Lessons learned from infertility investigations in the public sector

Objectives. To determine the main factors causing infertility in an urban, tertiary hospital population. To establish if any such major causal factor could be used to rationalise and improve the service for infertile couples in the public sector.Design. A retrospective analysis of the hospital records of 206 women who had a tubal patency test (hysterosalpingogram) performed and the results of the investigations performed in the couples with infertility.Results. Of the 206 women 38 (18.5%) had normal fallopian tubes on hysterosalpingogram; 33 (16%) had unilateral obstruction and 135 (65.5%) had bilateral tubal obstruction. Of the latter group 81 (60%) had significant hydrosalpinges. Semen analysis results in 148 partners (71.8%) demonstrated a normal count in 85 (62%), normal motility in 70 (51%) and normal morphology in only 25 (18%). Testing for ovulation (mid-luteal phase progesterone) was positive in 91 of 124 women tested (73%). Compliance, technical and logistical problems were encountered with both semen analysis and mid-luteal phase progesterone tests.Conclusions. Infertility is a major problem in South Africa, with limited resources for investigation and treatment in the public sector. Tubal factor infertility was the most common cause of infertility demonstrated in this study. In the presence of bilateral tubal obstruction with hydrosalpinges the prognosis is so poor that unless assisted reproductive techniques are available and affordable, further infertility investigations do not seem justified. Recommendations on an approach to the infertile couple in the public sector is outlined

Pulmonary oedema after hexoprenaline administration in preterm labour A report of 4 cases

Despite the widespread use of ,a-sympathomimetic agents for preterm labour there appears to be a limited appreciation of the need for cardiovascular monitoring in the mother. Four patients in whom pulmonary oedema developed during tocolysis with hexoprenaline are described and the aetiological factors and pathogenesis of this potentially lethal complication discussed. Guidelines for the safe use of hexoprenaline in preterm labour are suggested

The Introduction of Bioptic Driving in the Netherlands

Background: In many US states, people with moderately reduced visual acuity (eg, 20/50–20/200) can legally drive with the aid of a small, spectacle-mounted (“bioptic”) telescope.We conducted a demonstration project to assess the viability of implementing bioptic driving in the Netherlands. In this article, we describe the framework of the project from conception through to realization of our primary objective—the introduction of bioptic driving as a legal option for visually impaired people in the Netherlands. Methods: The project was based on bioptic driving programs in the United States, which were adapted to fit into current driving training and assessment practices in the Netherlands. The project convened a consortium of organizations including the Netherlands Bureau of Driving Skills Certificates, service organizations for the visually impaired, and research departments at universities investigating driving and vision. All organizations were educated about bioptic driving and participating professionals were trained in their specific aspects of the project. Media publicity led to significant interest and helped recruitment that enabled the screening and selection of potential participants. Outcomes: The project demonstrated that people with moderately reduced visual acuity can be trained to achieve an adequate level of proficient and safe driving (as assessed by the local official driving licensing professionals) when using a bioptic telescope for the road conditions in the Netherlands. Based on the successful project outcomes, a request was made to the minister to allow bioptic driving in the Netherlands. This request has been accepted; the legal procedures for implementation are in process

New approaches to selection system design in healthcare: The practical and theoretical relevance of a modular approach

This chapter presents a modular approach to healthcare selection system design. Contrary to the traditional holistic view on selection procedures, a modular approach highlights the components underlying selection procedures. Our framework identifies seven key design components of selection procedures (The stimulus format, contextualization, stimulus presentation consistency, the response format, response evaluation consistency, information source, and instructions) and reviews studies in the healthcare selection literature that compared the effect of these components on key selection outcomes. A modular approach allows (1) gaining insights into how the different components underlying selection procedures affect selection outcomes and (2) drawing conceptual similarities between components of different selection procedures. At a practical level, a modular approach permits developing a myriad of new selection procedures by "mixing and matching" different building blocks. We present two case studies and future research avenues to further illustrate these merits of a modular approach

The Perils and Promises of Self-Disclosure on Social Media

In addition to their professional social media accounts, individuals are increasingly using their personal profiles and casual posts to communicate their identities to work colleagues. They do this in order to ‘stand out from the crowd’ and to signal attributes that are difficult to showcase explicitly in a work setting. Existing studies have tended to treat personal posts viewed in a professional context as a problem, since they can threaten impression management efforts. These accounts focus on the attempts of individuals to separate their life domains on social media. In contrast, we present the narratives of professional IT workers in India who intentionally disrupt the boundaries between personal and professional profiles in order to get noticed by their employers. Drawing on the dramaturgical vocabulary of Goffman (1959) we shed light on how individuals cope with increased levels of self-disclosure on social media. We argue that their self-presentations can be likened to post-modern performances in which the traditional boundaries between actor and audience are intentionally unsettled. These casual posts communicate additional personal traits that are not otherwise included in professional presentations. Since there are no strict boundaries between formal front-stage and relaxed back-stage regions in these types of performance, a liminal mental state is often used, which enables a better assessment of the type of information to present on social media

The value of intravenous prostaglandin E2 after intra-uterine death

This study records the use of intravenous prostaglandin Ez in 23 consecutive cases of intra-uterine fetal death in the third trimester of pregnancy. The results presented are related to the causative factors of intra-uterine death and some suggestions are made in regard to the selection of patients and the method of management in these cases.S. Afr. Med. J, 48, 1941 (1974)

Laparoscopic versus open surgical exploration in premenopausal women with suspected acute appendicitis

Objectives. To assess the utility of laparoscopic versus conventional surgical exploration in premenopausal women with suspected acute appendicitis. Method. Female patients aged 15-45 years in whom an independent decision to undertake surgical exploration had been made, were randomised to laparoscopic or open procedures. Comparison of patient groups was conducted on an intention-to-treat basis. Results. Eighteen patients underwent laparoscopic exploration, with 1 procedure requiring conversion to lower midline laparotomy. Open surgical exploration was performed primarily in 16 patients. Postoperative complications (3 patients versus 1 patient) and diagnostic errors (5 patients versus 1 patient) were more frequent in patients undergoing open surgical procedures. Laparoscopic procedures tended to be of longer duration than open operations, but were generally associated with slightly more favourable indices of postoperative recovery (analgesic requirement, postoperative hospitalisation, return to normal activity, return to work). In patients found not to have acute appendicitis, the difference in mean postoperative hospitalisation following laparoscopic intervention (2.6 days) and conventional surgery (3.4 days) approached statistical significance (p < 0.1). Conclusions. Laparoscopy may carry some diagnostic advantage over open surgery in premenopausal women with suspected acute appendicitis. Patients found not to have acute appendicitis have a marginally shorter period of hospitalisation after laparoscopic intervention. The outcome following laparoscopic appendicectomy for confirmed acute appendicitis is at least equivalent to that achieved with conventional appendicectomy. Laparoscopic exploration is an acceptable option in premenopausal women requiring surgery for suspected acute appendicitis.Articl