Pentoxifylline Increases Antiadhesion Effect of Streptokinase on Postoperative Adhesion Formation: Involvement of Fibrinolytic Pathway

Pentoxifylline reduces peritoneal adhesions and increases peritoneal fibrinolysis in rodents. Furthermore, the activation of the fibrinolytic system by streptokinase leading to degradation of fibrin is effective in the prevention of adhesion formation. We have investigated the effects of pentoxifylline and streptokinase alone and/or coadministration on postoperative intra-abdominal adhesion formation in adult female NMRI mice. Drugs were administered from the day of surgery until 10 days after surgery. At relaparotomy 11 days after surgery, the abdomen was opened, and the adhesions were graded in a blinded fashion utilizing the classification system described. Oral gavage administration of lower doses of pentoxifylline (3.125, 6.25, and 12.5 mg/kg) had no significant effect on postsurgical adhesion formation, while the higher doses of pentoxifylline (25 and 50 mg/kg) significantly decreased postsurgical adhesion formation. Moreover, intraperitoneal injection of lower doses of streptokinase (9.375, 18.75, and 37.5 unit/kg, i.p.) had no significant effect on postsurgical adhesion formation, while the higher doses of streptokinase (75 and 150 unit/kg) significantly decreased postsurgical adhesion formation. In other series of experiments, coadministration of lower doses of pentoxifylline and streptokinase doses, which were ineffective when given alone, significantly decreased postsurgical intra-abdominal adhesion formation compared with streptokinase control group. The results suggest that pentoxifylline may interfere with streptokinase in the reduction of postoperative intra-abdominal adhesion formation by enhancing local fibrinolytic activity.     

Post‐trabeculectomy ocular biometric changes

Trabeculectomy is the most common surgical procedure for the management of glaucoma, which may significantly influence ocular biometry. Axial length and anterior chamber depth tend to decrease, while crystalline lens and choroidal thickness increase post‐operatively. An increase in with‐the‐rule astigmatism is also observed after the procedure. Such biometric changes affect intraocular lens power calculation even years after the procedure. Non‐contact biometric methods and postponing cataract surgery after trabeculectomy could reduce calculation errors associated with surgically induced alterations in ocular biometrics.     

Development,standardisation and pilot testing of an online fatigue self-management program

Purpose. Although an effective face-to-face fatigue program is available, people with transportation, time or geographic restrictions cannot access this intervention. Therefore, the aim of this study was to develop and to evaluate effectiveness of an online fatigue self-management program (online FSMP).

Methods. Key features of the face-to-face program were captured and transferred to an online FSMP prototype. Subsequently, three pilot tests were conducted for formative evaluation of the program and necessary changes were made to improve the program. During the third pilot test, the effectiveness of the online FSMP was also tested using a pre-test post-test design on a sample of individuals with multiple sclerosis, Parkinson's disease or post-polio syndrome.

Results. The study resulted in a standardised 7-week online FSMP mimicking its face-to-face version. Participants were offered fatigue self-management skills through structured activities, sharing information and experiences, expressing their ideas or feelings and offering advice and support to one another. The participants in the third pilot study improved significantly on the Fatigue Impact Scale (p <0.05) and a trend toward significance was shown on the Personal Wellbeing index (p = 0.08).

Conclusions. The online FSMP is a viable treatment for people with neurological conditions and warrants further study.     

Self-management programs conducted within a practice setting: Who participates,who benefits and what can be learned?

Objective

To investigate the impact of generic and diabetes-specific self-management programs offered in a real world context.

Methods

A quasi-experimental design with 12-week follow-up compared Living with a Chronic Condition and Living with Diabetes. Self-report data collected included: Self-management Knowledge and Skills; Health Related Quality of Life (HRQOL); Depression; Social Isolation; Loneliness; Self-efficacy; and Health Behaviours.

Results

Participants (N = 458) in the two programs differed on almost all baseline measures. Both demonstrated statistically significant improvements in Self-management Knowledge and Skills, as well as reductions in depression. In addition to younger age, low HRQOL, high self-efficacy and Positive and Active Engagement in Life, were the clinical factors most likely to lead to improvements in HRQOL and self-efficacy. Changes in different characteristics predicted different outcomes.

Conclusion

Both generic and disease-specific programs led to improved outcomes, despite the two programs attracting significantly different participants. Referral patterns also differed but GP referral rates were low for both.

Practice implications

Positive participant outcomes can be achieved in real life clinical settings. While younger people with a positive attitude may appear to gain more, it is important to encourage people from low socio-economic status to enter these programs so that social inequalities in health are not worsened.