Guidance for the provision of absorbent products for adult incontinence.

The Association for Continence Professionals first published their guidance for the provision of absorbent products for adult incontinence in 2017. This consensus document is targeted towards commissioning leads, NHS Trust Boards, Bladder and Bowel leads, among others, and has been updated over the years to ensure that all adults who suffer with continence issues undergo a comprehensive assessment and have access to an equitable service. This article provides an overview of the latest guidelines which were published in February 2023.

Eye-tracking analysis for situation awareness of incontinence pad changing during older adult nursing training: An observational study.

AIM: This study aims to investigate eye tracking in the practical training of incontinence pad change, which is commonly required in older adult nursing. BACKGROUND: Some competencies possessed by skilled and experienced personnel are difficult to verbalize into textbooks. However, this is crucial for education, especially nursing practice education. Eye-gaze analysis is one such tool that can aid the efficient transfer of knowledge to students. Therefore, eye-gaze analysis, a novel technology for visualizing situational awareness and decision-making, has recently gained traction in healthcare. DESIGN: An observation study METHODS: Ten nursing faculty members and 13 nursing students with prior incontinence pad change experience participated in this study using an older adult simulator. There were two groups of students - S1 with more recent experience in older adult care and incontinence pad changing and S2 with less. Areas of interest (AOIs) during incontinence pad preparation and fitting were determined based on gaze fixation and the time spent fixating on these areas was compared. RESULTS: Students took longer than nursing faculty members. When visualizing the eye movements between the AOIs in the network, the faculty nurses and S1 alternated their gaze between the new incontinence pad and the buttocks and between other AOIs. Simultaneously, S2 tended to gaze or stare only at the new incontinence pad. CONCLUSION: The presented data may help interpret visual-based situational awareness and establish effective nursing education, especially in acquiring skills that are difficult to verbalize.

The Effects of Incontinence Pad Application on Loaded Skin With Reference to Biophysical and Biochemical Parameters: An Exploratory Cohort Study Using a Repeated-Measures Design.

PURPOSE: The purpose of this study was to evaluate temporal changes in skin responses following exposure to moisture alone or moisture in combination with mechanical loading. DESIGN: Comparison cohort with a repeated-measures design. SUBJECTS AND SETTINGS: The sample comprised 12 healthy volunteers. Participants were purposely sampled from 2 different age groups; half were 32 to 39 years old and half were 50 to 62 years old. Participants identified as White, Black, or mixed; 83% (n = 10) identified as White; 8 (67%) were female. METHODS: Four sites at the sacrum were challenged with the application of specimens taken from 2 absorbent products; the pad specimens were applied dry or saturated with synthetic urine (SU; pH = 8); a further site from the sacral skin was also selected and used as a control. Skin assessments were performed at different points in time: (1) 60 minutes after exposure to dry or SU-saturated pad specimens; (2) 60 minutes after exposure to pads and mechanical loading (application of pressure in the form of 45°C high sitting); and (3) 30 minutes after removal of all pads (recovery period). Outcome measures were transepidermal water loss (TEWL), stratum corneum (SC) hydration, erythema, pH, and skin inflammatory biomarkers measured at each of the time points described earlier. RESULTS: The control site and those exposed to dry pads showed minimal time-dependent changes irrespective of the parameter investigated. In contrast, significant increases in TEWL (P = .0000007) and SC hydration responses (P = .0000007) were detected at the sites under absorbent pad specimens after saturation with SU (exposure to moisture). In some participants, TEWL and SC hydration parameters were significantly higher during pressure application. Skin pH remained in the mildly acidic range throughout the test session, and no consistent trends were observed with erythema. Skin inflammatory biomarkers also exhibited considerable variability across participants; none changed significantly over time. Significant differences (P = .02) were also detected following the exposure of moisture in combination with pressure. CONCLUSION: We evaluated an array of parameters to identify changes following skin exposure to 2 absorbent pads in the presence and absence of SU and mechanical loading. Analysis revealed changes in skin barrier properties in the presence of moisture and/or pressure. This observation suggests a need for frequent pad changing as well as periods of skin off-loading to protect the skin health of individuals with incontinence.

Pathway for post-prostatectomy urinary incontinence: impact on patient confidence and satisfaction.

BACKGROUND: Between 8 and 87% of prostatectomies result in urinary incontinence, with around half of patients using incontinence pads daily at 6 months. Specialist urology continence nurses at the Norfolk and Norwich University Hospitals (NNUH) NHS Foundation Trust created a pre- and post-surgical care pathway formalising support for these patients, which involves the provision of TENA Men (Essity) male incontinence pads. AIMS: This audit aimed to assess patient satisfaction with this pathway and TENA Men pads. METHODS: Patients who underwent a radical prostatectomy at NNUH between 27 April and 9 November 2021 and who required continence pads were invited to fill out an online anonymous mixed-method (mainly qualitative) survey. RESULTS: Of 28 respondents, 71% reported incontinence after their surgical catheter was removed. Most (89%) were satisfied with the preoperative advice. Of 19 respondents to questions on confidence and satisfaction, 16 were confident that the pads they had been prescribed were helping them to manage urinary leakage, and 16 were confident or very confident that they could manage their incontinence themselves. Generally, respondents were confident that their overall and mental health had improved, and most were confident or very confident that they had less anxiety. However, less than a quarter of respondents were 'very confident' about going out, meeting people or exercising. All but one respondent found TENA Men pads easy to fit, and the most used words in the free-text explanations of what they most liked, included 'easy', 'discreet', 'comfortable' and 'unobtrusive'. CONCLUSION: The clinical pathway helped give patients undergoing radical prostatectomy confidence in their ability to manage post-surgery incontinence themselves and could be of value in other hospitals. Easy access to incontinence pads designed for the male anatomy has an important part in this.

Men's satisfaction with female/unisex and male incontinence pads: a comparative clinical audit.

BACKGROUND: Urinary incontinence is a common and impactful condition. Despite the availability of incontinence pads specifically designed for the male form, many men use pads designed to fit the female anatomy. AIM: This clinical audit-based study compares female/unisex and male incontinence pads in male community patients with urinary incontinence. METHOD: A survey was used to collect Likert-scale data on overall satisfaction and satisfaction with specific aspects of female/unisex and male incontinence pads, as well as with their health and wellbeing and situation and attitudes before and after intervention. Qualitative data were collected on positive features of, reasons for dissatisfaction with and suggested changes to each pad. RESULTS: Among 18 participants, and in all but one domain, satisfaction scores were higher for male pads overall, with the greatest increases in score (1-5) for physical coverage of genital area (1.5), ability to hold urine without leaks (1.4) and level of comfort when wet (1.3). Using a male pad had a positive impact on participants' sense of health and wellbeing. Positive qualitative feedback focused on comfort, ease of use and reliability, as well as the anatomical fit of the male pad. CONCLUSIONS: Sex-specific fit is an important factor in the acceptability of an incontinence pad for men with urinary incontinence. Wearing pads specifically designed for the male anatomy provides men with a greater sense of comfort and confidence.

Interpenetrating and semi-interpenetrating network superabsorbent hydrogels based on sodium alginate and cellulose nanocrystals: A biodegradable and high-performance solution for adult incontinence pads.

Superabsorbent hydrogels (SAHs) are essential in various applications, including hygienic products like adult incontinence pads. However, synthetic-based super absorbent polymers (SAPs) dominate the market despite being non-biodegradable. Alternatively, bio-based hydrogels, such as sodium alginate (SA)-based hydrogels, offer biodegradable alternatives. In this study, we aimed to enhance the practical applied properties of SA-based hydrogels by grafting SA with acrylic acid (AA) and incorporating cellulose nanocrystals (CNCs). Specifically, we investigated the potential of interpenetrating network (IPN) and semi-interpenetrating network (S-IPN) hydrogels as absorbent materials in adult incontinence pads. The fabricated SAHs were characterized by Fourier transform infrared (FT-IR) spectroscopy and scanning electron microscopy (SEM). They were also evaluated for absorption and rheological properties. The results showed that in IPN/SAHs, the addition of CNCs decreased pore sizes, while in S-IPN/SAHs, CNC incorporation increased pore sizes. The S-IPN/SAHs exhibited a significantly higher free swelling capacity (FSC) with CNCs loading, reaching 142.29 g/g in 0.9 % NaCl solution and 817.4 g/g in distilled water. On the other hand, IPN/SAHs showed a higher storage modulus and lower loss modulus compared to S-IPN/SAHs. Notably, the superior samples from this study showed a 33 % reduction in SAP consumption compared to commercial SAPs, making them more cost-effective for adult incontinence pad manufacturers. Overall, our research demonstrates the potential of interpenetrating and semi-interpenetrating network superabsorbent hydrogels as high-performance absorbent materials. The results offer improved absorbency and cost savings for producers of adult incontinence pads, and bio-based hydrogels like SA-based hydrogels are promising biodegradable alternatives to synthetic-based SAPs.

Men's satisfaction with female/unisex and male incontinence pads: a comparative clinical audit.

BACKGROUND: Urinary incontinence is a common and impactful condition. Despite the availability of incontinence pads specifically designed for the male form, many men use pads designed to fit the female anatomy. AIM: This clinical audit-based study compares female/unisex and male incontinence pads in male community patients with urinary incontinence. METHOD: A survey was used to collect Likert-scale data on overall satisfaction and satisfaction with specific aspects of female/unisex and male incontinence pads, as well as with their health and wellbeing and situation and attitudes before and after intervention. Qualitative data were collected on positive features of, reasons for dissatisfaction with and suggested changes to each pad. RESULTS: Among 18 participants, and in all but one domain, satisfaction scores were higher for male pads overall, with the greatest increases in score (1-5) for physical coverage of genital area (1.5), ability to hold urine without leaks (1.4) and level of comfort when wet (1.3). Using a male pad had a positive impact on participants' sense of health and wellbeing. Positive qualitative feedback focused on comfort, ease of use and reliability, as well as the anatomical fit of the male pad. CONCLUSIONS: Sex-specific fit is an important factor in the acceptability of an incontinence pad for men with urinary incontinence. Wearing pads specifically designed for the male anatomy provides men with a greater sense of comfort and confidence.

The effectiveness of the Attends Product Selector Tool in continence management in a care home setting.

Qualified nurses are accountable for selecting a suitable containment product for care home residents, which can be challenging for both the resident and health professional. Absorbent incontinence products are the most commonly used products for containing leakage. The purpose of this observational study was to review and understand how effective the Attends Product Selector Tool is when used to assess a resident for an appropriate disposable incontinence product and the in-use experience of products in relation to containment, product use and effectiveness. The study was undertaken in three care homes, with 92 residents who had an initial assessment undertaken either by an Attends Product Manager or a nurse trained in how to use the tool. A total of 316 products over a 48-hour period were individually assessed by the observer to check the time the pad was changed, the type of pad used, the voided volume in the pad and if the pad had leaked. The results showed that some residents had their products changed inappropriately. Not all residents were using the products that best suited their assessment; this mostly occurred at night. Overall, the tool was effective in enabling staff to select an appropriate style of containment product. However, when it came to selecting the absorbency, the assessor tended to choose a higher absorbency rather than starting at the lower absorbency in the product guide range. The observer found the assessed product was not always used and was sometimes changed inappropriately due to lack of communication and staff turnover.

Efficacy, effectiveness, usability and acceptability of devices for female urinary incontinence: A scoping review.

AIMS AND OBJECTIVES: Investigate evidence available on the efficacy, safety and acceptability of devices for the management of female urinary incontinence, in which clinical settings and specific female populations they have been tested. Learn more about healthcare professionals' perspectives and experiences regarding female urinary incontinence devices. BACKGROUND: Urinary incontinence is defined as the involuntary leakage of urine, estimated to affect 25%-45% of women. Urinary incontinence predisposes the skin to urinary incontinence dermatitis, it is one of the most common documented causes of inappropriate urinary catheterisation, favouring catheter-associated infection. Several products for managing female urinary incontinence are available, no accurate and systematic data on usability, effectiveness and associated outcomes of these products are available. DESIGN AND METHODS: A scoping review was conducted, using a methodological framework including the following five steps: identification of the research question; identification of relevant documents; selection of documents included in the review; tracking of information and data; synthesis and reporting of results. Twenty-one articles were selected. PRISMA-ScR Checklist was followed. RESULTS: The devices explored in the studies were as follows: female external urinary catheter; disposable sanitary pads, diapers or sanitary pads used to manage urinary incontinence in women; mechanical devices; a new prototype of underwear that tracks where pads lose; reusable underwear for light incontinence; a new intelligent system pad. CONCLUSIONS: New smart pads, urine suction systems and female external catheters appear to be effective in preventing and reducing urinary incontinence dermatitis. The female external catheter reduces the days of indwelling catheterisation and could reduce the incidence of catheter associated urinary tract infection; therefore, it should be recommended.

Pathway for post-prostatectomy urinary incontinence: impact on patient confidence and satisfaction.

BACKGROUND: Between 8% and 87% of prostatectomies result in urinary incontinence, with around half of patients using incontinence pads daily at 6 months. Specialist urology continence nurses at the Norfolk and Norwich University Hospitals NHS Foundation Trust created a pre- and post-surgical care pathway formalising support for these patients, which involves the provision of TENA Men (Essity) male incontinence pads. AIMS: This audit aimed to assess patient satisfaction with this pathway and TENA Men pads. METHODS: Patients who underwent a radical prostatectomy at NNUH between 27 April and 9 November 2021 and who required continence pads were invited to fill out an online anonymous mixed-method (mainly qualitative) survey. RESULTS: Of 28 respondents, 71% reported incontinence after their surgical catheter was removed. Most (89%) were satisfied with the preoperative advice. Of 19 respondents to questions on confidence and satisfaction, 16 were confident that the pads they had been prescribed were helping them to manage urinary leakage, and 16 were confident or very confident that they could manage their incontinence themselves. Generally, respondents were confident that their overall and mental health had improved, and most were confident or very confident that they had less anxiety. However, less than a quarter of respondents were 'very confident' about going out, meeting people or exercising. All but one respondent found TENA Men pads easy to fit, and the most used words in the free-text explanations of what they most included 'easy', 'discreet', 'comfortable' and 'unobtrusive'. CONCLUSION: The clinical pathway helped give patients undergoing radical prostatectomy confidence in their ability to manage post-surgery incontinence themselves and could be of value in other hospitals. Easy access to incontinence pads designed for the male anatomy has an important part in this.

Construcción y validación de una herramienta para evaluación del conocimiento sobre la dermatitis asociada a la incontinencia / Construção e validação de um instrumento para avaliação do conhecimento sobre dermatite associada à incontinência / Construction and validation of a tool for evaluation of knowledge about incontinence-associated dermatitis

Objetivo: Construir y validar una herramienta para evaluar el conocimiento sobre la dermatitis por incontinencia entre profesionales de enfermería. Método: Investigación metodológica para la elaboración y la validación de contenido de una herramienta para evaluación del conocimiento sobre la dermatitis por incontinencia, efectuada en tres etapas, la elaboración de la herramienta se hizo entre junio y octubre de 2020 y la validación de contenido – por siete jueces y seis profesionales – y el pretest, se realizaron entre marzo y mayo de 2021. La construcción de la herramienta se ha fundamentado en documentos de consenso y revisiones sistemáticas del tema. Durante la validación, fue adoptado el Método Delphi. Para el análisis de la concordancia entre examinadores se ha calculado el Índice de Validez de Contenido. Resultados: La concordancia entre los evaluadores fue superior al 83% en los elementos y en el dominio del test. Por medio del análisis de la varianza, se identificó que no hubo diferencia estadística significativa entre las respuestas de los evaluadores. La versión final de la herramienta presenta 57 ítems. Conclusiones: El test elaborado fue considerado adecuado por los evaluadores en cuanto a los criterios de relevancia, claridad y simplicidad, por lo que puede aplicarse en la población objetivo, para orientar acciones de educación permanente en salud. (AU)

Objetivo: Construir e validar um instrumento para avaliar o conhecimento sobre dermatite associada à incontinência entre profissionais de enfermagem. Método: Pesquisa metodológica, para a elaboração e validação de conteúdo de um instrumento para avaliação do conhecimento sobre dermatite associada a incontinência, realizada em três etapas sendo, a elaboração do instrumento entre junho e outubro de 2020, validação de conteúdo por sete juízes e seis profissionais e pré-teste, entre março e maio de 2021. A construção do mesmo, fundamentou-se em documentos de consenso e revisões sistemáticas do tema. Durante a validação adotou-se a Técnica Delphi. Para análise da concordância entre examinadores, calculou-se o Índice de Validade de Conteúdo.Resultados: A concordância entre os avaliadores foi superior a 83%, nos itens e domínios do teste. Através de análise da variância, identificou-se que não houve diferença estatística significativa entre as respostas dos avaliadores. A versão final do instrumento apresenta 57 itens. Conclusões: O teste elaborado foi considerado adequado pelos avaliadores, quanto aos critérios de relevância, clareza e simplicidade, podendo ser aplicado na população fim, para nortear ações de educação permanente em saúde. (AU)

Objective: Building and validating a tool to evaluate knowledge about incontinence-associated dermatitis among nursing professionals. Method: Methodological research, for the elaboration and content validation of a tool to assess knowledge about incontinence-associated dermatitis, carried out in three stages: the elaboration of the instrument between June and October 2020, content validation by seven judges and six professionals, and pre-test, between March and May 2021. Its construction was based on consensus documents and systematic reviews of the topic. During validation, the Delphi method was adopted. Content Validity Index was calculated to analyze the agreement between examiners. Results: The agreement among the evaluators was higher than 83% in the test items and domains. Through analysis of variance, it was identified that there was no statistically significant difference among the evaluators' responses. The final version of the tool has 57 items. Conclusions: The test developed was considered adequate by the evaluators, regarding the criteria of relevance, clarity and simplicity, and can be applied to the target population for guiding permanent health education actions. (AU)

Patient and caretaker satisfaction with the PureWick system.

INTRODUCTION: The BD PureWick System (PureWick) allows for non-invasive management of urinary incontinence (UI) by using a low-pressure suction to wick urine from an external catheter into a collection canister. The purpose of this study was to assess satisfaction of using PureWick for management of UI in the outpatient setting based on patient and caregiver feedback. MATERIALS AND METHODS: Patients and caregivers utilizing PureWick completed an online questionnaire between August and October 2020. Factors evaluated included demographics, satisfaction, recommendations, and claims using multiple choice questions, checklists, 6-point Likert Scale, and open-ended questions. Patient and caregiver responses were compared using the independent samples t-test and z-test. RESULTS: Of the 119 patients and 205 caregivers completing the questionnaire, > 80% indicated satisfaction, comfort benefits, continued future use, and likelihood of recommendation despite > 70% reporting increased expense compared to diapers. Additionally, > 20% indicated sleep benefits. Compared to patients, caregivers found PureWick easier to use (3% vs. 20%, p < 0.001) and associated with less perceived UTI and skin infections (7% vs. 17%, p = 0.008). Claims, using the 6-point Likert Scale, with mean ratings ≥ 5 included PureWick being easy to set up, empty, clean, and, compared to diapers, requiring leaving the bed less to use the bathroom. Caregivers gave higher ratings than patients to claims on PureWick being easy to set up and allowing for feelings of increased rest the morning after use. CONCLUSIONS: Patients and caregivers using PureWick in the outpatient setting reported convenience in managing UI, intended future use, and more satisfaction in comparison to adult diapers.

Non-medication coping strategies for urinary incontinence in older adults: factors associated with frequency of use.

INTRODUCTION AND HYPOTHESIS: The aim of this study is to determine the frequency of the use of non-medication coping strategies for urinary incontinence in older adults. METHODS: This methodological and cross-sectional study was conducted in 320 older adults. The data of the study were collected using a personal information form and a urinary incontinence questionnaire form regarding the frequency of the use of non-medication coping strategies for urinary incontinence. Within the scope of the validity and reliability study of the questionnaire, Cronbach's alpha, factor analysis tests, KMO, Bartlett's test, and principal components analysis were used. Descriptive statistics, independent t test, ANOVA, and correlation test were also used for data. The statistical accepted significance level was p < 0.05. RESULTS: The mean age of the participants in the study was 75.54 ± 9.34 years. Older adults who are illiterate, who are single, who have a chronic disease, who are at an advanced age, who are women, who describe having urinary incontinence during activities, who always experience leaking urine, whose diapers or underwear get wet, who share these issues with their relatives, and who do not consult a doctor because they are afraid of being examined were all found to have a higher frequency of use of coping strategies for urinary incontinence (p < 0.05). CONCLUSIONS: This study recommends carrying out studies to raise awareness about urinary incontinence in older adults. In addition, this study suggests that the questionnaire applied to older adults study subjects regarding the frequency of the use of non-medication coping strategies for urinary incontinence might be used for all age groups.

Difference in Incontinence Pad Use between Patients after Radical Prostatectomy and Cancer-Free Population with Subgroup Analysis for Open vs. Minimally Invasive Radical Prostatectomy: A Descriptive Analysis of Insurance Claims-Based Data.

PURPOSE: to quantify and compare pre- and post-surgical incontinence pad use between men treated with radical prostatectomy (RP) for prostate cancer (PCa) and cancer-free controls, using population-based Austrian insurance claims data. METHODS: Men who underwent RP for treating PCa between 2013-2015 were identified. Cancer-free men ≥45 years with and without benign prostate hyperplasia (BPH) were used as controls. Longitudinal data on ICD-diagnoses, type of surgery, prescribed incontinence pads, and hospitals' surgery volumes were aggregated between 2011-2018 to capture pre- and up to three years post-RP follow-up. Monthly rates of pad use were calculated and compared between RP types and cancer-free controls. RESULTS: A total of 6248 RP patients, 7158 cancer-free men with BPH, and 50,257 cancer-free men without BPH were analyzed. Comparing to pre-RP (0.03, 95%CI: 0.02-0.05), RP resulted in significantly higher rates of prescribed pads (at 3 months: 12.61, 95%CI: 11.59-13.65; 12 months: 6.71, 95%CI: 6.10-7.34; 36 months: 4.91, 95%CI: 3.76-4.62). These rates were also higher than those for cancer free controls (with BPH:0.06, 95%CI: 0.04-0.09; without BPH:0.12, 95%CI: 0.10-0.14). The rate of prescribed pads after surgery continued to decline over time and remained higher among men who underwent minimally invasive RP compared to those who underwent an open procedure. CONCLUSION: Despite progress in surgical techniques, post-RP incontinence remains a prevalent adverse event. The rate of pad usage steadily improved over the first three years post RP. The rate of patients with incontinence needing pads was higher among those who were treated minimally invasive compared to open approach.

Comparative Outcomes of Salvage Retzius-Sparing versus Standard Robotic Prostatectomy: An International, Multi-Surgeon Series.

PURPOSE: Salvage radical prostatectomy is rare due to the risk of postoperative complications. We compare salvage Retzius-sparing robotic assisted radical prostatectomy (SRS-RARP) with salvage standard robotic assisted radical prostatectomy (SS-RARP). MATERIALS AND METHODS: A total of 72 patients across 9 centers were identified (40 SRS-RARP vs 32 SS-RARP). Demographics, perioperative data, and pathological and functional outcomes were compared using Student's t-test and ANOVA. Cox proportional hazard models and Kaplan-Meier curves were constructed to assess risk of incontinence and time to continence. Linear regression models were constructed to investigate postoperative pad use and console time. RESULTS: Median followup was 23 vs 36 months for SRS-RARP vs SS-RARP. Console time and estimated blood loss favored SRS-RARP. There were no differences in complication rates or oncologic outcomes. SRS-RARP had improved continence (78.4% vs 43.8%, p <0.001 for 0-1 pad, 54.1% vs 6.3%, p <0.001 for 0 pad), lower pads per day (0.57 vs 2.03, p <0.001), and earlier return to continence (median 47 vs 180 days, p=0.008). SRS-RARP was associated with decreased incontinence defined as >0-1 pad (HR 0.28, 95% CI 0.10-0.79, p=0.016), although not when defined as >0 pad (HR 0.56, 95% CI 0.31-1.01, p=0.053). On adjusted analysis SRS-RARP was associated with decreased pads per day. Lymph node dissection and primary treatment with stereotactic body radiation therapy were associated with longer console time. CONCLUSIONS: SRS-RARP is a feasible salvage option with significantly improved urinary function outcomes. This may warrant increased utilization of SRS-RARP to manage men who fail nonsurgical primary treatment for prostate cancer.

Preliminary Report From the Pelvic Floor Disorders Consortium: Large-Scale Data Collection Through Quality Improvement Initiatives to Provide Data on Functional Outcomes After Rectal Prolapse Repair.

BACKGROUND: The surgical management of rectal prolapse is constantly evolving, yet numerous clinical trials and meta-analyses studying operative approaches have failed to make meaningful conclusions. OBJECTIVE: The purpose of this study was to report on preliminary data captured during a large-scale quality improvement initiative to measure and improve function in patients undergoing rectal prolapse repair. DESIGN: This was a retrospective analysis of prospectively collected surgical quality improvement data. SETTINGS: This study was conducted at 14 tertiary centers specializing in pelvic floor disorders from 2017 to 2019. PATIENTS: A total of 181 consecutive patients undergoing external rectal prolapse repair were included. MAIN OUTCOME MEASURES: Preoperative and 3-month postoperative Wexner incontinence score and Altomare obstructed defecation score were measured. RESULTS: The cohort included 112 patients undergoing abdominal surgery (71 suture rectopexy/56% minimally invasive, 41 ventral rectopexy/93% minimally invasive). Those offered perineal approaches (n = 68) were older (median age, 75 vs 62 y; p < 0.01) and had more comorbidities (ASA 3-4: 51% vs 24%; p < 0.01) but also reported higher preintervention rates of fecal incontinence (Wexner 11.4 ± 6.4 vs 8.6 ± 5.8; p < 0.01). Patients undergoing perineal procedures had similar incremental improvements in function after surgery as patients undergoing abdominal repair (change in Wexner, -2.6 ± 6.4 vs -3.1 ± 5.6, p = 0.6; change in Altomare, -2.9 ± 4.6 vs -2.7 ± 4.9, p = 0.8). Similarly, patients undergoing posterior suture rectopexy and ventral mesh rectopexy had similar incremental improvements in overall scores; however, patients undergoing ventral mesh rectopexy had a higher decrease in the need to use pads after surgery. LIMITATIONS: The study was limited by its retrospective data analysis and 3-month follow-up. CONCLUSIONS: Functional outcomes improved in all of the patients undergoing prolapse surgery. Larger cohorts are necessary to show superiority among surgical procedures. Quality improvement methods may allow for systematic yet practical acquisition of information and data analysis. We call for the creation of a robust database to benefit this patient population. See Video Abstract at http://links.lww.com/DCR/B581. REPORTE PRELIMINAR DEL CONSORCIO DE TRASTORNOS DEL PISO PLVICO RECOLECCIN DE DATOS A GRAN ESCALA MEDIANTE INICIATIVAS DE MEJORAMIENTO DE LA CALIDAD PARA PROPORCIONAR INFORMACIN SOBRE LOS RESULTADOS FUNCIONALES: ANTECEDENTES:El tratamiento quirúrgico del prolapso rectal está evolucionando constantemente, sin embargo, numerosos estudios clínicos y metaanálisis que evalúan los tratamientos quirúrgicos no han logrado demostrar conclusiones significativas.OBJETIVO:Reportar datos preliminares obtenidos a gran escala durante una iniciativa de mejoramiento de la calidad para medir y mejorar la función en pacientes sometidos a reparación de prolapso rectal.DISEÑO:Análisis retrospectivo de datos recolectados prospectivamente de mejoramiento de la calidad quirúrgica.ENTORNO CLINICO:Este estudio se realizó en 14 centros terciarios especializados en trastornos del piso pélvico del 2017 al 2019.PACIENTES:Un total de 181 pacientes consecutivos sometidos a reparación de prolapso rectal externo.PRINCIPALES MEDIDAS DE VALORACION:Escala de incontinencia de Wexner y de defecación obstruida de Altomare preoperatoria y tres meses postoperatoria.RESULTADOS:El cohorte incluyó 112 pacientes sometidos a cirugía abdominal (71 rectopexia con sutura / 56% minimally invasive, 41 rectopexia ventral / 93% minimally invasive). Aquellos a los que se les realizaron abordajes perineales (n = 68) eran mayores (edad media de 75 vs. 62, p <0,01) y tenían mayorcomorbilidades (ASA 3-4: 51% vs. 24%, p <0,01), además reportaron una mayor tasa de incontinencia fecal previo a la intervención (Wexner 11,4 ± 6,4 vs. 8,6 +/- 5,8, p <0,01). Posterior a la cirugía, los pacientes sometidos a procedimientos perineales tuvieron mejoría progresiva en la función similar que los pacientes sometidos a reparación abdominal (cambio en Wexner -2,6 ± 6,4 vs. -3,1 ± 5,6, p = 0,6; cambio en Altomare -2,9 ± 4,6 vs. -2,7 ± 4,9, p = 0,8). De manera similar, los pacientes con rectopexia posterior con sutura y rectopexia ventral con malla tuvieron mejoría progresiva similares en las escalas generales; no obstante, pacientes con rectopexia ventral con malla tuvieron una mayor disminución en la necesidad de usar paños protectores después de la cirugía.LIMITACIONES:Análisis de datos retrospectivo y seguimiento de tres meses.CONCLUSIONES:Los resultados funcionales mejoraron en todos los pacientes sometidos a cirugía de prolapso. Se necesitan cohortes más grandes para demostrar superioridad entre los procedimientos quirúrgicos. Métodos de mejoramiento de la calidad pueden permitir la adquisición sistemática, pero práctica de información y análisis de datos. Hacemos un llamado para la creación de una base de datos sólida para beneficiar a esta población de pacientes. Consulte Video Resumen en http://links.lww.com/DCR/B581. (Traducción- Dr Francisco M. Abarca-Rendon).

Escala de avaliação do uso de fraldas e absorventes: estudo metodológico / Evaluation scale for the use of adult diapers and absorbent products': methodological study / Escala de evaluación del uso de pañales y absorbentes: estudio metodológico

OBJETIVO: Validar o conteúdo da escala de avaliação do uso de fraldas e produtos absorventes (Escala AUFA) por idosos na atenção primária. MÉTODO: Estudo metodológico de validação de conteúdo com 23 especialistas em enfermagem gerontológica ou feridas pela avaliação do nome e itens da escala. A análise dos dados ocorreu por meio de índice de validação de conteúdo (IVC) e coeficiente de validação de conteúdo (CVC), percentual de concordo totalmente e concordância pelo Alfa de Cronbach, com o mínimo de 0,80 cada. RESULTADOS: Os IVC e CVC gerais foram de, respectivamente, 0,91 e 0,89. Entretanto, os percentuais de concordo completamente e Alfa de Cronbach foram de, respectivamente, 0,65 e 0,51. Após três envios e modificações da escala, a avaliação foi de 0,95 e 0,85. DISCUSSÃO: Os juízes contribuíram para o conteúdo da escala, principalmente quanto ao número de trocas CONCLUSÃO: Após as análises e sugestões dos juízes, o conteúdo foi refinado e validado.

OBJECTIVE: To validate the content of the 'Evaluation Scale for the Use of Adult Diapers and Absorbent Products' (AUFA Scale) among elderly patients in primary care. METHOD: Methodological study for validation of contente with 23 specialists in gerontological nursing and/or wounds for evaluating the name and the items of the scale. The analysis of the data was done according to the Index of Validation of Content (IVC) and the Coefficient of Validation of Content (CVC), the 'Fully Agree" percentage and the compliance to 'Cronbach's Alpha', with a minimum score of 0,80 for each. RESULTS: The general IVC and CVC were 0,91 and 0,89, respectively. However, the 'Fully Agree' and 'Cronbach's Alpha' percentages were 0,65 and 0,51, respectively. After three 3 submissions and modifications of the scale, the scores changed to 0,95 and 0,85. DISCUSSION: Judges contributed to the content of the scale, especially regarding the number of absorbent product changes CONCLUSION: After taking into account the analyses and suggetions made by the judges, the content was refined and considered validated.

OBJETIVO: Validar el contenido de la escala de evaluación para el uso de pañales y productos absorbentes (Escala AUFA) en ancianos en atención primaria. MÉTODO: Estudio metodológico de validación de contenido con 23 especialistas en enfermería gerontológica y/o heridas para la evaluación del nombre y de los ítems de la escala. El análisis de los datos se realizó mediante el Índice de Validación de Contenido (IVC) y el Coeficiente de Validación de Contenido (CVC), así como del porcentaje de la respuesta 'Totalmente de acuerdo' y del 'Alfa de Cronbach', con un puntaje mínimo de 0.80 para cada uno.RESULTADOS: Los IVC y CVC generales fueron de 0.91 y 0.89, respectivamente. Sin embargo, el porcentaje de 'Totalmente de acuerdo' y del 'Alfa de Cronbach' fue de 0.65 y 0.51, respectivamente. Después de 3 presentaciones y modificaciones de la escala, la evaluación fue de 0.95 y 0.85. DISCUSIÓN: Los jueces contribuyeron al contenido de la escala, principalmente en cuanto al número de cambios. CONCLUSIÓN: Luego del análisis y de las sugerencias de los jueces, el contenido se refino el contenido hasta considerarlo validado.