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.

Urinary symptoms in pregnant women in their third trimester-a cross-sectional study.

INTRODUCTION AND HYPOTHESIS: Urinary symptoms are common in pregnancy. Our study aims to understand the extent of these symptoms in a cohort of pregnant women in the third trimester and their impact on quality of life (QOL) from the women's perspective. METHODS: A single-centre cross-sectional study of self-reported urinary symptoms of pregnant women in the third trimester conducted from August 2018 at the Diana Princess of Wales Hospital, Northern Lincolnshire, and Goole NHS Foundation Trust, Grimsby, UK. We used an international validated questionnaire (ICIQ-FLUTS questionnaire) (Brookes et al. Am J Obstet Gynecol. 191(1):73-82, 2004). RESULTS: A total of 302 women were included in this study. Nocturia was the most common symptom, reported by 97%, affecting QOL in 80%. Urgency of micturition was the second most common, present in 83%, adversely affecting QOL in 75%. Our study showed a startling finding of bladder pain in 47% (95% CI 41.1%, 52.3%) of these women. There was a high prevalence of nocturnal enuresis in 9.9% (95% CI 7.05%, 13.8%). Straining during micturition is not a well-known symptom in pregnancy, however reported by 18.2% (95% CI 14.2%, 23.0%). CONCLUSION: The high prevalences of bladder pain, nocturnal enuresis and straining in the third trimester of pregnancy are novel findings. Our study also confirms that the prevalence of all voiding, filling and incontinence symptoms in pregnancy is significantly higher than in the non-pregnant population, having a negative impact on QOL, and yet is not discussed as part of routine antenatal care.

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.