Treatment success for overactive bladder with urinary urge incontinence refractory to oral antimuscarinics: a review of published evidence

<p>Abstract</p> <p>Background</p> <p>Treatment options for overactive bladder (OAB) with urinary urge incontinence (UUI) refractory to oral antimuscarinics include: botulinum toxin type A (BoNTA), sacral neuromodulation (SNM), and augmentation cystoplasty (AC). A standard treatment success metric that can be used in both clinical and economic evaluations of the above interventions has not emerged. Our objective was to conduct a literature review and synthesis of published measures of treatment success for OAB with UUI interventions and to identify a treatment success outcome.</p> <p>Methods</p> <p>We performed a literature review of primary studies that used a definition of treatment success in the OAB with UUI population receiving BoNTA, SNM, or AC. The recommended success outcome was compared to generic and disease-specific health-related quality-of-life (HRQoL) measures using data from a BoNTA treatment study of neurogenic incontinent patients.</p> <p>Results</p> <p>Across all interventions, success outcomes included: complete continence (n = 23, 44%), ≥ 50% improvement in incontinence episodes (n = 16, 31%), and subjective improvement (n = 13, 25%). We recommend the OAB with UUI treatment success outcome of ≥ 50% improvement in incontinence episodes from baseline. Using data from a neurogenic BoNTA treatment study, the average change in the Incontinence Quality of Life questionnaire was 8.8 (95% CI: -4.7, 22.3) higher for those that succeeded (N = 25) versus those that failed (N = 26). The average change in the SF-6D preference score was 0.07 (95% CI: 0.02, 0.12) higher for those that succeeded versus those that failed.</p> <p>Conclusion</p> <p>A treatment success definition that encompasses the many components of underlying OAB with UUI symptoms is currently not practical as a consequence of difficulties in measuring urgency. The treatment success outcome of ≥ 50% improvement in incontinence episodes was associated with a clinically meaningful improvement in disease-specific HRQoL for those with neurogenic OAB with UUI. The recommended success definition is less restrictive than a measure such as complete continence but includes patients who are satisfied with treatment and experience meaningful improvement in symptoms. A standardized measure of treatment success will be useful in clinical and health economic applications.</p

ICAR: endoscopic skull‐base surgery

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THE STRUCTURE OF THE EIGENVECTORS OF SPARSE MATRICES

We discuss the following question: Given the zero-nonzero pattern of a matrix A with complex entries, what can be said about the zero-nonzero pattern of its eigenvectors? To be more general, what are the possible sparsity patterns for the bases of the maximal invariant subspaces of A associated with each of its eigenvalues? Or even, what is the sparsity pattern of the similarity transformation M such that M-1 AM is in Jordan canonical form, i.e., A's Jordan basis? Let struct(A) be the usual directed graph associated with the zero-nonzero pattern of A. The main result of this paper is that there exists a matrix B such that if lambda is an eigenvalue of A with algebraic multiplicity m, then there are m columns of B that form a basis for the maximal invariant subspace of A associated with lambda and such that struct(B) is a subgraph of the graph obtained by adding all the edges of the form (i, i) to the transitive closure of struct(A), which we call rstruct(A). We show that if the defective eigenvalues of A have geometric multiplicity one, then the matrix B above can be chosen in such a way that there exists a permutation matrix P for which BP is a Jordan basis of A. We present examples and theorems showing that our results are sharp. Similar results hold for the real Jordan canonical form.20712

The affine scaling algorithm fails for stepsize 0.999

We present two examples in which the dual affine scaling algorithm converges to a vertex that is not optimal if at each iteration we move 0.999 of the step to the boundary of the feasible region.71344

ON PARLETTS MATRIX NORM INEQUALITY FOR THE CHOLESKY DECOMPOSITION

We show that a certain matrix norm ratio studied by Parlett has a supremum that is O(root n) when the chosen norm is the Frobenius norm, while it is O(log n) for the 2-norm. This ratio arises in Parlett's analysis of the Cholesky decomposition of an n by n matrix.2324325

Method of sentinels for packing items within arbitrary convex regions

A new method is introduced for packing items in convex regions of the Euclidian n-dimensional space. By means of this approach the packing problem becomes a global finite-dimensional continuous optimization problem. The strategy is based on the new concept of sentinels. Sentinels sets are finite subsets of the items to be packed such that, when two items are superposed, at least one sentinel of one item is in the interior of the other. Minimal sets of sentinels are found in simple two-dimensional cases. Numerical experiments and pictures showing the potentiality of the new technique are presented.57673574