Individualised pelvic floor muscle training in women with pelvic organ prolapse: a multicentre randomised controlled trial

<br>Background: Pelvic organ prolapse is common and is strongly associated with childbirth and increasing age. Women with prolapsed are often advised to do pelvic floor muscle exercises, but supporting evidence is limited. Our aim was to establish if one-to-one individualised pelvic floor muscle training (PFMT) is effective in reducing prolapse symptoms.</br> <br>Methods: A parallel‐group multicentre randomised controlled trial (ISRCTN35911035) in female outpatients with newly-diagnosed, symptomatic stage I, II or III prolapse, comparing five PFMT appointments over 16 weeks (n=225) versus a lifestyle advice leaflet (n=222). Treatment allocation was by remote computer allocation using minimisation. Our primary endpoint was participants’ self-report of prolapsed symptoms at 12 months. Group assignment was masked from outcome assessors. We compared outcomes between trial groups in an intention-to-treat analysis. The cost of PFMT and savings on subsequent treatments were calculated to estimate cost-effectiveness.</br> <br>Findings: Compared to the control group, the intervention group reported fewer prolapse symptoms at 12 months (mean difference between groups in change score 1.52, 95% CI [0.46, 2.59], p=0.0053); reported their prolapse to be “better” more often (57.2% versus 44.7%, difference 12.6%, 95% CI [1.1%, 24.1%], p=0.0336); and had an increased but non-significant odds of having less severe stage of prolapse at their 6-month clinical examination, (OR 1.47, 95% CI [0.97, 2.27], p=0.07). The control group had a greater uptake of other prolapse treatment (49.6% versus 24.1%, difference 25.5%, 95% CI [14.5%, 36.0%], p <0.0001). Findings were robust to missing data. The net cost of the 25 intervention was £131.61 per woman and the cost per one-point reduction in the symptom score was £86.59, 95% CI [£50.81, £286.11]. </br&gt

Effectiveness and cost-effectiveness of basic versus biofeedback-mediated intensive pelvic floor muscle training for female stress or mixed urinary incontinence: protocol for the OPAL randomised trial

This is the final version. Available on open access from BMJ Publishing Group via the DOI in this recordIntroduction Accidental urine leakage is a distressing problem that affects around one in three women. The main types of urinary incontinence (UI) are stress, urgency and mixed, with stress being most common. Current UK guidelines recommend that women with UI are offered at least 3 months of pelvic floor muscle training (PFMT). There is evidence that PFMT is effective in treating UI, however it is not clear how intensively women have to exercise to give the maximum sustained improvement in symptoms, and how we enable women to achieve this. Biofeedback is an adjunct to PFMT that may help women exercise more intensively for longer, and thus may improve continence outcomes when compared with PFMT alone. A Cochrane review was inconclusive about the benefit of biofeedback, indicating the need for further evidence. Methods and analysis This multicentre randomised controlled trial will compare the effectiveness and cost-effectiveness of PFMT versus biofeedback-mediated PFMT for women with stress UI or mixed UI. The primary outcome is UI severity at 24 months after randomisation. The primary economic outcome measure is incremental cost per quality-adjusted life-year at 24 months. Six hundred women from UK community, outpatient and primary care settings will be randomised and followed up via questionnaires, diaries and pelvic floor assessment. All participants are offered six PFMT appointments over 16 weeks. The use of clinic and home biofeedback is added to PFMT for participants in the biofeedback group. Group allocation could not be masked from participants and healthcare staff. An intention-to-treat analysis of the primary outcome will estimate the mean difference between the trial groups at 24 months using a general linear mixed model adjusting for minimisation covariates and other important prognostic covariates, including the baseline score. Ethics and dissemination Approval granted by the West of Scotland Research Ethics Committee 4 (16/LO/0990). Written informed consent will be obtained from participants by the local research team. Serious adverse events will be reported to the data monitoring and ethics committee, the ethics committee and trial centres as required. A Standard Protocol Items: Recommendations for Interventional Trials checklist and figure are available for this protocol. The results will be published in international journals and included in the relevant Cochrane review. Trial registration number ISRCTN57746448; Pre-results.National Institute for Health Research (NIHR

Surgical interventions for uterine prolapse and for vault prolapse: the two VUE RCTs

This report The research reported in this issue of the journal was funded by the HTA programme as project number 11/129/183. The contractual start date was in November 2012. The draft report began editorial review in February 2018 and was accepted for publication in August 2018. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HTA editors and publisher have tried to ensure the accuracy of the authors’ report and would like to thank the reviewers for their constructive comments on the draft document. However, they do not accept liability for damages or losses arising from material published in this report.Peer reviewedPublisher PD

Effectiveness of pelvic floor muscle training with and without electromyographic biofeedback for urinary incontinence in women: multicentre randomised controlled trial

This is the final version. Available on open access from BMJ Publishing Group via the DOI in this recordObjective To assess the effectiveness of pelvic floor muscle training (PFMT) plus electromyographic biofeedback or PFMT alone for stress or mixed urinary incontinence in women. Design Parallel group randomised controlled trial. Setting 23 community and secondary care centres providing continence care in Scotland and England. Participants 600 women aged 18 and older, newly presenting with stress or mixed urinary incontinence between February 2014 and July 2016: 300 were randomised to PFMT plus electromyographic biofeedback and 300 to PFMT alone. Interventions Participants in both groups were offered six appointments with a continence therapist over 16 weeks. Participants in the biofeedback PFMT group received supervised PFMT and a home PFMT programme, incorporating electromyographic biofeedback during clinic appointments and at home. The PFMT group received supervised PFMT and a home PFMT programme. PFMT programmes were progressed over the appointments. Main outcome measures The primary outcome was self-reported severity of urinary incontinence (International Consultation on Incontinence Questionnaire-urinary incontinence short form (ICIQ-UI SF), range 0 to 21, higher scores indicating greater severity) at 24 months. Secondary outcomes were cure or improvement, other pelvic floor symptoms, condition specific quality of life, women’s perception of improvement, pelvic floor muscle function, uptake of other urinary incontinence treatment, PFMT self-efficacy, adherence, intervention costs, and quality adjusted life years. Results Mean ICIQ-UI SF scores at 24 months were 8.2 (SD 5.1, n=225) in the biofeedback PFMT group and 8.5 (SD 4.9, n=235) in the PFMT group (mean difference −0.09, 95% confidence interval −0.92 to 0.75, P=0.84). Biofeedback PFMT had similar costs (mean difference £121 ($154; €133), −£409 to £651, P=0.64) and quality adjusted life years (−0.04, −0.12 to 0.04, P=0.28) to PFMT. 48 participants reported an adverse event: for 23 this was related or possibly related to the interventions. Conclusions At 24 months no evidence was found of any important difference in severity of urinary incontinence between PFMT plus electromyographic biofeedback and PFMT alone groups. Routine use of electromyographic biofeedback with PFMT should not be recommended. Other ways of maximising the effects of PFMT should be investigated.National Institute for Health Research (NIHR

Психологическая специализация в юридическом вузе

Protocol for long-term follow-up. (PDF 30 kb

City of Hitchcock Comprehensive Plan 2020-2040

Hitchcock is a small town located in Galveston County (Figure 1.1), nestled up on the Texas Gulf Coast. It lies about 40 miles south-east of Houston. The boundaries of the city encloses an area of land of 60.46 sq. miles, an area of water of 31.64 sq. miles at an elevation just 16 feet above sea level. Hitchcock has more undeveloped land (~90% of total area) than the county combined. Its strategic location gives it a driving force of opportunities in the Houston-Galveston Region.The guiding principles for this planning process were Hitchcock’s vision statement and its corresponding goals, which were crafted by the task force. The goals focus on factors of growth and development including public participation, development considerations, transportation, community facilities, economic development, parks, and housing and social vulnerabilityTexas Target Communitie

Evaluating the impacts of Smart Growth : a quantitative analysis of state-level Smart Growth policies

Smart Growth is a collection of development principles that address the undesirable environmental, land use, and fiscal impacts that stem from urban sprawl. This report intends to analyze the impacts of Smart Growth through the comparison of Smart Growth states and non-Smart Growth states. Informed by the literature, I selected multiple indicators that quantify the impacts of state-level Smart Growth-policies in Oregon and New Jersey. These indicators were also measured in one non-Smart Growth state: Colorado. Indicators of mobility include work commute mode share, the volume vehicle miles traveled, and the relationship between density (population and employment) and work commute mode share. Housing affordability indicators are home values, multifamily units as a share of new units, and the prevalence of cost burdened households. Each state performed best in at least two of the indicators measured. New Jersey posted the best results for four indicators: the share of cost-burdened renter, median home value, median rent, and vehicle miles traveled. Oregon performed the best for two indicators: new multifamily development and commute by public transit. Colorado also performed the best for two indicators: cost-burdened homeowners and commute by driving alone. Trends revealed by changes in selected indicators suggest Smart Growth policies may produce intended outcomes but are not the best or only way in guiding successful growth management. Planners and scholars might therefore ask whether additional steps are needed to guide successful growth management.Community and Regional Plannin

The Impacts of Car-Free Days and Events on the Environment and Human Health.

PURPOSE OF REVIEW: In this paper, we seek to elucidate the impact of car-free days and events on human health. Car-free days and events are often designed to alleviate the impact of transportation-related air pollution, noise, physical inactivity, traffic congestion, or other detrimental externalities of private motor vehicle travel. We reviewed existing peer-reviewed and gray literature to understand the variety of potential public health impacts that have been measured as a result of car-free days or events and associated changes in environmental exposures and lifestyles. RECENT FINDINGS: The impacts of car-free days and events are highly variable and seem to depend on the scope (frequency, duration, and geographic size) and goals of each car-free day and event. Most of the existing literature measures impacts in terms of air and noise pollution and some studies focus on physical activity metrics. In some cases, car-free days and events were successful in reducing the concentration of certain air pollutants but had little or adverse impacts on the concentration of others. Often, traffic is diverted from cordoned areas to surrounding streets, displacing traffic congestion and adverse environmental exposures to other areas of a city, with potential understudied implications to environmental justice. Car-free days and events are often an attractive policy option; however, they require intensive planning to be successful. The organization and execution of car-free days and events, as well as public support and stakeholder engagement, greatly influence the level of success and the sustainability of such initiatives. Health benefits may be a palatable and convincing argument to the general public. However, very few studies focus on actual health impacts associated with car-free days and events. Future research could be most useful if it focused on measuring health outcomes associated with car-free days and events through longitudinal studies