Efficacy of prompted voiding for reversing urinary incontinence in older adults hospitalized in a functional recovery unit: Study protocol.

AIMS: To assess the efficacy of a prompted voiding programme for restoring urinary continence at discharge in hospitalized older adults who presented with reversible urinary incontinence (UI) on admission to a functional recovery unit (FRU). To assess the maintenance of the outcomes achieved after hospitalization. To identify modifiable and unmodifiable factors associated with the success of the prompted voiding programme. DESIGN: Quasi-experimental, pre-/post-intervention study without a control group. METHODS: Participants were aged 65 and over with a history of reversible UI in the previous year who had been admitted to a FRU and were on a prompted voiding programme throughout their hospitalization period. The sample consisted of 221 participants. A non-probabilistic sampling method, in order of recruitment after signing the informed consent form, was used. The primary outcomes were UI assessed at discharge and 1 month, 3 months and 6 months after discharge. Funding was granted in July 2019 by the Spain Health Research Fund (PI19/00168, Ministry of Health). The proposal was approved by the Spanish Research Ethics Committee. DISCUSSION: The prompted voiding programme described can reverse UI or decrease the frequency and amount of urine loss in hospitalized older adults. IMPACT: Urinary incontinence is highly prevalent in hospitalized older adults. There is a need for care aimed at prevention, recovery and symptom control. Prompted voiding is a therapy provided by the nursing team during hospitalization and can also be provided by family caregivers at home after receiving proper training by the nursing team. Prompted voiding will enhance the health, functional ability and quality of life of older adults with UI, resulting in the reduction of associated healthcare costs and the risk of developing complications.

Exploring Sentiment and Care Management of Hospitalized Patients During the First Wave of the COVID-19 Pandemic Using Electronic Nursing Health Records: Descriptive Study.

BACKGROUND: The COVID-19 pandemic has changed the usual working of many hospitalization units (or wards). Few studies have used electronic nursing clinical notes (ENCN) and their unstructured text to identify alterations in patients' feelings and therapeutic procedures of interest. OBJECTIVE: This study aimed to analyze positive or negative sentiments through inspection of the free text of the ENCN, compare sentiments of ENCN with or without hospitalized patients with COVID-19, carry out temporal analysis of the sentiments of the patients during the start of the first wave of the COVID-19 pandemic, and identify the topics in ENCN. METHODS: This is a descriptive study with analysis of the text content of ENCN. All ENCNs between January and June 2020 at Guadarrama Hospital (Madrid, Spain) extracted from the CGM Selene Electronic Health Records System were included. Two groups of ENCNs were analyzed: one from hospitalized patients in post-intensive care units for COVID-19 and a second group from hospitalized patients without COVID-19. A sentiment analysis was performed on the lemmatized text, using the National Research Council of Canada, Affin, and Bing dictionaries. A polarity analysis of the sentences was performed using the Bing dictionary, SO Dictionaries V1.11, and Spa dictionary as amplifiers and decrementators. Machine learning techniques were applied to evaluate the presence of significant differences in the ENCN in groups of patients with and those without COVID-19. Finally, a structural analysis of thematic models was performed to study the abstract topics that occur in the ENCN, using Latent Dirichlet Allocation topic modeling. RESULTS: A total of 37,564 electronic health records were analyzed. Sentiment analysis in ENCN showed that patients with subacute COVID-19 have a higher proportion of positive sentiments than those without COVID-19. Also, there are significant differences in polarity between both groups (Z=5.532, P<.001) with a polarity of 0.108 (SD 0.299) in patients with COVID-19 versus that of 0.09 (SD 0.301) in those without COVID-19. Machine learning modeling reported that despite all models presenting high values, it is the neural network that presents the best indicators (>0.8) and with significant P values between both groups. Through Structural Topic Modeling analysis, the final model containing 10 topics was selected. High correlations were noted among topics 2, 5, and 8 (pressure ulcer and pharmacotherapy treatment), topics 1, 4, 7, and 9 (incidences related to fever and well-being state, and baseline oxygen saturation) and topics 3 and 10 (blood glucose level and pain). CONCLUSIONS: The ENCN may help in the development and implementation of more effective programs, which allows patients with COVID-19 to adopt to their prepandemic lifestyle faster. Topic modeling could help identify specific clinical problems in patients and better target the care they receive.

Nursing care for patients with urinary incontinence based on behavioural therapies. / Cuidados basados en terapias conductuales aplicados al paciente con incontinencia urinaria.

Urinary Incontinence is a highly prevalent and important health problem in hospitalized elderly people. The increase in the elderly population in Spain requires the care and techniques that apply to geriatric, dependent and chronic patients to be updated. Evidence-based health care procedures assist professionals in decision-making and reduce variability in clinical practice. This article describes the care procedure for patients with urinary incontinence in the Guadarrama Hospital based on the use of behavioural therapies.

Managing urinary incontinence in older people in hospital: a best practice implementation project.

OBJECTIVES: This project aimed to improve care in managing urinary incontinence in older patients admitted to a medium-to-long-stay hospital by developing and implementing strategies to improve the compliance with best practice in managing urinary incontinence and decrease its prevalence. INTRODUCTION: Urinary incontinence (UI) is a major problem in hospitalized older people and is of great significance to public health. The application of evidence-based recommendations for this problem could be expected to improve the quality of care. METHODS: The project used the Joanna Briggs Institute's Practical Application of Clinical Evidence System and Getting Research into Practice audit tools for promoting change in healthcare practice. Participants were evaluated at baseline and at two follow-ups at three and six months after key strategies had been implemented. The location of this implementation project was the functional rehabilitation ward of a medium-to-long-stay Spanish hospital. RESULTS: In baseline audit there were four process criteria with a high level of compliance: two criteria with 35% and 44% respectively and one criterion without compliance. Action was taken to address the four barriers identified, leading to an increase in all cases except one, which was related to the characteristics of the patient. Prevalence of urinary incontinence decreased at follow-up. CONCLUSIONS: The development and implementation of strategies improved quality of care. This project obtained positive results in patient health, and the implementation of the strategies used decreased the prevalence of urinary incontinence in patients.