Surgery for recurrent stress urinary incontinence: the views of surgeons and women

Introduction and hypothesis: The objectives were to explore the views of women with recurrent stress incontinence (SUI) with regard to treatment preferences and the acceptability of randomisation to a future trial, and to survey the views of UK specialists on treatment preferences and equipoise regarding different treatment alternatives. Methods: An online survey of the British Society of Urogynaecology (BSUG) and British Society of Urological Surgeons (BAUS) was carried out. Qualitative semi-structured interviews with a purposive sample of surgeons and women suffering from recurrent SUI from three UK centres. Results: Two hundred fifty-six survey replies were received (176 gynaecology; 80 urology). Comparing the treatments offered, urogynaecologists were more likely to offer pelvic floor exercises (p < 0.05), and repeat midurethral tape (MUT) (p < 0.001). From the Surgical Equipoise Scale (SES) responses, “no preference” was rarely the commonest response. Marked differences for several options existed; midurethral tape dominated responses whenever it appeared. Twenty-one clinicians were interviewed. Treatment preferences were complex, influenced by a range of factors (reason for failure, patient comorbidity, investigations, personal experience, training). A future trial was regarded as important. Eleven women were interviewed. Most had considered more than one option, but felt that decision-making was more a process of elimination rather than a positive process. Randomisation to a study was regarded as unacceptable by most. Conclusions: No consensus exists among surgeons about preferred treatment options for recurrent SUI, and personal experience and training dominate decision-making. For patients, choices were usually based on an elimination of options, including that of a repeat failed procedure. This contrasts with surgeons, who mostly preferred a repeat MUT above other options. Any future comparative study will be challenging

Additional file 2: of Understanding variations in patient screening and recruitment in a multicentre pilot randomised controlled trial: a vignette-based study

Referral letters for evaluation of screening processes. (DOC 104 kb

Additional file 1: of Understanding variations in patient screening and recruitment in a multicentre pilot randomised controlled trial: a vignette-based study

Letter of invitation to take part and instructions for screeners. (DOC 28 kb

Multimorbidity and risk among patients with established cardiovascular disease: a cohort study

Background Most patients managed in primary care have more than one condition. Multimorbidity presents challenges for the patient and the clinician, not only in terms of the process of care, but also in terms of management and risk assessment. Aim To examine the effect of the presence of chronic kidney disease and diabetes on mortality and morbidity among patients with established cardiovascular disease. Design of study Retrospective cohort study. Setting Random selection of 35 general practices in the west of Ireland. Method A practice-based sample of 1609 patients with established cardiovascular disease was generated in 2000-2001 and followed for 5 years. The primary endpoint was death from any cause and the secondary endpoint was a cardiovascular composite endpoint that included death from a cardiovascular cause or any of the following cardiovascular events: myocardial infarction, heart failure, peripheral vascular disease, or stroke. Results Risk of death from any cause was significantly increased in patients with increased multimorbidity (

Additional file 1: of Evaluation of the chromogenic anti-factor IIa assay to assess dabigatran exposure in geriatric patients with atrial fibrillation in an outpatient setting

Individual patient characteristics. (DOCX 61 kb

MSJ768722_Appendix_4 – Supplemental material for Factors affecting continuation of clean intermittent catheterisation in people with multiple sclerosis: Results of the COSMOS mixed-methods study

<p>Supplemental material, MSJ768722_Appendix_4 for Factors affecting continuation of clean intermittent catheterisation in people with multiple sclerosis: Results of the COSMOS mixed-methods study by Doreen McClurg, Carol Bugge, Andrew Elders, Tasneem Irshad, Suzanne Hagen, Katherine N Moore, Brian Buckley and Mandy Fader in Multiple Sclerosis Journal</p

MSJ768722_Appendix_2 – Supplemental material for Factors affecting continuation of clean intermittent catheterisation in people with multiple sclerosis: Results of the COSMOS mixed-methods study

<p>Supplemental material, MSJ768722_Appendix_2 for Factors affecting continuation of clean intermittent catheterisation in people with multiple sclerosis: Results of the COSMOS mixed-methods study by Doreen McClurg, Carol Bugge, Andrew Elders, Tasneem Irshad, Suzanne Hagen, Katherine N Moore, Brian Buckley and Mandy Fader in Multiple Sclerosis Journal</p

MSJ768722_Appendix_3 – Supplemental material for Factors affecting continuation of clean intermittent catheterisation in people with multiple sclerosis: Results of the COSMOS mixed-methods study

<p>Supplemental material, MSJ768722_Appendix_3 for Factors affecting continuation of clean intermittent catheterisation in people with multiple sclerosis: Results of the COSMOS mixed-methods study by Doreen McClurg, Carol Bugge, Andrew Elders, Tasneem Irshad, Suzanne Hagen, Katherine N Moore, Brian Buckley and Mandy Fader in Multiple Sclerosis Journal</p

Physiologically-Based Toxicokinetic Modeling of Zearalenone and Its Metabolites: Application to the Jersey Girl Study

<div><p>Zearalenone (ZEA), a fungal mycotoxin, and its metabolite zeranol (ZAL) are known estrogen agonists in mammals, and are found as contaminants in food. Zeranol, which is more potent than ZEA and comparable in potency to estradiol, is also added as a growth additive in beef in the US and Canada. This article presents the development and application of a Physiologically-Based Toxicokinetic (PBTK) model for ZEA and ZAL and their primary metabolites, zearalenol, zearalanone, and their conjugated glucuronides, for rats and for human subjects. The PBTK modeling study explicitly simulates critical metabolic pathways in the gastrointestinal and hepatic systems. Metabolic events such as dehydrogenation and glucuronidation of the chemicals, which have direct effects on the accumulation and elimination of the toxic compounds, have been quantified. The PBTK model considers urinary and fecal excretion and biliary recirculation and compares the predicted biomarkers of blood, urinary and fecal concentrations with published <i>in vivo</i> measurements in rats and human subjects. Additionally, the toxicokinetic model has been coupled with a novel probabilistic dietary exposure model and applied to the Jersey Girl Study (JGS), which involved measurement of mycoestrogens as urinary biomarkers, in a cohort of young girls in New Jersey, USA. A probabilistic exposure characterization for the study population has been conducted and the predicted urinary concentrations have been compared to measurements considering inter-individual physiological and dietary variability. The <i>in vivo</i> measurements from the JGS fall within the high and low predicted distributions of biomarker values corresponding to dietary exposure estimates calculated by the probabilistic modeling system. The work described here is the first of its kind to present a comprehensive framework developing estimates of potential exposures to mycotoxins and linking them with biologically relevant doses and biomarker measurements, including a systematic characterization of uncertainties in exposure and dose estimation for a vulnerable population.</p></div

Chemical structures of ZEA and its metabolites.

<p>(a) Compounds of the zeranol family of mycotoxins and their biotransformation pathways (adapted from Kleinova <i>et al.</i><a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0113632#pone.0113632-Kleinova1" target="_blank">[29]</a>); The stars represent the relative estrogenic potency of the compounds which is in the order: <i>α</i>-ZAL> <i>α</i>-ZOL> <i>β</i>-ZAL> ZEA> <i>β</i>-ZOL. (b) Zearalenone (ZEA) (bottom) and Zeranol (ZAL) (top) molecules with their structural representation.</p