Day case transobturator tapes: a cut and dried solution.

BACKGROUND: The transobturator tape (TOT) has been utilized in the surgical management of SUI since 2001 when it was first described and is associated with minimal risk of trauma as its purely perineal insertion avoids entry to the retropubic space. Given its high success rate, low associated peri-operative morbidity and relative ease of insertion, it has been increasingly used as a day case procedure worldwide. AIM: This study aims to demonstrate the suitability of the transobturator tape (TOT) as a day surgery procedure in the Republic of Ireland. METHODS: A retrospective review of all the patients who underwent TOT as a day case procedure at a tertiary referral centre in Dublin over a 1 year period (March 2015-March 2016) was carried out. This was post the introduction of the procedure as a day case for a select group of patients. The outcomes evaluated included intraoperative and postoperative complication rates, voiding dysfunction rates, unscheduled inpatient admissions following the procedure and continence rates post-procedure. RESULTS: Fifteen cases were reviewed. There was one case with minor intraoperative complication of bladder perforation which was managed as an outpatient. One patient (6 %) failed to achieve adequate voiding within the 6-h timeframe allowed and, therefore, required overnight admission. All patients reported dryness at the 6-week review. Major elective waiting time for the gynaecology list decreased from 28 to 10 weeks 1 year post-commencement of the protocol. CONCLUSIONS: We conclude that the transobturator tape procedure is suitable as a day case in a select group of patients in the Irish healthcare setting. There was no increased rate of morbidity demonstrated in the group and readmission rates were low. It has reduced waiting times by increasing throughput of cases and ultimately will lead to reduced costs for hospitals.

Contraception for renal transplant recipients in the Republic of Ireland : a review.

Renal transplantation has extended the duration and quality of life for a growing number of women in the Republic of Ireland. Pregnancy has now become a reasonable and viable option for women who were previously too ill to conceive, leading the Royal college of Obstetricians and Gynaecologists to issue opinions on the management of women with renal disease in pregnancy. In the 10-year period, from 2000 to 2009, 1,412 renal transplants were undertaken at Beaumont Hospital, Dublin. Of these, 541 were female patients and 333 of these women were in the reproductive age group (18-49 years) and thus would have potentially required some method of contraception. Improvements in overall health can lead to an early return to fertility and menstruation following renal transplant. It is recommended that the optimal management after renal transplantation is to ensure graft stability and optimal function before pregnancy is considered. It is also advisable to titrate immunosuppressive medication to the lowest maintenance dose possible to minimise potential fetal effects. Thus, a duration of 1 year post-living donor renal transplant and 2 years post-cadaveric donor transplant is usually quoted before embarking on a pregnancy, although this may vary from case to case. Women of reproductive age undergoing renal transplantation have a need for highly effective contraception. This review provides an overview of methods available in the Republic of Ireland and the evidence for their use in renal transplant recipients.

A study of the use of aspirin in the secondary prevention of myocardial infarction in Trinidad and Tobago

OBJECTIVE: To determine the knowledge, attitude to and practice of aspirin prescribing by physicians, dispensing by pharmacies and usage by patients in the secondary prevention of myocardial infarction (MI) during the period September 1998 to August 1999. DESIGN AND METHODS: 119 doctors registered with the Trinidad and Tobago Medical Association were administered a questionnaire via a telephone interview on their prescription of aspirin in the secondary prevention of MI. Ninety-four registered pharmacies were administered a similar questionnaire to assess availability of aspirin. Seventy-three patients attending the San Fernando General Hospital (SFGH) and 82 patients from the Eric Williams Medical Sciences Complex (EWMSC) Cardiology clinic with a history of MI were each administered a questionnaire on their use of aspirin. RESULTS: Forty-three doctors (36.1 percent, 95 percent CI: 27.5-45.4) prescribed the recommended dose of 75-100 mg of aspirin for the secondary prevention of MI. Of the 82 patients interviewed from EMSC, 28 (34.2 percent) were taking the recommended dose, as compared with 11 (15.19 percent) patients from SFGH. Throughout Trinidad and Tobago, only 51 pharmacies (54.3 percent, 95 percent CI 43.7-64.6) stocked the required dose. CONCLUSIONS: The prescribing habits, availability and use of the recommended dose of aspirin in the secondary prevention of MI are unacceptable and clearly indicate an urgent need to improve the management of MI.(Au)