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ObjectiveTo estimate the effectiveness and safety of laparoscopic surgical excision of rectovaginal endometriosis.DesignA multicentre, prospective cohort study.Setting51 hospitals accredited as specialist endometriosis centres.Participants5162 women of reproductive age with rectovaginal endometriosis of which 4721 women had planned laparoscopic excision.InterventionsLaparoscopic surgical excision of rectovaginal endometriosis requiring dissection of the pararectal space.Main outcome measuresStandardised symptom questionnaires enquiring about chronic pelvic pain, bladder and bowel symptoms, analgesia use and quality of life (EuroQol) completed prior to surgery and at 6, 12 and 24 months postoperatively. Serious perioperative and postoperative complications including major haemorrhage, infection and visceral injury were recorded.ResultsAt 6 months postsurgery, there were significant reductions in premenstrual, menstrual and non-cyclical pelvic pain, deep dyspareunia, dyschezia, low back pain and bladder pain. In addition, there were significant reductions in voiding difficulty, bowel frequency, urgency, incomplete emptying, constipation and passing blood. These reductions were maintained at 2 years, with the exception of voiding difficulty. Global quality of life significantly improved from a median pretreatment score of 55/100 to 80/100 at 6 months. There was a significant improvement in quality of life in all measured domains and in quality-adjusted life years. These improvements were sustained at 2 years. All analgesia use was reduced and, in particular, opiate use fell from 28.1% prior to surgery to 16.1% at 6 months. The overall incidence of complications was 6.8% (321/4721). Gastrointestinal complications (enterotomy, anastomotic leak or fistula) occurred in 52 (1.1%) operations and of the urinary tract (ureteric/bladder injury or leak) in 49 (1.0%) procedures.ConclusionLaparoscopic surgical excision of rectovaginal endometriosis appears to be effective in treating pelvic pain and bowel symptoms and improving health-related quality of life and has a low rate of major complications when performed in specialist centres.

Background Medical Visit Companions (MVCs) are encouraged for older adults’ routine medical encounters. Little data exist on the experiences and contributions of non-spouse companions for the growing population of older adults without a living spouse. Methods We conducted six focus groups with forty non-spouse MVCs identified through churches in Baltimore, Maryland. Thematic analysis was used to identify key issues before the visit, during the visit itself, after the visit, and in the overall companion experience. Results MVCs described their experiences positively but also highlighted many challenges related to the role that extended far beyond the visit itself. These included scheduling, transportation, communication, and coordination of care expectations. Conclusion Our increasingly complex healthcare system can be challenging for older adults to navigate successfully. The diverse nature of tasks performed by companions in this study highlight the many benefits of having a companion accompany older patients to medical visits. The positive experience of the companions studied and their willingness to continue their role in the future highlights the untapped potential for increased social facilitation to improve the quality of healthcare visits and achieve patient-centered care for all older patients.

Objective. We determined estimates of homicide among American Indians/Alaska Natives (AI/ANs) compared with non-Hispanic white people to characterize disparities and improve AI/AN classification in incidence and mortality reporting. Methods. We linked 1999-2009 death certificate data with Indian Health Service (IHS) patient registration data to examine death rates from homicide among AI/AN and non-Hispanic white people. Our analysis focused primarily on residents of IHS Contract Health Service Delivery Area counties and excluded Hispanic people to avoid underestimation of incidence and mortality in AI/ANs and for consistency in our comparisons. We used age-adjusted death rates per 100,000 population and stratified our analyses by sex, age, and IHS region. Results. Death rates per 100,000 population from homicide were four times higher among AI/ANs (rate = 12.1) than among white people (rate = 2.8). Homicide rates for AI/ANs were highest in the Southwest (25.6 and 6.9 for males and females, respectively) and in Alaska (17.7 and 10.3 for males and females, respectively). Disparities between AI/ANs and non-Hispanic white people were highest in the Northern Plains region among men (rate ratio [RR] = 9.8, 95% confidence interval [CI] 8.5, 11.3) and among those aged 25-44 years (RR=9.0, 95% CI 7.5, 10.7) and 0-24 years (RR=7.4, 95% CI 6.1, 8.9). Conclusion. Death rates from homicide among AI/ANs were higher than previously reported and varied by sex, age, and region. Violence prevention efforts involving a range of stakeholders are needed at the community level to address this important public health issue.

African American faith-based organizations (FBOs) play an important role in addressing health disparities. Increasingly, churches offer health fairs, screenings, or education through health ministries. However, little is known about linking these organizations with evidence-based interventions (EBIs) developed by research. This study explored 1) factors that facilitate or impede health ministry activities, including the adoption of EBIs, and 2) opportunities to use technology to support/enhance the capacity of FBOs to sustain health-related activities. We conducted 18 key informant interviews with African American pastors and FBO leaders and six focus groups with members. A popular health ministry strategy was distribution of print materials. There was limited awareness of EBIs and how to access them. Challenges included maintaining qualified volunteers, financial resources, and technical assistance needs. Participants used technology and social media but older adults did so less often. Findings have implications for dissemination/implementation research in FBOs, in relation to the translational continuum.

Could your future jogging partner be a robot? Graham Phillips dons his trainers and hits the track with the help of a flying machine called Joggobot.

Graham Phillips argues that pharmacists could help the NHS deal with its shortage of GPs and reduce pressure on other services

The purpose of this study is to evaluate the reliability of volume-based fluid balance monitoring in operative hysteroscopy. The actual volume of twenty 3-litre Glycine 1.5 % bags was measured by weighing the contents of each bag and by converting the weight into volume knowing the specific gravity of Glycine 1.5 %. The volume of the Serres OY suction canisters that represents the output volume was measured using a calibrated 1000-ml beaker. The volume in the 3-litre Glycine 1.5 % bags ranged from a minimum 3105 ml to a maximum of 3124 ml with a mean volume of 3115.3 ml. The actual volume of fluid in the Serres OY suction canisters containing the plastic liner when the reading is 500 ml was 425 ml, at 1000 ml, it was 900 ml, and at 2000 ml, it was 1850 ml. Therefore, a measured 3-litre outflow would have an actual volume of 2750 ml. It is concluded that volume-based fluid monitoring is not a reliable method in operative hysteroscopy. Therefore, weight-based fluid management systems should be used to ensure patient safety and prevent fluid overload.

Modern appliances are complex machines with processors, operating systems, and application software. While there are books that will tell you how to run Linux on embedded hardware, and books on how to build a Linux application, Linux Appliance Design is the first book to demonstrate how to merge the two and create a Linux appliance. You'll see for yourself why Linux is the embedded operating system of choice for low-cost development and a fast time to market. Linux Appliance Design shows how to build better appliances-appliances with more types of interfaces, more dynamic interfaces, and better debugged interfaces. You'll learn how to build backend daemons, handle asynchronous events, and connect various user interfaces (including web, framebuffers, infrared control, SNMP, and front panels) to these processes for remote configuration and control. Linux Appliance Design also introduces the Run-Time Access library, which provides a uniform mechanism for user interfaces to communicate with daemons. Learn to: Separate your user interfaces from your daemonsGive user interfaces run time access to configuration, status, and statisticsAdd professional network management capabilities to your applicationUse SNMP and build a MIBBuild a web-based appliance interfaceBuild a command line interface (CLI)Build a framebuffer interface with an infrared control as inputManage logs and alarms on an applianceCompanion CD includes a prototype appliance-a home alarm system-that supports the book's lessons.

Objective To compare the effects of laparoscopic hysterectomy and abdominal hysterectomy in the abdominal trial, and laparoscopic hysterectomy and vaginal hysterectomy in the vaginal trial. Design Two parallel, multicentre, randomised trials. Setting 28 UK centres and two South African centres. Participants 1380 women were recruited; 1346 had surgery; 937 were followed up at one year. Primary outcome Rate of major complications. Results In the abdominal trial laparoscopic hysterectomy was associated with a higher rate of major complications than abdominal hysterectomy (11.1% v 6.2%, P = 0.02; difference 4.9%, 95% confidence interval 0.9% to 9.1%) and the number needed to treat to harm was 20. Laparoscopic hysterectomy also took longer to perform (84 minutes v 50 minutes) but was less painful (visual analogue scale 3.51 v 3.88, P = 0.01) and resulted in a shorter stay in hospital after the operation (3 days v 4 days). Six weeks after the operation, laparoscopic hysterectomy was associated with less pain and better quality of life than abdominal hysterectomy (SF-12, body image scale, and sexual activity questionnaires). In the vaginal trial we found no evidence of a difference in major complication rates between laparoscopic hysterectomy and vaginal hysterectomy (9.8% v 9.5%, P = 0.92; difference 0.3%, -5.2% to 5.8%), and the number needed to treat to harm was 333. We found no evidence of other differences between laparoscopic hysterectomy and vaginal hysterectomy except that laparoscopic hysterectomy took longer to perform (72 minutes v 39 minutes) and was associated with a higher rate of detecting unexpected pathology (16.4% v 4.8%, P = < 0.01). However, this trial was underpowered. Conclusions Laparoscopic hysterectomy was associated with a significantly higher rate of major complications than abdominal hysterectomy. It also took longer to perform but was associated with less pain, quicker recovery, and better short term quality of life. The trial comparing vaginal hysterectomy with laparoscopic hysterectomy was underpowered and is inconclusive on the rate of major complications; however, vaginal hysterectomy took less time.

As the Mars science rover Curiosity touched down on the Martian surface this month, Graham Phillips was in NASA’s control room to feel the tension and excitement.