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Article ; Online: Transforming CAMHS: discordance between ambition and reality.

Varma, Rajesh

2019 Volume 364, Page(s) l1360

Language	English
Publishing date	2019-03-26
Publishing country	England
Document type	Letter
ZDB-ID	1362901-3
ISSN	1756-1833 ; 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
ISSN (online)	1756-1833
ISSN	0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
DOI	10.1136/bmj.l1360
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Article ; Online: Laparoscopy complications. Apply safety rule of thumb.

Varma, Rajesh

BMJ (Clinical research ed.)

2011 Volume 342, Page(s) d799

MeSH term(s)	Early Diagnosis ; Humans ; Laparoscopy/adverse effects ; Safety Management
Language	English
Publishing date	2011-02-08
Publishing country	England
Document type	Comment ; Letter
ZDB-ID	1362901-3
ISSN	1756-1833 ; 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
ISSN (online)	1756-1833
ISSN	0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
DOI	10.1136/bmj.d799
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Article ; Online: Resuscitation in pregnancy article omitted several points.

Varma, Rajesh

BMJ (Clinical research ed.)

2004 Volume 328, Issue 7432, Page(s) 168–169

MeSH term(s)	Cesarean Section/methods ; Female ; Heart Arrest/therapy ; Humans ; Pregnancy ; Pregnancy Complications, Cardiovascular/therapy ; Resuscitation/methods
Language	English
Publishing date	2004-01-17
Publishing country	England
Document type	Comment ; Letter
ZDB-ID	1362901-3
ISSN	1756-1833 ; 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
ISSN (online)	1756-1833
ISSN	0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
DOI	10.1136/bmj.328.7432.168-c
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Heavy menstrual flow: current and future trends in management.

Beebeejaun, Yusuf / Varma, Rajesh

Reviews in obstetrics & gynecology

2013 Volume 6, Issue 3-4, Page(s) 155–164

Abstract: Menorrhagia accounts for a large number of secondary care referrals in the West. Women of different ages have different expectations from the treatment offered to them. Young women of reproductive age often demand treatment that simultaneously reduces ... ...

Abstract	Menorrhagia accounts for a large number of secondary care referrals in the West. Women of different ages have different expectations from the treatment offered to them. Young women of reproductive age often demand treatment that simultaneously reduces bleeding, preserves fertility, and has very few side effects, whereas older women who ultimately wish to keep their reproductive organs may have reason to avoid hormonal manipulation. This article discusses possible management options and introduces a hierarchical approach to the management of menorrhagia based on the medical therapies and surgical procedures currently available. We explore the medical therapies for menorrhagia, which include hormone-modifying drug therapies and the new combined oral contraceptive pill. We also review novel fibroid surgical therapies and the latest surgical procedures, such as laparoscopic bilateral uterine artery occlusion, transvaginal Doppler-guided vascular clamp, and laparoscopic and intrauterine ultrasound-guided radiofrequency ablation.
Language	English
Publishing date	2013-01-24
Publishing country	United States
Document type	Journal Article
ZDB-ID	2864499-2
ISSN	2153-8166 ; 1941-2797
ISSN (online)	2153-8166
ISSN	1941-2797
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Article ; Online: Tubal ectopic pregnancy.

Varma, Rajesh / Gupta, Janesh

BMJ clinical evidence

2012 Volume 2012

Abstract: Introduction: Approximately 1/100 pregnancies are ectopic, with the conceptus usually implanting in the fallopian tube. Some ectopic pregnancies resolve spontaneously, but others continue to grow and lead to rupture of the tube. Risks are higher in ... ...

Abstract	Introduction: Approximately 1/100 pregnancies are ectopic, with the conceptus usually implanting in the fallopian tube. Some ectopic pregnancies resolve spontaneously, but others continue to grow and lead to rupture of the tube. Risks are higher in women with damage to the fallopian tubes due to pelvic infections, surgery, or previous ectopic pregnancy. Methods and outcomes: We conducted a systematic review and aimed to answer the following clinical question: What treatments improve outcomes in women with unruptured tubal ectopic pregnancy? We searched: Medline, Embase, The Cochrane Library, and other important databases up to July 2011 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations, such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). The authors also separately searched Medline and Pubmed up to July 2011 in addition to the Clinical Evidence systematic search to support the comments and clinical guide sections. Results: We found 19 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions: In this systematic review we present information relating to the effectiveness and safety of the following interventions: salpingotomy, salpingectomy, methotrexate, methotrexate following salpingotomy, methotrexate plus mifepristone, and expectant management.
MeSH term(s)	Animals ; Fallopian Tubes ; Female ; Humans ; Incidence ; Methotrexate/therapeutic use ; Pregnancy ; Pregnancy, Ectopic/drug therapy ; Pregnancy, Tubal/drug therapy
Chemical Substances	Methotrexate (YL5FZ2Y5U1)
Language	English
Publishing date	2012-02-10
Publishing country	England
Document type	Journal Article ; Review ; Systematic Review
ZDB-ID	2393858-4
ISSN	1752-8526 ; 1757-0816 ; 1475-9225
ISSN (online)	1752-8526
ISSN	1757-0816 ; 1475-9225
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Article ; Online: Tubal ectopic pregnancy.

Varma, Rajesh / Gupta, Janesh

BMJ clinical evidence

2009 Volume 2009

Abstract	Introduction: Approximately 1/100 pregnancies are ectopic, with the conceptus usually implanting in the fallopian tube. Some ectopic pregnancies resolve spontaneously, but others continue to grow and lead to rupture of the tube. Risks are higher in women with damage to the fallopian tubes due to pelvic infections, surgery, or previous ectopic pregnancy. Methods and outcomes: We conducted a systematic review and aimed to answer the following clinical question: What treatments improve outcomes in women with unruptured tubal ectopic pregnancy? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2008 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). The authors also separately searched Medline and Pubmed up to May 2008 in addition to the Clinical Evidence systematic search to support the comments and clinical guide sections. Results: We found 47 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions: In this systematic review we present information relating to the effectiveness and safety of the following interventions: salpingotomy, salpingectomy, systemic methotrexate, systemic methotrexate following salpingotomy, and expectant management.
MeSH term(s)	Animals ; Drug Administration Schedule ; Fallopian Tubes ; Female ; Humans ; Incidence ; Methotrexate ; Pregnancy ; Pregnancy Outcome ; Pregnancy, Ectopic/surgery ; Pregnancy, Tubal ; Salpingectomy
Chemical Substances	Methotrexate (YL5FZ2Y5U1)
Language	English
Publishing date	2009-04-20
Publishing country	England
Document type	Journal Article ; Review ; Systematic Review
ZDB-ID	2393858-4
ISSN	1752-8526 ; 1757-0816 ; 1475-9225
ISSN (online)	1752-8526
ISSN	1757-0816 ; 1475-9225
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Article: Evaluation of knowledge and utility of the 2014 Australian sexually transmissible infection and HIV testing guidelines for asymptomatic men who have sex with men among general practitioners in Sydney.

Templeton, David J / Adam, Phillipe C G / Varma, Rajesh / Read, Phillip / Bourne, Chistopher / Kao, Shih-Chi

Sexual health

2017 Volume 15, Issue 1, Page(s) 96–98

Abstract: The Australian sexually transmissible infection and HIV testing guidelines for asymptomatic men who have sex with men were updated in 2014. An evaluation study targeting Sydney-based general practitioners was conducted among 85 clinicians. Respondents ... ...

Abstract	The Australian sexually transmissible infection and HIV testing guidelines for asymptomatic men who have sex with men were updated in 2014. An evaluation study targeting Sydney-based general practitioners was conducted among 85 clinicians. Respondents with knowledge of guideline recommendations were significantly more likely to feel comfortable asking men who have sex with men about their sexual history (98.1% vs 81.3%, P=0.039), and to recommend at least annual testing (94.0% vs 68.8%, P=0.015), 3-month retesting after chlamydia or gonorrhoea treatment (96.2% vs 73.3%, P=0.017) and syphilis testing with routine HIV monitoring bloods (90.2% vs 57.1%, P=0.037). Familiarity with the guidelines was associated with a range of positive outcomes on general practitioners' clinical practice. Novel approaches are required to ensure more widespread distribution of future guidelines.
MeSH term(s)	Adult ; Attitude of Health Personnel ; Australia ; General Practitioners/organization & administration ; Guideline Adherence ; HIV Infections/diagnosis ; HIV Infections/prevention & control ; Homosexuality, Male ; Humans ; Male ; Mass Screening/methods ; Sexual Behavior/statistics & numerical data ; Sexual Partners ; Sexually Transmitted Diseases/prevention & control
Language	English
Publishing date	2017-10-24
Publishing country	Australia
Document type	Journal Article
ZDB-ID	2256731-8
ISSN	1449-8987 ; 1448-5028
ISSN (online)	1449-8987
ISSN	1448-5028
DOI	10.1071/SH17113
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Article ; Online: Laparoscopic entry techniques: clinical guideline, national survey, and medicolegal ramifications.

Varma, Rajesh / Gupta, Janesh K

Surgical endoscopy

2008 Volume 22, Issue 12, Page(s) 2686–2697

Abstract: Background: This study aimed to establish criteria for safe laparoscopic entry through a systematic literature search and evidence-based medicine appraisal, to determine surgeon preferences for laparoscopic entry in the United Kingdom, and to appraise ... ...

Abstract	Background: This study aimed to establish criteria for safe laparoscopic entry through a systematic literature search and evidence-based medicine appraisal, to determine surgeon preferences for laparoscopic entry in the United Kingdom, and to appraise the medicolegal ramifications of complications arising from laparoscopic entry. Methods: A systematic literature search of MEDLINE and EMBASE (1996-2007) was performed as well as a national surgeon survey by questionnaire (May-December 2006). Results: Laparoscopic entry criteria involving 10 steps were established based on the systematic literature search and evidence-based critical appraisal. The national survey had 226 respondents, with the majority aware of the Middlesbrough consensus or Royal College of Obstetricians and Gynaecologists [RCOG]-sourced guidance. There was considerable variation in preferred laparoscopic entry techniques. Currently, there is clear judicial guidance on the medicolegal stance toward laparoscopic entry-related complications. Conclusions: Despite widespread awareness of laparoscopic entry guidelines, there remains considerable variation in the techniques adopted in clinical practice. Unless practice concurs with recommended guidance, women undergoing laparoscopy will be exposed to increased unnecessary operative risk. Laparoscopic entry-related injury in an uncomplicated woman is considered negligent practice according to UK legal case law.
MeSH term(s)	Data Collection ; Evidence-Based Medicine ; Female ; Guideline Adherence/legislation & jurisprudence ; Guideline Adherence/statistics & numerical data ; Gynecologic Surgical Procedures/adverse effects ; Gynecologic Surgical Procedures/methods ; Gynecologic Surgical Procedures/statistics & numerical data ; Humans ; Intraoperative Complications/epidemiology ; Intraoperative Complications/etiology ; Knowledge ; Laparoscopy/adverse effects ; Laparoscopy/methods ; Malpractice/legislation & jurisprudence ; Pneumoperitoneum, Artificial/adverse effects ; Pneumoperitoneum, Artificial/instrumentation ; Pneumoperitoneum, Artificial/methods ; Practice Guidelines as Topic ; Practice Patterns, Physicians'/statistics & numerical data ; Pressure ; Punctures/adverse effects ; Risk Factors ; Surveys and Questionnaires ; United Kingdom
Language	English
Publishing date	2008-04-10
Publishing country	Germany
Document type	Journal Article ; Review
ZDB-ID	639039-0
ISSN	1432-2218 ; 0930-2794
ISSN (online)	1432-2218
ISSN	0930-2794
DOI	10.1007/s00464-008-9871-6
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Article: Australian sexually transmissible infection and HIV testing guidelines for asymptomatic men who have sex with men 2014: a review of the evidence.

Templeton, David J / Read, Phillip / Varma, Rajesh / Bourne, Christopher

Sexual health

2014 Volume 11, Issue 3, Page(s) 217–229

Abstract: Men who have sex with men (MSM) in Australia and overseas are disproportionately affected by sexually transmissible infections (STIs), including HIV. Many STIs are asymptomatic, so regular testing and management of asymptomatic MSM remains an important ... ...

Abstract	Men who have sex with men (MSM) in Australia and overseas are disproportionately affected by sexually transmissible infections (STIs), including HIV. Many STIs are asymptomatic, so regular testing and management of asymptomatic MSM remains an important component of effective control. We reviewed articles from January 2009-May 2013 to inform the 2014 update of the 2010 Australian testing guidelines for asymptomatic MSM. Key changes include: a recommendation for pharyngeal chlamydia (Chlamydia trachomatis) testing, use of nucleic acid amplification tests alone for gonorrhoea (Neisseria gonorrhoeae) testing (without gonococcal culture), more frequent (up to four times a year) gonorrhoea and chlamydia testing in sexually active HIV-positive MSM, time required since last void for chlamydia first-void urine collection specified at 20min, urethral meatal swab as an alternative to first-void urine for urethral chlamydia testing, and the use of electronic reminders to increase STI and HIV retesting rates among MSM.
Language	English
Publishing date	2014-07
Publishing country	Australia
Document type	Journal Article
ZDB-ID	2256731-8
ISSN	1449-8987 ; 1448-5028
ISSN (online)	1449-8987
ISSN	1448-5028
DOI	10.1071/SH14003
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Article: Predicting negligence in female sterilization failure using time interval to sterilization failure: analysis of 131 cases.

Varma, Rajesh / Gupta, Janesh K

Human reproduction (Oxford, England)

2007 Volume 22, Issue 9, Page(s) 2437–2443

Abstract: Background: Sterilization failure due to 'tubal non-occlusion' or 'wrong structure sterilization' is considered negligent, whereas 'spontaneous tubal recanalization' or 'fistula formation' is considered non-negligent. We examined whether interval to ... ...

Abstract	Background: Sterilization failure due to 'tubal non-occlusion' or 'wrong structure sterilization' is considered negligent, whereas 'spontaneous tubal recanalization' or 'fistula formation' is considered non-negligent. We examined whether interval to pregnancy failure was predictive of a negligent rather non-negligent failure mechanism. We aim to test this hypothesis in a selected population series of known mechanisms of sterilization failure and their time interval to failure. Methods: Analyses of 131 failed sterilizations pooled from UK (NHS Litigation Authority, Medical Protection Society and our hospital), Australia and a qualitative systematic review. Results: We identified 88 negligent and 43 non-negligent sterilization failures. Filshie and ring methods failed earlier than diathermy and Pomeroy methods. Sterilization failure occurred significantly earlier in negligent than non-negligent failure mechanisms [median failure intervals 7.0 versus 12.0 months; Hazard ratio (2.35 95% CI 1.31-4.21)]. Knowing that sterilization failure occurred early, increased the probability that the failure mechanism was likely to be negligent rather than non-negligent. Conclusions: A short interval to failure is suggestive of a negligent failure mechanism. There is less certainty in the predictive value of longer time intervals on the mechanism of failure due to a paucity of cases. A national register of failed sterilizations that have been systematically investigated is needed to improve our understanding of negligent and non-negligent failure mechanisms.
MeSH term(s)	Adult ; Female ; Humans ; Malpractice ; Pregnancy ; Probability ; Proportional Hazards Models ; Sterilization, Tubal/methods ; Time Factors
Language	English
Publishing date	2007-09
Publishing country	England
Document type	Journal Article
ZDB-ID	632776-x
ISSN	1460-2350 ; 0268-1161 ; 1477-741X
ISSN (online)	1460-2350
ISSN	0268-1161 ; 1477-741X
DOI	10.1093/humrep/dem188
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