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2.
Gynecol Oncol ; 155(2): 359-364, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31575391

RESUMO

OBJECTIVE: To assess whether there were any significant changes in surgical training volume over the past 20 years that might have ramifications toward preparedness for practice. METHODS: We used deidentified annual summaries of fellow case numbers for the academic years 1999 through 2018. Unpaired t-tests with Welch's correction were performed on all surgical categories for 10-year and 5-year periods. RESULTS: The total number of hysterectomies performed each year did not change significantly. The percent of hysterectomies performed by minimally invasive surgery increased significantly starting in 2008. There was a significant decline in the number of radical hysterectomies conducted starting after 2004, which then remained stable. There was also a significant decline in the number of bowel resections/anastomoses performed by fellows on the gynecologic oncology services that occurred and stabilized during the same time frame. There were other significant trends associated with the introduction of minimally invasive techniques. CONCLUSION: The results of this study suggest the need to reevaluate fellowship training and/or the scope of surgical practice in gynecologic oncology.


Assuntos
Educação de Pós-Graduação em Medicina/tendências , Bolsas de Estudo/tendências , Procedimentos Cirúrgicos em Ginecologia/educação , Ginecologia/educação , Oncologia/educação , Bolsas de Estudo/estatística & dados numéricos , Feminino , Florida , Procedimentos Cirúrgicos em Ginecologia/tendências , Ginecologia/tendências , Humanos , Histerectomia/estatística & dados numéricos , Laparoscopia/estatística & dados numéricos , Excisão de Linfonodo/estatística & dados numéricos , Oncologia/tendências , Padrões de Prática Médica/estatística & dados numéricos , Padrões de Prática Médica/tendências , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos
3.
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
5.
Clin Microbiol Rev ; 32(4)2019 09 18.
Artigo em Inglês | MEDLINE | ID: mdl-31413046

RESUMO

Health care-associated infections (HAIs) are a global problem associated with significant morbidity and mortality. Controlling the spread of antimicrobial-resistant bacteria is a major public health challenge, and antimicrobial resistance has become one of the most important global problems in current times. The antimicrobial effect of copper has been known for centuries, and ongoing research is being conducted on the use of copper-coated hard and soft surfaces for reduction of microbial contamination and, subsequently, reduction of HAIs. This review provides an overview of the historical and current evidence of the antimicrobial and wound-healing properties of copper and explores its possible utility in obstetrics and gynecology.


Assuntos
Anti-Infecciosos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/prevenção & controle , Cobre/uso terapêutico , Infecção Hospitalar/tratamento farmacológico , Ginecologia/tendências , Obstetrícia/tendências , Humanos
6.
J Pak Med Assoc ; 69(8): 1190-1193, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31431778

RESUMO

This research was conducted to determine the impact of gender and other factors in choosing a medical speciality. This cross-sectional study was conducted from 5th February 2017 to 5th July 2017 at different Medical Colleges and Teaching Hospitals. Students from fourth, final year and House Officers were enrolled using a self made questionnaire. Data was analyzed using SPSS 22. Of the 314 participants, 171(54.5%) were males and 143(45.5%) were females. Majority chose Surgery 90(28.7%), and Internal Medicine 58(18.5%). Only 1(0.3%) participant chose Public Health as a career speciality. The main reason for choice for both genders was "Interest in Content" and "Good Salary". Research shows a shift in trend of women towards Surgery and Internal Medicine rather than Gynaecology and Paediatrics, which indicates more competition in Surgery in near future. Main influencing factors for choice were personal interest and good salary. Students should be counselled regarding career in Public Health and Psychiatry.


Assuntos
Escolha da Profissão , Medicina , Admissão e Escalonamento de Pessoal , Salários e Benefícios , Estudantes de Medicina , Anestesiologia , Estudos Transversais , Dermatologia , Feminino , Cirurgia Geral/tendências , Ginecologia/tendências , Humanos , Medicina Interna/tendências , Masculino , Oncologia , Neurologia , Oftalmologia , Otolaringologia , Paquistão , Pediatria/tendências , Psiquiatria , Radiologia , Fatores Sexuais , Adulto Jovem
7.
Obstet Gynecol Clin North Am ; 46(3): 553-561, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31378295

RESUMO

The past 40 years have witnessed a major redesign of health care, largely driven by rampantly increasing costs and the perception of lack of better outcomes to justify those costs. Many demographic changes have also challenged the women's health care provider workforce, and evolving new payment systems are likewise a source of angst for these providers. Managed care is seeking to cut costs, and the challenge is to do so without sacrificing quality. Burnout is a new challenge in the present environment. There is now an opportunity to meet these challenges and provide the excellent care our patients deserve.


Assuntos
Ginecologia/tendências , Pessoal de Saúde/tendências , Obstetrícia/tendências , Assistência à Saúde/economia , Assistência à Saúde/tendências , Feminino , Ginecologia/economia , Humanos , Obstetrícia/economia , Atenção Primária à Saúde/tendências , Qualidade da Assistência à Saúde , Especialização , Estados Unidos , Seguro de Saúde Baseado em Valor , Saúde da Mulher
9.
10.
Obstet Gynecol ; 133(6): 1278-1280, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31135746

RESUMO

This month we focus on current research in hysterectomy for benign gynecologic disorders. Dr. Famuyide discusses four recent publications, which are concluded with a "bottom-line" that is the take-home message. A complete reference for each can be found on on this page along with direct links to abstracts.


Assuntos
Histerectomia/tendências , Feminino , Ginecologia/tendências , Humanos
11.
J Obstet Gynaecol Res ; 45(7): 1222-1229, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31141843

RESUMO

Current treatments for fibroids are mainly surgical and expensive, so alternatives need to be found. It is, therefore, vital to develop and evaluate alternatives to surgical procedures, especially when fertility preservation is the goal. Selective progesterone receptor modulators (SPRMs) are synthetic compounds that have either an agonistic or antagonistic impact on target tissues determined by their binding to progesterone receptors. Their mixed activity depends on recruitment of cofactors that regulate transcription along so-called genomic pathways, as well as nongenomic interactions with other signaling pathways. There is no doubt that surgery remains indicated in some instances, but we must now establish whether use of SPRMs (notably ulipristal acetate) allows less invasive surgery or even complete avoidance of surgery. Long-term intermittent administration of ulipristal acetate will undoubtedly change our approach to the management of uterine fibroids according to the International Federation of Gynecology and Obstetrics classification, which provides a comprehensive basis for different treatment options. When considering less invasive techniques (uterus-sparing options like myomectomy), the choice is guided by the size, number and location of fibroids, as well as the personal experience of the gynecologist and available equipment. There is now a growing body of evidence pointing to the crucial role of progesterone pathways in the pathophysiology of uterine fibroids. SPRMs should, therefore, be considered an alternative to surgical therapy, or at least an adjunct to surgery, as illustrated in the algorithms. © 2019 Japan Society of Obstetrics and Gynecology.


Assuntos
Ginecologia/tendências , Leiomioma , Neoplasias Uterinas , Adulto , Gerenciamento Clínico , Feminino , Humanos , Pessoa de Meia-Idade
12.
J Gynecol Obstet Hum Reprod ; 48(7): 489-494, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30986541

RESUMO

OBJECTIVES: The aim of our work was to investigate changes in presentation and endometrial cancer (EC) types frequencies thorough a 40 years study period. PATIENTS AND METHODS: The patient group consisted of consecutive women undergoing surgery for endometrial cancer in our institution between 1975, and 2014. Clinical data included age, BMI (Kg/m2), histological data from surgical staging and survival data. RESULTS: 842 patients with the final diagnosis of endometrial cancer were enrolled. BMI was overweight rising through study decades. Age of diagnosis was also in constant augmentation since 1975. Type II EC proportion was 9.2% in the seventies and 27.9% after 2000. Overall survival was stable over time. Women with BMI < 18 kg/m2 had lower overall survival when compared to women with other BMI categories (p < 0.0001). DISCUSSION AND CONCLUSION: An analysis on a larger population of underweight women with EC is needed to identify specific factors. A trend to develop more type II EC can partly explain these results. We identified a clear trend of augmentation of type II EC, known to have a poor prognosis while necessitating specific surgical management. Histologic analysis standardisation, surgical strategy and amelioration of adjuvant treatments permitted to maintain a stable overall survival for the whole population despite this augmentation.


Assuntos
Carcinoma Endometrioide/epidemiologia , Neoplasias do Endométrio/epidemiologia , Ginecologia/tendências , Oncologia/tendências , Adulto , Idoso , Idoso de 80 Anos ou mais , Institutos de Câncer/estatística & dados numéricos , Carcinoma Endometrioide/mortalidade , Carcinoma Endometrioide/patologia , Neoplasias do Endométrio/mortalidade , Neoplasias do Endométrio/patologia , Feminino , França/epidemiologia , Ginecologia/estatística & dados numéricos , Humanos , Oncologia/estatística & dados numéricos , Pessoa de Meia-Idade , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Análise de Sobrevida , Centros de Atenção Terciária/estatística & dados numéricos
13.
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
14.
J Gynecol Oncol ; 30(3): e35, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30887757

RESUMO

OBJECTIVE: To determine patterns among gynecologic oncologists in sentinel lymph node mapping (SLNM) for endometrial cancer (EC) and cervical cancer (CC). METHODS: A online survey assessing the practice of SLNM, including incidence, patterns of usage, and reasons for non-use was distributed to Society of Gynecologic Oncology candidate and full members in August 2017. Descriptive statistics and univariate analysis was performed. RESULTS: The 1,117 members were surveyed and 198 responses (17.7%) were received. Of the 70% (n=139) performing SLNM, the majority reported use for both CC and EC (64.0%) or EC alone (33.1%). In those using SLNM in EC, the majority (86.6%) performed SLNM in >50% of cases for all patients (56.3%), International Federation of Gynecology and Obstetrics grade 1 (43.0%) and 2 (42.2%). Reported benefits of SLNM in EC were reduced surgical morbidity (89.6%), lymphedema (85.2%), and operative time (63.7%). Among those using SLNM for CC, the majority (73.1%) did so in >50% of cases. In EC, 77.2% and 21.3% reported that micro-metastatic disease (0.2-2.0 cm) and isolated tumor cells (ITCs) should be treated as node positive, respectively. In those not using SLNM for EC (n=64) and CC (n=105), concerns were regarding efficacy of SLNM and lack of training. When queried regarding training, 73.7% felt that SLNM would impact skill in full lymphadenectomy (LND). CONCLUSION: The SLNM is utilized frequently among gynecologic oncologists for EC and CC staging. Common reasons for non-uptake include uncertainty of current data, lack of training and technology. Concerns exist regarding impact of SLNM in fellowship training of LND.


Assuntos
Atitude do Pessoal de Saúde , Neoplasias do Endométrio/patologia , Padrões de Prática Médica , Biópsia de Linfonodo Sentinela , Linfonodo Sentinela/patologia , Neoplasias do Colo do Útero/patologia , Adulto , Idoso , Neoplasias do Endométrio/epidemiologia , Feminino , Ginecologia/estatística & dados numéricos , Ginecologia/tendências , Humanos , Excisão de Linfonodo/métodos , Excisão de Linfonodo/estatística & dados numéricos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Oncologistas/estatística & dados numéricos , Oncologistas/tendências , Padrões de Prática Médica/estatística & dados numéricos , Padrões de Prática Médica/tendências , Biópsia de Linfonodo Sentinela/métodos , Biópsia de Linfonodo Sentinela/psicologia , Biópsia de Linfonodo Sentinela/estatística & dados numéricos , Inquéritos e Questionários , Estados Unidos/epidemiologia , Neoplasias do Colo do Útero/epidemiologia
15.
Int J Health Care Qual Assur ; 32(1): 164-175, 2019 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-30859871

RESUMO

PURPOSE: Today, quality management systems (QMS) are a promising candidate for the improvement of healthcare services. The purpose of this paper is to investigate the opinions/attitudes of gynecology healthcare professionals toward quality and quality management in healthcare facilities (HFs) in Greece. DESIGN/METHODOLOGY/APPROACH: An anonymous self-administered questionnaire was distributed to healthcare professionals, asking for opinions on quality objectives associated with the everyday workflow in HFs (e.g. management of patients, resources, etc.) and on QMS. The study was conducted in Hippokration Hospital of Thessaloniki, including 187 participants. Statistical assessment and analysis of the questionnaires were carried out. FINDINGS: Although 87.5 percent recognized the importance of potential QMS implementation and accreditation, over 50 percent believed that it would lead rather to increased workload and bureaucracy than to any considerable quality improvement. More than 60 percent were completely unaware of the implementation of quality objectives such as quality handbook, quality policy, audit meetings and accreditation status in their HFs. This unawareness was also reported in terms of patient, data, human and general resources management. Finally, awareness over medical malpractice and positive attitude toward official reporting were detected. ORIGINALITY/VALUE: Most respondents acknowledged the significance of quality, QMS implementation and accreditation in Greek hospitals. However, there was a critical gap in knowledge about quality management objectives/processes that could be possibly resolved by expert teams and well-organized educational programs aiming to educate personnel regarding the various quality objectives in Greek HFs.


Assuntos
Atitude do Pessoal de Saúde , Ginecologia/normas , Pessoal de Saúde/organização & administração , Qualidade da Assistência à Saúde , Inquéritos e Questionários , Adulto , Assistência à Saúde/organização & administração , Estudos de Avaliação como Assunto , Feminino , Grécia , Ginecologia/tendências , Hospitais/normas , Humanos , Masculino , Pessoa de Meia-Idade , Controle de Qualidade , Gestão da Segurança , Adulto Jovem
17.
Obstet Gynecol ; 133(3): 477-483, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30741798

RESUMO

OBJECTIVE: To estimate the proportion of obstetrician-gynecologists (ob-gyns) who provided induced abortion in the prior year, disaggregated by surgical and medication methods, and document barriers to provision of medication abortion. METHODS: In 2016-2017, we conducted a cross-sectional survey of a national sample of American College of Obstetricians and Gynecologists Fellows and Junior Fellows who were part of the Collaborative Ambulatory Research Network. We sent the survey by email, and mailed nonresponders paper surveys. We performed descriptive statistics, χ tests, and logistic regression analyses. RESULTS: Sixty-seven percent (655/980) of Collaborative Ambulatory Research Network members responded. Ninety-nine percent reported seeing patients of reproductive age, and 72% reported having a patient in the prior year who needed or wanted an abortion. Among those seeing patients of reproductive age, 23.8% (95% CI 20.5%-27.4%) reported performing an induced abortion in the prior year; 10.4% provided surgical and medication abortion, 9.4% surgical only, and 4.0% medication only. In multivariable analysis, physicians practicing in the Midwest (adjusted odds ratio [AOR] 0.31, 95% CI 0.16-0.60) or South (AOR 0.22, 95% CI 0.11-0.42) had lower odds of provision compared with those practicing in the Northeast, whereas those practicing in an urban inner city (AOR 2.71, 95% CI 1.31-5.60) or urban non-inner-city area (AOR 2.89, 95% CI 1.48-5.64 vs midsize towns, rural areas, or military settings) had higher odds of provision. The most common reasons for not providing medication abortion were personal beliefs (34%) and practice restrictions (19%). Among those not providing medication abortion, 28% said they would if they could write a prescription for mifepristone. CONCLUSION: Compared with the previous national survey in 2008-2009, abortion provision may be increasing among practicing ob-gyns, although important geographic disparities persist. Few provide medication abortion, but uptake might increase if mifepristone could be prescribed.


Assuntos
Abortivos , Aborto Induzido/métodos , Aborto Induzido/estatística & dados numéricos , Ginecologia/estatística & dados numéricos , Obstetrícia/estatística & dados numéricos , Adulto , Atitude do Pessoal de Saúde , Estudos Transversais , Feminino , Ginecologia/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Mifepristona , Obstetrícia/tendências , Política Organizacional , Prática Profissional/organização & administração , Serviços de Saúde Rural/estatística & dados numéricos , Serviços de Saúde Suburbana/estatística & dados numéricos , Estados Unidos , Serviços Urbanos de Saúde/estatística & dados numéricos
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