Sunday, 8 December 2019

Is urinary urgency in older women associated with falls?

Roger Watson, Editor-in-Chief

There is good reason to suspect that having to go to the toilet frequently by older women may be associated with falls. These older women are possibly more likely to be frail and, in addition to frequent visits to the toilet during the day - which can be exhausting in itself - having to go at night adds additional danger.

This study from South Korea by Park et al (2019) titled: Association Between Urinary Urgency and Falls Among rural dwelling Older Wome and published in JAN aimed to: 'examine the association between urinary urgency and falls in older women living in rural areas in South Korea.' The study included nearly 250 women aged over 65. The frequency of falls and the factors associated with them were examined. Just over 30% of the women had experienced a fall in the past year and a range of hazards such as slippery floors was associated with this. Also, urinary frequency and osteoporosis were associated with falls.

The authors concluded: 'The current study found that urinary urgency was associated with falls among older women living in Korean rural areas. The sense of a strong urge to void often makes older women with urinary urgency rush to the bathroom and places them at a high risk of falls.' Among other recommendations: 'The findings also have implications for policymakers with regard to designing safer indoor and outdoor environments for older women living in rural areas, such as by amending building codes for elder-friendly environments or by providing funds for remodeling their residence spaces or neighbourhood.'

You can listen to this as a podcast.

Reference

Park, J., Lee, K. and Lee, K. (2019), Association Between Urinary Urgency and Falls Among rural dwelling Older Women. J Adv Nurs. doi:10.1111/jan.14284

Friday, 29 November 2019

Sarcoma Clinical Nurse Specialist and former patient reunite after a decade in support of new charity awareness campaign


November 26th marked the launch of Sarcoma UK’s new comprehensive report ‘The Loneliest Cancer’ which reveals how this little-known disease has a devastating impact on patients and their families.

Over 5,300 people are diagnosed with sarcoma in the UK every year. This is a tenth of those found with breast cancer, meaning that those diagnosed with sarcoma might never meet someone who shares the same type as them – in many ways, sarcoma is the loneliest cancer. Sarcomas are tumours that develop in the cells of either the body’s soft tissue or bones and they can appear in almost any part of the body.

As part of the campaign activity, sarcoma Clinical Nurse Specialist Helen Stradling and a former patient she treated over ten years ago, Liam Harrison, came together to raise awareness of this complex and commonly misunderstood cancer.

Helen spent many years practising at Nuffield Orthopaedic Centre, and in 2005 became the first sarcoma specialist nurse in Oxford. She first became involved with Sarcoma UK in 2010, and for the past three years has been on the frontline of support and awareness by helping to man Sarcoma UK’s national Support Line, which, since its establishment in February 2016, has taken 5,500 calls and emails from 1500 people. Back in 2006, Helen treated the then 20-year-old Liam Harrison. Liam had been playing football when he suffered a hip injury. When the pain did not subside, Liam went to hospital where an x-ray suggested something more sinister. Further tests revealed that he had chondrosarcoma - the most common type of bone sarcoma. Helen remembers being in the room with Liam and his mother when he received his diagnosis. “Up until I was told I had a sarcoma, I’d never heard of it,” said Liam. “At first, I couldn’t believe it was happening to me”. Within two weeks, his damaged hip joint was removed and replaced with a prosthetic. Happily, his relatively early diagnosis, together with a steely determination, ensured Liam made a full recovery and he is now living in Spain, where he is working as a teacher.

Over ten years on, Helen and Liam joined forces to raise awareness of sarcoma and the launch of the new charity report. Helen spent the day participating in a series of radio interviews and speaking to journalists to help flag up symptoms, treatment routes and support services, and was joined for one interview by Liam. The charity’s campaign also aimed to increase healthcare professionals’ understanding of the cancer via a series of free Sarcoma Diagnostic Toolkits.  The guides contain simple yet effective tools outlining clinical presentations, investigations for adults and children, as well as guidance on how to refer patients to their nearest Sarcoma Specialist Centre for diagnosis and treatment – they can be downloaded at.

Richard Davidson, Chief Executive of Sarcoma UK comments; “Appallingly, this destructive cancer has maintained a low profile until now, even though lives are still being lost or devastated by amputations and invasive treatments. 15 people each day in the UK receive the shattering news that they have sarcoma, yet according to a YouGov poll, 75% of people “do not know what sarcoma is”. With greater awareness, diagnosis could be quicker and with increased funding for pioneering research, survival rates could be improved.  I’m really grateful to both Helen and Liam for helping to spread the word.”

Sarcoma UK Support Line Specialists are here for every person affected by sarcoma. Monday to Friday, 10am - 3pm. Phone: 0808 801 0401 or email.

Wednesday, 27 November 2019

Depressive symptom management interventions may have significantly positive effects on low-income mothers.



With great interest, we read the article by Kim K et al. entitled “The effects of depressive symptom management interventions on low-income mothers: A systematic review and meta-analysis.” published in the June 2019 issue of Journal of Advanced Nursing (Kim & Lee, 2019). The authors performed a meta-analysis to evaluate the effects of depressive symptom management interventions (DSMIs) for low-income mothers. The study is of profound academic importance, and there are some points we would like to address.

Regarding the outcome of the effect of interventions on the depressive symptoms of low-income mothers, the heterogeneity according to the Cochrane Handbook for Systematic Reviews of Interventions (Higgins & Green, 2011) is I2=58% (P=0.01), which means the heterogeneity of the pooled data is considerable and the results are possibly not robust and reliable. Therefore, to get a reliable result, following the guidance of the guideline (Higgins & Green, 2011), we performed sensitivity analysis with REVMAN software (version 5.3 for Windows. Copenhagen: The Nordic Cochrane Centre, the Cochrane Collaboration). After excluding one study by Chan et al. (Chan, Whitford, Conroy, Gibney, & Hollywood, 2011), the heterogeneity significantly decreased (I2=32%, P=0.17), and the P value for the overall effect is 0.003 (as shown in Fig. 1). This, however, indicates that compared to usual care with verbal or written material used for education, DSMIs have significantly positive effect on the depressive symptoms of low-income mothers. This is different from the conclusion the authors drew regarding this point.

In addition, funnel plots of the outcomes should be presented to evaluate the publication bias of current review, according to the Cochrane Handbook for Systematic Reviews of Interventions (Higgins & Green, 2011).

We appreciate the authors` contribution in providing a meta-analysis to investigate the effects of DSMIs on low-income mothers. Based on the current evidence, DSMIs do have significantly positive effects on the depressive symptoms of low-income mothers. Future research is warranted to further confirm this finding.

Meixing Zhong1,2 , Hui Chen2Aihua Zhou3Yaling Zheng2*

1  Mental Health Clinic, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
2   Department of Hospital Infection Control, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
3   Department of Neurosurgery, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi,China  

*Corresponding author: Yaling Zheng

  Department of Hospital Infection Control, First Affiliated Hospital of Gannan
 Medical University, Ganzhou, Jiangxi, China

Tel: +86 0797-8689051

E-mail address:  zhengyaling81@gmail.com

Meixing Zhong is an associate professor in Mental Health Clinic and Department of Hospital Infection Control at the First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China.

Hui Chen and Yaling Zheng are senior nurses in Department of Hospital Infection Control at the First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China.

Aihua Zhou is a senior nurse in Department of Neurosurgery at the First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China.

Acknowledgements


  None.

Declaration of Conflicting Interests

No conflict of interest has been declared by the authors.

Funding statement.

  This work was supported by The Open Project of Key Laboratory of Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases of Ministry of Education, China [XN201814].


 Acknowledgements
This work was supported by The Open Project of Key Laboratory of Prevention and Treatment of
Cardiovascular and Cerebrovascular Diseases of Ministry of Education, China [XN201814].

Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

References
Chan, W. S., Whitford, D. L., Conroy, R., Gibney, D., & Hollywood, B. (2011). A multidisciplinary primary care team consultation in a socio-economically deprived community: an exploratory randomised controlled trial. BMC Health Serv Res, 11, 15. doi: 10.1186/1472-6963-11-15
Higgins, Julian PT, & Green, Sally. (2011). Cochrane handbook for systematic reviews of interventions (Vol. 4): John Wiley & Sons.
Kim, K., & Lee, Y. (2019). The effects of depressive symptom management interventions on low-income mothers: A systematic review and meta-analysis. J Adv Nurs, 75(6), 1173-1187. doi: 10.1111/jan.13912






















Figure legend
Fig. 1 Effect size of depressive symptom intervention after sensitivity analysis.






































Tuesday, 26 November 2019

Wear Orange to show solidarity


Catherine Best & Dr Parveen Ali


In 2009 the United Nations declared:

‘Violence against women and girls is one of the most widespread, persistent and devastating human rights violations in our world today remains largely unreported due to the impunity, silence, stigma and shame surrounding it’.

The UN Sustainable Development Goals and in particular number 5 Gender Equality, recognises the essential foundation through which a peaceful, prosperous and viable society can live, work and grow and yet women and girls continue to be ostracised and both physically and sexually abused across the globe. There is no place for this in a civilised, gender equal world.

25th November is therefore dedicated as the International Day for the Elimination of Violence against Women. This day should be emblazoned on the hearts and minds of all those who believe that violence against women is wrong. Every year this day aims to increase awareness about women’s rights and violence against women in all its forms. This year the focus will be on increasing awareness about rape and its impact. 25th November also marks the start of ‘16 days of activism’, which will end on 10th December 2019 on Human Rights Day.

Rape is only one type of abuse and sadly every day women and girls experience multiple forms. Violence against women happens at home, in the streets, in offices, in peacetime and in war. It takes many forms, including physical, psychological and sexual abuse. It affects women and girls of all ages, in the form of female infanticide, female genital mutilation, child marriage, grooming, trafficking, forced marriage, honour killing, domestic violence and intimate partner violence. Violence against women is associated with grave physical, emotional and mental health consequences. It not only impacts the lives of women victims of violence but also has a negative impact on children and families.

Gender-related killing of women and girls remains a major problem across regions, in countries both rich and poor. In 2017, this study affirms, the number of women killed by ‘intimate partners or family members’ accounted for 58% of all women homicide victims globally, and disappointingly, little headway has been made in preventing this most heinous of crimes. Within the UK deaths as a result of domestic violence have reached an all-time high in the last 5 years.

In the past few decades, much has been done to highlight this issue and to attract the attention of policy makers and practitioners at National and International level. As a result, many countries, around the world, have developed laws that aim to end violence against women, though the implementation of such laws remains challenging. There is undeniably a need to challenge and change societal and cultural norms, which do not condemn violence against women and to mobilise people in every walk of life to play their part in its prevention.
Campaigns across the UK have sought to raise awareness of the impact of domestic abuse, including those run by Refuge, Women’s Aid, White Ribbon UK and Neighbourhood Watch.

Disappointingly however, more still needs to be done before the world can start becoming a slightly better place for girls and women, where they don’t have to fight for their rights and where they are not abused and killed just because of their gender.

Economic issues are affecting provision of all kind of services, including services for women affected by violence. In the UK, for example, cuts to funding has meant many specialist domestic violence services have experienced financial issues and many refuges have closed. At the same time many perpetrators of domestic abuse are walking free as a result of the impact of funding cuts on police services. While, the Government seeks to bring perpetrators to justice through the Domestic Abuse Bill, a lot still needs to be done to improve the lives of those affected by it and to protect others from experiencing it. There needs to be a sustainable funding strategy for violence against women services, so the women and children are able to access the safety and support they deserve.

Within healthcare many nurses, midwives and other healthcare professionals witness the impact of domestic abuse every day though they are not always effectively prepared to respond to the needs of these women. There is a requirement therefore to increase the knowledge and skills of all healthcare professionals, so they can provide effective support and appropriate care.

There are also various learning opportunities available. The number is increasing frequently and can be used to support revalidation. For example, the Royal College of Nursing provides resources that enable nurses to gain a better understanding of how to support affected women and their children. Further resources  include an interactive boardgame that aims to facilitate acquisition of knowledge through discussion and reflection… and why not sign up to an online, free course offered on the platform of FutureLearn. This course can help you confidently support those in need of your help.

All these learning materials present a wonderful opportunity to develop new knowledge and understanding in a world where sadly domestic abuse remains a significant concern, not just Nationally but Globally. Ultimately, it cannot be right that women and girls suffer at the hands of others simply for being well… women and girls. Can it?

Catherine best is Chair RCN Yorkshire and Humber Regional Board

Dr Parveen Ali, Senior Lecturer, University of Sheffield








Thursday, 17 October 2019

Voluntary stopping of eating and drinking is a rare but nevertheless relevant phenomenon in long-term care


Sabrina Stängle*, MSc, RN
Wissenschaftliche Mitarbeiterin
ZHAW Zürcher Hochschule für Angewandte Wissenschaften Institut für Pflege, Departement Gesundheit Technikumstrasse 81, Postfach CH - 8401 Winterthur Tel. +41 58 934 4144
E-mail: sabrina.staengle@zhaw.ch

Voluntary stopping of eating and drinking (VSED) is a way to end life prematurely. People who choose this path are able to make decisions, are able to eat and drink and are neither cognitively impaired nor suffer from mental illness. They decide to follow this path in order to end unbearable suffering that cannot be alleviated despite medical progress. Aware of the phenomenon, VSED was included as a controversially discussed option in 2018, when the guideline of the Swiss Academy of Medical Sciences "Dealing with Dying and Death" was updated. The guideline is trend-setting for health professionals. However, it was unclear what relevance VSED has in Switzerland. For this reason, the objectives of this study were to assess the incidence of VSED in long-term care and to gain insights into the attitudes of long-term care nurses about the VSED. Heads of Swiss nursing homes (535; 34%) took part in an online survey on this subject. The results could show that almost every second institution among the participants has already accompanied a VSED case. Moreover, among all persons who died in Swiss nursing homes in 2016, 1.7% are due to VSED. Participants' overall views on the VSED are very positive, whereas it is assumed that it is a phenomenon of old age. Professionals still lack sufficient knowledge about this phenomenon, which could be clarified through training.

* Forthcoming article: Stängle S, Schnepp W, Büche D, Fringer A (2019) Long-term care nurses´ attitudes and the incidence of voluntary stopping of eating and drinking: a cross-sectional study Journal of Advanced Nursing (in press)