PubMed Health⌕ Search

Biomedical subjects

K N Moore

Publications and source records attributed to K N Moore.

12 recordsLinked to original sources
PubMed1996

Urge incontinence in elderly people: factors predicting the severity of urine loss before and after pharmacological treatment.

Geriatric patients with urge incontinence lose different amounts of urine and respond differently to treatment. Identification of factors predicting the amount of urine loss before or after treatment might help to select therapy. We have sought such factors in 41 elderly patients (23 women and 18 men), mean age 79 years with established urge incontinence that was urodynamically proven to be associated with detrusor hyperreflexia, who were treated with oxybutynin chloride. Urine loss was measured by 24-hour monitoring (mean 378 g/24 hour). Demographic, psychosocial, behavioral, cortical, circulatory, urodynamic, and urological factors were studied before and after treatment. Multiple regression analysis showed that, before intervention, factors predicting the amount of urine loss were fluid intake, voiding frequency, and impaired orientation on cognitive testing. After intervention, urine loss was significantly smaller (mean 259 g/24 hour). Different factors predicted the amount of this persistent incontinence: underperfusion of the cerebral cortex, reduced bladder sensation, and (again) impaired orientation. The analysis confirms that the severity of geriatric urge incontinence associated with detrusor hyperreflexia, particularly incontinence that is resistant to anticholinergic therapy, depends on cortical factors, that bladder sensation plays an important role, and that therapeutic manipulation of fluid intake and voiding frequency may offer a modest reduction in urine loss (e.g., about 40 g/day).

Aged↗
PubMed1995

Problem solving and troubleshooting: the indwelling catheter.

Long-term use of an indwelling catheter is seldom free of problems, and the complications associated with indwelling catheters cause significant morbidity and mortality. Often there are alternatives to long-term catheterization; it is assumed in this article that the patient will have been appropriately assessed for other methods of continence control. In this article, leakage around the catheter (bypassing) is discussed. This problem is multifactorial: irritation caused by the catheter balloon, improper sizing of catheter, confusion of the patient, bacteriuria, constipation or fecal impaction, blocked catheters, problems related to materials used in catheter construction, and improper positioning of the catheter are all potential problems contributing to leakage in the patient with an indwelling catheter. Emphasis is placed on etiology because understanding the underlying problem is crucial to implementing effective treatment.

Aged↗
PubMed1995

Periurethral implantation of glutaraldehyde cross-linked collagen (Contigen) in women with type I or III stress incontinence: quantitative outcome measures.

OBJECTIVE: To evaluate the effectiveness of periurethral collagen (Contigen) implantation as a treatment for stress incontinence, using quantitative measures of urine loss and the patients' subjective response. PATIENTS AND METHODS: Twelve women, age range 46-87 years, had video urodynamic testing--confirming Type I or III stress urinary incontinence and were eligible for periurethral collagen implant. Eleven had had at least one anti-incontinence operation. One woman was withdrawn from the study because of a severe subcutaneous skin reaction 21 days after the skin-test and one patient declined follow-up. Ten patients had up to two implants each, introduced 3-5 months apart under local anaesthetic (5 mL collagen per implant). All patients underwent 10 h pad tests (with 2-hourly pad changes) at baseline and 8 weeks after collagen implant. The following quantitative measures of incontinence severity and voiding function were studied: urine loss during the 10 h test, number of wet pads, weight of urine in the wettest pad, maximum voided volume, residual volume on ultrasound, maximum flow rate and urinary flow curve pattern. Blind to the quantitative results, patients were asked to categorize their outcome as cured, improved and failed. RESULTS: There was a significant decrease in urine loss (P = 0.007), number of wet pads (P = 0.05) and weight of the wettest pad (g) (P = 0.03) from baseline to 8 weeks after the second collagen implant. There was no significant difference at any point in maximum voided volume, maximum urinary flow rate and residual volume after voiding measured on ultrasound. Objectively, two women appeared cured (< 5 g urine loss on 10 h pad test); subjectively, both reported themselves as improved (not cured); one subject stated she was cured and on pad test had 11 g urine loss; two women stated there was no change yet urine loss decreased markedly by > 60% from 434 g to 123 g and 533 g to 199 g. The remaining six stated they were improved although, objectively, their urine loss after the collagen implant remained high (mean 132 g, range 87-185). CONCLUSION: These results show a significant reduction in urine loss at 8 weeks after the second collagen implant and an objective cure rate of 18%. There was little relationship between the objective measure of success and the self-report. Of interest is the fact that no obstructive changes occurred in the voided amount, the flow curve and the residual volume after voiding.

Aged↗
PubMed1995

Compliance or collaboration? The meaning for the patient.

Noncompliance exasperates health care professionals, leaves them worrying about the effective outcome of medical care, and results in noncompliant patients being labelled as 'difficult' or 'troublesome'. It is suggested that professionals who label a patient as noncompliant are following convenient paternalistic principles rather than considering the impact of a prescribed regimen on an individual patient. In this paper, the author considers autonomy and respect to be foremost in patient care. Further, compliance does not necessarily indicate that both professional and patient have developed a collaborative understanding relationship. Noncompliance is described as a lack of recognition by the health care professional of the meaning of the regimen to the patient. Treatment interventions will be most successful when the patient participates in the prescription. Without acknowledgement of the patient as an equal partner, and listening to his or her narrative, care will be, at best, paternalistic.

Ethics, Nursing↗
PubMed1994

Electrical stimulation for the treatment of urinary incontinence: do we know enough to accept it as part of our practice?

While many nurses are involved in the treatment of incontinent patients, few are well-informed on electrical stimulation. In this paper, patient-controlled stimulation is discussed and implications for current nursing practice considered. The paper includes a discussion of the weaknesses in current research with electrostimulation and concludes with recommendations for future research in the treatment of incontinence with this new modality.

Clinical Trials as Topic↗
PubMed1994

Urinary incontinence in the elderly: the brain factor.

Recent research has shown that urge incontinence is common in the elderly and is often combined with reduced bladder sensation. It is associated with cognitive impairment and with underperfusion of the frontal lobes of the cortex. To test for an expected preferential association with particular aspects of cognitive function, 47 incontinent patients (25 men and 22 women, median age 78 y) underwent cognitive testing, 24-hour monitoring of bladder function and videourodynamics. Median CAMCOG score was 72/107. Median urine loss in 24 h was 36 g (range 11-1347 g). 17 patients had urodynamic proof of urge incontinence, 8 with normal and 9 with reduced bladder sensation. Impaired orientation in time was more strongly associated with proven urge incontinence than overall cognitive impairment; it was the only significant predictor (P < 0.00005). Praxis, calculation ability, abstract thinking or recent memory were less closely involved. Thus dysfunction of the frontal cortical lobes and impairment of temporal orientation appear to constitute a "brain factor" underlying geriatric urge incontinence, particularly in combination with reduced bladder sensation.

Aged↗
PubMedDate not supplied

Intermittent catheterization: sterile or clean?

Bacteriuria--asymptomatic and symptomatic--always has the potential to develop into a serious problem when intermittent catheterization is being used. Research on the best method of reducing bacteriuria is inconclusive. Studies have focused on the use of sterile technique, oral or vesical antibiotics, and the frequency of catheterization. This article presents a summary of current research on bacteriuria in the patient requiring intermittent catheterization.

Bacteriuria↗
PubMedDate not supplied

Bacteriuria in intermittent catheterization users: the effect of sterile versus clean reused catheters.

Monthly urine cultures were analyzed at the University of Alberta Department of Medical Microbiology and Infectious Diseases to determine whether single-use sterile catheters and clean technique reduced the incidence of bacterial colonization in those using long-term intermittent self-catheterization. Thirty subjects with spina bifida, ages 3 years to 16 years, entered a crossover study with random assignment to 6 months of sterile single-use catheters or clean reused catheters. Seventeen subjects were catheterized by a parent or caregiver; 13 were responsible for self-catheterization and cleaning of the catheters. Six months of descriptive data were also collected at Alberta Children's Hospital from a similar group of subjects with spina bifida who used sterile catheters only. In the crossover group, 38% of all urine cultures were positive regardless of whether sterile single-use or clean reused catheters were employed. The other group using only sterile catheters had a 36% positive culture rate. No difference in positive cultures was found between males and females or between children who catheterized themselves and children whose parents catheterized them. The authors concluded that plastic urethral catheters may be reused.

Adolescent↗
PubMedDate not supplied

Intermittent self-catheterisation: research-based practice.

Intermittent self-catheterisation (ISC) is an effective management strategy for people who have urinary retention or postvoid residual due to urethral sphincter or detrusor dysfunction. However, some questions still need to be answered on the details of ISC. This article presents current research findings that may resolve some of the practice issues and suggests that nurses are in a prime position to implement research-based practice.

Clinical Nursing Research↗