Developing and implementing a social prescribing initiative in primary care: insights into the possibility of normalisation and sustainability from a UK case study.

Aim To conduct a process-based evaluation of the inception and early implementation of a social prescribing initiative (Healthy Connections Stewartry) in two UK General Practices. BACKGROUND: Prescribing a range of social, cultural, arts and educational activities to clients in primary care (known as 'social prescribing' or 'community linking schemes') as a means of addressing long-term physical health conditions and promoting mental health and well-being is becoming increasingly prominent and popular. However, concerns exist over a lack of evidence of effectiveness and formalised insights into how such initiatives may be optimally implemented. METHODS: Within a case study design and using 1-1 semi-structured interviews, three related data sets were developed over a 12-month period from 30 purposively sampled informants: the project steering group; the wider primary care team; and various community groups. Data analysis drew on various theoretical resources, particularly those pertaining to nurturing sufficient capacity for the organisational 'normalisation' of this practice and understanding the dynamic flows and linkages between potential clients, 'prescribing' primary care staff and the available community resources. Findings The inception and implementation of the initiative had been broadly successful and that more generally, there were grounds to suggest that these practices were becoming 'normalised' into the day-to-day cultures and routines of the primary care organisations. A series of procedural features are considered significant in achieving such ends. Some specific barriers to change are identified and ultimately in the context of potential 'transferability', a wider reflection is undertaken of the potential for such innovative practice to become established in less advantageous organisational circumstances. Fundamental difficulties are recognised and thus the need for formally implemented 'change' processes. Furthermore, for social prescribing to become a pervasive feature of health-care provision, the need for necessary capacity and resources is stressed.

Sexual dysfunction in patients with painful bladder syndrome.

PURPOSE: The degree of sexual dysfunction in patients with Painful Bladder Syndrome (PBS) has not been documented previously. The Female Sexual Function Index (FSFI) was used to measure the degree of female sexual dysfunction (FSD) in these patients. MATERIALS AND METHODS: The FSFI was administered on-line to female patients with self-reported PBS. This 19-item questionnaire evaluated FSD in six domains: desire, arousal, lubrication, orgasm, satisfaction, and pain. RESULTS: The data was analyzed on an item-for-item basis and by the six domains of sexual dysfunction for 100 patients and compared to a control group of 131 healthy volunteers and a second group consisting of 128 patients with Female Sexual Arousal Disorder (FSAD). When compared with the controls, PBS patients self-report sexual dysfunction in all domains evaluated by the FSFI. CONCLUSIONS: The degree of FSD in PBS patients is significantly higher in all domains when compared to the control group.

Sexual dysfunction in patients with painful bladder syndrome is age related and progressive.

INTRODUCTION/OBJECTIVE: The degree of sexual dysfunction in patients with painful bladder syndrome (PBS) across their lifespan has not been previously documented. MATERIAL AND METHODS: The Female Sexual Function Index (FSFI) is a research tool to measure the degree of clinical female sexual dysfunction (FSD). This 19-item questionnaire evaluates FSD in six domains: desire, arousal, lubrication, orgasm, satisfaction, and pain. This study used the FSFI with the additional variables of age, geographical location, and current medications. The participants were not blinded to the fact that this study was examining the link between PBS and FSD. Each question in the survey was targeted to a specific variable of FSD and the answers were rated on a Lickert scale. RESULTS: When compared with controls, PBS patients self-report significant sexual dysfunction in all domains evaluated by the FSFI (p < 0.001). Age-specific results were observed in regards to the domains of arousal, lubrication, and pain (p < 0.01). CONCLUSIONS: PBS patients report significant FSD in all domains when compared to controls (p < 0.001). Significant differences in the domains of arousal, lubrication, and pain exist between respondents < 30 years old and in those > 50 years of age. The extent of sexual dysfunction is worse in the areas of pain in each age group evaluated. Pain is the most significant finding in patients with FSD and PBS.

Self-assembled elastin-like polypeptide particles.

In this work, the self-assembly of a recombinant elastin-based block copolymer containing both hydrophobic and cross-linking domains from the human elastin protein was investigated. The particle formation and dynamic behavior were characterized using inverted microscopy and dynamic light scattering. The morphology and stability were evaluated using scanning and transmission electron microscopy. Above a critical temperature the molecules self-assembled into a bimodal distribution of nano- and micron-sized particles. The larger particles increased in size through coalescence. Micron-sized particle formation appeared largely reversible, although a self-assembly/disassembly hysteresis was observed. At high polyethylene glycol (PEG) concentrations particle coalescence and settling were reduced, particle stability seemed enhanced and PEG coated the particles. Particle stabilization was also achieved through covalent cross-linking using glutaraldehyde. This study laid the foundation for optimization of particle size and stability through modification of the solvent system and has shown that this family of elastin-based polypeptides holds potential for use as particulate drug carriers.