The extent to which chaperone policies are used in acute hospital trusts in England.

OBJECTIVE: To determine whether the Ayling Inquiry's recommendations (2004) concerning chaperone policy implementation in acute hospital trusts in England has been implemented. METHODS: A quantitative questionnaire based on the Ayling Inquiry was posted to medical directors of all acute hospital trusts in England during December 2005 to March 2006 to determine whether their trusts had implemented the inquiry's recommendations by 1 December 2005. The same questionnaire was resent between December 2007 and March 2008 to determine whether their trusts had implemented the inquiry's recommendations by 1 December 2007. RESULTS: The total response rates were 59.4% and 47.7% for the first and second cohorts, respectively. The percentage of trusts having a chaperone policy increased from 41.3% in December 2005 to 56.5% in December 2007. By the end of 2007, 17.3% had accredited training for chaperones, 57.7% had a management lead and 71.2% of trusts formally investigated a breach of the chaperone policy, the latter being a fall from 88.4% in December 2005. Informing patients verbally of the policy was the most common method of distributing the information in both cohorts. By 1 December 2007, 50.0% of trusts did not use any resources towards their chaperone policy. Of the trusts without a chaperone policy by 1 December 2007, 52.5% intend to start a policy. CONCLUSION: Despite a public inquiry, only a small majority of acute trusts in England have a chaperone policy in place, which may have severe medico-legal repercussions in the future. Commencing a chaperone policy is a must for acute trusts and regular auditing necessary to ensure recommendations be maintained.

Anthropometric measurements in the diagnosis of pelvic size: an analysis of maternal height and shoe size and computed tomography pelvimetric data.

BACKGROUND: To determine whether measurements of maternal height and shoe size are predictors of pelvic size, using erect lateral computerized tomography (CT) pelvimetry as gold standard. MATERIALS AND METHODS: Three hundred and fifty three obstetric patients out of a sequential population of 6112 (5.8%) had CT pelvimetry performed between January 1990 and December 1991 at the Department of Obstetrics and Gynecology, York District Hospital, United Kingdom. Multivariable logistic regression models were built using maternal height (n = 322), shoe size (314) and weight at last clinic visit (n = 318). The reference standard for pelvic size was CT Pelvimetry. Pelvic adequacy was defined as an anterior-posterior diameter of the inlet of > or =11 cm and an anterior-posterior diameter of the outlet > or =10 cm on erect lateral CT pelvimetry. Women with values lower than these were regarded as having an inadequate pelvis. The diagnostic accuracy of the models was determined by the area under the receiver operating characteristic curve (AUC). RESULTS: The area under the curve (AUC) for maternal height (0.768) was not significantly greater than that for shoe size (0.686, p = 0.163 for the difference in AUC's) and weight at the last clinic visit (0.655, p = 0.057 for the difference in the AUCs). The change in the AUC for each of the models (the full model with height, shoe size and weight [0.769]; model for height and shoe size [0.767] model for just height [0.768]) was also not significantly different. CONCLUSIONS: Measurements of maternal height, shoe size and weight at the last clinic visit are not useful for the identification of women with inadequate pelvis.

Tamoxifen DNA damage detected in human endometrium using accelerator mass spectrometry.

This study was aimed to establish whether tamoxifen binds irreversibly to uterine DNA when given to women. Patients were given a single therapeutic dose of [(14)C]tamoxifen citrate orally (20 mg, 0.37 or 1.85 MBq) approximately 18 h prior to hysterectomy or breast surgery. Nonmalignant uterine tissue was separated into myometrium and endometrium. DNA and protein were isolated and bound radiolabel determined by the sensitive technique of accelerator mass spectrometry. Levels of irreversible DNA binding of tamoxifen in the endometrium of treated patients were 237 +/- 77 adducts/10(12) nucleotides (mean +/- SE, n = 10). In myometrial tissues, a similar extent of DNA binding was detected (492 +/- 112 adducts/10(12) nucleotides). Binding of tamoxifen to endometrial and myometrial proteins was 10 +/- 3 and 20 +/- 4 fmol/mg, respectively. In breast tissue, sufficient DNA could not be extracted but protein binding was an order of magnitude higher than that seen with endometrial proteins (358 +/- 81 fmol/mg). These results demonstrate that after oral administration, tamoxifen forms adducts in human uterine DNA but at low numbers relative to those previously reported in women after long-term tamoxifen treatment where levels, when detected, ranged from 15000 to 130000 adducts/10(12) nucleotides. Our findings support the hypothesis that the low level of DNA adducts in human uterus is unlikely to be involved with endometrial cancer development.