Editorial Staff

EditorBarbara Zeiger

Associate EditorKelsey Moroz

Web EditorSamantha Alleman

Special Projects Editor Amanda Wright

Editorial Correspondance

Barbara Zeiger, Editor, OWM

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Suite 100, Malvern PA, 19355

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Email: bzeiger@hmpcommunications.com

December, 2006 | Volume 52 - Issue 12

The Last Taboos — Urinary and Fecal Incontinence

  This issue continues the OWM tradition of focusing the December articles on incontinence and features the work of incontinence specialists, including several of my colleagues. The articles address both urinary and fecal incontinence.

  Urinary incontinence (UI) can affect 10% to 35% of community-dwelling adults and more than 50% of residents in nursing homes or those receiving skilled nursing visits at home.1 The disorder is more prevalent among women than among men and incidence increases with age. Fecal incontinence (FI) – the inability to control liquid or solid stool – and incontinence of flatus (defined as anal incontinence2) occur in about 1% of elderly persons and in 23% to 66% of nursing home residents.3...

No Ifs, Ands, or Butts: Save the SKIN and STOP the Sore

  All butt(ock)s are not created equal and all altered buttock skin integrity is not created equally. Although altered skin integrity on the buttocks is frequently identified as pressure ulcers, other sources must be considered. Unless clinicians identify the etiology accurately, they will not 1) be able to interpret the applicable risk factors or 2) intervene appropriately and institute prevention care plans. By following this simple mnemonic, nurses can save the SKIN and STOP the sore. ...

Use of an Atraumatic Dressing in the Treatment of a Painful Wound Resulting from Herpes Zoster

  The overwhelming focus of the wound care specialist is on healing. However, the patient’s greatest concern may be the pain associated with his or her wound; therefore, the prescribed treatment must promote healing while minimizing pain. Despite evidence that patients experience the greatest pain with dressing removal,1 some practitioners continue to employ dressings that exacerbate the patient’s pain, such as saline wet-to-dry dressings and topical silver sulfadiazine dressing (SSD). ...

Is a Rose Always a Rose?

  Gertrude Stein immortalized the line “a rose is a rose is a rose” in the 1913 poem Sacred Emily.1 When later interviewed, she stated that this famous line made the “rose … red for the first time in English poetry for one hundred years.” Many years before Stein’s famous quotation, Romeo and Juliet also wondered whether a name was an artificial and meaningless convention. Because they were from feuding families, Romeo challenged Juliet by saying, “What’s in a name? … that which we call a rose by any other word would smell as sweet.” ...

A Continence Care Champion for Research

  Anne M. Weber, MD, MS, directs the program on Female Pelvic Floor Disorders at the National Institute of Child Health and Human Development (NICHD), one of the National Institutes of Health. In this capacity, she provides administrative supervision and scientific input in the running of the multicenter Pelvic Floor Disorders Network (PFDN, www.pfdn.org), composed of seven academic institutions and a data coordinating center that work together to develop and perform protocols for women with pelvic floor disorders such as urinary incontinence, fecal incontinence, and/or pelvic organ prolapse. ...

The Use of Botulinum Toxin in the Treatment of Refractory Overactive Bladder

  Overactive bladder (OAB) is a symptom complex that comprises urinary urgency, with or without urge urinary incontinence (UUI), and often involves increased urinary frequency and nocturia.1 Behavioral interventions and recent pharmacological advancements have offered symptom relief in many patients. Botulinum toxin (BTX) has provided an additional alternative in the treatment of refractory OAB....

Urinary Incontinence, Catheters, and Urinary Tract Infections: An Overview of CMS Tag F 315

Index: Ostomy Wound Manage. 2006;52(12);34-44.

  More than 65% of nursing home residents experience some type of urinary incontinence (UI). It is a leading cause of institutionalization second only to dementia.1 In addition to UI, other bladder-related disorders such as urinary retention and urinary tract infection (UTI) are common in nursing home residents. In this environment, in addition to urinary incontinence, identified areas of concern include the use of indwelling catheters without medical necessity, poor perineal hygiene and care, inadequate indwelling urinary catheter care, repeated UTIs, lack of toileting or bladder rehabilitation programs, and the misuse of absorbent products. ...

Incontinence-Associated Skin Damage in Nursing Home Residents: A Secondary Analysis of a Prospective, Multicenter Study

Index: Ostomy Wound Manage. 2006;52(12):46-55.

Dr. Bliss and Ms. Zehrer disclose they are employees of 3M Health Care. Dr. Bliss has received funding for projects from Birchwood Labs, Inc, Kimberly Clark, Inc, and 3M Health Care and speaker honoraria from Healthpoint. Research for the project was funded by a grant from 3M Health Care.

  Due to the high prevalence of incontinence in nursing home residents, dermatitis in the perineal area is a common complication in this population. More than 50% of nursing home residents are incontinent of urine and or feces.1-4 Although pressure ulcers have been studied widely, few studies report or describe incontinence-associated dermatitis (IAD) in adults in nursing homes or other settings....

Fecal Incontinence in Acutely and Critically Ill Patients: Options in Management

Index: Ostomy Wound Manage. 2006;52(12):56-66.

The author discloses she received an unrestricted educational grant from Hollister, Inc. to support the writing of this manuscript.

  Caring for acutely or critically ill patients with fecal incontinence is a daunting task that consumes substantial caregiver time and erodes patient comfort, self-image, and strength. Families and significant others often also are distressed by the evident patient discomfort, odor, and stigma associated with lack of bowel control. To avoid or minimize complications, fecal leakage, stool containment, and skin integrity must be addressed. ...

Correlating the Fecal Incontinence Quality-of-Life Score and the SF-36 to a Proposed Ostomy Function Index in Patients with a St

Index: Ostomy Wound Manage. 2006;52(12):68-74.

This article is based on a poster presented at the annual meeting of the American Society of Colon and Rectal Surgeons, Chicago, Ill, June 3-8, 2003.

  According to studies by McLeod et al1 and Nugent et al, 2 who assessed the results of almost 1,000 patients by questionnaire, as well as the reviews of the literature by other authors,3-5 quality of life is negatively affected by the creation of an ostomy. Ostomy function, which includes leakage, frequency of emptying and changing, difficulty in changing, duration of change, assistance required, and the impact on lifestyle, does not appear to be uniform from patient to patient. Studies of quality of life in persons with ostomies performed to date often fail to consider this factor. ...

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