The scope and limitations of treatment. An interview with Ann Lett, Principle, British School--Reflex Zone Therapy of the Feet

Ann Lett was born in Johannesburg South Africa and trained as a nurse in 1953, and subsequently as a midwife in London. In 1977 she was treated with reflex zone therapy following a road traffic accident, and subsequently pursued a career in reflex zone therapy by undertaking training with many European practitioners. In 1979 she trained with Hanne Marquardt in Germany, and in 1981 was asked to develop the British School of Reflex Zone Therapy at the National Hospital for Nervous Diseases in London. Shortly after this, she and Ms. Marquardt established schools of reflex zone therapy in Israel and Barcelona. Her book Reflex Zone Therapy for Health Professionals, published in 2000 by Churchill Livingstone (ISBN 0 443 060150), is the culmination of 23 years of expertise in reflex zone therapy, and 47 years of nursing experience. She is presently Principle, British School Reflex Zone Therapy of the Feet, Wembley Park, UK. In this interview, Ann discusses the scope and limitations of reflexology and how she sees this profession developing in the future.     

Long-term Efficacy of Pelvic Floor Muscle Rehabilitation for Older Women With Urinary Incontinence

ObjectivesTo determine the efficacy of pelvic floor muscle (PFM) rehabilitation for elderly women with urinary incontinence after five years of follow-up, and to assess the adherence to PFM exercises five years after physiotherapy.MethodsWe conducted a retrospective chart review of women ≥ 60 years old who underwent PFM physiotherapy for urinary incontinence between September 1999 and February 2004. PFM rehabilitation techniques were taught to patients by a certified physiotherapist. The mean number of sessions was eight. Telephone surveys were conducted at two months, six months, and one to five years after physiotherapy. Objective data on the efficacy of treatment (number of voids, incontinence, use of pads) and on adherence to PFM exercises were collected using a uniform grid. Data were used to determine the continence status at follow-up and compared with the data collected at the end of the PFM training sessions (improved, maintained, or deteriorated).ResultsOf 89 older women (mean age 70 years; range 60 to 81) treated during the study period, 40 were followed up to five years and were suitable for analysis. At five years of follow-up, 27.5% had improved, 57.5% remained stable, and 15% had deteriorated compared with their post-treatment continence status. Twenty-nine patients (72.5%) were continuing their PFM exercises, and 42.5% were performing the exercises daily. All adherent patients had “improved” or “stable” status after five years versus 45.5% of non-adherent patients (P < 0.05).ConclusionPelvic floor muscle rehabilitation for urinary incontinence remains highly effective for up to five years in older women. Most women continue to perform PFM exercises five years after completing their physiotherapy education sessions.     

A study of Reiki therapy on unpleasant symptoms in children with cerebral palsy

Children with Cerebral Palsy (CP) commonly experience unpleasant symptoms such as pain, anger, and sadness. The purpose of this quasi-experimental study, guided by the Theory of Unpleasant Symptoms (TOUS), was to examine the practicality and impact of delivering Reiki Therapy (RT) in homes over an 8-week intervention phase to children with CP. Thirteen pediatric participants were recruited, ranging in age from 5 to 16 years. Reiki Therapy was administered by a Level 3 Reiki Therapist in the home for 8 consecutive weeks. Parents completed on-line questionnaires addressing their children's unpleasant symptoms. Hair cortisol was measured as an indicator of stress. Nearly all study procedures were completed by the participants, indicating that the methods are feasible for a larger study. Reiki Therapy significantly decreased pain while lying down (3.09 vs. 2.00; p = .002) but not while sitting (2.55 vs. 2.09; p = .40). Anger symptoms showed a trend towards improvement in the participants. These preliminary findings demonstrate that Reiki is a therapeutic modality worthy of further investigation in the CP pediatric population.     

Feasibility of the “Cuff-Sleeve” Suture Method for Functional Neocervix Reconstruction in Laparoscopic Radical Trachelectomy: A Retrospective Analysis

Study ObjectivesThe purpose of this study was to evaluate the feasibility of “cuff-sleeve” sutures for reconstructing a functional neocervix in laparoscopic radical trachelectomy (RT).DesignA retrospective analysis of a case series.SettingA teaching hospital.PatientsTwenty-five patients who were diagnosed as early-stage cervical cancer from June 2017 to October 2020 in Sun Yat-sen Memorial Hospital.InterventionsLaparoscopic RT with the “cuff-sleeve” suture method for cervicovaginal reconstruction.Measurements and Main ResultsTwenty-five patients successfully underwent the laparoscopic RT with the “cuff-sleeve” suture method for cervicovaginal reconstruction, and no intraoperative complications occurred or conversion to laparotomy was needed. For all patients, approximately 80% of the cervical length was removed. Surgical radicality and negative surgical margins were also confirmed. During a median follow-up time of 29 months (range 8–48 months), no severe postoperative complications were observed. No cervical stenosis or secondary abnormal menstruation was reported. After the removal of the uterine stent 6 months after surgery, the neocervix length was approximately 14 mm (range 10–19 mm) and almost all the neocervixes were restored closely to the original anatomy. Four of 8 patients attempting actively to conceive were successful, and the cervical length of these pregnant patients was greater than or equal to 15 mm in all but one measurement at different gestational age. Three patients were ongoing pregnant, and the other had delivered successfully with a 16- mm cervix at term without cerclage.ConclusionThe “cuff-sleeve” suture method in cervicovaginal reconstruction is feasible in laparoscopic RT. This simplified suture technique can provide a functional neocervix to reduce cervical stenosis and incompetence.     

Is fetal pain a real evidence?

Due to the progress in fetal surgery, it is important to acquire data about fetal pain. Material and methods: We performed a Medline research from 1995, matching the following key words: “pain” and “fetus”, with the following: “subplate”, “thalamocortical”, “myelination”, “analgesia”, “anesthesia”, “brain”, “behavioral states”, “substance p”. We focused on: (a) fetal development of nociceptive pathways; (b) fetal electrophysiological, endocrinological and behavioral reactions to stimuli and pain. Results: We retrieved 217 papers of which 157 were highly informative; some reported similar data or were only case-reports, and were not quoted. Most endocrinological, behavioral and electrophysiological studies of fetal pain are performed in the third trimester, and they seem to agree that the fetus in the 3rd trimester can experience pain. But the presence of fetal pain in the 2nd trimester is less evident. In favor of a 2nd trimester perception of pain is the early development of spino-thalamic pathways (approximately from the 20th week), and the connections of the thalamus with the subplate (approximately from the 23rd week). Against this possibility, some authors report the immaturity of the cortex with the consequent lack of awareness, and the almost continuous state of sleep of the fetus. Conclusions: Most studies disclose the possibility of fetal pain in the third trimester of gestation. This evidence becomes weaker before this date, though we cannot exclude its increasing presence since the beginning of the second half of the gestation.     

A prospective randomized study comparing acupuncture with physiotherapy for low-back and pelvic pain in pregnancy

BACKGROUND: The aim of this study was to describe the effects of acupuncture in the treatment of low-back and pelvic pain during pregnancy and compare it with physiotherapy. METHODS: Sixty pregnant women were allotted to acupuncture or physiotherapy. The women estimated the severity of their pain using a visual analog scale (VAS) from 0 to 10 and disability in performing twelve common daily activities using a disability-rating index (DRI) from 0 to 10. RESULTS: In the acupuncture group all 30 women completed the study (two exclusions), in the physiotherapy group only 18. Before treatment the two study groups were rather similar with respect to pain and disability. After treatment the mean morning VAS had declined from 3.4 to 0.9 (p<0.01) in the acupuncture group and from 3.7 to 2.3 (NS) in the physiotherapy group. The corresponding evening values had declined from 7.4 to 1.7 (p<0.01) and 6.6 to 4.5 (p<0.01), respectively. The mean VAS values were lower after acupuncture than after physiotherapy both in the morning (p=0.02) and in the evening (p<0.01). After treatment also the mean DRI values had decreased significantly in the acupuncture group for 11 of 12 activities and the values were significantly lower for all activities than in the physiotherapy group where no significant changes had taken place. Overall satisfaction was good in both groups. There were no serious adverse events in any of the patients. CONCLUSIONS: Acupuncture relieved pain and diminished disability in low-back pain during pregnancy better than physiotherapy.     

Surgical treatment of endometriosis

In this review, the pitfalls that still exist with the surgical treatment of endometriosisassociatedpelvic pain have been discussed and the best evidence regarding various aspects of surgical techniques have been reviewed. When laparoscopy is performed to evaluate a woman with pelvic pain symptoms, it is important she be counseled that the primary function of the surgery is to confirm the presence (and allow surgical treatment) of endometriosis, and that it is not the penultimate diagnostic modality for her pelvic pain. There are many etiologies of pelvic pain that present with symptoms resembling those of endometriosis-associated pelvic pain that are not diagnosable with laparoscopy, such as interstitial cystitis and irritable bowel syndrome. It is unfortunate that many women are left with the belief that if a laparoscopy fails to provide a diagnosis of a pain generator, then it means there are no diagnoses other than that the “pain is in her head,” often disparagingly termed “supratentorial” byclinicians. In fact, the pain-related diagnoses that are amenable to and possibly require a laparoscopy are quite limited, a group of diagnoses that this author terms the “dirty dozen” because there are just 12, and only the first 4 have good evidence to clearly associate them with chronic pelvic pain:1. Endometriosis 2. Ovarian remnant syndrome 3. Pelvic inflammatory disease 4. Tuberculous salpingitis 5. Adhesions 6. Benign cystic mesothelioma 7. Postoperative peritoneal cysts 8. Adnexal cysts (nonendometriotic)9. Chronic ectopic pregnancy 10. Endosalpingiosis 11. Residual accessory ovary 12. Hernias: ventral, inguinal, femoral, spigelian.I would argue that diagnostic laparoscopy in modern gynecology has a limited, if any role, and that when laparoscopy is planned for women with chronic pelvic pain, it should be with a very high suspicion of a diagnosis and with plans to treat the disease operatively. In this era, a negative diagnostic laparoscopy should be a rare event.     

我国青少年子宫内膜异位症:Meta分析

目的探讨中国青少年子宫内膜异位症的发病机理、临床特征、诊断及治疗方法。方法在CNKI、万方、维普上收集与青少年子宫内膜异位症相关的文章,根据入选标准选出相关文献8篇,共计129例患者。计算患者平均发病的年龄、初潮年龄,总结患者主要的症状、病变部位、CA125水平、疾病分期,治疗及随访情况。结果患者就诊时的平均年龄是17.92岁。平均初潮年龄13.63岁,25%患者合并有生殖道畸形。主要症状包括痛经(39.53%)、盆腔包块(30.23%)、慢性盆腔痛(27.13%)、急腹症(8.53%)及不孕症(1.55%)。卵巢是最常见的受累器官(81.40%)。患者均接受了手术治疗,病变严重者术后予以药物辅助治疗。复发率为19.51%。结论青少年子宫内膜异位症的临床表现可以不典型,由生殖道畸形引发的子宫内膜异位症比率较高。对严重痛经及慢性盆腔痛的青少年要警惕子宫内膜异位症的可能。     

Palliativmedizin – weit mehr als nur Schmerztherapie

The WHO definition of palliative care clearly states that it is more than just pain therapy with a “humanistic touch”. The widespread misunderstanding of palliative medicine as a “pain therapy for dying (cancer) patients” has been disproved by clinical reality. The principles of palliative medicine are increasingly being applied to non-oncological patient groups, especially neurological patients. It is now generally accepted that palliative care is care for, but not just at the end of life. Palliative psychosocial and spiritual support play at least as important a role within palliative care as medical symptom control (pain, internal medicine and neuropsychiatric symptoms). The goal of palliative care, as Cicely Saunders said, is “to provide space” in order to allow patients to live fully until they die.     

Efficacy of Tribulus Terrestris for the treatment of premenopausal women with hypoactive sexual desire disorder: a randomized double-blinded,placebo-controlled trial

Although hypoactive sexual desire disorder (HSDD) is the most common sexual complaint, there is no consensus for the ideal treatment. Our study aimed to evaluate the efficacy of treating premenopausal women with HSDD with Tribulus terrestris and its effect on the serum levels of testosterone. We performed a prospective, randomized, double-blind, placebo-controlled trial, with 40 premenopausal women reporting diminished libido, receiving T. terrestris or placebo. The questionnaires FSFI and the QS-F were used to evaluate sexual dysfunction before and after treatment. Patients treated with T. terrestris experienced improvement in total score of FSFI (p?p?p?=?.005), “lubrication” (p?=?.001), “orgasm” (p?<.001), “pain” (p?=?.030) and “satisfaction” (p?=?.001). Treatment with placebo did not improve the scores for the “lubrication” and “pain”. QS-F scores showed that patients using T. terrestris had improvements in “desire” (p?=?.012), “sexual arousal/lubrication” (p?=?.002), “pain” (p?=?.031), “orgasm” (p?=?.004) and “satisfaction” (p?=?.001). Women treated with placebo did not score improvements. Women receiving T. terrestris had increased levels of free (p?=?.046) and bioavailable (p?T. terrestris might be a safe alternative for the treatment of premenopausal women with HSDD as it was effective in reducing the symptoms, probably due to an increase in the serum levels of free and bioavailable testosterone.     

Radiation Dose to the Penile Structures and Patient‐Reported Sexual Dysfunction in Long‐Term Prostate Cancer Survivors

AimThe involvement of various penile structures in radiotherapy (RT)‐induced sexual dysfunction among prostate cancer survivors remains unclear and domains beyond erectile dysfunction such as orgasm, and pain have typically not been considered. The purpose of this study was to investigate sexual dysfunction post‐RT for localized prostate cancer and to examine whether radiation dose to different penile structures can explain these symptoms.MethodsWe investigated sexual dysfunction in two treated prostate cancer cohorts and in one non‐pelvic‐irradiated cohort, 328 sexually active men part of an unselected, population‐based study conducted in 2008. The treated subjects were prescribed primary/salvage external‐beam RT to 70 Gy@2.0 Gy/fraction. Absorbed RT doses (D_mean and D_max) of the corpora cavernosa (CC), the penile bulb (PB), and the total penile structure (CC + PB) were related to 13 patient‐reported symptoms on sexual dysfunction by means of factor analysis (FA) and logistic regression.ResultsThree distinct symptom domains were identified across all cohorts: “erectile dysfunction” (ED, two to five symptoms), “orgasmic dysfunction” (OD, two to four symptoms), and “pain” (two to three symptoms). The strongest predictor for ED symptoms was CC + PB D_max (P = 0.001–0.03), CC and PB D_mean predicted OD symptoms equally well (P = 0.03 and 0.02–0.05, respectively), and the strongest predictor for pain symptoms was CC + PB D_mean (P = 0.02–0.03).ConclusionSexual dysfunction following RT was separated into three main domains with symptoms related to erectile dysfunction, orgasmic dysfunction, and pain. Chances for intact sexual functionality may be increased if dose to the total penile structure can be restricted for these domains in the planning of RT. Thor M, Olsson CE, Oh JH, Alsadius D, Pettersson N, Deasy JO, and Steineck G. Radiation dose to the penile structures and patient‐reported sexual dysfunction in long‐term prostate cancer survivors. J Sex Med 2015;12:2388–2397.     

Adherence to Initial PDE5 Inhibitor Treatment: Randomized OpenLabel Study Comparing Tadalafil Once a Day,Tadalafil on Demand,and Sildenafil on Demand in Patients with Erectile Dysfunction

IntroductionPhosphodiesterase type 5 (PDE5) inhibitor treatment for erectile dysfunction (ED) is frequently discontinued; adherence may vary depending on the initial regimen.AimTo evaluate the effects of initiating treatment with tadalafil once a day (OaD), tadalafil on demand (pro re nata [PRN]), or sildenafil PRN on treatment adherence.MethodsIn this multicenter, openlabel study, men (≥18 years) with ED, naïve to PDE5 inhibitors, were randomized (1:1:1) to tadalafil 5 mg OaD, tadalafil 10 mg PRN, or sildenafil 50 mg PRN. An 8week randomized treatment (RT) period (dose adjustment possible) was succeeded by 16 weeks of pragmatic treatment (switches between PDE5 inhibitors allowed).Main Outcome MeasuresTreatment adherence was measured as time to discontinuation of RT (any cause), estimated by Kaplan–Meier productlimit method. Treatmentgroup differences were estimated as hazard ratio (HR; Cox proportional hazards).ResultsSeven hundred seventy patients (mean age 53 years) were randomized to tadalafil OaD (N = 257), tadalafil PRN (N = 252), and sildenafil PRN (N = 261). Kaplan–Meier estimates for patients discontinuing RT were 52.2, 42.0, and 66.7%, respectively. Median time to discontinuation of RT was significantly longer for tadalafil OaD and PRN (130 and >168 days) compared with sildenafil (67 days) (HR [97.5% confidence interval]: 0.66 [0.51, 0.85] and 0.49 [0.37, 0.65]; P < 0.001). Reasons for discontinuation with significant differences between groups (P < 0.05) included “lack of efficacy (duration of erection)” (sildenafil 9.2% vs. tadalafil OaD 4.3%, PRN 2.8%), “time constraints due to short window of action” (sildenafil 4.2% vs. tadalafil OaD 0%, PRN 0.4%), and “feel medication controls my sexual life” (sildenafil 2.7% vs. tadalafil OaD 0%). No betweengroup differences were found in International Index of Erectile FunctionErectile Function domain change from baseline to end of RT (least squares mean: 9.4–10.0, P = 0.359) or discontinuations due to adverse events (1.2–1.6%). The most common adverse event (≥4%) was headache.ConclusionsED patients assigned to tadalafil OaD or PRN adhered significantly longer to initial treatment than patients assigned to sildenafil PRN. Improvement of erectile function and safety profiles were similar in all three treatment groups.     

Neuropelveological assessment of neuropathic pelvic pain

The aim of the present report is to emphasize the importance of taking neurological considerations into account in the diagnostic workup of chronic pelvic pain (CPP) of “unknown origin.” Based on new knowledge of the functional neuroanatomy of the pelvis and recent developments in the treatment of pelvic neuropathies, we incorporated well-known neurologic diagnostic methods into the classical gynecological workup for CPP. “Neuropelveological” assessment of CPP in women requires a detailed gynecological and neurologic history, a classical gynecological workup, and an adapted “gynecological” examination of the pelvic nerves and plexuses. The present report provides guidelines for “neuropelveological” assessment of chronic pelvic pain in clinical practice. It emphasizes the benefits of taking “neurological” considerations into account when diagnosing chronic pelvic pain.     

Assessment of Patient Satisfaction With Postoperative Pain Management After Ambulatory Gynaecologic Laparoscopy

ObjectiveTo determine patient satisfaction with postoperative pain control after ambulatory gynaecologic laparoscopic surgery.MethodsA prospective cohort study in a major tertiary care centre was performed to assess patient satisfaction with postoperative analgesia on the day of surgery and on postoperative days one and two. Data were collected either by telephone or mail-in questionnaire on each postoperative day. Each patient rated her level of satisfaction according to a 5-point scale at the end of each postoperative day as an average for that day. The final outcome was recorded as either satisfied, with all days classified as “very satisfied” or “perfectly satisfied,” or unsatisfied, if any single day was rated as “not satisfied at all,” “only slightly satisfied,” or “somewhat or partly satisfied.ResultsForty-nine patients completed the questionnaire. Surgical procedures included tubal ligation with cautery (20), ovarian cystectomy (5), oophorectomy (2), diagnostic laparoscopy (14), and Burch procedure (8). Sixty percent of patients (30/49) were classified as satisfied with their level of postoperative analgesia.ConclusionsOnly 60% of patients undergoing gynaecologic laparoscopy as day surgery were satisfied with postoperative pain control. This is suboptimal, particularly in light of the ongoing trend towards more complex procedures being performed as day surgery via minimally invasive techniques.     

Long-Acting Reversible Contraceptive Attitudes and Acceptability in Adolescents and Young Adults: A Key to Patient-Centered Contraceptive Counseling

PurposeTo examine the attitudes of adolescent and young adults (AYA) toward long-acting reversible contraception (LARC), and to assess how attitudes are associated with acceptability.DesignSurvey.SettingChildren's Hospital Colorado Adolescent Family Planning Clinic in Aurora, Colorado.Participants, Interventions, and Main Outcome MeasuresYoung persons 14-24 years of age presenting for any type of visit between March and August 2018.ResultsA total of 332 participants were enrolled; the majority (62.3%) had high LARC acceptability. We found 5 “attitude” factors: 77.7% of the sample endorsed “Effective” attitudes (eg, wants most effective method), 37.3% endorsed “Good attributes” (eg, discreet, convenient), 23.1% endorsed “Scary” (eg, fears device will move), 16.1% endorsed “Bad for health,” (eg, too many side effects), and 9% endorsed “Not for me” (eg, concerns about pain). Although participants who endorsed “Effective” (OR 6.60, 95% CI 3.01-14.49) and “Good attributes” (OR 3.17, 95% CI 1.51-6.66) were more likely to have high LARC acceptability than those who endorsed “Scary” (OR 0.28, 95% CI: (0.13-0.61)) and “Not for me” (OR 0.07, 95% CI 0.01-0.41) factors, approximately 10% of participants with high LARC acceptability endorsed “Scary” or “Bad for health” attitudes, whereas 54% of those with low LARC acceptability endorsed “Effective” attitudes.ConclusionAlthough most participants had high LARC acceptability and valued contraceptive effectiveness, the association between LARC attitudes and acceptability is nuanced. Providers should identify and discuss young people's contraceptive knowledge, attitudes, and acceptability.     

Preliminary results of concurrent radiotherapy and chemotherapy in advanced cervical carcinoma: a phase I-II prospective intergroup NCOG-RTOG Study

Thirty-eight patients with advanced carcinoma of the cervix were prospectively treated with a concurrent combination of radiotherapy (RT) and chemotherapy (CT) using the drugs 5-fluorouracil (5FU), mitomycin C and cis-platinum as part of a Northern California Oncology Group (NCOG) and Radiation Therapy Oncology Group (RTOG) intergroup study. RT consisted of 36.00 Gy to the pelvis in 4 weeks followed by a 9.00-Gy parametrial boost. This was followed by two intracavitary applications for a total of 4000 mg hr of radium equivalent when possible. 5FU (1000 mg/m2/24 hr for 96 hr by iv infusion) and mitomycin C (10 mg/m2/iv bolus) were given during the second week of external RT. 5FU (dose as above) and cis-platinum (75 mg/m2/iv over 6 hr) were given during the first intracavitary application. Of 36 patients evaluable for toxicity, 11% had grade 3 nonhematological toxicity and 11% had reversible grade 4 hematological toxicity. There were no toxic deaths. A complete response rate of 62.5% was obtained overall (median survival not reached). This study suggests that this particular combination of RT and CT in advanced cervical carcinoma is effective and well tolerated.     

Web-based News Reports on Midwives Compared with Obstetricians: A Prospective Analysis

Abstract: Background: The media both creates and reflects public opinion. The way in which health professionals are depicted in the media is likely to influence views held by and about different health professions. The aim of this study was to examine how midwives and obstetricians are reported in English language web-based news reports from around the world. Methods: News alerts from the Internet search engine Google were created to search for the terms “midwife,”“midwives,”“midwifery,”“obstetrics,” and “obstetricians.” These alerts were received over a 12-month period (May 1, 2006–April 31, 2007), downloaded, and analyzed using quantitative content analysis. Results: A total of 522 web-based news reports for midwifery and 564 for obstetrics (n = 1,086) were found. Dominant categories for midwives were: “mainstreaming midwives” (models of care/rise of midwifery) (28%); “the Cinderella of the maternity care” (workforce/industrial) (27%); “delivering the baby with your hands tied” (funding, insurance, and legislation) (21%); “ask the expert” (education, research, and health advice) (8%), “recognizing midwives” (awards and announcements) (7%), “unsafe midwives” (litigation) (6%); and “the art of birth” (books, film, and photographs) (2%). Dominant categories for obstetricians were: “ask the expert” (research and advice) (26%); “doctors are heroes amongst us” (awards and announcements) (19%); “obstetric workforce woes” (workforce/industrial) (19%); “new frontiers” (trends in care and new technology) (17%); “the disappearing obstetrician” (insurance and litigation) (10%); and “human-interest news reports” (9%). Obstetricians were more likely to be recognized as experts on pregnancy and birth and receive public recognition compared with midwives. Midwives were more likely to be depicted as struggling to be a mainstream option while being hampered by lack of funding, insurance, and legislative barriers. Conclusions: Although midwives have rising acceptance, they still struggle with recognition. Obstetricians have both acceptance and recognition. Countries where midwifery is a mainstream option have more news reports related to midwifery than obstetrics. Different issues appear more dominant in some countries, such as work force in the United Kingdom and funding, insurance, and legislation in the United States. (BIRTH 39:1 March 2012)