David A. Alexander

Randomised trial comparing hysterectomy with endometrial ablation for dysfunctional uterine bleeding: psychiatric and psychosocial aspects

Abstract Objective: To compare in psychiatric and psychosocial terms the outcome of hysterectomy and endometrial ablation for the treatment of dysfunctional uterine bleeding. Design: Prospective randomised controlled trial. Setting: Obstetrics and gynaecology department of a large teaching hospital. Subjects: 204 women with dysfunctional bleeding for whom hysterectomy would have been the preferred treatment were recruited over 24 months and randomly allocated to hysterectomy (99 women) or to hysteroscopic surgery (transcervical resection (52 women) or laser ablation (53 women)). Main outcome measures: Mental state, marital relationship, psychosocial and sexual adjustment in assessments conducted before the operation and one month, six months, and 12 months later. Results: Both treatments significantly reduced the anxiety and depression present before the operation, and there were no differences in mental health between the groups at 12 months. Hysterectomy did not lead to postoperative psychiatric illness. Sexual interest after the operation did not vary with treatment. Overall, 46 out of 185 (25%) women reported a loss of sexual interest and 50 out of 185 (27%) reported increased sexual interest. Marital relationships were unaffected by surgery. Personality and duration of dysfunctional uterine bleeding played no significant part in determining outcome. Conclusions: Hysteroscopic surgery and hysterectomy have a similar effect on psychiatric and psychosocial outcomes. There is no evidence that hysterectomy leads to postoperative psychiatric illness. Key messages Key messages Hitherto hysterectomy has been the preferred procedure, though women may be ill postoperatively The introduction of hysteroscopic procedures demands an evaluation of different surgical methods according not only to gynaecological criteria but also in terms of their psychiatric and psychosocial outcome This randomised trial of hysterectomy and hysteroscopic surgery found that both methods had satisfactory outcomes in terms of anxiety, depression, and psychosocial adjustment

A pragmatic randomised comparison of transcervical resection of the endometrium with endometrial laser ablation for the treatment of menorrhagia

Objective To compare endometrial laser ablation (ELA) with transcervical resection of the endometrium (TCRE) in the treatment of menorrhagia.

The emotional burden of miscarriage for women and their partners: trajectories of anxiety and depression over 13 months

Objective  To identify the trajectories of anxiety and depression in women and in their partners over 13 months after miscarriage.

Are health professionals getting caught in the crossfire? The personal implications of caring for trauma victims

Objectives: To investigate the long term psychological sequelae of treating multiple victims of traumatic incidents, such as violent crime and motor vehicle accidents, and to assess staff exposure to violent patients in the emergency department. Methods: A self administered questionnaire booklet was distributed to all full time and part time staff working within the Johannesburg Hospital Trauma Unit during September 2002. Participation was voluntary. The questionnaire was specifically designed for the study as no relevant, validated questionnaire was found to be suitable. Psychological assessment comprised two standardised measures, the impact of event scale-revised and the Maslach burnout inventory. Results: Thirty eight staff members completed the questionnaire, a response rate of 90%. Over 40% of respondents had been physically assaulted while at work and over 90% had been verbally abused. Staff reported a significant level of post-traumatic symptoms, evaluated by the impact of event scale-revised (median = 17.5, range = 0–88), as a result of critical incidents they had been involved in during the previous six months. At least half of the respondents also reported a “high” degree of professional burnout in the three sub-scales of the Maslach burnout tnventory—that is emotional exhaustion, depersonalisation, and personal accomplishment. Conclusions: Preventative measures, such as increased availability of formal psychological support, should be considered by all trauma units to protect the long term emotional wellbeing of their staff.

First responders after disasters: a review of stress reactions, at-risk, vulnerability, and resilience factors

Disasters are widely reported, commonplace events that characteristically leave an enormous legacy of human suffering through death, injury, extensive infrastructural damage, and disorganization to systems and communities. The economic costs may be almost incalculable. Professional and civilian first responders play a vital role in mitigating these effects. However, to maximize their potential with the minimum health and welfare costs to first responders, it is important to have a good understanding of the demands of such work on them, how they cope, and what enables them to fulfill their roles. This review will explore these themes by highlighting important findings and areas of uncertainty.

Biochemical terrorism: too awful to contemplate, too serious to ignore: subjective literature review.

Background It is important not to foster unnecessary public anxiety with regard to the risk of a biochemical terrorist incident, but the authorities need to consider their response strategy, particularly with regard to mental health issues. Aims To describe the likely effects of a terrorist incident involving biochemical agents and to identify important response issues. Method Literature survey. Results Observations following conventional terrorist incidents and other major trauma, including biochemical and nuclear accidents, suggest that a biochemical terrorist incident would have widespread public effects. The mental health services should play a major role in designing an effective multi-disciplinary response, particularly with regard to the reduction of public anxiety, identifying at-risk individuals and collaborating with medical and emergency services, as well as providing care for those who develop post-traumatic psychopathology. Conclusions We should not feel helpless in the face of a biochemical threat; there is considerable knowledge and experience to be tapped. Awell-designed, well-coordinated and rehearsed strategy based on empirical evidence will do much to reduce public anxiety and increase professional confidence.

Children, resilience and disasters: recent evidence that should influence a model of psychosocial care.

Purpose of review This paper draws on articles and chapters published mainly in 2006 and 2007 to identify implications for designing sustainable programmes of psychosocial care for children and young people who are affected by disasters and terrorism. Recent findings Recent research confirms previous knowledge that most children and young people are resilient, but also very vulnerable to the psychosocial effects of disasters. Most children are distressed in the immediate aftermath when they gain their sense of safety from adults, predictable routines and consistent support systems. Others may develop serious mental disorders though post-traumatic mental disorders may not develop until weeks, months or years later. Research instruments may be sensitive to cultural variability; simply translating measures into other languages is insufficient. Summary International experience of different types of disaster and terrorist incidents suggests that the broad principles of good service design include integrating responses to the psychosocial needs of children and adolescents into general disaster preparedness and recovery plans; working with families rather than individual children to address their needs; identifying professionals who specialize in responding to disasters and are skilled in working with children prior to events; and focusing resources on increasing the capabilities of staff of community facilities to recognize and respond to childrens common reactions to trauma and provide assistance.

Medical Career Choice: Current Status of Research Literature.

This article examines the research evidence supporting relationships between both personal and social factors and the career choices of physicians in training. Although the research literature in this area is limited by a lack of longitudinal studies, a dependence on cross‐sectional designs, and a lack of multivariate investigations, data support relationships in each of the following areas: sociodemographic characteristics of student, student personality and attitudinal variables, institutional characteristics of the medical school, characteristics of the specialty training programs, and information available to students about the various careers. Additionally, this review investigates the stability of career preferences and career choices over time.

One hundred requests for predictive testing for Huntington's disease.

In Grampian region, the first 100 requests for predictive testing for Huntingtons disease have been analysed. Forty‐five presymptomatic predictive test results have been given, eleven families have made a decision to undergo prenatal exclusion tests, and so far eleven pregnancies have been investigated using chorion villus biopsy. This paper presents the protocol used and a descriptive analysis of those receiving results, those choosing to leave the programme, and those unable to complete it because of an unsuitable family structure or unco‐operative relatives.

Attention dysfunction in senile dementia

A group of 14 patients suffering from senile dementia were compared with 40 normal and 20 non-brain-damaged psychiatric controls on a visual vigilance task. The senile Ss were able to perform at a level appropriate to their ages when the task involved a simple S-R paradigm. When the complexity of the task was increased by requiring the short-term retention of response-relevant information, brain-damaged patients were markedly less efficient. Over-responsiveness was the characteristic error of the brain-damaged patients. Dementia may be associated with a disorder of selective attention.