What women want now!

IMPORTANCE: Stress urinary incontinence and pelvic organ prolapse are common conditions affecting women with many different conservative and surgical treatment options available for women. OBJECTIVES: Our primary aim was to determine patient views and preferences surrounding theoretical potential future treatment options for pelvic floor dysfunction (PFD): pelvic organ prolapse/SUI and determine what level of success patients would find acceptable and see if their choice was dependent on severity of their symptoms. All patients had either just completed or were about to start a course of 3 months physiotherapy. All patients with overactive bladder symptoms were excluded. STUDY DESIGN: We conducted an service evaluation study of 100 consecutive women attending our urogynaecology clinic. Patients attending clinic completed a questionnaire. They were asked to choose a preferred treatment between "Option A": A surgical procedure which had an 80% success rate in curing symptoms but would require 1-2 day hospital stay and carry a small risk of complications. Or "Option B": A hypothetical course of outpatient, non-surgical treatments which would have a variable chance of improving (but not curing) symptoms (ranging from 70%, 50% or 25% chance of improvement) but would require no "down-time" and have no long term safety issues. RESULTS: Our results showed 100% of women with severe PFD would chose a surgical procedure. However those with mild/moderate symptoms would prefer a non-surgical treatment (if one were available) which may only improve their symptoms but had no long-term complications. There was a moderate correlation (r = 0.46) between severity of symptoms and chance of success. CONCLUSIONS: This study is important as it highlights a change in patient demand from one of highest efficacy to possibly one with the greatest safety profile and quickest recovery time. Newer treatment technologies such as energy-based devices (radiofrequency, laser and magnetic therapy) have shown to have lower success rates but may be favourable for some women. This supports the need for further research in these areas.

A Literature Review of the Pharmacokinetics and Pharmacodynamics of Dobutamine in Neonates.

Since its discovery in 1975 dobutamine has been used off-label for treating hemodynamic insufficiency in newborns and children. We present a structured literature review of pharmacokinetic and pharmacodynamic data for dobutamine in the pediatric population. Structured searches were conducted to identify relevant articles according to pre-defined inclusion criteria. Where possible, results for the pharmacodynamic and pharmacokinetic effect of dobutamine were reported as pooled data. Forty-six papers met the inclusion criteria. With regard to pharmacodynamic data a number of studies reported significant increases in a number of clinical parameters such as heart rate, blood pressure, cardiac output across a wide range of pediatric populations. With regard to pharmacokinetic data studies reported that the infusion rate was positively correlated to plasma dobutamine concentration. There was great variability with regard to dobutamine clearance between individuals and as to whether it followed first- or zero-order elimination kinetics. While the pharmacodynamic effects of dobutamine appear to reflect the pharmacological profile of the drug, the pharmacokinetic data are difficult to interpret due to inhomogeneity between study populations ages, comorbidities, dobutamine dosages and methodologies. High-quality prospective pharmacokinetic and pharmacodynamic data especially in newborns are urgently required prior to a large randomized study.