Vibegron for the treatment of overactive bladder: a comprehensive update.

INTRODUCTION: Overactive bladder (OAB) is associated with physical, emotional, and financial burden. After failed conservative measures, second-line therapy includes medications, such as antimuscarinics and beta-3 adrenergic receptor (ß3AR) agonists. Antimuscarinics are most commonly prescribed but have systemic side effects that lead to poor compliance. ß3AR agonists include mirabegron and vibegron. Mirabegron is a first-generation ß3AR agonist that is effective for frequency, urgency urinary incontinence (UUI) and urgency, but has interactions with cytochrome P450 enzymes (CYPs) and cardiovascular sequelae. Vibegron is a second-generation ß3AR agonist that is highly selective and does not interact with CYPs. It is effective for reducing UUI episodes and daily micturition number and has a favorable side effect profile. AREAS COVERED: Clinical background, pharmacology, and clinical studies for vibegron. EXPERT OPINION: Vibegron is a welcomed addition to the OAB therapeutic landscape. This single dose, once daily option is effective, especially for patients with wet OAB, with a favorable side effect profile. Sub-analyses of patients ≥ 65 years have shown continued efficacy and safety. The few drug interactions are of benefit, especially for older patients with polypharmacy. As long-term data accrues, vibegron has the potential to drive the OAB therapeutic market.

Urinary magnesium, calcium, and phosphate excretion during magnesium sulfate infusion.

Urinary excretion of magnesium, calcium, and phosphate was measured in 20 preeclamptic pregnant women treated with intravenous magnesium sulfate. Blood levels of these substances, as well as of parathyroid hormone and calcitonin, were also measured. Urinary magnesium excretion increased 20-fold during magnesium sulfate infusion. Seventy-five percent of the infused magnesium was excreted during the infusion, and 90% within 24 hours after treatment. Urinary calcium concentration increased 4.5-fold during magnesium sulfate infusion, and the urinary calcium excretion rate was 3 times that observed in controls. Urinary phosphate concentration and excretion rate were the same in treated and control subjects. During treatment, maternal serum total calcium fell 25%, ionized calcium fell 12%, and parathyroid hormone rose 26%. Magnesium sulfate therapy depresses maternal calcium levels by increasing urinary calcium loss, and increased parathyroid hormone output prevents more marked hypocalcemia.

The proper focus of nursing: a critique of the "caring" ideology.

Some nurse educators in the United Kingdom are following the lead of North American theorists by asserting that caring "is" the core of nursing. This paper offers a focused critique of the caring ideology, through an examination of: (a) the views of a founding figure in the "caring" movement, and (b) a proposal for the integration of a "caring curriculum" within Project 2000. An overview of the "caring" literature prefaces an examination of Watson's notion of a "science of caring". Finally, Kirby and Slevin's recent proposals for a "curriculum of care" are examined in terms of their necessity and practicality.

Clients' reflections on relationships with nurses: comparisons from Canada and Scotland.

It has been suggested that the crucial elements in nursing situations are the nurse, the client, and what goes on between them. This paper examines what goes on between clients and nurses during interpersonal relationships, from the perspective of the clients. Data are presented from studies conducted in Canada and Scotland. It is shown that what clients want, or do not want, during relationships with their nurses, is similar on both sides of the Atlantic. The findings reported in this paper are relevant to transcultural nursing, ethical care, the growth in consumerism, and client advocacy. The findings suggest also that there is a need for nursing research to focus on clinical outcomes in order to establish whether clients' perceptions of helping relationships have any relevance to favourable health outcomes, and the evidence base for clinical nursing.

Putting it all together: dealing with complexity in the understanding of the human condition.

In this paper, two mental health nurses who have experienced long academic careers reflect on the way their own thinking and teaching about the human condition has changed over the course of their careers. Three major paradigms that have attempted to explain the human condition, the biological sciences, psychodynamic theory, and socio-cultural theory, are discussed. It is argued that no single approach is sufficient to address the complexities of providing care within psychiatric and mental health nursing. It is further argued that the integration of these perspectives has not been well considered or articulated in practice. The authors conclude that the arguments presented in this paper are likely to challenge people's loyalties to a particular perspective of the human condition.

Patient centered teaching: a future role for the psychiatric nurse teacher?

It was suggested by Reynolds & Cormack (1982), that psychiatric nursing skills could be taught more realistically, if there was a greater concentration of teaching resources in the clinical areas, in order to make fuller use of the learning opportunities to which learners are exposed. They expressed the view that this was essential in order to clarify the psychiatric nurse's role and to shift the emphasis of psychiatric nurse education away from psychomotor skills to interpersonal skills. This paper describes a trial teaching programme which was designed to gain access to, and utilize, 'live' patient centered teaching opportunities in the clinical area more effectively. It involved the writer and four nurse learners, who were allocated to a long-term ward during a 12-week psychiatric nursing module within a comprehensive modular system of nurse training. The main teaching method involved structured interaction with the patients.

Effect of a randomized, controlled trial of exercise on mood and physical function in individuals with fibromyalgia.

OBJECTIVE: To evaluate the effect of exercise on mood and physical function in individuals with fibromyalgia. METHODS: Subjects were randomly assigned to an exercise (EX) or control (CTL) group. EX subjects participated in 3 30-minute exercise classes per week for 23 weeks. Subjects were tested at entry and at 6, 12, and 23 weeks. Tests included the Beck Depression Inventory (BDI), 6-minute walk, State-Trait Anxiety Inventory (STAI), Mental Health Inventory (MHI), Fibromyalgia Impact Questionnaire (FIQ), Arthritis Self-Efficacy Scale (ASES), and a measure of tender points and knee strength. RESULTS: Fifty subjects (27 EX, 23 CTL) completed the study, and 31 (15 EX, 16 CTL) met criteria for efficacy analyses. In efficacy analyses, significant improvements were seen for EX subjects in 6-minute walk distances, BDI (total, cognitive/ affective), STAI, FIQ, ASES, and MHI (3 of 5 subscales) scores. These effects were reduced but remained during intent-to-treat analyses. CONCLUSION: Exercise can improve the mood and physical function of individuals with fibromyalgia.