Reproduction/Infertility

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Comments on Preti et al: "The clinical role of LASER for vulvar and vaginal treatments in gynecology and female urology: An ICS/ISSVD best practice consensus document".

Neurourol Urodyn. 2019 09;38(7):2010-2011

Authors: Gambacciani M

PMID: 31436354 [PubMed - indexed for MEDLINE]

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LASER users' expert opinion in response to "The clinical role of LASER for vulvar and vaginal treatments in gynecology and female urology: An ICS/ISSVD best practice consensus document".

Neurourol Urodyn. 2019 11;38(8):2383-2384

Authors: Salvatore S, Athanasious S, Yuen HTH, Karram M

PMID: 31432545 [PubMed - indexed for MEDLINE]

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Challenges in the Era of Coding and Corporatization.

Obstet Gynecol Clin North Am. 2019 Sep;46(3):553-561

Authors: DeFrancesco MS

Abstract
The past 40 years have witnessed a major redesign of health care, largely driven by rampantly increasing costs and the perception of lack of better outcomes to justify those costs. Many demographic changes have also challenged the women's health care provider workforce, and evolving new payment systems are likewise a source of angst for these providers. Managed care is seeking to cut costs, and the challenge is to do so without sacrificing quality. Burnout is a new challenge in the present environment. There is now an opportunity to meet these challenges and provide the excellent care our patients deserve.

PMID: 31378295 [PubMed - indexed for MEDLINE]

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Integrated Mind/Body Care in Women's Health: A Focus on Well-Being, Mental Health, and Relationships.

Obstet Gynecol Clin North Am. 2019 Sep;46(3):469-483

Authors: Batra P

Abstract
Integrated care with mental health clinicians embedded in medical departments remains rare despite evidence of the need and effectiveness of such a model. Comprehensive, efficacious, and meaningful health care requires adequate attention be paid to the physiologic and the psychological symptoms of the patient. In the obstetrics/gynecology setting, myriad psychosocial concerns routinely present and cannot be adequately addressed in the current systems of care. The need is there, providers and patients have shown preference for such a structure, and the outcomes are promising. This article outlines common patient concerns in such settings and discusses possible interventions.

PMID: 31378289 [PubMed - indexed for MEDLINE]

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Sources of support for and resistance to abortion training in obstetrics and gynecology residency programs.

Am J Obstet Gynecol. 2019 08;221(2):156.e1-156.e6

Authors: Turk JK, Landy U, Chien J, Steinauer JE

Abstract
BACKGROUND: Only 64% of obstetrics and gynecology program directors report routine, scheduled training in abortion, despite the Accreditation Council for Graduate Medical Education's requirements for routine training. Most report that exposure to training is limited to specific clinical circumstances.
OBJECTIVE: We sought to describe residency program directors' perspectives of support for and resistance to abortion training in residency training programs in the United States.
MATERIALS AND METHODS: A national survey of directors explored the availability of abortion training as well as support for and resistance to abortion training within their departments and institutions. In addition, directors who indicated that training was not available at all, available only as an elective, or as routine but limited to specific clinical circumstances, were also asked which procedures were limited, in what ways, and by whom. Descriptive and bivariate analyses were performed.
RESULTS: A total of 190 residency program directors (79%) responded from throughout the United States (30% in the Northeast, 30% in the South, 23% in the Midwest, and 16% in the West), and 14% described their program as religiously affiliated. Most directors (73%) reported at least some institutional or government restrictions to training, and reported an average of 3 types of restrictions. Hospital policy was the most commonly reported restriction, followed by state law. Programs with routine abortion training reported an average of 2 restrictions, compared with 4 restrictions in programs with optional training, and 5 restrictions in programs with no abortion training.
CONCLUSION: Significant barriers to integrating abortion training into residents' schedules continue to exist decades after the Accreditation Council for Graduate Medical Education training mandate. We should use these data to develop better support and targeted strategies for increasing the number of trained abortion providers in the United States.

PMID: 31047880 [PubMed - indexed for MEDLINE]

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Long-term follow-up of laparoscopic sacrocolpopexy: comparison of two different techniques used in urology and gynecology.

Int Urogynecol J. 2019 04;30(4):623-632

Authors: Orhan A, Ozerkan K, Vuruskan H, Ocakoglu G, Kasapoglu I, Koşan B, Uncu G

Abstract
INTRODUCTION AND HYPOTHESIS: Numerous studies have found that the short-term results of laparoscopic sacrocolpopexy for pelvic organ prolapse are safe and effective. This study evaluates the long-term results of the laparoscopic sacrocolpopexy operation between the urology and gynecology branches.
METHODS: A prospective study enrolling 206 patients was conducted to evaluate laparoscopic sacrocolpopexy as a surgical treatment for vaginal vault prolapse from 2011 to 2014. Two different surgical branches (urology and gynecology) applied laparoscopic sacrocolpopexy to their patients with their own techniques. The long-term results were assessed postoperatively after 4 years by pelvic examinations, including the Pelvic Organ Prolapse Quantification system (POP-Q) and quality-of-life assessments using validated questionnaires.
RESULTS: A total of 190 patients (94 urology and 96 gynecology patients) received a full clinical follow-up examination between April 2014-June 2018. Postoperative pelvic organ prolapse recurrence rates in each compartment were similar in both groups during the 4 years; 87.2% of the urology and 86.5% of the gynecology patients had no prolapse in any compartment according to the POP-Q system. The reoperation rate was 5.3% for the urology and 6.2% for the gynecology group. Mesh erosion was detected in two patients in both groups. Three patients responded to local estrogen therapy, and we removed the mesh vaginally in one patient. The subjective cure rate was 89.4% in the urology and 88.5% in the gynecology group after 4 years.
CONCLUSIONS: Although different surgical branches perform laparoscopic sacrocolpopexy with their own techniques, long-term anatomical and functional results are similar between the branches. From a urogynecological point of view, laparoscopic sacrocolpopexy is a gold standard surgical procedure that can be performed by both urologists and gynecologists with similar long-term outcomes.

PMID: 30627828 [PubMed - indexed for MEDLINE]

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The proportion of women with central sensitivity syndrome in gynecology outpatient clinics (GOPDs).

Int Urogynecol J. 2019 Mar;30(3):483-488

Authors: Vij M, Davies A, Dua A, Freeman R

Abstract
INTRODUCTION AND HYPOTHESIS: Patients in gynecology outpatient clinics (GOPDs) may present with symptoms that do not correlate well with the observed pathology and are usually labelled as having a functional disorder or medically unexplained symptoms (MUS). Underlying central sensitivity syndrome (CSS) with central sensitization (CS) as a potential mechanism may be responsible for some of their symptoms. The aim of this study is to identify the proportion of women with central sensitivity syndrome attending GOPDs.
METHODS: This was a prospective study. All women attending a GOPD included in the study were asked to complete a validated Central Sensitization Inventory (CSI). The responses were graded on a Likert scale from 0 (never) to 4 (always). The total score ranges from 0 to 100. For screening purposes, a single CSI cutoff score of 40 was used to identify the group of women who may have central sensitization syndrome.
RESULTS: Three hundred twenty-six women participated in the study. Overall, 123 (37%) women achieved a score above 40. This could be interpreted as these patients having increased risk of underlying central sensitization. Of these, 43 had a previously confirmed diagnosis of migraine, 55 (44%) depression, 39 (31.7%) anxiety, 11 fibromyalgia (FM), 34 irritable bowel syndrome (IBS) and 16 chronic fatigue syndrome (CFS/ME).
CONCLUSIONS: Managing patients and their expectations in gynecological outpatient departments when symptoms are inconsistent with observable pathological findings is challenging. This is further complicated when patients have a concomitant central sensitivity syndrome, which can also influence the surgical outcome. Identifying these patients is a key factor for appropriate management.

PMID: 29974141 [PubMed - indexed for MEDLINE]

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Optimizing resident operative self-confidence through competency-based surgical education modules: are we there yet?

Int Urogynecol J. 2019 Mar;30(3):423-428

Authors: Geoffrion R, Koenig NA, Sanaee MS, Lee T, Todd NJ

Abstract
INTRODUCTION AND HYPOTHESIS: Self-confidence is the belief in one's ability to perform and can be enhanced by training. Surgical education should aim to optimize trainee confidence. We designed three procedure-specific competency-based modules to teach vaginal hysterectomy (VH), anterior (AR) and posterior repair (PR) to novice gynecology residents. We hypothesized each module would improve self-confidence and satisfaction during index procedure performance in the operating room.
METHODS: This was an ancillary analysis of a larger randomized-controlled trial of gynecologic educational interventions. Residents at three Canadian universities were included if they had previously performed fewer than five index procedures independently. Intervention residents received educational modules; controls engaged in self-directed learning. All residents performed one or more of the three surgeries and filled out a validated Self-Confidence Scale and a Satisfaction Scale. Scores were compared between groups. Correlations were sought between self-confidence and various variables.
RESULTS: Forty-six residents at three Canadian universities were randomized (21 intervention, 25 control). Most residents had never performed the index procedure. Overall, self-confidence was significantly higher (p = 0.021) in the intervention group for VH, but not for AR and PR (p = 0.94 and p = 0.12, respectively). Compared with controls, self-confidence was also significantly higher in intervention residents who had never performed VH (p = 0.026) or PR (p = 0.027) and in first and second year intervention residents. There was a positive correlation between self-confidence and satisfaction.
CONCLUSIONS: Surgical modules improved self-confidence preferentially in the most junior residents and for more complicated procedures. The wide self-confidence ranges observed suggest that optimization should be an important goal for surgical educators.

PMID: 29644383 [PubMed - indexed for MEDLINE]

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Patient safety culture in obstetrics and gynecology and neonatology units: the nurses' and the midwives' opinion.

J Matern Fetal Neonatal Med. 2019 Oct;32(19):3244-3250

Authors: Ribeliene J, Blazeviciene A, Nadisauskiene RJ, Tameliene R, Kudreviciene A, Nedzelskiene I, Macijauskiene J

Abstract
Background: Patients treated in health care facilities that provide services in the fields of obstetrics, gynecology, and neonatology are especially vulnerable. Large multidisciplinary teams of physicians, multiple invasive and noninvasive diagnostic and therapeutic procedures, and the use of advanced technologies increase the probability of adverse events. The evaluation of knowledge about patient safety culture among nurses and midwives working in such units and the identification of critical areas at a health care institution would reduce the number of adverse events and improve patient safety. The aim of the study was to evaluate the opinion of nurses and midwives working in clinical departments that provide services in the fields of obstetrics, gynecology, and neonatology about patient safety culture and to explore potential predictors for the overall perception of safety. Methods: We used the Hospital Survey on Patient Safety Culture (HSOPSC) to evaluate nurses' and midwives' opinion about patient safety issues. The overall response rate in the survey was 100% (n = 233). Results: The analysis of the dimensions of safety on the unit level showed that the respondents' most positive evaluations were in the Organizational Learning - Continuous Improvement (73.2%) and Feedback and Communication about Error (66.8%) dimensions, and the most negative evaluations in the Non-punitive Response to Error (33.5%) and Staffing (44.6%) dimensions. On the hospital level, the evaluation of the safety dimensions ranged between 41.4 and 56.8%. The percentage of positive responses in the outcome dimensions Frequency of Events Reported was 82.4%. We found a significant association between the outcome dimension Frequency of Events Reported and the Hospital Management Support for Patient Safety and Feedback and Communication about Error Dimensions. Conclusions: On the hospital level, the critical domains in health care facilities that provide services in the fields of obstetrics, gynecology, and neonatology were Teamwork Across Hospital Units, and on the unit level - Communication Openness, Teamwork Within Units, Non-punitive Response to Error, and Staffing. The remaining domains were seen as having a potential for improvement.

PMID: 29618234 [PubMed - indexed for MEDLINE]

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