bluuebunny/crossref_metadata_2025 huggingface dataset:
Proctocolectomy and pelvic pouch – Is a diverting stoma dangerous for the patient?
Authors: Gunnarsson U. , Karlbom U. , Docker M. , Raab Y. , Påhlman L.
Published: December 2003

Objective  A diverting loop ileostomy was previously considered mandatory for minimizing the effects of septic complications in pelvic pouch surgery. During the past decade there has been a trend towards omission of the loop ileostomy without obvious signs of increased numbers of pouch complications or impaired long‐term function. The aim of the present study was to evaluate the risk of complications associated with the construction and closure of the loop ileostomy itself.

Patients and methods  Complications following diverting loop ileostomies in 143 patients subjected to restorative pelvic pouch surgery during the period 1983–97 were studied retrospectively by evaluation of case records.

Results  In the period between discharge after pelvic pouch surgery and closure of the loop ileostomy, 20 (14%) patients were hospitalized because of excessive stoma flow and 19 (13%) patients were treated for other surgical complications, of whom 10 (7%) required surgical intervention. In the early postoperative period (within 30 days) after closure of the loop ileostomy, 18 (13%) patients suffered complications necessitating surgery. Another 12 (8%) patients were hospitalized because of intestinal obstruction that could be treated conservatively.

Conclusion  The proportion of complications associated with diverting loop ileostomies in pelvic pouch surgery was considerable. A randomised controlled multicentre study is ethically defensible and is recommended.
Ano‐rectal physiological changes after rubber band ligation and closed haemorrhoidectomy
Authors: Bursics A. , Weltner J. , Flautner L. E. , Morvay K.
Published: December 2003

Objective  The effect of treatment for haemorrhoids on ano‐rectal physiology was studied in a prospective longitudinal follow‐up study.

Methods  Thirty‐six consecutive patients having II–III degree (Group I, 18 patients) or IV degree (Group II, 18 patients) haemorrhoids were studied. Group I underwent rubber band ligation while Group II underwent closed scissors haemorrhoidectomy.

Results  Patients in Group I had significantly lower maximum basal pressure (P < 0.05) and also significantly lower maximum squeeze pressure (P < 0.05) compared to Group II before treatment. Both basal and squeeze pressures dropped after haemorrhoidectomy (P < 0.001) whereas they remained unchanged after rubber band ligation (P > 0.1). The volume of first sensation was higher in Group II before treatment (P < 0.001) and remained so after treatment. Rectal compliance was higher (P < 0.005) in Group I before treatment. It increased significantly in both groups (P < 0.05, Group I; P < 0.001, Group II) after treatment.

Conclusions  The results show a significant increase in anal pressures in constantly prolapsing (IV degree) haemorrhoids. Most of the physiological differences observed between the two groups were abolished after treatment. This suggests that these may be a consequence rather than a cause of haemorrhoids.
The role of positron emission tomography in the management of colorectal cancer
Authors: Tutt A. N. J. , Plunkett T. A. , Barrington S. F. , Leslie M. D.
Published: December 2003

Positron emission tomography (PET) is a functional imaging modality that has made the transition from the research enviroment to the clinical enviroment over the last 10 years. Its major role is in the field of oncology where it is being used increasingly in the management of several tumour types including colorectal cancer. This review aims to outline the current and future role of PET scanning in the field of colorectal cancer.
Cultural Differences in Newcomer Feedback Seeking: A Comparison of the United States and Hong Kong
Authors: Morrison Elizabeth Wolfe , Chen Ya‐Ru , Salgado Susan Reilly
Published: December 2003

Les travaux sur la recherche de feedback de la part des nouveaux arrivants peuvent s’appuyer sur des présupposés qui ne sont pas universellement valides, à savoir que les nouveaux arrivants font preuve d’auto‐affirmation, qu’ils jugent leur patron accessible (faible distance hiérarchique) et qu’ils doivent faire preuve d’initiative pour obtenir l’information dont il ont besoin, ce qui relève d’un processus de socialisation individuelle et informelle. Dans cette étude sur les nouveax arrivants, les Americains signalèrent plus de demandes de feedback que les gens de Hong Kong. Cette divergence est à rapporter aux différences culturelles dans l’auto‐affirmation et la distance hiérarchique. Ces résultats suggèrent que certains des présupposés implicites concernant la recherche de feedback de la part des nouveaux arrivants peuvent voir leur validité remise en cause en debors des Etats‐Unis. En particulier, les nouveaux arrivants vivant dans des sociétés communautariste et à grande distance hiérarchique sont moins susceptibles de faire appel à la rétroaction centrée sur le supérieur pour réduire l’incertitude et gérer leur efficacité professionnelle.

Research on newcomer feedback seeking may be based on assumptions that are not universally valid: that newcomers are self‐assertive, that they perceive their boss as approachable (low power distance), and that they need to be proactive to obtain the information that they need (informal, individual socialisation process). In this study, individuals from the United States reported more newcomer feedback inquiry than individuals from Hong Kong. This difference was related to cultural differences in self‐assertiveness and power distance. These results suggest that some of the implicit assumptions about newcomer feedback seeking may be less valid outside of the US. In particular, newcomers within low‐individualism and high power distance societies may be less likely to rely on supervisor‐focused feedback inquiry for reducing uncertainty and managing their performance.
The Effect of Upward Feedback on Managerial Behavior
Authors: Heslin Peter A. , Latham Gary P.
Published: December 2003

Un feed‐back de gratification a été donné par des subordonnés aux managers australiens d’une firme internationale de prestation de services. Dans cette recherche quasi‐expérimentale, la perfomance au travail de ces managers, a pu être observée six mois plus tard par les subordonnés comme s’étant accrue par rapport à la performance initiale et à ceux obtenus par un groupe de comparaison. L’efficacité personnelle modère la portée de ces résultats suggérant qu’elle joue un rôle clé en déterminant des réactions comportementales au feed‐back de gratification. L’orientation vers un but d’apprentissage fut corrélée de manière significative à leur performance subséquente.

Upward feedback from subordinates was provided to Australian managers in an international professional services firm. The job performance of the managers in this quasi‐experimental study was observed by subordinates to be significantly higher six months later, compared to both initial performance and subordinate ratings of a comparison group. Self‐efficacy moderated this finding, suggesting that it plays a key role in determining behavioral reactions to upward feedback. The managers’ learning goal orientation correlated significantly with their subsequent performance.
Eastern versus Western Control Beliefs at Work: An Investigation of Secondary Control, Socioinstrumental Control, and Work Locus of Control in China and the US
Authors: Spector Paul E. , Sanchez Juan I. , Siu Oi Ling , Salgado Jesus , Ma Jianhong
Published: December 2003

La théorie et la recherche concernant les croyances (LOC) et les perceptions du contrôle suggèrent que les Asiatiques tendent à obtenir des scores plus bas et àêtre plus passifs que les Américains, mais ces travaux ont été menés à l’aide de concepts et d’échelles développés principalement aux USA qui certifient une primauté du contrôle interne (ex: en changeant l’environnement pour l’adapter à soi). Une équipe de recherche internationale a étendu la notion de croyance dans le contrôle en développant des échelles qui permettent de reconsidérer la notion en faisant état de croyances secondaires dans le contrôle (ex: en adaptant le soi à l’environnement) et de faire état d’un concept nouveau de croyances socio‐instrumentales (ex: le contrôle par les relations interpersonelles) qui permettent de rendre compte de manière plus pertinente des croyances en un contrôle dans les cultures collectivistes. Nous nous attendions à ce que, par l’utilisation d’échelles culturellement appropriées, les Américains n’obtiennent pas une croyance en un contrôle plus importante que les Asiatiques. Les hypothèses ont été partiellement confirmées en ce que les Américains se sont montrés comme obtenant un contrôle plus bas que les Chinois (de Hong Kong et de RP de Chine) sur ces échelles. Il est suggéré que voir les Asiatiques comme évitant passivement le contrôle au travail peut être incorrect et dû aux insuffisances de contrôle socio‐instrumental.

Research and theory concerning beliefs (locus of control) and perceptions of control suggest that Asians tend to be lower and more passive than Americans, but this work has been conducted mainly with US‐developed constructs and scales that assess primary control (i.e. changing the environment to adapt to the self). An international research team expanded the notion of control beliefs by developing scales to assess secondary control beliefs (i.e. adapting the self to the environment) and the new construct of socioinstrumental control beliefs (i.e. control via interpersonal relationships), both of which were thought to better fit the control beliefs of collectivist cultures than Western‐developed control scales. We expected that, when culturally appropriate scales were employed, Americans would not show higher control beliefs than Asians. Hypotheses were partially confirmed that Americans would be lower than Chinese (Hong Kong and PR China) on these new scales. It is suggested that views of Asians as passive avoiders of control at work may be incorrect and due to the overlooking of socioinstrumental control.
Components and Symbols of Ethnic Identity: A Case Study in Informal Education and Identity Formation in Diaspora
Authors: Cohen Erik H.
Published: December 2003

L’identité des membres de groupes ethniques qui vivent dans de nombreux pays est influencée par la culture environnante. Ce travail développe un outil qui peit aider les chercheurs à comprendre la façon dont les individus vivent leur identité ethnique. On analyse les composantes et les symboles qui fixent l’dentification ethnique. L’application de techniques d’analyse multidimentionnelle à un ensemble de données empiriques révéla une structure identitaire sur deux axes (cognitif–affectif; particulier–universel). Cette structure permet de faire des comparaisons entre des sous‐populations nationales selon leurs perceptions et accentuations diversifiées de l’identité ethnique. On examine ici les cas de membres de l’enseignement relevant de l’éducation juive informelle. 2119 de ces personnes provenant de sept pays ont fourni des définitions d’elles‐mêmes et des symboles qui exprimaient leur lien avec l’héritage ethnique et religieux. Cette typologie de base pourrait être utilisée dans des études portant sur d’autres groupes ethniques dont les membres ont émigré dans divers pays d’acceuil.

The ethnic identity of members of ethnic groups who live in a number of different countries is influenced by the surrounding cultures. This study develops a tool which can help researchers understand the ways in which individuals perceive their own ethnic identity. The components and symbols that determine ethnic identification are analysed. By applying multidimensional analysis techniques to a set of empirical data, we were able to uncover a structure of identity along two axes: the cognitive/affective and the specific/universal. This structure enables us to make comparisons between national sub‐populations in terms of their various emphases and perceptions of ethnic identity. We examine here the case of staff members in Jewish informal educational settings: 2,119 staff members from seven countries were surveyed on the self‐definitions and symbols that express their relationship with their ethnic and religious heritage. This basic typology could be used in studies of other ethnic groups whose members have emigrated to a number of host countries.
From Dramaturgy to Theatre as Technology: The Case of Corporate Theatre*
Authors: Clark Timothy , Mangham Iain
Published: December 2003

ABSTRACT This article examines a piece of corporate theatre. Although theatre has entered organization studies through the dramatistic writing of Kenneth Burke and the dramaturgical writings of Erving Goffman, this article is concerned with an approach variously described asorganizational, radical,situationorcorporatetheatre that treats theatre not primarily as a resource, an ontology or a metaphor but as a technology. This approach involves the deployment by an organization of dramatists, actors, directors, set designers, lighting specialists, and musicians to put on performances in front of audiences. Using frameworks derived from studies of theatre a particular piece of corporate theatre is described and analysed. It is argued that this form of theatre appears to be used to contain reflection and to promote the views of a particular group within an organization. It does not confront an audience but subtly suggests alternative ways of evaluating, construing and understanding issues. This may be achieved by anaesthetizing audience reaction by encouraging imaginative participation in the performance so that cherished beliefs and values do not appear to be directly challenged.
Exploring Organizationally Directed Citizenship Behaviour: Reciprocity or ‘It's my Job’?*
Authors: Coyle‐Shapiro Jacqueline A‐M. , Kessler Ian , Purcell John
Published: December 2003

ABSTRACT  This study sets out to examine two explanations for why employees engage in organizational citizenship behaviour (OCB). The first explanation views OCB as a form of reciprocation where employees engage in OCB to reciprocate fair or good treatment from the organization. The second view is that employees engage in OCB because they define those behaviours as part of their job. The research methodology consisted of survey data from 387 hospital employees on their perceptions of procedural and interactional justice, mutual commitment, job breadth and OCB. The results suggest that procedural and interactional justice are positively associated with mutual commitment that in turn, is related directly to OCB and indirectly through expanding the boundaries of an individual's job. These findings suggest that together the reciprocation thesis and ‘it's my job’ argument complement each other and provide a more complete foundation for our understanding of OCB. The difference between the two perspectives lies in the process by which individuals respond; that is, role enlargement and role maintenance. Implications and directions for future research are discussed.
Is a Long‐term Business Relationship an Implied Contract? Two Views of Relationship Disengagement*
Authors: Harrison Debbie
Published: December 2003

ABSTRACT Current knowledge of business‐to‐business relationship dissolution centres upon definitions of relationship dissolution, models of dissolution, antecedents for dissolution, and dissolution strategies. In this paper an empirical case example of a terminated business relationship in the aftermath stage of the dissolution process is presented. William Baird sued Marks and Spencer for £53.6 m for breach of contract. The relationship between the actors was long‐term, exclusive, and involved substantial investment in specific assets. There was no written contract in place, yet one actor considered that the relationship was equal to an implied contract. The contribution of the paper is to discuss the possibility for legal redress using the transaction cost economics, relational contracting, and industrial networks literatures.
On Vision, Spectacle and Panorama
Authors: Rowe Dorothy
Published: December 2003

Books reviewed in this article:

Michael Fried, Menzel's Realism: Art and Embodiment in Nineteenth‐Century Berlin

Jonathan Crary, Suspensions of Perception: Attention, Spectacle and Modern Culture

Wilhem S. Wurzer (ed), Panorama: Philosophies of the Visible
Dancers Exult at the Awakening
Authors: Smith W. Alan
Published: December 2003

Abstract.  This article explores the art form of dance as a metaphor for the teaching of theology. Employing the work of Maria Harris, the author contends that there are seven elements of dance than can serve as metaphors for teachers of theology: preparation, rhythm, movement, expectancy, response, embodiment, and performance. Each dance element is described in detail, and the correlations between specific elements of dance and how one might teach theology are presented as possible methodological steps for teaching.
Experiential Learning and Social Justice Action: An Experiment in the Scholarship of Teaching and Learning
Authors: Glennon Fred
Published: December 2003

Abstract.  This essay discusses the process and findings of an experiment on the scholarship of teaching and learning conducted in a religious ethics classroom that utilized an experiential approach to teaching and learning about social justice. The first part lays out the focus of the investigation and the pedagogical principles drawn from experiential learning theory that provided the foundation for the experiment. The second part describes all of the components of the pedagogical strategy used in the experiment, the social justice action project. The third part discusses the qualitative methodology used to gather evidence and the findings drawn from that evidence. What the evidence shows is that an experiential approach to teaching and learning about social justice can be quite effective. The essay concludes with discussions of areas for further study and the implications for the practice of others. (The survey described in this article can be found on the Wabash Center Web site〈http://www.wabashcenter.wabash.edu/journal/glennon.html〉).
Excision of mature teratoma using culdotomy, with and without laparoscopy: a prospective randomised trial
Authors: Wang Peng‐Hui , Lee Wen‐Ling , Juang Chi‐Mou , Tsai Wen‐Ying , Chao Hsiang‐Tai , Yuan Chiou‐Chung
Published: December 2003

Objective To compare the results of removing mature teratoma with laparoscopy or without laparoscopy.

Design A prospective, randomised trial.

Setting Medical centre.

Participants Seventy‐nine women with mature teratomas identified using results of ultrasound examinations and biochemical markers.

Intervention Cystectomy with laparoscopic approach or without laparoscopic approach through a culdotomy.

Methods Patients were randomly assigned to have their cysts removed via vaginal cystectomy without laparoscopy (n=37, Group A) or laparoscopic cystectomy via culdotomy opening (n=42, Group B). Inclusion criteria were history of vaginal delivery, no previous abdominal surgery, no history of pelvic inflammatory disease, no medical illness, and no presenting symptoms. Eight women randomised to Group A withdrew before surgery. The laparoscopically resected tumours were each put into a cellulose bag, and tumours without laparoscopic‐assistance were removed directly via the vagina.

Results Blood loss in Group A (88±37 ml) was significantly more than that in Group B (64±20 ml, P=0.000). The post‐operative recovery times were 20 and 17 hours, respectively (P=0.030). The rates of successful surgery were 58.6 and 97.6%, respectively (P=0.002). The spillage rates were 44.8% and 19.0%, respectively (P=0.006). There were no significant differences in tumour size, patient age, and operative time between groups.

Conclusion Cystectomy without assistance of laparoscopy could be applied to manage mature teratoma of the ovary; however, because of the difficulty of this technique, we had high percentages of tumour spillage and more blood loss during operation and a high percentage of patients who required conversion to laparotomy compared with laparoscopic cystectomy. We favoured laparoscopically assisted cystectomy to manage mature teratoma.
Venous thromboembolism in pregnancy and the puerperium: incidence and additional risk factors from a London perinatal database
Authors: Simpson E.L. , Lawrenson R.A. , Nightingale A.L. , Farmer R.D.T.
Published: December 2003

Objective To determine the incidence of venous thromboembolism in pregnancy and the puerperium and to identify risk factors for pregnancy‐related venous thromboembolism.

Design Cohort study and case–control study.

Setting London, UK.

Population 395,335 women with live births or pregnancies of 24 or more weeks of gestation between 1988 and 1997.

Methods Data extraction from the St Mary's Maternity Information System database. Random sample of 5% for case–control study.

Main outcome measures Incidence of venous thromboembolism; odds ratios for variables associated with venous thromboembolism.

Results The incidence of venous thromboembolism was 85/100,000 maternities. There were approximately twice as many postpartum as antepartum events. Blood group A, multiple pregnancy, caesarean section, cardiac disease, delivery at gestational age of <36 weeks, a body mass index of ≥25, or more and maternal age of 35 or over were all found to increase incidence of venous thromboembolism.

Conclusions Although venous thromboembolism is the leading cause of maternal deaths in the UK, it is still a rare event. Most of these events are deep vein thromboses occurring in the postpartum period. Antenatally multiple birth is an important risk factor. Postnatally women who have had a caesarean section, premature delivery or history of cardiac disease should be assessed carefully for venous thromboembolism.
Trends in risk factors for caesarean sections in France between 1981 and 1995: lessons for reducing the rates in the future
Authors: Guihard Pascal , Blondel Béatrice
Published: December 2003

Objective To assess the effects of the characteristics of mothers, fetuses and maternity units on the trends in caesarean section use, especially for primiparae.

Design Cross sectional surveys.

Setting Maternity units.

Population Two representative national samples of births including 5410 newborns in 1981 and 13318 in 1995.

Method Univariate analysis and logistic regression analysis.

Results The overall rate of caesarean section rose from 10.7% in 1981 to 15.3% in 1995. This trend is mainly attributable to the increases in the proportion of previously sectioned women (from 4.1% to 8.2%) and in caesarean sections for primiparae (from 12.6% to 17.8%). Among primiparae several maternal risk factors such as late childbearing and obesity before pregnancy were more frequent in 1995 than in 1981. The increase in caesarean sections affected both the high risk group (25.4% to 32.4%) and the low risk group (8.1% to 12.0%).

Conclusion A significant reduction in the overall rate cannot be achieved without regulating caesarean section use for primiparae. Strategies to change delivery patterns should be aimed at both high and low risk women.
A randomised controlled trial of epidural compared with non‐epidural analgesia in labour
Authors: Howell C.J. , Kidd C. , Roberts W. , Upton P. , Lucking L. , Jones P.W. , Johanson R.B.
Published: December 2003

Objectives
To investigate possible short and long term side effects of epidural analgesia, compared with non‐epidural analgesia for pain relief in labour.

Design
Randomised controlled study, with long term follow up by questionnaire. Analysis by intention‐to‐treat.

Setting
Busy maternity unit within a district general hospital in England.

Participants
Three hundred and sixty nine primigravid women in labour were included (randomised allocation: epidural n= 184, non‐epidural n= 185).

Main outcome measures
Backache at three and twelve months after delivery, instrumental delivery rates and maternal opinion of pain relief in labour.

Results
No significant differences were found in the reported incidence of backache between the groups at three months: middle backache [22%vs 20%, χ2= 0.057, P= 0.81; odds ratio (95% CI) 1.4(0.9‐2.3)]; low backache [35%vs 34%, χ2= 0.009, P= 0.92; odds ratio (95% CI) 1.0(0.6‐1.6)]. Nor were there significant differences at 12 months: [middle backache 16%vs 16%, χ2= 0.013, P= 0.91; odds ratio (95% CI) 1.0(0.5‐1.8)]; or low backache [35%vs 27%, χ2= 1.91, P= 0.17; odds ratio (95% CI) 1.4(0.9‐2.3)]. The incidence of instrumental delivery was somewhat higher in the epidural group [30%vs 19%, odds ratio (95% CI) 1.77 (1.09‐2.86)]. Maternal satisfaction was not significantly different between the groups.

Conclusions
This study provided no evidence to support the suggestion of a direct association between the use of epidural anaesthesia in labour and the incidence of long term backache. Despite a significant proportion of women in each group not receiving their allocated analgesia, a significant difference in terms of instrumental delivery rates remained. Satisfaction in both groups of women was high.
Postpartum intrauterine pressure studies of the uterotonic effect of oral misoprostol and intramuscular syntometrine
Authors: Chong Y.S. , Chua S. , El‐Refaey H. , Choo W.L. , Chanrachakul B. , Tai B.C. , Rodeck C. , Arulkumaran S.
Published: December 2003

Objectives
To investigate the effect of oral misoprostol in dosages varying from 200 μg to 800 μg on postpartum uterine contractility and to establish their side effects.

Design
A prospective descriptive study.

Participants
Fifty‐seven women who delivered vaginally after spontaneous labours not requiring augmentation.

Methods
Within 5 minutes of delivery of the placenta, a calibrated Gaeltec catheter with an intrauterine pressure transducer at its tip was inserted transcervically into the uterine cavity. Cumulative uterine activity was recorded for 30 minutes in each woman before administering the oral misoprostol tablets and continued for a further 90 minutes after its administration. Thus each woman acted as her own control regarding changes in uterine contractility. Uterine activity was recorded on a Sonicaid Meridian fetal monitor, which measures active contraction area automatically. The incidence of side effects was also recorded.

Results
There was no statistical difference (P=0.887) in the adjusted mean difference in cumulative uterine activity following all the doses of oral misoprostol, compared with intramuscular syntometrine, the largest difference being seen in oral misoprostol 200 μg (adjusted mean difference –2282 kPas s, 95% CI –7954 to 3390 kPas s). The mean onset of action of oral misoprostol (6.1, SD 2.1 min) was significantly slower than that of intramuscular syntometrine (3.2, SD 1.5 min; P=0.002), but their durations of action were similar (P=0.637). In the misoprostol group the commonest side effects were shivering (36%) and a rise in body temperature above 38°C (40%). In the syntometrine group, the most commonly observed side effect was moderate uterine pain (nine out of ten women) and a rise in diastolic blood pressure of 20 mmHg (two out of ten women).

Conclusion
The results of this study show that oral misoprostol has a definite uterotonic effect on the postpartum uterus. At doses of 200 μg to 400 μg, oral misoprostol has a similar uterotonic effect to intramuscular syntometrine. Higher doses of oral misoprostol are associated with significantly more side effects.
Collaboration in maternity care: a randomised controlled trial comparing community‐based continuity of care with standard hospital care
Authors: Homer Caroline S. E. , Davis Gregory K. , Brodie Pat M. , Sheehan Athena , Barclay Lesley M. , Wills Jo , Chapman Michael G.
Published: December 2003

Objective To test whether a new community‐based model of continuity of care provided by midwives and obstetricians improved maternal clinical outcomes, in particular a reduced caesarean section rate.

Design Randomised controlled trial.

Setting A public teaching hospital in metropolitan Sydney, Australia.

Sample 1089 women randomised to either the community‐based model (n= 550) or standard hospital‐based care (n= 539) prior to their first antenatal booking visit at an Australian metropolitan public hospital.

Main outcome measures Data were collected on onset and outcomes of labour, antenatal, intrapartum and postnatal complications, antenatal admissions to hospital and neonatal mortality and morbidity.

Results There was a significant difference in the caesarean section rate between the groups, 13.3% (73/550) in the community‐based group and 17.8% in the control group (96/539). This difference was maintained after controlling for known contributing factors to caesarean section (OR=0.6, 95% CI 0.4–0.9, P= 0.02). There were no other significant differences in the events during labour and birth. Eighty babies (14.5%) from the community‐based group and 102 (18.9%) from the control group were admitted to the special care nursery, but this difference was not significant (OR 0.75, 95% CI 0.5‐1.1, P= 0.12). Eight infants died during the perinatal period (four from each group), for an overall perinatal mortality rate of 7.3 per 1000 births.

Conclusion Community‐based continuity of maternity care provided by midwives and obstetricians resulted in a significantly reduced caesarean section rate. There were no other differences in clinical outcomes.
The treatment of incomplete miscarriage with oral misoprostol
Authors: Pandian Zabeena , Ashok Premila , Templeton Allan
Published: December 2003

In a retrospective study of 112 women, the effectiveness of three sequential oral doses of misoprostol was evaluated for the treatment of incomplete miscarriage. We report our experience with this regimen, which achieved a complete miscarriage rate of 85%. Surgical intervention was required in 17 women (15%). The regimen appears to be effective in terms of a high rate of complete miscarriage, and it is safe.
Blood selenium and glutathione peroxidases in miscarriage
Authors: Zachara Bronisław A. , Dobrzyński Waldemar , Trafikowska Urszula , Szymański Wiesław
Published: December 2003

Objective
To investigate the selenium glutathione and glutathione peroxidase (glutathione‐Px) levels in blood in women who experience miscarriage.

Design
An observational study.

Participants
Forty women with miscarriage occurring in the first and second trimesters.

Methods
Concentrations were measured in whole blood and plasma. Glutathione was measured in red cells and glutathione‐Px activity was measured in the red cells and plasma. The results were compared with 36 women in the same period of viable pregnancy and 28 age‐matched, healthy, non‐pregnant controls.

Results
The selenium concentrations in whole blood and plasma of women following abortion were the same as in viable pregnancy, but were significantly lower compared with controls. The glutathione levels were significantly higher in women with miscarriage compared with viable pregnancies and with non‐pregnant women. Red cell and plasma glutathione‐Px activities of women who had had a miscarriage were significantly lower than in both normal pregnancies and the control group.

Conclusion
The decreased activities of the antioxidant enzymes, red cell and plasma glutathione‐Px, may play an important role in the aetrology of spontaneous abortion.
Expectant management of early pregnancies of unknown location: a prospective evaluation of methods to predict spontaneous resolution of pregnancy
Authors: Banerjee Saikat , Aslam Naaila , Woelfer Brigitte , Lawrence Alexandra , Elson Janine , Jurkovic Davor
Published: December 2003

Objective To assess prospectively the ability of two multiparameter diagnostic models and their individual components to predict the outcome of early pregnancies which could not be identified on transvaginal ultrasound scan.

Design Prospective observational study.

Setting Dedicated early pregnancy unit in an inner city teaching hospital.

Population Women with a positive urine pregnancy test and clinical suspicion of early pregnancy complications.

Methods A full medical history, clinical examination and transvaginal ultrasound scan were carried out at the initial visit. When the location of the pregnancy could not be ascertained by ultrasound, serum beta‐human chorionic gonadotrophin (β‐hCG) and progesterone levels were measured. All women were managed expectantly until either a normal pregnancy was visualised on scan; the pregnancy resolved spontaneously or intervention was required due to a worsening of clinical symptoms or non‐declining β‐hCG levels.

Main outcome measures Spontaneous resolution of pregnancy (i.e. cessation of symptoms and decline in serum β‐hCG level to < 20 iu/L) without need for any active intervention.

Results Of the 104 women recruited, 72 (69%) pregnancies resolved spontaneously. Both multiparameter diagnostic models identified resolving pregnancies with positive predictive values ≥ 95%. Their performances were not significantly better compared with individual progesterone levels which achieved a positive predictive value of 97% using a cutoff level of 20 nmol/L.

Conclusion Serum progesterone measurement alone is as accurate as more complex diagnostic models for the prediction of successful expectant management in pregnancies of unknown location.
Fetal and maternal lactate increase during active second stage of labour
Authors: Nordström Lennart , Achanna Siva , Naka Keiichi , Arulkumaran Sabaratnam
Published: December 2003

Objective
To determine longitudinally fetal and maternal blood lactate concentrations during the second stage of labour.

Design
Prospective, observational study of randomly selected labours.

Setting
Labour ward, Sultanah Aminah General Hospital, Johore Bahru, Malaysia.

Main outcome measures
Fetal scalp and maternal venous blood lactate, umbilical arterial and vein lactate and acid–base balance at delivery.

Results
Sixty‐nine women and their infants were monitored in the second stage of labour. Mean maternal venous lactate by the end of the first stage was 2.6 ± 1.0 (±S.D.) mmol/L and increased to 3.6 ±1.4, 4.2 ±1.7, 4.8 ±1.6, 5.4 ±2.1 and 4.3±0.9 mmol/L, respectively, for every 15 minute of bearing down. Corresponding values for fetal scalp blood lactate were 2.4 ±1.1, 3.1 ±1.6, 3.2 ±1.8, 4.2 ±2.4, 4.9 ±2.8 and 5.8±1.9 mmol/L. The mean slope of maternal lactate increase was 0.070 mmol/L per minute (95% CI 0.050, 0.090) and for fetal lactate increase 0.032 mmol/L per minute (95% C.I.: 0.018, 0.045). The duration of active second stage was significantly associated with fetal lactate (P<0.001) and maternal lactate (P=0.03) at the time of crowning of the fetal head, and lactate in umbilical arterial and vein blood at delivery (P<0.001). Expulsion time ≥ 45 minutes, compared with shorter active second stage, and acidaemia at birth implied larger arterial‐venous lactate differences (P<0.001). Fetal lactate at crowning was also significantly associated with the umbilical arterial‐veonus lactate difference (P=0.03).

Conclusions
Maternal and fetal lactate concentrations increase significantly with duration of the active second stage of labour, more rapidly in the mother. It is likely that fetal anaerobic metabolism is the main source for the fetal lactate increase.
Female genital mutilation: analysis of the first twelve months of a southeast London specialist clinic
Authors: Momoh Comfort , Ladhani Shamez , Lochrie Denise P. , Rymer Janice
Published: December 2003

Objectives To analyse the sources and reasons for referral of women who have undergone genital mutilation to a recently established specialist clinic, and to determine the consequences of the genital mutilation procedure.

Design Retrospective descriptive case series.

Setting The maternity units of Guy's and St. Thomas's Hospital, London.

Population One hundred and sixteen women attending the clinic over a one‐year period.

Main outcome measures (1) sources and reasons for referral to the specialist clinic; (2) characteristics of the women attending the clinic; (3) acute and chronic complications of the genital mutilation procedure; (4) attitudes towards female genital mutilation.

Results Complete case records were available for 108 women. Of the 86 women who could remember the procedure, 78% were performed by a medically unqualified person, usually at home (71%), at a median age of seven years. Acute and chronic complications were each present in 86% of women with Type III genital mutilation. Most women (82%) were referred by their midwife because they were pregnant, of whom 48% were primigravid. Eighteen non‐pregnant women also attended the clinic to request either defibulation or for advice. None of the 89 pregnant women requested re‐infibulation after delivery, but almost 6% were seriously considering having their daughter undergo genital mutilation outside the United Kingdom. In addition, fewer than 10% of the women refused to continue the tradition of female genital mutilation.

Conclusions During its first year, the recently established African Well Woman Clinic has provided specialist care for 116 women with genital mutilation. Such women may attend with a variety of common medical or psychiatric conditions and often do not volunteer that they have undergone the procedure. Doctors and midwives in particular, should enquire specifically about genital mutilation when caring for women from high risk countries, and offer the services of specialist clinics for female genital mutilation.
Psychosocial and other characteristics of women complaining of menorrhagia, with and without actual increased menstrual blood loss
Authors: Hurskainen Ritva , Aalto Anna‐Mari , Teperi Juha , Grenman Seija , Kivela¨ Aarre , Kujansuu Erkki , Vuorma Sirkku , Yliskoski Merja , Paavonen Jorma
Published: December 2003

Objective
To discover whether psychosocial factors can explain why many women with normal menstrual blood loss seek care for menorrhagia.

Design
sectional comparative study of women referred for menorrhagia.

Setting
Gynaecology departments of all five university teaching hospitals in Finland.

Sample
Two hundred and twenty‐six women aged 35‐49 years complaining of menorrhagia.

Main outcome measures
Several psychosocial factors, seeking medical attention, menstrual blood loss.

Results
Twenty‐nine percent of the women had their menstrual blood loss in the normal range (menstrual blood loss <60 mL). By univariate analysis, unemployment, anxiety, perceived inconvenience, abdominal pain, haemoglobin level and serum ferritin concentration distinguished this group of women from those with true menorrhagia. Unemployment, perceived inconvenience, abdominal pain and serum ferritin remained significant variables by multivariate analysis.

Conclusions
A significant proportion of women with complaints of menorrhagia have their measured menstrual blood loss within the normal range. Psychosocial factors can have an impact on their seeking health care. Better understanding of the factors, which explain complaints of menorrhagia in women with normal bleeding could improve both medical outcomes and reduce the cost of treatment for menorrhagia.
Bladder neck mobility in continent nulliparous women
Authors: Peschers Ursula M. , Fanger Gabi , Schaer Gabriel N. , Vodusek David B. , DeLancey John O.L. , Schuessler Bernhard
Published: December 2003

Objective
To evaluate the mobility of the vesical neck during coughing and valsalva in healthy nulliparous volunteers and to test the reliability of the technique applied.

Design
Clinical observational study.

Setting
Department of Obstetrics and Gynaecology, Cantonal Hospital Lucerne, Switzerland.

Population
Thirty‐nine nulliparous volunteers.

Methods
Vesical neck motion was assessed with perineal ultrasound. Intra–abdominal pressure was controlled for with an intrarectal probe. Intra‐rater reliability was evaluated.

Results
Vesical neck mobility was significantly lower during coughing (8 mm, SD 4 mm) than during valsalva (15 mm, SD 10 mm) (P < 0.005). Between individuals mobility varied from 4 mm to 32 mm during coughing and from 2 mm to 31 mm during valsalva. Test‐retest‐studies showed a maximum difference between to tests during coughing of 4 mm and during valsalva of 5 mm.

Conclusion
The bladder neck is mobile in normal continent women and bladder neck mobility is lower during coughing than during Valsalva.
Biochemical markers of maternal bone turnover are elevated in pre‐eclampsia
Authors: Anim‐Nyame Nick , Sooranna Suren R. , Jones Julia , Alaghband‐Zadeh Jamie , Steer Philip J. , Johnson Mark R.
Published: December 2003

Objectives
To investigate the hypothesis that bone turnover is reduced in pre‐eclampsia compared with normal pregnancy.

Design
A prospective sectional study.

Setting
Obstetric unit at the Chelsea and Westminster Hospital, London.

Methods
Third trimester maternal plasma levels of the linked carboxyl‐terminal telo‐peptide of type I collagen (ICTP), (a marker of bone resorption) and the carboxyl terminal pro‐peptide of type I pro‐collagen (PICP), (a marker of bone formation) were compared in 25 women with pre‐eclampsia and in 24 normal pregnant controls. The subjects were matched for maternal age, booking body mass index and gestational age. PICP and ICTP levels were measured by radio‐immunoassay.

Results
ICTP and PICP levels were significantly increased in women with pre‐eclampsia compared with the normal pregnant controls (P= 0.0001 and P= 0.004, for ICTP and PICP respectively, Wilcoxon signed ranked test). There was no significant correlation between either of the markers and booking body mass index, blood pressure, serum uric acid levels or platelet count.

Conclusions
These data suggest that bone turnover is increased in established pre‐eclampsia compared with normal pregnancy. Further studies are required to investigate whether this precedes the onset of the disease.
Inadequate repeatability of the one‐hour pad test: the need for a new incontinence outcome measure
Authors: Simons A.M. , Yoong W.C. , Buckland S. , Moore K.H.
Published: December 2003

Objective
To assess the reproducibility of two one‐hour pad tests performed within one week using serial ultrasound scanning to obtain identical bladder volumes, and to measure the effect of patient anxiety upon test reproducibility.

Design
Prospective observational study.

Setting
Tertiary urogynaecological unit.

Sample
Fifty‐six incontinent women undergoing 112 pad tests.

Method
Two one‐hour pad tests were performed with natural diuresis one week apart prior to treatment. At the second test, serial ultrasound scans were performed until bladder volume reached that of the first test, followed by identical provocation.

Main outcome measures
One‐hour pad loss, bladder volumes (Vol1, Vol2), anxiety VAS questionnaire.

Results
Despite serial scanning, bladder volumes differed significantly. Median volume before second pad test was 541 mL, compared with 433 mls before first test (P<0.001). The second pad test was also significantly larger than first (median 16g vs 4g, P=0.017), and 13/56 (23%) women were dry on the first test but incontinent on the second. In 26 women (46%) both bladder volumes were similar, but the second pad loss was still significantly greater (median 14g vs 4g, P=0.037). The mean difference between tests was 10g and the limits of agreement were wide (ranging from –44 to +66 g difference for the test result). Women were more anxious about leaking during the first test (Median VAS during the first test was 2.8cm, compared with 0.6cm during the second test, P=0.008). 42.5% found the second test to be more typical.

Conclusion
In women with similar bladder volumes, the test–retest reliability of the one‐hour pad test was judged to be clinically inadequate, as the first and second pad test could differ by –44 to +66g. Lower anxiety levels at the second test may account for this finding. The one‐hour pad test is a useful baseline measure of incontinence, but the poor repeatability suggests that is not an optimal measure of post‐treatment change.
Exploration of cyclical changes in memory and mood in postmenopausal women taking sequential combined oestrogen and progestogen preparations
Authors: Natale Vincenzo , Albertazzi Paola , Zini Monica , Di Micco Raffaele
Published: December 2003

Objective
To investigate the effect of progesterone on cognitive function, mood, sleep quality and libido when added to oestrogen in sequential combined hormonal replacement therapy regimens.

Design
Observational study over three hormonal replacement therapy cycles.

Setting
Menopause Centre of Ospedale Maternità, Bologna, Italy.

Population
Twenty‐three postmenopausal women with an average of 70 months of amenorrhoea (range 12 to 234 months) on different sequential combined hormonal replacement therapy regimen for an average of 15 months (range 3–48) months.

Methods
Psychological testing for memory, mood, sleep quality and libido during the oestrogen only part of the cycle compared with the oestrogen‐progestogen part of the cycle.

Results
Twenty women completed the six visits of the trial. The addition of progestogens to oestrogen appeared to benefit memory (P<0.01) but worsened mood (P<0.005). There was no evidence of change in other parameters such as sleep quality or libido.

Conclusion
The addition of progestogens improved memory above what was obtained with oestrogen alone. This effect did not depend on an improvement of mood since the latter worsened during the progestogenic phase of an hormonal replacement therapy cycle. Progestogen added to oestrogen did not significantly influence sleep or libido.
Can a cyclo‐oxygenase type‐2 selective tocolytic agent avoid the fetal side effects of indomethacin?
Authors: Locatelli Anna , Vergani Patrizia , Bellini Primula , Strobelt Nicola , Ghidini Alessandro
Published: December 2003

We evaluated the efficacy and safety of nimesulide (100 mg orally twice daily for > 48 hours) in a pilot series of five women (two with twin pregnancies) at 24+6 weeks (range 21+3–27+2) in preterm labour which was unresponsive to intravenous ritodrine. Nimesulide therapy was continued for eight days (5–16) and was associated with a prolongation of pregnancy of 27 days (6–69). Oligohydramnios occurred in all seven fetuses after three to nine days of therapy, and in the five pregnancies that continued after discontinuation of nimesulide, it resolved within four days (2–7). None of the babies manifested permanent renal damage.
Maternal plasma glucose at high altitude
Authors: Krampl Elisabeth , Kametas Nikos A. , Zegarra Ana Maria Cacho , Roden Michael , Nicolaides Kypros H.
Published: December 2003

Objective
To compare plasma glucose in pregnant women living at very high altitude; pregnant women living at sea level; non‐pregnant women living at very high altitude; and non‐pregnant women living at sea level.

Design
sectional study.

Participants
Ninety‐four pregnant women attending for routine antenatal care at 8–42 weeks of gestation in Cerro de Pasco, Peru which is situated 4370 m above sea level; 122 pregnant women in Lima, which is at sea level; 22 non‐pregnant women in Cerro de Pasco; and 31 non‐pregnant women in Lima.

Methods
Plasma glucose concentrations were measured in samples obtained from the antecubital vein between 8 am and 10 am after an overnight period of fasting for at least 10 hours.

Results
Fasting plasma glucose was lower in women at high altitude than in those at sea level, and in both groups the level was lower in pregnant women than in non‐pregnant controls. The body mass index was not significantly different between all four groups, and it did not have a significant independent contribution in explaining the variance in fasting plasma glucose.

Conclusion
Women native at high altitude have lower plasma glucose concentrations before and during pregnancy than those at sea level.