Robotic surgery has been shown to shorten hospital stays, decrease complication rates and allow surgeons to perform finer tasks, when compared to the traditional laparoscopic and open approaches. These benefits, however, must be balanced against increased intraoperative times, vast financial costs and the increased training burden associated with robotic techniques. The outcome of such a cost-benefit analysis appears to vary depending on the procedure being conducted; indeed the strongest evidence in favour of its use comes from the fields of urology and gynaecology. It is hoped that with the large-scale, randomised, prospective clinical trials underway, and an ever-expanding research base, many of the outstanding questions surrounding robotic surgery will be answered in the near future.
wider potential in health promotion, including within sexual health. In September 2013 we carried out a patient and public involvement user group to investigate what female genitourinary medicine clinic attendees thought about texts encouraging regular STI checks, use of long acting reversible contraception (LARC) and HIV testing. These three topics were chosen in response to the 2013 Framework for Sexual Health Improvement, which highlights sexually transmitted infections (STIs), teenage pregnancies and late diagnosis of HIV as major public health problems. 3 Consecutive women aged 16-24 years attending the Courtyard Sexual Health Clinic at St George's NHS Trust, London were invited to complete a confidential, anonymous questionnaire and to express opinions. The response rate was 100% (30/30), and the mean age of participants was 20 years (range 16-24 years). Text 1: 'Time for your check-up? Please telephone …' 27/30 (90%) thought this reminder a good idea, and 23/30 (77%) said they would book a checkup. Text 2: 'Have you thought about trying a contraceptive implant or coil so you don't have to keep remembering? Ask when you go for your checkup .' 23/30 (77%) were happy to receive this, and 20/30 (67%) would ask about LARC. Text 3: 'Have you thought about HIV testing … ? Ask when you have your checkup .' 25/30 (83%) liked this reminder, and 24/30 (80%) would ask about HIV testing at their next checkup. Comments included: 'A really good idea and could help a lot of women.' 'Very straight and to the point.' 'Young girls don't think about this so it's good to give them awareness.' Overall there was a positive response to receiving all three texts, and over two-thirds of responders said they would act on them. We agree with Douglas and Free 1 that it is important for healthcare professionals to understand patient experiences of a text messaging service. User groups can also be helpful. Text messages are increasingly used for appointment reminders in primary care and could have potential as key health promotion tools in the future.
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