Absorbent products for incontinence: 'treatment effects' and impact on quality of life

Abstract Aim. This study aimed to determine how the use and characteristics of absorbent products for incontinence impact on women's quality of life, and to examine the concept of ‘treatment effects’ in the context of pad use. Method. Key pad performance characteristics were identified from the literature and focus group work. Semi‐structured interviews with 99 women with light incontinence were used to investigate the impact of pad use on women's quality of life, including both positive and negative ‘treatment effects’, and to rank pad characteristics by their importance. Results. Achieving effective and discrete containment of urine was the dominant factor impacting on women's lives. Sub‐themes embraced physical effects, psychological impact and social functioning. The five pad characteristics ranked most important for day time use were: ‘to hold urine, to contain smell, to stay in place, discreteness, and comfort when wet. For night use discreteness was replaced by to keep skin dry’. High levels of reported anxiety were associated with perceived risk of poor pad performance, lack of discreteness and need for complex regimes for pad management. Conclusion. Insufficient attention has been paid to the balance between the beneficial and negative treatment effects of absorbent pads to date. Existing continence‐related quality of life measures are not designed for conditions where change in symptoms is not an outcome measure. The study findings provide the basis for developing a more sensitive, patient‐oriented, quality of life measure for pad‐users which can aid product selection, new product development and inform future evaluative comparisons between products/products and treatments. Relevance to clinical practice. This paper illustrates the complex influence on quality of life caused by using absorbent pads to contain incontinence. It raises awareness of the importance of careful selection of the most appropriate pad for each individual to minimize unfavourable side effects, and the need for a new quality of life measure designed for pad‐users.     

气管插管全麻手术相关的消毒管理研究

目的观察气管插管全麻手术医院内下呼吸道感染的相关因素,作好消毒管理。方法采用现场采样和实验室检验方法,对麻醉机内部元件及相关麻醉用品自然菌污染和人工菌杀灭效果进行了检测。结果患者呼出的气体经过一次性病毒/细菌过滤器过滤后进入呼吸回路的管道,细菌明显减少,一次性呼吸回路管道未能检出细菌。麻醉机内部的螺纹管、气阀均未检出致病菌。麻醉机内部的二氧化碳吸收剂(钠石灰)对细菌繁殖体、结核分枝杆菌和细菌芽孢均具有一定杀灭作用。结论麻醉用品的病毒/细菌过滤器对进入病人的呼吸道微生物具有一定过滤效果,管路中的二氧化碳吸收剂具有一定杀菌作用。     

A method comparison study to assess the reliability of urine collection pads as a means of obtaining urine specimens from non-toilet-trained children for microbiological examination

BACKGROUND: In young, non-toilet-trained children, the collection of a urine sample for microbiology can be challenging, with the application of a urine bag being the main method of collection. However, recent research has shown that absorbent pads can be used yielding similar results to bag specimens. However, weaknesses in study design erode confidence in research findings. Therefore, improvements in research design are required to fully evaluate the reliability of pad collection. AIMS OF THE STUDY: This pilot study sought to test the feasibility of a technique for the collection of concurrent bag/pad urine samples from non-toilet-trained children, and to assess the reliability of urine pads over bags as a collection method for urine specimens for microbiological evaluation. DESIGN: A pilot, method comparison study. METHODS: Twenty concurrent bag and pad specimens were collected from non-toilet-trained children, following parental consent. Urine specimens were analysed for presence or absence of white cell count (WBC), and bacterial growth, using standard laboratory methods. DATA ANALYSIS: The Kappa (kappa) statistics and confidence interval (CI) estimation were used to assess agreement between the two collection methods. RESULTS: Despite concurrent samples there was a lack of agreement between bag and pad specimens on both main outcome measures. Agreement between bag and pad specimens for the presence of WBC yielded a kappa=0.10 (95% CI: 0.19, 0.39), indicating poor agreement, while a kappa of 0.5 (95% CI: 0.12, 0.88) was calculated for the degree of agreement in bacterial growth reflecting moderate agreement. Differences in proportions of the presence of WBC between bag and pad did not quite reach significance at the 5% level 0.2 (95% CI: 0.00, 0.42, P=0.062). For cultures the difference was calculated as 0.15 (95% CI: 0.05, 0.35, P=0.125). CONCLUSION: The pilot study demonstrates that concurrent urine samples can be obtained without difficulty. Despite poor to moderate agreement on outcome measures the level of agreement is greater than reported in those other studies, that use non-current methods of urine collection, suggesting an advantage of the concurrent technique. It is recommended that larger scale studies be undertaken using the concurrent collection technique to assess reliability of these findings.     

Effects of absorbent incontinence pads on pressure management mattresses

AIM: 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.     

Reducing the leakage of body-worn incontinence pads

The aim of this research was to evaluate the effect of various absorbent materials (fluff pulp and superabsorbent) on the leakage performance of incontinence pads. A shaped pad-and-pant system was used as the basic design and four pad types made to different specifications were compared using a double-blind technique. Forty-five elderly hospital residents who were incontinent of urine used all four pad types in a randomly allocated order. Data were recorded on more than 5000 pads over a 2-month period. Leakage was reduced by adding a second layer of fluff pulp and, whilst the addition of a superabsorbent material tended to reduce leakage further, we found no clear relationship between the amount of superabsorbent and the reduction of leakage. Other data indicated the importance of securing the pad in place with the appropriate net pants and the leakage rates of pads in relation to the amount of urine they contained. This research suggests that superabsorbent materials have great potential for reducing the leakage rate of incontinence pads but that the way in which they are incorporated into the pad, the amount of fluff pulp and the design of the pad also play an important part.     

A preliminary evaluation of the interaction between urine specific gravity and leukocyte esterase results using Bayer Multistix and the Clinitek 500

OBJECTIVES: To determine the sensitivity of the leukocyte esterase (LE) pad to predict microscopically quantified white blood cells in urine sediment and to assess the interaction of urine specific gravity (SG) on leukocyte esterase sensitivity. METHODS: Microscopic quantification of white blood cells in urine sediment was performed manually and automated chemical urinalysis was performed using the Bayer Clinitek 500 and Multistix 8 SG strips on 422 random urine specimens. RESULTS: The sensitivity of the leukocyte esterase pad to predict white blood cells in centrifuged urine was 58% (61/106). There was a weak but statistically significant negative correlation between SG and LE pad performance, r = -0.12, p < 0.05. CONCLUSIONS: The 58% sensitivity of the Multistix leukocyte esterase detection of white blood cells in urine sediment was consistent with previous reports. The negative correlation of specific gravity and leukocyte esterase provides partial explanation for the lack of sensitivity of the leukocyte esterase test.     

Disposable pull-ups versus disposable nappies for children with a disability

Most children are expected to be dry by the age of three years (Lukeman, 1997). However, children with physical and/or learning disabilities may have difficulty achieving continence and will have an ongoing need for absorbent products. Historically these were disposable nappies. In recent years, the disposable pull-up style pad (Fig 1) has proved popular as an alternative design.     

Exploring the relationship between skin property and absorbent pad environment

Aim. The aim of this study is to identify the related factors of skin lesions found in the surrounding environment of absorbent pads by clinical investigation. Background. Most older patients with incontinence use absorbent products, therefore causing many patients to have skin lesion in the absorbent pad area. To prevent these skin lesions from occurring, it is necessary to examine the absorbent pad environment of clinical patients since there are many contributing factors that complicate the pathophysiology in this area. Design. A cross‐sectional design was used. Methods. One hundred older Japanese patients with faecal and/or urinary incontinence using diapers and absorbent pads participated. Excluding blanchable erythema, the presence of skin lesions in the absorbent pad area was confirmed. Skin pH, hydration level and bacterial cultures were used to assess the skin property. Absorbent pad environment and patient demographics were also investigated. Results. The overall prevalence of skin lesions was 36%. Forty percent of the skin lesions were contact dermatitis. Multivariate logistic regression analysis revealed that only the presence of diarrhoea independently affected contact dermatitis. Conclusion. There was a significant relationship between contact dermatitis and the use of absorbent pads when the patient had diarrhoea. Although the factors related to skin lesions in the absorbent pad area are complexly intertwined, this study was the first to be able to determine diarrhoea as one specific factor in clinical setting. Relevance to clinical practice. This finding suggests that the presence of diarrhoea is significantly related with contact dermatitis. Therefore, when a patient has diarrhoea, health‐care professionals should immediately implement a preventative care program which includes careful skin observation and improved skin care. It is also necessary to develop a more effective absorbent pad to protect the skin of incontinent patients who suffer from the irritating effects of liquid stool.     

Pyuria detection using a dipstick applied to urine in incontinence pads

The purpose of this study was to determine whether pressing a dipstick into a pad within 2 hours of urine saturation detected pyuria as effectively as immersing a dipstick in a urine specimen. Sensitivity, specificity, and positive and negative predictive values indicated that results of the pad method were as effective as those of direct dipstick into clean-catch urine in detecting pyuria. In the elderly, sensitivity of the pad method was 100%, indicating this would be an effective method for initial assessment of pyuria.     

Urinary incontinence verification in elderly men

This study considered the problem of verifying the amount and frequency of incontinent urine loss in an outpatient population. The sample consisted of elderly male community-dwelling veterans who experienced urinary incontinence. Two amount tests (60-minute and 3-day) were completed by 46 volunteer subjects and 7-day frequency records were kept by an additional 44 volunteers. Results indicated that 60-minute and 3-day absorbent pad tests for amount of urine loss classified 59% (n = 27) of the subjects the same way (normal or abnormal). Thus, the shorter test appears useful as a screening test and offers advantages of lower cost and more accurate reporting. If abnormal urine loss is not identified with the short test, the long test should be used to detect infrequent episodes. Three-day tests for incontinence frequency classified 86% (n = 28) of subjects the same as 4-day tests. Therefore, a 3-day test appears adequate to determine the number and pattern of incontinent episodes as well as associations with relevant events such as activity levels and fluid intake.     

Assessment of microPET performance in analyzing the rat brain under different types of anesthesia: comparison between quantitative data obtained with microPET and ex vivo autoradiography

MicroPET (positron emission tomography) has been implemented for use in experiments with small animals. However, the quantification and optimal conditions for scanning are not established yet. The aim of this study was to compare the results obtained by microPET with those by ex vivo autoradiography of rat brain slices, based on the 2-[18F]fluoro-2-deoxy-D-glucose (FDG) method, and to establish the optimal conditions for scanning. As an example, we examined glucose metabolism in the rat brain under 6 types of anesthesia and in the conscious state. The scanning conditions for the rat brain were (1) use of a 4-mm-thick leaden jacket, (2) an energy window of 350-650 keV, and (3) a coincidence time window of 6 ns. Under these conditions, the quantitative ROI data from microPET showed a good correlation with the corresponding ROI data from FDG autoradiography in the animal study (r2=0.81). With our protocol, when anesthesia was started 40 min after the FDG injection, the glucose metabolism was almost the same as that in the conscious rat brain.     

小动物脑功能磁共振成像研究进展

本文主要介绍血氧水平依赖的小动物脑功能磁共振成像的研究条件、范围和研究方法,并简述小动物在发展非血氧水平依赖功能磁共振技术中所起的作用。尽管小动物脑磁共振成像研究受到麻醉等条件的限制,这项研究已经在神经科学及神经药理学范围作出了诸多贡献,并受到越来越多的重视。     

Metabolic profiles of urinary organic acids recovered from absorbent filter paper

We evaluated for reliability and reproducibility a semiquantitative gas-chromatographic assay of organic acids in samples of normal urine recovered from absorbent filter paper. We also evaluated this method for use in diagnosis of some of the more common organic acidurias. Transfer of urine from diapers to absorbent filter paper eases the usual trauma of specimen collection from young children; it also simplifies sample storage and shipment.     

Detection of Carbon Monoxide Production as a Result of the Interaction of Five Volatile Anesthetics and Desiccated Sodalime with an Electrochemical Carbon Monoxide Sensor in an Anesthetic Circuit Compared to Gas Chromatography

OBJECTIVES: There is a continuing risk of production of toxic levels of carbon monoxide (CO) as a result of interaction of volatile anesthetics and desiccated strong base carbon dioxide absorbents like soda lime. The aim of this study is to establish the reliability of detection of CO levels by an electrochemical carbon monoxide sensor compared to gas chromatography. METHODS: Completely desiccated sodalime was conducted through a circle anesthesia system connected to an artificial lung. For different rates of CO production, a low flow anesthesia with a oxygen/nitrous oxide mixture was maintained using five volatile anesthetics. For quantification of CO production, a portable gas chromatograph (GC) was connected to this setup, as well as a Bedfont EC40 electrochemical carbon monoxide sensor (ES) with a claimed reliable sensitivity of 0-200 parts per million (ppm) and a maximum detection range of more than 5500 ppm. To assess the agreement between the GC and ES measurements the intra class correlation coefficient (ICC) and the 95% limits of agreement were calculated. Bland and Altman scatterplots were made to visualize the difference between measurements. RESULTS: For concentrations up to 200 ppm, no significant differences between the GC and ES mean CO measurements were found in the halothane experiments. However CO was not accurately measured at every moment during these experiments by the ES. For concentrations above 200 ppm the results of the two instruments differed significantly. The ES malfunctioned when exposed to sevoflurane and desiccated sodalime. CONCLUSIONS: From these data we conclude that the ES can only be used as an indicator of CO production. When this sensor is used with sevoflurane and desiccated sodalime it is not capable of normal operation. The use of a strong base free carbon dioxide absorbent is therefore recommended.     

Use of CO2/O2 anesthesia in the collection of samples for serum corticosterone analysis from Fischer 344 rats.

Serum corticosterone is used as a biomarker of stress in laboratory rats for the evaluation of the response to experimental stressors. Environmental (animal handling) influences can confound the experiment by introducing extraneous stressors. The purpose of this study was to evaluate the use of carbon dioxide-oxygen anesthesia, with two different animal handling techniques, as an appropriate procedure for the collection of serum samples for corticosterone determinations in male and female Fischer 344 rats. The design of the study mimicked the initiation of a toxicity study, but only sham dosing occurred prior to blood collection. Animals were divided into two groups, acclimated and nonacclimated. Acclimated animals were anesthetized in their home cage, whereas nonacclimated animals were anesthetized in a separate anesthesia chamber. Blood was obtained from the retro-orbital plexus under carbon dioxide-oxygen anesthesia after the fourth day of sham administration of 0.5% aqueous methylcellulose. Serum corticosterone was measured by radioimmunoassay. Mean serum corticosterone concentrations in acclimated male and female rats were approximately 25% and 50% those of nonacclimated animals, respectively. Serum corticosterone concentrations in the acclimated groups were similar to those published for Fischer 344 rats after blood collection by decapitation and were lower than concentrations in studies using other collection methods. A minor change in the handling technique by anesthetizing animals in their home cage can result in reliable baseline corticosterone concentrations in male and female Fischer 344 rats. This refinement in technique will allow for decreased animal stress and decreased animal numbers (reuse of animal for future bleeds). These improvements in animal use can lead to better corticosterone data and lower variability on a given toxicology study.     

THE INHIBITION OF THE TOXICITY OF URANIUM NITRATE BY SODIUM CARBONATE,AND THE PROTECTION OF THE KIDNEY ACUTELY NEPHROPATHIC FROM URANIUM FROM THE TOXIC ACTION OF AN ANESTHETIC BY SODIUM CARBONATE

1. The toxicity of uranium in animals of different ages is associated with the power of the metal to lead to the formation of organic acids, as, for instance, diacetic acid and also acetone. 2. The power of sodium carbonate to lessen the toxicity of uranium depends upon its power to delay the formation of such bodies and to cause their appearance in the urine in lessened amounts, and does not depend upon the power of the carbonate to detoxicate the metal. 3. The protection of the kidney by the carbonate, which is shown by the kidney being functionally much more active during an anesthesia than the kidney of a control animal, and by the Jack of fatty degeneration, acute swelling, and necrosis of the renal epithelium which is constantly seen in the unprotected kidneys, is probably dependent upon two factors: the neutralization of organic acids formed prior to and during the anesthesia, and the neutralization of hydrochloric acid which Graham has shown to be liberated by chloroform during an anesthesia induced by this substance.     

Management of night-time urinary incontinence in residential settings for older people: an investigation into the effects of different pad changing regimes on skin health

Absorbent pads are the main method of managing urinary incontinence in residential settings for older people. Improvements in technology have resulted in highly absorbent products which may be worn all night, but the effects of prolonged pad wearing on aged skin are unknown. The aim of this study was to examine the effects of two different pad changing regimes on skin health. A cross-over design was used. Subjects from residential settings were randomly allocated to one of two pad changing regimes: a frequent pad changing regime or a less frequent pad changing regime. Each regime lasted 4 weeks and was followed by the alternative regime. Skin measurements were taken twice during each regime using (i) the Diastron Erythema meter, (ii) a visual grading scale, (iii) the Servomed evaporimeter, and (iv) a pH meter. The primary outcome variable was the Diastron Erythema meter index. Eighty-one subjects completed the study. No significant differences were found in the severity of erythema, or skin pH, between regimes. Measurements of trans-epidermal water loss were significantly higher in the less frequent pad changing regime indicating that skin was 'wetter' (P = 0.01; 95% CI: 2.89-21.39). Five subjects developed grade 2 pressure ulcers (abrasions) during the less frequent pad changing regime, but none in the frequent pad changing regime; this result was not significant (P = 0.1; 95% CI: 0-1.09). No evidence was found that a less frequent pad changing regime has an effect on skin erythema or pH. There is evidence that skin is wetter which may make it more vulnerable to friction and abrasion. The statistically non-significant finding of greater incidence of grade 2 pressure ulcers is a cause for concern and merits further investigation because of the clinical significance of loss of skin integrity.     

尿干化学分析法、散射比浊法、酶法检测尿清蛋白与尿肌酐及比值结果的一致性分析

目的 评价使用尿干化学法和散射比浊法检测尿清蛋白(Alb)、使用尿干化学法和酶法检测尿肌酐(Cr)及尿清蛋白肌酐比(ACR)的结果一致性分析。方法 收集157例清晨第一次尿液样本,尿清蛋白使用尿干化学法和散射比浊法、尿肌酐使用尿干化学法和酶法分别进行测定。采用kappa检验评价结果的一致性。结果 尿清蛋白kappa值为0.837 9(95%可信区间:0.718 1～0.957 7); 尿肌酐kappa值为0.769 7(95%可信区间:0.665 2～0.874 2); 尿清蛋白肌酐比kappa值为0.756 6(95%可信区间:0.628 6～0.884 6)。结论 尿干化学法检测尿清蛋白,尿肌酐及ACR的结果和散射比浊法检测尿Alb,酶法检测尿Cr及ACR结果具有较高的一致性。可以用于早期肾脏疾病的筛查以及CKD的分级中,初筛患者或长期病情维持过程中复查的监控手段。     

Renal medullary hypoxia during experimental cardiopulmonary bypass: a pilot study

OBJECTIVES: To determine the effect of cardiopulmonary bypass (CPB) on renal medullary oxygenation. DESIGN: Observational. SETTING: Laboratory. PARTICIPANTS: Pigs (n=3). INTERVENTIONS: Following induction of general anesthesia, a Paratrend blood gas probe was placed directly into the left renal medulla. Two animals were subjected to 90 min of CPB, while a third served as a non-CPB control. A probe was also placed in the left renal pelvis of one (CPB) animal to allow direct urine PO2 measurements. MEASUREMENTS AND MAIN RESULTS: Medullary hypoxia (PO2 <65 mmHg) was evident prior to CPB. With the onset of CPB, medullary PO2 further declined to nearly unmeasurable levels; PCO2 and pH were unchanged. Brief circulatory arrest during CPB in one animal resulted in rapid additional PCO2 rise and pH decline that corrected with reperfusion. Following the cessation of CPB, medullary PO2 gradually increased, but remained lower than pre-CPB levels. No changes in medullary PO2 were observed in the sham animal. Renal pelvis urine PO2, but not pH or PCO2, appeared to correlate with medullary values at all times. CONCLUSIONS: Our findings indicate that renal medullary hypoxia is extreme during CPB and may persist following CPB. These data suggest a basis for the vulnerability of the kidney to injury during cardiac surgery. Renal pelvis urine PO2 appears to correlate closely with medullary PO2 and may be a useful tool for studying medullary oxygenation during CPB in humans.     

Investigating neural-hemodynamic coupling and the hemodynamic response function in the awake rat

An understanding of the relationship between changes in neural activity and the accompanying hemodynamic response is crucial for accurate interpretation of functional brain imaging data and in particular the blood oxygen level-dependent (BOLD) fMRI signal. Much physiological research investigating this topic uses anesthetized animal preparations, and yet, the effects of anesthesia upon the neural and hemodynamic responses measured in such studies are not well understood. In this study, we electrically stimulated the whisker pad of both awake and urethane anesthetized rats at frequencies of 1-40 Hz. Evoked field potential responses were recorded using electrodes implanted into the contralateral barrel cortex. Changes in hemoglobin oxygenation and concentration were measured using optical imaging spectroscopy, and cerebral blood flow changes were measured using laser Doppler flowmetry. A linear neural-hemodynamic coupling relationship was found in the awake but not the anesthetized animal preparation. Over the range of stimulation conditions studied, hemodynamic response magnitude increased monotonically with summed neural activity in awake, but not in anesthetized, animals. Additionally, the temporal structure of the hemodynamic response function was different in awake compared to anesthetized animals. The responses in each case were well approximated by gamma variates, but these were different in terms of mean latency (approximately 2 s awake; 4 s anesthetized) and width (approximately 0.6 s awake; 2.5 s anesthetized). These findings have important implications for research into the intrinsic signals that underpin BOLD fMRI and for biophysical models of cortical hemodynamics and neural-hemodynamic coupling.