The effect of systematic screening of older women for urinary incontinence on treatment uptake: The URINO trial

Abstract

To increase treatment uptake, screening must be followed by active encouragement for further diagnostics and treatment. Based on the principles of Wilson and Jungner, female urinary incontinence is a condition suitable for screening. The effect of treatment however needs further evaluation before screening can be recommended. The results of the URINO trial will fill this gap in knowledge.

Cost‐effectiveness of a pro‐active approach of urinary incontinence in women

“…Further study is needed to establish the best way to implement this strategy. Further research is recommended into the effects and cost‐effectiveness of screening the population for urinary incontinence …”

“…The current economic evaluation was performed alongside the URINO trial. This is a cluster randomised controlled trial, in which the effects and costs of active encouragement of older community‐dwelling women with urinary incontinence to undergo diagnostic testing and treatment was compared to usual care . The design of this trial and the clinical results have been published elsewhere .…”

“…10,11 The design of this trial and the clinical results have been published elsewhere. 10,11 In brief, all women 55 years and older from 14 general practices were invited to complete a questionnaire measuring symptoms of urinary incontinence, and asked if they were willing to participate in the URINO trial. Women were eligible for inclusion if they reported involuntary loss of urine at least once a month, were able to fill in a questionnaire in Dutch and had given informed consent.…”

Authors' reply re: Clinical pharmacokinetic properties of magnesium sulphate in women with pre‐eclampsia and eclampsia: a systematic review

“…For some drugs, no clear or simple relationship exists between pharmacological effects and plasma concentration. 2 In our view, the pharmacokinetic and clinical evidence available so far does not support a clear relationship between serum magnesium concentration and observed clinical effects, and without a standard exposure-response study, it would be too early to confidently attribute clinical efficacy to any particular serum concentration. This assertion is supported by reports of clinical efficacy among pre-eclamptic women with lower serum magnesium concentrations, and clinical failure among those with concentrations within the so-called therapeutic range.…”

“…3 It is true that that the volume of distribution is a critical pharmacokinetic parameter that should dictate the adjustment of dosage in an individual woman; however, it is important to note that the volume of distribution does not depend only on weight, and can differ according to other variables such as age, body composition, and presence of disease. 2 Recommending low-dose MgSO 4 regimens solely on the basis of lower maternal weight ignores the relevance of these variables and other important pharmacokinetic parameters that differ between women and settings. For instance, MgSO 4 clearance (which could vary by disease severity) and its bioavailability (which depends on administration route) compound an assumption of a linear relationship between maternal weight and serum magnesium concentration.…”