Effect of mobile-phase modifiers on the enantioselective retention behavior of methyl mandelate with an amylose 3,5-dimethylphenylcarbamate chiral stationary phase under reversed-phase conditions.

In this study, methanol, ethanol, n-propyl alcohol, isopropyl alcohol, acetone, and tert-butanol were used as organic modifiers in reversed-phase mode chiral liquid-chromatography to systematically investigate the effects of mobile phase components on the enantioselective retention behavior of methyl mandelate with immobilized amylose 3,5-dimethylphenylcarbamate-based sorbent called Chiralpak IA. A two-site enantioselective model was used to obtain information on the recognition mechanisms by observing the dependence of the enantioselectivity and retention factor difference on the modifier content. Similar enantioselective retention behaviors were observed for all modifiers, and characteristic modifier concentration points (PL , PM , and PH ) were identified. At modifier concentrations up to PM , the weakened hydrophobic environment resulted in polymer structural relaxation, which changed the recognition mechanisms. By contrast, at concentrations beyond PH , considerably different enantioselectivity behaviors were observed, indicating that the existence of dipole-dipole interaction, which was stronger at higher modifier concentrations, contributed to the retention mechanisms. The concentrations at which these characteristic points occurred were dependent on the carbon number of the modifier molecule. Modifiers with more carbon numbers facilitated the transition in the enantioselective behaviors. These results demonstrated that the proposed method can provide a physically consistent quantitative description of enantioselective retention behavior in reversed-phase mode.

Treatment strategy for urinary frequency in women.

The purpose of this paper is to discuss the differential diagnosis of the underlying etiologies of urinary frequency and the treatment strategies for urinary frequency in women. Urinary frequency is a symptom, a sign, and a condition of uncertainty and of multifactorial cause. Common causes of urinary frequency include psychosocial, medical, sexual, urological, gynecologic, endocrine, and pharmacological in origin. Hence, treatment of symptoms and possible cures need a high-level plan or strategy to overcome the multifactorial etiology. Proper investigation of the chief complaint, history and physical examinations, is needed to evaluate urinary frequency. Pregnancy test, wet smear, urinalysis, midstream urine culture, frequency-volume charts, cystourethroscopy, urodynamics, and genitourinary imaging are the basic routine of office investigations. These tools promote the accuracy of the differential diagnosis of the underlying cause of urinary frequency. It is then often helpful to adopt an algorithmic approach to the management of this complaint. Treatment of urinary frequency might be empirical, and it remains a clinical challenge to gynecologists. To cure the disease, it is important to listen to the patient and consider the condition in all its aspects and use proven techniques.

Single-incision mesh repair versus traditional native tissue repair for pelvic organ prolapse: results of a cohort study.

INTRODUCTION AND HYPOTHESIS: To compare the efficacy and safety of the Elevate™ anterior and posterior prolapse repair system and traditional vaginal native tissue repair in the treatment of stage 2 or higher pelvic organ prolapse. METHODS: A cohort study was conducted between January 2010 and July 2012. Patients who underwent transvaginal pelvic reconstruction surgery for prolapse were recruited. The primary outcome was anatomical success 1 year after surgery. The secondary outcome included changes in the quality of life and surgical complications. Recurrence of prolapse was defined as stage 2 or higher prolapse based upon the pelvic organ prolapse qQuantification system. RESULTS: Two hundred and one patients (100 in the Elevate™ repair group and 101 in the traditional repair group) were recruited and analyzed. The anatomical success rate of the anterior compartment was significantly higher in the Elevate™ repair group than in the traditional repair group (98 % vs 87 %, p = 0.006), but not for the apical (99 % vs. 6 %, p = 0.317) or posterior (100 % vs 97 %, p = 0.367) compartments after a median 12 months of follow-up. Both groups showed significant improvements in the quality of life after surgery with no statistical difference. Mesh-related complications included extrusion (3 %) and the need for revision of the vaginal wound (1 %). Those in the mesh repair group had a longer hospital stay (p = 0.04), operative time (p < 0.001), and greater estimated blood loss (p = 0.05). Other complications were comparable with no statistical difference. CONCLUSIONS: The Elevate™ prolapse repair system had a better 1-year anatomical cure rate of the anterior compartment than traditional repair, with slightly increased morbidity.

A prospective study of transobturator tape as treatment for stress urinary incontinence after transvaginal mesh repair.

INTRODUCTION AND HYPOTHESIS: The transobturator suburethral sling is a common surgical treatment for stress urinary incontinence (SUI). In patients with incontinence after trocar-guided transvaginal mesh repair (Prolift), data on outcome remain limited. In the present study, we hypothesized that transobturator tape in such cases is assumed to be as effective as surgery alone. METHODS: This was a prospective analysis of outcomes of transobturator slings in women who had undergone transvaginal mesh repair and in those who underwent sling surgery alone (controls). Objective cure was defined as the absence of urinary leakage during the stress test at filling cystometry and a negative cough test during pelvic examination. The success rates were evaluated 3-6 months postoperatively. RESULTS: One hundred women were recruited for the study. Compared to the control group, women after transvaginal mesh repair had a significantly lower objective success rate (62 vs 86%, p = 0.005) and poorer bladder neck mobility (0.5 ± 0.8 vs 1.1 ± 0.5 cm, p = 0.001). CONCLUSIONS: The transobturator sling has lower objective success rate in women after transvaginal mesh that may be due to decreased bladder neck mobility. Patients with post-mesh repair SUI who opt for sling surgery should be informed of these less satisfactory outcomes during preoperative counseling.

Central Compartment Atopic Disease and Its Surgical Outcomes: Olfactory Changes and Technical Notes.

Background: Central compartment atopic disease (CCAD) is a recent, novel phenotype of chronic rhinosinusitis. Only a few studies have assessed olfactory function in patients with CCAD. Objectives: We aimed to investigate olfactory function changes after functional endoscopic sinus surgery (FESS) in patients with CCAD and proposed some surgical techniques to enhance the postoperative olfactory outcomes in such patients. Design: A retrospective cohort study. Methods: We collected data from 23 patients (8 men and 15 women) with CCAD who underwent FESS performed by a surgeon in Taiwan, between June 2018 and December 2021. The demographic data, olfactory function, and serum and tissue eosinophil percentages of the included patients were analyzed. The Top International Biotech Smell Identification Test (TIBSIT; Top International Biotech, Taipei, Taiwan) was used to assess olfactory function. Results: Of the 23 patients, most (95%) showed a positive reaction to aeroallergens, and 2 patients (8.7%) had asthma. Ten patients (43.5%) had peripheral eosinophilia, and 9 (39%) had eosinophilic nasal polyps. Moreover, the patients presented with variable olfactory dysfunction; the mean preoperative TIBSIT (pr-TIBSIT) score was 12.8 ± 2.3 (range: 0-43), whereas the mean postoperative TIBSIT (po-TIBSIT) score was 29.2 ± 1.9 (range: 16-44). The po-TIBSIT score was significantly better than the pre-TIBSIT score (paired t test, P < .0001). The improvement in olfactory function was not significantly correlated with the patients' age, serum eosinophil percentages, and nasal polyp eosinophil counts. Conclusion: Our findings indicate that CCAD is significantly associated with olfactory dysfunction and that FESS can effectively improve olfactory function. To optimize postoperative olfactory outcomes, precise removal of polyps from the olfactory cleft without damaging the neuroepithelium is recommended. Our study provides valuable insights into the management of CCAD patients undergoing FESS and can guide surgical decision-making to achieve optimal olfactory function outcomes.

Five-year results of no-fault compensation related to childbirth injuries in Taiwan.

OBJECTIVE: Increasing obstetric medical litigations had great impacts in health care system resulted in lower recruitment of residents and higher medical cost of defensive medicine in Taiwan. In order to reduce medical litigation, the "Childbirth Accident Emergency Relief Act" was implemented in June 2016. This study presented five-year results of a novel childbirth accident compensation system. MATERIALS AND METHODS: The purpose of the Relief Act was to establish a national relief system to ensure timely relief, reduce medical disputes, promote the partnership between patient and medical personnel. The compensations included maximal 2 million NTD for maternal death, maximal 0.3 million NTD for neonatal and fetal deaths, and 3, 2, and 1.5 million NTD for maternal or neonatal profound, severe, and moderate disabilities, respectively. Puerperal hysterectomy was included with maximal 0.8 million NTD compensation. RESULTS: Since June 30, 2016 to June 30, 2021, there were 1340 applications reviewed by Committee and 1258 were approved with total relief of 744.7 million NTD (26.6 million USD) with approve rate of 93.9%. It took an average of 109.8 days to start application from childbirth and 102.4 days to get compensation from application. 66.1% of accident victims agreed this system can restore doctor-patient relationship by immediate care and assistance from medical institutions. CONCLUSION: The Relief Act is the first government leading compensation system to establish a national relief system. It was enacted to reduce medical disputes, promote the partnership between patient and medical personnel, and enhance health and safety of women during childbirth. A no-fault compensation would be an efficient alternative disputes resolution to childbirth accidents.

Potential Role of CXCL13/CXCR5 Signaling in Immune Checkpoint Inhibitor Treatment in Cancer.

Immune checkpoint inhibitors (ICIs), including antibodies that target programmed cell death protein 1 (PD-1), programmed death-ligand 1 (PD-L1), or cytotoxic T lymphocyte antigen 4 (CTLA4), represent some of the most important breakthroughs in new drug development for oncology therapy from the past decade. CXC chemokine ligand 13 (CXCL13) exclusively binds CXC chemokine receptor type 5 (CXCR5), which plays a critical role in immune cell recruitment and activation and the regulation of the adaptive immune response. CXCL13 is a key molecular determinant of the formation of tertiary lymphoid structures (TLSs), which are organized aggregates of T, B, and dendritic cells that participate in the adaptive antitumor immune response. CXCL13 may also serve as a prognostic and predictive factor, and the role played by CXCL13 in some ICI-responsive tumor types has gained intense interest. This review discusses how CXCL13/CXCR5 signaling modulates cancer and immune cells to promote lymphocyte infiltration, activation by tumor antigens, and differentiation to increase the antitumor immune response. We also summarize recent preclinical and clinical evidence regarding the ICI-therapeutic implications of targeting the CXCL13/CXCR5 axis and discuss the potential role of this signaling pathway in cancer immunotherapy.

A new laparoscopic technique for uterine prolapse: one-sided uterine fixation through the round ligament.

INTRODUCTION AND HYPOTHESIS: In this study, we provide a description of laparoscopic uterine suspension technique through round ligament. METHODS: From 1997 to 2010, 55 patients with uterine prolapse were treated by laparoscopic uterine suspension. It is performed by suturing and tying a 1-0 Ethibond on the left round ligament at its insertion into the uterus. Then curved forceps pass the lateral puncture wound into the extraperitoneal space along the round ligament and penetrates the anterior leaf of the broad ligament into the peritoneal cavity and grasps the free ends of the Ethibond. They are withdrawn extraperitoneally along the round ligament then tightly tied at the fasciae on either side of the lateral puncture wound. RESULTS: Forty-two out of 55 patients (76.4%) experienced a reduction of prolapse to stage 0, regardless of what stage they started from. Twelve out of 55 (21.8%) experienced a reduction of prolapse varying from one to two stages. One out of 55 (1.8%) experienced no reduction in prolapse. CONCLUSIONS: This technique reconstructs a new, inelastic round ligament.

Impact of Prolift procedure on bladder function and symptoms in women with pelvic organ prolapse.

INTRODUCTION AND HYPOTHESIS: This study aims to investigate the impact of the Prolift procedure on bladder function and symptoms in women with pelvic organ prolapse. METHODS: Seventy-one consecutive patients who underwent the Prolift procedure were evaluated on the subjective reporting of symptoms and objective urodynamic measurements pre- and 1 year postoperatively. RESULTS: Subjective symptoms significantly improved after surgery included frequency, urgency incontinence, straining to void, incomplete bladder emptying, and poor urine stream but the incidence of stress urinary incontinence was unchanged. Compared with preoperative urodynamic measurements, the residual urine volume, maximal bladder capacity, and urethral closure pressure significantly decreased postoperatively. CONCLUSIONS: After 1-year follow-up, the Prolift procedure resulted in reduced storage function and impaired bladder capacity urodynamically, but emptying function improved. Lower urinary tract symptoms were significantly improved, except for an unchanged incidence of stress urinary incontinence. Women should be informed of the possible impacts before the procedure.

Outcome of transvaginal pelvic reconstructive surgery with Prolift after a median of 2 years' follow-up.

INTRODUCTION AND HYPOTHESIS: This study seeks to analyze the medium- to long-term outcome of transvaginal pelvic reconstructive surgery using the Prolift™ system for pelvic organ prolapse. METHODS: Sixty-five patients who underwent pelvic floor reconstruction using Prolift™ were followed for 1 to 3 years postoperatively. Assessment included pre- and postoperative Pelvic Organ Prolapse Quantification (POP-Q) stage, Urogenital Distress Inventory (UDI-6), and Incontinence Impact Questionnaire (IIQ-7) scores. RESULTS: The overall anatomic success rate was 97% after a median of 24.5 months and 94% for the 34 women followed for more than 2 years. POP-Q stage, UDI-6, and IIQ-7 scores all improved significantly after surgery. Complications included one bladder perforation (1.5%) and one bowel perforation (1.5%), prolonged catheterization in four patients (6%), and mesh erosion in one (2%). Eight received blood transfusion (12%). CONCLUSIONS: Prolift™ surgery yielded a good anatomical outcome and satisfactory symptom improvement that appeared to be durable after 2 years.

Effect of 2-propanol content on solute retention mechanisms determined using amylose tris(3,5-dimethylphenylcarbamate) chiral stationary phase under normal- and reversed-phase conditions.

The electrostatic interactions between chiral solutes and polysaccharide (PS)-based chiral selectors are the key to achieving chiral recognition; however, PS-based sorbents, derivatized of phenyl moieties, can exhibit considerably non-polar characteristics, and they are also useful for the separation of enantiomers in the reversed-phase mode. In this study, an immobilized amylose 3,5-dimethylphenylcarbamate-based sorbent was used to investigate the balance between electrostatic interactions and solvophobic interactions, with complementary effects on solute retention behavior when the isopropanol (IPA) concentration was altered. It was proposed that in both normal- and reversed-phase modes, information on the retention mechanisms could be obtained by observing the curvature of the logarithm of the retention factor versus the logarithm of the IPA concentration, and the slope values of the curves were related to the number of displaced IPA molecules upon solute adsorption. Using the proposed model and the two-site adsorption model, the retention behaviors of pantolactone (PL) enantiomers in both normal- and reversed-phase modes were investigated. The PL-sorbent interactions were classified into four types: electrostatic/enantioselective, electrostatic/nonselective, solvophobic/enantioselective, and solvophobic/nonselective. At IPA concentrations below 50 vol.% in n-hexane, the retention behaviors of PL were dominated by electrostatic/enantioselective sites, whereas at IPA concentrations beyond 50 vol.%, the solvophobic interactions of PL-sorbent were strengthened and mostly nonselective. By contrast, in the reversed-phase mode, a reverse in the enantiomeric elution order of PL was observed at 10 vol.% IPA, and considerably different enantioselectivity behaviors were found below and above 20 vol.%, indicating an abrupt change in the sorbent molecular environment. At IPA concentrations beyond 40 vol.%, the presence of PL-sorbent electrostatic interactions enhanced chiral recognition.

A survey of career-decision factors for obstetrics and gynecology residents in Taiwan.

OBJECTIVE: The recruitment of obstetrics and gynecology residents has been challenging in Taiwan since 2000. There are a lots factors influencing applying, including career interest and prospects, lifestyle, salary, litigation, stress level, time demands of specialty work and gender consideration. The purpose of this study was to evaluate the factors influencing the career choice of current OB/GYN residents and identify the important factors influencing recruitment. MATERIALS AND METHODS: A cross-sectional questionnaire of career-decision factors was sent to all 280 residents during December, 2019. Total 16 factors were rated on a 5-point Likert and were ranking by their average score on the scale. Gender of residents was analyzed for their association with the scores by a two-sample test and two-tailed t test. RESULTS: 91 (32.5%) residents responded and 61 were female and 30 were male. The top influencing factor was being interested in clinical expertise with an average score of 4.32. The second factor was having a great sense of accomplishment in saving people with an average score of 3.82, followed by it being easier to become a medical practitioner at 3.77. The lowest scoring factor was fewer hours of work, with an average score of 1.77 and a safer working environment with a score of 2.33 was the second lowest factor. Female residents agreed that it was easier to get specialist certification with a score of 3.0. This score was significantly higher than male doctors at 2.63 with p value of 0.017. CONCLUSION: Career interest and prospects were key influencing factors for applying OB/GYN residents. Minimizing the influence of detracting factors like heavy workload and medical litigation was also effective. Enrolling new residents is key to maintaining adequate staffing in specialties in healthcare. Establishing a safer work environment and determining the optimal workload will be the next reforms in the future.

Investigation of Normative Value of Commercialized Taiwan Smell Identification Test.

BACKGROUND: The Taiwan Smell Identification Test (TWSIT) was developed and successfully administered in Taiwanese population since 2015. However, for sanitation reason, the original liquid-jar form of this test is not appropriate. The commercialized TWSIT was then re-designed as "scratch-and-sniff" version: the TIBSIT (Top International Biotech, Taipei, Taiwan). This project aims to investigate the normative value of TIBSIT in different age groups and genders. METHODS: Volunteers aged 20 to 80 with no subjective smell loss were recruited in a rhinology clinic. The participants were given full instructions on using the TIBSIT. RESULTS: Two hundred and nine healthy subjects (female: male =107: 102) were enrolled into this study. The median TIBSIT score in female and male subjects is 47 and 46, respectively. Subjects were further divided into three age groups: (A) 20∼34 years (n = 77), (B) 35∼54 years (n = 77), and (C) 55∼80 years (n = 55). The TIBSIT scores at the tenth percentile value at each age group of male patients are 43, 42 and 37; while the scores at the tenth percentile value at each age group of female patients are 42, 42 and 41. TIBSIT score was significantly and inversely correlated with age (Spearman rho = - 0.20, p = 0.004.). CONCLUSION: We established the normative values of the new TIBSIT in different age groups in Taiwan. Future nation-wide screening is needed for more sophisticated norms establishment.

Short term impact on female sexual function of pelvic floor reconstruction with the Prolift procedure.

INTRODUCTION: The Prolift system is an effective and safe procedure using mesh reinforcement for vaginal reconstruction of pelvic organ prolapse (POP), but its effect on sexual function is unclear. AIM: To evaluate the impact of transvaginal pelvic reconstruction with Prolift on female sexual function at 6 months post-operatively. METHODS: Thirty-three sexually active women who underwent Prolift mesh pelvic floor reconstruction for symptomatic POP were evaluated before and 6 months after surgery. Their sexual function was assessed by using the short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) before and after surgery. The quality of life was also evaluated with the short forms of the Urogenital Distress Inventory (UDI-6) and the Incontinence Impact Questionnaire (IIQ-7) as a control for efficacy of the procedure. The Pelvic Organ Prolapse Quantification system was used to evaluate the degree of prolapse. MAIN OUTCOME MEASURES: PISQ-12 scores at 6 months post-operatively. RESULTS: The total PISQ-12 score decreased from 29.5 +/- 9.0 to 19.3 +/- 14.7 (P < 0.001), indicating worsening of sexual function 6 months post-operatively. The behavioral, physical, and partner-related domains of PISQ-12 were each significantly reduced (5.2 +/- 3.7 vs. 2.9 +/- 3.7, P = 0.016; 15.4 +/- 4.7 vs. 10.4 +/- 8.6, P = 0.001; 8.9 +/- 3.8 vs. 6.4 +/- 5.5, P = 0.01, respectively). UDI-6 and IIQ-7 scores were significantly improved at the 6-month follow-up, as was anatomic recovery. Of the 33 subjects, 24 (73%) had worse sexual function 6 months after the procedure. CONCLUSION: The Prolift procedure provided an effective anatomic cure of POP, but it had an adverse effect on sexual function at 6 months after surgery.

Functional and anatomic assessments for transobturator vaginal tape inside-out operation for urodynamic stress incontinence.

AIM: The aim of the present study was to assess by urodynamic study and chain urethrocystography the functional and anatomic changes before and after transobturator vaginal tape inside-out (TVT-O) operation. METHODS: From January 2005 to February 2006, 35 women were enrolled who had urodynamic stress incontinence, with or without intrinsic sphincter deficiency, and had undergone TVT-O with regular follow-up. Investigations, including pelvic examination, pad test, urodynamic study, chain urethrocystography and questionnaire with short forms of Urogenital Distress Inventory and Incontinence Impact Questionnaire, were performed pre- and postoperatively. RESULTS: The mean follow-up period was 12.8 months. The subjective and objective cure rates were 80 and 71.4%, respectively. The maximal urethral pressure was significantly decreased (from 67.0 to 58.9 cmH(2)O) after surgery and bladder neck mobility was reduced. Quality of life assessment revealed significant improvement after TVT-O. CONCLUSION: TVT-O is an effective operation for female urodynamic stress incontinence. Improved postoperative bladder neck mobility showed anatomic correction, indicating a hammock effect. The decreased maximal urethral pressure may reflect neurogenic damage during surgery; thus, minimal dissection and avoidance of unnecessary dissection to prevent periurethral damage are advised.

Prevalence of and attitude toward urinary incontinence in postmenopausal women.

OBJECTIVE: To investigate the prevalence of urinary incontinence, and the knowledge, attitudes, and practices of Taiwanese women aged 60 years or older. METHOD: A nationwide epidemiological study was conducted and a sample of 2410 women was selected. Personal visits to 1517 women were completed. RESULTS: A total of 485 (29.8%) women reported urinary incontinence; 250 (69.9%) urinary incontinent women experienced symptoms less than once a month. Regarding knowledge, attitudes, and practices, 822 (54.3%) of the women surveyed knew the meaning of urinary incontinence, and 147 (30.3%) with urinary incontinence had visited a doctor. The main reason given for not seeking medical help was shyness. CONCLUSION: Although urinary incontinence is a common symptom, it is often not reported to doctors, which leads to undertreatment. From a public health perspective, there is considerable opportunity to improve women's quality of life by increasing health education about urinary incontinence and its treatment.

Nocturia among women aged 60 or older in Taiwan.

BACKGROUND: From a public health point of view, it is important to evaluate the prevalence of nocturia and to identify the associated factors for nocturia among the elderly that might impair the quality of life of sufferers. However, those among the Taiwanese female population aged 60 or older are still unclear. AIMS: To estimate the prevalence of nocturia in Taiwanese women aged 60 or older and to assess its associated factors. METHODS: Nocturia, defined by the International Continence Society, and its associated problems were evaluated, and medical history and sociodemographic variables were recorded. A sample of 2410 female was selected by a multistage random sampling method. RESULTS: Six hundred and twenty-one women who were selected had been deceased. Face-to-face interviews with 1523 women were completed, producing a response rate of 85.1% (1523 of 1789) and 73.5% (1120 of 1523) of the interviewees reported having had nocturia. Age, diabetes mellitus, hypertension, prior drug allergy and urinary incontinence significantly increased the risk of nocturia. CONCLUSIONS: Although the pathophysiologies of nocturia are still not all known, it is a common condition among Taiwanese women. Multiple approaches are necessary to treat the patients with nocturia. Treatment of nocturia in this patient population can both improve their quality of life and reduce the risk of deterioration in their general state of health.

Assessment of treatment outcomes of interstitial cystitis with hydrodistention and bladder training by O'Leary-Sant Interstitial Cystitis Symptom and Problem Indices.

OBJECTIVE: To investigate whether the O'Leary-Sant Interstitial Cystitis Symptom Index (ICSI) and Interstitial Cystitis Problem Index (ICPI) is efficacy measure tool for interstitial Cystitis (IC) treatment with hydrodistention (HD) and bladder training (BT). MATERIALS AND METHODS: From January 2003 to March 2006, 108 consecutive IC patients were treated by HD and BT after HD. This study evaluated the efficacy of treatment with the specific questionnaire for IC, the ICSI and ICPI. Each patient filled out the questionnaire before HD and three months after HD and BT. The efficacy of the treatment was evaluated using the average scores of ICSI and ICPI. RESULTS: The mean ± margin of error, (95% confidence interval) of total scores of ICSI and ICPI were 13.89 ± 2.95, (13.33-14.45) and 12.51 ± 2.50, (12.04-12.98) before HD, respectively, and were 2.70 ± 1.16, (2.44-2.95) and 1.99 ± 1.27, (1.71-2.26) (all p < 0.005) three months after HD and BT, respectively. CONCLUSION: O'Leary-Sant ICSI and ICPI is not only a screening tool for IC but also a useful assessment tool for IC treatment outcomes.

Work hours of employed obstetricians in Taiwan.

OBJECTIVE: Obstetricians have longer work hours and work hour restriction of employed physicians will be implemented thereafter. This study was to survey the impact of work hour restriction and determine the weekly work hours of obstetricians. MATERIALS AND METHODS: Since December 1, 2017, to January 31, 2018, a questionnaire about reasonable workload investigation, impact of work hour restriction and weekly work diary was mailed to 196 employed obstetricians who delivered more than 20 newborns per months. The work types and coefficient of correlation with work hours was evaluated using the Pearson correlation coefficient (r). RESULTS: 72 returned the questionnaires, 21 (31.4%) believed that 40-49 h were reasonable, while 22 (32.8%), 13 (19.4%), 7 (10.4%), and 4 (6%) thought that 50-59, 60-69, 70-79, and >80 h were reasonable. 66 completed their weekly work diary. The average weekly work hours were 80.14 ± 6.85. If the time of awaiting delivery was calculated into total work hours, then the average work hours were 116.96 ± 12.41. The coefficient of correlation between on-duty and weekly work hours was 0.7. The average work hours of physicians with on-duty work were 92.08 ± 8.7, which were significantly higher than the work hours of those without on-duty works (63.95 ± 7.79). CONCLUSION: The weekly work hours of employed obstetricians is higher than their expected reasonable work hours. Implementation of work hour restriction will have a significant impact on medical care. It is important to determine a reasonable work hour restriction and modify the patient care model to reduce workload.