Editorial

Botulinum toxin: effective for overactive bladder in clinical practice

Botulinum toxin A effectively treats symptoms of overactive bladder (OAB) with high rates of patient satisfaction, according to questionnaire study from a UK centre.
A total of 60 women (median age 59 years) with OAB treated at University Hospital of North Staffordshire received botulinum toxin injections into the detrusor muscle. All had been unsuccessfully treated with urinary incontinence medications and most had received physiotherapy.
According to results of a questionnaire sent after botulinum toxin treatment, 50% of the patients experienced improved symptoms within one week, with a further 30% showing improvement between two weeks and four months after the procedure. Symptom improvement lasted between zero and nine months for 53% of the patients. Three-quarters of the patients noted that the botulinum toxin injections were “very effective, effective or moderately effective” in treating their symptoms.
Patients also expressed high satisfaction, with 73% commenting that the injection exceeded or met their expectations and 80% saying they would repeat the treatment if required.

These results suggest that botulinum toxin A may provide a valuable alternative treatment for OAB. Current NICE guidance advises that botulinum toxin A should be only used in women who have not responded to lifestyle interventions, bladder retraining and pharmacological treatment and who are willing and able to self-catheterise.

Rigby J et al. Int J Gynecol Obst 2012:119(Suppl 3): S463 (A0573)
NICE guidelines on the management of urinary incontinence in women. October 2006. http://www.nice.org.uk/nicemedia/live/10996/30282/30282.pdf

British Heart Foundation – new support for practice nurses

The British Heart Foundation (BHF) is often seen as an organisation focused on patients. This is true, but along with major research, supporting healthcare professionals is also a vital part of our role. In the past we have worked mainly with specialists in secondary care, but now we are re-focusing our attention. For the first time, we are supporting primary healthcare professionals with education and training.

It has certainly been a summer to remember, and one with important take-home messages for the health of every woman. The London Olympic Games demonstrated the benefits that can accrue from the best of evidence-based health care and individual healthy behaviours. And the London Paralympics show that, with personal determination and excellent support, it is possible to overcome almost unimaginable disadvantages to achieve at the highest level.

A question of culture? Faith and a woman’s choice of contraception

The most effective contraceptive is the one that the woman seated opposite you will use. Women are more likely to adhere to contraception when they have been actively involved in choosing the method. This choice is influenced by the patient’s values and beliefs, which are in turn informed by her religious or cultural background. Awareness of these influences helps us to better understand and facilitate patient choice.

Improving survival in vulval cancer

Vulval cancer is primarily a disease of elderly women, but is increasingly seen before the menopause. It is a rare disease, and a primary care health professional may see only one case every seven years. It is, however, essential for GPs and practice nurses to be aware of the early signs and symptoms of vulval cancer, since it is highly curable if diagnosed and treated at an early stage.

New perception, new QOF, new opportunity

Recent changes in the perception of osteoporosis and fracture risk have placed their management firmly within primary care. The inclusion of osteoporosis in the Quality and Outcomes Framework (QOF) supports this change and acknowledges the important role of GPs and practice nurses. A new online resource aims to help primary care in taking this opportunity to improve patient care and achieve QOF domains.

Could it be cancer? Investigating postmenopausal bleeding

Primary care is usually the first point of contact when a woman presents with postmenopausal bleeding (PMB). Prompt referral is essential, since bleeding may be a sign of endometrial cancer. But it is also important for GPs and practice nurses to explain to the patient the reasons for concern, as well as the purpose of the investigations that she is likely to encounter in secondary care.

A lasting legacy? Winning the race for bone health

As we watch our young female athletes compete in the Olympics, we hope that their legacy will be increasing participation in sports and exercise by all women. The positive effects of exercise are well known, and a sedentary lifestyle can reduce bone mineral density and increase the risk of postmenopausal osteoporosis. But for the young female performer, high volumes of exercise may paradoxically be linked to the loss of oestrogen and higher risk of stress fracture and osteoporosis associated with the female athlete triad.

Vulval itch

The vulva is the area of skin just outside the vagina. Most women have a slight vulval itch from time to time, but pruritus vulvae means that the itch is persistent and is often worse at night. Pruritus vulvae affects about one in 10 women at some time in their lives.

Age and fertility: How old is too old?

Over the last 30 years, there has been a trend towards lower parity, older mothers, and a significant rise in the incidence of multiple pregnancies, both spontaneous and induced by assisted reproductive technologies (ART). These developments mean that women receive contradictory information on age-related effects on their ability to conceive. Primary healthcare professionals can play a key role in enabling women to make realistic and informed choices about the risks of deferring childbirth.

The right prescription for nausea and vomiting in pregnancy

Nausea and vomiting in pregnancy (NVP) are regarded as a ‘normal’ phenomenon of early pregnancy, and so their impact is under-appreciated and under-researched. The condition can, however, be so serious that women need admission for fluid replacement. GPs and practice nurses looking after women with NVP need to be aware of its potential severity and be willing to offer safe and effective therapy.

Putting chronic liver disease on the primary care agenda

Chronic liver disease is a problem for all of us. It develops silently, often taking many years to cause sufficient damage to be detectable or cause signs or symptoms for which a patient would seek attention. Primary care has a central role in improving the prevention and early detection of chronic liver disease. This special issue of the British Journal of Primary Care Nursing (BJPCN) and Primary Care Cardiovascular Journal on chronic liver disease is full of step-by-step guides and informative articles to give you the key information and tools to get to grips with this important condition.

Editorial

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