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  • 1
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Objective To compare endometrial laser ablation (ELA) with transcervical resection of the endometrium (TCRE) in the treatment of menorrhagia.Design Randomised controlled trial.Setting Gynaecology department of a large teaching hospital.Participants Women with menorrhagia due to dysfunctional uterine bleeding (n= 372) were randomly allocated to ELA (n= 188) or TCRE (n= 184).Main outcome measures Operative complications, post-operative recovery, relief of menstrual and other symptoms, need for further surgical treatment, satisfaction with treatment after 6 and 12 months, and differential resource use.Results TCRE was significantly quicker, with lower rates of fluid overload. Perioperative morbidity was low and similar hi both groups. Outcome at 12 months was also similar: 72 women (45%) had either amenorrhoea or brown discharge in the ELA group compared with 71 (49%) in the TCRE group; 79 (49%) versus 68 (46%) had lighter periods. Thirty (16%) versus36 (20%) had received further surgical treatment: 9 (5%) compared with 25 (14%) had had a hysterectomy, and 21 (11%) versus 11 (6%) had received repeat ablation. Anxiety and depression, dysmenorrhoea and pre-menstrual symptoms were improved by both procedures and bladder symptoms were affected by neither. At 12 months 148 (90%) women in the ELA group and 140 (91%) women in the TCRE group were satisfied with their treatment. The estimated additional cost of ELA was £145 per procedure.Conclusions At one year there was no clear difference in clinical outcome between ELA and TCRE.Both procedures were associated with low morbidity. ELA was the more costly procedure. Despite the need for further surgery for about one in six women, satisfaction rates were high following both ELA and TCRE.
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    BJOG 104 (1997), S. 0 
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Objectives To study survival in women treated for cervical carcinoma in Grampian region, to identify clinical and pathological prognostic factors, and to correlate survival with cytology history.Design A retrospective study of all cases of cervical carcinoma using a prospectively gathered database. Data validated by 1 in 10 randomised retrospective case note sampling.Setting Aberdeen Royal Infirmary.Subjects Three hundred and sixty-three women resident within Grampian diagnosed as having cervical carcinoma between 1980 and 1991, with five-year survival data on the 206 diagnosed by the end of 1986.Main outcome measure Five-year survival rates.Results The mean annual incidence of cervical carcinoma in our population was 11.2 per 100 000 women, with an overall five-year survival of 67% in those under 40 years of age and 60% in those aged 40 years and over. On univariate analysis, survival was significantly adversely affected by tumour stage, grade and absence of previous smears. On multivariate analysis, the effect of previous smear history was lost, but stage and grade remained strong independent risk factors for survival. There was no significant difference in five-year survival by age or tumour type.Conclusions The prognosis of cervical carcinoma in Grampian region was independently affected only by stage of disease and tumour grading and cervical smear history.
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    BJOG 104 (1997), S. 0 
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Objective To evaluate colposcopic practice over a 12-month period in the UK, April 1993 to March 1994, to compare this with 1988, and to test penetration and acceptance of previously introduced national guidelines.Design A nationwide survey of colposcopy practice by postal questionnaire, including referral criteria, diagnosis and treatment, follow up, waiting times and information and counselling.Setting All gynaecology clinics in the United Kingdom.Results Returns were obtained from 215 clinics (78%), that saw an average of 434 new women per year. Seventy percent of clinics follow the current national guideline for cytological referral criteria for colposcopy. Diathermy loop excision is now by far the most popular treatment method for CIN. The majority of clinics employ both colposcopy and cytology for follow up. A total of 103 invasive cancers following treatment for CIN were reported during the 12-month period of the survey. Most clinics provide new patients with both information and counselling.Conclusions Colposcopy practice has undergone considerable changes in the last five years. There has been a good response to the introduction of a national guideline for referral for colposcopy. While local audits are necessary to identify improvements that need to be made to individual clinical services, this national audit has shown some trends over the past five years, has highlighted the problem of invasive cancer following treatment for CIN and has assessed the impact of a national guideline.
    Type of Medium: Electronic Resource
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  • 6
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Objective To determine if large loop excision of the transformation zone affects subsequent fertility and pregnancy outcome.Design A case-control study.Setting A teaching hospital serving a regional population.Subjects One thousand women who had undergone large loop excision of the transformation zone (LLETZ) for the treatment of cervical intraepithelial neoplasia (CIN) between 1989 and 1991. Two controls were matched for each of the 149 women who had a singleton pregnancy progressing beyond 20 weeks of gestation following treatment, with regard to age, parity, height, husband's or partner's social class and smoking habits to account for common independent risk factors for adverse obstetric outcome and cervical intraepithelial neoplasia.Main outcome measures Intention to conceive, number of pregnancies, gestation, low birthweight, mean birthweight, mode of delivery, and duration of labour.Results Out of a cohort of 1000 women who underwent LLETZ for the treatment of CIN, 653 women replied to a postal questionnaire. When asked up to 54 months after treatment, 130 women (19.9%) had become pregnant and 47 (7.2%) had tried to become pregnant. A total of 199 pregnancies from 178 women was identified from the cohort of women.For the 149 women from the case cohort, the mean birthweight was 3380 g compared with 3373 g in the control group (P= 0.88). The incidence of low birthweight in pregnancies progressing to at least 37 weeks of gestation was 3.1% in the treated group, compared with 3.2% in the control group (P= 098). Following LLETZ, 94% of deliveries were preterm (〈 37 weeks of gestation), compared with 50% in the control group (P= 0.12). There was no significant difference in mean gestation, mode of delivery, indication for caesarean section or duration of labour between the women who had undergone LLETZ and the controls.Conclusion When socio-epidemiological factors associated with the development of cervical intraepithelial neoplasia are controlled for, LLETZ does not appear to exert an independent adverse effect on subsequent pregnancy outcome.
    Type of Medium: Electronic Resource
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  • 7
    ISSN: 1365-2303
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: This study investigated the 5-year follow-up status of women with cervical smears showing borderline nuclear changes (BNC) or mild dyskaryosis and the effect of koilocytosis on the outcome. Thirteen per cent of women with cervical smears showing BNC had high-grade cervical intraepithelial neoplasia (CIN). In contrast, 28% of women with cervical smears showing mild dyskaryosis had high-grade CIN. The presence of koilocytosis (24% for borderline smears and 34% for mild dyskaryotic smears) did not appear to influence the risk of developing high-grade CIN. Our results suggest that the simultaneous implementation of the British Society for Clinical Cytology proposed terminology and the colposcopy guidelines from the British Society for Colposcopy and Cervical Pathology could have an impact on colposcopy services.
    Type of Medium: Electronic Resource
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  • 8
    Electronic Resource
    Electronic Resource
    Oxford UK : Blackwell Science Ltd.
    Cytopathology 13 (2002), S. 0 
    ISSN: 1365-2303
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 9
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing
    Cytopathology 14 (2003), S. 0 
    ISSN: 1365-2303
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The success of the Cervical Screening Programme (CSP) is due in part to its management being underpinned by Quality Assurance. These measures ensure uniform standards across the country. Since 1992 Colposcopy Guidelines have been in place; these were updated in 1997 and have just been redefined. It is entirely consistent with the National CSP that colposcopy is governed by Guidelines.The aim of clinical practice guidelines is to raise the standard of care and improve outcomes. The objectives are, therefore:〈list xml:id="l1" style="custom"〉a) to develop evidence based guidelines;b) to ensure the guidelines are widely adopted.The credibility of guidelines is crucial to their adoption and this depends far more on the demonstration of an evidence base than that the authors are ‘experts’. Development by a professional group or body who are seen as having a legitimate role is very important as is involvement of all ‘stakeholders’ in ensuring acceptability.In terms of their nature, guidelines should be valid i.e. they will achieve what they are intended to achieve, and they should be robust i.e. they will work when implemented by different individuals in different settings. Colposcopy lends itself well to guidelines because it is largely a routine practice, but substandard care can have serious consequences.In previous years there has been a set of Guidelines for Practice/〉/〉 and a set of Quality Standards/〉. On this occasion these two components have been put together in a simple publication.It needs to be borne in mine that the new guidelines were being developed in the context of a number of potential changes which could interact with each other and impact on the Guidelines. These include: 〈inlineGraphic alt="inline image" href="urn:x-wiley:09565507:CYT086_5:CYT_086_fu1" location="image_n/CYT_086_fu1.gif"/〉 The process for the development of the Guidelines included an Editor, an editorial group, and a group of contributors to produce a draft set of evidence based guidelines across 18 areas. New areas covered included HIV +ve women, immuno suppressed women, and working practice.The draft has been available for comment for several months and amendments have been made. Clearly there are areas where evidence is lacking and where different views are expressed. The most contentious area not surprisingly is in the topic of managing mild dyskaryosis; controversy in this has persisted for many years.The quality standards are either attainable or within attainment and are a driver for rising standards. These programme practice guidelines and standards have earned UK colposcopy international respect. They provide a benchmark for QA assessment and will continue to require amendment as new developments come into being.
    Type of Medium: Electronic Resource
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  • 10
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    BJOG 98 (1991), S. 0 
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Objective— To audit various aspects of colposcopy practice throughout the United Kingdom on behalf of BSCCP.Design— A postal questionnaire was circulated to those responsible for colposcopy services in all districts in the United Kingdom in 1988, followed by a smaller survey of 40 clinics in 1990 to detect any trends.Main outcome measures— Information was sought on colposcopy workload, referral criteria, treatment method and follow-up, waiting times, staffing and training.Results— There was a 71% response to the national survey of 1988 practice which alone accounted for 80 000 new referrals for colposcopy. Cytological criteria for colposcopy referral were generally liberal. In 1988 laser ablation was the single most popular method, and waiting times for colposcopy varied, with 79% of patients being seen within 8 weeks of referral. Colposcopy clinies run by non-gynaecologists, mainly genito-urinary physicians, were reported by 32% of districts. Half the respondents did not have accurate statistics, only 17% being computerized, and dissatisfaction with clerical support was widespread. Resources are required to improve administration and data collection. The principal findings from the 1990 data subset were a 10% reduction for new patient referrals compared with 1988 and the use of diathermy loop excision by one-third as their preferred treatment.Conclusions— This audit of colposcopy has provided useful information as well as a means of monitoring trends in colposcopy activity in the future.
    Type of Medium: Electronic Resource
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