NONSURGICAL TREATMENTS FOR URINARY INCONTINENCE
According to this review:
* Pelvic floor muscle and bladder training resolves or improves urinary incontinence in women.
* Anticholinergic drugs are also effective.
The combination of pelvic floor muscle training and bladder training resolved urinary incontinence in women, according to a recent systematic review of published studies on nonsurgical treatments for urinary incontinence. The anticholinergic drugs oxybutynin and tolterodine also "resolved urinary incontinence."
Researchers searched for randomized controlled trials on urinary incontinence published in English from 1990 through May 2007 in the MEDLINE, CINAHL, and Cochrane library databases. The review included 96 randomized controlled trials and three systematic reviews addressing nonsurgical treatments for urinary incontinence in women. Continence lasting for more than six months at follow-up was the primary outcome.
Compared with usual care, pelvic floor muscle training combined with bladder training consistently increased continence rates. Pelvic muscle training alone resolved or improved urinary incontinence, but the "effect size was not consistent across the studies." The anticholinergic drugs oxybutynin and tolterodine improved urinary incontinence better than placebo; it was unknown if one drug was more effective than the other. Duloxetine was shown to improve but not resolve incontinence. Other treatments, such as electrical stimulation, oral hormones, adrenergic drugs, transdermal and vaginal estrogen, injectable bulking agents, and medical devices, weren't found to be particularly effective.
"National and international evidence-based guidelines recommend that these interventions [pelvic floor muscle and bladder training] be used as first-line treatments for urinary incontinence," said Jean Wyman, a clinical expert and coauthor of the review, in an interview with AJN. She added, "Nurses and NPs have a core role in providing incontinence education and treatment."-JC
Shamliyan TA, et al. Ann Intern Med 2008;148(6):459-73.
PEDIATRIC VISITS FOR EAR PAIN
According to this study:
* A nurse-administered program providing ear pain education and a prescription for otic drops can decrease children's medical visits because of ear pain.
* Education can improve parents' behavior and prevent unnecessary medical care visits.
In 2003, nurses at a primary care site of the Mayo Clinic began providing education and prescriptions for antipyrine-benzocaine analgesic otic drops to parents at their child's routine 15-month visit. The program taught parents to identify and relieve ear pain safely and to recognize symptoms of a serious illness that would require urgent medical care. Nurses explained how to administer the otic drops, and parents were given written information about dosages of pain relievers and other ways to reduce ear pain. Parents received other educational materials about the advantages of primary care-as opposed to ED or urgent care visits. Nurses spent five to 10 minutes providing this education.
This study investigated the effects of this program on ED, urgent care, and primary care visits prompted by ear pain. The intervention group (n = 191) was compared with three cohorts who did not use the program: one from the same practice who had routine visits the previous year (n = 168) and two at other practices (n = 133 and n = 126).
By comparing visits before and after the program, the authors found that visits because of ear pain decreased at the ED by 80.3%, at urgent care centers by 40.3%, and at the primary care center by 27.8%. There was no significant change in the number of visits in the control groups.
When surveyed during their child's 24-month visit, 42% of parents in the intervention group said that they thought their child had experienced ear pain since the 15-month checkup. Of these parents, more than 80% thought that the nurse-provided education during the previous visit helped them avoid taking their child to the ED or an after-hours primary care visit and that the otic drops helped them avoid such a visit. Surveys of parents at the 15-month and 24-month visits showed support for both the nurse-administered education and the otic drops.
The authors estimate that the program saved approximately "$65,779 (per 1,000 patients) [horizontal ellipsis] for a net savings of approximately $50 per child" because of a decrease in medical visits. They also suggest that the program helped parents understand that ear pain is manageable and doesn't always require medical attention.-SDSJ
McWilliams DB, et al. Arch Pediatr Adolesc Med 2008;162(2):151-6.