Provider Practice Patterns Regarding Over-The-Counter Continence Devices

INTRODUCTION AND HYPOTHESIS

Vaginal inserts and continence devices are recommended as a conservative treatment option for the management of stress urinary incontinence (SUI); however, practice patterns for recommendation and use of such devices are currently unknown. Our objectives were to better understand counseling patterns relating to over-the-counter (OTC) continence devices, to assess perceived barriers to recommending these devices, and to estimate clinician familiarity with three such devices currently available in the USA.

METHODS

In this cross-sectional study, an anonymous electronic survey was distributed to all Accreditation Council for Graduate Medical Education-accredited OB/GYN and Urology residency and Female Pelvic Medicine and Reconstructive Surgery (FPMRS) fellowship programs. A total of 326 survey responses were collected. Multivariate logistic regression was used to assess respondent characteristics associated with recommending OTC continence devices to patients.

RESULTS

Sixty-four percent of respondents expressed familiarity with any OTC continence device. Of respondents who reported regular evaluation and treatment of women with SUI (n = 269), 60% reported ever recommending OTC devices for SUI. On multivariate regression, being a trainee and general OB/GYN provider were associated with being less likely to recommend OTC devices for SUI. Of respondents who did not regularly recommend OTC continence devices, reported barriers to doing so included a lack of training with these devices, leading to clinician discomfort (70%) and not remembering OTC devices as an option (15%).

CONCLUSIONS

Given the low risk associated with patient use of these easily accessible devices, our study highlights barriers to clinician recommendation with the goal of increasing clinician awareness and consideration of OTC continence devices.

An evaluation of pelvic floor disorders in a public and private healthcare setting

INTRODUCTION AND HYPOTHESIS

The objectives were to determine whether a difference exists in the duration of pelvic floor disorder (PFD) symptoms among patients presenting to urogynecologists in two healthcare systems: private and county; and to elucidate differences in baseline characteristics, type of PFDs, symptom severity and management, stratified by healthcare plans.

METHODS

A multi-center retrospective study was conducted including new patients presenting to three urogynecology clinics between March 2016 and May 2018: one private clinic (site A) and two public clinics in the same county healthcare system (sites B and C). Baseline data included age, race, BMI, parity, and comorbidities. Primary outcome was "time to presentation" defined as PFD duration in months. Secondary outcomes were symptom severity and PFD management, analyzed by healthcare setting and insurance type.

RESULTS

A total of 1,055 private and 439 public patients were included. Patients in the public setting were younger (54 vs 61 years, p<0.001), largely Hispanic (76% vs 14%, p<0.001), of higher parity (4 vs 3, p=0.001), and had more comorbidities, with a predominance of county-funded healthcare plans. There was no difference in duration of symptoms between the public and private groups respectively (54 vs 56 months, p=0.94). Patients in the public setting had more severe urinary incontinence (3 vs 2 pads/day, p<0.001) and prolapse (stages 3-4, 71% vs 61%, p=0.004); however, they had lower rates of surgical management for stress incontinence and prolapse. Differences in fecal incontinence could not be evaluated owing to small sample size.

CONCLUSIONS

Public patients presented younger with more severe symptoms but had lower rates of surgery for PFDs traditionally managed surgically.

Plaque regression and improved clinical outcomes following statin treatment in atherosclerosis

3-hydroxy-3-methylglutaryl-coenzymeA reductase inhibitors, or statins, represent an important class of agents that improve clinical outcomes in atherosclerotic cardiovascular disease. Aside from lowering total and low density lipoprotein cholesterol, statins have important pleiotropic effects that include anti-inflammatory, antioxidant, antithrombotic actions as well as mobilization of endothelial progenitor cells and modification of plaque cholesterol crystallization. These combined effects lead to atherosclerotic plaque stabilization that is both quantitative (slowing of plaque progression or plaque volume regression) as well as qualitative (reduced inflammation and amount of lipid rich necrotic plaque) in nature. Statins have been shown to reduce overall mortality when used for either primary or secondary prevention of cardiovascular disease in multiple randomized clinical trials, but such trials involve a large sample size, long treatment duration and enormous financial cost. Imaging of change in plaque burden by various means such as coronary angiography, intravascular and B mode ultrasound and magnetic resonance imaging represents a means of measuring surrogate endpoints by directly assessing statin effects on plaque regression. Multiple imaging studies have demonstrated plaque stabilization or regression with statin treatment that paralleled improvement in lipid profile and clinical outcomes, although it is unlikely that imaging modalities can replace hard clinical outcomes in assessing treatment efficacy.

The Effect of Grain Boundaries and Substrate Interactions with Hydrogen on the CVD Growth of Device-Quality Copper

The effects of grain boundaries and substrate interactions with hydrogen on the CVD growth of device-quality copper were investigated by high-resolution x-ray photoelectron spectroscopy (HRXPS), Auger electron spectroscopy (AES), four-point resistivity probe, x-ray diffraction (XRD), and hydrogen profiling techniques. The films were deposited at 200° C in a stainless-steel cold-wall-type CVD reactor in an atmosphere of pure H2 from various β-diketonate precursors, including bis(6,6,7,7,8,8,8-heptafluoro-2,2- dimethyl-3,5-octanediono)copper(II), Cu(fod)2, and bis(2,2,6,6-tetramethyl- 3,5-heptanedionato)copper(II), Cu(tmhd)2. The results of these studies showed that films grown on in-situ plasma-cleaned metallic substrates were uniform, continuous, adherent, and highly pure. Films with grain size larger than 500Å exhibited very low resistivity, as low as 1.7 μΩcm. Preliminary investigations of the mechanisms of selective copper CVD showed that selectivity is independent of precursor chemistry and is a function of the nature and degree of substrate interactions with hydrogen.