Margaret Macaulay

A pilot study to evaluate reusable absorbent body-worn products for adults with moderate/heavy urinary incontinence.

OBJECTIVE The purpose of this pilot study was to evaluate the performance of reusable absorbent body-worn products for adults with moderate/heavy urinary incontinence, compare their performance with a group of equivalent disposable products, and establish the need for a larger statistically robust study. SETTING AND SUBJECTS Ten men and 4 women living in the community were recruited from locations throughout the United Kingdom. METHODS A randomized multiple crossover design was used in which all subjects were given the opportunity to test each product. All the products were available on the UK market in January 2001. The following tools were used in the evaluation: a product performance questionnaire and a pad leakage diary. Overall opinion was used as the primary outcome indicator. RESULTS The reusable Paddy T was the best performing product overall, outperforming the disposable products. For low leakage and good absorbency (the most important product attributes identified by the subjects), the disposable all-in-one product performed best during the day. However, the Paddy T performed best for night use. The remaining reusable products performed poorly overall. CONCLUSIONS Reusable products for moderate/heavy incontinence remain unpopular for use in isolation. Surprisingly, a product manufactured from terry toweling, a traditional material, performed relatively well. Reusables may provide a useful alternative to disposable products in certain circumstances. The results from this study do not support a more comprehensive costly study.

A noninvasive continence management system: development and evaluation of a novel toileting device for women.

Purpose This paper describes a project to develop and clinically evaluate a novel toileting device for women called the Non-Invasive Continence Management System (NICMS). The NICMS device is designed to provide an alternative toileting facility that overcomes problems some women experience when using conventional female urinals. Design A single product evaluation was completed; participants used the same device with 1 or 2 interface variants. Subjects and Setting Eighty women from 6 countries who were either mobile or wheelchair dependent evaluated the product over a 15-month period. Results The device was found to be useful in some circumstances for women and their caregivers. Conclusion Significant further development is required for it to work reliably and to provide an acceptable device in terms of reliability, size, weight, noise, and aesthetics.

A multicenter evaluation of absorbent products for children with incontinence and disabilities.

OBJECTIVE To evaluate all disposable pull-up-style pads (pull-ups) designed for children with learning and or physical disabilities and compare these with a representative sample of disposable diapers (diapers). DESIGN A multicenter randomized crossover trial where all children evaluated each product. SETTING AND CHILDREN A total of 61 community dwelling children with disabilities were recruited from 5 areas throughout the United Kingdom. Families were invited by letter to participate through their local clinical nurse specialist for continence care. INSTRUMENTS Instruments used included a range of questionnaires (product performance, design performance, and design preference questionnaires) and pad weight and leakage diaries. METHODS The children tested 10 products (5 pull-ups and 5 diapers) for up to 1 week per product both at home and at school. Caregivers (parents and guardians) completed the questionnaires after evaluation of individual products and design groups had been completed. They recorded wet product weights and scored pad leakage at each pad change. School staff completed an abbreviated product performance questionnaire for each product. RESULTS There was little difference in the overall performance of the pull-ups compared with the diapers. In the pull-up group, one product performed significantly worse than the others for some performance aspects. Pull-ups worked particularly well for children able to assist with toileting and pad changes. Diapers were liked for ease of changing if the child used calipers, adapted footwear, or trousers. Diapers were more popular than pull-ups for night use, when greater absorbency was required. Neither design performed differently for school or home use. Most caregivers expressed a preference for diapers or pull-ups based on a range of individual needs, for example, level of independence in toileting, discreetness in pad change, fit, and product appearance. CONCLUSIONS Diapers and pull-ups have different strengths and limitations, and both meet the specific needs of individual children. Although pull-ups are more expensive than diapers, their use is justified if based on a thorough assessment of individual need.

Reuse of intermittent catheters: A qualitative study of IC users’ perspectives

Objectives To explore the views of intermittent catheter (IC) users regarding the advantages and disadvantages of single-use or reuse of catheters. Design Qualitative study with semi-structured interviews. The interviews were recorded, transcribed and analysed thematically. Setting Participant’s own homes in Hampshire and Dorset, UK. Participants A convenience sample of 39 IC users, aged 23–86 years, using IC for at least 3 months. Results The analysis revealed four main themes: concerns regarding risk of urinary tract infection (UTI); cleaning, preparation and storage; social responsibility; practicalities and location. The main concern was safety, with the fear that reuse could increase risk of UTI compared with single-use sterile catheters. If shown to be safe then around half of participants thought they might consider reusing catheters. The practicalities of cleaning methods (extra products, time and storage) were considered potentially burdensome for reuse; but for single-use, ease of use and instant usability were advantages. Always having a catheter without fear of ‘running out’ was considered an advantage of reuse. Some participants were concerned about environmental impact (waste) and cost of single-use catheters. The potential for reuse was usually dependent on location. The analysis showed that often the disadvantages of single-use could be off-set by the advantages of reuse and vice versa, for example, the need to take many single-use catheters on holiday could be addressed by reuse, while the burden of cleaning would be obviated by single-use. Conclusions If shown to be safe with a practical cleaning method, some participants would find reuse an acceptable option, alongside their current single-use method. The choice to use a mixture of single-use and reuse of catheters for different activities (at home, work or holiday) could optimise the perceived advantages and disadvantages of both. The safety and acceptability of such an approach would require testing in a clinical trial.

The MultICath study: creating an evidence base

The dependence of the NHS on single-use IC catheters is not the worldwide norm. In many places the re-use of catheters remains commonplace and accepted. Recent studies in developed countries such as the USA, Canada and Australia have found that nearly half of those performing IC regularly reuse catheters (Woodbury et al, 2008; Bolinger and Engberg, 2013; Leek et al, 2013). In developing countries, where access to and affordability of single-use products is problematic, re-use is the norm.