Quality of life, need for retreatment, and the re-equilibration phenomenon after venous sinus stenting for idiopathic intracranial hypertension.

BACKGROUND: Long term failure rates after venous sinus stenting (VSS) for idiopathic intracranial hypertension (IIH) are poorly understood. METHODS: Retrospective analysis was performed on a prospectively-maintained single center database to identify patients with medically refractory IIH who underwent VSS. Patients with persistent or severe recurrent symptoms after VSS undergo lumbar puncture (LP), therefore LP serves as a marker for treatment failure. RESULTS: 81 patients underwent VSS with a mean follow-up of 10 months; 44 (54.3%) patients underwent LP after VSS due to persistent or recurrent symptoms at a mean of 12 months (median 7, range 2-43). There was a mean decrease in opening pressure (OP) on LP from pre- to post-VSS of 9.1 cm H2O (median 9.5). Overall, a total of 21 (25.9%) patients underwent further surgical intervention following VSS, including five who underwent repeat VSS (6.2% of total) and 18 who underwent cerebrospinal fluid shunting (22.2% of total). There was a non-significant (p=0.18) but overall increase in quality of life scores from pre-stenting (61.2) to last follow-up (71.2), and a significant decrease in Headache Impact Test-6 (HIT-6) scores (p=0.03) with mean pre-stenting and last follow-up scores of 62.7 and 55.8, respectively. CONCLUSIONS: VSS is an effective treatment for venous sinus stenosis in IIH; however, this study found higher rates of symptomatic recurrence and need for further surgical intervention (26%) than previously reported in the literature. Recurrence of symptoms occurred at a median of 7 months, even though OP remained lower at follow-up LP, suggestive of a re-equilibration phenomenon.

Patients' perception and attitude to totally implantable venous access for urologic or digestive cancer: A cross-sectional study.

INTRODUCTION: Totally implanted venous access (TIVA) improves the safety and welfare of patients treated with cancer chemotherapy (CCT). We aimed to evaluate patients' perception of TIVA placement, TIVA use, and information on TIVA, and to assess the association between patients' perception and their attitude regarding a potential TIVA re-implantation. METHODS: We conducted a single center cross-sectional survey in a university hospital in Northern France. Patients included were consecutive urologic or digestive cancer inpatients admitted for a CCT cycle via TIVA between April 9th and May 9th 2014. We analyzed patients' satisfaction, experience, and attitude, especially when requiring potential TIVA re-implantation under local anesthesia (LA), using a standardized questionnaire and medical records. We analyzed risk factors for refusing potential TIVA re-implantation under LA using multivariate logistic regression. RESULTS: Eighty-one patients were interviewed (no refusals), including 57 with a TIVA device placed under LA in our university hospital. Among them, 52/57 (91%) reported satisfactory TIVA placement, but respectively 21/57 (37%) and 18/57 (32%) complained of painful or uncomfortable TIVA placement; 51/57 (89%) were satisfied with care provided during CCT cycles. Risk factors for refusing potential re-implantation under LA were: TIVA placement considered painful (P=0.012) or uncomfortable (P=0.038) and dissatisfaction with care provided during CCT cycles (P=0.028). DISCUSSION: We show that despite good overall satisfaction regarding TIVA, some aspects were less positive and warrant improvement actions. It suggests that these actions could not only improve patients' experience of TIVA use but could also facilitate continuation of treatment in the long term.

Why do people with chronic obstructive pulmonary disease repeat pulmonary rehabilitation? Perspectives of patients and health professionals.

Many people with chronic obstructive pulmonary disease (COPD) undertake pulmonary rehabilitation more than once. This study examined patient experiences and health professional perspectives regarding repeating pulmonary rehabilitation. Participants were 14 patients with COPD and 15 health professionals. Patients had undertaken pulmonary rehabilitation at a tertiary hospital; health professionals were doctors, physiotherapists, and nurses. Semi-structured interviews were conducted, and data were analyzed using thematic analysis. Patients described improved fitness and better breathing after repeating pulmonary rehabilitation; however, some also reported that repeating required confronting their disease progression. Improved confidence and motivation were an important outcome of repeating. Although most participants had attended community-based exercise classes, they valued the greater intensity of exercise and closer supervision that came with repeating pulmonary rehabilitation. Health professionals reported referring patients to repeat pulmonary rehabilitation if they had worsening functional capacity, an exacerbation, or hospitalization. There was no agreement regarding the optimal time for repeating and many would only re-refer if the patient demonstrated motivation to attend. In conclusion, patients with COPD reported many symptomatic benefits from repeating pulmonary rehabilitation and gained confidence from a supervised program. There was no agreement between health professionals regarding the optimal time to repeat pulmonary rehabilitation.

Effect of Listening to Music on Patient Anxiety and Pain Perception during Urodynamic Study: Randomized Controlled Trial.

OBJECTIVE: Urodynamic studies (UDS) include assessments of the physics and physiology of the lower urinary tract (LUT). It is an invasive test and patients can feel fear and anxiety, especially at the beginning of the test. The aim of this study was to determine whether listening to music during urodynamic study decreases patient anxiety and pain. METHODS: Sixty-two patients who underwent urodynamic study were randomized into the following groups: no music (group 1, n = 30) or classical music (group 2, n = 32) during the procedure. Patient anxiety levels were quantified using the State-Trait Anxiety Inventory (STAI) and Beck's Anxiety Inventory (BAI). A visual analog scale (VAS) was used for self-assessment of discomfort and willingness among patients to have a repeat urodynamic study. RESULTS: Demographic characteristics, mean age, duration of procedure, systolic and diastolic blood pressure (SBP and DBP) and heart rate before procedure were statistically significantly similar between the two groups. Statistically significant differences were detected between the two groups in the mean pain score on VAS (4.1 ± 1.4 vs 2.6 ± 1.8), mean post-procedural STAI score (46 ± 5.8 vs 37.3 ± 5) and mean BAI score (14.2 ± 1.7 vs 3.5 ± 0.7). SBP and DBP and heart rate were similar between the groups. CONCLUSION: Music is a cheap, safe and effective intervention that has gained increasing recognition as an effective tool to reduce pain and anxiety. Listening to music during urodynamic study reduced patient pain and anxiety.

Psychological implications of abortion: a longitudinal study on two cohorts of women who recur to elective and therapeutic abortion.

OBJECTIVE: The aim of this work was to identify risk predictors of a negative psychological outcome among personal, situational and systemic characteristics of women who choose to interrupt a pregnancy by elective (e.g., not feeling ready for giving birth) or therapeutic means (e.g., fetal abnormalities). METHODS: A prospective study on two cohorts were conducted and focused on a group of women: the first recurred to elective abortion (VTP) (n=20) and the second recurred to therapeutic abortion (TTP) (n=30). The psychological distress was measured before and after abortion through the administration of two psychometric tests: SCL-90-r and CES-D. Dependent samples t-test was used to evaluate the tendency of the two cohorts' mean scores before and after abortion; repeated measures analysis of variance (ANOVA) was used to analyze the variance of mean scores of subgroups isolated for variables of interest before and after abortion. RESULTS: After the termination of pregnancy, in VTP a significant decrease between t-0 and t-1 mean score (p<0.05) was observed in all SCL-90-r's global scores and subscales: GSI (p=0.036), PST (p=.031), PSDI (p=0.004), SOM (p=0.009), DEP (p=0.032), ANX (p=0.036) and even in CES-D score of DEP (p=0.017) and SOM (p=0.011) subscales. In TTP a relevant decrease was found in SCL-90's SOM (p=0.023) and ANX, (p=0.016) subscales and in CES-D total score (p=0.020), POS (p=0.014) and SOM (p=0.09)subscales. In VTP group presence of partner support and absence of relational problems resulted as protective factors from a worse outcome. CONCLUSION: The results of this study suggest that, following an induced abortion, women experienced a significant improvement in the mood state compared to the period before the event; poor partner support and relational problems related with the abortion emerged as risk factors for a significantly worse psychological outcome compared to other causes interruption of pregnancy.

Follow-up and tracing of tuberculosis patients who fail to attend their scheduled appointments in Cotonou, Benin: a retrospective cohort study.

BACKGROUND: In the "Centre National Hospitalier de Pneumo-Phtisiologie" of Cotonou, Benin, little is known about the characteristics of patients who have not attended their scheduled appointment, the results of tracing and the possible benefits on improving treatment outcomes. This study aimed to determine the contribution of tracing activities for those who missed scheduled appointments towards a successful treatment outcome. METHODS: A retrospective cohort study was carried out among all smear-positive pulmonary tuberculosis patients treated between January and September 2013. Data on demographic and diagnostic characteristics and treatment outcomes were accessed from tuberculosis registers and treatment cards. Information on those who missed their scheduled appointments was collected from the tracing tuberculosis register. A univariate analysis was performed to explore factors associated with missing a scheduled appointment. RESULTS: Of 457 patients (410 new smear-positive and 47 retreatment tuberculosis), 37 (8%) missed one or more of their appointments with a total of 44 episodes of missed appointments. The 3.5th (32%) and 5th (43%) month appointments were the ones most likely to be missed. Being male was associated with a higher risk of missing appointments (RR = 4.2; 95% CI = 1.5-11.8, p = 0.004) while having HIV infection was associated with a lower risk (RR = 0.3, 95% CI = 0.1-0.9, p = 0.03). Principal reasons for missed appointments were travelling outside Cotonou (34%) and feeling better (21%). In 24 (55%) of these 44 episodes of missed appointments, contact was made with the patient who returned to the programme. These follow-up activities increased the treatment success by 4%. CONCLUSION: In Cotonou, Benin, less than 10% of tuberculosis patients miss at least one of their scheduled appointments. Tracing activities increase the treatment success rate by 4% and current on-going practices in the Programme need to be endorsed and encouraged.

Experiences of Brazilian children and family caregivers facing the recurrence of cancer.

PURPOSE: The aim of the study was to examine the different perspectives of the children and their family caregivers' experiences in the treatment of relapsed cancer. METHODS: We conducted 16 sessions of the Drawing-and-Story Procedure (D-S) with 5 to 12-year-old children who were in treatment due to recurrence of cancer, and 8 in-depth interviews among their family caregivers. The D-S and the interviews were audio-recorded with the participants' consent; the transcripts were analyzed using the thematic content analysis. RESULTS: The children evidenced that they perceived the threatening and uncertainty, independently of their age or kind of communication established about the disease and prognosis. Caregivers expressed feelings of frustration, threat and loss of control in view of the relapsed cancer diagnosis and prognosis, which enhanced the fear of losing their children and hampered the process of attributing meaning to their existence. Dyads showed similar experiences related to the recurrent cancer issues, and the first treatment experience seemed to help them to give new meanings to the current situation. CONCLUSION: Understanding the experiences of the children and their family caregivers can support the planning of psychological interventions that favor coping with the peculiarities of the disease situation resulting from the relapse diagnosis of childhood cancers.

Retratamiento con lamotrigina después de reacción cutánea de rash. Estudio de casos abiertos y metaanálisis combinados / Lamotrigine rechallenge after a skin rash. A combined study of open cases and a meta-analysis

Objetivo: Investigar la seguridad de la reintroducción de lamotrigina después de un episodio de rash inicial en pacientes con trastorno bipolar Método: Estudio prospectivo de casos abiertos de pacientes que desarrollaron rash inicial al ser tratados con lamotrigina y que fueron refractarios a otros tratamientos, a los cuales se les ofreció reintroducción de lamotrigina usando distintas estrategias de escaladas de dosis. Además, se efectuó una revisión de reportes previos de estrategias de manejo de rash y reintroducción de lamotrigina Resultados: De 10 pacientes retratados con lamotrigina 3 requirieron discontinuación de la droga debido a rash persistente. Uno de estos fue potencialmente serio y se resolvió con la discontinuación de lamotrigina. La revisión de la literatura identificó varios estudios de retratamiento con lamotrigina con tasas variables de resultados satisfactorios, entre 70 y 87% según los estudios. Ningún paciente desarrolló síndrome de Stevens-Johnson o necrólisis epidérmica tóxica después de la reintroducción. La tasa de rash fue elevada cuando el retratamiento comenzó dentro de las 4 semanas del rash inicial (19 vs 7%, p = 0,001) y se redujo cuando el rash inicial no tuvo signos de seriedad potencial (0 v.19%, p = 0,01) Conclusiones: Retratamiento es una opción viable después de rash benigno por lamotrigina y se puede retratar con más precauciones después del rash con uno o 2 signos de seriedad potencial. Para los casos de rash con mas signos de gravedad no hay datos fiables sobre al seguridad del retratamiento y puede conllevar un riesgo significativo. En estos casos el retratamiento debería evitarse dentro de las 4 semanas del rash inicial (AU)

Objective: To determine the safety of lamotrigine rechallenge after a first episode of skin rash in bipolar patients. Method: An open cases prospective study was conducted with patients who, developed a skin rash when first treated with lamotrigine, were refractory to other treatments, and were offered lamotrigine rechallenge using a different dose titration. Additionally a review was performed on previous skin rash management strategies and lamotrigine rechallenge reports. Results: Every 3 out of 10 lamotrigine rechallenge patients required drug interruption due to persistent rash. One of them was potentially serious and resolved by stopping the lamotrigine. The review of available literature identified several lamotrigine rechallenge studies with rates of positive results varying between 70% and 87% depending on the study. No patient developed Stevens-Johnson syndrome or toxic epidermal necrolysis after rechallenge. The rate of rash was higher when rechallenge began between 4 weeks from initial rash (19% vs. 7%, P=.001) and decreased when first rash showed no potentially serious signs (0% vs.19%, P=.01). Conclusions: Rechallenge is a viable option after a benign lamotrigine-induced rash, and can even be rechallenged after rash with greater precautions when there exists one or two potentially serious signs. In cases of more serious rash there are no reliable data available on rechallenge safety and it may pose a significant risk. In those cases rechallenge should better be avoided between 4 weeks from first rash (AU)

Decision regret in men undergoing dose-escalated radiation therapy for prostate cancer.

PURPOSE: Decision regret (DR) is a negative emotion associated with medical treatment decisions, and it is an important patient-centered outcome after therapy for localized prostate cancer. DR has been found to occur in up to 53% of patients treated for localized prostate cancer, and it may vary depending on treatment modality. DR after modern dose-escalated radiation therapy (DE-RT) has not been investigated previously, to our knowledge. Our primary aim was to evaluate DR in a cohort of patients treated with DE-RT. METHODS AND MATERIALS: We surveyed 257 consecutive patients with localized prostate cancer who had previously received DE-RT, by means of a validated questionnaire. RESULTS: There were 220 responses (85.6% response rate). Image-guided intensity modulated radiation therapy was given in 85.0% of patients and 3-dimensional conformal radiation therapy in 15.0%. Doses received included 73.8 Gy (34.5% patients), 74 Gy (53.6%), and 76 Gy (10.9%). Neoadjuvant androgen deprivation (AD) was given in 51.8% of patients and both neoadjuvant and adjuvant AD in 34.5%. The median follow-up time was 23 months (range, 12-67 months). In all, 3.8% of patients expressed DR for their choice of treatment. When asked whether they would choose DE-RT or AD again, only 0.5% probably or definitely would not choose DE-RT again, compared with 8.4% for AD (P<.01). CONCLUSION: Few patients treated with modern DE-RT express DR, with regret appearing to be lower than in previously published reports of patients treated with radical prostatectomy or older radiation therapy techniques. Patients experienced more regret with the AD component of treatment than with the radiation therapy component, with implications for informed consent. Further research should investigate regret associated with individual components of modern therapy, including AD, radiation therapy and surgery.

Quality of life among tuberculosis (TB), TB retreatment and/or TB-HIV co-infected primary public health care patients in three districts in South Africa.

INTRODUCTION: TB and HIV co-morbidity amount to a massive burden on healthcare systems in many countries. This study investigates health related quality of life among tuberculosis (TB), TB retreatment and TB-HIV co-infected public primary health care patients in three districts in South Africa. METHODS: A cross sectional study was conducted among 4900 TB patients who were in the first month of anti-TB treatment in primary public health care clinics in three districts in South Africa. Quality of life was assessed using the social functioning (SF)-12 Health Survey through face to face interviews. Associations of physical health (Physical health Component Summary = PCS) and mental health (Mental health Component Summary = MCS) were identified using logistic regression analyses. RESULTS: The overall physical and mental health scores were 42.5 and 40.7, respectively. Emotional role, general health and bodily pain had the lowest sub-scale scores, while energy and fatigue and mental health had the highest domain scores. Independent Kruskal-Wallis tests found significant positive effects of being TB-HIV co-infected on the domains of mental health functioning, emotional role, energy and fatigue, social function and physical role, while significant negative effects were observed on general health, bodily pain and physical function. In multivariable analysis higher educational, lower psychological distress, having fewer chronic conditions and being HIV negative were significantly positively associated with PCS, and low poverty, low psychological distress and being HIV positive were positively significantly associated with MCS. CONCLUSION: TB and HIV weaken patients' physical functioning and impair their quality of life. It is imperative that TB control programmes at public health clinics design strategies to improve the quality of health of TB and HIV co-infected patients.

Determinants for the retreatment groups of pulmonary tuberculosis patients treated in a DOTS programme in Sikkim, India.

OBJECTIVE: To assess knowledge, attitude and different health-seeking behaviours among 250 cured and 250 category-II tuberculosis patients. METHODS: A case-control study was conducted in different health settings in Sikkim, a part of the Indian continent. A questionnaire was filled for the purpose. RESULTS: Results showed significant differences in overcrowding, smoking and alcohol intake. There was a general unawareness with the disease and its treatment between the two groups. 45% of the respondents reported that tuberculosis is caused by germs. 81.4% stated that tuberculosis presents only as cough. 94.8% of the case group and 90.8% of the control group stated that it is a transmissible disease. Sharing food with tuberculosis patients (64% of case group, 55% of the control group; p < 0.05), inadequate diet (16.4% of case group, 9.6% of the control group; p < 0.03) were mentioned as modes of transmission. Sixty six per cent of the case group and 56.8% of the control group mentioned the use of DOTS for prevention and control (p < 0.05). Sixty three per cent of the control group regarded tuberculosis as a life threatening condition (p < 0.00) [(adjusted OR = 2.04, (95% CI: 1.43, 2.93)]. Tuberculosis was considered as a completely curable disease by 96.4% of the case group (p < 0.05). 40.6% of the respondents agreed to be in contact with a tuberculosis infected person. 64% of the retreatment group discontinued their treatment due to frequent travelling for work. CONCLUSION: The study revealed lack of knowledge, positive attitude and inappropriate health seeking behaviours among of the tuberculosis patients, irrespective of their categorization.

War zone veterans returning to treatment: effects of social functioning and psychopathology.

Patients with mental illness often return for further treatment after an initial episode of care. Two processes that may contribute to the return for further treatment are the severity of patients' initial social and clinical status; and/or deterioration in their status over time, regardless of their initial status. This study examined these processes in an administrative database of war zone veterans who had received outpatient treatment from a Veterans Affairs specialized posttraumatic stress disorder program. The results suggest that both initial severity and deterioration of status contribute to return to treatment and involve changes in both social functioning and psychopathology. Determination of the direction of effects between social functioning and psychopathology showed that psychopathology in the form of PTSD, other Axis I disorder or violent behavior generally affected subsequent social functioning, but not vice versa. Psychopathology in the form of alcohol or drug abuse/dependence, however, showed reciprocal effects with social functioning. These results point to the importance of emphasizing interventions that address social dysfunction and that address psychopathology, from the beginning of treatment as a way of maximizing the benefits and minimizing the need for recurrent care.

Does pretreatment severity moderate the efficacy of psychological treatment of adult outpatient depression? A meta-analysis.

OBJECTIVE: It is widely believed that psychological treatment has little effect on more severely depressed patients. This study assessed whether pretreatment severity moderates psychological treatment outcome relative to controls by means of meta-analyses. METHOD: We included 132 studies (10,134 participants) from a database of studies (www.evidencebasedpsychotherapies.org) in which the effects of psychological treatment on adult outpatients with a depressive disorder or an elevated level of depressive symptoms were compared with a control condition in a randomized controlled trial. Two raters independently extracted outcome data and rated study characteristics. We conducted metaregression analyses assessing whether mean pretreatment depression scores predicted psychological treatment versus control condition posttreatment effect size and subgroup analyses summarizing the results of studies reporting within-study analyses of depression severity and psychological treatment outcome. RESULTS: Psychological treatment was found to be consistently superior to control conditions (d = 0.40-0.88). We found no indication that pretreatment mean depression scores predicted psychological treatment versus control condition posttreatment effect size, even after adjusting for relevant study characteristics. However, among the smaller subset of studies that reported within-study severity analyses, posttreatment effect sizes were higher for high-severity patients (d = 0.63) than for low-severity patients (d = 0.22) when psychological treatment was efficacious relative to a more stringent control. CONCLUSION: Contrary to conventional wisdom, our findings suggest that when compared with control conditions, psychological treatment might be more efficacious for high-severity than for low-severity patients. Because the number of studies reporting within-study severity analyses is small, we recommend that future studies routinely report tests for Severity × Treatment interactions.

The disutility of restenosis--the impact of repeat percutaneous coronary intervention on quality of life.

BACKGROUND: Percutaneous coronary intervention (PCI) with coronary stenting is a common medical procedure that is used to treat the symptoms of both stable angina and acute coronary syndromes. Drugeluting stents (DES) decrease restenosis and repeat revascularization procedures but are more expensive than bare-metal stents. A proper cost-effectiveness analysis of DES requires an understanding of the health value patients place on the avoidance of restenosis accompanied by a repeat PCI. OBJECTIVE: To estimate quality-of-life (QoL) benefits ascribed to avoiding the return of coronary symptoms and the need for a repeat revascularization procedure. METHODS: A prospective, single-centre study was conducted involving PCI patients. A time trade-off (TTO) question, based on a hypothetical restricted lifespan of 10 years, was used to estimate the QoL benefits patients attach to the avoidance of recurrent symptoms and a repeat PCI. This was accomplished by interviewing the patients by telephone, two weeks post-PCI. The TTO question was also administered to the catheterization laboratory staff. RESULTS: Between January and March 2007, and between April and June 2008, 103 interviews were completed. The median TTO was zero weeks (interquartile range zero to 1.7 weeks). Six interventional cardiologists and eight cardiac catheterization nurses reported a similar median disutility. CONCLUSION: Despite acknowledgement of the substantial clinical benefits of DES, the results of the present study suggest that patients do not place a great disutility on avoiding restenosis, thereby providing little QoL justification for the large incremental cost associated with this technology.

Health-related quality of life (HRQL) in all-patients treated with chemotherapy only: a report from the late effects surveillance system in Germany.

BACKGROUND: The study examines the HRQL in children suffering from ALL over time. PATIENTS: 96 patients (average age 7.1 years) were included, treated with chemotherapy in 15 German study centres between 1997 and 2003. METHODS: The HRQL was assessed based on both the parent report (POQOLS) and the patient self-report (KINDL) at 3 intervals: up to 2 weeks after diagnosis (T1), upon completion of the re-induction therapy (T2) and at the end of the maintenance therapy (T3). To analyse the changes of HRQL over time, the differences between the individual scores (T2-T1 and T3-T1) were calculated and statistically tested. The HRQL results from KINDL were also compared to a sample from the German general population. RESULTS: POQOLS (scale 0 (optimum) to 6): A decrease of HRQL was found in the domain "activity" at T1 (mean score=3.1) and T2 (mean score=2.6). Over time, HRQL improved significantly with a mean score-difference T3-T1=-0.7 (p=0.001). KINDL (scale 0 to 100 (optimum)): The individual HRQL-scores improved over time with the major increases occurring in the domains "physical" with a mean score-difference T2-T1=21.7 (p<0.0001) and a mean score-difference T3-T1=20.6 (p=0.0002) and "mental" with a mean score-difference T2-T1=7.1 (p=0.02) and T3-T1=8.1 (p=0.02). However, the mean overall HRQL-score was significantly lower compared to the general population. CONCLUSIONS: Children with ALL show lower HRQL compared to the general population. Over time, HRQL improved significantly from both the patient and the parent perspective.

Drop-out from treatment for the eating disorders: a problem for clinicians and researchers.

All professionals who work in the field of eating disorders will have encountered patients who do not make it into or through a course of treatment. This paper considers some of the difficulties that drop-out poses to clinicians and researchers. It also suggests strategies for addressing these challenges in future research and clinical practice.

Anaesthetic choice in the colposcopy clinic: a retrospective analysis of routinely collected data.

OBJECTIVES: Current guidelines recommend that less than 20% of treatments in colposcopy clinics should be under general anaesthetic. The objective of this study was to increase the evidence base for guidelines by establishing the proportion of women receiving general anaesthesia for treatment, determining the predictors of and reasons recorded for general anaesthetic use. DESIGN: Retrospective analysis of routinely collected data. SETTING: NHS Trust in the West Midlands. PARTICIPANTS: Colposcopy patients; January 2003 to March 2005. METHODS: Logistic regression of factors associated with general anaesthetic choice. MAIN OUTCOME MEASURES: Proportion of women treated under general anaesthesia, factors associated with anaesthetic choice and reasons recorded for general anaesthetic use. RESULTS: About 5.4% (204/3777) of new appointments for colposcopy received treatment under general anaesthetic. Of women requiring treatment, 20% (204/1003) received general anaesthetic. General anaesthetic was more likely to be used when the woman required loop excision (OR = 3.63, 95% CI 2.11-6.24) and less likely when directed biopsy was performed (OR = 0.11, 95% CI 0.01-0.80), when the patient appointment date was after introduction of new guidelines (OR = 0.37, 95% CI 0.24-0.56) or when the assessment visit was with a nonconsultant status doctor rather than nurse or consultant (OR = 0.70, 95% CI 0.50-0.97). General anaesthetic use varied between colposcopists ranging from 0 to 16.5% of new patients seen. Woman's choice was the most commonly specified reason for the use of general anaesthetic. CONCLUSIONS: The proportion of colposcopy patients treated under general anaesthetic is 20%, within guideline limits. Substantial variation in general anaesthetic rates between colposcopists was observed, and further investigation is required to discover the reason for this.

Stability over time of patients' attitudes toward ECT.

This study examined the stability of patients' attitudes toward electroconvulsive therapy (ECT). Surveys were administered to 64 study participants at 2 and 4 weeks post treatment. The survey responses were highly significantly correlated and not significantly different, which suggests that attitudes toward ECT are stable during this time.