The impact of age, gender and severity of overactive bladder wet on quality of life, productivity, treatment patterns and satisfaction

Objective:

The objective of this article is to determine the impact of idiopathic overactive bladder wet (OAB wet) severity, age and gender on health-related quality of life (HRQoL), productivity, treatment patterns and treatment satisfaction.

Materials and methods:

A prospective, cross-sectional online survey of adults in the United Kingdom was performed to screen for self-reported symptoms of OAB wet. Respondents completed the King’s Health Questionnaire or the Incontinence Quality of Life, as well as the Euroqol 5D, and the Work Productivity and Activity Impairment Specific Health Problem questionnaire, and questions pertaining to distress, treatment and treatment satisfaction.

Results:

A total of 249 of 1126 respondents (22.1%) met the criteria for OAB wet. Respondents with moderate/severe OAB wet and all women experienced significantly worse HRQoL and work productivity than those with mild symptoms and all men, respectively. Among all OAB wet responders, 62.7% were receiving treatment for their condition, predominantly pads (40.2%); only 1.6% were receiving specialised treatment. Nearly one-half (44.6%) were somewhat or completely dissatisfied with their current treatment.

Conclusion:

In individuals with OAB wet, severity and gender negatively impact HRQoL and work productivity. A substantial proportion of OAB wet individuals were untreated, and low treatment satisfaction was reported in those receiving treatment. Treatment was generally conservative.

Electromagnetic vortex fields, spin, and spin-orbit interactions in electron vortices

Electron vortices are shown to possess electric and magnetic fields by virtue of their quantized orbital angular momentum and their charge and current density sources. The spatial distributions of these fields are determined for a Bessel electron vortex. It is shown how these fields lead naturally to interactions involving coupling to the spin magnetic moment and spin-orbit interactions which are absent for ordinary electron beams. The orders of magnitude of the effects are estimated here for ȧngström scale electron vortices generated within a typical electron microscope.

Glasgow supported self-management trial (GSuST) for patients with moderate to severe COPD: randomised controlled trial

OBJECTIVE

To determine whether supported self management in chronic obstructive pulmonary disease (COPD) can reduce hospital readmissions in the United Kingdom.

DESIGN

Randomised controlled trial.

SETTING

Community based intervention in the west of Scotland.

PARTICIPANTS

Patients admitted to hospital with acute exacerbation of COPD.

INTERVENTION

Participants in the intervention group were trained to detect and treat exacerbations promptly, with ongoing support for 12 months.

MAIN OUTCOME MEASURES

The primary outcome was hospital readmissions and deaths due to COPD assessed by record linkage of Scottish Morbidity Records; health related quality of life measures were secondary outcomes.

RESULTS

464 patients were randomised, stratified by age, sex, per cent predicted forced expiratory volume in 1 second, recent pulmonary rehabilitation attendance, smoking status, deprivation category of area of residence, and previous COPD admissions. No difference was found in COPD admissions or death (111/232 (48%) v 108/232 (47%); hazard ratio 1.05, 95% confidence interval 0.80 to 1.38). Return of health related quality of life questionnaires was poor (n=265; 57%), so that no useful conclusions could be made from these data. Pre-planned subgroup analysis showed no differential benefit in the primary outcome relating to disease severity or demographic variables. In an exploratory analysis, 42% (75/150) of patients in the intervention group were classified as successful self managers at study exit, from review of appropriateness of use of self management therapy. Predictors of successful self management on stepwise regression were younger age (P=0.012) and living with others (P=0.010). COPD readmissions/deaths were reduced in successful self managers compared with unsuccessful self managers (20/75 (27%) v 51/105 (49%); hazard ratio 0.44, 0.25 to 0.76; P=0.003).

CONCLUSION

Supported self management had no effect on time to first readmission or death with COPD. Exploratory subgroup analysis identified a minority of participants who learnt to self manage; this group had a significantly reduced risk of COPD readmission, were younger, and were more likely to be living with others.

TRIAL REGISTRATION

Clinical trials NCT 00706303.

Comparison of positive lymph node ratio with an inflammation-based prognostic score in colorectal cancer

BACKGROUND

Two prognostic scoring systems have been proposed in colorectal cancer: the pathologically based positive lymph node ratio (pLNR) and the inflammation-based modified Glasgow Prognostic Score (mGPS). This study compared these two scores with the tumour node metastasis (TNM) staging system in terms of cancer survival.

METHODS

Between 2003 and 2005, 206 patients, of mean(s.d.) age 69·9(10·6) (range 40-95) years, underwent curative resection for colorectal cancer in two centres. Age, sex, primary tumour site and whether radio/chemotherapy was given were recorded in addition to the three scores (TNM stage, pLNR and mGPS). Univariable and multivariable analyses of overall survival were performed.

RESULTS

Age, rectal cancer, TNM stage, pLNR and mGPS were significant factors in univariable analysis. On multivariable analysis, N category and tumour stage (I-III) were removed from the model, leaving pLNR and mGPS as independent predictors of overall survival: hazard ratio 1·51 (95 per cent confidence interval 1·24 to 1·84; P < 0·001) and 1·56 (1·18 to 2·08; P = 0·020) respectively. C-statistic analysis, used to compare pLNR and mGPS directly, found only pLNR to be significant (P < 0·001)

CONCLUSION

This study found pLNR to be the superior prognostic scoring system in determining long-term survival in patients undergoing resection for colorectal cancer.

Understanding the experience of prophylactic bilateral mastectomy: a qualitative study of ten women

Prophylactic bilateral mastectomy represents a new and controversial cancer prevention strategy for women at high-risk of familial breast cancer, the psychosocial implications of which are yet to be fully explored. A qualitative methodology was therefore adopted to provide a discovery-orientated study of the perspectives of ten women who had undergone prophylactic mastectomy and the views of eight of their partners. Each participant was interviewed with the aim of exploring the personal experiences of surgery, factors associated with psychological adjustment and the impact on the family. Data were transcribed and systematically analysed using Grounded Theory. Themes emerging from participants' accounts formed seven significant categories that represented women's key experiences: (i) deciding; (ii) telling; (iii) experiencing surgery and recovering; (iv) maintaining womanliness; (v) processing the loss; and (vi) moving on. The importance of the social context in women's experience and difficulties of isolation/eliciting support were also highlighted: (vii) isolation and being supported. A core category of 'Suffering and countering multiple loss' considered central to women's experience, integrated the seven significant categories and provided further conceptualisation of women's experience. Implications for clinical practice are highlighted.

Failure to influence hypotension during spinal anaesthesia with a limb tourniquet

Fourty patients undergoing total hip replacement under spinal anaesthesia were allocated randomly to have a thigh tourniquet inflated after exanguination of the leg not being operated on or to act as controls. Significant hypotension (systolic arterial pressure < 70 mm Hg) was treated with i.v. ephedrine in 6 mg boluses. There was no significant difference between the two groups with respect to systolic blood pressure or requirement of ephedrine, during the hour that the tourniquet was applied or the period immediately after the removal of the tourniquet.

Policy for controlling pain after surgery: effect of sequential changes in management

OBJECTIVE

To observe the effects of introducing an acute pain service to the general surgical wards of a large teaching hospital.

DESIGN

A study in seven stages: (1) an audit of current hospital practice succeeded by the sequential introduction to the general surgical wards of (2) pain assessment charts; (3) an algorithm to allow more frequent use of intramuscular analgesia; (4) increased use of local anaesthetic techniques of wound infiltration and nerve blocks; (5) an information sheet for patients about postoperative pain; (6) the introduction of patient controlled analgesia; (7) a repeat audit of hospital practice. Data were collected on each patient 24 hours after operation.

SETTING

University Hospital of Wales, which has both district general and tertiary referral functions.

PATIENTS

2035 patients over nine months from all surgical specialties (excluding cardiac) at the hospital. General surgical operations were studied in detail and separated into major, intermediate, and minor for data collection.

MAIN OUTCOME MEASURES

A change in the median visual analogue pain scores 24 hours after surgery for pain during relaxation, pain on movement, and pain on deep inspiration at each stage of the study.

RESULTS

There was a reduction in median visual analogue scores during the study. The median (95% confidence interval) scores for pain during relaxation decreased from 45 (34 to 53) in stage 1 to 16 (10 to 20) in stage 7 for major surgical procedures. Pain on movement decreased from 78 (66 to 80) to 46 (38 to 48), and pain on deep inspiration decreased from 64 (48 to 78) to 36 (31 to 38). The reductions in median scores for intermediate and minor operative procedures showed similar patterns.

CONCLUSIONS

The introduction of an acute pain service to the general surgical wards led to considerable improvement in the level of postoperative pain as assessed by visual analogue scores. Simple techniques of regular pain assessment and the more frequent use of intramuscular analgesia as a result of using an algorithm were particularly effective.

Is there still a place for prolonged bladder distension?

Over a 2-year period, 31 patients underwent prolonged hydrostatic bladder distension for benign and malignant bladder disease in this unit. Of these, 29 patients had benign functional disorders or bladder contracture, and in 2 patients hydrodistension was performed for complications of treatment for bladder neoplasia. Of the 29 patients with benign disease, 6 observed marked improvement and 8 some improvement in their symptoms, and 12 received no benefit. Patients with detrusor hypersensitivity fared better than those with detrusor instability or interstitial cystitis. A patient with malignant bladder disease died soon after the procedure as a result of a myocardial infarction. Problems attributed to the hydrostatic balloon catheter were responsible for 2 failures. The regional anaesthetic technique failed to provide adequate anaesthesia for hydrodistension in 9 procedures and limited the duration to 2 h in 13 others. Following recall of the perished balloon catheters by the manufacturer, and the introduction of continuous spinal anaesthesia, the number of technical failures has been reduced. This technique still has an important role to play in the relief of severe symptoms unresponsive to medical treatment, but it is important that ideal conditions are provided for hydrodistension in order to ensure maximum success, particularly when the alternative is major surgery.

Black student enrollment in US medical schools

Blacks represent about 12% of the nation's population, but only 6% of the total medical school enrollment, 5% of medical school graduates, 5% of postgraduate trainees, 3% of physicians in practice, and 2% of medical school faculties. Addressing this underrepresentation of blacks in medicine not only is a matter of justice, equity, and national conscience but also has implications for the provision of quality physician care to this nation's minority and medically underserved populations. Black physicians are more likely to understand the cultural and social context of illness and disability among blacks and are also more likely to be able to communicate effectively with black patients. Black physicians are also more likely to practice in communities whose residents lack adequate access to medical care. An approach to addressing the problem of underrepresentation is proposed, consisting of activities at the precollege, college, and medical school levels.

Subscriber suits: how to avoid them

As HMOs and PROs become more significant elements of the health delivery system, they also become more likely targets for lawsuits. This article identifies twelve major liability risks of these organizations as well as those who provide services to HMOs and PPOs. Also presented are steps that can be taken to help protect against those risks.

Practice patterns of black physicians: results of a survey of Howard University College of Medicine alumni

Over 600 Howard University medical alumni of seven representative classes graduating from 1955 to 1975 were surveyed by questionnaire in 1975 and 1976. Replies of the 252 black respondents confirm that these graduates are providing substantial care to blacks, the economically disadvantaged, and residents of the inner city. Survey findings reaffirm the necessity to train more black physicians and to provide data on current and future practice patterns. Comparisons are made between the practice patterns of earlier (1955 to 1970) and later (1973 to 1975) black graduates. A general bibliography of publications relevant to the practice patterns of black physicians is included.