The lactation consultant as expert witness.

Several factors contributed to the impact of Ms. Scott's testimony on the judge and thereby on the case. Most obvious was the degree of her expertise; just as important was the way in which she presented her testimony. She maintained a moderate tone throughout and never gave the impression that what she was saying was anything but mainstream or that she was speaking from zealotry. Her greatest strength, as for any LC's testimony, is that she spoke in terms of what was best for the child. In any initial custody case the judge must decide what is in the child's best interests or some small variation on that theme. By its very nature, breastfeeding and all the information provided about it speaks to the same issue. In that sense, the testimony is not offered on behalf of one of the parents, but on behalf of the welfare of the child. It is this nonpartisan aspect of an LC's testimony that can make it so powerful.     

Patient satisfaction in gynaecological outpatient clinic attendances.

A questionnaire was used to assess patients' perception of and satisfaction with gynaecology outpatient appointment date and waiting times at gynaecology outpatient clinics. While 95% were satisfied with the overall service, 19% expressed dissatisfaction with waiting times for first appointment and 26% with the waiting time at the clinic. These findings are discussed in the light of the recommendations of the Patient's Charter and with respect to reorganising outpatient gynaecology services to improve efficiency.     

Chlamydial infection in a Chinese gynecologic outpatient clinic

In an attempt to detect the presence, if any, of cervical chlamydial infection, we obtained endocervical smears from 1000 female patients attending the outpatient gynecologic and family planning clinics at Women's Hospital, Zheijiang Medical University, Hangzhou, People's Republic of China. Using direct immunofluorescent monoclonal antibody staining technique, we identified elementary bodies typical of the Chlamydia trachomatis organism in ten of the 1000 slides (1%). The only characteristic of statistical significance in this small group of infected women was the complaint of infertility for more than two years' duration, noted in six of the ten cases.     

Mental health of patients visiting an outpatient menopause clinic

OBJECTIVE: It is understood that psychological factors affect climacteric disturbances. However, details behind these issues remain unknown. The aim of this study was to investigate the mental health of climacteric patients. SUBJECTS AND METHODS: The subjects were 127 Japanese women who visited our outpatient menopause clinic, complaining chiefly of climacteric disturbances. There were 38 premenopausal patients included. The responses to the HADS (Hospital Anxiety and Depression Scale) and the SDS (Self-rating Depression Scale), obtained at the first examination, were compared with HADS data from 2,943 healthy women and 94 patients hospitalized to receive gynecological surgery. RESULTS: The HADS score and the SDS score of the outpatients of the menopause clinic showed a relatively high (statistically significant) correlation. The average HADS total, anxiety and depression scores for these patients were significantly higher than those for healthy controls. The total and depression scores were also significantly higher than those for patients hospitalized to undergo surgery for benign conditions, and were comparable to those for patients with malignant conditions. The comparison between pre- and postmenopausal patients showed that the premenopausal group was more likely to be depressed. The anxiety score was also high in this group (not significantly). CONCLUSIONS: These results indicate that patients with climacteric disturbances, especially premenopausal patients, often experience psychological discomfort, and that attention should be given not only to their depression but also to their anxiety.     

Ultrasonic prediction of term birth weight in Hispanic women. Accuracy in an outpatient clinic

OBJECTIVE: To investigate the accuracy of ultrasonic fetal biometric algorithms for estimating term fetal weight. STUDY DESIGN: Ultrasonographic fetal biometric assessments were made in 74 Hispanic women who delivered at 37-42 weeks of gestation. Measurements were taken of the fetal biparietal diameter, head circumference, abdominal circumference and femur length. Twenty-seven standard fetal biometric algorithms were assessed for their accuracy in predicting fetal weight. Results were compared to those obtained by merely guessing the mean term birth weight in each case. RESULTS: The correlation between ultrasonically predicted and actual birth weights ranged from 0.52 to 0.79. The different ultrasonic algorithms estimated fetal weight to within +/- 8.6-15.0% (+/- 295-520 g) of actual birth weight as compared with +/- 13.6% (+/- 449 g) for guessing the mean birth weight in each case (mean +/- SD). The mean absolute prediction errors for 17 of the ultrasonic equations (63%) were superior to those obtained by guessing the mean birth weight by 3.2-5.0% (96-154 g) (P < .05). Fourteen algorithms (52%) were more accurate for predicting fetal weight to within +/- 15%, and 20 algorithms (74%) were more accurate for predicting fetal weight to within +/- 10% of actual birth weight than simply guessing the mean birth weight (P < .05). Ten ultrasonic equations (37%) showed significant utility for predicting fetal weight > 4,000 g (likelihood ratio > 5.0). CONCLUSION: Term fetal weight predictions using the majority of sonographic fetal biometric equations are more accurate, by up to 154 g and 5%, than simply guessing the population-specific mean birth weight.     

A demographic study to profile non-attenders at a gynaecology outpatient clinic

Missed outpatient appointments result in the inefficient utilisation of resources and have secondary effects on the health of the non-attenders, as well as on other patients who have to wait longer for their appointments. The first part of the study involved retrospective analysis of trends of non-attendance based on a computerised database of all gynaecology appointments over 12 months. The second comprised a prospective case-control study in which women who missed their gynaecology outpatient appointments (index cases) over 2 months were compared with patients who attended the same clinics matched for indication for referral (control cases). The overall non-attendance rate over 12 months was 16.1%, of whom 42% were recurrent non-attenders. Data from 105 defaulters were compared with 105 non-defaulters who attended the same clinics. Defaulters were significantly younger, single or separated and were more likely to be 'follow-ups' rather than new cases (all p < 0.05). Longer intervals between the appointment letter and actual appointment date was significantly related to non-attendance (p = 0.01) and there was a trend to a greater degree of smoking and alcohol ingestion in the defaulter group (p = 0.059). Comparison of other variables such as severity of symptoms, parity, source of referral and fluency of English did not reach statistical significance (p > 0.05). This prospective study has demonstrated certain profiles which are common to defaulters and which can be used to develop strategies to minimise non-attendance. Examples include reducing the time interval between sending the appointment letter and actual appointment date and selectively over-booking younger, single women who smoke.     

Quality of life after treatment for gynecologic malignancies: a pilot study in an outpatient clinic

OBJECTIVE: The objective of this study was to determine the health-related quality of life (QOL) of disease-free patients after therapy for gynecologic malignancies at follow-up in an outpatient clinic. METHODS: Eighty-five patients (P) completed the general Functional Assessment of Cancer Therapy (FACT-G) QOL questionnaire at least 6 months after treatment for a gynecologic malignancy. Responses were compared to 42 unmatched healthy women (H) who were seen for standard gynecologic screening exams. Statistical evaluation was done using t tests, chi(2),and Wilcoxon rank-sum tests, Spearman rank correlations, and linear regression. RESULTS: The demographic data for the groups were as follows: median age P, 59 years; H, 56 years; Caucasian P, 51%; H, 56%, African American P, 49%; H, 44%, cervix cancer (n = 51, 60%), uterine cancer (n = 24, 28%), ovarian cancer (n = 10, 12%). The median time since therapy was 39 months (range 6-149 months). There were no overall differences in FACT-G scores of patients and healthy women. Cancer survivors scored slightly higher on the emotional well-being subscale (mean 20.4 vs 19.2). Among cancer patients, all scores were lowest in patients with ovarian cancer. Longer treatment time was associated with a lower physical well-being. Older patients scored higher on emotional well-being, but lower on social/family well-being. Poor education and no help at home were associated with lower functional well-being and total FACT scores. Linear regression analysis revealed significantly lower total QOL scores in patients with the following characteristics: ovarian cancer diagnosis, treatment with radiation therapy or multi-modality therapy, less than high school education, and lack of help at home. CONCLUSION: Overall the recovery from treatment for gynecological cancer is good. Patients with ovarian cancer, prolonged therapy, poor education, and little social support have the most significant impairments in health-related quality of life and need additional support resources.