Women’s preference for laparoscopic or abdominal hysterectomy

In the present study, women’s preferences on advantages and disadvantages of laparoscopic hysterectomy (LH) and abdominal hysterectomy (AH) have been studied. Patients’ preferences were evaluated in individual, structured interviews in women scheduled for hysterectomy and questionnaires in nurses. Forty-three patients and 39 nurses were included. After general information, 84% of patients and 74% of nurses preferred LH over AH. This preference did not change after supplying more detailed information or after hysterectomy. The avoidance of complications was indicated as the most important factor in the decision. More than half of the women evaluated a difference of 1% as the maximum acceptable risk of major complications. When confronted with scenarios based on current evidence, both patients and nurses prefer LH over AH. This study supports further implementation of LH in clinical practice. The actual major complication rate in hysterectomy, however, is perceived as high

Reliability of the Luganda version of the Child Behaviour Checklist in measuring behavioural problems after cerebral malaria

This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Do Bat Gantries and Underpasses Help Bats Cross Roads Safely?

Major roads can reduce bat abundance and diversity over considerable distances. To mitigate against these effects and comply with environmental law, many European countries install bridges, gantries or underpasses to make roads permeable and safer to cross. However, through lack of appropriate monitoring, there is little evidence to support their effectiveness. Three underpasses and four bat gantries were investigated in northern England. Echolocation call recordings and observations were used to determine the number of bats using underpasses in preference to crossing the road above, and the height at which bats crossed. At gantries, proximity to the gantry and height of crossing bats were measured. Data were compared to those from adjacent, severed commuting routes that had no crossing structure. At one underpass 96% of bats flew through it in preference to crossing the road. This underpass was located on a pre-construction commuting route that allowed bats to pass without changing flight height or direction. At two underpasses attempts to divert bats from their original commuting routes were unsuccessful and bats crossed the road at the height of passing vehicles. Underpasses have the potential to allow bats to cross roads safely if built on pre-construction commuting routes. Bat gantries were ineffective and used by a very small proportion of bats, even up to nine years after construction. Most bats near gantries crossed roads along severed, pre-construction commuting routes at heights that put them in the path of vehicles. Crossing height was strongly correlated with verge height, suggesting that elevated verges may have some value in mitigation, but increased flight height may be at the cost of reduced permeability. Green bridges should be explored as an alternative form of mitigation. Robust monitoring is essential to assess objectively the case for mitigation and to ensure effective mitigation

The management of acne vulgaris in primary care: a cohort study of consulting and prescribing patterns using the Clinical Practice Research Datalink.

Background Effective management of acne vulgaris in primary care involves support (usually provided over a number of consultations) and prescription of effective treatments. However, consulting and prescribing patterns for acne in primary care are not well described. Objectives To describe the rate of primary-care consultations and follow-up consultations; prescribing patterns, including overall use of acne-related medications (ARMs); and initial and follow-up prescription for acne vulgaris in the U.K. Methods U.K. primary-care acne consultations and prescriptions for ARMs were identified in the Clinical Practice Research Datalink. Annual consultation rates (between 2004 and 2013) by age and sex, new consultations and consultations in the subsequent year were calculated, along with prescribing trends – during a new consultation and over the subsequent 90 days and year – using the number of registered patients as the denominator. Results Two-thirds (66.1%) of patients who had a new acne consultation had no further acne consultations in the subsequent year. Overall 26.7%, 24.9%, and 23.6% and 2.8% of patients were prescribed no ARM, an oral antibiotic, a topical antibiotic or an oral plus topical antibiotic, respectively, during a new acne consultation. In total 60.1% and 38.6% of patients prescribed an ARM received no further ARM prescriptions in the following 90 days and 1 year, respectively, despite most prescriptions being for 2 months or less. Prescribing rates for lymecycline and topical combined clindamycin and benzoyl peroxide increased substantially between 2004 and 2013. There were no important changes in consultation rates between 2004 and 2013. Conclusions These data suggest that patients with acne are receiving a suboptimal initial choice of ARMs, longitudinal care and prescribing.</p

Are hedgerows effective corridors between fragments of woodland habitat? An evidence-based approach

Anthropogenic modification of the countryside has resulted in much of the landscape consisting of fragments of once continuous habitat. Increasing habitat connectivity at the landscape-scale has a vital role to play in the conservation of species restricted to such remnant patches, especially as species may attempt to track zones of habitat that satisfy their niche requirements as the climate changes. Conservation policies and management strategies frequently advocate corridor creation as one approach to restore connectivity and to facilitate species movements through the landscape. Here we examine the utility of hedgerows as corridors between woodland habitat patches using rigorous systematic review methodology. Systematic searching yielded 26 studies which satisfied the review inclusion criteria. The empirical evidence currently available is insufficient to evaluate the effectiveness of hedgerow corridors as a conservation tool to promote the population viability of woodland fauna. However, the studies did provide anecdotal evidence of positive local population effects and indicated that some species use hedgerows as movement conduits. More replicated and controlled field investigations or long term monitoring are required in order to allow practitioners and policy makers to make better informed decisions about hedgerow corridor creation and preservation. The benefits of such corridors in regard to increasing habitat connectivity remain equivocal, and the role of corridors in mitigating the effects of climate change at the landscape-scale is even less well understood