Discrepancies between author- and industry-reported disclosures of financial relationships at an annual gynecologic oncology research meeting.

OBJECTIVE: Trillions of dollars pass to physicians from industry-related businesses annually, leading to many opportunities for financial conflicts of interest. The Open Payments Database (OPD) was created to ensure transparency. We describe the industry relationships as reported in the OPD for presenters at the 2019 Society of Gynecologic Oncology (SGO) Annual Meeting and evaluate concordance between author disclosures of their financial interests and information provided by the OPD. METHODS: This is an observational, cross-sectional study. Disclosure data were collected from authors with oral and featured abstract presentations in the 2019 SGO annual conference. These disclosures were compared to data available for each author in the 2018 OPD, which included the amount and nature of industry payments. RESULTS: We examined the disclosures of 301 authors who met inclusion criteria. Of 161 authors who had disclosure statements on their presentations,147 reported "no disclosures," and 14 disclosed industry relationships. The remaining 140 did not list any disclosure information. Sixty percent (184/301) of authors had industry relationships in the 2018 OPD, including 173 of 287 (60.3%) of authors who either reported no disclosures or did not have disclosure data available in their presentations. These transactions totaled over 43 million USD from 122 different companies, with most payments (46%) categorized as "Research or Associated Research." Accurate disclosure reporting was associated with receiving higher payments or research payments, and being a presenting author. CONCLUSIONS: Most authors at the SGO annual conference did not correctly disclose their industry relationships when compared with their entries in the OPD.

Ética em ginecologia e obstetrícia - 2021 / Ethics in gynecology and obstetrics - 2021

Durante a pandemia de covid-19, o Conselho Regional de Medicina do Estado de Goiás (Cremego) encontrou na tecnologia um aliado para manter a atualização de conhecimentos dos médicos que atuam na região. Ao longo do período, a autarquia organizou uma série de lives para discutir diferentes temas de interesse para os profissionais que, independentemente da emergência sanitária, se desdobravam nos cuidados com a população. É dessa iniciativa que nasceu o livro Ética em Ginecologia e Obstetrícia. Trata-se da continuidade dessa grande aposta do Cremego na valorização da educação médica continuada e do estímulo ao debate e à troca de experiências. Assim, ao transformar as discussões promovidas em artigos, o Conselho permite que médicos de outros estados possam acessar o conteúdo gerado, ampliando seu alcance. O leque de assuntos é dos mais relevantes. As discussões abordam temáticas que encerram polêmicas e suscitam dúvidas, como ética na reprodução assistida e em medicina fetal; atendimento à adolescente; assistência ao parto; direitos da gestante; e impactos da covid-19 na gravidez. Quem saborear essa publicação se deparará com um trabalho que vai além da discussão teórica sobre cada um dos temas. Na verdade, isso se deve aos autores que tiverem a felicidade de trazer para seus textos suas experiências e visões privilegiadas de quem conhece a linha de cuidados que deve ser oferecida à mulher.

Atendendo a adolescente no consultório de ginecologia / Assisting the teenager in the gynecology office

A presença de pacientes adolescentes tem sido uma situação cada vez mais frequente para os ginecologistas. Dentre os motivos de consulta, destacam-se a avaliação do desenvolvimento da puberdade, distúrbios do ciclo menstrual, corrimento e o desejo de contracepção. Obter a confiança da adolescente é um dos maiores desafios para o profissional que atende uma paciente adolescente, tanto pelos aspectos biopsicossociais como também pelas questões éticas e legais que estão envolvidas na consulta. Embora a consulta ginecológica da adolescente tenha diversos pontos em comum com a da mulher adulta, os aspectos relacionados à sexualidade devem ser indagados com cautela, pois, na maioria das vezes, a adolescente está acompanhada e nem sempre compartilha sua prática sexual com seus familiares. A empatia mútua poderá beneficiar a adolescente, garantindo um momento propício para a abordagem dos cuidados relacionados aos aspectos da sua saúde sexual e reprodutiva.(AU)

Surgeon Volume in Benign Gynecologic Surgery: Review of Outcomes, Impact on Training, and Ethical Contexts.

It is becoming increasingly clear that surgeon volume affects surgical outcomes. High-volume surgeons demonstrate reduced perioperative complications, shorter operative times, and reduced blood loss during multiple modalities of benign gynecologic surgery. Furthermore, high-volume surgeons consistently demonstrate higher rates of minimally invasive approaches, low rates of conversion to laparotomy, and lower per-procedure case costs. It is suggested that surgeons who have completed postresidency training have improved surgical outcomes, although these data are limited. Surgical exposure in obstetrics and gynecology residency is varied and does not consistently meet demonstrated surgical learning curves. Deficiencies in residency surgical training may be related to the volume-outcome relationship. We suggest reforming residency surgical training and tracking postresidency practice to provide optimal surgical care. Additionally, surgeons may have an ethical obligation to inform patients of their surgical volume and outcomes, with options for referrals if needed.

Consulta ginecológica e a relação profissional-cliente: perspectiva de usuárias / The gynecological appointment and health professional-client relations: the users' perspective / Consulta ginecológica y la relación profesional-cliente: perspectiva de las usuarias

Objetivo: descrever a perspectiva de mulheres sobre a consulta ginecológica a partir da relação profissional-cliente. Método: estudo descritivo, qualitativo, realizado em um campus universitário no Rio de Janeiro, entre julho e setembro/2014. Foram entrevistadas 11 mulheres que frequentam esse campus. Para sistematização dos dados seguiu-se os pressupostos da análise conteúdo temática. Resultados: foram encontradas duas categorias: Percebendo a atitude do profissional como prescritiva e hierarquizada, que evidencia um caráter prescritivo, autoritário e hierárquico por parte do profissional com o olhar voltado somente para sintomas físicos e carência de informações pelas mulheres; e Percebendo o distanciamento do profissional, que evidencia pouco contato visual, mobiliário como barreira, consultas rápidas e impessoais nas quais não há possibilidade de formação de vínculo. Conclusão: as mulheres estão insatisfeitas com a relação profissional-cliente na consulta ginecológica. Assim, é primordial a adoção de estratégias que visem à humanização.

Objective: to describe women's perspective on the gynecological appointment and the health personnel-client relationship. Method: this qualitative, descriptive study was conducted on a university campus in Rio de Janeiro from July to September/2014. The participants were 11 women attending the campus. Data were systematized on the assumptions of thematic content analysis. Results: two categories were found: Perceiving the professional's attitude as prescriptive and hierarchical, which evidenced a prescriptive and hierarchical quality in the professionals who look only for physical symptoms and a lack of information on the part of the women; and Perceiving the professional's remoteness, where there is little eye contact, furniture is a barrier, appointments are brief and impersonal, and there is no chance of bonding. Conclusion: women are dissatisfied with the health personnel-client relationship in the gynecological appointment. Accordingly, it is essential to pursue strategies designed to humanize gynecological care

Objetivo: describir la perspectiva de mujeres sobre la consulta ginecológica desde el punto de vista de la relación profesional-cliente. Método: estudio descriptivo, cualitativo, desarrollado en una universidad de Río de Janeiro, de julio a septiembre/2014. Fueron entrevistadas 11 mujeres que acuden a esa universidad. Para la sistematización de los datos, se siguieron los supuestos del contenido temático. Resultados: se encontraron dos categorías: percibiendo la actitud del profesional como prescriptiva e jerarquizada, lo que demuestra un carácter prescriptivo, autoritario y jerárquico por parte del profesional con la mirada hacia síntomas físicos y la falta de información por parte de las mujeres; y percibiendo la distancia profesional que muestra poco contacto visual, donde los muebles son una barrera, las consultas son rápidas e impersonales sin posibilidad de formar enlaces. Conclusión: las mujeres no están satisfechas con la relación profesional-cliente en la consulta ginecológica. Por lo tanto, es importante adoptar estrategias dirigidas a la humanización.

Therapeutic and Ethical Dilemma of Puberty and Menstruation Problems in an Intellectually Disabled (Autistic) Female: a Case Report.

Intellectual disability is a term used when a person has certain limitations in mental functioning and skills. Autism is a group of developmental brain disorders, collectively called autism spectrum disorder (ASD). Teenagers with learning and physical disabilities are more likely to have menstrual problems compared to the general populations. The parents of a 12-year-old girl with autism spectrum disorder and intellectual disability referred to the coroner due to her numerous problems of puberty (menstruation) including: poor hygiene and polluting herself and the environment, not allowing to put or change the pads and changes in mood and physical health prior period, requested for the surgery (hysterectomy). In legal medicine organization after reviewing the medical records, physical exams and medical consultations with a gynecologist and psychiatric, surgery was not accepted. Hysterectomy (surgery) due to the age of the child, either physically or morally is not recommended. The use of hormone replacement therapy has side effects such as osteoporosis. In these cases, it seems noninvasive methods (behavioral therapy and learning care skills) under the welfare experts is also more effective and morally.

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

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

La bioética en el desarrollo de la ginecobstetricia / Bioethics in the Development of Gynecology

El surgimiento de la bioética ha marcado un interés cada vez mayor para los hombres que se dedican a las ciencias, y sobre todo, a las ciencias médicas. Se realiza una reflexión con el objetivo de exponer la influencia de la bioética en el desarrollo de la obstetricia y ginecología actual, con ejemplos clásicos de su aplicación, polémica, dilemas y conflictos en nuestra labor cotidiana que garanticen una mejor calidad de la atención médica a nuestra población.

The emergence of bioethics has marked a growing interest for men who are dedicated to science, and above all, to medical science. Reflection is done with the goal of exposing the influence of bioethics in the development of modern gynecology- obstetrics, with classic examples of its application, controversy, dilemmas, and conflicts in our daily work to ensure our population a better quality of health care.

Bits and pieces: the ethics of uterine morcellation.

Intensive media and policy attention has been focused on the ongoing controversy surrounding uterine morcellation in gynecologic surgery. What has been missing from this impassioned discourse is an objective analysis of the ethical implications of uterine power morcellation in gynecologic surgery. This article discusses competing ethical duties of physicians, industry, the U.S. Food and Drug Administration, and the media to develop a more robust and nuanced understanding of informed consent for the use of morcellation in benign gynecologic surgery. Ultimately, as physicians, we must remain steadfast in our dedication to the use of evolving technologies to better patient health in a safe and ethical manner that is well-studied, informed, and implemented with appropriate training and precautions.