Biomedical subjects

Janis M Miller

Publications and source records attributed to Janis M Miller.

9 recordsLinked to original sources

PubMed2006

Urinary incontinence symptoms during and after pregnancy in continent and incontinent primiparas.

OBJECTIVE: Examine patterns of urinary incontinence during and after pregnancy, as recalled by incontinent and continent primiparas. STUDY DESIGN: Primiparous women reporting no pre-pregnancy incontinence, were recruited 6 to 9 months postpartum. Those reporting current continence and demonstrating a negative stress test were considered "Primiparous Continent" (PC, n=64). Those reporting current incontinence and demonstrating a positive stress test were considered "Primiparous Incontinent" (PI, n=57). Subjects self-administered a questionnaire recalling leakage during and after pregnancy. RESULTS: Sixteen percent of PC women leaked during pregnancy. Of these, 70% experienced frequent leakage during pregnancy. Seventy-eight percent of PI women leaked both during and after pregnancy. Several patterns arose surrounding leakage frequency for PI women: 19% only leaked frequently during pregnancy, 4% only leaked frequently after pregnancy, and 51% leaked frequently both during and after pregnancy. CONCLUSION: Nearly five times as many primiparous incontinent women, compared with primiparous continent women, leaked during pregnancy.

Adult↗

PubMed2006

The physical finding of stress urinary incontinence among African women in Ghana.

The aim of this study is to determine the proportion of women with the physical sign of stress urinary incontinence in a sample of Ghanaian women. Two hundred randomly selected women from attendants at a convenience selected ultrasound clinic were interviewed about symptoms of urinary incontinence. A paper towel test was performed to objectively demonstrate the physical sign of stress urinary incontinence as leakage on coughing. Forty-two percent of the women had a positive paper towel test. The two major symptoms reported by the women with positive paper towel test were (1) loss of urine while waiting to use the toilet (48.2%) and (2) loss of urine on coughing (43.4%) in daily life. The physical sign of stress urinary incontinence could be present in up to 42% of Ghanaian women.

Adolescent↗

PubMed2006

Interrater reliability and physical examination of the pubovisceral portion of the levator ani muscle, validity comparisons using MR imaging.

AIMS: Defects in the pubovisceral portion of the levator ani muscle are seen with MR imaging. This study aims to determine interrater reliability of physical examination in detecting these defects, and to validate findings from physical examination using comparisons with MR images. METHODS: Two examiners palpated the pubovisceral muscles of 29 women to assess for defects in this muscle. Each examiner was blinded to the others findings. MR scans were acquired on a further 24 women after structured clinical examination by one examiner. These images were read to determine pubovisceral muscle defects, blinded to patient identifiers. Agreement between raters and between MR imaging and clinical examination were calculated. RESULTS: The two examiners had positive agreement (presence of a defect) of 72.7% and negative agreement (absence of a defect) of 83.3%. The positive agreement between physical examination and MR imaging was 27.3% and the negative agreement 86.5%. CONCLUSION: The structured physical examination to detect defects in the pubovisceral portion of the levator ani muscle can be learned as shown by good interrater agreement. However, examination alone underestimates these defects compared with MR imaging.

Adult↗

PubMed2006

Obstetric factors associated with levator ani muscle injury after vaginal birth.

OBJECTIVE: To identify obstetric factors associated with development of levator ani injury after vaginal birth. METHODS: Magnetic resonance images were taken of the pelvic floor of 160 women 9 to 12 months after first term vaginal delivery. Half the women had de novo stress incontinence and half were continent controls. Abnormalities of the pubovisceral portion were identified on magnetic resonance as present or absent. Defect severity was further scored in each muscle from 0 (no defect) to 3 (complete muscle loss). A summed score for the 2 sides (0 to 6) was assigned and grouped as minor (0-3) or major (4-6). Obstetric details were collected. The association between obstetric variables and muscle injury were analyzed using Fisher exact test and t tests. RESULTS: The following increased odds ratios for levator defect were found: forceps use 14.7 (95% confidence interval [CI] 4.9-44.3), anal sphincter rupture 8.1 (95% CI 3.3-19.5) and episiotomy 3.1 (95% CI 1.4-7.2) but not vacuum delivery 0.9 (95% CI 0.19-4.3), epidural use 0.9 (95% CI 0.4-2.0), or oxytocin use 0.8 (95% CI 0.3-1.8). Women with levator injury were 3.5 years older and had a 78-minute longer second stage of labor. Differences in gestational age, birth weight, and head circumference were not statistically significant. A major defect in the pubovisceral muscle was seen in 22 women and a minor defect in 7 women. CONCLUSION: Injuries to the levator ani muscles in women after their first vaginal delivery are associated with several obstetric factors indicating difficult vaginal birth and with older age. LEVEL OF EVIDENCE: II-3.

Adult↗

PubMed2004

Can women without visible pubococcygeal muscle in MR images still increase urethral closure pressures?

OBJECTIVE: The purpose of this study was to determine if the ability to increase maximum urethral closure pressure (MUCP) with a pelvic muscle contraction is impaired in women without pubococcygeal muscle (PCM). STUDY DESIGN: This was a cross-sectional study of continent women comparing those with (n=28) and those without (n=17) PCM as identified by MR scans. A pelvic muscle contraction was performed simultaneously with recordings of urethral and bladder pressures. RESULTS: Eighty-six percent of the women with PCM compared with 41% of the women without could volitionally increase (>5 cm H(2)O) their MUCP. Those with PCM generated a mean intraurethral pressure rise of 14.0 (10.8) cm H(2)O, compared with 6.2 (8.7) cm H(2)O in those without (P=.015). Among women who could produce a visible pressure rise, there was not a statistically significant difference between groups (with PCM=17.2 [7.8] cm H(2)O; without PCM=14.7 [7.5] cm H(2)O; P=.457). CONCLUSION: Selective women without visible PCM can increase MUCP.

Female↗

PubMed2003

Indices for studying urinary incontinence and levator ani function in primiparous women.

Urinary incontinence (UI) is a complex phenomenon that is prevalent in pregnant and parous women and requires the use of sophisticated measures to adequately reflect functioning of the continence system. The purpose of this study was to develop reliable and valid measures of UI and levator ani function for use in research and clinical settings. A Leakage Index (LI) and a Levator Ani Function Index (LAFI) were developed using data from a longitudinal study of primiparous women. Reliability and validity tests were conducted to: (i) estimate the internal consistency reliability of each index, (ii) determine whether the indices captured change in continence status and pelvic floor function during pregnancy through 1 year postpartum, and (iii) estimate association between the indices as a test of predictive validity. Cronbach's alpha ranged from 0.72 to 0.84 for the LI and from 0.53 to 0.79 for the LAFI across the six data collection time points of the study. Average LI scores increased late in pregnancy and decreased postpartum, though not significantly. Average LAFI scores decreased significantly at 35 weeks gestation (t = 4.84, P = 0.000) and increased significantly at 12 months postpartum (t = -3.51, P = 0.002) relative to baseline. The LI and LAFI were significantly associated at 20 weeks gestation (Pearson r = -0.40, P = 0.007) and at 6 weeks postpartum (Pearson r = -0.33, P = 0.029). The findings suggest the LI and LAFI are reliable and valid measures of UI and levator ani function in primiparous women, which can be used with confidence in clinical and research settings.

Adolescent↗

PubMed2002

Criteria for therapeutic use of pelvic floor muscle training in women.

Success in pelvic floor muscle training as a therapeutic modality for prevention or treatment of incontinence in women is dependent on appropriate patient selection. This article synthesizes data that supports 4 criteria to be met before beginning a program of pelvic floor muscle training: adequate alignment of pelvic organs, intact structural support, functional muscle activation ability, and absence of existing reversible causes for incontinence. Two components of pelvic floor muscle training are described: strengthening exercises and skill development. For each component, protocols of training and refined patient selection criteria are discussed.

Adult↗

PubMed2002

Critical elements of documentation for data-based research.

Scientific integrity and progress are enhanced by precise documentation of the conceptual development and information management aspects of research. Careful and complete documentation of the research process supports accurate reporting. The exercise of documenting data management activities provides an opportunity for nurse researchers to reflect on a study to guide current work and inform and enhance future research. The literature includes many references to the need for data management but contains little advice regarding the nuts and bolts of documenting data management activities. This article describes specific steps for documenting data-based research beginning with the study design and ending with data analysis. The documentation framework and examples presented are sufficient to guide the comprehensive record keeping required for complex studies and can be modified to meet the simpler needs of smaller research projects.

Clinical Nursing Research↗

PubMedDate not supplied

Provider support of spontaneous pushing during the second stage of labor.

OBJECTIVE: To describe the association between provider communication and actual maternal pushing behavior in second-stage labor and to test differences in length of second stage and total maternal pushing time by maternal pushing behavior. DESIGN: Descriptive. SETTING: Midwest hospital birth unit. PARTICIPANTS: Twenty primigravidas who gave birth vaginally. INTERVENTION: Type of provider communication (supportive of spontaneous or directed pushing). MAIN OUTCOME MEASURE: Maternal pushing behavior (spontaneous or directed) documented by videotape review. RESULTS: The percentage of provider communication supporting spontaneous pushing versus directed pushing and the percentage of actual spontaneous versus directed maternal pushing behavior were associated (Pearson r = .80, p = .001, for spontaneous and r = .89, p = .001, for directed). Neither duration of second stage (t = .06, p = .95) nor time spent pushing (t = .15, p = .89) differed by spontaneous versus directed pushing style. CONCLUSION: The proportion of spontaneous pushing by the birthing woman was positively and significantly associated with the proportion of caregiver communication supporting and encouraging spontaneous pushing. Importantly, spontaneous pushing did not significantly lengthen the duration of second-stage labor or total time spent pushing.

Adult↗