Operative vaginal delivery in Scotland A 20 year overview : with a chapter on multiple pregnancy in Scotland

Includes bibliographical references. Births in Scotland publication seriesAvailable from British Library Document Supply Centre- DSC:8361. 8173(no 18) / BLDSC - British Library Document Supply CentreSIGLEGBUnited Kingdo

A systematic review of trend studies of women seeking termination of pregnancy

This article reports a systematic review of trend studies (1995-2006) that answers five questions: What are the patterns of: (1) age of women seeking termination of pregnancy, (2) first ever pregnancy ending in a termination, (3) contraception usage at the time of conception, (4) contraception chosen immediately post-operatively and (5) referral sources to termination of pregnancy services? Background: Fertility patterns are changing and there is evidence to indicate that numbers of older women conceiving for the first time is increasing. At the same time there are new methods of contraception widely available. Little is known about the implications of these changes on termination patterns. Design An extensive electronic search of databases such as CINAHL, MEDLINE® In–Process (OVID) and was conducted from January 1995 - June 2006 for trend studies in pregnancy terminations. Methods: Articles chosen were based on trend studies greater than five years, contained primary quantitative research and official government statistical reports. Results: Results of the search showed age was unable to be compared due to the many variations in measurements and time periods, there was only limited research worldwide of trends in contraception at the time of conception in relation to a termination of pregnancy. Additionally, there were no studies worldwide in the past 11 years which specifically examined trends in the characteristics of the number of first ever pregnancies which ended in a termination, contraception choices post-operative of a termination of pregnancy, or referral source to a termination of pregnancy provider. Conclusion: Little is reported in the literature on trends in the five characteristics related to pregnancy termination. Relevance to clinical practice Evidence about the changing patterns of women seeking pregnancy termination is needed to inform policy and practice and to ensure that health promotion strategies are underpinned by accurate information that reflects the needs of the populations of women in relation to their reproductive health

Cost-utility analysis of open versus laparoscopic groin hernia repair: results from a multicentre randomized clinical trial

Background: This study was a pragmatic economic evaluation carried out alongside a multicentre randomized controlled trial comparing laparoscopic with open groin hernia repair. The primary economic evaluation framework employed was a cost–utility analysis. <p/>Methods: At 26 hospitals in the UK and Ireland, 928 patients with a groin hernia were assigned randomly to laparoscopic or open repair. Cost data were identified and measured both within and outwith the trial. Cost data were combined with quality-adjusted life years (QALYs) from the EQ-5D questionnaire to obtain cost-per-QALY ratios. <p/>Results: The mean cost of laparoscopic hernia repair was £1112·64, compared with £788·79 for the open operation. The extra cost of £323·85 in the laparoscopic group was mainly due to additional theatre time and increased equipment and sterilization costs. The estimated incremental cost per QALY of the laparoscopic over the open method was £55 548·00 (95 per cent confidence interval £47 216·00–£63 885·00). <p/>Conclusion: While the results show that a high cost was incurred to produce an additional QALY by using laparoscopic over open hernia repair, sensitivity analyses show that there are specific situations in which laparoscopic repair may be a viable alternative, such as when reusable equipment is employed