Abdominal sacrohysteropexy versus vaginal hysterectomy for pelvic organ prolapse in young women

Background: Pelvic organ prolapse (POP) is the descent of the pelvic organs beyond their anatomical confines. The definitive treatment of symptomatic prolapse is surgery but its management in young is unique due to various considerations. Aim of this study was to evaluate anatomical and functional outcome after abdominal sacrohysteropexy and vaginal hysterectomy for pelvic organ prolapse in young women.Methods: A total 27 women less than 35 years of age with pelvic organ prolapse underwent either abdominal sacrohysteropexy or vaginal hysterectomy with repair. In all women, pre-op and post-op POP-Q was done for evaluation of anatomical defect and a validated questionnaire was given for subjective outcome.Results: Anatomical outcome was significant in both groups as per POP-Q grading but the symptomatic outcome was better for sacrohysteropexy with regard to surgical time, bleeding, ovarian conservation, urinary symptoms, sexual function.Conclusions: Sacrohysteropexy is a better option

Association between body mass index and operative morbidity in women undergoing hysterectomy for benign indications: a cohort study

Background: Hysterectomy is the most common gynaecological operation performed in the world. This study was done to investigate association between body mass index (BMI) and operative morbidity in women who underwent hysterectomy for benign indications.Methods: Total 201 women were studied. 114 (56.7%) had BMI between 20-24.9 and 87 (43.3%) had BMI 25 and above. In both groups, abdominal and vaginal hysterectomy were performed. They were compared for duration of surgery, intraoperative blood loss, postoperative fever, wound infection, secondary haemorrhage, deep vein thrombosis, resuturing and readmission.Results: Mean duration of surgery in women with BMI 20-24.9 was 2.47 hours, standard deviation was 0.665 and in women with BMI 25 and above was 2.45 hours, and standard deviation was 0.589. T value was 0.215 and p value was 0.83 which is not statistically significant. Mean blood loss during surgery with BMI less than 25 was 184.74 ml, standard deviation was 104.518 and with BMI more than 25 was 200.57 ml, and standard deviation was 77.462. T value was 1.234 and p value was 0.219 which is not clinically significant. Out of 114 women with BMI less than 25, 16 (38.1%) had complications and 98 (61.6%) had no complications. Out of 87 women with BMI more than 25, 26 (61.9%) had complications and 61 (38.4%) had no complications, Chi square test was 7.48, and p value of 0.006 which was clinically significant. It shows that women with BMI 25 and above had more chances of postoperative complications.Conclusions: There is no statistically significant difference in intraoperative blood loss and duration of surgery in both women with normal BMI and women with BMI 25 and above who underwent hysterectomy. But postoperative complications in terms of wound infection, fever, bleeding, necessity of resuturing and readmission were more in women with BMI 25 and above as compared to women with normal BMI

Knowledge, attitude and practices of breast feeding in primigravida women in tertiary care hospital in central India

Introduction: There are gaps between UNICEF and BFHI recommendations and actual implementations of breastfeeding practices due to inadequate counseling of primigravida on breastfeeding, reflected nationally as poor infant nutritional status. Objectives: The study aims to assess the knowledge, attitude and practices of primigravida about breastfeeding, counsel the primigravida women on the prescribed scientific breastfeeding methods, to analyze the change in their perspective about breastfeeding after counseling and to suggest recommendations based on findings. Methods: Questionnaire based descriptive cross sectional study conducted on selected 75 primigravida with gestational age of 36 weeks or more, attending ANC OPD or admitted to NKPSIMS during April and May 2014 after consent. A structured validated pre/posttest questionnaire was administered to assess the knowledge, attitude and practices of breastfeeding of participants. Demographic variables were recorded. Pretest was conducted, followed by counseling on the importance of breastfeeding, maternal nutrition, duration of exclusive breastfeeding, mother’s and baby’s position during breastfeeding using flashcards which was followed by posttest on the same questionnaire. The data was analyzed using SPSS software Open Epi Info version 2.3 year 2009. P values < 0.05 were considered as statistically significant. Results: Comparison of pre/posttest results showed statistically significant change in importance of exclusive breast feeding, colostrum, early initiation, suitable position and duration of breastfeeding, perception of baby’s satisfaction and stool color, maternal nutrition and breast problems during lactation after counseling. Conclusion: Antenatal breastfeeding counseling must be strengthened by a multi pronged individualized approach, reinforcement focusing on the recommended practices of breastfeeding to promote and sustain breastfeeding

“Don’t Judge a Book by Its Cover”: A Qualitative Study of Methadone Patients’ Experiences of Stigma

Introduction: Despite its efficacy and widespread use, methadone maintenance treatment (MMT) continues to be widely stigmatized. Reducing the stigma surrounding MMT will help improve the accessibility, retention, and treatment outcomes in MMT. Methods: Semi-structured interviews were conducted with 18 adults undergoing MMT. Thematic content analysis was used to identify overarching themes. Results: In total, 78% of participants reported having experienced stigma surrounding MMT. Common stereotypes associated with MMT patients included the following: methadone as a way to get high, incompetence, untrustworthiness, lack of willpower, and heroin junkies. Participants reported that stigma resulted in lower self-esteem; relationship conflicts; reluctance to initiate, access, or continue MMT; and distrust toward the health care system. Public awareness campaigns, education of health care workers, family therapy, and community meetings were cited as potential stigma-reduction strategies. Discussion and Conclusion: Stigma is a widespread and serious issue that adversely affects MMT patients’ quality of life and treatment. More efforts are needed to combat MMT-related stigma

A call for consensus in defining efficacy in clinical trials for opioid addiction: combined results from a systematic review and qualitative study in patients receiving pharmacological assisted therapy for opioid use disorder

Abstract Background Given the complex nature of opioid addiction treatment and the rising number of available opioid substitution and antagonist therapies (OSAT), there is no ‘gold standard’ measure of treatment effectiveness, and each successive trial measures a different set of outcomes which reflect success in arbitrary or opportune terms. We sought to describe the variation in current outcomes employed across clinical trials for opioid addiction, as well as determine whether a discrepancy exists between the treatment targets that patients consider important and how treatment effectiveness is measured in the literature. Methods We searched nine commonly used databases (e.g., EMBASE, MEDLINE) from inception to August 1, 2015. Outcomes used across trials were extracted and categorized according to previously established domains. To evaluate patient-reported goals of treatment, semi-structured interviews were conducted with 18 adults undergoing methadone treatment. Results We identified 60 trials eligible for inclusion. Once outcomes were categorized into eight broad domains (e.g., abstinence/substance abuse), we identified 21 specific outcomes with furthermore 53 subdomains and 118 measurements. Continued opioid use and treatment retention were the most commonly reported measures (46%, n = 28). The majority of patients agreed that abstinence from opioids was a primary goal in their treatment, although they also stressed goals under-reported in clinical trials. Conclusions There is inconsistency in the measures used to evaluate the effectiveness of OSATs. Individual and population level decision making is being guided by a standard of effect considered useful to researchers yet in direct conflict with what patients deem important. Trial registration PROSPERO, CRD42013006507