Public Release: 

Behavioral therapy generally more effective than pharmacologic therapies for UI

American College of Physicians

1. Behavioral therapy generally more effective than pharmacologic therapies for urinary incontinence

Evidence review finds that many nonsurgical treatments help to improve outcomes in UI

Abstract: http://annals.org/aim/article/doi/10.7326/M18-3227

URLs go live when the embargo lifts

Most nonpharmacologic and pharmacologic interventions are more likely than no treatment to improve outcomes for women with either stress or urgency urinary incontinence (UI). Behavioral therapy, alone or in combination with other interventions, was found to be generally more effective than pharmacologic therapies alone. Findings from a systematic evidence review and network meta-analysis of clinical outcomes of nonpharmacologic and pharmacologic interventions for UI are published in Annals of Internal Medicine.

UI is a common malady in women and may be categorized as stress UI (the involuntary loss of urine with effort or physical exertion or on sneezing or coughing), urgency UI (a sudden compulsion to urinate that is difficult to defer), or mixed UI (with features of both stress and urgency UI). Nonsurgical interventions include nonpharmacologic interventions that aim to strengthen the pelvic floor or change behaviors that influence bladder function, and pharmacologic treatments that primarily address bladder and urethral sphincter function.

Researchers from Brown University School of Public Health conducted a systematic review of the clinical effects of all nonsurgical treatments for stress, urgency, and mixed UI in nonpregnant women to compare their effectiveness for improving UI outcomes. A network meta-analysis included 84 studies and showed that all interventions studied, except hormones and periurethral bulking agents, resulted in better UI outcomes than no treatment. For stress UI, among treatments commonly used as first- or second-line interventions, behavioral therapy was more effective than either alpha agonists or hormones and combination behavioral therapy and hormones were more effective than alpha agonists. Alpha agonists were found to be more effective than hormones. There was insufficient evidence comparing periurethral bulking agents and intravesical pressure release treatments used as third-line interventions for women with stress UI. For urgency UI, among treatments commonly used as first- or second-line interventions, behavioral therapy was more effective than anticholinergics. Onabotulinum toxin A may be more effective than neuromodulation as third-line therapy.

Media contact: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. To interview the senior clinical author, Peter C. Jeppson, MD, please contact Mollie Rappe at mollie_rappe@brown.edu.

2. CDC checklist can rapidly distinguish anthrax from nonanthrax illnesses after suspected exposure

Field identification of anthrax cases could save lives after an aerosol attack with Bacillus anthracis spores

Abstract: http://annals.org/aim/article/doi/10.7326/M18-1817

URLs go live when the embargo lifts

A brief, evidence-based checklist covering symptoms and signs of anthrax may help to rapidly distinguish anthrax from other conditions with minimal need for diagnostic testing after known or suspected population exposure. The checklist is described in an article published in Annals of Internal Medicine.

Few health emergencies would rival the medical consequences of a wide-area aerosol attack with Bacillus anthracis spores, the causative agent of anthrax, over a populated area. Even with modern critical care, almost half of the patients would die. To save as many lives as possible, rapidly separating anthrax cases from other illnesses would be crucial, and laboratory-based mass screening of the affected population would take too much time. Having evidence-based triage algorithms that could be used in the field may mean the difference between life and death.

Researchers from the Centers for Disease Control and Prevention (CDC) developed a field-deployable checklist that rapidly distinguishes most anthrax from nonanthrax illnesses on the basis of clinical presentation. To develop the checklist, the authors reviewed published literature from 1880 to 2013 to compare the clinical presentations of adult patients with anthrax to those of persons presenting for evaluations at two epicenters of the 2001 U.S. anthrax attacks. Their checklist-directed triage without diagnostic testing correctly classified 95 percent of 353 adult anthrax cases and 76 percent of 647 control patients. They also found that their checklist sensitivity and specificity were minimally affected by the inclusion of pediatric patients. Sensitivity increased to 97 percent and 98 percent respectively when only inhalation anthrax cases or higher-quality case reports were investigated.

Media contact: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. To interview the lead author, Kate Hendricks, MD, MPH&TM, please contact Christine Pearson at boy3@cdc.gov.

Also New in this issue:

Developing and Testing the Agency for Healthcare Research and Quality's National Guideline Clearinghouse Extent of Adherence to Trustworthy Standards (NEATS) Instrument J. Jane Jue, MD, MSc; Sarah Cunningham, MA; Kathleen Lohr, PhD; Paul Shekelle, MD, PhD; Richard Shiffman, MD, MCIS; Craig Robbins, MD, MPH; Mary Nix, MS; Vivian Coates, MBA; and Karen Schoelles, MD, SM

Research and Reporting Methods

Abstract: http://annals.org/aim/article/doi/10.7326/M18-2950

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