***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: BACKGROUND Pipelle is a silastic curette which does not require a tenaculum or straightening of the cervical fundus axis because of its flexibility and does not require general anaesthesia , whereas Dilatation and curettage ( D&C ) requires hospitalization and general anaesthesia along with the problem of postoperative pain . The objective of the study was to assess the effectiveness of Pipelle sampling in terms of adequate specimen collection and patients ' knowledge and perception about Pipelle and compare it D&C. METHODS In this r and omized control trial , 203 women presenting with abnormal uterine bleeding were enrolled . The patients were r and omly assigned to one of the two procedures . In group A 102 patients were subjected to Pipelle endometrial sampling  and in group B 101 patients were enrolled for D&C.  Frequencies of adequacy of histopathology reports and cost effectiveness of both groups were compared . Patient 's knowledge , perception , pain and acceptability of the procedure of both groups were also assessed and compared . RESULTS The mean age of the patients was 46.3 ± 4.45 years . Tissue obtained for histopathology was 100 % adequate when the procedure was D&C while it was 98 % in Pipelle group . In group-A 92 % patients experienced no discomfort , with only 2 % experiencing severe pain and 6 % mild pain . On the other h and in group-B , 45 % patients experienced moderate and 5 % experienced severe pain up to 9 on visual analogue scale ( VAS ) postoperatively arid requiring post-operative analgesia . The acceptability for the Pipelle  suction curette was 98 % and for the D&C group was 34 % . Regarding previous knowledge of procedure none of patients ( 100 % ) knew about Pipelle procedure but 98 % patients were aware of D&C procedure . Pipelle was eight times more cost effective as compared to D&C. CONCLUSIONS The results of obtained by endometrial sample by Pipelle and D&C are compareable . Pipelle significantly produced less pain than In this prospect i ve study , we compared the histological results of Pipelle endometrial sampling ( PES ) with that of hysterectomy to examine whether endometrial sampling with the Pipelle device can accurately diagnose endometrial carcinoma .  PES was performed in 26 patients with known endometrial carcinoma whose initial therapy consisted of hysterectomy .  Discomfort and pain during the biopsy were reported to be mild by 22 patients , moderate by 3 patients and severe by only 1 patient . All of the sample s were found to be adequate . Twenty-four of 26 PES confirmed endometrial carcinoma , a correlation of 95 % , and the histological grade reported on PES agreed with that of hysterectomy specimens in 87.5 % of the patients . On the other h and , the tumor grade in the specimens obtained at dilation and curettage correlated with hysterectomy specimens in 95 % of the patients . We conclude that Pipelle is an accurate device in patients with endometrial carcinoma Background : “ Referral ” characterises a significant area of interaction between primary and secondary care . Despite advantages , it can be inflexible , and may lead to duplication . Objective : To examine the outcomes of an integrated model that lends weight to general practitioner (GP)-led evidence based care . Design : A prospect i ve , non-r and om comparison of two services : women attending the new ( Bridges ) pathway compared with those attending a consultant-led one-stop menstrual clinic ( OSMC ) . Patients ’ views were examined using patient career diaries , health and clinical outcomes , and re source utilisation . Follow-up was for 8 months . Setting : A large teaching hospital and general practice s within one primary care trust ( PCT ) . Results : Between March 2002 and June 2004 , 99 women in the Bridges pathway were compared with 94 women referred to the OSMC by GPs from non-participating PCTs . The patient career diary demonstrated a significant improvement in the Bridges group for patient information , fitting in at the point of arrangements made for the patient to attend hospital ( ease of access ) ( p<0.001 ) , choice of doctor ( p = 0.020 ) , waiting time for an appointment ( p<0.001 ) , and less “ limbo ” ( patient experience of non-coordination between primary and secondary care ) ( p<0.001 ) . At 8 months there were no significant differences between the two groups in surgical and medical treatment rates or in the use of GP clinic appointments . Significantly fewer ( traditional ) hospital outpatient appointments were made in the Bridges group than in the OSMC group ( p<0.001 ) . Conclusion : A general practice -led model of integrated care can significantly reduce outpatient attendance while improving patient experience , and maintaining the quality of care OBJECTIVES Our aim was to compare the Pipelle , Accurette , and Explora endometrial sampling devices . STUDY DESIGN Patients ( n = 248 ) undergoing endometrial biopsy  were r and omized to one of the three sampling instruments . Diagnostic accuracy , ability to obtain sufficient tissue for histologic diagnosis , and patient discomfort during sampling of the three devices were compared . When available , endometrial biopsy specimens were compared with subsequent pathologic findings at hysterectomy . Statistical analysis was performed with one-way variance of the means , chi 2 , and Kruskal-Wallis statistic . RESULTS In successful biopsies there was no statistical difference among groups in specimen adequacy and there was no discrepancy between endometrial biopsy and hysterectomy pathologic findings . However , 42 % of Accurette biopsies either were failed attempts or obtained insufficient tissue ( p < 0.01 ) . Pain scores were similar among the groups . CONCLUSION The results with the Pipelle and Explora endometrial sample rs appear to be comparable . However , given a 42 % unusable specimen rate , the Accurette can not be recommended for routine endometrial sampling OBJECTIVES To compare three outpatient methods of endometrial evaluation in terms of performance , patient acceptability and cost-effectiveness . DESIGN Pragmatic unblinded trial r and omised separately within three groups determined by risk of endometrial cancer . SETTING The gynaecology outpatient clinic of a large city hospital in Edinburgh , Scotl and . PARTICIPANTS Women referred for investigation and management of abnormal bleeding between January 1999 and May 2001 . INTERVENTIONS Investigations were : blind biopsy alone , hysteroscopy with biopsy , ultrasound evaluation including transvaginal ultrasound , and , in the low-risk group , the option of no investigation . Within this design , two devices for obtaining endometrial biopsy were compared , the Pipelle sample r and the Tao brush . MAIN OUTCOME MEASURES Successful ( informative ) completion of the investigation , acceptability of the investigation method to women , women 's satisfaction with clinic care in the short term and at 10 months and 2 years of follow-up , and cost-effectiveness to the end of investigation . RESULTS Minor adverse events ( e.g. shock , patient distress ) did not occur for ultrasound , but occurred in 16 % and 10 % of women for hysteroscopy and biopsy procedures respectively . Pipelle biopsy provided an acceptable endometrial sample for 79 % of moderate-risk women , but only 43 % of high-risk women . The Tao brush gave similar performance in moderate-risk women ( 77 % ) , but was more successful than the Pipelle sample r in postmenopausal ( high-risk ) women ( 72 % ) . There were significantly more successful visualizations for ultrasound than for hysteroscopy in both the low-risk and the moderate-risk group , and a similar but non-significant trend in the high-risk group . Ultrasound was significantly better than hysteroscopy at detecting fibroids , but hysteroscopy significantly better for polyps . At the 10-month follow-up , high-risk women who had been investigated by hysteroscopy ( with biopsy ) had the most positive views of their clinic experience , but this effect had largely disappeared by 24 months . In the moderate-risk group , the subgroup r and omised to biopsy alone gave the most negative responses about their clinic experience and health now . Women wishing they had more investigation comprised 22 % of moderate-risk women and 38 % of low-risk women , but only 14 % of postmenopausal women . At follow-up the moderate-risk women ( with menstrual bleeding problems ) , compared with postmenopausal women , had much worse ratings for clinic experience and health now . Re source use tended to be higher in the moderate- and low-risk women . There was minimal difference in cost-effectiveness between investigation options in the high-risk group , with the option involving hysteroscopy being marginally better than ultrasound . The most cost-effective investigation in the moderate-risk group was biopsy alone and in the low-risk group ultrasound . CONCLUSIONS Decision-making about investigation would be clarified if postmenopausal women were studied separately from premenopausal women with menstrual bleeding problems . For postmenopausal women exclusion of cancer is a main objective , so once investigation has been completed discharge follows , but in the woman with abnormal menstrual bleeding , even if serious pathology is excluded , the original presenting symptoms require management . About 60 % of premenopausal women with abnormal bleeding reported that their symptoms were not ' much improved ' at 10 months . Research is needed to underst and this phenomenon , and to explore ways to integrate patient factors into optimising evaluation and treatment . The significance of benign pathologies in this group also requires clarification . Given the relatively small differences observed in cost-effectiveness , there is justification for allowing other issues ( such as clinician preferences and women 's perspectives ) to influence decisions as to the investigation method . There is scope to make better use of patient factors to inform decisions as to the most efficient and acceptable method of investigation for an individual woman . Additional analyses , using data available as a result of this study , will contribute to this agenda OBJECTIVE To evaluate the feasibility and accuracy of Pipelle Mark II sampling ( design ed for combined cytology and histology testing ) in the diagnosis of endometrial disease . MATERIAL S AND METHODS A 97 women with abnormal uterine bleeding or intrauterine lesions on ultrasound examination underwent Pipelle Mark II endometrial sampling , followed by diagnostic hysteroscopy . The adequacy of endometrial sample s obtained for cytological and histological analysis was assessed . A correlation was established between endometrial cytology , histology and diagnostic hysteroscopy results . Where discrepancies were found , they were compared with the histological results obtained from operative hysteroscopy . RESULTS The tissue sample s obtained for cytological and histological diagnoses were insufficient in 14.4 % and 11.3 % of patients , respectively . The opposite was found in the group of postmenopausal women ( N=52 ) : the tissue sample s for cytological and histological diagnoses were insufficient in only 3.8 % and 15.4 % of cases , respectively . The cytological results corroborated diagnostic hysteroscopy findings and histological results in all cases but 3 ( 3.6 % ) . Only two cases of endometrial carcinoma were reported in this group of patients , and they were both detected by all three methods . The rate of false positives with endometrial cytological sampling was 3.6 % . There were no false negatives . CONCLUSION Pipelle Mark II endometrial sampling is feasible . It provides adequate sample s for histological and /or cytological analysis and reliable results . It reduces the rate of false negative results for endometrial cancer . Pipelle Mark II sampling is particularly useful in postmenopausal women and in women with endometrial atrophy . Other larger studies are necessary to evaluate the efficiency of Pipelle Mark II This prospect i ve , r and omized study compares sample adequacy , pain associated with endometrial biopsy , and correlation of endometrial histologic sampling with hysterectomy histologic results in specimens obtained by the  Pipelle  ( Unimar Inc. , Wilton , Conn. )  device ( N = 149 ) and the Novak ( Miltex , Inc. , Lake Success , N.Y. )  curette  ( N = 126 ) . During a 2-year period , patients with abnormal uterine bleeding seen in our ambulatory care facility were enrolled in this trial , unless they did not wish to participate or had a positive pregnancy test result . Patients in both groups were similar with respect to mean gravidity , parity , and menopausal status , although patients in the Novak group were older ( 43.4 vs 39.1 years , p = 0.005 ) . Patients undergoing Novak biopsy  had a mean pain score of 4.36 with 22 of 126 ( 17 % ) reporting severe pain , whereas patients undergoing  Pipelle biopsy had a mean pain score of 3.21 with only 10 of 149 ( 6.7 % ) reporting severe pain ( p less than 0.05 ) . These pain scores were not affected by menstrual day , gravidity , parity , or menopausal status . Insufficient tissue was reported in 12.8 % of patients in the Pipelle group compared with 9.5 % in the Novak group ( p greater than 0.05 ) . Fifty patients underwent subsequent hysterectomy . In 48 of 50 ( 96 % ) , the pathologic results at hysterectomy were in agreement with the histologic findings at endometrial sampling . This clinical trial suggests that Pipelle biopsy appears to be as effective as the Novak curette in obtaining an adequate specimen for histologic analysis and is associated with less pain Abstract The aim of this study is to investigate the accuracy and adequ 
    Output:
    
Results Pipelle seems to perform as well as dilation and curettage and , as well or better than other ES devices in terms of sampling adequacy and sensitivity .
It also seems to be better regarding pain/discomfort and costs .
However , Pipelle can disrupt the sonographic appearance of the endometrium and may be limited by cervical stenosis , pelvic organ prolapse and endometrial atrophy .
Conclusions The current evidence supports the use of Pipelle in the management of low-risk women presenting in the outpatient setting with symptomatic AUB when combined with clinical assessment and ultrasound scanning .