Elderly adults at risk for physical disabilities are able to adhere to a regular program of moderate exercise for one year, a recent study of 213 men and women suggests. Led by corresponding author Roger Fielding, Ph.D., of the Jean Mayer USDA Human Nutrition Research Center on Aging (USDA HNRCA) at Tufts University, the authors observed that improvement in physical function was related to the participants’ ability to adhere to the physical activity regimen.

“At the beginning, middle and end of the study the participants were tested on their walking speed, strength, flexibility and balance to gauge their physical function,” said Fielding, director of the Nutrition, Exercise Physiology and Sarcopenia Laboratory at the USDA HNRCA. “We saw a greater improvement in physical function in the participants who reported exercising 150 minutes or more per week.”

The study, published in the November issue of Medicine & Science in Sports & Exercise, analyzed data from the physical intervention arm of the Lifestyle Intervention and Independence for Elders Pilot (Life-P). The participants ranged in age from 70 to 89 years-old, were sedentary when they enrolled, had health problems, such as cardiovascular disease and osteoporosis, and some physical limitations such as difficulty walking or climbing stairs. They followed a moderate exercise program that consisted of walking, strength, flexibility, and balance training.

For the first six months of the study, the participants exercised under supervision at one of four university centers and at home. Center visits were optional during the second six months. The participants filled out surveys to track their adherence to the physical activity regimen during the center visits and at home. The authors observed that physical activity adherence was consistent with earlier studies that followed older adults for shorter durations.

A future randomized trial would study a larger population of elderly for a longer period of time. “Larger studies are needed to confirm that exercise can improve physical function in elderly at high risk for physical disabilities,” said Fielding, who is also a professor at the Friedman School of Nutrition Science and Policy and School of Medicine at Tufts University. “What we found, however, is that this group can commit to a regular program of physical activity in a long-term randomized trial and the better their adherence to a program of physical activity the greater their improvements in physical functioning.”

This study was supported by the United States Department of Agriculture (USDA) and the National Institute on Aging, part of the National Institutes of Health.

Fielding, RA, Katula, J, Miller, ME, Abbott-Pillola, K, Jordan, A, Glynn, NW, Goodpaster, B, Walkup, MP, King, AC, Rejeski, WJ, and for the Life Study Investigators. Medicine & Science in Sports & Exercise. 2007 (November); 39 (11): 1997-2004. “Activity Adherence and Physical Function in Older Adults with Functional Limitations.

The Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy at Tufts University is the only independent school of nutrition in the United States. The school’s eight centers, which focus on questions relating to famine, hunger, poverty, and communications, are renowned for the application of scientific research to national and international policy. For two decades, the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University has studied the relationship between good nutrition and good health in aging populations. Tufts research scientists work with federal agencies to establish the USDA Dietary Guidelines, the Dietary Reference Intakes, and other significant public policies.

Tufts University
Medford Somerville, MA
United States
tufts.edu

AARP issued a statement in response to today’s announcement of
improvements to the Centers for Medicare and Medicaid Services’ (CMS)
“Nursing Home
Compare” web site. The statement, from AARP Executive Vice President John
Rother, follows:

“Choosing a nursing home is a daunting decision for any family, often made
even harder by a
rush to move a loved one into a new home. In such a difficult time,
transparency of quality and
safety information is essential. We applaud CMS for its work to simplify
the process of
choosing a safe, quality nursing home by making improvements to the
‘Nursing Home Compare’
web site.

“The star rating system proposed today could make it easier for families
to identify facilities that
consistently provide quality service and safety for their residents. AARP
is also hopeful that
added transparency will spur the industry to improve the performance of
every nursing home.
We look forward to working with CMS to refine the rating system announced
today as we work
toward making ‘Nursing Home Compare’ an even more valuable tool for
families in need of
long-term care.”

AARP has several resources, including a nursing home evaluation checklist,
to help families
make better decisions when exploring long-term care options. More
information is available at
aarp/health/longtermcare.

AARP is a nonprofit, nonpartisan membership organization that helps people
50+ have
independence, choice and control in ways that are beneficial and
affordable to them and society
as a whole. AARP does not endorse candidates for public office or make
contributions to either
political campaigns or candidates.

aarp

Millions of post-menopausal women use hormone replacement therapy (HRT) as a method to reduce symptoms associated with menopause. In a recent University of Missouri study, researchers found that one of the hormones used in HRT, a synthetic progestin, could be a major factor in promoting breast cancer. At the same time, the researchers have compelling evidence that using an antibody that prevents new blood vessel formation in tumors, or a small molecular drug, known as PRIMA, with similar properties as the antibody may be effective in treating or preventing the negative effects of progestin.

In a study published in the journal, Cancer Research, MU scientist Salman Hyder and his research team found that exposing tumor cells to progestin caused an increase in a growth factor that is involved in the formation of new blood vessels in tumors. Increasing the blood supply allows the tumors to expand as the availability of nourishment increases. However, when they used an antibody that inhibits the growth factor, the tumor shrank. Hyder’s team found similar results using PRIMA, which re-activated a protein known as p53. When p53 was activated within tumor cells, the number of breast cancer cells reduced significantly.

“As women age, many develop tiny lesions in their breasts,” said Hyder, professor of biomedical sciences in the College of Veterinary Medicine and the Dalton Cardiovascular Research Center. “The majority of the time, these lesions never expand. We think this might be due to a specific protein, p53, that, under normal circumstances, prevents tumor cells from living. We found in our study that when the protein is active, it reduces the number of breast cancer cells in the body by inhibiting the growth factor that supplies blood vessels to the tumor. However, when the cells of these lesions are exposed to progestin in a body that does not have an active p53 protein, we found that the cells might start expanding and turn into tumors.”

The synthetic progestin Hyder’s team studied is known as medroxyprogesterone acetate (MPA), which is commonly used in HRT. Using an animal model, Hyder introduced MPA to the animals that were carrying human breast cancer cells. When the breast cancer cells were exposed to MPA, they began growing at an accelerated rate. Later, when the research team exposed the cells to the antibody known as 2C3, or PRIMA – both of which block formation of new blood vessels in tumors – the tumor cells failed to grow and spread in response to the MPA.

“Since MPA is a synthetic hormone, it stays in the body longer,” Hyder said. “Unfortunately, while the drug is used to protect the uterus from the harmful effects of estrogens in HRT formulations, it is hurting the breast.”

The Women’s Health Initiative estimated a 26 percent jump in the number of breast cancer cases among women ingesting estrogen and progestin. Hyder believes that a large number of these women might also have a p53 protein that is not active and, therefore, not able to inhibit MPA-induced growth factor that helps to proliferate the tumor cells. Hyder cautioned that these studies are at an early stage and a lot of work remains to link progestin use firmly with progression of breast cancers in women.

###

Hyder, who also is the Zalk Endowed Professor of Tumor Angiogenesis, was assisted in the study by Yayun Liang, research assistant professor of biomedical sciences, Cynthia Besch-Williford, associate professor of veterinary pathobiology, and Rolf Brekken, assistant professor of Therapeutic Oncology and Surgery at the University of Texas Southwestern Medical Center.

Source: Christian Basi

University of Missouri-Columbia

The national real estate crisis has affected all aspects of life, and long term care is no exception. For many seniors unable to sell their homes, moving to an assisted living facility is no longer financially possible. For this reason, the option of aging-in-place with retrofits is growing in popularity along with utilizing home care assistance. By using caregivers and modifying homes to be friendlier to the aging process, many seniors will be able to remain in their homes for as long as possible – which, according to an AARP housing research report, is exactly what 83 percent of older Americans would choose to do when given a choice.

Always There Resources knows there’s no place like home and would like to educate the local community about how aging in place with home care can be a viable option. About Senior Health reports that seniors who go to nursing homes or other assisted type facilities are usually not in need of complex medical care, but rather are having difficulty taking care of their personal needs. Additionally, when faced with making a choice for care, oftentimes home care can be more affordable than moving to a care facility.

Staying in their own homes as long as is possible can mean a great deal to many seniors. Familiar surroundings can be therapeutic. When faced with recuperative needs and considering in-home services, here are some important factors to consider:

– Culture of the care recipient

– Current financial situation of the care recipient

– Formal/informal support system of the care recipient

– Current level of care required; future level of care prognosis

– Mental status of the care recipient

– Ability to get up and down out of a chair or a bed

Because it is not always clear to the average person whether an ailing senior can use care at home or when it is more appropriate to move elsewhere, it is usually best to consult a professional for advice. Understand that making a decision to move into a facility and sell a home is an unalterable decision, once completed. Prior to making any formal recommendation for long term care that involves a move away from home, available home care options should be fully explored.

Look at Activities of Daily Living needs when choosing care. Activities of Daily Living (ADLs) are simply activities in which people engage on a day-to-day basis. These activities are fundamental to caring for oneself and maintaining independence. Why is it important to be aware of a person’s limitations with Activities of Daily Living when choosing care?

– Determining the type of ADL care that is needed enables a clear idea of whether or not staying at home with care is an option.

– Recognizing a person’s limitations is the first step in developing a care plan to provide the appropriate type and level of assistance.

– Admission policies for adult day services, care communities and institutions often reflect on ADLs to determine eligibility for care and placement for a certain type of care.

– Long-term care insurance policies/programs often rely on ADL measures (the inability to perform a certain number of ADLs) to determine whether or not an individual qualifies for benefits.

In addition to long-term care insurance, there are many ways to pay for in-home care, including private funds, family funds, Veteran’s benefits, worker’s compensation, Medicaid waivers, and grants from some charitable organizations or religious organizations. Generally, it is less expensive to stay at home with 8 hours of care or less per day than it is to move to another location.

When grappling with long-term care decisions, the National Institute on Aging recommends checking with your insurance provider – there is a chance that paying just a few services out of pocket could cost less in the long run than moving into an independent living, assisted living or long-term care facility.

Navigating long-term care in today’s economic climate can be a stressful ride, but there are many resources available to aid in the decision. It is a good idea to talk with friends, neighbors and trusted advisors or professionals to learn more about the in-home care options available. For more information about in-home care services in our local community, please contact Always There Resources.

About Always There Resources, Inc.

Always There Resources is committed to helping seniors live better at home. We believe that each and every senior deserves the best quality of life possible. A team approach is the only way this can be accomplished that is why each family works closely with a professional care manager who uses their expertise to ensure the senior’s needs are being met. Services include: Philips Lifeline medical alarms, medication dispensing equipment, live-in care, and hourly homemaker and transportations services. Please visit alwaysthere.

Always There Resources, Inc.
alwaysthere

The 2009 spring issue of the NAMI Advocate Magazine features a cover story about two conversations Matt Kunz of the National Alliance on Mental Illness (NAMI) had with President Barack Obama on the mental health needs of America’s veterans.

The cover photo shows Obama sitting at a picnic table in a park in Billings, Montana talking with Matt, his wife Sandy and their infant daughter during the 2008 campaign. Inside the issue, Kuntz also shares the conversation he had with the President aboard the Inaugural train, where he presented him with a religious medal to help him through hard times, and one to Mrs. Obama to protect their family.

Faith, family and hope are also prominent themes in the issue’s other features.

For instance, Joyce Cooling , one of the nation’s leading jazz musicians, recalls her brother’s schizophrenia and their parents holding NAMI meetings in their home. Cooling will perform at NAMI’s annual convention in San Francisco on July 7, 2009. Her latest album, Global Cooling,was released last month.

The theme of hope continues in this issue of NAMI’s Advocate Magazine, with a feature on NAMI’s “Sharing Hope” initiative that is reaching out to African American congregations. Robert Dr. John H. Harris, Jr., pastor of Galilee Baptist Church in Trenton, NJ is quoted in the piece, “Just as we never thought we would have an African American president…It’s time for us to come out of the dark ages in dealing with mental illness.”

The issue also provides an update regarding the popular NAMIWalks, which have begun in earnest this month in communities around the country. More than 100,000 walkers are expected to participate, a tenfold increase from just a few years ago! Walkers hope to raise an estimated $8.5 million for local NAMI programs.

Source
NAMI

A new meta-analysis of existing research finds that patients who have immobilized lower legs due to a plaster cast or brace can greatly reduce their risk of a dangerous blood clot if they take a common anticoagulant drug.

In a new Cochrane Library review, the researchers suggest that adult patients whose upper or lower legs are in casts or braces should have routine treatment with the drug known as low-molecular-weight heparin. The risk of bleeding, a side effect of anticoagulant drugs, is low in such patients, the researchers report.

Although familiarly known as “blood thinners,” anticoagulant drugs work by preventing the formation of blood clots. Low-molecular-weight heparin is a newer form of heparin.

At issue is the risk that a kind of blood clot known as a deep vein thrombosis will form in an immobilized leg and travel to the lungs, where it could clog vessels that bring oxygen to the heart.

Clots in the lungs, known as pulmonary emboli, kill about 300,000 people a year in the United States, said Dr. Victor Tapson, director of the Center for Pulmonary Vascular Disease at Duke University Medical Center. Other estimates vary, starting at 50,000 such deaths a year.

“That may not be as many as heart attacks, but it often is more sudden,” Tapson said. “Someone with an embolism can be a young, apparently healthy patient, although more often it’s someone with clearly defined risk factors.”

People with hip fractures, hip replacements and any kind of reduced mobility are at special risk, Tapson said. Airplane passengers are in danger of pulmonary emboli because their legs are often immobile and cramped for long periods.

“The less mobile the legs are, the more likely you are to get a clot,” Tapson said. “Blood isn’t much like water. If it can’t flow and move, it will be more susceptible to thickening and clotting.”

A noted recent American victim of a pulmonary embolism is NBC reporter David Bloom, who died in 2003 after cramming his body in a military vehicle while covering the Iraq War.

In the new review, researchers in the Netherlands examined six randomized controlled studies in which 1,490 patients with immobilized lower legs received either low-molecular-weight heparin or a placebo or no preventive treatment. In all cases, plaster casts or braces immobilized the legs of the patients.

The review appears in the latest issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

The researchers conducted a meta-analysis, pooling the findings from the studies.

The rate of blood clots for patients who were in a cast or brace for at least one week ranged between 4.3 percent and 40 percent among those who received no anti-clotting treatment. However, the rate fell by about one-half in those who received daily injections of low-molecular-weight heparin.

The drug can cause excessive bleeding because it is more difficult for blood to coagulate and block holes in vessels. Still, “major bleeding events” were very rare in the patients who took heparin, striking about one in every 300, the reviewers found. Up to 8 percent of the patients who took heparin had “minor” bleeding problems.

The researchers recommend low-molecular-weight heparin as a routine treatment for patients with upper- or lower-leg casts or braces, but point out that blood clots are still a risk, even when the drug is used.

When patients have leg injuries, “immobilization should be avoided as much as possible, and treatment requiring less immobilization should always be considered,” the researchers write.

Tapson was impressed with the review and said he hopes it provide new insight for doctors.

Currently, doctors routinely do not give anticoagulants to everyone in a leg cast, Tapson said. “There aren’t really clear recommendations,” he said. “If you’ve got someone 70 years old in a cast, you’re much more likely to consider [an anticoagulant]. A 25 year old may not be as high risk.”

Even in light of the findings of the review, he said, doctors are not likely to give anticoagulants to all patients in casts, but instead consider it depending on their individual circumstances, he said.

Another pulmonary specialist said the review appears to be “sound.” Dr. Kenneth. Leeper Jr., associate professor of medicine at Emory University, added that immobilized patients “probably” should receive low-molecular-weight heparin routinely, unless there is a good reason not to administer the medication.

The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. Visit cochrane for more information.

Testroote M, et al. Low molecular weight heparin for prevention of venous thromboembolism in patients with lower-leg immobilization. Cochrane Database of Systematic Reviews 2008, Issue 4.

Health Behavior News Service
Center for the Advancement of Health, 2000 Florida Ave. NW, Ste. 210
Washington, DC 20009
United States
hbns

More than one in four elderly Americans lacked the capacity to make their own medical care decisions at the end of life, according to a study of 3,746 people to be published April 1 in the New England Journal of Medicine.

Those who had advance directives – including living wills or durable powers of attorney for healthcare – received the care they wanted most of the time, says lead author Maria Silveira, M.D., M.P.H., physician scientist at the VA Ann Arbor Healthcare System’s Clinical Management Research and assistant professor of Internal Medicine at the University of Michigan.

“Prior to our study, no one knew how many elderly adults might need others to make complex medical decisions on their behalf at the end of life,” says Silveira. “Our research shows that a substantial number of older adults need someone else to make decisions about whether aggressive, limited, or comfort care should be provided at the end of life.”

“This study underscores the need to prepare oneself and one’s family for the often emotional and difficult medical decisions that can arise at the end of life. It also suggests that the time spent to craft a living will and appoint a durable power of attorney for health care can be worthwhile.”

Advance directives usually document patients’ wishes for life-sustaining treatment in a living will, as well as their choice of a proxy decision-maker in a durable power of attorney for health care Advance directives are sanctioned in all 50 states and can be completed for free without the aid of an attorney. (Silveira recommends this site.)

Still, “There is a lot of myth and misunderstanding about advance directives,” Silveira says.

For example, many people do not understand that advance directives are used only when patients can’t make medical care decisions for themselves, and they can be revoked by the patient at any time, either in writing or orally. Advance directives are frequently confused with wills and durable powers or attorney – which have no bearing on medical care decisions.

Of the subjects studied, 61 percent had advance directives. Of those, more than 90 percent requested either limited or comfort care at the end of life. Among those who needed decisions made, but couldn’t make them themselves, 83% who had requested limited care and 97% who had requested comfort care, received the care that was in line with their wishes, Silveira says.

The study subjects were elderly Americans living at home or in facilities across the US who died between 2000 and 2006 and participated in the Health and Retirement Study, a national longitudinal study conducted at the University of Michigan’s Institute for Social Research and funded by the National Institute on Aging.

“Folks with a living will or durable power of attorney for health care were less likely to die in a hospital or to get aggressive care – but that is what most of them wanted,” she says.

One interesting finding suggests the importance of having both a living will as well as an appointed surrogate decision-maker. The study showed that among the handful of subjects who indicated a preference for aggressive care, half did not receive it.

“Given this, some might conclude that advance directives are used to deny wanted health care, but our study showed that a preference for aggressive care had a very strong association with receiving such care, when compared to those who did not state a preference for it. It’s just that at the end of life, aggressive treatment is often not an option; limited care and comfort care are always an option, ” Silveira says.

Co-authoring the study were Kenneth M. Langa, M.D., Ph.D., professor of in the Department of Internal Medicine at the University of Michigan , core investigator with VA Ann Arbor Healthcare System’s Clinical Management Research, and professor of Health Management and Policy in U-M’s School of Public Health
and Scott Y.H. Kim, M.D., Ph.D., associate professor of Psychiatry and an investigator in the Bioethics Program and Center for Behavioral and Decision Sciences in Medicine at the University of Michigan.

Silveira says many patients expect their physicians to start the conversation about end of life care and advance directives, and that physicians should be supported in their attempts to do so. The recent effort to provide Medicare reimbursement for periodic end-of-life discussions was a good start, she says.

“The health care system should ensure that providers have the time, space, and reimbursement to conduct the complex and time-consuming discussions necessary to plan appropriately for the end of life. Most elderly patients want and expect this,” she says.

Source:
Mary Masson

University of Michigan Health System

The process of aging disturbs a broad range of cellular mechanisms in a complex fashion and is not well understood. Computer models using fuzzy logic might help to unravel these complexities and predict how aging progresses in cells and organisms, according to a study from Drexel University in Philadelphia and Children’s Hospital Boston.

“One important goal of computational approaches in aging is to develop integrated models of a unifying aging theory in order to better understand the progression of aging phenotypes grounded on molecular mechanisms,” said Andres Kriete, Associate Professor at Drexel’s School of Biomedical Engineering, Science and Health Systems and lead author of the study.

The study, which will appear in the June issue of PLOS Computational Biology , relates progressive damage and dysfunction in aging, dubbed a vicious cycle, to inflammatory and metabolic stress response pathways. Interestingly, the activation of these pathways remodels the inner functioning of the cell in a protective and adaptive manner and thus extends lifespan.

This is the first time that scientists have applied fuzzy logic modeling to the field of aging. “Since cellular biodynamics in aging may be considered a complex control system, a fuzzy logic approach seems to be particularly suitable,” said Dr. William Bosl, co-author of this study. Dr. Bosl, a staff scientist in the Informatics Program at Children’s Hospital Boston, developed a fuzzy logic modeling platform called Bionet together with a cell biologist, Dr. Rong Li of the Stowers Institute for Medical Research in Kansas City, to study the complex interactions that occur in a cell’s machinery using the kind of qualitative information gained from laboratory experiments.

Fuzzy logic can handle imprecise input, but makes precise decisions and has wide industrial applications from air conditioning to anti-lock break systems in cars, using predefined rules. In a similar fashion, the aging model relies on sets of rules drawn from experimental data to describe molecular interactions. “Integration of such data is the declared goal of systems biology, which enables simulation of the response of cells to signaling cues, cell cycling and cell death,” said Glenn Booker, who is Faculty at the College of Information Science and Technology at Drexel and co-author on the study.

Applications in aging are currently geared towards deciphering the underlying connections and networks. “We have to realize that the real strength of computational systems biology in aging is to be able to predict and develop strategies to control cellular networks better as they may be related to age related diseases,” said Dr. Kriete, “and our approach is just a first step in this direction.”

Source
Drexel University

Friday 28 November, 2008
Edumund Blacket Building, Prince of Wales Hospital
Cost: Free for UNSW staff and students; others $80 / $30-students

This full day symposium shows the breadth of stem cell research being carried out across various stem cell disciplines at the University of New South Wales and affiliated institutions such as the Children’s Cancer Institute Australia, Garvan Institute, Prince of Wales Hospital, St George Hospital, St Vincent’s Hospital, Victor Chang Cardiac Research Institute.

Click here to register

Source
NSW Stem Cell Network (Australia)
The NSW Stem Cell Network is a professional community with an interest in both adult and embryonic stem cells. It encompasses the science, medicine, ethics, law, business and public awareness of stem cells. Regular workshops, seminars, conferences and courses organised by the Network have allowed this community to blossom, sharing knowledge and professional skills and embarking on collaborative research and commercial projects. Since the Network was established in Nov 2002, it has grown from 120 to over 500 members.
stemcellnetwork.au

A history of smoking is associated with an increased risk of metastatic disease in patients treated with radiotherapy (XRT) for prostate cancer (CaP), according to a report in the online version of the BJU International. The work is published by Dr. Pantarotto and colleagues in Ottawa, Canada.

In this retrospective review, 434 patients were treated with 66Gy of definitive radiotherapy between 1990 and 1999. To be included, patients had a PSA level less than 100ng/ml and no clinical or radiographic evidence of lymph node or distant metastasis. A smoking history categorized patients as non-smokers, previous smokers (>6 months smoking history but not smokers at time of consultation) or current smokers. Biochemical failure was defined by ASTRO criteria. Data regarding time to biochemical failure, time to local failure, time to distant failure, overall survival and disease-specific survival were generated.

A smoking history was obtained in 416 of 434 patients (96%) and the lifetime prevalence of smoking was 71%. Current smokers constituted 17% and non-smokers 29% of the cohort. Median follow-up was 70 months and current smokers presented at a younger median age of 66.4 years, compared with 69.9 years for previous smokers and 70 years for non-smokers. Clinical T stage, Gleason score and initial PSA were not significantly different between the smoking categories.

Biochemical, local and distant failure occurred in 44.6%, 23.2%, and 15.5% of patients, respectively. While biochemical and local failure rates were similar among smoking groups, a higher proportion of current smokers had distant failure events. Disease-specific survival was not significantly different among the three smoking groups, whereas overall survival was worse for current smokers than non-smokers (46% vs. 26%). The cohort death rate was 34%, with 39% of those deaths due to CaP. In univariate analysis, both previous and current smoking was associated with higher distant failure rates. In multivariate analysis, previous and current smokers had a higher risk of distant failure, 2.90 and 5.24, respectively. Overall and CaP-specific survival were not significantly different among the three smoking groups.

Several mechanisms have been proposed regarding the impact of smoking on CaP patient outcomes to XRT. Smoking-induced hypoxia secondary to high serum carboxyhemoglobin levels that interfere with hemoglobin-oxygen dissociation is thought to significantly contribute. Smoking also likely affects cellular mechanisms that result in tumor progression.

Jason Pantarotto, Shawn Malone, Simone Dahrouge, Victor Gallant and Libni Eapen

BJU Int 2006; 99(3): 564-569

By Christopher P. Evans, MD

About UroToday

UroToday attracts more than 45,000 readers monthly. The website covers over 22 urology disease categories and provides the most in depth Urological conference reports available online. UroToday is the world leader in delivering a quality, global online publication providing accurate and timely education that is clinically relevant in the practice of Urology. All scientific content is developed by urologists committed to translating research into clinically relevant science, including all genitourinary cancers, pediatric and geriatric urological dysfunctions for urologists, medical oncologists and advanced nurse practitioners.

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