Browsing by Author "Glazener, Cathryn Margaret Anne"

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Developing a pelvic floor muscle training regimen for use in a trial intervention
(Elsevier, 2009) Dorey, Grace; Glazener, Cathryn Margaret Anne; Buckley, Brian; Cochran, Claire; Moore, Katherine
This paper explains the rationale behind the intervention used for a large multi centred randomised controlled trial for men following transurethral resection of prostate or radical prostatectomy. It shows the content of the protocol used and explains why this particular protocol of pelvic floor muscle exercises and urge suppression techniques was chosen for men in the intervention group. The trial will evaluate whether this intervention will be effective for men with urinary incontinence and sexual dysfunction after prostate surgery.
Efficacy and safety of using mesh or grafts in surgery for anterior and/or posterior vaginal wall prolapse: systematic review and meta-analysis.
(Elsevier Science, 2008) Jia, Xueli; Glazener, Cathryn Margaret Anne; Mowatt, Graham; MacLennan, Graeme Stewart; Fraser, Cynthia Mary; Bain, Christine; Burr, Jennifer Margaret
Background The efficacy and safety of mesh/graft in surgery for anterior or posterior pelvic organ prolapse is uncertain. Objectives To systematically review the efficacy and safety of mesh/graft for anterior or posterior vaginal wall prolapse surgery. Search strategy Electronic databases and conference proceedings were searched, experts and manufacturers contacted and reference lists of retrieved papers scanned. Selection criteria Randomised controlled trials (RCTs), non-randomised comparative studies, registries, case series involving at least 50 women, and RCTs published as conference abstracts from 2005 onwards. Data collection and analysis One reviewer screened titles/abstracts, undertook data extraction, and assessed study quality. Data analysis was conducted for three subgroups: anterior, posterior, and anterior and/or posterior repair (not reported separately). Results Forty-nine studies involving 4569 women treated with mesh/graft were included. Study quality was generally high. Median follow up was 13 months (range 1 to 51). In anterior repair, there was short-term evidence that mesh/graft (any type) significantly reduced objective prolapse recurrence rates compared with no mesh/graft (relative risk 0.48, 95% CI 0.32-0.72). Non-absorbable synthetic mesh had a significantly lower objective prolapse recurrence rate (8.8%, 48/548) than absorbable synthetic mesh (23.1%, 63/273) and biological graft (17.9%, 186/1041), but a higher erosion rate (10.2%, 68/666) than synthetic mesh (0.7%, 1/147) and biological graft (6.0%, 35/581). There was insufficient information to compare any of the other outcomes regardless of prolapse type. Conclusion Evidence for most outcomes was too sparse to provide meaningful conclusions. Rigorous long-term RCTs are required to determine the comparative efficacy of using mesh/graft.
Incontinence-specific quality of life measures used in trials of treatments for female urinary incontinence: a systematic review.
(Springer, 2006-05) Ross, S; Soroka, D; Karahalios, A; Glazener, Cathryn Margaret Anne; Hay-Smith, E. J. C.; Drutz, H.P
This systematic review examined the use of incontinence-specific QOL measures in clinical trials of female incontinence treatments, and systematically evaluated their quality using a standard checklist. Of 61 trials included in the review, 58 (95.1%) used an incontinence-specific QOL measure. The most commonly used were IIQ (19 papers), I-QoL (12 papers) and UDI (9 papers). Eleven papers (18.0%) used measures which were not referenced or were developed specifically for the study. The eight QOL measures identified had good clinical face validity and measurement properties. We advise researchers to evaluate carefully the needs of their specific study, and select the QOL measure that is most appropriate in terms of validity, utility and relevance, and discourage the development of new measures. Until better evidence is available on the validity and comparability of measures, we recommend that researchers consider using IIQ or I-QOL with or without UDI in trials of incontinence treatments.
New postnatal urinary incontinence: obstetric and other risk factors in primparae.
(Blackwell Publishing, 2006-02) Glazener, Cathryn Margaret Anne; Herbison, G.P; MacArthur, C; Lancashire, R; McGee, M; Grant, Adrian Maxwell
Objective To identify obstetric and other risk factors for urinary incontinence which occurs during pregnancy or after childbirth. Design Questionnaire survey of women. Setting Maternity units in Aberdeen (Scotland), Birmingham (England) and Dunedin (New Zealand). Population 3405 primiparous women with singleton births delivered during one year. Methods Questionnaire responses and obstetric casenote data were analysed using multivariate analysis to identify associations with urinary incontinence. Main outcome measures Urinary incontinence at three months after delivery first starting in pregnancy or after birth. Results The prevalence of urinary incontinence was 29%. New incontinence first beginning after delivery was associated with higher maternal age (oldest versus youngest group, odds ratio, OR 2.02, 95% CI 1.35 to 3.02); and method of delivery (caesarean section versus spontaneous vaginal delivery, OR 0.28, 95% CI 0.19 to 0.41). There were no significant associations with forceps delivery (OR 1.18, 95% CI 0.92 to 1.51) or vacuum delivery (OR 1.16, 95% CI 0.83 to 1.63). Incontinence first occurring during pregnancy and still present at three months was associated with higher maternal body mass index (BMI > 25, OR 1.68, 95% CI 1.16 to 2.43), and heavier babies (birthweight in top quartile, OR 1.56, 95% CI 1.12 to 2.19). In these women, caesarean section was associated with less incontinence (OR 0.39, 95% CI 0.27 to 0.58) but incontinence was not associated with age. Conclusions Women have less urinary incontinence after a first delivery by caesarean section whether or not that first starts during pregnancy. Older maternal age was associated with new postnatal incontinence, and higher body mass index and heavier babies with incontinence first starting during pregnancy. The effect of further deliveries may modify these findings.
Persistent urinary incontinence and delivery mode history: a six-year longitudinal study.
(Blackwell Publishing, 2006-02) MacArthur, C; Glazener, Cathryn Margaret Anne; Wilson, P.D; Lancashire, R; Herbison, G.P; Grant, Adrian Maxwell
Objective: To investigate the prevalence of persistent and long term postpartum urinary incontinence and associations with mode of first and subsequent delivery. Setting: Maternity units in Aberdeen (Scotland), Birmingham (England) and Dunedin (New Zealand). Design: Longitudinal study Population: 4214 women who returned postal questionnaires 3 months and 6 years after the index birth. Methods: Symptom data were obtained from both questionnaires and obstetric data from case-notes for the index birth and the second questionnaire for subsequent births. Logistic regression investigated the independent effects of mode of first delivery and delivery mode history. Main outcome measures: Urinary incontinence – persistent (at 3 months and 6 years after index birth) and long-term (at 6 years after index birth). Results: The prevalence of persistent urinary incontinence was 24%. Delivering exclusively by Caesarean section was associated with both less persistent (OR= 0.46, 95% CI 0.32 to 0.68) and long term urinary incontinence (OR=0.50, 95% CI 0.40 to 0.63). Caesarean section birth in addition to vaginal delivery however was not associated with significantly less persistent incontinence (OR 0.93, 95%CI 0.67 to 1.29). There were no significant associations between persistent or long-term urinary incontinence and forceps or vacuum extraction delivery. Other significantly associated factors were increasing number of births and older maternal age. Conclusions: The risk of persistent and long term urinary incontinence is significantly lower following Caesarean section deliveries but not if there is another vaginal birth. Even when delivering exclusively by Caesarean section, the prevalence of persistent symptoms (14%) is still high.
Psychometric properties of the Pelvic Organ Prolapse Symptom Score
(Blackwells, 2009-01) Hagen, S; Glazener, Cathryn Margaret Anne; Sinclair, L; Stark, D; Bugge, C
Objective To assess the internal consistency, construct validity and sensitivity to change of a pelvic organ prolapse symptom score (POP-SS). Design Analysis of data from three prolapse studies, including symptomatic and asymptomatic women who completed the POP-SS. Setting (1) A community setting in New Zealand, (2) two gynaecology outpatient departments in Scotland and (3) a gynaecological surgery department in Scotland. Population or sample (1) Participants from a survey of postnatal women at 12-year follow up, invited to complete a prolapse questionnaire and have prolapse assessment, (2) new gynaecology outpatients presenting with prolapse symptoms, randomised to pelvic floor muscle training (PFMT) or control and (3) women having anterior and/or posterior prolapse surgery, randomised to mesh insert or no mesh. Method Data were analysed to assess internal consistency, construct validity and sensitivity to change of the POP-SS. Main outcome measures Cronbach's alpha, significance of differences in POP-SS scores between studies and significance of difference in POP-SS scores pre- to post-intervention. Results For internal consistency, Cronbach's alpha ranged from 0.723 to 0.828. Women having surgery had higher POP-SS scores than those having conservative management (mean difference 5.0, 95% CI 3.1–6.9), who in turn had higher scores than the asymptomatic women (mean difference 5.9, 95% CI 4.4–7.4). Significant differences in POP-SS score were detected after surgery and PFMT. The improvement due to surgery was significantly greater than that associated with PFMT (z =−3.006, P = 0.003). Conclusion The POP-SS has good internal consistency and construct validity and is sensitive to change.
A randomised controlled trial evaluating the use of polyglactin mesh, polydioxanone and polyglactin sutures for pelvic organ prolapse surgery
(Taylor & Francis, 2008) Alladin, S; Glazener, Cathryn Margaret Anne; Bain, Christine
To compare the effectiveness of polyglactin mesh, and polydioxanone or polyglactin sutures in women having pelvic organ prolapse surgery. Randomised controlled trial with a factorial 2(2 design of polyglactin mesh or not, and polydioxanone or polyglactin suture. Outcomes were assessed using questionnaires at baseline and on the third day and at 6 months after surgery. Women were also examined clinically 3 months after surgery. The primary outcome was the subjective improvement in prolapse symptoms and quality of life scores from baseline to 6 months. There was a subjective improvement in the prolapse symptom score from baseline to 6 months after surgery (mean difference of 9.2 (95% CI for difference 7.2-11.2, p < 0.001) and an improvement in the mean quality of life score over the same period with a reduction of 3.4 (95% CI for difference 2.4-4.3, p < 0.001). However, there were no significant differences in the mean difference in prolapse symptoms and quality of life (QoL) scores according to the randomised groups. The majority (86%) of women were satisfied with their surgery. Our study demonstrated that at short-term follow-up, there was no significant difference in the mean differences in prolapse symptoms and QoL scores after surgery using polyglactin mesh or not, polyglactin or polyglactin sutures, but the numbers were too small for a definitive conclusion. Longer-term follow-up and/or a larger trial are required.
A randomised controlled trial of pelvic floor muscle training for stages I and II pelvic organ prolapse
(Springer, 2009) Hagen, Suzanne; Stark, Diane; Glazener, Cathryn Margaret Anne; Sinclair, Lesley; Ramsay, Ian
Abstract Forty-seven women participated in a pilot study for a multi-centre randomized controlled trial of the effectiveness of pelvic floor muscle training (PFMT) for women with prolapse. Women with symptomatic stage I or II prolapse [measured by Pelvic Organ Prolapse Quantification (POP-Q)] were randomized to a 16-week physiotherapy intervention (PFMT and lifestyle advice; n=23) or a control group receiving a lifestyle advice sheet (n=24). Symptom severity and quality of life were measured via postal questionnaires. Blinded POP-Q was performed at baseline and follow-up. Intervention women had significantly greater improvement than controls in prolapse symptoms (mean score decrease 3.5 versus 0.1, p=0.021), were significantly more likely to have an improved prolapse stage (45% versus 0%, p=0.038) and were significantly more likely to say their prolapse was better (63% versus 24%, p=0.012). The data support the feasibility of a substantive trial of PFMT for prolapse. A multi-centre trial is underway.
Sexual function, delivery mode history, pelvic floor muscle exercises and incontinence : a cross-sectional study six years postpartum
(Wiley Interscience, 2008-06-03) Dean, Nicola; Wilson, Don; Herbison, Peter; Glazener, Cathryn Margaret Anne; Aung, Thiri; MacArthur, Christine
Background: There is controversy over the effect of mode of delivery, pelvic floor muscle exercises (PFME), incontinence and sexual function. Aim: To investigate the relationship of sexual function with delivery mode history, PFMEs and incontinence. Methods: This was a cross-sectional postal survey of women, six years post-partum, who had given birth in maternity units in Aberdeen, Birmingham and Dunedin and had answered a previous questionnaire. Each sexual function question was analysed separately by ANOVA. Results: At six years post-index delivery, 4214 women responded, of whom 2765 (65%) answered the optional ten sexual function questions. Although there was little association between delivery mode history and most sexual function questions, women who had delivered exclusively by caesarean section scored significantly better on the questions relating to their perception of vaginal tone for their own (P-value < 0.0001) and partner's (P-value 0.002) sexual satisfaction, especially when compared with women who had had vaginal and instrumental deliveries. Women who reported that they were currently performing PFME scored significantly better on seven questions. Women with urinary or faecal incontinence scored significantly poorer on all sexual function questions. Conclusions: Mode of delivery history appeared to have minimal effect on sexual function. Current PFME performance was positively associated with most aspects of sexual function, however, all aspects were negatively associated with urinary and faecal incontinence.
Systematic review of the clinical effectiveness and cost-effectiveness and economic modelling of minimal incision total hip replacement approaches in the management of arthritic disease of the hip
(Gray Publishing, 2008-06) De Verteuil, Robyn; Imamura, Mari; Zhu, S.; Glazener, Cathryn Margaret Anne; Fraser, Cynthia Mary; Munro, N.; Hutchison, James Douglas; Grant, Adrian Maxwell; Coyle, D.; Coyle, K.; Vale, Luke David; University of Aberdeen, School of Medicine & Dentistry, Division of Applied Health Sciences; University of Aberdeen, School of Medicine & Dentistry, Division of Applied Medicine
Objectives: To assess the clinical effectiveness and cost-effectiveness of minimal incision approaches to total hip replacement (THR) for arthritis of the hip. Data sources: Major electronic databases were searched from 1966 to 2007. Relevant websites were also examined and experts in the field were consulted. Review methods: Studies of minimal (one or two) incision THR compared with standard THR were assessed for inclusion in the review of clinical effectiveness. A systematic review of economic evaluations comparing a minimal incision approach to standard THR was also performed and the estimates from the systematic review of clinical effectiveness were incorporated into an economic model. Utilities data were sourced to estimate quality-adjusted life-years (QALYs). Due to lack of data, no economic analysis was conducted for the two mini-incision surgical method. Results: Nine randomised controlled trials (RCTs), 17 non-randomised comparative studies, six case series and one registry were found to be useful for the comparison of single mini-incision THR with standard THR. One RCT compared two mini-incision THR with standard THR, and two RCTs, five non-randomised comparative studies and two case series compared two mini-incision with single mini-incision THR. The RCTs were of moderate quality. Most had fewer than 200 patients and had a follow-up period of less than 1 year. The single mini-incision THR may have some perioperative advantages, e.g. blood loss [weighted mean difference (WMD) –57.71 ml, p < 0.01] and shorter operative time, of uncertain practical significance. It may also offer a shorter recovery period and greater patient satisfaction. Evidence on long-term outcomes (especially revision) is too limited to be useful. Lack of data prevented subgroup analysis. With respect to the two-incision approach, data were suggestive of shorter recovery compared with single-incision THR, but conclusions must be treated with caution. The costs to the health service, per patient, of single mini-incision THR depend upon assumptions made, but are similar at 1 year (£7060 vs £7350 for standard THR). For a 40-year time horizon the costs were £11,618 for mini-incision and £11,899 for standard THR. Two existing economic evaluations were identified, but they added little, if any, value to the current evidence base owing to their limited quality. In the economic model, mini-incision THR was less costly and provided slightly more QALYs in both the 1- and 40-year analyses. The mean QALYs at 1 year were 0.677 for standard THR and 0.695 for mini-incision THR. At 40 years, the mean QALYs were 8.463 for standard THR and 8.480 for mini-incision. At 1 year the probabilistic sensitivity analyses indicate that mini-incision THR has a 95% probability of being cost-effective if society’s willingness to pay for a QALY were up to £50,000. This is reduced to approximately 55% for the 40-year analysis. The results were driven by the assumption of a 1-month earlier return to usual activities and a decreased hospital length of stay and operation duration following mini-incision THR. If mini-incision THR actually required more intensive use of resources it would become approximately £200 more expensive and would only be cost-effective (cost per QALY > £30,000) if recovery was 1.5 weeks faster. A threshold analysis around risk of revision showed, using the same cost per QALY threshold, mini-incision THR would have to have no more than a 7.5% increase in revisions compared with standard THR for it to be no longer considered cost-effective (one more revision for every 200 procedures performed). Further sensitivity analysis involved relaxing assumptions of equal long-term outcomes where possible. and broadly similar results to the base-case analysis were found in this and further sensitivity analyses. Conclusions: Compared with standard THR, minimal incision THR has small perioperative advantages in terms of blood loss and operation time. It may offer a shorter hospital stay and quicker recovery. It appears to have a similar procedure cost to standard THR, but evidence on its longer term performance is very limited. Further long-term follow-up data on costs and outcomes including analysis of subgroups of interest to the NHS would strengthen the current economic evaluation.