bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of a stroke rehabilitation education programme for nurses
Authors: Booth Joanne , Hillier Valerie F. , Waters Karen R. , Davidson Ian
Published: February 2005

Aims.  This paper reports a study which aimed to explore the effects of education on the practice of nurses working in stroke rehabilitation units.

Background.  It has been suggested that a key component of the success of stroke units in reducing mortality and disability is the contribution made by nurses, but debate continues around their specific role. Literature has concentrated on nurses’ perceptions of their role rather than their actual activities with patients. In studying the effects of education on nurses’ practice with stroke patients there is a need to identify what nurses actually do, rather than what they say they do.

Methods.  A quasi‐experimental, non‐equivalent control group design was used to study two stroke rehabilitation units. Non‐participant observation was conducted during morning care sessions, focusing on styles of physical interaction. Base‐line observations were recorded in each unit, after which the staff in the intervention unit received 7 hours’ education, specifically focused on therapeutic handling in relation to morning care activities. Following this, postintervention observations were conducted and comparisons of interaction styles made between units.

Results.  Twenty‐six staff and 37 patients took part in the study. Following the education, staff in the intervention unit showed a change in physical interaction style more in line with therapeutic practice, with the proportion of ‘doing for’ interventions reducing (45·4% vs. 33·2%; P < 0·05). The proportion of facilitatory interventions increased (3·9% vs. 6·1%) however, this difference was not statistically significant (P = 0·098). The change in styles of practice was achieved with no increased demand on nurses’ time.

Conclusion.  Education for nurses which aims to change styles of interaction with stroke patients can be effective. However, further research is required to identify the effect of nursing interventions on patient outcomes following stroke.
Self‐reported characteristics of women and men with intimate body piercings
Authors: Caliendo Carol , Armstrong Myrna L. , Roberts Alden E.
Published: February 2005

Aim.  The purpose of this paper is to report the findings of a study exploring factors associated with female and male intimate body piercing, with particular emphasis on health issues.

Background.  Nipple and genital piercings (intimate piercings) have become common types of body art. Scant medical and nursing literature is available, leading to little understanding of these body modifications by health care providers.

Method.  A convenience sample of intimately pierced individuals (63 women and 83 men) from 29 states in the United States of America was surveyed via an author‐developed questionnaire. Questions focused on demographic characteristics, decision factors and health problems related to intimate piercings. Self‐reported characteristics were compared between female and male participants, and participants were compared demographically to United States general population.

Results.  Participants reported wearing nipple piercings (43%), genital piercings (25%) and both types (32%). Respondents were significantly younger, less ethnically diverse, better educated, less likely to be married, more often homosexual or bisexual and they initiated sexual activity at a younger age than the US population. Deliberate, individual decisions for procurement of the intimate piercings were made. Average purchase consideration was at age 25 (nipple) and 27 (genital); average age to obtain the piercing was 27 (nipple) and 28 (genital) years. Purposes for obtaining the piercings included uniqueness, self‐expression and sexual expression. Most participants still liked their piercing (73–90%). Health concerns related to intimate piercings were described by both those with nipple piercings (66%) and with genital piercings (52%) and included site sensitivity, skin irritation, infection and change in urinary flow (male genital). Few STDs (3%) were reported and no HIV or hepatitis. Usually non‐medical advice was sought for problems – often from the body piercer.

Conclusions.  Understanding client rationale is not a necessary prerequisite for providing quality patient care; however, awareness of purposes and decision‐making in intimate piercing can help nurses to be sensitive to client needs and plan appropriate health education.
The meaning for elders of receiving family care
Authors: Crist Janice D.
Published: February 2005

Aims. This paper reports a study undertaken to broaden nurse clinicians’, policy‐makers’, and researchers’ understandings of what it means to elders to receive family care.

Background. The number of older people receiving assistance at home will increase tremendously in coming decades in proportion to the rapidly increasing aged population. Seventy to 80% of the care received by elders is provided by family members. As more elders with fewer family carers are predicted, nursing's insight into the family care phenomenon becomes even more important. The literature contains reports of specific aspects of family care. Most results include reports of elders dreading giving up their independence in the context of Euro‐American United States society's highly valued cultural norm of independence. No studies have explored elders’ views of the meaning of receiving family care.

Methods. Hermeneutic interpretive phenomenology was chosen, and a sample of nine elders (five women and four men) was interviewed. Participants were asked for descriptions of their day‐to‐day experiences of receiving family care in two to five interviews, and were observed interacting with their family carers in naturalistic settings.

Findings. Elders living at home were found to incorporate help from family members comfortably into their lives. They viewed themselves as autonomous and able to maintain balance between autonomy and dependence on loved ones.

Conclusions. Receiving family care may have positive meaning for elders, especially when the care is provided within the context of positive relationships with family carers. These findings are in contrast to previous reports. If validated in further research, they could be used to inform practice and policy in health care systems involved in collaborating with families to develop care arrangements for community‐living elders.
Evaluation of a reflective practice intervention to enhance family care
Authors: Peden‐McAlpine Cynthia , Tomlinson Patricia S. , Forneris Susan G. , Genck Gail , Meiers Sonja J.
Published: February 2005

Aim.  This paper discusses the design, evaluation and outcomes of a reflective practice intervention (RPI) that taught paediatric critical care nurses how to incorporate a family intervention into their practice.

Background.  The literature on reflective practice contains numerous descriptions of reflective practice and various frameworks on how to engage in reflective practice. Additionally, there has been wide debate about the benefits of and problems with the use of reflective practice. However, few empirical studies have been done to evaluate its effectiveness in changing nursing practice.

Method.  Van Manen's phenomenological research approach was adapted for use in this study. This approach was consistent with the experiential nature of reflective practice. Interviews were conducted with eight staff nurse participants after the RPI to determine changes in family practice. Analysis of the interview text produced three essential themes.

Findings.  Three interrelated themes describe change in the nurses’ experiences as a result of participating in the RPI: (1) acknowledging and re‐framing preconceived ideas about families, (2) recognizing the meaning of family stress and (3) beginning to incorporate the family into nursing care.

Conclusions.  The RPI stimulated double loop learning that changed paediatric critical care nurses’ attitudes about family, enhanced their communication and ability to build trusting relationships with families and brought about a new appreciation of the uniqueness of family stress. There was a new integration of family care into the nurses’ practice as a result of the intervention.
Stages of change for physical activity among family caregivers
Authors: Tung Wei‐Chen , Gillett Patricia A.
Published: February 2005

Aim.  This paper reports a study exploring the factors that affect stages of change for regular physical activity in family caregivers in Taiwan.

Background.  In Chinese society, family caregivers play a significant role in the treatment of mentally ill patients in home care because of Chinese cultural obligations. Prochaska and DiClemente's transtheoretical model suggests that individuals adopting physical activity behaviour move through five stages of change. Discovering the factors that affect the stages of change for physical activity of family caregivers of mentally ill patients could have a significant impact on the health of this population, as well as on the health of the patients for whom they care.

Methods.  Family caregivers’ stages for regular physical activity were assessed using The Stages of Change for Regular Physical Activity Questionnaire. Demographic factors were measured using The Family Caregiver's Demographic Characteristic Questionnaire. Data were collected from 108 primary family caregivers of mentally ill patients receiving home care from a psychiatric hospital in southern Taiwan.

Results.  Older caregivers were more likely to be in the action/maintenance stage compared with younger caregivers age [rs(108) = 0·24, P < 0·05]. Caregivers’ stages of change were significantly associated with caregivers’ relationship to the patient [χ2(6, n = 108) = 13·68, P = 0·03], and marital status [χ2(4, n = 108) =10·56, P = 0·03].

Conclusions.  The findings on relationships between stage of change for physical activity, caregivers’ age, relationship to the patient, and marital status represent a first step in better understanding those who do and do not intend to engage in a regularly active lifestyle among family caregivers in Taiwan. This study reveals that cultural issues may play a critical role in physical activity behaviour among Taiwanese family caregivers and need to be further investigated.
Nursing attitudes towards acute mental health care: development of a measurement tool
Authors: Baker John A. , Richards David A. , Campbell Malcolm
Published: February 2005

Aim.  This paper reports the development, piloting and validation of a tool to measure attitudes for use with nursing staff working in acute mental health care units.

Background.  The quality of care provided for service users in acute mental health care has come under both scrutiny and severe criticism. The attitudes of staff working in these environments have been cited as a contributory factor in poor care. No measure of attitudes specific to acute mental health has been reported.

Methods.  A 64‐question measure was constructed and distributed to a sample of qualified and unqualified nurses drawn from seven mental health care units in the North of England. Exploratory factor analysis and a number of other statistical tests were performed to validate the questionnaire.

Results.  Preliminary analysis reduced the original 64 questions to 37. Five components were retained, accounting for 42% of the variance, and the five rotated factors were identified. The resultant ‘Attitudes Towards Acute Mental Health Scale’ (ATAMHS) achieved good internal reliability, with a Cronbach's alpha of 0·72.

Conclusion.  The construction and validation of the ATAMHS measure will enable improved understanding of the attitudes of nursing staff working in acute mental health care settings to occur. This measure is available for use in a clinical area of nursing in which attitude change is of fundamental importance for future development of care.
Improving uptake and adherence in cardiac rehabilitation: literature review
Authors: Beswick Andrew D. , Rees Karen , West Robert R. , Taylor Fiona C. , Burke Margaret , Griebsch Ingolf , Taylor Rod S. , Victory Jackie , Brown Jacqueline , Ebrahim Shah
Published: February 2005

Aims.  This paper presents a comprehensive systematic review of literature carried out to identify studies of interventions to improve uptake, adherence and professional compliance in cardiac rehabilitation.

Background.  Guidelines recommend that cardiac rehabilitation should be offered to patients following acute myocardial infarction and revascularization. Uptake and adherence are low, particularly in women, older people, and socially deprived and ethnic minority patients. Although patient, service and professional barriers to rehabilitation uptake have been described, no attempt has been made to evaluate systematically interventions aimed at improving uptake and adherence in cardiac rehabilitation.

Methods.  A comprehensive search strategy identified studies of cardiac rehabilitation, using the terms uptake, adherence and compliance. The search included grey literature, hand searching of specialist journals and conference abstracts. No language restriction was applied. Studies were summarized in three qualitative overviews and assessed by quality of evidence.

Results.  From 3261 publications identified, 957 were acquired on the basis of title or abstract. Few studies were of sufficient quality to make specific recommendations. Six, 12 and five studies, respectively, provided adequate information on methods to improve uptake, adherence or professional compliance. A minority of studies were randomized controlled trials. Studies of motivational and self‐management strategies and use of lay volunteers showed some promise in improving rehabilitation uptake or lifestyle change. Nurse‐led coordination of care after hospital discharge may have a role in improving rehabilitation uptake. Limited information was provided on resource implications, and there was a lack of studies with under‐represented groups. The literature contained numerous suggested interventions which merit evaluation in appropriately designed studies.

Conclusions.  Little research has been reported evaluating interventions to improve uptake, adherence and professional compliance in cardiac rehabilitation. A wide range of possible interventions was identified and further evaluations of methods are indicated.
Health ‘care’ interventions: making health inequalities worse, not better?
Authors: Hart Angie , Freeman Marnie
Published: February 2005

Aim.  The aim of this paper is to present a model, the ‘Effect of the Professional Ego’, which provides a psychodynamically informed analytical framework for examining professional practice in arenas where issues of inequalities need to be addressed.

Background.  There is a great deal of literature on the psychosocial aspects of inequalities in health care provision. However, the impact of intrapsychic and professional cultural elements has not been explored in this context. Moreover, the body of work which does explore these elements in relation to health care workers does not address how they might impact on health inequalities.

Discussion.  Drawing on empirical work, we discuss ways in which intrapsychic and professional cultural elements feed into the dynamic between clients and health care professionals in a way which can subvert espoused, positive client health outcomes. Based on this discussion, we propose the Effect of the Professional Ego model, which identifies two main aspects of the professional ego – the grandiose self and self‐preservation – and how they influence the professional/client dynamic.

Conclusion.  Systematic self‐reflection on the part of professionals would be a valuable contribution to the development of professional practice. This applies particularly to conceptualizing the links between the actions of service providers and the adverse health of clients.
Impact of interferon‐alpha therapy on liver fibrosis progression in patients with HBeAg‐negative chronic hepatitis B
Authors: Papatheodoridis G. V. , Petraki K. , Cholongitas E. , Kanta E. , Ketikoglou I. , Manesis E. K.
Published: February 2005

Summary.  The possible effect of interferon‐alpha (IFNa) on liver fibrosis progression has not been adequately studied in chronic hepatitis B. We evaluated 147 patients with HBeAg‐negative chronic hepatitis B who had ≥2 liver biopsies and had been treated with IFNa (n = 120) or had remained untreated (n = 27). The median interval between the two biopsies was 24 (12–160) months. All biopsies were scored blindly by a single liver histopathologist according to the classification of Ishak et al. (J Hepatol 1995; 22: 696–699). IFNa induced sustained biochemical response in 30, initial response and subsequent relapse in 57 and no response in 33 patients. Fibrosis improved in 17.5% of treated (sustained responders: 40%, relapsers: 9%, nonresponders: 12%) and 4% of untreated patients and worsened in 34% (sustained responders: 7%, relapsers: 40%, nonresponders: 48%) and 70% of cases, respectively (P = 0.002). The annual rate of fibrosis progression was worse in the untreated (0.427 ± 0.119) than in treated patients (0.067 ± 0.052, P = 0.001). However, the fibrosis progression rate in the untreated patients was not significantly different than the net fibrosis progression rate (after subtraction of IFNa duration) in nonresponders or relapsers. In multivariate analysis, worse fibrosis progression rate was associated with older age (P = 0.010), worse baseline grading score (P < 0.001), lower baseline fibrosis (P = 0.035) and the type of response to IFNa (P = 0.032). In conclusion, in HBeAg‐negative chronic hepatitis B, IFNa significantly reduces the rate of fibrosis progression, but such an effect is mainly observed in patients with sustained biochemical responses. In relapsers and nonresponders, fibrosis benefit equals the treatment period. The strongest factor associated with fibrosis progression is the change in necroinflammatory activity.
Nitric oxide and blood: a review
Authors: Wallis J. P.
Published: February 2005

Summary.  Nitric oxide (NO) was identified as a physiological mediator of vascular tone in 1987. NO produced by endothelial cells causes vasodilatation and also inhibits platelet aggregation and leucocyte adhesion. Red cells metabolize NO to nitrate but may possibly carry and release, or even produce, NO in hypoxic conditions. NO physiology may have important implications for transfusion medicine, ranging from adverse effects of haemoglobin substitutes to preservation of stored platelets and to detrimental effects of stored red cells.
Blood transfusion and autologous donation: a survey of post‐surgical patients, interest group members and the public
Authors: Moxey A. J. , O'Connell D. L. , Treloar C. J. , Han P. Y. S. , Henry D. A.
Published: February 2005

Summary.  Before planned surgery, patients may choose autologous donation in order to avoid the small, but potential, risks of receiving an allogeneic blood transfusion. This study examined the perceived risks of allogeneic blood transfusions, preferences and willingness to pay for autologous donation and the desired role in the decision‐making process in three populations: post‐surgical patients, special interest group members and the general public. Quantitative and qualitative data were collected from 206 respondents with the help of computer‐assisted semi‐structured telephone interviews. Thirty‐three per cent of the sample voiced concerns about receiving allogeneic blood transfusions. The risks of hepatitis C virus, human immunodeficiency virus, variant Creutzfeldt–Jakob disease and a haemolytic reaction were perceived as being low, but were rated as numerically higher than those of other life events that have equal probability. Autologous donation was perceived as removing all the risks associated with transfusion, and respondents were willing to pay a median $976 AUD ($664 US) to use this technique. Over 80% of respondents preferred to be involved in making the decision about whether to use autologous donation. Even though autologous donation is not ‘risk‐free’ and the blood supply is very safe, people overestimate the associated risks and have a preference for their own blood. Decision aids presenting balanced information on the advantages and disadvantages of both allogeneic and autologous blood may be required.
Is third party information true? Should blood donors be excluded because of it?
Authors: Paley O. J.
Published: February 2005

Summary.  The Welsh Blood Service contacted and attempted to interview 40 donors about whom information from a third party had been received. This information would have excluded the donor from donation if it had been forthcoming from the donor. 57·5% of donors denied the information, but 25% of them accepted that the information was true and were removed from the register. 17·5% of donors did not respond and they were also removed from the register.

Interviewing donors, about whom third party information has been received, enables those who have not divulged a risk factor or who do not wish to discuss a risk factor, to be removed from the donor panel. This increases the safety of the blood supply.
Pre‐storage leucocyte depletion and transfusion reaction rates in cancer patients
Authors: Da Ponte A. , Bidoli E. , Talamini R. , Steffan A. , Abbruzzese L. , Toffola R. Tassan , De Marco L.
Published: February 2005

Summary.  Passenger leucocytes transfused with allogenic blood are responsible for potential adverse effects. The impact of pre‐storage leucodepletion (in‐line filtration) of all whole blood units on transfusion reaction rate among patients suffering from cancer was retrospectively studied, comparing all reactions following red blood cell (RBC) transfusions during 2 years of pre‐storage vs. 2 years of selective (bedside) leucodepletion. During selective leucodepletion, 5165 RBC units – of which 2745 were bedside filtered units– were transfused to 866 patients. Twenty‐eight reactions were recorded: 22 (15 in the bedside group) febrile non‐haemolytic transfusion reactions (FNHTR) and six allergic reactions (five in the bedside group). The overall percentage of reactions was 0·54 (0·76 for bedside) and 0·42 for FNHTR (0·54 for bedside). During pre‐storage leucodepletion, 4116 RBC units were transfused to 841 patients. Eleven reactions were recorded: four FNHTR and seven allergic reactions (urticaria). The percentage of reactions for transfused RBC units was 0·26 (0·09 for FNHTR). Comparison between pre‐storage filtration and bedside filtration with regard to FNHTR showed an odds ratio of 2·80 (95% confidence interval = 0·83–14·87) for bedside filtration. The study suggests that, for transfused patients affected by cancer, pre‐storage leucodepletion is more effective than selective (bedside) filtration in reducing the incidence of transfusion reactions (FNHTR).
Compliance with prophylactic platelet transfusion trigger in haematological patients
Authors: Eikenboom J. C. J. , Van Wordragen R. , Brand A.
Published: February 2005

Summary.  The aim of prophylactic platelet transfusions in haemato‐oncologic patients with thrombocytopenia is to prevent bleeding. Currently, a platelet transfusion trigger of 10 × 109 L− 1 is considered to be safe. Transfusion compliance with this trigger can save costs. To investigate the compliance with this trigger of 10 × 109 L− 1, we have evaluated 1447 platelet transfusions given during a period of 1 year to haematological patients. In half of the transfusions, there had been compliance with the trigger of 10 × 109 L− 1. About three‐quarters of all platelet transfusions were given at platelet counts ≤20 × 109 L− 1. Transfusions at levels >20 × 109 L− 1 were usually performed because of bleeding, scheduled interventions or concurrent anticoagulant therapy. We conclude that compliance with the prophylactic platelet transfusion trigger of 10 × 109 L− 1 was about 50%; however, deviation from the trigger was partly explained by risk factors that justify a higher transfusion trigger.
High frequency of partial DIIIa and DAR alleles found in sickle cell disease patients suggests increased risk of alloimmunization to RhD
Authors: Castilho L. , Rios M. , Rodrigues A. , Pellegrino J. , Saad S. T. O. , Costa F. F.
Published: February 2005

Summary.  We have set out to determine the frequency of DIIIa and DAR alleles among sickle cell disease (SCD) patients. These D variants permit the unexpected development of antibodies to RhD among individuals who are otherwise classified as RhD+. DNA samples from 130 SCD patients were tested for 455A>C (specific for DIIIa), 602C>G, 667T>G (common for both DIIIa and DAR) and 1025T>C (specific for DAR) by polymerase chain reaction‐restriction fragment length polymorphism (PCR‐RFLP) and sequence analysis. The PCR‐RFLP showed that 12 (9·2%) of the SCD patients were carrying DIIIa and DAR alleles. Genomic DNA analysis performed by sequence showed that three samples were heterozygous DIIIa (2·3%), seven heterozygous DAR (4·6%) and two (1·5%) samples carried a partial D with four mutations: 455A>C (heterozygous), 602C>G and 667T>G (homozygous) and 1025T>C (heterozygous), indicating compound heterozygosity for one DIIIa allele and one DAR allele. The predicted phenotypes of eight (6·2%) SCD patients were DIIIa, DAR and DIIIa/DAR. Three patients were anti‐D immunized (DAR, n = 1; DIIIa/DAR, n = 2). These findings suggest that SCD patients who are candidates for chronic transfusion may benefit from genotyping for DIIIa and DAR to prevent alloimmunization.
Social Welfare Functionals on Restricted Domains and in Economic Environments
Authors: BORDES GEORGES , HAMMOND PETER J. , LE BRETON MICHEL
Published: February 2005

Arrow's “impossibility” and similar classical theorems are usually proved for an unrestricted domain of preference profiles. Recent work extends Arrow's theorem to various restricted but “saturating” domains of privately oriented, continuous, (strictly) convex, and (strictly) monotone “economic preferences” for private and/or public goods. For strongly saturating domains of more general utility profiles, this paper provides similar extensions of Wilson's theorem and of the strong and weak “welfarism” results due to d'Aspremont and Gevers and to Roberts. Hence, for social welfare functionals with or without interpersonal comparisons of utility, most previous classification results in social choice theory apply equally to strongly saturating economic domains.
Stable Assignment of Public Facilities under Congestion
Authors: BOGOMOLNAIA ANNA , NICOLÒ ANTONIO
Published: February 2005

We study the problem of locating multiple public facilities when each member of society has to be assigned to exactly one of these facilities. Individuals' preferences are assumed to be single‐peaked over the interval of possible locations and negatively affected by congestion. We characterize strategy‐proof, efficient, and stable allocation rules when agents have to be partitioned between two groups of users and discuss the normative content of the stability property. Finally we prove that when more than two groups have to be formed, even with common information on the distribution of the peaks, there is no strategy‐proof, efficient, and stable allocation rule.
Bunching, Time Constraints, and Workfare
Authors: BRETT CRAIG
Published: February 2005

This paper explores the use of workfare as part of the optimal tax mix. When agents have preferences that are quasilinear in leisure, unproductive workfare is optimal only if an optimal nonlinear tax scheme in the absence of workfare would feature distortions at the bottom of the wage distribution. These distortions can arise from two sources: binding constraints on the maximum available time, and bunching. An example is presented to illustrate the computation of an optimal schedule with work requirements.
Poverty‐Reducing Tax Reforms with Heterogeneous Agents
Authors: DUCLOS JEAN‐YVES , MAKDISSI PAUL , WODON QUENTIN
Published: February 2005

The poverty impact of indirect tax reforms is analyzed using sequential stochastic dominance methods. This allows agents to differ in dimensions that cannot always be precisely captured within the usual money‐metric indicators of living standards. Examples of such dimensions include household size and composition, temporal or spatial variation in price indices, and individual needs and “merits.”
Committee report: Guidelines for human startle eyeblink electromyographic studies
Authors: Blumenthal Terry D. , Cuthbert Bruce N. , Filion Diane L. , Hackley Steven , Lipp Ottmar V. , Van Boxtel Anton
Published: February 2005

The human startle response is a sensitive, noninvasive measure of central nervous system activity that is currently used in a wide variety of research and clinical settings. In this article, we raise methodological issues and present recommendations for optimal methods of startle blink electromyographic (EMG) response elicitation, recording, quantification, and reporting. It is hoped that this report will foster more methodological validity and reliability in research using the startle response, as well as increase the detail with which relevant methodology is reported in publications using this measure.
Hysteroscopic sterilisation: a study of women's attitudes to a novel procedure
Authors: Baxter N. , Hudson H. , Rogerson L. , Duffy S.
Published: February 2005

Laparoscopy is the most common mode of surgery for female tubal sterilisation. Hysteroscopic sterilisation is a new method which can be performed in the outpatient setting under local anaesthetic. We carried out a prospective cohort trial to determine whether women would actually favour hysteroscopic sterilisation over laparoscopic sterilisation. Data analysis in a cohort of 96 women showed that 77% would prefer laparoscopic sterilisation over the hysteroscopic procedure (23%), despite the advantages of an outpatient setting. Age, obstetric history, employment and marital status, access to transport and previous anaesthetic did not significantly influence the choice made.
Safety and efficacy of using the LigaSure vessel sealing system for securing the pedicles in vaginal hysterectomy: randomised controlled trial
Authors: Hefni M.A. , Bhaumik J. , El‐Toukhy T. , Kho P. , Wong I. , Abdel‐Razik T. , Davies A.E.
Published: February 2005

Objective  To assess the safety and efficacy of using the LigaSure vessel sealing system for securing the pedicles during vaginal hysterectomy in comparison with the conventional method of securing the pedicles by suture ligation.

Design  Randomised controlled trial.

Setting  Gynaecology Department, Benenden Hospital, Kent.

Population  One hundred and sixteen women undergoing vaginal hysterectomy were prospectively randomised to either LigaSure (Group I) or suture ligation (Group II) for securing the pedicles.

Methods  Data of patients were collected prospectively. Statistical analysis was performed using the Mann–Whitney U test, χ2 and Fisher's exact test as appropriate.

Main outcome measures  Operating time, operative blood loss and peri‐operative complications.

Results  The operating time was significantly shorter in the LigaSure group compared with the control group (P < 0.04). There was no statistical significant difference between the two groups in operative blood loss (P= 0.433), but peri‐operative haemorrhagic complications were less frequent in the LigaSure group (0%vs 6.8%, P= 0.057). Four patients in the control group required either conversion to laparotomy because of bleeding, return to theatre for immediate post‐operative haemorrhage or readmission for vault haematoma, whereas none in the LigaSure group had bleeding from unsecured pedicles.

Conclusion  The LigaSure vessel sealing system is a safe alternative for securing pedicles in vaginal hysterectomy when compared with conventional suture ligation. Larger studies are required to determine its place in gynaecological surgery.
Social and environmental conditions across the life course and age at menopause in a British birth cohort study
Authors: Hardy Rebecca , Kuh Diana
Published: February 2005

Objective To assess whether socio‐economic status, environmental stress and hardship throughout the life course are associated with age at menopause.

Design Birth cohort study.

Setting England, Scotland, Wales.

Sample A total of 1515 women from a stratified sample of all births in one week in 1946.

Methods Age at menopause was collected using annual postal questionnaires from age 47 to 53 years. Information on socio‐economic conditions and hardship were collected at contacts throughout life from age 2 to 43 years. Socio‐economic indicator variables were defined to represent cumulative exposure to hardship in childhood and in adulthood.

Main outcome measures Age at menopause.

Results Cox's proportional hazard models indicated that women whose fathers were in a manual social class occupation at three time points during her childhood had an earlier age at menopause than those whose fathers were in non‐manual occupations at all three (HR: 1.51; 95% CI: 0.93–2.47). Similar findings were seen for household crowding. These socio‐economic gradients could not be explained by adult socio‐economic status, behaviour and lifestyle or by psychological health and stress, but were attenuated by other early life factors. Women who experienced parental divorce early in life (before five years of age) had double the rate of menopause of those whose parents did not divorce (HR: 2.14; 95% CI: 1.33–3.42). There were no consistent findings with adult socio‐economic indicators.

Conclusions There is some evidence of a cumulative effect of socio‐economic circumstances in childhood, but not in adulthood, on age at menopause. Childhood nutrition, cognition and emotional stress possibly underlie the social gradient.
Proteinuria in pre‐eclampsia: how much matters?
Authors: Chan Patricia , Brown Mark , Simpson Judy M. , Davis Gregory
Published: February 2005

Objective  To determine, in women with proteinuric pre‐eclampsia, whether a discriminant value of proteinuria at the time of diagnosis predicts the presence or absence of subsequent adverse maternal and fetal outcomes.

Design  Retrospective cohort study.

Setting  One teaching hospital and two primary referral hospitals in Sydney, Australia.

Sample  Three hundred and twenty‐one pregnant women with proteinuric pre‐eclampsia, managed according to a uniform management protocol.

Methods  All women with the diagnosis of proteinuric pre‐eclampsia in the years 1998–2001 were studied. After exclusion of women with pre‐eclampsia superimposed on pre‐existing hypertension, a twin pair, unavailable spot urine results, 353 women were analysed using logistic regression to determine separately the predictors of any adverse maternal or fetal outcomes at the time of delivery. Receiver operating characteristic (ROC) curves, sensitivity and specificity were then calculated from the data.

Main outcome measures  Adverse maternal outcomes: severe maternal hypertension (BP ≥ 170/110 mmHg), renal insufficiency, liver disease, cerebral irritation, haematological disturbances. Adverse fetal outcomes: small for gestational age, perinatal mortality.

Results  There were 108 (34%) adverse maternal outcomes and 60 (19%) adverse fetal outcomes including two stillbirths. In multivariate analysis, an adverse maternal outcome was significantly associated with higher spot urine protein/creatinine ratio at diagnosis (P < 0.0001) with an odds ratio (OR) of 1.003 per mg/mmol (95% confidence interval [CI] 1.002–1.004) and with older maternal age (P= 0.014) with OR 1.06 per year (95% CI 1.01–1.11). An increased risk of adverse fetal outcome was associated with higher spot urine protein/creatinine (P= 0.013; OR 1.44 per log [mg/mmol], 95% CI 1.08–1.92), gestation at diagnosis <34 weeks (P < 0.0001; OR 3.60, 95% CI 1.90–6.82) and early pregnancy systolic blood pressure ≤115 mmHg (P= 0.0002; OR 3.41, 95% CI 1.77–6.57). The area under the receiver operating characteristic (ROC) curve was 0.67 for adverse maternal outcomes and 0.72 for adverse fetal outcomes.

Conclusions  With increasing proteinuria, there is increased risk of adverse maternal and fetal outcomes. Although we did not identify a specific spot protein/creatinine ratio that could be used as a definitive screening value for adverse outcomes, it is possible to utilise data from this study to predict the likelihood of adverse maternal and fetal outcomes. A high spot urine protein/creatinine ratio in pre‐eclamptic women of greater than 900 mg/mmol (∼9 g/day), or greater than 500 mg/mmol (∼5 g/day) in women over 35 years, is associated with a greatly increased likelihood of adverse maternal outcomes.
Cardiovascular death in women who had hypertension in pregnancy: a case–control study
Authors: Arnadottir Gerdur A. , Geirsson Reynir T. , Arngrimsson Reynir , Jonsdottir Lilja S. , Olafsson Örn
Published: February 2005

Objective  To determine whether an association exists between hypertension in pregnancy and later development of cardiovascular disease.

Design  Case–control study of women who delivered with and without hypertensive complications during the same period.

Setting  University Hospital in Reykjavik, Iceland.

Population  Three hundred and twenty‐five women with hypertension in pregnancy (blood pressure ≥140/90 mmHg after 20 weeks of gestation) in the years 1931–1947, graded by severity. For each case, two normotensive control women, delivering before or after the case and matched for parity and age were selected, giving a total of 629 women.

Methods  Causes of death were evaluated for the presence of ischaemic heart disease, cerebrovascular events and cancer, up until the end of 1996.

Main outcome measures  Survival curves, median survival times, risk of death by age group and severity of disease.

Results  Death with evidence of ischaemic heart disease was more common in cases (24.3%) than in control women (14.6%) (RR 1.66; 95% CI 1.27–2.17). Cerebrovascular event deaths occurred in 9.5% of cases and in 6.5% of controls (RR 1.46; 95% CI 0.94–2.28). Cancer death rates were not different (RR 1.22; 95% CI 0.91–1.63). Survival times were shorter on average by three to nine years as a consequence of cardiovascular disease. This varied by age group in the index pregnancy for women with a history of hypertension in pregnancy. The effect was smaller if the case pregnancy occurred at a young age. There was a linear trend with increasing severity of hypertensive disease in pregnancy in death rates from ischaemic heart disease (χ21= 5.8, P= 0.02).

Conclusions  Long term follow up suggests an increased risk of death from ischaemic heart disease and cerebrovascular events among women who suffered hypertension in pregnancy.
Is radical hysterectomy for early stage cervical cancer an outdated operation?
Authors: Selman T.J. , Luesley D.M. , Murphy D.J. , Mann C.H.
Published: February 2005

Radical hysterectomy and pelvic lymphadenectomy is the standard surgical treatment for early stage cervical cancer. This operation is well recognised as having a higher morbidity and mortality rate than a simple hysterectomy. We studied the histology results of 131 patients who had standard surgery for cervical cancer to ascertain if a radical hysterectomy was required for adequate treatment. Of 110 (84%) patients with negative pelvic lymphadenopathy, only 9 (8%) had positive parametrial histology and all required adjuvant therapy independent of their parametrial histology. This study confirms that a less radical hysterectomy and pelvic lymphadenectomy provides adequate treatment and allows us to consider a more conservative, minimal access approach to the management of these patients.
Outcome of fertility‐preserving treatment in young women with endometrial carcinomas
Authors: Niwa K. , Tagami K. , Lian Z. , Onogi K. , Mori H. , Tamaya T.
Published: February 2005

Objective  To evaluate the outcome of conservative treatment of young women with endometrial cancer.

Design  Observational study.

Setting  Gifu University Hospital, Japan from 1988 to 2002.

Population  Twelve women with endometrial cancer, FIGO IA estimated by MRI under 35 years.

Methods  Patients were treated with medroxyprogestreone acetate (400–600 mg/day) for 6–10 months, with endometrial curettage performed every four weeks.

Main outcome measures  Response to therapy, pregnancies and reoccurrence of disease during follow up over a 30‐month period.

Results  All cases had pathological complete remissions within 6–10 months. Seven of 10 wishing to have babies conceived, and five of them were delivered of full‐term babies. Eight of nine cases receiving long term follow up (over 30 months) developed recurrent disease, with four opting for hysterectomy. No patient developed distant metastases or had disease‐related death.

Conclusion  Conservative therapy is feasible in carefully selected young women with endometrial cancer. Recurrence rates were high during long term observation even after pathological complete remissions. Therefore, close follow up is recommended.
Obstetric anal sphincter injury ten years after: subjective and objective long term effects
Authors: Fornell Eva Uustal , Matthiesen Leif , Sjödahl Rune , Berg Göran
Published: February 2005

Objective  To establish the long term effects of obstetric anal sphincter rupture.

Design  Prospective observational study.

Setting  University hospital in Sweden.

Population  Eighty‐two women from a prospective study from 1990 to compare anorectal function after third degree tear.

Methods  Women completed a structured questionnaire, underwent a clinical examination and anorectal manometry, endoanal ultrasound (EAUSG) with perineal body measurement.

Main outcome measures  Symptoms of anal incontinence, sexual symptoms, anal manometry scores and evidence of sphincter damage on EAUSG.

Results  Five women had undergone secondary repair and three were lost to follow up. Fifty‐one women (80%) completed the questionnaire. Twenty‐six out of 46 (57%) of the original study group and 6/28 (20%) of the original controls were examined. Incontinence to flatus and liquid stool was more severe in the study group than in controls. Flatus incontinence was significantly more pronounced among women with subsequent vaginal deliveries. Mean maximal anal squeeze pressures were 69 mmHg in the partial rupture group and 42 mmHg in the complete rupture group (P= 0.04). Study group women with signs of internal sphincter injury reported more pronounced faecal incontinence and had lower anal resting pressures (24 mmHg) than those with intact internal sphincters (40 mmHg) (P= 0.01). Perineal body thickness of less than 10 mm was associated with incontinence for flatus and liquid stools, less lubrication during sex and lower anal squeeze pressures (58 mmHg vs 89 mmHg, P= 0.04).

Conclusions  Subjective and objective anal function after anal sphincter injury deteriorates further over time and with subsequent vaginal deliveries. Thin perineal body and internal sphincter injury seem to be important for continence and anal pressure.
Pregnancy following uterine artery embolisation for symptomatic fibroids: a series of 26 completed pregnancies
Authors: Carpenter T.T. , Walker W.J.
Published: February 2005

Objectives  To evaluate the outcome of pregnancies after uterine artery embolisation for uterine fibroids.

Design  Retrospective analysis of pregnancy subsequent to uterine artery embolisation by one interventional radiologist.

Setting  A UK District General Hospital.

Population  Twenty‐nine pregnancies in 671 women who had undergone uterine artery embolisation.

Methods  Cases were identified by screening questionnaire and from the study database. Detailed information was collected by questionnaires, direct conversations with women and, when necessary, from hospital records.

Main outcome measures  Pregnancy outcome, complications and neonatal outcomes.

Results  Of 26 completed pregnancies, detailed information was available for 24 and limited information for 2. Seven (27%) ended in miscarriage, there were two terminations and one ectopic pregnancy. Of 16 deliveries after 24 weeks, first and second trimester bleeding occurred in 40% and 33%, respectively, 4 (25%) had preterm deliveries and the caesarean section rate was 88%. Two (13%) women developed proteinuric hypertension and two others had preterm spontaneous rupture of the membranes. Fourteen of 16 cases were delivered by caesarean section. The rate of primary postpartum haemorrhage was 3/15 (20%). The mean birthweight of term babies was 3.39 kg (SD 0.64) and none required admission to neonatal intensive care. There was one (6.7%) case of fetal growth restriction.

Conclusion  Although this study is relatively small, there is an increase in delivery by caesarean section. There does not appear to be any other major excess obstetric associated risk when the demographics of the population in question is considered.
Multifilament polypropylene mesh for urinary incontinence: 10 cases of infections requiring removal of the sling
Authors: Bafghi Abdolreza , Benizri Emmanuel I. , Trastour Cynthia , Benizri Eric J. , Michiels Jean‐François , Bongain André
Published: February 2005

One hundred and forty‐nine women received a suburethral woven polypropylene mesh insertion for urodynamic stress incontinence. Eleven patients (7.5%) presented between 4 and 17 months after surgery (mean 10 months) with symptoms of retropubic infection. Ten patients required surgical exploration, drainage of the collection and removal of the tape either unilaterally (six) or bilaterally (four). Bacterial cultures were negative in nine women. Following removal of the tape, eight patients reported residual incontinence, either stress leakage (five) or de novo urge incontinence (three). Multifilament polypropylene meshes appear to be more at risk of infection, usually requiring sling removal, which may be related to pore size of the mesh. Our data reinforce the importance of proper evaluation of new surgical procedures by rigorously designed randomised trials with adequate follow up to identify rare but potentially serious complications.
Fetal fibronectin test predicts delivery before 30 weeks of gestation in high risk women, but increases anxiety
Authors: Shennan Andrew , Jones Griff , Hawken Jennifer , Crawshaw Sarah , Judah Jeanette , Senior Victoria , Marteau Theresa , Chinn Susan , Poston Lucilla
Published: February 2005

Objective  To assess efficacy of cervico‐vaginal fetal fibronectin as a predictor of spontaneous preterm birth in a high risk antenatal population, and to evaluate the psychological impact of fetal fibronectin testing.

Design  An observational study.

Setting  The antenatal clinic at a tertiary referral hospital.

Population  One hundred and forty‐six pregnant women with known risk factors for spontaneous preterm birth.

Methods  Women designated as ‘at risk’ for preterm delivery by clinical history were screened for fetal fibronectin at 24 and again at 27 weeks of gestation. Anxiety levels were assessed by questionnaire and compared with anxiety levels of 206 low risk women also tested for fetal fibronectin. Fetal fibronectin results were disclosed to the woman and her clinician.

Main outcome measures  Maternal anxiety and efficacy of the 24‐week fetal fibronectin test to predict delivery before 30, 34 and 37 weeks of gestation.

Results  Maternal anxiety was higher pretesting in those at high risk compared with low risk women undergoing the test. Among the high risk women, anxiety was raised to clinically significant levels in those receiving a positive fetal fibronectin screening test result. In all women, 5%, 9% and 21% delivered <30, <34 or <37 weeks of gestation, respectively. Nine percent (n= 13) tested positive for fetal fibronectin at 24 weeks. Predictive power for fetal fibronectin (24 weeks) was greatest for delivery <30 weeks of gestation, with a likelihood ratio of 15 for a positive test (6/13 positive women delivered before 30 weeks).

Conclusions  Fetal fibronectin was most efficient as a predictor of preterm spontaneous delivery <30 weeks of gestation, but was associated with high levels of anxiety.