Smartphone apps for urolithiasis.

There are an increasing number of healthcare smartphone applications ('apps') available. Urolithiasis presents a major healthcare burden. Patients are increasingly keen to educate themselves regarding the diagnosis and management of their condition. There is no formal regulation of healthcare apps, including a large number of apps relating to urolithiasis. This review aims to examine the range of apps available, and the prevalence of healthcare professional input. Four international smartphone app stores were searched: Apple's App Store, Google Play (Android), BlackBerry App World and the Windows Phone App store. A total of 42 unique apps were downloaded and analysed. Recorded data included the cost (£/$), publisher information, number of ratings, average rating and any documentation of medical professional involvement. Twenty-one (50%) apps required payment for download. The mean cost was £3.58 ($6.04) with range £0.61-£34.90 ($1.03-$58.87). Thirty-three (79%) of the 42 apps were designed to be used by patients. Fifteen (36%) of the 42 apps had clear input from health professionals. Twenty-two apps offered patient information, including dietary advice on lowering calcium intake, which is contrary to current evidence-based practice. We conclude that urolithiasis apps have future potential to inform both patients and healthcare professionals on stone management. However, inaccuracies in the recommendations made by some apps can be misleading or even harmful due to a lack of specialist involvement. We recommend improving the usefulness of these apps by seeking a 'quality stamp' from recognised urological organisations and greater clinician involvement in future app development.

Interferential therapy: lack of effect upon experimentally induced delayed onset muscle soreness.

This study was designed to assess the analgesic effects of interferential therapy (IFT) on experimentally induced muscular pain under randomized, double-blind, placebo-controlled conditions. After ethical approval and written consent were obtained, 40 healthy human volunteers (20 males: 20 females) aged 18-25 years were recruited and randomly assigned to one of four experimental groups (n = 10 per group: male = female): IFT 1, IFT 2, control or placebo. Delayed onset muscle soreness (DOMS) was induced in the elbow flexors of the non-dominant arm of each subject using a single bout of eccentric exercises to exhaustion. Measurements of isometric peak torque, resting angle, mechanical pain threshold and visual analogue scales were performed at set time points. Treatment was applied for 30 min daily over the biceps brachii muscle, for five consecutive days, according to group allocation. IFT 1 received 10-20 Hz, whilst subjects in IFT 2 were treated with 80-100 Hz (bi-pole; carrier frequency: 4 kHz; pulse duration: 125 microseconds). For the placebo group, the procedure was identical to that in the active treatment groups; however, no interferential current was delivered. The control group received no treatment. No significant between group difference was identified at any time point (P > or = 0.14). However, some inconsistent, yet significant differences in daily treatment effects, interactive effects and effects over time were detected. Based on the results of this study it can be concluded that application of IFT at the parameters used here, had no overall beneficial effect on DOMS.

The effect of three electrotherapeutic modalities upon peripheral nerve conduction and mechanical pain threshold.

The current study was designed to examine the neurophysiological and hypoalgesic effects of three types of electrical stimulation. Following approval by the University's Research Ethical Committee, healthy volunteers (n=40; 20 males and 20 females; age 20-40 years; mean age 26.18 years) were recruited and screened for contraindications. Subjects were randomly allocated in equal numbers to the following groups: control, transcutaneous electrical nerve stimulation (TENS; 150 Hz, 125 micros), interferential therapy (IFT; 150 Hz, 125 micros) or action potential stimulation therapy (APS; 153 Hz, 6.4 ms). All treatments were applied under double-blind conditions for 15 min over the course of the median nerve in the subject's right forearm. Antidromic median nerve compound action potentials (CAPs) were recorded pretreatment, immediately post-treatment (i.e. at 15 min) and then at 25, 35 and 45 min. Immediately following CAP recording, mechanical pain threshold (MPT) was recorded from two sites on the palmar surface of the right hand. Statistical analysis showed significant differences between groups for peak to peak amplitude (PPA) at 25, 35 and 45 min (Kruskal-Wallis: P=0.01, 0.01 and 0.02). Mann-Whitney U-tests indicated a significant increase in PPA in the IFT group compared with all other groups at 25 and 35 min and compared with the TENS and APS groups at 45 min. No significant differences were found for the MPT data. This study has therefore demonstrated that none of the aforementioned modalities produced a significant hypoalgesic effect; however, IFT produced a significant change in PPA compared with TENS and APS.

Transcutaneous electrical nerve stimulation (TENS): the effect of electrode placement upon cutaneous blood flow and skin temperature.

In the current study the effect of electrode placement on cutaneous blood flow and skin temperature were assessed using laser Doppler flowmetry. Following approval from the University's ethical committee, 30 subjects were recruited (15 male: 15 female) and randomly assigned to a control or one of two treatment groups (n=10 all groups). TENS was applied either over the median nerve or to the Hegyu acupuncture point (L.I.4) for 15 minutes. Blood flow and skin temperature data were recorded during TENS and for 15 minutes post TENS. Analysis of results showed significant differences between groups for cutaneous blood flow (p=0.0001; repeated measures ANOVA). There was a significant increase in blood flow in the TENS median nerve group compared with the other two groups during TENS application. No significant changes in skin temperature were observed between groups. This study demonstrates that the effect of TENS upon cutaneous blood flow is dependent upon electrode placement sites.

The effect of interferential therapy upon cutaneous blood flow in humans.

The aim of the current controlled and blinded study was to investigate the effect of various interferential current frequencies upon cutaneous blood flow in humans using laser Doppler flowmetry, in an attempt to define the physiological mechanisms involved. Following approval from the university's ethical committee, 50 healthy volunteers (25 male, 25 female; age 18-34 years) were randomly allocated into one of five experimental groups: (i) control; neither suction nor interferential current was applied, (ii) placebo; suction only was applied, (iii) IFT 1; 10-100 Hz beat frequency applied, (iv) IFT 2; 80-100 Hz beat frequency applied, and (v) IFT 3; 10-20 Hz beat frequency applied. In the IFT groups, interferential currents were applied through four suction electrodes positioned to target the quadriceps femoris muscle. The following parameters were used in all IFT groups: 125 micros pulse duration, 4 kHz carrier frequency and a 6/6 sweep. In IFT groups 1 and 2 only, the rotating vector system was made active. Ambient and skin temperatures were measured concomitantly. Repeated-measures ANOVA showed a significant difference between groups (P=0.0361) and over time (P=0.0001) for blood flow data; one-factor ANOVA showed a significant increase in blood flow in the IFT 3 group (10-20 Hz) when compared to all experimental groups at 12 min (P=0.0156). In addition, at 21 min, there were significant differences between the IFT 3 group and all other groups except control (P=0.0213). Statistical analysis of skin temperature data demonstrated significant differences over time (P=0.0001) and a significant interactive effect (P=0.0022), with no significant differences observed between groups. These findings provide some evidence of a putative vasodilatory effect caused by interferential current therapy when applied through suction electrodes at a modulated frequency of 10-20 Hz.

Use of biofeedback in treatment of psychogenic voiding dysfunction.

A young man with psychologic problems and a long history of social inadequacy presented with voiding dysfunction. Videocystometrography revealed a normal filling phase and normal initiation of voiding interrupted by considerable straining by the patient and marked sphincter electromyographic (EMG) activity. Temporary amelioration was achieved by infiltration of the sphincter with lignocaine hydrochloride and by biofeedback therapy. In such cases optimal results are expected from long-term behavioral therapy.