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Biomedical subjects

L M Irvine

Publications and source records attributed to L M Irvine.

16 recordsLinked to original sources
PubMed2006

Surgical management of ectopic pregnancy in a district general hospital.

The mainstay of management of ectopic pregnancies is laparoscopic surgery. Other treatment options include open laparotomy, methotrexate or expectant approach. Recently the Royal College of Obstetricians and Gynaecologists (RCOG) revised its guidelines regarding management of suspected ectopic pregnancies. We undertook a retrospective study looking at management of ectopic pregnancies over a defined 12-month period (1 October 2003 - 30 September 2004) in a district general hospital to the north of London and compared this with the recommended RCOG guidelines 2004. Cases of ectopic pregnancy were identified from the theatre, ward log, and cross-referenced with histopathological reports. The case notes of these women were reviewed and data extracted according to a drawn-up questionnaire. A total of 64 cases met the diagnostic criteria and were included in the study. Nine of the 64 cases were haemodynamically unstable and seven underwent rapid laparotomy. All of the stable 55 cases underwent laparoscopy, which was converted to open laparotomy in 13 cases (23.6%). Three patients were treated with methotrexate all of whom had been previously managed surgically. The majority of cases of ectopic pregnancy were managed according to the RCOG recommendations. Further changes in practice will be required to incorporate expectant and primary medical management as proposed by the recent guidelines (RCOG 2004). This study reveals progress achieved in management of ectopic pregnancies in UK with the introduction of RCOG guidelines 1999.

Adolescent↗
PubMed2001

Trial of scar or elective repeat caesarean section at maternal request?

In a study between 1 January 1996 and 31 December 1998 at Watford General Hospital, we identified all women who booked having had a previous caesarean section. Data on age, social class and previous obstetric history was extracted from the notes, as was mode of delivery. Of the 718 patients identified, 497 were considered suitable for trial of scar. Of these 221 (44.5%) requested repeat caesarean section. Age, social class and indication for previous caesarean section could not predict those who accepted trial of scar. Of the 60 women who had had a previous successful trial of scar 59 (98.3%) underwent trial of scar and of the 48 who had had a vaginal delivery prior to caesarean section 37 (77.1%) underwent trial of scar (P < 0.01). Maternal request for caesarean section, without obstetric contraindication to trial of scar, accounted for 24.9% of all the elective caesarean sections undertaken in our unit.

Journal Article↗
PubMed2001

Declining incidence of ectopic pregnancy in a UK city health district between 1990 and 1999.

BACKGROUND: On the basis of clinical impression that the number of cases of ectopic pregnancy seen in the City and Hackney Health District, London, was changing, a retrospective study of the years between 1990 and 1999 was carried out. METHODS: From the histopathology databases, cases of ectopic pregnancy and early pregnancy failure were identified. The number of deliveries at The Homerton Hospital was obtained from the Labour Ward register; the number of terminations of pregnancy and the number of fertile women was obtained from the Office for National Statistics, UK. RESULTS: There were 73 cases of ectopic pregnancy in 1990 rising to 96 in 1991 and then a fall to 52 cases in 1999. In terms of ectopic pregnancy per 100 deliveries, per all known pregnancies and per 1000 fertile women per year, there was a peak in 1991 and a fall to 1999. With regard to relative incidence per deliveries and per all known pregnancies, these falls were significant (P < 0.05). In 1991, there were 2.4 ectopic pregnancies per 100 deliveries, falling to 1.6 in 1999, a 33% fall. The reasons for this large decline are uncertain. CONCLUSIONS: There has been no change in patient population, diagnostic aids used or management protocols for patients with ectopic pregnancies.

Birth Rate↗
PubMed1998

The influence of maternal request on the elective caesarean section rate.

At a time when there is much criticism of increasing caesarean section rates, as well as an increased emphasis on involving the patient in decisions regarding her care, we decided to assess the effect of maternal request on the elective caesarean section rate. The study was a prospective patient interview and case note review, set at a District General Hospital in Watford, Hertfordshire over a 1-year period. Eligible patients included all women undergoing elective caesarean section, with the main outcome measure being the number of elective caesarean sections performed without obstetric contraindication to vaginal delivery. Out of 3025 deliveries, 570 (18.8%) were delivered by caesarean section, 276 (9.1%) electively and 293 (9.7%) as an emergency procedure. Of the elective procedures (18.2% of the total number of operations), 38% were performed because of maternal request. We conclude that maternal request is a significant factor in the rise in caesarean section rate.

Journal Article↗
PubMed1995

Can concept mapping be used to promote meaningful learning in nurse education?

Recent changes in nurse education have led to a desire in nurse educators to promote meaningful learning rather than rote learning of facts. A major metacognitive learning strategy that appears to promote this is concept mapping. However, many nurse educators appear to be unaware of this strategy's existence, or of the research evidence available that supports the claim of promoting meaningful learning. This paper sets out to address these issues. It explores the nature of a concept map, the research on concept mapping and meaningful learning and possible reasons why its use has not been noticeable in nurse education. By addressing these issues it is hoped that more nurse educators will attempt to use concept mapping in the promotion of meaningful learning.

Concept Formation↗
PubMed1993

A randomized comparative study of the metabolic effects of two regimens of gestrinone in the treatment of endometriosis.

OBJECTIVE: To study some of the metabolic effects of oral gestrinone on plasma lipoprotein risk markers for cardiovascular disease and on bone density, a risk marker for osteoporosis. DESIGN: Randomized double-blind study. SETTING: All patients were referred to Gynaecology Clinic of Royal Free Hospital Medical School. PATIENTS: Twenty premenopausal women with laparoscopically confirmed endometriosis. INTERVENTIONS: Subjects were randomized in a double-blind fashion to receive either 1.25 mg or 2.5 mg gestrinone two times per week for 6 months. MAIN OUTCOME MEASURE: Laparoscopy was performed before treatment, and clinical responses were determined by second laparoscopy after 6 months. Plasma lipid and bone density measurements during and after therapy were compared with baseline. RESULT: Median total endometriosis scores decreased from 7.5 to 1.0 in the 1.25-mg group and from 7.0 to 0 in the 2.5-mg group. There were no significant between-group differences in endometriosis scores. At both doses, bone density in the spine and the proximal femur was conserved, but plasma concentrations of low-density lipoproteins rose by 13% and those of high-density lipoproteins fell by 40%. CONCLUSIONS: Reducing the dose of gestrinone to 1.25 mg appeared to maintain the therapeutic effectiveness of this treatment but was still associated with potentially unfavorable effects on lipids and lipoproteins.

Adult↗
PubMed1990

Patient-recorded domiciliary fetal monitoring.

Domiciliary fetal monitoring via a telephone link has been in clinical use at the Royal Free Hospital for 2 years, during which time 858 traces of 134 patients who were moderately at risk have been transmitted to the hospital. All recognized abnormal heart rate patterns were detected during the study period. In seven patients obstetric intervention took place on the basis of the domiciliary fetal monitoring recording and subsequent hospital monitoring. There were no intrauterine or neonatal deaths, and there was no overall increase in obstetric operative intervention. There appeared to be a significant reduction in the inconvenience suffered by the patient and her family, compared with conventional monitoring. Fetal heart recordings performed solely by the patient were of a high quality and reduced the demand on midwifery resources. To allow this only 3 hours of midwifery time daily was required and no additional demands on obstetric staff were made. It is anticipated that domiciliary fetal monitoring, performed by patients, will become an essential and established service throughout the United Kingdom (and probably Europe) as the principal means of monitoring fetal well-being.

Adult↗
PubMed1990

Elevated viral antibody titres in spontaneous abortion.

To assess the possible role of virus infections in spontaneous abortion we undertook a prospective study of three groups of patients: women who had a spontaneous abortion; women seen in the antenatal booking clinic; and those undergoing therapeutic termination of pregnancy. Venous blood was taken for antibody detection, cervical swabs for virus isolation, and in the cases of spontaneous and therapeutic abortion products of conception were sent for virus culture. The infectious agents studied were influenza A and B, adenovirus, respiratory syncytial virus, measles, psittacosis, Varicella zoster, and mumps virus. Statistical analysis revealed that women in the spontaneous abortion group has a higher incidence of antibodies against respiratory syncytial virus (P less than 0.01), and mumps virus (P less than 0.01). Among women seropositive for each virus, higher titres were found only for respiratory syncytial virus (P less than 0.05) in cases rather than controls. These results could be explained if viruses such as respiratory syncytial virus caused abortion or if women having a spontaneous abortion mount exaggerated immune responses to fetal and viral infections, and the former altered immune response is associated with spontaneous abortion.

Abortion, Spontaneous↗