Search

Aims: People who live in rural areas have reduced access to appropriate and timely healthcare, leading to poorer health outcomes than their metropolitan‐based counterparts. The aims of the workshops were to ascertain participants' perspectives on barriers to access to dialysis and transplantation, to identify and prioritize the roles of a rural patient navigator, to discuss the acceptability and feasibility of implementing this role and identify possible outcomes that could be used to measure the success of the programme in a clinical trial. Methods: Rural patients (n = 19), their caregivers (n = 5) and health professionals (n = 18) from Australia participated in three workshops. We analysed the data using thematic analysis. Results: We identified four themes related to access to dialysis and transplantation: overwhelmed by separate and disconnected health systems, unprepared for emotional toll and isolation, lack of practical support and inability to develop trust and rapport. Four themes related to the role of the patient navigator programme: valuing lived experience, offering cultural expertise, requiring a conduit, and flexibility of the job description. The key roles prioritized by participants were psychological support and networking, provision/consolidation of education, and provision of practical support. Conclusion: Rural patients, caregivers and health professionals believed that programmes that include navigators with lived experience of dialysis and kidney transplantation and cultural expertise, especially for Aboriginal Australians, may have the potential to improve patient experiences in accessing healthcare. Summary at a Glance: Rural patient navigator programmes have potential to improve access to kidney replacement therapy for rural patients. Workshops were held to inform the co‐design and implementation of a rural patient navigator programme for adults with CKD, with a particular focus on improving access to all modalities of dialysis and kidney transplantation. The programme will include the features prioritized by the participants (rural patients, caregivers and their health providers) including education, cultural safety and connection, communication, valuing of lived experience and being flexible to the differing needs of people from different communities. [ABSTRACT FROM AUTHOR]

Severe acute respiratory syndrome‐coronavirus 2 (SARS‐CoV‐2) viral loads change rapidly following symptom onset, so to assess antivirals it is important to understand the natural history and patient factors influencing this. We undertook an individual patient‐level meta‐analysis of SARS‐CoV‐2 viral dynamics in humans to describe viral dynamics and estimate the effects of antivirals used to date. This systematic review identified case reports, case series, and clinical trial data from publications between January 1, 2020, and May 31, 2020, following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. A multivariable Cox proportional hazards (Cox‐PH) regression model of time to viral clearance was fitted to respiratory and stool samples. A simplified four parameter nonlinear mixed‐effects (NLME) model was fitted to viral load trajectories in all sampling sites and covariate modeling of respiratory viral dynamics was performed to quantify time‐dependent drug effects. Patient‐level data from 645 individuals (age 1 month to 100 years) with 6,316 viral loads were extracted. Model‐based simulations of viral load trajectories in samples from the upper and lower respiratory tract, stool, blood, urine, ocular secretions, and breast milk were generated. Cox‐PH modeling showed longer time to viral clearance in older patients, men, and those with more severe disease. Remdesivir was associated with faster viral clearance (adjusted hazard ratio (AHR) = 9.19, P < 0.001), as well as interferon, particularly when combined with ribavirin (AHR = 2.2, P = 0.015; AHR = 6.04, P = 0.006). Combination therapy should be further investigated. A viral dynamic dataset and NLME model for designing and analyzing antiviral trials has been established. [ABSTRACT FROM AUTHOR]

A structurally identifiable micro‐rate constant mechanistic model was used to describe the interaction between pitavastatin and eltrombopag, with improved goodness‐of‐fit values through comeasurement of pitavastatin and eltrombopag. Transporter association and dissociation rate constants and passive rates out of the cell were similar between pitavastatin and eltrombopag. Translocation into the cell through transporter‐mediated uptake was six times greater for pitavastatin, leading to pronounced inhibition of pitavastatin uptake by eltrombopag. The passive rate into the cell was 91 times smaller for pitavastatin compared with eltrombopag. A semimechanistic physiologically‐based pharmacokinetic (PBPK) model was developed to evaluate the potential for clinical drug–drug interactions (DDIs). The PBPK model predicted a twofold increase in the pitavastatin peak blood concentration and area under the concentration‐time curve in the presence of eltrombopag in simulated healthy volunteers. The use of structural identifiability supporting experimental design combined with robust micro‐rate constant parameter estimates and a semimechanistic PBPK model gave more informed predictions of transporter‐mediated DDIs. [ABSTRACT FROM AUTHOR]

Aims: The aim of our study was to investigate noninvasive predictors for detrusor underactivity (DUA) in male patients with lower urinary tract symptoms (LUTS) and benign prostatic enlargement (BPE). Methods: A consecutive series of patients aged 45 years or older with non‐neurogenic LUTS were prospectively enrolled. Patients underwent standard diagnostic assessment including International Prostatic Symptoms Score, uroflowmetry, urodynamic studies (cystometry and pressure‐flow studies), transrectal ultrasound of the prostate, and ultrasound measurements of the bladder wall thickness (BWT). Logistic regression analysis was used to investigate predictors of DUA, defined as a bladder contractility index < 100 mm H2O. A nomogram was developed based on the multivariable logistic regression model. Results: Overall 448 patients with a mean age of 66 ± 11 years were enrolled. In a multivariable logistic age‐adjusted regression model BWT (odds ratio [OR]: 0.50 per mm; 95% confidence interval [CI], 0.30‐0‐66; P =.001) and Qmax (OR: 0.75 per mL/s; 95% CI, 0.70‐0.81; P =.001) were significant predictors for DUA. The nomogram based on the model presented good discrimination (area under the curve [AUC]: 0.82), good calibration (Hosmer‐Lemeshow test, P >.05) and a net benefit in the range of probabilities between 10% and 80%. Conclusions: According to our results, BWT and Qmax can noninvasively predict the presence of DUA in patients with LUTS and BPE. Although our study should be confirmed in a larger prospective cohort, we present the first available nomogram for the prediction of DUA in patients with LUTS. [ABSTRACT FROM AUTHOR]

Abstract: Walking and cycling have been transformed by digital technologies, which range from mapping apps for wayfinding, through ‘wearables’ which monitor activity, to social media apps for comparing activity within social groups. Some technologies are explicitly orientated to health projects, others are not, yet all have potentially profound effects on bodies, health‐orientated identities, and understandings of health. This paper uses the concept of biomedicalisation to explore emerging literature on the intersection of digital technologies with everyday mobility, focusing on walking and cycling. Beyond simply ‘medicalising’ mobility (by bringing it into the realm of public health), digital technologies contribute to various transformations of health: encouraging some health practices, inhibiting others; creating or excluding individual and collective health‐related identities; and reconfiguring health and well‐being. There is research evidence on the contingent and multiple relationships between digital technologies and social practices, with specific themes including quantification; the role of apps in framing walking as extraordinary, cycling as competitive; enabling users to perform as healthy, neoliberal citizens; and digital careers. There has been less attention on how social divisions are reproduced or disrupted by the mediation of mobility through digital technologies. Further research should consider the impact of digital technologies on political economies of health. [ABSTRACT FROM AUTHOR]

Aims To evaluate the role of Bladder wall thickness (BWT) as a predictor of Detrusor overactivity (DO) in patients with Lower urinary tract symptoms (LUTS)/Benign prostatic enlargement without Bladder Outlet Obstruction. Methods From January 1996 to December 2000, each new patient, aged 45 years or older with LUTS, underwent standard diagnostic assessment, urodynamic studies (cystometry and pressure flow studies), and ultrasound measurements of the bladder wall thickness (BWT) in two centers. In order to exclude the possible effect of benign prostatic obstruction (BPO) on detrusor thickness, patients with a Schaefer class was ≥2 were excluded from the study. The area under the receiver operating characteristics curve (AUC) quantified the predictive accuracy (PA) of BWT for the diagnosis of DO. Results Overall 195 patients were enrolled. DO was observed in 98/195 patients (50%). The BWT presented an AUC of 0.70; 95% CI: 0.62-0.77 for the diagnosis of DO. At the best cut-off value of 3.85 mm sensitivity was 73%; specificity was 59%; positive predictive value (64%, PPV). Negative predictive value (69%, NPV). Conclusions Our study firstly showed, how BWT in male patients may be a consequence of DO other than BPO. Our finding, if confirmed in further studies, could limit the accuracy of BWT in patients with DO and BPO. [ABSTRACT FROM AUTHOR]

The understanding of the role of complement dysregulation in atypical haemolytic uraemic syndrome (aHUS) has led to major changes in therapeutic approaches and outcomes. Eculizumab is a humanized anti-C5 monoclonal antibody that inhibits the terminal complement pathway and has revolutionized the treatment and prognosis of aHUS. However, published reports to date have had relatively short-term follow-up. We report two paediatric cases of aHUS successfully treated with eculizumab longer than 6 years with no serious adverse events and preservation of renal function. [ABSTRACT FROM AUTHOR]

Aims To develop a nomogram predicting benign prostatic obstruction (BPO). Methods We included in this study 600 men with lower urinary tract symptoms (LUTS) and benign prostatic enlargement (BPE) who underwent standardized pressure flow studies (PFS) between 1996 and 2000. Complete clinical and urodynamic data were available for all patients. Variables assessed in univariate and multivariate logistic regression models consisted of IPSS, PSA, prostate size, maximal urinary flow rate (Qmax) at free flow, residual urine (RU), and bladder wall thickness (BWT). These were used to predict significant BPO (defined as a Schäfer grade ≥ 3 in PFS). Results A preliminary multivariate model, including IPSS, Qmax at free flow and RU, suggested that only Qmax at free flow was a statistically significant predictor of BPO ( P = 0.00) with a predictive accuracy (PA) of 82%. Further development of the multivariate model showed how the inclusion of BWT did not increase PA. Only transitional zone volume (TZV) proved to be an additional statistically significant predictor for BPO ( P = 0.00). The combination of Qmax at free flow and TZV demonstrated a PA of 83.2% and were included in the final nomogram format. Conclusions We developed a clinical nomogram, which is both accurate and well calibrated, which can be helpful in the management of patients with LUTS and BPE. External validation is warranted to confirm our findings. Neurourol. Urodynam. 35:235-240, 2016. © 2014 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Biosecurity, as a response to threats from zoonotic, food-borne and emerging infectious diseases, implies and is often understood in terms of a spatial segregation of forms of life, a struggle to separate healthy life from diseased bodies. While an ensuing will to closure in the name of biosecurity is evident at various sites, things are, in practice and in theory, more intricate than this model would suggest. There are transactions and transformations that defy easily segmented spaces. Using multi-species ethnographic work across a range of sites, from wildlife reserves to farms and food processing plants, we argue for a shift of focus in biosecurity away from defined borderlines towards that of borderlands. The latter involves the detachment of borders from geographic territory and highlights the continuous topological interplay and resulting tensions involved in making life live. We use this spatial imagination to call for a different kind of biopolitics and for a shift in what counts as a biosecurity emergency. As a means to re-frame the questions concerning biosecurity, we argue for a change of discourse and practice away from disease 'breach points' towards the 'tipping points' that can arise in the intense foldings that characterise pathological lives. [ABSTRACT FROM AUTHOR]

This paper traces the emergence of the therapeutic use of sunlight in medicine during the first half of the twentieth century. This was a period of considerable flux in medicine with various strands of practice and theory competing. Drawing on two case studies of sunlight therapy, both artificial (actinotherapy) and natural (heliotherapy), in the treatment of rickets and tuberculosis this paper will explore how medicine was constituted within these regimes. The paper will argue that therapeutic and clinical applications of sunlight helped establish an association between sunlight and health but also defined a particular and specific performance of medicine. [ABSTRACT FROM AUTHOR]

The article presents a study which examines the clinical coding error rate in urological practice. It states that the study aims to identify the causal factors of the errors, and to calculate the total lost revenue. It mentions that the study found that the coding errors occur due to the inadequate knowledge of clinical coders in urology, the use of medical terminology, and the mis-coding of the comorbidities of patients.

To investigate the variation in urodynamic variables during repeated filling cystometry and the impact that the variability had on the observed incidence of detrusor overactivity, to evaluate the correlation of detrusor overactivity with the symptoms of urge in men with lower urinary tract symptoms (LUTS), and to compare the variability of detrusor overactivity in men with LUTS to that in men with spinal cord injury (SCI).Sixty men with LUTS and 35 with neurogenic bladders after SCI were assessed. Investigations included the International Prostate Symptom Score (IPSS), Madsen–Iversen Symptom Score (MSS), uroflowmetry, filling cystometry and pressure-flow, in three successive studies.In men with LUTS, a significant decrease in the number and pressure of involuntary detrusor contractions (IDCs) in consecutive cystometries resulted in a reduction of observed detrusor overactivity from 72% to 63% and 48%, in the three studies. Urgency scores were significantly lower in men who became‘stable’ than in those who remained‘unstable’ throughout the three studies. In men with SCI, cystometric variables and detrusor overactivity remained consistent over sequential studies.Urodynamic detrusor overactivity is affected by repeated cystometry. In men with LUTS, two populations with detrusor overactivity were identified; one group adapted to repeated filling while another had persistent IDCs and greater urgency scores. The latter group had bladder behaviour similar to that of men with neurogenic bladders secondary to SCI. These findings might be important in explaining the cause of symptoms, initiating further investigation, and predicting the outcome of therapy. [ABSTRACT FROM AUTHOR]

To determine whether prostate specific antigen (PSA) level can usefully predict or exclude bladder outlet obstruction (BOO), in men with lower urinary tract symptoms (LUTS).A cohort of men from 1996 to 1999 who had LUTS caused by BPH was evaluated by serum PSA and pressure-flow urodynamic studies, and a blinded comparison made. The settings were teaching hospitals in London, UK and L’Aquila, Italy. Men (302) were referred by primary-care practitioners with LUTS and a PSA of< 10 ng/mL. Regression analysis was used to predict the extent of BOO, and create likelihood ratios and predictive values for BOO according to the PSA value.PSA was significantly associated with BOO (P < 0.001;r2 0.07), with significant likelihood ratios altering the probability of BOO. If the PSA was> 4 ng/mL, mild or definite BOO was likely (89%), whereas if the PSA was<2 ng/mL, there was about a one-third chance each of no, mild and definite BOO.High PSA levels in patients with LUTS are significantly associated with BOO; low PSA levels mean that definite BOO is unlikely. [ABSTRACT FROM AUTHOR]

Population pharmacokinetic (PK) models are widely used to inform drug development by pharmaceutical companies and facilitate drug evaluation by regulatory agencies. Developing a population PK model is a multi‐step, challenging, and time‐consuming process involving iterative manual model fitting and evaluation. A tool for fully automatic model development (AMD) of common population PK models is presented here. The AMD tool is implemented in Pharmpy, a versatile open‐source library for pharmacometrics. It consists of different modules responsible for developing the different components of population PK models, including the structural model, the inter‐individual variability (IIV) model, the inter‐occasional variability (IOV) model, the residual unexplained variability (RUV) model, the covariate model, and the allometry model. The AMD tool was evaluated using 10 real PK datasets involving the structural, IIV, and RUV modules in three sequences. The different sequences yielded generally consistent structural models; however, there were variations in the results of the IIV and RUV models. The final models of the AMD tool showed lower Bayesian Information Criterion (BIC) values and similar visual predictive check plots compared with the available published models, indicating reasonable quality, in addition to reasonable run time. A similar conclusion was also drawn in a simulation study. The developed AMD tool serves as a promising tool for fast and fully automatic population PK model building with the potential to facilitate the use of modeling and simulation in drug development. [ABSTRACT FROM AUTHOR]

A letter to the editor that cites the case of a 31-year-old woman with an aneurysmal bone cyst or a giant cell tumor with celiac disease is presented.