44 research outputs found
An investigation of laboratory test methods for predicting the in-use leakage performance of urine-absorbing aids in nursing homes
No full textThe absorption before leakage method for measuring the absorption capacity of urine-absorbing aids was investigated. Along with the existing international standard (ISO 11948-1:1996, the Rothwell method), it was run on 12 experimental products whose in-use leakage performance was established by 55 incontinent nursing home residents. Methods were evaluated by considering their simplicity, their repeatability within – and their reproducibility between – six laboratories, and their correlation with in-use product performance. ISO 11948-1:1996 – which measures the absorption capacity of products under simple conditions – showed good repeatability and reproducibility, and reasonable correlation with in-use data. However, it proved blind to the effects of leg cuffs that conferred measurable benefits in real use. It should, therefore, be used with caution. The absorption before leakage method – which measures how much a product will hold before leakage when it is mounted on a manikin and standard aliquots of liquid are applied – is more complex and had poorer repeatability and reproducibility. However, it had stronger correlations with in-use data and successfully detected the benefits of leg cuffs on insert products. It is concluded that it holds potential as a new international standard to replace or complement ISO 11948-1:1996, and the necessary refinement work has been ongoing since the 2007 project described here. Two other laboratory methods were run opportunistically. A rewet method (Spanish national standard UNE 153601-2:2008) – for measuring the escape of fluid from a product under pressure – showed poor repeatability and reproducibility. Finally, an acquisition method was used to measure how quickly products absorbed two successive standard aliquots of liquid. It proved robust, showing good repeatability and reproducibility. Although measurements generally correlated well with in-use leakage performance, a direct causal link is unlikely. Products with high absorption capacity tend also to absorb quickly.</p
Effects of absorbent incontinence pads on pressure management mattresses
No full textAim. The aim of this paper is to report a study to determine the effects of absorbent pads on the pressure-relieving properties of 'standard' and pressure management mattresses.Background. Pressure ulcers and incontinence often co-exist. There is a strong association between poor mobility and continence problems and patients using pressure management products are therefore also likely to be using absorbent pads.Methods. An instrumented articulated anthropometric phantom with simulated soft body 'tissues' in the gluteal and sacral areas was used as the 'subject'. The phantom was raised and lowered on to three mattresses (standard foam, visco-elastic foam and surface-cut foam) in three states: naked, wearing a dry pad (Tena Super, SCA Hygiene AB) and wearing a wet pad. The pressure mapping device Xsensor was used to record the distribution of pressure over the sacral and ischial areas of the phantom. Peak pressure was used as the primary outcome variable and 10 repeats were made on each mattress under each condition.Results. There were substantial and significant differences for all three mattresses in recorded peak pressures between the naked buttocks and the buttocks wearing a dry pad. There were no significant differences between measurements made using the dry vs. wet pad. Peak pressures frequently occurred over areas of pad folds. Additional testing showed that pads that were 'smoothed' by hand had significantly lower peak pressures than 'unsmoothed' pads.Conclusions. Absorbent pads have a substantial adverse effect on the pressure redistribution properties of mattresses. Pad folds appear to contribute to this effect, which can be ameliorated slightly by smoothing. Absorbent pad manufacturers should consider engineering pads that minimize disruption to pressure management. Further examination of continence and pressure management products is necessary to establish optimum combinations for nursing care
A multicentre comparative evaluation: washable pants with an integral pad for light incontinence
No full text• The Continence Product Evaluation Network (CPE network) is funded by the Medical Devices Agency (MDA) of the Department of Health, to undertake comparative evaluations of continence products.• There are a wide variety of continence products on the UK market and very little information is available to aid product selection. The aim of this study was to evaluate washable pants with integral pads for women with light incontinence.• A randomized multiple cross-over design was used. Seventy-two women tested each of the 10 products that were available on the UK market at the time of the evaluation. Both subjective and objective outcome measures were used to evaluate the products.• Products performed similarly in terms of leakage but there were statistically significant differences in other performance aspects, e.g. fit and discreteness.• This study should be valuable in enabling purchasers, carers and users to make informed decisions when purchasing products
Development and psychometric evaluation of ICIQ-PadPROM:: A quality of life questionnaire to assess the treatment effect of absorbent continence products
No full textAim: To describe the development and evaluation of the ICIQ-PadPROM, the first self-reported quality of life questionnaire to assess the treatment effect of absorbent continence products, a new addition to the set of ICIQ modules providing international standardised assessment of lower pelvic dysfunction.Methods: Developed in four phases, question items semi-structured interviews were conducted with pad using men (n=19), women (n=6), with secondary analysis undertaken on transcripts (n=15 women) from a previous study. Validity of a draft 67 item questionnaire was tested through cognitive debriefing interviews (n=34) and postal survey (n=239). Reliability was evaluated by 65 users with a three week interval between completions. Expert opinion and factor analysis were used to reduce the final questionnaire to 17 scored and 3 unscored items.Results: The questionnaire comprises four scored domains: Pad design and Physical Effects (7 items), Psychological Effects (4 items), Social Effects and Pad Leakage (3 items) and Burden of Pad Use (3 items), plus 3 unscored items. Levels of missing data ranged from 0 to 7.6%, with fair-to-moderate agreement. The Cronbach’s alpha coefficient for all question items was 0.91 and factor analysis was undertaken to reduce redundancy.Conclusion: Existing incontinence-related outcome tools measure change in symptoms and quality of life impact. The ICIQ PadPROM questionnaire is the first to measure the impact of absorbent continence products on quality of life in the absence of any change in symptoms and will help policy-makers, clinicians, industry and researchers to evaluate different products designs and materials for different patient populations.<br/
Sustainability 2: are sustainable continence products a realistic option?
No full textIncontinence management currently depends largely on single-use products. Reusable products exist but are less developed and less widely used. There are advantages and disadvantages to both types of products. Some evidence exists to support the use of reusable products instead of, or as well as, single-use ones.Currently it is likely that some use of reusable products, in a mix with single-use products, is the best route to more sustainable product provision. This article discusses the evidence for, and barriers to, the use of reuseable products, and suggestions to promote it
Is it feasible to use incontinence-associated dermatitis assessment tools in routine clinical practice in the long-term care setting?
No full textPURPOSE: To investigate the feasibility of using incontinence-associated dermatitis (IAD) tools in routine clinical practice by asking nursing home staff (RNs and non-RN caregivers) and tissue viability specialty (TVS) nurses to evaluate 3 instruments and a 4-point severity scoring system for describing and grading IAD examples captured in photographs of skin underneath absorptive pads in nursing home patients.DESIGN: Feasibility study.SUBJECTS AND SETTING: Twelve female nursing home residents whose incontinence was managed with pads and who had previously been identified as experiencing IAD were recruited, along with 16 nursing home staff (6 RNs and 10 non-RNs) and 10 TVS nurses.METHODS: Weekly high-quality photographs were taken of the skin beneath absorptive pads of nursing home residents for 8 weeks yielding a library of 78 photographs. A subset of 10 representative photographs was chosen. The 16 nursing home staff and 10 TVS nurses were then asked to describe and grade the IAD in the 10 photographs using 3 IAD instruments and simple severity scoring system (SSS) developed for this study. Particular attention was paid to identifying any practical challenges staff encountered in conducting their task.RESULTS: The TVS nurses were able to use all 3 IAD instruments and the SSS and reported that they could incorporate them into their clinical practice with relative ease. Although the RNs were able to use the 3 instruments adequately with some initial assistance, they generally felt that they were too busy to complete them. By contrast, they reported that they found the SSS simple and quick enough to incorporate into their routine practice. The caregivers had difficulty with the text-based instruments, especially if English was not their first language, and they were only able to use the SSS. The caregivers' SSS scores for a given photograph varied more than TVS nurse scores, but the correlation between the mean TVS scores, which were operationally defined as the gold standard for purposes of this study, and the mean RN and caregiver scores (R = 0.811) were fairly high.CONCLUSIONS: Existing IAD instruments are too time-consuming and linguistically complex for use in routine clinical practice in nursing homes. We found that staff generally found the SSS easy to judge IAD severity based on pictures used in the study. This finding suggests that the SSS could be improved by adding reference photographs of skin illustrating each of the 4 points on the scale. Such an instrument could be designed and validated with an emphasis on integration into current clinical practice pathways
An exploratory study of skin problems experienced by UK nursing home residents using different pad designs
No full textPURPOSE: The primary aim of this study was to determine whether the severity of incontinence-associated dermatitis (IAD) among nursing home–based incontinence pad users varies between pad designs. A second aim was to examine the utility of a simple method for reporting skin health problems in which healthcare assistants were asked to record basic observational data at each pad change.STUDY DESIGN: Randomized, multiple crossover, observational, exploratory.SUBJECTS AND SETTING: Twenty-one men and 57 women using absorbent continence products to contain urinary and/or fecal incontinence were recruited from 10 nursing homes in London and the south of England.METHODS: A day-time variant and a night-time variant of each of the 4 main disposable pad designs on the market for moderate/heavy incontinence were tested: (1) insert pads with stretch pants; (2) 1-piece all-in-one diapers; (3) pull-up pants; and (4) belted/T-shape diapers. All pad variants for day-time use had an absorption capacity of 1900 mL ± 20% (measured using ISO 11948-1 International Standards Organization) while the capacity of night-time variants was 2400 mL ± 20%. Each resident used each of the 4 pad designs (day-time and night-time variants) for 2 weeks and the order of testing was randomized by nursing home. Skin health data were collected using 2 methods in parallel. Method 1 comprised visual observation by researchers (1 observation per pad design; 4 observations in total over 8 weeks). In method 2, healthcare assistants logged observational data on skin health at every pad change for the 8 weeks. The primary outcome variable was severity of the most severe skin problem noted by the researcher for each resident, and for each pad design (method 1). Descriptive data on skin care methods used in the nursing homes were also collected using short questionnaires and researcher observation.RESULTS: No significant differences in the severity or incidence of skin problems were found between observations using the 4 pad designs. However, a wide range of skin conditions was recorded that made classification difficult; the skin was often marked with creases from absorbent products, temporary marks, and pink/purple discoloration. We observed few cases of the severe erythema, rashes, and vesicles that are commonly used descriptors in previous skin tools. Nevertheless, the collected data reflect an abundance of skin problems that were difficult to categorize neatly. Researcher observations (method 1) showed that nearly all the residents (96%) had at least 1 IAD skin problem recorded over the 8-week period and 64% of residents had at least 1 problem that was rated as maximum severity. Healthcare assistants logged skin problems on 6.1% of pad changes. The discrepancy between researcher and healthcare assistant data appears to be largely due to healthcare assistants sometimes discounting low-grade IAD as normal for that population.CONCLUSION: Incontinence-associated dermatitis is common among nursing home residents who use incontinence pads, and it is often severe. No evidence was found that any design of pad was more likely than any others to be associated with skin problems. The method devised to enable healthcare assistants to record basic observational data on skin health in the diaper area at each pad change (Method 2) proved simple to use but still resulted in substantial underreporting of IAD, suggesting that further work is needed to develop a tool that more successfully encourages them to log and treat IAD problems
Review of methods used for quantifying excess water in over-hydrated skin using evaporimetry
No full textBackground: advances in diapers and skin barrier products are often aimed at reducing water penetration of the skin to prevent diaper dermatitis and evaporimetry has commonly been measured to quantify excess water in the skin. The aim of this study was to critically review the methods used to measure water vapour flux density (WVFD) using evaporimetry in order to identify a standardised methodology.Methods: we used MEDLINE (1980–2008) and hand searching to identify published papers that used evaporimetry to measure WVFD when the skin has been exposed to water/saline/urine. We compared the papers with respect to subjects, sites, methods of hydrating the skin, the conditions of logging, timing and analysing the evaporimetry data.Results: we identified 10 papers. Methods and techniques for measuring WVFD and analysing data varied considerably between studies and it was not possible to identify a standardised method. The main sources of error and variation are discussed.Conclusion: little work has been carried out to establish the optimum methods and techniques needed to minimise variation in measurements of WVFD using evaporimetery. There is a need to develop more robust, standardised methods and to demonstrate their reliability for further wor
Continence products: research priorities to improve the lives of people with urinary and/or fecal leakage
No full textAlthough many successful treatments for incontinence exist they are not effective or suitable for all people. Inconspicuous and dependable management with continence products and devices plays a crucial part in maintaining quality of life. We aim to briefly review what is known and not known in the field of continence products and devices and set out suggested priorities for research and development. The field of continence product research encompasses techniques and designs from basic laboratory science, through to clinical trials of products and to evaluations of service delivery models. Priorities for research include determining prevalence and costs of product use, development of patient reported outcomes, and development of methods for measuring skin health and for quantifying urine/faecal leakage. Product development priorities include better washable pads for women, absorbent products for fecal incontinence and flatus filters. Clinical trials of different product categories (e.g., devices for men) are needed, as are qualitative studies of patient experiences of product use<br/
Development and psychometric evaluation of the ICIQ-LTCqol: a self-report quality of life questionnaire for long-term indwelling catheter users
No full textAims: Long-term indwelling catheterisation may affect health related quality of life, but clinical assessment and monitoring of people with indwelling catheters is poorly recorded because there are no validated measures to capture these criteria. In this paper, we describe the development of the ICIQ-Long Term Catheter quality of life (ICIQ-LTCqol), one of the modules of the ICIQ series, an international project to standardise assessment of lower pelvic dysfunction: www.iciq.net.Methods: In-depth interviews were conducted with 27 catheter-users and 4 informal carers and cognitive debriefing with a further 31 catheter-users and clinical experts to evaluate clarity and comprehensiveness. The draft 44 item questionnaire was then sent by post to 893 long-term catheter-users; the 370 completed questionnaires were used to test content validity, test re-test reliability and internal consistency (Cronbach ? coefficient). Factor analysis alongside expert opinion was used to formulate the final questionnaire of 16 items. This was then sent by post to another 438 long-term catheter-users to evaluate domain scores.Results: The final questionnaire consists of two scored domains: catheter function and concern (9 items) and lifestyle impact (3 items) and four standalone items, relating to pads, pain, sexual activity and bladder spasm. Levels of missing data are good (mean 3.6%) with moderate to good agreement and acceptable internal consistency (Cronbach's alpha 0.76 and 0.74 for each domain respectively), suggesting acceptability and stability of the questionnaire.Conclusion: The ICIQ-LTCqol is a psychometrically robust self-report questionnaire for the clinical assessment and evaluation of health related quality of life for long-term catheter users. Neurourol. Urodynam. 9999:XX–XX, 2015. © 2015 Wiley Periodicals, Inc
