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1.
Gynecol Endocrinol ; 40(1): 2396628, 2024 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-39217621

RESUMO

BACKGROUND: The aim was to conduct a benchmark pilot study to find the best practice for consultation hours in the field of gynecological endocrinology. Suitable benchmarking participants were found in China, Germany, Greece, and Switzerland. Specifically, the study aimed to find the most time-efficient and beneficial consultation type in gynecological endocrinology focused on menopause and whether a shorter face-to-face consultation correlates with lower patient satisfaction. METHODS: This was an observational study. To analyze the processes of all benchmarking participants three tools were used: a measurement of time needed for the different consultation types, a questionnaire for patients and one for physicians. The primary endpoint was the time measurement of first consultations. Secondary endpoints were the time measurements of follow-up consultations and phone consultations and patient satisfaction. RESULTS: The mean overall duration of a first consultation differed from 20.4 min to 39.7 min (p = 0.003), mainly based on differences of the mean time to acquire the patient history, 5.6 to 21.6 min (p < 0.001). The percentage of patients who felt they had enough time to discuss questions ranged from 70% to 100% (p < 0.001). The percentage of patients who felt fully understood by their physician ranged from 62.5% to 92% (p = 0.006). The duration of a first consultation did not correlate with patients feeling well consulted (r=-0.048, p = 0.557). CONCLUSIONS: A concise patient history that concentrates on the most relevant points can reduce the total consultation time. Reducing consultation time can be made without compromising how well patients feel consulted.


Assuntos
Endocrinologia , Ginecologia , Satisfação do Paciente , Encaminhamento e Consulta , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Benchmarking , Endocrinologia/organização & administração , Endocrinologia/normas , Ginecologia/organização & administração , Ginecologia/normas , Satisfação do Paciente/estatística & dados numéricos , Relações Médico-Paciente , Projetos Piloto , Encaminhamento e Consulta/organização & administração , Encaminhamento e Consulta/normas , Encaminhamento e Consulta/estatística & dados numéricos , Inquéritos e Questionários , Fatores de Tempo
2.
Wiad Lek ; 77(5): 971-979, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39008585

RESUMO

OBJECTIVE: Aim: Development of an algorithm of management actions for the formation of a resilient system of quality of medical care in health care institutions of obstetric and gynecological profile and formalization of its closed structural and logical scheme. PATIENTS AND METHODS: Materials and Methods: A set of theoretical approaches of social medicine and methods of business process reengineering is used, taking into account the dominant ones: systemic and integrated approach and alarm and process approaches; the concept of resilience; quality of medical care; reproductive health care using business ecosystem methods. RESULTS: Results: The algorithm of management actions for the formation of a resilient system of quality of medical care in obstetric and gynecological health care institutions, which is formalized in nine stages: analysis of needs and identification of problems; substantiation of performance requirements; development of a health care quality strategy; involvement of stakeholders; formation of a system of relative indicators; development of an action plan; implementation of a set of measures; monitoring and evaluation; improving the quality of health care. CONCLUSION: Conclusions: The results made it possible: construction of a closed structural and logical scheme of management actions, taking into account the combination of factors of influence, harmonized with the main functions of the resilient system, which determine the peculiarities of its functioning; justification of the boundaries of managerial and social responsibility of management entities according to the binary components of the medical and social justification of the process of improving the quality of medical care.


Assuntos
Algoritmos , Qualidade da Assistência à Saúde , Humanos , Atenção à Saúde/normas , Atenção à Saúde/organização & administração , Ginecologia/organização & administração , Ginecologia/normas , Obstetrícia/normas , Obstetrícia/organização & administração , Feminino
3.
Eur J Obstet Gynecol Reprod Biol ; 300: 49-53, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-38986272

RESUMO

In an epoch where digital innovation is redefining the medical landscape, electronic health records (EHRs) stand out as a pivotal transformative force. Urogynecology, a discipline anchored in intricate patient histories and meticulous follow-ups, is on the brink of profound transformation due to these digital strides. While EHRs have unified patient data, challenges related to data privacy, interoperability, and access persist. In response, we present Pelvic Health Place (PHPlace) - a multilingual, patient-centric application. Purposefully designed to bolster patient engagement, PHPlace provides clinicians with essential pre-consultation insights, streamlines the consent process, vividly delineates surgical pathways, and assures comprehensive long-term monitoring. This platform also establishes a foundation for global data amalgamation, promising to invigorate research and potentially harness artificial intelligence (AI) capabilities. With AI integration, we anticipate a more tailored treatment approach and enriched patient education, signaling a pivotal shift in urogynecology and emphasizing the imperative for ongoing academic inquiry.


Assuntos
Registros Eletrônicos de Saúde , Ginecologia , Aprendizado de Máquina , Urologia , Feminino , Humanos , Registros Eletrônicos de Saúde/organização & administração , Registros Eletrônicos de Saúde/tendências , Ginecologia/organização & administração , Ginecologia/tendências , Aprendizado de Máquina/tendências , Assistência Centrada no Paciente/organização & administração , Assistência Centrada no Paciente/tendências , Urologia/organização & administração
4.
Clin Obstet Gynecol ; 67(3): 531-538, 2024 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-38666712

RESUMO

Gender inequity persists in academic medicine. This article reviews the historical context, ongoing leadership challenges, and societal biases. The persistent barriers to gender equity in leadership roles, pay, and professional recognition are considered through the lens of obstetrics and gynecology where these issues persist despite a significant presence of women in the field. The impact of gender stereotypes, the role of intersectionality, and the need for systemic change are evident. Embracing diverse leadership styles and creating inclusive pathways to leadership will help actualize the potential benefits of a gender-diverse workforce, enhancing health care outcomes and fostering innovation.


Assuntos
Ginecologia , Liderança , Obstetrícia , Humanos , Obstetrícia/organização & administração , Ginecologia/organização & administração , Feminino , Equidade de Gênero , Masculino , Sexismo , Médicas
5.
Clin Obstet Gynecol ; 66(1): 14-21, 2023 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-36657044

RESUMO

As Obstetrics and Gynecology begins to recognize how structural racism drives inequitable health outcomes, it must also acknowledge the effects of structural racism on its workforce and culture. Black physicians comprise ~5% of the United States physician population. Unique adversities affect Black women physicians, particularly during residency training, and contribute to the lack of equitable workforce representation. Eliminating racialized inequities in clinical care requires addressing these concerns. By applying historical context to present-day realities and harms experienced by Black women (ie, misogynoir), Obstetrics and Gynecology can identify interventions, such as equity-focused recruitment and retention strategies, that transform the profession.


Assuntos
Ginecologia , Equidade em Saúde , Obstetrícia , Feminino , Humanos , Negro ou Afro-Americano/psicologia , Negro ou Afro-Americano/estatística & dados numéricos , Ginecologia/educação , Ginecologia/organização & administração , Equidade em Saúde/organização & administração , Disparidades nos Níveis de Saúde , Mão de Obra em Saúde/organização & administração , Disparidades em Assistência à Saúde/etnologia , Internato e Residência , Obstetrícia/educação , Obstetrícia/organização & administração , Cultura Organizacional , Médicas/psicologia , Profissionalismo , Racismo/prevenção & controle , Estados Unidos
7.
Pan Afr Med J ; 38: 15, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34567342

RESUMO

Having to cope with corona virus disease 2019 (COVID-19) is likely to create imbalances in health care provision in the obstetrics and gynecology practices in Africa where most countries still battle with high rate of maternal morbidities and mortalities as well as poor or inadequate quality gynecological care. COVID-19 has spread to the continents of the world including all African nations since it was first reported in Wuhan, China in December 2019. Its impact and implications on the obstetrics and gynecology practice in Africa are yet to be fully explored. Routine essential services are being disrupted; therefore, giving rise to the need to redeploy the already limited health personnel across health services in Africa. This is an attempt to discuss the potential implications for obstetrics and gynecologic practice in Africa.


Assuntos
COVID-19 , Ginecologia/organização & administração , Obstetrícia/organização & administração , África , Atenção à Saúde/organização & administração , Atenção à Saúde/normas , Feminino , Ginecologia/normas , Pessoal de Saúde/organização & administração , Humanos , Obstetrícia/normas , Gravidez , Qualidade da Assistência à Saúde
8.
Int J Gynecol Cancer ; 31(11): 1453-1458, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34489352

RESUMO

OBJECTIVES: Twitter is the most frequently used social media platform by healthcare practitioners, at medical conferences. This study aimed to analyze Twitter conversations during the virtual International Gynecological Cancer Society 2020 conference to understand the interactions between Twitter users related to the conference. METHODS: Tweets using the hashtag '#IGCS2020' were searched using the Twitter Search Application Programming Interface (API) during the period 10-13 September 2020. NodeXL Pro was used to retrieve data. The Clauset-Newman-Moore cluster algorithm clustered users into different groups or 'clusters' based on how users interacted. RESULTS: There were 2009 registrants for the virtual IGCS 2020 conference. The total number of users within the network was 168, and there were 880 edges connecting users. Five types of edges were identified as follows: 'replies to' (n=18), 'mentions' (n=221), 'mentions in retweets' (n=375), retweets (n=198), and tweets (n=68). The most influential account was that of the IGCS account itself (@IGCSociety). The overall network shape resembled a community where distinct groups formed within the network. Our current analyses demonstrated that less than 10% of the total members interacted on Twitter. CONCLUSION: This study identified the most influential Twitter users within the '#IGCS2020' community. he results also confirmed the community network shape of the #IGCS2020 hashtag and found that the most frequent co-related words were 'ovarian' and 'cancer' (n=39).


Assuntos
Ginecologia/organização & administração , Oncologia/organização & administração , Mídias Sociais/estatística & dados numéricos , Congressos como Assunto , Humanos , Sociedades Médicas
9.
J Gynecol Obstet Hum Reprod ; 50(10): 102206, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34391952

RESUMO

OBJECTIVE: To provide guidelines from the French College of Obstetricians and Gynecologists (CNGOF), based on the best currently available evidence, for the prophylactic procedures associated with gynecological surgery for benign disease such as superficial endometriosis lesions and adhesions. METHODS: The CNGOF has decided to adopt the AGREE II and GRADE systems for grading scientific evidence. Each recommendation for practice was allocated a grade that reflects the quality of evidence (QE) (clinical practice guidelines). RESULTS: Endometriosis and pelvic pain Superficial endometriosis can be entirely asymptomatic. Surgical treatment of asymptomatic superficial peritoneal endometriosis is not recommended in women of childbearing age for the prevention of pelvic pain, especially in case of proximity to noble organs (e.g., the ureters, rectum and sigmoid, and ovaries in nulligravida) as there is no evidence that the disease will progress to become symptomatic (low level of evidence). In case of accidental discovery of superficial endometriosis in women of childbearing age with pelvic pain, it is recommended that the lesions are excised, if surgically accessible. Removal of superficial endometriosis lesions in patients with painful symptoms improves quality of life and pain (low level of evidence). Endometriosis and infertility It appears that women with isolated superficial endometriosis diagnosed by laparoscopy with histological confirmation have a significantly higher incidence of primary infertility than patients without endometriosis. However, there is no data regarding the impact of treatment of these lesions on the fertility in these women or on the natural course of their disease (low level of evidence). It is recommended that excision is performed rather than monopolar coagulation of superficial endometriosis lesions in infertile women, as this results in a higher spontaneous pregnancy rate (low level of evidence). Adhesions and pelvic pain There is limited data in the literature regarding the benefit of performing systematic adhesiolysis during laparoscopy to prevent pelvic pain when incidental pelvic adhesions are discovered. For patients with pelvic pain, it is probably better not to perform adhesiolysis to prevent pelvic pain, although this can be decided on a case-by-case basis depending on the extent of the adhesions, the topography, and the type of surgery considered (low level of evidence). For asymptomatic patients, it is recommended not to perform adhesiolysis to prevent pelvic pain due to the lack of clear efficacy both short- or long-term and due to the increased risk of surgical injuries (low level of evidence). Adhesions and infertility There is limited data in the literature regarding the potential benefit of performing systematic adhesiolysis when there is an incidental discovery of pelvic adhesions during laparoscopy to prevent infertility. For infertile women, in the event of fortuitous discovery of adhesions at laparoscopy, it is probably better not to perform complex adhesiolysis. Only adhesiolysis of tubo-ovarian adhesions that are minimal or slight in terms of their extension and/or their nature may be useful to improve the chances of spontaneous pregnancy. However, it remains to be decided on a case-by-case basis depending on other potential causes of infertility (low level of evidence). For women without known infertility issues, it is probably better not to perform systematic adhesiolysis in order to improve their pregnancy chances, considering the balance between the unknown benefit and the risks of complications inherent to surgery (low level of evidence). CONCLUSION: Further investigations are needed in order to increase the quality of management regarding associated interventions such as the treatment of superficial endometriosis or adhesions performed during a gynecologic surgical procedure and, thereby, bolster these recommendations.


Assuntos
Endometriose/cirurgia , Guias como Assunto , Procedimentos Cirúrgicos em Ginecologia/métodos , Aderências Teciduais/prevenção & controle , Adulto , Endometriose/complicações , Feminino , França , Procedimentos Cirúrgicos em Ginecologia/normas , Procedimentos Cirúrgicos em Ginecologia/tendências , Ginecologia/métodos , Ginecologia/organização & administração , Ginecologia/tendências , Humanos , Gravidez , Aderências Teciduais/etiologia , Aderências Teciduais/cirurgia
10.
J Gynecol Obstet Hum Reprod ; 50(10): 102188, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34166864

RESUMO

OBJECTIVE: To provide guidelines from the French College of Obstetricians and Gynaecologists (CNGOF), based on the best evidence available, concerning the impact of endometrial destruction on bleeding and endometrial cancer risk reduction in patients candidates for operative hysteroscopy. METHODS: Recommendations were made according to AGREE II and the GRADE® (Grading of Recommendations Assessment, Development and Evaluation) systems to determine separately the quality of evidence (QE) and in the level of recommendation. RESULTS: In a retrospective study comparing the incidence of endometrial cancer in 4776 patients with menorrhagia treated with endometrial destruction vs 229 945 patients with a medical treatment. There was a non-significant reduced risk of developing endometrial cancer (HR, 0.45; 95% CI, 0.15-1.40; p = .17). In premenopausal women, five studies compared the incidence of endometrial cancer in patients treated with endometrial ablation/destruction (EA/D) to the incidence of endometrial cancer in a comparable population of women from national registers, all of which show reduced risk of endometrial cancer after endometrectomy. In case of menopausal metrorrhagia, the prevalence of endometrial cancer is 9%, by analogy with the results found in premenopausal patients, the combination of endometrial ablation during operative hysteroscopy seems justified. In a retrospective cohort of 177 non-menopausal patients treated with myomectomy for metrorrhagia and/or menorrhagia, a significantly better control of bleeding at 12 months was found when myomectomy was combined with endometrectomy using roller-ball (OR: 0.18 [95% Cl 0.05-0.63]; p = 0.003). CONCLUSION: In premenopausal women with heavy menstrual bleeding, when an operative hysteroscopy is performed, it is recommended to propose an endometrial ablation/destruction in order to prevent the risk of endometrial cancer, (QE3) and to prevent recurrence of bleeding (QE2). In menopausal women, it is probably recommended to also perform an endometrial ablation/destruction in case of operative hysteroscopy in order to prevent the risk of endometrial cancer (QE1).


Assuntos
Técnicas de Ablação Endometrial/métodos , Guias como Assunto , Ginecologia/métodos , Histerectomia/métodos , Adulto , Técnicas de Ablação Endometrial/instrumentação , Técnicas de Ablação Endometrial/normas , Endométrio/cirurgia , Feminino , França , Ginecologia/organização & administração , Ginecologia/tendências , Humanos , Histerectomia/tendências , Pessoa de Meia-Idade , Estudos Retrospectivos
11.
Gynecol Oncol ; 162(1): 12-17, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33941382

RESUMO

OBJECTIVE: To compare gynecologic oncology surgical treatment modifications and delays during the first wave of the COVID-19 pandemic between a publicly funded Canadian versus a privately funded American cancer center. METHODS: This is a retrospective cohort study of all planned gynecologic oncology surgeries at University Health Network (UHN) in Toronto, Canada and Brigham and Women's Hospital (BWH) in Boston, USA, between March 22,020 and July 302,020. Surgical treatment delays and modifications at both centers were compared to standard recommendations. Multivariable logistic regression was performed to adjust for confounders. RESULTS: A total of 450 surgical gynecologic oncology patients were included; 215 at UHN and 235 at BWH. There was a significant difference in median time from decision-to-treat to treatment (23 vs 15 days, p < 0.01) between UHN and BWH and a significant difference in treatment delays (32.56% vs 18.29%; p < 0.01) and modifications (8.37% vs 0.85%; p < 0.01), respectively. On multivariable analysis adjusting for age, race, treatment site and surgical priority status, treatment at UHN was an independent predictor of treatment modification (OR = 9.43,95% CI 1.81-49.05, p < 0.01). Treatment delays were higher at UHN (OR = 1.96,95% CI 1.14-3.36 p = 0.03) and for uterine disease (OR = 2.43, 95% CI 1.11-5.33, p = 0.03). CONCLUSION: During the first wave of COVID-19 pandemic, gynecologic oncology patients treated at a publicly funded Canadian center were 9.43 times more likely to have a surgical treatment modification and 1.96 times more likely to have a surgical delay compared to an equal volume privately funded center in the United States.


Assuntos
Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Neoplasias dos Genitais Femininos/cirurgia , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Tempo para o Tratamento/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/epidemiologia , COVID-19/prevenção & controle , COVID-19/transmissão , Canadá/epidemiologia , Institutos de Câncer/organização & administração , Institutos de Câncer/normas , Institutos de Câncer/estatística & dados numéricos , Controle de Doenças Transmissíveis/normas , Feminino , Neoplasias dos Genitais Femininos/diagnóstico , Procedimentos Cirúrgicos em Ginecologia/estatística & dados numéricos , Ginecologia/economia , Ginecologia/organização & administração , Ginecologia/normas , Ginecologia/estatística & dados numéricos , Hospitais Privados/economia , Hospitais Privados/organização & administração , Hospitais Privados/normas , Hospitais Públicos/economia , Hospitais Públicos/organização & administração , Hospitais Públicos/normas , Humanos , Oncologia/economia , Oncologia/organização & administração , Oncologia/normas , Oncologia/estatística & dados numéricos , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Estudos Retrospectivos , Centros de Atenção Terciária/economia , Centros de Atenção Terciária/organização & administração , Centros de Atenção Terciária/normas , Centros de Atenção Terciária/estatística & dados numéricos , Fatores de Tempo , Triagem/estatística & dados numéricos , Estados Unidos/epidemiologia , Adulto Jovem
12.
Gynecol Oncol ; 162(1): 4-11, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33994014

RESUMO

OBJECTIVE: The COVID-19 pandemic has quickly transformed healthcare systems with expansion of telemedicine. The past year has highlighted risks to immunosuppressed cancer patients and shown the need for health equity among vulnerable groups. In this study, we describe the utilization of virtual visits by patients with gynecologic malignancies and assess their social vulnerability. METHODS: Virtual visit data of 270 gynecology oncology patients at a single institution from March 1, 2020 to August 31, 2020 was obtained by querying a cohort discovery tool. Through geocoding, the CDC Social Vulnerability Index (SVI) was utilized to assign social vulnerability indices to each patient and the results were analyzed for trends and statistical significance. RESULTS: African American patients were the most vulnerable with a median SVI of 0.71, Asian 0.60, Hispanic 0.41, and Caucasian 0.21. Eighty-seven percent of patients in this study were Caucasian, 8.9% African American, 3.3% Hispanic, and 1.1% Asian, which is comparable to the baseline institutional gynecologic cancer population. The mean census tract SVI variable when comparing patients to all census tracts in the United States was 0.31 (range 0.00 least vulnerable to 0.98 most vulnerable). CONCLUSIONS: Virtual visits were utilized by patients of all ages and gynecologic cancer types. African Americans were the most socially vulnerable patients of the cohort. Telemedicine is a useful platform for cancer care across the social vulnerability spectrum during the pandemic and beyond. To ensure continued access, further research and outreach efforts are needed.


Assuntos
COVID-19/prevenção & controle , Neoplasias dos Genitais Femininos/terapia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Telemedicina/estatística & dados numéricos , Populações Vulneráveis/estatística & dados numéricos , Negro ou Afro-Americano/estatística & dados numéricos , Idoso , Asiático/estatística & dados numéricos , COVID-19/epidemiologia , COVID-19/transmissão , Estudos de Coortes , Controle de Doenças Transmissíveis/normas , Feminino , Neoplasias dos Genitais Femininos/diagnóstico , Ginecologia/organização & administração , Ginecologia/normas , Ginecologia/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Hispânico ou Latino/estatística & dados numéricos , Humanos , Oncologia/organização & administração , Oncologia/normas , Oncologia/estatística & dados numéricos , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Fatores Socioeconômicos , Telemedicina/organização & administração , Telemedicina/normas , Estados Unidos/epidemiologia , População Branca/estatística & dados numéricos
13.
J Gynecol Obstet Hum Reprod ; 50(8): 102134, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33794370

RESUMO

OBJECTIVE: To provide guidelines from the French College of Obstetricians and Gynecologists (CNGOF), based on the best evidence available, concerning subtotal or total hysterectomy, for benign disease. METHODS: The CNGOF has decided to adopt the AGREE II and GRADE systems for grading scientific evidence. Each recommendation for practice was allocated a grade, which depends on the quality of evidence (QE) (clinical practice guidelines). RESULTS: Conservation of the uterine cervix is associated with an increased risk of cervical cancer (0.05 to 0.27%) and an increased risk of reoperation for cervical bleeding (QE: high). Uterine cervix removal is associated with a moderate (about 11 min) increase in operative time when hysterectomy is performed by the open abdominal route (laparotomy), but is not associated with longer operative time when the hysterectomy is performed by laparoscopy (QE: moderate). Removal of the uterine cervix is not associated with increased prevalence of short-term follow-up complications (blood transfusion, ureteral or bladder injury) (QE: low) or of long-term follow-up complications (pelvic organ prolapse, sexual disorders, urinary incontinence (QE: moderate). CONCLUSION: Removal of the uterine cervix is recommended for hysterectomy in women presenting with benign uterine disease (Recommendation: STRONG [GRADE 1-]; the level of evidence was considered to be sufficient and the risk-benefit balance was considered to be favorable).


Assuntos
Colo do Útero/cirurgia , Tratamento Conservador/normas , Guias como Assunto , Histerectomia/métodos , Idoso , Colo do Útero/fisiopatologia , Tratamento Conservador/métodos , Tratamento Conservador/estatística & dados numéricos , Feminino , França/epidemiologia , Ginecologia/organização & administração , Ginecologia/tendências , Humanos , Histerectomia/tendências , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/cirurgia
14.
Gynecol Oncol ; 162(1): 203-209, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33722417

RESUMO

The GOG Foundation, Inc. (GOG-F) is a non-profit 501(c)(3) organization with the purpose of promoting excellence in the quality and integrity of clinical and basic scientific research in the field of gynecologic malignancies. GOG Partners (GOG-P) is a program of the GOG-F and is positioned alongside NRG Oncology under the GOG-F organizational umbrella. GOG-P operates outside of the federally funded NCI NRG Oncology, a key distinguishing feature. By functioning as a site management organization (SMO), GOG-P provides an additional platform for clinical trial development, mentorship opportunities, patient accrual, and site infrastructure support yielding an expanded gynecologic oncology clinical trials infrastructure in the US. GOG-P has a consistent track record of conducting high quality clinical trials that lead to bringing novel FDA approved treatments for gynecologic cancer. This manuscript summarizes the history and organizational structure of the GOG-P. In addition, we outline the other key supportive programs within the GOG-F that help support the GOG-P effort to perform transformative gynecologic cancer research.


Assuntos
Ensaios Clínicos como Assunto/organização & administração , Indústria Farmacêutica/organização & administração , Neoplasias dos Genitais Femininos/terapia , Ginecologia/organização & administração , Oncologia/organização & administração , Ensaios Clínicos como Assunto/métodos , Feminino , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
17.
J Minim Invasive Gynecol ; 28(2): 179-203, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-32827721

RESUMO

This is the first Enhanced Recovery After Surgery (ERAS) guideline dedicated to standardizing and optimizing perioperative care for women undergoing minimally invasive gynecologic surgery. The guideline was rigorously formulated by an American Association of Gynecologic Laparoscopists Task Force of US and Canadian gynecologic surgeons with special interest and experience in adapting ERAS practices for patients requiring minimally invasive gynecologic surgery. It builds on the 2016 ERAS Society recommendations for perioperative care in gynecologic/oncologic surgery by serving as a more comprehensive reference for minimally invasive endoscopic and vaginal surgery for both benign and malignant gynecologic conditions. For example, the section on preoperative optimization provides more specific recommendations derived from the ambulatory surgery and anesthesia literature for the management of anemia, hyperglycemia, and obstructive sleep apnea. Recommendations pertaining to multimodal analgesia account for the recent Food and Drug Administration warnings about respiratory depression from gabapentinoids. The guideline focuses on workflows important to high-value care in minimally invasive surgery, such as same-day discharge, and tackles controversial issues in minimally invasive surgery, such as thromboprophylaxis. In these ways, the guideline supports the American Association of Gynecologic Laparoscopists and our collective mission to elevate the quality and safety of healthcare for women through excellence in clinical practice.


Assuntos
Recuperação Pós-Cirúrgica Melhorada/normas , Doenças dos Genitais Femininos/cirurgia , Procedimentos Cirúrgicos em Ginecologia/reabilitação , Procedimentos Cirúrgicos em Ginecologia/normas , Procedimentos Cirúrgicos Minimamente Invasivos/reabilitação , Procedimentos Cirúrgicos Ambulatórios/métodos , Procedimentos Cirúrgicos Ambulatórios/reabilitação , Procedimentos Cirúrgicos Ambulatórios/normas , Anestesia/métodos , Anestesia/normas , Anticoagulantes/uso terapêutico , Consenso , Aconselhamento Diretivo/métodos , Aconselhamento Diretivo/normas , Feminino , Doenças dos Genitais Femininos/reabilitação , Procedimentos Cirúrgicos em Ginecologia/métodos , Ginecologia/organização & administração , Ginecologia/normas , Humanos , Laparoscopia/métodos , Laparoscopia/reabilitação , Laparoscopia/normas , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/normas , Alta do Paciente/normas , Educação de Pacientes como Assunto/métodos , Educação de Pacientes como Assunto/normas , Assistência Perioperatória/métodos , Assistência Perioperatória/normas , Período Pré-Operatório , Sociedades Médicas/organização & administração , Sociedades Médicas/normas , Infecção da Ferida Cirúrgica/prevenção & controle , Tromboembolia Venosa/prevenção & controle
18.
BJOG ; 128(4): 728-736, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-32725920

RESUMO

OBJECTIVE: To describe the current testing practice, referral pathways and gynaecological services available to women with Lynch syndrome (LS) in the UK. DESIGN: Cross-sectional nationwide survey of gynaecological oncologists and women with LS. SETTING: United Kingdom. METHODS: Gynaecological oncologists were contacted directly. Women with LS were identified from national and regional clinical databases and the patient support group, Lynch syndrome UK. MAIN OUTCOME MEASURES: Gynaecological oncologists were asked to report rates of LS testing and current practice regarding risk-reducing strategies and gynaecological surveillance for women with LS. Women with LS were asked to describe their experiences of gynaecological care. RESULTS: In total, 41 gynaecological oncologists and 298 women with LS responded to the survey. Of the gynaecological oncologists surveyed, 37% were unfamiliar with any clinical guidelines for the management of LS. Only 29% of gynaecological oncologists supported universal testing of endometrial cancer for LS; one centre routinely performed such testing. In all, 83% said they perform risk-reducing gynaecological surgery and 43% were aware of a local gynaecological surveillance service for women with LS. Of women with LS, most had undergone a hysterectomy (n = 191/64.1%), most frequently to reduce their gynaecological cancer risk (n = 86/45%). A total of 10% were initially referred for LS testing by their gynaecologist and 55% of those eligible regularly attended gynaecological surveillance; however, 62% wanted more regular surveillance. Regional variation was evident across all standards of care. CONCLUSIONS: There is widespread variation in the services offered to women with LS in the UK. As a community, gynaecological oncologists should move towards a nationally agreed provision of services. TWEETABLE ABSTRACT: A mismatch in care for mismatch repair. Survey finds significant variation in gynaecological care for #Lynchsyndrome in the UK.


Assuntos
Neoplasias Colorretais Hereditárias sem Polipose/diagnóstico , Neoplasias Colorretais Hereditárias sem Polipose/terapia , Ginecologia/organização & administração , Acessibilidade aos Serviços de Saúde/organização & administração , Padrões de Prática Médica/estatística & dados numéricos , Encaminhamento e Consulta/organização & administração , Serviços de Saúde da Mulher/organização & administração , Adulto , Idoso , Estudos Transversais , Feminino , Ginecologia/estatística & dados numéricos , Pesquisas sobre Atenção à Saúde , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Encaminhamento e Consulta/estatística & dados numéricos , Medicina Estatal/organização & administração , Medicina Estatal/estatística & dados numéricos , Reino Unido , Serviços de Saúde da Mulher/estatística & dados numéricos
19.
Gynecol Oncol ; 160(3): 649-654, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33358197

RESUMO

BACKGROUND: Surgery is the cornerstone of gynecological cancer management, but inpatient treatment may expose both patients and healthcare staff to COVID-19 infections. Plans to mitigate the impact of the COVID-19 pandemic have been implemented widely, but few studies have evaluated the effectiveness of these plans in maintaining safe surgical care delivery. AIM: To evaluate the effects of mitigating plans implemented on the delivery of gynecological cancer surgery during the COVID-19 pandemic. METHODS: A comparative cohort study of patients treated in a high-volume tertiary gyneoncological centre in the United Kingdom. Prospectively-recorded consecutive operations performed and early peri-operative outcomes during the same calendar periods (January-August) in 2019 and 2020 were compared. RESULTS: In total, 585 operations were performed (296 in 2019; 289 in 2020). There was no significant difference in patient demographics. Types of surgery performed were different (p = 0.034), with fewer cytoreductive surgeries for ovarian cancer and laparoscopic procedures (p = 0.002) in 2020. There was no difference in intra-operative complication rates, critical care admission rates or length of stay. One patient had confirmed COVID-19 infection (0.4%). The 30-day post-operative complication rates were significantly higher in 2020 than in 2019 (58 [20.1%] versus 32 [10.8%]; p = 0.002) for both minor and major complications. This increase, primarily from March 2020 onwards, coincided with the first peak of the COVID-19 pandemic in the UK. CONCLUSIONS: Maintaining surgical throughput with meticulous and timely planning is feasible during the COVID-19 pandemic but this was associated with an increase in post-operative complications due to a multitude of reasons.


Assuntos
COVID-19/prevenção & controle , Atenção à Saúde/organização & administração , Neoplasias dos Genitais Femininos/cirurgia , Procedimentos Cirúrgicos em Ginecologia/estatística & dados numéricos , Ginecologia/organização & administração , Oncologia Cirúrgica/organização & administração , Idoso , COVID-19/diagnóstico , Estudos de Coortes , Procedimentos Cirúrgicos de Citorredução/estatística & dados numéricos , Atenção à Saúde/métodos , Feminino , Ginecologia/métodos , Pessoal de Saúde , Humanos , Controle de Infecções/métodos , Unidades de Terapia Intensiva/estatística & dados numéricos , Complicações Intraoperatórias/epidemiologia , Laparoscopia/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Programas de Rastreamento , Pessoa de Meia-Idade , Serviço Hospitalar de Oncologia , Equipamento de Proteção Individual , Complicações Pós-Operatórias/epidemiologia , Quarentena , SARS-CoV-2 , Medicina Estatal , Oncologia Cirúrgica/métodos , Centros de Atenção Terciária , Reino Unido
20.
Gynecol Oncol ; 160(1): 3-9, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33243442

RESUMO

OBJECTIVE: To assess whether the number of practice sites per gynecologic oncologist (GO) and geographic access to GOs has changed over time. METHODS: This is a retrospective repeated cross-sectional study using the 2015-2019 Physician Compare National File. All GOs in the 50 United States and Washington, DC, who had completed at least one year of practice were included in the study. All practice sites with complete addresses were included. Linear regression analyses estimated trends in GOs' number of practice sites and geographic dispersion of practice sites. Secondary analyses assessed temporal trends in the number of geographic areas served by at least one GO. RESULTS: Although there was no significant change in the number of GOs from 2015 to 2019 (n = 1328), there was a significant increase in the number of practice sites (881 to 1416, p = 0.03), zip codes (642 to 984, p = 0.03), HSAs (404 to 536, p = 0.04), and HRRs (218 to 230, p = 0.03) containing a GO practice. The mean number of practice sites (1.64 versus 2.13, p < 0.001) and dispersion of practice sites (0.03 versus 0.43 miles, p = 0.049) per GO increased significantly. CONCLUSIONS: Between 2015 and 2019, an increasing number of GOs have multi-site practices, and more geographic regions contain a GO practice. Improvements in geographic access to GOs may represent improved access to care for many women in the US, but its effect on patients, physicians, and geographic disparities is unknown.


Assuntos
Atenção à Saúde/organização & administração , Atenção à Saúde/estatística & dados numéricos , Neoplasias dos Genitais Femininos/terapia , Ginecologia/organização & administração , Oncologia/organização & administração , Padrões de Prática Médica/estatística & dados numéricos , Estudos Transversais , Feminino , Ginecologia/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Humanos , Oncologia/estatística & dados numéricos , Padrões de Prática Médica/organização & administração , Estudos Retrospectivos , Estados Unidos
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