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Aims to show that audit and feedback could improve the prescribing of hormone replacement therapy (HRT) to women with a history of hysterectomy. Describes a randomised controlled trial involving 28 practices and covering a total of 3,169 women with a baseline coded history of hysterectomy. In addition to data extraction and feedback, intervention practices were given educational material and audit support. A rise in prescribing was evident in both younger and older women. There was also evidence of significant improvement in the appropriate prescribing of HRT. Concludes that prescribing feedback linked with educational material and audit can improve the prescribing of HRT in primary care in women with a history of hysterectomy and that this technique has wider application in the new era of clinical governance.

The purpose of the paper is to measure compliance with agreed protocols for prophylactic antibiotics for five elective procedures: transurethral resection of the prostate, cholecystectomy, hysterectomy, joint arthroplasty and herniorrhaphy in two teaching hospitals.

Compliance was measured during the pre and post intervention periods by reviewing medical records.

Overall, compliance improved by 18 per cent (95 per cent CI: 12 per cent, 23 per cent) with greater improvements for transurethral resection of the prostate and hysterectomy, increasing by 27 per cent (95 per cent CI: 14 per cent, 40 per cent) and 24 per cent (95 per cent CI: 16 per cent, 32 per cent) respectively. Compliance remained low for cholecystectomy (17 per cent) and hysterectomy (25 per cent). Overall, the proportion of patients not receiving any prophylaxis where its use was indicated, declined by 6 per cent (95 per cent CI: 1 per cent, 11 per cent) from 23 per cent. The use of additional anti‐microbials that were not recommended in the protocol was high for joint arthroplasty 65 per cent and hysterectomy 71 per cent, but overall this practice declined by 8 per cent (95 per cent CI: 3 per cent, 14 per cent). Costs were reduced from $11.72 to $10.53 per patient between the pre and post intervention groups, while a complete adoption of the protocols could reduce costs by 70 per cent to $3.40. There were large variations in correct dosages and timing of antibiotics between procedural groups.

Although compliance improved there were large differences between the specialties. The adoption of preventive strategies is fundamental to providing safe patient care. The use of inappropriate antimicrobials is also an important patient safety issue that contributes to antibiotic resistance and is associated with increased costs. Introducing change in health organizations is difficult and the factors influencing successful change strategies require further study.

The paper measures and improves compliance with agreed protocols in health care intervention procedures.

Osteoporosis demands systematic management for optimum use of resources. Guidelines from the Primary Care Rheumatology Society (PCRS) aim to improve its diagnosis and treatment. We identified all admissions over three months to a district general hospital of patients with fracture of femur, vertebra, or distal forearm and of women who underwent oophorectomy or hysterectomy. We audited their care using the criteria that the diagnosis and risk of osteoporosis should be recorded; that management should follow PCRS guidelines; and that this information should be communicated to general practitioners. An ideal standard of 100% compliance with these criteria was chosen. Overwhelmingly these audit criteria were not met, the only one that was met being the prescription of hormone replacement therapy after oophorectomy. Potential for prevention of 35% of hip and distal forearm fractures was identified, the commonest risk factor being long‐term corticosteroid therapy. Identification of high risk patients is feasible by simple methods and their management needs improvement. We suggest that a ‘long‐term corticosteroid therapy register’ and a dedicated ‘osteoporosis service’ would facilitate this.

The purpose of this study is to measure the adverse event rates for five elective surgical procedures: transurethral resection of prostate, cholecystectomy, hysterectomy, joint arthroplasty, and herniorrhaphy.

A retrospective two‐stage medical record review was conducted on 1,177 admissions in 1998 and 2000 at two tertiary hospitals. Records found to be positive for any of 17 screening criteria during the first stage were reviewed by surgeons from the relevant specialty for adverse events associated with the admissions.

The adverse event (AE) rate overall was 23.1 per cent. There were large variations between the procedural groups, ranging from 12.7 per cent (laparoscopic cholecystectomy) to 44.8 per cent (abdominal hysterectomy). Of the 272 AEs, 89 (32.7 per cent) had an unplanned readmission requiring 709 additional days in hospital and 55 (20.2 per cent) patients had additional surgery (seven returned to theatre during their admission for the procedure). AEs involving a disability that resolved within 12 months occurred for 91.2 per cent, 6.3 per cent had permanent disability, and 2.5 per cent resulted in death. The surgical reviewers determined that 24.7 per cent of the AEs were highly preventable.

The study confirms that surgical admissions have a high risk for AEs. The risk varies between procedural groups and 47.3 per cent are not preventable. Adverse events are an important patient safety issue. Preventing AEs would reduce readmissions, patient discomfort and associated costs. Routine monitoring of AEs is recommended.

Communications professor, Norman Denzin, describes interactional moments that create potentially transformational experiences as epiphanies, which are subdivided into the major, the minor, the cumulative, the illuminative, and the relived. In his paradigm for the examination of racialized identity formation, psychologist William Cross offers a Nigrescence Model with a four-stage approach to understand the development of Black racial identity. Cross’ model has been modified to assess other aspects of identity formation such as gender consciousness. My story illuminates how the convergence of these theories offers a new lens through which to view the maturation of raced and gendered subjectivities. This performance text uses an Africana feminism performance pedagogy rooted in Yoruba feminist philosophy to expose the reproductive violence perpetuated against Black women and recover the healing, generative force of female power.

For the millions of women living with endometriosis, significant disruption to normative life expectations and a considerable impact on everyday life are common. Whilst for many women concerns about and experiences of infertility may be a central feature of life with the condition, little work has considered the impact that chronic illness has on reproductive decision-making or on the ways in which a medical condition is managed in relation to plans for conception. This chapter considers how heterosexual women with endometriosis and their male partners experience the intersection of fertility desires with the use of reproductive technologies (contraceptive and conceptive) and how these experiences intersect with the medical and surgical management of endometriosis. Three themes drawn from interview data are presented: the first considers how the uncertain and indeterminate character of endometriosis shapes imaginaries about future fertility, conception and childbearing. The second focuses on how endometriosis mediates expectations about the success of fertility treatments and technologies; exploring in particular the manifestation of low expectations in relation to possible success. The third theme considers how endometriosis and fertility pathways intersect, creating specific disruptions whereby fertility treatment may be delayed by endometriosis care, and where endometriosis care may be interrupted or paused by fertility desires. Our data show how endometriosis shapes reproductive desires, decision-making and experiences and has important implications for understanding how for those living with a chronic illness, plans for having children are made within a context of biographical and biomedical contingency.

Objectives: The cost‐effectiveness of routine cervical cytology during follow‐up after treatment for carcinoma of cervix is examined. Subjects: All patients having routine follow‐up smears during the financial year 1993–1994. A total of 212 patients generated 311 smears, 96 had an intact cervix and 116 had surgical removal as part of their treatment. Ninety‐one patients with intact cervices and 109 without were evaluable. Results: Nine recurrences were detected, in every case this was expected, based on clinical findings. In two of these the smear was reported as normal. Two hundred and thirty smears were from entirely asymptomatic patients. Conclusions: Limiting cervical smears to those who are symptomatic, or where an abnormality is found on examination, would save approximately £3500 per year. This cost needs to be set beside the possibility of detecting an asymptomatic recurrence at an early stage; as reported by others. This suggests that the impact of this strategy is limited. A randomized trial with prospective economic assessment would be the only way to evaluate the cost‐effectiveness of routine cervical smears in the follow‐up of patients treated for cancer of cervix.

Obstetric adverse outcomes (AOs) are an important topic and the use of composite measures may favor the understanding of their impact on patient safety. The aim of the present study was to estimate AO frequency and obstetric care quality in low and high-risk maternity hospitals.

A one-year longitudinal follow-up study in two public Brazilian maternity hospitals. The frequency of AOs was measured in 2,880 randomly selected subjects, 1,440 in each institution, consisting of women and their newborn babies. The frequency of 14 AOs was estimated every two weeks for one year, as well as three obstetric care quality indices based on their frequency and severity as follows: the Adverse Outcome Index (AOI), the Weighted Adverse Outcome Score and the Severity Index.

A significant number of mothers and newborns exhibited AOs. The most prevalent maternal AOs were admission to the ICU and postpartum hysterectomy. Regarding newborns, hospitalization for > seven days and neonatal infection were the most common complications. Adverse outcomes were more frequent at the high-risk maternity, however, they were more severe at the low-risk facility. The AOI was stable at the high-risk center but declined after interventions during the follow-up year.

High AO frequency was identified in both mothers and newborns. The results demonstrate the need for public patient safety policies for low-risk maternity hospitals, where AOs were less frequent but more severe.

Purpose: We respond to a call for studies of “embodied experiences of stigma in context” by investigating how transgender embodiment shapes perceived needs for access to and experiences of “sex-specific” cancer screenings (SSCS) (e.g., breast and prostate exams, Pap smears) in the North American healthcare system.

Design/Methodology/Approach: We analyze data from semistructured interviews with a diverse sample of 35 transgender-identified adults. Based on thematic narrative analysis, we explore four themes in relation to embodiment: discrimination; discomfort and hyperawareness of genitalia; strategic reframing and active management; and SSCS health care encounters as positive and gender affirming.

Findings: In relation to SSCS, transgender individuals experience discrimination, do emotion work, and actively manage situations to obtain needed health care, and sometimes forego care because barriers are insurmountable. Health care providers' responses to transgender embodiment can disrupt health care encounters, but they can also facilitate access and create opportunities for affirmation, agency, advocacy, and new forms of interaction. Embodiment- and gender-affirming interactions with health care providers, which varied by gender, emerged as key influences on participants' experiences of SSCS.

Research Limitations/Implications: Our sample primarily includes binary gender-identified individuals, and while our interview guide covered many topics, the SSCS question did not explicitly reference testicular exams.

Practical Implications: Cancer prevention and detection Cancer prevention and detection require health care professionals who are prepared for differently embodied persons. Preventive cancer screenings are not “sex-specific”; they are relevant to individuals with medically necessary needs regardless of gender identity or embodiment.

Social Implications

Originality/Value: Few medical sociologists have focused on transgender embodiment. Findings enhance our understanding of how transgender embodiment and minority stress processes influence access to needed SSCS.

Purpose – Intravenous leiomyomatosis (IVL) is a very rare subtype of leiomyoma, involving the right obstruction of the heart, and is an unusual cause of outflow tract obstruction. The IVL grows from the vessel’s smooth muscle, protruding into the vessel’s lumen, and can expand to the right atrium and even beyond causing death due to blood flow obstruction into the right atrium and even to pulmonary artery.

Design/Methodology/Approach – We present a 33-year-old Indonesian woman with cardiopulmonary symptoms predominantly, and marked by an intravascular leiomyoma extending from inferior vena cava (IVC) to right chamber atrium, with the chief complaint being easily fatigued since seven months.

Findings – Echocardiography observations found a mass in the right atrium and the IVC that caused dynamics obstructed in tricuspid valve, right atrium and ventricle were dilated, no left ventricular (LV) hypertrophy, normal LV and right ventricular (RV) functions, and no valve abnormality except the tricuspid valve gradient being 21 mmHg with mild regurgitation. Venography resulted in a mobile tumor mass in IVC mouth which partially flew into the right atrium, and partially blocked the IVC mouth. Tumor size was 6.4 cm × 4.8 cm. Abdominal multislice computed tomography resulted in a residual soft tissue mass (leiomyoma) along the IVC extended to the right atrium. The tumor mass size in the IVC and the right atrium was bigger compared to tumor mass on July 2008. The correct diagnosis was established during surgery; therefore a two-stage resection was done.

Originality/Value – Surgical resection is the best treatment for intracardiac extension of intravenous leiomyoma. To remove the ilio-caval portion, iliac venotomy was recommended for the tumor in both stages of the surgeries.