Open-access transvaginal sonography in women of reproductive age with abnormal vaginal bleeding: a descriptive study in general practice

Background

Diagnostic ultrasonography is used by GPs in approximately 10% of patients of reproductive age with abnormal vaginal bleeding. Transvaginal sonography is recommended as a first-line diagnostic instrument for assessing uterine pathology.

Aim

To assess if findings resulting from openaccess sonography were in agreement with the GPs’ working hypotheses and if these findings contributed to GPs’ management.

Design and setting

Prospective observational cohort study of GPs working in the health district of the Academic Medical Center, Amsterdam and their patients consulting with abnormal vaginal bleeding.

Method

Data on patients’ history, GPs’ primary working hypotheses, and intended management were recorded. After sonography, GPs recorded their actual management.

Results

A total of 122 patients were included by 18 GPs from June 2003 to December 2004. Data from 89 patients were available for analysis. The GPs’ working hypotheses implied ‘no structural pathology’ in 65/89 patients, and ‘fibroids’ in 24/89 patients. Sonographic findings were confirmed in 50/65 patients where ‘no structural pathology’, and in 14/24 of those where ‘fibroids’ were expected. Initially, GPs had intended to refer nine patients to a gynaecologist. Actual management after sonographic assessment was watchful waiting or drug therapy in 57/89 patients. Eighty-nine per cent of these patients had normal sonographic findings. The actual referral rate rose to 27/89 patients. In 17 referred patients, sonographic findings were suggestive of intracavitary abnormalities.

Conclusion

Open-access sonography contributed to more accurate diagnoses and improved GPs’ management of women with abnormal vaginal bleeding.     

Challenging assumptions about risk factors and the role of screening for violence risk in the field of mental health

Research demonstrates that mental illness is not a major cause of violence yet assumptions about a link and concern about the risks posed by mentally disordered people has resulted in the predominance of a public safety role for mental health services (Munro and Rumgay 2000 Munro, E. and Rumgay, J. 2000. Role of risk assessment in reducing homicides by people with mental illness. British journal of psychiatry, 176: 116–120. [Crossref], [PubMed], [Web of Science ®] [Google Scholar]). In consequence, screening, classifying and monitoring individuals considered to pose a potential risk to others due to their potential for violence has become a key responsibility. The purpose of healthcare screening is to identify a disease or condition, or its associated risk factors, to provide treatment or encourage preventative action on the part of ‘at risk’ individuals. Mental health screening differs since neither a disease entity nor a causal model to link mental disorder and violence exist (Leitner et al. 2006 Leitner, M. 2006. Systematic review of prevention and intervention strategies for populations at high risk of engaging in violent behaviour, London: Department of Health. Final project report to the NHS National Forensic Mental Health R&D Programme [Google Scholar]). Mental health service users are typically marginalised and screening may occur without their consent, knowledge or involvement. They may also disagree that they have the condition in question, i.e. a propensity to violence. The expectation upon professionals to promote service user involvement in care and treatment sits uneasily with these processes. This paper reviews the ongoing but unsuccessful efforts to develop effective screening for violence amongst people defined as mentally disordered and explores the implications for mental health services in the light of this evidence. It also considers the continuing lack of service user involvement in risk assessment. First however, the paper considers correlates for violence since screening depends for its efficacy upon risk factors thought to be positively associated with the condition of concern.     

阿德福韦双酯治疗拉米夫定耐药的慢性乙肝患者时出现的耐药问题

背景:阿德福韦双酯(ADV) 是一种有效治疗野生型和耐拉米夫定乙肝病毒(HBV)的核苷酸类药物。在使用核苷酸类药物治疗慢性乙肝时,当治疗时间为 48、96、144周时,耐ADV变异体出现的累积发生率分别为0、 0．8-3％和0-5．9％。目的:研究67例对拉米夫定耐药且接受ADV治疗的慢性乙肝患者耐ADV病毒变异体的表型和基因型特点。方法:HBV DNA含量采用实时定量PCR技术。ADV变异体检测采用基质辅助激光解吸电离／飞行时间质谱为基础的基因分型     

Evaluation of reporting quality for observational studies using routinely collected health data in pharmacovigilance

Objectives: To appraise the reporting quality of studies which concerned linezolid-related thrombocytopenia referring to REporting of studies Conducted using Observational Routinely collected health Data (RECORD) statement.

Methods: Medline, Embase, Cochrane library and clinicaltrial.gov were searched for observational studies concerning linezolid-related thrombocytopenia using routinely collected health data from 2000 to 2017. Two reviewers screened potential eligible articles and extracted data independently. Finally, reporting quality assessment was performed by two senior researchers using RECORD statement.

Results: Of 25 included studies, 11 (44.0%) mentioned the type of data in the title and/or abstract. In 38 items derived from RECORD statement, the median number of items reported in the included studies was 22 (inter-quartile range 18–27). Inadequate reporting issues were discovered in the following aspects: validation studies of the codes or algorithms, study size estimation, quantitative variables, subgroup statistical methods, missing data, follow-up/matching or sampling strategy, sensitivity analysis and cleaning methods, funding and role of funders and accessibility of protocol, raw data.

Conclusion: This study provides the evidence that the reporting quality of post-marketing safety evaluation studies conducted using routinely collected health data was often insufficient. Future stakeholders are encouraged to endorse the RECORD guidelines in pharmacovigilance.     

Vitamin E, vitamin A and essential fatty acid status of patients hospitalized for anorexia nervosa

A group of 17 patients hospitalized for anorexia nervosa was assessed for nutritional status with respect to the essential fatty acids and vitamins E and A. Plasma aliquots available from blood drawn upon hospital admission were frozen and later extracted for total lipids. The total lipids were then fractionated by thin layer chromatography to isolate the phospholipids (PL). The fatty acid profile of both total plasma and PLs was determined by gas chromatography. High pressure liquid chromatography was used to quantitate the tocopherol isomers and retinol (vitamins E and A, respectively). The anorexic patients showed below normal weight-for-height, decreased percent body fat, and a high incidence of secondary amenorrhea. Of the four tocopherol isomers measured, only the beta + gamma fraction was significantly lower than the normal value (0.16 +/- .06 mg/dl vs 0.25 +/- 0.51 mg/dl, p less than .001). The essential fatty acids, linoleate and linolenate, were lower in the PL fraction of the anorexic group (linoleate, 19.35 +/- 5.65 vs 24.96 +/- 2.24, p less than .01); linolenate, none detected vs 0.16 +/- 0.13, p less than .05). Other indicators of essential fatty acid status differed from the normal group in the direction of deficiency (total omega 6, 31.44 +/- 7.41 vs 37.42 +/- 3.40, p less than .05; 20:4 omega 6/18:2 omega 6, 0.49 +/- 0.14 vs 40 +/- 0.02, mean +/- standard deviation, p less than .01). Eicosatrienoic acid, however, was not detected in either group.(ABSTRACT TRUNCATED AT 250 WORDS)     

A randomized controlled trial of electromagnetic therapy in the primary care management of venous leg ulceration

OBJECTIVE: The aim was to establish the potential efficacy, tolerabilityand side-effect profile of electromagnetic therapy as an adjunctto conventional dressings in the treatment of venous leg ulcers. METHOD: A prospective, randomized, double blind controlled clinicaltrial was carried out in a dedicated leg ulcer clinic basedin one urban general practice. Nineteen patients with leg ulcersof confirmed venous aetiology were assessed. The main outcomemeasures were rate and scale of venous leg ulcer healing, changesin patient-reported pain levels, quality of life, degree ofmobility, side effect profile and acceptability to patientsand staff. RESULTS: Sixty-eight per cent of patients attending this dedicated clinicachieved improvements in the size of their ulcer (4, 21%, healedfully) and in reduced pain levels (P < 0.05) during the trial,despite the chronicity of ulcer histories. Patients treatedwith electromagnetic therapy at 800 Hz were found at day 50to have significantly greater healing (P < 0.05) and paincontrol (P < 0.05) than placebo therapy or treatment with600 Hz. All patients reported improved mobility at the end ofthe study. The electromagnetic therapy was well tolerated bypatients, with no differences between groups in reporting adverseevents, and proved acceptable to staff. CONCLUSION: Despite the small numbers in this pilot study, electromagnetictherapy provided significant gains in the healing of venousleg ulcers and reduction in pain. Keywords. Electromagnetic therapy, RCT, leg ulcers, primary care.