Safety aspects of hysteroscopy, specifically in relation to entry and specimen retrieval: a UK survey of practice.

BACKGROUND: The purpose of this study is to evaluate current practice amongst gynaecologists across the UK, regarding safety aspects of inpatient hysteroscopy under anaesthesia, specifically in relation to entry and specimen retrieval.A survey was created using survey monkey. The first round was circulated to all registrar trainees and consultant gynaecologists across Wales. Following a good response, the survey was then circulated to all members of the British Society of Gynaecological Endoscopy (BSGE). RESULTS: There were 212 responses including, 140 consultants, 36 senior registrars, 17 junior registrars and 18 clinical nurse specialists. In total, 136 out of 212 (64.7%) always perform a vaginal examination prior to hysteroscopy. 10.4% always sound the uterus, and 5.2% always dilate the uterus prior to insertion of the hysteroscope. Twenty-three consultants, six senior registrars, three junior registrars and one clinical nurse specialist knew how to position the internal cervical os as visualised through the scope when using a 30° hysteroscope. 35.8% of candidates always perform a post-procedure cavity check, and 9% use suction to flush the cavity to aid vision during the post-procedure cavity check. The majority (76%) predicted dilatation as the stage most likely to cause uterine perforation and predicted the most likely site for perforation as the posterior uterine wall in the anteverted uterus and the anterior uterine wall in the retroverted uterus. CONCLUSION: This study highlights varied practice across the UK regarding safety aspects of hysteroscopy, in relation to entry and specimen retrieval. There is a need for increased awareness of the risks of hysteroscopy and paramount precautions that should be performed routinely as part of their practice. Standardised guidelines may be a beneficial tool to help bring about this change in practice, leading to a reduction in uterine perforation rates.

Quality of life among women in Bangladesh following ileal conduit urinary diversion operations for irreparable vesicovaginal fistula and bladder exstrophy: observational study.

OBJECTIVE: To determine the quality of life (QOL) of fistula patients in Bangladesh who have undergone ileal conduit (IC) urinary diversion operations, and to assess whether the risks and ethical challenges involved, outweigh the reality of leaving a woman with urinary incontinence for the rest of her life. DESIGN: Observational study. SETTING: LAMB Hospital, Bangladesh. POPULATION: Seventeen women who had undergone IC between February 2012 and March 2016: 14 women previously had irreparable obstetric fistulas and three had bladder exstrophy. METHODS: Demographic, obstetric, IC-related, stigma and discrimination information were collected by questionnaire. Univariate analysis was done using the two-sided t-test for comparison of differences before and after IC surgery. MAIN OUTCOME METHODS: Change in stigma and discrimination scores. Health-related QOL assessed using the 36-item Short Form Health Survey. RESULTS: Of the 17 women, 14 (82.3%) felt they were cured of their fistula disease. Three complained of occasional leakage due to insufficient seal of the bag, mainly at night, and all but one experienced no limits to their daily activities. Stigma and discrimination scores were significantly lower after having the IC surgery. The mean difference from when the woman had a fistula to when she had an IC for stigma score was 3.17 (1.12-4.16, P < 0.001), and for discrimination score was 3 (1.9-4.1, P < 0.001). CONCLUSION: Overall, there has been improved QOL following IC among the women in this study and all would recommend IC to women in the same situation. They remain chronic patients with some physical symptoms, but are well re-integrated back into their communities. TWEETABLE ABSTRACT: Improved QOL following ileal conduit in women with persistent fistula related disorder in Bangladesh.

The dangers of the day of birth.

OBJECTIVE: To compare the risk of fetal death on the day of childbirth, with the risk of death at other ages, and with the risks of some hazardous activities, on a common scale of risk per day. DESIGN: Review of publicly available data. SETTING UK SAMPLE: Data extracted from the Office of National Statistics and other sources. METHODS: Data from the Office of National Statistics and other sources were used to calculate death rates at different ages expressed as rates per day of life. Death rates for different activities were also calculated as risks per day, or risks per activity, as appropriate. All risks were expressed in micromorts, the number of one in a million chances of dying. Figures on life expectancy (LE) were used to compare potential life years lost. MAIN OUTCOME MEASURES: Daily, or unit of activity, risk of dying for different activities compared with the risk of dying on the day of childbirth. RESULTS: The risk of dying on the day of birth (0.43 per 1000, or 430 micromorts) exceeds that of any other average day of life until the 92nd year. It is comparable with other apparently more dangerous activities, such as undergoing major surgery. For comparison, the average risk of non-natural death per day and the increased risk from smoking one cigarette or travelling 200 miles by car are all about 1 micromort. CONCLUSIONS: The lifetime risk of death in childbirth is low, but is concentrated in a short period, making being born a high-risk activity. Parents considering interventions to reduce these risks should be made aware of this.

Teenagers' knowledge of the acquired immunodeficiency syndrome and associated risk behaviors.

Adolescents are now recognized as being at high risk for contracting the human immunodeficiency virus (HIV), the presumed cause of acquired immunodeficiency syndrome (AIDS). This article reports the findings of a survey that examined AIDS knowledge, risk behaviors, and informational sources for AIDS in a group of suburban New Jersey high school students (N = 152). This group had knowledge of HIV and its transmission, but results indicated that students also participated in behaviors considered "risky" for the transmission of HIV. These behaviors included unprotected sexual intercourse (40% of sexually active males) and sexual intercourse with multiple partners over a period of time (23% of sexually active males).

WAIS profiles in mentally retarded adults.

The present study investigated WAIS indices of scatter in a sample of 83 mentally retarded adults (FIQ, means = 58). Overall subtest scatter was significantly correlated with VIQ, PIQ and FIQ. There was no significant relationship between the discrepancy score (absolute value of the difference between VIQ and PIQ), and VIQ, PIQ and FIQ. The scatter and discrepancy score means were surprisingly large. Analysis of VIQ and PIQ configuration revealed that VIQ greater than PIQ, and PIQ greater than VIQ occurred with nearly equal frequency.

Fibrin(ogen)olysis in polymyalgia rheumatica and temporal arteritis: preliminary findings on association with disease activity.

Postulating an increased production of fibrin(ogen)olytic degradation products (FDP) and an abnormality of fibrinogen metabolism in polymyalgia rheumatica (PMR) and temporal arteritis (TA), we studied 16 PMR/TA patients and 10 control subjects using a sensitive radioimmunoassay for a specific type of FDP, namely, fibrin(ogen)-related D-antigen. Median serum D-antigen levels were increased five-fold in those 11 PMR/TA patients who were untreated compared with control subjects. In the five PMR/TA patients who were treated with prednisone the median D-antigen levels were not significantly different from those of the healthy controls. D-antigen concentration correlated significantly (r = 0.83) with ESR in the seven untreated PMR patients. In PMR patients prednisone therapy was followed by a reduction of serum D-antigen levels.

Urea synthesis after protein feeding reflects hepatic mass in rats.

Urea synthesis is an exclusive biosynthetic function of the liver. Since the exact relationship between urea synthesis in vivo and functional liver mass remains unclear, we established an animal model using oral protein loading and measurement of resultant urea synthesis in rats. We studied rats subjected to sham operation, 40% hepatectomy, 66% hepatectomy, portacaval shunt and CCl4-induced cirrhosis. Urea synthesis was calculated as the sum of urinary urea excretion and accumulation of urea in body water during the 6-hr period after oral administration of a casein protein load equivalent to 20 gm per kg body weight. Peak urea synthesis rate in the sham-operated group of rats was 142 +/- 11 mumoles per hr per gm wet liver weight (mean +/- 1 S.D.), 473 +/- 34 mumoles per hr per gm liver protein and 80 +/- 5 mumoles per hr per mg liver DNA. This rate closely matched those of the other groups for each type of liver mass measurement. Marked reduction (p less than 0.01) of urea synthesis on a DNA basis was noted only in the CCl4-cirrhotic livers, related to the significantly higher (p less than 0.01) DNA content of the cirrhotic livers. Similarly, increased (p less than 0.05) liver protein content of the sham-operated rats when compared with the other groups was reflected in slightly lower urea synthesis rates expressed on the basis of liver protein (p less than 0.05) when compared to that of all other groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Race-associated differences in drinking behaviour.

An evaluation of the oral intake and the need for alternative therapy in aboriginal and white (European ancestry) children hospitalized for dehydration due to diarrhoea revealed significant differences in drinking behaviour. In a retrospective study of 120 children (36 aboriginal), the white children were far more likely to require an alternative mode of fluid administration (39 of 86 white versus 3 of 34 aboriginal). In a prospective study, although treated in the same manner by the same staff, during the first eight hours after admission white children had a mean oral intake of 2.9 ml/kg/hr (range 0.4-6.6, S.D. 1.6) whereas the aboriginal children had a mean oral intake of 6.1 ml/kg/hr (range 2.2-9.2, S.D. 2.1). The drinking behaviour of children varies with racial and/or cultural background. This should be considered in designing and administering rehydration solutions.

Long-term lithium carbonate therapy causes hyperparathyroidism.

Twelve patients taking lithium carbonate for two to 13 years were compared with age- and sex-matched controls to determine whether long-term lithium carbonate therapy is associated with alterations in calcium metabolism. As a group and individually, patients had significantly higher levels of serum total calcium, ionized calcium, and parathyroid hormone. When compared with serum calcium levels, patients' parathyroid hormone levels were significantly more likely than those of controls to indicate hyperparathyroidism. Lithium carbonate-induced mild hyperparathyroidism appears to be more common than had previously been suspected.

Sodium and water content of feedings for use in infants with diarrhea.

The sodium and water intakes of a group of infants treated for diarrhea and dehydration in 1972-73, when hypernatremia was common, and a group of infants treated for diarrhea and dehydration in 1978-79, when hypernatremia was rare, were compared. Infants from both study periods whose intake was poor and who received feedings containing sodium in concentrations greater than 17 mEq/liter were more likely to develop elevated serum sodium concentrations. In a group of infants recovering from diarrhea, the effect upon the serum concentration of sodium of varying water and sodium intake was studied. Those treated with small amounts of a solution containing 30 mEq sodium per liter regularly demonstrated an elevation of serum sodium, whereas those treated with large amounts of the same solution regularly demonstrated a depression. It is concluded that infants with diarrhea should receive feedings containing sodium in concentrations less than 17 mEq/liter unless a high fluid intake can be assured.

Pharmacokinetics of cefamandole in infants and children.

In infants less than 3 months of age, the serum concentration of cefamandole during therapy was higher and more prolonged than that in children older than 1 year. A dosage of 37 mg/kg administered intravenously at 6-h intervals provided a serum concentration in excess of the minimum inhibitory concentrations of common bacterial pathogens for 4 h, and in young infants for 5 h, after dosing.

A randomization test for comparison of groups of growth curves with different polynomial design matrices.

Well defined methods for comparing mean polynomial growth curves exist when subjects are measured at identical times, modeled with polynomials of identical degree and when multivariate normality of the measurements can be assumed. Relaxing these conditions creates problems solved here for the special case of a completely randomized design by developing a randomization test which is both practical and interval specific. The procedure is applied to longitudinal data from a study of human growth.