Biomedical subjects

Tim J Peters

Publications and source records attributed to Tim J Peters.

At least 55 records · Page 3Linked to original sources

PubMed2004

Factors associated with variations in older people's use of community-based continence services.

Many people who have urinary incontinence and who may benefit from healthcare and professional advice do not currently access UK National Health Service services, even though effective treatments are available in the community. Older people have an increased prevalence of incontinence and a correspondingly increased need for continence services. Therefore, increasing older people's access to continence services has the potential to reduce inequalities and improve quality of life. The present study aimed to identify older people with urinary incontinence living in the community, to describe and compare the characteristics of users and non-users of continence services, and to identify factors which prevent older people seeking help. A cross-sectional postal survey of patients aged over 65 years registered with four general practices in an urban area found an overall prevalence of 39% of older people with urinary incontinence, only 15% of whom had accessed services. Two-thirds of respondents who reported that they experienced urinary leakage several times per week to all the time, and up to two-thirds of those reporting leakage of moderate or large volumes of leakage had not accessed services. The majority of older people are in regular contact with health professionals, and the greatest single influence on use of services was that of being asked whether there were continence problems by a health professional. Being married or having a partner, experiencing less pain generally, and suffering relatively high frequency and volumes of urinary leakage also appeared to be associated independently with continence service use. In conclusion, there appears to be considerable unmet need for continence services. Health professionals should be aware that incontinence is an important health problem for older people, and by asking older people specifically about urinary leakage, they could reduce inequalities in use of services.

Aged↗

PubMed2004

Serum insulin-like growth factor-I is positively associated with serum prostate-specific antigen in middle-aged men without evidence of prostate cancer.

We have examined the relationship between serum insulin-like growth factor-I (IGF-I) and prostate-specific antigen in 367 healthy men without evidence of prostate cancer and found a positive association (P = 0.05). In men without prostate cancer, serum prostate-specific antigen is closely related to prostate size, and our findings, therefore, suggest that IGF-I may induce prostatic epithelial proliferation. Higher circulating levels of IGF-I have been associated with increased risk of both prostate cancer and possibly benign prostatic hyperplasia. Greater rates of cell proliferation induced by IGF-I may be a key biological pathway underlying these disorders.

Age Distribution↗

PubMed2004

Predicting complications from acute cough in pre-school children in primary care: a prospective cohort study.

BACKGROUND: There is uncertainty about which children with cough are most and least likely to experience complications. AIM: To derive a clinical prediction rule for complications in pre-school children presenting to primary care with acute cough. DESIGN OF STUDY: Prospective cohort study. SETTING: Eight general practices in Leicestershire, United Kingdom. METHOD: Pre-school children with cough for < or =28 days and without asthma were recruited. Sociodemographic, clinical history, and examination data were collected and univariable logistic regression used to explore the associations with complications. These were defined as any new symptom, sign or diagnosis identified by a primary care clinician at a parent initiated reconsultation, or hospital admission, before cough resolution. Those factors with stronger relationships (P< 0.2) were then modelled using multivariable logistic regression to identify the factors independently associated with complications. RESULTS: The pre-test probability of complications was 10%. On univariable analysis, fever (odds ratio [OR] = 4.86; 95% confidence interval [CI] = 1.74 to 13.6), chest signs (OR = 2.72; CI = 1.06 to 6.96), and tachypnoea (OR = 3.80; CI = 1.22 to 11.8) were associated with complications. On multivariable analysis, only fever (OR = 5.56; CI = 1.75 to 17.6) and chest signs (OR = 2.88; CI = 1.02 to 8.05) were independently associated with complications. These ORs translate into post-test probabilities of complications of 6% for children with neither fever nor chest signs, 18% for children with chest signs, 28% for children with fever, and 40% for children with fever and chest signs. CONCLUSIONS: If validated, this clinical prediction rule could be used to individualise the management of acute cough in pre-school children.

Acute Disease↗

PubMed2004

The use of infrared thermometry for the detection of fever.

The use of tympanic thermometry is attractive in primary care, but a recent systematic review highlighted the paucity of data comparing tympanic thermometry with conventional methods. We report a study of 94 preschool children presenting to primary care in the United Kingdom (UK) with acute cough in whom tympanic infrared and axillary mercury thermometry are compared. Infrared thermometry showed poor agreement, poor sensitivity and high specificity. Infrared thermometry is too insensitive to be used as a screening test for fever, but when fever is already suspected, for example by touch, it may be useful as a 'rule in' test.

Axilla↗

PubMed2003

Design, analysis and presentation of factorial randomised controlled trials.

BACKGROUND: The evaluation of more than one intervention in the same randomised controlled trial can be achieved using a parallel group design. However this requires increased sample size and can be inefficient, especially if there is also interest in considering combinations of the interventions. An alternative may be a factorial trial, where for two interventions participants are allocated to receive neither intervention, one or the other, or both. Factorial trials require special considerations, however, particularly at the design and analysis stages. DISCUSSION: Using a 2 x 2 factorial trial as an example, we present a number of issues that should be considered when planning a factorial trial. The main design issue is that of sample size. Factorial trials are most often powered to detect the main effects of interventions, since adequate power to detect plausible interactions requires greatly increased sample sizes. The main analytical issues relate to the investigation of main effects and the interaction between the interventions in appropriate regression models. Presentation of results should reflect the analytical strategy with an emphasis on the principal research questions. We also give an example of how baseline and follow-up data should be presented. Lastly, we discuss the implications of the design, analytical and presentational issues covered. SUMMARY: Difficulties in interpreting the results of factorial trials if an influential interaction is observed is the cost of the potential for efficient, simultaneous consideration of two or more interventions. Factorial trials can in principle be designed to have adequate power to detect realistic interactions, and in any case they are the only design that allows such effects to be investigated.

Data Interpretation, Statistical↗

PubMed2003

Treating depression in primary care in low-income women in Santiago, Chile: a randomised controlled trial.

BACKGROUND: Depression in women is one of the commonest problems encountered in primary care. We aimed to compare the effectiveness of a stepped-care programme with usual care in primary-care management of depression in low-income women in Santiago, Chile. METHODS: In a randomised controlled trial, in three primary-care clinics in Chile, 240 adult female primary-care patients with major depression were allocated stepped care or usual care. Stepped care was a 3-month, multicomponent intervention led by a non-medical health worker, which included a psychoeducational group intervention, structured and systematic follow-up, and drug treatment for patients with severe depression. Data were analysed on an intention-to-treat basis. The primary outcome measure was the Hamilton depression rating scale (HDRS) administered at baseline and at 3 and 6 months after randomisation. FINDINGS: About 90% of randomised patients completed outcome assessments. There was a substantial between-group difference in all outcome measures in favour of the stepped-care programme. The adjusted difference in mean HDRS score between the groups was -8.89 (95% CI -11.15 to -6.76; p<0.0001). At 6-months' follow-up, 70% (60-79) of the stepped-care compared with 30% (21-40) of the usual-care group had recovered (HDRS score <8). INTERPRETATION: Despite few resources and marked deprivation, women with major depression responded well to a structured, stepped-care treatment programme, which is being introduced across Chile. Socially disadvantaged patients might gain the most from systematic improvements in treatment of depression.

Adult↗

PubMed2003

Who can best recruit to randomized trials? Randomized trial comparing surgeons and nurses recruiting patients to a trial of treatments for localized prostate cancer (the ProtecT study).

BACKGROUND AND OBJECTIVE: Recruitment to randomized trials is often difficult, but few studies have investigated interventions to improve recruitment. In a randomized trial nested within a trial of treatments for localized prostate cancer, we investigated the comparative effectiveness and cost-effectiveness of nurses and surgeons in recruiting patients. METHODS: Men with localized prostate cancer were randomized to see a nurse or urologic surgeon for an "information appointment" in which they were asked to consent to the ProtecT treatment trial comparing surgery, radiotherapy, and active monitoring. Analysis was conducted by intention to treat using chi-square with 95% confidence intervals for proportions and differences between groups. An economic evaluation was performed using the duration of appointments and grade of recruitment staff. RESULTS: Case-finding identified 167 men with localized prostate cancer. One hundred fifty (90%) took part in the recruitment trial. There was a 4.0% difference between nurses and surgeons in recruitment rates (67% nurses, 71% urologists, 95% CI -10.8% to +18.8%, P=.60). Cost-minimization analysis showed that nurses spent longer times with patients but surgeon costs were higher and nurses often supported surgeon-led clinics. CONCLUSION: Nurses were as effective and more cost-effective recruiters than urologic surgeons. This suggests an increased role for nurses in recruiting patients to randomized trials.

Aged↗

PubMed2003

Factors that contribute to quality of life outcomes prioritised by people with multiple sclerosis.

The aim was to investigate factors associated with depression and social function, two outcomes identified as important by people with multiple sclerosis (MS) and to identify underlying dimensions of psycho-social well-being that may be useful as outcome measures. People with MS in eight randomly selected health authorities/boards in England and Scotland completed a postal questionnaire relating to preferences and needs for their health and social care, along with the Beck Depression Inventory and the SF-36. Responses to 10 of the original items were subjected to factor analysis. These and other explanatory variables were entered into multivariable regression models for the two outcomes. The factor analysis resulted in three dimensions representing different aspects of psycho-social well-being; one of these (representing autonomy) was associated with improvements in both outcomes, as was the SF-36 emotional role limitation score. Three other SF-36 dimensions and lack of contact with a health professional in the last year were related just to social function. The regression models emphasise the value of enabling autonomy and self-reliance amongst people with MS, as well as more general measures of emotional health. The present work identifies specific questions that could be used to measure pivotal aspects of an individual's psycho-social well-being. While these findings warrant replication for people with MS, they may have relevance to those with other long-term illnesses.

Adult↗

PubMed2003

Variables associated with attendance at, and the perceived helpfulness of, meetings for people with multiple sclerosis.

People who have chronic disabling conditions are frequently advised by health or social care practitioners to attend meetings organised specifically for individuals who have the same or similar health problems. The purpose of the analyses described in the present paper was to ascertain the variables independently associated with attendance at meetings for people with multiple sclerosis (MS), and amongst those who did attend, variables related to the level of perceived helpfulness. A postal questionnaire was sent to a random sample of 471 people with MS in eight randomly selected health authorities/boards across England and Scotland with the general aim of eliciting their preferences for and views of health and social care. There were 318 respondents to this questionnaire (68%), 136 (43%) of whom had attended such a meeting. Logistic regression and proportional odds regression models were used to investigate the relationships with the two outcomes of attendance and helpfulness for 23 explanatory variables drawn from the questionnaire. The explanatory variables related to the following six broad areas: socio-demographic, illness-related, support, self-management, psycho-social factors and social function. Just under half of the respondents reported that they had attended a meeting. Half of these individuals found the last meeting that they had attended to be reasonably helpful, and one in five found it of no help. The individuals who were more likely to have attended were aged 45-64 years, had been in contact with a health professional in the past 12 months and felt that they had the ability and means to access MS-related information. The last meeting was considered more helpful by those who reported greater contentment with access to MS-related information and by those with mild depression. These findings should be useful to health professionals who may consider recommending meetings to people with MS, and also to those who are engaged in ensuring that meetings are both attractive and relevant to all potential attendees.

Aged↗

PubMed2003

Patient-reported use of health service resources compared with information from health providers.

The objectives of the present study were to examine the accuracy of older people's reports of health services resource use after discharge from acute care compared with information from healthcare providers. Paired data were obtained from health providers and a consecutive sample of hospitalised patients (aged 60 years or over) enrolled in a randomised controlled trial of hospital-at-home versus usual acute care. Retrospective reports of the use (yes/no) and number of patient hospital admissions, and community nursing, physiotherapy, health visiting and general practitioner (GP) services were obtained between baseline, and 4- and 12-week follow-ups, although the recall period varied for different resources. The comparability of paired reports was examined by using crude and chance-corrected agreement, and by testing for systematic differences in the distribution of paired responses. Out of 219 patients enrolled in the trial, 190 and 185 patients provided data at 4 (87%) and 12 weeks (84%), respectively. Crude agreement was over 72% (range = 42-93%), and chance-corrected agreement was moderate or good (kappa coefficients from 0.23 to 0.71) for 11 out of 12 comparisons. Systematic differences in the pattern of paired responses were observed for seven comparisons. Patients more often reported receiving a routine GP home visit (by 12 weeks), whilst health providers reported statistically significantly (P < 0.05) more patients admitted to hospital (12 weeks) and more admissions per person, requesting a GP home visit (12 weeks) or surgery consultation, and having district nursing (4 and 12 weeks) and physiotherapy (4 weeks only). The data indicate that patients tend to underestimate resources used compared with health providers over relatively short time frames.

Aged↗

PubMed2003

The provision of 'same-day' care in general practice: an observational study.

BACKGROUND: Surveys suggest that general practice is perceived to be inaccessible, with long delays before it is possible to be seen by a doctor. Although there is demand for rapid access to care, this has the potential to decrease continuity of care, which research consistently shows to be valued by patients but stressful for doctors. OBJECTIVE: Our aim was to investigate the provision of 'same-day' care and the characteristics, treatment expectations and priorities of patients attending for 'routine' and 'same-day' appointments. METHODS: The uptake of same-day and routine appointments was determined from appointment system records. A self-completed questionnaire survey of people attending 362 same-day and 362 routine appointments at 15 general practices in Avon and Gloucestershire enabled comparisons with respect of patient characteristics and consultation experiences, patients' preferences for rapid access, seeing a known practitioner or seeing a doctor rather than a nurse. RESULTS: The uptake per 1000 practice population per day was 7.6 [95% confidence interval (CI) 7.1-8.1] for routine appointments and 3.8 (95% CI 3.5-4.2) for same-day appointments. In univariable analyses, use of same-day care was greater by people who were younger, non-white, in work and with educational qualifications. They had attended the practice less often, waited less time to see a doctor previously, had their current problem for a shorter time and were more likely to expect a prescription. From multivariable analyses, only age, speed of previously obtaining appointments, expecting a prescription and having the problem for a short time were independently associated with receiving same-day care. Rapid access to care was rated as more important than seeing a known doctor for two clinical scenarios. CONCLUSIONS: Much care is provided currently on the day it is requested in general practice. The use of same-day care was related to acute illness and expectations but was not associated with deprivation or patient characteristics apart from age.

Adolescent↗

PubMed2003

The duration of acute cough in pre-school children presenting to primary care: a prospective cohort study.

BACKGROUND: Professional and parental uncertainty about the natural history of cough in pre-school children may in part be responsible for the high consultation and reconsultation rates and widespread antibiotic use in primary care. A recent systematic review of the natural history of cough included studies of unrepresentative, selected patients with heterogeneous measures and definitions of cough duration. OBJECTIVES: The aim of the present study was to describe the post-consultation duration of cough, compare this with clinician and parental prediction of cough duration, and to determine the clinical factors associated with prolonged cough. METHODS: A prospective cohort study of children aged 0-4 years with cough < or =28 days without asthma presenting to eight general practices in Leicestershire, UK was carried out. Socio-demographic and clinical data were collected, and parents and clinicians were asked to predict the proportion recovering within 7, 14, 21 and 28 days. Parents used a symptom diary to record cough and five other symptoms. Survival analysis was used to describe cough duration, and multivariable Cox regression was used to identify the factors independently associated with prolonged cough. RESULTS: Fifty percent of the children had recovered at 10 days and 90% at 25 days. Cough was associated with fever, breathlessness, disrupted sleep and reduced activity in a high proportion of children. Longer post-consultation cough was associated with longer pre-consultation cough and use of day care facilities. Clinicians overestimated how quickly children recovered from acute cough. Parents' predictions were accurate within 2 weeks, but they underestimated the proportion recovering in weeks 3 and 4. CONCLUSIONS: Clinicians should be aware that from the parental perspective, acute cough is not a trivial illness and that some children remain unwell at 3-4 weeks. For health professionals negotiating the use of antibiotics, this information may enable parental self-care, reduce medicalization and displace the need to prescribe.

Child, Preschool↗

PubMed2003

A factorial randomised controlled trial of decision analysis and an information video plus leaflet for newly diagnosed hypertensive patients.

BACKGROUND: There is a lack of evidence regarding the value of tools designed to aid decision making in patients with newly diagnosed hypertension. AIM: To evaluate two interventions for assisting newly diagnosed hypertensive patients in the decision whether to start drug therapy for reducing blood pressure. DESIGN OF STUDY: Factorial randomised controlled trial. SETTING: Twenty-one general practices in south-west England, UK. METHOD: Adults aged 32 to 80 years with newly diagnosed hypertension were randomised to receive either: (a) computerised utility assessment interview with individualized risk assessment and decision analysis; or (b) information video and leaflet about high blood pressure; or (c) both interventions; or (d) neither intervention. Outcome measures were decisional conflict, knowledge, state anxiety, intentions regarding starting treatment, and actual treatment decision. RESULTS: Of 217 patients randomised, 212 (98%) were analysed at the primary follow-up (mean age = 59 years, 49% female). Decision analysis patients had lower decisional conflict than those who did not receive this intervention (27.6 versus 38.9, 95% confidence interval [CI] for adjusted difference = -13.0 to -5.8, P < 0.001), greater knowledge about hypertension (73% versus 67%, adjusted 95% CI = 2% to 9%, P = 0.003) and no evidence of increased state anxiety (34.8 versus 36.8, adjusted 95% CI = -5.6 to 0.1, P = 0.055). Video/leaflet patients had lower decisional conflict than corresponding controls (30.3 versus 36.8, adjusted 95% CI = -7.4 to -0.6, P = 0.021), greater knowledge (75% versus 65%, adjusted 95% CI = 6% to 13%, P < 0.001) and no evidence of increased state anxiety (35.7 versus 36.1, adjusted 95% CI = -3.9 to 1.7, P = 0.46). There were no differences between either of the interventions and their respective controls in the proportion of patients prescribed antihypertensive medication (67%). CONCLUSIONS: This trial demonstrates that, among patients facing a real treatment decision, interventions to inform patients about hypertension and to clarify patients' values concerning outcomes of treatment are effective in reducing decisional conflict and increasing patient knowledge, while not resulting in any increases in state anxiety.

Adult↗

PubMed2003

Cluster-randomised trial of risk communication to enhance informed uptake of cervical screening.

BACKGROUND: Women overestimate both population and individual risk of cervical cancer. This may contribute to the recognised excess screening frequency for low-risk women. AIM: To investigate whether an individualized risk communication package could affect stated preferences for screening interval and actual screening behaviour. DESIGN: Pragmatic, practice-based cluster randomised controlled trial. SETTING: Twenty-nine practices (15 intervention, 14 control) in North Wales recruited 1890 women attending for cervical smears. METHOD: A risk communication package containing visual material was compared with normal practice. Practice nurses received training in its delivery. The short-term primary outcome was stated preference for screening interval; the long-term primary outcome was actual screening behaviour. RESULTS: In the short term, intervention arm women were significantly less likely to prefer a shorter than recommended interval (odds ratio [OR] = 0.51, 95% confidence interval [CI] = 0.41 to 0.64; P < 0.0001). At the five-year follow-up, fewer women in the intervention arm had attended for screening sooner than their recommended recall. The magnitude of difference in excess screening interval preference and behaviour was similar, but behaviour had a wider confidence interval and a marginally non-significant P-value (OR = 0.61, 95% CI = 0.36 to 1.03; P = 0.063). Better knowledge and more accurate risk perceptions were demonstrated, with an improvement in measures of anxiety. The extra cost per woman receiving the intervention was 6 Pounds. CONCLUSIONS: Women's perception of risk contributes to determining screening intervals in addition to practice factors. Simple risk information delivered in primary care affected women's stated preferences for tests. The impact on actual screening behaviour was more equivocal. Overall, the intervention showed a substantial benefit and any disbenefit can be ruled out. This approach to providing risk information could, at low cost, benefit other screening programmes and may relieve anxiety.

Adult↗

PubMed2003

A systematic review of the effect of primary care-based service innovations on quality and patterns of referral to specialist secondary care.

BACKGROUND: Innovations are proliferating at the primary-secondary care interface, affecting referral to secondary care and resource use. Evidence about the range of effects and implications for the healthcare system of different types of innovation have not previously been summarised. AIM: To review the available evidence on initiatives affecting primary care referral to specialist secondary care. SETTING: Studies of primary-secondary care interface. METHOD: Systematic review of trials, using adapted Cochrane Collaboration (effective practice and organisation of care) criteria. Studies from 1980 to 2001 were identified from a wide range of sources. Strict inclusion criteria were applied, and relevant clinical, service and cost data extracted using an agreed protocol. The main outcome measures were referral rates to specialist secondary care. RESULTS: Of the 139 studies initially identified. 34 met the review criteria. An updated search added a further 10 studies. Two studies provided economic analysis only. Referral was not the primary outcome of interest in the majority of included studies. Professional interventions generally had an impact on referral rates consistent with the intended change in clinician behaviour. Similarly, specialist 'outreach' or other primary care-based specialist provider schemes had at least a small effect upon referral rates to secondary care with the direction of effect being that intended or rational from a clinical and sociological perspective. Of the financial interventions, one was aimed primarily at changing the numbers or proportion of referrals from primary to specialist secondary care, and the direction of change was as expected in all cases. The quality of the reporting of the economic components of the 14 studies giving economic data was poor in many cases. When grouped by intervention type, no overall pattern of change in referral costs or total costs emerged. CONCLUSION: The studies identified were extremely diverse in methodology, clinical subject, organisational form, and quality of evidence. The number of good quality evaluations of innovative schemes to enhance the existing capacity of primary care was small, but increasing. Well-evaluated service initiatives in this area should be supported. Organisational innovations in the structure of service provision need not increase total costs to the National Health Service (NHS), even though costs associated with referral may increase. This review provides limited, partial, and conditional support for current primary care-oriented NHS policy developments in the United Kingdom.

Family Practice↗

PubMed2003

The quality of record keeping in primary care: a comparison of computerised, paper and hybrid systems.

BACKGROUND: Computerised record keeping in primary care is increasing. However, no study has systematically examined the completeness of computer records in practices using different forms of record keeping. AIM: To compare computer-only record keeping to paper-only and hybrid systems, by measuring the number of consultations and symptoms recorded within individual consultations. DESIGN OF STUDY: Retrospective cohort study. SETTING: Eighteen general practices in the Exeter Primary Care Trust. METHOD: This study was part of a retrospective case control study of cancer patients aged over 40 years. All recorded consultations for a 2-year period were identified and coded for 1396 patients. Records were classified as paper, computer, or hybrid, depending on which medium stored the clinical information from consultations. RESULTS: More consultations were recorded in hybrid systems (median in 2 years = 11, interquartile range [IQR] = 6-18) than computer systems (median in 2 years = 9, IQR = 4-16.5) or paper systems (median in 2 years = 8, IQR = 5-14,): P <0.001. In a Poisson regression analysis, which included age, sex, and future cancer diagnosis, the rates of consultations recorded in paper and computer systems were 16% and 11% lower, respectively, than in hybrid systems. Fewer telephone consultations were recorded in paper systems, and fewer home visits in computer systems. Fewer symptoms were recorded in individual consultations on computer systems. Recording of absent symptoms and severity of symptoms was highest in paper systems. CONCLUSION: Hybrid systems of primary care record keeping document higher numbers of consultations than computer-only or paper-only systems. The quality of individual consultation recording is highest in paper-only systems. This has medicolegal implications and may impact upon continuity of care.

Aged↗

PubMed2002

General practice based intervention to prevent repeat episodes of deliberate self harm: cluster randomised controlled trial.

OBJECTIVES: To evaluate the impact of an intervention based in general practice on the incidence of repeat episodes of deliberate self harm. DESIGN: Cluster randomised controlled trial in which 98 general practices were assigned in equal numbers to an intervention or a control group. The intervention comprised a letter from the general practitioner inviting the patient to consult, and guidelines on assessment and management of deliberate self harm for the general practitioner to use in consultations. Control patients received usual general practitioner care. SETTING: General practices within Avon, Wiltshire, and Somerset Health Authorities, whose patients lived within the catchment area of four general hospitals in Bristol and Bath. PARTICIPANTS: 1932 patients registered with the study practices who had attended accident and emergency departments at one of the four hospitals after an episode of deliberate self harm. MAIN OUTCOME MEASURES: Primary outcome was occurrence of a repeat episode of deliberate self harm in the 12 months after the index episode. Secondary outcomes were number of repeat episodes and time to first repeat. RESULTS: The incidence of repeat episodes of deliberate self harm was not significantly different for patients in the intervention group compared with the control group (odds ratio 1.2, 95% confidence interval 0.9 to 1.5). Similar findings were obtained for the number of repeat episodes and time to first repeat. Subgroup analyses indicated that there was no differential effect of the intervention according to patient's sex (P=0.51) or method used to cause deliberate self harm (P=0.64). The treatment seemed to be beneficial for people with a history of deliberate self harm, but it was associated with an adverse effect in people for whom the index episode was their first episode (interaction P=0.017). CONCLUSIONS: An invitation to consult, sent by the general practitioner of patients who have deliberately harmed themselves, and the use of management guidelines during any subsequent consultation did not reduce the incidence of repeat self harm. A subgroup analysis that indicated that patients who had previously harmed themselves benefited from the intervention was inconsistent with previous evidence and should be treated with caution. More research is needed on how to manage patients who deliberately harm themselves, to reduce the incidence of repeat episodes.

Adolescent↗

PubMed2002

Sexual dysfunction in men after treatment for lower urinary tract symptoms: evidence from randomised controlled trial.

OBJECTIVE: To examine the impact on sexual function of treatments for lower urinary tract symptoms in men. DESIGN: Multicentre pragmatic randomised controlled trial of standard surgery (transurethral resection of the prostate), non-contact laser therapy, and conservative management (no active intervention). SETTING: Three clinical centres in the United Kingdom. PARTICIPANTS: 340 men aged between 48 and 90 years with lower urinary tract symptoms related to benign prostatic enlargement. MAIN OUTCOME MEASURES: ICSsex questionnaire items concerned with erectile stiffness, ejaculatory volume, pain or discomfort on ejaculation, whether sex life was spoilt by urinary symptoms. RESULTS: Erectile and ejaculatory dysfunction were common (70%) and problematic at baseline and showed the expected trends with ageing. After treatment, reduced ejaculation was reported in all groups but was not significantly worse after standard surgery than after laser therapy. Erectile function was significantly improved after standard surgery; no significant difference was found between standard surgery and laser therapy (odds ratio 0.70, 95% confidence interval 0.36 to 1.38). Standard surgery was significantly better at relieving pain or discomfort on ejaculation than either conservative management (0.06, 0.007 to 0.49) or laser therapy (0.09, 0.01 to 0.73). CONCLUSIONS: Compared with laser therapy standard surgery for lower urinary tract symptoms has a beneficial effect on aspects of sexual function-particularly in improving erectile function and reducing reported pain or discomfort on ejaculation. Older men who need treatment and want to retain or improve sexual function may thus want to consider standard surgery rather than non-contact laser therapy.

Aged↗