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Biomedical subjects

C Overton

Publications and source records attributed to C Overton.

13 recordsLinked to original sources
PubMed2005

Self-reported bladder function five years post-hysterectomy.

We have examined the contribution of hysterectomy, compared with less invasive surgery, for dysfunctional uterine bleeding (DUB) on the prevalence of bladder problems five years after surgery. We report a prospective cohort study of over 25,000 women treated for benign cause menorrhagia by three types of surgery - transcervical endometrial resection/ablation and hysterectomy with or without bilateral oophorectomy. Postal questionnaires were sent five years after surgery investigating satisfaction with surgery and bladder function. When adjusted for confounders the odds of severe urinary incontinence (OR = 1.59, CI 95%, 1.35 - 1.87), urinary frequency (1.23 (1.04 - 1.45)), and nocturia (1.19, (1.03 - 1.38)) - were increased for women who had a hysterectomy compared with endometrial ablation. Hysterectomy with bilateral oophorectomy was not as strongly associated with severe bladder problems. Women who had the LAVH were most likely to report severe urinary incontinence (2.02, CI 95% 1.32 - 3.07), but not severe frequency or nocturia.

Adult↗
PubMed2005

Readmission to hospital 5 years after hysterectomy or endometrial resection in a national cohort study.

OBJECTIVES: To investigate the readmission experience of a large national prospective cohort of women up to 5 years after undergoing either transcervical resection of the endometrium (TCRE) or hysterectomy to assess reasons for readmission and whether TCRE can be viewed as a definitive substitute for hysterectomy. DESIGN AND PARTICIPANTS: Data are from the VALUE/MISTLETOE prospective national cohort studies of hysterectomy and TCRE respectively. 5294 women who underwent hysterectomy for dysfunctional uterine bleeding in 1994/5 and 4032 women who underwent TCRE in 1993/4 and who responded to postal questionnaires were included. Surgeons gathered operative details. Women completed postal follow up questionnaires at 3 and 5 years after surgery asking about readmission to hospital and reasons for readmission. Adjusted proportional hazard ratios were calculated for likelihood of readmission in each category comparing types of surgery. RESULTS: 41.7% of women undergoing hysterectomy and 44.6% of women undergoing TCRE experienced one or more readmissions to hospital overall within 5 years (adjusted hazard ratio for all readmissions (AHR) 0.87 (95% confidence interval (CI) 0.80 to 0.95)). 12.6% of hysterectomy patients and 30.3% of TCRE patients were readmitted for gynaecological reasons (AHR 0.40 (95% CI 0.33 to 0.48)). Rates of readmission for gynaecological reasons were similar up to 6 months but were markedly reduced for hysterectomy compared with TCRE patients towards the end of the follow up period (AHR for readmission at 3-5 years 0.28 (95% CI 0.20 to 0.39)). CONCLUSIONS: There are differences in the pattern of readmission to hospital after hysterectomy and TCRE for dysfunctional uterine bleeding. Women undergoing a hysterectomy are less likely to be readmitted to hospital up to 5 years after their operation overall, and are significantly less likely to be readmitted for reasons related to their operation, particularly for gynaecological reasons. Hysterectomy appears to be a more definitive operation. The different options for surgery for dysfunctional uterine bleeding are not interchangeable; they represent different patterns of care. Information should be available to women and practitioners to inform choices between these options.

Adult↗
PubMed2004

Radiotherapy for glioma during pregnancy: fetal dose estimates, risk assessment and clinical management.

Cancer in pregnancy is relatively uncommon, but constitutes a major problem. We report the measurement of scatter dose to the fetus and the estimated fetal risk from that exposure in an illustrative case of a patient, 20 weeks pregnant, with a grade 3 anaplastic astrocytoma. A clinical decision was made to withhold radiotherapy, if possible, until after delivery. Sequential magnetic resonance imaging (MRI) showed no progression during the pregnancy. In the event, she was managed conservatively until the successful completion of her pregnancy. In case radiotherapy was required, an estimation of the fetal risk was made. Phantom measurements were undertaken to assess the likely fetal dose. Film badges were used to estimate the scattered radiation energy. Measurements were made on a Varian 600C at 6 MV and Asea Brown Boveri (ABB) accelerator at 8 and 16 MV. Doses were measured at 30, 45 and 60 cm from the isocentre; the fetus was assumed to lie at about 60 cm and not closer than 45 cm from the isocentre. Estimated doses to the position of the fetus were lowest with the 6 MV Varian accelerator. Using this machine without additional abdominal shielding, the estimated dose on the surface at 45 cm from the tumour volume was 2.2 cGy for a tumour dose of 54 Gy; using the ABB accelerator, the dose varied between 49-59 cGy. The energy of scattered radiation was in the range 208-688 keV, so that additional shielding would be practical to further reduce the fetal dose. The risk of cancer up to the age of 15 years attributable to radiation is 1 in 1700 per cGy, of which half will be fatal (i.e. 1 in 3300 per cGy). A dose of 2.2 cGy adds a risk of fatal cancer by the age 15 years of only 1 in 1500. Because the addition of shielding might halve the fetal dose, this risk should be reduced to 1 in 3000. For comparison, the overall UK risk of cancer up to the age 15 years is 1 in 650. In conclusion, careful choice of linear accelerator for the treatment of a pregnant woman and the use of additional shielding is valuable, as this can dramatically affect fetal dose.

Adult↗
PubMed2002

The VALUE national hysterectomy study: description of the patients and their surgery.

OBJECTIVES: To describe hysterectomies practised in 1994 and 1995: the patients, their surgery and short term outcomes. DESIGN: One of two large cohorts, with prospective follow up, recruited to compare the outcomes of endometrial destruction with those of hysterectomy. SETTING: England, Wales and Northern Ireland. POPULATION: All women who had hysterectomies for non-malignant indications carried out during a 12-month period. METHODS: Gynaecologists in NHS and independent hospitals were asked to report cases. Follow up data were obtained at outpatient follow up approximately six weeks post-surgery. MAIN OUTCOME MEASURES: Indication for surgery, method of hysterectomy, ovarian status post-surgery, surgical complications. RESULTS: 37,298 cases were reported which is estimated to reflect about 45% of hysterectomies performed during the period studied. The median age was 45 years, and the most common indication for surgery was dysfunctional uterine bleeding (46%). Most hysterectomies were carried out by consultants (55%). The proportions of women having abdominal, vaginal or laparoscopically-assisted hysterectomy were 67%, 30% and 3%, respectively. Forty-three percent of women had no ovaries conserved after surgery. The median length of stay was five days. The overall operative complication rate was 3.5%, and highest for the laparoscopic techniques. The overall post-operative complication rate was 9%. One percent of these was regarded as severe, with the highest rate for severe in the laparoscopic group (2%). There were no operative deaths; 14 deaths were reported within the six-week post-operative period: a crude mortality rate soon after surgery of 0.38 per thousand (95% CI 0.25-0.64). CONCLUSIONS: This large study describes women who undergo hysterectomy in the UK, and presents results on early complications associated with the surgery. Operative complications occurred in one in 30 women, and post-operative complications in at least one in 10. Laparoscopic techniques tend to be associated with higher complication rates than other methods.

Adolescent↗
PubMed2000

RN and LPN accountabilities and responsibilities.

Although the scopes of practice of RNs and LPNs overlap, the main difference between the two scopes lies in the breadth and depth of the knowledge, and the clinical judgments of registered nurses. Changes in staff mix and introducing LPNs into organizations that were previously staffed only by RNs provide challenges for all care providers. Moving from all RN staffing to an RN-LPN mix requires redefining how care is delivered. Carefully planned, with an awareness of the scopes of practice and of the breadth and depth of nursing knowledge of RNs and LPNs, these changes can be accomplished with minimal conflict and disruption.

British Columbia↗
PubMed1997

A national survey of the complications of endometrial destruction for menstrual disorders: the MISTLETOE study. Minimally Invasive Surgical Techniques--Laser, EndoThermal or Endorescetion.

OBJECTIVES: To study the frequency of complications of endometrial resection and ablation for menstrual disturbances and the influence of the experience of the operators. DESIGN: Prospective survey with additional retrospective reporting by theatre staff. SETTING: 300 National Health Service and independent hospitals in the United Kingdom (excluding Scotland). POPULATION: 10,686 women registered by 690 doctors (1-222 cases/doctor) from April 1993 to October 1994. METHODS: Mailings were sent to relevant medical and non medical staff at every hospital to ascertain who performed the operations. These doctors were asked to complete a questionnaire detailing their previous experience. Completed patient registration forms were returned each month. Theatre contacts returned lists of cases reported in theatre registers. MAIN OUTCOME MEASURES: Perioperative, post-operative and delayed complications by method of surgery and experience of operator. RESULTS: Two directly related deaths were reported. Laser and rollerball ablations were associated with least operative and post-operative complications. Combined loop and rollerball diathermy was associated with a higher rate, but with fewer immediate operative complications than loop resection alone. Endometrial thinning agents were not associated with decreased complications. Fibroids were associated with increased operative haemorrhage. Early post-operative complication rates ranged from 0.77% to 1.51%. Six-week follow up in 82.5% of the women revealed few complications (1.25% to 4.58%). Increasing operative experience was associated with fewer uterine perforations in the loop resection alone group (chi 2 for trend, P < 0.001), but had no effect on operative haemorrhage in any group. CONCLUSIONS: These procedures were used widely in 1993 to 1994 with low morbidity and mortality. The techniques may be relatively easily learned in the apprenticeship system without compromising safety. Combined diathermy resection appears safer than loop resection alone, but laser and rollerball ablation were safest.

Adult↗
PubMed1996

Peritoneal fluid cytokines and the relationship with endometriosis and pain.

It is generally accepted that the current scoring system for endometriosis has little correlation with clinical symptoms such as pain, and therefore we may deduce that either endometriosis does not cause pain, or that the current scoring system does not indicate the biological activity of the disease. Pain may occur because the presence of endometriosis produces an intraperitoneal inflammatory response, and several studies have shown that the cytokine content of peritoneal fluid differs between women with and without endometriosis. We studied the relationship between tumour necrosis factor alpha (TNF alpha), platelet-derived growth factor (PDGF), interleukin (IL)-6, IL-4 and TNF (alpha and beta) activity in peritoneal fluid and the clinical history of pain and infertility. TNF alpha concentrations were increased in peritoneal fluid of women with endometriosis and of infertile women; PDGF concentrations were increased in peritoneal fluid of parous women; IL-6 was increased in peritoneal fluid of women with adhesions; IL-4 was absent from peritoneal fluid. PDGF and IL-6 concentrations were cycle related, with the highest amounts in the menstrual and proliferative phases respectively. We failed to demonstrate any association between concentrations of cytokines in vitro and pain symptoms or severity of endometriosis.

Adult↗
PubMed1995

Audit of currently available endometrial ablative techniques.

Techniques for the treatment of menorrhagia have changed rapidly over the last few years. The enthusiastic introduction by a small number of protagonists of a variety of ablation/resection techniques has been followed by an exponential uptake in their use. At the same time there has been a period of critical appraisal by the Royal College of Obstetricians and Gynaecologists and the British Society for Gynaecological Endoscopy. The MISTLETOE Survey was the culmination of this association and has provided useful large data sets of the various techniques under evaluation. It is expected that recommendations concerning; the training of potential operators; various practical aspects of the surgical, medical and anaesthetic techniques required to undertake the procedures safely; types and frequencies of complications of the procedures, and success rates following the widespread use of these procedures will be made available following analysis of the data sets.

Catheter Ablation↗
PubMed1995

Challenges in integrating biological data sources.

Scientific data of importance to biologists reside in a number of different data sources, such as GenBank, GSDB, SWISS-PROT, EMBL, and OMIM, among many others. Some of these data sources are conventional databases implemented using database management systems (DBMSs) and others are structured files maintained in a number of different formats (e.g., ASN.1 and ACE). In addition, software packages such as sequence analysis packages (e.g., BLAST and FASTA) produce data and can therefore be viewed as data sources. To counter the increasing dispersion and heterogeneity of data, different approaches to integrating these data sources are appearing throughout the bioinformatics community. This paper surveys the technical challenges to integration, classifies the approaches, and critiques the available tools and methodologies.

Chromosomes, Artificial, Yeast↗
PubMed1993

The Back Injury Prevention Project pilot study. Assessing the effectiveness of back attack, an injury prevention program among nurses, aides, and orderlies.

The Back Injury Prevention Project was a pilot study of "Back Attack," an educational program designed to prevent back injuries among nurses, nurses' aides, and orderlies. The pilot tested program feasibility, developed and tested instruments, and generated preliminary data measuring program effectiveness. Fifty-five nurses, aides, and orderlies on two medical/surgical units at two Kaiser Permanente medical centers in Portland, Oregon participated in the study. Intervention group scores on the composite back pain and composite fatigue scales decreased relative to the control group, but this did not reach statistical significance. A 19% improvement in scores for quality of patient transfer was observed for the intervention group (P < .0003), while the control group did not show any significant improvement during the same time period. Results of the pilot suggest that the Back Attack program changes behavior at least in the short term. Further study will be necessary to determine if the behavior change persists and back pain and injury rates are subsequently reduced.

Accidents, Occupational↗