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JBI Database of Systematic Reviews and... Nov 2017Clinical practice frequently involves the practitioner touching patients' bodies in areas that are highly personal. If inappropriately performed, such intimate touch may... (Review)
Review
BACKGROUND
Clinical practice frequently involves the practitioner touching patients' bodies in areas that are highly personal. If inappropriately performed, such intimate touch may result in much anxiety, confusion and misinterpretation. Examination of evidence is necessary to guide practice in this area to mitigate risks and foster optimal clinician-patient relations and care.
OBJECTIVES
The objective of this qualitative systematic review was to identify and synthesize findings on the perceptions, experiences and preferences of patients receiving a clinician's touch during intimate care and procedures INCLUSION CRITERIA TYPES OF PARTICIPANTS: The current review considered studies that included patients who had received a clinician's touch during intimate care and procedures.
PHENOMENA OF INTEREST
The current review considered qualitative studies that evaluated patients' perceptions, experiences and preferences of a clinician's touch during intimate care and procedures.
TYPES OF STUDIES
The current review considered studies that collected qualitative data and included studies using designs such as phenomenology, grounded theory, ethnography, action research, qualitative description, focus group methodology and feminist research. In the absence of research studies, other text such as opinion papers and reports were considered.
CONTEXT
The current review considered studies that included patients' perceptions, experiences and preferences of a clinician's touch during intimate care and procedures. Intimate care is likely to occur in any clinical setting where patients need assistance with personal care, where physical examinations occur, or in settings were gynecologic, genitourinary, lower intestinal, dermatologic, cardiac or other procedures involving highly personal areas of the body are performed.
SEARCH STRATEGY
A three-step search strategy was used to find published and unpublished studies in English from 1970 to 2016, searching various databases which included searches of reference lists of studies selected for appraisal.
METHODOLOGICAL QUALITY
Included studies were assessed for methodological quality independently by two reviewers using the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) prior to inclusion. Of the two studies included in the review, one did not discuss ontological and epistemological assumptions, and the other did not include the personal assumptions and role of the researcher.
DATA EXTRACTION
Data were extracted using the data extraction tool from the JBI-QARI. The data extracted included details about the phenomenon of interest, populations and study methods.
DATA SYNTHESIS
Qualitative findings were synthesized using JBI-QARI.
RESULTS
Two studies were included in this review. Seven findings were organized into three categories and one synthesized finding, "clinician respect". The finding suggests that clients prefer engaged and meaningful communication prior to and during an intimate touch encounter, expect autonomy over their bodies and desire shared decision making relative to how and by whom intimate touch is provided.
CONCLUSION
The synthesized finding from this review suggests that:More research is needed to explore the perceptions and preferences for intimate touch among diverse populations, generations, cultures and contexts. Particular exploration is needed for populations with additional vulnerabilities to misunderstandings, anxiety and abuse, such as pediatric and geriatric patients, and patients with physical, mental and cognitive impairments.
Topics: Communication; Decision Making; Gynecological Examination; Health Personnel; Humans; Patient Preference; Perception; Physical Examination; Qualitative Research; Touch
PubMed: 29135751
DOI: 10.11124/JBISRIR-2017-003375 -
International Urogynecology Journal Jan 2020Pelvic organ prolapse (POP) is a common medical condition universally. In addition to physical examination, experts have increasingly turned their attention to...
INTRODUCTION AND HYPOTHESIS
Pelvic organ prolapse (POP) is a common medical condition universally. In addition to physical examination, experts have increasingly turned their attention to ultrasound in diagnosing POP for its low cost and dynamic imaging. The aim of this paper is to provide an overview of the methods of pelvic floor ultrasound in diagnosing POP, which has been lacking up till now.
METHODS
We included original papers comparing the outcome of the Pelvic Organ Prolapse Quantification system and ultrasound, published from 2008 to present in English, using electronic databases (MEDLINE, EMBASE, CENTRAL, PUBMED). All stages of the review were conducted in parallel by two reviewers.
RESULTS
Fifteen papers were included. We found that current methods have advantages and limitations. The main methods are to measure levator hiatus-related parameters and distances between the lowest point of the pelvic organs and reference lines during Valsalva maneuver, contraction, and at rest.
CONCLUSIONS
Pelvic floor ultrasound is valuable in diagnosing POP, yet suffers from a weakness in precision compared with physical examination. From the existing research, we found that the differences in baseline data such as weight, height, ethnicity, etc., may affect the cutoffs of the above-mentioned parameters. Further research is required to find one appropriate cutoff for each parameter, even if it is necessary to set group values for every parameter according to varying situations.
Topics: Adult; Aged; Female; Humans; Middle Aged; Pelvic Floor; Pelvic Organ Prolapse; Physical Examination; Predictive Value of Tests; Sensitivity and Specificity; Ultrasonography
PubMed: 31485686
DOI: 10.1007/s00192-019-04066-w -
International Journal of Gynaecology... Mar 2024Studies aimed to assess risk factors for pelvic organ prolapse (POP) recurrence following colpocleisis with nonconclusive results. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Studies aimed to assess risk factors for pelvic organ prolapse (POP) recurrence following colpocleisis with nonconclusive results.
OBJECTIVE
To investigate risk factors for POP recurrence following colpocleisis.
SEARCH STRATEGY
MEDLINE, PUBMED, Embase, Web of Science, and Cochrane databases were systematically searched.
SELECTION CRITERIA
Experimental and non-experimental studies investigating POP recurrence following colpocleisis.
DATA COLLECTION AND ANALYSIS
We assessed the association between preoperative and postoperative physical examination findings, demographics and medical history, and the risk of recurrence following colpocleisis.
MAIN RESULTS
A total of 954 studies were identified, of which five studies comprising 2978 patients were eligible for analysis. Both preoperative and postoperative genital hiatus length were significantly longer in the recurrence group (mean difference [MD] 0.48, 95% confidence interval [CI] 0.01-0.94, P = 0.04, I = 0% and MD 1.15, 95% CI 0.50-1.81, P = 0.005, I = 0%; respectively). Preoperative total vaginal length (TVL) did not differ between groups (MD 0.05, 95% CI -0.40 to 0.50, P = 0.83, I = 6%), postoperative TVL was found significantly longer in the recurrence group (MD 0.07, 95% CI -0.03 to 1.38, P = 0.04, I = 68%). Both preoperative and postoperative perineal body did not differ between groups. Women with a previous POP surgery were more likely to experience recurrence following colpocleisis (relative risk 2.09, 95% CI 1.18-3.69, P = 0.01, I = 0%). Patient's age and previous hysterectomy did not affect recurrence rates.
CONCLUSION
Wider preoperative and postoperative genital hiatus as well as longer post-operative TVL and previous POP surgery were associated with a higher risk for recurrence following colpocleisis, highlighting the importance of appropriate patient selection and surgical technique in minimizing this risk.
Topics: Pregnancy; Humans; Female; Colpotomy; Vagina; Pelvic Organ Prolapse; Hysterectomy; Risk Factors; Treatment Outcome; Gynecologic Surgical Procedures; Recurrence
PubMed: 37488940
DOI: 10.1002/ijgo.14999 -
The Journal of Sexual Medicine Jan 2023Alterations in pelvic floor muscle (PFM) function have been observed in women with persistent noncancer pelvic pain (PNCPP) as compared with women without PNCPP;... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Alterations in pelvic floor muscle (PFM) function have been observed in women with persistent noncancer pelvic pain (PNCPP) as compared with women without PNCPP; however, the literature presents conflicting findings regarding differences in PFM tone between women with and without PNCPP.
AIM
To systematically review the literature comparing PFM tone in women with and without PNCPP.
METHODS
MEDLINE, Embase, Emcare, CINAHL, PsycINFO, and Scopus were searched from inception to June 2021 for relevant studies. Studies were included that reported PFM tone data in women aged ≥18 years with and without PNCPP. The risk of bias was assessed with the National Heart, Lung, and Blood Institute Quality Assessment Tool. Standardized mean differences (SMDs) for PFM tone measures were calculated via random effects models.
OUTCOMES
Resting PFM tone parameters, including myoelectrical activity, resistance, morphometry, stiffness, flexibility, relaxation, and intravaginal pressure, measured by any clinical examination method or tool.
RESULTS
Twenty-one studies met the inclusion criteria. Seven PFM tone parameters were measured. Meta-analyses were conducted for myoelectrical activity, resistance, and anterior-posterior diameter of the levator hiatus. Myoelectrical activity and resistance were higher in women with PNCPP than in women without (SMD = 1.32 [95% CI, 0.36-2.29] and SMD = 2.05 [95% CI, 1.03-3.06], respectively). Women with PNCPP also had a smaller anterior-posterior diameter of the levator hiatus as compared with women without (SMD = -0.34 [95% CI, -0.51 to -0.16]). Meta-analyses were not performed for the remaining PFM tone parameters due to an insufficient number of studies; however, results of these studies suggested greater PFM stiffness and reduced PFM flexibility in women with PNCPP than in women without.
CLINICAL IMPLICATIONS
Available evidence suggests that women with PNCPP have increased PFM tone, which could be targeted by treatments.
STRENGTHS AND LIMITATIONS
A comprehensive search strategy was used with no restriction on language or date to review studies evaluating PFM tone parameters between women with and without PNCPP. However, meta-analyses were not undertaken for all parameters because few included studies measured the same PFM tone properties. There was variability in the methods used to assess PFM tone, all of which have some limitations.
CONCLUSION
Women with PNCPP have higher PFM tone than women without PNCPP; therefore, future research is required to understand the strength of the relationship between pelvic pain and PFM tone and to investigate the effect of treatment modalities to reduce PFM tone on pelvic pain in this population.
Topics: Female; Humans; Adolescent; Adult; Pelvic Floor; Muscle Tonus; Pelvic Pain; Pelvic Floor Disorders; Muscle Contraction
PubMed: 36897234
DOI: 10.1093/jsxmed/qdac002 -
Frontiers in Medicine 2021Endometriosis-related pleural effusion (PE) is a relatively rare but treatable cause of bloody PE. The clinical characteristics and outcome of patients with...
Endometriosis-related pleural effusion (PE) is a relatively rare but treatable cause of bloody PE. The clinical characteristics and outcome of patients with endometriosis-related PE remain unknown. We present a case of endometriosis-related PE diagnosed on pleural fluid cytology. A systematic review of all endometriosis-related PE cases in literature was conducted to elucidate the clinical characteristics, explore the diagnostic yield of pathological examinations, and to summarize the outcomes of therapeutic approaches in this disease. A case of endometriosis-related PE diagnosed in study hospital was reported. PubMed, Web of Science, and EMBASE were searched for publications pertaining to cases of endometriosis-related PE using predefined search terms. This case and those identified from PubMed, Web of Science, and EMBASE were analyzed. A total of 67 patients were included. Catamential symptoms were presented in 30 (44.8%) patients. Dyspnea was presented in 50 patients (74.6%), followed by right chest/shoulder pain in 34 (50.7%) and cough in 18 (26.9%). 82.8% of the patients had concomitant pelvic endometriosis and 76.7% was infertile or nulliparous. The diagnostic yield of pleural fluid cytological examination, percutaneous pleural biopsy, and surgical biopsy was 9.0, 45.5, and 78.7%, respectively. The patients who received surgery-based therapy had a significantly longer time to relapse than those who received progestational agents or GnRH analogs alone ( = 0.025) or hysterectomy and bilateral salpingoophorectomy (HBSO) ( = 0.040). High clinical awareness of pleural endometriosis is essential in all female with hemorrhagic PE, especially in young females who have infertility and/or pelvic endometriosis. Plerual fluid cytology might be a simple minimally invasive and cost-effective modality in the diagnosis of endometriosis-related PE. Treatment is challenging due to high recurrence and the optimal management of endometriosis-related PE needs further evaluation. The combined approach by surgery and hormonal therapy may achieve the best relapse-free survival.
PubMed: 33859990
DOI: 10.3389/fmed.2021.631048 -
Gynecologie, Obstetrique, Fertilite &... Dec 2018To provide national clinical guidelines focusing on intrauterine contraception.
OBJECTIVE
To provide national clinical guidelines focusing on intrauterine contraception.
METHODS
A systematic review of available literature was performed using Pubmed and Cochrane libraries. American, British and Canadian guidelines were considered as well.
RESULTS
Intrauterine contraception (IUC) displays a wide panel of indications, including adolescents, nulliparous, patients living with HIV before AIDS (Grade B) and women with history of ectopic pregnancy (Grade C). Cervical cancer screening should not be modified in women with IUC (Grade B). Bimanual examination and cervix inspection are mandatory before device insertion (Grade B). Patients should not systematically undergo screening for sexually transmitted infections (STI) before device insertion (Grade B). Screening for STI should be preferably done before insertion but it can be performed at the time of device insertion in asymptomatic women (Grade B). Routine antibiotic prophylaxis and premedication are not recommended before insertion (Grade A). A follow-up visit may be offered several weeks after insertion (Professional consensus). Routine pelvic ultrasound examination in not recommended after device insertion (Grade B). In patients with IUC, unscheduled bleeding, when persistent or associated with pelvic pain, requires further investigation to rule out complication (Professional agreement). Suspected uterine perforation warrants radiological workup to locate the device (Professional consensus). Laparoscopic approach should be preferred for elective removal of intrauterine device from abdominal cavity (Professional consensus). In case of accidental pregnancy with intrauterine device in situ, ectopic pregnancy should be excluded (Grade B). In case of viable and desired intrauterine pregnancy, intrauterine device removal is recommended if the strings are reachable (Grade C). Detection of Actinomyces-like organisms on pap smear in asymptomatic patients with intrauterine contraception does not require further intervention (Grade B). Immediate removal of intrauterine device is not recommended in case of STI or pelvic inflammatory disease (Grade B). Device removal should be considered in the absence of clinical improvement after 48 to 72 hours of appropriate treatment (Grade B).
CONCLUSION
Intrauterine contraception is a long-acting and reversible contraception method displaying great efficacy and high continuation rate. In contrast, complication rate is low. It should thus be offered to both nulliparous and multiparous women.
Topics: Adolescent; Adult; Contraception; Device Removal; Female; France; Humans; Intrauterine Devices; Pelvic Inflammatory Disease; Pregnancy; Pregnancy, Ectopic; Sexually Transmitted Diseases; Uterine Hemorrhage
PubMed: 30429071
DOI: 10.1016/j.gofs.2018.10.004 -
Journal of Ultrasonography Sep 2022The purpose of this study was to use ultrasonographic data to rule out and distinguish diseases that cause acute pelvic pain.
OBJECTIVE
The purpose of this study was to use ultrasonographic data to rule out and distinguish diseases that cause acute pelvic pain.
MATERIAL AND METHOD
The literature was reviewed using a systematic search of the databases Google Scholars and PubMed, as well as through hand searching. We looked through a total of 35 articles, but only 26 were selected after preliminary screening. Furthermore, 14 articles were left out because they required a membership, copyright clearance, or featured non-English references. There were a total of 12 articles included in the final revuew. Among all the study-related articles, only original research studies and one systematic review that sonographically explored the gynecological etiology of acute pelvic pain were selected.
RESULTS
Acute pelvic pain in women might be difficult to identify between gynecologic and non-gynecologic causes based solely on patient history and examination. Advanced imaging, like ultrasound, aids in determining the reason. Pelvic inflammatory disease can be difficult to diagnose, and clinicians should use a low threshold for starting presumptive treatment in order to avoid significant long-term effects such as infertility.
CONCLUSIONS
Pelvic pain can be acute, chronic or functional. Imaging investigations such as CT, ultrasonography, and MRI can assist in establishing a diagnosis. Particularly ultrasound scanning makes it possible to arrive at a diagnosis with a high degree of precision.
PubMed: 36482928
DOI: 10.15557/jou.2022.0030 -
Journal of Obstetrics and Gynaecology :... Jul 2018This three part systematic review gathered all the current evidence on the use, quality and effects of pelvic examination (abdominal palpation, bimanual vaginal...
AIM
This three part systematic review gathered all the current evidence on the use, quality and effects of pelvic examination (abdominal palpation, bimanual vaginal examination ± visualisation of the cervix) in primary care in diagnosing gynaecological cancer. Research questions • Do primary care practitioners perform pelvic examination during the assessment of symptoms, which are potentially indicative of gynaecological cancer? (RQ1) • What is the quality of pelvic examination performed in primary care, in terms of technical competence and interpretation of findings? (RQ2) • Is pelvic examination associated with the referral of patients with gynaecological cancer, and if so, in what way? (RQ3) Methods: PRISMA guidelines were followed. MEDLINE, EMBASE and Cochrane databases were searched using a combination of four terms, their MeSH terms and synonyms: pelvic examination; primary care; competency and gynaecological cancer. Inclusion and exclusion criteria were defined. Citation lists of all identified papers were searched. Two authors (PW and PM or CMB or CB) independently screened titles, abstracts and the full texts of publications. Data extraction was performed by PW and duplicated in all papers by a second reviewer (PM, CMB or CB). Paper quality was assessed using CASP methodology.
RESULTS
Nine hundred fifty four references were identified: 21 met the inclusion criteria: 5 RQ1; 6 RQ2; 10 RQ3. Examination rates prior to referral were generally low: one paper identified pre-referral PE in 52% of the patients; remaining papers demonstrated examination in less than half of the patients with suspicious symptoms. No papers explored GPs' competence at performing PE directly; but one paper identified 39% of 'clinically suspicious' cervices referred for colposcopy as having no abnormality. Pre-referral PE was associated with reduced diagnostic delay and early stage diagnosis.
CONCLUSIONS
Pre-referral pelvic examination in symptomatic women appears to be under-performed, despite urgent suspected cancer referral guideline recommendation to do so (Healthcare Improvement Scotland 2014 ; National Institute for Health and Care Excellence 2015 ). While no evidence was found to confirm GPs' competence for performing PE, there was an association with shorter diagnostic delay and better outcomes in those women where it was performed.
PubMed: 29944043
DOI: 10.1080/01443615.2018.1444410 -
Annals of Palliative Medicine Nov 2021The combination of shear wave elastography (SWE) and gray-scale ultrasound is widely used in the measurement of female pelvic floor muscle. However, the value of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The combination of shear wave elastography (SWE) and gray-scale ultrasound is widely used in the measurement of female pelvic floor muscle. However, the value of gray-scale ultrasound combined with SWE in the evaluation of primipara pregnancy and delivery is still controversial.
METHODS
Using the PubMed, Web of Science, Spring and Science Direct databases, clinical studies on gray-scale ultrasound combined with SWE on the diagnosis of primiparous pregnancy and childbirth published from January 2010 to December 2020 were searched. The RevMan5.3 software was used to conduct a meta-analysis of the indicators of gray-scale ultrasound combined with SWE for primiparas and non-primiparas, including: age, body mass index (BMI), gestational age at examination, gestational age at delivery, fetal weight, cervical length, shear wave velocity (SWV), front lip SWV, back lip SWV, Young's modulus and SWE index. Heterogeneity of the assessment results was tested using Cochran's chi-square.
RESULTS
A total of 13 articles were included. Age, BMI before delivery, gestational age (when gray-scale ultrasound was combined with SWE examination), gestational age at delivery, neonatal weight, cervical depth, SWV of placental margin, SWV of anterior lip, SWV of posterior lip and Young's modulus of the study group were significantly different from those of the control group. The elastic modulus of the perineal body and the SWE of the anterior lip of the study group were significantly higher than those of the control group [mean difference (MD) =8.11, 4.39, 95% confidence interval (CI): 3.90-12.31, 0.94-7.83; Z=3.78, 2.49, P=0.0002, 0.01]. The SWE of the posterior lip in the study group was significantly lower than that in the control group (MD =-4.34, 95% CI: -7.23 to 1.44; Z=2.93, P=0.003).
DISCUSSION
The number of cases in the control group in the included articles was significantly more than that in the observation group, and there were fewer descriptions of gray-scale ultrasound combined with SWE indicators in the included articles. There may be a certain degree of bias for indicators without obvious heterogeneity, and further analysis was required through a large number of clinical verifications. However, this study can provide certain reference values for the diagnosis of primipara pregnancy.
Topics: Elasticity Imaging Techniques; Female; Humans; Infant, Newborn; Placenta; Pregnancy; Ultrasonography
PubMed: 34872291
DOI: 10.21037/apm-21-2672 -
Pain Physician Aug 2021Chronic pain is one of the most often seen, but often undertreated, sequelae in survivors of cancer. Also, this population often shows significant nutritional...
BACKGROUND
Chronic pain is one of the most often seen, but often undertreated, sequelae in survivors of cancer. Also, this population often shows significant nutritional deficiencies, which can affect quality of life, general health status, and even risk of relapse. Given the influence of nutrition on brain plasticity and function, which in turn is associated with chronic pain in the population with cancer, it becomes relevant to focus on the association between pain and nutritional aspects in this population.
OBJECTIVE
To identify relevant evidence regarding nutrition and chronic pain in patients with cancer/survivors of cancer.
STUDY DESIGN
Systematic review.
METHODS
PubMed, Embase, and Web of Science were systematically searched for interventional and experimental studies that included patients with cancer /survivors of cancer with chronic pain, a nutrition-related observation/examination, and a pain-related outcome. Studies that complied with the inclusion and exclusion criteria were screened for methodological quality and risk of bias by using the Qualsyst (standard quality assessment criteria for evaluating primary research) tool.
RESULTS
The 2 included studies entailed uncontrolled trials which examined different nutritional supplements usage in various patients with cancer (breast, gastrointestinal and gynecological cancers). One study evaluated the effects of vitamin C, but did not report a change in pain outcomes. The other study, looking at the nutritional supplements glucosamine and chondroitin, found an improvement in pain after 12- and 24 weeks.
LIMITATIONS
The limitations to the generalization of these results include the insufficient amount of eligible studies and diversity in therapeutic interventions and participant groups.
CONCLUSION
The association between nutrition and chronic pain in patients with cancer /survivors of cancer is not well documented. The available studies are uncontrolled, and are therefore limited to draw firm conclusions. Additional research is highly needed, and a research agenda is proposed within this paper.
Topics: Chronic Pain; Dietary Supplements; Humans; Neoplasms; Quality of Life; Survivors
PubMed: 34323435
DOI: No ID Found