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Biomedical subjects

J E Batista-Miranda

Publications and source records attributed to J E Batista-Miranda.

13 recordsLinked to original sources
PubMed2001

Quality-of-life assessment in patients with benign prostatic hyperplasia: effects of various interventions.

A literature search was conducted to review quality-of-life (QOL) measurement in patients with benign prostatic hypertrophy (BPH). The different QOL instruments are discussed in relation to their correlation with symptom evaluation in studies of treatment options for BPH. Symptom evaluation of BPH has been standardised internationally with the International Prostatic Symptom Score (IPSS), but there is neither agreement nor data to decide which QOL instrument is preferable. The most widely used QOL instrument is the disease-specific QOL single question added to the IPSS. Other QOL instruments have been used, but none has gained unanimous approval. The results of QOL assessments obtained from comparative clinical studies of treatment options for BPH are discussed. These studies compare treatment options such as watchful waiting, drug treatment and surgery. Disease-specific QOL domains (interference with daily activities) tend to improve more with treatment interventions than general health measures (i.e. general well-being). The use of QOL instruments to evaluate patients with BPH, and their many treatment options, is still open to debate with regard to which instruments are preferred and their importance to the clinical evaluation of the patient. The challenge remains to find an acceptable disease-specific QOL instrument that adds information to currently used disease measures of BPH.

Doxazosin↗
PubMed1999

Outcome of colposuspension in patients with stress urinary incontinence and abnormal cystometry.

OBJECTIVE: To analyze the prognostic value of preoperative cystometric alterations in the outcome of women undergoing colposuspension for stress incontinence. PATIENTS AND METHODS: Over a 5 year period, 220 women were operated on for stress urinary incontinence using the Burch or Marshall colposuspension techniques. An abnormal cystometry was found pre-operatively in 44 (20%), which was associated with urge incontinence in 11 (25%). Cystometric abnormalities comprised 3 subgroups: detrusor instability (DI), low bladder compliance (LBC) and small detrusor contractions (SDC). Women with an abnormal cystometry had responded partially to anticholinergic therapy. Detailed postoperative questioning was undertaken to differentiate stress from urge incontinence, as well as storage symptoms. Results of patients with cystometric abnormalities were compared to an age-matched group of 44 patients with a stable bladder on the preoperative study. RESULTS: Bladder compliance was statistically lower in the preoperative CMG of patients with abnormal cystometry (p < 0.005). Groups were followed for a mean of 39 (abnormal CMG) and 36 months (stable bladder), respectively. The presence of the aforementioned cystometric alterations was not associated with lower cure rates of the stress incontinence. However, the group with DI referred more postoperative storage symptoms. "De novo" DI was found in 20% of patients with a previously stable bladder who referred storage symptoms postoperatively. CONCLUSIONS: Small detrusor contractions are not a contraindication for colposuspension. Patients with DI and low bladder compliance who also have stress incontinence showed more storage symptoms on postoperative evaluation.

Aged↗
PubMed1995

[The IPPS questionnaire in patients and controls. Psychometric validation].

The translation into Spanish of the AUA/International Prostatic Symptom (AUA/IPS) Score hadn't been validated in spanish. METHODS. AUA/IPS questionnaire was self administered by 103 consecutive patients and by 24 healthy volunteers. An alternative formulation to question 4 (ALT-4) was added. RESULTS. 51 patients (49%) and 17 controls (79%) completed al questions (Feasibility). Reliability was measured by: a) Crohnbach's alpha (0.68 and 0.70 with ALT-4) b) Kendall's coefficient of concordance (0.097, significance < 0.001) and c) retesting 17 patients within 2 months. The relation of the AUA/IPS scores with quality of life (Construct validity) showed a Spearman's correlation coefficient of 0.57 (confidence = 0.0001), and 0.52/0.0004 with ALT-4. The relation with uroflowmetry (Concurrent empirical validity) was poor as shown in ROC curves. CONCLUSIONS. The Spanish version of the AUA/IPS questionnaire given in an easy format improves feasibility without alteration of reliability or validity. The relation of the AUA/IPS score with uroflowmetry is poor, although the questionnaire can be considered valid and reliable.

Case-Control Studies↗
PubMed1995

[The use of the IPSS questionnaire in surgical patients. International Prostatic Symptom Score].

Some feasibility problems were detected during the evaluation of the IPSS questionnaire in Spanish that might limit its application. Our initial experience with the IPSS in patients undergoing surgery had 3 aims: 1) assess if changes in format and wording will improve feasibility; 2) evaluate symptoms before and after surgery according to the patients' point of view and 3) determine possible predictive factors of bad outcome in patients undergoing surgery for BPH. 50 patients were included and 35 completed symptom and urolow evaluation before and after the intervention. First objective: a modified format improved feasibility up to 92% (from 49% with the original format). Second objective: 7 patients had a poor symptomatic outcome (either worsened or had an unsignificant improvement), but only one of them had a low postoperative Qmax. Third objective: patients with preoperative urinary retention had a worse urodynamic outcome, but most improved in their symptoms. Worse symptomatic results occurred in: a) patients with a IPSS score smaller than 13 and b) patients undergoing transurethral incision of the prostate. The results are presented both in global (comparison of mean values) and in an individualized manner to call upon the pitfalls in their interpretation.

Aged↗
PubMed1992

[Bacteremia caused by Clostridium perfringens as a complication of ureterosigmoidostomy].

A 63 year old male underwent cystectomy and ureterosigmoidostomy after diffuse carcinoma "in situ" of the bladder was discovered, and thereafter, various episodes of pyelonephritis and metabolic imbalance, in one of them, a left pneumo-ureter and a positive blood culture for Clostridium Perfringens and enterococci was detected. Empiric therapy with Aztreonam was started, and changed after to high-dose intravenous amoxicillin. Two months later the ureterosigmoidostomy was converted to an ileal conduit. The patient has remained asymptomatic on subsequent controls.

Bacteremia↗
PubMed1991

[Experience in rationalization and use of drugs in military primary health care].

We describe a pharmacologic revision program in a military primary health-care facility, following the criteria of efficacy and safety proposed in the Spanish "Pharmacological guide for primary health care". After the revision, the number of products used dropped from 133 to 63, and the monthly expenditure in medicines from 940 to 300 pesetas/person. We have also calculated the daily defined dose per 1.000 inhabitants/day (DHD) in some drugs and compared them to others previously published. Some of our DHD were higher than those of other primary-health care groups. Therefore, we think that in rationalization programs on the use of medicines, the reduction of products to be prescribed is only the first part. Afterwards, DHD should be calculated, and, in case of being unjustifiably high, a revision of the indications should be undertaken.

Drug Utilization↗
PubMedDate not supplied

[Environment, patient information, and organization in a pediatrics urodynamics unit].

OBJECTIVES: Urodynamic studies require patient cooperation, and this can be difficult in the pediatric age due to their invasive nature. Our aim was to assess the benefits of organization, facility design and information specifically adapted to children. METHODS: We describe the facility design and organization of the Urodynamics Unit at the Children's Hospital in Boston. Environmental factors are adapted to the pediatric age and aim to reduce the impact of the examination. There are child's objects, images and toys in the examining room. Parents are allowed to be in the room while the test is performed, and music is played during the procedure. We describe the information pattern and the behavior of the nurses and physicians to preserve the child's privacy. An information leaflet and a survey on symptoms is sent to parents before the test. Information is adapted to every age and aims to reduce parental anxiety towards the test and make them understand the need for the study. There are two premises for information: 1) every procedure will be explained to the child and parents, and 2) they will be told the truth. RESULTS: An enhanced cooperation has been noted following these guidelines. Between 5 and 8% of the studies performed are not evaluable due to lack of cooperation from the patient and only two children have totally refused the test in the last two years (0.2%). CONCLUSIONS: Cooperation among urologists and specialized nurses as well as attention towards the child's and parents' psychological factors can enhance the diagnostic yield of this test.

Adolescent↗