Fourth consensus of the International Society for Premenstrual Disorders (ISPMD): auditable standards for diagnosis and management of premenstrual disorder.

Whilst professional bodies such as the Royal College and the American College of Obstetricians and Gynecologists have well-established standards for audit of management for most gynaecology disorders, such standards for premenstrual disorders (PMDs) have yet to be developed. The International Society of Premenstrual Disorders (ISPMD) has already published three consensus papers on PMDs covering areas that include definition, classification/quantification, clinical trial design and management (American College Obstetricians and Gynecologists 2011; Brown et al. in Cochrane Database Syst Rev 2:CD001396, 2009; Dickerson et al. in Am Fam Physician 67(8):1743-1752, 2003). In this fourth consensus of ISPMD, we aim to create a set of auditable standards for the clinical management of PMDs. All members of the original ISPMD consensus group were invited to submit one or more auditable standards to be eligible in the inclusion of the consensus. Ninety-five percent of members (18/19) responded with at least one auditable standard. A total of 66 auditable standards were received, which were returned to all group members who then ranked the standards in order of priority, before the results were collated. Proposed standards related to the diagnosis of PMDs identified the importance of obtaining an accurate history, that a symptom diary should be kept for 2 months prior to diagnosis and that symptom reporting demonstrates symptoms in the premenstrual phase of the menstrual cycle and relieved by menstruation. Regarding treatment, the most important standards were the use of selective serotonin reuptake inhibitors (SSRIs) as a first line treatment, an evidence-based approach to treatment and that SSRI side effects are properly explained to patients. A set of comprehensive standards to be used in the diagnosis and treatment of PMD has been established, for which PMD management can be audited against for standardised and improved care.

Environmental Noise as an Operative Stressor During Simulated Laparoscopic Surgery.

OBJECTIVE: This study aimed to determine what effect environmental noise has upon the psychological and physiological stress response of medical students during simulated laparoscopic surgery. MATERIALS AND METHODS: An anonymous cohort of medical students were randomized into 2 arms and performed a laparoscopic task on a simulator. The "control" group performed the task in silence, whereas the "noise" group were exposed to an 80 dB verbal recording. Operator stress response was measured using a validated acute stress questionnaire and continuous heart rate (HR). RESULTS: A total of 70 medical students participated. The "state" component of the State Trait Anxiety Inventory questionnaire increased significantly following the task in both groups with globally higher scores recorded in the noise group. Peak-resting HR values were significantly higher in the noise group. Mean-resting HR was significantly higher in the noise group. CONCLUSIONS: Environmental noise in a simulated theater environment generates a measurable increase in operator stress response during laparoscopy.