS: The temporal method is a potential noninvasive alternative to the oral method for the adult hematology/oncology population.

Community respiratory virus infection in hematopoietic stem cell transplantation recipients and household member characteristics.

PURPOSE/OBJECTIVES: To determine if children or the number of contacts living in an immediate household increases the risk of community respiratory virus (CRV) acquisition in hematopoietic stem cell transplantation (HSCT) recipients. DESIGN: Retrospective, exploratory study. SETTING: National Cancer Institute-designated comprehensive cancer center located in the Southeast. SAMPLE: 720 adult outpatients post-autologous or allogeneic HSCT. METHODS: Data were gathered using a retrospective medical record review from July 1, 2006, to December 31, 2009. Summary statistics were used to describe sample characteristics. Binary logistic regression was used to determine whether the number of household member contacts or number of children in each age group was a significant predictor of CRV infection. Multivariate linear regression was used to investigate predictors of the number of CRV infections. MAIN RESEARCH VARIABLES: The dependent variable was acquisition of CRV infection. Independent variables included the number of children in the household and the number of household members. FINDINGS: Across all HSCT recipients, children aged 0-4 years (p = 0.01) and 5-12 years (p = 0.001) predicted CRV infection. The allogeneic group had the greatest incidence of CRV infection and was most sensitive to the presence of young children. The total number of household members was not a predictor of CRV infection. CONCLUSIONS: Households with children aged 12 years and younger more than doubled the risk of an HSCT recipient acquiring CRV infection. Additional studies are needed to test interventions designed to interrupt household transmission of CRV infection from children to vulnerable HSCT recipients. IMPLICATIONS FOR NURSING: Household contacts, particularly children, should be included in HSCT teaching. As indicated by the potentially high number of days from transplantation to acquisition of CRV infection, re-education and continuing focus on prevention of CRV infection should be reinforced throughout the lengthy transplantation period.

Bladder management in adult care homes. Review of a program in North Carolina.

In North Carolina there are approximately 34,000 residents in adult care homes (ACHs). Approximately 40% of these residents have urinary incontinence, and others require assistance with toileting. High prevalence of cognitive impairment, few licensed staff, and low staff-to-resident ratios in ACHs make behavioral techniques used in community-dwelling populations and toileting programs used in nursing homes inappropriate for these residents. This program was implemented using a two-level approach (facility and individual resident) and uses an education consultation approach for implementation.

Central venous access devices: an investigation of oncology nurses' troubleshooting techniques.

Experienced oncology nurses use different troubleshooting techniques for clearing occluded central venous access devices (CVADs) with varying degrees of success. The purpose of this study was to explore troubleshooting techniques used for clearing occluded CVADs by experienced oncology RNs and identify the perceived effectiveness of each technique. An invitation for a web-based survey was sent to select RN members of the Oncology Nursing Society. All nurses (N = 224) reported asking patients to raise and/or move their arm. Most nurses asked patients to lie down, cough, and take deep breaths. Respondents considered instilling a thrombolytic agent to be the most effective technique. No associations were found between techniques and respondents' years in oncology nursing, work setting, certification, or academic degree. The findings contribute to knowledge about care of patients with occluded devices and will help formulate direction for additional investigation of CVADs. Establishing the appropriateness of practice-related troubleshooting techniques may eliminate unnecessary steps and save nursing time. Educating nurses on the topic will also help reduce techniques that are not expected to yield results or are contraindicated.

Marketing evidence-based practice: what a CROC™!

Nurses should be engaged in evidence-based practice (EBP) to ensure that nursing care is efficient and effective. This article describes one cancer center's use of the Marketing Mix framework to educate staff nurses with the CROC™: Clinging Rigidly to Outdated Care campaign. As a result of the campaign, five EBP projects have been initiated in the cancer center.

Factors related to lower urinary tract symptoms among a sample of employed women in Taipei.

AIM: To identify factors associated with lower urinary tract symptoms (LUTS) among female elementary school teachers in Taipei. METHODS: This study is a cross-sectional, descriptive study. A total of 520 surveys were distributed to 26 elementary schools in Taipei. Logistic regression was used to identify possible factors related to individual LUTS. RESULTS: Study results were based on the information provided by 445 participants. Of the 445 teachers, 293 (65.8%) experienced at least one type of LUTS. Factors associated with urinary incontinence were body mass index (BMI), vaginal delivery, obstetric and/or gynecological surgery, bladder habits, and job control. Increased daytime urinary frequency was associated with chronic cough and chronic constipation. Bladder habits, straining to lift heavy objects at work and chronic constipation were associated with urgency. Nocturia was associated with age and caffeine consumption while intermittent stream was associated with the presence of a family history of LUTS and chronic constipation. Bladder habits and regular exercise were associated with weak urinary stream. Incomplete emptying was more likely to occur in teachers with chronic constipation and in those who did not exercise regularly. CONCLUSION: All the LUTS under logistic regression analyses were associated with 1-3 modifiable factors. Identification of these modifiable contributing factors may be useful to health care providers. Education of women may include the importance of maintaining normal body weight, good bladder/bowel habits, and regular exercise, treating chronic cough, decreasing daily caffeine consumption, and implementing feasible environmental modifications in employment settings.

Prevalence of lower urinary tract symptoms among female elementary school teachers in Taipei.

The aim of this study was to estimate the prevalence of lower urinary tract symptoms (LUTS) among female elementary school teachers in Taipei. A total of 520 self-administered surveys were distributed to 26 elementary schools in Taipei City. Data analyses were based on 445 usable surveys. The prevalence rates for different types of LUTS ranged from 9.9 to 44.5%. The prevalence of urinary incontinence (UI; 26.7%) and nocturia (16.0%) fell within the prevalence estimates of these LUTS in North American and European women. Employed women in this study were more likely to experience LUTS than women in previous epidemiological or community studies. This study extended research on UI into other LUTS among employed women in Asia. Study results suggest that the working environment may affect LUTS in female elementary school teachers. This preliminary study is important for developing future behavioral interventions for female LUTS in the workplace.

Buried alive: the presence of nursing on hospital Web sites.

BACKGROUND: Increasingly, hospitals are using sites on the World Wide Web (Web) to market their services and products and to advertise employment opportunities. These Web sites are a potential resource for information on the hospitals' nursing care and nurses' impact on patient outcomes. OBJECTIVE: The aim of this study was to explore the presence of nursing-accessible and visible data on nurses, nursing practice, or nursing care-on hospital Web sites. METHODS: A random sample of 50 hospital Web sites from the U.S. News and World Report's 2003 list of America's best hospitals was examined. A tool developed to capture the characteristics that denote a presence of nursing was used to examine hospital Web sites. RESULTS: All 50 sites had at least two occurrences of visible data in the form of pictures, graphics, or text that related to nurses, nursing care, or nursing practice. However, nurse-related content on these hospital Web sites was minimally to somewhat present and was frequently located on pages deep within the site. DISCUSSION: The presence of nursing on hospital Web sites could represent the importance of nursing, nursing practice, or nursing care for patients entering hospital systems. Instead, nursing content on hospital Web sites primarily focuses on nursing employment.

Developing and validating a Chinese instrument to measure lower urinary tract symptoms among employed women in Taiwan.

Lower urinary tract symptoms (LUTS), including urinary incontinence, negatively affect women's quality of life. Employed women are particularly prone to experiencing the negative aspects of LUTS due to their irregular access to toilet facilities. In Taiwan, about 70% of women 25-44 years of age are employed, yet little research on LUTS in the workplace has been conducted. In this article, the development of a Chinese instrument for estimating prevalence of LUTS and identifying factors related to LUTS among employed women is discussed. After instrument-generation and translations, content validity of the instrument was assessed and found to be satisfactory. Following a pilot test, psychometric testing of the instrument (which included test-retest reliability and internal consistency) was conducted. Test-retest reliability for the majority of the items and internal consistency for the construct LUTS were adequate. Based on initial psychometric testing, the authors suggest the instrument is appropriate for use with women in Taiwan. Additional testing is recommended before being used with other populations.

Effectiveness of a computer-based system to deliver a continence health promotion intervention.

OBJECTIVE: The objective of this study was to test a computer-based system for continence health promotion that included self-management techniques for women with symptoms of involuntary urine loss, urinary frequency or urgency, or nocturia. DESIGN: A quasi-experimental trial design with repeated measures was used. SETTING AND SUBJECTS: Older women (n = 71) with continence problems were recruited and completed a computer session. INSTRUMENTS: Outcomes were measured with the Urogenital Distress Inventory-Short Form, the Incontinence Impact on Life Questionnaire-Short Form, and a bladder diary. A modified Questionnaire for User Interface Satisfaction was used to measure satisfaction with the system. METHODS: Participants assigned to the intervention group (n = 36) used the computer-based system for continence health promotion, and those in the wait list control group (n = 35) used an alternate system. Data were collected at baseline and 8 weeks after the computer session. RESULTS: Analysis of covariance results on symptom distress and quality of life scores showed no significant treatment effect, although a trend toward improvement was observed. The intervention group improved significantly on urogenital distress (P = .01) and quality of life (P = .003) outcomes, but the control group did not. Women had little difficulty using the system and expressed satisfaction with the individualized information provided. CONCLUSIONS: Although the computer-based system did not result in significantly improved outcomes when comparing women in the 2 groups, the computer-based group improved significantly from baseline to follow-up. Further research on a computer-based system that women could access independently or that nurses could use to supplement traditional care is warranted.

Analysis of interactive continence health information on the Web.

OBJECTIVE: The purpose of this study was to describe interactive information about continence health promotion for women that is available on Web sites identified by popular search engines or health/medical search engines or that is available on community-based or select health organizations' Web sites. METHODS: We used a variety of search services to search the Web for sites that disseminated information about continence health for women, for example, urinary incontinence, urine loss, and bladder problems. Two reviewers initially evaluated sites to determine if an interactive feature that provided individualized feedback was present. Web sites that had an interactive-with-feedback feature were further examined to delineate the purpose of the site and other descriptive characteristics. We evaluated each site according to content pertaining to continence health information. RESULTS: Most major search engines located more than 100,000 Web sites in the initial search; narrowing the search terms with the words "and women" decreased the number of sites. Only 13 sites with interactive-with-feedback features were located for further evaluation. E-mail was the most common interactive feature; none of the sites contained comprehensive information on continence health promotion. CONCLUSIONS: Web sites exist and are informative in terms of continence health promotion, but they lack an emphasis on self-care and sufficient information to promote it. The functionality of computer technology and the Web has not been maximized for the purpose of delivering continence health information.

Development of a computer-based system for continence health promotion.

Computer-based systems (CBS) can provide information to help individuals analyze their health care needs and make decisions about management of health problems. This article discusses the development of a CBS that delivers an individualized educational intervention for continence health promotion. System development included cycles of prototype design, testing, analysis, and redesign. Knowledge acquisition, representation methods, and design decisions are discussed. Participants completed 4 rounds of usability testing and a pilot test, which resulted in enhancements to both the CBS and the expert system feature that produced individualized feedback. This iterative design process involved users throughout system development. User involvement resulted in a tutorial to explain navigation and other features of the CBS, graphics to enhance the written message, and clarification of continence-related content. The procedures resulted in an informative, usable product; they can be used to develop systems that provide information about symptom self-management for other health conditions.

Prevention of urinary incontinence in adults: population-based strategies.

BACKGROUND: Urinary incontinence (UI) affects large numbers of adults, especially older adults, with an estimated 200 million adults worldwide having this life-altering condition. OBJECTIVES: To identify key populations at risk for urinary incontinence and propose population-based strategies to promote continence with a substantive focus on UI prevention. METHODS: Critical review of extant literature and iterative synthesis were undertaken to generate an action plan to guide future UI prevention research. RESULTS: Key populations identified to be at risk for UI are women in selected occupations, childbearing women, older adults with lifestyle risk factors, older adults with comorbid conditions, and nursing home residents. Population-based research activities are proposed. Growing evidence supports the benefit of pelvic floor muscle training to prevent childbirth and prostatectomy-related UI. Bladder training has demonstrated preventive capacity. CONCLUSIONS: Because of its high prevalence and chronic but preventable nature, UI is most appropriately considered a public health problem. Nursing research is needed to test prevention programs for UI using a population-based public health focus.

A randomized trial of behavioral management for continence with older rural women.

Urinary incontinence (UI) is a commonly underreported and underdiagnosed condition. The purpose of this trial was to implement and evaluate behavioral management for continence (BMC), an intervention to manage symptoms of UI with older rural women in their homes. Participants were randomized into BMC or a control group, and 178 were followed for between 6 and 24 months. The intervention involved self-monitoring, bladder training, and pelvic muscle exercise with biofeedback. The primary outcome variable-severity of urine loss-was evaluated by pad test. Secondary variables were episodes of urine loss, micturition frequency, voiding interval, quality of life, and subjective report of severity. Urine loss severity at baseline evaluation was not significantly different in the two groups. But using the generalized linear mixed model analysis, at the four follow-ups, severity of urine loss, episodes of urine loss, quality of life, and subjective report of severity were significantly different. At 2 years the BMC group UI severity decreased by 61%; the control group severity increased by 184%. Self-monitoring and bladder training accounted for most of the improvement. The results support the use of simple strategies based on bladder diaries before implementing more complex treatments.