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Wood TC, Rahman R, Bainton T, Ahmed J, Raza A. The importance of non-technical skills in robot-assisted surgery in gynaecology. J Robot Surg 2024; 18:192. [PMID: 38693443 DOI: 10.1007/s11701-024-01956-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 04/17/2024] [Indexed: 05/03/2024]
Abstract
Robot-assisted surgery (RAS) in gynaecology has undergone exponential growth in recent decades, with utility in treating both benign and malignant gynaecological conditions. The technological complexities and amended theatre dynamics that RAS demands mean that effective non-technical skills (NTS) are vitally important to overcome these unique challenges. However, NTS have been neglected in RAS-training programmes with focus placed instead on the exclusive acquisition of technical skills (TS). NTS include teamwork, communication, leadership, situational awareness, decision-making and stress management. Communication is the most frequently cited NTS impacted during RAS, as the physical limitations imposed by the robotic hardware make communication exchange difficult. The full immersion that RAS enables can contribute to situational awareness deficits. However, RAS can complement communication and teamwork when multidisciplinary (MDT) surgeries (such as complex endometriosis excisions) are undertaken; dual-console capabilities facilitate the involvement of specialties such as general surgery and urology. The development of NTS in RAS cannot be achieved with in-situ experience alone, and current training is poorly standardised. RAS-training programmes and curricula for gynaecology do exist, however the integration of NTS remain limited. Simulation is a viable tool to facilitate enhanced-NTS integration, yet cost implications form a barrier to its wider implementation. However, given that RAS will continue to occupy a greater proportion of the gynaecological caseload, integration of NTS within gynaecological RAS training curricula is necessary. Patients undergoing gynaecological RAS would benefit from the improved safety standards and enhanced surgical outcomes that would result.
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Affiliation(s)
- Thomas Charles Wood
- Department of Obstetrics and Gynaecology, The Hillingdon Hospital, Pield Heath Road, Uxbridge, UB8 3NN, UK.
| | - Rumana Rahman
- Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK
| | - Thomas Bainton
- Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK
| | - Jeffrey Ahmed
- Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK
| | - Amer Raza
- Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK
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Hill H, Wagenhäuser I, Schuller P, Diessner J, Eisenmann M, Kampmeier S, Vogel U, Wöckel A, Krone M. Establishing semi-automated infection surveillance in obstetrics and gynaecology. J Hosp Infect 2024; 146:125-133. [PMID: 38295904 DOI: 10.1016/j.jhin.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/11/2024] [Accepted: 01/13/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Surveillance is an acknowledged method to decrease nosocomial infections, such as surgical site infections (SSIs). Electronic healthcare records create the opportunity for automated surveillance. While approaches for different types of surgeries and indicators already exist, there are very few for obstetrics and gynaecology. AIM To analyse the sensitivity and workload reduction of semi-automated surveillance in obstetrics and gynaecology. METHODS In this retrospective, single-centre study at a 1438-bed tertiary care hospital in Germany, semi-automated SSI surveillance using the indicators 'antibiotic prescription', 'microbiological data' and 'administrative data' (diagnosis codes, readmission, post-hospitalization care) was compared with manual analysis and categorization of all patient files. Breast surgeries (BSs) conducted in 2018 and caesarean sections (CSs) that met the inclusion criteria between May 2013 and December 2019 were included. Indicators were analysed for sensitivity, number of analysed procedures needed to identify one case, and potential workload reduction in detecting SSIs in comparison with the control group. FINDINGS The reference standard showed nine SSIs in 416 BSs (2.2%). Sensitivities for the indicators 'antibiotic prescription', 'diagnosis code', 'microbiological sample taken', and the combination 'diagnosis code or microbiological sample' were 100%, 88.9%, 66.7% and 100%, respectively. The reference standard showed 54 SSIs in 3438 CSs (1.6%). Sensitivities for the indicators 'collection of microbiological samples', 'diagnosis codes', 'readmission/post-hospitalization care', and the combination of all indicators were 38.9%, 27.8%, 85.2% and 94.4%, respectively. CONCLUSIONS Semi-automated surveillance systems may reduce workload by maintaining high sensitivity depending on the type of surgery, local circumstances and thorough digitalization.
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Affiliation(s)
- H Hill
- Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany; Infection Control and Antimicrobial Stewardship Unit, University Hospital Würzburg, Würzburg, Germany
| | - I Wagenhäuser
- Infection Control and Antimicrobial Stewardship Unit, University Hospital Würzburg, Würzburg, Germany; Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - P Schuller
- Infection Control and Antimicrobial Stewardship Unit, University Hospital Würzburg, Würzburg, Germany
| | - J Diessner
- Department of Obstetrics and Gynaecology, University Hospital Würzburg, Würzburg, Germany
| | - M Eisenmann
- Infection Control and Antimicrobial Stewardship Unit, University Hospital Würzburg, Würzburg, Germany
| | - S Kampmeier
- Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany; Infection Control and Antimicrobial Stewardship Unit, University Hospital Würzburg, Würzburg, Germany
| | - U Vogel
- Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany; Infection Control and Antimicrobial Stewardship Unit, University Hospital Würzburg, Würzburg, Germany
| | - A Wöckel
- Department of Obstetrics and Gynaecology, University Hospital Würzburg, Würzburg, Germany
| | - M Krone
- Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany; Infection Control and Antimicrobial Stewardship Unit, University Hospital Würzburg, Würzburg, Germany.
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Subba K, Lambert E, El-Ghobashy A. Tips and tricks in gynaecological robotic surgery. Best Pract Res Clin Obstet Gynaecol 2024; 93:102453. [PMID: 38219641 DOI: 10.1016/j.bpobgyn.2023.102453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/07/2023] [Accepted: 12/21/2023] [Indexed: 01/16/2024]
Abstract
It was the dawn of a new era for robotic surgery when the Food and Drug Administration (FDA) approved da Vinci robotic surgical system for general laparoscopic procedures in 2000. The surgical practice saw a transformative breakthrough towards minimally invasive approach with the ever-increasing uptake of advanced robots proven to benefit patients and surgeons in various ways. However, these innovative machines only complement and enhance a surgeon's operating skills, and with such privilege come responsibilities and new challenges. Heavy reliance on such advanced devices while operating on humans necessitates thorough training and supervision to ensure safe and efficient applications. It is the surgeon's responsibility to direct the procedure constantly and lead other team members who assist during the surgery. In this chapter, we provide miscellaneous tips and tricks that can help beginners navigate through robotic surgery with more confidence and enthusiasm.
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Affiliation(s)
- Kamana Subba
- Obstetrics and Gynaecology, Gynaecological Oncology, UK.
| | | | - Alaa El-Ghobashy
- Department of Gynaecological Oncology, The Royal Wolverhampton NHS Trust, West Midlands, UK
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Klein D, van Dijke I, van Langen IM, Dondorp W, Lakeman P, Henneman L, Cornel MC. Perceptions of reproductive healthcare providers regarding their involvement in offering expanded carrier screening in fertility clinics: a qualitative study. Reprod Biomed Online 2024; 49:103857. [PMID: 38643517 DOI: 10.1016/j.rbmo.2024.103857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 01/01/2024] [Accepted: 01/29/2024] [Indexed: 04/23/2024]
Abstract
RESEARCH QUESTION What are the main arguments of reproductive healthcare providers in favour or against their involvement in offering expanded carrier screening (ECS) for recessive disorders at fertility clinics in the Netherlands? DESIGN Semi-structured interview study with 20 reproductive healthcare providers between May 2020 and January 2021. Participants included 11 gynaecologists, seven fertility doctors, one nurse practitioner and one clinical embryologist, recruited from academic medical centres (n = 13), peripheral facilities associated with academic centres (n = 4), and independent fertility treatment centres (n = 3) in the Netherlands. An interview guide was developed, and thematic content analysis was performed using ATLAS.ti software. RESULTS Arguments of reproductive healthcare providers in favour of their potential involvement in offering ECS included: (i) opportunities offered by the setting; (ii) motivation to assist in reproduction and prevent suffering; and (iii) to counter unwanted commercialization offers. Arguments against involvement included: (i) lack of knowledge and familiarity with offering ECS; (ii) insufficient staff and resources, and potential high costs for clinics and/or couples; (iii) the emotional impact it may have on couples; (iv) perceived complexity of counselling and expected elongation of waiting lists; and (v) expected low impact on reducing the burden of diseases. Participants felt that more evidence and research on the costs-benefits, implications and demand are needed prior to their involvement. CONCLUSION While agreeing that the field of medically assisted reproduction provides a unique opportunity to offer ECS, reproductive healthcare workers feel a lack of capability and limited motivation to offer ECS to all or a selection of couples at their fertility clinics.
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Affiliation(s)
- David Klein
- Department of Human Genetics, Amsterdam Reproduction and Development Research Institute, Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ivy van Dijke
- Department of Human Genetics, Amsterdam Reproduction and Development Research Institute, Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Centre for Reproductive Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Irene M van Langen
- Department of Genetics, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Wybo Dondorp
- Department of Health, Ethics and Society, Care and Public Health Research Institute, Maastricht University Medical Centre, Maastricht University, Maastricht, the Netherlands
| | - Phillis Lakeman
- Department of Human Genetics, Amsterdam Reproduction and Development Research Institute, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Lidewij Henneman
- Department of Human Genetics, Amsterdam Reproduction and Development Research Institute, Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Martina C Cornel
- Department of Human Genetics, Amsterdam Reproduction and Development Research Institute, Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Giagio S, Stracciolini A, Faigenbaum A, Pillastrini P, Rial Rebullido T. Infographic. Ten naked truths about the pelvic floor in athletes. Br J Sports Med 2023; 57:1583-1584. [PMID: 37666641 DOI: 10.1136/bjsports-2023-107241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2023] [Indexed: 09/06/2023]
Affiliation(s)
- Silvia Giagio
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
- Division of Occupational Medicine, IRCCS University Hospital of Bologna S Orsola-Malpighi Polyclinic, Bologna, Italy
| | - Andrea Stracciolini
- Division of Sports Medicine, Orthopedics Department, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Avery Faigenbaum
- Department of Kinesiology and Health Sciences, The College of New Jersey, Ewing, New Jersey, USA
| | - Paolo Pillastrini
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Tamara Rial Rebullido
- Department of Health and Physical Education, Monmouth University, West Long Branch, New Jersey, USA
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Tsonis O, Kopeika J. Fertility preservation in patients with gynaecologic malignancy: Response to ovarian stimulation and long-term outcomes. Eur J Obstet Gynecol Reprod Biol 2023; 290:93-100. [PMID: 37757729 DOI: 10.1016/j.ejogrb.2023.09.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/17/2023] [Accepted: 09/22/2023] [Indexed: 09/29/2023]
Abstract
OBJECTIVE To the best of our knowledge, the available evidence on the effect and efficacy of controlled ovarian stimulation (COS) in this group of patients remains poorly reported. Concerns related to the impact of stimulation to cancer progression and recurrence, as well as the risk of disease dissemination during egg collection, might explain the aforementioned trend. METHODS Overall, our FP Service received 192 gynaecological referrals, between 2005 and 2021, regarding gynaecologic conditions mainly cancer related. A total of 68 (35.4%) patients underwent COS. These patients were diagnosed with the following gynaecologic pathologies: 33 cases (48,5%) of cervical cancer were noted (stage 1b1-2b), 25 ovarian pathology (36.7%), 9 cases (13.2%) of endometrial cancer, and a single case of vaginal cancer (1.5%). RESULTS The mean age of patients attending the fertility preservation service was 31.5 (std 5.8). The patients presenting to their initial appointment with a mean BMI 24.5 (IQR 6.9) and a median AFC of 12 (IQR 13). The mean duration of COS was 11 days (IQR 3), and the median dose of gonadotrophins was calculated at 300 IU (IQR 75 IU). In 95.4% of the cases, GnRH agonist was used as a trigger for final maturation. The median number of follicles measuring more than 14 mm at the time of trigger was 11 (IQR 8), whereas the median number of oocytes collected was 11 (IQR 9). The complication rate was reported at less than 2%. So far, one in four women of this FP group (17/68, 25% of the overall group) returned to our service to claim their cryopreserved eggs/embryos and successful livebirths were reported in 58.8% of this sample (10/17 cases). The mean time to return to use their oocytes/embryos was 36 months (min value 16 months - max value 85 months). There was no significant difference in mortality rate between patients who received FP vs those who did not (hazard ratio of mortality was estimated at 0.91 (p-value 0.88)). CONCLUSION Based on our findings, ovarian stimulation for patients presenting with gynaecologic malignancy is a safe and efficient method of fertility preservation. Undoubtedly, the sample size is limited, however our results are reassuring and highlight the efficacy of COS for the purpose of FP based on data coming from the largest Assisted Conception Unit of the South-East of the UK.
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Affiliation(s)
- Orestis Tsonis
- Senior Clinical Fellow in Reproductive Medicine and Assisted Conception, Fertility Preservation Service, ACU, Guy's Hospital, London, UK.
| | - Julia Kopeika
- Consultant Gynaecologist and Subspecialist in Reproductive Medicine and Surgery, ACU, Guy's Hospital, London, UK.
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Vieira-Coimbra M, Nogueira-Martins N, Zadykowicz R, Rodrigues Gaspar H, Calleja-Agius J, Pakiz M, Mukhopadhyay S, Mahmood T. Provision of screening services for cervical and breast cancer - A scientific study commissioned by the European Board & College of Obstetrics and Gynaecology (EBCOG). Eur J Obstet Gynecol Reprod Biol 2023; 289:208-216. [PMID: 37679212 DOI: 10.1016/j.ejogrb.2023.08.385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
OBJECTIVE Cancer screening can play an important role in early detection, improving treatment outcomes and reducing morbidity and mortality. Breast and cervical cancers belong to the most common gynaecological cancers group. Countries provide different screening programmes on its eligible population basis centred on different health care policies. This scientific study aims to assess and understand the health inequalities in the member countries of the European Board & College of Obstetrics and Gynaecology (EBCOG) as regards screening programmes of gynaecological cancer, with a special focus on breast and cervical cancers' screening strategies. STUDY DESIGN A descriptive questionnaire-based study was conducted, addressed to EBCOG member countries. RESULTS Ninety-one percent of the countries have an organized national or regional screening programme for cervical cancer. Of these, 45% of countries use both cytology and testing for Human Papilloma Virus (HPV) as screening test, 31% use cytology exclusively and 17% only perform HPV testing. Considerable differences were found regarding the interval of screening test: there are countries performing HPV detection triennially, while others perform only conventional cytology every 5 years. Sixty-nine percent of countries included in this study begin screening for cervical cancer in women aged 25 to 29 years, four of them using HPV detection as the screening test. Six countries begin cervical cancer screening before the age of 25. As regards vaccination against HPV, almost all countries have implemented national HPV vaccination programme, except in Poland and Turkey. The 9-valent HPV vaccine is the most frequently offered (77% of countries) and the majority vaccination programmes include both girls and boys. As regards breast cancer screening, all thirty-two countries have an implemented screening programme. All countries perform mammography as the screening test, 62.5% of them begin in women aged 50 to 54, with a 2-yearly interval in the majority. In five countries, screening programmes are performed biennially, starting between 45 and 49 years old. Seven countries start in women aged 41 to 44. CONCLUSIONS There are discrepancies around gynaecological cancer screenings provision among EBCOG member countries. It is important to establish European recommendations about screening for gynaecological cancers, in order to standardize the access to equitable better health care in gynaecological cancers within Europe.
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Affiliation(s)
- Márcia Vieira-Coimbra
- Department of Gynaecology and Obstetrics of Centro Hospitalar Tondela-Viseu EPE, Viseu, Portugal.
| | - Nuno Nogueira-Martins
- Department of Gynaecology and Obstetrics of Centro Hospitalar Tondela-Viseu EPE, Viseu, Portugal
| | - Rafal Zadykowicz
- Department of Obstetrics, Perinatology and Gynaecology, Medical University of Warsaw, Poland
| | - Hugo Rodrigues Gaspar
- Department of Gynaecology and Obstetrics of Hospital Central do Funchal, Madeira, Portugal
| | - Jean Calleja-Agius
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Malta
| | - Maja Pakiz
- Department for Gynaecologic and Breast Oncology, University Medical Centre Maribor, Slovenia
| | - Sambit Mukhopadhyay
- Department of Obstetrics and Gynaecology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Tahir Mahmood
- Visiting Consultant Gynaecologist Spire Murrayfield Hospital, Edinburgh, Scotland, UK and Chair Standing Committee on Standards of Care and Position Statements of EBCOG
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Vieira-Coimbra M, Nogueira-Martins N, Zadykowicz R, Gaspar HR, Calleja-Agius J, Pakiz M, Mukhopadhyay S, Mahmood T. EBCOG position statement on Inequalities in screening for cervical and breast cancer. Eur J Obstet Gynecol Reprod Biol 2023; 289:217-218. [PMID: 37689510 DOI: 10.1016/j.ejogrb.2023.08.386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2023]
Abstract
Gynaecological cancers, namely breast and cervical cancer represent a high burden in women's health. It is well established that cervical and breast cancer screening programmes are effective in reducing morbidity and mortality. It is of the most importance to define strategies to provide a universal access to screening. In European countries, significant progress has been made over the past years concerning screening strategies, namely the choice of screening test, its frequency as well as the age to start and stop the screening. Introduction of Human Papillomavirus vaccination programmes is also making a measurable impact to reduce cervical cancer prevalence and mortality. Our survey has shown a variation among European countries in delivery of cervical and breast cancer screening programmes. These variations can be due to organizational, economic or cultural reasons. The European Board and College of Obstetrics and Gynaecology calls for an implementation of a unified policy of prevention, screening and early detection of cervical and breast cancer across Europe to optimize clinical outcomes and reduce variations.
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Affiliation(s)
- Márcia Vieira-Coimbra
- Department of Gynaecology and Obstetrics of Centro Hospitalar Tondela-Viseu EPE, Viseu, Portugal.
| | - Nuno Nogueira-Martins
- Department of Gynaecology and Obstetrics of Centro Hospitalar Tondela-Viseu EPE, Viseu, Portugal
| | - Rafal Zadykowicz
- Department of Obstetrics, Perinatology and Gynaecology, Medical University of Warsaw, Poland
| | - Hugo Rodrigues Gaspar
- Department of Gynaecology and Obstetrics of Hospital Central do Funchal, Madeira, Portugal
| | - Jean Calleja-Agius
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Malta
| | - Maja Pakiz
- Department for Gynaecologic and Breast Oncology, University Medical Centre Maribor, Slovenia
| | - Sambit Mukhopadhyay
- Department of Obstetrics and Gynaecology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Tahir Mahmood
- Visiting Consultant Gynaecologist Spire Murrayfield Hospital, Edinburgh, Scotland and Chair Standing Committee on Standards of Care and Position Statements of EBCOG, UK
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Pehlivan MJ, Sherman KA, Wuthrich V, Gandhi E, Zagic D, Kopp E, Perica V. The effectiveness of psychological interventions for reducing poor body image in endometriosis, PCOS and other gynaecological conditions: a systematic review and meta-analysis. Health Psychol Rev 2023:1-28. [PMID: 37675797 DOI: 10.1080/17437199.2023.2245020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Gynaecological conditions (e.g., endometriosis, PCOS) result in bodily changes that negatively impact body image. Psychological interventions (e.g., CBT, psychoeducation) have shown promise in reviews with the general population for alleviating body image concerns. This systematic review and meta-analysis aims to provide asynthesis of the impact of psychological interventions for reducing body image concerns for individuals with gynaecological conditions. Electronic databases were searched for relevant psychological intervention studies with body image outcomes. Twenty-one eligible studies were included in the systematic review (ten were included in a random-effects meta-analysis). Studies included participants (N = 1483, M = 71.85, SD = 52.79) with a range of gynaecological conditions, ages (Mage = 35.08, SD = 12.17) and cultural backgrounds. Most included studies reported at least one positive effect with the meta-analysis indicating psychological interventions were moderately superior to control conditions for reducing body image concerns (SMD -.41, 95% CI [-0.20 -0.62]). However, there was a high risk of bias and moderate heterogeneity. Results suggest psychological interventions may hold promise for reducing body image concerns among individuals gynaecological conditions in the short term. Further, preliminary support was found for the use of theory-guided psychological interventions delivered in group settings in particular, with further research needed on optimal intervention length and particular psychotherapeutic approach.
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Affiliation(s)
- Melissa J Pehlivan
- Lifespan, Health and Wellbeing Research Centre, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Kerry A Sherman
- Lifespan, Health and Wellbeing Research Centre, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Viviana Wuthrich
- Lifespan, Health and Wellbeing Research Centre, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Esther Gandhi
- Lifespan, Health and Wellbeing Research Centre, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Dino Zagic
- Lifespan, Health and Wellbeing Research Centre, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Emily Kopp
- Lifespan, Health and Wellbeing Research Centre, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Valentina Perica
- Lifespan, Health and Wellbeing Research Centre, School of Psychological Sciences, Macquarie University, Sydney, Australia
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Mahmud A, De Silva P, Smith P, Justin Clark T. Patient experiences of outpatient hysteroscopy. Eur J Obstet Gynecol Reprod Biol 2023; 288:142-152. [PMID: 37531755 DOI: 10.1016/j.ejogrb.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 08/04/2023]
Abstract
OBJECTIVES Patient perspectives have an important role in improving the quality of outpatient hysteroscopy (OPH) services. Understanding women's experiences can help provide important insights regarding the OPH journey. The purpose of this paper is to share perspectives and reflect on the experiences of women that participated in a national benchmarking OPH survey. In addition, we explore the correlation between women's experience of OPH and reported pain scores. MATERIAL AND METHODS Over a two-month period, 5151 women took part in the national OPH survey. Free text comments relating to women's OPH experience, collected as part of the survey, were subjected to qualitative analysis using NVivo 12 software to provide a better understanding of the OPH journey. In addition, correlations were drawn between the qualitative and quantitative data collected for pain scores and satisfaction using SPSS software. RESULTS 1720 (33.3%) women provided comments on their OPH experience. Qualitative thematic analysis generated themes that were divided into positive (82%) and negative (7%) experiences of care. Potential areas of improvement in relation to the OPH service were highlighted in 11% of themes. Most women regarded OPH as a safe, tolerable, and well delivered outpatient service. Quantitative analysis showed that 1829 (35.5%) women reported procedural pain between 70 and 100 mm. These women reported equivalent quality of care on a 10 cm visual analogue scale (9.71 [SD1.04] vs. 9.76 [0.73]; P = 0.06) but were more likely to decline having the procedure done in the same way again (19.4% vs. 3.1%; RR 6.30, 95% CI 5.06 to 7.83) compared to women with pain scores < 70 mm. CONCLUSION Qualitative data supports the usefulness, safety, tolerability, and acceptance of hysteroscopy in an outpatient setting by most women. However, the reasons for high procedural pain, poor tolerability and negative experiences warrant review and exploration of both individual patient and relevant institutional factors including training, equipment, and local processes.
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Affiliation(s)
- Ayesha Mahmud
- Department of Obstetrics & Gynaecology, Royal Stoke University Hospital, Newcastle Rd, Stoke-on-Trent ST4 6QG, UK.
| | - Prathiba De Silva
- Department of Obstetrics & Gynaecology, Birmingham Women's & Children's NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TG, UK; Institute of Metabolism & Systems Research, University of Birmingham, UK
| | - Paul Smith
- Department of Obstetrics & Gynaecology, Birmingham Women's & Children's NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TG, UK
| | - T Justin Clark
- Department of Obstetrics & Gynaecology, Birmingham Women's & Children's NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TG, UK; Institute of Metabolism & Systems Research, University of Birmingham, UK
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Baekelandt J, Kapurubandara S. A novel approach using vaginal natural orifice transluminal endoscopic surgery (vNOTES) for a wide local excision vaginal intraepithelial neoplasia (VaIN). Eur J Obstet Gynecol Reprod Biol 2023; 287:239-240. [PMID: 37380542 DOI: 10.1016/j.ejogrb.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 06/08/2023] [Accepted: 06/11/2023] [Indexed: 06/30/2023]
Affiliation(s)
- J Baekelandt
- The Department of Gynaecological Oncology and Minimally Invasive Surgery, Imelda Hospital, Bonheiden, Belgium; KU Leuven-University of Leuven, Department of Development and Regeneration, Faculty of Medicine, Group Biomedical Sciences, UZ Herestraat 49 - box 902, 3000 Leuven, Belgium.
| | - S Kapurubandara
- Department of Obstetrics and Gynaecology, Westmead Hospital, NSW, Australia; University of Sydney, NSW, Australia; Sydney West Area Pelvic Surgical Unit (SWAPS), Westmead Hospital, NSW, Australia
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Spain E, Tumelty ME, Hannigan A, Cinnamond K, Cheema A, Cotter A. Factors impacting on the decision of graduate entry medical school students to pursue a career in obstetrics and gynecology in Ireland. BMC Med Educ 2023; 23:449. [PMID: 37337239 DOI: 10.1186/s12909-023-04425-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 06/05/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Challenges in recruiting appropriately trained obstetricians and gynaecologists have been identified across the world. Given well documented staff shortages within obstetrics and gynaecology in Ireland, it is increasingly important to understand the factors which influence medical students to choose or reject a career in the speciality. The aim of this study was to ascertain the perceptions of final year graduate entry medical students of obstetrics and gynaecology, including the factors which may influence a student's decision to pursue in a career in the speciality. METHODS Paper-based surveys of graduate entry medical students (n = 146) were conducted at the beginning and end of a six week rotation in obstetrics and gynaecology in Ireland. Responses to the surveys pre- and post-rotation were matched and changes in career choices, merits and demerits over time were analysed. All analysis was conducted using SPSS for Windows version 25. RESULTS The responses of 72 students to both questionnaires could be matched (response rate of 49.3%). No male students expressed an interest in obstetrics, gynaecology or both as a first choice of career in the pre rotation survey. Obstetrics as a first choice of career increased from 6.9% pre rotation to 19.4% post rotation (p = 0.04) and this increase was seen in male and female students. Gynaecology as a first choice increased slightly from 1.4 to 4.2% (p = 0.50) and the dual speciality increased from 6.9 to 13.9% (p = 0.23). Students identified many merits of obstetrics pre-rotation with more than 60% identifying it as exciting, interesting fulfilling and challenging. However, incompatibility with family life was cited as a demerit by 72% of respondents and 68.1% identified fear of litigation as a demerit. Participants were less positive overall about the merits of a career in gynaecology with less than 40% viewing it as exciting, fulfilling, and varied. CONCLUSIONS While respondents were positive about the merits of a career in obstetrics and gynecology, concerns remain about work-life balance, career opportunities, and the high-risk nature of the specialty. These concerns should be addressed by the profession and policy makers if they wish to attract sufficient numbers to address anticipated need in the coming years. Gender differences in speciality choice were also evident. If males are to be recruited into obstetrics and gynaecology, consideration should be given to the positive impact of internship.
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Affiliation(s)
- Eimear Spain
- School of Medicine, University of Limerick, Limerick, Ireland.
| | | | - Ailish Hannigan
- School of Medicine, University of Limerick, Limerick, Ireland
| | | | - Ayesha Cheema
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Amanda Cotter
- School of Medicine, University of Limerick, Limerick, Ireland
- University Maternity Hospital Limerick, Limerick, Ireland
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Liao S, Wang X, Fu N, Huang Y. High-intensity focussed ultrasound and hysteroscopy endo-operative system cold device procedures for treating >4cm diameter FIGO Type 2 uterine myoma and ensuring successful pregnancy. EUR J CONTRACEP REPR 2023:1-4. [PMID: 37267044 DOI: 10.1080/13625187.2023.2216329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 05/16/2023] [Accepted: 05/16/2023] [Indexed: 06/04/2023]
Abstract
PURPOSE Laparotomic or hysteroscopic myomectomy, and high-intensity focussed ultrasound (HIFU), can be used in the treatment of Type 2 myomas with a > 50% intramural component. Hysteroscopic electroresection may damage the remaining endometrium and complete ablation of myomas may not be realised via HIFU treatment. We report and examine the results of 1 case of HIFU treatment, accompanied with the hysteroscopy endo-operative system (HEOS) cold device procedure. MATERIALS AND METHODS These were used for treating a > 4cm diameter Type 2 uterine myoma and ensuring successful pregnancy. HIFU treatment of uterine myomas can achieve point-by-point ablation of lesions as far as possible without damaging the endometrium. The HEOS cold device procedure was implemented 3 months after HIFU treatment. RESULTS The patient got pregnant naturally in the third month after receiving treatment, with no complications during her pregnancy. The patient gave birth to a healthy male via full-term cesarean section. CONCLUSIONS HIFU treatment, accompanied with the HEOS cold device procedure, ensured complete myoma removal. It also preserved the integrity of the myometrium and prevented uterine perforation during surgery.
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Affiliation(s)
- Sha Liao
- Department of Operating Room Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Xiaoli Wang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
- Department of Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Na Fu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
- Department of Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yan Huang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
- Department of Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
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Harris W, Skuse K, Sharp C, Molyneux M, Crouch N. From coding to clinical nurse specialist: how a review of coding practice enabled hysteroscopy nurse development. Br J Nurs 2023; 32:372-377. [PMID: 37083380 DOI: 10.12968/bjon.2023.32.8.372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
Clinical coding, the method by which departments are reimbursed for providing services to patients, is widely mispractised within the NHS. Improving clinical coding accuracy therefore offers an opportunity to increase departmental income, guide efficient resource allocation and enable staff development. The authors audited the clinical coding in outpatient hysteroscopy clinics at their institution and found that coding errors were both prevalent and correctable. By implementing simple changes in coding procedure, and without any additional administrative cost, they significantly improved coding accuracy and achieved an increase in total annual tariffs. Although not applicable in a block contract, this will become highly relevant in a restoration of the Payment by Results tariff system. Nurse development is a key objective of the NHS Long Term Plan but can be hindered by staff costs, which require departmental funding. In the authors' institution, improved clinical coding accuracy directly led to a departmental restructuring, funded the development of a new hysteroscopy nurse development and improved care delivery. Coding errors are not unique to the authors' trust, yet simple amendments led to meaningful changes. Therefore, careful auditing and implemented change are needed to raise national clinical coding standards, to enable clinical restructuring, staff development, and provide more efficient, patient-centred care.
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Affiliation(s)
- William Harris
- Foundation Year 1 Doctor, Department of Obstetrics and Gynaecology, St Michael's Hospital, Bristol
| | - Kate Skuse
- Foundation Year 1 Doctor, Department of Obstetrics and Gynaecology, St Michael's Hospital, Bristol
| | - Cathryn Sharp
- Advanced Nurse Practitioner, Department of Obstetrics and Gynaecology, St Michael's Hospital, Bristol
| | - Matthew Molyneux
- Consultant Anaesthetist, Department of Obstetrics and Gynaecology, St Michael's Hospital, Bristol
| | - Naomi Crouch
- Consultant Gynaecologist, Department of Obstetrics and Gynaecology, St Michael's Hospital, Bristol
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Semertzidou A, Grout-Smith H, Kalliala I, Garg A, Terzidou V, Marchesi J, MacIntyre D, Bennett P, Tsilidis K, Kyrgiou M. Diabetes and anti-diabetic interventions and the risk of gynaecological and obstetric morbidity: an umbrella review of the literature. BMC Med 2023; 21:152. [PMID: 37072764 PMCID: PMC10114404 DOI: 10.1186/s12916-023-02758-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/27/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Diabetes has reached epidemic proportions in recent years with serious health ramifications. The aim of this study was to evaluate the strength and validity of associations between diabetes and anti-diabetic interventions and the risk of any type of gynaecological or obstetric conditions. METHODS Design: Umbrella review of systematic reviews and meta-analyses. DATA SOURCES PubMed, Medline, Embase, Cochrane Database of Systematic Reviews, manual screening of references. ELIGIBILITY CRITERIA Systematic reviews and meta-analyses of observational and interventional studies investigating the relationship between diabetes and anti-diabetic interventions with gynaecological or obstetric outcomes. Meta-analyses that did not include complete data from individual studies, such as relative risk, 95% confidence intervals, number of cases/controls, or total population were excluded. DATA ANALYSIS The evidence from meta-analyses of observational studies was graded as strong, highly suggestive, suggestive or weak according to criteria comprising the random effects estimate of meta-analyses and their largest study, the number of cases, 95% prediction intervals, I2 heterogeneity index between studies, excess significance bias, small study effect and sensitivity analysis using credibility ceilings. Interventional meta-analyses of randomised controlled trials were assessed separately based on the statistical significance of reported associations, the risk of bias and quality of evidence (GRADE) of included meta-analyses. RESULTS A total of 117 meta-analyses of observational cohort studies and 200 meta-analyses of randomised clinical trials that evaluated 317 outcomes were included. Strong or highly suggestive evidence only supported a positive association between gestational diabetes and caesarean section, large for gestational age babies, major congenital malformations and heart defects and an inverse relationship between metformin use and ovarian cancer incidence. Only a fifth of the randomised controlled trials investigating the effect of anti-diabetic interventions on women's health reached statistical significance and highlighted metformin as a more effective agent than insulin on risk reduction of adverse obstetric outcomes in both gestational and pre-gestational diabetes. CONCLUSIONS Gestational diabetes appears to be strongly associated with a high risk of caesarean section and large for gestational age babies. Weaker associations were demonstrated between diabetes and anti-diabetic interventions with other obstetric and gynaecological outcomes. TRIAL REGISTRATION Open Science Framework (OSF) (Registration https://doi.org/10.17605/OSF.IO/9G6AB ).
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Affiliation(s)
- Anita Semertzidou
- Department of Metabolism, Digestion and Reproduction - Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Harriet Grout-Smith
- Department of Metabolism, Digestion and Reproduction - Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Ilkka Kalliala
- Department of Metabolism, Digestion and Reproduction - Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Akanksha Garg
- Queen Charlotte's and Chelsea - Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Vasso Terzidou
- Department of Metabolism, Digestion and Reproduction - Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Queen Charlotte's and Chelsea - Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Julian Marchesi
- Department of Metabolism, Digestion and Reproduction - Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- School of Biosciences, Cardiff University, Cardiff, UK
| | - David MacIntyre
- Department of Metabolism, Digestion and Reproduction - Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Phillip Bennett
- Department of Metabolism, Digestion and Reproduction - Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Queen Charlotte's and Chelsea - Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Konstantinos Tsilidis
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Maria Kyrgiou
- Department of Metabolism, Digestion and Reproduction - Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.
- Queen Charlotte's and Chelsea - Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK.
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Moldassarina RS, Manabayeva GK, Akylzhanova ZY, Rashidova AM. The importance of vitamin D in the diagnosis and treatment of adenomyosis. Mol Cell Biochem 2023; 478:571-579. [PMID: 35951150 DOI: 10.1007/s11010-022-04533-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 07/30/2022] [Indexed: 10/15/2022]
Abstract
There is still no unified theory of the occurrence of adenomyosis. The theories of retrograde menstruation, metaplasia, activation of Mullerian residues, lymphatic and vascular dissemination, iatrogenic dissemination, immunological changes, genetic predisposition, etc. are discussed. The theory of retrograde menstruation is the most relevant among all these theories. The aim is to study the content of folic acid, vitamins B1, D, E, ferritin in the blood, zinc, copper, calcium in the blood and removed uterine tissues, to assess the hormonal status in women with combined uterine pathology leiomyoma and adenomyosis. 150 women underwent a health examination, residents of the cities of Pavlodar and Nur-Sultan, aged 18 to 49 years with benign dishormonal diseases of reproductive organs (the main group). The control group consisted of 40 women without gynaecological pathology. The study of the somatic status, objective general somatic, clinical and laboratory, gynaecological examination was carried out by routine methods. Ultrasound examination was performed for mammary glands, thyroid gland, pelvic organs in a real-time mode according to standard methods.
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Affiliation(s)
- Rymgul S Moldassarina
- Department of Obstetrics and Gynecology, Semey Medical University, 103 Abay Kunanbayev Str., 071400, Semey, Republic of Kazakhstan.
| | - Gulshat K Manabayeva
- Department of Perinatology, Semey Medical University, 103 Abay Kunanbayev Str., 071400, Semey, Republic of Kazakhstan
| | - Zhansulu Ye Akylzhanova
- Department of Obstetrics and Gynecology, Pavlodar Branch of the Semey Medical University, 72/1 Toraigyrov Str., 140002, Pavlodar, Republic of Kazakhstan
| | - Azima M Rashidova
- Department of Obstetrics and Gynecology, Emirates Hospital Clinics Group, 9 Palm Jumeirah, Dubai, United Arab Emirates
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Rajan S, Sagili H, Durairaj J, Gupta A. Vaginal mesh erosion - a challenging entity. Trop Doct 2023; 53:176-178. [PMID: 36131508 DOI: 10.1177/00494755221125625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pelvic reconstructive surgery with mesh for pelvic organ prolapse (POP) has been reported to have a superior anatomical cure rate compared with traditional repair methods. Mesh-related adverse events are increasing worldwide. We describe a case of excision of mesh erosion following vaginal hysterectomy. A 45yr old lady presented with 3 × 2 cm infected mesh erosion on the anterior vaginal wall following a vaginal hysterectomy a year earlier in a camp setting. Cystoscopy was normal. Under anesthesia, the mesh was dissected from the vagina and excised. The vaginal edges were freshened, and approximated Postoperative period was uneventful, and she was discharged home the next day. Surgical revision is indicated for large or multiple erosions. Mesh excision can be a challenging procedure with difficulty in gaining access and increased risk of surgical bleeding. A multidisciplinary approach in conjunction with a urologist will help optimise outcomes.
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Affiliation(s)
- Saroj Rajan
- 29988Department of Obstetrics and Gynaecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Haritha Sagili
- 29988Department of Obstetrics and Gynaecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Jaylakshmi Durairaj
- 29988Department of Obstetrics and Gynaecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Avantika Gupta
- 29988Department of Obstetrics and Gynaecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
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Robinson D. Preventing treatment delays for benign gynaecological conditions. Case Rep Womens Health 2022; 36:e00448. [PMID: 36092376 PMCID: PMC9450483 DOI: 10.1016/j.crwh.2022.e00448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 09/06/2022] [Indexed: 01/03/2023] Open
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Goncalves-Henriques M, Horala A, Topcu EG, Boekhorst F, Khattak H. The implementation of the European Working Time Directive in Europe and its impact on training in obstetrics and gynaecology: A ten year follow-up. Eur J Obstet Gynecol Reprod Biol 2022; 278:1-5. [PMID: 36108448 DOI: 10.1016/j.ejogrb.2022.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/25/2022] [Accepted: 08/26/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To reassess the compliance with the European Working Time Directive (EWTD) in the member countries of the European Network of Trainees in Obstetrics and Gynaecology (ENTOG) and to investigate the impact of the EWTD on training. STUDY DESIGN In this observational, cross-sectional study, an online questionnaire, containing multiple-choice questions and open questions, was distributed among Obstetrics and Gynaecology trainees in 33 ENTOG member countries. The questionnaire was designed as a follow-up of a similar survey conducted by ENTOG in 2009 and assessed the overall compliance with the EWTD, the adaptations needed to achieve this compliance, the impact of the EWTD on the quality of training and the well-being of trainees. The answers were analysed using descriptive statistics in Microsoft Excel. RESULTS 59 responses from 28/33 (84.8%) ENTOG member countries were collected. Only 5 out of 28 (17.9%) countries were found to be nationally compliant with EWTD. There were no clear differences in the compliance between different types of the hospitals (university/teaching/district), but a trend was observed towards higher rate of implementation in smaller hospitals (<1500 deliveries per year). Regarding the changes needed to become EWTD-compliant and yet maintain high-quality training, the most common suggestions were: hiring extra junior doctors, restructuring training, having less doctors on duty simultaneously, consultants performing more hands on work, dedicated training sessions, reduction of administrative tasks and simulation training for surgical skills. The majority of trainees, 7 out of 12, (58.3%) in the EWTD-compliant hospitals experienced a positive effect on their training, whereas the majority of trainees in non-compliant hospitals, 31 out of 47, (66%) were uncertain about the impact of the EWTD on the quality of training. Among the positive changes, better work-life balance and more consultants available out of the daily working hours were listed. CONCLUSIONS Despite the introduction and implementation of the EWTD over two decades ago, the compliance rates across Europe remain low and seem not to have altered in the last ten years. In order to ensure the quality of training and, most importantly patient safety, we suggest that European nations keep striving to implement the EWTD for doctors in training. We also suggest for nations that have yet to implement this directive to use the strategies as an exemplar in countries that follow EWTD.
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De Ramón Fernández A, Ruiz Fernández D, Prieto Sánchez MT. Prediction of the mode of delivery using artificial intelligence algorithms. Comput Methods Programs Biomed 2022; 219:106740. [PMID: 35338883 DOI: 10.1016/j.cmpb.2022.106740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 02/27/2022] [Accepted: 03/08/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND OBJECTIVE Mode of delivery is one of the issues that most concerns obstetricians. The caesarean section rate has increased progressively in recent years, exceeding the limit recommended by health institutions. Obstetricians generally lack the necessary technology to help them decide whether a caesarean delivery is appropriate based on antepartum and intrapartum conditions. METHODS In this study, we have tested the suitability of using three popular artificial intelligence algorithms, Support Vector Machines, Multilayer Perceptron and, Random Forest, to develop a clinical decision support system for the prediction of the mode of delivery according to three categories: caesarean section, euthocic vaginal delivery and, instrumental vaginal delivery. For this purpose, we used a comprehensive clinical database consisting of 25,038 records with 48 attributes of women who attended to give birth at the Service of Obstetrics and Gynaecology of the University Clinical Hospital "Virgen de la Arrixaca" in the Murcia Region (Spain) from January of 2016 to January 2019. Women involved were patients with singleton pregnancies who attended to the emergency room on active labour or undergoing a planned induction of labour for medical reasons. RESULTS The three implemented algorithms showed a similar performance, all of them reaching an accuracy equal to or above 90% in the classification between caesarean and vaginal deliveries and somewhat lower, around 87% between instrumental and euthocic. CONCLUSIONS The results validate the use of these algorithms to build a clinical decision system to help gynaecologists to predict the mode of delivery.
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Affiliation(s)
- Alberto De Ramón Fernández
- Department of Computer Technology (DTIC), University of Alicante, Carretera San Vicente s/n, Alicante 03690, Spain
| | - Daniel Ruiz Fernández
- Department of Computer Technology (DTIC), University of Alicante, Carretera San Vicente s/n, Alicante 03690, Spain.
| | - María Teresa Prieto Sánchez
- Service of Gynecology and Obstetrics, "Virgen de la Arrixaca" University Clinical Hospital, Institute for Biomedical Research of Murcia (IMIB-Arrixaca), Ctra. Madrid-Cartagena, s/n, El Palmar, Murcia 30120, Spain
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Dedden SJ, Bouwsma EVA, Geomini PMAJ, Bongers MY, Huirne JAF. Predictive factors of return to work after hysterectomy: a retrospective study. BMC Surg 2022; 22:84. [PMID: 35246078 PMCID: PMC8896112 DOI: 10.1186/s12893-022-01533-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/21/2022] [Indexed: 11/10/2022] Open
Abstract
Purpose Although hysterectomy is one of the most frequently performed gynaecological surgeries, there is a dearth of evidence on perioperative care. The aim of the current study was to identify sociodemographic, surgical-related and work-related predictors of recovery following different approaches of hysterectomy. Methods Eligible patients for this retrospective cohort study were women who underwent vaginal, abdominal or laparoscopic hysterectomy for both benign and malignant gynaecological disease in 2014 in Máxima Medical Centre in the Netherlands. The main outcome measure was full return to work (RTW). Data were collected using a patient survey. Potential prognostic factors for time to RTW were examined in univariate Cox regression analyses. The strongest prognostic factors were combined in a multivariable model. Results In total 83 women were included. Median time to full return to work was 8 weeks (interquartile range [IQR] 6–12). The multivariable analysis showed that higher age (hazard ratio [HR] 1.053, 95% confidence interval [CI] 1.012–1.095) and same day removal of indwelling catheter (HR 0.122, 95% CI 0.028–0.539) were predictors of shorter duration until full RTW after hysterectomy. Conclusions This study provided insight in the predictors of recovery after hysterectomy. By identifying patient specific factors, pre-operative counselling can be individualized, changes can be made in perioperative care and effective interventions can be designed to target those factors.
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Affiliation(s)
- Suzanne J Dedden
- Department of Obstetrics and Gynaecology, Máxima Medisch Centrum, Veldhoven, The Netherlands. .,GROW School of Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.
| | - Esther V A Bouwsma
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Peggy M A J Geomini
- Department of Obstetrics and Gynaecology, Máxima Medisch Centrum, Veldhoven, The Netherlands
| | - Marlies Y Bongers
- Department of Obstetrics and Gynaecology, Máxima Medisch Centrum, Veldhoven, The Netherlands.,GROW School of Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Judith A F Huirne
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Amsterdam, The Netherlands
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Nwosu IA, Njemanze VC, Ekpechu JO, Eteng MJ, Ukah JA, Eyisi EC, Ohuruogu B, Alo CA, Ordu GEO, Ezeali TC. Prevalence and determinants of use of traditional methods of infertility treatment among women attending infertility clinic in Southeast Nigeria. Afr J Reprod Health 2022; 26:63-73. [PMID: 37585113 DOI: 10.29063/ajrh2022/v26i3.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
Infertility, an obstacle to healthy living, makes its victims patronize traditional methods of infertility treatment (TMIT) in spite of associated complications. They turn to hospitals when this method fails. This is actually a serious issue because the presence of contaminated herbal products and the relationship between the use of TMIT and noncompliance with biomedical treatment regimens constitutes a major concern in medical practice. And the use of traditional methods of infertility treatment has been correlated with severe and fatal consequences. Therefore, the study assessed prevalence/determinants of TMIT use among patients visiting the gynaecology clinic at Alex Ekwueme Federal University Teaching Hospital Abakaliki (AE-FUTHA). Descriptive cross-sectional design was adopted for the research. Only 263 women took part in the study. The research instrument was questionnaire. Data were analyzed using descriptive statistics. Findings revealed that 95.4% of these women have used traditional methods for infertility treatment and factors influencing infertile women's use of TMIT are demographic characteristics, infertility duration, husbands' relatives' pressure and cheap cost of traditional medical treatment. Again, inability of infertile women to disclose TMIT use to healthcare providers makes effective treatment difficult. Therefore, these impediments expose infertile women to use TMIT. The result is a guide to healthcare providers who are expected to know the extent of their parents' use of TMIT.
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Affiliation(s)
- Innocent A Nwosu
- Department of Sociology, Alex Ekwueme Federal University Ndufu-Alike, Ikwo, Nigeria
| | - Vivian C Njemanze
- Department of Sociology, Alex Ekwueme Federal University Ndufu-Alike, Ikwo, Nigeria
| | - Joseph O Ekpechu
- Department of Sociology, Alex Ekwueme Federal University Ndufu-Alike, Ikwo, Nigeria
| | - Mary J Eteng
- Department of Sociology, Alex Ekwueme Federal University Ndufu-Alike, Ikwo, Nigeria
| | - Jonathan A Ukah
- Department of Sociology, Alex Ekwueme Federal University Ndufu-Alike, Ikwo, Nigeria
| | - Emmanuel C Eyisi
- Department of Sociology, Alex Ekwueme Federal University Ndufu-Alike, Ikwo, Nigeria
| | - Ben Ohuruogu
- Department of Health Education, Ebonyi State University, Abakaliki, Nigeria
| | - Chinyere A Alo
- Department of Physical & Health Education, Alex Ekwueme Federal University Ndufu-Alike, Ikwo, Nigeria
| | - Gilbert E O Ordu
- Department of Criminology & Security Studies, Alex Ekwueme Federal University Ndufu Alike, Ikwo Nigeria
| | - Thonia C Ezeali
- Department of Mass Communication, Alex Ekwueme Federal University Ndufu Alike, Ikwo, Nigeria
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Robijns J, Censabella S, Bollen H, Claes S, Van Bever L, Becker J, Pannekoeke L, Bulens P, Van de Werf E. Vaginal mucositis in patients with gynaecological cancer undergoing (chemo-)radiotherapy: a retrospective analysis. J OBSTET GYNAECOL 2022; 42:2156-2163. [PMID: 35170399 DOI: 10.1080/01443615.2022.2035329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The objective of this retrospective analysis was to determine the incidence and extent of vaginal mucositis (VM) in women with gynaecological cancer undergoing external (chemo)radiation therapy (CRT). A retrospective analysis was set up to collect data on the incidence and severity of VM in women treated with external pelvic RT for gynaecological cancer at the Jessa Hospital, Hasselt and ZOL, Genk, BE between January 2017 and June 2018. At the start and end of their external (C)RT, they rated the frequency and intensity of five common symptoms of VM. Thirty-three patients treated with RT for gynaecological cancer met the inclusion criteria. A non-negligible proportion of patients already experienced at least one VM symptom to any degree before the start of RT, a proportion that further increased towards the end of the RT (73%). At the end of RT, on average, about 25% of these patients reported moderate-to-severe symptoms (against about 7% before the (C)RT). These results suggest that VM is a rather frequent side effect in gynaecological cancer patients that aggravates during treatment up to a moderate severity level. Although the small sample size, these data highlight the need for attention to VM.Impact StatementWhat is already known about this topic? Radiotherapy plays an important role in the treatment of gynaecological malignancies. A debilitating complication in patients undergoing pelvic radiotherapy is vaginal mucositis, an inflammation of the vaginal mucosal lining. To date, the incidence of vaginal mucositis is still not well documented.What this paper adds? A non-negligible proportion of patients already experienced at least one symptom related to vaginal mucositis before the start of radiotherapy. Most patients presented mild to moderate vaginal mucositis symptoms at the end of external pelvic radiotherapy. Burning sensation, pruritus, and pain were the most frequently documented radiotherapy-induced complications.The implications of this paper: Vaginal mucositis is an underrated side effect of pelvic radiotherapy that needs to be tackled multidisciplinary by a team of nurses, radiotherapists, oncologists, and gynaecologists. The team should tackle the complication from the start of radiotherapy by using the most appropriate measures. Due to a possible link between acute vaginal mucositis and late vaginal toxicity, the team needs to follow-up patient's post-radiotherapy to support patients in late complications and advise/encourage patients in performing vaginal dilatation to prevent vaginal stenosis.
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Affiliation(s)
- Jolien Robijns
- Faculty of Medicine and Life Sciences, LCRC, Hasselt University, Hasselt, Belgium
| | - Sandrine Censabella
- Limburg Oncology Center, Jessa Hospital - Campus Virga Jesse, Hasselt, Belgium
| | - Heleen Bollen
- Department of Radiotherapy, UZ Leuven campus Gasthuisberg, Leuven, Belgium
| | - Stefan Claes
- Limburg Oncology Center, Jessa Hospital - Campus Virga Jesse, Hasselt, Belgium
| | - Leen Van Bever
- Limburg Oncology Center, Jessa Hospital - Campus Virga Jesse, Hasselt, Belgium
| | - Jindra Becker
- Limburg Oncology Center, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Luc Pannekoeke
- Limburg Oncology Center, Jessa Hospital - Campus Virga Jesse, Hasselt, Belgium
| | - Paul Bulens
- Limburg Oncology Center, Jessa Hospital - Campus Virga Jesse, Hasselt, Belgium
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El-Hamamsy D, Parmar C, Shoop-Worrall S, Reid FM. Public understanding of female genital anatomy and pelvic organ prolapse (POP); a questionnaire-based pilot study. Int Urogynecol J 2022; 33:309-318. [PMID: 33787954 PMCID: PMC8803818 DOI: 10.1007/s00192-021-04727-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 02/04/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Health literacy underpins informed consent and shared decision-making. In gynaecology, this includes understanding of normal anatomy and urogenital disease. This study evaluated public knowledge of external female genital anatomy and pelvic organ prolapse (POP). METHODS A questionnaire study asked participants for their demographics and to label a female external genitalia diagram and included free-text questions on POP, its symptoms and treatment. Questionnaires were distributed at general outpatient (OPD) and urogynaecology (UG) departments at a UK teaching hospital. Differences in the number of correct anatomy labels between participant genders were assessed via chi-squared tests and, within female participants, multivariable linear and logistic regressions assessed associations with increasing correct anatomical labels and an understanding (versus no understanding) of POP, respectively. RESULTS Within 191 (n = 160 OPD, n = 31 UG), 9/103 (9%) labelled all anatomical structures correctly. Females had more correct labels (median 1, IQR 0,3) versus males (median 0, IQR 0,1), P = 0.022). Higher education (vs. < secondary) and white ethnicity were associated with greater numbers of correct labels [coefficient (95% CI): 1.05 (0.14, 1.96), P = 0.024, 1.45 (0.58, 2.33), P = 0.001 respectively]. Fifty-three per cent understood POP. POP understanding increased with increasing age, white ethnicity (OR: 4.38, 95% CI: 1.36, 14.08, P = 0.013) and more correct anatomy labels (OR: 1.43, 95% CI 1.14, 1.79, P = 0.002). Of those who understood POP, only 35% identified "bulge" as a symptom and 7% physiotherapy as a treatment option. CONCLUSION There was poor public understanding of external female genital anatomy and POP, which may have significant implications for health-seeking, shared decision-making and informed consent.
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Affiliation(s)
- Dina El-Hamamsy
- The Warrell Unit, Saint Mary's Hospital, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Hathersage Road, Manchester, M13 9WL, UK
| | - Chanel Parmar
- 5th year medical student, Manchester University, Manchester, UK
| | - Stephanie Shoop-Worrall
- Centre for Health Informatics, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, M13 9PT, UK
- Centre for Epidemiology Versus Arthritis, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, M13 9PT, UK
| | - Fiona M Reid
- The Warrell Unit, Saint Mary's Hospital, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Hathersage Road, Manchester, M13 9WL, UK.
- Institute of Human Development, Faculty of Medical & Human Sciences, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
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25
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Vejlgaard AS, Rasmussen S, Haastrup PF, Jarbøl DE, Balasubramaniam K. Is concern for gynaecological alarm symptoms associated with healthcare-seeking? A Danish population-based cross-sectional study. BMC Public Health 2022; 22:25. [PMID: 34991531 PMCID: PMC8739714 DOI: 10.1186/s12889-021-12389-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 12/06/2021] [Indexed: 11/26/2022] Open
Abstract
Background Diagnosing cancer at an early stage increases survival, and for most gynaecological cancers the diagnostic pathway is initiated, when women seek medical attention with symptoms. As many factors influence healthcare-seeking, knowledge about these factors is important. Concern can act as a barrier or a trigger for women experiencing gynaecological alarm symptoms. This study aimed to examine whether concern for the symptom or the current health was associated with healthcare-seeking among women with gynaecological alarm symptoms. Methods Some 100,000 randomly selected Danish citizens were invited to a national web-based survey. The questionnaire included items regarding symptom experiences, healthcare-seeking and concern for the experienced symptoms and current health. This study included 5019 women with self-reported gynaecological alarm symptoms (pelvic pain, pain during intercourse, bleeding during intercourse and postmenopausal bleeding). Concern was reported on a 5-point Likert scale from ‘not at all’ to ‘extremely’. Data were analysed using multivariate logistic regression models. Results Women who were ‘extremely’ concerned about a gynaecological alarm symptom had two to six times higher odds of reporting healthcare-seeking compared to women who were ‘not at all’ concerned. Symptom concern was associated with higher odds of healthcare-seeking for all four gynaecological alarm symptoms and the odds increased with increasing levels of concern. Additionally, concern for current health was associated with higher odds of healthcare-seeking. Concern for current health as expressed by others was positively associated with healthcare-seeking but had only minor influence on the association between concern for current health and healthcare-seeking. Conclusions Concern for a gynaecological alarm symptom and for current health was positively associated with healthcare-seeking. The results can be used for future informational health campaigns targeting individuals at risk of postponing warranted healthcare-seeking.
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Affiliation(s)
- Anja Schmidt Vejlgaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, DK5000, Odense C, Denmark
| | - Sanne Rasmussen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, DK5000, Odense C, Denmark
| | - Peter Fentz Haastrup
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, DK5000, Odense C, Denmark
| | - Dorte Ejg Jarbøl
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, DK5000, Odense C, Denmark
| | - Kirubakaran Balasubramaniam
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, DK5000, Odense C, Denmark.
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26
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Kayem G, Sentilhes L. [Which validation of surgical skills in oncology for optimal patient management?]. Gynecol Obstet Fertil Senol 2022; 50:1. [PMID: 34748990 DOI: 10.1016/j.gofs.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Indexed: 06/13/2023]
Affiliation(s)
- G Kayem
- Service de gynécologie obstétrique, hôpital Trousseau, Sorbonne Université, AP-HP, Paris, France.
| | - L Sentilhes
- Service de gynécologie-obstétrique, CHU de Bordeaux, Bordeaux, France
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Dixon F, Khanna A, Vitish-Sharma P, Singh NS, Nakade K, Singh A, Qureshi A, O'Hara R, Keeler BD. Initiation and feasibility of a multi-specialty minimally invasive surgical programme using a novel robotic system: A case series. Int J Surg 2021; 96:106182. [PMID: 34848372 DOI: 10.1016/j.ijsu.2021.106182] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 11/10/2021] [Accepted: 11/21/2021] [Indexed: 01/22/2023]
Abstract
INTRODUCTION There are a number of small case series examining new robotic surgical systems, but this is the first large case series assessing the feasibility of the Versius® system from CMR Surgical (1 Evolution Business Park, Cambridge, UK) in a multi-specialty setting. MATERIALS AND METHODS All patients undergoing Versius®-assisted surgery in a previously robot-naïve centre were consented for collection of data on demographics, pre-, intra-, and postoperative outcomes. Data collection was performed prospectively from the start of the robotic surgical programme. RESULTS 160 operations were performed over a 19-month period, including 68 colorectal, 60 gynaecology, and 32 general surgery cases. The conversion rate to open surgery was 4.4% for colorectal, and 0% for gynaecology and general surgery. Median length of stay was 6 days for colorectal, 1 day for gynaecology, and 0 days for general surgery. Other outcomes were comparable to existing literature for robotic assisted surgery. CONCLUSION The Versius® system is safe and feasible for use in a multi-specialty minimally invasive surgery programme, including colorectal, general surgical & gynaecological cases, and operative volume can be safely and easily scaled up in a district general hospital setting without prior robotic surgical experience.
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Affiliation(s)
- Frances Dixon
- Department of Colorectal Surgery, Milton Keynes University Hospital NHS Foundation Trust, MK6 5LD, UK Department of General Surgery, Milton Keynes University Hospital NHS Foundation Trust, MK6 5LD, UK Department of Obstetrics & Gynaecology, Milton Keynes University Hospital NHS Foundation Trust, MK6 5LD, UK University of Buckingham, Buckingham, MK18 1EG, UK
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28
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Recker F, Dohmen S, Egger EK, Stope MB, Dimitrova D, Könsgen D, Ritter M, Sehouli J, Bondio MG, Mustea A. Impact of COVID-19 on gynaecological patient care: results of patient's survey with 327 patients. Arch Gynecol Obstet 2021; 305:389-395. [PMID: 34705116 PMCID: PMC8549413 DOI: 10.1007/s00404-021-06280-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 10/11/2021] [Indexed: 11/12/2022]
Abstract
Purpose The pandemic SARS-CoV-2 poses new and unprecedented challenges for health care systems on a national and global level. Although the current situation has been going on for more than 1 year, there is limited data on the impact of the pandemic on general hospital and medical practice care. This survey captures the perspective of patients with gynaecological diseases of this impact. Methods Using a paper-based questionnaire, 327 patients were asked about medical care and their experiences during the pandemic at the University Hospital Bonn and the University Hospital Charité Berlin. The study was performed from the 1st June to 30th September 2020. Results A total of 327 patients participated in the study: 156 stated to have been tested for coronavirus, and 1 patient reported a positive test. 41.3% of the patients felt insecure about the current situation, 30.4% were concerned about the risk of infection during the hospital stay. The pandemic-specific measures in hospitals and medical practices unsettled 6.8% of patients. 18.1% of patients feared that their gynaecological disease would not be treated adequately due to the pandemic. 55.7% of patients reported that their confidence in their physicians has increased during the pandemic. Conclusion The results show that patients’ confidence in the healthcare system and the physicians acting significantly increased during the COVID-19 crisis. Transparent and comprehensive information policy regarding actions and restrictions within the COVID-19 crisis eases patients concerns and improves patients’ confidence in their physicians, which is crucial for a successful treatment’s outcome.
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Affiliation(s)
- F Recker
- Department for Gynecology and Gynecological Oncology, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany.
| | - S Dohmen
- Department for Gynecology and Gynecological Oncology, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - E K Egger
- Department for Gynecology and Gynecological Oncology, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - M B Stope
- Department for Gynecology and Gynecological Oncology, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - D Dimitrova
- Department for Gynecology with Centre for Oncological Surgery, Campus Virchow Klinikum, Berlin, Germany
| | - D Könsgen
- Department for Gynecology and Gynecological Oncology, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - M Ritter
- Department of Urology, University Hospital Bonn, Bonn, Germany
| | - J Sehouli
- Department for Gynecology with Centre for Oncological Surgery, Campus Virchow Klinikum, Berlin, Germany
| | - M Gadebusch Bondio
- Institute of Medical Humanities, University Hospital Bonn, Bonn, Germany
| | - A Mustea
- Department for Gynecology and Gynecological Oncology, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
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29
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Dayan N, Shapiro GD, Luo J, Guan J, Fell DB, Laskin CA, Basso O, Park AL, Ray JG. Development and internal validation of a model predicting severe maternal morbidity using pre-conception and early pregnancy variables: a population-based study in Ontario, Canada. BMC Pregnancy Childbirth 2021; 21:679. [PMID: 34615477 PMCID: PMC8496026 DOI: 10.1186/s12884-021-04132-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 09/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Improvement in the prediction and prevention of severe maternal morbidity (SMM) - a range of life-threatening conditions during pregnancy, at delivery or within 42 days postpartum - is a public health priority. Reduction of SMM at a population level would be facilitated by early identification and prediction. We sought to develop and internally validate a model to predict maternal end-organ injury or death using variables routinely collected during pre-pregnancy and the early pregnancy period. METHODS We performed a population-based cohort study using linked administrative health data in Ontario, Canada, from April 1, 2006 to March 31, 2014. We included women aged 18-60 years with a livebirth or stillbirth, of which one birth was randomly selected per woman. We constructed a clinical prediction model for the primary composite outcome of any maternal end-organ injury or death, arising between 20 weeks' gestation and 42 days after the birth hospital discharge date. Our model included variables collected from 12 months before estimated conception until 19 weeks' gestation. We developed a separate model for parous women to allow for the inclusion of factors from previous pregnancy(ies). RESULTS Of 634,290 women, 1969 experienced the primary composite outcome (3.1 per 1000). Predictive factors in the main model included maternal world region of origin, chronic medical conditions, parity, and obstetrical/perinatal issues - with moderate model discrimination (C-statistic 0.68, 95% CI 0.66-0.69). Among 333,435 parous women, the C-statistic was 0.71 (0.69-0.73) in the model using variables from the current (index) pregnancy as well as pre-pregnancy predictors and variables from any previous pregnancy. CONCLUSIONS A combination of factors ascertained early in pregnancy through a basic medical history help to identify women at risk for severe morbidity, who may benefit from targeted preventive and surveillance strategies including appropriate specialty-based antenatal care pathways. Further refinement and external validation of this model are warranted and can support evidence-based improvements in clinical practice.
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Affiliation(s)
- Natalie Dayan
- Department of Medicine and Research Institute, McGill University Health Centre, 5252 de Maisonneuve West, 2B.40, Montreal, QC, H4A 3S5, Canada. .,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Purvis Hall, 1020 Pine Ave West, Montreal, QC, H3A 1A2, Canada.
| | - Gabriel D Shapiro
- Department of Medicine and Research Institute, McGill University Health Centre, 5252 de Maisonneuve West, 2B.40, Montreal, QC, H4A 3S5, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Purvis Hall, 1020 Pine Ave West, Montreal, QC, H3A 1A2, Canada
| | - Jin Luo
- ICES, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Jun Guan
- ICES, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Deshayne B Fell
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Centre for Practice-Changing Research Building, Room L-1154, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - Carl A Laskin
- Departments of Medicine and Obstetrics and Gynecology, University of Toronto, 123 Edward St., suite 1200, Toronto, ON, M5G 1E2, Canada.,TRIO Fertility, 655 Bay St, Toronto, ON, M5G 2K4, Canada
| | - Olga Basso
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Purvis Hall, 1020 Pine Ave West, Montreal, QC, H3A 1A2, Canada
| | - Alison L Park
- ICES, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Joel G Ray
- ICES, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.,Departments of Medicine and Obstetrics and Gynecology, University of Toronto, 123 Edward St., suite 1200, Toronto, ON, M5G 1E2, Canada
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30
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Roullier C, Sanguin S, Parent C, Lombart M, Sergent F, Foulon A. General practitioners and endometriosis: Level of knowledge and the impact of training. J Gynecol Obstet Hum Reprod 2021; 50:102227. [PMID: 34520875 DOI: 10.1016/j.jogoh.2021.102227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 08/30/2021] [Accepted: 09/07/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To assess general practitioners' (GPs') knowledge of and practice in the diagnosis and management of endometriosis following the publication of updated French national guidelines in 2017. MATERIALS AND METHODS A descriptive, anonymous, epidemiological survey of 102 GPs in the Picardie region of France. RESULTS Only 25% of the GPs considered that they knew enough about endometriosis for their routine clinical practice. This proportion was 58.9% amongst GPs with an university diploma in gynaecology and 31.4% amongst those participating in continuing medical education courses on gynaecology. Only 19.6% of the GPs were aware of the updated French national guidelines. With regard to five main suggestive, localizing signs of endometriosis, dyspareunia, dysmenorrhoea and infertility were mentioned as being of diagnostic value by 55.9%, 37.3% and 43.1% of the GPs, respectively; in contrast, functional urinary tract disorders and painful defecation were not mentioned very often. GPs with a qualification in gynaecology and those participating in continuing medical education in gynaecology knew more about treating endometriosis. CONCLUSION In the Picardie region of France, GPs appear to be only moderately aware of how to manage endometriosis; this probably contributes to the diagnostic delay associated with this condition. GPs with a university diploma in gynaecology and those participating in continuing medical education in gynaecology appeared to have a better grasp of the subject. Continuing medical education on this topic should therefore be promoted and expanded.
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Affiliation(s)
- Chloé Roullier
- Département de médecine générale, Faculté de Médecine, Université Picardie Jules Verne, 3 rue des Louvels, 80000 Amiens, France
| | - Sophie Sanguin
- Service de gynécologie et d'obstétrique, CHU Amiens Picardie, 1 Bd du Pr Christian Cabrol, 80054 Amiens, France
| | - Camille Parent
- Service de gynécologie et d'obstétrique, CHU Amiens Picardie, 1 Bd du Pr Christian Cabrol, 80054 Amiens, France
| | - Mélyne Lombart
- Service de gynécologie et d'obstétrique, CHU Amiens Picardie, 1 Bd du Pr Christian Cabrol, 80054 Amiens, France
| | - Fabrice Sergent
- Service de gynécologie et d'obstétrique, CHU Amiens Picardie, 1 Bd du Pr Christian Cabrol, 80054 Amiens, France; Faculté de Médecine, Université Picardie Jules Verne, 3 rue des Louvels, 80000 Amiens, France
| | - Arthur Foulon
- Service de gynécologie et d'obstétrique, CHU Amiens Picardie, 1 Bd du Pr Christian Cabrol, 80054 Amiens, France.
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Aarts JWM, Thompson R, Alam SS, Dannenberg M, Elwyn G, Foster TC. Encounter decision aids to facilitate shared decision-making with women experiencing heavy menstrual bleeding or symptomatic uterine fibroids: A before-after study. Patient Educ Couns 2021; 104:2259-2265. [PMID: 33632633 DOI: 10.1016/j.pec.2021.02.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 11/19/2020] [Accepted: 02/11/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Is the level of shared decision-making (SDM) higher after introduction of a SDM package (including encounter decision aids on treatment options for heavy menstrual bleeding and training for clinicians) than before?. METHODS This before-after study, performed in OB-GYN practice, compared consultations before and after introduction of a SDM package. The target sample size was 25 patients per group. Women seeking treatment for heavy menstrual bleeding were eligible. After their appointments, patients filled out a three-item patient-reported SDM measure. Treatment discussions were audio-recorded and rated for SDM using Observer OPTION5. Consultation transcripts in the 'after' group were checked for adherence to the steps required for intended use of decision aids. RESULTS 16 gynaecologists participated. 25 patients participated before introduction of the decision aids and 28 after. The proportion of women reporting optimal SDM was higher after introduction (75 %) than before (50 %;p < 0.001). The mean observer-rated level of SDM was also significantly higher after than before (MD = 12.50,95 % CI 5.53-19.47). CONCLUSION The level of SDM was higher after the introduction of the package than before. PRACTICE IMPLICATIONS This study was conducted in a real-life setting in three clinics, both large academic and small rural, offering opportunities for implementation in different type of organizations.
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Affiliation(s)
- Johanna W M Aarts
- Department of Gynecology and Obstetrics, Amsterdam UMC University Medical Center, Amsterdam, the Netherlands.
| | - Rachel Thompson
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Shama S Alam
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon NH, USA
| | - Michelle Dannenberg
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon NH, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon NH, USA
| | - Tina C Foster
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon NH, USA; Department Obstetrics & Gynaecology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
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Ee TX, Toh WL, Chan JKY. Rare Surgical Complication of In Vitro Fertilisation Treatment: Bladder Injury During Oocyte Retrieval. J Med Cases 2021; 12:102-106. [PMID: 34434438 PMCID: PMC8383583 DOI: 10.14740/jmc3632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 12/22/2020] [Indexed: 12/01/2022] Open
Abstract
Current literature suggests that surgical complications from oocyte retrievals (ORs) are uncommon. Here, we present a rare case of bladder injury during OR and its subsequent management. A 37-year-old nulliparous woman underwent assisted reproductive therapy (ART) for primary infertility secondary to anovulatory cycle. During OR, there was an inadvertent puncture of the bladder, with active intra-bladder bleeding seen on transvaginal ultrasound. Bladder washout followed by continuous drainage was instituted with antibiotic coverage over several days. Bladder integrity ascertained through computer tomography urogram and cystoscopy were unremarkable. She was discharged well and continued with her fertility treatment. Transvaginal OR is associated with few complications. Bladder injury, albeit rare, can present with massive hematuria and hemodynamic instability. Early identification of the injury is key to management with insertion of the indwelling urinary catheter, hemodynamic resuscitation and bladder irrigation. With a urological multi-disciplinary approach, most bladder injuries can be resolved non-invasively.
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Affiliation(s)
- Tat Xin Ee
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Wuen Lynn Toh
- Department of Obstetrics and Gynecology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Jerry K Y Chan
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore, Singapore.,Cancer and Stem Cell Biology, Duke-NUS Medical School, Singapore, Singapore
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Hennings LI, Sørensen JL, Hybscmann J, Strandbygaard J. Tools for measuring technical skills during gynaecologic surgery: a scoping review. BMC Med Educ 2021; 21:402. [PMID: 34311735 PMCID: PMC8314568 DOI: 10.1186/s12909-021-02790-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 06/09/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Standardised assessment is key to structured surgical training. Currently, there is no consensus on which surgical assessment tool to use in live gynaecologic surgery. The purpose of this review is to identify assessment tools measuring technical skills in gynaecologic surgery and evaluate the measurement characteristics of each tool. METHOD We utilized the scoping review methodology and searched PubMed, Medline, Embase and Cochrane. Inclusion criteria were studies that analysed assessment tools in live gynaecologic surgery. Kane's validity argument was applied to evaluate the assessment tools in the included studies. RESULTS Eight studies out of the 544 identified fulfilled the inclusion criteria. The assessment tools were categorised as global rating scales, global and procedure rating scales combined, procedure-specific rating scales or as a non-procedure-specific error assessment tool. CONCLUSION This scoping review presents the current different tools for observational assessment of technical skills in intraoperative, gynaecologic surgery. This scoping review can serve as a guide for surgical educators who want to apply a scale or a specific tool in surgical assessment.
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Affiliation(s)
| | - Jette Led Sørensen
- Juliane Marie Centre for children, women and reproduction, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jane Hybscmann
- Juliane Marie Centre for children, women and reproduction, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Jakobsen DH, Høgdall C, Seibæk L. Postoperative mobilisation as an indicator for the quality of surgical nursing care. ACTA ACUST UNITED AC 2021; 30:S4-S15. [PMID: 33641401 DOI: 10.12968/bjon.2021.30.4.s4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Postoperative mobilisation is an important part of fundamental care. Increased mobilisation has positive effect on recovery, but immobilisation is still a challenge in postoperative care. AIMS To report how the establishment of a national nursing database was used to measure postoperative mobilisation in patients undergoing surgery for ovarian cancer. METHODS 'Mobilisation' was defined as at least 3 hours out of bed on postoperative day 1, with the goal set at achieving this in 60% of patients. Data entry was performed by clinical nurses on 4400 patients with ovarian cancer. FINDINGS 46.7% of patients met the goal for mobilisation on the first postoperative day, but variations in duration and type of mobilisation were observed. Of those mobilised, 51.8% had been walking in the hallway. CONCLUSIONS A national nursing database creates opportunities to optimise fundamental care. By comparing nursing data with oncological, surgical and pathology data it became possible to study mobilisation in relation to cancer stage, comorbidity, treatment and extent of surgery.
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Affiliation(s)
- Dorthe Hjort Jakobsen
- Clinical Head Nurse, Section of Surgical Pathophysiology, Copenhagen University Hospital, Denmark
| | - Claus Høgdall
- Professor, Department of Gynecology, Rigshospitalet, Juliane Marie Centre, Copenhagen University Hospital, Denmark
| | - Lene Seibæk
- Associate professor, Department of Gynaecology and Obstetrics, Aarhus University Hospital, Denmark
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Massoth C, Schwellenbach J, Saadat-Gilani K, Weiss R, Pöpping D, Küllmar M, Wenk M. Impact of opioid-free anaesthesia on postoperative nausea, vomiting and pain after gynaecological laparoscopy - A randomised controlled trial. J Clin Anesth 2021; 75:110437. [PMID: 34229292 DOI: 10.1016/j.jclinane.2021.110437] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/22/2021] [Accepted: 06/26/2021] [Indexed: 01/02/2023]
Abstract
STUDY OBJECTIVE Opioid-free anaesthesia may enhance postoperative recovery by reducing opioid-related side effects such as nausea, hyperalgesia or tolerance. The objective was to investigate the impact of multimodal opioid-free general anaesthesia on postoperative nausea, vomiting, pain and morphine consumption compared to the traditional opioid-based approach. DESIGN This study was conducted as a prospective parallel-group randomised controlled trial. SETTING Perioperative Care. PATIENTS 152 adult women undergoing elective inpatient gynaecological laparoscopy. INTERVENTIONS Patients were randomly assigned for opioid-free anaesthesia (Group OF) with dexmedetomidine, esketamine and sevoflurane or to have opioid-based anaesthesia (Group C) with sufentanil and sevoflurane. MEASUREMENTS Primary outcome was the occurrence of nausea within 24 h after surgery. Patients were assessed for the incidence and severity of PONV, postoperative pain and morphine consumption and recovery characteristics. MAIN RESULTS Patients in both groups had comparable clinical and surgical data. 69.7% of patients in the control group and 68.4% of patients in the opioid-free group met the primary endpoint (OR 1.06, 95% Confidence Interval (CI) (0.53; 2.12) p = 0.86). The incidence of clinically important PONV defined by the PONV impact scale was 8.1% (Group C) vs 10.5% (OF); p = 0.57). Antiemetic requirements, pain scores and morphine consumption were equivalent in both groups. Postoperative sedation was significantly increased in group OF (p < 0.001), and the median length of stay at the post-anaesthesia care unit was 69.0 min (46.5-113.0) vs 50.0 (35.3-77.0) minutes in the control group (p < 0.001). CONCLUSIONS Opioid-free multimodal general anaesthesia is feasible but did not decrease the incidence of PONV, or reduce pain scores and morphine consumption compared to an opioid-containing anaesthetic regimen.
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Affiliation(s)
- Christina Massoth
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, A1, 48149 Münster, Germany.
| | - Judith Schwellenbach
- Department of Anesthesiology, Intensive Care and Pain Medicine, Florence-Nightingale-Hospital, Kreuzbergstraße 79, 40489 Düsseldorf, Germany
| | - Khaschayar Saadat-Gilani
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, A1, 48149 Münster, Germany
| | - Raphael Weiss
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, A1, 48149 Münster, Germany
| | - Daniel Pöpping
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, A1, 48149 Münster, Germany
| | - Mira Küllmar
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, A1, 48149 Münster, Germany
| | - Manuel Wenk
- Department of Anesthesiology, Intensive Care and Pain Medicine, Florence-Nightingale-Hospital, Kreuzbergstraße 79, 40489 Düsseldorf, Germany
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MacCraith E, Forde JC, O'Brien FJ, Davis NF. Contemporary trends for urological training and management of stress urinary incontinence in Ireland. Int Urogynecol J 2021. [PMID: 34160634 DOI: 10.1007/s00192-021-04887-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/26/2021] [Indexed: 11/22/2022]
Abstract
Introduction and hypothesis The aim of this study is to evaluate the trends in stress urinary incontinence (SUI) surgery since the 2018 pause on use of the polypropylene (PP) mid-urethral sling (MUS) and to quantify the effect this has had on surgical training. Methods Two anonymous surveys were sent to all current urology trainees and to all consultant surgeons who specialise in stress urinary incontinence surgery. Results Prior to the pause, 86% (6 out of 7) of consultant urologists and 73% (11 out of 15) of consultant gynaecologists would “always”/“often” perform MUS for SUI. After that, 100% (22 out of 22) of consultants reported that they “never” perform MUS. There has been a modest increase in the use of urethral bulking agent (UBA) procedures among urologists, with 43% (3 out of 7) now “often” performing this, compared with 71% (5 out of 7) “never” performing it pre-2018. Trainee exposure to SUI surgery reduced by 75% between 2016 and 2020. Despite a ten-fold increase in UBA procedures logged by trainees, the decline in MUS has resulted in a major reduction in total SUI surgeries. Coinciding with this decrease in surgeries, there was a 56% reduction in trainees’ self-assessed competence at SUI surgery. Thirteen percent of trainees are interested in specialising in Female Urology and those trainees had significantly greater exposure to SUI procedures during their training than those who did not (p = 0.0072). Conclusions This study has identified a downward trend in SUI surgery, which is concerning for the undertreatment of females with SUI. A decline in SUI surgery training has resulted in reduced trainee confidence and interest in this subspecialty.
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Kapurubandara S, Lowenstein L, Salvay H, Herijgers A, King J, Baekelandt J. Consensus on safe implementation of vaginal natural orifice transluminal endoscopic surgery (vNOTES). Eur J Obstet Gynecol Reprod Biol 2021; 263:216-22. [PMID: 34237485 DOI: 10.1016/j.ejogrb.2021.06.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 05/20/2021] [Accepted: 06/14/2021] [Indexed: 12/24/2022]
Abstract
STUDY OBJECTIVE The first ever report of vaginal natural orifice transluminal endoscopic surgery (vNOTES) for benign gynaecological was reported in 2012. There has been an exponential uptake of the number of surgeons performing such procedures worldwide with no official guidance to ensure the safe implementation of this technique into gynaecological practice due its recency. The objective of this study is to report an international consensus-based statement to help guide a basis for adopting vNOTES into clinical practice. STUDY DESIGN The consensus-based statement was developed amongst 39 international experts using the Delphi methodology over three successive rounds. Consensus was pre-defined as an agreement of 80% or more by the experts. Consensus sought over eight key concepts pertaining to vNOTES including patient selection, perioperative management, surgical technique, instruments, anatomy, training, registries and trials and definition of the surgical technique. Recommendations from an expert anaesthetist and urogynaecologist were also sought to give a broader perspective with respect to the implementation of vNOTES. RESULTS Fifty nine international surgeons were invited to participate and 39 (66%) agreed to participate based on being involved in a minimum of 20 vNOTES procedures. They were from 13 countries across 5 continents (Europe, North America, South America, Australia and Asia). Participation was 100% on all three rounds. Overall, consensus was reached in 50 of the 56 questions (89%) with the remaining 6 questions where consensus was not reached pertaining to the domain of patient selection. CONCLUSION An international expert based vNOTES statement is presented here to help guide adoption of vNOTES based on the experience of early adopters. Consensus was achieved on most components of this consensus statement. Given the recency of this technique, until high-level evidence becomes available, this statement provides an appropriate guidance to the safe implementation of vNOTES into gynaecological practice.
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Addley S, McMullan JC, Scott S, Soleymani Majd H. 'Well-leg' compartment syndrome associated with gynaecological surgery: a perioperative risk-reduction protocol and checklist. BJOG 2021; 128:1517-1525. [PMID: 33988902 DOI: 10.1111/1471-0528.16749] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2021] [Indexed: 12/01/2022]
Abstract
'Well-leg' compartment syndrome (WLCS) is an uncommon, but potentially devastating, complication associated with prolonged patient positioning for abdomino-pelvic surgery. Gynaecologists, anaesthetists and the wider theatre team share a responsibility to minimise the risk of this highly morbid, and even fatal, postoperative complication. This article provides an overview of WLCS related to gynaecological surgery - raising awareness amongst gynaecologists and highlighting the time-critical nature of diagnosis and management. Given the potential litiginous nature of this complication, we also present a perioperative checklist and risk-reduction protocol to suggest a standardised approach to prevention and relevant documentation. TWEETABLE ABSTRACT: Gynaecologists share a responsibility to minimise the risk of postoperative 'well-leg' compartment syndrome.
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Affiliation(s)
- S Addley
- Department of Gynaecology Oncology, Churchill Hospital, Oxford, UK
| | - J C McMullan
- Department of Obstetrics and Gynaecology, Antrim Area Hospital, Antrim, UK
| | - S Scott
- Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford, UK
| | - H Soleymani Majd
- Department of Gynaecology Oncology, Churchill Hospital, Oxford, UK
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Nasution LA, Afiyanti Y. Spiritual based intervention effect on the psychological aspect of patients with gynaecologic and breast cancer: A systematic review. Enferm Clin 2021; 31 Suppl 2:S90-5. [PMID: 33849238 DOI: 10.1016/j.enfcli.2020.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The complexity of care on patients with gynaecological and breast cancer causes various psychological effects, and therefore, spiritual-based intervention is developed to overcome these problems. The purpose of this study is to determine the effects of the spiritual-based intervention on the psychological aspect of patients with gynaecological and breast cancer. The method used to prepare this systematic review is Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). There are 14 related articles. Spiritual-based interventions in this study were conducted ranging from 4 to 8 sessions, with an average duration of about 60-90min/session. The effects of spiritual-based intervention on the psychological aspect of cancer patients include reducing anxiety and depression, improving spiritual and emotional well-being, improving coping and quality of life for patients with gynaecological and breast cancer. Spiritual-based intervention is affecting the physical condition, psychological state, and quality of life of cancer patients.
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Khan ZM, Kershaw V, Madhuvrata P, Radley SC, Connor ME. Patient experience of telephone consultations in gynaecology: a service evaluation. BJOG 2021; 128:1958-1965. [PMID: 34033200 DOI: 10.1111/1471-0528.16771] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate patient perspective of telephone consultations (TCs) in gynaecology and identify which patients benefit most from a telemedicine system. DESIGN Service evaluation. SETTING Gynaecology outpatient services at a tertiary referral hospital. POPULATION Patients who received a TC during May and June 2020. METHODS Postal questionnaire combining three validated tools: QQ-10, Patient Enablement Index (PEI) and National Health Service Friends and Family Test (NHS-FFT). Quantitative data and free text responses were analysed. MAIN OUTCOME MEASURES Responses to QQ-10, PEI and NHS-FFT. RESULTS In total, 1307 patients were contacted and 504 patients responded (39%). Most (89%) described their experience as 'Very good' or 'Good' (NHS-FFT). Positive themes from responses included 'convenience', 'effectiveness' and 'equivalent care'. QQ-10 responses demonstrated a high Value score of 79 (0-100) and a low Burden score of 15. PEI scores suggested that most patients felt better or much better able to understand and cope with their condition following TC. The majority of patients (77%) would 'Strongly agree' or 'Mostly agree' to a repeat TC. Regarding patient outcomes, 21% were discharged and 71% required follow up. Menopause, fertility and endometriosis follow-up clinic patients benefited most from TC. Gynaecology-oncology patients found TC least acceptable. CONCLUSION We report a large questionnaire survey of patient experience of TC in gynaecology. Telemedicine is convenient, acceptable and effective for conducting care in selected groups. TC can support patients in communicating intimate symptoms. TWEETABLE ABSTRACT Telephone consultations are a convenient, acceptable and effective medium for conducting patient care in gynaecology. TWEETABLE ABSTRACT.
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Affiliation(s)
- Z M Khan
- The Medical School, University of Sheffield, Sheffield, UK
| | - V Kershaw
- Department of Obstetrics and Gynaecology, Jessop Wing, Sheffield Teaching Hospitals, Sheffield, UK
| | - P Madhuvrata
- Department of Obstetrics and Gynaecology, Jessop Wing, Sheffield Teaching Hospitals, Sheffield, UK
| | - S C Radley
- The Medical School, University of Sheffield, Sheffield, UK.,Department of Obstetrics and Gynaecology, Jessop Wing, Sheffield Teaching Hospitals, Sheffield, UK
| | - M E Connor
- Department of Obstetrics and Gynaecology, Jessop Wing, Sheffield Teaching Hospitals, Sheffield, UK
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Boekhorst F, Khattak H, Topcu EG, Horala A, Gonçalves Henriques M. The influence of the COVID-19 outbreak on European trainees in obstetrics and gynaecology: A survey of the impact on training and trainee. Eur J Obstet Gynecol Reprod Biol 2021; 261:52-58. [PMID: 33892209 PMCID: PMC8035806 DOI: 10.1016/j.ejogrb.2021.04.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/16/2021] [Accepted: 04/07/2021] [Indexed: 12/01/2022]
Abstract
Objective The purpose of this study is to evaluate how the obstetrics and gynaecology residency program and trainees have been affected by the Corona Virus Disease-19 (COVID-19) pandemic in Europe. Study Design This study is a cross-sectional explorative survey using an online questionnaire. The questionnaire comprised of 40 questions that were subdivided into 4 subjects; workload, specialist training aspects in obstetrics and gynaecology, health and safety of the trainee and women’s health and maternal health issues. Inclusion criteria consisted of being a trainee in Obstetrics and Gynaecology (ObGyn) at the time of the COVID-19 pandemic in Europe or trainees who had recently finished their training during the time of the outbreak. Taking part in the survey was voluntary. The questionnaire was shared on the website of the European Network for Trainees in Obstetrics and Gynaecology (ENTOG), ENTOG social media, in the ENTOG-newsletter and through the national representatives of ENTOG. Results 110 ObGyn trainees from 25 different countries responded to the questionnaire. Almost all trainees (95 %, N = 105) reported an effect on their training due to COVID-19 pandemic. Training was interrupted in 21 % of cases (n = 23). Trainees observed a decrease in educational activities or lectures and a decrease in number of patients. The possibility of training surgical skills decreased, because 67 % (N = 74) trainees reported that surgeries were cancelled. Trainees expressed concerns about reaching the goals of their ObGyn specialist training in 60 % (n = 66) of cases. A decrease in workload was experienced during the first COVID-19 wave in Europe by 60 % (n = 66) of trainees. On average these trainees worked 33 % less hours compared to a normal workweek. Although 22 % (n = 24) were expected to be available continuously for 24 h a day and 7 days a week for unscheduled duties, 15 % (n = 16) were deployed to work on special COVID-units. Concerning preparation, 45 % of the trainees (n = 50) had not received any training for treating COVID-positive patients. Trainees claimed to have enough personal protective equipment (PPE), although problems were reported. Any form of psychosocial support was arranged for 65 % of trainees (n = 71) by the hospital or department. The results of the survey suggest that obstetric care was not affected much (92 % (n = 102) of the respondents said at least necessary care continued) while patients in need for reproductive medicine were affected the most; out of the 110 departments 58 % (n = 60) were closed and 35 % (n = 36) reduced their activities. Access to family planning and benign gynaecology were also significantly reduced; 77 % and 87 % respectively of the departments were less accessible or only open to emergency cases. Conclusion COVID-19 pandemic has had a tremendous effect on the ObGyn training in Europe. Exposure to learning opportunities, surgeries and teaching has been decreased during the outbreak and may result in a decrease in quality of care provided to women in the future if impairment of training is not recovered.
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Affiliation(s)
- Ferry Boekhorst
- Haaglanden Medical Center, Lijnbaan 32, 2512VA, The Hague, The Netherlands.
| | - Hajra Khattak
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, B15 2TT, UK.
| | | | - Agnieszka Horala
- Gynecologic Oncology Department, Poznan University of Medical Sciences, 33 Polna Street, 60-535, Poznan, Poland.
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Sairally BZF, Clark TJ. Prioritisation of outpatient appointments and elective surgery in gynaecology. Best Pract Res Clin Obstet Gynaecol 2021; 73:2-11. [PMID: 33883091 DOI: 10.1016/j.bpobgyn.2021.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 03/09/2021] [Indexed: 11/27/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic continues to be a global public health concern. It has posed a multitude of challenges from managing the supply chain of personal protective equipment (PPE), reducing the spread of the virus through national restrictions, disrupting the routine delivery of healthcare services to now the race in developing novel treatments and vaccines. As the National Health Service (NHS) considers a phased restoration of non-emergency services, it is imperative to consider the high volume of patients awaiting specialist reviews and surgical procedures. Gynaecology services have to be prioritised according to the patients’ clinical needs rather than their individual waiting times. In this chapter, we look at the varying aspects of prioritising non-emergency gynaecology care, including outpatient appointments and elective surgery, how innovative pathways have evolved in response to necessity, what some of the barriers have been to implement these and how this has overall impacted on individual gynaecological specialties.
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Odejinmi F, Egbase E, Clark TJ, Mallick R. COVID-19 in Women's health reducing the risk of infection to patients and staff during acute and elective hospital admission for gynaecological surgery. Best Pract Res Clin Obstet Gynaecol 2021; 73:40-55. [PMID: 33879364 PMCID: PMC7970477 DOI: 10.1016/j.bpobgyn.2021.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/09/2021] [Indexed: 11/06/2022]
Abstract
The novel coronavirus SARS-Cov-2 has changed healthcare on a worldwide scale. This highly contagious respiratory virus has overwhelmed healthcare systems. Many staff were redeployed, and there was widespread cessation of non-urgent outpatient clinics and surgery. Outpatient clinics and theatre areas were converted to COVID-19 wards and intensive care units. Following the first peak, services began to recommence with new triaging and prioritisation guidance to safeguard patients and staff. Different countries and healthcare systems produced differing guidance and, in particular, variation in the best approach to continuing acute and elective surgical procedures. This chapter collates and evaluates the increasing international literature concerning the surgical management of gynaecological conditions during the pandemic, such that clear inferences, recommendations and guidance can be generated to aid clinical practice and safeguard against further major disruption arising from further COVID-19 peaks. The available data are assessed within the context of the current phase of the COVID-19 pandemic.
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Affiliation(s)
| | | | - T Justin Clark
- Department of Obstetrics and Gynaecology, Birmingham Women's and Children's Hospital, Birmingham, UK
| | - Rebecca Mallick
- Princess Royal Hospital, University Hospitals Sussex NHS Foundation Trust, Haywards Heath, UK.
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Leow HW, Koscielniak M, Williams L, Saunders PTK, Daniels J, Doust AM, Jones MC, Ferguson GD, Bagger Y, Horne AW, Whitaker LHR. Dichloroacetate as a possible treatment for endometriosis-associated pain: a single-arm open-label exploratory clinical trial (EPiC). Pilot Feasibility Stud 2021; 7:67. [PMID: 33712086 PMCID: PMC7953373 DOI: 10.1186/s40814-021-00797-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 02/15/2021] [Indexed: 01/31/2023] Open
Abstract
Background Endometriosis (where endometrial-like tissue is found outside the uterus) affects ~ 176 million women worldwide and can lead to debilitating pelvic pain. There is an unmet need for new medical treatment options for endometriosis. Pelvic peritoneal mesothelial cells of women with endometriosis exhibit detrimental metabolic reprogramming that creates an environment favouring the formation and survival of endometriosis lesions. We have generated powerful preclinical proof-of-concept data to show that it is possible to correct this metabolic phenotype using dichloroacetate (DCA), a non-hormonal compound previously used to treat rare metabolic disorders in children. We plan a single-arm, open-label, single site exploratory clinical trial to inform the design of a future randomised controlled trial (RCT) to determine the efficacy of DCA for the treatment of endometriosis-associated pain. Methods We will recruit 30 women with endometriosis-associated pain over a 6-month period. All participants will receive approximately 6.25 mg/kg oral DCA capsules twice daily for 6 weeks, with a dose increase to approximately 12.5 mg/kg twice daily for a further 6 weeks if their pain has not been adequately controlled on this dose regime and side-effects are acceptable. If pain is adequately controlled with minimal side-effects, the lower dose will be continued for a further 6 weeks. The primary objective is to determine whether it is possible to achieve acceptable recruitment and retention rates within the defined exclusion and inclusion criteria. Secondary objectives are to determine the acceptability of the trial to participants, including the proposed methods of recruitment, treatment, follow-up frequency and number of questionnaires. The recruitment rate will be determined by the proportion of patients recruited from the pool of eligible women. The retention rate will be determined by the proportion of participants who attended the final trial visit. Discussion This is a feasibility study to explore effectiveness and acceptability of the proposed field methodology (recruitment, retention, study processes and compliance with treatment). The results will be used to inform the design of a future RCT. Trial registration ClinicalTrials.gov, NCT04046081 Registered 6 August 2019
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Affiliation(s)
- H W Leow
- MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - M Koscielniak
- MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - L Williams
- Usher Institute, NINE Edinburgh BioQuarter, 9 Little France Road, Edinburgh, EH16 4UX, UK
| | - P T K Saunders
- Centre for Inflammation Research, Queen's Medical Research Institue, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - J Daniels
- Clinical Trials Unit, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - A M Doust
- MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - M-C Jones
- Institute of Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - G D Ferguson
- Reproductive Medicine and Maternal Health, Ferring Research Institute, San Diego, CA, 92121, USA
| | - Y Bagger
- Reproductive Medicine and Maternal Health, Ferring Research Institute, San Diego, CA, 92121, USA
| | - A W Horne
- MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK.
| | - L H R Whitaker
- MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
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Cheng SM, Chan JJI, Tan CW, Lu E, Sultana R, Sng BL. Use of wireless respiratory rate sensor monitoring during opioid patient-controlled analgesia after gynaecological surgery: A prospective cohort study. Indian J Anaesth 2021; 65:146-152. [PMID: 33776090 PMCID: PMC7983829 DOI: 10.4103/ija.ija_1262_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 10/23/2020] [Accepted: 01/19/2021] [Indexed: 11/30/2022] Open
Abstract
Background and Aims: Respiratory depression is a rare but serious complication during opioid administration. Therefore, early detection of signs of deterioration is paramount. The current standard of care of using manual intermittent respiratory rate (RR) measurement is labour intensive and inefficient. We evaluated a wireless sensor monitor, Aingeal (Renew Health Ltd, Ireland), to continuously monitor RR, heart rate (HR) and temperature compared to standard clinical measurements. Methods: Patients who underwent major gynaecological operations and received postoperative opioid patient-controlled analgesia were recruited. Patients were connected to the sensor monitor via a central station software platform. The primary outcome was comparison of RR between sensor and nursing monitoring, with secondary outcomes being HR and temperature between two methods. Feedback from patients and healthcare providers was also collected. Bland-Altman analyses were used to compare the vital signs recorded in sensor against those in patient's electronic record. Results: A total of 1121 hours of vital signs data were analysed. Bias for RR was -0.90 (95% confidence interval (CI): -9.39, 7.60) breaths/min between nursing and averaged sensor readings. Bias for heart rate was -1.12 (95% CI: -26.27, 24.03) and bias for temperature was 1.45 (95% CI: -5.67, 2.76) between the two methods. Conclusion: There is satisfactory agreement of RR measurements, as well as HR and temperature measurements, by the wireless sensor monitor with standard clinical intermittent monitoring with overall good user experience.
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Affiliation(s)
- Shang-Ming Cheng
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore
| | - Jason Ju In Chan
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore.,Anaesthesiology and Perioperative Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Chin Wen Tan
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore.,Anaesthesiology and Perioperative Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Enhong Lu
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore
| | - Rehena Sultana
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
| | - Ban Leong Sng
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore.,Anaesthesiology and Perioperative Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
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Mahmud A, Smith P, Clark TJ. Benchmarking services in outpatient hysteroscopy (OPH): A quality improvement project. Eur J Obstet Gynecol Reprod Biol 2021; 259:211-221. [PMID: 33573857 DOI: 10.1016/j.ejogrb.2021.01.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/02/2020] [Accepted: 01/18/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To develop a survey evaluating women's experience of outpatient hysteroscopy (OPH) to generate data to benchmark OPH practice in the UK that can be used to optimise women's experience of OPH and improve services. DESIGN Quality improvement project and a population-based national survey. SETTING 77 hospitals with outpatient hysteroscopy (OPH) services across the UK collected data over two month-period (October-November 2019). POPULATION 5151 women attending for outpatient hysteroscopy. METHODS A new OPH-Patient Satisfaction Survey (OPH-PSS) was developed using a multi-disciplinary approach. Good practice guidance in hysteroscopy and existing survey's provided content for the survey. Pilot testing identified aspects of the women's OPH journey that contributed to a final survey. The final OPH-PSS was rolled out nationally to generate data for benchmarking OPH services. MAIN OUTCOME VARIABLE The adequacy of OPH services reflected in women's experience of their OPH journey and the quality of care being delivered. RESULTS The majority (3193, 76 %) of hysteroscopic procedures were recorded as diagnostic. Most (4485, 87 %) women received adequate information regarding their OPH. 4581, 89 % of women agreed that they were given an opportunity to discuss analgesia and 5033, 97 % of women felt involved in their care. As regards patient experience, although pain was reported by most women (4490, 87 %), just over half considered the degree of pain as slight. While (787, 15 %) felt pain throughout their OPH with 1 in 10 women feeling anxious. Although, 1217 (26 %) women experienced feeling faint most only felt this slightly. Overall, more than 90 % (4867) of women considered the OPH service good. The mean score rating for the overall level of care was considerably high (9.7/10). Comparative pain scores for OPH vs the worst pain felt during a menstrual period showed OPH procedures to be less painful except for endometrial ablation (P < 0.001). CONCLUSION This novel survey, evaluating women's experience of OPH (OPH-PSS), provides a useful tool for benchmarking performance across different OPH units. Overall, the information provided to women and their subsequent experience of OPH is good, but pain is common.
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Affiliation(s)
- Ayesha Mahmud
- Department of Obstetrics & Gynaecology, Royal Stoke University Hospital, Newcastle Rd, Stoke-on-Trent, ST4 6QG, UK.
| | - Paul Smith
- Department of Obstetrics & Gynaecology, Birmingham Women's & Children's NHS Foundation Trust, Mindelsohn Way, Birmingham, B15 2TG, UK; University of Birmingham, UK
| | - T Justin Clark
- Department of Obstetrics & Gynaecology, Birmingham Women's & Children's NHS Foundation Trust, Mindelsohn Way, Birmingham, B15 2TG, UK; University of Birmingham, UK
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47
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Pannecoeck K, Tummers P, De Visschere P. Cervical Adenoma Malignum in Third Trimester Pregnancy. J Belg Soc Radiol 2021; 105:2. [PMID: 33506174 DOI: 10.5334/jbsr.2298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Teaching Point: Adenoma malignum is a rare, non-HPV associated subtype of mucinous adenocarcinoma of the cervix, of which we present an exceptional case that was discovered during the third trimester of pregnancy.
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48
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Zimmerman E, Martins NN, Verheijen RHM, Mahmood T. EBCOG position statement - Simulation-based training for obstetrics and gynaecology during the COVID-19 pandemic. Eur J Obstet Gynecol Reprod Biol 2020; 258:457-458. [PMID: 33518409 DOI: 10.1016/j.ejogrb.2020.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 12/04/2020] [Indexed: 11/30/2022]
Abstract
The specialty of Obstetrics and Gynaecology has been on the forefront of introducing simulation in post graduate education for the past two decades. Simulation training is known to enhance psychomotor skills and is considered an important step in the transition from classroom learning to clinical practice. Training on simulators allows trainees to acquire basic skills before getting involved in day to day care in real life situations. Clinical circumstances around the COVID 19 pandemic have highlighted the key importance of simulation training in delivering post graduate curriculum.
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Affiliation(s)
- Erin Zimmerman
- Product Communication Specialist, VirtaMed, Inc. Lithia, FL, United States.
| | - Nuno N Martins
- EBCOG Standing Committee on Training Recognition, Department of Obstetrics and Gynaecology, Centro Hospitalar Tondela, Viseu, Portugal.
| | - René H M Verheijen
- Formerly Dept. of Gynaecological Oncology, Cancer Centre, University Medical Centre Utrecht, the Netherlands; EBCOG Standards of Care and Position Statements Group, United Kingdom.
| | - Tahir Mahmood
- Victoria Hospital, Kirkcaldy, Scotland, United Kingdom; EBCOG Standards of Care and Position Statements Group, United Kingdom.
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49
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Issaoui M, Miloro P, Balandraud X, Rivens I, Grédiac M, Blaysat B, Ouchchane L, Delabaere A, Sauvant-Rochat MP, Lemery D. Temperature Elevation in an Instrumented Phantom Insonated by B-Mode Imaging, Pulse Doppler and Shear Wave Elastography. Ultrasound Med Biol 2020; 46:3317-3326. [PMID: 32962891 DOI: 10.1016/j.ultrasmedbio.2020.08.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 08/19/2020] [Accepted: 08/21/2020] [Indexed: 06/11/2023]
Abstract
Diagnostic ultrasound is the gold standard for obstetric scanning and one of the most important imaging techniques for perinatal and neonatal monitoring and diagnosis. Ultrasound provides detailed real-time anatomic information, including blood flow measurements and tissue elasticity. The latter is provided through various techniques including shear wave elastography (SWE). SWE is increasingly used in many areas of medicine, especially in detection and diagnosis of breast, thyroid and prostate cancers and liver disease. More recently, SWE has found application in gynaecology and obstetrics. This method mimics manual palpation, revealing the elastic properties of soft biological tissues. Despite its rising potential and expanding clinical interest in its use in obstetrics and gynaecology (such as for assessment of cervical ripening or organ development and structure during pregnancy), its effects on and potential risks to the developing fetus remain unknown. Risks should be evaluated by regulatory bodies before recommendations are made on the use of SWE. Because ultrasound is known to produce thermal and mechanical effects, this study measured the temperature increase caused by B-mode, pulse Doppler (PD) and SWE, using an instrumented phantom with 11 embedded thermocouples. Experiments were performed with an Aixplorer diagnostic ultrasound system (Supersonic Imagine, Aix-en-Provence, France). As expected, the greatest heating was detected by the thermocouple closest to the surface in contact with the transducer (2.9°C for SWE, 1.2°C for PD, 0.7°C for B-mode after 380-s excitation). Both conduction from the transducer face and direct heating owing to ultrasound waves contribute to temperature increase in the phantom with SWE associated with a larger temperature increase than PD and B-mode. This article offers a methodological approach and reference data for future safety studies, as well as initial recommendations about SWE safety in obstetrics and gynaecology.
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Affiliation(s)
- Maha Issaoui
- Université Clermont Auvergne, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France.
| | - Piero Miloro
- Ultrasound and Underwater Acoustics, National Physical Laboratory, Teddington, UK
| | - Xavier Balandraud
- Université Clermont Auvergne, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
| | - Ian Rivens
- Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - Michel Grédiac
- Université Clermont Auvergne, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
| | - Benoit Blaysat
- Université Clermont Auvergne, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
| | - Lemlih Ouchchane
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France; Département de Santé Publique, Unité de Biostatistique et Informatique Médicale, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Amélie Delabaere
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France; Pôle Femme et Enfant, CHU de Clermont-FerrandClermont-Ferrand, France
| | - Marie-Pierre Sauvant-Rochat
- Université Clermont Auvergne, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France; Département de Santé Publique et Environnement, Université Clermont-Auvergne, UFR Pharmacie, Clermont-Ferrand, France
| | - Didier Lemery
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France; Pôle Femme et Enfant, CHU de Clermont-FerrandClermont-Ferrand, France
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50
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Ahmed SM, Sundby J, Aragaw YA, Nordeng H. Medication-related problems among hospitalized pregnant women in a tertiary teaching hospital in Ethiopia: a prospective observational study. BMC Pregnancy Childbirth 2020; 20:737. [PMID: 33243156 PMCID: PMC7690074 DOI: 10.1186/s12884-020-03433-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 11/17/2020] [Indexed: 12/05/2022] Open
Abstract
Background Studies on medication-related problems (MRPs) among pregnant women are scarce, despite the potential consequences for both mother and child. This study aimed to describe the prevalence, clinical significance, and risk factors for MRPs among hospitalized pregnant or postpartum women at Jimma University Medical Centre (JUMC) in Ethiopia. Methods A prospective follow-up and clinical audit of 1117 hospitalized pregnant or postpartum women in the maternity and gynaecology wards at JUMC was carried out between February and June 2017. Patients were followed throughout their stay in the hospital to assess the presence and development of MRPs. Pre-tested data extraction form and an interview-guided structured questionnaire were used to collect data. Descriptive statistics were used to describe MRPs. Logistic regression analysis was used to identify factors associated with MRPs. Results One or more MRPs occurred among 323 (28.9%) study participants, mostly in relation to lack of iron supplementation. A total of 278 (70.6%) of all MRPs were considered to be of moderate to high clinical significance. When excluding MRPs due to iron from the analysis, chronic disease (adjusted OR 1.91; 95% CI 1.02, 3.58), medication use prior to admission (adjusted OR 2.38; 95% CI 1.24, 4.56), nulliparity (adjusted OR 1.99; 95% CI 1.22, 3.24) and multiparity (adjusted OR 1.91; 95% CI 1.17, 3.12) were significantly associated with experiencing an MRP. Conclusions Nearly 3 out of 10 hospitalized pregnant women at JUMC had one or more MRPs. The need for additional iron therapy was by far the most common type of MRP. Improved adherence to guidelines on iron supplementation are required. Multidisciplinary approaches including physicians, nurses, anesthesia professionals and clinical pharmacists in the maternity and gynaecology wards could possibly prevent MRPs and promote patient safety for women and children. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-020-03433-6.
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Affiliation(s)
- Seid Mussa Ahmed
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway. .,Division of Social and Administrative Pharmacy, School of Pharmacy, Faculty of Health Sciences, Jimma Institute of Health, Jimma University, Jimma, Ethiopia.
| | - Johanne Sundby
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Yesuf Ahmed Aragaw
- Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, Jimma Institute of Health, Jimma University, Jimma, Ethiopia
| | - Hedvig Nordeng
- Pharmacoepidemiology and Drug Safety Research Group, Department of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway.,Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
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