Centres of excellence for the management of advanced endometriosis: where are they and what do they do?

We examined how advanced endometriosis is managed in the United Kingdom, and what support exists for the development of centres of excellence. A questionnaire was sent to all 1,447 registered consultants in the United Kingdom. Of the 617 who replied some 505 treated endometriosis, representing 267 of the 341 hospitals listed. Of the consultants 157 (31%) felt that they worked in a centre of excellence, representing 94 of the 267 hospitals. There were 169 consultants who treated rectovaginal disease themselves, but only 66 used excisional procedures. Support was expressed by 429 consultants (84.9%) for the development of centres of excellence for the treatment of advanced endometriosis.     

Hysterectomy: what do women need and want to know?

OBJECTIVE: The purpose of this article is to describe women's experiences of hysterectomy and to identify their fears, concerns, and met as well as unmet health care needs. DESIGN: Narrative data of women's hysterectomy experiences were collected via a written survey. SETTING: Data were collected from women living in southeastern Wisconsin. PARTICIPANTS: Participants were 102 women who had undergone hysterectomy within the previous 2 years. The mean age of the women was 43 and mean time since hysterectomy was 13 months. Eighty percent of the women had undergone both hysterectomy and oophorectomy, and 78% were taking hormone replacement therapy. MAIN OUTCOME MEASURES: A questionnaire of women's hysterectomy needs and a demographic questionnaire were used to collect data via mail. The data from three open-ended questions were content analyzed. RESULTS: Seven themes about women's experiences of hysterectomy were identified: (a) positive aspects, (b) hormone replacement therapy, (c) insufficient information, (d) changes in sexual feelings and functioning, (e) emotional support, (f) psychologic sequelae, and (g) feelings of loss. CONCLUSIONS: Women wanted treatment choices, a part in decision-making, accurate and useful information at an appropriate time, provider support, and access to professional and lay support systems. The essentials for hysterectomy care are outlined and include the characteristics of care that women desire, the informational content that women want, health care systems that support patient satisfaction, and the outcomes women want.     

Home birth attendants in low income countries: who are they and what do they do?

ABSTRACT: BACKGROUND: Nearly half the world's babies are born at home. We sought to evaluate the training, knowledge, skills, and access to medical equipment and testing for home birth attendants across 7 international sites. METHODS: Face-to-face interviews were done by trained interviewers to assess level of training, knowledge and practices regarding care during the antenatal, intrapartum and postpartum periods. The survey was administered to a sample of birth attendants conducting home or outof- facility deliveries in 7 sites in 6 countries (India, Pakistan, Guatemala, Democratic Republic of the Congo, Kenya and Zambia). RESULTS: A total of 1226 home birth attendants were surveyed. Less than half the birth attendants were literate. Eighty percent had one month or less of formal training. Most home birth attendants did not have basic equipment (e.g., blood pressure apparatus, stethoscope, infant bag and mask manual resuscitator). Reporting of births and maternal and neonatal deaths to government agencies was low. Indian auxilliary nurse midwives, who perform some home but mainly clinic births, were far better trained and differed in many characteristics from the birth attendants who only performed deliveries at home. CONCLUSIONS: Home birth attendants in low-income countries were often illiterate, could not read numbers and had little formal training. Most had few of the skills or access to tests, medications and equipment that are necessary to reduce maternal, fetal or neonatal mortality.     

Midwives and pregnant women talk about alcohol: what advice do we give and what do they receive?

Background

the Australian National Health and Medical Research Council (NHMRC) recently revised its guidelines for alcohol consumption during pregnancy and breast feeding, moving from a recommendation of minimising intake to one of abstinence. Women are potentially exposed to a variety of messages about alcohol and pregnancy, including from the media and social contacts, and are likely to see midwives as the source of expert advice in understanding these contradictory messages.

Objective

to explore the advice that midwives believe they give to pregnant women about alcohol consumption, and the advice that pregnant women believe they receive; the knowledge and attitudes of both groups regarding alcohol consumption and the consistency with the NHMRC guidelines; and the receptivity and comfort of both groups in discussing alcohol consumption in the context of antenatal appointments.

Design

individual semi-structured interviews with midwives and pregnant women.

Setting

face-to-face interviews with midwives and telephone interviews with pregnant women were conducted in two regional areas of New South Wales in 2008-2009.

Participants

12 midwives and 12 pregnant women.

Findings

midwives and pregnant women consistently agreed that conversations about alcohol are generally limited to brief screening questions at the first visit, and the risks are not discussed or explained (except for high-risk women).

Key conclusions

both groups expressed comfort with the idea of discussing alcohol consumption, but lacked knowledge of the risk and recommendation, and it appears that this opportunity to provide women with information is under-utilised.

Implications for practice

there is a need to provide midwives with accurate information about the risks of alcohol consumption during pregnancy and effective communication tools to encourage them to discuss the risks and recommendations with their patients.     

Social media in the REI clinic: what do patients want?

Purpose

To elicit patient preferences for social media utilization and content in the infertility clinic.

Methods

This was a cross-sectional survey study conducted in three US fertility practices. Women presenting to the infertility clinic for an initial or return visit were offered an anonymous voluntary social media survey. The survey elicited patient perception of whether social media use in the infertility clinic is beneficial, and preferences regarding topics of interest.

Results

A total of 244 surveys were collected during the study period, of which 54.5% were complete. Instagram is a more popular platform than Twitter across all age groups. Use of both platforms varies by age, with patients ≥?40 less likely to be active users. The majority of respondents felt that social media provided benefit to the patient experience in the infertility clinic (79.9%). “Education regarding infertility testing and treatment” and “Myths and Facts about infertility” were the most popular topics for potential posts, with 93.4 and 92.0% of patients endorsing interest respectively. The least popular topic was “Newborn photos and birth announcements,” with only 47.4% endorsing interest. A little over half of respondents (56.3%) would feel comfortable with the clinic posting a picture of their infant. The vast majority of patients (96.2%) feel comfortable communicating electronically with their infertility clinic.

Conclusion

Patients are interested in the use of social media as a forum for patient education and support in the infertility clinic. Patient preferences regarding post topics should be carefully considered.

     

History of human papillomavirus, warts and cancer: what do we know today?

Human papillomavirus has been a cause of infection in humans for thousands of years. The history of papillomaviruses, knowledge of their causative role in benign and malignant disease, and their structural characteristics have led to the development of vaccines to prevent cervical and anogenital cancers. Many questions remain unanswered before HPV vaccines can be optimised; however, the concept of virtual eradication of cervical cancer is not impossible, and remains a realistic aspiration.     

Endometriosis and risk of ovarian cancer: what do we know?

Despite long and intensive research, endometriosis remains one of the leading causes of morbidity among premenopausal women. The majority of endometriosis-related ovarian carcinomas occur in the presence of atypical ovarian endometriosis. Nevertheless, despite the increased incidence of ovarian cancer in patients with endometriosis, our knowledge of the risk factors and mechanisms is still incomplete. Narrative overview, synthesizing the recent findings of literature retrieved from databases. Herein, we reviewed and summarized the most recent knowledge regarding endometriosis and ovarian cancer. The evidence showing that patients with endometriosis have a higher risk of developing ovarian cancer is compelling. However, the question of how much higher the absolute risk is, is not fully clear.     

Immunopathogenesis of pelvic inflammatory disease and infertility -- what do we know and what shall we do?

The most significant complication of sexually transmitted diseases (STDs) in women is pelvic inflammatory disease (PID), which is responsible for considerable medical, social, and economic problems. Chlamydia trachomatis, Neisseria gonorrhoeae, or both cause PID in at least 50% of cases. Other microorganisms that are part of the abnormal vaginal flora also cause PID. Gonorrhea rates have quickly fallen in most developed countries, but chlamydia infection rates are still high in developed countries as well as in developing countries. The clinical signs and symptoms of PID have changed over time. More and more PID cases are classified as atypical or subclinical. Typical PID is rare. A strong association exists between chlamydia infection and tubal factor infertility or ectopic pregnancy in women with or without a history of PID. Health providers are concerned about the problem of unrecognized PID. Thus, recommendations for PID diagnosis have changed. A syndromic diagnosis of PID is advocated. The minimum criteria for syndromic diagnosis of PID include lower abdominal tenderness, bilateral adnexal tenderness, cervical motion tenderness, and no evidence of competing diagnosis (e.g., acute appendicitis). Application of this improved approach will provide appropriate treatment earlier in the course of PID. PID-related morbidity (i.e., infertility and ectopic pregnancy) is a considerable public health problem worldwide. In order to prevent PID, clinicians and public health specialists need to understand the interactions of PID-causing microorganisms with the host immune system. By the time PID symptoms are detected, considerable tubal damage already exists limiting the effect of tertiary prevention of PID. Secondary prevention keeps lower genital tract infection from moving up to the upper genital tract. Health providers play a key role in secondary prevention by screening for STDs and in primary prevention by counseling patients about safer sex practices.     

Atypical decelerations: do they matter?

Objective: To estimate the association between atypical variable decelerations and neonatal acidemia.

Method: We conducted a one-year case-control study comparing the last thirty minutes before delivery of fetal heart rate tracings of 102 acidemic neonates (umbilical arterial cord gas pH?≤?7.10) with 100 non-acidemic controls (umbilical arterial cord gas pH?>?7.10). Incidence of atypical features and total number of decelerations, number of atypical decelerations, number of slow return decelerations and number of decelerations with loss of moderate variability during deceleration were extracted. We estimated the association between atypical features, neonatal acidemia and neonatal morbidity.

Results: Acidemic neonates showed a larger number of atypical decelerations (4 [0-12] vs. 3 [0-10]), “slow return” decelerations (4 [0-11] vs. 1 [0-10]) and decelerations with non-moderate variability (0[0-12] vs. 0 [0-6]) compared to non-acidemic controls. “Slow return” was significantly associated with an increased risk of acidemia at birth (OR 4.46; CI 95%: 2.18 – 9.15) “Slow return” was the most discriminating feature between groups with an AUC: 0.745.

Conclusion: Certain atypical features, as “slow return” and loss of moderate variability within decelerations are associated with neonatal acidemia. “Slow return” could help in the gradation of acidemia risk levels, as an indicator of gravity.