Newman and Wein’s Managing and Treating Urinary Incontinence, 2nd Edition, provides clinicians the knowledge base to effectively assess and treat urinary incontinence and to evaluate clinical outcomes of urinary incontinence management. Organized into 13 chapters, the book describes various forms of incontinence and their significance, examines the synergy of the bladder and pelvic floor, considers the role of risk factors in creating bowel and bladder dysfunction, addresses clinical assessment of urinary incontinence, and presents various therapeutic strategies and information about the specialists who incorporate specific service models into their practice to effectively provide treatment. Chapters new to the second edition include evaluation and management of pelvic organ prolapse and surgical interventions for incontinence.

If you set goals and go after them with all the determination you can muster, your gifts will take you places that will amaze you.”- Les Brown

  A few years ago, if you asked Pamela Nordin, RN, WCC, if she had any interest in working in long-term care, she would have said, “Never!” As fate would have it, her original career path took some detours she never imagined possible, all guiding her to her current position as Director of Nursing, Lutheran Home and Rehabilitation Center, Jamestown, NY.

  After several years in nursing, the New York native decided to stop working and spend more time with her family. Pam remembers that summer as one of her best but when autumn arrived, she was refreshed and rejuvenated and ready to get back to work. The Lutheran Home seemed to fulfill her desire for a chance for professional advancement and growth; she came on board as a supervisor. Initially, she thought the position would be short-term — a stepping-stone for bigger and better opportunities elsewhere. That was 11 years ago. Since then, Pam has held the positions of Nurse Manager, Nursing Coordinator, and Assistant Director of Nursing within Lutheran’s facility. This experience prepared Pam for her current nursing roles on the front line of long-term care. For the past 4 years, Pam has served as Lutheran’s Director of Nursing and recently added Assistant Administrator of Clinical Services to her title.

Index: Ostomy Wound Manage. 2008;54(12):36-46.

Wound closure using topical negative pressure (TNP) has been reported to be effective, but equipment costs can be prohibitive in resource-challenged countries. Because nonhealing wounds are exceedingly common in developing countries such as India, the ability to optimize wound care with limited resources is very important. To investigate the feasibility and efficacy of providing TNP in an Indian medical referral center, a randomized controlled trial comparing a locally constructed TNP device (treatment) to wet-to-dry gauze dressings (control) was conducted. Eligible study participants (N = 48) were recruited from the inpatient wards. Wound etiologies included diabetic foot ulcers (15), pressure ulcers (11), cellulitis/fasciitis (11), and “other” (11). Following enrollment, wound size was assessed using computer-aided measurements of digital photographs and block-randomized to the study arms using a concealed allocation table. Wounds in both treatment groups were débrided before dressing application and patients were followed until wound closure or being lost to follow-up for an average of 26.3 days (± 18.5) in the control and 33.1 days (± 37.3) in the treatment group. No statistically significant differences in time to closure between the two treatment groups were observed except in a subset analysis of pressure ulcers (mean 10 ± 7.11 days for treatment and 27 ± 10.6 days in control group, P = 0.05). Direct costs to close a pressure ulcer also were lower in the TNP than in the control group. A review of the literature suggests the outcomes obtained using a locally constructed TNP device are similar to those obtained using commercially available devices. As a result of this study, a dedicated tissue viability team has been established to identify wounds suitable for TNP, oversee treatment, monitor the need for surgical débridement, and employ wound healing principles and technology appropriately. These results suggest that inexpensive materials can be utilized for TNP wound closure in a developing country.

As of October 1, 2008, prompt identification and accurate staging of pressure ulcers present on admission to acute care hospitals became essential for Medicare reimbursement. In short, Medicare will no longer cover the added costs associated with care of Stage III and Stage IV pressure ulcers not present on admission; such ulcers will be classified as hospital-acquired conditions that could reasonably be prevented with application of evidence-based guidelines. Unstageable pressure ulcers present a particular challenge under the new policy. According to national pressure ulcer guidelines, until enough slough and/or eschar is removed to expose the base of the wound, the true depth, and therefore stage, cannot be determined. The authors describe the first three patients (a 61-year-old woman and 52-year-old and 89-year-old men, all with different comorbidities and ulcer locations) to receive acoustic pressure wound therapy (APWT) for rapid debridement of unstageable pressure ulcers at their acute care hospital. Within 2 days, ulcers that had been completely covered with slough and/or eschar were cleared enough to be accurately identified as Stage III or Stage IV. Rapid and efficient debridement maximized reimbursement potential for the additional costs associated with these advanced-stage pressure ulcers.