Uterine perforation by intrauterine devices: a 16-year review

2017 ◽  
Vol 43 (4) ◽  
pp. 289-295
Author(s):  
Paul A O’Brien ◽  
Sarah Pillai
Keyword(s):  
Outcome Data ◽  
Annual Rate ◽  
Uterine Perforation ◽  
Intrauterine Devices ◽  
Perforation Rate ◽  
Statistical Process ◽  
Community Clinic ◽  
Intrauterine Contraception ◽  
The Uk ◽  
True Peak

IntroductionOne of the major concerns with the insertion of intrauterine devices is uterine perforation. Though uncommon, it can be debilitating and result in failure of the device. In this article we review uterine perforation with intrauterine contraception (IUC) in a community clinic in the UK over a 16-year period.MethodsWe prospectively collected data on uterine perforations for the years 2000–2015, reviewed associated factors and calculated the annual rate of perforation, estimating if this lay within the expected range of normal variation using statistical process control (SPC) analysis. We analysed the rates of perforation in relation to the time from delivery and to breastfeeding.ResultsWe identified 30 uterine perforations in 22 795 IUC insertions over the 16 years of observation, with an annual rate ranging from 0 to 4.3 per 1000 insertions, and a mean annual rate of 1.3 per 1000 insertions (95% CI 0.9 to 1.9), which remain within the SPC limits. Twenty-eight of the perforations were in parous women, 87% of whom were within 18 weeks of delivery, peaking at 13 weeks postpartum. Twenty of these were in breastfeeding women. In 3/28 cases for which we have outcome data the device was adherent to or had perforated either the bladder or bowel.ConclusionOur perforation rate is consistent with other studies. Most of our perforations were within 18 weeks of childbirth, earlier than in a recent major study. We cannot tell from our data if there is a true peak in perforations 3 months postpartum as that may be a time when a high proportion of insertions are done.

scholarly journals Causal Associations Between Blood Lipids and COVID-19 Risk: A Two-Sample Mendelian Randomization Study

2021 ◽  
Author(s):  
Kun Zhang ◽  
Shan-Shan Dong ◽  
Yan Guo ◽  
Shi-Hao Tang ◽  
Hao Wu ◽  
...  
Keyword(s):  
Total Cholesterol ◽  
Blood Lipids ◽  
Mendelian Randomization ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Outcome Data ◽  
Causal Effects ◽  
Lipoprotein Cholesterol ◽  
Global Pandemic ◽  
The Uk

Objective: Coronavirus disease 2019 (COVID-19) is a global pandemic caused by the severe acute respiratory syndrome coronavirus 2. It has been reported that dyslipidemia is correlated with COVID-19, and blood lipids levels, including total cholesterol, HDL-C (high-density lipoprotein cholesterol), and LDL-C (low-density lipoprotein cholesterol) levels, were significantly associated with disease severity. However, the causalities of blood lipids on COVID-19 are not clear. Approach and Results: We performed 2-sample Mendelian randomization (MR) analyses to explore the causal effects of blood lipids on COVID-19 susceptibility and severity. Using the outcome data from the UK Biobank (1221 cases and 4117 controls), we observed potential positive causal effects of dyslipidemia (odds ratio [OR], 1.27 [95% CI, 1.08–1.49], P =3.18×10 −3 ), total cholesterol (OR, 1.19 [95% CI, 1.07–1.32], P =8.54×10 −4 ), and ApoB (apolipoprotein B; OR, 1.18 [95% CI, 1.07–1.29], P =1.01×10 −3 ) on COVID-19 susceptibility after Bonferroni correction. In addition, the effects of total cholesterol (OR, 1.01 [95% CI, 1.00–1.02], P =2.29×10 −2 ) and ApoB (OR, 1.01 [95% CI, 1.00–1.02], P =2.22×10 −2 ) on COVID-19 susceptibility were also identified using outcome data from the host genetics initiative (14 134 cases and 1 284 876 controls). Conclusions: In conclusion, we found that higher total cholesterol and ApoB levels might increase the risk of COVID-19 infection.

scholarly journals Acetic acid-guided biopsies in Barrett’s surveillance for neoplasia detection versus non-targeted biopsies (Seattle protocol): A feasibility study for a randomized tandem endoscopy trial. The ABBA study

2018 ◽  
Vol 06 (01) ◽  
pp. E43-E50 ◽  
Author(s):  
Fergus Chedgy ◽  
Carole Fogg ◽  
Kesavan Kandiah ◽  
Hugh Barr ◽  
Bernard Higgins ◽  
...  
Keyword(s):  
Acetic Acid ◽  
Barrett’S Esophagus ◽  
Barrett's Esophagus ◽  
Qualitative Interviews ◽  
Current Treatment ◽  
Outcome Data ◽  
Endoscopic Techniques ◽  
Repeat Endoscopy ◽  
The Uk ◽  
Barrett’S Surveillance

Abstract Background and study aims Barrett’s esophagus is a potentially pre-cancerous condition, affecting 375,000 people in the UK. Patients receive a 2-yearly endoscopy to detect cancerous changes, as early detection and treatment results in better outcomes. Current treatment requires random mapping biopsies along the length of Barrett’s, in addition to biopsy of visible abnormalities. As only 13 % of pre-cancerous changes appear as visible nodules or abnormalities, areas of dysplasia are often missed. Acetic acid chromoendoscopy (AAC) has been shown to improve detection of pre-cancerous and cancerous tissue in observational studies, but no randomized controlled trials (RCTs) have been performed to date. Patients and methods A “tandem” endoscopy cross-over design. Participants will be randomized to endoscopy using mapping biopsies or AAC, in which dilute acetic acid is sprayed onto the surface of the esophagus, highlighting tissue through an whitening reaction and enhancing visibility of areas with cellular changes for biopsy. After 4 to 10 weeks, participants will undergo a repeat endoscopy, using the second method. Rates of recruitment and retention will be assessed, in addition to the estimated dysplasia detection rate, effectiveness of the endoscopist training program, and rates of adverse events (AEs). Qualitative interviews will explore participant and endoscopist acceptability of study design and delivery, and the acceptability of switching endoscopic techniques for Barrett's surveillance. Results Endoscopists’ ability to diagnose dysplasia in Barrett’s esophagus can be improved. AAC may offer a simple, universally applicable, easily-acquired technique to improve detection, affording patients earlier diagnosis and treatment, reducing endoscopy time and pathology costs. The ABBA study will determine whether a crossover “tandem” endoscopy design is feasible and acceptable to patients and clinicians and gather outcome data to power a definitive trial.

scholarly journals Thrombotic and haemorrhagic complications in critically ill patients with COVID-19: a multicentre observational study

Critical Care ◽  
2020 ◽  
Vol 24 (1) ◽  
Author(s):  
Akshay Shah ◽  
Killian Donovan ◽  
Anna McHugh ◽  
Manish Pandey ◽  
Louise Aaron ◽  
...  
Keyword(s):  
Observational Study ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
White Cell Count ◽  
Laboratory Data ◽  
Outcome Data ◽  
Icu Length Of Stay ◽  
Tertiary Hospitals ◽  
Thrombotic Complications ◽  
The Uk

Abstract Background Optimal prophylactic and therapeutic management of thromboembolic disease in patients with COVID-19 remains a major challenge for clinicians. The aim of this study was to define the incidence of thrombotic and haemorrhagic complications in critically ill patients with COVID-19. In addition, we sought to characterise coagulation profiles using thromboelastography and explore possible biological differences between patients with and without thrombotic complications. Methods We conducted a multicentre retrospective observational study evaluating all the COVID-19 patients received in four intensive care units (ICUs) of four tertiary hospitals in the UK between March 15, 2020, and May 05, 2020. Clinical characteristics, laboratory data, thromboelastography profiles and clinical outcome data were evaluated between patients with and without thrombotic complications. Results A total of 187 patients were included. Their median (interquartile (IQR)) age was 57 (49–64) years and 124 (66.3%) patients were male. Eighty-one (43.3%) patients experienced one or more clinically relevant thrombotic complications, which were mainly pulmonary emboli (n = 42 (22.5%)). Arterial embolic complications were reported in 25 (13.3%) patients. ICU length of stay was longer in patients with thrombotic complications when compared with those without. Fifteen (8.0%) patients experienced haemorrhagic complications, of which nine (4.8%) were classified as major bleeding. Thromboelastography demonstrated a hypercoagulable profile in patients tested but lacked discriminatory value between those with and without thrombotic complications. Patients who experienced thrombotic complications had higher D-dimer, ferritin, troponin and white cell count levels at ICU admission compared with those that did not. Conclusion Critically ill patients with COVID-19 experience high rates of venous and arterial thrombotic complications. The rates of bleeding may be higher than previously reported and re-iterate the need for randomised trials to better understand the risk-benefit ratio of different anticoagulation strategies. Graphical abstract

scholarly journals Striving for excellence in abortion services

2006 ◽  
Vol 30 (4) ◽  
pp. 468 ◽  
Author(s):  
Ea C Mulligan
Keyword(s):  
Quality Improvement ◽  
Surgical Outcomes ◽  
Surgical Outcome ◽  
Potential Effect ◽  
Outcome Data ◽  
Uterine Perforation ◽  
Complication Rates ◽  
Incomplete Abortion ◽  
Positive Results

The legalisation of abortion allowed the publication of surgical outcome data demonstrating low complication rates. South Australian data from the outcomes of surgery conducted at the Pregnancy Advisory Centre illustrate the monitoring of complication rates such as uterine perforation, continuing pregnancy and incomplete abortion to improve surgical outcomes. While quality improvement systems produce positive results, there are many barriers to their uptake in Australia. Hostility towards abortion has the potential effect of retarding the adoption of improved techniques.

The logistical management of tertiary urethral disease in the United Kingdom: Implications from an online audit of male reconstructive urethral surgery

2020 ◽  
Vol 13 (4) ◽  
pp. 288-294
Author(s):  
Stephen R Payne ◽  
Sarah Fowler ◽  
Anthony R Mundy ◽  
A. Alhasso ◽  
Y. Almallah ◽  
...  
Keyword(s):  
High Volume ◽  
Risk Groups ◽  
Outcome Data ◽  
Urethral Reconstruction ◽  
Level Of Evidence ◽  
The United Kingdom ◽  
Surgical Complexity ◽  
Volume Outcome ◽  
Definition Of ◽  
The Uk

Objective: To determine those patient groupings, based on volume and risk, whose optimal urethral reconstructive management might be provided by a reorganisation of UK reconstructive surgeons. Methods: Between 2010 and 2017, ~689 men/year were enrolled onto an online audit platform collecting data about urethral reconstruction in the UK; this accrual was compared against hospital episode statistics (HES). The available workforce, and where this was based, was collected. Individual and institutional incumbent patient volumes, pathology, surgical complexity and outcomes from treatment were collated to stratify volume/risk groups. Results: More than 90% of all HES-recorded data were accrued, being provided by 50 surgeons at 39 operative sites. Most reconstructive surgery was provided at 10 centres performing >20 procedures/year. More than 50% of all interventions were of a high-volume low-risk type. Of activity, 32.3% was intermediate volume or moderate risk, and 12.5% of men presented for lower-volume or higher-risk procedures. Conclusion: Correlation of detailed volume/outcome data allows the definition of patient populations presenting for urethral reconstruction. Stratification of each group’s management, to optimise the surgical outcome, may be applied to a hierarchical service delivery model based on the complexity of the patient’s presenting urethral pathology. Level of evidence: Level IV

Ethics and the law involving the elderly

2017 ◽  
Author(s):  
Chris Dodds ◽  
Chandra M. Kumar ◽  
Frédérique Servin
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Informed Consent ◽  
The Elderly ◽  
Outcome Data ◽  
Ethical Principles ◽  
Assisted Death ◽  
The Uk

The role of ethics in the care of the elderly is discussed, and some of the aspects of importance to anaesthesia are reviewed. Ethical principles are commonly viewed as either consequential, where the risk/benefit balance between necessary harm (surgery) provides improved quality of life, or deontological, where it is simply the action that is judged and not the outcome. The lack of individualized outcome data is identified as a major issue for the consequential process. Consent for surgery (and anaesthesia) is described in the context of the UK, but it is applicable worldwide. The validity of informed consent is reviewed against the criteria of competence, lack of duress, and appropriately provided information. The capacity to give consent and the use of legal alternatives such as health attorneys is detailed. Finally, the debate on excellent palliative care rather than assisted death is reviewed.

An In-patient Behavioural Psychotherapy Unit

1991 ◽  
Vol 158 (3) ◽  
pp. 362-367 ◽  
Author(s):  
Graham Thornicroft ◽  
Louise Colson ◽  
Isaac Marks
Keyword(s):  
Social Adjustment ◽  
Outcome Data ◽  
Substantial Improvement ◽  
Response Prevention ◽  
Regional Basis ◽  
The Uk

An in-patient behavioural psychotherapy unit is described that emphasises self-treatment, teaching relatives to become cotherapists while resident in the unit, routine collection of outcome data, minimising use of medication, and absence of night nurses. Patients are referred from all over the UK, mostly with chronic disabling OCD. Treatment includes self-exposure and self-imposed response prevention. A year's cohort (52 patients) showed substantial improvement that consolidated during six-month follow-up (83% decrease in total ritual time per day, 58% fall in target ritual scores, better social adjustment), and families noted relief of burden; eight patients dropped out. Further such units are needed in the UK, perhaps on a regional basis; they could be run as specialist hostels.

UK trial of the Osseointegrated Prosthesis for the Rehabilitation for Amputees: 1995–2018

2018 ◽  
Vol 43 (1) ◽  
pp. 112-122 ◽  
Author(s):  
Douglas John Matthews ◽  
Mateen Arastu ◽  
Maggie Uden ◽  
John Paul Sullivan ◽  
Kristina Bolsakova ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Short Form ◽  
Deep Infection ◽  
Outcome Data ◽  
Superficial Infection ◽  
Kaplan Meier ◽  
The Uk ◽  
Implant System

Background: Amputation of a limb impacts on patients’ self-perception and quality of life. Prostheses directly anchored to the skeleton are being investigated, aiming to avoid soft tissue complications. Objectives: We report outcome data for the UK trial of the Osseointegrated Prosthesis for the Rehabilitation of Amputees Implant System with a minimum of 9-year follow-up. Methods: Eighteen transfemoral amputees received unilateral implants between 1997 and 2008. Five were implanted before a formalised protocol, called Osseointegrated Prosthesis for the Rehabilitation of Amputees, was developed. Mean follow-up of the Pre-Osseointegrated Prosthesis for the Rehabilitation of Amputees group is 11.4 years (1.8–18.6 years), while for the Post-Osseointegrated Prosthesis for the Rehabilitation of Amputees group it is 12.3 years (2.9–15.9). Results: The Kaplan–Meier cumulative survivorship is 40% for the Pre-Osseointegrated Prosthesis for the Rehabilitation of Amputees group and 80.21% for the Post-Osseointegrated Prosthesis for the Rehabilitation of Amputees group. Five implants (28%) have been removed, three (17%) for deep infection, one (5.6%) for chronic pain, later proven to be infected and one (5.6%) due to implant fracture secondary to loosening due to infection. Two patients (11%) have peri-implant infections suppressed with oral antibiotics. Eleven cases (61%) of superficial infection were successfully treated with antibiotics. 36-Item short-form health survey and Questionnaire for persons with a Transfemoral Amputation showed significant improvements in quality of life up to 5 years after implantation. Conclusion: This small cohort of patients demonstrates osseointegrated prosthesis allows prolonged usage and improves patients’ quality of life compared to conventional prostheses. Clinical relevance These prostheses may provide a future gold standard for amputees and this study provides the first outcome data over such a time period to be reported from outside of the developers group.

Emerging findings in the Cancer Research UK stratified medicine program.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. TPS10633-TPS10633 ◽  
Author(s):  
Emily Shaw ◽  
Alice Tuff ◽  
Rowena Sharpe ◽  
Louise K. Jones ◽  
Tarita Turtiaien ◽  
...  
Keyword(s):  
Cancer Research ◽  
Clinical Outcome ◽  
Healthcare System ◽  
Large Scale ◽  
Outcome Data ◽  
Cancer Registration ◽  
Data Repository ◽  
Stratified Medicine ◽  
High Quality ◽  
The Uk

TPS10633^ Background: Molecular analysis of tumours may be used to identify those predicted to benefit from novel targeted therapies. The Cancer Research UK programme is piloting plans to apply such testing broadly across the UK healthcare system, linking molecular phenotype to clinical outcomes. Methods: The Stratified Medicine Programme (SMP) aims to develop a model for high quality, large-scale molecular characterization of cancer specimens through an initiative developed in partnership with AstraZeneca, Pfizer, the UK Department of Health and academic researchers. Phase One of the SMP is a two year feasibility study. It aims to demonstrate the submission of consented blood samples and sections of surplus diagnostic formalin-fixed paraffin-embedded tumour tissue from 9,000 patients at centres across the UK to one of three ‘technology hubs’ for mutation testing of genes of potential clinical interest (KRAS, BRAF, NRAS, PIK3CA, TP53, PTEN, TMPRSS2-ERG, EGFR, EML4-ALK and KIT) in six selected tumour types. The tests are technically validated and will be completed in clinically relevant timescales. Data including pathological and treatment information and clinical outcome is also collected for the recruited patients, linked to the genetic data and stored in a central data repository hosted within the National Cancer Registration Service. The study opened in September 2011 at 7 sites across the UK and by the end of 2011, 760 patientswith breast, lung, prostate, colorectal, ovarian cancer or metastatic malignant melanoma had consented to participate. 142 sets of molecular results had been returned to clinical teams. Updated figures will be presented at the meeting, by which time the programme is projected to have accrued 4000 subjects. By 2013, we hope to have developed a scalable model for routine, high quality, prospective molecular characterisation of tumours for NHS cancer patients, with consent for the collection, storage and research use of population-scale genetic and clinical outcome data. We will report the emerging results from the Stratified Medicines Programme and early insights into implications for wider implementation across the UK healthcare system.

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