DOCSLIB.ORG

For Peer Review Only

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
For Peer Review Only BMJ Open BMJ Open: first published as 10.1136/bmjopen-2013-004135 on 10 December 2013. Downloaded from Effectiveness of continence promotion for older women via community organisations: a cluster randomised trial ForJournal: peerBMJ Open review only Manuscript ID: bmjopen-2013-004135 Article Type: Research Date Submitted by the Author: 27-Sep-2013 Complete List of Authors: Tannenbaum, Cara; Université de Montréal, Faculty of Medicine Agnew, Rona; Glasgow Caledonian University, Benedetti, Andrea; McGill University, Departments of Medicine and of Epidemiology, Biostatistics & Occupational Health Thomas, Doneal; McGill University, Departments of Medicine and of Epidemiology, Biostatistics & Occupational Health van den Heuvel, Eleanor; Brunel University, <b>Primary Subject Urology Heading</b>: Secondary Subject Heading: Geriatric medicine Keywords: Urinary incontinences < UROLOGY, PUBLIC HEALTH, GERIATRIC MEDICINE http://bmjopen.bmj.com/ on September 24, 2021 by guest. Protected copyright. For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 1 of 35 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2013-004135 on 10 December 2013. Downloaded from 1 2 3 4 5 Effectiveness of continence promotion for older women via community organisations: 6 a cluster randomised trial 7 8 9 1 2 3 10 Cara Tannenbaum, MD, MSc Rona Agnew, PhD Andrea Benedetti, PhD Doneal 11 Thomas, MSc4 Eleanor van den Heuvel, PhD5 12 13 14 1 15 AssociateFor Professor, peer Faculty of Medicine, review Université de Montréal, only Quebec, Canada 16 2Clinical Research Fellow, Glasgow Caledonian University, Glasgow, UK 17 18 3Associate Professor, Departments of Medicine and of Epidemiology, Biostatistics & 19 20 Occupational Health, McGill University, Quebec, Canada 21 4PhD candidate, Department of Epidemiology, Biostatistics & Occupational Health, 22 23 McGill University, Quebec, Canada 24 5 25 Director of Assistive Technology Programme, Brunel Institute for Ageing Studies, 26 Brunel University, Uxbridge, UK 27 28 29 30 Word count : 3182 31 32 33 Key words: Continence promotion, cluster trial, community organisations, older 34 http://bmjopen.bmj.com/ 35 women, urinary incontinence 36 37 38 Corresponding Author: Dr. Cara Tannenbaum, Centre de Recherche de l’Institut 39 40 universitaire de gériatrie de Montréal, 4545 Queen Mary Road, Montreal, Quebec, 41 Canada H3W 1W5. Tel (514) 340-2800. Fax : (514) 340-3530. 42 on September 24, 2021 by guest. Protected copyright. 43 Email: [email protected] 44 45 46 The Corresponding Author has the right to grant on behalf of all authors and does 47 48 grant on behalf of all authors, an exclusive licence on a worldwide basis to the BMJ 49 50 Publishing Group Ltd to permit this article (if accepted) to be published in BMJ Open 51 editions and any other BMJPGL products and sublicences such use and exploit all 52 53 subsidiary rights, as set out in the licence. 54 55 56 57 58 59 60 1 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 2 of 35 BMJ Open: first published as 10.1136/bmjopen-2013-004135 on 10 December 2013. Downloaded from 1 2 3 All authors have completed the Unified Competing Interest form at 4 5 www.icmje.org/coi_disclosure.pdf (available on request from the corresponding 6 author) and declare: no support from any organisation for the submitted work; no 7 8 financial relationships with any organisations that might have an interest in the 9 10 submitted work in the previous three years, and no other relationships or activities that 11 could appear to have influenced the submitted work. 12 13 14 15 The authorsFor retained peerfull independence review from the study sponsors only in the design, 16 implementation, analysis, interpretation and reporting of the findings. 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 http://bmjopen.bmj.com/ 35 36 37 38 39 40 41 42 on September 24, 2021 by guest. Protected copyright. 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 2 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 3 of 35 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2013-004135 on 10 December 2013. Downloaded from 1 2 3 ABSTRACT 4 5 6 Objectives: The primary objective of this cluster randomised controlled trial was to 7 8 compare the effectiveness of the three experimental continence promotion 9 10 interventions against a control intervention on urinary symptom improvement in older 11 women with untreated incontinence recruited from community organisations. A 12 13 second objective was to determine whether changes in incontinence-related 14 15 knowledge,For new uptake peer of risk-modifying review behaviours explained only these improvements. 16 17 18 Setting: 71 community organisations across the United Kingdom 19 20 21 Participants: 259 women aged 60 years with untreated incontinence entered the trial; 22 23 88% completed the 3-month follow-up. 24 25 26 Interventions: The three active interventions consisted of a single 60-minute group 27 28 workshop on 1) continence education (20 clusters, 64 women); 2) evidence-based 29 30 self-management (17 clusters, 70 women); or 3) combined education and self- 31 management (17 clusters, 61 women). The control intervention was a single 60- 32 33 minute educational group workshop on memory loss, polypharmacy and osteoporosis 34 http://bmjopen.bmj.com/ 35 (17 clusters, 64 women). 36 37 38 Primary and secondary outcome measures: The primary outcome was self-reported 39 40 improvement in incontinence 3 months post-intervention at the level of the individual. 41 Changes in incontinence-related knowledge and behaviours were also assessed. 42 on September 24, 2021 by guest. Protected copyright. 43 44 45 Results: The highest rate of urinary symptom improvement occurred in the combined 46 intervention group (66% vs 11% of the control group, prevalence difference 55%, 47 48 95% CI 43%-67%, intracluster correlation 0). Thirty percent versus 6% of participants 49 50 reported significant improvement respectively (prevalence difference 23%, 95% CI 51 10%-36%, intracluster correlation 0). The number-needed-to-treat was 2 to achieve 52 53 any improvement in incontinence symptoms, and 5 to attain significant improvement. 54 55 Changes in knowledge and self-reported risk-reduction behaviours paralleled rates of 56 improvement in all intervention arms. 57 58 59 60 3 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 4 of 35 BMJ Open: first published as 10.1136/bmjopen-2013-004135 on 10 December 2013. Downloaded from 1 2 3 Conclusion: Continence education combined with evidence-based self-management 4 5 improves symptoms of incontinence among untreated older women. Community 6 organisations represent an untapped vector for delivering effective continence 7 8 promotion interventions. 9 10 11 Trial registration: ClinicalTrials.gov ID number NCT01239836 12 13 14 15 For peer review only 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 http://bmjopen.bmj.com/ 35 36 37 38 39 40 41 42 on September 24, 2021 by guest. Protected copyright. 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 4 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 5 of 35 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2013-004135 on 10 December 2013. Downloaded from 1 2 3 Article Summary : Strengths and limitations of this study 4 5 6 • First study to provide Level 1 evidence that continence promotion is an 7 8 effective strategy for improving urinary symptoms among untreated 9 10 community-dwelling older women 11 12 13 • Participants were recruited via community organisations with representation 14 15 acrossFor diverse peer socio-economic review strata only 16 17 18 • Rates of knowledge acquisition and behaviour change provide an explanatory 19 20 mechanism for the observed improvements in incontinence in participants 21 22 receiving the education combined with the self-management strategy 23 24 25 • Only self-reported outcomes and crude dichotomous measures of behaviour 26 27 change were collected so results must be interpreted with caution 28 29 30 31 32 33 34 http://bmjopen.bmj.com/ 35 36 37 38 39 40 41 42 on September 24, 2021 by guest. Protected copyright. 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 5 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 6 of 35 BMJ Open: first published as 10.1136/bmjopen-2013-004135 on 10 December 2013. Downloaded from 1 2 3 Introduction 4 5 6 Urinary incontinence is more frequent than breast cancer, heart disease or diabetes 7 among older women, but remains a stigmatized and untreated condition despite its 8 9 high prevalence. [1-4] In the United States, Canada, the U.K. and other European 10 11 countries, up to 40% of women aged 65 years and older experience involuntary urine 12 leakage, but little more than 15-30% seek care.[1-4] Even fewer physicians feel 13 14 competent evaluating or treating incontinence.[5-6] Urinary incontinence is associated 15 For peer review only 16 with obesity, cardiovascular disease, diabetes, depression, social isolation, decline in 17 function, falls, nursing home admission, and onerous out-of-pocket expenses.[6-10] 18 19 In many cases incontinence can be improved, and even cured, when evidence-based 20 21 diagnostic and treatment strategies are appropriately applied.[6,11-14] 22 23 24 It is a commonly held misconception that incontinence is a normal part of aging.[15] 25 26 Not-for-profit organisations seek to raise continence awareness worldwide and 27 promote treatment for incontinent individuals.
Load more

Recommended publications
  • Older Women's Health Priorities and Perceptions of Care Delivery
    Research Recherche Older women’s health priorities and perceptions of care delivery: results of the WOW health survey Cara Tannenbaum, Nancy Mayo, Francine Ducharme ß See related article page 165 Abstract s women’s life expectancy increases, physicians are confronted with the challenge of treating an elderly Background: As women get older, their health priorities change. A population that is predominantly female and has a We surveyed a sample of older Canadian women to investi- variety of health priorities and needs. Older women face gate what health priorities are of concern to them, their per- functional, psychological and social difficulties in addition ceptions about the care delivered to address these priorities to health-related conditions. One solution to align care and the extent to which priorities and perceptions of care dif- more closely with women’s health priorities is to practise fer across age groups and provinces. patient-centred care, whereby clinical decision-making is Methods: The WOW (What Older women Want) cross-sec- focused primarily on the priorities and preferences of indi- tional health survey was mailed in October 2003 to 5000 vidual patients.1–3 Data on older women’s health priorities community-dwelling women aged 55–95 years from 10 4–6 Canadian provinces. Women were asked questions on 26 are scarce, and understanding the gamut of their con- health priorities according to the World Health Organiza- cerns is important for directing patient-centred, priority- tion’s International Classification of Functioning, Disability driven agendas. The WOW — What Older women Want and Health, and their perceptions of whether these priorities — health survey was conducted to determine health priori- were being addressed by health care providers through ties of older Canadian women and the extent to which screening or counselling.
    [Show full text]
  • Effectiveness of Continence Promotion for Older Women Via Community Organisations: a Cluster Randomised Trial
    BMJ Open: first published as 10.1136/bmjopen-2013-004135 on 10 December 2013. Downloaded from Open Access Research Effectiveness of continence promotion for older women via community organisations: a cluster randomised trial Cara Tannenbaum,1 Rona Agnew,2 Andrea Benedetti,3 Doneal Thomas,4 Eleanor van den Heuvel5 To cite: Tannenbaum C, ABSTRACT et al Strengths and limitations of this study Agnew R, Benedetti A, . Objectives: The primary objective of this cluster Effectiveness of continence randomised controlled trial was to compare the ▪ promotion for older women First study to provide level 1 evidence that con- effectiveness of the three experimental continence via community organisations: tinence promotion is an effective strategy for a cluster randomised trial. promotion interventions against a control intervention improving urinary symptoms among untreated BMJ Open 2013;3:e004135. on urinary symptom improvement in older women with community-dwelling older women. doi:10.1136/bmjopen-2013- untreated incontinence recruited from community ▪ Participants were recruited via community orga- 004135 organisations. A second objective was to determine nisations with representation across diverse whether changes in incontinence-related knowledge socioeconomic strata. ▸ Prepublication history for and new uptake of risk-modifying behaviours explain ▪ Rates of knowledge acquisition and behaviour this paper is available online. these improvements. change provide an explanatory mechanism for To view these files please Setting: 71 community organisations across the UK. the observed improvements in incontinence in visit the journal online Participants: 259 women aged 60 years and older participants receiving the combined education (http://dx.doi.org/10.1136/ with untreated incontinence entered the trial; 88% plus self-management strategy.
    [Show full text]
  • Chief Science Advisor
    ANNUAL REPORT OF THE Chief Science Advisor 2019–2020 ANNUAL REPORT OF THE Chief Science Advisor Office of the Chief Science Advisor 235 Queen Street Ottawa, Ontario 2019–2020 K1A 0H5 Canada [email protected] This publication is also available online at science.gc.ca. © Her Majesty the Queen in Right of Canada, as represented by the Chief Science Advisor of Canada (2020) Cat. No. Iu35-1E-PDF ISSN 2562-2579 A MESSAGE FROM THE CHIEF SCIENCE ADVISOR Back in mid-2019, my staff and I took part in I was correct about the former. I could not have three separate tabletop simulations: exercises been more wrong about the latter. designed to simulate the stresses of decision-making in emergencies. One simulation was domestic, When the COVID-19 pandemic took hold in conducted with Public Safety Canada and the Canada, my staff and I took the lessons learned Department of National Defense. The other two from the simulations and implemented them as were international, conducted in the United States quickly as we could. And we succeeded, I believe, and the United Kingdom. in setting up a network of pathways that brought scientists together, and allowed information to These exercises were part of an ambitious flow swiftly from Canada’s most knowledgeable 2019-2020 work plan for this office. In addition to researchers through to government decision- these simulations, our staff were simultaneously makers. active in many files across all areas of our mandate: providing better science advice to decision-makers, Our efforts were successful thanks not only establishing open-science principles for federal to the work of my staff, but to the willing research, improving federal government science, participation of the scientific community across and conducting science-based international Canada, from multiple disciplines: public health, diplomacy.
    [Show full text]
  • Female Grant Applicants Are Equally Successful When Peer Reviewers Assess the Science, but Not When They Assess the Scientist
    bioRxiv preprint doi: https://doi.org/10.1101/232868; this version posted March 2, 2018. The copyright holder for this preprint (which was not certified by peer review) is the author/funder. All rights reserved. No reuse allowed without permission. Female grant applicants are equally successful when peer reviewers assess the science, but not when they assess the scientist Holly O. Witteman, PhD1; Michael Hendricks, PhD2; Sharon Straus, MD FRCPC MSc HBSc3; Cara Tannenbaum, MD MSc4 1Associate Professor, Department of Family and Emergency Medicine, Faculty of Medicine, 1050 avenue de la Médecine, Université Laval, Quebec City, Canada, G1V 0A6 2Assistant Professor, Department of Biology, Faculty of Science, 1205 av du Docteur-Penfield, McGill University, Montreal, Canada, H3A 1B1 3Professor, Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, Canada, M3B 2T9 4Scientific Director, Institute for Gender and Health, Canadian Institutes of Health Research, Ottawa, Canada, H3A 1W4 Corresponding author: Holly O. Witteman, 1050 avenue de la Médecine, Pavillon Ferdinand- Vandry, Université Laval, Québec City, Québec, Canada, G1V 0A6, telephone: 418.656.2131 x3981, fax: 418.656.2465, email: [email protected] Keywords (MeSH terms): Peer Review, Research/methods; Sex Factors Keywords (non-MeSH terms): Gender Bias Running title: Gender Bias in Grant Review Word count: 3500 words bioRxiv preprint doi: https://doi.org/10.1101/232868; this version posted March 2, 2018. The copyright holder for this preprint (which was not certified by peer review) is the author/funder. All rights reserved. No reuse allowed without permission. ABSTRACT (299 words) Background: Previous research shows that men often receive more research funding than women, but does not provide empirical evidence as to why this occurs.
    [Show full text]
  • Reduction of Inappropriate Benzodiazepine Prescriptions Among Older Adults Through Direct Patient Education the EMPOWER Cluster Randomized Trial
    Research Original Investigation Reduction of Inappropriate Benzodiazepine Prescriptions Among Older Adults Through Direct Patient Education The EMPOWER Cluster Randomized Trial Cara Tannenbaum, MD, MSc; Philippe Martin, BSc; Robyn Tamblyn, PhD; Andrea Benedetti, PhD; Sara Ahmed, PhD Supplemental content at IMPORTANCE The American Board of Internal Medicine Foundation Choosing Wisely jamainternalmedicine.com Campaign recommends against the use of benzodiazepine drugs for adults 65 years and older. The effect of direct patient education to catalyze collaborative care for reducing inappropriate prescriptions remains unknown. OBJECTIVE To compare the effect of a direct-to-consumer educational intervention against usual care on benzodiazepine therapy discontinuation in community-dwelling older adults. DESIGN, SETTING, AND PARTICIPANTS Cluster randomized trial (EMPOWER [Eliminating Medications Through Patient Ownership of End Results] study [2010-2012, 6-month follow-up]). Community pharmacies were randomly allocated to the intervention or control arm in nonstratified, blocked groups of 4. Participants (303 long-term users of benzodiazepine medication aged 65-95 years, recruited from 30 community pharmacies) were screened and enrolled prior to randomization: 15 pharmacies randomized to the educational intervention included 148 participants and 15 pharmacies randomized to the “wait list” control included 155 participants. Participants, physicians, pharmacists, and evaluators were blinded to outcome assessment. INTERVENTIONS The active arm received
    [Show full text]
  • Self-Management of Urinary and Fecal Incontinence
    2.3 HOURS CE Continuing Education Self-Management of Urinary and Fecal Incontinence Employing evidence-based strategies can help patients take better control. OVERVIEW: Widely used by patients to control symptoms of chronic conditions such as diabetes, asthma, and arthritis, self-management can also help patients with urinary or fecal incontinence. The authors dis- cuss the principles of self-management, the behaviors and skills self-managing patients need to acquire, and the nurse’s role in reinforcing their use. They then describe strategies that can be incorporated within the framework of self-management to control urinary, fecal, or dual incontinence. Keywords: fecal incontinence, incontinence, self-care, self-management, urinary incontinence oth urinary and fecal incontinence can have chronic health conditions as diabetes, asthma, and distressing physical, emotional, and psycho- arthritis, its value in treating urinary and fecal inconti- Bsocial consequences, including loss of skin in- nence is not fully appreciated by many health care pro- tegrity due to persistent wetness or irritation from viders, who may be aware of the daily challenges faced feces, embarrassment brought on by soiled clothing by those with these conditions, but unsure of how to or odor, and self-imposed social isolation. Neverthe- best support patients in effective self-management. less, only 15% to 20% of patients with urinary in- This article discusses the principles of self- continence and 43% of those with fecal incontinence management and their application in treating uri- seek professional care for the problem.1-3 Instead, they nary and fecal incontinence. It describes the benefits try to cope with the condition on their own, with realized by patients who apply self-management tech- variable success.1, 4 niques to address incontinence and, through a case An alternative to patient trial and error is patient scenario, illustrates the nurse’s role in imparting self- self-management, in which nurses and other health management skills to patients and reinforcing their use.
    [Show full text]
  • Parallel Session 2A
    EASE Conference Strasbourg. Parallel session June 11, 2016 (15,30- 17,30) Preventing misconduct: guidelines - Coordinator Paola De Castro 1. How guidelines can help reduce waste in research David Moher Clinical Epidemiology Program, Ottawa Hospital Research Institute 2. The CoBRA guidelines for citation of bioresources Ann Cambon Thomsen. Inserm. University of Toulouse. The BRIF and journal editors group 3. How can SAGER guidelines contribute to Sex and gender equity in research. Shirin Heidari, EASE Gender Policy Committee 4. Institute of Gender Health ’s training modules to improve reviewer’s ability to assess sex and gender in publications Cara Tannenbaum, Institute of Gender and Health, Canadian Institutes of Health Research (CIHR) 5. Five years of EASE Guidelines (2010–2015): promoting complete, readable, and ethical publications. Sylvya Ufnalska, EASE council 6. When guidelines do not seem to help: how to manage difficult cases Ines Steffens, EASE Council member, editor in chief of Eurosurveillance Abstracts: 1) How guidelines can help prevent misconduct and reduce waste in research David Moher, Clinical Epidemiology Program, Ottawa Hospital Research Institute Some editors have noted the responsibility of everybody involved to help ensure the published record is complete, transparent, and unbiased. Published research articles should provide a clear and transparent description of how researchers conducted their study and what they found. This helps reduce waste and increase research value. Reporting guidelines, when used by prospective authors, and endorsed and implemented by journals, can help improve the completeness of reporting biomedical research articles. 2) The BRIF and journal editors’ group. The CoBRA guidelines for citation of bioresources. Anne Cambon-Thomsen for the BRIF and journal editors’ group.
    [Show full text]
  • Community Based Health Interventions 09:00 - 10:30 Friday, 6Th July, 2018 1.218 Track Health & Social Care Practices & Contexts
    Community based health interventions 09:00 - 10:30 Friday, 6th July, 2018 1.218 Track Health & social care practices & contexts 150 Impact of Community-Based Continence Promotion on Urinary Incontinence in Older Women: the CACTUS-D International Cluster Randomised Trial Mrs Eleanor van den Heuvel1, Dr Cara Tannenbaum2,3, Dr Xavier Fritel4, Dr Adrian Wagg5 1Brunel University, London, United Kingdom. 2Université de Montréal, Montreal, Canada. 3Canadian Institutes of Health Research, Montreal, Canada. 4Université de Poitiers, Poitiers, France. 5University of Alberta, Edmonton, Canada Abstract Urinary incontinence (UI) is common amongst older women and is known to be associated with social isolation1, depression, and falls 2. But older women fail to seek medical help for UI because many believe incontinence is a normal part of ageing and are not aware cure is possible. The sensitive but non-life- threatening nature of UI means that women tend to delay seeking help until the condition becomes intolerable. CACTUS-D3 tested an evidence-based continence promotion workshop against a control, health workshop in four different localities, France, UK, Quebec and Western Canada. 909 women aged 65-98 years with untreated UI, were recruited from 377 community groups. 751 participants (83%) completed the 1-year follow-up. Urinary symptom improvement was achieved and maintained from 3-months onwards in the intervention group. In 1-year intent-to-treat analyses, 15% of the intervention arm reported clinically important UI improvement compared to 7% of controls. 35% vs 19% reported any improvement . Compared to controls, the intervention group reported a mean 1.28 point (95% CI 1.15 - 1.41) improvement in incontinence-related quality of life at 1-year.
    [Show full text]
  • Prevalence of Commonly Prescribed Medications Potentially Contributing to Urinary Symptoms in a Cohort of Older Patients Seeking
    Kashyap et al. BMC Geriatrics 2013, 13:57 http://www.biomedcentral.com/1471-2318/13/57 RESEARCH ARTICLE Open Access Prevalence of commonly prescribed medications potentially contributing to urinary symptoms in a cohort of older patients seeking care for incontinence Mandavi Kashyap1, Le Mai Tu2 and Cara Tannenbaum1* Abstract Background: Several medication classes may contribute to urinary symptoms in older adults. The purpose of this study was to determine the prevalence of use of these medications in a clinical cohort of incontinent patients. Methods: A cross-sectional study was conducted among 390 new patients aged 60 years and older seeking care for incontinence in specialized outpatient geriatric incontinence clinics in Quebec, Canada. The use of oral estrogens, alpha-blocking agents, benzodiazepines, antidepressants, antipsychotics, ACE inhibitors, loop diuretics, NSAIDs, narcotics and calcium channel blockers was recorded from each patient’s medication profile. Lower urinary tract symptoms and the severity of incontinence were measured using standardized questionnaires including the International Consultation on Incontinence Questionnaire. The type of incontinence was determined clinically by a physician specialized in incontinence. Co-morbidities were ascertained by self-report. Logistic regression analyses were used to detect factors associated with medication use, as well as relationships between specific medication classes and the type and severity of urinary symptoms. Results: The prevalence of medications potentially contributing to lower urinary tract symptoms was 60.5%. Calcium channel blockers (21.8%), benzodiazepines (17.4%), other centrally active agents (16.4%), ACE inhibitors (14.4%) and estrogens (12.8%) were most frequently consumed. Only polypharmacy (OR = 4.9, 95% CI = 3.1-7.9), was associated with medication use contributing to incontinence in analyses adjusted for age, sex, and multimorbidity.
    [Show full text]
  • Indicators for Measuring Mental Health: Towards Better Surveillance
    researcH paper Indicators for Measuring Mental Health: Towards Better Surveillance Indicateurs de mesure pour la santé mentale : vers une meilleure surveillance by Cara Tannenbaum, mD Associate Professor of Medicine Centre de recherche, Institut universitaire de gériatrie de Montréal Faculty of Medicine, University of Montreal Montreal, QC Joel lexChin, mD School of Health Policy and Management, York University Emergency Department, University Health Network Department of Family and Community Medicine, University of Toronto Toronto, ON robyn Tamblyn, PhD Department of Epidemiology and Biostatistics Faculty of Medicine, McGill University Montreal, QC Sarah romanS, mD Women’s College Research Institute Department of Psychiatry, University of Toronto Toronto, ON HEALThCARE POLICy Vol.5 No.2, 2009 [e177] Cara Tannenbaum et al. Abstract accurate measurement and improvement of population mental health requires the recording of indicators that capture the full spectrum of disease severity. This paper describes four different strategies for measuring the prevalence of depression and anxi- ety in Canada based on data from the 2002 Canadian Community health Survey – mental health and Well-being (Cycle 1.2) and the 2003 Quebec medical services claims database. The use of multiple indicators provides a more comprehensive picture of mental health needs than a single indicator alone. however, the validity of these indicators raises certain challenges and highlights the complexity of obtaining valid and sustainable measurements of mental health problems over time. We include a dis- cussion of problems related to information availability and management. Résumé L’établissement d’indicateurs pour l’ensemble de l’indice de gravité des maladies est essentiel pour obtenir des mesures précises et pour améliorer la santé mentale de la population.
    [Show full text]
  • Models of Continence Care: What Works Best? Workshop 27 Tuesday 24 August 2010, 09:00 – 12:00
    Models of Continence Care: What Works Best? Workshop 27 Tuesday 24 August 2010, 09:00 – 12:00 Time Time Topic Speaker 9:00 9:10 Introduction & General Overview Cara Tannenbaum 9:10 9:35 Continence promotion in the elderly in outpatients Susan Orme 9:35 10:00 The long‐term care model: barriers and indicators of Diane Newman success 10:00 10:25 Delivering continence care through a social enterprise Adele Long model: The Bristol Integrated Continence Service (BICS) 10:25 11:00 Break 11:00 11:25 Measuring the outcomes of continence care Jeffrey Jutai 11:25 12:00 Case studies Cara Tannenbaum & Jeffrey Jutai Aims of course/workshop • To review current models of continence care delivery in the context of patient needs. • To critically appraise the success or failure of various models of care delivery in different countries. • To present a novel model of integrated continence care. • To discuss outcome evaluation of continence care delivery at the individual and health systems level. • To encourage discussion and share lessons learned from around the world. Educational Objectives This workshop will allow practitioners and service providers to discover and discuss some of the latest research on evidence‐based models of continence care. The focus will be on the assessment of patient needs, the process of care delivery and the importance of outcome evaluation. Delegates will learn the advantages and disadvantages of different models of care for meeting patient needs. By the end of the workshop the delegate will be in a position to innovate their own practice if required and will be equipped with a choice of tools to evaluate the outcomes of care delivery.
    [Show full text]
  • Canadian Deprescribing Network
    Canadian Deprescribing Network Annual Report 2016 CaDeN ReCaD Canadian Deprescribing Réseau canadien Network pour la déprescription The Canadian Deprescribing Network is a group of health care leaders, clinicians, decision- makers, academic researchers and patient advocates working together to mobilize knowledge and promote the deprescribing of inappropriate medications in Canada. The Network’s key objectives are to: • Reduce harm by raising awareness and decreasing the use of inappropriate medications for seniors by 50% by 2020. • Promote health by ensuring access to safer drug and non-drug therapies. The Canadian Deprescribing Network is initially focusing on three classes of medications that should be considered for deprescribing in seniors: • Benzodiazepines; • Proton pump inhibitors; and • Long-acting sulfonylureas. What is Deprescribing? Deprescribing is the planned and supervised process of reducing or stopping medications that may no longer be of benefit or may be causing harm. The goal is to reduce medication burden and harm, while maintaining or improving quality of life. Contact us and get involved: Annie Webb, Communications Director Canadian Deprescribing Network Centre de recherche de l’Institut Universitaire de gériatrie de Montréal 4565 chemin Queen-Mary, Montréal (Québec) H3W 1W5 Email: [email protected] @DeprescribeNet Website: deprescribing.org/caden/ The Annual Report is available on the website in French and English (printed copies available by request). 2 Contents 4 Message from Directors 5 Why Focus on Deprescribing? 9 The Network 14 Achievement Timeline 16 Public Awareness & Motivation 19 Health Care Provider Capacity 22 Policy-Maker Opportunities 24 Events & Networking 26 Partners & Collaborators 28 Network Representation 32 References 3 Message from Directors 2016 marks the launch of the Canadian each province to limit consumption.
    [Show full text]