Surgical instrument wrap: a pilot recycling initiative.

BACKGROUND: Seven per cent of general waste and 20% of healthcare risk waste produced in acute hospitals in Ireland comes from operating theatres. Surgical wrap comprises 11% of operating theatre waste. AIMS: The primary aim of this study was to pilot the implementation of a recycling initiative for surgical instrument set wrap in an operating theatre in Ireland. Secondary aims included quantification of the surgical wrap diverted from general waste to recycling streams over a 5-week period and estimation of the annual carbon emissions associated with gynaecology surgical wrap use in Cork. METHODS: The amount of polypropylene surgical wrap generated by a single gynaecology theatre at Cork University Maternity Hospital was prospectively quantified from 24/1/22 to 1/3/22. At the end of the study period, individual sheets of polypropylene wrap were counted and dimensions were measured to calculate the total surface area of surgical wrap saved for recycling. RESULTS: A total of 66 surgeries were performed over the 5-week study period. Two hundred twenty-one individual sheets of surgical wrap were collected, equating to 282.1 m2 of polypropylene wrap. An estimated 11,564 m2 of surgical wrap could be recycled annually from the gynaecology theatre service in Cork with an associated annual carbon emissions equivalent of at least 2.2 tonnes of CO2. CONCLUSION: Diversion of surgical wrap from general waste and clinical waste streams to the recycling stream is achievable in every operating theatre. Small changes to operating theatre waste disposal practices have the potential to yield significant reductions to theatre waste outputs and to hospital carbon emissions.

Does membrane sweep work? Assessing obstetric outcomes and patient perception of cervical membrane sweeping at term in an Irish obstetric population: a prospective multi-centre cohort study.

BACKGROUND: Cervical membrane sweep is a mechanical method of cervical ripening at term gestation with the aim of avoiding prolonged pregnancy and reducing the need for labour induction for this indication. There is no published data on obstetric outcomes following membrane sweep in an Irish obstetric population or any studies on patient perception/recommendation of membrane sweep in the international literature. AIMS: This study is aimed at determining if cervical membrane sweep at term has an effect on duration of pregnancy and delivery outcome in an Irish population. Postnatally, patient perception of the experience of membrane sweep was evaluated as well as their recommendation of the procedure for other women. METHODS: A prospective multi-centre cohort study of women who had cervical membrane sweep at term was carried out which assesses labour and delivery outcomes as well as patient perceptions in women undergoing membrane sweep. RESULTS: Spontaneous labour occurred in 79% of women following membrane sweep. A quarter of nulliparae (25%) and 18% of multipara had labour induction despite membrane sweep. Three quarters of both nulliparae (73%) and multipara (76%) delivered within 7 days of membrane sweep. In the presence of a Bishop score greater than six, the rate of spontaneous labour was 97% in our patient cohort. Nine in ten women (91%) had previously heard of cervical membrane sweep. Two in three women (65%) thought that membrane sweep helped them to labour, and over 80% would recommend it to other pregnant women despite 63% of women reporting moderate discomfort with the procedure. CONCLUSIONS: Cervical membrane sweep is associated with spontaneous onset of labour within 7 days in the majority of patients, more so in the presence of higher Bishop score and better quality sweep. It has a high level of acceptability among patients and is highly recommended by them to other patients. The need for more than one membrane sweep is associated with less likelihood of spontaneous onset of labour.

Ultrasound assessment of uterine morphology in menorrhagia: case control study.

This was a prospective study to evaluate transvaginal ultrasound measurements in investigating patients with menorrhagia through detailed morphological assessment of the uterus and ovaries by comparing the study group with menorrhagia with a control group with no previous history of menorrhagia. 92 women participated in the study of whom 46 had a history of menorrhagia and 46 were control cases. Mean age of participants was 34.6 years with mean BMI of 27.2. Uterine volume was significantly larger in the index group (p = .024) having reduced uterine mobility (p = .002). 36% of women with menorrhagia were found to have vascular flow within the inner half of the myometrium (p = .002). Women in the study group documented higher pain score both during menstruation and during transvaginal examination compared with controls (p = .008). Uterine fibroids were found in 15% of women with menorrhagia, not significantly more frequently than women without menorrhagia (8.7%) (p = .33).Impact statementWhat is already known on this subject? Transvaginal ultrasound is the non-invasive diagnostic tool of choice in evaluating uterine morphology for menorrhagia in the recognition of the subtle myometrial changes of adenomyosis, fibroids and polyps.What do the results of this study add? Reduced mobility of the uterus against the rectum was more frequent in the study group suggesting the presence of adhesions between the uterus and rectum most likely due to history of endometriosis. Women with menorrhagia had a higher pain score experienced during transvaginal ultrasound as a result of a retroverted and less mobile uterus, hence the movement of the probe against structures which are adherent to each other can cause discomfort during the scan.What are the implications of these findings for clinical practice and/or further research? This study was performed in the hope that the findings obtained will help medical practitioners to provide more accurate information to patients regarding the cause of their menorrhagia, as well as potentially tailoring more specific treatments for menorrhagia based on their ultrasound findings.

Developing a clinical management tool to evaluate quality.

Peer review is used increasingly in the NHS as a form of evaluation between professionals, services and organisations, and as a way of offering participants a snapshot assessment of particular health services or at points in a clinical pathway. The model outlined in this article has been developed as an aide-memoire to clinical commissioning groups, provider organisations and clinical staff for the process of gathering evidence of good assurance and governance arrangements.

Encouraging workplace innovation using 'World Cafe' model.

To ensure that community health services are as good as they can be, professional leaders in Bassetlaw, Nottinghamshire, decided to engage staff using a method attributed to the World Café movement. The adopted model gives staff an opportunity to influence the development of services, and focuses on six areas: end of life care; health and wellbeing and reducing inequalities; children, young people and families; rehabilitation; acute care closer to home; and long-term conditions. Staff have appreciated being involved and there is now an action plan for each service area to continue its improvement.

Treatment of endometrial stromal sarcoma with a gonadotropin-releasing hormone analogue.

BACKGROUND: Endometrial stromal sarcoma can present management difficulties due to its lack of response to conventional chemotherapy and radiotherapy. Various hormonal therapies have been shown to reduce tumor volume in both primary and recurrent disease. CASE: A woman who underwent myomectomy was discovered to have a low-grade endometrial stromal sarcoma. Treatment with the gonadotropin-releasing hormone (GnRH) analogue triptorelin before surgery had produced reduction in uterine size. The woman developed tumor recurrence six months after definitive surgical treatment. The tumor enlarged rapidly during a 2-month period, with development of a right-sided hydronephrosis. Repeat administration of triptorelin was accompanied by resolution of the hydronephrosis and reduction in tumor volume. Biopsy results confirmed recurrent low-grade endometrial stromal sarcoma with moderate estrogen and progesterone receptor positivity. CONCLUSION: Control of progression of a recurrent endometrial stromal sarcoma was achieved with the GnRH analogue triptorelin. This is the first report in the English-language literature during a 30-year period of single-agent GnRH analogue being an effective treatment intervention in this context.

Does surgical staging of clinical Stage I endometrial carcinoma significantly alter adjuvant management?

Full surgical staging for endometrial cancer has been advocated since 1988, when FIGO redefined stage of disease on the basis of surgico-pathological criteria. However, such extensive surgery, performed on often elderly women, must counterbalance any increased morbidity against the potential gains of altered subsequent management. We report a 2-year review of 22 patients undergoing full surgical staging for Stage I endometrial cancer. Nine women (41%) had altered adjuvant treatment as a result. In seven patients, decisions regarding postoperative radiotherapy treatment were influenced and two women had an unsuspected ovarian tumour. Postoperative complications were minor, apart from one wound dehiscence. There were no perioperative deaths and no blood transfusions. Surgical staging was found to be a safe intervention with a significant impact on adjuvant management.