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Trew G, Pistofidis G, Pados G, Lower A, Mettler L, Wallwiener D, Korell M, Pouly JL, Coccia ME, Audebert A, Nappi C, Schmidt E, McVeigh E, Landi S, Degueldre M, Konincxk P, Rimbach S, Chapron C, Dallay D, Röemer T, McConnachie A, Ford I, Crowe A, Knight A, Dizerega G, Dewilde R. Gynaecological endoscopic evaluation of 4% icodextrin solution: a European, multicentre, double-blind, randomized study of the efficacy and safety in the reduction of de novo adhesions after laparoscopic gynaecological surgery. Hum Reprod 2011; 26:2015-27. [PMID: 21632697 DOI: 10.1093/humrep/der135] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Gynaecological laparoscopic surgery outcomes can be compromised by the formation of de novo adhesions. This randomized, double-blind study was designed to assess the efficacy and safety of 4% icodextrin solution (Adept(®)) in the reduction of de novo adhesion incidence compared to lactated Ringer's solution (LRS). METHODS Patients undergoing laparoscopic surgery for removal of myomas or endometriotic cysts were treated with randomized solution as an intra-operative irrigant and 1l post-operative instillate. De novo adhesion incidence (number of sites with adhesions), severity and extent were independently scored at a second-look procedure and the efficacy of the two solutions compared. The effect of surgical covariates on adhesion formation was also investigated. Initial exploratory analysis of individual anatomical sites of clinical importance was progressed. RESULTS Of 498 patients randomized, 330 were evaluable (160 LRS--75% myomectomy/25% endometriotic cysts; 170 Adept--79% myomectomy/21% endometriotic cysts). At study completion, 76.2% LRS and 77.6% Adept had ≥ 1 de novo adhesion. The mean (SD) number of de novo adhesions was 2.58 (2.11) for Adept and 2.58 (2.38) for LRS. The treatment effect difference was not significant (P = 0.909). Assessment of surgical covariates identified significant influences on the mean number of de novo adhesions regardless of treatment, including surgery duration (P = 0.048), blood loss in myomectomy patients (P = 0.019), length of uterine incision in myomectomy patients (P < 0.001) and number of suture knots (P < 0.001). There were 15 adverse events considered treatment-related in the LRS patients (7.2%) and 18 in the Adept group (8.3%). Of 17 reported serious adverse events (9 LRS; 8 Adept) none were considered treatment-related. CONCLUSIONS The study confirmed the safety of Adept in laparoscopic surgery. The proportion of patients with de novo adhesion formation was considerably higher than previous literature suggested. Overall there was no evidence of a clinical effect but various surgical covariates including surgery duration, blood loss, number and size of incisions, suturing and number of knots were found to influence de novo adhesion formation. The study provides direction for future research into adhesion reduction strategies in site specific surgery.
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Affiliation(s)
- G Trew
- Reproductive Medicine and Surgery, Hammersmith and Queen Charlotte's Hospital, London W12 OHS, UK.
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Bourbonnais R, Brisson C, Vinet A, Vézina M, Lower A. Development and implementation of a participative intervention to improve the psychosocial work environment and mental health in an acute care hospital. Occup Environ Med 2006; 63:326-34. [PMID: 16621853 PMCID: PMC2092489 DOI: 10.1136/oem.2004.018069] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.7] [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: 11/04/2022]
Abstract
OBJECTIVES To describe the development and implementation phases of a participative intervention aimed at reducing four theory grounded and empirically supported adverse psychosocial work factors (high psychological demands, low decision latitude, low social support, and low reward), and their mental health effects. METHODS The intervention was realised among 500 care providers in an acute care hospital. A prior risk evaluation was performed, using a quantitative approach, to determine the prevalence of adverse psychosocial work factors and of psychological distress in the hospital compared to an appropriate reference population. In addition, a qualitative approach included observation in the care units, interviews with key informants, and collaborative work with an intervention team (IT) including all stakeholders. RESULTS The prior risk evaluation showed a high prevalence of adverse psychosocial factors and psychological distress among care providers compared to a representative sample of workers from the general population. Psychosocial variables at work associated with psychological distress in the prior risk evaluation were high psychological demands (prevalence ratio (PR) = 2.27), low social support from supervisors and co-workers (PR = 1.35), low reward (PR = 2.92), and effort-reward imbalance (PR = 2.65). These results showed the empirical relevance of an intervention on the four selected adverse psychosocial factors among care providers. Qualitative methods permitted the identification of 56 adverse conditions and of their solutions. Targets of intervention were related to team work and team spirit, staffing processes, work organisation, training, communication, and ergonomy. CONCLUSION This study adds to the scarce literature describing the development and implementation of preventive intervention aimed at reducing psychosocial factors at work and their health effects. Even if adverse conditions in the psychosocial environment and solutions identified in this study may be specific to the healthcare sector, the intervention process used (participative problem solving) appears highly exportable to other work organisations.
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Affiliation(s)
- R Bourbonnais
- Rehabilitation Department, Medecine Faculty, Laval University, Québec, QC, Canada.
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Abstract
This paper identifies the risk and protective factors for injury in non-elite Australian Football. Five hundred and thirty five non-elite Australian footballers completed a baseline questionnaire at the commencement of the 1997 preseason. Participants were telephoned each month during the 1997 and 1998 playing seasons to provide details of their exposure at training and games and any injury experiences in the previous four weeks. The incidence of injury in this study was 24 injuries per 1000 player hours. The risk factors for injury were identified as: not wearing sports-specific football boots (IRR 1.40, 95% CI 1.03-1.90); an existing back pathology (IRR 1.29, 95% CI 1.10-1.51); excessive foot pronation (IRR 1.29, 95% CI 1.07-1.56); and extroverted behaviour (IRR 1.01, 95% CI 1.00-1.03). Cooling down after training (IRR 0.95, 95% CI 0.90-0.99) and not being injured in the previous 12 months (IRR 0.73, 95% CI 0.61-0.88) were found to be protective against injury. This study found that there was a high risk of injury associated with playing Australian Football at a community level. Further research is required to gain an understanding of the mechanisms by which the identified risk factors influence injury risk in community level Australian Football.
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Affiliation(s)
- A McManus
- WA Centre for Health Promotion Research, Curtin University of Technology, Perth, Australia
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Meuleners LB, Binns CW, Lee AH, Lower A. Perceptions of the quality of life for the adolescent with a chronic illness by teachers, parents and health professionals: a Delphi study. Child Care Health Dev 2002; 28:341-9. [PMID: 12296869 DOI: 10.1046/j.1365-2214.2002.00283.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS The perceptions that teachers, parents and health professionals have on the relative importance of different aspects of quality of life (QOL) for the adolescent with a chronic illness were explored using a three-round Delphi study. METHODS The first round questionnaire identified the level of importance each panel attached to 16 aspects relating to QOL. Panellists were also encouraged to provide additional comments on why they felt a particular item was important. In round two, panellists were asked to prioritize the items in order of importance, whereas round three attempted to achieve consensus among each of the three panels. RESULTS Differences between and within panels in the prioritization of items in round one and round two were evident. However, consensus was achieved in round three, except for the prioritization of very important items by the panel of teachers. Items identified by all three panels as extremely important included the adolescent's attitude, family relationships and friendships with the same age group. Themes to emerge from the qualitative responses to the open-ended questions included the perception of the chronically ill adolescent 'not wanting to be different' and the importance of a 'positive attitude'. The majority of participants also perceived adolescents with a chronic illness as having worse QOL than their healthy counterparts. CONCLUSIONS By increasing the awareness among the different groups of the impact of chronic illness on various aspects of adolescent QOL, the overall care and support of those adolescents could be improved. Further studies should also be undertaken to explore the views of the chronically ill adolescents themselves.
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Affiliation(s)
- L B Meuleners
- School of Public Health, Curtin University of Technology, Perth, Australia
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Sabatini L, Wilson C, Lower A, Al-Shawaf T, Grudzinskas JG. Superoxide dismutase activity in human follicular fluid after controlled ovarian hyperstimulation in women undergoing in vitro fertilization. Fertil Steril 1999; 72:1027-34. [PMID: 10593376 DOI: 10.1016/s0015-0282(99)00411-2] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.2] [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: 10/18/2022]
Abstract
OBJECTIVE To determine the activity of superoxide dismutase (SOD) and the total protein concentration in human preovulatory ovarian follicular fluid (FF) in relation to corresponding serum levels and the fertilization capacity of oocytes. DESIGN Prospective, observational study. SETTING Academic-based center for reproductive medicine. PATIENT(S) Twenty-eight female partners of infertile couples, 13 of whom were smokers, undergoing controlled ovarian hyperstimulation for IVF. INTERVENTION(S) Blood and follicular fluid samples were collected 34-36 hours after hCG administration. MAIN OUTCOME MEASURE(S) Levels of SOD activity and total protein concentrations. RESULT(S) Superoxide dismutase activity was present in all the FF studied and mean levels were statistically significantly higher than in serum. Total protein concentrations in serum were statistically significantly correlated with corresponding concentrations in FF. There was no difference in SOD activity between smokers and nonsmokers. Total protein concentrations in FF were marginally and statistically significantly lower in nonsmokers. Follicular fluid from patients whose oocytes did not become fertilized had a statistically significantly higher level of SOD activity than that from patients whose oocytes did become fertilized. CONCLUSION(S) Superoxide dismutase activity is present in FF and is higher than in serum. The degree of SOD activity is variable and seems to be inversely related to the fertilization of oocytes.
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Affiliation(s)
- L Sabatini
- Fertility Centre, Saint Bartholomew's Hospital, London, United Kingdom
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El-Nemr A, Sabatini L, Wilson C, Lower A, Al-Shawaf T, Grudzinskas J. P-087. Age, cigarette smoking and early follicular phase FSH concentrations in infertile women. Hum Reprod 1997. [DOI: 10.1093/humrep/12.suppl_2.161-b] [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: 11/12/2022] Open
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Balet R, Barua J, Reynard J, Khalifa C, Wilson C, Foad F, Knight S, Ashworth F, Lower A, Badenoch D, Grudzinskas J. R-094. A 5 year review of surgical sperm extraction and IVF. Hum Reprod 1997. [DOI: 10.1093/humrep/12.suppl_2.277] [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: 11/12/2022] Open
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Rufford C, Al-Mizyen E, Sabatini L, Lower A, Wilson C, Al-Shawaf T, Grudzinskas J. R-088. Pretreatment with progestogen or oral contraceptive pills in poor responders on the GnRHa flare protocol in IVF. Hum Reprod 1997. [DOI: 10.1093/humrep/12.suppl_2.274] [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: 11/14/2022] Open
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Grudzinskas JG, Palomino M, Armstrong P, Lower A. Relocation of ectopic pregnancy to the uterine cavity: a dream or a reality? Br J Obstet Gynaecol 1994; 101:651-3. [PMID: 7947494 DOI: 10.1111/j.1471-0528.1994.tb13176.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- J G Grudzinskas
- Department of Obstetrics and Gynaecology, Royal London Hospital, Whitechapel, UK
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Jacobs I, Prys Davies A, Bridges J, Stabile I, Fay T, Lower A, Grudzinskas J, Oram D. Prevalence screening for ovarian cancer in postmenopausal women by CA 125 measurement and ultrasonography. Int J Gynaecol Obstet 1994. [DOI: 10.1016/0020-7292(94)90056-6] [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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Jacobs I, Davies AP, Bridges J, Stabile I, Fay T, Lower A, Grudzinskas JG, Oram D. Prevalence screening for ovarian cancer in postmenopausal women by CA 125 measurement and ultrasonography. BMJ 1993; 306:1030-4. [PMID: 8490497 PMCID: PMC1677033 DOI: 10.1136/bmj.306.6884.1030] [Citation(s) in RCA: 237] [Impact Index Per Article: 7.6] [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 assess the performance of the sequential combination of serum CA 125 measurement and ultrasonography in screening for ovarian cancer. DESIGN The serum CA 125 concentration of each subject was determined and those with a concentration > or = 30 U/ml were recalled for abdominal ultrasonography. If ultrasonography gave abnormal results surgical investigation was arranged. Volunteers were followed up by annual postal questionnaire. SETTING General practice, occupational health departments, ovarian cancer screening clinic. SUBJECTS 22,000 women volunteers who were postmenopausal and aged over 45 years. MAIN OUTCOME MEASURES Apparent sensitivity, specificity, positive predictive value, years of cancer detected. RESULTS 41 women had a positive screening result and were investigated surgically. 11 had ovarian cancer (true positive result) and 30 had other disorders or no abnormality (false positive result). Of the 21,959 volunteers with a negative screening result, eight subsequently presented clinically with ovarian cancer (false negative result) and 21,951 had not developed ovarian cancer during follow up (apparent true negative result). The screening protocol achieved a specificity of 99.9%, a positive predictive value of 26.8%, and an apparent sensitivity of 78.6% and 57.9% at one year and two year follow up respectively. The estimated number of years of cancer detected by the prevalence screen was 1.4 years. CONCLUSIONS This screening protocol is highly specific for ovarian cancer and can detect a substantial proportion of cases at a preclinical stage. Further investigation is required to determine the effect of the screening protocol on the ratio of early to late stage disease detected and on mortality from ovarian cancer.
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Affiliation(s)
- I Jacobs
- Gynaecological Oncology Unit, Royal London Hospital
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White T, Miller R, Grudzinskas G, Lower A, Fay T. Human endometrial cells grown on extracellular matrix (ECM) form an in vivo type morphology and produce the endometrial protein PP-14 (α2-PEG). Placenta 1989. [DOI: 10.1016/0143-4004(89)90179-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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