The effectiveness of pelvic floor exercise on urinary incontinence in radical prostatectomy patients

Urinary incontinence (UI) is a major complication among patients after radical prostatectomy (RP). Although previous research supports the efficacy of pelvic floor exercises for male UI, there are both positive and no significant effects. The purpose of this study was to examine the effect of pelvic floor exercises on UI after RP. This was a quasi‐experimental, randomized, mixed‐method study design. All participants were older than 45 years and had undergone an RP. Outcome measurements included a 1‐h pad test, personal demographics, and disease‐related data. After catheter removal, participants were distributed into either an exercise group (n = 39) or a non‐exercise group (n = 28). Patients in the exercise group took part in a pelvic floor exercise during their regular daily activities. The non‐exercise group did not perform the prescribed exercise. We examined urinary function at 1, 3 and 6 months after catheter removal. Following a mixed‐model anova test for differences, the results of the pad test revealed significant differences for the main effect of time (F = 75·30,P < 0·001), indicating that the amount of urine leakage decreased over time regardless of the group. Results for the main effect of group were statistically significant (F = 8·85,p < 0·01), indicating that urine leakage also decreased over time in both groups, but that urinary control in the exercise group was better than in the non‐exercise group. Although improvements in surgical technique have significantly improved the outcome of prostate surgery, we believe that patient education regarding pelvic floor exercises by a nurse prior to and after surgery has a significant impact on the early recovery of urinary continence. We believe these exercises would certainly have a positive impact on our patients undergoing RP by improving the quality of life after major urological surgery.     

Frequency of known gene rearrangements in endometrial stromal tumors

Translocations resulting in gene fusion are characteristic of endometrial stromal tumors (ESTs). Rearrangements of JAZF1, SUZ12, PHF1, and EPC1 have been reported in endometrial stromal nodules (ESNs), endometrial stromal sarcomas (ESSs), and rarely in undifferentiated endometrial sarcomas (UESs). Detection of JAZF1, SUZ12, EPC1, and PHF1 rearrangement by fluorescence in situ hybridization was performed on tissue microarrays consisting of 94 ESTs of classic and variant morphology (20 ESNs, 43 primary uterine ESSs, 15 metastatic uterine ESSs, 4 primary extrauterine ESSs, 7 primary uterine UESs, and 5 unclassified ESTs), 16 Müllerian adenosarcomas, 2 malignant mixed Müllerian tumors, 2 uterine tumors resembling ovarian sex-cord tumors, 2 highly cellular leiomyomas, 1 leiomyosarcoma, and 7 polypoid endometriosis. Rearrangements were detected in 42 of 78 (54%) uterine ESTs, with JAZF1-SUZ12 fusion found in 50% of ESNs and in 33% of ESSs and JAZF1-PHF1 and EPC1-PHF1 fusions found in 1% and <1% of ESSs, respectively. PHF1 and JAZF1 were rearranged with unknown partners in 8 uterine ESTs. JAZF1-SUZ12 fusion, EPC1-PHF1 fusion, and PHF1 rearrangement were found in 3 extrauterine ESSs, whereas no rearrangements were observed in UESs or in any other non-EST studied. Our data confirm that gene rearrangements are present in more than 50% of uterine ESTs, with JAZF1-SUZ12 fusion being the most common, followed by rare EPC1-PHF1 and JAZF1-PHF1 fusions. The presence of identical gene rearrangements in both uterine and extrauterine ESTs suggests a similar pathogenesis. The presence of detectable gene rearrangements in uterine ESS may predict better patient outcome.     

Predictors of improved overactive bladder symptoms after transvaginal mesh repair for the treatment of pelvic organ prolapse

Introduction and hypothesis  

The aim of this study was to identify the predictors of improved overactive bladder (OAB) symptoms after transvaginal mesh repair.     

Care Coordination Strategies and Barriers during Medication Safety Incidents: a Qualitative,Cognitive Task Analysis

BackgroundMedication errors are prevalent in healthcare institutions worldwide, often arising from difficulties in care coordination among primary care providers, specialists, and pharmacists. Greater knowledge about care coordination surrounding medication safety incidents can inform efforts to improve patient safety.ObjectivesTo identify strategies that hospital and outpatient healthcare professionals (HCPs) use, and barriers encountered, when they coordinate care during a medication safety incident involving an adverse drug reaction, drug-drug interaction, or drug-renal concern.DesignWe asked HCPs to complete a form whenever they encountered these incidents and intervened to prevent or mitigate patient harm. We stratified incidents across HCP roles and incident categories to conduct follow-up cognitive task analysis interviews with HCPs.ParticipantsWe invited all physicians and pharmacists working in inpatient or outpatient care at a tertiary Veterans Affairs Medical Center. We examined 24 incidents: 12 from physicians and 12 from pharmacists, with a total of 8 incidents per category.ApproachInterviews were transcribed and analyzed via a two-stage inductive, qualitative analysis. In stage 1, we analyzed each incident to identify decision requirements. In stage 2, we analyzed results across incidents to identify emergent themes.Key ResultsMost incidents (19, 79%) were from outpatient care. HCPs relied on four main strategies to coordinate care: cognitive decentering; collaborative decision-making; back-up behaviors; and contingency planning. HCPs encountered four main barriers: role ambiguity and constraints, breakdowns (e.g., delays) in care, challenges related to the electronic health record, and factors that increased coordination complexity. Each strategy and barrier occurred across all incident categories and HCP groups. Pharmacists went to extra effort to ensure safety plans were implemented.ConclusionsSimilar strategies and barriers were evident across HCP groups and incident types. Strategies for enhancing patient safety may be strengthened by deliberate organizational support. Some barriers could be addressed by improving work systems.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-020-06386-w.KEY WORDS: care coordination, patient safety, human factors engineering, medication errors, adverse drug event, medication management     

Hyaluronan Up‐Regulates IL‐10 Expression in Fibroblast‐Like Synoviocytes from Patients with Tibia Plateau Fracture

Progression to osteoarthritis (OA) is a frequent sequela of severe articular fracture, particularly when weight‐bearing joints are involved. Prevention from post‐traumatic OA remains a challenge. Hyaluronan (HA) therapy is reported to represent a safe and effective treatment for patients with OA and rheumatoid arthritis. However, the capacity of HA to prevent the occurrence of osteoarthritic changes in fractured joints has not been demonstrated. The present study was undertaken to examine the effects of HA on expression of six OA‐related proteins in fibroblast‐like synoviocytes (FLS) from 10 patients with tibia plateau fracture. OA‐related factors were quantified using a sandwich enzyme‐linked immunosorbent assay. Regardless of induction of the FLS with interleukin (IL)‐1β, HA was found to down‐regulate expression of catabolic factors (IL‐1β, matrix metalloproteinase‐3, and tumor necrosis factor‐α) and to up‐regulate production of anti‐catabolic factors (tissue inhibitors of metalloproteinase‐1 and metalloproteinase‐2). HA also enhanced expression of IL‐10, an anti‐inflammatory cytokine, in FLS. Our results indicated that HA can promote the expression of both antiinflammatory and structure‐protective factors in FLS of patients with tibia plateau fracture. © 2010 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 29:495–500, 2011     

Dendritic cells pulsed with apoptotic cells activate self-reactive T-cells of lupus mice both in vitro and in vivo

OBJECTIVES: Systemic lupus erythematosus (SLE) is characterized by the presence of autoantibodies (autoAbs) directed against the nuclear structure. Previous studies have demonstrated that dendritic cells (DCs) can process and present self-antigens (Ags) from apoptotic cells (ACs) in lupus. However, there is no direct evidence demonstrating that ACs provide self-Ags, such as histones, to stimulate autoreactive T-cells in lupus. METHODS: AC-pulsed bone marrow-derived DCs (AC-BMDCs) were used to stimulate autoreactive T-cells in vitro and in vivo. RESULTS: In our study, we found that AC-BMDCs could induce the proliferation of CD4+ T-cells from unprimed NZB x NZW F1 (BWF1) mice, which spontaneously develop SLE, but not CD4+ T-cells, from non-autoimmune DBA-2 x NZW F1 (DWF1) mice. In addition, AC-BMDCs could induce significant proliferative responses to certain histone peptide-specific T-cells. Furthermore, these AC-BMDCs could induce a considerable anti-DNA Ab response in vivo after adoptive transfer into DWF1 mice, suggesting that AC-BMDCs can break tolerance in normal mice and initiate an autoimmune response. CONCLUSION: Our study provides a direct link between self-epitopes from ACs presented by DCs and autoreactive T-cell activation, and demonstrates that ACs are critical for the induction of autoimmunity in vivo.