Trial to compare mixed-use (multi-use and single-use) intermittent catheter management with single-use management over 12 months (The MultICath Trial): protocol for a non-inferiority randomised controlled trial.

Introduction: Evaluating the safety and acceptability of reusing catheters for intermittent catheterisation (IC) is one of the top 10 continence research priorities identified by the UK James Lind Alliance Priority Setting Partnership in 2008. There are an estimated 50 000 IC users in England and this number is rising. Globally, both single-use catheters (thrown away after use) and multi-use/reusable ones (cleaned between uses) are used.

Technology for managing incontinence: What are the research priorities?

Incontinence and toileting difficulties can often be successfully addressed by treating their underlying causes. However, (complete) cure is not always possible and continence products to prevent or contain unresolved leakage or to facilitate toileting are in widespread use. Many people use them successfully but identifying the product(s) most likely to meet individual needs can be challenging and the recently published Seventh International Consultation on Incontinence includes a chapter which draws on the literature to provide evidence-based recommendations to help clinicians and product users to select appropriate products.

An International Continence Society (ICS) report on the terminology for single-use body worn absorbent incontinence products.

Aims: In 2016, the International Continence Society (ICS) Standardization Steering Committee appointed a working group to address the confusing plethora of synonyms currently used to describe single-use body worn absorbent incontinence products by recommending preferred terminology.

Methods: An online questionnaire was posted in 2016/17 inviting input from stakeholders internationally. The data were analyzed and conclusions progressively refined through working group discussions, an open meeting at the 2017 annual ICS conference, and a review of further iterations-including from the parent ICS Standardization Committee-until consensus was reached.

An experimental study of friction between volar forearm skin and nonwoven fabrics used in disposable absorbent products for incontinence.

Incontinence-associated dermatitis is common among wearers of absorbent incontinence products and friction between product materials and skin is thought to be a contributing factor, but the details of its role are unclear. In this study, friction was measured between the dry volar forearm of 19 women (20-95 years) and five nonwovens typical of those in commercial disposable products. Euler's model/Amontons' law held to high precision for all person-fabric pairs for both static and dynamic friction, despite substantial variations in forearm size, soft tissue compliance and skin smoothness between subjects, sometimes substantial lateral contraction in fabric strips, and skin rucking beneath them.

An investigation of laboratory test methods for predicting the in-use leakage performance of urine-absorbing aids in nursing homes.

The absorption before leakage method for measuring the absorption capacity of urine-absorbing aids was investigated. Along with the existing international standard (ISO 11948-1:1996, the Rothwell method), it was run on 12 experimental products whose in-use leakage performance was established by 55 incontinent nursing home residents. Methods were evaluated by considering their simplicity, their repeatability within - and their reproducibility between - six laboratories, and their correlation with in-use product performance.

The Impact of Microclimate on Skin Health With Absorbent Incontinence Product Use: An Integrative Review.

This integrative review considers the role of skin occlusion and microclimate in incontinence-associated dermatitis (IAD), with a particular focus on disposable, body-worn, absorbent incontinence products. Although the mechanisms are not fully understood, the primary causes of IAD are well-established: occluded skin, in prolonged contact with urine and/or feces and exposed to abrasive forces, is more likely to be affected, and each of these factors can be influenced by wearing absorbent incontinence products. Studies comparing the effect of various absorbent products on skin health have been hindered by the many differences between compared products, making it difficult to clearly attribute any differences in performance to particular materials or design features.

In vivo estimation of water diffusivity in occluded human skin using terahertz reflection spectroscopy.

Water diffusion and the concentration profile within the skin significantly affect the surrounding chemical absorption and molecular synthesis. Occluding the skin causes water to accumulate in the top layer of the skin (the stratum corneum [SC]) and also affects the water diffusivity. Scar treatments such as silicone gel and silicone sheets make use of occlusion to increase skin hydration.

Development and psychometric evaluation of ICIQ-PadPROM: A quality of life questionnaire to assess the treatment effect of absorbent continence products.

Aim: To describe the development and evaluation of the ICIQ-PadPROM, the first self-reported quality of life questionnaire to assess the treatment effect of absorbent continence products, a new addition to the set of ICIQ modules providing international standardized assessment of lower pelvic dysfunction.

Methods: Developed in four phases, question items semi-structured interviews were conducted with pad using men (n = 19), women (n = 6), with secondary analysis undertaken on transcripts (n = 15 women) from a previous study. Validity of a draft 67 item questionnaire was tested through cognitive debriefing interviews (n = 34) and postal survey (n = 239).

Quantifying the Frictional Forces between Skin and Nonwoven Fabrics.

When a compliant sheet of material is dragged over a curved surface of a body, the frictional forces generated can be many times greater than they would be for a planar interface. This phenomenon is known to contribute to the abrasion damage to skin often suffered by wearers of incontinence pads and bed/chairbound people susceptible to pressure sores. Experiments that attempt to quantify these forces often use a simple capstan-type equation to obtain a characteristic coefficient of friction.

An Exploratory Study of Skin Problems Experienced by UK Nursing Home Residents Using Different Pad Designs.

Purpose: The primary aim of this study was to determine whether the severity of incontinence-associated dermatitis (IAD) among nursing home-based incontinence pad users varies between pad designs. A second aim was to examine the utility of a simple method for reporting skin health problems in which healthcare assistants were asked to record basic observational data at each pad change.

Study Design: Randomized, multiple crossover, observational, exploratory.

Is it Feasible to Use Incontinence-Associated Dermatitis Assessment Tools in Routine Clinical Practice in the Long-term Care Setting?

Purpose: To investigate the feasibility of using incontinence-associated dermatitis (IAD) tools in routine clinical practice by asking nursing home staff (RNs and non-RN caregivers) and tissue viability specialty (TVS) nurses to evaluate 3 instruments and a 4-point severity scoring system for describing and grading IAD examples captured in photographs of skin underneath absorptive pads in nursing home patients.

Design: Feasibility study.

Subjects And Setting: Twelve female nursing home residents whose incontinence was managed with pads and who had previously been identified as experiencing IAD were recruited, along with 16 nursing home staff (6 RNs and 10 non-RNs) and 10 TVS nurses.

Development and psychometric evaluation of the ICIQ-LTCqol: A self-report quality of life questionnaire for long-term indwelling catheter users.

Aims: Long-term indwelling catheterisation may affect health related quality of life, but clinical assessment and monitoring of people with indwelling catheters is poorly recorded because there are no validated measures to capture these criteria. In this paper, we describe the development of the ICIQ-Long Term Catheter quality of life (ICIQ-LTCqol), one of the modules of the ICIQ series, an international project to standardise assessment of lower pelvic dysfunction: www.iciq.

A trial of devices for urinary incontinence after treatment for prostate cancer.

Objective: To compare the performance of three continence management devices and absorbent pads used by men with persistent urinary incontinence (>1 year) after treatment for prostate cancer.

Patients And Methods: Randomised, controlled trial of 56 men with 1-year follow-up. Three devices were tested for 3 weeks each: sheath drainage system, body-worn urinal (BWU) and penile clamp.

A study of friction mechanisms between a surrogate skin (Lorica soft) and nonwoven fabrics.

Hygiene products such as incontinence pads bring nonwoven fabrics into contact with users' skin, which can cause damage in various ways, including the nonwoven abrading the skin by friction. The aim of the work described here was to develop and use methods for understanding the origin of friction between nonwoven fabrics and skin by relating measured normal and friction forces to the nature and area of the contact (fibre footprint) between them. The method development work reported here used a skin surrogate (Lorica Soft) in place of skin for reproducibility.

Individual budgets for people with incontinence: results from a 'shopping' experiment within the British National Health Service.

Background And Context: Most people with urinary incontinence are given limited choice when provided with absorbent products through the British National Health Service (NHS), even though the available range is large.

Objective: To investigate users' preferences for four disposable designs (inserts, all-in-ones, belted/T-shaped and pull-ups) and towelling washable/reusable products, day and night.

Design: Shopping experiment.

Continence products: research priorities to improve the lives of people with urinary and/or fecal leakage.

Although many successful treatments for incontinence exist they are not effective or suitable for all people. Inconspicuous and dependable management with continence products and devices plays a crucial part in maintaining quality of life. We aim to briefly review what is known and not known in the field of continence products and devices and set out suggested priorities for research and development.

Review of methods used for quantifying excess water in over-hydrated skin using evaporimetry.

Background: Advances in diapers and skin barrier products are often aimed at reducing water penetration of the skin to prevent diaper dermatitis and evaporimetry has commonly been measured to quantify excess water in the skin. The aim of this study was to critically review the methods used to measure water vapour flux density (WVFD) using evaporimetry in order to identify a standardised methodology.

Methods: We used MEDLINE (1980-2008) and hand searching to identify published papers that used evaporimetry to measure WVFD when the skin has been exposed to water/saline/urine.

Absorbent products for moderate-heavy urinary and/or faecal incontinence in women and men.

Background: Incontinence is a common and embarrassing problem which has a profound effect on social and psychological well-being. Many people wear absorbent products to contain urine and/or faeces and protect their clothes and dignity. Users of absorbent pads are very diverse, including younger women, particularly those who have had children, older men with prostate disease, people with neurological conditions and older people with mobility and mental impairment.

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.

Absorbent products for incontinence: 'treatment effects' and impact on quality of life.

Aim: This study aimed to determine how the use and characteristics of absorbent products for incontinence impact on women's quality of life, and to examine the concept of 'treatment effects' in the context of pad use.

Method: Key pad performance characteristics were identified from the literature and focus group work. Semi-structured interviews with 99 women with light incontinence were used to investigate the impact of pad use on women's quality of life, including both positive and negative 'treatment effects', and to rank pad characteristics by their importance.

Female urinals for women with impaired mobility.

Margaret Macaulay and colleagues describe the range of female urinals currently available, provide guidance on product selection and introduce a novel device designed to overcome some of the limitations of conventional urinals.

A multi-centre evaluation of absorbent products for men with light urinary incontinence.

Aims: This study compared the performance of the four main designs of absorbents for men with light incontinence: pouches (shields), leafs (guards), washable pant with integral pad (pantegral), and small disposable pad.

Materials And Methods: We did a multiple crossover trial. Men with light urinary incontinence were recruited.