Usability study of a novel, self-lighted, disposable speculum: military applications.

STUDY DESIGN: Data collected from a postutilization questionnaire were used to evaluate the usability of the OfficeSPEC disposable vaginal speculum, specifically the effectiveness, efficiency, and acceptability, in clinical, hospital, and austere environments. RESULTS: Usability data analysis showed the OfficeSPEC speculum had an effectiveness rating of 4.6/5, efficiency rating of 4.5/5, and acceptability rating of 4.6/5; overall usability in deployed environments was favorable. The overall rankings were 3.4 for plastic, 4.2 for metal (p < 0.001), and 4.5 for OfficeSPEC (p < 0.001). Cost analysis of the OfficeSPEC placed the disposable speculum as a reasonable alternative with yearly cost of $129,200, compared to traditional metal ($209,100) and plastic ($319,175). CONCLUSION: By evaluating the OfficeSPEC speculum within a usability framework, it proved to be practical, viable alternative in all environments, particularly in the forward deployed environment.

The C.L.E.A.R. Score: a new comprehensive assessment method for academic physicians in military medical centers.

INTRODUCTION: Evaluation of medical officer performance is a critical leadership role. OBJECTIVES: This study offers a comprehensive evaluation system for military physicians. METHODS: The Comprehensive Assessment equation (COMPASS equation), a modified Cobb-Douglas equation, was developed to evaluate academic physicians. The COMPASS equation assesses military physicians within five comprehensive dimensions: (1) Clinical (2) Leadership, (3) Educational (4) Administrative, and (5) Research productivity excellence to yield a composite "C.L.E.A.R. Score." RESULTS: The COMPASS equation's fidelity was tested with a cohort of military physicians within the department of Obstetrics and Gynecology in the Capital District Region and a C.L.E.A.R. score was calculated for individual physicians. Mean C.L.E.A.R score was 53.6 +/- 28.8 (range 10.1-98.5). The responsiveness of the model was tested using two hypothetical physician models: "low-performing-faculty" and "super-faculty," and calculated C.L.E.A.R. scores were 6.3 and 153.4, respectively. CONCLUSIONS: The C.L.E.A.R. score appears to recognize and assess the performance excellence of military physicians. Weighting measured characteristics of the COMPASS equation can be used to promote organizational priorities. Thus, leaders of military medicine can communicate institutional priorities and inculcate them through use of the COMPASS equation to reward and recognize the activities of military medical officers that are commensurate with institutional goals.

Laparoscopic hysterectomy using various energy sources in swine: a histopathologic assessment.

OBJECTIVE: Analyze energy-induced damage to the swine vagina during laparoscopic hysterectomy. STUDY DESIGN: Laparoscopic colpotomy was performed in swine using ultrasonic, monopolar, and bipolar energy. Specimens (n = 22) from 13 swine were stained with hematoxylin and eosin and Masson's trichrome for energy-related damage. The distal scalpel-cut margin was used as reference. Energy induced damage was assessed by gynecologic and veterinary pathologists blinded to energy source. RESULTS: Injury was most apparent on Masson's trichrome, demonstrating clear injury demarcation, allowing consistent, quantitative damage measurements. Mean injury was 0 ± 0 µM (scalpel, n = 22), 782 ± 359 µM (ultrasonic, n = 7), 2016 ± 1423 µM (monopolar, n = 8), and 3011 ± 1239 µM (bipolar, n = 7). Using scalpel as the reference, all were significant (P < .001). CONCLUSION: All energy sources demonstrated tissue damage, with ultrasonic showing the least and bipolar the greatest. Further study of tissue damage relative to cuff closure at laparoscopic hysterectomy is warranted.

Utility of ultrasound in the combat theater: experiences of a gynecologist during Operation Iraqi Freedom/Operation Enduring Freedom.

OBJECTIVE: The purpose of this study was to evaluate the utility of ultrasound in a combat theater. METHODS: A retrospective review of gynecology visits was evaluated at Camp Doha, Kuwait, from August 2003 through April 2004. Of the 1,737 visits, 237 required pelvic ultrasound. Demographic information, as well as the indications, diagnosis, and disposition of the patients, was compiled. RESULTS: The average age of the patient requiring ultrasound was 28 +/- 8 years. The primary presenting complaint was pelvic pain. Forty percent with pelvic pain had no identifiable cause. The most common final diagnosis was pregnancy. Of the 237 visits, the use of ultrasound resulted in 136 return-to-duty dispositions. Of the 31% who were administratively redeployed, the majority were secondary to pregnancy. CONCLUSION: Gynecologic ultrasound was found to be a very useful tool in the combat theater. Ultrasound resulted in improved diagnostic ability and enhanced reassurance to both provider and patient.