The Ulster medical journal
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Abnormal uterine bleeding is a common gynaecological symptom. Whilst most patients have benign disease, thorough investigation is necessary, particularly in the peri- and post-menopausal woman. Hysteroscopy with directed biopsy of suspicious lesions is the gold standard investigation but it is invasive and is not offered in all units as an outpatient procedure. ⋯ In order to develop a nomogram for the investigation of women with abnormal bleeding patterns, we compared ultrasound/biopsy diagnoses with hysteroscopy/biopsy diagnosis. Pre- and peri-menopausal patients, and post-menopausal patients taking hormone replacement therapy should be investigated further if the endometrial thickness is more than 10 mm, if endometrial biopsy is abnormal, or if symptoms are recurrent. Similarly, post-menopausal patients not taking hormone replacement therapy with an endometrial thickness of 5 mm or more should be referred for hysteroscopy.
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Current policy and practice emphasises much more than ever before a need for purchasers and providers to reduce appropriately the length of hospital stay. Consequently, a number of early discharge "schemes" have been developed. This paper presents the findings from an evaluation of a "home from hospital" (HFH) scheme. ⋯ Clients' dependency levels generally decreased during their time on the scheme. Research using a controlled design is necessary in order to draw firm conclusions about the cost-effectiveness of a HFH service. Overall, home-from-hospital appears to be an effective model of an early discharge scheme worthy of further attention.