Simplifying the language of fetal monitoring.

BACKGROUND: Health professionals in Australia and New Zealand have used various intrapartum fetal surveillance (IFS) guidelines, with clear differences in how these guidelines present information. Based on clinician feedback, the 2015 Queensland Clinical Guideline on IFS structured the prose-based Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) IFS Guidelines as a traffic-light matrix and represented the categorical terms of unlikely, maybe, possible and likely fetal compromise, as the colours GREEN, BLUE, AMBER, and RED, respectively. AIMS: To determine whether the interpretation of the RANZCOG IFS Guidelines in Table Format is more accurate and quicker compared to the current presentation of the RANZCOG Guideline in prose format. MATERIALS AND METHOD: Twenty-nine clinicians, naïve to the use of the RANZCOG IFS Guidelines, interpreted ten cardiotocographs (CTGs) using one format and then the alternative format (totalling 580 CTG interpretations). Accuracy and time to decision were recorded as well as a participant questionnaire. A repeated measures analysis of variance was used to compare differences. RESULTS: Compared to prose format, clinicians interpreted CTGs quicker using the table format (P < 0.01), especially CTGs representative of unlikely and maybe fetal compromise. There was a trend toward more accurate interpretation for table format for all clinicians, with significance among medical officers (P = 0.02). Participants responded more favourably to the table format regarding questions about ease of use, determining actions required, and desire to use the system in the future (P < 0.01). CONCLUSIONS: Presenting the RANZCOG IFS Guideline in table format as opposed to prose format improved the speed and accuracy of CTG interpretation and is preferred by clinicians.

Investigation and management of an ovarian mass.

BACKGROUND: Ovarian masses are very common in pre- and postmenopausal women and are typically an incidental finding. OBJECTIVE: This article aims to provide a systematic approach to an ovarian mass for general practitioners including investigations, risk of ovarian cancer and referral considerations. DISCUSSION: Investigation for an ovarian mass includes both transvaginal and transabdominal ultrasound. Simple, anechoic cysts 200. Complications of ovarian cysts include cyst rupture and torsion. Torsion is a gynaecological emergency and requires urgent review.

Macroscopic haematuria--a urological approach.

BACKGROUND: Haematuria is a common symptom with a multitude of differentials. It can often be a diagnostic dilemma. OBJECTIVE: This article looks at the role of the general practitioner in the investigation and initial management of macroscopic haematuria. DISCUSSION: Common urological causes of haematuria include urinary tract infection and ureteric and renal stones, but concurrent pathology should be suspected if haematuria is significant or persistent. Importantly, if benign conditions are excluded, and the haematuria continues, further investigation is advised, as this may be the only sign of an underlying genitourinary malignancy. Recommended investigations for haematuria include computed tomography intravenous pyelogram, urine cytology, urine microscopy and culture and blood tests (full blood examination, renal function and, in men, prostate-specific antigen). Patients with risk factors for genitourinary malignancy, macroscopic haematuria or those in whom no cause is found, should be referred to a urological service for further investigation including cystoscopy. Acute urinary retention is a common acute presentation of macroscopic haematuria. This can be managed with continuous irrigation and rarely requires emergency surgical intervention.