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Duffy JMN, Chequer S, Braddy A, Mylan S, Royuela A, Zamora J, Ip J, Hayden S, Showell M, Kinnersley P, Chenoy R, Westwood OM, Khan KS, Cushing A. Educational effectiveness of gynaecological teaching associates: a multi-centre randomised controlled trial. BJOG 2016; 123:1005-10. [PMID: 26776314 DOI: 10.1111/1471-0528.13824] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate, among medical students learning the female pelvic examination, the added benefits of training by gynaecological teaching associates compared with training involving a manikin only. DESIGN Randomised controlled trial. SETTING Nine university teaching hospitals. POPULATION Ninety-four medical students recruited prior to commencing a 4-week obstetrics and gynaecology rotation. METHODS The control training consisted of lectures, demonstration of the pelvic examination on a manikin, and opportunities to practise on this low-fidelity simulation (n = 40). The experimental group received additional gynaecological teaching associate training, delivered by pairs of experienced associates to groups of four medical students (n = 54). MAIN OUTCOME MEASURES Outcomes measured at the end of the rotation included knowledge of the correct order of examination components (Yes/No), and student comfort [Likert scales anchored between 1 (very uncomfortable) and 4 (very comfortable) on four items] and confidence [Likert scales anchored between 1 (No) and 3 (Yes) on six items]. The primary outcome, measured at the end of the academic year, was the objective structured clinical examination of a female pelvis (score range 0-54). RESULTS At baseline, the groups were similar in age, gender, and ethnicity. At the end of the clinical rotation, when compared with the control intervention, the experimental intervention had a moderate effect on student knowledge [difference 29.9% (95% CI 11.2-48.6%); P = 0.002] and confidence [difference 1 (95% CI 0-2); P < 0.001], and a large effect on student comfort [difference 1.8 (95% CI 0.6-3.0); P = 0.004]. At the end of the academic year, the experimental intervention had no impact on skills compared with the control [difference 2 (95% CI-1 to 4); P = 0.26]. CONCLUSIONS Among medical students taught the female pelvic examination by low-fidelity simulation, additional training by gynaecology teaching associates improved knowledge, comfort, and confidence at the end of the clinical rotation but did not improve examination skills at end of the academic year.
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Affiliation(s)
- J M N Duffy
- Balliol College, University of Oxford, Oxford, UK
| | | | - A Braddy
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - S Mylan
- Department of Primary Care and Population Health, UCL Medical School, London, UK
| | - A Royuela
- Clinical Biostatistics Unit, Hospital Ramón y Cajal, Madrid, Spain
| | - J Zamora
- Clinical Biostatistics Unit, Hospital Ramón y Cajal, Madrid, Spain
| | - J Ip
- Department of Obstetrics and Gynaecology, Homerton University Hospital NHS Foundation Trust, London, UK
| | - S Hayden
- Clinical and Communication Skills Learning Unit, Institute of Health Sciences Education, Barts and the London School of Medicine and Dentistry, London, UK
| | - M Showell
- Cochrane Menstrual Disorders and Subfertility Group, University of Auckland, Auckland, New Zealand
| | - P Kinnersley
- Institute of Medical Education, Cardiff University, Cardiff, UK
| | - R Chenoy
- Women's Health Research Unit, Queen Mary, University of London, London, UK
| | - O M Westwood
- Clinical and Communication Skills Learning Unit, Institute of Health Sciences Education, Barts and the London School of Medicine and Dentistry, London, UK
| | - K S Khan
- Women's Health Research Unit, Queen Mary, University of London, London, UK
| | - A Cushing
- Clinical and Communication Skills Learning Unit, Institute of Health Sciences Education, Barts and the London School of Medicine and Dentistry, London, UK
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Odejinmi F, Madhuvrata P, Naftalin A, Boulton J, Chenoy R, Raveendran M. Enthusiasm and teamwork—the basis for increase in laparoscopic surgery for ectopic pregnancy: an Inner London district hospital experience. J OBSTET GYNAECOL 2009; 23:645-7. [PMID: 14617469 DOI: 10.1080/01443610310001604439] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Laparoscopic surgery is the gold standard in the surgical management of ectopic pregnancy. It results in lower morbidity, less impact on reproductive health and faster return to normal activity. However, laparoscopic management is not available to all women. Between April 2001 and March 2002 a prospective audit of surgical management of ectopic pregnancy was carried out; 88.7% were performed laparoscopically, most due to concerted consultant input to the care of women with ectopic pregnancy.
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Chenoy R, Redman CWE, Tucker H, Gray J, Shafi MI, Luesley DM. Is there a significant association between Chlamydia trachomatis and mild cervical cytological abnormalities? J OBSTET GYNAECOL 2009. [DOI: 10.3109/01443619209025948] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lyons RA, Djahanbakhch O, Mahmood T, Saridogan E, Sattar S, Sheaff MT, Naftalin AA, Chenoy R. Fallopian tube ciliary beat frequency in relation to the stage of menstrual cycle and anatomical site. Hum Reprod 2002; 17:584-8. [PMID: 11870107 DOI: 10.1093/humrep/17.3.584] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The cyclical changes in ciliary structure and motion within the human Fallopian tube are well documented. Previous investigators have studied ciliary beat frequency (CBF) in relation to menstrual cycle and anatomical site, but with conflicting results. METHODS Using a technique that records variations in light intensity, we have studied the changes in CBF in relation to the menstrual cycle and anatomical site. Fallopian tubes were collected from 26 women who underwent hysterectomy for benign conditions. Menstrual history, hormone profile and endometrial biopsy results were used to determine the stage of the cycle. Fourteen women were in the proliferative phase, and 12 women in the secretory phase. RESULTS Mean CBF for all subjects was 5.3 plus minus 0.2 Hz. There was no significant difference in CBF in relation to anatomical site. In the fimbrial region the ciliary beat was faster in the secretory (5.8 plus minus 0.3 Hz) as compared with the proliferative phase (4.9 plus minus 0.2 Hz), P < 0.02. CONCLUSIONS It is possible that this increase in fimbrial CBF may contribute to ovum retrieval and transport after ovulation. However, the reproductive significance of the changes in CBF in relation to the menstrual cycle needs further investigation.
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Affiliation(s)
- R A Lyons
- Academic Department of Obstetrics and Gynaecology, St Bartholomew's and The Royal London Hospital School of Medicine and Dentistry, Whitechapel, London E1 1BB, UK
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Bhatt A, Chenoy R. Menorrhagia due to Bernard-Soulier Syndrome and its successful treatment by thermal balloon endometrial ablation. ACTA ACUST UNITED AC 2001. [DOI: 10.1016/s0306-5456(00)00130-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Affiliation(s)
- A Bhatt
- Department of Obstetrics and Gynaecology, Newham General Hospital, London, UK
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Howells RE, Dunn PD, Isasi T, Chenoy R, Calvert E, Jones PW, Shroff JF, Redman CW. Is the provision of information leaflets before colposcopy beneficial? A prospective randomised study. Br J Obstet Gynaecol 1999; 106:528-34. [PMID: 10426608 DOI: 10.1111/j.1471-0528.1999.tb08319.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the usefulness of a leaflet distributed to women before colposcopy designed to reduce their anxiety and psychosexual morbidity by providing information. DESIGN Prospective randomised study. SETTING Colposcopy clinic of a large district general hospital. SAMPLE Two hundred consecutive women undergoing colposcopy for the first time for a cervical cytological abnormality of severity no greater than moderate dyskaryosis. METHODS Women were randomised into one of two groups (leaflet or control). Those in the leaflet group were sent an information leaflet prior to attending the clinic. In the colposcopy clinic all the women completed a State/Trait Anxiety Inventory (StAI/TrAI) and a modified psychosexual questionnaire before undergoing colposcopy. This was repeated at the six-month follow up visit. Women in the leaflet group also completed a further questionnaire on the leaflet. MAIN OUTCOME MEASURES Differences of anxiety and psychosexual scores between leaflet and control groups. RESULTS The leaflet was well received. There were no statistical differences in StAI and TrAI scores between the study group and the control group at either visit, although in the whole study population StAI and TrAI scores were reduced at the second visit. The leaflet group had significantly more psychosexual problems but by the second visit, the scores had improved and the two groups were similar. When the mean differences in anxiety and psychosexual scores at the initial and second visits were compared between the groups, the reduction in negative sexual feelings and deterioration of TrAI scores experienced by the leaflet group was significant. CONCLUSIONS This study suggests that the provision of sending an information leaflet prior to colposcopy is not beneficial in isolation. Other approaches need to be considered.
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Affiliation(s)
- R E Howells
- Department of Obstetrics and Gynaecology, North Staffordshire NHS Hospital Trust and Keele University, Stoke-on-Trent, UK
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Thomas SS, Chenoy R, Fielding JW, Rollason TP, Jordan JA, Bracka A. Vulvoperineal reconstruction after excision of anogenital multifocal intraepithelial neoplasia ("MIN"). Br J Plast Surg 1996; 49:539-46. [PMID: 8976746 DOI: 10.1016/s0007-1226(96)90131-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Over the past 7 years, 12 women have been treated utilising a radical surgical approach for extensive vulval involvement as a component of multifocal intraepithelial neoplasia (MIN) of the female genital tract. The patients were analysed with respect to the anatomical site of involvement, age, presenting complaints and their duration, colposcopic examination, histopathology and surgical treatment. Gynaecologists, general surgeons and plastic surgeons were involved in the surgical treatment which was an initial colostomy followed by a definitive vulvoperineal resection and simultaneous vulval reconstruction using meshed split skin grafts or a combination of skin grafts and local flaps. 17 vulvoperineal reconstructions were done for 12 patients. Three had an incomplete histopathological clearance at the initial operation. Apart from these three patients, one had recurrence of symptoms alone, without any evidence of MIN, which was possibly due to human papilloma virus infection. One patient developed malignant squamous invasion 4 years later, which was cured with surgical excision and reconstruction. Colostomy closure was done after achieving local control of the disease. This staged approach does achieve the objectives of eliminating disease and alleviating symptoms. It preserves function and attempts to reconstruct normal anatomy without compromising the principles of surgical oncology and results in a high patient satisfaction.
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Chenoy R, Billingham L, Irani S, Rollason TP, Luesley DM, Jordan JA. The effect of directed biopsy on the atypical cervical transformation zone: assessed by digital imaging colposcopy. Br J Obstet Gynaecol 1996; 103:457-62. [PMID: 8624320 DOI: 10.1111/j.1471-0528.1996.tb09773.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To determine the effect of directed punch biopsy trauma on the natural history of atypical cervical transformation zones. DESIGN A prospective randomised clinical trial. SETTING Academic Unit colposcopy clinics in Birmingham. PARTICIPANTS One hundred and eighty women attending the colposcopy clinics were recruited over an 18 month period, of which 161 were eligible for analysis. METHODS Three-way randomisation of patients into 1. no biopsy, 2. central biopsy and 3. peripheral biopsy groups. Quantitative assessment of the change in surface area and severity of cervical intra-epithelial neoplasia (CIN) lesions in each group measured six weeks apart using digital imaging colposcopy. RESULTS No significant difference in change in lesion size (P = 0.40) was noted in the three treatment groups. Results suggest that the severity of the lesion was underestimated by the peripheral biopsy. CONCLUSIONS The results of this study suggest that directed punch biopsy trauma does not have a significant effect on the immediate natural history of CIN. No statistically significant differences were found in lesion size whether biopsy was employed or not. In addition, the site of biopsy had no influence on the outcome. It appears, therefore, that tissue trauma from punch biopsy and the subsequent inflammatory and wound healing processes do not modify the course of CIN. The regressive changes observed after punch biopsy in previous natural history studies are probably not a result of the initial inflammatory response to biopsy trauma and subsequent re-epithelialisation with normal cells, but may result from processes that continue long after tissue repair is completed.
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Affiliation(s)
- R Chenoy
- Academic Department of Obstetrics and Gynaecology, Birmingham Women's Hospital, Edgbaston, UK
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Houghton SJ, Shafi MI, Chenoy R, Kehoe S, Luesley DM. The outcome of replacing an intrauterine contraceptive device at the time of large loop excision of the transformation zone. J OBSTET GYNAECOL 1996. [DOI: 10.3109/01443619609004101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Affiliation(s)
- S Pradhan
- Academic Department of Obstetrics and Gynaecology, North Staffordshire Hospital, Stoke-on-Trent, UK
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Abstract
A prospective survey was carried out in two Kathmandu hospitals and two rural districts to establish urban and rural perinatal mortality rates (PNMRs) for these four centres in Nepal and to ascertain the causes of perinatal mortality. All perinatal deaths occurring over a 1-year period in the four centres were included (during which time there was a total of 14,967 births). Cause of death was established by contemporary review of hospital case records or by structured questionnaire ('verbal autopsy') in the rural areas. The PNMRs in the hospitals were 48.0 and 23.7 per thousand total births respectively, whilst those of the rural settings were 96.2 and 42.5 per thousand births. Perinatal asphyxia, low birthweight and infection were the most common causes but many of the deaths were unexplained. The high mortality rates were felt to reflect the difficult circumstances of childbirth in Nepal. It was concluded that a number of interventions would appear appropriate, but that these should be introduced in a scientific manner.
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Affiliation(s)
- T Geetha
- Patan Hospital, Kathmandu, Nepal
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Abstract
Colposcopic assessment may be normal in the presence of severe or persistent minor cytologic abnormality. To assess the significance of negative satisfactory colposcopy in patients with abnormal cervical smears, a retrospective review was carried out on 1170 patients who had undergone out-patient loop diathermy excision for abnormal cervical cytology. Of these, 69 patients were treated for abnormal cervical cytology, despite normal colposcopic findings. Cytologic abnormalities ranged from persistent borderline changes to severe dyskariosis. Histologic assessment of the excision specimens revealed cervical intraepithalial neoplasia (CIN) in 43 (62.3%) cases, of which high-grade CIN accounted for 24 (34.8%) cases. There was good correlation between cytologic and histologic diagnosis. Simple regression analysis showed r = 0.46, P < 0.0001. The cytologic abnormality was highly predictive of the corresponding histologic diagnosis. This analysis has shown that significant intraepithelial lesions may exist despite negative colposcopic examination and highlights the need for histologic evaluation in such cases. In these circumstances, loop cone biopsy permits accurate definition of lesion severity, avoids potential undertreatment of significant lesions and causes less morbidity than conventional cone biopsy.
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Affiliation(s)
- R. Chenoy
- Academic Department of Obstetrics and Gynaecology, University of Birmingham, Dudley Road Hospital, Birmingham and Academic Department of Obstetrics and Gynaecology, Keele University, North Staffordshire Medical Centre, Stoke-on-Trent, UK
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Shafi MI, Dunn JA, Chenoy R, Buxton EJ, Williams C, Luesley DM. Digital imaging colposcopy, image analysis and quantification of the colposcopic image. Br J Obstet Gynaecol 1994; 101:234-8. [PMID: 8193099 DOI: 10.1111/j.1471-0528.1994.tb13116.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To investigate the use of a digital imaging system for colposcopy, its use for image analysis and quantification of the colposcopic features that may predict histological outcome as defined by large loop excision of transformation zone. DESIGN Prospective programme study of all patients undergoing colposcopy for cytological abnormalities. SETTING Dudley Road Hospital, Birmingham. SUBJECTS Fifty consecutive patients having cytological and colposcopic abnormality treated with large loop excision of transformation zone formed the study group. MAIN OUTCOME MEASURES Pretreatment and colposcopic features correlated with histological diagnosis of excised transformation zone. RESULTS Index cytology and current smoking status are the most important variables for prediction of histological diagnosis. Other important variables are focality of lesion, surface pattern, intercapillary distance and degree of acetowhiteness. CONCLUSION Digital imaging colposcopy allows image capture, processing and objective analysis. This methodology holds advantages for basic and clinical research, teaching, diagnostics and clinical audit. The system can act as a quality control tool for colposcopy units. This system should prove invaluable for further quantitative studies, for natural history studies and for those patients with deferred treatment of their cytological and colposcopic abnormalities. The statistical models described may be incorporated into the system and can aid the colposcopist in management of the woman with abnormal cervical cytology and colposcopic abnormality.
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Affiliation(s)
- M I Shafi
- Department of Obstetrics and Gynaecology, Dudley Road Hospital, Birmingham, UK
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Abstract
OBJECTIVE To evaluate the efficacy of gamolenic acid provided by evening primrose oil in treating hot flushes and sweating associated with the menopause. DESIGN Randomised, double blind, placebo controlled study. SETTING District general hospital and teaching hospital. SUBJECTS 56 menopausal women suffering hot flushes at least three times a day. INTERVENTION Four capsules twice a day of 500 mg evening primrose oil with 10 mg natural vitamin E or 500 mg liquid paraffin for six months. MAIN OUTCOME MEASURES Change in the number of hot flushes or sweating episodes a month. RESULTS 56 diaries were analysed, 28 from women taking gamolenic acid and 28 from those taking placebo. Only 18 women given gamolenic acid and 17 given placebo completed the trial. The mean (SE) improvement in the number of flushes in the last available treatment cycle compared with the control cycle was 1.9 (0.4) (P < 0.001) for daytime flushes and 0.7 (0.3) (P < 0.05) for night time flushes in women taking placebo; the corresponding values for women taking gamolenic acid were 0.5 (0.4) and 0.5 (0.3). In women taking gamolenic acid the only significant improvement was a reduction in the maximum number of night time flushes (1.4 (0.6); P < 0.05). CONCLUSION Gamolenic acid offers no benefit over placebo in treating menopausal flushing.
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Affiliation(s)
- R Chenoy
- Academic Department of Obstetrics and Gynaecology, Keele University, North Staffordshire Medical Centre, Stoke on Trent
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Luesley D, Blomfield P, Dunn J, Shafi M, Chenoy R, Buxton J. Cigarette smoking and histological outcome in women with mildly dyskaryotic cervical smears. Br J Obstet Gynaecol 1994; 101:49-52. [PMID: 8297868 DOI: 10.1111/j.1471-0528.1994.tb13009.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To determine which patient related variables, available at the point of referral, predict the presence of high grade intraepithelial neoplasia when the smear result is mild dyskaryosis with or without co-existent koilocytosis. DESIGN Multivariate analysis of prospective programme trial. SETTING Academic Department Colposcopy clinics at Dudley Road Hospital, Birmingham, UK. SUBJECTS One hundred and sixty-seven women, whose worst ever cervical smear was mild dyskaryosis with or without koilocytosis, referred to colposcopy clinics. All the women had complete data sets, as determined by the format of an ongoing programme, and all were treated by diathermy loop excision of the cervical transformation zone. MAIN OUTCOME MEASURES Age, parity, contraceptive practice, smoking habit, duration of abnormal cytology and the grade of histology in the excised transformation zone. RESULTS Forty-seven out of 78 (60%) smokers, compared with 18 out of 73 (25%) nonsmokers, had high grade disease. The other variables considered in the analysis were not significant or very weakly associated with histological grade when analysed in a univariate analysis. Stepwise logistic regression identified cigarette smoking as a powerful independent predictor of high grade disease. CONCLUSION These data suggest a strong association between smoking and high grade intraepithelial neoplasia in a population of women whose worst ever smear report was mild dyskaryosis. Smoking is a variable that could be built into models to facilitate referral for colposcopic assessment.
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Affiliation(s)
- D Luesley
- Department of Obstetrics and Gynaecology, Dudley Road Hospital, Birmingham, UK
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Chenoy R, Johanson R. A randomized prospective study comparing delivery with metal and silicone rubber vacuum extractor cups. Int J Gynaecol Obstet 1993. [DOI: 10.1016/0020-7292(93)90430-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Doyle M, Warwick A, Redman C, Hillier C, Chenoy R, O'Brien S. Does application of Monsel's solution after loop diathermy excision of the transformation zone reduce post operative discharge? Results of a prospective randomised controlled trial. Br J Obstet Gynaecol 1992; 99:1023-4. [PMID: 1341890 DOI: 10.1111/j.1471-0528.1992.tb13714.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- M Doyle
- Academic Department of Obstetrics and Gynaecology, School of Postgraduate-Medicine and Biological Sciences, Keele University, Stoke-on-Trent, UK
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Warwick A, Redman C, Igwe F, Abukhalil I, Chenoy R. Cervical cone biopsy: a report of one hundred consecutive operations performed as day cases. Br J Obstet Gynaecol 1992; 99:935-6. [PMID: 1450151 DOI: 10.1111/j.1471-0528.1992.tb14451.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- A Warwick
- Academic Department of Obstetrics & Gynaecology, School of Postgraduate-Medicine and Biological Sciences, Keele University, Stoke-on-Trent, UK
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Buxton EJ, Shafi MI, Chenoy R, Luesley DM. Predicting mortality from cervical cancer. BMJ 1992; 305:833. [PMID: 1422382 PMCID: PMC1883469 DOI: 10.1136/bmj.305.6857.833-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Affiliation(s)
- M I Shafi
- Academic Department of Obstetrics and Gynaecology, Dudley Road Hospital, Birmingham, UK
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Abstract
OBJECTIVE To determine the relative benefits and complications of assisted vaginal delivery with metal and silicone rubber vacuum extractor cups. DESIGN Prospective randomized controlled study. SETTING A busy referral maternity hospital in Kathmandu, Nepal. SUBJECTS 101 women were assigned to delivery with the Silc-cup and 98 to delivery with the metal cup. MAIN OUTCOME MEASURES Success rate at achieving delivery with the assigned instrument and incidence of neonatal trauma. Analysis was by 'intention to deliver' with women remaining in their original group regardless of the eventual mode of delivery. RESULTS Randomization resulted in two groups of women similar in respect of age, parity, gestation and indication for delivery. The overall success rate was similar for the two instruments (Silc-cup 85% and metal cup 87%). The Silc-cup was more likely to fail if there was excessive caput (seven failures compared with one in the metal cup group). The frequency of clinically significant maternal trauma was low in both groups. There were fewer babies with clinically significant scalp trauma in the Silc-cup group (22%), compared with the metal cup group (37%). CONCLUSIONS The data indicate a greater tendency for the Silc-cup to fail when excessive caput is present but that metal cups are associated with increased scalp injuries.
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Affiliation(s)
- R Chenoy
- Dudley Road Hospital, Birmingham, UK
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Johanson RB, Rice C, Shokr A, Doyle M, Chenoy R, O'Brien PM. ST-waveform analysis of the fetal electrocardiogram could reduce fetal blood sampling. Br J Obstet Gynaecol 1992; 99:167-8. [PMID: 1294063 DOI: 10.1111/j.1471-0528.1992.tb14482.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- R B Johanson
- Keele University Academic Department of Obstetrics and Gynaecology, North Staffordshire Maternity Hospital, Stoke-on-Trent
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