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1.
Spinal Cord ; 54(1): 73-7, 2016 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-26193812

RESUMEN

STUDY DESIGN: Cost-effectiveness analysisObjective:To establish a model to investigate the cost effectiveness for people with spinal cord injury (SCI), from a lifetime perspective, for the usage of two different single-use catheter designs: hydrophilic-coated (HC) and uncoated (UC). The model includes the long-term sequelae of impaired renal function and urinary tract infection (UTI). SETTING: Analysis based on a UK perspective. METHODS: A probabilistic Markov decision model was constructed, to compare lifetime costs and quality-adjusted life years, taking renal and UTI health states into consideration, as well as other catheter-related events. UTI event rates for the primary data set were based on data from hospital settings to ensure controlled and accurate reporting. A sensitivity analysis was applied to evaluate best- and worst-case scenarios. RESULTS: The model predicts that a 36-year-old SCI patient with chronic urinary retention will live an additional 1.4 years if using HC catheters compared with UC catheters, at an incremental cost of £2100. Moreover, the lifetime number of UTI events will be reduced by 16%. All best- and worst-case estimates were within the UK threshold of being cost effective. CONCLUSION: The use of HC catheters for intermittent catheterisation in SCI patients is highly cost effective. The outcome is consistent irrespective of whether UTI data are collected in hospital or community settings.


Asunto(s)
Análisis Costo-Beneficio , Traumatismos de la Médula Espinal/terapia , Cateterismo Urinario/efectos adversos , Cateterismo Urinario/economía , Infecciones Urinarias , Adulto , Estudios de Cohortes , Conjuntos de Datos como Asunto/estadística & datos numéricos , Diseño de Equipo/economía , Femenino , Humanos , Masculino , Cadenas de Markov , Persona de Mediana Edad , Calidad de Vida , Años de Vida Ajustados por Calidad de Vida , Traumatismos de la Médula Espinal/complicaciones , Traumatismos de la Médula Espinal/mortalidad , Reino Unido , Infecciones Urinarias/economía , Infecciones Urinarias/etiología , Infecciones Urinarias/terapia , Adulto Joven
2.
Spinal Cord ; 53(12): 849-54, 2015 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-26193811

RESUMEN

STUDY DESIGN: Review study. OBJECTIVES: Alternative treatments to oral phosphodiesterase type 5 inhibitors (PDE5Is) in individuals with spinal cord lesions (SCLs) and erectile dysfunction (ED). SETTING: Italy. METHODS: Research clinical trials (1999-2014). RESULTS: Twelve studies were selected. One article documented that 76% of subjects reached satisfactory sexual intercourse (SI) using intracavernosal injection of vasoactive medications (papaverine and prostaglandin E1). One study regarding perineal training showed a significant increase (P<0.05) in penile tumescence in 10 individuals with preserved sacral segment. Two studies reported contrasting results on erectile function (EF) using various dosages of oral fampridine (25-40 mg). Furthermore, 95.1% of patients on fampridine 25 mg experienced drawbacks. Disappointing findings were found with intraurethral alprostadil (125-1000 µg) and sublingual apomorphine 3 mg. Two studies concerning penile prosthesis reported valid SI more than 75% of the time with a mean follow-up of 11 years, although around 15% of individuals showed side effects. As for surgical treatments, 88% of males submitted to Brindley sacral anterior root stimulator after sacral dorsal rhizotomy achieved valid erection up to 8 years following the procedure. Three studies documented the impact of definitive sacral neuromodulation implant (Medtronic, Minneapolis, MN, USA) also on EF. After surgery, 20-37.5% of patients with ED recovered normal EF. CONCLUSIONS: Data are scant on the efficacy of ED treatments for SCL subjects who did not respond to PDE5Is. Further research should investigate the effects of any SCL treatments even when they are not strictly used for neurogenic sexual dysfunction.


Asunto(s)
Disfunción Eréctil/tratamiento farmacológico , Disfunción Eréctil/etiología , Inhibidores de Fosfodiesterasa 5/uso terapéutico , Traumatismos de la Médula Espinal/complicaciones , 4-Aminopiridina/uso terapéutico , Ensayos Clínicos como Asunto/estadística & datos numéricos , Relación Dosis-Respuesta a Droga , Humanos , Estudios Longitudinales , MEDLINE/estadística & datos numéricos , Masculino , Traumatismos de la Médula Espinal/tratamiento farmacológico , Traumatismos de la Médula Espinal/cirugía
3.
Int J Clin Pract ; 68(7): 830-40, 2014 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-24754814

RESUMEN

AIMS: To systematically review dose-escalation data from flexible-dose studies of fesoterodine and summarise factors associated with dose-escalation decisions. METHODS: A PubMed search was conducted using the terms (fesoterodine AND flexible dose), with no limits. Articles were included if they contained fesoterodine dose-escalation data for efficacy or safety outcomes or factors associated with dose-escalation decisions. RESULTS: Of 13 articles identified by the search, 10 articles (six clinical studies) met inclusion criteria. In flexible-dose trials of fesoterodine, 51-63% of subjects initially receiving fesoterodine 4 mg opted for dose escalation to fesoterodine 8 mg. Escalators generally reported significantly more severe overactive bladder (OAB) symptoms, greater OAB symptom bother and worse health-related quality of life at baseline than non-escalators. Escalators demonstrated less treatment benefit with fesoterodine 4 mg than non-escalators. Non-escalators generally had a higher rate of dry mouth and constipation with fesoterodine 4 mg than escalators. The decision to escalate appeared to be determined by the efficacy/tolerability responses; fesoterodine escalators demonstrated a lower sensitivity (less efficacy and fewer adverse events) before their decision to escalate. By study end (8-11 weeks after escalation decision), the efficacy and tolerability profiles were similar in escalators and non-escalators. CONCLUSIONS: Data from flexible-dose studies provide strong evidence that fesoterodine provides treatment benefit to individual subjects with OAB because of its true dose-response effect. In clinical practice, it can be worthwhile to escalate to fesoterodine 8 mg in individual subjects who require additional efficacy benefit.


Asunto(s)
Compuestos de Bencidrilo/administración & dosificación , Antagonistas Muscarínicos/efectos adversos , Vejiga Urinaria Hiperactiva/tratamiento farmacológico , Femenino , Humanos , Masculino , Calidad de Vida , Encuestas y Cuestionarios , Resultado del Tratamiento
4.
Int J Clin Pract ; 68(9): 1165-73, 2014 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-25196247

RESUMEN

Overactive bladder and urgency incontinence are common and distressing conditions in older people, for which the first-line pharmacological treatment is a bladder antimuscarinic agent. Of these, oxybutynin is often recommended in guidelines, but is associated with a higher incidence of adverse drug effects, and in particular has been suggested to have deleterious cognitive effects. Despite this, guidelines often suggest oxybutynin as first-line treatment, and insurance based healthcare systems often require oxybutynin to be used as a first-line therapy and fail before reimbursement for the cost of newer anticholinergics is authorised. We reviewed the literature of bladder antimuscarinics in older adults, using the headings overactive bladder, urinary frequency, urgency, urge, oxybutynin, antimuscarinic, older, older people, and frail. In general, oxybutynin had a similar efficacy to other anticholinergic drugs, but a higher incidence of adverse drug events, in particular significant yet unnoticed cognitive impairment. We conclude that oxybutynin should not be used in frail older people.


Asunto(s)
Anciano Frágil , Vejiga Urinaria Hiperactiva/tratamiento farmacológico , Incontinencia Urinaria/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , Compuestos de Bencidrilo/efectos adversos , Compuestos de Bencidrilo/uso terapéutico , Antagonistas Colinérgicos/uso terapéutico , Cresoles/efectos adversos , Cresoles/uso terapéutico , Humanos , Antagonistas Muscarínicos/efectos adversos , Antagonistas Muscarínicos/uso terapéutico , Fenilpropanolamina/efectos adversos , Fenilpropanolamina/uso terapéutico
5.
Spinal Cord ; 51(9): 700-4, 2013 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-23896666

RESUMEN

OBJECTIVES: To develop an International Spinal Cord Injury (SCI) Urinary Tract Infection (UTI) Basic Data Set presenting a standardized format for the collection and reporting of a minimal amount of information on UTIs in daily practice or research. SETTING: International working group. METHODS: The draft of the Data Set developed by a working group was reviewed by the Executive Committee of the International SCI Standards and Data Sets, and later by the International Spinal Cord Society (ISCoS) Scientific Committee and the American Spinal Injury Association (ASIA) Board. Relevant and interested scientific and professional (international) organizations and societies (∼40) were also invited to review the data set, and it was posted on the ISCoS and ASIA websites for 3 months to allow comments and suggestions. The ISCoS Scientific Committee, Executive Committee and ASIA Board received the data set for final review and approval. RESULTS: The International SCI UTI Basic Data Set includes the following variables: date of data collection, length of time of sign(s)/symptom(s), results of urine dipstick test for nitrite and leukocyte esterase, urine culture results and resistance pattern. The complete instructions for data collection and the data form itself are freely available on the website of ISCoS (http://www.iscos.org.uk).


Asunto(s)
Traumatismos de la Médula Espinal/complicaciones , Infecciones Urinarias/complicaciones , Disreflexia Autónoma/etiología , Disreflexia Autónoma/fisiopatología , Dolor de Espalda/etiología , Temperatura Corporal/fisiología , Recolección de Datos , Bases de Datos Factuales , Disuria/etiología , Esterasas/metabolismo , Fiebre/fisiopatología , Humanos , Espasticidad Muscular/complicaciones , Espasticidad Muscular/epidemiología , Nitritos/metabolismo , Odorantes , Traumatismos de la Médula Espinal/epidemiología , Traumatismos de la Médula Espinal/psicología , Incontinencia Urinaria/complicaciones , Incontinencia Urinaria/epidemiología , Infecciones Urinarias/epidemiología , Infecciones Urinarias/psicología , Orina/microbiología
6.
Spinal Cord ; 51(3): 176-82, 2013 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-23448857

RESUMEN

OBJECTIVE: To develop a web-based educational resource for health professionals responsible for the management of spinal cord injury (SCI). The resource:www.elearnSCI.org is comprised of seven learning modules, each subdivided into various submodules. Six of the seven modules address the educational needs of all disciplines involved in comprehensive SCI management. The seventh module addresses prevention of SCI. Each submodule includes an overview, activities, self-assessment questions and references. DEVELOPMENT OF THE RESOURCE: Three hundred and thirty-two experts from The International Spinal Cord Society (ISCoS) and various affiliated societies from 36 countries were involved in developing the resource through 28 subcommittees. The content of each submodule was reviewed and approved by the Education and Scientific Committees of ISCoS and finally by an Editorial Committee of 23 experts. KEY FEATURES: The content of the learning modules is relevant to students and to new as well as experienced SCI healthcare professionals. The content is applicable globally, has received consumer input and is available at no cost. The material is presented on a website underpinned by a sophisticated content-management system, which allows easy maintenance and ready update of all the content. The resource conforms to key principles of e-learning, including appropriateness of curriculum, engagement of learners, innovative approaches, effective learning, ease of use, inclusion, assessment, coherence, consistency, transparency, cost effectiveness and feedback. CONCLUSION: www.elearnSCI.org provides a cost effective way of training healthcare professionals that goes beyond the textbook and traditional face-to-face teaching.


Asunto(s)
Curriculum/tendencias , Tecnología Educacional/tendencias , Personal de Salud/educación , Personal de Salud/tendencias , Internet/tendencias , Tecnología Educacional/métodos , Humanos , Internacionalidad
7.
Neurourol Urodyn ; 31(3): 370-4, 2012 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-22415808

RESUMEN

AIMS: Disturbed bladder sensations, or in broader terms, sensory dysfunctions are increasingly recognized as key elements in the origin and manifestation of symptom syndromes of urinary dysfunction. Adequate assessment of bladder sensation is crucial to improve our understanding of the pathophysiology and treatment of urinary dysfunction. This manuscript summarizes the discussions of a think tank on "How to measure bladder sensation" held at the ICI-RS meeting in 2011. METHODS: Based upon literature reviews on bladder sensation presented at the think tank in the ICI-RS meeting, discussions evolved which were summarized in the ICI-RS report. Different physicians/researchers further elaborated on this report, which is presented in this manuscript. RESULTS: Bladder sensations are not merely the result of bladder distension. Other factors inside the bladder or bladder wall: central processing and/or cognitive manipulation may play an important role. Current methods to measure sensations such as urodynamics, voiding diaries, forced diuresis, electrical stimulation and brain imaging are likely sub-optimal as they only consider part of these factors in isolation. CONCLUSIONS: Different methods to measure bladder sensations have been described and are used in clinical practice. Current methods only address part of the parameters responsible for the generation and perception of urinary sensations. Further focused research is required, and several recommendations are provided.


Asunto(s)
Técnicas de Diagnóstico Urológico , Sensación , Enfermedades de la Vejiga Urinaria/diagnóstico , Vejiga Urinaria/fisiopatología , Técnicas de Diagnóstico Urológico/normas , Medicina Basada en la Evidencia , Humanos , Mecanotransducción Celular , Vías Nerviosas/fisiopatología , Valor Predictivo de las Pruebas , Pronóstico , Índice de Severidad de la Enfermedad , Vejiga Urinaria/inervación , Enfermedades de la Vejiga Urinaria/fisiopatología , Urodinámica
8.
Spinal Cord ; 55(1): 1, 2017 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-28059161
9.
Neurourol Urodyn ; 30(5): 714-22, 2011 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-21661019

RESUMEN

AIMS: To report the conclusion of the Think Thank 8 on Compliance Discussions during the second ICI-RS meeting in 2010. METHODS: During a 3-day meeting a group of specialists discussed bladder compliance, what it represents, how it can be measured and if it is clinically relevant. RESULTS: Bladder compliance is the result of a mathematical calculation of the volume required for a unit rise of pressure measured during a cystometric filling. It gives an indication on how the different mechanisms in the bladder wall react on stretching. There is a need of standardization of measurement and suggestions for this are given in the text. Pitfalls are described and how to avoid them. There is a wide range of compliance values in healthy volunteers and groups of patients. Poor compliance needs to be defined better as it can have significant clinical consequences. Prevention and treatment are discussed. CONCLUSION: If compliance is correctly measured and interpreted, it has importance in urodynamic testing and gives information relevant for clinical management.


Asunto(s)
Modelos Biológicos , Vejiga Urinaria/fisiopatología , Enfermedades Urológicas/fisiopatología , Animales , Adaptabilidad , Humanos , Valor Predictivo de las Pruebas , Presión , Urodinámica , Enfermedades Urológicas/diagnóstico
13.
Spinal Cord ; 54(5): 329, 2016 May.
Artículo en Inglés | MEDLINE | ID: mdl-27152451
20.
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