Patient representation in New Zealand general practice and rural health case-based teaching: a quality improvement exercise.

Introduction Healthcare inequity disproportionately affects minority populations in Aotearoa New Zealand. Healthcare providers may contribute to inequity due to their biases. Medical education can unintentionally promote biases by reinforcing stereotypes or limiting exposure to diversity. Teaching staff from the Department of General Practice and Rural Health suggested a need to review current teaching materials to ascertain if they have the potential to contribute to this bias. Aim The aim of this study was to review case-based teaching material to determine its representation of the New Zealand population, and whether there is potential to contribute to implicit bias. Methods Document analysis of 135 cases used to teach fourth- and fifth-year medical students in the Department of General Practice and Rural Health, Otago Medical School was performed. Demographic, clinical and social features of each case were recorded and analysed. Results Cases typically included patient age (129/135, 95.6%), sex (127/135, 94.1%) and occupation status (91/136, 66.9%). Ethnicity (31/135, 23.0%), living situation (55/135, 40.7%), relationship status (57/135, 42.2%) and sexual orientation (52/135, 40.0%) were less frequently defined. Cases typically represented the population majority norms. Discussion Case-based teaching materials require regular review and updating to match population demographics. There is potential to improve representation of diversity, and hence cultural safety, though review and revision of written teaching cases.

Exploring the value of social network 'care maps' in the provision of long-term conditions care.

OBJECTIVES: There is renewed attention to the role of social networks as part of person-centred long-term conditions care. We sought to explore the benefits of 'care maps' - a patient-identified social network map of their care community - for health professionals in providing person-centred care. METHODS: We piloted care maps with 39 patients with long-term conditions in three urban and one rural general practice and two hospital wards. We interviewed the health professionals (n = 39) of these patients about what value, if any, care maps added to patient care. We analysed health professional interview data using thematic analysis to identify common themes. RESULTS: Health professionals all said they learned about their patients as a person-in-context. There was an increased understanding of patients' support networks, synthesising what is known and unknown. Health professionals understood patients' perceptions of health professionals and what really mattered to patients. There was discussion about the therapeutic value of care maps. The maps prompted reflection on practice. DISCUSSION: Care maps facilitated a broader focus than the clinical presentation. Using care maps may enable health professionals to support self-management rather than feeling responsible for many aspects of care. Care maps had 'social function' for health professionals. They may be a valuable tool for patients and clinicians to bridge the gap between medical treatment and patients' lifeworlds.

Alcohol, tobacco and cannabis use: Do students with mild-intellectual disability mimic students in the general population?

Education policies encourage inclusion of students with mild-intellectual disability (mild-ID) in community/school life. However, such policies potentially increase exposure to substance use. This article examines tobacco, alcohol and cannabis use among French students enrolled in special units for students with disabilities (ULIS) at mainstream junior high schools compared to those of general population of the equivalent age; and explores factors associated with substance use among ULIS students, known to present mostly mild-ID. In 2014, a questionnaire adapted from the international HBSC/WHO study was administered to 700 ULIS students (mean-age 14.2). Comparative data were gathered from 7023 junior high-school students (mean-age 13.6) in the general population. Among students <14 years-old, tobacco and alcohol use rates were similar between ULIS and general population. For students ≥14, alcohol use remained comparable, while tobacco and cannabis use were higher in general population. Among ULIS students, low perceived health/life satisfaction, divorced/separated parents and high perceived academic demands were associated with tobacco use. Bullying, not liking school very much and attending schools outside a deprived area were associated with alcohol use. Having had sexual intercourse and not perceiving one's health as excellent were associated with cannabis use. Having dated was associated with using all three substances.

Socialization instances linked to cannabis experimentation among French teenagers.

France presents one of the highest prevalence of teenagers aged 15-year-olds who report they already have experienced cannabis in Europe. Data from the French 2010 Health Behavior in School-aged Children (HSBC) survey and environmental parameters typifying schools' neighborhoods were used to study cannabis experimentation. We conducted a two-level logistic regression (clusters being schools) on 4,175 French 8th-10th graders from 156 schools. Several individual parameters were linked to cannabis experimentation. Living in a non-intact family, feeling insufficiently monitored, having poor communication with mother and being from a family with a high socio-economic status (SES) were all associated with increased risk of cannabis experimentation. At environmental level, only being in a priority education area was linked to this behavior, without explaining differences among schools.

Using motivational interviewing for weight feedback to parents of young children.

AIM: To determine whether a single session of motivational interviewing (MI) for feedback of a child's overweight status promotes engagement in treatment following screening. METHODS: One thousand ninety-three children aged 4-8 years were recruited through primary and secondary care to attend health screening, including assessment of parenting practices and motivation (questionnaire). Families with normal-weight children were informed about their child's weight but had no further involvement. Parents of overweight (body mass index ≥ 85th percentile) children (n = 271) were randomised to receive weight feedback via MI or best practice care (BPC) using a traffic light concept to indicate degree of health risk. Follow-up interviews were held 2 weeks later to examine intervention uptake, changes to motivation and behaviour, and parental response to feedback. RESULTS: Recruitment into the intervention was high (76%) and not altered by feedback condition (percentage difference 6.6 (95% confidence interval -2.9, 16.0). High scores on the Health Care Climate Questionnaire (rating of the interviewer) indicated satisfaction with how the information was provided to parents. No differences were observed in multiple indicators of harm. However, self-determined motivation for healthy life-styles was significantly higher in the MI condition at follow-up (0.18: 0.00, 0.35), after only a single session of MI. CONCLUSIONS: MI and BPC were both successful in encouraging parents to participate in a family-based intervention, with MI offering little significant benefit over BPC. A traffic light approach to weight feedback is a suitable way of providing sensitive information to parents not expecting such news.

The Safe and Effective Clinical Outcomes (SECO) clinic: learning responsibility for patient care through simulation.

BACKGROUND: This article describes a simulated General Practice clinic for medical students, which incorporates specific features to aid learning of clinical problem solving. DESCRIPTION: We outline the overall objectives of the simulation, explain the concept, and describe how the clinic works. The clinic is novel in that it utilises clinical outcomes as measures for student success in the consultation. There are no time restrictions on a consultation. Students are unobserved and have open access to clinical information and telephone advice from a senior colleague. EVALUATION: The achievement of the case-specific outcomes is assessed by reference to students' clinical notes and the responses of the simulated patients to specific scenario-related questions. Following the clinic there is a debrief session, and students are provided with the evidence base and outcomes for each scenario. CONCLUSIONS: The clinic has been part of our undergraduate curriculum since 2004. Collectively, students rate it as their most effective learning experience.

Motivational interviewing for screening and feedback and encouraging lifestyle changes to reduce relative weight in 4-8 year old children: design of the MInT study.

BACKGROUND: Because parental recognition of overweight in young children is poor, we need to determine how best to inform parents that their child is overweight in a way that enhances their acceptance and supports motivation for positive change. This study will assess 1) whether weight feedback delivered using motivational interviewing increases parental acceptance of their child's weight status and enhances motivation for behaviour change, and 2) whether a family-based individualised lifestyle intervention, delivered primarily by a MInT mentor with limited support from "expert" consultants in psychology, nutrition and physical activity, can improve weight outcomes after 12 and 24 months in young overweight children, compared with usual care. METHODS/DESIGN: 1500 children aged 4-8 years will be screened for overweight (height, weight, waist, blood pressure, body composition). Parents will complete questionnaires on feeding practices, physical activity, diet, parenting, motivation for healthy lifestyles, and demographics. Parents of children classified as overweight (BMI > or = CDC 85th) will receive feedback about the results using Motivational interviewing or Usual care. Parental responses to feedback will be assessed two weeks later and participants will be invited into the intervention. Additional baseline measurements (accelerometry, diet, quality of life, child behaviour) will be collected and families will be randomised to Tailored package or Usual care. Parents in the Usual care condition will meet once with an advisor who will offer general advice regarding healthy eating and activity. Parents in the Tailored package condition will attend a single session with an "expert team" (MInT mentor, dietitian, physical activity advisor, clinical psychologist) to identify current challenges for the family, develop tailored goals for change, and plan behavioural strategies that best suit each family. The mentor will continue to provide support to the family via telephone and in-person consultations, decreasing in frequency over the two-year intervention. Outcome measures will be obtained at baseline, 12 and 24 months. DISCUSSION: This trial offers a unique opportunity to identify effective ways of providing feedback to parents about their child's weight status and to assess the efficacy of a supportive, individualised early intervention to improve weight outcomes in young children. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12609000749202.

Nurse and parent partnership during children's vaccinations: a conversation analysis.

AIM: This paper is a report of a study conducted to examine the elements of partnership and communication between nurses and parents during actual events of immunization. BACKGROUND: Childhood immunizations require collaboration with parents, who may be anxious about immunization safety or subjecting their children to painful procedures. METHODS: Ten interactions during immunization events from six purposively selected general practices were videoed in 2005, giving 168 minutes of talk. Conversation analysis was conducted on talk during the short phase of injection administration. FINDINGS: During the immunization event nurse and mother talked to the baby/toddler rather than each other. Concurrent talk acted as a chorus, marked by sing-sing prosody, shared laughter and talk or reassuring noises. In coordinated talk nurse and parent took turns. Although overlap might occur, the actions accomplished by each speaker were different. Nurses most commonly cued bravery or stoicism to the child and stressed the progress made in administering the injections. In the less common pattern when pain was recognized as inevitable and there was no stress on stoicism and progress towards completion, the child displayed more distress and began crying before the injection. CONCLUSION: Communication skills and rapport are core to nursing work. What happens at the micro-level of turn-taking, where prosody and the actions achieved in talk, is of key importance. Our study suggests 'small talk' is of major importance - a practical professional skill in which nurses not only align with parents but simultaneously cue both mother and child about how the immunization should be conducted.

Porcine dermal hammock for repair of anterior and posterior vaginal wall prolapse: 5-year outcome.

STUDY OBJECTIVE: To estimate the long-term efficacy of acellular cross-linked porcine dermal implants for the substitution of prolapsed anterior and posterior endopelvic fascia. In addition, surgical techniques to improve outcome were examined. DESIGN: Prospective longitudinal study (Canadian Task Force classification II-2). SETTING: Private urogynecology clinic. PATIENTS: Patients were reviewed who had Pelvic Organ Prolapse Quantification stage 2 or greater anterior and/or posterior pelvic floor defects repaired with porcine dermis from March 2000 through August 2002 with at least 5 years of follow-up. INTERVENTIONS: Repairs consisted of endopelvic fascia implants side wall to side wall from the ischial spine to the vaginal introitus. Different techniques of dissection, wound closure, and tissue pliability were measured. MEASUREMENTS AND MAIN RESULTS: A total of 91 consecutive patients had endopelvic porcine dermal implants for pelvic organ prolapse. In all, 72 patients with a total of 82 defects had an objective cure rate of 81.6% and 86.4% at 5 years for anterior and posterior repairs, respectively. Concomitant anterior and posterior repairs had a 6 times higher objective failure rate. The method of dissection and mucosal wound closure significantly affected wound healing. Solid porcine implants had decreased tissue pliability. A significant improvement in quality-of-life questionnaires and high patient satisfaction occurred, shown by a visual analog scale. CONCLUSION: Complete replacement of the endopelvic fascia with porcine dermis had a better outcome than reported in many studies using classic plication or plication augmentation repairs. Porcine was well tolerated with high patient satisfaction and improved quality of life. Solid dermal implants resulted in thick scar plates, yet had a low occurrence of de novo dyspareunia and did not appear to adversely affect sexual activity.

Contraceptive use by 15-year-old students at their last sexual intercourse: results from 24 countries.

OBJECTIVES: To identify and report cross-national patterns in contraceptive use among sexually active adolescents. DESIGN: A cross-national cross-sectional survey. SETTING: Data were collected in 2002 by self-report questionnaire from students in school classrooms. PARTICIPANTS: A cluster sample of 33,943 students aged 15 years from 24 countries. MAIN OUTCOME MEASURES: International standardized questions on ever having had sexual intercourse and contraceptive use at last sexual intercourse. RESULTS: The percentages of students reporting having had sexual intercourse ranged from 14.1% in Croatia to 37.6% in England; 82.3% of those who were sexually active reported that they used condoms and/or birth control pills at last intercourse. Condom use only was most frequent and ranged from 52.7% in Sweden to 89.2% in Greece. Dual use of condoms and contraceptive pills was also relatively frequent, ranging from 2.6% in Croatia to 28.8% in Canada. The use of contraceptive pills was most frequent in northern and western Europe. No contraceptive use at last intercourse was reported by 13.2% of students. CONCLUSIONS: A substantial minority of 15-year-olds have engaged in sexual intercourse. Condom use is the most frequent method of contraception reported by the sexually active respondents, followed by the dual use of condoms and contraceptive pills and contraceptive pills only. The proportions of poorly protected and unprotected youth remain high, and attention to international policy and practice determinants of young sexual behavior and contraceptive use is required.

The use of a xenogenic barrier to prevent mesh erosion with laparoscopic sacrocolpopexy.

STUDY OBJECTIVE: To assess the efficacy of a xenogenic barrier in preventing vaginal mucosal erosion and the use of a collagen-coated polypropylene mesh in preventing small bowel obstruction with laparoscopic sacrocolpopexy for the treatment of severe vaginal prolapse. DESIGN: Prospective longitudinal study (Canadian Task Force classification II-1). SETTING: Private urogynecology clinic. PATIENTS: A total of 31 consecutive post-hysterectomy patients with severe apical vaginal prolapse (pelvic organ prolapse quantification [POP-Q] stages 2-4). INTERVENTIONS: Laparoscopic sacrocolpopexy, in conjunction with other laparoscopic and/or vaginal procedures, was used to correct pelvic floor disease. A Y-shaped polyester multifilament mesh, with a resorbable collagen coating, was used for the implant. The inner surfaces of the Y-shaped synthetic mesh had porcine dermal strips attached to act as a buffer/barrier for the vaginal wall. MEASUREMENTS AND MAIN RESULTS: A total of 29 (94%) of 31 patients were cured at 12 months (defined as POP-Q < stage II). There were no more failures in the 28 patients followed-up at 24 months. Two patients had recurrent apical prolapse (Point C = -1 and 0). There were no small bowel obstructions and no vaginal mesh erosions during the 2-year follow-up. There was significant improvement in the sexual and quality of life questionnaires after repair. CONCLUSION: Laparoscopic sacrocolpopexy is an effective treatment for apical vault prolapse. There were no cases of vaginal erosion in the first 2 years of follow-up with the "combination" biosynthetic mesh. It is suggested that the interposition of a collagen barrier between the synthetic mesh and the vaginal mucosa prevents erosion. Biosynthetic engineering appears promising in aiding the prevention of the most common complication in pelvic floor reconstructive surgery with permanent implants. The use of permanent synthetic mesh plays an important role in the success of sacrocolpopexy, removing the dependence on the use of poor in situ tissue seen in classic and site-specific repairs. The use of biologic barriers developed specifically for certain actions may be useful in minimally invasive vaginal repair surgery.

Laparoscopic sacrocolpopexy for severe vaginal vault prolapse: five-year outcome.

STUDY OBJECTIVE: To assess the efficacy of the laparoscopic sacrocolpopexy in the treatment of severe vaginal prolapse. DESIGN: (Canadian Task Force classification II-1). SETTING: Private clinic. PATIENTS: Fifty-one consecutive posthysterectomy patients with severe vaginal prolapse (Baden-Walker Grade 3 or 4). INTERVENTIONS: The patients were treated by laparoscopic sacrocolpopexy in conjunction with other laparoscopic and/or vaginal procedures, as indicated. MEASUREMENTS AND MAIN RESULTS: Of the 43 patients seen at 5-year follow-up, 3 had recurrent vaginal prolapse (objective cure rate 93%). In the patients with recurrence, the polypropylene mesh had torn partially or completely from the vaginal apex. When the posterior strip of mesh was extended to the perineal body, there were fewer recurrences of posterior compartment defects. Postoperatively, two patients had a partial small bowel obstruction secondary to bowel adherence to the mesh. Four patients had mesh erosion at the vaginal apex: two responded to local treatment, and two required vaginal flaps to cover the defect. CONCLUSION: Laparoscopic sacrocolpopexy can be used safely with cure rates similar to abdominal sacrocolpopexy. Extending the mesh to the perineum appears to decrease posterior vault defects. There is a protracted learning curve. Patient recovery is greatly enhanced, in most cases requiring only an overnight hospitalization.

Systemic inflammation correlates with increased expression of skeletal muscle ubiquitin but not uncoupling proteins in cancer cachexia.

Muscle wasting in experimental cancer cachexia has been associated with increased ubiquitin proteasome proteolytic system activity and increased uncoupling protein (UCP) expression. Increased ubiquitin proteasome pathway activity has also been found in gastric, but not lung, cancer patients. It therefore remains unclear in which patients modulation of this proteolytic system could be a therapeutic target. We investigated markers of systemic inflammation, hypermetabolism and expression of ubiquitin and uncoupling proteins 2 and 3 in muscle of pancreatic cancer patients. Rectus abdominis muscle was sampled from 15 weight-losing pancreatic cancer patients and 11 controls. UCP2 and 3, and ubiquitin mRNA expression were measured by Northern blots and UCP3 protein by Western blotting. Resting energy expenditure and plasma IL-6, sTNF-R and C-reactive protein (CRP) were also measured. Cancer patients had lost 18% of pre-illness stable weight, but were not significantly hypermetabolic compared with controls. IL-6, sTNF-R and CRP levels and ubiquitin 2.4 kb, but not 1.2 kb, mRNA expression were increased in cancer patients. UCP-2 and 3 mRNA and UCP-3 protein were similar in both groups. Weight loss correlated with systemic inflammation and ubiquitin 1.2 and 2.4 kb mRNA expression. Weight loss in pancreatic cancer is associated with systemic inflammation and increased mRNA expression for ubiquitin but not uncoupling proteins in skeletal muscle. The pro-inflammatory network and ubiquitin proteasome pathway may be targets for intervention in pancreatic cancer cachexia.

Effects of a large-scale industrial disaster on rates of symptoms consistent with posttraumatic stress disorders among schoolchildren in toulouse.

BACKGROUND: Posttraumatic stress disorder (PTSD) has been studied largely among adults and in the context of intentional, collective experiences such as war and terrorism. Far less is known about PTSD among adolescents and resulting from massive industrial accidents. Such an accident in Toulouse, France, 10 days after the World Trade Center disaster, provided an opportunity to examine its effects among adolescents already sensitized by media coverage of the World Trade Center disaster. OBJECTIVES: (1) To assess the presence of symptoms consistent with PTSD (SCW-PTSD) among adolescents in Toulouse after a massive industrial accident, (2) to determine the "excess" of SCW-PTSD among those directly exposed vs those nondirectly exposed, and (3) to examine dosage effects for exposure and the cumulative effect on PTSD of accident-related experiences. DESIGN, SETTING, AND PARTICIPANTS: A survey containing questions on exposure and SCW-PTSD was administered to students aged 11 years, 13 years, 15 years, and 17 years who were enrolled in randomly selected, grade-stratified classrooms from schools for directly exposed students (n = 577) in Toulouse and nondirectly exposed students (n = 900) in the region.Main Outcome Measure The prevalence of SCW-PTSD among directly exposed and nondirectly exposed students. RESULTS: Nine months after the industrial accident, 44.6% of 11- and 13-year-old directly exposed students and 28.5% of 15- and 17-year-old directly exposed students still showed SCW-PTSD, compared with 22.1% of 11- and 13-year-old nondirectly exposed students and 4.4% of 15-year-old nondirectly exposed students. Among 11- and 13-year-olds, the likelihood of having SCW-PTSD was higher for girls who were enrolled in elementary schools, were personally injured, and had severe damage at home, as opposed to boys who were high-school students without severe damage at home or personal injury. Among the 15- and 17-year-olds, being a girl, 17 years old, and personally injured increased the likelihood of having SCW-PTSD, as opposed to 15-year-old boys who were not injured. The effects of injuries were cumulative: students injured personally and with an injured family member were more likely to have SCW-PTSD than those experiencing either personal or family injury but not both. Excess of SCW-PTSD attributable to direct exposure was 50.5% for 11-year-olds, 49.3% for 13-year-olds, and 73.5% for 15-year-olds. CONCLUSIONS: A substantial proportion of Toulouse adolescents still had SCW-PTSD 9 months after the accident. Directly exposed students were far more likely to show SCW-PTSD than those nondirectly exposed, but both groups had SCW-PTSD at rates that were higher than expected. The symptoms were associated with demographic characteristics and direct experiences of trauma. Higher rates applied to students who were personally injured with injured family members and severe damage at home. Students with these characteristics predictive of SCW-PTSD should be given prompt attention to avoid long-lasting effects.

Assessing health risk behaviors among adolescents: the effect of question wording and appeals for honesty.

PURPOSE: To understand how methodological factors influence prevalence estimates of health-risk behaviors obtained from surveys, we examined the effect of varying question wording and honesty appeals while holding other aspects of the surveys constant. METHODS: A convenience sample of students (n = 4140) in grades 9 through 12 was randomly assigned to complete one of six versions of a paper-and-pencil questionnaire in classrooms. Each questionnaire version represented a different combination of honesty appeal (standard vs. strong) and questionnaire type. The questionnaire types varied in wording and in the number of questions assessing particular types of behaviors. The questionnaires were based on those used in three national surveys--the Youth Risk Behavior Survey, Monitoring the Future, and the National Household Survey on Drug Abuse. Logistic regression analyses examined how responses to each survey question assessing behavior were associated with questionnaire type, honesty appeal, and the interaction of those two variables. RESULTS: Among 32 behaviors with different question wording across questionnaire types, 12 showed a significant effect of questionnaire type. Among 45 behaviors with identical question wording across questionnaire types, five showed a significant main effect of questionnaire type. Among all 77 behaviors, one showed a significant main effect for honesty appeal and two showed a significant interaction between honesty appeal and questionnaire type. CONCLUSIONS: When population, setting, questionnaire context, mode of administration, and data-editing protocols are held constant, differences in question wording can create statistically significant differences in some prevalence estimates. Varying honesty appeals does not have an effect on prevalence estimates.

A prospective multisite study of radiofrequency bipolar energy for treatment of genuine stress incontinence.

STUDY OBJECTIVE: To assess the efficacy of radiofrequency electrothermal energy to treat genuine stress incontinence (GSI). DESIGN: Multicenter, prospective, single-arm, longitudinal study (Canadian Task Force classification II-1). SETTING: Six North American university-affiliated and private clinic sites. PATIENTS: Ninety-four women undergoing laparoscopic treatment for GSI. INTERVENTION: Radiofrequency bipolar treatment of paravaginal tissue to induce tissue shrinkage causing bladder neck elevation. MEASUREMENTS AND MAIN RESULTS: Patients underwent complete urogynecologic evaluations, with urodynamic testing, including Valsalva leak point pressure, to confirm the diagnosis of GSI. Paravaginal tissue was treated lateral from the urethra and bladder neck out to the arcus white line, with bipolar electrothermal energy to shrink bladder-supporting connective tissue. Treatment resulted in 30% shrinkage in paravaginal endopelvic fascia surface area by direct measurement. At 1 year the objective cure rate was 79% by urodynamic testing, improvement in quality of life by questionnaire was 81%, decrease in leaking episodes and pad use was significant (p <0.001), and patient satisfaction was 83%. Complications (7%) were secondary to laparoscopy. There were no injuries from the radiofrequency probe. CONCLUSION: Radiofrequency bipolar electrothermal energy appears to be a safe an efficient means of treating mild to moderate GSI. It results in shrinkage and elevation of paravaginal connective tissue, stabilizing the urethra and bladder neck, thereby restoring continence. Long-term follow-up is necessary.

Acute and long-term outcomes of radio frequency bladder neck suspension.

PURPOSE: A new treatment modality for women with stress urinary incontinence secondary to urethral hypermobility is radio frequency bladder neck suspension. Radio frequency energy is a form of electromagnetic energy that is reliable and highly controllable. This thermal therapy can produce well-defined areas of tissue heating. The technology has been used extensively in dermatological and orthopedic surgery for tissue shrinkage and ablation. Radio frequency thermal therapy is now being applied to the endopelvic fascia at the bladder neck and urethra for treating hypermobility in patients with stress urinary incontinence. The purported mechanism is shrinkage of the collagenated tissue that supports the bladder neck and proximal urethra. We report our acute and long-term experience with laparoscopic radio frequency bladder neck suspension for stress urinary incontinence. MATERIALS AND METHODS: Enrolled in this prospective multicenter trial were 94 women with a mean age of 48.4 +/- 7.6 years who had urethral hypermobility with an average cotton swab angle change of 41 degrees and Valsalva leak point pressures greater than 90 cm. water at 250 ml. bladder capacity. Detrusor instability was excluded by cystometry. In all cases precisely controlled radio frequency energy was applied to the endopelvic fascia to heat and shrink the tissue. The primary end points were physician assessment of continence, patient reported pad use and the number of patient reported episodes of urinary incontinence daily 1, 3, 6 and 12 months after surgery. RESULTS: Average operative time was less than 60 minutes and 98% of the patients were discharged home from the recovery room. Treatment surface area decreased an average of 17% in length and 21% in width. Preoperatively 78% of patients had an average of 1 or more episodes of urinary incontinence daily. At 1, 3, 6 and 12 months there was an average of 1 or fewer episodes of urinary incontinence daily in 84.7%, 85.6%, 85.9% and 77.4% of patients, respectively, and at 12 months 83.5% reported being continent or improved. Preoperatively 41.2% of patients reported using 1 pad or less daily, while at 1, 3, 6 and 12 months 85.6%, 90.4%, 87.2% and 86.9%, respectively, required 1 pad or less daily. Urodynamic evaluation at 12 months showed no leakage during the Valsalva maneuver in 78% of cases. There were no major postoperative complications and the minor complication rate was 5.3%. CONCLUSIONS: Early results of thermal treatment of the endopelvic fascia indicate that radio frequency bladder neck suspension is safe and effective for improving stress urinary incontinence in women. The improvement in symptomatology appears to be durable in most patients at the 1-year followup. Longer followup is needed to assess the durability of results and it is currently in progress.