Summary Sixty women with genuine stress incontinence were consecutively assigned to one of four physiotherapy groups who were treated for 6 weeks by either (1) pelvic floor exercises (PFE) in hospital; (2) PFE and faradism; (3) PFE and interferential therapy; (4) PFE at home. Assessment before and after treatment was by 7‐day bladder charts, urethral pressure profiles and perineometry. Approximately two‐thirds of the hospital‐treated patients (groups 1, 2 and 3) experienced marked or moderate subjective improvement and at 6 months, 27% were dry or almost dry. There was little difference in outcome between groups 1, 2 and 3 but hospital‐based therapy was more effective than home treatment. Statistical analyses showed that there were significant improvements in the objective indices measured in the 45 hospital‐treated patients. Successful treatment was more likely in younger patients, in those with lesser degrees of genuine stress incontinence and those who had had no previous pelvic floor surgery.

The advanced hysteroscopy special skills module has been developed by the Royal College of Obstetricians and Gynaecologists (RCOG) in association with the British Society of Gynaecologic Endoscopists (BSGE). It is mainly aimed at senior specialist registrars in obstetrics and gynaecology in their final two years of training, but it can also be undertaken by non-training posts in the same field. By completion of the module, ideally within a year, trainees are expected to have reached independent competence in performing both diagnostic, as well as operative hysteroscopy. A survey was done on trainees attending the mandatory course at the RCOG (intermediate/advanced hysteroscopic surgery course in 2006), which is part of the requirement for obtaining the Advanced hysteroscopy special skills module. Feedback was obtained from 44 trainees who were either already registered for the special skills module in advanced hysteroscopy or were planning on registering. Overall, 50% of candidates found the oneyear target difficult to achieve. The majority attended at least one hysteroscopy outpatient clinic per week (85%) and/or one hysteroscopy theatre list per week (87%). This suggested the adequate attendance of hysteroscopy sessions; however, the problem was with operative hysteroscopy, which comprised 0-20% of training for the majority of trainees (59%). The conclusion was that the one-year target for obtaining the special skills module was difficult to achieve, with the most evident cause being the inability to acquire the expected operative hysteroscopy standard within the intended time.

Background: With expansion of electronic health records, there is an increasing role for clinical decision support (CDS) alerts, however their acceptability for public health surveillance has not been studied. We surveyed primary care providers (PCPs) and nursing staff at nine clinics in New York City where a pilot respiratory virus surveillance system was implemented. Purpose: Evaluate acceptability of CDS alerts encouraging diagnostic testing for respiratory viruses. Methods: The pilot surveillance system was implemented at nine outpatient clinics in New York City. An evaluation of the first 5 weeks of operation, May 26-June 30, 2009, was performed. Online surveys for PCPs (N=45) and nursing staff (N=47) were developed and sent electronically 5 months after surveillance system implementation. Significance testing was performed using Fisher's exact test. Results: The survey response rate was 53% (n=24) for PCPs and 55% (n=26) for nursing staff. Nursing staff were significantly more likely to report adherence to CDS alerts than PCPs. PCPs and nursing staff had statistically significant differences in their perceptions of the clinical utility of diagnostic testing. PCPs primarily attributed nonadherence to low clinical utility of diagnostic testing, whereas nursing staff primarily attributed it to lack of PCP orders. Discussion: Low threshold for CDS alert triggers, low sensitivity of diagnostic testing, and prioritization of clinical utility over surveillance objectives contributed to suboptimal adherence among both PCPs and nursing staff to CDS alerts. Conclusion: PCPs and nursing staff perceive and adhere to CDS alerts differently. Future public health surveillance systems should choose user-centered frameworks in designing and implementing CDS alerts, provide training regarding surveillance objectives, consider targeting CDS alerts to the initial encounter between patient and nursing staff, and conduct periodic evaluations of adherence and acceptability.