Biomedical subjects
Publications and source records attributed to L M Duffy.
With the aging of the baby boomers, increased attention is being given to sexuality and aging. This article discusses what is found in the current literature regarding the sociocultural, psychological, and physical factors affecting sexuality in aging individuals.
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OBJECTIVES: To compare the safety and cost of clean versus sterile intermittent bladder catheterization in male nursing home residents. To provide evidence to support the hypothesis that intermittent catheterization is a valid, alternative method of bladder management in male residents of long-term care in whom urinary retention is a documented problem. DESIGN: Randomized clinical trial. SETTING: Three long-term care sites having predominantly male populations. PARTICIPANTS: Eighty male veterans, residents of three long-term care facilities, ranging in age from 36 to 96 years with a mean age of 72. INTERVENTIONS: Standardized procedures for clean and sterile intermittent catheterization (IC) were implemented by staff nurses at each site. Patients were randomized into clean and sterile IC groups. Nursing time and catheterization equipment usage were recorded using bar code readers. Clinical data were collected from the medical chart. Treatment of urinary tract infection was prescribed by the medical personnel responsible for each individual resident. MEASUREMENTS: We compared the number of treatment episodes for symptomatic bacteriuria between groups randomized to receive either clean or sterile intermittent catheterization. Laboratory analysis of blood and urine was done on predetermined days. Control variables were research site and patient history of urinary tract infection within the last 6 months. A cost comparison of nursing time and equipment usage for the two catheterization techniques was also performed. RESULTS: No significant differences were found between clean and sterile groups with regard to number of treatment episodes, time to first infection, type of organism cultured, or cost of antibiotic treatment. The cost of sterile technique was considerably higher both in terms of nursing time and supplies. CONCLUSIONS: Findings from this study demonstrate that clean technique intermittent catheterization is a safe and cost-effective bladder management technique with male, nursing home residents, despite the frailty of this high risk population. An annual savings of approximately $1460 per patient in nursing time and catheterization supplies could be anticipated if a patient were catheterized an average of four times per day substituting clean IC technique for sterile IC technique.
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Our physician-nurse team management of a program in vasoactive intracavernous pharmacotherapy to treat male impotence has provided a high degree of patient and partner satisfaction. Nurses participate in the assessment of the ability of a patient or partner to master the self-injection technique, and the potential of a couple for compliance with and commitment to the program, all of which are key factors for successful home therapy. A nurse also teaches the self-injection technique. Audiovisual materials and handouts are used as teaching aids to ensure that complete and consistent information is given. The patient or partner is required to perform a self-injection under nursing supervision before a prescription for home use written. Initial followup visits are scheduled with a nurse at 1 to 2-week intervals. At these visits the nurse identifies possible patient errors in self-injection technique, dose or frequency, and answers questions about the therapy. After the couple has mastered and is comfortable with home injection, followup appointments are scheduled with the physician at 4-week intervals to monitor for possible changes in response to treatment and for an examination of the phallus.
A total of 100 men with organic impotence underwent a trial of intracavernous drug-induced erections with a mixture of papaverine (25 mg./ml.) and phentolamine (0.8 mg./ml.). The response rates, that is functional erections, were 100 per cent in patients with neurogenic impotence, 65.7 per cent in those with vasculogenic impotence, 90 per cent in the undetermined group and 64.7 per cent in the neurogenic/vascular impotence group. Of the responders 79.5 per cent elected to practice self-injection as a method to restore erectile function. The dose required to obtain functional erections in the purely neurogenic impotence group was significantly lower than that required in other groups. Complications were few and included 4 patients with sustained erections that required intervention. Intracavernous injection of vasoactive drugs appears to have promising value in the treatment and differential diagnosis of erectile dysfunction.
The new Vance nonadhesive urostomy system has several advantages over established systems, including ease of assembly, cleanliness, large and less visible storage capacity, and security from leakage. We studied 44 patients using this system, including those who were previously satisfied with more established ostomy systems and those with stomal problems. We found the new system to be superior in most of the patients.
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