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C Maher

Publications and source records attributed to C Maher.

At least 19 recordsLinked to original sources
PubMed2006

Conservative management of pelvic organ prolapse in women.

BACKGROUND: Pelvic organ prolapse is common, and some degree of prolapse is seen in 50% of parous women. Women with prolapse can experience a variety of pelvic floor symptoms. Treatments include surgery, mechanical devices and conservative management. Conservative management approaches, such as giving lifestyle advice and delivering pelvic floor muscle training, are often used in cases of mild to moderate prolapse. OBJECTIVES: To determine the effects of conservative management (physical interventions and lifestyle interventions) for women with pelvic organ prolapse in comparison with no treatment or other treatment options (such as mechanical devices or surgery). SEARCH STRATEGY: We searched the Cochrane Incontinence Group Specialised Trials Register (searched on 19 September 2005), MEDLINE (January 1966 to August 2005), MEDLINE In Process & Other Citations (15 September 2005), EMBASE (January 1996 to Week 43 2005), CINAHL (January 1982 to October 2005), PEDro (September 2005), the UK National Research Register (Issue 3, 2005), the US National Institute of Health clinical trial register (5 October 2005), Current Controlled Trials register (5 October 2005), Controlled Clinical Trials (September 2005) and ZETOC (September 2005). We searched the reference lists of relevant articles. SELECTION CRITERIA: Randomised and quasi-randomised trials in women with pelvic organ prolapse that included a physical or lifestyle intervention in at least one arm of the trial. DATA COLLECTION AND ANALYSIS: Two reviewers assessed all trials for inclusion/exclusion and methodological quality. Data were extracted by the lead reviewer onto a standard form and cross checked by another. Disagreements were resolved by discussion. Data were processed as described in the Cochrane Handbook for Systematic Reviews of Interventions. MAIN RESULTS: Three trials of relevance to this review were identified. The largest of these, of pelvic floor muscle training in preventing anterior prolapse from worsening, had significant limitations which affect the generalisability and rigor of the findings. A small feasibility study (which is to be followed up with a larger trial) randomised 47 women to pelvic floor muscle training or control and found suggestions of better outcomes (better self-reported improvement, decreased severity) in the intervention group. The third trial evaluated peri-operative physiotherapy for women undergoing surgery for prolapse and/or incontinence. The authors report that urinary symptoms, pelvic floor muscle function and quality of life were improved more in the treatment group than the control group, but data were not provided to allow this to be assessed. The trial was small and no prolapse-specific outcome measures were used. It was not possible to combine data from the three trials. AUTHORS' CONCLUSIONS: Despite there now being reports of three eligible trials in this update, the evidence available is not significant to guide practice. There is some encouragement from a feasibility study that pelvic floor muscle training, delivered by a physiotherapist to symptomatic women in an outpatient setting, may reduce severity of prolapse. Further evidence from larger, better quality randomised control trials is however still necessary.

Adult↗
PubMed2006

Mass vaccination campaigns for polio eradication: an essential strategy for success.

Effective vaccines against poliomyelitis became available in the mid-1950s and early 1960s. Mass campaigns were an integral part of early control efforts. Thereafter, polio vaccines were used largely in routine childhood programs. The resolution in 1988 to eradicate polio globally led to the development of appropriate strategies to achieve this goal, including mass vaccination campaigns (i.e., national immunization days, sub-national immunization days and mop-up activities), to achieve the highest possible coverage in the shortest possible time. Unlike other vaccines, mass campaign use of oral poliovirus vaccine enhances the immunogenicity of this vaccine, primarily due to: (1) the decrease in the prevalence of other enteroviruses that potentially interfere with seroconversion; and (2) the secondary spread of vaccine virus from vaccinees to close contacts, resulting in seroconversion of some unvaccinated contacts. To reach the highest possible coverage, detailed planning, meticulous execution, careful supervision and standardized monitoring are critical. A number of innovative approaches to improve the quality and/or coverage have become the 'standard' of supplemental immunization activities. These mass campaigns have led to dramatic decreases in the incidence of polio. This chapter reviews the scientific, operational and programmatic data on mass campaign use of polio vaccines, and summarize the lessons learnt from implementing the mass vaccination strategies used to eradicate poliomyelitis globally.

Community Health Planning↗
PubMed2004

Surgical management of pelvic organ prolapse in women.

BACKGROUND: Pelvic organ prolapse may occur in up to 50% of parous women. A variety of urinary, bowel and sexual symptoms may be associated with prolapse. OBJECTIVES: To determine the effects of surgery in the management of pelvic organ prolapse. SEARCH STRATEGY: We searched the Cochrane Incontinence Group trials register (8 June 2004) and reference lists of relevant articles. We also contacted researchers in the field. SELECTION CRITERIA: Randomised or quasi-randomised controlled trials that included surgical operations for pelvic organ prolapse. DATA COLLECTION AND ANALYSIS: Trials were assessed and data extracted independently by at least two reviewers. Four investigators were contacted for additional information with two responding. MAIN RESULTS: Fourteen randomised controlled trials were identified evaluating 1004 women. Abdominal sacral colpopexy was better than vaginal sacrospinous colpopexy in terms of a lower rate of recurrent vault prolapse (RR 0.23, 95% CI 0.07 to 0.77) and less dyspareunia (RR 0.39, 95% CI 0.18 to 0.86), but the trend towards a lower re-operation rate for prolapse following abdominal sacrocolpopexy was not statistically significant (RR 0.46, 95% CI 0.19 to 1.11). However, the vaginal sacrospinous colpopexy was quicker and cheaper to perform and women had an earlier return to activities of daily living. The data were to evaluate other clinical outcomes and adverse events. For the anterior vaginal wall prolapse, standard anterior repair was associated with more recurrent cystoceles than when supplemented by Vicryl mesh overlay (RR 1.39, 95% CI 1.02 to 1.90) but data on morbidity and other clinical outcomes were too few for reliable comparisons. For posterior vaginal wall prolapse, the vaginal approach was associated with a lower rate of recurrent rectocele and/or enterocele than the transanal approach (RR 0.24, 95% CI 0.09 to 0.64), although there was a higher blood loss and postoperative narcotic use. However, data on the effect of surgery on bowel symptoms and the use of polyglactin mesh overlay on the risk of recurrent rectocele were insufficient for meta-analysis.Meta-analysis on the impact of pelvic organ prolapse surgery on continence issues was limited and inconclusive, although about 10% of women developed new symptoms after surgery. However, more women with occult stress urinary incontinence developed postoperative stress urinary incontinence after endopelvic fascia plication alone than after endopelvic fascia plication and tension-free vaginal tape (RR 5.5, 95% CI 1.36 to 22.32). REVIEWERS' CONCLUSIONS: Abdominal sacrocolpopexy is associated with a lower rate of recurrent vault prolapse and dyspareunia than the vaginal sacrospinous colpopexy. These benefits must be balanced against a longer operating time, longer time to return to activities of daily living and increased cost of the abdominal approach. The use of a polyglactin mesh overlay at the time of anterior vaginal wall repair may reduce the risk of recurrent cystocele. Posterior vaginal wall repair may be better than transanal repair in the management of rectoceles in terms of recurrence of prolapse. Adequately powered randomised controlled clinical trials are urgently needed.

Female↗
PubMed2004

Conservative management of pelvic organ prolapse in women.

BACKGROUND: Pelvic organ prolapse is common, and some degree of prolapse is seen in 50% of parous women. Women with prolapse can experience a variety of pelvic floor symptoms. Treatments include surgery, mechanical devices and conservative management. Conservative management approaches, such as giving lifestyle advice and delivering pelvic floor muscle training, are often used in cases of mild to moderate prolapse. OBJECTIVES: To determine the effects of conservative management (physical interventions, such as pelvic floor muscle training and lifestyle interventions) for women with pelvic organ prolapse in comparison with no treatment or other treatment options (such as mechanical devices or surgery). SEARCH STRATEGY: We searched the Cochrane Incontinence Group trials register (February 2004), MEDLINE (January 1966 to January 2003), PREMEDLINE (15 January 2003), EMBASE (January 1996 to January 2003), CINAHL (January 1982 to February 2003), PEDro (October 2003), the UK National Research Register (Issue 3, 2003), Controlled Clinical Trials (April 2003) and ZETOC (April 2003). We searched the reference lists of relevant articles. SELECTION CRITERIA: Randomised and quasi-randomised trials in women with pelvic organ prolapse that included a physical or lifestyle intervention in at least one arm of the trial. DATA COLLECTION AND ANALYSIS: No eligible completed, published or unpublished, randomised controlled trials were found; therefore no data collection or analysis were undertaken. MAIN RESULTS: No published reports of randomised controlled trials relevant to the review objectives were found. Three ongoing randomised controlled trials of physiotherapy interventions which include some women with prolapse were identified. REVIEWERS' CONCLUSIONS: Currently there is no rigorous evidence from randomised controlled trials regarding the use of conservative interventions in the management of pelvic organ prolapse.

Adult↗
PubMed2004

Mechanical devices for pelvic organ prolapse in women.

BACKGROUND: Pelvic organ prolapse is common, with some degree of prolapse seen in up to 50% of parous women in a clinic setting although many are asymptomatic. A number of symptoms may be associated with prolapse and treatments include surgery, mechanical devices and conservative therapies. A variety of mechanical devices or pessaries are described which aim to alleviate the symptoms of prolapse and avert or delay the need for surgery. OBJECTIVES: To determine the effects of mechanical devices for pelvic organ prolapse. SEARCH STRATEGY: We searched the Cochrane Incontinence Group trials register (24 February 2004), MEDLINE (January 1966 to January 2003), PREMEDLINE (15 January 2003), EMBASE (January 1996 to January 2003), CINAHL (January 1982 to February 2003), PEDro (October 2003), the UK National Research Register (Issue 3, 2003), Controlled Clinical Trials (April 2003) and ZETOC (April 2003). We searched the reference lists of relevant articles. SELECTION CRITERIA: Randomised and quasi-randomised controlled trials which included a mechanical device for pelvic organ prolapse in one arm of the study. DATA COLLECTION AND ANALYSIS: No eligible, completed, published or unpublished randomised controlled studies were found, therefore no data collection or analysis was possible. MAIN RESULTS: There was a dearth of studies on the use of mechanical devices and no published reports of randomised trials were identified. One study on pessary usage was excluded as it was not a randomised trial. REVIEWERS' CONCLUSIONS: Currently there is no evidence from randomised controlled trials upon which to base treatment of women with pelvic organ prolapse through the use of mechanical devices/pessaries. There is no consensus on the use of different types of device, the indications, nor the pattern of replacement and follow-up care. There is an urgent need for randomised studies to address the use of mechanical devices in comparison with no treatment, surgery and conservative measures.

Female↗
PubMed2002

Manual examination of accessory movements--seeking R1.

Movement diagrams are used by physiotherapists to depict the behaviour of resistance through the available range of accessory and physiological joint movement. It is generally accepted that for an asymptomatic joint, the resistance first felt by the therapist (R1) occurs towards the end of range. R1 is considered to be at the transition point between the toe and linear region of a load displacement curve. The aim of this study was to more accurately define R1 from force displacement curves of accessory movement to the spine and peripheral joints using a validated instrument, the Spinal Assessment Machine (SAM). Thirty archived force displacement curves obtained using the SAM, which applied a posteroanterior force of 100N at a frequency of 0.5 Hz to L3 spinous process, were examined. In addition force displacement curves were similarly obtained from the tibiofemoral joint, glenohumeral joint and radiocarpal joint of one asymptomatic individual. In all cases resistance to a PA movement commenced at the beginning of range, the curve ascending as soon as the force was applied. While in most cases there was a low stiffness 'toe' region there was no unambiguous point where it could be said that the toe region ended. It is concluded that for spinal and peripheral accessory movements both the onset of resistance and the toe occurs at the beginning of range. Therapists should therefore depict R1 at the beginning of range not toward the end of range as is current practice.

Humans↗
PubMed2001

Pubovaginal or vicryl mesh rectus fascia sling in intrinsic sphincter deficiency.

The aim of this study was to compare the pubovaginal sling with a new Vicryl mesh rectus fascia (VMRF) sling in the surgical treatment of low urethral pressure genuine stress incontinence. Fifty-one consecutive women who had a VMRF (n = 27) or a pubovaginal sling (n = 24) procedure between March 1995 and December 1997 were evaluated. The patient-determined subjective success rate of the VMRF sling (85%) was significantly higher than that of the pubovaginal sling (58%) in women with low urethral pressure stress incontinence (P=0.03). The objective success rates following the VMRF and the pubovaginal sling were 52% and 50%, respectively. The prevalence of postoperative symptomatic voiding dysfunction and de novo detrusor instability was 7% after the VMRF sling and 25% following the pubovaginal sling (P = 0.08). The VMRF sling had a higher patient-determined success rate and a lower complication rate than the pubovaginal sling, and should be considered in the surgical management of women with low urethral pressure stress incontinence.

Adult↗
PubMed2001

Stiffness properties of the human lumbar spine: a lumped parameter model.

OBJECTIVE: To characterise with a mechanical model, the force-displacement response of the human lumbar spine to postero-anterior loading. DESIGN: Single case with repetition. BACKGROUND: Previous attempts to characterise the spine's force-displacement response have been simplistic and only considered the loading curve. These approaches ignored valuable information such as viscosity, non-linear elasticity and inertia of the lumbar spine. METHODS: The Spinal Assessment Machine applied a postero-anterior load to the spines of 23 asymptomatic subjects and measured the force-displacement response. The data was analysed by two methods; by a traditional linear regression of part of the loading curve and by a new method where an equation including non-linear stiffness and damping was used to characterise the whole force-displacement relationship. RESULTS: The equation developed was found to account for virtually all of the variance in the raw data (R2 > 0.993). Four elements derived by the equation determine the contributions of linear elasticity, non-linear elasticity, linear viscosity and non-linear viscosity to the overall stiffness. CONCLUSIONS: Considering the excellent fit of the new equation to the raw data and its poor correlation with existing measures, it is proposed that the traditional measures provide an incomplete description of the force-displacement response. Relevance. Therapists use their perception of the force-displacement response of the spine to select the type of manipulative treatment to apply. To study this aspect of patient care, devices capable of measuring spinal stiffness have been developed, however to date the obtained data has been analysed only simply. A lumped parameter mechanical model incorporating non-linear damping and stiffness provides a more complete description of the force-displacement response and thus may offer added insight into the manipulative treatment of spinal pain.

Adult↗
PubMed2001

Sacral nerve root stimulation for lower urinary tract dysfunction: overcoming the problem of lead migration.

OBJECTIVE: To evaluate lead migration for two different test electrodes and the response to trial stimulation of the S3 nerve root during the selection of patients for a sacral neuromodulation implant to manage lower urinary tract dysfunction. PATIENTS AND METHODS: Twelve women (mean age 49 years, range 23-79; seven with detrusor instability and five with sensory urgency) undergoing peripheral nerve evaluation for refractory lower urinary tract symptoms were recruited. Urodynamics and a urinary diary were completed before and during test stimulation. Two electrodes (the original 041830-002 and new 3057 models, Medtronics Inc, USA) were inserted under local anaesthesia into the S3 nerve roots bilaterally. The location was determined by the functional response to stimulation. Stimulation was applied for one week using the new lead; a positive response was defined as a subjective improvement (> 50%) in urinary symptoms. Lateral sacral X-rays were taken after placement and before removing the lead. The distance from the lead tip to the ventral aspect of the S3 sacral foramen was measured by two assessors. RESULTS: Ten of the women had a positive response; the mean (range) migration of the new lead (on X-ray) was 4 (2-11) mm, and of the old lead was 12 (10-45) mm (P = 0.02). CONCLUSION: The response rate to trial stimulation was greater than in previous studies, possibly reflecting reduced migration of the new lead. The new electrode may reduce the number of test failures caused by lead migration rather than no response.

Adult↗
PubMed2001

Responsiveness of visual analogue and McGill pain scale measures.

OBJECTIVE: To compare the responsiveness of the McGill Pain Questionnaire with the Visual Analogue Scale (VAS). DESIGN: A repeated measures 2-group design was used, with subjects divided into "improved" and "non-improved" groups. The external criterion to identify improved and non-improved patients was a 7-point global perceived effect scale. SUBJECTS: Seventy-five patients with low back pain who had participated in a randomized controlled trial of postsurgical rehabilitation were included in the study. INTERVENTIONS: All patients completed both a VAS and McGill pain scale to describe their pain over the last 24 hours and a separate VAS to describe their current pain. MAIN OUTCOME MEASURES: Responsiveness was evaluated by using receiver-operating characteristic curves, with the analysis repeated for a range of cut-off points on the global perceived effect scale. Secondary analyses of responsiveness were provided by the t value for independent change scores and Spearman's rank correlation coefficient (rho). RESULTS: The study confirmed the results of earlier studies in finding that the VAS was less responsive to clinical change when used to rate current pain in comparison with pain over the last 24 hours. The study found that the VAS was more responsive than the McGill Pain Questionnaire when both instruments were used to rate pain over the last 24 hours. CONCLUSION: The results of this study suggest that the VAS may be a better tool than the McGill Pain Questionnaire for measuring pain in clinical trials and clinical practice.

Aged↗
PubMed2000

Magnitude estimation of manually assessed elastic stiffness: stability of the exponent.

Magnitude estimations were obtained for manual assessments of pure elastic stiffness stimuli (metal springs). 20 subjects of varied experience in manual assessment of spinal stiffness volunteered to participate. The mean exponent of the power function relating perceived magnitude of elastic stiffness to measured physical magnitude was 1.65. Exponents varied across the 20 individuals but were stable across testing sessions held at least 2 weeks apart, and the size of the exponent was not related to prior experience.

Adult↗
PubMed2000

PEDro.

Explore the source record for details and available documents.

Academies and Institutes↗
PubMed1999

The Burch colposuspension for recurrent urinary stress incontinence following retropubic continence surgery.

OBJECTIVE: To evaluate the Burch colposuspension with Cherney incision in women with recurrent urinary stress incontinence after retropubic continence surgery. DESIGN: A retrospective review. PARTICIPANTS: All 53 women had recurrent urinary stress incontinence after retropubic continence surgery with an average of 2.1 (range 1-5) previous failed continence procedures per woman. MAIN OUTCOME MEASURES: Subjective and objective success rates and complications including detrusor instability, voiding difficulties and genital prolapse. RESULTS: Forty-seven women (89%) had no or occasional (< one episode per week) stress or urge incontinence. One woman had persistent stress incontinence and five urge incontinence. Forty-two women (80%) rated their surgery as being highly successful and 38 women (72%) had no urinary leakage due to genuine stress incontinence or detrusor instability on repeat urodynamic evaluation. Three women (6%) developed de novo detrusor instability post-operatively. Two women (4%) had voiding difficulties post-operatively that necessitated the use of intermittent self-catheterisation for at least four months. The median length of follow up was nine months (4-72). In 39 women (73%), marked retropubic fibrosis was found at the time of surgery. CONCLUSIONS: Marked retropubic fibrosis should be expected in women with recurrent stress incontinence after retropubic continence surgery. The Burch colposuspension with the assistance of the Cherney incision and sharp dissection of retropubic fibrosis is an effective and safe procedure for women with this condition.

Adult↗
PubMed1999

Listeria monocytogenes Scott A: cell surface charge, hydrophobicity, and electron donor and acceptor characteristics under different environmental growth conditions.

We determined the variations in the surface physicochemical properties of Listeria monocytogenes Scott A cells that occurred under various environmental conditions. The surface charges, the hydrophobicities, and the electron donor and acceptor characteristics of L. monocytogenes Scott A cells were compared after the organism was grown in different growth media and at different temperatures; to do this, we used microelectrophoresis and the microbial adhesion to solvents method. Supplementing the growth media with glucose or lactic acid affected the electrical, hydrophobic, and electron donor and acceptor properties of the cells, whereas the growth temperature (37, 20, 15, or 8 degrees C) primarily affected the electrical and electron donor and acceptor properties. The nonlinear effects of the growth temperature on the physicochemical properties of the cells were similar for cells cultivated in two different growth media, but bacteria cultivated in Trypticase soy broth supplemented with 6 g of yeast extract per liter (TSYE) were slightly more hydrophobic than cells cultivated in brain heart infusion medium (P < 0.05). Adhesion experiments conducted with L. monocytogenes Scott A cells cultivated in TSYE at 37, 20, 15, and 8 degrees C and then suspended in a sodium chloride solution (1.5 x 10(-1) or 1.5 x 10(-3) M NaCl) confirmed that the cell surface charge and the electron donor and acceptor properties of the cells had an influence on their attachment to stainless steel.

Bacterial Adhesion↗
PubMed1999

Double fluorescent-amplification refractory mutation detection (dF-ARMS) of the factor V Leiden and prothrombin mutations.

Simultaneous fluorescent [F] detection of the factor V Leiden (G1691A) and the prothrombin 3'-untranslated region (G20210A) mutations were performed in a single tube polymerase chain reaction (PCR). Amplification refractory mutation detection system (ARMS) formed the basis of this assay design. Fluorescent-labelled primers incorporated into amplicons during the reaction facilitated detection directly by GeneScan analysis without further manipulation. To test the efficacy of this double [F]-ARMS (dF-ARMS) method, 48 patients with unexplained thrombotic tendencies were investigated for their factor V Leiden and prothrombin genotypes. These results corresponded exactly with data achieved using the more conventional methods of restriction fragment length polymorphism (RFLP)-PCR and direct DNA sequencing. Three out of the 48 patients in this group were found to be compound heterozygotes.

Alleles↗
PubMed1998

Disease eradication and health systems development.

This article provides a framework for the design of future eradication programmes so that the greatest benefit accrues to health systems development from the implementation of such programmes. The framework focuses on weak and fragile health systems and assumes that eradication leads to the cessation of the intervention required to eradicate the disease. Five major components of health systems are identified and key elements which are of particular relevance to eradication initiatives are defined. The dearth of documentation which can provide "lessons learned" in this area is illustrated with a brief review of the literature. Opportunities and threats, which can be addressed during the design of eradication programmes, are described and a number of recommendations are outlined. It is emphasized that this framework pertains to eradication programmes but may be useful in attempts to coordinate vertical and horizontal disease control activities for maximum mutual benefits.

Communicable Disease Control↗