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Algorithms for obstetrics and gynaecology / , Algorithms for obstetrics and gynaecology / , کتابخانه مرکزی دانشگاه علوم پزشکی تهران

Although there are a number of studies of patient safety during the August rotation, they often focus on newly qualified doctors. It remains unclear whether negative impacts are due to doctors’ inexperience, lack of technical skill or other aspects of rotation. This study used an electronic survey to seek the views of doctors working in obstetrics and gynaecology in the UK. A total of 1,879 responses were received. The August rotation was felt to be a stressful time, with a negative effect on patient care (82%) and safety (73%), lasting up to 1 month (62%). Although reducing services was thought to be helpful, there was strong support for staggering the rotation by grade (80%). This would ensure availability of doctors to cover services during the induction period, which should improve patient care and reduce staff stress. In addition, intensive skills training for junior staff and a supportive culture during the 1st month could optimise the integration and performance of doctors of all grades.

Women-centred maternity PRO measures can generate outcome measures that will allow benchmarking of service delivery using meaningful outcomes that will drive service improvement to ensure commitment to a culture of openness, patient satisfaction, patient safety and the delivery of clinically effective care. Moreover, they can generate new insights into women’s perspectives of healthcare delivery, allowing changes in attitude, practice and organisational services. Once developed, the adoption of PRO measures within units is likely to come at additional cost. However, the expected benefits in improved woman and family satisfaction, reduced legal claims and the presence of an early indicator of compromised quality of care will have the potential to save a significant amount of money for individual units and the wider health economy.

Definition Menopause begins one year after the last menstrual period. Symptoms often begin in the perimenopausal years.

As an alternative to a limited vendor/volume discount approach, our hospital employed a physician-driven free market strategy aimed at reducing joint implant costs. Surgeons were provided with vendor pricing and peer profile comparisons of implant cost data and asked to select implants providing the best value based on patient need. Vendors were challenged to reduce prices where appropriate. Total savings based on the 19951 997 volume-adjusted cost difference were $1 ,059,1 59, a 1 7.5% decrease. These results demonstrate the possibility of reducing joint implant costs using a strategy that does not limit vendors or cap prices.

Etude de la crise intellectuelle a laquelle aboutit Hume dans son exploration de l'anatomie de la nature humaine. Face a la contradiction des principes de la raison et face a l'illusion de l'imagination, Hume s'interroge sur l'attitude a adopter envers le jugement causal et revise l'idee de connexion necessaire au sein du raisonnement philosophique.

Objectives To assess the effects of six years tibolone therapy on the genital tract in postmenopausal women against matched voluntary controls. Design Prospective, non-randomised, open label study of the efficacy of tibolone. Methods Symptoms were assessed by questionnaires every six months. Assessment of genital tract cellular activity comprised annual vaginal smear and endometrial biopsy/smear in the tibolone group (n= 58) and vaginal smear alone in the control group (n= 55). As a recent protocol addition, transvaginal ultrasound assessment of endometrial thickness was performed in all women who gave consent. endometrial biopsy was performed in control women if the endometrial thickness was > 5 mm. Karyopyknotic index and maturation index were calculated from the vaginal smears. Results The rate of amenorrhoea between six months and six years treatment was 90% in the tibolone group compared with 91% in the controls (P was not significant). There was improvement in reported vaginal symptomatology in the treatment group but not in the controls. Median endometrial thickness increased slightly in the tibolone treated group (3.2 mm tibolone vs 2.5 mm control; P < 0.05). There were no cases of cytologically proven endometrial stimulation in asymptomatic women in either group. Both vaginal karyopyknotic index and maturation index increased significantly in the tibolone treated group over six years, but not in the control group. Conclusions Tibolone is effective at maintaining an inactive endometrium while providing oestrogenisation of the lower genital tract over a six year period.

The purpose of this review is to assimilate relevant experimental and clinical information available on selective estrogen receptor modulators with respect to their potential use as agents to improve women's health in the postmenopausal years. In addition, the mechanisms of action of these drugs are outlined. Selective estrogen receptor modulators represent an exciting group of antiestrogens that possess agonist action on bone, lipids, and lipoproteins and antagonistic action in the endometrium and breast. Thus in theory these drugs may preserve bone density and reduce the risk of osteoporotic fracture and coronary heart disease at the same time that they lower the incidences of breast and endometrial neoplasms. Short-term data with the use of raloxifene suggest that bone is preserved and lipid profiles are less atherogenic. Long-term studies are needed to determine whether raloxifene or other selective estrogen receptor modulators are associated with any decrease in the risk of breast or endometrial cancer.