Dean

@Sister_Medicine on twitter said she gave a dying patient a iPad so the family could say good bye

Sorry for the delay in response. i feel that it should only be done with C02 and that PPE for staff, including a disposable mask  for patients, needs to made available and a extra 15 mins on the 30 mins allocated  to be allowed for cleaning.                                      

Preferably disposable equipment as this only adds a £50 the camera stack must be swapped.  I can not believe it is currently not  when a manufacturer say its a potential source of infection it means it is source or infection.                                                               

I believe with the current practices  outpatient hysteroscopy should not be done.                                                                                                                                                                         

Firstly,  I want to say, that I did not want to write this with everything that is going on.  I did not want to criticise the NHS. But when a gynaecologist posts on twitter asking whether it is safe to do outpatient hysteroscopy and say they are concerned at this because hysteroscopies are aerosol generating procedures and there will always be some blood in some cases, I felt I needed to comment.  

A lot of this could be solved by using CO2. CO2 was abandoned, not solely but mainly because of the cost. It also endangers staff as close patient contact is necessary. A recent, large trial showed a 3% infection rate for outpatient hysteroscopy with vagioscopic and higher with speculum.  After speaking to someone at Olympus, he thought one possible infection route might be the camera stack, as it is not always wiped down after every procedure despite a disposable sheath surrounding it. First, the aerosol effect might bounce about and second, with time constraints, incorrect removal of sheath etc. might result in transfer of infection.  

Is there anyone who knows if aerosol blood from a patient with covid-19 is dangerous?   

There has never been a greater need for sedation with analgesia for hysteroscopy, because light and mild sedation does not need intubation, which is currently a big concern, although there are steps that can be taken to reduce this.

It's a bit long, but here are some of my thoughts ...

i have found trying to help hysteroscopy action i am sure that i am taken more seriously than a woman  and not seen as a hysterical woman by both sexes. i also am concerned that know things a experienced gynecologist does not. i referenced  post menopausal women are the most at risk of pain during a OPH to which he look at his nurse specialist and she nodded 

@PatientSafetyLearning Team this is defiantly not offered in the uk. the uk is very far behind in pan control and pain control studies. in fact the uk is obsessed with not using any pain relief  a recreant trail at Birmingham women's hospital called the vast trail compered vigscopic (no speculum) vers speculum and found the vagiscopic  method to be about 0.26 of a vas score better than speculum pain was measured o to 10 .10 being method pain                                                                                                                                                                                                                                                             the conclusion of the studie was was viagscopic should be used as default but there were pain scores of 8, 9, and even 10,s and there was a infection rate of %5 none of which was addressed i have attached the trail                                                                                                                                                                                                                                                 to top it of there is plenty of research money for Birmingham to do real pain control studies we have a working theory why they do not want to use anesthetic if you would like to her please say

Vaginoscopy Against Standard Treatment.pdf

@Claire Cox  i just wanted to mention one stop clinics they are illegal and any one take up litigation would win why are they allowed  NHS resolution has said all elective procedures require 24 hours notice https://concentric.health/blog/conversations-on-consent/ 

i would like to say the NHS was sold outpatient hysteroscopy as easy mainly by Italians the problem is it is not it is extremely skilled and needs decades of experience to be really good at it one gynecologist from Spain  has %5 failure rate and stops at VAS 5 how ever he gives 10mg of Diazepam. that high a dose can not be given in the uk and is essential to his successes rate plus he does not treat post menopausal women                                                                                                                                                                                                                                                                           there simply is only a hand full of gynecologists as skilled as he is in the uk plus the training in the uk is extremely poor and accesses to proper simulators (one that score on performance they say if you caused pain)  limited to a few hours if they see one at all instead they train on a piece of rubber  as its only £2000 for the machine and £45 for womb simulator with 7 polyps

PMB  women should not be referred to outpatient hysteroscopy they are the most at risk of pain vomiting fainting. the NHS get away with this because they use the fear of Cancer to do it on the cheap. it is a clear disregard for duty of care

there are very few places that do it well Sheffield is meant to be very good the problem is if hysterscopys were stopped at a appropriate pain level it would result in at least %25 failer rate in diagnostic and about %35 in operative and that is being generous the fact that it loses hospitals money  to do them in theater means they want to put patients trough they know are not suitable i will say Kingston in London has made big improvements after a complaint and have resonantly done a great patient information leaflet witch i helped with which i have linked . but there needs to be a end to best practice tariff increase for theater and most importantly sedation the biggest thing currently affecting outpatient hysteroscopy is no one is being the patients advocate and stopping when it obviously needs to again to be fair to kingston they have a new team and are told to be patients advocate

A0043 Hysteroscopy Leaflet.pdf