Verbal Advice Research Articles

Evaluation of a targeted prescriber education intervention on emergency department discharge oxycodone prescribing

The objective of this study was to evaluate the impact of an educational intervention on ED discharge opioid analgesic (OA) prescribing. A brief, one-on-one, educational intervention was delivered to ED OA prescribers by an ED clinical champion. The percentage of patients receiving (i) written advice regarding appropriate oxycodone use, (ii) written or verbal advice regarding appropriate post-discharge follow up and (iii) written general practitioner notification that oxycodone had been prescribed were determined pre- and post-intervention, through review of electronic patient records and structured patient telephone interviews conducted 3-7 days after ED attendance. Secondary outcomes included total amount prescribed and use of non-OA therapies. ED OA prescribers were surveyed to evaluate perceived effectiveness and intervention acceptability. A total of 30 ED OA prescribers received the 5-min intervention. Pre- and post-intervention, 80 and 81 patients were interviewed, respectively. Percentage of patients given written OA information increased from 10% to 22% (P = 0.04) and those receiving follow-up advice increased from 61 to 94% (P < 0.01). General practitioner notification of OA prescription increased from 15% to 88% (P < 0.01). Risk ratio for achieving all three end-points was 7.5 (95% confidence interval 1.8-32, P = 0.01). Median total amount of oxycodone prescribed/patient decreased from 100mg to 50mg (P = 0.04). Non-OA therapies were used by 49% of pre-intervention and 85% of post-intervention patients (P = <0.01). All ED OA prescribers agreed the intervention would change their prescribing practices; 70% deemed the intervention appropriate for delivery in their work environment. A brief, one-on-one educational intervention targeting ED OA prescribers was well received by clinicians and associated with improved quality of OA prescribing.

Smoking cessation care provision in Australian alcohol and other drug treatment services: A cross-sectional survey of staff self-reported practices

IntroductionClinical practice guidelines recommend alcohol and other drug (AOD) services assess client's smoking status and offer smoking cessation care (SCC) to all smokers. The aim of this study was to examine Australian AOD program staff report of recommended SCC practices: assessment and recording of smoking status; and the provision of 9 types of SCC. The study also assessed how the decision to provide SCC is made and the AOD program service and AOD staff characteristics associated with the provision of SCC. MethodsBetween July–October 2014, treatment staff from 31 Australian AOD services participated in an online cross-sectional survey. In addition, a site contact at each service was interviewed to gather service related data. ResultsOverall, 362 AOD program staff participated (response rate=57%) and 62% estimated that client smoking status was recorded for the “majority or all” of their clients. About a third (33%) reported that they “always” provide verbal advice to their clients to quit smoking, 18% “always” offered free or subsidized NRT and 16% “always” followed-up to check on client quit progress. Thirty percent reported that the decision to provide SCC was made on a client by client basis and 26% offered SCC only when the client requested assistance. Government-managed services, age and gender of AOD program staff were significantly associated with the provision of SCC. ConclusionMost AOD program staff report that smoking status is recorded for the majority of their clients however, the frequency with which SCC practices are delivered is low and the decision to provide care is arbitrary.

Maternal factors influencing exclusive breastfeeding of babies at six weeks of age

Background: Exclusive breastfeeding for first six months of life has several advantages for babies as well as mothers. However exclusive breastfeeding may not be followed by mothers due to various reasons. The objective of this study was to study the rates of exclusive breastfeeding and mixed feeding in infants at Six weeks of age. Methods: Prospective observational study. 200 mothers and their healthy full term newborns were included. Exclusive and early breastfeeding was initiated with guidance and support for the mothers during their hospital stay. All mothers were given verbal advice about the need and benefits of exclusive breastfeeding for first six months. Primary outcome: number of mothers giving exclusive breastfeeding or mixed feeding at six weeks postnatal age during the first immunisation visit . Results: 92.78% mothers were exclusively breastfeeding their babies at 6 weeks of age. 7.22% had started mixed feeding. 96.23% of multipara and 87.84% of primipara were respectively giving exclusive breastfeeding at 6 weeks. The difference was statistically significant (P value 0.0328). Mothers aged 20-35 years (95.65%) were more likely to continue exclusive breastfeeding than those aged<20 years (87.33%), P value 0.0071. Mothers with education of pre-university course and more (92%) were less likely to give exclusive breastfeeding than those with secondary school education and less (98.33%); P value 0.0397. Conclusions: Young mothers <20 years, primipara, those with higher education were more likely to deviate from exclusive breastfeeding at six weeks postnatal age. These mothers need additional counseling and support to continue exclusive breastfeeding for six months.

Erratum to: Characterising and comparing drug-dispensing practices at animal health outlets in the Rift Valley, Kenya: an exploratory analysis (part II).

A mixed-method study was conducted in the Rift Valley of Kenya to characterise drug-dispensing practices amongst staff at animal health outlets and to explore perceptions of veterinary medicines amongst pastoralists and farmers. Forty structured questionnaires were administered to staff at animal health outlets, including franchise outlets of ‘Sidai Africa Ltd.’, and two focus group discussions were facilitated to explore the perceptions of local animal health services by a Maasai pastoralist group and a dairy farmer cooperative. Differences were detected in the characteristics of Sidai outlets, agrovets, pharmacies and dukas. A greater proportion of Sidai outlet staff selected drugs based on principles of responsible drug use than staff at other types of outlet, and technical qualifications and training were associated with responsible drug use. Across all outlet types, staff knowledge and training gaps were identified, including in the correct administration of medicines. The majority of drug sales are accompanied by verbal advice to farmers. Members of the Maasai pastoralist group were concerned about accidental self-medication, withdrawal periods, drug residues and the misuse of drugs due to a lack of quality information and advice. The dairy farmer group raised similar concerns, reporting under-dosing as a common mistake amongst farmers. This study concludes that current knowledge, attitudes and practices of many service providers and livestock owners in the sale, purchase and use of veterinary medicines present risks of drug misuse and therefore the emergence of antimicrobial resistance. There is a clear demand from livestock keepers for accessible, affordable and quality animal health services and products in Kenya, and animal health practitioners have the potential to provide increased support to livestock-based livelihoods and act as stewards of our existing portfolio of animal and human medicines.

Psychology of behaviour change is key to effective oral health promotion.

Data sourcesAMED, CINAHL, Cochrane Library, Embase, Medline, PsycINFO, PsycARTICLES, ScienceDirect, SocINDEX, ASSIA, Social Policy and Practice, HMIC (Health Management Information Consortium), The Knowledge Network, Intute, MedNar, Copac, EPPI-Centre, EThOS, OpenGrey and TRIP databases. Searches were limited to publications in the English language published after 1994.Study selectionStudies set in general practice that investigated promoting good oral health in adult or child patients were considered. Study quality was assessed using NICE public health guidance checklists.Data extraction and synthesisStudies were grouped according to the evidence they offered in relation to the research questions and key findings and themes identified. No meta-analysis was conducted. Qualitative studies underwent thematic analysis. The evidence was synthesised after considering the studies' homogeneity, quality and applicability and studying the evidence tables.ResultsForty-four studies reported in 52 papers were considered. Fifteen studies were randomised controlled trials (RCTs), two cluster RCTs and one controlled trial. Five quasi-experimental studies, two before and after studies without controls, three surveys, 11 qualitative studies, three mixed methods studies, one audit and one pilot study were included.The studies were very heterogeneous; the quality of reporting highly variable with many using patient reported behaviours rather than objective measures. Follow-up periods were also short. Narrative summaries of psychological and behavioural models, verbal advice, written advice, other methods of conveying advice, message content, sender characteristics, receiver factors, 'framing' of advice, barriers and facilitators and patient satisfaction were provided.ConclusionsThe results of this review suggest that the psychology of behaviour change is the key to oral health promotion, and greater emphasis on teaching oral health professionals about health psychology would make oral health promotion in the dental surgery more effective.

P062 A Retrospective Audit of Hepatitis B Management in the GU Clinic

Background/introduction Background/introduction: Hepatitis B(HBV) is a sexually transmitted infection commonly diagnosed in GU settings. We routinely test for HBV in high risk patients such as men who have sex with men, sex workers and those from high prevalence areas. Aim(s)/objectives A retrospective audit was undertaken assessing whether patients diagnosed with HBV are being managed in accordance with BASHH guidance and whether changes made following a previous audit were implemented successfully. Methods Patients newly diagnosed with HBV over an 18 month period up to 31/8/15 had their records reviewed. Data was collected on demographics, investigations, initial management and follow up. Results 31 patients were included in the audit and their care compared to the 2008 national auditable standards. Median age was 28(range 16–46). 20 (64.5%) were male and 11 (35.5%) female. 29 (93.5%) identified as heterosexual, 2 (6.5%) as homosexual. 11 (35.5%) were of African descent. Only 6% of patients were provided with written information on HBV transmission and outcomes and 68% had documented partner notification. 95% had liver function tests performed post diagnosis, 97% had clear long term management plans documented and 87% were offered appointments with hepatology(compared to 67% in the previous audit). Conclusion Clinicians were failing to provide written information about HBV following diagnosis as information leaflets were not available in clinic. 87% of patients received verbal health advice but this still falls short of national standards. A scheme giving cards with QR codes linking to approved patient information is being trialled. Improved referral pathways have resulted in more patients having specialist review.

A review of approaches for dental practice teams for promoting oral health.

To determine the circumstances in which oral health promotion (OHP) in General Dental Practice is at its most effective, a systematic review was conducted to identify, critically appraise and synthesize the available evidence. The research question was: Is oral health promotion within dental practice effective and how can its effects be optimized? Systematic searches of 20 online resources (including Ovid Medline and Embase) were conducted. A call for evidence was also issued, and citation lists of other relevant systematic reviews were included. All studies published since 1994 which were set in the context of general dental practice and investigated promoting good oral health in adult or child patients were considered. 44 studies reported in 52 papers were included in the review. The evidence was heterogeneous and the quality of reporting was variable. Results showed that oral health promotion based on behavioural and psychological models was effective for improving oral health. Verbal advice affected knowledge and reported behaviour, written advice promoted oral health knowledge. There was moderate evidence that the attributes of the 'sender' of an oral health promotion message influenced its effectiveness. Many barriers and facilitators were shown to influence the effectiveness of OHP in dental practice. The results of this review suggest that the psychology of behaviour change is the key to oral health promotion and greater emphasis on teaching oral health professionals about health psychology would make oral health promotion in the dental surgery more effective.

A model for assessment and referral of clients with bowel symptoms in community pharmacies

Background To expedite diagnosis of serious bowel disease, efforts are required to signpost patients with high-risk symptoms to appropriate care. Community pharmacies are a recognized source of health advice regarding bowel symptoms. This study aimed to examine the effectiveness of a validated self-administered questionnaire, Jodi Lee Test (JLT), for detection, triage, and referral of bowel symptoms suggestive of carcinoma, in pharmacies.Method ‘Usual Practice’ was monitored for 12 weeks in 21 pharmacies in Western Australia, documenting outcomes for 84 clients presenting with bowel symptoms. Outcome measures were: acceptance of verbal advice from the pharmacist; general practitioner consultation; and diagnosis. Trial of the JLT involved staff training in the research protocol and monitoring of outcomes for 80 recruited clients over 20 weeks. Utility of the JLT was assessed by post-trial survey of pharmacy staff.Results Significantly more referrals were made by staff using the JLT than during Usual Practice: 30 (38%) vs 17 (20%). Clients’ acceptance of referrals was also higher for the intervention group (40% vs 6%). Two-thirds of pharmacy staff agreed that the JLT could be incorporated into pharmacy practice, and 70% indicated they would use the JLT in the future.Conclusion A pre–post design was considered more appropriate than a randomized control trial due to an inability to match pharmacies. Limitations of this study were: lack of control over adherence to the study protocol by pharmacy staff; no direct measure of client feedback on the JLT; and loss to follow-up. The JLT was effective in prompting decision-making by pharmacy staff and inter-professional care between pharmacies and general practice, in triage of clients at risk of bowel cancer.

Cryptosporidiosis outbreak in visitors of a UK industry-compliant petting farm caused by a rare Cryptosporidium parvum subtype: a case-control study.

A case-control study was conducted to investigate an outbreak of 46 cases of cryptosporidiosis in visitors to a petting farm in England. Details of exposures on the farm were collected for 38 cases and 39 controls, recruited through snowball sampling. Multivariable logistic regression identified that cases were 5·5 times more likely than controls to have eaten without washing their hands [95% confidence interval (CI) 1·51-19·9, P = 0·01] and 10 times less likely to report being informed of risk of infection on arrival (odds ratio 0·10, 95% CI 0·01-0·71, P = 0·02). An uncommon Cryptosporidium parvum gp60 subtype (IIaA19G1R1) was identified in a lamb faecal sample and all subtyped cases (n = 22). We conclude that lack of verbal advice and non-compliance with hand washing are significantly associated with a risk of cryptosporidiosis on open farms. These findings highlight the public health importance of effectively communicating risk to petting farm visitors in order to prevent future outbreaks of zoonotic infections.

Correlates of compliance with lifestyle modifications among hypertensive patients in Mazowe District, Zimbabwe

Non-compliance with lifestyle modifications is one of the most important reasons for uncontrolled blood pressure and hypertension complications among hypertensive patients. Our study sought to determine factors affecting compliance with recommended lifestyle modification among hypertensive patients (N = 290). A mixed methods design was adopted which involved both quantitative and qualitative data collection techniques. Data were collected through interviewer administered questionnaires, review of medical records and four focus group discussions. The prevalence of non-compliance with recommended lifestyle modifications ranged from 8.6% for non-compliance with limiting alcohol intake, to 89.6% for non-compliance with increased fruit consumption. Female patients were more likely to be compliant with reducing dietary salt [odds ratio (OR): 0.5; 95% confidence interval (95% CI): 0.25–0.93]. Patients aged 70 years and above were more likely to be non-compliant with engaging in regular physical activity (OR: 5.8; 95% CI: 3.32–10.51). Patients who bought vegetables from the local markets were more likely to be non-compliant with increasing vegetable consumption (OR: 7.8; 95% CI: 2.60–23.58) compared with those who obtained vegetables from their own gardens. Patients who did not perceive themselves to be at risk of hypertension complications were more likely to be non-compliant with reducing fat intake (OR: 4.4: 95% CI: 2.38–7.9). There was high prevalence of non-compliance with recommended lifestyle modifications among hypertensive patients. Factors that negatively affected compliance with recommended lifestyle modifications were lack of family support to modify lifestyle, lack of written advice that supplement verbal advice given at health centres, being aged 70 years and above, presence of co-morbidities, not having attended school, being unemployed and lack of risk perception.

Postnatal Lactational Counseling and Neonatal Weight Pattern.

To compare the impact of postnatal lactational counseling on the weight gain and frequency of mixed feeding in full term neonates. Observational study. Mother-infant pairs were observed in the maternity section of a multispecialty general hospital in Mumbai during two time periods. 260 mothers who delivered a full term, healthy, appropriate for gestational age neonate with birth weight >2.2 kg. Between 18 November, 2007 and 4 March, 2008, 126 mothers received unstructured verbal encouragement to maintain breastfeeding from the maternity staff. From 1 June, 2008 to 16 December, 2008, 134 mothers were counseled about breastfeeding by the pediatric residents and nurses with the help of charts, literature and verbal advice. They were supervised and helped during the first feed and subsequently until discharge. Weight gain (g/kg/day) of neonate at 28 days of life. The mean (SD) weight gain was significantly higher in the counseled group in comparison to historical control group [9.2 (4.5) g/kg/d vs. 7.9 (5.1) g/kg/d; P=0.03]. Mixed feeding occurred less frequently in [RR 0.36, 95% CI 0.13, 0.98; P=0.046] the counseled group (5/134) as compared to control group (13/126). Postnatal lactational counseling leads to higher weight gain, and lesser chances of mixed feeding in the neonatal period.

Drug-related problems identification in general internal medicine: The impact and role of the clinical pharmacist and pharmacologist

BackgroundPatients admitted to general internal medicine wards might receive a large number of drugs and be at risk for drug-related problems (DRPs) associated with increased morbidity and mortality. This study aimed to detect suboptimal drug use in internal medicine by a pharmacotherapy evaluation, to suggest treatment optimizations and to assess the acceptance and satisfaction of the prescribers. MethodsThis was a 6-month prospective study conducted in two internal medicine wards. Physician rounds were attended by a pharmacist and a pharmacologist. An assessment grid was used to detect the DRPs in electronic prescriptions 24h in advance. One of the following interventions was selected, depending on the relevance and complexity of the DRPs: no intervention, verbal advice of treatment optimization, or written consultation. The acceptance rate and satisfaction of prescribers were measured. ResultsIn total, 145 patients were included, and 383 DRPs were identified (mean: 2.6 DRPs per patient). The most frequent DRPs were drug interactions (21%), untreated indications (18%), overdosages (16%) and drugs used without a valid indication (10%). The drugs or drug classes most frequently involved were tramadol, antidepressants, acenocoumarol, calcium–vitamin D, statins, aspirin, proton pump inhibitors and paracetamol. The following interventions were selected: no intervention (51%), verbal advice of treatment optimization (42%), and written consultation (7%). The acceptance rate of prescribers was 84% and their satisfaction was high. ConclusionPharmacotherapy expertise during medical rounds was useful and well accepted by prescribers. Because of the modest allocation of pharmacists and pharmacologists in Swiss hospitals, complementary strategies would be required.

P172 Implementation of alcohol screening in patients attending a large walk-in sexual health service within london

Background UK national guidelines advocate a role for sexual health services to offer routine screening for high-risk alcohol consumption in patients. Screening for alcohol misuse and offering brief interventions in this setting has been shown to be acceptable to clinicians and patients. In August 2014 the Fast Alcohol Screening Test (FAST) was incorporated into the sexual history proforma in a London Genitourinary Medicine (GUM) clinic. Aim An audit was undertaken to assess the use of the FAST tool and management of patients with a positive FAST result. Methods A retrospective case-notes review of randomly selected patients attending the GUM clinic in October 2014 was performed. Information was collected on patient demographics, sexual history, sexually transmitted infections, completion of FAST tool and action dependent on outcome of risk assessment. Results 169 case notes were reviewed: 55% female and 45% male, mean age was 30 (range 17–74) years. The FAST tool was completed in 87% (147/169) of case notes. Of patients screened, 86% (127) identified as low risk, 10% (15) increasing and 4% (5) high risk (hazardous drinkers). Of hazardous drinkers, 90% (18) had a documented action for risk reduction; 56% (10) had verbal advice documented, 22% (4) accepted written advice, 22% (4) accepted referral to a sexual health advisor. Conclusion Clinician completion of the FAST tool within the sexual history proforma in a busy clinic was high, with some scope for improvement. Of the relatively low number of hazardous drinkers identified, most accepted only brief verbal advice in clinic.

G436(P) A Retrospective Audit of Melatonin Prescribing Amongst the Community Paediatricians in a Hertfordshire Child Development Centre and Cost Implications

Aims In 2012–2013 melatonin prescriptions cost our Paediatric department over £45,000 per year. An audit was carried out to explore the practice of prescribing melatonin among clinicians, compare it with current evidence for melatonin prescribing and find cost effective ways of reducing the annual melatonin spend. Methods Families of children with neurodevelopmental disorders issued with melatonin from hospital or community pharmacies from January to June 2013 were included in the audit. Cases were randomly selected and case-notes and doctor’s reports audited retrospectively. Children on melatonin for less than 6 months were excluded from the study. Results A total of 17 case-notes were audited. A detailed sleep history was documented in merely 1 case. Only 12% of cases were given verbal advice on sleep hygiene, prior to starting melatonin, and received sleep support whilst on melatonin. Paediatricians requested sleep hygiene support from Primary care in 6% of children. A sleep-diary was never used to monitor sleep at any stage of management. Children taking melatonin ranged from 1 to 8 years, with one child on melatonin for 12 years. Paediatricians did not suggest breaks from therapy in all cases. Given dosages of melatonin were ranged from 2 mg to 12 mg. Conclusion This audit highlighted the need for the development and implementation of evidence-based melatonin guidelines for Paediatricians, a sleep tool-kit for health professionals to help conduct a more effective sleep interview and sleep information to help support families establish good sleep hygiene in their children. So far, a melatonin guideline and sleep support tool-kit has been developed and circulated to relevant stakeholders. This has resulted in better prescribing practice, sleep support for families and a reduction in melatonin prescribing. Following the introduction of the guidelines, the preliminary results on the melatonin expenditure concluded a cost saving amount of £5651 over a period of 5 months, April to August 2014, compared to the same time period in 2013. These initial results are quite promising in predicting a larger saving in the future.

Current preventative and health promotional care offered to patients by chiropractors in the United Kingdom: a survey.

BackgroundWith increasing morbidity and mortality attributable to non-communicable disease, primary healthcare providers are urged to increasingly support people in making healthy lifestyle choices. Many chronic physical diseases associated with lifestyle behaviours have been linked to neuromusculoskeletal disorders and pain. Chiropractors, as primary healthcare professionals, are in a position to provide preventative and promotional healthcare to patients, however, it is unknown to what extent such care is provided, particularly in the United Kingdom (UK).MethodThis study was a cross sectional online questionnaire distributed to four UK chiropractic associations. The responses were collected over a period of two months from March 26th 2012 to May 25th 2012. Descriptive analyses were performed to identify the trends in current practice of chiropractors in the UK. Additionally, subgroup analyses of all items were performed using Pearson Chi-Square tests to determine statistically significant differences between respondents based on gender, years in practice, educational institution and association membership.ResultsOf the 2,448 members in the four participating associations, 509 chiropractors (approximately 21%) completed the survey. The great majority of UK chiropractors surveyed report evaluating and monitoring patients in regards to posture (97.1%), inactivity/overactivity (90.8%) and movement patterns (88.6%). Slightly fewer provide this type of care for psychosocial stress (82.3%), nutrition (74.1%) and disturbed sleep (72.9%). Still fewer do so for smoking (60.7%) and over-consumption of alcohol (56.4%). Verbal advice given by the chiropractor was reported as the most successful resource to encourage positive lifestyle changes as reported by 68.8% of respondents. Goal-setting is utilised by 70.7% to 80.4% of respondents concerning physical fitness issues. For all other lifestyle issues, goal-setting is used by approximately two-fifths (41.7%) or less. For smoking and over-consumption of alcohol, a mere one-fifth (20.0% and 20.6% respectively) of the responding chiropractors set goals.ConclusionsUK chiropractors are participating in promoting positive lifestyle changes in areas common to preventative healthcare and health promotion areas; however, more can be done, particularly in the areas of smoking and over-consumption of alcohol. In addition, goal-setting to support patient-provider relationships should be more widespread, potentially increasing the utility of such valuable advice and resources.

Pulmonary rehabilitation for chronic obstructive pulmonary disease.

Pulmonary rehabilitation for chronic obstructive pulmonary disease.

Early Obesity Prevention: A Randomized Trial of a Practice-Based Intervention in 0-24-Month Infants.

Objective. A pediatric office-based intervention was implemented following a randomized, controlled design, aimed at improving child feeding practices and growth patterns and ultimately reducing risk for overweight and obesity later in life. Methods. Four clinics (232 infants) were randomized to control or intervention (I), the latter delivered by health care provider at each of 7–9 well-baby visits over 2 years, using a previously developed program (Growing Leaps and Bounds) that included verbal, visual, and text advice and information for parents. Results. The I group offered significantly less soda (p = 0.006), sweetened tea (p = 0.01), punch (p = 0.02) and/or cow's milk (p = 0.001) to infants and delayed the introduction of drink/food other than breast milk (p < 0.05). Parents in the I group had a higher perceived parental monitoring (p = 0.05) and restriction (p = 0.01) on infant feeding. While the I group exhibited at baseline more adverse socioeconomic indicators than the control group, growth trajectory or body size indices did not significantly differ between groups. Conclusions. Education provided by health care providers in addition to follow-up monthly phone calls may help modify parental behaviors related to child feeding and increase parental sense of responsibility toward child eating behaviors.

Treating feverish illness in children aged under five years.

Fever is the most likely reason for a child to be taken to the doctor and, occasionally, the signs may indicate the start of serious illness. The National Institute for Health and Care Excellence has issued a quality standard for the care of feverish illness in children aged under five years, designed to ensure that no such cases are missed. Carers, usually parents, should be offered written and verbal advice if it is judged that they can safely take the child home and are happy to do so. The traffic light system is designed to assist assessment of the child on presentation and throughout the illness journey.

Prevention of postpartum stress incontinence in primigravidae with increased bladder neck mobility: a randomised controlled trial of antenatal pelvic floor exercises.

To test whether supervised pelvic floor exercises antenatally will reduce the incidence of postpartum stress incontinence in at-risk primigravidae with bladder neck mobility, ultrasonically proven. Single blind, randomised controlled trial. Antenatal clinic in a UK NHS Trust Hospital. Two hundred and sixty-eight primigravidae attending an antenatal clinic at approximately 20 weeks of gestation with bladder neck mobility, on standardised valsalva, of 5 mm or more linear movement. The median age was 28, ranging from 16 to 47 years. Patients randomised to supervised pelvic floor exercises (n = 139) attended a physiotherapist at monthly intervals from 20 weeks until delivery. The exercises comprised three repetitions of eight contractions each held for six seconds, with two minutes rest between repetitions. These were repeated twice daily. At 34 weeks of gestation the number of contractions per repetition was increased to 12. Both the untreated control group and the study group received verbal advice on pelvic floor exercises from their midwives antenatally. Subjective reporting of stress incontinence at three months postpartum. Pelvic floor strength, using perineometry, and bladder neck mobility measured by perineal ultrasound. Of the 268 women enrolled, information on the main outcome variable was available for 110 in the control group and 120 in the study group. Fewer women in the supervised pelvic floor exercise group reported postpartum stress incontinence, 19.2% compared with 32.7% in the control group (RR 0.59 [0.37-0.92]). There was no change in bladder neck mobility and no difference in pelvic floor strength between groups after exercise, although all those developing postpartum stress incontinence had significantly poorer perineometry scores than those who were continent. The findings suggest that antenatal supervised pelvic floor exercises are effective in reducing the risk of postpartum stress incontinence in primigravidae with bladder neck mobility.

Hepatitis C in European prisons: a call for an evidence-informed response.

Globally, over 10 million people are held in prisons and other places of detention at any given time. People who inject drugs (PWID) comprise 10-48% of male and 30-60% of female prisoners. The spread of hepatitis C in prisons is clearly driven by injection drug use, with many infected prisoners unaware of their infection status. Risk behaviour for acquisition of hepatitis C via common use of injecting equipment is widespread in many prison settings.In custodial settings, effective and efficient prevention models applied in the community are very rarely implemented. Only approximately 60 out of more than 10,000 prisons worldwide provide needle exchange. Thus, HCV prevention is almost exclusively limited to verbal advice, leaflets and other measures directed to cognitive behavioural change. Although the outcome of HCV antiviral treatment is comparable to non-substance users and substance users out of prison, the uptake for antiviral treatment is extremely low.Based on a literature review to assess the spread of hepatitis C among prisoners and to learn more about the impact for the prison system, recommendations regarding hepatitis C prevention, screening and treatment in prisons have been formulated in this article.