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Biomedical subjects

Katherine N Moore

Publications and source records attributed to Katherine N Moore.

At least 19 recordsLinked to original sources
PubMed2007

Open versus laparoscopic radical prostatectomy: a prospective comparison of postoperative urinary incontinence rates.

PURPOSE: We compared the 12-month postoperative urinary incontinence rates of open radical retropubic and laparoscopic radical prostatectomy. MATERIALS AND METHODS: This prospective study included all men with clinically localized prostate cancer scheduled for radical prostatectomy (open retropubic or laparoscopic) at the University of Alberta between October 1999 and July 2002. Preoperative evaluation included a 24-hour pad test, fluid volume voiding diary and International Prostate Symptom Score questionnaire. Postoperative evaluation included a 24-hour pad test at 3 and 12 months, as well as a voiding diary and International Prostate Symptom Score questionnaire at 3, 6, 9 and 12 months. RESULTS: A total of 239 patients met the eligibility criteria and consented to participate (172 open radical retropubic prostatectomy, 67 laparoscopic radical prostatectomy). Of the patients 87% (148) treated with open radical retropubic prostatectomy and 88% (57) of those treated with laparoscopic radical prostatectomy completed 12-month followup (p = 0.50). According to 24-hour pad testing 13% of those treated with open radical retropubic prostatectomy and 17% of those treated with laparoscopic radical prostatectomy remained incontinent at 1 year (p = 0.26). There was no difference in 24-hour pad weight, urinary symptom score and urinary quality of life at 1 year between the open and laparoscopic groups overall, or when stratified according to 12-month continence status. The majority of subjects in both groups described mild symptoms and a general satisfaction with urinary quality of life. CONCLUSIONS: Based on objective and subjective measures, there were no differences in urinary functional outcomes 1 year after open radical retropubic prostatectomy or laparoscopic radical prostatectomy. Urinary incontinence was found to affect a similar proportion of patients who underwent open (13%) and laparoscopic (17%) radical prostatectomy 12 months postoperatively.

Humans↗
PubMed2006

Intermittent catheterization in the rehabilitation setting: a comparison of clean and sterile technique.

OBJECTIVE: To compare the onset of symptomatic urinary tract infection in individuals with spinal cord injury in a rehabilitation setting who are randomized to clean or sterile intermittent catheterization technique. DESIGN: Randomized controlled design. SETTING: Spinal cord rehabilitation units in western Canada. SUBJECTS: Thirty-six patients with cervical spinal cord injuries requiring intermittent catheterization by nursing staff were recruited. None had a previous history of voiding dysfunction or urinary tract infections. INTERVENTIONS: Subjects were randomized to either clean or sterile intermittent catheterization technique. Protocols for both clean and sterile techniques were standardized and followed by nursing staff and caregivers. MAIN MEASURES: Primary outcome measure was symptomatic urinary tract infection as diagnosed by urine culture > or = 10(5) colony-forming units/mL, pyuria (> or =10 leukocytes on high-power field), and accompanying symptoms. RESULTS: A total of 189 urine specimens from 36 subjects were cultured. Of the 36 subjects, 15 (43%) developed a symptomatic urinary tract infection: 6/16 (37%) from the clean group; 9/20 (45%) from the sterile group (P> 0.05). Mean time to onset for symptomatic urinary tract infection for the clean group was 3.0 (standard deviation (SD) 2.4) weeks and for the sterile group, 3.6 (SD 1.3) weeks (P> 0.05). The most common urinary organisms at onset of symptomatic urinary tract infection were Enterococcus species followed by Klebsiella. CONCLUSION: Clean intermittent catheterization in the rehabilitation setting does not appear to place the patient with spinal cord injury at increased risk for developing symptomatic urinary tract infection, and has significant cost and time saving benefits for the health care system, as well as enhancing the transition for the patient from rehabilitation to community.

Adolescent↗
PubMed2006

Factors impacting self-care for urinary incontinence.

INTRODUCTION: Behavioral strategies such as pelvic floor muscle exercises (PFME), bladder retraining, and dietary modifications are generally considered to be the first line of treatment for urinary incontinence (UI). Yet little is understood about the client's abilities/motivation to manage their UI in the home setting. Self-care, the ability of clients to act on their own behalf to achieve and maintain health, is a fundamental component of these strategies. Despite the frequently chronic nature of UI, there is growing evidence that such maintenance of behavioral therapies is sporadic at best. OBJECTIVE: The purpose of this study was to enhance understanding of self-care strategies that individuals with UI employ, the perceived benefits of these strategies, the factors that influence their self-care choices, and the factors that impede or facilitate maintenance of behavioral therapies. METHOD: In this qualitative descriptive study, individual and focus group interviews with community-dwelling participants were conducted to enhance understanding regarding the participants' management of UI at home and why they maintain certain strategies and not others. Data were collected via loosely constructed individual (n=25) and focus group (n=3) interviews to facilitate open discussion of participants' perceptions. RESULTS: Thirty-eight individuals (33 women and 5 men) participated in the study. Analysis of data resulted in a major category of self-care strategies related to UI that was further subcategorized into factors that facilitated PFME and barriers to PFME performance. Factors that facilitated PFME included: (a) realistic goals and expectation, (b) positive affirmation, (c) follow up, and (d) maintaining an exercise routine. Barriers noted were: (a) insufficient information, (b) characteristics of the exercises, (c) competing interests, (d) financial cost, and (e) minor psychosocial impact. CONCLUSIONS: This study described the self-care strategies that participants with UI had initiated and maintained and additionally explored the perceived facilitators and barriers to self-care choices. Two major themes emerged: (a) self-care efforts were motivated by desire for a normal daily lifestyle and (b) participants were motivated to maintain strategies by the ability to visualize progress and by knowledge that they were progressing. These findings support the need for client-focused teaching that is grounded in the individual's daily realities and goals.

Activities of Daily Living↗
PubMed2004

Complications associated with clean intermittent catheterization in children with spina bifida.

PURPOSE: Clean intermittent catheterization (CIC) is commonly used in the management of voiding dysfunction associated with neurospinal dysraphism. We determined the incidence of genitourinary complications associated with this technique in a population of children with spina bifida. MATERIALS AND METHODS: The charts of all children younger than 13 years attending a multi-disciplinary spina bifida clinic between 1987 and 2002 were reviewed. Children in whom CIC had been performed for a minimum of 5 years were identified. Catheterization was performed with a polyvinyl chloride catheter and a water-based lubricant. All genitourinary complications that had occurred in this group were recorded. The caregiver of each patient was then contacted by telephone to confirm the accuracy of our data. RESULTS: There were 32 females and 27 males identified in whom CIC had been performed for a minimum of 5 years. Mean duration of CIC was 10.5 years (range 5 to 15). Of the patients 45 (76%) learned to perform CIC independently at a mean age of 8 years (range 4.7 to 15.3). Two complications were gross hematuria and a false passage in the bulbar urethra. Both complications occurred in males early in the course of CIC, and while being performed by a caregiver. Neither complication was associated with long-term sequelae. CONCLUSIONS: The incidence of genitourinary complications associated with CIC in children with spina bifida is low. We identified 2 complications during a period of 570 patient-years for an incidence of 3.5 complications/1000 patient-years (95% confidence interval -1.3, 8.3) of observation.

Adolescent↗
PubMed2004

Patient evaluation of a discharge program following a radical prostatectomy.

PURPOSE: The immediate postoperative period following radical retropubic prostatectomy (RP) can be stressful, especially if men perceive discharge teaching to be incomplete. In this study, using two telephone interviews, patient satisfaction with a revised teaching program on one urology unit was evaluated. METHODS: Men undergoing a RP were given an information letter about the study at the pre-admission clinic. At days 2 and 30 post discharge, they were asked to rate the value of the call, a patient education booklet, a discharge pack of incontinence supplies, and overall satisfaction with the discharge experience. They were also asked about the use of community resources after discharge (general practitioner, urologist, emergency, home care). RESULTS: One hundred men participated. Overall, they were very satisfied with the discharge teaching and felt it provided them necessary information for recovery. However, 25 subjects used community resources inappropriately, due to concerns about wound care, catheter care, or urine retention. CONCLUSION: Although men were satisfied with the information provided in discharge program, their overuse of community resources indicates additional reinforcement is needed for management in the first month after surgery.

Adult↗
PubMed2003

An exploratory study of continence care services worldwide.

Urinary incontinence (UI) is a complex symptom of underlying disorders that affects over one and a half million Canadians. Although there is good evidence that incontinence can be treated effectively, the most efficient and cost-effective method for delivery of treatment is uncertain. The purpose of this study was to explore and describe the continence services that exist internationally and in Canada in order to provide the background for a Canadian model of continence service. Data were collected by communication with international health care professionals with expertise in UI, and distribution of a questionnaire to international and Canadian continence care providers. Findings suggest that although physicians, nurses, and/or physiotherapists currently provide continence care, services are scattered and inconsistent and discrepancies exist in how they are funded. The major themes that emerged are the need for enhanced accessibility of continence care and the importance of multidisciplinary teamwork.

Australia↗
PubMed2003

A pilot study comparing two methods of intermittent catheterization: limitations and challenges.

Given a complex research design, a pilot study was conducted to compare a closed catheter system for intermittent catheterization to the traditional open system. Based on 33 urine samples for 11 subjects, the closed system yielded fewer positive cultures. Efforts to obtain this preliminary data proved beneficial in identifying unanticipated design limitations that will guide modifications of the main study, which will include multiple centers.

Adult↗
PubMed2003

Promoting social continence: products and devices in the management of urinary incontinence.

Urinary incontinence (UI) is a prevalent problem occurring in men and women across the lifespan. Technologic innovations have provided individuals with incontinence and caregivers with an array of options for achieving social continence. Even when UI cannot be completely cured, it can always be managed with products, skin care regimens, occlusive or drainage devices and toileting equipment to ensure optimal skin integrity, odorless urine containment, social independence, comfort, and freedom of movement. Various products, devices, and equipment available to help incontinent individuals preserve independence and quality of life and manage incontinence are described.

Humans↗
PubMed2002

Urge incontinence and impaired detrusor contractility in the elderly.

Among the elderly, both urge incontinence and elevated residual urine are common. When they occur together, they present a challenging clinical problem, called detrusor hyperactivity with impaired contractile function (DHIC). Impaired detrusor contractility has two aspects: elevated post-void residual urine volume and reduced detrusor contraction strength. Geriatric urge incontinence, especially in combination with reduced bladder sensation, is associated with specific cortical abnormalities: frontal and global cortical underperfusion and cognitive impairment. We have investigated, in 73 elderly incontinent patients, whether either aspect of impaired contractility is associated with urge incontinence, reduced sensation or these cortical abnormalities. For post-void residual urine, there are no significant associations. Detrusor contraction strength, however, is significantly increased (not impaired) if there is urge incontinence, reduced bladder sensation, or cortical underperfusion. Thus, DHIC appears to be a coincidental occurrence of two common conditions with different etiological factors.

Activities of Daily Living↗
PubMed2002

Pathogenesis of urinary tract infections: a review.

Pathogenesis of urinary tract infections (UTIs) is not well-understood. In this paper, we review the current understanding of UTIs, particularly in relationship to individuals using intermittent catheterization. Relationships exist between the human host, infectious agent and the environment. In the human host, the urethra connects the bladder to potential infectious agents on the perineum. A high-pressure zone exists within the urethra at a point where the urethra passes through the urogenital diaphragm. This zone creates a natural barrier to ascent of organisms colonized in the distal urethra and the bladder itself has natural defences against invading organisms. The interaction of host defences with bacteria (infectious agent) determines whether or not the bacteria persist. A small number of bacteria and some types of bacteria are controlled more effectively by natural bladder defence mechanisms and frequent bladder emptying than a large number of bacteria. Escherichia coli, coliforms and enterococci are considered common bacterial causes of UTIs and are found in high numbers on the perineum. Intermittent catheterization is an effective way of bladder emptying but as an invasive procedure it remains a risk factor in the development of UTI.

Bacterial Infections↗
PubMed2002

Nursing research and continence care.

Despite 50 years of attention to continence care and pivotal nursing research in the field, incontinence continues to challenge health care professionals and consumers alike. The role of nursing research in continence is traced from the early influences of Florence Nightingale to today's clinical practice guidelines and the influence of major nursing research centers.

Humans↗
PubMedDate not supplied

Diabetes-associated bladder dysfunction in the older adult (CE).

Diabetic cystopathy is a chronic complication of diabetes with a classic triad of symptoms: decreased bladder sensation, increased bladder capacity, and impaired detrusor contractility. This article discusses age- and diabetes-related changes that affect lower urinary tract function. The article also reviews bladder function in the older adult diabetic, explores bladder dysfunction prevention, and suggests management strategies for diabetic cystopathy. Little research has been published to date to guide practice in this area, and opportunities exist for nursing research to fill the gap in knowledge.

Aged↗
PubMedDate not supplied

Urinary incontinence in men: current status and future directions.

BACKGROUND: Despite similar rates of voiding dysfunction in older men and women, most funded research has focused on women. Strategic treatment plans for managing urinary incontinence and other lower urinary tract symptoms in men are limited by sparse or absent direct clinical evidence with most interventions supported by data extrapolated from studies in women. OBJECTIVES: To explore what is known about the epidemiology and etiology of incontinence in men, highlight some of the gaps in the current knowledge, address limitations in existing research, and consider future directions in men's continence care. METHODS: Existing literature on urinary incontinence in men was analyzed to generate a plan for future research. RESULTS: Gaps in our knowledge of urinary incontinence in men remain in the areas of etiology, psychosocial consequences, and treatment efficacy. CONCLUSIONS: Clinical research addressing incontinence in men is critical to explore the barriers or facilitators to seeking care, elucidate the biomechanical aspects of pelvic floor function, provide a clear description of the natural history of bladder dysfunction, and highlight the quality of life impact from incontinence.

Cholinergic Antagonists↗