Background The colposcopy-directed punch biopsy is widely used in the management of women with abnormal cervical cytology; however, its accuracy compared with definitive histology from an excision biopsy is not well established.Objectives To assess the accuracy of the colposcopy-directed punch biopsy to diagnose high-grade cervical intraepithelial neoplasia (CIN) by performing a systematic review and meta-analysis.Search strategy A systematic search of MEDLINE, EMBASE and the Cochrane Library was performed.Selection criteria Articles that compared the colposcopically directed cervical punch biopsy with definitive histology from an excisional cervical biopsy or hysterectomy.Data collection and analysis Random effects and hierarchical summary receiver operating characteristic regression models were used to compute the pooled sensitivity and specificity applying different test cut-offs for outcomes of high-grade CIN.Main results Thirty-two papers comprising 7873 paired punch/ definitive histology results were identified. The pooled sensitivity for a punch biopsy defined as test cut-off CIN1+ to diagnose CIN2+ disease was 91.3% (95% CI 85.3-94.9%) and the specificity was 24.6% (95% CI 16.0-35.9%). In most of the studies, the majority of enrolled women had positive punch biopsies. Pooling of the four studies where the excision biopsy was performed immediately after the punch biopsy, and where the rate of positive punch biopsies was considerably lower, yielded a sensitivity of 81.4% and specificity of 63.3%.Author's conclusion The observed high sensitivity of the punch biopsy derived from all studies is probably the result of verification bias.

No abstract

A detailed FTIR characterization of acid sites in two structurally related zeolites, ferrierite and SUZ-4, is carried out. Assignment of OH groups observed in the spectra is addressed taking into account zeolite structure and composition. In ferrierite, at least four types of bridging OH groups vibrating in 10-, 8-, and 6-membered rings are identified using a combination of experimental and computational techniques. Our results suggest that framework aluminum in ferrierite is preferentially sited in extended rings at the intersections of 8-and 6-ring channels resulting in a high concentration of OH groups in the large cages in 8-ring channels. The IR band corresponding to these hydroxyls, 3601 cm -1 , is not significantly shifted to low frequencies because the OH groups are vibrating in extended rings. At the same time, access to these hydroxyls is restricted by 8-membered rings. The band at 3565 cm -1 assigned to the bridging OH-groups in 6-membered rings is responsible for the strongly asymmetric shape of the experimental spectrum. For SUZ-4 zeolite, deconstruction of the spectrum, supported by H-D exchange and accessibility studies, results in three IR bands at 3560, 3592, and 3610 cm -1 corresponding to OH groups in 6-, 8-and 10-membered rings. The intensity of the first band is considerably lower than that in ferrierite, indicating that the residual potassium cations are located in small cages or in double 6-rings. The low-intensity band at 3560 cm -1 and the similar intensities of the bands at 3592 and 3610 cm -1 lead to a near-symmetrical experimental spectrum.

ObjectiveTo explore incidents of bullying and undermining among obstetrics and gynaecology (O&G) consultants in the UK, to add another dimension to previous research and assist in providing a more holistic understanding of the problem in medicine.DesignQuestionnaire survey.SettingRoyal College of Obstetricians and Gynaecologists (RCOG).ParticipantsO&G consultant members/fellows of the RCOG working in the UK.Main outcome measuresMeasures included a typology of 4 bullying and undermining consequences from major to coping.ResultsThere was a 28% (664) response rate of whom 44% (229) responded that they had been persistently bullied or undermined. Victims responded that bullying and undermining is carried out by those senior or at least close in the hierarchy. Of the 278 consultants who answered the question on ‘frequency of occurrence’, 50% stated that bullying and undermining occurs on half, or more, of all encounters with perpetrators and two-thirds reported that it had lasted more than 3 years. The reported impact on professional and personal life spans a wide spectrum from suicidal ideation, depression and sleep disturbance, and a loss of confidence. Over half reported problems that could compromise patient care. When victims were asked if the problem was being addressed, 73% of those that responded stated that it was not.ConclusionsSignificant numbers of consultants in O&G in the UK are victims of bullying and undermining behaviour that puts their own health and patient care at risk. New interventions to tackle the problem, rather than its consequences, are required urgently, together with greater commitment to supporting such interventions.

Objective To evaluate whether the implementation of the FAST-M complex intervention was feasible and improved the recognition and management of maternal sepsis in a low-resource setting. Design A before-and-after design. Setting Fifteen government healthcare facilities in Malawi. Population Women suspected of having maternal sepsis. Methods The FAST-M complex intervention consisted of the following components: the FAST-M maternal sepsis treatment bundle and the FAST-M implementation programme. Performance of selected process outcomes was compared between a 2-month baseline phase and 6-month intervention phase with compliance used as a proxy measure of feasibility. Main outcome result Compliance with vital sign recording and use of the FAST-M maternal sepsis bundle. Results Following implementation of the FAST-M intervention, women were more likely to have a complete set of vital signs taken on admission to the wards (0/163 [0%] versus 169/252 [67.1%], P < 0.001). Recognition of suspected maternal sepsis improved with more cases identified following the intervention (12/106 [11.3%] versus 107/166 [64.5%], P < 0.001). Sepsis management improved, with women more likely to receive all components of the FAST-M treatment bundle within 1 hour of recognition (0/12 [0%] versus 21/107 [19.6%], P = 0.091). In particular, women were more likely to receive antibiotics (3/12 [25.0%] versus 72/107 [67.3%], P = 0.004) within 1 hour of recognition of suspected sepsis. Conclusion Implementation of the FAST-M complex intervention was feasible and led to the improved recognition and management of suspected maternal sepsis in a low-resource setting such as Malawi.