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1.
Pan Afr Med J ; 35(Suppl 2): 150, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33193965

RESUMO

The new coronavirus 2019 epidemic declared in China on December 31, 2019 soon spread to the rest of the world, becoming the subject of an unprecedented health pandemic according to the World Health Organization's declaration of March 11, 2020. It is a disease that has the potential to cause multiple systemic infections. We report here the case of an acute polyradiculoneuritis of the Guillain-Barré type (GBS) indicative of a COVID-19 infection. This is a 41 year old patient seen for ascending, symmetrical and bilateral, progressive and acute tetraparesis with in a context of influenza syndrome and digestive infections treated 2 weeks earlier. During a COVID-19 infection, certain inflammatory cells stimulated by the virus produce inflammatory cytokines creating immune-mediated processes. The same mechanism is observed in GBS being also an immune-mediated disorder. The management of this disease in COVID-19 positive patients does not differ from that of patients who do not carry the virus. The risk of respiratory distress in COVID-19 positive patients becomes twice as great in patients with GBS who test positive for COVID-19 at the same time. Monitoring for hemodynamic disorders and respiratory distress in a neuro-intensive care unit may be fruitful.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/complicações , Síndrome de Guillain-Barré/etiologia , Pneumonia Viral/complicações , Adulto , Fibrilação Atrial/complicações , Azitromicina/uso terapêutico , Betacoronavirus/isolamento & purificação , Cloroquina/efeitos adversos , Cloroquina/uso terapêutico , Técnicas de Laboratório Clínico , Terapia Combinada , Contraindicações de Medicamentos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Diagnóstico Precoce , Síndrome de Guillain-Barré/diagnóstico , Síndrome de Guillain-Barré/fisiopatologia , Síndrome de Guillain-Barré/terapia , Humanos , Masculino , Debilidade Muscular/etiologia , Nasofaringe/virologia , Transtornos do Olfato/etiologia , Oxigenoterapia , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Quadriplegia/etiologia , Respiração Artificial , Incontinência Urinária/etiologia
2.
Medicine (Baltimore) ; 99(44): e22865, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126332

RESUMO

BACKGROUND: With the rising incidences stroke, the Post-Stroke Urinary Incontinence (PSUI) has become one of the common clinical sequelae. PSUI not only lowers the quality of life of patients, but also impacts tremendously to mental health. As a treasure of Chinese medicine, acupuncture and its related therapies have been widely accepted in clinical treatment of PSUI. Recently, there have been many clinical studies on the treatment of PSUI with acupuncture and related therapies, but the best way to treat PSUI is controversial. Therefore, the purpose of this paper is to provide an optimal ranking regarding acupuncture and its related therapies for PSUI. METHODS: The five domestic and foreign databases including PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Wanfang Database will be systematically searched. The time range of the literature search is from the date of establishment to August 31, 2020. The main evaluation outcome was the number of patients after treatment, and the frequency of urinary incontinence. The secondary evaluation outcome was International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), Barthel Activities of Daily Living Index (Barthel ADL Index) and the incidence rate of adverse events. The methodological quality of the article will evaluated by Cochrane Collaboration's Tool and the quality of evidence will evaluated through Grading of Recommendations Assessment, Development and Evaluation (GRADE) instrument. The Network Meta-Analysis (NMA) will be completed using Stata statistical software. RESULTS: The final results of this study will be published in a peer-reviewed journal. CONCLUSION: This network meta-analysis will compare the efficacy and safety of different acupuncture therapies in the treatment of PSUI and summarize the best treatment options, which will help patients and doctors to choose effective acupuncture methods in time.


Assuntos
Terapia por Acupuntura/normas , Metanálise como Assunto , Incontinência Urinária/terapia , Terapia por Acupuntura/métodos , Protocolos Clínicos , Humanos , Reabilitação do Acidente Vascular Cerebral/métodos , Reabilitação do Acidente Vascular Cerebral/normas , Revisões Sistemáticas como Assunto , Incontinência Urinária/etiologia
3.
BMJ ; 371: m3503, 2020 10 07.
Artigo em Inglês | MEDLINE | ID: mdl-33028540

RESUMO

OBJECTIVE: To assess treatment related changes in quality of life up to 15 years after diagnosis of localised prostate cancer. DESIGN: Population based, prospective cohort study with follow-up over 15 years. SETTING: New South Wales, Australia. PARTICIPANTS: 1642 men with localised prostate cancer, aged less than 70, and 786 controls randomly recruited from the New South Wales electoral roll into the New South Wales Prostate Cancer Care and Outcomes Study (PCOS). MAIN OUTCOME MEASURES: General health and disease specific quality of life were self-reported at seven time points over a 15 year period, using the 12-item Short Form Health Survey scale, University of California, Los Angeles prostate cancer index, and expanded prostate cancer index composite short form (EPIC-26). Adjusted mean differences were calculated with controls as the comparison group. Clinical significance of adjusted mean differences was assessed by the minimally important difference, defined as one third of the standard deviation (SD) from the baseline score. RESULTS: At 15 years, all treatment groups reported high levels of erectile dysfunction, depending on treatment (62.3% (active surveillance/watchful waiting, n=33/53) to 83.0% (non-nerve sparing radical prostatectomy, n=117/141)) compared with controls (42.7% (n=44/103)). Men who had external beam radiation therapy or high dose rate brachytherapy or androgen deprivation therapy as primary treatment reported more bowel problems. Self-reported urinary incontinence was particularly prevalent and persistent for men who underwent surgery, and an increase in urinary bother was reported in the group receiving androgen deprivation therapy from 10 to 15 years (year 10: adjusted mean difference -5.3, 95% confidence interval -10.8 to 0.2; year 15: -15.9; -25.1 to -6.7). CONCLUSIONS: Patients receiving initial active treatment for localised prostate cancer had generally worse long term self-reported quality of life than men without a diagnosis of prostate cancer. Men treated with radical prostatectomy faired especially badly, particularly in relation to long term sexual outcomes. Clinicians and patients should consider these long term quality of life outcomes when making treatment decisions.


Assuntos
Antagonistas de Androgênios , Braquiterapia , Efeitos Adversos de Longa Duração , Prostatectomia , Neoplasias da Próstata , Qualidade de Vida , Idoso , Antagonistas de Androgênios/efeitos adversos , Antagonistas de Androgênios/uso terapêutico , Austrália/epidemiologia , Braquiterapia/efeitos adversos , Braquiterapia/métodos , Estudos de Coortes , Disfunção Erétil/epidemiologia , Disfunção Erétil/etiologia , Humanos , Efeitos Adversos de Longa Duração/epidemiologia , Efeitos Adversos de Longa Duração/etiologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Prospectivos , Prostatectomia/efeitos adversos , Prostatectomia/métodos , Neoplasias da Próstata/epidemiologia , Neoplasias da Próstata/patologia , Neoplasias da Próstata/psicologia , Neoplasias da Próstata/terapia , Risco Ajustado , Incontinência Urinária/epidemiologia , Incontinência Urinária/etiologia
4.
Medicine (Baltimore) ; 99(38): e22275, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957379

RESUMO

BACKGROUND: Urinary incontinence (UI) is still a persistent challenge in many stroke survivors, affecting the quality of life and emotional being of these individuals. Numerous studies have demonstrated the curative effect of electroacupuncture on post-stroke incontinence, however they were mired with questionable quality and inconsistencies in safety and efficacy. Therefore, the main objective of this meta-analysis is to provide a comprehensive evaluation of the efficacy and safety of electroacupuncture against urinary incontinence after stroke, with a view of providing more reliable evidence-based solutions for UI. METHODS: A systematic literature search will be conducted using PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, Web of Science, and 4 Chinese databases from inception to June 2020 to identify randomized control trials that report on electroacupuncture against urinary incontinence after stroke. Two reviewers will independently identify eligible studies and extract data. The risk of bias of the included randomized control trials will be evaluated according to the Cochrane tool. Risk ratio and 95% confidence intervals will be used to estimate the efficacy of treatment,. and the grading of recommendations, assessment, development, and evaluation approach to rate the certainty of evidence. The statistical heterogeneity will be evaluated by Cochran's Q and the I. Data will be analyzed using Stata software (Version 13.0, Stata Corp, College Station, TX, USA). RESULTS: This study will provide a comprehensive evaluation of the efficacy and safety of electroacupuncture against UI after stroke, with a view of providing more reliable evidence-based solutions for UI. ETHICS AND DISSEMINATION: This work synthesises evidence from previously published studies and does not require ethics review or approval. A manuscript describing the findings will be submitted for publication in a peer-reviewed scientific journal. INPLASY REGISTRATION NUMBER: INPLASY202050073.


Assuntos
Eletroacupuntura/efeitos adversos , Metanálise como Assunto , Acidente Vascular Cerebral/complicações , Revisões Sistemáticas como Assunto , Incontinência Urinária/terapia , Humanos , Qualidade de Vida , Incontinência Urinária/etiologia
5.
Medicine (Baltimore) ; 99(30): e21077, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791679

RESUMO

BACKGROUND: The objective of this study is to examine the effectiveness and safety of electroacupuncture (EA) in the treatment of urinary incontinence (UI) in patients with spinal cord injury (SCI). METHODS: All potential studies will be retrieved from the electronic databases of MEDLINE, EMBASE, Cochrane Library, PsycINFO, Web of Science, CBM, and China National Knowledge Infrastructure from origin of each database up to January 31, 2020. Additionally, we will check other resources, such as Google scholar, dissertations, conference proceedings, and reference lists of included studies. No language and publication date limitations will be considered in the literature resources search. All randomized controlled trials using EA for the treatment of UI in patients with SCI will be included. Two independent investigators will perform study selection, data extraction and study quality assessment. If any conflicts occur, we will invite a third investigator to solve them. Cochrane risk of bias will be used for study quality assessment, and RevMan 5.3 software will be employed for statistical analysis. RESULTS: This study will summarize the most recent evidence to assess the effectiveness and safety of EA for the treatment of UI in patients with SCI. CONCLUSION: The results of this study will provide helpful evidence to determine whether EA is effective and safety for the treatment of UI in patients with SCI or not. PROSPERO REGISTRATION NUMBER: PROSPERO CRD42020165562.


Assuntos
Eletroacupuntura , Traumatismos da Medula Espinal/complicações , Incontinência Urinária/etiologia , Incontinência Urinária/terapia , Eletroacupuntura/efeitos adversos , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Revisões Sistemáticas como Assunto
6.
PLoS One ; 15(8): e0237518, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32810136

RESUMO

The study assessed the prevalence and determinants of non-fistulous urinary incontinence among gynaecologic care seekers as well as its interference with everyday life activities of affected women. A cross-sectional study involving 400 women was conducted in a tertiary facility in Ghana. Urinary incontinence was assessed using the International Consultation on Incontinence Questionnaire-short form (ICIQ-SF) which has not been validated locally. The questionnaire was administered mostly in the Asante Twi language with translation done at the time of the interview. The data was analysed for proportions and associations between selected variables. The prevalence of urinary incontinence was 12%, the common types being urgency (33.3%), stress (22.9%), and mixed (20.8%). Age ≥60 years compared to 18-39 years (OR 3.66 95%CI 1.48-9.00 P = 0.005), and a history of chronic cough (OR 3.80 95% CI 1.36-10.58 P = 0.01) were associated with urinary incontinence. Women with education beyond the basic level were 72% less likely to experience urinary incontinence (OR 0.28 95%CI 0.08-0.96 P = 0.04). Urinary incontinence interferes with everyday life activities of most affected women. Non-fistulous urinary incontinence is relatively common among gynaecologic care seekers yet very few women were referred with such a diagnosis. Advocacy measures aimed at urging affected women to report the condition and educating the general population on potential causes, prevention and treatment are needed.


Assuntos
Aceitação pelo Paciente de Cuidados de Saúde , Incontinência Urinária/epidemiologia , Incontinência Urinária/etiologia , Atividades Cotidianas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Gana/epidemiologia , Ginecologia/estatística & dados numéricos , Hospitais de Ensino , Humanos , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Qualidade de Vida , Encaminhamento e Consulta/estatística & dados numéricos , Fatores de Risco , Inquéritos e Questionários , Incontinência Urinária/diagnóstico , Adulto Jovem
7.
Anticancer Res ; 40(8): 4223-4228, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32727748

RESUMO

BACKGROUND/AIM: We studied the role of high or low inferior mesenteric artery (IMA) tie on defecatory, sexual and urinary dysfunctions in patients who underwent laparoscopic TME for early rectal cancer. PATIENTS AND METHODS: Forty-six consecutive patients undergoing curative laparoscopic resection for pT2N0M0, rectal adenocarcinoma from February 2013 to March 2019 were enrolled into this prospective randomized open label parallel trial to have a laparoscopic TME with a high (Group 1) or low IMA ligation (Group 2). Demographic data and information on symptoms and comorbidity, intra- and post-operative outcomes and defecatory, sexual and urinary functions before and after surgery according to the validated International quality of life questionnaires. RESULTS: A significant difference in postoperative total score of FIQL scale, Jorge-Wexner incontinence score and Agachan-Wexner constipation score were observed between the high and low tie groups at 1, 6, and 12 months after surgery. ICIQ-UI short form, FSFI, and IIEF demonstrated at 1, 6 and 12 months, the scores were significantly higher for patients of Group 1 as compared to those of Group 2. CONCLUSION: A low IMA ligation permits a better fecal continence, less abdominal pain, and less genito-urinary and sexual dysfunctions in patients submitted to TME for rectal cancer.


Assuntos
Laparoscopia/efeitos adversos , Artérias Mesentéricas/patologia , Neoplasias Retais/cirurgia , Disfunções Sexuais Fisiológicas/prevenção & controle , Incontinência Urinária/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Disfunções Sexuais Fisiológicas/etiologia , Taxa de Sobrevida , Incontinência Urinária/etiologia
8.
PLoS One ; 15(7): e0236026, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32701978

RESUMO

We report medium-term results in men receiving primary whole-gland HIFU (WG-HIFU) and following salvage treatment. One hundred and twenty-eight patients in a single hospital were enrolled. The enrolled patients were treated with WG-HIFU for primary localized prostate cancer. Salvage treatment include androgen deprivation therapy, secondary HIFU and salvage radiation therapy. Our primary outcomes were biochemical recurrence-free survival, salvage treatment-free survival, and metastasis-free survival. Secondary outcomes included urinary incontinence, de novo erectile dysfunction, acute epididymitis, bladder neck contracture, and urethral stricture. The 5-year biochemical recurrence-free survival rates were 85.7%, 82.7%, and 45.2% for D'Amico low-, intermediate-, and high-risk groups, respectively. Multivariate analysis revealed high risk group is the only predictor of significant shorter biochemical recurrence free survival, salvage treatment free survival, and metastasis free survival. Of 38 patients receiving salvage treatment after biochemical recurrence, 29 (76.3%) became free from biochemical recurrence. Rates of the adverse events of urinary incontinence, acute epididymitis, bladder neck contracture or urethral stricture, and de novo erectile dysfunction were 2.3%, 10.9%, 20.3%, 65.6%, respectively. In conclusion, WG-HIFU is an effective treatment option for localised prostate cancer, especially in D'Amico low- and intermediate-risk cases. The success rate of salvage treatment with radiation therapy and secondary HIFU for biochemical recurrence was acceptable. Fewer adverse events were caused by HIFU, especially incontinence and erectile dysfunction, than by radical prostatectomy and radiotherapy.


Assuntos
Ablação por Ultrassom Focalizado de Alta Intensidade/métodos , Neoplasias da Próstata/terapia , Idoso , Idoso de 80 Anos ou mais , Antagonistas de Androgênios/uso terapêutico , Estudos de Coortes , Intervalo Livre de Doença , Epididimite/diagnóstico , Ablação por Ultrassom Focalizado de Alta Intensidade/efeitos adversos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Neoplasias da Próstata/mortalidade , Neoplasias da Próstata/patologia , Neoplasias da Próstata/radioterapia , Recidiva , Estudos Retrospectivos , Terapia de Salvação , Resultado do Tratamento , Incontinência Urinária/etiologia
9.
Diabetes Res Clin Pract ; 166: 108315, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32679058

RESUMO

AIMS: To evaluate the effects of gestational diabetes mellitus (GDM) on the structural characteristics of the rectus abdominis muscle (RAM) and its indirect effects on pregnancy-specific urinary incontinence (PSUI). METHODS: A total of 92 pregnant women were divided into four groups, according to their clinical conditions: non-GDM continent, non-GDM associated PSUI, GDM continent and GDM associated PSUI. The muscle morphometry (histochemistry and immunohistochemistry) for the fiber types and collagen fiber distribution, the ultrastructural analysis (transmission electron microscopy), the protein expression of fiber types and calcium signaling (Western blotting), and the content of types I and III collagen fiber (ELISA) in RAM collected at delivery were assessed. RESULTS: The GDM groups presented a significantly increased number of slow fibers and slow-twitch oxidative fiber expression; decreased fiber area, number of fast fibers, and area of collagen; an increase in central nuclei; ultrastructural alterations with focal lesion areas such as myeloid structures, sarcomere disorganization, and mitochondrial alteration. The PSUI groups presented a considerable decrease in types I and III collagen contents and the localization of collagen fiber. CONCLUSIONS: Our data reveal that GDM causes morphological, biochemical and physiological changes in the RAM, and this might predispose women to PSUI.


Assuntos
Complicações do Diabetes/complicações , Diabetes Gestacional/fisiopatologia , Reto do Abdome/anormalidades , Incontinência Urinária/etiologia , Adulto , Estudos Transversais , Feminino , Humanos , Gravidez
10.
PLoS One ; 15(6): e0234389, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32530941

RESUMO

GOAL: To assess the impact of chemoradiation on pelvic floor (PF) muscle function after the treatment of cervical cancer (CC). METHODS: We performed a prospective cohort study of women between the ages of 20 and 70 years old who had a diagnosis of CC. Patients were treated with chemoradiation at the Barretos Cancer Hospital (BCH), between August 2016 and July 2017. We performed three evaluations at different time points after chemoradiation treatment to compare changes in muscle function. Pelvic floor muscle function was assessed through perineometry (PNM) and surface electromyography (EMG) at the following time points: Pretreatment Moment 1 (M1): evaluated before chemoradiation; Moment 2 (M2): at the first follow-up medical visit (usually 3 to 4 months after treatment); and Moment 3 (M3): at the second follow-up medical visit (usually after 6 to 9 months after treatment). Mean vaginal squeeze pressure levels were determined by PNM and muscle electromyographic activity by EMG and the results were evaluated by Generalized Linear Model comparisons. RESULTS: Forty-nine patients were evaluated at M1; 35 at M2; and 32 at M3, so that 32 patients had all three muscle evaluations performed. There was a statistically significant increase in the frequency of women with urgency urinary incontinence at the M2 evaluation time (41.9%), compared to pretreatment M1 (18.6%), p<0.001. The means of the vaginal squeeze pressures reduced through M1 to M3 in the phasic (M1: 17.7 mmHg; M3: 11.27mmHg) and tonic contractions (M1: 10.56 mmHg; M3: 7.52mmHg), p = 0.01 and p = 0.03 respectively. There was no difference in pelvic floor function in the three evaluations M1-M3, measured by EMG. The pelvic floor strength assessed by PMN and their interactions with anthropometric, parity and hormonal status variables, showed that a high body mass index (BMI) significantly influenced decreases in pelvic floor muscle function before and after treatment. CONCLUSION: These results show that chemoradiation causes reduction of muscle function of the pelvic floor, especially in the late phase after the end of treatment. Both the high BMI and urgent urinary incontinence symptoms were related to decreased muscle strength.


Assuntos
Quimiorradioterapia/efeitos adversos , Diafragma da Pelve/lesões , Neoplasias do Colo do Útero/terapia , Adulto , Idoso , Estudos de Coortes , Eletromiografia , Feminino , Humanos , Pessoa de Meia-Idade , Diafragma da Pelve/fisiopatologia , Estudos Prospectivos , Lesões por Radiação/etiologia , Lesões por Radiação/fisiopatologia , Incontinência Urinária/etiologia , Adulto Jovem
11.
Medicine (Baltimore) ; 99(26): e20852, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590783

RESUMO

RATIONALE: Either malacoplakia or xanthogranulomatous cystitis (XC) is a rare chronic infection disease of urinary bladder, which often mimics bladder masses undifferentiated from malignance and results in severe lower urinary tract symptoms. The malacoplakia combined with XC is even rarer in the literature. PATIENT CONCERNS: A 64-year-old female, who presented with nocturia, frequency of micturition, severe urgency with occasional urinary incontinence, and recurrent hematuria for >2 years, was diagnosed with azotemia and anemia. In addition, two 1.0 × 1.0 cm masses of bladder were detected by computer tomography. DIAGNOSES: Malacoplakia combined with xanthogranulomas cystitis was diagnosed histologically. Video urodynamic test showed poor bladder compliance (9 mL/comH2O), markedly decreased maximum bladder capacity (120 mL), and right vesicoureteral reflux at a low intravesical pressure level (25 cmH2O). INTERVENTIONS: Transurethral resection of bladder masses was carried out after treatment of urinary infection by intravenous piperacillin-tazobactam. Oral Ciprofloxacin and Tolterodine were postoperatively used to prevent recurrent lower urinary tract infections and alleviate detrusor overactivity. OUTCOMES: The treatment did not alleviate azotemia, frequency, urgency with incontinence, and bilateral hydroureteronephrosis, but the patient refused to undergo bladder augmentation on account of her poor economic status. LESSONS: Malacoplakia or/and xanthogranulomas cystitis may lead to poor bladder compliance and video urodynamic study should be considered in patients with refractory chronic lower urinary tract symptoms.


Assuntos
Cistite/complicações , Malacoplasia/complicações , Bexiga Urinária/anormalidades , Cistite/fisiopatologia , Feminino , Humanos , Malacoplasia/fisiopatologia , Pessoa de Meia-Idade , Noctúria/etiologia , Tomografia Computadorizada por Raios X/métodos , Bexiga Urinária/fisiopatologia , Incontinência Urinária/etiologia , Infecções Urinárias/etiologia , Infecções Urinárias/fisiopatologia
12.
J Clin Nurs ; 29(15-16): 3089-3096, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32445410

RESUMO

AIMS AND OBJECTIVES: To develop, in an inpatient rehabilitation setting, a programme theory that promotes continence in people who have suffered a stroke. BACKGROUND: Urinary incontinence in stroke survivors impacts the quality of life, rehabilitation outcomes and ultimately incurred costs of the patient. Different approaches are available for developing and testing complex interventions. DESIGN: Building a research-based programme theory. METHODS: To elaborate the intervention, a guidance for developing a complex intervention for nursing was chosen and the sources that should be considered were defined. Subsequently, a research-based programme theory was generated that was represented via a theoretical approach logic model. This study was guided by the checklist for reporting theory of change in public health interventions. RESULTS: The intervention consists of six parts with three outcome chains on interconnected levels, which are oriented towards patients and nurses. The important aspects of the programme theory are communication, individually tailored measures and the definition of interdisciplinary objectives. CONCLUSION: Developing a programme theory and representing it via a logic model help clarify the initial intervention and ensure that implementation strategies are well thought out. RELEVANCE TO CLINICAL PRACTICE: By employing detailed reflection and using previous research, it is expected that the intervention can be implemented successfully and its effectiveness can be investigated in more depth.


Assuntos
Desenvolvimento de Programas/métodos , Reabilitação do Acidente Vascular Cerebral/enfermagem , Incontinência Urinária/enfermagem , Humanos , Qualidade de Vida , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/enfermagem , Incontinência Urinária/etiologia
13.
PLoS One ; 15(5): e0233527, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32469921

RESUMO

The prevalence of urinary incontinence in Duchenne and Becker muscular dystrophy (D/BMD) is reported to be between 15-29%, this however includes ages across the lifespan, and with no description of impact on daily life. The present study, aimed to determine the prevalence of urinary incontinence in men with D/BMD, and to identify which aspects of daily life were impacted by urinary incontinence. Twenty-seven adult males, 11 with BMD and 16 with DMD, aged 20-57 years, volunteered to participate in this study. Six questionnaires were completed to provide an overview of participant mobility, urinary incontinence and distress caused by urinary incontinence. These included: The Barthel index of disability, International Consultation on Incontinence Questionnaire-Urinary Incontinence Form, Incontinence Impact Questionnaire Short Form, The Urogenital Distress Inventory, and the Brooke and Vignos scale. The prevalence of urinary incontinence within the present men with D/BMD was 37%, assessed as urine leakage of once a week or more. Those with urinary incontinence all reported only a "small amount" of urine leakage, with urinary incontinence frequency of once a week in 5/10 participants, two or three times a week in 2/10 participants, and once a day in 3/10 participants. Of those with urinary incontinence 8/10 experienced some impact on their daily life from urine leakage including travel (4/10), social aspects (5/10), and emotional aspects (8/10). All participants with urinary incontinence were bothered by some aspect, including urine leakage (9/10), and frequent urination (4/10). In conclusion, 37% of the present men with D/BMD experience urinary incontinence on a weekly or daily basis and negatively impacted aspects of life related to travel, social and emotional wellbeing. Urine leakage, and frequent urination should be considered a meaningful problem by care providers, and discussed openly with those with D/BMD.


Assuntos
Distrofia Muscular de Duchenne/complicações , Incontinência Urinária/epidemiologia , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Inquéritos e Questionários , Incontinência Urinária/etiologia , Adulto Jovem
14.
Neurourol Urodyn ; 39(5): 1417-1422, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32249971

RESUMO

BACKGROUND: Stress urinary incontinence (SUI) is a major component of the post radical prostatectomy (RP) trifecta. Surgical treatments are sub-urethral slings, artificial urinary sphincter (AUS) and adjustable peri-urethral balloons (PUB) ProACT. All options are imperfect at best and persistent SUI is challenging when AUS is not manageable. AIMS: This study analyzed the cumulate experience of our 2 centers with offering PUB implantation for SUI post RP in patients with insufficient improvement from slings. MATERIALS & METHODS: This retrospective study reviewed all patients implanted with second line ProACT. The primary endpoint was continence, defined as 0 pads per day (PPD). The secondary endpoints were 50% decrease in PPD and increases in the Incontinence Quality of Life score (IQOL). Refilling and complications were reported. RESULTS: Between 2007 and 2016, 26 patients were implanted. Five patients have had adjuvant radiotherapy (18%). The mean follow-up was 36 months (±20; min 14-max 128). All patient presented with persistent SUI, using 2.3 PPD (±1; min 1-max 6), and only one sling was removed due to infection. After ProACT with an average 3 mL refilling (±1.2 min 2-max 6), 18 patients (66.7%) were continent. Eight of the remaining patients (29.6%) were improved; their number of PPD decreased from 2.6 to 1. The average IQOL score of those 8 patients increased by 20 points, from 53.4 up to 74.2 (P = .005). Overall 26 patients (96.3%) were improved. The remaining patient was not implanted because of an intraoperative urethral injury and is considered a failed case (3.7%). He had instead an AUS implantation. Three patients (14.8%) needed PUB replacement. CONCLUSION: The limited population of patients from both our centers who presented with persistent SUI after RP, despite sling placement, improved with PUB ProACT implantations without significant complications.


Assuntos
Oclusão com Balão , Complicações Pós-Operatórias/terapia , Prostatectomia/efeitos adversos , Slings Suburetrais , Incontinência Urinária por Estresse/etiologia , Incontinência Urinária por Estresse/terapia , Esfíncter Urinário Artificial , Idoso , Idoso de 80 Anos ou mais , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Resultado do Tratamento , Uretra/fisiopatologia , Incontinência Urinária/etiologia , Incontinência Urinária por Estresse/psicologia
15.
Sultan Qaboos Univ Med J ; 20(1): e45-e53, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32190369

RESUMO

Objectives: Urinary incontinence (UI) in women is a common health problem which can have a negative impact on quality of life (QOL). This study aimed to determine the prevalence, risk factors and impact of UI on the QOL of Omani women attending primary healthcare centres in Muscat, Oman. Methods: This cross-sectional study was conducted at three primary healthcare centres in Muscat from April to August 2018. Women who were 20-50 years of age, not pregnant, not in the six-month postnatal period, not seriously ill and not diagnosed with pelvic organ prolapse were included. A self-administered questionnaire using the International Consultation Incontinence Questionnaire-Short Form was used to evaluate the frequency, severity and impact of UI on QOL. Results: A total of 1,070 women were included in this study (response rate = 92.5%). The mean age was 31.39 ± 7.64 years. UI was reported by 369 (34.5%) women, of whom 182 (49.3%) had stress UI, 97 (26.3%) had urgency UI, 88 (23.8%) had mixed UI and two (0.5%) had other UI. Age, body mass index (BMI), having been married or employed, hypertension, cough, constipation and vaginal or assisted vaginal delivery during the previous birth were significant risk factors for UI. Only 41 (11.1%) out of the 369 women with UI had ever sought medical advice despite the fact that more than two thirds of the women with UI reported negative effects on their QOL. Conclusion: UI is a common medical problem in Oman. Several risk factors, including age and BMI, were identified. Despite its negative consequences for QOL, women were found to be reluctant to seek medical attention for the condition.


Assuntos
Efeitos Psicossociais da Doença , Qualidade de Vida , Incontinência Urinária/epidemiologia , Adulto , Índice de Massa Corporal , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Omã/epidemiologia , Prevalência , Fatores de Risco , Inquéritos e Questionários , Incontinência Urinária/etiologia , Adulto Jovem
16.
Plast Reconstr Surg ; 145(6): 1512-1515, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32195856

RESUMO

The authors describe the technique of robotic vaginectomy, anterior vaginal flap urethroplasty, and use of a longitudinally split pedicled gracilis muscle flap to recreate the bulbar urethra and help fill the vaginal defect in female-to-male gender-affirming phalloplasty. Vaginectomy is performed by means of the robotically assisted laparoscopic transabdominal approach. Concurrently, gracilis muscle is harvested and passed through a tunnel between the groin and the vaginal cavity. It is then split longitudinally, and the inferior half is passed into the vaginal cavity; it is inset into the vaginal cavity. Following urethroplasty, the superior half of the gracilis flap is placed around the vaginal flap to buttress this suture line with well-vascularized tissue. From May of 2016 to March of 2018, 16 patients underwent this procedure. The average age of the patients was 35.1 ± 8.8 years, average body mass index was 31.4 ± 5.5 kg/m, and average American Society of Anesthesiologists class was 1.8 ± 0.6. The average length of surgery was 423.6 ± 84.6 minutes, with an estimated blood loss of 246.9 ± 84.9 ml. Patients were generally out of bed on postoperative day 1, ambulating on postoperative day 2, and discharged to home on postoperative day 3 (average day of discharge, 3.4 ± 1.4 days). At a mean follow-up time of 361.1 ± 175.5 days, no patients developed urinary fistula at the urethroplasty site. The authors' use of the longitudinally split gracilis muscle in first-stage phalloplasty represents a novel approach to providing well-vascularized tissue to achieve both urethral support and closure of intrapelvic dead space, with a single flap, in a safe, efficient, and reproducible manner. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, IV.


Assuntos
Músculo Grácil/transplante , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Robóticos/métodos , Cirurgia de Readequação Sexual/métodos , Retalhos Cirúrgicos/transplante , Adulto , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Pênis/cirurgia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Reprodutibilidade dos Testes , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Cirurgia de Readequação Sexual/efeitos adversos , Pessoas Transgênero , Uretra/cirurgia , Doenças Uretrais/epidemiologia , Doenças Uretrais/etiologia , Doenças Uretrais/prevenção & controle , Incontinência Urinária/epidemiologia , Incontinência Urinária/etiologia , Incontinência Urinária/prevenção & controle , Vagina/cirurgia , Adulto Jovem
17.
Transplant Proc ; 52(3): 850-856, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32122665

RESUMO

BACKGROUND: Robot-assisted laparoscopic radical prostatectomy (RARP) has been poorly studied in men with renal graft. OBJECTIVE: To determine the predictive factors for oncologic outcomes and complications after RARP in renal transplants recipients (RTRs). DESIGN AND PARTICIPANTS: A retrospective multicenter controlled study identified all RTRs who had undergone RARP between 2008 and 2016 in 2 experts departments. All RTRs were matched 1:1 with patients who had also undergone RARP but with no history of renal transplant (control group). INTERVENTION: Robot-assisted laparoscopic radical prostatectomy. OUTCOME MEASUREMENTS: Incontinence, oncologic outcomes, and complications according to the Clavien-Dindo classification. STATISTICAL ANALYSIS: Comparisons of the quantitative variables using Student's t tests, and comparisons of the qualitative variables using χ2 tests. Statistical analyses were performed using SAS (version 9.3). Independent risk factors of biochemical recurrence (BCR), postoperative complications, or incontinence were searched by using a multivariate linear regression. RESULTS: Twenty-seven RTRs were included in the transplant group and compared with 27 men in the control group with similar preoperative characteristics. Univariate analysis showed a shorter BCR-free survival in RTRs, with 26.9 months vs 49.3 months in the control group (P = .018). BCR rate was similar in each group (7.4% vs 11.1%, P = .639). No difference between groups was showed for immediate postoperative complications (29.6% vs 22.2%, P = .279). Multivariate analysis showed that a renal graft history was an independent risk factor of shorter BCR-free survival (hazard ratio = 4.291; 95% confidence interval, 2.102-8.761 and P < .001). Even if it is the first comparative study on this topic, the low number of men included is the main limitation of our study. CONCLUSIONS: These findings show the reliability of RARP in RTRs. The rate of BCR does not appear more frequently but BCR-free survival seems shorter in these patients. A prospective comparative study remains necessary with more patients to confirm our results.


Assuntos
Transplante de Rim/efeitos adversos , Laparoscopia/mortalidade , Complicações Pós-Operatórias/cirurgia , Prostatectomia/mortalidade , Neoplasias da Próstata/cirurgia , Procedimentos Cirúrgicos Robóticos/mortalidade , Idoso , Humanos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Período Pós-Operatório , Modelos de Riscos Proporcionais , Estudos Prospectivos , Prostatectomia/métodos , Neoplasias da Próstata/etiologia , Neoplasias da Próstata/mortalidade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Risco , Procedimentos Cirúrgicos Robóticos/métodos , Robótica , Resultado do Tratamento , Incontinência Urinária/etiologia
18.
BMC Urol ; 20(1): 8, 2020 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-32005113

RESUMO

BACKGROUND: Post-operative urinary incontinence is a significant concern for patients choosing to undergo a radical prostatectomy (RP) for treatment of prostate cancer. The aim of our study was to determine the effect of pre-operative MUL on 12 month continence outcomes in men having robot-assisted laparoscopic prostatectomy (RALP). METHODS: We use the South Australian Prostate Cancer Clinical Outcomes Collaborative (SA-PCCOC) database, to identify 602 patients who had undergone RALP by a high volume surgeon. Only patients who received an assessment and education by a specialist pelvic floor physiotherapist, had completed EPIC questionnaires before treatment and did not have radiotherapy treatment within 12 months of surgery were included. MUL measurements were taken from pre-operative magnetic resonance imaging (MRI) scans. The short-form version of the Expanded Prostate Cancer Index Composite (EPIC-26) was used to measure continence outcomes. Continence was defined as 100/100 in the EPIC-26 Urinary Continence domain score. RESULTS: The observed median MUL in this study was 14.6 mm. There was no association between MUL and baseline continence. MUL was associated with continence at 12 months post RALP (OR 1.13, 95% CI 1.03-1.21, p = 0.0098). In men who were continent before surgery, MUL was associated with return to continence at 12 months after RALP (OR 1.15, 1.05-1.28, p = 0.006). MUL was also associated with change in continence after surgery (ß = 1.22, p = 0.002). CONCLUSIONS: MUL had no effect on baseline continence but had a positive and significant association with continence outcomes over 12 months post RALP.


Assuntos
Complicações Pós-Operatórias/diagnóstico , Prostatectomia/tendências , Procedimentos Cirúrgicos Robóticos/tendências , Uretra/anatomia & histologia , Incontinência Urinária/diagnóstico , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Complicações Pós-Operatórias/etiologia , Prostatectomia/efeitos adversos , Recuperação de Função Fisiológica/fisiologia , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Austrália do Sul , Resultado do Tratamento , Incontinência Urinária/etiologia
19.
Midwifery ; 83: 102647, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32014618

RESUMO

OBJECTIVE: Many women experience urinary incontinence (UI) during and after pregnancy. Pelvic floor muscle exercises (PFME) can prevent and reduce the symptoms of UI. The objective of the study was to explore challenges, opportunities and concerns for women and health care professionals (HCPs), related to the implementation of PFME training for women in current antenatal care. DESIGN: An ethnographic study design was used. Researchers also formed and collaborated with a public advisory group, consisting of seven women with recent experiences of pregnancy, throughout the study. PARTICIPANTS: Seventeen midwife-woman interactions were observed in antenatal clinics. In addition, 23 midwives and 15 pregnant women were interviewed. Repeat interviews were carried out with 12 of the women postnatally. Interviews were also carried out with other HCPs; four physiotherapists, a linkworker/translator and two consultant obstetricians. Additional data sources included field notes, photographs, leaflets, policy and other relevant documents. SETTING: Data were collected in three geographical areas of the UK spanning rural, urban and suburban areas. Data collection took place in antenatal clinics, in primary and secondary care settings, and the majority of women were interviewed in their homes. FINDINGS: Three broad and inter-related themes of "ideological commitment", "confidence" and "assumptions, stigma and normalisation" were identified. The challenges, opportunities and concerns regarding PFME implementation were explored within these themes. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Although HCPs and some women knew that PFME were important, they were not prioritised and the significant benefits of doing PFME may not have been communicated by midwives or recognised by women. There was a lack of confidence amongst midwives to teach PFME and manage UI within the antenatal care pathway and amongst women to ask about PFME or UI. A perceived lack of consistent guidelines and policy at local and national levels may have impeded clear communication and prioritisation of PFME. Furthermore, assumptions made by both women and midwives, for example, women regarding UI as a normal outcome of pregnancy, or midwives' perception that certain women were more likely to do PFME, may have exacerbated this situation. Training for midwives to help women in the antenatal period to engage in PFME could address challenges and concerns and to help prevent opportunities for women to learn about PFME from being missed.


Assuntos
Exercício Físico/psicologia , Relações Enfermeiro-Paciente , Diafragma da Pelve/fisiologia , Adulto , Antropologia Cultural/métodos , Feminino , Humanos , Gravidez , Complicações na Gravidez/prevenção & controle , Complicações na Gravidez/psicologia , Resultado do Tratamento , Reino Unido , Incontinência Urinária/etiologia , Incontinência Urinária/prevenção & controle , Incontinência Urinária/psicologia
20.
World Neurosurg ; 137: 341-344, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32084622

RESUMO

BACKGROUND: Early and late images of 123I-iomazenil (123I-IMZ) single-photon emission computed tomography (SPECT) are considered to show cerebral blood flow and neuronal activity, respectively, and this modality may demonstrate temporal dysfunction of the frontal lobes in obstructive hydrocephalus. In this report, we examined 123I-IMZ SPECT in a patient with chronic obstructive hydrocephalus owing to compression of the aqueduct by a partially thrombosed aneurysm of the left posterior cerebral artery for the first time. CASE DESCRIPTION: A woman aged 77 years presented with progression of cognitive decline, gait disturbance, and urinary incontinence. She had a medical history of epilepsy and subarachnoid hemorrhage due to a ruptured left posterior cerebral artery aneurysm, treated conservatively when she was age 56 years. Magnetic resonance imaging revealed a mass lesion in the pineal region, which showed a target sign with gadolinium-based contrast agents, causing obstructive hydrocephalus owing to compression of the cerebral aqueduct. A right vertebral angiogram confirmed the presence of a partially thrombosed giant aneurysm at the left posterior cerebral artery. To rule out the involvement of nonconvulsive status epilepticus in her pathology, we performed 123I-IMZ SPECT, and both early and late images demonstrated low uptake in the bilateral frontal cortex. After surgical trapping of the parent artery and resection of the aneurysm, hydrocephalus was relieved, and the symptoms disappeared along with improvement in early and late 123I-IMZ SPECT images. CONCLUSIONS: The findings in the present case indicate that 123I-IMZ SPECT can detect reversible cerebral blood flow reduction and neuronal viability in the frontal lobes, which may affect the clinical manifestation of obstructive hydrocephalus.


Assuntos
Flumazenil/análogos & derivados , Lobo Frontal/diagnóstico por imagem , Hidrocefalia/diagnóstico por imagem , Aneurisma Intracraniano/diagnóstico por imagem , Trombose/diagnóstico por imagem , Tomografia Computadorizada de Emissão de Fóton Único , Idoso , Sobrevivência Celular , Circulação Cerebrovascular , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/fisiopatologia , Feminino , Lobo Frontal/irrigação sanguínea , Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/fisiopatologia , Humanos , Hidrocefalia/etiologia , Hidrocefalia/fisiopatologia , Hidrocefalia/cirurgia , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/cirurgia , Imagem por Ressonância Magnética , Neurônios , Trombose/complicações , Trombose/fisiopatologia , Trombose/cirurgia , Incontinência Urinária/etiologia , Incontinência Urinária/fisiopatologia
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