Consensus guidelines for the promotion and management of continence by primary health care teams: development, implementation and evaluation. NHS Executive Nursing Directorate.

A project was undertaken as part of the NHS Executive Strategy for Major Clinical Guidelines, involving the development of national clinical guidelines for the promotion and management of continence by primary health care teams, through the process of managed consensus based on scientific review. The guidelines were then implemented at one urban general practice. This article outlines the development and implementation of the guidelines and describes the study undertaken to evaluate the impact of implementation on clinical outcomes. The study involved a pre-and post-implementation postal survey of a random sample of 17% of patients aged 18 years and over from the practice (n = 1503). The pre-implementation survey determined the period prevalence of incontinence, related biological data and data on the pre-implementation management of incontinence. Incontinence sufferers were invited to have their condition assessed or reviewed. All sufferers who agreed to be followed-up were sent the post-implementation survey, which identified those patients who had sought help, and ascertained reasons for not seeking help. Data on the management of incontinence post-implementation were also obtained. Clinical outcomes measured pre- and post-implementation were a validated severity index for urinary incontinence, (also adapted for faecal incontinence) and perception of the incontinence as a problem. A 3-month period was allowed between pre- and post-implementation surveys. The study confirmed previous research which showed that few incontinence sufferers respond to invitations to seek help, and that help-seeking behaviour was significantly related to severity of incontinence. The guidelines did not have any positive impact on the clinical outcomes measured, although slight improvements in approaches taken by the primary health care team to the promotion and management of continence were recorded. However, the study was limited by the small sample size and short time scale. Further evaluation of the impact of the guidelines on these outcomes is therefore recommended.

Analysis of R59022 actions in Xenopus laevis oocytes.

R59022, a diacylglycerol (DAG) kinase inhibitor, stimulated meiotic maturation of Xenopus laevis oocytes when applied extracellularly. The time course of R59022-induced oocyte maturation was proportional to the concentration of R59022 in the low micromolor range, and the 30 microM-induced response was a fast or faster than progesterone-induced maturation. Dose-response analysis yielded an apparent EC50 for R59022-induced oocyte maturation of approximately 15 microM. An increase in total oocyte DAG levels was observed following treatment with 10 microM R59022. Treatment of oocytes with R59022 also resulted in a significant increase in intracellular pH similar to the increase observed with progesterone. When various phosphodiesterase (PDE) inhibitors were tested for their effects on R59022-induced oocyte maturation, papaverine (a potent nonselective inhibitor of PDE) and CI-930 (a selective PDE III inhibitor) were observed to significantly inhibit the R59022-stimulated response. The sensitivity of R59022-induced oocyte maturation to inhibition by papaverine was intermediate between the sensitivities of the IGF-1- or progesterone-induced responses. Treatment of oocytes with R59022 did not significantly affect the level of oocyte PDE activity measured in vivo, suggesting that elevated levels of DAG may parallel observed increases in PDE but do not directly lead to a stimulation of PDE. The t ime course for stimulation of ribosomal S6 kinase activity by R59022 followed the pattern for stimulation of ribosomal S6 kinase activity by R59022 followed the pattern for stimulation by progesterone rather than IGF-1. Treatment of isolated membranes with R59022 resulted in inhibition of membrane-associated adenyl cyclas e activity that was not mimicked by DAG analogs. Thus, in addition to elevating oocyte levels of DAG, R59022 also has steroid-like actions.