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Brenda Roe

Publications and source records attributed to Brenda Roe.

9 recordsLinked to original sources
PubMed2007

Systematic reviews of bladder training and voiding programmes in adults: a synopsis of findings from data analysis and outcomes using metastudy techniques.

AIM: This paper reports a comparison of the data analysis and outcomes from four Cochrane systematic reviews on bladder training and voiding programmes for the management of urinary incontinence using metastudy descriptive techniques to inform clinical practice, generate new ideas and identify future research directions. BACKGROUND: Bladder training is used for cognitively and physically able adults to regain continence by increasing the time interval between voids. Prompted voiding, habit retraining and timed voiding, collectively known as voiding programmes, are generally used for people with cognitive and physical impairments in institutional settings. Bladder training and voiding programmes feature as common clinical practice for the management of urinary incontinence. METHODS: A synopsis of four Cochrane systematic reviews that included randomized controlled trials on bladder training, prompted voiding, habit retraining and timed voiding was undertaken using metastudy techniques for the synthesis of qualitative research, and has provided a discursive comparison and contrast of the meta-data analysis and outcomes of these reviews. RESULTS: Frequency of incontinence was the most common and constant outcome measure of effectiveness in the reviews. Limited data were available on other health outcomes, change in dependency status, quality of life and cost-effectiveness. The systematic review on bladder training included different types of urinary incontinence, whereas those on voiding programmes did not differentiate the type of incontinence. There is evidence on the effectiveness of bladder training but long-term follow up studies are needed. Evidence on the effectiveness of voiding programmes is limited and not available for many outcomes. CONCLUSION: Future research needs to consider the theory underpinning interventions for bladder training and voiding programmes for urinary incontinence and should incorporate recognized 'quality' research designs, established outcomes and long-term follow up. It is unclear whether health outcomes for people with comorbidities, cognitive and physical impairments will improve if extensive diagnostic and assessment investigations are undertaken.

Adult↗
PubMed2007

Systematic reviews of bladder training and voiding programmes in adults: a synopsis of findings on theory and methods using metastudy techniques.

AIM: This paper reports a comparison of four Cochrane systematic reviews on bladder training and voiding programmes for the management of urinary incontinence using metastudy descriptive techniques. It presents a synopsis of findings on theory and methods for interventions. BACKGROUND: From the mid-1970s bladder training, prompted voiding, habit retraining and timed voiding have been developed and form the basis of nursing practice for the management of urinary incontinence in adults in institutional and community settings. METHODS: A synopsis of four Cochrane systematic reviews was undertaken using metastudy techniques developed for qualitative research and has provided a discursive comparison and contrast of the selection and appraisal of primary research, meta-theory and meta-method. FINDINGS: All programmes share a therapeutic focus on voiding and the degree and active participation of the client and caregiver. Bladder training focuses on the restoration of continence, while prompted voiding, habit retraining and timed voiding focus on the avoidance of incontinence. Bladder training and prompted voiding share the two characteristics of cognitive behavioural modification and active client participation. Habit retraining and timed voiding pre-empt episodes and avoid incontinence using operant conditioning rather than modifying behaviour. Variability of methods and operational terminology makes comparison between studies difficult. Use of cognitive behavioural approaches and operant conditioning need to be better understood in relation to future theory, interventions and study design. Bladder training is aimed at people who are cognitively and physically able, while the other voiding programmes are mainly used with for people with cognitive and physical impairments reliant on caregivers. CONCLUSION: The theoretical approaches underpinning bladder training and voiding programmes, their components and suitability for patients need to be re-considered when designing future studies. There is a need for long-term follow-up in future studies. Future trials should adhere to recognized standards of good practice and incorporate outcomes from existing systematic reviews to enable future meta-analysis to be undertaken. Metastudy techniques for the synthesis of qualitative research provide useful methods for the descriptive synopsis of quantitative systematic reviews.

Adult↗
PubMed2005

Effects of timed voiding for the management of urinary incontinence in adults: systematic review.

AIM: The aim of this paper is to present a systematic review assessing the effectiveness of timed voiding for the management of urinary incontinence in adults. BACKGROUND: Despite the widespread use of systematic voiding programmes, their effectiveness is unclear, and the evidence for timed voiding has not been subject to rigorous and systematic evaluation. The impact on psychosocial factors and cost is also untested. The physiological basis for timed voiding is also poorly established. METHODS: The systematic review incorporated the methodology of the Cochrane Collaboration. All randomized or quasi-randomized controlled trials that addressed timed voiding for the management of urinary incontinence in adults were searched, appraised, analysed and summarized. The date of the latest search was 2002. Data were extracted independently and appraised according to the level of concealment of random allocation prior to formal entry; few and identifiable withdrawals and dropouts and an analysis based on an intention to treat. The relative risk for dichotomous data was calculated with 95% confidence intervals. Where data were insufficient to support quantitative analysis, a narrative overview was undertaken. RESULTS: Two trials of timed voiding met the inclusion criteria. In both, timed voiding was combined with other strategies. Participants were predominantly cognitively and physically impaired older women who resided in nursing home settings. Within-group improvements for the intervention groups were reported for both trials. One trial additionally reported a statistically significant reduction in night-time incontinence for the intervention group. The quality of the trials was modest and interpretation was limited by the potential for bias associated with inadequate concealment, missing data and no analysis by intention to treat. CONCLUSION: Terms used to describe voiding programmes that involve a fixed interval of voiding are variable. No conclusions can be drawn at this point about the effectiveness of timed voiding for the management of urinary incontinence in adults.

Aged, 80 and over↗
PubMed2003

Development and evaluation of intermediate care.

Intermediate care is being developed as part of the national strategy for older people in England and Wales to prevent their admission to hospital and facilitate early discharge. Evaluation of intermediate care is implicit within current policy directives. This project evaluated the client information across a number of intermediate care schemes within one National Health Service community trust for 3 months and disseminated the results to staff as part of a reflective workshop which also provided an opportunity for additional data collection. Rates of referral and acceptance on intermediate care were high for all the schemes except one, indicating reliable referral and inclusion criteria. Older people were the recipients of intermediate care with nearly half of them having experienced falls. A number of developments were identified by staff covering both current services and long-term strategy for intermediate care and indicating the importance of involving providers in the evaluation and development of services. Fall prevention initiatives and involvement of users and carers in the evaluation and development of intermediate care were also identified.

Aftercare↗
PubMed2003

Delivering a different kind of primary care? Nurses working in personal medical service pilots.

This article examines the roles and responsibilities of primary care nurses in England. The study was commissioned by the Department of Health to consider how nurses were working in Personal Medical Service (PMS) pilots--a new initiative launched in April 1998. All nurses in the study reported that they had extended their clinical role--in varying degrees. Nurses were running new clinics and services, and general practitioner time was freed up. Some of the nurses used PMS to deliver a different kind of primary care, one that was more community and patient focused than other General Medical Service providers. Many of the nurses in the study are successfully breaking down traditional demarcations between primary and secondary care, between medicine and nursing, and between professionals and patients.

England↗
PubMedDate not supplied

Translating research on incontinence into practice.

BACKGROUND: Translating research evidence into clinical practice (TRIP) is an important initiative for health services so that care delivered is cost-effective, is efficient, and improves patient outcomes. Most TRIP studies have reported on disseminating and implementing clinical practice guidelines, protocols, or care pathways and have been undertaken in acute rather than community settings. OBJECTIVES: To identify the factors that influence incontinence TRIP and to present key international studies on incontinence TRIP. METHODS: Existing literature on TRIP was analyzed to generate a plan for future research. RESULTS: Several methods to effect incontinence TRIP are described, including clinical practice guidelines and protocols, clinical pathways, partnerships between organizations, a model for incorporating UI research based on generic questions, and implementation strategies that incorporate change theory and consideration of barriers. CONCLUSIONS: Future research is needed on incontinence TRIP in the following areas: barriers, the best theoretical approaches, the effectiveness of empowerment approaches, the value of mentors, effective strategies for nurses and unlicensed personnel, the impact of international collaboration, and regulations across settings.

Critical Pathways↗
PubMedDate not supplied

Incontinence and falls in older people: is there a link?

Incontinence, falling and cognitive impairment have been recognised as 'geriatric syndromes' for many years (Reuben, 1991). They often result from the accumulated effect of impairments in multiple domains (organ systems) (Tinetti et al, 1988). The relationship between cognitive impairment and incontinence has been extensively written about (McGrother et al, 1990), but the relationship between falls and urinary incontinence (UI) has hardly been studied.

Accidental Falls↗