Background
Many women without preexisting stress urinary incontinence (SUI) who undergo vaginal surgery to correct pelvic organ prolapse will develop symptoms of SUI. A concomitant prophylactic anti-incontinence procedure may prevent SUI symptom development in women undergoing vaginal prolapse surgery.
Purpose
To present the rationale, design and methodology of a randomized controlled surgical trial (RCT), the Outcomes Following Vaginal Prolapse Repair and Mid Urethral Sling (OPUS) Trial. The primary aims of this RCT are to determine (1) whether the prevalence of post-operative urinary incontinence (UI) differs between stress continent women receiving vaginal prolapse repair with concomitant tension-free vaginal tape (TVT®; a sling procedure commonly used to treat SUI) and those with only sham incisions at 3 months post surgery (2) whether it is more cost-effective to place a TVT prophylactically than to treat the SUI symptoms postoperatively as they occur over a 12 month period after the index surgery.. The study also incorporates a patient preference trial (PPT).
Methods
Primary outcome, defined as signs (positive cough stress test), symptoms (per validated questionnaire) and/or need for treatment of SUI and its associated cost, at 3 and 12 months post-operatively. Secondary outcomes consist of group differences in lower urinary tract and prolapse symptoms, health related quality of life, measures of vaginal anatomy, and surgical complications.
Limitations
Given the invasive nature of surgical intervention trials, some individuals may be reluctant to agree with random assignment, potentially impacting result generalizability. To evaluate the magnitude and direction of non-participation bias, the PPT will enroll a sample of those who decline participation in the RCT but are otherwise eligible.
Conclusion
This sham-controlled RCT will provide important information for patients and surgeons regarding both the short- and long-term optimal treatment approach for stress continent women undergoing a vaginal surgery for prolapse. Non-participation bias will be estimated.
Objective-To describe the effect of lifting maneuver and quantity of weight lifted on the generation of intra-abdominal pressure.Study Design-Forty-one women undergoing urodynamic evaluation performed four lifting maneuvers, each while lifting 0, 2.5, 5, 10, and 15 kg. The lifting maneuvers were routine activities including squatting with and without assistance, lifting from a counter and receiving weight. Pressure was recorded with a rectal microtip catheter. Each lift was performed twice and the average pressure change was analyzed.Results-Controlling for potential confounding variables, repeated-measures ANOVA revealed a significant interaction between lift weight and lift maneuver (p= <0.001). Squatting was associated with generation of higher intra-abdominal pressure than lifting from a counter or receiving weights into outstretched arms (p= <0.001). Lifting ≥2.5 kg resulted in significant changes in intra-abdominal pressure regardless of lift maneuver (p= <0.001).Conclusions-Both lifting maneuver and quantity of weight should be considered when counseling patients regarding postoperative lifting.
Background:
Nursing faculty sought to promote students' engagement with course material and their peers by using Kaizen, an online educational game. The purpose of this qualitative study was to learn more about nursing students' perceptions of team competition in an educational game and whether the game promoted their engagement with educational material in one fundamental nursing course.
Method:
Qualitative data collection included focus groups, observations of students, documents showing leaderboards and game participation, and “status of competition” e-mails. Data were transcribed and coded to determine emerging themes.
Results:
Four themes emerged from data analysis: learning in teams, motivators to play, learning course content, and suggestions for game improvement.
Conclusion:
Students were overwhelmingly positive about using a gamified platform for its educational rewards. They perceived that playing the game increased their knowledge retention, and they believed it helped them improve their test-taking skills.
[
J Nurs Educ
. 2019;58(2):79–85.]
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