To increase use of foot care programs among homeless adults, services must be offered during the day time when they are not competing to secure nightly shelter. Foot care programs should be innovative and tailored to their unique needs and address concern for sensitivity to feet, sock, and shoe condition; cost; specific services provided; competing needs; source of care; and how to access these services.
Aim
Determine the efficacy of behavioral therapy for urinary symptoms in Parkinson's disease.
Methods
Randomized trial of behavioral therapy compared with control condition among adults (aged 54‐85 years, 74% male, 10% Black/ 83% White) with Parkinson's and greater than or equal to 4 incontinence episodes weekly. Behavioral therapy included pelvic floor muscle exercises, bladder training, fluid and constipation management. Both groups completed bladder diary self‐monitoring. Outcomes included diary‐derived incontinence and ICIQ‐overactive bladder (OAB) score (range, 0‐16) with bother and quality of life questionnaires (higher scores = worse outcomes).
Results
Fifty‐three participants randomized and 47 reported 8‐week outcomes including 26 behavioral therapy and 21 control. Behavioral vs control participants were similar with respect to age (71.0 ± 6.1 vs 69.7 ± 8.2 years), sex (70% vs 78% male), motor score, cognition, mean weekly incontinence episodes (13.9 ± 9.6 vs 15.1 ± 11.1) and OAB symptoms (8.9 ± 2.4 vs 8.3 ± 2.2). Weekly incontinence reduction was similar between behavioral (−6.2 ± 8.7) and control participants (−6.5 ± 13.8) (P = 0.89). After multiple imputation analysis, behavioral therapy participants reported statistically similar reduction in OAB symptoms compared to control (−3.1 ± 2.8 vs −1.9 ± 2.2, P = 0.19); however quality of life (−22.6 ± 19.1 vs −7.0 ± 18.4, P = 0.048) and bother (−12.6 ± 17.2 vs − 6.7 ± 8.8, P = 0.037) improved significantly more with behavioral therapy.
Conclusion
Self‐monitoring resulted in fewer urinary symptoms; however, only multicomponent behavioral therapy was associated with reduced bother and improved quality of life. Providers should consider behavioral therapy as initial treatment for urinary symptoms in Parkinson's disease.
A nursing model that examines the elements of client uniqueness and assesses the interaction between NP and client can achieve positive health outcomes.
Schools of nursing located within academic health centers have embraced expanded opportunities to lead in this era of rapid change and considerable uncertainty in US health care. These schools bear a unique responsibility to work with their clinical nursing partners to advance the care of patients, improve the health of communities and populations, and help steward the nation's health care resources. This article describes how the Emory University Nell Hodgson Woodruff School of Nursing has formed and sustained academic-practice partnerships in response to these imperatives. The structures and processes that have supported the partnerships are shared, as are the keys to success in a true partnership. The authors describe the work required to achieve mutually agreed-upon goals, along with the challenges that faculty and health care leaders have faced in their journey to system partnerships.
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