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PubMed2000

The Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial of the National Cancer Institute: history, organization, and status.

The Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial is enrolling 148,000 men and women ages 55-74 at ten screening centers nationwide with balanced randomization to intervention and control arms. For prostate cancer, men receive a digital rectal examination and a blood test for prostate-specific antigen. For lung cancer, men and women receive a posteroanterior view chest X-ray. For colorectal cancer, men and women undergo a 60-cm flexible sigmoidoscopy. For ovarian cancer, women receive a blood test for the CA125 tumor marker and transvaginal ultrasound. Members of the control arm continue with their usual care. Follow-up in both groups will continue for at least 13 years from randomization to assess health status and cause of death. The primary endpoint is mortality from the four PLCO cancers, which accounts for about 53% of all cancer deaths in men and 41% of cancer deaths in women in the United States each year. Blood specimens are collected from screened participants, buccal cell DNA from controls, and histology slides from cases; these are maintained in a biorepository. Participants complete a baseline questionnaire (covering health status and risk factors) and a dietary questionnaire. More than 12,000 participants were enrolled in the pilot phase (concluded in September 1994). Changes in the eligibility criteria followed. As of April 2000, enrollment exceeded 144,500. Data are scanned into designated on-site computers for uploading by participant identification number to the coordinating center for quality checks, archival storage, and preparation of analysis datasets for use by the National Cancer Institute (NCI). Scientific direction is provided by NCI scientists, trial investigators, external consultants, and an independent data safety and monitoring board. Performance and data quality are monitored via data edits, site visits, random record audits, and teleconferences. The PLCO trial is formally endorsed by the American Cancer Society and has been ranked by the American Urological Association as one of the most important prostate cancer studies being conducted. Special efforts to enroll black participants are cosponsored by the U.S. Centers for Disease Control and Prevention.

Aged↗

PubMed1995

Urinary incontinence in an acute care setting.

OBJECTIVE: To determine the prevalence of urinary incontinence in an acute care setting and the approaches to the management of it. STUDY DESIGN: An audit of hospital charts containing a diagnosis of urinary incontinence was conducted to gather data about patient demographics, related factors such as skin integrity and orientation, urinary tract infections, and nursing interventions. The audit was conducted by two data collectors who had an established interrater reliability at 100%. RESULTS: A 0.87% prevalence rate of cases with a diagnosis of urinary incontinence was found. An additional 13% of cases were documented only in nurses' notes. Nursing comfort measures were the primary choice the management of urinary incontinence. Bladder training and discharge planning were implemented infrequently. Additional findings regarding gender and age distribution, mental status, and management strategies are reported. CONCLUSIONS: Efforts to diagnosis and treat urinary incontinence must be directed to all age groups. Nursing protocols for accurate and consistent assessment, documentation, and discharge planning with follow-up should be implemented in the acute care setting so that patients can benefit from improved procedures to treat and manage urinary incontinence.

Acute Disease↗

PubMedDate not supplied

Atypical presentation of acute myocardial infarction in 3 age groups.

OBJECTIVE: The purpose of this study was to compare the clinical manifestations of first-time acute myocardial infarction (AMI) in 3 age groups of men and women who presented to the emergency departments of 3 acute tertiary care hospitals. DESIGN: An exploratory, descriptive design was used, and there were 2 phases to the project. Phase 1 was a retrospective chart audit of a systematic random sample of patient charts, and phase 2 included a structured interview of a prospective random sample of emergency and intensive care unit nurses and physicians. The data were collected by using a chart audit tool and a semistructured interview, respectively. SETTING: The study took place at a western Canada university affiliated with acute tertiary care centres. SAMPLE: A systematic random sample of 153 (105 men and 48 women) patient charts were audited from the health records departments of 3 acute care hospitals. All of the patients had experienced a first-time AMI. In addition, a random sample of emergency/intensive care unit nurses (n = 60) and physicians (n = 18) was interviewed. RESULTS: The results indicate that a statistically significant number of the oldest (75 years or older) male patients present with atypical manifestations of AMI compared with the men in the younger age groups (P =.005). The same trend was not noted for female patients. The results of the study are limited with respect to the small number of women in each age category. Caution must therefore be exercised in generalizing the results to the target population of women with AMI. The atypical manifestations are described. The results of the interviews revealed that many clinicians do not look for different clinical manifestations when assessing older patients. CONCLUSIONS: It is essential that nurses and physicians accurately assess patients with AMI, especially patients in the older age groups who may be presenting atypically. It is also important that professional and nonprofessional public health education initiatives include information regarding both typical and atypical presentation of AMI, particularly in the older patient.

Activities of Daily Living↗

PubMed1996

An accident and emergency based child accident surveillance system: is it possible?

OBJECTIVE: To evaluate the possibility of setting up a database on childhood accidents within an accident and emergency (A&E) department. DESIGN: A proforma detailing epidemiological details about the child and details of the injury was designed and tested for accuracy. It was completed in parallel with the existing case documentation. A retrospective sample was analysed after completion of the study to determine times when data collection was poorest. SETTING: Regional paediatric hospital (total catchment population c. 500,000). RESULTS: Of 13,958 patients in whom full information was available, 65% had all the information available on the forms. Areas of discrepancy in the remainder included (1) transposition of date and time of injury with date and time of attendance (73%), (2) wrong coding (11%), (3) illegible digits (6%), (4) inaccurate data entry to computer (6%). Form completion was worst between 1800 hours and midnight. CONCLUSIONS: Data collection is feasible in the A&E department and is a necessary step in effective child accident prevention. It should be done using real time entry onto computer systems. Additional audit staff must be employed to ensure data collection is as complete as possible as close to the time of the initial attendance as possible. Regular analysis of the findings is essential.

Accidents↗

PubMed1992

Ward pharmacy: a foundation for prescribing audit?

OBJECTIVES: To determine the extent and nature of prescription monitoring incidents by hospital pharmacists and to derive a performance indicator to allow prescription monitoring to be compared among hospitals in North West Thames region. DESIGN: Survey of all self recorded prescription monitoring incidents for one week in June 1990. SETTING: All (31) acute hospitals in the region with pharmacy departments on site, covering 10,337 beds. SUBJECTS: 210 pharmacists. MAIN MEASURES: Number of prescription monitoring incidents recorded, their nature, and outcome; a performance indicator of prescription monitoring (incidents/100 beds/week) and its variation according to specialty and site. RESULTS: 3273 prescription monitoring incidents were recorded (median 89 per hospital, range 3-301), the most common being related to the dose and frequency of administration of the drug (933 incidents, 29%). These incidents led to alterations of prescriptions on 1611 occasions; the pharmacist's advice was rejected on 81. The greatest number of prescription monitoring incidents/100 beds/week by specialty was recorded for intensive therapy units (median 75); the medians for medicine and surgery were 32 and 21 respectively. This performance indicator varied 20-fold when analysed by site, values ranging from 3.6 to 82.1 (median 29.8). CONCLUSIONS: Hospital pharmacists play a large part in monitoring and improving prescribing, and most of their interventions are related to the basics of prescribing. They therefore have a role in medical audit, working with clinicians to identify prescribing problems, and to set standards and monitor practice. A performance indicator of prescription monitoring incidents/100 beds/week allows comparison of pharmacists' activities among sites and may be a valuable tool in auditing them.

Data Collection↗

PubMed1998

Consensus standards for the process of cancer care: a modified expert panel method applied to head and neck cancer. South and West Expert Tumour Panel for Head and Neck Cancer.

There are many pressures to improve the standard of care delivered to cancer patients, including the reforms subsequent to the Calman-Hine report. The establishment of standards is a prerequisite for audit, benchmarking and certification of cancer centres and units. Randomized trials of head and neck cancer are uncommon, and other forms of evidence often conflicting. In the south and west of England, a multidisciplinary expert panel consensus method has been applied to the development of standards. A panel representative of specialties involved in the process of care at all three levels, plus social medicine and lay members, was constructed. A model for the process of care was developed consisting of activity areas. For each activity, a near exhaustive list of tasks and standards was established. A three-iteration method with statistical group response was then used to refine the standards. The same method was also applied to the production of a minimum data set for registration, recording and audit. The resulting standards will be regularly reviewed. We have developed a model of the care process, and an expert panel methodology that is applicable to a wide range of problems in clinical oncology.

Head and Neck Neoplasms↗

PubMed1998

The impact of a computer generated patient held health record.

OBJECTIVE: To examine the use and impact of a computer generated, patient held health record (PHR) on information sharing, responsibility sharing and preventive health care. SETTING: An academic group, private solo and private group general practice in Adelaide, South Australia. METHODS: Patients with chronic health problem(s) were randomly assigned to an experimental control or post test only group. Pre and post intervention data were collected using a standardised audit and abstraction of the patient records into a computer based record system. In addition, patient and doctor questionnaires, telephone follow ups and face to face interviews were conducted. OUTCOME MEASURES: Patient and GP use of, and satisfaction with the PHR; effectiveness of information and responsibility sharing; and uptake and performance of selected preventive health care by patient and GP. RESULTS: Seventy-two patients were recruited (29 received the PHR, and 22 each were in the control and post test only groups). The PHR was well received and used in both primary and secondary care settings. No statistically significant differences in the outcome measures were found between the groups as well as before and after the intervention (Kruskal-Wallis, p > 0.05). Data trends suggested that the PHR may increase information and responsibility sharing as well as improve patient awareness of the issues involved, with patient participation in information sharing, preventive health care and clinical decision making. Provided training and resources were made available, participating GPs believed that the computer based methodology developed was a practical option for use in practice. CONCLUSION: The computer generated PHR is an important determinant of patient participation in information and responsibility sharing, health promotion, and disease management. Implementation and evaluation studies are recommended.

Adolescent↗

PubMedDate not supplied

Clinical research infrastructures and networks in France: report on the French ECRIN workshop.

A meeting was organised in Paris on 13 September 2004, to provide an in-depth description of the state of the art in institutional clinical research infrastructures and their environment in France. This meeting was scheduled within the ECRIN (European Clinical Research Infrastructures Network) project, funded by the European Union (6th Framework Programme). Ten items were addressed: (i) centres and networks; (ii) funding and sponsoring of clinical research; (iii) ethics; (iv) legislation and regulation; (v) adverse-event reporting and drug dispensing; (vi) methodology, data management and data monitoring; (vii) quality management and audits; (viii) communication with investigators, sponsors and participants; (ix) transparency and registration of clinical studies; and (x) education and careers. This description, together with parallel workshops held in other countries using a similar pattern, helped prepare a comparative analysis enabling better identification of the bottlenecks for multinational research in Europe, and define the most relevant approaches to harmonisation and the services required to support the role of sponsors in transnational studies.

Biomedical Research↗

PubMed2005

Institutionalization after stroke.

BACKGROUND AND PURPOSE: There are widespread regional variations in the institutionalization rate after stroke. This study sought to identify the factors that predict institutionalization after a primary diagnosis of stroke and determine whether institutionalization rate could be used to assess the quality of hospital care. METHODS: A retrospective case note audit of 2778 consecutive admissions with stroke, between 1 September and 31 October 2000 from a randomly selected sample of 79 hospitals in England, Wales and Northern Ireland. Data were collected on demographics, case-mix, clinical outcome, organization of discharge, and place of residence at discharge and at three and six months. The figures from this audit were validated using data from the 1998 National Sentinel Audit of Stroke. RESULTS: Overall 14% of patients previously living at home were discharged to nursing or residential homes. Using logistic regression, Barthel Index score at discharge accounted for 40% of variation. Two-thirds of patients with a discharge Barthel score of < 5 were institutionalized. Age alone explained 14% and when taken together with discharge Barthel and length of stay it accounted for 54% of variation. On admission 22% of the variation in institutionalization rate could be accounted for by total Glasgow Coma Score (15, < 15), age and ability to walk unaided. Regional variations in institutionalization rates are evident and may in part be explained by differences in ease of access to the institutions. CONCLUSIONS: Discharge disability and older age were the dominant factors determining admission to nursing and residential homes. It is not possible to predict sufficiently reliably for an individual patient the likelihood of institutionalization at admission or at 72 h after admission, to justify early resource allocation decisions.

Age Distribution↗

PubMedDate not supplied

Community implementation of home care palliative care education.

PURPOSE: The purpose of this National Cancer Institute-funded training project was to improve end-of-life care agencies through implementation of a palliative care curriculum. The Home Care Outreach for Palliative Care Education (HOPE) program was designed to improve the knowledge and skills of home healthcare professionals who provide care to the terminally ill and their families at home. DESCRIPTION OF PROGRAM: A five-module palliative care education curriculum was designed and implemented in five home care agencies in the Los Angeles area. One hundred twenty-five nurses and 28 home health aides participated. The methods of data collection included two written surveys conducted before and after intervention, chart audit tool and a case study analysis form. RESULTS: The precourse data revealed deficiencies in home-care agency staff knowledge in and clinical aspects of end-of-life care. Regarding agency nurses' knowledge on end-of-life issues, the overall percentage scores from preeducation to posteducation rose from 84.6% to 89.0% (P =.0001). Participants rated the education program as extremely valuable for the home care agency staff. CLINICAL IMPLICATIONS: As home care will likely continue to be a primary setting for end-of-life healthcare, improvement of palliative care education in home health agencies is needed. The HOPE project provided insight and experience in the education of nonhospice home care staff in end-of-life care. Participant responses and evaluations indicated that end-of-life care education can improve the quality of care provided by home health agencies. Finally, this education program may result in a heightened awareness of hospice care and, although not objectively quantified, perhaps an increase in referrals to hospice.

Health Services Research↗

PubMed1995

Quality assurance in clinical neurophysiology: the ESTEEM project example.

This paper describes the current status of the utilisation of clinical practice guidelines (protocols) in the ESTEEM project as one form of the clinical quality assurance procedures considered in the project. The performance of electrodiagnostic studies, in terms of which types of conclusions need to be inferred during the examination plan, is briefly described. The main focus of the paper is a description of an European multicentre clinical audit in the field of Clinical Neurophysiology, using a common data-entry protocol for prospective EMG case collection and assessment with the ultimate objective of building up a multicentre reference database of EMG cases.

Computer Communication Networks↗

PubMed1999

Computerizing the cancer centre.

This article describes a PC-based computer network that caters for the clinical information needs of a cancer centre, crossing specialty boundaries and involving all members of the multidisciplinary team. Data are captured at all stages of patients' progress, from diagnosis through to treatment and follow-up. Office automation is integral to the system, which produces work-load and process audit information as well as clinical outcomes. Data are entered prospectively at the point of care by health care professionals, ensuring a high degree of clinical confidence. It incorporates internationally recognized datasets and its modular structure facilitates implementation and development.

Computer Communication Networks↗

PubMed2005

[Transient psychiatric abnormalities in patients with acute myocardial infarction].

UNLABELLED: Psychiatric abnormalities (PA) are often observed in patients (pts) in the Coronary Care Units. The origin of such abnormalities is not always clear, but it is known that they may aggravate patients status and interfere with further treatment. The aim of this study was to analyze the factors potentially predisposing to the occurrence of PA in pts with acute myocardial infarction (AMI). MATERIAL: The study group consisted of 200 consecutive pts hospitalized due to AMI. In 63 of them (Group A) the in-hospital course was complicated by PA (agitation, anxiety, hallucinations). Sex- and age-matched 63 pts of the remaining 137 pts which had not PA were control group (Group B). METHODS: The data related to coronary artery disease history, AMI diagnosis and treatment were withdrawn from hospital reports. Second group of parameters was focused on history of central nervous system (CNS) diseases, vision and audition ability, stimulant or drug addiction. The data about patient's employment and familial status, level of education, self-estimation of quality of life (QoL) in hospital were the third group of parameters. The second and third group of data were questionnaire-based information. RESULTS: There were no significant differences between groups in arrhythmias, localization of AMI, percentage of pts with high level of education, neither living alone or with family, jobless, retired or employed ones. Also self-evaluation of QoL was distributed similarly. The parameters which differed Group A versus Group B were respectively: history of CNS diseases (48% vs 20%, p<0,05), in particular--CNS traumas (18% vs 2,3%, p<0,05) and ischemic episodes (10% vs 0%, p = 0,039), thrombolytic (non-percutaneous interventional) treatment 23,8 vs 4,6%, p<0,05), handicap of visual ability (16% vs 0%, p--0,012), nicotinism (30% vs 9,1%, p<0,05), left ventricle ejection fraction <40% (34% vs 5%, p<0,05), treatment with atropine (12,7% vs 0%, p = 0,012) or amiodarone (16,7% vs 0%, p = 0,037). CONCLUSION: History of neurological diseases, thrombolytic treatment, left ventricle ejection fraction <40%, handicap of visual ability, nicotinism and amiodarone or atropine in pharmacological treatment are factors which may be helpful to predict PA in pts with AMI. Cumulation of such factors increases a risk of occurrence of transient psychiatric abnormalities. Proper psychoactive pretreatment should be applied in pts with such profile in purpose to avoid behavior related complications.

Adult↗

PubMed1997

Over-the-counter drugs and prescribing in general practice.

BACKGROUND: Both the government and the pharmaceutical industry are interested in increasing the use of over-the-counter (OTC) medicines. The reaction on the part of general practitioners is more circumspect. AIM: To investigate whether fundholding or dispensing status and patient exemption from, or prepayment of prescription charges influence the behaviour of general practitioners with respect to prescribing preparations otherwise available OTC. METHOD: Regression analysis of data for all 105 Lincolnshire practices for the fiscal year 1993-94, using the number of items prescribed by the practice that were also available OTC as the outcome variable. Comparison of Audit Commission Thematic Analysis of Prescribing (ACTAP) data for fundholders' and non-fundholders' OTC prescribing in the same year. RESULTS: The prescription of medicines otherwise available OTC is less likely when the practice is fundholding and more likely when the practice has dispensing status. Prescription of such medicines also increases as the proportion of patients exempt from, or having prepaid prescription charges increases.

Attitude of Health Personnel↗

PubMed2026

Quantum Threats to Bitcoin, Cryptocurrency and Blockchain.

OBJECTIVE: The authors evaluated how quantum computing threatens the cryptographic primitives used in Bitcoin and other blockchain systems. These findings were translated into a standards-aligned post-quantum migration profile for healthcare ledgers, including consent, identity, provenance, audit, and encrypted off-chain data exchange. METHODOLOGY: Narrative analysis, theoretical security analysis, and healthcare-oriented deployment mapping of classical public-key and hash primitives used in blockchain protocols were paired with an implementation-oriented migration profile based on finalized National Institute of Standards and Technology (NIST) post-quantum standards. We summarize the mathematical assumptions underlying RSA, Elliptic Curve Cryptography/Elliptic Curve Digital Signature Algorithm (ECC/ECDSA), and Secure Hash Algorithm (SHA-2/SHA-3-family) hash functions; analyze their susceptibility to Shor's and Grover's quantum algorithms; compare Federal Information Processing Standards (FIPS) 203 Module-Lattice-Based Key-Encapsulation Mechanism Standard (ML-KEM), FIPS 204 Module-Lattice-Based Digital Signature Standard (ML-DSA), and FIPS 205 Stateless Hash-Based Digital Signature Standard (SLH-DSA); and map their distinct roles to healthcare-ledger authorization, auditability, identity, and encrypted off-chain exchange. The term Advanced Hybrid Module-LWE & Code-Based (AHMC) is used only as shorthand for a standards-aligned hybrid post-quantum cryptography (PQC) migration profile and does not denote a proprietary product, a novel algorithm, or a new cryptographic primitive. Proposed adoption of hybrid, quantum-resistant cryptographic primitives for cryptocurrency wallets, transaction signatures, and ledger security during an interim migration period (hybrid classical + PQC, followed by PQC-only). Qualitative and implementation-oriented assessment of (1) break feasibility of RSA/ECC under Shor's algorithm, (2) effective security reduction for hash functions under Grover's algorithm, (3) security assumptions and composition requirements of a standards-aligned hybrid migration profile, (4) transaction-size and verification-cost impact, and (5) healthcare-specific implications for long-retention consent, identity, provenance, and audit records. RESULTS: Shor's algorithm reduces integer factorization and discrete logarithms to polynomial time, directly compromising Rivest-Shamir-Adleman (RSA) and ECC/ECDSA once fault-tolerant, large-scale quantum computers exist. Grover's algorithm yields a quadratic speedup for brute-force search, effectively halving the security margin of symmetric keys and hash functions at fixed output sizes. The AHMC-L1/L3/L5 profiles use ML-KEM-512/768/1024 for key establishment and ML-DSA-44/65/87 for transaction authentication, with SLH-DSA as a hash-based fallback. During a hybrid ECDSA+PQC migration, verification requires one classical and one PQC verification per authorization; transaction-size overhead is dominated by PQC signatures, approximately 2.4 KB for ML-DSA-44, 3.3 KB for ML-DSA-65, and 4.6 KB for ML-DSA-87 before script and encoding overhead. For healthcare ledgers, these findings support selective use of post-quantum signatures for:high-value state transitions,one-time public-key registration where possible, andcontinued off-chain storage of protected health information.Deployment suitability remains contingent on workflow-specific latency, storage, availability, key lifecycle, and side-channel testing. CONCLUSIONS: Quantum risk to blockchain signatures has direct implications for healthcare systems that depend on long-lived consent, identity, provenance, and audit records. A staged, standards-aligned migration profile can preserve authorization and ledger verifiability while keeping protected health information off-chain. The AHMC label refers only to this migration profile, not to a new cryptographic primitive; healthcare adoption requires open implementations, empirical benchmarking, crypto-agile key governance, and side-channel-resistant engineering.

ML-DSA↗

PubMed1994

Hand-held computers in clinical audit: a comparison with established paper and pencil methods.

The performance of hand-held computer terminals was compared with that of paper and pencil data collection methods. The study was carried out on two wards, with a comparative study in the medical audit unit at Rampton Hospital, one of three special hospitals managed by the Special Hospitals Service Authority. These were analysed, focusing on time factors, error rates, ease of use and financial implications. Findings showed that the electronic system saved time, reduced staffing costs and errors and had unit-wide potential. The electronic data collection contributed to a cost-effective and flexible data-processing system for use in auditing.

Computer Terminals↗

PubMed2002

A regional audit of the prevention and treatment of corticosteroid-induced osteoporosis in patients with rheumatic diseases in the West Midlands.

BACKGROUND: Audit is an important tool in clinical governance. Combining resources from across a region may facilitate data collection and allow variation in practice between individual units to be analysed. This audit is the first such regional audit to be carried out in rheumatology in the West Midlands and the organization and value of regional audit is discussed. This audit assessed the prevention and management of corticosteroid-induced osteoporosis (CIOP). METHODS: Adult patients attending rheumatology follow-up clinics in 10 units, during a 2-week period were assessed using the 1998 National Osteoporosis Society (NOS) guidance on the prevention and management of CIOP. The audit standard adopted was that 80% of eligible patients should be on appropriate therapy. RESULTS: Data was collected on 1766 (95.2%) of 1855 patients during the audit period. Two hundred and thirty-five (13.3%) were currently being prescribed or about to commence >or=7.5 mg daily of oral prednisolone for >or=6 months. Dual X-ray absorptiometry scans were performed in 102 patients (43.4%). Of these, 53 (52%) had a T score of -1.5 or below at the hip or spine. Of the 235 patients, 202 (86%) were receiving osteoporosis treatment. One hundred and forty-eight patients (63%) were receiving appropriate osteoporosis medication according to the NOS 1998 guidelines and 87 (37%) were inappropriately treated. Of these, 71 (81.6%) were under-treated and 16 (18.4%) were over-treated. CONCLUSIONS: Overall, the Region failed to meet the audit standard. The audit highlighted a number of differences and potential problems in the West Midlands with regard to CIOP which are currently being addressed by individual units and the West Midlands Rheumatology Services and Training Committee (WMRSTC). The Committee plan to re-audit in 2 yr.

Female↗

PubMed1999

A general practice pilot audit study to assess advice and treatment offered to women following hysterectomy.

BACKGROUND: Current evidence suggests that information and treatment offered to women post-hysterectomy to prevent osteoporosis are poor. OBJECTIVES: To pilot a general practice audit protocol, to assess its ability to identify hysterectomized women and to offer appropriate information on fracture prevention. METHOD: A pilot audit study was designed to assess advice offered to hysterectomized women aged 25-64 years. Data on ovarian status were evaluated. Women were recalled for counselling if there was no evidence of advice on fracture prevention and if they were not taking hormone replacement therapy (HRT). Change in HRT usage was used as the outcome measure to assess the impact of the audit. RESULTS: Baseline data were collated for 5743 women. In 1456 (25%), both ovaries were removed and 4029 (70%) had one or both ovaries conserved; 258 (5%) had incomplete ovarian data. The average age at hysterectomy with both ovaries removed was 43.9 years, and with conservation of one or both ovaries was 40.5 years and 40.1 years, respectively. Some 2888 (50%) were ever-users of HRT (both ovaries removed 70%, one ovary removed 53%, both ovaries conserved 44%). A total of 2083 (36%) were known current users (both ovaries removed 53%, one ovary removed 40%, both ovaries conserved 30%). The mean duration of use in 2620 ever-users was 44 months. This was similar for all the women irrespective of ovarian status. Eighty per cent of those given HRT reported receiving some advice. Seventy-seven per cent of those not given HRT had not received advice. By the end of the audit, 424 had commenced HRT (20% increase). Current use rose to 44% (both ovaries removed 59%, one ovary conserved 46%, both ovaries conserved 39%). Sixty-three per cent of new users chose transdermal preparations. CONCLUSIONS: The mean age at hysterectomy of between 40.1 and 43.9 years indicates the potential for early ovarian failure. Use of HRT is associated with availability of counselling. Uptake was better than anticipated, but HRT usage was still well below optimum. This audit fulfills its objectives but not without cost implications. Year by year it should achieve significantly improved management and health of hysterectomized women, and improved standards of patient care.

Adult↗