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To assess a policy of women holding and thus having constant access to their own obstetric records, 290 women attending a peripheral consultant clinic in Newbury, West Berkshire. were randomly allocated to hold either their full case notes, or the more usual co-operation card. Women holding their full records were significantly more likely to feel in control of their antenatal care (rate ratio 1.45; 95% confidence interval 1.08-1.95) and to feel it was easier to talk to doctors and midwives (rate ratio 1.73; 95% confidence interval 1-1&2-59). No other beneficial effects were detected. Asked about their preferences for any subsequent pregnancies, women holding their own records in the index pregnancy were more likely to say they would prefer to hold the same kind of record again in a subsequent pregnancy than were women holding a co-operation card (rate ratio 1.56; 95% confidence interval 1.34-1.81). There was no evidence of negative effects. In particular, women holding their case notes did not feel more anxious than co-operation card holders. The policy of women holding their notes resulted in savings in clerical time, without evidence of an increase in the rate of lost notes.The present system of shared maternity care in the United Kingdom is characterized by multiple contacts between women and a variety of staff. This situation has spawned a number of parallel medical records systems. At a minimum these include those of hospital staff, the woman's general practitioner and the community midwife. This duplication may be wasteful of scarce

In conversation, speakers occasionally use figurative expressions such as “had a good innings,” “take with a pinch of salt,” or “come to the end of her tether.” This article investigates WHERE in conversation such expressions are used, in terms of their sequential distribution. One clear distributional pattern is found: Figurative expressions occur regularly in topic transition sequences, and specifically in the turn where a topic is summarized, thereby initiating the closing of a topic. The paper discusses some of the distinctive features of the topic termination/transition sequences with which figurative closings are associated, particularly participants' orientation to their moving to new topics. Finally, the interactional use of figurative expressions is considered in the context of instances where their use fails to secure topical closure, manifesting some conflict (disaffiliation, etc.) between the participants. (Figurative expressions, idioms, conversation, topic)

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It is difficult to offer an alternative to an infective explanation for the present findings. A possible relation between leukaemia in children under 1 year and maternal use of drugs such as marijuana'7 cannot be relevant here, since the period in question long preceded any appreciable use of such drugs in Britain. Similarly, a hypothesis about mutations caused by delayed exposure to immunological challenges'8 cannot be invoked since it would apply only in leukaemia occurring later than the ages that show the excess in this study.The findings support the hypothesis that prompted this study-that the presence of large numbers of servicemen, particularly in rural districts, was conducive to an increase in the incidence of childhood leukaemia. They also point to an infection transmitted among adults, as also implied by a recent study of the effects of the population mixing associated with increases in commuting. ' Design-Randomised study of two treatment groups with a minimum follow up of nine months.Setting-Royal Berkshire Hospital, Reading. Subjects-51 of 78 menorrhagic women without pelvic pathology who were on the waiting list for abdominal hysterectomy.Treatment-Endometrial resection or abdominal hysterectomy (according to randomisation). Endometrial resections were performed by an experienced hysteroscopic surgeon; hysterectomies were performed by two other gynaecological surgeons.Main outcome measures-Length of operating time, hospitalisation, recovery; cost of surgery; short term results of endometrial resection.Results-Operating time was shorter for endometrial resection (median 30 (range 20-47) minutes) than for hysterectomy (50 (39-74) minutes). The hospital stay for endometrial resection (median 1 (range 1-3) days) was less than for hysterectomy (7 (5-12) days). Recovery after endometrial resection (median 16 (range 5-62) days) was shorter than after hysterectomy (58 (11-125) days). The cost was £407 for endometrial resection and £1270 for abdominal hysterectomy. Four women (16%) who did not have an acceptable improvement in symptoms after endometrial resection had repeat resections. No woman has required hysterectomy during a mean follow up of one year.Conclusion-For women with menorrhagia who have no pelvic pathology endometrial resection is a useful alternative to abdominal hysterectomy, with many short term benefits. Larger numbers and a longer follow up are needed to estimate the incidence of complications and the long term efficacy of endometrial resection. IntroductionEndometrial resection is gaining widespread acceptance as a surgical treatment for menorrhagia. A survey in August 1990 showed that 36 British centres had performed a total of over 4000 endometrial ablation procedures.' Seventy per cent of these were endometrial resections with the urological resectoscope.The technique was initially used for treating intractable uterine bleeding in women who were unfit for hysterectomy because of blood dyscrasias or extreme anaesthetic risk.2 Follow up showed that most remained amenorrhoeic. Tr...

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Idiomatic, proverbial, and other figurative expressions are quite frequently employed by speakers in ordinary talk. Our analysis of idioms in naturally occurring conversations reveals that they are used, not randomly, but most notably when one speaker is complaining to another. In this sequential environment the particularly egregious character of the matter being complained about is portrayed through an idiom. In view of the role complaints play in casting private troubles or anxieties into the public domain, it is significant that typically a complaint is formulated idiomatically at a point where there is some conflict or lack of alignment between complainant and recipient. Thus, idioms are introduced in "inauspicious environments, "where, up until then, recipients have withheld sympathizing or affiliating with a complainant. Idioms have a special robustness which lends them the function of summarizing the complaint in such a way as to enhance its legitimacy, and simultaneously to bring the complaint to a close.