Corrigendum: Echocardiography and extravascular lung water during 3 weeks of exposure to high altitude in otherwise healthy asthmatics

[This corrects the article DOI: 10.3389/fphys.2023.1214887.].

Echocardiography and extravascular lung water during 3 weeks of exposure to high altitude in otherwise healthy asthmatics

Background: Asthma rehabilitation at high altitude is common. Little is known about the acute and subacute cardiopulmonary acclimatization to high altitude in middle-aged asthmatics without other comorbidities. Methods: In this prospective study in lowlander subjects with mostly mild asthma who revealed an asthma control questionnaire score >0.75 and participated in a three-week rehabilitation program, we assessed systolic pulmonary artery pressure (sPAP), cardiac function, and extravascular lung water (EVLW) at 760 m (baseline) by Doppler-echocardiography and on the second (acute) and last day (subacute) at a high altitude clinic in Kyrgyzstan (3100 m). Results: The study included 22 patients (eight male) with a mean age of 44.3 ± 12.4 years, body mass index of 25.8 ± 4.7 kg/m2, a forced expiratory volume in 1 s of 92% ± 19% predicted (post-bronchodilator), and partially uncontrolled asthma. sPAP increased from 21.8 mmHg by mean difference by 7.5 [95% confidence interval 3.9 to 10.5] mmHg (p < 0.001) during acute exposure and by 4.8 [1.0 to 8.6] mmHg (p = 0.014) during subacute exposure. The right-ventricular-to-pulmonary-artery coupling expressed by TAPSE/sPAP decreased from 1.1 by -0.2 [-0.3 to -0.1] mm/mmHg (p < 0.001) during acute exposure and by -0.2 [-0.3 to -0.1] mm/mmHg (p = 0.002) during subacute exposure, accordingly. EVLW significantly increased from baseline (1.3 ± 1.8) to acute hypoxia (5.5 ± 3.5, p < 0.001) but showed no difference after 3 weeks (2.0 ± 1.8). Conclusion: In otherwise healthy asthmatics, acute exposure to hypoxia at high altitude increases pulmonary artery pressure (PAP) and EVLW. During subacute exposure, PAP remains increased, but EVLW returns to baseline values, suggesting compensatory mechanisms that contribute to EVLW homeostasis during acclimatization.

Effect of 5 weeks of oral acetazolamide on patients with pulmonary vascular disease: A randomized, double-blind, cross-over trial

BACKGROUND

The carbonic anhydrase inhibitor acetazolamide stimulates ventilation through metabolic acidosis mediated by renal bicarbonate excretion. In animal models, acetazolamide attenuates acute hypoxia-induced pulmonary hypertension (PH), but its efficacy in treating patients with PH due to pulmonary vascular disease (PVD) is unknown.

METHODS

28 PVD patients (15 pulmonary arterial hypertension, 13 distal chronic thromboembolic PH), 13 women, mean±SD age 61.6±15.0 years stable on PVD medications, were randomised in a double-blind crossover protocol to 5 weeks acetazolamide (250mg b.i.d) or placebo separated by a ≥2 week washout period. Primary endpoint was the change in 6-minute walk distance (6MWD) at 5 weeks. Additional endpoints included safety, tolerability, WHO functional class, quality of life, arterial blood gases, and hemodynamics (by echocardiography).

RESULTS

Acetazolamide had no effect on 6MWD compared to placebo (treatment effect: mean change [95%CI] -18 [-40 to 4]m, p=0.102) but increased arterial blood oxygenation through hyperventilation induced by metabolic acidosis. Other measures including pulmonary hemodynamics were unchanged. No severe adverse effects occurred, side effects that occurred significantly more frequently with acetazolamide vs. placebo were change in taste (22/0%), paraesthesia (37/4%) and mild dyspnea (26/4%).

CONCLUSIONS

In patients with PVD, acetazolamide did not change 6MWD compared to placebo despite improved blood oxygenation. Some patients reported a tolerable increase in dyspnoea during acetazolamide treatment, related to hyperventilation, induced by the mild drug-induced metabolic acidosis. Our findings do not support the use of acetazolamide to improve exercise in patients with PVD at this dosing.

CLINICALTRIALS

GOV IDENTIFIER

NCT02755298.

Promoting urinary continence in people suffering a stroke: Effectiveness of a complex intervention-An intervention study

Aim

The study aimed to implement and measure effectiveness of a systematic continence management intervention in people suffering a stroke in undertaking rehabilitation.

Design

An intervention study was conducted.

Methods

In the first part of the study, patients were included in the control group and observed. After the training of the nursing staff, participants were assigned to the intervention group. The intervention consisted of screening, assessment, treatment, communication and evaluation.

Results

Forty‐six patients took part in the study, of which 35 were in the control and 11 in the intervention groups. Within the two groups, significant improvements in outcomes were mostly seen during the study. For the Incontinence Quality of Life Social Embarrassment scale, a significantly higher increase was observed for the intervention group. The improvement between admission and discharge in the intervention group was notably larger for the outcome's incontinence and quality of life.

Promoting urinary continence with nonpharmacological interventions in Parkinson's disease

Background: The evidence of nonpharmacological interventions promoting urinary continence in Parkinson's disease is low and rehabilitation nurses do not give it a high priority. Aim: To examine the effects of a urinary incontinence management program on continence and quality of life in persons with Parkinson's disease in inpatient rehabilitation. The acceptance of the intervention and the knowledge of the nurses were also of interest. Methods: A nonrandomized experimental study was conducted. The data collection commenced with a control group followed by an intervention group. A structured urinary incontinence management was performed in the intervention phase. This includes incontinence assessment, care planning, individual interventions, discharge planning, and telephone support at home. Results: Urinary continence and quality of life were enhanced in both groups; however, improvements were higher in the intervention group but the differences were not significant. Knowledge of the nurses about urinary incontinence improved during the study duration. The acceptance of the intervention was high. Conclusions: A structured urinary continence management may improve urinary continence in persons suffering from Parkinson's disease. In clinical practice it is important to perform a detailed assessment to identify problems regarding urinary incontinence.

Effectiveness of a group-walking intervention for people with dementia based on quality of life and caregivers' burden

Aims

To test the effectiveness of a 28‐week group‐walking intervention for person with dementia. Participants were accompanied by trained volunteers. The effectiveness was assessed according to the quality of life, ability to perform activities of daily living, independence, mobility, cognition, challenging behaviours and the burden on their caregiving relatives.

Design

Quasi‐experimental, one‐group, pretest–posttest trial.

Methods

Thirty‐two persons with dementia and their caregiving relatives were recruited. The nursing intervention consists on easy walking tours lasting three and a half hours. The walks were performed biweekly and each person with dementia had support from one or two trained volunteer helpers.

Results

The quality of life was stable through all seasons. The secondary outcomes were uneven. While the impairment (WHODAS) and the dependence (IADL) increased, the challenging behaviours and the burden on the caregivers were stable through all seasons.

Facilitators and barriers to implement nurse-led interventions in long-term dementia care: a qualitative interview study with Swiss nursing experts and managers

Background

To support the implementation of nurse-led interventions in long-term dementia care, in-depth knowledge of specific supporting factors and barriers is required. Conditions and structures of caring for people with dementia differ widely, depending on the country and the care context. Our study aimed to describe the experiences and opinions of nursing experts and managers with regard to facilitators and barriers to the implementation of nurse-led interventions in long-term dementia care.

Methods

We conducted a qualitative descriptive study using individual interviews based on qualitative vignettes as a useful stimulus to generate narrations allowing to study peoples’ perceptions and beliefs. The study took place in nursing homes in the German-speaking part of Switzerland and in the Principality of Liechtenstein using purposive sampling. We intended to conduct the interviews face-to-face in a quiet room according to the participant’s choice. However, due to the lockdown of nursing homes during the COVID-19 pandemic in spring 2020, we performed interviews face-to-face and by video. We analysed data thematically following Braun and Clarke to achieve a detailed, nuanced description. To verify our interpretation and to ensure congruence with participants’ perspectives, we conducted member checks. The Standards for Reporting Qualitative Research (SRQR) served to structure our manuscript.

Results

Six dyads of nursing home managers and nursing experts from six nursing homes took part in our study (n = 12). Our thematic analysis yielded seven themes reflecting facilitators and barriers to implementing nurse-led interventions in long-term dementia care: «A common attitude and cohesion within the organization», «Commitment on several levels», «A needs-oriented implementation», «The effect and the public perception of the intervention», «A structured and guided implementation process», «Supporting knowledge and competencies», as well as «Resources for implementing the intervention».

Conclusions

To support the implementation of nurse-led interventions in long-term dementia care, active commitment-building seems essential. It is necessary that the value of the intervention is perceptible.Commitment-building is the precondition to reach the persons involved, such as nursing home managers, nursing staff, residents and relatives. Furthermore, nurses should precisely inform about the intervention. It is necessary that the value of the intervention is perceptible. In addition, nurses should adjust the interventions to the situational needs of people with dementia, thus. Therefore, it is important to support dementia-specific competencies in long-term care. Findings indicate that the barrier is determined by the intervention and its implementation – and not by the behaviour of the person with dementia.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02120-1.

Urinary incontinence in stroke survivors - Development of a programme theory

AIMS AND OBJECTIVES

To develop, in an inpatient rehabilitation setting, a programme theory that promotes continence in people who have suffered a stroke.

BACKGROUND

Urinary incontinence in stroke survivors impacts the quality of life, rehabilitation outcomes and ultimately incurred costs of the patient. Different approaches are available for developing and testing complex interventions.

DESIGN

Building a research-based programme theory.

METHODS

To elaborate the intervention, a guidance for developing a complex intervention for nursing was chosen and the sources that should be considered were defined. Subsequently, a research-based programme theory was generated that was represented via a theoretical approach logic model. This study was guided by the checklist for reporting theory of change in public health interventions.

RESULTS

The intervention consists of six parts with three outcome chains on interconnected levels, which are oriented towards patients and nurses. The important aspects of the programme theory are communication, individually tailored measures and the definition of interdisciplinary objectives.

CONCLUSION

Developing a programme theory and representing it via a logic model help clarify the initial intervention and ensure that implementation strategies are well thought out.

RELEVANCE TO CLINICAL PRACTICE

By employing detailed reflection and using previous research, it is expected that the intervention can be implemented successfully and its effectiveness can be investigated in more depth.

Prioritäten der Pflegeforschung für das Themenfeld "Dementia Care" im deutschsprachigen Raum - Eine Delphi-Studie

Priorities of nursing research in dementia care in German-speaking countries - A Delphi study Abstract. Background and objective: To meet the central needs of people with dementia, their relatives and their caregivers in complex living conditions and care situations, a substantive examination of research priorities is required. The aim of this work was the identification and prioritisation of nursing research topics concerning dementia care in German-speaking countries.

METHODS

To identify existing research agendas in dementia care, we conducted a systematic literature research. As part of a Delphi process, systematically identified dementia care experts from German-speaking countries supplemented research priorities extracted from existing research agendas and assessed their importance. Subsequently, they prioritized topics of particular importance for nursing research.

RESULTS

Fifteen experts supplemented 61 topics previously identified in existing research agendas. They assessed 107 topics in terms of their importance and prioritized 79 topics.

CONCLUSIONS

The research priorities developed are a potential framework for nursing science, health policy and research funding in order to structure research activities. To ensure currency, priorities should be regularly updated and re-opened for discussion.

[The Healthcare Teams' Perspective on Caring for People with Dementia in Acute Hospitals: A Qualitative Study]

The Healthcare Teams' Perspective on Caring for People with Dementia in Acute Hospitals: A Qualitative Study Abstract. Introduction: To deal with the complexity of the situation of people with dementia in acute hospitals, it is necessary to develop tailored interventions. In doing so, it is important to consider the perspectives of all relevant persons, including health care teams.

AIM

The aim of this study was to explore the situation of people with dementia in three Swiss acute hospitals from the perspective of health care teams.

METHODS

We conducted three focus group interviews with health care teams consisting of medical doctors, nurses and therapists. Data were analysed by means of summarising content analysis according to Mayring.

RESULTS

A total of 20 health professionals took part. Three main categories were identified: "People with dementia confront the hospital system", "The hospital system fails to meet the needs of people with dementia" and "Necessary changes take place in the hospital system". The results show a lack of intention in the hospital system to address the specific needs of people with dementia. Health care teams feel forced to intensify their teamwork. This occurs unsystematically and with little organisational support.

CONCLUSION

It seems of paramount importance to systematically support the teams' initiatives for enhanced teamwork in caring for people with dementia. Teamwork should be considered as a key aspect when developing interventions.

The multicomponent Debus–Radziszewski reaction in macromolecular chemistry

The well-known Debus–Radziszewski reaction is over one century old. However, this reaction has only been considered very recently as a new tool to design original imidazole and imidazolium-containing polymers by direct formation of the imidazole ring during the polymerization process. This article reports recent advances concerning the use of this newly emerging reaction in macromolecular chemistry.

Experiences of nurses with the care of patients with dementia in acute hospitals: A secondary analysis

AIMS AND OBJECTIVES

To describe nurses' experiences in caring for people with dementia in acute hospital settings.

BACKGROUND

Recent research suggests that nurses' experience in caring for people with dementia in acute hospitals is characterised by frustration, overall job dissatisfaction and feelings of powerlessness and guilt. Despite a growing body of knowledge concerning the care of people with dementia in acute care settings, it remains unclear how nurses in acute hospitals provide care for people with dementia and what general conditions characterise the nursing care provided to these patients.

DESIGN

A qualitative secondary analysis was conducted.

METHODS

Data were collected using audio-recorded focus group discussions with nurses in Germany and Austria. Overall, 12 focus group discussions, which were part of two larger research projects in Germany and Austria, were expanded into a qualitative secondary analysis (a content analysis).

RESULTS

The findings show that nurses face great uncertainty in caring for people with dementia in acute hospital settings and that each nurse reacts in different ways to address this uncertainty. The results also underline that, even for nurses who provide some form of person-centred care, the hospital environment imposes several contextual constraints.

CONCLUSIONS

Hospitals must minimise constraints to give every nurse the chance to perform person-centred care. Furthermore, it is important to sensitise nurses and give them sufficient training and education to enable them to care for people with dementia.

RELEVANCE TO CLINICAL PRACTICE

The results may contribute to a better understanding of the factors that support or constrain person-centred nursing care for people with dementia in acute hospitals.

(Can) Not talk about it - Urinary incontinence from the point of view of stroke survivors: a qualitative study

PURPOSE

The current study intends to gain an in-depth understanding of stroke survivors' lived experience of urinary incontinence and its treatment in an inpatient rehabilitation clinic.

METHODS

A qualitative approach was chosen. Semi-structured individual interviews with ten stroke survivors suffering from urinary incontinence were conducted in an inpatient rehabilitation clinic and analysed using qualitative content analysis with an inductive approach.

RESULTS

'(Can) not talk about it' was identified as the first main category. The affected persons do not talk about urinary incontinence because they are ashamed. At the same time, no one asks them about this issue. Psychological strain is so high that patients feel the need to talk about incontinence, but from their point of view, conversations with nurses - if they indeed occur - are superficial or nurses do not listen. Therefore, patients' needs and concerns are not properly considered. 'Trying to command incontinence' was also identified as a main category. Participants reported that they try to command incontinence and to develop their own strategies in order to hide urinary incontinence and prevent shameful situations. However, this proved mostly unsuccessful and resulted in resignation to their condition.

CONCLUSION

It is important to raise awareness within the treatment team of urinary incontinence in stroke survivors. Team members should be able to communicate about urinary incontinence in an open and empathic way. Obviously, there is great potential for supporting stroke survivors in dealing with incontinence.

Effectiveness of non-pharmacological interventions to promote urinary continence in stroke survivors – a systematic literature review

Background: Around half of the people who survive a cerebrovascular insult are suffering from urinary incontinence. This is a predictor for functional outcomes and affects the quality of life negatively. Until now, it is not clear, which the optimal method of treatment is. A systematic review of 2008 showed an insufficient data situation and couldn’t make a recommendation. Research question: Which non-pharmacological interventions are effective to promote urinary continence in adult persons who have suffered a cerebrovascular insult? Method: To answer the question a systematic literature review was performed. The literature search was conducted in the databases PubMed, CINAHL, CENTRAL and PsycInfo. The period from March 2007 to May 2015 was taken into account. Results: There were a total of six studies included which examined 732 persons. The following interventions were explored for their effectiveness: transcutaneous electrical nerve stimulation, urodynamic assessment with recommendation of bladder emptying method and interventions that consist of several components (e. g. toilet training). All studies showed a positive effect in at least one outcome. Conclusions: There is limited evidence for interventions to promote urinary continence in people suffering a cerebrovascular insult. An intervention consisting of assessment and individual adapted measures currently appear to be the best treatment method.

Reliability of parameters during stair ascent measured with Leonardo Mechanograph(®) Stair A in healthy subjects

OBJECTIVES

Stair climbing (SC) as daily activity is assessed with different SC-tests, but none directly measures ground reaction force over several steps. The Leonardo Mechanograph Stair A has five steps and four force sensors. This study aimed at investigating the reliability of the Stair A test for force, power and time to SC.

METHODS

55 healthy participants (age: 48±14 years) were five times tested during SC with self-chosen and fast speed. 30 participants were examined for test-retest-reliability, calculated with the intraclass correlation coefficient (ICC). The variability was examined with the coefficient of variation (CV). To determine potential associations between SC and jumping performance or daily activity, squat and countermovement jumps were additionally performed and the International physical activity questionnaire (IPAQ) was completed.

RESULTS

The inter-visit ICCs of self-chosen and fast SC were good to excellent 0.63-0.77. The intra-visit ICCs were excellent after three trials (0.78-0.88). The CVs for SC with self-chosen speed were lower (2.1-6.6%) than those for fast SC (4.9-10.8%). There were no significant correlations between SC and jump parameters and only moderate correlations with the IPAQ.

CONCLUSION

The Stair A is a reliable tool for the assessment of SC.

"Fighting an uphill battle": experience with the HCV triple therapy: a qualitative thematic analysis

Background

Hepatitis C virus (HCV) infections are a severe burden on public health worldwide, causing mortality rates triple that of the general population. Since 2011, for both therapy-naive and therapy-experienced genotype 1 patients, the first generation of direct acting antivirals (DAAs), i.e., the protease-inhibitors (PI) telaprevir and boceprevir have been added to existing dual therapies. The therapeutic effect of the resulting triple therapy is striking; however, treatment regimens are complex and commonly cause side effects. Little is known of how patients implement therapy in their daily lives, or of how they deal with these effects.

This study aims to describe HCV patients' experiences with protease-inhibitor-based triple therapy and their support needs.

Methods

A qualitative design was used. Patients from three outpatient clinics, with ongoing, completed or discontinued PI treatment experience were recruited using a maximum variation sampling approach. Open-ended interviews were conducted and analyzed using thematic analysis according to Braun & Clarke (Qual Res Psychol 3:77-101, 2006).

Results

Thirteen patients participated in the interviews. All described themselves as highly motivated to undergo treatment, since they saw the new therapy as a “real chance” for a cure. However, all later described the therapy period as a struggle. The constitutive theme–“Fighting an uphill battle”– describes the common existential experience of and negative consequences of coping with side effects. The processes that fostered this common experience followed three sub-themes: “encountering surprises”, “dealing with disruption” and “reaching the limits of systems”.

Conclusion

HCV patients undergoing outpatient protease-inhibitor-based triple therapy need systematic support in symptom management. This will require specially trained professionals to advise and support them and their families, and to provide rapid responses to their needs throughout this complex course of therapy. As the generation of DAAs for all genotypes, are expected to have less severe side effects, and many HCV patients require treatment, this knowledge can improve treatment support tremendously, especially for patients who are quite difficult to treat. Furthermore, these findings are helpful to illustrate development in HCV treatment.

Electronic supplementary material

The online version of this article (doi:10.1186/1471-2334-14-507) contains supplementary material, which is available to authorized users.

Im Körper gefangen sein – Das Erleben und die Bewältigung der krankheitsbedingt veränderten Bewegungsmuster von Menschen mit Parkinson und ihren Angehörigen

Menschen mit einer Parkinsonerkrankung leiden an verschiedenen Symptomen. Die krankheitsbedingt veränderten Bewegungsmuster stehen oft im Zentrum und wirken sich auf den Alltag der Betroffenen und Angehörigen aus. In dieser Studie wurde untersucht, wie Betroffene und Angehörige die veränderten Bewegungsmuster erleben und wie sie die daraus resultierenden Probleme im Alltag bewältigen. Es wurden leitfadengestützte Interviews mit acht Betroffenen und sechs Angehörigen durchgeführt, und anhand der Inhaltsanalyse nach Mayring ausgewertet. Die Analyse ergab zwei Hauptkategorien: «Auswirkungen des veränderten Bewegungsmusters auf den Alltag» und «Bewältigungsstrategien im Umgang mit der veränderten Bewegung». Das Erleben ist geprägt durch die Empfindung «im Körper gefangen zu sein» und durch einen immer langsamer werdenden Alltag. Die Bewältigungsstrategien stellen sich sehr unterschiedlich dar. Wichtig ist allen Befragten, ihre Bewegungsfähigkeit zu erhalten. Partnerinnen und Partner übernehmen viele Tätigkeiten und unterstützen die Betroffenen selbstverständlich. Dies ist für sie mit viel Stress verbunden und mit dem Gefühl, ständig präsent sein zu müssen. Die vielfältigen Bewältigungsstrategien sollten in die tägliche Pflege von Menschen mit Parkinson miteinbezogen werden. Wichtig bei der Entwicklung von Strategien sind die Berücksichtigung des individuellen Erlebens der veränderten Bewegung und die Unterstützung der Betroffenen und ihres Umfelds damit sie in Bewegung bleiben können.

[Interrater reliability and agreement of the Swiss MDS version 2.0]

Numerous studies have been performed to assess the validity and reliability of the Minimum Data Set (MDS) of the Resident Assessment Instrument (RAI), which was developed and initially implemented in the United States. In general, RAI-MDS 2.0 has been reported to have moderate to high interrater reliability. From the late 1990s onwards the geriatric nursing assessment has been used in nursing homes in Switzerland. The objective of this study was to examine interrater agreement and reliability of the Swiss version of RAI-MDS 2.0 for the first time. For this purpose, 61 nursing home residents were independently assessed by two assessors. The MDS coordinator of the nursing home and an extern expert conducted independent resident assessments by reviewing the chart and asking front line staff about the residents' behaviour. Proportions of exact agreement were calculated and interrater reliability was assessed using kappa and intraclass correlation (ICC) coefficients. For most of the checked items, a high agreement between the two raters was observed. The reliability coefficients for 47 % of the items reached values between 0,81 and 1,0. 29 % of the items achieved values between 0,61 and 0,80. The values of 10 % of the items ranged between 0,41 and 0,60. Two items assessing skin condition obtained a value of 0,25 and 0, respectively. The results of the reliability analysis show that mainly items evaluating pain, mood and behavior, and some items estimating physical function and skin condition are less reliable.

Pflegebedarfserfassungsinstrumente BESA und RAI: Vergleich der Outcomes in Minuten

In der Schweiz wird der Pflegeaufwand von Pflegeheimbewohnenden entweder mit dem BESA Leistungskatalog 2010 (LK 2010) oder mit dem Minimum Data Set (MDS) des Resident Assessment Instruments (RAI) erhoben. Der Pflegeaufwand wird mit beiden Instrumenten in Minuten dargestellt, anhand derer eine Zuteilung zu einer Tarifstufe erfolgt. Ziel der Studie war, den gemessenen Pflegeaufwand beider Instrumente zu vergleichen. Dafür wurden in zwei Pflegeheimen je 60 Bewohnende mit dem LK 2010 und MDS eingestuft. Dies erfolgte einmal durch Pflegefachpersonen der jeweiligen Institution (Eigeneinschätzung), das andere Mal durch Systemexperten/Systemexpertinnen (Fremdeinschätzung). Neben einer deskriptiven Datenanalyse wurde ein Vergleich der Einschätzungen basierend auf Minuten und Pflegestufen durchgeführt. Die Eigeneinschätzung lag im Durchschnitt höher als die Fremdeinschätzung. In beiden Heimen wurde die Hälfte bzw. 54 % der Bewohnenden mittels Eigeneinschätzung in eine höhere Tarifstufe eingeteilt. Sowohl beim Vergleich der Minuten als auch beim Vergleich der Pflegestufen wurden signifikante Unterschiede festgestellt. Vor allem bei stärker pflegeabhängigen Bewohnenden kann es zu unterschiedlichen Einstufungen kommen, wodurch sich höhere oder niedrigere Pflegekosten ergeben.

[Incontinence--a common issue for people with Parkinson's disease. A systematic literature review]

Parkinson's disease is among the most common neurological diseases. About 4.1 million people are attected worldwide. The course of Parkinson's disease is chronically progressive. With L-Dopa therapy the life expectancy of people being affected by Parkinon's disease is not shortened compared with people who are not affected. Therefore people with Parkinson's disease often suffer from the serious effects for decades which include motor symptoms as well as vegetative disturbance, which concerns bladder function and functions of the gastrointestinal tract. Urinary and fecal incontinence involve severe impairment of quality of life. In this review the occurence of urinary and fecal incontinence should be determined in order to be able to describe its extent. There are different measures for treatment or improvement. These are reviewed based on the following research question: Which effects do interventions have in improving urinary and fecal incontinence in persons with Parkinson's disease compared to usual care? In order to answer the questions a systematic review was conducted. The literature search occured in the electronic databases Cochrane database, PubMed and CINAHL. Three studies investigating the prevalence with a total sample size of n = 1077 and for the evaluation of interventions four studies with a total sample size of n = 48 have been included. 25 percent of the women with Parkinson's disease suffer from urgency incontinence compared to seven percent of the women without Parkinson's disease (p < 0.01). Among men with Parkison's disease 28 percent are affected and six percent among men without Parkinson's disease (p < 0.01). In respect to stress and fecal incontinence there were no significant differences between people affected and people not affected by Parkinson's disease. With pelvic floor muscle exercises and accompanying measures as well as with injections of botulinum toxin A a reduction of urinary incontinence seems to be possible. Due to methodological insufficiency of these studies, no clear recommendations can be given.

A systematic review of physical impairments following radical prostatectomy: effect of psychoeducational interventions

AIMS

To determine the effect of psychoeducational interventions on urinary and faecal incontinence and erectile dysfunction in men 50 years and older after prostatectomy for prostate cancer in comparison to usual care.

BACKGROUND

Prostate cancer is the second most frequently diagnosed cancer in men worldwide. The major complications of radical prostatectomy are urinary and faecal incontinence as well as sexual dysfunction, associated with significantly reduced quality of life.

DESIGN

A systematic review of randomized controlled trials was undertaken to provide a narrative synthesis and critical appraisal of included studies.

DATA SOURCES

The electronic databases MEDLINE and CINAHL were searched using a systematic search strategy for studies published between January 2001-December 2012. In addition, reference lists of included papers were checked. The Cochrane Database was screened for whether a review on this topic already exists.

REVIEW METHODS

The systematic review included randomized controlled trials in men after prostate cancer treatment and psychoeducational interventions to influence urinary or faecal incontinence and erectile dysfunction. The quality of studies was assessed by the reviewers using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method.

RESULTS

Eight trials met the inclusion criteria. Although these studies are heterogeneous and of varied quality, a descriptive synthesis of results suggests that psychoeducational interventions may improve urinary incontinence, bowel bother, sexual function and sexual bother to some extent.

CONCLUSION

The results of this systematic review indicate that it would be worthwhile to implement postprostatectomy psychoeducational interventions into nursing discharge planning. Future research is necessary to corroborate these results and define the most favourable time to implement psychoeducational interventions.

[Supervised exercise training in patients with pulmonary arterial hypertension - analyses of the effectiveness and safety]

Both in today's scientific research and in clinical practice, there exists a need to address the uncertainty concerning the effectiveness and safety of cardiopulmonary exercise training (CPET) in patients with pulmonary arterial hypertension (PAH). It is commonly believed that CPET may be dangerous for patients with PAH, because increasing pressure on the pulmonary arteries may worsen right-sided heart failure. Recently, the first clinical trials on exercise training in patients with pulmonary hypertension reported promising results. Extension of the walking distance at the 6-minute walk test improved quality of life, endurance capacity and a reduction in symptoms were observed after CPET. Furthermore, CPET was well tolerated by the patients in five clinical trials. In conclusion, it may be postulated that CPET is an effective therapy in patients with PAH and was tendentially well tolerated by the patients.

[Frequency of using the bedpan in acute care]

Although the bedpan is a subject of everyday nursing practice, little research was found concerning this issue. Patients often describe that the use of the bedpan is uncomfortable and painful. Studies also underline that using a bedpan is very embarrassing and shameful for the patients. Their privacy is violated considerably. In this quantitative descriptive cross-sectional study, the frequency and duration of use of the bedpan was measured in acute care. 362 women and 367 men were included in the study, 18.2 % of them needed the bedpan for a certain time. It was used more often during the night than during the day, departmental differences were also identified. Women used the bedpan most at the orthopedic and medical wards, followed by the prenatal ward (for urine). Men from surgical wards used the bedpan most (12.3 %), followed by medical wards (8.3 %). Most patients required assistance while using the bedpan. Because of this the resulting workload for nurses should be underestimated. The introduction of alternative urine drainage systems could lead to more autonomy of patients and might reduce the workload for nurses.

Investigating the standard of continence care in nursing homes

This article describes the results of two studies that explored the prevalence, incidence and risk factors of urinary incontinence among residents in Swiss nursing homes and the knowledge and practice of nurses and nurse assistants in dealing with residents with urinary incontinence.

Nurses' knowledge and practice about urinary incontinence in nursing home care

BACKGROUND

An important barrier in the implementation of effective incontinence treatments is the level of knowledge of the nurses concerning assessment and treatment of urinary incontinence. Therefore, it is important to assess current nurses' knowledge and practice in urinary incontinence care so that nurses can receive adequate training and education.

AIMS AND OBJECTIVES

This article reports on the development and testing of the Urinary Incontinence Practice and Knowledge Scale as well as the results of nurses' practice and knowledge about urinary incontinence.

METHODS

A cross-sectional design with a convenience sample of nurses and nurse assistants was used.

RESULTS

Nurses answer two-thirds of the questions correctly. The level of knowledge of the nurse assistants is lower than that of nurses. Education and experience in the field are associated with the level of knowledge. Nurses and nurse assistants perform continence-related actions only 'sometimes' or 'often' at best. Both groups have best results in the subscale 'Support' and they have most deficits in 'Documentation'.

CONCLUSION

Nurses and nurse assistants need more education and training in urinary incontinence care. Special focus should lie on documentation. The results give information towards adequate education and training for nurses as well as nurse assistants.

Risk factors for urinary incontinence in nursing home residents

QUESTION

What are potential risk factors for urinary incontinence in nursing home residents older than 65 years at the time of admission and over time?

METHOD

Secondary analysis of data from the Minimum Data Set of the Resident Assessment Instrument in a cross-section as well as a longitudinal section. The sample contained data of 2722 residents from 42 different geriatric and nursing homes in north-west Switzerland.

RESULTS

The cross-sectional analysis showed the variable "moving in bed" as the most important personal variable for incontinence at admission. LONGITUDINAL ANALYSES: The most important risk factor was 'moving in bed' as it continued its action even at 12 months. In a further analysis (incontinence one year after admission with the risk factors at admission) the items "long-term memory, state season and walking in room" were important factors.

CONCLUSION

The data suggest that mental and physical exercises could be a way to reduce urinary incontinence. However, physical exercises would be the most important, because "moving in bed" continued its action even at 12 months. Despite some limitations attributable to the data collection, this is the first study in Switzerland to examine risk factors for urinary incontinence among nursing home residents.

Risk factors for urinary incontinence in nursing home residents

QUESTION

What are potential risk factors for urinary incontinence in nursing home residents older than 65 years at the time of admission and over time?

METHOD

Secondary analysis of data from the Minimum Data Set of the Resident Assessment Instrument in a cross-section as well as a longitudinal section. The sample contained data of 2722 residents from 42 different geriatric and nursing homes in north-west Switzerland.

RESULTS

The cross-sectional analysis showed the variable "moving in bed" as the most important personal variable for incontinence at admission. LONGITUDINAL ANALYSES: The most important risk factor was 'moving in bed' as it continued its action even at 12 months. In a further analysis (incontinence one year after admission with the risk factors at admission) the items "long-term memory, state season and walking in room" were important factors.

CONCLUSION

The data suggest that mental and physical exercises could be a way to reduce urinary incontinence. However, physical exercises would be the most important, because "moving in bed" continued its action even at 12 months. Despite some limitations attributable to the data collection, this is the first study in Switzerland to examine risk factors for urinary incontinence among nursing home residents.

[When women care for women]

What are the experiences of young nurses when they care for older women? The paper which follows is a shortened version of the dissertation presented at the conclusion of the diploma course for Clinical Nurse Specialists. I tried to answer the question: How do young nurses feel about nursing older patients? A qualitative method was chosen. Results show on the one hand, which older women fascinate young nurses, on the other hand, what they find lacking in the nursing care of older women. Care of these patients is very demanding. Recommendations are offered for the support of young professional women.