A multicenter investigation of reablement in Norway: a clinical controlled trial.

BACKGROUND: Reablement is an emerging approach in rehabilitation services, but evidence for its efficacy is rather weak and inconsistent. The purpose of the present study is therefore to investigate the health effects of reablement in home-dwelling adults. METHODS: A multicenter, clinical controlled trial involving 47 municipalities in Norway, with assessments at baseline, and after 10 weeks and at 6 and 12 months. The sample consisted of 707 persons that received a 4-10 week reablement program and 121 underwent treatment as usual. Primary outcomes were activity performance and satisfaction with performance measured by the Canadian Occupational Performance Measure (COPM, 1-10). Secondary outcomes included the Short Physical Performance Measure Battery (SPPB), the European Quality of Life Scale (EQ-5D-5 L), and the Sense of Coherence Questionnaire (SOC). Overall treatment effects were estimated with mixed-model repeated measures analyses. RESULTS: Significant treatment effects in the rehabilitation group compared with the control group were found in COPM-Performance and COPM-Satisfaction scores at 10 weeks (mean differences between groups (MD), 1.61, 95% confidence interval (CI), 1.13, 2.10 and MD 1.47, CI 0.98, 1.97, respectively), and at 6 months (MD 1.42; CI 0.82,2.02 and MD 1.37; CI 0.77,1.98, respectively). There were also significant treatment effects in the SPPB-subscales for balance and walking after 6 months, in the total SPPB score and in the subscale for sit-to-stand after 12 months. In the EQ-5D-5 L assessment, significant treatment effects were found in the subscales for mobility, and for usual activities and health after 6 months. There was a significant difference in the SOC after six months. CONCLUSION: Reablement seems to be a more effective rehabilitation service for persons with functional decline than traditional home-based services after six months. After 12 months, the differences between the groups decreased. TRIAL REGISTRATION: The trial was registered at ClinicalTrials.gov on October 24, 2014, (retrospectively registered) identifier: NCT02273934 .

Amniotic fluid turbidity: a useful adjunct for assessing fetal pulmonary maturity status.

A rapid, very simple technique for establishing fetal pulmonary maturity status is presented. Among 100 receiving amniocenteses, aspiration of turbid amniotic fluid that would not permit the reading of newsprint through it was associated with a lecithin/sphingomyelin (LS) ratio of greater than or equal to 2.0, or the presence of phosphatidyl glycerol (PG) in 97% (specificity 98%, positive predictive value 97%). The authors conclude that when turbid fluid is aspirated, delay until LS and PG results are known may not be necessary.

New method to quantify the urodynamic improvement when treating bladder outlet obstruction: the efficacy of transurethral resection in benign prostatic hypertrophy.

A method to measure the urodynamic improvement when treating urethral obstruction is introduced and applied to patients with benign prostatic hypertrophy. The patients performed pressure-flow studies before and 3-6 months after TUR-p. The urethral resistance relation was estimated by curve fitting in the pressure flow plot. The new method quantifies the improvement in urethral resistance as the distance between the urethral resistance relation before and after treatment expressed in pressure units. The distance is measured at the flow rate equal to 75% of the maximum flow rate for the micturition with the lowest maximum flow rate and this distance is called delta-URA. The median improvement after TUR-p was 71 cm H2O (range 2-119). The improvement was strongly correlated to the resistance before treatment and the regression line indicates that the operation normalizes the resistance irrespective of its preoperative value. On the average a lowering of the urethral resistance relation with 8 cm H2O improved the maximum flow rate with 1 ml/s. The greatest advantage with the new method is that it has a high validity and is almost completely insensitive to changes in contractility.

Tamsulosin 0.4 mg once daily: effect on sexual function in patients with lower urinary tract symptoms suggestive of benign prostatic obstruction.

OBJECTIVE: To evaluate the effect of tamsulosin, 0.4 mg once daily, on sexual function in comparison with placebo and alfuzosin, 2.5 mg three times daily, in patients with lower urinary tract symptoms (LUTS) suggestive of benign prostatic obstruction (BPO). METHODS: Data from 830 patients randomized into three European multicenter studies with similar protocols were analyzed. In two studies, patients were randomized to receive either tamsulosin, 0.4 mg once daily, or placebo, and in the third, patients were randomized to receive either a fixed dose of tamsulosin, 0.4 mg once daily, or alfuzosin, titrated to 2.5 mg three times daily. The studies employed a 2-week placebo run-in period, followed by a 12-week study period. Sexual function was assessed by related adverse events and by a sexual function score determined from a life-style questionnaire. RESULTS: Abnormal ejaculation occurred significantly more frequently in patients treated with tamsulosin than in those receiving placebo (p = 0.045); however, the incidence of abnormal ejaculation was similar in patients receiving tamsulosin or alfuzosin in the comparative study. Abnormal ejaculation was not perceived as a major problem by the patients since it resulted in few treatment discontinuations (n = 3). It was also reversible on drug withdrawal. There was no difference between tamsulosin and placebo or alfuzosin with regard to the occurrence of decreased libido or impotence. In addition, there was no significant difference in the change in sexual function score between patients treated with tamsulosin and those treated with alfuzosin. Compared with patients receiving placebo, there was, however, a significant improvement in total sexual function score in patients receiving tamsulosin (p = 0.042). CONCLUSIONS: Tamsulosin, 0.4 mg once daily, is well tolerated and has no overall negative impact on sexual function compared with placebo or alfuzosin. Compared with placebo, tamsulosin may even improve sexual function.