Complexities of midwifery care delivered to perinatal women in prison: A qualitative study.

PURPOSE: To provide insight into the challenges faced by imprisoned perinatal women in accessing appropriate information, support, and care and the importance of the midwife's role in this context. METHOD: This paper draws on two studies conducted in one United Kingdom (UK) women's prison over two separate time points (2019, 2021). In both qualitative evaluative studies that were descriptive in nature, semi-structured interviews were conducted with perinatal women and professionals involved in their care. PARTICIPANTS: 17 women participated across the two qualitative studies, six were pregnant, nine were on the Mother and Baby Unit (MBU) and two had given birth in the last 12 months but were not on the MBU. 12 professionals participated across the two studies. RESULTS: The studies highlight the specific challenges that perinatal women in prison face compared to their community counterparts in being able to access reliable information on pregnancy, birth, and parenting; having access to appropriate and reliable peer support and mental health support not only in terms of provision but also in terms of accessibility; and in being able to advocate for themselves or having people that can advocate for them. CONCLUSION: These challenges arguably heighten the importance of, as well as the pressure on the midwife in this context. The authors therefore highlight the need for consideration of three factors for midwifery in this context: (1) Resourcing (2) Information provision to, and information sharing between, midwives to increase awareness of challenges faced by this cohort, and (3) Strengthening the midwife's position to support and advocate for women's perinatal mental health in prison.

Gender-inclusive language in midwifery and perinatal services: A guide and argument for justice.

Effective communication in relation to pregnancy and birth is crucial to quality care. A recent focus in reproductive healthcare on "sexed language" reflects an ideology of unchangeable sex binary and fear of erasure, from both cisgender women and the profession of midwifery. In this paper, we highlight how privileging sexed language causes harm to all who birth-including pregnant trans, gender diverse, and non-binary people-and is, therefore, unethical and incompatible with the principles of midwifery. We show how this argument, which conflates midwifery with essentialist thinking, is unstable, and perpetuates and misappropriates midwifery's marginalized status. We also explore how sex and gender essentialism can be understood as colonialist, heteropatriarchal, and universalist, and therefore, reinforcing of these harmful principles. Midwifery has both the opportunity and duty to uphold reproductive justice. Midwifery can be a leader in the decolonization of childbirth and in defending the rights of all childbearing people, the majority of whom are cisgender women. As the systemwide use of inclusive language is central to this commitment, we offer guidance in relation to how inclusive language in perinatal and midwifery services may be realized.

The experiences of black and minority ethnic nurses working in the UK.

Evidence suggests that black and minority ethnic (BME) midwives are more likely to face fitness to practise hearings than white registrants and BME NHS staff are less likely to be in senior positions. This literature review critically evaluates the literature published since a systematic review on the topic was conducted in 2005. It found that BME nurses and midwives, especially those who registered abroad and subsequently came to live and work in the UK are 'underemployed' and consequently expressed feelings of loss of self-confidence. This was further compounded by accounts of excessive scrutiny and punishment. Many felt excluded from white networks of power and opportunities for staff development and promotion. The literature also describes experiences of covert as well as overt racism between the white majority and BME staff as well as 'horizontal racism' between BME staff of differing ethnicities.

Why won't Polish women birth at home?

Polish women living in the United Kingdom (UK) are statistically more likely to have normal births than their British counterparts, yet anecdotally, do not choose to birth their babies at home. A medicalised approach to birth in their country of origin means women are unaware of the benefits of midwifery-led care, which they often perceive as sub-standard. Affordable travel means Polish women can access care in both countries and compounds the difficulties in acclimatising to UK maternity services. Online discussion groups and Internet forums represent an opportunity for midwives to engage with women to promote their services. This is increasingly important with rising numbers of both Polish migrants to the UK and Polish residents applying for British citizenship.

Helium-oxygen therapy for infants with bronchiolitis: a randomized controlled trial.

OBJECTIVE: To compare nebulized racemic epinephrine delivered by 70% helium and 30% oxygen or 100% oxygen followed by helium-oxygen inhalation therapy via high-flow nasal cannula (HFNC) vs oxygen inhalation via HFNC in the treatment of bronchiolitis. DESIGN: Prospective, randomized, controlled, single-blind trial. SETTING: This study was conducted from October 1, 2004, through May 31, 2008, in the emergency department of an urban, tertiary care children's hospital. Patients Infants aged 2 to 12 months with a Modified Wood's Clinical Asthma Score (M-WCAS) of 3 or higher. INTERVENTIONS: Patients initially received nebulized albuterol treatment driven by 100% oxygen. Patients were randomized to the helium-oxygen or oxygen group and received nebulized racemic epinephrine via a face mask. After nebulization, humidified helium-oxygen or oxygen was delivered by HFNC. After 60 minutes of inhalation therapy, patients with an M-WCAS of 2 or higher received a second delivery of nebulized racemic epinephrine followed by helium-oxygen or oxygen delivered by HFNC. Main Outcome Measure Degree of improvement of M-WCAS for 240 minutes or until emergency department discharge. RESULTS: Of 69 infants enrolled, 34 were randomized to the helium-oxygen group and 35 to the oxygen group. The mean change in M-WCAS from baseline to 240 minutes or emergency department discharge was 1.84 for the helium-oxygen group compared with 0.31 for the oxygen group (P < .001). The mean M-WCAS was significantly improved for the helium-oxygen group compared with the oxygen group at 60 minutes (P = .005), 120 minutes (P < .001), 180 minutes (P < .001), and 240 minutes (P < .001). CONCLUSION: Nebulized racemic epinephrine delivered by helium-oxygen followed by helium-oxygen inhalation therapy delivered by HFNC was associated with a greater degree of clinical improvement compared with that delivered by oxygen among infants with bronchiolitis. Trial Registration clinicaltrials.gov Identifier: NCT00116584.

Utility of serial urinary cytology in the initial evaluation of the patient with microscopic hematuria.

BACKGROUND: We determine the utility of serial urinary cytologies in patients presenting with microscopic hematuria who were evaluated with upper and lower urinary tract studies to rule out a malignancy. METHODS: Two hundred and thirty-seven patients with the diagnosis of microscopic hematuria were evaluated at an inner-city tertiary care hospital. Of these 239 patients, 182 patients had 405 cytologies obtained as part of their evaluation for hematuria. In addition, all patients had their lower urinary tract and upper tract thoroughly evaluated. RESULTS: Two hundred and seventy four cytology samples were read as normal, 104 (26%) as atypia, 7 (2%) as suspicious/malignant, and 20 (5%) as unsatisfactory. Seventeen patients (9.3%) had biopsy confirmed bladder cancer. Of these 17 patients, 2 had normal cytology, 11 had atypia, and 5 had suspicious/malignant. No patient had a positive cytology and a negative biopsy. Overall the number of hematuric patients harboring bladder cancer was small (7%). Cytology #1 detected 4 cases of cancer, cytology #2 detected an additional case and cytology #3 did not detect any additional cancers. CONCLUSION: Because of this low prevalence of bladder cancer in patients presenting with microscopic hematuria and the low sensitivity of detecting bladder cancers, the utility of urinary cytology in the initial evaluation of patients with hematuria may be minimal. The exact role of urinary cytology in the evaluation of hematuria is unknown.

Prostate cancer knowledge and screening attitudes of inner-city men.

BACKGROUND: We hypothesized that inner-city men are less knowledgeable about prostate health. METHODS: The prostate cancer knowledge and screening attitudes of 100 inner-city men (median age 62 +/- 11 years) seen at a urology clinic were assessed through a 30-item questionnaire administered before and after an educational intervention. RESULTS: Overall, intervention led to significantly better mean knowledge scores (47% before vs 80% after; P < .0001) but did not affect mean screening attitude scores. CONCLUSIONS: Although educational interventions might improve prostate cancer knowledge and screening rates among inner-city men, other approaches must also be considered.

Knowledge and attitudes of primary care physicians regarding prostate cancer screening.

INTRODUCTION: We report the results of a questionnaire administered to primary care physicians to determine their baseline knowledge of prostate cancer and their attitudes on prostate cancer screening. MATERIALS AND METHODS: A 27-item questionnaire designed to assess prostate cancer knowledge and screening attitudes was administered to primary care physicians in Duval and Alachua counties. Completed surveys were returned, entered into the master database and analyzed. RESULTS: Mean initial knowledge score was 66%. In multivariate regression analysis, there were no covariates independently associated with knowledge scores. In multivariate regression analysis, there were no covariates independently associated with attitude scores. Lastly, knowledge scores were not associated with attitude scores (p=0.85). CONCLUSIONS: Our findings imply that physicians' knowledge is not an important predictor of their screening behavior. Thus, this study raises the possibility that factors other than educational programs must be assessed as a means to increase screening in specific communities.

Phase II trial of isoflavone in prostate-specific antigen recurrent prostate cancer after previous local therapy.

BACKGROUND: Data exist that demonstrate isoflavones' potent antiproliferative effects on prostate cancer cells. We evaluated the efficacy of isoflavone in patients with PSA recurrent prostate cancer after prior therapy. We postulated that isoflavone therapy would slow the rate of rise of serum PSA. METHODS: Twenty patients with rising PSA after prior local therapy were enrolled in this open-labeled, Phase II, nonrandomized trial (Trial registration # NCT00596895). Patients were treated with soy milk containing 47 mg of isoflavonoid per 8 oz serving three times per day for 12 months. Serum PSA, testosterone, lipids, isoflavone levels (genistein, daidzein, and equol), and quality of life (QOL) were measured at various time points from 0 to 12 months. PSA outcome was evaluated. RESULTS: Within the mixed regression model, it was estimated that PSA had increased 56% per year before study entry and only increased 20% per year for the 12-month study period (p = 0.05). Specifically, the slope of PSA after study entry was significantly lower than that before study entry in 6 patients and the slope of PSA after study entry was significantly higher than before study entry in 2 patients. For the remaining 12 patients, the change in slope was statistically insignificant. Nearly two thirds of the patients were noted to have significant levels of free equol in their serum while on therapy. CONCLUSION: Dietary intervention with isoflavone supplementation may have biologic activity in men with biochemical recurrent prostate cancer as shown by a decline in the slope of PSA. This study may lend support to the literature that nutritional supplements have biologic activity in prostate cancer and therefore, further studies with these agents in randomized clinical trials should be encouraged.

The feasibility of expectant management with inner-city men with newly diagnosed localized prostate cancer.

OBJECTIVE: To determine the compliance rate for treatment recommendations consistent with expectant management of inner-city men with prostate cancer. METHODS: Twenty-seven out of 560 men who underwent biopsy of the prostate were found to harbor cancer and opted for expectant management. Clinic and hospital records were reviewed for adherence to follow-up schema. RESULTS: Of the 27 men on expectant management, 22 men (82%) adhered to strict follow-up schema. At 6-month follow-up, there were no significant changes in clinicopathologic features (e.g., prostate specific antigen (PSA), Gleason score, and stage). With a median follow-up of 12 months, only 2 men demonstrated a rise of more than 30% from baseline PSA (repeat biopsy demonstrated persistent low grade, low stage disease). CONCLUSIONS: Our findings imply that expectant management may be feasible in inner-city settings. Thus, in subsequent expectant management trials, inner-city men should be actively recruited.

Positive surgical margins at radical prostatectomy: importance of intra-operative bladder neck frozen sections

OBJECTIVE: To determine if intraoperative frozen sections of the bladder neck during radical prostatectomy (RP) could decrease the incidence of final positive surgical margins at the bladder neck. MATERIALS AND METHODS: This prospective cohort study included 51 consecutive men who underwent anatomic RP at University of Florida & Shands Jacksonville. All patients had intraoperative frozen section of bladder neck sent for analysis. Preoperative, operative, and postoperative data were collected and analyzed. Main Outcome Measures: Outcome measures were intraoperative bladder neck margin status, final pathologic bladder neck margin status, and postoperative urinary complications. Median follow-up for the 51 patients was 22 months. RESULTS: The final positive surgical margin rate was 20 percent (10 patients). An additional three patients had positive surgical margins at the bladder neck intraoperatively. These patients then had a wider resection of the affected bladder neck until the frozen sections were negative for cancer or prostatic tissue. Final pathologic evaluation of bladder neck margin was negative for tumor or persistent prostatic tissue in all 51 men. CONCLUSION: With intra-operative frozen sections, we were able to obtain a negligible positive bladder neck margin rate. Surgeons who are still on the learning curve for RP should consider intra-operative frozen section of the bladder neck.

Outcomes of men who present with elevated serum PSA (>20 ng/mL) to an inner-city hospital.

INTRODUCTION: We report the incidence, clinicopathologic features, and outcomes of men who presented to an inner-city hospital with serum PSA >20 ng/ml. MATERIALS AND METHODS: Five-hundred-sixty men underwent a transrectal ultrasound needle-guided biopsy of the prostate for elevated PSA >4 ng/ml with or without an abnormal digital rectal examination. RESULTS: Of the 560 men, 65 (12%) were found to have a serum PSA >20 ng/ml, and 57 (10%) were diagnosed with prostate cancer. In the group of 57 men with cancer, the positive predictive value of PSA alone was 72% for PSA levels of 20-29.99 ng/ml and 100% for PSA >30 ng/ml. Of the 57 men, 18 underwent definitive therapy, 24 underwent androgen deprivation, 8 refused treatment or were lost to follow-up, and 7 were treated on protocol. An additional seven men with cancer refused therapy or were lost to follow-up, thus giving a total of 15 (26%) men who were noncompliant to medical advice. CONCLUSIONS: Serum PSA >30 ng/ml is an almost certain predictor of the presence of prostate cancer. Aggressive prostate cancer education and screening programs are needed in our inner cities in order to detect prostate cancer at an earlier, treatable stage.

The use of enoxaparin to prevent venous thromboembolism in patients undergoing radical retropubic prostatectomy: feasibility and utility.

OBJECTIVE: To assess the utility of enoxaparin in prevention of venous thromboembolism (VTE) in men poorly compliant with pneumatic compression stockings (PCS) in the immediate postoperative period after a radical retropubic prostatectomy (RP). MATERIALS AND METHODS: This retrospective study included 47 men who underwent RP at an inner-city tertiary care hospital. All patients were started on enoxaparin 40 mg subcutaneously 6-8 hours postoperatively and daily while hospitalized. Preoperative, operative, and postoperative data were collected and analyzed. Median follow-up was 18 months. RESULTS: Median patient age was 64 +/- 7 years, median prostate-specific antigen level was 4.9 ng/mL and median prostate biopsy-determined Gleason score was 6. Forty-one men (87%) underwent a pelvic lymph node dissection. Median operative time was 181 minutes (range 164-450 minutes). Median estimated blood loss was 700 mL. Approximately 36% of the men wore PCS the recommended > 19 hours/day. On average PCS were worn 10.3 +/- 7.5 hours/day. Postoperative complications were not increased in this cohort. Two patients developed pulmonary embolism requiring long-term anticoagulation. There were no mortalities. CONCLUSIONS: In men non-compliant with PCS, initiation of enoxaparin in the immediate postoperative setting was well-tolerated and maintained a low (4%) rate of VTE. Thus, enoxaparin may be useful in adjunct with PCS in these patients.

The use of enoxaparin to prevent venous thromboembolism in patients undergoing radical retropubic prostatectomy: feasibility and utility

OBJECTIVE: To assess the utility of enoxaparin in prevention of venous thromboembolism (VTE) in men poorly compliant with pneumatic compression stockings (PCS) in the immediate postoperative period after a radical retropubic prostatectomy (RP). MATERIALS AND METHODS: This retrospective study included 47 men who underwent RP at an inner-city tertiary care hospital. All patients were started on enoxaparin 40 mg subcutaneously 6-8 hours postoperatively and daily while hospitalized. Preoperative, operative, and postoperative data were collected and analyzed. Median follow-up was 18 months. RESULTS: Median patient age was 64 ± 7 years, median prostate-specific antigen level was 4.9 ng/mL and median prostate biopsy-determined Gleason score was 6. Forty-one men (87 percent) underwent a pelvic lymph node dissection. Median operative time was 181 minutes (range 164-450 minutes). Median estimated blood loss was 700 mL. Approximately 36 percent of the men wore PCS the recommended > 19 hours/day. On average PCS were worn 10.3 ± 7.5 hours/day. Postoperative complications were not increased in this cohort. Two patients developed pulmonary embolism requiring long-term anticoagulation. There were no mortalities. CONCLUSIONS: In men non-compliant with PCS, initiation of enoxaparin in the immediate postoperative setting was well-tolerated and maintained a low (4 percent) rate of VTE. Thus, enoxaparin may be useful in adjunct with PCS in these patients.

Neoadjuvant therapy before radical prostatectomy: where have we been? Where are we going?

Prostate cancer is curable only when treated at an early stage, when the tumor is still localized to the prostate gland. However, even in apparent cases of clinically localized disease, unsuspected extracapsular disease may significantly increase the risk of primary treatment failure. This risk is especially high if the patient has > or =1 of the following risk factors: a serum prostate-specific antigen level of >20 ng/ml, a Gleason score of >7, locally advanced disease (clinical stage T3/T4), and extensive disease on prostate biopsy. Various regimens of neoadjuvant hormonal therapy, chemotherapy, or both have produced mixed results and, in general, have not significantly influenced the rate of disease relapse (as defined by prostate-specific antigen level) in high-risk patients with localized prostate cancer. In addition, anti-angiogenic agents, gene therapy, molecular targeting agents, and other promising new therapies have been investigated in a neoadjuvant setting with limited results. Therefore, this patient population continues to pose a therapeutic dilemma for physicians.

Positive surgical margins at radical prostatectomy: importance of intra-operative bladder neck frozen sections.

OBJECTIVE: To determine if intraoperative frozen sections of the bladder neck during radical prostatectomy (RP) could decrease the incidence of final positive surgical margins at the bladder neck. MATERIALS AND METHODS: This prospective cohort study included 51 consecutive men who underwent anatomic RP at University of Florida & Shands Jacksonville. All patients had intraoperative frozen section of bladder neck sent for analysis. Preoperative, operative, and postoperative data were collected and analyzed. MAIN OUTCOME MEASURES: Outcome measures were intraoperative bladder neck margin status, final pathologic bladder neck margin status, and postoperative urinary complications. Median follow-up for the 51 patients was 22 months. RESULTS: The final positive surgical margin rate was 20% (10 patients). An additional three patients had positive surgical margins at the bladder neck intraoperatively. These patients then had a wider resection of the affected bladder neck until the frozen sections were negative for cancer or prostatic tissue. Final pathologic evaluation of bladder neck margin was negative for tumor or persistent prostatic tissue in all 51 men. CONCLUSION: With intra-operative frozen sections, we were able to obtain a negligible positive bladder neck margin rate. Surgeons who are still on the learning curve for RP should consider intra-operative frozen section of the bladder neck.

Combination of oral tramadol, acetaminophen and 1% lidocaine induced periprostatic nerve block for pain control during transrectal ultrasound guided biopsy of the prostate: a prospective, randomized, controlled trial.

PURPOSE: Prostate biopsy for diagnosing cancer can be painful. Tramadol is a centrally acting analgesic used to treat many pain disorders. We determined whether administering oral tramadol and acetaminophen combined with 1% lidocaine induced periprostatic nerve block would significantly decrease the pain experienced by patients during standard 10-core transrectal ultrasound guided needle biopsy of the prostate. MATERIALS AND METHODS: A total of 60 men who presented for diagnostic prostate biopsy were randomized to receive placebo plus periprostatic 1% lidocaine as the control group of 30 or 75 mg tramadol/650 mg acetaminophen orally plus periprostatic 1% lidocaine as the experimental group of 30 before undergoing biopsy. Immediately after biopsy each patient was asked to rate the pain on a linear 10-point scale and a standard 6-point faces pain scale. Complications of pain medication administration in each group were noted and compared. RESULTS: Pain medication administration was well tolerated by each study group except for lightheadedness/dizziness and itching in 1 patient each in the experimental group, and lightheadedness/dizziness in 1 patient in the control group. Overall patients in the experimental group reported a mean decrease +/- SD in the pain score of 2.3 +/- 2.4 on the scale of 1 to 10 (p = 0.0008) and 1.11 +/- 1.25 on the scale of 0 to 5 compared with scores in controls (p = 0.0009). CONCLUSIONS: Administering 75 mg tramadol/650 mg acetaminophen orally with periprostatic 1% lidocaine before transrectal ultrasound guided prostate biopsy is a safe, easy and effective method of controlling pain during the biopsy procedure.

Impact of fellowship training on pathologic outcomes and complication rates of radical prostatectomy.

BACKGROUND: The study was conducted to assess the results of radical prostatectomy (RP) performed by fellowship-trained surgeons in the first year of independent practice. METHODS: A prospective cohort study of 66 men who underwent RP performed by 2 recently graduated fellowship-trained surgeons (C.J.R., n = 27; A.M.K., n = 39) in their first year of independent practice was undertaken. Preoperative, operative, and postoperative data were collected and analyzed. Median follow-up of the cohort is 12.5 months. RESULTS: The median patient age was 61.2 +/- 6.9 years (range, 44-74 years), the median prostate-specific antigen level was 5 ng/mL (range, 1.2-39.4 ng/mL), and the median prostate biopsy-determined Gleason score was 7. Of the 66 men, 25 (38%) underwent a bilateral nerve-sparing RP, 20 (30%) underwent a unilateral nerve-sparing RP, and 21 (32%) underwent a nonnerve-sparing procedure. Forty-two men (63%) underwent a pelvic lymph node dissection. The median operative time was 201 minutes. Median estimated blood loss was 734 mL (range, 300-1600 mL). There were 4 major complications--a pulmonary embolism in 3 patients and an intraoperative rectal injury in 1. Pathologic classification was as follows: pT2, 74%; pT3a, 23%; pT3b, 2%; and pN+, 2%. The positive margin rate was 14% overall and only 2% in men with pT2 disease. CONCLUSIONS: Results of RP performed by fellowship-trained surgeons in their first year of practice compare favorably with results of RP in a large series reported by more experienced surgeons. Being trained in an environment where an experienced surgeon serves as first assistant to the trainee appears to abbreviate the learning curve associated with this procedure.

Prostate cancer screening and detection in inner-city and underserved men.

CONTEXT: In the era of serum prostate-specific antigen (PSA) screening, the incidence of prostate cancer has increased dramatically. Simultaneously however, stage migration has occurred, and treatment outcomes have improved. Inner-city men have lower screening rates and, thus, may be diagnosed with more advanced disease that it less likely to be successfully treated. OBJECTIVE: To assess the detection rate of prostate cancer and tumor stage at presentation in inner-city men. DESIGN, SETTING, AND PATIENTS: A retrospective cohort of 368 men underwent transrectal ultrasound needle-guided biopsy at an inner-city hospital from January 2003 to May 2005. Clinical and pathologic data were collected and analyzed. MAIN OUTCOME MEASURES: Clinic and hospital records were reviewed for several key outcomes, including prostate cancer incidence, tumor stage and tumor grade. RESULTS: The median age of the cohort was 67 +/- 9.1 years (range, 23-93 years). Prostate cancer was diagnosed in 44% of subjects (161/368). The median PSA level at the time of diagnosis was significantly higher in African-American men than in Caucasian men (9.82 vs. 5.97 ng/mL, P=0.008). Abnormally high serum PSA levels (>20 ng/mL) were present in disproportionately more African-American men than Caucasian men with prostate cancer (32.9% vs. 19.7% P=0.011). African-American men in this inner-city cohort also had a higher incidence of advanced disease or distant metastasis (T3/T4, N1, or M1) than did Caucasians (16.1% vs. 3.8%; P=0.045). CONCLUSIONS: Compared with inner-city Caucasian men, disproportionately more inner-city, African-American men present with advanced prostate cancer. This observation warrants prostate cancer education and consideration of early detection programs in underserved inner-city communities.