Seventy-four patients presenting with a mixed pattern of urinary symptoms were randomly allocated to undergo either inpatient or outpatient continence programs as initial treatment, without prior urodynamic investigation. Both programs consisted of physiotherapy, bladder retraining, fluid normalization, dietary advice and general support and advice. Nine out of 39 in the outpatient group and 8 out of the 35 of the inpatient group failed to complete the study. There was a significant decrease in frequency, nocturia, number of incontinent episodes and visual analog scores for both groups. In addition the outpatients had a significant reduction in loss on pad testing, and a significantly greater improvement in their visual analog score. In each group 63% were cured or improved to the extent that they did not require further treatment. Staff costs per outpatient were half those for an inpatient. We conclude that outpatient conservative treatment as detailed above is a successful first-line treatment of urinary incontinence in women. It is as successful and possibly better than inpatient treatment, and is significantly cheaper.

Adult↗

PubMed1996

Comparison of continuous infusion of fentanyl to bolus dosing in neonates after surgery.

OBJECTIVE: Concern about respiratory depression may lead to underuse of postoperative narcotic analgesia in neonates. The authors compared continuous infusion of fentanyl with bolus dosing in infants after surgery to determine whether continuous infusion is associated with less respiratory depression. STUDY DESIGN: In the first phase of the study, 16 patients were randomly assigned to receive fentanyl by continuous infusion (C) or bolus dosing every 2 hours (B) in a double-blinded trial. Respiratory events were recorded. An observational pain score and saliva for cortisol concentration were obtained 2, 8, and 24 hours after beginning treatment to compare efficacy of pain control. In the second phase, 20 additional patients received fentanyl by continuous infusion in an unblinded fashion, with the same data collection, to more accurately determine the incidence of respiratory events. RESULTS: In phase 1, apnea occurred in eight of nine B patients (89%) compared with one of seven C patients (14%; P < .009), prompting termination of the randomized trial. The incidence of apnea or significant respiratory depression in the next 20 patients (phase 2) who received fentanyl by continuous infusion was 25% (5 of 20; P < .01 v B). Episodes of apnea in B patients required significantly more intervention than episodes in C patients (P < .01). However, in phase 2, more patients remained intubated and ventilated than in phase 1. Pain scores and salivary cortisol concentrations decreased over the 24-hour study period and were similar in B and C patients during both phases of the study. CONCLUSION: Continuous infusion of fentanyl at the doses studied is associated with pain control similar to that with bolus dosing at regular intervals. Although episodes of respiratory depression were less severe and less frequent for C patients, there may be an increased need for ventilator support with continuous infusion of fentanyl to achieve acceptable pain control. Providing adequate pain control to neonates in the immediate postoperative period remains a challenge.

Analgesics, Opioid↗

PubMed1996

Cough and asthma in children.

Explore the source record for details and available documents.

Anti-Asthmatic Agents↗

PubMed1996

Dental laboratory excellence can help build a successful practice.

Explore the source record for details and available documents.

Communication↗

PubMed1996

How does your hygiene department measure up?

Explore the source record for details and available documents.

Appointments and Schedules↗

PubMed1995

Prevalence of dementia among patients referred to an aged care assessment team and associated stress in their carers.

The objective of this study was to determine the prevalence of dementia among patients referred to an aged care assessment team and to compare levels of burden and psychological morbidity between carers of cognitively normal persons and carers of people with dementia, in this population. Validated cognitive tests were administered to participants drawn from a random sample of all persons referred to the North West Hospital Aged Care Assessment Team, and diagnoses of dementia were made according to ICD-10 criteria. Available carers were assessed for psychological morbidity and burden with the General Health Questionnaire and the Zarit Family Burden Interview. Of 100 patients selected, 78 were assessed, of whom 34 (44 per cent) were cognitively normal and 34 (44 per cent) fulfilled ICD-10 criteria for dementia. A further 8 (10 per cent) had cognitive impairment not meeting the criteria for dementia. There was a high level of psychological morbidity and burden among the carers of both the cognitively normal patients and the dementia sufferers, which was largely accounted for by the patients' physical disability. This has implication for the adequate provision of health care and services to both patients and carers of this population. Adequate education of members of aged care assessment teams in the identification of dementia and their ability to refer to appropriate dementia-specific services and provide counselling for carers requires future planning.

Activities of Daily Living↗

PubMed1995

Reviewing scientific papers.

Guidelines for the preparation of structured reports for laboratory studies, clinical studies, epidemiological studies, and observations could be useful. A structured report should prompt reviewers to acknowledge familiarity or otherwise with method, background papers, and so on. New reviewers could draw up their own system. Reports should be helpful and courteous so that whether or not the paper is accepted for publication the authors have a chance to improve it.

Education, Medical↗

PubMed1995