Risk factors for severe perineal trauma during childbirth: An updated meta-analysis.

Several studies have investigated the importance of maternal, fetal factors and intrapartum characteristics in predicting severe perineal lacerations. The purpose of the present systematic review is to accumulate current evidence and provide estimated effect sizes for the various risk factors described. We reviewed Medline, Scopus, Clinicaltrials.

Appraisal of clinical practice guidelines on the management of obstetric perineal lacerations and care using the AGREE II instrument.

Pelvic floor trauma during childbirth is highly prevalent and is associated with long term risks of incontinence and pelvic organ prolapse. Societies and organizations have published clinical guidelines in order to standardise and improve the management of perineal care. The aim of this study was to systematically evaluate the quality of clinical guidelines on obstetric perineal trauma and care using the AGREE II instrument.

Open access availability of anatomy papers presented at meetings of the American and British Associations of Clinical Anatomists.

Introduction: Dissemination of research depends on published work being accessible. In many disciplines open access (OA) research is more frequently cited, although this has never before been demonstrated amongst anatomy publications. The objective of this study was to assess a selection of published anatomy papers to determine the effect of gold and bronze OA availability on citation rates.

A systematic review and meta-synthesis of qualitative studies on pelvic organ prolapse for the development of core outcome sets.

Aims: In the current climate of evidence-based health care, the aim of this meta-synthesis was to collect and systematically analyse data from primary qualitative studies on pelvic organ prolapse (POP), to identify patient-centered perspectives on the natural course of POP. Information acquired in this study may be useful for ongoing research towards the development of core outcome sets (COS) in pelvic floor disorders.

Methods: A CHORUS Working Group performed a standardized search of three different databases (Medline, Embase, Scopus), from inception to October 2019.

Metformin use in obese mothers is associated with improved cardiovascular profile in the offspring.

Background: Maternal obesity increases the risk for pregnancy complications and adverse neonatal outcome and has been associated with long-lasting adverse effects in the offspring, including increased body fat mass, insulin resistance, and increased risk for premature cardiovascular disease. Lifestyle interventions in pregnancy have produced no or modest effects in the reduction of adverse pregnancy outcomes in obese mothers. The Metformin in Obese Pregnant Women trial was associated with reduced adverse pregnancy outcomes and had no effect on birthweight.

Randomized, Controlled Trial of Tacrolimus and Prednisolone Monotherapy for Adults with Minimal Change Disease: A Multicenter, Randomized, Controlled Trial.

Background And Objectives: Minimal change disease is an important cause of nephrotic syndrome in adults. Corticosteroids are first-line therapy for minimal change disease, but a prolonged course of treatment is often required and relapse rates are high. Patients with minimal change disease are therefore often exposed to high cumulative corticosteroid doses and are at risk of associated adverse effects.

Focussing on the fundaments - assessing and treating Clozapine Induced Gastrointestinal Hypomotility.

Clozapine is a second-generation antipsychotic used in treatment-resistant Schizophrenia (TRS). Clozapine Induced Gastrointestinal Hypomotility (CIGH) is the commonest cause of clozapine related death, yet remains under-recognised and under-monitored. To review the pharmacological management of CIGH.

Systematic Review of Stress Radiographic Modalities Stability Assessment in Supination External Rotation Ankle Fractures.

Background: Isolated distal fibular fractures resulting from supination external rotation (SER) injuries without evidence of obvious talar shift on standard radiographs present a diagnostic dilemma for clinicians. The status of the deep deltoid ligament, the main stabilizer of the ankle joint, is assessed by an increase in medial clear space (MCS) on radiographs. Therefore, these injuries can be either stable or unstable.

Postretinal Detachment Retinal Displacement: How Best to Detect It?

Purpose: The reported incidence of postretinal detachment (RD) macular displacement varies markedly (14-72%). This may in part be due to the imaging modalities used. We compared the ability of 2 types of fundus autofluorescence (FAF) imaging modalities to detect this phenomenon.

A systematic review of reported outcomes and outcome measures in randomized trials evaluating surgical interventions for posterior vaginal prolapse to aid development of a core outcome set.

Background: Recent systematic reviews have demonstrated wide variations on outcome measure selection and outcome reporting in trials on surgical treatments for anterior, apical and mesh prolapse surgery. A systematic review of reported outcomes and outcome measures in posterior compartment vaginal prolapse interventions is highly warranted in the process of developing core outcome sets.

Objective: To evaluate outcome and outcome measures reporting in posterior prolapse surgical trials.

Successful versus unsuccessful instrumental deliveries-Predictors and obstetric outcomes.

Objective: The purpose of this study was to examine instrumental births in a multi-ethnic population to assess the factors associated with success and failure in instrumental births.

Study Design: This was a large retrospective study of 7954 women that underwent either a successful or an unsuccessful instrumental delivery in a single centre over a 10 year period.

Results: Logistic regression analysis showed that women with a BMI of more than 30, attempted Forceps delivery, having a prolonged second stage, Macrosomia (birth weight more than 4 kg) and a senior obstetrician performing the procedure increase the risk of a failed instrumental delivery.

An animal experimental study on pubourethral ligament restoration with platelet rich plasma for the treatment of stress urinary incontinence.

Introduction: Minimally invasive methods for injured ligament and tendon restoration have been developed and gained popularity in recent years. Injury and relaxation of the pubourethral ligament (PUL) can lead to stress urinary incontinence (SUI). The aim of this study was to investigate the impact of injecting platelet rich plasma (PRP) into the PUL following its surgical transection resulting in SUI, confirmed by leak point pressure (LPP) measurements pre- and post-intervention in an experimental animal model.

Non-medical prescribing: a reflective case study on prescribing anticoagulation for deep vein thrombosis.

Prescribing is a high-risk, complex skill. There are more than 50,000 nurse prescribers in the UK, and it is important that they undertake regular reflection on their clinical practice to enhance their skills. This article reflects on the clinical factors that influenced the author's decision-making when prescribing anticoagulation medication for a patient with deep vein thrombosis.

Mycobacterium avium-intracellulare septic arthritis of the sternoclavicular joint in an immunocompetent host; a three-year follow-up.

A 34 year-old lady was referred for rheumatology review by the orthopaedic team for further investigation of chronic left sternoclavicular joint pain. No preceding event such as trauma, injury or infection had occurred. A rheumatology workup turned out to be negative for an inflammatory arthropathy.

The use of urethral bulking injections in post-prostatectomy stress urinary incontinence: A narrative review of the literature.

Aims: Post-prostatectomy stress urinary incontinence (PPI) is a common condition with significant impact on patient quality of life. With rising numbers of prostatectomies performed, recognition of incontinence during survivorship care is growing. With increasing hesitance of the use of suburethral mesh in females, urethral bulking injections in this patient population as a minimally invasive alternative to surgery are evaluated.

Update to the study protocol, including statistical analysis plan, for the multicentre, randomised controlled OuTSMART trial: a combined screening/treatment programme to prevent premature failure of renal transplants due to chronic rejection in patients with HLA antibodies.

Background: Chronic rejection is the single biggest cause of premature kidney graft failure. HLA antibodies (Ab) are an established prognostic biomarker for premature graft failure so there is a need to test whether treatment decisions based on the presence of the biomarker can alter prognosis. The Optimised TacrolimuS and MMF for HLA Antibodies after Renal Transplantation (OuTSMART) trial combines two elements.

Surveillance arterioveNous fistulAs using ultRasound (SONAR) trial in haemodialysis patients: a study protocol for a multicentre observational study.

Introduction: Arteriovenous fistulas (AVFs) are considered the best and safest modality for providing haemodialysis in patients with end-stage renal disease. Only 20% of UK centres achieve the recommended 80% target for achieving dialysis of the prevalent dialysis population via permanent access (as opposed to a central venous catheter). This is partly due to the relatively poor maturation rate of newly created fistulas, with as many as 50% of fistulas failing to mature.

Long term outcomes in monoclonal gammopathy of renal significance.

Unlike AL amyloid and cast nephropathy, the long-term outcomes of monoclonal gammopathy of renal significance (MGRS) patients with other renal histopathologies remain unclear. It is uncertain if early intervention improves renal outcomes, because of a lack of evidence from prospective studies. In this retrospective study, we examined outcomes of 41 MGRS patients treated between 2004 and 2017 across five centres: four in the UK and one in the Republic of Ireland.

Variations in bladder pain syndrome/interstitial cystitis (IC) definitions, pathogenesis, diagnostics and treatment: a systematic review and evaluation of national and international guidelines.

Introduction And Hypothesis: Interstitial cystitis (IC) and bladder pain syndrome (BPS) are challenging and encompassing hypersensitivity disorders of the lower urinary tract. A variety of national and international guidelines have been published including guidance on nomenclature, definitions, etiopathology, diagnostics and treatment. A lack of universally established clinical guidance is apparent.

Clinical and Patient-reported Outcome Measures in Men Referred for Consideration of Surgery to Treat Lower Urinary Tract Symptoms: Baseline Results and Diagnostic Findings of the Urodynamics for Prostate Surgery Trial; Randomised Evaluation of Assessment Methods (UPSTREAM).

Background: Clinical evaluation of male lower urinary tract symptoms (MLUTS) in secondary care uses a range of assessments. It is unknown how MLUTS evaluation influences outcome of therapy recommendations and choice, notably urodynamics (UDS; filling cystometry and pressure flow studies).

Objective: To report participants' sociodemographic and clinical characteristics, and initial diagnostic findings of the Urodynamics for Prostate Surgery Trial; Randomised Evaluation of Assessment Methods (UPSTREAM).

New evidence-based A1, A2, A3 alarm time zones for transferring thrombolysed patients to hyper-acute stroke units: faster is better.

Objectives: The National Institute of Health and Clinical Excellence and The Royal College of Physicians recommend transferring thrombolysed patients with stroke to a hyperacute stroke unit (HASU) within 4 h from hospital arrival (T), but there is paucity of evidence to support this cut-off. We assessed if a shorter interval within this target threshold conferred a significant improvement in patient mortality.

Design: We conducted a retrospective analysis of prospectively collected data from the Sentinel Stroke National Audit Programme.

Postoperative critical care and high-acuity care provision in the United Kingdom, Australia, and New Zealand.

Background: Decisions to admit high-risk postoperative patients to critical care may be affected by resource availability. We aimed to quantify adult ICU/high-dependency unit (ICU/HDU) capacity in hospitals from the UK, Australia, and New Zealand (NZ), and to identify and describe additional 'high-acuity' beds capable of managing high-risk patients outside the ICU/HDU environment.

Methods: We used a modified Delphi consensus method to design a survey that was disseminated via investigator networks in the UK, Australia, and NZ.