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Biomedical subjects

H M Duffin

Publications and source records attributed to H M Duffin.

14 recordsLinked to original sources
PubMed1996

The management of urinary incontinence in residential and nursing homes for older people.

We assessed the management of urinary incontinence amongst older people in residential and nursing homes and examined strategies for continence care in the homes. A random sample of local authority and private residential and nursing homes was drawn from an earlier census of long-term care. Strategies for continence care, the standard of care provided and the need for more help were determined by means of a structured questionnaire and the observations of a continence adviser. A random selection of residents in each of the homes was assessed for the presence, severity and symptoms of urinary incontinence, for symptom control and physical dependency. Eighty-seven per cent of the homes used pads and 83% daytime toileting to promote continence care but only 52% practised night-time toileting and 49% the use of clear toilet signs. A greater emphasis was placed on incontinence management rather than continence promotion, the latter being "good' in only 32% of homes. Although the majority of homes reported having adequate access to aids and appliances, 39% of residents had severe symptoms of urinary incontinence resulting in bed-wetting and wetting of clothing. Substantial social and psychological effects were found; 87% of residents needed changes in their management of the condition and incontinence management was "good' in only 47% of homes. Although 73% of homes were optimistic about offering good continence care, they were infrequently supported by continence nurses (30% of homes) or specialist continence doctors (9% of homes). Consequently 57% requested more help from the specialist services. The high prevalence of severe and uncontrolled symptoms of urinary incontinence combined with the lack of support received by the homes for the management of these residents indicated the urgent need for a greater input from the specialist continence service.

Activities of Daily Living↗
PubMed1989

Long-term follow-up of habit retraining for bladder instability in elderly patients.

Sixty patients with detrusor instability were contacted 2 to 3 years after their initial diagnosis and treatment. When first treated, 40 had improved, nine were catheterized and the remainder were unchanged. By the time of the first outpatient appointment 1 month later, a further 6% had been catheterized and 26% had lost control. Two to 3 years later, 17 of the 40 who had improved initially had maintained their improvement. The control in all the remainder had deteriorated and ten of the original 60 had died. Four of these deaths occurred in the group initially catheterized, only two of this group still had their catheter in situ, but were experiencing problems from it, and the remaining three had removed their catheter and were managing with pants and pads. Thus, two-thirds of elderly patients with bladder instability respond initially to treatment, but 2 to 3 years later only two-fifths of these are still deriving benefit.

Aged↗
PubMed1987

Urodynamic findings in sacrococcygeal chordoma.

The clinical and urodynamic findings in two cases of sacrococcygeal chordoma are described. The urodynamic findings suggest that the urinary problems in this condition are caused by an incomplete lower motor neurone lesion.

Aged↗
PubMed1986

Double-blind study of imipramine and placebo for incontinence due to bladder instability.

We compared imipramine with placebo in a double-blind study in Leicester, in elderly incontinent patients. The results revealed that 14 out of 19 patients became dry after imipramine and six out of 14 after placebo treatment. Patients on imipramine also tended to become drier sooner. However, these results must only be taken as preliminary evidence of drug effect since statistical analysis between drug and placebo did not reach significance. The results do, however, confirm the great benefit of habit-retraining which all patients received. It is now our practice to try this alone first, and to reserve drugs for slow or nonresponders, because of their possible adverse effects.

Aged↗
PubMed1985

Urinary tract infection after cystometry.

Eighteen of 67 patients who underwent cystometry for assessment of incontinence had a urinary tract infection 72 hours later. Though four of the 18 had an infection prior to cystometry, the true postcystometry infection was still high at 21%. Clinical details and urodynamic studies on these patients showed no correlation with sex, mobility, mental score, random blood sugar, renal function, initial residual volume of urine, previous pelvic operations or the type of bladder abnormality diagnosed on cystometry. The elderly and males with a high residual volume seemed more susceptible to infection. Thus cystometry carries a definite risk of infection even under optimal conditions and should not be undertaken lightly or without arrangements to follow up patients.

Aged↗
PubMed1985

Factors influencing outcome in elderly patients with urinary incontinence and detrusor instability.

The majority of elderly incontinent patients with detrusor instability in whom various medical treatments had been tried and failed, became dry or very significantly improved following attendance at a Continence Clinic. The reason for this was not only because this clinic had access to specialized investigational equipment, but also because patients received individual psychological and practical management of their incontinence. All were given time to discuss their problems, had imipramine titrated against effect, and practised habit-retraining programmes. Treatment was started in hospital if there was any doubt of the patients misunderstanding or not complying with such regimens. Patients did best if they were sensible and mobile. Urodynamic measurements seemed less important individually, although overall final outcome correlated with the severity of the instability.

Age Factors↗
PubMed1984

The effect of physiotherapy on stress incontinence.

Physiotherapy is a safe and effective means of decreasing the symptoms and signs of stress incontinence. Fourteen out of 19 women became dry or improved sufficiently not to warrant wearing any protective garment over a 4-week treatment period. The use of a novel machine to measure pelvic floor squeeze did not improve the success of physiotherapy alone in this condition but may have an important role in instructing the patient on the correct use of the pelvic floor muscles.

Adult↗
PubMed1983

In vivo and in vitro studies on the effect of sodium antagonists on the bladder in man and rat.

The effect of oral mexiletine and intravenous lignocaine was examined in elderly patients with urinary incontinence associated with detrusor instability. Lignocaine had no demonstrable urodynamic effect in 13 patients, but 12 out of 20 patients who completed the study with mexiletine benefited, 10 becoming dry. The incidence of side-effects was high. Since there was no associated urodynamic improvement on the drug, the clinical improvement was probably secondary to the toileting regime instigated in every case. The results of the in vitro experiments on 11 rat bladders supported this contention, since mexiletine caused contractions of the preparation, and increased the rate and magnitude of spontaneous activity. Acetylcholine, histamine and 5-hydroxytryptamine receptors were not involved in these contractions.

Adult↗
PubMed1982

Clinical and urodynamic effects of ephedrine in elderly incontinent patients.

The effect of ephedrine, an adrenergic receptor agonist, was investigated in 24 elderly patients with urinary incontinence associated with unstable detrusor contractions. After 3 weeks of oral ephedrine repeat cystometry showed mean increases of 21 per cent in bladder capacity and of 23 per cent in urethral pressure. Of 21 patients studied 7 became continent and 12 were improved. However, the urodynamic improvement did not reach statistical significance even in the continent group and, thus, the clinical improvement was unlikely to be owing to ephedrine. Therefore, open studies of drug treatment for detrusor instability may be misleading unless clinical and cystometric data are obtained.

Aged↗
PubMed1981

Clinical and urodynamic studies in 100 elderly incontinent patients.

Clinical details were noted and urodynamic studies carried out on 100 elderly patients referred to an incontinence clinic, of whom 48 attended as day patients. Thirty patients had no problem apart from their incontinence, and only 38 had a clinically detectable neurological lesion. The average mental orientation score in 48 of the patients was 7.6, 23 patients scoring the top score of 10. Most patients were mobile without assistance from another person. Patients could be placed into one of four diagnostic groups according to the appearance of the cystometric tracings, but no bladder capacity or pressure was characteristic of any group. The maximum urethral closure pressure and functional profile length were similar for each group within each sex. There was no correlation between clinical and urodynamic findings, yet each of the four diagnostic categories have different therapeutic implications. It is concluded that urodynamic investigation is necessary in elderly incontinent patients before treatment.

Aged↗
PubMed1981

Guidelines for controlling urinary incontinence without drugs or catheters.

Catheterization of the elderly incontinent patient is frequently unnecessary. It is also often unsuccessful, as most patients have unstable bladders and therefore leakage continues around the tube. Simple measures, like toileting regimens and restricting fluids in the evening, are often effective alone. Incontinence garments restore a patient's self-respect, reduce laundering and should be used more frequently whilst other methods, such as drugs, are being tried.

Aged↗