Background One in three women in the United Kingdom (UK) will have an abortion before age 45, making abortion provision an essential aspect of reproductive healthcare. Despite this, abortion remains ethically contested and stigmatised, with variable teaching in UK medical schools and concerns about falling numbers of doctors willing to participate in abortion care. University College London Medical School (UCLMS) has designed practical, inclusive, teaching that aims to give students an understanding of the importance of abortion care and prepare them to be competent practitioners in this area. This study aimed to determine students’ opinions of this teaching and their wider attitudes towards abortion. Methods We invited all 357 final-year UCL medical students to complete an online survey consisting of closed-ended questions, exploring their opinions on their abortion teaching, their personal beliefs about abortion and their future willingness to be involved in abortion care. We analysed responses using non-parametric tests. Results One hundred and forty-six questionnaires (41% response rate) showed 83% of students identified as pro-choice (agree with the right to choose an abortion). Fifty-seven percent felt they received the right amount of abortion teaching, 39% would have liked more and 4% stated they received too much. There was no correlation between students’ attitudes to abortion and the rating of teaching; both pro-choice and pro-life (opposed to the right to choose an abortion) students generally rated the teaching as important and valued the range of methods used. Students requested more simulated practice speaking to patients requesting an abortion. Students with pro-life beliefs expressed lower willingness to discuss, refer, certify and provide future abortions. Students interested in careers in specialties where they may encounter abortion were more likely to be pro-choice than pro-life. Conclusions The majority of participating UCL medical students were pro-choice and willing to be involved in future abortion care. Efforts to make teaching on abortion practical, engaging, sensitive and inclusive were appreciated. As well as preparing students to be competent and caring practitioners, the teaching appears to contribute towards them viewing abortion as an essential aspect of women’s healthcare, and may contribute to destigmatising abortion.
This pilot study researched the attitudes towards and the knowledge of female genital mutilation (FGM) in adult women with FGM and their partners. The participant population consisted of English-speaking women and men over 18 years old attending specialist FGM clinics in two London hospitals. The participants completed a questionnaire on the attitudes and the knowledge of FGM, which were adapted with permission from the United Nations Children's Fund and the United States Agency for International Development household surveys. 54 participants (51 women, 3 men) took part in the surveys. 89% of participants thought that FGM should be stopped (95%CI: 0.81-0.97) and 72% said they knew FGM is illegal in the United Kingdom (UK). 15% reported that FGM caused no danger, or were unaware of any danger to women's health. This study demonstrates the opposition to FGM by participants, but some lack of knowledge regarding the legal and health implications. The exploration of attitudes in diaspora community groups is often cited as key to safeguarding girls from FGM. This is one of the first UK studies of individuals from FGM-practising communities, and we recommend use of the study questionnaires for a multicentre, cross-community study. Impact statement What is already known about this subject? Women and children are affected by female genital mutilation (FGM) globally and in the United Kingdom (UK). The majority of knowledge on practices and the attitudes towards FGM comes from UNICEF and USAID research in Africa and there is scant data on FGM practices in diaspora communities in the UK. What do the results of this study add? This study provides an appropriate questionnaire and protocol for use in community-based national research to improve healthcare for women by collecting up-to-date data on the attitudes towards FGM among the members of FGM-practising communities in the UK. What are the implications of these findings for clinical practice and further research? The implications of the results of this study are that health professionals need to understand that patients do not always know the law on FGM, even after a consultation. Health and social care professionals are placed in a unique position to work with community members to educate men and women to end FGM.
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Background One in three women in the United Kingdom (UK) will have an abortion before age 45, making abortion provision an essential aspect of reproductive healthcare. Despite this, abortion remains ethically contested and stigmatised, with variable teaching in UK medical schools and concerns about falling numbers of doctors willing to participate in abortion care. University College London Medical School (UCLMS) has designed practical, inclusive, teaching that aims to give students an understanding of the importance of abortion care and prepare them to be competent practitioners in this area. This study aimed to determine students’ opinions of this teaching and their wider attitudes towards abortion. Methods We invited all 357 final-year UCL medical students to complete an online survey consisting of closed-ended questions, exploring their opinions on their abortion teaching, their personal beliefs about abortion and their future willingness to be involved in abortion care. We analysed responses using non-parametric tests. Results 146 questionnaires (41% response rate) showed 83% of students identified as pro-choice (agree with the right to choose an abortion). 57% felt they received the right amount of abortion teaching, 39% would have liked more and 4% stated they received too much. There was no correlation between students’ attitudes to abortion and the rating of teaching; both pro-choice and pro-life (opposed to the right to choose an abortion) students generally rated the teaching as important and valued the range of methods used. Students requested more simulated practice speaking to patients requesting an abortion. Students with pro-life beliefs expressed lower willingness to discuss, refer, certify and provide future abortions. Students interested in careers in specialties where they may encounter abortion were more likely to be pro-choice than pro-life. Conclusions The majority of participating UCL medical students were pro-choice and willing to be involved in future abortion care. Efforts to make teaching on abortion practical, engaging, sensitive and inclusive were appreciated. As well as preparing students to be competent and caring practitioners, the teaching appears to contribute towards them viewing abortion as an essential aspect of women’s healthcare, and may contribute to destigmatising abortion.
Takotsubo (stress) cardiomyopathy, is defined by transient left ventricular systolic dysfunction without epicardial coronary disease. Case report A 50-year-old man presented with headache and visual disturbance with no past medical history of note. He had recently separated from his wife and children had moved out of the family home. He was very depressed and stressed due to this. His blood pressure was 180/110 mmHg and bloods showed creatinine of 442 umol/L; potassium 3.6 mmol/L; eGFR 13 mL/min/1.73m 2 . Renal Ultrasound and virology/immunology screen were normal. Echocardiogram showed severe left ventricular (LV) dysfunction with an ejection fraction (EF) of 35% with LV hypertrophy. Plasma normetanephrine and metanephrine levels were elevated at 4805 pmol/L (120-1180) and 819 (80 - 510) respectively. Urine 24 hour metanephrines showed elevated urine normetanephrine output of 7.62 umol/24 h (0-3.3) and mildly elevated urine metanephrine output of 1.31 umol/24 h (0-1.2). CT Adrenals showed a low density 1 cm left adenoma with benign washout characteristics. He was started on alphablocker and amlodipine with good effect. 2 months later, repeat Echo normalised with LVEF of 55-60%. Repeat urine metanephrines were normal. Plasma normetanephrine dropped to 1253 pmol/L and plasma metanephrine to 338 pmol/L. I 123 MIBG (meta-iodo-benzyl guanidine) SPECT-CT normal uptake. Overnight dexamethasone suppression test and aldosterone renin ratio were normal. Discussion: This 50-year-old gentleman under considerable emotional stress, presented with severe hypertension and severely impaired LV function. On follow-up, the LV impairment returned to normal and the initially elevated plasma and urine metanephrines normalised. The adrenal tumour was an incidental benign non-secretory tumour. There are several reports of phaeochromocytomas presenting with stress cardiomyopathy, however stress cardiomyopathy mimicking phaeochromocytoma is not well reported. A study by Wittstein et al reported significant elevations of metanephrines in patients with stress cardiomyopathy. However this has not been universally accepted and subsequent studies have not fully replicated this. As per a 2017 metanalysis by Darr et al the sensitivity and specificity of plasma metanephrines for phaeochromocytoma/paraganglioma is 94% and 93% and for urinary metanephrines, 91% and 93%. Critical illness can elevate plasma and urinary metanephrines. In this case, the patient did have severe hypertension, but was not critically ill. The current case report provides a cautionary example that the specificity of plasma and urinary metanephrines in the diagnosis of phaeochromocytoma and paraganglioma may be impaired in people presenting with stress related cardiomyopathy. This is especially true in this case given that this patient also had an incidental adrenal tumour.
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