Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 16.324
Filtrar
1.
Ann Anat ; 239: 151826, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34474126

RESUMO

BACKGROUND: Due to the importance, anatomy training is worldwide recognizable in virtually all undergraduate curricula and many postgraduate surgical curricula (Estai and Bunt, 2016; Older, 2004). The postgraduate curriculum of Obstetrics and Gynaecology (O&G) is such a surgical curriculum. It is a diverse branch of medicine and the role of anatomy in O&G is versatile. In the Netherlands nor in Europe the expectations of knowledge on anatomy are specified in the current training program, making trainees insecure about their performance in anatomy knowledge ("Better Education for Obsetrics and Gynaecology,"). Therefore, we recently performed a Delphi study to determine which anatomical structures should be taught to ensure safe and competent practice among general gynaecologists (Koppes et al., 2020). The aim of this study is the determination of the anatomical knowledge level in postgraduate training for O&G. Our hypothesis is that the trainees possess a good knowledge of anatomy and on average at least 80% of correct answers on core knowledge is shown. METHODS: A longitudinal knowledge analysis was performed under Dutch Trainees Obstetrics and Gynaecology. The anatomy questions of the annual progress tests from 2010 to 2019 were analysed. Anatomy questions were selected and assessed on relevance based on the previous performed Delphi study which identified 86 structures which are essential to perform safe and competent practice as a general gynaecologist. Scores on relevant anatomy questions were calculated. RESULTS: In 10-year 3136 trainees performed the annual progress test. 54 Anatomy related questions were asked on a total of 1637 questions (3.3%). Of these 54 questions, 38 (70%) were concerned as relevant questions. Overall 10-year score was 64.5%. CONCLUSIONS: The anatomy knowledge of trainees' Obstetrics and Gynaecology is insufficient. Our results are a step in the awareness of testing and improving anatomy knowledge of postgraduate O&G training.


Assuntos
Ginecologia , Obstetrícia , Competência Clínica , Currículo , Feminino , Ginecologia/educação , Humanos , Conhecimento , Obstetrícia/educação , Gravidez
2.
Obstet Gynecol Clin North Am ; 48(4): 689-703, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34756290

RESUMO

Simulation in obstetrics and gynecology has advanced significantly since its beginnings in the seventeenth century with wooden birthing and pelvic models. In recent years, more and more evidence has emerged showing improvements in participant confidence, skills, behaviors, and, finally, patient outcomes following simulation program implementation. Several regulatory bodies and national organizations have begun to require simulation of obstetrician-gynecologists, and the newer generation of physicians has experienced simulation throughout their training. Simulation is embedded in the medical culture and hopefully is making obstetrician-gynecologists better for it.


Assuntos
Ginecologia , Obstetrícia , Médicos , Simulação por Computador , Feminino , Pessoal de Saúde , Humanos , Gravidez
3.
Obstet Gynecol Clin North Am ; 48(4): 737-744, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34756293

RESUMO

The growth in the number of obstetrics and gynecology resident graduates pursuing fellowships has exceeded growth in the number of resident graduates, because more fellowship programs are being developed in more subspecialties rather than additional residency programs. Approximately 1 in 4 residents pursues subspecialty training, compared with 1 in 12 in 2001. The number of fellowships remains competitive, because nearly all programs fill their match and the number of applicants exceeds the number of positions. Graduating residents who serve as frontline women's health specialists need to serve as leaders of interprofessional teams to better serve their patients, especially in underserved areas.


Assuntos
Ginecologia , Internato e Residência , Obstetrícia , Bolsas de Estudo , Feminino , Ginecologia/educação , Humanos , Obstetrícia/educação , Especialização , Saúde da Mulher
4.
Obstet Gynecol Clin North Am ; 48(4): 759-776, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34756295

RESUMO

Robotics has become an essential part of the surgical armamentarium for a growing number of surgeons around the world. New companies seek to compete with established robotic systems that have dominated the market to date. Evolving robotic surgery platforms have introduced technologic and design advancements to optimize ergonomics, improve visualization, provide haptic feedback, and make systems smaller and cheaper. With the introduction of any new technology in the operating room, it is imperative that safeguards be in place to ensure its appropriate use. Current processes for granting of hospital robotic surgery privileges are inadequate and must be strengthened and standardized.


Assuntos
Ginecologia , Procedimentos Cirúrgicos Robóticos , Robótica , Humanos
5.
Obstet Gynecol Clin North Am ; 48(4): 787-800, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34756297

RESUMO

This article encourages the obstetrician-gynecologists to use social media platforms to share their wealth of clinical expertise and experience with the public in an engaging and empowering way. Social media is a powerful tool that increases communication, education, and support that can be leveraged to increase comprehension of women's health topics and advocate for our patients, both inside and outside the examination room. Included are tips for physicians on how to harness their social media superpower to connect with patients on social media, build a brand, and network in a meaningful and authentic way.


Assuntos
Ginecologia , Obstetrícia , Médicos , Mídias Sociais , Feminino , Humanos , Gravidez , Saúde da Mulher
6.
J Obstet Gynaecol Can ; 43(11): 1316-1323.e1, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34758906

RESUMO

OBJECTIVE: Provide strategies for improving the care of perimenopausal and postmenopausal women based on the most recent published evidence. TARGET POPULATION: Perimenopausal and postmenopausal women. BENEFITS, HARMS, AND COSTS: Target population will benefit from the most recent published scientific evidence provided via the information from their health care provider. No harms or costs are involved with this information since women will have the opportunity to choose among the different therapeutic options for the management of the symptoms and morbidities associated with menopause, including the option to choose no treatment. EVIDENCE: Databases consulted were PubMed, MEDLINE, and the Cochrane Library for the years 2002-2020, and MeSH search terms were specific for each topic developed through the 7 chapters. VALIDATION METHODS: The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations). INTENDED AUDIENCE: physicians, including gynaecologists, obstetricians, family physicians, internists, emergency medicine specialists; nurses, including registered nurses and nurse practitioners; pharmacists; medical trainees, including medical students, residents, fellows; and other providers of health care for the target population. SUMMARY STATEMENTS: RECOMMENDATIONS.


Assuntos
Ginecologia , Cognição , Feminino , Humanos , Menopausa , Sono
7.
Int J Med Educ ; 12: 233-242, 2021 Nov 26.
Artigo em Inglês | MEDLINE | ID: mdl-34842177

RESUMO

Objectives: We aimed to explore learning experiences among medical students learning to perform pelvic examinations and to identify factors that facilitate their training. Methods: A mixed-methods study including a web-based survey and focus group discussions (FGDs) was conducted among medical students who had completed their obstetrics and gynaecology (ObGyn) clerkship. The FGDs were recorded, transcribed and analysed using qualitative content analysis with systematic text condensation. Survey factors were compared using the χ2 test or Fisher's exact test. Results: 160 students (97 female, 61 male, two other) at six universities in Sweden responded to the survey. Two mixed FGDs were conducted. The majority (87%) of the students experienced confidence in performing pelvic examinations, stating that sufficient, repeated training opportunities and support from a clinical tutor were crucial components of the learning experience. Prior to the ObGyn clerkship, negative expectations were more common among male students. The male participants experienced having a disadvantage because of their gender, while female students considered their gender an advantage (p<0.001, N=121, Fisher's Exact Test). The clinical tutor and the use of professional patients (PPs) had a fundamental role in providing learning opportunities by including the student in patient care activities. Conclusions: The importance of the clinical tutor, as well as the use of PPs, are important factors when planning education in pelvic examinations, and this knowledge could be used when educating other intimate examinations during medical school. In addition, similar investigations on students' experience in training other intimate examinations could be considered.


Assuntos
Estágio Clínico , Ginecologia , Obstetrícia , Estudantes de Medicina , Feminino , Exame Ginecológico , Ginecologia/educação , Humanos , Masculino , Obstetrícia/educação , Gravidez
9.
Obstet Gynecol Surv ; 76(10): 634-643, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34724075

RESUMO

Importance: Substance use during pregnancy is a major health issue for both the mother and the fetus, but it also represents an important public health concern. Objective: The aim of this review was to summarize and compare recommendations from recently published guidelines on substance use during pregnancy and especially regarding alcohol, smoking, and drug use. Evidence Acquisition: A descriptive review of guidelines from the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, the World Health Organization (WHO), the Society of Obstetricians and Gynaecologists of Canada, and the American College of Obstetricians and Gynecologists on substance use was conducted. Regarding the term "substance use," the most recently published Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition substances were used. Results: All the reviewed guidelines recommend appropriate counseling and screening women regarding alcohol, smoking, and drug use during the antenatal period, while the management options vary. More specifically, the prompt management of alcohol dependence is emphasized by all the guidelines except from the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, which makes no recommendation upon. The use of alcohol during breastfeeding should be avoided. Regarding smoking cessation, all guidelines recommend the use of certain psychosocial, behavioral interventions, and pharmacotherapy. All the guidelines, except the one from the WHO, suggest screening drug users for coexistent sexually transmitted infections. Brief interventions are considered beneficial, while a gradual decrease in benzodiazepines is suggested, as well as the discontinuation of marijuana and methamphetamine use. However, there is controversy regarding breastfeeding in those women as the WHO recommends in favor, whereas the Society of Obstetricians and Gynaecologists of Canada and the American College of Obstetricians and Gynecologists recommend against this practice. Finally, all the guidelines state that, following delivery, close monitoring of the neonate is needed. Conclusions: The diversity of guidelines' recommendations concerning substance use reflects the different ways of the management of pregnant women during routine antenatal care due to absence of strong evidence. More research in the areas of dispute may allow the adoption of an international consensus, in order to early detect and appropriately manage pregnant women with harmful addictions.


Assuntos
Ginecologia , Transtornos Relacionados ao Uso de Substâncias , Austrália , Canadá , Feminino , Humanos , Recém-Nascido , Gravidez , Cuidado Pré-Natal , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/terapia
10.
BMC Pregnancy Childbirth ; 21(1): 670, 2021 Oct 03.
Artigo em Inglês | MEDLINE | ID: mdl-34602060

RESUMO

BACKGROUND: Coronavirus currently cause a lot of pressure on the health system. Accordingly, many changes occurred in the way of providing health care, including pregnancy and childbirth care. To our knowledge, no studies on experiences of maternity care Providers during the COVID-19 Pandemic have been published in Iran. We aimed to discover their experiences on pregnancy and childbirth care during the current COVID-19 pandemic. METHODS: This study was a qualitative research performed with a descriptive phenomenological approach. The used sampling method was purposive sampling by taking the maximum variation possible into account, which continued until data saturation. Accordingly, in-depth and semi-structured interviews were conducted by including 12 participants, as 4 gynecologists, 6 midwives working in the hospitals and private offices, and 2 midwives working in the health centers. Data were analyzed using Colaizzi's seven stage method with MAXQDA10 software. RESULTS: Data analysis led to the extraction of 3 themes, 9 categories, and 25 subcategories. The themes were as follows: "Fear of Disease", "Burnout", and "Lessons Learned from the COVID-19 Pandemic", respectively. CONCLUSIONS: Maternal health care providers experience emotional and psychological stress and work challenges during the current COVID-19 pandemic. Therefore, comprehensive support should be provided for the protection of their physical and mental health statuses. By working as a team, utilizing the capacity of telemedicine to care and follow up mothers, and providing maternity care at home, some emerged challenges to maternal care services can be overcome.


Assuntos
COVID-19/psicologia , Pessoal de Saúde/psicologia , Serviços de Saúde Materna/estatística & dados numéricos , Assistência Perinatal/estatística & dados numéricos , Adulto , Esgotamento Psicológico/psicologia , COVID-19/diagnóstico , COVID-19/epidemiologia , COVID-19/virologia , Emoções/fisiologia , Feminino , Ginecologia/estatística & dados numéricos , Pessoal de Saúde/estatística & dados numéricos , Humanos , Recém-Nascido , Entrevistas como Assunto , Irã (Geográfico)/epidemiologia , Serviços de Saúde Materna/tendências , Pessoa de Meia-Idade , Tocologia/estatística & dados numéricos , Assistência Perinatal/organização & administração , Transtornos Fóbicos/psicologia , Gravidez , Pesquisa Qualitativa , SARS-CoV-2/genética , Estresse Psicológico/psicologia , Telemedicina/métodos
11.
Rev Med Suisse ; 17(755): 1770-1773, 2021 Oct 20.
Artigo em Francês | MEDLINE | ID: mdl-34669290

RESUMO

The deaf and hard of hearing population suffers from difficulties in accessing the health care system due to communication barriers with health care and administrative personnel who are often insufficiently trained in deafness issues. Gynecology-obstetrics consultations represent a gateway to the health system. Since 2011, there is a gynecology and obstetrics consultation dedicated to deaf people at the CHUV. This article presents the means of communication support put in place within the context of this specific consultation as well as the experience of a group of patients. Awareness of deafness among all staff in contact with patients as well as the use of professional interpreters are the key elements of care that respects the needs and rights of deaf people.


Assuntos
Surdez , Ginecologia , Perda Auditiva , Obstetrícia , Audição , Humanos
12.
Rev Med Suisse ; 17(755): 1798-1802, 2021 Oct 20.
Artigo em Francês | MEDLINE | ID: mdl-34669295

RESUMO

Progesterone (P4), a steroid primarily secreted by the corpus luteum, placenta and adrenal glands, plays an essential role on female reproductive function. Progestins (PS) are synthetic analogues of P4 with specific steroid receptor affinities. A progestin-only-pill (POP) with an antimineralocorticoid effect was recently marketed with a tolerance and safety profile superior to existing POPs. In contrast, PS with antiandrogenic properties used at high doses for the treatment of hirsutism have been associated with an increased meningioma risk. New clinical and fundamental data open paths for research into the therapeutic use of P4 in cognition, neuroprotection and bone.


Assuntos
Ginecologia , Feminino , Humanos , Placenta , Gravidez , Progesterona , Progestinas/uso terapêutico
13.
J Med Case Rep ; 15(1): 517, 2021 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-34670612

RESUMO

BACKGROUND: We report here a case of a healthy 23-year-old female patient who was assessed at the gynecology emergency department for genital ulcers, fever, and blurred vision. After suspicion of herpes simplex virus-2 lesions, the diagnosis of Behçet's disease was made. We report this case with the aim of including Behçet's disease in the differential diagnosis of genital ulcers, and emphasize the emergency of the vision loss that can be irreversible. CASE PRESENTATION: A healthy 23-year-old European female patient was assessed by gynecology in the emergency department for genital lesions associated with fever and blurred vision. At first, these lesions were suspected to be primary herpes simplex virus-2 infection One day later, she experienced decreased visual acuity in both eyes. After 4 days of worsening genital ulcers and persistent blurred vision, the patient was referred to the ophthalmology department. Fundoscopic examination showed retinal hemorrhages that were consistent with the first presentation of Behçet's disease. CONCLUSIONS: This case demonstrates that genital ulcers can be the very initial symptom of this ophthalmologic emergency. The differential diagnosis of genital ulcers is challenging. Behçet's disease should be included, especially when associated with systemic or ocular manifestations, and should be considered an emergency for the gynecologist to prevent long-term vision loss.


Assuntos
Síndrome de Behçet , Ginecologia , Obstetrícia , Oftalmologistas , Adulto , Síndrome de Behçet/complicações , Síndrome de Behçet/diagnóstico , Feminino , Humanos , Úlcera , Adulto Jovem
14.
Br J Hosp Med (Lond) ; 82(9): 1-3, 2021 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-34601937

RESUMO

Patients requiring pelvic floor and functional urological, gynaecological and coloproctological surgery were viewed as a low priority even before COVID-19. A consensus report outlines recommendations to improve care and encourage clinicians to help bring about positive changes for patients with pelvic floor problems.


Assuntos
COVID-19 , Ginecologia , Humanos , Assistência ao Paciente , Diafragma da Pelve , SARS-CoV-2
15.
J Med Libr Assoc ; 109(3): 382-387, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34629966

RESUMO

Objective: To compare the accuracy, time to answer, user confidence, and user satisfaction between UpToDate and DynaMed (formerly DynaMed Plus), which are two popular point-of-care information tools. Methods: A crossover study was conducted with medical residents in obstetrics and gynecology and family medicine at the University of Toronto in order to compare the speed and accuracy with which they retrieved answers to clinical questions using UpToDate and DynaMed. Experiments took place between February 2017 and December 2019. Following a short tutorial on how to use each tool and completion of a background survey, participants attempted to find answers to two clinical questions in each tool. Time to answer each question, the chosen answer, confidence score, and satisfaction score were recorded for each clinical question. Results: A total of 57 residents took part in the experiment, including 32 from family medicine and 25 from obstetrics and gynecology. Accuracy in clinical answers was equal between UpToDate (average 1.35 out of 2) and DynaMed (average 1.36 out of 2). However, time to answer was 2.5 minutes faster in UpToDate compared to DynaMed. Participants were also more confident and satisfied with their answers in UpToDate compared to DynaMed. Conclusions: Despite a preference for UpToDate and a higher confidence in responses, the accuracy of clinical answers in UpToDate was equal to those in DynaMed. Previous exposure to UpToDate likely played a major role in participants' preferences. More research in this area is recommended.


Assuntos
Medicina Baseada em Evidências , Ginecologia/educação , Obstetrícia/educação , Sistemas Automatizados de Assistência Junto ao Leito , Estudos Cross-Over , Estudos Transversais , Ginecologia/economia , Humanos , Distribuição Aleatória , Inquéritos e Questionários
18.
BJOG ; 128(12): 1893, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34617665
19.
Int J Gynaecol Obstet ; 155(3): 556-560, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34628655

RESUMO

Medical associations and leading courts reinforce the duty of physicians who conscientiously object to participating in treatment indicated for their patients to refer them to non-objecting practitioners. Ethical and legal duties require continuity of care when physicians withdraw from patients' treatment on grounds of conscience. The duty to refer might affect gynecologists when their patients request for example, contraceptive means, sterilization, abortion, medically assisted reproductive procedures, or gender reassignment. Legislation and leading law courts, notably the UK Supreme Court and Constitutional Court of Colombia, and professional associations such as the College of Physicians and Surgeons of Ontario, have clarified the duty to refer. Physicians are expected to cater their individual conscience to their professional ethical and legal duties, favoring their patients' choices over their personal objections. Physicians can object to "hands-on" conduct of procedures they find objectionable, but cannot deny referral on grounds of complicity in what other care providers do.


Assuntos
Aborto Induzido , Ginecologia , Médicos , Consciência , Feminino , Humanos , Gravidez , Recusa do Médico a Tratar
20.
Glob Health Epidemiol Genom ; 2021: 1158533, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34631112

RESUMO

Community-Based Health Insurance (CBHI) is a form of micro health insurance targeted at low-income groups that permits for grouping of assets to tackle the expenses of future, uncertain, health-related circumstances. According to the International Labour Organisation, more than 80% of India's employed nonagricultural population is in the informal sector, implying that they are possibly excluded from receiving health insurance benefits. This is where CBHI comes into play, wherein groups of people belonging to a community define the demand and benefits and pool their resources to provide financial protection to all their members. This study aims to scrutinize the package prices sanctioned by these schemes and compare them with the cost incurred by the hospital. The expense pattern of three surgeries in the Department of Obstetrics and Gynaecology was analysed under three insurance schemes: Arogya Bhagya Yojana, Arogya Karnataka, and Employees' State Insurance Scheme. Methodology. A retrospective study was conducted in a 2,032-bedded tertiary care hospital in South India. Patients of abdominal hysterectomy, vaginal hysterectomy, and caesarean section surgeries covered by any of the insurance schemes mentioned above were a part of the inclusion criteria. The patient records were examined from the hospital's Medical Records Department (MRD). The patients' bills were assembled from the inpatient billing department to scrutinize all the expenses associated with each surgery. The variable costs include consumables, medicine, electricity and AC, diagnostics, blood bank materials, doctor's fee, package differences, and others. In contrast, fixed costs include bed cost, equipment cost (purchase + annual maintenance cost), manpower cost-OT, manpower cost-nursing, and allocated indirect costs associated with the medical treatment. These were computed and compared with the package price of respective insurance schemes to determine if the schemes are profit-yielding schemes or loss-yielding schemes, using the data from the finance department. Results and Conclusion. It has been observed that the operating loss of the hospital for abdominal hysterectomy, vaginal hysterectomy, and caesarean section under CBHI schemes ranges between 7% and 36%. The highest loss was observed in Arogya Karnataka Scheme for caesarean section surgery (BPL patients). The amount received through these schemes is insufficient to cover the costs acquired by the hospital, let alone make a profit. However, under Arogya Bhagya and ESI Schemes, the hospital has made a profit in covering the variable costs for these surgeries. The study concludes that the hospital is running under loss due to the three Community-Based Health Insurance (CBHI) schemes.


Assuntos
Seguro de Saúde Baseado na Comunidade , Ginecologia , Obstetrícia , Cesárea , Estudos de Viabilidade , Feminino , Humanos , Índia , Gravidez , Estudos Retrospectivos , Centros de Atenção Terciária
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...