Women's Knowledge of Bladder Health: What We Have Learned in the Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium.

Purpose of Review: The goal of this manuscript is to review the current literature on bladder health education, summarize Prevention of Lower Urinary Tract Symptoms (PLUS) [50] findings on environmental factors that influence knowledge and beliefs about toileting and bladder function, and describe how PLUS work will contribute to improved understanding of women's bladder-related knowledge and inform prevention intervention strategies. Recent Findings: Analysis of focus group transcripts revealed the various ways women view, experience, and describe bladder function. In the absence of formal bladder health educational platforms, women appear to develop knowledge of normal and abnormal bladder function from a variety of social processes including environmental cues and interpersonal sources. Importantly, focus group participants expressed frustration with the absence of structured bladder education to inform knowledge and practices. Summary: There is a lack of bladder health educational programming in the USA, and it is unknown to what degree women's knowledge, attitudes, and beliefs influence their risk of developing lower urinary tract symptoms (LUTS). The PLUS Consortium RISE FOR HEALTH study will estimate the prevalence of bladder health in adult women and assess risk and protective factors. A Knowledge, Attitudes, and Beliefs (KAB) questionnaire will be administered to determine KAB around bladder function, toileting, and bladder-related behaviors, and examine the relationship of KAB to bladder health and LUTS. The data generated from PLUS studies will identify opportunities for educational strategies to improve bladder health promotion and well-being across the life course.

Penicillium marneffei infection in a lung transplant recipient.

Penicillium marneffei is a thermally dimorphic fungus that can cause severe opportunistic infections in endemic regions of Southeast Asia, particularly in individuals infected with human immunodeficiency virus-1, but has rarely been reported in solid organ transplant recipients. Herein, we report the first case, to our knowledge, of P. marneffei infection in a lung transplant recipient, occurring in a 41-year-old woman 28 months post lung transplantation, after recent travel to Vietnam. We have reviewed the literature to derive some management principles for this rare infection in this clinical context. The number of P. marneffei infections in transplant recipients may increase, as a result of increasing rates of transplantation and travel to endemic areas.

Computer simulation to estimate the effectiveness of carotid endarterectomy.

OBJECTIVES: To investigate the benefit of carotid endarterectomy relative to medical treatment, by comparing the outcome for different groups of patients following transient ischaemic attacks. METHODS: A Markov model was used to describe the survival and quality of life of patients treated for a transient ischaemic attack. The benefit is measured in terms of quality adjusted life months (QALMs). The outcome was estimated using a computer simulation with parameters based on published studies on the probability of events following treatment. The benefit of carotid endarterectomy was explored using a baseline set of parameters and a sensitivity analysis. RESULTS: The baseline scenario of a 65-year-old male patient with the model factors set at an intermediate level showed a benefit for surgery of 3 QALMs compared with medical treatment alone. The sensitivity analysis showed that the most favourable combination of factors had a benefit of 13.4 QALMs and the least favourable a loss of 2 QALMs. Of all 128 factor combinations, 79.9% showed a benefit for surgery, 5.5% showed equal benefit, and 15.6% showed a benefit for medical treatment. CONCLUSIONS: Computer simulations have the potential for deriving estimates of benefit for different patient groups from the results of clinical trials. Combined with reliable information on costs, the technique could also demonstrate variations in cost-effectiveness for these groups. For patients following a transient ischaemic attack, the results from this simulation and limited cost information suggest that carotid endarterectomy is unlikely to be a cost-effective intervention in the UK for many patient groups despite a reduction in the risk of stroke.

Screening immigrants for tuberculosis in Newcastle upon Tyne.

BACKGROUND: Successive national guidelines on the control of tuberculosis in the United Kingdom have included recommendations for screening immigrants coming from countries with a high prevalence of tuberculosis. As there has been only one other study on the process and outcome of screening immigrants at a district level the aim of this study was to assess the contribution of screening immigrants to the control of tuberculosis in Newcastle. METHODS: The Port of Arrival (POA) forms were used to identify all new immigrants for screening in Newcastle during 1993. The Family Health Services Authority (FHSA) register was used to identify additional new immigrants from the Indian sub-continent. For all new immigrants identified by the POA forms and FHSA register, hospital and practice records were reviewed for evidence of screening and its outcome up to the end of 1994. RESULTS: There were 252 POA forms in 1993, 100 of which were for immigrants from the Indian sub-continent. This represents less than a third of all new immigrants from the Indian sub-continent. Of all immigrants identified by POA forms, 99 (39 per cent) had been screened. This resulted in the detection of one active case of tuberculosis. CONCLUSIONS: The POA system alone is inadequate for identifying immigrants for screening. The published evidence on screening immigrants for tuberculosis suggests that the system does not work well and the yield of new cases is low. To assess the effectiveness of screening immigrants a national audit is needed.

Research into purchasing health care: time to face the challenge.

Purchasing health care is at the core of the reforms of the UK NHS and yet there is little research evidence on which the policy is based. Research in this area is hampered by a lack of clarity over the aims of purchasing and the pace of change within the NHS. Purchasing developments such as general practice fund-holding are proceeding without a large scale evaluation of their impact. At a national level a research effort is required to investigate this key area of the NHS reforms.

Serological responses in primary neuritic leprosy.

The serological responses to 2 Mycobacterium leprae specific epitopes and one common mycobacterial antigen were examined in 46 untreated patients with primary neuritic (PN) leprosy. M. leprae specific antibodies to the terminal disaccharide of phenolic glycolipid and/or the ML-04 defined epitope on the 35 kDa protein were detected in 41% of PN patients and 47% responded to one of the 3 antigens. This serological response mirrored that observed in paucibacillary leprosy patients. There was a significant increase in the level of antibody response when more nerve trunks were involved. Changes in antibody levels in seropositive PN patients may prove useful in monitoring the response to chemotherapy.

How obstetric/gynecologic nurse practitioners make practice changes: a national study.

A national study to determine how obstetric/gynecologic nurse practitioners (OGNPs) make practice change was conducted. A random sample of 1000 currently certified OGNPs was surveyed. Results indicated that continuing education meetings were primary sources of practice change information. Other important sources included discussion with physicians and other NP colleagues, as well as nursing and medical journals. The survey results indicate that continuous learning for practice change is occurring and that a variety of sources are used to assist OGNPs in keeping their practice activities current.