Science.gov

Sample records for gynecology outpatient unit

  1. Female sexual dysfunction: facts and factors among gynecology outpatients.

    PubMed

    Jahan, Muna Shalima; Billah, Syed Muhammad Baqui; Furuya, Hiroyuki; Watanabe, Tetsu

    2012-01-01

    This study was aimed at assessing the female sexual dysfunction of respondents at gynecology outpatient clinics.   The cross-sectional study involved interviewing 137 female respondents from the gynecology outpatient department of Dhaka Medical College Hospital and Shaheed Suhrawardy Hospital with a semi-structured questionnaire during March-August 2007. The sociodemographic details and sexual history with sexual problems were recorded. Half (51.8%) the respondents had one or more sexual problems. Pain during intercourse (71.8%) and reduced desire (54.9%) were highest among different complaints followed by orgasmic (43.66%) and arousal problems (32.39%). Age and education were significantly associated with reduced desire (P=0.03). Delivery mode was significantly associated with inhibited desire (P=0.01) and arousal problems (P=0.003), and not significantly with pain (P=0.06). After adjusting confounding factors, parity (odds ratio [OR]=3.4, 95% confidence interval [CI]: 1.21-9.68), history of menstrual regulation (OR=2.84, 95%CI: 1.31-6.22), mental stress (OR=2.81, 95%CI: 1.05-7.50) and sexual problems of the husband (OR=3.16, 95%CI: 1.19-8.44) became risk factors for increasing odds of having dysfunction while increased frequency of intercourse showed a marginally significant reducing effect (OR=0.764, 95%CI: 0.95-1.00). This is a pioneer study in Bangladesh to postulate female sexuality, revealing pain disorder as most prevalent; the women with dysfunction were dissatisfied with their sexual life. In order to determine the cause of female sexual dysfunction, the topic needs further exploration involving intervention at regular medical investigations. © 2011 The Authors. Journal of Obstetrics and Gynaecology Research © 2011 Japan Society of Obstetrics and Gynecology.

  2. Psychological Symptoms Among Obstetric Fistula Patients Compared to Gynecology Outpatients in Tanzania

    PubMed Central

    Wilson, Sarah M.; Sikkema, Kathleen J.; Watt, Melissa H.; Masenga, Gileard G.

    2016-01-01

    Background Obstetric fistula is a childbirth injury prevalent in sub-Saharan Africa that causes uncontrollable leaking of urine and/or feces. Research has documented the social and psychological sequelae of obstetric fistula, including mental health dysfunction and social isolation. Purpose This cross-sectional study sought to quantify the psychological symptoms and social support in obstetric fistula patients, compared with a patient population of women without obstetric fistula. Methods Participants were gynecology patients (N = 144) at the Kilimanjaro Christian Medical Center in Moshi, Tanzania, recruited from the Fistula Ward (n = 54) as well as gynecology outpatient clinics (n = 90). Measures included previously validated psychometric questionnaires, administered orally by Tanzanian nurses. Outcome variables were compared between obstetric fistula patients and gynecology outpatients, controlling for background demographic variables and multiple comparisons. Results Compared to gynecology outpatients, obstetric fistula patients reported significantly higher symptoms of depression, posttraumatic stress disorder, somatic complaints, and maladaptive coping. They also reported significantly lower social support. Conclusions Obstetric fistula patients present for repair surgery with more severe psychological distress than gynecology outpatients. In order to address these mental health concerns, clinicians should engage obstetric fistula patients with targeted mental health interventions. PMID:25670025

  3. Psychiatric morbidity in outpatients of gynecological oncology clinic in a tertiary care hospital

    PubMed Central

    Mendonsa, Rohan Dilip; Appaya, Prakash

    2010-01-01

    Background: Psychiatric morbidity in gynecological oncology patients is relatively less studied. Aims: This cross-sectional observational study was undertaken to assess the common psychiatric disorders in women who consult the gynecological oncology outpatients’ department. Materials and methods: We assessed a total of 101 outpatients who were recruited by convenience method of sampling. The main outcome measures were PRIME-MD PHQ diagnoses, gynecological and sociodemographic profiles. Results: Psychiatric disorders as detected by PRIME –MD PHQ were diagnosed in 44% of the patients. Mood disorders were most common. Major depression was present in 25.7% of patients. Anxiety disorders were diagnosed in 16.8% of the patients. Among 44 patients with a psychiatric diagnosis only one patient was on psychiatric treatment. Major depression was much more common (34.4%) in cancer patients than in women with benign conditions (16.6%). Conclusion: The findings of our study reveal a high rate of psychiatric morbidity in the gynecological oncology outpatients. PMID:21267366

  4. Outpatient Intraperitoneal Catumaxomab Therapy for Malignant Ascites Related to Advanced Gynecologic Neoplasms.

    PubMed

    Kurbacher, Christian Martin; Horn, Olympia; Kurbacher, Jutta Anna; Herz, Susanne; Kurbacher, Ann Tabea; Hildenbrand, Ralf; Bollmann, Reinhardt

    2015-11-01

    Catumaxomab (CATU) is a trifunctional antibody approved for intraperitoneal (i.p.) treatment of malignant ascites (MA) related to carcinomas expressing the epithelial cell-adhesion molecule (EpCAM). CATU is mostly given to hospitalized patients, although outpatient treatment seems appropriate in selected individuals. This observational trial sought to obtain more detailed information regarding the feasibility of CATU in outpatients with MA related to various gynecologic tumors, including epithelial ovarian (EOC) and metastatic breast cancer (MBC). A total of 30 patients were included, 17 with EOC, 7 with MBC, and 6 with other malignancies. The patients had failed a median of 5 (range 1-12) previous systemic treatments. CATU was administered via an indwelling i.p. catheter at four increasing doses (i.e., 10, 20, 50, and 150 µg) given at 4-day intervals over 2 weeks. Toxicities were scored according to the Common Terminology Criteria for Adverse Events, version 4.03. Puncture-free survival (PuFS) was calculated from the start of CATU until the next puncture for MA, death, or loss to follow-up. Overall survival (OS) was calculated from the start of CATU to death from any reason or loss to follow-up. We also investigated various clinical parameters to predict PuFS and OS. These included age, tumor type, performance status, intensity of pretreatment, presence of extraperitoneal metastases, relative lymphocyte count at baseline, patient adherence to therapy, and the patients' ability to undergo systemic treatment after CATU. CATU was exclusively given on an outpatient basis, and 19 patients (63.3%) received all four planned i.p. instillations. Toxicity was the reason for discontinuation in only 2 patients. Toxicity was generally manageable, with abdominal pain, nausea/vomiting, fatigue, and fever the predominant adverse effects. Secondary hospitalization was necessary for 7 patients (23.3%), with a general deteriorated condition in 5 and fever/infection or abdominal

  5. Domestic sexual violence and sexual problems among gynecology outpatients: an example from Turkey.

    PubMed

    Ipekten Alaman, Mehtap; Yıldız, Hatice

    2014-01-01

    Domestic violence is a universal problem, and sexual violence in marriage, in particular, is a hidden form of it. This descriptive, cross-sectional study was conducted to determine to the prevalence of domestic sexual violence by husbands, the prevalence of sexual problems, and the relation of these among married women attending a gynecology outpatient clinic. This study was performed in a university hospital in Turkey and data were collected February-April 2009. The study sample consisted of 200 married women, 53% of whom reported having been exposed to at least one type of domestic sexual violence behaviors by their husbands. Among those behaviors, the rate of marital rape was 33%. The frequency of experiencing any sexual problem was 82%. Women expressed that they mostly had orgasmic problems, and their husbands had premature ejaculation problems. The majority of women who reported sexual violence reported experiencing sexual problems; the frequency of sexual problems was higher in the participants who did (94.3%) than in those who did not report (68.1%) sexual violence (p < .001). Bad sexual harmony (Odds ratio [OR] = 13.50, 95% confidence interval [CI] = 3.87-47.01) and experiencing sexual problems (OR = 12.67, 95% CI = 3.78-42.35) were strongly related to sexual violence in marriage. The results also revealed that the prevalence of sexual violence and sexual problems among those married women who attended gynecology clinics was considerable, even though they did not report this to the health care provider as a problem.

  6. Outpatient template-guided permanent interstitial brachytherapy using (131)Cs in gynecologic malignancies: Initial report.

    PubMed

    Feddock, Jonathan; Aryal, Prakash; Steber, Cole; Edwards, Jason; Cheek, Dennis; Randall, Marcus

    Optimal curative intent brachytherapy for certain gynecologic cancers requires interstitial brachytherapy, often using template-guided techniques such as a Syed-Neblett implant. Whether high or low dose rate (LDR), these procedures pose significant risks to patients, partly attributable to the prolonged period of bed rest. Published results of free-handed permanent interstitial brachytherapy (PIB) with (131)Cs demonstrate it to be an effective modality for the management of small volume gynecologic cancers. This report is the first to describe a permanent template-guided interstitial technique using (131)Cs for gynecologic cancers, performed as an LDR outpatient procedure. Five sequential patients with recurrent or primary gynecologic malignancies underwent template-guided PIB using (131)Cs. A posttreatment planning CT was obtained immediately after the procedure and again 3-4 weeks later. Both CT data sets were fused and the relative positions compared to assess for migration in the x, y, and z planes. Seed positions as well as dosimetric parameters including D90, D100, V100, and the dose to 2 cc of rectum and bladder were compared to quantify migration of sources and the resulting effect, if any, on the treatment. The median age was 69 years (range 64-85). All patients received a template-guided (131)Cs PIB implant to treat gross disease. All 5 patients had significant medical comorbidities that limited treatment options. Considering all 5 patients, a total of 40 interstitial needles were placed. Ten needles carried only Vicryl-stranded sources, and 30 needles carried a combination of stranded (131)Cs seeds and free seeds. Needle count was between 6 and 10 needles per patient, with active lengths of 4-10 cm. The median dose was 30 Gy (range 25-55 Gy) to permanent decay, enabling a cumulative median biological effective dose 91.5 Gy (range 60.9-92.1 Gy) and equivalent dose at 2 Gy per fraction 75.9 Gy (range 50.7-76.8 Gy). All implants were performed as

  7. [Awareness of cervical cancer prevention among patients of gynecological outpatient clinic].

    PubMed

    Ulman-Włodarz, Izabela; Nowosielski, Krzysztof; Romanik, Małgorzata; Pozowski, Janusz; Jurek, Marzena

    2011-01-01

    Improvement of cervical cancer statistics in Poland is believed to be one of the main goals of all medical services. Cervical cancer is an easily preventable neoplasm thus effective strategies for its prophylaxis should be proposed and introduced to the whole population of Polish citizens. The aim of the study was to measure the extent of knowledge of females about cervical cancer and its prevention. 250 female patients of gynecological clinic at the Medical Centre in Krakow, Poland, aged 18-60, were included into the retrospective study The research was based on an original questionnaire designed by the authors containing questions concerning general socio-epidemiological status, as well as cervical cancer epidemiology and HPV infection prevention methods. The majority of respondents (68%) rated their knowledge on cervical cancer prevention strategies as medium. The main sources of information on that prophylaxis were: women's magazines (59% of respondents), media (47%) and Internet (38%). Additionally only one in three women acquired that information from gynecologist The main reason for performing the Pap smear test was the request of the respondent (43% of cases). Only 3% of them attended the test as a result of a personal invitation sent by National Health Service. The main reasons for not attending Pap smear test were: fear of pain (39%), lack of any symptoms (18%), carelessness (15%) and embarrassment (12%). 1. Knowledge on HPV infections and cervical cancer prevention among women attending gynecological outpatient clinic is insufficient. 2. Education, especially in the field of cervical cancer main risk factors as well as the course of pap smear collection, seems to be necessary in order to reduce the cervical cancer morbidity and the fear of performing pap smear tests.

  8. Obstetrics and gynecology outpatient scenario of an Indian homeopathic hospital: A prospective, research-targeted study

    PubMed Central

    Saha, Subhranil; Koley, Munmun; Saha, Sangita; Singh, Rakesh; Hossain, Md. Monowar; Pramanik, Indrani

    2015-01-01

    The authors aimed to document prescriptions and clinical outcomes in routine homeopathic practice to short list promising areas of targeted research and efficacy trials of homeopathy in obstetrics and gynecology (O&G). Three homeopathic physicians participated in methodical data collection over a 3-month period in the O&G outpatient setting of The Calcutta Homeopathic Medical College and Hospital, West Bengal, India. A specifically designed Excel spreadsheet was used to record data on consecutive appointments, including date, patient identity, socioeconomic status, place of abode, religion, medical condition/complaint, whether chronic/acute, new/follow-up case, patient-assessed outcome (7-point Likert scale: −3 to +3), prescribed homeopathic medication, and whether other medication/s was being taken for the condition. These spreadsheets were submitted monthly for data synthesis and analysis. Data on 878 appointments (429 patients) were collected, of which 61% were positive, 20.8% negative, and 18.2% showed no change. Chronic conditions (93.2%) were chiefly encountered. A total of 434 medical conditions and 52 varieties were reported overall. The most frequently treated conditions were leucorrhea (20.5%), irregular menses (13.3%), dysmenorrhea (10%), menorrhagia (7.5%), and hypomenorrhea (6.3%). Strongly positive outcomes (+3/+2) were mostly recorded in oligomenorrhea (41.7%), leucorrhea (34.1%), polycystic ovary (33.3%), dysmenorrhea (28%), and irregular menses (22.2%). Individualized prescriptions predominated (95.6%). A total of 122 different medicines were prescribed in decimal (2.9%), centesimal (87.9%), and 50 millesimal potencies (4.9%). Mother tinctures and placebo were prescribed in 3.4% and 30.4% instances, respectively. Several instances of medicine-condition pairings were detected. This systematic recording cataloged the frequency and success rate of treating O&G conditions using homeopathy. PMID:27114940

  9. Prevalence of genital warts in reproductive-aged Turkish women presenting at gynecology outpatient clinics for any reason.

    PubMed

    Kose, M F; Akin, L; Yuce, K

    2013-01-01

    The objective of this multicenter descriptive study was to calculate the frequency of genital warts among Turkish women aged 15-49 years, who visited outpatient gynecology clinics for a variety of reasons. The study was conducted in February 2011 to collect data for a minimum of 154 patients at each center, and the total sample size reached 2,967 women (95.1% completion rate). Oral informed consents were obtained. A questionnaire including data on socio-demographic characteristics and reasons for admission was administered, and a pelvic examination was performed. The overall point prevalence was 35% (95% CI = 3.1%-4.0%), correcting for sampling design, with the highest rates observed in the 15 to 19-year-old group. The odds of having a genital wart was 1.82 times (95% CI = 0.99-3.33) higher among non-pregnant participants than in pregnant women (p = 0.051). The overall point prevalence of genital warts among reproductive-aged women attending gynecology outpatient clinics for any reason in Turkey was 35%.

  10. Outpatient Hysterectomy Volume in the United States.

    PubMed

    Cohen, Sarah L; Ajao, Mobolaji O; Clark, Nisse V; Vitonis, Allison F; Einarsson, Jon I

    2017-07-01

    To estimate the number of outpatient hysterectomies being performed annually in the United States in an effort to offer more correct estimates of hysterectomy use in light of reported decreasing inpatient case volume. This is a cross-sectional analysis of State Ambulatory Surgery and Services Databases from 16 states with complete information for year 2011. Adult women undergoing hysterectomy were included. Procedure volume, route, and associated patient and surgical characteristics were calculated. There were 64,612 ambulatory hysterectomies reported; 81.5% of surgeries were performed laparoscopically and 16% vaginally. If these numbers are extrapolated to national estimates, this represents 100,000-200,000 outpatient hysterectomies per year. The strongest driver of the laparoscopic, compared with vaginal, route of hysterectomy in this data set was presence of cancer (odds ratio 4.01 [3.19-5.05], P<.001). In addition to indication for surgery, patient characteristics such as age, race, income, location, and primary payer were associated with mode of hysterectomy. The laparoscopic surgeries were associated with shorter length of stay (mean stay 0.65 days, [99% confidence interval 0.65-0.66] compared with 0.79 days [0.78-0.81], adjusted incidence rate ratio 0.89 [0.86-0.92], P<.001) and higher mean charges ($24,227 [$24,053-24,402] versus $14,068 [$13,811-14,330], P<.001) compared with vaginal surgeries. The perceived decline that has been reported in national hysterectomy volume may represent lack of reporting of surgeries performed in ambulatory settings. This information has considerable implications for business, public health interventions, and insurance carriers among other key stakeholders in women's health care delivery.

  11. Remote location interstitial brachytherapy with patient stabilization and subsequent transport to an outpatient center for treatment is safe and effective for the treatment of gynecologic malignancies.

    PubMed

    Tumati, Vasu; Folkert, Michael R; Lawson, Sandra; Wise, Elsa; Wolcott, Sheila; Richardson, Debra; Carlson, Matthew; Kehoe, Siobhan; Lea, Jayanthi; Abdulrahman, Ramzi; Albuquerque, Kevin

    2016-01-01

    Interstitial brachytherapy is an essential component of definitive treatment for locally advanced gynecological malignancies. Although many outpatient centers are capable of delivering the radiation component of brachytherapy, they are not associated with an operative center for implant placement, limiting the ability to deliver appropriate care. In this study, we report on our experience with noncolocated implant placement and radiation delivery, and the impact of patient stabilization improvements on patient safety. Between 9/2010 and 11/2014, 25 patients with gynecologic malignancy underwent interstitial implantation and subsequent transport for high-dose-rate brachytherapy treatment. From 9/2010 to 10/2012, patients were transported using a standard ambulance stretcher; from 11/2012 to 11/2014, patients were placed on a patient positioning board or a WAFFLE support. Potential transport-associated toxicity was assessed, and the association between standard and augmented transport types and toxicity was analyzed. A total of 234 transports were performed. Median cost of transport was $150 per transport. There were 14 (10 patients) potential transportation-associated toxicities, including two lacerations/local trauma, three infections, and nine ulcers. There were 6 Grade 3 toxicities, all in the standard group. There was no association between stretcher type and laceration or ulcers, but enhanced support was associated with fewer overall toxicities, Grade 3 toxicities, and infections. Noncolocated implantation and treatment is safe and facilitates optimal therapy. Toxicities potentially associated with transport are minimal and seem to be reduced by augmented stabilization. Understanding that this is a reasonable way to deliver brachytherapy may allow more stand-alone centers to deliver high-quality care for patients and improve gynecologic cancer outcomes in the United States. Copyright © 2016 American Brachytherapy Society. Published by Elsevier Inc. All rights

  12. Omission of nitrous oxide from a propofol-based anesthetic does not affect the recovery of women undergoing outpatient gynecologic surgery.

    PubMed

    Arellano, R J; Pole, M L; Rafuse, S E; Fletcher, M; Saad, Y G; Friedlander, M; Norris, A; Chung, F F

    2000-08-01

    Although nitrous oxide (N2O) is used commonly during anesthesia, clinically relevant advantages-disadvantages of using this agent are not well established in the ambulatory setting. This study in women undergoing ambulatory gynecologic surgery compares outcomes in patients administered total intravenous anesthesia with propofol versus the propofol plus N2O. The primary outcome was the time to home readiness. Secondary outcomes included the incidence of postanesthetic adverse events. Women presenting for elective ambulatory termination of pregnancy or gynecologic laparoscopy were induced with an intravenous sleep dose of propofol and fentanyl. After induction, subjects were randomly allocated to maintenance anesthesia with propofol alone or propofol plus 65% N2O. Patients were assessed by a blinded observer in the postanesthetic care unit at 20-min intervals to determine home readiness. Postoperative pain and nausea were measured with visual analog scales. Postoperative analgesics and antiemetics were recorded. The incidence of adverse events occurring after hospital discharge was assessed by a telephone interview 24 h postoperatively. A total of 740 patients received propofol alone, and 750 patients received propofol plus N2O. Mean home readiness times were not significantly different between treatment groups. There were no significant differences between groups in pain scores, nausea scores, analgesia administration, or antiemetic administration before discharge. There were no significant differences in the frequency of adverse events for 24 h after discharge from hospital. Omission of N2O from a propofol-based anesthetic for ambulatory gynecologic surgery does not affect time to home readiness or the incidence of postoperative adverse events up to 24 h after discharge from hospital. (Key words: Awareness; outpatient surgery; total intravenous anesthesia.)

  13. Nurse Manager Safety Practices in Outpatient Hemodialysis Units.

    PubMed

    Thomas-Hawkins, Charlotte; Flynn, Linda; Lindgren, Teri G; Weaver, Susan

    2015-01-01

    Little is known regarding the specific managerial activities or best practices that nurse managers in outpatient hemodialysis settings use to achieve positive safety outcomes. The purpose of this study was to identify and describe specific managerial practices used by nurse managers in outpatient hemodialysis units to enhance patient safety and quality of care. A descriptive qualitative design was used. Seventeen nurse managers in outpatient hemodialysis units comprised the study sample. Telephone interviews were conducted, and qualitative content analysis was used to encode the data. Nurse managers identified patients, staff, the dialysis unit environment, and the dialysis organization as sources of safety risks. Nurse manager safety practices illuminated from the data were complex and multifaceted, and were aimed at reducing patient, staff environmental, and organization risks. The findings from this study offer a description and a better understanding of the practices in which nurse managers in outpatient hemodialysis units engage to keep patients safe in their units, and they underscore the critical role of nurse managers in creating and maintaining patient safety within outpatient hemodialysis settings.

  14. Outpatient rapid 4-step desensitization for gynecologic oncology patients with mild to low-risk, moderate hypersensitivity reactions to carboplatin/cisplatin.

    PubMed

    Li, Quan; Cohn, David; Waller, Allyson; Backes, Floor; Copeland, Larry; Fowler, Jeffrey; Salani, Ritu; O'Malley, David

    2014-10-01

    The primary objective of this study is to assess the efficacy and safety of an outpatient, 4-step, one-solution desensitization protocol in gynecologic oncology patients with history of mild to low-risk, moderate hypersensitivity reactions (HSRs) to platinums (carboplatin and cisplatin). This was a single institutional retrospective review. Gynecologic oncology patients with a documented history of mild or low-risk, moderate immediate HSRs to carboplatin/cisplatin and continued treatment with 4-step, one-solution desensitization protocols in the outpatient infusion center were included. Patients with delayed HSRs or immediate high-risk, moderate or severe HSRs were excluded. The primary end point was the rate of successful administrations of each course of platinums. From January 2011 to June 2013, eighteen eligible patients were evaluated for outpatient 4-step, one-solution desensitization. Thirteen patients had a history of HSRs to carboplatin and 5 with HSRs to cisplatin. All of 18 patients successfully completed 94 (98.9%) of 95 desensitization courses in the outpatient infusion center. Eight of 8 (100%) patients with initial mild HSRs completed 29/29 (100%) desensitization courses, and 9 of 10 (90%) of patients with initial moderate HSRs completed 65/66 (94%) desensitization courses. In total, 65/95 (68%) desensitizations resulted in no breakthrough reactions, and mild, moderate and severe breakthrough reactions were seen in 19%, 12% and 1% desensitizations, respectively. No patients were hospitalized during desensitization. The outpatient rapid, 4-step, one-solution desensitization protocol was effective and appeared safe among gynecologic oncology patients who experienced mild to low-risk, moderate HSRs to carboplatin/cisplatin. Copyright © 2014 Elsevier Inc. All rights reserved.

  15. [Relationship of HPV infection and BV, VVC, TV: a clinical study based on 1 261 cases of gynecologic outpatients].

    PubMed

    Meng, L T; Xue, Y; Yue, T; Yang, L; Gao, L; An, R F

    2016-10-25

    Objective: To Explore the relationship between HPV infection and bacterial vaginosis(BV), vulvovaginal candidiasis(VVC), and trichomonal vaginitis(TV). Methods: Clinical data from 1 261 gynecologic outpatients who underwent the vaginal microecology and HPV type detection during June 2015 to December 2015 were collected and analyzed in the First Affiliated Hospital of Xi'an Jiaotong University. Results: In 1 261 patients, 328 cases infected with HPV, infection rate was 26.01%(328/1 261); vaginal infectious disease in 328 cases of HPV infections were 219 cases(66.8%, 219/328), vaginal infectious diseases in 933 cases of HPV uninfected were 503 cases(53.9%, 503/933), incidence of vaginal infectious disease in HPV infected patients was higher than that in HPV uninfected patients(χ(2)=5.87, P=0.01). 142 cases of BV had 54 cases infected with HPV(38.0%, 54/142), 296 cases of intermediate type BV had 88 cases infected with HPV(29.7%, 88/296), 231 cases of normal vaginal microecology had 51 cases infected with HPV(22.1%, 51/231), 99 cases of VVC had 15 cases infected with HPV(15.2%, 15/99), 2 patients with TV had 0 cases infected with HPV(0/2), HPV infection rate in BV, intermediate type BV patients were significantly higher than normal patients(P<0.05), while there were no statistical differences among VVC, TV and normal patients(P>0.05). The intensity of HPV infection were positively correlated with BV, intermediate type BV(OR=2.17, 95% CI: 1.37-3.43, P<0.01; OR=1.49, 95% CI: 1.00-2.22, P= 0.04); while, VVC, TV were uncorrelated with HPV infection(all P>0.05). Conclusions: BV, intermediate type BV are positively correlated with HPV infection, especially for the high-risk HPV. VVC and TV are not correlated with HPV infection.

  16. Stress Levels of Nurses in Oncology Outpatient Units.

    PubMed

    Ko, Woonhwa; Kiser-Larson, Norma

    2016-04-01

    Oncology nursing is often a source of substantial stress for nurses. Many nurses, particularly novice nurses, have inadequate preparation to care for patients at the end of life and their families. Unless nurses prevent or manage work-related stress by using effective coping strategies, oncology nursing staff will continue to suffer from burnout and compassion fatigue. The purpose of this article is to identify stress levels and stressful factors of nurses working in oncology outpatient units and to explore coping behaviors for work-related stress of oncology staff nurses in outpatient units. A descriptive, cross-sectional design was used to identify stress levels and stressful factors for outpatient oncology nurses, investigate differences in stress levels among nurses' demographic characteristics, and explore coping behaviors of the nurses. Study participants (N = 40) included RNs and licensed practical nurses who completed the Nursing Stress Scale, three open-ended questions, and a demographic questionnaire. The highest sources of stress were workload and patient death and dying. Demographic variables of age and work experience in nursing showed a significant positive relationship to work-related stress scores. The three most frequently used coping behaviors were verbalizing, exercising or relaxing, and taking time for self. Continuing education programs on stress management are highly recommended. Outpatient oncology nurses should be nurtured and supported through tailored interventions at multiple levels to help them find effective coping strategies and develop self-care competencies. Although younger and less experienced nurses had lower mean stress scores than older and more experienced nurses, the continuing education programs and tailored interventions would be helpful for all oncology nursing staff.

  17. Robotic surgery training in gynecologic fellowship programs in the United States.

    PubMed

    Fatehchehr, Soorena; Rostaminia, Ghazaleh; Gardner, Michael O; Ramunno, Elisa; Doyle, Nora M

    2014-01-01

    The increasing use and acceptance of robotic platforms calls for the need to train not only established surgeons but also residents and fellow trainees within the context of the traditional residency and fellowship program. Our study aimed to clarify the current status of robotic training in gynecologic fellowship programs in the United States. This was a Web-based survey of four gynecology fellowship programs in the United States from November 2010 to March 2011. Programs were selected based on their geographic areas. A questionnaire with 43 questions inquiring about robotic surgery performance and training was sent to the programs and either a fellow or the fellowship director was asked to complete. Participation was voluntary. We had 102 responders (18% respond rate) with an almost equal response rate from all four gynecologic fellowships, with a median response rate of 25% (range 21-29%). Minimally Invasive Surgery (MIS) and Gynecologic Oncology (Gyn Onc) fellowships had the highest rate of robotic training in their fellowship curriculum-95% and 83%, respectively. Simulator training was used as a training tool in 74% of Female Pelvic Medicine and Reconstructive Surgery (FPMRS); however, just 22% of Reproductive Endocrinology and Infertility fellowships had simulator training. Eighty-seven percent of Gyn Onc fellows graduate with >50 robotic cases, but this was 0% for Reproductive Endocrinology Infertility fellows. Our study showed that the use of a robotic system was built into fellowship curriculum of >80% of MIS and Gyn Onc fellowship programs that were entered in our study. Simulator training has been used widely in Ob&Gyn fellowship programs as part of their robotic training curriculum.

  18. Management of gynecologic oncology emergencies

    SciTech Connect

    Harwood-Nuss, A.L.; Benrubi, G.I.; Nuss, R.C.

    1987-08-01

    Gynecologic malignancies are the third most common cancer among women in the United States. Because of often subtle early findings, the diagnosis may not be made before the widespread dissemination of the disease. The Emergency Department physician will commonly encounter a woman with vaginal bleeding, pelvic pain, or a symptomatic abdominal mass. In this article, we have described the epidemiology, recognized patterns of spread, and associated findings of gynecologic tumors. The proper Emergency Department evaluation and management of these problems is emphasized with guidelines for the timing of referrals and consultation with the gynecologic oncologist. The treatment of gynecologic malignancies is often complicated and responsible for Emergency Department visits. The various modalities are addressed according to the organ systems affected and include sections on postoperative problems, gastrointestinal complaints, urologic complications of therapy, radiation therapy and its complications, with an emphasis on the most serious complications necessitating either careful outpatient management or hospital admission. As cost-containment pressure grows, we have included sections on chemotherapy and total parenteral nutrition, both of which are becoming common outpatient events for the cancer patient. 28 references.

  19. Clinical effects of gynecologic laparoscopy courses in the United Arab Emirates.

    PubMed

    Elbiss, Hassan M; Raheel, Hina; George, Sami; Abu-Zidan, Fikri M

    2014-01-01

    To evaluate the impact of gynecologic laparoscopy courses on the participants' laparoscopy practice. We conducted 5 repeated laparoscopy courses between 2008 and 2012 at the United Arab Emirates University in Al Ain, United Arab Emirates, so as to enhance performance in the operating room. An electronic questionnaire was sent to all participants from each of the courses to evaluate the impact of course attendance on clinical practice. Of 70 participants who were approached to complete the online questionnaire, 38 (54.3%) responded. The majority were female (94.7%) and specialists (65.8%). Half the participants (50.0%) thought they would probably not have started performing laparoscopy without having attended the course. Of the participants, 18.4% thought that their operating skills had greatly improved, 63.2% felt that their operating skills had improved moderately to a lot, and 6/12 participants who had not been performing laparoscopy before attendance of the course began doing so. Overall, the course had no significant impact on the participants' performance of laparoscopy (P=0.51, McNemar test), but the proportion of participants who performed level II laparoscopy was significantly increased after course attendance (10.5% versus 47.4%; P=0.001, McNemar test). Gynecologic laparoscopy courses encourage gynecologists to use laparoscopy in clinical practice. © 2013.

  20. Hidden female urinary incontinence in urology and obstetrics and gynecology outpatient clinics in Turkey: what are the determinants of bothersome urinary incontinence and help-seeking behavior?

    PubMed

    Cetinel, Bulent; Demirkesen, Oktay; Tarcan, Tufan; Yalcin, Onay; Kocak, Taner; Senocak, Mustafa; Itil, Ismail

    2007-06-01

    The purpose of this study was to assess the prevalence of female urinary incontinence (UI) and risk factors of bothersomeness and help-seeking behavior of hidden female UI in urology and obstetrics and gynecology outpatient clinics. This multicentric and cross-sectional study was conducted as a part of the Turkish Overactive Bladder Study. Female patients (n = 5,565) who were referred with complaints other than UI and overactive bladder symptoms were surveyed using the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) with supplementation of five more questions. The crude prevalence of UI was found to be 35.7%. The prevalence of frequent and severe incontinence was 8.2 and 6.8%, respectively. The mean age of incontinent patients was significantly higher (p < 0.001). The prevalence of stress, urge, and mixed UI was 39.8, 24.8, and 28.9%, respectively. More than half (53%) of incontinent patients were not bothered by UI, and only 12% of incontinent patients had previously sought medical help for their problem. Frequency, severity, and type of UI were independent factors for predicting bothersome UI, while only bothersomeness increased help-seeking behavior. The ICIQ-SF score of 8 has been found to be the best cutoff value to delineate the bothersome UI. Although the crude prevalence of female UI was found to be high, bothersome UI was not so common. The majority of incontinent female patients did not seek medical help. Frequency, severity, and mixed type of UI were found to be the determinants of bothersome UI for which the ICIQ-SF cutoff score of 8 was obtained.

  1. Genotype distribution of human papillomavirus (HPV) and co-infections in cervical cytologic specimens from two outpatient gynecological clinics in a region of southeast Spain

    PubMed Central

    2009-01-01

    Background Human Papillomavirus (HPV) genotype distribution and co-infection occurrence was studied in cervical cytologic specimens from Murcia Region, (southeast Spain), to obtain information regarding the possible effect of the ongoing vaccination campaign against HPV16 and HPV18. Methods A total of 458 cytologic specimens were obtained from two outpatient gynecological clinics. These included 288 normal benign (N/B) specimens, 56 atypical squamous cell of undetermined significance (ASC-US), 75 low-grade squamous intraepithelial lesions (LSIL) and 39 high-grade squamous intraepithelial lesions (HSIL). HPV genotyping was performed using PCR and tube array hybridization. Results The most frequent genotype found was HPV16 (14.9% in N/B; 17.9% in ASC-US; 29.3% in LSIL and 33.3% HSIL). Distribution of other genotypes was heavily dependent on the cytologic diagnoses. Co-infections were found in 15.3% of N/B, 10.7% of ASC-US, 48% of LSIL and 25.6% of HSIL cases (significantly different at p < 0.001). Strikingly, in N/B diagnoses, genotypes from A5 species were found as coinfecting in all cases. Genotypes from A7 or A9 species appeared in co-infections in 56.5% and 54% respectively whereas genotypes from A6 species appeared in 25.1% of cases. Conclusion HPV vaccination might prevent 34.6% and 35.8% of LSIL and HSIL, respectively. Co-infection rate is dependent on both cytologic diagnosis and HPV genotype. Moreover, genotypes belonging to A5, A7 and A9 species are more often found as co-infections than genotype pertaining to A6 species. This suggests that phylogenetically related genotypes might have in common similar grades of dependency for cervical epithelium colonization. PMID:19664248

  2. p16/Ki-67 dual-stained cytology for detecting cervical (pre)cancer in a HPV-positive gynecologic outpatient population.

    PubMed

    Luttmer, Roosmarijn; Dijkstra, Maaike G; Snijders, Peter J F; Berkhof, Johannes; van Kemenade, Folkert J; Rozendaal, Lawrence; Helmerhorst, Theo J M; Verheijen, René H M; Ter Harmsel, W Abraham; van Baal, W Marchien; Graziosi, Peppino G C M; Quint, Wim G V; Spruijt, Johan W M; van Dijken, Dorenda K E; Heideman, Daniëlle A M; Meijer, Chris J L M

    2016-08-01

    Women who test positive for a high-risk type of the human papillomavirus (HPV) require triage testing to identify those women with cervical intraepithelial neoplasia grade 3 or cancer (≥CIN3). Although Pap cytology is considered an attractive triage test, its applicability is hampered by its subjective nature. This study prospectively compared the clinical performance of p16/Ki-67 dual-stained cytology to that of Pap cytology, with or without HPV16/18 genotyping, in high-risk HPV-positive women visiting gynecologic outpatient clinics (n=446 and age 18-66 years). From all women, cervical scrapes (for Pap cytology, HPV16/18 genotyping, and p16/Ki-67 dual-stained cytology) and colposcopy-directed biopsies were obtained. The sensitivity of p16/Ki-67 dual-stained cytology for ≥CIN3 (93.8%) did neither differ significantly from that of Pap cytology (87.7%; ratio 1.07 and 95% confidence interval (CI): 0.97-1.18) nor from that of Pap cytology combined with HPV16/18 genotyping (95.1%; ratio 0.99 and 95% CI: 0.91-1.07). However, the specificity of p16/Ki-67 dual-stained cytology for ≥CIN3 (51.2%) was significantly higher than that of Pap cytology (44.9%; ratio 1.14 and 95% CI: 1.01-1.29) and Pap cytology combined with HPV16/18 genotyping (25.8%; ratio 1.99 and 95% CI: 1.68-2.35). After exclusion of women who had been referred because of abnormal Pap cytology, the specificity of p16/Ki-67 dual-stained cytology for ≥CIN3 (56.7%) remained the same, whereas that of Pap cytology (60.3%) increased substantially, resulting in a similar specificity of both assays (ratio 0.94 and 95% CI: 0.83-1.07) in this sub-cohort. In summary, p16/Ki-67 dual-stained cytology has a good clinical performance and is an interesting objective microscopy-based triage tool for high-risk HPV-positive women.

  3. 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.

  4. Variation in outpatient antibiotic prescribing in the United States.

    PubMed

    Steinman, Michael A; Yang, Katherine Y; Byron, Sepheen C; Maselli, Judith H; Gonzales, Ralph

    2009-12-01

    To evaluate variation in outpatient antibiotic utilization among US commercial health plans and the implications of this variation for cost and quality. We measured antibiotic utilization rates among 229 US commercial health plans that participated in the 2005 Healthcare Effectiveness Data and Information Set. Rates were adjusted to account for health plan age and sex distribution. To estimate antibiotic costs, we multiplied utilization data for each drug class by national estimates of intraclass distribution of drugs, duration of therapy, and median average wholesale price. Antibiotic utilization rates varied markedly among plans, ranging from 0.64 antibiotic fills per member per year (PMPY) at the 5th percentile of plans to 1.08 fills PMPY at the 95th percentile, with a mean of 0.88 (SD +/- 0.15) antibiotic fills PMPY. US census region was the strongest predictor of antibiotic utilization. Antibiotic costs averaged $49 PMPY and ranged from $34 to $63 PMPY among plans at the 5th and 95th percentiles of cost, respectively. If a health plan with 250,000 members at the 90th percentile of antibiotic costs reduced its costs to the 25th percentile, annual drug cost savings would be approximately $4.1 million. Antibiotic utilization varies substantially among commercial health plans and is not accounted for by differences in the age and sex distribution of plan members. Because reducing rates of antibiotic utilization is likely to lower costs and improve quality, high-utilizing plans may reap considerable rewards from investing in programs to reduce the overuse of antibiotics.

  5. [Prescription and drug expenditure in gynecology and obstetrics in Northwest medical units from IMSS].

    PubMed

    Torres Gómez, Luis Guillermo; Canales Muñoz, José Luis

    2006-08-01

    Drug prescription is the most frequent medical intervention in Gynecology and Obstetrics; however, studies of prescription profile are limited. In this study, we analyzed differences of expense by drug prescription for gynecologic and obstetrics health problems. It was performed a cross sectional study for one year analysis in each medical area that shape IMSS western district. We calculated spending and consumption coefficients for each drug and therapeutic groups. User coefficients were ordered to compare consumption differences. Besides the statistical ratio of consumption between drugs groups, we described the differences found and analyzed the prescription profile among medical regions. Data related to the expenses in each one of the regions show important differences in each one of the drugs and therapeutic groups. The most common expense for drugs is related to the treatment of osteoporosis, menopause and fertility problems. We also found differences in prescription drug preferences in each therapeutic subgroup. Drug prescription studies are useful as a basis for further specific studies in each pharmacologic subgroup. There are few studies that analyze the drug prescription profile on Gynecology and Obstetrics. In this study it is possible to suppose that medical prescription was not based on known medical evidences; therefore, we must reconsider the need of a permanent actualization and systematic medical evaluation.

  6. [Availability of Palliative Care Units and Outpatient Services in Japan - A Nation-Wide Survey].

    PubMed

    Shirado, Akemi; Morita, Tatsuya; Okusaka, Takuji; Sakamoto, Yasunari; Kizawa, Yoshiyuki; Shima, Yasuo; Shimizu, Chikako

    2015-09-01

    We conducted a nation-wide survey to clarify the availability of palliative care units and outpatient palliative care services in Japan. We sent 306 questionnaires to the managing physicians of all certified palliative care units, and obtained 243 responses (79%). Eighteen percent reported that patients undergoing anti-cancer treatment are not able to apply for admission; 82% offered outpatient services. In 20% of the institutions, waiting time before admission was 11 days or longer for patients with pain and a predicted prognosis of less than 1 month. Only 10% reported that all patients who expressed a desire for admission were actually able to be admitted. Oncologists and palliative care physicians need to discuss the creation of a system so that all patients who want them can actually avail of palliative care services.

  7. Public managed care and service access in outpatient substance abuse treatment units.

    PubMed

    Chuang, Emmeline; Wells, Rebecca; Alexander, Jeffrey A

    2011-10-01

    The continued growth of public managed behavioral health care has raised concerns about possible effects on services provided. This study uses a national sample of outpatient substance abuse treatment units surveyed in 2005 to examine associations between public managed care and service access, measured as both the types of services provided and the amount of treatment received by clients. The percentage of clients funded through public managed care versus other types of public funding was positively associated with treatment units' odds of providing some types of resource-intensive services and with the odds of providing transportation to clients, but was negatively associated with the average number of individual therapy sessions clients received over the course of treatment. In general, public managed care does not appear to restrict access to outpatient substance abuse treatment, although states should monitor these contracts to ensure clients receive adequate courses of individual treatment.

  8. [Success of referral in a psychosomatic-psychotherapeutic outpatient unit of a dental school].

    PubMed

    Schwichtenberg, Julia; Doering, Stephan

    2008-01-01

    The success of referral for psychotherapy and the predictors thereof are investigated in dentistry in an outpatient unit for psychosomatics. 238 patients were asked in a telephone interview concerning their satisfaction with the consultation as well as any change in their complaints and treatments after their contact with the outpatient unit. 82.3 % of the patients were satisfied with the consultation, and 55.9 % reported an improvement in their complaints. In 76.1 % of the patients psychotherapy was indicated, and 56.7 % showed motivation and were referred to psychotherapy. Thereof, 66.7 % actually began treatment. Introspective capacity and motivation for psychotherapy predicted successful referral. Patients suffering from somatoform disorders were significantly less motivated to begin psychotherapy and showed a tendency toward premature termination of psychotherapy. In patients with anxiety disorders, the reverse was the case. Patients who did not begin psychotherapy changed their dentist significantly more frequently. The consultation at the outpatient unit can be regarded as successful insofar as four-fifths of the patients were satisfied and two-thirds of those referred actually began psychotherapy, which in turn significantly reduces "dentist shopping."

  9. Outpatient management of heart failure in the United States, 2006-2008.

    PubMed

    Mosalpuria, Kailash; Agarwal, Sunil K; Yaemsiri, Sirin; Pierre-Louis, Bredy; Saba, Samir; Alvarez, Rene; Russell, Stuart D

    2014-06-01

    Better outpatient management of heart failure might improve outcomes and reduce the number of rehospitalizations. This study describes recent outpatient heart-failure management in the United States. We analyzed data from the National Ambulatory Medical Care Survey of 2006-2008, a multistage random sampling of non-Federal physician offices and hospital outpatient departments. Annually, 1.7% of all outpatient visits were for heart failure (51% females and 77% non-Hispanic whites; mean age, 73 ± 0.5 yr). Typical comorbidities were hypertension (62%), hyperlipidemia (36%), diabetes mellitus (35%), and ischemic heart disease (29%). Body weight and blood pressure were recorded in about 80% of visits, and health education was given in about 40%. The percentage of patients taking β-blockers was 38%; the percentage taking angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARBs) was 32%. Medication usage did not differ significantly by race or sex. In multivariate-adjusted logistic regression models, a visit to a cardiologist, hypertension, heart failure as a primary reason for the visit, and a visit duration longer than 15 minutes were positively associated with ACEI/ARB use; and a visit to a cardiologist, heart failure as a primary reason for the visit, the presence of ischemic heart disease, and visit duration longer than 15 minutes were positively associated with β-blocker use. Chronic obstructive pulmonary disease was negatively associated with β-blocker use. Approximately 1% of heart-failure visits resulted in hospitalization. In outpatient heart-failure management, gaps that might warrant attention include suboptimal health education and low usage rates of medications, specifically ACEI/ARBs and β-blockers.

  10. 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

  11. 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.

  12. Development of certified environmental management in hospital and outpatient haemodialysis units.

    PubMed

    García Vicente, Sergio; Morales Suárez-Varela, María; Martí Monrós, Anna; Llopis González, Agustín

    2015-01-01

    The environmental impact of haemodialysis is very high. Institutional activity in this sense is important, even in the production of references. Voluntary environmental management systems (EMS), environmental management and auditing systems (EMAS) and the International Organization for Standardization standards (ISO 14001) are important tools for environmental protection, together with legislation, taxation and tax benefits. To determine the degree of implementation of EMS in hospital units and outpatient haemodialysis in the Spanish National Health System to provide a group of reference centres in environmental management in this healthcare activity. Development of a list by autonomous communities showing hospital and outpatient dialysis units using an EMAS and/or ISO 14001 in 2012-2013. The sources of information were the Spanish National Catalogue of Hospitals, Spanish Registry of Healthcare Certification and Accreditation, European and regional EMAS records, world ISO registrations, dialysis centre lists from scientific societies and patients, responses from accredited entities in Spain for environmental certification and the institutional website of each haemodialysis centre identified. Of the 210 hospitals with a dialysis unit, 53 (25%) have the ISO 14001 and 15 of these also have an EMAS). This constitutes 30% of all hospital dialysis chairs in Spain: 1,291 (of 4,298). Only 11 outpatient clinics are recorded, all with the ISO 14001. There is no official documentation of the implementation of EMS in dialysis units. Making this list provides an approach to the situation, with special reference to haemodialysis because of its significant environmental impact. Copyright © 2015 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

  13. [Evaluation of outpatient treatment units according to the Crime Victims' Regulation Act].

    PubMed

    Bollmann, Kirsten; Schürmann, Ivonne; Nolting, Björn; Dieffenbach, Ina; Fischer, Gottfried; Zurek, Gisela; Bering, Robert; Heuft, Gereon

    2012-01-01

    Over the past years, 35 trauma outpatient units have been established in accordance with the Crime Victims' Compensation Act in the federal state of North Rhine-Westphalia (Germany) for both children and adolescents as well as for adults. They are operated by the social welfare authorities and, since 2008, by the regional authorities of Westphalia-Lippe and Rhineland. They enable victims to receive qualified psychotraumatological help within the first few days after suffering violence. Since trauma units have now been set up across most parts of this federal state, the time has come to assess the effectiveness of their acute care provision to victims of violence. In 2007, on the order of the Ministry of Labour, Health and Social Affairs of the federal state of North Rhine-Westphalia, trauma outpatient units were subjected to scientific evaluation. In 17 trauma outpatient units, a data assessment protocol was officially implemented that included repeat measurements (immediately before the initial contact, after completion of intervention, at follow-up six months after intervention) of traumatized subjects aged 14 and older. Socio-demographic data were gathered, and the scores of the Impact of Event Scale - Revised (IES-R), the Symptom Checkliste-27 (SCL-27), the simplified Beck Depressions Inventory (BDI-V), the Global Assessment of Functioning Scale (GAF) as well as the Cologne Risk Index (CRI) (expert rating) were collected. Nearly three-fourths (65.9 %) of the traumatic experiences of the 211 patients investigated can be characterized as type-1 traumatisation. 31.8 % of patients were victims of crimes involving violations of the right to sexual self-determination (94.0 % of sexual offences being committed against girls and women). Crimes against physical integrity, which according to crime statistics are the most frequent of crimes against individuals (88.8 %, 34.8 % females), were suffered by 36.0 % of all patients of the trauma outpatient units (63.2 % being

  14. Factors Associated With Outpatient Visit Attendance After Discharge From Inpatient Psychiatric Units in a New York City Hospital.

    PubMed

    Humensky, Jennifer L; Fattal, Omar; Feit, Rachel; Mills, Sarah D; Lewis-Fernández, Roberto

    2017-06-01

    A class action lawsuit in New York (Koskinas v. Cuomo) established the right of psychiatric inpatients to receive discharge planning, including arranging outpatient treatment. The attendance rate of the initial outpatient appointment after discharge from inpatient treatment in one city hospital was examined to determine whether rates varied by inpatient unit type. The authors performed retrospective chart review of 1,884 discharges to outpatient care. Multivariate regression models were used to examine the odds of attending the initial appointment. Eighty-four percent of patients attended the initial appointment. Higher odds of attendance were associated with case management, living in a shelter or being homeless, general medical comorbidity, and inpatient treatment in a co-occurring disorders unit. Lower odds were associated with being non-Latino black. Inpatient treatment in a Latino unit had no significant effect. Hospital characteristics, patient population, and availability of local outpatient services may influence continuity of care.

  15. 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.

  16. 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.

  17. Contribution of the outpatient surgery unit ITO the general surgery department of a district hospital.

    PubMed

    Carrasco; Flores; Aguayo; de Andres B; Moreno Egea A; Cartagena; De Vicente JP; Martin

    2000-07-01

    Introduction: The creation of Outpatient Surgery (OPS) units to combine the quality of medical attention and rationalize costs allows for greater efficiency in the use of resources. Aim: To report our series of patients undergoing surgery at the OPS units integrated into our Hospital (Type II): Patients and method: Between May 1994 and March 1998, 832 outpatients, of a total of 5230, underwent surgery at our General Surgery Unit. The criteria for exclusion from the programme depended on the patient and the enviroment or resulted from the operation itself. Results: Mean patient age was 47.5 years; there were 420 males and 412 females. Surgery was performed for 229 inguinofemoral hernias, 47 umbilical-epigastric hernias, nine incisional hernias, 193 pilonidal sinuses, 156 mammary nodules, 65 varicose veins, 64 arteriovenous fistulae and 69 proctology operations. The most common anesthesia techniques performed were rachianesthesia and local anesthesia. Eight point seven percent of the patients required admission (OPS failure), the most frequent causes being excessive pain, orthostatic-syncopal hypotension, nausea and vomiting and urine retention. There was no morbidity or mortality. Conclusion: OPS is a highly efficient procedure for resolving the most common pathologies in General Surgery. The anesthesia technique was an important factor in the rate of failure.

  18. Odontogenic infections: an 8-year epidemiologic analysis in a dental emergency outpatient care unit.

    PubMed

    Cachovan, Georg; Phark, Jin-Ho; Schön, Gerhard; Pohlenz, Philipp; Platzer, Ursula

    2013-01-01

    The purpose of this investigation was to analyze epidemiological patterns, clinical features and the management of odontogenic infections in patients undergoing treatment in a dental emergency outpatient care unit. A retrospective analysis of 58 161 case records of patients presenting to an emergency outpatient unit in Hamburg, Germany between 2000-2007 was performed. From this pool, patients with odontogenic infections were identified using an ICD-10 code, analyzing age, gender, medical co-morbidities, duration of pain, ratio of infiltrates/abscesses, affected teeth, management of infection and administered antibiotics. Of the 58 161 patients, 5357 (9.2%) were identified as having odontogenic infections, with 2689 (50.2%) inflammatory infiltrates and 2668 (49.8%) abscesses. Mean age was 34.8 ± 16.8 years. As the primary site of odontogenic infection, the most significantly affected teeth were the maxillary and mandibular first molars. Patients in age-group 20-29 years (25.1%) utilized the emergency care unit more frequently than other age groups. Clindamycin was the most frequently administered antibiotic. Early recognition, diagnosis and management of odontogenic infections are requisite for avoiding or minimizing the development of potential complications. Strategies and evidence-based protocols should be developed within the dental ambulatory care sector, advancing interdisciplinary cooperation between general dentists and oral or maxillofacial surgeons.

  19. The Evolving Role of the Acute Assessment Unit - from inpatient to outpatient care.

    PubMed

    Connolly, V; Hamad, M; Scott, Y; Bramble, M

    2005-01-01

    Acute Assessment Units (AAUs) have been developed to meet the demand for emergency care. Traditionally, AAUs have been an admission route to secondary care but the role is now evolving to assessment. AAUs are complex and have many interactions both in hospitals and the community. The effective functioning of an AAU requires excellent clinical leadership, appropriate facilities, timely access to diagnostics and input from the multi-disciplinary team. Increasingly, AAUs will have to develop services which are not dependent on using hospital beds. A variety of emergency medical presentations can, with the appropriate resources, be delivered in an out-patient setting.

  20. 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.

  1. Exploring Death Anxiety and Burnout Among Staff Members Who Work In Outpatient Hemodialysis Units.

    PubMed

    Lee, Valerie L; King, Anita H

    2014-01-01

    Outpatient hemodialysis unit staff members are at risk for psychological stress, including death anxiety, unresolved grieving, and burnout, due tofrequent interactions with chronically ill patients who have a high mortality rate. Experiencing death anxiety and burnout may impair the ability to build interpersonal relationships, decrease job satisfaction, and impact quality of patient care. A quantitative study to evaluate the effect of educational classes on the level of death anxiety and burnout among hemodialysis caregivers revealed a decrease in participants' level of death anxiety and a decrease in emotional exhaustion in one area that was directly related to the work environment Information from the study can be used to decrease psychological stress through education and support for staff members who work in the hemodialysis unit environment.

  2. Significant Independent Predictors of Vitamin D Deficiency in Inpatients and Outpatients of a Nephrology Unit

    PubMed Central

    Bentli, Recep; Taskapan, Hulya; Toktaş, Halil; Ulutas, Ozkan; Ozkahraman, Adnan; Comert, Melda

    2013-01-01

    Aims. Kidney disease was found to be a major risk factor for vitamin D deficiency in a population study of patients hospitalized. The aims of the study were to describe the prevalence of vitamin D deficiency inpatients and outpatients in a nephrology department during fall and to evaluate effect of assessing serum 25-hydroxyvitamin D (25(OH)D) levels and previous supplementation of cholecalciferol on vitamin D status. Methods. We studied 280 subjects in total, between October and January. The subjects were recruited from the following two groups: (a) inpatients and (b) outpatients in nephrology unit. We examined previous documentary evidence of vitamin D supplementation of the patients. Results. The prevalence of vitamin D deficiency among these 280 patients was 62,1% (174 patients). Fifty-three patients (18.9%) had severe vitamin D deficiency, 121 patients (43.2%) moderate vitamin D deficiency, and 66 patients (23.6%) vitamin D insufficiency. In logistic regression analysis female gender, not having vitamin D supplementation history, low serum albumin, and low blood urea nitrogen levels were significant independent predictors of vitamin D deficiency while no association of vitamin D deficiency with diabetes mellitus, serum creatinine, eGFR, and being hospitalized was found. Conclusion. Vitamin D deficiency, seems to be an important problem in both inpatients and outpatients of nephrology. Monitoring serum 25(OH)D concentrations regularly and replacement of vitamin D are important. Women in Turkey are at more risk of deficiency and may therefore need to consume higher doses of vitamin D. PMID:23737771

  3. Update on adolescent gynecology.

    PubMed

    Granada, Catalina; Omar, Hatim; Loveless, Meredith Buonanno

    2013-04-01

    Adolescent gynecology is an important part of clinical care of adolescent females. This discussion provides a basic review of current issues in adolescent gynecology, including consideration of current pubertal concepts with attention also given to delayed and precocious puberty. Causes of breast masses are reviewed, including discussion of the ANDI classification. It is recommended that physicians provide sexuality education to their adolescent patients, in addition to the community, to reduce the high rates of unintended adolescent pregnancy and STIs in teens that continue in the United States. Finally, attention is provided to ovarian masses and their management. Adolescent medicine physicians may have to work with a variety of specialists in their care of adolescents and the many gynecologic conditions that may arise.

  4. 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.

  5. Starting together: a focus group for the organization of a CKD outpatient care unit.

    PubMed

    Piccoli, Giorgina Barbara; Consiglio, Valentina; Deagostini, Maria Chiara; Manente, Elisa; Scarpa, Roberto Mario

    2010-01-01

    The growing interest in patient empowerment in chronic diseases underlines the importance of assessing patients' opinions in planning healthcare strategies. Focus groups are flexible tools for investigating innovative aspects of care. The aim of the study was to use a focus group to define the main requirements for a chronic kidney disease (CKD) outpatient care unit. The focus group met during the opening of a new CKD outpatient facility. It consisted of 12 patients with long-term experience of CKD, dialysis and transplantation; they had been followed previously by the senior physician, who moderated the discussion. The discussion was tape-recorded and the results were summarized and approved by all participants. The group made 10 major suggestions: 1. Therapeutic continuity in all disease phases, from pre-dialysis to transplantation; 2. Possibility to choose the reference physician; 3. Strict integration with the nursing activities; 4. Organizational flexibility, to adapt to the needs of daily life; 5. To be "fully" taken care of, with organizational support for blood tests, imaging and consultations; 6. Need for time with the reference physician in critical phases of the disease; 7. Identification of a network of consultants, in keeping with the need for continuity of care; 8. Educational sessions; 9. Meetings for critical discussion of organizational performances; 10. As a setting: a home for the disease and not a disease to take home. Continuity of care and flexibility of organization, allowing time for education and discussion, are the quality requirements of our CKD patients.

  6. 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.

  7. Conservative surgical management of malignant ovarian germ cell tumors: the experience of the Gynecologic Oncology Unit at Ain Shams University.

    PubMed

    El-Lamie, I K; Shehata, N A; Abou-Loz, S K; El-Lamie, K I

    2000-01-01

    To evaluate the role of extended surgical staging in patients with malignant ovarian germ cell tumors in the presence of cisplatinum-based combination chemotherapy. 16 patients aged between 13 and 40 years (mean 20.5) diagnosed and treated for malignant ovarian germ cell tumors at the Gynecologic Oncology Unit. Ain Shams University, during the period from May 1994 to October 1999. Six patients were diagnosed with dysgerminoma, six with immature teratoma and four with endodermal sinus tumor. Only seven cases were primarily managed at the unit and were subjected to proper surgical staging as required by FIGO (two in each of the stages IC, IIC and IIIA and one in stage IV). However, the remaining nine cases were referred to the unit, six after having unilateral salpingo-oophorectomy and no surgical staging, one patient after total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH+BSO), and one with recurrent dysgerminoma in the retroperitoneum and mediastinum following suboptimal treatment. None of these cases were surgically re-explored and all including the first six cases were given the standard BEP chemotherapy for 4-6 courses (mean 5.8). Follow-up ranged from 7-72 months (mean 30.5). All patients are alive without any evidence of disease recurrence except for one patient with a stage IIIA immature teratoma who had a local and distant recurrence and is undergoing second-line chemotherapy. All patients have their menstrual function preserved except for three patients; one having 46,XX pure gonadal dysgenesis with a preoperative FSH level of 120 U/l and the eldest two patients having a TAH+BSO as they had completed their families. Three patients are currently pregnant. In view of the high chemosensitivity and curability of ovarian germ cell tumors and their occurrence in young patients, every effort should be made to preserve one ovary and the uterus for future reproduction even in advanced cases. The role of revisional surgical staging, in particular

  8. Setting up a Paediatric Rapid Access Outpatient Unit: Views of general practice teams

    PubMed Central

    Williams, Lisa; Fryer, Jane; Andrew, Rachel; Powell, Colin; Pink, Jim; Elwyn, Glyn

    2008-01-01

    Background Rapid Access Outpatient Units (RAOUs) have been suggested as an alternative to hospital inpatient units for the management of some acutely unwell children. These units can provide ambulatory care, delivered close to home, and may prevent unnecessary hospital admission. There are no qualitative data on the views of primary care practitioners regarding these types of facilities. The aim of the study was to explore the opinions of primary care practitioners regarding a newly established RAOU. Methods The RAOU was established locally at a district general hospital when inpatient beds were closed and moved to an inpatient centre, based six miles away at the tertiary teaching hospital. Qualitative, practice based group interviews with primary care practitioners (general practitioners (GPs), nurse practitioners and practice nurses) on their experiences of the RAOU. The data collection consisted of three practice based interviews with 14 participants. The interviews were recorded and transcribed verbatim. Thematic content analysis was used to evaluate the data. Results There was positive feedback regarding ease of telephone access for referral, location, and the value of a service staffed by senior doctors where children could be observed, investigated and discharged quickly. There was confusion regarding the referral criteria for the assessment unit and where to send certain children. A majority of the practitioners felt the utility of the RAOU was restricted by its opening hours. Most participants felt they lacked sufficient information regarding the remit and facilities of the unit and this led to some uneasiness regarding safety and long term sustainability. Conclusion Practitioners considered that the RAOU offered a rapid senior opinion, flexible short term observation, quick access to investigations and was more convenient for patients. There were concerns regarding opening hours, safety of patients and lack of information about the unit's facilities

  9. Geographic variation in the prescription of schedule II opioid analgesics among outpatients in the United States.

    PubMed

    Curtis, Lesley H; Stoddard, Jennifer; Radeva, Jasmina I; Hutchison, Steve; Dans, Peter E; Wright, Alan; Woosley, Raymond L; Schulman, Kevin A

    2006-06-01

    To measure geographic variation in opioid use in a large, commercially insured, outpatient population in the United States. Outpatient prescription drug claims database of a national pharmaceutical benefit manager for 7,873,337 subjects with at least one prescription drug claim in 2000. We measured the period prevalence of claims for opioid analgesics and controlled-release oxycodone at the state level. We measured geographic variation using the weighted coefficient of variation and systematic component of variation. In county-level multivariable regression, we explored associations between potential explanatory variables and claims for opioid analgesics and controlled-release oxycodone. A total of 567,778 (64.2 per 1,000 total claims) were for oral opioid analgesics. Claim rates by state ranged from <20 to >100 claims per 1,000 total claims. States with long-standing prescription monitoring programs had among the lowest rates. In the county-level data, presence of a statewide prescription monitoring program and proportions of the population aged 15-24 and 65 years and older were independently and negatively associated with claim rates for all opioid analgesics. Surgeons per 1,000, proportion of the population reporting illicit drug use, and proportion who were female were independently and positively associated with claim rates for all opioid analgesics. Only the proportion of the population aged 25-34 and number of surgeons per 1,000 were independently and positively associated with claim rates for oxycodone. Claim rates for opioid analgesics vary significantly by state. Presence of a statewide prescription monitoring program is associated with lower claim rates at the county level. Future research should use individual-level data to assess whether these findings reflect a reduction in abuse and diversion or suboptimal treatment of pain.

  10. The unit costs of inpatient hospital days, outpatient visits, and daycare treatments in the fields of oncology and hematology.

    PubMed

    Tan, Siok Swan; Van Gils, Chantal W M; Franken, Margreet G; Hakkaart-van Roijen, Leona; Uyl-de Groot, Carin A

    2010-01-01

    Many economic evaluations are conducted in the fields of oncology and hematology, partially owing to the introduction of new expensive drugs in this field. Even though inpatient days, outpatient visits, and daycare treatments are frequently the main drivers of total treatment costs, their unit costs often lack generalizability. Therefore, we aimed to determine the unit costs of inpatient hospital days, outpatient visits, and daycare treatments specifically for oncological and hematological diseases in The Netherlands from the hospital's perspective. Unit costs were collected from 30 oncological and hematological departments of 6 university and 24 general hospitals. Costs included direct labor and indirect labor, hotel and nutrition, overheads and capital. Ordinary least squares regression models were constructed to examine the degree of association between unit costs and hospital and hospital department characteristics. All costs were based on Euro 2007 cost data. At university hospitals, the unit costs per inpatient day were determined at €633 in oncological and €680 in hematological departments. At general hospitals, the mean costs per inpatient day were €400. Unit costs for inpatient hospital days, outpatient visits. and daycare treatments equalled the relative ratio 100:21:44. Direct labor costs were the major cost driver and the type of hospital (university, yes/no) was a strong predictor of unit costs. The present study provided unit costs for inpatient hospital days, outpatient visits, and daycare treatments in the fields of oncology and hematology. The results may be used as Dutch reference unit prices in economic evaluations assessing oncological and hematological diseases. © 2010, International Society for Pharmacoeconomics and Outcomes Research (ISPOR).

  11. Visual ability of patients seeking outpatient low vision services in the United States.

    PubMed

    Goldstein, Judith E; Chun, Melissa W; Fletcher, Donald C; Deremeik, James T; Massof, Robert W

    2014-10-01

    Most patients with low vision are elderly and have functional limitations from other health problems that could add to the functional limitations caused by their visual impairments. To identify factors that contribute to visual ability measures in patients who present for outpatient low vision rehabilitation (LVR) services. As part of a prospective, observational study of new patients seeking outpatient LVR, 779 patients from 28 clinical centers in the United States were enrolled in the Low Vision Rehabilitation Outcomes Study (LVROS) from April 25, 2008, through May 2, 2011. The Activity Inventory (AI), an adaptive visual function questionnaire, was administered to measure overall visual ability and visual ability in 4 functional domains (reading, mobility, visual motor function, and visual information processing) at baseline before LVR. The Geriatric Depression Scale, Telephone Interview for Cognitive Status, and Medical Outcomes Study 36-Item Short-Form Health Survey physical functioning questionnaires were also administered to measure patients' psychological, cognitive, and physical health states, respectively. Predictors of visual ability and functional domains as measured by the AI. Among the 779 patients in the LVROS sample, the mean age was 76.4 years, 33% were male, and the median logMAR visual acuity score was 0.60 (0.40-0.90 interquartile range). Correlations were observed between logMAR visual acuity and baseline visual ability overall (r = -0.42) and for all functional domains. Visual acuity was the strongest predictor of visual ability (P  < .001) and reading ability (P < .001) and had a significant independent effect on the other functional domains. Physical ability was independently associated with (P < .001) overall visual ability as well as mobility and visual motor function. Depression had a consistent independent effect (P < .001) on overall visual ability and on all functional domains, whereas cognition had an effect on only

  12. Variation in Surgical Antibiotic Prophylaxis for Outpatient Pediatric Urological Procedures at United States Children's Hospitals.

    PubMed

    Chan, Katherine H; Bell, Teresa; Cain, Mark; Carroll, Aaron; Benneyworth, Brian D

    2017-03-01

    Guidelines recommend surgical antibiotic prophylaxis for clean-contaminated procedures but none for clean procedures. The purpose of this study was to describe variations in surgical antibiotic prophylaxis for outpatient urological procedures at United States children's hospitals. Using the PHIS (Pediatric Health Information System®) database we performed a retrospective cohort study of patients younger than 18 years who underwent clean and/or clean-contaminated outpatient urological procedures from 2012 to 2014. We excluded those with concurrent nonurological procedures or an abscess/infected wound. We compared perioperative antibiotic charges for clean vs clean-contaminated procedures using a multilevel logistic regression model with a random effect for hospital. We also examined whether hospitals that were guideline compliant for clean procedures, defined as no surgical antibiotic prophylaxis, were also compliant for clean-contaminated procedures using the Pearson correlation coefficient. We examined hospital level variation in antibiotic rates using the coefficient of variation. A total of 131,256 patients with a median age of 34 months at 39 hospitals met study inclusion criteria. Patients undergoing clean procedures were 14% less likely to receive guideline compliant surgical antibiotic prophylaxis than patients undergoing clean-contaminated procedures (OR 0.86, 95% CI 0.84-0.88, p <0.0001). Hospitals that used antibiotics appropriately for clean-contaminated procedures were more likely to use antibiotics inappropriately for clean procedures (r = 0.7, p = 0.01). Greater variation was seen for hospital level compliance with surgical antibiotic prophylaxis for clean-contaminated procedures (range 9.8% to 97.8%, coefficient of variation 0.36) than for clean procedures (range 35.0% to 98.2%, coefficient of variation 0.20). Hospitals that used surgical antibiotic prophylaxis appropriately for clean-contaminated procedures were likely to use surgical antibiotic

  13. Influenza Antiviral Expenditures and Outpatient Prescriptions in the United States, 2003-2012.

    PubMed

    Suda, Katie J; Hunkler, Robert J; Matusiak, Linda M; Schumock, Glen T

    2015-11-01

    The clinical efficacy and cost-effectiveness of influenza antiviral use are controversial, with recent analyses suggesting potentially limited value. Thus, the objectives of this study were to describe influenza antiviral expenditures overall and by health care setting over a 10-year period (2003-2012) and to assess the correlation between outpatient influenza antiviral prescription use and influenza-like illness (ILI) outpatient visits. Retrospective, cross-sectional study. IMS Health National Sales Perspectives and Xponent databases and Centers for Disease Control and Prevention ILINet national influenza surveillance system database. All prescriptions for oseltamivir, rimantadine, or zanamivir from community pharmacies, mail order pharmacies, clinics, nonfederal hospitals, and other health care settings (federal hospitals, military facilities, jails and prisons, universities, staff-model health maintenance organizations, veterinary hospitals and clinics, and long-term care facilities) between January 1, 2003, and December 31, 2012. Prescribing rates were calculated (prescriptions/1000 persons) for each year from 2003 to 2012 by using U.S. Census Bureau data. Influenza season was defined as July 1-June 30 of each calendar year. Linear regression assessed the correlation between influenza antiviral expenditures, prescription use, and ILI diagnoses. From 2003 to 2012, influenza antiviral drug expenditures accounted for $3.74 billion, with the majority from community pharmacies. After adjusting for inflation, no growth was observed for expenditures. A total of 32.8 million influenza antiviral prescriptions were dispensed from community pharmacies during the study period, and these prescriptions experienced 133.2% growth from 2003 to 2012. One third of expenditures and one quarter of dispensed prescriptions were in 2009. Influenza seasons were correlated with ILI and antiviral prescriptions. Annual community pharmacy expenditures were also associated with influenza

  14. Chance of psychiatric morbidity amongst recently diagnosed cancer outpatients attending a chemotherapy unit.

    PubMed

    Chaves, A C; Pinto, R N; Lourenço, M T; Mari, J J

    2005-09-01

    The prevalent rate of psychiatry morbidity amongst patients with cancer reported in various studies ranges from 5 to 50%, a variation that can be attributed to differences in sample size, the disease itself and treatment factors. The objectives of the present study were to determine the frequency of psychiatric morbidity amongst recently diagnosed cancer outpatients and try to identify which factors might be related to further psychological distress. Two hundred and eleven (70.9%) female patients and 87 (29.1%) male patients from the chemotherapy unit of the Cancer Hospital A.C. Camargo (São Paulo) completed a questionnaire that featured data on demographic, medical and treatment details. The Self Reporting Questionnaire (SRQ-20) was administered to the patients to determine their personal psychiatric morbidity. Seventy-two patients (25.8%) scored > or = 8 in the SRQ-20, the cut-off point for a patient to be considered a psychiatric case. When the low and high scoring groups were compared no differences were detected regarding age, marital status, tumor site, sex, or previous treatment. Nonetheless, patients in the lowest social class and those who were bedridden less than 50% of the time had a significantly higher probability of being a psychiatric case. Regarding help-seeking behavior in situations in which they had doubts or were frightened, about 64% of the total sample did not seek any type of support and did not talk to anyone. This frequency of psychiatric morbidity agrees with data from the cancer literature. According to many investigators, the early detection of a comorbid psychiatric disorder is crucial to relieve a patient's suffering.

  15. Intersecting gender, evaluations, and examinations: Averting gender bias in an obstetrics and gynecology clerkship in the United States.

    PubMed

    Jacques, Laura; Kaljo, Kristina; Treat, Robert; Davis, Joseph; Farez, Rahmouna; Lund, Michael

    2016-01-01

    The purpose of this study was to determine whether gender bias was present in the final third-year medical student obstetrics/gynecology clerkship performance evaluation completed by faculty and resident physicians. This was a retrospective cohort study of third-year medical students over the course of ten years (2004 - 2014) at a private medical school in the northern US state of Wisconsin. Each student's performance during their required 6-week obstetrics/gynecology clerkship was assessed by a combination of the student's scores on a clinical performance evaluation and on a standardized national subject examination. The clinical performance evaluations are comprised of 10 domains, each using a 9-point Likert scale and completed by faculty and resident physicians. All clerkships at our institution use the same evaluation form, which was designed and validated by the medical education statistics department. Final obstetrics/gynecology clerkship average clinical evaluation scores (Scale 1-9) and obstetrics/gynecology standardized national subject examination scores (Percentile 1-99) were compared to see if a gender based difference between subject examination and performance evaluation scores existed. 1,976 student records were analyzed. Mean standardized national subject exam scores were significantly higher for females [74.4 (8.1)] than males [72.9 (8.2)] (Possible range 1-99) with Cohen's d = 0.2 (P = 0.001). The average female score on the clinical evaluation was mean (SD) = 7.4 (0.9), compared to an average clinical evaluation score of 7.2 (1.0) for males (P = 0.001) (range 1-9). Performance on the standardized national subject exam was significantly correlated (r = 0.3, P = 0.001) with clinical evaluation scores, and when split by gender the strength of the correlation remained. Medical student performance on the standardized national subject exam correlated with clinical evaluations independent of gender. Women had higher scores on both the subject

  16. A Public Health Priority: Disparities in Gynecologic Cancer Research for African-Born Women in the United States

    PubMed Central

    Pinder, Leeya F.; Nelson, Brett D.; Eckardt, Melody; Goodman, Annekathryn

    2016-01-01

    African-born immigrants comprise one of the fastest growing populations in the U.S., nearly doubling its population size in recent years. However, it is also one of the most underrepresented groups in health-care research, especially research focused on gynecologic and breast malignancies. While the opportunity exists for access to an advanced health-care system, as immigrants migrate to the U.S., they encounter the same health-care inequalities that are faced by the native-born population based on ethnicity and social class, potentiated by limitations of health literacy and lack of familiarity with U.S. health systems. Given the continued influx of African-born immigrants in the U.S., we sought to understand the representation of this population in cervical and breast cancer research, recognizing the population’s high risk for these diseases at baseline while residing in their native countries. We determined that there is limited research in these diseases that disproportionately affect them; yet, there are identifiable and potentially modifiable factors that contribute to this paucity of evidence. This clinical commentary seeks to underscore the clear lack of research available involving African-born immigrants with respect to gynecologic and breast malignancies in the existing literature, demonstrate the need for more robust research in this population, and provide fundamental insights into barriers and solutions critical to the continued health of this growing population. PMID:27499654

  17. Reported Sexual Violence among Women and Children Seen at the Gynecological Emergency Unit of a Rural Tertiary Health Facility, Northwest Nigeria

    PubMed Central

    Ashimi, AO; Amole, TG; Ugwa, EA

    2015-01-01

    Background: Various forms of sexual violence including: Coerced marriage or wife inheritance, female genital mutilation, forced exposure to pornography, rape by intimate partner or strangers, unwanted sexual advances, and sexual abuse occurs, especially in vulnerable groups. However, most of these cases are not reported. Aim: The aim was to review reported cases in the facility, determine the prevalence and pattern of presentation. Subjects and Methods: This was a prospective longitudinal study undertaken at the Gynecological Emergency Unit of a Tertiary Health Facility in a rural setting Northwest Nigeria. A study of survivors of alleged sexual violence who presented to the hospital from the September 1, 2011 to August 31, 2013. Results: During the study period, there were 24 cases of sexual violence (22 were alleged rape and 2 were others) of 973 gynecological consultations at the emergency unit, giving a prevalence of 3% (24/973) for sexual violence and 2.3% (22/973) for alleged rape. Majority 91.7% (22/24) of the cases were children < 16 years; 45.8% (11/24) had no formal education while 33.3% (8/24) hawked homemade drinks and snacks. The assailants were known in 83.3% (20/24) of the cases; of which 45.8% (11/24) were neighbors, 29.2% (7/24) were buyers of snacks and drinks while 8.3% (2/24) were family members. Conclusion: The prevalence of reported sexual violence in this facility was low with the majority of the survivors being children and nonstranger assailants’, mostly neighbors. PMID:25745572

  18. Reported Sexual Violence among Women and Children Seen at the Gynecological Emergency Unit of a Rural Tertiary Health Facility, Northwest Nigeria.

    PubMed

    Ashimi, Ao; Amole, Tg; Ugwa, Ea

    2015-01-01

    Various forms of sexual violence including: Coerced marriage or wife inheritance, female genital mutilation, forced exposure to pornography, rape by intimate partner or strangers, unwanted sexual advances, and sexual abuse occurs, especially in vulnerable groups. However, most of these cases are not reported. The aim was to review reported cases in the facility, determine the prevalence and pattern of presentation. This was a prospective longitudinal study undertaken at the Gynecological Emergency Unit of a Tertiary Health Facility in a rural setting Northwest Nigeria. A study of survivors of alleged sexual violence who presented to the hospital from the September 1, 2011 to August 31, 2013. During the study period, there were 24 cases of sexual violence (22 were alleged rape and 2 were others) of 973 gynecological consultations at the emergency unit, giving a prevalence of 3% (24/973) for sexual violence and 2.3% (22/973) for alleged rape. Majority 91.7% (22/24) of the cases were children < 16 years; 45.8% (11/24) had no formal education while 33.3% (8/24) hawked homemade drinks and snacks. The assailants were known in 83.3% (20/24) of the cases; of which 45.8% (11/24) were neighbors, 29.2% (7/24) were buyers of snacks and drinks while 8.3% (2/24) were family members. The prevalence of reported sexual violence in this facility was low with the majority of the survivors being children and nonstranger assailants', mostly neighbors.

  19. Emergency Department and Outpatient Treatment of Acute Injuries Among Older Adults in the United States, 2009–2010

    PubMed Central

    Betz, Marian E.; Ginde, Adit A.; Southerland, Lauren T.; Caterino, Jeffrey M.

    2014-01-01

    OBJECTIVES Studies of injury among older adults have primarily focused on hospitalizations, especially at trauma centers, which may result in a skewed understanding and underestimation of the burden of injury. We sought to describe epidemiologic patterns of acute injuries treated in both ED and outpatient primary care settings in the United States. DESIGN Retrospective cross-sectional analysis of data from the 2009 and 2010 National Health Care Surveys. SETTING EDs and outpatient primary care clinics. PARTICIPANTS Older adults (age ≥65) with initial visits for acute injuries. MEASUREMENTS Frequencies and incidence rates of medically-attended injury by patient characteristics and care setting. RESULTS Of the 19.7 million medically-attended acute injuries among older adults in 2009–2010, 50% were treated at EDs and 50% at outpatient primary care clinics. The annual incidence rate of medically-attended injuries rose with age, from 20.8 (95% Confidence Interval [CI]=17.0–24.6) per 100 among those aged 65 to 74 years up to 41.5 (95%CI=33.5–49.4) per 100 for those ≥85 years. Of injury-related ED visits, 60% occurred outside standard business hours, 36% were triaged as “low acuity,” and 25% resulted in admission. Only 9% of injury-related primary care visits had injury prevention counseling documented. CONCLUSION Medically-attended injuries occur in older adults at high incidence and increase with advancing age. Half of all initial visits for acute injuries among older adults are to primary care clinics. Most injured patients are discharged home but injury prevention counseling is rarely documented. In order to appropriately inform injury prevention efforts and avoid underestimating the burden of injury, future injury studies should include a range of outpatient and inpatient care settings. PMID:24890363

  20. Regional variations in the provision of NHS gynecological and abortion services.

    PubMed

    Maresh, M

    1979-07-01

    areas where it appears that consultant policy is greatly limiting Naitonal Health Service abortions, it may be necessary for outpatient abortion units to be established relatively independent of the gynecological service.

  1. Managed care and technical efficiency in outpatient substance abuse treatment units.

    PubMed

    Alexander, J A; Wheeler, J R; Nahra, T A; Lemak, C H

    1998-11-01

    This article examines (1) the extent to which managed care participation is associated with technical efficiency in outpatient substance abuse treatment (OSAT) organizations and (2) the contributions of specific managed care practices as well as other organizational, financial, and environmental attributes to technical efficiency in these organizations. Data are from a nationally representative sample survey of OSAT organizations conducted in 1995. Technical efficiency is modeled using data envelopment analysis. Overall, there were few significant associations between managed care dimensions and technical efficiency in outpatient treatment organizations. Only one managed care oversight procedure, the imposition of sanctions by managed care firms, was significantly associated with relative efficiency of these provider organizations. However, several organizational factors were associated with the relative level of efficiency including hospital affiliation, mental health center affiliation, JCAHO accreditation, receipt of lump sum revenues, methadone treatment modality, percentage clients unemployed, and percentage clients who abuse multiple drugs.

  2. Modelling an outpatient unit in a clinical health centre using discrete event simulation

    NASA Astrophysics Data System (ADS)

    Sharif, Nurul Atikah Mohd; Aziz, Azizah; Ahmad, Norazura; Nawawi, Mohd Kamal Mohd

    2016-10-01

    This paper describes a project paper of a simulation modelling course. It presents the potential of computer simulation in modelling the current performance of an outpatient department of a clinical health centre in a rural area. The model was run using Arena student version 14.5. From the 60 replication length run, the obtained result shows that the patient's waiting time is 26.4 minutes, which is lesser than the established standard waiting time of 30 minutes.

  3. Society of Gynecologic Surgeons

    MedlinePlus

    ... Myers, MD SGS Mission The mission of the Society of Gynecologic Surgeons is to promote excellence in ... research, and professional and public education. Research The Society prides itself in mentoring young gynecologic surgeons and ...

  4. Factors Associated With Use of ASAM Criteria and Service Provision in a National Sample of Outpatient Substance Abuse Treatment Units.

    PubMed

    Chuang, Emmeline; Wells, Rebecca; Alexander, Jeffrey A; Friedmann, Peter D; Lee, I-Heng

    2009-09-01

    Standardized patient placement criteria such as those developed by the American Society of Addiction Medicine are increasingly common in substance abuse treatment, but it is unclear what factors are associated with their use or with treatment units' provision of related services. This study examined these issues in the context of a national survey of outpatient substance abuse treatment units. Regressions using 2005 data revealed that both public and private managed care were associated with a greater likelihood of using American Society of Addiction Medicine criteria to develop client treatment plans. However, only public managed care was associated with a greater likelihood of offering more resource-intensive services. Associations between client population severity and resource-intensive service provision were sparse but positive.

  5. Patterns in admission delays to outpatient methadone treatment in the United States.

    PubMed

    Gryczynski, Jan; Schwartz, Robert P; Salkever, David S; Mitchell, Shannon Gwin; Jaffe, Jerome H

    2011-12-01

    Waiting lists for methadone treatment have existed in many U.S. communities, but little is known nationally about what patient and service system factors are related to admission delays that stem from program capacity shortfalls. Using a combination of national data sources, this study examined patterns in capacity-related admission delays to outpatient methadone treatment in 40 U.S. metropolitan areas (N = 28,920). Patient characteristics associated with admission delays included racial/ethnic minority status, lower education, criminal justice referral, prior treatment experience, secondary cocaine or alcohol use, and co-occurring psychiatric problems. Injection drug users experienced fewer delays, as did self-pay patients and referrals from health care and addiction treatment providers. Higher community-level utilization of methadone treatment was associated with delay, whereas delays were less common in communities with higher utilization of alternative modalities. These findings highlight potential disparities in timely admission to outpatient methadone treatment. Implications for improving treatment access and service system monitoring are discussed.

  6. Definitions of Obstetric and Gynecologic Hospitalists.

    PubMed

    McCue, Brigid; Fagnant, Robert; Townsend, Arthur; Morgan, Meredith; Gandhi-List, Shefali; Colegrove, Tanner; Stosur, Harriet; Olson, Rob; Meyer, Karenmarie; Lin, Andrew; Tessmer-Tuck, Jennifer

    2016-02-01

    The obstetric hospitalist and the obstetric and gynecologic hospitalist evolved in response to diverse forces in medicine, including the need for leadership on labor and delivery units, an increasing emphasis on quality and safety in obstetrics and gynecology, the changing demographics of the obstetric and gynecologic workforce, and rising liability costs. Current (although limited) research suggests that obstetric and obstetric and gynecologic hospitalists may improve the quality and safety of obstetric care, including lower cesarean delivery rates and higher vaginal birth after cesarean delivery rates as well as lower liability costs and fewer liability events. This research is currently hampered by the use of varied terminology. The leadership of the Society of Obstetric and Gynecologic Hospitalists proposes standardized definitions of an obstetric hospitalist, an obstetric and gynecologic hospitalist, and obstetric and gynecologic hospital medicine practices to standardize communication and facilitate program implementation and research. Clinical investigations regarding obstetric and gynecologic practices (including hospitalist practices) should define inpatient coverage arrangements using these standardized definitions to allow for fair conclusions and comparisons between practices.

  7. Working toward a common goal: a collaborative obstetrics and gynecology practice.

    PubMed

    Marshall, Nicole; Egan, Sarah; Flores, Christina; Kirsch, Abbe; Mankoff, Ruth; Resnick, Melissa

    2012-09-01

    Health care reform in the United States will continue to necessitate creativity in the organization and staffing of health care models. The Department of Obstetrics and Gynecology at Bronx-Lebanon Hospital Center has expanded its staff by placing midwives as primary providers for most routine care and much of the specialty care offered within the department. Midwives and attending physicians work collaboratively in outpatient specialty clinics. Inpatient care is provided by a team of midwives, residents, and attending physicians. This model of care is easily replicated, and has resulted in improvements in clinical practice and increased patient and personnel satisfaction.

  8. 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.

  9. [Information technology in gynecological oncology today].

    PubMed

    Kupka, M S; Richter, O; Tutschek, B

    2003-11-01

    Information technology has been integrated in gynecological oncology treatment. Therefore, new software has been established in hospitals and out-patient clinics. A German law concerning data collection in oncology has attempted to unify different strategies. All intentions to establish new documentation systems for tumor diseases need a standardized basic data set. Nevertheless, local governmental health organizations are not yet prepared to implement a global information system such as prenatal and perinatal care databases. Financial support and political work is therefore needed.

  10. Organizational characteristics that foster early adoption of cultural and linguistic competence in outpatient substance abuse treatment in the United States.

    PubMed

    Guerrero, Erick G

    2012-02-01

    Recent years have seen an increased interest in developing culturally and linguistically responsive systems of care in substance abuse treatment in the United States. This study examines the extent to which external and internal organizational pressures contributed to the degree of adoption of culturally and linguistically responsive practices in the nation's outpatient substance abuse treatment system early in the period of development of this system of care. Findings show that a higher degree of adoption of culturally competent practices was most likely in treatment programs with high dependence on external funding and regulation. Internally, programs with a larger number of professionals were associated with the lowest degree of adoption, while managers' cultural sensitivity contributed significantly to a high degree of adoption of these responsive practices. Considering the passage of recent legislation enforcing the use of cultural and linguistic competence in health care, implications of these baseline findings on early adoption patterns are discussed for future research and health care policy evaluation.

  11. How Outpatient Substance Abuse Treatment Unit Director Activities May Affect Provision of Community Outreach Services

    ERIC Educational Resources Information Center

    Chuang, Emmeline; Wells, Rebecca; Alexander, Jeffrey; Green, Sherri

    2013-01-01

    Aims: Community outreach services play an important role in infectious disease prevention and engaging drug users not currently in treatment. However, fewer than half of US substance abuse treatment units provide these services and many have little financial incentive to do so. Unit directors generally have latitude about scope of services,…

  12. How Outpatient Substance Abuse Treatment Unit Director Activities May Affect Provision of Community Outreach Services

    ERIC Educational Resources Information Center

    Chuang, Emmeline; Wells, Rebecca; Alexander, Jeffrey; Green, Sherri

    2013-01-01

    Aims: Community outreach services play an important role in infectious disease prevention and engaging drug users not currently in treatment. However, fewer than half of US substance abuse treatment units provide these services and many have little financial incentive to do so. Unit directors generally have latitude about scope of services,…

  13. 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

  14. United states medical licensing examination scores as a predictor of performance on the annual council of resident education in obstetrics and gynecology examinations.

    PubMed

    Spellacy, William N; Downes, Katheryne L

    2014-01-01

    To determine how well the United States Medical Licensing Examination (USMLE) Step 1 and Step 2 scores predict the performance of residents on the annual Council of Resident Education in Obstetrics and Gynecology (CREOG) examination given to the residents at the second and third years of their residency. USMLE Steps 1 and 2 scores from medical school were compared to the resident CREOG examination scores at the second and third years of training for 61 residents from 2000 to 2011. A strong, statistically significant (p < 0.001) correlation was found between the USMLE and CREOG scores, ranging between r = 0.588 and r = 0.667 for the USMLE 1 scores and r = 0.630 and r = 0.640 for the USMLE 2 scores. This observation should be useful for program directors in selecting the future medical students for their residency program since those with high USMLE Steps 1 and 2 scores typically do very well on their objective testing during and after the residency.

  15. Improving Nonattendance at Outpatient Pediatric Endoscopy Unit of a Tertiary Center.

    PubMed

    Kogan-Liberman, Debora; Rivas, Yolanda; Thompson, John; Tomer, Gitit

    2015-08-01

    Failure to attend pediatric outpatient endoscopic procedures leads to inefficient use of resources, longer wait-list times, and delay in diagnoses. The causes for pediatric endoscopy nonattendance are not well studied. The aim of the study was to identify factors associated with failure to attend endoscopic procedures and to assess the value of quality improvement (QI) interventions implemented to improve pediatric endoscopy attendance. This was a continuous QI project. We collected nonattendance data from November 2011 to November 2013. Information collected included procedure type, age, sex, time on the waiting list, history of previous procedures, and reason for nonattendance. The following QI interventions were implemented sequentially: an appointment reminder letter, a telephone call 1 week before procedure, and creation of an electronic medical note dedicated to endoscopy appointment. Pareto charts and statistical process control charts were used for analysis. From November 2011 to November 2013, we were able to decrease nonattendance from 17% to 11% (P = 0.005). No-show rate was reduced from 5% to 0.9% (P = 0.00001). There was no significant difference between attendees and nonattendees in relation to sex, age, or having a previous procedure. Longer waiting time (33 vs 26 days) was associated with increased risk for nonattendance (P = 0.0007). The most common causes for nonattendance were illness (31.5%), followed by caregiver/patients who no longer wanted the procedure (17.7%), and patients who improved (12.9%). Applying QI methods and tools improved pediatric endoscopy attendance. Longer wait time for endoscopic procedures is associated with nonattendance. Given the increased pediatric endoscopy demand, strategies should be implemented to reduce wait time for pediatric endoscopy.

  16. Outpatient hypertension treatment, treatment intensification, and control in Western Europe and the United States.

    PubMed

    Wang, Y Richard; Alexander, G Caleb; Stafford, Randall S

    2007-01-22

    Hypertension guidelines in the United States tend to have more aggressive treatment recommendations than those in European countries. To explore international differences in hypertension treatment, treatment intensification, and hypertension control in western Europe and the United States, we conducted cross-sectional analyses of the nationally representative CardioMonitor 2004 survey, which included 21 053 hypertensive patients visiting 291 cardiologists and 1284 primary care physicians in 5 western European countries and the United States. The main outcome measures were latest systolic and diastolic blood pressure (BP) levels, hypertension control (latest BP level, <140/90 mm Hg), and medication increase (dose escalation or an addition to or switch of drug therapy) for inadequately controlled hypertension. At least 92% of patients in each country received antihypertensive drug treatment. The initial pretreatment BP levels were lowest and the use of combination drug therapy (>or=2 antihypertensive drug classes) was highest in the United States. Multivariate analyses controlling for age, sex, current smoking, and physician specialty indicated that, compared with US patients, European patients had higher latest systolic BP levels (by 5.3-10.2 mm Hg across countries examined) and diastolic BP levels (by 1.9-5.3 mm Hg), a smaller likelihood of hypertension control (odds ratios, 0.27-0.50), and a smaller likelihood of medication increase for inadequately controlled hypertension (odds ratios, 0.29-0.65) (all P<.001). In addition, controlling for initial pretreatment BP level attenuated the differences in latest systolic and diastolic BP levels and the likelihood of hypertension control. Lower treatment thresholds and more intensive treatment contribute to better hypertension control in the United States compared with the western European countries studied.

  17. Cost of Outpatient Arthroscopic Anterior Cruciate Ligament Reconstruction Among Commercially Insured Patients in the United States, 2005-2013

    PubMed Central

    Herzog, Mackenzie M.; Marshall, Stephen W.; Lund, Jennifer L.; Pate, Virginia; Spang, Jeffrey T.

    2017-01-01

    Background: Despite the significance of anterior cruciate ligament (ACL) injuries, these conditions have been under-researched from a population-level perspective. It is important to determine the economic effect of these injuries in order to document the public health burden in the United States. Purpose: To describe the cost of outpatient arthroscopic ACL reconstruction and health care utilization among commercially insured beneficiaries in the United States. Study Design: Economic and decision analysis; Level of evidence, 3. Methods: The study used the Truven Health Analytics MarketScan Commercial Claims and Encounters database, an administrative claims database that contains a large sample (approximately 148 million) of privately insured individuals aged <65 years and enrolled in employer-sponsored plans. All claims with Current Procedural Terminology (CPT) code 29888 (arthroscopically aided ACL reconstruction or augmentation) from 2005 to 2013 were included. “Immediate procedure” cost was computed assuming a 3-day window of care centered on date of surgery. “Total health care utilization” cost was computed using a 9-month window of care (3 months preoperative and 6 months postoperative). Results: There were 229,446 outpatient arthroscopic ACL reconstructions performed over the 9-year study period. Median immediate procedure cost was $9399.49. Median total health care utilization cost was $13,403.38. Patients who underwent concomitant collateral ligament (medial [MCL], lateral [LCL]) repair or reconstruction had the highest costs for both immediate procedure ($12,473.24) and health care utilization ($17,006.34). For patients who had more than 1 reconstruction captured in the database, total health care utilization costs were higher for the second procedure than the first procedure ($16,238.43 vs $15,000.36), despite the fact that immediate procedure costs were lower for second procedures ($8685.73 vs $9445.26). Conclusion: These results provide a

  18. POLYCLONAL OUTBREAK OF BLOODSTREAM INFECTIONS CAUSED BY Burkholderia cepacia COMPLEX IN HEMATOLOGY AND BONE MARROW TRANSPLANT OUTPATIENT UNITS

    PubMed Central

    Boszczowski, Icaro; do Prado, Gladys Villas Boas; Dalben, Mirian F.; Telles, Roberto C. P.; Freire, Maristela Pinheiro; Guimarães, Thaís; Oliveira, Maura S.; Rosa, Juliana F.; Soares, Robson E.; Llacer, Pedro Enrique Dorlhiac; Dulley, Frederico Luiz; Costa, Silvia F.; Levin, Anna S.

    2014-01-01

    Aim: The objective was to describe an outbreak of bloodstream infections by Burkholderia cepacia complex (Bcc) in bone marrow transplant and hematology outpatients. Methods: On February 15, 2008 a Bcc outbreak was suspected. 24 cases were identified. Demographic and clinical data were evaluated. Environment and healthcare workers' (HCW) hands were cultured. Species were determined and typed. Reinforcement of hand hygiene, central venous catheter (CVC) care, infusion therapy, and maintenance of laminar flow cabinet were undertaken. 16 different HCWs had cared for the CVCs. Multi-dose heparin and saline were prepared on counter common to both units. Findings: 14 patients had B. multivorans (one patient had also B. cenopacia), six non-multivorans Bcc and one did not belong to Bcc. Clone A B. multivorans occurred in 12 patients (from Hematology); in 10 their CVC had been used on February 11/12. Environmental and HCW cultures were negative. All patients were treated with meropenem, and ceftazidime lock-therapy. Eight patients (30%) were hospitalized. No deaths occurred. After control measures (multidose vial for single patient; CVC lock with ceftazidime; cleaning of laminar flow cabinet; hand hygiene improvement; use of cabinet to store prepared medication), no new cases occurred. Conclusions: This polyclonal outbreak may be explained by a common source containing multiple species of Bcc, maybe the laminar flow cabinet common to both units. There may have been contamination by B. multivorans (clone A) of multi-dose vials. PMID:24553612

  19. [Robotic surgery in gynecology].

    PubMed

    Hibner, Michał; Marianowski, Piotr; Szymusik, Iwona; Wielgós, Mirosław

    2012-12-01

    Introduction of robotic surgery in the first decade of the 21 century was one of the biggest breakthroughs in surgery since the introduction of anesthesia. For the first time in history the surgeon was placed remotely from the patient and was able to operate with the device that has more degrees of freedom than human hand. Initially developed for the US Military in order to allow surgeons to be removed from the battlefield, surgical robots quickly made a leap to the mainstream medicine. One of the first surgical uses for the robot was cardiac surgery but it is urology and prostate surgery that gave it a widespread popularity Gynecologic surgeons caught on very quickly and it is estimated that 31% of hysterectomies done in the United States in 2012 will be done robotically. With over half a million hysterectomies done each year in the US alone, gynecologic surgery is one of the main driving forces behind the growth of robotic surgery Other applications in gynecology include myomectomy oophorectomy and ovarian cystectomy resection of endometriosis and lymphadenectomy Advantages of the surgical robot are clearly seen in myomectomy The wrist motion allows for better more precise suturing than conventional "straight stick" laparoscopy The strength of the arms allow for better pulling of the suture and the third arm for holding the suture on tension. Other advantage of the robot is scaling of the movements when big movement on the outside translates to very fine movement on the inside. This enables much more precise surgery and may be important in the procedures like tubal anastomosis and implantation of the ureter Three-dimensional vision provides excellent depth of field perception. It is important for surgeons who are switching from open surgeries and preliminary evidence shows that it may allow for better identification of lesions like endometriosis. Another big advantage of robotics is that the surgeon sits comfortably with his/her arms and head supported. This

  20. Identifying core obstetric and gynecologic skills required of, and used by, graduates of the Faculty of Medicine and Health Sciences, United Arab Emirates University.

    PubMed

    Rizk, D E; Elzubeir, M

    2000-01-01

    Acquisition of core practical skills by students assures quality and relevance of medical education. To determine whether students and interns are acquiring core obstetric and gynecologic skills. A self-administered questionnaire was sent to obstetric and gynecology clerkship coordinators (n = 3), consultants (n = 14), residents (n = 13); interns (n = 13) and final-year students (n = 29; n = 93, response rate = 77%, N = 72). The questionnaire contained a stimulus list of 21 clinical, 8 communication, and 5 professional skills. Of 34 listed skills, 24 were identified as core skills. At least 50% of consultants, faculty, and residents expected 28 core skills to be covered in the undergraduate program. At least 50% of interns believed that 21 core skills had been acquired at graduation. Our curriculum is facilitating acquisition of core obstetric and gynecologic skills.

  1. 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.

  2. What’s in a Name? Use of Brand versus Generic Drug Names in United States Outpatient Practice

    PubMed Central

    Chren, Mary-Margaret; Landefeld, C. Seth

    2007-01-01

    Background The use of brand rather than generic names for medications can increase health care costs. However, little is known at a national level about how often physicians refer to drugs using their brand or generic names. Objective To evaluate how often physicians refer to drugs using brand or generic terminology. Design and Participants We used data from the 2003 National Ambulatory Medical Care Survey (NAMCS), a nationally representative survey of 25,288 community-based outpatient visits in the United States. After each visit, patient medications were recorded on a survey encounter form by the treating physician or transcribed from office notes. Measurements Our main outcome measure was the frequency with which medications were recorded on the encounter form using their brand or generic names. Results For 20 commonly used drugs, the median frequency of brand name use was 98% (interquartile range, 81–100%). Among 12 medications with no generic competition at the time of the survey, the median frequency of brand name use was 100% (range 92–100%). Among 8 medications with generic competition at the time of the survey (“multisource” drugs), the median frequency of brand name use was 79% (range 0–98%; P < .001 for difference between drugs with and without generic competition). Conclusions Physicians refer to most medications by their brand names, including drugs with generic formulations. This may lead to higher health care costs by promoting the use of brand-name products when generic alternatives are available. PMID:17443372

  3. Characterizing functional complaints in patients seeking outpatient low-vision services in the United States.

    PubMed

    Brown, Jamie C; Goldstein, Judith E; Chan, Tiffany L; Massof, Robert; Ramulu, Pradeep

    2014-08-01

    To characterize functional complaints of new low-vision rehabilitation patients. Prospective observational study. The Low Vision Rehabilitation Outcomes Study recruited 819 patients between 2008 and 2011 from 28 clinical centers in the United States. New patients referred for low-vision rehabilitation were asked, "What are your chief complaints about your vision?" before their appointment. Full patient statements were transcribed as free text. Two methods assessed whether statements indicated difficulty in each of 13 functional categories: (1) assessment by 2 masked clinicians reading the statement, and (2) a computerized search of the text for specific words or word fragments. Logistic regression models were used to predict the influence of age, gender, and visual acuity on the likelihood of reporting a complaint in each functional category. Prevalence and risk factors for patient concerns within various functional categories. Reading was the most common functional complaint (66.4% of patients). Other functional difficulties expressed by at least 10% of patients included driving (27.8%), using visual assistive equipment (17.5%), mobility (16.3%), performing in-home activities (15.1%), lighting and glare (11.7%), and facial recognition and social interactions (10.3%). Good agreement was noted between the masked clinician graders and the computerized algorithm for categorization of functional complaints (median κ of 0.84 across the 13 categories). Multivariate logistic regression models demonstrated that the likelihood of reading difficulties increased mildly with age (odds ratio, 1.4 per 10-year increment in age; 95% confidence interval, 1.3-1.6), but did not differ with visual acuity (P = 0.09). Additionally, men were more likely to report driving difficulties and difficulties related to lighting, whereas women were more likely to report difficulty with either in-home activities or facial recognition or social interaction (P<0.05 for all). Mobility concerns

  4. 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)

  5. [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.

  6. Low level technology tool (LLTT) in screening for blindness: test qualities in the outpatients department of a tertiary eye unit using the Snellen chart.

    PubMed

    Masanganise, R; Rusakaniko, S; Manjonjori, N

    2010-01-01

    To validate the use of finger counting (low level technology tool) in screening for blindness in the outpatients department of a tertiary eye unit with the view of employing the test for screening illiterate people in hard to reach parts of the country where the conventional visual acuity charts are not available. Aperformance evaluation of counting fingers (LLTT) in screening for blindness against the standard test (Snellen chart). Sekuru Kaguvi Eye Unit, Parirenyatwa Hospital, Zimbabwe. Patients presenting to the Eye Outpatient Department at Sekuru Kaguvi Eye Unit with various eye problems. Sensitivity of low level technology tool (LLTT) in identifying blind people. Sensitivity and specificity of LLTT in detecting blindness in all age groups combined was 100% and 88.5% respectively. Although sensitivity was not affected by patient age, specificity decreased with increasing age. The overall positive predictive value for the test was 53.3% and the prevalence of blindness among outpatient attendees was 11.6%. Finger counting is an effective tool that can be employed in screening for blindness in communities which are hard to reach, have low literacy rate and when conventional methods of testing visual acuity are not available.

  7. Gynecologic conditions and HIV.

    PubMed

    1997-07-01

    Studies are reinforcing the need for HIV-infected women to continue getting regular gynecologic examinations so that gynecologic complications can be detected early and monitored regularly. HIV-infected women who also have the human papillomavirus are more likely to progress to cervical cancer than their HIV-negative counterparts. Also, HIV-infected women are more likely to have abnormal pap smears and the presence of squamous intraepithelial lesions (SIL) compared to women who are HIV-negative. Because pap smears are not always accurate, women who have a history of cervical intraepithelial neoplasia (CIN) or SIL should probably include a colposcopy with their pap smear. Studies are showing a positive effect of anti-HIV therapy in lowering viral levels in vaginal secretions and in blood and semen in men. HIV RNA levels, however, have increased in vaginal secretions in response to standard treatment for CIN. HIV levels have also been shown to increase in the presence of sexually transmitted diseases, but when HIV viral levels are suppressed, there appears to be a lower susceptibility to gynecologic infections. Since research shows the benefits of early detection and treatment of gynecologic infections or conditions, all women should be aggressive and proactive in maintaining their health through regular gynecologic care.

  8. Peripheral neuropathy in patients with gynecologic cancer receiving chemotherapy: patient reports and provider assessments.

    PubMed

    Kiser, Deleslie W; Greer, Tara B; Wilmoth, Margaret C; Dmochowski, Jacek; Naumann, R Wendel

    2010-11-01

    To analyze the incidence of chemotherapy-induced neuropathy in a set of patients with gynecologic cancer who were treated with known neurotoxic agents, to identify correlative factors related to patients' experience of neuropathy, and to analyze providers' assessment and treatment of neuropathy. Observational descriptive study of patient-reported neuropathy using a retrospective chart analysis. A hospital-based outpatient infusion center in the southeastern United States. A convenience sample of 171 patients with gynecologic cancer for a total of 302 chemotherapy treatments. A mixed model and compound symmetry covariance matrix was used to adjust for correlations between neuropathy treatment scores and patients who completed more than one chemotherapy cycle. Backward elimination method was used to determine the final model. Functional Assessment of Cancer Treatment/Gynecologic Oncology Group-Neuropathy Treatment scores, patients' demographic information, past medical history, and chemotherapy history. Patients who were physically shorter and heavier than the average population had the highest rating of neuropathy. Patients who were treated with nontaxane and platinum therapies had less neuropathy than patients who were treated with first-line taxanes and platinums. Neuropathy was noted by providers early in the course of treatment, and providers' grading was consistent with the patients' scoring. First-line treatments for gynecologic malignancies resulted in the highest neuropathy scores; however, patients who had received previous treatment with taxane and platinum therapies had lower neuropathy scores than patients currently receiving taxanes and platinums, suggesting that neuropathy improved after completion of first-line therapy and that second-line therapies were not necessarily correlative with worsening scores. Nurses must educate patients about symptoms of neuropathy and the need to report symptoms. Nurses must recognize patients at highest risk for

  9. 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

  10. Decentralization of Care for Adults with Congenital Heart Disease in the United States: A Geographic Analysis of Outpatient Surgery

    PubMed Central

    Maxwell, Bryan G.; Maxwell, Thane G.; Wong, Jim K.

    2014-01-01

    Background Guidelines recommend that adults with congenital heart disease (CHD) undergo noncardiac surgery in regionalized centers of expertise, but no studies have assessed whether this occurs in the United States. We hypothesized that adults with CHD are less likely than children to receive care at specialized CHD centers. Methods Using a comprehensive state ambulatory surgical registry (California Ambulatory Surgery Database, 2005–2011), we calculated the proportion of adult and pediatric patients with CHD who had surgery at a CHD center, distance to the nearest CHD center, and distance to the facility where surgery was performed. Results Patients with CHD accounted for a larger proportion of the pediatric population (n = 11,254, 1.0%) than the adult population (n = 10,547, 0.07%). Only 2,741 (26.0%) adults with CHD had surgery in a CHD center compared to 6,403 (56.9%) children (p<0.0001). Adult CHD patients who had surgery at a non-specialty center (11.9±15.4 miles away) lived farther from the nearest CHD center (37.9±43.0 miles) than adult CHD patients who had surgery at a CHD center (23.2±28.4 miles; p<0.0001). Pediatric CHD patients who had surgery at a non-specialty center (18.0±20.7 miles away) lived farther from the nearest CHD center (35.7±45.2 miles) than pediatric CHD patients who had surgery at a CHD center (22.4±26.0 miles; p<0.0001). Conclusions Unlike children with CHD, most adults with CHD (74%) do not have outpatient surgery at a CHD center. For both adults and children with CHD, greater distance from a CHD center is associated with having surgery at a non-specialty center. These results have significant public health implications in that they suggest a failing to achieve adequate regional access to specialized ACHD care. Further studies will be required to evaluate potential strategies to more reliably direct this vulnerable population to centers of expertise. PMID:25247694

  11. Antiprogestins in gynecological diseases

    PubMed Central

    Goyeneche, Alicia A; Telleria, Carlos M

    2015-01-01

    Antiprogestins constitute a group of compounds, developed since the early 1980s, that bind progesterone receptors with different affinities. The first clinical uses for antiprogestins were in reproductive medicine, e.g., menstrual regulation, emergency contraception, and termination of early pregnancies. These initial applications, however, belied the capacity for these compounds to interfere with cell growth. Within the context of gynecological diseases, antiprogestins can block the growth of and kill gynecological-related cancer cells, such as those originating in the breast, ovary, endometrium, and cervix. They can also interrupt the excessive growth of cells giving rise to benign gynecological diseases such as endometriosis and leiomyomata (uterine fibroids). In this article, we present a review of the literature providing support for the antigrowth activity that antiprogestins impose on cells in various gynecological diseases. We also provide a summary of the cellular and molecular mechanisms reported for these compounds that lead to cell growth inhibition and death. The preclinical knowledge gained during the past few years provides robust evidence to encourage the use of antiprogestins in order to alleviate the burden of gynecological diseases, either as monotherapies or as adjuvants of other therapies with the perspective of allowing for long-term treatments with tolerable side effects. The key to the clinical success of antiprogestins in this field probably lies in selecting those patients who will benefit from this therapy. This can be achieved by defining the genetic makeup required – within each particular gynecological disease – for attaining an objective response to antiprogestin-driven growth inhibition therapy. Free Spanish abstract A Spanish translation of this abstract is freely available at http://www.reproduction-online.org/content/149/1/15/suppl/DC1. PMID:25252652

  12. Spirituality and religion in outpatients with schizophrenia: a multi-site comparative study of Switzerland, Canada, and the United States.

    PubMed

    Mohr, Sylvia; Borras, Laurence; Nolan, Jennifer; Gillieron, Christiane; Brandt, Pierre-Yves; Eytan, Ariel; Leclerc, Claude; Perroud, Nader; Whetten, Kathryn; Pieper, Carl; Koenig, Harold G; Huguelet, Philippe

    2012-01-01

    To assess the importance of spirituality and religious coping among outpatients with a DSM-IV diagnosis of schizophrenia or schizoaffective disorder living in three countries. A total of 276 outpatients (92 from Geneva, Switzerland, 121 from Trois-Rivières, Canada, and 63 from Durham, North Carolina), aged 18-65, were administered a semi-structured interview on the role of spirituality and religiousness in their lives and to cope with their illness. Religion is important for outpatients in each of the three country sites, and religious involvement is higher than in the general population. Religion was helpful (i.e., provided a positive sense of self and positive coping with the illness) among 87% of the participants and harmful (a source of despair and suffering) among 13%. Helpful religion was associated with better social, clinical and psychological status. The opposite was observed for the harmful aspects of religion. In addition, religion sometimes conflicted with psychiatric treatment. These results indicate that outpatients with schizophrenia or schizoaffective disorder often use spirituality and religion to cope with their illness, basically positively, yet sometimes negatively. These results underscore the importance of clinicians taking into account the spiritual and religious lives of patients with schizophrenia.

  13. Outpatient Antibiotic Prescribing Practices for Uncomplicated Urinary Tract Infection in Women in the United States, 2002–2011

    PubMed Central

    Kobayashi, Miwako; Shapiro, Daniel J.; Hersh, Adam L.; Sanchez, Guillermo V.; Hicks, Lauri A.

    2016-01-01

    Background. Urinary tract infection (UTI) is one of the most common diagnoses leading to an antibiotic prescription for women seeking ambulatory care. Understanding current national outpatient antibiotic prescribing practices will help ongoing stewardship efforts to optimize antibiotic use; however, information on recent national outpatient antibiotic prescribing trends for UTI is limited. Methods. We analyzed the National Ambulatory Medical Care and National Hospital Ambulatory Medical Care Survey datasets from 2002 to 2011. Outpatient visits of women aged ≥18 years with a diagnosis of uncomplicated UTI were included for analysis. We conducted weighted descriptive analyses, examined time trends in antibiotic prescribing, and used multivariable logistic regression to identify patient and provider factors associated with fluoroquinolone prescribing. Results. A total of 7111 visits were identified. Eighty percent of visits resulted in an antibiotic prescription; fluoroquinolones were the most frequently prescribed antibiotics throughout the study period (49% overall). Older patients (adjusted odds ratio [AOR] for adults aged ≥70 years = 2.5; 95% confidence interval [CI], 1.6–3.8) and patients treated by internists (AOR = 2.0; 95% CI, 1.1–3.3) were more likely than younger patients and those treated by family practitioners to receive fluoroquinolones. Outpatient visits in the West US Census region were less likely to be associated with fluoroquinolone prescribing (AOR = 0.6; 95% CI, .4–1.0) compared with visits in the Northeast. Conclusions. Fluoroquinolones were the most frequently selected antibiotic treatment for uncomplicated UTI in women during the study period. Outpatient antibiotic stewardship initiatives should include efforts to reduce overuse of fluoroquinolones for uncomplicated UTI. PMID:27704014

  14. Robotic surgery in gynecology

    PubMed Central

    Sinha, Rooma; Sanjay, Madhumati; Rupa, B.; Kumari, Samita

    2015-01-01

    FDA approved Da Vinci Surgical System in 2005 for gynecological surgery. It has been rapidly adopted and it has already assumed an important position at various centers where this is available. It comprises of three components: A surgeon's console, a patient-side cart with four robotic arms and a high-definition three-dimensional (3D) vision system. In this review we have discussed various robotic-assisted laparoscopic benign gynecological procedures like myomectomy, hysterectomy, endometriosis, tubal anastomosis and sacrocolpopexy. A PubMed search was done and relevant published studies were reviewed. Surgeries that can have future applications are also mentioned. At present most studies do not give significant advantage over conventional laparoscopic surgery in benign gynecological disease. However robotics do give an edge in more complex surgeries. The conversion rate to open surgery is lesser with robotic assistance when compared to laparoscopy. For myomectomy surgery, Endo wrist movement of robotic instrument allows better and precise suturing than conventional straight stick laparoscopy. The robotic platform is a logical step forward to laparoscopy and if cost considerations are addressed may become popular among gynecological surgeons world over. PMID:25598600

  15. Danish Gynecological Cancer Database

    PubMed Central

    Sørensen, Sarah Mejer; Bjørn, Signe Frahm; Jochumsen, Kirsten Marie; Jensen, Pernille Tine; Thranov, Ingrid Regitze; Hare-Bruun, Helle; Seibæk, Lene; Høgdall, Claus

    2016-01-01

    Aim of database The Danish Gynecological Cancer Database (DGCD) is a nationwide clinical cancer database and its aim is to monitor the treatment quality of Danish gynecological cancer patients, and to generate data for scientific purposes. DGCD also records detailed data on the diagnostic measures for gynecological cancer. Study population DGCD was initiated January 1, 2005, and includes all patients treated at Danish hospitals for cancer of the ovaries, peritoneum, fallopian tubes, cervix, vulva, vagina, and uterus, including rare histological types. Main variables DGCD data are organized within separate data forms as follows: clinical data, surgery, pathology, pre- and postoperative care, complications, follow-up visits, and final quality check. DGCD is linked with additional data from the Danish “Pathology Registry”, the “National Patient Registry”, and the “Cause of Death Registry” using the unique Danish personal identification number (CPR number). Descriptive data Data from DGCD and registers are available online in the Statistical Analysis Software portal. The DGCD forms cover almost all possible clinical variables used to describe gynecological cancer courses. The only limitation is the registration of oncological treatment data, which is incomplete for a large number of patients. Conclusion The very complete collection of available data from more registries form one of the unique strengths of DGCD compared to many other clinical databases, and provides unique possibilities for validation and completeness of data. The success of the DGCD is illustrated through annual reports, high coverage, and several peer-reviewed DGCD-based publications. PMID:27822089

  16. [Outpatient care for urological patients].

    PubMed

    Kul'chitskiĭ, V V

    1999-01-01

    The presence of adequately equipped surgical unit in outpatient clinics provides surgical aid to more patients with urological diseases. Preoperative preparation, aseptic and antiseptic measures, local anesthesia were routine. 64 operations for phimosis, condylomatous growth of the foreskin, hydrocele, cyst of the epididymis and spermatic cord, chronic epididymitis, short frenulum of the prepuce were performed in outpatient setting. Recovery lasted as usual.

  17. Gynecology in Pompeii.

    PubMed

    Bliquez, L J

    1995-01-01

    By tracing the proveniences of the Greco-Roman surgical instruments in the Naples Museum, it is possible to identify sites in Pompeii where surgeons were active. Some of these sites attract special attention owing to the intricacy and quantity of the tools in their instrumentaria. In a few cases a surgical specialty is apparent. Into this category fall three houses that can be associated with the practice of gynecology.

  18. Lymphoscintigraphy in gynecologic malignancies

    SciTech Connect

    Bloomer, W.D.

    1983-01-01

    Lymphoscintigraphy is an easily performed noninvasive procedure that offers the potential to detect small numbers of ascitic tumor cells and early diaphragmatic tumor involvement. Moreover, it can be used to delineate and define abnormalities in lymph nodes that are not routinely visualized by bipedal contrast lymphangiography, ultrasound or computed tomography. Lymphoscintigraphy is recommended as an important investigative and adjunctive procedure in diagnosing gynecologic malignancies; there does not appear to be sufficient sensitivity and specificity to justify its routine clinical use.

  19. 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

  20. [Outpatient emergencies].

    PubMed

    Rivallan, Armel; Le Nagard, Philippe

    2014-01-01

    The outpatient monitoring of patients sometimes involves emergency situations. In their practice, the nurses who visit the patient's home are confronted with the limits of their intervention. Faced with these delicate situations team coordination is a strength and the reactivity of the caregivers often contributes to a satisfactory outcome for the patient.

  1. Institute of Medicine 2009 Gestational Weight Gain Guideline Knowledge: Survey of Obstetrics/Gynecology and Family Medicine Residents of the United States

    PubMed Central

    Moore Simas, Tiffany A.; Waring, Molly E.; Sullivan, Gina M. T.; Liao, Xun; Rosal, Milagros C.; Hardy, Janet R.; Berry, Robert E.

    2014-01-01

    Background In 2009, the Institute of Medicine revised gestational weight gain recommendations; revisions included body mass index (BMI) category cut-point changes and provision of range of gain for obese women. Our objective was to examine resident prenatal care providers’ knowledge of revised guidelines. Methods Anonymous electronic survey of Obstetrics/Gynecology and Family Medicine residents across U.S. from January–April 2010. Results 660 completed the survey; 79% female and 69% aged 21–30 years. When permitted to select ≥1 response, 87.0% reported using BMI to assess weight status at initial visits, 44.4% reported using “clinical impression based on patient appearance”, and 1.4% reported not using any parameters. When asked the most important baseline parameter for providing recommendations, 35.8% correctly identified pre-pregnancy BMI, 2.1% reported “I don’t provide guidelines,” and 4.5% reported “I do not discuss gestational weight gain.” 57.6% reported not being aware of new guidelines. Only 7.6% selected correct BMI ranges for each category. Only 5.8% selected correct gestational weight gain ranges. Only 2.3% correctly identified both BMI cutoffs and recommended gestational weight gain ranges per 2009 guidelines. Conclusions Guideline knowledge is the foundation of accurate counseling, yet resident prenatal care providers were minimally aware of the 2009 Institute of Medicine gestational weight gain guidelines almost a year after their publication. PMID:24344704

  2. Predictive value of human biomonitoring in environmental medicine: experiences at the outpatient unit of environmental medicine (UEM) of the University Hospital Aachen, Germany.

    PubMed

    Straff, Wolfgang; Möller, Manfred; Jakobi, Nikolaus; Weishoff-Houben, Michaela; Dott, Wolfgang; Wiesmüller, Gerhard Andreas

    2002-07-01

    There is little data on the distribution of biomonitoring parameters in patients at outpatient Units of Environmental Medicine (UEM). We evaluated the biomonitoring parameters of 646 UEM outpatients from our University Hospital 1988-1998. Few patients were exposed to specific substances. Data of patients who were not obviously exposed was analysed statistically (geometric mean, standard deviation, median, 95th percentile). Results were compared with reference values in literature. Normal distribution of biomonitoring parameters was rare. 95th percentiles for arsenic, chromium, selenium, zinc, phenol and toluene were below standard, 95th percentiles for copper and mercury above, and 95th percentiles for lead, cadmium, pentachlorophenol, lindane, and beta-hexachlorocyclohexane were within the published range of reference values. Thallium as well as most volatile organic compounds analyzed were below detection levels. Aluminum and fluorine exposure was rarely analysed. In view of these results, it is concluded that the indication for biomonitoring needs to be stringent as levels of biomonitoring parameters are generally not risen in patients of the UEM.

  3. 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.

  4. 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.

  5. [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.

  6. 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.

  7. Too much, too late: Aggressive measures and the timing of end of life care discussions in women with gynecologic malignancies.

    PubMed

    Zakhour, Mae; LaBrant, Lia; Rimel, B J; Walsh, Christine S; Li, Andrew J; Karlan, Beth Y; Cass, Ilana

    2015-08-01

    This study describes the patterns of end of life (EOL) discussions and their impact on the use of aggressive measures in women with terminal gynecologic malignancies at a single institution. An IRB-approved retrospective chart review identified 136 patients who died of gynecologic cancer between 2010 and 2012 with at least one interaction with their oncologists in the last 6 months of life. Aggressive measures were defined as chemotherapy within the last 14 days of life, emergency department (ED) visits, hospital and intensive care unit (ICU) admissions within the last 30 days of life, and inpatient deaths. The frequency and timing of EOL conversations were recorded. Utilization of hospice care was also described. In the last 30 days of life, 54 (40%) patients were evaluated in the ED, 67 (49%) were admitted into hospital, and 16 (12%) were admitted to the ICU. Thirteen patients (10%) had chemotherapy in the last 14 days of life. Ninety-seven (71%) patients had a documented EOL conversation, eighteen (19%) as outpatients, and 79 (81%) as inpatients. Thirty (22%) patients died in the hospital. At the time of death, 55 (40%) patients were enrolled in outpatient hospice care. The mean amount of time in hospice was 28 days. End of life care discussions rarely occurred in the outpatient setting or >30 days before death. Inpatient encounters led to discussions about hospice and code status. Evaluation in the ED frequently resulted in escalation of care. Earlier EOL care discussions resulted in less aggressive measures. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. Gynecologic malignancy in pregnancy

    PubMed Central

    Ji, Yong Il

    2013-01-01

    Gynecologic malignancy during pregnancy is a stressful problem. For the diagnosis and treatment of malignancy during pregnancy, a multidisciplinary approach is needed. Patients should be advised about the benefits and risk of treatment. When selecting a treatment for malignancy during pregnancy, the physiologic changes that occur with the pregnancy should be considered. Various diagnostic procedures that do not harm the fetus can be used. Laparoscopic surgery or laparotomy may be safely performed. The staging approach and treatment should be standard. Systemic chemotherapy during the first trimester should be delayed if possible. Radiation therapy should preferably start postpartum. Although delivery should be delayed preferably until after 35 weeks of gestation, termination of pregnancy may be considered when immediate treatment is required. Subsequent pregnancies do not increase the risk of malignancy recurrence. PMID:24328018

  9. Contemporary pediatric gynecologic imaging.

    PubMed

    Servaes, Sabah; Victoria, Teresa; Lovrenski, Jovan; Epelman, Monica

    2010-04-01

    Ultrasound is the primary screening modality for the evaluation of pediatric gynecologic maladies. Magnetic resonance imaging (MRI) is used progressively more in this field, particularly for the evaluation of complex pelvic masses and congenital anomalies. However, ultrasound remains the preferred modality due to the excellent visualization, the dynamic nature of the examination modality, lack of ionizing radiation and sedation risks, and comparatively lower cost. MRI is generally a second-line examination and is preferred over computed tomography as it does not involve the use of ionizing radiation. Additionally, visualization of the female reproductive system anatomy with MRI is superior to computed tomography, the latter being reserved generally for tumor staging. Fluoroscopic examinations and abdominal radiographs can provide additional information that may support a diagnosis. Copyright (c) 2010 Elsevier Inc. All rights reserved.

  10. Awareness of Infectious Diseases in Obstetrics and Gynecology Among Residents and Residency Directors

    PubMed Central

    Beigi, Richard H.; Switzer, Galen E.; Presley, Larraine; Soper, David E.

    2006-01-01

    Awareness of the subspecialty of infectious diseases in obstetrics and gynecology is low among United States residents and residency directors. Objective. Given the burden of infectious diseases on women's health, we sought to assess current awareness, interest, and perceived value of the subspecialty of infectious diseases in obstetrics and gynecology among current United States obstetrics and gynecology residents and residency directors. Methods. Two separate surveys addressing awareness, perceived value and interest in the subspecialty were sent to (1) a random 20% sample of obstetrics and gynecology residents and (2) all obstetrics and gynecology residency directors. Results. Seventy percent of the residency directors were familiar with the subspecialty and 67.0% placed value on infectious disease specialists in an academic department. Thirty percent of the residents reported awareness of the subspecialty. Thirty-six percent of residency directors reported that medical infectious disease specialists deliver formal education to the obstetrics and gynecology residents. Conclusion. United States obstetrics and gynecology residents and residency directors have a low awareness of the subspecialty. An open niche exists for formal education of residents in infectious diseases in obstetrics and gynecology by department specialists. These findings can be incorporated into ongoing recruitment efforts for the subspecialty of infectious diseases in obstetrics and gynecology. PMID:17485801

  11. Incidence of outpatient physician claims for upper gastrointestinal symptoms among new users of celecoxib, ibuprofen, and naproxen in an insured population in the United States.

    PubMed

    Goldstein, Jay L; Zhao, Sean Z; Burke, Thomas A; Palmer, Ryan; von Allmen, Heather; Henderson, Scott C

    2003-12-01

    The aim of this study was to compare the risk of outpatient medical claims for UGI symptoms among new users of celecoxib versus ibuprofen, and naproxen. The study was conducted using LifeLink, an insurance claims database of approximately 1.8 million employees, dependents, and retirees in the United States. Patients newly treated with a prescription of celecoxib, ibuprofen, or naproxen between June 1, 1999, and June 30, 2001, were included. A patient with an upper GI (UGI) symptom was any individual with an outpatient physician claim for dyspepsia (ICD-9 = 536.8), abdominal pain (789.0), or nausea/vomiting (787.0). Incidence was determined using person-time analysis. Multivariate analyses were conducted using Poisson and Cox regression models. The cohort consisted of patients prescribed celecoxib (n = 68,939), ibuprofen (n = 71,456), or naproxen (n = 50,014). At baseline, celecoxib users were older and more likely to have a history of UGI or cardiovascular conditions. The incidence rate of any UGI symptom was 0.46 per 1,000 patient-days for celecoxib, 0.70 for ibuprofen, and 0.62 for naproxen. After adjusting for confounding factors using Poisson regression, the ibuprofen rate was 48% higher than the celecoxib rate (incidence rate ratio (IRR) = 1.48; 95% CI = 1.39-1.58; p < 0.001), whereas the naproxen rate was 40% higher (IRR = 1.40; 95% CI = 1.31-1.49; p < 0.001). The association between drug use and UGI symptoms was confirmed by Cox regression analysis; the hazard ratios were 1.21 (95% CI = 1.13-1.29; p < 0.001) for ibuprofen and 1.15 (95% CI = 1.07-1.23; p < 0.001) for naproxen relative to celecoxib. Younger age, female sex, medical history of UGI, cardiovascular and renal conditions, and higher baseline average healthcare expenditures for the 12-month period preceding the index prescription were also significantly associated with an increased incidence of UGI symptoms. Celecoxib use is associated with a significantly decreased risk of outpatient physician

  12. 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…

  13. 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…

  14. 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.

  15. [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.

  16. Robotic Surgery in Gynecologic Oncology

    PubMed Central

    DeBernardo, Robert; Starks, David; Barker, Nichole; Armstrong, Amy; Kunos, Charles A.

    2011-01-01

    Robotic surgery for the management of gynecologic cancers allows for minimally invasive surgical removal of cancer-bearing organs and tissues using sophisticated surgeon-manipulated, robotic surgical instrumentation. Early on, gynecologic oncologists recognized that minimally invasive surgery was associated with less surgical morbidity and that it shortened postoperative recovery. Now, robotic surgery represents an effective alternative to conventional laparotomy. Since its widespread adoption, minimally invasive surgery has become an option not only for the morbidly obese but for women with gynecologic malignancy where conventional laparotomy has been associated with significant morbidity. As such, this paper considers indications for robotic surgery, reflects on outcomes from initial robotic surgical outcomes data, reviews cost efficacy and implications in surgical training, and discusses new roles for robotic surgery in gynecologic cancer management. PMID:22190946

  17. 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.

  18. Robotic surgery in gynecology

    PubMed Central

    Alkatout, Ibrahim; Mettler, Liselotte; Maass, Nicolai; Ackermann, Johannes

    2016-01-01

    Robotic surgery is the most dynamic development in the sector of minimally invasive operations currently. It should not be viewed as an alternative to laparoscopy, but as the next step in a process of technological evolution. The advancement of robotic surgery, in terms of the introduction of the Da Vinci Xi, permits the variable use of optical devices in all four trocars. Due to the new geometry of the “patient cart,” an operation can be performed in all spatial directions without re-docking. Longer instruments and the markedly narrower mechanical elements of the “patient cart” provide greater flexibility as well as access similar to those of traditional laparoscopy. Currently, robotic surgery is used for a variety of indications in the treatment of benign gynecological diseases as well as malignant ones. Interdisciplinary cooperation and cooperation over large geographical distances have been rendered possible by telemedicine, and will ensure comprehensive patient care in the future by highly specialized surgery teams. In addition, the second operation console and the operation simulator constitute a new dimension in advanced surgical training. The disadvantages of robotic surgery remain the high costs of acquisition and maintenance as well as the laborious training of medical personnel before they are confident with using the technology. PMID:27990092

  19. Laser treatment in gynecology

    NASA Astrophysics Data System (ADS)

    de Riese, Cornelia

    2004-07-01

    This presentation is designed as a brief overview of laser use in gynecology, for non-medical researchers involved in development of new laser techniques. The literature of the past decade is reviewed. Differences in penetration, absorption, and suitable delivery media for the beams dictate clinical application. The use of CO2 laser in the treatment of uterine cervical intraepithelial lesions is well established and indications as well as techniques have not changed over 30 years. The Cochrane Systematic Review from 2000 suggests no obviously superior technique. CO2 laser ablation of the vagina is also established as a safe treatment modality for VAIN. CO2 laser permits treatment of lesions with excellent cosmetic and functional results. The treatment of heavy menstrual bleeding by destruction of the endometrial lining using various techniques has been the subject of a 2002 Cochran Database Review. Among the compared treatment modalities are newer and modified laser techniques. Conclusion by reviewers is that outcomes and complication profiles of newer techniques compare favorably with the gold standard of endometrial resection. The ELITT diode laser system is one of the new successful additions. CO2 laser is also the dominant laser type used with laparoscopy for ablation of endometriotic implants. Myoma coagulation or myolysis with Nd:Yag laser through the laparoscope or hysteroscope is a conservative treatment option. Even MRI guided percutaneous approaches have been described. No long-term data are available.

  20. Robotic surgery in gynecology.

    PubMed

    Alkatout, Ibrahim; Mettler, Liselotte; Maass, Nicolai; Ackermann, Johannes

    2016-01-01

    Robotic surgery is the most dynamic development in the sector of minimally invasive operations currently. It should not be viewed as an alternative to laparoscopy, but as the next step in a process of technological evolution. The advancement of robotic surgery, in terms of the introduction of the Da Vinci Xi, permits the variable use of optical devices in all four trocars. Due to the new geometry of the "patient cart," an operation can be performed in all spatial directions without re-docking. Longer instruments and the markedly narrower mechanical elements of the "patient cart" provide greater flexibility as well as access similar to those of traditional laparoscopy. Currently, robotic surgery is used for a variety of indications in the treatment of benign gynecological diseases as well as malignant ones. Interdisciplinary cooperation and cooperation over large geographical distances have been rendered possible by telemedicine, and will ensure comprehensive patient care in the future by highly specialized surgery teams. In addition, the second operation console and the operation simulator constitute a new dimension in advanced surgical training. The disadvantages of robotic surgery remain the high costs of acquisition and maintenance as well as the laborious training of medical personnel before they are confident with using the technology.

  1. Gynecologic electrical impedance tomograph

    NASA Astrophysics Data System (ADS)

    Korjenevsky, A.; Cherepenin, V.; Trokhanova, O.; Tuykin, T.

    2010-04-01

    Electrical impedance tomography extends to the new and new areas of the medical diagnostics: lungs, breast, prostate, etc. The feedback from the doctors who use our breast EIT diagnostic system has induced us to develop the 3D electrical impedance imaging device for diagnostics of the cervix of the uterus - gynecologic impedance tomograph (GIT). The device uses the same measuring approach as the breast imaging system: 2D flat array of the electrodes arranged on the probe with handle is placed against the body. Each of the 32 electrodes of the array is connected in turn to the current source while the rest electrodes acquire the potentials on the surface. The current flows through the electrode of the array and returns through the remote electrode placed on the patient's limb. The voltages are measured relative to another remote electrode. The 3D backprojection along equipotential surfaces is used to reconstruct conductivity distribution up to approximately 1 cm in depth. Small number of electrodes enables us to implement real time imaging with a few frames per sec. rate. The device is under initial testing and evaluation of the imaging capabilities and suitability of usage.

  2. Is treatment in groups a useful alternative for psychiatry in low-income countries? An evaluation of a psychiatric outpatient unit in Nicaragua.

    PubMed

    Caldera, T; Kullgren, G; Penayo, U; Jacobsson, L

    1995-11-01

    Centro de Atención Psicosocial in León, Nicaragua is a psychiatric outpatient unit that has developed a group-oriented model of working, in which 80% of all visits are in groups: first-admission groups, insight-oriented group psychotherapy, psycho-educative, family groups and relatives groups. The aim of the present study was to analyze patient characteristics and make a preliminary study of improvement, compliance and patient satisfaction in a 1-year perspective. One hundred consecutive visits were assessed, 44 of them first admissions. They were assessed according to all axes of DSM-III-R plus the Structural Clinical Interview for DSM-III Disorders. A 1-year follow up was conducted on 39 of 41 selected patients within the major diagnostic groups. One of 4 patients had a psychotic disorder where schizophrenia dominated. Among nonpsychotics major depression, anxiety and adjustment disorders were most frequent. Personality disorders were common (80%) among nonpsychotic patients, paranoid, obsessive-compulsive, passive-aggressive and masochistic personality disorders dominating. The illiteracy rate was 10%, but 50% had high school or university background. Severity of mental disorders and functional level did not differ between educational levels. There was a strong male dominance in all diagnostic, socioeconomic and educational level strata and few old patients. Improvement in functional level was clinically and statistically significant in all groups, and more than two thirds were very satisfied with the group treatment offered.

  3. [Voice disorder clinic in the speech therapy outpatient unit at "Hospital das Clínicas da Universidade Federal de Minas Gerais"].

    PubMed

    Menezes, Letícia Neiva de; Behlau, Mara; Gama, Ana Cristina Côrtes; Teixeira, Letícia Caldas

    2011-07-01

    This study set out to describe the profile of the patients with voice complaints and/or alterations who were attended between July 2003 and December 2006 at the speech therapy outpatient unit of "Hospital das Clínicas da Universidade Federal de Minas Gerais." This was analyzed according to age, sex, profession, schooling, origin, treatment performed and factors that interfere in medical care evolution. This was a retrospective study based on the analysis of the recorded data of the individuals according to a specifically prepared Protocol. The results showed that the individuals included in this study were predominantly young women, referred by a specialist from Belo Horizonte, who do not work and also have incomplete elementary school education. Attendance of those patients was on an individual basis, and almost half of them were discharged by the speech therapist. The elderly patients, who have functional or psychogenic dysphonia and a neutral or wheezy type of voice, showed a close correlation with the discharge rate by speech therapist. The younger individuals with organo-functional dysphonia bore a statistical correlation with abandoning treatment. The individuals who eventually abandoned treatment did not bear any correlation with the crossed variables.

  4. Cost-minimization analysis favors outpatient quick diagnosis unit over hospitalization for the diagnosis of potentially serious diseases.

    PubMed

    Sanclemente-Ansó, Carmen; Bosch, Xavier; Salazar, Albert; Moreno, Ramón; Capdevila, Cristina; Rosón, Beatriz; Corbella, Xavier

    2016-05-01

    Quick diagnosis units (QDUs) are a promising alternative to conventional hospitalization for the diagnosis of suspected serious diseases, most commonly cancer and severe anemia. Although QDUs are as effective as hospitalization in reaching a timely diagnosis, a full economic evaluation comparing both approaches has not been reported. To evaluate the costs of QDU vs. conventional hospitalization for the diagnosis of cancer and anemia using a cost-minimization analysis on the proven assumption that health outcomes of both approaches were equivalent. Patients referred to the QDU of Bellvitge University Hospital of Barcelona over 51 months with a final diagnosis of severe anemia (unrelated to malignancy), lymphoma, and lung cancer were compared with patients hospitalized for workup with the same diagnoses. The total cost per patient until diagnosis was analyzed. Direct and non-direct costs of QDU and hospitalization were compared. Time to diagnosis in QDU patients (n=195) and length-of-stay in hospitalized patients (n=237) were equivalent. There were considerable costs savings from hospitalization. Highest savings for the three groups were related to fixed direct costs of hospital stays (66% of total savings). Savings related to fixed non-direct costs of structural and general functioning were 33% of total savings. Savings related to variable direct costs of investigations were 1% of total savings. Overall savings from hospitalization of all patients were €867,719.31. QDUs appear to be a cost-effective resource for avoiding unnecessary hospitalization in patients with anemia and cancer. Internists, hospital executives, and healthcare authorities should consider establishing this model elsewhere. Copyright © 2015. Published by Elsevier B.V.

  5. Reflecting on the methodological challenges of recruiting to a United Kingdom-wide, multi-centre, randomised controlled trial in gynaecology outpatient settings.

    PubMed

    Dickson, Sylvia; Logan, Janet; Hagen, Suzanne; Stark, Diane; Glazener, Cathryn; McDonald, Alison M; McPherson, Gladys

    2013-11-15

    Successful recruitment of participants to any trial is central to its success. Trial results are routinely published, and recruitment is often cited to be slower and more difficult than anticipated. This article reflects on the methodological challenges of recruiting women with prolapse attending United Kingdom (UK) gynaecology outpatient clinics to a multi-centre randomised controlled trial (RCT) of physiotherapy, and the systems put in place in an attempt to address them. Gynaecology outpatients with symptomatic prolapse were to be recruited over a 16-month period from 14 UK hospitals and one New Zealand hospital. Eligible women were informed about the trial by their gynaecologist and informed consent was obtained by the central trial office. Recruitment difficulties were encountered early on, and a number of strategies were employed to try to improve recruitment. Some strategies were more successful than others and they differed in the resources required. Actions that facilitated recruitment included increasing recruiting centres to 23 UK and two international hospitals, good centre support, using processes embedded in clinical practice, and good communication between the trial office, collaborators and participants. Collaborator incentives, whereby staff involved received the benefit immediately, were more successful than a nominal monetary payment per woman randomised. Barriers to recruitment included fewer eligible women than anticipated, patient's preference to receive active treatment rather than allocation to the control group, lack of support staff and high staff turnover. Geographical variations in Primary Care Trust Research Management and Governance approval systems and general practitioner (GP) referral procedures also impacted negatively on recruitment. Our article reflects on the methodological challenges of recruiting to a multi-centre RCT in a UK gynaecology setting. Effective interventions included increasing the number of recruiting centres and

  6. Reflecting on the methodological challenges of recruiting to a United Kingdom-wide, multi-centre, randomised controlled trial in gynaecology outpatient settings

    PubMed Central

    2013-01-01

    Background Successful recruitment of participants to any trial is central to its success. Trial results are routinely published, and recruitment is often cited to be slower and more difficult than anticipated. This article reflects on the methodological challenges of recruiting women with prolapse attending United Kingdom (UK) gynaecology outpatient clinics to a multi-centre randomised controlled trial (RCT) of physiotherapy, and the systems put in place in an attempt to address them. Methods Gynaecology outpatients with symptomatic prolapse were to be recruited over a 16-month period from 14 UK hospitals and one New Zealand hospital. Eligible women were informed about the trial by their gynaecologist and informed consent was obtained by the central trial office. Recruitment difficulties were encountered early on, and a number of strategies were employed to try to improve recruitment. Results Some strategies were more successful than others and they differed in the resources required. Actions that facilitated recruitment included increasing recruiting centres to 23 UK and two international hospitals, good centre support, using processes embedded in clinical practice, and good communication between the trial office, collaborators and participants. Collaborator incentives, whereby staff involved received the benefit immediately, were more successful than a nominal monetary payment per woman randomised. Barriers to recruitment included fewer eligible women than anticipated, patient’s preference to receive active treatment rather than allocation to the control group, lack of support staff and high staff turnover. Geographical variations in Primary Care Trust Research Management and Governance approval systems and general practitioner (GP) referral procedures also impacted negatively on recruitment. Conclusions Our article reflects on the methodological challenges of recruiting to a multi-centre RCT in a UK gynaecology setting. Effective interventions included

  7. Illness Progression as a Function of Independent and Accumulating Poor Prognosis Factors in Outpatients With Bipolar Disorder in the United States

    PubMed Central

    Altshuler, Lori L.; Leverich, Gabriele S.; Nolen, Willem A.; Kupka, Ralph; Grunze, Heinz; Frye, Mark A.; Suppes, Trisha; McElroy, Susan L.; Keck, Paul E.; Rowe, Mike

    2014-01-01

    Objective: Many patients with bipolar disorder in the United States experience a deteriorating course of illness despite naturalistic treatment in the community. We examined a variety of factors associated with this pattern of illness progression. Method: From 1995 to 2002, we studied 634 adult outpatients with bipolar disorder (mean age of 40 years) emanating from 4 sites in the United States. Patients gave informed consent and completed a detailed questionnaire about demographic, vulnerability, and course-of-illness factors and indicated whether their illness had shown a pattern of increasing frequency or severity of manic or depressive episodes. Fifteen factors previously linked in the literature to a poor outcome were examined for their relationship to illness progression using Kruskal-Wallis test, followed by a 2-sample Wilcoxon rank sum (Mann-Whitney) test, χ2, and logistical regression. Results: All of the putative poor prognosis factors occurred with a high incidence, and, with the exception of obesity, were significantly (P < .05) associated with illness progression. These factors included indicators of genetic and psychosocial risk and loss of social support, early onset, long delay to first treatment, anxiety and substance abuse comorbidity, rapid cycling in any year, and the occurrence of more than 20 prior episodes prior to entering the network. A greater number of factors were linearly associated with the likelihood of a progressively worsening course. Conclusions: Multiple genetic, psychosocial, and illness factors were associated with a deteriorating course of bipolar disorder from onset to study entry in adulthood. The identification of these factors provides important targets for earlier and more effective therapeutic intervention in the hope of achieving a more benign course of bipolar disorder. PMID:25834764

  8. Feasibility of the EORTC/NCIC Trial Protocol in a Neurosurgical Outpatient Unit: The Case for Neurosurgical Neuro-Oncology.

    PubMed

    Rapp, Marion; Sadat, Hosai; Slotty, Philipp Joerg; Steiger, Hans Jakob; Budach, Wilfried; Sabel, Michael

    2015-07-01

    patients [53%]). Median overall survival in our patient cohort was 19 months (versus 14.6 months); median time to progression was 9 months (versus 6.9 months). Comparison between the feasibility of the treatment protocol established by the EORTC/NCIC trial (performed within the setting of a prospective randomized trial) and the daily routine in a dedicated neurosurgical neuro-oncologic department demonstrates that the protocol is suitable for daily practice within a neurosurgical unit. Georg Thieme Verlag KG Stuttgart · New York.

  9. Gynecologic tumors: how to communicate imaging results to the surgeon

    PubMed Central

    Calareso, Giuseppina; De Maria, Federica; Zanagnolo, Vanna; Lazzari, Roberta; Cecconi, Agnese; Bellomi, Massimo

    2013-01-01

    Abstract Gynecologic cancers are a leading cause of morbidity and mortality for female patients, with an estimated 88,750 new cancer cases and 29,520 deaths in the United States in 2012. To offer the best treatment options to patients it is important that the radiologist, surgeon, radiation oncologist, and gynecologic oncologist work together with a multidisciplinary approach. Using the available diagnostic imaging modalities, the radiologist must give appropriate information to the surgeon in order to plan the best surgical approach and its timing. PMID:24434038

  10. 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.

  11. 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.

  12. Gynecologic Cancer Center for Racial Disparities

    DTIC Science & Technology

    2008-08-01

    Psychological Outcomes for Gynecologic Cancer Survivors. Arch Sex Behav. 2008 Apr 17. [Epub ahead of print]. 3. Simonelli LE, Fowler J, Maxwell GL, Andersen...Maxwell GL, Andersen BL: Does sexual morbidity predict psychological outcomes in gynecologic cancer survivors? Poster presented at Society of Behavioral...AD_________________ Award Number: W81XWH-05-2-0065 TITLE: Gynecologic Cancer Center for Racial

  13. [Gynecological theories and prescriptions for andriatric diseases].

    PubMed

    Sun, Yi-ming; Yu, Chang-fei

    2015-04-01

    Andrology and gynecology have a similar or the same theoretical basis in Traditional Chinese Medicine (TCM). Andrology has a history of less than 3 decades in China, while TCM gynecology has developed for over a thousand years. The development of andrology could be greatly promoted with the guidance of the theories and prescriptions of gynecology.

  14. Bariatric surgery and adolescent gynecology.

    PubMed

    Miller, Rachel J; Xanthakos, Stavra A; Hillard, Paula J Adams; Inge, Thomas H

    2007-10-01

    This review summarizes the impact of bariatric surgery on gynecologic complications in the context of the extremely obese adolescent and reviews contraceptive considerations before and after adolescent bariatric surgery. Eighteen percent of children and adolescents have a body mass index greater than the 95th percentile, with 4% of adolescents being greater than the 99th percentile. Gynecologic morbidities identified in obese adolescents include anovulatory complications such as acute menorrhagia, polycystic ovary syndrome and endometrial hyperplasia, and cancer. When conventional dietary and behavioral therapy fail to result in weight loss, specific criteria have been identified to justify bariatric surgery in extremely obese adolescents. Bariatric surgery in adult women often results in resumption of ovulatory menses, resolution of clinical and laboratory evidence of hyperandrogenism, and return of fertility. Adolescents are at risk for unintended pregnancies, and there are special concerns regarding pregnancy in bariatric patients. Specific contraceptive methods have particular potential risks, benefits, and drawbacks for use in obese adolescents. Clinicians who provide care for extremely obese adolescents must be aware of the potential for gynecologic morbidities including polycystic ovary syndrome, dysfunctional bleeding and endometrial hyperplasia, expected gynecologic and fertility outcomes of weight loss surgery for teens, as well as the implications on contraceptive options.

  15. 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

  16. Obesity and gynecologic cancer etiology and survival.

    PubMed

    Webb, Penelope M

    2013-01-01

    The prevalence of overweight and obesity in the United States and elsewhere has increased dramatically in recent decades. It has long been known that obese women have an increased risk of developing endometrial cancer, but recent studies suggest this association is strongest for the most common low-grade endometrioid endometrial cancers and weaker for the other histologic subtypes. There are insufficient data to assess whether obesity affects endometrial cancer-specific survival or whether the relation with all-cause mortality is similar to that seen in the general population. Recent data suggest obesity also increases risk of ovarian cancer, although it may not influence risk of the high-grade serous cancers that account for the majority of ovarian cancer deaths, and that it is also associated with poorer outcomes. There is currently insufficient evidence to draw any clear conclusions regarding the relation between obesity and risk of/survival from other gynecologic cancers although there are suggestions that obesity may increase risk of cervical cancer, particularly adenocarcinoma, and perhaps vulvar cancer. Possible mechanisms whereby obesity might influence gynecologic cancer risk and survival include: its strong association with endogenous estrogen levels among postmenopausal women, its effects on glucose metabolism, its effects on the wide range of adipocytokines and inflammatory mediators that are produced by adipose tissue and altered in concentration among obese individuals, and its potential effects on patient management, particularly with regard to chemotherapy dosing.

  17. Electrocardiograms of Adult Outpatients Followed-Up in Basic Health Care Units in the Community of the South Region of São Paulo City

    PubMed Central

    Yamada, Alice T; Baldow, Renata X; Ribeiro, Carla; Ribeiro, Wilma N; Peruzzi, Carolina; Matsuda, Nilce M; Mansur, Alfredo J

    2014-01-01

    Objective: The electrocardiogram (ECG) is an important, available, and inexpensive diagnostic tool to assess cardiac symptoms. Few studies address the prevalence of ECG abnormalities or changes of a normal tracing in ECG in outpatients. Our objective was to evaluate ECGs of adult outpatients to determine whether changes from a normal tracing could disclose the patients’ cardiovascular health status. Methods: We evaluated all elective ECGs obtained in adult outpatients, from January 2009 to January 2010, at a municipal hospital in the city of São Paulo, Brazil. Electrocardiography was performed with a 3-channel, 12-lead machine (Dixtal Cardio-page EP-3, Dixtal Biomedica, São Paulo, Brazil), and results were interpreted by a cardiologist. Results: Electrocardiography was performed in 3567 adult outpatients, 62.5% of whom were women, with a mean age of 51 years (standard deviation [SD] = 16 years). Of the 1918 patients whose ECGs showed abnormalities (mean age = 56 years, SD = 15 years), 1137 were women. Electrocardiographic changes were found in 1184 of the patients. Minor changes were found in 38.3% of patients. A total of 3133 changes were found in 1918 abnormal ECG results. There was a statistical difference related to sex and age, and abnormal ECG results were more frequent in men. There was a high prevalence of abnormal ECG results in the population studied. Conclusions: There were more ECGs obtained from women; however, men and elderly patients more frequently had abnormal ECG results. PMID:24694315

  18. 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.

  19. Complications of Laparoscopic Gynecologic Surgery

    PubMed Central

    Fuentes, Mariña Naveiro; Naveiro Rilo, José Cesáreo; Paredes, Aida González; Aguilar Romero, María Teresa; Parra, Jorge Fernández

    2014-01-01

    Background and Objectives: To analyze the frequency of complications during laparoscopic gynecologic surgery and identify associated risk factors. Methods: A descriptive observational study was performed between January 2000 and December 2012 and included all gynecologic laparoscopies performed at our center. Variables were recorded for patient characteristics, indication for surgery, length of hospital stay (in days), major and minor complications, and conversions to laparotomy. To identify risk factors and variables associated with complications, crude and adjusted odds ratios were calculated with unconditional logistic regression. Results: Of all 2888 laparoscopies included, most were procedures of moderate difficulty (adnexal surgery) (54.2%). The overall frequency of major complications was 1.93%, and that of minor complications was 4.29%. The level of technical difficulty and existence of prior abdominal surgery were associated with a higher risk of major complications and conversions to laparotomy. Conclusion: Laparoscopic gynecologic surgery is associated with a low frequency of complications but is a procedure that is not without risk. Greater technical difficulty and prior surgery were factors associated with a higher frequency of complications. PMID:25392659

  20. Prevention of Diseases in Gynecology

    PubMed Central

    Izetbegovic, Sebija; Alajbegovic, Jasmin; Mutevelic, Alma; Pasagic, Almir; Masic, Izet

    2013-01-01

    Background: Prevention of diseases in gynecology can be improved by better understanding of health promotion and management of diseases. Management is “the art of performing jobs by or with other people” Mary Parker Follet. Methods: A descriptive analysis was performed on scientific studies in several published articles in medical journals and books. Results: There are five primary functions of management as: Anticipate and plan, organize, command, coordinate and control. If we introduce the following definition in the sense of medical science and apply it to the medical practice that would mean way of recognizing, managing and resolving issues of diagnosis and therapy of diseases (in this case gynecology diseases) according to certain guidelines and treatment algorithms. Treatment of family doctors is an important aspect in the quality-of-life of women and their reproductive health as well as a significant issue in public, environmental and social problems. Conclusions: It is very important to deal with it on the primary care level and in addition to promote the primary and secondary prevention of diseases, which is sometimes more important than the curative procedures. The primary prevention involves regular gynecological examinations and screening. The doctors have also a duty to educate women about the risk factors for malignant diseases, as well as proposing some of the qualitative preventive measures. PMID:24498489

  1. Knowledge and Comfort With Pessary Use: A Survey of US Obstetrics and Gynecology Residents.

    PubMed

    Kandadai, Padma; Mcvay, Samantha; Larrieux, Jean-Robert; OʼDell, Katharine

    This study aimed to determine factors associated with perceived comfort with pessary management among obstetrics and gynecology (OB/GYN) residents in the United States. A 31-item anonymous electronic survey regarding experience with, attitudes toward, and comfort with pessary management was distributed to US OB/GYN residents in all postgraduate years (PGYs). Demographic and program-specific data on pessary education were collected. Descriptive statistical analyses were performed. Single-predictor logistic regression analysis, followed by analysis of a multivariable model that included significant single predictors, was performed to determine factors associated with residents' perception of comfort. Results were stratified for junior (PGYs 1, 2), senior (PGYs 3, 4), and chief (PGY4) residents. Four hundred seventy-eight completed surveys were returned and analyzed. Mean age of respondents was 29.5 (±2.56) years. Training levels were distributed evenly (PGY1, 25%; PGY2, 28%; PGY3, 25%; PGY4, 22%). Twenty-eight percent had a urogynecology fellowship in the department. Factors associated with comfort were similar for all training levels and included working with advanced practitioners, a formal urogynecology rotation, experience with pessary fitting, and receiving formal pessary-specific didactics (P < 0.001). PGY4s also benefitted from a formal urogynecology rotation. Factors that did not improve comfort were having a urogynecology fellowship and receiving general didactics on prolapse and incontinence. Gaining outpatient experience, especially with pessary fitting, along with formal didactics specific to pessary fitting and management may improve resident' confidence with pessary use.

  2. Palliative Care Education in Gynecologic Oncology: a Survey of Gynecologic Oncologists and Gynecologic Oncology Fellows in Thailand.

    PubMed

    Ratanakaaew, A; Khemapech, N; Laurujisawat, P

    2015-01-01

    The main purpose of this study was to survey the education and training of certified gynecologic oncologists and fellows in Thailand. A secondary objective was to study the problems in fellowship training regarding palliative care for gynecologic cancer patients. A descriptive study was conducted by sending a questionnaire regarding palliative care education to all certified gynecologic oncologists and gynecologic oncology fellows in Thailand. The contents of the survey included fellowship training experience, caring for the dying, patient preparation, attitudes and respondent characteristics. Statistics were analyzed by percentage, mean and standard deviation and chi-square. One hundred seventy completed questionnaires were returned; the response rate was 66%. Most certified gynecologic oncologists and fellows in gynecologic oncology have a positive attitude towards palliative care education, and agree that "psychological distress can result in severe physical suffering". It was found that the curriculum of gynecologic oncology fellowship training equally emphasizes three aspects, namely managing post-operative complications, managing a patient at the end of life and managing a patient with gynecologic oncology. As for experiential training during the fellowship of gynecologic oncology, education regarding breaking bad news, discussion about goals of care and procedures for symptoms control were mostly on-the-job training without explicit teaching. In addition, only 42.9% of respondents were explicitly taught the coping skill for managing their own stress when caring for palliative patients during fellowship training. Most of respondents rated their clinical competency for palliative care in the "moderately well prepared" level, and the lowest score of the competency was the issue of spiritual care. Almost all certified gynecologic oncologists and fellows in gynecologic oncology have a positive attitude towards learning and teaching in palliative care. In this

  3. Reactionary Hemorrhage in Gynecological Surgery

    PubMed Central

    Mc Laren, Glenda; Khalil, Akram

    2008-01-01

    Background: Bleeding is a major complication in contemporary gynecological surgery. We discusses this rare, albeit potentially serious, unexpected complication. The authors mean by “reactionary,” hemorrhage that occurs within the first 24 hours after surgery. More or less, all gynecological surgeons have had to deal with this situation at some stage of their career. The seriousness of this complication stems from the fact that often the surgeon is not in the immediate vicinity to promptly step in and treat the patient. Nevertheless, the key to successful management is prompt diagnosis, immediate resuscitation, and operative intervention. Methods: By using the collective hospital database, we reviewed 719 patient records. The authors operated on these patients between November 1990 and March 2007 (inclusive) in one hospital, Royal Brisbane and Women's Hospital, the main teaching hospital in Brisbane, Queensland, Australia. The procedures performed in the 719 patients comprised 476 vaginal hysterectomies and 243 laparoscopic hysterectomies. Both public and private patients were included. The objective of the review was to establish the incidence of postoperative reactionary hemorrhage following the initial operation, as defined by the number of patients returning to the operating theatre (OT) because of postoperative hemorrhage within 24 hours of the initial hysterectomy. Results: Of the 719 patients, 6 experienced reactionary postoperative hemorrhage, 3 each in the vaginal hysterectomy and laparoscopic hysterectomy groups. That would make the incidence of postoperative reactionary hemorrhage 0.6% in the vaginal hysterectomy and 1.2% in the laparoscopic hysterectomy group. None of these 6 patients had any preoperative hemorrhagica diatheses. There was neither ureteric, bladder, intestinal, nor any other injuries in the whole series. No long-term complications or mortalities occurred. Conclusion: Reactionary postoperative hemorrhage is a rare, albeit serious

  4. 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.

  5. Surgical Complications of Gynecologic Surgery

    PubMed Central

    Weekes, Leroy R.; Gandhi, Shobhana Anil; Gandhi, Anil Krishnakumar

    1977-01-01

    Complications of gynecological surgery are considerable and when reviewed in detail are almost frightening. There is no substitute for experience and intimate knowledge of the intricate pelvic structures in health and disease. Anyone who is active in the field is sooner or later going to experience some difficulty whether it be due to his miscalculation or to innate conditions in the patient which are beyond his/her control. It is the responsibility of the pelvic surgeon to recognize the complication and apply proper corrective measures. The patient should not be given false hopes of sure success nor should she be deprived of whatever hope for success does exist. PMID:572875

  6. Robotic Surgery in Gynecologic Field

    PubMed Central

    Kim, Sang Wun; Jung, Yong Wook

    2008-01-01

    Operative laparoscopy was initially developed in the field of gynecology earlier on and the advent of laparoscopic surgery led to advances in general surgery as well. In the last few years, a number of articles have been published on the performance of surgical procedures using the robot-assisted laparoscopy. The shortcomings of conventional laparoscopy have led to the development of robotic surgical system and future of telerobotic surgery is not far away, enabling a surgeon to operate at a distance from the operating table. The complete loss of tactile sensation is often quoted as a big disadvantage of working with robotic systems. Although the first generation da Vinci robotic surgical system provides improved imaging and instrumentation, the absence of tactile feedback and the high cost of the technology remain as limitations. New generations of the robotic surgical systems have been developed, allowing visualization of preoperative imaging during the operation. Though the introduction of robotics is very recent, the potential for robotics in several specialties is significant. However, the benefit to patients must be carefully evaluated and proven before this technology can become widely accepted in the gynecologic surgery. PMID:19108009

  7. The Effect of Information About Gynecological Examination on the Anxiety Level of Women Applying to Gynecology Clinics: A Prospective, Randomized, Controlled Study

    PubMed Central

    Ulker, Kahraman; Kivrak, Yuksel

    2016-01-01

    Background: Crowded hospital outpatient clinics and endless waiting lines that make patients feel overlooked tend to exaggerate patients’ anxiety levels. In addition, fear of pain, shyness, religious and traditional thoughts, women’s sexual role in society, and previous information and experience also contribute to people’s anxiety levels with regard to gynecologic examination. Objectives: We aimed to analyze the effect of specific information about gynecologic examination on anxiety levels of women applying to gynecology clinics. Materials and Methods: In this randomized prospective study, the women applying for a gynecological examination were randomly allocated into control, intervention 1, and intervention 2 groups. Power analysis indicated that in order to achieve a one-point decrease from the previous anxiety score of 43.85 ± 5.41 at one side alpha 0.05 with a power of 80%, at least 79 women were needed in each group. Four medical school students interviewed 75 women (25 in control, 25 in intervention 1, and 25 in intervention 2). The data were collected using the demographic, social, and economic data form, and the Turkish version of the state-trait anxiety inventory (STAI). The women in the intervention 1 and 2 groups were instructed to read a paper that contained brief information about the gynecological examination procedure and the profits obtained from forests, respectively. All participants, including the women in the control group, filled the STAI by themselves. The three groups were compared appropriately. Results: The demographics pertaining to age, gravidity and parity, miscarriage, induced abortion, ectopic pregnancy, offspring number, place of residence, working status, education level and previous experience of gynecological examination did not differ among the groups (P > 0.05). According to the STAI scores, all groups had mild state (control: 40.20 ± 10.53, intervention 1: 42.00 ± 11.98, and intervention 2: 39.53 ± 10.32) and severe

  8. Crohn disease and the gynecologic patient.

    PubMed

    Sides, Cleve; Trinidad, Mari Charisse; Heitlinger, Leo; Anasti, James

    2013-01-01

    Although Crohn disease (CD) is considered an inflammatory bowel disease, extraintestinal gynecologic manifestations are varied, frequent, and oftentimes difficult to manage. Its predilection for young and reproductive-age women makes it an important disease process for the gynecologist to understand, as its complications can have long-term repercussions on the developmental, sexual, reproductive, and psychological health of affected women. Patients may present with a variety of vulvovaginal, perineal, perianal, and urologic complaints. Perianal involvement from an intestinal fistula is the most common skin manifestation seen in CD. Other gynecologic manifestations include metastatic CD and rectovaginal and urovaginal fistulas. Recognition and accurate diagnosis of extraintestinal gynecologic manifestations, as well as a good understanding of the gynecologic effects of chronic disease, are necessary for optimal management. The article provides an overview of CD and highlights the gynecologic considerations in caring for women affected by this disease.

  9. 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.

  10. Outcomes of outpatient management of pediatric burns.

    PubMed

    Brown, Matthew; Coffee, Tammy; Adenuga, Paul; Yowler, Charles J

    2014-01-01

    The literature surrounding pediatric burns has focused on inpatient management. The goal of this study is to characterize the population of burned children treated as outpatients and assess outcomes validating this method of burn care. A retrospective review of 953 patients treated the burn clinic and burn unit of a tertiary care center. Patient age, burn etiology, burn characteristics, burn mechanism, and referral pattern were recorded. The type of wound care and incidence of outcomes including subsequent hospital admission, infection, scarring, and surgery served as the primary outcome data. Eight hundred and thirty children were treated as outpatients with a mean time of 1.8 days for the evaluation of burn injury in our clinic. Scalds accounted for 53% of the burn mechanism, with burns to the hand/wrist being the most frequent area involved. The mean percentage of TBSA was 1.4% for the outpatient cohort and 8% for the inpatient cohort. Burns in the outpatient cohort healed with a mean time of 13.4 days. In the outpatient cohort, nine (1%) patients had subsequent admissions and three (0.4%) patients had concern for infection. Eight patients from the outpatient cohort were treated with excision and grafting. The vast majority of pediatric burns are small, although they may often involve more critical areas such as the face and hand. Outpatient wound care is an effective treatment strategy which results in low rates of complications and should become the standard of care for children with appropriate burn size and home support.

  11. Point prevalence of complications between the Y connection technique and the usual care technique for blood restitution in patients of an outpatient hemodialysis unit: a comparison.

    PubMed

    Tacchini-Jacquier, Nadine; Verloo, Henk

    2017-01-01

    Central venous catheter-related infections (CVCIs) in patients on maintenance hemodialysis (HD) have been documented due to unsafe/unsterile manipulations by nurses during HD machine deconnection and reconnection. Given the gravity of CVCIs in HD patients using catheter access, precise, safe installation of the device, and good nursing technique are crucial. To assess and compare safety performance and complications of a Y-connection (n=133) versus the usual tunneled central venous catheter (CVC) technique (n=73) among HD patients and then explore preferences between techniques among patients and frontline HD nurses. A prospective, comparative, 3-month point prevalence survey was conducted among HD outpatients and frontline HD nurses in a 600-bed teaching hospital in the canton of Valais. Nine HD outpatients (average age, 68.3 years; SD=12.3) were recruited. The two techniques showed no differences in C-reactive protein levels (p=0.465), pain (p=1.00), or local complications due to dressings soiled by exudate at the catheter insert point (p=0.066). The relative risk ratio (RR) indicated that CVCI was 1.667 times (95% CI; 0.437, 6.358, p=0.50) more likely with a Y-connection. Neither the Y-connection technique (RR 1.63; [95% CI; 0.554, 4.790]; p=0.32) nor usual CVC technique (RR 0.58; [95% CI; 0.277, 1.217]; p=0.13) were significant relative risk factors for complications. Fifty-seven percent of HD patients stated that they felt more secure and comfortable using the Y-connection technique than the usual care technique. Eleven of the 12 nurses involved preferred the Y-connection technique, feeling that is was safer and easier in use. No difference was found in the complication rates of two blood restitution techniques - the Y-connection versus the usual CVC technique. HD outpatients and nurses preferred the Y-connection for blood restitution.

  12. Incidental (Prophylactic) Salpingectomy at Benign Gynecologic Surgery and Cesarean Section: a Survey of Practice in Austria.

    PubMed

    Potz, F L; Tomasch, G; Polterauer, S; Laky, R; Marth, C; Tamussino, K

    2016-12-01

    Introduction: Most serous ovarian cancers are now thought to originate in the fallopian tubes. This has raised the issue of performing incidental salpingectomy (also called elective, opportunistic, prophylactic or risk-reducing salpingectomy) at the time of benign gynecologic surgery or cesarean section. We conducted an online survey to ascertain the policies regarding incidental salpingectomy in Austria in late 2014. Material and Methods: All 75 departments of obstetrics and gynecology in public hospitals in Austria were surveyed for their policies regarding incidental salpingectomy at benign gynecologic surgery or cesarean section. Results: Sixty-six of 75 surveyed departments completed the questionnaire, resulting in a response rate of 88 %. Overall, 46 of 66 (70 %) units reported offering or recommending incidental salpingectomy at benign gynecologic surgery, 12 units (18 %) did not, and eight units (12 %) did not have a consistent policy. Salpingectomy was the preferred method for surgical sterilization, including sterilization at the time of cesarean section (71 % and 64 % of units, respectively). Conclusions: Incidental (elective, opportunistic, prophylactic, risk-reducing) salpingectomy is now widely offered at benign gynecologic surgery and cesarean section in Austria. Evidence for the role of the fallopian tubes in the origin of serous pelvic cancer has led to changes in clinical practice.

  13. Incidental (Prophylactic) Salpingectomy at Benign Gynecologic Surgery and Cesarean Section: a Survey of Practice in Austria

    PubMed Central

    Potz, F. L.; Tomasch, G.; Polterauer, S.; Laky, R.; Marth, C.; Tamussino, K.

    2016-01-01

    Introduction: Most serous ovarian cancers are now thought to originate in the fallopian tubes. This has raised the issue of performing incidental salpingectomy (also called elective, opportunistic, prophylactic or risk-reducing salpingectomy) at the time of benign gynecologic surgery or cesarean section. We conducted an online survey to ascertain the policies regarding incidental salpingectomy in Austria in late 2014. Material and Methods: All 75 departments of obstetrics and gynecology in public hospitals in Austria were surveyed for their policies regarding incidental salpingectomy at benign gynecologic surgery or cesarean section. Results: Sixty-six of 75 surveyed departments completed the questionnaire, resulting in a response rate of 88 %. Overall, 46 of 66 (70 %) units reported offering or recommending incidental salpingectomy at benign gynecologic surgery, 12 units (18 %) did not, and eight units (12 %) did not have a consistent policy. Salpingectomy was the preferred method for surgical sterilization, including sterilization at the time of cesarean section (71 % and 64 % of units, respectively). Conclusions: Incidental (elective, opportunistic, prophylactic, risk-reducing) salpingectomy is now widely offered at benign gynecologic surgery and cesarean section in Austria. Evidence for the role of the fallopian tubes in the origin of serous pelvic cancer has led to changes in clinical practice. PMID:28017973

  14. Clinical and economic burden of chemotherapy-induced nausea and vomiting among patients with cancer in a hospital outpatient setting in the United States.

    PubMed

    Craver, Chris; Gayle, Julie; Balu, Sanjeev; Buchner, Deborah

    2011-01-01

    This study evaluated the overall burden of illness of chemotherapy-induced nausea and vomiting (CINV) and associated all-cause costs from a hospital's perspective (costs to the hospital) in patients with cancer treated with chemotherapy (CT) in the US hospital outpatient setting. Patients with a cancer diagnosis aged ≥18 years initiating CT in a hospital outpatient setting for the first time between April 1 2007 and March 31 2009 were extracted from the Premier Perspective Database. Patients were followed through eight CT cycles or 6 months post-index date, whichever occurred first. Within each CT cycle, the follow-up time for CINV event estimation was from day 1 (except rescue medication use that was identified from day 2) to cycle end. A multivariate regression model was developed to predict the CINV event rate per CT cycle in the study follow-up period. Associated total all-cause costs of managing CINV from a hospital's perspective were analyzed descriptively. Event rate and associated costs were estimated in the entire hospital setting (outpatient, inpatient, and emergency room). All-cause costs included inpatient, hospital outpatient, and ER visit costs (identified through a primary or secondary diagnosis code for nausea, vomiting, and/or volume depletion) and pharmacy cost (rescue medications for CINV treatment). All physician costs and non CINV-related treatment (pharmacy) costs were excluded from the analyses. Among 11,495 study patients, 8,806 patients (76.6%) received prophylaxis for all cycles in the follow-up period. The overall base population had an average age of 63.3 years, was 51.0% female, and 72.7% White. The distribution of emetogenicity for cycle 1 CT cycle was 26.0% HEC, 46.1% MEC, and 26.4% LEC/MinEC combined. In the follow-up period, a total of 47,988 CINV events with an associated total all-cause treatment cost of $89 million were observed. Average daily treatment cost for all care settings was $1854.7. The regression model predicted a 20

  15. [Profile of the nurse in the outpatient units of INAMPS in Brazil. O Instituto Nacional de Assistência Médica da Previdência Social].

    PubMed

    Oguisso, T

    1990-04-01

    The objective of this study was to outline a profile of the nurses working within the INAMPS (National Health Service) outpatients centers in Brasil. Its purpose was to offer some assistance on the understanding of the subject, to the nursing educational system, to the employers of the product of that system, to the nurses' associations and to the nurses themselves. In the pursue of the objective, the author depicted: personal and professional traits of the nurses; job satisfaction and perceived support from the administration; the most frequent nurses activities performed. It also established the relations between nurses traits, job satisfaction, perceived support, and activities performed. Data was collected from March to December 1984. The questionnaires were sent to the universe of working nurses in the outpatient centers--1158 nurses. 927 (80.1%) answers were obtained. The population studied represented: 94.3% female, majority married; 30 to 40 years old, year of graduation and year of admission in the INAMPS in the 70's. Gross results were: job satisfaction 83.6%, perception of support from administration 75.2%, prepared as specialists 71.3%, and frequence to continuing educational programs 84.1%. Mains activities performed by nurses in decreasing order: supervision of nursing personnel 39.3%, direct nursing care 36.7%, teaching of patients and families 21.7%, administrative--functions 17.9%, and inservice training of personnel 3.6%. No relation was demonstrated between graduate preparation and job satisfaction nor perceived support from administration. Positive relation was found between educative activities and job satisfaction, and between supervision of nursing personnel or performance of administrative functions and perception of support from the administration.

  16. [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.

  17. Gynecological Management of Neuropathic Pain

    PubMed Central

    TU, Frank F.; HELLMAN, Kevin; BACKONJA, Miroslav

    2011-01-01

    Obstetrician/gynecologists often are the initial management clinicians for pelvic neuropathic pain. While treatment may require comprehensive team management and consultation with other specialists, there a few critical and basic steps that can be performed on an office visit that offer the opportunity to significantly improve quality of life in this patient population. A key first step is a thorough clinical examination to physically map the pain site and identify potentially involved nerves. Only limited evidence exists on how best to manage neuropathic pain, but generally a combination of surgical, manipulative or pharmacological methods should be considered. Experimental methods for more precisely characterizing the nature of the nerve dysfunction exist to diagnose and treat neuropathic pain, but additional scientific evidence is needed to unanimously recommend these options. In the meantime, an approach adopted from guidelines of the International Association for Study of Pain tailored for gynecological pain is suggested. PMID:21777899

  18. [Research and medicine in obstetrics and gynecology].

    PubMed

    Shalev, Eliezer

    2009-07-01

    The current issue of "Harefuah" is dedicated to original and descriptive research as well as to reviews of obstetric and gynecological topics. Original research includes the study on the progesterone receptor's profile in endometrial carcinoma cell lines, as well as the correlation of maternal serum and amniotic fluid Leptin Levels with neonatal birth weight. There are three descriptive articles and one review that are related to pain in gynecology and post partum, and two articles describing one complication and the second presenting a simulation of gynecological surgery. ULtrasound is represented in one descriptive case and two reviews describe sonographic signs for chromosomal abnormalities and fetal viral infection.

  19. Contemporary Quality of Life Issues Affecting Gynecologic Cancer Survivors

    PubMed Central

    Carter, Jeanne; Penson, Richard; Barakat, Richard; Wenzel, Lari

    2015-01-01

    Gynecologic cancers account for approximately 11% of the newly diagnosed cancers in women in the United States and 18% in the world.1 The most common gynecologic malignancies occur in the uterus and endometrium (53%), ovary (25%), and cervix (14%).2 Cervical cancer is most prevalent in premenopausal women, during their childbearing years, whereas uterine and ovarian cancers tend to present in the perimenopausal or menopausal period. Vaginal and vulvar cancers and malignancies arising from gestation, or gestational trophoblastic neoplasms, occur to a lesser extent. Regardless of cancer origin or age of onset, the disease and its treatment can produce short- and long-term sequelae (ie, sexual dysfunction, infertility, or lymphedema) that adversely affect quality of life (QOL). This article outlines the primary contemporary issues or concerns that may affect QOL and offers strategies to offset or mitigate QOL disruption. These contemporary issues are identified within the domains of sexual functioning, reproductive issues, lymphedema, and the contribution of health-related QOL (HRQOL) in influential gynecologic cancer clinical trials. PMID:22244668

  20. Gynecological and reproductive issues for women in space: a review.

    PubMed

    Jennings, R T; Baker, E S

    2000-02-01

    Women have been an integral part of United States space crews since the initial flight of Dr. Sally Ride in 1983, and a total of 40 women have been selected as U.S. astronauts. This article examines the reproductive and gynecological aspects of selecting, training, medically certifying, and flying women in space. Gynecological data from the astronaut selection cycles in 1991 to 1997 are reviewed. In addition, the reproductive implications of delaying childbearing for a career as an astronaut and the impact of new technology such as assisted reproductive techniques are examined. The reproductive outcomes of U.S. female astronauts after spaceflight are also presented. Because women have gained considerable operational experience on the Shuttle and Mir, the unique operational considerations for preflight certification, menstruation control and hygiene, contraception, and urination are discussed. Medical and surgical implications for women on long-duration missions to remote locations are still evolving, and enabling technologies for health care delivery are being developed. There has been considerable progress in the development of zero-gravity surgical techniques, including laparoscopy, thoracoscopy, and laparotomy. The concepts of prevention of illness, conversion of surgical conditions to medically treatable conditions, and surgical intervention for long-duration spaceflights are explored in detail. There currently are no operational gynecological or reproductive constraints for women that would preclude their successful participation in the exploration of our nearby solar system.

  1. Durvalumab, Tremelimumab + Radiotherapy in Gynecologic Cancer

    ClinicalTrials.gov

    2017-09-08

    Recurrent Gynecological Cancer; Metastatic Cervical Cancer; Metastatic Ovarian Cancer; Metastatic Vaginal Cancer; Metastatic Vulvar Cancer; Metastatic Endometrial Cancer; Recurrent Cervical Carcinoma; Recurrent Ovarian Carcinoma; Recurrent Vaginal Cancer; Recurrent Vulvar Cancer; Recurrent Endometrial Cancer

  2. Obstetrics and Gynecology: Considerations in Career Selection

    PubMed Central

    Stephen Petrilli, Edmund

    1981-01-01

    Current training programs in obstetrics and gynecology are not producing an excess of specialists in view of future manpower needs. In addition to being specialists and consultants, obstetrician-gynecologists also function as providers of primary care for women. During the last decade, three formal sub-specialties of obstetrics and gynecology have evolved: gynecologic oncology, maternal-fetal medicine and reproductive endocrinology. These have improved patient care and have altered the structure of resident education. With more American medical school graduates entering this specialty, the quality of resident applicants has improved, creating intense competition for desirable training positions. Those inclined toward a career in obstetrics and gynecology can be assured that it will provide an increasingly favorable and challenging environment for professional activity in the future. PMID:7210670

  3. 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.

  4. Adolescent Gynecologic Conditions Presenting in Emergency Settings.

    PubMed

    Kozlowski; Gottlieb; Graham; Cleveland

    1993-02-01

    What an adolescent patient and her parents define as a gynecologic emergency often proves to be merely a prolonged period. Nevertheless, because gynecologic complaints can be serious, each patient must be thoroughly evaluated. Common problems include dysfunctional uterine bleeding (mild, moderate, or severe), ectopic pregnancy, pelvic inflammatory disease, spontaneous abortion, and abdominal pain. Diagnosis and management of each of these conditions are discussed in detail.

  5. Topical hemostatic agents in gynecologic surgery.

    PubMed

    Duenas-Garcia, Omar Felipe; Goldberg, Jeffrey M

    2008-06-01

    Biosurgical compounds and pharmacologic agents can serve as surgical adjuncts to prevent or curtail intraoperative bleeding. Medline, PubMed, and Cochrane electronic data bases were used to search the English literature from 1966 to March 2007 using the terms topical, hemostatic agents, and gynecologic surgery. Several effective topical hemostatic agents are available to reduce intraoperative blood loss. Data on their application in gynecologic surgery are limited, and guidelines for selecting one over another for specific indications are lacking.

  6. Obstetric and Gynecologic Patients' Attitudes and Perceptions Toward Medical Students in Saudi Arabia

    PubMed Central

    Anfinan, Nisrin; Alghunaim, Nadine; Boker, Abdulaziz; Hussain, Amro; Almarstani, Ahmad; Basalamah, Hussain; Sait, Hesham; Arif, Rawan; Sait, Khalid

    2014-01-01

    Objective To identify patients’ attitudes, preferences and comfort levels regarding the presence and involvement of medical students during consultations and examinations. Methods A cross-sectional descriptive study was conducted from September 2011 to December 2011 at King Abdulaziz University Hospital in Jeddah, Saudi Arabia. Participants were randomly selected from the outpatient and inpatient clinics at the Department of Obstetrics and Gynecology and the Emergency Department, provided they were admitted for obstetric or gynecology-related conditions. Data were collected using a structured questionnaire, and data analysis was performed using the Statistical Package for Social Sciences. Results Of the 327 patients who were recruited, 272 (83%) were elective patients who were seen at the outpatient and inpatient clinics of the Department of Obstetrics and Gynecology (group I). The other 55 (16.8%) were seen at the Emergency Department or the Labor and Delivery Ward (group II). One hundred seventy-nine participants (160 [58.8%] in group I and 19 [34.5%] in group II) reported positive attitudes about the presence of female medical students during consultations. Fewer participants (115 [42.3%] were in group I and 17 [30.9%] in group II) reported positive attitudes regarding the presence of male medical students during consultations (p=0.095). The gender of the medical student was the primary factor that influenced patients’ decision to accept or decline medical student involvement. No significant associations were observed between patients’ attitudes and perceptions toward medical students and the patients' age, educational level, nationality or the gender of the consultant. Conclusion Obstetrics and Gynecology patients are typically accepting of female medical student involvement during examinations. Student gender is the primary factor that influences patient attitudes regarding student involvement during physical examinations. PMID:24715936

  7. [The observatory of rare malignant gynecologic tumors].

    PubMed

    Devouassoux-Shisheboran, Mojgan; Vacher-Lavenu, Marie-Cécile

    2014-02-01

    The observatory of gynecological rare tumors (TMRG) has been initially created for ovarian rare neoplasms (TMRO). Because of the similarities between ovarian and other gynecological tumors, this observatory has been then extended to all gynecological rare tumors. The recognition by INCa of three national expert centers (centre Léon-Bérard, hôpitaux de Paris, institut Gustave-Roussy) in rare gynecological cancers and a network of regional expert centers in 2010, expend the experience of the website "Observatoire francophone des tumeurs rares de l'ovaire". The major goals of this gynecology rare tumors experts network, are to promote systematic second opinion for initial diagnostic by experts in gynecopathology, systematic multidisciplinary advice by surgeons and medical oncologist experts, to disseminate clinical guidelines dedicated to rare gynecological tumors, to promote specific fundamental and translational research within clinical trials dedicated to rare tumors. At the end, we would like to improve benefit in term of survival and/or fertility for all these potential young patients.

  8. Fluorescence diagnostics in oncological gynecology

    NASA Astrophysics Data System (ADS)

    Belyaeva, Ludmila A.; Adamyan, Leila V.; Kozachenko, Vladimir P.; Stratonnikov, Alexander A.; Stranadko, Eugene F.; Loschenov, Victor B.

    2003-10-01

    The method of fluorescent diagnostics (FD) of tumors is a promising tool that may allow to increase sensitivity of tumor detection especially at initial stages. One of the most promising photosensitizers today is 5-aminolevulinic acid (5-ALA) that, actually, is not photosensitizer itself but precursor of protoporphyrin IX (PpIX). This paper deals with cancer diagnostics in gynecology by means of ALA-induced Pp IX laser-fluorescence spectroscopy. The tissue fluorescence spectra in vivo were studied in patients with various pathologies of ovaries, uterine and vulva after 5-aminolevulinic acid administration. It was shown that different pathologies varies in accumulation of Pp IX. Coefficient of fluorescence kf for normal tissue is not high, but exceptions are endometrium and mucous membrane of uterine tubes. Benign tumors of uterus and ovary have low values of kf, but polyps of endometrium exhibit high kf. Optical express-biopsy is important for diagnosis of ovarian cancer and micrometastatic spread. Coefficients of diagnostic contrast were determined for cancer of endometrium, cervical cancer, vulvar cancer.

  9. Antimicrobial resistance of Streptococcus pneumoniae recovered from outpatients in the United States during the winter months of 1994 to 1995: results of a 30-center national surveillance study.

    PubMed

    Doern, G V; Brueggemann, A; Holley, H P; Rauch, A M

    1996-05-01

    A total of 1,527 clinically significant outpatient isolates of Streptococcus pneumoniae were prospectively collected in 30 different U.S. medical centers between November 1994 and April 1995. Overall, 23.6% of strains were not susceptible to penicillin, with 14.1% intermediate and 9.5% high-level resistant. The frequencies of recovery of intermediate and high-level resistant strains varied considerably between different medical centers and in different geographic areas. In general, intermediate and high-level penicillin resistance was most common with isolates of S. pneumoniae recovered from pediatric patients. The in vitro activities of 22 other antimicrobial agents were assessed against this collection of isolates. Ampicillin was consistently 1 twofold dilution less active than penicillin. Amoxicillin and amoxicillin-clavulanate were essentially equivalent to penicillin in activity. The rank order of activity for cephalosporins was cefotaxime = ceftriaxone > or = cefpodoxime > or = cefuroxime > cefprozil > or = cefixime > cefaclor = loracarbef > cefadroxil = cephalexin. The National Committee for Clinical Laboratory Standards [Performance Standards for Antimicrobial Susceptibility Testing, Sixth Information Supplement (M100-S6), 1995] has established MIC breakpoints for resistance (i.e., > or = 2 micrograms/ml) with three cephalosporins versus S. pneumoniae, namely, cefotaxime, ceftriaxone, and cefuroxime. The overall percentages of strains resistant to these three antimicrobial agents were 3, 5, and 12, respectively. The overall frequency of resistance was 10% with all three macrolides examined in this study, clarithromycin, erythromycin, and azithromycin. The overall percentages of chloramphenicol, tetracycline, and trimethoprim-sulfamethoxazole resistance were 4.3, 7.5, and 18, respectively. The resistance percentages among the cephalosporins, macrolides, chloramphenicol, tetracycline, and trimethoprim-sulfamethoxazole were consistently higher among penicillin

  10. Antimicrobial resistance of Streptococcus pneumoniae recovered from outpatients in the United States during the winter months of 1994 to 1995: results of a 30-center national surveillance study.

    PubMed Central

    Doern, G V; Brueggemann, A; Holley, H P; Rauch, A M

    1996-01-01

    A total of 1,527 clinically significant outpatient isolates of Streptococcus pneumoniae were prospectively collected in 30 different U.S. medical centers between November 1994 and April 1995. Overall, 23.6% of strains were not susceptible to penicillin, with 14.1% intermediate and 9.5% high-level resistant. The frequencies of recovery of intermediate and high-level resistant strains varied considerably between different medical centers and in different geographic areas. In general, intermediate and high-level penicillin resistance was most common with isolates of S. pneumoniae recovered from pediatric patients. The in vitro activities of 22 other antimicrobial agents were assessed against this collection of isolates. Ampicillin was consistently 1 twofold dilution less active than penicillin. Amoxicillin and amoxicillin-clavulanate were essentially equivalent to penicillin in activity. The rank order of activity for cephalosporins was cefotaxime = ceftriaxone > or = cefpodoxime > or = cefuroxime > cefprozil > or = cefixime > cefaclor = loracarbef > cefadroxil = cephalexin. The National Committee for Clinical Laboratory Standards [Performance Standards for Antimicrobial Susceptibility Testing, Sixth Information Supplement (M100-S6), 1995] has established MIC breakpoints for resistance (i.e., > or = 2 micrograms/ml) with three cephalosporins versus S. pneumoniae, namely, cefotaxime, ceftriaxone, and cefuroxime. The overall percentages of strains resistant to these three antimicrobial agents were 3, 5, and 12, respectively. The overall frequency of resistance was 10% with all three macrolides examined in this study, clarithromycin, erythromycin, and azithromycin. The overall percentages of chloramphenicol, tetracycline, and trimethoprim-sulfamethoxazole resistance were 4.3, 7.5, and 18, respectively. The resistance percentages among the cephalosporins, macrolides, chloramphenicol, tetracycline, and trimethoprim-sulfamethoxazole were consistently higher among penicillin

  11. [Gynecological abnormalities in patients with rectovestibular fistula].

    PubMed

    Vilanova-Sánchez, A; Sánchez Galán, A; Andrés Moreno, A M; Encinas Hernández, J L; Núñez Cerezo, V; Amesty Morello, V; Chocarro Amatrianin, G; Martínez Martínez, L; Martínez-Urruta, M J; López Santamaría, M

    2016-04-10

    Patients with recto vestibular fistula may have gynecological malformations that could be unnoticed at the initial examination. The aim of this paper is to demonstrate the incidence of these malformations and propose a study method to help diagnose these malformations, avoiding unnecessary surgeries. We reviewed the records of patients treated with rectovaginal fistula (RVF) in the last 18 years and studied their gynecological malformations, time at diagnosis and treatment received. Of the 39 patients treated, 5 of them (13.1%) demonstrated 9 gynecological malformations: Hemivaginas (2), hemiuteros (2), uterine agenesis (2), vaginal agenesis (2) and vaginal septum (1). The diagnosis was made after the posterior sagittal approach (PSA) in two patients (acute abdomen and hydrometrocolpos), during the PSA in 2 patients and only one of them was diagnosed before the PSA. The 2 patients with hemivaginas and hemiuterus underwent a hemihysterosalpinguectomy and a vaginoplasty later in adolescence. The patient with vaginal and uterine agenesis diagnosed prior to PSA underwent a posterior sagittal anorectoplasty and a vaginoplasty with colon in the same procedure. The patient with vaginal and uterine agenesis (age 13 months) is waiting for vaginal replacement. The patient with vaginal septum (intraoperative finding) underwent a septum resection during the PSA. Gynecological defects are part of RVF spectrum. Girls with RVF require a complete gynecological examination prior to the definitive repair. Preoperative examinations assist in the timing and type of repair, and ultimately avoids complications and unnecessary interventions.

  12. 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…

  13. Obstetrics and Gynecology Residency and Fertility Needs.

    PubMed

    Aghajanova, Lusine; Hoffman, Jacquelyn; Mok-Lin, Evelyn; Herndon, Christopher N

    2017-03-01

    Infertility is a common reproductive disease, with a prevalence of 9% to 18% of the general population. To date, no studies have attempted to examine the prevalence and experience of infertility among resident physicians in the United States. In female obstetrics and gynecology (Ob/Gyn) residents of age where infertility becomes more prevalent, ability to seek fertility may be influenced by rigorous professional demands and low remuneration. We seek to understand the prevalence of infertility, as well as experience and utilization of infertility services among Ob/Gyn residents. Cross-sectional descriptive survey was distributed among US Accreditation Council for Graduate Medical Education-accredited Ob/Gyn programs. Demographics, intentions to conceive during residency, fertility problems, fertility treatment, affordability of care, and perceptions of support were surveyed. A total of 241 responses were received in an equal distribution between junior (n = 120) and senior (n = 121) residents. The majority of respondents were female (91%), 25 to 35 years old (94%), and married (54%). Eighty-five percent (195 of 230) did not actively pursue fertility during residency. Twenty-nine percent (68 of 235) considered fertility preservation, but only 2% sought consultation. Twenty-nine percent of those interested in fertility (22 of 75) experienced infertility of some degree. Sixty-three percent felt low or no support from the program. Thirty-five percent reported stigma associated with their infertility. In conclusion, infertility is a prevalent reproductive health impairment among Ob/Gyn residents. The majority of residents defer childbearing during residency despite advancing reproductive age. A majority felt little or no support from training programs in addressing their fertility care. Further studies are indicated to understand the barriers and impact among resident trainees.

  14. The Relevance of Gynecologic Oncologists to Provide High-Quality of Care to Women with Gynecological Cancer

    PubMed Central

    Minig, Lucas; Padilla-Iserte, Pablo; Zorrero, Cristina

    2016-01-01

    Gynecologic oncologists have an essential role to treat women with gynecological cancer. It has been demonstrated that specialized physicians who work in multidisciplinary teams to treat women with gynecological cancers are able to obtain the best clinical and oncological outcomes. However, the access to gynecologic oncologists for women with suspected gynecological cancer is scarce. Therefore, this review analyzes the importance of specialized care of women with ovarian, cervical, and endometrial cancer. In addition, the role of gynecologic oncologists who offer fertility-sparing treatment as well as their role in assisting general gynecologists and obstetricians is also reviewed. PMID:26835417

  15. Pelvic Surgical Site Infections in Gynecologic Surgery

    PubMed Central

    Lachiewicz, Mark P.; Moulton, Laura J.; Jaiyeoba, Oluwatosin

    2015-01-01

    The development of surgical site infection (SSI) remains the most common complication of gynecologic surgical procedures and results in significant patient morbidity. Gynecologic procedures pose a unique challenge in that potential pathogenic microorganisms from the skin or vagina and endocervix may migrate to operative sites and can result in vaginal cuff cellulitis, pelvic cellulitis, and pelvic abscesses. Multiple host and surgical risk factors have been identified as risks that increase infectious sequelae after pelvic surgery. This paper will review these risk factors as many are modifiable and care should be taken to address such factors in order to decrease the chance of infection. We will also review the definitions, microbiology, pathogenesis, diagnosis, and management of pelvic SSIs after gynecologic surgery. PMID:25788822

  16. Laparoscopic Diagnosis and Treatment in Gynecologic Emergencies

    PubMed Central

    Cantele, Héctor; Leyba, José Luis; Navarrete, Manuel; Llopla, Salvador Navarrete

    2003-01-01

    Objective: To present an analysis of our experience with 22 consecutive cases of acute abdominal gynecologic emergencies managed with a laparoscopic approach. Methods: From March 1997 to October 1998, 22 patients with a diagnosis of acute abdominal gynecologic emergencies underwent laparoscopic intervention. A transvaginal ultrasound was performed on all patients preoperatively to supplement the diagnostic workup. Surgical time, complications, and length of hospital stay were evaluated, and the laparoscopic diagnosis was compared with the preoperative diagnosis. Results: The laparoscopic diagnosis was different from the preoperative diagnosis in 31.8% of patients. Of the 22 patients, laparoscopic therapeutic procedures were performed in 18 (81.8%), all satisfactorily, and with no need for conversion to open surgery. No morbidity or mortality occurred. Conclusion: Laparoscopy is a safe and effective method for diagnosing and treating gynecologic emergencies. PMID:14558712

  17. Achieving cost control in the hospital outpatient department.

    PubMed

    Sulvetta, M B

    1991-01-01

    The rapid growth in outpatient expenditures and the congressional mandate for development of a prospective payment system (PPS) for these expenditures are discussed. Extension of diagnosis-related groups to outpatient care is shown to be infeasible. Alternative patient classification schemes and options for defining the unit of payment and establishing weights and rates are discussed. A PPS primarily controls price and can only address volume by defining a broad unit of payment, such as an episode of care. Therefore, adoption of a volume performance standard approach could be effective. Outpatient payment policies must be integrated with those of other ambulatory care providers.

  18. Prevalence of violence exposure in women with premenstrual dysphoric disorder in comparison with other gynecological patients and asymptomatic controls.

    PubMed

    Segebladh, Birgitta; Bannbers, Elin; Kask, Kristiina; Nyberg, Sigrid; Bixo, Marie; Heimer, Gun; Sundström-Poromaa, Inger

    2011-07-01

    The aim of the present study was to estimate prevalence rates of physical, emotional and sexual abuse in women with premenstrual dysphoric disorder (PMDD) in comparison with gynecological outpatients and asymptomatic healthy control subjects. Cross-sectional study. Departments of obstetrics and gynecology in three different Swedish hospitals. Fifty-eight women meeting strict criteria for PMDD, a control group of 102 women seeking care at the gynecological outpatient clinic (ObGyn controls) and 47 asymptomatic healthy control subjects were included in this study. The Swedish version of the Abuse Assessment Screen was used to collect information on physical and sexual abuse, and the screening instrument was administered as a face-to-face interview. Previous and ongoing physical and sexual abuse. Any lifetime abuse (physical, emotional or sexual) was reported by 31.0% of PMDD patients, by 39.2% of ObGyn controls and by 21.3% of healthy controls. The ObGyn controls reported physical and/or emotional abuse significantly more often than PMDD patients as well as healthy controls (p<0.05). Lifetime sexual abuse was reported significantly more often by ObGyn controls than by healthy controls (p<0.05). Patients with PMDD appear not to have suffered physical, emotional or sexual abuse to a greater extent than other gynecological patients or healthy control subjects. However, exposure to violence was common in all groups of interviewed women, and for the individual patient these experiences may contribute to their experience of symptoms. © 2011 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2011 Nordic Federation of Societies of Obstetrics and Gynecology.

  19. [Stepwise outpatient care].

    PubMed

    Valdes-Stauber, Juan; Vietz, Johannes; Kilian, Reinhold

    2015-05-01

    To assess possible differences in clinical, social, care, and satisfaction profile of patients treated by outpatient clinics or office based psychiatrists. The study sample consists of 100 patients of a psychiatric outpatient clinic and 100 patients treated by office based psychiatrists in the same catchment area. Patients were examined using standardized assessment instruments for severity of illness (HoNOS, CGI), general (GAF) and specific functional impairment (PSP), and satisfaction with psychiatric services (ZUF-8). Chi-square tests, univariate ANOVAs and stepwise multivariate logistic regression models were applied. Compared with patients treated by office based psychiatrists, patients treated by the outpatient clinic showed higher HoNOS and CGI scores, lower GAF and PSP scores, and had more often a disability pension, a legal guardianship, a schizophrenia diagnosis, suicide attempts, hospitalizations, and therapeutic contacts. However, there were no significant differences regarding care satisfaction. The assessed outpatient clinic met the German statutory criteria for its legitimation. However, care needs have to be specified in a better way, and the different care intensity as well as concrete interventions between both settings have to be specified more accurately. © Georg Thieme Verlag KG Stuttgart · New York.

  20. Robotic-Assisted Laparoscopy in Gynecological Surgery

    PubMed Central

    Saberi, Naghmeh S.; Shahmohamady, Babac; Nezhat, Farr

    2006-01-01

    Background: Laparoscopic surgery has revolutionized the concept of minimally invasive surgery for the last 3 decades. Robotic-assisted surgery is one of the latest innovations in the field of minimally invasive surgery. Already, many procedures have been performed in urology, cardiac surgery, and general surgery. In this article, we attempt to report our preliminary experience with robotic-assisted laparoscopy in a variety of gynecological surgeries. We sought to evaluate the role of robotic-assisted laparoscopy in gynecological surgeries. Methods: The study was a case series of 15 patients who underwent various gynecologic surgeries for combined laparoscopic and robotic-assisted laparoscopic surgery. The da Vinci robot was used in each case at a tertiary referral center for laparoscopic gynecologic surgery. An umbilicus, suprapubic, and 2 lateral ports were inserted. These surgeries were performed both using laparoscopic and robotic-assisted laparoscopic techniques. The assembly and disassembly time to switch from laparoscopy to robotic-assisted surgery was measured. Subjective advantages and disadvantages of using robotic-assisted laparoscopy in gynecological surgeries were evaluated. Results: Fifteen patients underwent a variety of gynecologic surgeries, such as myomectomies, treatment of endometriosis, total and supracervical hysterectomy, ovarian cystectomy, sacral colpopexy, and Moskowitz procedure. The assembly time to switch from laparoscopy to robotic-assisted surgery was 18.9 minutes (range, 14 to 27), and the disassembly time was 2.1 minutes (range, 1 to 3). Robotic-assisted laparoscopy acts as a bridge between laparoscopy and laparotomy but has the disadvantage of being costly and bulky. Conclusion: Robotic-assisted laparoscopic surgeries have advantages in providing a 3-dimensional visualization of the operative field, decreasing fatigue and tension tremor of the surgeon, and added wrist motion for improved dexterity and greater surgical precision. The

  1. Clinical statistics of gynecologic cancers in Japan

    PubMed Central

    Nagase, Satoru

    2017-01-01

    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. PMID:28198168

  2. 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.

  3. [Discussion on English translation of TCM gynecologic terms].

    PubMed

    Jiang, Kun; Han, Bing; Wang, Kui

    2008-01-01

    The existent problems, principles that should be observed and methods for English translation of TCM gynecological terms were discussed, and a scheme of translation for 150 TCM gynecological terms was explored.

  4. North American Society for Pediatric and Adolescent Gynecology

    MedlinePlus

    ... removeClass('notactive'); autoPlay();}); }); About NASPAG The North American Society for Pediatric and Adolescent Gynecology (NASPAG), founded in ... Bayer/NASPAG Young Investigator Grant The North American Society for Pediatric and Adolescent Gynecology (NASPAG) has partnered ...

  5. 21 CFR 884.4120 - Gynecologic electrocautery and accessories.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... Surgical Devices § 884.4120 Gynecologic electrocautery and accessories. (a) Identification. A gynecologic... under direct visual observation. This generic type of device may include the following accessories: an...

  6. 21 CFR 884.4120 - Gynecologic electrocautery and accessories.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... Surgical Devices § 884.4120 Gynecologic electrocautery and accessories. (a) Identification. A gynecologic... under direct visual observation. This generic type of device may include the following accessories: an...

  7. 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

  8. 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.

  9. A Matter of Perspective: Comparison of the Characteristics of Persons with HIV Infection in the United States from the HIV Outpatient Study, Medical Monitoring Project, and National HIV Surveillance System

    PubMed Central

    Buchacz, Kate; Frazier, Emma L.; Hall, H. Irene; Hart, Rachel; Huang, Ping; Franklin, Dana; Hu, Xiaohong; Palella, Frank J.; Chmiel, Joan S.; Novak, Richard M.; Wood, Kathy; Yangco, Bienvenido; Armon, Carl; Brooks, John T.; Skarbinski, Jacek

    2015-01-01

    Comparative analyses of the characteristics of persons living with HIV infection (PLWH) in the United States (US) captured in surveillance and other observational databases are few. To explore potential joint data use to guide HIV treatment and prevention in the US, we examined three CDC-funded data sources in 2012: the HIV Outpatient Study (HOPS), a multisite longitudinal cohort; the Medical Monitoring Project (MMP), a probability sample of PLWH receiving medical care; and the National HIV Surveillance System (NHSS), a surveillance system of all PLWH. Overall, data from 1,697 HOPS, 4,901 MMP, and 865,102 NHSS PLWH were analyzed. Compared with the MMP population, HOPS participants were more likely to be older, non-Hispanic/Latino white, not using injection drugs, insured, diagnosed with HIV before 2009, prescribed antiretroviral therapy, and to have most recent CD4+ T-lymphocyte cell count ≥500 cells/mm3 and most recent viral load test<2 00 copies/mL. The MMP population was demographically similar to all PLWH in NHSS, except it tended to be slightly older, HIV diagnosed more recently, and to have AIDS. Our comparative results provide an essential first step for combined epidemiologic data analyses to inform HIV care and prevention for PLWH in the US. PMID:26793282

  10. [Open narcissism, covered narcissism and personality disorders as predictive factors of treatment response in an out-patient Drug Addiction Unit].

    PubMed

    Salazar-Fraile, José; Ripoll-Alandes, Carmen; Bobes, Julio

    2010-01-01

    Although a high prevalence of personality disorders has been reported in substance users, the literature on their value for predicting treatment response is controversial. On the other hand, while the predictive validity of personality traits as predictors of response to drug abuse or dependence has been studied, research on the validity of narcissistic personality traits is scarce. To study the predictive value of personality disorders, narcissistic personality traits and self-esteem for predicting treatment response. We assessed 78 patients attended at an addiction treatment unit using personality disorder diagnoses and measures of self-esteem, narcissism and covert (hypersensitive) narcissism. These variables were used in a Cox survival model as predictive variables of time to relapse into drug use. Hypersensitive (covert) narcissism and borderline and passive-aggressive personality disorders were risk factors for relapse into drug use, while open narcissism was a protective factor. Self-esteem did not show predictive validity. Personality disorders characterized by impulsivity-instability and passivity-resentfulness show higher risk of relapse into drug abuse. Personality traits characterized by high sensitivity to humiliation increase the risk of relapse, whereas pride and self-confidence are protective factors.

  11. 42 CFR 493.945 - Cytology; gynecologic examinations.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 5 2011-10-01 2011-10-01 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...

  12. 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...

  13. 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...

  14. 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...

  15. 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...

  16. 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...

  17. 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...

  18. 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...

  19. 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... Devices § 884.2225 Obstetric-gynecologic ultrasonic imager. (a) Identification. An obstetric-gynecologic ultrasonic imager is a device designed to transmit and receive ultrasonic energy into and from a...

  20. 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... Devices § 884.2225 Obstetric-gynecologic ultrasonic imager. (a) Identification. An obstetric-gynecologic ultrasonic imager is a device designed to transmit and receive ultrasonic energy into and from a...

  1. 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...

  2. 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...

  3. 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...

  4. 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...

  5. 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...

  6. 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…

  7. 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…

  8. 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.

  9. 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…

  10. 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

  11. Outpatient therapeutic nuclear oncology.

    PubMed

    Turner, J Harvey

    2012-05-01

    In the beginning, nuclear medicine was radionuclide therapy, which has evolved into molecular tumour-targeted control of metastatic cancer. Safe, efficacious, clinical practice of therapeutic nuclear oncology may now be based upon accurate personalised dosimetry by quantitative gamma SPECT/CT imaging to prescribe tumoricidal activities without critical organ toxicity. Preferred therapy radionuclides possess gamma emission of modest energy and abundance to enable quantitative SPECT/CT imaging for calculation of the beta therapy dosimetry, without radiation exposure risk to hospital personnel, carers, family or members of the public. The safety of outpatient radiopharmaceutical therapy of cancer with Iodine-131, Samarium-153, Holmium-166, Rhenium-186, Rhenium-188, Lutetium-177 and Indium-111 is reviewed. Measured activity release rates and radiation exposure to carers and the public are all within recommendations and guidelines of international regulatory agencies and, when permitted by local regulatory authorities allow cost-effective, safe, outpatient radionuclide therapy of cancer without isolation in hospital.

  12. Optimal outpatient appointment scheduling.

    PubMed

    Kaandorp, Guido C; Koole, Ger

    2007-09-01

    In this paper optimal outpatient appointment scheduling is studied. A local search procedure is derived that converges to the optimal schedule with a weighted average of expected waiting times of patients, idle time of the doctor and tardiness (lateness) as objective. No-shows are allowed to happen. For certain combinations of parameters the well-known Bailey-Welch rule is found to be the optimal appointment schedule.

  13. Urinary complications of gynecologic surgery: iatrogenic urinary tract system injuries in obstetrics and gynecology operations.

    PubMed

    Ozdemir, E; Ozturk, U; Celen, S; Sucak, A; Gunel, M; Guney, G; Imamoglu, M A; Danisman, A N

    2011-01-01

    To evaluate iatrogenic urinary tract system injuries in obstetrics and gynecology operations and compare the results with the literature. We examined the records of patients who had obstetric and gynecology operations at the Ministry of Health, Dr. Zekai Tahir Burak Women's Health, Training and Research Hospital between June 2007 and June 2010. All the patients who were diagnosed as having urinary system injuries in either the intraoperative or postoperative period were determined. During this period, 25,998 gynecologic and obstetrical operations were performed, 0.03% ureteric, 0.20% bladder, and one case of urethral injury, in a total of 0.24% urinary tract injuries were observed. The bladder was the most frequently injured organ. Total urinary tract injury rates were 0.79% (0.49% bladder, 0.24% ureteral) in gynecologic operations and 0.19% (0.18% bladder and 0.01% ureteral) in obstetric operations. Urinary system injuries are seen in approximately 1% of all gynecologic and obstetric surgeries. The complication rates observed in our patients were comparable with the other studies in the literature. A gynecologic surgeon must become familiar with the anatomy of the urinary tract and must be aware of common intraoperative and postoperative complications to decrease the risk of morbidity.

  14. [Obstetrics, surgical gynecology, or medical gynecology: what type of practice interests today's interns?].

    PubMed

    Nizard, J

    2002-10-01

    Two major modifications have recently changed the training program of interns in obstetrics and gynecology in France. The first modification is an important increase in the number of interns in OBGYN, allowing more lower ranked medical students to enter this training. The second modification is the imposed subdivision of the pool of interns in two distinctive branches: obstetrics and gynecological surgery, and medical gynecology with a 2/1 ratio. These modifications were decided without consulting interns on the type of practice they intend to have later. This study tries to determine what type of practice French interns in OBGYN intend to have when they have finished their training. We distributed surveys to all French interns in OBGYN. The survey included questions on the type of practice they intend to have, and questions on their opinions on how OBGYN show be taught. Two third of interns wanted to have a full practice in OBGYN. This proportion was the same considering only first year interns. Three quarters of interns wanted to have a future practice that includes at least medical gynecology, and only one intern wanted to do solely medical gynecology later. French interns in OBGYN wanted more medical gynecology teaching during their training Despite recent modifications in the training program, French interns in OBGYN intend to have a full practice later. This choice is not influenced by the 5 years of training.

  15. [Gynecological emergencies: A prospective study about patients purpose of consultation and outcome].

    PubMed

    Calvo, J; Louges, M A; Sanchez, S; Lipere, A; Duminil, L; Graesslin, O

    2016-11-01

    Aiming to evaluate the profile type, complaint and outcome of patients consulting a gynecologic emergency unit in order to enhance "real" emergencies and improve their management. We enrolled prospectively 308 women consulting to Reims teaching hospital gynecologic emergency unit from the 15th of May to the 25th of June 2013. Two hundred and fifty-seven women (83.4%) spontaneously consulted without previous medical examination. Two hundred and thirty-eight of them (77.3%) had already been through gynecologic emergency units and 99 (32.1%) had no regular follow-up. Pelvic pain and/or metrorragia were registered as main complaint for 219 patients (71.1%). Median age was thirty years old (±11) and an average forty-minute wait was recorded. Gynecologic ultrasound was the first exam to be performed after clinical examination for 255 patients (82.8%). Twenty-two (7.1%) were hospitalized for surgical procedures or medical care, respectively 10 (3.2%) and 12 (3.9%). Among 51 women addressed by another healthcare professional, 9 were hospitalized (17.6%) versus 12 hospitalized (4.7%) out of 257, when consulting without initial professional expertise. A significant relationship between hospitalizations and general practitioner consultation was found with an OR=4.34 (95%CI: 1.51-12.05, P=0.002). Main motive of consultation involving home treatment turned out to be on-going pregnancies (92 patients, 29.9%). A large majority of gynecologic hospital consultations, responsible for time waste and professional monopolizing, can be treated by general practitioners and could contribute to a better management of life-threatening emergencies. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  16. 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

  17. Outpatient Pain Rehabilitation Programs

    PubMed Central

    Chen, Joseph J

    2006-01-01

    Outpatient pain rehabilitation programs that include an interdisciplinary approach have been shown to be effective treatments for patients with chronic pain. The objectives of this article are to describe the common interdisciplinary pain rehabilitation programs available, the appropriate indications for use, the components of typical pain rehabilitation programs, the short-term and long-term success rates, the costs of attending these programs, and the significant societal costs of those patients who do not complete these programs and do not return to work. PMID:16789457

  18. 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.

  19. Perineovulvovaginal preoperative preparation in minor gynecological surgery.

    PubMed

    Adeleye, J A

    1976-09-01

    Fifty consecutive patients underwent minor elective gynecologic surgery. Most of them were from the low socioeconomic class. Twenty-five patients had their pubic, vulval and perineal hair shaved as part of the preoperative preparation. All patients underwent the same routine perineal, vulval and vaginal swabbing in the operating room. All patients were then examined for postoperative complications. Only two women (who were shaved) complained of mild lower abdominal pain 48 hours after operation, but neither had any clinical evidence of genital or urinary infection. Their symptoms disappeared with the use of analgesics. Even in developing countries where patients with poor personal hygiene are common, preoperative vulval, pubic and perineal hair shaving prior to minor gynecologic surgery is unnecessary. We suggest that this procedure should be discontinued.

  20. Geriatric gynecology: promoting health and avoiding harm.

    PubMed

    Miller, Karen L; Baraldi, Carole A

    2012-11-01

    Age increases vulnerability, commonly accompanied by greater reliance on others and susceptibility to maltreatment. Physiologic processes become less resilient; the potential for harm from medical care increases. Awareness of frailty, functional, social, and potential maltreatment issues enables early referrals to help the patient maintain her independence. Health issues that may impede both gynecologic care and self-sufficiency include sensory deficits, physical disability, and cognitive impairment. Speaking slowly and providing contextual information enhance patient comprehension. Cancer screening depends on life expectancy. Osteoporosis treatment requires managing fall risk. Gynecologic symptoms more likely have multiple contributing factors than one etiology. Incontinence is a particularly complex issue, but invariably includes bladder diary assessment and pelvic floor muscle training. Function and frailty measures best predict perioperative morbidity. Communication with the patient, her family, other providers, and health care organizations is an important frontier in avoiding errors and adverse outcomes.

  1. Gene therapy of benign gynecological diseases☆

    PubMed Central

    Hassan, Memy H.; Othman, Essam E.; Hornung, Daniela; Al-Hendy, Ayman

    2015-01-01

    Gene therapy is the introduction of genetic material into patient’s cells to achieve therapeutic benefit. Advances in molecular biology techniques and better understanding of disease pathogenesis have validated the use of a variety of genes as potential molecular targets for gene therapy based approaches. Gene therapy strategies include: mutation compensation of dysregulated genes; replacement of defective tumor-suppressor genes; inactivation of oncogenes; introduction of suicide genes; immunogenic therapy and antiangiogenesis based approaches. Preclinical studies of gene therapy for various gynecological disorders have not only shown to be feasible, but also showed promising results in diseases such as uterine leiomyomas and endometriosis. In recent years, significant improvement in gene transfer technology has led to the development of targetable vectors, which have fewer side-effects without compromising their efficacy. This review provides an update on developing gene therapy approaches to treat common gynecological diseases such as uterine leiomyoma and endometriosis. PMID:19446586

  2. Gynecologic masses: value of magnetic resonance imaging.

    PubMed

    Hricak, H; Lacey, C; Schriock, E; Fisher, M R; Amparo, E; Dooms, G; Jaffe, R

    1985-09-01

    Forty-two women with gynecologic abnormalities were studied with the use of magnetic resonance imaging. Magnetic resonance imaging correctly assessed the origin of the pelvic mass in all patients. In the evaluation of leiomyoma, magnetic resonance imaging accurately depicted the number, size, and location of the lesion. In the evaluation of endometrial carcinoma, magnetic resonance imaging depicted the location of the lesion, the presence of cervical extension, and the depth of myometrial penetration in the majority of the cases. In the analysis of adnexal cysts, magnetic resonance imaging was sensitive in localizing the lesion and was able to distinguish serous from hemorrhagic fluid. This preliminary report indicates that magnetic resonance imaging may become a valuable imaging modality in the diagnosis of gynecologic abnormalities.

  3. Virtual Reality Simulation of Gynecologic Laparoscopy

    PubMed

    Bernstein

    1996-08-01

    Realistic virtual simulation of gynecologic laparoscopy would permit the surgeon to practice any procedure, with any degree of pathology, at any time and as many times as necessary to achieve proficiency before attempting it in the operating room. Effective computer simulation requires accurate anatomy, realistic three-dimensional computer graphics, the ability to cut and deform tissue in response to instruments, and an appropriate hardware interface. The Visible Human Project from the National Library of Medicine has made available extremely accurate, three-dimensional, digital data that computer animation companies have begun to transform to three-dimensional graphic images. The problem of tissue deformation and movement is approached by a software package called TELEOS. Hardware consisting of two scissor-grip laparoscopic handles mounted on a sensor can interface with any simulation program to simulate a multiplicity of laparoscopic instruments. The next step will be to combine TELEOS with the three-dimensional anatomy data and configure it for gynecologic surgery.

  4. Urinary Problems Amongst Gynecological Consultations. Association Between Prolapse, Gynecological Surgery and Diabetes

    PubMed Central

    Saadia, Zaheera

    2015-01-01

    Background: Urinary incontinence is the inability of a woman to maintain bladder control. Symptoms range from urgency, frequency, nocturia to urge incontinence (1). It limits functional and social activities and leads to depression and social withdrawal. (2). This observational study aimed to describe the common urinary problems amongst gynecological consultations. It also describes the relationship of urinary incontinence with history of diabetes, previous gynecological surgery and prolapse. Methods: The study was conducted as a descriptive cross sectional study from Jan-May 2015 at Qassim University Clinic, Buraidah. Women with urinary problem and those without urinary problems were compared for risk factors including diabetes, prolapse and previous gynecological surgery. The Statistical Package for the Social Sciences 22 (SPSS 22) was used to conduct proportion z-tests to determine the association of prolapse, gynecological surgeries and diabetes with urinary incontinence. To test the hypothesis, differences between two groups on the aforementioned factors were examined. The groups included participants that reported having urinary problems (n = 111) and those who do not have urinary problems (n = 100). Results: The most frequent complaints of participants with urinary problems were urgency (n = 66, 59.46%), Stress incontinence (SI) (n = 65, 58.56%) and frequency (n = 62, 55.86%). For participants with a urinary problem, 89.19% have not had a gynecological surgery (n = 99) and the remaining 10.81% of participants had a gynecological surgery (n = 12). For participants without a urinary problem, 97.0% have not had a gynecological surgery (n = 97) and the remaining 3.0% had a gynecological surgery (n = 3). For participants with a urinary problem, 72.97% did not have diabetes (n = 81) and the remaining 27.03% of participants did have diabetes (n = 30). For participants without a urinary problem, 92.0% did not have diabetes (n = 92) and the remaining 8.0% did report

  5. URINARY PROBLEMS AMONGST GYNECOLOGICAL CONSULTATIONS. ASSOCIATION BETWEEN PROLAPSE, GYNECOLOGICAL SURGERY AND DIABETES

    PubMed Central

    Saadia, Zaheera

    2016-01-01

    Background: Urinary incontinence is the inability of a woman to maintain bladder control. Symptoms range from urgency, frequency, nocturia to urge incontinence (1). It limits functional and social activities and leads to depression and social withdrawal. (2). This observational study aimed to describe the common urinary problems amongst gynecological consultations. It also describes the relationship of urinary incontinence with history of diabetes, previous gynecological surgery and prolapse. Methods: The study was conducted as a descriptive cross sectional study from Jan-May 2015 at Qassim University Clinic, Buraidah. Women with urinary problem and those without urinary problems were compared for risk factors including diabetes, prolapse and previous gynecological surgery. The Statistical Package for the Social Sciences 22 (SPSS 22) was used to conduct proportion z-tests to determine the association of prolapse, gynecological surgeries and diabetes with urinary incontinence. To test the hypothesis, differences between two groups on the aforementioned factors were examined. The groups included participants that reported having urinary problems (n = 111) and those who do not have urinary problems (n = 100). Results: The most frequent complaints of participants with urinary problems were urgency (n = 66, 59.46%), Stress incontinence (SI) (n = 65, 58.56%) and frequency (n = 62, 55.86%). For participants with a urinary problem, 89.19% have not had a gynecological surgery (n = 99) and the remaining 10.81% of participants had a gynecological surgery (n = 12). For participants without a urinary problem, 97.0% have not had a gynecological surgery (n = 97) and the remaining 3.0% had a gynecological surgery (n = 3). For participants with a urinary problem, 72.97% did not have diabetes (n = 81) and the remaining 27.03% of participants did have diabetes (n = 30). For participants without a urinary problem, 92.0% did not have diabetes (n = 92) and the remaining 8.0% did report

  6. Gynecologic Cancer Center for Racial Disparities

    DTIC Science & Technology

    2006-08-01

    required approvals from the Committee on Experimental Medicine as well as the Uterine Committee of the Gynecologic Oncology Group. Currently, our...WRAMC in conjunction with the Armed Forces Institute of Pathology (Months 1-48). The focus during Months 1-12 will be on validating abnormal ...was administered twice at three and six weeks. Sera was collected by bleed from ear at every week after each immunization for determination of

  7. 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.

  8. 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.

  9. 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.

  10. RTOG Gynecologic Oncology Working Group: Comprehensive Results

    PubMed Central

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

    2016-01-01

    The purpose of this report is to comprehensively describe the activities of the Gynecologic Oncology Working Group within the RTOG. Clinical trials will be reviewed as well as translational science and ancillary activities. Over the past 40 years, a myriad of clinical trials have been performed within the RTOG with the aim of improving overall survival 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 overall survival in patients with stages IB through IIB cervical carcinoma receiving prophylactic paraaortic irradiation compared to pelvic radiation alone. RTOG 9001 demonstrated that cisplatin and 5-FU chemoradiotherapy to the pelvis for advanced cervix cancer markedly improved overall survival compared to extended field radiotherapy alone. More recent trials have employed radioprotectors, molecular targeted therapy, and intensity modulated radiation therapy. Ancillary studies have developed CTV atlases for research protocols and routine clinical use. Worldwide practice patterns have been investigated in cervix, endometrial, and vulvar cancer thru the Gynecologic Cancer Intergroup (GCIG). 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. PMID:24819663

  11. Gynecology resident laparoscopy training: present and future.

    PubMed

    Shore, Eliane M; Lefebvre, Guylaine G; Grantcharov, Teodor P

    2015-03-01

    Simulator education is essential to surgical training and it should be a requirement at all training programs across North America. Yet, in a survey of North American obstetrics and gynecology program directors (response rate 52%), we found that while 73% (n = 98) of programs teach laparoscopic skills, only 59% (n = 81) were satisfied with their curriculum. Most programs lacked standard setting in the form of theoretical examinations (94%, n = 127) or skills assessments (91%, n = 123) prior to residents performing surgery on patients in the operating room. Most programs (97%, n = 131) were interested in standardizing laparoscopy education by implementing a common curriculum. We present 3 core recommendations to ensure that gynecologists across North America are receiving adequate training in gynecologic laparoscopic surgery as residents: (1) uniform simulator education should be implemented at all training programs across North American residency programs; (2) a standardized curriculum should be developed using evidence-based techniques; and (3) standardized assessments should take place prior to operating room performance and specialty certification. Future collaborative research initiatives should focus on establishing the content of a standardized laparoscopy curriculum for gynecology residents utilizing a consensus method approach.

  12. Minimally Invasive Surgery in Gynecologic Oncology

    PubMed Central

    Mori, Kristina M.; Neubauer, Nikki L.

    2013-01-01

    Minimally invasive surgery has been utilized in the field of obstetrics and gynecology as far back as the 1940s when culdoscopy was first introduced as a visualization tool. Gynecologists then began to employ minimally invasive surgery for adhesiolysis and obtaining biopsies but then expanded its use to include procedures such as tubal sterilization (Clyman (1963), L. E. Smale and M. L. Smale (1973), Thompson and Wheeless (1971), Peterson and Behrman (1971)). With advances in instrumentation, the first laparoscopic hysterectomy was successfully performed in 1989 by Reich et al. At the same time, minimally invasive surgery in gynecologic oncology was being developed alongside its benign counterpart. In the 1975s, Rosenoff et al. reported using peritoneoscopy for pretreatment evaluation in ovarian cancer, and Spinelli et al. reported on using laparoscopy for the staging of ovarian cancer. In 1993, Nichols used operative laparoscopy to perform pelvic lymphadenectomy in cervical cancer patients. The initial goals of minimally invasive surgery, not dissimilar to those of modern medicine, were to decrease the morbidity and mortality associated with surgery and therefore improve patient outcomes and patient satisfaction. This review will summarize the history and use of minimally invasive surgery in gynecologic oncology and also highlight new minimally invasive surgical approaches currently in development. PMID:23997959

  13. Pediatric outpatient anesthesia.

    PubMed

    Hannallah, R S

    1987-02-01

    Successful anesthetic management of children undergoing outpatient surgery requires that the surgeon and anesthesiologist be actively involved in all aspects of management. Guidelines should be established in consultation with the surgeons, nurses, and administrators to ensure proper selection and preoperative preparation of patients. The psychological evaluation and preparation of children, and the use of pharmacologic premedication when indicated, will ensure a pleasant experience for all involved. The anesthesiologist should choose a specific anesthetic agent and a technique that are appropriate for each individual child. Use of "routine" induction techniques is rarely, if ever, appropriate. Early ambulation and discharge are very desirable in outpatients. Long-acting drugs and techniques that are associated with excessive drowsiness or nausea and vomiting should not be utilized. Special attention must be paid to the analgesic requirements of the child. Regional blocks should be used whenever possible to supplement "light" general anesthesia and to limit the need for narcotics during recovery. Specific criteria for discharge ensure the safety and protection of the child and staff.

  14. Gynecologic anatomic abnormalities following anorectal malformations repair.

    PubMed

    Vilanova-Sanchez, Alejandra; Reck, Carlos A; McCracken, Kate A; Lane, Victoria A; Gasior, Alessandra C; Wood, Richard J; Levitt, Marc A; Hewitt, Geri D

    2017-07-24

    Patients may present with gynecologic concerns after previous posterior sagittal anorectoplasty (PSARP) for repair of an anorectal malformation (ARM). Common findings include an inadequate or shortened perineal body, as well as introital stenosis, retained vaginal septum, and remnant rectovestibular fistula. An inadequate or shortened perineal body may impact fecal continence, sexual function and recommendations regarding obstetrical mode of delivery. We describe our experience with female patients referred to our center for evaluation of their previously repaired ARM, with a specific focus on perineal body anatomy and concomitant gynecologic abnormalities. We outline our collaborative evaluation process and findings as well as subsequent repair and outcomes. A single site retrospective chart review from May 2014 to May 2016 was performed. Female patients with a history of prior ARM repair who required subsequent reoperative surgical repair with perineoplasty were included. The decision for reoperation was made collaboratively after a multidisciplinary evaluation by colorectal surgery, urology, and gynecology which included examination under anesthesia (EUA) with cystoscopy, vaginoscopy, rectal examination, and electrical stimulation of anal sphincters. The type of original malformation, indication for reoperative perineoplasty, findings leading to additional procedures performed at time of perineoplasty, postoperative complications, and the length of follow up were recorded. During the study period 28 patients were referred for evaluation after primary ARM repair elsewhere and 15 patients (60%) met inclusion criteria. Thirteen patients (86.6%) originally had a rectovestibular fistula with prior PSARP and 2 patients (13.4%) originally had a cloacal malformation with prior posterior sagittal anorectovaginourethroplasty. The mean age at the time of the subsequent perineoplasty was 4.6years (0.5-12). Patients had an inadequate perineal body requiring reoperative

  15. 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.

  16. Outpatient benzodiazepine detoxification procedure for methadone patients.

    PubMed

    McDuff, D R; Schwartz, R P; Tommasello, A; Tiegel, S; Donovan, T; Johnson, J L

    1993-01-01

    Benzodiazepines are used by a substantial minority of opioid addicts on methadone maintenance. Alprazolam, now the most widely prescribed benzodiazepine in the United States, appears to have supplanted diazepam as the benzodiazepine drug of choice in this population. Its greater addiction liability, shorter half-life, and more intense withdrawal symptoms make addiction to alprazolam more likely and its management in methadone patients more complicated. This article describes a slow outpatient tapered reduction procedure that was utilized to detoxify benzodiazepine dependent methadone patients seen over a two-year period. The reduction procedure was offered to 22 opioid addicts on methadone maintenance who were regularly ingesting low to moderate amounts of benzodiazepines, primarily alprazolam. Of the 22 patients, 4 patients refused outpatient detoxification, and 18 were started on a reduction procedure. Twelve patients completed the detoxification procedure which averaged 7.8 weeks. Comparisons are made between completers and non-completers and essential design features of the procedure are discussed.

  17. Breast and Gynecologic Cancer | Division of Cancer Prevention

    Cancer.gov

    [[{"fid":"184","view_mode":"default","fields":{"format":"default","field_file_image_alt_text[und][0][value]":"Breast and Gynecologic Cancer Research Group Homepage Logo","field_file_image_title_text[und][0][value]":"Breast and Gynecologic Cancer Research Group Homepage Logo","field_folder[und]":"15"},"type":"media","attributes":{"alt":"Breast and Gynecologic Cancer Research Group Homepage Logo","title":"Breast and Gynecologic Cancer Research Group Homepage Logo","height":"266","width":"400"," | Prevention and early detection of breast, cervix, endometrial and ovarian cancers and their precursors.

  18. 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.

  19. Synchronous gynecologic cancer and the use of imaging for diagnosis.

    PubMed

    Boaventura, Camila Silva; Galvão, José Lucas Scarpinetti; Soares, Giovanna Milanes Bego; Bitencourt, Almir Galvão Vieira; Chojniak, Rubens; Bringel, Shenia Lauanna Rezende; Brot, Louise De

    2016-04-01

    Endometrial and cervical cancers are the most prevalent gynecologic neoplasms. While endometrial cancer occurs in older women, cervical cancer is more prevalente in young subjects. The most common clinical manifestation in these two gynecological cancers is vaginal bleeding. In the first case, diagnosis is made based on histological and imaging evaluation of the endometrium, while cervical cancers are diagnosed clinically, according to the International Federation of Gynecology and Obstetrics (FIGO). The authors present a case of synchronous gynecological cancer of the endometrium and cervix diagnosed during staging on MRI and confirmed by histological analysis of the surgical specimen.

  20. Evaluation of the complexity of postoperative care following breast and gynecologic cancer surgery.

    PubMed

    Meloni Rosa, Teresa Celina; Dias de Souza, João Paulo; Sarian, Luis Otávio; Soares, Fabiano Miguel; Morais, Sirlei Siani; Mauricette Derchain, Sophie Françoise

    2006-01-01

    The purpose of this study was to evaluate the complexity of postoperative care required by women who had undergone breast or gynecologic cancer surgery, using the Therapeutic Intervention Scoring System-28. An observational, longitudinal study was carried out on 83 women admitted postoperatively to the Intensive Care Unit of the Center for Women's Integrated Healthcare. The results of this study show that women diagnosed with gynecologic cancer had a significantly higher mean Therapeutic Intervention Scoring System-28 score compared with women who had been diagnosed with breast cancer (P = .01). Women who underwent gynecologic surgery had a significantly higher mean Therapeutic Intervention Scoring System-28 score than women who had breast surgery (P = .03). Most of the activities performed by staff during the postoperative intensive care unit period involved only basic care procedures. Only advanced age and hypertension were related to death during the postoperative period. In conclusion, from the nursing standpoint, the complexity of care required in the intensive care unit during the postoperative period was moderate. Women aged 80 years or older were at the highest risk of death during this period.

  1. 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.

  2. Preparedness of Ob/Gyn residents for fellowship training in gynecologic oncology

    PubMed Central

    Doo, David W.; Powell, Matthew; Novetsky, Akiva; Sheeder, Jeanelle; Guntupalli, Saketh R.

    2015-01-01

    Residency training in obstetrics and gynecology is being challenged by increasingly stringent regulations and decreased operative experience. We sought to determine the perception of preparedness of incoming gynecologic oncology fellows for advanced surgical training in gynecologic oncology. An online survey was sent to gynecologic oncologists involved in fellowship training in the United States. They were asked to evaluate their most recent incoming clinical fellows in the domains of professionalism, level of independence/graduated responsibility, psychomotor ability, clinical evaluation and management, and academia and scholarship using a standard Likert-style scale. The response rate among attending physicians was 40% (n = 105/260) and 61% (n = 28/46) for program directors. Of those who participated, 49% reported that their incoming fellows could not independently perform a hysterectomy, 59% reported that they could not independently perform 30 min of a major procedure, 40% reported that they could not control bleeding, 40% reported that they could not recognize anatomy and tissue planes, and 58% reported that they could not dissect tissue planes. Fellows lacked an understanding of pathophysiology, treatment recommendations, and the ability to identify and treat critically ill patients. In the academic domain, respondents agreed that fellows were deficient in the areas of protocol design (54%), statistical analysis (54%), and manuscript writing (65%). These results suggest that general Ob/Gyn residency is ineffective in preparing fellows for advanced training in gynecologic oncology and should prompt a revision of the goals and objectives of resident education to correct these deficiencies. PMID:26076160

  3. [Laparoscopy and gynecologic cancer in 2005].

    PubMed

    Canis, M; Farina, M; Jardon, K; Rabischong, B; Rivoire, C; Nohuz, E; Botchorishvili, R; Pouly, J-L; Mage, G

    2006-04-01

    All the surgical procedures, which may be required to treat a gynecologic cancer, can be performed endoscopically. However prospective randomized studies required to confirm the oncologic efficacy of the technique are still lacking in gynecology, whereas such studies are available in digestive surgery. Animal studies suggested that the risk of tumor dissemination in non traumatized peritoneum is higher after a pneumoperitoneum than after a laparotomy. Experimental studies also emphasized two points: the surgeon and the surgical technique are essential, all the parameters of the pneumoperitoneum may influence the postoperative dissemination. Changing these parameters we may, in the future, be able to create a peritoneal environment adapted to oncologic patients in order to prevent or to decrease the risks of peritoneal dissemination and/or of postoperative tumor growth. Until the results of prospective randomized studies become available, the preoperative selection of the patients and the surgical technique should be very strict. In patients with endometrial cancer, the laparoscopic approach should be reserved to clinical stage I disease, if the vaginal extraction is anticipated to be easy accounting for the volume of the uterus and the local conditions. In cervical cancer, the laparoscopic approach should be reserved to patients with favorable prognostic factors: stage IB of less than 2 cm in diameter. Laparoscopy is the gold standard for the surgical diagnosis of adnexal masses. But the puncture should be avoided whenever possible. The surgical treatment of invasive ovarian cancer should be performed by laparotomy whatever the stage. In contrast restaging of an early ovarian cancer initially managed as a benign mass, is a good indication of the laparoscopic approach. The laparoscopic management of low malignant potential tumors should include a complete staging of the peritoneum. Knowledge of the principles of endoscopy and of oncologic surgery is required

  4. 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.

  5. Clinical applications of immunohistochemistry in gynecological malignancies.

    PubMed

    Shutter, J; Atkins, K A; Ghartey, K; Herzog, T J

    2007-01-01

    Over the past two decades, immunohistochemical techniques have improved to such a degree that it is now a common adjuvant test to the traditional hematoxylin and eosin-stained histologic sections. It is used in most realms of surgical pathology and can often aid in final diagnosis and, in some cases, prognosis. However, immunohistochemistry (IHC) is not always helpful and many pitfalls to its use exist. Understanding the basics of IHC, its utility and difficulties will aid clinicians in better understanding how diagnoses are rendered. This study reviews the general principles of IHC and demonstrates its utility with several commonly encountered problematic areas in gynecological pathology.

  6. Postoperative infections in obstetrics and gynecology.

    PubMed

    Jaiyeoba, Oluwatosin

    2012-12-01

    Postoperative infection is the most commonly seen complication of surgery in obstetrics and gynecology. The use of antibiotic prophylaxis has greatly decreased though not completely eliminated this adverse outcome. Postoperative infections include wound cellulitis, wound abscess, endomyometritis, pelvic cellulitis, and pelvic abscess. Infections usually manifest as fever and greater than normal postoperative pain. Refractory fevers maybe because of septic pelvic vein thrombophlebitis or maybe noninfectious in origin. Broad-spectrum antibiotics should be initiated as soon as possible when diagnosis of postoperative infection is made; most patients will respond to treatment within 24 to 48 hours when appropriate antibiotics are selected.

  7. Estrogen therapy in gynecological cancer survivors.

    PubMed

    Guidozzi, F

    2013-12-01

    Treatment of gynecological cancer has significant impact on a woman's quality of life because it commonly includes removal of the uterus and ovaries, both being the core of a woman's femininity, whilst irradiation and chemotherapy, be they as primary therapy or when indicated as postoperative adjuvant therapy, will lead to ablation of ovarian function if the ovaries had not been removed. This will lead to an acute onset of menopausal symptoms, which may be more debilitating than those occurring as a result of natural aging, and of which hot flushes, night sweats, insomnia, mood swings, vaginal dryness, decreased libido, malaise and a general feeling of apathy are the most common. About 25% of gynecological cancers will occur in pre- and perimenopausal women, a large percentage of whom will become menopausal as a result of their treatment. There are also the gynecological cancer survivors who are not rendered menopausal as a result of the treatment strategy but who will become menopausal because of natural aging. Concern among the medical attendants of these women is whether use of estrogen therapy or estrogen and progestogens for their menopausal symptoms will reactivate tumor deposits and therefore increase the rate of recurrence and, as a result, decrease overall survival among these women. Yet the data that are available do not support this concern. There are eight retrospective studies and only one randomized study that have analyzed outcome in endometrial cancer survivors who used hormone therapy after their surgery, whilst, among ovarian cancer survivors, there are four retrospective studies and one randomized study. The studies do suffer from small numbers and, although the studies pertaining to endometrial cancer analyze mostly women with early-stage disease, a number of the studies in both the endometrial and ovarian cancer survivors do have a sizeable follow-up. These studies seem to support that estrogen therapy after the treatment for gynecological

  8. Interobserver Reproducibility Among Gynecologic Pathologists in Diagnosing Heterologous Osteosarcomatous Component in Gynecologic Tract Carcinosarcomas.

    PubMed

    Sangoi, Ankur R; Kshirsagar, Malti; Roma, Andres A; Horvai, Andrew E; Chivukula, Mamatha; Ellenson, Lora H; Fadare, Oluwole; Folkins, Ann K; Garg, Karuna; Hanley, Krisztina; Longacre, Teri A; Haas, Jacqueline; McCluggage, W Glenn; McKenney, Jesse K; Nucci, Marisa R; Oliva, Esther; Park, Kay J; Parkash, Vinita; Quick, Charles M; Rabban, Joseph T; Rutgers, Joanne K L; Soslow, Robert; Vang, Russell; Yemelyanova, Anna; Zaloudek, Charles; Beck, Andrew H

    2017-02-17

    Distinguishing hyalinized stroma from osteoid production by a heterologous osteosarcomatous component can be challenging in gynecologic tract carcinosarcomas. As heterologous components in a carcinosarcoma may have prognostic and therapeutic implications, it is important that these are recognized. This study examines interobserver reproducibility among gynecologic pathologists in the diagnosis of osteosarcomatous components, and its correlation with expression of the novel antibody SATB2 (marker of osteoblastic differentiation) in these osteosarcomatous foci. Digital H&E images from 20 gynecologic tract carcinosarcomas were reviewed by 22 gynecologic pathologists with a request to determine the presence or absence of an osteosarcomatous component. The 20 preselected cases included areas of classic heterologous osteosarcoma (malignant cells producing osteoid; n=10) and osteosarcoma mimics (malignant cells with admixed nonosteoid matrix; n=10). Interobserver agreement was evaluated and SATB2 scored on all 20 cases and compared with the original diagnoses. Moderate agreement (Fleiss' κ=0.483) was identified for the 22 raters scoring the 20 cases with a median sensitivity of 7/10 and a median specificity of 9/10 for the diagnosis of osteosarcoma. SATB2 showed 100% sensitivity (10/10) and 60% (6/10) specificity in discriminating classic osteosarcoma from osteosarcoma mimics. Utilizing negative SATB2 as a surrogate marker to exclude osteosarcoma, 73% (16/22) of the reviewers would have downgraded at least 1 case to not contain an osteosarcomatous component (range, 1-6 cases, median 1 case). Gynecologic pathologists demonstrate only a moderate level of agreement in the diagnosis of heterologous osteosarcoma based on morphologic grounds. In such instances, a negative SATB2 staining may assist in increasing accuracy in the diagnosis of an osteosarcomatous component.

  9. The FIGO Leadership in Obstetrics and Gynecology for Impact and Change (LOGIC) Initiative in Maternal and Newborn Health.

    PubMed

    Taylor, David J; Vander Plaetse, Bart

    2014-10-01

    The FIGO Leadership in Obstetrics and Gynecology for Impact and Change (LOGIC) Initiative in Maternal and Newborn Health developed the organizational capacity of national professional organizations of obstetrics and gynecology in eight African and Asian countries. The initiative was funded by a grant from the Bill and Melinda Gates Foundation and had three key objectives. These goals were to support the eight FIGO member associations to strengthen their capacity to work effectively; to influence national policies on maternal and newborn health; and to work toward improving clinical practice in this area. The current supplement presents evidence that the focus and effectiveness of a national obstetric and gynecologic association-as well as its influence on major public health issues (such as United Nations Millennium Development Goals 4 and 5)-can be substantially broadened and enhanced by the provision of external support.

  10. Pulmonary Embolism Following Outpatient Vasectomy

    PubMed Central

    Mott, Frank E.; Farooqi, Bilal; Moore, Harry

    2016-01-01

    Venous thromboembolic events have several known major risk factors such as prolonged immobilization or major surgery. Pulmonary embolism has rarely been reported after an outpatient vasectomy was completed. We present the rare case of a healthy 32-year-old Caucasian male with no known risk factors who presented with pleuritic chest pain 26 days after his outpatient vasectomy was performed. Subsequently, he was found to have a pulmonary embolism as per radiological imaging. We explore the association between outpatient vasectomies and venous thromboembolic events. A review of the literature is also included. PMID:26989373

  11. Monitoring Outpatient Care

    NASA Technical Reports Server (NTRS)

    2003-01-01

    Each year, health care costs for managing chronically ill patients increase as the life expectancy of Americans continues to grow. To handle this situation, many hospitals, doctors practices, and home care providers are turning to disease management, a system of coordinated health care interventions and communications, to improve outpatient care. By participating in daily monitoring programs, patients with congestive heart failure, chronic obstructive pulmonary disease, diabetes, and other chronic conditions requiring significant self-care are facing fewer emergency situations and hospitalizations. Cybernet Medical, a division of Ann Arbor, Michigan-based Cybernet Systems Corporation, is using the latest communications technology to augment the ways health care professionals monitor and assess patients with chronic diseases, while at the same time simplifying the patients interaction with technology. Cybernet s newest commercial product for this purpose evolved from research funded by NASA, the National Institute of Mental Health, and the Advanced Research Projects Agency. The research focused on the physiological assessment of astronauts and soldiers, human performance evaluation, and human-computer interaction. Cybernet Medical's MedStar Disease Management Data Collection System is an affordable, widely deployable solution for improving in-home-patient chronic disease management. The system's battery-powered and portable interface device collects physiological data from off-the-shelf instruments.

  12. Endometrial aspiration cytology in gynecological disorders

    PubMed Central

    Jadhav, Meenal V.; Phatke, Anjali S.; Kadgi, Nalini Vinayak; Rane, Sharda R.; Kulkarni, Kalpana K.

    2016-01-01

    Context: Endometrial aspiration is not a popular modality for the study of the endometrium despite its simplicity and potential utility. Aim: The present study was aimed at evaluating the utility of endometrial aspiration in various gynecological disorders. Materials and Methods: In this diagnostic accuracy study, 55 prospectively registered women with various gynecological disorders were evaluated clinically and subjected to endometrial aspiration cytology and study of endometrial histology. Endometrial aspiration was performed by infant feeding tube in 10 cases and intra cath cannula in 45 cases. The slides were stained with rapid Papanicolaou (PAP) stain and Leishman stain. Results: Endometrial aspiration cytology showed 90% and 94.6% sampling adequacy with infant feeding tube and intra cath cannula, respectively. Intra cath cannula was very convenient to handle and superior to infant feeding tube in aspirating the endometrium. Of the two stains used, rapid PAP stain was less time-consuming and superior to Leishman stain in studying the nuclear details. Leishman stain was helpful in detecting cytoplasmic vacuoles of secretory endometrium. Overall diagnostic accuracy of endometrial cytology was 90.4% while that for morphological hormonal evaluation was 97.6%. It enjoyed a sensitivity of 91.66%, a specificity of 88.23%, positive predictive value of 94.28%, and negative predictive value of 83.33%. Conclusion: Intra cath cannula emerged as an inexpensive, effective, and convenient device for endometrial aspiration. Endometrial aspiration proved to be a fairly effective, simple, and informative diagnostic modality. PMID:27011435

  13. [Interventional ultrasound in obstetrics and gynecology].

    PubMed

    Kurjak, A; Alfirević, Z

    1989-01-01

    During 1988 there were 1029 invasive obstetrical and gynecological ultrasonically guided procedures: 788 early amniocenteses and 84 late amniocenteses, 26 chorion villi sampling, 24 by transcervical and 2 by transabdominal route, 74 fetal blood sampling (chordocenthesis) mainly for fetal karyotyping, in 9 cases the assessment of the fetal acid-base status was the main indication for the procedure. There was one patient with the increased risk of epidermolysis bulosa in whom fetal skin biopsy was performed. Prostaglandine was administered intraamnially under ultrasound control in 44 cases, in which the second trimester termination of pregnancy was indicated for medical reasons. In 3 cases a huge polyhydramnion was evacuated and in one case of several fetal hydrocephaly, craniocentesis and aspiration of the cerebral fluid were performed. There was one selective fetocide in twin pregnancy with a large meningomyelocele in one twin. In one case of a nonimune fetal hydrops at the 27-week gestation, the aspiration of the accumulated fluid and the intraperitoneal injection of albumin at 27 and 34 weeks, respectively, were performed. A total number of 6 gynecological invasive ultrasonically guided procedures was done. Three of them were punctures of ovarian follicles as part of IVF programme, one puncture of a large simple ovarian cyst, and two aspirations of extrauterine pregnancy with the administration of Metotrexate.

  14. Gynecologic concerns in patients with cloacal anomaly.

    PubMed

    Breech, Lesley

    2016-04-01

    Children with anorectal malformations (ARM) constitute a significant group within a pediatric surgery practice. It is important with female cases of anorectal malformations to consider the association of gynecologic anomalies, especially at the time of the definitive repair. However, it is critical to consider the association of such gynecologic anomalies when caring for patients with a cloacal anomaly. If not recognized, an opportunity to diagnose and treat such anomalies may be missed with the possibility of negative implications for future reproductive capacity. With the knowledge of the associated anomalies and long-term sequelae, surgeons can provide better care for girls and important counseling for parents. Knowledge of reproductive related issues in females with cloaca allows the pediatric surgeon an opportunity both, to provide optimal surgical management in infancy, childhood, and into young adulthood and to collaborate medically and surgically with an experienced gynecologist in patients with more complex anatomic variations. Appropriate counseling for patients and families about potential reproductive concerns that may develop many years after the definitive surgical repair allows preparation and planning to preserve future fertility. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Ultrasonography in obstetrics and gynecology, 2nd edition

    SciTech Connect

    Callen, P.W.

    1988-01-01

    A text on obstetric and gynecologic ultrasound for radiologists, OB/GYN practitioners, and radiologic technicians. The second edition places greater emphasis on diagnosis of specific systemic disorders in the fetus, as well as the most current applications of ultrasound in gynecologic diagnosis.

  16. 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... HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION LABORATORY REQUIREMENTS Participation...

  17. PACU PTH facilitates safe outpatient total thyroidectomy.

    PubMed

    Houlton, Jeffrey J; Pechter, William; Steward, David L

    2011-01-01

    To determine if a serum parathyroid hormone (PTH)-based discharge algorithm can be used to safely facilitate outpatient total thyroidectomy. Case series with chart review of consecutive total and completion thyroidectomies performed by the senior author from March 2008 to November 2009. An academic tertiary care center. At the authors' institution, patients undergoing total or completion thyroidectomy are subject to a same-day discharge algorithm that incorporates postanesthesia care unit rapid PTH as the major discharge criterion. Patients with PTH >30 pg/mL are eligible for same-day discharge without supplementation, patients with PTH between 20 and 30 pg/mL are eligible for discharge but receive calcium supplementation, and patients with PTH <20 pg/mL are observed overnight (23 hours) with calcium and vitamin D supplementation. One hundred eighty patients (mean age, 48.9 years; 83.3% female) underwent total (77.2%) or completion (22.7%) thyroidectomy with or without node dissection. Forty-two percent were performed with minimally invasive video-assisted (MIVA) technique. Seventy-six percent (137/180) of patients had a PTH >20 pg/mL, meeting the PTH discharge criterion. Sixty-nine percent (95/137) of eligible patients were discharged on the same day (53.1% of total). Ten percent of discharge-eligible patients were admitted due to drain placement. Of the 95 patients undergoing outpatient surgery, none were admitted, seen, or called for symptoms of hypocalcemia in the postoperative period. All 180 patients were eucalcemic at postoperative day (POD) 7 and POD 30 office visits. No patients were hypoparathyroid at POD 30. No significant difference in postoperative hypoparathyroidism existed between completion versus total thyroidectomy (11.1% vs 22.2%, P = .28) or MIVA versus standard technique (P = .37). A PTH-based discharge algorithm can safely facilitate outpatient total or completion thyroidectomy, with minimal risk of clinically significant outpatient

  18. Improving quality and decreasing cost in gynecologic oncology care. Society of gynecologic oncology recommendations for clinical practice.

    PubMed

    Rimel, B J; Burke, William M; Higgins, Robert V; Lee, Paula S; Lutman, Christopher V; Parker, Lynn

    2015-05-01

    To identify potential cost savings in gynecologic oncology care without sacrificing quality. Members of the Clinical Practice Committee of the Society of Gynecologic Oncology were asked to review current practice patterns in gynecologic oncology and assess the potential for cost savings founded on evidence-based medicine and current guidelines. Five clinical practices were identified including the following: vaginal cytology for endometrial cancer survivors; colposcopy for low grade cytologic abnormalities for cervical cancer survivors; routine imaging studies for gynecologic cancer survivors; screening for ovarian cancer with serum biomarkers and ultrasound; and improving palliative care for gynecologic cancer patients. Review of the published literature and guidelines were performed to make evidence-based recommendations for cost effective quality gynecologic oncology care. • Do not perform Pap tests of the vaginal cuff in patients with a history of endometrial cancer. • Do not perform colposcopy for low grade Pap tests in women with a history of cervical cancer. • Avoid routine imaging for cancer surveillance in asymptomatic women with gynecologic cancer, specifically ovarian, endometrial, cervical, vulvar and vaginal cancer. • Do not screen women at low risk for ovarian cancer with ultrasound or CA-125 or other biomarkers. • Do not delay basic level palliative care for women with advanced or relapsed gynecologic cancer, do refer to a palliative care specialist when needed, and avoid unnecessary treatments at life's end. Copyright © 2015 Elsevier Inc. All rights reserved.

  19. Sexuality and intimacy after gynecological cancer.

    PubMed

    Ratner, Elena S; Foran, Kelly A; Schwartz, Peter E; Minkin, Mary Jane

    2010-05-01

    Matters of sexuality and intimacy greatly impact quality of life of patients with gynecologic cancers. Vast amount of evidence exists showing that cancer dramatically impacts woman's sexuality, sexual functioning, intimate relationships and sense of self. Sexual functioning can be affected by illness, pain, anxiety, anger, stressful circumstances and medications. There is a growing acknowledgement that these needs are not being appropriately addressed by providers. With improvements in early detection, surgery and adjuvant therapy for gynecologic cancer, long term survival and cure are becoming possible. Quality of life is thus becoming a major issue for patients. Patients suffer from hot flashes, difficulty sleeping, loss of libido and intimacy, all resulting in significant morbidity and loss of quality of life. Using hormone replacement therapy in gynecologic cancer survivors is a topic a great debate. While limited studies are available to date, retrospective cohort reviews show no reported differences in overall or disease-free survival in patients using hormone replacements vs. controls in patients with ovarian cancer, endometrial cancer, cervical, vaginal or vulva cancer. Since safety of using HRT remains controversial and prospective studies are lacking, providers need to be able to provide alternatives to HRT. Centrally acting agents such as antiseizure agent gabapentin and selective serotonine re-uptake inhibitors, such as venlafaxine and fluoxitine have been demonstrated to show effectiveness in treating vasomotor symptoms and are easily tolerated. To address cardiovascular and osteoporosis risks of post-menopausal status, exercise, healthy diet, bisphosphonates, raloxifen and statins have been found to be effective. Psychotherapy plays an essential part in management of these issues. Review of the literature reveals recent trends among health psychologists to utilize psychoeducational interventions that include combined elements of cognitive and

  20. Potential Impact of Obstetrics and Gynecology Hospitalists on Safety of Obstetric Care.

    PubMed

    Srinivas, Sindhu K

    2015-09-01

    Staffing models are critical aspects of care delivery. Provider staffing on the labor and delivery unit has recently received heightened attention. Based on the general medicine hospitalist model, the obstetrics and gynecology hospitalist or laborist model of obstetric care was introduced more than a decade ago as a plausible model-of-care delivery to improve provider satisfaction, with the goal of also improving safety and outcomes through continuous coverage by providers whose sole focus was on the labor and delivery unit without other competing clinical duties. It is plausible that this model of provider staffing and care delivery will increase safety.

  1. Palonosetron versus other 5-HT₃ receptor antagonists for prevention of chemotherapy-induced nausea and vomiting in patients with hematologic malignancies treated with emetogenic chemotherapy in a hospital outpatient setting in the United States.

    PubMed

    Craver, Chris; Gayle, Julie; Balu, Sanjeev; Buchner, Deborah

    2011-01-01

    This study evaluated the rate of uncontrolled chemotherapy-induced nausea and vomiting (CINV) after initiating antiemetic prophylaxis with palonosetron versus other 5-HT₃ receptor antagonists (RAs) in patients diagnosed with hematologic malignancies (lymphoma and leukemia) and receiving highly emetogenic chemotherapy (HEC) or moderately emetogenic chemotherapy (MEC) in a hospital outpatient setting. Patients aged ≥ 18 years and diagnosed with hematologic malignancies initiating HEC or MEC and antiemetic prophylaxis with palonosetron (Group 1) and other 5-HT₃ RAs (Group 2) for the first time in a hospital outpatient setting between 4/1/2007 and 3/31/2009 were identified from the Premier Perspective Database. Within each cycle, CINV events were identified (in the hospital outpatient, inpatient, and emergency room settings) through ICD-9 codes for nausea, vomiting, and/or volume depletion (from each CT administration day 1 until the end of the CT cycle), or use of rescue medications (day 2 until the end of the CT cycle). Negative binomial distribution generalized linear multivariate regression model estimating the CINV event rate on CT, specific CT cycles, and cancer diagnosis (leukemia/lymphoma)-matched groups in the follow-up period (first of 8 cycles or 6 months) was developed. Of 971 identified patients, 211 initiated palonosetron (Group 1). Group 1 patients comprised of more females [50.2 vs. 41.4%; p = 0.0226], Whites [74.4 vs. 70.4%, and Hispanics [7.6 vs. 6.3%; all races p = 0.0105], received more HEC treatments [89.6 vs. 84.2%; all CT types p = 0.0129], and had more lymphoma diagnosed patients [89.6 vs. 76.3%; all cancer types p = 0.0033] at baseline. After controlling for differences in several demographic and clinical variables, the regression model predicted a 20.4% decrease in CINV event rate per CT cycle for Group 1 versus Group 2 patients. Study limitations include potential lack of generalizability, absence of data on certain

  2. [The typical pathway of a patient in short route outpatient surgery].

    PubMed

    Chabanais, Stéphane; Debris, Annie; Paulhia, Guylaine; Pignoux, Agnès; Godarc, Marylène

    2014-01-01

    The short route is an outpatient surgical unit characterised by immediate proximity to the operating theatre. It is an organisational and architectural concept in which the patient management aims to be personalised and safe. After the procedure, patients are monitored for as long as necessary, as with traditional outpatient surgery, before being discharged.

  3. Prophylactic Gynecologic Specimens from Hereditary Cancer Carriers.

    PubMed

    Shaw, Patricia A; Clarke, Blaise A

    2016-06-01

    Hereditary breast ovarian cancer and Lynch/hereditary nonpolyposis colorectal cancer syndrome account for most hereditary gynecologic cancers. In the absence of effective cancer screening and other preventative strategies, risk-reducing surgery in women who are known to be at genetic risk of BRCA-associated or of Lynch syndrome carcinomas is effective in significantly decreasing the lifetime risk of developing malignancy. Reflex genomic testing of high-grade ovarian cancers and reflex immunohistochemistry in endometrial cancers will lead to greater recognition of germline-associated cancers. Approaches to processing surgical specimens, the recognition and classification of cancer precursor lesions, and differentiation from their mimics are discussed. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Celiac disease and obstetrical-gynecological contribution

    PubMed Central

    Casella, Giovanni; Orfanotti, Guido; Giacomantonio, Loredana; Bella, Camillo Di; Crisafulli, Valentina; Villanacci, Vincenzo; Baldini, Vittorio; Bassotti, Gabrio

    2016-01-01

    Celiac disease (CD) shows an increased prevalence in female, particularly during the fertile period. Celiac disease should be researched in infertility, spontaneous and recurrent abortions, delayed menarche, amenorrhea, early menopause, and children with low birth-weight. Celiac disease is still little considered during the evaluation of infertility. Up to 50% of women with untreated CD refer an experience of miscarriage or an unfavorable outcome of pregnancy. Celiac patients taking a normal diet (with gluten) have a shorter reproductive period. Women with undiagnosed CD had a higher risk of small for gestation age infants very small for gestational age infants and pre-term birth when compared with women with noted CD. The link between NCGS and infertility is actually unknown. The goal of our work is to perform an actual review about this topic and to increase the awareness in the medical population to research celiac disease in selected obstetric and gynecological disorders. PMID:27895849

  5. Sexual and physical abuse and gynecologic disorders

    PubMed Central

    Schliep, K.C.; Mumford, Sunni L.; Johnstone, Erica B.; Peterson, C. Matthew; Sharp, Howard T.; Stanford, Joseph B.; Chen, Zhen; Backonja, Uba; Wallace, Maeve E.; Buck Louis, Germaine M.

    2016-01-01

    STUDY QUESTION Is sexual and/or physical abuse history associated with incident endometriosis diagnosis or other gynecologic disorders among premenopausal women undergoing diagnostic and/or therapeutic laparoscopy or laparotomy regardless of clinical indication? SUMMARY ANSWER No association was observed between either a history of sexual or physical abuse and risk of endometriosis, ovarian cysts or fibroids; however, a history of physical abuse was associated with a higher likelihood of adhesions after taking into account important confounding and mediating factors. WHAT IS KNOWN ALREADY Sexual and physical abuse may alter neuroendocrine-immune processes leading to a higher risk for endometriosis and other noninfectious gynecologic disorders, but few studies have assessed abuse history prior to diagnosis. STUDY DESIGN, SIZE, DURATION The study population for these analyses includes the ENDO Study (2007–2009) operative cohort: 473 women, ages 18–44 years, who underwent a diagnostic and/or therapeutic laparoscopy or laparotomy at 1 of the 14 surgical centers located in Salt Lake City, UT, USA or San Francisco, CA, USA. Women with a history of surgically confirmed endometriosis were excluded. PARTICIPANTS/MATERIALS, SETTING AND METHODS Prior to surgery, women completed standardized abuse questionnaires. Relative risk (RR) of incident endometriosis, uterine fibroids, adhesions or ovarian cysts by abuse history were estimated, adjusting for age, race/ethnicity, education, marital status, smoking, gravidity and recruitment site. We assessed whether a history of chronic pelvic pain, depression, or STIs explained any relationships via mediation analyses. MAIN RESULTS AND ROLE OF CHANCE 43 and 39% of women reported experiencing sexual and physical abuse. No association was observed between either a history of sexual or physical abuse, versus no history, and risk of endometriosis (aRR: 1.00 [95% confidence interval (CI): 0.80–1.25]); aRR: 0.83 [95% CI: 0.65–1

  6. Complications in gynecological minimal-access oncosurgery.

    PubMed

    Becker, Sven; De Wilde, Rudy Leon

    2016-08-01

    Complications are the limiting factors of all surgeries. More than performing the actual surgery, learning how to avoid complications before, during, and after surgery is the most important task of every surgeon. Severe complications can lead to patient death. Complications such as ureterovaginal fistulas, resulting from <2 s of inattentive preparation, can lead to years of hardship, suffering, accusation, and litigation. Excellent surgery is about performing the right surgery for the right patient without any complications. Minimally invasive surgery in complex cases is technically challenging. This article details the major causes of complications in laparoscopy for the gynecologic cancer patient and present strategies for prevention, early detection, and intra- and postoperative management.

  7. [Adolescent gynecology in the medical office].

    PubMed

    Hürlimann, Renate

    2013-09-04

    In the age group of adolescents occur some gynecological problems which present different than in adult women. One is heavy menstrual bleeding, another menstrual problem is life burdening dysmenorrhea. Girls often do not speak about, they do not know what is really normal. Malignant breast masses are very rare, mostly fibroadenoma or cysts are found. With childhood obesity PCOS is a rising hormonal disturbance with impact on future fertility. Counseling adolescents in contraception is another challenge, focused on adherence, chronic disease and disabled teenagers. Together with the risks of unintended pregnancy adolescents have a high risk of sexually transmitted infections. Recommending preservative use and HPV and Hepatitis B vaccination is very important. Cervical cancer screening should start at age 21, girls with special risks (immunodeficiency, very early sexual activity) starting individually at earlier age.

  8. Gynecological cancers: an alternative approach to healing

    PubMed Central

    Saso, Srdjan; Jones, Benjamin P; Bracewell-Milnes, Timothy; Huseyin, Gulsen; Boyle, Deborah C; Priore, Giuseppe Del; Smith, James Richard

    2017-01-01

    Grief and hope are two conflicting emotions that a patient recently diagnosed with cancer has to master. The real challenge for gynecologic oncologists is how to reach out. Conventional wisdom states that offering patients focus and belief when combating cancer in their lives allows them to embrace hope with greater confidence, which minimizes their grief. Three pictorial models are presented: ‘4-cusp approach’ model used at the initial consultation; ‘tapestry of bereavement or landscape of grief’ model at the postsurgery consultation; and ‘Venn-diagram’ model at any time during patient management. We have applied these models in our practice and believe that they can act as a fulcrum for the patient, the family and healthcare team around which therapy should be centered. PMID:28884005

  9. The debate over robotics in benign gynecology.

    PubMed

    Rardin, Charles R

    2014-05-01

    The debate over the role of the da Vinci surgical robotic platform in benign gynecology is raging with increasing fervor and, as product liability issues arise, greater financial stakes. Although the best currently available science suggests that, in the hands of experts, robotics offers little in surgical advantage over laparoscopy, at increased expense, the observed decrease in laparotomy for hysterectomy is almost certainly, at least in part, attributable to the availability of the robot. In this author's opinion, the issue is not whether the robot has any role but rather to define the role in an institutional environment that also supports the safe use of vaginal and laparoscopic approaches in an integrated minimally invasive surgery program. Programs engaging robotic surgery should have a clear and self-determined regulatory process and should resist pressures in place that may preferentially support robotics over other forms of minimally invasive surgery. Copyright © 2014 Mosby, Inc. All rights reserved.

  10. Inferior vena cava filter placement in the gynecologic oncology patient: A 15-year institutional experience.

    PubMed

    Dewdney, Summer B; Benn, Teri; Rimel, B J; Gao, Feng; Saad, Nael; Vedantham, Suresh; Mutch, David G; Zighelboim, Israel

    2011-05-01

    Venous thrombosis is a frequent complication of gynecologic cancer. Data regarding the use of inferior vena cava (IVC) filters in this population is limited. The aim of this study was to review our experience with gynecologic oncology patients who received an IVC filter, specifically to evaluate indications for filter placement and survival outcomes. This was a retrospective, single-institution study of patients who had an IVC filter placed after a histologically confirmed gynecologic malignancy. Patients were identified from a prospectively collected interventional radiology (IR) database. Clinicopathologic characteristics, procedure details, and outcome data were obtained from outpatient and inpatient medical records. Survival after IVC filter placement was analyzed using the Kaplan-Meier product limit method and compared by log-rank test. A total of 128 patients were identified and 103 were found to be eligible for analysis. Most patients had ovarian cancer (52%), followed by cervical cancer (25%) and endometrial cancer (21%). Two-thirds had advanced stage disease (III/IV). The procedure complication rate was 2%. Median survival after IVC filter placement was 7.8months (95% CI, 4.1-13.6). The most common indication for IVC filter placement was contraindication to anticoagulation secondary to hemorrhage (44%), followed by perioperative indications (30%) and failed anticoagulation (14%). There was no difference in survival by IVC filter placement indication (p=0.18). The majority of the IVC filters placed were permanent (90.5%) and in an infrarenal position (95.8%). There was no difference in survival according to specific thromboembolic event (DVT vs. PE vs. both). Patients able to receive anticoagulation after IVC filter placement had improved survival (HR 0.45, 95%CI 0.45-0.27, p=0.003). We present the largest series of gynecologic oncology patients treated with IVC filters. Long-term survival after IVC filter placement is uncommon. Patients who receive

  11. German gynecologic societies investigating their Nazi past.

    PubMed

    Frobenius, Wolfgang; Kinzelbach, Annemarie; Anthuber, Christoph; Dross, Fritz

    2014-11-01

    Research into the activities of German medical specialist associations during the Nazi period is still in its initial stages even today. In the field of gynecology and obstetrics as well, most representatives of the discipline continued to take an attitude based on "concealment and forgetting", even after the turn of the millennium. In order to break with this approach, the Bavarian Society for Obstetrics and Gynecology (Bayerische Gesellschaft für Geburtshilfe und Frauenheilkunde, BGGF) commissioned an interdisciplinary research group to focus on clarifying its Nazi past for the purposes of a history of the institution on the occasion of its centenary. The research was based on the Society's archive. When the files were found to show conspicuous gaps for the Nazi period, the investigation was extended into the role of BGGF representatives and members who were active at the time. In some cases, it was possible to draw on existing studies and to supplement the available information from additional archival sources. It was found that the BGGF started at a very early stage to marginalize and ignore its "non-Aryan" members. No official decision to exclude such members was apparently taken, however. Many representatives and honorary members of the society were involved in promoting and carrying out eugenic sterilizations, simultaneously conducting abortions on some victims, and they at least shared responsibility for forced abortions among Ostarbeiterinnen ("Eastern workers", forced laborers from Eastern Europe). Accompanying unethical research that was mainly intended to garner academic prestige for the physicians involved was never discussed at the Society's conferences. Representatives of the Society who were substantially incriminated were able to continue their careers almost without interruption after 1945.

  12. [Colpocytology in a preventive gynecological ambulatory service].

    PubMed

    Motta, E V; Fonseca, A M; Bagnoli, V R; Ramos, L; Pinotti, J A

    2001-01-01

    evaluate the results of Pap smear in women attended at a gynecology preventive ambulatory (University of São Paulo Medical School Clinical Hospital). 6821 women were submitted to a medical interview, clinical and gynecologic exam. Cervical and vaginal cytology (Pap smear) were analyzed according to the Papanicolaou method and classification. All women were grouped according to their age into three categories:under 40 years old, between 41 and 60 years and over 60 years. most of them, and mainly the younger ones, had been submitted to a previous Pap smear in a period shorter than 1 year (44.2%). The majority of women recognized the usefulness of the exam and knew its interval; the group that best knew its importance and interval was the one with ages between 41 and 60 years, while most women over 60 years did not know both its importance and interval. Cytological material was considered insufficient for analysis in 15,1% and inadequate in 1.1%, and for those with adequate material results were classes I (21.7%), II (59.9%), III (2.0%), IV (0.1%) and V (0.1%). Distribution of cervical intraepithelial neoplasia (CIN) were similar in the three groups. The main microbiologic findings was Gardnerella sp. (8,6%) and Human papillomavirus (HPV) incidence was significantly lower among women over 60 years. Cytological diagnoses of neoplastic modifications were performed in 2,2% and Gardnerella sp. was the most prevalent microbiologic agent. Distribution of HPV showed a decrease with age. Older women had lower knowledge on the importance of regular Pap smear examination.

  13. Extreme Sport/Adventure Activity Correlates in Gynecologic Cancer Survivors.

    PubMed

    Crawford, Jennifer J; Vallance, Jeff K; Holt, Nicholas L; Courneya, Kerry S

    2016-03-01

    We examined the demographic, medical and behavioral correlates of participation and interest in extreme sport/adventure activities (ESAA) in gynecologic cancer survivors. A random sample of 621 gynecologic cancer survivors in Alberta, Canada, completed a mailed self-report questionnaire assessing medical, demographic, and behavioral variables and participation and interest in ESAA. Multivariate analyses revealed that gynecologic cancer survivors were more likely to participate in ESAA if they met aerobic exercise guidelines (OR=1.75 [95%CI:1.02-2.99]), had better general health (OR=1.71 [95%CI: 1.01-2.90]), had cervical or ovarian cancer (OR=1.95 [95%CI:0.97-3.93]), were employed (OR=1.71 [95%CI:0.95-3.08]), and were of healthy weight (OR=1.58 [95%CI:0.93-2.68]). Moreover, gynecologic cancer survivors were more likely to be interested in trying an ESAA if they had cervical or ovarian cancer (OR=1.76 [95%CI:0.94-3.27]) and were meeting the strength exercise guidelines (OR=1.68 [95%CI:0.95-2.98]). Medical, demographic, and behavioral variables correlate with participation and interest in ESAA in gynecologic cancer survivors. The pattern of correlates suggests that gynecologic cancer survivors are more likely to participate in ESSA if they have the physical capability and financial resources. Interventions to promote ESAA in gynecologic cancer survivors need to address these 2 key barriers.

  14. [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.

  15. Profile of gynecologic malignancies reported at a tertiary care center in India over the past decade: comparative evaluation with international data.

    PubMed

    Agarwal, S; Malhotra, K P; Sinha, S; Rajaram, S

    2012-01-01

    Comprehensive statistics on gynecologic malignancies reported from India are deficient. This study was performed to ascertain the profile of gynecologic cancers reported at our center regarding incidence, histologic subtypes, frequency of involvement at various sites and stage at presentation. We endeavored to compare our data with gynecologic cancers reported at other national and international centers. Retrospective review of records of gynecologic cancers obtained from Departments of Pathology and Gynecology, at a tertiary care center, Delhi from January 2000 to December 2009 was performed. Comparison with international data was performed using Fishcher's exact test and chi square tests. A total of 1315 gynecologic cancers were reported. Cervical malignancies were the commonest at our center as compared to uterine malignancies in data from Surveillance, Epidemiology, and End Results (SEER) Program of United States and European Union. All malignancies except cervical cancers affected a younger age group at our center than in the US population. Cervical cancer presented at a relatively more advanced stage, ovarian cancers at more localized stages, whereas uterine cancers presented at similar stages as compared to Western data. Our registry presents composite data from North India. Higher age and advanced stage at presentation of cervical cancers suggests lacunae in screening programs available. Ovarian malignancies were more localized at presentation than in the Western population for which environmental or genetic factors may be causative.

  16. 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.

  17. Clinical practice recommendations for quality of life assessment in patients with gynecological cancer.

    PubMed

    Leppert, Wojciech; Gottwald, Leszek; Forycka, Maria

    2015-12-01

    Quality of life (QoL) is a multidimensional concept regarding self-assessment of patients' situation. Quality of life has not been clearly defined up to date, although it is clear that it is a subjective self-assessment that to a significant extent is determined by individual needs, beliefs, values, attitudes, which are changing with time. Health-related QoL comprises basic dimensions such as patients' performance status, physical, emotional, and social functioning, symptoms of the disease and adverse effects of treatment, spiritual (God and existential) and other dimensions. In women, the ovary, cervical, corpus uterus, vagina and vulva cancers deteriorate QoL by disease progression and consequences of treatment, also in cancer survivors. Common symptoms include the genito-urinary system, the lower gastrointestinal tract and peripheral neuropathies induced by chemotherapy. In young women, QoL is impaired by infertility, sexual problems and menopause symptoms. An overview of QoL questionnaires used in oncology with special regard to patients with gynecological tumors was conducted. A screening tool for psychological state assessment of oncology patients (distress thermometer), the Edmonton Symptom Assessment System (ESAS) and modular approach of QoL assessment recommended by the EORTC (European Organization for the Research and Treatment of Cancer) were presented. Practical guidelines were proposed to assess appropriately QoL in patients with gynecological cancers who stay at in-patient gynecology units and those treated at home and in an ambulatory care setting.

  18. Clinical practice recommendations for quality of life assessment in patients with gynecological cancer

    PubMed Central

    Gottwald, Leszek; Forycka, Maria

    2015-01-01

    Quality of life (QoL) is a multidimensional concept regarding self-assessment of patients’ situation. Quality of life has not been clearly defined up to date, although it is clear that it is a subjective self-assessment that to a significant extent is determined by individual needs, beliefs, values, attitudes, which are changing with time. Health-related QoL comprises basic dimensions such as patients’ performance status, physical, emotional, and social functioning, symptoms of the disease and adverse effects of treatment, spiritual (God and existential) and other dimensions. In women, the ovary, cervical, corpus uterus, vagina and vulva cancers deteriorate QoL by disease progression and consequences of treatment, also in cancer survivors. Common symptoms include the genito-urinary system, the lower gastrointestinal tract and peripheral neuropathies induced by chemotherapy. In young women, QoL is impaired by infertility, sexual problems and menopause symptoms. An overview of QoL questionnaires used in oncology with special regard to patients with gynecological tumors was conducted. A screening tool for psychological state assessment of oncology patients (distress thermometer), the Edmonton Symptom Assessment System (ESAS) and modular approach of QoL assessment recommended by the EORTC (European Organization for the Research and Treatment of Cancer) were presented. Practical guidelines were proposed to assess appropriately QoL in patients with gynecological cancers who stay at in-patient gynecology units and those treated at home and in an ambulatory care setting. PMID:26848300

  19. The experience of lower limb lymphedema for women after treatment for gynecologic cancer.

    PubMed

    Ryan, Mary; Stainton, M Colleen; Jaconelli, Carmel; Watts, Sally; MacKenzie, Patricia; Mansberg, Tamar

    2003-01-01

    To describe women's experiences with lower limb lymphedema to inform both preventive and management clinical practices. A retrospective survey. The gynecology/oncology unit of a tertiary referral women's hospital in Australia. 82 women who developed lower limb lymphedema after surgical and radiation treatment for gynecologic cancers. Structured interviews. Psychosocial and emotional impact, physical effects, knowledge, support, treatment modalities. Women identified changes in appearance and sensation in the legs and the triggers that both preceded and exacerbated symptoms. Women described seeking help and receiving inappropriate advice with as many as three assessments prior to referral to lymphedema specialists. Many women implemented self-management strategies. Lower limb lymphedema had an impact on appearance, mobility, finances, and self-image. Increasing longevity after gynecologic oncology treatment requires all practitioners to be aware of known or potential triggers of lower limb lymphedema and the appropriate referral and management strategies available. Women at risk need to know early signs and symptoms and where to seek early care. The role of nursing in acute and community care of women at risk for developing lower limb lymphedema includes (a) engaging women in protecting their legs from infection or trauma pre- and postoperatively, (b) providing nursing care and education during the pre- and postoperative phases, and (c) ensuring that women being discharged are aware of early signs and symptoms of lower limb lymphedema and how to access qualified, specialized therapists so that early and effective management can be initiated.

  20. Perception of naturopathy for female patients with metastatic gynecological cancer: A qualitative study.

    PubMed

    Legenne, Myriam; Chirac, Anne; Ruer, Murielle; Reix, Fanny; Filbet, Marilène

    2015-12-01

    Women with gynecological cancer have been reported as very high users of complementary medicine. The goal of our study was to explore the perceptions of patients with an advanced gynecological cancer who use naturopathy as complementary medicine. We were looking more specifically at patients' opinions on the effect of naturopathy on their quality of life and its relation to conventional oncological treatments. This pilot qualitative study used semistructured interviews, and data were analyzed using grounded theory and qualitative methods. The main criterion for inclusion in the study was the use of naturopathy as a treatment complementary to conventional cancer treatment for gynecological metastatic cancer on the oncology day care unit. Six patients were included until data saturation. They express the physical and psychological impact of treatments and disease. Usually, chemotherapy is perceived as something that may be curative or may at least lead to remission. Unlike conventional treatments, naturopathy is not perceived as drugs, and it is seen as a way to relieve symptoms, improve well-being, and as a way of enabling them to take an active decision-making role in their care journey. Patients want to have more information about naturopathy. This study suggests that patients are aware of the benefits of a specific cancer treatment as chemotherapy, but they resort to naturopathy for symptom control, and also to take a more active role during treatment.

  1. 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.

  2. [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.

  3. The impact of robotic surgery on gynecologic oncology.

    PubMed

    Nick, Alpa M; Ramirez, Pedro T

    2011-09-01

    The objective of this article was to review the published scientific literature pertaining to robotic surgery and its applications in gynecologic malignancies and to summarize the impact of robotic surgery on the field of gynecologic oncology. Summarizing data from different gynecologic disease-sites, robotic-assisted surgery is safe, feasible, and demonstrates equivalent histopathologic and oncologic outcomes. In general, benefits to robotic surgery include decreased blood loss, fewer perioperative complications and decreased length of hospital stay. Disadvantages include accessibility to robot surgical systems, decreased haptic sensation and fixed cost as well as cost of disposable equipment. As robotic surgery becomes readily available it will be imperative to develop standardized training modalities. Further research is needed to validate the role of robotic surgery in the treatment of gynecologic malignancies.

  4. Differences in skin flora between inpatients and chronically ill outpatients.

    PubMed

    Larson, E L; Cronquist, A B; Whittier, S; Lai, L; Lyle, C T; Della Latta, P

    2000-01-01

    Changes in skin flora have been reported among hospitalized and critically ill patients, but little is known about whether these changes are associated with hospitalization or with chronic, serious illness. The purpose of this survey was to compare skin flora of chronically ill outpatients and inpatients. Aerobic skin flora of forearm and midsternum of 250 patients in an intensive care unit and 251 outpatients was sampled by contact plates. Mean colony-forming units were 160.6, forearm; 229. 4, sternum (P <.000). In logistic regression analysis, patients in the medical intensive care unit were significantly more likely to have high counts on the arm (odds ratio, 2.48; 95% confidence interval: 1.34-4.43; P =.004), and blacks were significantly more likely to have higher counts on the sternum when compared with other ethnic groups (odds ratio, 1.92; confidence interval: 1.18-3.11; P =. 009). No differences were noted between inpatients or outpatients in prevalence of methicillin-sensitive Staphylococcus aureus, but inpatients were more likely to carry methicillin-resistant Staphylococcus aureus (arm, P =.007; sternum, P =.02). Outpatients had a higher prevalence of micrococci and gram-negative bacteria at both skin sites (all P <.01) and yeast at the sternal site (P =.007). This comparison provides data to differentiate between effects of hospitalization and effects of chronic illness on skin flora.

  5. 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.

  6. The principles and practice of ultrasonography in obstetrics and gynecology

    SciTech Connect

    Sanders, R.C.; James, A.E.

    1985-01-01

    This is the latest edition of a reference on diagnostic ultrasound in obstetrics and gynecology. Chapters have been added on infertility, legal aspects of ultrasound, and interventional techniques. Descriptions of instrumentation, physics and bioeffects, measurement data and normal anatomy in the fetus are given. There is a section on fetal anomalies and the investigation and management of various obstetrical problems, such as multiple pregnancy and hydatidiform mole. Coverage of gynecological ultrasound includes normal pelvic anatomy, pelvic masses, pelvic inflammatory disease, and breast evaluation.

  7. Surveillance and Care of the Gynecologic Cancer Survivor

    PubMed Central

    MacLaughlin, Kathy L.; Long, Margaret E.; Pruthi, Sandhya; Casey, Petra M.

    2015-01-01

    Abstract Background: Care of the gynecologic cancer survivor extends beyond cancer treatment to encompass promotion of sexual, cardiovascular, bone, and brain health; management of fertility, contraception, and vasomotor symptoms; and genetic counseling. Methods: This is a narrative review of the data and guidelines regarding care and surveillance of the gynecologic cancer survivor. We searched databases including PubMed, Cochrane, and Scopus using the search terms gynecologic cancer, cancer surveillance, and cancer survivor and reached a consensus for articles chosen for inclusion in the review based on availability in the English language and publication since 2001, as well as key older articles, consensus statements, and practice guidelines from professional societies. However, we did not undertake an extensive systematic search of the literature to identify all potentially relevant studies, nor did we utilize statistical methods to summarize data. We offer clinical recommendations for the management of gynecologic cancer survivors based on review of evidence and our collective clinical experience. Results: Key messages include the limitations of laboratory studies, including CA-125, and imaging in the setting of gynecologic cancer surveillance, hormonal and non-hormonal management of treatment-related vasomotor symptoms and genitourinary syndrome of menopause, as well as recommendations for general health screening, fertility preservation, and contraception. Conclusions: A holistic approach to care extending beyond cancer treatment alone benefits gynecologic cancer survivors. In addition to surveillance for cancer recurrence and late treatment side effects, survivors benefit from guidance on hormonal, contraceptive, and fertility management and promotion of cardiovascular, bone, brain, and sexual health. PMID:26208166

  8. Helical computed tomography in differentiating appendicitis and acute gynecologic conditions.

    PubMed

    Rao, P M; Feltmate, C M; Rhea, J T; Schulick, A H; Novelline, R A

    1999-03-01

    To determine the accuracy and effect of helical computed tomography (CT) in women clinically suspected of having either appendicitis or an acute gynecologic condition. One hundred consecutive nonpregnant women suspected of having appendicitis or an acute gynecologic condition prospectively had helical CT. Interpretations were correlated with surgical and pathologic findings (41 cases) and clinical follow-up for at least 2 months (59 cases). The accuracy for confirming or excluding both appendicitis and acute gynecologic conditions was determined. The effect on patient care was determined by comparing pre-CT plans with actual treatment. Thirty-two women had appendicitis, 15 had acute gynecologic conditions, 27 had other specific diagnoses, and 26 had nonspecific abdominal pain. For diagnosing appendicitis or acute gynecologic conditions, CT had 100% and 87% sensitivity, 97% and 100% specificity, 94% and 100% positive predictive value, 100% and 98% negative predictive value, and 98% and 98% accuracy, respectively. After CT was done, 36 planned hospital admissions, 25 planned hospital observations, and six planned appendectomies were deferred; six women had alternative surgical procedures on the basis of CT results. One patient had an unnecessary appendectomy on the basis of CT findings. Helical CT is an excellent imaging option for differentiating appendicitis from most acute gynecologic conditions.

  9. The role of consulting psychiatrists for obstetric and gynecologic inpatients.

    PubMed

    Lin, Huang-Li; Chou, Hung-Hsueh; Liu, Chia-Yih; Hsu, Shi-Chieh; Hsiao, Mei-Chun; Juang, Yeong-Yuh

    2011-01-01

    The purpose of this study was to investigate the consultation psychiatry service to the Obstetrics and Gynecology Department in a general hospital, focusing on referral patterns and consultation recommendations. A retrospective review of the medical charts and consultation records of obstetric and gynecological patients referred for psychiatric consultation from Dec. 2003 to Nov. 2009 was performed. One hundred and eleven patients were referred during the 6-year period, a psychiatric referral rate of 0.11% among 99,098 obstetric and gynecologic admissions. Obstetric and gynecologic consultations comprised 0.64% of all psychiatric consultations. The most common reasons for referral were depression (52.25%), past psychiatric history (31.53%), insomnia (29.73%) and confusion (24.32%). The most common DSM-IV psychiatric diagnoses were depressive disorder (37.84%), schizophrenia and other psychoses (20.72%), delirium (17.12%) and adjustment disorder (10.81%). The most frequent physical diagnoses of referred patients were neoplasms (72.97%), infectious diseases (42.34%) and complications of pregnancy and puerperium (17.12%). Recommendations included pharmacological intervention (89.19%) and psychological management (72.07%). The psychiatric referral rate of obstetric and gynecological inpatients was relatively low compared with that of other departments. More collaboration and liaison between gynecologists and consultation psychiatrists may provide better care for obstetric and gynecological inpatients.

  10. 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

  11. Compliance with research standards within gynecologic oncology fellowship: A Gynecologic Oncology Fellowship Research Network (GOFRN) study.

    PubMed

    Moulton, Laura J; Michener, Chad M; Levinson, Kimberly; Cobb, Lauren; Tseng, Jill; Jernigan, Amelia

    2017-09-01

    Participation in clinical and basic science research is emphasized in gynecologic oncology training. We sought to identify trends in adherence to expected research practices and reasons for non-adherence among gynecologic oncology fellows. An anonymous 31-question online survey assessing academic behaviors, including IRB compliance, authorship assignment, data sharing, and potential barriers to non-adherence was distributed to all SGO gynecologic oncology fellow members in July 2016. Descriptive statistics and univariate analyses were performed. Of 190 members, 35.3% (n=67) responded. 73% (n=49) of respondents reported personal non-compliance and 79.1% (n=53) reported having witnessed others being non-complaint with at least one expected research practice. Areas of compliance failure included changing a research question without appropriate IRB amendment (20%; n=14), conducting research under a nonspecific IRB (13.9%; n=9), and performing research without IRB approval (6.1%; n=4). Longer institutional time for IRB approval was significantly associated with IRB non-adherence (p<0.05). First year fellows were more likely to use a nonspecific IRB (p=0.04) or expand a question without amending the IRB (p=0.04). When asked about storage of protected health information (PHI) for research, 53% reported non-secure storage with 17.1% (n=6) having done so for >1000 patients. Thirty respondents (45.5%) assigned authorship to someone who failed to meet ICMJE criteria and twelve (18.5%) accepted authorship without meeting ICMJE criteria. Most commonly cited reasons for non-adherence were: cumbersome IRB processes (80.3%), pressure from senior authors (78.8%), fear of someone else publishing first, (74.2%) and lack of support navigating appropriate research practices (71.2%). Fellow non-compliance with expected research practices is high, particularly with regards to secure storage of PHI and appropriate authorship assignment. Time-consuming and cumbersome IRB procedures

  12. Outpatient mastectomy: clinical, payer, and geographic influences.

    PubMed

    Case, C; Johantgen, M; Steiner, C

    2001-10-01

    To determine (1) the use of outpatient services for all surgical breast procedures for breast cancer and (2) the influence of payer and state on the use of outpatient services for complete mastectomy in light of state and federal length-of-stay managed care legislation. Healthcare Cost and Utilization Project representing all discharges from hospitals and ambulatory surgery centers for five states (Colorado, Connecticut, Maryland, New Jersey, and New York) and seven years (1990-96). Longitudinal, cross-sectional analyses of all women undergoing inpatient and outpatient complete mastectomy (CMAS), subtotal mastectomy (STMAS), and lumpectomy (LUMP) for cancer were employed. Total age-adjusted rates and percentage of outpatient CMAS, STMAS, and LUMP were compared. Independent influence of state and HMO payer on likelihood of receiving an outpatient CMAS was determined from multivariate models, adjusting for clinical characteristics (age < 50 years, comorbidity, metastases, simple mastectomy, breast reconstruction) and hospital characteristics (teaching, ownership, urban). In 1993, 1 to 2 percent of CMASs were outpatient in all states. By 1996, 8 percent of CMASs were outpatient in Connecticut, 13 percent were outpatient in Maryland, and 22 percent were outpatient in Colorado. In comparison, LUMPs were 78 to 88 percent outpatient, and by 1996, 43 to 72 percent of STMASs were outpatient. In 1996, women were 30 percent more likely to receive an outpatient CMAS in New York, 2.5 times more likely in Connecticut, 4.7 times more likely in Maryland, and 8.6 times more likely in Colorado compared to New Jersey. In addition, women with Medicare, Medicaid, or private commercial insurance were less likely to receive an outpatient CMAS compared to women with an HMO payer. LUMP is an outpatient procedure, and STMAS is becoming primarily outpatient. CMAS, while still primarily inpatient, is increasingly outpatient in some states. Although clinical characteristics remain important

  13. Color Doppler sonography in obstetrics and gynecology.

    PubMed

    Fleischer, Arthur C; Andreotti, Rochelle F

    2005-09-01

    This review aims to provide the reader with an overview of the present and future clinical applications in color Doppler sonography for the evaluation of vascularity and blood flow within the uterus (both gravid and nongravid), ovaries, fetus and placenta. The clinical use of color Doppler sonography has been demonstrated within many organ systems. Color Doppler sonography has become an integral part of cardiovascular imaging. Significant improvements have recently occurred, improving the visualization and evaluation of intra-organ vascularity, resulting from enhancements in delineation of tissue detail through electronic compounding and harmonics, as well as enhancements in signal processing of frequency- and/or amplitude-based color Doppler sonography. Spatial representation of vascularity can be improved by utilizing 3D and 4D (live 3D) processing. Greater sensitivity of color Doppler sonography to macro- and microvascular flow has provided improved anatomic and physiologic assessment throughout pregnancy and for pelvic organs. The potential use of contrast enhancement is also mentioned as a means to further differentiate benign from malignant ovarian lesions. The rapid development of these new sonographic techniques will continue to enlarge the scope of clinical applications in a variety of obstetric and gynecologic disorders.

  14. [SENTINEL LYMPH NODES DISSECTION IN GYNECOLOGICAL MALIGNANCIES].

    PubMed

    Naaman, Yael; Goldenhersh, Limor; Ben-Arie, Alon

    2017-02-01

    During the last decade sentinel lymph nodes biopsy has become an essential part of primary surgical treatment in a number of malignancies including breast cancer, melanoma and head-and-neck malignancies. Dye or radioactive substances are injected at the primary tumor site, followed by pre-operative and intra-operative mapping. During surgery only positive lymph nodes are being dissected instead of a complete dissection of the lymphatic basin. The advantages of sentinel lymph nodes dissection are reducing the side effects of extensive lymph nodes dissection, while maintaining high detection rates and sensitivity in identifying cases with lymphatic tumor spread. In the past years, the use of sentinel lymph nodes biopsy has also been incorporated in the treatment of gynecological malignancies. In vulvar cancer, it has been shown that sentinel lymph nodes biopsy is correlated with the same survival and recurrence rates as full groin lymph nodes dissection, while substantially lowering complications and especially morbid lymphedema. Preliminary experience in cervical cancer and carcinoma of the endometrium also displays the feasibility and liability of this method. Yet, there are still several controversies regarding the optimal detection method, site of injection and its oncological safety. In this article we present a review of the current literature on this evolving field.

  15. Interstitial therapy of perineal and gynecological malignancies.

    PubMed

    Martinez, A; Herstein, P; Portnuff, J

    1983-03-01

    Thirty-five patients, 38 to 88 years of age, were treated with 125-Iodine or 192-Iridium interstitial implants at Stanford University Medical Center between July 1974, and December, 1978. There were 25 primary epithelial malignancies, eight extensions from intrapelvic organs and two metastatic tumors (hypernephroma and Hodgkin's disease). The involved sites were: urethra (6 patients); vulva (9 patients); vagina (8 patients); anus (7 patients); cervix (5 patients). Implantation was usually performed to treat evident or microscopic disease in conjunction with external beam pelvic treatment with or without local excision. Computerized implant preplanning was used. 125-Iodine seeds were inserted either directly or within absorbable suture Polyglactin 910; 192-Iridium in nylon carriers was placed by suture or transperineal template. Two patients were lost to follow-up leaving 33 patients, 27 of whom are alive and free of local disease from 37 to 76 months. The overall local control rate was 88%, or 29/33 patients. All four local recurrences appeared before 24 months. Minor complications included: 10 patients with transient mucositis, four with superficial ulcers, and one patient with infection at the implanted site. Two major complications occurred: a necrotic rectal ulcer requiring a colostomy and a contracted, painful bladder necessitating a urinary diversion. We conclude that in selected cases interstitial irradiation provides good local control of perineal and gynecological malignancies with low morbidity in this elderly and quite often fragile group of patients.

  16. [Gynecology and obstetrics in Ancient Rome].

    PubMed

    Dumont, M

    1992-10-01

    Gods and Goddesses were invoked by the Romans for the termination of a good delivery. Diana, Juno, Lucina and Cybele were the preferred ones. Sterility was sometimes treated by the whip of the Lupercali of ministers of Pan. The first doctors in Rome were coming from Greece. Celsus, Pliny the Elder were encyclopedists, Rufus an anatomist, Dioscorides a pharmacologist. Archigenes, Aretaeus and Antyllus surgeons. Soranus from Ephesus, was the first to recommend podalic version. His works was a long time buried in a profound oblivion and discovered by scholars during the nineteenth century. Galen was looked as the most famous medical man after Hippocrates. During the Roman Empire of Occident (Byzantine Empire), Oribasius, Aurelianus Caelius, Moschion and above all Aetius and Paul of Aegina wrote many works which were many times plagiarized. Roman laws concerning public health were severe. Midwives took an important action in the care of pregnant women. Roman poets as Plautus, Terence, Lucilius, Catullus, Virgil, Tibullus, Ovid and Martial were many times concerned in their writings with gynecologic or obstetric subjects. Children were easily forsaken. Three Emperors, Trajan, Marcus-Aurelius and Alexander Severius, a writer, Aulu-Gelles, and a rhetor, Quintilian, took protection of them.

  17. New radiation techniques in gynecological cancer.

    PubMed

    Ahamad, A; Jhingran, A

    2004-01-01

    Radiation therapy has been a major therapeutic modality for eradicating malignant tumors over the past century. In fact, it was not long after the discovery of radium that the first woman with cervical cancer underwent intracavitary brachytherapy. Progress in the way that this cytotoxic agent is manipulated and delivered has seen an explosive growth over the past two decades with technological developments in physics, computing capabilities, and imaging. Although radiation oncologists are educated in and familiar with the wealth of new revolutionary techniques, it is not easy for other key members of the team to keep up with the rapid progress and its significance. However, to fully exploit these enormous gains and to communicate effectively, medical and gynecological oncologists are expected to be aware of state-of-the-art radiation oncology. Here, we elucidate and illustrate contemporary techniques in radiation oncology, with particular attention paid to the external beam radiotherapy used for adjuvant and primary definitive management of malignancies of the female pelvis.

  18. Retention in outpatient drug free treatment clinics.

    PubMed

    Joe, G W; Singh, B K; Garland, J; Lehman, W; Sells, S B; Seder, P

    1983-01-01

    This study examined time in treatment and the percentage of clients who quit or were expelled from drug treatment clinics as dependent measures in a general model including socioecological aspects of the clinic neighborhood environment, the clinic structure (attributes, e.g., size, and services and staffing), and the client composition of the clinic (sociodemographic and deviance). In this study the clinic was the unit of analysis. The data were analyzed by means of path analysis, for (1) drug free outpatient, nonopiate orientation (DFO-N) and (2) drug free outpatient, opiate orientation (DFO-O). There were 204 DFO-N and 130 DFO-O clinics. The path analytic model proved to be useful for the explanation of clinic retention outcomes. The socioecological variables predicted the types of clients who entered treatment. These in turn along with clinic attributes were significant predictors of clinic retention. Clinic attributes also predicted clinic services and staffing. The results suggested that both clinic variables and client composition variables are important predictors of clinic retention.

  19. Postoperative nausea and vomiting: comparison of the effect of postoperative meperidine or morphine in gynecologic surgery patients.

    PubMed

    Ezri, Tiberiu; Lurie, Samuel; Stein, Arnold; Evron, Shmuel; Geva, Daniel

    2002-06-01

    To evaluate the incidence and severity of postoperative nausea and vomiting in women receiving postoperative intravenous morphine or meperidine following gynecologic surgery. Prospective, double-blind, randomized study. Tertiary-care academic medical center. 200 ASA physical status I, II, and III patients scheduled for elective gynecologic surgery. Patients received either postoperative IV morphine (n = 100) or meperidine (n = 100) following gynecologic surgery. We compared pain scores, sedation scores, nausea scores, well-being scores, vomiting rate, and patient satisfaction in both groups 15, 30, 60, and 120 minutes after arrival in the postoperative anesthesia care unit. The vomiting rate was 8/100 versus 7/100 (at 15 min), 4/100 versus 26/100 (at 30 min) (p < 0.05), 3/100 versus 23/100 (at 60 min) (p < 0.05), and 0/100 versus 0/100 (at 120 min) in the morphine or meperidine groups, respectively. The pain and sedation scores were similar in both groups. No major complications were noted in either group. Our study demonstrates an advantage of the use of morphine rather than meperidine for pain control in the immediate postoperative period following gynecologic surgery.

  20. 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

  1. Factors influencing same-day hospital discharge and risk factors for readmission after robotic surgery in the gynecologic oncology patient population.

    PubMed

    Rivard, Colleen; Casserly, Kelly; Anderson, Mary; Isaksson Vogel, Rachel; Teoh, Deanna

    2015-02-01

    To determine the factors that allow for a safe outpatient robotic-assisted minimally invasive gynecologic oncology surgery procedure. Retrospective chart review (Canadian Task Force classification II-1). University hospital. All patients (140) undergoing robotic-assisted minimally invasive surgery with the gynecologic oncology service from January 1, 2013, to December 31, 2013. Risk factors for unsuccessful discharge within 23 hours of surgery and same-day discharge were assessed using logistic regression models. All patients were initially scheduled for same-day discharge. The outpatient surgery group was defined by discharge within 23 hours of the surgery end time, and a same-day surgery subgroup was defined by discharge before midnight on the day of surgery. One hundred fifteen (82.1%) were successfully discharged within 23 hours of surgery, and 90 (64.3%) were discharged the same day. The median hospital stay was 5.3 hours (range, 1-48 hours). Unsuccessful discharge within 23 hours was associated with a preoperative diagnosis of lung disease and intraoperative complications; unsuccessful same-day discharge was associated with older age and later surgery end time. Only 2 patients (1.4%) were readmitted to the hospital within 30 days of surgery. Outpatient robotic-assisted minimally invasive surgery is safe and feasible for most gynecologic oncology patients and appears to have a low readmission rate. Older age, preoperative lung disease, and later surgical end time were risk factors for prolonged hospital stay. These patients may benefit from preoperative measures to facilitate earlier discharge. Copyright © 2015 AAGL. Published by Elsevier Inc. All rights reserved.

  2. Interoperability evaluation case study: an Obstetrics-Gynecology Department and related Information Systems.

    PubMed

    Vida, Mihaela; Stoicu-Tivadar, Lăcrămioara; Blobel, Bernd; Bernad, Elena

    2013-01-01

    The paper presents the steps and metrics for evaluating the interoperability of an Obstetrics-Gynecology Department Information System applied on Bega Clinic Timisoara regarding its readiness for interoperability in relation with similar systems. The developed OGD IS was modeled starting from the Generic Component Model and sends information to other medical units using the HL7 Clinical Document Architecture and Continuity of Care Document standards. The data for evaluation are real, collected between 2009 and 2010 from Bega Clinic Timisoara. The results were relatively good for the investigated data and structure.

  3. 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.

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

    PubMed

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

    2017-09-14

    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-post curriculum 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 three medical emergency scenarios (seizure, over-sedation/cardiopulmonary arrest and hemorrhage) in the simulation lab both before and after completing the curriculum. Evaluators, blinded to training level, scored the simulation performance videotapes using a graded rubric with critical action checklists. Scenario scores were assigned in five domains and globally. Paired t-tests were used to determine differences pre- and post- curriculum. Thirty residents completed the curriculum and pre- and post-curriculum testing. Subjects' objective performance scores improved in all five domains (p < .05) in all scenarios. When stratified by level of training, all participants demonstrated global improvement. When stratified by prior outpatient simulation experience, subjects with prior experience improved in all but management of excess sedation. Pre- and post-curriculum self-efficacy evaluations demonstrated improvement in seven of eight 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=0.001) and ability to communicate well in emergency situations (p<0.001). A simulation

  5. Estimation of the Optimal Brachytherapy Utilization Rate in the Treatment of Gynecological Cancers and Comparison With Patterns of Care

    SciTech Connect

    Thompson, Stephen R.; Delaney, Geoff P.; Gabriel, Gabriel S.; Jacob, Susannah; Das, Prabir; Barton, Michael B.

    2013-02-01

    Purpose: We aimed to estimate the optimal proportion of all gynecological cancers that should be treated with brachytherapy (BT)-the optimal brachytherapy utilization rate (BTU)-to compare this with actual gynecological BTU and to assess the effects of nonmedical factors on access to BT. Methods and Materials: The previously constructed inter/multinational guideline-based peer-reviewed models of optimal BTU for cancers of the uterine cervix, uterine corpus, and vagina were combined to estimate optimal BTU for all gynecological cancers. The robustness of the model was tested by univariate and multivariate sensitivity analyses. The resulting model was applied to New South Wales (NSW), the United States, and Western Europe. Actual BTU was determined for NSW by a retrospective patterns-of-care study of BT; for Western Europe from published reports; and for the United States from Surveillance, Epidemiology, and End Results data. Differences between optimal and actual BTU were assessed. The effect of nonmedical factors on access to BT in NSW were analyzed. Results: Gynecological BTU was as follows: NSW 28% optimal (95% confidence interval [CI] 26%-33%) compared with 14% actual; United States 30% optimal (95% CI 26%-34%) and 10% actual; and Western Europe 27% optimal (95% CI 25%-32%) and 16% actual. On multivariate analysis, NSW patients were more likely to undergo gynecological BT if residing in Area Health Service equipped with BT (odds ratio 1.76, P=.008) and if residing in socioeconomically disadvantaged postcodes (odds ratio 1.12, P=.05), but remoteness of residence was not significant. Conclusions: Gynecological BT is underutilized in NSW, Western Europe, and the United States given evidence-based guidelines. Access to BT equipment in NSW was significantly associated with higher utilization rates. Causes of underutilization elsewhere were undetermined. Our model of optimal BTU can be used as a quality assurance tool, providing an evidence-based benchmark against

  6. 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

  7. 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.

  8. Problems in outpatients with laryngeal hyperplastic lesions.

    PubMed

    Goldman, N C

    1997-01-01

    The care of outpatients with epithelial hyperplastic lesions of the larynx presents problems of classification, treatment, continued surveillance and prognosis. One hundred patients who underwent microlaryngoscopy and vocal cord stripping from 1990 through 1995 were studied retrospectively with a follow-up period of 8-156 months. Twenty-eight patients with biopsy proven epithelial hyperplastic lesions were given 21 different pathological diagnoses exclusive of invasive carcinoma following 52 operative microlaryngoscopies. Prognosis was inferred and treatment commenced primarily on the basis of the pathology report. Microlaryngoscopy and stripping with and without the carbon dioxide laser, "watchful waiting," radiation therapy, and partial laryngectomy were all used as treatment modalities. Controversy remains as of choice of treatment. Encouraging the patient to discontinue smoking is an integral part of treatment; however, most patients continue to smoke. Recent changes in the United States health care delivery system present additional problems in surveillance of the patient.

  9. Learning Needs of Gynecologic Cancer Survivors.

    PubMed

    Akkuzu, Gulcihan; Kurt, Gonul; Guvenc, Gulten; Kok, Gulsah; Simsek, Sevgi; Dogrusoy, Safiye; Ayhan, Ali

    2016-10-15

    To define the learning needs of patients with gynecological oncology. The study was performed as a descriptive study. A total of 92 patients were participated. Data were collected using Patient Learning Needs Scale (PLNS). The Pearson correlation test, independent sample t test, and analysis of one-way of variance (ANOVA) followed by Tukey's-B post hoc tests were used for statistical analyses by the SPSS 15.0 software package. The mean age of women's was 50.37 ± 12.20 years. The women's diagnoses were cervical (45.7 %), ovarian (27.2 %), and endometrial (19.6 %) cancers. The most frequently stated learning needs topics were coping with pain (47.8 %), daily living activities (46.2 %), and psychological support (44.6 %). The mean PLNS score of women was 212.56 ± 35.83. The mean subscales scores of PLNS were 34.06 ± 7.29 for medicines, 38.34 ± 6.74 for daily living activities, and 24.68 ± 5.41 for community subscales. Women who graduated from elementary school needed more education than the women with higher education (p < 0.001). Learning needs level of the women are high and related to increase quality of life, medicine usage, complications of treatment, skin problems, pain management, and supportive care. As a healthcare professional, we should plan and develop educational programs in order to adequately inform patients about their learning needs.

  10. 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.

  11. Three-Dimensional Imaging in Gynecologic Brachytherapy: A Survey of the American Brachytherapy Society

    SciTech Connect

    Viswanathan, Akila N.; Erickson, Beth A.

    2010-01-15

    Purpose: To determine current practice patterns with regard to three-dimensional (3D) imaging for gynecologic brachytherapy among American Brachytherapy Society (ABS) members. Methods and Materials: Registered physician members of the ABS received a 19-item survey by e-mail in August 2007. This report excludes physicians not performing brachytherapy for cervical cancer. Results: Of the 256 surveys sent, we report results for 133 respondents who perform one or more implantations per year for locally advanced cervical cancer. Ultrasound aids 56% of physicians with applicator insertion. After insertion, 70% of physicians routinely obtain a computed tomography (CT) scan. The majority (55%) use CT rather than X-ray films (43%) or magnetic resonance imaging (MRI; 2%) for dose specification to the cervix. However, 76% prescribe to Point A alone instead of using a 3D-derived tumor volume (14%), both Point A and tumor volume (7%), or mg/h (3%). Those using 3D imaging routinely contour the bladder and rectum (94%), sigmoid (45%), small bowel (38%), and/or urethra (8%) and calculate normal tissue dose-volume histogram (DVH) analysis parameters including the D2cc (49%), D1cc (36%), D0.1cc (19%), and/or D5cc (19%). Respondents most commonly modify the treatment plan based on International Commission on Radiation Units bladder and/or rectal point dose values (53%) compared with DVH values (45%) or both (2%). Conclusions: More ABS physician members use CT postimplantation imaging than plain films for visualizing the gynecologic brachytherapy apparatus. However, the majority prescribe to Point A rather than using 3D image based dosimetry. Use of 3D image-based treatment planning for gynecologic brachytherapy has the potential for significant growth in the United States.

  12. The development of outpatient milestones.

    PubMed

    Rosen, Donald E

    2014-06-01

    The Milestones work group sought to establish a baseline of expected competence development across the six core competencies. The subcompetencies and milestones reflect the committee's work with input from ABPN, AADPRT, and AAP. They are intended to serve not only as consistent markers of progress nationwide but also as a basis by which individual programs can build their own milestones that reflect unique qualities of any given learning environment. The Milestones work group anticipates that iterative changes will be made as the milestones are broadly implemented. In anticipating the implementation of outpatient milestones, the committee will be particularly interested to how effectively psychotherapy milestones will be captured through the combination of outpatient evaluations and other data points captured in the program director's semiannual evaluation.

  13. Simulation analysis of an outpatient services facility.

    PubMed

    Levy, J L; Watford, B A; Owen, V T

    1989-11-01

    Anderson Memorial Hospital in Anderson, South Carolina is in the process of constructing a new Outpatient Services Center. The Outpatient Services Center will combine existing outpatient services within the hospital and offsite services at the Outpatient Diagnostic Center. A simulation model of the proposed facility has been developed based on historical data. The information obtained from the simulation model includes the analysis of outpatient services utilization, patient waiting and flow times, and service area queue sizes. This information has been used to determine minimum facility design requirements, such as waiting room size, based on the expected demands.

  14. Aspects of molecular diagnostics and therapy in obstetrics and gynecology.

    PubMed

    Beckmann, Matthias W; Strick, Reiner; Strissel, Pamela L; Fasching, Peter A; Oppelt, Peter; Pöhls, Uwe D; Malur, Sabine U; Ackermann, Sven

    2003-05-01

    Scientific progress and information relating to the theoretical and clinical work being carried out in the field of obstetrics and gynecology has dramatically increased due to recent developments in molecular biology. Molecular obstetrics and gynecology is therefore the link between the different sections in obstetrics and gynecology. At present, the molecular understanding of cellular pathways is much greater than that of the direct integration of molecular diagnostics and therapy in routine clinical practice. The use of molecular diagnostics, such as preimplantation diagnostics or predictive genetic testing, still has technical problems as well as novel, and to date unclear, social, ethical and legal implications. To date, the technical elements of molecular therapy have not yet fulfilled their expectations. In the broad spectrum of obstetrics and gynecology, new molecular discoveries are influenced not only by technical but also by socioeconomic and political considerations. These include, for example, free access to genetic testing, patents for genes and the financial monopoly over molecular medication. Society must propose rules for the potential integration of the knowledge of molecular obstetrics and gynecology into the daily care of those seeking aid or advice.

  15. 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

  16. [Complaints from medical care in obstetrics and gynecology].

    PubMed

    Noguera-Sánchez, Marcelo Fidias; García-Kavanagh, Rosalilia; Cruz-Rojas, Roberto Efraín

    2010-05-01

    The fulfillment and satisfaction regarding the expectations of the patients at services of obstetrics and gynecology, it is related to the quality of care. Failure to meet these expectations will rise to the dissatisfaction and enhances the culture of demand, with these considerations this presents study were developed, researching the patients complaints reported by the State Commission o Medical Arbitration of Oaxaca in 2007 with the aim of identifying the medical complaint emphasis on obstetrics care. To identify the medical lawsuits to Gineco-obstetricians in Oaxaca. We conducted a documentary research, descriptive, transversal, retrospective and without ethical implications, through analysis of databases of the State Commission of Medical Arbitration of Oaxaca, corresponding to 2007 activity report; 100% of selected records were medical complaints in the specialty of gynecology-obstetrics. The attention given to 10.5% are disagreements or complaints which medical complaints in gynecology-obstetrics specialty are second with 21% and the report file complaints state ranks first with 12.3% of cases, 70% of medical care is provided by gynecologists and total complaints, 40% were confined to expert medical advice. Complaints in gynecological and obstetric care rank first places relative to other specialties, the attention given in the two-thirds is provided by medical specialists in obstetrics and gynecology, and less than the half were certified by the Board and expert medical opinions reported evidence of malpractice and corporate responsibility in the complaints.

  17. 3T MR-Guided Brachytherapy for Gynecologic Malignancies

    PubMed Central

    Kapur, Tina; Egger, Jan; Damato, Antonio; Schmidt, Ehud J.; Viswanathan, Akila N.

    2012-01-01

    Gynecologic malignancies are a leading cause of death in women worldwide. Standard treatment for many primary and recurrent gynecologic cancer cases includes a combination of external beam radiation, followed by brachytherapy. Magnetic Resonance Imaging (MRI) is benefitial in diagnostic evaluation, in mapping the tumor location to tailor radiation dose, and in monitoring the tumor response to treatment. Initial studies of MR-guidance in gynecologic brachtherapy demonstrate the ability to optimize tumor coverage and reduce radiation dose to normal tissues, resulting in improved outcomes for patients. In this article we describe a methodology to aid applicator placement and treatment planning for 3 Tesla (3T) MR-guided brachytherapy that was developed specifically for gynecologic cancers. This has been used in 18 cases to date in the Advanced Multimodality Image Guided Operating suite at Brigham and Women’s Hospital. It is comprised of state of the art methods for MR imaging, image analysis, and treatment planning. An MR sequence using 3D-balanced steady state free precession in a 3T MR scan was identified as the best sequence for catheter identification with ballooning artifact at the tip. 3D treatment planning was performed using MR images. Item in development include a software module designed to support virtual needle trajectory planning that includes probabilistic bias correction, graph based segmentation, and image registration algorithms. The results demonstrate that 3T MR has a role in gynecologic brachytherapy. These novel developments improve targeted treatment to the tumor while sparing the normal tissues. PMID:22898699

  18. [Outpatient rheumatologic treatment in Germany].

    PubMed

    Edelmann, E

    2014-03-01

    Outpatient rheumatologic treatment in Germany is managed by rheumatologists in private practice (n = 557), by authorized rheumatism outpatient centers (n = 116), by rheumatism centers according to §116b (n = 43) and by university outpatient departments. A total number of 975 rheumatologists were registered by the end of 2012 of whom approximately 830 were active in outpatient care. With this number of rheumatologists Germany is in the middle range in comparison to eight industrial nations including the USA. This number is not sufficient to provide adequate medical care and the consequences are too long waiting times for an appointment with a rheumatologist. Statistical data of the Kassenärztliche Bundesvereinigung (KBV, National Association of Statutory Health Insurance Physicians) showed 688,000 general insurance patients with rheumatoid arthritis (RA). As some 68.9 % of the population are in this insurance scheme there are some 770,000 RA patients in Germany (almost 1 % of the population). One way to improve rheumatology care in spite of the lack of rheumatologists could be special agreements with the general health insurance providers to improve cooperation and division of responsibilities between rheumatologists and general practitioners, to implement patient education, tighter control and treat to target in rheumatology care. Another way could be a new treatment level called "ambulant specialist care", with no budget for medical care and no budget for the number of patients treated and therefore the chance for rheumatologists to treat more patients and have a better income. To achieve that more young doctors receive approval as a specialist in rheumatology, more chairs of rheumatology at universities and a nationwide stipendium for training assistants are needed.

  19. Annual report of the Committee on Gynecologic Oncology, the Japan Society of Obstetrics and Gynecology.

    PubMed

    Yamagami, Wataru; Aoki, Daisuke

    2015-02-01

    The Japan Society of Obstetrics and Gynecology collects and analyzes annual data on gynecologic cancers from member institutions. Here we present the Patient Annual Report for 2012 and the Treatment Annual Report for 2006. Data on 7028 patients with cervical cancer, 8217 with endometrial cancer, 5140 with ovarian cancer and 1725 with ovarian borderline tumor for whom treatment was initiated in 2012 were summarized in the Patient Annual Report. Data on the prognosis of 2699 patients with cervical cancer, 3243 with endometrial cancer and 1898 with ovarian cancer for whom treatment was initiated in 2006 were analyzed in the Treatment Annual Report. In the Patient Annual Report for 2012, stage I accounted for 55.4%, stage II for 23.0%, stage III for 11.0% and stage IV for 10.6% of all patients with cervical cancer. Stage I accounted for 72.2%, stage II for 7.0%, stage III for 13.4% and stage IV for 7.3% of all patients with endometrial cancer. Stage I accounted for 43.1%, stage II for 9.2%, stage III for 29.7% and stage IV for 7.2% of all patients with ovarian cancer. In the Treatment Annual Report for 2006, the 5-year overall survival rates for patients with cervical cancer were 92.9% for stage I, 74.6% for stage II, 55.3% for stage III and 24.3% for stage IV. The equivalent rates for patients with endometrial cancer were 96.3%, 92.7%, 80.6% and 35.8%, respectively; and those for patients with ovarian surface epithelial-stromal tumors were 90.6%, 82.9%, 48.7% and 40.9%, respectively.

  20. Update on immune checkpoint inhibitors in gynecological cancers

    PubMed Central

    2017-01-01

    In recent years, progress in our understanding of immune-modulatory signaling pathways in immune cells and the tumor microenvironment (TME) has led to rejuvenated interest in cancer immunotherapy. In particular, immunotherapy targeting the immune checkpoint receptors such as cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4), programmed cell-death 1 (PD-1), and programmed cell-death ligand 1 (PD-L1) have demonstrated clinical activity in a wide variety of tumors, including gynecological cancers. This review will focus on the emerging clinical data on the therapeutic role of immune checkpoint inhibitors, and potential strategies to enhance the efficacy of this class of compounds, in the context of gynecological cancers. It is anticipated that future biomarker-directed clinical trials will provide further insights into the mechanisms underlying response and resistance to immunotherapy, and help guide our approach to designing therapeutic combinations that have the potential to enhance the benefit of immunotherapy in patients with gynecologic cancers. PMID:28028993

  1. New clinical research strategies for rare gynecologic malignancies.

    PubMed

    Ray-Coquard, Isabelle; Pujade-Lauraine, Eric; Ledermann, Jonathan A

    2015-02-01

    More than 50% of all gynecologic cancers can be classified as rare tumors (defined as an incidence of <6 per 100 000) and as such represent a major challenge for clinicians. The rapidly increasing number of targeted therapies provides a unique opportunity to improve treatment options of rare gynecologic cancers; however, their low frequency makes it difficult to test these new agents. Harmonization of medical practices and novel trial designs are needed to identify and develop new treatments for rare gynecologic tumors. This requires international partnerships, harmonization of treatment recommendations, and international collaborations to overcome existing regulatory barriers in international trials. Whereas randomized trials may be possible in some rare tumor types, there are others for which conducting even single arm studies may be challenging. For these very rare tumors, robust collection of data through national registries could lead to improvements in treatment.

  2. The loneliness level of patients with gynecological cancer.

    PubMed

    Sevil, U; Ertem, G; Kavlak, O; Coban, A

    2006-01-01

    The purpose of this descriptive study was to determine the loneliness levels and the variables that have an effect on the loneliness of women with a gynecological cancer diagnosis. The main questions that the study addressed were as follows: (1) What is the loneliness level of patients with gynecological cancer? and (2) What kind of relationships are there between general demographic characteristics of patients with gynecological cancer and their loneliness? This descriptive study was conducted at Ege University, Faculty of Medicine, Application and Investigation Hospital, Maternity and Women Diseases Gynecology Clinic, from July to December 2002. Maternity and Women Diseases Clinic Oncology Service treated 161 patients during this time period. While all patients hospitalized between the specified dates constituted the universe of the investigation; the actual sample was 94 patients. As data collection tools, a questionnaire form, which aimed at identifying sociodemographic characteristics of patients and the features related to their diseases relevant to the literature and the UCLA-loneliness scale were used. The general loneliness mean score of women with gynecological cancer was 35.85 +/- 9.302. Women's mean scores of loneliness were affected by whether psychologic support was needed, genital organ diseases were treated, or a family member had a gynecological operation, and by the income situation. The disease of cancer, which creates the most fear and anxiety in the community, has adverse psychologic effects on both the patient and the family. In societies where men dominate, as is the case in our society, women's place in the society has been reduced to their reproductive capacity, and thus, the health of their genital organs is very important.

  3. 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

  4. 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

  5. Inappropriate use of antibiotics in patients undergoing gynecologic surgery

    PubMed Central

    Joyce, John; Langsjoen, Jessica; Sharadin, Cynthia; Kuehl, Thomas J.

    2017-01-01

    We retrospectively examined prophylactic antibiotic use and documentation of wound classification in patients having gynecologic surgery at a tertiary hospital. Of the 326 cases reviewed, 175 (54%) received prophylactic antibiotics when not indicated according to guidelines of the American College of Obstetricians and Gynecologists. Antibiotic administration varied significantly (P < 0.02) among the different types of surgery, being given in 82% of laparoscopic cases, 35% of nonobstetrical dilation and curettage and operative hysteroscopy procedures, and 51% of open abdominal procedures. There were no recorded episodes of anaphylaxis or pseudomembranous colitis. In conclusion, antibiotic use is high among gynecologic surgeons at a tertiary hospital, but this use was unnecessary. PMID:28127125

  6. Diagnosis of gynecological pseudoaneurysms and embolization with cyanoacrylate.

    PubMed

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

    2016-12-21

    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.

  7. [Progress in ambulatory anesthesia applied to gynecological surgery].

    PubMed

    Rascol, N; Schneider, E; Gindre, G; Schoeffler, P

    2006-05-01

    Ambulatory gynecological surgery enables fast recovery of vital functions, ambulation and a relational life of quality. Patients whose disease is well-controlled at the anesthesia consultation can benefit from ambulatory procedures. Improved material and surgical practices broaden potential indications, limiting the risk of postoperative pain which can be controlled with simple analgesic protocols. The choice of the anesthesic techniques or the agents used during the intervention ensures fast recovery of higher functions. Nausea and vomiting, which may develop after returning home and compromise oral drug intake, must be prevented. More ambulatory gynecological procedures can be expected in the near future, pointing out the importance of developing more adapted medical structures.

  8. New Developments in Minimally Invasive Gynecologic Oncology Surgery

    PubMed Central

    STEWART, KATHERINE IKARD; FADER, AMANDA N.

    2017-01-01

    Minimally invasive surgery continues to transform the field of gynecologic oncology and has now become the standard of care for many early-stage malignancies. The proven benefits of minimally invasive surgery are driving the rapid introduction and dissemination of novel technologies and the increasing ability to perform even the most complex procedures less invasively. In this article, we will review the current literature on traditional multiport laparoscopy, robotic-assisted laparoscopy, laparoendoscopic single-site surgery as well as robotic-assisted laparoendoscopic single-site surgery, with a specific focus on their role in the treatment of gynecologic malignancies. PMID:28406810

  9. 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.

  10. 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.

  11. Leptomeningeal metastasis from gynecologic cancers diagnosed by brain MRI.

    PubMed

    Toyoshima, Masafumi; Tsuji, Keita; Shigeta, Shogo; Tokunaga, Hideki; Ito, Kiyoshi; Watanabe, Yoh; Yoshinaga, Kosuke; Otsuki, Takeo; Niikura, Hitoshi; Yaegashi, Nobuo

    Leptomeningeal metastasis (LM) is rarely observed in gynecologic cancers. As gadolinium-enhanced magnetic resonance imaging (Gd-MRI) is highly effective for diagnosing LM, the aim of this study is to describe the clinical behaviors and outcomes of LM patients who were diagnosed by Gd-MRI. After securing institutional review board approvals, we retrospectively reviewed patient records. Eight patients were found to have LM from gynecological malignancies. Primary tumors included three ovarian cancers, one tubal cancer, one peritoneal cancer, two endometrial cancers, and one cervical cancer. Gd-MRI of the brain and the spine is indicated as the high-priority inspection for the diagnosis of this devastating complication.

  12. [Robotic surgery in gynecology: is it the future?].

    PubMed

    Coronado Martín, Pluvio Jesús

    2011-01-01

    Gynecologic surgery has been undergone a significant change in the last decade thanks to innovation in health technology. The appearance of the Da Vinci Surgical System has revolutionized the concept of minimally invasive surgery, due to add advantages over conventional laparoscopic surgery, such us three-dimensional vision, wristed forceps and a complete control of the instruments by the surgeon. The evidence published reflects that robotic surgery is preferable to laparotomy and laparoscopic approach, because it is more accurate, versatile, intuitive, and reduces perioperative morbidity. The future of Gynecologic Surgery is linked to the robotic approach.

  13. 21 CFR 884.4520 - Obstetric-gynecologic general manual instrument.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... SERVICES (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Obstetrical and Gynecological... uterine clamp is an instrument used to hold the uterus by compression. (6) A uterine packer is an...

  14. 21 CFR 884.4530 - Obstetric-gynecologic specialized manual instrument.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... blades and handles used to pull, grasp, or compress during gynecological examination. (8) A cervical cone... cervix or vagina. (14) A gynecological biopsy forceps is an instrument with two blades and handles...

  15. Development and evaluation of the Korean version of the Gynecologic Cancer Lymphedema Questionnaire in gynecologic cancer survivors.

    PubMed

    Lim, Myong Cheol; Lee, Jeong Seon; Joo, Jungnam; Park, Kibyung; Yoo, Heon Jong; Seo, Sang-Soo; Kang, Sokbom; Chung, Seung Hyun; Park, Sang-Yoon

    2014-04-01

    The purpose of this study was two-fold: first, to develop a Korean version of the Gynecologic Cancer Lymphedema Questionnaire (GCLQ-K) and evaluate its reliability and reproducibility and second, to examine the diagnostic efficacy of GCLQ-K in predicting lymphedema in gynecologic cancer survivors. We designed a case-control study, and the GCLQ-K was completed by 33 gynecologic cancer survivors with lymphedema and 34 gynecologic cancer survivors without lymphedema. A follow-up GCLQ-K was completed 3weeks after the baseline questionnaire. The GCLQ-K showed high reliability with a Cronbach's α of 0.83 and high reproducibility with an intraclass correlation of 0.96. Of the 7 symptom clusters, 6 identified patients with lymphedema with statistical significance; identification of lymphedema using the physical functioning and infection-related symptom clusters did not reach significance. The area under the receiver operating characteristic curve (AUC) to distinguish patients with and without lymphedema was 0.868 (95% confidence interval [CI], 0.779-0.956). Following the exclusion of the physical functioning and infection-related symptom clusters, which showed poor prediction value for lymphedema, the AUC of the GCLQ-K total score further improved to 0.922 (95% CI, 0.864-0.981). The GCLQ-K was successfully developed with minimal modifications to adapt the original GCLQ to the Korean culture and showed high internal consistency and reproducibility. Moreover, gynecologic cancer survivors with and without lymphedema could be satisfactorily distinguished using the GCLQ-K. Thus, GCLQ-K was proven to be a reliable tool, capable of identifying lymphedema in Korean gynecological cancer survivors. Copyright © 2014 Elsevier Inc. All rights reserved.

  16. The effect of the SNAPPS (summarize, narrow, analyze, probe, plan, and select) method versus teacher-centered education on the clinical gynecology skills of midwifery students in Iran.

    PubMed

    Barangard, Hamideh; Afshari, Poorandokht; Abedi, Parvin

    2016-01-01

    This study aimed to determine the effect of the SNAPPS (summarize, narrow, analyze, probe, plan, and select) method versus teacher-centered education on the clinical skills of midwifery students in Iran. In this clinical trial, 36 midwifery students in their 4th year of education in 2015 were enrolled and divided into 6 groups, 3 groups for teacher-centered education and 3 groups for the SNAPPS method, with each group spending 10 days in the outpatient gynecology clinic. A questionnaire and a checklist were used to gather data. An independent t-test and chi-square test were used to analyze the data. Ability to gain the trust of the patient, verbal and nonverbal communication skills, history taking, preparation of the patient for gynecological examination, and diagnosis and treatment of common diseases were significantly better in the SNAPPS group compared to the teacher-centered education group (P<0.05). The SNAPPS education method can significantly improve the clinical skills of midwifery students in gynecology, in particular history taking, differential diagnosis, and treatment of common diseases.

  17. The effect of the SNAPPS (summarize, narrow, analyze, probe, plan, and select) method versus teacher-centered education on the clinical gynecology skills of midwifery students in Iran

    PubMed Central

    2016-01-01

    This study aimed to determine the effect of the SNAPPS (summarize, narrow, analyze, probe, plan, and select) method versus teacher-centered education on the clinical skills of midwifery students in Iran. In this clinical trial, 36 midwifery students in their 4th year of education in 2015 were enrolled and divided into 6 groups, 3 groups for teacher-centered education and 3 groups for the SNAPPS method, with each group spending 10 days in the outpatient gynecology clinic. A questionnaire and a checklist were used to gather data. An independent t-test and chi-square test were used to analyze the data. Ability to gain the trust of the patient, verbal and nonverbal communication skills, history taking, preparation of the patient for gynecological examination, and diagnosis and treatment of common diseases were significantly better in the SNAPPS group compared to the teacher-centered education group (P<0.05). The SNAPPS education method can significantly improve the clinical skills of midwifery students in gynecology, in particular history taking, differential diagnosis, and treatment of common diseases. PMID:27894183

  18. Intensive outpatient treatment of elephantiasis.

    PubMed

    Pereira De Godoy, J M; Amador Franco Brigidio, P; Buzato, E; Fátima Guerreiro De Godoy, M

    2012-10-01

    The aim of this paper was to report on a novel approach to the intensive outpatient treatment of elephantiasis of an underprivileged population. Prospective, random study, the diagnosis of lymphedema was clinical and the inclusion of patients was by order of arrival in the treatment center where all were invited to participate in the study. Intensive outpatient therapy was performed for 6 to 8 hours daily over a period of four weeks. Eleven legs with grade III elephantiasis of 8 patients were evaluated in a random prospective study. Three patients were men and five were women with ages ranging between 28 and 66 years old. Treatment included mechanical lymph drainage using the RAGodoy® apparatus for a period of 6 to 8 hours daily and the Godoy & Godoy cervical stimulation technique for 20 minutes per day, both associated to the use of a home-made medical compression stocking using a low-stretch cotton-polyester material. Additionally, manual lymph drainage using the Godoy & Godoy technique was performed for one hour. Perimetry was used to compare measurements made before and after treatment, of the three points of the limb with the largest circumferences. The paired t-test was utilized for statistical analysis with an alpha error greater than 5% (P-value <0.05). Reductions in the perimeter of affected limbs were significant over this 4-week treatment program (P-value=0.001). Intensive outpatient treatment is an option for all types of lymphedema with large volumetric reductions being possible in a short period when treating elephantiasis.

  19. Outpatient mastectomy: clinical, payer, and geographic influences.

    PubMed Central

    Case, C; Johantgen, M; Steiner, C

    2001-01-01

    OBJECTIVE: To determine (1) the use of outpatient services for all surgical breast procedures for breast cancer and (2) the influence of payer and state on the use of outpatient services for complete mastectomy in light of state and federal length-of-stay managed care legislation. DATA SOURCES: Healthcare Cost and Utilization Project representing all discharges from hospitals and ambulatory surgery centers for five states (Colorado, Connecticut, Maryland, New Jersey, and New York) and seven years (1990-96). STUDY DESIGN: Longitudinal, cross-sectional analyses of all women undergoing inpatient and outpatient complete mastectomy (CMAS), subtotal mastectomy (STMAS), and lumpectomy (LUMP) for cancer were employed. Total age-adjusted rates and percentage of outpatient CMAS, STMAS, and LUMP were compared. Independent influence of state and HMO payer on likelihood of receiving an outpatient CMAS was determined from multivariate models, adjusting for clinical characteristics (age < 50 years, comorbidity, metastases, simple mastectomy, breast reconstruction) and hospital characteristics (teaching, ownership, urban). PRINCIPAL FINDINGS: In 1993, 1 to 2 percent of CMASs were outpatient in all states. By 1996, 8 percent of CMASs were outpatient in Connecticut, 13 percent were outpatient in Maryland, and 22 percent were outpatient in Colorado. In comparison, LUMPs were 78 to 88 percent outpatient, and by 1996, 43 to 72 percent of STMASs were outpatient. In 1996, women were 30 percent more likely to receive an outpatient CMAS in New York, 2.5 times more likely in Connecticut, 4.7 times more likely in Maryland, and 8.6 times more likely in Colorado compared to New Jersey. In addition, women with Medicare, Medicaid, or private commercial insurance were less likely to receive an outpatient CMAS compared to women with an HMO payer. CONCLUSIONS: LUMP is an outpatient procedure, and STMAS is becoming primarily outpatient. CMAS, while still primarily inpatient, is increasingly

  20. An Effective Outpatient Appointment System for General Leonard Wood Army Community Hospital

    DTIC Science & Technology

    1990-07-13

    Orthopedics, Pediatric , Physical Examination, xPodiatry, Surgical, Urology, Well Baby, Body Fat Evaluation, Nutrition , PFB, and Speech. 2. RESPONSIBILITIES. a...PROJECT TASK WvORK UNIT I1 I ILUE (include Securiy assicton) An Effective Outpatient Appointment System for Gen Leonard Wood Army Comunity Hospital 12...analysis. Thirty two variables were provided by the reports for the six following clinic; Internal Medicine, Pediatrics , General Outpatient, Family Practice

  1. Identifying priority actions for improving patient satisfaction with outpatient cancer care.

    PubMed

    Gesell, Sabina B; Gregory, Nancy

    2004-01-01

    In parallel to developing new cancer therapies, the healthcare community has the responsibility of creating positive treatment experiences for patients. Data from 5907 cancer outpatients treated at 23 hospitals across the United States were analyzed to identify the top priorities for service improvement in outpatient cancer treatment facilities. They included meeting patients' emotional needs, providing information to patients and family members, reducing waiting times, and providing convenience and coordinated care among physicians and other care providers.

  2. 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…

  3. 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

    ... HUMAN SERVICES Food and Drug Administration Obstetrics and Gynecology Devices Panel of the Medical... Obstetrics and Gynecology Devices Panel of the Medical Devices Advisory Committee. This meeting was announced... July 14, 2011, FDA announced that a meeting of the Obstetrics and Gynecology Devices Panel of...

  4. 21 CFR 884.4520 - Obstetric-gynecologic general manual instrument.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Obstetric-gynecologic general manual instrument... Surgical Devices § 884.4520 Obstetric-gynecologic general manual instrument. (a) Identification. An obstetric-gynecologic general manual instrument is one of a group of devices used to perform...

  5. Chemotherapy-induced nausea and vomiting and antiemetic prophylaxis with palonosetron versus other 5-HT3 receptor antagonists in patients with cancer treated with low emetogenic chemotherapy in a hospital outpatient setting in the United States.

    PubMed

    Schwartzberg, Lee; Morrow, Gary; Balu, Sanjeev; Craver, Chris; Gayle, Julie; Cox, David

    2011-08-01

    The incidence of overall (acute and delayed) chemotherapy-induced nausea and vomiting (CINV) events among patients treated with single- and multi-day low emetogenic chemotherapy (LEC) is not well established. We studied a cohort of patients receiving LEC and antiemetic prophylaxis with palonosetron (Group 1) versus other 5-HT(3) receptor antagonists (5-HT(3)-RAs) (Group 2), to determine the overall rate of CINV and the proportion of patients experiencing delayed CINV (days 2-7 of a CT cycle) in a hospital outpatient setting. Patients aged ≥18 years with cancer diagnosis initiating single-day and multi-day LEC for the first time between 4/1/2007 and 3/31/2009 were identified from the Premier Perspective database. CINV events (ICD-9-CM codes for nausea, vomiting, or volume depletion or CINV-related rescue medications) were assessed descriptively. A generalized linear multivariate regression model was developed, estimating the overall CINV event rate among Group 1 and 2 patients in the follow-up period (first of eight chemotherapy [CT] cycles or 6 months). In the follow-up period, out of a total of 10,137 overall CINV events (single-day and multi-day LEC), 8783 events (86.6%) were identified in single-day LEC treated patients. Within single-day LEC treated events, in the first cycle, of 3184 events, 2996 (94.1%) events were delayed. Average number of delayed events per patient remained consistent throughout the eight cycles (3.1 [1st cycle] vs. 2.9 [8th cycle]; P = 0.842]). Among 2439 patients on antiemetic prophylaxis with a 5-HT(3)-RA, 10.1% (n = 247) initiated palonosetron. Regression analysis indicated that Group 1 patients (versus Group 2) had a 15.2% reduction in CINV event rate per CT cycle; P = 0.0403. Study limitations include potential lack of generalizability, absence of data on certain confounders including alcohol consumption and prior history of motion sickness, potential underestimation of incidence of uncontrolled CINV, and inability to

  6. Effect of a multi-modal intervention on immunization rates in obstetrics and gynecology clinics.

    PubMed

    Mazzoni, Sara E; Brewer, Sarah E; Pyrzanowski, Jennifer L; Durfee, M Josh; Dickinson, L Miriam; Barnard, Juliana G; Dempsey, Amanda F; O'Leary, Sean T

    2016-05-01

    There is increasing attention on immunizations by obstetrician-gynecologists and a need to improve vaccination rates for all women. To evaluate the effect of a multimodal intervention on rates of immunization with tetanus, diphtheria, and acellular pertussis (Tdap); human papillomavirus (HPV); and influenza in outpatient obstetrics and gynecology clinics. Immunization rates at 2 clinics were compared pre- and post-implementation of multiple interventions at a public integrated health-care system. Study interventions began on June 6, 2012 and concluded on May 31, 2014; the preimplementation time period used was June 6, 2010 to June 5, 2012. Interventions included stocking of immunizations in clinics, revision and expansion of standing orders, creation of a reminder/recall program, identification of an immunization champion to give direct provider feedback, expansion of a payment assistance program, and staff education. All women aged 15 and older who made a clinic visit during influenza season were included in the influenza cohort; women who delivered an infant during the study time period and had at least 1 prenatal visit within 9 months preceding delivery were included in the Tdap cohort; each clinic visit by a nonpregnant woman aged 15-26 years was assessed and included in the HPV analysis as an eligible visit if the patient was lacking any of the 3 HPV vaccines in the series. The primary outcome was receipt of influenza and Tdap vaccine per current American College of Obstetricians and Gynecologists guidelines and receipt of HPV vaccine during eligible visits. Influenza and Tdap were assessed with overall coverage rates at the institutional level, and HPV was assessed at the visit level by captured opportunities. All analyses included generalized estimating equations and the primary outcome was assessed with time as a covariate in all models. A total of 19,409 observations were included in the influenza cohort (10,231 pre- and 9178 post-intervention), 2741 in

  7. 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…

  8. 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.…

  9. 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.

  10. Obstetric Outcomes in Non-Gynecologic Cancer Patients in Remission

    PubMed Central

    Timur, Hakan; Tokmak, Aytekin; Iskender, Cantekin; Yildiz, Elif Sumer; Inal, Hasan Ali; Uygur, Dilek; Danisman, Nuri

    2016-01-01

    Objective: The aim of the present study was to evaluate the obstetric and perinatal outcomes in treated women who were diagnosed with non-gynecologic cancer and to compare these findings with pregnant women with no history of cancer. Materials and Methods: This retrospective study was conducted on 21 pregnant women with non-gynecologic cancer who were in remission (study group) and 63 pregnant women with no history of cancer (control group). The women were admitted to the high-risk pregnancy clinic of Zekai Tahir Burak Women’s Health Training and Research Hospital with a diagnosis of pregnancy and cancer between January 2010 and January 2015. Obstetric outcomes and demographic characteristics of the patients were recorded. Age, gravida, parity, abortus, body mass index (BMI), gestational week, smoking, mode of delivery, gestational weight, and perinatal outcomes were examined for each woman. Results: The most common cancer types were thyroid (28.5%) and breast cancers (23.8%), which constituted just over half of the non-gynecologic cancer cases during pregnancy. The time elapsed after the diagnosis was 3.8±2.2 (1–9) years. No statistically significant differences were found between the two groups with regard to age, obstetric history, BMI, gestational week, smoking, and obstetric and perinatal outcomes (p>0.05). Conclusion: Negative perinatal outcomes in non-gynecologic cancer patients in remission were found to be within acceptable levels. PMID:27551177

  11. 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…

  12. 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.…

  13. Observations related to chronologic and gynecologic age in pregnant adolescents.

    PubMed Central

    Felice, M. E.; James, M.; Shragg, P.; Hollingsworth, D. R.

    1984-01-01

    A low chronologic age (less than or equal to 15 years) and low gynecologic age (less than or equal to 2 years) have been considered factors that increase medical complications among adolescent pregnant women. Gynecologic age (GA) is defined in this study as age in years at conception minus age at menarche. Two hundred twelve consecutive pregnant teenagers were followed prospectively in the Teen OB Clinic at the University of California, San Diego Medical Center, between August 1978 and July 1981. The clinic population consisted of 37.3 percent Whites, 35.8 percent Hispanics, 20.8 percent Blacks, and 6.1 percent other (mostly Indochinese). Sixty-eight percent of the patients were funded by MediCal. The patient population was divided by chronological age (CA) at conception into those 15 years or less or 16 years or older. A low chronological age was found to be a significant risk factor for premature rupture of membranes. Teenagers with a low gynecologic age (less than or equal to 2) had a lower mean pre-pregnancy weight and body mass index (Kg/M2) than teenagers with a higher gynecologic age. In this study, we did not find that a low CA or GA was correlated with a higher frequency of pregnancy-induced hypertension, prenatal medical problems, obstetrical problems at labor or delivery, or an excessive number of low-birthweight infants. PMID:6523906

  14. Vitamin-B12 deficiency following therapy in gynecologic oncology

    SciTech Connect

    Bandy, L.C.; Clarke-Pearson, D.L.; Creasman, W.T.

    1984-03-01

    Vitamin-B12 deficiency results from inadequate absorption of the vitamin by the distal ileum and depletion of available stores. Both radiotherapy and intestinal resection can contribute to development of this condition. The significance of this problem in gynecologic oncology is discussed and two patients are described.

  15. Gynecologic and obstetric problems of the female dancer.

    PubMed

    Shade, A R

    1983-11-01

    The effect of athletics and exercise on women is a new area of medicine, and little factual information is currently available. This discussion briefly reviews some of the gynecologic and obstetric information available to give guidelines for the woman involved in strenuous physical activity.

  16. 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

  17. Urologic issues in the pediatric and adolescent gynecology patient.

    PubMed

    Yerkes, Elizabeth B

    2009-03-01

    This article lends the urologist's perspective on complaints commonly seen in a pediatric and adolescent gynecology practice, such as perineal pain, repetitive posturing, vulvovaginitis and interlabial masses. Evaluation and management of urinary tract infections and daytime incontinence is discussed. The role of constipation and pelvic floor dysfunction in many of these complaints is emphasized.

  18. Biochemical Abnormalities in Psychiatric Outpatients

    PubMed Central

    Lipman, Daniel G.; Collins, James L.; Mathura, Clyde B.; Elder, Zelda B.

    1984-01-01

    This research project was an outgrowth of the observations of the senior author over a period exceeding four decades of practice, teaching, and research as internist and psychiatrist, with primary emphasis on relationships between psyche and soma. Patients at the Outpatient Psychiatric Clinic of the Howard University Hospital, Washington, DC, were given thorough annual physical examinations and laboratory evaluations of blood and urine. The authors found a significantly high incidence of medical illnesses and abnormal laboratory findings not previously suspected. There was a significant and direct correlation between psychopathology as projected in the Lipman Personality Image Projection (LPIP) test and abnormal laboratory and physical findings. The results in this study concur with previous reports that so-called purely psychogenic stress symptoms may be related to unrecognized medical illnesses. These somatic illnesses may remain unrecognized for indefinite periods of time in the traditional psychiatric outpatient setting from which patients are often referred elsewhere for treatment of nonpsychiatric illness. Initial and periodic physical and laboratory examinations should be performed by psychiatrists trained to recognize nonpsychiatric diseases that often present with psychiatric symptoms. A thorough knowledge of the mind-body relationship is essential to the practice of modern psychiatry. PMID:6716498

  19. Outpatient management of pediatric burns.

    PubMed

    Kassira, Wrood; Namias, Nicholas

    2008-07-01

    The leading etiologies of pediatric burns are scald, thermal, and electrical injuries. The initial management of burns involves assessment of burn depth and total body surface area (TBSA) affected, a history, and physical examination. Calculation of percent of TBSA affected is an important determinant of the necessity for hospitalization versus outpatient management. Only second- and third-degree burns are included in the calculation. The criteria for outpatient management vary based on the center experience and resources. One such set of criteria in an experienced burn center includes burn affecting less than 15% TBSA, therefore not requiring fluid resuscitation; the ability to take in oral fluids, excluding serious perioral burns; no airway involvement or aspiration of hot liquid; no abuse; and dependable family able to transport the patient for clinic appointments. Once the child is ready to reenter school, the physician must discuss with the family and school staff any needs and expectations for the child, including wound care. Social reintegration can be difficult. Educating the teachers and staff of the child's appearance may help prepare the students.

  20. Anaesthesia for the paediatric outpatient.

    PubMed

    Jöhr, Martin; Berger, Thomas M

    2015-12-01

    The aim of this review was to discuss recent developments in paediatric anaesthesia, which are particularly relevant to the practitioner involved in paediatric outpatient anaesthesia. The use of a pharmacological premedication is still a matter of debate. Several publications are focussing on nasal dexmedetomidine; however, its exact place has not yet been defined. Both inhalational and intravenous anaesthesia techniques still have their advocates; for diagnostic imaging, however, propofol is emerging as the agent of choice. The disappearance of codeine has left a breach for an oral opioid and has probably worsened postoperative analgesia following tonsillectomy. In recent years, a large body of evidence for the prevention of postoperative agitation has appeared. Alpha-2-agonists as well as the transition to propofol play an important role. There is now some consensus that for reasons of practicability prophylactic antiemetics should be administered to all and not only to selected high-risk patients. Perfect organization of the whole process is a prerequisite for successful paediatric outpatient anaesthesia. In addition, the skilled practitioner is able to provide a smooth anaesthetic, minimizing complications, and, finally, he has a clear concept for avoiding postoperative pain, agitation and vomiting.

  1. Fatigue Experiences Among OCD Outpatients.

    PubMed

    Pasquini, Massimo; Piacentino, Daria; Berardelli, Isabella; Roselli, Valentina; Maraone, Annalisa; Tarsitani, Lorenzo; Biondi, Massimo

    2015-12-01

    Patients with OCD are impaired in multiple domains of functioning and quality of life. While associated psychopathology complaints and neuropsychological deficits were reported, the subjective experience of general fatigue and mental fatigue was scarcely investigated. In this single-center case-control study we compared 50 non-depressed OCD outpatients consecutively recruited and 50 panic disorder (PD) outpatients, to determine whether they experienced fatigue differently. Assessment consisted of structured clinical interview for DSM-IV criteria by using the SCID-I and the SCID-II. Symptom severity was assessed using the Yale-Brown Obsessive-Compulsive Scale, the Hamilton Anxiety Rating Scale, the Hamilton Depression Rating Scale, the Clinical Global Impressions Scale, severity and the Global Assessment of Functioning Scale. Fatigue was assessed by using the Multidimensional Fatigue Inventory (MFI). Regarding MFI physical fatigue, an OR of 0.196 (95 % CI 0.080-0.478) was found, suggesting that its presence is associated with lower odds of OCD compared to PD. The same can be said for MFI mental fatigue, as an OR of 0.138 (95 % CI 0.049-0.326) was found, suggesting that its presence is associated with lower odds of OCD. Notably, OCD patients with OCDP co-morbidity reported higher scores of mental fatigue. In this study fatigue, including mental fatigue, seems not to be a prominent experience among adult non-depressed OCD patients.

  2. Clinical research: making it work in the outpatient dialysis facility.

    PubMed

    Doss, Sheila; Schiller, Brigitte; Fox, Rosemary; Moran, John

    2009-01-01

    Performing clinical research in the outpatient dialysis facility can be very challenging. Research protocols define time-specific and detailed procedures to be performed. In dialysis units where staff members are responsible for the delivery of life-sustaining therapy to an aging end stage renal disease patient population with multiple co-morbidities, these requirements can easily be considered too burdensome to be implemented successfully. In the authors'facility, clinical research has been successfully implemented with a close team approach supported by a dedicated research group and unit staff

  3. 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.

  4. Availability of gynecologic services in the department of veterans affairs.

    PubMed

    Seelig, Michelle D; Yano, Elizabeth M; Bean-Mayberry, Bevanne; Lanto, Andy B; Washington, Donna L

    2008-01-01

    The optimum approach to providing the Congressionally mandated gender-specific services for which women veterans are eligible is unknown. We evaluated onsite availability of gynecologic services, clinic type and staffing arrangements, and the impact of having a gynecology clinic (GYN) and/or an obstetrician gynecologist (OBGYN) routinely available. We analyzed data from the 2001 national VHA Survey of Women Veterans Health Programs and Practices (n = 136 sites; response rate, 83%). We assessed availability of gynecologic services, and evaluated differences in availability by clinic type (designated women's health provider in primary care [PC], separate women's health clinic for primary care [WHC], and/or separate GYN) and staffing arrangements (OBGYN routinely involved versus not). Out of 133 sites, 77 sites (58%) offered services through a GYN and 56 sites (42%) did not have GYN. Seventy-two (54%) sites had a WHC. More sites with an OBGYN provided endometrial biopsies (91% vs. 20%), IUD insertion (85% vs. 14%), infertility evaluation (56% vs. 23%), infertility treatment (25% vs. none), gynecologic surgery (65 vs. 28%), p < .01. In comparison to sites without WHC, those with WHC were more likely to offer services onsite: endometrial biopsy odds ratio (OR) 6.0 (95% confidence interval [CI], 2.0-18.1); IUD insertion 4.4 (1.6-12.2); infertility evaluation 2.8 (1.2-6.3); and gynecologic surgery 2.3 (1.0-5.4). As the VA develops strategic plans for accommodating the growing number of women veterans, leaders should consider focusing on establishing WHC for primary care and routine availability of OBGYN or other qualified clinicians, rather than establishing separate GYN.

  5. Are Costs of Robot-Assisted Surgery Warranted for Gynecological Procedures?

    PubMed Central

    van Dam, Peter; Hauspy, Jan; Verkinderen, Luc; Trinh, Xuan Bich; van Dam, Pieter-Jan; Van Looy, Luc; Dirix, Luc

    2011-01-01

    The exponential use of robotic surgery is not the result of evidence-based benefits but mainly driven by the manufacturers, patients and enthusiastic surgeons. The present review of the literature shows that robot-assisted surgery is consistently more expensive than video-laparoscopy and in many cases open surgery. The average additional variable cost for gynecological procedures was about 1600 USD, rising to more than 3000 USD when the amortized cost of the robot itself was included. Generally most robotic and laparoscopic procedures have less short-term morbidity, blood loss, intensive care unit, and hospital stay than open surgery. Up to now no major consistent differences have been found between robot-assisted and classic video-assisted procedures for these factors. No comparative data are available on long-term morbidity and oncologic outcome after open, robotic, and laparoscopic gynecologic surgery. It seems that currently only for very complex surgical procedures, such as cardiac surgery, the costs of robotics can be competitive to open surgical procedures. In order to stay viable, robotic programs will need to pay for themselves on a per case basis and the costs of robotic surgery will have to be reduced. PMID:21941556

  6. Gynecologic age is an important risk factor for obstetric and perinatal outcomes in adolescent pregnancies.

    PubMed

    Kaplanoglu, Mustafa; Bülbül, Mehmet; Konca, Capan; Kaplanoglu, Dilek; Tabak, Mehmet Selcuk; Ata, Barıs

    2015-12-01

    Adolescent pregnancy is an important public health problem. Physiological maturity affects obstetric and perinatal outcomes. Almost all assessments of adolescent pregnancies are based on chronological age. Gynecologic age (GA) is defined as age in years at conception minus age at menarche and it is an indicator of physiological maturity. To compare obstetric and perinatal outcomes between adult and adolescent pregnancies as categorized according to GA. In this retrospective study, 233 adolescent pregnant women were divided into two groups based on GA≤3 years (101 women) and GA>3 years (132 women). Their obstetric and perinatal results were compared with 202 adult pregnancies who gave birth in the same period. Gestational age at delivery, APGAR scores, birth weight, and incidence of preterm birth, admission to neonatal intensive care unit (NICU), intrauterine growth restriction, low birth weight, and premature rupture of membranes were significantly different between the study groups. Compared to adolescent pregnancies with GA>3 years, adolescent pregnancies with GA≤3 years had significantly lower birth weight, gestational age, APGAR scores, and significantly higher incidence of intrauterine growth restriction, low birth weight and admission to NICU. Low GA is associated with an increased rate of obstetric and perinatal complications in adolescent pregnancies. Although the main aim is the prevention of adolescent pregnancies, a detailed evaluation of such pregnancies including determination of the gynecological age together with a multidisciplinary approach may decrease potential complications. Copyright © 2015 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  7. A retrospective analysis of analgesics and sedative-hypnotics in hospitalized obstetrical and gynecological patients.

    PubMed

    Kaul, A F; Harsfield, J C; Osathanondh, R; Ostheimer, G W

    1978-02-01

    In a retrospective analysis, the dose per patient day (DPPD) of controlled analgesics and sedative-hypnotics dispensed to inpatients at a women's hospital in the United States were studied from October 1974 through September 1975. Obstetric patients received as many analgesics (1.872 DPPD) as did gynecologic patients (1.945 DPPD). Percodan and meperidine were the most frequently dispensed oral and parenteral analgesics (0.673 and 0.526 DPPD) respectively. Obstetric patients received greater quantities of sedative-hypnotics (0.453 DPPD) than did gynecologic patients (0.311 DPPD). Secobarbital and pentobarbital were the most frequently dispensed oral and parenteral sedative-hypnotics (0.161 and 0.015 DPPD), respectively. A decline in the use of barbiturates was observed toward the end of the study year, with a corresponding increase in the use of the non-barbiturate sedative-hypnotics. It is recommended that intrapartum administration of analgesics and sedatives be carefully evaluated in view of their possible depressant effects on the fetus/newborn.

  8. Family planning, obstetrical and gynecological health care provision in the Soviet Far East.

    PubMed

    Thomsen, R J

    1992-01-01

    The Soviet model for both obstetrical and gynecological care and family planning provision seems entrenched in the Soviet Far East as found during a July 1991 visit to the Magadan and Chukotka Regions. Modern birth control is minimally practiced, but does include use of the older Soviet Loop intrauterine contraceptive device (IUD), recent introduction of the new Soviet Copper-T IUD and sporadic availability of condoms and foreign made birth control pills. Without male or female surgical sterilizations being performed, the consequence is that the major form of family planning is first trimester abortion. During this visit, I introduced the use of the NORPLANT Subdermal Contraceptive System and the Copper-T380A IUD to physicians at Anadry and Pevek regional hospitals. Gynecological surgery was also performed and fairly typical ob-gyn care units were toured. Ob-Gyn physicians in the Soviet Far East were found to be highly motivated. They look to the West for help in upgrading family planning and ob-gyn health care in the face of severe shortages after a half decade of perestroika.

  9. 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

  10. NBME Obstetrics and Gynecology clerkship final examination scores: predictive value of standardized tests and demographic factors.

    PubMed

    Ogunyemi, Dotun; De Taylor-Harris, Shawn

    2004-12-01

    To assess the predictive value of standardized tests and demographic factors on performance on the National Board of Medical Examiners (NBME) Obstetrics and Gynecology (OBGYN) examination. The study included 171 students who rotated through obstetrics and gynecology from 1992 to 2001. Correlations between NBME OBGYN scores and United States Medical Licensing Examination (USMLE) step 1, MCAT and GPA scores, and temporal and demographic factors were analyzed. The mean Medical College Admission Test (MCAT), NBME and USMLE step 1 scores were 24.03, 67.47 and 194.53, respectively. Significant correlations with NMBE OBGYN were USMLE step 1 scores (r = .517, p < 0.001), MCAT scores (r = .481, p < 0.001), faculty evaluation grade (r=.223, p <0.01), OBGYN residency interest (r= .179, p < 0.05) and female gender (r=.157, p< 0.05) with a significant negative correlation with clerkship duration (r = -.208, p < 0. 01). On logistic regression analysis, USMLE, MCAT, academic year and faculty evaluation grade were independently predictive of NBME OBGYN scores. All preclinical standardized tests showed positive correlation with progressive academic years and decreasing student age. and decreasing student age. USMLE step 1, MCAT scores and faculty evaluation grades were predictive of NMBE OBGYN scores. They may be helpful in assessing third-year medical students in need of special supervision and assistance.

  11. Burnout, depression, and career satisfaction: cross-sectional study of obstetrics and gynecology residents.

    PubMed

    Becker, Julie L; Milad, Magdy P; Klock, Susan C

    2006-11-01

    This study was undertaken to measure career satisfaction among obstetrics and gynecology residents and assess its relationship to burnout, depression, and malpractice concerns. A 63-item, anonymous, self-administered survey was distributed to residents at 23 randomly selected obstetric and gynecologic residency programs in the United States. The outcome measures included the Maslach Burnout Inventory-Human Services Survey, the Center for Epidemiological Studies-Depression Scale, and perceptions of malpractice and career satisfaction. Eighty-three percent of the residents were either "very or somewhat satisfied" with their career choice. The majority (89.8%) showed evidence of moderate burnout and 34.2% were considered depressed. Ninety-six percent were concerned about malpractice with 35% pursuing fellowship solely because of malpractice concerns. Residents dissatisfied with their career choice were twice as likely to be depressed (30% vs 55%, P = .03). Both emotional exhaustion (P < .0001) and consideration of fellowship because of malpractice (P < .0001) were strongly predictive of diminishing career satisfaction. Resident career satisfaction was inversely correlated with burnout and depression, which were more prevalent than expected. Overall, residents were satisfied with their career choice, but also negatively influenced by malpractice concerns.

  12. Patient Safety in Obstetrics and Gynecology Departments of two Teaching Hospitals in Delhi

    PubMed Central

    Gupta, Bindiya; Guleria, Kiran; Arora, Renu

    2016-01-01

    Background: A healthy safety culture is integral to positive health care. A sound safety climate is required in Obstetrics and Gynecology to prevent adverse outcomes. Objective: The objective of this study was to assess and compare patient safety culture in two departments of Obstetrics and Gynecology. Materials and Methods: Using a closed-ended standard version of Hospital Survey on Patient Safety Culture (HSOPS), respondents were asked to answer 42 survey items, grouped into 10 dimensions and two outcome variables in two tertiary care teaching hospitals in Delhi. Qualitative data were compared using Fisher's exact test and chi-square test wherever applicable. Mean values were calculated and compared using unpaired t-test. Results: The overall survey response rate was 55%. A positive response rate of 57% was seen in the overall perception of patient safety that ranged from very good to acceptable. Sixty-four percent showed positive teamwork across hospital departments and units, while 36% gave an affirmative opinion with respect to interdepartmental handoffs. However, few adverse events (0-10) were reported in the last 12 months and only 38% of mistakes by doctors were reported. Half of the respondents agreed that their mistakes were held against them. There was no statistical difference in the safety culture between the two hospitals. Conclusions: Although the perception of patient safety and standards of patient safety were high in both the hospitals' departments, there is plenty of scope for improvement with respect to event reporting, positive feedback, and nonpunitive error. PMID:27385879

  13. A Study of Factors Influencing Productivity in the Obstetrics and Gynecology Outpatient Clinic at Walter Reed Army Medical Center.

    DTIC Science & Technology

    1992-08-01

    effectiveness). Many health care professionals view the whole concept of productivity in a negative context. Middle managers, front line supervisors...missions, goals, long-term and short-term objectives for the whole department. The OB-GYN Clinic 31 five missions listed are the following: (1) "provide...for fourteen physicians conducting various clinics (i.e., post-partum, oncology, infertility, colposcopy, cryotherapy , and sterilization), (d) three

  14. Organizational Determinants of Outpatient Substance Abuse Treatment Duration in Women

    PubMed Central

    Alexander, Jeffrey A.; Lemak, Christy Harris

    2009-01-01

    Longer treatment duration has consistently been related to improved substance use outcomes. This study examined how tailored women's programming and organizational characteristics were related to duration in outpatient substance abuse treatment in women. Data were from two waves of a national outpatient substance abuse treatment unit survey (n=571 in 1999/2000, n=566 in 2005). Analyses were conducted separately for methadone and non-methadone programs. Negative binomial regressions tested associations between organizational determinants, tailored programming, and women's treatment duration. Of the tailored programming services, childcare was significantly related to longer duration in the non-methadone programs, but few other organizational factors were. Tailored programming was not associated to treatment duration in methadone programs, but ownership, affiliation, and accreditation were related to longer duration. Study findings suggest evidence for how external relationships related to resources, treatment constraints, and legitimacy may influence women's treatment duration. Methadone programs may be more vulnerable to external influences. PMID:19038526

  15. Heart Failure Update: Outpatient Management.

    PubMed

    Wojnowich, Katherine; Korabathina, Ravi

    2016-03-01

    Outpatient management of heart failure (HF) is aimed at treating symptoms and preventing hospitalizations and readmissions. Management is initiated in a stepwise approach. Blockade of the renin-angiotensin system is a cornerstone of therapy and should be started, along with beta blockers, as soon as the diagnosis of HF is made. Other drugs, including diuretics, aldosterone antagonists, hydralazine, and nitrates, may be added based on symptoms and American College of Cardiology/American Heart Association stage. Despite a great interest in and theoretical benefit of naturoceutical products in the mitigation of oxidative stress and HF progression, none has been proven to be beneficial, and concerns exist regarding their interactions with standard HF drugs. Other nonpharmacologic interventions, including sodium restriction, regular exercise, and/or cardiac rehabilitation, should be initiated at diagnosis. HF often is progressive, and clinicians should be aware of late stage management options, including implantable devices, cardiac transplantation, and hospice care.

  16. Outpatient treatment of adult asthma.

    PubMed Central

    Kleerup, E C; Tashkin, D P

    1995-01-01

    As a chronic disease with intermittent exacerbations, asthma is treated primarily in the outpatient setting by primary care physicians. Asthma is the result of complex and only partially understood interactions of respiratory, inflammatory, and neural cells and their mediators. The goals of asthma therapy are to prevent and relieve symptoms, allow normal activities of daily living, restore and maintain normal pulmonary function, avoid adverse effects from interventions, and minimize inconvenience and cost. These goals can be achieved through educating patients, assessing and monitoring asthma severity, avoiding or controlling asthma triggers, establishing an intervention plan for routine self-management and the management of exacerbations, and providing regular follow-up care. We present a stepped approach to asthma pharmacotherapy, emphasizing anti-inflammatory therapy--inhaled corticosteroids, cromolyn sodium, or nedocromil sodium--as a summary of recent national and international recommendations. PMID:7667983

  17. Transcutaneous Electrical Acupoint Stimulation Improves the Postoperative Quality of Recovery and Analgesia after Gynecological Laparoscopic Surgery: A Randomized Controlled Trial

    PubMed Central

    Yao, Yusheng; Zhao, Qiuyan; Gong, Cansheng; Wu, Yihuan; Chen, Ying; Qiu, Liangcheng; Wu, Xiaodan; Chen, Yanqing

    2015-01-01

    Background. We conducted this prospective, randomized, double-blind, placebo-controlled study to evaluate the effects of transcutaneous electric acupoint stimulation (TEAS) on the quality of recovery (QoR) and postoperative analgesia after gynecological laparoscopic surgery. Methods. 74 American Society of Anesthesiologists physical status (ASA) I or II patients undergoing gynecological laparoscopic surgery were randomly allocated to TEAS or control groups. The primary outcome was the quality of recovery, which was assessed on the day before surgery and 24 h after surgery using a 40-item questionnaire. Secondary outcomes included postoperative pain scores, the incidence of postoperative nausea and vomiting (PONV), duration of postanesthesia care unit (PACU) stay, and patient's satisfaction. Results. The TEAS group had higher QoR scores than control group upon 24 h after surgery (177 versus 165; P < 0.001). Compared with the control group, postoperative pain scores and the cumulative number of opioids administered were lower in the TEAS group patients (P = 0.04). TEAS reduced the incidence of PONV and dizziness, as well as duration of PACU stay. Simultaneously, the patient's satisfaction scores were higher in the TEAS group (P = 0.002). Conclusion. Preoperative TEAS enhances QoR, improves postoperative analgesia and patient's satisfaction, alleviates postoperative side effects, and accelerates discharge after general anesthesia for gynecological laparoscopic surgery. PMID:26170873

  18. 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.

  19. Strategies for boosting outpatient care profitability.

    PubMed

    Baptist, A J; Lameka, R B

    1990-02-01

    With outpatient charges approaching one-fourth of hospital revenues nationwide, healthcare providers are pressed to handle this care more efficiently and profitably. Five steps toward healthier profit margins for outpatient services involve finding ways to expand volume and market share; setting and meeting strict quality standards; studying operational efficiency; working with physicians to improve productivity; and monitoring price-cost relationships.

  20. Involuntary Outpatient Commitment of the Mentally Ill.

    ERIC Educational Resources Information Center

    Wilk, Ruta J.

    1988-01-01

    Examines the issue of involuntary outpatient commitment, and its implications for social workers working in the health system. Describes a nationwide movement to establish a new system of involuntary outpatient commitment to address the failure of deinstitutionalization, mandating mental health treatment in the community for persons ineligible for…

  1. A Study to Determine the Impact of the Recently Established Primus Clinics on the Patient Workload in the Pediatric Clinic, General Outpatient Clinic and Emergency Room at Darnall Army Community Hospital

    DTIC Science & Technology

    1989-07-03

    pediatric clinic, general outpatient clinic, and emergency room at Darnall. 4. The present organization and resources for primary medical care at...specialty (e.g. family practice, internal medicine, pediatrics , emergency medicine, or obstetrics/gynecology). The medical director of the PRIMUS...Germantown, MD. < m zCallahan, Charles W. Jr. 1988. " Pediatric Clinic Briefing." KM z 12 September. CHAMPUS (Civilian Health and Medical Program of the

  2. Colonic surgery in gynecologic oncology. Risk factor analysis.

    PubMed

    Burnett, A F; Potkul, R K; Barter, J F; Barnes, W A; Delgado, G

    1993-02-01

    Colonic surgery is a critical part of gynecologic oncology care. A 12-year review of colonic surgery on a gynecologic oncology service was performed evaluating risk factors and their impact on postoperative morbidity. There were 124 procedures performed on 92 patients; 9 patients had no prior surgery, chemotherapy or radiation. Fifty-six percent of the patients were considered malnourished on the basis of a serum albumin level < 3.5 g/dL. The 124 procedures consisted of 57 colon resections with primary reanastomosis, 10 small bowel-colon bypass procedures and 57 colostomies. Of the 57 (67%) colostomy operations, 38 also had concomitant abdominal-pelvic procedures. There were 15 major bowel complications and 17 major systemic postoperative complications. Prior surgery and poor nutritional status significantly correlated with postoperative morbidity; however, prior radiation did not reveal an increased risk for postoperative complications.

  3. 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.

  4. Gynecologic Symptoms and Sexual Behaviors among Adolescent Women

    PubMed Central

    Woods, Jennifer L.; Hensel, Devon J.; Fortenberry, J. Dennis

    2009-01-01

    Study Objective Little is understood either about the prevalence of gynecologic symptoms such as vulvo-vaginal pain, pelvic cramps and vaginal discharge, or about the relationship of symptom duration to event-level sexual behaviors. Design/Setting/Participants/Main Outcome Measures Data were daily diaries collected from an ongoing, longitudinal cohort with the three symptom variables; symptom duration was calculated and event level sexual behaviors were included. Results Reported relatively frequently, single symptoms had positive and negative effects while multiple symptoms and duration of symptoms decreased likelihood of all non-coital sexual behaviors. Conclusions Gynecologic symptoms influence the likelihood of sexual behaviors suggesting a complex relationship between the occurrences. PMID:19734076

  5. Prevention and management of urologic injury during gynecologic laparoscopy.

    PubMed

    Findley, Austin D; Solnik, M Jonathon

    2016-08-01

    This article provides an update on the best practices for the prevention, recognition, and management of urinary tract injuries that may occur during gynecologic laparoscopic surgery. Higher surgical volume is directly associated with improved surgical outcomes, denoted by consistently lower rates of complications for commonplace procedures such as hysterectomy. As a result, expert opinion on prevention of iatrogenic urologic injury suggests a real need for improved education and training of gynecologic surgeons. Discontinued manufacturing of indigo carmine has led to the utilization of alternative methods to assess ureteral patency during cystoscopy, such as phenazopyridine or sodium fluorescein. Intraoperative cystoscopy has been shown to detect approximately 50% of urinary tract injuries during hysterectomy, but has limited accuracy and does not necessarily decrease delayed postoperative complications. When identified, most urologic injuries can be managed in a minimally invasive fashion. A thorough understanding of pelvic anatomy and early recognition of urinary tract injuries can significantly reduce surgical morbidity for women undergoing laparoscopic surgery.

  6. Once-daily dosing of gentamicin in obstetrics and gynecology.

    PubMed

    Ward, Kristy; Theiler, Regan N

    2008-09-01

    Gentamicin, an aminoglycoside with broad antimicrobial activity, is commonly used in both obstetrics and gynecology. Traditional dosing regimens for gentamicin have called for 3 times daily dosing, but recent insights into the pharmacodynamics of the drug have led to multiple studies of once-daily dosing regimens. Many studies have demonstrated efficacy, safety, and economy of the 24-hour dosing interval, resulting in recommendations that this become the standard for aminoglycoside administration. However, because of the unique considerations for drug administration in pregnant and postpartum women, the once-daily dosing regimens have not been widely adopted. Additional studies in pregnant and postpartum women have demonstrated therapeutic noninferiority, no increase in adverse events, and significant cost savings with once-daily dosing versus 3 times daily dosing of gentamicin. We review the literature and present rationale based on multiple controlled studies supporting single-daily dosing of gentamicin, 5 mg/kg/d actual body weight, for many common obstetrics-gynecology infections.

  7. Depot medroxyprogesterone acetate contraception and the risk of breast and gynecologic cancer.

    PubMed

    Kaunitz, A M

    1996-05-01

    As the use of depot medroxyprogesterone acetate (DMPA) contraception increases in the United States and worldwide, assessing any impact on the risk of breast and gynecologic cancers becomes increasingly important. Overall, use of DMPA does not affect breast cancer risk. An elevated risk of this disease, however, has been noted in recent or current users. Hence, the association between DMPA use and breast cancer risk appears similar to that observed with oral contraceptives. Use of DMPA is associated with an 80% risk reduction of endometrial adenocarcinoma, a level of protection even greater than that noted with oral contraceptives. The risk of epithelial ovarian cancer and cervical neoplasia does not appear to be affected by DMPA use. Except for a substantial reduction in the risk of endometrial adenocarcinoma, use of DMPA does not appear to influence reproductive tract cancer risks.

  8. Trichomonas vaginalis vaginitis in obstetrics and gynecology practice: new concepts and controversies.

    PubMed

    Coleman, Jenell S; Gaydos, Charlotte A; Witter, Frank

    2013-01-01

    Trichomonas vaginalis (TV) is the most common curable sexually transmitted infection worldwide. Annually, 7.4 million new infections are estimated in the United States, which is greater than combined new cases of Chlamydia, gonorrhea, and syphilis. Serious adverse reproductive health outcomes including pregnancy complications, pelvic inflammatory disease, and an increased risk of HIV acquisition have been linked to TV infection. There are several sensitive and specific diagnostic tests available, including a newly approved nucleic acid amplification test (NAAT) that utilizes the same instrumentation platform and clinical sample as Chlamydia and gonorrhea tests. In this article, we review TV pathogenicity, adverse reproductive health outcomes, detection, and treatment followed by clinical scenarios for which TV diagnosis may prove useful in obstetrics and gynecology practice.

  9. 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

  10. 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.

  11. 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

  12. 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.

  13. The Use of Barbed Sutures in Obstetrics and Gynecology

    PubMed Central

    Greenberg, James A

    2010-01-01

    Despite the multitude of different procedures performed with a host of different wound closure biomaterials, no study or surgeon has yet identified the perfect suture for all situations. In recent years, a new class of suture material—barbed suture—has been introduced into the surgeon’s armamentarium. This review focuses on barbed suture to better understand the role of this newer material in obstetrics and gynecology. PMID:21364859

  14. 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

  15. Advances in Suture Material for Obstetric and Gynecologic Surgery

    PubMed Central

    Greenberg, James A; Clark, Rachel M

    2009-01-01

    Despite millennia of experience with wound closure biomaterials, no study or surgeon has yet identified the perfect suture for all situations. Tissue characteristics, tensile strength, reactivity, absorption rates, and handling properties should be taken into account when selecting a wound closure suture. This review discusses the wound healing process and the biomechanical properties of currently available suture materials to better understand how to choose suture material in obstetrics and gynecology. PMID:19826572

  16. Core Privileging and Credentialing: Hospitals' Approach to Gynecologic Surgery.

    PubMed

    Siddique, Moiuri; Shah, Nemi; Park, Amy; Chen, Beatrice; Emery, Stephen; Falcone, Tommaso; Margulies, Rebecca; Rardin, Charles; Iglesia, Cheryl

    Privileging and credentialing requirements are determined by medical staff leadership at the hospital level to ensure clinicians provide safe healthcare services. No standardized guidelines exist for gynecologic surgery. The objective of this study is to examine the variability of the criteria used to grant surgical privileges and credentials for gynecologic procedures at 5 high-volume academic and community-based US hospitals. We conducted a cross-sectional study (Canadian Task Force classification III). Data was obtained from obtained from 5 geographically diverse hospital systems. We examined criteria for designating core gynecologic privileges, credentialing, and other training requirements as well as minimum and annual case numbers for initial granting and maintenance of surgical privileges. Major inconsistencies in privileging were found across the 5 institutions. Hospitals varied widely in procedures designated as core versus those requiring advanced training. Institutions greatly contrasted in the case numbers and temporal factors used to define experience. Of particular concern was absent privileging criteria for 38.4% to 76.9% of minor procedures, 26.7% to 46.7% of endoscopic procedures, and 6.67% to 56.7% of major procedures. Initial and maintenance privileging requirements for special procedures (i.e., robotic-assisted surgery) were likewise discrepant, with minimum annual case numbers ranging from 3 to 48 across hospitals. Considerable variability exists in the criteria used by hospitals for granting and maintaining surgical privileges for gynecologic procedures. Standardization will likely require efforts at a national leadership level. Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.

  17. Using a laparoscope manipulator (LAPMAN) in laparoscopic gynecological surgery.

    PubMed

    Polet, Roland; Donnez, Jaques

    2008-01-01

    The LAPMAN (Medsys, Gembloux, BELGIUM) is a dynamic laparoscope holder guided by a joystick clipped onto the laparoscopic instruments under the index finger of the operator. It confers optimal control of the visual field while operating, ensures stable and smooth displacement of the laparoscope, and allows the operator to work in conditions of restricted surgical assistance, due to either unavailability of staff or economic constraints. It has been tested successfully in pilot studies in laparoscopic gynecologic surgery.

  18. Anesthesia for outpatient female sterilization.

    PubMed

    Fishburne, J I

    1983-04-01

    This issue of the Bulletin deals with the principles of anesthesia for outpatient female sterilization with emphasis on techniques for laparoscopy and minilaparotomy. General anesthesia techniques provide analgesia, amnesia, and muscle relaxation and are particularly useful for managing the anxious patient. Disadvantages include increased expense, need for specialized equipment, and highly trained personnel, and delayed recovery. Complications, though relatively rare, can be life-threatening and include aspiration of stomach contents, hypoxia, hypercarbia, hypotension, hypertension, cardiac arrhythmias, cardiorespiratory arrest, and death. There is no single preferred technique of general anesthesia, athough most anesthetists employ methods that allow rapid recovery of faculties, enabling the patient to be discharged soon after surgery. To accomplish this end, light anesthesia with sodium thiopental induction and nitrous oxide maintenance is often used. Short duration muscle relaxation with an agent such as succinylcholine supplements this technique. Other techniques include light anesthesia with inhalational anesthetic agents and the use of intravenous ketamine. Local anesthesia augmented by systemic and/or inhalational analgesia is supplanting general anesthesia techniques for laparoscopy in many locales. This approach is also particularly well-suited for minilaparotomy in developing countries, where it has achieved its greatest popularity. The local technique carries with it reduced morbidity and mortality but may not entirely relieve discomfort. The primary danger of local anesthesia is respiratory depression due to excessive narcosis and sedation. The operator must be alert to the action of the drugs and should always use the minimal effective dose. Although toxicity due to overdosage with local anesthetic drugs is occasionally experienced, allergic reactions to the amide-linkage drugs such as lidocaine or bupivacaine are exceedingly rare. For outpatient

  19. [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.

  20. 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

  1. [Prevalence of burnout among obstetrics and gynecology residents].

    PubMed

    Rua, C; Body, G; Marret, H; Ouldamer, L

    2015-01-01

    Prevalence assessment of burnout among obstetrics and gynecology residents and predisposing factors. Multicentric cross-sectional survey based on a questionnaire sent by email to the residents including demographics data and Maslach Burnout Inventory. Mean burnout scores were 19.67±10.19 for emotional exhaustion, 33.94±5.01 for personal accomplishment and 8.72±6.10 for depersonalization, corresponding to a moderate burnout for each category. High scores of burnout were seen on 19.45 % of residents for emotional exhaustion, 33.33 % for depersonalization and 11.11 % for personal accomplishment. 36.11 % of residents showed evidence of high burnout in emotional exhaustion or depersonalization, and 5.55 % in the three dimensions. The number of semesters is correlated with depersonalization (P=0.01). There is a strong personal accomplishment among obstetrics and gynecology residents; however, burnout and emotional exhaustion remains a reality during obstetrics and gynecology residency. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  2. 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.

  3. 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.

  4. Folic acid use by women receiving routine gynecologic care.

    PubMed

    Cleves, Mario A; Hobbs, Charlotte A; Collins, H Breck; Andrews, Nancy; Smith, Laura N; Robbins, James M

    2004-04-01

    Many health professional groups recommend folic acid supplementation for all women able to become pregnant. In this study, we document folic acid supplement use among a sample of women receiving routine gynecologic care. A short questionnaire was administered to 322 women aged 18-45 years who were seeking routine gynecologic care at participating clinics in Little Rock, Arkansas. Questions covered knowledge and use of folic acid supplements, pregnancy intention, and demographic and socioeconomic characteristics. Primary study outcomes were self-reported folic acid awareness, daily or weekly use of folic acid supplements, and intention to begin taking folic acid. Factors affecting study outcomes were examined individually by computing crude odd ratios and adjusted for other covariates using unconditional logistic regression. Although 61.8% of women reported awareness of the association between folic acid and birth defects prevention, only 27.1% of these women, and 22.7% of all study participants, reported daily use of a folic acid supplement. Substantially more women (39.8%) were taking a folic acid supplement at least once per week. Age, race, educational level, folic acid awareness, marital status, pregnancy intent, and other preventive health behaviors were the most important predictors of compliance. The results indicate a need for targeted interventions directed toward minority women, young women, and those of lower socioeconomic and educational status. The routine gynecologic visit is an ideal opportunity to counsel women of reproductive age to take folic acid daily. III

  5. The epidemiologic status of gynecologic cancer in Thailand.

    PubMed

    Wilailak, Sarikapan; Lertchaipattanakul, Nuttapong

    2016-11-01

    Between the years of 2010-2012, it was estimated there were a total of 112,392 new cases of cancers in Thailand, thus, the total age-standardized rate (ASR) per 100,000 is 137.6. In regards to the most prevalent types of cancer in female, breast cancer has the highest ASR, followed by cervical cancer (ASR=14.4); liver and bile duct cancer; colon and rectum cancer; trachea, bronchus and lung cancer; ovarian cancer (ASR=6.0); thyroid cancer; non-Hodgkin lymphoma and uterine cancer (ASR=4.3). The trend of cervical cancer in Thailand is decreasing, one key factor in making this possible was the employment of dual tract strategy (Pap smear and visual inspection with acetic acid [VIA]) by the government in 2005. In the future, the government is also considering integrating human papillomavirus (HPV) vaccination into the national immunization program, which may assist in the prevention of cervical cancer. By studying the statistical data of gynecologic cancer, it will be possible to formulate measures for the prevention, control and treatment of gynecologic cancer. Eventually, it will potentially improve the quality of life (QoL) of patients as well as decrease the mortality rate caused by gynecologic cancer.

  6. Gynecological cancers: A summary of published Indian data

    PubMed Central

    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. PMID:27606294

  7. [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.

  8. 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.

  9. 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.

  10. Gynecologic disorders and menstrual cycle lightheadedness in postural tachycardia syndrome

    PubMed Central

    Peggs, Kiffany J.; Nguyen, HoVan; Enayat, Diba; Keller, Nancy R.; Al-Hendy, Ayman; Raj, Satish R.

    2012-01-01

    Objective To assess differences in gynecologic history and lightheadedness during menstrual cycle phases among patients with POTS and healthy control women. Methods In a prospective, questionnaire-based study carried out at Paden Autonomic Dysfunction Center, Vanderbilt University, between April 2005 and January 2009, a custom-designed questionnaire was administered to patients with POTS (n=65) and healthy individuals (n=95). The results were analyzed via Fisher exact test and Mann–Whitney U test. Results Patients with POTS reported increased lightheadedness through all phases of the menstrual cycle phases as compared with healthy controls. Both groups experienced the greatest lightheadedness during menses, and a decrease in lightheadedness during the follicular phase. Patients with POTS reported a higher incidence of gynecologic diseases as compared with healthy controls. Conclusion The severity of lightheadedness was found to vary during the menstrual cycle, which may relate to changes in estrogen levels. Patients with POTS also reported an increase in estrogen-related gynecologic disease. PMID:22721633

  11. Management and outcome of rectal injury during gynecologic laparoscopic surgery.

    PubMed

    Jo, Eun Ju; Lee, Yoo-Young; Kim, Tae-Joong; Choi, Chel Hun; Lee, Jeong-Won; Bae, Duk-Soo; Kim, Byoung-Gie

    2013-01-01

    To assess the incidence and management of accidental rectal injury during gynecologic laparoscopic surgery. A retrospective study with review of outcomes (Canadian Task Force classification II-3). A tertiary care/research/university hospital. Patients with colon injury during laparoscopy for gynecologic diseases at Samsung Medical Center, Seoul, Korea, from January 2000 to April 2012. Use of absorbable suture or staples in primary repair of injured colon. From January 2000 to April 2012, 12 354 patients underwent laparoscopic surgery. Rectal injury occurred in 15 women (0.12%). Their median age was 42.5 years (30-49), and the median length of injury was 3 cm (0.7-7). Among 13 patients with rectal injuries recognized during surgery, 10 patient injuries were repaired primarily with interrupted absorbable sutures without converting laparotomy, 1 patient underwent laparoscopic low anterior resection with Endo-GIA, 1 underwent open primary repair, and 1 underwent open low anterior resection. Two rectal injuries were detected after surgery. One of these patients underwent primary repair under laparotomy at day 4 after surgery. The other patient had development of a rectovaginal fistula requiring open segmental resection 30 days after primary laparoscopy despite conservative management, including percutaneous drainage and prophylactic antibiotics. Rectal injury during laparoscopy in the gynecologic field can be repaired successfully without the need for a colostomy regardless of mechanism of injury and the size of injury if adequate rectal tissue is available and recognized during surgery. Copyright © 2013 AAGL. Published by Elsevier Inc. All rights reserved.

  12. Gynecologic and Obstetric Consequences of Obesity in Adolescent Girls.

    PubMed

    Elizondo-Montemayor, Leticia; Hernández-Escobar, Claudia; Lara-Torre, Eduardo; Nieblas, Bianca; Gómez-Carmona, Merith

    2017-04-01

    In the past few decades, there has been an overwhelming increase in childhood and adolescent obesity worldwide. Besides the well recognized cardiometabolic complications and other physical conditions associated with obesity, during adolescence, it causes psychological and social distress in a period of life that is already sensitive for a girl. This in turn increases their risk of low self-esteem and depression. Furthermore, obesity diminishes health-related quality of life and years of life. Overweight and obese teenagers are more likely to have gynecologic and obstetric complications, during adolescence and also later in life. Consequences of obese and overweight childhood and adolescence include sexual maturation and reproductive dysfunction, alterations in menstruation, dysmenorrhea, risky sexual behavior, and inefficient use of contraception, polycystic ovary syndrome, bone density abnormalities, macromastia, and an increased risk of breast and endometrial cancer. Obese adolescents are at greater risk of pregnancy and perinatal complications, such as preeclampsia, gestational hypertension and preeclampsia, gestational diabetes mellitus, primary cesarean delivery, and induction of labor, to mention a few. Evidence shows that infants born to obese teenagers are also more likely to have complications including preterm or post-term delivery, small-for-gestational age newborns, macrosomia, meconium aspiration, respiratory distress, and even stillbirth, among others. This comprehensive review focuses on the gynecological and obstetric consequences of obesity in adolescent girls. Copyright © 2016 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  13. 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

  14. The epidemiologic status of gynecologic cancer in Thailand

    PubMed Central

    2016-01-01

    Between the years of 2010–2012, it was estimated there were a total of 112,392 new cases of cancers in Thailand, thus, the total age-standardized rate (ASR) per 100,000 is 137.6. In regards to the most prevalent types of cancer in female, breast cancer has the highest ASR, followed by cervical cancer (ASR=14.4); liver and bile duct cancer; colon and rectum cancer; trachea, bronchus and lung cancer; ovarian cancer (ASR=6.0); thyroid cancer; non-Hodgkin lymphoma and uterine cancer (ASR=4.3). The trend of cervical cancer in Thailand is decreasing, one key factor in making this possible was the employment of dual tract strategy (Pap smear and visual inspection with acetic acid [VIA]) by the government in 2005. In the future, the government is also considering integrating human papillomavirus (HPV) vaccination into the national immunization program, which may assist in the prevention of cervical cancer. By studying the statistical data of gynecologic cancer, it will be possible to formulate measures for the prevention, control and treatment of gynecologic cancer. Eventually, it will potentially improve the quality of life (QoL) of patients as well as decrease the mortality rate caused by gynecologic cancer. PMID:27775261

  15. An audit of travel and waiting times for outpatient radiotherapy.

    PubMed

    Junor, E J; Macbeth, F R; Barrett, A

    1992-05-01

    The object of this study was to assess the non-medical factors which detract from the quality of outpatient receiving service to a population of 2.7 million in a wide geographical area. We conducted a survey by patient questionnaire of all outpatients receiving radiotherapy in the West of Scotland on a single day in 1990. A total of 216 outpatients attended for radiotherapy with a 92% response rate to the questionnaire being achieved. Median values (and ranges) were: age 58 (4-85) years, number of daily treatments 20 (4-33), distance travelled in one direction 10 (1-60) miles, travelling time 45 (5-130) minutes, waiting time in the unit for treatment 60 (0-200) minutes, and a time away from home of 2 hours 50 minutes (35 minutes-7 hours). Sixteen per cent of patients had a relative who lost time from work by transporting the patient and only 12 of 60 patients who were away from home over a meal time were offered a hospital meal. Sixteen per cent of patients came by ambulance and 73% by motor car. Of 146 travelling by car 27% used a charity service and 20% a volunteer driver ambulance service car. It is concluded that long travelling distances, travelling times and treatment waiting times for many patients require revision of transport provision, a strict appointment system, more treatment machines and hostel accommodation.

  16. Building an Outpatient Kidney Palliative Care Clinical Program.

    PubMed

    Scherer, Jennifer S; Wright, Rebecca; Blaum, Caroline S; Wall, Stephen P

    2017-08-09

    A diagnosis of advanced chronic kidney disease (CKD), or end stage renal disease (ESRD) represents a significant life change for patients and families. Individuals often experience high symptom burden, decreased quality of life, increased health care utilization, and end-of-life care discordant with their preferences. Early integration of palliative care with standard nephrology practice in the outpatient setting has the potential to improve quality of life through provision of expert symptom management, emotional support, and facilitation of advance care planning that honors the individual's values and goals. This special report describes application of participatory action research (PAR) methods to develop an outpatient integrated nephrology and palliative care program. Stakeholder concerns were thematically analyzed to inform translation of a known successful model of outpatient kidney palliative care to a practice in a large, urban medical center in the United States. Stakeholder needs and challenges to meeting these needs were identified. We uncovered a shared understanding of the clinical need for palliative care services in nephrology practice, but apprehension towards practice change. Action steps to modify the base model were created in response to stakeholder feedback. The development of a model of care that provides a new approach to clinical practice requires attention to relevant stakeholder concerns. PAR is a useful methodological approach that engages stakeholders and builds partnerships. This creation of shared ownership can facilitate innovation and practice change. We synthesized stakeholder concerns to build a conceptual model for an integrated nephrology and palliative care clinical program. Copyright © 2017. Published by Elsevier Inc.

  17. 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

  18. 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

  19. Anesthesia for the elderly outpatient.

    PubMed

    Aurini, Lucia; White, Paul F

    2014-12-01

    As the number of ambulatory surgery procedures continues to grow in an aging global society, the implementation of evidence-based perioperative care programs for the elderly patients will assume increased importance. Increasing evidence supports the expanded use of ambulatory surgery for managing elderly patients undergoing elective surgery procedures. This review article describes the demographics of ambulatory surgery in the elderly population. This review article describes the effects of aging on the responses of geriatric patients to anesthetic and analgesic drugs used during ambulatory surgery. Important considerations in the preoperative evaluation of elderly outpatients with co-existing diseases, as well as the advantages and disadvantages of different anesthetic techniques on a procedural-specific basis, and recommendations regarding the management of common postoperative side-effects (including delirium and cognitive dysfunction, fatigue, dizziness, pain, and gastrointestinal dysfunction) after ambulatory surgery. Finally, we discuss the future challenges related to the continued expansion of ambulatory surgery practice in this growing segment of our surgical population. The role of anesthesiologists as perioperative physicians is of critical importance for optimizing surgical outcomes for elderly patients undergoing ambulatory surgery. Providing high-quality, evidence-based anesthetic and analgesic care for elderly patients undergoing elective operations on an ambulatory basis will assume greater importance in the future.

  20. [Outpatient treatments of haemorrhoidal disease].

    PubMed

    Staumont, Ghislain; Gorez, Etienne; Suduca, Jean-Michel

    2011-10-01

    Only three non-surgical treatments of haemorrhoids are clearly validated: infrared coagulation, injection sclerotherapy and rubber band ligation. Those procedures are only indicated for painless symptoms related to internal haemorrhoids, i.e. bleeding at defecation or spontaneously reducible prolapse. Their main interest is to be possible on the outpatient clinic, with a simple anuscope, without enema or anaesthesia, since they are applied to non-sensitive area on the top of internal haemorrhoids. The aim of all these treatments is to create local fibrosis, which reduces vascular tissue and hold rectal mucosa to underlying muscle. Short-dated efficiency of all techniques is similar on bleeding. After one and three years, rubber band ligation is clearly more efficient than other techniques, especially on prolapse. Secondary effects are non-constant and usually minor, as transient pain or tenesmus, and mild bleeding for few days. Infrequent complications may occur, only after haemorrhoidal banding and sclerotherapy, as thrombosis, massive delayed bleeding or local abscess. Exceptional life-threatening pelvic cellulitis cases have been reported. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

  1. Prevalence of mental distress and associated factors among caregivers of patients with severe mental illness in the outpatient unit of Amanuel Hospital, Addis Ababa, Ethiopia, 2013: Cross-sectional study.

    PubMed

    Sintayehu, Mezinew; Mulat, Haregwoin; Yohannis, Zegeye; Adera, Tewodros; Fekade, Maereg

    2015-01-01

    Caregivers like family members or other relatives are central and provide not only practical help and personal care but also give emotional support, and they are suffering from plenty of challengeable tasks. These, eventually, cast out family caregivers into multidimensional problems prominently for mental distress like depression, anxiety, sleep problem and somatic disorder which are followed by physiologic changes and impaired health habits that ultimately lead to illness and possibly to death. Numerous studies demonstrate that mental distress of caregivers are two times compared to general populations. Despite it was not uncommon to observe manifestations of caregivers' mental distress, yet there was no study on this area. Therefore, this study was intended to assess the prevalence of mental distress and associated factors among the caregivers of persons with severe mental illness in the out patients unit of Amanuel Hospital, Ethiopia. Institutional based cross sectional study was conducted from May 1 to 31, 2013 at Amanuel Hospital, Addis Ababa, Ethiopia. Systematic random sampling technique with "k" interval of 13 was employed to withdraw a total of 423 participants from study population. Five psychiatric nurses carried out interview by using standardized and validated Self Reported Questionnaire (SRQ 20). Descriptive statistics, binary and multivariate logistic regression analysis were conducted. This study revealed that the overall prevalence of mental distress was found to be 221(56.7 %). The factors like missed social support, two or more times admission of patient, care giving for psychotic patient, being farmer and being female were found to be predictors for mental distress of caregivers with this [AOR 95 % CI = 9.523(5.002, 18.132)], 3.293(1.474, 3.3560), 2.007(1.109, 3.634), 2.245(1.129, 4.463) and 3.170(1.843, 5.454)] respectively. In this respect the study observed that there was a higher level of mental distress experienced by caregivers of

  2. 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

  3. [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

  4. 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.

  5. 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.

  6. 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.

  7. An Assessment of Postoperative Outpatient Cases

    PubMed Central

    Ogg, T. W.

    1972-01-01

    A total of 100 outpatients in the North-East of Scotland were given a simple anaesthetic of propanidid, nitrous oxide, oxygen, and halothane. The study was undertaken to assess what happened to patients when they left hospital after outpatient surgery. An outpatient questionnaire was used, and results show that 31% of patients journeyed home unaccompanied by a responsible person, 73% of car owners drove within 24 hours of the operation, and 9% drove themselves home. Postoperative symptoms of drowsiness (26%), headache (27%), nausea (22%), and dizziness (11%) were recorded, and a higher incidence of symptoms was recorded when surgery exceeded 15 minutes. A new form for outpatient operative procedures in Aberdeen has been devised with modern legal implications in mind. PMID:4643394

  8. Outpatient Myelography: A Prospective Trial Comparing Complications after Myelography between Outpatients and Inpatients in Japan

    PubMed Central

    Matsumoto, Tomohiro; Inoue, Hidenori; Aoki, Takaaki; Ishiguro, Naoki; Osawa, Yoshimitsu

    2015-01-01

    Study Design Prospective comparative study. Purpose To compare the incidence and severity of adverse reactions associated with myelography performed in outpatients vs. in inpatients and report the safety and usefulness of outpatient myelography in Japanese patients. Overview of Literature Myelography is normally performed as an inpatient procedure in most hospitals in Japan. No studies have reported the usefulness and adverse effects of outpatient myelography in Japanese patients. Methods We performed 221 myelography procedures. Eighty-five of the 221 patients underwent outpatient myelography using our new protocol. The incidence and severity of adverse reactions were compared with the other 136 patients, who underwent conventional inpatient myelography. We further compared the cost of outpatient and inpatient myelography. Results The overall rate of adverse effects was 9.4% in outpatients, as compared with 7.4% in inpatients. Overall, 1.2% of outpatients and 0.74% inpatients experienced "severe" adverse effects (requiring hospitalization). There were no significant differences between the 2 groups in either the overall rate of adverse effects or the rate of "severe" adverse effects. Moreover, the average outpatient procedure cost was only one-third to one-half that of the inpatient procedure. Conclusions This was the first study to address the safety and usefulness of outpatient myelography in Japanese patients. If selected according to proper inclusion criteria for outpatient procedure, no significant differences were observed in the adverse effects between inpatients and outpatients. The outpatient procedure is more economical and has the added benefit of being more convenient and time-efficient for the patient. PMID:26713127

  9. [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.

  10. Resident education curriculum in pediatric and adolescent gynecology: the short curriculum.

    PubMed

    Fleming, Nathalie; Amies Oelschlager, Anne-Marie; Browner-Elhanan, Karen J; Huguelet, Patricia S; Kaul, Paritosh; Talib, Hina J; Wheeler, Carol; Loveless, Meredith

    2014-04-01

    The degree of exposure to Pediatric and Adolescent Gynecology (PAG) varies across academic programs in Obstetrics and Gynecology, Pediatrics, and Adolescent Medicine. Nevertheless, these programs are responsible to train residents and provide opportunities within their training programs to fulfill PAG learning objectives. To that end, North American Society for Pediatric and Adolescent Gynecology has taken a leadership role in PAG resident education by disseminating the Short Curriculum with specific learning objectives and list of essential resources where key concepts in PAG can be covered. Copyright © 2014 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  11. Trends over time with commonly performed obstetric and gynecologic inpatient procedures.

    PubMed

    Oliphant, Sallie S; Jones, Keisha A; Wang, Li; Bunker, Clareann H; Lowder, Jerry L

    2010-10-01

    To estimate trends over time in inpatient obstetric and gynecologic surgical procedures, and to estimate commonly performed obstetric and gynecologic surgical procedures across a woman's lifespan. Data were collected for procedures in adult women from 1979 to 2006 using the National Hospital Discharge Survey, a federal discharge dataset of U.S. inpatient hospitals, including patient and hospital demographics and International Classification of Diseases, 9th Revision, Clinical Modification procedure codes for adult women from 1979 to 2006. Age-adjusted rates per 1,000 women were created using 1990 U.S. Census data. Procedural trends over time were assessed. More than 137 million obstetric and gynecologic procedures were performed, comprising 26.5% of surgical procedures for adult women. Sixty-four percent were only obstetric and 29% were only gynecologic, with 7% of women undergoing both obstetric and gynecologic procedures during the same hospitalization. Obstetric and gynecologic procedures decreased from approximately 5,351,000 in 1979 to 4,949,000 in 2006. Both operative vaginal delivery and episiotomy rates decreased, whereas spontaneous vaginal delivery and cesarean delivery rates increased. All gynecologic procedure rates decreased during the study period, with the exception of incontinence procedures, which increased. Common procedures by age group differed across a woman's lifetime. Inpatient obstetric and gynecologic procedures rates decreased from 1979 to 2006. Inpatient obstetric and gynecologic procedure rates are decreasing over time but still comprise a large proportion of inpatient surgical procedures for U.S. women. III.

  12. Furthering the profession: the early years of the American Gynecological Club and its first European tours.

    PubMed

    Eby, Michael W; Longo, Lawrence D

    2002-02-01

    Beginning early in the 20th century, a group of North American leaders in obstetrics and gynecology met annually to promote the furtherance of the specialty. The American Gynecological Club held its meetings at academic medical centers, spending 2 to 4 days viewing the latest diagnostic and operative techniques and hearing presentations by investigators at that institution. On several occasions, club members spent 1 month visiting the foremost medical centers in Great Britain and continental Europe, where they observed surgical procedures, attended clinics, and established friendships that transcended national boundaries. The early years of the American Gynecological Club represent a somewhat idyllic and bygone era in medicine and obstetrics and gynecology.

  13. Health Services for Women in Outpatient Substance Abuse Treatment

    PubMed Central

    Campbell, Cynthia I; Alexander, Jeffrey A

    2005-01-01

    Objective To evaluate how a sample of outpatient substance abuse treatment units respond to organizational and environmental influences by adopting and implementing treatment services for women. Data Sources The National Drug Abuse Treatment System Survey from 1995 and 2000, a national survey of outpatient substance abuse treatment units. Study Design Health services for women are the dependent variables. The predictors include organizational and environmental factors that represent resource dependence and institutional pressures for the treatment unit. Logistic regression and Heckman selection models were used to test hypotheses. Data Collection Program directors and clinical supervisors at each treatment unit were interviewed by telephone in 1995 and 2000. Principal Findings Units that depended on specific funding for women's programs and that depended on government funds were more likely to adopt, but not necessarily implement, women's services. Methadone units and units that train more staff to work with women were more likely to adopt as well as implement women's services. Private not-for-profit units were more likely to adopt some services, while for-profit units were less so. However, in general, neither for-profit nor not-for-profit units significantly implemented services. There was evidence that the odds of adopting services were greater in 2000 than 1995 for two services, but were otherwise stable. Conclusions There is considerable variation in the adoption and implementation of women's services. In addition, not all adopted services were significantly implemented, which could reflect limited organizational resources and/or conflicting expectations. This also suggests that referral mechanisms to these services, and therefore access, may not be adequate. Government funds and specific funds for women's programs are important resources for the provision of these services. Women's services appear more available in methadone units, suggesting that regulation

  14. [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

  15. Postoperative Irradiation of Gynecologic Malignancies: Improving Treatment Delivery Using Aperture-Based Intensity-Modulated Radiotherapy

    SciTech Connect

    Nadeau, Sylvain . E-mail: sylvainn@rrsb.nb.ca; Bouchard, Myriam; Germain, Isabelle; Raymond, Paul-Emile; Beaulieu, Frederic; Beaulieu, Luc; Roy, Rene; Gingras, Luc

    2007-06-01

    Purpose: To evaluate dosimetric and treatment delivery advantages of aperture-based intensity-modulated radiotherapy (AB-IMRT) for the treatment of patients receiving whole pelvic radiotherapy for gynecologic malignancies. Methods and Materials: Nineteen patients undergoing pelvic radiotherapy after resection of endometrial cancers were selected. A 45-Gy dose was prescribed to the target volume delineated on a planning CT scan. An in-house inverse planning system, Ballista, was used to develop a treatment plan using aperture-based multileaf collimator segments. This approach was compared with conventional four-field, enlarged four-field, and static beamlet-based IMRT (BB-IMRT) techniques in terms of target coverage, dose-volume histogram statistics for surrounding normal tissues, and numbers of segments and monitor units (MU). Results: Three quarters (76.4%) of the planning target volume received the prescription dose with conventional four-field plans. With adequate target coverage, the Ballista plans significantly reduced the volume of bowel and bladder irradiated at the prescribed dose (p < 0.001), whereas the two approaches provided equivalent results for the rectum (p 0.5). On the other hand, AB-IMRT and BB-IMRT plans showed only small differences in dose-volume histogram statistics of unknown clinical impact, whereas Ballista plan delivery required on average 73% and 59% fewer segments and MU, respectively. Conclusion: With respect to conventional techniques, AB-IMRT for the treatment of gynecologic malignancies provides dosimetric advantages similar to those with BB-IMRT but with clear treatment delivery improvements.

  16. Identifying Gaps and Inconsistencies in Urogynecologic Surgical Training of Obstetrics and Gynecology Residents.

    PubMed

    Weber LeBrun, Emily E; Asumu, Hazel; Richardson, Anne M; Cooper, LouAnn A; Davis, John D

    This study aims to determine the expectations of Obstetrics and Gynecology (ObGyn) residency and Female Pelvic Medicine & Reconstructive Surgery (FPMRS) fellowship program directors (FPDs) for the independent performance of urogynecologic procedures during residency and to compare these expectations with the Council on Resident Education in Obstetrics and Gynecology (CREOG) educational objectives. Two parallel, anonymous surveys were distributed simultaneously to all directors of accredited ObGyn residency and FPMRS fellowship programs in the United States. Respondents provided their own professional and program demographic information and indicated whether they expected their residents to independently perform 27 selected urogynecologic procedures. Among residency program directors (RPDs) and FPDs, the online survey response rate was 24.8% (n = 59) and 51.9% (n = 27), respectively. More RPDs expected residents to perform prolapse procedures with mesh, including laparoscopic sacrocolpopexy, all apical suspensions, mesh excisions, and cystotomy repairs, than FPDs. In addition, RPDs expected mastery of most urogynecologic procedures by the Post Graduate Year 3 level, whereas most FPDs did not expect independent performance of these procedures during residency at all. There were notable differences between RPDs' expectations and CREOG objectives regarding several surgical procedures. Whereas CREOG recommends independent performance of anterior and posterior repair, vaginal suspension, vaginal hysterectomy, and transobturator slings, a significant number of RPDs did not report expecting mastery of these procedures during residency. Approximately 30% of RPDs expected residents to perform open sacrocolpopexy and vesicovaginal fistula repair, whereas CREOG recommends only the understanding of these, without procedural mastery. Although community needs vary by region and setting, CREOG objectives serve as the standard for resident surgical education. This study highlights

  17. Impact of obesity on recovery and pulmonary functions of obese women undergoing major abdominal gynecological surgeries.

    PubMed

    Moustafa, Ahmed A M; Abdelazim, Ibrahim A

    2016-06-01

    To determine impact of obesity on recovery parameters and pulmonary functions of women undergoing major abdominal gynecological surgeries. Eighty women undergoing major gynecological surgeries were included in this study. Anesthesia was induced by remifentanil bolus, followed by propofol and cisatracurium to facilitate oro-tracheal intubation and was maintained by balanced anesthesia of remifentanil intravenous infusion and sevoflurane in oxygen and air. Time from discontinuation of maintenance anesthesia to fully awake were recorded at 1-min intervals and time from discontinuation of anesthesia until patient was transferred to post-anesthesia care unit (PACU) and discharged from PACU was also recorded. Pulmonary function tests were performed before surgery and repeated 4 h, days 1, 2 and 3 post-operative for evaluation of forced vital capacity, forced expiratory volume in 1 s and peak expiratory flow rate. Occurrence of post-operative complications, re-admission to ICU, hospital stay and morbidities were also recorded. Induction of anesthesia using remifentanil bolus injection resulted in significant decrease of heart rate and arterial pressures compared to pre-operative and pre-induction values. Recovery times were significantly shorter in obese compared to morbidly obese women. Post-operative pulmonary function tests showed significant deterioration compared to pre-operative measures but showed progressive improvement through first 3 post-operative days. Hospital stay was significantly shorter for obese compared to morbid obese women. Obesity delays recovery from general anesthesia, adversely affects pulmonary functions and increases post-operative complications. Remifentanil infusion and sevoflurane could be appropriate combination for obese and morbidly obese women undergoing major surgeries.

  18. Preoperative ketamine improves postoperative analgesia after gynecologic laparoscopic surgery.

    PubMed

    Kwok, Rebecca F K; Lim, Jean; Chan, Matthew T V; Gin, Tony; Chiu, Wallace K Y

    2004-04-01

    In this study, we evaluated the preemptive effect of a small dose of ketamine on postoperative wound pain. In a randomized, double-blinded, controlled trial, we compared the analgesic requirement in patients receiving preincision ketamine with ketamine after skin closure or placebo after gynecologic laparoscopic surgery. One-hundred-thirty-five patients were randomly assigned to receive preincision or postoperative ketamine 0.15 mg/kg or saline IV. Anesthetic technique was standardized. Patients were interviewed regularly up to 4 wk after surgery. Pain score, morphine consumption, side effects, and quality of recovery score were recorded. Patients receiving preincision ketamine had a lower pain score in the first 6 h after operation compared with the postoperative (P = 0.001) or placebo groups (P < 0.001). The mean (95% confidence intervals) time to first request for analgesia in the preincision group, 1.8 h (1.4-2.1), was longer than the postoperative group, 1.2 h (0.9-1.5; P < 0.001), or the placebo group, 0.7 h (0.4-0.9; P < 0.001). The mean +/- SD morphine consumption in the preincision group, 1.5 +/- 2.0 mg, was less than that in the postoperative group, 2.9 +/- 3.1 mg (P = 0.04) and the placebo group, 3.4 +/- 2.7 mg (P = 0.003). There was no significant difference among groups with respect to hemodynamic variables or side effects. No patient complained of hallucinations or nightmares. We conclude that a small dose of ketamine is not only safe, but it also provides preemptive analgesia in patients undergoing gynecologic laparoscopic surgery. In women undergoing laparoscopic gynecologic surgery, a small preoperative dose of ketamine (0.15 mg/kg) produced preemptive analgesia. There were no significant hemodynamic and psychological side effects with this dose.

  19. Robotics and gynecologic oncology: review of the literature.

    PubMed

    Cho, Jennifer E; Nezhat, Farr R

    2009-01-01

    The objectives of this article were to review the published scientific literature about robotics and its application to gynecologic oncology to date and to summarize findings of this advanced computerenhanced laparoscopic technique. Relevant sources were identified by a search of PUBMED from January 1950 to January 2009 using the key words Robot or Robotics and Cervical cancer, Endometrial cancer, Gynecologic oncology, and Ovarian cancer. Appropriate case reports, case series, retrospective studies, prospective trials, and review articles were selected. A total of 38 articles were identified on the subject, and 27 were included in the study. The data for gynecologic cancer show comparable results between robotic and laparoscopic surgery for estimated blood loss, operative time, length of hospital stay, and complications. Overall, there were more wound complications with the laparotomy approach compared with laparoscopy and robotic-assisted laparoscopy. There were more lymphocysts, lymphoceles, and lymphedema in the robotic-assisted laparoscopic group compared with the laparoscopy and laparotomy groups in patients with cervical cancer. Infectious and lung-related morbidity, postoperative ileus, and bleeding or clot formation were more commonly reported in the laparotomy group compared with the other 2 cohorts in patients with endometrial cancer. Computer-enhanced technology may enable more surgeons to convert laparotomies to laparoscopic surgery with its associated benefits. It seems that in the hands of experienced laparoscopic surgeons, final outcomes are the same with or without use of the robot. There is good evidence that robotic surgery facilitates laparoscopic surgery, with equivalent if not better operative time and comparable surgical outcomes, shorter hospital stay, and fewer major complications than with surgeries using the laparotomy approach.

  20. Unexpected gynecologic malignancy diagnosed after hysterectomy performed for benign indications.

    PubMed

    Mahnert, Nichole; Morgan, Daniel; Campbell, Darrell; Johnston, Carolyn; As-Sanie, Sawsan

    2015-02-01

    To define the incidence of unexpected gynecologic malignancies among women who underwent hysterectomy for benign indications. We conducted a data analysis of hysterectomy cases from a quality and safety database maintained by the Michigan Surgical Quality Collaborative, a statewide group of hospitals that voluntarily reports perioperative outcomes. Cases were abstracted from January 1, 2013, through December 8, 2013. Benign preoperative surgical indications included pelvic mass, family history of cancer, hyperplasia without atypia, prolapse, endometriosis, pelvic pain, abnormal uterine bleeding, or leiomyomas. Women with a surgical indication of cancer, cervical dysplasia, or hyperplasia with atypia were excluded. During the study period, 7,499 women underwent a hysterectomy and 85.24% (n = 6,360) were performed for benign indications. The incidence of unexpected gynecologic malignancy among hysterectomies performed for benign indications was 2.7% (n = 172) and included ovarian, peritoneal, and fallopian tube cancer (n = 69 [1.08%]), endometrial cancer (n = 65 [1.02%]), uterine sarcoma (n = 14 [0.22%]), metastatic cancer (n = 13 [0.20%]), and cervical cancer (n = 11 [0.17%]). The most common indications for hysterectomy were leiomyomas and abnormal uterine bleeding. There was no difference in the mean age (46.86 ± 10.57 compared with 47.0 ± 10.76 years, P = .96) of women with unexpected sarcoma compared with benign disease. Women with unexpected sarcoma were more likely to have a history of venous thromboembolism and preoperative blood transfusion, but this did not reach statistical significance. The 2.7% incidence of unexpected gynecologic malignancy includes a 0.22% incidence of uterine sarcoma and 1.02% incidence of endometrial cancer. No reliable predictors of uterine sarcoma exist and caution is warranted in preoperative planning for hysterectomy.

  1. 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.

  2. Obesity management in gynecologic cancer survivors: provider practices and attitudes.

    PubMed

    Jernigan, Amelia M; Tergas, Ana I; Satin, Andrew J; Fader, Amanda N

    2013-05-01

    Obesity is associated with the development and risk of death from several women's cancers. The study objective was to describe and compare oncologic providers' attitudes and practices as they relate to obesity counseling and management in cancer survivors. Society of Gynecologic Oncology members (n = 924) were surveyed with the use of a web-based, electronic questionnaire. χ(2) and Fisher exact tests were used to analyze responses. Of the 240 respondents (30%), 92.9% were practicing gynecologic oncologists or fellows, and 5.1% were allied health professionals. Median age was 42 years; 50.8% of the respondents were female. Of the respondents, 42.7% reported that they themselves were overweight/obese and that ≥50% of their survivor patients were overweight/obese. Additionaly, 82% of the respondents believed that discussing weight would not harm the doctor-patient relationship. Most of the respondents (95%) agreed that addressing lifestyle modifications with survivors is important. Respondents believed that gynecologic oncologists (85.1%) and primary care providers (84.5%) were responsible for addressing obesity. More providers who were ≤42 years old reported undergoing obesity management training (P < .001) and were more likely to believe that survivors would benefit from obesity education than providers who were >42 years old (P = .017). After initial counseling, 81.5% of the respondents referred survivors to other providers for obesity interventions. Oncology provider respondents believe that addressing obesity with cancer survivors is important. Providers believed themselves to be responsible for initial counseling but believed that obesity interventions should be directed by other specialists. Further research is needed to identify barriers to care for obese cancer survivors and to improve physician engagement with obesity counseling in the "teachable moment" that is provided by a new cancer diagnosis. Copyright © 2013 Mosby, Inc. All rights reserved.

  3. Group B Streptococcal Endocarditis in Obstetric and Gynecologic Practice

    PubMed Central

    Crespo, Antonio; Retter, Avi S.

    2003-01-01

    Background: We describe a case and review ten other instances of group B streptococcal endocarditis in the setting of obstetric and gynecologic practice reported since the last review in 1985. Case: Abortion remains a common antecedent event, but in contrast to earlier reports, most patients did not have underlying valvular disease, the tricuspid valve was most often involved, and mortality was low. Patients with tricuspid valve infection tended to have a subacute course, whereas those with aortic or mitral involvement typically had a more acute, fulminant course. Conclusion: Despite an improvement in mortality, morbidity remains high, with 8 of 11 patients having clinically significant emboli. PMID:14627217

  4. Gynecologic Manifestations of Less Commonly Encountered Hereditary Syndromes.

    PubMed

    DeLair, Deborah F; Soslow, Robert A

    2016-06-01

    This review covers gynecologic manifestations that may occur in rare hereditary syndromes. Recent advances in disorders, such as hereditary leiomyomatosis, renal cell carcinoma syndrome and tuberous sclerosis complex, are discussed as well as lesions that occur in von Hippel-Lindau syndrome, nevoid basal cell carcinoma syndrome, Cowden syndrome, Ollier disease/Maffucci syndrome, and Carney complex. Characteristic clinicopathologic features of each of these syndromes are discussed with an emphasis on the key features that enable pathologists to identify patients at highest risk for these diseases. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Robotic radical hysterectomy in the management of gynecologic malignancies.

    PubMed

    Pareja, Rene; Ramirez, Pedro T

    2008-01-01

    Robotic surgery is being used with increasing frequency in gynecologic oncology. To date, 44 cases were reported in the literature of radical hysterectomy performed with robotic surgery. When comparing robotic surgery with laparoscopy or laparotomy in performing a radical hysterectomy, the literature shows that robotic surgery offers an advantage over the other 2 surgical approaches with regard to operative time, blood loss, and length of hospitalization. Future studies are needed to further elucidate the equivalence or superiority of robotic surgery to laparoscopy or laparotomy in performing a radical hysterectomy.

  6. Surgical site infection in women undergoing surgery for gynecologic cancer.

    PubMed

    Mahdi, Haider; Gojayev, Anar; Buechel, Megan; Knight, Jason; SanMarco, Janice; Lockhart, David; Michener, Chad; Moslemi-Kebria, Mehdi

    2014-05-01

    The objectives of this study were to describe the rate and predictors of surgical site infection (SSI) after gynecologic cancer surgery and identify any association between SSI and postoperative outcome. Patients with endometrial, cervical, or ovarian cancers from 2005 to 2011 were identified from the American College of Surgeons National Surgical Quality Improvement Program. The extent of surgical intervention was categorized into modified surgical complexity scoring (MSCS) system. Univariate and multivariate logistic regression analyses were used. Odds ratios were adjusted for patient demographics, comorbidities, preoperative laboratory values, and operative factors. Of 6854 patients, 369 (5.4%) were diagnosed with SSI. Surgical site infection after laparotomy was 3.5 times higher compared with minimally invasive surgery (7% vs 2%; P < 0.001). Among laparotomy group, independent predictors of SSI included endometrial cancer diagnosis, obesity, ascites, preoperative anemia, American Society of Anesthesiologists class greater than or equal to 3, MSCS greater than or equal to 3, and perioperative blood transfusion. Among laparoscopic cases, independent predictors of SSI included only preoperative leukocytosis and overweight. For patients with deep or organ space SSI, significant predictors included hypoalbuminemia, preoperative weight loss, respiratory comorbidities, MSCS greater than 4, and perioperative blood transfusion for laparotomy and only preoperative leukocytosis for minimally invasive surgery. Surgical site infection was associated with longer mean hospital stay and higher rate of reoperation, sepsis, and wound dehiscence. Surgical site infection was not associated with increased risk of acute renal failure or 30-day mortality. These findings were consistent in subset of patients with deep or organ space SSI. Seven percent of patients undergoing laparotomy for gynecologic malignancy developed SSI. Surgical site infection is associated with longer hospital

  7. 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

  8. Towards increase of diagnostic efficacy in gynecologic OCT

    NASA Astrophysics Data System (ADS)

    Kirillin, Mikhail; Panteleeva, Olga; Eliseeva, Darya; Kachalina, Olga; Sergeeva, Ekaterina; Dubasova, Lyubov; Agrba, Pavel; Mikailova, Gyular; Prudnikov, Maxim; Shakhova, Natalia

    2013-06-01

    Gynecologic applications of optical coherence tomography (OCT) are usually performed in combination with routine diagnostic procedures: laparoscopy and colposcopy. In combination with laparoscopy OCT is employed for inspection of fallopian tubes in cases of unrecognized infertility while in colposcopy it is used to identify cervix pathologies including cancer. In this paper we discuss methods for increasing diagnostic efficacy of OCT application in these procedures. For OCT-laparoscopy we demonstrate independent criteria for pathology recognition which allow to increase accuracy of diagnostics. For OCT-colposcopy we report on application of device for controlled compression allowing to sense the elasticity of the inspected cervix area and distinguish between neoplasia and inflammatory processes.

  9. Organizing an Effective Obstetric/Gynecologic Hospitalist Program.

    PubMed

    Swain, Christopher; Simon, Mark; Monks, Brian

    2015-09-01

    The thoughtful development and implementation of a comprehensive obstetric/gynecologic (OB/GYN) hospitalist program can result in a cost-effective practice model that provides increased value through a wide variety of services. The continuous on-site availability of an OB/GYN specialist affords many benefits to patients, hospitals, and practicing physicians. A well-implemented and effective OB/GYN hospitalist program will be associated with many different service line improvements for hospitals. Such programs increase patient safety, promote risk reduction, and improve clinical outcomes, while enriching the quality of life of obstetricians and gynecologists. Copyright © 2015 Elsevier Inc. All rights reserved.

  10. 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…

  11. Outpatient Mental Health Services for Children in Foster Care: A National Perspective

    ERIC Educational Resources Information Center

    Leslie, Laurel K.; Hurlburt, Michael S.; Landsverk, John; Barth, Richard; Slymen, Donald J.

    2004-01-01

    Objective: To determine factors influencing the use of outpatient mental health services provided by mental health professionals (OMHS) for children in foster care using a national probability sample in the United States. Method: As part of the National Survey of Child and Adolescent Well-being, detailed survey data were collected on 462 children,…

  12. Outpatient Mental Health Services for Children in Foster Care: A National Perspective

    ERIC Educational Resources Information Center

    Leslie, Laurel K.; Hurlburt, Michael S.; Landsverk, John; Barth, Richard; Slymen, Donald J.

    2004-01-01

    Objective: To determine factors influencing the use of outpatient mental health services provided by mental health professionals (OMHS) for children in foster care using a national probability sample in the United States. Method: As part of the National Survey of Child and Adolescent Well-being, detailed survey data were collected on 462 children,…

  13. 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…

  14. Dropout from outpatient mental health care in the United States.

    PubMed

    Olfson, Mark; Mojtabai, Ramin; Sampson, Nancy A; Hwang, Irving; Druss, Benjamin; Wang, Philip S; Wells, Kenneth B; Pincus, Harold Alan; Kessler, Ronald C

    2009-07-01

    Although mental health treatment dropout is common, patterns and predictors of dropout are poorly understood. This study explored patterns and predictors of mental health treatment dropout in a nationally representative sample. Data were from the National Comorbidity Survey Replication, a nationally representative household survey. Respondents who had received mental health treatment in the 12 months before the interview (N=1,664) were asked about dropout, which was defined as quitting treatment before the provider wanted them to stop. Cross-tabulation and discrete-time survival analyses were used to identify predictors. Approximately one-fifth (22%) of patients quit treatment prematurely. The highest dropout rate was from treatment received in the general medical sector (32%), and the lowest was from treatment received by psychiatrists (15%). Dropout rates were intermediate from treatment in the human services sector (20%) and among patients seen by nonpsychiatrist mental health professionals (19%). Over 70% of all dropout occurred after the first or second visits. Mental health insurance was associated with low odds of dropout (odds ratio=.6, 95% confidence interval=.4-.9). Psychiatric comorbidity was associated with a trend toward dropout. Several patient characteristics differentially predicted dropout across treatment sectors and in early and later phases of treatment. Roughly one-fifth of adults in mental health treatment dropped out before completing the recommended course of treatment. Dropout was most common in the general medical sector and varied by patient characteristics across treatment sectors. Interventions focused on high-risk patients and sectors that have higher dropout rates will likely be required to reduce the large proportion of patients who prematurely terminate treatment.

  15. Dropout from Outpatient Mental Health Care in the United States

    PubMed Central

    Olfson, Mark; Mojtabai, Ramin; Sampson, Nancy A.; Hwang, Irving; Kessler, Ronald C.

    2009-01-01

    Objectives Although mental health treatment dropout is common, patterns and predictors of dropout are poorly understood. This study explores patterns and predictors of mental health treatment dropout in a nationally representative sample. Methods Data come from the National Comorbidity Survey Replication (NCS-R), a nationally representative household survey. Respondents in mental health treatment in the 12 months (n=1,664) before interview were asked about dropout defined as quitting treatment before the provider wanted. Cross-tabulation and discrete-time survival analyses were used to identify predictors. Results Approximately one-fifth (22.4%) of patients quit treatment prematurely. The highest dropout rate was from the general medical sector (31.6%) and the lowest was from psychiatrists (15.1%). Dropout rates were intermediate in the human service sector (19.7%) and among patients seen by non-psychiatrist mental health professionals (18.9%). Over 70% of all dropout occurred after the first or second visits. Mental health insurance was associated with low odds of dropout (0.6, 0.4–0.9). Psychiatric comorbidity was associated with a trend towards dropout. Several patient characteristics differentially predicted dropout across treatment sectors and in early and later phases of treatment. Conclusions Roughly one-fifth of adults in mental health treatment each year drop out before completing the recommended course of treatment. Dropout is most common in the general medical sector and varies by patient characteristics across treatment sectors. Interventions focused on high-risk patients and sectors will likely be required to reduce the high proportion of patients who prematurely terminate treatment. PMID:19564219

  16. Factors influencing the use of thromboprophylaxis in cancer outpatients in clinical practice: A prospective study.

    PubMed

    Panizo, Elena; Alfonso, Ana; García-Mouriz, Alberto; López-Picazo, José M; Gil-Bazo, Ignacio; Hermida, José; Páramo, José A; Lecumberri, Ramón

    2015-12-01

    Current clinical practice guidelines do not recommend routine pharmacological thromboprophylaxis in cancer outpatients receiving chemotherapy. However, a high proportion of cancer-associated venous thromboembolism (VTE) events occur in this setting. There are scarce data on the use of thromboprophylaxis in ambulatory cancer patients in real clinical practice. We conducted a single-center prospective study aimed to evaluate the use and factors influencing pharmacological prophylaxis in consecutive cancer patients receiving ambulatory chemotherapy. Patients were followed for 90 days after inclusion. A total of 1108 patients were included. According to the Khorana score, 45.8% patients were classified as low-risk, 47.4% intermediate-risk and 6.8% as high-risk. Outpatient pharmacological prophylaxis was administered at any time during follow-up to 157 patients (14.2%) with a median duration of 42 days (range 1-90). Main factors influencing thromboprophylaxis were: previous history of VTE (odds ratio [OR], 19.11; 95% CI, 9.61-37.98), intercurrent hospitalization (OR, 5.40; 95% CI, 3.57-8.16), and gastrointestinal or gynecologic cancer (OR, 1.76; 95% CI, 1.11-2.80 and OR, 2.34; 95% CI, 1.05-5.26, respectively). During follow-up 58 (5.2%) VTE events were observed. Independent predictors of VTE were the site of malignancy (OR, 3.04; 95%CI, 1.20-7.71 and OR, 2.47; 95%CI, 1.21-5.01 for pancreas and lung cancer, respectively) and previous VTE (OR, 4.23; 95%CI, 1.26-14.27). Outpatient prophylaxis was associated with a lower risk of VTE during follow-up (OR, 0.30; 95%CI, 0.10-0.95). Although the type of malignancy appears as the most relevant variable for decision-making, additional efforts are required to identify patients at particular high thrombosis risk. Copyright © 2015 Elsevier Ltd. All rights reserved.

  17. Mapping the literature of maternal-child/gynecologic nursing

    PubMed Central

    Jacobs, Susan Kaplan

    2006-01-01

    Objectives: 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. Methods: Three source journals were selected and subjected to a citation analysis of articles from 1996 to 1998. Results: 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. Conclusion: 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. PMID:16710464

  18. Changes in the Practice of Obstetrics and Gynecology.

    PubMed

    Rayburn, William F; Tracy, Erin E

    2016-01-01

    A projected shortage of obstetrician-gynecologists (OB-GYNs) is a result of both the increasing US population and the relatively static number of residency graduates. In addition, generational changes have contributed to increasing subspecialization, more desiring part-time employment, and earlier retirement. This article reviews data regarding changes in the practice of obstetrics and gynecology. Residency education is focusing more on a core curriculum in general obstetrics and gynecology, while subspecialty fellowship training has grown in popularity. There are no recent data to describe whether OB-GYNs are working fewer hours, yet more are employed in larger practices at mostly metropolitan locations. A team-based care model that incorporates nonphysician clinicians and digital conversion of clinical data has been encouraged to increase accessibility, improve comprehensiveness, commit to more continuity of care, and reduce redundancy. Compared with other medical specialists, OB-GYNs retire slightly earlier, especially females who will represent the field more. The specialty is moving toward a more comprehensive women's health care practice model that is more patient-centered, efficient, cost controlling, team-based, and adaptable to the needs of a diverse population. Implications from these changes for our practices and improving patient care are currently unclear and await more reported experience.

  19. Knowledge of genetics among residents in obstetrics and gynecology.

    PubMed Central

    Kershner, M A; Hammond, E A; Donnenfeld, A E

    1993-01-01

    A supervised genetics examination was administered to 76 obstetrics and gynecology (ob/gyn) residents from 15 different institutions in the Philadelphia area. The questions were specifically designed to be applicable to obstetrical practice. Overall, the mean score was 69% (range 32%-88%). Using the nonparametric Mann-Whitney rank sum test, we found that the 25 residents from institutions with an obstetrics-gynecology-genetics (OGG) program, coordinated by an obstetrician/gynecologist board certified in clinical genetics, had statistically significant higher scores than the remaining 51 residents from institutions without an OGG program (77% vs. 65%, respectively; P < .001). This study demonstrates that knowledge of genetics among residents in ob/gyn is deficient, especially among residents at institutions without OGG programs. Special efforts should be made to provide genetics education to these individuals. We propose that more obstetricians be encouraged to pursue postgraduate training in genetics in light of the rapid development of medical genetics; its application to prenatal screening, diagnosis, and counseling; the anticipated utilization of genetics services; and the need for educational initiatives geared toward ob/gyn patients. PMID:8250052

  20. Patient Perceptions of Open, Laparoscopic, and Robotic Gynecological Surgeries

    PubMed Central

    Prabakar, Cheruba; Nematian, Sepide; Julka, Nitasha; Bhatt, Devika; Bral, Pedram

    2016-01-01

    Objective. To investigate patient knowledge and attitudes toward surgical approaches in gynecology. Design. An anonymous Institutional Review Board (IRB) approved questionnaire survey. Patients/Setting. A total of 219 women seeking obstetrical and gynecological care in two offices affiliated with an academic medical center. Results. Thirty-four percent of the participants did not understand the difference between open and laparoscopic surgeries. 56% of the participants knew that laparoscopy is a better surgical approach for patients than open abdominal surgeries, while 37% thought that laparoscopy requires the surgeon to have a higher technical skill. 46% of the participants do not understand the difference between laparoscopic and robotic procedures. 67.5% of the participants did not know that the surgeon moves the robot's arms to perform the surgery. Higher educational level and/or history of previous abdominal surgeries were associated with the highest rates of answering all the questions correctly (p < 0.05), after controlling for age and race. Conclusions. A substantial percentage of patients do not understand the difference between various surgical approaches. Health care providers should not assume that their patients have an adequate understanding of their surgical options and accordingly should educate them about those options so they can make truly informed decisions. PMID:27840826

  1. Genetic screening for gynecological cancer: where are we heading?

    PubMed

    Manchanda, Ranjit; Jacobs, Ian

    2016-01-01

    The landscape of cancer genetics in gynecological oncology is rapidly changing. The traditional family history-based approach has limitations and misses >50% mutation carriers. This is now being replaced by population-based approaches. The need for changing the clinical paradigm from family history-based to population-based BRCA1/BRCA2 testing in Ashkenazi Jews is supported by data that demonstrate population-based BRCA1/BRCA2 testing does not cause psychological harm and is cost effective. This article covers various genetic testing strategies for gynecological cancers, including population-based approaches, panel and direct-to-consumer testing as well as the need for innovative approaches to genetic counseling. Advances in genetic testing technology and computational analytics have facilitated an integrated systems medicine approach, providing increasing potential for population-based genetic testing, risk stratification, and cancer prevention. Genomic information along-with biological/computational tools will be used to deliver predictive, preventive, personalized and participatory (P4) and precision medicine in the future.

  2. Major clinical research advances in gynecologic cancer in 2012.

    PubMed

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

    2013-01-01

    Ten topics were chosen among major clinical research achievements in gynecologic oncology in 2012. For ovarian cancer, comprehensive review of the history of bevacizumab studies was followed by poly adenosine diphosphate [ADP]-ribose polymerase (PARP) inhibitors and other molecular targeted agents such as epidermal growth factor receptor tyrosine kinase inhibitor and AMG 386. For the development of genomic study in gynecologic cancers, BRCA and DICER1 mutations were covered in epithelial and nonepithelial ovarian cancer, respectively. For endometrial cancer, targeted agents including mammalian target of rapamycin (mTOR) inhibitors and bevacizumab were discussed. Radiation therapy "sandwiched" between combination chemotherapy schedules for the treatment of uterine papillary serous carcinoma was also reviewed. Preoperative prediction of lymph node metastasis, definition of low-risk group, and recurrence and survival outcomes of laparoscopic approaches were addressed. For cervical cancer, we reviewed long-term benefit of human papillomavirus test and efficacy of paclitaxel/carboplatin versus paclitaxel/cisplatin in stage IVB, persistent or recurrent disease. In addition, the effect of three dimensional image-based high-dose rate brachytherapy was also reviewed. For vulvar cancer, the diagnostic value of sentinel lymph node biopsy was discussed. For breast cancer, positive results of three outstanding phase III randomized clinical trials, CLEOPATRA, EMILIA, and BOLERO-2 were introduced. Lastly, updates of major practice guidelines were summarized.

  3. Major clinical research advances in gynecologic cancer in 2012

    PubMed Central

    Suh, Dong Hoon; Kim, Kidong; Kim, Hak Jae; Lee, Kyung-Hun

    2013-01-01

    Ten topics were chosen among major clinical research achievements in gynecologic oncology in 2012. For ovarian cancer, comprehensive review of the history of bevacizumab studies was followed by poly adenosine diphosphate [ADP]-ribose polymerase (PARP) inhibitors and other molecular targeted agents such as epidermal growth factor receptor tyrosine kinase inhibitor and AMG 386. For the development of genomic study in gynecologic cancers, BRCA and DICER1 mutations were covered in epithelial and nonepithelial ovarian cancer, respectively. For endometrial cancer, targeted agents including mammalian target of rapamycin (mTOR) inhibitors and bevacizumab were discussed. Radiation therapy "sandwiched" between combination chemotherapy schedules for the treatment of uterine papillary serous carcinoma was also reviewed. Preoperative prediction of lymph node metastasis, definition of low-risk group, and recurrence and survival outcomes of laparoscopic approaches were addressed. For cervical cancer, we reviewed long-term benefit of human papillomavirus test and efficacy of paclitaxel/carboplatin versus paclitaxel/cisplatin in stage IVB, persistent or recurrent disease. In addition, the effect of three dimensional image-based high-dose rate brachytherapy was also reviewed. For vulvar cancer, the diagnostic value of sentinel lymph node biopsy was discussed. For breast cancer, positive results of three outstanding phase III randomized clinical trials, CLEOPATRA, EMILIA, and BOLERO-2 were introduced. Lastly, updates of major practice guidelines were summarized. PMID:23346316

  4. GYNECOLOGIC ISSUES IN THE HIV-INFECTED WOMAN

    PubMed Central

    Cejtin, Helen E.

    2008-01-01

    With the advent of highly active antiretroviral therapy (HAART), women living with HIV can now enjoy longer lifespans in relative good health as well as the prospect of bearing children with an overwhelmingly low risk of vertical transmission. Thus, increasingly, seropositive women are now facing issues around longevity as well as those associated with fertility. The clinician caring for the HIV-infected woman must be alert to the gynecologic issues that are prevalent in this population. Among those faced by the gynecologist are menstrual abnormalities, lower genital tract neoplasia, sexually transmitted infections, the need for gynecologic surgery, and menopausal issues including osteopenia/osteoporosis. Contraception in HIV seropositive women presents unique management issues, because of the necessity for a dual role of prevention of both pregnancy and HIV transmission, the possible effect of birth control on HIV infection, and the interaction between birth control and HIV therapies. With ever increasing frequency, the gynecologist will be presented with the seropositive woman or couple who wishes to conceive. The purpose of this chapter is to review the current knowledge on the relationship between HIV infection and menstrual abnormalities, genital neoplasias, contraceptive options, surgical complications, and menopause with its associated disorders. Special considerations in the seropositive woman contemplating pregnancy will also be discussed. The treatment of pelvic infections is discussed elsewhere in this volume, and only changes in standard therapy because of concurrent HIV-infection will be discussed here. PMID:18954760

  5. Minimally invasive surgery in gynecologic oncology: laparoscopy versus robotics.

    PubMed

    Nezhat, Farr

    2008-11-01

    The role of laparoscopy has evolved from a diagnostic tool to an integral approach to management of gynecologic malignancies. This surgical approach has afforded patients the benefits of shorter hospitalizations, more rapid recoveries, smaller incisions, less need for analgesics, and fewer complications. Additionally, specific to gynecologic malignancies, improved visualization and shorter intervals to postoperative treatments are advantages to minimally invasive surgery. However, laparoscopy is limited by its long learning curve, counterintuitive motions, and two-dimensional views. To overcome these challenges of laparoscopy, technology has expanded to include computer-enhanced technology in the form of robotics. Robotic-assisted surgery provides three-dimensional views, intuitive motions, less operator fatigue, tremor filtration facilitating more precise movements, and possesses a shorter learning curve. Robotic-assisted surgery has also paved a pathway to telesurgery and telementoring. This may expand the availability of advanced minimally invasive surgeries throughout the globe. However, robotic-assisted procedures are not without limitations-cost, bulky size, lack of haptic feedback, limited instrumentation, and larger required incisions.

  6. Bullying in an adolescent and young adult gynecology population.

    PubMed

    Seltzer, Marlene B; Long, Robert A

    2013-02-01

    To determine prevalence of exposure to bullying in an adolescent/young adult gynecology population, whether pelvic pain is an associated somatic complaint, and if health care providers are viewed as a resource. An anonymous self-reporting survey about exposure to bullying, somatic and mental health symptoms, and disclosure patterns was given to 224 consecutive gynecology patients aged 15 to 24 years in a suburban practice. Prevalence of exposure as a bully, victim, witness, or combination was 80.5%. Missing school for pelvic pain was significantly greater in the bully-victim-witness and victim-witness groups. Taking medication for depression or anxiety was significantly greater in the bully-victim-witness group. No one disclosed bullying exposure to a health care provider. Gynecologists see large numbers of patients exposed to bullying. Patients exposed in combinations of bully, victim, and witness have increased frequency of pelvic pain, depression, and anxiety. Patients do not disclose exposure to bullying to health care providers.

  7. 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

  8. MAUDE: analysis of robotic-assisted gynecologic surgery.

    PubMed

    Manoucheri, Elmira; Fuchs-Weizman, Noga; Cohen, Sarah L; Wang, Karen C; Einarsson, Jon

    2014-01-01

    To evaluate the adverse events encountered during robotic gynecologic surgery, as reported to the FDA MAUDE database from January 2006 to December 2012. Database search (Canadian Task Force classification III). A search of the FDA MAUDE database was performed by brand name "da Vinci" and manufacturer "Intuitive Surgical." Reports reflecting gynecologic procedures either by description or procedure name were included. A record of reports was kept to ensure that no duplicates were added. The date and type of event (operator-related error, technical system failure, or surgical injuries attributed to use of the robot) and the clinical outcome were recorded. Twenty-six percent of reported events (n = 73) resulted in injury, and 8.5% (n = 24) resulted in death. Of note, although adnexal procedures were performed in <3% of the cohort, they accounted for 20% of the fatalities. Twenty-one percent of injuries were attributed to operator-related error, and 14% to technical system failure; 65% were not directly related to use of the robot. Fifteen deaths were reported during planned hysterectomy. Four of those were due to injury to a major blood vessel (iliac artery in 3, and aorta in 1), although a detailed description of how the injury occurred was absent from the event description. It is important to continue to evaluate the occurrence of injuries during robot-assisted surgery in an effort to identify unique challenges associated with this advanced technology. Published by Elsevier Inc.

  9. Nitromusk compounds in women with gynecological and endocrine dysfunction.

    PubMed

    Eisenhardt, S; Runnebaum, B; Bauer, K; Gerhard, I

    2001-12-01

    Musk xylene (MX), musk ketone (MK), musk ambrette, musk moskene, and musk tibetene are synthetic fragrances. Between 1994 and 1996 these five nitromusk compounds (NMCs) were tested in the blood of 152 women who consulted the Endocrinological Department of the University Hospital of Obstetrics and Gynecology, Heidelberg, Germany, because of gynecological problems. The testing was conducted by gas chromotography with mass-specific detector and mass spectrometry in a retrospective cross-sectional study. MX was detected in 95% and MK in 85% of the blood samples (>20 ng per liter whole blood). The median concentration of MX was 65.5 ng/L and the maximum level of MX was 1183 ng/L; the corresponding values for MK were respectively 55.5 and 518 ng/L. The other three NMCs were found in only a few patients or not at all. Significant associations between MX and MK concentrations were found in blood and different clinical parameters of the endocrine system. MX and MK may act centrally as a disrupter of the (supra-) hypothalamic-ovarian axis, which may result in a mild ovarian insufficiency. On the basis of our data, a reproductive toxicity and an endocrine effect of NMCs in women cannot be ruled out. Further experimental and clinical studies should be conducted.

  10. Burnout, depression and job satisfaction in obstetrics and gynecology residents.

    PubMed

    Govardhan, Lakshmi Magavi; Pinelli, Vincent; Schnatz, Peter F

    2012-08-01

    This study among ObGyn residents was designed to determine the relationship of burnout to job satisfaction, depression, and self-care activities. The link to a 64-item, anonymous, self-administered online survey was distributed to obstetrics and gynecology residents at six obstetric and gynecologic residency programs in the greater Hartford Connecticut region. We used the Maslach Burnout Inventory-Human Services Survey to assess job burnout, the Center for Epidemiological Studies-Depression Scale to identify depression, and we incorporated questions regarding job satisfaction and self care activities. Of the surveyed residents, 13% satisfied all three subscale scores for high burnout and > 50% have high levels of depersonalization and emotional exhaustion. Residents with high levels of emotional exhaustion were less satisfied with their careers (P = 0.001), regretted choosing ObGyn (P < 0.001), and had higher rates of depression (P < 0.001). A high level of depersonalization was inversely correlated to job satisfaction and personal accomplishment, and strongly correlated to depression. A high level of personal accomplishment was strongly correlated with job satisfaction and satisfaction with the specialty but was inversely correlated with a sense of depersonalization. There was no correlation between burnout and self-care activities. Burnout is strongly correlated with depression and inversely correlated with job satisfaction. Burnout and depression were highly prevalent among ObGyn residents. Decreasing stressors and assuring motivated, committed, and supportive educators may prove to be helpful in the enhancement of resident job satisfaction.

  11. The role of antifibrinolytic agents in gynecologic cancer surgery.

    PubMed

    Celebi, Nalan; Celebioglu, Bilge; Selcuk, Mehtap; Canbay, Ozgur; Karagoz, Ayse H; Aypar, Ulku

    2006-05-01

    To compare the effects of crystalloid and colloid solutions, tranexamic acid and epsilon-aminocaproic acid on the need for allogenic blood transfusion and on coagulation and fibrinolysis parameters. We conducted the study in the Anesthesiology and Reanimation Department of Hacettepe University Medical Faculty, Ankara, Turkey between March 2004 and April 2005. The study included 105 patients, classified by the American Society of Anesthesiology as physical status groups I-II, undergoing gynecologic cancer treatment. We divided them into 5 groups: group I (crystalloid) received crystalloid solutions, group II (colloid) received colloid solutions, group III (tranexamic acid) received 10 mg x kg(-1) tranexamic acid, and group 5 (epsilon-aminocaproic acid) received 100 mg x kg(-1) epsilon-aminocaproic acid. All patients bleeding amount was measured and recorded perioperatively, and at the 12th and 24th hours postoperatively. We then evaluated the patients' hemoglobin, hematocrit, activated thromboplastin time, international normalized ration, fibrinogen, and thrombocyte count and symptoms of pulmonary embolism. In comparing the amount of bleeding, the bleeding in the tranexamic acid group was 30.8% less than the crystalloid group (p<0.05), 33.3% less than the colloid group (p<0.05), and 23.9% less than the epsilon-aminocaproic acid group (p<0.05). When the negative effects of blood transfusions were considered, tranexamic acid administration can be recommended for decreasing the need for blood transfusion in gynecologic cancer surgery.

  12. 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.

  13. Maternity leave: existing policies in obstetrics and gynecology residency programs.

    PubMed

    Davis, J L; Baillie, S; Hodgson, C S; Vontver, L; Platt, L D

    2001-12-01

    To survey program directors in obstetrics and gynecology regarding maternity leave and to determine how programs are dealing with maternity leave coverage. Questionnaires regarding impact and policy on maternity leave were mailed to accredited obstetrics and gynecology residency programs. A total of 188 of 274 (69%) questionnaires were returned completed. Respectively, 80% and 69% of respondents indicated that they have a formal maternity (maximum mean 8.7 weeks) and paternity (mean 5.27 days) leave policy. Approximately 75% of programs require residents to make up time if their leave exceeds 8 weeks during the first 3 years. Eighty-five percent of programs require residents to make up time if their leave exceeds 6 weeks during the fourth year. Ninety-three percent of programs require residents to make up time if their leave exceeds 20 weeks over the 4 years. Seventy-seven percent of respondents have other residents in their program cover for the absent resident. Thirty-seven percent of programs have schedules flexible enough to allow rearrangement so that some rotations go uncovered. Eighty-three percent of programs surveyed stated that maternity leave has a somewhat to very significant impact on the residents' schedules. Most residency programs have written maternity/paternity leave policies. A more flexible curriculum may help to accommodate the residents on leave without overburdening the residents who are left to cover.

  14. Preoperative evaluation of the gynecologic patient: considerations for improved outcomes.

    PubMed

    Johnson, Bruce E; Porter, Joann

    2008-05-01

    The preoperative evaluation serves several purposes for the gynecologist. Patients with previously undiagnosed, or incompletely managed, medical concerns are identified and appropriate treatment initiated. In women with known medical concerns, the surgeon can anticipate problems and plan for appropriate postoperative care. In certain cases, the preoperative evaluation identifies medical conditions that are unstable enough to adversely affect the postoperative outcome, and appropriate referral for medical management can be made. One of the most important aspects of the evaluation is the identification of women at high risk for cardiovascular complications. A stepwise approach is useful to identify those women who may proceed to surgery and those who need further testing. Much of the preoperative evaluation of the woman with pulmonary disease can be done during the history and physical examination without additional testing. Deep venous thrombosis is a significant concern in gynecologic surgery; appropriate identification of the woman at risk is important, with initiation of prophylaxis occurring shortly after the surgery concludes. Many women undergoing gynecologic surgery have diabetes. Careful management of diabetes in the perioperative period has become more germane, with evidence of improved outcomes as tight control is achieved. Much of the preoperative evaluation falls easily into the purview of the gynecologist, with advice presented as to when medical consultation should be considered.

  15. 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 extremity lymphedema following surgical treatment of these diseases. |

  16. 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…

  17. 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…

  18. 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.

  19. 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…

  20. 38 CFR 4.116 - Schedule of ratings-gynecological conditions and disorders of the breast.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Reproductive Organs (diagnostic codes 7610 through 7615): Symptoms not controlled by continuous treatment 30.... 7627Malignant neoplasms of gynecological system or breast 100 Note: A rating of 100 percent shall continue... recurrence or metastasis, rate on residuals. 7628Benign neoplasms of the gynecological system or breast. Rate...

  1. 38 CFR 4.116 - Schedule of ratings-gynecological conditions and disorders of the breast.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Reproductive Organs (diagnostic codes 7610 through 7615): Symptoms not controlled by continuous treatment 30.... 7627Malignant neoplasms of gynecological system or breast 100 Note: A rating of 100 percent shall continue... recurrence or metastasis, rate on residuals. 7628Benign neoplasms of the gynecological system or breast. Rate...

  2. Evaluation of Students' Clinical and Communication Skills in Performing a Gynecologic Examination.

    ERIC Educational Resources Information Center

    Fang, Wei Li; And Others

    1984-01-01

    The use of trained gynecologic teaching associates (GTAs) in providing instruction on the gynecologic examination is discussed. GTAs work in pairs; while one provides instruction, the other serves as a model. A study to measure student anxiety and confidence during the examination is described. (MLW)

  3. Outpatient Emergencies: Acute Heart Failure.

    PubMed

    Mysliwiec, Malgorzata; Bonita, Raphael E

    2017-05-01

    Heart failure is an epidemic in the United States and a major health problem worldwide. The syndrome of acute heart failure is marked by a recent onset of symptoms usually in terms of days to a few weeks of worsening fatigue, shortness of breath, orthopnea, swelling, and sudden onset of weight gain. Physicians caring for patients with heart failure must know the risk factors for this disease, pathophysiology, symptomatology, important examination findings, key diagnostic tests, and management approach so as to improve symptoms and reduce mortality. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Success and safety in outpatient microlumbar discectomy.

    PubMed

    Best, Natalie M; Sasso, Rick C

    2006-07-01

    Currently, many spine surgeons perform microlumbar discectomies on an outpatient basis. Yet, it is often customary for patients to have a 1-night stay in the hospital. Many studies have shown the efficacy of microlumbar discectomy (MLD) and its preference among surgeons for the treatment of lumbar disc herniation. It has also been shown to be safe, successful, and cost-effective. However, a large comprehensive study of this magnitude, gauging safety, success, and patient satisfaction for these procedures on an outpatient basis has not yet been done. One thousand three hundred seventy-seven MLD procedures have been done from 1992 to 2001 by 1 surgeon. A retrospective chart review was done on all procedures. Patients were then contacted by either telephone or mail to complete an outcome questionnaire. Seven hundred thirteen patients (53.9%) completed the questionnaire. Follow-up questionnaires were not completed due to deaths, incorrect contact information, and refused responses. Out of all MLD procedures, 55 (4.0%) were done with a hospital stay-only 24 of these (1.7%) were originally intended outpatient procedures. Of those that were done on an outpatient basis, 8.6% had a complication, including 6.4% who had a recurrent disc herniation. When asked, 81.6% said they would undergo the procedure again as an outpatient. In 82.1% the surgery's outcome was good, very good, or excellent. MLD is a routine procedure that can be performed on an outpatient basis safely, successfully, and with high patient satisfaction.

  5. Continuous Intravenous Milrinone Therapy in Pediatric Outpatients

    PubMed Central

    Curley, Michelle; Liebers, Jill

    2017-01-01

    Milrinone is a phosphodiesterase 3 inhibitor with both positive inotropic and vasodilator properties. Administered as a continuous infusion, milrinone is indicated for the short-term treatment of patients with acute decompensated heart failure. Despite limited data supporting long-term milrinone therapy in adults with congestive heart failure, children managed as outpatients may benefit from continuous milrinone as a treatment for cardiac dysfunction, as a destination therapy for cardiac transplant, or as palliative therapy for cardiomyopathy. The aim of this article is to review the medical literature and describe a home infusion company's experience with pediatric outpatient milrinone therapy. PMID:28248808

  6. Current situation: lower genital tract pathology and colposcopy training in spanish gynecology and obstetrics residents.

    PubMed

    Rodríguez-Mias, Núria-Laia; Cortés, Javier; Xercavins, Jordi; Lailla, Josep M

    2013-01-01

    This study aimed to evaluate the impact of an educational intervention in lower genital tract pathology (LGTP) on the knowledge and skills acquired by the Spanish specialist residents. This didactic change was carried out under the auspices of the Asociación Española de Patología Cervical y Colposcopia and the Sociedad Española Ginecología y Obstetricia and its Resident Section. This is an observational, descriptive, and cross-sectional study. The survey was composed of 15 questions voluntarily answered by Spanish gynecology and obstetrics trainees. Compared with a previous survey, a substantial increase in the proportion of Spanish teaching hospitals with an LGTP unit (9/42 vs 47/59) has been detected while doubling the percentage of residents who acknowledge medium to high knowledge on this pathology. The same cannot be said about the handling capacity of vulvodynia registering a great improvement. Spanish scientific societies, concerned in the quality of LGTP training gained by their residents, have focused on the necessity of LGTP units. Our study confirms the usefulness of this performance in the new continued LGTP education.

  7. Clopidogrel hypersensitivity: a novel multi-day outpatient oral desensitization regimen.

    PubMed

    Fajt, Merritt; Petrov, Andrej

    2010-01-01

    Clopidogrel hypersensitivity has posed a problem for the acute treatment and long-term care of a particular patient population with coronary artery disease and stent placement. Patients with clopidogrel hypersensitivity have had an increased risk of hypersensitivity reactions, including anaphylaxis, if they ingest clopidogrel without undergoing an oral desensitization procedure. The previously published desensitization protocols have either been performed in the intensive care unit, requiring significant cost and healthcare utilization, or have required a full-day outpatient commitment on behalf of the patient. To determine whether a multi-day outpatient oral clopidogrel desensitization protocol is effective and safe for patients with clopidogrel hypersensitivity. We retrospectively assessed the efficacy of a 10-dose outpatient multi-day clopidogrel desensitization protocol performed in a university allergy-immunology center from April 2006 to October 2008 in patients with clopidogrel hypersensitivity. Patients were desensitized over 2-3 half-day clinical visits and were able to go home between desensitization sessions. A preliminary cost analysis was performed using the average of actual costs for the outpatient clopidogrel desensitization procedure and was compared with the average cost for an inpatient oral desensitization completed at our institution. Eight patients with coronary artery disease, cardiac stent placement, and clopidogrel hypersensitivity underwent an outpatient multi-day oral clopidogrel desensitization procedure. All patients were successfully desensitized with the multi-day protocol without complications. No patient had recurrence of allergic reaction 3 months after the procedure. A preliminary cost analysis demonstrated a lower cost for the outpatient compared to the inpatient oral clopidogrel desensitization protocol. This outpatient 10-dose multi-day clopidogrel desensitization protocol is a safe and effective novel approach for the

  8. Improving the safety and efficiency of outpatient lumbar puncture service.

    PubMed

    Sweeney, Mark; Al-Diwani, Adam; Hadden, Robert

    2016-01-01

    Lumbar puncture (LP) is a commonly performed procedure in diagnosis and management of neurological conditions. LP is generally safe, however there are a number of potentially serious complications, including epidural haematoma and cerebral herniation. The risks of these should be considered and minimised prior to undertaking LP. Our regional neuroscience centre provides an outpatient LP service for patients throughout southeast England. Referrals from distant hospitals meant there was frequently no access to important clinical information, including indication for LP, past medical history, or medication history until the day of the procedure, and no access to results of investigations such as coagulation profile, platelet count, or intracranial imaging. Furthermore, there was limited capacity or time available in the day ward to perform these tests prior to LP. As a result, patients were either having LPs cancelled on the day of the procedure, were delayed by several hours on the day of the procedure for investigations, or were subject to the risk of having the LP performed without the knowledge of these key safety indicators. To address this issue we implemented an LP safety checklist to be completed by referring neurologists, providing details of the patient's medical history and results of investigations performed locally. In doing this, we increased the proportion of patients with an available platelet count prior to LP from 25% to 89%, and available coagulation profile from 18% to 82%. In addition, we saw a qualitative increase in the confidence of junior doctors in the safety of the LP clinic, as measured by a survey taken before and after the implementation of this system. This simple intervention made a rapid and remarkable difference to the safety and efficiency of this outpatient LP clinic. We would encourage other units to adopt this approach to address similar problems in a variety of outpatient settings.

  9. 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…

  10. 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…

  11. Medicaid program; clarification of outpatient hospital facility (including outpatient hospital clinic) services definition. Final rule.

    PubMed

    2008-11-07

    Outpatient hospital services are a mandatory part of the standard Medicaid benefit package. This final rule aligns the Medicaid definition of outpatient hospital services more closely to the Medicare definition in order to: Improve the functionality of the applicable upper payment limits (which are based on a comparison to Medicare payments for the same services), provide more transparency in determining available hospital coverage in any State, and generally clarify the scope of services for which Federal financial participation (FFP) is available under the outpatient hospital services benefit category.

  12. Risk profiles of treatment noncompletion for inpatients and outpatients undergoing alcohol disorder rehabilitation treatment

    PubMed Central

    Preuss, Ulrich W; Zimmermann, Jörg; Schultz, Gabriele; Watzke, Anna; Schmidt, Peggy; Löhnert, Bärbel; Soyka, Michael

    2012-01-01

    Background Rehabilitation treatment noncompletion is considered a risk factor for long term relapse in alcohol-dependent individuals. The aim of this analysis of in- and outpatients in alcohol dependence rehabilitation in Germany is to identify social, mental, and somatic risk profiles for treatment noncompletion. Methods A total of 92 individuals from an outpatient program and 303 individuals from two inpatient rehabilitation treatment units in three different locations in Germany were recruited and assessed with a structured interview and several measures of psychopathology (personality disorders, anxiety, depression, and impulsivity) at treatment admission, with termination at 12 months follow-up. Participants were subdivided into treatment completers and noncom-pleters for any reason. Results A total of 10.2% of inpatients and 16.1% of outpatients did not complete treatment. Compared with treatment completers, noncompleters had a significantly lower rate of continuous abstinence at 1-year follow-up, more recent alcohol consumption before admission, and a higher rate of borderline personality disorders. Among inpatients, an elevated rate of lifetime mental disorders, depression, and suicide attempts was found among treatment noncompleters; among outpatients, treatment noncompleters were more often than completers to be married but live separated. Conclusion Rates of treatment noncompletion in inpatient and outpatient rehabilitation programs correspond to results from previous research. Noncompletion is a significant correlate of relapse 1 year after treatment, and noncompleters show an elevated level of psychopathology. These findings may help rehabilitation treatment facilities to tailor specific therapies for these individuals to reduce risk for treatment noncompletion. PMID:24474864

  13. The cost of outpatient pneumonia in children <5 years of age in Fiji.

    PubMed

    Temple, Beth; Griffiths, Ulla Kou; Mulholland, Edward Kim; Ratu, Felisita Tupou; Tikoduadua, Lisi; Russell, Fiona Mary

    2012-02-01

    Pneumonia is the most common reason for visiting an outpatient facility among children <5 years old in Fiji. The objective of this study is to describe for the first time the costs associated with an episode of outpatient pneumonia in Fiji, in terms of cost both to the government health sector and to the household. Costs were estimated for 400 clinically diagnosed pneumonia cases from two outpatient facilities, one in the capital, Suva, and one in a peri-urban and rural area, Nausori. Household expenses relating to transport costs, treatment costs and indirect costs were determined primarily through structured interview with the caregiver. Unit costs were collected from a variety of sources. Patient-specific costs were summarised as average costs per facility. The overall average societal cost associated with an episode of outpatient pneumonia was $18.98, ranging from $14.33 in Nausori to $23.67 in Suva. Household expenses represent a significant proportion of the societal cost (29% in Nausori and 45% in Suva), with transport costs the most important household cost item. Health sector expenses were dominated by personnel costs at both sites. Both the average total household expenses and the average total health sector expenses were significantly greater in Suva than Nausori. A single episode of outpatient pneumonia represents a significant cost both to the government health sector and to affected households. Given the high incidence of this disease in Fiji, this places a considerable burden on society. © 2011 Blackwell Publishing Ltd.

  14. The opinion of Greek parents on the advantages and disadvantages of the outpatient pediatric oncology setting.

    PubMed

    Matziou, Vasiliki; Servitzoglou, Marina; Vlahioti, Efrosini; Deli, Haralampia; Matziou, Theodora; Megapanou, Efstathia; Perdikaris, Pantelis

    2013-12-01

    The aim of this study was to assess parental opinions on the advantages and disadvantages of a pediatric oncology outpatient setting in comparison to the inpatient oncology ward. The sample of the study consisted of 104 parents whose children were diagnosed and treated for pediatric cancer. The survey took place at the Pediatric Oncology Wards, as well as their respective outpatient settings of the two General Children's Hospitals in Athens, Greece from May 2010 to August 2010. According to parents' view the outpatient setting was preferable due to the maintenance keeping of their daily routine (x(2) = 75.9, p = 0.000), maintaining the family life (x(2) = 90.1, p = 0.000) and young patients' participation in activities (x(2) = 25.6, p = 0.000). Moreover, young patients were more happy, less anxious and less scared when they were attending in the daily clinic (x(2) = 25.9, p = 0.000). According to parents' view, the outpatient setting has many advantages. The judgment of children and parents on the services offered by the Pediatric Oncology Unit overall, in both inpatient and outpatient setting can give the necessary feedback to improve the qualitative provided care. Copyright © 2013 Elsevier Ltd. All rights reserved.

  15. Utilization and cost comparison of erythropoiesis-stimulating agents in inpatient and outpatient hospital settings.

    PubMed

    Lafeuille, Marie-Hélène; Bailey, Robert A; Vekeman, Francis; Scott McKenzie, R; Lefebvre, Patrick

    2012-01-01

    To compare utilization and associated costs of epoetin alfa (EPO) and darbepoetin alfa (DARB), two erythropoiesis-stimulating agents (ESAs), in patients with cancer undergoing chemotherapy and patients with chronic kidney disease (CKD) not on dialysis in inpatient and outpatient hospital settings. An analysis of medical claims recorded between January 2006 and December 2009 was conducted using the Premier Perspective Comparative Hospital database. Patients included were ≥18 years old with cancer and chemotherapy or with pre-dialysis CKD and with ≥1 claim for EPO or DARB during a hospital inpatient or outpatient treatment episode. Patients treated with both ESAs or who were receiving dialysis were excluded. Mean cumulative drug costs and dose ratios (units EPO: mcg DARB) were calculated using cumulative dose and April 2010 wholesale acquisition costs. Cancer chemotherapy: 13,832 inpatient stays (EPO: 10,454; DARB: 3378) and 5590 outpatient treatment episodes (EPO: 2856; DARB: 2734) were identified. The inpatient and outpatient populations reported ESA dose ratios of 230:1 and 238:1 with DARB cost premiums of 42% (EPO: $948; DARB: $1348) and 38% (EPO: $3358; DARB: $4627), respectively. CKD: 148,746 hospital stays (EPO: 116,017; DARB: 32,729) and 11,012 outpatient treatment episodes (EPO: 6921; DARB 4091) were identified. The inpatient and outpatient populations reported ESA dose ratios of 251:1 and 257:1 with DARB cost premiums of 30% (EPO: $566; DARB: $738) and 27% (EPO: $2077; DARB: $2642), respectively. The lack of randomization may have led to confounding by indication. In addition, statistical significance must be interpreted with caution in studies involving large samples. This study of 19,422 patients with cancer receiving chemotherapy and 159,758 patients with pre-dialysis CKD reported ESA dose ratios ranging from 230:1-257:1 (units EPO: mcg DARB) and associated cost premiums of 27-42% for DARB.

  16. Tobacco Smoking in Adolescent Psychiatric Outpatients

    ERIC Educational Resources Information Center

    Ditchburn, K. Marie; Sellman, J. Douglas

    2013-01-01

    Three main aims of this study were to ascertain the prevalence rate of smoking among adolescent psychiatric outpatients; estimate smokers' degree of nicotine dependence; and investigate the relationship between smoking and common mental health disorders. Face-to-face interviews were conducted on 93 patients ages 13-18 presenting to an adolescent…

  17. The Transition from Inpatient to Outpatient Care.

    ERIC Educational Resources Information Center

    Berman, Alan L.; And Others

    1994-01-01

    Presents case of 29-year-old white male veteran, whose case illustrates need for coordination of inpatient and outpatient services for chronically suicidal patients to reduce risk during transition. Includes comments on case from Phillip Kleespies, Sarah Marshall, Teri Pokrajac, and Richard Amodio and from Mark Goldblatt. (NB)

  18. Tobacco Smoking in Adolescent P