Pub Date : 2000-04-01DOI: 10.1783/147118900101194139
P A O'Brien
new method has arrived, we know more about how to optimise treatment, and new distribution channels are opening up. Combined with the political will, these advances should significantly reduce the burden of unwanted pregnancies. One of the important new ingredients is the WHO trial demonstrating the superior efficacy of levonorgestrel used on its own; the pregnancy rate with levonorgestrel alone was a third that of the comparison group using the traditional Yuzpe regime.1 The study was the largest of its kind, with almost 2 000 participants, had a secure method of randomisation, and was blinded to all participants. Two study groups were thus created which differed only in the type of emergency contraception used, thereby minimising the possibilities for random error and bias. The result, however, has been questioned on a number of accounts. The Yuzpe regime did not appear to perform particularly well in the trial and this might have influenced the comparison.2,3 But the method used to estimate the ‘true efficacy’ of emergency contraception, or proportion of pregnancies prevented, has limitations, although, as it was applied equally to both arms of the trial, it should not have biased the result. In the absence of placebo controlled trials, external controls, derived from published studies in which no contraception was used, are used to provide an estimate of the number of ‘expected pregnancies’, based on fecundity on each day of the menstrual cycle.4–6 However, these calculations assume that the day of ovulation can be accurately determined from retrospective reporting of day of the last menstrual period and cycle length. A recent study found a poor correlation between menstrual data and hormonal status on the day of emergency treatment.7 Not surprisingly, studies of emergency contraception frequently find pregnancies occurring when none are expected, using what is, in effect, the rhythm method to estimate risk of pregnancy. In the WHO study the external controls used were older and some desired pregnancy, while almost half of the women in the trial had accidents with a barrier contraceptive, often with a spermicide. Other differences from the external controls are likely. Applying these externally derived estimates to randomised trials opens too many doors through which error can enter into otherwise well-conducted studies. Because of its unreliability, this attempt to correct for a possible imbalance in risk of pregnancy should be dropped from randomised trials which will distribute women of equal risk of pregnancy to each arm, if the numbers are large enough, as indeed they were in the recent WHO trial. We cannot tell the so-called ‘true effectiveness’ of each method, but we can tell reliably if one is better than the other, and by how much precisely the sort of information required for clinical decision making. The opportunity to determine the true efficacy of Yuzpe was lost as the early workers, as is common, felt it unethical to conduct a p
{"title":"Emergency contraception with levonorgestrel: one hormone better than two.","authors":"P A O'Brien","doi":"10.1783/147118900101194139","DOIUrl":"https://doi.org/10.1783/147118900101194139","url":null,"abstract":"new method has arrived, we know more about how to optimise treatment, and new distribution channels are opening up. Combined with the political will, these advances should significantly reduce the burden of unwanted pregnancies. One of the important new ingredients is the WHO trial demonstrating the superior efficacy of levonorgestrel used on its own; the pregnancy rate with levonorgestrel alone was a third that of the comparison group using the traditional Yuzpe regime.1 The study was the largest of its kind, with almost 2 000 participants, had a secure method of randomisation, and was blinded to all participants. Two study groups were thus created which differed only in the type of emergency contraception used, thereby minimising the possibilities for random error and bias. The result, however, has been questioned on a number of accounts. The Yuzpe regime did not appear to perform particularly well in the trial and this might have influenced the comparison.2,3 But the method used to estimate the ‘true efficacy’ of emergency contraception, or proportion of pregnancies prevented, has limitations, although, as it was applied equally to both arms of the trial, it should not have biased the result. In the absence of placebo controlled trials, external controls, derived from published studies in which no contraception was used, are used to provide an estimate of the number of ‘expected pregnancies’, based on fecundity on each day of the menstrual cycle.4–6 However, these calculations assume that the day of ovulation can be accurately determined from retrospective reporting of day of the last menstrual period and cycle length. A recent study found a poor correlation between menstrual data and hormonal status on the day of emergency treatment.7 Not surprisingly, studies of emergency contraception frequently find pregnancies occurring when none are expected, using what is, in effect, the rhythm method to estimate risk of pregnancy. In the WHO study the external controls used were older and some desired pregnancy, while almost half of the women in the trial had accidents with a barrier contraceptive, often with a spermicide. Other differences from the external controls are likely. Applying these externally derived estimates to randomised trials opens too many doors through which error can enter into otherwise well-conducted studies. Because of its unreliability, this attempt to correct for a possible imbalance in risk of pregnancy should be dropped from randomised trials which will distribute women of equal risk of pregnancy to each arm, if the numbers are large enough, as indeed they were in the recent WHO trial. We cannot tell the so-called ‘true effectiveness’ of each method, but we can tell reliably if one is better than the other, and by how much precisely the sort of information required for clinical decision making. The opportunity to determine the true efficacy of Yuzpe was lost as the early workers, as is common, felt it unethical to conduct a p","PeriodicalId":22378,"journal":{"name":"The British journal of family planning","volume":"26 2","pages":"67-9"},"PeriodicalIF":0.0,"publicationDate":"2000-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1783/147118900101194139","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21622628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2000-04-01DOI: 10.1783/147118900101194210
{"title":"25th Anniversary of the North West Society of Sexual Medicine and Family Planning","authors":"","doi":"10.1783/147118900101194210","DOIUrl":"https://doi.org/10.1783/147118900101194210","url":null,"abstract":"","PeriodicalId":22378,"journal":{"name":"The British journal of family planning","volume":"34 1","pages":"113 - 113"},"PeriodicalIF":0.0,"publicationDate":"2000-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81332970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Forgotten IUDS.","authors":"R Vijayanand","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":22378,"journal":{"name":"The British journal of family planning","volume":"26 2","pages":"117"},"PeriodicalIF":0.0,"publicationDate":"2000-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21737315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2000-04-01DOI: 10.1783/147118900101194148
A Bigrigg
The Family Planning Directorate in Glasgow received trust financing at the end of the financial year 1994-95 to purchase computer hardware and software to update the family planning appointment system at the central clinic and to introduce electronic clinical records for clients attending the clinic. The system was expected to improve the efficiency of clinic administration and raise standards in the clinical areas of management, communication, audit, and information. This paper discusses the use of information technology (IT) within the clinic and considers how far the objectives have been achieved. Over the years, the system has embedded itself in the culture of the central clinic. In the clients¿ viewpoints, taken in 1997, the majority thought that the computers were necessary and were not more time-consuming during the clinical consultation. In addition, most clients thought enough care was taken with confidentiality of their personal records and they were happy with the personal details held on file about them. In the context of meeting initial objectives, the overall observation is that the IT system provides support to many aspects of administration and clinical care, improves the standard of record keeping, and increases the consultation time.
{"title":"Are computers of any use in a family planning clinic?","authors":"A Bigrigg","doi":"10.1783/147118900101194148","DOIUrl":"https://doi.org/10.1783/147118900101194148","url":null,"abstract":"The Family Planning Directorate in Glasgow received trust financing at the end of the financial year 1994-95 to purchase computer hardware and software to update the family planning appointment system at the central clinic and to introduce electronic clinical records for clients attending the clinic. The system was expected to improve the efficiency of clinic administration and raise standards in the clinical areas of management, communication, audit, and information. This paper discusses the use of information technology (IT) within the clinic and considers how far the objectives have been achieved. Over the years, the system has embedded itself in the culture of the central clinic. In the clients¿ viewpoints, taken in 1997, the majority thought that the computers were necessary and were not more time-consuming during the clinical consultation. In addition, most clients thought enough care was taken with confidentiality of their personal records and they were happy with the personal details held on file about them. In the context of meeting initial objectives, the overall observation is that the IT system provides support to many aspects of administration and clinical care, improves the standard of record keeping, and increases the consultation time.","PeriodicalId":22378,"journal":{"name":"The British journal of family planning","volume":"26 2","pages":"100-3"},"PeriodicalIF":0.0,"publicationDate":"2000-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1783/147118900101194148","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21622534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2000-04-01DOI: 10.1783/147118900101194300
S Gupta, J E Miller
Aims To investigate knowledge and attitudes towards intra-uterine contraception. Design Anonymous postal survey of 441 GPs (153 female and 288 male GPs) from the FHSA register in Stockport and Manchester. Setting General practices in Stockport and Manchester. Main outcome measure Response to a series of questions concerning attitudes and knowledge of intra-uterine contraception. Results One hundred and forty-two responses were received, giving a 35% response rate. Thirty-four percent of responding GPs did not fit intra-uterine devices (IUDs), with only 10% fitting more than 30 a year. There was a significant trend against IUD fitting by male GPs and GPs aged <40 years. Younger GPs with <10 years experience were significantly more aware of the reliability of intra-uterine contraception, but perceived IUD fitting as inconvenient for both the patient and the doctor. Female GPs had better knowledge and more positive attitudes to IUDs than male GPs. Conclusion GPs may have difficulties in maintaining expertise. Primary care groups may opt to concentrate fittings in a few expert practices, or refer women to centrally based family planning clinics for IUD fitting.
{"title":"A survey of GP views in intra-uterine contraception.","authors":"S Gupta, J E Miller","doi":"10.1783/147118900101194300","DOIUrl":"https://doi.org/10.1783/147118900101194300","url":null,"abstract":"Aims To investigate knowledge and attitudes towards intra-uterine contraception. Design Anonymous postal survey of 441 GPs (153 female and 288 male GPs) from the FHSA register in Stockport and Manchester. Setting General practices in Stockport and Manchester. Main outcome measure Response to a series of questions concerning attitudes and knowledge of intra-uterine contraception. Results One hundred and forty-two responses were received, giving a 35% response rate. Thirty-four percent of responding GPs did not fit intra-uterine devices (IUDs), with only 10% fitting more than 30 a year. There was a significant trend against IUD fitting by male GPs and GPs aged <40 years. Younger GPs with <10 years experience were significantly more aware of the reliability of intra-uterine contraception, but perceived IUD fitting as inconvenient for both the patient and the doctor. Female GPs had better knowledge and more positive attitudes to IUDs than male GPs. Conclusion GPs may have difficulties in maintaining expertise. Primary care groups may opt to concentrate fittings in a few expert practices, or refer women to centrally based family planning clinics for IUD fitting.","PeriodicalId":22378,"journal":{"name":"The British journal of family planning","volume":"26 2","pages":"81-4"},"PeriodicalIF":0.0,"publicationDate":"2000-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1783/147118900101194300","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21622630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2000-04-01DOI: 10.1783/147118900101194229
{"title":"Dame Josephine Barnes 1912–1999","authors":"","doi":"10.1783/147118900101194229","DOIUrl":"https://doi.org/10.1783/147118900101194229","url":null,"abstract":"","PeriodicalId":22378,"journal":{"name":"The British journal of family planning","volume":"235 2","pages":"115 - 115"},"PeriodicalIF":0.0,"publicationDate":"2000-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72576709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2000-04-01DOI: 10.1136/acupmed-2013-010327
BMAS Points Practical Courses These courses follow a rolling programme of four days, focussing on practical needling of particular regions of the body. A selection of the four days will be covered over one year. The four days cover the core skills training for the Diploma of Medical Acupuncture (DipMedAc). Other self-directed study is required to cover the knowledge and research base for the DipMedAc.
{"title":"Meetings and Courses","authors":"","doi":"10.1136/acupmed-2013-010327","DOIUrl":"https://doi.org/10.1136/acupmed-2013-010327","url":null,"abstract":"BMAS Points Practical Courses These courses follow a rolling programme of four days, focussing on practical needling of particular regions of the body. A selection of the four days will be covered over one year. The four days cover the core skills training for the Diploma of Medical Acupuncture (DipMedAc). Other self-directed study is required to cover the knowledge and research base for the DipMedAc.","PeriodicalId":22378,"journal":{"name":"The British journal of family planning","volume":"26 1","pages":"118 - 119"},"PeriodicalIF":0.0,"publicationDate":"2000-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85141221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Levonorgestrel IUS use in Islamic Malaysia.","authors":"C Y Wong","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":22378,"journal":{"name":"The British journal of family planning","volume":"26 2","pages":"117"},"PeriodicalIF":0.0,"publicationDate":"2000-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21737316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Depo Provera--irregular bleeding management.","authors":"M Hickey, C M Paterson","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":22378,"journal":{"name":"The British journal of family planning","volume":"26 2","pages":"117"},"PeriodicalIF":0.0,"publicationDate":"2000-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21737314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Comments on Implanon review.","authors":"P A O'Brien","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":22378,"journal":{"name":"The British journal of family planning","volume":"26 2","pages":"117-8"},"PeriodicalIF":0.0,"publicationDate":"2000-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21737318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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