Prospective validation of a novel visual analogue uroflowmetry score (VAUS) in 1000 men with lower urinary tract symptoms (LUTS).

INTRODUCTION AND AIMS: Family physicians are limited by lack of tools to monitor benign prostate hyperplasia. VAUS provides a cost-effective, easily administered non-invasive tool. Our primary aim was to validate VAUS correlation with uroflowmetry measured maximal flow rate (Qmax), voided volume and International Prostate Symptom Scores (IPSS) symptom scores. Secondary aim was to study how the VAUS fared at predicting poor flow (Qmax < 10 ml/s) compared to age, voided volume and IPSS. Tertiary aim was to predict the best VAUS as a cutoff for poor flow. METHODS: After IRB approval, 1000 patients were prospectively recruited. They had VAUS, uroflowmetry and IPSS performed. VAUS is a novel five-point visual analogue scoring of urine flow, with one being the weakest and five the strongest. Data were analysed using SPSS where spearman's correlation coefficient and logistic regression analysis were performed looking for significance. Receiver operating curves (ROC) curves were used to identify best VAUS cutoff. RESULTS: 1000 patients were studied with mean age of 68.99 (50-95). VAUS showed good correlation with Qmaxp < 0.001, voided volume p = 0.006 and IPSS p <0.001. On multivariate analysis both VAUS and voided volume predicted poor flow significantly with p value of<0.001 and p =0.001, respectively. On ROC analysis VAUS of 2.5 was identified as best value for predicting poor flow with p value <0.001. CONCLUSION: VAUS is a validated tool for monitoring of lower urinary tract symptoms in our patients showing significant correlation with uroflowmetry, voided volume and IPSS.

Anodyne therapy for recalcitrant diabetic foot ulcers: a report of four cases.

Four patients with diabetic foot ulcers that failed to heal after one month of treatment underwent anodyne therapy. Each therapy session lasted half an hour and was conducted 3 times a week for patients at home or daily for patients in hospital, for one to 2 months. The wound sizes and depths were graded according to the Wagner classification. Pictures were taken to evaluate the effects of anodyne therapy. All 4 patients had good healing of their foot ulcers. Anodyne therapy augments the effects of conservative treatment. Proper wound care and appropriate antibiotic coverage remain the basis of treatment.

An audit of morphine prescribing in a hospice.

AIM OF STUDY: This audit was designed to investigate the morphine prescribing pattern in a hospice. METHOD: A review of 358 medical charts of all existing patients was conducted with a set of questionnaire. The prevailing practice was compared with an established standard guideline. RESULT: One-third (35%) of patients were receiving morphine. Several deficiencies in morphine prescribing were identified. These include omission of breakthrough morphine dosing, use of morphine as p.r.n. (when necessary) alone for chronic pain, absence of review after prescribing treatment, and lack of double dosing at night. Prophylactic laxative and anti-emetics were often not co-prescribed. CONCLUSION: Despite much of what is known about the pharmacology and therapeutic use of morphine, there is much variation and even inappropriate prescription in a palliative care institution. Implementation of recommended European guidelines and education may improve morphine prescribing habits. However, such guidelines may have to be validated in future studies to see if they need to be revised to suit our local population.