Electronic Continuous Pain Measurement vs Verbal Rating Scale in gynaecology:A prospective cohort study

OBJECTIVE: To compare pain measured with a new electronic device - the Continuous Pain Score Meter (CPSM) - and the Verbal Rating Scale (VRS) during gynaecological procedures in an outpatient setting, and to correlate these outcomes with baseline anxiety and patient (in)tolerance to the procedure. STUDY DESIGN: This prospective cohort study was undertaken in two centres: a university hospital and a large teaching hospital in The Netherlands. Patients undergoing an outpatient hysteroscopy, colposcopy or ovum pick-up procedure for in-vitro fertilization in one of the two participating hospitals with availability of the CPSM were included. Pain was measured by both the CPSM and the VRS. Patient tolerance to the procedure was reported. Various outcomes of the CPSM were compared with those of the VRS and related to baseline anxiety scores. RESULTS: Ninety-one of 108 included patients (84 %) used the CPSM correctly during the procedure, and it was possible to analyse the CPSM scores for 87 women (81 %). The CPSM scores were all linearly related to the VRS. The peak pain score on the CPSM (CPSM-PPS) had the strongest correlation with the VRS score for all three procedures. Higher CPSM-PPS was related to patient (in)tolerance to the procedure (p = 0.03-0.002). Anxiety at baseline was not correlated with pain perception, except for VRS during colposcopy (r = 0.39, p = 0.016). CONCLUSION: The majority of patients were able to use the CPSM correctly, resulting in detailed information on pain perception for each individual pain stimulus during three outpatient gynaecological procedures. The CPSM-PPS had the strongest correlation with the VRS score and patient (in)tolerance to the procedure

Considerations on implementation of the newest treatment for symptomatic uterine fibroids : oral GnRH antagonists

Peer reviewe

Sexuality and Body Image After Uterine Artery Embolization and Hysterectomy in the Treatment of Uterine Fibroids: A Randomized Comparison

In this paper the effect of uterine artery embolization (UAE) on sexual functioning and body image is investigated in a randomized comparison to hysterectomy for symptomatic uterine fibroids. The EMbolization versus hysterectoMY (EMMY) trial is a randomized controlled study, conducted at 28 Dutch hospitals. Patients were allocated hysterectomy (n = 89) or UAE (n = 88). Two validated questionnaires (the Sexual Activity Questionnaire [SAQ] and the Body Image Scale [BIS]) were completed by all patients at baseline, 6 weeks, and 6, 12, 18, and 24 months after treatment. Repeated measurements on SAQ scores revealed no differences between the groups. There was a trend toward improved sexual function in both groups at 2 years, although this failed to reach statistical significance except for the dimensions discomfort and habit in the UAE arm. Overall quality of sexual life deteriorated in a minority of cases at all time points, with no significant differences between the groups (at 24 months: UAE, 29.3%, versus hysterectomy, 23.5%; p = 0.32). At 24 months the BIS score had improved in both groups compared to baseline, but the change was only significant in the UAE group (p = 0.009). In conclusion, at 24 months no differences in sexuality and body image were observed between the UAE and the hysterectomy group. On average, both after UAE and hysterectomy sexual functioning and body image scores improved, but significantly so only after UAE

‘Is er een dokter aan boord?’

International medical conferences aim to improve health outcomes, but the associated air travel-related carbon emissions are a significant contributor to the environmental impact of medical scientific activities. The COVID-19 pandemic has urged the medical world to shift towards virtual conferences, decreasing associated carbon emissions by 94% to 99%. However, virtual conferences are still not the norm and doctors are returning to business as usual. Various stakeholders need to be mobilized to minimize carbon-intensive flights to conferences. Doctors, (academic) hospitals, conference organizers and universities all hold a responsibility to incorporate every effort to decarbonize and build climate mitigation into their decisions. These efforts include sustainable travel policies, selecting accessible venues, decentralizing host locations, encouraging low carbon alternatives to air travel, increasing virtual attendance and increasing awareness

Review of nonsurgical/minimally invasive treatments for uterine fibroids

Purpose of review Many nonsurgical and minimally invasive therapies for symptomatic uterine fibroids have been introduced. The purpose of this review is to summarize the recent evidence on these techniques, and their effect on fibroid volume, menorrhagia, health related quality of life (HRQOL), fertility and their risk of complications. Recent findings Laparoscopic or hysteroscopic myomectomy and uterine artery embolization (UAE) have been the most widely studied and all show significantly beneficial effects on menorrhagia and HRQOL, with a low incidence of complications. Magnetic resonance-guided high-intensity focused ultrasound (MRgFUS), myolysis/radiofrequency ablation (RFA) and laparoscopic or vaginal occlusion of uterine vessels (L/V-OUA) are newer interventions, with a smaller body of evidence. For women wishing to retain their childbearing possibilities, myomectomy is the best-studied intervention. Hysteroscopic myomectomy is specifically indicated in submucosal fibroids with subsequently beneficial effects on fertility. The use of UAE in fertile women has not been studied extensively, but evidence points toward an increase in adverse pregnancy outcomes after UAE compared with myomectomy. For MRgFUS, myolysis/RFA and L/V-OUA more evidence is needed. Summary Laparoscopic/hysteroscopic myomectomy and UAE are evidence-based beneficial alternative therapies for symptomatic uterine fibroids. Until more evidence is available, myomectomy stays the option of choice for women who wish to conceive in the futur

Uterine artery embolization versus hysterectomy in the treatment of symptomatic uterine fibroids: 2 years' outcome from the randomized EMMY trial

This randomized controlled trial compares the efficacy of uterine artery embolization versus hysterectomy to treat uterine fibroid-induced menorrhagia at 2 years after surger

Symptomatic uterine fibroids: Treatment with uterine artery embolization or hysterectomy - Results from the randomized clinical embolisation versus hysterectomy (EMMY) trial

Purpose: To prospectively evaluate health-related quality of life (HRQOL) outcomes for uterine artery embolization (UAE) and hysterectomy up to 24 months after the intervention in tern-us of mental and physical health, urinary and defecatory function, and overall patient satisfaction. Materials and Methods: Ethics committee approval and informed consent were obtained for the Embolisation versus Hysterectomy Trial. Women (n = 177) with uterine fibroids and heavy menstrual bleeding who were scheduled to Undergo hysterectomy were randomly assigned to undergo UAE (n = 88) or hysterectomy), (it = 89). HRQOL was measured six times during a 24-month follow-up period with the following validated questionnaires: Medical Outcome Study Short Form 36 (SF-36) mental component, summary (MCS) and physical component summary) (PCS), Health Utilities Index Mark 3, EuroQol 5D, urogenital distress inventory (UDI), incontinence impact questionnaire, and defecation distress inventory (DDI). Satisfaction was assessed with a seven-point Likert scale. Repeated measurement; analysis was performed lot, between-group analysis. Paired t tests were performed for within-group analysis. Satisfaction was analyzed with the Fisher exact test. Results: The SF-36 MCS and PCS, Health Utilities Index Mark 3, EuroQol 5D, and UDI scores were improved significantly in both groups at 6 months and afterward (P <.05). The DDI score was improved significantly in only the UAE group at 6 months and afterward (P <.05). No differences between were observed, with the exception of PCS scores at 6-week follow-tip: Patients in the UAE group had significantly better scores than did patients in the hysterectomy group (P <.001.). Improvement in PCS score at 24-month follow-up was significantly higher for patients who were employed at baseline (P =.035). At 24-month follow-up, patients in the hysterectomy group were significantly more satisfied than those in the UAE group (P =.02). Conclusion: Both UAE, and hysterectomy improved HRQOL No differences were observed between groups regarding HRQOL at 24-month follow-up. Oil the basis of HRQOL results, the authors determined that, UAE is a good alternative to hysterectom

Sexuality and body image after uterine artery embolization and hysterectomy in the treatment of uterine fibroids: a randomized comparison

In this paper the effect of uterine artery embolization (UAE) on sexual functioning and body image is investigated in a randomized comparison to hysterectomy for symptomatic uterine fibroids. The EMbolization versus hysterectoMY (EMMY) trial is a randomized controlled study, conducted at 28 Dutch hospitals. Patients were allocated hysterectomy (n = 89) or UAE (n = 88). Two validated questionnaires (the Sexual Activity Questionnaire [SAQ] and the Body Image Scale [BIS]) were completed by all patients at baseline, 6 weeks, and 6, 12, 18, and 24 months after treatment. Repeated measurements on SAQ scores revealed no differences between the groups. There was a trend toward improved sexual function in both groups at 2 years, although this failed to reach statistical significance except for the dimensions discomfort and habit in the UAE arm. Overall quality of sexual life deteriorated in a minority of cases at all time points, with no significant differences between the groups (at 24 months: UAE, 29.3%, versus hysterectomy, 23.5%; p = 0.32). At 24 months the BIS score had improved in both groups compared to baseline, but the change was only significant in the UAE group (p = 0.009). In conclusion, at 24 months no differences in sexuality and body image were observed between the UAE and the hysterectomy group. On average, both after UAE and hysterectomy sexual functioning and body image scores improved, but significantly so only after UA