Royal Women's Hospital

Symptoms of endometriosis are often incompletely managed and recurrent surgeries are commonplace. The impact of re-operation on fertility remains unclear. This systematic review compares fertility outcomes in patients who underwent primary surgery versus re-operation for endometriosis. A systematic search of Embase, Medline, PubMed, and Web of Science was conducted, on publications between 2003 and 2023. Eligible studies included reproductive-aged women who underwent at least one surgery for endometriosis. Participants were divided into two groups: primary (one surgery) and re-operation (two or more surgeries). Outcomes included: rates of spontaneous pregnancy, live birth, miscarriage, pregnancy per embryo transfer (ET), and cumulative live birth. A meta-analysis was performed to calculate a combined estimate of the odds ratio (OR) across studies for selected outcomes. Seven retrospective cohort studies involving a total of 2101 participants met the inclusion criteria. The meta-analysis found that the odds of having spontaneous pregnancy were 2.1 times (95%CI, 1.5-2.8; P < 0.01) higher following a primary surgery compared to re-operation. The likelihood of having pregnancy per ET was 2.5 times (95% CI, 1.2---5.0; P = 0.01) higher following a primary surgery than with re-operation. Overall, for women attempting conception either naturally or via assisted reproductive technologies (ART), re-operation when compared to a single operation for endometriosis may negatively impact upon fertility and pregnancy outcomes, which has important implications for clinicians and patients when considering surgery.

Ductal carcinoma in situ (DCIS) is frequently identified during mammographic screening and treated to minimize the risk of development of invasive cancer. Local recurrence is a recognised risk after breast conserving surgery (BCS), and radiotherapy (RT) is frequently used to reduce this, despite having no impact on overall survival. Little is known about the impact of RT on patient-reported outcomes. We conducted a retrospective study to assess differences in health-related quality of life (HRQoL), fear of recurrence or progression (FRP), risk perceptions, and illness beliefs in women with DCIS, based on RT status. Women with DCIS diagnosed or treated at a tertiary hospital in Melbourne from 2010 to 2022 who underwent BCS were eligible. HRQoL (QLQ-C30; BR45), FRP (FCRI-SF), illness perceptions (BIPQ) and perceptions of risk of DCIS recurrence or progression were assessed by self-report. Questionnaires from 160 women (RT n = 80, no RT n = 80) were analysed. Median age was 65 and median time since diagnosis was 7.7 years. Overall impact on HRQoL of treatment was low irrespective of treatment. There was no difference in FRP according to RT status. Women who received RT had larger tumours (P < .001), more breast symptoms (P = .015) and stronger beliefs in the effectiveness of treatment (P = .034). In multivariate analysis, neuroticism, perceived likelihood of DCIS progression to invasive disease and emotional impact of DCIS predicted FRP. DCIS treatment was associated with minimal long-term HRQoL impact and low FRP, irrespective of RT. Improving understanding of recurrence/progression risk may protect against persistent FRP in these women.

An early lung ultrasound score (eaLUS) predicts surfactant administration in neonates of any gestational age with respiratory distress syndrome stabilized on CPAP. Whether this is also true for more unwell infants, non invasively and invasively ventilated, is not known. To assess whether an eaLUS may predict surfactant replacement in infants on different respiratory support modes (CPAP, nasal ventilation and mechanical ventilation). We also investigated eaLUS as a potential marker of unfavorable respiratory outcomes. Prospective, international, multicenter diagnostic study conducted from March 2024 to March 2025 in seven, level III Italian and Spanish neonatal intensive care units. Participants: neonates of any gestational age presenting with respiratory distress, enrolled within 2 h of birth and before the administration of surfactant. Intervention: eaLUS calculated within the first 2 h of life masked to attending physician evaluating both the type of respiratory support and the need for surfactant administration. Main outcome: prognostic accuracy of eaLUS to predict surfactant administration overall and in three subgroups based on early respiratory stabilization strategy (CPAP, NIV and MV). As secondary outcomes we investigated the accuracy of oxygen inspiratory fraction (FiO2) > 0.3 by mode of respiratory support to predict surfactant need. Additionally, logistic regression analysis was used to investigate the link between eaLUS with prolonged mechanical ventilation and death or BPD as secondary outcomes. We enrolled 229 infants stabilized on CPAP (n = 117), nasal ventilation (n = 58) and mechanical ventilation (n = 54). eaLUS had good prognostic accuracy in the total population (AUC, 0.86; 95% CI, 0.81–0.91). Despite the wide gap of mean airway pressure (MAP) across the population, eaLUS and MAP were only moderately correlated (rho = 0.39; p < 0.001). Optimal thresholds for surfactant replacement were slightly different (LUS ≥ 8 for CPAP; LUS ≥ 9 for nasal ventilation; LUS ≥ 10 for mechanical ventilation). FiO2 > 0.3 was a less accurate predictor of surfactant replacement. eaLUS was significantly associated to prolonged mechanical ventilation beyond both 72 and 168 h. Finally, eaLUS emerged as an independent predictor of BPD or death. An early LUS accurately predicts surfactant replacement in neonates non invasively and invasively ventilated and it is a noninvasive imaging prognostic marker of disease severity and adverse respiratory outcomes in this population. ISRCTN Registry (number ISRCTN10205806).

IntroductionPsychodynamic group therapy (PDGT) for schizophrenia offers a therapeutic space where patients can explore conflicts considered pathognomonic for the disorder. This study examines the role of PDGT during a crisis, focusing on psychotic dilemmas as described by Mentzos while also exploring the relevance of psychodynamic psychosis theory in ensuring effective psychotherapeutic care.Materials and methodsUsing qualitative content analysis, we analyzed transcribed audio recordings of therapy sessions during the COVID-19 pandemic. Thematic categories were inductively developed and examined within Mentzos’ psychodynamic framework.ResultsFour key themes emerged: (1) Loss of something meaningful, reflecting existential fears intensified by the crisis; (2) Paranoia, manifesting as distrust toward external structures; (3) Care and self-care, illustrating oscillations between autonomy and dependence; and (4) Closeness and distance in relationships, highlighting struggles of relationship formation, especially in times of rigid social boundaries. These themes mirror the psychotic dilemmas identified by Mentzos, reinforcing their relevance in crisis settings. The findings suggest that PDGT enables patients to explore these dilemmas and negotiate interpersonal conflicts. However, the crisis environment led to therapy disruptions, impacting group cohesion and participation, likely exacerbating symptoms in some patients.ConclusionPsychodynamic group therapy is crucial in supporting patients with schizophrenia, especially during crises, by enabling engagement with core conflicts through relationships rather than symptom formation. However, maintaining therapeutic continuity remains a challenge. Future research should examine group cohesion in various crises and its link to delusional symptoms, as well as strategies to stabilize group therapy and expand PDGT access internationally.

Abstract Background Colposcopy is a diagnostic procedure undertaken following an abnormal cervical screening result to assess and diagnose cervical precancer and cancer. First-time attendance is frequently associated with anxiety, uncertainty, and limited knowledge about the procedure. Evidence indicates that patient-facing information can enhance understanding, improve preparedness, and support attendance. In 2024, an educational video was introduced into outpatient care for first-time colposcopy patients at an Australian Dysplasia Clinic. The video was tailored to the clinical setting and embedded into appointment reminders and the hospital’s patient portal. This evaluation examined its reach, use, acceptability, and impacts. Methods A mixed-methods evaluation was conducted over three months in 2025 using website analytics and a patient survey (n = 70). Quantitative data examined reach and engagement, while survey responses explored usefulness, acceptability, and psychological impact. Descriptive statistics summarised quantitative findings, and open-ended responses provided qualitative insights. Results The video was viewed 1,101 times during the study period, with an average watch time of 3 minutes and 12 seconds. Among survey participants, 84% had watched the video, indicating strong reach and engagement. Viewers reported the video was easy to understand (98%) and an effective way to receive information (95%). The majority indicated that the video helped them feel prepared for their colposcopy (93%), reduced their concerns (83%), and did not increase anxiety (73%). Qualitative feedback emphasised the video was informative, clarified expectations and provided reassurance. Although 96% felt informed, many still expressed concerns about potential results of the colposcopy and future treatment options. Most (68%) suggested no changes to the video content, though some requested additional detail on procedure steps, including menstruation, biopsy and pain management and possible outcomes. Conclusions Embedding video resources into clinical systems is an effective strategy for improving patient knowledge and providing reassurance before a first colposcopy. While the video addressed informational needs and reduced concerns for most viewers, anxiety related to diagnostic outcomes persisted, underscoring the need for complementary and personalised emotional support strategies where required. These findings demonstrate the value and acceptability of video-based information in real world settings and inform future enhancements to patient-centred care.