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1.
J Pediatr Adolesc Gynecol ; 32(5S): S30-S35, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31585616

RESUMO

Adolescents are at high risk for unintended pregnancy and rapid repeat pregnancy, both of which can be associated with negative health and social outcomes. Intrauterine device (IUD) use has been shown to decrease unintended pregnancy and rapid repeat pregnancy. Evidence supports IUD insertion postabortion and postpartum as safe and practical for nearly all women, including adolescent and young adult women. Providers of adolescent gynecology can play an important role in decreasing repeat and unintended pregnancy among adolescents by increasing access to IUDs, reducing barriers to care, and providing IUDs immediately postabortion and postpartum.


Assuntos
Assistência ao Convalescente/métodos , Anticoncepção/métodos , Ginecologia/métodos , Acesso aos Serviços de Saúde , Dispositivos Intrauterinos , Aborto Induzido , Adolescente , Feminino , Humanos , Período Pós-Parto , Gravidez , Gravidez na Adolescência/prevenção & controle , Gravidez não Planejada , Adulto Jovem
2.
J Pediatr Adolesc Gynecol ; 32(5S): S7-S13, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31585618

RESUMO

Professional organizations agree that adolescents are good candidates for intrauterine device (IUD) use. The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists affirm that IUDs should be considered first-line as contraceptive methods for adolescents. Although the number of teens using IUDs is growing, multiple barriers remain, including systems, and patient- and provider-level obstacles. Only through concerted efforts and a committed action plan will adolescents achieve better access to IUDs.


Assuntos
Acesso aos Serviços de Saúde , Dispositivos Intrauterinos/estatística & dados numéricos , Contracepção Reversível de Longo Prazo/métodos , Adolescente , Feminino , Ginecologia/educação , Ginecologia/métodos , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Guias de Prática Clínica como Assunto , Gravidez , Gravidez na Adolescência/prevenção & controle
3.
Anticancer Res ; 39(10): 5631-5637, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31570460

RESUMO

BACKGROUND/AIM: Pelvic exenteration is a radical procedure for certain advanced or recurrent gynaecological cancers, performed with curative or palliative intent. Its validity has evolved as operative mortality and morbidity have improved. This surgery was evaluated to determine the validity of these claims. PATIENTS AND METHODS: The details of surgery and outcomes of 13 patients who underwent pelvic exenteration (6 curative intent, 7 palliative intent) for advanced or recurrent gynaecological cancers in our Department were retrospectively evaluated. RESULTS: There were no significant differences in blood loss, surgical time, hospital stay, and complications between curative pelvic exenteration and palliative pelvic exenteration. The curative intent group had a good prognosis; the palliative-intent group showed a trend to a worse prognosis. All patients' symptoms were relieved, but in patients with short survival, symptom relief lasted for up to 3 months. CONCLUSION: Pelvic exenteration is an acceptable and valuable procedure for gynaecological cancers.


Assuntos
Neoplasias dos Genitais Femininos/cirurgia , Recidiva Local de Neoplasia/cirurgia , Adulto , Idoso , Feminino , Neoplasias dos Genitais Femininos/mortalidade , Ginecologia/métodos , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/mortalidade , Duração da Cirurgia , Exenteração Pélvica/métodos , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Adulto Jovem
5.
In Vivo ; 33(5): 1547-1551, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31471403

RESUMO

An increasing trend in funding towards artificial intelligence (AI) research in medicine has re-animated huge expectations for future applications. Obstetrics and gynaecology remain highly litigious specialities, accounting for a large proportion of indemnity payments due to poor outcomes. Several challenges have to be faced in order to improve current clinical practice in both obstetrics and gynaecology. For instance, a complete understanding of fetal physiology and establishing accurately predictive antepartum and intrapartum monitoring are yet to be achieved. In gynaecology, the complexity of molecular biology results in a lack of understanding of gynaecological cancer, which also contributes to poor outcomes. In this review, we aim to describe some important applications of AI in obstetrics and gynaecology. We also discuss whether AI can lead to a deeper understanding of pathophysiological concepts in obstetrics and gynaecology, allowing delineation of some grey zones, leading to improved healthcare provision. We conclude that AI can be used as a promising tool in obstetrics and gynaecology, as an approach to resolve several longstanding challenges; AI may also be a means to augment knowledge and assist clinicians in decision-making in a variety of areas in obstetrics and gynaecology.


Assuntos
Inteligência Artificial , Ginecologia , Informática Médica , Obstetrícia , Feminino , Ginecologia/métodos , Ginecologia/normas , Ginecologia/tendências , Humanos , Informática Médica/métodos , Informática Médica/normas , Informática Médica/tendências , Obstetrícia/métodos , Obstetrícia/normas , Obstetrícia/tendências , Medicina de Precisão/métodos , Medicina de Precisão/normas
6.
Obstet Gynecol Clin North Am ; 46(3): 469-483, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31378289

RESUMO

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


Assuntos
Prestação Integrada de Cuidados de Saúde , Saúde Mental , Saúde da Mulher , Feminino , Ginecologia/métodos , Humanos , Terapias Mente-Corpo , Obstetrícia/métodos , Gravidez , Psicologia , Delitos Sexuais , Estados Unidos
8.
Scand J Prim Health Care ; 37(2): 264-270, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31140330

RESUMO

Introduction: Little is known about the indications general practitioners (GPs) perceive as relevant for performing gynaecological examinations (GEs), how GPs master the GE and associated procedures, and how they handle the sensitive nature of GEs. Methods: In 2015, 70 medical students at the University of Bergen distributed a questionnaire to all 175 GPs in the practices they visited. The questions covered practical routines related to GEs, insertion of intrauterine device, frequency of GEs in different clinical settings and use of assisting personnel. Statistical analyses included chi-square tests and multiple logistic regressions adjusting for age, gender, specialization and localization. Results: Ninety male and 61 female GPs (87% of invited GPs) responded to the questionnaire. A minority (8%) usually had other staff present during GEs. Compared with female colleagues, male GPs performed bimanual palpation significantly less often in connection with routine Pap smear (AOR 0.3 (95% CI 0.1-0.6)). Twenty-eight percent of the GPs stated that they often/always omitted the GE if the patient was anxious about GE and 35% when the patient asked for referral to a gynaecologist. Omission was more frequent among male GPs. When the GP decided to refer to a gynaecologist based on the patient's symptoms, more male than female GPs omitted GE (AOR 2.5 (95% CI 1.1-5.4)). Conclusion: Male gender of the GP may be associated with barriers to medical evaluation of pelvic symptoms in women, potentially leading to substandard care. Possibly, however, male GPs' reluctance to perform the GE may also limit unnecessary bimanual palpation in asymptomatic women.


Assuntos
Atitude do Pessoal de Saúde , Identidade de Gênero , Medicina Geral , Clínicos Gerais , Ginecologia/métodos , Exame Físico , Padrões de Prática Médica , Adulto , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Noruega , Aceitação pelo Paciente de Cuidados de Saúde , Encaminhamento e Consulta , Inquéritos e Questionários
9.
Int J Gynaecol Obstet ; 146(2): 263-264, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31099034

RESUMO

We identified mobile applications (apps) found on digital platforms (iTunes Store and Google Play) that addressed topics about gynecology and obstetrics.


Assuntos
Aplicativos Móveis/estatística & dados numéricos , Smartphone , Feminino , Ginecologia/métodos , Humanos , Aplicativos Móveis/classificação , Obstetrícia/métodos , Gravidez
10.
Obstet Gynecol Clin North Am ; 46(2): 339-351, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31056135

RESUMO

Patient safety is inseparable from quality and is a top priority for the United States health care system. This article explores factors that contribute to errors and patient harm in office practice, discusses key ways in which errors in the outpatient setting compare with those occurring in the inpatient setting, and describes strategies for supporting and improving patient safety in office practice.


Assuntos
Assistência Ambulatorial , Segurança do Paciente , Qualidade da Assistência à Saúde , Assistência Ambulatorial/estatística & dados numéricos , Procedimentos Cirúrgicos Ambulatórios , Erros de Diagnóstico , Feminino , Ginecologia/métodos , Humanos , Erros Médicos/prevenção & controle , Erros Médicos/estatística & dados numéricos , Obstetrícia/métodos , Visita a Consultório Médico/estatística & dados numéricos , Gravidez , Garantia da Qualidade dos Cuidados de Saúde
11.
Obstet Gynecol Clin North Am ; 46(2): 367-378, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31056137

RESUMO

Diagnostic ultrasound is a powerful tool in obstetrics/gynecology. It has multiple applications, but for every use there are potential pitfalls that can have significant deleterious effects. Guidelines and certifications have been implemented to enhance the safety of this technique.


Assuntos
Ginecologia/métodos , Obstetrícia/métodos , Ultrassonografia Pré-Natal , Ultrassonografia , Colo do Útero/diagnóstico por imagem , Feminino , Desenvolvimento Fetal , Doenças Fetais/diagnóstico por imagem , Feto/anormalidades , Feto/diagnóstico por imagem , Idade Gestacional , Humanos , Erros Médicos , Placenta/diagnóstico por imagem , Gravidez , Complicações na Gravidez/diagnóstico por imagem , Gravidez Múltipla , Nascimento Prematuro/diagnóstico por imagem
13.
J Gynecol Obstet Hum Reprod ; 48(7): 441-454, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31051299

RESUMO

The French College of Obstetrics and Gynecology (CNGOF) has released its first comprehensive recommendations for clinical practices in contraception, to provide physicians with an updated synthesis of the available data as a basis for their practice. The organizing committee and the working group adopted the objective methodological principles defined by the French Authority for Health (HAS) and selected 12 themes relevant to medical professionals' clinical practices concerning contraception. The available literature was screened through December 2017 and served as the basis of 12 texts, reviewed by experts and physicians from public and private practices, with experience in this field. These texts enabled us to develop evidence based, graded recommendations. Male and female sterilization, as well as the use of hormonal treatments not authorized for contraception ("off-label") were excluded from the scope of our review. Specific practical recommendations are provided for the management of contraception prescription, patient information concerning effectiveness, risks, and benefits of the different methods, patient follow-up, intrauterine contraception, emergency contraception, local and natural methods, contraception in teenagers, in women after 40, for women at high thromboembolism or cardiovascular risk, and for those at of primary cancer or relapse. The short- and mid-term future of contraception depends mainly on improving the use of currently available methods. This includes reinforced information for users and increased access to contraception for women, regardless of their social and clinical contexts. The objective of these guidelines is to aid in enabling this improvement.


Assuntos
Anticoncepção/métodos , Anticoncepção/normas , Ginecologia/normas , Obstetrícia/normas , Adolescente , Anticoncepção Pós-Coito/métodos , Anticoncepção Pós-Coito/normas , Feminino , França , Ginecologia/métodos , Humanos , Dispositivos Intrauterinos/normas , Masculino , Obstetrícia/métodos , Gravidez , Sociedades Médicas/organização & administração , Sociedades Médicas/normas
14.
J Obstet Gynaecol Res ; 45(7): 1260-1267, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30977232

RESUMO

AIM: In Cambodia, the Japan Society of Obstetrics and Gynecology and the Cambodian Society of Gynecology and Obstetrics have an on-going project, started in 2015, for cervical cancer prevention and treatment. The project, currently aimed at factory workers, includes a women's health education program that leads into cervical cancer prevention by establishment of a system for early detection and treatment. It begins by health education, screening for human papillomavirus (HPV), followed by colposcopy and quicker treatment of earlier precursor lesions. METHODS: Rates for participant screening, HPV test positivity, cervical intraepithelial neoplasia (CIN) detection and distribution of HPV types were compared between two screening programs, factory-based and hospital-based. Some HPV test samples were divided into two, one of which was sent to Japan for a quality-control check of the Cambodian testing. RESULTS: The factory-based participant screening rate was 19% (128/681). HPV was detected more frequently in the factory-based program participants (12%) than in the hospital-based program participants (5%). Unfortunately, however, the rate of receiving proper secondary colposcopy screening among the HPV-positive females was significantly higher in the hospital-based program (94%) than the factory-based program (40%) (P < 0.001). The Cambodian laboratory HPV testing accuracy was 92.6%. HPV types demonstrated no significant difference between the two prevention programs. CONCLUSION: We could successfully introduce HPV-based screening, starting from health education. However, low rate of screening, especially secondary screening for HPV positive factory workers was identified. Also, HPV testing could be further improved for accuracy through close monitoring.


Assuntos
Detecção Precoce de Câncer/métodos , Ginecologia/métodos , Educação em Saúde/métodos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Neoplasias do Colo do Útero/prevenção & controle , Adulto , Camboja , Neoplasia Intraepitelial Cervical/prevenção & controle , Neoplasia Intraepitelial Cervical/virologia , Colposcopia/estatística & dados numéricos , Feminino , Implementação de Plano de Saúde , Humanos , Cooperação Internacional , Japão , Pessoa de Meia-Idade , Papillomaviridae , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/virologia , Avaliação de Programas e Projetos de Saúde , Sociedades Médicas , Neoplasias do Colo do Útero/virologia
16.
Gynecol Oncol ; 152(3): 486-491, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30876493

RESUMO

Quality improvement in healthcare has accelerated over the past two decades, including in gynecologic oncology. Improvements have been made on a practice, institution, system and national scale, and efforts have focused on improving safety, efficiency, and cost of care. Gynecologic oncology practitioners ought to engage in this work to improve patient outcomes, comply with federal regulation, and continue to meet required educational requirements of training programs. In gynecologic oncology there are already many examples of successful quality improvement initiatives that have resulted in improved patient care, including the implementation of enhanced recovery after surgery programs, reduction in blood transfusion, and increases in guideline adherent cancer care. Quality improvement methodology is born out of industrial engineering and includes Six Sigma and Lean; both are frameworks for implementing quality improvement as a process and can be adopted in healthcare settings to achieve the desired outcomes. Six Sigma is a system that aims to have a 99.9997% defect free process, and uses the DMAIC (Define-Measure-Analyze-Improve-Control) framework to guide stakeholders in their work. Lean is a concept aimed at reducing waste in process. Regardless of methodology used, the most important aspect of successful quality improvement is the use of change-management theory to achieve stakeholder buy-in and institutional participation. The physician champion is a key element to this. Finally, once a project has been completed, successfully or not, it is important to disseminate the experience. This will allow for adoption and replication in other institutions. It also can serve as a mechanism for academic recognition and advancement. Quality improvement is an important and growing field in medicine, and has an important role in the future of gynecologic oncology.


Assuntos
Neoplasias dos Genitais Femininos/terapia , Ginecologia/normas , Oncologia/normas , Feminino , Previsões , Ginecologia/métodos , Ginecologia/tendências , Humanos , Oncologia/métodos , Oncologia/tendências , Melhoria de Qualidade
17.
Gynecol Oncol ; 152(3): 533-539, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30876500

RESUMO

Clinical research in gynecologic oncology has seen a proliferation of studies that investigate the effectiveness of treatments using existing data sources such as cancer registries, electronic health records, and insurance claims. These observational studies are often feasible when randomized trial may not be, and may be more generalizable than randomized trials, because of greater diversity in the study populations. While statistical methods such as multivariable regression, matching, stratification, and weighting can adjust for the confounding in observational studies, statistical adjustment cannot control for confounders that are unmeasured in the data. Observational studies comparing the effectiveness of treatments for gynecologic malignancies are susceptible to bias from unmeasured confounding because factors like functional status, frailty and disease burden, which influence treatment selection and outcome, are often not reported in existing data sources. Like randomized trials, quasi-experimental designs attempt to account for both measured and unmeasured confounding by exploiting natural experiments arising in the real world. These methods are underutilized in gynecologic oncology research and are particularly relevant to studies that use large datasets to study the effectiveness of treatments. In this review, we consider methodological challenges that arise in the analysis of non-randomized studies, and describe how application of quasi-experimental methodology can estimate unbiased treatment effects even in the presence of unmeasured confounders.


Assuntos
Neoplasias dos Genitais Femininos/terapia , Ginecologia/métodos , Oncologia/métodos , Estudos Observacionais como Assunto/métodos , Feminino , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Projetos de Pesquisa
18.
Int Urogynecol J ; 30(5): 673-681, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30927040

RESUMO

AIM: Urogynaecological conditions can have a significant impact on body image. Patient-reported outcome measures (PROMs) are widely used in urogynaecology to assess symptoms and their impact on quality of life. This systematic review aimed to identify currently available PROMs used to assess body image within a urogynaecological population and to identify the most psychometrically robust and appropriate PROM tools to use in this context. METHODS: Ovid Medline, AMED, CINAHL, Cochrane Collaboration, EMBASE and Web of Science databases were searched from January 1966 to November 2018 to identify studies that had administered a PROM to assess body image to patients diagnosed with a urogynaecological condition. The information extracted and critically appraised included study setting, PROM instrument used and the reported psychometric properties of the PROM. RESULTS: Seventeen studies were included from 3207 screened articles. Seven different PROMs used to assess body image in a urogynaecological population were identified. Two of these PROMs (Genital Self-Image Scale-20 and Body Image in Pelvic Organ Prolapse questionnaire) had good psychometric evidence for use, but this was only in the context of women with prolapse. Evidence for validity and reliability was limited for the other five PROMs identified. CONCLUSION: Further development and psychometric testing of PROMs to assess body image in urogynaecology, for both research purposes and clinical practice, are required. Further research is also required to investigate the relationship between body image and urogynaecological symptomatology, and developing valid, reliable and functional PROMs will be integral to this.


Assuntos
Imagem Corporal/psicologia , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida/psicologia , Feminino , Ginecologia/métodos , Humanos , Reprodutibilidade dos Testes , Urologia/métodos
19.
Eur J Obstet Gynecol Reprod Biol ; 235: 116-120, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30826159

RESUMO

Paediatric and Adolescent Gynaecology (PAG) is a multidisciplinary field combining aspects of gynaecology but also includes paediatrics, endocrinology, genetics, radiology, psychology and urology. Specialist knowledge is warranted for the care of these youngsters, and it is important that doctors attending to the gynaecological needs of children must understand that they are not just "little women". Their needs and accompanying clinical approaches required are very different from those of adults in this sensitive area, as is the spectrum of diseases and problems. A multidisciplinary collaboration is as important as the establishment and adoption of standards in education, training and management. The situation in Europe in PAG is varied, reflecting the relative youth of this area of special interest and thereby allowing for earlier consolidation of standards and services across Europe. This article summarises the background to PAG in Europe, inequitable current provision of care and issues relating to education and training all of which are relevant in providing a common approach to PAG problems and endeavouring to obtain the best outcomes. There remains huge diversity how the services for "young women" are currently delivered across different countries within Europe. A concerted European approach is urgently required to streamline standards of training and clinical care, to ensure high quality care by using agreed national and European pathways.


Assuntos
Serviços de Saúde do Adolescente , Medicina do Adolescente/métodos , Serviços de Saúde da Criança , Ginecologia/métodos , Pediatria/métodos , Adolescente , Criança , Assistência à Saúde , Europa (Continente) , Feminino , Ginecologia/organização & administração , Humanos , Obstetrícia/métodos , Obstetrícia/organização & administração , Equipe de Assistência ao Paciente , Gravidez , Sociedades Médicas , Conselhos de Especialidade Profissional
20.
Obstet Gynecol ; 133(4): e260-e273, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30913197

RESUMO

Fecal incontinence, or the involuntary leakage of solid or loose stool, is estimated to affect 7-15% of community-dwelling women (1). It is associated with reduced quality of life, negative psychologic effects, and social stigma (2), yet many women do not report their symptoms or seek treatment. Less than 3% of women who do self-report fecal incontinence will have this diagnosis recorded in their medical record (3). Obstetrician-gynecologists are in a unique position to identify women with fecal incontinence because pregnancy, childbirth, obstetric anal sphincter injuries (OASIS), and pelvic floor dysfunction are important risk factors that contribute to fecal incontinence in women. The purpose of this Practice Bulletin is to provide evidence-based guidelines on the screening, evaluation, and management of fecal incontinence to help obstetrician-gynecologists diagnose the condition and provide conservative treatment or referral for further work up and surgical management when appropriate. For discussion on fecal incontinence associated with OASIS, see Practice Bulletin No. 198, Prevention and Management of Obstetric Lacerations at Vaginal Delivery (4).


Assuntos
Incontinência Fecal/diagnóstico , Incontinência Fecal/terapia , Ginecologia/métodos , Obstetrícia/métodos , Canal Anal/efeitos dos fármacos , Canal Anal/fisiopatologia , Fibras na Dieta , Incontinência Fecal/cirurgia , Feminino , Humanos , Laxantes , Papel do Médico , Complicações Pós-Operatórias , Qualidade de Vida , Sacro/inervação
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