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The aim of this study was to investigate the intra-rater and inter-rater reliability of digital pelvic floor muscle strength assessment by physiotherapists participating in a multicentre study of the management of female stress urinary incontinence. Pelvic floor muscle strength was assessed and rated according to the modified Oxford scale. Intra-rater reliability for the primary author and inter-rater reliability between the primary author and fifty participating physiotherapists was determined. Testing was conducted at six sites across Australia and data from all sites was aggregated for overall analysis. Intra-rater agreement was 93% (n=14), Kappa coefficient 0.9, P<0.001 and weighted Kappa 0.4. Inter-rater agreement was 56% (n=352), Kappa coefficient 0.4, P <0.001 and weighted Kappa 0.4. However, when inter-rater agreement was broadened to include one grade higher or lower, agreement increased to 96%. It was concluded that the physiotherapists broadly agreed in their assessment of pelvic floor muscle strength to allow confidence in their baseline assessment for clinical decision-making. [ABSTRACT FROM AUTHOR]

Abstract: Pain science education (PSE) provides people with an understanding of "how pain works" grounded in the biopsychosocial model of pain; it has been demonstrated to improve outcomes in musculoskeletal pain conditions. Preliminary evidence suggests PSE may be effective for female individuals with persistent pelvic pain, but how the content of PSE needs to be modified for this group remains to be determined. A reflexive thematic analysis of qualitative data was performed to identify PSE concepts that female individuals with persistent pelvic pain consider important and why. Twenty individual, semistructured interviews were conducted with adult females who had engaged with PSE and had self-identified as having "improved" pelvic pain. Most participants had been diagnosed with endometriosis (n = 16). Four themes were generated capturing PSE concepts considered important by female individuals with "improved" pelvic pain: (1) "A sensitised nervous system leads to overprotective pain" validated their pelvic pain as being real; (2) "Pain does not have to mean the body is damaged (although sometimes it does)" provided reassurance that pelvic pain does not mean their condition is worsening; (3) "How I think, feel, and 'see' my pain can make it worse" enabled participants to find optimal ways to manage their pain; and (4) "I can change my pain… slowly" provided hope that pelvic pain can improve and empowered them to pursue pain improvement as a viable goal. This study generated 4 PSE learning concepts that were important to female individuals with improved pelvic pain and may be incorporated into PSE curricula for female individuals with pelvic pain., (Copyright © 2024 International Association for the Study of Pain.)

Self-management is critical for the care of endometriosis. Females with endometriosis frequently use self-management strategies to manage associated symptoms; however, the efficacy of such strategies is unknown. The aim of this review was to systematically appraise the evidence concerning efficacy of self-management strategies for endometriosis symptoms. Electronic databases, including Medline, Embase, Emcare, Web of Science Core Collection, Scopus, and the Cochrane Central Register of Controlled Trials, were searched from inception to March 2021. We included peer-reviewed experimental studies published in English evaluating the efficacy of self-management strategies in human females laparoscopically diagnosed with endometriosis. Studies underwent screening, data extraction, and risk of bias appraisal (randomised studies: Risk of Bias 2 tool; non-randomised studies: Risk Of Bias In Non-randomized Studies - of Interventions tool). Of the fifteen studies included, 10 evaluated dietary supplements, three evaluated dietary modifications, one evaluated over-the-counter medication, and one evaluated exercise. Most studies had a high-critical risk of bias. Many self-management strategies were not more effective at reducing endometriosis symptoms compared to placebo or hormonal therapies. Where studies suggest efficacy for self-management strategies, no recommendations can be made due to the poor quality and heterogeneity of evidence. High-quality empirical evidence is required to investigate the efficacy of self-management strategies for females with endometriosis., (© 2022. The Author(s).)

Introduction and Hypothesis: Vaginal support pessaries are intravaginal devices designed to relieve symptoms of pelvic organ prolapse, but they can cause serious medical complications if not managed well. Physiotherapists are well placed to manage pessaries, but there are no guidelines on the training required for competency in pessary management (PM)., Methods: A scoping review of current literature on PM training was conducted to develop draft competency standards, which were reviewed by a multidisciplinary focus group. Using e-Delphi methodology, a multidisciplinary and multinational expert panel then refined the standards. Three rounds of e-Delphi online surveys were conducted, with individual participant feedback and one videoconference to discuss items that did not reach consensus. Consensus was set at 80% agreement and stability measured using kappa coefficient., Results: Pessary training competency standards, developed by 29 experts, covered three key domains including: (1) prerequisite knowledge and understanding; (2) entrustable professional activities; (3) pessary-specific standards under ten key roles. Consensus was reached on all 73 (100%) competency standards and stability demonstrated for 95.9% of standards. There was no attrition of expert panel participants through the e-Delphi rounds., Conclusions: This e-Delphi study provides the first, robust recommendations on training standards for physiotherapists in PM. These competency standards will provide clinicians with a self-assessment tool, and educators and training institutions with a benchmark in training for PM, which should improve options and reduce risk for women with prolapse being managed with a pessary., (© 2021. The International Urogynecological Association.)

Objective: Persistent pelvic pain (PPP) is a complex condition often influenced by psychological factors that can alter treatment outcomes. These factors are potentially modifiable; however, currently there is no instrument to screen for them. The purpose of this study was to determine: (1) which psychological factors should be screened in individuals with PPP, and (2) the most appropriate statements to represent these psychological factors., Methods: The study used a focus group design followed by an electronic-Delphi (e-Delphi) process. A focus group consisting of 8 experts was conducted to determine the relevant psychological factors to screen. These results informed round 1 of the e-Delphi process, consisting of a panel of 14 pain/pelvic pain experts. The e-Delphi process consisted of 3 rounds of online surveys and 2 teleconference discussions to establish consensus on the most appropriate statement to screen for each of the psychological factors., Results: The focus group identified 13 relevant psychological factors. During the e-Delphi process, relevant screening statements were assessed using a 100-point allocation system. Experts could reword and suggest new statements. Statements were assessed for consensus and stability and were eliminated as the rounds progressed if they met the exclusion criteria. At the termination of round 3, there were 15 statements remaining., Conclusion: The final list of 15 statements will assist clinicians in screening for psychological factors and is an important step for clinicians in providing psychologically informed care to people with PPP. Future research should determine the psychometric properties of the statements to determine their clinical utility as a questionnaire., Impact: This study has refined a list of statements to help screen for psychological factors in individuals with PPP. Developed robustly using an e-Delphi method, this list is an important first step forward for clinicians to provide psychologically informed care to these individuals., (© The Author(s) 2021. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Purpose: The efficacy of pelvic floor muscle training (PFMT) for men with postprostatectomy incontinence (PPI) after robotic-assisted radical prostatectomy (RARP) is controversial and the mechanism for its possible effect remains unclear. The aim of this study was to investigate the relationship between bladder neck (BN) displacement, as a proxy for puborectal muscle activation, and continence outcomes after RARP., Methods: Data were extracted from the South Australian Prostate Cancer Clinical Outcomes Collaborative database for men undergoing RARP by high volume surgeons who attended preoperative pelvic floor physiotherapy for pelvic floor muscle (PFM) training between 2012 and 2015. Instructions were to contract the PFM as if stopping the flow of urine. BN displacement was measured with 2-dimensional transperineal ultrasound, without digital rectal examination. Urinary continence status was assessed preoperatively and at 3, 6, and 12 months using the Expanded Prostate Cancer Index Composite 26. Data were analysed using logistic regression and mixed effects linear modelling. Confounding variables considered were baseline continence, age at diagnosis, margin status, nerve sparing procedures and pathological stage., Results: Of 671 eligible men, 358 met the inclusion criteria and were available for analysis, with 136 complete datasets at 12-month follow-up. While BN movement was associated with preoperative continence, there was no significant effect of BN displacement on the change in urinary continence at 12 months postprostatectomy (P=0.81) or on the influence of time on continence over 3-12 months., Conclusions: Continence outcomes were not associated with BN displacement, produced by activity of the puborectal portion of the levator ani muscle, at 3, 6, or 12 months after RARP. These results suggest that the puborectal muscle does not play a role in the recovery of continence after RARP and may help to explain the negative findings of many studies of PFMT for PPI.

Objective: Acute respiratory failure can make long distance transport by air extremely difficult. Despite pressurised cabins, the pressure will fall to about three quarters of one atmosphere, and the oxygen partial pressure will fall proportionally. Interventional lung assist (iLA) is a well documented treatment in the critical care unit, but has not been evaluated scientifically in long range aero-medical evacuation. The present animal study was performed to test the feasibility of treating lung failure with iLA during intercontinental air evacuation in a military setting., Methods: Eight adult female pigs were cannulated in the right axillary artery and the right jugular vein. An arterio-venous iLA device (Novalung) was connected. The ventilator was adjusted to below half of the needed minute volume before the use of iLA. The animals went through different modalities of transportation in ambulances, helicopters and aircraft. Two of the pigs were tested in a hypobaric chamber, and the remaining two animals underwent a 7.5 h intercontinental transportation from Denmark to Greenland in a Hercules C130J transport airplane., Results: It was possible to maintain physiological PaCO(2) and PaO(2) in normal flight altitudes with iLA. Compared to pump-driven ECMO systems iLA is safer and more efficient. The current study demonstrates the feasibility of iLA during military aero-medical evacuation.

Background: Stress urinary incontinence (SUI) is a prevalent and costly condition which may be treated surgically or by physical therapy. The aim of this review was to systematically assess the literature and present the best available evidence for the efficacy and effectiveness of pelvic floor muscle training (PFMT) performed alone and together with adjunctive therapies (eg biofeedback, electrical stimulation, vaginal cones) for the treatment of female SUI., Methods: All major electronic sources of relevant information were systematically searched to identify peer-reviewed English language abstracts or papers published between 1995 and 2005. Randomised controlled trials (RCTs) and other study designs eg non-randomised trials, cohort studies, case series, were considered for this review in order to source all the available evidence relevant to clinical practice. Studies of adult women with a urodynamic or clinical diagnosis of SUI were eligible for inclusion. Excluded were studies of women who were pregnant, immediately post-partum or with a diagnosis of mixed or urge incontinence. Studies with a PFMT protocol alone and in combination with adjunctive physical therapies were considered. Two independent reviewers assessed the eligibility of each study, its level of evidence and the methodological quality. Due to the heterogeneity of study designs, the results are presented in narrative format., Results: Twenty four studies, including 17 RCTs and seven non-RCTs, met the inclusion criteria. The methodological quality of the studies varied but lower quality scores did not necessarily indicate studies from lower levels of evidence. This review found consistent evidence from a number of high quality RCTs that PFMT alone and in combination with adjunctive therapies is effective treatment for women with SUI with rates of 'cure' and 'cure/improvement' up to 73% and 97% respectively. The contribution of adjunctive therapies is unclear and there is limited evidence about treatment outcomes in primary care settings., Conclusion: There is strong evidence for the efficacy of physical therapy for the treatment for SUI in women but further high quality studies are needed to evaluate the optimal treatment programs and training protocols in subgroups of women and their effectiveness in clinical practice.

Objective: To evaluate the costs and benefits of physiotherapy for stress urinary incontinence (SUI) in Australia., Methods: We evaluated the costs and benefits of physiotherapy for the treatment of SUI using outcome data from a prospective multicentre observational study conducted in 1999/2000. Women presenting with SUI to physiotherapists trained in continence management in 35 centres across Australia were recruited into the study. The outcomes of treatment were assessed using subjective, objective and quality-of-life measures at the conclusion of treatment and with 12-month follow-up. The number of treatments in an average episode of care was calculated and adverse events were recorded., Results: Of the 274 consenting subjects, 208 completed an episode of physiotherapy care consisting of a median (IQ range) of five (4-6) visits. The estimated average costs for an episode of ambulatory physiotherapy treatment were dollar 302.40. Based on 'intention to treat' principles, 64% of women were objectively cured. There was a clinically and statistically significant improvement (p < 0.05) in all outcomes after treatment and these were maintained at one-year follow-up. No adverse events were reported., Conclusions and Implications: Specialised ambulatory physiotherapy for SUI in Australia is a low-cost, low-risk and effective treatment. These results provide evidence to support international recommendations that physiotherapy should be routinely implemented as first-line treatment before consideration of surgery. This information has important economic implications for planning future health services.

This double-blind study determined whether daily bathing with an antibacterial soap would reduce the number of Staphylococcus aureus on the skin and result in clinical improvement of atopic dermatitis. For 9 weeks, 50 patients with moderately severe atopic dermatitis bathed daily with either an antimicrobial soap containing 1.5% triclocarban or the placebo soap. They also used a nonmedicated moisturizer and 0.025% triamcinolone acetonide cream as needed, but the availability of the corticosteroid cream was discontinued after 6 weeks. The antimicrobial soap regimen caused significantly greater improvement in the severity and extent of skin lesions than the placebo soap regimen, which correlated with reductions both in S aureus in patients with positive cultures at baseline and in total aerobic organisms. Outcome measures included reductions in S aureus, total aerobic organisms, and dermatologic assessments. Overall, daily bathing with an antibacterial soap was well tolerated, provided clinical improvement, and reduced levels of skin microorganisms.

Many personal cleansers claim to provide a skin moisturization benefit, but there has been relatively little discussion in the scientific literature of the clinical methods that provide the basis for such claims. We have developed a leg wash method to assess the dry skin improvement potential of personal cleansing products. The protocol is performed on 'natural' dry leg skin to avoid potential confounds that may result from applying cleansers to soap-damaged skin. Washes are conducted over a period of days or weeks, with visual and instrumental assessments performed at various times throughout the period to characterize products' short-term and cumulative skin effects. Studies conducted with a variety of personal cleansing technologies demonstrate the method's ability to discriminate products on the basis of their dry skin improvement potential. Further, results from a series of eleven leg wash studies conducted with the same treatment pair under different test conditions (time of year, test facility, expert grader) demonstrate the protocol's robustness. The data generated under this protocol show that personal cleansing products differ widely in their ability to improve dry skin. Our results indicate that there is a wide range of efficacy among moisturizing personal cleansing products, with some products delivering a significant dry skin improvement benefit even for periods as long as 24 hours.

The effects of an induction dose of atracurium 0.6 mg/kg and supplementary doses of 0.2 mg/kg and 0.1 mg/kg were investigated in 20 patients undergoing non-urgent laparotomy while anesthetized with halothane-N2O-O2. Atracurium was the only muscle relaxant used. Complete neuromuscular block was achieved in all patients, lasting an average of 37 min. Following a supplementary dose of 0.2 mg/kg or 0.1 mg/kg the neuromuscular block was extended on average for a further 25 min (range 13-37 min) or 15 min (range 5-30 min), respectively. The time to spontaneous reversion of complete neuromuscular block at TOF = 0.75 was 39 min (mean). Neither blood pressure nor pulse rate changed significantly following injection of the induction dose. In 3 patients (15%) there was a brief period of erythema with no simultaneous change in pulse rate or blood pressure after administration of the induction dose. The erythema did not recur in the same patients following the supplementary doses. Transitory rises in AST and LDH were noted in 1 patient.

Forty patients, scheduled for elective surgery in a thoracic and vascular surgical unit, were anaesthetized by a total intravenous anaesthesia technique using midazolam and fentanyl. Subsequent reversal of anaesthesia by the specific benzodiazepine antagonist flumazenil was evaluated in a double-blind trial. The patients were observed in the recovery room postoperatively until the next morning, and their recovery was repeatedly evaluated during the first 240 min after anaesthesia. Six patients in the placebo group required an oral airway or an endotracheal tube during the first hours of recovery, whereas none who received flumazenil did. The respiratory rate was significantly higher after flumazenil than placebo during the first 4 h postoperatively (Anova, P less than 0.01). Blood pressure and heart rate were not different between the two groups. The degree of sedation, orientation in time and space and the ability to cooperate were significantly superior after flumazenil than placebo (Anova, P less than 0.01). Some degree of resedation was observed in both groups, affecting 95% of the patients who received flumazenil against 30% after placebo (Mann-Whitney, P less than 0.05). No adverse reactions attributable to the use of flumazenil were encountered.

Plasma concentrations of morphine were studied in 16 patients with chronic pain due to advanced cancer, treated with regular doses of morphine chloride by the oral route. Doses ranged from 20 to 125 mg every 4 h and a significant, positive, linear correlation was found between dose (range 0.22-3.01 mg/kg) and mean plasma concentration (range 22-364 ng/ml). The profile of the 4 h concentration curve is described and found to be subject to considerable, individual variation. The present investigation supports the experience that good pain relief can be obtained, if individual requirements as to dose and dose interval are taken into consideration.