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The latest evidence for practice

Choice picks from the research journals,
with some choice comment …

Una Adderley
Specialist Nurse
Team Leader

Diagnosing urinary incontinence in women

As the population ages, increasing numbers of people are suffering from urinary incontinence; although it is not a condition that only affects the very elderly. Accurate diagnosis of the cause and type of incontinence is important in order to select the most appropriate interventions. This study reviewed the evidence regarding the most effective way to clinically assess urinary incontinence in adult women.

The review selected studies that had evaluated clinical diagnosis of stress or urge urinary continence and which had used a reference standard of diagnosis either by an expert or through the use of urodynamic studies. Forty studies met the selection criteria.

The review found that simple questions, such as, "Do you lose urine during sudden physical exertion, lifting, coughing or sneezing?" and "Do you experience such a strong and sudden urge to void that you leak before reaching the toilet", identified stress and urge incontinence respectively. The stress test (checking for urine loss during coughing) can help diagnose stress incontinence. However, other tests, such as the Q-tip test (observer checks for upward movement of a Q-tip inserted into the urethra during Valsalva manoeuvre) and the pad test (a pad is worn during the day and then weighed), were less useful. The reviewers concluded that simple questions, questionnaires, clinical tests and overall clinical assessment are moderately useful in diagnosing stress and urge incontinence in adults.

A commentary notes that although this review provides useful information to help clinicians wishing to differentiate between stress and urge incontinence, there was little mention of overflow incontinence and it did not address other important contributing factors that should be assessed before starting treatment. Such factors include pelvic muscle strength, fluid intake, medications and constipation. It should also be noted that a significant proportion of the studies dated from the 1980s and early 1990s, and assessment practice may have moved on
since then.

Reference
Holdroyd-Leduc JM, Tannenbaum C, Thorpe KE, Straus SE. What type of urinary incontinence does this woman have? JAMA 2008;299:1446–56.

Commentary
Robbs L. Evid Base Nurs 2008;11(4):121.

The importance of culturally appropriate diabetes education

Ethic minority populations have an increased risk of developing type 2 diabetes, and self-management education has been shown to improve glycaemic control and improve knowledge. This Cochrane systematic review sought to discover whether culturally tailored health education improved outcomes in members of ethnic minority groups with type 2 diabetes.

The review sought studies that compared a culturally appropriate health education intervention with conventional health education in patients with type 2 diabetes who were members of an ethnic minority group living in high income countries. The "culturally appropriate" education programmes had to be tailored to the cultural and religious beliefs and linguistic and literary skills of the particular community. Eleven randomized, controlled trials met the inclusion criteria.

The review found that culturally appropriate diabetes education improved short-term glycaemic control and diabetes knowledge in members of ethnic minority groups with type 2 diabetes. A commentary notes that the populations included in this review were diverse and, therefore, any conclusions must be cautious.

However, the review does suggest that a combination of individual and group education strategies is more effective than either strategy alone. It also notes that this review highlights the shortage of research that addresses the needs of minority groups.

Reference
Hawthorne K, Robles Y, Cannings–John R, Edwards AG. Culturally appropriate health education for type 2 diabetes mellitus in ethnic minority groups. Cochrane Database Syst Rev 2008;16(3):CD006424.

Commentary
Upchurch SL. Evid Base Nurs 2009;12(1):15.