Cervical cancer screening "see and treat approach": real-life uptake after invitation and associated factors at health facilities in Gondar, Northwest Ethiopia.

BACKGROUND: Although cervical cancer is a preventable disease, screening coverage in Ethiopia is far below the target. There is limited evidence on uptake among the general population in Ethiopia. Thus, this study was conducted to assess uptake and associated factors with the cervical cancer screening "see and treat approach" among eligible women in public health facilities in Gondar town, Northwest Ethiopia. METHOD: A facility-based, cross-sectional study was conducted. The total sample size was 493. A consecutive sampling method was applied. Participants were informed about and invited to cervical cancer screening using visual inspection with acetic acid. Crude and adjusted odds ratios were calculated to determine statistical association with socio-demographic variables. Multivariable logistic regression was used to determine factors of cervical cancer screening uptake. RESULT: Out of 464 women advised for screening, 76 (16.4, 95% CI [13, 19.8%]) attended the screening. Primary education and above (AOR = 5.3, 95% CI [2.20, 13.0]), knowledge about the disease (AOR = 8.4, 95% CI [3.33, 21.21]), perceived susceptibility (AOR = 6.5, 95% CI [2.72, 15.51]), fewer perceived barriers (AOR = 6.4, 95% CI [2.30, 17.80]), cues to action (AOR = 4.6, 95% CI [1.86, 11.32]), perceived self-efficacy (AOR = 5, 95% CI [2.14, 11.73]), and previous recommendation for screening (AOR = 2.7, 95% CI [1.15, 6.51]) were significantly associated with screening uptake. CONCLUSION: The actual uptake of screening offered in this study was high relative to only 3% national screening coverage. There is a need to implement active invitation for screening with special focus on less-educated women. Repeated invitation may facilitate future screening uptake.

Diagnostic Accuracy of Intraoperative Tools for Detecting Endometriosis: A Systematic Review and Meta-analysis.

OBJECTIVE: To evaluate the diagnostic accuracy of intraoperative laparoscopic imaging tools in reference to that of histopathology for detecting endometriotic lesions and to compare them with conventional white-light inspection by performing a systematic review with meta-analysis. DATA SOURCES: We searched the MEDLINE, EMBASE, and CENTRAL databases in addition to citations and reference lists until the end of February 2019. METHODS OF STUDY SELECTION: Two authors screened 1038 citations for eligibility. We included randomized controlled trials or prospective cohort studies published in English, assessing the accuracy of intraoperative imaging tools for diagnosing endometriosis during laparoscopy. We considered studies using histopathologic evaluation as a standard criterion. TABULATION, INTEGRATION, AND RESULTS: Seven studies were eligible, including 472 women and 1717 histopathologic specimens, and they involved study of the use of narrow-band imaging (2 studies), 5-aminolevulinic acid-induced fluorescence (2 studies), autofluorescence imaging (1 study), indocyanine green (1 study), and a 3-dimensional robotic laparoscopy (1 study). Two authors extracted data and assessed the validity of the included studies. Bivariate random-effects models and McNemar's test were used to compare the tests and evaluate sources of heterogeneity. Four studies were attributed a high risk of bias, and biopsies of normal-looking peritoneum were not performed to verify the results in 3 studies; both factors were identified as significant sources of heterogeneity, leading to the overestimation of the sensitivity and underestimation of the specificity of imaging tools. In all studies, additional endometriotic lesions were diagnosed with the enhanced imaging tool compared with white-light inspection alone. In the 4 studies that appropriately performed control biopsies (171 women, 448 specimens), enhanced imaging techniques were associated with a higher sensitivity and specificity compared with white-light inspection (0.84 and 0.89 compared with 0.75 and 0.76, respectively, p ≤.001). Adverse events were uncommon (n = 5) and reported only with the use of exogeneous photosensitizers. There were no reports of long-term changes in patient-reported outcomes arising from better detection of endometriosis lesions. CONCLUSION: Studies report that enhanced imaging allows for the detection of additional endometriotic lesions missed by conventional white-light laparoscopy. The benefits of finding these additional lesions using enhanced imaging compared with white-light inspection alone on long-term postoperative outcomes have not been determined, and these tools should be considered only in a research context at this time.

Health professional's knowledge and use of the partograph in public health institutions in eastern Ethiopia: a cross-sectional study.

BACKGROUND: The partograph is a vital tool for health professionals who need to be able to identify pathological labor. It is used to recognize complications in childbirth on time and to take appropriate actions. We aimed to assess the knowledge and utilization of the partograph and associated factors among health professionals at public health institutions in eastern Ethiopia. METHODS: An institution based cross-sectional quantitative study was carried out among health professionals who were working in public health institutions. Multistage sampling with proportional to size allocation was used to recruit a total of 441 study participants. Self-administered questionnaire was used to collect data in this study. Eight midwives were recruited and trained to facilitate the data collection activities. Data were entered into Epi data software and exported into SPSS (22.0) for analysis. Descriptive statistics, bivariate and multiple logistic regression were computed to determine proportions and significant association with knowledge and use of the partograph among health professionals. RESULTS: More than half of health professionals, 232(53.7%) had a good level of knowledge about the partograph. However, only 196(45.4%) of health professionals had fair knowledge of partograph. Nevertheless, the proportion of the partograph utilization to follow labor progress by health professionals was 92.6%. Working in the health center [AOR = 0.31, 95% CI: 0.20, 0.48], being a midwife [AOR = 2.80, 95% CI: 1.60, 5.60] and in-service training [AOR = 2.0, 95% CI: 1.22, 3.42] were significantly associated with good level of knowledge. Health professionals who had in-service training about the partograph [AOR = 3.10, 95% CI: 1.35, 4.98] and who had positive attitude about the partograph [AOR = 2.90, 95% CI: 1.30, 6.30] were significantly associated with utilization of the partograph. CONCLUSION: Only less than half of health professionals had fair knowledge about the partograph. Having in-service obstetric care training, type of health institutions and profession were significantly associated with knowledge of the partograph. Health professionals who had positive attitude towards use of the partograph were significantly associated with the partograph utilization. We suggest regular in-service training of health professionals can enhance their knowledge and utilization of the partograph.

The predictive value of lactate levels in vaginal fluid on the latent period in pregnant women with preterm premature rupture of membranes.

The aim of the present study was to investigate the relationship between lactate level in vaginal fluid and the latent phase of labour in pregnancies complicated by preterm premature rupture of membranes (PPROM). Seventy pregnant women with PPROM during 28-34 weeks' gestation were selected for this prospective observational study. All subjects underwent a pelvic examination involving the insertion of a vaginal speculum, and lactate levels were measured in vaginal fluid samples. The relationship between the lactate levels in the vaginal fluid and the latent phase of the labour was analysed using a logistic regression test. Of the patients, 48 (68.6%) had a latent period of 48 h or less, and 22 patients (31.4%) had a latent period longer than 48 h. The median lactate level was 3.81 mmol/L in patients with a latent period ≤ 48 h, and 3.36 mmol/L in patients with a latent period > 48 h. The lactate level in vaginal fluid was not found to be distinctive in the differentiation of patients according to the duration of the latent phase (receiver operating characteristic or ROC: 0.509; 95% confidence interval or CI: 0.361-0.657; p = 0.904). There was no significant correlation between the lactate level in the vaginal fluid and the transition from the latent phase to the active phase of labour in pregnancies complicated by PPROM.

Surgical and systemic management of endometrial cancer: an international survey.

PURPOSE: To ascertain the spectrum of clinical management of endometrial carcinoma (EC) the largest international survey was conducted to evaluate and identify differences worldwide. METHODS: After validation of a 15-item questionnaire regarding surgical and adjuvant treatment of EC in Germany, an English-adapted questionnaire was put online and posted to all the major gynecological cancer Societies worldwide for further distribution commencing in 2010 and continued for 26 months. RESULTS: A total of 618 Institutions around the world participated: Central Europe (CE), Southern Europe (SE), Northern Europe (NE), Asia and USA/Canada/UK. Both a therapeutic and staging value was attributed to systematic pelvic and paraaortic lymph node dissection (LND) in CE (74.6%) and in Asia (67.2%), as opposed to USA/UK where LND was mainly for staging purposes (53.5%; p < 0.001). LND was performed up to the renal veins in CE in 86.8%, in Asia in 80.8%, in USA/UK in 51.2% and in SE in 45.1% (p < 0.001) of cases. In advanced disease, centers from Asia were treated most with adjuvant chemotherapy alone (93.6%), as opposed to centers in SE, CE and UK/USA that employed combination chemo-radiotherapy in 90.9% (p < 0.001) of cases. Paclitaxel/carboplatin was mostly used followed by doxorubicin/cisplatin (75 vs. 23.3%; p < 0.001). In total, 94% of all participants supported the concept of treating EC patients within appropriate clinical trials. CONCLUSIONS: There is broad range in both the surgical and adjuvant treatment of EC across different countries. Large-scale multicenter prospective trials are warranted to establish consistent, evidence-based guidelines to optimize treatment worldwide.

CERVICAL CANCER: ASSESSMENT OF DIAGNOSIS AND TREATMENT FACILITIES IN PUBLIC HEALTH INSTITUTIONS IN ADDIS ABABA, ETHIOPIA.

BACKGROUND: Cervical cancer is the second most common cancer in women globally and the leading cause of cancer deaths in women in low income countries. The majority of cervical cancer related deaths occur in the developing world. It is also an important public health problem in Ethiopia, a country without a well-established control program for the disease. This study assessed the diagnostic and therapeutic facility for cervical cancer (including health providers' awareness of the disease) in Addis Ababa public health institutions which can be used to develop control strategies and to visualize the amount of resources required. METHODS: A cross-sectional study was conducted including all public health institutions in Addis Ababa in August 2010. Health providers' awareness of cervical cancer was assessed using a self-administered questionnaire. Checklist was used to register diagnostic and therapeutic infrastructure in each health facility. Data was analyzed using STATA. RESULTS: All health providers responded they had heard about cervical cancer. Half of the participants were able to identify common symptoms of the disease. Only 23% of the participants mentioned human papilloma virus (HPV) as the primary cause of cervical cancer. A significant association between awareness and profession was seen. Absence of skilled manpower, equipment and proper documentation was reported in the majority of the institutions. CONCLUSION: This study assessed the existing skilled man power and infrastructure to diagnose and treat cervical cancer in public institutions in Addis Ababa which is important to develop an effective cervical cancer control program. In addition, the study showed the more work that should be done to improve health providers' awareness in cervical cancer through education and training.

Differences in regional diagnostic strategies and in intended versus actual first-line treatment of patients with advanced ovarian cancer in Denmark.

BACKGROUND: Triage of patients with ovarian cancer to primary debulking surgery (PDS) or neoadjuvant chemotherapy (NACT) is challenging. In Denmark, the use of NACT has increased, but substantial differences in the use of NACT or PDS exist among centers. We aimed to characterize the differences between intended and actual first-line treatments in addition to the differences in the triage process among the centers and to evaluate the different diagnostic modalities and the clinical aspects' influence in the triage process. MATERIALS AND METHODS: From 4 centers, forms containing data about the diagnostic process and intended treatment were prospectively collected and merged with data from the Danish Gynecological Cancer Database and medical records. RESULTS: Of the 671 completed forms, 540 patients had stage IIIC or IV epithelial ovarian cancer. Of the 238 (44%) referred to PDS, 91% received PDS and 4% never had debulking surgery. Of the 288 patients (53%) referred to NACT, 44% were never debulked. Fourteen patients (3%) were referred to palliative treatment. The use of different imaging modalities, diagnostic laparoscopy, and laparotomy varied significantly among the centers. Diagnostic surgical procedures were considered to be most influential in the triage process. Regardless of the intended first-line treatment or center, the tumor size and dissemination was the most influential clinical aspect. CONCLUSIONS: In Denmark, substantial differences exist between intended and actual first-line treatments as well as in the diagnostic process and use of NACT, calling for further discussion on diagnostic strategy and therapeutically approach for patients with advanced ovarian cancer.

Nationwide analysis on surgical staging procedures and systemic treatment for patients with endometrial cancer in Germany.

OBJECTIVE: In 2009 and 2006, the Arbeitsgemeinschaft Gynäkologische Onkologie evaluated therapeutic approaches for endometrial carcinoma (EC) in Germany. METHODS AND MATERIALS: A questionnaire was developed and sent to 775 German gynecologic departments in 2009 (500 in 2006). The results of the questionnaires were compared with each other and with the recommendations of the Arbeitsgemeinschaft Gynäkologische Onkologie's guideline. Subgroup analyses were performed, dividing the participating centers into small and large centers and into centers with less and more experience with EC. RESULTS: Responses were available in 33.3% in 2009 and 35.8% in 2006. Comparing 2009 with 2006, it became apparent that peritoneal washing cytology was performed in 94.6% versus 86.9% (P = 0.008), pelvic lymphadenectomy (LAN) in 98.3% versus 95.3%, and paraaortic LAN in 90.2% versus 73.8% (P < 0.001) for endometrioid EC, and LAN for histologic high-risk subtypes of EC in 99.6% versus 94.2% (P = 0.001), respectively. In 2009, all these criteria met the recommendation of the guidelines. Reoperation for LAN after postoperative upstaging was performed in 66.1% versus 50.6% (P = 0.002), and adjuvant systemic treatment with chemotherapy and endocrine therapy was performed in 63.7% versus 48.8% (P = 0.003) and 25.7% versus 15.4% (P = 0.014), respectively. This showed nonadherence to the guidelines. Laparoscopic approach was performed in 30.4% versus 19.7% (P = 0.014) of the participating centers, respectively. In subgroup analysis, laparoscopic approach showed a significant difference between small centers (11.5%) and large centers (27.3%) in 2006 (P = 0.012). CONCLUSIONS: German hospitals increasingly follow the guidelines concerning LAN and peritoneal washing cytology. However, recommendations concerning reoperating in upstaged patients and adjuvant treatment decisions do not meet the guidelines, thus underlining great uncertainties in this field of gynecologic oncology.

Knowledge and utilization of partograph among obstetric care givers in public health institutions of Addis Ababa, Ethiopia.

BACKGROUND: Globally, there was an estimated number of 287,000 maternal deaths in 2010. Eighty five percent (245,000) of these deaths occurred in Sub-Saharan Africa and Southern Asia. Among the causes of these deaths were obstructed and prolonged labour which could be prevented by cost effective and affordable health interventions like the use of the partograph. The Use of the partograph is a well-known best practice for quality monitoring of labour and subsequent prevention of obstructed and prolonged labour. However, a number of cases of obstructed labour do happen in health facilities due to poor quality of intrapartum care. METHODS: A cross-sectional quantitative study assessed knowledge and utilization of partograph among obstetric care givers in public health institutions of Addis Ababa, Ethiopia using a structured interviewer administered questionnaire. The collected data was analyzed using SPSS version 16.0. Logistic regression analysis was used to identify factors associated with knowledge and use of partograph among obstetric care givers. RESULTS: Knowledge about the partograph was fair: 189 (96.6%) of all the respondents correctly mentioned at least one component of the partograph, 104 (53.3%) correctly explained the function of alert line and 161 (82.6%) correctly explained the function of action line. The study showed that 112 (57.3%) of the obstetric care givers at public health institutions reportedly utilized partograph to monitor mothers in labour. The utilization of the partograph was significantly higher among obstetric care givers working in health centres (67.9%) compared to those working in hospitals (34.4%) [Adjusted OR = 3.63(95%CI: 1.81, 7.28)]. CONCLUSIONS: A significant percentage of obstetric care givers had fair knowledge of the partograph and why it is necessary to use it in the management of labour and over half of obstetric care givers reported use of the partograph to monitor mothers in labour. Pre-service and on-job training of obstetric care givers on the use of the partograph should be given emphasis. Mandatory health facility policy is also recommended to ensure safety of women in labour in public health facilities in Addis Ababa, Ethiopia.

Hysterosalpingocontrast sonography (HyCoSy): evaluation of the pain perception, side effects and complications.

BACKGROUND: Tubal and uterine cavity diseases commonly compromise female fertility. At the present time, hysteroscopy, laparoscopy with chromopertubation and RX-Hysterosalpingography (RX-HSG) are widely accepted screening procedures enabling the effective assessment of both tubal patency and uterine cavity. Nevertheless, consistent evidence supports the reliability of Hysterosalpingocontrast sonography (HyCoSy) in uterine cavity and tubal patency investigation, as a part of the standard infertility work-up. This prospective study was aimed at evaluating the tolerability of the technique as well as the incidence of related side effects and complications in a large series of infertile patients. METHODS: Pain perception of 632 infertile women was measured by means of an 11-point numeric rating scale. Side effects and late complications were also recorded. RESULTS: The mean numeric rating scale was 2.15 ± 2.0 SD. Most of the patients (374/632, 59.17%) rated HyCoSy as a non-painful procedure, whereas 24.36% (154/632) women reported mild pelvic pain and 9.96% (63/632) classified the discomfort as "moderate". Only 6.48% (41/632) of the patient population experienced severe pelvic pain. Fifteen (2.37%) patients required drug administration for pain relief. Twenty-six patients (4.11%) showed mild vaso-vagal reactions that resolved without atropine administration. No severe vaso-vagal reactions or late complications were observed. CONCLUSIONS: HyCoSy is a well-tolerated examination and the associated vagal effects are unusual and generally mild. Consequently, we support its introduction as a first-line procedure for tubal patency and uterine cavity investigation in infertile women.

Imaging analysis of cervical elastography for prediction of successful induction of labor at term.

OBJECTIVES: The aim of this study was to evaluate the value of imaging analysis of cervical elastography to predict successful induction of labor in nulliparous women at term. METHODS: Successful labor induction was defined as onset of active labor within 9 hours or delivery within 24 hours. The Bishop score, cervical length, and cervical elastographic parameters, including cervical area, mean elastographic index, and cervical hard area, were measured and analyzed by the image analyzer. RESULTS: The areas under the curves for the cervical length, cervical area, Bishop score, mean elastographic index, and cervical hard area were 0.63, 0.64, 0.47, 0.68, and 0.70, respectively, for onset of active labor within 9 hours and 0.70, 0.68, 0.63, 0.71, and 0.76 for delivery within 24 hours. The combination of cervical length and elastographic data was more predictable for successful labor induction (P < .05). CONCLUSIONS: Imaging analysis of cervical elastography is available to predict successful induction of labor.

Hysteroscopic detection of chronic endometritis: Evaluating proposed hysteroscopic features suggestive of chronic endometritis.

PURPOSE: To evaluate the proposed criteria in a large sample and in additional subgroups in order to test the validity of the hysteroscopic features widely-accepted as suggestive of CE. METHOD(S): All patients (n: 2675) underwent outpatient hysteroscopy, with the vaginoscopic approach technique. Hysteroscopic features such as, stromal oedema, diffuse or focal hyperaemia, "strawberry aspect", micropolyposis and endometrial polyps, are often indicate the presence of chronic endometritis. All hysteroscopic features, alone and in combination were applied in 7 (seven) different subgroups of the sample: total sample, women in reproductive age, women with infertility issues/IVF screening, women with history of recurrent miscarriages, menopausal women, and women with hysteroscopic indication of Abnormal Uterine Bleeding (AUB) in women of reproductive age and postmenopausal bleeding (PMB). From each case, endometrial samples were obtained and immunohistochemistry, identifying CD-138, was applied in order to diagnose CE. RESULT(S): A total of 2675 patients were included of which, 1444 women were found with at least one of the proposed hysteroscopic features mentioned above. Stromal oedema, focal or diffuse hyperaemia and "strawberry aspect" in combination with micropolyposis demonstrated higher rates of diagnostic accuracy in the detection of CE correlated to histologic confirmation. Micropolyposis, stromal oedema, focal or diffuse hyperaemia and "strawberry aspect" offer great diagnostic accuracy in the hysteroscopic detection of Chronic Endometritis, regardless reproductive status and/or clinical presentation. Endometrial polyps are not valid hysteroscopic features in cases of suspected CE. CONCLUSION(S): Diagnostic hysteroscopy can accurately diagnose cases of CE, based on stromal oedema, focal or diffuse hyperaemia and "strawberry aspect", in combination with micropolyposis. In subgroups of infertile women, higher diagnostic accuracy based on the hysteroscopic features mentioned, was more likely to be achieved. Whether endometrial polyps are suggestive of CE, when identified during office hysteroscopy, remains controversial.

A new method to measure vaginal sensibility.

INTRODUCTION: Vaginal surgery may affect sexual function both positively and negatively. Possibly, negative consequences of surgical interventions on sexuality may be caused by reduced sensibility of the vaginal wall. AIMS: To develop a new method to measure vaginal sensibility. METHODS: We developed a technique to measure the sensibility of the vaginal wall consisting of a St Marks electrode on a gloved index finger, with a stimulating electrode mounted at the tip. Measurements were performed in four different target areas (caudal and cranial, posterior and anterior) by two independent female researchers in a random order. Subjects were 12 healthy women. RESULTS: The intra-observer reproducibility of both researchers was almost perfect (Pearsons-Rho correlation coefficient 0.77-0.96 < 0.001). The inter-observer reproducibility was moderate (Pearsons-Rho correlation coefficient 0.39-0.49). Both researchers measured increased sensibility in the cranial posterior vaginal wall relative to the cranial anterior vaginal wall, but for all measurements, researcher 2 obtained higher sensibility ratings than researcher 1. In addition, researcher 2 found a decreased sensibility in the cranial anterior vaginal wall for women not using oral contraceptives. Phase of the menstrual cycle did not influence vaginal sensibility. CONCLUSION: We developed a new instrument to measure vaginal sensibility. The instrument has excellent intra-observer reproducibility. This method is sufficiently sensitive so as to differentiate between anterior and posterior cranial vaginal wall sensibility, but outcome differs as a function of researcher. Further evaluation of the clinical use of this method is needed, provided that measurements are performed by the same researcher.

[Does a combination of foetal biometry and maternal MRI pelvimetry decrease the frequency of secondary caesarean section?]. / Senkt die Kombination von fetaler Biometrie und MRT-Pelvimetrie die Rate an sekundären Sectiones?

OBJECTIVE: Cephalopelvic disproportion (CPD) is a frequent indication for secondary Caesarean section. The delivery simulation software Anapelvis was developed to predict a CPD on the basis of foetal ultrasound biometry and maternal pelvimetry data. The objective of this retrospective study was to analyse the predictive value of Anapelvis software in consideration of antenatal foetal biometry quality. PATIENTS AND METHODS: 162 pregnant women with suspected CPD who had undergone a magnetic resonance imaging pelvimetry were included in this study. The antenatal foetal biometry was carried out within a week before delivery. RESULTS: The positive predictive value (PPV) for arrest of delivery was 85.7% in the group of 79 pregnancies with planned vaginal delivery. Sensitivity was 56.3%, specificity 60.0% and negative predictive value (NPV) 24.3% accordingly. The highest accuracy [percent error (PE) -0.1%] of fetal weight estimation was found in the group where an arrest of delivery was predicted. The lowest accuracy (PE -4.4%) was detected in the group with the prediction of vaginal delivery. CONCLUSIONS: Labour simulation software can be helpful only in such cases where an arrest of delivery was predicted. The accuracy of delivery simulation with the Anapelvis software was considerably affected by the quality of antenatal foetal ultrasound biometry.

Gynaecologists blaze the trail in primary studies and systematic reviews of diagnostic test accuracy.

As the Cochrane Collaboration is poised to begin publishing systematic reviews of diagnostic test accuracy studies in addition to its traditional systematic reviews of treatment effectiveness, we are likely to see a major expansion in the number of primary studies and systematic reviews of diagnostic test accuracy in the medical literature. Obstetricians and gynaecologists have played an important role in initiating this newer area of research. However, the methodology for such studies is challenging and the published literature is riddled with pitfalls. This editorial seeks to simplify the concepts involved in diagnostic test accuracy studies and systematic reviews, to reflect on the early development of this research in our specialty and to envision the future pathway for screening and diagnostic research.

Contemporary practice patterns in the use of amniocentesis for fetal lung maturity.

PURPOSE: Fetal lung maturity (FLM) testing has been performed to help direct delivery timing in complex obstetrical conditions. We explored current practice patterns of FLM testing attempting to identify factors affecting its use. MATERIALS AND METHODS: We distributed a 31-question survey to obstetricians and perinatologists that examined practice characteristics potentially affecting FLM usage. Logistic regression measured associations between these factors and test utilization. Weighted averages were calculated for conditions in which respondents considered FLM testing helpful. RESULTS: Three hundred four surveys were completed. The response rate for respondents actively practicing obstetrics was 52%. The majority of respondents utilize FLM testing; however, 80% reported a decline in use over the past five years with 64% citing "published guidelines" as the reason. Respondents found FLM testing most applicable for poorly dated pregnancies. After an immature FLM test, 44% of respondents administer antenatal corticosteroids in the late-preterm period. None of the factors surveyed were significantly associated with FLM testing use. CONCLUSION: The majority of respondents use FLM testing although significant factors contributing to its use were not identified. We discover a high frequency of antenatal corticosteroid administration beyond 34 weeks gestational age in response to immature FLM indices that may be an area for future study.

Knowledge of partograph and its associated factors among obstetric care providers in North Shoa Zone, Central Ethiopia: a cross sectional study.

BACKGROUND: Globally, there are 210 maternal deaths per 100,000 live births in 2013. Ethiopia is one of the ten countries contributing to 60% of the global maternal deaths. Most of these deaths could be averted by enhancing safe motherhood strategies and providing skilled care at each delivery. This skilled care includes the use of partograph to monitor the progress of labor. With this aspect, this study is aimed to assess knowledge of partograph and its associated factors among obstetric care providers in North Shoa Zone, Central Ethiopia. METHODS: An institution-based cross-sectional study was conducted in June, 2013. Four hundred three obstetric care providers were included in the study. A pre-tested and structured questionnaire was used to collect data. Data were entered into the Epi-Info software and exported to SPSS software for further analysis. Logistic regression analyses were used to identify the associated factors. Odds ratios with 95% confidence interval (CI) were computed to determine the presence and strength of association. RESULTS: In this study; 287 (71.2%) of obstetric care providers had a good level of knowledge on the partograph. Working in the hospital [Adjusted odds ratio (AOR) = 2.71, P = 0. 027, 95% CI 1.32, 5.57) and getting on the job training (AOR = 5.49, P = 0.001, 95% CI 3.32, 9.08) were significantly associated with knowledge about partograph. CONCLUSIONS: A significant percentage of care providers had a good level of knowledge about partograph. Working in the hospital and getting on the job training were factors affecting provider's knowledge on the partograph. The provision of on the job training is necessary to improve provider's knowledge on the partograph. Moreover, giving a due attention for provider at health centers is also important.

A data review and re-assessment of ovarian cancer serum proteomic profiling.

BACKGROUND: The early detection of ovarian cancer has the potential to dramatically reduce mortality. Recently, the use of mass spectrometry to develop profiles of patient serum proteins, combined with advanced data mining algorithms has been reported as a promising method to achieve this goal. In this report, we analyze the Ovarian Dataset 8-7-02 downloaded from the Clinical Proteomics Program Databank website, using nonparametric statistics and stepwise discriminant analysis to develop rules to diagnose patients, as well as to understand general patterns in the data that may guide future research. RESULTS: The mass spectrometry serum profiles derived from cancer and controls exhibited numerous statistical differences. For example, use of the Wilcoxon test in comparing the intensity at each of the 15,154 mass to charge (M/Z) values between the cancer and controls, resulted in the detection of 3,591 M/Z values whose intensities differed by a p-value of 10-6 or less. The region containing the M/Z values of greatest statistical difference between cancer and controls occurred at M/Z values less than 500. For example the M/Z values of 2.7921478 and 245.53704 could be used to significantly separate the cancer from control groups. Three other sets of M/Z values were developed using a training set that could distinguish between cancer and control subjects in a test set with 100% sensitivity and specificity. CONCLUSION: The ability to discriminate between cancer and control subjects based on the M/Z values of 2.7921478 and 245.53704 reveals the existence of a significant non-biologic experimental bias between these two groups. This bias may invalidate attempts to use this dataset to find patterns of reproducible diagnostic value. To minimize false discovery, results using mass spectrometry and data mining algorithms should be carefully reviewed and benchmarked with routine statistical methods.

About time: diagnostic guidelines that help clinicians.

Clinical guidelines often make recommendations on the use of diagnostic tests. Compared with sensitivity and specificity, the use of pre- and post-test probabilities allows a more explicit and rational selection and interpretation of diagnostic tests. Ideally, clinical guidelines relating to diagnosis should routinely incorporate this information to enhance individualised decision making. We report our experience of incorporating pre- and post-test probabilities into a guideline on the investigation of women with postmenopausal bleeding developed by the Scottish Intercollegiate Guidelines Network. Issues relating to their application are highlighted, including the limitations of available evidence on diagnostic tests and prevalence of disease, acceptability to guideline users, and the uncertain impact on actual clinical decision making. Despite these potential difficulties, the incorporation of data on pre- and post-test probabilities into the development and presentation of guideline recommendations may offer an important opportunity to make clinical decision making more transparent for both clinicians and patients.

[No consensus on the definition, diagnosis and treatment of habitual abortion in the Netherlands]. / Geen eenduidigheid over definitie, diagnostiek en behandeling van habituele abortus in Nederland.

OBJECTIVE: To review the current policy in diagnosis and treatment of recurrent miscarriage in the Netherlands. DESIGN: Cross-sectional survey. METHOD: A printed questionnaire was sent in 1996 to all 125 departments of gynaecology in the Netherlands with questions about definition, investigation and therapy of recurrent miscarriage. RESULTS: The response rate was 90% (n = 112). Twenty-nine per cent of the respondents defined recurrent miscarriage as having two or more abortions and 71% as three or more abortions. In 42% of the departments a diagnostic protocol for recurrent miscarriage was present. Diagnostic investigations most frequently performed were vaginal ultrasound (79%), parental chromosome analysis (78%), thyroid-stimulating hormone (72%), lupus anticoagulant (69%), blood glucose (65%), hysterosalpingography (56%) and anticardiolipin antibodies (IgG, IgM) (56%). Therapy most frequently applied was prescription of folic acid (53%). CONCLUSION: The definition of recurrent miscarriage differed. Uncertainty about a rational diagnostic approach was evident from the large number of tests requested by 20-50% of the respondents. Some diagnostic tests like immunological investigation and search for infectious factors were not followed by a therapeutical intervention.