2020 |
Doherty E, Kingsland M, Wiggers J, Anderson AE, Elliott EJ, Symonds I, et al., 'Barriers to the implementation of clinical guidelines for maternal alcohol consumption in antenatal services: A survey using the theoretical domains framework', Health Promotion Journal of Australia, 31 133-139 (2020) [C1]
© 2019 Australian Health Promotion Association Issue addressed: The aim of this study was to assess potential barriers to the implementation of clinical guideline recommendations ... [more]
© 2019 Australian Health Promotion Association Issue addressed: The aim of this study was to assess potential barriers to the implementation of clinical guideline recommendations regarding maternal alcohol consumption by antenatal clinicians and managers. Methods: Cross-sectional surveys of antenatal clinicians and managers employed in a New South Wales Local Health District were undertaken. Survey items were developed based on 11 domains of the Theoretical Domains Framework. Consistent with previous studies, a cut point of less than 4 was applied to mean values of survey items (range: 1-5) to identify domains representing barriers to the implementation. Results: Thirty-three antenatal clinicians and eight managers completed the surveys. For clinicians, the domains with the lowest mean values included ¿environmental context and resources¿ (ie, complexity of appointments and availability of supporting systems) (mean: 3.13, SD: 0.93); ¿social influences¿ (ie, expectations of others that alcohol will be addressed) (mean: 3.33, SD: 0.68); ¿beliefs about capabilities¿ (ie, confidence in providing guideline recommendations) (mean: 3.51, SD: 0.67); and ¿behavioural regulation¿ (ie, planning and responding to feedback) (mean: 3.53, SD: 0.64). For managers, ¿emotion regulation¿ (ie, stress in managing change) (mean: 2.13, SD: 0.64) and ¿environmental context and resources¿ (ie, complexities of managing change) (mean: 3.13, SD: 0.83) were the lowest scoring domains. Conclusions: The antenatal service environment and availability of resources appear to be primary barriers to both clinicians and managers implementing guidelines for maternal alcohol consumption. So what?: In the development of interventions to support the delivery of clinical guideline recommendations addressing alcohol consumption during pregnancy, a broad range of potential barriers at both the clinician and manager levels need to be considered and targeted by effective implementation strategies.
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2019 |
Bunjo Z, Bunjo LJ, Bacchi S, Donnelly F, Hudson JN, Symonds I, 'Sleep Patterns and Risky Driving Behaviors in Clinical Medical and Nursing Students', ACADEMIC PSYCHIATRY, 43 555-556 (2019)
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2019 |
Doherty E, Kingsland M, Wolfenden L, Wiggers J, Dray J, Hollis J, et al., 'Implementation strategies to improve preconception and antenatal care for tobacco smoking, alcohol consumption and weight management: a systematic review protocol', SYSTEMATIC REVIEWS, 8 (2019)
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2018 |
Symonds I, 'A common medical schools curriculum in obstetrics and gynaecology', Australian and New Zealand Journal of Obstetrics and Gynaecology, 58 491-493 (2018)
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2018 |
You W, Symonds I, Henneberg M, 'Low fertility may be a significant determinant of ovarian cancer worldwide: An ecological analysis of cross- sectional data from 182 countries', Journal of Ovarian Research, 11 (2018)
© 2018 The Author(s). Background: Ageing, socioeconomic level, obesity, fertility, relaxed natural selection and urbanization have been postulated as the risk factors of ovarian c... [more]
© 2018 The Author(s). Background: Ageing, socioeconomic level, obesity, fertility, relaxed natural selection and urbanization have been postulated as the risk factors of ovarian cancer (OC56). We sought to identify which factor plays the most significant role in predicting OC56 incidence rate worldwide. Methods: Bivariate correlation analysis was performed to assess the relationships between country-specific estimates of ageing (measured by life expectancy), GDP PPP (Purchasing power parity), obesity prevalence, fertility (indexed by the crude birth rate), opportunity for natural selection (Ibs) and urbanization. Partial correlation was used to compare contribution of different variables. Fisher A-to-Z was used to compare the correlation coefficients. Multiple linear regression (Enter and Stepwise) was conducted to identify significant determinants of OC56 incidence. ANOVA with post hoc Bonferroni analysis was performed to compare differences between the means of OC56 incidence rate and residuals of OC56 standardised on fertility and GDP respectively between the six WHO regions. Results: Bivariate analyses revealed that OC56 was significantly and strongly correlated to ageing, GDP, obesity, low fertility, Ibs and urbanization. However, partial correlation analysis identified that fertility and ageing were the only variables that had a significant correlation to OC56 incidence when the other five variables were kept statistically constant. Fisher A-to-Z revealed that OC56 had a significantly stronger correlation to low fertility than to ageing. Stepwise linear regression analysis only identified fertility as the significant predictor of OC56. ANOVA showed that, between the six WHO regions, multiple mean differences of OC56 incidence were significant, but all disappeared when the contributing effect of fertility on OC56 incidence rate was removed. Conclusions: Low fertility may be the most significant determining predictor of OC56 incidence worldwide.
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2018 |
Waller A, Bryant J, Cameron E, Galal M, Symonds I, Sanson-Fisher R, 'Screening for recommended antenatal risk factors: How long does it take?', Women and Birth, 31 489-495 (2018) [C1]
© 2018 Australian College of Midwives Background: Detection and management of antenatal risk factors is critical for quality care. Aims: To determine (1) women's views about ... [more]
© 2018 Australian College of Midwives Background: Detection and management of antenatal risk factors is critical for quality care. Aims: To determine (1) women's views about when they should be asked about antenatal health factors as recommended in the Australian antenatal guidelines; and (2) the time required to provide recommended care using a clinical scenario. Methods: In Phase 1, pregnant women attending an outpatient obstetrics clinic at a public hospital were surveyed about preferred screening for antenatal risk factors during visit(s). In Phase 2, a hypothetical clinical scenario of a woman attending her first antenatal visit with a practising midwife was video-recorded to extrapolate the time taken to ask about and offer assistance to manage clinical, screening and lifestyle risk factors. Findings: Most women (96%) perceived they should be asked about each of the risk factors at least once (i.e. at first visit). Total time taken to ask about all risk factors was 52 min. More time was spent discussing clinical (11 min) than lifestyle factors (4 min). Adjusting for the estimated prevalence of each risk factor, the time taken to offer assistance was 8 min per woman. Average time required for detecting and offering assistance to manage risk factors is 60 min per average risk woman. Conclusion: Women are willing to be asked about risk factors; however this process is time-consuming. Strategies to streamline visits and prioritise recommendations so time-efficient yet comprehensive care can be delivered are needed, particularly when factors require monitoring over time and for those who may be ¿at-risk¿ for multiple factors.
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2018 |
Kingsland M, Doherty E, Anderson AE, Crooks K, Tully B, Tremain D, et al., 'A practice change intervention to improve antenatal care addressing alcohol consumption by women during pregnancy: research protocol for a randomised stepped-wedge cluster trial', IMPLEMENTATION SCIENCE, 13 (2018)
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2016 |
Lovett S, Roche J, Hunter S, Symonds I, Tomlinson N, Gagnon R, et al., 'Respective value of the traditional clinical rotation and high fidelity simulation on the acquisition of clinical reasoning skills in medical students A Randomized Controlled Trial.', MedEdPublish, 5 (2016) [C1]
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2015 |
Southgate E, Kelly BJ, Symonds IM, 'Disadvantage and the 'capacity to aspire' to medical school', Medical Education, 49 73-83 (2015) [C1]
© 2014 John Wiley & Sons Ltd. Objectives: This study was designed to elucidate why students from backgrounds of lower socio-economic status (SES) and who may be first in the... [more]
© 2014 John Wiley & Sons Ltd. Objectives: This study was designed to elucidate why students from backgrounds of lower socio-economic status (SES) and who may be first in their family (FIF) to enter university continue to be under-represented in medical schools. Methods: Academically able high school students (n = 33) from a range of socio-economic backgrounds participated in focus groups. School careers advisors (n = 5) were interviewed. Students discussed their career and education plans and ideas about a medical career. Careers advisors discussed enablers and barriers to a medical career for their students. Results: Students of lower SES and of FIF status attending schools situated in poorer geographic locations had limited access to suitable work experience and, despite their participation in gifted and talented classes, were considered to be at greater risk of not achieving the high level of academic achievement required for admission to medical school. Conclusions: There is utility in exploring intersecting differences and Appardurai's theory of the 'capacity to aspire' for the purpose of understanding the causes of the under-representation of disadvantaged students in medical schools. A focused materialist approach to building the aspirations of disadvantaged students, particularly those attending schools located in poorer areas, is required if effective pre-entry equity programmes are to be developed and evaluated. Alternatively, medical schools might rethink their reliance on very high academic attainment in the admission process. Discuss ideas arising from the article at www.mededuc.com discuss.
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2014 |
Symonds IM, 'The Journal of Obstetrics and Gynaecology - A personal perspective', Journal of Obstetrics and Gynaecology, 34 551-552 (2014)
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2014 |
Wan C, Latter JL, Amirshahi A, Symonds I, Finnie J, Bowden N, et al., 'Progesterone Activates Multiple Innate Immune Pathways in Chlamydia trachomatis-Infected Endocervical Cells', American Journal of Reproductive Immunology, 71 165-177 (2014) [C1]
Problem: Susceptibility to Chlamydia trachomatis infection is increased by oral contraceptives and modulated by sex hormones. We therefore sought to determine the effects of femal... [more]
Problem: Susceptibility to Chlamydia trachomatis infection is increased by oral contraceptives and modulated by sex hormones. We therefore sought to determine the effects of female sex hormones on the innate immune response to C. trachomatis infection. Method of study: ECC-1 endometrial cells, pre-treated with oestradiol or progesterone, were infected with C. trachomatis and the host transcriptome analysed by Illumina Sentrix HumanRef-8 microarray. Primary endocervical epithelial cells, prepared at either the proliferative or secretory phase of the menstrual cycle, were infected with C. trachomatis and cytokine gene expression determined by quantitative RT-PCR analysis. Results: Chlamydia trachomatis yield from progesterone-primed ECC-1 cells was significantly reduced compared with oestradiol-treated cells. Genes upregulated in progesterone-treated and Chlamydia-infected cells only included multiple CC and CXC chemokines, IL-17C, IL-29, IL-32, TNF-a, DEFB4B, LCN2, S100A7-9, ITGAM, NOD2, JAK1, IL-6ST, type I and II interferon receptors, numerous interferon-stimulated genes and STAT6. CXCL10, CXCL11, CX3CL1 and IL-17C, which were also upregulated in infected secretory-stage primary cells, and there was a trend towards higher levels of immune mediators in infected secretory-phase compared with proliferative-phase cells. Conclusion: Progesterone treatment primes multiple innate immune pathways in hormone-responsive epithelial cells that could potentially increase resistance to chlamydial infection. © 2013 John Wiley & Sons Ltd.
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2013 |
Symonds IM, Talley NJ, 'Can professionalism be taught?: Yes, but a more strategic approach should replace didactic methods', Medical Journal of Australia, 199 380-381 (2013) [C3]
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2013 |
Symonds IM, 'Screening for gynaecological conditions', Obstetrics, Gynaecology and Reproductive Medicine, 23 14-19 (2013) [C1]
Well-organized cervical screening programmes have reduced the mortality from cervical cancer by up to 50% in the developed world. Despite the successful development of human papil... [more]
Well-organized cervical screening programmes have reduced the mortality from cervical cancer by up to 50% in the developed world. Despite the successful development of human papillomavirus vaccines there is likely to remain a need for cervical screening for the foreseeable future. In contrast, the value of mass screening for other gynaecological cancers remains unproven, although current screening methods can detect early stage ovarian cancer in asymptomatic individuals. Breast screening does appear to be associated with a reduction in mortality in women aged 50-69 years but disagreement remains about its value in younger and older women. Testing for sexually transmitted infections is effective in reducing morbidity but tends to be selective at present because of concerns over the cost and psychosocial implications of general population screening. © 2012.
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2012 |
Foster AB, Symonds IM, 'A comparative study of efficacy and outcomes of large loop excision of the transformation zone procedure performed under general anaesthesia versus local anaesthesia', Australian & New Zealand Journal of Obstetrics & Gynaecology, 52 128-132 (2012) [C1]
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2012 |
Nair BR, Hensley MJ, Parvathy MSD, Lloyd DM, Murphy B, Ingham K, et al., 'A systematic approach to workplace-based assessment for international medical graduates', Medical Journal of Australia, 196 399-402 (2012) [C1]
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2012 |
Lynagh MC, Bonevski B, Sanson-Fisher RW, Symonds IM, Scott A, Hall AE, Oldmeadow CJ, 'An RCT protocol of varying financial incentive amounts for smoking cessation among pregnant women', BMC Public Health, 12 1032 (2012) [C3]
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2012 |
Galal M, Symonds IM, Murray H, Petraglia F, Smith R, 'Postterm pregnancy', Facts, Views & Visions in OBGYN, 4 175-187 (2012) [C1]
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2011 |
Amirshahi A, Wan C, Beagley K, Latter JL, Symonds IM, Timms P, 'Modulation of the Chlamydia trachomatis In vitro transcriptome response by the sex hormones estradiol and progesterone', BMC Microbiology, 11 (2011) [C1]
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2011 |
Lynagh MC, Bonevski B, Symonds IM, Sanson-Fisher RW, 'Paying women to quit smoking during pregnancy? Acceptability among pregnant women', Nicotine & Tobacco Research, 13 1029-1036 (2011) [C1]
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2010 |
Lumsden MA, Symonds IM, 'New undergraduate curricula in the UK and Australia', Best Practice and Research: Clinical Obstetrics and Gynaecology, 24 795-806 (2010) [C1]
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2010 |
Proietto AM, Otton GR, Symonds IM, McEvoy MA, Attia JR, Gilbert M, et al., 'Polymorphisms in genes of the steroid hormone biosynthesis and metabolism pathways and endometrial cancer risk', Cancer Epidemiology, 34 328-337 (2010) [C1]
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2010 |
Palliser HK, Zakar T, Symonds IM, Hirst JJ, 'Progesterone receptor isoform expression in the guinea pig myometrium from normal and growth restricted pregnancies', Reproductive Sciences, 17 776-782 (2010) [C1]
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2010 |
Ashton KA, Proietto AM, Otton GR, Symonds IM, McEvoy MA, Attia JR, Scott R, 'Toll-Like Receptor (TLR) and Nucleosome-binding Oligomerization Domain (NOD) gene polymorphisms and endometrial cancer risk', BMC Cancer, 10 1-7 (2010) [C1]
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2009 |
Ashton KA, Proietto AM, Otton GR, Symonds IM, McEvoy MA, Attia JR, et al., 'Estrogen receptor polymorphisms and the risk of endometrial cancer', BJOG: An International Journal of Obstetrics and Gynaecology, 116 1053-1061 (2009) [C1]
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2009 |
James D, Ferguson E, Powis DA, Bore MR, Munro D, Symonds IM, Yates J, 'Graduate entry to medicine: Widening psychological diversity', BMC Medical Education, 9 1-8 (2009) [C1]
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2009 |
Ashton KA, Proietto AM, Otton GR, Symonds IM, Scott R, 'Genetic variants in MUTYH are not associated with endometrial cancer risk', Hereditary Cancer in Clinical Practice, 7 1-5 (2009) [C1]
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2009 |
Symonds IM, 'Screening for gynaecological conditions', Obstetrics, Gynaecology and Reproductive Medicine, 19 301-307 (2009) [C1]
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2009 |
Angstetra D, Tait T, Tan J, Symonds IM, 'Should liquid-based cytology be performed prior to colposcopy? A comparison of the accuracy, unsatisfactory rates and cost in a tertiary referral setting', Australian & New Zealand Journal of Obstetrics & Gynaecology, 49 681-684 (2009) [C1]
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2009 |
Soltani H, Dickinson F, Symonds IM, 'Placental cord drainage after spontaneous vaginal delivery as part of the management of the third stage of labour', Cochrane Database of Systematic Reviews, (2009)
Background: Cord drainage in the third stage of labour involves unclamping the previously clamped and separated umbilical cord and allowing the blood from the placenta to drain fr... [more]
Background: Cord drainage in the third stage of labour involves unclamping the previously clamped and separated umbilical cord and allowing the blood from the placenta to drain freely into an appropriate receptacle. Currently there are no systematic reviews of the effects of placental cord drainage on the management of the third stage of labour. Objectives: The objective of this review was to assess the specific effects of placental cord drainage on the third stage of labour, with or without the prophylactic use of oxytocics. Search strategy: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (July 2005), CINAHL (1982 to December 2004) and the National Research Register (December 2004). We updated the search of the Cochrane Pregnancy and Childbirth Group's Trials Register on 16 July 2009 and added the results to the awaiting classification section. Selection criteria: Randomised trials involving placental cord drainage as a variable within the package of interventions as part of the management of the third stage of labour. Data collection and analysis: Two review authors independently assessed the quality of trials and extracted data. Main results: Two studies met our inclusion criteria in terms of quality and relevance. Cord drainage could impact the third stage of labour as the results show a statistically significant reduction in the length of third stage of labour (one trial, n = 147, weighted mean difference (minutes) -5.46, 95% confidence interval (CI) -8.02 to -2.90). In the incidence of retained placenta at 30 minutes after birth (one trial, n = 477, relative risk 0.28, 95% CI 0.10 to 0.73) a significant difference was found, but this should be interpreted with caution due to potential intervention bias. Authors' conclusions: It is difficult to draw conclusions from such a small number of studies, especially where the review outcomes were presented in a variety of formats. However, there does appear to be some potential benefit from the use of placental cord drainage in terms of reducing the length of the third stage of labour. More research is required to investigate the impact of cord drainage on the management of the third stage of labour. Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
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2009 |
Ashton KA, Proietto AM, Otton GR, Symonds IM, McEvoy MA, Attia JR, et al., 'Polymorphisms in TP53 and MDM2 combined are associated with high grade endometrial cancer', Gynecologic Oncology, 113 109-114 (2009) [C1]
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2008 |
Ashton KA, Proietto AM, Otton GR, Symonds IM, McEvoy MA, Attia JR, et al., 'The influence of the Cyclin D1 870 G\A polymorphism as an endometrial cancer risk factor', BMC Cancer, 8 1-6 (2008) [C1]
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2008 |
James D, Feguson E, Powis DA, Symonds I, Yates J, 'Graduate entry to medicine: Widening academic and socio-demographic access', Medical Education, 42 294-300 (2008) [C1]
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2007 |
Shaw RW, Symonds IM, Tamizian O, Chaplain J, Mukhopadhyay S, 'Randomised comparative trial of thermal balloon ablation and levonorgestrel intrauterine system in patients with idiopathic menorrhagia', Australian and New Zealand Journal of Obstetrics and Gynaecology, 47 335-340 (2007)
Aims: To compare the effectiveness of thermal balloon ablation (TBA) and levonorgestrel intrauterine system (LNG-IUS) in the management of idiopathic menorrhagia and changes in pi... [more]
Aims: To compare the effectiveness of thermal balloon ablation (TBA) and levonorgestrel intrauterine system (LNG-IUS) in the management of idiopathic menorrhagia and changes in pictorial blood loss assessment chart (PBAC) scores in patients who had failed on oral medical treatment. Methods: Phase III, single-centre, open randomised controlled trial. Following full screening and evaluation of 104 women, 33 were randomised to TBA and 33 to LNG-IUS. Primary outcomes were changes in PBAC scores from baseline to 12 months. Secondary outcomes were changes in haemoglobin and serum ferritin, at six.months, continuation with treatment and hysterectomy rates at two years and changes in PBAC scores at three, six and nine months. Results: All patients randomised had a PBAC score of =120. At all assessment times, median PBAC scores were less than baseline, the greatest reductions being seen at 12 months for both treatments. When the median PBAC for the LNG-IUS (26 (0-68)) was significantly different to the median PBAC for the TBA cohort (62 (0-142)) P<0.001. Irregular bleeding problems were the most common reason for discontinuation of the LNG-IUS and resulted in more women (39.8%) seeking other treatment by two years than the TBA (23.1%) (P<0.05) and more undergoing a hysterectomy (20.7% vs 13.3%, respectively) (p>0.05). Patient acceptability of the LNG-IUS and TBA was similar at 12 and 24.months in terms of their perceived satisfaction of effect on menorrhagia. Conclusions: Both TBA and LNG-IUS achieved significant decreases in PBAC scores, with those for the LNG-IUS being significantly greater at 12 months. However, prolonged days of bleeding resulted in fewer women continuing with the LNG-IUS at two years. © 2007 The AuthorsJournal compilation © 2007 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.
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2007 |
Broughton Pipkin F, Broughton Pipkin F, Kalsheker N, Morgan L, O'Malley S, Henfrey M, et al., 'Babies, pre-eclamptic mothers and grandparents: A three-generation phenotyping study', Journal of Hypertension, 25 849-854 (2007)
OBJECTIVES: Pre-eclampsia (PE) is associated with an increased incidence of cardiovascular disease in later life. Daughters of PE mothers have an increased risk of developing the ... [more]
OBJECTIVES: Pre-eclampsia (PE) is associated with an increased incidence of cardiovascular disease in later life. Daughters of PE mothers have an increased risk of developing the disease; recent epidemiological data suggest a (grand)paternal contribution. We have directly studied the parents of 673 women with stringently defined PE in relation to their daughters' disease. METHODS: (Grand)parental medical history, current medication and blood pressure (using an Omron 705 automated monitor) were recorded, with obstetric history for the grandmother, including directly verified pregnancy hypertension. RESULTS: The age of the 649 participating grandmothers was 55.5 ± 7.5 years (mean ± SD) and that of the 542 participating grandfathers was 58.0 ± 7.3 years. Essential hypertension (EHT) requiring therapy was present in 23.4% of the grandmothers and 22.8% of the grandfathers. Patients had moderate to severe PE; a quarter were delivered before 34 weeks' gestation. A third of the babies had birthweights below the third centile; the perinatal mortality rate was 2.1%. Grandpaternal absolute systolic pressures and EHT status were highly significant determinants of maternal systolic pressure during gestation (F = 11.8, P < 0.001; F = 8.91, P = 0.003, respectively); maternal body mass index (BMI) had less effect. A similar, less marked, pattern was seen for diastolic pressure (F = 6.01, P = 0.014; F = 11.50, P < 0.0001). Grandmaternal EHT did not influence her daughter's systolic or diastolic pressure (P > 0.2 for both). CONCLUSIONS: A paternal, but not maternal, history of EHT is associated with increased risks of non-pregnant hypertension in the children, the risk being greater in daughters than sons. Pregnancy may unveil or exacerbate this effect, possibly reflecting underlying endothelial vulnerability. © 2007 Lippincott Williams & Wilkins, Inc.
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2007 |
Symonds IM, 'Screening for gynaecological conditions', The Foundation Years, 3 263-267 (2007) [C2] |
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2006 |
Symonds IM, 'Screening for gynaecological conditions', Current Obstetrics and Gynaecology, 16 337-343 (2006) [C2]
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2006 |
Symonds IM, 'Gynaecological surgery: Techniques, training, skills and assessment - Preface', Best Practice & Research in Clinical Obstetrics & Gynaecology, 20 1-2 (2006) [C3] |
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2006 |
Symonds I, 'Preface', Best Practice and Research: Clinical Obstetrics and Gynaecology, 20 1-2 (2006)
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2005 |
Fraser DM, Symonds IM, Cullen L, 'Multiprofessional or interprofessional education in gynaecology', The Obstetrician & Gynaecologist, 7 271-275 (2005) [C1]
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2005 |
Morgan L, Farrall M, Baker PN, Pipkin FB, Kalsheker N, O Malley S, et al., 'Disentangling fetal and maternal susceptibility for pre-eclampsia: A British multicenter candidate-gene study', American Journal of Human Genetics, 77 127-131 (2005)
© 2005 by The American Society of Human Genetics. The Genetics of Pre-Eclampsia (GOPEC) collaboration aims to identify genetic factors in U.K. families affected by pre-eclampsia. ... [more]
© 2005 by The American Society of Human Genetics. The Genetics of Pre-Eclampsia (GOPEC) collaboration aims to identify genetic factors in U.K. families affected by pre-eclampsia. A number of genetic studies have reported associations with pre-eclampsia, but attempts to replicate these findings have yielded inconsistent results. We describe the results of extensive genotyping of seven candidate genes previously reported as conferring susceptibility to pre-eclampsia. Six hundred fifty-seven women affected by pre-eclampsia and their families were genotyped at 28 single-nucleotide polymorphisms in the genes encoding angiotensinogen, the angiotensin receptors, factor V Leiden variant, methylene tetrahydrofolate reductase, nitric oxide synthase, and TNFa. Genotypes were analyzed by the transmission/disequilibrium test. Genotype risk ratios (GRRs) associated with maternal genotypes had a range of 0.70-1.16; GRRs associated with fetal genotypes had a range of 0.72-1.11. No GRR achieved the prespecified criteria for statistical significance (posterior probability >.05). We conclude that none of the genetic variants tested in this large study of strictly defined pre-eclamptic pregnancies confers a high risk of disease. The results emphasize the importance of conducting rigorously designed studies of adequate size to provide precise genetic risks with narrow confidence intervals, if overreporting of falsepositive results is to be avoided.
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2004 |
Tao S, Symonds I, 'Menstrual disturbance', Current Obstetrics and Gynaecology, 14 216-219 (2004)
In the past, the mainstay of surgical treatment of menorrhagia was hysterectomy. This is an effective form of treatment in terms of outcome but it does carry a degree of morbidity... [more]
In the past, the mainstay of surgical treatment of menorrhagia was hysterectomy. This is an effective form of treatment in terms of outcome but it does carry a degree of morbidity and prolonged convalescence. Endometrial ablation techniques were initially developed using the urological resectoscope, and recently, simpler methods have been developed to strive to obtain high patient satisfaction rates with less associated morbidity. This article looks at the considerations in the development of these new treatments, as well as medical treatment options such as the use of intra-uterine progestogens. © 2004 Elsevier Ltd. All rights reserved.
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2004 |
Tobin MJ, Chesters MA, Chalmers JM, Rutten JM, Fisher SE, Symonds IM, et al., 'Infrared microscopy of epithelial cancer cells in whole tissues and in tissue culture, using synchrotron radiation.', Faraday Discussions, 126 27-40 (2004) [C1]
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2003 |
Symonds IM, 'Evidence based management of ectopic pregnancy', Sri Lankan Journal of Obstetrics and Gynaecology, 25 (2003) [C3] |
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2003 |
Condous GS, Arulkumaran SA, Symonds IM, Chapman R, Sinha A, Razvi K, 'The "tamponade test" in the management of massive postpartum haemorrhage.', Obstetrics and Gynecology, 101 767-772 (2003) [C1]
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2003 |
Symonds IM, Cullen L, Fraser D, 'An Evaluation of a Formative Interprofessional Team Objective Structured Clinical Examination (ITOSCE): a Method of Shared Learning in Maternity Education.', Medical Teacher, 25 38-41 (2003) [C1]
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2003 |
Cullen L, Fraser D, Symonds IM, 'Strategies for interprofessional education: the Interprofessional Team Objective Structured Clinical Examination for midwifery and medical students', Nurse Education Today, 23 427-433 (2003) [C1]
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2002 |
Symonds IM, Cullen L, Fraser D, 'Inter-professional education in obstetrics using formative team objective structured clinical examination', ANZJ Obstet Gynaecol, 42 (2002) [C3] |
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2002 |
Symonds IM, Thomas A-M, Rutten F, Hitchcock A, Chesters M, 'Single cell analysis of cervical smears using infrared microspectroscopy', ANZJ Obstet Gynaecol, 42 (2002) [C3] |
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2002 |
Tobin M, Rutten F, Chesters M, Chalmers J, Symonds IM, Fisher S, et al., 'Investigating the Potential for Infrared Microanalysis in Cancer Screening.', European Clinical Laboratory 2002, (2002) [C1] |
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2002 |
Tamizian O, Gilby J, Symonds IM, Cust MP, Arulkumaran SA, 'Immediate and associated complications of hysterectomy for benign disease.', ANZJ Obstet Gynaecol, 2002 :42:2:292, (2002) [C1]
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2001 |
Symonds I, 'Ultrasound, hysteroscopy and endometrial biopsy in the investigation of endometrial cancer', Best Practice and Research: Clinical Obstetrics and Gynaecology, 15 381-391 (2001)
Over the course of the last two decades hysteroscopy with endometrial biopsy has begun to replace dilation and curettage as the method of choice for the diagnosis of endometrial c... [more]
Over the course of the last two decades hysteroscopy with endometrial biopsy has begun to replace dilation and curettage as the method of choice for the diagnosis of endometrial carcinoma. In the majority of women this can be performed as an outpatient procedure with no loss in diagnostic accuracy. Transvaginal ultrasound measurement of endometrial thickness provides a highly sensitive and less invasive alternative means of assessing the endometrium but has a low positive predictive value for cancer, especially in women taking hormone replacement therapy. The cut-off value used to define normality needs to take into account patient age and ethnic origin. Ultrasound screening may not be suitable for women taking tamoxifen and those with recurrent or late-onset abnormal uterine bleeding.
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2001 |
Symonds I, 'Balliere''s Best Practice', Research in Clinical Obstetrics and Gynaecology, 15 381-391 (2001) [C1] |
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2001 |
Nunns D, Symonds IM, 'The Vulval Pain Syndromes.', Journal of Pediatrics,Obstetrics and Gynaecology, 2001:27(6);42-48., 42-48 (2001) [C1] |
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2000 |
Fraser D, Symonds M, Cullen L, Symonds I, 'A university department merger of midwifery and obstetrics: A step on the journey to enhancing interprofessional learning', Medical Teacher, 22 179-183 (2000)
A first-class maternity service requires effective team working and opportunities for multiprofessional learning. However, it has been found that collaboration and cohesive workin... [more]
A first-class maternity service requires effective team working and opportunities for multiprofessional learning. However, it has been found that collaboration and cohesive working between doctors and midwives is not always evident. This paper describes the context for a unique merger of two academic departments, obstetrics/gynaecology and midwifery, with a view to enhancing interprofessional collaboration in teaching and research. Although interprofessional learning, particularly at undergraduate level, can be difficult to design and implement it is argued that it is necessary to enhance multiprofessional teamwork. It was found that a staged programme of action is needed to develop and evaluate curricular initiatives in interprofessional learning. Whilst learning about and valuing each other's roles is as important as sharing curriculum content it can involve an element of risk and considerable resources. Pilot work locally suggests that it is well worth the time and effort involved but long-term success will be dependent upon staff commitment and evaluation of the process as well as the outcomes.
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2000 |
Symonds IM, 'Self-assessment questions: Vulval disorders', Current Obstetrics and Gynaecology, 10 55-58 (2000)
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1999 |
Nunns D, Symonds IM, 'Vulval Pain Syndrome Study Day, Derby, 5 March 1999', Journal of Obstetrics and Gynaecology, 19 566-568 (1999)
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1999 |
Arulkumaran S, Symonds IM, 'Psychosocial support or active management of labour or both to improve the outcome of labour', BJOG: An International Journal of Obstetrics and Gynaecology, 106 617-619 (1999)
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1999 |
Symonds IM, 'Establishing an outpatient hysteroscopy service', Current Obstetrics and Gynaecology, 9 158-162 (1999)
Hysteroscopic examination of the endometrium can be carried out as an outpatient procedure with no loss in diagnostic accuracy and at considerably lower cost than when done as a d... [more]
Hysteroscopic examination of the endometrium can be carried out as an outpatient procedure with no loss in diagnostic accuracy and at considerably lower cost than when done as a day-case. Cervical dilation is required in less than 20% of cases and only one-third of patients require local anaesthetic. Over 90% of women find the procedure acceptable and report minimal discomfort. Approximately 50% of women will have some abnormality identified at hysteroscopy of whom 1-2% will have endometrial malignancy. Twenty per cent of patients require subsequent hysteroscopic surgery under general anaesthetic, mostly for the removal of benign lesions. The initial capital investment required to establish a new service is small when compared to the long-term savings on the cost per patient procedure.
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1999 |
Symonds IM, 'Self-assesment questions: Diagnosis and management of cervical neoplasia', Current Obstetrics and Gynaecology, 9 173-176 (1999)
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1998 |
Symonds IM, 'Ectopic pregnancy: Modern management', Current Obstetrics and Gynaecology, 8 27-31 (1998)
Laparoscopy is increasingly being replaced by transvaginal ultrasound and quantitative serum human chorionic gonadotrophin (hCG) measurement in the diagnosis of suspected ectopic ... [more]
Laparoscopy is increasingly being replaced by transvaginal ultrasound and quantitative serum human chorionic gonadotrophin (hCG) measurement in the diagnosis of suspected ectopic pregnancy. For haemodynamically-stable patients, laparoscopic treatment is associated with less morbidity and lower costs than laparotomy. The rate of successful intrauterine pregnancy is higher following linear salpingotomy than salpingectomy. However, conservative surgery also appears to be associated with higher rates of recurrent ectopic pregnancy and is more likely to be complicated by persistent trophoblastic tissue. Medical treatment with local or systemic injection of methotrexate is a suitable alternative for selected patients.
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1996 |
Davies Q, Symonds IM, Perkins AC, Kerslake RW, Wastie ML, Worthington BS, Symonds EM, 'Magnetic resonance imaging, OC125 immunoscintigraphy and serum CA125 levels in the management of patients with suspected primary or recurrent ovarian carcinoma', Journal of Obstetrics and Gynaecology, 16 108-116 (1996)
A total of 39 patients with suspected primary (n = 17) or recurrent/residual (n = 22) ovarian carcinoma were investigated by pelvic magnetic resonance imaging (MRI) and immunoscin... [more]
A total of 39 patients with suspected primary (n = 17) or recurrent/residual (n = 22) ovarian carcinoma were investigated by pelvic magnetic resonance imaging (MRI) and immunoscintigraphy using the monoclonal antibody OC-125 labelled with Indium-111. The results of the imaging studies were compared with surgical evaluation and pathological examination of resected material in each case. In patients with suspected primary tumours, the sensitivity and specificity of MRI for the diagnosis of ovarian carcinoma was 37.5 and 66 per cent respectively, and for immunoscintigraphy 75 and 22 per cent. In patients with suspected recurrent disease, the sensitivity and specificity were 88 and 40 per cent for MRI and 82 and 60 per cent for immunoscintigraphy, compared with serum CA125 levels which had a sensitivity of 81 per cent and specificity of 50 per cent. The predictive value of a positive result was 83 per cent for MRI, 87 per cent for immunoscintigraphy and 81 per cent for serum CA125, with a negative predictive value of 50 per cent for all three techniques. These techniques are proving to be the main imaging methods for the assessment of patients with ovarian carcinoma, however, both techniques showed limitations in the detection of very small volume disease and were no more sensitive than serum CA125 in the detection of recurrence.
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1993 |
Perkins AC, Symonds IM, Pimm MV, Price MR, Wastie ML, Symonds EM, 'Immunoscintigraphy of ovarian carcinoma using a monoclonal antibody (
An anti-polymorphic epithelial mucin (PKM) monoclonal antibody NCRC48 (IgG3) has been tested for its capacity to localize in tumours according to accepted guidelines for human adm... [more]
An anti-polymorphic epithelial mucin (PKM) monoclonal antibody NCRC48 (IgG3) has been tested for its capacity to localize in tumours according to accepted guidelines for human administration. Following radiolabelling with 111In, 1 mg antibody was administered to 19 patients with a clinical suspicion of ovarian malignancy. Initial imaging and biodistribution studies confirm the safety of this conjugate although six out of 11 patients tested developed an antibody response to the monoclonal antibody. Immunoscintigraphy with this antibody was compared with magnetic resonance imaging and ultrasound in relation to the final tumour histology, the final accuracies being 79, 79 and 64% respectively. Positive localization of antibody was confirmed in malignant tissue with little evidence of uptake in benign tissue. © 1993 Chapman and Hall Ltd.
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1992 |
Symonds IM, 'Monoclonal antibodies in ovarian cancer', Current Obstetrics and Gynaecology, 2 212-217 (1992)
Monoclonal antibodies recognising a number of antigens are used in the diagnosis and treatment of ovarian carcinoma. Conventional histology and cytology can be supplemented by imm... [more]
Monoclonal antibodies recognising a number of antigens are used in the diagnosis and treatment of ovarian carcinoma. Conventional histology and cytology can be supplemented by immunohistology. Antigens shed from tumours are routinely measured in patients sera by monoclonal based assays to monitor disease progression. Radiolabelled antibodies can be used to localise tumour in vivo by gamma camera imaging or intraoperatively using a hand held probe. Antibodies conjugated to radionuclides have been successfully used in the treatment of patients with small volume residual disease and malignant serous effusions. © 1992.
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1990 |
Price MR, Pugh JA, Hudecz F, Griffiths W, Jacobs E, Symonds IM, et al., 'C595 - a monoclonal antibody against the protein core of human urinary epithelial mucin commonly expressed in breast carcinomas', British Journal of Cancer, 61 681-686 (1990)
Urinary mucins which express determinants for the anti-breast carcinoma monoclonal antibody, NCRC-11 (IgM), closely resemble the mammary mucins found in milk fat globules and carc... [more]
Urinary mucins which express determinants for the anti-breast carcinoma monoclonal antibody, NCRC-11 (IgM), closely resemble the mammary mucins found in milk fat globules and carcinomas. An IgG3 monoclonal antibody, C595, was prepared against urinary mucins isolated on a NCRC-11 antibody affinity column, and this ¿second generation¿ antibody was shown to have a very similar pattern of reactivity to the original NCRC-11 antibody. By immunohistology, the profile of reactivity of both antibodies with tumour and normal tissue specimens was virtually identical. Both antibodies reacted with epithelial mucins isolated from breast tumours or normal urine using an NCRC-11 antibody affinity column, although the antibodies were unreactive with other antigen preparations. Heterologous immunoradiometric assays (¿sandwich¿ tests) confirmed that NCRC-11 and C595 epitopes were co-expressed on the same molecule. C595 antibodies inhibited the binding of radiolabelled NCRC-11 antibodies to antigen, suggesting that the two epitopes were in close topographical proximity. The protein core of the mammary mucins has recently been shown to consist predominantly of a repeated 20 amino acid sequence (Gendler et al., 1988). Peptides with this complete sequence and small fragments were synthesised, and the C595 antibody was found to recognise an epitope within this repeat. The ability to identify and synthesise monoclonal antibody-defined determinants, as well as those in the adjacent or overlapping sequences within the protein core of epithelial mucins, is viewed as a strategy for facilitating the production of antibodies of new and novel specificity to complement the panels of existing anti-breast cancer reagents. © The MacMillan Press Ltd., 1990.
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Lynagh M, Kelly B, Horton G, Walker B, Powis D, Bore M, et al., 'Have we got the selection process right? The validity of selection tools for predicting academic performance in the first year of undergraduate medicine', MedEdPublish, 6
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