Renly Lim

Pulsed Magnetic Stimulation for Stress Urinary Incontinence: 1-Year Followup Results

Purpose: Despite significant differences in success rates between surgical and nonsurgical treatments for female stress urinary incontinence, a few cross‐sectional surveys showed that most patients still prefer the latter. We evaluated the efficacy of the under studied nonsurgical treatment using pulsed magnetic stimulation for female stress urinary incontinence. Materials and Methods: This randomized, double‐blind, sham controlled study was performed in 120 female subjects at least 21 years old with stress urinary incontinence. Treatment involved pulsed magnetic stimulation for 2 sessions per week for 2 months (16 sessions). After 2 months, subjects could opt for 16 additional sessions regardless of initial randomization. The primary response criterion was a 5‐point reduction in the ICIQ‐UI SF (International Consultation on Incontinence Questionnaire for Urinary Incontinence‐Short Form) score. Key secondary response criteria included objective and subjective cure, supplemented by other secondary criteria. Followups were performed at months 1, 2, 5, 8 and 14. Results: At 2 months 45 of 60 subjects (75%) in the active arm vs 13 of 60 (21.7%) in the sham arm were treatment responders (p <0.001). After 2 months 24 subjects (40%) in the active arm and 41 (68%) in the sham arm elected additional active pulsed magnetic stimulation. At 14 months, subjects who received 32 sessions of active pulsed magnetic stimulation had the highest percentage of treatment responders (18 of 24 or 75.0%), followed by those who received 16 sessions (26 of 36 or 72.2% and 28 of 41 or 68.3%) and those who did not receive any active pulsed magnetic stimulation (4 of 19 or 21.1%) (p <0.001). Conclusions: The encouraging long‐term response rates show that pulsed magnetic stimulation is an attractive nonsurgical alternative for patients who do not want to undergo surgery.

Magnetic stimulation for stress urinary incontinence: study protocol for a randomized controlled trial

BackgroundThere is currently a lack of randomized, sham-controlled trials that are adequately powered, using validated outcomes, to allow for firm recommendations on the use of magnetic stimulation for stress urinary incontinence. We report a protocol of a multicenter, randomized, double-blind, sham-controlled parallel-group trial to evaluate the efficacy of magnetic stimulation for stress urinary incontinence.Methods/DesignOne hundred twenty subjects with stress urinary incontinence will be randomized in a 1:1 allocation to either active or sham magnetic stimulation using computer-generated, permuted blocks of variable sizes. Subjects will receive 2 sessions of magnetic stimulation per week for 8 weeks (16 sessions total). The primary outcome is the improvement in severity of involuntary urine loss based on the International Consultation on Incontinence Questionnaire for Urinary Incontinence Short Form at the end of treatment sessions compared with baseline. Secondary outcomes include cure, stress urinary incontinence–related symptoms (incontinence episode frequency, urine loss in 1-hour pad test, pelvic floor muscle strength) and health-related quality of life (Patient Global Impression of Improvement, International Consultation on Incontinence Questionnaire–Lower Urinary Tract Symptoms Quality of Life and EQ-5D). The safety of magnetic stimulation will also be assessed. Besides evaluation of clinical treatment effectiveness, cost-effectiveness analysis using patient-reported outcomes will be performed.DiscussionThis trial is designed to provide pending outcome information on this non-invasive treatment option. We intend to acknowledge the existing flaws in previous clinical trials and determine conclusively whether magnetic stimulation is effective for stress urinary incontinence.Trial registrationClinicalTrials.gov Identifier: NCT01924728. Date of Registration: 14 August 2013.

Efficacy of electromagnetic therapy for urinary incontinence: A systematic review.

To review whether patients with urinary incontinence (UI) treated with magnetic stimulation (MS) have a higher continence rate compared to sham.

Validity, reliability, and responsiveness of the ICIQ-UI SF and ICIQ-LUTSqol in the Malaysian population.

To enable the use of the International Consultation on Incontinence Questionnaire‐Urinary Incontinence Short Form (ICIQ‐UI SF) and ICIQ‐Lower Urinary Tract Symptoms Quality of Life (ICIQ‐LUTSqol) in Southeast Asia, we translated and subsequently evaluated their validity (content and discriminant validity), reliability (internal consistency and test–retest reliability), and responsiveness in female patients with stress urinary incontinence.

Validity and Reliability of the Golombok Rust Inventory of Sexual Satisfaction in Couples with Incontinent Partners

There is currently no published information on the validity and reliability of the Golombok Rust Inventory of Sexual Satisfaction in the Asian population, specifically in patients with stress urinary incontinence, which limits its use in this region. Our study aimed to evaluate the psychometric properties of this questionnaire in the Malaysian population. Ten couples were recruited for the pilot testing. The agreement between the English and Chinese or Malay versions were tested using the intraclass correlation coefficients, with results of more than 0.80 for all subscales and overall scores indicating good agreement. Sixty-six couples were included in the subsequent phase. The following data are presented in the order of English, Chinese, and Malay. Cronbachs alphas for the male total score were 0.82, 0.88, and 0.95. For the female total score, Cronbachs alphas were 0.76, 0.78, and 0.88. Intraclass correlation coefficients for the male total score were 0.93, 0.94, and 0.99, while intraclass correlation coefficients for the female total score were 0.89, 0.86, and 0.88. In conclusion, the English, Chinese, and Malay versions each proved to be valid and reliable in our Malaysian population.

Reflections on a Community Engagement Strategy for Mass Antimalarial Drug Administration in Cambodia.

Abstract. Mass drug administration (MDA) to interrupt malaria transmission requires the participation of entire communities. As part of a clinical trial in western Cambodia, four villages received MDA in 2015–2016. Before approaching study communities, a collaboration was established with the local health authorities, village leaders, and village malaria workers. Formative research guided the development of engagement strategies. In each village, a team of volunteers was formed to explain MDA to their neighbors and provide support during implementation. Public mobilization events featuring drama and music were used to introduce MDA. Villages comprised groups with different levels of understanding and interests; therefore, multiple tailored engagement strategies were required. The main challenges were explaining malaria transmission, managing perceptions of drug side effects, and reaching mobile populations. It was important that local leaders took a central role in community engagement. Coverage during each round of MDA averaged 84%, which met the target for the trial.

Effect of Pulsed Magnetic Stimulation on Sexual Function in Couples With Female Stress Urinary Incontinence Partners

ABSTRACT We prospectively evaluated the effects of pulsed magnetic stimulation (PMS) on sexual function of couples with stress urinary incontinence (SUI) partners. Female SUI subjects received 16 or 32 biweekly PMS sessions, depending on treatment response. Prior to, immediately after, and at 6-months posttreatment, couples completed the Golombok Rust Inventory of Sexual Satisfaction (GRISS) questionnaire. Fifty-three (80.3%) of 66 couples completed reassessments. Based on the overall GRISS score, there were significant improvements in sexual function in both female subjects (Mdiff −5.05, SE 1.34, p = 0.001) and their partners (Mdiff −3.42, SE 1.24, p = 0.026). Our findings suggest that PMS improved sexual function of SUI patients and their partners.

Treatment of chronic back pain using indirect vibroacoustic therapy: A pilot study

BACKGROUND Low frequency sound wave stimulation therapy has become increasingly popular in the rehabilitation fields, due to its ease, less fatiguing and time efficient application. OBJECTIVE This 12-week pilot study examines the efficacy of applying low frequency sound wave stimulation (between 16-160 Hz) through both hands and feet on relieving pain and improving functional ability in patients with chronic back pain. METHODS Twenty-three participants with chronic shoulder (eleven participants) or low back pain (twelve participants) underwent a 12-week vibration therapy program of three sessions per week. A low frequency sound wave device comprising four piezoelectric vibration-type tactile tranducers enclosed in separate 5-cm diameter circular plates, which generate sinusoidal vibratory stimuli at a frequency of 16-160 Hz, was used in this study. Primary outcome measure was pain sensation measured using the Visual Analogue Scale (P-VAS). The secondary outcome measures were pain-related disability measured using the pain disability index (PDI) and quality of life measured using the SF-12. RESULTS At week 12, significant reductions in pain sensation and pain-related disability were observed, with mean reductions of 3.5 points in P-VAS and 13.5 points in the PDI scores. Sixty-five percent of the participants had a reduction of at least 3 points on the P-VAS score, while 52% participants showed a decrease of at least 10 points in the PDI score. Significant improvement was observed in the SF-12 physical composite score but not the mental composite score. CONCLUSIONS The preliminary findings showed that passive application of low frequency sound wave stimulation therapy through both hands and feet was effective in alleviating pain and improving functional ability in patients with chronic back pain.

Leaking in silence: women with stress urinary incontinence who do not have access to or refuse surgery

Research on stress urinary incontinence (SUI) is usually conducted in high-income countries, with more emphasis on surgical interventions [1]. The current mainstay for surgical treatment of SUI is the minimally invasive procedure using a vaginal mesh sling. In recent years, following reports of mesh complications, international authorities have issued alerts regarding the use of mesh, while the controversy has garnered significant media attention [2–4]. Accruing evidence shows that mesh is safe in the case of SUI [1, 5]. However, what is missing from the bigger picture is that these results mean very little to lowand middle-income countries, where surgical interventions for SUI are either not commonly available or may not be performed due to sociocultural barriers. There continues to be a research gap between developed and developing countries. Given the lack of access to or poor acceptance of incontinence surgery in such regions, it seems plausible to presume that pelvic floor muscle training (PFMT), which is recommended as the first-line nonsurgical treatment, will be used. However, many women have limited understanding of PFMT or do not know how to contract the correct muscles. For many lowand middle-income countries, including Malaysia, there are very few, if any, continence physiotherapy centers that offer PFMT. Most women have never received instructions from their healthcare providers. Furthermore, compliance with PFMT is questionable. The most significant barrier to compliance is that patients perceive it has minimal benefits [6]. Other nonsurgical interventions that may be available include biofeedback, mechanical devices (e.g., vaginal pessaries), electrical or magnetic stimulation, and complementary therapies (e.g., acupuncture). Some treatment options, such as pessaries and electrical stimulation, may be less popular than others because they involve insertion of a foreign object into the vagina. However, despite the shortcomings of nonsurgical treatments, many patients find these methods more acceptable to manage SUI than invasive surgery. It is true that nonsurgical methods are not as effective as surgical methods, yet it is also true that many patients in such regions do not have access to or do not want to undergo surgical treatment. We believe that more effort should be channelled into promoting conservative treatments and educating the public about the myriad nonsurgical options available. More studies could be done to investigate new nonsurgical treatment options or refine existing options. Clinicians have the onus of discussing all possible treatment options with their patients, taking into account availability, efficacy, and acceptability; risk of adverse events; and patients’motivation. As healthcare professionals, we should scale up efforts to raise awareness about SUI diagnosis and management. For example, lifestyle and behavioral advice (e.g., appropriate fluid intake, weight management, and smoking cessation) are simple methods that can significantly improve quality of life of not only women with incontinence but also for members of the general public. In conclusion, we urge that more focus be given to women \where there is little access to or who are unwilling to undergo minimally invasive treatment. With the hype about efficacy of (or potential lawsuits following) surgery for SUI in developed countries, it is a grave disservice that millions of women with SUI in underserved regions continue to suffer from the condition no one wants to talk about.With 80% of all older people projected to live in lowand middle-income countries by 2050 [7], women with SUI are likely to suffer longer. Researchers, policy makers, and healthcare professionals should work together to improve education and public awareness related to SUI so that these women do not continue to Bleak in silence.^ * Renly Lim renly_lim@hotmail.com

Use of medicines and health services for chronic obstructive pulmonary disease among a cohort of Australians over 50 years

Background It is not known if the medicines and services for COPD are used in Australia according to the COPD-X guideline. This study examined the use of medicines and health services for COPD among an Australian cohort to determine if they were consistent with recommendations. Methods The administrative claims data from the Australian Government Department of Veterans’ Affairs were used and included persons aged ≥50 years who were using medicines for COPD in April 2016. Use of medicines was identified using the Anatomical, Therapeutic and Chemical Classification and Pharmaceutical Benefits Scheme. Use of services was identified using the Medicare Benefits Schedule and Australian Government Department of Veterans’ Affairs Fee Schedule. Results Of the 143,261 persons aged ≥50 years, 12,623 (8.8%) were on medicines for COPD. Of the total COPD population, 42% were managed on monotherapy, 36% on dual therapy, 21% on triple therapy, and 1.5% on more than three COPD medicines. Monotherapy comprised tiotropium (80%) predominantly. Services to practitioners who may provide pulmonary rehabilitation service showed less than 10% of the cohort had a claim for a visit to an exercise physiologist and less than a third had a claim for a physiotherapist visit in the prior 12 months. Services to assist with care coordination in the form of general practitioner management plans were only claimed by half of the cohort, while services supporting appropriate medicine use were claimed by less than one in six cases, despite high levels of inhaler use and multiple inhaler use. Conclusion More than three-quarters of COPD persons aged 50 years and above were managed on either monotherapy or dual therapy, consistent with the guideline recommendations. Almost one-quarter was on three or more therapies, which will create challenges for multiple device management. Many services that may benefit persons with COPD appear to be underutilized.