PROPEL: implementation of an evidence based pelvic floor muscle training intervention for women with pelvic organ prolapse: a realist evaluation and outcomes study protocol.

BACKGROUND: Pelvic Organ Prolapse (POP) is estimated to affect 41%-50% of women aged over 40. Findings from the multi-centre randomised controlled "Pelvic Organ Prolapse PhysiotherapY" (POPPY) trial showed that individualised pelvic floor muscle training (PFMT) was effective in reducing symptoms of prolapse, improved quality of life and showed clear potential to be cost-effective. However, provision of PFMT for prolapse continues to vary across the UK, with limited numbers of women's health physiotherapists specialising in its delivery. Implementation of this robust evidence from the POPPY trial will require attention to different models of delivery (e.g. staff skill mix) to fit with differing care environments. METHODS: A Realist Evaluation (RE) of implementation and outcomes of PFMT delivery in contrasting NHS settings will be conducted using multiple case study sites. Involving substantial local stakeholder engagement will permit a detailed exploration of how local sites make decisions on how to deliver PFMT and how these lead to service change. The RE will track how implementation is working; identify what influences outcomes; and, guided by the RE-AIM framework, will collect robust outcomes data. This will require mixed methods data collection and analysis. Qualitative data will be collected at four time-points across each site to understand local contexts and decisions regarding options for intervention delivery and to monitor implementation, uptake, adherence and outcomes. Patient outcome data will be collected at baseline, six months and one year follow-up for 120 women. Primary outcome will be the Pelvic Organ Prolapse Symptom Score (POP-SS). An economic evaluation will assess the costs and benefits associated with different delivery models taking account of further health care resource use by the women. Cost data will be combined with the primary outcome in a cost effectiveness analysis, and the EQ-5D-5L data in a cost utility analysis for each of the different models of delivery. DISCUSSION: Study of the implementation of varying models of service delivery of PFMT across contrasting sites combined with outcomes data and a cost effectiveness analysis will provide insight into the implementation and value of different models of PFMT service delivery and the cost benefits to the NHS in the longer term.

Nebuliser cleaning and disinfection practice in the home among patients with cystic fibrosis.

BACKGROUND: Nebulised delivery of different classes of drugs is of fundamental importance in therapeutic regimens relating to both the management of disease progression in cystic fibrosis disease and its associated complications. The aim of this study was to determine if current nebuliser hygiene practices in the home environment by paediatric and adult cystic fibrosis populations are appropriate to ensure appropriate infection control and prevention measures have been addressed. METHODS: An Audit Questionnaire Study was completed with adult cystic fibrosis patients (n=20) or with parents of cystic fibrosis children (n=24), through a healthcare professional interview on a one-to-one basis, during either a home visit or during patient/parent attendance at cystic fibrosis clinic. RESULTS: Hygienic practices relating to nebuliser care varied, with paediatric carers more likely to clean and disinfect their devices. This study suggests there is much variation and confusion with regard to how to clean and disinfect nebulisers, as well as who is responsible for delivering this advice. CONCLUSION: The adult cystic fibrosis community in particular needs to be educated on practicalities associated with nebuliser hygiene and the reasons why this is important. Furthermore, to date there is a lack of a universally recommended guideline suitable for all types of cystic fibrosis nebulisers that all relevant pharmaceutical manufacturers advocate.

Young Children with Behavior Disorders in Low-Income Families: The Role of Clinic Observations in the Assessment of Parenting.

Children from low-income families are at elevated risk of meeting diagnostic criteria for behavior disorders. Although mastery-based Behavioral Parent Training (BPT) programs have a robust evidence-base for reducing disruptive behaviors of young children, socioeconomically disadvantaged families are more likely to drop out of treatment and, in turn, are less likely to benefit. Therefore, efficient assessment and treatment may be needed. Less research, however, has addressed the value of time-consuming behavioral observations relative to caregiver-report of problem behaviors in the assessment of this at-risk and underserved group. In the current study, 43 low-income parents and their clinic-referred child were observed during a standard mastery-based BPT interaction task (Child's Game) at baseline. Findings revealed that parents were observed to displayed an extremely high proportion of maladaptive behaviors targeted for reduction by subsequent treatment (Instructions plus Questions) relative to behaviors that the treatment was designed to increase (Attends plus Rewards). In contrast, parents reported they utilized relatively high and low rates of positive and negative parenting, respectively. Behaviorally-observed parenting was not correlated with caregiver-reported parenting. The findings suggest that baseline observations of behaviors targeted in mastery-based BPT interventions are an important part of assessment in parenting programs for low-income families with young disruptive children.