Much has changed, but much remains the same.
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Aged↗
Biomedical subjects
Jean F Wyman
Publications and source records attributed to Jean F Wyman.
Measurement characteristics of a voiding diary for use by men and women with overactive bladder.
OBJECTIVES: To examine the test-retest reliability and the validity of a voiding diary designed to assess the symptoms of frequency, urgency, and urge urinary incontinence (UI). METHODS: Voiding diaries serve as the primary tool to assess symptoms of overactive bladder in clinical settings and in clinical trials of treatment for overactive bladder. Despite the widespread use of these instruments, few studies have documented their measurement properties or investigated the number of days required to assess symptoms accurately. Study participants included 21 men and 133 women at least 20 years of age recruited from urogynecology and urology clinics. All had a history of urge incontinence or mixed incontinence with urge as the primary component. Participants completed a 7-day voiding diary on two occasions, separated by at least 1 week. RESULTS: Men and women reported a daily average of approximately 10 micturitions, 7 occurrences of strong urge, and 2 episodes of urge urinary incontinence. The diary exhibited good to excellent reliability, with estimated intraclass correlation coefficients (ICCs) ranging from 0.81 to 0.86 for the symptoms of strong urge, diurnal and nocturnal micturitions, total incontinence, and urge incontinence episodes. Estimates did not differ appreciably between men and women. Moderate correlations with global questions on micturition frequency and UI episodes supported the validity of the diary. Diaries completed for 3 and 4 days were similar, with only slightly lower estimates of reliability (ICC 0.79 to 0.84). CONCLUSIONS: The voiding diary completed for 7 days, following detailed instruction, is reliable and appears to be valid for documenting the change in symptoms of overactive bladder in men and women with predominantly urge incontinence. Because of comparable reliability and reduced patient burden, diaries of shorter duration may also be acceptable to assess the symptoms of overactive bladder, depending on the degree of precision required.
Aged↗
Treatment of urinary incontinence in men and older women: the evidence shows the efficacy of a variety of techniques.
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Adult↗
Sexual function in women with urinary incontinence and pelvic organ prolapse.
OBJECTIVE: To compare sexual function in women with urinary incontinence and pelvic organ prolapse and to determine the effects of therapy on sexual function. METHODS: 343 community-dwelling women older than 45 years with urinary incontinence or advanced prolapse were recruited into a multi-armed clinical trial. Women with incontinence were stratified to receive estrogen therapy, behavioral therapy, or surgical therapy. Women with prolapse were enrolled in a randomized surgical trial. All women completed a standardized urogynecologic evaluation and a sexual function questionnaire at baseline and after therapy. RESULTS: Women with prolapse or detrusor instability were more likely to cite pelvic floor symptoms as a reason for sexual inactivity than were women with other conditions. One third of patients with prolapse reported that their pelvic floor condition affected their ability to have sexual relations "moderately" or "greatly" significantly more than did other groups. Patients with genuine stress incontinence who underwent surgical or behavioral therapy were less likely to report being worried about urine leakage during intercourse after therapy than at baseline. After surgery, women with prolapse were less likely to report that their symptoms affected their ability to have sexual relations compared with baseline. Overall sexual satisfaction was the same at baseline and remained unchanged in all therapeutic groups at 6 months. CONCLUSION: Prolapse is more likely than urinary incontinence to result in sexual inactivity and to be perceived as affecting sexual relations. However, overall sexual satisfaction appears to be independent of diagnosis of or therapy for urinary incontinence or prolapse.
Aged↗
Eye-head coordination during postural perturbation as a predictor of falls in community-dwelling elderly women.
OBJECTIVES: To assess the functional significance of eye-head coordination during postural perturbations and to determine the contribution of angular vestibulo-ocular reflex (AVOR) suppression to the prediction of 1-year fall history in community-dwelling elderly women. DESIGN: Descriptive analysis of factors correlated with falls. SETTING: Community-based independent and senior assisted living facilities. PARTICIPANTS: Volunteer sample of 38 older women (mean age +/- standard deviation, 81.6+/-3.9y; range, 74-92y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Multiple and logistic regression variables (slope coefficients, partial R2, percent-correct fall history classifications) and fall prediction equations generated by using minimal sets of predictor variables. RESULTS: Instantaneous AVOR gain and sedative use were predictors of 1-year history of falls in all minimal sets of predictor variables. R2 for the prediction models varied from.47 to.62 and indicated substantial shared variance with the 1-year history of falling. Elderly women who failed to suppress the AVOR gain were 18 times more likely to have experienced a fall in the past year compared with elderly women who showed AVOR suppression (odds ratio=18; 95% confidence interval, 1.63-198.42). CONCLUSIONS: When controlling for all other variables in the model, instantaneous AVOR gain accounted for nearly 30% of the variance of fall history. The strong association between 1-year fall history, the use of sedatives, and changes in the AVOR gain supports a functional link between AVOR suppression and effective balance in elderly women.
Accidental Falls↗
The operations manual: a mechanism for improving the research process.
BACKGROUND: The development and use of an operations manual has the potential to improve the capacity of nurse scientists to address the complex, multifaceted issues associated with conducting research in today's healthcare environment. An operations manual facilitates communication, standardizes training and evaluation, and enhances the development and standard implementation of clear policies, processes, and protocols. A 10-year review of methodology articles in relevant nursing journals revealed no attention to this topic. OBJECTIVES: This article will discuss how an operations manual can improve the conduct of research methods and outcomes for both small-scale and large-scale research studies. It also describes the purpose and components of a prototype operations manual for use in quantitative research. CONCLUSION: The operations manual increases reliability and reproducibility of the research while improving the management of study processes. It can prevent costly and untimely delays or errors in the conduct of research.
Cost-Benefit Analysis↗
Shaping future directions for incontinence research in aging adults: executive summary.
BACKGROUND: The Center for Gerontological Nursing, School of Nursing, University of Minnesota, as part of the John A. Hartford Foundation's Geriatric Nursing Initiative, convened an invitational nursing research summit on incontinence in St. Paul, Minnesota on October 16-18, 2003. OBJECTIVE: To identify new approaches for conducting urinary and fecal incontinence research in aging adults, identify strategies for reinvigorating and better positioning nursing research on incontinence, and develop recommendations for attracting new nurse investigators to incontinence research and facilitating their research training and mentorship. METHOD: Forty-seven researchers, project officers, clinician leaders, doctoral students, and consumer advocates from the United States, Canada, United Kingdom, Japan, Norway, and Australia attended a 1(1/2) day conference involving trigger talks, reaction papers, and small and large group discussions around broad thematic areas on incontinence research. Recommendations with suggested strategies were derived from the discussion groups. RESULTS: Participants identified issues related to each of the summit objectives and discussed potential strategies to overcome these challenges. Twenty-one recommendations were derived: eleven recommendations focused on new approaches to incontinence research; eight on reinvigorating and repositioning nursing research on incontinence; and two on attracting and mentoring new investigators. CONCLUSIONS: The summit model used effectively engaged an international cadre of researchers and clinicians in stimulating discussions that yielded the identification of strategic directions for conducting and funding incontinence research and strategies for reinvigorating and repositioning nursing research on incontinence.
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Use of time studies for determining intervention costs.
BACKGROUND: Cost-effectiveness analyses are increasingly recommended to evaluate the effectiveness of health interventions. Determining the costs associated with delivery of a particular intervention is essential in conducting a cost-effectiveness analysis. Yet, there are few guidelines available to assist investigators in how to assess intervention costs associated with the personnel portion of an intervention. OBJECTIVES: To describe the use of time studies in calculating the program costs of personnel for use in future cost-effectiveness analysis of health interventions. METHODS: The literature on calculating intervention costs for use in cost-effectiveness analyses is reviewed. The process for conducting a time study for determining personnel costs in delivering an intervention and a step-by-step example from a time study are used to illustrate how personnel costs associated with delivery of the intervention can be separated from those costs associated with implementation of research procedures in the determination of research costs. CONCLUSIONS: Time studies provide a good estimate of part of the cost of implementing an intervention that is often difficult to determine-personnel time. The design of the time study should consider intervention components, staff involvement, and the time period for data collection.
Accidental Falls↗
Prevalence and correlates of perineal dermatitis in nursing home residents.
BACKGROUND: Perineal dermatitis is an adverse outcome of incontinence, which is common in older nursing home residents; yet knowledge about perineal dermatitis in this population is sorely lacking. OBJECTIVES: To determine the prevalence and significant correlates of perineal dermatitis in older nursing home residents. METHODS: Assessment data from 59,558 records in the Minimum Data Set (MDS) were linked with 2,883,049 orders in the medical record which enabled definition of variables related to perineal dermatitis, identification of cases, and determination of the prevalence of perineal dermatitis. Data from two subsamples, each with the records of 10,215 older nursing home residents, were analyzed using logistic regression to identify the significant correlates of perineal dermatitis. RESULTS: Perineal dermatitis was found in 5.7% (n = 3,405) of residents and 73% of these were incontinent. Having perineal dermatitis was significantly associated with (a) impairments in tissue tolerance (i.e., more health problems, presence of a fever, requiring nutrition support, and having more problems of diminished perfusion or oxygenation); (b)problems of the perineal environment (i.e., having fecal incontinence only, double incontinence, and more items associated with mechanical chafing); and (c) altered toileting ability from daily use of restraints. DISCUSSION: Several correlates of perineal dermatitis (mechanical chafing, fecal and double incontinence, and use of restraints) appear modifiable through nursing intervention. Clinical interventions should consider the complex health status of this population.
Activities of Daily Living↗
Breaking the cycle of stigmatization: managing the stigma of incontinence in social interactions.
Incontinence is a highly stigmatizing condition. This article explores the dynamics of stigmatization in interpersonal interactions from the perspective of both individuals who are stigmatized and individuals who are not stigmatized. When people who are stigmatized and nonstigmatized interact with each other, both experience threats to self-esteem, but for different reasons. Individuals who are stigmatized may experience self-esteem decrements because they feel that their group is devalued in the eyes of others. Those who are nonstigmatized may fear that their actions will be perceived as biased, thereby threatening their self-image as an unprejudiced person. Individuals who are stigmatized and nonstigmatized act in ways that make their worst fears more than likely come true. Ways that nurses can facilitate ending this cycle with patients who are incontinent are discussed.
Adaptation, Psychological↗