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Biomedical subjects

Gillian Penney

Publications and source records attributed to Gillian Penney.

At least 19 recordsLinked to original sources
PubMed2006

Treatment of pain during medical abortion.

A structured literature review was undertaken to determine, in the context of early medical abortion, the proportion of women who require analgesia, the predictors of analgesia requirement and the most appropriate analgesia regimen. Studies from different centers show wide variations in analgesia use, but, overall, around 75% of women use narcotic analgesics on the day of prostaglandin administration. Differences are likely to be due to differences in policies for offering analgesia rather than differences in patient characteristics. The following characteristics are consistently associated with increased requirement for analgesia: increasing gestation, younger patient age, nulliparity and White race. A regimen comprising 325-500 mg of paracetamol (acetaminophen) with 10 mg of dihydrocodeine or 30 mg of codeine has been used by thousands of women without apparent problems.

Abortion, Induced↗
PubMed2005

Theory-based identification of barriers to quality improvement: induced abortion care.

BACKGROUND: The UK Royal College of Obstetricians and Gynaecologists published the clinical guideline, The Care of Women Requesting Induced Abortion, to address recognized variations in care. There is little empirical evidence on factors that influence compliance with the guideline. A better understanding of such factors is needed for quality improvement initiatives. OBJECTIVE: To identify factors that influence compliance with two key guideline recommendations: offer of an assessment appointment within 5 days of referral, and supply of contraceptives at discharge. SETTING: Thirteen hospital gynaecology units in Scotland. METHODS: Guideline compliance was measured by a case note review. Barriers and facilitators were identified using a combination of approaches: semi-structured interviews with local gynaecologists and a survey of clinical staff. The questionnaire, based upon constructs from the Theory of Planned Behaviour, measured behavioural intention, attitude, subjective norm (perceived social pressure), and perceived behavioural control. RESULTS: Of 507 cases reviewed, median unit compliance was 46% for the assessment appointment and 59% for contraceptive supplies. Questionnaires were returned by 151 (74%) of 205 staff in 12 units. The interviews and open-ended questions highlighted organizational barriers to guideline implementation. Staff generally had strong intentions and positive attitudes to follow both recommendations. For the assessment appointment, perceived behavioural control was low. The Theory of Planned Behaviour accounted for 27% of the variation in intentions, with subjective norm being the strongest predictor. Intention and perceived behavioural control best explained unit compliance, together explaining 15% of the variation. For contraceptive supplies, the theory accounted for 34% of the variation in intentions, with perceived behavioural control being the strongest predictor. CONCLUSION: Clinical staff were highly motivated to implement the guideline but hindered by organizational constraints. Quality improvement initiatives need to target organizational barriers as well as individual professionals.

Abortion, Induced↗
PubMed2005

FFPRHC Guidance (July 2005): The use of contraception outside the terms of the product licence.

This Guidance provides information for clinicians and women considering the use of contraception outside the terms of the product licence. A key to the grades of recommendations, based on levels of evidence, is given at the end of this document. Details of the methods used by the Clinical Effectiveness Unit (CEU) in developing this Guidance and evidence tables summarising the research basis of the recommendations are available on the Faculty website (www.ffprhc.org.uk). Abbreviations (in alphabetical order) used include: CEU, Clinical Effectiveness Unit; COC, combined oral contraception/contraceptive; DMPA, depot medroxyprogesterone acetate; ENG, etonogestrel; IUD, copper-bearing intrauterine contraceptive device; LNG-IUS, levonorgestrel-releasing intrauterine system; NET-EN, norethisterone enantate; PGD, Patient Group Direction; PIL, Patient Information Leaflet; POC, progestogen-only contraception/contraceptive; POEC, progestogen-only emergency contraception; POP, progestogen-only pill; RCT, randomised controlled trial; SPC, Summary of Product Characteristics; UPSI, unprotected sexual intercourse; WHO, World Health Organization; WHOMEC, WHO Medical Eligibility Criteria for Contraceptive Use; WHOSPR, WHO Selected Practice Recommendations for Contraceptive Use.

Contraception↗
PubMed2004

Quantifying severe maternal morbidity: a Scottish population study.

OBJECTIVE: To quantify the incidence of severe maternal morbidity in Scotland and determine the feasibility of doing so. DESIGN: Prospective observational study. SETTING: All 22 consultant led maternity units in Scotland, between 1 October 2001 and 30 September 2002. POPULATION: Women during pregnancy and the puerperium. METHODS: Definitions for 13 categories of severe maternal morbidity were developed from published work. Recruitment of maternity units, and training of staff, took place at a national meeting. Each month, every unit reported cases meeting the agreed definitions, the category of incident and date. Data were collated centrally and analysed to determine the frequency of incidents. The number of maternal deaths occurring in Scotland over the same period was obtained from the Confidential Enquiry into Maternal Deaths. MAIN OUTCOME MEASURES: Number and rate of defined events being reported. A subjective view of the feasibility of collecting national data routinely. RESULTS: Severe morbidity was reported in 196 women, out of 51,165 deliveries in Scotland (rate 3.8 per 1000 deliveries). Thirty percent of cases fell into more than one defined category. Major obstetric haemorrhage accounted for 50% of events. Only a third of identified patients were admitted to intensive care units. Four relevant maternal deaths occurred. CONCLUSIONS: Categories of severe maternal morbidity can be defined and may provide a useful measure of the quality of maternity services, particularly in developed countries where maternal mortality is very rare. It appears feasible to set up a national reporting system for maternal morbidity, as well as mortality.

Adult↗
PubMed2004

FFPRHC Guidance (January 2004). The copper intrauterine device as long-term contraception.

This Guidance provides information for clinicians providing women with copper-bearing intrauterine devices as long-term contraception. A key to the grades of recommendations, based on levels of evidence, is given at the end of this document. Details of the methods used by the Clinical Effectiveness Unit (CEU) in developing this Guidance and evidence tables summarising the research basis of the recommendations are available on the Faculty website (www.ffprhc.org.uk). Abbreviations (in alphabetical order) used include: acquired immune deficiency syndrome (AIDS); actinomyces-like organisms (ALOs); automated external defibrillator (AED); blood pressure (BP); British National Formulary (BNF); confidence interval (CI); copper-bearing intrauterine contraceptive device (IUD); emergency contraception (EC); Faculty Aid to Continuing Professional Development Topic (FACT); levonorgestrel-releasing intrauterine system (IUS); human immunodeficiency virus (HIV); Medicines and Healthcare products Regulatory Agency (MHRA); non-steroidal antiinflammatory drugs (NSAIDs); odds ratio (OR); pelvic inflammatory disease (PID); relative risk (RR); Royal College of Obstetricians and Gynaecologists (RCOG); Scottish Intercollegiate Guidelines Network (SIGN); sexually transmitted infection (STI); termination of pregnancy (TOP); World Health Organization (WHO); WHO Medical Eligibility Criteria (WHOMEC); WHO Selected Practice Recommendations (WHOSPR).

Consumer Product Safety↗
PubMed2003

A consensus process to adapt the World Health Organization selected practice recommendations for UK use.

The nominal group technique for consensus development was used to consider the World Health Organization Selected Practice Recommendations for Contraceptive Use for adoption or adaptation in the United Kingdom. The nominal group comprised 11 opinion leaders who agreed that 74% of the WHO recommendations were consistent with current UK practice. Of 63 recommendations considered by the group to be at odds with current practice, 23 were adopted with advice that United Kingdom practice should change in line with WHO. Twenty-five were adopted because, although the group felt that the WHO recommendation differed from practice in the UK, it was unable to reach a consensus on an alternative recommendation. Thirteen WHO recommendations underwent minor revision for UK use. The group rejected two further WHO recommendations [on the timing of starting low-dose progestogen-only contraception (POC) during lactation] but was unable to reach consensus on any alternative guidance. It was agreed clinicians should be left to decide for themselves how to advise breastfeeding women about when to start low-dose POC. A UK version of the WHO Selected Practice Recommendations should help to standardize practice and improve the quality of care for couples using contraception.

Contraception↗
PubMed2002

Attributes of clinical recommendations that influence change in practice following audit and feedback.

The object of this study was to determine which attributes of clinical practice recommendations influence changes in clinical practice following audit and feedback. This was an observational study using multilevel modeling to examine the relationship between attributes of clinical practice recommendations and compliance with the recommendations before and after audit and feedback. Sixteen hospital gynecology units in Scotland participated in a national audit project. Clinical practice recommendations covering selected gynecological topics were developed and data collected to assess baseline (preintervention) compliance. Summaries of performance were fed back to consultant gynecologists in each hospital and follow-up (postintervention) data were collected. Trained audit assistants used standardized forms to abstract data from case notes. Compliance data were available at baseline and follow-up for a total of 42 clinical practice recommendations. Altogether, 4,664 case notes contributed to baseline data and 4,382 to follow-up data. Thirteen attributes describing clinical practice recommendations were developed, based upon previous work, and pretested. A panel of seven consultant gynecologists rated the extent to which each of the 42 recommendations possessed each of the 13 attributes. The main outcome measures were the association of each attribute with compliance and with changes in clinical practice. Recommendations compatible with clinician values and not requiring changes to fixed routines were independently associated with greater compliance at baseline and follow-up. However, recommendations incompatible with clinician values were independently associated with greater change in practice following audit and feedback. Attributes of recommendations may influence the effectiveness of audit and feedback in secondary care. Recommendations seen as incompatible with clinician values are associated with lower compliance but greater behavioral change following audit and feedback.

Attitude of Health Personnel↗