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"Chester, Jonathan"
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The role of ambulatory urodynamics in investigation of female urinary incontinence
Introduction and hypothesis
Lower urinary tract symptoms (LUTS) impact upon quality of life and occur in women of all ages. The National Institute for Clinical Excellence states that ambulatory urodynamic monitoring (AUM) should be used as a second-line investigational modality; however, its use is becoming more frequent. AUM provides a valid second line to conventional urodynamic methods that may be more widely used.
Method
A literature review was undertaken to assess evidence for the use of AUM alongside a retrospective review of patients undergoing AUM at a tertiary care centre and symptom reporting at a follow-up visit. Both these methods included evidence for pathology detection, technical ease of use, recreation of symptoms and patient experience, allowing comparison of literature results to those experienced in day-to-day use.
Results
The literature shows AUM to have sensitivity superior to that of other urodynamic investigations. However, evidence suggests this correlates less well with clinical effectiveness. Patients felt AUM was superior in recreating their symptoms, and they tolerated the procedure well. The increased technical demands of AUMs, however, meant that traces were more commonly harder to interpret than with conventional urodynamics. Our experience correlates well with the existing literature, suggesting increased symptom diagnosis; 63.2 % of diagnoses correlated well with symptoms.
Conclusion
AUM remains an important urodynamic method to supplement conventional urodynamics. Evidence suggests it is superior in LUTS diagnosis, but its technical difficulty can affect results.
Journal Article
Motherhood, Gender, and Self-Willed Death in the Mahābhārata: Psychological Applications of Foucauldian Feminist Perspectives to an Ancient Sanskrit Epic
Bringing together the disparate fields of clinical psychology, postmodern feminist politics, and classical Hinduism, this study uses Foucauldian feminism as a methodological lens for understanding a selection of stories from the Mahābhārata, one of two major epic poems of ancient India. It attempts to defamiliarize conventional and seemingly self-evident Western perspectives regarding suicide, gender identity, and parenthood. First, it undermines the construct of suicide by highlighting models of self-willed death in the Mahābhārata that exist outside the narrow, traditional, Western association of suicide with mental illness. Second, with reference to particular characters in the epic, it raises questions about the constitution and performance of gender in order to facilitate understanding, challenging, and subverting current gendered norms and expectations. Third, it draws from both contemporary scholarship and tales in the Mahābhārata regarding parenthood in arguing for models of mothering as primarily enacted and relational, as opposed to primarily rooted in biology. This study will be useful for scholars and practitioners who seek to expose blind spots and biases in the Western mental health care system that may inadvertently marginalize or harm clients, as well as to stimulate reflection for new possibilities outside the inherited models, all in the service of providing therapy in ways that honor the irreducible plurality of clients' needs, values, and lived experiences.
Dissertation
Manual vacuum aspiration under local anaesthetic for early miscarriage: 2 years experience in a university teaching hospital in UK
Manual vacuum aspiration under local anaesthesia (MVA-LA) in an outpatient setting is an alternative to the standard surgical aspiration under general anaesthesia for miscarriage. We evaluate the feasibility, safety and clinical outcomes of MVA-LA in the management of miscarriage at less than 12 weeks of gestation in an outpatient setting. This prospective cohort study was conducted at the Birmingham Women’s Hospital. One hundred and thirty-one women with ultrasound scan confirmed incomplete or missed miscarriage underwent MVA-LA between November 2010 and January 2013. A computer database was used to record relevant information. The mean gestation age was 8.3 weeks (±1.8). Successful evacuation was achieved in 100 % of cases. One hundred and fourteen (87 %) patients underwent the procedure with direct intracervical LA block and the remaining cases did not have LA. There were no reported complications in 96 % of procedures. Cervical injury and vasovagal symptoms noted in 3.8 % of cases. In all cases, vaginal bleeding was minimal or mild. The post-operative pain was controlled successfully with a combination of paracetamol and diclofenac in 82 % of patients. The MVA method was associated with high levels (93 %) of patient satisfaction and acceptability. MVA-LA in an outpatient setting is a safe and acceptable therapeutic option for women diagnosed with early missed or incomplete miscarriage.
Journal Article
FREEZE FRAME: ANTARCTICA
Antarctica is a wilderness photographer's paradise. It is not a white icy void, but a land of never-ending glaciers, massive crevasses, leviathan icebergs, and many penguins and seals.
Journal Article
PROJECT BLIZZARD: Mawson's Icy Legacy
Antarctic adventurers on a mission: Save Mawson's Hut!
Magazine Article
Cautious lenders in Hong Kong hold rates steady
The U.S. Federal Reserve cut its rates by 0.50 percentage point Wednesday, and the Hong Kong Monetary Authority matched the move first thing Thursday, as it typically does to maintain the Hong Kong dollar's peg to the U.S. dollar. Hong Kong's commercial banks can go their own way, however. HSBC Holdings PLC unit Hongkong & Shanghai Banking Corp. kept its prime lending rate unchanged at 5.25%. So did Hang Seng Bank Ltd., which is controlled by HSBC, and BOC (Hong Kong) Ltd., the Hong Kong arm of Bank of China Ltd. Standard Chartered PLC's Hong Kong arm and Bank of East Asia Ltd. kept their prime rates at 5.50%. The banks didn't give a reason. They have kept the same rates since March despite previous cuts. \"We're now in a once-in-a-century global financial crisis, and the traditional relationship between interbank rates and the central banks' policy rates no longer holds,\" said Joe Lo, an economist with Citigroup in Hong Kong.
Newspaper Article
Hong Kong banks ignore rate cuts
The U.S. Federal Reserve cut its rates by 0.50 percentage point Wednesday, and the Hong Kong Monetary Authority matched the move first thing Thursday, as it typically does to maintain the Hong Kong dollar's peg to the U.S. dollar. Hong Kong's commercial banks can go their own way, however. HSBC Holdings PLC unit Hongkong & Shanghai Banking Corp. kept its prime lending rate unchanged at 5.25%. So did Hang Seng Bank Ltd., which is controlled by HSBC, and BOC (Hong Kong) Ltd., the Hong Kong arm of Bank of China Ltd. Standard Chartered PLC's Hong Kong arm and Bank of East Asia Ltd. kept their prime rates at 5.50%. The banks didn't give a reason. They have kept the same rates since March, despite previous cuts. \"We're now in a once-in-a-century global financial crisis, and the traditional relationship between interbank rates and the central banks' policy rates no longer holds,\" said Joe Lo, an economist with Citigroup in Hong Kong.
Newspaper Article