Staff awareness of pelvic floor muscle training (PFMT) in tertiary care - a qualitative cross-sectional study.

Pelvic floor muscle training (PFMT) is proven to protect against pelvic-floor weakness in the form of urinary incontinence (UI) and pelvic organ prolapse (POP). National Institute for Health and Care Excellence (NICE) guidelines advise supervised PFMT as first-line treatment of stress or mixed UI and POP. Healthcare professionals play a crucial role in educating patients. Our aim is to study the extent of awareness of PFMT amongst healthcare professionals by a single-centre cross-sectional study of voluntarily participating 44 healthcare professionals. The term 'pelvic floor exercise' had varied explanations; 53% staff thought they knew how to undertake pelvic-floor assessment, although there was no standard method or terminology to describe the technique or outcome. Staff were unaware of PERFECTR method, Modified Oxford Grading, slow and fast contractions which form the basic criteria of standardised pelvic floor assessment and training. Only 43% staff were aware of online resources.Impact StatementWhat is already known on this subject? There have been many studies confirming the effectiveness of pelvic floor muscle training (PFMT) in the prevention and treatment of long-term morbidities like urinary incontinence, pelvic organ prolapse and sexual dysfunction. However, there have been no studies in the published literature about staff awareness of this important evidence based health intervention in women's health services.What do the results of this study add? We believe the awareness among health care staff about PFMT is still limited. Our study is the first of its kind in literature to highlight that staff awareness about this health intervention is still poor which in turn means staff are not well equipped to offer the support and guidance the patients need.What are the implications of these findings for clinical practice and/or further research? The lack of awareness of staff needs addressing on an urgent basis. Knowledge of PFMT is essential for health care staff to provide appropriate patient education and support. We recommend including information of PFMT and assessment methods in local and national guidelines to help increase awareness of staff and patients alike and help achieve better global pelvic health.

Perioperative outcomes and prospective patient reported outcome measures for transvaginal mesh surgery.

PURPOSE: To determine perioperative morbidity associated with the transvaginal mesh and analyse patient reported outcome measures following transvaginal mesh surgery via a prospective cohort study. METHODS: A retrospective review and a prospective cohort study of vaginal symptoms via a validated questionnaire (Ethically approved). 159 consecutive women who underwent transvaginal polypropylene mesh repair for pelvic organ prolapse from January 2009 to January 2012 by a single experienced urogynaecologist were identified using theatre records and formed the study population. The type and frequency of intraoperative and postoperative complications, mesh exposure rates and need for further surgery were recorded. 59/159 patients consented to complete both preoperative and postoperative assessment of vaginal symptoms using the validated International Consultation on Incontinence Modular Questionnaire-Vaginal symptoms (ICIQ-VS). 51/59 patients completed both questionnaires. RESULTS: The average age of the study population was 63 years (range 39-87 years). The mean BMI was 28.5 (range 20-40). 86 % (n = 138/159) had a previous hysterectomy. 98 % (n = 156/159) of patients did not have any intraoperative complications. 0.62 % (n = 1/159) had a bladder injury. Mesh exposure was noted in 4 % of the entire group (n = 6/135) at follow-up with overall reoperation rate of 9 % (n = 13/135). Statistically significant improvement in most arms of the ICIQ-VS questionnaire was noted in the cohort of 51 patients at follow-up. CONCLUSION: Our data revealed a very low intraoperative complication rate with a mesh exposure rate of 4 %. The prospective study showed a statistically significant improvement in vaginal symptoms.

The place of Kielland's forceps in reducing caesarean section rates.

The rise in births by caesarean section (CS) is a global issue. A skilled obstetrician with a midwife knowledgeable in Kielland's forceps (KF) is often able to achieve a successful rotational vaginal birth when safe. The KF, however, has risks--and outcomes must be audited. In this article we present the results of a literature review and retrospective audit, evaluate maternal and neonatal morbidity associated with KF in our unit and compliance with national standards. Our conclusion is that our unit complies with national standards and offers the woman an alternative to CS when it is safe to do so. Adverse outcomes with KF are not different from other modes of operative birth.

Women's perspective: intra-detrusor botox versus sacral neuromodulation for overactive bladder symptoms after unsuccessful anticholinergic treatment.

INTRODUCTION AND HYPOTHESIS: Comprehension of women's perspective and reasons for their choice between intra-detrusor botox (botox) and sacral neuromodulation (SNM) after failed anticholinergic treatment for overactive bladder syndrome (OAB) have not been evaluated and reported in the literature. Our voluntary service evaluation survey aimed to determine reasons behind individual patient choice. METHODS: All women were counseled in detail regarding the two treatment options available after failed anticholinergic treatment as per the hospital trust policy. Once the decision-making process was completed, they were asked to highlight one or more of the 12 questions within the survey that influenced their decision-making process. RESULTS: Fifty patients, with a mean age of 61.66 years (range 38-82 years) participated in our voluntary survey. Seventy-four per cent chose Botox and 26% chose SNM. In the botox group 54.05% disliked the thought of a foreign body in the back with SNM; 45.94% quoted shorter waiting times and 43.24% said that the quicker onset of benefit (within 3-5 days) with botox compared with SNM (up to 2 weeks) helped to influence their decision towards botox. In the SNM group 61.53% were averse to the potential need for botox to be repeated at variable intervals; 46.15% chose SNM to avoid the risk of urinary retention associated with botox. CONCLUSION: The botox group seemed more likely to need quicker results with easy access to the treatment modality, whilst the SNM group seemed keener to focus on a more permanent option with a known interval for the repeat procedure. The difference in patient choice was found to be statistically significant.

Staff Awareness of Anti-Cholinergic Burden (ACB) - A Qualitative Cross-Sectional Study in a Tertiary Care Hospital.

Introduction and hypothesis Anticholinergics are commonly used for a variety of conditions including urinary incontinence. Many studies show the ill effects of anticholinergics on cognition resulting in increased morbidity and mortality. However, the interaction of anticholinergic medications and cumulative anti-cholinergic burden (ACB) of different medications are not well known in general population and amongst health care professionals. Our aim is to study the extent of current awareness of ACB amongst health care professionals which plays a crucial role in educating patients and avoiding these morbidities. Methods A single centre cross-sectional study of 50 health care professionals who participated voluntarily. A questionnaire was designed to assess the knowledge, beliefs and attitudes towards anticholinergic burden and participants were also asked to choose the ACB score for 17 commonly used medications. Results A total of 74% participants admitted to have no understanding of the term ACB, 48% participants prescribe anticholinergics in their daily role, 44% knew that cognition was adversely affected by anticholinergics, and 16% participants were aware of scoring system. Only 16% participants routinely counsel women of cognitive side effects when anticholinergics are started. 86% reported that they would avoid prescribing medications which might affect cognition if possible. If given choice as a patient, 94% would avoid these medications if they were informed of the specific side effects like impaired cognition, physical decline, falls, hospital admissions and increased mortality. Conclusion Anticholinergic burden (ACB) is a serious phenomenon associated with increased morbidity and mortality in the general population as well as elderly population. It is evident from this study that the knowledge and awareness of ACB in our health care staff are still lacking.