Perineal body length as a risk factor for ultrasound-diagnosed anal sphincter tear at first delivery.

INTRODUCTION AND HYPOTHESIS: Shortened perineal body (PB) is associated with an increased risk of ultrasound-detected obstetric anal sphincter tear. The objective was to determine if shortened perineal body length (<3 cm) is a risk factor for ultrasound-detected anal sphincter tear at first delivery. METHODS: Pregnant nulliparous women were recruited over 18 months. At 35-37 weeks' gestation and 6 weeks' postpartum perineal body length (PB) was measured and subjects completed quality of life questionnaires. Primary outcome was ultrasound-diagnosed anal sphincter tear at 6 weeks postpartum. Secondary outcomes were also assessed. A priori power analysis determined that 70 subjects were needed to detect a difference in anal sphincter tear based on a PB cut-off of 3 cm. RESULTS: Seventy-three subjects completed the study. Mode of delivery was 69.9% spontaneous vaginal, 15.1% operative vaginal, and 15.1% labored cesarean. There were 25 anal sphincter abnormalities (34.2%) seen on ultrasound: 11 (15.1%) internal or external sphincter tears, 3 (4.1%) internal sphincter atrophy, 6 (8.2%) external sphincter thinning, and 7 (9.6%) external sphincter scarring. Only the 11 sphincter tears qualified as abnormal for the primary outcome. In the vaginal delivery group 16.4% (10 out of 61) had a sphincter tear, compared with 8.3% (1 out of 12) in the labored cesarean group (p = 0.68). Women with PB < 3 had a significantly higher rate of ultrasound-diagnosed anal sphincter tear (40.0% vs 11.1%, p = 0.038). When comparing women with and without sphincter tear, there was a significant difference in mean antepartum PB (3.1 vs 3.7 cm, p = 0.043). CONCLUSIONS: A shortened perineal body length in primiparous women is associated with an increased risk of anal sphincter tear at the time of first delivery.

Hospice patients' and nurses' perceptions of self-care deficits based on symptom experience.

Although the relief and/or control of physically, emotionally, and spiritually distressing symptoms are the hallmarks of hospice care, accurate assessment of the individual's unique and often rapidly changing symptom experience is lacking. The purpose of this descriptive, correlational study was to assess and quantify hospice patients' perceptions of their symptom experiences and those of the hospice nurse assessing them. A convenience sample of 53 hospice patients (32 males, 21 females), with a mean age of 69 years, from a large midwestern home-based hospice completed the Adapted Symptom Distress Scale Form 2 (ASDS-2) at admission, and at 2 and 4 weeks after admission. The Hospice Admission Intake was completed at admission. Individual hospice nurses completed the ASDS-2 within 24 hours of their hands-on assessment, in addition to the demographic characteristics profile. Findings indicated an improvement in symptom experience, distress, and occurrence scores from admission to week 2, and in the symptom experience and distress scores from admission to week 4. Hospice nurses tended to give higher symptom experience scores than the patients gave to themselves. These findings demonstrate the importance of obtaining information about symptom experience from the patient as well as the nurse.

The use of antidepressant drugs in general practice. A questionnaire survey.

The aim of this study was to examine the anti-depressant drug prescribing preferences and habits of a population of general practitioners. The method used was that of a questionnaire survey, including case vignettes. The response rate exceeded 70% Data are presented out-lining the attitudes of the respondents to the use of antidepressant drugs in the management of common psychiatric presentations in the primary care setting. The majority of general practitioners (G.P.'s) had received little or no post-graduate education in psychiatry. The antidepressants most frequently prescribed were amitriptyline, clomipramine, trazodone and lofepramine. Despite recognition of the alarming frequency of serious self-poisoning incidents with some of these compounds, 26% of respondents confessed to an inability to make an informed choice of antidepressant drug, with 14% using the same drug with every patient with no attempt to select according to individual patient requirements. The management of depressive neurosis generates considerable clinical confusion with a variety of interventions favoured. The use of a sedating antidepressant is popular. There is greater accord for the management of endogenomorphic depression. The use of the benzodiazepine drugs in the management of anxiety disorders is infrequent, with appropriate recognition of the merits of behavioural approaches. However, the role for antidepressant drugs in the management of anxiety disorders is under-recognized. We conclude that general practitioners are required to undertake a significant body of work for which they may be inadequately trained.

Oral clonidine loading in hypertensive urgencies.

The response to oral clonidine hydrochloride loading in 36 severely hypertensive patients is presented. Each patient initially received 0.2 mg of clonidine hydrochloride, followed by 0.1 mg each hour until a dose of 0.7 mg had been given, or the diastolic blood pressure (BP) reached a predetermined goal (110 mm Hg or total fall of at least 20 mm Hg). Only two patients (6%) failed to reach this goal. Supine BP in the group fell from 212 +/- 22 (SD)/139 +/- 11 (SD) mm Hg to 151 +/- 21 (SD) mm Hg at six hours. The average dose of clonidine required was 0.45 mg and control was maximized at five hours. The response to oral clonidine loading in the individual patient was not predictive of the eventual dose of clonidine necessary to achieve acceptable BP control at two weeks. Oral clonidine loading is safe and effective in the management of "hypertensive urgencies" and offers several advantages over parenteral antihypertensive agents in this clinical situation.

External form and internal anatomy of Holsteins and Jerseys.

Body weights, external dimensions, and postmortem measures of internal body dimensions or weights of organs and glands of Holsteins and Jerseys were used to establish norms, interrelationships of traits, and effects of sire and inbreeding on changes in external form. Sires differed in nearly all measures of external body form. Sire effects increased with advancing age whereas effects of inbreeding (greater than 12.5, 3.0 to 12.4, or less than 3.0% of inbreeding) declined. Skeletal dimensions were smallest in the greater than 12.5% inbred group. Differences due to inbreeding were largest at 3 and 6 mo of age and in first lactation. Body heights and head dimensions were nearer to mature size at 3 and 6 mo than other measures. In both breeds, most rapid development was between 3 and 6 mo, but Jersey matured 1 to 2% faster. Age (2 to 3, 4 to 5, 6 to 10, greater than 10 yr) was significant for most postmortem measurements. Correlations among measures of external form were .30 to .93. Correlations between external form and internal features or between internal dimensions and organs were lower. External and internal features were positively correlated, but few external features showed strong enough association with internal features for use as predictors of size of organs, glands, or digestive capacity.