Predictors of readmission after outpatient plastic surgery.

PubMed

Mioton, Lauren M; Buck, Donald W; Rambachan, Aksharananda; Ver Halen, Jon; Dumanian, Gregory A; Kim, John Y S

2014-01-01

Hospital readmissions have become a topic of focus for quality care measures and cost-reduction efforts. However, no comparative multi-institutional data on plastic surgery outpatient readmission rates currently exist. The authors endeavored to investigate hospital readmission rates and predictors of readmission following outpatient plastic surgery. The 2011 National Surgical Quality Improvement Program database was reviewed for all outpatient procedures. Unplanned readmission rates were calculated for all 10 tracked surgical specialties (i.e., general, thoracic, vascular, cardiac, orthopedics, otolaryngology, plastics, gynecology, urology, and neurosurgery). Multivariate logistic regression models were used to determine predictors of readmission for plastic surgery. A total of 7005 outpatient plastic surgery procedures were isolated. Outpatient plastic surgery had a low associated readmission rate (1.94 percent) compared with other specialties. Seventy-five patients were readmitted with a complication. Multivariate regression analysis revealed obesity (body mass index ≥ 30), wound infection within 30 days of the index surgery, and American Society of Anesthesiologists class 3 or 4 physical status as significant predictors for unplanned readmission. Unplanned readmission after outpatient plastic surgery is infrequent and compares favorably to rates of readmission among other specialties. Obesity, wound infection within 30 days of the index operation, and American Society of Anesthesiologists class 3 or 4 physical status are independent predictors of readmission. As procedures continue to transition into outpatient settings and the drive to improve patient care persists, these findings will serve to optimize outpatient surgery use.

Sexual health in Spanish postmenopausal women presenting at outpatient clinics.

PubMed

Cornellana, M J; Harvey, X; Carballo, A; Khartchenko, E; Llaneza, P; Palacios, S; Mendoza, N

2017-04-01

One of the most common complaints among postmenopausal women is a change in sexual drive. The aim of this study was to assess the current state of sexual health in Spanish postmenopausal women who present at outpatient gynecology clinics. In this multicenter, observational, cross-sectional, questionnaire-based study, a survey was conducted that included 3026 Spanish postmenopausal women in a routine clinical setting in outpatient gynecology clinics at public and private institutions throughout Spain. We used the Women's Sexual Function questionnaire, which has been validated in Spain. In the multivariate analysis, we found that the best indicators of sexual health in postmenopausal women were a higher education (p < 0.001), working or previously worked (p < 0.001), a stable partner (p < 0.001), living in an urban area (p < 0.01), healthy habits and received information about menopause (p < 0.001). These results indicate that it is important to provide health education and information about menopause and the complaints associated with this period in a woman's life.

Use of Psychosocial Services Increases after a Social Worker-Mediated Intervention in Gynecology Oncology Patients

ERIC Educational Resources Information Center

Abbott, Yuko; Shah, Nina R.; Ward, Kristy K.; McHale, Michael T.; Alvarez, Edwin A.; Saenz, Cheryl C.; Plaxe, Steven C.

2013-01-01

The purpose of this study was to determine whether the introduction of psychosocial services to gynecologic oncology outpatients by a social worker increases service use. During the initial six weeks (phase I), patients were referred for psychosocial services by clinic staff. During the second six weeks (phase II), a nurse introduced available…

Gynecologic Cancer Disparities: a Report from the Health Disparities Taskforce of the Society of Gynecologic Oncology

PubMed Central

Collins, Yvonne; Holcomb, Kevin; Chapman-Davis, Eloise; Khabele, Dineo; Farley, John H.

2014-01-01

Objectives To review the extent of health disparities in gynecologic cancer care and outcomes and to propose recommendations to help counteract the disparities. Methods We searched the electronic databases PubMed and the Cochrane Library. We included studies demonstrating quantifiable differences by race and ethnicity in the incidence, treatment, and survival of gynecologic cancers in the United States (US). Most studies relied on retrospective data. We focused on differences between Black and White women, because of the limited number of studies on non-Black women. Results White women have a higher incidence of ovarian cancer compared to Black women. However, the all-cause ovarian cancer mortality in Black women is 1.3 times higher than that of White women. Endometrial and cervical cancer mortality in Black women is twice that of White women. The etiology of these disparities is multifaceted. However, much of the evidence suggests that equal care leads to equal outcomes for Black women diagnosed with gynecologic cancers. Underlying molecular factors may play an additional role in aggressive tumor biology and endometrial cancer disparities. Conclusion Gynecologic cancer disparities exist between Black and White women. The literature is limited by the lack of large prospective trials and adequate numbers of non-Black racial and ethnic groups. We conclude with recommendations for continued research and a multifaceted approach to eliminate gynecologic cancer disparities. PMID:24406291

Experiences of gynecological cancer patients receiving care from specialist nurses: a qualitative systematic review.

PubMed

Cook, Olivia; McIntyre, Meredith; Recoche, Katrina; Lee, Susan

2017-08-01

The care needs of women with gynecological cancer are complex and change over the course of their cancer journey. Specialist nurses are well positioned to play a role in meeting the needs of women with gynecological cancer although their role and scope of practice have not been well defined. As patients are a key stakeholder, understanding their experience of care is an important step in better defining the role and scope of practice of specialist nurses in gynecological oncology in Australia and New Zealand. This review sought to consider gynecological cancer patients' experiences of specialist nursing care. Exploring the patient's experience of care by a specialist nurse is one step in the process of better defining the role and scope of practice of specialist gynecological-oncology nurses in Australia and New Zealand. This review included studies with a focus on women with gynecological cancer who had been cared for by a specialist nurse. Studies of women with gynecological cancer at any point on the continuum of care from pre-diagnosis to survivorship or end of life, including those with a recurrence of the disease, were included, with no limit to the duration of care received for inclusion in the review. Studies that explored how women with gynecological cancer experience the care and interventions of specialist nurses were included. Qualitative studies including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research were considered for review. This review also considered the qualitative components of mixed method studies. Research conducted in any country was considered for inclusion in this review providing that the study was reported in English. Studies conducted in any setting including, but not limited to, acute hospitals, outpatient/ambulatory clinics, chemotherapy or radiotherapy units, support groups, palliative care units or the patient's home were included. A three-step search strategy

Pedagogical Implications of Partnerships Between Psychiatry and Obstetrics-Gynecology in Caring for Patients with Major Mental Disorders.

PubMed

Coverdale, John; Roberts, Laura Weiss; Balon, Richard; Beresin, Eugene V

2015-08-01

Because there are no formal reviews, the authors set out to identify and describe programs that serve female patients with major mental disorders by integrating mental health care with services in obstetrics and gynecology and to describe the pedagogical implications of those programs. The authors searched PubMed for all articles describing a program in which psychiatry was formally integrated with obstetric or gynecological services, other than standard consultation-liaison programs, in the care of patients with major mental disorders. The search terms used included interdisciplinary, interprofessional, integrated, collaborative care, psychiatry, and obstetrics-gynecology or psychosomatic obstetrics-gynecology. The authors found six distinct integrated programs. These included family planning clinics that were integrated into inpatient psychiatry services; inpatient and outpatient psychiatry services for pregnant mentally ill women in close collaboration with obstetric services; a day hospital for pregnant women with psychiatric disorders in an obstetric setting; an interdisciplinary training site providing care for predominantly depressed, low-income, and minority women; a primary care HIV service for women integrated with departments of obstetrics-gynecology and psychiatry; and an obstetrics-gynecology clinic-based collaborative depression care intervention for socially disadvantaged women. Residents' involvement was described in four of the programs. These innovative and integrated programs potentially enhance the care of vulnerable and culturally diverse women with major mental disorders. The authors discuss how these programs may contribute to the education of residents in psychiatry and obstetrics-gynecology.

A comparative analysis of readmission rates after outpatient cosmetic surgery.

PubMed

Mioton, Lauren M; Alghoul, Mohammed S; Kim, John Y S

2014-02-01

Despite the increasing scrutiny of surgical procedures, outpatient cosmetic surgery has an established record of safety and efficacy. A key measure in assessing surgical outcomes is the examination of readmission rates. However, there is a paucity of data on unplanned readmission following cosmetic surgery procedures. The authors studied readmission rates for outpatient cosmetic surgery and compared the data with readmission rates for other surgical procedures. The 2011 National Surgical Quality Improvement Program (NSQIP) data set was queried for all outpatient procedures. Readmission rates were calculated for the 5 surgical specialties with the greatest number of outpatient procedures and for the overall outpatient cosmetic surgery population. Subgroup analysis was performed on the 5 most common cosmetic surgery procedures. Multivariate regression models were used to determine predictors of readmission for cosmetic surgery patients. The 2879 isolated outpatient cosmetic surgery cases had an associated 0.90% unplanned readmission rate. The 5 specialties with the highest number of outpatient surgical procedures were general, orthopedic, gynecologic, urologic, and otolaryngologic surgery; their unplanned readmission rates ranged from 1.21% to 3.73%. The 5 most common outpatient cosmetic surgery procedures and their associated readmission rates were as follows: reduction mammaplasty, 1.30%; mastopexy, 0.31%; liposuction, 1.13%; abdominoplasty, 1.78%; and breast augmentation, 1.20%. Multivariate regression analysis demonstrated that operating time (in hours) was an independent predictor of readmission (odds ratio, 1.40; 95% confidence interval, 1.08-1.81; P=.010). Rates of unplanned readmission with outpatient cosmetic surgery are low and compare favorably to those of other outpatient surgeries.

Survey of robotic surgery training in obstetrics and gynecology residency.

PubMed

Gobern, Joseph M; Novak, Christopher M; Lockrow, Ernest G

2011-01-01

To examine the status of resident training in robotic surgery in obstetrics and gynecology programs in the United States, an online survey was emailed to residency program directors of 247 accredited programs identified through the Accreditation Council for Graduate Medical Education website. Eighty-three of 247 program directors responded, representing a 34% response rate. Robotic surgical systems for gynecologic procedures were used at 65 (78%) institutions. Robotic surgery training was part of residency curriculum at 48 (58%) residency programs. Half of respondents were undecided on training effectiveness. Most program directors believed the role of robotic surgery would increase and play a more integral role in gynecologic surgery. Robotic surgery was widely reported in residency training hospitals with limited availability of effective resident training. Robotic surgery training in obstetrics and gynecology residency needs further assessment and may benefit from a structured curriculum. Published by Elsevier Inc.

Mortality of induced abortion, other outpatient surgical procedures and common activities in the United States.

PubMed

Raymond, Elizabeth G; Grossman, Daniel; Weaver, Mark A; Toti, Stephanie; Winikoff, Beverly

2014-11-01

The recent surge of new legislation regulating induced abortion in the United States is ostensibly motivated by the desire to protect women's health. To provide context for interpreting the risk of abortion, we compared abortion-related mortality to mortality associated with other outpatient surgical procedures and selected nonmedical activities. We calculated the abortion-related mortality rate during 2000-2009 using national data. We searched PubMed and other sources for contemporaneous data on mortality associated with other outpatient procedures commonly performed on healthy young women, marathon running, bicycling and driving. The abortion-related mortality rate in 2000-2009 in the United States was 0.7 per 100,000 abortions. Studies in approximately the same years found mortality rates of 0.8-1.7 deaths per 100,000 plastic surgery procedures, 0-1.7deaths per 100,000 dental procedures, 0.6-1.2 deaths per 100,000 marathons run and at least 4 deaths among 100,000 cyclists in a large annual bicycling event. The traffic fatality rate per 758 vehicle miles traveled by passenger cars in the United States in 2007-2011 was about equal to the abortion-related mortality rate. The safety of induced abortion as practiced in the United States for the past decade met or exceeded expectations for outpatient surgical procedures and compared favorably to that of two common nonmedical voluntary activities. The new legislation restricting abortion is unnecessary; indeed, by reducing the geographic distribution of abortion providers and requiring women to travel farther for the procedure, these laws are potentially detrimental to women's health. Copyright © 2014 Elsevier Inc. All rights reserved.

Receipt of outpatient cardiac rehabilitation among heart attack survivors--United States, 2005.

PubMed

2008-02-01

Each year, approximately 865,000 persons in the United States have a myocardial infarction (i.e., heart attack). In 2007, direct and indirect costs of heart disease were estimated at approximately $277.1 billion. Cardiac rehabilitation, an essential component of recovery care after a heart attack, focuses on cardiovascular risk reduction, promoting healthy behaviors, reducing death and disability, and promoting an active lifestyle for heart attack survivors. Current guidelines from the American Heart Association (AHA) and the American Association of Cardiovascular and Pulmonary Rehabilitation emphasize the importance of cardiac rehabilitation, which reduces morbidity and mortality, improves clinical outcomes, enhances psychological recovery, and decreases the risk for secondary cardiac events. To estimate the prevalence of receipt of outpatient cardiac rehabilitation among heart attack survivors in 21 states and the District of Columbia (DC), data from the 2005 Behavioral Risk Factor Surveillance System (BRFSS) were assessed. The results of that assessment indicated that 34.7% of BRFSS respondents who had experienced a heart attack participated in outpatient cardiac rehabilitation. Outpatient cardiac rehabilitation for eligible patients after a heart attack is an essential component of care that should be incorporated into treatment plans. Increasing the number of persons who participate in cardiac rehabilitation services also can reduce health-care costs for recurrent events and reduce the burden on families and caregivers of patients with serious sequelae.

Cost-effectiveness of robotic surgery in gynecologic oncology.

PubMed

Xie, Yue

2015-02-01

Robotically assisted surgeries have flourished in the United States, especially in gynecological procedures. Current robotic systems have high upfront and procedure costs that have led many in the medical community to question the new technology's cost-effectiveness. Recent research continues to find that robotically assisted gynecological cancer treatments have comparable outcomes to traditional laparoscopy and similar or better outcomes than that of laparotomy in the cases studied. However, robotic surgery costs remain higher than that of traditional laparoscopy. Under the current reimbursement climate, practicing physicians and hospitals should collaborate on identifying cost-effective uses of robotic systems and pushing manufacturers to lower purchase and procedure costs to a level that may be accepted by all stakeholders.

[Robotic surgery in gynecology].

PubMed

Csorba, Roland

2012-06-24

Minimally invasive surgery has revolutionized gynecological interventions over the past 30 years. The introduction of the da Vinci robotic surgery in 2005 has resulted in large changes in surgical management. The robotic platform allows less experienced laparoscopic surgeons to perform more complex procedures. It can be utilized mainly in general gynecology and reproductive gynecology. The robot is being increasingly used for procedures such as hysterectomy, myomectomy, adnexal surgery, and tubal anastomosis. In urogynecology, the robot is being utilized for sacrocolopexy as well. In the field of gynecologic oncology, the robot is being increasingly used for hysterectomy and lymphadenectomy in oncologic diseases. Despite the rapid and widespread adaption of robotic surgery in gynecology, there are no randomized trials comparing its efficacy and safety to other traditional surgical approaches. This article presents the development, technical aspects and indications of robotic surgery in gynecology, based on the previously published reviews. Robotic surgery can be highly advantageous with the right amount of training, along with appropriate patient selection. Patients will have less blood loss, less post-operative pain, faster recovery, and fewer complications compared to open surgery and laparoscopy. However, until larger randomized control trials are completed which report long-term outcomes, robotic surgery cannot be stated to have priority over other surgical methods.

Opportunistic bilateral salpingectomy during benign gynecological surgery for ovarian cancer prevention: a survey of Gynecologic Oncology Committee of Japan Society of Obstetrics and Gynecology.

PubMed

Mikami, Mikio; Nagase, Satoru; Yamagami, Wataru; Ushijma, Kimio; Tashiro, Hironori; Katabuchi, Hidetaka

2017-07-01

Recent evidence has supported the concept that epithelial ovarian cancer (EOC) arises from the cells of the fallopian tube or endometrium. This study investigated current practice in Japan with respect to performing opportunistic bilateral salpingectomy (OBS) during gynecological surgery for benign disease for Ovarian Cancer Prevention. We mailed a questionnaire to 767 hospitals and clinics, comprising 628 accredited training institutions of the Japan Society of Obstetrics and Gynecology (JSOG), Japan Society of Gynecologic Oncology (JSGO), or Japan Society of Gynecologic and Obstetric Endoscopy and Minimally Invasive Therapy (JSGOE) and 139 private institutions with at least one JSGOE-certified licensed gynecologic laparoscopist. Among the 767 institutions, 444 (57.9%) provided responses, including 91 (20.6%) that were both JSGOE and JSGO accredited, 71 (16.0%) that were only JSGO accredited, 88 (19.8%) that were only JSGOE accredited, and 194 (43.7%) that were unaccredited. It was found that awareness and performance of OBS largely depended on the JSGO and/or JSGOE accreditation status. OBS was only performed at 54.0% of responding institutions and just 6.8% of the institutions were willing to participate in randomized controlled trials to validate this method for reducing the incidence of ovarian cancer. The JSOG Gynecologic Tumor Committee will announce its opinion on salpingectomy for ovarian cancer prevention to all JSOG members and will develop a system for monitoring the number of OBS procedures in Japan. Copyright © 2017. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology

Evaluation of the impact of resident work hour restrictions on resident outpatient clinical experience.

PubMed

Patel, Shweta V; Driggers, Rita W; Zahn, Christopher M

2011-01-01

To estimate the effect of work hour restrictions on resident outpatient clinical experience. Schedule templates from academic years 1998-1999 (before work hour restrictions), 2002-2003 (when night float rotation was added in anticipation of work hour restrictions), and 2008-2009 (during work hour restrictions) were compared for outpatient clinic experience before and after work hour restrictions were implemented. Actual clinics on specific rotations and estimated patient encounters per scheduled clinic were considered. Between academic year (AY) 1998-1999 and AY 2008-2009 there was a generalized downward trend in average outpatient encounters for postgraduate year (PGY)-2, PGY-3 and PGY-4 residents (45%, 34% and 36%, respectively). For obstetrics, gynecology and ambulatory rotations, there was a downward trend in average outpatient encounters for each rotation type (61%, 14% and 63%, respectively). The average number of scheduled clinics per week was slightly decreased when comparing AY 1998-1999 to either AY 2002-2003 or AY 2008-2009. Rotation schedules before and after work hour restrictions demonstrated a downward trend in the number of scheduled outpatient encounters. These findings indicate a potential negative impact on preparation for clinical practice.

Outpatient Mental Health Treatment Utilization and Military Career Impact in the United States Marine Corps

PubMed Central

Ghahramanlou-Holloway, Marjan; LaCroix, Jessica M.; Koss, Kari; Perera, Kanchana U.; VanSickle, Marcus R.; Novak, Laura A.

2018-01-01

Service members (SM) are at increased risk of psychiatric conditions, including suicide, yet research indicates SMs believe seeking mental health treatment may negatively impact their military careers, despite a paucity of research examining actual career impacts. This study examined the link between seeking outpatient mental health (MH) treatment and military career impacts within the United States Marine Corps. In Phase 1, a retrospective medical record review of outpatient MH treatment-seeking Marines (N = 38) was conducted. In Phase 2, a sample of outpatient MH treatment-seeking Marines (N = 40) was matched to a non-treatment-seeking sample of Marines (N = 138) to compare career-progression. In Phase 1, there were no significant links between demographic, military, and clinical characteristics and referral source or receipt of career-affecting treatment recommendations. In Phase 2, MH treatment-seeking Marines in outpatient settings were more likely than matched controls to be separated from the military (95.0% versus 63.0%, p = 0.002), but no more likely to experience involuntary separation. MH treatment-seeking Marines were more likely to have documented legal action (45.0% versus 23.9%, p = 0.008) and had a shorter time of military service following the index MH encounter than matched controls (p < 0.001). Clinical, anti-stigma, and suicide prevention policy implications are discussed. PMID:29690594

Outpatient Mental Health Treatment Utilization and Military Career Impact in the United States Marine Corps.

PubMed

Ghahramanlou-Holloway, Marjan; LaCroix, Jessica M; Koss, Kari; Perera, Kanchana U; Rowan, Anderson; VanSickle, Marcus R; Novak, Laura A; Trieu, Theresa H

2018-04-23

Service members (SM) are at increased risk of psychiatric conditions, including suicide, yet research indicates SMs believe seeking mental health treatment may negatively impact their military careers, despite a paucity of research examining actual career impacts. This study examined the link between seeking outpatient mental health (MH) treatment and military career impacts within the United States Marine Corps. In Phase 1, a retrospective medical record review of outpatient MH treatment-seeking Marines ( N = 38) was conducted. In Phase 2, a sample of outpatient MH treatment-seeking Marines ( N = 40) was matched to a non-treatment-seeking sample of Marines ( N = 138) to compare career-progression. In Phase 1, there were no significant links between demographic, military, and clinical characteristics and referral source or receipt of career-affecting treatment recommendations. In Phase 2, MH treatment-seeking Marines in outpatient settings were more likely than matched controls to be separated from the military (95.0% versus 63.0%, p = 0.002), but no more likely to experience involuntary separation. MH treatment-seeking Marines were more likely to have documented legal action (45.0% versus 23.9%, p = 0.008) and had a shorter time of military service following the index MH encounter than matched controls ( p < 0.001). Clinical, anti-stigma, and suicide prevention policy implications are discussed.

Responses of advanced directives by Jehovah’s Witnesses on a gynecologic oncology service

PubMed Central

Nagarsheth, Nimesh P; Gupta, Nikhil; Gupta, Arpeta; Moshier, Erin; Gretz, Herbert; Shander, Aryeh

2015-01-01

Objectives To review the responses of advance directives signed by Jehovah’s Witness patients prior to undergoing surgery at a gynecologic oncology service. Study design A retrospective chart review of gynecologic oncology patients undergoing surgery at a bloodless surgery center from 1998–2007 was conducted. Demographic, pathologic, and clinical data were recorded. The proportion of patients who accepted and refused various blood-derived products was determined and was compared to previously published results from a similar study of labor and delivery unit patients. Results No gynecologic oncology patients agreed to accept transfusions of whole blood, red cells, white cells, platelets, or plasma under any circumstance, whereas 9.8% of pregnant patients accepted transfusion (P=0.0385). However, 98% of gynecologic oncology patients agreed to accept some blood products, including fractions such as albumin, immunoglobulins, and clotting factors, while only 39% of pregnant patients agreed (P<0.0001). In addition, all gynecologic oncology patients (100%) accepted intraoperative hemodilution, compared to 55% of pregnant patients (P<0.0001). Conclusion Our results confirm the commonly held belief that the majority of Jehovah’s Witness patients refuse to accept major blood components. However, Jehovah’s Witness patients at a gynecologic oncology service will accept a variety of blood-derived products (minor fractions) and interventions designed to optimize outcomes when undergoing transfusion-free surgery. Patients presenting to a gynecologic oncology service respond differently to advanced directives related to bloodless surgery, as compared to patients from an obstetrical service. PMID:25565911

Local inpatient units may increase patients' utilization of outpatient services: a comparative cohort-study in Nordland County, Norway.

PubMed

Myklebust, Lars Henrik; Sørgaard, Knut; Wynn, Rolf

2015-01-01

In the last few decades, there has been a restructuring of the psychiatric services in many countries. The complexity of these systems may represent a challenge to patients that suffer from serious psychiatric disorders. We examined whether local integration of inpatient and outpatient services in contrast to centralized institutions strengthened continuity of care. Two different service-systems were compared. Service-utilization over a 4-year period for 690 inpatients was extracted from the patient registries. The results were controlled for demographic variables, model of service-system, central inpatient admission or local inpatient admission, diagnoses, and duration of inpatient stays. The majority of inpatients in the area with local integration of inpatient and outpatient services used both types of care. In the area that did not have beds locally, many patients that had been hospitalized did not receive outpatient follow-up. Predictors of inpatients' use of outpatient psychiatric care were: Model of service-system (centralized vs decentralized), a diagnosis of affective disorder, central inpatient admission only, and duration of inpatient stays. Psychiatric centers with local inpatient units may positively affect continuity of care for patients with severe psychiatric disorders, probably because of a high functional integration of inpatient and outpatient care.

Local inpatient units may increase patients’ utilization of outpatient services: a comparative cohort-study in Nordland County, Norway

PubMed Central

Myklebust, Lars Henrik; Sørgaard, Knut; Wynn, Rolf

2015-01-01

Objectives In the last few decades, there has been a restructuring of the psychiatric services in many countries. The complexity of these systems may represent a challenge to patients that suffer from serious psychiatric disorders. We examined whether local integration of inpatient and outpatient services in contrast to centralized institutions strengthened continuity of care. Methods Two different service-systems were compared. Service-utilization over a 4-year period for 690 inpatients was extracted from the patient registries. The results were controlled for demographic variables, model of service-system, central inpatient admission or local inpatient admission, diagnoses, and duration of inpatient stays. Results The majority of inpatients in the area with local integration of inpatient and outpatient services used both types of care. In the area that did not have beds locally, many patients that had been hospitalized did not receive outpatient follow-up. Predictors of inpatients’ use of outpatient psychiatric care were: Model of service-system (centralized vs decentralized), a diagnosis of affective disorder, central inpatient admission only, and duration of inpatient stays. Conclusion Psychiatric centers with local inpatient units may positively affect continuity of care for patients with severe psychiatric disorders, probably because of a high functional integration of inpatient and outpatient care. PMID:26604843

Business and Organizational Models of Obstetric and Gynecologic Hospitalist Groups.

PubMed

Garite, Thomas J; Levine, Lisa; Olson, Rob

2015-09-01

The growth of obstetric and gynecologic (OB/GYN) hospitalists throughout the United States has led to different organizational approaches, depending on the perception of what an OB/GYN hospitalist is. There are advantages of OB/GYN hospitalist practices; however, practitioners who do this as just 1 piece of their practice are not fulfilling the promise of what this new specialty can deliver. Because those with office practices have their own business models, this article is devoted to the organizational and business models of OB/GYN hospitalists for physicians whose practice is devoted to inpatient obstetrics with or without emergency room and/or inpatient gynecology coverage. Copyright © 2015 Elsevier Inc. All rights reserved.

Asian Society of Gynecologic Oncology International Workshop 2014.

PubMed

Park, Jeong Yeol; Ngan, Hextan Yuen Sheung; Park, Won; Cao, Zeyi; Wu, Xiaohua; Ju, Woong; Chung, Hyun Hoon; Chang, Suk Joon; Park, Sang Yoon; Ryu, Sang Young; Kim, Jae Hoon; Cho, Chi Heum; Lee, Keun Ho; Lee, Jeong Won; Kumarasamy, Suresh; Kim, Jae Weon; Wilailak, Sarikapan; Kim, Byoung Gie; Kim, Dae Yeon; Konishi, Ikuo; Lee, Jae Kwan; Wang, Kung Liahng; Nam, Joo Hyun

2015-01-01

The Asian Society of Gynecologic Oncology International Workshop 2014 on gynecologic oncology was held in Asan Medical Center, Seoul, Korea on the 23rd to 24th August 2014. A total of 179 participants from 17 countries participated in the workshop, and the up-to-date findings on the management of gynecologic cancers were presented and discussed. This meeting focused on the new trends in the management of cervical cancer, fertility-sparing management of gynecologic cancers, surgical management of gynecologic cancers, and recent advances in translational research on gynecologic cancers.

Asian Society of Gynecologic Oncology International Workshop 2014

PubMed Central

Park, Jeong-Yeol; Ngan, Hextan Yuen Sheung; Park, Won; Cao, Zeyi; Wu, Xiaohua; Ju, Woong; Chung, Hyun Hoon; Chang, Suk-Joon; Park, Sang-Yoon; Ryu, Sang-Young; Kim, Jae-Hoon; Cho, Chi-Heum; Lee, Keun Ho; Lee, Jeong-Won; Kumarasamy, Suresh; Kim, Jae-Weon; Wilailak, Sarikapan; Kim, Byoung-Gie; Kim, Dae-Yeon; Konishi, Ikuo; Lee, Jae-Kwan; Wang, Kung-Liahng

2015-01-01

The Asian Society of Gynecologic Oncology International Workshop 2014 on gynecologic oncology was held in Asan Medical Center, Seoul, Korea on the 23rd to 24th August 2014. A total of 179 participants from 17 countries participated in the workshop, and the up-to-date findings on the management of gynecologic cancers were presented and discussed. This meeting focused on the new trends in the management of cervical cancer, fertility-sparing management of gynecologic cancers, surgical management of gynecologic cancers, and recent advances in translational research on gynecologic cancers. PMID:25609163

Fatigue and gynecologic cancer.

PubMed

Olt, George J

2003-02-01

Fatigue is common in women with gynecologic cancers and is thought to be multifactorial. Anemia, cachexia, pain, and depression are frequently associated with cancer and treatment-related fatigue and should be evaluated and treated. The National Comprehensive Cancer Network Fatigue Practice Guidelines are helpful in the assessment and treatment of women with gynecologic cancer-related fatigue.

Aspects of emotional and physical discomfort in gynecologic examination: a study of Turkish women.

PubMed

Tugut, Nilufer; Golbasi, Zehra

2014-06-01

This cross-sectional study was carried out to determine physical and emotional discomforts experienced before and after a gynecologic examination by women who presented to the outpatient clinic of the gynecology and obstetrics department at a university hospital. The sample of study was composed of 248 women. Data were collected with a survey form developed by researchers. T-test and variance analysis were used in statistical analysis. Emotional discomfort before the examination was felt by 80.2% of the women, while 80.6% stated they felt emotional discomfort after the examination. Physical discomfort before the examination was experienced by 67.3% of the women, while 76.6% stated that they felt physical discomfort after the examination. The emotional discomfort mean score was 5.02 ± 3.24 before examination and 4.62 ± 3.23 after examination (P > 0.05). The physical discomfort mean score was 3.38 ± 3.12 before examination and 3.94 ± 3.02 after examination and the difference between mean scores was statistically significant (P < 0.05). The women felt more physical discomfort during the examination than they anticipated beforehand. The emotional discomfort in women who preferred a female physician was significantly higher than in those who preferred a male physician or who had no preference on the sex of their physician. © 2014 The Authors. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology.

An institutional analysis of HIV prevention efforts by the nation's outpatient drug abuse treatment units.

PubMed

D'Aunno, T; Vaughn, T E; McElroy, P

1999-06-01

Drawing from an institutional-theory perspective on innovations in organizations, this paper examines the use of human immunodeficiency virus (HIV) prevention practices by the nation's outpatient substance abuse treatment units during a critical period from 1988 to 1995. An institutional perspective argues that organizations adopt new practices not only for technical reasons, but also because external actors actively promote or model the use of particular practices. We examine the extent to which treatment units use several practices to prevent HIV infection among their clients and among drug-users not in treatment. Results from random-effects regression analyses of national survey data show that treatment units significantly increased their use of HIV prevention practices from 1988 to 1995. Further, the results show that treatment units' use of prevention practices was related to clients' risk for HIV infection, unit resources available to support these practices, and organizational support for the practices. Implications are discussed for an institutional view of organizational innovation as well as for research on HIV prevention.

Epidemiology of gynecologic cancers in China.

PubMed

Jiang, Xiyi; Tang, Huijuan; Chen, Tianhui

2018-01-01

Cancer has become a major disease burden across the globe. It was estimated that 4.29 million new incident cases and 2.81 million death cases of cancer would occur in 2015 in China, with the age-standardized incidence rate (ASIR) of 201.1 per 100,000 and age-standardized mortality rate (ASMR) of 126.9 per 100,000, respectively. For females, 2 of the top 10 most common types of cancer would be gynecologic cancers, with breast cancer being the most prevalent (268.6 thousand new incident cases) and cervical cancer being the 7th most common cancer (98.9 thousand new incident cases). The incidence and mortality of gynecologic cancers have been constantly increasing in China over last 2 decades, which become a major health concern for women. Survival rates of gynecologic cancers are generally not satisfactory and decrease along with advancing stage, though national data on survival are still not available. It is of great importance to overview on the epidemiology of gynecologic cancers, which may provide scientific clues for strategy-making of prevention and control, and eventually lowering the incidence and mortality rate as well as improving the survival rate in the future. Copyright © 2018. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology.

21 CFR 884.4550 - Gynecologic surgical laser.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Gynecologic surgical laser. 884.4550 Section 884....4550 Gynecologic surgical laser. (a) Identification. A gynecologic surgical laser is a continuous wave carbon dioxide laser designed to destroy tissue thermally or to remove tissue by radiant light energy...

21 CFR 884.4550 - Gynecologic surgical laser.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Gynecologic surgical laser. 884.4550 Section 884....4550 Gynecologic surgical laser. (a) Identification. A gynecologic surgical laser is a continuous wave carbon dioxide laser designed to destroy tissue thermally or to remove tissue by radiant light energy...

42 CFR 493.945 - Cytology; gynecologic examinations.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 5 2014-10-01 2014-10-01 false Cytology; gynecologic examinations. 493.945 Section... Nonwaived Testing Proficiency Testing Programs by Specialty and Subspecialty § 493.945 Cytology; gynecologic... gynecologic examinations (Pap smears) in cytology, a program must provide test sets composed of 10- and 20...

42 CFR 493.945 - Cytology; gynecologic examinations.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 5 2012-10-01 2012-10-01 false Cytology; gynecologic examinations. 493.945 Section... Nonwaived Testing Proficiency Testing Programs by Specialty and Subspecialty § 493.945 Cytology; gynecologic... gynecologic examinations (Pap smears) in cytology, a program must provide test sets composed of 10- and 20...

42 CFR 493.945 - Cytology; gynecologic examinations.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 5 2013-10-01 2013-10-01 false Cytology; gynecologic examinations. 493.945 Section... Nonwaived Testing Proficiency Testing Programs by Specialty and Subspecialty § 493.945 Cytology; gynecologic... gynecologic examinations (Pap smears) in cytology, a program must provide test sets composed of 10- and 20...

21 CFR 884.4550 - Gynecologic surgical laser.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Gynecologic surgical laser. 884.4550 Section 884....4550 Gynecologic surgical laser. (a) Identification. A gynecologic surgical laser is a continuous wave carbon dioxide laser designed to destroy tissue thermally or to remove tissue by radiant light energy...

21 CFR 884.4550 - Gynecologic surgical laser.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Gynecologic surgical laser. 884.4550 Section 884....4550 Gynecologic surgical laser. (a) Identification. A gynecologic surgical laser is a continuous wave carbon dioxide laser designed to destroy tissue thermally or to remove tissue by radiant light energy...

21 CFR 884.4550 - Gynecologic surgical laser.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Gynecologic surgical laser. 884.4550 Section 884....4550 Gynecologic surgical laser. (a) Identification. A gynecologic surgical laser is a continuous wave carbon dioxide laser designed to destroy tissue thermally or to remove tissue by radiant light energy...

Cross-Cultural Obstetric and Gynecologic Care of Muslim Patients.

PubMed

Shahawy, Sarrah; Deshpande, Neha A; Nour, Nawal M

2015-11-01

With the growing number of Muslim patients in the United States, there is a greater need for obstetrician-gynecologists (ob-gyns) to understand the health care needs and values of this population to optimize patient rapport, provide high-quality reproductive care, and minimize health care disparities. The few studies that have explored Muslim women's health needs in the United States show that among the barriers Muslim women face in accessing health care services is the failure of health care providers to understand and accommodate their beliefs and customs. This article outlines health care practices and cultural competency tools relevant to modern obstetric and gynecologic care of Muslim patients, incorporating emerging data. There is an exploration of the diversity of opinion, practice, and cultural traditions among Muslims, which can be challenging for the ob-gyn who seeks to provide culturally competent care while attempting to avoid relying on cultural or religious stereotypes. This commentary also focuses on issues that might arise in the obstetric and gynecologic care of Muslim women, including the patient-physician relationship, modesty and interactions with male health care providers, sexual health, contraception, abortion, infertility, and intrapartum and postpartum care. Understanding the health care needs and values of Muslims in the United States may give physicians the tools necessary to better deliver high-quality care to this minority population.

Emergency in the clinic: a simulation curriculum to improve outpatient safety.

PubMed

Espey, Eve; Baty, Gillian; Rask, John; Chungtuyco, Michelle; Pereda, Brenda; Leeman, Lawrence

2017-12-01

Emergency response skills are essential when events such as seizure, anaphylaxis, or hemorrhage occur in the outpatient setting. As services and procedures increasingly move outside the hospital, training to manage complications may improve outcomes. The objective of this study was to evaluate a simulation-based curriculum in outpatient emergency management skills with the outcome measures of graded objective performance and learner self-efficacy. This pre- and postcurriculum study enrolled residents and fellows in Obstetrics and Gynecology and Family Medicine in a simulation-based, outpatient emergency management curriculum. Learners completed self-efficacy questionnaires and were videotaped managing 3 medical emergency scenarios (seizure, over-sedation/cardiopulmonary arrest, and hemorrhage) in the simulation laboratory both before and after completion of the curriculum. Evaluators who were blinded to training level scored the simulation performance videotapes using a graded rubric with critical action checklists. Scenario scores were assigned in 5 domains and globally. Paired t-tests were used to determine differences pre- and postcurriculum. Thirty residents completed the curriculum and pre- and postcurriculum testing. Subjects' objective performance scores improved in all 5 domains (P<.05) in all scenarios. When scores were stratified by level of training, all participants demonstrated global improvement. When scores were stratified by previous outpatient simulation experience, subjects with previous experience improved in all but management of excess sedation. Pre- and postcurriculum self-efficacy evaluations demonstrated improvement in all 7 measured areas: confidence, use of appropriate resources, communication skills, complex airway management, bag mask ventilation, resuscitation, and hemorrhage management. Self-efficacy assessment showed improvement in confidence managing outpatient emergencies (P=.001) and ability to communicate well in emergency

Robotic Single-Site and Conventional Laparoscopic Surgery in Gynecology: Clinical Outcomes and Cost Analysis of a Matched Case-Control Study.

PubMed

El Hachem, Lena; Andikyan, Vaagn; Mathews, Shyama; Friedman, Kathryn; Poeran, Jashvant; Shieh, Kenneth; Geoghegan, Michael; Gretz, Herbert F

2016-01-01

To assess the clinical outcomes and costs associated with robotic single-site (RSS) surgery compared with those of conventional laparoscopy (CL) in gynecology. Retrospective case-control study (Canadian Task Force classification II-2). University-affiliated community hospital. Female patients undergoing RSS or CL gynecologic procedures. Comparison of consecutive RSS gynecologic procedures (cases) undertaken between October 2013 and March 2014 with matched CL procedures (controls) completed during the same time period by the same surgeon. Patient demographic data, operative data, and hospital financial data were abstracted from the electronic charts and financial systems. An incremental cost analysis based on the use of disposable equipment was performed. Total hospital charges were determined for matched RSS cases vs CL cases. RSS surgery was completed in 25 out of 33 attempts; 3 cases were aborted before docking, and 5 were converted to a multisite surgery. There were no intraoperative complications or conversions to laparotomy. The completed cases included 11 adnexal cases and 14 hysterectomies, 3 of which included pelvic lymph node dissection. Compared with the CL group, total operative times were higher in the RSS group; however, there were no significant between-group differences in estimated blood loss, length of hospital stay, or complication rates. Disposable equipment cost per case, direct costs, and total hospital charges were evaluated. RSS was associated with an increased disposable cost per case of $248 to $378, depending on the method used for vaginal cuff closure. The average total hospital charges for matched outpatient adnexal surgery were $15,450 for the CL controls and $18,585 for the RSS cases (p < .001), and the average total hospital charges for matched outpatient benign hysterectomy were $14,623 for the CL controls and $21,412 for the RSS cases (p < .001). Although RSS surgery and CL have comparable clinical outcomes in selected patients

Impact of a Pediatric and Adolescent Gynecology Curriculum on an Obstetrics and Gynecology Residency.

PubMed

Palaszewski, Dawn M; Miladinovic, Branko; Caselnova, Petra M; Holmström, Shelly W

2016-12-01

To determine the effectiveness of a new pediatric and adolescent gynecology (PAG) curriculum for improving obstetrics/gynecology resident physician knowledge and comfort level in patient management and to describe the current deficiencies in resident physician knowledge and comfort level in PAG. A PAG curriculum was implemented for the obstetrics/gynecology resident physicians (n = 20) at the University of South Florida in July 2013. Before and after the curriculum was introduced, resident physicians and recent graduates of the residency program completed a survey to assess their comfort level and a knowledge assessment consisting of 20 case-based questions. University-based residency program. Resident physicians and recent resident physician graduates in the Department of Obstetrics and Gynecology. Introduction of a PAG curriculum during the 2013-2014 academic year. Improvement in resident physicians' comfort level and knowledge in PAG. After the curriculum was introduced, comfort increased in examining the genitals of a pediatric gynecology patient (median difference = 1.5; P = .003) and history-taking, physical examination skills, and management (median difference = 1; P = .002) compared with before the curriculum. There was no significant difference in overall quiz score (15.5 ± 1.87 vs 15.8 ± 1.3; P = .78). A curriculum in PAG did improve resident comfort level in managing PAG patients, but did not significantly improve knowledge of this topic. Copyright © 2016.

[Subspecialization in gynecology--pro and con].

PubMed

Ludwig, H

1990-01-01

To discuss the problem of subspecialization in gynecology is very popular at present. Whether or not a complete separation into the three subdisciplines, (1) materno-fetal medicine--obstetrics, (2) surgical gynecology--gynecologic oncology, and (3) gynecologic endocrinology--reproductive medicine, is recommendable remains unclear. Some authors describe forms of supplementary postgraduate education only, a kind of prolongation of the basic gynecologic and obstetric training concentrating on one of the three main fields. The complete separation, i.e. into obstetric medicine, reproductive medicine, and gynecologic pelvic surgery, has the advantage of a more effective concentration on each of the respective subdisciplines in clinical work and in research. On the other hand, the separation will produce several disadvantages: (a) that which falls between the subdisciplines will be difficult to integrate; (b) the principle of the gynecologist functioning as a primary health care physician for women will be weakened, i.e. his competence in family-planning, pregnancy and delivery, cancer screening for genital and breast tumors, cycle disorders, pelvic inflammatory diseases and the care of postmenopausal women; (c) the lectures will become more split or overloaded with details than at present; (d) the need for a cost-effective and widely available general gynecologic care will not be met, and (e) the opportunities for younger colleagues to have an office of their own will be restricted. The disadvantages outweigh the advantages. The solution might be a combination of the two competitive models: the creation of subdisciplines, completely separated from one another but for a minority only (i.e. to candidates for leading posts in clinics of the tertiary care, university hospitals etc).(ABSTRACT TRUNCATED AT 250 WORDS)

Cell-based immunotherapy in gynecologic malignancies.

PubMed

Schaar, Bruce; Krishnan, Venkatesh; Tallapragada, Supreeti; Dorigo, Oliver

2018-02-01

To provide an overview of the principles, safety and efficacy of adoptive cell therapy (ACT) in solid tumors particularly in gynecological cancers. Efforts to target solid tumors using tumor-infiltrating lymphocytes and genetically modified T cells have shown promising efficacy in some patients. Two food and drug administration approvals for the treatment of leukemia are the first gene therapies available for cancer treatment in the United States. Genetic engineering of antitumor immunity using T cells has the potential to target specific tumor-associated antigens and overcome obstacles to successful immunotherapy like immune-suppressive factors in the tumor microenvironment.

CCCT - NCTN Steering Committees - Gynecologic Cancers

Cancer.gov

The Gynecologic Cancers Steering Committee evaluates and prioritizes concepts for phase 2 and 3 clinical trials in adult gynecologic cancers. The GCSC is also intent on fostering collaboration with international groups and institutions conducting trials.

Commercial insurance coverage for outpatient cardiac rehabilitation in patients with heart failure in the United States.

PubMed

Thirapatarapong, Wilawan; Thomas, Randal J; Pack, Quinn; Sharma, Saurabh; Squires, Ray W

2014-01-01

Although cardiac rehabilitation (CR) improves outcomes in patients with heart failure (HF), studies suggest variable uptake by patients with HF, as well as variable coverage by insurance carriers. The purpose of this study was to determine the percentage of large commercial health insurance companies that provide coverage for outpatient (CR) for patients with HF. We identified a sample of the largest US commercial health care providers and analyzed their CR coverage policies for patients with HF. We surveyed 44 large private health care insurance companies, reviewed company Web sites, and, when unclear, contacted companies by e-mail or telephone. We excluded insurance clearinghouses because they did not directly provide health care insurance. Of 44 eligible insurance companies, 29 (66%) reported that they provide coverage for outpatient CR in patients with HF. The majority of companies (83%) covered CR for patients with any type of HF. A minority (10%) did not cover CR for patients with HF if it was considered a preexisting condition. A significant percentage of commercial health care insurance companies in the United States report that they currently cover outpatient CR for patients with HF. Because health insurance coverage is associated with patient participation in CR, it is anticipated that patients with HF will increasingly participate in CR in coming years.

Gynecologic Cancer Prevention and Control in the National Comprehensive Cancer Control Program: Progress, Current Activities, and Future Directions

PubMed Central

Lakhani, Naheed; Brown, Phaeydra M.; Larkin, O. Ann; Moore, Angela R.; Hayes, Nikki S.

2013-01-01

Abstract Gynecologic cancer confers a large burden among women in the United States. Several evidence-based interventions are available to reduce the incidence, morbidity, and mortality from these cancers. The National Comprehensive Cancer Control Program (NCCCP) is uniquely positioned to implement these interventions in the US population. This review discusses progress and future directions for the NCCCP in preventing and controlling gynecologic cancer. PMID:23865787

Nerve Injuries in Gynecologic Laparoscopy.

PubMed

Abdalmageed, Osama S; Bedaiwy, Mohamed A; Falcone, Tommaso

2017-01-01

Nerve injuries during gynecologic endoscopy are an infrequent but distressing complication. In benign gynecologic surgery, most of these injuries are associated with patient positioning, although some are related to port placement. Most are potentially preventable with attention to patient placement on the operating room bed and knowledge of the relative anatomy of the nerves. The highest risk group vulnerable to these injuries includes women who have extreme body mass index and those with longer surgical times in the Trendelenburg position. Upper and lower limb peripheral nerves are the most common nerves injured during gynecologic endoscopy. These injuries can result in transient or permanent sensory and motor disabilities that can interrupt patient recovery in an otherwise successful surgery. Numerous strategies are suggested to reduce the frequency of nerve injuries during gynecologic endoscopies. Proper patient positioning and proper padding of the pressure areas are mandatory to prevent malposition-related nerve injuries. Anatomic knowledge of the course of nerves, especially ilioinguinal and iliohypogastric, nerves can minimize injury. Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.

Costs of outpatient parenteral antimicrobial therapy (OPAT) administered by Hospital at Home units in Spain.

PubMed

González-Ramallo, V J; Mirón-Rubio, M; Mujal, A; Estrada, O; Forné, C; Aragón, B; Rivera, A J

2017-07-01

The aim of this study was to assess the direct healthcare costs of outpatient parenteral antimicrobial therapy (OPAT) administered by Hospital at Home (HaH) units in Spain. An observational, multicentre, economic evaluation of retrospective cohorts was conducted. Patients were treated at home by the HaH units of three Spanish hospitals between January 2012 and December 2013. From the cost accounting of HaH OPAT (staff, pharmacy, transportation, diagnostic tests and structural), the cost of each outpatient course was obtained following a top-down strategy based on the use of resources. Costs associated with inpatient stay, if any, were estimated based on length of stay and ICD-9-CM diagnosis. There were 1324 HaH episodes in 1190 patients (median age 70 years). The median (interquartile range) stay at home was 10 days (7-15 days). Of the OPAT episodes, 91.5% resulted in cure or improvement on completion of intravenous therapy. The mean total cost of each infectious episode was €6707 [95% confidence interval (CI) €6189-7406]. The mean cost per OPAT episode was €1356 (95% CI €1247-1560), mainly distributed between healthcare staff costs (46%) and pharmacy costs (39%). The mean cost of inpatient hospitalisation of an infectious episode was €4357 (95% CI €3947-4977). The cost per day of inpatient hospitalisation was €519, whilst the cost per day of OPAT was €98, meaning a saving of 81%. This study shows that OPAT administered by HaH units resulted in lower costs compared with inpatient care in Spain. Copyright © 2017 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.

Evaluating Infection Prevention Strategies in Out-Patient Dialysis Units Using Agent-Based Modeling.

PubMed

Wares, Joanna R; Lawson, Barry; Shemin, Douglas; D'Agata, Erika M C

2016-01-01

Patients receiving chronic hemodialysis (CHD) are among the most vulnerable to infections caused by multidrug-resistant organisms (MDRO), which are associated with high rates of morbidity and mortality. Current guidelines to reduce transmission of MDRO in the out-patient dialysis unit are targeted at patients considered to be high-risk for transmitting these organisms: those with infected skin wounds not contained by a dressing, or those with fecal incontinence or uncontrolled diarrhea. Here, we hypothesize that targeting patients receiving antimicrobial treatment would more effectively reduce transmission and acquisition of MDRO. We also hypothesize that environmental contamination plays a role in the dissemination of MDRO in the dialysis unit. To address our hypotheses, we built an agent-based model to simulate different treatment strategies in a dialysis unit. Our results suggest that reducing antimicrobial treatment, either by reducing the number of patients receiving treatment or by reducing the duration of the treatment, markedly reduces overall colonization rates and also the levels of environmental contamination in the dialysis unit. Our results also suggest that improving the environmental decontamination efficacy between patient dialysis treatments is an effective method for reducing colonization and contamination rates. These findings have important implications for the development and implementation of future infection prevention strategies.

Musculoskeletal Pain in Gynecologic Surgeons

PubMed Central

Adams, Sonia R.; Hacker, Michele R.; McKinney, Jessica L.; Elkadry, Eman A.; Rosenblatt, Peter L.

2013-01-01

Objective To describe the prevalence of musculoskeletal pain and symptoms in gynecologic surgeons. Design Prospective cross-sectional survey study (Canadian Task Force classification II-2). Setting Virtual. All study participants were contacted and participated via electronic means. Participants Gynecologic surgeons. Interventions An anonymous, web-based survey was distributed to gynecologic surgeons via electronic newsletters and direct E-mail. Measurements and Main Results There were 495 respondents with complete data. When respondents were queried about their musculoskeletal symptoms in the past 12 months, they reported a high prevalence of lower back (75.6%) and neck (72.9%) pain and a slightly lower prevalence of shoulder (66.6%), upper back (61.6%), and wrist/hand (60.9%) pain. Many respondents believed that performing surgery caused or worsened the pain, ranging from 76.3% to 82.7% in these five anatomic regions. Women are at an approximately twofold risk of pain, with adjusted odds ratios (OR) of 1.88 (95% confidence interval [CI], 1.1–3.2; p 5 .02) in the lower back region, OR 2.6 (95% CI, 1.4–4.8; p 5 .002) in the upper back, and OR 2.9 (95% CI, 1.8–4.6; p 5 .001) in the wrist/hand region. Conclusion Musculoskeletal symptoms are highly prevalent among gynecologic surgeons. Female sex is associated with approximately twofold risk of reported pain in commonly assessed anatomic regions. Journal of Minimally Invasive Gynecology (2013) 20, 656-660 PMID:23796512

Optical coherence tomography in gynecology: a narrative review

NASA Astrophysics Data System (ADS)

Kirillin, Mikhail; Motovilova, Tatiana; Shakhova, Natalia

2017-12-01

Modern gynecologic practice requires noninvasive diagnostics techniques capable of detecting morphological and functional alterations in tissues of female reproductive organs. Optical coherence tomography (OCT) is a promising tool for providing imaging of biotissues with high resolution at depths up to 2 mm. Design of the customized probes provides wide opportunities for OCT use in gynecology. This paper contains a retrospective insight into the history of OCT employment in gynecology, an overview of the existing gynecologic OCT probes, including those for combination with other diagnostic modalities, and state-of-the-art application of OCT for diagnostics of tumor and nontumor pathologies of female genitalia. Perspectives of OCT both in diagnostics and treatment planning and monitoring in gynecology are overviewed.

42 CFR 493.855 - Standard; Cytology: gynecologic examinations.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Standard; Cytology: gynecologic examinations. 493... Complexity, Or Any Combination of These Tests § 493.855 Standard; Cytology: gynecologic examinations. To participate successfully in a cytology proficiency testing program for gynecologic examinations (Pap smears...

42 CFR 493.855 - Standard; Cytology: gynecologic examinations.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 5 2014-10-01 2014-10-01 false Standard; Cytology: gynecologic examinations. 493... Complexity, Or Any Combination of These Tests § 493.855 Standard; Cytology: gynecologic examinations. To participate successfully in a cytology proficiency testing program for gynecologic examinations (Pap smears...

42 CFR 493.855 - Standard; Cytology: gynecologic examinations.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 5 2011-10-01 2011-10-01 false Standard; Cytology: gynecologic examinations. 493... Complexity, Or Any Combination of These Tests § 493.855 Standard; Cytology: gynecologic examinations. To participate successfully in a cytology proficiency testing program for gynecologic examinations (Pap smears...

42 CFR 493.855 - Standard; Cytology: gynecologic examinations.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 5 2012-10-01 2012-10-01 false Standard; Cytology: gynecologic examinations. 493... Complexity, Or Any Combination of These Tests § 493.855 Standard; Cytology: gynecologic examinations. To participate successfully in a cytology proficiency testing program for gynecologic examinations (Pap smears...

42 CFR 493.855 - Standard; Cytology: gynecologic examinations.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 5 2013-10-01 2013-10-01 false Standard; Cytology: gynecologic examinations. 493... Complexity, Or Any Combination of These Tests § 493.855 Standard; Cytology: gynecologic examinations. To participate successfully in a cytology proficiency testing program for gynecologic examinations (Pap smears...

Clinical statistics of gynecologic cancers in Japan.

PubMed

Yamagami, Wataru; Nagase, Satoru; Takahashi, Fumiaki; Ino, Kazuhiko; Hachisuga, Toru; Aoki, Daisuke; Katabuchi, Hidetaka

2017-03-01

Cervical, endometrial, and ovarian cancers, have both high morbidity and mortality among the gynecologic malignant tumors in Japan. The present study was conducted using both the population-based cancer registry and the gynecologic cancer registry to elucidate the characteristics of gynecologic malignant tumors in Japan. Based on nationwide estimates from the population-based cancer registry in Japan, the morbidities and mortality of cervical, endometrial, and ovarian cancers were obtained and used for analysis. Clinicopathologic factors for cervical cancer, endometrial cancer, ovarian cancer, including age, clinical stage, postsurgical stage, histological type, therapeutic strategy, and prognosis were retrieved from the gynecologic cancer registry published by the Japan Society of Obstetrics and Gynecology and used for analysis. The morbidities of cervical, endometrial, and ovarian cancers were 10,908, 13,606, and 9,384 women in 2012, respectively. The prevalence of endometrial cancer has significantly and consistently been increasing and represents the most common gynecologic malignant tumor in Japan. The mortalities of cervical, endometrial, and ovarian cancers were 2.1, 1.3, and 3.2 per 100,000 in 2012, respectively. In 2014, 52.2% of cervical cancer patients were classified as stage I, 22.5% as stage II, 10.2% as stage III, and 11.2% as stage IV. In addition, 71.9% of endometrial cancer patients were classified as stage I, 6.0% as stage II, 13.3% as stage III, and 7.5% as stage IV. Finally, 43.2% of ovarian cancer patients were classified as stage I, 9.1% as stage II, 27.6% as stage III, and 7.2% as stage IV. Twelve-point six percent of ovarian cancer patients received neoadjuvant chemotherapy. Copyright © 2017. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology.

Equal Pay for Equal Work in Academic Obstetrics and Gynecology.

PubMed

Eichelberger, Kacey Y

2018-02-01

The most compelling data suggest women in academic obstetrics and gynecology earn approximately $36,000 less than male colleagues per year in regression models correcting for commonly cited explanatory variables. Although residual confounding may exist, academic departments in the United States should consider rigorous examination of their own internal metrics around salary to ensure gender-neutral compensation, commonly referred to as equal pay for equal work.

Investigating Black-White disparities in gynecologic oncology: Theories, conceptual models, and applications.

PubMed

Doll, Kemi M

2018-04-01

Within gynecologic oncology are two of the top five widest Black-White mortality gaps among all cancer diagnoses in the United States. A rich body of work from the social sciences, including anthropology, sociology and social epidemiology, have broadened the understanding of and research approaches to the study of health and healthcare inequity experienced by Black Americans. Yet, these intellectual advancements in understanding are virtually absent from the gynecologic oncology literature. The goal of this analytic essay will be to introduce three current frameworks of studying racial inequity: The Ecosocial Theory of Disease Distribution, The Fundamental Cause Theory, and The Public Health Critical Race Praxis. Applications of each conceptual model to gynecologic oncology are illustrated. The Ecosocial Theory, in particular the concept of embodiment, can be used to design and interpret racial differences in molecular and genetic studies. The Fundamental Cause Theory explains the relationship of socioeconomic position with the evolving treatability of a given disease over time, and provides understanding to the contrast in racial disparities within ovarian, endometrial, and cervical cancers. The Public Health Critical Race Praxis is an iterative methodology that helps frame how to study the impact of racism on healthcare delivery. Different analytic approaches that account for the interaction of race and socioeconomic factors are reviewed. Finally, considerations for racial equity research in gynecologic oncology are proposed. Copyright © 2017 Elsevier Inc. All rights reserved.

Tenure of academic chairs in obstetrics and gynecology: a 25-year perspective.

PubMed

Rayburn, William F; Schrader, Ronald M; Cain, Joanna M; Artal, Raul; Anderson, Garland D; Merkatz, Irwin R

2006-11-01

To assist in predicting future leadership needs, this longitudinal study examines turnover and net retention rates among chairs at university obstetrics and gynecology departments between 1981 and 2005. A database of appointment dates and tenure of chairs at each of 125 Association of American Medical Colleges-approved United States medical schools was collated using membership listings from the Association of Professors of Gynecology and Obstetrics and from the Council of University Chairs in Obstetrics and Gynecology. Complete data from 118 departments were confirmed by selective correspondence at individual departments and further review by the investigators. A total of 260 individuals (232 men, 28 women) became new chairs between 1981 and 2005. The annual turnover rate increased gradually from 6.0% to 12.7%. Five-year net retention rates remained steady between 1982 and 1997 but dropped after 1997 (85.6% compared with 63.2%; P=.03). A chair's tenure ranged widely (1 to 23 years; median 8 years), regardless of gender or school type, size, or location. Approximately one half of interim chairs became permanent chairs, usually at their own institution. The number of new women chairs increased from none in 1981 to 17 (15.2% of total chairs) in 2005. Academic chair positions in obstetrics and gynecology experienced a doubling in annual turnover rates, while retention rates declined. The proportion of chairs occupied by women increased progressively. II-2.

Breast and Gynecologic Cancer | Division of Cancer Prevention

Cancer.gov

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Characteristics and Outcomes of Intensive Care Unit Survivors: Experience of a Multidisciplinary Outpatient Clinic in a Teaching Hospital.

PubMed

Duarte, Péricles A D; Costa, Jaquilene Barreto; Duarte, Silvana Trilo; Taba, Sheila; Lordani, Claudia Regina Felicetti; Osaku, Erica Fernanda; Costa, Claudia Rejane Lima Macedo; Miglioranza, Dalas Cristina; Gund, Daniela Prochnow; Jorge, Amaury Cesar

2017-12-01

To describe the experience of an outpatient clinic with the multidisciplinary evaluation of intensive care unit survivors and to analyze their social, psychological, and physical characteristics in a low-income population and a developing country. Retrospective cohort study. Adult survivors from a general intensive care unit were evaluated three months after discharge in a post-intensive care unit outpatient multidisciplinary clinic over a period of 6 years (2008-2014) in a University Hospital in southern Brazil. A total of 688 out of 1945 intensive care unit survivors received care at the clinic. Of these, 45.2% had psychological disorders (particularly depression), 49.0% had respiratory impairments (abnormal spirometry), and 24.6% had moderate to intense dyspnea during daily life activities. Patients experienced weight loss during hospitalization (mean=11.7%) but good recovery after discharge (mean gain=9.1%), and 94.6% were receiving nutrition orally. One-third of patients showed a reduction of peripheral muscular strength, and 5.7% had moderate to severe tetraparesis or tetraplegia. There was a significant impairment in quality of life (SF-36), particularly in the physical and emotional aspects and in functional capacity. The economic impacts on the affected families, which were mostly low-income families, were considerable. Most patients did not have full access to rehabilitation services, even though half of the families were receiving financial support from the government. A significant number of intensive care unit survivors evaluated 3 months after discharge had psychological, respiratory, motor, and socioeconomic problems; these findings highlight that strategies aimed to assist critically ill patients should be extended to the post-hospitalization period and that this problem is particularly important in low-income populations.

Orthostatic hypotension and overall mortality in 1050 older patients of the outpatient comprehensive geriatric assessment unit.

PubMed

Freud, Tamar; Punchik, Boris; Kagan, Ella; Barzak, Alex; Press, Yan

2018-03-02

Orthostatic hypotension is a common problem in individuals aged ≥65 years. Its association with mortality is not clear. The aim of the present study was to evaluate associations between orthostatic hypotension and overall mortality in a sample of individuals aged ≥65 years who were seen at the Outpatient Comprehensive Geriatric Assessment Unit, Clalit Health Services, Beer-Sheva, Israel. Individuals who were evaluated in the Outpatient Comprehensive Geriatric Assessment Unit between January 2005 and December 2015, and who had data on orthostatic hypotension were included in the study. The database included sociodemographic characteristics, body mass index, functional and cognitive state, geriatric syndromes reached over the course of the assessment, and comorbidity. Data on mortality were also collected. The study sample included 1050 people, of whom 626 underwent comprehensive geriatric assessment and 424 underwent geriatric consultation. The mean age was 77.3 ± 5.4 years and 35.7% were men. Orthostatic hypotension was diagnosed in 294 patients (28.0%). In univariate analysis, orthostatic hypotension was associated with overall mortality only in patients aged 65-75 years (HR 1.5, 95% CI 1.07-2.2), but in the multivariate model this association disappeared. In older frail patients, orthostatic hypotension was not an independent risk factor for overall mortality. Geriatr Gerontol Int 2018; ••: ••-••. © 2018 Japan Geriatrics Society.

Decreasing laboratory turnaround time and patient wait time by implementing process improvement methodologies in an outpatient oncology infusion unit.

PubMed

Gjolaj, Lauren N; Gari, Gloria A; Olier-Pino, Angela I; Garcia, Juan D; Fernandez, Gustavo L

2014-11-01

Prolonged patient wait times in the outpatient oncology infusion unit indicated a need to streamline phlebotomy processes by using existing resources to decrease laboratory turnaround time and improve patient wait time. Using the DMAIC (define, measure, analyze, improve, control) method, a project to streamline phlebotomy processes within the outpatient oncology infusion unit in an academic Comprehensive Cancer Center known as the Comprehensive Treatment Unit (CTU) was completed. Laboratory turnaround time for patients who needed same-day lab and CTU services and wait time for all CTU patients was tracked for 9 weeks. During the pilot, the wait time from arrival to CTU to sitting in treatment area decreased by 17% for all patients treated in the CTU during the pilot. A total of 528 patients were seen at the CTU phlebotomy location, representing 16% of the total patients who received treatment in the CTU, with a mean turnaround time of 24 minutes compared with a baseline turnaround time of 51 minutes. Streamlining workflows and placing a phlebotomy station inside of the CTU decreased laboratory turnaround times by 53% for patients requiring same day lab and CTU services. The success of the pilot project prompted the team to make the station a permanent fixture. Copyright © 2014 by American Society of Clinical Oncology.

Gynecological complaints and their associated factors among women in a family health-care clinic.

PubMed

von Glehn, Mateus de Paula; Sidon, Linconl Uchôa; Machado, Eleuza Rodrigues

2017-01-01

The aim of this study was to describe the most common gynecological complaints and possible associated factors among women of reproductive age attended at a family health-care clinic. A transversal study conducted with a sample of an outpatient population consisting of women of reproductive age. Pregnant women and minors were excluded. The final sample consisted of women between 18 and 49 years of age. The participants answered a questionnaire in which the complaints of the last 4 weeks were registered. They were examined, had the vaginal pH assessed, and secretion was tested using a 10% potassium hydroxide solution to verify the presence of amine odor (whiff test). Most participants were black or of mixed races. Considering the frequency of complaints, there were no significant differences between white and nonwhite women. There was an association between vaginal pH and discharge complaints as well as unpleasant odor, positive test of amines, smoking, and performing vaginal douches. Vaginal complaints were common among participants; the practice of vaginal douches was also frequent and was associated with higher pH values. The use of hormonal contraceptives was associated with lower pH values. There was no significant association between condom use and gynecological complaints, vaginal pH, or the whiff test.

Anxiety and support resources for Israeli women before gynecological surgery.

PubMed

Peles Bortz, Anat; Bluvstein, Irit; Bergman, Liat; Barnoy, Sivia

2017-03-01

Gynecologic surgery is a frequent procedure for benign and malignant diseases and may evoke anxiety and a need for support. The purpose of the present study was to examine whether women with suspicion of gynecologic malignancy and those with no suspicion of gynecologic malignancy had different sources of social support and the relationship between this support and their anxiety. A descriptive cross-sectional method was used at a large medical center. Data were collected between June and December 2010 from 100 hospitalized women 20-28 hours prior to gynecologic surgery: 50 with suspicion of gynecologic malignancy and 50 with no suspicion of gynecologic malignancy. Social Support and Anxiety Questionnaires were distributed to the participants. The results showed that sources of support differed between the groups: women with suspicion of gynecologic malignancy reported receiving more support from their family and from the nursing staff while women with no suspicion of gynecologic malignancy reported receiving more support from friends or the Internet. Both groups reported similar levels of anxiety. Because women seek support prior to gynecologic surgery, healthcare professionals should play a more active role by offering their support in addition to guiding patients to websites that aim to provide information and support.

Quality-of-life assessment in gynecologic surgery.

PubMed

Rock, J A

2001-05-01

More than 90% of gynecologic surgery is performed for nonmalignant conditions, with a major objective of improving the patient's health-related quality of life (QOL). Clinical studies and patient surveys demonstrate that fatigue, diminished energy levels, increased need for rest, delayed time to return to work, difficulty performing daily routines, and difficulty caring for family and home persist for weeks to months or more following surgery. The social and economic implications of these outcomes provide a rationale for improving the QOL of gynecologic patients in the early weeks of recovery from surgery. Persistent and debilitating fatigue, which can lead to diminished QOL, is even more common than pain following hysterectomy. Global and specific subjective self-assessment instruments have been developed to measure fatigue as well as QOL parameters in postoperative gynecologic surgery patients. In addition, a QOL instrument combining both subjective self-assessment scales and objective measures of hemoglobin, hematocrit and muscle strength has been validated in postoperative orthopedic patients and may also have application in gynecologic surgery patients. Collectively, these various instruments may be useful in the assessment of recuperative power and vitality during early postoperative recovery in patients undergoing gynecologic surgery.

Mammaglobin expression in gynecologic adenocarcinomas.

PubMed

Hagemann, Ian S; Pfeifer, John D; Cao, Dengfeng

2013-04-01

Mammaglobin (MGB) has been proposed as a sensitive and specific immunohistochemical marker for adenocarcinoma of the breast. The differential diagnosis of breast adenocarcinoma versus a gynecologic primary frequently arises. We performed a semiquantitative survey of MGB immunoreactivity in 26 benign gynecologic tissues (6 ectocervices, 9 endocervices, 11 endometria), 86 ovarian adenocarcinomas, 70 endometrial adenocarcinomas, and 10 endocervical adenocarcinomas. Among ovarian tumors, MGB was present in 40% of endometrioid carcinomas; 36%, serous carcinomas; 21%, clear cell carcinomas; and 6%, mucinous carcinomas. Among endometrial cancers, MGB reactivity was present in 57% of endometrioid carcinomas, but only 30% of serous carcinomas and 6% of clear cell carcinomas. MGB was absent in endocervical adenocarcinomas. Across all tumor types with positive staining, MGB was focal or patchy (ie, less than diffuse) in 50 of 57 cases. Using a scale of 0 to 3+, the only 3 tumors with 3+ MGB reactivity were all serous carcinomas (1 ovarian and 2 endometrial). There were no cases with diffuse 3+ MGB expression. On the other hand, diffuse 2+ MGB was seen in 4 cases: 1 endometrioid carcinoma of ovary, 1 serous carcinoma of ovary, and 2 clear cell carcinomas of ovary. In conclusion, a diagnostically significant proportion of gynecologic carcinomas are immunoreactive for MGB. Gynecologic primaries should be considered in the differential diagnosis of MGB-positive malignancies of unknown origin. Copyright © 2013 Elsevier Inc. All rights reserved.

College of American Pathologists Gynecologic Cytopathology Quality Consensus Conference on good laboratory practices in gynecologic cytology: background, rationale, and organization.

PubMed

Tworek, Joseph A; Henry, Michael R; Blond, Barbara; Jones, Bruce Allen

2013-02-01

Gynecologic cytopathology is a heavily regulated field, with Clinical Laboratory Improvement Amendments of 1988 mandating the collection of many quality metrics. There is a lack of consensus regarding methods to collect, monitor, and benchmark these data and how these data should be used in a quality assurance program. Furthermore, the introduction of human papilloma virus testing and proficiency testing has provided more data to monitor. To determine good laboratory practices in quality assurance of gynecologic cytopathology. Data were collected through a written survey consisting of 98 questions submitted to 1245 Clinical Laboratory Improvement Amendments-licensed or Department of Defense laboratories. There were 541 usable responses. Additional input was sought through a Web posting of results and questions on the College of American Pathologists Web site. Four senior authors who authored the survey and 28 cytopathologists and cytotechnologists were assigned to 5 working groups to analyze data and present statements on good laboratory practices in gynecologic cytopathology at the College of American Pathologists Gynecologic Cytopathology Quality Consensus Conference. Ninety-eight attendees at the College of American Pathologists Gynecologic Cytopathology Quality Consensus Conference discussed and voted on good laboratory practice statements to obtain consensus. This paper describes the rationale, background, process, and strengths and limitations of a series of papers that summarize good laboratory practice statements in quality assurance in gynecologic cytopathology.

Clinical audit in gynecological cancer surgery: development of a risk scoring system to predict adverse events.

PubMed

Kondalsamy-Chennakesavan, Srinivas; Bouman, Chantal; De Jong, Suzanne; Sanday, Karen; Nicklin, Jim; Land, Russell; Obermair, Andreas

2009-12-01

Advanced gynecological surgery undertaken in a specialized gynecologic oncology unit may be associated with significant perioperative morbidity. Validated risk prediction models are available for general surgical specialties but currently not for gynecological cancer surgery. The objective of this study was to evaluate risk factors for adverse events (AEs) of patients treated for suspected or proven gynecological cancer and to develop a clinical risk score (RS) to predict such AEs. AEs were prospectively recorded and matched with demographical, clinical and histopathological data on 369 patients who had an abdominal or laparoscopic procedure for proven or suspected gynecological cancer at a tertiary gynecological cancer center. Stepwise multiple logistic regression was used to determine the best predictors of AEs. For the risk score (RS), the coefficients from the model were scaled using a factor of 2 and rounded to the nearest integer to derive the risk points. Sum of all the risk points form the RS. Ninety-five patients (25.8%) had at least one AE. Twenty-nine (7.9%) and 77 (20.9%) patients experienced intra- and postoperative AEs respectively with 11 patients (3.0%) experiencing both. The independent predictors for any AE were complexity of the surgical procedure, elevated SGOT (serum glutamic oxaloacetic transaminase, > or /=35 U/L), higher ASA scores and overweight. The risk score can vary from 0 to 14. The risk for developing any AE is described by the formula 100 / (1 + e((3.697 - (RS /2)))). RS allows for quantification of the risk for AEs. Risk factors are generally not modifiable with the possible exception of obesity.

Contributions of the Japanese Gynecologic Oncology Group (JGOG) in Improving the Quality of Life in Women With Gynecological Malignancies.

PubMed

Futagami, Masayuki; Yokoyama, Yoshihito; Shimada, Muneaki; Sato, Shinya; Miyagi, Etsuko; Tozawa-Ono, Akiko; Suzuki, Nao; Fujimura, Masaki; Aoki, Yoichi; Sagae, Satoru; Sugiyama, Toru

2017-04-01

The Japanese Gynecologic Oncology Group (JGOG) is leading Japan in the treatment of gynecological malignancies. The JGOG consists of three treatment committees focusing on uterine cervical cancer, endometrial cancer, and ovarian cancer. Each committee makes efforts to improve treatment and diagnosis. In addition, the Supportive and Palliative Care Committee was established in 2015. Novel studies of supportive care and palliative care have been initiated by this committee. Furthermore, surveys about not only treatment results such as overall survival rates but also quality of life (QOL) and cost-effectiveness assessments are performed by the ovarian cancer committee. Improvements of patients' QOL in the treatment of gynecological malignancies were divided into three concepts as follows: QOL associated with cancer treatment, health care after cancer therapy, and progression of cancer. In this review, we report the contributions and future plans for the improvement of QOL in patients with gynecological malignancies.

Epidemiology of gynecologic cancers in China

PubMed Central

2018-01-01

Cancer has become a major disease burden across the globe. It was estimated that 4.29 million new incident cases and 2.81 million death cases of cancer would occur in 2015 in China, with the age-standardized incidence rate (ASIR) of 201.1 per 100,000 and age-standardized mortality rate (ASMR) of 126.9 per 100,000, respectively. For females, 2 of the top 10 most common types of cancer would be gynecologic cancers, with breast cancer being the most prevalent (268.6 thousand new incident cases) and cervical cancer being the 7th most common cancer (98.9 thousand new incident cases). The incidence and mortality of gynecologic cancers have been constantly increasing in China over last 2 decades, which become a major health concern for women. Survival rates of gynecologic cancers are generally not satisfactory and decrease along with advancing stage, though national data on survival are still not available. It is of great importance to overview on the epidemiology of gynecologic cancers, which may provide scientific clues for strategy-making of prevention and control, and eventually lowering the incidence and mortality rate as well as improving the survival rate in the future. PMID:29185265

Simulation laboratories for training in obstetrics and gynecology.

PubMed

Macedonia, Christian R; Gherman, Robert B; Satin, Andrew J

2003-08-01

Simulations have been used by the military, airline industry, and our colleagues in other medical specialties to educate, evaluate, and prepare for rare but life-threatening scenarios. Work hour limits for residents in obstetrics and gynecology and decreased patient availability for teaching of students and residents require us to think creatively and practically on how to optimize their education. Medical simulations may address scenarios in clinical practice that are considered important to know or understand. Simulations can take many forms, including computer programs, models or mannequins, virtual reality data immersion caves, and a combination of formats. The purpose of this commentary is to call attention to a potential role for medical simulation in obstetrics and gynecology. We briefly describe an example of how simulation may be incorporated into obstetric and gynecologic residency training. It is our contention that educators in obstetrics and gynecology should be aware of the potential for simulation in education. We hope this commentary will stimulate interest in the field, lead to validation studies, and improve training in and the practice of obstetrics and gynecology.

Payment Reform: Unprecedented and Evolving Impact on Gynecologic Oncology

PubMed Central

Apte, Sachin M.; Patel, Kavita

2016-01-01

With the signing of the Medicare Access and CHIP Reauthorization Act in April 2015, the Centers for Medicare and Medicaid Services (CMS) is now positioned to drive the development and implementation of sweeping changes to how physicians and hospitals are paid for the provision of oncology-related services. These changes will have a long-lasting impact on the sub-specialty of gynecologic oncology, regardless of practice structure, physician employment and compensation model, or local insurance market. Recently, commercial payers have piloted various models of payment reform via oncology-specific clinical pathways, oncology medical homes, episode payment arrangements, and accountable care organizations. Despite the positive results of some pilot programs, adoption remains limited. The goals are to eliminate unnecessary variation in cancer treatment, provide coordinated patient-centered care, while controlling costs. Yet, meaningful payment reform in oncology remains elusive. As the largest payer for oncology services in the United States, CMS has the leverage to make cancer services more value based. Thus far, the focus has been around pricing of physician-administered drugs with recent work in the area of the Oncology Medical Home. Gynecologic oncology is a unique sub-specialty that blends surgical and medical oncology, with treatment that often involves radiation therapy. This forward-thinking, multidisciplinary model works to keep the patient at the center of the care continuum and emphasizes care coordination. Because of the breadth and depth of gynecologic oncology, this sub-specialty has both the potential to be disrupted by payment reform as well as potentially benefit from the aspects of reform that can align incentives appropriately to improve coordination. Although the precise future payment models are unknown at this time, focused engagement of gynecologic oncologists and the full care team is imperative to assure that the practice remains patient centered

Payment Reform: Unprecedented and Evolving Impact on Gynecologic Oncology.

PubMed

Apte, Sachin M; Patel, Kavita

2016-01-01

With the signing of the Medicare Access and CHIP Reauthorization Act in April 2015, the Centers for Medicare and Medicaid Services (CMS) is now positioned to drive the development and implementation of sweeping changes to how physicians and hospitals are paid for the provision of oncology-related services. These changes will have a long-lasting impact on the sub-specialty of gynecologic oncology, regardless of practice structure, physician employment and compensation model, or local insurance market. Recently, commercial payers have piloted various models of payment reform via oncology-specific clinical pathways, oncology medical homes, episode payment arrangements, and accountable care organizations. Despite the positive results of some pilot programs, adoption remains limited. The goals are to eliminate unnecessary variation in cancer treatment, provide coordinated patient-centered care, while controlling costs. Yet, meaningful payment reform in oncology remains elusive. As the largest payer for oncology services in the United States, CMS has the leverage to make cancer services more value based. Thus far, the focus has been around pricing of physician-administered drugs with recent work in the area of the Oncology Medical Home. Gynecologic oncology is a unique sub-specialty that blends surgical and medical oncology, with treatment that often involves radiation therapy. This forward-thinking, multidisciplinary model works to keep the patient at the center of the care continuum and emphasizes care coordination. Because of the breadth and depth of gynecologic oncology, this sub-specialty has both the potential to be disrupted by payment reform as well as potentially benefit from the aspects of reform that can align incentives appropriately to improve coordination. Although the precise future payment models are unknown at this time, focused engagement of gynecologic oncologists and the full care team is imperative to assure that the practice remains patient centered

Outpatient training in neurology: history and future challenges.

PubMed

Naley, MaryAlice; Elkind, Mitchell S V

2006-01-10

The organization of neurology as a specialty and of neurology training specifically has evolved tremendously over the last 130 years. Originally primarily an outpatient specialty, the focus of training shifted to inpatient neurology in the early 20th century when accreditation of programs required training in newly established inpatient-based neurologic departments. Now and in the near future, the growth of neurologic critical care and the expansion of neurology intensive care units may require even more inpatient responsibilities in neurology residency programs. Contrary to these trends in training, most community neurology practice is still focused on outpatients, and surveys of neurologists have consistently indicated a need for more outpatient exposure in neurology training. This article briefly reviews the history of neurology training, discusses current challenges to outpatient training, and recommends possible solutions for the future.

Hospital costs associated with adverse events in gynecological oncology.

PubMed

Kondalsamy-Chennakesavan, Srinivas; Gordon, Louisa G; Sanday, Karen; Bouman, Chantal; De Jong, Suzanne; Nicklin, James; Land, Russell; Obermair, Andreas

2011-04-01

Treatment for gynecological malignancies is complex and may cause unintended or accidental adverse events (AE). We evaluated the costs of hospitalization associated with those AEs among patients who had an abdominal or laparoscopic procedure for proven or suspected gynecological cancer at a tertiary gynecological cancer center in Australia. Data on AEs were prospectively collected and matched with cost data (AU$ 2008) from the hospital's clinical costing unit and linked to demographical, clinical and histopathological data. Total costs were adjusted for various clinical factors and estimated using log-transformed ordinary least squared regression. Back-transformation was achieved using smearing factors. From epidemiological data, we also estimated the costs of AEs Australia-wide and undertook scenario and probabilistic sensitivity analyses to investigate the potential cost impact of reducing AEs. A total of 369 patients had surgical procedures of which 95 patients (26%) had at least one AE. Patients with AEs incurred an extra AU$12,780 on average, adjusted for age, co-morbidities, ovarian cancer, major or minor complications, surgical complexity, presence of malignancy and abdominal surgery. Mean adjusted costs (95% CI) for patients with intra-operative, minor post-operative and major post-operative AEs were AU$40,746 (11,582-71,859) AU$18,459 (17,270-19,713) and AU$67,656 (5324-131,761), respectively. Up to an estimated AU$20.6 million/year could be saved if the AEs were reduced by 40%. Adverse events are associated with significantly increased hospitalization costs and appropriate evidence-based interventions are justified to minimize AEs. Copyright © 2010 Elsevier Inc. All rights reserved.

EMMPRIN in gynecologic cancers: pathologic and therapeutic aspects.

PubMed

Liu, Dan-tong

2015-07-01

The highly glycosylated transmembrane protein extracellular matrix metalloproteinase inducer (EMMPRIN) is associated with several pathological conditions, including various types of cancers. In different gynecological malignancies, such as ovarian, cervical, and endometrial cancers, EMMPRIN plays significant roles in cell adhesion modulation, tumor growth, invasion, angiogenesis, and metastasis by inducing the production of various molecules, including matrix metalloproteinases and vascular endothelial growth factor. Because of its high level of expression, EMMPRIN can possibly be used as a diagnostic marker of gynecological cancers. Recent studies have showed that targeting EMMPRIN, especially by RNA interference (RNAi) technology, has promising therapeutic potential in basic research on gynecological cancer treatments, which make a platform for the future clinical success. This review study focused on the association of EMMPRIN in gynecological cancers in the perspectives of pathogenesis, diagnosis, and therapeutics.

Stop waiting and start creating: service learning with an outpatient bone marrow transplant unit art cart program.

PubMed

Fletcher, Tina; Bayer, Christina; Beyer, Emily; Gonzales, Jessica; Ralston, Ashley; Yount, Phyllis

2013-01-01

This paper examines how master of occupational therapy students, their occupational therapy instructor, and a community-based licensed clinical social worker collaborated in a service learning art cart program on an outpatient bone marrow transplant unit. As they progressed through the phases of Kolb's model of service learning, occupational therapy students, their occupational therapy instructor, and the licensed clinical social worker were all able to meet mutual goals of serving a unique patient population, increasing knowledge of best practices, and building and fostering university/community relationships.

Baseline traits of low vision patients served by private outpatient clinical centers in the United States.

PubMed

Goldstein, Judith E; Massof, Robert W; Deremeik, James T; Braudway, Sonya; Jackson, Mary Lou; Kehler, K Bradley; Primo, Susan A; Sunness, Janet S

2012-08-01

To characterize the traits of low vision patients who seek outpatient low vision rehabilitation (LVR) services in the United States. In a prospective observational study, we enrolled 764 new low vision patients seeking outpatient LVR services from 28 clinical centers in the United States. Before their initial appointment, multiple questionnaires assessing daily living and vision, physical, psychological, and cognitive health states were administered by telephone. Baseline clinical visual impairment measures and disorder diagnoses were recorded. Patients had a median age of 77 years, were primarily female (66%), and had macular disease (55%), most of which was nonneovascular age-related macular degeneration. More than one-third of the patients (37%) had mild vision impairment with habitual visual acuity (VA) of 20/60 or greater. The VA correlated well with contrast sensitivity (r = -0.52) but poorly with self-reported vision quality. The intake survey revealed self-reported physical health limitations, including decreased endurance (68%) and mobility problems (52%). Many patients reported increased levels of frustration (42%) and depressed mood (22%); memory and cognitive impairment (11%) were less frequently endorsed. Patients relied on others for daily living support (87%), but many (31%) still drove. Most patients seeking LVR are geriatric and have macular disease with relatively preserved VA. The disparity between VA and subjective quality of vision suggests that LVR referrals are based on symptoms rather than on VA alone. Patients seen for LVR services have significant physical, psychological, and cognitive disorders that can amplify vision disabilities and decrease rehabilitation potential.

Venous thromboembolism prophylaxis in gynecologic surgery: a systematic review.

PubMed

Rahn, David D; Mamik, Mamta M; Sanses, Tatiana V D; Matteson, Kristen A; Aschkenazi, Sarit O; Washington, Blair B; Steinberg, Adam C; Harvie, Heidi S; Lukban, James C; Uhlig, Katrin; Balk, Ethan M; Sung, Vivian W

2011-11-01

To comprehensively review and critically assess the available gynecologic surgery venous thromboembolism prophylaxis literature and provide clinical practice guidelines. MEDLINE and Cochrane databases from inception to July 2010. We included randomized controlled trials in gynecologic surgery populations. Interventions and comparators included graduated compression stockings, intermittent pneumatic compression, unfractionated heparin, and low molecular weight heparin; placebo and routine postoperative care were allowed as comparators. One thousand two hundred sixty-six articles were screened, and 14 randomized controlled trials (five benign gynecologic, nine gynecologic oncology) met eligibility criteria. In addition, nine prospective or retrospective studies with at least 150 women were identified and provided data on venous thromboembolism risk stratification, gynecologic laparoscopy, and urogynecologic populations. Two reviewers independently screened articles with discrepancies adjudicated by a third. Eligible randomized controlled trials were extracted for these characteristics: study, participant, surgery, intervention, comparator, and outcomes data, including venous thromboembolism incidence and bleeding complications. Studies were individually and collectively assessed for methodologic quality and strength of evidence. Overall incidence of clinical venous thromboembolism was 0-2% in the benign gynecologic population. With use of intermittent pneumatic compression for benign major procedures, venous thromboembolism incidence was less than 1%. No venous thromboembolisms were identified in prospective studies of benign laparoscopic procedures. Overall quality of evidence in the benign gynecologic literature was poor. Gynecologic-oncology randomized controlled trials reported venous thromboembolism incidence (including "silent" venous thromboembolisms) of 0-14.8% with prophylaxis and up to 34.6% without prophylaxis. Fair quality of evidence supports that

Subspecialist training in surgical gynecologic oncology in the Nordic countries.

PubMed

Antonsen, Sofie L; Avall-Lundqvist, Elisabeth; Salvesen, Helga B; Auranen, Annika; Salvarsdottir, Anna; Høgdall, Claus

2011-08-01

To survey the centers that can provide subspecialty surgical training and education in gynecological oncology in the Nordic countries, we developed an online questionnaire in co-operation with the Nordic Society of Gynecological Oncology. The link to the survey was mailed to 22 Scandinavian gynecological centers in charge of surgical treatment of cancer patients. Twenty (91%) centers participated. Four centers reported to be accredited European subspecialty training centers, a further six were interested in being accredited, and 11 centers were accredited by the respective National Board. Fourteen (74%) centers were interested in being listed for exchange of fellows. Our data show a large Nordic potential and interest in improving the gynecologic oncology standards and can be used to enhance the awareness of gynecologic oncology training in Scandinavia and to facilitate the exchange of fellows between Nordic countries. © 2011 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2011 Nordic Federation of Societies of Obstetrics and Gynecology.

Development of obstetrical and gynecological journals, 2007 to 2013: a trend analysis.

PubMed

Domröse, Christian M; Keyver-Paik, Mignon-Denise; Lorenzen, Henning; Kuhn, Walther C; Mallmann, Michael R

2016-02-01

To analyze the trends and developments among journals in the specialty of obstetrics and gynecology. Using the Journal Citation Reports from 2007 to 2013, we analyzed the impact factor (IF), Eigenfactor® Score (ES), and Article Influence® Score (AIS) of 43 journals in the field of obstetrics and gynecology published in this time period. From 78 journals of the Journal Citation Report 2013, 43 were selected for this study. The mean IF grew from 1.68 ± 0.97 in 2007 to 2.12 ± 1.05 in 2013, the ES from 0.0113 ± 0.0169 to 0.0114 ± 0.0140, and the AIS from 0.513 ± 0.302 to 0.663 ± 0.359. Differences in the IF, ES, and AIS between journals from the United States versus Europe could be observed. In most cases, the IF, ES, and AIS increased between 2007 and 2013. Strong correlations could be found between IF, AIS, and ES. The overall mean IF for obstetrical and gynecological journals increased over the analyzed time period. The IF remains the standard measure to compare scientific journals. It correlates well with two major alternative measures of scientific impact, the ES and especially the AIS. Other measures are evolving and might show superior usage in the future.

Ongoing strategies and updates on pain management in gynecologic oncology patients.

PubMed

Hacker, Kari E; Reynolds, R Kevin; Uppal, Shitanshu

2018-05-01

The opioid crisis in the United States has been declared a public health emergency. Various governmental agencies, cancer care organizations and the Centers for Disease Control and Prevention have issued guidelines in hopes of managing this crisis. Curbing over-prescription of opioids by medical professionals has been a central theme in many of these guidelines. Gynecologic oncologists encounter patients with a variety of pain sources, including acute pain secondary to the underlying malignancy or surgical procedures as well as chronic pain related to the malignancy and the sequelae of treatments rendered. In this review, we discuss the various etiologies of pain experienced by gynecologic oncology patients and discuss modalities frequently used to treat this pain. We highlight strategies to reduce the number of opioids prescribed and focus on incorporating non-opioid pain relief management principles in this review. We also discuss the mechanisms and etiology of various types of pain, with a focus on multimodal treatment strategies including preoperative counseling, strategies to identify individuals at risk of developing opioid dependence, and the role of symptom management and palliative care teams. Finally, we provide a blueprint for gynecologic oncology practices to develop their practice-specific pain management contracts to engage patients in a meaningful conversation around the addictive potential of opioids. Copyright © 2018 Elsevier Inc. All rights reserved.

Gynecologic imaging: current and emerging applications.

PubMed

Iyer, V R; Lee, S I

2010-01-01

Common diagnostic challenges in gynecology and the role of imaging in their evaluation are reviewed. Etiologies of abnormal uterine bleeding identified on pelvic sonography and sonohysterography are presented. An algorithmic approach for characterizing an incidentally detected adnexal mass and use of magnetic resonance imaging for definitive diagnosis are discussed. Finally, the role of F18-fluorodeoxyglucose positron emission tomography in the management of gynecological malignancies, and pitfalls associated with their use are examined.

National Training Course. Emergency Medical Technician. Paramedic. Instructor's Lesson Plans. Module XI. Obstetric/Gynecologic Emergencies.

ERIC Educational Resources Information Center

National Highway Traffic Safety Administration (DOT), Washington, DC.

This instructor's lesson plan guide on obstetric/gynecologic emergencies is one of fifteen modules designed for use in the training of emergency medical technicians (paramedics). Six units of study are presented: (1) anatomy and physiology of the female reproductive system; (2) patient assessment; (3) pathophysiology and management of gynecologic…

Comparison of 2015 Medicare relative value units for gender-specific procedures: Gynecologic and gynecologic-oncologic versus urologic CPT coding. Has time healed gender-worth?

PubMed

Benoit, M F; Ma, J F; Upperman, B A

2017-02-01

In 1992, Congress implemented a relative value unit (RVU) payment system to set reimbursement for all procedures covered by Medicare. In 1997, data supported that a significant gender bias existed in reimbursement for gynecologic compared to urologic procedures. The present study was performed to compare work and total RVU's for gender specific procedures effective January 2015 and to evaluate if time has healed the gender-based RVU worth. Using the 2015 CPT codes, we compared work and total RVU's for 50 pairs of gender specific procedures. We also evaluated 2015 procedure related provider compensation. The groups were matched so that the procedures were anatomically similar. We also compared 2015 to 1997 RVU and fee schedules. Evaluation of work RVU's for the paired procedures revealed that in 36 cases (72%), male vs female procedures had a higher wRVU and tRVU. For total fee/reimbursement, 42 (84%) male based procedures were compensated at a higher rate than the paired female procedures. On average, male specific surgeries were reimbursed at an amount that was 27.67% higher for male procedures than for female-specific surgeries. Female procedure based work RVU's have increased minimally from 1997 to 2015. Time and effort have trended towards resolution of some gender-related procedure worth discrepancies but there are still significant RVU and compensation differences that should be further reviewed and modified as surgical time and effort highly correlate. Copyright © 2016. Published by Elsevier Inc.

Using simulation in out-patient queues: a case study.

PubMed

Huarng, F; Lee, M H

1996-01-01

Overwork and overcrowding in some periods was an important issue for the out-patient department of a local hospital in Chia-Yi in Taiwan. The hospital administrators wanted to manage the patient flow effectively. Describes a study which focused on the utilization of doctors and staff in the out-patient department, the time spent in the hospital by an out-patient, and the length of the out-patient queue. Explains how a computer simulation model was developed to study how changes in the appointment system, staffing policies and service units would affect the observed bottleneck. The results show that the waiting time was greatly reduced and the workload of the doctor was also reduced to a reasonable rate in the overwork and overcrowding periods.

End-of-life care of women with gynecologic malignancies: a pilot study.

PubMed

Nevadunsky, Nicole S; Spoozak, Lori; Gordon, Sharon; Rivera, Enid; Harris, Kimala; Goldberg, Gary L

2013-03-01

There are limited data regarding the end-of-life care for women with gynecologic malignancies. We set out to generate pilot data describing the care that women with gynecologic malignancies received in the last 6 months of life. Patient demographics, patterns of care, and utilization of palliative medicine consultation services were evaluated. One hundred patients who died of gynecologic malignancies were identified in our institutional database. Only patients who had received treatment with a gynecologic oncologist within 1 year of death were included. Medical records were reviewed for relevant information. Data were abstracted from the electronic medical record, and analyses were made using Student t test and Mann-Whitney U test with SPSS software. The mean age of patients was 60 years (range, 30-94 years). Racial/ethnic distribution was as follows: 38%, white; 34%, black; and 15%, Hispanic. Seventy-five percent of patients received chemotherapy within the last 6 months of life, and 30% received chemotherapy within the last 6 weeks of life. The median number of days hospitalized during the last 6 months of life was 24 (range, 0-183 days). During the last 6 months of life, 19% were admitted to the intensive care unit, 17% were intubated, 5% had terminal extubation, and 13% had cardiopulmonary resuscitative efforts. Sixty-four percent had a family meeting, 50% utilized hospice care, and 49% had palliative medicine consultations. There was a significant difference in hospice utilization when comparison was made between patients who had 14 days or more from consultation until death versus patients who had 14 days or less or no consultation, 21 (72%) versus 29 (41%), P = 0.004. Patients who were single were less likely to have a palliative medicine consultation, P = 0.005. End-of-life care for patients with gynecologic malignancies often includes futile, aggressive treatments and invasive procedures. It is unknown whether these measures contribute to longevity or

Gynecological Care and Information

ERIC Educational Resources Information Center

Cibley, Leonard

1978-01-01

Based upon his experience as gynecologist at the Fernald School, the author suggests a set of criteria for establishing and running a gynecology program at an institution for the mentally retarded. (SBH)

Enhanced recovery pathways in gynecologic oncology.

PubMed

Nelson, Gregg; Kalogera, Eleftheria; Dowdy, Sean C

2014-12-01

Many commonplace perioperative practices are lacking in scientific evidence and may interfere with the goal of optimizing patient recovery. Individual components of perioperative care have therefore been scrutinized, resulting in the creation of so-called "enhanced recovery" pathways (ERP), with the goal of hastening surgical recovery through attenuation of the stress response. In this review we examine the evidence for ERP in gynecologic oncology using data from our specialty and general surgery. We performed a systematic literature search on ERP in gynecologic oncology in June 2014 using PubMed/MEDLINE, EMBASE, and The Cochrane Library. All study types were included. References were hand reviewed to ensure completeness. The Enhanced Recovery After Surgery (ERAS) Society was contacted to identify any unpublished protocols. Seven investigations were identified that examined the role of ERP in gynecologic oncology. Common interventions included allowing oral intake of fluids up to 2 hours before induction of anesthesia, solids up to 6 hours before anesthesia, carbohydrate supplementation, intra- and postoperative euvolemia, aggressive nausea/vomiting prophylaxis, and oral nutrition and ambulation the day of surgery. In addition, bowel preparations, the NPO after midnight rule, nasogastric tubes, and intravenous opioids were discontinued. While no randomized data are available in gynecologic oncology, significant improvements in patient satisfaction, length of stay (up to 4 days), and cost (up to $7600 in savings per patient) were observed in ERP cohorts compared to historical controls. Morbidity, mortality, and readmission rates were no different between groups. Enhanced recovery is a safe perioperative management strategy for patients undergoing surgery for gynecologic malignancies, reduces length of stay and cost, and is considered standard of care at a growing number of institutions. Our specialty would benefit from a formalized ERP such as ERAS which audits

[Analysis of funding of projects on obstetrics and gynecology supported by National Natural Science Foundation of China from 2007 to 2016].

PubMed

Qin, S H; Huang, Q S; Yao, S Z

2017-04-25

Objective: To summarize the funding of scientific research projects on obstetrics and gynecology by National Natural Science Foundation of China (NSFC) from 2007 to 2016 and to display the hotspots of scientific research on obstetrics and gynecology. Methods: A systemic search was performed for the information of projects supported by NSFC from 2007 to 2016. The indicators for analysis included the number of projects, total investment, project categories, research units and research field. The research direction of each project was decided based on title, summary and key words provided by the profile of each project. Results: The total investment on obstetrics and gynecology by NSFC was 23.214 million with a total of 82 projects in 2007. It increased year by year and reached the peak in 2014 (359 projects 208.990 million). The investment and number of projects remained stable after 2014. General projects (1 109 projects 608.000 million) formed the majority of projects. Youth science fund projects (1 035 projects 214.976 million) increased steadily and the number was nearly equal to general projects. There were only a small amount of key projects (20 projects 54.720 million) and major projects (7 projects 38.400 million). The investment varied in different research units. The greatest 10 units (less than 6% of total), including 7 comprehensive universities, 2 medical universities and 1 institute of medicine, got 1 113 projects invested (43.84% of total, 1 113/2 539). The hot areas like gynecological tumor (920 projects 350.615 million), hypertensive disorders complicating pregnancy (91 projects 37.470 million) and polycystic ovarian syndrome (77 projects 29.540 million) were more likely to receive investment, while some interdisciplinary science like maternal and child health (28 projects 12.050 million), imaging and biomedicine (37 projects 14.770 million) began to achieve attention in recent years. Conclusions: The number of researches invested will be increased

Do Changes in Hospital Outpatient Payments Affect the Setting of Care?

PubMed Central

He, Daifeng; Mellor, Jennifer M

2013-01-01

Objective To examine whether decreases in Medicare outpatient payment rates under the Outpatient Prospective Payment System (OPPS) caused outpatient care to shift toward the inpatient setting. Data Sources/Study Setting Hospital inpatient and outpatient discharge files from the Florida Agency for Health Care Administration from 1997 through 2008. Study Design This study focuses on inguinal hernia repair surgery, one of the most commonly performed surgical procedures in the United States. We estimate multivariate regressions of inguinal hernia surgery counts in the outpatient setting and in the inpatient setting. The key explanatory variable is the time-varying Medicare payment rate specific to the procedure and hospital. Control variables include time-varying hospital and county characteristics and hospital and year-fixed effects. Principal Findings Outpatient hernia surgeries fell in response to OPPS-induced rate cuts. The volume of inpatient hernia repair surgeries did not increase in response to reductions in the outpatient reimbursement rate. Conclusions Potential substitution from the outpatient setting to the inpatient setting does not pose a serious threat to Medicare's efforts to contain hospital outpatient costs. PMID:23701048

Subspecialization in gynecology and obstetrics: advantages and disadvantages.

PubMed

Ludwig, H

1991-08-20

To discuss the problem of subspecialization in our discipline is presently very popular. Whether or not a complete separation into the three subdisciplines: (1) materno-fetal medicine - obstetrics (2) surgical gynecology - gynecologic oncology (3) gynecologic endocrinology - reproductive medicine is recommended remains unclear in most of the statements. Some describe forms of only a supplementary postgraduate education, a kind of prolongation of the basic gynecologic and obstetrical training concentrated on one of the three main fields. The complete separation, i.e., in obstetrical medicine, reproductive medicine, gynecologic pelvic surgery, has the advantage of a more effective concentration on each of the respective subdisciplines in clinical work and in research. On the other hand, the separation will certainly produce several disadvantages: (a) What is inbetween the subdisciplines will be difficult to integrate. (b) The principle of the gynecologist functioning as a primary health care physician for women will be weakened, i.e., his competence for family-planning, pregnancy and delivery of normal cases, for cancer screening of genital and breast tumors, for disorders of the cycle, for pelvic inflammatory diseases and for the care of postmenopausal women will be less integral. (c) The lectures will be more than at present split or overloaded with detailed facts. (d) The need of general gynecologic care - as well cost-effective as widely available - will less frequently be met than now. (e) The opportunities for younger colleagues to settle with an office of their own will be restricted. The disadvantages outweigh the advantages.(ABSTRACT TRUNCATED AT 250 WORDS)

Bleeding disorder education in obstetrics and gynecology residency training: a national survey.

PubMed

Dietrich, Jennifer E; Tran, Xuan G; Giardino, Angelo P

2011-04-01

The purpose of this study was to assess the educational approach to the bleeding disorder evaluation in Obstetrics and Gynecology residency training programs in the continental United States. Information was sought from chief residents regarding training experiences and fund of knowledge regarding the evaluation of menorrhagia and diagnosis of bleeding disorders during their residency. A 24-item questionnaire was sent to the chief residents at 241 non-military Obstetrics and Gynecology residency programs. The study was conducted at Texas Children's Health Plan in Houston, Texas. Chief residents at 241 non-military Obstetrics and Gynecology residency programs. Responses to questionnaires. The overall response rate was 30%. Residents reported training in the medical evaluation of menorrhagia during residency with a mean of 9.1 hours per year in the first year of residency and 11.1 hours/year in the 2(nd), 3(rd) and 4(th) years; 67.7% reported they viewed their training in the medical evaluation of menorrhagia and bleeding disorders as sufficient preparation for clinical practice; and over two thirds reported specific training in common bleeding disorders, such as von Willebrand disease. The current state of training in the evaluation of menorrhagia and bleeding disorders appeared to be mixed regarding the evaluation of dysfunctional uterine bleeding. An area for improvement was identified to better approach best clinical practice in the evaluation of women with menorrhagia and underlying bleeding disorders, which can be guided by the thoughtful approach taken in the recent NHLBI von Willebrand disease guidelines. Copyright © 2011 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Obstetric and Gynecologic Problems Associated with Eating Disorders

PubMed Central

Kimmel, M.C.; Ferguson, E.H.; Zerwas, S.; Bulik, C.M.; Meltzer-Brody, S.

2017-01-01

Objective This article summarizes the literature on obstetric and gynecologic complications associated with eating disorders. Method We performed a comprehensive search of the current literature on obstetric and gynecologic complications associated with eating disorders using PubMed. More recent randomized-controlled trials and larger data sets received priority. We also chose those that we felt would be the most relevant to providers. Results Common obstetric and gynecologic complications for women with eating disorders include infertility, unplanned pregnancy, miscarriage, poor nutrition during pregnancy, having a baby with small head circumference, postpartum depression and anxiety, sexual dysfunction and complications in the treatment for gynecologic cancers. There are also unique associations by eating disorder diagnosis, such as earlier cessation of breastfeeding in anorexia nervosa; increased polycystic ovarian syndrome in bulimia nervosa; and complications of obesity as a result of binge eating disorder. Discussion We focus on possible biological and psychosocial factors underpinning risk for poor obstetric and gynecological outcomes in eating disorders. Understanding these factors may improve both our understanding of the reproductive needs of women with eating disorders and their medical outcomes. We also highlight the importance of building multidisciplinary teams to provide comprehensive care to women with eating disorders during the reproductive years. PMID:26711005

Robotic Surgery in Gynecology: An Updated Systematic Review

PubMed Central

Weinberg, Lori; Rao, Sanjay; Escobar, Pedro F.

2011-01-01

The introduction of da Vinci Robotic Surgery to the field of Gynecology has resulted in large changes in surgical management. The robotic platform allows less experienced laparoscopic surgeons to perform more complex procedures. In general gynecology and reproductive gynecology, the robot is being increasingly used for procedures such as hysterectomies, myomectomies, adnexal surgery, and tubal anastomosis. Among urogynecology the robot is being utilized for sacrocolopexies. In the field of gynecologic oncology, the robot is being increasingly used for hysterectomies and lymphadenectomies in oncologic diseases. Despite the rapid and widespread adoption of robotic surgery in gynecology, there are no randomized trials comparing its efficacy and safety to other traditional surgical approaches. Our aim is to update previously published reviews with a focus on only comparative observational studies. We determined that, with the right amount of training and skill, along with appropriate patient selection, robotic surgery can be highly advantageous. Patients will likely have less blood loss, less post-operative pain, faster recoveries, and fewer complications compared to open surgery and potentially even laparoscopy. However, until larger, well-designed observational studies or randomized control trials are completed which report long-term outcomes, we cannot definitively state the superiority of robotic surgery over other surgical methods. PMID:22190948

Gynecologic Concerns in the Adolescent Girl.

PubMed

Merens, Teri A

2016-01-01

The ever-evolving role of the health care provider can present a variety of challenges, not the least of which is becoming familiar with basic knowledge of other specialties, including gynecologic care. The primary care office provides a comfortable, familiar environment in which the patient can seek medical attention. It is essential that most pediatric offices be equipped to deal with basic adolescent gynecologic care, and that their patients have access to sensitive and confidential care. Copyright 2016, SLACK Incorporated.

Robotic surgery in gynecologic cancer.

PubMed

Yim, Ga Won; Kim, Young Tae

2012-02-01

The development of robotic technology has facilitated the application of minimally invasive techniques for complex operations in gynecologic oncology. The objective of this article is to review the published literature regarding robotic surgery and its application to gynecologic cancer. To date, 20 articles addressing radical hysterectomy, six articles of radical trachelectomy, seven articles of surgical procedure in advanced or recurrent cervical cancer, 14 articles of endometrial cancer staging, and two articles solely on ovarian cancer all performed robotically are published in the literature. The majority of publications on robotic surgery are still retrospective or descriptive in nature. However, the data for gynecologic cancer show comparable results of robotic surgery compared with laparoscopy or laparotomy in terms of blood loss, length of hospital stay, and complications. Computer-enhanced technology with its associated benefits appears to facilitate the surgical approach for technically challenging operations performed to treat selected cases of cervical, endometrial, and ovarian cancer as evidenced by the current literature. Continued research and clinical trials are needed to further elucidate the equivalence or superiority of robot-assisted surgery to conventional methods in terms of oncologic outcome and patients' quality of life.

The Role of Ultrasound Simulation in Obstetrics and Gynecology Training: A UK Trainees' Perspective.

PubMed

Patel, Hersha; Chandrasekaran, Dhivya; Myriokefalitaki, Eva; Gebeh, Alpha; Jones, Kate; Jeve, Yadava B

2016-10-01

Ultrasonography is a core skill required by all obstetrics and gynecology trainees; however, training opportunities in clinical ultrasound are declining. Simulation ultrasound training has been proposed as a strategy to overcome this.The study aims were to determine the current availability of clinical and simulation ultrasound training in obstetrics and gynecology in the United Kingdom and to explore the trainees' perspective on the role of ultrasound simulation. All obstetrics and gynecology trainees within the East Midlands Local Education Training Board in the United Kingdom were asked to complete an anonymous web-based survey in July 2014. Of 140 trainees, 70 (50%) responded to the survey, and 69% reported rarely having dedicated clinical ultrasound sessions. Fifty percent had failed to achieve ultrasound competencies required for their stage of training, and 83% felt that the pressures of service provision limited their exposure to clinical ultrasound.Seventy-three percent of the trainees considered ultrasound simulation to be an essential component of training, and 69% agreed that it would help improve their clinical skills. Only 50% had access to an ultrasound simulator. Seventy-seven percent of the trainees thought that it would be useful to have ultrasound simulation integrated into training. Trainees are struggling to achieve minimal ultrasound competences with clinical ultrasound training alone. They believe that ultrasound simulation will shorten the learning curve and improve their clinical skills and knowledge. Despite the cost implications of simulation training, we propose that consideration is given to formal integration of ultrasound simulation into the curriculum as a possible way forward.

Lower Body Lymphedema in Patients with Gynecologic Cancer.

PubMed

Biglia, Nicoletta; Zanfagnin, Valentina; Daniele, Alberto; Robba, Elisabetta; Bounous, Valentina E

2017-08-01

Lower body lymphedema is a chronic condition and a significant cause of morbidity following treatment of gynecologic cancer that strongly impacts patients' quality of life (QoL). Most studies on secondary lymphedema have been performed on the upper limb after breast cancer treatment and much less is known about lower body lymphedema after gynecologic malignancies. This review focuses on secondary lymphedema due to gynecologic cancer treatment, analyzing its incidence in the different types of gynecologic cancer, diagnosis, risk factors, impact on QoL and treatment. A systematic search of Medline has been performed to track the studies evaluating lower body lymphedema after treatment for endometrial, ovarian, cervical and vulvar cancer. Unfortunately, there is no consensus about a uniform evaluation and, as a consequence, the reported incidence is broadly different among the studies. Standardization in lymphedema evaluation is required to better compare the outcome of different types of treatment. Copyright© 2017, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

Vitamin D and VDR in Gynecological Cancers-A Systematic Review.

PubMed

Deuster, Eileen; Jeschke, Udo; Ye, Yao; Mahner, Sven; Czogalla, Bastian

2017-11-04

In recent years, a vast amount of studies have centered on the role of vitamin D in the pathogenesis of certain types of cancers such as breast, colorectal and lung cancer. Increasing evidence suggests that vitamin D and its receptor play a crucial role in the development of gynecological cancers. In this review, we systematically analyzed the effect of vitamin D and the vitamin D receptor on endometrial, ovarian, cervical, vulvar and vaginal cancer. Our literature research shows that vitamin D levels and vitamin-D-related pathways affect the risk of gynecological cancers. Numerous ecological studies give evidence on the inverse relationship between UVB exposure and gynecological cancer risk. However, epidemiologic research is still inconclusive for endometrial and ovarian cancer and insufficient for rarer types of gynecological cancers. The vitamin D receptor (VDR) is upregulated in all gynecological cancers, indicating its influence on cancer etiology. The VDR polymorphism FokI (rs2228570) seems to increase the risk of ovarian cancer. Other nuclear receptors, such as the RXR, also influence gynecological cancers. Although there is limited knowledge on the role of the VDR/RXR on the survival of endometrial, cervical, vulvar or vaginal cancer patients, some studies showed that both receptors influence survival. Therefore, we suggest that further studies should focus on the vitamin D- and its hetero dimer receptor RXR in gynecological cancers.

Gender Differences in Scholarly Productivity Within Academic Gynecologic Oncology Departments

PubMed Central

Hill, Emily K.; Blake, Rachel A.; Emerson, Jenna B.; Svider, Peter; Eloy, Jean Anderson; Raker, Christina; Robison, Katina; Stuckey, Ashley

2016-01-01

OBJECTIVE To estimate whether there is a gender difference in scholarly productivity among academic gynecologic oncologists. METHODS In this cross-sectional study, the academic rank and gender of gynecologic oncology faculty in the United States were determined from online residency and fellowship directories and departmental web sites. Each individual’s h-index and years of publication were determined from Scopus (a citation database of peer-reviewed literature). The h-index is a quantification of an author’s scholarly productivity that combines the number of publications with the number of times the publications have been cited. We generated descriptive statistics and compared rank, gender, and productivity scores. RESULTS Five hundred seven academic faculty within 137 U.S. teaching programs were identified. Of these, 215 (42%) were female and 292 (58%) were male. Men had significantly higher median h-indices than women, 16 compared with 8, respectively (P<.001). Women were more likely to be of junior academic rank with 63% of assistant professors being female compared with 20% of full professors. When stratifying h-indices by gender and academic rank, men had significantly higher h-indices at the assistant professor level (7 compared with 5, P<.001); however, this difference disappeared at the higher ranks. Stratifying by the years of active publication, there was no significant difference between genders. CONCLUSION Female gynecologic oncologists at the assistant professor level had lower scholarly productivity than men; however, at higher academic ranks, they equaled their male counterparts. Women were more junior in rank, had published for fewer years, and were underrepresented in leadership positions. PMID:26551177

Gender Differences in Scholarly Productivity Within Academic Gynecologic Oncology Departments.

PubMed

Hill, Emily K; Blake, Rachel A; Emerson, Jenna B; Svider, Peter; Eloy, Jean Anderson; Raker, Christina; Robison, Katina; Stuckey, Ashley

2015-12-01

To estimate whether there is a gender difference in scholarly productivity among academic gynecologic oncologists. In this cross-sectional study, the academic rank and gender of gynecologic oncology faculty in the United States were determined from online residency and fellowship directories and departmental web sites. Each individual's h-index and years of publication were determined from Scopus (a citation database of peer-reviewed literature). The h-index is a quantification of an author's scholarly productivity that combines the number of publications with the number of times the publications have been cited. We generated descriptive statistics and compared rank, gender, and productivity scores. Five hundred seven academic faculty within 137 U.S. teaching programs were identified. Of these, 215 (42%) were female and 292 (58%) were male. Men had significantly higher median h-indices than women, 16 compared with 8, respectively (P<.001). Women were more likely to be of junior academic rank with 63% of assistant professors being female compared with 20% of full professors. When stratifying h-indices by gender and academic rank, men had significantly higher h-indices at the assistant professor level (7 compared with 5, P<.001); however, this difference disappeared at the higher ranks. Stratifying by the years of active publication, there was no significant difference between genders. Female gynecologic oncologists at the assistant professor level had lower scholarly productivity than men; however, at higher academic ranks, they equaled their male counterparts. Women were more junior in rank, had published for fewer years, and were underrepresented in leadership positions. III.

The place of robotics in gynecologic surgery.

PubMed

Quemener, J; Boulanger, L; Rubod, C; Cosson, M; Vinatier, D; Collinet, P

2012-10-01

Robot-assisted laparoscopic gynecologic surgery has undergone widespread development in recent years. The surgical literature on this subject continues to grow. The goal of this article is to summarize the principal indications for robotic assistance in gynecologic surgery and to offer a general overview of the principal articles dealing with robotic surgery for both benign and malignant disease. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

Does a robotic surgery approach offer optimal ergonomics to gynecologic surgeons?: a comprehensive ergonomics survey study in gynecologic robotic surgery.

PubMed

Lee, Mija Ruth; Lee, Gyusung Isaiah

2017-09-01

To better understand the ergonomics associated with robotic surgery including physical discomfort and symptoms, factors influencing symptom reporting, and robotic surgery systems components recommended to be improved. The anonymous survey included 20 questions regarding demographics, systems, ergonomics, and physical symptoms and was completed by experienced robotic surgeons online through American Association of Gynecologic Laparoscopists (AAGL) and Society of Robotic Surgery (SRS). There were 289 (260 gynecology, 22 gynecology-oncology, and 7 urogynecology) gynecologic surgeon respondents regularly practicing robotic surgery. Statistical data analysis was performed using the t-test, χ² test, and logistic regression. One hundred fifty-six surgeons (54.0%) reported experiencing physical symptoms or discomfort. Participants with higher robotic case volume reported significantly lower physical symptom report rates (p<0.05). Gynecologists who felt highly confident about managing ergonomic settings not only acknowledged that the adjustments were helpful for better ergonomics but also reported a lower physical symptom rate (p<0.05). In minimizing their symptoms, surgeons changed ergonomic settings (32.7%), took a break (33.3%) or simply ignored the problem (34%). Fingers and neck were the most common body parts with symptoms. Eye symptom complaints were significantly decreased with the Si robot (p<0.05). The most common robotic system components to be improved for better ergonomics were microphone/speaker, pedal design, and finger clutch. More than half of participants reported physical symptoms which were found to be primarily associated with confidence in managing ergonomic settings and familiarity with the system depending on the volume of robotic cases. Optimal guidelines and education on managing ergonomic settings should be implemented to maximize the ergonomic benefits of robotic surgery. Copyright © 2017. Asian Society of Gynecologic Oncology, Korean Society

Reimbursement for office-based gynecologic procedures.

PubMed

Pritzker, Jordan

2013-12-01

Reimbursement for office-based gynecologic procedures varies with the contractual obligations that the physician has with the payers involved with the care of the particular patient. The payers may be patients without health insurance coverage (self-pay) or patients with third-party health insurance coverage, such as an employer-based commercial insurance carrier or a government program (eg, Medicare [federal] or Medicaid [state based]). This article discusses the reimbursement for office-based gynecologic procedures by third-party payers. Copyright © 2013 Elsevier Inc. All rights reserved.

Sentinel lymph node mapping in gynecological oncology

PubMed Central

Du, Jiang; Li, Yaling; Wang, Qing; Batchu, Nasra; Zou, Junkai; Sun, Chao; Lv, Shulan; Song, Qing; Li, Qiling

2017-01-01

The intraoperative mapping of sentinel lymph nodes (SLNs) is part of the treatment strategy for a number of types of tumor. To retrospectively compare results from the mapping of pelvic SLNs for gynecological oncology, using distinct dyes, the present review was conducted to determine the clinical significance of SLN mapping for gynecological oncology. In addition, the present study aimed at identifying an improved choice for SLN mapping tracers in clinical application. Each dye exhibits demerits when applied in the clinical environment. The combination of radioisotopes and blue dyes was identified to exhibit the most accurate detection rate of SLN drainage of gynecological oncology. However, contrast agents were unable to identify whether a SLN is positive or negative for metastasis prior to pathologic examination; additional studies are required. PMID:29344213

6 Common Cancers - Gynecologic Cancers Cervical, Endometrial, and Ovarian

MedlinePlus

... Bar Home Current Issue Past Issues 6 Common Cancers - Gynecologic Cancers Cervical, Endometrial, and Ovarian Past Issues / Spring 2007 ... of this page please turn Javascript on. Gynecologic Cancers Cervical, Endometrial, and Ovarian NCI estimates that endometrial, ...

Carboplatin plus paclitaxel in the treatment of gynecologic malignancies: the Cleveland Clinic experience.

PubMed

Markman, M; Kennedy, A; Webster, K; Kulp, B; Peterson, G; Belinson, J

1997-10-01

To examine the toxicity profile and antineoplastic activity of carboplatin (area under the concentration-time curve of 4 to 7.5) plus 3-hour infusional paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) (135 or 175 mg/m2) in women with advanced gynecologic malignancies, we retrospectively reviewed the experience of the Gynecologic Cancer Program at The Cleveland Clinic with this combination chemotherapy regimen. To date, 92 patients (median age, 67 years) have received a total of 460 courses (median number per patient, six) of this two-drug combination. The initial paclitaxel dose was 175 mg/m2 and the carboplatin area under the concentration-time curve was > or = 5 in 72% and 73% of patients, respectively. The major toxicity was neutropenia (grade 4 in 9% of patients), resulting in two febrile episodes and a single septic death. Grade 4 thrombocytopenia and grade 3 peripheral neuropathy were noted in one and two patients, respectively. Twelve patients (13%) experienced at least one episode of paclitaxel-associated hypersensitivity, but all were able to continue with the treatment program. Of the 62 patients with ovarian cancer or primary peritoneal carcinoma with carbohydrate antigen-125 levels > or = 60 U/mL before the initiation of chemotherapy, 74% exhibited a > or = 90% decline in the tumor marker following treatment. We conclude that the combination of carboplatin and 3-hour infusional paclitaxel can be administered in the outpatient setting with a highly acceptable toxicity profile and with major activity in patients with ovarian cancer and primary carcinoma of the peritoneum.

Effectiveness of the Gynecology Teaching Associate in Teaching Pelvic Examination Skills.

ERIC Educational Resources Information Center

Guenther, Susan M.; And Others

1983-01-01

The effectiveness of using gynecology teaching associates is compared with training by gynecology residents on clinic patients for teaching the gynecologic examination. Sophomore medical students at the University of Iowa participated in the instruction and an evaluation session with a simulated patient trained to rate the students' examination…

Outpatient laparoscopic sterilization.

PubMed

Hamid Arshat; Yuliawiratman

1981-03-01

This is a report on a pilot study conducted in Malaysia of outpatient sterilization utilizing laparoscopic technique under local anesthesia and sedation. The preliminary report based on 305 patients is presented with emphasis on the advantages and possible weaknesses of such procedure. Sterilization is performed in the Family Planning Specialist Center, Maternity Hospital. Patients are motivated towards sterilization during the immediate postpartum period in the Maternity Hospital and are counseled regarding the actual procedure. The mean age of the 305 patients was 32.08 years; the mean gravidity was 4.92; and the mean parity was 4.57. The majority of the patients came from the lower social strata with low educational attainment and low income. 253 cases of sterilizations were performed by laparoscopic procedures and 43 cases by minilaparotomy. In 9 cases difficulty was encountered with laparoscopy and subsequently the minilaparotomy was used. The majority of cases seemed to tolerate the sedation and local anesthesia fairly well and without much complaint of pain. Only a very small number of patients complained of pain particularly at the time when the Fallope or Lay rings were applied to the fallopian tubes. The overall complication rate was 14 (4.9%) and of these mild wound sepsis accounted for 6 (1.96%). Most of the wound sepsis was very mild and healed very quickly on daily dressing. No cases of pelvic sepsis were reported. There were 3 cases of uterine perforation by the uterine elevator. There were 2 cases where the fallopian tubes were traumatized and some degree of bleeding occurred. The bleeding was easily controlled by applying another Fallope ring. 2 patients had vomiting during the laparoscopic procedure. There were 7 cases of failed sterilization. 6 of the cases were performed by a trainee registrar in obstetrics and gynecology. The last was performed by a specialist gynecologist. Most of the failures were due to wrong application of rings. The cost

Trajectories of Evening Fatigue in Oncology Outpatients Receiving Chemotherapy

PubMed Central

Wright, Fay; Melkus, Gail D’Eramo; Hammer, Marilyn; Schmidt, Brian L.; Knobf, M. Tish; Paul, Steven M.; Cartwright, Frances; Mastick, Judy; Cooper, Bruce A.; Chen, Lee-May; Melisko, Michelle; Levine, Jon D.; Kober, Kord; Aouizerat, Bradley E.; Miaskowski, Christine

2015-01-01

Context Fatigue is a distressing, persistent sense of physical tiredness that is not proportional to a person’s recent activity. Fatigue impacts patients’ treatment decisions and can limit their self-care activities. While significant interindividual variability in fatigue severity has been noted, little is known about predictors of interindividual variability in initial levels and trajectories of evening fatigue severity in oncology patients receiving chemotherapy (CTX). Objectives To determine whether demographic, clinical, and symptom characteristics were associated with initial levels as well as the trajectories of evening fatigue. Methods A sample of outpatients with breast, gastrointestinal, gynecological, and lung cancer (N=586) completed demographic and symptom questionnaires a total of six times over two cycles of CTX. Fatigue severity was evaluated using the Lee Fatigue Scale. Hierarchical linear modeling (HLM) was used to answer the study objectives. Results A large amount of interindividual variability was found in the evening fatigue trajectories. A piecewise model fit the data best. Patients who were White, diagnosed with breast, gynecological, or lung cancer, and who had more years of education, child care responsibilities, lower functional status, and higher levels of sleep disturbance and depression reported higher levels of evening fatigue at enrollment. Conclusion This study identified both non-modifiable (e.g., ethnicity) and modifiable (e.g., child care responsibilities, depressive symptoms, sleep disturbance) risk factors for more severe evening fatigue. Using this information, clinicians can identify patients at higher risk for more severe evening fatigue, provide individualized patient education, and tailor interventions to address the modifiable risk factors. PMID:25828560

Developing and implementing a complex Complementary and Alternative (CAM) nursing intervention for breast and gynecologic cancer patients undergoing chemotherapy--report from the CONGO (complementary nursing in gynecologic oncology) study.

PubMed

Klafke, Nadja; Mahler, Cornelia; von Hagens, Cornelia; Blaser, Gisela; Bentner, Martina; Joos, Stefanie

2016-05-01

The purpose of this study was to develop a complex nursing intervention including complementary and alternative medicine (CAM) for breast and gynecologic cancer patients during chemotherapy to improve quality of life. Data sources Theoretical framework and concepts, practical nursing knowledge, and evidence-based studies were compiled in interprofessional meetings. Data synthesis The final complex intervention consists of three autonomous, but interacting components: (1) CAM nursing package, (2) resource-oriented counseling, and (3) evidence-based information material on CAM. CAM interventions include acupressure, aromatherapy, compress, and massage, targeting 14 clinically relevant symptoms during chemotherapy. Participants receive these interventions during chemotherapy with instructions for self care. During a counseling interview, the patient's needs and preferences are assessed by trained nurses. Furthermore, participants are equipped with evidence-based information material (booklet and DVD). Prior to study start, nurses attended training modules for administering CAM therapies and for communicating and counseling within the salutogenic approach. It was possible to design a multimodal CAM nursing intervention based on a theoretical concept, evidence-based studies, and practical nursing experience targeting the prevention or relief of side-effects women suffer during chemotherapy. The systematic analysis of the CONGO study will contribute to evidence-based CAM nursing care within supportive cancer care. Oncology nurses play an important role in supportive CAM care of breast and gynecologic cancer patients in daily clinical practice. Within oncology outpatient services, the implementation of evidence-based CAM nursing interventions and counseling may contribute to understand the impact of nursing on patient quality of life and symptom relief. This can lead to a new understanding of the nurse's professional role.

Advantages of robotics in benign gynecologic surgery.

PubMed

Truong, Mireille; Kim, Jin Hee; Scheib, Stacey; Patzkowsky, Kristin

2016-08-01

The purpose of this article is to review the literature and discuss the advantages of robotics in benign gynecologic surgery. Minimally invasive surgery has become the preferred route over abdominal surgery. The laparoscopic or robotic approach is recommended when vaginal surgery is not feasible. Thus far, robotic gynecologic surgery data have demonstrated feasibility, safety, and equivalent clinical outcomes in comparison with laparoscopy and better clinical outcomes compared with laparotomy. Robotics was developed to overcome challenges of laparoscopy and has led to technological advantages such as improved ergonomics, visualization with three-dimensional capabilities, dexterity and range of motion with instrument articulation, and tremor filtration. To date, applications of robotics in benign gynecology include hysterectomy, myomectomy, endometriosis surgery, sacrocolpopexy, adnexal surgery, tubal reanastomosis, and cerclage. Though further data are needed, robotics may provide additional benefits over other approaches in the obese patient population and in higher complexity cases. Challenges that arose in the earlier adoption stage such as the steep learning curve, costs, and operative times are becoming more optimized with greater experience, with implementation of robotics in high-volume centers and with improved training of surgeons and robotic teams. Robotic laparoendoscopic single-site surgery, albeit still in its infancy where technical advantages compared with laparoscopic single-site surgery are still unclear, may provide a cost-reducing option compared with multiport robotics. The cost may even approach that of laparoscopy while still conferring similar perioperative outcomes. Advances in robotic technology such as the single-site platform and telesurgery, have the potential to revolutionize the field of minimally invasive gynecologic surgery. Higher quality evidence is needed to determine the advantages and disadvantages of robotic surgery in benign

[Association of human papillomavirus infection with other microbial pathogens in gynecology].

PubMed

Zheng, Mei-yun; Zhao, He-lan; Di, Jun-ping; Lin, Gan; Lin, Ying; Lin, Xi; Zheng, Min-qiao

2010-06-01

To Investigate correlation between screening assay of human papillomavirus (HPV) and microbial pathogens in gynecology. Cervical samples were collected to search for HPV, bacteria and yeast infections in gynecologic outpatients. HPV typing was carried out by PCR and sequencing on cervical brush specimens. Chlamydia trachomatis was identified by strand displacement amplification (SDA) and the other microorganisms were detected by conventional methods. All data were analyzed to investigate the correlation among them. In this cross-sectional study, among 857 enrolled outpatients, there were 266 cases with positive HPV DNA, and the rate of infection was 31.0% (266/857). HPV genotype showed that thirty-five different HPV types were identified, of which HPV16 was the most prevalent (14.5%, 38/262), followed by HPV58 (9.2%, 24/262), HPV53 (8.0%, 21/262) and HPV42 (6.1%, 16/262); while other genotypes were present in less than 5% of HPV positive women. According to the reclassification, the aggregated percentage (high-risk and probably high-risk) of detected HPV was 58.8% (154/262), 27.9% (73/262) for low-risk and 13.4% (35/262) for unknown-risk HPV types. Among HPV positive women, cervical brush specimens results showed that more than 60% cases with normal cytology, 3.8% (10/266) with high-grade squamous intraepithelial lesions (HSIL), 29.7% (79/266) with low-grade squamous intraepithelial lesions (LSIL) and 3.0% (8/266) with atypical squamous cells of undetermined significance (ASCUS), respectively. Statistical analyses revealed there was a significant association between the infected HPV and Chlamydia trachomatis or Ureaplasma urealyticum (> 10,000 CCU/ml; all P < 0.01), while no correlation was found between HPV infection and bacterial vaginosis, streptococcus agalactiae, candida, Trichomonas vaginalis or Ureaplasma urealyticum (≤ 10 000 CCU/ml; all P > 0.05). Among the cases with bacterial vaginosis, the positive rate of HPV infected was 42.6%. Chlamydia trachomatis

What is an Obstetrics/Gynecology Hospitalist?

PubMed

McCue, Brigid

2015-09-01

The obstetrics/gynecology (OB/GYN) hospitalist is the latest subspecialist to evolve from obstetrics and gynecology. Starting in 2002, academic leaders recognized the impact of such coalescing forces as the pressure to reduce maternal morbidity and mortality, stagnant reimbursements and the increasing cost of private practice, the decrease in applications for OB/GYN residencies, and the demand among practicing OB/GYNs for work/life balance. Initially coined laborist, the concept of the OB/GYN hospitalist emerged. Thinking of becoming an OB/GYN hospitalist? Here is what you need to know. Copyright © 2015 Elsevier Inc. All rights reserved.

Comparative Effectiveness Research in Gynecologic Oncology

PubMed Central

Patankar, Sonali; Tergas, Ana I.

2015-01-01

The field of gynecologic oncology is faced with a number of challenges including how to incorporate new drugs and procedures into practice, how to balance therapeutic efficacy and toxicity of treatment, how to individualize therapy to particular patients or groups of patients, and how to contain the rapidly rising costs associated with oncologic care. In this chapter we examine three common and highly debated clinical scenarios in gynecologic oncology: the initial management of ovarian cancer, the role of lymphadenectomy in the treatment of endometrial cancer, and the choice of adjuvant therapy for ovarian cancer. PMID:25677027

Cost and robotic surgery in gynecology.

PubMed

Knight, Jason; Escobar, Pedro F

2014-01-01

Since the introduction of robotic technology, there have been significant changes to the field of gynecology. The number of minimally invasive procedures has drastically increased, with robotic procedures rising remarkably. To date several authors have published cost analyses demonstrating that robotic hysterectomy for benign and oncologic indications is more costly compared to the laparoscopic approach. Despite being more expensive than laparoscopy, other studies have found robotics to be less expensive and more effective than laparotomy. In this review, controversies surrounding cost-effectiveness studies are explored. © 2013 The Authors. Journal of Obstetrics and Gynaecology Research © 2013 Japan Society of Obstetrics and Gynecology.

Utilization of Clinical Trials Registries in Obstetrics and Gynecology Systematic Reviews.

PubMed

Bibens, Michael E; Chong, A Benjamin; Vassar, Matt

2016-02-01

To evaluate the use of clinical trials registries in published obstetrics and gynecologic systematic reviews and meta-analyses. We performed a metaepidemiologic study of systematic reviews between January 1, 2007, and December 31, 2015, from six obstetric and gynecologic journals (Obstetrics & Gynecology, Obstetrical & Gynecological Survey, Human Reproduction Update, Gynecologic Oncology, British Journal of Obstetrics and Gynaecology, and American Journal of Obstetrics & Gynecology). All systematic reviews included after exclusions were independently reviewed to determine whether clinical trials registries had been included as part of the search process. Studies that reported using a trials registry were further examined to determine whether trial data were included in the analysis of these systematic reviews. Our initial search resulted in 292 articles, which was narrowed to 256 after exclusions. Of the 256 systematic reviews meeting our selection criteria, 47 (18.4%) used a clinical trials registry. Eleven of the 47 (23.4%) systematic reviews found unpublished data and two included unpublished data in their results. A majority of systematic reviews in clinical obstetrics and gynecology journals do not conduct searches of clinical trials registries or do not make use of data obtained from these searches. Failure to make use of such data may lead to an inaccurate summary of available evidence and may contribute to an overrepresentation of published, statistically significant outcomes.

A survey of outpatient visits in a United States Army forward unit during Operation Desert Shield.

PubMed

Wasserman, G M; Martin, B L; Hyams, K C; Merrill, B R; Oaks, H G; McAdoo, H A

1997-06-01

Reports suggest that deployed soldiers during Operations Desert Shield and Desert Storm remained healthy, but primary care data are limited. We reviewed the outpatient visit surveillance data from the 3d Armored Cavalry Regiment to obtain information regarding soldiers' health in the field. Nontraumatic orthopedic problems accounted for the highest incidence of primary health care visits, followed by unintended injuries, gastrointestinal, respiratory, and dermatologic conditions. Visits for heat injuries, sexually transmitted diseases, unexplained fever, and psychiatric problems were low, probably due to preventive measures. These results suggest that increased prevention to decrease orthopedic problems and unintended injuries may substantially reduce outpatient visits during future deployments. Medical surveillance during future deployments can be improved by taking advantage of current advances in technology to facilitate patient data retrieval and provide timely information to first- and second-echelon medical personnel.

[110 years--University Obstetrics and Gynecology Hospital "Maichin dom"].

PubMed

Zlatkov, V

2014-01-01

The first specialized Obstetrics and Gynecology Hospital in Bulgaria was founded based on the idea of Queen Maria Luisa (1883). Construction began in 1896 and the official opening of the hospital took place on November 19, 1903. What is unique about the University Obstetrics and Gynecology Hospital "Maichin dom" is above all the fact that the Bulgarian school of obstetrics and gynecology was founded within its institution. Currently, the hospital has nearly 400 beds and 600 employees who work at nine clinics and six laboratories, covering the entire spectrum of obstetric and gynecological activities. Its leading specialists still continue to embody the highest level of professionalism and dedication. The future development of the hospital is chiefly associated with the renovation of facilities, resources and equipment and with the enhancement of the professional competence of the staff and of the quality of hospital products to improve the health and satisfaction of the patients.

Outpatient Antibiotic Use and the Need for Increased Antibiotic Stewardship Efforts.

PubMed

Zetts, Rachel M; Stoesz, Andrea; Smith, Brian A; Hyun, David Y

2018-06-01

Antibiotic-resistant infections pose a growing threat to public health. Antibiotic use, regardless of whether it is warranted, is a primary factor in the development of resistance. In the United States, the majority of antibiotic health care expenditures are due to prescribing in outpatient settings. Much of this prescribing is inappropriate, with research showing that at least 30% of antibiotic use in outpatient settings is unnecessary. In this State of the Art Review article, we provide an overview of the latest research on outpatient antibiotic prescribing practices in the United States. Although many of the researchers in these studies describe antibiotic prescribing across all patient age groups, we highlight prescribing in pediatric populations when data are available. We then describe the various factors that can influence a physician's prescribing decisions and drive inappropriate antibiotic use and the potential role of behavioral science in enhancing stewardship interventions to address these drivers. Finally, we highlight the role that a wide range of health care stakeholders can play in aiding the expansion of outpatient stewardship efforts that are needed to fully address the threat of antibiotic resistance. Copyright © 2018 by the American Academy of Pediatrics.

Blended Learning in Obstetrics and Gynecology Resident Education: Impact on Resident Clinical Performance.

PubMed

Ghareeb, Allen; Han, Heeyoung; Delfino, Kristin; Taylor, Funminiyi

2016-01-01

Effects of residents' blended learning on their clinical performance have rarely been reported. A blended learning pilot program was instituted at Southern Illinois University School of Medicine's Obstetrics and Gynecology program. One of the modules was chronic hypertension in pregnancy. We sought to evaluate if the resident blended learning was transferred to their clinical performance six months after the module. A review of patient charts demonstrated inadequate documentation of history, evaluation, and counseling of patients with chronic hypertension at the first prenatal visit by Obstetrics and Gynecology (OB/GYN) residents. A blended learning module on chronic hypertension in pregnancy was then provided to the residents. A retrospective chart review was then performed to assess behavioral changes in the OB/GYN residents. This intervention was carried out at the Department of Obstetrics and Gynecology, Southern Illinois University. All 16 OB/GYN residents were enrolled in this module as part of their educational curriculum. A query of all prenatal patients diagnosed with chronic hypertension presenting to the OB/GYN resident clinics four months prior to the implementation of the blended learning module (March 2015-June 2015) and six months after (July 20, 2015-February 2016) was performed. Data were collected from outpatient charts utilizing the electronic medical record. Data were abstracted from resident documentation at the first prenatal visit. The residents thought that the blended learning module was applicable to performance improvement in the real-world setting. Patients evaluated before ( n = 10) and after ( n = 7) the intervention were compared. After the intervention, there was an increase in assessment of baseline liver enzymes, referral for electrocardiogram, and early assessment for diabetes in the obese patients. More patients were provided a blood pressure cuff after the module (71.4% vs. 20%). Data were provided to the residents in an

Blended Learning in Obstetrics and Gynecology Resident Education: Impact on Resident Clinical Performance

PubMed Central

Ghareeb, Allen; Han, Heeyoung; Delfino, Kristin; Taylor, Funminiyi

2016-01-01

Problem Effects of residents’ blended learning on their clinical performance have rarely been reported. A blended learning pilot program was instituted at Southern Illinois University School of Medicine's Obstetrics and Gynecology program. One of the modules was chronic hypertension in pregnancy. We sought to evaluate if the resident blended learning was transferred to their clinical performance six months after the module. Intervention A review of patient charts demonstrated inadequate documentation of history, evaluation, and counseling of patients with chronic hypertension at the first prenatal visit by Obstetrics and Gynecology (OB/GYN) residents. A blended learning module on chronic hypertension in pregnancy was then provided to the residents. A retrospective chart review was then performed to assess behavioral changes in the OB/GYN residents. Context This intervention was carried out at the Department of Obstetrics and Gynecology, Southern Illinois University. All 16 OB/GYN residents were enrolled in this module as part of their educational curriculum. A query of all prenatal patients diagnosed with chronic hypertension presenting to the OB/GYN resident clinics four months prior to the implementation of the blended learning module (March 2015–June 2015) and six months after (July 20, 2015–February 2016) was performed. Data were collected from outpatient charts utilizing the electronic medical record. Data were abstracted from resident documentation at the first prenatal visit. Outcome The residents thought that the blended learning module was applicable to performance improvement in the real-world setting. Patients evaluated before (n = 10) and after (n = 7) the intervention were compared. After the intervention, there was an increase in assessment of baseline liver enzymes, referral for electrocardiogram, and early assessment for diabetes in the obese patients. More patients were provided a blood pressure cuff after the module (71.4% vs. 20%). Data

Hospital outpatient perceptions of the physical environment of waiting areas: the role of patient characteristics on atmospherics in one academic medical center

PubMed Central

Tsai, Chun-Yen; Wang, Mu-Chia; Liao, Wei-Tsen; Lu, Jui-Heng; Sun, Pi-hung; Lin, Blossom Yen-Ju; Breen, Gerald-Mark

2007-01-01

Background This study examines hospital outpatient perceptions of the physical environment of the outpatient waiting areas in one medical center. The relationship of patient characteristics and their perceptions and needs for the outpatient waiting areas are also examined. Method The examined medical center consists of five main buildings which house seventeen primary waiting areas for the outpatient clinics of nine medical specialties: 1) Internal Medicine; 2) Surgery; 3) Ophthalmology; 4) Obstetrics-Gynecology and Pediatrics; 5) Chinese Medicine; 6) Otolaryngology; 7) Orthopedics; 8) Family Medicine; and 9) Dermatology. A 15-item structured questionnaire was developed to rate patient satisfaction covering the four dimensions of the physical environments of the outpatient waiting areas: 1) visual environment; 2) hearing environment; 3) body contact environment; and 4) cleanliness. The survey was conducted between November 28, 2005 and December 8, 2005. A total of 680 outpatients responded. Descriptive, univariate, and multiple regression analyses were applied in this study. Results All of the 15 items were ranked as relatively high with a range from 3.362 to 4.010, with a neutral score of 3. Using a principal component analysis' summated scores of four constructed dimensions of patient satisfaction with the physical environments (i.e. visual environment, hearing environment, body contact environment, and cleanliness), multiple regression analyses revealed that patient satisfaction with the physical environment of outpatient waiting areas was associated with gender, age, visiting frequency, and visiting time. Conclusion Patients' socio-demographics and context backgrounds demonstrated to have effects on their satisfaction with the physical environment of outpatient waiting areas. In addition to noticing the overall rankings for less satisfactory items, what should receive further attention is the consideration of the patients' personal characteristics when

Hospital outpatient perceptions of the physical environment of waiting areas: the role of patient characteristics on atmospherics in one academic medical center.

PubMed

Tsai, Chun-Yen; Wang, Mu-Chia; Liao, Wei-Tsen; Lu, Jui-Heng; Sun, Pi-Hung; Lin, Blossom Yen-Ju; Breen, Gerald-Mark

2007-12-05

This study examines hospital outpatient perceptions of the physical environment of the outpatient waiting areas in one medical center. The relationship of patient characteristics and their perceptions and needs for the outpatient waiting areas are also examined. The examined medical center consists of five main buildings which house seventeen primary waiting areas for the outpatient clinics of nine medical specialties: 1) Internal Medicine; 2) Surgery; 3) Ophthalmology; 4) Obstetrics-Gynecology and Pediatrics; 5) Chinese Medicine; 6) Otolaryngology; 7) Orthopedics; 8) Family Medicine; and 9) Dermatology. A 15-item structured questionnaire was developed to rate patient satisfaction covering the four dimensions of the physical environments of the outpatient waiting areas: 1) visual environment; 2) hearing environment; 3) body contact environment; and 4) cleanliness. The survey was conducted between November 28, 2005 and December 8, 2005. A total of 680 outpatients responded. Descriptive, univariate, and multiple regression analyses were applied in this study. All of the 15 items were ranked as relatively high with a range from 3.362 to 4.010, with a neutral score of 3. Using a principal component analysis' summated scores of four constructed dimensions of patient satisfaction with the physical environments (i.e. visual environment, hearing environment, body contact environment, and cleanliness), multiple regression analyses revealed that patient satisfaction with the physical environment of outpatient waiting areas was associated with gender, age, visiting frequency, and visiting time. Patients' socio-demographics and context backgrounds demonstrated to have effects on their satisfaction with the physical environment of outpatient waiting areas. In addition to noticing the overall rankings for less satisfactory items, what should receive further attention is the consideration of the patients' personal characteristics when redesigning more comfortable and customized

The future of lasers in gynecology

NASA Astrophysics Data System (ADS)

Keye, William R.

1993-05-01

There were many claims of extraordinary possibilities for laser surgery by the early gynecologic laser surgeons. They promised that by using the laser there would be increased speed of the operation, decreased blood loss, decreased infection rates, decreased thermal damage and finally increased clinical results. Despite this `hype,' our clinical experience over the last decade has demonstrated in a large part that the clinical results using the laser are equivalent to those using either sharp scalpel or electrocautery. It appears that the skill of the surgeon is a far more important variable than the type of instrument used by the surgeon. As a result, since 1990, the laser has begun to fall out of favor with gynecologists and, more recently, general surgeons. The gynecologic surgeon of the 1990s is now exploring the use of intra-abdominal endoscopically delivered sutures and staples as well as electrocautery. Considering the increased expense associated with lasers, it is likely that a gynecologic surgeon will continue to explore non-laser options in the future. With planning and cooperation and consultation between clinicians, basic scientists and industry, lasers may ultimately play an even more significant role than they have in the 1980s.

Radiation Therapy for Gynecologic Cancers

MedlinePlus

... A RE LEARNING ABOUT CLINICAL TRIALS The radiation oncology team is constantly exploring new ways to treat ... Cl inical Trials. gov www.clinicaltrials.gov NRG Oncology (Clinical Trials Using Radiation) www.nrgoncology.org Gynecologic ...

[Innovating to support the development of outpatient surgery].

PubMed

Dubois, Ronan

Le Confluent private hospital in Nantes has opened a unit devoted to outpatient surgery. Its architecture, organisation, facilities and services have all been designed to treat patients in as short a timeframe as possible. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

FDG-PET Assessment of Other Gynecologic Cancers.

PubMed

Faria, Silvana; Devine, Catherine; Viswanathan, Chitra; Javadi, Sanaz; Korivi, Brinda Rao; Bhosale, Priya R

2018-04-01

PET and PET/computed tomography play a role in the staging, monitoring of response to therapy, and surveillance for cervical and ovarian cancers. Currently, it is also an integral part of the assessment of patients with endometrial cancer and other gynecologic malignancies, such as vaginal and vulvar cancers and uterine sarcomas. In this article, we discuss in detail and highlight the potential role of PET and PET/computed tomography in evaluating these gynecologic malignancies using illustrative cases with relevant imaging findings. Copyright © 2017 Elsevier Inc. All rights reserved.

Robotics in Gynecology: Why is this Technology Worth Pursuing?

PubMed Central

Ayala-Yáñez, Rodrigo; Olaya-Guzmán, Emilio José; Haghenbeck-Altamirano, Javier

2013-01-01

Robotic laparoscopy in gynecology, which started in 2005 when the Da Vinci Surgical System (Intuitive Surgical Inc) was approved by the US Food and Drug Administration for use in gynecologic procedures, represents today a modern, safe, and precise approach to pathology in this field. Since then, a great deal of experience has accumulated, and it has been shown that there is almost no gynecological surgery that cannot be approached with this technology, namely hysterectomy, myomectomy, sacrocolpopexia, and surgery for the treatment of endometriosis. Albeit no advantages have been observed over conventional laparoscopy and some open surgical procedures, robotics do seem to be advantageous in highly complicated procedures when extensive dissection and proper anatomy reestablishment is required, as in the case of oncologic surgery. There is no doubt that implementation of better logistics in finance, training, design, and application will exert a positive effect upon robotics expansion in gynecological medicine. Contrary to expectations, we estimate that a special impact is to be seen in emerging countries where novel technologies have resulted in benefits in the organization of health care systems. PMID:24453521

Immunotherapy in Gynecologic Cancers: Are We There Yet?

PubMed

Pakish, Janelle B; Jazaeri, Amir A

2017-08-24

Immune-targeted therapies have demonstrated durable responses in many tumor types with limited treatment options and poor overall prognosis. This has led to enthusiasm for expanding such therapies to other tumor types including gynecologic malignancies. The use of immunotherapy in gynecologic malignancies is in the early stages and is an active area of ongoing clinical research. Both cancer vaccines and immune checkpoint inhibitor therapy continue to be extensively studied in gynecologic malignancies. Immune checkpoint inhibitors, in particular, hold promising potential in specific subsets of endometrial cancer that express microsatellite instability. The key to successful treatment with immunotherapy involves identification of the subgroup of patients that will derive benefit. The number of ongoing trials in cervical, ovarian, and endometrial cancer will help to recognize these patients and make treatment more directed. Additionally, a number of studies are combining immunotherapy with standard treatment options and will help to determine combinations that will enhance responses to standard therapy. Overall, there is much enthusiasm for immunotherapy approaches in gynecologic malignancies. However, the emerging data shows that with the exception of microsatellite unstable tumors, the use of single-agent immune checkpoint inhibitors is associated with response rates of 10-15%. More effective and likely combinatorial approaches are needed and will be informed by the findings of ongoing trials.

Clinical studies of the High-Intensity Narrow-Spectrum light Environmental Decontamination System (HINS-light EDS), for continuous disinfection in the burn unit inpatient and outpatient settings.

PubMed

Bache, Sarah E; Maclean, Michelle; MacGregor, Scott J; Anderson, John G; Gettinby, George; Coia, John E; Taggart, Ian

2012-02-01

Infections are the leading cause of morbidity and mortality in burn patients and prevention of contamination from exogenous sources including the hospital environment is becoming increasingly emphasised. The High-Intensity Narrow-Spectrum light Environmental Decontamination System (HINS-light EDS) is bactericidal yet safe for humans, allowing continuous disinfection of the environment surrounding burn patients. Environmental samples were collected from inpatient isolation rooms and the outpatient clinic in the burn unit, and comparisons were then made between the bacterial contamination levels observed with and without use of the HINS-light EDS. Over 1000 samples were taken. Inpatient studies, with sampling carried out at 0800 h, demonstrated a significant reduction in the average number of bacterial colonies following HINS-light EDS use of between 27% and 75%, (p<0.05). There was more variation when samples were taken at times of increased activity in the room. Outpatient studies during clinics demonstrated a 61% efficacy in the reduction of bacterial contamination on surfaces throughout the room during the course of a clinic (p=0.02). The results demonstrate that use of the HINS-light EDS allows efficacious bacterial reductions over and above that achieved by standard cleaning and infection control measures in both inpatient and outpatient settings in the burn unit. Copyright © 2011 Elsevier Ltd and ISBI. All rights reserved.

OCT in Gynecology

NASA Astrophysics Data System (ADS)

Kuznetsova, Irina A.; Gladkova, Natalia D.; Gelikonov, Valentin M.; Belinson, Jerome L.; Shakhova, Natalia M.; Feldchtein, Felix I.

Timely and efficient diagnosis of diseases of the female reproductivesystem is very important from the social viewpoint [1, 2]. Diagnosticefficacy of the existing techniques still needs improvement sincemalignant neoplasms of the female reproductive system organs are stableleaders among causes of death (over 35.9 %) [3]. Each year, 851.9 thousand genital cancer cases are recorded worldwide [1, 2]. However, the diagnostic efficacy of the visual examination with biopsy is limited. Correct interpretation of colposcopic features requires high skills and long-term clinical experience, which makes colposcopy very subjective and limits interobserver agreement [8-10]. OCT is known to visualize in vivo and noninvasively tissue microstructure with spatial resolution approaching the histologic level and therefore can be expected to guide biopsies and to provide real-time tissue structure information when biopsies are contraindicated or impractical. Although thorough clinical studies are required to determine if OCT can be suitable for this purpose in gynecology in general and for cervical cancer in particular, the early results look encouraging. In this chapter, we present a wide spectrum of the OCT studies of different partsof the female reproductive system and demonstrate the potential of the clinical use of this new visualization method in gynecological practice.

PET/MR Imaging in Gynecologic Oncology.

PubMed

Ohliger, Michael A; Hope, Thomas A; Chapman, Jocelyn S; Chen, Lee-May; Behr, Spencer C; Poder, Liina

2017-08-01

MR imaging and PET using 2-Deoxy-2-[ 18 F]fluoroglucose (FDG) are both useful in the evaluation of gynecologic malignancies. MR imaging is superior for local staging of disease whereas fludeoxyglucose FDG PET is superior for detecting distant metastases. Integrated PET/MR imaging scanners have great promise for gynecologic malignancies by combining the advantages of each modality into a single scan. This article reviews the technology behind PET/MR imaging acquisitions and technical challenges relevant to imaging the pelvis. A dedicated PET/MR imaging protocol; the roles of PET and MR imaging in cervical, endometrial, and ovarian cancers; and future directions for PET/MR imaging are discussed. Copyright © 2017 Elsevier Inc. All rights reserved.

[Oncologic gynecology and the Internet].

PubMed

Gizler, Robert; Bielanów, Tomasz; Kulikiewicz, Krzysztof

2002-11-01

The strategy of World Wide Web searching for medical sites was presented in this article. The "deep web" and "surface web" resources were searched. The 10 best sites connected with the gynecological oncology, according to authors' opinion, were presented.

[Secondary osteoporosis in gynecology].

PubMed

Taguchi, Y; Gorai, I

1998-06-01

Several diseases and medications are known to induce secondary osteoporosis. Among them, same situations are related to gynecological field. They include Turner's syndrome, anorexia nervosa, ovarian dysfunction, oophorectomy, GnRH agonist therapy, and osteoporosis associated with pregnancy. We briefly describe these secondary osteoporosis in this article as follows. Several studies have found osteoporosis to be a common complication of Turner's syndrome and hormone replacement therapy has been used as a possible management; in anorexic patient, low body weight, prolonged amenorrhea, early onset of anorexia nervosa, and hypercortisolism have been reported to be risks for bone demineralization; since oophorectomy which is a common intervention in gynecology leads osteoporosis, it is important to prevent osteoporosis caused by surgery as well as postmenopausal osteoporosis; GnRH agonist, which induces estrogen deficient state and affect bone mass, is commonly used as a management for endometriosis and leiomyoma of uterus; associated with pregnancy, post-pregnancy spinal osteoporosis and transient osteoporosis of the hip are clinically considered to be important and heparin therapy and magnesium sulfate therapy are commonly employed during pregnancy, affecting calcium homeostasis.

Integrating Prevention into Obstetrics/Gynecology.

ERIC Educational Resources Information Center

Carey, J. Christopher

2000-01-01

Discusses formats to teach preventive medicine in obstetrics and gynecology (including learning objectives, lectures/seminars, and rounds/office practice) and evaluation methods (oral examinations, computerized question banks, objective structured clinical examinations). Offers examples from specific programs at American medical schools, including…

[Evaluation of the instruction and the instructors by the students during a clinical training period in a gynecology and obstetrics unit].

PubMed

Ploteau, S; Winer, N; Barrier, J; Rogez, J-M; Philippe, H-J

2007-12-01

The evaluation of an educational system is part of the essential process to get high-quality teaching. We wanted to assess the teaching and the teachers in a gynaecological unit with a view to improve the education of the trainees within a dynamic educational system. It is a prospective study which took place in the gynecology-obstetric unit of the University of Nantes. Thanks to a questionnaire called "Evaluation of the teaching during a gynecologic-obstetric training course", we evaluated the feelings of 21 medical students about their two-month training course. This questionnaire of 27 items is divided in several parts. The first one is about the quality of the teaching, the second about planification, the third about the quality of the learning resources, and the fourth is about the educational quality of each teacher (interaction teacher-student). The fifth one evaluates the perception of this work experience by the student, notably his clinical activity and his personal implication in the unity. There are also some open questions which point out the positive aspects of the teaching but also its failings and the parts that must be improved. We give here the details of the different stages of this assessment from the questionnaire up to the results, mentioning their limits considering the conceptual orientations and the methodological orientations chosen. Analysis of the data was done determining the percentage of agreement and disagreement to a statement of the questionnaire. All the students find the teachings interesting and stimulating, objectives were gone through thoroughly. Courses were well organised. Their integration in the medical team was good. They feel responsible especially when they are on call (88.3%). On the other hand, for a quarter of them, educational supports are not adapted, teaching documents are not clear and adapted to the National Test. Half of them (45%) are not satisfied by the numerical campus which does not facilitate

Perineal template techniques for interstitial implantation of gynecological cancers using the Paris system of dosimetry

DOE Office of Scientific and Technical Information (OSTI.GOV)

Leung, S.

1990-09-01

Since 1984, perineal template/needle techniques for interstitial implantation of gynecologic cancer-cervix, vagina, vulva-have been developed at the Peter MacCallum Cancer Institute. The Paris System of dosimetry has been used resulting in greater dose homogeneity, fewer needles and radioactive sources and considerable simplification and ease of implantation compared with comparable techniques developed in the United States. Principles and techniques of implantation are described in detail.

e-Consultation Improves Efficacy in Thoracic Surgery Outpatient Clinics.

PubMed

Novoa, Nuria M; Gómez, Maria Teresa; Rodríguez, María; Jiménez López, Marcelo F; Aranda, Jose L; Bollo de Miguel, Elena; Diez, Florentino; Hernández Hernández, Jesús; Varela, Gonzalo

2016-11-01

The aim of this study is analysing the impact of the systematic versus occasional videoconferencing discussion of patients with two respiratory referral units along 6 years of time over the efficiency of the in-person outpatient clinics of a thoracic surgery service. Retrospective and comparative study of the evaluated patients through videoconferencing and in-person first visits during two equivalents periods of time: Group A (occasional discussion of cases) between 2008-2010 and Group B (weekly regular discussion) 2011-2013. Data were obtained from two prospective and electronic data bases. The number of cases discussed using e-consultation, in-person outpatient clinics evaluation and finally operated on under general anaesthesia in each period of time are presented. For efficiency criteria, the index: number of operated on cases/number of first visit outpatient clinic patients is created. Non-parametric Wilcoxon test is used for comparison. The mean number of patients evaluated at the outpatient clinics/year on group A was 563 versus 464 on group B. The median number of cases discussed using videoconferencing/year was 42 for group A versus 136 for group B. The mean number of operated cases/first visit at the outpatient clinics was 0.7 versus 0.87 in group B (P=.04). The systematic regular discussion of cases using videoconferencing has a positive impact on the efficacy of the outpatient clinics of a Thoracic Surgery Service measured in terms of operated cases/first outpatient clinics visit. Copyright © 2016 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.

Outpatient Surgery

MedlinePlus

Skip to content Menu Anesthesia 101 Pain Management Preparing for Surgery Stories Resources About Policymakers Media ASA Member Toolkit Preparation Outpatient Surgery Explore this page: Outpatient Surgery What types of anesthesia are available? How ...

Gynecologic simulation training increases medical student confidence and interest in women's health.

PubMed

Nitschmann, Caroline; Bartz, Deborah; Johnson, Natasha R

2014-01-01

Exposure to commonly performed gynecologic procedures via simulation has potential to improve medical student knowledge and foster confidence with procedures. To implement and evaluate a gynecologic simulation curriculum for 3rd-year medical students during their obstetrics and gynecology core clerkship. A gynecologic simulation curriculum was implemented for medical students during their obstetrics and gynecology clerkship. Participants completed pre-and postsurveys to assess learner confidence; effect on interest in a surgical field, women's health, and obstetrics and gynecology as a career; and whether the session met their learning needs. Fifty-nine students participated. Improved confidence in performing the procedures was noted when comparing mean survey scores before and after the simulation for IUD insertion and removal (1.9 pre, 4.3 post, p < .0001), for dilatation and curettage (1.7 pre, 3.8 post, p < .0001), and basic laparoscopy skills (2.1 pre, 4.3 post, p < .0001). An increase in pursuing a surgical field (3.3 pre, 3.6 post, p < .003) and interest in women's health (3.7 pre, 4.9 post, p < .004) was noted among students after the simulation session. The curriculum strongly met the students learning needs with a mean score of 4.54 on the 5-point scale. Gynecologic simulation training for medical students can increase confidence in procedures, interest in pursuing a surgical field and women's health, and was highly effective in meeting student learning needs.

The optimal organization of gynecologic oncology services: a systematic review

PubMed Central

Fung-Kee-Fung, M.; Kennedy, E.B.; Biagi, J.; Colgan, T.; D’Souza, D.; Elit, L.M.; Hunter, A.; Irish, J.; McLeod, R.; Rosen, B.

2015-01-01

Background A system-level organizational guideline for gynecologic oncology was identified by a provincial cancer agency as a key priority based on input from stakeholders, data showing more limited availability of multidisciplinary or specialist care in lower-volume than in higher-volume hospitals in the relevant jurisdiction, and variable rates of staging for ovarian and endometrial cancer patients. Methods A systematic review assessed the relationship of the organization of gynecologic oncology services with patient survival and surgical outcomes. The electronic databases medline and embase (ovid: 1996 through 9 January 2015) were searched using terms related to gynecologic malignancies combined with organization of services, patterns of care, and various facility and physician characteristics. Outcomes of interest included overall or disease-specific survival, short-term survival, adequate staging, and degree of cytoreduction or optimal cytoreduction (or both) for ovarian cancer patients by hospital or physician type, and rate of discrepancy in initial diagnoses and intraoperative consultation between non-specialist pathologists and gyne-oncology–specialist pathologists. Results One systematic review and sixteen additional primary studies met the inclusion criteria. The evidence base as a whole was judged to be of lower quality; however, a trend toward improved outcomes with centralization of gynecologic oncology was found, particularly with respect to the gynecologic oncology care of patients with advanced-stage ovarian cancer. Conclusions Improvements in outcomes with centralization of gynecologic oncology services can be attributed to a number of factors, including access to specialist care and multidisciplinary team management. Findings of this systematic review should be used with caution because of the limitations of the evidence base; however, an expert consensus process made it possible to create recommendations for implementation. PMID:26300679

A Surgical Virtual Reality Simulator Distinguishes Between Expert Gynecologic Laparoscopic Surgeons and Perinatologists

PubMed Central

von Dadelszen, Peter; Allaire, Catherine

2011-01-01

Background: Concern regarding the quality of surgical training in obstetrics and gynecology residency programs is focusing attention on competency based education. Because open surgical skills cannot necessarily be translated into laparoscopic skills and with minimally invasive surgery becoming standard in operative gynecology, the discrepancy in training between obstetrics and gynecology will widen. Training on surgical simulators with virtual reality may improve surgical skills. However, before incorporation into training programs for gynecology residents the validity of such instruments needs to first be established. We sought to prove the construct validity of a virtual reality laparoscopic simulator, the SurgicalSimTM, by showing its ability to distinguish between surgeons with different laparoscopic experience. Methods: Eleven gynecologic surgeons (experts) and 11 perinatologists (controls) completed 3 tasks on the simulator, and 10 performance parameters were compared. Results: The experts performed faster, more efficiently, and with fewer errors, proving the construct validity of the SurgicalSim. Conclusions: Laparoscopic virtual reality simulators can measure relevant surgical skills and so distinguish between subjects having different skill levels. Hence, these simulators could be integrated into gynecology resident endoscopic training and utilized for objective assessment. Second, the skills required for competency in obstetrics cannot necessarily be utilized for better performance in laparoscopic gynecology. PMID:21985726

Abortion training in Canadian obstetrics and gynecology residency programs.

PubMed

Liauw, J; Dineley, B; Gerster, K; Hill, N; Costescu, D

2016-11-01

To evaluate the current state of abortion training in Canadian Obstetrics and Gynecology residency programs. Surveys were distributed to all Canadian Obstetrics and Gynecology residents and program directors. Data were collected on inclusion of abortion training in the curriculum, structure of the training and expected competency of residents in various abortion procedures. We distributed and collected surveys between November 2014 and May 2015. In total, 301 residents and 15 program directors responded, giving response rates of 55% and 94%, respectively. Based on responses by program directors, half of the programs had "opt-in" abortion training, and half of the programs had "opt-out" abortion training. Upon completion of residency, 66% of residents expected to be competent in providing first-trimester surgical abortion in an ambulatory setting, and 35% expected to be competent in second-trimester surgical abortion. Overall, 15% of residents reported that they were not aware of or did not have access to abortion training within their program, and 69% desired more abortion training during residency. Abortion training in Canadian Obstetrics and Gynecology residency programs is inconsistent, and residents desire more training in abortion. This suggests an ongoing unmet need for training in this area. Policies mandating standardized abortion training in obstetrics and gynecology residency programs are necessary to improve delivery of family planning services to Canadian women. Abortion training in Canadian Obstetrics and Gynecology residency programs is inconsistent, does not meet resident demand and is unlikely to fulfill the Royal College of Physicians and Surgeons of Canada objectives of training in the specialty. Copyright © 2016 Elsevier Inc. All rights reserved.

Trends in salaries of obstetrics-gynecology faculty, 2000-01 to 2008-09.

PubMed

Rayburn, William F; Fullilove, Anne M; Scroggs, James A; Schrader, Ronald M

2011-01-01

We sought to determine whether downward trends in inflation-adjusted salaries (1989-99) continued for obstetrics and gynecology faculty. Data were gathered from the Faculty Salary Survey from the Association of American Medical Colleges for academic years 2001 through 2009. We compared median physician salaries adjusted for inflation according to rank and specialty. While faculty compensation increased by 24.8% (2.5% annually), change in salaries was comparable to the cumulative inflation rate (21.3%). Salaries were consistently highest among faculty in gynecologic oncology (P < .001), next highest among maternal-fetal medicine specialists (P < .001), and were not significantly different between general obstetrics-gynecology and reproductive-endocrinology-infertility. Inflation-adjusted growth of salaries in general obstetrics-gynecology was not significantly different from that in general internal medicine and pediatrics. Growth in salaries of physician faculty in obstetrics and gynecology increased from 2000-01 through 2008-09 with real purchasing power keeping pace with inflation. Copyright © 2011 Mosby, Inc. All rights reserved.

[Japanese who affected modern medicine in Taiwan: obstetrics and gynecology].

PubMed

Wang, Ming-Tung

2009-12-01

This text describes the leaders who established the modem obstetrics and gynecology for Taiwan. during the Japan-colonizing period (1895-1945). These leaders are Mr. Kawasoye, M., Mr. Mukae K., and Mr. Magara M. The lives of these leaders were different, but they all strongly contributed to the development of modem obstetrics and gynecology in Taiwan. With regard to the passage of time, Mr. Kawasoye contributed the initial efforts, Mr. Mukae worked during the flourishing period of the clinic; and Mr. Magara worked during the mature period, emphasizing research. These three periods are closely correlated with the course of the development of modem obstetrics and gynecology in Taiwan.

No gynecologist in town: the gynecological care of women in rural Taiwan

PubMed Central

Lai, Li-Jung; Chou, Chia-Lin; Su, H Irene; Chen, Tzeng-Ji; Chou, Li-Fang; Chou, Yueh-Ching; Hwang, Shinn-Jang; Yu, Hann-Chin

2015-01-01

Background A shortage of gynecologists exists in many countries. Even within an affluent country, gynecological clinics might not be evenly distributed. The purpose of the study was to investigate the disparity in gynecological care between adult women living in towns with and without gynecologists in Taiwan. Methods Data sources were the cohort datasets of the National Health Insurance Research Database, with claims data of 1 million beneficiaries in 2010. A woman’s residency was operationally inferred from the locations where she had most frequently visited physicians’ clinics or local community hospitals within the year. Results In Taiwan, 145 (39.4%) of 368 towns had no practicing gynecologist. Of 382,167 women with health care use in the datasets, 21,794 (5.7%) lived in towns without a gynecologist. The overwhelming majority of these towns lay in sparsely populated, rural areas. During the year, 132,702 women (34.7%) had sought medical help for gynecological diseases and 113,698 (29.8%) had visited gynecologists for gynecological diseases. Women in towns without a gynecologist were less likely to consult for gynecological diseases (23.8% versus 35.4%; P<0.001) and visit gynecologists (18.7% versus 30.4%; P<0.001) than women in towns with a gynecologist. The disparity existed in each age group. Among 5,189 adult women living in towns without a gynecologist and having gynecological diseases, 78.5% (number [n]=4,074) visited gynecologists out of town, especially for infertility, benign disorders of the uterus and ovaries, gynecological examinations, and contraceptive problems, and by contrast 23.3% (n=1,209) visited nongynecologists in town, most commonly for menopausal disorders, endometriosis and pelvic pain, menstrual disorders and hormonal dysfunction, and genital dysplasia. Conclusion Gynecological care of rural women was adversely affected by the shortage of gynecologists. The consequences of accessibility in underserved areas deserve further

ASCO 2017-highlights of gynecological cancer.

PubMed

Radl, Bianca; Mlineritsch, Brigitte

2017-01-01

At this year's ASCO annual meeting several important studies in the field of gynecological cancer were presented. Here we report a personal selection of the most interesting and clinically relevant data.

Cost analysis of prophylactic intraoperative cystoscopic ureteral stents in gynecologic surgery.

PubMed

Fanning, James; Fenton, Bradford; Jean, Geraldine Marie; Chae, Clara

2011-12-01

Prophylactic intraoperative ureteral stent placement is performed to decrease operative ureteric injury, though few data are available on the effectiveness of this procedure, and no data are available on its cost. To analyze the cost of prophylactic intraoperative cystoscopic ureteral stents in gynecologic surgery. All cases of prophylactic ureteral stent placement performed in gynecologic surgery during a 1-year period were identified and retrospectively reviewed through the electronic medical records database of Summa Health System. Costs were obtained through the Healthcare Cost Accounting System. The principles of cost-effective analysis were used (ie, explicit and detailed descriptions of costs and cost-effectiveness statistics). Importantly, we evaluated cost and not charges or financial model estimates. In addition, we obtained the contribution margins (ie, the hospital's net profit or loss) for prophylactic ureteral stent placement. Other gynecologic procedures were also analyzed. Among 792 major inpatient gynecologic procedures, 18 cases of prophylactic intraoperative ureteral stents were identified. Median costs were as follows: additional cost of prophylactic intraoperative ureteral stenting, $1580; additional cost of surgical resources, $770; cost of ureteral catheters, $427; cost of surgeons, $383. The contribution margins per case for various gynecologic surgical procedures were as follows: oophorectomy, $2804 profit; abdominal hysterectomy, $2649 profit; laparoscopically assisted vaginal hysterectomy (LAVH), $1760 profit. When intraoperative ureteral stenting was added, the contribution margins changed to the following: oophorectomy, $782 profit; abdominal hysterectomy, $627 profit; LAVH, $262 loss. Overall, the contribution margin profit was decreased by about 85%, from $2400 to $380. Prophylactic intraoperative ureteral stenting in gynecologic surgery decreases a hospital's contribution margin. Because of the expense of this procedure, as well as

Cochrane Reviews in Obstetrics and Gynecology: What is the Contribution of Indian Studies?

PubMed

Radhika, A G; Pandey, Garima; Singh, Nilanchali; Sinha, Anju

2016-10-01

Cochrane reviews aim to produce evidence for health care practice globally including India. We wanted to assess the contribution of Indian origin studies in developing these systematic reviews in the field of obstetrics and gynecology. The objective of this study is to determine the number of Indian origin studies in obstetrics and gynecology which provided conclusive data and hence contributed toward formulating Cochrane Reviews in Obstetrics and Gynecology. A total of 910 Cochrane reviews were accessed from gynecology and pregnancy and child birth list from Cochrane health topics. The details of studies included for each review were accessed from references section. Indian origin studies were then identified from this for further analysis. Of the total 910 Cochrane reviews available on the subject of obstetrics and gynecology, 93 reviews had 225 studies of Indian origin. In the subject-wise categorisation, there were 404 and 506 systematic reviews in Gynecology and Obstetrics respectively. Indian studies were included in 32 and 61 systematic reviews of Gynecology and Obstetrics respectively. Regarding the details of 225 Indian studies included for our analysis, 162 were related to Obstetrics and 63 to Gynecology. The place of study could be ascertained in 81 of the 225 studies despite extensive search. Studies published after 1980 are available in the electronic databases while the earlier studies are difficult to access. Studies with duplicate mentions were counted once. There is an urgent continuing need for high quality research and its publication in India in the field of obstetrics and gynecology. Awareness building measures amongst Obstetricians and Gynecologists in this regard need to be addressed. Better quality studies are especially required in specific areas posing a challenge to our country, to improve the health care practices.

Photodynamic therapy in patients with recurrent gynecological carcinomas

NASA Astrophysics Data System (ADS)

Hetzel, Heinz; Mueller, Elisabeth; Kostron, Herwig

1993-03-01

Patients with recurrent gynecological carcinomas have a poor prognosis with a median survival time of 3 - 6 months. Four patients with recurrent vulva carcinomas, one patient with a recurrent breast cancer, and one with a recurrent cervical carcinoma underwent PDT after parenteral or topical sensitization with Photosan 3. Of those patients two women made a complete recovery with no evidence of disease 27 and 24 months after. One patient responded partially with two recurrences which were retreated twice after topical sensitization, she has survived 16 months. The remaining patients showed partial response and died 3 and 8 months after PDT. The energy delivered by an argon-dye-laser ranged between 225 and 750 J/cm2. Photosan 3 was given intravenously at a dose of 2.5 mg/kg body weight and was tolerated without any allergic reaction. A response rate of nearly 50% in recurrent gynecological malignancies encourages us to pursue PDT in gynecological diseases.

Genetics of Breast and Gynecologic Cancers (PDQ®)—Health Professional Version

Cancer.gov

Genetics of Breast and Gynecologic Cancers includes information on BRCA1 and BRCA2 variants (breast and ovarian cancer) and Lynch syndrome (endometrial cancer). Get more information about hereditary breast and gynecologic cancer syndromes in this clinician summary.

Pre-participation gynecological evaluation of female athletes: a new proposal

PubMed Central

Parmigiano, Tathiana Rebizzi; Zucchi, Eliana Viana Monteiro; de Araujo, Maíta Poli; Guindalini, Camila Santa Cruz; Castro, Rodrigo de Aquino; Bella, Zsuzsanna Ilona Katalin de Jármy Di; Girão, Manoel João Batista Castello; Cohen, Moisés; Sartori, Marair Gracio Ferreira

2014-01-01

Objective To propose the inclusion of a gynecological investigation during the evaluation of athletes before competitions, using a specific instrument called the Pre-participation Gynecological Examination (PPGE). Methods The study assessed 148 athletes, mean age of 15.4±2.0 years, who engaged in eight different sports modalities, and who responded to a questionnaire named Pre-Participation Gynecological Examination (PPGE), to the International Consultation on Incontinence Questionnaire - Short Form (for urinary loss), and to the Eating Attitudes Test (for eating disorders). Results Fifty percent of the participants reported irregular menstrual intervals, 23.0% did not know about sexually transmitted diseases, and 72.4% denied having, at least, an annual gynecological appointment. The study identified 18.2% who had urinary loss, and 15% presented with an increased risk of eating disorders. Moreover, 89.9% were not familiar with the occurrence of urinary incontinence in athletes and did not know that they were susceptible to the female athlete triad. A total of 87.1% of them stated that would not mention these issues to their coaches even if this would improve their health or performance. Conclusion The Pre-Participation Gynecological Examination can be considered an easy-to-apply instrument that allowed the diagnosis of alterations often underestimated by the athletes themselves. After its application, the alterations were identified, and determined the athletes’ referral to appropriate evaluation and treatment. PMID:25628197

The Role of Palliative Surgery in Gynecologic Cancer Cases

PubMed Central

Hope, Joanie Mayer

2013-01-01

The decision to undergo major palliative surgery in end-stage gynecologic cancer is made when severe disease symptoms significantly hinder quality of life. Malignant bowel obstruction, unremitting pelvic pain, fistula formation, tumor necrosis, pelvic sepsis, and chronic hemorrhage are among the reasons patients undergo palliative surgeries. This review discusses and summarizes the literature on surgical management of malignant bowel obstruction and palliative pelvic exenteration in gynecologic oncology. PMID:23299775

Opportunities to improve the value of outpatient surgical care.

PubMed

Erhun, Feryal; Malcolm, Elizabeth; Kalani, Maziyar; Brayton, Kimberly; Nguyen, Christine; Asch, Steven M; Platchek, Terry; Milstein, Arnold

2016-09-01

Nearly 57 million outpatient surgeries-invasive procedures performed on an outpatient basis in hospital outpatient departments (HOPDs) or ambulatory surgery centers (ASCs)-produced annually in the United States account for roughly 7% of healthcare expenditures. Although moving inpatient surgeries to outpatient settings has lowered the cost of care, substantial opportunities to improve the value of outpatient surgery remain. To exploit these remaining opportunities, we composed an evidence-based care delivery composite for national discussion and pilot testing. Evidence-based care delivery composite. We synthesized peer-reviewed publications describing efforts to improve the value of outpatient surgical care, interviewed patients and clinicians to understand their most deeply felt discontents, reviewed potentially relevant emerging science and technology, and observed surgeries at healthcare organizations nominated by researchers as exemplars of efficiency and effectiveness. Primed by this information, we iterated potential new designs utilizing criticism from practicing clinicians, health services researchers, and healthcare managers. We found that 3 opportunities are most likely to improve value: 1) maximizing the appropriate use of surgeries via decision aids, clinical decision support, and a remote surgical coach for physicians considering a surgical referral; 2) safely shifting surgeries from HOPDs to high-volume, multi-specialty ASCs where costs are much lower; and 3) standardizing processes in ASCs from referral to recovery. Extrapolation based on published studies of the effects of each component suggests that the proposed 3-part composite may lower annual national outpatient surgical spending by as much as one-fifth, while maintaining or improving outcomes and the care experience for patients and clinicians. Pilot testing and evaluation will allow refinement of this composite.

Multi-disciplinary summit on genetics services for women with gynecologic cancers: A Society of Gynecologic Oncology White Paper.

PubMed

Randall, Leslie M; Pothuri, Bhavana; Swisher, Elizabeth M; Diaz, John P; Buchanan, Adam; Witkop, Catherine T; Bethan Powell, C; Smith, Ellen Blair; Robson, Mark E; Boyd, Jeff; Coleman, Robert L; Lu, Karen

2017-08-01

To assess current practice, advise minimum standards, and identify educational gaps relevant to genetic screening, counseling, and testing of women affected by gynecologic cancers. The Society of Gynecologic Oncology (SGO) organized a multidisciplinary summit that included representatives from the American College of Obstetricians and Gynecologists (ACOG), the American Society Clinical Oncology (ASCO), the National Society of Genetic Counselors (NSGC), and patient advocacy groups, BrightPink and Facing our Risk of Cancer Empowered (FORCE). Three subject areas were discussed: care delivery models for genetic testing, barriers to genetic testing, and educational opportunities for providers of genetic testing. The group endorsed current SGO, National Comprehensive Cancer Network (NCCN), and NSGC genetic testing guidelines for women affected with ovarian, tubal, peritoneal cancers, or DNA mismatch repair deficient endometrial cancer. Three main areas of unmet need were identified: timely and universal genetic testing for women with ovarian, fallopian tube, and peritoneal cancers; education regarding minimum standards for genetic counseling and testing; and barriers to implementation of testing of both affected individuals as well as cascade testing of family members. Consensus building among all stakeholders resulted in an action plan to address gaps in education of gynecologic oncology providers and delivery of cancer genetics care. Copyright © 2017. Published by Elsevier Inc.

Global health perspective on gynecologic oncology.

PubMed

del Carmen, Marcela G; Rice, Laurel W; Schmeler, Kathleen M

2015-05-01

To describe challenges faced by low-middle income countries (LMICs) across the cancer spectrum, with specific focus on gynecologic cancers. MEDLINE was searched for research articles published in English between January 1, 2000 and February 1, 2015 which reported on global health efforts in LMICs. An estimated 80% of global cancer burden and only 5% of global cancer spending affect LMICs. The overwhelming majority of cervical cancer cases and related deaths occur in LMICs. The charge to close this cancer divide is at the center of global health efforts. Prevention is central to global health efforts to close the cancer divide. The gynecologic oncology community is well positioned to lead efforts in global health by partnering with institutions, professional societies and advocacy groups. Copyright © 2015 Elsevier Inc. All rights reserved.

Designing a Standardized Laparoscopy Curriculum for Gynecology Residents: A Delphi Approach

PubMed Central

Shore, Eliane M.; Lefebvre, Guylaine G.; Husslein, Heinrich; Bjerrum, Flemming; Sorensen, Jette Led; Grantcharov, Teodor P.

2015-01-01

Background Evidence suggests that simulation leads to improved operative skill, shorter operating room time, and better patient outcomes. Currently, no standardized laparoscopy curriculum exists for gynecology residents. Objective To design a structured laparoscopy curriculum for gynecology residents using Delphi consensus methodology. Methods This study began with Delphi methodology to determine expert consensus on the components of a gynecology laparoscopic skills curriculum. We generated a list of cognitive content, technical skills, and nontechnical skills for training in laparoscopic surgery, and asked 39 experts in gynecologic education to rate the items on a Likert scale (1–5) for inclusion in the curriculum. Consensus was predefined as Cronbach α of ≥ 0.80. We then conducted another Delphi survey with 9 experienced users of laparoscopic virtual reality simulators to delineate relevant curricular tasks. Finally, a cross-sectional design defined benchmark scores for all identified tasks, with 10 experienced gynecologic surgeons performing the identified tasks at basic, intermediate, and advanced levels. Results Consensus (Cronbach α = 0.85) was achieved in the first round of the curriculum Delphi, and after 2 rounds (Cronbach α = 0.80) in the virtual reality curriculum Delphi. Consensus was reached for cognitive, technical, and nontechnical skills as well as for 6 virtual reality tasks. Median time and economy of movement scores defined benchmarks for all tasks. Conclusions This study used Delphi consensus to develop a comprehensive curriculum for teaching gynecologic laparoscopy. The curriculum conforms to current educational standards of proficiency-based training, and is suggested as a standard in residency programs. PMID:26221434

[Textual research on Huang shinüke (Huang's Obstetrics and Gynecology)].

PubMed

Wen, Jianfang; Wu, Tong

2015-07-01

Huang shi nü ke (Huang's Obstetrics and Gynecology), a handwritten copy of the Ming Dynasty passed on by Huang Xiaoyou, Yuanyi and Huang Dongjiu, and sorted out by Huang Yanrong, was a family medical book of Huang's obstetrics and gynecology in Xin'an, being a summary of their clinical experience.There were altogether 44 chapters divided into 4 parts, including general introduction, general principle of treatment, discussions on prenatal conditions and qi acquired from the mother, and gynecological diseases in sequence, with the appendixes of pulse diagnostics for differentiating male and female, and the 10-month methods of protecting the fetus.

Effect of Intraperitoneal Bupivacaine on Postoperative Pain in the Gynecologic Oncology Patient

PubMed Central

Rivard, Colleen; Vogel, Rachel Isaksson; Teoh, Deanna

2015-01-01

Study Objective To evaluate if the administration of intraperitoneal bupivacaine decreased postoperative pain in patients undergoing minimally invasive gynecologic and gynecologic cancer surgery. Design Retrospective cohort study (Canadian Task Force classification II-3). Setting University-based gynecologic oncology practice operating at a tertiary medical center. Patients All patients on the gynecologic oncology service undergoing minimally invasive surgery between September 2011 and June 2013. Interventions Starting August 2012, intraperitoneal administration of .25% bupivacaine was added to all minimally invasive surgeries. These patients were compared with historical control subjects who had surgery between September 2011 and July 2012 but did not receive intraperitoneal bupivacaine. Measurements and Main Results One-hundred thirty patients were included in the study. The patients who received intraperitoneal bupivacaine had lower median narcotic use on the day of surgery and the first postoperative day compared with those who did not receive intraperitoneal bupivacaine (day 0: 7.0 mg morphine equivalents vs 11.0 mg, p = .007; day 1: .3 mg vs 1.7 mg, p = .0002). The median patient-reported pain scores were lower on the day of surgery in the intraperitoneal bupivacaine group (2.7 vs 3.2, p = .05) Conclusions The administration of intraperitoneal bupivacaine was associated with improved postoperative pain control in patients undergoing minimally invasive gynecologic and gynecologic cancer surgery and should be further evaluated in a prospective study. PMID:26216095

Resident Education Curriculum in Pediatric and Adolescent Gynecology: The Short Curriculum 2.0.

PubMed

Talib, Hina J; Karjane, Nicole; Teelin, Karen; Abraham, Margaret; Holt, Stephanie; Chelvakumar, Gayaythri; Dumont, Tania; Huguelet, Patricia S; Conner, Lindsay; Wheeler, Carol; Fleming, Nathalie

2018-04-01

The degree of exposure to pediatric and adolescent gynecology (PAG) varies across residency programs in obstetrics and gynecology and pediatrics. Nevertheless, these programs are responsible for training residents and providing opportunities within their programs to fulfill PAG learning objectives. To that end, the North American Society for Pediatric and Adolescent Gynecology has taken a leadership role in PAG resident education by creating and systematically updating the Short Curriculum. This curriculum outlines specific learning objectives that are central to PAG education and lists essential resources for learners' reference. This updated curriculum replaces the previous 2014 publication with added content, resources, and updated references. Additionally, attention to the needs of learners in pediatrics and adolescent medicine is given greater emphasis in this revised North American Society for Pediatric and Adolescent Gynecology Short Curriculum 2.0. Copyright © 2017 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

[Observational study of outpatient unit duration of stay depending on the route of administration (intravenous vs subcutaneous) for a targeted therapy].

PubMed

Despiau, Frédéric; Zagala, Yann; Delord, Jean-Pierre; Montastruc, Marion; Lacaze, Jean-Louis; Ferrand, Régis; Bombail, Marie

2017-10-01

New routes of administration available for some targeted therapies, especially subcutaneous injections, have an impact not only on the patients' daycare experience, but also on the unit's organization. This observational study conducted on 48 voluntary patients at the Institut universitaire du cancer Toulouse-Oncopole shows that the mean duration of the outpatient unit stay is diminished by one hour when a subcutaneous injection is used instead of an intravenous route. This duration decrease is mainly caused by an 82% average reduction in treatment duration. However, the waiting times before and after the treatment itself are not significantly impacted. Organizational methods related to the treatment prescription and preparation remain indeed the same. Anticipated prescription is not noticeably impacted either. This reduction of the duration of stay will truly be obtained if the whole unit's organization is adapted. Copyright © 2017 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

Small cell carcinoma of the gynecologic tract: a multifaceted spectrum of lesions.

PubMed

Atienza-Amores, Maria; Guerini-Rocco, Elena; Soslow, Robert A; Park, Kay J; Weigelt, Britta

2014-08-01

Small cell carcinoma (SmCC) of the female genital tract constitutes a diagnostic and clinical challenge given its rarity and the lack of standardized therapeutic approaches. Here we review the morphological, clinical and molecular features of gynecologic SmCCs and discuss potential areas for future research. Data for this review article were identified by searches of PubMed, EMBASE and the Internet using the search terms "small cell carcinoma" or "neuroendocrine carcinoma" and "gynecologic", "uterine cervix", "cervix", "uterus", "endometrium", "ovary", "vagina", "fallopian tube" or "vulva", and research articles published in English between 1972 and February 2014 were included. SmCCs arising from different organs within the gynecologic tract share the same histopathologic characteristics, which closely resemble those of small cell lung carcinoma. The expression of at least one immunohistochemical neuroendocrine marker is a common finding. The uterine cervix is the most frequent site of SmCC in the female genital tract. HPV infection seems to play a role in the development of cervical SmCC but not in cancers of other gynecologic sites. FIGO stage is an established prognostic factor, in particular in SCCs of the cervix. Irrespective of the site, SmCCs of the gynecologic tract display an aggressive clinical behavior with few reported long-term survivors. The therapeutic management includes surgery, radiotherapy and chemotherapy. Despite the potential differences in etiology and risk factors, SmCCs from different sites of the gynecologic tract have similar morphologic appearances and clinical behavior. Recent genomic analyses of small cell carcinoma of the lung have revealed potential driver genomic alterations. We posit that the comprehensive genomic characterization of gynecologic SmCCs may lead to the identification of markers that result in an improvement of diagnostic reproducibility of SmCCs of the gynecologic tract, and of molecular aberrations that may be

Safety Model for the Introduction of Robotic Surgery in Gynecology.

PubMed

Gomes, Mariano Tamura Vieira; Costa Porto, Beatriz Taliberti da; Parise Filho, Jose Pedro; Vasconcelos, Ana Luiz; Bottura, Bruna Fernanda; Marques, Renato Moretti

2018-05-18

 To analyze the perioperative results and safety of performing gynecological surgeries using robot-assisted laparoscopy during implementation of the technique in a community hospital over a 6-year period.  This was a retrospective observational study in which the medical records of 274 patients who underwent robotic surgery from September 2008 to December 2014 were analyzed. We evaluated age, body mass index (BMI), diagnosis, procedures performed, American Society of Anesthesiologists (ASA) classification, the presence of a proctor (experienced surgeon with at least 20 robotic cases), operative time, transfusion rate, perioperative complications, conversion rate, length of stay, referral to the intensive care unit (ICU), and mortality. We compared transfusion rate, perioperative complications and conversion rate between procedures performed by experienced and beginner robotic surgeons assisted by an experienced proctor.  During the observed period, 3 experienced robotic surgeons performed 187 surgeries, while 87 surgeries were performed by 20 less experienced teams, always with the assistance of a proctor. The median patient age was 38 years, and the median BMI was 23.3 kg/m 2 . The most frequent diagnosis was endometriosis (57%) and the great majority of the patients were classified as ASA I or ASA II (99.6%). The median operative time was 225 minutes, and the median length of stay was 2 days. We observed a 5.8% transfusion rate, 0.8% rate of perioperative complications, 1.1% conversion rate to laparoscopy or laparotomy, no patients referred to ICU, and no deaths. There were no differences in transfusion, complications and conversion rates between experienced robotic surgeons and beginner robotic surgeons assisted by an experienced proctor.  In our casuistic, robot-assisted laparoscopy demonstrated to be a safe technique for gynecological surgeries, and the presence of an experienced proctor was considered a highlight in the safety model adopted for the

Gynecological cancers: A summary of published Indian data.

PubMed

Maheshwari, Amita; Kumar, Neha; Mahantshetty, Umesh

2016-01-01

Gynecological cancers are among the most common cancers in women and hence an important public health issue. Due to the lack of cancer awareness, variable pathology, and dearth of proper screening facilities in developing countries such as India, most women report at advanced stages, adversely affecting the prognosis and clinical outcomes. Ovarian cancer has emerged as one of the most common malignancies affecting women in India and has shown an increase in the incidence rates over the years. Although cervical cancer is on a declining trend, it remains the second most common cancer in women after breast cancer. Many researchers in India have published important data in the field of gynecologic oncology, covering all domains such as basic sciences, preventive oncology, pathology, radiological imaging, and clinical outcomes. This work has given us an insight into the in-depth understanding of these cancers as well as the demographics and survival rates in the Indian population. This aim of this review is to discuss the important studies done in India for all gynecological cancers.

[Comparison of robotic surgery documentary in gynecological cancer].

PubMed

Vargas-Hernández, Víctor Manuel

2012-01-01

Robotic surgery is a surgical technique recently introduced, with major expansion and acceptance among the medical community is currently performed in over 1,000 hospitals around the world and in the management of gynecological cancer are being developed comprehensive programs for implementation. The objectives of this paper are to review the scientific literature on robotic surgery and its application in gynecological cancer to verify its safety, feasibility and efficacy when compared with laparoscopic surgery or surgery classical major surgical complications, infections are more common in traditional radical surgery compared with laparoscopic or robotic surgery and with these new techniques surgical and staying hospital are lesser than the former however, the disadvantages are the limited number of robot systems, their high cost and applies only in specialized centers that have with equipment and skilled surgeons. In conclusion robotic surgery represents a major scientific breakthrough and surgical management of gynecological cancer with better results to other types of conventional surgery and is likely in the coming years is become its worldwide.

Anesthetic Considerations in Robotic-Assisted Gynecologic Surgery

PubMed Central

Kaye, Alan D.; Vadivelu, Nalini; Ahuja, Nitin; Mitra, Sukanya; Silasi, Dan; Urman, Richard D.

2013-01-01

Background Robotic-assisted surgery has evolved over the past 2 decades with constantly improving technology that assists surgeons in multiple subspecialty disciplines. The surgical requirements of lithotomy and steep Trendelenburg positions, along with the creation of a pneumoperitoneum and lack of direct access to the patient all present management challenges in gynecologic surgery. Patient positioning requirements can have significant physiologic effects and can result in many complications. Methods This review focuses on the anesthetic and surgical implications of robot-assisted technology in gynecologic surgery. Conclusion Good communication among team members and knowledge of the nuances of robotic surgery have the potential to improve patient outcomes, increase efficiency, and reduce complications. PMID:24358000

Anti-tumor effect of emodin on gynecological cancer cells.

PubMed

Wang, Yaoxian; Yu, Hui; Zhang, Jin; Ge, Xin; Gao, Jing; Zhang, Yunyan; Lou, Ge

2015-10-01

Although an anti-tumor effect of emodin has been reported before, its effect on human gynecological cancer cells has so far not been studied. Here, we assessed the effect of emodin on cervical cancer-derived (Hela), choriocarcinoma-derived (JAR) and ovarian cancer-derived (HO-8910) cells, and investigated the possible underlying molecular and cellular mechanisms. The respective cells were treated with 0, 5, 10 or 15 μM emodin for 72 h. Subsequently, MTT and Transwell in vitro migration assays revealed that emodin significantly decreased the viability and invasive capacity of the gynecological cancer-derived cells tested. We found that emodin induced apoptosis and significantly decreased mitochondrial membrane potential and ATP release in these cells. We also found that emodin may exert its apoptotic effects via regulating the activity of caspase-9 and the expression of cleaved-caspase-3. Moreover, we found that emodin induced a cell cycle arrest at the G0/G1 phase, possibly through down-regulating the key cell cycle regulators Cyclin D and Cyclin E. Interestingly, emodin also led to autophagic cell death, as revealed by increased MAP LC3 expression, a marker of the autophagosome, and decreased expression of the autophagy regulators Beclin-1 and Atg12-Atg5. Finally, we found that the protein levels of both VEGF and VEGFR-2 were significantly decreased in emodin-treated cells, suggesting an anti-angiogenic effect of emodin on gynecological cancer-derived cells. Our results suggest that emodin exhibits an anti-tumor effect on gynecological cancer-derived cells, possibly through multiple mechanisms including the induction of apoptosis and autophagy, the arrest of the cell cycle, and the inhibition of angiogenesis. Our findings may provide a basis for the design of potential emodin-based strategies for the treatment of gynecological tumors.

Major clinical research advances in gynecologic cancer in 2017.

PubMed

Suh, Dong Hoon; Kim, Miseon; Lee, Kyung Hun; Eom, Keun Yong; Kjeldsen, Maj Kamille; Mirza, Mansoor Raza; Kim, Jae Weon

2018-03-01

In 2017, 10 topics were selected as major clinical research advances in gynecologic oncology. For cervical cancer, efficacy and safety analysis results of a 9-valent human papillomavirus (HPV) vaccine and long-term impact of reduced dose of quadrivalent vaccine were updated. Brief introduction of KEYNOTE trials of pembrolizumab, a monoclonal antibody that blocks the interaction between programmed death (PD)-1 and its ligands, PD-L1 and PD-L2, followed. Tailored surveillance programs for gynecologic cancer related with Lynch syndrome and update on sentinel lymph node mapping were reviewed for uterine corpus cancer. For ovarian cancer, 5 topics were selected including poly(ADP-ribose) polymerases inhibitors and immunotherapy. The other potential practice changers covered in this review were lymphadenectomy in advanced disease, secondary cytoreductive surgery in recurrent disease, weekly dose-dense regimen for first-line chemotherapy, incorporation of bevacizumab maintenance in platinum-sensitive recurrent disease, and effect of platinum-free interval prolongation. Conflicting opinions of academic societies on periodic pelvic examination were introduced in conjunction with relevant literature review. For the field of radiation oncology, results of 2 big trials, The Postoperative Radiation Therapy in Endometrial Carcinoma-3 and Gynecologic Oncology Group-258, for endometrial cancer and recent advance in high-dose-rate brachytherapy for cervical cancer were reported. Topics for breast cancer covered adjuvant capecitabine after preoperative chemotherapy, adjuvant pertuzumab and trastuzumab in early human epidermal growth factor receptor 2-positive disease, olaparib for metastatic cancer in patients with a germline BRCA mutation, 20-year risks of recurrence after stopping endocrine therapy at 5 years, and contemporary hormonal contraception and the risk of breast cancer. Copyright © 2018. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology.

Determinants of suicidal ideation in gynecological cancer patients.

PubMed

Tang, G X; Yan, P P; Yan, C L; Fu, B; Zhu, S J; Zhou, L Q; Huang, X; Wang, Y; Lei, J

2016-01-01

Gynecological cancer survivors are at increased risk of psychological problems including suicide risk. Suicidal ideation, which was thought to be precursor to suicide attempts, has not been well studied. This study aimed to investigate the prevalence, and determinants of suicidal ideation for women with gynecological cancer, and then to assess the effect of coping style and social support on suicidal ideation. Patients with cervical, ovarian and endometrial cancers seen at Hunan Provincial Tumor Hospital from September 2012 to June 2013 were consecutively recruited and were asked to complete the Zung Self-Rating Depression Scale, Suicidal Ideation of Self-rating Scale, Medical Coping Modes Questionnaire and Social Support Rating Scale. Path analysis was used to examine the relationship among coping style, social support, depression symptoms and suicidal ideation. A total of 579 (579/623, 93.0%) gynecological cancer patients were enrolled in this study and completed all investigations between September 2012 and June 2013. Among them, 105 (18.1%) patients reported suicidal ideation, with the highest rate in patients with ovarian cancer (30.16%). Suicidal ideation was associated with depression symptoms, care providers, chemotherapy history and acceptance-resignation. Path analysis showed that the acceptance-resignation affected suicidal ideation directly as well as mediated by social support and depression symptoms, while confrontation and avoidance affected suicidal ideation entirely through social support and depression symptoms. Suicidal ideation is high among patients with gynecological cancer, especially among ovarian cancer patients. Coping strategies such as confrontation and avoidance, and social support may be helpful for preventing suicidal ideation among them. Copyright © 2015 John Wiley & Sons, Ltd.

Pain Management for Gynecologic Procedures in the Office.

PubMed

Ireland, Luu Doan; Allen, Rebecca H

2016-02-01

Satisfactory pain control for women undergoing office gynecologic procedures is critical for both patient comfort and procedure success. Therefore, it is important for clinicians to be aware of the safety and efficacy of different pain control regimens. This article aimed to review the literature regarding pain control regimens for procedures such as endometrial biopsy, intrauterine device insertion, colposcopy and loop electrosurgical excisional procedure, uterine aspiration, and hysteroscopy. A search of published literature using PubMed was conducted using the following keywords: "pain" or "anesthesia." These terms were paired with the following keywords: "intrauterine device" or "IUD," "endometrial biopsy," "uterine aspiration" or "abortion," "colposcopy" or "loop electrosurgical excisional procedure" or "LEEP," "hysteroscopy" or "hysteroscopic sterilization." The search was conducted through July 2015. Articles were hand reviewed and selected by the authors for study quality. Meta-analyses and randomized controlled trials were prioritized. Although local anesthesia is commonly used for gynecologic procedures, a multimodal approach may be more effective including oral medication, a dedicated emotional support person, and visual or auditory distraction. Women who are nulliparous, are postmenopausal, have a history of dysmenorrhea, or suffer from anxiety are more likely to experience greater pain with gynecologic procedures. Evidence for some interventions exists; however, the interpretation of intervention comparisons is limited by the use of different regimens, pain measurement scales, patient populations, and procedure techniques. There are many options for pain management for office gynecologic procedures, and depending on the procedure, different modalities may work best. The importance of patient counseling and selection cannot be overstated.

Does the North American Society for Pediatric and Adolescent Gynecology Short Curriculum Increase Resident Knowledge in Pediatric and Adolescent Gynecology?

PubMed

Huguelet, P S; Browner-Elhanan, K J; Fleming, N; Karjane, N W; Loveless, M; Sheeder, J; Talib, H J; Wheeler, C; Kaul, P

2016-12-01

To determine if the North American Society for Pediatric and Adolescent Gynecology (NASPAG) Short Curriculum improves self-reported knowledge in pediatric and adolescent gynecology (PAG) among obstetrics and gynecology (Ob/Gyn) residents, at programs without PAG-trained faculty. Prospective, cross-sectional exposure to the NASPAG short curriculum with a follow-up questionnaire. Ob/Gyn residency training programs without PAG faculty. Ob/Gyn residents in training from February 2015 to June 2015. Exposure to the NASPAG Short Curriculum. Improvement in self-perceived knowledge after completion of curriculum. Two hundred twenty-seven residents met inclusion criteria; 34 completed the study (15% response). Less than 50% of residents reported adequate knowledge in the areas of prepubertal vaginal bleeding, vulvovaginitis, precocious and delayed puberty, Home environment, Education and Employment, Eating, peer-related Activities, Drugs, Sexuality, Suicide/depression, Safety from injury and violence (HEEADSSS) interview, pelvic pain, and bleeding management in teens with developmental delay. After completion of the curriculum, self-reported knowledge improved in 8 of 10 learning objectives, with no significant improvement in bleeding disorders or Müllerian anomalies. There was no association between pretest knowledge and level of residency training, type of residency program, previous exposure to PAG lectures, and previous exposure to patients with PAG complaints. Significant deficiencies exist regarding self-reported knowledge of core PAG topics among Ob/Gyn residents at programs without PAG-trained faculty. Use of the NASPAG Short Curriculum by residents without access to PAG-trained faculty resulted in improved self-reported knowledge in PAG. Copyright © 2016 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Does a robotic surgery approach offer optimal ergonomics to gynecologic surgeons?: a comprehensive ergonomics survey study in gynecologic robotic surgery

PubMed Central

2017-01-01

Objective To better understand the ergonomics associated with robotic surgery including physical discomfort and symptoms, factors influencing symptom reporting, and robotic surgery systems components recommended to be improved. Methods The anonymous survey included 20 questions regarding demographics, systems, ergonomics, and physical symptoms and was completed by experienced robotic surgeons online through American Association of Gynecologic Laparoscopists (AAGL) and Society of Robotic Surgery (SRS). Results There were 289 (260 gynecology, 22 gynecology-oncology, and 7 urogynecology) gynecologic surgeon respondents regularly practicing robotic surgery. Statistical data analysis was performed using the t-test, χ2 test, and logistic regression. One hundred fifty-six surgeons (54.0%) reported experiencing physical symptoms or discomfort. Participants with higher robotic case volume reported significantly lower physical symptom report rates (p<0.05). Gynecologists who felt highly confident about managing ergonomic settings not only acknowledged that the adjustments were helpful for better ergonomics but also reported a lower physical symptom rate (p<0.05). In minimizing their symptoms, surgeons changed ergonomic settings (32.7%), took a break (33.3%) or simply ignored the problem (34%). Fingers and neck were the most common body parts with symptoms. Eye symptom complaints were significantly decreased with the Si robot (p<0.05). The most common robotic system components to be improved for better ergonomics were microphone/speaker, pedal design, and finger clutch. Conclusion More than half of participants reported physical symptoms which were found to be primarily associated with confidence in managing ergonomic settings and familiarity with the system depending on the volume of robotic cases. Optimal guidelines and education on managing ergonomic settings should be implemented to maximize the ergonomic benefits of robotic surgery. PMID:28657231

The Effect of Student Gender on the Obstetrics and Gynecology Clerkship Experience

PubMed Central

Odrobina, Michele R.; McIntyre-Seltman, Kathleen

2010-01-01

Abstract Objectives To explore the effects of the students' gender on their perception of quality and quantity of teaching, the amount of experiential learning, and their interest in obstetrics and gynecology. Methods Anonymous, self-administered surveys to third-year medical students rotating on the obstetrics and gynecology clerkship. Results Eighty-one of 91 students participated (89% response rate): 33 men, 46 women, 2 declined to reveal their gender. No significant gender differences existed regarding number of interactions with residents and faculty; number of deliveries, surgeries, or examinations performed; perceived quality of teaching; or feeling included as part of the clinical team. Male students were more likely to report performing specific surgical procedures, such as operating the bovie cautery during gynecological surgeries (p = 0.005). More men experienced patients refusing to allow them to participate in the clinical interview (p < 0.0001) and physical examination (p < 0.0001). Male students were also more likely to report feeling that their gender negatively impacted their clerkship experience (p < 0.0001). Although less likely to report preclerkship and postclerkship career interest in obstetrics and gynecology, male students were more likely to report that their interest increased at the end of the clerkship. Conclusions Male students were more likely to experience gender bias from patients on the obstetrics and gynecology service. Male students also described feeling socially excluded from female-dominated clinical teams. Obstetrics and gynecology educators need to consider methods of encouraging patients to accept medical student participation regardless of gender. Obstetrics and gynecology faculty and residents need to be sensitive to subtle forms of gender bias and ensure equal inclusion for both male and female medical students. PMID:20088663

Selecting aesthetic gynecologic procedures for plastic surgeons: a review of target methodology.

PubMed

Ostrzenski, Adam

2013-04-01

The objective of this article was to assist cosmetic-plastic surgeons in selecting aesthetic cosmetic gynecologic-plastic surgical interventions. Target methodological analyses of pertinent evidence-based scientific papers and anecdotal information linked to surgical techniques for cosmetic-plastic female external genitalia were examined. A search of the existing literature from 1900 through June 2011 was performed by utilizing electronic and manual databases. A total of 87 articles related to cosmetic-plastic gynecologic surgeries were identified in peer-review journals. Anecdotal information was identified in three sources (Barwijuk, Obstet Gynecol J 9(3):2178-2179, 2011; Benson, 5th annual congress on aesthetic vaginal surgery, Tucson, AZ, USA, November 14-15, 2010; Scheinberg, Obstet Gynecol J 9(3):2191, 2011). Among those articles on cosmetic-plastic gynecologic surgical technique that were reviewed, three articles met the criteria for evidence-based medicine level II, one article was level II-1 and two papers were level II-2. The remaining papers were classified as level III. The pertinent 25 papers met the inclusion criteria and were analyzed. There was no documentation on the safety and effectiveness of cosmetic-plastic gynecologic procedures in the scientific literature. All published surgical interventions are not suitable for a cosmetic-plastic practice. The absence of documentation on safety and effectiveness related to cosmetic-plastic gynecologic procedures prevents the establishment of a standard of practice. Traditional gynecologic surgical procedures cannot be labeled and used as cosmetic-plastic procedures, it is a deceptive practice. Obtaining legal trademarks on traditional gynecologic procedures and creating a business model that tries to control clinical-scientific knowledge dissemination is unethical. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings

Lower limb lymphedema in gynecological cancer survivors--effect on daily life functioning.

PubMed

Dunberger, Gail; Lindquist, Helene; Waldenström, Ann-Charlotte; Nyberg, Tommy; Steineck, Gunnar; Åvall-Lundqvist, Elisabeth

2013-11-01

Lower limb lymphedema (LLL) is a common condition after pelvic cancer treatment but few studies have evaluated its effect on the quality of life and its consequences on daily life activities among gynecological cancer survivors. We identified a cohort of 789 eligible women, treated with pelvic radiotherapy alone or as part of combined treatment of gynecological cancer, from 1991 to 2003 at two departments of gynecological oncology in Sweden. As a preparatory study, we conducted in-depth interviews with gynecological cancer survivors and constructed a study-specific questionnaire which we validated face-to-face. The questionnaire covered physical symptoms originating in the pelvis, demographic, psychological, and quality of life factors. In relation to the lymph system, 19 questions were asked. Six hundred sixteen (78 %) gynecological cancer survivors answered the questionnaire and participated in the study. Thirty-six percent (218/606) of the cancer survivors reported LLL. Overall quality of life was significantly lower among cancer survivors with LLL. They were also less satisfied with their sleep, more worried about recurrence of cancer, and more likely to interpret symptoms from the body as recurrence. Cancer survivors reported that LLL kept them from physical activity (45 %) and house work (29 %) and affected their ability to partake in social activities (27 %) or to meet friends (20 %). Lower limb lymphedema has a negative impact on quality of life among gynecological cancer survivors, affecting sleep and daily life activities, yet only a few seek professional help.

Outpatient Shoulder Arthroplasty.

PubMed

Brolin, Tyler J; Throckmorton, Thomas W

2018-01-01

Health care policy makers have placed increased attention on the cost of health care making outpatient joint arthroplasty an attractive alternative to routine hospital admission. Recent studies have shown outpatient shoulder arthroplasty is a safe and cost-effective alternative to inpatient shoulder arthroplasty. Proper patient selection, patient education, effective pain management strategies, and attention to intraoperative blood loss are keys in the success of outpatient shoulder arthroplasty. Copyright © 2017 Elsevier Inc. All rights reserved.

Munchausen's syndrome in obstetrics and gynecology: a review.

PubMed

Edi-Osagie, E C; Hopkins, R E; Edi-Osagie, N E

1998-01-01

Nineteen review articles and case reports were identified and reviewed through August 1996 in Index Medicus, MEDLINE (English and foreign language), conference abstracts, and bibliographies from major articles, textbooks and reviews, to review Munchausen's syndrome in obstetrics and gynecology. In these 19 articles, 30 reported cases of the syndrome were identified in obstetric and gynecological patients. This survey found that the presentation varied, diagnosis was difficult, treatment was unclear, and the economic burden was enormous. Increasingly, this syndrome is becoming an important clinical entity in the specialty, and requires a high index of suspicion to improve detection and optimize treatment.

Pediatric and adolescent gynecology learned via a Web-based computerized case series.

PubMed

De Silva, Nirupama K; Dietrich, Jennifer E; Young, Amy E

2010-04-01

To increase resident knowledge in pediatric and adolescent gynecology via a Web-based self-tutorial. Prospective cohort involving 11 third- and fourth-year residents in a large university program. Residents were asked to complete a Web-based teaching series of cases involving common topics of pediatric and adolescent gynecology (PAG). A pretest and a posttest were completed to assess knowledge gained. Residents were asked to give feedback regarding improvements to the Web-based series for future case development. University-affiliated residency program in a major metropolitan area. Resident physicians in the Department of Obstetrics and Gynecology. Introduction of a Web-based teaching series to enhance resident education. Improvement of resident knowledge in PAG. All residents improved their knowledge in PAG after reviewing the series of cases. The pretest group mean score was 50%. The posttest group score was 69% (P < .05). All (100%) of participants said that this tool was an effective way to improve resident knowledge in PAG. A computer-based self-tutorial in pediatric and adolescent gynecology is a feasible and satisfactory teaching adjunct to PAG. Copyright 2010 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Comparing definitions of outpatient surgery: Implications for quality measurement.

PubMed

Mull, Hillary J; Rivard, Peter E; Legler, Aaron; Pizer, Steven D; Hawn, Mary T; Itani, Kamal M F; Rosen, Amy K

2017-08-01

Adverse event (AE) rates in outpatient surgery are inconsistently reported, partly because of the lack of a standard definition of outpatient surgery. We compared the types and rates of surgical procedures defined by two national healthcare agencies: Health Care Cost Institute (HCCI) and the Healthcare Cost and Utilization Project (HCUP) and considered implications for quality measurement. We used HCCI and HCUP definitions to identify FY2012-14 VA outpatient surgeries. There were six times as many HCCI surgeries as HCUP (6,575,830 versus 1,086,640). Ninety-nine percent of HCUP-defined surgeries were also identified by HCCI. More HCUP surgeries had higher average Medicare Relative Value Units then HCCI surgeries [5.3 (SD = 4.4) versus 1.6 (SD = 2.3) RVUs]. Rates and types of procedures vary widely between definitions. Quality measurement using HCCI versus HCUP may produce significantly lower AE rates because many of the surgeries included reflect low complexity and potentially low risk of AEs. Published by Elsevier Inc.

Additive homeopathy in cancer patients: Retrospective survival data from a homeopathic outpatient unit at the Medical University of Vienna.

PubMed

Gaertner, Katharina; Müllner, Michael; Friehs, Helmut; Schuster, Ernst; Marosi, Christine; Muchitsch, Ilse; Frass, Michael; Kaye, Alan David

2014-04-01

Current literature suggests a positive influence of additive classical homeopathy on global health and well-being in cancer patients. Besides encouraging case reports, there is little if any research on long-term survival of patients who obtain homeopathic care during cancer treatment. Data from cancer patients who had undergone homeopathic treatment complementary to conventional anti-cancer treatment at the Outpatient Unit for Homeopathy in Malignant Diseases, Medical University Vienna, Department of Medicine I, Vienna, Austria, were collected, described and a retrospective subgroup-analysis with regard to survival time was performed. Patient inclusion criteria were at least three homeopathic consultations, fatal prognosis of disease, quantitative and qualitative description of patient characteristics, and survival time. In four years, a total of 538 patients were recorded to have visited the Outpatient Unit Homeopathy in Malignant Diseases, Medical University Vienna, Department of Medicine I, Vienna, Austria. 62.8% of them were women, and nearly 20% had breast cancer. From the 53.7% (n=287) who had undergone at least three homeopathic consultations within four years, 18.7% (n=54) fulfilled inclusion criteria for survival analysis. The surveyed neoplasms were glioblastoma, lung, cholangiocellular and pancreatic carcinomas, metastasized sarcoma, and renal cell carcinoma. Median overall survival was compared to expert expectations of survival outcomes by specific cancer type and was prolonged across observed cancer entities (p<0.001). Extended survival time in this sample of cancer patients with fatal prognosis but additive homeopathic treatment is interesting. However, findings are based on a small sample, and with only limited data available about patient and treatment characteristics. The relationship between homeopathic treatment and survival time requires prospective investigation in larger samples possibly using matched-pair control analysis or randomized

Subspecialty and gender of obstetrics and gynecology faculty in department-based leadership roles.

PubMed

Hofler, Lisa; Hacker, Michele R; Dodge, Laura E; Ricciotti, Hope A

2015-02-01

To characterize the cohort who may become senior leaders in obstetrics and gynecology by examining the gender and subspecialty of faculty in academic department administrative and educational leadership roles. This is an observational study conducted through web sites of U.S. obstetrics and gynecology residency programs accredited in 2012-2013. In obstetrics and gynecology departmental administrative leadership roles, women comprised 20.4% of chairs, 36.1% of vice chairs, and 29.6% of division directors. Among educational leaders, women comprised 31.9% of fellowship directors, 47.3% of residency directors, and 66.1% of medical student clerkship directors. Chairs were most likely to be maternal-fetal medicine faculty (38.2%) followed by specialists in general obstetrics and gynecology (21.8%), reproductive endocrinologists (15.6%), and gynecologic oncologists (14.7%). Among chairs, 32.9% are male maternal-fetal medicine specialists. Family planning had the highest representation of women (80.0%) among division directors, whereas reproductive endocrinology and infertility had the lowest (15.8%). The largest proportion of women chairs, vice chairs, residency program directors, and medical student clerkship directors were specialists in general obstetrics and gynecology. Women remained underrepresented in the departmental leadership roles of chair, vice chair, division director, and fellowship director. Representation of women was closer to parity among residency program directors, in which women held just under half of positions. Nearly one in three department chairs was a male maternal-fetal medicine specialist. Compared with subspecialist leaders, specialist leaders in general obstetrics and gynecology were more likely to be women.

Society of Gynecologic Oncology Future of Physician Payment Reform Task Force report: The Endometrial Cancer Alternative Payment Model (ECAP).

PubMed

Ko, Emily M; Havrilesky, Laura J; Alvarez, Ronald D; Zivanovic, Oliver; Boyd, Leslie R; Jewell, Elizabeth L; Timmins, Patrick F; Gibb, Randall S; Jhingran, Anuja; Cohn, David E; Dowdy, Sean C; Powell, Matthew A; Chalas, Eva; Huang, Yongmei; Rathbun, Jill; Wright, Jason D

2018-05-01

Health care in the United States is in the midst of a significant transformation from a "fee for service" to a "fee for value" based model. The Medicare Access and CHIP Reauthorization Act of 2015 has only accelerated this transition. Anticipating these reforms, the Society of Gynecologic Oncology developed the Future of Physician Payment Reform Task Force (PPRTF) in 2015 to develop strategies to ensure fair value based reimbursement policies for gynecologic cancer care. The PPRTF elected as a first task to develop an Alternative Payment Model for thesurgical management of low risk endometrial cancer. The history, rationale, and conceptual framework for the development of an Endometrial Cancer Alternative Payment Model are described in this white paper, as well as directions forfuture efforts. Copyright © 2018 Elsevier Inc. All rights reserved.

Satisfaction with work-life balance among U.S. gynecologic oncologists, a cross-sectional study

PubMed Central

Szender, J Brian; Grzankowski, Kassondra S; Eng, Kevin H; Lele, Shashikant B; Odunsi, Kunle; Frederick, Peter J

2016-01-01

Objectives To evaluate the satisfaction with work-life balance (WLB) and career satisfaction of gynecologic oncologists. Methods In August 2014, members of the Society of Gynecologic Oncology (SGO) were sent an anonymous, cross-sectional survey evaluating demographic variables, practice characteristics, career satisfaction, fatigue, and satisfaction with WLB. Fatigue was assessed using a visual-analog scale. Career satisfaction and WLB were assessed with a Likert scale. Inferential statistics were computed with type I error rates of 0.05. Results Out of the 1002 gynecologic oncologists surveyed, 290 (28.9%) responded. Only 18.6% of respondents were satisfied with WLB and there were significant associations between gender (P = 0.0157), time spent in work related activities at home (P = 0.0024), on weekends (P = 0.0017), and in the hospital (P = 0.0001). More than 84% of physicians reported they would choose medicine as a career again and of those 90% would choose to be a gynecologic oncologist again. Fatigue was strongly associated with dissatisfaction with WLB in univariate and multivariate analysis (P < 0.0001). Conclusions Although gynecologic oncologists indicated they are satisfied with their careers, most are not satisfied with their WLB. Given the forecast shortage of gynecologic oncologists and projected increased cancer rates, understanding the factors associated with career satisfaction may assist the SGO in meeting future gynecologic cancer care needs. PMID:27088113

Satisfaction with work-life balance among U.S. gynecologic oncologists, a cross-sectional study.

PubMed

Szender, J Brian; Grzankowski, Kassondra S; Eng, Kevin H; Lele, Shashikant B; Odunsi, Kunle; Frederick, Peter J

To evaluate the satisfaction with work-life balance (WLB) and career satisfaction of gynecologic oncologists. In August 2014, members of the Society of Gynecologic Oncology (SGO) were sent an anonymous, cross-sectional survey evaluating demographic variables, practice characteristics, career satisfaction, fatigue, and satisfaction with WLB. Fatigue was assessed using a visual-analog scale. Career satisfaction and WLB were assessed with a Likert scale. Inferential statistics were computed with type I error rates of 0.05. Out of the 1002 gynecologic oncologists surveyed, 290 (28.9%) responded. Only 18.6% of respondents were satisfied with WLB and there were significant associations between gender (P = 0.0157), time spent in work related activities at home (P = 0.0024), on weekends (P = 0.0017), and in the hospital (P = 0.0001). More than 84% of physicians reported they would choose medicine as a career again and of those 90% would choose to be a gynecologic oncologist again. Fatigue was strongly associated with dissatisfaction with WLB in univariate and multivariate analysis (P < 0.0001). Although gynecologic oncologists indicated they are satisfied with their careers, most are not satisfied with their WLB. Given the forecast shortage of gynecologic oncologists and projected increased cancer rates, understanding the factors associated with career satisfaction may assist the SGO in meeting future gynecologic cancer care needs.

Cosmetic gynecology in the view of evidence-based medicine and ACOG recommendations: a review.

PubMed

Ostrzenski, Adam

2011-09-01

To conduct a methodological review of the existing scientific literature within the field of cosmetic gynecology in the view of evidence-based medicine and to establish their relevance to the ACOG Committee Opinion No. 378. The appropriate medical subject heading terms were selected and applied in the search of the Internet multiple databases since 1900 until January 2010. Articles focusing on cosmetic gynecology were reviewed. Also, anecdotal and advertising literatures were analyzed. A methodological review of the literatures was conducted. In peer review journals, 72 relevant articles related to cosmetic gynecology were identified. Anecdotal information was identified in 3 sources and over 1,100 published marketing literatures were identified on the Internet and no scientific journals. Among reviewed articles on cosmetic gynecology, only two articles met the level II-2 in evidence-based medicine. The absence of documentations on the safety and effectiveness of cosmetic vaginal procedures in the scientific literatures was ACOG's main concern. Practicing cosmetic gynecology within ACOG recommendations is desirable and possible. Currently, the standard of practice of cosmetic gynecology cannot be determined due to the absence of the documentation on safety and effectiveness. Traditional gynecologic surgical procedures cannot be called cosmetic procedures, since it is a deceptive form of practice and marketing. Creating medical terminology trademarks and establishing a business model that tries to control clinical-scientific knowledge dissemination is unethical.

Prospective evaluation of IOTA logistic regression models LR1 and LR2 in comparison with subjective pattern recognition for diagnosis of ovarian cancer in an outpatient setting.

PubMed

Nunes, N; Ambler, G; Foo, X; Widschwendter, M; Jurkovic, D

2018-06-01

To determine whether International Ovarian Tumor Analysis (IOTA) logistic regression models LR1 and LR2 developed for the preoperative diagnosis of ovarian cancer could also be used to differentiate between benign and malignant adnexal tumors in the population of women attending gynecology outpatient clinics. This was a single-center prospective observational study of consecutive women attending our gynecological diagnostic outpatient unit, recruited between May 2009 and January 2012. All the women were first examined by a Level-II ultrasound operator. In those diagnosed with adnexal tumors, the IOTA-LR1/2 protocol was used to evaluate the masses. The LR1 and LR2 models were then used to assess the risk of malignancy. Subsequently, the women were also examined by a Level-III examiner, who used pattern recognition to differentiate between benign and malignant tumors. Women with an ultrasound diagnosis of malignancy were offered surgery, while asymptomatic women with presumed benign lesions were offered conservative management with a minimum follow-up of 12 months. The initial diagnosis was compared with two reference standards: histological findings and/or a comparative assessment of tumor morphology on follow-up ultrasound scans. All women for whom the tumor classification on follow-up changed from benign to malignant were offered surgery. In the final analysis, 489 women who had either or both of the reference standards were included. Their mean age was 50 years (range, 16-91 years) and 45% were postmenopausal. Of the included women, 342/489 (69.9%) had surgery and 147/489 (30.1%) were managed conservatively. The malignancy rate was 137/489 (28.0%). Overall, sensitivities of LR1 and LR2 for the diagnosis of malignancy were 97.1% (95% CI, 92.7-99.2%) and 94.9% (95% CI, 89.8-97.9%) and specificities were 77.3% (95% CI, 72.5-81.5%) and 76.7% (95% CI, 71.9-81.0%), respectively (P > 0.05). In comparison with pattern recognition (sensitivity 94.2% (95% CI, 88

Association of Hysteroscopic vs Laparoscopic Sterilization With Procedural, Gynecological, and Medical Outcomes.

PubMed

Bouillon, Kim; Bertrand, Marion; Bader, Georges; Lucot, Jean-Philippe; Dray-Spira, Rosemary; Zureik, Mahmoud

2018-01-23

Safety of hysteroscopic sterilization has been recently questioned following reports of general symptoms such as allergy, tiredness, and depression in addition to associated gynecological results such as pelvic pain, perforation of fallopian tubes or uterus, and unwanted pregnancy. To compare the risk of reported adverse events between hysteroscopic and laparoscopic sterilization. French nationwide cohort study using the national hospital discharge database linked to the health insurance claims database. Women aged 30 to 54 years receiving a first hysteroscopic or laparoscopic sterilization between 2010 and 2014 were included and were followed up through December 2015. Hysteroscopic sterilization vs laparoscopic sterilization. Risks of procedural complications (surgical and medical) and of gynecological (sterilization failure that includes salpingectomy, second sterilization procedure, or pregnancy; pregnancy; reoperation) and medical outcomes (all types of allergy; autoimmune diseases; thyroid disorder; use of analgesics, antimigraines, antidepressants, benzodiazepines; outpatient visits; sickness absence; suicide attempts; death) that occurred within 1 and 3 years after sterilization were compared using inverse probability of treatment-weighted Cox models. Of the 105 357 women included (95.5% of eligible participants; mean age, 41.3 years [SD, 3.7 years]), 71 303 (67.7% ) underwent hysteroscopic sterilization, and 34 054 (32.3%) underwent laparoscopic sterilization. During the hospitalization for sterilization, risk of surgical complications for hysteroscopic sterilization was lower: 0.13% for hysteroscopic sterilization vs 0.78% for laparoscopic sterilization (adjusted risk difference [RD], -0.64; 95% CI, -0.67 to -0.60) and was lower for medical complications: 0.06% vs 0.11% (adjusted RD, -0.05; 95% CI, -0.08 to -0.01). During the first year after sterilization, 4.83% of women who underwent hysteroscopic sterilization had a higher risk of sterilization

Primary versus secondary hypertension in children followed up at an outpatient tertiary unit.

PubMed

Gomes, Romina S; Quirino, Isabel G; Pereira, Regina M; Vitor, Breno M; Leite, Alysson F; Oliveira, Eduardo A; Simões e Silva, Ana Cristina

2011-03-01

Childhood hypertension has classically been recognized as a secondary disease. However, primary hypertension also occurs in children. The aim of this study was to compare clinical features of pediatric patients with elevated blood pressure, which were referred to an outpatient tertiary unit, and to detect variables associated with the identification of primary hypertension. The records of 220 patients with hypertension followed between 1996 and 2006 were analyzed. The variable of interest was primary hypertension. Logistic regression analysis was applied to identify clinical variables that were independently associated with primary hypertension. Of 220 patients, 33 (15%) had primary hypertension, and 187 (85%) exhibited secondary hypertension. No statistically significant differences were detected in gender, race, age at diagnosis, and systolic/diastolic blood pressure levels between both groups. After adjustment, four variables at baseline remained independently associated with primary hypertension: absence of signs/symptoms (OR 18.87, 95% CI 6.32-56.29), normal serum creatinine (OR 0.02, 95% CI 0.00-0.27), family history of hypertension (OR 3.03, 95% CI 1.04-8.79), and elevated body weight (OR 1.06, 95% CI 1.02-1.10). The absence of signs/symptoms, normal serum creatinine, family history of hypertension, and overweight/obesity at admission are clues to diagnose primary hypertension in childhood.

Pain relief assessment by aromatic essential oil massage on outpatients with primary dysmenorrhea: a randomized, double-blind clinical trial.

PubMed

Ou, Ming-Chiu; Hsu, Tsung-Fu; Lai, Andrew C; Lin, Yu-Ting; Lin, Chia-Ching

2012-05-01

This study assessed the effectiveness of blended essential oils on menstrual cramps for outpatients with primary dysmenorrhea and explored the analgesic ingredients in the essential oils. A randomized, double-blind clinical trial was conducted. Forty-eight outpatients were diagnosed with primary dysmenorrhea by a gynecologist and had 10-point numeric rating scales that were more than 5. The patients were randomly assigned to an essential oil group (n = 24) and a synthetic fragrance group (n = 24). Essential oils blended with lavender (Lavandula officinalis), clary sage (Salvia sclarea) and marjoram (Origanum majorana) in a 2:1:1 ratio was diluted in unscented cream at 3% concentration for the essential oil group. All outpatients used the cream daily to massage their lower abdomen from the end of the last menstruation continuing to the beginning of the next menstruation. Both the numeric rating scale and the verbal rating scale significantly decreased (P < 0.001) after one menstrual cycle intervention in the two groups. The duration of pain was significantly reduced from 2.4 to 1.8 days after aromatherapy intervention in the essential oil group. Aromatic oil massage provided relief for outpatients with primary dysmenorrhea and reduced the duration of menstrual pain in the essential oil group. The blended essential oils contain four key analgesic components that amount to as much as 79.29%; these analgesic constitutes are linalyl acetate, linalool, eucalyptol, and β-caryophyllene. This study suggests that this blended formula can serve as a reference for alternative and complementary medicine on primary dysmenorrhea. © 2012 The Authors. Journal of Obstetrics and Gynaecology Research © 2012 Japan Society of Obstetrics and Gynecology.

Rational selection of antibacterial drugs and postoperative nursing for gynecologic and obstetric surgery patients.

PubMed

Hou, Li; Zhang, Yan; Luan, Yan; Xin, Beibei; Wang, Chunxia

2018-05-01

Infection after gynecologic surgery is very common and frequent. If the control is not good, it will lead to serious consequences. Therefore, it is necessary to use antibiotics in the period of obstetrics and gynecology. This study will explore the use of antimicrobial agents in gynecologic and obstetric surgery, thus standardizing the use of antibiotics in the process of obstetrics and gynecology. Through the analysis of the use of antibacterials, we can see that the highest utilization rate of 5 kinds of antibacterial drugs followed by Cefaclor Sustained Release Tablets (65.7%), metronidazole (32.5%), cefathiamidine (26.8%), enoxacin (22.5%) and cefoperazone tazobactam sodium (11.8%). At the same time, the hospital should improve the consciousness of rational drug use and strengthen the administration of antibacterials in the operative period of obstetrics and gynecology. The application of antibiotics in the operative period of the department of obstetrics and gynecology can improve the current situation of its irrational use. Nursing work must take strict aseptic operation to prevent cross infection. At the same time, we should strengthen the observation of the effect of medication, monitor the body temperature and blood pressure, and identify the side effects of drugs.

Subspecialty Influence on Scientific Peer Review for an Obstetrics and Gynecology Journal With a High Impact Factor.

PubMed

Parikh, Laura I; Benner, Rebecca S; Riggs, Thomas W; Hazen, Nicholas; Chescheir, Nancy C

2017-02-01

To evaluate whether quality of peer review and reviewer recommendation differ based on reviewer subspecialty in obstetrics and gynecology and to determine the role of experience on reviewer recommendation. We performed a retrospective cohort study of reviews submitted to Obstetrics & Gynecology between January 2010 and December 2014. Subspecialties were determined based on classification terms selected by each reviewer and included all major obstetrics and gynecology subspecialties, general obstetrics and gynecology, and nonobstetrics and gynecology categories. Review quality (graded on a 5-point Likert scale by the journal's editors) and reviewer recommendation of "reject" were compared across subspecialties using χ, analysis of variance, and multivariate logistic regression. There were 20,027 reviews from 1,889 individual reviewers. Reviewers with family planning subspecialty provided higher-quality peer reviews compared with reviewers with gynecology only, reproductive endocrinology and infertility, gynecologic oncology, and general obstetrics and gynecology specialties (3.61±0.75 compared with 3.44±0.78, 3.42±0.72, 3.35±0.75, and 3.32±0.81, respectively, P<.05). Reviewers with gynecology-only subspecialty recommended rejection more often compared with reviewers with a nonobstetrics and gynecology subspecialty (57.7% compared with 38.7%, P<.05). Editorial Board members recommended rejection more often than new reviewers (68.0% compared with 41.5%, P<.05). Increased adjusted odds of manuscript rejection recommendation were associated with reproductive endocrinology, female pelvic medicine and reconstructive surgery, and gynecology-only reviewer subspecialty (adjusted odds ratio [OR] 1.23 [1.07-1.41], 1.21 [1.05-1.39], and 1.11 [1.02-1.20]). Manuscript rejection recommendation rate was also increased for reviewers who had completed the highest quintile of peer reviews (greater than 195) compared with the lowest quintile (one to seven) (adjusted OR 2.85 [2

Genetics of Breast and Gynecologic Cancers (PDQ®)—Health Professional Version

Cancer.gov

Expert-reviewed information summary about the genetics of breast and gynecologic cancers, including information about specific genes and family cancer syndromes. The summary also contains information about interventions that may influence the risk of developing breast and gynecologic cancers in individuals who may be genetically susceptible to these diseases. Psychosocial issues associated with genetic testing are also discussed.

American Society of Clinical Oncology 2012 Annual Meeting: highlights from the gynecologic oncology track.

PubMed

Tewari, Krishnansu S

2012-11-01

The 2012 Annual Meeting of the American Society of Clinical Oncology (ASCO) was held in Chicago, June 1-5, 2011, and brought together more than 25,000 oncology professionals from a broad range of specialties to explore the theme, "Collaborating to Conquer Cancer". The Gynecologic Oncology Track had a strong international presence, with important clinical trials being presented from Japan, Germany, Norway, the United States, and others. This meeting report will highlight several phase 3 and phase 2 clinical trials as well as notable translational research endeavors and other selected abstracts.

Use of topical hemostatic agents in gynecologic surgery.

PubMed

Wysham, Weiya Z; Roque, Dario R; Soper, John T

2014-09-01

Sutures, hemoclips, and electrocautery are the primary mechanisms used to achieve hemostasis during gynecologic surgery, but in situations in which these are inadequate or not feasible, an array of hemostatic agents are available to help achieve hemostasis. These agents include physical agents such as cellulose, collagen, or gelatin products as well as biologic agents such as thrombin and fibrin products. Limited data are available on many of these agents, although their use is increasing, sometimes at high costs. In gynecologic surgery, hemostatic agents are likely most effective when used in areas of oozing or slow bleeding and as an adjunct to conventional surgical methods of hemostasis.

Readmission After Gynecologic Surgery: A Comparison of Procedures for Benign and Malignant Indications.

PubMed

Cory, Lori; Latif, Nawar; Brensinger, Colleen; Zhang, Xiaochen; Giuntoli, Robert L; Burger, Robert A; Morgan, Mark; Ko, Emily

2017-08-01

To compare 30-day postsurgical readmission rates and associated risk factors for readmission among women undergoing gynecologic surgery for benign and malignant conditions. In a retrospective cohort study, we identified patients after surgery for benign and malignant gynecologic conditions in the National Surgical Quality Improvement Program database between January 1, 2011, and December 31, 2012. Data collected included surgical factors, perioperative characteristics, surgical complications, and 30-day readmissions. The primary study outcome was readmission rates after gynecologic surgery for benign and oncologic conditions. Secondary study outcomes were risk factors associated with readmission among gynecologic surgeries performed for benign and oncologic conditions. Approximately 3% (1,444/46,718) compared with 8.2% (623/7,641) of patients who underwent gynecologic surgery for benign and malignant indications, respectively, were readmitted (P<.01). Compared with patients with benign surgical indications, those with uterine cancer (readmission rate 6.6%; odds ratio [OR] 2.21, 95% CI 1.95-2.51), ovarian cancer (readmission rate 10.9%; OR 3.82, 95% CI 3.29-4.45), and cervical cancer (readmission rate 10.1%; OR 3.51, 95% CI 2.71-4.53) were more likely to be readmitted. In multivariable models, independent risk factors for readmission for gynecologic cancer surgery included worse preoperative conditions (OR 1.49, 95% CI 1.17-1.90) and major complications (OR 17.84, 95% CI 14.19-22.43). In comparison, independent risk factors for readmission after surgery for benign indications included comorbid conditions (OR 1.36, 95% CI 1.18-1.57), operative time (15-59 minutes: referent; 60 minutes or greater: 1.37, 95% CI 1.14-1.63) and major complications (OR 53.91, 95% CI 46.98-61.85). Among gynecologic surgeries, those performed for oncologic indications were associated with readmission rates 2.8 times that of surgeries performed for benign indications. In adjusted models

Gender and the gynecological examination: women's identities in doctors' narratives.

PubMed

Galasiński, Dariusz; Ziółkowska, Justyna

2007-04-01

The authors explore the constructions of gender in male doctors' narratives of gynecological examinations. Focusing on the ways in which gender identities are constructed in the stories of the medical encounter, they argue, first, that gender is more flexible during the visit with a gynecologist than has been suggested. Gendered identities are assumed and put aside as the interaction progresses, with its final stage--the pelvic examination--being constructed with gender removed. Second, they argue that undressing is invested with a special status during the examination. It is a gendered rite of passage between the two different ungendered subject positions of the doctor and the patient. They conclude that contrary to the assumptions in the literature on gynecological interactions, it is the genderization of undressing that is most conducive to securing the least face-threatening gynecological examination for the woman.

Hypnosis closed loop TCI systems in outpatient surgery.

PubMed

Ramos-Luengo, A; Asensio-Merino, F

Determine the influence of general anaesthesia with closed-loop systems in the results of outpatient varicose vein surgery. Retrospective observational study including data from 270 outpatients between 2014 and 2015. The patients were divided into 2 groups according to the type of general anaesthesia used. The CL Group included patients who received propofol in closed-loop guided by BIS and remifentanil using TCI, and the C Group received non-closed-loop anaesthesia. Age, sex, surgical time, discharge time and failure of outpatient surgery were recorded. Quantitative data were checked for normal distribution by the method of Kolmogorov-Smirnov-Lilliefors. Differences between groups were analysed by a Student-t-test or Mann-Whitney-Wilcoxon test, depending on their distribution. Categorical data were analysed by a Chi-squared test. We used Kaplan-Meier estimator and the effect size (calculated by Cohen's d) to study the discharge time. Statistical analysis was performed using R 3.2.3 binary for Mac OS X 10.9. There were no significant differences in age, sex and surgical time and failure of outpatient surgery. Discharge time was different in both groups: 200 (100) vs. 180 (82.5) minutes, C Group and CL Group, respectively (data are median and interquartile rank); P=.005. The use of closed-loop devices for the hypnotic component of anaesthesia hastens discharge time. However, for this effect to be clinically significant, some improvements still need to be made in our outpatient surgery units. Copyright © 2016 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

[Gynecologic oncology at the Royal Hospital for Women, Sidney. Report on a 10 month overseas stay].

PubMed

Gitsch, G

1995-01-01

Gynecologic oncology is centralized in Australia. In centers like the Royal Hospital for Women in Sydney, more than 300 patients/year with gynecologic malignancies are operated on. The establishment of gynecologic oncology as a special field is illustrated. In addition, the 3-year training program of gynecologic oncologists is reviewed. The international trend towards specialization is emphasized, and the advantages of centralization and additional training are pointed out. An adaptation of the Australian model for Austrian circumstances is proposed.

Gynecologic disorders diagnosed during deployment to Southwest/Central Asia, active component females, U.S. Armed Forces, 2008-2013.

PubMed

2014-08-01

Service women in the U.S. Armed Forces face unique challenges that may lead to or exacerbate gynecologic disorders - particularly during deployment. This report documented that approximately one in 10 military women who served in Southwest/Central Asia were diagnosed with a gynecologic disorder at least once during deployment. In addition, gynecologic disorders accounted for approximately one of every 20 medical evacuations of female service members from the war zone. A majority of clinically significant gynecologic disorder cases were attributable to irregular menstruation/bleeding or unspecified inflammation or pain of the female genital organs. Incidence rates of gynecologic disorder diagnoses were higher among black, non-Hispanic service women, among younger women, and among those in the Army and in motor transport and communications/intelligence occupations. Approximately 50% of gynecologic disorder cases had received gynecologic care within 6 months prior to deployment and nearly 90% had received care within 2 years of deployment. Despite pre-deployment care, it is apparent from this report that service women need continuous access to gynecologic care during deployment, particularly if conditions during deployment lead to and exacerbate gynecologic disorders.

Stability and Change of Interest in Obstetrics-Gynecology among Medical Students: Eighteen Years of Longitudinal Data.

ERIC Educational Resources Information Center

Forouzan, Iraj; Hojat, Mohammadreza

1993-01-01

A study investigated, first, the percentage of medical students maintaining interest in obstetrics/gynecology during medical school compared to those maintaining interest in other specialties and, second, changes of interest from obstetrics/gynecology to other specialties and other specialties to obstetrics/gynecology. Results indicate instability…

A new progestogen-only medical therapy for outpatient management of acute, abnormal uterine bleeding: a pilot study.

PubMed

Ammerman, Stacy R; Nelson, Anita L

2013-06-01

The objective of this investigation was to study short-term efficacy and feasibility of a new progestogen-only treatment for outpatient management of acute abnormal uterine bleeding. This was a prospective, single-arm, pilot clinical trial of a progestogen-only bridging treatment for acute abnormal uterine bleeding in nonpregnant, premenopausal women in the Gynecologic Urgent Care Clinic at Harbor-UCLA Medical Center. Subjects were administered a depo-medroxyprogesterone acetate 150 mg intramuscular injection and given medroxyprogesterone acetate 20 mg to be taken orally every 8 hours for 3 days. The primary outcome measures included a percentage of women who stopped bleeding in 5 days, time to bleeding cessation, reduction in numbers of pads used, side effects, and patient satisfaction. All 48 women stopped bleeding within 5 days; 4 women had spotting only at the time of their last contact during the 5 day follow-up. Mean time to bleeding cessation was 2.6 days. Side effects were infrequent and patient satisfaction was high. Injection of depo-medroxyprogesterone acetate 150 mg intramuscularly combined with 3 days of oral medroxyprogesterone acetate 20 mg every 8 hours for 9 doses is an effective outpatient therapy for acute abnormal uterine bleeding. Copyright © 2013 Mosby, Inc. All rights reserved.

Ways of coping with stress and perceived social support in gynecologic cancer patients.

PubMed

Yilmaz, Sema Dereli; Bal, Meltem Demirgöz; Beji, Nezihe Kzlkaya; Arvas, Macit

2015-01-01

Stress is commonly encountered among cancer patients and may be a challenge affecting immune system resistance. Social support may contribute positively to the health of cancer patients, playing a role in coping with stress. The aim of this study was to determine whether ways of coping are related to social support given to women with gynecologic cancer. The study was performed as a cross-sectional design in a university hospital in Istanbul, Turkey, with 221 women with gynecologic cancer; the data were collected via 3 questionnaires, the first with sociodemographic and clinical features, the second with multidimensional scale of perceived social support, and the third with the scale of ways of coping with stress. Women with gynecologic cancer who were employed and declared their incomes as balanced and reported more years of education were more likely to perceive higher social support and to use the ineffective coping ways with stress at a lower rate (P < .05) than other participants. Based on correlational analysis, effective coping ways with stress increase as perceived social support from family, friends, significant other, and total increases (P < .05). Social support from family members is the mainstay of coping with stress by women with gynecologic cancer. Nurses are indispensable in increasing social support required by women with gynecologic cancer. Well-trained clinical nurses via in-service programs should be experienced and aware of women diagnosed with gynecologic cancer in need of social support during hospital visits and provide necessary guidance.

High school students' opinions of gynecological consultations in Rio de Janeiro, Southeastern Brazil.

PubMed

Pereira, Sandra de Morais; Taquette, Stella Regina; Pérez, Maurício de Andrade

2013-02-01

To analyze sociocultural differences and perceptions of gynecological consultations for high school girls. A transversal study with 418 high school girls from three schools of different profiles in the city of Rio de Janeiro, Southeastern Brazil in 2010. A structured questionnaire encompassing socio-demographic characteristics, sexual behavior and evaluation of gynecological consultations was completed. Yates' Chi-square test and the Student's t-test were utilized adopting a value of p < 0.05. The students of private and federal public schools presented similar profiles but both were different from the state school girls. The latter had lower socioeconomic status, and their parents had lower levels of education, the predominance of afro-descendants was observed, as were a larger number of sexual partners, pregnancy and cases of sexual violence. The average age of menarche and sexarche among the students were similar, but the first gynecological consultation was significantly later among the state school students. The majority showed some knowledge of contraception and STDs, although only a minority received guidance from the consultations. Students expressed the desire that the professionals dedicate more time, patience and availability to them during consultations. The provision of gynecological services for teenagers is not satisfactory, according to the teenagers' evaluations. Users of the private health system have gynecological consultations earlier than those who only have access to the public system. It is necessary to create mechanisms that facilitate access and adhesion to a routine of gynecological prevention for this age group.

Eating disorders and obstetric-gynecologic care.

PubMed

Leddy, Meaghan A; Jones, Candace; Morgan, Maria A; Schulkin, Jay

2009-09-01

Disordered eating can have consequences for gynecologic and obstetric patients and fetuses. Amenorrhea, infertility, hyperemesis gravidarum, and preterm birth have been linked to eating disorders (EDs). This study aimed to evaluate obstetrician-gynecologists' ED-related knowledge, attitudes, and practices. Questionnaires were sent to 968 Fellows of the American College of Obstetricians and Gynecologists between November 2007 and March 2008. Data were analyzed separately for generalists (provide obstetric and gynecologic care) and gynecologists only (treat only gynecologic patients). A majority of obstetrician-gynecologists assess body weight, exercise, body mass index, and dieting habits. Less than half assess ED history, body image concerns, weight-related cosmetic surgery, binging, and purging. Over half (54%) of generalists believed ED assessment falls within their purview. Most (90.8%) generalists agreed or strongly agreed that EDs can negatively impact pregnancy outcome. A majority rated residency training in diagnosing (88.5%) and treating (96.2%) EDs as barely adequate or less. Most knew low birth weight (91%) and postpartum depression (90%) are associated with maternal EDs, though over a third was unsure about several consequences. Some gender differences emerged; females screen for more ED indicators and are more likely to view ED assessment as within their role. Despite the consequences of EDs and the fact that most physicians agree EDs can negatively impact pregnancy, only about half view ED assessment as their responsibility. Only some weight- and diet-related topics are assessed, and there are gaps in knowledge of ED consequences. Obstetrician-gynecologists are not confident in their training regarding EDs. Improvement in knowledge and altering obstetrician-gynecologists' view of their responsibilities may improve ED screening rates.

[The concept "a case in outpatient treatment" in military policlinic activity].

PubMed

Vinogradov, S N; Vorob'ev, E G; Shklovskiĭ, B L

2014-04-01

Substantiates the necessity of transition of military policlinics to the accounting system and evaluation of their activity on the finished cases of outpatient treatment. Only automating data-statistical processes can solve this problem. On the basis of analysis of the literature data, requirements of the guidance documents and observational results concludes that preliminarily should be done revisal (formalisation) of existing concepts of medical statistics from the position of information environment which in use - electronic databases. In this aspect specified the main features of outpatient treatment case as a unit of medical-statistical record, and formulated its definition.

Diagnosis of gynecological pseudoaneurysms and embolization with cyanoacrylate.

PubMed

Fernández Bermúdez, M J; Fernández Martínez, A M; Domitrovic, L A; Balboa Arregui, Ó

Pseudoaneurysms of the uterine artery are an uncommon cause of severe gynecological bleeding secondary to surgical manipulation of the pelvis or to instrumental delivery. The different imaging techniques are of vital importance in the diagnosis. Angiography is the technique used for confirmation and also for treatment in many cases. Endovascular treatment by embolizing the pseudoaneurysm has become established as the treatment of choice, making it possible to avoid hysterectomy in women of childbearing age. This article presents two cases of gynecological bleeding due to pseudoaneurysms (one secondary to surgery and one secondary to childbirth) that were embolized in a novel way using cyanoacrylate. Copyright © 2016 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

[Microecological investigation of vaginal microflora in women with varying degree gynecologic symptoms in clinics].

PubMed

Xiao, Bing-bing; Liu, Zhao-hui; Liao, Qin-ping

2009-01-01

To investigate the microecological status of vaginal microflora in the women with different vaginal symptoms. From March 2006 to October 2007, 6982 cases with varying degree vaginal symptoms including pruritus, increaseed leucorrhea, the leucorrhea having unusual smell, in the gynecology outpatient department were studied. The vagina secretions were examined in terms of the pH value, the hydrogen peroxide test, and Gram dyeing inspection of vaginal bacteria and microecology appraisal for colony's density, the multiplicity, the superiority fungus, and the inflammatory response. Among 6982 patients, normal vaginal microecology was identified in 750 (10.74%, 750/6982); abnormal microecology was found in 6232 (89.26%, 6232/6982); bacterial vaginosis (BV) was detected in 729 (10.44%, 729/6982); vulvovaginal candidiasis (VVC) was in 1527 (21.87%, 1527/6982). Ninety five patients (1.36%, 95/6982) were with both BV and VVC. Abnormal bacteria colonies were found in 1229 (17.60%, 1229/6982), and others were found in 2652 (37.98%, 2652/6982). The vaginal microecology in the women with different vaginal symptoms can be either normal or abnormal. Microecology clinical evaluation system can assess the vaginal microecosystem.

Stereotactic body radiotherapy (SBRT): Technological innovation and application in gynecologic oncology.

PubMed

Higginson, Daniel S; Morris, David E; Jones, Ellen L; Clarke-Pearson, Daniel; Varia, Mahesh A

2011-03-01

Stereotactic body radiotherapy (SBRT) is a novel form of noninvasive, highly conformal radiation treatment that delivers a high dose to tumor. The advantage of the technique resides in its ability to provide a high dose to tumor but spare normal tissues to an extent not previously possible. In this paper we will provide an introduction and review of this technology with regard to its use in gynecologic malignancies. Preliminary results from our experience are presented for the purpose of illustrating the range of SBRT applications in gynecologic oncology. A comprehensive literature review was conducted and our experience from the past three years was reviewed. Six case series are published that report results of SBRT for gynecologic malignancies. Sixteen gynecologic patients have been treated with SBRT at our institution. Treatment sites include pelvic and periaortic nodes (9 patients), oligometastatic disease (2), and cervical or endometrial primary tumors when other conventional external radiation or brachytherapy techniques were unsuitable (5). Preliminary follow-up at a median of 11 months (range, 0.3-33 months) demonstrates 79% locoregional control, 43% distant failure, and 50% overall survival. SBRT boosts to macroscopic periaortic node recurrences and other sites seem to provide local control and a possibility of long-term disease-free survival in carefully selected patients. Previously this had been difficult to achieve with conventional radiotherapy because of the proximity of periaortic nodes to small bowel. SBRT also offers a novel approach for minimally invasive treatment in the management of gynecological cancer where current surgical and radiotherapy techniques are unsuitable. Copyright © 2010 Elsevier Inc. All rights reserved.

76 FR 50485 - Obstetrics and Gynecology Devices Panel of the Medical Devices Advisory Committee; Amendment of...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-15

...] Obstetrics and Gynecology Devices Panel of the Medical Devices Advisory Committee; Amendment of Notice AGENCY... an amendment to the notice of meeting of the Obstetrics and Gynecology Devices Panel of the Medical... Obstetrics and Gynecology Devices Panel of the Medical Devices Advisory Committee would be held on September...

A Sexuality Curriculum for Gynecology Residents

ERIC Educational Resources Information Center

Levine, Stephen B.; And Others

1978-01-01

The summary report of an educational research program conducted with the obstetrics and gynecology residents at University Hospitals of Cleveland in 1976 is presented. The goals were to provide residents with basic knowledge about female sexual problems, assess skill and comfort in interviewing patients with sexual problems, document the effects…

Association Between Availability of a Price Transparency Tool and Outpatient Spending.

PubMed

Desai, Sunita; Hatfield, Laura A; Hicks, Andrew L; Chernew, Michael E; Mehrotra, Ateev

2016-05-03

There is increasing interest in using price transparency tools to decrease health care spending. To measure the association between offering a health care price transparency tool and outpatient spending. Two large employers represented in multiple market areas across the United States offered an online health care price transparency tool to their employees. One introduced it on April 1, 2011, and the other on January 1, 2012. The tool provided users information about what they would pay out of pocket for services from different physicians, hospitals, or other clinical sites. Using a matched difference-in-differences design, outpatient spending among employees offered the tool (n=148,655) was compared with that among employees from other companies not offered the tool (n=295,983) in the year before and after it was introduced. Availability of a price transparency tool. Annual outpatient spending, outpatient out-of-pocket spending, use rates of the tool. Mean outpatient spending among employees offered the tool was $2021 in the year before the tool was introduced and $2233 in the year after. In comparison, among controls, mean outpatient spending changed from $1985 to $2138. After adjusting for demographic and health characteristics, being offered the tool was associated with a mean $59 (95% CI, $25-$93) increase in outpatient spending. Mean outpatient out-of-pocket spending among those offered the tool was $507 in the year before introduction of the tool and $555 in the year after. Among the comparison group, mean outpatient out-of-pocket spending changed from $490 to $520. Being offered the price transparency tool was associated with a mean $18 (95% CI, $12-$25) increase in out-of-pocket spending after adjusting for relevant factors. In the first 12 months, 10% of employees who were offered the tool used it at least once. Among employees at 2 large companies, offering a price transparency tool was not associated with lower health care spending. The tool was used by

Patient characteristics for outpatient acupuncture in Beijing, China.

PubMed

Napadow, Vitaly; Kaptchuk, Ted J

2004-06-01

This study quantifies and compares patient characteristics in outpatient acupuncture. Prospective primary source evidence was gathered at two prominent outpatient acupuncture clinics in Beijing, China (n = 563, n = 233). The most common condition was Bell's palsy, which represented 20.6% and 25.3% of total cases at the two clinics, respectively. The second most common condition was cerebrovascular accident (CVA) rehabilitation. These treatments represented 11.9% and 12.0% of treatments at the two clinics, respectively. Other trends at the clinics included the following: (1) neurologic complaints predominated; (2) doctors see a large number of patients per day; (3) the majority of patients overall were female; while (4) the majority of patients treated for CVAs rehabilitation were male. As cultural and socioeconomic differences in perceptions of acupuncture exist between peoples of different countries, this study also compared patient main complaints in China to available data on acupuncture patients seen in other parts of China, Germany, the United Kingdom, Australia, and the United States. Except for the German clinic data, Western clinic acupuncturists saw more musculoskeletal complaints compared to China, where neurologic complaints predominated. Another significant difference between Asian and Western clinics was the number of patients seen per hour. While acupuncturists were reported to see 1.2 patients per hour in U. S. clinics, acupuncturists at the two Beijing, China, clinics saw 7.0 and 10.4 patients per hour, respectively. The main complaints seen in acupuncture outpatient clinics throughout the world likely result from a combination of inherent disease prevalence as well as patients' attitudes toward what acupuncture can treat successfully. Copyright Mary Ann Liebert, Inc.

Traumatization in Deaf and Hard-of-Hearing Adult Psychiatric Outpatients

ERIC Educational Resources Information Center

Øhre, Beate; Uthus, Mette Perly; von Tetzchner, Stephen; Falkum, Erik

2015-01-01

Deaf and hard-of-hearing persons are at risk for experiencing traumatic events and such experiences are associated with symptoms of mental disorder. We investigated the prevalence of traumatic events and subsequent traumatization in adults referred to specialized psychiatric outpatient units for deaf and hard-of-hearing patients. Sixty-two…

Outpatient rehabilitation as an intervention to improve employees' physical capacity.

PubMed

Ojala, Birgitta; Nygård, Clas-Håkan; Nikkari, Seppo T

2016-01-01

The aging of the workforce poses new challenges for maintaining work ability. Because of limited information on the effectiveness of vocational rehabilitation performed in traditional inpatient programs, extended interest in outpatient rehabilitation has risen in the past few years. We examined the effects of a new outpatient rehabilitation program where every participant defined their own goals to improve work ability by the aid of a goal-oriented multi-professional team. This report will focus on the employees' physical capacity during a nine-month program. A total of 605 municipal employees from different production areas of the City of Tampere took part in the outpatient rehabilitation program, implemented by the occupational health unit. Groups of 12 employees participated in eight one-day sessions at intervals of two to three weeks; the final follow-up was 9 months from the beginning. Submaximal aerobic capacity was tested by a calibrated cycle ergometer with a commercial program (Aino Fitware pro, Helsinki, Finland). Musculoskeletal tests assessed muscle strength, balance and mobility. During the 9-month follow-up of the rehabilitation program, the employees' physical capacity was improved. The follow-up test scores from a total of 329 employees were significantly higher in the submaximal aerobic capacity test (p < 0.001). Other tests were also improved, such as standing on one foot (p = 0.001), back side bending flexibility test (p < 0.001), dynamic sit up (p = 0.001), upper extremity right (p < 0.001), and knee bending (p = 0.029). About 40% of the participants did not have an adequate health situation to take part in physical capacity tests; however they took part in the intervention. The new outpatient rehabilitation program organized by the occupational health unit had a positive influence on employees' physical capacity during a nine-month follow up.

HIV patients' experiences with inpatient and outpatient care: results of a national survey.

PubMed

Wilson, Ira B; Ding, Lin; Hays, Ron D; Shapiro, Martin F; Bozzette, Samuel A; Cleary, Paul D

2002-12-01

Little is known about HIV patients' care experiences. To assess HIV patients' experiences with inpatient and outpatient care, and to assess the relationship and relative influence of patient characteristics and site of care on care experiences. Cohort study. Patients with HIV receiving care outside of emergency rooms, prisons, or the military throughout the continental United States. One thousand seventy-four patients provided ratings of an inpatient stay and 2204 rated an outpatient visit; 818 patients provided evaluations of both inpatient and outpatient care. A national probability sample of persons in care for HIV from the HIV Cost and Services Utilization Study. Outcome variables were rates of problems with, and global ratings of, inpatient and outpatient care. Mean problem rates were 20.9% and 8.4% (lower score means fewer problems) for inpatient and outpatient care, respectively. On 9 of 10 of the individual inpatient report items, 15% or more of respondents reported problems. Global ratings of inpatient and outpatient care were 65.3 and 75.0 (0-100 scale, higher scores indicate better ratings), respectively. In multivariable models that controlled for site effects, the only patient characteristic that was consistently associated with problem rates and global ratings of care was mental health (P <0.0001 for both inpatient and outpatient care). Models including site effects explained two to four times as much variance as models excluding site effects. Inpatients with HIV reported higher problem rates with inpatient than outpatient care. Better provider-patient communication during inpatient stays is needed. For both inpatient and outpatient care, quality improvement efforts may be most productively focused on providers and processes of care at sites rather than on specific patient subgroups.

Surgical Coagulator With Carbon Dioxide Laser For Gynecology

NASA Astrophysics Data System (ADS)

Wolinski, Wieslaw; Kazmirowski, Antoni; Korobowicz, Witold; Olborski, Zbigniew

1987-10-01

The technical data and parameters of the CO2 surgical laser for gynecology are given. Coagulator was designed and constructed in Institute of Microelectronics and Optoelectronics Warsaw Technical University.

The Association Between Pain and Quality of Life for Patients With Cancer in an Outpatient Clinic, an Inpatient Oncology Ward, and Inpatient Palliative Care Units.

PubMed

Mikan, Fukiko; Wada, Makoto; Yamada, Michiko; Takahashi, Ayaka; Onishi, Hideki; Ishida, Mayumi; Sato, Kazuki; Shimizu, Sachiko; Matoba, Motohiro; Miyashita, Mitsunori

2016-09-01

This study was designed to clarify the association between pain and quality of life (QOL) of Japanese patients with cancer using a cancer-specific QOL scale (European Organization for Research and Treatment of Cancer [EORTC] QLQ-C15-PAL) in 3 care settings (outpatient, inpatient, and palliative care units [PCUs]). We examined the above-mentioned purpose for the total of 404 patients. In outpatients, physical, emotional functioning (EF), and global health status/QOL (QL item) were significantly correlated with average pain, and their correlation coefficients were -0.37 to -0.46 (P < .0001). In inpatients, they were -0.33 (P = .006), -0.26 (P = .030), and -0.31 (P = .012). In the PCU patients, they were -0.12 (P = .316), -0.30 (P = .009), and -0.28 (P = .015). Patients' pain had an association with physical and emotional QOL, and the association was smaller in the PCU patients than the others. © The Author(s) 2016.

Gynecological surgery from the Hippocratics to the fall of the Roman Empire.

PubMed

Bliquez, Lawrence J

2010-01-01

The article aims to explore advances in the Greco-Roman gynecological surgery with particular emphasis on the Roman Empire. The development and improvement of the Roman surgical instrumentarium occurred in tandem with surgical advances, gynecological as well as general. It might therefore be said that the approach taken in this paper is one based on material culture.

[Indications for genetic amniocentesis investigated at the Department of Gynecology, Obstetrics, and Oncologic Gynecology, Nicolaus Copernicus University, Collegium Medicum, Bydgoszcz].

PubMed

Sadłecki, Paweł; Walentowicz-Sadłecka, Małgorzata; Pasińska, Magdalena; Adamczak, Rafał; Grabiec, Marek

2014-06-01

Genetic amniocentesis (GA) is the most common prenatal diagnostic test. One of the main indications for GA is maternal age of > or = 35 years. In many countries, the age indication has been replaced by an assessment of individual risk for chromosomal abnormalities, calculated on the basis of maternal age, pregnancy duration, as well as a combination of biochemical and ultrasound markers. The aim of the study was to investigate indications for and results of GA performed between 2010-2012 at the Department of Gynecology Obstetrics, and Oncologic Gynecology Nicolaus Copernicus University Collegium Medicum, Bydgoszcz. A total of 632 GA tests were performed at the Department of Gynecology Obstetrics, and Oncologic Gynecology Nicolaus Copernicus University Collegium Medicum, Bydgoszcz. Average maternal age was 34 (between 17 and 47 years), with patients < 35 constituting 47.9% (N = 303), and patients > or = 35 constituting 52.1% (N = 329) of the investigated group. Indications for GA as well as test results were analyzed in relation to maternal age. The result of earlier non-invasive tests were also analyzed. Abnormal ultrasound findings, combined with abnormal first-trimester screening results, were the most common indication (46.53%) for GA in patients < 35 years, whereas abnormal first-trimester screening results, combined with a history of obstetric complications, were the reason for GA in patients > or = 35 years. Mean time of GA was 16 gestational weeks in both groups. Abnormal karyotype was detected in 74 (11.7%) cases. 13 or any other abnormal karyotypes occurrence were observed in both age groups. GA-related complications (miscarriage/intrauterine fetal death) occurred in 9 (1.42%) cases. If performed properly GA between 15 and 20 weeks of pregnancy is a harmless procedure both, for the mother and the fetus, associated with an acceptable complication rate. Prenatal screening for the most common malformations and chromosomal aberrations should be offered to all

Patients' experiences of receiving chemotherapy in outpatient clinic and/or onboard a unique nurse-led mobile chemotherapy unit: a qualitative study.

PubMed

Mitchell, T

2013-07-01

There is a drive in the UK to revise chemotherapy provision for people living in rural communities. Using a different model of treatment delivery might impact positively upon the experience of receiving chemotherapy. In 2007 the first nurse-led mobile chemotherapy unit (MCU) in the UK was launched in the South West of England with the intention of providing treatment closer to home. The aim of the research was to explore experiences of people with cancer who received chemotherapy treatment in outpatient clinic and/or onboard the MCU using an interpretive phenomenological approach. Interviews were conducted with 20 people and data were interpreted using thematic analysis. The cancer and chemotherapy journey was described as being undertaken by the participant and their significant other. Available car parking and travelling impacted upon quality of life, as did the environment and accessibility of nurses to discuss issues with participants. The most important, distinguishing feature between receiving chemotherapy in outpatient clinic and the MCU was the amount of time spent waiting. Having treatment on the MCU was perceived to be less formal and therefore less stressful. Participants reported significant savings in time spent travelling, waiting and having treatment, expenditure on fuel and companion costs. © 2013 John Wiley & Sons Ltd.

Current situation in gynecological oncology training in Spain: where we are and where we want to go.

PubMed

Padilla-Iserte, P; Minig, L; Zapardiel, I; Chiva, L; Laky, R; de Santiago, J

2018-04-01

It is important to know what a young gynecologic oncologist perceives as a need to achieve a good training in gynecologic oncology. This study aims to evaluate the level of training in gynecologic oncology in Spain. A Web-based anonymous questionnaire was sent via e-mail to Spanish trainees listed in European Network of Young Gynecological Oncology (ENYGO). The survey was developed in four sections: (1) general training in gynecologic oncology, (2) distribution of current clinical activity, (3) surgical training, and (4) perspective future gynecologic oncology. It contained 51 questions, with multiple-choice answers that had to be answered by the ENYGO members. The questionnaire was sent to 64 people listed in the ENYGO database. Of these, 37 members responded (response rate of 58%). Overall, more training in surgery is necessary, to perform radical oncological surgeries. It is claimed a sub-specialty recognition, to ensure an equalitarian and homogeneous training.

Supervision and autonomy of ophthalmology residents in the outpatient Clinic in the United States: a survey of ACGME-accredited programs.

PubMed

Singman, Eric L; Srikumaran, Divya; Green, Laura; Tian, Jing; McDonnell, Peter

2017-06-26

The development and demonstration of incremental trainee autonomy is required by the ACGME. However, there is scant published research concerning autonomy of ophthalmology residents in the outpatient clinic setting. This study explored the landscape of resident ophthalmology outpatient clinics in the United States. A link to an online survey using the QualtricsTM platform was emailed to the program directors of all 115 ACGME-accredited ophthalmology programs in the United States. Survey questions explored whether resident training programs hosted a continuity clinic where residents would see their own patients, and if so, the degree of faculty supervision provided therein. Metrics such as size of the resident program, number of faculty and clinic setting were also recorded. Correlations between the degree of faculty supervision and other metrics were explored. The response rate was 94%; 69% of respondents indicated that their trainees hosted continuity clinics. Of those programs, 30% required a faculty member to see each patient treated by a resident, while 42% expected the faculty member to at least discuss (if not see) each patient. All programs expected some degree of faculty interaction based upon circumstances such as the level of training of the resident or complexity of the clinical situation. 67% of programs that tracked the contribution of the clinic to resident surgical caseloads reported that these clinics provided more than half of the resident surgical volumes. More ¾ of resident clinics were located in urban settings. The degree of faculty supervision did not correlate to any of the other metrics evaluated. The majority of ophthalmology resident training programs in the United States host a continuity clinic located in an urban environment where residents follow their own patients. Furthermore, most of these clinics require supervising faculty to review both the patients seen and the medical documentation created by the resident encounters. The

Interactions with industry under the Sunshine Act: an example from gynecologic oncology.

PubMed

Shalowitz, David I; Spillman, Monique A; Morgan, Mark A

2016-06-01

Clinicians may be unaware that industry payments to physicians are now publicly searchable under the Physician Payments Sunshine Act. Furthermore, the extent of industry's financial involvement in subspecialty practice has not been previously accessible. As an example, 6948 direct, research-unrelated payments totaling $1,957,004 were made to 765 gynecologic oncologists in 2014, the first full year of data available. A total of 153 companies reported at least 1 payment; however, the 10 manufacturers reporting the highest total payment amount accounted for 82% of all payments to physicians. In all, 48 gynecologic oncologists received >$10,000 from manufacturers, accounting for $1,202,228, or 61%, of total payments. Obstetrician-gynecologists, including gynecologic oncologists, should be aware of their publicly reported payments from industry and ensure reports' accuracy. Professional organizations, including the Society of Gynecologic Oncology (SGO), should strongly consider proactively developing guidelines regarding interactions with industry for their general memberships. Copyright © 2016 Elsevier Inc. All rights reserved.

Perioperative sexual interest in women with suspected gynecologic malignancies.

PubMed

Bretschneider, C E; Bensen, Jeannette T; Geller, Elizabeth J; Gehrig, Paola A; Wu, Jennifer M; Doll, Kemi M

2017-07-01

For women with gynecologic cancer, the impact of surgery on sexual interest and desire in the immediate and later postoperative period is not well characterized. The objective of this study was to report the perioperative trends of changing sexual interest and desire in a cohort of women undergoing surgery for suspected gynecologic malignancies. This is an ancillary analysis of a cohort study analyzing health-related outcomes in women who underwent primary surgical management of a suspected gynecologic malignancy between 10/2013 and 10/2014. Subjects completed the Patient-Reported Outcomes Measurement Information System Sexual Function and Satisfaction Questionnaire (PROMIS-SFQ) preoperatively and questions on sexual interest and desire at one, three, and six months postoperatively. Bivariate tests and multiple linear regression were used to analyze data. Of 231 women who completed a baseline PROMIS-SFQ, 187 (81%) completed one-month, 170 (74%) three-month, and 174 (75%) six-month follow-up interviews. Following surgery, 71% of enrolled subjects were diagnosed with a malignancy. Women age <55 had a greater decrease in sexual interest from baseline to one month than women age >55 (-5.5±1.0 vs -2.3±0.9, p=0.02). In a multivariable analysis, age <55 remained associated with a larger decrease in sexual interest at one month postoperatively (-4.6, 95% CI: -1.8, -7.4), as did having cancer vs benign disease for women of all ages (-5.6, 95% CI: -9.6, -1.5). This study provides new data regarding the timing and magnitude of changes in sexual interest following gynecologic oncology procedures. Copyright © 2017 Elsevier Inc. All rights reserved.

Possibilities of electrical impedance tomography in gynecology

NASA Astrophysics Data System (ADS)

V, Trokhanova O.; A, Chijova Y.; B, Okhapkin M.; V, Korjenevsky A.; S, Tuykin T.

2013-04-01

The paper describes results of comprehensive EIT diagnostics of mammary glands and cervix. The data were obtained from examinations of 170 patients by EIT system MEM (multi-frequency electrical impedance mammograph) and EIT system GIT (gynecological impedance tomograph). Mutual dependence is discussed.

Gynecological Surgery and Low Back Pain in Older Women

PubMed Central

Ericksen, Jeffery; Pidcoe, Peter E.; Ketchum-McKinney, Jessica M.; Burnet, Evie N.; Huang, Emily; Wilson, James C.; Hoogstad, Vincent

2010-01-01

Objective: To determine sacroiliac joint compliance characteristics and pelvic floor movements in older women relative to gynecological surgery history and back pain complaints. Design: Single-visit laboratory measurement. Setting: University clinical research center. Participants: Twenty-five women aged 65 years or older. Outcome Measures: Sacroiliac joint compliance measured by Doppler imaging of vibrations and ultrasound measures of pelvic floor motion during the active straight leg raise test. Results: Doppler imaging of vibrations demonstrated test reliability ranging from 0.701 to 0.898 for detecting vibration on the ilium and sacrum sides of the sacroiliac joint. The presence of low-back pain or prior gynecological surgery was not significantly associated with a difference in the compliance or laxity symmetry of the sacroiliac joints. No significant difference in pelvic floor movement was found during the active straight leg raise test between subject groups. All P values were ≥.4159. Conclusions: Prior gynecological surgery and low-back pain were not significantly associated with side-to-side differences in the compliance of the sacroiliac joints or in significant changes in pelvic floor movement during a loading maneuver in a group of older women. PMID:23569659

Gastrointestinal surgery in gynecologic oncology: evaluation of surgical techniques.

PubMed

Penalver, M; Averette, H; Sevin, B U; Lichtinger, M; Girtanner, R

1987-09-01

In recent years, the use of surgical staples has become popular in all subspecialties of surgery. The advantages proposed have been a decrease in operative time and morbidity. This paper reviews the University of Miami/Jackson Memorial Medical Center, Division of Gynecologic Oncology experience with the use of surgical staples in gastrointestinal surgery on patients with a diagnosis of a gynecologic malignancy. Between January 1, 1979 and July 1, 1985, a total of 152 procedures were done, 81 by stapler and 71 by suture anastomosis. Ninety-one patients had received previous radiation or chemotherapy. The average age of the patients was 52 years. The results show a decrease in operating time, blood loss, and postoperative hospital stay in those patients where the stapler anastomosis was used. The postoperative morbidity and mortality were not increased. Twenty-seven total pelvic exenterations were performed during the period of study and they were evaluated separately. The hospital stay and blood loss as well as the operative time were significantly less using staplers. This report includes a detailed evaluation of the results. From this study, we concluded that surgical staples are a safe alternative in gastrointestinal surgery in patients with a gynecologic malignancy.

Perceived gynecological morbidity among young ever-married women living in squatter settlements of Karachi, Pakistan.

PubMed

Sajan, F; Fikree, F F

1999-04-01

Community-based information on obstetric and gynecological morbidity in developing countries is meager and nearly non-existent in Pakistan. To estimate the prevalence of specific gynecological morbidities and investigate the predictors of pelvic inflammatory disease. Users [404] and non-users [313] of modern contraceptives were identified from eight squatter settlements of Karachi, Pakistan and detailed information on basic demographics, contraceptive use, female mobility, decision-making and gynecological morbidities were elicited. The perceived prevalence of menstrual disorders were 45.3%, uterine prolapse 19.1%, pelvic inflammatory disease 12.8% and urinary tract infection 5.4%. The magnitude of gynecological morbidity was high with about 55% of women reporting at least one gynecological morbidity though fewer [20%] reported at least two gynecological morbidities. Significant predictors of pelvic inflammatory disease were intrauterine contraceptive device users (OR = 3.1; 95% CI 1.7-5.6), age < or = 20 years (OR = 2.3; 95% CI 1.1-4.8) and urban life style (OR = 2.1; 95% CI 1.0-4.6). There is an immense burden of reproductive ill-health and a significant association between ever users of intrauterine contraceptive device and pelvic inflammatory disease. We therefore suggest improvement in the quality of reproductive health services generally, but specifically for family planning services.

Distinct Evening Fatigue Profiles in Oncology Outpatients Receiving Chemotherapy

PubMed Central

Wright, Fay; Cooper, Bruce A.; Conley, Yvette P.; Hammer, Marilyn J.; Chen, Lee-May; Paul, Steven M.; Levine, Jon D.; Miaskowski, Christine; Kober, Kord M.

2018-01-01

Background Fatigue is the most common and debilitating symptom experienced by oncology patients during chemotherapy (CTX). Fatigue severity demonstrates a large amount of inter-individual and diurnal variability. Purpose Study purposes were to evaluate for subgroups of patients with distinct evening fatigue profiles and evaluate how these subgroups differed on demographic, clinical, and symptom characteristics. Methods Outpatients with breast, gastrointestinal, gynecological, or lung cancer (n=1332) completed questionnaires six times over two cycles of CTX. Lee Fatigue Scale (LFS) evaluated evening fatigue severity. Latent profile analysis was used to identify distinct evening fatigue profiles. Results Four distinct evening fatigue classes (i.e., Low (14.0%), Moderate (17.2%), High (36.0%), Very High (32.8%)) were identified. Compared to the Low class, patients in the Very High evening fatigue class were: younger, female, had childcare responsibilities, had more years of education, had a lower functional status, had a higher comorbidity burden, and were diagnosed with breast cancer. Patients in the Very High class reported higher levels of depressive symptoms, sleep disturbance, and evening fatigue at enrollment. Conclusions Findings provide new insights into modifiable risk factors for higher levels of evening fatigue. Clinicians can use this information to identify higher risk patients and plan appropriate interventions. PMID:29725554

[Clinical competence evaluation in undergraduate gynecology and obstetrics].

PubMed

Larios Mendoza, Heriberto; Trejo Mejía, Juan Andrés; Gaviño Ambriz, Salvador; Cortés Gutiérrez, Ma Teresa

2002-11-01

Assess the clinical competence in Gynecology and obstetrics to the Internship students of the Faculty of Medicine, UNAM. The study design was descriptive, transverse type. We assessed 64 students, which had finished their gynecology field rotation with the objective structured clinical examination. The criteria to consider a competent performance level, was arbitrarily set up in 60%, both for individual problems and for the exam's global result. In 15 stations, the result was a 56.2 global average. The best performances were achieved in the following stations: take the pap smear (74.7), Pregnancy diagnostic (67.9), history of Gynecology and obstetrics (67.1), self examination of breast explanation (62.2) preclampsia (61.7) and cervicovaginitis (60). All the rest got a mark lower than 60. The results are lower than the ones obtained in written exams, because these cannot assess clinical skills. It could be observed that a student's performance in a clinical problem does not certainly predict his performance in other, so it seems to be determined more by the specific knowledge and the student's experience related to the case, than by a general problem-solving skill. The results show the advantages of this instrument to assess clinical skills, that justify its application in the formative process. This work evidences that its necessary to improve the acquisition of basic clinical skills trough systematic instructionals strategies and greater opportunities of learning.

Fatigue, pain, and functional status during outpatient chemotherapy.

PubMed

Siefert, Mary Lou

2010-03-01

To examine the relationship of fatigue and pain with functional status and the pattern of the two symptoms' occurrence over time in individuals with cancer who were receiving outpatient chemotherapy. The aims were to describe the levels of fatigue and pain with functional status and the inter-relationships with each other and with demographic and clinical variables over time. Descriptive, correlational. Outpatient chemotherapy clinic in the New England region of the United States. Total available population of 70 consecutive adult patients with breast cancer (n = 9), colorectal cancer (n = 21), lung cancer (n = 21), or lymphoma (n = 19). Retrospective data were extracted from the medical records; descriptive, correlational, and mixed-modeling methods were used to describe the sample and to examine the relationships of the symptoms and functional status. Fatigue, pain, functional status, and demographic and clinical factors. Fatigue was the most frequently reported symptom; pain was rarely and almost exclusively reported by patients with lung cancer or lymphoma during their early treatments. Fatigue and functional status impairment were highly associated with each other and had similar relationships with the other variables. The patterns and relationships of fatigue and functional status reported by this fairly healthy sample provide useful information to help guide early assessments and nursing interventions for people receiving outpatient chemotherapy. The patterns and severity of symptoms and functional status impairment in people with colorectal cancer or lymphoma warrant further investigation. Targeted exercise interventions for specific outpatient populations should be developed and tested to address specific patterns of symptoms and functional status impairment in individuals with cancer.

Outpatient presentations to burn centers: data from the Burns Registry of Australia and New Zealand outpatient pilot project.

PubMed

Gabbe, Belinda J; Watterson, Dina M; Singer, Yvonne; Darton, Anne

2015-05-01

Most studies about burn injury focus on admitted cases. To compare outpatient and inpatient presentations at burn centers in Australia to inform the establishment of a repository for outpatient burn injury. Data for sequential outpatient presentations were collected at seven burn centers in Australia between December 2010 and May 2011 and compared with inpatient admissions from these centers recorded by the Burns Registry of Australia and New Zealand for the corresponding period. There were 788 outpatient and 360 inpatient presentations. Pediatric outpatients included more children <3 years of age (64% vs 33%), scald (52% vs 35%) and contact burns (39% vs 24%). Adult outpatients included fewer males (58% vs 73%) and intentional injuries (3.3% vs 10%), and more scald (46% vs 30%) and contact burns (24% vs 13%). All pediatric, and 98% of adult, outpatient presentations involved a %TBSA<10. The pattern of outpatient presentations was consistent between centers. Outpatient presentations outnumbered inpatient admissions by 2.2:1. The pattern of outpatient burns presenting to burn centers differed to inpatient admission data, particularly with respect to etiology and burn severity, highlighting the importance of the need for outpatient data to enhance burn injury surveillance and inform prevention. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

Handling Sexuality Concerns in Women with Gynecological Cancer: Egyptian Nurse's Knowledge and Attitudes

ERIC Educational Resources Information Center

Mansour, Suzan E.; Mohamed, Hanan E.

2015-01-01

Sexuality is an important part of normal human functioning. Gynecological cancer diagnosis and treatment has devastating effect on Sexual issues. Study aim was to investigate Oncology Nurses knowledge and attitudes in Relation to Provision of Sexual Health Care to Women Diagnosed with Gynecological Cancer. The study setting was conducted at…

Safety considerations for outpatient electroconvulsive therapy.

PubMed

Reti, Irving M; Walker, Melinda; Pulia, Kathy; Gallegos, Jesus; Jayaram, Geetha; Vaidya, Punit

2012-03-01

As electroconvulsive therapy (ECT) requires general anesthesia and is associated with both cognitive and non-cognitive side effects, careful consideration must be given to the safety aspects of providing ECT on an outpatient basis. Drawing upon published literature and their clinical experience administering outpatient ECT, the authors propose best practices for safely providing ECT to outpatients. They review criteria for selecting patients for outpatient ECT as well as treatment and programmatic issues. The authors highlight the importance of educating referring clinicians as well as patients and their families about factors involved in the safe delivery of ECT for outpatients. Fiscal considerations and the drive toward reduced length of stay are prompting insurers and caregivers to choose outpatient over inpatient ECT. For each patient, such a choice merits a careful analysis of the risks of outpatient ECT, as well as the implementation of measures to ensure patient safety.

The roles of pathology in targeted therapy of women with gynecologic cancers.

PubMed

Murali, Rajmohan; Grisham, Rachel N; Soslow, Robert A

2018-01-01

The role of the pathologist in the multidisciplinary management of women with gynecologic cancer has evolved substantially over the past decade. Pathologists' evaluation of parameters such as pathologic stage, histologic subtype, grade and microsatellite instability, and their identification of patients at risk for Lynch syndrome have become essential components of diagnosis, prognostic assessment and determination of optimal treatment of affected women. Despite the use of multimodality treatment and combination cytotoxic chemotherapy, the prognosis of women with advanced-stage gynecologic cancer is often poor. Therefore, expanding the arsenal of available systemic therapies with targeted therapeutic agents is appealing. Anti-angiogenic therapies, immunotherapy and poly ADP ribose polymerase (PARP) inhibitors are now routinely used for the treatment of advanced gynecologic cancer, and many more are under investigation. Pathologists remain important in the clinical management of patients with targeted therapy, by identifying potentially targetable tumors on the basis of their pathologic phenotype, by assessing biomarkers that are predictive of response to targeted therapy (e.g. microsatellite instability, PD1/PDL1 expression), and by monitoring treatment response and resistance. Pathologists are also vital to research efforts exploring novel targeted therapies by identifying homogenous subsets of tumors for more reliable and meaningful analyses, and by confirming expression in tumor tissues of novel targets identified in genomic, epigenetic or other screening studies. In the era of precision gynecologic oncology, the roles of pathologists in the discovery, development and implementation of targeted therapeutic strategies remain as central as they are for traditional (surgery-chemotherapy-radiotherapy) management of women with gynecologic cancers. Copyright © 2017 Elsevier Inc. All rights reserved.

Diabetes mellitus and gynecologic cancer: molecular mechanisms, epidemiological, clinical and prognostic perspectives.

PubMed

Vrachnis, Nikolaos; Iavazzo, Christos; Iliodromiti, Zoe; Sifakis, Stavros; Alexandrou, Andreas; Siristatidis, Charalambos; Grigoriadis, Charalambos; Botsis, Dimitrios; Creatsas, George

2016-02-01

Diabetes mellitus, the prevalence of which has increased dramatically worldwide, may put patients at a higher risk of cancer. The aim of our study is the clarification of the possible mechanisms linking diabetes mellitus and gynecological cancer and their epidemiological relationship. This is a narrative review of the current literature, following a search on MEDLINE and the Cochrane Library, from their inception until January 2012. Articles investigating gynecologic cancer (endometrial, ovarian, and breast) incidence in diabetic patients were extracted. The strong evidence for a positive association between diabetes mellitus and the risk for cancer indicates that energy intake in excess to energy expenditure, or the sequelae thereof, is involved in gynecological carcinogenesis. This risk may be further heightened by glucose which can directly promote the production of tumor cells by functioning as a source of energy. Insulin resistance accompanied by secondary hyperinsulinemia is hypothezised to have a mitogenic effect. Steroid hormones are in addition potent regulators of the balance between cellular differentiation, proliferation, and apoptosis. Inflammatory pathways may also be implicated, as a correlation seems to exist between diabetes mellitus and breast or endometrial carcinoma pathogenesis, although an analogous correlation with ovarian carcinoma is still under investigation. Antidiabetic agents have been correlated with elevated cancer risk, while metformin seems to lower the risk. Diabetes mellitus is associated with an elevation in gynecologic cancer risk. Moreover, there are many studies exploring the prognosis of patients with diabetes and gynecological cancer, the outcome and the overall survival in well-regulated patients.

[The representations of adolescents about gynecological consultation].

PubMed

Gomes, Vera Lúcia de Oliveira; Fonseca, Adriana Dora da; Oliveira, Denize Cristina de; Silva, Camila Daiane; Acosta, Daniele Ferreira; Pereira, Fabiani Weiss

2014-06-01

To analyze the social representation of adolescents about gynecological consultation and the influence of those in searching for consultations. Qualitative descriptive study based on the Social Representations Theory, conducted with 50 adolescents in their last year of middle school. The data was collected between April and May of 2010 by Evocations and a Focal Group. The software EVOC and contextual analysis were used in the data treatment. The elements fear and constraint, constant in the central nucleus, can justify the low frequency of adolescents in consultations. The term embarrassment in the peripheral system reinforce current sociocultural norms, while prevention, associated with learning about sex and clarifying doubts, allows to envision an educative function. Obtained testimonies in the focal groups exemplify and reinforce those findings. For an effective health education, professionals, including nurses, need to clarify the youth individually and collectively about their rights to privacy, secrecy, in addition to focus the gynecological consultation as a promotion measure to sexual and reproductive health.

Tethered Cord Syndrome in the Pediatric-Adolescent Gynecologic Patient.

PubMed

Granada, Catalina; Loveless, Meredith; Justice, Tiffany; Moriarty, Thomas; Mutchnick, Ian; Dietrich, Jennifer E; LaJoie, A Scott; Hertweck, Paige

2015-10-01

To describe how pediatric and adolescent patients present to the gynecologist when they have tethered cord syndrome (TCS). We conducted a retrospective chart review on all patients suspected by the gynecologist of having TCS. Single pediatric and adolescent gynecology clinic in a mid-sized city in the midwest. Thirty-two patients, first seen between 2005 and 2012, suspected of having TCS and for whom follow-up information was available. Patient characteristics, including patient history, gynecologic clinical indicators, clinical outcomes, indications for surgery, and postoperative resolution of symptoms, were reviewed. The initial review of systems indicated stress urinary incontinence, back pain, and constipation as common markers in the 32 patients who were suspected of having TCS. All 32 patients underwent lumbar magnetic resonance imaging without contrast and evaluation by neurosurgery. Of the 32 patients with suspected TCS, 18 were later confirmed and 14 were shown to not have TCS. Of the 18 patients with sufficient information to justify a detethering procedure, 14 patients were followed and 93% (13 patients) had complete resolution of symptoms. Final diagnosis in the non-TCS group varied, including vulvovaginitis, enuresis, chronic constipation, and lichen sclerosis. Symptoms improved with the treatment of each primary condition. TCS symptoms overlap with gynecologic conditions; therefore, patients with TCS may present initially to the gynecologist. In pediatric/adolescent patients, TCS should be considered when stress urinary incontinence, back pain, and constipation are discovered in the review of systems. Because possible irreversible ischemic and neurologic changes are believed to be involved, early diagnosis and surgery are crucial for resolution. Providers should be aware of TCS in these pediatric and adolescent settings, because quick assessment may result in complete resolution of a chronic progressive disease. Copyright © 2015 North American

Port-site metastases following robot-assisted laparoscopic surgery for gynecological malignancies.

PubMed

Lönnerfors, Celine; Bossmar, Thomas; Persson, Jan

2013-12-01

To evaluate the incidence and possible predictors associated with port-site metastases following robotic surgery. Prospective study. University Hospital. Women with gynecological cancer. The occurrence of port-site metastases in the first 475 women undergoing robotic surgery for gynecological cancer was reviewed. Rate of port-site metastases. A port-site metastasis was detected in nine of 475 women (1.9%). Eight women had either an unexpected locally advanced disease or lymph-node metastases at the time of surgery. All nine women received postoperative adjuvant therapy. Women with ≥ stage III endometrial cancer and women with node positive cervical cancer had a significantly higher risk of developing a port-site metastasis, as did women with high-risk histology endometrial cancer. Port-site metastases were four times more likely to occur in a specimen-retrieval port. One (0.2%) isolated port-site metastasis was detected. The median time to occurrence of a port-site metastasis was 6 months (range 2-19 months). Six of the nine women (67%) have died and their median time of survival from recurrence was 4 months (range 2-16 months). In women with gynecological cancer, the incidence of port-site metastases following robotic surgery was 1.9%. High-risk histology and/or advanced stage of disease at surgery seem to be contributing factors. © 2013 Nordic Federation of Societies of Obstetrics and Gynecology.

[Noninvasive total hemoglobin monitoring based on multiwave spectrophotometry in obstetrics and gynecology].

PubMed

Pyregov, A V; Ovechkin, A Iu; Petrov, S V

2012-01-01

Results of prospective randomized comparative research of 2 total hemoglobin estimation methods are presented. There were laboratory tests and continuous noninvasive technique with multiwave spectrophotometry on the Masimo Rainbow SET. Research was carried out in two stages. At the 1st stage (gynecology)--67 patients were included and in second stage (obstetrics)--44 patients during and after Cesarean section. The standard deviation of noninvasive total hemoglobin estimation from absolute values (invasive) was 7.2 and 4.1%, an standard deviation in a sample--5.2 and 2.7 % in gynecologic operations and surgical delivery respectively, that confirms lack of reliable indicators differences. The method of continuous noninvasive total hemoglobin estimation with multiwave spectrophotometry on the Masimo Rainbow SET technology can be recommended for use in obstetrics and gynecology.

EM-navigated catheter placement for gynecologic brachytherapy: an accuracy study

NASA Astrophysics Data System (ADS)

Mehrtash, Alireza; Damato, Antonio; Pernelle, Guillaume; Barber, Lauren; Farhat, Nabgha; Viswanathan, Akila; Cormack, Robert; Kapur, Tina

2014-03-01

Gynecologic malignancies, including cervical, endometrial, ovarian, vaginal and vulvar cancers, cause significant mortality in women worldwide. The standard care for many primary and recurrent gynecologic cancers consists of chemoradiation followed by brachytherapy. In high dose rate (HDR) brachytherapy, intracavitary applicators and /or interstitial needles are placed directly inside the cancerous tissue so as to provide catheters to deliver high doses of radiation. Although technology for the navigation of catheters and needles is well developed for procedures such as prostate biopsy, brain biopsy, and cardiac ablation, it is notably lacking for gynecologic HDR brachytherapy. Using a benchtop study that closely mimics the clinical interstitial gynecologic brachytherapy procedure, we developed a method for evaluating the accuracy of image-guided catheter placement. Future bedside translation of this technology offers the potential benefit of maximizing tumor coverage during catheter placement while avoiding damage to the adjacent organs, for example bladder, rectum and bowel. In the study, two independent experiments were performed on a phantom model to evaluate the targeting accuracy of an electromagnetic (EM) tracking system. The procedure was carried out using a laptop computer (2.1GHz Intel Core i7 computer, 8GB RAM, Windows 7 64-bit), an EM Aurora tracking system with a 1.3mm diameter 6 DOF sensor, and 6F (2 mm) brachytherapy catheters inserted through a Syed-Neblett applicator. The 3D Slicer and PLUS open source software were used to develop the system. The mean of the targeting error was less than 2.9mm, which is comparable to the targeting errors in commercial clinical navigation systems.

Gamma Knife Surgery for Metastatic Brain Tumors from Gynecologic Cancer.

PubMed

Matsunaga, Shigeo; Shuto, Takashi; Sato, Mitsuru

2016-05-01

The incidences of metastatic brain tumors from gynecologic cancer have increased. The results of Gamma Knife surgery (GKS) for the treatment of patients with brain metastases from gynecologic cancer (ovarian, endometrial, and uterine cervical cancers) were retrospectively analyzed to identify the efficacy and prognostic factors for local tumor control and survival. The medical records were retrospectively reviewed of 70 patients with 306 tumors who underwent GKS for brain metastases from gynecologic cancer between January 1995 and December 2013 in our institution. The primary cancers were ovarian in 33 patients with 147 tumors and uterine in 37 patients with 159 tumors. Median tumor volume was 0.3 cm(3). Median marginal prescription dose was 20 Gy. The local tumor control rates were 96.4% at 6 months and 89.9% at 1 year. There was no statistically significant difference between ovarian and uterine cancers. Higher prescription dose and smaller tumor volume were significantly correlated with local tumor control. Median overall survival time was 8 months. Primary ovarian cancer, controlled extracranial metastases, and solitary brain metastasis were significantly correlated with satisfactory overall survival. Median activities of daily living (ADL) preservation survival time was 8 months. Primary ovarian cancer, controlled extracranial metastases, and higher Karnofsky Performance Status score were significantly correlated with better ADL preservation. GKS is effective for control of tumor progression in patients with brain metastases from gynecologic cancer, and may provide neurologic benefits and preservation of the quality of life. Copyright © 2016 Elsevier Inc. All rights reserved.

Survival of gynecological cancers in Turkey: where are we at?

PubMed

Gultekin, Murat; Dundar, Selin; Kucukyildiz, Irem; Karaca, Mujdegul Zayifoglu; Boztas, Guledal; Turan, Semra Hatice; Hacikamiloglu, Ezgi; Keskinkilic, Bekir

2017-11-01

To investigate the 5-year relative survival rates in gynecological cancers diagnosed and treated in Turkey by year 2009 and to compare the results with developed countries. Data of patients diagnosed for ovarian, corpus uteri or cervix uteri cancer at year 2009 are collected from 9 national cancer registry centers. Date of deaths are retracted from governmental Identity Information Sharing System (KPS). In order to calculate relative survival rates, national general population mortality tables are obtained from Turkish Statistical Institute (TurkStat). Hakulinen method is used for computing curves by R program. Data for European, Asian and some developed countries were obtained from official web pages. A total of 1,553 patients are evaluated. Among these, 713 (45.9%) are corpus uteri cancers, while remaining 489 (31.5%) are ovarian and 351 (22.6%) are cervix uteri. Five-year overall relative survival rates are 85%, 50%, and 62% for corpus uteri, ovarian, and cervix uteri, respectively. These figures are between 73%-87% for corpus uteri, 31%-62% for ovarian and 61%-80% for cervix uteri in developed countries. Stage is the most important factor for survival in all cancers. Five-year relative survival rates in corpus uteri cancers are 92%, 66%, and 38% for localized, regional, and distant metastatic disease, respectively. These figures are 77%, 57%, and 29% for ovarian; 80%, 50%, and 22% for cervix uteri. This is the first report from Turkey giving national overall relative survival for gynecological cancers from a population based cancer registry system. Copyright © 2017. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology

Gynecologic symptoms and sexual function in female kidney allograft recipients.

PubMed

Karayalcin, R; Genc, V; Oztuna, D; Huseynova, N; Ersoz, S

2010-09-01

There is little information in the literature about changing menstrual patterns, sexuality, and fertility after kidney transplantation. The purpose of this study was to describe gynecologic symptoms, menstrual characteristics, sexual functions, details of pregnancies and gynecologic care before and after women underwent renal transplantation. A detailed Turkish questionnaire was prepared for gynecologic evaluation. Fifty women of reproductive age who underwent renal transplantation took part in this study. The questionnaires were filled out at the time of the postoperative follow-up. The mean age and body mass index of all study participants at the time of interview was 33.9 years (range, 18-52) and 23.5 kg/m(2) (range, 16.5-33.3), respectively. There were no differences between bleeding between periods, heavy period, painful period, and period duration before and after transplantation. Eight women left active working life after grafting on their own accord. Thirteen women ceased sexual activity after transplantation. None of the women reported pregnancy after grafting. A total of 98% of women reported that they were never instructed about regular gynecologic care. We found that restrictions in the lives of women with transplanted kidneys included ceasing sexual activity and leaving active working life and that these were due to fear of possible organ damage. Women with transplanted kidneys must be informed about posttransplant sex life and the requirement for regular examinations by a gynecologist. Hence, close collaborations should be formed between patients, primary care physicians, and gynecologists. 2010 Elsevier Inc. All rights reserved.

Payment methods for outpatient care facilities

PubMed Central

Yuan, Beibei; He, Li; Meng, Qingyue; Jia, Liying

2017-01-01

trials, non-randomised trials, controlled before-after studies, interrupted time series, and repeated measures studies that compared different payment methods for outpatient health facilities. We defined outpatient care facilities in this review as facilities that provide health services to individuals who do not require hospitalisation or institutionalisation. We only included methods used to transfer funds from the purchaser of healthcare services to health facilities (including groups of individual professionals). These include global budgets, line-item budgets, capitation, fee-for-service (fixed and unconstrained), pay for performance, and mixed payment. The primary outcomes were service provision outcomes, patient outcomes, healthcare provider outcomes, costs for providers, and any adverse effects. Data collection and analysis At least two review authors independently extracted data and assessed the risk of bias. We conducted a structured synthesis. We first categorised the comparisons and outcomes and then described the effects of different types of payment methods on different categories of outcomes. We used a fixed-effect model for meta-analysis within a study if a study included more than one indicator in the same category of outcomes. We used a random-effects model for meta-analysis across studies. If the data for meta-analysis were not available in some studies, we calculated the median and interquartile range. We reported the risk ratio (RR) for dichotomous outcomes and the relative change for continuous outcomes. Main results We included 21 studies from Afghanistan, Burundi, China, Democratic Republic of Congo, Rwanda, Tanzania, the United Kingdom, and the United States of health facilities providing primary health care and mental health care. There were three kinds of payment comparisons. 1) Pay for performance (P4P) combined with some existing payment method (capitation or different kinds of input-based payment) compared to the existing payment method We

Identification of iPhone and iPad applications for obstetrics and gynecology providers.

PubMed

Farag, Sara; Chyjek, Kathy; Chen, Katherine T

2014-11-01

To systematically identify the number of applications ("apps") compatible with the iPhone and the iPad that are potentially useful to obstetrician-gynecologists (ob-gyns). Obstetrics and gynecology MeSH terms were searched in the Apple iTunes Store. A master list of unique apps was created and the apps were divided into categories and subcategories. A total of 1,816 unique apps using 55 different obstetrics and gynecology MeSH terms were found. Of these unique apps, 242 apps (13.3%) were considered potentially useful to ob-gyns. The MeSH terms that yielded the highest number of potentially useful apps were "gynecology" (23%), "breast cancer" (17%), "obstetrics" (14%), and "pregnancy" (12%). Less than 15% of apps found were considered potentially useful to ob-gyns. Thus, the obstetrics and gynecology community is in need of an organized effort to identify, review, and determine the accuracy of apps that can potentially improve the performance of health care providers and lead to better patient outcomes. We propose the formation of a committee to guide in this important task.

Clinical outcomes research in gynecologic oncology.

PubMed

Melamed, Alexander; Rauh-Hain, J Alejandro; Schorge, John O

2017-09-01

Clinical outcomes research seeks to understand the real-world manifestations of clinical care. In particular, outcomes research seeks to reveal the effects of pharmaceutical, procedural, and structural aspects of healthcare on patient outcomes, including mortality, disease control, toxicity, cost, and quality of life. Although outcomes research can utilize interventional study designs, insightful use of observational data is a defining feature of this field. Many questions in gynecologic oncology are not amenable to investigation in randomized clinical trials due to cost, feasibility, or ethical concerns. When a randomized trial is not practical or has not yet been conducted, well-designed observational studies have the potential to provide the best available evidence about the effects of clinical care. Such studies may use surveys, medical records, disease registries, and a variety of administrative data sources. Even when a randomized trial has been conducted, observational studies can be used to estimate the real-world effect of an intervention, which may differ from the results obtained in the controlled setting of a clinical trial. This article reviews the goals, methodologies, data sources, and limitations of clinical outcomes research, with a focus on gynecologic oncology. Copyright © 2017. Published by Elsevier Inc.

Maintaining Sexual Health throughout Gynecologic Cancer Survivorship: A Comprehensive Review and Clinical Guide

PubMed Central

Huffman, Laura B.; Hartenbach, Ellen M.; Carter, Jeanne; Rash, Joanne K.; Kushner, David M.

2016-01-01

Objective The diagnosis and treatment of gynecologic cancer can cause short- and long-term negative effects on sexual health and quality of life (QoL). The aim of this article is to present a comprehensive overview of the sexual health concerns of gynecologic cancer survivors and discuss evidence-based treatment options for commonly encountered sexual health issues. Methods A comprehensive literature search of English language studies on sexual health in gynecologic cancer survivors and the treatment of sexual dysfunction was conducted in MEDLINE databases. Relevant data are presented in this review. Additionally, personal and institutional practices are incorporated where relevant. Results Sexual dysfunction is prevalent among gynecologic cancer survivors as a result of surgery, radiation, and chemotherapy--negatively impacting QoL. Many patients expect their healthcare providers to address sexual health concerns, but most have never discussed sex-related issues with their physician. Lubricants, moisturizers, and dilators are effective, simple, non-hormonal interventions that can alleviate the morbidity of vaginal atrophy, stenosis, and pain. Pelvic floor physical therapy can be an additional tool to address dyspareunia. Cognitive behavioral therapy has been shown to be beneficial to patients reporting problems with sexual interest, arousal, and orgasm. Conclusion Oncology providers can make a significant impact on the QoL of gynecologic cancer survivors by addressing sexual health concerns. Simple strategies can be implemented into clinical practice to discuss and treat many sexual issues. Referral to specialized sexual health providers may be needed to address more complex problems. PMID:26556768

The Checklist of Unit Behaviours (CUB): Validation within a Canadian outpatient day hospital programme.

PubMed

Taube-Schiff, M; El Morr, C; Counsell, A; Mehak, Adrienne; Gollan, J

2018-05-01

WHAT IS KNOWN ON THE SUBJECT?: The psychometrics of the CUB measure have been tested within an inpatient psychiatric setting. Results show that the CUB has two factors that reflect patients' approach and avoidance of dimensions of the treatment milieu, and that an increase of approach and decrease of avoidance are correlated with discharge. No empirical research has examined the validity of the CUB in a day hospital programme. WHAT THIS ARTICLE ADDS TO EXISTING KNOWLEDGE?: This study was the first to address the validity of this questionnaire within a psychiatric day hospital setting. This now allows other mental health service providers to use this questionnaire following administration of patient engagement interventions (such as behavioural activation), which are routinely used within this type of a setting. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Our results can enable healthcare providers to employ an effective and psychometrically validated tool in a day hospital setting to measure treatment outcomes and provide reflections of patients' approach behaviours and avoidance behaviours. Introduction We evaluated the Checklist of Unit Behaviours (CUBs) questionnaire in a novel mental health setting: a day hospital within a large acute care general hospital. No empirical evidence exists, as of yet, to look at the validity of this measure in this type of a treatment setting. The CUB measures two factors, avoidance or approach, of the patients' engagement with the treatment milieu within the previous 24 hr. Aim A confirmatory factor analysis (CFA) was conducted to validate the CUB's original two factor structure in an outpatient day programme. Methods Psychiatric outpatients (n = 163) completed the CUB daily while participating in a day hospital programme in Toronto, Canada. Results A CFA was used to confirm the CUB factors but resulted in a poor fitting model for our sample, χ 2 (103) = 278.59, p < .001, CFI = 0.80, RMSEA = 0.10, SRMR = 0.10. Questions

Transarterial embolization for the treatment of massive bleeding in gynecologic and obstetric emergencies: a single center experience.

PubMed

Hongsakul, Keerati; Songjamrat, Apiradee; Rookkapan, Sorracha

2014-08-01

Delayed treatment of the massive bleeding in gynecologic and obstetric conditions can cause high morbidity and mortality. The aim of this study is to assess the angiographic findings and outcomes of transarterial embolization in cases of massive hemorrhage from underlying gynecological and obstetrical conditions. This is a retrospective study of 18 consecutive patients who underwent transarterial embolization of uterine and/or hypogastric arteries due to massive bleeding from gynecological and obstetrical causes from January 2006 to December 2011. The underlying causes of bleeding, angiographic findings, technical success rates, clinical success rates, and complications were evaluated. Massive gynecological and obstetrical bleeding occurred in 12 cases and 6 cases, respectively. Gestational trophoblastic disease was the most common cause of gynecological bleeding. The most common cause of obstetrical hemorrhage was primary post-partum hemorrhage. Tumor stain was the most frequent angiographic finding (11 cases) in the gynecological bleeding group. The most common angiographic findings in obstetrical patients were extravasation (2 cases) and pseudoaneurysm (2 cases). Technical and final clinical success rates were found in all 18 cases and 16 cases. Collateral arterial supply, severe metritis, and unidentified cervical laceration were causes of uncontrolled bleeding. Only minor complications occurred, which included pelvic pain and groin hematoma. Percutaneous transarterial embolization is a highly effective and safe treatment to control massive bleeding in gynecologic and obstetric emergencies.

Traveling through the cancer trajectory: social support perceived by women with gynecologic cancer in Hong Kong.

PubMed

Chan, C W; Molassiotis, A; Yam, B M; Chan, S J; Lam, C S

2001-10-01

A qualitative research design was selected to gather data on the experiences of social support for Chinese women with gynecologic cancer. Eighteen women were recruited and interviewed at an oncology unit of a teaching hospital in Hong Kong. Content analysis of the interview data showed Chinese women with gynecologic cancer placed enormous emphasis on their human relationships. Family members were especially significant to them although not all identified their family relations as satisfactory or helpful. Their social network comprised 4 major sources, including family and friends, work and colleagues, health professionals, and religion and spiritual beliefs. Each network offered significant reciprocal relations, authoritative relations, or entrusting relations. The positive appraisal of the support function was linked to the Chinese value of food, work ethics, the Confucian and religious philosophy, whereas negative aspects of support, such as the stress of maintaining relationships and inadequate information, conjoined with the Chinese suppression of emotion and the busyness of health professionals. Future studies, including social relations as a determinant, should ensure a broad and multifunctional view of social support and acknowledge the cultural influences on the perspective of support.

[A cross-sectional survey of the prevalence of depressive-anxiety disorders among general hospital outpatients in five cities in China].

PubMed

He, Yan-ling; Ma, Hong; Zhang, Lan; Liu, Zhe-ning; Jia, Fu-jun; Zhang, Ming-yuan

2009-09-01

To find the prevalence of depressive and anxiety disorders among general hospital outpatients and to evaluate the diagnoses and treatment provided by physicians in China. A multi-center, hospital-based cross-sectional study was conducted. A total of 8478 subjects were screened by using HADS and PHQ-15 together with medical history review list and were followed by regular clinical visit process. Physician's diagnoses and management were recorded. Mini International Neuropsychiatric Interview (MINI) was used to evaluate by psychiatrists afterwards for 4172 subjects scored >or= 8 on HADS. The adjusted prevalence rates of MINI-diagnosed depressive disorder, anxiety disorder, depression and anxiety, depression or anxiety disorders were 12.0%, 8.6%, 4.1% and 16.5%, respectively. The prevalence of depressive and/or anxiety disorder in outpatients visiting department of neurology and digestive diseases were higher than that in patients visiting departments of cardiovascular diseases and gynecology with statistical significance (P < 0.0001). High prevalence and low identification and treatment rate of depressive and/or anxiety disorders were found in the general hospitals. In order to improve the status quo, training program for physicians and specialists other than psychiatric professionals in general hospitals should be enhanced together with psychiatric consultation.

Building capacity in VA to provide emergency gynecology services for women.

PubMed

Cordasco, Kristina M; Huynh, Alexis K; Zephyrin, Laurie; Hamilton, Alison B; Lau-Herzberg, Amy E; Kessler, Chad S; Yano, Elizabeth M

2015-04-01

Visits to Veterans Administration (VA) emergency departments (EDs) are increasingly being made by women. A 2011 national inventory of VA emergency services for women revealed that many EDs have gaps in their resources and processes for gynecologic emergency care. To guide VA in addressing these gaps, we sought to understand factors acting as facilitators and/or barriers to improving VA ED capacity for, and quality of, emergency gynecology care. Semistructured interviews with VA emergency and women's health key informants. ED directors/providers (n=14), ED nurse managers (n=13), and Women Veteran Program Managers (n=13) in 13 VA facilities. Leadership, staff, space, demand, funding, policies, and community were noted as important factors influencing VA EDs building capacity and improving emergency gynecologic care for women Veterans. These factors are intertwined and cross multiple organizational levels so that each ED's capacity is a reflection not only of its own factors, but also those of its local medical center and non-VA community context as well as VA regional and national trends and policies. Policies and quality improvement initiatives aimed at building VA's emergency gynecologic services for women need to be multifactorial and aimed at multiple organizational levels. Policies need to be flexible to account for wide variations across EDs and their medical center and community contexts. Approaches that build and encourage local leadership engagement, such as evidence-based quality improvement methodology, are likely to be most effective.

Fundamentals of Laparoscopic Surgery: A Surgical Skills Assessment Tool in Gynecology

PubMed Central

Arden, Deborah; Dodge, Laura E.; Zheng, Bin; Ricciotti, Hope A.

2011-01-01

Objective: To describe our experience with the Fundamentals of Laparoscopic Surgery (FLS) program as a teaching and assessment tool for basic laparoscopic competency among gynecology residents. Methods: A prospective observational study was conducted at a single academic institution. Before the FLS program was introduced, baseline FLS testing was offered to residents and gynecology division directors. Test scores were analyzed by training level and self-reported surgical experience. After implementing a minimally invasive gynecologic surgical curriculum, third-year residents were retested. Results: The pass rates for baseline FLS skills testing were 0% for first-year residents, 50% for second-year residents, and 75% for third- and fourth-year residents. The pass rates for baseline cognitive testing were 60% for first- and second-year residents, 67% for third-year residents, and 40% for fourth-year residents. When comparing junior and senior residents, there was a significant difference in pass rates for the skills test (P=.007) but not the cognitive test (P=.068). Self-reported surgical experience strongly correlated with skills scores (r-value=0.97, P=.0048), but not cognitive scores (r-value=0.20, P=.6265). After implementing a curriculum, 100% of the third-year residents passed the skills test, and 92% passed the cognitive examination. Conclusions: The FLS skills test may be a valuable assessment tool for gynecology residents. The cognitive test may need further adaptation for applicability to gynecologists. PMID:21902937

[Gender stereotypes in gynecology and obstetrics: obstacles for young male physicians?].

PubMed

Buddeberg-Fischer, Barbara

2003-10-01

Up to the mid 1990s, a 'feminization' of medicine took place that was especially pronounced in the field of gynecology. The present paper looks into the reasons for this change based on the literature and results from a study conducted by the author. In 2001, two thirds of the new qualifications in gynecology/obstetrics were awarded to women. The feminist movement has led to the emancipation of women and the assertion that women should be treated by female doctors only. Parallel to this development, gender roles also underwent a change: nowadays, the ideal woman or man is 'androgynous'. Young physicians are both highly instrumental and highly expressive. The increasing similarities between the sexes exert an influence on lifestyle and biographical planning. An increasing number of young physicians no longer prioritize their profession. Male physicians with high expressiveness are often family oriented and consciously refrain from choosing to specialize in gynecology/obstetrics because of the long hours and heavy workload. On the other hand, quite a few women physicians are more instrumental and prioritize their professional commitment. If more male physicians are not attracted into gynecology/obstetrics over the next few years, a process of 'horizontal segregation' could occur, with women physicians accomplishing the patient-focused work while their male colleagues take over the surgery and scientific part of the specialty. It is the very differences between the sexes, however, and the exchange between them, which allow a medical discipline to thrive.

42 CFR 493.945 - Cytology; gynecologic examinations.

Code of Federal Regulations, 2010 CFR

2010-10-01

... dysplasia/CIN-2 and severe dysplasia/carcinoma in-situ/CIN-3. (2) Squamous cell carcinoma. (3... gynecologic examinations (Pap smears) in cytology, a program must provide test sets composed of 10- and 20..., provided the slides have been retained by the laboratory for the required period specified in §§ 493.1105(a...

[Rare or little known syndromes in gynecology and obstetrics].

PubMed

Dumont, M

1986-04-01

The author presents fourty-three years' experience of rare syndromes or those which he considers are poorly understood in the area of gynecologic obstetrics. He briefly reviews: spontaneous post-cesarian perforation of the cecum, post-partum paralysis of the external popliteal sciatic, carpal canal syndrome in pregnacy, meralgia paresthetica in pregnant women, diaphragmatic hernia and its complications during pregnancy and labor, post-mortem cesarian, the "molar lung", early pregnancy and late pregnancy, fulguration and electroshock in pregnant women, the "acrobatic fetus", the rupture of an aneurysm of the splenic artery, geophagia or "pica", extramucous ruptures of the uterus, "virtually pure" type XX familial gonadic dysgenesis with deaf-muteness, gynecologic pathomimesis, genital perihepatitis or Fitz-Hugh-Curtis syndrome, vulvar mammary ectopism, post-hysterectomic pregnancy, recurrent hydramnios, locoregional ecchymatosis.

Virtual reality robotic surgical simulation: an analysis of gynecology trainees.

PubMed

Sheth, Sangini S; Fader, Amanda N; Tergas, Ana I; Kushnir, Christina L; Green, Isabel C

2014-01-01

To analyze the learning curves of gynecology trainees on several virtual reality da Vinci Skills Simulator exercises. Prospective cohort pilot study. Academic hospital-based gynecology training program. Novice robotic surgeons from a gynecology training program. Novice robotic surgeons from an academic gynecology training program completed 10 repetitions of 4 exercises on the da Vinci Skills Simulator: matchboard, ring and rail, suture sponge, and energy switching. Performance metrics measured included time to completion, economy of instrument movement, excessive force, collisions, master workspace range, missed targets, misapplied energy, critical errors, and overall score. Statistical analyses were conducted to define the learning curve for trainees and the optimal number of repetitions for each exercise. A total of 34 participants were enrolled, of which 9 were medical students, 22 were residents, and 3 were fellows. There was a significant improvement in performance between the 1st and 10th repetitions across multiple metrics for all exercises. Senior trainees performed the suture exercise significantly faster than the junior trainees during the first and last repetitions (p = 0.004 and p = 0.003, respectively). However, the performance gap between seniors and juniors narrowed significantly by the 10th repetition. The mean number of repetitions required to achieve performance plateau ranged from 6.4 to 9.3. Virtual reality robotic simulation improves ability through repetition at all levels of training. Further, a performance plateau may exist during a single training session. Larger studies are needed to further define the most high-yield simulator exercises, the ideal number of repetitions, and recommended intervals between training sessions to improve operative performance. Copyright © 2014 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Unverifiable Accomplishments and Publications on Applications for Gynecologic Oncology Fellowships

PubMed Central

Frumovitz, Michael; Kriseman, Maya L.; Sun, Charlotte C.; Blumenthal-Barby, Jennifer; Sood, Anil K.; Bodurka, Diane C.; Soliman, Pamela T.

2013-01-01

Objective Selection of physicians for fellowships in obstetrics and gynecology subspecialties has become increasingly competitive. The number and quality of research publications is an important factor in the selection process. We sought to estimate the incidence of unverifiable (“ghost”) publications among gynecologic oncology fellowship applicants. Methods We reviewed the applications to a single gynecologic oncology fellowship program during 2004–2008. Articles and book chapters reported as published, “in press”, “submitted”, or “in progress” were systematically searched for by three reviewers using PubMed and Google. Chi-square analysis was used to evaluate associations between demographic factors and unverifiable publications. Results Two hundred forty-three applications met the inclusion criteria. Of the 35 applicants who listed membership in Alpha Omega Alpha, 4 (11%) were not listed on the organization’s website as inductees. Of the 464 articles reported as published or “in press”, only 387 (83%) could be verified. Of the 148 applicants who reported at least 1 published/“in press” article, 44 (30%) had at least 1 unverifiable publication. On multivariable analysis, only male gender increased the likelihood of unverifiable publications (OR 2.1, 95% CI 1.1–4.1). Of the 282 manuscripts reported as “submitted” or “in progress”, only 126 (44%) were published. Of the 124 applicants who reported at least 1 “submitted”/“in progress” manuscript, 88 (71%) had at least 1 unverifiable manuscript. Conclusion The proportion of unverifiable publications listed on gynecologic oncology fellowship applications is concerning. Stringent review of applications before interview invitations and match list submission is warranted. PMID:22353948

[Clinical analysis of 23 gynecologic carcinoma patients with brain metastasis].

PubMed

Zhang, J X; Wang, S Z; Li, B; Zhang, Z Y

2016-06-21

To explore the clinicopathological characteristics and treatments of brain metastasis (BM) in patients with gynecologic carcinoma. Twenty-three pathologically confirmed patients with gynecologic carcinoma who had brain metastasis between February 2008 and October 2012 were analyzed retrospectively. The primary carcinoma was cervical cancer in 5 patients, endometrial carcinoma in 8 patients and ovarian cancer in 10 patients, which accounted for 1.81% (5/276), 2.10% (8/380) and 2.67% (10/374) of patient with the same diagnosis of the same period, respectively.Among them, 91.3% (21/23) patients had heterochronous BM.Single BM was documented in 52.2% (12/23) patients.Besides, 78.2% (18/23) BM located in cerebrum.At the time of BM, 91.3% (21/23) patients had symptoms of central nervous system, in which headache ranked the top (90.4%). Altogether, thirteen patients had extracranial metastasis, in which 9 of them had metastasis of the lung.The median post-brain-metastasis survival (mPBMS) for the recursive partitioning analysis (RPA) classes Ⅰ-Ⅲ was 54 months, 9 months and 1 month, respectively (P<0.01). None of surgery, radiotherapy or chemotherapy treatment was proven to have prognosis-improving ability either in single variant or multivariate analysis.However, in patients with extracranial metastasis, chemotherapy could significantly improve their mPBMS (P<0.05). The incidence of brain metastasis in patients with cervical cancer, endometrial carcinoma, and ovarian cancer increased gradually.RPA was valuable for a prognostic assessment in gynecologic carcinoma patients with BM.Chemotherapy could significantly improve prognosis of gynecologic carcinoma patients with BM if extracranial metastasis was presented.

The impact of surgical complications on health-related quality of life in women undergoing gynecologic and gynecologic oncology procedures: a prospective longitudinal cohort study.

PubMed

Doll, Kemi M; Barber, Emma L; Bensen, Jeannette T; Revilla, Matthew C; Snavely, Anna C; Bennett, Antonia V; Reeve, Bryce B; Gehrig, Paola A

2016-10-01

There are currently no assessments of the impact of surgical complications on health-related quality of life in gynecology and gynecologic oncology. This is despite complications being a central focus of surgical outcome measurement, and an increasing awareness of the need for patient-reported data when measuring surgical quality. We sought to measure the impact of surgical complications on health-related quality of life at 1 month postoperatively, in women undergoing gynecologic and gynecologic oncology procedures. This is a prospective cohort study of women undergoing surgery by gynecologic oncologists at a tertiary care academic center from October 2013 through October 2014. Patients were enrolled preoperatively and interviewed at baseline and 1, 3, and 6 months postoperatively. Health-related quality of life measures included validated general and disease-specific instruments, measuring multiple aspects of health-related quality of life, including anxiety and depression. The medical record was abstracted for clinical data and surgical complications were graded using validated Clavien-Dindo criteria, and women grouped into those with and without postoperative complications. Bivariate statistics, analysis of covariance, responder analysis, and multivariate modeling was used to analyze the relationship of postoperative complications to change health-related quality of life from baseline to 1 month. Plots of mean scores and change over time were constructed. Of 281 women enrolled, response rates were 80% (n = 231/281) at baseline, and from that cohort, 81% (n = 187/231), 74% (n = 170/231), and 75% (n = 174/231) at 1, 3, and 6 months, respectively. The primary analytic cohort comprised 185 women with completed baseline and 1-month interviews, and abstracted clinical data. Uterine (n = 84, 45%), ovarian (n = 23, 12%), cervical (n = 17, 9%), vulvar (n = 3, 2%), and other (n = 4, 2%) cancers were represented, along with 53 (30%) cases of benign disease. There

Women in leadership positions within obstetrics and gynecology: does the past explain the present?

PubMed

Baecher-Lind, Laura

2012-12-01

To determine whether the proportion of leadership positions in obstetrics and gynecology held by women is consistent with expectations based on the proportion of women entering residency at the time of current leaders. Leadership positions were considered as department chairs affiliated with the Council of University Chairs of Obstetrics and Gynecology, editors of the 20 obstetrics and gynecology journals with the highest impact factors [corrected],and presidents of influential professional societies. Publically available data were accessed to determine sex and the year of medical school graduation for each individual holding each leadership position, as well as to determine the number of men and women entering residency in obstetrics and gynecology per year. Actual and expected proportions of leadership positions held by women were compared using χ² tests. Women should hold 71 of the total 194 leadership positions based on the proportion of women entering residency during the mean graduation year among leaders. Women actually hold 41 of these leadership positions (21.1%; P<.001). Considering only leaders who graduated during the years in which residency matching data were available, women should hold 28 of these 74 leadership positions. Women actually hold 20 of the leadership positions from this subset (27.0%; P=.05). Women are underrepresented in leadership positions in obstetrics and gynecology, and this cannot be explained by historical sex imbalances among physicians entering our specialty.

Residents as role models: the effect of the obstetrics and gynecology clerkship on medical students' career interest.

PubMed

Chang, Judy C; Odrobina, Michele R; McIntyre-Seltman, Kathleen

2010-09-01

Medical students' choice of residency specialty is based in part on their clerkship experience. Postclerkship interest in a particular specialty is associated with the students' choice to pursue a career in that field. But, many medical students have a poor perception of their obstetrics and gynecology clerkships. To determine whether fourth-year medical students' perceptions of teaching quality and quantity and amount of experiential learning during the obstetrics-gynecology clerkship helped determine their interest in obstetrics-gynecology as a career choice. We distributed an anonymous, self-administered survey to all third-year medical students rotating through their required obstetrics and gynecology clerkship from November 2006 to May 2007. We performed bivariate analysis and used χ(2) analysis to explore factors associated with general interest in obstetrics and gynecology and interest in pursuing obstetrics and gynecology as a career. Eighty-one students (N  =  91, 89% response rate) participated. Postclerkship career interest in obstetrics and gynecology was associated with perceptions that the residents behaved professionally (P < .0001) and that the students were treated as part of a team (P  =  .008). Having clear expectations on labor and delivery procedures (P  =  .014) was associated with postclerkship career interest. Specific hands-on experiences were not statistically associated with postclerkship career interest. However, performing more speculum examinations in the operating room trended toward having some influence (P  =  .068). Although more women than men were interested in obstetrics and gynecology as a career both before (P  =  .027) and after (P  =  .014) the clerkship, men were more likely to increase their level of career interest during the clerkship (P  =  .024). Clerkship factors associated with greater postclerkship interest include higher satisfaction with resident professional behavior and students

Residents as Role Models: The Effect of the Obstetrics and Gynecology Clerkship on Medical Students' Career Interest

PubMed Central

Chang, Judy C.; Odrobina, Michele R.; McIntyre-Seltman, Kathleen

2010-01-01

Background Medical students' choice of residency specialty is based in part on their clerkship experience. Postclerkship interest in a particular specialty is associated with the students' choice to pursue a career in that field. But, many medical students have a poor perception of their obstetrics and gynecology clerkships. Objective To determine whether fourth-year medical students' perceptions of teaching quality and quantity and amount of experiential learning during the obstetrics-gynecology clerkship helped determine their interest in obstetrics-gynecology as a career choice. Methods We distributed an anonymous, self-administered survey to all third-year medical students rotating through their required obstetrics and gynecology clerkship from November 2006 to May 2007. We performed bivariate analysis and used χ2 analysis to explore factors associated with general interest in obstetrics and gynecology and interest in pursuing obstetrics and gynecology as a career. Results Eighty-one students (N  =  91, 89% response rate) participated. Postclerkship career interest in obstetrics and gynecology was associated with perceptions that the residents behaved professionally (P < .0001) and that the students were treated as part of a team (P  =  .008). Having clear expectations on labor and delivery procedures (P  =  .014) was associated with postclerkship career interest. Specific hands-on experiences were not statistically associated with postclerkship career interest. However, performing more speculum examinations in the operating room trended toward having some influence (P  =  .068). Although more women than men were interested in obstetrics and gynecology as a career both before (P  =  .027) and after (P  =  .014) the clerkship, men were more likely to increase their level of career interest during the clerkship (P  =  .024). Conclusions Clerkship factors associated with greater postclerkship interest include higher satisfaction with

Obstetric and gynecologic malpractice claims in Saudi Arabia: Incidence and cause.

PubMed

AlDakhil, Lateefa O

2016-05-01

The occurrence of a bad outcome, injury or death of a patient during treatment increases the chance of malpractice litigation, increases legal responsibility and leads to increased fees for malpractice insurance. Physicians practicing obstetrics and gynecology face among the highest risks of malpractice litigation, and such litigation has led to an increase in the practice of defensive medicine and has made this specialty less appealing. Previous clinical data from Saudi Arabia have shown that more malpractice litigation concerns claims in obstetrics and gynecology than claims in any other field of medicine. To identify the main causes of obstetrics and gynecology (OBGYN) professional liability claims in Saudi Arabia to have a better understanding and management of risks. All OBGYN claims opened in Saudi Arabia between 2008 and 2013 were analyzed to identify the most common causes of claims. The results of these claims and the times until a final judgment made were also analyzed. Out of a total of 463 malpractice claims that were closed during the study period, 114 (24.6%) claims were in obstetrics and gynecology, and 92 (80.7%) of these claims concerned complications related to delivery room events. The most common causes of obstetric malpractice litigation were shoulder dystocia (brachial plexus injury) and fetal distress (hypoxic ischemic encephalopathy). Urinary system injury was the most common cause of gynecology cases. Most cases were decided in favor of the defendants with the exception of cases for which maternal and/or fetal death was the cause of litigation; nearly all of those cases were decided against the defendants. Obstetricians face a high risk of malpractice claims in Saudi Arabia, although most claims do not end in payments to plaintiffs. However, the effects of such claims on obstetric care should not be underestimated. Adherence to standards of care and careful documentation may decrease litigation and the number of indefensible malpractice

Molecular profiles and tumor mutational burden analysis in Chinese patients with gynecologic cancers.

PubMed

Wang, Min; Fan, Wensheng; Ye, Mingxia; Tian, Chen; Zhao, Lili; Wang, Jianfei; Han, Wenbo; Yang, Wen; Gu, Chenglei; Li, Mingxia; Zhang, Zhe; Wang, Yongjun; Zhang, Henghui; Meng, Yuanguang

2018-06-12

The goal of this work was to investigate the tumor mutational burden (TMB) in Chinese patients with gynecologic cancer. In total, 117 patients with gynecologic cancers were included in this study. Both tumor DNA and paired blood cell genomic DNA were isolated from formalin-fixed paraffin-embedded (FFPE) specimens and blood samples, and next-generation sequencing was performed to identify somatic mutations. TP53, PTEN, ARID1A, and PIK3CA alterations were significantly different in various types of gynecologic cancers (p = 0.001, 1.15E-07, 0.004, and 0.009, respectively). The median TMB of all 117 gynecologic tumor specimens was 0.37 mutations/Mb, with a range of 0-41.45 mutations/Mb. Despite the lack of significant difference, endometrial cancer cases had a higher median TMB than cervical and ovarian cancer cases. Younger gynecologic cancer patients (age <40 years) had a significantly lower TMB than older patients (age ≥40 years) (p = 0.04). In addition, TMB was significantly increased with increasing clinical stage of disease (p = 0.001). PTEN alterations were commonly observed in patients with a moderate to high TMB (n = 8, 38.10%, p = 9.95E-04). Although limited by sample size, all of the patients with TSC2 (n = 3, p = 3.83E-11) or POLE (n = 2, p = 0.005) mutations had a moderate to high TMB. Further large-scale, prospective studies are needed to validate our findings.

Mental health of residents during Obstetrics and Gynecology training in Thailand.

PubMed

Prasertsiri, K; Suntharasaj, T; Pitanupong, J

2006-03-01

To evaluate mental health of residents during Obstetrics and Gynecology training and identify the factors that affect mental health problems. During January-April 2004, one hundred and sixty Obstetrics and Gynecology residents (62% of 259) had completed a self-administered questionnaire composed of demographic data, workload, self-report of life stressors, and the Thai Mental Health Questionnaire (TMHQ-70). The prevalence of mental health problems was 29% (46/160). Somatization and social function were found in the first and second rank (18.1% and 11.9%), respectively. A resident who was younger than 25 years old, was married, cared for more than 20 patients per 8 hours in the labor room, performed more than 10 academic activities per year, or attended more than 5 examinations per year was at risk to develop social function problems. About one-third of residents training in Obstetrics and Gynecology have faced mental health problems--somatization, social function, depression and anxiety. The significant risk factors associated with social function problems were younger age, marriage and excessive workload

Resource savings and outcomes associated with outpatient laparoscopic appendectomy for nonperforated appendicitis.

PubMed

Gurien, Lori A; Burford, Jeffrey M; Bonasso, Patrick C; Dassinger, Melvin S

2017-11-01

Postoperative admission for acute appendicitis utilizes health care system resources. We evaluated outcomes and hospital charges for children with nonperforated appendicitis who underwent outpatient laparoscopic appendectomy. A retrospective chart review was performed for patients ≤18years old who underwent laparoscopic appendectomy for acute appendicitis in 2015. Patients were categorized into discharge from postanesthesia care unit (PACU) (outpatient), admission for <24-h, and admission for >24-h. Continuous variables were compared using analysis of variance and categorical variables were compared using chi-square test, with p<0.05 considered significant. Of the 171 patients identified, 63 (37%) were discharged from the PACU, 94 (55%) were admitted <24-h, and 14 (8%) were admitted >24-h. There were no differences in postoperative emergency department/clinic visits, complications, or readmissions. Hospital charges for admission <24-h and >24-h were $1007 and $2237 more per patient than the PACU-discharge group, respectively. Outpatient laparoscopic appendectomies became more common over time, occurring in only 20% of patients with acute appendicitis in the first quarter of the year versus 49% of patients in the last quarter. Outpatient laparoscopic appendectomy for nonperforated appendicitis in children is a safe practice that decreases length of stay and hospital charges. Adoption of an outpatient strategy allows for better standardization of care and can lead to savings in health care resources. III (Treatment: retrospective comparative study). Copyright © 2017 Elsevier Inc. All rights reserved.

The North American Society for Pediatric and Adolescent Gynecology Fellowship Family Tree.

PubMed

Pecchioli, Yael; Jamieson, Mary Anne

2015-12-01

To create a family tree to chronicle the proliferation of our specialty through fellowships (formal and informal) within the pediatric and adolescent gynecology practice and among the membership of the North American Society for Pediatric and Adolescent Gynecology (NASPAG). This historical project was undertaken as a way to demonstrate NASPAG's rich sense of heritage and community. The tree is meant to be a dynamic project, a living document, changing and expanding as this field of medicine grows, and offers a form of institutional memory for NASPAG. Questionnaires were sent out to all current NASPAG members via e-mail (and the list-serve) and were available at the 2014 NASPAG Annual Clinical and Research Meeting. Data from the questionnaires were recorded within GRAMPS 3.4.8, software used to create a family tree. The result of the project was an elegant and intricate tree, containing 379 "family members" including physicians who specialize in pediatric and adolescent gynecology, adolescent medicine, reproductive endocrinology and infertility, and pediatric endocrinology. The family tree, which shows how one mentor might train multiple trainees and how past trainees later become mentors, highlights the value of physicians who take on supervisory and educational roles and the existence of comprehensive and inspirational training programs. Copyright © 2015 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Gynecological malignancy risk in colorectal cancer survivors: A population-based cohort study.

PubMed

Chang, Wei-Chun; Muo, Chih-Hsin; Liang, Ji-An; Sung, Fung-Chang; Kao, Chia-Hung

2015-10-01

This study was carried out to assess the risk of gynecological malignancy in colorectal cancer survivors using a population-based retrospective cohort study. Using the National Health Insurance Research Database (NHIRD) of Taiwan, we identified 37,176 patients with colorectal cancer diagnosed in 1998-2009, aged 20 years and above, without other cancer history. We also randomly selected 148,700 women without any cancer in the comparison cohort, frequency matched by age and diagnosis date. Incidences and hazards of breast, cervix, endometrial and ovarian cancers were evaluated by 201l. The overall incidence of the 4 types of gynecological cancer was 39.0% higher in colorectal cancer patients than in comparisons (2.99 vs. 2.14 per 1000 person-years) with an adjusted hazard ratio (HR) of 1.46 (95% confidence interval (CI) = 1.31-1.62). Breast cancer accounted for most subsequent cancer. The multivariable Cox method measured HR was the highest for endometrial cancer (3.40, 95% CI = 2.59-4.47) for the colorectal cohort relative to comparisons, followed by ovarian cancer and breast cancer, except cervix cancer. The risk of gynecological malignancies was apparently elevated for colorectal cancer survivors <50 years of age. Follow-up measures are suggested for women with colorectal cancer for early detection and prevention of the subsequent gynecological malignancy. Copyright © 2015 Elsevier Ltd. All rights reserved.

Continuum of Medical Education in Obstetrics and Gynecology.

ERIC Educational Resources Information Center

Dohner, Charles W.; Hunter, Charles A., Jr.

1980-01-01

Over the past eight years the obstetric and gynecology specialty has applied a system model of instructional planning to the continuum of medical education. The systems model of needs identification, preassessment, instructional objectives, instructional materials, learning experiences; and evaluation techniques directly related to objectives was…

The 80-hour work week for residents: views from obstetric and gynecology program directors.

PubMed

Janoo, Jabin; Hashmi, Mahreen; Seybold, Dara J; Shapiro, Robert; Calhoun, Byron C; Bush, Stephen H

2014-01-01

In 2003, the Accreditation Council for Graduate Medical Education mandated an 80-hour work week restriction for residency programs. We examined program directors' views on how this mandate affects the education of Obstetrics and Gynecology residents. A 25 question survey was administered via Survey Monkey to Obstetrics and Gynecology program directors in the United States over three months in 2011. Fifty program directors (response rate of 28%) completed it with more men (62%) than women (38%) respondents. Overall, only 28% (14/50) responded that the program had improved, with significantly fewer men (5/14; 16.1%) than women (47.4% 9/19; p < 0.0169) directors reporting this. There was little perceived improvement in any of the six core ACGME performance objectives and in the CREOG scores, with the improvement ranging from 8% to 12%. In fact, while we observed the percentage of women directors reporting improvement in patient care and interpersonal and communication skills significantly higher compared with their male counterparts, the majority of women still reported either no improvement or a decline in these areas. Though our sample size was small, we found some significant difference between the views of male and female program directors. Both groups nonetheless responded with the majority with a decline or no change rather than a perceived improvement in any of the educational endeavors studied.

The 80-hour Work Week for Residents: Views from Obstetric and Gynecology Program Directors

PubMed Central

Janoo, Jabin; Hashmi, Mahreen; Seybold, Dara J.; Shapiro, Robert; Calhoun, Byron C.; Bush, Stephen H.

2015-01-01

In 2003, the Accreditation Council for Graduate Medical Education mandated an 80-hour work week restriction for residency programs. We examined program directors’ views on how this mandate affects the education of Obstetrics and Gynecology residents. A 25 question survey was administered via Survey Monkey to Obstetrics and Gynecology program directors in the United States over three months in 2011. Fifty program directors (response rate of 28%) completed it with more men (62%) than women (38%) respondents. Overall, only 28% (14/50) responded that the program had improved, with significantly fewer men (5/14; 16.1%) than women (47.4% 9/19; p<0.0169) directors reporting this. There was little perceived improvement in any of the six core ACGME performance objectives and in the CREOG scores, with the improvement ranging from 8% to 12%. In fact, while we observed the percentage of women directors reporting improvement in patient care and interpersonal and communication skills significantly higher compared with their male counterparts, the majority of women still reported either no improvement or a decline in these areas. Though our sample size was small, we found some significant difference between the views of male and female program directors. Both groups nonetheless responded with the majority with a decline or no change rather than a perceived improvement in any of the educational endeavors studied. PMID:25643470

Large bowel injuries during gynecological laparoscopy.

PubMed

Ulker, Kahraman; Anuk, Turgut; Bozkurt, Murat; Karasu, Yetkin

2014-12-16

Laparoscopy is one of the most frequently preferred surgical options in gynecological surgery and has advantages over laparotomy, including smaller surgical scars, faster recovery, less pain and earlier return of bowel functions. Generally, it is also accepted as safe and effective and patients tolerate it well. However, it is still an intra-abdominal procedure and has the similar potential risks of laparotomy, including injury of a vital structure, bleeding and infection. Besides the well-known risks of open surgery, laparoscopy also has its own unique risks related to abdominal access methods, pneumoperitoneum created to provide adequate operative space and the energy modalities used during the procedures. Bowel, bladder or major blood vessel injuries and passage of gas into the intravascular space may result from laparoscopic surgical technique. In addition, the risks of aspiration, respiratory dysfunction and cardiovascular dysfunction increase during laparoscopy. Large bowel injuries during laparoscopy are serious complications because 50% of bowel injuries and 60% of visceral injuries are undiagnosed at the time of primary surgery. A missed or delayed diagnosis increases the risk of bowel perforation and consequently sepsis and even death. In this paper, we aim to focus on large bowel injuries that happen during gynecological laparoscopy and review their diagnostic and management options.

Robotic-assisted surgery in gynecologic oncology.

PubMed

Sinno, Abdulrahman K; Fader, Amanda N

2014-10-01

The quest for improved patient outcomes has been a driving force for adoption of novel surgical innovations across surgical subspecialties. Gynecologic oncology is one such surgical discipline in which minimally invasive surgery has had a robust and evolving role in defining standards of care. Robotic-assisted surgery has developed during the past two decades as a more technologically advanced form of minimally invasive surgery in an effort to mitigate the limitations of conventional laparoscopy and improved patient outcomes. Robotically assisted technology offers potential advantages that include improved three-dimensional stereoscopic vision, wristed instruments that improve surgeon dexterity, and tremor canceling software that improves surgical precision. These technological advances may allow the gynecologic oncology surgeon to perform increasingly radical oncologic surgeries in complex patients. However, the platform is not without limitations, including high cost, lack of haptic feedback, and the requirement for additional training to achieve competence. This review describes the role of robotic-assisted surgery in the management of endometrial, cervical, and ovarian cancer, with an emphasis on comparison with laparotomy and conventional laparoscopy. The literature on novel robotic innovations, special patient populations, cost effectiveness, and fellowship training is also appraised critically in this regard. Copyright © 2014 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Factors associated with attendance to scheduled outpatient endoscopy

PubMed Central

Laiyemo, Adeyinka O.; Williams, Carla D.; Burnside, Clinton; Moghadam, Sepideh; Sanasi-Bhola, Kamla D.; Kwagyan, John; Brim, Hassan; Ashktorab, Hassan; Scott, Victor F.; Smoot, Duane T.

2015-01-01

Background Non-attendance of 42% has been reported for outpatient colonoscopy among persons with low socioeconomic status (SES) in an open access system in the United States. Objectives To evaluate attendance to outpatient endoscopy among populations with low SES after in-person consultations with endoscopists prior to scheduling. Methods Retrospectively, we reviewed the endoscopy schedule from September 2009 to August 2010 in an inner city teaching hospital in Washington DC. We identified patients who came for their procedures. We defined non-attendance as when patients did not notify the facility up to 24 hours prior to their scheduled procedures and did not show up . Results A total of 3,304 patients were scheduled for outpatient endoscopy (mean age 55.2 years; 59.5% females). Only 36 (1.1%) patients were uninsured. 716 (21.7%) patients did not show up for their procedures. There were no differences in attendance by age, sex and race. Patients seen in a private endoscopist's office (OR=1.47; 95%CI: 1.07–2.04) were more likely to attend when compared to patients seen in trainees’ continuity clinic. Married patients (OR=1.40; 95%CI: 1.11–1.78) were also more likely to attend. Conversely, Medicaid and uninsured patients were less likely to attend. Restricting our analysis to patients scheduled for only colonoscopy yielded similar results except that patients who were 50 years and older were more likely to attend. Conclusions Our study suggests improved attendance to endoscopy when populations with lower SES undergo prior consultation with an endoscopist. There is a potential to further improve attendance to out-patient endoscopy by directly involving the social support of the patients. PMID:25180285

Alcohol withdrawal syndrome: symptom-triggered versus fixed-schedule treatment in an outpatient setting.

PubMed

Elholm, Bjarne; Larsen, Klaus; Hornnes, Nete; Zierau, Finn; Becker, Ulrik

2011-01-01

To investigate whether, in the treatment with chlordiazepoxide for outpatient alcohol withdrawal, there are advantages of symptom-triggered self-medication over a fixed-schedule regimen. A randomized controlled trial in outpatient clinics for people suffering from alcohol dependence (AD) and alcohol-related problems; 165 adult patients in an outpatient setting in a specialized alcohol treatment unit were randomized 1:1 to either a symptom-triggered self-medication or tapered dose, using chlordiazepoxide. Alcohol withdrawal symptoms, amount of medication, duration of symptoms, time to relapse and patient satisfaction were measured. Patients assessed their symptoms using the Short Alcohol Withdrawal Scale (SAWS). Patient satisfaction was monitored by the Diabetes Treatment Satisfaction Questionnaire. We used the Well-Being Index and the European addiction severity index for the 1-year follow-up. We found no differences in the quantity of medication consumed, time to relapse, well being or treatment satisfaction. Symptom-triggered self-medication was as safe as fixed-schedule medication in treating outpatients with AD and mild to moderate symptoms of AWS. The SAWS is a powerful monitoring tool, because it is brief and permits the subject to log the withdrawal symptoms.

Obstetrics and Gynecology Resident Interest and Participation in Global Health.

PubMed

Stagg, Amy R; Blanchard, May Hsieh; Carson, Sandra A; Peterson, Herbert B; Flynn, Erica B; Ogburn, Tony

2017-05-01

To evaluate obstetrics and gynecology resident interest and participation in global health experiences and elucidate factors associated with resident expectation for involvement. A voluntary, anonymous survey was administered to U.S. obstetrics and gynecology residents before the 2015 Council on Resident Education in Obstetrics and Gynecology in-training examination. The 23-item survey gathered demographic data and queried resident interest and participation in global health. Factors associated with resident expectation for participation in global health were analyzed by Pearson χ tests. Of the 5,005 eligible examinees administered the survey, 4,929 completed at least a portion of the survey for a response rate of 98.5%. Global health was rated as "somewhat important" or "very important" by 96.3% (3,761/3,904) of residents. "Educational opportunity" (69.2%) and "humanitarian effort" (17.7%) were cited as the two most important aspects of a global health experience. Residents with prior global health experience rated the importance of global health more highly and had an increased expectation for future participation. Global health electives were arranged by residency programs for 18.0% (747/4,155) of respondents, by residents themselves as an elective for 44.0% (1,828/4,155), and as a noncredit experience during vacation time for 36.4% (1,514/4,155) of respondents. Female gender, nonpartnered status, no children, prior global health experience, and intention to incorporate global health in future practice were associated with expectations for a global health experience. Most obstetrics and gynecology residents rate a global health experience as somewhat or very important, and participation before or during residency increases the perceived importance of global health and the likelihood of expectation for future participation. A majority of residents report arranging their own elective or using vacation time to participate, suggesting that residency programs have

Cost assessment of robotics in gynecologic surgery: a systematic review.

PubMed

Iavazzo, Christos; Papadopoulou, Eleni K; Gkegkes, Ioannis D

2014-11-01

The application of robotics is an innovation in the field of gynecologic surgery. Our objective was to evaluate the currently available literature on the cost assessment of robotic surgery of various operations in the field of gynecologic surgery. PubMed and Scopus databases were systematically searched in order to retrieve the included studies in our review. We retrieved 23 studies on a variety of gynecologic operations. The mean cost for robotic, open and laparoscopic surgery ranged from 1731 to 48,769, 894 to 20,277 and 411 to 41,836 Euros, respectively. Operative charges, in hysterectomy, for robotic, open and laparoscopic technique ranged from 936 to 33,920, 684 to 25,616 and 858 to 25,578 Euros, respectively. In sacrocolpopexy, these costs ranged from 2067 to 7275, 2904 to 69,792 and 1482 to 2000 Euros, respectively. Non-operative charges ranged from 467 to 39,121 Euros. The mean total costs for myomectomy ranged from 27,342 to 42,497 and 13,709 to 20,277 Euros, respectively, for the robotic and open methods, while the mean total cost of the laparoscopic technique was 26,181 Euros. Conversions to laparotomy were present in 79/36,185 (0.2%) cases of laparoscopic surgery and in 21/3345 (0.62%) cases of robotic technique. Duration of robotic, open and laparoscopic surgery ranged from 50 to 445, 83.7 to 701 and 74 to 330 min, respectively. Robotic surgery has the potential to become cost-effective in centers with many patients while industry competition could reduce the cost of the robotic instrumentation, making robotic technology more affordable and cost-effective. © 2014 The Authors. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology.

How virtual reality may enhance training in obstetrics and gynecology.

PubMed

Letterie, Gerard S

2002-09-01

Contemporary training in obstetrics and gynecology is aimed at the acquisition of a complex set of skills oriented to both the technical and personal aspects of patient care. The ability to create clinical simulations through virtual reality (VR) may facilitate the accomplishment of these goals. The purpose of this paper is 2-fold: (1) to review the circumstances and equipment in industry, science, and education in which VR has been successfully applied, and (2) to explore the possible role of VR for training in obstetrics and gynecology and to suggest innovative and unique approaches to enhancing this training. Qualitative assessment of the literature describing successful applications of VR in industry, law enforcement, military, and medicine from 1995 to 2000. Articles were identified through a computer-based search using Medline, Current Contents, and cross referencing bibliographies of articles identified through the search. One hundred and fifty-four articles were reviewed. This review of contemporary literature suggests that VR has been successfully used to simulate person-to-person interactions for training in psychiatry and the social sciences in a variety of circumstances by using real-time simulations of personal interactions, and to launch 3-dimensional trainers for surgical simulation. These successful applications and simulations suggest that this technology may be helpful and should be evaluated as an educational modality in obstetrics and gynecology in two areas: (1) counseling in circumstances ranging from routine preoperative informed consent to intervention in more acute circumstances such as domestic violence or rape, and (2) training in basic and advanced surgical skills for both medical students and residents. Virtual reality is an untested, but potentially useful, modality for training in obstetrics and gynecology. On the basis of successful applications in other nonmedical and medical areas, VR may have a role in teaching essential elements

Proportion of gynecologic cancer patients using complementary and alternative medicine.

PubMed

Supoken, Amornrat; Chaisrisawatsuk, Thitima; Chumworathayi, Bandit

2009-01-01

Complementary and alternative medicine (CAM) for treatment of cancer and for supportive care of cancer patients must be clearly separated. There is encouraging evidence for CAM in the latter area, such as acupuncture and progressive muscle relaxation for chemotherapy-related nausea and vomiting, and aromatherapy for decreasing anxiety and increasing quality of life. However, there are limited data about CAM used by gynecologic cancer patients, especially in Thai women. Therefore, the authors aimed to investigate the proportion and types of CAM using in our gynecologic cancer patients. This cross-sectional survey was conducted between October to December, 2008. Totals of 50 admitted and 50 walk-in gynecologic cancer patients 1 month after diagnosis, aged more than 20 years and able to give informed consent, were selected for one-by-one interview by random walking survey. Among the 100 interviewed patients, aged 21-69 (mean=50.12), there were 46 cases of cervical cancers, 35 of ovarian cancers, 18 of endometrial cancers (two of these also had ovarian cancers), 2 of malignant gestational trophoblastic diseases, 1 of vulvar cancer, and 1 liver cancer (in a patient with ovarian cancer). Some 67% (95% CI, 57.8-76.2%) of them used CAM. As diet modifications, 11 used Chinese vegetarian, 8 common vegetarian, 5 Cheewajit, and 1 macrobiotics. Five of them used dietary supplements while colonic detoxification was emplyed in three. As herbal medicines, 27 used Thai herbs, 4 Chinese herbs, and 1 a herbal sauna. Twelve were receiving Thai massage. As exercises, 23 used aerobics and 5 stretching. Interestingly, 62 of them used Buddhist praying while only 3 employed native magic. The three most common forms of CAM used by our gynecologic cancer patients were Buddhist praying (62/67, 92.5%), followed by herbal medicines (27/67, 40.3%) and exercises (25/67, 37.3%).

World gynecologic oncology publications and the Turkish contribution to the literature between 2000 and 2007.

PubMed

Dursun, Polat; Gultekin, Murat; Ayhan, Ali

2011-01-01

To investigate the number of publications and the contribution from top-ranking countries, institutions, and authors in 3 gynecologic oncology journals (Gynecologic Oncology [GO], International Journal of Gynecological Cancer [IJGC], and European Journal of Gynaecological Oncology [EJGO]),as well as the degree of Turkish contribution between 2000 and 2007. Articles published between 2000 and 2007 in 3 gynecologic oncology journals indexed by the Science Citation Index were accessed via the ISI-Thomson website. Additionally, PubMed, Sciencedirect, and Blackwell-Synergy databases were used to identify the originating countries and institutions of the published articles. The types of articles, originating countries, and names of the institutions and authors were determined. Furthermore, the number of articles affiliated with Turkish institutions and the publication year were also determined. We located 6,851 articles published in the 3 journals. During this period 36.1%, 7.7%, 7.2%, 5.8% and 4.8% of the papers originated from the USA, Japan, Italy, Turkey, and England, respectively. The 5 most productive institutions were the University of Texas, Memorial Sloan-Kettering Cancer Center, Roswell Park Cancer Institute, University of Alabama, and University of Athens. The 5 most productive authors were Markman (USA), Chi (USA), Ayhan (Turkey), Barakat (USA), and Vergote (Belgium), respectively. In all, 36.1% of the papers originated from the USA, while 44% originated from 17 European countries. The USA was the first-ranked country of origin in GO and IJGC, while Turkey was the first-ranked country of origin in EJGO. Overall, 399 (5.8%) papers originated from Turkish institutions. Most of the gynecologic oncology publications originated from the USA and Western European countries, where gynecologic oncology training is available and surgical and research traditions are well established. On the other hand, Turkish researchers made an important contribution to gynecologic

The commercialization of robotic surgery: unsubstantiated marketing of gynecologic surgery by hospitals.

PubMed

Schiavone, Maria B; Kuo, Eugenia C; Naumann, R Wendel; Burke, William M; Lewin, Sharyn N; Neugut, Alfred I; Hershman, Dawn L; Herzog, Thomas J; Wright, Jason D

2012-09-01

We analyzed the content, quality, and accuracy of information provided on hospital web sites about robotic gynecologic surgery. An analysis of hospitals with more than 200 beds from a selection of states was performed. Hospital web sites were analyzed for the content and quality of data regarding robotic-assisted surgery. Among 432 hospitals, the web sites of 192 (44.4%) contained marketing for robotic gynecologic surgery. Stock images (64.1%) and text (24.0%) derived from the robot manufacturer were frequent. Although most sites reported improved perioperative outcomes, limitations of robotics including cost, complications, and operative time were discussed only 3.7%, 1.6%, and 3.7% of the time, respectively. Only 47.9% of the web sites described a comparison group. Marketing of robotic gynecologic surgery is widespread. Much of the content is not based on high-quality data, fails to present alternative procedures, and relies on stock text and images. Copyright © 2012 Mosby, Inc. All rights reserved.

[Outpatient breast surgery].

PubMed

Cappel, J; Lüders, K

1980-01-24

Indication, standard operative procedure and technique of ambulant diagnostic mammary surgery is shown in detail from 15 years of experience. In respect of reducing costs intraoperative quick-frozen sections and in case of malignancy radical mastectomy immediately after biopsy during continuous general anesthesia is important. By retrospective analysis we could prove that operative results in treatment of benign breast tumors by out-patient surgery or otherwise for in-patients do not differ. According to an inquiry patients preferred by 60% out-patient procedure.

Highly-sensitive troponin I is increased in patients with gynecological cancers.

PubMed

Danese, Elisa; Montagnana, Martina; Giudici, Silvia; Aloe, Rosalia; Franchi, Massimo; Guidi, Gian Cesare; Lippi, Giuseppe

2013-08-01

To investigate troponin I (TnI) in patients with gynecological cancers. Highly-sensitive (HS) and conventional TnI were measured in 25 patients with untreated ovarian cancer, 25 with endometriosis and 25 with benign masses. Both HS and conventional TnI were increase in cancer patients. Values above the cut-off were found in 44% and 16% cancer patients using HS and conventional TnI methods, respectively. Cardiac involvement is frequent in patients with gynecological cancers and should be preferably assessed using HS troponin immunoassays. Copyright © 2013 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

[Administration of activated recombinant factor VII (novo seven) for the control of massive bleeding in gynecology].

PubMed

Tanchev, S; Pandurski, F; Georgiev, A; Gesheva, Iu; Platikanov, V; Dinov, P

2004-01-01

We report our clinical opinion for recombinant activated factor VII (NovoSeven, Novo Nordisk, Copenhagen, Denmark) administration in gynecology patients with massive haemorrhage. 3 women with gynecology deseases and severe bleeding in recieved NovoSeven in bolus IV. The blood loss and laboratory changes in hematology and haemostasis parameters are monitored. The bleeding was ceased in all cases. Decrease in values of Hb, Er and PTT was noted. The use of recombinant factor VIIA in gynecology patients with severe bleeding is effective and safe enough and could be an alternative to the extreme surgical procedures.

Statistics usage in the American Journal of Obstetrics and Gynecology: has anything changed?

PubMed

Welch, Gerald E; Gabbe, Steven G

2002-03-01

Our purpose was to compare statistical listing and usage between articles published in the American Journal of Obstetrics and Gynecology in 1994 with those published in 1999. All papers included in the obstetrics, fetus-placenta-newborn, and gynecology sections and the transactions of societies sections of the January through June 1999 issues of the American Journal of Obstetrics and Gynecology (volume 180, numbers 1 to 6) were reviewed for statistical usage. Each paper was given a rating for the cataloging of applied statistics and a rating for the appropriateness of statistical usage, when possible. These results were compared with the data collected on a similar review of articles published in 1994. Of the 238 available articles, 195 contained statistics and were reviewed. In comparison to the articles published in 1994, there were significantly more articles that completely cataloged applied statistics (74.3% vs 47.4%) (P <.0001), and there was a significant improvement in appropriateness of statistical usage (56.4% vs 30.3%) (P <.0001). Changes in the Instructions to Authors regarding the description of applied statistics and probable changes in the behavior of researchers and Editors have led to an improvement in the quality of statistics in papers published in the American Journal of Obstetrics and Gynecology.

ACOG Technology Assessment in Obstetrics and Gynecology No. 6: Robot-assisted surgery.

PubMed

2009-11-01

The field of robotic surgery is developing rapidly, but experience with this technology is currently limited. In response to increasing interest in robotics technology, the Committee on Gynecologic Practice's Technology Assessment was developed to describe the robotic surgical system,potential advantages and disadvantages, gynecologic applications, and the current state of the evidence. Randomized trials comparing robot-assisted surgery with traditional laparoscopic, vaginal, or abdominal surgery are needed to evaluate long-term clinical outcomes and cost-effectiveness, as well as to identify the best applications of this technology.

42 CFR 419.21 - Hospital outpatient services subject to the outpatient prospective payment system.

Code of Federal Regulations, 2010 CFR

2010-10-01

.... (c) Partial hospitalization services furnished by community mental health centers (CMHCs). (d) The... 42 Public Health 3 2010-10-01 2010-10-01 false Hospital outpatient services subject to the outpatient prospective payment system. 419.21 Section 419.21 Public Health CENTERS FOR MEDICARE & MEDICAID...

21 CFR 884.4120 - Gynecologic electrocautery and accessories.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Gynecologic electrocautery and accessories. 884.4120 Section 884.4120 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... under direct visual observation. This generic type of device may include the following accessories: an...

21 CFR 884.2225 - Obstetric-gynecologic ultrasonic imager.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Obstetric-gynecologic ultrasonic imager. 884.2225 Section 884.2225 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... generic type of device may include the following: signal analysis and display equipment, electronic...

21 CFR 884.2225 - Obstetric-gynecologic ultrasonic imager.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Obstetric-gynecologic ultrasonic imager. 884.2225 Section 884.2225 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... generic type of device may include the following: signal analysis and display equipment, electronic...

21 CFR 884.2225 - Obstetric-gynecologic ultrasonic imager.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Obstetric-gynecologic ultrasonic imager. 884.2225 Section 884.2225 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... generic type of device may include the following: signal analysis and display equipment, electronic...

The Lymphedema and Gynecologic Cancer (LEG) Study: Incidence, Risk Factors, and | Division of Cancer Prevention

Cancer.gov

DESCRIPTION (provided by applicant): The proposed study, Lymphedema and Gynecologic cancer (LEG): Incidence, Risk Factors and Impact, will innovatively utilize the cooperative group setting of the GOG (Gynecologic Oncology Group) to prospectively study 1300 women newly diagnosed with cervical, endometrial, or vulvar cancer to determine the incidence and impact of lower

Major clinical research advances in gynecologic cancer in 2015

PubMed Central

2016-01-01

In 2015, fourteen topics were selected as major research advances in gynecologic oncology. For ovarian cancer, high-level evidence for annual screening with multimodal strategy which could reduce ovarian cancer deaths was reported. The best preventive strategies with current status of evidence level were also summarized. Final report of chemotherapy or upfront surgery (CHORUS) trial of neoadjuvant chemotherapy in advanced stage ovarian cancer and individualized therapy based on gene characteristics followed. There was no sign of abating in great interest in immunotherapy as well as targeted therapies in various gynecologic cancers. The fifth Ovarian Cancer Consensus Conference which was held in November 7–9 in Tokyo was briefly introduced. For cervical cancer, update of human papillomavirus vaccines regarding two-dose regimen, 9-valent vaccine, and therapeutic vaccine was reviewed. For corpus cancer, the safety concern of power morcellation in presumed fibroids was explored again with regard to age and prevalence of corpus malignancy. Hormone therapy and endometrial cancer risk, trabectedin as an option for leiomyosarcoma, endometrial cancer and Lynch syndrome, and the radiation therapy guidelines were also discussed. In addition, adjuvant therapy in vulvar cancer and the updated of targeted therapy in gynecologic cancer were addressed. For breast cancer, palbociclib in hormone-receptor-positive advanced disease, oncotype DX Recurrence Score in low-risk patients, regional nodal irradiation to internal mammary, supraclavicular, and axillary lymph nodes, and cavity shave margins were summarized as the last topics covered in this review. PMID:27775259

Position-related injury is uncommon in robotic gynecologic surgery.

PubMed

Ulm, Michael A; Fleming, Nicole D; Rallapali, Vijayashri; Munsell, Mark F; Ramirez, Pedro T; Westin, Shannon N; Nick, Alpa M; Schmeler, Kathleen M; Soliman, Pamela T

2014-12-01

To assess the rate and risk factors for position-related injury in robotic gynecologic surgery. A prospective database from 12/2006 to 1/2014 of all planned robotic gynecologic procedures was retrospectively reviewed for patients who experienced neurologic injury, musculoskeletal injury, or vascular compromise related to patient positioning in the operating room. Analysis was performed to determine risk-factors and incidence for position-related injury. Of the 831 patients who underwent robotic surgery during the study time period, only 7 (0.8%) experienced positioning-related injury. The injuries included minor head contusions (n=3), two lower extremity neuropathies (n=2), brachial plexus injury (n=1) and one large subcutaneous ecchymosis on the left flank and thigh (n=1). There were no long term sequelae from the positioning-related injuries. The only statistically significant risk factor for positioning-related injury was prior abdominal surgery (P=0.05). There were no significant associations between position-related injuries and operative time (P=0.232), body mass index (P=0.847), age (P=0.152), smoking history (P=0.161), or medical comorbidities (P=0.229-0.999). The incidence of position-related injury among women undergoing robotic surgery was extremely low (0.8%). Due to the low incidence we were unable to identify modifiable risk factors for position-related injury following robotic surgery. A standardized, team-oriented approach may significantly decrease position-related injuries following robotic gynecologic surgery. Copyright © 2014 Elsevier Inc. All rights reserved.

Visuospatial ability correlates with performance in simulated gynecological laparoscopy.

PubMed

Ahlborg, Liv; Hedman, Leif; Murkes, Daniel; Westman, Bo; Kjellin, Ann; Felländer-Tsai, Li; Enochsson, Lars

2011-07-01

To analyze the relationship between visuospatial ability and simulated laparoscopy performed by consultants in obstetrics and gynecology (OBGYN). This was a prospective cohort study carried out at two community hospitals in Sweden. Thirteen consultants in obstetrics and gynecology were included. They had previously independently performed 10-100 advanced laparoscopies. Participants were tested for visuospatial ability by the Mental Rotations Test version A (MRT-A). After a familiarization session and standardized instruction, all participants subsequently conducted three consecutive virtual tubal occlusions followed by three virtual salpingectomies. Performance in the simulator was measured by Total Time, Score and Ovarian Diathermy Damage. Linear regression was used to analyze the relationship between visuospatial ability and simulated laparoscopic performance. The learning curves in the simulator were assessed in order to interpret the relationship with the visuospatial ability. Visuospatial ability correlated with Total Time (r=-0.62; p=0.03) and Score (r=0.57; p=0.05) in the medium level of the virtual tubal occlusion. In the technically more advanced virtual salpingectomy the visuospatial ability correlated with Total Time (r=-0.64; p=0.02), Ovarian Diathermy Damage (r=-0.65; p=0.02) and with overall Score (r=0.64; p=0.02). Visuospatial ability appears to be related to the performance of gynecological laparoscopic procedures in a simulator. Testing visuospatial ability might be helpful when designing individual training programs. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Major clinical research advances in gynecologic cancer in 2015.

PubMed

Suh, Dong Hoon; Kim, Miseon; Kim, Hak Jae; Lee, Kyung Hun; Kim, Jae Weon

2016-11-01

In 2015, fourteen topics were selected as major research advances in gynecologic oncology. For ovarian cancer, high-level evidence for annual screening with multimodal strategy which could reduce ovarian cancer deaths was reported. The best preventive strategies with current status of evidence level were also summarized. Final report of chemotherapy or upfront surgery (CHORUS) trial of neoadjuvant chemotherapy in advanced stage ovarian cancer and individualized therapy based on gene characteristics followed. There was no sign of abating in great interest in immunotherapy as well as targeted therapies in various gynecologic cancers. The fifth Ovarian Cancer Consensus Conference which was held in November 7-9 in Tokyo was briefly introduced. For cervical cancer, update of human papillomavirus vaccines regarding two-dose regimen, 9-valent vaccine, and therapeutic vaccine was reviewed. For corpus cancer, the safety concern of power morcellation in presumed fibroids was explored again with regard to age and prevalence of corpus malignancy. Hormone therapy and endometrial cancer risk, trabectedin as an option for leiomyosarcoma, endometrial cancer and Lynch syndrome, and the radiation therapy guidelines were also discussed. In addition, adjuvant therapy in vulvar cancer and the updated of targeted therapy in gynecologic cancer were addressed. For breast cancer, palbociclib in hormone-receptor-positive advanced disease, oncotype DX Recurrence Score in low-risk patients, regional nodal irradiation to internal mammary, supraclavicular, and axillary lymph nodes, and cavity shave margins were summarized as the last topics covered in this review.

The prevalence of personality disorders in psychiatric outpatients with borderline intellectual functioning: Comparison with outpatients from regular mental health care and outpatients with mild intellectual disabilities.

PubMed

Wieland, Jannelien; Van Den Brink, Annemarie; Zitman, Frans G

2015-01-01

There is little research on the subject of personality disorder (PD) in individuals with borderline intellectual functioning (BIF). Unlike in most countries, in the Netherlands, patients with BIF are eligible for specialized mental health care. This offers the unique possibility of examining the rates of PDs in patients, who in other countries are treated relatively invisibly in regular mental health care. To compare, in a naturalistic setting, the frequency of PD diagnoses in outpatients with BIF with outpatients from regular mental health care and outpatients with mild ID. We compared the rates of all DSM-IV-TR axis II PDs in outpatients with BIF (BIF group; n = 235) with rates of the same disorders in outpatients from regular mental health care (RMHC group; n = 1026) and outpatients with mild intellectual disability (ID) (mild ID group; n = 152) in a naturalistic cross-sectional anonymized medical chart review. Over half of the patients with BIF (52.8%) were diagnosed with a PD, compared with one in five in the RMHC group (19.3%) and one in three of the mild ID group (33.6%). All PD diagnoses, except for cluster A PDs and histrionic PDs, were most frequently diagnosed in the BIF group. PD NOS and borderline PD were the most frequently diagnosed PDs in BIF. The majority of PD patients had one or more comorbid axis I disorder. There is a high frequency of PD diagnoses in BIF outpatients in daily clinical practice. In anticipation of further scientific research, results suggest that PDs should not be overlooked in patients with BIF.

Intraoperative Sensorcaine significantly improves postoperative pain management in outpatient reduction mammaplasty.

PubMed

Culliford, Alfred T; Spector, Jason A; Flores, Roberto L; Louie, Otway; Choi, Mihye; Karp, Nolan S

2007-09-15

Breast reduction is one of the most frequently performed plastic surgical procedures in the United States; more than 160,500 patients underwent the procedure in 2005. Many outpatient reduction mammaplasty patients report the greatest postoperative discomfort in the first 48 hours. The authors' investigated the effect of intraoperative topical application of the long-acting local anesthetic agent bupivacaine (Sensorcaine or Marcaine) on postoperative pain, time to postanesthesia care unit discharge, and postoperative use of narcotic medication. In a prospective, randomized, single-blind trial, intraoperative use of Sensorcaine versus placebo (normal saline) was compared. Postoperative pain was quantified using the visual analogue scale, and time to discharge from the postanesthesia care unit was recorded. Patients documented their outpatient pain medication usage. Of the 37 patients enrolled in the study, 20 were treated with intraoperative topical Sensorcaine and 17 received placebo. Patients treated with Sensorcaine were discharged home significantly faster (2.9 hours versus 3.8 hours, p = 0.002). The control arm consistently had higher pain scores in the postanesthesia care unit (although not statistically significant) than the Sensorcaine group using the visual analogue scale system. Furthermore, patients receiving Sensorcaine required significantly less narcotic medication while recovering at home (mean, 3.5 tablets of Vicodin) than the control group (mean, 6.4 tablets; p = 0.001). There were no complications resulting from Sensorcaine usage. This prospective, randomized, single-blind study demonstrates that a single dose of intraoperative Sensorcaine provides a safe, inexpensive, and efficacious way to significantly shorten the length of postanesthesia care unit stay and significantly decrease postoperative opioid analgesic use in patients undergoing ambulatory reduction mammaplasty.

Investigating Compliance with Standard Precautions During Residency Physicians in Gynecology and Obstetrics.

PubMed

Carvalho, Milton Jorge de; Pereira, Fernanda Maria Vieira; Gir, Elucir; Lam, Simon Ching; Barbosa, Caio Parente

2016-07-01

Physician compliance with standard precautions is important in the specialty of gynecology and obstetrics because of the high frequency of invasive procedures. The current study investigated compliance with standard precautions among resident physicians working in gynecology and obstetrics. A cross-sectional study was conducted among resident physicians in gynecology and obstetrics in their first (R1), second (R2) and third (R3) years of residency at a teaching hospital in a city in São Paulo. A structured questionnaire that included demographic and professional aspects and the Standard Precautions Adherence Scale were used to collect data. Statistical analysis was performed using IBM® SPSS version 20. Ethical aspects were considered. Fifty-eight resident physicians participated in the study. Of the enrolled participants, 27 (46.6%) were in R1, 12 (20.7%) were in R2 and 19 (32.8%) were in R3. The standard precautions compliance score was 4.1, which was classified as intermediate. There were no significant differences in the compliance scores of the resident physicians across the three years of residency (H=2.34, p=0.310). Compliance with standard precautions among resident physicians was intermediate. Preventive measures in clinical practice are not fully adopted in the specialty of gynecology and obstetrics. More important, many professionals claimed lack of sufficient training in standard precautions in the workplace. Such circumstances should draw the attention of hospital management with regard to occupational health risks.

Investigating Compliance with Standard Precautions During Residency Physicians in Gynecology and Obstetrics

PubMed Central

de Carvalho, Milton Jorge; Pereira, Fernanda Maria Vieira; Gir, Elucir; Lam, Simon Ching; Barbosa, Caio Parente

2016-01-01

OBJECTIVES: Physician compliance with standard precautions is important in the specialty of gynecology and obstetrics because of the high frequency of invasive procedures. The current study investigated compliance with standard precautions among resident physicians working in gynecology and obstetrics. METHOD: A cross-sectional study was conducted among resident physicians in gynecology and obstetrics in their first (R1), second (R2) and third (R3) years of residency at a teaching hospital in a city in São Paulo. A structured questionnaire that included demographic and professional aspects and the Standard Precautions Adherence Scale were used to collect data. Statistical analysis was performed using IBM® SPSS version 20. Ethical aspects were considered. RESULTS: Fifty-eight resident physicians participated in the study. Of the enrolled participants, 27 (46.6%) were in R1, 12 (20.7%) were in R2 and 19 (32.8%) were in R3. The standard precautions compliance score was 4.1, which was classified as intermediate. There were no significant differences in the compliance scores of the resident physicians across the three years of residency (H=2.34, p=0.310). CONCLUSION: Compliance with standard precautions among resident physicians was intermediate. Preventive measures in clinical practice are not fully adopted in the specialty of gynecology and obstetrics. More important, many professionals claimed lack of sufficient training in standard precautions in the workplace. Such circumstances should draw the attention of hospital management with regard to occupational health risks. PMID:27464295

Risk of Anal Cancer in Women With a Human Papillomavirus-Related Gynecological Neoplasm: Puerto Rico 1987-2013.

PubMed

Acevedo-Fontánez, Adrianna I; Suárez, Erick; Torres Cintrón, Carlos R; Ortiz, Ana P

2018-04-11

The aim of the study was to estimate the magnitude of the association between HPV-related gynecological neoplasms and secondary anal cancer among women in Puerto Rico (PR). We identified 9,489 women who had been diagnosed with a primary cervical, vaginal, or vulvar tumor during 1987-2013. To describe the trends of invasive cervical, vulvar, vaginal, and anal cancer, the age-adjusted incidence rates were estimated using the direct method (2000 US as Standard Population). Standardized incidence ratios (observed/expected) were computed using the indirect method; expected cases were calculated using 2 methods based on age-specific rates of anal cancer in PR. The ratio of standardized incidence ratios of anal cancer was estimated using the Poisson regression model to estimate the magnitude of the association between HPV-gynecologic neoplasms and secondary anal cancer. A significant increase in the incidence trend for anal cancer was observed from 1987 to 2013 (annual percent change = 1.1, p < .05), whereas from 2004 to 2013, an increase was observed for cervical cancer incidence (annual percent change = 3.3, p < .05). The risk of secondary anal cancer among women with HPV-related gynecological cancers was approximately 3 times this risk among women with non-HPV-related gynecological cancers (relative risk = 3.27, 95% CI = 1.37 to 7.79). Anal cancer is increasing among women in PR. Women with gynecological HPV-related tumors are at higher risk of secondary anal cancer as compared with women from the general population and with those with non-HPV-related gynecological cancers. Appropriate anal cancer screening guidelines for high-risk populations are needed, including women with HPV-related gynecological malignancies and potentially other cancer survivors.

Gynecological pelvic pain as emergency pathology.

PubMed

Rivera Domínguez, A; Mora Jurado, A; García de la Oliva, A; de Araujo Martins-Romeo, D; Cueto Álvarez, L

Acute pelvic pain is a common condition in emergency. The sources of acute pelvic pain are multifactorial, so it is important to be familiar with this type of pathologies. The purpose of this article is review the main causes of gynecological acute pelvic pain and their radiologic appearances to be able to make an accurate diagnosis and provide objective criteria for patient management. Copyright © 2016 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

[Comparisons outpatient drug prescriptions: France, Denmark, Norway, Sweden].

PubMed

Dezileaux, Barbara; Martinez, Florie

2016-06-01

Comparisons outpatient drug prescriptions: France, Denmark, Norway, Sweden. Project compares quantitatively outpatient drug prescriptions in France, Denmark, Norway and Sweden. Data were obtained from national databases; the unit of measurement was defined daily dose per 1000 inhabitants. The five most prescribed drug classes were compared in each country in 2009, then benzodiazepines and antibiotics from 2006 to 2012. A literature review was focused on the context of prescriptions for each country. In 2009, the five most prescribed drug classes in the four countries represented seven classes in total. France was not the biggest prescriber of drugs, but from 2006 to 2012 benzodiazepines and antibiotics were prescribed much more in France than in the other countries. The evolution of prescriptions was different for each country, and very stable in France. In 2009, France was not the biggest drugs consumer of all classes, but was characterized by high prescriptions in some classes. Copyright © 2016 Société française de pharmacologie et de thérapeutique. Published by Elsevier Masson SAS. All rights reserved.

The Scope of Global Health Training in U.S. Obstetrics and Gynecology Residency Programs

PubMed Central

Hung, Kristin J.; Tsai, Alexander C.; Johnson, Timothy R.B.; MD, MPH, Rochelle P.; Bangsberg, David R.; Kerry, Vanessa B.

2013-01-01

Objective To enumerate global health training activities in U.S. obstetrics and gynecology residency programs, and to examine the worldwide distribution of programmatic activity relative to the maternal and perinatal disease burden. Methods Using a systematic, Web-based protocol, we searched for global health training opportunities at all U.S. obstetrics and gynecology residency programs. Country-level data on disability-adjusted life years due to maternal and perinatal conditions were obtained from the Global Burden of Disease study. We calculated Spearman’s rank correlation coefficients to estimate the cross-country association between programmatic activity and disease burden. Results Of the 243 accredited U.S. obstetrics and gynecology residency programs, we identified 41 (17%) with one of several possible predefined categories of programmatic activity. Thirty-three residency programs offered their residents opportunities to participate in one or more elective-based rotations, eight offered extended field-based training, and 18 offered research activities. A total of 128 programmatic activities were dispersed across 64 different countries. At the country level, the number of programmatic activities had a statistically significant association with the total disease burden due to maternal (Spearman’s ρ=0.37; 95% confidence interval [CI], 0.14-0.57) and perinatal conditions (ρ=0.34; 95% CI, 0.10-0.54) but not gynecologic cancers (ρ=−0.24; 95% CI, −0.46 to 0.01). Conclusions There are few global health training opportunities for U.S. obstetrics and gynecology residents. These activities are disproportionately distributed among countries with greater burdens of disease. PMID:24104785

Systematic review of robotic surgery in gynecology: robotic techniques compared with laparoscopy and laparotomy.

PubMed

Gala, Rajiv B; Margulies, Rebecca; Steinberg, Adam; Murphy, Miles; Lukban, James; Jeppson, Peter; Aschkenazi, Sarit; Olivera, Cedric; South, Mary; Lowenstein, Lior; Schaffer, Joseph; Balk, Ethan M; Sung, Vivian

2014-01-01

The Society of Gynecologic Surgeons Systematic Review Group performed a systematic review of both randomized and observational studies to compare robotic vs nonrobotic surgical approaches (laparoscopic, abdominal, and vaginal) for treatment of both benign and malignant gynecologic indications to compare surgical and patient-centered outcomes, costs, and adverse events associated with the various surgical approaches. MEDLINE and the Cochrane Central Register of Controlled Trials were searched from inception to May 15, 2012, for English-language studies with terms related to robotic surgery and gynecology. Studies of any design that included at least 30 women who had undergone robotic-assisted laparoscopic gynecologic surgery were included for review. The literature yielded 1213 citations, of which 97 full-text articles were reviewed. Forty-four studies (30 comparative and 14 noncomparative) met eligibility criteria. Study data were extracted into structured electronic forms and reconciled by a second, independent reviewer. Our analysis revealed that, compared with open surgery, robotic surgery consistently confers shorter hospital stay. The proficiency plateau seems to be lower for robotic surgery than for conventional laparoscopy. Of the various gynecologic applications, there seems to be evidence that renders robotic techniques advantageous over traditional open surgery for management of endometrial cancer. However, insofar as superiority, conflicting data are obtained when comparing robotics vs laparoscopic techniques. Therefore, the specific method of minimally invasive surgery, whether conventional laparoscopy or robotic surgery, should be tailored to patient selection, surgeon ability, and equipment availability. Copyright © 2014 AAGL. Published by Elsevier Inc. All rights reserved.

Mobile information and communication in the hospital outpatient service.

PubMed

Jen, Wen-Yuan; Chao, Chia-Chen; Hung, Ming-Chien; Li, Yu-Chuan; Chi, Y P

2007-08-01

Most healthcare providers provide mobile service for their medical staff; however, few healthcare providers provide mobile service as part of their outpatient service. The mobile outpatient service system (MOSS) focuses on illness treatment, illness prevention and patient relation management for outpatient service users. Initiated in a local hospital in Taiwan, the MOSS pilot project was developed to improve outpatient service quality and pursue higher patient safety. This study focuses on the development of the MOSS. The workflow, architecture and target users of the MOSS are delineated. In addition, there were two surveys conducted as part of this study. After a focus group of medical staff identified areas in which outpatient services might be improved by the MOSS, the first survey was administered to outpatients to confirm the focus group's intuitions. The second administration of the survey explored outpatient satisfaction after they used the MOSS service. With regard to outpatient attitudes, about 93% of participants agreed that the mobile outpatient service improved outpatient service quality. In the area of outpatient satisfaction, about 89% of participants indicated they were satisfied with the mobile outpatient service. Supported by our study finding, we propose that more diverse mobile outpatient services can be provided in the future.

Outcome of Pediatric Gastroenterology Outpatients With Fever and Central Line.

PubMed

Alexander, Thomas; Blatt, Julie; Skinner, Asheley Cockrell; Jhaveri, Ravi; Jobson, Meghan; Freeman, Katherine

2016-11-01

Although management algorithms for fever and central venous catheters (CVCs) have been implemented for pediatric oncology (PO) patients, management of pediatric outpatients with noncancer diagnoses and CVCs lacks clear protocols. The aim of the study was to assess outcomes for pediatric outpatients with gastrointestinal disorders presenting with fever and CVC. Using a microbiology database and emergency department records, we created a database of pediatric gastroenterology (PGI) and PO outpatients with fever and a CVC who presented to our emergency department or clinics from January 2010 through December 2012. We excluded patients who had severe neutropenia (absolute neutrophil count, <500/mm). We performed chart reviews to assess demographic and clinical characteristics. A total of 334 episodes in 144 patients were evaluated. Fifty-three percent (95% confidence interval, 38%-68%) of PGI patients had a bloodstream infection, whereas only 9% (95% confidence interval, 5%-14%) of PO patients had a bloodstream infection (P < 0.001). Among patients with a bloodstream infection, the PGI patients were more likely than the PO patients to have polymicrobial infections (46% vs 15%), gram-negative infections (57% vs 27%), and/or infection with enteric organisms (61% vs 23%). The PGI patients had higher rates of CVC removal (19% vs 4%) but no statistical difference in intensive care unit needs (11% vs 4%). Pediatric gastroenterology outpatients with fever and a CVC have a high prevalence of bloodstream infection. Algorithms for management need to be subspecialty specific. Pediatric gastroenterology patients presenting to emergency departments or clinics with fever and CVC require admission for monitoring and management.

The role of monitoring interpretive rates, concordance between cytotechnologist and pathologist interpretations before sign-out, and turnaround time in gynecologic cytology quality assurance: findings from the College of American Pathologists Gynecologic Cytopathology Quality Consensus Conference working group 1.

PubMed

Clary, Karen M; Davey, Diane D; Naryshkin, Sonya; Austin, R Marshall; Thomas, Nicole; Chmara, Beth Anne; Sugrue, Chiara; Tworek, Joseph

2013-02-01

The College of American Pathologists (CAP) conducted a national survey of gynecologic cytology quality assurance (QA) practices. Experts in gynecologic cytology were asked to join 5 working groups that studied the survey data on different aspects of QA. Evaluating the survey data and follow-up questions online, together with a review of pertinent literature, the working groups developed a series of preliminary statements on good laboratory practices in cytology QA. These were presented at a consensus conference and electronic voting occurred. To evaluate a set of QA monitors in gynecologic cytology. Working group 1 evaluated (1) monitoring interpretive rate categories for Papanicolaou tests (Pap tests), (2) concordance of cytotechnologist and pathologist interpretations before sign-out, and (3) turnaround time for Pap tests. The statements are based on a survey of gynecologic cytology QA practice patterns and of opinions from working group members and consensus conference attendees. The outcomes of this process demonstrate the current state of practice patterns in gynecologic cytology QA. Monitoring interpretive rates for all Bethesda System categories is potentially useful, and it is most useful to monitor interpretive rates for cytotechnologists individually and in comparison to the entire laboratory. Laboratories need to determine what level of discrepancy between cytotechnologist and pathologist interpretations of Pap tests is important to track. Laboratories should consider formalizing procedures and policies to adjudicate such discrepant interpretations. Turnaround time should be monitored in gynecologic cytology, but individual laboratories should determine how to measure and use turnaround time internally.

Students' and Physicians' Evaluations of Gynecologic Teaching Associate Program.

ERIC Educational Resources Information Center

Plauche, Warren C.; Baugniet-Nebrija, Wendy

1985-01-01

Gynecologic teaching associates taught third-year medical students to perform physical examination of the female pelvis and breasts. Evaluations by the students of this teaching method and assessment by the teaching associates of student problems were obtained from questionnaires. (Author/MLW)

Payment methods for outpatient care facilities.

PubMed

Yuan, Beibei; He, Li; Meng, Qingyue; Jia, Liying

2017-03-03

-after studies, interrupted time series, and repeated measures studies that compared different payment methods for outpatient health facilities. We defined outpatient care facilities in this review as facilities that provide health services to individuals who do not require hospitalisation or institutionalisation. We only included methods used to transfer funds from the purchaser of healthcare services to health facilities (including groups of individual professionals). These include global budgets, line-item budgets, capitation, fee-for-service (fixed and unconstrained), pay for performance, and mixed payment. The primary outcomes were service provision outcomes, patient outcomes, healthcare provider outcomes, costs for providers, and any adverse effects. At least two review authors independently extracted data and assessed the risk of bias. We conducted a structured synthesis. We first categorised the comparisons and outcomes and then described the effects of different types of payment methods on different categories of outcomes. We used a fixed-effect model for meta-analysis within a study if a study included more than one indicator in the same category of outcomes. We used a random-effects model for meta-analysis across studies. If the data for meta-analysis were not available in some studies, we calculated the median and interquartile range. We reported the risk ratio (RR) for dichotomous outcomes and the relative change for continuous outcomes. We included 21 studies from Afghanistan, Burundi, China, Democratic Republic of Congo, Rwanda, Tanzania, the United Kingdom, and the United States of health facilities providing primary health care and mental health care. There were three kinds of payment comparisons. 1) Pay for performance (P4P) combined with some existing payment method (capitation or different kinds of input-based payment) compared to the existing payment methodWe included 18 studies in this comparison, however we did not include five studies in the effects

Feasibility of a modified outpatient regimen of intravenous/intraperitoneal chemotherapy in optimally debulked stage III ovarian cancer patients: a GEICO study.

PubMed

Oaknin, Ana; Roda, Desamparado; González-Martín, Antonio; Chiva, Luis; García-Donas, Jesús; de Juan, Ana; Redondo, Andrés; Martínez, Sergio; García, Yolanda; Catot, Sílvia; Ponce, Jordi; Del Campo, J M; Cervantes, Andrés; Poveda, Andrés

2011-08-01

The objective of the study was to assess the feasibility, toxicity, and reasons for early discontinuation of a modified outpatient intraperitoneal/intravenous (IP/IV) chemotherapy regimen for the treatment of patients with optimally debulked stage III ovarian cancer. Between February 2006 and November 2008, 51 consecutive patients from Institutions of the Spanish Ovarian Cancer Group (GEICO) were treated with a modified outpatient IP chemotherapy regimen. Patients received IV paclitaxel 175 mg/m over 3 hours on day 1, followed by IP cisplatin 100 mg/m (or 75 mg/m according to the principal investigator's criteria) on day 2. On day 8, patients received IP paclitaxel 60 mg/m. To homogenize the IP administration and supportive measures, a GEICO guideline for IP chemotherapy was established. Patients were treated with the intention to receive 6 courses of chemotherapy every 21 days. The median age of the patients was 49 years (range, 36-75 years), and most of them had papillary serous ovarian cancer (78%), International Federation of Gynecology and Obstetrics stage IIIC (76%). Thirty-nine patients completed 4 or more IP cycles, and 28 (61%) completed all 6 IP cycles. Twenty-two patients discontinued the IP/IV treatment, mainly because of chemotherapy toxicity (10 patients) and catheter-related complications (5 patients). The most prevalent grade 3/4 toxicities were neutropenia (14 patients; 30%) and gastrointestinal events (12 patients; 26%). The GEICO outpatient modified regimen resulted in a lesser toxicity and a greater rate of treatment completion than previously reported. The accurate selection of patients and the administration following well-defined guidelines can increase the feasibility of IP chemotherapy administration.

Delivering an effective outpatient service in gynaecology. A randomised controlled trial analysing the cost of outpatient versus daycase hysteroscopy.

PubMed

Marsh, Fiona; Kremer, Christian; Duffy, Sean

2004-03-01

To examine the cost implications of outpatient versus daycase hysteroscopy to the National Health Service, the patient and their employer. Randomised controlled trial. The gynaecology clinic of a large teaching hospital. Ninety-seven women with abnormal uterine bleeding requiring investigation. Women were randomly allocated to either outpatient or daycase hysteroscopy. They were asked to complete diaries recording expenses and time off work. The National Health Service costs were calculated for a standard outpatient and daycase hysteroscopy. Costs to the National Health Service, costs to the employer, loss of income, childcare costs and travel expenses. The outpatient group required significantly less time off work compared with the daycase group (0.8 days vs 3.3 days), P < 0.001. Of those women who lost income due to the hysteroscopy, the average loss of income was twice as much in the daycase group ( pound 20.40 in the outpatient group vs pound 50.60 in the daycase group). The average cost of childcare required to cover the time spent in hospital undergoing the hysteroscopy was similar in both groups, however, the number of women requiring childcare was small. Travel costs incurred by the women were 74% more in the daycase group compared with the outpatient group-with an average cost of pound 3.46 in the outpatient group and pound 6.02 in the daycase group. Daycase hysteroscopy costs the National Health Service approximately pound 53.88 more per patient, than performing an outpatient hysteroscopy. Purchasing the hysteroscopes necessary to perform an outpatient hysteroscopy is a more expensive outlay than those required for daycase hysteroscopy. However, there are so many other savings that only 38 patients need to undergo outpatient hysteroscopy (even with a 4% failure rate) rather than daycase hysteroscopy in order to recoup the extra money required to set up an outpatient hysteroscopy service. Outpatient hysteroscopy offers many benefits over its traditional

38 CFR 17.94 - Outpatient medical services for military retirees and other beneficiaries.

Code of Federal Regulations, 2011 CFR

2011-07-01

... pensioners of nations allied with the United States in World War I and World War II when duly authorized. [32... 38 Pensions, Bonuses, and Veterans' Relief 1 2011-07-01 2011-07-01 false Outpatient medical services for military retirees and other beneficiaries. 17.94 Section 17.94 Pensions, Bonuses, and Veterans...

38 CFR 17.94 - Outpatient medical services for military retirees and other beneficiaries.

Code of Federal Regulations, 2014 CFR

2014-07-01

... pensioners of nations allied with the United States in World War I and World War II when duly authorized. [32... 38 Pensions, Bonuses, and Veterans' Relief 1 2014-07-01 2014-07-01 false Outpatient medical services for military retirees and other beneficiaries. 17.94 Section 17.94 Pensions, Bonuses, and Veterans...

38 CFR 17.94 - Outpatient medical services for military retirees and other beneficiaries.

Code of Federal Regulations, 2013 CFR

2013-07-01

... pensioners of nations allied with the United States in World War I and World War II when duly authorized. [32... 38 Pensions, Bonuses, and Veterans' Relief 1 2013-07-01 2013-07-01 false Outpatient medical services for military retirees and other beneficiaries. 17.94 Section 17.94 Pensions, Bonuses, and Veterans...

38 CFR 17.94 - Outpatient medical services for military retirees and other beneficiaries.

Code of Federal Regulations, 2012 CFR

2012-07-01

... pensioners of nations allied with the United States in World War I and World War II when duly authorized. [32... 38 Pensions, Bonuses, and Veterans' Relief 1 2012-07-01 2012-07-01 false Outpatient medical services for military retirees and other beneficiaries. 17.94 Section 17.94 Pensions, Bonuses, and Veterans...

38 CFR 17.94 - Outpatient medical services for military retirees and other beneficiaries.

Code of Federal Regulations, 2010 CFR

2010-07-01

... pensioners of nations allied with the United States in World War I and World War II when duly authorized. [32... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Outpatient medical services for military retirees and other beneficiaries. 17.94 Section 17.94 Pensions, Bonuses, and Veterans...

Robotic surgery in gynecology.

PubMed

Magrina, J F

2007-01-01

Robotic technology is nothing more than an enhancement along the continuum of laparoscopic technological advances and represents only the beginning of numerous more forthcoming advances. It constitutes a major improvement in the efficiency, accuracy, ease, and comfort associated with the performance of laparoscopic operations. Instrument articulation, downscaling of movements, absence of tremor, 3-D image, and comfort for the surgeon, assistant and scrub nurse are all new to the practice of laparoscopy. In our hands, robotic operative times for simple and radical hysterectomy are shorter than those obtained by conventional laparoscopy. Robotic technology is preferable to conventional laparoscopic instrumentation for the surgical treatment of gynecologic malignancies and most operations for benign disease of certain complexity such as hysterectomy myomectomy, and invasive pelvic endometriosis.

Evaluation of ethics education in obstetrics and gynecology residency programs.

PubMed

Byrne, John; Straub, Heather; DiGiovanni, Laura; Chor, Julie

2015-03-01

The objective of the study was to assess the current status of ethics education in obstetrics-gynecology residency programs. A cross-sectional, web-based survey was designed in conjunction with a professional survey laboratory at the University of Chicago. The survey was piloted with a convenience sample of clinical medical ethics fellows to assess question content and clarity. The survey was deployed by e-mail to all obstetrics-gynecology residency program directors. Descriptive statistics were used to analyze participant responses. The University of Chicago's Institutional Review Board deemed this study exempt from institutional review board formal review. Of 242 eligible obstetrics-gynecology residency program directors, 118 (49%) completed the survey. Most respondents were from university-based programs (n = 78, 66%) that were not religiously affiliated (n = 98, 83%) and trained 4-6 residents per postgraduate year (n = 64, 70%). Although 50% of program directors (n = 60) reported having ethics as part of their core curriculum, most programs teach ethics in an unstructured manner. Fifty-seven percent of respondents (n = 66) stated their program dedicated 5 or fewer hours per year to ethics. The majority of program directors (n = 80, 73%) responded they would like more to a lot more ethics education and believed that ethics education should be required (n = 93, 85%) for residents to complete their training. Respondents identified that crowding in the curriculum was a significant barrier to increased ethics training (n = 50, 45%) and two-thirds (n = 74, 67%) reported a lack of faculty expertise as a moderate barrier to providing ethics education in the residency curriculum. This study found that a lack of structured curricula, inadequate faculty expertise, and limited time were important barriers for ethics education in obstetrics-gynecology programs across the nation. Despite these existing challenges, program directors have a strong interest in increasing ethics

Major clinical research advances in gynecologic cancer in 2014.

PubMed

Suh, Dong Hoon; Lee, Kyung Hun; Kim, Kidong; Kang, Sokbom; Kim, Jae Weon

2015-04-01

In 2014, 9 topics were selected as major advances in clinical research for gynecologic oncology: 2 each in cervical and corpus cancer, 4 in ovarian cancer, and 1 in breast cancer. For cervical cancer, several therapeutic agents showed viable antitumor clinical response in recurrent and metastatic disease: bevacizumab, cediranib, and immunotherapies including human papillomavirus (HPV)-tumor infiltrating lymphocytes and Z-100. The HPV test received FDA approval as the primary screening tool of cervical cancer in women aged 25 and older, based on the results of the ATHENA trial, which suggested that the HPV test was a more sensitive and efficient strategy for cervical cancer screening than methods based solely on cytology. For corpus cancers, results of a phase III Gynecologic Oncology Group (GOG) 249 study of early-stage endometrial cancer with high-intermediate risk factors are followed by the controversial topic of uterine power morcellation in minimally invasive gynecologic surgery. Promising results of phase II studies regarding the effectiveness of olaparib in various ovarian cancer settings are summarized. After a brief review of results from a phase III study on pazopanib maintenance therapy in advanced ovarian cancer, 2 outstanding 2014 ASCO presentations cover the topic of using molecular subtypes in predicting response to bevacizumab. A review of the use of opportunistic bilateral salpingectomy as an ovarian cancer preventive strategy in the general population is presented. Two remarkable studies that discussed the effectiveness of adjuvant ovarian suppression in premenopausal early breast cancer have been selected as the last topics covered in this review.

Gynecologic pain related to occupational stress among female factory workers in Tianjin, China

PubMed Central

Sznajder, Kristin K; Harlow, Siobán D; Burgard, Sarah A; Wang, Yanrang; Han, Cheng; Liu, Jing

2014-01-01

Background: Dysmenorrhea, dyspareunia, and non-cyclic pelvic pain are health concerns for factory workers in China and may be increased by occupational stress. Objectives: To estimate the prevalence and demographic and occupational factors associated with three types of gynecologic pain among female factory workers in Tianjin. Methods: The study included 651 female workers from three factories in Tianjin, China. Logistic regression models were estimated to determine associations between occupational stress and gynecologic pain. Results: Occupational stress including high job strain, exhaustion, and stress related to working conditions was a risk factor for gynecologic pain. High job strain and poor job security were associated with an increased risk for dysmenorrhea. Compulsory overtime and exhaustion were associated with increased non-cyclic pelvic pain. Working overtime and exhaustion were associated with increased dyspareunia. Conclusions: As China’s population of female factory workers grows, research on the reproductive health of this population is essential. PMID:24804338

Image-guided percutaneous cryotherapy for the management of gynecologic cancer metastases.

PubMed

Solomon, Leigh A; Munkarah, Adnan R; Vorugu, Vinaya R; Deppe, Gunter; Adam, Barbara; Malone, John M; Littrup, Peter J

2008-11-01

To report the clinical response to image-guided percutaneous cryotherapy (IPC) for the palliative management of localized metastases in patients with gynecologic malignancies. Institutional review board approval and patient consent were obtained. Gynecologic oncology patients were identified from our institution's cryotherapy database from August 2003 to August 2007. Cryotherapy was performed with 2.4 mm diameter probes (Endocare, Irvine, CA) with ultrasound or computerized tomography (CT) guidance under conscious sedation and local anesthesia. Follow-up was conducted by imaging studies and clinical encounters, using Response Evaluation Criteria in Solid Tumors (RECIST criteria). Twenty-eight ablation sessions were performed for 41 metastatic foci in 15 patients with gynecologic malignancies. Twelve patients had prior chemotherapy and 5 patients had prior radiation. Median follow-up was 317.5 days (range 95-1189). Median post-procedure pain score: 3/10 (range 0-5). Mean initial tumor size was 2.6 cm in maximal diameter. Median reduction in tumor diameter at 1 month was 21.4% (range 2-67.4%), at 3 months was 43.6% (range 16-80.4%), at 6 months was 54.7% (range (16.6-88.9%) and at 9 months was 58.2% (range 32-88.9%). Ten patients received concurrent chemotherapy, 8 had progression of disease at other sites and 2 had stable disease, while the cryotherapy site improved. One of 5 patients who had cryotherapy in the previously irradiated zone had recurrence. A liver capsule hematoma developed as an immediate complication in one patient and an enterocutaneous fistula developed in another. IPC is a well-tolerated, effective tool for local control of isolated metastatic foci as a single-modality treatment and for local control of symptomatic metastases in select patients undergoing systemic therapy for the management of gynecologic malignancies.

Comprehensive Outpatient Rehabilitation Program: Hospital-Based Stroke Outpatient Rehabilitation.

PubMed

Rice, Danielle; Janzen, Shannon; McIntyre, Amanda; Vermeer, Julianne; Britt, Eileen; Teasell, Robert

2016-05-01

Few studies have considered the effectiveness of outpatient rehabilitation programs for stroke patients. The objective of this study was to assess the effectiveness of a hospital-based interdisciplinary outpatient stroke rehabilitation program with respect to physical functioning, mobility, and balance. The Comprehensive Outpatient Rehabilitation Program provides a hospital-based interdisciplinary approach to stroke rehabilitation in Southwestern Ontario. Outcome measures from physiotherapy and occupational therapy sessions were available at intake and discharge from the program. A series of paired sample t-tests were performed to assess patient changes between time points for each outcome measure. A total of 271 patients met the inclusion criteria for analysis (56.1% male; mean age = 62.9 ± 13.9 years). Significant improvements were found between admission and discharge for the Functional Independence Measure, grip strength, Chedoke-McMaster Stroke Assessment, two-minute walk test, maximum walk test, Timed Up and Go, Berg Balance Scale, and one-legged stance (P < .003 for all). The findings indicate that an interdisciplinary rehabilitation program was effective at improving the physical functioning, mobility, and balance of individuals after a stroke. A hospital-based, stroke-specific rehabilitation program should be considered when patients continue to experience deficits after inpatient rehabilitation. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

National outpatient medication profiling: medications associated with outpatient fractures in community-dwelling elderly veterans

PubMed Central

French, Dustin D; Campbell, Robert; Spehar, Andrea; Rubenstein, Laurence Z; Branch, Laurence G; Cunningham, Francesca

2007-01-01

What is already known about this subject Polypharmacy, to include a subissue of potentially inappropriate prescribing, in community-dwelling elderly is widespread. The objective of this study was to identify the magnitude of problematic outpatient drug prescribing and its potential association as a risk factor for injuries. What this study adds This is the first national study of outpatient injuries in elderly veterans. The results are consistent with previous published literature highlighting the risks associated with prescribing central nervous system drugs in the elderly. Aims The primary objective of this retrospective case–control study in an elderly veteran population was to assess the impact of specific medications with recognized side-effects that increase the risk of a fall and were prescribed prior to fractures treated in the outpatient setting compared with patients treated for nonspecific chest pain. Methods Two national Veterans Health Administration (VHA) databases were used to identify 17 273 unique patients, aged ≥65 years, treated in outpatient settings with a fracture in fiscal year 2005, and for whom we could link to all of their outpatient prescriptions (809 536). For comparison, we identified other elderly patients with outpatient clinic visits for nonspecific chest pain (N = 62 331) for whom we could link with their 2 987 394 outpatient prescriptions. We categorized the fall-related medications as drugs that primarily affect the cardiovascular (CVS), the central nervous (CNS) or the muscular skeletal system (MSS). Results Significant differences in the two patient groups occurred in the CNS category. Approximately 41% of the patients with fracture-coded encounters were prescribed CNS drugs compared with 31% of the patients in the comparison group (P < 0.0003). Finally, the use of muscle relaxants in the MSS category was significantly higher in the fracture group than in the nonspecific chest pain group. Conclusions Studies using

Building a pediatric neurocritical care program: a multidisciplinary approach to clinical practice and education from the intensive care unit to the outpatient clinic.

PubMed

Wainwright, Mark S; Grimason, Michele; Goldstein, Joshua; Smith, Craig M; Amlie-Lefond, Catherine; Revivo, Gadi; Noah, Zehava L; Harris, Zena L; Epstein, Leon G

2014-12-01

We describe our 10-year experience developing the Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program at Northwestern University Feinberg School of Medicine. The neurocritical care team includes intensivists, neurologists, and an advanced practice nurse who have expertise in critical care neurology and who continue care in long-term follow-up of intensive care unit patients in a dedicated neurocritical care outpatient clinic. Brain-directed critical care requires collaboration between intensivists and neurologists with specific expertise in neurocritical care, using protocol-directed consistent care, and physiological measures to protect brain function. The heterogeneity of neurologic disorders in the pediatric intensive care unit requires a background in the relevant basic science and pathophysiology that is beyond the scope of standard neurology or critical care fellowships. To address this need, we also created a fellowship in neurocritical care for intensivists, neurologists, and advanced practice nurses. Last, we discuss the implications for pediatric neurocritical care from the experience of management of pediatric stroke and the development of stroke centers. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

Copper-vapor laser in medical practice: gynecology

NASA Astrophysics Data System (ADS)

Chvykov, Vladimir V.; Zazulya, O. I.; Zemskov, Konstantin I.

1993-10-01

About 100 patients were treated for cervical erosion, cervical leukoplakia, and vulval warts in the Gynecology Department of the adult polyclinic of the Zelenograd Center of Medicine. Copper vapor laser (CVL) was used with output average power up to 4 W in two lines (510 nm, 578 nm). Pulse repetition rate was about 10 kHz, pulselength approximately 20 - 40 ns. Four to twelve procedures were sufficient to recover.

Women with Gynecologic Malignancies Have a Greater Incidence of Suicide than Women with Other Cancer Types

ERIC Educational Resources Information Center

Ward, Kristy K.; Roncancio, Angelica M.; Plaxe, Steven C.

2013-01-01

To evaluate risk of suicide of women with invasive gynecologic malignancies, the National Cancer Institute's Surveillance, Epidemiology, and End Results Program (1973-2007) was queried. Suicide per 100,000 women with gynecologic malignancies was compared with that of women with other malignancies; suicide was 30% more likely in those with…

Dissociative identity disorder among adolescents: prevalence in a university psychiatric outpatient unit.

PubMed

Sar, Vedat; Onder, Canan; Kilincaslan, Ayse; Zoroglu, Süleyman S; Alyanak, Behiye

2014-01-01

The aim of this study was to determine the prevalence of dissociative identity disorder (DID) and other dissociative disorders among adolescent psychiatric outpatients. A total of 116 consecutive outpatients between 11 and 17 years of age who were admitted to the child and adolescent psychiatry clinic of a university hospital for the 1st time were evaluated using the Adolescent Dissociative Experiences Scale, adolescent version of the Child Symptom Inventory-4, Childhood Trauma Questionnaire, and McMaster Family Assessment Device. All patients were invited for an interview with the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D) administered by 2 senior psychiatrists in a blind fashion. There was excellent interrater reliability between the 2 clinicians on SCID-D diagnoses and scores. Among 73 participants, 33 (45.2%) had a dissociative disorder: 12 (16.4%) had DID, and 21 (28.8%) had dissociative disorder not otherwise specified. There was no difference in gender distribution, childhood trauma, or family dysfunction scores between the dissociative and nondissociative groups. Childhood emotional abuse and family dysfunction correlated with self-reported dissociation. Of the dissociative adolescents, 93.9% had an additional psychiatric disorder. Among them, only separation anxiety disorder was significantly more prevalent than in controls. Although originally designed for adults, the SCID-D is promising for diagnosing dissociative disorders in adolescents, its modest congruence with self-rated dissociation and lack of relationship between diagnosis and childhood trauma and family dysfunction suggest that the prevalence rates obtained with this instrument originally designed for adults must be replicated. The introduction of diagnostic criteria for adolescent DID in revised versions of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, would refine the assessment of dissociative disorders in this age group.

A National Initiative for Women and Healthcare Providers: CDC’s Inside Knowledge: Get the Facts About Gynecologic Cancer Campaign

PubMed Central

Rim, Sun Hee; Polonec, Lindsey; Stewart, Sherri L.; Gelb, Cynthia A.

2015-01-01

The Inside Knowledge: Get the Facts About Gynecologic Cancer campaign raises awareness of the five main types of gynecologic cancer: cervical, ovarian, uterine, vaginal, and vulvar. It encourages women to pay attention to their bodies and know what is normal for them so they can recognize the warning signs of gynecologic cancers and seek medical care. This report provides an overview of the development of this national campaign. PMID:21933006

Improvement of Gynecological Screening of Female Renal Transplant Recipients by Self-Sampling for Human Papillomavirus Detection.

PubMed

Hinten, Floor; Hilbrands, Luuk B; Meeuwis, Kim A; van Bergen-Verkuyten, Muriël C; Slangen, Brigitte F; van Rossum, Michelle M; Rahamat-Langendoen, Janette; Massuger, Leon F; de Hullu, Joanne A; Melchers, Willem J

2017-01-01

Female renal transplant recipients (RTRs) have increased risk for developing human papillomavirus (HPV)-related (pre)malignancies of the lower genital tract. Annual cervical screening is advised for RTRs, but the participation rate is low. The aim of this study is to investigate whether HPV self-sampling is suitable for gynecological screening of RTRs to increase participation rate. A large cohort of 253 RTRs was investigated for the prevalence of HPV. All participants received a device for a cervicovaginal self-sample. Questionnaires were sent to assess the experience with this device. High-risk (hrHPV) presence was determined with the SPF10-LiPA25 system and GP5+/6+ PCR. HrHPV-positive patients underwent gynecological examination. More than 90% of the patients rated their experience with the self-sample device as good to excellent, and 77% preferred self-sampling over a physician taken sample. Approximately thirty-five of 217 women tested hrHPV positive with SPF10- LiPA25, and 22 tested positive with the GP5+/6+ PCR. Eleven hrHPV-positive patients had clinically relevant gynecological abnormalities, and they all tested positive with GP5+/6+ PCR. Self-sampling is clinically applicable in a gynecological screening and is preferred by female RTRs. Therefore, self-sampling could be implemented with the aim to increase the participation rate of female RTRs in yearly gynecological screening.

Analgesia Following Major Gynecological Laparoscopic Surgery - PCA versus Intermittent Intramuscular Injection

PubMed Central

Lam, Alan M.; Carlton, Mark A.; Cario, Gregory M.; McBride, Lindsay

1998-01-01

Background and Objectives: To compare the use of patient-controlled analgesia to intermittent intramuscular injections of morphine following major gynecological laparoscopic procedures in order to assess differences in level of pain, sedation, episodes of nausea and/or vomiting, hospitalization time and patient satisfaction with their postoperative analgesia. Methods: Seventy-two patients undergoing major gynecological laparoscopic surgery were randomized to receive either postoperative analgesia via intermittent intramuscular injection of morphine (Group 1) or patient controlled analgesia (PCA - Group 2). All patients received anesthesia via a standardized protocol. Postoperative pain levels were recorded via a 10 cm visual analogue scale, and sedation scores were recorded on a standard PCA form. Episodes of nausea and vomiting were also recorded on the same form. Results: There were no statistically significant differences between intramuscular analgesia and PCA for any of the factors studied. Most significantly it was found that most patients ceased to require either form of parenteral analgesia within 24 hours of their procedure, regardless of the operating time. Conclusion: It is important for the surgeon to be aware of the effects of postoperative analgesia on his or her patients' level of satisfaction. We do not recommend the use of PCA analgesia following major laparoscopic gynecological surgery. PMID:9876706

Clinical audit of COPD in outpatient respiratory clinics in Spain: the EPOCONSUL study.

PubMed

Calle Rubio, Myriam; Alcázar Navarrete, Bernardino; Soriano, Joan B; Soler-Cataluña, Juan J; Rodríguez González-Moro, José Miguel; Fuentes Ferrer, Manuel E; López-Campos, José Luis

2017-01-01

Chronic obstructive pulmonary disease (COPD) outpatients account for a large burden of usual care by respirologists. EPOCONSUL is the first national clinical audit conducted in Spain on the medical care for COPD patients delivered in outpatient respiratory clinics. We aimed to evaluate the clinical interventions and the degree of adherence to recommendations in outpatients of current COPD clinical practice guidelines. This is an observational study with prospective recruitment (May 2014-May 2015) of patients with a COPD diagnosis as seen in outpatient respiratory clinics. The information collected was historical in nature as for the clinical data of the last and previous consultations, and the information concerning hospital resources was concurrent. A total of 17,893 clinical records of COPD patients in outpatient respiratory clinics from 59 Spanish hospitals were evaluated. Of the 5,726 patients selected, 4,508 (78.7%) were eligible. Overall, 12.1% of COPD patients did not fulfill a diagnostic spirometry criteria. Considerable variability existed in the available resources and work organization of the hospitals, although the majority were university hospitals with respiratory inpatient units. There was insufficient implementation of clinical guidelines in preventive and educational matters. In contrast, quantitative evaluation of dyspnea grade (81.9%) and exacerbation history (70.9%) were more frequently performed. Only 12.4% had COPD severity calculated according to the Body mass index, airflow Obstruction, Dyspnoea and Exercise capacity (BODE) index. Phenotype characteristics according to Spanish National Guideline for COPD were determined in 46.3% of the audited patients, and the risk evaluation according to Global initiative for chronic Obstructive Lung Disease was estimated only in 21.9%. The EPOCONSUL study reports the current situation of medical care for COPD patients in outpatient clinics in Spain, revealing its variability, strengths, and weaknesses

[Perceiving gender or profession: the practical experience of male nursing students in the obstetrics and gynecology ward].

PubMed

Lee, Ya-Fen; Yang, Yu-O; Tu, Chia-Ling

2013-06-01

The impact of general gender stereotypes on nursing is severe and influential, especially with regard to male nursing students working in obstetrics and gynecology wards. This study examined the experience of male nursing students in obstetrics and gynecology wards. We used a phenomenological qualitative research approach and a sample of 10 male nursing students currently studying at a nursing college in central Taiwan. All participants had obstetrics and gynecology ward experience. Individual interviews were transcribed into the procedural record. Colaizzi content analysis analyzed and categorized research data. Based on participants practical experiences in the obstetrics and gynecology ward, the main stages of participants professional development through their internship experience included: (1) Unbalanced self-role recognition; (2) being defined by the gender framework (gender stereotypes); (3) the difference between male doctor and male nurse; (4) learning appropriate communication techniques; (5) mutual and empathetic understanding of the female psychology during childbirth; (6) gaining sources for positive feedback; (7) releasing the shackles of gender and gaining full insight into and comprehension of nursing functions; and (8) given the opportunity to learn. Through ongoing examination and learning, participant internships in the obstetrics and gynecology wards were significant and essential learning experiences that validated their necessity. Nursing schools and internship institutions alike must realize the importance of gender-equality education to the nursing profession. Medical institutions are encouraged to offer equal learning opportunities to male and female nursing students and provide targeted assistance to males to help them master clinical nursing care practices in the obstetrics and gynecology department.

Alpha lipoic acid in obstetrics and gynecology.

PubMed

Di Tucci, Chiara; Di Feliciantonio, Mara; Vena, Flaminia; Capone, Carmela; Schiavi, Michele Carlo; Pietrangeli, Daniela; Muzii, Ludovico; Benedetti Panici, Pierluigi

2018-05-04

Alpha-Lipoic acid (ALA) is a natural antioxidant synthetized by plants and animals, identified as a catalytic agent for oxidative decarboxylation of pyruvate and α-ketoglutarate. In this review, we analyzed the action of ALA in gynecology and obstetrics focusing in particular on neuropathic pain and antioxidant and anti-inflammatory action. A comprehensive literature search was performed in PubMed and Cochrane Library for retrieving articles in English language on the antioxidant and anti-inflammatory effects of ALA in gynecological and obstetrical conditions. ALA reduces oxidative stress and insulin resistance in women with polycystic ovary syndrome (PCOS). The association of N-acetyl cysteine (NAC), alpha-lipoic acid (ALA), and bromelain (Br) is used for prevention and treatment of endometriosis. In association with omega-3 polyunsaturated fatty acids (n-3 PUFAs) with amitriptyline is used for treatment of vestibulodynia/painful bladder syndrome (VBD/PBS). A promising area of research is ALA supplementation in patients with threatened miscarriage to improve the subchorionic hematoma resorption. Furthermore, ALA could be used in prevention of diabetic embryopathy and premature rupture of fetal membranes induced by inflamation. In conclusion, ALA can be safely used for treatment of neuropatic pain and as a dietary support during pregnancy.

[Vitreoretinal outpatient surgery: clinical and financial considerations].

PubMed

Creuzot-Garcher, C; Aubé, H; Candé, F; Dupont, G; Guillaubey, A; Malvitte, L; Arnavielle, S; Bron, A

2008-11-01

Vitreoretinal surgery has benefited from great advances opening the opportunity for outpatient management. We report on the 6-month experience of outpatient surgery for vitreoretinal diseases. From November 2007 to April 2008, 270 patients benefited from a vitreoretinal surgery, with 173 retinal detachments, 63 epiretinal membranes, and 34 other procedures. Only 8.5% (n=23) of the patients had to stay at the hospital one or two nights. The main reasons were the distance from the hospital and surgery on a single-eye patient. The questionnaire given after the surgery showed that almost all the patients were satisfied with the outpatient setting. In contrast, the financial results showed a loss of income of around 400,000 euros due to the low level of payment of outpatient surgery in France by the national health insurance system. Vitreoretinal surgery can be achieved in outpatient surgery with an improvement in the information given to the patients and the overall organization of the hospitalization. However, the current income provided with vitreoretinal outpatient surgery is highly disadvantageous in France, preventing this method from being generalized.

Obstetrics and Gynecology Hospitalist Fellowships.

PubMed

Vintzileos, Anthony M

2015-09-01

This article establishes the rationale and development of an obstetrics and gynecology (OB/GYN) hospitalist fellowship program. The pool of OB/GYN hospitalists needs to be drastically expanded to accommodate the country's needs. Fellowship programs should provide extra training and confidence for recent resident graduates who want to pursue a hospitalist career. Fellowships should train physicians in a way that aligns their interests with those of the hospital with respect to patient care, teaching, and research. Research in the core measures should be a necessary component of the fellowship so as to provide long-term benefits for all stakeholders, including hospitals and patients. Copyright © 2015 Elsevier Inc. All rights reserved.

Single-port gynecologic surgery with a novel surgical platform.

PubMed

Knight, Jason; Tunitsky-Britton, Elena; Muffly, Tyler; Michener, Chad M; Escobar, Pedro F

2012-09-01

Laparoendoscopic single-site surgery (LESS) allows better cosmesis and decreased pain when compared with traditional laparoscopy (TL). Instrument crowding and diminished triangulation are limitations. This study evaluates a novel single-port surgical platform (NSP) designed to facilitate the transition from TL to LESS (TransEnterix SPIDER, Durham, NC). NSP and TL were compared using standardized dry lab tasks. Feasibility of NSP in gynecology was assessed using the porcine model. Completion times with NSP were longer for ring transfer (P = .025) and trended longer for disc cutting (P = .074). Disc cutting accuracy was lower with NSP versus TL (P = .008). NSP operative times for hysterectomy, pelvic and para-aortic node dissection were 22.3, 13.3, and 26 minutes, respectively, without complications. Fatigue and lack of integrated bipolar cautery were limitations of NSP. While application of NSP to gynecology appears feasible, lower performance when compared with TL underscores the need for caution when applying NSP to humans.

Robotic assisted surgery in pediatric gynecology: promising innovation in mini invasive surgical procedures.

PubMed

Nakib, Ghassan; Calcaterra, Valeria; Scorletti, Federico; Romano, Piero; Goruppi, Ilaria; Mencherini, Simonetta; Avolio, Luigi; Pelizzo, Gloria

2013-02-01

Robotic assisted surgery is not yet widely applied in the pediatric field. We report our initial experience regarding the feasibility, safety, benefits, and limitations of robot-assisted surgery in pediatric gynecological patients. Descriptive, retrospective report of experience with pediatric gynecological patients over a period of 12 months. Department of Pediatric Surgery, IRCCS Policlinico San Matteo Foundation. Children and adolescents, with a surgical diagnosis of ovarian and/or tubal lesions. Robot assembly time and operative time, days of hospitalization, time to cessation of pain medication, complication rate, conversion rate to laparoscopic procedure and trocar insertion strategy. Six children and adolescents (2.4-15 yrs), weighing 12-55 kg, underwent robotic assisted surgery for adnexal pathologies: 2 for ovarian cystectomy, 2 for oophorectomy, 1 for right oophorectomy and left salpingo-oophorectomy for gonadal disgenesis, 1 for exploration for suspected pelvic malformation. Mean operative time was 117.5 ± 34.9 minutes. Conversion to laparatomy was not necessary in any of the cases. No intra- or postoperative complications occurred. Initial results indicate that robotic assisted surgery is safely applicable in the pediatric gynecological population, although it is still premature to conclude that it provides better clinical outcomes than traditional laparoscopic surgery. Randomized, prospective, comparative studies will help characterize the advantages and disadvantages of this new technology in pediatric patients. Copyright © 2013 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Describing care coordination of gynecologic oncology in western healthcare settings: a rapid review.

PubMed

Grant, Sean; Motala, Aneesa; Chrystal, Joya G; Shanman, Roberta; Zuchowski, Jessica; Zephyrin, Laurie; Cordasco, Kristina M

2018-05-23

Caring for women with gynecologic malignancies requires multidisciplinary communication and coordination across multiple providers. This article discusses a rapid review of the literature on characteristics of care coordination for gynecologic malignancies. Five electronic databases (from inception through March 2015) were searched for empirical studies on coordinated care models for female adults with gynecologic malignancies. A single reviewer extracted and synthesized information on how care was coordinated, how care teams made decisions, who performed what tasks, how care teams communicated information to coordinate care, and potential impact of the characteristic on delivering coordinated care. From 26 included studies, predominant characteristics of coordinated care were identified: multidisciplinary teams, patient navigators, scheduled follow-ups, survivorship care plans, and colocated services. Decision-making was best documented for studies that utilized teams that had periodic scheduled meetings with set agendas and consistent procedures. Providers' roles in coordinating care were numerous, reflecting professional backgrounds: oncologists had most authority in making treatment decisions; radiologists and pathologists shared vital biomedical information; and nurses coordinated care and communicated with patients. Communication tools and strategies across studies included having shared medical records, integrated treatment plans, and telephone-based or teleconferencing communication. There was limited information available on the impact of characteristics and accompanying strategies or tools. Several characteristics of care coordination models for gynecologic cancers have been published in the literature. Further investigation is needed to understand the relative effectiveness of these ways to coordinate care.

Psychiatric Disorders in Outpatients With Borderline Intellectual Functioning: Comparison With Both Outpatients From Regular Mental Health Care and Outpatients With Mild Intellectual Disabilities

PubMed Central

Wieland, Jannelien; Haan, Sara Kapitein-de; Zitman, Frans G

2014-01-01

Objective: In the Netherlands, patients with borderline intellectual functioning are eligible for specialized mental health care. This offers the unique possibility to examine the mix of psychiatric disorders in patients who, in other countries, are treated in regular outpatient mental health care clinics. Our study sought to examine the rates of all main Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, Axis I psychiatric diagnoses in outpatients with borderline intellectual functioning of 2 specialized regional psychiatric outpatient departments and to compare these with rates of the same disorders in outpatients from regular mental health care (RMHC) and outpatients with mild intellectual disabilities (IDs). Method: Our study was a cross-sectional, anonymized medical chart review. All participants were patients from the Dutch regional mental health care provider Rivierduinen. Diagnoses of patients with borderline intellectual functioning (borderline intellectual functioning group; n = 235) were compared with diagnoses of patients from RMHC (RMHC group; n = 1026) and patients with mild ID (mild ID group; n = 152). Results: Compared with the RMHC group, psychotic and major depressive disorders were less common in the borderline intellectual functioning group, while posttraumatic stress disorder and V codes were more common. Compared with the mild ID group, psychotic disorders were significantly less common. Conclusion: Mental health problems in people with borderline intellectual functioning may not be well addressed in general psychiatry, or by standard psychiatry for patients with ID. Specific attention to this group in clinical practice and research may be warranted lest they fall between 2 stools. PMID:25007114

Psychiatric disorders in outpatients with borderline intellectual functioning: comparison with both outpatients from regular mental health care and outpatients with mild intellectual disabilities.

PubMed

Wieland, Jannelien; Kapitein-de Haan, Sara; Zitman, Frans G

2014-04-01

In the Netherlands, patients with borderline intellectual functioning are eligible for specialized mental health care. This offers the unique possibility to examine the mix of psychiatric disorders in patients who, in other countries, are treated in regular outpatient mental health care clinics. Our study sought to examine the rates of all main Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, Axis I psychiatric diagnoses in outpatients with borderline intellectual functioning of 2 specialized regional psychiatric outpatient departments and to compare these with rates of the same disorders in outpatients from regular mental health care (RMHC) and outpatients with mild intellectual disabilities (IDs). Our study was a cross-sectional, anonymized medical chart review. All participants were patients from the Dutch regional mental health care provider Rivierduinen. Diagnoses of patients with borderline intellectual functioning (borderline intellectual functioning group; n = 235) were compared with diagnoses of patients from RMHC (RMHC group; n = 1026) and patients with mild ID (mild ID group; n = 152). Compared with the RMHC group, psychotic and major depressive disorders were less common in the borderline intellectual functioning group, while posttraumatic stress disorder and V codes were more common. Compared with the mild ID group, psychotic disorders were significantly less common. Mental health problems in people with borderline intellectual functioning may not be well addressed in general psychiatry, or by standard psychiatry for patients with ID. Specific attention to this group in clinical practice and research may be warranted lest they fall between 2 stools.

Gynecological cancer in Indonesia.

PubMed

Aziz, M Farid

2009-03-01

To overview the status of gynecologic cancer in Indonesia. Information regarding Indonesia obtained from World Bank Report and Statistical Yearbook of Indonesia 2007, epidemiological data obtained from Histopathological Data of Cancer in Indonesia 2002, Department of Health-Registry Body of Indonesian Specialist of Pathology Association-Indonesian Cancer Society; Various Hospitals in big Cities in Indonesia. Indonesia is an Archipelago with a total area of 1,922,570.00 km(2), the population is 222,192,000 (2006), the fourth world rank. Female is 49.86% with life expectancy 69 years. Gross National Product per Capita is 690.00 USD. Histopathological report in 2002 revealed that cervical cancer, ovarian cancer and uterine cancer were the most frequent cancer among female, which were the first (2,532 cases), the third (829 cases) and the eighth (316 cases) rank respectively. The peak age for cervical, uterine and ovarian cancer was 45-54 years. HPV 16, 18 were found in 82% of invasive cervical. Data from various academic hospitals in 2007 showed that cervical cancer is the most common malignancy followed by ovary, uterus, vulva and vagina. Five-year survival rate of stage I, II, III, IV cervical cancer were 50%, 40%, 20%, and 0% respectively. Overall five-year survival rate of carcinoma of the ovary was 54.8%. If sub-classified by stage, five-year survival rate are 94.3%, 75.0%, 31%, and 11.7% for stage I, II, III, and IV respectively. Five-year disease-free survival rate of endometrial cancer was 71.9%. Indonesia is the biggest Archipelago with a dense population but the income per capita still low (poor country). The most common gynecologic cancer is cervical cancer, followed by ovarian and uterine cancer. These cancers are included in top ten cancers in Indonesia. HPV 16, 18 were the most cause of cervical cancer. The five-year survival rates are comparable with world report.

Facilitators and barriers to the use of standing orders for vaccination in obstetrics and gynecology settings.

PubMed

Barnard, Juliana G; Dempsey, Amanda F; Brewer, Sarah E; Pyrzanowski, Jennifer; Mazzoni, Sara E; O'Leary, Sean T

2017-01-01

Many young and middle-aged women receive their primary health care from their obstetrician-gynecologists. A recent change to vaccination recommendations during pregnancy has forced the integration of new clinical processes at obstetrician-gynecology practices. Evidence-based best practices for vaccination delivery include the establishment of vaccination standing orders. As part of an intervention to increase adoption of evidence-based vaccination strategies for women in safety-net and private obstetrician-gynecology settings, we conducted a qualitative study to identify the facilitators and barriers experienced by obstetrician-gynecology sites when establishing vaccination standing orders. At 6 safety-net and private obstetrician-gynecology practices, 51 semistructured interviews were completed by trained qualitative researchers over 2 years with clinical staff and vaccination program personnel. Standardized qualitative research methods were used during data collection and team-based data analysis to identify major themes and subthemes within the interview data. All study practices achieved partial to full implementation of vaccine standing orders for human papillomavirus, tetanus diphtheria pertussis, and influenza vaccines. Facilitating factors for vaccine standing order adoption included process standardization, acceptance of a continual modification process, and staff training. Barriers to vaccine standing order adoption included practice- and staff-level competing demands, pregnant women's preference for medical providers to discuss vaccine information with them, and staff hesitation in determining HPV vaccine eligibility. With guidance and commitment to integration of new processes, obstetrician-gynecology practices are able to establish vaccine standing orders for pregnant and nonpregnant women. Attention to certain process barriers can aid the adoption of processes to support the delivery of vaccinations in obstetrician-gynecology practice setting, and

Auditing psychiatric out-patient records.

PubMed

Pillay, Selena; O'Dwyer, Sarah; McCarthy, Marguerite

2010-01-01

Up-to-date patient records are essential for safe and professional practice. They are an intrinsic component for providing adequate care and ensuring appropriate and systematic treatment 2009 plans. Furthermore, accurate and contemporaneous notes are essential for achieving professional standards from a medico-legal perspective. The study's main aim was to investigate current record-keeping practices by looking at whether out-patient communication pathways to general practitioners, from letter dictation to insertion in the chart, were being satisfied. From current out-patient attendees over six months, 100 charts were chosen randomly, and reviewed. A pro-forma was used to collect data and this information was also checked against electronic records. Of the charts reviewed, 15 per cent had no letter. If one considers that one-month is an acceptable time for letters to be inserted into the chart, then only 11 per cent satisfied this condition. Electronic data were also missing. It is impossible to discern whether letters to GPs were dictated by the out-patient doctor for each patient reviewed. Another limitation was that some multidisciplinary hospital teams have different out-patient note-keeping procedures, which makes some findings difficult to interpret. The review drew attention to current record-keeping discrepancies, highlighting the need for medical record-keeping procedures and polices to be put in place. Also brought to light was the importance of providing a workforce sufficient to meet the out-patient team's administrative needs. An extended audit of other medical record-keeping aspects should be carried out to determine whether problems occur in other areas. The study highlights the importance of establishing agreed policies and procedures for out-patient record keeping and the need to have a checking mechanism to identify system weaknesses.

A comparison of medical litigation filed against obstetrics and gynecology, internal medicine, and surgery departments.

PubMed

Hamasaki, Tomoko; Hagihara, Akihito

2015-10-24

The aim of this study was to review the typical factors related to physician's liability in obstetrics and gynecology departments, as compared to those in internal medicine and surgery, regarding a breach of the duty to explain. This study involved analyzing 366 medical litigation case reports from 1990 through 2008 where the duty to explain was disputed. We examined relationships between patients, physicians, variables related to physician's explanations, and physician's breach of the duty to explain by comparing mean values and percentages in obstetrics and gynecology, internal medicine, and surgical departments with the t-test and χ(2) test. When we compared the reasons for decisions in cases where the patient won, we found that the percentage of cases in which the patient's claim was recognized was the highest for both physician negligence, including errors of judgment and procedural mistakes, and breach of the duty to explain, in obstetrics and gynecology departments; breach of the duty to explain alone in internal medicine departments; and mistakes in medical procedures alone in surgical departments (p = 0.008). When comparing patients, the rate of death was significantly higher than that of other outcomes in precedents where a breach of the duty to explain was acknowledged (p = 0.046). The proportion of cases involving obstetrics and gynecology departments, in which care was claimed to be substandard at the time of treatment, and that were not argued as breach of a duty to explain, was significantly higher than those of other evaluated departments (p <0.001). However, internal medicine and surgical departments were very similar in this context. In obstetrics and gynecology departments, the proportion of cases in which it had been conceded that the duty to explain had been breached when seeking patient approval (or not) was significantly higher than in other departments (p = 0.002). It is important for physicians working in obstetrics and gynecology

Use of augmented reality in laparoscopic gynecology to visualize myomas.

PubMed

Bourdel, Nicolas; Collins, Toby; Pizarro, Daniel; Debize, Clement; Grémeau, Anne-Sophie; Bartoli, Adrien; Canis, Michel

2017-03-01

To report the use of augmented reality (AR) in gynecology. AR is a surgical guidance technology that enables important hidden surface structures to be visualized in endoscopic images. AR has been used for other organs, but never in gynecology and never with a very mobile organ like the uterus. We have developed a new AR approach specifically for uterine surgery and demonstrated its use for myomectomy. Tertiary university hospital. Three patients with one, two, and multiple myomas, respectively. AR was used during laparoscopy to localize the myomas. Three-dimensional (3D) models of the patient's uterus and myomas were constructed before surgery from T2-weighted magnetic resonance imaging. The intraoperative 3D shape of the uterus was determined. These models were automatically aligned and "fused" with the laparoscopic video in real time. The live fused video made the uterus appear semitransparent, and the surgeon can see the location of the myoma in real time while moving the laparoscope and the uterus. With this information, the surgeon can easily and quickly decide on how best to access the myoma. We developed an AR system for gynecologic surgery and have used it to improve laparoscopic myomectomy. Technically, the software we developed is very different to approaches tried for other organs, and it can handle significant challenges, including image blur, fast motion, and partial views of the organ. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Radiation therapy oncology group gynecologic oncology working group: comprehensive results.

PubMed

Gaffney, David K; Jhingran, Anuja; Portelance, Lorraine; Viswanathan, Akila; Schefter, Tracey; Weidhaas, Joanne; Small, William

2014-06-01

The purpose of this report was to comprehensively describe the activities of the Gynecologic Oncology Working Group within the Radiation Therapy Oncology Group (RTOG). Clinical trials will be reviewed as well as translational science and ancillary activities. During the past 40 years, a myriad of clinical trials have been performed within the RTOG with the aim of improving overall survival (OS) and decreasing morbidity in women with cervical or endometrial cancer. Major study questions have included hyperbaric oxygen, neutron radiotherapy, altered fractionation, hypoxic cell sensitization, chemosensitization, and volume-directed radiotherapy.RTOG 7920 demonstrated improvement in OS in patients with stages IB through IIB cervical carcinoma receiving prophylactic para-aortic irradiation compared to pelvic radiation alone. RTOG 9001 demonstrated that cisplatin and 5-FU chemoradiotherapy to the pelvis for advanced cervix cancer markedly improved OS compared to extended field radiotherapy alone. More recent trials have used radioprotectors, molecular-targeted therapy, and intensity-modulated radiation therapy. Ancillary studies have developed clinical target volume atlases for research protocols and routine clinical use. Worldwide practice patterns have been investigated in cervix, endometrial, and vulvar cancer through the Gynecologic Cancer Intergroup. Translational studies have focused on immunohistochemical markers, changes in gene expression, and miRNA patterns impacting prognosis.The RTOG gynecologic working group has performed clinical trials that have defined the standard of care, improved survival, and added to our understanding of the biology of cervical and endometrial cancers.

The gynecologic oncology fellowship interview process: Challenges and potential areas for improvement.

PubMed

Gressel, Gregory M; Van Arsdale, Anne; Dioun, Shayan M; Goldberg, Gary L; Nevadunsky, Nicole S

2017-05-01

The application and interview process for gynecologic oncology fellowship is highly competitive, time-consuming and expensive for applicants. We conducted a survey of successfully matched gynecologic oncology fellowship applicants to assess problems associated with the interview process and identify areas for improvement. All Society of Gynecologic Oncology (SGO) list-serve members who have participated in the match program for gynecologic oncology fellowship were asked to complete an online survey regarding the interview process. Linear regression modeling was used to examine association between year of match, number of programs applied to, cost incurred, and overall satisfaction. Two hundred and sixty-nine eligible participants reported applying to a mean of 20 programs [range 1-45] and were offered a mean of 14 interviews [range 1-43]. They spent an average of $6000 [$0-25,000], using personal savings (54%), credit cards (50%), family support (12%) or personal loans (3%). Seventy percent of respondents identified the match as fair, and 93% were satisfied. Interviewees spent a mean of 15 [0-45] days away from work and 37% reported difficulty arranging coverage. Linear regression showed an increase in number of programs applied to and cost per applicant over time ( p  < 0.001) between 1993 and 2016. Applicants who applied to all available programs spent more ( p  < 0.001) than those who applied to programs based on their location or quality. The current fellowship match was identified as fair and satisfying by most respondents despite being time consuming and expensive. Suggested alternative options included clustering interviews geographically or conducting preliminary interviews at the SGO Annual Meeting.

Maylard incision in gynecologic surgery: 4-year experience in Thammasat University Hospital.

PubMed

Manusook, Sakol; Suwannarurk, Komsun; Pongrojpaw, Densak; Bhamarapravatana, Kornkarn

2014-08-01

To present the results of Maylard incisionfor gynecologic surgery in Thammasat University Hospital during the past four years. A retrospective study of gynecologic surgery performed via the Maylard muscle cutting incision compare to Pfannenstiel muscle splitting and midline incision. Data came from subjects who underwent gynecologic surgey at Thammasat University Hospital, Pathumthani, Thailand friom January 2010 to December 2013. In the period of 4 years, there were 283 cases of elective surgery that performed via Maylard, Pfannenstiel and midline incision by the single experience gynecologic surgeon team. One hundred and six cases were performed via Maylard incision technique. The remaining 59 and 118 cases were performed via Pfannenstiel and midline incision technique, respectively. Two-thirds and one-thirds of cases underwent hysterectomy and conservative surgery, respectively. Benign conditions were the major indicationfor surgery at the percentage of 83.4. Operative results were not significantly different from well-known midline and Pfannenstiel incision in terms of blood loss, time to first meal and postoperative pain. Operative time in Maylard incision was longer than in Pfannenstiel incision. Length of stay in Maylard incision was longer than Pfannenstiel but shorter than midline incision. Overall complications (eoperation, bowel injuries, urinary bladder injuries and blood transfusion rate) were not significantly different. Maylard incision provides similar operative results with midline and Pfannenstiel technique. Even though it takes more time for abdominal entry but it gives more operative exposure than Pfannenstiel incision. In the woman with previous low transverse scar and gynaecologic surgery is needed, Maylard incision could be an optional technique that provides cosmetic and successfud results. Hand on training for Maylard incision from their mentors should be encouraged to more practice.

Robotic surgery in complicated gynecologic diseases: experience of Tri-Service General Hospital in Taiwan.

PubMed

Tan, Shun-Jen; Lin, Chi-Kung; Fu, Pei-Te; Liu, Yung-Liang; Sun, Cheng-Chian; Chang, Cheng-Chang; Yu, Mu-Hsien; Lai, Hung-Cheng

2012-03-01

Minimally invasive surgery has been the trend in various specialties and continues to evolve as new technology develops. The development of robotic surgery in gynecology remains in its infancy. The present study reports the first descriptive series of robotic surgery in complicated gynecologic diseases in Taiwan. From March 2009 to February 2011, the records of patients undergoing robotic surgery using the da Vinci Surgical System were reviewed for patient demographics, indications, operative time, hospital stay, conversion to laparotomy, and complications. Sixty cases were reviewed in the present study. Forty-nine patients had benign gynecologic diseases, and 11 patients had malignancies. These robot-assisted laparoscopic procedures include nine hysterectomy, 15 subtotal hysterectomy, 13 myomectomy, eight staging operation, two radical hysterectomy, five ovarian cystectomy, one bilateral salpingo-oophorectomy and myomectomy, two resections of deep pelvic endometriosis, one pelvic adhesiolysis, three sacrocolpopexy and one tuboplasty. Thirty-three patients had prior pelvic surgery, and one had a history of pelvic radiotherapy. Adhesiolysis was necessary in 38 patients to complete the whole operation. Robotic myomectomy was easily accomplished in patients with huge uterus or multiple myomas. The suturing of myometrium or cervical stump after ligation of the uterine arteries minimized the blood loss. In addition, it was much easier to dissect severe pelvic adhesions. The dissection of para-aortic lymph nodes can be easily accomplished. All these surgeries were performed smoothly without ureteral, bladder or bowel injury. The present analyses include various complicated gynecologic conditions, which make the estimation of the effectiveness of robotic surgery in each situation individually not appropriate. However, our experiences do show that robotic surgery is feasible and safe for patients with complicated gynecologic diseases. Copyright © 2012. Published by

Scientific research in obstetrics and gynecology: changes in the trends over three decades

PubMed Central

Kassem, Gamal A

2015-01-01

Aim The aim of this work was to assess scientific research of master’s and doctoral theses and essays in the Department of Obstetrics and Gynecology, Zagazig University, Egypt. Materials and methods All master’s and doctoral theses and essays since the foundation of Department of Obstetrics and Gynecology, Zagazig University, Egypt, in 1975 till end of 2012 were reviewed. Results A total of 703 theses and essays were reviewed. The important topics in the specialty of obstetrics and gynecology were covered and updated. Infertility, in vitro fertilization–embryo transfer (IVF-ET) and related techniques, and polycystic ovarian disease were the most common gynecologic topics (27.2%), followed by gynecologic oncology (18.5%). Preeclampsia was the most common obstetrics topic (18.8%), followed by issues of high-risk pregnancy, fetal growth restriction, and fetal well-being (11.6%). The number of researches that allow the candidates to learn skills was 183 and it was increased from 4.4% of all research in the period 1979–1988 to 33.2% in period 1989–2000 then slightly decreased to 31.2% in period 2001–2012. Ultrasonography was on the top and was present in 99 out of 183 (54.1%) followed by laparoscopy (30, 16.4%), hysteroscopy (25, 13.7%), IVF-ET and related techniques (16, 8.7%) and colposcopy (13, 7.1%) researches. Multi-disciplinary research was decreased by 61.7% in the period 2001–2012. Researches in academic fields were abandoned and in some clinically important areas like preeclampsia were decreased. Conclusion Scientific research of master’s and doctoral theses and essays was comprehensive, updated, and had some autonomy independent of plans. Research which enable the candidate to learn skills were increased on the expense of academic, clinical and multidisciplinary research. It could be recommended that plans for scientific research should be flexible and should leave a space for local departmental views. Proper training of residents during their

Scientific research in obstetrics and gynecology: changes in the trends over three decades.

PubMed

Kassem, Gamal A

2015-01-01

The aim of this work was to assess scientific research of master's and doctoral theses and essays in the Department of Obstetrics and Gynecology, Zagazig University, Egypt. All master's and doctoral theses and essays since the foundation of Department of Obstetrics and Gynecology, Zagazig University, Egypt, in 1975 till end of 2012 were reviewed. A total of 703 theses and essays were reviewed. The important topics in the specialty of obstetrics and gynecology were covered and updated. Infertility, in vitro fertilization-embryo transfer (IVF-ET) and related techniques, and polycystic ovarian disease were the most common gynecologic topics (27.2%), followed by gynecologic oncology (18.5%). Preeclampsia was the most common obstetrics topic (18.8%), followed by issues of high-risk pregnancy, fetal growth restriction, and fetal well-being (11.6%). The number of researches that allow the candidates to learn skills was 183 and it was increased from 4.4% of all research in the period 1979-1988 to 33.2% in period 1989-2000 then slightly decreased to 31.2% in period 2001-2012. Ultrasonography was on the top and was present in 99 out of 183 (54.1%) followed by laparoscopy (30, 16.4%), hysteroscopy (25, 13.7%), IVF-ET and related techniques (16, 8.7%) and colposcopy (13, 7.1%) researches. Multi-disciplinary research was decreased by 61.7% in the period 2001-2012. Researches in academic fields were abandoned and in some clinically important areas like preeclampsia were decreased. Scientific research of master's and doctoral theses and essays was comprehensive, updated, and had some autonomy independent of plans. Research which enable the candidate to learn skills were increased on the expense of academic, clinical and multidisciplinary research. It could be recommended that plans for scientific research should be flexible and should leave a space for local departmental views. Proper training of residents during their rotation in these subspecialties may help to revive the lost

Effective feedback strategies for teaching in pediatric and adolescent gynecology.

PubMed

Kaul, Paritosh; Gong, Jennifer; Guiton, Gretchen

2014-08-01

The clinical setting of pediatric and adolescent gynecology poses complex tasks for the physician with its numerous procedures and the communication demands of interacting with an adolescent and/or guardian. Needless to say, teaching within this setting is highly demanding. Regardless of the level of learner or the professional role (e.g., nurse, medical student, resident, physician assistant) represented, clinical teaching requires that the instructor provide feedback in ways that benefit the student. Recent research on feedback suggests a more complex understanding of feedback than in the past. This article highlights key research and its implication for effective feedback by presenting a three part framework; know your learner, understand what is to be learned, and plan for improvement. Copyright © 2014 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Allocation of nursing care hours in a combined ophthalmic nursing unit.

PubMed

Navarro, V B; Stout, W A; Tolley, F M

1995-04-01

Traditional service configuration with separate nursing units for outpatient and inpatient care is becoming ineffective for new patient care delivery models. With the new configuration of a combined nursing unit, it was necessary to rethink traditional reporting methodologies and calculation of hours of care. This project management plan is an initial attempt to develop a standard costing/productivity model for a combined unit. The methodology developed from this plan measures nursing care hours for each patient population to determine the number of full time equivalents (FTEs) for a combined unit and allocates FTEs based on inpatient (IP), outpatient (OP), and emergency room (ER) volumes.

The role of obstetrics and gynecology national societies during natural disasters.

PubMed

Lalonde, André; Adrien, Lauré

2015-07-01

When a natural disaster occurs, such as an earthquake, floods, or a tsunami, the international response is quick. However, there is no organized strategy in place to address obstetric and gynecological (ob/gyn) emergencies. International organizations and national ob/gyn societies do not have an organized plan and rely on the good will of volunteers. Too often, local specialists are ignored and are not involved in the response. The massive earthquake in Haiti in 2010 exemplifies the lack of coordinated response involving national organizations following the disaster. The Society of Obstetricians and Gynaecologists of Canada (SOGC) engaged rapidly with Haitian colleagues in response to the obstetric and gynecological emergencies. An active strategy is proposed. Copyright © 2015. Published by Elsevier Ireland Ltd.

Impact of Postoperative Intravenous Acetaminophen on Opioid Requirements and Pain Scores Following Gynecologic Procedures.

PubMed

Stoudenmire, Laura G; Norman, Christy M; Latif, Erin Z

2016-10-01

This study aims to assess the impact of postoperative intravenous (IV) acetaminophen on opioid requirements and pain scores in patients following gynecologic procedures. A retrospective cohort study of patients undergoing gynecologic procedures was conducted to assess the impact of adding scheduled IV acetaminophen to postoperative analgesic regimens. The control group consisted of patients admitted prior to formulary addition of IV acetaminophen; the study group consisted of patients admitted after formulary addition of IV acetaminophen who received scheduled IV acetaminophen for at least the first 24 hours postoperatively. Opioid requirements 0 to 24 hours postoperatively served as the primary end point. Secondary end points included average pain score, cumulative acetaminophen dose, nonopioid analgesic requirements, and rate of adverse events 0 to 24 hours postoperatively. One hundred and thirty-seven patients who underwent a gynecologic procedure from January 2009 to April 2013 were included in this study. Baseline characteristics were similar between the groups. In the first 24 hours postoperatively, there was no difference in opioid requirements between the groups (21 mg [interquartile range, IQR, 15-39.8 mg] vs 32.6 mg [IQR, 16.75-41 mg], P = 0.150). The average pain score and incidence of adverse events did not differ between the 2 groups. Postoperative administration of IV acetaminophen did not provide a significant opioid-sparing effect in patients undergoing gynecologic procedures. © The Author(s) 2015.

Outpatient substance abuse treatment and HIV prevention: an update.

PubMed

Pollack, Harold A; D'Aunno, Thomas; Lamar, Barbara

2006-01-01

Testing and counseling, along with community outreach, have been identified as valuable in the prevention of human immunodeficiency virus (HIV) and other blood-borne diseases. This article assesses the extent to which outpatient substance abuse treatment (OSAT) programs provide such services. Longitudinal data for 1988-2000 were analyzed from the National Drug Abuse Treatment System Survey (NDATSS). Random-effects regression was used to examine factors associated with the provision of prevention services. HIV testing, which had became more common between 1990 and 1995, continued to proliferate between 1995 and 2000. The proportion of units that provide HIV testing and counseling increased from 66% to 86%. The proportion of units that provide HIV community outreach increased significantly before 1995 but then slightly decreased from 77% to 73% between 1995 and 2000. In conclusion, HIV testing and counseling widely proliferated in OSAT care. However, OSAT units remain less likely to offer HIV community outreach services.

21 CFR 884.4530 - Obstetric-gynecologic specialized manual instrument.

Code of Federal Regulations, 2011 CFR

2011-04-01

.... This type of device consists of the following: (1) An amniotome is an instrument used to rupture the... cerclage needle is a looplike instrument used to suture the cervix. (10) A hook-type contraceptive... cervix or vagina. (14) A gynecological biopsy forceps is an instrument with two blades and handles used...

Opioid use in gynecologic oncology in the age of the opioid epidemic: Part I - Effective opioid use across clinical settings, a society of gynecologic oncology evidence-based review.

PubMed

Lefkowits, Carolyn; Buss, Mary K; Ramzan, Amin A; Fischer, Stacy; Urban, Renata R; Fisher, Christine M; Duska, Linda R

2018-05-01

As the only oncologists that provide both medical and surgical oncologic care, gynecologic oncologists encounter an exceptionally broad range of indications for prescribing opioids, from management of acute post-operative pain to chronic cancer-related pain to end-of-life care. If we are to balance opioid efficacy, safety and accessibility for our patients, we must be intimately familiar with appropriate clinical use of opioids in a range of settings, and engage in the national conversation around opioid misuse and how associated regulations and legislation may impact us and our patients. This article examines the appropriate use of opioids across the range of clinical settings encountered in gynecologic oncology. Copyright © 2018 Elsevier Inc. All rights reserved.

Pregnancy and abortion in greek adolescent gynecologic clinics.

PubMed

Deligeoroglou, Efthimios; Christopoulos, Panagiotis; Creatsas, George

2004-01-01

Recently was noted that teenagers are sexually active in younger ages and demonstrate lower compliance to contraceptive methods. An unintended, and most of the times unwanted pregnancy, brings teenagers before a crisis. The decision for the interruption of the pregnancy is nowadays taken frequently. Purpose of this study was to evaluate adolescent pregnancy and abortion rates in Greek adolescents. We recorded all adolescents presented and admitted in the University Departments of Obstetrics and Gynecology of Athens Medical School, from 1985 to 2003. We recorded the gestational age at delivery, pregnancy outcome and birth weight. Adolescent mothers, aged 14-19 years old, represent 7,48% of total births of the two University Departments of Obstetrics and Gynecology of Athens Medical School. Among the teenage pregnancies, 36% resulted in birth, 56% in abortion and 8% in miscarriage. The mean gestational age at delivery was 38 weeks and 4 days and the mean birth weight was 2.920 g. Teenage birth rate has declined from 9.0% in 1985 to 5.2% in 2003. Teenage pregnancy rates have declined over the last years but still remains a serious medical and social problem. Abortion rates are still extremely high during adolescence.

Comparison of Women in Department Leadership in Obstetrics and Gynecology With Those in Other Specialties.

PubMed

Hofler, Lisa G; Hacker, Michele R; Dodge, Laura E; Schutzberg, Rose; Ricciotti, Hope A

2016-03-01

To compare the representation of women in obstetrics and gynecology department-based leadership to other clinical specialties while accounting for proportions of women in historical residency cohorts. This was a cross-sectional observational study. The gender of department-based leaders (chair, vice chair, division director) and residency program directors was determined from websites of 950 academic departments of anesthesiology, diagnostic radiology, general surgery, internal medicine, neurology, obstetrics and gynecology, pathology, pediatrics, and psychiatry. Each specialty's representation ratio-proportion of leadership roles held by women in 2013 divided by proportion of residents in 1990 who were women-and 95% confidence interval (CI) were calculated. A ratio of 1 indicates proportionate representation. Women were significantly underrepresented among chairs for all specialties (ratios 0.60 or less, P≤.02) and division directors for all specialties except anesthesiology (ratio 1.13, 95% CI 0.87-1.46) and diagnostic radiology (ratio 0.97, 95% CI 0.81-1.16). The representation ratio for vice chair was below 1.0 for all specialties except anesthesiology; this finding reached statistical significance only for pathology, pediatrics, and psychiatry. Women were significantly overrepresented as residency program directors in general surgery, anesthesiology, obstetrics and gynecology, and pediatrics (ratios greater than 1.19, P≤.046). Obstetrics and gynecology and pediatrics had the highest proportions of residents in 1990 and department leaders in 2013 who were women. Despite having the largest proportion of leaders who were women, representation ratios demonstrate obstetrics and gynecology is behind other specialties in progression of women to departmental leadership. Women's overrepresentation as residency program directors raises concern because education-based academic tracks may not lead to major leadership roles.

[Patients of immigrant origin in outpatient psychiatric facilities: a comparison between Turkish, eastern European and German patients].

PubMed

Schouler-Ocak, Meryam; Bretz, H Joachim; Hauth, Iris; Montesinos, Amanda Heredia; Koch, Eckhardt; Driessen, Martin; Heinz, Andreas

2010-11-01

Nationwide representative survey of the use of psychiatric outpatient services in Germany. Every fifth patient of several psychiatric outpatient services was surveyed on one index day (27 (th) of May 2008) with respect to sociodemographic characteristics, ICD-10 diagnoses, difficulties in communication, treatment duration, and number of sickness certificates. Patients with immigrant background comprised 32.5 % of all patients. Compared to German patients, patients with immigrant background received significantly more neurotic, stress-related and somatoform disorders (F4). Turkish patients received significantly more mood (affective) disorders diagnoses (F3), compared to German and Eastern Europe patients. Immigrants had shorter treatment duration and a higher number of sickness certificates. Eastern European patients had a significantly higher education, compared to patients with Turkish background. Patients with immigrant background were younger compared to German patients and had significantly more children. The utilization of outpatient psychiatric services by patients with a migratory background is high. This suggests that immigrants benefit from the multiprofessional team and the low-treshold service offered by outpatient units. © Georg Thieme Verlag KG Stuttgart · New York.

Prevalence of Burnout in residents of obstetrics and gynecology: A systematic review and meta-analysis

PubMed Central

Moradi, Yousef; Baradaran, Hamid Reza; Yazdandoost, Maryam; Atrak, Shahla; Kashanian, Maryam

2015-01-01

Background: Burnout is currently a major concern among physicians due to their high level of stress at work. There are several reports on various levels of burnout in residency programs due to several predisposing factors. The aim of this systematic review was to estimate a more precise prevalence of burnout among residents of obstetrics and gynecology. Methods: PubMed, Science Direct and Scopus were searched to identify peer-reviewed Englishlanguage studies published from January 1974 to 2005 reporting burnout among residents of obstetrics and gynecology. The key words used in the search were as follows: Residents, gynecology and obstetrics, professional burnout, depersonalization, distress, anxiety, or emotional exhaustion. Relevant additional articles were identified from the lists of the retrieved articles. Results: We identified 12 studies which met our criteria. A total of 2509 participants were included in this meta-analysis. The overall prevalence rate of burnout on all the three subscales was 44% (95% CI: 30 - 57) in this group of residents. Conclusion: This meta-analysis revealed a high prevalence of burnout syndrome in residents during obstetrics and gynecology residency program. Therefore, it is recommended to consider and address this important issue to develop solutions and interventions which could improve the work condition of the medical residents. PMID:26793673

Enhanced recovery pathways in abdominal gynecologic surgery: a systematic review and meta-analysis.

PubMed

de Groot, Jeanny J A; Ament, Stephanie M C; Maessen, José M C; Dejong, Cornelis H C; Kleijnen, Jos M P; Slangen, Brigitte F M

2016-04-01

Enhanced recovery pathways have been widely accepted and implemented for different types of surgery. Their overall effect in abdominal gynecologic surgery is still underdetermined. A systematic review and meta-analysis were performed to provide an overview of current evidence and to examine their effect on postoperative outcomes in women undergoing open gynecologic surgery. Searches were conducted using Embase, Medline, CINAHL, and the Cochrane Library up to 27 June 2014. Reference lists were screened to identify additional studies. Studies were included if at least four individual items of an enhanced recovery pathway were described. Outcomes included length of hospital stay, complication rates, readmissions, and mortality. Quantitative analysis was limited to comparative studies. Effect sizes were presented as relative risks or as mean differences (MD) with 95% confidence intervals (CI). Thirty-one records, involving 16 observational studies, were included. Diversity in reported elements within studies was observed. Preoperative education, early oral intake, and early mobilization were included in all pathways. Five studies, with a high risk of bias, were eligible for quantitative analysis. Enhanced recovery pathways reduced primary (MD -1.57 days, 95% CI CI -2.94 to -0.20) and total (MD -3.05 days, 95% CI -4.87 to -1.23) length of hospital stay compared with traditional perioperative care, without an increase in complications, mortality or readmission rates. The available evidence based on a broad range of non-randomized studies at high risk of bias suggests that enhanced recovery pathways may reduce length of postoperative hospital stay in abdominal gynecologic surgery. © 2015 Nordic Federation of Societies of Obstetrics and Gynecology.

21 CFR 884.4530 - Obstetric-gynecologic specialized manual instrument.

Code of Federal Regulations, 2014 CFR

2014-04-01

... cervix or vagina. (14) A gynecological biopsy forceps is an instrument with two blades and handles used... and hold the cervix or fundus. (16) An internal pelvimeter is an instrument used within the vagina to... used to expose the interior of the vagina. (18) A fiberoptic nonmetal vaginal speculum is a nonmetal...

21 CFR 884.4530 - Obstetric-gynecologic specialized manual instrument.

Code of Federal Regulations, 2013 CFR

2013-04-01

... cervix or vagina. (14) A gynecological biopsy forceps is an instrument with two blades and handles used... and hold the cervix or fundus. (16) An internal pelvimeter is an instrument used within the vagina to... used to expose the interior of the vagina. (18) A fiberoptic nonmetal vaginal speculum is a nonmetal...

21 CFR 884.4530 - Obstetric-gynecologic specialized manual instrument.

Code of Federal Regulations, 2012 CFR

2012-04-01

... cervix or vagina. (14) A gynecological biopsy forceps is an instrument with two blades and handles used... and hold the cervix or fundus. (16) An internal pelvimeter is an instrument used within the vagina to... used to expose the interior of the vagina. (18) A fiberoptic nonmetal vaginal speculum is a nonmetal...

[HYPNOSIS IN OBSTETRICS AND GYNECOLOGY].

PubMed

Rabinerson, David; Yeoshua, Effi; Gabbay-Ben-Ziv, Rinat

2015-05-01

Hypnosis is an ancient method of treatment, in which an enhanced state of mind and elevated susceptibility for suggestion of the patient, are increased. Hypnosis is executed, either by a caregiver or by the person himself (after brief training). The use of hypnosis in alleviating labor pain has been studied as of the second half of the 20th century. In early studies, the use of hypnosis for this purpose has been proven quite effective. However, later studies, performed in randomized controlled trial terms, have shown controversial results. Other studies, in which the effect of hypnosis was tested in various aspects of both obstetrics and gynecology and with different levels of success, are elaborated on in this review.

Introductory Course in Biomedical Ethics in the Obstetrics-Gynecology Residency.

ERIC Educational Resources Information Center

Elkins, Thomas E.

1988-01-01

Information used in a brief lecture that introduces a biomedical ethics curriculum in an obstetrics and gynecology residency is described. Major components include theories of philosophic ethics (formalist and consequentialist) and principles of biomedical ethics (honesty, contract-keeping, nonmaleficence, justice, autonomy, beneficence,…

Personal digital assistant use in Florida obstetrics and gynecology residency programs.

PubMed

Joy, Saju; Benrubi, Guy

2004-05-01

Improvements in electronic technologies have resulted in affordable, smaller computers that operate at faster speeds. The personal digital assistant (PDA) is a tool that has the potential to enhance residency education by allowing residents immediate access to an abundance of information. This article assesses the current use of this tool at obstetrics and gynecology residency programs in the state of Florida. The authors conducted a statewide survey addressing the general question: is the PDA useful in an obstetrics and gynecology residency training program? Specifically, the authors asked residents how much time was perceived to be saved weekly with the use of this tool, and in what aspect of their training use of this tool was most helpful. At the survey's close, five of seven programs had returned the survey for evaluation. These five institutions included both university- and community-based residency programs. Forty percent of obstetrics and gynecology residents at these programs responded to this questionnaire. Resident responses to the survey revealed that most of the perceived benefit was in maintaining procedural statistics logs, pharmacology reference manuals, and personal clinical protocols. Most responses revealed that only minimal time savings (<2 h/wk) were gained with using this tool. However, many residents felt they were not using this tool to its maximum potential. Nearly 90% of those who responded felt that the PDA should be available at residency programs and anticipated using it after completing residency. This study posed the question of PDA usefulness at obstetric and gynecology residency programs in the state of Florida. Although not all programs provided their residents with a PDA, 95% of the respondents revealed that they owned one of these tools. Experience at the authors' institution revealed high expectations for the potential uses of a PDA. Although many residents were not using this tool to its full potential, a PDA tutorial session

Therapeutic Approaches of Botulinum Toxin in Gynecology.

PubMed

Moga, Marius Alexandru; Dimienescu, Oana Gabriela; Bălan, Andreea; Scârneciu, Ioan; Barabaș, Barna; Pleș, Liana

2018-04-21

Botulinum toxins (BoNTs) are produced by several anaerobic species of the genus Clostridium and, although they were originally considered lethal toxins, today they find their usefulness in the treatment of a wide range of pathologies in various medical specialties. Botulinum neurotoxin has been identified in seven different isoforms (BoNT-A, BoNT-B, BoNT-C, BoNT-D, BoNT-E, BoNT-F, and BoNT-G). Neurotoxigenic Clostridia can produce more than 40 different BoNT subtypes and, recently, a new BoNT serotype (BoNT-X) has been reported in some studies. BoNT-X has not been shown to actually be an active neurotoxin despite its catalytically active LC, so it should be described as a putative eighth serotype. The mechanism of action of the serotypes is similar: they inhibit the release of acetylcholine from the nerve endings but their therapeutically potency varies. Botulinum toxin type A (BoNT-A) is the most studied serotype for therapeutic purposes. Regarding the gynecological pathology, a series of studies based on the efficiency of its use in the treatment of refractory myofascial pelvic pain, vaginism, dyspareunia, vulvodynia and overactive bladder or urinary incontinence have been reported. The current study is a review of the literature regarding the efficiency of BoNT-A in the gynecological pathology and on the long and short-term effects of its administration.

Factors affecting sexual function: A comparison between women with gynecological or rectal cancer and healthy controls.

PubMed

Li, Chia-Chun; Rew, Lynn; Chen, Lynn

2015-03-01

This study had two purposes: (i) to explore differences in sexual function between women with gynecological or rectal cancer after related pelvic-area treatments and women without cancer; and (ii) to investigate the relationships among body image, anxiety and depression, sexual relationship power, sexual self-schema, and female sexual function. The participants (n = 139) were recruited through Internet cancer support groups and women's health organizations in the USA. Six structured questionnaires were mailed, and the data were analyzed using descriptive and inferential statistics. The results showed that women with gynecological or rectal cancer had significantly worse sexual function than women without cancer. Having gynecological/rectal cancer and a negative sexual self-schema were significantly related to poor sexual function. Furthermore, sexual self-schema moderated the relationship between sexual relationship power and female sexual function. Healthcare providers could give more attention to sexual issues in women who have undergone treatment for gynecological or rectal cancer, especially for those with a negative sexual self-schema and high sexual relationship power, which might improve these women's quality of life. © 2014 Wiley Publishing Asia Pty Ltd.

Subsequent Oophorectomy and Ovarian Cancer after Hysterectomy for Benign Gynecologic Conditions at Chiang Mai University Hospital.

PubMed

Jitkunnatumkul, Aurapin; Tantipalakorn, Charuwan; Charoenkwan, Kittipat; Srisomboon, Jatupol

2016-01-01

This study was undertaken to determine the incidence of subsequent oophorectomy due to ovarian pathology or ovarian cancer in women with prior hysterectomy for benign gynecologic conditions at Chiang Mai University Hospital. Medical records of women who underwent hysterectomy for benign gynecologic diseases and pre-cancerous lesions between January 1, 2004 and December 31, 2013 at Chiang Mai University Hospital were retrospectively reviewed. The incidence and indications of oophorectomy following hysterectomy were analyzed. During the study period, 1,035 women had hysterectomy for benign gynecologic conditions. Of these, 590 women underwent hysterectomy with bilateral salpingo-oophorectomy and 445 hysterectomy with bilateral ovarian preservation or unilateral salpingo-oophorectomy. The median age was 47 years (range, 11-75 years). Ten women (2.45 %) had subsequent oophorectomy for benign ovarian cysts. No case of ovarian cancer was found. The mean time interval between hysterectomy and subsequent oophorectomy was 43.1 months (range, 2-97 months) and the mean follow-up time for this patient cohort was 51 months (range, 1.3-124.9 months). According to our hospital-based data, the incidence of subsequent oophorectomy in women with prior hysterectomy for benign gynecologic conditions is low and all present with benign conditions.

Consensus Bundle on Prevention of Surgical Site Infections After Major Gynecologic Surgery.

PubMed

Pellegrini, Joseph E; Toledo, Paloma; Soper, David E; Bradford, William C; Cruz, Deborah A; Levy, Barbara S; Lemieux, Lauren A

2017-01-01

Surgical site infections are the most common complication of surgery in the United States. Of surgeries in women of reproductive age, hysterectomy is one of the most frequently performed, second only to cesarean birth. Therefore, prevention of surgical site infections in women undergoing gynecologic surgery is an ideal topic for a patient safety bundle. The primary purpose of this safety bundle is to provide recommendations that can be implemented into any surgical environment in an effort to reduce the incidence of surgical site infection. This bundle was developed by a multidisciplinary team convened by the Council on Patient Safety in Women's Health Care. The bundle is organized into four domains: Readiness, Recognition and Prevention, Response, and Reporting and Systems Learning. In addition to recommendations for practice, each of the domains stresses communication and teamwork between all members of the surgical team. Although the bundle components are designed to be adaptable to work in a variety of clinical settings, standardization within institutions is encouraged.

Fall risk and function in older women after gynecologic surgery.

PubMed

Miller, Karen L; Richter, Holly E; Graybill, Charles S; Neumayer, Leigh A

2017-11-01

To examine change in balance-related fall risk and daily functional abilities in the first 2 post-operative weeks and up to 6 weeks after gynecologic surgery. Prospective cohort study in gynecologic surgery patients age 65 and older. Balance confidence (Activities-specific Balance Confidence Scale) and functional status (basic and instrumental activities of daily living) were recorded pre- and post-operatively daily for 1 week and twice the second week. Physical performance balance and functional mobility were measured pre- and 1 week post-operatively using the Tinetti Fall Risk Scale, Timed Up and Go, and 6-Minute Walk test. Measures were repeated 6 weeks after surgery. Non-parametric tests for paired data were used comparing scores baseline to post-operative (POD) 7 and to POD 42. Median age was 72 years (range 65-88). Fall risk was elevated during the first 2 post-operative weeks, greatest on the median discharge day, POD 2 (p<0.01). Balance performance and functional mobility at 1 week were significantly lower than baseline (p<0.01). Functional abilities declined, including new dependence in medication management at home in 22% of these independent and cognitively intact women. After gynecologic surgery, older women's fall risk is highest on POD 2 and remains elevated from baseline for 2 weeks. Functional limitations in the early home recovery period include the anticipated (bathing, cooking, etc.) and some unanticipated (medication management) ones. This information may help with post-operative discharge planning. Copyright © 2017 The Author(s). Published by Elsevier B.V. All rights reserved.

The impact of physician burnout on clinical and academic productivity of gynecologic oncologists: A decision analysis.

PubMed

Turner, Taylor B; Dilley, Sarah E; Smith, Haller J; Huh, Warner K; Modesitt, Susan C; Rose, Stephen L; Rice, Laurel W; Fowler, Jeffrey M; Straughn, J Michael

2017-09-01

Physician burnout is associated with mental illness, alcohol abuse, and job dissatisfaction. Our objective was to estimate the impact of burnout on productivity of gynecologic oncologists during the first half of their career. A decision model evaluated the impact of burnout on total relative value (RVU) production during the first 15years of practice for gynecologic oncologists entering the workforce from 2011 to 2015. The SGO practice survey provided physician demographics and mean annual RVUs. Published data were used to estimate probability of burnout for male and female gynecologic oncologists, and the impact of depression, alcohol abuse, and early retirement. Academic productivity was defined as annual PubMed publications since finishing fellowship. Without burnout, RVU production for the cohort of 250 gynecologic oncologists was 26.2 million (M) RVUs over 15years. With burnout, RVU production decreased by 1.6 M (5.9% decrease). Disproportionate rates of burnout among females resulted in 1.1 M lost RVUs for females vs. 488 K for males. Academic production without burnout was estimated at 9277 publications for the cohort. Burnout resulted in 1383 estimated fewer publications over 15years (14.9%). The impact of burnout on clinical and academic productivity is substantial across all specialties. As health care systems struggle with human resource shortages, this study highlights the need for effective burnout prevention and wellness programs for gynecologic oncologists. Unless significant resources are designated to wellness programs, burnout will increasingly affect the care of our patients and the advancement of our field. Copyright © 2017 Elsevier Inc. All rights reserved.

Vaginal vault dehiscence after robotic hysterectomy for gynecologic cancers: search for risk factors and literature review.

PubMed

Drudi, Laura; Press, Joshua Z; Lau, Susie; Gotlieb, Raphael; How, Jeffrey; Eniu, Ioana; Drummond, Nancy; Brin, Sonya; Deland, Claire; Gotlieb, Walter H

2013-06-01

Vaginal vault dehiscence following robotic-assisted hysterectomy for gynecologic cancer may be attributed to surgical techniques and postoperative therapeutic interventions. We searched for risk factors in patients with gynecologic cancers and complemented this with a literature review. Evaluation of prospectively gathered information on all consecutive robotic surgeries for gynecologic cancers was performed in a tertiary academic cancer center between December 2007 and March 2012. The literature was reviewed for articles relevant to "gynecologic oncology" and "robotics" with "vaginal cuff dehiscence" in the English and French languages. Respective authors were contacted to complete relevant information. Seven dehiscences were identified of 441 cases with established gynecologic cancers. The closures in these 7 were performed using interrupted 1-Vicryl (Ethicon Inc) (3/167; 1.8%), combination of interrupted 1-Vicryl and 1-Biosyn (Covidien Inc) (3/156, 1.9%), and V-Loc (Covidien Inc) (1/118, 0.8%) sutures. Associated risk factors included adjuvant chemotherapy and/or brachytherapy, early resumption of sexual activity, and low body mass index (mean, 23 ± 3.23 kg/m²). Dehiscences occurred regardless of suturing by staff or trainees. Review of operative videos did not reveal a detectable etiologic factor, such as excessive cautery damage to the vaginal cuff or shallow tissue sutured. All 7 colporrhexis repairs were performed through a vaginal approach without the need of laparoscopy or laparotomy. Postoperative chemotherapy, brachytherapy, and early resumption of sexual activities are risk factors for vaginal vault dehiscence. Surgical technique, particularly the use of delayed absorbable sutures, deserves further evaluation.

Specific and unspecific gynecological alarm symptoms--prevalence estimates in different age groups: a population-based study.

PubMed

Balasubramaniam, Kirubakaran; Ravn, Pernille; Larsen, Pia V; Søndergaard, Jens; Jarbøl, Dorte E

2015-02-01

To determine prevalence estimates of gynecological alarm symptoms in different age groups and to describe common patterns of gynecological symptoms. Web-based cross-sectional survey study. Nationwide in Denmark. A random sample of 51,090 women aged 20 years or above from the general population. An internet-based questionnaire study regarding the prevalence estimates of symptom experiences. A total of 18 symptoms of cervical, endometrial and ovarian cancer were selected through an extensive literature search, which included national and international guidelines. Prevalence estimates of self-reported experience of gynecological alarm symptoms within the preceding 4 weeks. A total of 26,466 women (54.5%) participated in the study. Some 80.3% had experienced at least one of the alarm symptoms within the preceding 4 weeks, and the median number of experienced symptoms was 2 (interquartile range 1-4). The most common symptoms were tiredness (53.0%) and abdominal bloating (36.7%); postmenopausal bleeding (2.3%) and involuntary weight loss (2.8%) were least frequent. Most of the symptoms were more prevalent among younger women, whereas only dyspnea and increased urgency of urination were more frequent among older women. Among younger women, multiple abdominal symptoms often occurred simultaneously and frequently in combination with pelvic pain, whereas older women were more likely to report single symptoms. Gynecological alarm symptoms are frequent in the general population, mostly among younger women. Older women reported fewer symptoms, and these often appeared as single symptoms. © 2014 Nordic Federation of Societies of Obstetrics and Gynecology.

Prognostic and Clinicopathological Significance of ARID1A in Endometrium-Related Gynecological Cancers: A Meta-Analysis.

PubMed

Liu, Guangquan; Xu, Pengfei; Fu, Ziyi; Hua, Xiangdong; Liu, Xiaoguang; Li, Wenqu; Zhang, Mi; Wu, Jiacong; Wen, Juan; Xu, Juan; Jia, Xuemei

2017-12-01

The tumor suppressor gene, AT Rich Interactive Domain 1A (ARID1A) mutation has been reported in a variety of cancers, especially the endometrium-related gynecological cancers, including the ovarian clear cell carcinoma, ovarian endometrioid carcinoma, and uterine endometrioid carcinoma. However, the prognostic value of ARID1A in endometrium-related gynecological cancers is still inconclusive. Therefore, we performed this meta-analysis to evaluate the clinical significance of ARID1A in endometrium-related gynecological cancers. By systematically searching all the relevant studies from Pubmed, Cochrane Library, and Web of Science up to September 2016, 11 studies with 1,432 patients were included. All the study characteristics and the prognostic data were extracted. Hazard ratios (HRs) and 95% confidence intervals (CIs) were pooled using the fixed-effect or random-effect model. Our results indicated that negative ARID1A expression predicted shorter Progression free survival (PFS, HR, 1.84; 95%CI, 1.32-2.57, P = 0.000) of patients with endometrium related gynecological cancers, especially the patiently with OCCC and the patients in Japan. Besides, a marginal trend towards the same direction was found in the Overall analysis (OS, HR, 1.34; 95%CI, 0.93-1.93, P = 0.112). Furthermore, the significant correlation was achieved between the negative ARID1A expression and the FIGO stage of endometrium-related gynecological cancers, but not the other characteristics. J. Cell. Biochem. 118: 4517-4525, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Intersocietal Accreditation Commission Accreditation Status of Outpatient Cerebrovascular Testing Facilities Among Medicare Beneficiaries: The VALUE Study.

PubMed

Brown, Scott C; Wang, Kefeng; Dong, Chuanhui; Farrell, Mary Beth; Heller, Gary V; Gornik, Heather L; Hutchisson, Marge; Needleman, Laurence; Benenati, James F; Jaff, Michael R; Meier, George H; Perese, Susana; Bendick, Phillip; Hamburg, Naomi M; Lohr, Joann M; LaPerna, Lucy; Leers, Steven A; Lilly, Michael P; Tegeler, Charles; Katanick, Sandra L; Alexandrov, Andrei V; Siddiqui, Adnan H; Rundek, Tatjana

2016-09-01

Accreditation of cerebrovascular ultrasound laboratories by the Intersocietal Accreditation Commission (IAC) and equivalent organizations is supported by the Joint Commission certification of stroke centers. Limited information exists on the accreditation status and geographic distribution of cerebrovascular testing facilities in the United States. Our study objectives were to identify the proportion of IAC-accredited outpatient cerebrovascular testing facilities used by Medicare beneficiaries, describe their geographic distribution, and identify variations in cerebrovascular testing procedure types and volumes by accreditation status. As part of the VALUE (Vascular Accreditation, Location, and Utilization Evaluation) Study, we examined the proportion of IAC-accredited facilities that conducted cerebrovascular testing in a 5% Centers for Medicare and Medicaid Services random Outpatient Limited Data Set in 2011 and investigated their geographic distribution using geocoding. Among 7327 outpatient facilities billing Medicare for cerebrovascular testing, only 22% (1640) were IAC accredited. The proportion of IAC-accredited cerebrovascular testing facilities varied by region (χ(2)[3] = 177.1; P < .0001), with 29%, 15%, 13%, and 10% located in the Northeast, South, Midwest, and West, respectively. However, of the total number of cerebrovascular outpatient procedures conducted in 2011 (38,555), 40% (15,410) were conducted in IAC-accredited facilities. Most cerebrovascular testing procedures were carotid duplex, with 40% of them conducted in IAC-accredited facilities. The proportion of facilities conducting outpatient cerebrovascular testing accredited by the IAC is low and varies by region. The growing number of certified stroke centers should be accompanied by more accredited outpatient vascular testing facilities, which could potentially improve the quality of stroke care.

Incidence and risk factors for lower limb lymphedema after gynecologic cancer surgery with initiation of periodic complex decongestive physiotherapy.

PubMed

Deura, Imari; Shimada, Muneaki; Hirashita, Keiko; Sugimura, Maki; Sato, Seiya; Sato, Shinya; Oishi, Tetsuro; Itamochi, Hiroaki; Harada, Tasuku; Kigawa, Junzo

2015-06-01

Lower limb lymphedema (LLL) is one of the most frequent postoperative complications of retroperitoneal lymphadenectomy for gynecologic cancer. LLL often impairs quality of life, activities of daily living, sleep, and sex in patients with gynecologic cancer. We conducted this study to evaluate the incidence and risk factors for LLL after gynecologic cancer surgery in patients who received assessment and periodic complex decongestive physiotherapy (CDP). We retrospectively reviewed 126 cases of gynecologic cancer that underwent surgery involving retroperitoneal lymphadenectomy at Tottori University Hospital between 2009 and 2012. All patients received physical examinations to detect LLL and underwent CDP by nurse specialists within several months after surgery. The International Society of Lymphology staging of lymphedema severity was used as the diagnostic criteria. Of 126 patients, 57 (45.2%) had LLL, comprising 45 and 12 patients with stage 1 and stage 2 LLL, respectively. No patient had stage 3 LLL. LLL was present in 37 (29.4%) patients at the initial physical examination. Multivariate analysis revealed that adjuvant concurrent chemoradiotherapy and age ≥ 55 years were independent risk factors for ≥ stage 2 LLL. To minimize the incidence of ≥ stage 2 LLL, gynecologic oncologists should be vigilant for this condition in patients who are ≥ 55 years and in those who undergo adjuvant chemoradiotherapy. Patients should be advised to have a physical assessment for LLL and to receive education about CDP immediately after surgery involving retroperitoneal lymphadenectomy for gynecologic cancer.

Effect of Music Therapy on Postoperative Pain Management in Gynecological Patients: A Literature Review.

PubMed

Sin, Wai Man; Chow, Ka Ming

2015-12-01

Unrelieved postoperative pain may have a negative impact on the physiological and psychological well-being of patients. Pharmacological methods are currently used to relieve such pain in gynecological patients; however, inadequate pain control is still reported, and the use of nonpharmacological pain-relieving methods is increasingly being advocated, one of which is music therapy. The purpose of this literature review was to identify, summarize, and critically appraise current evidence on music therapy and postoperative pain management among gynecological patients. A systematic search of MEDLINE, CINAHL, PsycINFO, British Nursing Index, and Allied and Complementary Medicine was conducted using the search terms music, gynecological, pain, surgery, operative, and post-operative to identify relevant articles in English from 1995 to the present. All identified articles were assessed independently for inclusion into review. A total of 7 articles were included after removal of duplicates and exclusion of irrelevant studies. All the included studies assessed the effects of music therapy on postoperative pain intensity, and three of them measured pain-related physiological symptoms. The findings indicated that music therapy, in general, was effective in reducing pain intensity, fatigue, anxiety, and analgesic consumption in gynecological patients during the postoperative period. It is recommended as an adjunct to pharmacological pain-relieving methods in reducing postoperative pain. Future researches on music therapy to identify the most effective application and evaluate its effect by qualitative study are recommended. Copyright © 2015 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Database nurse staffing indicators: explaining risks of staff job dissatisfaction in outpatient care.

PubMed

Kaunonen, Marja; Salin, Sirpa; Aalto, Pirjo

2015-07-01

To explore factors associated with nursing intensity, work environment intensity and nursing resources that may affect nurse job satisfaction and risk of dissatisfaction in outpatient care at one university hospital in Finland. Much research has been done to study how nursing intensity, work environment intensity and nursing resources are associated with nurse job satisfaction, but not in the context of outpatient care. This research used a cross-sectional design. The data were collected from the hospital information systems of outpatient units (n = 12) in autumn 2010. Management style showed a statistically significant association with job satisfaction. The risk of dissatisfaction increased when nursing staff had no influence over the design of their jobs, when conflicts and contradictions were not addressed in the workplace and when feedback was not processed. Nursing intensity and work environment intensity had no effect on nurse job satisfaction. Nursing resources and patient satisfaction, on the other hand, were important to nurses' job satisfaction. The results indicate that nursing management should involve nursing staff in the development of their jobs and the care delivery model. © 2013 John Wiley & Sons Ltd.

[Investigation of dental manpower in non-public medical units in Shanghai].

PubMed

Liu, Yi; Feng, Xi-Ping

2010-02-01

A mass survey on dental manpower was made in non-public medical units in Shanghai in 2007 to analyze the number,structure,composition,distribution,equipment and out-patient departments (OPDs) of dental manpower and to approach the existing problems. The purpose was to provide information for investigating the dental manpower in Shanghai and the reasonable allocation and utilization of the dental manpower in Shanghai. A mass survey on dental manpower was made in non-public medical units in Shanghai in 2007 by means of questionnaire investigation, which included direct interview and telephone interview. The survey content included the number,structure,composition,distribution,equipment and out-patient departments(OPDs) of dental manpower in non-public medical units in Shanghai. There were 488 non-public dental units and 1172 dentists, 848 nurses, 79 technicians, 1377 dental units in Shanghai. 86.9% of the dentists were young and middle-aged, 44.88% of them had middle level professional tiles, 51.28% of them had university educational background and the specialty of 89.59% of the dentists was general dentistry. 81.84% of the nurses had primary professional tiles and 75.47% of the nurses' educational background was below the junior college degree. The ratio of the dentists to nurses to technicians was 15:11:1. The non-public dental units and dental manpower resources were concentrated in the downtown with 54.1% of the units, 57.85% of the dentists, 61.57% of the nurses and 79.75% of the technicians there. The total amount of dental out-patient departments DOPDs in non-public medical units in Shanghai in 2007 was 976,650, 61.42% in the downtown. 38.97% of the units thought the DOPDs were few or less while 57.82% considered it was just right. Among them, 20.04% of the units thought their units needed dentists. Among them, 68.09% of the units needed general dentists. Dental manpower in non-public medical units in Shanghai concentrates in the downtown and Pudong new area

Clinical audit of COPD in outpatient respiratory clinics in Spain: the EPOCONSUL study

PubMed Central

Calle Rubio, Myriam; Alcázar Navarrete, Bernardino; Soriano, Joan B; Soler-Cataluña, Juan J; Rodríguez González-Moro, José Miguel; Fuentes Ferrer, Manuel E; López-Campos, José Luis

2017-01-01

Background Chronic obstructive pulmonary disease (COPD) outpatients account for a large burden of usual care by respirologists. EPOCONSUL is the first national clinical audit conducted in Spain on the medical care for COPD patients delivered in outpatient respiratory clinics. We aimed to evaluate the clinical interventions and the degree of adherence to recommendations in outpatients of current COPD clinical practice guidelines. Methodology This is an observational study with prospective recruitment (May 2014–May 2015) of patients with a COPD diagnosis as seen in outpatient respiratory clinics. The information collected was historical in nature as for the clinical data of the last and previous consultations, and the information concerning hospital resources was concurrent. Results A total of 17,893 clinical records of COPD patients in outpatient respiratory clinics from 59 Spanish hospitals were evaluated. Of the 5,726 patients selected, 4,508 (78.7%) were eligible. Overall, 12.1% of COPD patients did not fulfill a diagnostic spirometry criteria. Considerable variability existed in the available resources and work organization of the hospitals, although the majority were university hospitals with respiratory inpatient units. There was insufficient implementation of clinical guidelines in preventive and educational matters. In contrast, quantitative evaluation of dyspnea grade (81.9%) and exacerbation history (70.9%) were more frequently performed. Only 12.4% had COPD severity calculated according to the Body mass index, airflow Obstruction, Dyspnoea and Exercise capacity (BODE) index. Phenotype characteristics according to Spanish National Guideline for COPD were determined in 46.3% of the audited patients, and the risk evaluation according to Global initiative for chronic Obstructive Lung Disease was estimated only in 21.9%. Conclusion The EPOCONSUL study reports the current situation of medical care for COPD patients in outpatient clinics in Spain, revealing

Pediatric and Adolescent Gynecology in Europe: Clinical Services, Standards of Care, and Training.

PubMed

Richmond, Anna; Priyanka, Sweta; Mahmood, Tahir; MacDougall, Jane; Wood, Paul

2016-06-01

To identify current clinical services and training available across Europe within pediatric and adolescent gynecology (PAG) and establish the extent to which PAG services meet current European Board and College of Obstetrics and Gynecology (EBCOG) standards. Quantitative and qualitative questionnaire. European countries that are members of the EBCOG and the European Association of Pediatric and Adolescent Gynecology. Thirty-six countries that were approached beginning in September 2013; data were obtained from 27 countries. Questionnaires with 28 stems were sent to clinical leaders in 36 European countries. National society, national standards, legislation for female genital mutilation, protocols for transition to adult services, human papilloma virus vaccination programs, sex and contraception education, safeguarding, clinical leads for PAG, delivery of PAG services, and training available for PAG. Of 36 countries, 27 responded. Seventy-seven percent had a national PAG society but only 44% had national standards in PAG. There was agreement that PAG cases should be multidisciplinary but not all have clinical networks in place to facilitate this. Human papilloma virus programs are available in some European countries and not all have legislation against female genital mutilation. A significant proportion of cases continue to be seen in adult gynecology clinics as opposed to designated PAG clinics with only 41% with processes to transfer patients into adult care. In this article we provide a framework to explore areas for improvement within PAG services and training across Europe. The EBCOG standards of care are not being adhered to in many countries because processes and clinical networks are not in place to facilitate them. Crown Copyright © 2015. Published by Elsevier Inc. All rights reserved.

[Gynecological malignant tumor related multiple primary malignant neoplasms: clinical analysis of 30 cases].

PubMed

Shi, Li; Zhou, Shulin; Jiang, Yi; Wan, Yicong; Ma, Jingjing; Fu, Shilong; Cheng, Wenjun

2014-03-01

To investigate the clinical features of gynecological malignant tumor related multiple primary malignant neoplasms (MPMN). Apply retrospective and comprehensive analysis to the clinical data of 30 patients with gynecological malignant tumor related MPMN. Synchronous MPMN were found in 9 patients. Their average age was 50.2 years old and their median age was 49 years old. The neoplasms were located at ovary, uterus, cervix, breast and intestine. Metachronous MPMN were found in 21 patients. Their average age was 57.7 and their median age was 57 years old. The median interval between the first and the second primary malignant neoplasm was 4.0 years. The neoplasms were located at breast, ovary, uterus, gastrointestinal tract, uterine cervix, lung etc. In 30 cases, 26 of them were treated by surgical operation and further adjunctive treatment of chemotherapy and (or) radiotherapy was conducted as per the neoplasm staging and its pathological results. The rest 4 patients (first primary malignant neoplasms were excised from 3 of them and another one was not treated by surgical operation) received adjunctive treatment of chemotherapy and (or) radiotherapy. Followed ups, which varied from 6 to 60 months, were made to 29 patients and 20 out of the 29 were alive.5-year survival rate of patients with gynecological malignant tumor related MPMN was 47.8%, 2-year survival rate was 73.9%, and 1-year survival rate was 88.6%. Pay more attention to the patients with gynecological malignant tumor related MPMN, examine the high-risk patients with malignant tumor comprehensively, identify whether it is recurrence, metastasis or new growth of malignant neoplasm, and further ensure early diagnosis and proper treatment, avoiding misdiagnosis and missed diagnosis.

Gynecological Lymphoma: A Case Series and Review of the Literature.

PubMed

Slonimsky, Einat; Korach, Jacob; Perri, Tamar; Davidson, Tima; Apter, Sara; Inbar, Yael

The aim of the study was to evaluate the radiological characteristics of gynecological lymphoproliferative disease (LPD) and specific imaging features that may suggest the diagnosis. Two readers conducted a retrospective evaluation of imaging studies of 13 female patients presenting with a gynecological LPD. A literature review was also performed. Of the 13 evaluated women, 9 had ovarian involvement, 3 had cervical involvement, and 1 had uterine involvement. The most common lesion characteristics were homogenous masses (11), with mild contrast enhancement (9), followed by soft-tissue necrosis (4), prominent blood vessels displaced by the lesions (4), linear arrangement of cysts at the periphery of the ovaries (3), and "touching" ovaries in all cases of bilateral ovarian involvement. A solid large homogeneous mass with mild contrast enhancement should alert the radiologist to the possibility of the differential diagnosis of LPD. Radiologists should be "the gatekeepers" by raising this possibility to avoid unnecessary surgery and enable appropriate treatment.

Physician and patient attitudes towards complementary and alternative medicine in obstetrics and gynecology

PubMed Central

Furlow, Mandi L; Patel, Divya A; Sen, Ananda; Liu, J Rebecca

2008-01-01

Background In the U.S., complementary and alternative medicine (CAM) use is most prevalent among reproductive age, educated women. We sought to determine general attitudes and approaches to CAM among obstetric and gynecology patients and physicians. Methods Obstetrician-gynecologist members of the American Medical Association in the state of Michigan and obstetric-gynecology patients at the University of Michigan were surveyed. Physician and patient attitudes and practices regarding CAM were characterized. Results Surveys were obtained from 401 physicians and 483 patients. Physicians appeared to have a more positive attitude towards CAM as compared to patients, and most reported routinely endorsing, providing or referring patients for at least one CAM modality. The most commonly used CAM interventions by patients were divergent from those rated highest among physicians, and most patients did not consult with a health care provider prior to starting CAM. Conclusion Although obstetrics/gynecology physicians and patients have a positive attitude towards CAM, physician and patients' view of the most effective CAM therapies were incongruent. Obstetrician/gynecologists should routinely ask their patients about their use of CAM with the goal of providing responsible, evidence-based advice to optimize patient care. PMID:18582380

Effect of home care service on the quality of life in patients with gynecological cancer.

PubMed

Aktas, Demet; Terzioglu, Fusun

2015-01-01

The purpose of the research was to determine the effect of home care service on the quality of life in patients with gynecological cancer. This randomized case control study was carried out in a womans hospital between September 2011 and February 2012. Women undergoing gynecological cancer treatment were separated into intervention and control groups, of 35 patients each. The intervention group was provided with nursing care service through hospital and home visits (1st, 12th weeks) within the framework of a specifically developed nursing care plan. The control group was monitored without any intervention through the hospital routine protocols (1st, 12th weeks). Data were collected using An Interview Form, Home Visit Monitoring Form and Quality of Life Scale/Cancer Survivors. Effects of home care service on the quality of life in gynecological cancer patients were investigated using chi-square tests, McNemar's test, independent t-test and ANOVA. This study found that the intervention group receiving home care service had a moderately high quality of life (average mean: 6.01±0.64), while the control group had comparatively lower quality (average mean: 4.35±0.79) within the 12 week post- discharge period (p<0.05). This study found home care services to be efficient in improving the quality of life in patients with gynecological cancer.

Association between human resources and risk of hospitalisation in end-stage renal disease outpatients receiving haemodialysis: a longitudinal cohort study using claim data during 2013-2014.

PubMed

Choi, Hoon-Hee; Han, Kyu-Tae; Nam, Chung Mo; Moon, Ki Tae; Kim, Woorim; Park, Eun-Cheol

2016-08-17

The number of patients requiring haemodialysis has gradually increased in South Korea. Owing to this growth, concerns have been raised regarding haemodialysis quality of care, and healthcare professionals must consider alternatives for appropriate management of patients with chronic kidney disease (CKD). Therefore, we investigated the association between risk of hospitalisation of outpatients who received haemodialysis due to end-stage renal disease (ESRD) and the human resources of the haemodialysis unit. We used data from National Health Insurance (NHI) claims during October 2013 to September 2014. These data comprised 40 543 outpatients with ESRD (4 751 047 outpatient cases) who received haemodialysis. No interventions were made. We performed Poisson regression analysis using a generalised estimating equation that included both patient and haemodialysis unit characteristics to examine the factors associated with hospitalisation of outpatients with ESRD. Among 4 751 047 outpatient cases, 27 997 (0.59%) were hospitalised during the study period. A higher proportion of haemodialysis patient care specialists and a higher number of nurses experienced in haemodialysis were inversely associated with the risk of hospitalisation (per 10% increase in haemodialysis patient care specialists: relative risk (RR)=0.987, 95% CI 0.981 to 0.993; per 10-person increase in nurses who provided haemodialysis: RR=0.876, 95% CI 0.833 to 0.921). In addition, such associations were greater in severe patients. Our findings suggest that haemodialysis units with high-quality, haemodialysis-specialised human resources could positively affect the outcomes of outpatients with ESRD. Based on our findings, health policymakers and professionals should implement strategies for the optimal management of patients with CKD. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Energy sources for gynecologic laparoscopic surgery: a review of the literature.

PubMed

Law, Kenneth S K; Abbott, Jason A; Lyons, Stephen D

2014-12-01

A range of energy sources are used in gynecologic laparoscopy. These energy sources include monopolar electrosurgery, bipolar electrosurgery (including "advanced bipolar" devices that incorporate tissue feedback monitoring), and various types of laser and ultrasonic technologies. Gynecologists using these tools should be aware of the potential benefits and potential dangers of these instruments. This review provides an overview of the biophysics of these energy sources, their tissue effects, and the complications that may arise. It aims to highlight any potential advantages or disadvantages of various energy sources, as reported by clinical and laboratory studies. Literature relating to energy sources used in gynecologic laparoscopy was reviewed. While laboratory-based studies have reported differences between various energy sources, these differences may not be clinically significant. The choice of instrumentation may depend on the nature of the surgical task being performed, but other factors, such as the surgeon's training/experience, cost, and industry marketing, may also influence the decision. TAn awareness of the pros and cons of each energy modality and their relative efficacy profiles is paramount. It is important that surgeons have an understanding of the biophysics of these technologies in order to understand their limitations and potential dangers and to utilize the most appropriate energy source(s) in the appropriate clinical setting, in order to both minimize the risk of inadvertent injuries during gynecologic laparoscopy and to maximize cost-efficient delivery of health care.

Ergonomic deficits in robotic gynecologic oncology surgery: a need for intervention.

PubMed

Craven, Renatta; Franasiak, Jason; Mosaly, Prithima; Gehrig, Paola A

2013-01-01

To evaluate surgeon strain using validated ergonomic assessment tools. Observational study (Canadian Task Force classification III). Academic medical center. Robotic surgeons performing gynecologic oncology surgical procedures. Videotape footage of surgeons performing robotic gynecologic oncology procedures was obtained. A human factors engineer experienced with health care ergonomics analyzed the video recordings and performed ergonomic evaluations of the surgeons. An initial evaluation was conducted using the Rapid Upper Limb Assessment (RULA) survey, an ergonomic assessment and prioritization method for determining posture, force, and frequency concerns with focus on the upper limbs. A more detailed analysis followed using the Strain Index (SI) method, which uses multiplicative interactions to identify jobs that are potentially hazardous. Seventeen hours of video recordings were analyzed, and descriptive data based on RULA/SI analysis were collected. Ergonomic evaluation of surgeon activity resulted in a mean RULA score of 6.46 (maximum possible RULA score, 7), indicating a need for further investigation. The mean SI grand score was 24.34. SI scores >10 suggest a potential for hazard to the operator. Thus, the current use of the surgical robot is potentially dangerous with regards to ergonomic positioning and should be modified. At a high-volume robotics center, there are ergonomics deficits that are hazardous to gynecologic surgeons and suggest the need for modification and intervention. A training strategy must be developed to address these ergonomic issues and knowledge deficiencies. Copyright © 2013 AAGL. Published by Elsevier Inc. All rights reserved.

Effect of resident evaluations of obstetrics and gynecology faculty on promotion.

PubMed

Curran, Diana S; Stalburg, Caren M; Xu, Xiao; Dewald, Samantha R; Quint, Elisabeth H

2013-12-01

Promotion for academic faculty depends on a variety of factors, including their research, publications, national leadership, and quality of their teaching. We sought to determine the importance of resident evaluations of faculty for promotion in obstetrics-gynecology programs. A 28-item questionnaire was developed and distributed to 185 department chairs of US obstetrics-gynecology residency programs. Fifty percent (93 of 185) responded, with 40% (37 of 93) stating that teaching has become more important for promotion in the past 10 years. When faculty are being considered for promotion, teaching evaluations were deemed "very important" 60% of the time for clinician track faculty but were rated as mainly "not important" or "not applicable" for research faculty. Sixteen respondents (17%) stated a faculty member had failed to achieve promotion in the past 5 years because of poor teaching evaluations. Positive teaching evaluations outweighed low publication numbers for clinical faculty 24% of the time, compared with 5% for research faculty and 8% for tenured faculty being considered for promotion. The most common reason for rejection for promotion in all tracks was the number of publications. Awards for excellence in teaching improved chances of promotion. Teaching quality is becoming more important in academic obstetrics-gynecology departments, especially for clinical faculty. Although in most institutions promotion is not achieved without adequate research and publications, the importance of teaching excellence is obvious, with 1 of 6 (17%) departments reporting a promotion had been denied due to poor teaching evaluations.

Increasing awareness of gynecological cancer symptoms and reducing barriers to medical help seeking: does health literacy play a role?

PubMed

Boxell, Emily M; Smith, Samuel G; Morris, Melanie; Kummer, Sonja; Rowlands, Gill; Waller, Jo; Wardle, Jane; Simon, Alice E

2012-01-01

Health literacy may influence the efficacy of print-based public health interventions. A key part of the U.K. cancer control strategy is to provide information to the public on earlier diagnoses with a view to improving the United Kingdom's relatively poor 1-year cancer survival statistics. This study examined the effect of health literacy on the efficacy of a gynecological cancer information leaflet. Participants (n = 451) were recruited from 17 Cancer Research UK events. Health literacy was assessed with the Newest Vital Sign test. Gynecological cancer symptom awareness and barriers to medical help seeking were assessed before and after participants read the leaflet. Symptom awareness improved, and barriers to medical help seeking were reduced (ps < .001). Symptom awareness was lower in individuals in lower health literacy groups, both at baseline and at follow-up (p < .05, p < .001, respectively), but there were no significant differences in barriers to medical help seeking at either time point (p > .05). As predicted, individuals with lower health literacy benefited less after exposure to the leaflet (ps < .01 for interactions). Despite careful consideration of information design principles in the development of the leaflet, more intensive efforts may be required to ensure that inequalities are not exacerbated by reliance on print-based public health interventions.

Application of laser in obstetrics and gynecology

NASA Astrophysics Data System (ADS)

Ding, Ai-Hua

1998-11-01

Mainman developed the first ruby laser in 1960 and after 13 Kaplan successfully reported the use of CO2 laser in the treatment of cervicitis. Soon after, Chinese gynecologists started to use the laser for diagnosis and therapy. It had been proved that more than 30 kinds of gynecological diseases could be treated effectively by laser. The remarkable laser treatment technique partially replaced with conventional methods used in that century. However, the application of laser had shown a broad prospect along with its further investigation.

Evolving technologies in robotic surgery for minimally invasive treatment of gynecologic cancers.

PubMed

Levinson, Kimberly L; Auer, Melinda; Escobar, Pedro F

2013-09-01

Since the introduction of robotic technology, there have been significant changes to the field of gynecologic oncology. The number of minimally invasive procedures has drastically increased, with robotic procedures rising remarkably. With recent evidence suggesting that minimally invasive techniques should be the standard of care for early endometrial and cervical cancers, the push for new technology and advancements has continued. Several emerging robotic technologies have significant potential in the field of gynecologic oncology. The single-site robotic platform enables robotic surgery through a single incision; the Firefly camera detects the fluorescent dye indocyanine green, which may improve sensitivity in sentinel lymph node biopsy; and a robotic vessel-sealing device and stapler will continue to improve efficiency of the robotic surgeon.

Influence of Music on Preoperative Anxiety and Physiologic Parameters in Women Undergoing Gynecologic Surgery.

PubMed

Labrague, Leodoro J; McEnroe-Petitte, Denise M

2016-04-01

The aim of this study was to determine the influence of music on anxiety levels and physiologic parameters in women undergoing gynecologic surgery. This study employed a pre- and posttest experimental design with nonrandom assignment. Ninety-seven women undergoing gynecologic surgery were included in the study, where 49 were allocated to the control group (nonmusic group) and 48 were assigned to the experimental group (music group). Preoperative anxiety was measured using the State Trait Anxiety Inventory (STAI) while noninvasive instruments were used in measuring the patients' physiologic parameters (blood pressure [BP], pulse [P], and respiration [R]) at two time periods. Women allocated in the experimental group had lower STAI scores (t = 17.41, p < .05), systolic (t = 6.45, p < .05) and diastolic (t = 2.80, p < .006) BP, and P rate (PR; t = 7.32, p < .05) than in the control group. This study provides empirical evidence to support the use of music during the preoperative period in reducing anxiety and unpleasant symptoms in women undergoing gynecologic surgery. © The Author(s) 2014.

A National Survey of Undergraduate Teaching in Obstetrics and Gynecology.

ERIC Educational Resources Information Center

And Others; Stenchever, Morton A.

1979-01-01

A survey of academic departments of obstetrics and gynecology was designed to assess undergraduate educational programs and the impact of efforts made to improve teaching in the specialty. It focuses on instructional patterns, the clinical clerkship, student evaluation, and program administration and evaluation. Prior surveys are noted.…

A Systematic Assessment of Google Search Queries and Readability of Online Gynecologic Oncology Patient Education Materials.

PubMed

Martin, Alexandra; Stewart, J Ryan; Gaskins, Jeremy; Medlin, Erin

2018-01-20

The Internet is a major source of health information for gynecologic cancer patients. In this study, we systematically explore common Google search terms related to gynecologic cancer and calculate readability of top resulting websites. We used Google AdWords Keyword Planner to generate a list of commonly searched keywords related to gynecologic oncology, which were sorted into five groups (cervical cancer, ovarian cancer, uterine cancer, vulvar cancer, vaginal cancer) using five patient education websites from sgo.org . Each keyword was Google searched to create a list of top websites. The Python programming language (version 3.5.1) was used to describe frequencies of keywords, top-level domains (TLDs), domains, and readability of top websites using four validated formulae. Of the estimated 1,846,950 monthly searches resulting in 62,227 websites, the most common was cancer.org . The most common TLD was *.com. Most websites were above the eighth-grade reading level recommended by the American Medical Association (AMA) and the National Institute of Health (NIH). The SMOG Index was the most reliable formula. The mean grade level readability for all sites using SMOG was 9.4 ± 2.3, with 23.9% of sites falling at or below the eighth-grade reading level. The first ten results for each Google keyword were easiest to read with results beyond the first page of Google being consistently more difficult. Keywords related to gynecologic malignancies are Google-searched frequently. Most websites are difficult to read without a high school education. This knowledge may help gynecologic oncology providers adequately meet the needs of their patients.

Staff perception of interprofessional working relationships after a work redesign intervention in a Danish orthopaedic hand unit outpatient clinic.

PubMed

de Beijer, Anke Elisabeth; Hansen, Torben Bæk; Stilling, Maiken; Jakobsen, Flemming

2016-01-01

There is evidence that clinical pathways improve quality of care; however, knowledge is limited concerning the influence on and the benefits experienced by the interprofessional teams working with these pathways. Our working methods in a hand unit in an orthopaedic outpatient clinic in Denmark were redesigned to include, among other changes, the introduction of clinical pathways. Changes included standardising treatment and communication methods, delegating tasks from medical specialists to nurses, and providing nurses with their own consultation room. Using focus group interviews before and after the implementation of the new working methods, we investigated staff-perceived experiences of the effects on working relationships and the utilisation of professional skills and attitudes, resulting from the mentioned change in working methods. The results were changes in daily communication methods among healthcare staff and improvements in the actual communication and collaborative problem solving skills concerning standard patients with simple hand pathology; however, there are still challenges for patients with more complex hand pathology. Though this new interprofessional arrangement improves the use of nurse and medical specialist professional competencies, it also requires a high degree of trust among the team members.

A cost-benefit analysis on the specialization in departments of obstetrics and gynecology in Japan.

PubMed

Shen, Junyi; Fukui, On; Hashimoto, Hiroyuki; Nakashima, Takako; Kimura, Tadashi; Morishige, Kenichiro; Saijo, Tatsuyoshi

2012-03-27

In April 2008, the specialization in departments of obstetrics and gynecology was conducted in Sennan area of Osaka prefecture in Japan, which aims at solving the problems of regional provision of obstetrical service. Under this specialization, the departments of obstetrics and gynecology in two city hospitals were combined as one medical center, whilst one hospital is in charge of the department of gynecology and the other one operates the department of obstetrics. In this paper, we implement a cost-benefit analysis to evaluate the validity of this specialization. The benefit-cost ratio is estimated at 1.367 under a basic scenario, indicating that the specialization can generate a net benefit. In addition, with a consideration of different kinds of uncertainty in the future, a number of sensitivity analyses are conducted. The results of these sensitivity analyses suggest that the specialization is valid in the sense that all the estimated benefit-cost ratios are above 1.0 in any case.

Disparities in Use of Gynecologic Oncologists for Women with Ovarian Cancer in the United States

PubMed Central

Austin, Shamly; Martin, Michelle Y; Kim, Yongin; Funkhouser, Ellen M; Partridge, Edward E; Pisu, Maria

2013-01-01

Objective To examine disparities in utilization of gynecologic oncologists (GOs) across race and other sociodemographic factors for women with ovarian cancer. Data Sources Obtained SEER-Medicare linked dataset for 4,233 non-Hispanic White, non-Hispanic African American, Hispanic of any race, and Non-Hispanic Asian women aged ≥66 years old diagnosed with ovarian cancer during 2000–2002 from 17 SEER registries. Physician specialty was identified by linking data to the AMA master file using Unique Physician Identification Numbers. Study Design Retrospective claims data analysis for 1999–2006. Logistic regression models were used to analyze the association between GO utilization and race/ethnicity in the initial, continuing, and final phases of care. Principal Findings GO use decreased from the initial to final phase of care (51.4–28.8 percent). No racial/ethnic differences were found overall and by phase of cancer care. Women >70 years old and those with unstaged disease were less likely to receive GO care compared to their counterparts. GO use was lower in some SEER registries compared to the Atlanta registry. Conclusions GO use for the initial ovarian cancer treatment or for longer term care was low but not different across racial/ethnic groups. Future research should identify factors that affect GO utilization and understand why use of these specialists remains low. PMID:23206237

Routine cystoscopy after robotic gynecologic oncology surgery.

PubMed

Nguyen, My-Linh T; Stevens, Erin; LaFargue, Christopher J; Karsy, Michael; Pua, Tarah L; Gorelick, Constantine; Tedjarati, Sean S; Pradhan, Tana S

2014-01-01

Our aim was to determine whether the use of routine cystoscopy increases lower urinary tract injury detection (bladder and/or ureter) after robotic surgery performed by gynecologic oncologists. A retrospective chart review of patients who presented for robotic hysterectomy from 2009-2012 was performed at 2 separate academic medical centers, one that performed routine cystoscopy and one that did not. Statistical analysis was performed with t tests and χ2 tests. We identified 140 cases without cystoscopy and 109 cases with routine cystoscopy. There were no intraoperative or postoperative urinary injuries detected in either group. There were no significant differences in age and body mass index. In the non-cystoscopy group, a larger specimen size (P<.001), less blood loss (P=.013), and a longer mean operative time were observed (P<.0001). In the routine cystoscopy group, more lymphadenectomies were performed with hysterectomy (P=.007) and more patients underwent hysterectomy for ovarian cancer (P=.0192). There were no differences in surgical indications or secondary procedures including bilateral salpingo-oophorectomy, radical hysterectomy, ureterolysis, and pelvic organ prolapse-related procedures. The minimum follow-up period was 30 days in both groups. Routine use of cystoscopy did not appear to affect the detection rate of intraoperative lower urinary tract injury during robotic gynecologic surgery because this rate was zero in both groups. However, cystoscopy is relatively simple to perform and can be efficiently incorporated into robotic surgery to avoid the severe morbidity and possible litigation surrounding a urinary tract injury.

Therapeutic Approaches of Botulinum Toxin in Gynecology

PubMed Central

Moga, Marius Alexandru; Dimienescu, Oana Gabriela; Bălan, Andreea; Scârneciu, Ioan; Barabaș, Barna; Pleș, Liana

2018-01-01

Botulinum toxins (BoNTs) are produced by several anaerobic species of the genus Clostridium and, although they were originally considered lethal toxins, today they find their usefulness in the treatment of a wide range of pathologies in various medical specialties. Botulinum neurotoxin has been identified in seven different isoforms (BoNT-A, BoNT-B, BoNT-C, BoNT-D, BoNT-E, BoNT-F, and BoNT-G). Neurotoxigenic Clostridia can produce more than 40 different BoNT subtypes and, recently, a new BoNT serotype (BoNT-X) has been reported in some studies. BoNT-X has not been shown to actually be an active neurotoxin despite its catalytically active LC, so it should be described as a putative eighth serotype. The mechanism of action of the serotypes is similar: they inhibit the release of acetylcholine from the nerve endings but their therapeutically potency varies. Botulinum toxin type A (BoNT-A) is the most studied serotype for therapeutic purposes. Regarding the gynecological pathology, a series of studies based on the efficiency of its use in the treatment of refractory myofascial pelvic pain, vaginism, dyspareunia, vulvodynia and overactive bladder or urinary incontinence have been reported. The current study is a review of the literature regarding the efficiency of BoNT-A in the gynecological pathology and on the long and short-term effects of its administration. PMID:29690530

Tubeless outpatient robotic upper urinary tract reconstruction in the pediatric population: short-term assessment of safety.

PubMed

Fichtenbaum, Eric J; Strine, Andrew C; Concodora, Charles W; Schulte, Marion; Noh, Paul H

2018-06-01

Robotic upper urinary tract reconstruction (UUTR) has been widely utilized for surgical management of congenital obstruction. To further reduce morbidity and simplify postoperative care, outpatient robotic pyeloplasty (RP) and robotic ureteroureterostomy (RUU) were performed without ureteral stents, drains, or urethral catheters. The aim of the study was to assess the safety of performing tubeless robotic UUTR as an outpatient procedure. A retrospective review was performed for patients who underwent outpatient tubeless RP and RUU between July 2015 and January 2017. All procedures were primary interventions. No ureteral stents, drains, or urethral catheters were utilized. No regional blocks were utilized. Patients were discharged from the post anesthesia care unit as a scheduled outpatient procedure without an extended stay. Primary outcomes included 30-day complications, emergency room (ER) visits, and readmissions. A total of 19 patients (14 male, 5 female) were identified (RP = 17, RUU = 3), including one patient who underwent staged bilateral RP. Median age was 21.5 months (range 3-220). Median weight was 11.5 kg (range 6-89). Median operative time was 167 min (range 108-249), defined as skin incision to closure. No 30-day complications, ER visits, or readmissions were observed for any patient. The study concludes that pediatric tubeless outpatient robotic UUTR is safe. Further evaluation is needed to assess this approach on a larger scale, as well as assessing the long-term outcomes of tubeless reconstruction.

42 CFR 410.141 - Outpatient diabetes self-management training.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 2 2012-10-01 2012-10-01 false Outpatient diabetes self-management training. 410... HUMAN SERVICES MEDICARE PROGRAM SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS Outpatient Diabetes Self-Management Training and Diabetes Outcome Measurements § 410.141 Outpatient diabetes self-management training...

42 CFR 410.141 - Outpatient diabetes self-management training.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 2 2011-10-01 2011-10-01 false Outpatient diabetes self-management training. 410... HUMAN SERVICES MEDICARE PROGRAM SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS Outpatient Diabetes Self-Management Training and Diabetes Outcome Measurements § 410.141 Outpatient diabetes self-management training...

42 CFR 410.141 - Outpatient diabetes self-management training.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 2 2014-10-01 2014-10-01 false Outpatient diabetes self-management training. 410... HUMAN SERVICES MEDICARE PROGRAM SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS Outpatient Diabetes Self-Management Training and Diabetes Outcome Measurements § 410.141 Outpatient diabetes self-management training...

42 CFR 410.141 - Outpatient diabetes self-management training.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 2 2013-10-01 2013-10-01 false Outpatient diabetes self-management training. 410... HUMAN SERVICES MEDICARE PROGRAM SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS Outpatient Diabetes Self-Management Training and Diabetes Outcome Measurements § 410.141 Outpatient diabetes self-management training...

42 CFR 410.141 - Outpatient diabetes self-management training.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Outpatient diabetes self-management training. 410... HUMAN SERVICES MEDICARE PROGRAM SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS Outpatient Diabetes Self-Management Training and Diabetes Outcome Measurements § 410.141 Outpatient diabetes self-management training...

Association between human resources and risk of hospitalisation in end-stage renal disease outpatients receiving haemodialysis: a longitudinal cohort study using claim data during 2013–2014

PubMed Central

Choi, Hoon-Hee; Han, Kyu-Tae; Nam, Chung Mo; Moon, Ki Tae; Kim, Woorim; Park, Eun-Cheol

2016-01-01

Objective The number of patients requiring haemodialysis has gradually increased in South Korea. Owing to this growth, concerns have been raised regarding haemodialysis quality of care, and healthcare professionals must consider alternatives for appropriate management of patients with chronic kidney disease (CKD). Therefore, we investigated the association between risk of hospitalisation of outpatients who received haemodialysis due to end-stage renal disease (ESRD) and the human resources of the haemodialysis unit. Setting We used data from National Health Insurance (NHI) claims during October 2013 to September 2014. Participants These data comprised 40 543 outpatients with ESRD (4 751 047 outpatient cases) who received haemodialysis. Interventions No interventions were made. Outcome measure We performed Poisson regression analysis using a generalised estimating equation that included both patient and haemodialysis unit characteristics to examine the factors associated with hospitalisation of outpatients with ESRD. Results Among 4 751 047 outpatient cases, 27 997 (0.59%) were hospitalised during the study period. A higher proportion of haemodialysis patient care specialists and a higher number of nurses experienced in haemodialysis were inversely associated with the risk of hospitalisation (per 10% increase in haemodialysis patient care specialists: relative risk (RR)=0.987, 95% CI 0.981 to 0.993; per 10-person increase in nurses who provided haemodialysis: RR=0.876, 95% CI 0.833 to 0.921). In addition, such associations were greater in severe patients. Conclusions Our findings suggest that haemodialysis units with high-quality, haemodialysis-specialised human resources could positively affect the outcomes of outpatients with ESRD. Based on our findings, health policymakers and professionals should implement strategies for the optimal management of patients with CKD. PMID:27534988

Dusting off another shelf: further comments on classic gynecologic pathology books of yesteryear.

PubMed

Young, Robert H

2005-01-01

Selected outstanding books from the older literature on gynecologic pathology are reviewed with emphasis on drawing attention to the abundant helpful information and often outstanding illustrations that are worthy of review by present-day pathologists. This represents a follow up to a previous similar essay that appeared in Volume 19:67-84, 2000. The first three books cover general gynecological pathology: Gynecological Pathology by Carl Abel; Gynecological and Obstetrical Pathology by Robert T. Frank; and Haines and Taylor's Gynaecological Pathology by Magnus Haines and Claud W. Taylor. Each of them emphasizes the time-honored problem of mimicry of malignancy by diverse benign lesions or even aspects of normal histology. Awareness of the clinical background and cooperation between the clinician and pathologist are emphasized. The other three books considered are all devoted largely or exclusively to the ovary: Ovarian Tumors by Hans Selye, Ovarian Neoplasms, Morphology, and Classification by Karel Motlik, and Special Tumors of Ovary and Testis and Related Extragonadal Lesions by Gunnar Teilum. The book of Selye has a truly remarkable encyclopedic coverage of the older literature, the references being so comprehensive that they are presented in a separate volume. A number of aspects of the histopathology of ovarian tumors that have been emphasized in recent years are noted in Selye's book. Dr. Motlik's book presents a very high quality consideration of the differential diagnosis of ovarian tumors. Teilum's book contains a masterful account of the histopathology of germ cell tumors emphasizing a neoplasm with which his name will always be associated, the yolk sac tumor (endodermal sinus tumor). Numerous beautiful and refreshingly large illustrations are provided, and Dr. Teilum's interest in comparative pathology is evident in the pages, his linking of the famous Schiller-Duval bodies with the endodermal sinuses of the rat placenta, being the most notable example.

Antibiotic Resistance Patterns of Outpatient Pediatric Urinary Tract Infections

PubMed Central

Edlin, Rachel S.; Shapiro, Daniel J.; Hersh, Adam L.; Copp, Hillary L.

2014-01-01

Purpose We characterize the current national patterns of antibiotic resistance of outpatient pediatric urinary tract infection. Materials and Methods We examined outpatient urinary isolates from patients younger than 18 years in 2009 using The Surveillance Network®, a database with antibiotic susceptibility results and patient demographic data from 195 United States hospitals. We determined the prevalence and antibiotic resistance patterns for the 6 most common uropathogens, ie Escherichia coli, Proteus mirabilis, Klebsiella, Enterobacter, Pseudomonas aeruginosa and Enterococcus. We compared differences in uropathogen prevalence between males and females using chi-square analysis. Results We identified 25,418 outpatient urinary isolates. E. coli was the most common uropathogen overall but the prevalence of E. coli was higher among females (83%) than males (50%, p <0.001). Other common species among males were Enterococcus (17%), P. mirabilis (11%) and Klebsiella (10%). However, these uropathogens each accounted for 5% or less of female isolates (p <0.001). Resistance among E. coli was highest for trimethoprim-sulfamethoxazole (24%) but lower for nitrofurantoin (less than 1%) and cephalothin (15%). Compared to 2002 Surveillance Network data, E. coli resistance rates increased for trimethoprim-sulfamethoxazole (from 23% to 31% in males and from 20% to 23% in females) and ciprofloxacin (from 1% to 10% and from 0.6% to 4%, respectively). Conclusions E. coli remains the most common pediatric uropathogen. Although widely used, trimethoprim-sulfamethoxazole is a poor empirical choice for pediatric urinary tract infections in many areas due to high resistance rates. First-generation cephalosporins and nitrofurantoin are appropriate narrow-spectrum alternatives given their low resistance rates. Local antibiograms should be used to assist with empirical urinary tract infection treatment. PMID:23369720

Accreditation Status and Geographic Location of Outpatient Echocardiographic Testing Facilities Among Medicare Beneficiaries: The VALUE-ECHO Study.

PubMed

Brown, Scott C; Wang, Kefeng; Dong, Chuanhui; Yi, Li; Marinovic Gutierrez, Carolina; Di Tullio, Marco R; Farrell, Mary Beth; Burgess, Pamela; Gornik, Heather L; Hamburg, Naomi M; Needleman, Laurence; Orsinelli, David; Robison, Susana; Rundek, Tatjana

2018-02-01

Accreditation of echocardiographic testing facilities by the Intersocietal Accreditation Commission (IAC) is supported by the American College of Cardiology and American Society of Echocardiography. However, limited information exists on the accreditation status and geographic distribution of echocardiographic facilities in the United States. Our study aimed to identify (1) the proportion of outpatient echocardiography facilities used by Medicare beneficiaries that are IAC accredited, (2) their geographic distribution, and (3) variations in procedure type and volume by accreditation status. As part of the VALUE-ECHO (Value of Accreditation, Location, and Utilization Evaluation-Echocardiography) study, we examined the proportion of IAC-accredited echocardiographic facilities performing outpatient echocardiography in the 2013 Centers for Medicare and Medicaid Services outpatient limited data set (100% sample) and their geographic distribution using geocoding in ArcGIS (ESRI, Redlands, CA). Among 4573 outpatient facilities billing Medicare for echocardiographic testing in 2013, 99.6% (n = 4554) were IAC accredited (99.7% in the 50 US states and 86.2% in Puerto Rico). The proportion IAC-accredited echocardiographic facilities varied by region, with 98.7%, 99.9%, 99.9%, 99.5%, and 86.2% of facilities accredited in the Northeast, South, Midwest, West, and Puerto Rico, respectively (P < .01, Fisher exact test). Of all echocardiographic outpatient procedures conducted (n = 1,890,156), 99.8% (n = 1,885,382) were performed in IAC-accredited echocardiographic facilities. Most procedures (90.9%) were transthoracic echocardiograms, of which 99.7% were conducted in IAC-accredited echocardiographic facilities. Almost all outpatient echocardiographic facilities billed by Medicare are IAC accredited. This accreditation rate is substantially higher than previously reported for US outpatient vascular testing facilities (13% IAC accredited). The uniformity of imaging

Urinary Tract Injury in Gynecologic Laparoscopy for Benign Indication: A Systematic Review.

PubMed

Wong, Jacqueline M K; Bortoletto, Pietro; Tolentino, Jocelyn; Jung, Michael J; Milad, Magdy P

2018-01-01

To perform a comprehensive literature review of the incidence, location, etiology, timing, management, and long-term sequelae of urinary tract injury in gynecologic laparoscopy for benign indication. A systematic review of PubMed, EMBASE, Cochrane Library, and ClinicalTrials.gov was conducted. Four hundred thirty-three studies were screened for inclusion with 136 full-text articles reviewed. Ninety studies published between 1975 and 2015 met inclusion criteria, representing 140,444 surgeries. Articles reporting the incidence of urinary tract injury in gynecologic laparoscopy for benign indication were included. Exclusion criteria comprised malignancy, surgery by urogynecologists, research not in English, and insufficient data. A total of 458 lower urinary tract injuries were reported with an incidence of 0.33% (95% CI 0.30-0.36). Bladder injury (0.24%, 95% CI 0.22-0.27) was overall three times more frequent than ureteral injury (0.08%, 95% CI 0.07-0.10). Laparoscopic hysterectomy not otherwise specified (1.8%, 95% CI 1.2-2.6) and laparoscopically assisted vaginal hysterectomy (1.0%, 95% CI 0.9-1.2) had the highest rates of injury. Most ureteral injuries resulted from electrosurgery (33.3%, 95% CI 24.3-45.8), whereas most bladder injuries resulted from lysis of adhesions (23.3%, 95% CI 18.7-29.0). Ureteral injuries were most often recognized postoperatively (60%, 95% CI 47-76) and were repaired by open ureteral anastomosis (47.4%, 95% CI 36.3-61.9). In contrast, bladder injuries were most often recognized intraoperatively (85%, 95% CI 75-95) and were repaired by laparoscopic suturing (34.9%, 95% CI 29.2-41.7). The incidence of lower urinary tract injury in gynecologic laparoscopy for benign indication remains low at 0.33%. Bladder injury was three times more common than ureteral injury, although ureteral injuries were more often unrecognized intraoperatively and underwent open surgical repair. These risk estimates can assist gynecologic surgeons in effectively

Unplanned 30-day hospital readmission as a quality measure in gynecologic oncology.

PubMed

Wilbur, MaryAnn B; Mannschreck, Diana B; Angarita, Ana M; Matsuno, Rayna K; Tanner, Edward J; Stone, Rebecca L; Levinson, Kimberly L; Temkin, Sarah M; Makary, Martin A; Leung, Curtis A; Deutschendorf, Amy; Pronovost, Peter J; Brown, Amy; Fader, Amanda N

2016-12-01

Thirty-day readmission is used as a quality measure for patient care and Medicare-based hospital reimbursement. The primary study objective was to describe the 30-day readmission rate to an academic gynecologic oncology service. Secondary objectives were to identify risk factors and costs related to readmission. This was a retrospective, concurrent cohort study of all surgical admissions to an academic, high volume gynecologic oncology service during a two-year period (2013-2014). Data were collected on patient demographics, medical comorbidities, psychosocial risk factors, and results from a hospital discharge screening survey. Mixed logistic regression was used to identify factors associated with 30-day readmission and costs of readmission were assessed. During the two-year study period, 1605 women underwent an index surgical admission. Among this population, a total of 177 readmissions (11.0%) in 135 unique patients occurred. In a surgical subpopulation with >1 night stay, a readmission rate of 20.9% was observed. The mean interval to readmission was 11.8days (SD 10.7) and mean length of readmission stay was 5.1days (SD 5.0). Factors associated with readmission included radical surgery for ovarian cancer (OR 2.87) or cervical cancer (OR 4.33), creation of an ostomy (OR 11.44), a Charlson score of ≥5 (OR 2.15), a language barrier (OR 3.36), a median household income in the lowest quartile (OR 6.49), and a positive discharge screen (OR 2.85). The mean cost per readmission was $25,416 (SD $26,736), with the highest costs associated with gastrointestinal complications at $32,432 (SD $32,148). The total readmission-related costs during the study period were $4,523,959. Readmissions to a high volume gynecologic oncology service were costly and related to radical surgery for ovarian and cervical cancer as well as to medical, socioeconomic and psychosocial patient variables. These data may inform interventional studies aimed at decreasing unplanned readmissions in

Surgical manual of the Korean Gynecologic Oncology Group: ovarian, tubal, and peritoneal cancers.

PubMed

Jeon, Seob; Lee, Sung Jong; Lim, Myong Cheol; Song, Taejong; Bae, Jaeman; Kim, Kidong; Lee, Jung Yun; Kim, Sang Wun; Chang, Suk Joon; Lee, Jong Min

2017-01-01

The Surgery Treatment Modality Committee of the Korean Gynecologic Oncology Group has determined to develop a surgical manual to facilitate clinical trials and to improve communication between investigators by standardizing and precisely describing operating procedures. The literature on anatomic terminology, identification of surgical components, and surgical techniques were reviewed and discussed in depth to develop a surgical manual for gynecologic oncology. The surgical procedures provided here represent the minimum requirements for participating in a clinical trial. These procedures should be described in the operation record form, and the pathologic findings obtained from the procedures should be recorded in the pathologic report form. Here, we describe surgical procedure for ovarian, fallopian tubal, and peritoneal cancers.

Surgical manual of the Korean Gynecologic Oncology Group: ovarian, tubal, and peritoneal cancers

PubMed Central

2017-01-01

The Surgery Treatment Modality Committee of the Korean Gynecologic Oncology Group has determined to develop a surgical manual to facilitate clinical trials and to improve communication between investigators by standardizing and precisely describing operating procedures. The literature on anatomic terminology, identification of surgical components, and surgical techniques were reviewed and discussed in depth to develop a surgical manual for gynecologic oncology. The surgical procedures provided here represent the minimum requirements for participating in a clinical trial. These procedures should be described in the operation record form, and the pathologic findings obtained from the procedures should be recorded in the pathologic report form. Here, we describe surgical procedure for ovarian, fallopian tubal, and peritoneal cancers. PMID:27670260

38 CFR 17.161 - Authorization of outpatient dental treatment.

Code of Federal Regulations, 2013 CFR

2013-07-01

... outpatient dental treatment. 17.161 Section 17.161 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Dental Services § 17.161 Authorization of outpatient dental treatment. Outpatient dental treatment may be authorized by the Chief, Dental Service, for beneficiaries defined in 38 U.S.C...

38 CFR 17.161 - Authorization of outpatient dental treatment.

Code of Federal Regulations, 2011 CFR

2011-07-01

... outpatient dental treatment. 17.161 Section 17.161 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Dental Services § 17.161 Authorization of outpatient dental treatment. Outpatient dental treatment may be authorized by the Chief, Dental Service, for beneficiaries defined in 38 U.S.C...

38 CFR 17.161 - Authorization of outpatient dental treatment.

Code of Federal Regulations, 2010 CFR

2010-07-01

... outpatient dental treatment. 17.161 Section 17.161 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Dental Services § 17.161 Authorization of outpatient dental treatment. Outpatient dental treatment may be authorized by the Chief, Dental Service, for beneficiaries defined in 38 U.S.C...

38 CFR 17.161 - Authorization of outpatient dental treatment.

Code of Federal Regulations, 2014 CFR

2014-07-01

... outpatient dental treatment. 17.161 Section 17.161 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Dental Services § 17.161 Authorization of outpatient dental treatment. Outpatient dental treatment may be authorized by the Chief, Dental Service, for beneficiaries defined in 38 U.S.C...

38 CFR 17.161 - Authorization of outpatient dental treatment.

Code of Federal Regulations, 2012 CFR

2012-07-01

... outpatient dental treatment. 17.161 Section 17.161 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Dental Services § 17.161 Authorization of outpatient dental treatment. Outpatient dental treatment may be authorized by the Chief, Dental Service, for beneficiaries defined in 38 U.S.C...

42 CFR 410.155 - Outpatient mental health treatment limitation.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Outpatient mental health treatment limitation. 410... § 410.155 Outpatient mental health treatment limitation. (a) Limitation. For services subject to the... Medicare payment amount and the patient liability amounts for outpatient mental health services subject to...

42 CFR 410.155 - Outpatient mental health treatment limitation.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 2 2014-10-01 2014-10-01 false Outpatient mental health treatment limitation. 410... § 410.155 Outpatient mental health treatment limitation. (a) Limitation. For services subject to the... Medicare payment amount and the patient liability amounts for outpatient mental health services subject to...

Angiogenesis Markers in Gynecological Tumors and Patents for Anti-Angiogenic Approach: Review.

PubMed

Abdalla, Douglas R; Simoens, Cindy; Bogers, John-Paul; Murta, Eddie F C; Michelin, Marcia A

2015-01-01

The formation of a tumor-associated vascular network is an important step in understanding the stages of tumor progression. This review aims to highlight the main markers of induction, proliferation and inhibition of angiogenesis, as well as the quantification of microvessel density, correlated with preclinical and clinical research in gynecologic cancers and also discussed related patents. Studies show that in the most advanced cases of gynecological cancers, biomarkers such as VEGF (Vascular Endothelial Growth Factor), MMP (Matrix Metalloproteinase), CD105 (Endoglin), TIMP (tissue inhibitors of metalloproteinases) and VASH (Vasohibin) are more expressed compared to healthy individuals. Continuous evaluation of these biomarkers in cancer cases could serve in the future as a basis for development of new therapeutic approaches, leading to a good response to cancer treatment, and thus increase survival of cancer patients.

Serum vascular endothelial growth factor and adiponectin levels in patients with benign and malignant gynecological diseases.

PubMed

Lasalandra, Carla; Coviello, Maria; Falco, Gaetano; Divella, Rosa; Trojano, Giuseppe; Laterza, Anna Maria; Quero, Carmela; Pepe, Vito; Zito, Francesco Alfredo; Quaranta, Michele

2010-05-01

One of the most specific and critical regulators of angiogenesis is vascular endothelial growth factor (VEGF), which regulates endothelial proliferation, permeability, and survival. Vascular endothelial growth factor is an angiogenic mediator in tumors and has been implicated in the pathogenesis and progression of cancer. Adipose tissue is a major endocrine and it secretes hormones termed adipokines. These factors are derived from adipocytes and include proteins and metabolites such as adiponectin. Recently, adiponectin was also shown to modulate angiogenesis. This study was designed to determine the serum VEGF and adiponectin levels in patients with benign and malignant gynecological diseases and if there was a correlation between serum VEGF and adiponectin. Serum samples, collected fasting before surgery or intervention, were available for total of 114 female patients recorded between October 2006 and December 2008. Diagnosis of benign and malignant gynaecological diseases was established by biopsy. Serum levels VEGF and adiponectin were using commercially available enzyme linked immunosorbent assay (R&D Systems Inc, Minneapolis, MN), respectively. Statistical analysis was performed by using the SPSS 9.0 software package (SPSS, Inc, Chicago, IL). The correlation between serum VEGF and serum Adiponectin was calculated using the Pearson correlation coefficient. P values of < 0.05 were considered statistically significant. Our results were analyzed on the basis of 2 different parameters: age and benign and malignant gynecological diseases of the patient. Only for serum VEGF levels was a significant difference observed (P = 0.004) between patients with benign and malignant gynecological diseases. A significantly inverse correlation between serum VEGF and adiponectin levels among patients with benign and malignant gynecological diseases was found. Adiponectin level is not correlated with body mass index. This is one of the first report on adiponectin in benign and

Preoperative vaginal preparation with baby shampoo compared with povidone-iodine before gynecologic procedures.

PubMed

Lewis, Linda A; Lathi, Ruth B; Crochet, Patrice; Nezhat, Camran

2007-01-01

The objective of this study was to compare the postoperative infection rates between patients receiving either povidone-iodine (PI) or baby shampoo vaginal preparations before gynecologic surgery. Cohort study (Canadian Task Force classification II-2). University referral center for gynecologic endoscopy. All patients underwent minimally invasive gynecologic surgery including hysteroscopy or laparoscopy. The agents used for vaginal preparation were either baby shampoo in a 1:1 dilution with sterile normal saline solution or PI 7.5% scrub solution. Charts were reviewed for evidence of infection within 30 days of surgery (symptoms of urinary tract infection, abdominal or vaginal wound infections, temperature > 100.4 degrees F, and fungal or bacterial vaginitis). A total of 249 cases were collected; 96 subjects underwent surgery before the change to baby shampoo and 153 subjects after. Both groups were well matched for the types of surgery performed, age, risk factors for postoperative infections, and the postoperative diagnosis. The infection rates were 14/96 (14.6%) with PI preparation versus 18/153 (11.8%) with baby shampoo (p = .52). Baby shampoo should be studied as an alternative to PI because it is a nonirritating, inexpensive mild detergent. This preliminary study suggests that baby shampoo is as effective as PI in preventing postoperative infection.

The role of interventional radiology in management of benign and malignant gynecologic diseases.

PubMed

Yu, Hyeon; Stavas, Joseph M

2013-10-01

This article focuses on the role of interventional radiology in the therapeutic and diagnostic management of benign and malignant gynecologic conditions. The subspecialty of interventional radiology utilizes minimally invasive advanced image-guided percutaneous techniques in gynecology that include central venous catheter placement, fluid aspiration, drainage catheter placement, tissue biopsy, inferior vena cava filter placement, and pelvic arterial embolization. Central venous catheters, such as ports, peripherally inserted central catheters, and tunneled catheters, are placed for intermediate to long-term intravenous chemotherapy or total parental nutrition or antibiotics. Patients with refractory malignant ascites or pleural effusion from seeding of advanced gynecologic cancers may benefit by percutaneous aspiration of fluid collections or placement of drainage catheters. Postoperative fluid collections including abscess, seroma, or lymphocele are managed by percutaneous drainage catheter insertion. Pelvic, peritoneal, or retroperitoneal masses can be sampled by image-guided percutaneous biopsy or aspiration of fluid to determine a pathologic diagnosis. Certain patients are at risk for deep venous thrombosis with pulmonary embolism and may benefit from an inferior vena cava filter. Patients with uncontrolled postoperative or postpartum bleeding can be effectively managed with emergent transarterial pelvic embolization. Each of the aforementioned interventions with indications, expected benefits, and complications is described including a published literature.

Relationship between social support and fatigue in geriatric patients receiving outpatient chemotherapy.

PubMed

Karakoç, Tuğba; Yurtsever, Sabire

2010-02-01

This descriptive study was conducted with the purpose of determining the relationship between fatigue and social support in elderly individuals receiving chemotherapy. It was conducted in the oncology outpatient chemotherapy units of two university hospitals and one research hospital. A total of 71 patients who were 60 years old and older and receiving outpatient chemotherapy were included. Data were collected using a "Personal Information Form," "Social Support Scale in Cancer Patients," and "Visual Analogue Scale for Fatigue." Fatigue was the most common symptom (93%) in elderly patients receiving chemotherapy. The elderly individuals' perceived level of social support was found to be "good", the main form of support they received from those around them was "security" and the area most lacking was felt to be "information." As the individuals' level of social support increased, the severity of the fatigue they experienced decreased. The data demonstrate that social support was imperative in coping with fatigue. Copyright 2009 Elsevier Ltd. All rights reserved.

The target invites a foe: antibody-drug conjugates in gynecologic oncology.

PubMed

Campos, Maira P; Konecny, Gottfried E

2018-02-01

Antibody-drug conjugates (ADCs) represent a promising new class of cancer therapeutics. Currently more than 60 ADCs are in clinical development, however, only very few trials focus on gynecologic malignancies. In this review, we summarize the most recent advances in ADC drug development with an emphasis on how this progress relates to patients diagnosed with gynecologic malignancies and breast cancer. The cytotoxic payloads of the majority of the ADCs that are currently in clinical trials for gynecologic malignancies or breast cancer are auristatins (MMAE, MMAF), maytansinoids (DM1, DM4), calicheamicin, pyrrolobenzodiazepines and SN-38. Both cleavable and noncleavable linkers are currently being investigated in clinical trials. A number of novel target antigens are currently being validated in ongoing clinical trials including folate receptor alpha, mesothelin, CA-125, NaPi2b, NOTCH3, protein tyrosine kinase-like 7, ephrin-A4, TROP2, CEACAM5, and LAMP1. For most ADCs currently in clinical development, dose-limiting toxicities appear to be unrelated to the targeted antigen but more tightly associated with the payload. Rational drug design involving optimization of the antibody, the linker and the conjugation chemistry is aimed at improving the therapeutic index of new ADCs. Antibody-drug conjugates can increase the efficacy and decrease the toxicity of their payloads in comparison with traditional cyctotoxic agents. A better and quicker translation of recent scientific advances in the field of ADCs into rational clinical trials for patients diagnosed with ovarian, endometrial or cervical cancer could create real improvements in tumor response, survival and quality of life for our patients.

The quality and readability of online consumer information about gynecologic cancer.

PubMed

Sobota, Aleksandra; Ozakinci, Gozde

2015-03-01

The Internet has become an important source of health-related information for consumers, among whom younger women constitute a notable group. The aims of this study were (1) to evaluate the quality and readability of online information about gynecologic cancer using validated instruments and (2) to relate the quality of information to its readability. Using the Alexa Rank, we obtained a list of 35 Web pages providing information about 7 gynecologic malignancies. These were assessed using the Health on the Net (HON) seal of approval, the Journal of the American Medical Association (JAMA) benchmarks, and the DISCERN instrument. Flesch readability score was calculated for sections related to symptoms and signs and treatment. Less than 30% of the Web pages displayed the HON seal or achieved all JAMA benchmarks. The majority of the treatment sections were of moderate to high quality according to the DISCERN. There was no significant relationship between the presence of the HON seal and readability. Web pages achieving all JAMA benchmarks were significantly more difficult to read and understand than Web pages that missed any of the JAMA benchmarks. Treatment-related content of moderate to high quality as assessed by the DISCERN had a significantly better readability score than the low-quality content. The online information about gynecologic cancer provided by the most frequently visited Web pages is of variable quality and in general difficult to read and understand. The relationship between the quality and readability remains unclear. Health care providers should direct their patients to reliable material online because patients consider the Internet as an important source of information.

[Evolution and viability of an outpatient surgery center for cataract surgery on a large scale in a university hospital].

PubMed

Kara-Junior, Newton; Espíndola, Rodrigo França de

2010-01-01

To analyze the number of surgeries performed in outpatient surgical center at a university hospital and to assess its financial viability during and after the interruption of the Cataract National Campaign in 2006. Retrospective analytical study between 2005 and 2009 at the Clinical Hospital of the University of São Paulo (HC-FMUSP) which evaluated the economic viability of the outpatient surgical center, the number of cataract surgeries performed and the number of surgeons present daily in that unit. It would be necessary to perform at least 400 procedures monthly to ensure the financial viability of the outpatient surgical center. This number was lower than the expected in the years of 2008 and 2009 (average of 370.6 and 390.1 surgeries respectively). The number of cataract fellows decreased from 13 in 2005 to 3 in 2009. The main factor for the reduction in the number of cataract surgeries performed in the outpatient surgical center after 2006 was the difficulty of access of the population to the hospital due to restrictions on the development of screening projects. The increased use of the operating rooms by other clinics and the decrease in the admission of new surgeons, made the outpatient surgical center appropriate and viable for the new political-economic reality.

[Patient satisfaction in the outpatient department--a pilot study for customer satisfaction in ENT].

PubMed

Schmidt, K; Meyer, J; Jahnke, I; Wollenberg, B; Schmidt, C

2009-03-01

Customer satisfaction in German hospitals is becoming more important because of increasing competition in the healthcare market. Because the majority of patients with ear-nose-throat (ENT) problems are treated in an outpatient setting, this competition is not only taking place among hospitals but also among specialists in private practices. To assess patient preferences, reliable and valid questionnaires are necessary, which so far exist only for inpatients. The aim of the study was to develop an instrument with which to discover areas for potential improvement of the outpatient department. The questionnaire was developed according to the guidelines of the EORTC and tested in a prestudy. During the time of observation, 98 patients were available, of whom 79 could be included in the study. The return rate was 71%. Of these patients, 18 were female and 38 male; the median age was 56 years. There were no differences between the study group and the yearly clinic average in terms of age, gender, or ratio of tumor patients. Patients mainly complained about waiting times in the outpatient department and diagnostic units as well as high patient turnover. Concerning positive aspects, patients mentioned the medical competence of the treating physicians; concerning negative aspects, the building infrastructure was noted. The questionnaire showed sufficient psychometric properties and helped find areas for improvement in the outpatient department. However, a complete picture of the department will be feasible only with repeated measures, especially when taking steps to improve the department's processes.

Patients' perspectives of fast-track surgery and the role of the fast-track clinical nurse consultant in gynecological oncology.

PubMed

Philp, Shannon; Carter, J; Barnett, C; DʼAbrew, N; Pather, S; White, K

2015-01-01

This study examines the role of the fast-track nurse in gynecology from a patient perspective. The fast-track nurse is a specialist nursing role, which coordinates patient care, in addition to providing specialized clinical care. Semistructured interviews were conducted with women who had fast-track surgery for gynecological cancer.

Outpatient Percutaneous Nephrolithotomy: The UC San Diego Health Experience.

PubMed

Bechis, Seth K; Han, Daniel S; Abbott, Joel E; Holst, Daniel D; Alagh, Amy; DiPina, Thomas; Sur, Roger L

2018-05-01

Outpatient percutaneous nephrolithotomy (PCNL) has been described for highly selected patients. We sought to assess the safety and feasibility of outpatient PCNL in a tertiary referral stone center without strict patient selection criteria. We reviewed all PCNLs performed at our institution from September 2015 to October 2016. Of the 97 eligible cases, 60 patients underwent planned outpatient PCNL. Primary outcome was complication rate, and secondary outcome determined predictor variables of inpatient admission. Thirty-seven inpatient and 60 planned outpatient (one bilateral) PCNLs were performed with 65% and 44% American Society of Anesthesiologists (ASA) score ≥3, respectively. The 30-day overall complication rate for the inpatient and planned outpatient groups was 27% and 20%, respectively (p = 0.43) [70% and 92% Clavien grades I-II]. Emergency department presentation within 30 days was 19% and 18% (p = 0.94), and unplanned hospital readmission rate was 3% and 10% (p = 0.05). The 37 inpatient PCNL patients had larger total stone burden than outpatient cases (40.7 vs 25.8 mm, p = 0.0014); more often required two or more punctures into the kidney during the procedure (73% vs 45%, p = 0.025); and more often had supracostal access (20% vs 7%, p = 0.05). For the outpatient PCNL cohort, 72% patients were discharged same day, 28% were observed overnight for refractory symptoms or social reasons. Outpatient cohort radiographic stone-free rate by CT (no stones) was 67%. Outpatient PCNL has been safely and effectively performed within our institution in moderate-sized stones almost regardless of comorbidity status. We suggest that this approach is a potential algorithmic change in centers with sufficient case volume.

Withdrawal strategies for outpatients

PubMed Central

Mezciems, Edgar

1996-01-01

This article discusses outpatient withdrawal strategies for patients addicted to alcohol, benzodiazepines, barbiturates, and opiates and describes some practical ways to support recovery. PMID:8828877

What if pediatric residents could bill for their outpatient services?

PubMed

Ng, M; Lawless, S T

2001-10-01

We prospectively studied the potential of billing and coding practices of pediatric residents in outpatient clinics and extrapolated our results to assess the financial implications of billing inaccuracies. Using Medicare as a common measure of "currency," we also used the relative value unit (RVU) and ambulatory payment class methodologies as means of assessing the productivity and financial value of resident-staffed pediatric clinics. Residents were asked to submit voluntarily shadow billing forms and documentation of outpatient clinic visits. Documentation of work was assessed by a blinded reviewer, and current procedure terminology evaluation and management codes were assigned. Comparisons between resident codes and calculated codes were made. Financial implications of physician productivity were calculated in terms of dollar amounts and RVUs. Resource intensity was measured using the ambulatory payment class methodology. A total of 344 charts were reviewed. Coding agreement for health maintenance visits was 86%, whereas agreement for acute care visits was 38%. Eighty-three percent of coding disagreement in the latter group was resulting from undercoding by residents. Errors accounted for a 4.79% difference in potential reimbursement for all visit types and a 19.10% difference for acute care visits. No significant differences in shadow billing discrepancies were found between different levels of training. Residents were predicted to generate $67 230, $87 593, and $96 072 in Medicare revenue in the outpatient clinic setting during each successive year of training. On average, residents generated 1.17 +/- 0.01 and 0.81 +/- 0.02 work RVUs for each health maintenance visit and office visit, respectively. Annual productivity from outpatient clinic settings was estimated at 548, 735, and 893 work RVUs in the postgraduate levels 1, 2, and 3, respectively. When pediatric residents are not trained adequately in proper coding practices, the potential for billing

[Consequences of increasing and ageing population of Basse-Normandie on gynecology and obstetrics activity].

PubMed

Mandon, M; Macé, J-M; Dreyfus, M; Berger, L

2015-11-01

In Basse-Normandie, the population over 65 years old will expend more rapidly between 2007 and 2042 (+11.6%) than the rest of the French population (+9.2%). The same population of Basse-Normandie will get old in the 15 years to come. The impact of these demographic changes over the activity in the gynecology-obstetrics field is not clearly identified. Although we cannot predict the technical and scientific developments in the next 15 years, we are presenting a model allowing to hypothesize about changes of gynecology and obstetrics according to population's aging. We have established a projection model for the realizable surgical acts in obstetrics and gynecology in accordance with the aging of the population in Basse-Normandie. The study was realized based on the acts concerning the cesarean sections (C-section), tubal sterilization, hysteroscopy and hysterectomy as well as ovarectomy and breast surgery. For each activity branch, the codes of the Classification commune des actes médicaux (CCAM) were selected and then removed from the Programme médicalisé des systèmes d'information (PMSI) database. We have used and adapted the Omphale model of the National Statistics and Economical Studies Institute and we have applied it for the period of 2009-2025. Our projection model has permeated to show a 5.5% regression of the C-section acts, a 2% incretion of the hysterectomies and hysteroscopies, 7.7% of ovarectomies as well as a 9.8% augmentation of the breast surgeries. However, we predict a 11.8% diminution of the sterilizations by tubal implants. Globally, the activity in obstetrics and gynecology will remain constant with an insignificant augmentation of 46 acts (0.01%). In Basse-Normandie, the surgical activity in gynecology-obstetrics will moderately increase in the next 15 years. This constant activity signifies that there is no need to form more residents than the number of practitioner to retire. The interest of this model is that it is applicable at a

42 CFR 410.60 - Outpatient physical therapy services: Conditions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 2 2012-10-01 2012-10-01 false Outpatient physical therapy services: Conditions... Services § 410.60 Outpatient physical therapy services: Conditions. (a) Basic rule. Except as specified in paragraph (a)(3)(iii) of this section, Medicare Part B pays for outpatient physical therapy services only if...

42 CFR 410.60 - Outpatient physical therapy services: Conditions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 2 2013-10-01 2013-10-01 false Outpatient physical therapy services: Conditions... Services § 410.60 Outpatient physical therapy services: Conditions. (a) Basic rule. Except as specified in paragraph (a)(3)(iii) of this section, Medicare Part B pays for outpatient physical therapy services only if...

42 CFR 410.60 - Outpatient physical therapy services: Conditions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 2 2011-10-01 2011-10-01 false Outpatient physical therapy services: Conditions... Services § 410.60 Outpatient physical therapy services: Conditions. (a) Basic rule. Except as specified in paragraph (a)(3)(iii) of this section, Medicare Part B pays for outpatient physical therapy services only if...

42 CFR 410.60 - Outpatient physical therapy services: Conditions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Outpatient physical therapy services: Conditions... Services § 410.60 Outpatient physical therapy services: Conditions. (a) Basic rule. Except as specified in paragraph (a)(3)(iii) of this section, Medicare Part B pays for outpatient physical therapy services only if...

42 CFR 410.60 - Outpatient physical therapy services: Conditions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 2 2014-10-01 2014-10-01 false Outpatient physical therapy services: Conditions... Services § 410.60 Outpatient physical therapy services: Conditions. (a) Basic rule. Except as specified in paragraph (a)(3)(iii) of this section, Medicare Part B pays for outpatient physical therapy services only if...

Preoperative Obstructive Sleep Apnea Screening in Gynecologic Oncology Patients.

PubMed

Harrison, Ross F; Medlin, Erin E; Petersen, Chase B; Rose, Stephen L; Hartenbach, Ellen M; Kushner, David M; Spencer, Ryan J; Rice, Laurel W; Al-Niaimi, Ahmed N

2018-05-21

Women with a gynecologic cancer tend to be older, obese, and postmenopausal, characteristics that are associated with an increased risk for obstructive sleep apnea. However, there is limited investigation regarding the condition's prevalence in this population or its impact on postoperative outcomes. In other surgical populations, patients with obstructive sleep apnea have been observed to be at increased risk for adverse postoperative events. To estimate the prevalence of obstructive sleep apnea among gynecologic oncology patients undergoing elective surgery and to investigate for a relationship between obstructive sleep apnea and postoperative outcomes. Patients referred to an academic gynecologic oncology practice were approached for enrollment in this prospective, observational study. Patients were considered eligible for study enrollment if they were scheduled for a non-emergent inpatient surgery and could provide informed consent. Enrolled patients were evaluated for a preexisting diagnosis of obstructive sleep apnea. Those without a prior diagnosis were screened using the validated, 4-item STOP [i.e. Snore loudly, daytime Tiredness, Observed apnea, elevated blood Pressure] questionnaire. All patients who screened positive for obstructive sleep apnea were referred for polysomnography. The primary outcome was the prevalence of women with obstructive sleep apnea or those who screened at high risk for the condition. Secondary outcomes examined the correlation between body mass index (kg/m 2 ) with obstructive sleep apnea and assessed for a relationship between obstructive sleep apnea and postoperative outcomes. Over a 22-month accrual period, 383 eligible patients were consecutively approached to participate in the study. A cohort of 260 patients were enrolled. A total of 33/260 patients (13%) were identified as having a previous diagnosis of obstructive sleep apnea. An additional 66/260 (25%) screened at risk for the condition using the STOP questionnaire. Of

Mapping the literature of maternal-child/gynecologic nursing.

PubMed

Jacobs, Susan Kaplan

2006-04-01

As part of a project to map the literature of nursing, sponsored by the Nursing and Allied Health Resources Section of the Medical Library Association, this study identifies core journals cited in maternal-child/gynecologic nursing and the indexing services that access the cited journals. Three source journals were selected and subjected to a citation analysis of articles from 1996 to 1998. Journals were the most frequently cited format (74.1%), followed by books (19.7%), miscellaneous (4.2%), and government documents (1.9%). Bradford's Law of Scattering was applied to the results, ranking cited journal references in descending order. One-third of the citations were found in a core of 14 journal titles; one-third were dispersed among a middle zone of 100 titles; and the remaining third were scattered in a larger zone of 1,194 titles. Indexing coverage for the core titles was most comprehensive in PubMed/MEDLINE, followed by Science Citation Index and CINAHL. The core of journals cited in this nursing specialty revealed a large number of medical titles, thus, the biomedical databases provide the best access. The interdisciplinary nature of maternal-child/ gynecologic nursing topics dictates that social sciences databases are an important adjunct. The study results will assist librarians in collection development, provide end users with guidelines for selecting databases, and influence database producers to consider extending coverage to identified titles.

Fee-for-Service Revenue for School Mental Health through a Partnership with an Outpatient Mental Health Center

ERIC Educational Resources Information Center

Lever, Nancy A.; Stephan, Sharon Hoover; Axelrod, Jennifer; Weist, Mark D.

2004-01-01

School mental health programs are increasingly prominent in the United States and in other countries, but funding remains tentative. This article describes a partnership between a school mental health program and an outpatient mental health center, and considers the larger goal of promoting sustainability and increasing revenue. Issues related to…

Human Factors Evaluation of Surgeons' Working Positions for Gynecologic Minimal Access Surgery.

PubMed

Hignett, Sue; Gyi, Diane; Calkins, Lisa; Jones, Laura; Moss, Esther

To investigate work-related musculoskeletal disorders (WRMSD) in gynaecological minimal access surgery (MAS), including bariatric (plus size) patients DESIGN: Mixed methods (Canadian Task Force classification III). Teaching hospital in the United Kingdom. Survey, observations (anthropometry, postural analysis), and interviews. Work-related musculoskeletal disorders (WRMSDs) were present in 63% of the survey respondents (n = 67). The pilot study (n = 11) identified contributory factors, including workplace layout, equipment design, and preference of port use (relative to patient size). Statistically significant differences for WRMSD-related posture risks were found within groups (average-size mannequin and plus-size mannequin) but not between patient size groups, suggesting that port preference may be driven by surgeon preference (and experience) rather than by patient size. Some of the challenges identified in this project need new engineering solutions to allow flexibility to support surgeon choice of operating approach (open, laparoscopic or robotic) with a workplace that supports adaptation to the task, the surgeon, and the patient. Copyright © 2017 American Association of Gynecologic Laparoscopists. Published by Elsevier Inc. All rights reserved.

Consensus Bundle on Prevention of Surgical Site Infections After Major Gynecologic Surgery.

PubMed

Pellegrini, Joseph E; Toledo, Paloma; Soper, David E; Bradford, William C; Cruz, Deborah A; Levy, Barbara S; Lemieux, Lauren A

2017-02-06

Surgical site infections are the most common complication of surgery in the United states. Of surgeries in women of reproductive age, hysterectomy is one of the most frequently performed, second only to cesarean birth. Therefore, prevention of surgical site infections in women undergoing gynecologic surgery is an ideal topic for a patient safety bundle. The primary purpose of this safety bundle is to provide recommendations that can be implemented into any surgical environment in an effot to reduce the incidence of surgical site infection. This bundle was developed by a multidisciplinary team convened by the Council on Patient Safety in Women's Health Care. The bundle is organized into four domains: Readiness, Recognition and Prevention, Response, and Reporting and Systems Learning. In addition to recommendations for practice, each of the domains stresses communication and teamwork between all members of the surgical team. Although the bundle components are designed to be adaptable to work in a variety of clinical settings, standardization within institutions is encouraged. Copyright ©2016 American College of Obstetricians and Gynecologists.

Ambient Air Pollution, Meteorological Factors and Outpatient Visits for Eczema in Shanghai, China: A Time-Series Analysis.

PubMed

Li, Qiao; Yang, Yingying; Chen, Renjie; Kan, Haidong; Song, Weimin; Tan, Jianguo; Xu, Feng; Xu, Jinhua

2016-11-08

Environmental irritants are important risk factors for skin diseases, but little is known about the influence of environmental factors on eczema incidence. In this time-series study, our objective was to examine the associations of environmental factors with outpatient visits for eczema. Daily outpatient visits between 2007 and 2011 (1826 days) were collected from Huashan Hospital in Shanghai, China. We used an overdispersed generalized additive model to investigate the short-term association between environmental factors and outpatient visits for eczema. Daily outpatient visits for eczema were significantly associated with air pollution and meteorological factors. For example, a 10 μg/m³ increase of 7-day (lag 06) average concentrations of PM 10 (particulate matter no greater than 10 microns), SO₂, NO₂ was associated with 0.81% (95% confidence intervals (CI) 0.39%, 1.22%), 2.22% (95% CI: 1.27%, 3.16%) and 2.31% (95% CI: 1.17%, 3.45%) increase in outpatient visits for eczema, respectively. A 10 °C elevation of temperature on lag 0 day were associated with 8.44% (95% CI: 4.66%, 12.22%) increase in eczema visits, whereas 10 unit decrease of 7-day average relative humidity were associated with 10.86% (95% CI: 8.83%, 12.89%) increase in eczema visits. This study provided clear evidence of ambient air pollution, high temperature and low relative humidity on increasing the incidence of eczema in Shanghai, China.

Outpatient cataract surgery: incident and procedural risk analysis do not support current clinical ophthalmology guidelines.

PubMed

Koolwijk, Jasper; Fick, Mark; Selles, Caroline; Turgut, Gökhan; Noordergraaf, Jeske I M; Tukkers, Floor S; Noordergraaf, Gerrit J

2015-02-01

To evaluate whether an ophthalmologist-led, non-anesthesia-supported, limited monitoring pathway for phacoemulsification/intraocular lens cataract surgery, can be performed safely with only a medical emergency team providing support. Retrospective, observational, cohort study. All patients who underwent elective phacoemulsification/intraocular lens surgery under topical anesthesia in the ophthalmology outpatient unit between January 1, 2011, and December 31, 2012. Cataract surgery was performed by phacoemulsification under topical anesthesia. The intake process mainly embraced ophthalmic evaluation, obtaining a medical history, and proposing the procedure. A staff ophthalmologist performed the procedure assisted by 2 registered nurses in an independent outpatient clinic operating room within the hospital. The clinical pathway was without dedicated presence of or access to anesthesia service. Perioperative monitoring was limited to blood pressure and plethysmography preoperatively and intraoperatively. Patients were offered supportive care and instructed to avoid fasting and continue all their chronic medication. The primary outcome measure was the incidence of adverse events requiring medical emergency team (MET) interventions throughout the pathway. Secondary outcome measures were surgical ocular complication rates, use of oral sedatives, and reported reasons to perform the surgery in the classical operation room complex. Within the cataract pathway, 6961 cases (4347 patients) were eligible for analysis. Three MET interventions related to the phacoemulsification/intraocular lens pathway occurred in the 2-year study period, resulting in an intervention rate of 0.04%. None of the interventions was intraoperative. All 3 patients were diagnosed as vasovagal collapse and recuperated uneventfully. No hospital admittance was required. Eight other incidents occurred within the general ophthalmology outpatient unit population during the study period. Cataract surgery can

Cancer and treatment effects on job task performance for gynecological cancer survivors.

PubMed

Nachreiner, Nancy M; Shanley, Ryan; Ghebre, Rahel G

2013-01-01

Over 91,000 new cases of gynecological cancers are expected to be diagnosed in 2013 in the US alone. As cancer detection technology and treatment options improve, the number of working-age cancer survivors continues to grow. To describe US gynecological cancer survivors' perceptions of the effects of cancer and treatment on their job tasks. 104 adult gynecological cancer survivors who were working at the time of their cancer diagnosis, treated at a University-based women's health clinic, diagnosed in the previous 24 months, and spoke English. Women completed written surveys to describe their work experiences following diagnosis. Clinical characteristics were obtained through medical record review. Descriptive statistics and cross tabulations were performed to describe characteristics and associations. Fifteen percent of women had chemotherapy and radiation treatment; 48% had only chemotherapy, 9% only radiation therapy, and 28% had neither. Survivors described the frequency of performing seven job tasks, such as 'intense concentration', 'analyzing data', and 'lifting heavy loads.' Women who had undergone radiation treatment were more likely to indicate limitations for physical tasks; women undergoing chemotherapy were more likely to report limitations in more analytic tasks. Only 29% of women noted an employer-based policy facilitated their return-to-work process. Cancer and treatment have important effects on job performance and may vary by type of treatment. Employer-based policies focusing on improved communication and work accommodations may improve the return to work process.

Sevoflurane with or without antiemetic prophylaxis of dexamethasone in spontaneously breathing patients undergoing outpatient anorectal surgery.

PubMed

Wu, Jyh-I; Lu, Shao-Fong; Chia, Yuan-Yi; Yang, Lin-Cheng; Fong, Wen-Po; Tan, Ping-Heng

2009-11-01

To evaluate the prophylactic use of dexamethasone with sevoflurane in outpatient anorectal surgery. Randomized, controlled study. Operating room and Postanesthesia Care Unit of a general hospital. 60 adult, ASA physical status I and II outpatients undergoing anorectal surgery. Patients were randomized to receive either dexamethasone 5 mg intravenously (IV; Group D; n = 30) or an equal volume of saline (Group S; n = 30) before anesthesia induction. Anesthesia was induced with propofol 2.5 mg.kg(-1), fentanyl two microg.kg(-1), and 2% lidocaine one mg.kg(-1) followed by placement of a Laryngeal Mask Airway. Frequency of postoperative nausea and vomiting (PONV), visual analog scale (VAS) pain scores, and patient satisfaction were recorded. Frequency of PONV and VAS pain scores were significantly lower in Group D than Group S (P < 0.05). The time required for "home readiness" was significantly shorter in Group D than Group S (P < 0.05). The prophylactic administration of 5 mg dexamethasone IV can reduce the frequency of PONV, lower VAS pain scores, facilitate recovery to home readiness, and improve satisfaction in outpatients undergoing anorectal surgery.

Surgical manual of the Korean Gynecologic Oncology Group: classification of hysterectomy and lymphadenectomy

PubMed Central

Choi, Chel Hun; Chun, Yi Kyeong

2017-01-01

The Surgery Treatment Modality Committee of the Korean Gynecologic Oncologic Group (KGOG) has determined to develop a surgical manual to facilitate clinical trials and to improve communication between investigators by standardizing and precisely describing operating procedures. The literature on anatomic terminology, identification of surgical components, and surgical techniques were reviewed and discussed in depth to develop a surgical manual for gynecologic oncology. The surgical procedures provided here represent the minimum requirements for participating in a clinical trial. These procedures should be described in the operation record form, and the pathologic findings obtained from the procedures should be recorded in the pathologic report form. Here, we focused on radical hysterectomy and lymphadenectomy, and we developed a KGOG classification for those conditions. PMID:27670259

Surgical manual of the Korean Gynecologic Oncology Group: classification of hysterectomy and lymphadenectomy.

PubMed

Lee, Maria; Choi, Chel Hun; Chun, Yi Kyeong; Kim, Yun Hwan; Lee, Kwang Beom; Lee, Shin Wha; Shim, Seung Hyuk; Song, Yong Jung; Roh, Ju Won; Chang, Suk Joon; Lee, Jong Min

2017-01-01

The Surgery Treatment Modality Committee of the Korean Gynecologic Oncologic Group (KGOG) has determined to develop a surgical manual to facilitate clinical trials and to improve communication between investigators by standardizing and precisely describing operating procedures. The literature on anatomic terminology, identification of surgical components, and surgical techniques were reviewed and discussed in depth to develop a surgical manual for gynecologic oncology. The surgical procedures provided here represent the minimum requirements for participating in a clinical trial. These procedures should be described in the operation record form, and the pathologic findings obtained from the procedures should be recorded in the pathologic report form. Here, we focused on radical hysterectomy and lymphadenectomy, and we developed a KGOG classification for those conditions.

Targeting mTOR pathway in gynecological malignancies: Biological rationale and systematic review of published data.

PubMed

Kassem, Loay; Abdel-Rahman, Omar

2016-12-01

mTOR inhibitors are widely used in different malignancies with several trials testing their efficacy and safety in gynecological malignancies. We aimed to review the current evidence that support the expansion of using such drugs in the treatment of advanced gynecological cancers. A comprehensive systematic review of literature has been conducted to include prospective trials that used everolimus, temsirolimus or ridaforolimus in the management of gynecological cancers and have available efficacy and toxicity results. A total of 23 studies including 980 patients were considered eligible for our review. Our review included 16 phase II and 7 phase I studies with the majority of patients having uterine cancers. Regarding Endometrial cancer, the CBR ranged from 21% to 60% and median PFS from 2.8 months to 7.3 months. In Ovarian cancers, CBR ranged from 24% to 50% and median PFS from 3.2 months to 5.9 months. In the single phase II study in cervical cancer the CBR was 61% and median PFS was 3.5 months. The toxicity profile was consistent with what was observed previously in other malignancies with fatigue, mucositis, and hematological toxicities being the most common adverse events observed. mTOR inhibitors seem to be a promising option in the second line management of advanced gynecological cancers with best safety and efficacy outcomes when given as a single agent or in combination with hormonal treatment. More research is needed for better patient selection. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Outpatient Infection Prevention: A Practical Primer

PubMed Central

Steinkuller, Fozia; Harris, Kristofer; Vigil, Karen J; Ostrosky-Zeichner, Luis

2018-01-01

Abstract As more patients seek care in the outpatient setting, the opportunities for health care–acquired infections and associated outbreaks will increase. Without uptake of core infection prevention and control strategies through formal initiation of infection prevention programs, outbreaks and patient safety issues will surface. This review provides a step-wise approach for implementing an outpatient infection control program, highlighting some of the common pitfalls and high-priority areas. PMID:29740593

Outpatients' Knowledge About and Attitude Toward Randomised Clinical Trials

ClinicalTrials.gov

2017-03-23

Ambulatory Patients in the Dep. of Medical Gastroenterology; Ambulatory Patients in the Dep. of Gynecology; Ambulatory Patients in the Dep. of Orthopedic Surgery; Ambulatory Patients in the Dep. of Urology

Cost of post-stroke outpatient care in Malaysia.

PubMed

Akhavan Hejazi, Seyed Majid; Mazlan, Mazlina; Abdullah, Saini Jeffery Freddy; Engkasan, Julia Patrick

2015-02-01

This study aimed to investigate the direct cost of outpatient care for patients with stroke, as well as the relationship between the aforementioned cost and the sociodemographic and stroke characteristics of the patients. This was a cross-sectional study involving patients with first-ever stroke who were attending outpatient stroke rehabilitation, and their family members. Participants were interviewed using a structured questionnaire designed to obtain information regarding the cost of outpatient care. Stroke severity was measured using the National Institute of Health Stroke Scale. This study comprised 49 patients (28 men, 21 women) with a mean age of 60.2 (range 35-80) years. The mean total cost incurred was USD 547.10 (range USD 53.50-4,591.60), of which 36.6% was spent on attendant care, 25.5% on medical aids, 15.1% on travel expenses, 14.1% on medical fees and 8.5% on out-of-pocket expenses. Stroke severity, age > 70 years and haemorrhagic stroke were associated with increased cost. The mean cost of attending outpatient therapy per patient was USD 17.50 per session (range USD 6.60-30.60), with travelling expenses (41.8%) forming the bulk of the cost, followed by medical fees (38.1%) and out-of-pocket expenses (10.9%). Multiple regression analysis showed that stroke severity was the main determinant of post-stroke outpatient care cost (p < 0.001). Post-stroke outpatient care costs are significantly influenced by stroke severity. The cost of attendant care was the main cost incurred during the first three months after hospital discharge, while travelling expenses was the main cost incurred when attending outpatient stroke rehabilitation therapy.

Antibiotic resistance patterns of outpatient pediatric urinary tract infections.

PubMed

Edlin, Rachel S; Shapiro, Daniel J; Hersh, Adam L; Copp, Hillary L

2013-07-01

We characterize the current national patterns of antibiotic resistance of outpatient pediatric urinary tract infection. We examined outpatient urinary isolates from patients younger than 18 years in 2009 using The Surveillance Network®, a database with antibiotic susceptibility results and patient demographic data from 195 United States hospitals. We determined the prevalence and antibiotic resistance patterns for the 6 most common uropathogens, ie Escherichia coli, Proteus mirabilis, Klebsiella, Enterobacter, Pseudomonas aeruginosa and Enterococcus. We compared differences in uropathogen prevalence between males and females using chi-square analysis. We identified 25,418 outpatient urinary isolates. E. coli was the most common uropathogen overall but the prevalence of E. coli was higher among females (83%) than males (50%, p <0.001). Other common species among males were Enterococcus (17%), P. mirabilis (11%) and Klebsiella (10%). However, these uropathogens each accounted for 5% or less of female isolates (p <0.001). Resistance among E. coli was highest for trimethoprim-sulfamethoxazole (24%) but lower for nitrofurantoin (less than 1%) and cephalothin (15%). Compared to 2002 Surveillance Network data, E. coli resistance rates increased for trimethoprim-sulfamethoxazole (from 23% to 31% in males and from 20% to 23% in females) and ciprofloxacin (from 1% to 10% and from 0.6% to 4%, respectively). E. coli remains the most common pediatric uropathogen. Although widely used, trimethoprim-sulfamethoxazole is a poor empirical choice for pediatric urinary tract infections in many areas due to high resistance rates. First-generation cephalosporins and nitrofurantoin are appropriate narrow-spectrum alternatives given their low resistance rates. Local antibiograms should be used to assist with empirical urinary tract infection treatment. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Margin alert: time to revisit your outpatient strategy.

PubMed

Abramson, Steven M; Tyler, David

2006-04-01

An increasingly competitive market for outpatient services has made it necessary for acute care hospitals to reevaluate their outpatient, and inpatient, strategies. Many acute care hospitals are in a strong market position to command premium payment for their inpatient services. Under current market conditions, hospitals are in danger of pricing themselves out of the outpatient market. Hospitals can benefit from the increased focus of consumers and payers on quality and the rise of pay for performance by investing in service excellence.

Surgical outcomes for low-volume vs high-volume surgeons in gynecology surgery: a systematic review and meta-analysis.

PubMed

Mowat, Alex; Maher, Christopher; Ballard, Emma

2016-07-01

The aim of this study was to determine the impact of gynecological surgeon volumes on patient outcomes. Eligible studies were selected through an electronic literature search from database inception up until September 2015 and references in published studies. Search terms included surgical volume, surgeon volume, low-volume or high-volume, and gynecology or hysterectomy or sling or pelvic floor repair or continence procedure. The literature search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We defined a low-volume surgeon (LVS) as one performing the procedure once a month or less, and studies were excluded if their definition of LVS was > ±33% of our definition. Primary outcomes were total complications, intraoperative complications, and postoperative complications. All outcome data for individual studies were entered into systematic review software. When 2 or more studies evaluated a designated outcome, a meta-analysis of the entered data was undertaken as per the Cochrane database methodology. Data analysis was entered into a software product, which generated a summary of findings table that included structured and qualified grading (very low to high) of the quality for the evidence of the individual outcomes and provided a measure of effect. Fourteen peer-reviewed studies with 741,760 patients were included in the systematic review. For gynecology the LVS group had an increased rate of total complications (odds ratio [OR], 1.3, 95% confidence interval [CI], 1.2-1.5), intraoperative complications (OR, 1.6, 95% CI, 1.2-2.1), and postoperative complications (OR, 1.4 95% CI, 1.3-1.4). In gynecological oncology, the LVS group had higher mortality (OR, 1.9, 95% CI, 1.3-2.6). In the urogynecology group, a single study reported that the LVS group had a higher rate of any complication (risk ratio [RR], 1.4, 95% CI, -1.2-1.6). Another single study found that LVS had higher rates of

Meta-Analysis of the Effect of Gum Chewing After Gynecologic Surgery.

PubMed

Park, Seong-Hi; Choi, Myung Sook

2018-05-01

To describe the scientific evidence related to gum chewing to reduce ileus after gynecologic surgery. A literature search was performed using Ovid Medline, Embase, Cochrane Library, CINAHL, Scopus, and Web of Science databases. Inclusion criteria included randomized controlled trials (RCTs) on the use of gum chewing after gynecologic surgery in which the main outcomes measured were time to first flatus, time to defecation, and length of hospital stay. Data on authors, country, randomization method, the type of disease, surgical and anesthetic methods, sample characteristics such as age and body mass index, gum chewing program, and study results were extracted from selected articles. Of 493 publications, eight RCTs conducted between 2013 and 2017 involving 1,077 women were included in our meta-analysis. Weighted mean differences (WMDs) with 95% confidence intervals were calculated for the eight studies with the use of Cochrane Review Manager Version 5.3 (RevMan; 2014). The pooled results showed that gum chewing was superior to no gum chewing, with a reduction in WMD for time to first flatus of -6.20 hours (95% confidence interval [CI] [-9.51, -2.88]), WMD for time to first defecation of -9.03 hours (95% CI [-14.02, -4.04]), and WMD for length of hospital stay of -0.36 days (95% CI [-0.72, -0.01]). Gum chewing significantly reduced the time to first flatus and defecation after gynecologic surgery and should be recommended by health care providers. Copyright © 2018 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

Cost-effectiveness assessment in outpatient sinonasal surgery.

PubMed

Mortuaire, G; Theis, D; Fackeure, R; Chevalier, D; Gengler, I

2018-02-01

To assess the cost-effectiveness of outpatient sinonasal surgery in terms of clinical efficacy and control of expenses. A retrospective study was conducted from January 2014 to January 2016. Patients scheduled for outpatient sinonasal surgery were systematically included. Clinical data were extracted from surgical and anesthesiology computer files. The cost accounting methods applied in our institution were used to evaluate logistic and technical costs. The standardized hospital fees rating system based on hospital stay and severity in diagnosis-related groups (Groupes homogènes de séjours: GHS) was used to estimate institutional revenue. Over 2years, 927 outpatient surgical procedures were performed. The crossover rate to conventional hospital admission was 2.9%. In a day-1 telephone interview, 85% of patients were very satisfied with the procedure. All outpatient cases showed significantly lower costs than estimated for conventional management with overnight admission, while hospital revenue did not differ between the two. This study confirmed the efficacy of outpatient surgery in this indication. Lower costs could allow savings for the health system by readjusting the rating for the procedure. More precise assessment of cost-effectiveness will require more fine-grained studies based on micro costing at hospital level and assessment of impact on conventional surgical activity and post-discharge community care. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Optimising the performance of an outpatient setting.

PubMed

Sendi, Pedram; Al, Maiwenn J; Battegay, Manuel; Al Maiwenn, J

2004-01-24

An outpatient setting typically includes experienced and novice resident physicians who are supervised by senior staff physicians. The performance of this kind of outpatient setting, for a given mix of experienced and novice resident physicians, is determined by the number of senior staff physicians available for supervision. The optimum mix of human resources may be determined using discrete-event simulation. An outpatient setting represents a system where concurrency and resource sharing are important. These concepts can be modelled by means of timed Coloured Petri Nets (CPN), which is a discrete-event simulation formalism. We determined the optimum mix of resources (i.e. the number of senior staff physicians needed for a given number of experienced and novice resident physicians) to guarantee efficient overall system performance. In an outpatient setting with 10 resident physicians, two staff physicians are required to guarantee a minimum level of system performance (42-52 patients are seen per 5-hour period). However, with 3 senior staff physicians system performance can be improved substantially (49-56 patients per 5-hour period). An additional fourth staff physician does not substantially enhance system performance (50-57 patients per 5-hour period). Coloured Petri Nets provide a flexible environment in which to simulate an outpatient setting and assess the impact of any staffing changes on overall system performance, to promote informed resource allocation decisions.

About the Breast and Gynecologic Cancer Research Group | Division of Cancer Prevention

Cancer.gov

The Breast and Gynecologic Cancer Research Group conducts and fosters the development of research on the prevention and early detection of breast cancer, cervix and human papillomavirus (HPV)-related cancers, endometrial cancers, ovarian cancers, and precursor conditions related to these cancers. |

Gynecologic Care of the Female-to-Male Transgender Man

PubMed Central

Dutton, Lauren; Koenig, Karel; Kristopher, Fennie

2016-01-01

Transgender men are a vulnerable population whose health care needs have been difficult to identify because of limited research and an inability to identify the population. Limited evidence suggests that transgender men are at increased risk of having polycystic ovarian syndrome, contracting HIV, experiencing violence, and committing suicide. This qualitative study, conducted through face-to-face interviews of a convenient sample, was a three-part interview containing a demographic and health questionnaire, the Norbeck Social Support Questionnaire, as well as the Health Care Relationship Trust Scale. Audio recordings and written notes were reviewed and common themes were identified via content analysis. Six self-identified transgender men between the ages of 19 and 45 years were enrolled in the study. Participants were at varying degrees of social and medical transition. Four major themes were identified: 1) receiving gynecologic care was perceived to be important; 2) breasts caused the most gender identity conflict; 3) transgender men struggle with revealing their gender identity to health care providers; and 4) the male/female boxes on health intake forms, as well as pronoun usage by medical staff, were barriers to receiving health care. This gynecologic health care needs assessment of transgender men begins to characterize the barriers transgender men face when seeking health care. PMID:18586186

Factors Influencing Burnout Syndrome in Obstetrics and Gynecology Physicians

PubMed Central

Muraru, Diana; Dirtu, Catalin; Soponaru, Camelia; Ilea, Ciprian; Socolov, Demetra-Gabriela

2017-01-01

Aim To identify the influence of environmental, personality, and alexithymia factors on burnout syndrome among obstetrics and gynecology physicians. Material and Methods A total of 116 physicians (35 men and 81 women) completed questionnaires and sociodemographic data sheets. The Maslach Burnout Inventory, the Big Five Inventory, and the Toronto Alexithymia Scale were used to measure burnout, innate personality traits, and alexithymia, respectively. The t-test and Pearson correlations were used for other measurements. Results Of the 116 study physicians, 12.9% have suffered or still suffer from depression and 35.3% have had or still have problems related to insomnia. Regarding emotional exhaustion and depersonalization factors, men obtained lower scores than women (18.73 ± 13.48 versus 24.14 ± 11.71 for emotional exhaustion; 5.97 ± 5.45 versus 7.70 ± 5.29 for depersonalization). Self-reported depression was related to higher scores for all 3 domains, to higher total scores for alexithymia and neuroticism, and to lower scores for extraversion, conscientiousness, and openness. Residents and consultants had markedly different scores. Conclusion The results of this study will help obstetrics and gynecology physicians cope with professional burnout and to consider personality traits, alexithymia domains, and environmental factors when finding strategies to cope with their professional stress. PMID:29359161