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OBJECTIVE: To test the feasibility of training laywomen as professional patients to teach doctors to fit the contraceptive diaphragm. DESIGN: Semi-structured interviews with instructing doctors and questionnaires to DFFP trainees. These documented current teaching practice and the acceptability of professional patients. The Delphi technique was used to establish a curriculum for the professional patients' training programme. RESULTS: The results show that there is currently a lack of standardisation in teaching methods and content with respect to diaphragm fitting. All instructing doctors and DFFP trainees involved had experienced difficulties in recruiting women for training, and the majority would be happy to work with professional patients. After three rounds of the Delphi procedure, consensus was reached and a curriculum developed. Five women were recruited on to a training programme, and four successfully completed it. CONCLUSION: Lack of standardisation and difficulty recruiting patients are current problems when training doctors to fit diaphragms. Our study shows that the use of professional patients would be acceptable to both DFFP trainees and instructing doctors, and that it is possible to recruit and train women for this purpose.

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OBJECTIVES: To assess compliance with the protocol for the management of women with Chlamydia trachomatis diagnosed in community family planning (FP) clinics; to assess the rate of attendance at genitourinary medicine (GUM) clinics by these women; to assess the rate of adequate treatment and to assess the level of communication between GUM clinics and FP clinics. METHOD: Retrospective review of FP clinic records and case notes to identify all women with positive or equivocal Chlamydia results during a 6 month period, and a retrospective review of records from five local GUM clinics. RESULTS: One hundred and twelve women were identified from FP clinic records with positive or equivocal Chlamydia results. Eighty-nine (79.5%) were referred to a GUM clinic. Twelve out of 14 women not referred had equivocal results. The median delay from the test being taken to the results being seen by a doctor was 9 days, and to the woman being referred was 10 days. Fifty-eight (51.7%, n = l12) women definitely attended a local GUM clinic. The FP clinics provided a letter of referral in 76 (85.4%, n = 89) women and the GUM clinics provided a letter of reply in 21 (48.8%, n = 43) women who attended with a referral letter. Three months after testing, only 54 (48.2%) of the 112 women with positive or equivocal Chlamydia tests were known by the referring FP clinic to have been treated. CONCLUSIONS: The majority of women with positive or equivocal Chlamydia results were referred to a GUM clinic according to the protocol. Attendance at GUM clinics was disappointing, as only 51.7% of the 112 women with positive or equivocal results had documented evidence of having attended. This raises the question not whether community clinics should be testing, but whether they should be initiating treatment and partner notification. Collaborative work between GUM clinics and community clinics around partner notification is needed, as well as funding for training and additional pharmacy costs. Further collaborative work between GUM and FP and reproductive healthcare (RHC) to evaluate the role of community clinics in the diagnosis and management of chlamydial infection and other sexually transmitted infections (STIs) is needed.

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PIP: Genitourinary medicine (GUM) clinics are likely to play an expanded role in the provision of family planning services. A recent survey of GUM clinics in the UK indicated that 71.4% provided emergency contraception and 48.1% provided routine contraception services. To facilitate the ability of GUM practitioners to provide contraceptive counseling and supplies to both men and women, this article reviews the current state of emergency contraception, combined oral contraceptives (OCs), modern IUDs, the levonorgestrel-releasing intrauterine system, female condoms, and the personalized computerized contraceptive system Persona. Also reviewed are current issues regarding the possible impact of combined OCs on an increased risk of venous thromboembolism and breast cancer.^ieng

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Sixty-nine patients (48 primigravidae and 21 multigravidae) with 12 hours of spontaneous premature rupture of membranes (PROM) after 36 weeks gestation were randomly allocated to receive either prostaglandin E2 (PGE2) oral tablets or intravenous oxytocin to stimulate labor. The two treatments were compared regarding stimulation - delivery interval (SDI), analgesic requirements, maternal and fetal side effects, and patient acceptability. The mean SDI was shorter in the oxytocin group, but without statistical significance. Analgesic requirements and fetal side effects were similar in the two groups, but there was a higher incidence of nausea and vomiting in those patients receiving the maximum dose (1 mg hourly) of PGE2. On subjective assessment, clinicians considered oxytocin to be more effective (p less than 0.05), while midwives felt both regimes to be equally helpful. PGE2 oral tablets were significantly (p less than 0.05) more acceptable to the patients, who preferred the convenience of oral dosing, the absence of an i.v. line and the increased mobility. It is concluded that PGE2 tablets are a safe and effective method of stimulating labor following PROM, and highly acceptable to parturients. In those women in whom labor has not been established within 8 h of initiating PGE2 therapy, or in whom gastric side effects are troublesome, intravenous oxytocin should be substituted.

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PIP: Comprehensive management of premenstrual syndrome (PMS) is reviewed, including assessment, counseling, diet, relaxation techniques, exercise, social adaptation, hormonal and medical treatment. Studies of PMS are remarkable for high (40-95%) placebo response, and good results with any treatment, especially in the 1st cycle in uncontrolled studies, but poor performance of therapies in random, double-blind, placebo-controlled studies. Heterogeneous groups of subjects, small numbers and too few cycles may contribute to these findings. The 1st step in treating PMS is thorough assessment and counseling, with at least a hour of listening to the patient. A healthy, varied diet should be suggested, limiting refined sugars, salt, red meat, diary products, chocolate, caffeine products, tobacco, alcohol, and increasing complex carbohydrates and PUFAs, in several small meals. PMS patients rarely have abnormal glucose tolerance tests, but they often exhibit related symptoms. Relaxation and exercise should be prescribed so as to raise endorphins, lower stress, increase control and provide enjoyment. Starting with non-hormonal medications, 100 mg vitamin B6 daily and 1.5 g evening primrose oil bid are suggested to regulate dopamine, serotonin and prostaglandin metabolism. Depending on symptoms, spironolactone diuretics, non-steroidal antiinflammatory drugs or anxiolytics may be prescribed. Hormone treatment ranges from progesterone per rectum or vagina, or oral progestins (usually didrogesterone), estradiol sc, implants, orally or transdermally, oral contraceptives, to hormonal antagonists such as bromocriptine, danazol or LH-RH analogues. The theoretical case for hormone treatments is not established, although some women obtain relief from certain treatments.^ieng

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