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BACKGROUND: Urinary incontinence (UI) in women adversely affects quality of life. PURPOSE: To conduct a systematic literature review of drugs for urgency UI in women. DATA SOURCES: MEDLINE, the Cochrane Central Register of Controlled Trials, SCIRUS, and Google Scholar were searched for articles published from 1966 to November 2011. STUDY SELECTION: Randomized, controlled trials (RCTs) reported in English. DATA EXTRACTION: Rates of outcomes and risk of bias were extracted by using a standardized form to pool absolute risk differences and calculate the number of attributable events per 1000 patients treated, with 95% CIs. DATA SYNTHESIS: 94 RCTs were eligible. Pooled analyses showed that among drugs for urgency UI, per 1000 treated women, continence was restored in 130 with fesoterodine (CI, 58 to 202), 85 with tolterodine (CI, 40 to 129), 114 with oxybutynin (CI, 64 to 163), 107 with solifenacin (CI, 58 to 156), and 114 with trospium (CI, 83 to 144). Rates of treatment discontinuation due to adverse effects were 31 per 1000 treated with fesoterodine (CI, 10 to 56), 63 with oxybutynin (CI, 12 to 127), 18 with trospium (CI, 4 to 33), and 13 with solifenacin (CI, 1 to 26). The studies' inconsistent definitions of reduction in UI and quality of life hampered synthesis of evidence. LIMITATION: Evidence for quality-of-life improvements and comparative effectiveness with drugs was limited, and evidence for the effects of race, baseline severity of UI, and comorbid conditions on treatment success was insufficient. CONCLUSION: Overall, drugs for urgency UI showed similar small benefit. Therapeutic choices should consider the harms profile. Evidence for long-term adherence and safety of treatments is lacking. PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality. [ABSTRACT FROM AUTHOR]

A large body of research has documented the prevalence and severity of menopausal symptoms, especially vasomotor symptoms, in breast cancer survivors and their impact on quality of life. However, urinary symptoms as part of the constellation of menopausal symptoms have received relatively little attention. Thus, less is known about the prevalence and severity of urinary symptoms in breast cancer survivors. The authors of this report conducted a systematic review of studies published between 1990 and 2010 to describe the prevalence and severity of urinary symptoms in breast cancer survivors. In total, 16 eligible studies that involved >2500 women were identified. The studies varied with respect to purpose, design, and nature of the samples included; the majority used the same definition and assessment approach for urinary symptoms. Prevalence rates for symptoms ranged from 12% of women reporting burning or pain on micturition to 58% reporting difficulty with bladder control. Although, in many studies, the largest percentage of women rated symptoms as mild, 23% reported severe symptoms. Symptoms appeared to adversely affect women's quality of life. The authors concluded that there is a need for additional research assessing the natural history of urinary symptoms using consensus definitions and validated measures in diverse populations. Nevertheless, this review suggested that clinicians should screen for urinary symptoms in breast cancer survivors and should offer treatment recommendations or make referrals as appropriate. [ABSTRACT FROM AUTHOR]

Background: Falls are a leading cause of injury in older adults. Obtaining cost data for a randomized controlled trial aimed at preventing falls was problematic, and an approach was needed to obtain these data on a relatively small sample of women who used healthcare services.Approach: The study population was 272 community-dwelling women aged 70 and over who were participants in a fall prevention trial. Fall incident reports and billing records were used to obtain costs associated with outpatient visits, emergency department visits, acute care hospitalizations, nursing home stays, home healthcare visits, rehabilitation visits, and ambulance use. Average time and costs for obtaining fall-related healthcare cost data also were estimated.Results: The mean age of those with falls requiring healthcare utilization was 78.9 years (SD = 5.1 years). Billing records were obtained for 47 of 55 injurious falls (85%). Costs ranged from $63 to $85,984, with a mean cost of $6,606 and a median cost of $658 per fall-related injurious event. The average time it took to collect the data was just over 5 hr per fall, with an estimated data collection cost of $170 per fall.Discussion: The mean cost of falls was higher than seen in other studies, although methods differ. Collecting cost data related to a specific fall injury event directly from study participants was feasible, practical, and relatively inexpensive. Direct costs of injurious falls are greater than have been estimated in previous studies. [ABSTRACT FROM AUTHOR]

The article reflects on the editorial "The Problem of Incontinence," by James P. Smith, published in the 1982 issue of the "Journal of Advanced Nursing." It provides an overview of the editorial. It mentions research techniques on incontinence in aging adults. The article also proposes ways to improve nursing care for incontinence.

Background: Bladder health encompasses total bladder well-being and not merely the absence of urinary symptoms. While much is known about the prevalence of urinary symptoms in women, little is known about the distribution of bladder health (e.g., optimal to poor)., Objective: We report the distributions of multiple dimensions of bladder health and function in a population-based sample of community-dwelling women, overall and separately in women without urinary symptoms to begin to explore bladder health dimensions that may precede the onset of symptoms., Study Design: RISE FOR HEALTH is a regionally-representative cohort study of US women aged 18 and older. Baseline surveys included the validated Bladder Health Scales/Bladder Function Indices, the 10-item Symptoms of Lower Urinary Tract Dysfunction Research Network Symptom Index, and additional study items. Bladder well-being was assessed across 10 scales and bladder function across six indices. Bladder Health Scale scores were adjusted for adaptive/coping behaviors (e.g., using/carrying pads, staying close to a toilet) to account for the perceived impact of urinary symptoms on well-being. Scores for scales and indices ranged from 0 (poor well-being/function) to 100 (optimal well-being/function). We calculated summary statistics for each scale (with and without adaptive behavior adjustment) and each index in the full study population and subset of women without urinary symptoms., Results: The mean age of 3,027 eligible participants was 49.8 years (SD 17.9). The median global Bladder Health Scale score was 72 (IQR: 56, 84) before adjustment for adaptive/coping behaviors and 55 (IQR: 34, 78) after adjustment. Median scores for the other scales ranged from 75-100 before and 61-72 after adjustment. Sixty-nine percent of participants reported using adaptive/coping behaviors, including using pads (40%), toilet mapping (58%), and staying close to a toilet (3%). The median overall Bladder Function Index score was 77 (IQR: 63, 89); individual median scores ranged from 63-68 for frequency, sensation, continence, and emptying indices to 100 for biosis/urinary tract infection and comfort indices. Among participants without reported urinary symptoms (n=700), scores were higher across all scales (unadjusted medians=88-100 and adjusted medians=82-100) and indices (medians=93-100), indicating better, but not optimal health; however, 38% of asymptomatic women reported using adaptive/coping behaviors: 11% using pads, 30% toilet mapping, and 2% staying close to a toilet., Conclusion: We observed a wide range of bladder well-being and function in RISE participants, and high utilization of adaptive/coping behaviors. Bladder health variability and utilization of adaptive/coping behaviors was also observed in women without urinary symptoms, highlighting bladder health dimensions not captured by traditional urinary symptom tools and potentially identifying a group of women with "sub-clinical" symptoms who may be at greater risk of developing urinary symptoms. Future prospective analyses should investigate this novel group of women further., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Although surveys and apps are available for women to report urination and bladder symptoms, they do not include their decisions regarding toileting. Real-world factors can interfere with toileting decisions, which may then influence bladder health. This premise lacks data per want of a robust data collection tool., Objective: The Prevention of Lower Urinary Tract Symptoms (PLUS) research consortium engaged a transdisciplinary team to build and test WhereIGo, a mobile data collection app for Android and iOS. The design goal was a comprehensive reporting system for capturing environmental, sociocultural, and physical factors that influence women's decisions for toileting. Aims include having (1) an innovative feature for reporting physiologic urge sensation when "thinking about my bladder" and shortly before "I just peed," (2) real-time reporting along with short look-back opportunities, and (3) ease of use anywhere., Methods: The development team included a plain language specialist, a usability specialist, creative designers, programming experts, and PLUS scientific content experts. Both real-time and ecological momentary assessments were used to comprehensively capture influences on toileting decisions including perceived access to toileting, degree of busyness or stress or focus, beverage intake amount, urge degree, or a leakage event. The restriction on the maximal number of taps for any screen was six. PLUS consortium investigators did pilot-testing. Formal usability testing relied on the recruitment of community-dwelling women at four PLUS research sites. Women used the app for 2 consecutive days. Outcome measures were the system usability scale (SUS; 0-100 range) and the functional Mobile Application Rating Scale (1-5 range). These scales were embedded at the end of the app. The estimated a priori sample size needed, considering the SUS cut point score set at ≥74, was 40 women completing the study., Results: Funding was provided by the National Institute of Diabetes and Digestive and Kidney Diseases since July 2015. The integrity of the build process was documented through multiple 5-minute videos presented to PLUS Consortium and through WhereIGo screenshots of the final product. Participants included 44 women, with 41 (93%) completing data collection. Participants ranged in age from 21 to 85 years, were predominantly non-Hispanic White (n=25, 57%), college-educated (n=25, 57%), and with incomes below US $75,000 (n=27, 62%). The SUS score was 78.0 (SE 1.7), which was higher than 75% of the 500 products tested by the SUS developers. The mean functional Mobile Application Rating Scale score was 4.4 (SE 0.08). The build and informal acceptability testing were completed in 2019, enrollment for formal usability testing completed by June 2020, and analysis was completed in 2022., Conclusions: WhereIGo is a novel app with good usability for women to report toileting decisions, urination, and fluid intake. Future research using the app could test the influence of real-time factors on bladder health., International Registered Report Identifier (irrid): RR1-10.2196/54046., (©Janis M Miller, Jean F Wyman, Lawrence An, Haitao Chu, Cynthia S Fok, Missy Lavender, Cora Elizabeth Lewis, Alayne D Markland, Leslie M Rickey, Ying Sheng, Siobhan Sutcliffe, Lisa Kane Low, Elizabeth R Mueller, The Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 18.09.2024.)

Purpose: To examine the validity and usability of a paper log for evaluating exercise duration in older women., Method: Data from 23 females (mean age = 70.4 years) who completed an 8-week pilot randomized controlled trial investigating the effects of yoga and aerobic/strength training on knee osteoarthritis were included in this secondary analysis. Participants were asked to complete a paper log and video recording of their home exercise sessions., Results: Concurrent validity was high between minutes reported on the paper logs and video recordings during Weeks 2 to 7 ( r = 0.878). Usability was high, with participants completing 79% to 91% of paper logs and 74% to 100% of video diaries weekly. Overall minutes reported on the paper exercise logs and video diaries were positively correlated to Physical Activity Scale for the Elderly scores at 8 weeks., Conclusion: Exercise logs are a valid and useful method in assessing adherence to prescribed exercise duration in unsupervised home programs. [ Research in Gerontological Nursing, 17 (5), 219-225.].

Authorship and dissemination policies vary across NIH research consortia. We aimed to describe elements of real-life policies in use by eligible U01 clinical research consortia. Principal investigators of eligible, active U01 clinical research projects identified in the NIH Research Portfolio Online Reporting Tools database shared relevant policies. The characteristics of key policy elements, determined a priori, were reviewed and quantified, when appropriate. Twenty one of 81 research projects met search criteria and provided policies. K elements (e.g., in quotations): "manuscript proposals reviewed and approved by committee" (90%); "guidelines for acknowledgements" (86%); "writing team formation" (71%); "process for final manuscript review and approval" (71%), "responsibilities for lead author" (67%), "guidelines for other types of publications" (67%); "draft manuscript review and approval" (62%); "recommendation for number of members per consortium site" (57%); and "requirement to identify individual contributions in the manuscript" (19%). Authorship/dissemination policies for large team science research projects are highly variable. Creation of an NIH policies repository and accompanying toolkit with model language and recommended key elements could improve comprehensiveness, ethical integrity, and efficiency in team science work while reducing burden and cost on newly funded consortia and directing time and resources to scientific endeavors.

Shared decision-making (SDM) and multidisciplinary team-based care delivery are recommended across several cardiology clinical practice guidelines. However, evidence for benefit and guidance on implementation are limited. Informed consent, the use of patient decision aids, or the documentation of these elements for governmental or societal agencies may be conflated as SDM. SDM is a bidirectional exchange between experts: patients are the experts on their goals, values, and preferences, and clinicians provide their expertise on clinical factors. In this Expert Panel perspective, we review the current state of SDM in team-based cardiovascular care and propose best practice recommendations for multidisciplinary team implementation of SDM., Competing Interests: Dr Perpetua has been a consultant for Edwards Lifesciences and is a consultant for Abbott Vascular. Ms. Palmer is a consultant for Edwards Lifesciences. Dr Beckman is a consultant for Norvartis, Janssen, and JanOne. Dr Keegan is a consultant for Edwards Lifesciences and Abbott Vascular. Dr Guibone is a consultant for Medtronic and Abbott Vascular. Dr Lauck is a consultant for Edwards Lifesciences. Dr Le has received research grant funding from Janssen and is a consultant for 10.13039/100008272Novartis. Dr Lindman is supported by R01AG073633 from the 10.13039/100000002National Institutes of Health and has been a consultant for and received investigator-initiated research grants from 10.13039/100006520Edwards Lifesciences. Dr Wyman has been a consultant for Edwards Lifesciences and Boston Scientific. Dr Gulati has been a consultant for Esperion, Boehringer Ingelheim, and Medtronic. There was no funding support for this expert panel. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2024 The Authors.)

Aims: To describe women's experiences with a range of bladder self-care practices., Design: We conducted a secondary, directed content analysis of qualitative data from the Study of Habits, Attitudes, Realities and Experiences, a multisite focus group study designed to explore adolescent and adult women's experiences, perceptions, beliefs, knowledge and behaviours related to bladder health. This study was conducted by the National Institute of Diabetes and Digestive and Kidney Diseases' Prevention of Lower Urinary Tract Symptoms Research Consortium. Study methods were informed by the Consortium's conceptual framework, based on a social ecological model adapted from Glass and McAtee's Society-Behavior-Biology Nexus., Methods: Participants were recruited at seven geographically diverse United States research centres between July 2017 and April 2018. Data for the current analysis were collected using a semi-structured discussion group with 36 focus groups involving 316 community-dwelling adult women aged 18-93 years. Coded text was re-examined according to eight self-care behavioural domains identified through literature review and expert opinion as potentially influencing bladder health., Results: Participants described many self-care practices they had adopted to prevent bladder problems or manage existing symptoms and conditions. Eight themes were identified: 'Choosing fluids, foods and medications'; 'Dressing for bladder health'; 'Promoting bodily cleanliness'; 'Managing toileting environments'; 'Timing when to void'; 'Exercising pelvic floor muscles for bladder control'; 'Limiting physical activities that challenge the bladder' and 'Staying home and navigating when away'. Thirteen subthemes were derived from five of the eight themes., Conclusion: Women use a broad array of self-care practices related to their bladder health. Research is needed to examine the efficacy of self-care behaviours for preventing or managing bladder symptoms and conditions, and to discern potential risks. Results have important implications for development of bladder health promotion interventions and public health messaging around women's bladder health., Implications for the Profession And/or Patient Care: This study provides a comprehensive framework for understanding women's bladder self-care practices, which can be used by clinicians and public health professionals in designing interventions to promote bladder health and function., Impact: Women with and without lower urinary tract symptoms use a broad range of self-care practices that may affect their bladder health, including some that may be harmful. Because of the high prevalence of bladder symptoms in women, this study may help patient assessment and counselling regarding self-care practices., Reporting Method: This study was reported according to the Standards for Reporting Qualitative Research (SRQR)., Patient or Public Contribution: No patient or public contribution., (© 2024 The Author(s). Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Background: The clinical efficacy and safety of alcohol septal ablation (ASA) for obstructive hypertrophic cardiomyopathy (HCM) have been well-established; however, less is known about outcomes in patients undergoing preemptive ASA before transcatheter mitral valve replacement (TMVR)., Aims: The goal of this study is to characterize the procedural characteristics and examine the clinical outcomes of ASA in both HCM and pre-TMVR., Methods: This retrospective study compared procedural characteristics and outcomes in patient who underwent ASA for HCM and TMVR., Results: In total, 137 patients were included, 86 in the HCM group and 51 in the TMVR group. The intraventricular septal thickness (mean 1.8 vs. 1.2 cm; p < 0.0001) and the pre-ASA LVOT gradient (73.6 vs. 33.8 mmHg; p ≤ 0.001) were higher in the HCM group vs the TMVR group. The mean volume of ethanol injected was higher (mean 2.4 vs. 1.7 cc; p < 0.0001). The average neo-left ventricular outflow tract area increased significantly after ASA in the patients undergoing TMVR (99.2 ± 83.37 mm 2 vs. 196.5 ± 114.55 mm 2 ; p = <0.0001). The HCM group had a greater reduction in the LVOT gradient after ASA vs the TMVR group (49.3 vs. 18 mmHg; p = 0.0040). The primary composite endpoint was higher in the TMVR group versus the HCM group (50.9% vs. 25.6%; p = 0.0404) and had a higher incidence of new permanent pacemaker (PPM) (25.5% vs. 18.6%; p = 0.3402). The TMVR group had a higher rate of all-cause mortality (9.8% vs. 1.2%; p = 0.0268)., Conclusions: Preemptive ASA before TMVR was performed in patients with higher degree of clinical comorbidities, and correspondingly is associated with worse short-term clinical outcomes in comparison to ASA for HCM patients. ASA before TMVR enabled percutaneous mitral interventions in a small but significant minority of patients that would have otherwise been excluded. The degree of LVOT and neoLVOT area increase is significant and predictable., (© 2024 Wiley Periodicals LLC.)

Background: There is no clear consensus regarding the optimal risk stratification of high-degree atrioventricular block (HDAVB) after transcatheter aortic valve replacement (TAVR)., Methods: This prospective study sought to determine the utility of the pre- and post-TAVR His-ventricular (HV) interval in the risk stratification of post-TAVR HDAVB. One hundred twenty-one patients underwent an electrophysiology study before and after TAVR. The primary outcome was HDAVB requiring pacemaker implantation within 30 days post-TAVR. A separate retrospective cohort was analyzed to determine the postoperative interval at which the risk of HDAVB is reduced to <5%., Results: HDAVB occurred in 12 (10%) patients. Baseline right bundle branch block (RBBB) (odds ratio [OR]: 13.6), implant depth >4 mm (OR: 3.9), use of mechanically- or self-expanding valves (OR: 6.3), and post-TAVR HV > 65 ​ms (OR: 4.9) were associated with increased risk of HDAVB, whereas PR intervals and pre-TAVR HV were not. In patients without baseline RBBB or new persistent left bundle branch block (LBBB), not one patient with post-TAVR HV < 65 ​ms developed HDAVB. In the separate retrospective cohort (N = 1049), the risk of HDAVB is reduced (<5%) on postoperative days 4 and 3 in patients with pre-TAVR RBBB and post-TAVR persistent LBBB, respectively., Conclusions: Baseline RBBB, new persistent LBBB, implant depth >4 mm, and a post-TAVR HV ≥ 65 ​ms were associated with a higher risk of post-TAVR HDAVB, whereas an HV ≤ 65 ​ms was associated with a lower risk. The pre-TAVR HV was not associated with our outcome, and the delta HV did not have practical incremental prognostic value. Among those without pre-TAVR RBBB or post-TAVR persistent LBBB, no patients with post-TAVR HV < 65 ​ms developed HDAVB., Competing Interests: P. Villablanca is a consultant for Edwards LifeSciences and Teleflex. D. D. Wang is a consultant for Abbott, Boston Scientific, and Edwards LifeSciences. D. D. Wang receives research grant support from Boston Scientific assigned to her employer, Henry Ford Health. B. O'Neill is a consultant to Abbott, Edwards LifeSciences, and Medtronic and receives research support from Edwards LifeSciences assigned to his employer, Henry Ford Health. T. Frisoli is a clinical proctor for Edwards Lifesciences, Abbott, Boston Scientific, and Medtronic. W. O'Neill is a consultant to Abiomed, Medtronic, and Boston Scientific. The other authors had no conflicts to declare., (© 2024 Published by Elsevier Inc. on behalf of Cardiovascular Research Foundation.)

Importance: Despite guidelines that recommend physical activity (PA), little is known about which types of behavior change strategies (BCSs) effectively promote sustained increases in PA in older adults who are insufficiently active., Objective: To determine whether intrapersonal BCSs (eg, goal setting) or interpersonal BCSs (eg, peer-to-peer sharing or learning) combined with the Otago Exercise Program (17 strength and balance exercises and a walking program that are learned and individually tailored, with instruction to perform 3 times per week at home or location of choice) and a wearable PA monitor help older adults sustain increases in their PA., Design, Setting, and Participants: This 2 × 2 factorial randomized clinical trial (Community-Based Intervention Effects on Older Adults' Physical Activity) of community-dwelling older adults 70 years or older with PA levels below minimum national PA guidelines was conducted in urban community centers. Dates of enrollment were from November 17, 2017, to June 15, 2021, with final follow-up assessments completed on September 2, 2022., Interventions: Participants were randomized to intrapersonal (eg, goal setting) BCSs, interpersonal (eg, problem-solving with peer-to-peer sharing and learning) BCSs, intrapersonal and interpersonal BCSs, or an attention control group. All interventions included a PA monitor and 8 weekly small-group meetings with discussion, practice, and instructions to implement the exercise program and relevant BCSs independently between meetings and after the intervention., Main Outcomes and Measures: The primary outcome was daily minutes of objectively measured total PA (light, moderate, or vigorous intensities) averaged over 7 to 10 days, measured at baseline and after the intervention at 1 week, 6 months, and 12 months., Results: Among 309 participants (mean [SD] age, 77.4 [5.0] years; 240 women [77.7%]), 305 (98.7%) completed the intervention, and 302 (97.7%) had complete data. Participants receiving PA interventions with interpersonal BCS components exhibited greater increases in total PA than did those who did not at 1 week (204 vs 177 PA minutes per day; adjusted difference, 27.1 [95% CI, 17.2-37.0]; P < .001), 6 months (195 vs 175 PA minutes per day; adjusted difference, 20.8 [95% CI, 10.0-31.6]; P < .001), and 12 months (195 vs 168 PA minutes per day; adjusted difference, 27.5 [95% CI, 16.2-38.8]; P < .001) after the intervention. Compared with participants who did not receive interventions with intrapersonal BCS components, participants who received intrapersonal BCSs exhibited no significant changes in total PA at 1 week (192 vs 190 PA minutes per day; adjusted difference, 1.8 [95% CI, -8.6 to 12.2]; P = .73), 6 months (183 vs 187 PA minutes per day; adjusted difference, -3.9 [95% CI, -15.0 to 7.1]; P = .49), or 12 months (177 vs 186 PA minutes per day; adjusted difference, -8.8 [95% CI, -20.5 to 2.9]; P = .14) after the intervention. Interactions between intrapersonal and interpersonal BCSs were not significant., Conclusions and Relevance: In this randomized clinical trial, older adults with low levels of PA who received interpersonal BCSs, the exercise program, and a PA monitor exhibited significant increases in their PA for up to 12 months after the intervention. Intrapersonal BCSs elicited no significant PA changes and did not interact with interpersonal BCSs. Our findings suggest that because effects of a PA intervention on sustained increases in older adults' PA were augmented with interpersonal but not intrapersonal BCSs, approaches to disseminating and implementing the intervention should be considered., Trial Registration: ClinicalTrials.gov Identifier: NCT03326141.

To examine whether psychosocial needs in diabetes care are associated with carbohydrate counting and if carbohydrate counting is associated with satisfaction with diabetes applications' usability, a randomized crossover trial of 92 adults with type 1 or 2 diabetes requiring insulin therapy tested two top-rated diabetes applications, mySugr and OnTrack Diabetes. Survey responses on demographics, psychosocial needs (perceived competence, autonomy, and connectivity), carbohydrate-counting frequency, and application satisfaction were modeled using mixed-effect linear regressions to test associations. Participants ranged between 19 and 74 years old (mean, 54 years) and predominantly had type 2 diabetes (70%). Among the three tested domains of psychosocial needs, only competence-not autonomy or connectivity-was found to be associated with carbohydrate-counting frequency. No association between carbohydrate-counting behavior and application satisfaction was found. In conclusion, perceived competence in diabetes care is an important factor in carbohydrate counting; clinicians may improve adherence to carbohydrate counting with strategies designed to improve perceived competence. Carbohydrate-counting behavior is complex; its impact on patient satisfaction of diabetes application usability is multifactorial and warrants consideration of patient demographics such as sex as well as application features for automated carbohydrate counting., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Despite evidence that regular physical activity (PA) among older adults confers numerous health and functional benefits, PA participation rates are low. Using commercially available wearable PA monitors (PAMs) is one way to augment PA promotion efforts. However, while expert recommendations exist for the specific information needed at the beginning of PAM ownership and the general ongoing need for structures that support as-needed technical troubleshooting, information is lacking about the type, frequency, and modes of assistance needed during initial and long-term ownership., Objective: This paper describes problems reported and technical assistance received by older adults who used PAMs during the 18 months they participated in a community-based PA trial: Ready Steady 3.0 (RS3)., Methods: This was an ad-hoc longitudinal analysis of process variables representing technical problems reported and assistance received by 113 RS3 study participants in the 18 months after their orientation to PAMs. Variables included date of contact, problem(s) reported, mode of technical assistance, and whether the equipment was replaced. The descriptive analysis included frequencies and incidence rates of distinct contacts, types of problems, and technical assistance modes., Results: On average, participants were aged 77 (SD 5.2) years. Most identified as female (n=87, 77%), reported experience using smartphones (n=92, 81.4%), and used the PAM between 2 and 18 months. Eighty-two participants (72.6%) reported between 1 to 9 problems with using PAMs, resulting in a total of 150 technical assistance contacts with a mean of 1.3 (SD 1.3) contacts. The incidence rate of new, distinct contacts for technical assistance was 99 per 100 persons per year from 2018 to 2021. The most common problems were wearing the PAM (n=43, 28.7%), reading its display (n=23, 15.3%), logging into its app (n=20, 13.3%), charging it (n=18, 12%), and synchronizing it to the app (n=16, 10.7%). The modalities of technical assistance were in person (n=53, 35.3%), by telephone (n=51, 34%), by email (n=25, 16.7%), and by postal mail (n=21, 14%)., Conclusions: In general, the results of this study show that after receiving orientation to PAMs, problems such as uncomfortable wristbands, difficulty using the PAM or its related app, and obtaining or interpreting relevant personal data were occasionally reported by participants in RS3. Trained staff helped participants troubleshoot and solve these technical problems primarily in person or by phone. Results also underscore the importance of involving older adults in the design, usability testing, and supportive material development processes to prevent technical problems for the initial and ongoing use of PAMs. Clinicians and researchers should further assess technical assistance needed by older adults, accounting for variations in PAM models and wear time, while investigating additional assistance strategies, such as proactive support, short GIF videos, and video calls., (© Elizabeth A Choma, Shannon Hayes, Beth A Lewis, Jean F Wyman, Alexander J Rothman, Weihua Guan, Siobhan K McMahon. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org).)

Over the last few decades, there have been dramatic advances in the understanding of the mechanisms of valvular heart disease and development of percutaneous treatment options. These innovations have resulted in the need for a multidisciplinary heart team approach for quality patient outcomes, a team in which nursing is an integral member. This update provides an overview of the major valve diseases, current guideline recommendations, catheter-based treatment options and key elements of nursing care: physical examination, diagnostic testing, pre- and post-procedure care protocols, and patient education elements., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Specifications of what and how much health behavior change (BC) content within research interventions are needed to advance BC science, its implementation, and dissemination. We analyzed the types and dosages of the smallest potentially active BC ingredients and associated behavioral prescriptions intended to be delivered in an ongoing physical activity optimization trial for older adults (Ready Steady 3.0 [RS3]). We defined BC types as behavior change techniques (BCT) and behavioral prescriptions. Our protocol integrated the BCT Taxonomy coding procedures with BCT roles (primary or secondary) and, when relevant, linkages to behavioral prescriptions. Primary BCTs targeted theoretical mechanisms of action, whereas secondary BCTs supported primary BCT delivery. Behavioral prescriptions represented what participants were encouraged to do with each primary BCT in RS3 (ascertain, practice, implement). We assessed dosage parameters of duration, frequency, and amount in each BCT and prescription. Results provided a catalog of in-depth, multidimensional content specifications with 12 primary BCTs, each supported by 2-7 secondary BCTs, with dosages ranging from 2 to 8 weeks, 1 to 8 contacts, and 5 to 451 minutes. Minutes spent on behavioral prescriptions varied: ascertain (1 to 41), practice (5 to 315), and implement (0 to 38). Results can be organized and summarized in varied ways (e.g., by content component) to strengthen future assessments of RS3 fidelity and intervention refinement. Results highlight potential benefits of this early, integrated approach to analyzing BC content and frames questions about how such information might be incorporated and disseminated with reporting research outcomes., (© The Author(s) 2023. Published by Oxford University Press on behalf of the Society of Behavioral Medicine.)

Introduction: The spectrum of bladder health and the factors that promote bladder health and prevent lower urinary tract symptoms (LUTS) among women are not well understood. This manuscript describes the rationale, aims, study design, sampling strategy, and data collection for the RISE FOR HEALTH (RISE) study, a novel study of bladder health in women conducted by the Prevention of Lower Urinary Tract Symptom (PLUS) Research Consortium., Methods and Results: RISE is a population-based, multicenter, prospective longitudinal cohort study of community-dwelling, English- and Spanish-speaking adult women based in the United States. Its goal is to inform the distribution of bladder health and the individual factors (biologic, behavioral, and psychosocial) and multilevel factors (interpersonal, institutional, community, and societal) that promote bladder health and/or prevent LUTS in women across the life course. Key study development activities included the: (1) development of a conceptual framework and philosophy to guide subsequent activities, (2) creation of a study design and sampling strategy, prioritizing diversity, equity, and inclusion, and (3) selection and development of data collection components. Community members and cross-cultural experts shaped and ensured the appropriateness of all study procedures and materials. RISE participants will be selected by simple random sampling of individuals identified by a marketing database who reside in the 50 counties surrounding nine PLUS clinical research centers. Participants will complete self-administered surveys at baseline (mailed paper or electronic) to capture bladder health and LUTS, knowledge about bladder health, and factors hypothesized to promote bladder health and prevent LUTS. A subset of participants will complete an in-person assessment to augment data with objective measures including urogenital microbiome specimens. Initial longitudinal follow-up is planned at 1 year., Discussion: Findings from RISE will begin to build the necessary evidence base to support much-needed, new bladder health promotion and LUTS prevention interventions in women., (© 2022 Wiley Periodicals LLC.)

Introduction: Few instruments measure knowledge, attitudes, and beliefs (KAB) related to bladder health. Existing questionnaires have predominantly focused on KAB related to specific conditions such as urinary incontinence, overactive bladder, and other pelvic floor disorders. To address this literature gap, the Prevention of Lower Urinary Tract Symptoms (PLUS) research consortium developed an instrument that is being administered in the baseline assessment of the PLUS RISE FOR HEALTH longitudinal study., Methods: The bladder health knowledge, attitudes, and beliefs (BH-KAB) instrument development process consisted of two phases, item development and evaluation. Item development was guided by a conceptual framework, review of existing KAB instruments, and a review of qualitative data from the PLUS consortium Study of Habits, Attitudes, Realities, and Experiences (SHARE). Evaluation comprised three methods to assess content validity and reduce and refine items: q-sort, e-panel survey, and cognitive interviews., Results: The final 18-item BH-KAB instrument assesses self-reported bladder knowledge; perceptions of bladder function, anatomy, and related medical conditions; attitudes toward different patterns of fluid intake, voiding, and nocturia; the potential to prevent or treat urinary tract infections and incontinence; and the impact of pregnancy and pelvic muscle exercises on bladder health., Conclusion: The PLUS BH-KAB instrument may be used independently or in conjunction with other KAB instruments for a more comprehensive assessment of women's KAB related to bladder health. The BH-KAB instrument can inform clinical conversations, health education programming, and research examining potential determinants of bladder health, LUTS, and related behavioral habits (e.g., toileting, fluid intake, pelvic muscle exercises)., (© 2023 Wiley Periodicals LLC.)

Objectives: To describe the methods for the in-person musculoskeletal (MSK) assessment of the RISE FOR HEALTH (RISE) study, a population-based multicenter prospective cohort study designed to identify factors associated with bladder health (BH) conducted by the Prevention of Lower Urinary Tract Symptoms Research Consortium (PLUS)., Methods: A subset of RISE participants who express interest in the in-person assessment are screened to ensure eligibility (planned n = 525). Eligible consenting participants are asked to complete a standardized MSK assessment to evaluate core stability (four component core stability test, lumbar spine pain (seated slump test), pelvic girdle pain, (sacroiliac joint, anterior superior iliac spine, pubic symphysis tenderness, and pelvic girdle pain provocation test), hip pain (flexion, abduction, internal rotation and flexion, adduction and external rotation) and pelvic girdle function (active straight leg raise). Participants are also asked to complete the Short Physical Performance Battery to measure balance, gait speed, lower extremity strength, and functional capacity., Results: Detailed online and in-person MSK training sessions led by physical therapy were used to certify research staff at each clinical center before the start of RISE in-person assessments. All evaluators exceeded the pre-specified pass rates., Conclusions: The RISE in-person MSK assessment will provide further insight into the role of general body MSK health and dysfunction and the spectrum of BH., (© 2022 Wiley Periodicals LLC.)

Introduction: The prevalence of healthy bladder storage and emptying function in community-dwelling women is not well established., Methods: A planned secondary analysis of a US cross-sectional study designed to validate a bladder health instrument was conducted in women aged ≥18 years. A subset was invited to complete the novel 2-day bladder health diary capturing bladder storage and emptying experiences. Overall healthy bladder function was defined as ≤8 waking/daytime voids and ≤1 void during sleeping/nighttime; along with the absence of leakage, urgency, emptying difficulties (initiation, flow, efficacy, relief of urge sensation) and pain. Descriptive statistics of healthy bladder functions and regression models of factors associated with healthy function are reported., Results: Of the 383 invited, 237 (62%) eligible women returned complete dairies. Of these, 12% (29/237) met criteria for overall healthy bladder function. Most (96%) denied pain, 74% had healthy daytime and 83% had healthy nighttime voiding frequency, 64% were continent, 36% reported healthy emptying and 30% denied any urgency episodes. Middle income (odds ratio [OR]:95% confidence interval [CI] = 11.4:1.9-67.4 for $75k-$99 999 vs. $25 000-$49 999), Graduate education (4.8:1.4-17) and previously seeking treatment for bladder problems (OR:95%CI = 0.1; 0-0.9) were associated with overall healthy function., Conclusion: The prevalence of overall healthy bladder function was very low based on our strict definition of health as measured on a 2-day diary. However, most women had healthy voiding frequency and denied pain or urinary leakage. Postvoid dribbling and urgency most commonly contributed to an overall unhealthy bladder. Further investigation is needed to determine whether these diary derived measures are meaningful for patient-oriented bladder health research., (© 2023 Wiley Periodicals LLC.)

Background: Using a diabetes app can improve glycemic control; however, the use of diabetes apps is low, possibly due to design issues that affect patient motivation., Objective: This study aimed to describes how adults with diabetes requiring insulin perceive diabetes apps based on 3 key psychological needs (competence, autonomy, and connectivity) described by the Self-Determination Theory (SDT) on motivation., Methods: This was a qualitative analysis of data collected during a crossover randomized laboratory trial (N=92) testing 2 diabetes apps. Data sources included (1) observations during app testing and (2) survey responses on desired app features. Guided by the SDT, coding categories included app functions that could address psychological needs for motivation in self-management: competence, autonomy, and connectivity., Results: Patients described design features that addressed needs for competence, autonomy, and connectivity. To promote competence, electronic data recording and analysis should help patients track and understand blood glucose (BG) results necessary for planning behavior changes. To promote autonomy, BG trend analysis should empower patients to set safe and practical personalized behavioral goals based on time and the day of the week. To promote connectivity, app email or messaging function could share data reports and communicate with others on self-management advice. Additional themes that emerged are the top general app designs to promote positive user experience: patient-friendly; automatic features of data upload; voice recognition to eliminate typing data; alert or reminder on self-management activities; and app interactivity of a sound, message, or emoji change in response to keeping or not keeping BG in the target range., Conclusions: The application of the SDT was useful in identifying motivational app designs that address the psychological needs of competence, autonomy, and connectivity. User-centered design concepts, such as being patient-friendly, differ from the SDT because patients need a positive user experience (ie, a technology need). Patients want engaging diabetes apps that go beyond data input and output. Apps should be easy to use, provide personalized analysis reports, be interactive to affirm positive behaviors, facilitate data sharing, and support patient-clinician communication., (©Helen N C Fu, Jean F Wyman, Cynthia J Peden-McAlpine, Claire Burke Draucker, Titus Schleyer, Terrence J Adam. Originally published in JMIR Diabetes (https://diabetes.jmir.org), 24.02.2023.)

Cardiovascular multidisciplinary heart teams (MDHTs) have evolved significantly over the past decade. These teams play a central role in the treatment of a wide array of cardiovascular diseases affecting interventional cardiology, cardiac surgery, interventional imaging, advanced heart failure, adult congenital heart disease, cardio-oncology, and cardio-obstetrics. To meet the specific needs of both patients and heart programs, the composition and function of cardiovascular MDHTs have had to adapt and evolve. Although lessons have been learned from multidisciplinary cancer care, best practices for the operation of cardiovascular MDHTs have yet to be defined, and the evidence base supporting their effectiveness is limited. This expert panel review discusses the history and evolution of cardiovascular MDHTs, their composition and role in treating patients across a broad spectrum of disciplines, basic tenets for successful operation, and the future challenges facing them., Competing Interests: Dr Batchelor has received institutional research grant support from Abbott and Boston Scientific; and is a consultant for Abbott, Medtronic, Edwards, V-Wave Medical, and Boston Scientific. Dr Anwaruddin is a consultant/proctor/advisory board member at Medtronic; proctor at Edwards; on the steering committee of Boston Scientific; on the advisory board of OpSens; and has equity in East End Medical. Dr Wang is a consultant at Edwards Lifesciences, Boston Scientific, Abbott, and Neochord; and has received institutional research grant support from Boston scientific. Dr Velugapudi is on the Speakers Bureau of Abiomed and Opsens; and is on the advisory board of Women’s Health Initiative. Ms Wyman is a consultant at Edwards Lifesciences and Boston Scientific. Ms Perpetua is a consultant at Abbott and Edwards; and is on the advisory board of Abbott. Dr Maini has equity in East End Medical; is on the advisory board of Boston Scientific, Abbott, and Medtronic; is on the Speakers Bureau of Boston Scientific, Abbott, and Medtronic; and has received proctorship honoraria from Boston Scientific, Abbott, and Medtronic. Dr Mack is a co-principal investigator/study chair (no renumeration) for Abbott, Edwards Lifesciences, and Medtronic. Dr Leon is on the advisory board (no renumeration) of Abbott, BSC, MDT, Edwards, Gore, and Venus Medtech. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2023 The Authors.)

Background: Mentored research career development programs are excellent training opportunities for junior faculty/early-stage investigators to transition into independent research careers. However, there is limited evidence that provides guidance on best practices for measuring the impact and reach of these programs, both for individual Scholars and the program as a whole. This article evaluates both the individual and overall impact of the Building Interdisciplinary Research Careers in Women's Health (BIRCWH) National Institutes of Health research career development award at the University of Minnesota. Materials and Methods: BIRCWH Scholars ( n  = 16) and a comparison group ( n  = 17) were evaluated on traditional metrics ( e.g. , publications, grant funding) in addition to bibliometrics ( e.g. , network growth, interdisciplinary collaborations, international reach, policy impact). Results: Traditional metric findings showed that BIRCWH Scholars had significantly more publications from pre- to post-BIRCWH experience than the comparison group and more grant funding. Bibliometric findings showed exponential network growth, interdisciplinary collaborations, international citations, and policy impact from pre- to post-BIRCWH Scholar experience. Conclusion: Findings from this evaluation have potential important implications. At the Scholar level, the results can be used to provide evidence of research impact in materials developed for merit review and promotion as well as in job and research grant applications. At the program level, the results can be used at the institutional level to gain broad administrative support and leverage additional funds for program activities and for evidence of program success for continuation funding from federal agencies.

Purpose of Review: The goal of this manuscript is to review the current literature on bladder health education, summarize P revention of L ower U rinary Tract S ymptoms (PLUS) [50] findings on environmental factors that influence knowledge and beliefs about toileting and bladder function, and describe how PLUS work will contribute to improved understanding of women's bladder-related knowledge and inform prevention intervention strategies., Recent Findings: Analysis of focus group transcripts revealed the various ways women view, experience, and describe bladder function. In the absence of formal bladder health educational platforms, women appear to develop knowledge of normal and abnormal bladder function from a variety of social processes including environmental cues and interpersonal sources. Importantly, focus group participants expressed frustration with the absence of structured bladder education to inform knowledge and practices., Summary: There is a lack of bladder health educational programming in the USA, and it is unknown to what degree women's knowledge, attitudes, and beliefs influence their risk of developing lower urinary tract symptoms (LUTS). The PLUS Consortium RISE FOR HEALTH study will estimate the prevalence of bladder health in adult women and assess risk and protective factors. A Knowledge, Attitudes, and Beliefs (KAB) questionnaire will be administered to determine KAB around bladder function, toileting, and bladder-related behaviors, and examine the relationship of KAB to bladder health and LUTS. The data generated from PLUS studies will identify opportunities for educational strategies to improve bladder health promotion and well-being across the life course., Competing Interests: Conflict of Interest S.S. Brady reports grants from 1 U24DK106786, during the conduct of the study. B.R Williams reports grants from NIH-NIDDK, during the conduct of the study. J.F. Wyman reports grants from National Institutes of Diabetes and Digestive and Kidney Disorders/National Institutes of Health, during the conduct of the study. A.S. James reports grants from NIH, during the conduct of the study; grants from NCI, outside the submitted work. M.A. Brault reports grant K01TW011480 from the Fogarty International Center at NIH, outside the submitted work. L.M. Rickey, D.R. Camenga, A.L. Smith, D.Y. LaCoursiere, M.D. Lavender, and L.K. Low declare that they have no conflict of interest. Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium declare no conflict of interest.

Background: Limited information on the normal range of urination frequencies in women is available to guide bladder health promotion efforts., Objectives: This study used data from the Boston Area Community Health (BACH) Survey to (a) estimate normative reference ranges in daytime and nighttime urination frequencies in healthy women based on two operational definitions of "healthy" and (b) compare urination frequencies by age, race/ethnicity, and fluid intake., Methods: A secondary analysis of cross-sectional interview data collected from female participants was performed using less restrictive ("healthy") and strict ("elite healthy") inclusion criteria. All analyses were weighted to account for the BACH sampling design. Normative reference values corresponding to the middle 95% of the distribution of daytime and nighttime urination frequencies were calculated overall and stratified by age, race/ethnicity, and fluid intake. Generalized linear regression with a log-link was used to estimate rate ratios of daytime and nighttime urination frequencies by age, race/ethnicity, and fluid intake., Results: Of the 2,534 women who completed the BACH follow-up interviews, 1,505 women met healthy eligibility criteria, and 300 met elite healthy criteria. Overall, reference ranges for urination frequencies were 2-10 times/day and 0-4 times/night in healthy women and 2-9 times/day and 0-2 times/night in elite healthy women. Women ages 45-64 years, but not 65+ years, reported a greater number of daytime urination than those aged 31-44 years, whereas women 65+ years reported a greater number of nighttime urination. Black women reported fewer daytime urination and more nighttime urinations than White women. Women who consumed less than 49 oz daily reported fewer daytime and nighttime urinations than those who drank 50-74 oz; drinking 75+ oz had only a small effect on urination frequencies., Discussion: Normative reference values for daytime and nighttime urination frequencies were similar in women using strict and relaxed definitions of health. These results indicate a wide range of "normal" urination frequencies, with some differences by age, race/ethnicity, and fluid intake. Future research is needed to examine urination frequencies in minority women and whether fluid intake amount and type influence the development of lower urinary tract symptoms., Competing Interests: The authors have no conflicts of interest to report., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Recruiting older adults with Alzheimer's disease (AD) dementia into clinical trials is challenging requiring multiple approaches. We describe recruitment and screening processes and results from the Functional Improvement from Aerobic Training in Alzheimer's Disease study (FIT-AD Trial), a single-site, pilot randomized controlled trial testing the effects of a 6-month aerobic exercise intervention on cognition and hippocampal volume in community-dwelling older adults with mild-to-moderate AD dementia., Methods: Ten recruitment strategies and a 4-step screening process were used to ensure a homogenous sample and exercise safety. The initial target sample was 90 participants over 48 months which was increased to 96 to allow those in the screening process to enroll if qualified. A tertiary analysis of recruitment and screening rates, recruitment yields and costs, and demographic characteristics of participants was conducted., Results: During the 48-month recruiting period, 396 potential participants responded to recruitment efforts, 301 individuals were reached and 103 were tentatively qualified. Of these, 67 (69.8%) participants completed the optional magnetic resonance imaging and 7 were excluded due to abnormal magnetic resonance imaging findings. As a result, we enrolled 96 participants with a 2.92 screen ratio, 2.14 recruitment rate, and 31.9% recruitment yield. Referrals (28.1%) and Alzheimer's Association events/services (21.9%) yielded over 49% of the enrolled participants. Total recruitment cost was $38 246 or $398 per randomized participant., Conclusions: A multiprong approach involving extensive community outreach was essential in recruiting older adults with AD dementia into a single-site trial. For every randomized participant, 3 individuals needed to be screened. Referrals were the most cost-effective recruitment strategy. Clinical Trials Registration Number: NCT0194550., (© The Author(s) 2021. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Purpose: An online bladder health survey was administered to national registry volunteers to: (1) determine the feasibility of using ResearchMatch for studying lower urinary tract symptoms (LUTS); (2) pilot the new, comprehensive Lower Urinary Tract Dysfunction Research Network Symptom Index-29 (LURN-SI-29) and determine its ability to detect known associations with LUTS; and (3) explore novel areas of bladder health in community-based women., Methods: A cross-sectional web-based survey was administered to a random sample of ResearchMatch adult female, transgender and non-binary volunteers. Participant demographics, health characteristics, the LURN-SI-29, and LUTS-related experiences were collected., Results: A total of 1725 ReseachMatch volunteers with a mean age of 44.0 years completed the study and were eligible for the analysis. Participants were primarily white, cisgendered, highly educated, nulliparous, and premenopausal. The median LURN-SI-29 score was 17 (interquartile range: 11-26). More than half the sample reported urinary urgency (71.0%), nocturia (65.7%), and stress incontinence (52.3%) a "few times" or more in the last 7 days. Approximately half reported sensation of incomplete bladder emptying (49.6%) with one-third reporting urgency incontinence (37.6%); notably, 52.6% of respondents reported being at least "somewhat" bothered by LUTS. LURN-SI-29 scores increased with age, body mass index, decrements in self-reported health, medical comorbidity, parity, menopausal status, and urinary symptom bother, providing evidence of convergent validity. LURN-SI-29 scores varied by race and education, with the lowest scores in Asian and highly educated women., Conclusion: Overall, the prevalence and spectrum of LUTS in an online research registry of women volunteers were high and comparable to other population-based samples. The new LURN-SI-29 demonstrated its ability to detect expected associations with demographic and health characteristics in a nonclinical population., (© 2022 Wiley Periodicals LLC.)