Sexual abuse in children is a problem that often goes unnoticed by parents. Sometimes it is really difficult for parents to be aware of it. Children should not only receive sex education but should also be alerted to the possibility of assault by
strangers, teachers, superiors in offices/workplaces, etc. Special counselling is required, and a great deal of psychological reassurance and
support by their elders may also be n...
Sexual abuse in children is a problem that often goes unnoticed by parents. Sometimes it is really difficult for parents to be aware of it. Children should not only receive sex education but should also be alerted to the possibility of assault by
strangers, teachers, superiors in offices/workplaces, etc. Special counselling is required, and a great deal of psychological reassurance and
support by their elders may also be needed. In spite of such measures, some children are inevitably going to suffer abuse, and consequently there is a great need for psychologist services.
(FIGURES AVAILABLE FROM AUTHOR ON REQUEST - UNABLE TO UPLOAD TO THIS SITE)
The two letters describing individuals' different techniques for
implant removal are timely [1,2]. Routine removal with or without refit is
common practice throughout the UK as implants have become widely available
and popular. It is not yet clear whether introduction of Nexplanon will
lead to fewer difficult removals. It is evident from th...
(FIGURES AVAILABLE FROM AUTHOR ON REQUEST - UNABLE TO UPLOAD TO THIS SITE)
The two letters describing individuals' different techniques for
implant removal are timely [1,2]. Routine removal with or without refit is
common practice throughout the UK as implants have become widely available
and popular. It is not yet clear whether introduction of Nexplanon will
lead to fewer difficult removals. It is evident from these letters and
conversations between clinicians that diverse and innovative approaches
have evolved for fit and removal. These letters are therefore relevant as
they highlight the need to recognise key principles when removing (and
fitting) implants: whatever the technique it should be minimally
traumatic/invasive, effective and - importantly - safe for the patient
and safe for the operator. Dr Menon questions the merit of Dr Kandiyil's
splinting technique for routine removal. He points out that blind
introduction of the needle theoretically and unnecessarily could damage
deeper structures. I would be interested to learn, in terms of these
principles, what comparative advantages Dr Kandiyil's method has over the
simple use of local anaesthetic and scalpel for palpable devices.
Removal of impalpable implants presents a different situation and
this same technique, when used with ultrasound guidance, minimises risk to
otherwise unseen structures and focuses the operating field on the precise
location of the implant. It also has the advantage of bringing the implant
superficially towards the skin where it is then often palpable (Figures 1 and 2).
Ultrasound-guided splinting technique therefore provides safety
advantages for the patient. Having used this method for a few years I
have, however, faced the challenge of identifying a technique that is
'safe' for the operator (and for this reason have been reluctant to teach
the method to others). Use of a regular phlebotomy needle puts the
operator at risk of injury. I have considered various needles
(amniocentesis, spinal, etc.) looking for combined properties of slim but
firm, suitable to penetrate arm skin, and long enough that the exposed end
can be safely sheathed while operating. Most recently the flush needle
pictured (Figure 3) has proved one satisfactory solution.
I am keen to learn what other devices clinicians have found safe and
suitable for this use.
Splinting is just one novel practice that has been adopted. The
following are examples of other developments: (1) bandages are no longer applied following implant fitting or removal, (2) fitters no longer anaesthetise along the insertion track and (3) ethyl chloride used as an alternative to lignocaine hydrochloride for fitting (not removal).
Organon convenes implant-fitting workshops but there has been to my
knowledge no formal arrangement for appraisal of practice. I wonder
whether it is time as a specialty for a process of bringing together
experiences and methods, complete with success rates, complications,
advantages/disadvantages and patient feedback with the intention of
improving practice and informing training for the future. I look forward
to hearing Journal readers' views on this.
References
1. Kandiyil VN. Easy method for Implanon removal [Letter]. J Fam Plan Reprod
Health Care 2012;38:207-208.
2. Menon K. Implanon removal technique [Letter]. J Fam Plan Reprod Health Care, published online 13th August 2012.
Well done Berkshire. I completely agree with Mehigan and Burnett[1] - it
is essential that some standardisation is needed in the training of nurses
in SRH across the UK and it is preferable that this should be accredited
by the FSRH.
There is also the valuable point that there is a belief that accreditation
can only be achieved through academic institutes and the RCN! This is
usually at significant cost for the course, time...
Well done Berkshire. I completely agree with Mehigan and Burnett[1] - it
is essential that some standardisation is needed in the training of nurses
in SRH across the UK and it is preferable that this should be accredited
by the FSRH.
There is also the valuable point that there is a belief that accreditation
can only be achieved through academic institutes and the RCN! This is
usually at significant cost for the course, time out of practice and the
cost of replacing that member of staff for the duration of the course;
consequently not cost effective in these times of ever-reducing budgets. The
application for accreditation from the RCN is now very expensive. The
nurses that have had the enthusiasm and dedication to train in fitting implants and IUD/IUS (which increases the flexibility of the SRH service and
improves service user choice) need to have the opportunity to access
accreditation. I would support the notion that all nurses who have undertaken the
SRH course and extended training in these areas should be able to obtain
accreditation from the FSRH and therefore ensure that their skills are
transferable. I would be very happy to offer any assistance and support to
move this forward.
Reference 1. Mehighan S, Burnett J. An innovative training for nurses in sexual and reproductive health. J Fam Plann Reprod Health Care 2012;38:194–195.
We read with great interest the article[1] by Mehigan and Burnett in
the July 2012 issue of this Journal about training for post-graduation
nurses in this particular field of specialism and agree wholeheartedly
with the authors about the deplorable lack of standardised training in the
UK. It is important to equip nurses with knowledge and skills to provide
competency in the delivery of safe and effective methods of contra...
We read with great interest the article[1] by Mehigan and Burnett in
the July 2012 issue of this Journal about training for post-graduation
nurses in this particular field of specialism and agree wholeheartedly
with the authors about the deplorable lack of standardised training in the
UK. It is important to equip nurses with knowledge and skills to provide
competency in the delivery of safe and effective methods of contraception
and the treatment of sexual health problems.
At Oxfordshire Contraception and Sexual Health Service (CASH) we have
piloted our first training programme following the lead from the Reading
model. We have used the e-SRH e-learning theory followed by the Course of
5 (C5) with clinical experience organised in clinical placements with
dedicated mentors and course leader supervision.
A small cohort of nurses completed their training and evaluated the
course positively. We are embarking on another course soon and hope that
we can offer a more substantial validation in acknowledgement of all the
trainees' hard work.
We look forward to an accreditation from the Faculty of Sexual and
Reproductive Health (FSRH) that addresses the disparity in training and
assessment between doctors and nurses. A qualification for nurses similar
to the Diploma of the Faculty of Sexual and Reproductive Healthcare
(DFSRH) would be greatly appreciated.
Reference
1. Mehigan S, Burnett J. An innovative training for nurses in sexual and
reproductive health. J Fam Plann Reprod Health Care 2012;38:194-195.
I read the article[1] by Mehigan and Burnett in the July 2012 issue
of this Journal about training for nurses working in the field of sexual
and reproductive health (SRH) with interest.
This is certainly a challenge faced by many, and one which we are
trying to work on in Solihull at the moment. We have a significant number
of nurses who are shining stars in the world of SRH and are waiting for
funding to atten...
I read the article[1] by Mehigan and Burnett in the July 2012 issue
of this Journal about training for nurses working in the field of sexual
and reproductive health (SRH) with interest.
This is certainly a challenge faced by many, and one which we are
trying to work on in Solihull at the moment. We have a significant number
of nurses who are shining stars in the world of SRH and are waiting for
funding to attend a university-based course that is currently being run in
Coventry. We have an excellent relationship with our commissioner here and
luckily have managed to secure two or three places this year, which is
great news! However, some general practitioners are asking for a payment
to backfill the nurse's post whilst they are out of the practice.
All of our practice nurses have access to SHIP Training
(http://www.ship.bham.nhs.uk/), which provides an excellent foundation of
knowledge at entry level, with the course at Coventry being the next
level.
I agree and support the authors' thinking for nurses to have access
to the Diploma of the Faculty of Sexual and Reproductive Healthcare
(DFSRH) with equal accreditation. This would certainly overcome the need
to invest large amounts of money into a university-based course and would
give nurses an even footing within our field. It also provides an
established and structured programme of learning that has certainly been
tried and tested.
Over the coming months we will be making some decisions around the
type of training offered to our nurses, both within our CASH and GUM
services as well as within primary care. Taking on board the authors'
comments about "wobbly wheels" has really helped to clarify where we'll be
heading with our discussions.
Journal readers will probably gather that training and development
within the field is close to my heart as I am sure it is to Mehigan and
Burnett. Consequently, I would be willing to offer my assistance and
support to the worthy cause of improving training and accreditation for
nurses working within SRH.
Reference
1. Mehigan S, Burnett J. An innovative training for nurses in sexual and
reproductive health. J Fam Plann Reprod Health Care 2012;38:194-195.
I read with interest the letter by Dr Kandiyil on a method for
removal of Implanon® in the July 2012 edition of this Journal [1]. The
method describes stabilising the implant prior to its removal.
Inserting a needle is an unnecessary trauma and carries the risk of
damage to structures in the arm, especially in thin persons.
I find it easier and less traumatic to remove an implant, as far as
possible, t...
I read with interest the letter by Dr Kandiyil on a method for
removal of Implanon® in the July 2012 edition of this Journal [1]. The
method describes stabilising the implant prior to its removal.
Inserting a needle is an unnecessary trauma and carries the risk of
damage to structures in the arm, especially in thin persons.
I find it easier and less traumatic to remove an implant, as far as
possible, through the site of its insertion provided this is in close
proximity to its lower end. A small amount, usually 1 ml, of local
anaesthesia is injected subdermally under the tip of the implant. This
prevents oedema between the tip and the surface skin and so facilitates
easy palpation of the former while affording analgesia for the procedure.
The overlying skin is stretched (tenting) by the tip of the implant, which
is pushed down. An incision on the stretched skin over the tip is made and
through this the fibrous capsule around the end of the implant is
breached. Often the implant pops out with ease.
As always, the ease of removal of an implant is facilitated by the
device being correctly deployed subdermally at the time of insertion.
Reference
1. Kandiyil VN. Easy method for Implanon® removal. J Fam Plan Reprod
Health Care 2012;38:207-208.
I have just read and would like to congratulate the authors on their excellent article "An innovative training for nurses in sexual
reproductive health" in the July 2012 issue of this Journal [1].
I totally agree with the five benefits of their methods of training. The most
important one is matched multidisciplinary skills, this being so necessary
for nurses to undertake further training to fit implants and intrauterine
devi...
I have just read and would like to congratulate the authors on their excellent article "An innovative training for nurses in sexual
reproductive health" in the July 2012 issue of this Journal [1].
I totally agree with the five benefits of their methods of training. The most
important one is matched multidisciplinary skills, this being so necessary
for nurses to undertake further training to fit implants and intrauterine
devices/systems.
I was a founder member of the Faculty Associate Members Working Group
(established in 2005) that has been trying to resolve the problem of opening up the Faculty's medical Diploma to nurses. Some 7 years on, surely now the time is appropriate to
permit this for the future training of nurses in sexual reproductive health?
The Faculty now has 16 nurses training doctors in subdermal implants and
has nationally recognised their competence and skills.
Please could the Faculty produce an accreditation mechanism for nurses in
sexual reproductive health?
Reference
1. Mehighan S, Burnett J. An innovative training for nurses in sexual and reproductive health. J Fam Plann Reprod Health Care 2012;38:194-195.
Thank you for publishing the article by Draper et al. on intrauterine device (IUD) checks.(1) I would like to highlight an omission that is potentially
confusing. The authors state "until recently, it has been usual for a
patient [using intrauterine methods] to be advised to have an annual
check". Reference is made to relevant clinical guidelines from the
National Institute of Clinical Excellence (NICE) and from organisat...
Thank you for publishing the article by Draper et al. on intrauterine device (IUD) checks.(1) I would like to highlight an omission that is potentially
confusing. The authors state "until recently, it has been usual for a
patient [using intrauterine methods] to be advised to have an annual
check". Reference is made to relevant clinical guidelines from the
National Institute of Clinical Excellence (NICE) and from organisations
outside the UK, but there is no mention of Faculty of Sexual and
Reproductive Healthcare (FSRH) guidance.
FSRH guidance has not recommended annual IUD
checks since 2004,(2) based on World Health Organization Selected Practice
Recommendations published in 2002.(3) Follow-up is still recommended after
the first menses or 3-6 weeks after insertion.(4)
The study supports FSRH recommendations on annual checks. As
acknowledged by Dr Draper and colleagues, further research is required to
assess the benefits of the initial post-insertion check.
Louise Melvin, MRCOG, MFSRH
Director, FSRH Clinical Effectiveness Unit, Sandyford, Glasgow, UK;
louise.melvin@nhs.net
Competing interests None.
References
(1)Draper IB, Haque MS, McManus RJ. Routine intrauterine device
checks: are they advisable? J Fam Plann Reprod Health Care 2012;38:15-18.
(2)Clinical Effectiveness Unit. FFPRHC Guidance (January 2004). The
copper intrauterine device as long-term contraception. J Fam Plann Reprod
Health Care 2004;30:29-42.
(3)World Health Organization (WHO). Selected Practice Recommendations
for Contraceptive Use. Geneva, Switzerland: WHO, 2002.
(4)Faculty of Sexual and Reproductive Healthcare. Intrauterine
Contraception. 2007.
http://www.fsrh.org/pdfs/CEUGuidanceIntrauterineContraceptionNov07.pdf
[accessed 23 April 2012].
I was very pleased to see the article by Shapiro and colleagues[1]
that was recently published online in the Journal of Family Planning and
Reproductive Health Care but dismayed to see the emotional response from
epidemiologists.[2] This reanalysis of data from the so-called 'Million
Women' study[3] raises important clinical concerns about the original
strongly stated conclusions. I think it is essential that we see
co...
I was very pleased to see the article by Shapiro and colleagues[1]
that was recently published online in the Journal of Family Planning and
Reproductive Health Care but dismayed to see the emotional response from
epidemiologists.[2] This reanalysis of data from the so-called 'Million
Women' study[3] raises important clinical concerns about the original
strongly stated conclusions. I think it is essential that we see
continuing debate about these complex epidemiological studies, where
results are open to different interpretations.
Putting emotions aside, there are some problems with the original
analysis of the Million Women Study (MWS). This type of study cannot make
allowances for every possible bias, and as we are all aware 'big is not
necessarily better' when biases are present. The statistically significant
differences seen in the MWS are still very small, and potential biases
could considerably change the final statistics.
It is the traditional scientific way to have debate about the
findings of controversial studies, and, to me, it seems appropriate that
the epidemiologists should set aside emotion and address the legitimate
questions and criticisms of other scientists in the original journal to
which the article was submitted.
The epidemiologists have managed to raise fear among women in the
general community about use of hormone replacement preparations, yet these
therapies have an enormous impact on many aspects of wellbeing, such that
the benefit-risk ratio for most individual women is very positive. I would
really like to show the epidemiologists I know (who do not see any
patients) the dramatic impact that hormone replacement therapy (HRT) can
have on the quality of the lives of many menopausal women.
We should not forget that the much vaunted and highly criticised
Women's Health Initiative study showed a significant reduction in risk of
breast cancer for women using oestrogen-alone HRT.[4] I do not hear the epidemiologists trumpeting this!
Everything we do in this life carries risk. Please can we look
realistically at what are the many potential benefits of HRT and put them
in perspective with individual risk. Let the debate continue - without
emotion!
References
1. Shapiro S, Farmer RDT, Stevenson JC, Burger HG, Mueck AO. Does hormone
replacement therapy cause breast cancer? An application of causal
principles to three studies. Part 4. The Million Women Study. J Fam Plann
Reprod Health Care 2012;doi:10.1136/jfprhc-2011-100229.
2. Kmietowicz Z. Articles disputing link between HRT and breast cancer are
"ridiculous" BMJ 2012;344:e513.
3. Million Women Study Collaborators. Breast cancer and hormone
replacement therapy in the Million Women Study. Lancet 2003;362:419-427.
4. The Women's Health Initiative Steering Committee. Effects of conjugated
equine estrogen in postmenopausal women with hysterectomy: the Women's
Health Initiative randomized controlled trial. JAMA 2004;291:1701-1712.
Yet again scientists and epidemiologists are publicly debating the
controversies around the previously reported risks of HRT (hormone
replacement therapy). Is this further publicity deserved? The impact of
studies such as the Million Women Study (MWS)[1] and Women's Health
Initiative (WHI)[2] has been profound leading to significant reductions in
the use of HRT. This has understandably affected millions of menopausal
wom...
Yet again scientists and epidemiologists are publicly debating the
controversies around the previously reported risks of HRT (hormone
replacement therapy). Is this further publicity deserved? The impact of
studies such as the Million Women Study (MWS)[1] and Women's Health
Initiative (WHI)[2] has been profound leading to significant reductions in
the use of HRT. This has understandably affected millions of menopausal
women globally who deserve to be fully informed of any doubts that may
exist concerning the studies and should be aware of the debate.[3-4]
Ever since these publications were published the headlines in the
popular press have been biased towards the 'bad news' messages, resulting
in our patients feeling confused and under pressure to stop HRT. Following
a recent web-based survey 70% of women who came off their HRT were below
the age of 50. More importantly had these women known what we know today,
45% would have stayed on treatment.[5]
Many patients have been advised by their doctors to stop HRT and in
some cases have had their prescriptions unilaterally withdrawn. These
women have sought additional, poorly researched products with unproven
safety and efficacy - often sold as food supplements to circumvent
regulatory authorities.
Which risk is greatest? Taking a treatment which has little evidence
of effectiveness or safety, or taking a product with the enormous research
base that applies to HRT? Do we really know the answer? Is there enough
information to allow carers or patients to be fully informed? We believe
that the risk, if any is small and it is the view of the British Menopause
Society (BMS) that, when used appropriately, any risks are outweighed by
the benefits for the majority of women.
We must not forget that at the centre of the current published
arguments there are millions of women who want to be properly informed
about whether they should be taking HRT. Further, there are likely to be
thousands of doctors and nurses who want to be more knowledgeable and
confident about prescribing HRT.
In recognition of the menopause having diverse consequences and in an
attempt to improve the provision of essential information for women, the
BMS has recently submitted recommendations to the Department of Health.
The key recommendation is that women should, around the time of the
menopause transition, have a formal assessment of their needs, including
advice concerning lifestyle, diet and individualised discussion of the
risks and benefits of any suitable hormonal therapies. The BMS also
suggested that whilst this would require additional resources, the
potential long-term health gains would make this consultation highly cost
effective in disease prevention terms.[6]
The two main areas that require addressing urgently are:
1) A robust understanding of the benefits and risks of HRT for
patients and carers.
Most women who have been taking HRT since the publication of WHI and
MWS will have been doing so having weighed up the pros and cons of
treatment. Many women, even if there were genuinely a small increased risk
of breast cancer, would accept this, if they could have a good quality of
life through relief of the debilitating symptoms that invariably affect
personal, social and wider quality of life.
The clear benefits in osteoporosis treatment and prevention have
recently been included in a recommendation from the National Osteoporosis
Society that recommends HRT for the treatment and prevention of
osteoporosis in women under 60.[7]
2) HRT is not a single drug as the press and our patients seem to
have derived from the publicity.
HRT is a comprehensive suite of preparations and delivery routes
produced by the pharmaceutical industry in response to women's needs over
more than 20 years of development, refinement and research. This research
continues, even though research funding is a fraction of what it once
was.[8]
Recently completed trials not only suggest that natural progesterone
may not affect the risk of breast cancer and have a neutral effect,[9] but
also that soon to be released small studies of lower dose, endogenous-type
hormone treatments given to recently menopausal women show great
promise.[10]
The BMS feels that the research must continue. As the female
population lives longer after the menopause we need to establish safe ways
to prevent disease and maintain a high quality of life. This requires a
trial to establish definitively the correct indications, patients and
hormones for optimal postmenopausal health.[11] We should harness the
wealth of knowledge from the debates around WHI and MWS to design this
study rather than watch the arguments from the sidelines.
The BMS is dedicated to advancing education in all matters relating
to the menopause and to the primary prevention of the burden of
preventable chronic disease.
Nick Panay, Chairman, British Menopause Society;
Consultant Gynaecologist, Queen Charlotte's and Chelsea & Westminster
Hospitals, Honorary Lecturer, Imperial College London, London, UK
Heather Currie, Medical Advisory Council Member, British Menopause Society;
Associate Specialist Gynaecologist, Dumfries and Galloway Royal Infirmary,
Dumfries, UK; Medical Director "Menopause Matters Ltd"
Edward Morris, Medical Advisory Council Member, British Menopause Society;
Consultant, Obstetrics & Gynaecology, Norfolk & Norwich University
Hospital, Norwich, UK
References
[1] Million Women Study Collaborators. Breast cancer and HRT in the
Million Women Study. Lancet 2003; 362: 419-427.
[2] Writing group for the Women's Health Initiative Investigators.
Risks and benefits of estrogen plus progestin in healthy postmenopausal
women: principal results from the Women's health initiative randomised
controlled trial JAMA 2002; 288(3): 321-333.
[3] Shapiro S, Farmer RD, Stevenson JC, Burger H, Mueck AO. Does
hormone replacement therapy cause breast cancer? An application of causal
principles to three studies Part 4: The Million Women Study J Fam Plann
Reprod Health Care 2012. Jan 16 (ahead of print)
[4] Shapiro S, Farmer RD, Mueck AO, Seaman H, Stevenson JC. Does
hormone replacement therapy cause breast cancer? An application of causal
principles to three studies: part 2. The Women's Health Initiative:
estrogen plus progestogen. J Fam Plann Reprod Health Care 2011
Jul;37(3):165-172.
[5] Cumming GP, Currie HD, Panay N, Moncur R, Lee AJ. Stopping
hormone replacement
therapy: were women ill advised? Menopause Int 2011; 17(3): 82-87.
[6] British Menopause Society Council. Modernizing the NHS:
observations and recommendations from the British Menopause Society.
Menopause Int 2011 Jun;17(2):41-43.
[7] Bowring CE, Francis RM. National Osteoporosis Society's Position
Statement on hormone replacement therapy in the prevention and treatment
of osteoporosis. Menopause Int 2011; 17: 63-65.
[8] Panay N, Ylikorkala O, Archer DF, Rakov V, Gut R, Lang E. Ultra
low-dose estradiol and norethisterone acetate: Effective menopausal
symptom relief. Climacteric 2007; 10(2): 120-131.
[9] Fournier A, Fabre A, Mesrine S, Boutron-Ruault MC, Berrino F,
Clavel-Chapelon F. Use of different postmenopausal hormone therapies and
risk of histology- and hormone receptor-defined invasive breast cancer. J
Clin Oncol 2008; 26(8):1260-1268.
[10] Harman SM, Brinton EA, Cedars M, Lobo R, Manson JE, Merriam GR,
Miller VM, Naftolin F, Santoro N. KEEPS: The Kronos Early Estrogen
Prevention Study. Climacteric 2005 Mar;8(1):3-12.
[11] Panay N, Fenton A. Has the time for the definitive, randomized,
placebo-controlled HRT trial arrived? Climacteric 2011 Apr;14(2):195-196.
Conflict of Interest:
Nick Panay (NP), Eddie Morris (EM) and Heather Currie (HC) have received sponsorship for lectures and advisory work performed for pharmaceutical companies.
NP and HC have received educational grants for meetings and NP has received funding for pharmaceutical trials.
NP is co-editor in chief of Climacteric (International Menopause Society Journal) and EM/HC are co-editors in chief of Menopause International (British Menopause Society Journal).
Sexual abuse in children is a problem that often goes unnoticed by parents. Sometimes it is really difficult for parents to be aware of it. Children should not only receive sex education but should also be alerted to the possibility of assault by strangers, teachers, superiors in offices/workplaces, etc. Special counselling is required, and a great deal of psychological reassurance and support by their elders may also be n...
(FIGURES AVAILABLE FROM AUTHOR ON REQUEST - UNABLE TO UPLOAD TO THIS SITE)
The two letters describing individuals' different techniques for implant removal are timely [1,2]. Routine removal with or without refit is common practice throughout the UK as implants have become widely available and popular. It is not yet clear whether introduction of Nexplanon will lead to fewer difficult removals. It is evident from th...
Well done Berkshire. I completely agree with Mehigan and Burnett[1] - it is essential that some standardisation is needed in the training of nurses in SRH across the UK and it is preferable that this should be accredited by the FSRH. There is also the valuable point that there is a belief that accreditation can only be achieved through academic institutes and the RCN! This is usually at significant cost for the course, time...
We read with great interest the article[1] by Mehigan and Burnett in the July 2012 issue of this Journal about training for post-graduation nurses in this particular field of specialism and agree wholeheartedly with the authors about the deplorable lack of standardised training in the UK. It is important to equip nurses with knowledge and skills to provide competency in the delivery of safe and effective methods of contra...
I read the article[1] by Mehigan and Burnett in the July 2012 issue of this Journal about training for nurses working in the field of sexual and reproductive health (SRH) with interest.
This is certainly a challenge faced by many, and one which we are trying to work on in Solihull at the moment. We have a significant number of nurses who are shining stars in the world of SRH and are waiting for funding to atten...
I read with interest the letter by Dr Kandiyil on a method for removal of Implanon® in the July 2012 edition of this Journal [1]. The method describes stabilising the implant prior to its removal.
Inserting a needle is an unnecessary trauma and carries the risk of damage to structures in the arm, especially in thin persons.
I find it easier and less traumatic to remove an implant, as far as possible, t...
I have just read and would like to congratulate the authors on their excellent article "An innovative training for nurses in sexual reproductive health" in the July 2012 issue of this Journal [1]. I totally agree with the five benefits of their methods of training. The most important one is matched multidisciplinary skills, this being so necessary for nurses to undertake further training to fit implants and intrauterine devi...
Thank you for publishing the article by Draper et al. on intrauterine device (IUD) checks.(1) I would like to highlight an omission that is potentially confusing. The authors state "until recently, it has been usual for a patient [using intrauterine methods] to be advised to have an annual check". Reference is made to relevant clinical guidelines from the National Institute of Clinical Excellence (NICE) and from organisat...
I was very pleased to see the article by Shapiro and colleagues[1] that was recently published online in the Journal of Family Planning and Reproductive Health Care but dismayed to see the emotional response from epidemiologists.[2] This reanalysis of data from the so-called 'Million Women' study[3] raises important clinical concerns about the original strongly stated conclusions. I think it is essential that we see co...
Yet again scientists and epidemiologists are publicly debating the controversies around the previously reported risks of HRT (hormone replacement therapy). Is this further publicity deserved? The impact of studies such as the Million Women Study (MWS)[1] and Women's Health Initiative (WHI)[2] has been profound leading to significant reductions in the use of HRT. This has understandably affected millions of menopausal wom...
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