Pelvic floor dysfunction: a scoping study exploring current service provision in the UK, interprofessional collaboration and future management priorities.

OBJECTIVE: Pelvic floor dysfunction (PFD) has a significant socioeconomic and healthcare cost. This study aimed to investigate current service provision for PFD in the UK, highlighting any gaps and areas for improvement to inform future service improvement. METHODS: A three-phase design comprised a scoping literature review, consultation survey with frontline practitioners from four key professional groups and an overarching synthesis. An interpretative analytical framework was informed by the concepts of interdisciplinary and interprofessional collaboration. RESULTS: Empirical evidence on PFD service provision is limited. No overarching strategic approach to PFD as a single clinical entity in the UK was identified. Two hundred and forty-three medical, nursing and physiotherapy practitioners from different clinical subspecialties participated in the survey. Access and availability to services, models of delivery and individual practice vary widely within and across the disciplines. Time restrictions, mixed professional attitudes, lack of standardisation and low investment priority were identified as major barriers to optimal service provision. Five overlapping areas for improvement are highlighted: access and availability, team working and collaboration, funding and investment, education, training and research, public and professional awareness. CONCLUSIONS: Current services are characterised by a fragmented approach with asynchronous delivery, limited investment and poor interprofessional integration. An improved service delivery model has the potential to improve outcomes through better interdisciplinary collaboration and efficient use of resources.

Effects of biodegradable polymer particles on rat marrow-derived stromal osteoblasts in vitro.

Effects of biodegradable particles of poly(L-lactic acid) (PLLA) and poly(DL-lactic-co-glycolic acid) (PLGA) 50/50 with diameter ranging from 1.0 to 1.5 microm on rat marrow stromal osteoblasts in vitro have been investigated over a period of 28 days. This study examined the effects of three particle parameters, concentration, polymer molecular weight, and composition, on osteoblast proliferation and function. Cell cultures were challenged with particles at two different time points: upon cell seeding (Day 1), and after cells had begun to establish their own mineralized extracellular matrix (Day 14). The most significant trend observed in those cultures challenged with particles beginning on Day 1 was due to increasing the concentration of particles, resulting in decreased [3H]-thymidine incorporation, cell count, and mineralization. Those cultures challenged with particles beginning on Day 14 were significantly more mineralized than those challenged with particles beginning on Day 1. In addition, increasing osteocalcin secretion confirmed the osteoblastic phenotype of the derived stromal cells. These studies suggest that the particles may affect the bone remodeling process surrounding a degrading implant by direct interaction with osteoblasts in addition to their indirect contributions to the inflammatory mechanism via mediators secreted by macrophages upon their phagocytosis.

Birmingham Craniofacial Score: a scoring system for craniofacial deformities.

A system was devised to score facial and head appearance in craniofacial patients in an attempt to quantify the severity of craniofacial deformities and measure the effect of corrective operations. It was deliberately kept simple to be "user friendly," and it must be regarded as incomplete. It has all the limitations of other scoring systems, but nevertheless it consistently reflects the results of operations, allowing quantitative comparisons and statistical analysis. It should be emphasized that deformity, not aesthetics, is measured. Fifteen features are scored. For every normal feature 1 point is awarded; for every abnormal feature, no point is scored. The range, therefore, extends from 0 to 15. In practice, there seems to be good correlation between the total score and the degree of deformity. A score of 13 or greater indicates that the appearance is cosmetically very good and the patient could be regarded as normal; a score ranging from 9 to 12 indicates a definite deformity; and a score of 8 or lower indicates the deformity is severe.

Fabrication of pliable biodegradable polymer foams to engineer soft tissues.

We have fabricated pliable, porous, biodegradable scaffolds with poly(lactic-co-glycolic acid) (PLGA) and poly(ethylene glycol) (PEG) blends using a solvent-casting and particulate-leaching technique. Our study investigated the effects of four different processing parameters on pliability and pore morphology of the biodegradable scaffolds. The parameters investigated were the PLGA copolymer ratio, the PLGA/PEG blend ratio, the initial salt weight fraction, and the salt particle size. A wide range of shear moduli (0.59 to 9.55 MPa), porosities (0.798 to 0.942), and median pore diameters (71 to 154 microns) was able to be achieved by varying the combination of these parameters. Our study indicates that initial salt weight fraction and PLGA/PEG blend ratio have the most significant effects on the physico-mechanical properties of the scaffolds. Enhanced pliability of the three dimensional foams made with blends of PLGA and PEG is evidenced by the ability to roll them into a tube without macroscopic damage to the scaffold. Pliable polymer substrates hold great promise for regeneration of soft tissues such as skin, or those requiring a tubular conformation such as intestine or vascular grafts.

Review: Hydrogels for cell immobilization.

Hydrogels are being investigated for mammalian cell immobilization. Their material properties can be engineered for biocompatibility, selective permeability, mechanical and chemical stability, and other requirements as specified by the application including uniform cell distribution and a given membrane thickness or mechanical strength. These aqueous gels are attractive for analytical and tissue engineering applications and can be used with immobilization in therapies for various diseases as well as to generate bioartificial organs. Recent advances have broadened the use of hydrogel cell immobilization in biomedical fields. To provide an overview of available technology, this review surveys the current developments in immobilization of mammalian cells in hydrogels. Discussions cover hydrogel requirements for use in adhesion, matrix entrapment, and microencapsulation, the respective processing methods, as well as current applications. (c) 1996 John Wiley & Sons, Inc.

Guided bone growth in sheep: a model for tissue-engineered bone flaps.

The emerging field of tissue engineering is yielding a variety of new strategies for bone replacement. In vivo assessment of candidate bone substitutes to demonstrate biocompatibility, degradability, and the ability to produce meaningful quantities of bone is essential prior to clinical use. We present results of a large animal model using formed plastic chambers implanted adjacent to the rib periosteum in sheep to fabricate vascularized bone flaps of different shapes. Chambers packed with morcellized corticocancellous bone graft, representing the most favorable natural circumstances for bone formation, were compared to empty chambers, representing the least favorable. Implants containing bone chips yielded formed blocks of vascularized bone after 6 weeks with evidence of remodeling after 13 weeks. Histomorphometric analysis demonstrated that there was full bone penetration into shallow (5 mm) chambers and 8.8 mm (+/-0.6) penetration into deep (10 mm) implants after 6 weeks. Molded bone segments failed to grow in empty chambers. This model presents a quantifiable range of bone forming potential to which different bone substitutes may be compared for usefulness in creating tissue engineered bone flaps for reconstructive surgery.

Dynamics of fibrovascular tissue ingrowth in hydrogel foams.

We have investigated and quantified the degree of fibrovascular tissue ingrowth in cylindrical poly(vinyl alcohol) (PVA) foams of 12.5 mm diameter, 5 mm thickness, and 71% porosity implanted in the mesentery of rats over a period of 25 days. Fibrovascular tissue penetrated the center of PVA foams 5 days postimplantation yet the void fraction available for cell seeding was 55% and the volume average pore diameter was 190 (+/- 39) microns. By 10 days postimplantation the void fraction had decreased to 32% and the volume average pore diameter was 121 (+/- 20) microns. As time elapsed fibrovascular tissue continued to expand and fill the remaining pore space. At 15 days postimplantation the void space was impractical for cell seeding and continued to decrease through the remainder of the study. Our data suggest that hydrogel foams with a polydispersed pore morphology can be prevascularized with adequate space for cell seeding as the volume of tissue penetrating the foam is limited by the smaller pores in the foam structure; however, available void space for cell seeding decreases with time.

Pore morphology effects on the fibrovascular tissue growth in porous polymer substrates.

The feasibility of developing biodegradable polymer scaffolds to engineer tissues was investigated by studying the effects of pore size on the dynamics of fibrovascular tissue ingrowth. Tissue advanced into amorphous poly(L-lactic acid) porous substrates faster as the pore diameter increased. Porous cylindrical devices of 13.5 mm diameter, 5 mm thickness, and approximately 500 microns pore size were filled completely by tissue 5 days postimplantation. Although prevascularized devices possessed minimal void volume for cell seeding to regenerate metabolic organs, they hold promise in the regeneration of tubular tissues by relying on the epithelization of prevascularized grafts.

The median cleft face syndrome with associated cleft mandible, bifid odontoid peg and agenesis of the anterior arch of atlas.

A case is reported of median cleft face syndrome with bifid tongue and odontoid peg and failure of formation of the anterior arch of the atlas. These are features which have not been reported previously. The preoperative CT demonstrated its potential to enhance our understanding of complex and rare craniofacial deformities.