Prevalence of Asherman's syndrome after secondary removal of placental remnants or a repeat curettage for incomplete abortion

This prospective study assesses the prevalence of intrauterine adhesions among women undergoing secondary removal of placental remnants after delivery, or a repeat curettage for incomplete abortions, and evaluates risk factors associated with the presence of intrauterine adhesions. In 50 women, undergoing either a secondary removal of placental remnants more than 24 h after delivery, or a repeat curettage for incomplete abortions, ambulatory hysteroscopy was performed 3 months after the intervention. Intrauterine adhesions were found in 20 of the women (40%): five patients had Asherman's syndrome grade I, six had grade II, six had grade III and three had grade IV. In women with menstrual disorders a statistically significant 12-fold increased risk for Asherman's syndrome grade II-IV was found. Previous abortion as well as infection during surgery were associated with a mildly but non-significant increased risk. Based on our findings, hysteroscopy is recommended only in those patients who develop menstrual disorders, either after secondary intervention for placental remnants after delivery or after a repeat curettage.      

The role of communication in paediatric drug safety

Medication errors cause substantial harm to patients, and considerable cost to healthcare systems. Evidence suggests that communication plays a crucial role in the generation, management and prevention of such incidents. This review identifies how paediatric medication errors can be managed, and in particular focuses on the pathway of steps that can operationalise the current research findings. Furthermore, the current data suggesting how communication can help to prevent errors occurring in the first place is examined. From this data, it is apparent that there are three domains in which communication could play an important preventative role: first, patient doctor communication, and second interprofessional communication and finally researcher/professional dialogue. This review is an attempt to identify the importance of communication in paediatric mediation safety and to allow practical application of these findings.     

Stress,burnout and doctors' attitudes to work are determined by personality and learning style: A twelve year longitudinal study of UK medical graduates

Background

The study investigated the extent to which approaches to work, workplace climate, stress, burnout and satisfaction with medicine as a career in doctors aged about thirty are predicted by measures of learning style and personality measured five to twelve years earlier when the doctors were applicants to medical school or were medical students.

Methods

Prospective study of a large cohort of doctors. The participants were first studied when they applied to any of five UK medical schools in 1990. Postal questionnaires were sent to all doctors with a traceable address on the current or a previous Medical Register. The current questionnaire included measures of Approaches to Work, Workplace Climate, stress (General Health Questionnaire), burnout (Maslach Burnout Inventory), and satisfaction with medicine as a career and personality (Big Five). Previous questionnaires had included measures of learning style (Study Process Questionnaire) and personality.

Results

Doctors' approaches to work were predicted by study habits and learning styles, both at application to medical school and in the final year. How doctors perceive their workplace climate and workload is predicted both by approaches to work and by measures of stress, burnout and satisfaction with medicine. These characteristics are partially predicted by trait measures of personality taken five years earlier. Stress, burnout and satisfaction also correlate with trait measures of personality taken five years earlier.

Conclusions

Differences in approach to work and perceived workplace climate seem mainly to reflect stable, long-term individual differences in doctors themselves, reflected in measures of personality and learning style.

     

Adrenal cysts: imaging and percutaneous aspiration

Six patients with primary adrenal cysts were encountered during a period of 3 years. Multiple imaging modalities were used to characterize these lesions, including magnetic resonance imaging in one case. Percutaneous aspiration was performed on four of the six cysts - in one case, in the operating room prior to excision of the cyst. Cholesterol was detected in four cysts and cortisol in one cyst. Cytologic findings from aspiration biopsy were benign in all five cases. Two cysts were removed, one of them after reaccumulation of the fluid after needle aspiration. The findings in this small series of adrenal cysts suggest that in certain cases, complete cyst aspiration, rather than surgical excision, may be carried out initially for diagnosis and management of indeterminate suprarenal cystic lesions and symptomatic cysts of the adrenal gland.     

The Ventilatory Cost of Exercise Compared in Chronic Heart Failure and Chronic Renal Anaemia

The cardiorespiratory responses to maximal treadmill exercisewere compared in matched groups of patients with chronic renalanaemia or treated chronic heart failure, and in normal controls.Exercise capacity was similarly reduced in both patient groupscompared to normal controls, the raised respiratory exchangeratio at peak exercise implying anaerobic metabolism due tolimited oxygen delivery in heart failure and limited oxygencarrying capacity in anaemia. Minute ventilation (V_F) was relatedlinearly to minute CO₂ production (VCO₂) in all subjects (eachr>0.92) from all three groups. The slope of the V_E/VCO₂ relationshipwas normal in anaemia but steeper in heart failure, reflectingventilation/perfusion mismatching in chronic heart failure.