Review: optical micrometer resolution scanning for non-invasive grading of precancer in the human uterine cervix.

Management of cervical precancer is archetypal for other cancer prevention programmes but has to consider diagnostic and logistic challenges. Numerous optical tools are emerging for non-destructive near real-time early diagnosis of precancerous lesions of the cervix. Non-destructive, real-time imaging modalities have reached pre-commercial status, but high resolution mapping tools are not yet introduced in clinical settings. The NCBI PubMed web page was searched using the keywords 'CIN diagnosis' and the combinations of 'cervix {confocal, optical coherence tomography, ftir, infrared, Raman, vibrational, spectroscopy}'. Suitable titles were identified and their relevant references followed. Challenges in precancer management are discussed. The following tools capable of non-destructive high resolution mapping in a clinical environment were selected: confocal microscopy, optical coherence tomography, IR spectroscopy, and Raman spectroscopy. Findings on the clinical performance of these techniques are put into context in order to assist the reader in judging the likely performance of these methods as diagnostic tools. Rationale for carrying out research under the prospect of the HPV vaccine is given.

Can an advanced nurse practitioner take on the role of senior house officer within a specialised area of practice: an evaluation.

This study looked at the impact of advanced nurse practitioners (ANPs) taking on the role of senior house officer (SHO) within obstetrics and gynaecology. It was anticipated that such a change would have benefits for patients and for service delivery. The project took place in the gynaecology department of a district general hospital. All patients who would normally be under the care of the SHOs with one medical team received this care from one or other of two ANPs. Focus groups were used to look at the impact of the changes on other staff within the unit. Patient questionnaires were used to assess the opinions of patients about the care they received. Length of stay, readmissions and cancellations were used to assess the impact on patient care. The change in role of the ANPs has had lasting benefits in terms of better communication and multidisciplinary working and the development of an informal referral system that allowed patients to be seen more quickly and appropriately. There were no ill effects on patient care.

Influence of early discharge after hysterectomy on patient outcome and GP workloads.

This paper examines the impact of early discharge following hysterectomy on patient outcome and GP workload. Results are presented from a survey of patient attitudes on care and recovery, pain relief and contacts overall with their general practitioner (GP) surgery. The findings are compared with those of a previous study where a policy of early discharge had been shown to increase GP workloads. The paper discusses the importance of preparing patients adequately for their surgery and postoperative recovery, and highlights the beneficial effects on patient attitudes of the introduction of patient information leaflets, a preadmission clinic and a telephone advice service following discharge.

Current practice for induction of labour in the United Kingdom: time for a review?

This paper presents the results of postal survey of protocols for induction of labour. The drug regimes used for the induction of labour in NHS hospitals in England and Wales have been compared to both RCOG guidelines and to the drug manufacturer's recommendations. A wide variation in practice was found, with many units using dosages that are different from those recommended. The implications of such departures from the norm are discussed in terms of the importance of evidence-based practice and the role of national guidelines in ensuring optimum care.

Outpatient endometrial assessment.

Over the past 10 years, outpatient endometrial assessment has largely replaced traditional dilatation and curettage, offering a quick, reliable and cost-effective alternative which avoids the need for general anaesthesia. The techniques available and their scope are discussed in detail.

Efficacy and safety of large-loop excision of the transformation zone.

Large-loop excision of the transformation zone (LLETZ) has become a popular treatment for women with cervical intraepithelial neoplasia (CIN) before long-term effectiveness and safety have been fully evaluated. Women who took part in a 1990 study of the procedure have been followed-up by cervical cytology for longer than 2 years. The rate of recurrences and residual lesions was 5.0% in the first year and 0.6% in the second year. LLETZ was also effective when used as a repeat procedure, although the negative histology rate was much higher (4.7% for initial procedures and 20% for repeat procedures). 250 women from the original study group of 1000 answered a questionnaire on fertility and menstrual symptoms 3 years after LLETZ. We found no differences between these women and controls of the same age, living in the same geographical area, with a history of negative cervical smears. LLETZ is a safe and effective procedure with no effect on menstruation or fertility.

Induction of labour with prostaglandin gel in patients with unfavourable cervices.

151 primigravid patients with Bishop scores of 4 or less were induced with prostaglandin E2 gel using an initial dose of 2 mg followed by 1 mg or 2 mg at 6 hours. Eighty one patients (53.6 per cent) were in established labour or had delivered by 12 hours, and a further 31 (20.5 per cent) had achieved successful ripening of the cervix. Ninety per cent and 64.5 per cent respectively achieved vaginal delivery and although 39 patients failed to respond to this regime, 72 per cent delivered vaginally after augmentation. No case of hypertonus was recorded and only one patient had abdominal delivery for "failed induction". This regime provides an effective means of induction of labour for a difficult group of patients with little worry of overstimulation and low "failed induction" rates.

Management of women referred to early pregnancy assessment unit: care and cost effectiveness.

OBJECTIVE: To assess the efficiency of an early pregnancy assessment unit in the care of women with bleeding or pain in early pregnancy. DESIGN: Analysis of women attending in the first year of the unit's operation and in the six months immediately before its introduction. SETTING: Early pregnancy assessment unit in a district general hospital serving a population of 310,000. PATIENTS: 1141 women referred with bleeding or pain in early pregnancy. MAIN OUTCOME MEASURES: Length of stay in hospital required for diagnosis and treatment. RESULTS: Before the unit was established the mean admission time was one and a half (range half to three) days for women who required no treatment and three (one and a half to five) days in women requiring evacuation of uterus. These times were reduced to two hours as an outpatient and one day respectively for most women after the unit was established. Between 318 and 505 women were estimated to have been saved from unnecessary admission, and 233 had their stay reduced; the associated saving was between pounds 95,000 and pounds 120,000 in one year. CONCLUSIONS: The early pregnancy assessment unit improved the quality of care and also produced considerable savings in financial and staff resources.

Induction of labour in the presence of ruptured membranes with prostaglandin E2 gel.

The study shows the safety and the efficacy of labour induction with prostaglandin E2 gel. By combining an initially conservative approach with later induction by PGE2 a vaginal delivery rate of 96.8% was achieved.