A hybrid process fidelity assessment in a home-based randomized clinical trial.

A process fidelity assessment was conducted as a nested study within a home-based randomized clinical trial teaching self-management to 101 long-term indwelling urinary catheter users in the treatment group. Our hybrid model combined external assessments (outside observations and tape recordings) with internal evaluation methods (through study nurse forms and notes) for a comprehensive process fidelity assessment. Barriers, patient-related issues, and nurse perspectives were identified demonstrating the complexity in home care intervention research. The complementary and synergistic approaches provided in-depth information about the context of the delivery and the impact of the intervention on study outcomes.

Long-term urinary catheter users self-care practices and problems.

AIMS AND OBJECTIVES: To characterise a sample of 202 adult community-living long-term indwelling urinary catheter users, to describe self-care practices and catheter problems, and to explore relationships among demographics, catheter practices and problems. BACKGROUND: Long-term urinary catheter users have not been well studied, and persons using the device indefinitely for persistent urinary retention are likely to have different patterns of catheter practices and problems. DESIGN: The study was a cross-sectional descriptive and exploratory analysis. METHODS: Home interviews were conducted with catheter users who provided information by self-reported recall over the previous two months. Data were analysed by descriptive statistics and tests of association between demographics, catheter practices and catheter problems. RESULTS: The sample was widely diverse in age (19-96 years), race and medical diagnosis. Urethral catheters were used slightly more often (56%) than suprapubic (44%), for a mean of six years (SD 7 years). Many persons were highly disabled, with 60% having difficulty in bathing, dressing, toileting and getting out of the bed; 19% also required assistance in eating. A high percentage of catheter problems were reported with: 43% experiencing leakage (bypassing of urine), 31% having had a urinary tract infection, 24% blockage of the catheter, 23% catheter-associated pain and 12% accidental dislodgment of the catheter. Treatments of catheter-related problems contributed to additional health care utilisation, including extra nurse or clinic visits, trips to the emergency department or hospitalisation. Symptoms of catheter-associated urinary tract infections were most often related to changes in the colour or character of urine or generalised symptoms. CONCLUSIONS: Catheter-related problems contribute to excess morbidity and health care utilisation and costs. RELEVANCE TO CLINICAL PRACTICE: More research is needed in how to minimise catheter-associated problems in long-term catheter users. Information from this study could help inform the development of interventions in this population.

Attentional blink in patients with multiple sclerosis.

The attentional blink (AB), characterized as a failure to detect a second target following correct identification of a previous target in a rapid serial visual presentation (RSVP), has become a useful measure for investigation of the temporal dynamics of attention. In our previous work, we proposed a two-stage concurrent inhibition model that attributes AB not only to capacity limitations at the central, working memory but also to the lack of proper inhibitory processes, which depend in part on the integrity of white matter. To test the hypothesis that attentional blink can be influenced by the integrity of the white matter, we investigated AB in patients with multiple sclerosis (MS), where the dominant neuropathology is demyelination-related cortical white matter impairments. We tested 22 MS patients and 22 age-matched controls with RSVP task. MS patients were further examined with standard tests of motor functioning (9 Hole Peg Test-9HPT and 8m walking test) and 2 tests of working memory (Paced Auditory Serial Addition Test-PASAT and Digit Ordering test-DOT). On average, MS patients did not show working memory impairments, but greater and longer AB. Our results thus support the hypothesis that one potential mechanism of attentional impairments in MS could be unreliable inhibitory processes. We propose that in MS inhibitory processes depend on white matter integrity, i.e., functional connectivity between the perceptual and working memory modules. Future research should focus on concurrent measurements of neuroanatomical and attentional features of MS patients to further support our findings.

Cognitive fatigue during a test requiring sustained attention: a pilot study.

BACKGROUND: Fatigue is common in multiple sclerosis (MS), but difficulty quantifying fatigue severity has impeded studies of its characteristics, mechanisms, and therapeutics. Motor fatigue can be objectively measured as the decline in strength occurring during sustained contractions. Analogous declines in cognitive performance occur during tasks requiring sustained attention. OBJECTIVE: To objectively measure cognitive fatigue as a decline in performance during tests requiring sustained attention. DESIGN/METHODS: Patients with clinically stable MS (n = 20) and healthy controls (n = 21) with comparable age, gender, and education completed the Paced Auditory Serial Addition Test (PASAT) and the Digit Ordering Test (DOT) at two identical test sessions separated by 4-10 days, within a month after two practice sessions. Cognitive fatigue was quantified with two pre-specified methods for each test. The reliability of cognitive fatigue assessments was evaluated with intraclass correlation coefficients (ICCs) and construct validity was evaluated using correlations with measures of self-reported fatigue, cognition, and overall impairment/disability. RESULTS: MS patients had an average of 18.7 items correct on the first 20 items of the PASATand 17.8 correct on the last 20 items, quantified as 5.3-5.8% declines in performance using the different measurement methods (P = 0.01, rejecting the null hypothesis of zero mean decline). Although MS patients as a group demonstrated a similar decline at both sessions, ICCs were relatively low. Control patients did not demonstrate significant declines in performance during PASAT administration, but tests comparing declines in MS patients and controls did not demonstrate significant differences. Fatigue was not demonstrated using the DOT, and test-retest reliability was very poor. CONCLUSIONS: MS patients have objectively measurable cognitive fatigue during administration of the PASAT.