Long term follow up of hysteroscopic myomectomy assessed by survival analysis

Objective To identify patient characteristics which affect outcome after hysteroscopic myomectomy for submucous fibroids.
Design Prospective observational study.
Setting A university teaching hospital.
Sample One hundred and twenty-two consecutive patients treated by hysteroscopic myomectomy for submucous leiomyoma over a period of almost eight years.
Methods Hysteroscopic electroresection of the leiomyoama using a continuous flow resectoscope.
Main outcome measures The avoidance of further surgery and patient satisfaction.
Results The average age of the patients at the time of their surgery was 424 years. A total of 194 fibroids were removed. The mean follow up period was 2.3 years (range 1–7.6). Of those asked, 71.4% were satisfied with the results of surgery. Sixteen women required further surgery for fibroids, and six ultimately underwent hysterectomy. Survival analysis showed that the risk of further surgery was 21% at four years after the myomectomy, and 0% thereafter. Univariate regression analysis suggested that outcome was significantly better in older women, and in cases where the uterus was equivalent in size to I 6 weeks of gestation, the fibroid was I 3 cm in diameter and mainly intracavitary, and the proce- dure time was I 20 minutes. The influence of hormonal pre-treatment and the number of fibroids excised was not statistically significant. After multivariate regression analysis, only overall uterine size and the position of the fibroid being removed were found to significantly influence the success of surgery.
Conclusions Hysteroscopic myomectomy is an effective way to manage patients with symptomatic submucous leiomyomata, particularly when the uterus is not grossly enlarged and the fibroid(s) are mainly inside the uterine cavity.     

Dealing with death: An audit of family bereavement programs in Australian intensive care units

Patient death in Intensive Care Units (ICU) can be sudden and unexpected, leading to emotionally charged situations and life changing circumstances for family members. Supporting families during and after this critical period is particularly challenging for ICU nurses who often feel dissatisfied with the way they deal with the situation. Bereavement programs in various areas of nursing have been reported to be beneficial in promoting normal grief patterns. There is, however, a lack of research in the area of evaluation of bereavement programs in adult ICUs. This paper presents the results of an Australia-wide audit on current practices in the area of bereavement programs within adult ICUs.

Surveys were sent to 117 adult Australian ICUs; 99 surveys were returned completed (84.6% response rate). It was identified that most surveyed units offer minimal components of bereavement programs, such as viewing of the deceased and communicating with family members. Less than one third (n=26) provide additional follow-up services in the form of telephone calls and sympathy cards or referral to additional services. Ten units employ some form of program evaluation. Verbal feedback from staff and families is the primary assessment method. Over half of responding ICUs indicated they are considering or interested in providing a bereavement program in their unit.

This study highlights the need for research-based data to support the introduction or deletion of strategies for bereavement programs using family-centred outcome measures. ICU nurses are interested in this area of clinical practice and require considerable support. It is recommended that this support can come via postgraduate and on-going education, hospital policies and procedures.     

Transcutaneous electrical nerve stimulation in labour pain: a systematic review

Objective To review the effectiveness and safety of transcutaneous electrical nerve stimulation (TENS) for labour pain.
Design A systematic review of randomised controlled trials of TENS in pain during labour.
Sample Eight reports involving 712 women were included; 352 women received active TENS and 360 acted as controls.
Methods Reports were sought by searching MEDLINE and the Oxford Pain Relief Database.
Main outcome measures Analgesic and adverse effect outcomes.
Results Evidence for reduced pain using TENS in labour was weak. Additional analgesic interventions may be less likely with TENS (odds ratio 0.57; 95% CI 0.34–0.96), number-needed-to-treat 14 (95% CI 7.3–119).
Conclusions Randomised controlled trials provide no compelling evidence for TENS having any analgesic effect during labour. Weak positive effects in secondary (analgesic sparing) and tertiary (choosing TENS for future labours) outcomes may be due to inadequate blinding causing overestimation of treatment effects.     

Toward a theory of touch: the touching process and acquiring a touching style

Methods of grounded theory were used to explore the questions How do intensive care nurses perceive touch and the process of touching? How do intensive care nurses learn to touch? Data were collected by in-depth interviews with eight experienced intensive care nurses from the same intensive care unit of a large urban Canadian hospital Findings revealed two substantive processes, the touching process and acquiring a touching style, neither of which has been previously reported The stages and phases of these processes are described as well as cueing, the core variable Based on the data analysis, touch was conceptualized as a gestalt with multiple dimensions, suggesting that valid operational definitions of touch must incorporate more than skin-to-skin contact     

Achieving statistical power through research design sensitivity

The challenge for nurse researchers is to design their intervention studies with sufficient sensitivity to detect the treatment effects they are investigating In order to meet this challenge, researchers must understand the factors that influence statistical power Underpowered studies can result in a majority of null results in a research area when, in fact, the interventions are effective The sensitivity of a research design is not a function of just one element of the design but of the entire research design its plan, implementation and statistical analysis When discussing factors that can increase a research design's statistical power, attention is most often focused on increasing sample size This paper addresses a variety of factors and techniques, other than increasing sample size, that nurse researchers can use to enhance the sensitivity of a research design so that it can attain adequate power     

Antibiotic prophylaxis for endocarditis: time to reconsider

Some cardiac conditions require antibiotic prophylaxis for some types of dental treatment to reduce the risk of infective endocarditis (IE). All medical and dental practitioners are familiar with this practice but tend to use different regimens in apparently similar circumstances. Generally, the trend has been to prescribe antibiotics if in doubt. This review explores the evidence for antibiotic prophylaxis to prevent IE: does it work and is it safe? The changing nature of IE, the role of bacteraemia of oral origin and the safety of antibiotics are also reviewed. Most developed countries have national guidelines and their points of similarity and difference are discussed. One can only agree with the authority who describes antibiotic guidelines for endocarditis as being 'like the Dead Sea Scrolls, they are fragmentary, imperfect, capable of various interpretations and (mainly) missing!' Clinical case-controlled studies show that the more widely antibiotics are used, the greater the risk of adverse reactions exceeding the risk of IE. However, the consensus is that antibiotic prophylaxis is mandatory for a small number of high-risk cardiac and high-risk dental procedures. There are a large number of low-risk cardiac and dental procedures in which the risk of adverse reactions to the antibiotics exceeds the risk of IE, where prophylaxis should not be provided. There is an intermediate group of cardiac and dental procedures for which careful individual evaluation should be made to determine whether IE or antibiotics pose the greater risk. These categories are presented. All medical and dental practitioners need to reconsider their approach in light of these current findings.     

Medicaments: Aids to success in endodontics. Part 2. Clinical recommendations

In order to predictably achieve bacteria-free root canal systems, especially in pulpless teeth, it is necessary to use intra-canal medicaments. Medicaments can also be used to influence the peri-radicular response to endodontic treatment. Consideration of a material's therapeutic action must be made when selecting a medicament for any pathological condition. In general, only two commercial preparations satisfy the general requirements for root canal medicaments. Guidelines and the rationale for the use of these preparations are presented.