Gestión del cuidado en obstetricia y ginecología: Una mirada integral / Care management in obstetrics and gynecology: A comprehensive look

RESUMEN Objetivo: Describir la gestión del cuidado en obstetricia y ginecología: Una mirada integral. Metodología: La investigación se desarrolló desde el paradigma cuantitativo, además se enmarcó desde un diseño documental-bibliográfico, mediante la indagación, recolección y análisis crítico documental y referencial bibliográfico, basándose en la exploración metódica, rigurosa y profunda de diversas fuentes documentales tales como investigaciones científicas, artículos y trabajos arbitrados, tesis, describiendo los hallazgos encontrados y permitiendo desarrollar el cuerpo teórico en relación al tema de estudio. Resultados: Se puede observar los múltiples factores que son considerados por las mujeres que acuden a los centros asistenciales, por ello deben ser orientadas de forma integral. En conclusión: La integración de los cuidados en obstetricia y ginecología, es una acción que contribuirá a un mejor desempeño y desarrollo de la mujer en estado de gestación, tanto de ella como del niño, en tal sentido de forma integral deben ser llevadas a cabo sus cuidados y consultas.

ABSTRACT Objective: To describe the management of care in obstetrics and gynecology: A comprehensive view. Methodology: The research was developed from the quantitative paradigm, also framed from a documentary-bibliographic design, through inquiry, collection and critical documentary analysis and bibliographic reference, based on the methodical, rigorous and deep exploration of various documentary sources such as scientific research, articles and refereed papers, theses, describing the findings found, allowing the development of the theoretical body in relation to the subject of study. Results: It is possible to observe the multiple factors that are considered by the women who come to the health care centers, for this reason they should be oriented in an integral way. In conclusion: The integration of care in obstetrics and gynecology is an action that will contribute to a better performance and development of the pregnant woman, both for her and the child, and her care and consultations should be carried out in an integral manner.

Gestión del cuidado en obstetricia y ginecología: Una mirada integral / Care management in obstetrics and gynecology: A comprehensive look

Describir la gestión del cuidado en obstetricia y ginecología: Una mirada integral. Metodología: La investigación se desarrolló desde el paradigma cuantitativo, además se enmarcó desde un diseño documental-bibliográfico, mediante la indagación, recolección y análisis crítico documental y referencial bibliográfico, basándose en la exploración metódica, rigurosa y profunda de diversas fuentes documentales tales como investigaciones científicas, artículos y trabajos arbitrados, tesis.Describiendo los hallazgos encontrados, permitiendo desarrollar el cuerpo teórico en relación al tema de estudio. Resultados: Se puede observar los múltiples factores que son consideradas por las mujeres que acuden a los centros asistenciales, por ello deben ser orientadas de forma integral. En conclusión: La integración de los cuidados en obstetricia y ginecología, es una acción que contribuirá a un mejor desempeño y desarrollo de la mujer en estado de gestación, tanto de ella como del niño, de forma integral debe ser llevadas a cabo sus cuidados, consultas.

To describe the management of care in obstetrics and gynecology: A comprehensive view. Methodology: The research was developed from the quantitative paradigm, also framed from a documentary-bibliographic design, through inquiry, collection and critical documentary analysis and bibliographic reference, based on the methodical, rigorous and deep exploration of various documentary sources such as scientific research, articles and refereed papers, theses, describing the findings found, allowing the development of the theoretical body in relation to the subject of study. Results: It is possible to observe the multiple factors that are considered by the women who come to the health care centers, for this reason they should be oriented in an integral way. In conclusion: The integration of care in obstetrics and gynecology is an action that will contribute to a better performance and development of the pregnant woman, both for her and the child, and her care and consultations should be carried out in an integral manner

Development of a perineal pain management scheme after vaginal delivery based on integrated maternity and childbirth / 现代临床护理

Objective To propose an integrated management scheme for perineal pain after vaginal delivery.Methods Literature review and Delphi inquiry were conducted to propose the perineal pain management scheme after vaginal delivery from November 2022 to April 2023.A total of 21 experts were consulted with 2 rounds of correspondence.Results Questionnaires collected from the two rounds of correspondence consultations were both at 100.0%.The expert authority coefficients for the two rounds were 0.930 and 0.935,respectively,with the expert coordination coefficients of the two rounds at 0.109(P<0.001)and 0.392(P<0.001),full mark rate 100%.A total of 3 primary items,15 secondary items and 40 tertiary items were summarised for the perineal pain management scheme after vaginal delivery in relation to prenatal prophylaxis,intrapartum protection and postnatal treatment.Conclusions The developed perineal pain management scheme after vaginal delivery is scientific and reliable.It provides a scientific reference for the prevention and treatment of perineal pain after vaginal delivery.

Effect of occupational stress on psychological health of obstetrics and gynecology residents in Guangdong Province / 中国职业医学

{L-End}Objective To analyze the effect of occupational stress on the psychological health of obstetricians and gynecologists who participated in the standardized residency training (hereinafter referred to as "obstetrics and gynecology residents") in Guangdong Province. {L-End}Methods A total of 509 obstetrics and gynecology residents from national-level western medicine residency training bases in Guangdong Province were selected as the research subjects using a convenience sampling method. The psychological health status and occupational stress were investigated using the Symptom Checklist-90 and the Clinician Occupational Stressor Scale. The effects of occupational stress on psychological health of obstetrics and gynecology residents in Guangdong Province were analyzed by binary logistic regression. {L-End}Results The positive detection rate of psychological health in obstetrics and gynecology residents in Guangdong Province was 47.5% (242/509), and the detection rate of high-level occupational stress was 63.9% (325/509). The results of binary logistic regression analysis showed that career development, interpersonal relationships, and professional interests were influencing factors of their psychological health after controlling the confounding factors (all P<0.05). Residents with high level of occupational stress in career development, interpersonal relationships, and professional interests had poor psychological health. {L-End}Conclusion The psychological health of obstetrics and gynecology residents in Guangdong Province is generally poor, with career development, interpersonal relationships, and professional interests being risk factors for their psychological health.

Diagnostic value of vaginal color Doppler flow parameters in different FIGO stages of epithelial ovarian cancer / 中华内分泌外科杂志

Objective:To investigate the diagnostic value of vaginal color Doppler flow parameters in patients with epithelial ovarian cancer in different FIGO staging.Methods:178 patients with ovarian tumors who were treated by surgery in Dingzhou People’s Hospital from Jul. 2016 to Jul. 2022 were selected, and they were divided into ovarian cancer group (65 cases) and ovarian cyst group (113 cases) according to the results of postoperative pathological diagnosis. According to FIGO staging standards, ovarian cancer was divided into FIGO stage I (18 cases) , FIGO stage II (16 cases) , FIGO stage III (16 cases) and FIGO stage IV (15 cases) . The blood flow parameters of vaginal color Doppler ultrasound were measured, including arterial pulsatility index (PI) , end diastolic flow velocity (EDV) , resistance index (RI) , peak flow velocity (PSV) , serum vascular endothelial growth factor (VEGF) and human epididymal epithelial secretory protein 4 (HE4) . The levels of PI, EDV, RI, PSV, VEGF and HE4 were compared between the two groups and patients with different FIGO stages, and the value of ROC analysis of vaginal color Doppler flow parameters in predicting the occurrence of ovarian cancer was analyzed. The correlation between FIGO stage and vaginal color Doppler flow parameters and serum VEGF and HE4 levels was analyzed by person coefficient.Results:PI and RI levels in ovarian cancer group were (0.79 ± 0.15) , and (0.39 ± 0.12) , lower than those in ovarian cyst group (1.51 ± 0.17) , (0.72 ± 0.16) ; EDV, PSV, HE4, VEGF levels were (13.88 ± 4.18) cm/s, (25.61 ± 4.53) cm/s, (283.92 ± 28.97) pmol/L, and (372.55 ± 38.96) ng/mL, higher than those in ovarian cyst group ( P<0.05) . According to ROC analysis, the best cutoff values of transvaginal color Doppler blood flow parameters for predicting the occurrence of ovarian cancer were PI<1.235, EDV≥10.985 cm/s, RI<0.580, PSV≥22.975cm/s, all P<0.05. The levels of PI and RI in patients with different FIGO stages showed a decreasing trend with the increase of the severity of the disease, while the levels of EDV, HE4 and VEGF showed an increasing trend ( P<0.05) . There was no significant difference in PSV levels between patients with different FIGO stages ( P>0.05) . The correlation analysis showed that FIGO stage was positively correlated with the blood flow parameters EDV and the levels of serum HE4 and VEGF. FIGO stage was negatively correlated with PI and RI ( P<0.05) . Conclusions:There were significant differences in the levels of PI, RI and EDV in patients with ovarian cysts and ovarian cancer at different FIGO stages. The levels of PI, RI and EDV are closely related to the malignant degree of ovarian cancer.

Como avaliar programas de residência a partir do Teste de Progresso? / How can residency programs be evaluated based on the Progress Test?

Resumo: Introdução: Embora o conhecimento especializado seja um elemento fundamental para a prática médica qualificada, não há, na maioria das especialidades, uma avaliação cognitiva unificada dos médicos residentes, e, consequentemente, não é possível verificar o conhecimento agregado durante o treinamento pelos programas de residência médica (PRM). O Teste de Progresso (TP) oferece uma oportunidade para avaliação dos PRM a partir do desempenho dos seus residentes. Em 2018, a Febrasgo implementou o Teste de Progresso Individual do Residente em Ginecologia e Obstetrícia (TPI-GO), que tem sido aplicado em todo o Brasil. Relato de experiência: Este estudo descritivo se refere ao acompanhamento longitudinal dos residentes que iniciaram a participação no TPI-GO em 2018 como R1 (n = 497) e concluíram a participação em 2020 como R3 (n = 314). O desempenho desses residentes no TPI-GO serviu de base para analisar o perfil de 32 PRM localizados nas Regiões Sul (28,1%), Sudeste (68,8%) e Centro-Oeste (3,1%), sendo identificados cinco diferentes perfis de PRM em relação ao desempenho dos residentes iniciantes, diferenças de desempenho entre R3 e R1 e desempenho dos concluintes. Discussão: No Brasil, não são oferecidas avaliações abrangentes e unificadas de conhecimento aos médicos residentes na maioria das especialidades, e consequentemente ainda não é possível incorporar essas informações na avaliação dos PRM. No modelo aqui apresentado, o desempenho dos residentes no TP possibilita inferir sobre o processo seletivo, o conhecimento agregado pelo PRM ao longo do treinamento e o nível de conhecimento dos concluintes, sendo reconhecidos PRM qualificados (tipo 1) e PRM que necessitam de melhorias (tipos 2, 3, 4 e 5). Conclusão: O TP oferece uma oportunidade para avaliação dos PRM a partir do desempenho dos seus residentes. Por meio do modelo aqui apresentado, é possível obter informações para subsidiar decisões institucionais que promovam melhorias dos PRM e do seu processo de formação na especialidade.

Abstract: Introduction: Although specialized knowledge is a fundamental element for qualified medical practice, in most specialties, there is no unified cognitive assessment of resident physicians, and it is impossible to verify the knowledge gained during training in Medical Residency Programs (MRPs). The Progress Test (PT) provides an opportunity to evaluate MRPs based on the performance of the residents. In 2018, Febrasgo applied the Resident Progress Test in Gynecology and Obstetrics (TPI-GO) throughout Brazil. Experience report: This descriptive study refers to the longitudinal follow-up of residents who started participating in the TPI-GO in 2018 as R1 (n=497) and completed their participation in 2020 as R3 (n = 314). The performance of these residents in the TPI-GO served as a basis for analyzing the profile of 32 MRPs located in the South (28.1%), Southeast (68.8%), and Central-West (3.1%) regions of Brazil, with five different identified PRM profiles in relation to the performance of beginner residents, differences in performance between R3 and R1 and the performance of residency graduates. Discussion: In Brazil, comprehensive and unified assessments of knowledge are not offered to resident physicians in most specialties, and consequently, it is not yet possible to incorporate this information into the assessment of MRPs. In the model presented here, the performance of residents in the PT enables one to make inferences about the selection process, the knowledge added by the MRP throughout the training, and the level of knowledge of the graduates, being recognized as qualified MRPs (type 1) and MRPs that need improvement (types 2, 3, 4 and 5). Conclusion: The PT offers an opportunity to evaluate MRPs based on the performance of their residents. Through the model presented here, it is possible to obtain information to support institutional decisions that promote improvements in MRPs and their training process in the specialty.

Application of the Micro-Teachermate platform combined with PBL in gynecology and obstetrics teaching / 中华医学教育探索杂志

Objective:To illustrate the effectiveness of Micro-Teachermate platform combined with problem-based learning (PBL) in gynecology and obstetrics teaching.Methods:Students from different classes were randomly divided into experimental group and control group, and the general data of the two groups were compared. The two groups respectively adopted Micro-Teachermate platform combined with PBL and traditional lecture teaching methods. The class attendance rate and the scores of relevant chapters in the final examination were analyzed through statistical methods for assessing the enthusiasm of students and teaching quality in class in terms of the same content and the same class hours. A questionnaire survey was conducted to know students' evaluation of this teaching mode, evaluating its teaching effect and satisfaction comprehensively. SPSS 17.0 was used for t test and chi-square test. Results:There was no difference in general information between the two groups. The class attendance rate of the experimental group (274/279) was significantly higher than that of the control group (61/90), while the scores of the relevant chapters in the final exam were also significantly higher ( P<0.01). Questionnaire survey results among 93 students in the experimental group were taken back 93 valid questionnaires (the effective rate, 100%), showing that most of the students were very satisfied with this teaching mode (90/93) and hoped to apply it to more subjects teaching (89/93). Conclusion:The application of Micro-Teachermate platform combined with PBL in gynecology and obstetrics class teaching contributes to improve students' participating enthusiasm and can effectively improve the quality and efficiency of teaching. Most students highly recognize the teaching method, which is worth applying and popularizing.

Tecnologia educativa para promoção de ações de segurança do paciente em uma maternidade / Educational technology to promote patient safety actions in a maternity hospital

Introdução: Potenciais riscos aos pacientes são intrínsecos à assistência à saúde, sendo que na maternidade, a ocorrência de eventos adversos pode repercutir em danos a mulher e ao recémnascido (RN). Diante disso, políticas públicas estabelecem ações de melhoria da assistência por meio da corresponsabilização e participação ativa dos pacientes e acompanhantes no cuidado e na prevenção de incidentes. Nesse contexto, a literatura sugere o desenvolvimento de tecnologias educativas (TE) para aperfeiçoar a comunicação, aumentar a capacidade de escuta e engajar o paciente e família na segurança do paciente (SP). Entretanto, as evidências sobre o desenvolvimento e utilização de TE em busca do maior envolvimento do acompanhante e do paciente na SP na maternidade, especialmente com a participação desses atores são insuficientes. Objetivos de pesquisa: Conhecer as percepções e as experiências de pacientes, acompanhantes e profissionais de saúde da maternidade sobre a participação da paciente e do acompanhante na segurança da paciente e do RN. Objetivo de prática: Elaborar e avaliar uma tecnologia educativa para promoção do envolvimento das pacientes internadas na maternidade e seus acompanhantes nas ações do cuidado seguro. Método: O estudo seguiu os preceitos metodológicos da Pesquisa Convergente-Assistencial e sustentou-se nos fundamentos teóricos de Paulo Freire. Foi realizado na maternidade de um hospital público de Belo Horizonte e a produção de dados foi dividida em três etapas. A primeira etapa subsidiou a construção da cartilha através de entrevistas para conhecer as percepções e o conhecimento dos participantes sobre a SP e a participação da paciente e do acompanhante na segurança; e identificar as barreiras que dificultam colocar em prática as ações de SP. Participaram dessa etapa 13 profissionais de saúde, 11 pacientes e 06 acompanhantes. Na segunda foi desenvolvida a TE em forma de cartilha e na terceira, a mesma foi avaliada pelos participantes. Na última etapa aceitaram continuar participando da pesquisa os 13 profissionais da saúde, 08 pacientes e 05 acompanhantes. A coleta de dados ocorreu por meio de entrevista semiestruturada e registro de diário de campo. A análise dos dados foi realizada pela análise de conteúdo e foram criadas duas categorias provenientes da primeira etapa: Saberes e experiências sobre a segurança da paciente e do RN na maternidade e Desafios para o envolvimento da paciente e acompanhante nas ações de segurança. Resultados: Na primeira categoria os achados evidenciaram que as pacientes e os acompanhantes esboçaram diferentes entendimentos sobre a SP, sendo que a maioria apresentava compreensão limitada sobre o tema e desconhecia como poderiam contribuir para SP. Os profissionais enfatizaram que as pacientes e os acompanhantes se envolvem pouco na SP e poderiam ser mais informados e estimulados pela própria equipe. A segunda categoria apontou as fragilidades para a participação da paciente e acompanhante nas ações de segurança, como a falta de conhecimento, diálogo e escuta, e a posição autoritária de alguns profissionais. Os achados da primeira etapa contribuíram para a construção da TE, no formato de cartilha. Na terceira etapa, os participantes avaliaram a TE como sendo um material importante para impulsionar a participação das pacientes e acompanhantes na SP. Conclusão: O processo interativo e dialogado com os participantes possibilitou a criação da TE como ferramenta importante no envolvimento das pacientes e acompanhantes nas ações de SP. Essa experiência vai ao encontro do pensamento de Paulo Freire que afirma que, o educador deve reconhecer o educando têm saberes, experiências e leituras de mundo próprias, sendo o respeito essencial para influenciar no desenvolvimento de novos saberes.

Potential risks to patients are intrinsic to health care, and in maternity hospitals, the occurrence of adverse events can affect women and newborns (NB). Therefore, public policies establish actions to improve care through co-responsibility and active participation of patients and caregivers in the care and prevention of incidents. In this context, the literature suggests the development of educational technologies (ET) to improve communication, increase listening skills and engage the patient and family in patient safety (PS). However, the evidence on the development and use of ET in search of greater involvement of the companion and the patient in PS in the maternity hospital, especially with the participation of these actors, is insufficient. Research objectives: Know the perceptions and experiences of patients, companions and health professionals in the maternity ward about the participation of the patient and companion in the safety of the patient and the NB. Practice objective Develop and evaluate an educational technology to promote the involvement of patients admitted to the maternity ward and their companions in safe care actions. Method: The study followed the methodological precepts of the Convergent Care Research and was supported by Paulo Freire's theoretical foundations. It was carried out in the maternity of a public hospital in Belo Horizonte and data production was divided into three stages. The first stage supported the construction of the booklet through interviews to learn about the participants' perceptions and knowledge about PS and the patient's and companion's participation in safety; and identify the barriers that make it difficult to put PS actions into practice. Thirteen health professionals, 11 patients and 06 caregivers participated in this stage. In the second, the ET was developed in the form of a booklet and in the third, it was evaluated by the participants. In the last stage, the 13 health professionals, 08 patients and 05 companions agreed to continue participating in the research. Data collection took place through semi-structured interviews and field diary records. Data analysis was performed using content analysis and two categories were created from the first stage: Knowledge and experiences about patient and newborn safety in the maternity ward and Challenges for the involvement of the patient and companion in safety actions. Results: In the first category, the findings showed that patients and caregivers outlined different understandings about PS, and most of them had limited understanding of the topic and did not know how they could contribute to PS. Professionals emphasized that patients and companions are little involved in PS and could be more informed and encouraged by the team itself. The second category pointed out the weaknesses for the participation of the patient and companion in safety actions, such as the lack of knowledge, dialogue and listening, and the authoritarian position of some professionals. The findings of the first stage contributed to the construction of the ET, in the form of a booklet. In the third stage, participants assessed ET as being an important material to boost the participation of patients and caregivers in the PS. Conclusion: The interactive process and dialogue with the participants enabled the creation of ET as an important tool in the involvement of patients and caregivers in PS actions. This experience is in line with the thought of Paulo Freire who states that the educator must recognize that the student has their own knowledge, experiences and readings of the world, with respect being essential to influence the development of new knowledge.

Desafío hospitalario: experiencia de un equipo de ginecología en el manejo integral de pacientes COVID 19 / A hospital challenge: experience of a gynecology team in the comprehensive management of patients COVID 19

INTRODUCCIÓN: La infección por el coronavirus SARS-CoV2 (COVID 19), causal de la pandemia actual, ha significado a nivel mundial la hospitalización simultánea de múltiples pacientes poniendo a prueba la infraestructura hospitalaria y la capacidad de reacción del personal de salud. Una de las estrategias para el manejo es la reconversión de camas y servicios clínicos. OBJETIVOS: presentar experiencia de un equipo ginecológico en el manejo integral de pacientes no gineco-obstétricas con COVID 19, durante el mes de junio de 2020 en un hospital público de la Región Metropolitana. MÉTODOS: Estudio de corte transversal observacional, descriptivo. Se consideró el total de pacientes adultos hombres y mujeres sin patología gineco-obstétrica con COVID 19 ingresados al puerperio del Hospital Santiago Oriente, obteniéndose datos clínicos y demográficos a través del registro interno de la unidad y del sistema de información de red asistencial. RESULTADOS: Ingresaron 82 pacientes, 32 mujeres y 50 hombres, promedio de edad 64. El promedio de días de hospitalización fue 5, con diagnóstico de ingreso principal neumonía viral por COVID-19. Las comorbilidades frecuentes fueron hipertensión arterial sistémica y diabetes mellitus. La complicación más frecuente fue el tromboembolismo pulmonar agudo. Hubo una alta cobertura de entrega de información vía telefónica a familiares. De los 82 ingresos, 54 pacientes egresaron a su domicilio. El resto a otras unidades dentro de la institución, centros de menor complejidad o residencias sanitarias. Una paciente sexo femenino de 75 años fallece a causa de descompensación de patologias de base secundario a neumonia por Staphylococus aereus. En ella, se descarta la infección por COVID 19 dado tres exámenes por reacción de polimerasa en cadena negativos realizado antes y durante su hospitalización. CONCLUSIONES: Esta experiencia constituyó un desafío para todo el equipo de salud gineco-obstétrico, considerando que nos enfrentamos a otro tipo de pacientes y a una patología nueva. Los resultados médicos son promisorios, la experiencia humana y sentido de trabajo en equipo fue extraordinario.

INTRODUCTION: The infection by the SARS-CoV2 coronavirus (COVID 19), the cause of the current pandemic we are experiencing, has meant the simultaneous hospitalization of many patients worldwide, putting the hospital infrastructure and the reaction capacity of health personnel to the test. One of the management strategies is the reconversion of clinical services. OBJECTIVES: present the experience of a gynecological team in the comprehensive management of non-gyneco-obstetric patients with COVID 19, during the month of June 2020 in a public hospital in the Metropolitan Region. METHODS: descriptive, observational cross-sectional study. The total number of patients admitted to the ex-puerperium of the Santiago Oriente Hospital was considered, obtaining clinical and demographic data through the unit's internal registry and the healthcare network information system. RESULTS: 82 patients were admitted, 32 women and 50 men, average age 64. The average number of days of hospitalization was 5, with the main admission diagnosis being viral pneumonia due to COVID-19. Frequent comorbidities were systemic arterial hypertension and diabetes mellitus. The most frequent complication was acute pulmonary thromboembolism. There was a high coverage of the delivery of information via telephone to relatives. Of the 82 admissions, 54 patients were discharged home and the rest to other units within the institution, less complex centers or health residences. One 75 years old female patient dies from concomitant pathologies, and she wasn't positive for COVID-19. CONCLUSIONS: This experience was a challenge for the entire gynecological-obstetric health team, considering that we are facing other types of patients and a new pathology. The medical results are promising, the human experience and sense of teamwork was extraordinary.

FIGO 2018 staging of cervical cancer and related issues / 中华肿瘤杂志

Globally, cervical cancer continues to be one of the most common cancers among females. Although screening for cervical cancer has been gradually carried out, the incidence and mortality of cervical cancer in China are still at a high level. So the prevention and treatment of cervical cancer in China still has lots of work to do. The International Federation of Obstetrics and Gynecology (FIGO) gynecological oncology committee revised the staging of cervical cancer in 2018. The new staging changed in terms of stage ⅠB and stage Ⅲ compared with previous FIGO staging. FIGO also provided prevention and treatment strategies and the treatment regimens of each stage, which had an important impact on the prevention and treatment of cervical cancer as well as an important enlightenment for China.

Culture of patient safety in hospital units of gynecology and obstetrics: a cross-sectional study / Cultura de seguridad del paciente en unidades hospitalarias de ginecología y obstetricia: estudio transversal / Cultura de segurança do paciente em unidades hospitalares de ginecologia e obstetrícia: estudo transversal

ABSTRACT Objectives: to assess the patient safety culture of the health team working in three maternity hospitals. Methods: observational, cross-sectional, comparative study. 301 professionals participated in the study. The Hospital Survey on Patient Safety Culture questionnaire validated in Brazil was used. For data analysis, it was considered a strong area in the patient safety culture when positive responses reached over 75%; and areas that need improvement when positive responses have reached less than 50%. To compare the results, standard deviation and thumb rule were used. Results: of the 12 dimensions of patient safety culture, none obtained a score above 75%, with nine dimensions scoring between 19% and 43% and three dimensions between 55% and 57%. Conclusions: no strong dimensions for safety culture were identified in the three maternity hospitals. It is believed that these results may contribute to the development of policies that promote a culture of safety in institutions.

RESUMEN Objetivos: evaluar la cultura de seguridad del paciente de la equipe de salud que actúa en tres maternidades. Métodos: estudio observacional, transversal, comparativo. Participaron del estudio 301 profesionales. Se ha utilizado el cuestionario Hospital Survey on Patient Safety Culture validado en Brasil. Para el análisis de los datos, ha sido considerado área fuerte en la cultura de seguridad del paciente cuando las respuestas positivas atingieron arriba de 75%; y áreas que precisan de mejorías cuando las respuestas positivas atingieron menos de 50%. Para la comparación de los resultados, se empleó desviación típica y regla del pulgar. Resultados: de las 12 dimensiones de la cultura de seguridad del paciente, ninguna obtuvo puntuación arriba de 75%, siendo nueve dimensiones con puntuación entre 19% y 43% y tres dimensiones entre 55% y 57%. Conclusiones: No han sido identificadas dimensiones fuertes para cultura de seguridad en las tres maternidades. Se cree que esos resultados puedan contribuir en la elaboración de políticas que promuevan la cultura de seguridad en las instituciones.

RESUMO Objetivos: avaliar a cultura de segurança do paciente da equipe de saúde que atua em três maternidades. Métodos: estudo observacional, transversal, comparativo. Participaram do estudo 301 profissionais. Utilizou-se o questionário Hospital Survey on Patient Safety Culture validado no Brasil. Para a análise dos dados, considerou-se área forte na cultura de segurança do paciente quando as respostas positivas atingiram acima de 75%; e áreas que precisam de melhorias quando as respostas positivas atingiram menos de 50%. Para a comparação dos resultados, empregou-se desvio-padrão e regra do polegar. Resultados: das 12 dimensões da cultura de segurança do paciente, nenhuma obteve escore acima de 75%, sendo nove dimensões com escore entre 19% e 43% e três dimensões entre 55% e 57%. Conclusões: não foram identificadas dimensões fortes para cultura de segurança nas três maternidades. Acredita-se que esses resultados possam contribuir na elaboração de políticas que promovam a cultura de segurança nas instituições.

Frequency of etiologies of acute kidney injury in Faisalabad and surrounding districts

Background: To find out the causes of Acute Kidney Injury (AKI) in population.Methods: A total of 150 patients were enrolled from medical, surgical, gynecology and obstetrics units of Allied Hospital and Madinah Teaching Hospital, Faisalabad, Pakistan. History, physical examination and investigations were recorded on specially designed proforma. Patients were evaluated to find out the etiologies of AKI. All patients were subjected to urine analysis, complete blood count, blood biochemistry (urea, creatinine, electrolytes, uric acid, calcium and phosphorus) and ultrasound scan of the abdomen and pelvis. Renal biopsy, immunological assays, such as hepatitis B surface antigen, anti-hepatitis C virus antibody, complements level, antinuclear antibody, anti-double-stranded DNA, anti-neutrophil cytoplasmic antibody and anti-glomerular basement membrane antibody were performed in selected cases.Results: Male (36%) and female (64%). Pre-renal AKI was most common and was reported in 80 patients (53.33%). Intrinsic Renal azotemia in 56 patients (37.33%). Post renal azotemia in 14 patients (9.33%). Among 80 patients of prerenal AKI, hemorrhage in 45(56.25%), gastroenteritis in 16(20%), sepsis in 8(10%), cardiac diseases in 4(5%), hepatorenal syndrome in 3 (3.75%), peritonitis in 2 (2.50%) and burns in 2(2.50%) were the main causes of Pre-renal AKI. Among 56 patients of intrinsic renal AKI, 40(71.4%) had acute tubular necrosis (ATN), 12(21.4%) with multifactorial causes and 4(7.14%) were found to have glomerulonephritis. Among 14 patients of post renal AKI, 6(42.9%) were having calculi, 6(42.9%) were to have enlarged prostate and 2(4.3%) were having stricture urethra. In this study, contribution of obstetrical, medical and surgical etiologies were recorded as 40%, 36% and 20% respectively.Conclusions: In contrast to study reported from neighbouring country, this study shows rather increase in pregnancy related AKI.

Application of flipped classroom based on Moodle in the teaching of gynecology and obstetrics nursing / 中华医学教育探索杂志

The traditional teaching method of the medical curricculum, gynecology and obstetrics nursing has many problem. The flipped classroom subvetted the traditional teaching structure, and realizes the advance of knowledge transfer and optimization of knowledge internalization. The research group made design , recorded micro-course video and used the free and open source of Moodle course management platform to implement flipped classroom. The interactive function of the platform released learning tasks before class, had discussion in class and answered after-class quesstions. The subjectivity of students was highly emphasized . The results showed that the flipped classroom can improve students' academic performance, develop students' good study habits and learning interest, and also bears significance for the cultivation of autonomic learning ability and critical thinking.

Application of flipped classroom based on Moodle in the teaching of gynecology and obstetrics nursing / 中华医学教育探索杂志

The traditional teaching method of the medical curricculum, gynecology and obstetrics nursing has many problem. The flipped classroom subvetted the traditional teaching structure, and realizes the advance of knowledge transfer and optimization of knowledge internalization. The research group made design, recorded micro-course video and used the free and open source of Moodle course management platform to implement flipped classroom. The interactive function of the platform released learning tasks before class, had discussion in class and answered after-class quesstions. The subjectivity of students was highly emphasized. The results showed that the flipped classroom can improve students' academic performance, develop students' good study habits and learning interest, and also bears significance for the cultivation of autonomic learning ability and critical thinking.

Application of "medical Salon" teaching in standardized training of residents in gynecology and obstetrics department / 中华医学教育探索杂志

Objective To investigate the application of "medical Salon" teaching in standardized training of residents in gynecology and obstetrics department. Methods A total of 30 residents of obstetrics and gynaecology receiving standardized training in the People's Hospital of Wuhan University from August 2015 to March 2018 were enrolled. They were randomly divided into experimental group and control group, with 15 persons in each group. In addition to daily training, the experimental group held a "theoretical salon" once a week and a "surgical salon" every quarter. Both groups of physicians took examinations of basic theories and clinical practice level and received evaluation of training satisfaction;SPSS 17.0 was used to perform t-test or paired t-test on intra-and inter-group data. Results Before the standardization training began, there was no significant difference in the scores of the basic theory and clinical practice between the two groups (P>0.05). After the training, the basic theory and clinical practice scores of the two groups were improved compared with those before training, and the difference was statistically significant (P<0.05). After the training, the scores of the basic theoretical examination of the experimental group were higher than those of the control group [(95.20±3.67) vs. (82.10±5.62)], and the scores of clinical practice of the experimental group was higher than the control group [(96.80±3.26) vs. (79.50±5.28)]; the teaching satisfaction scores of the experimental group were higher as well [(95.50±3.54) vs. (86.70±4.95)]. The differences were statistically significant (P<0.05). Conclusion The"Medical Salon"teaching helps to improve the quality of standardized training for obstetrics and gynecology residents and is worth promoting.

Efecto de una estrategia de intervención para conocer las habilidades de los residentes de Ginecología y Obstetricia en reanimación cardiopulmonar básica de la paciente embarazada / Effect of the intervention strategy to know the skills of residents of Gynecology and Obstetrics in basic cardiopulmonary resuscitation of the pregnant patient

Resumen OBJETIVO: Determinar qué repercusión tienen en la supervivencia de la paciente con paro cardiorrespiratorio las estrategias de intervención y las habilidades para la reanimación cardiopulmonar básica, por parte del residente de Ginecología y Obstetricia, en un hospital de segundo nivel de atención. MATERIALES Y MÉTODOS: Estudio prospectivo, transversal, analítico y comparativo efectuado entre los meses de marzo a agosto de 2018 en residentes de Ginecología y Obstetricia del Hospital General Regional 1 de Ciudad Obregón, Sonora, a quienes se evaluó antes y después de una intervención de soporte vital básico en pacientes embarazadas. Para observar las diferencias en conocimientos clínicos entre los grupos se aplicó la prueba de Kruskal-Wallis, para medir la diferencia entre los grupos se utilizó U de Mann Whitney y para el análisis estadístico descriptivo se utilizaron medidas de tendencia central. RESULTADOS: Se evaluaron de manera inmediata 20 residentes y solo 1 no aprobó. En la evaluación final mediata 16 de 19 aprobaron. CONCLUSIONES: Se demostró un efecto favorable de la estrategia de intervención aplicada a los residentes de Ginecología y Obstetricia pues se obtuvieron resultados estadísticamente significativos.

Abstract OBJECTIVE: To determine the impact of the intervention strategy and basic cardiopulmonary resuscitation skills on the part of the resident of Gynecology and Obstetrics on the survival of the patient with cardiorespiratory arrest in a second-level care hospital. MATERIALS AND METHODS: Prospective and cross-sectional study, carried out in the period from March to August 2018, including all the resident physicians of the specialty of Gynecology and Obstetrics of HGR 1 of Ciudad Obregón, who underwent pre and post intervention evaluation of Vital Support Basic in the pregnant patient. To observe the differences in the level of clinical knowledge between the groups, Kruskal-Wallis was used and to measure the difference between the groups, the Mann Whitney U was used. For the descriptive statistical analysis, measures of central tendency were used. RESULTS: In the immediate final evaluation, there were 20 residents evaluated, 19 (95%) approved and 1 non-approving (5%). Average final evaluation, of 19 residents evaluated, 16 (84%) approved, and 3 (16%) did not approve. CONCLUSION: A favorable effect of the intervention strategy applied to residents of Gynecology and Obstetrics was demonstrated, since statistically significant results were obtained.

Proceso de evaluación del desempeño del residente de Ginecología y Obstetricia en la Facultad de Ciencias Médicas "Finlay-Albarrán" / The Process of Performance Evaluation of the Gynaecology and Obstetrics Resident in Finlay Albarrán Medical School

Introducción: El proceso de evaluación en las especialidades médicas es fundamentalmente cualitativo, de verificación de evidencias del desempeño para garantizar una adecuada formación profesional. El Programa de la especialidad de Ginecología y Obstetricia en Cuba, se ha enriquecido con nuevos contenidos desde su implementación, pero el sistema de evaluación del residente ha experimentado pocas modificaciones. Objetivo: Caracterizar el proceso de evaluación del desempeño del residente de Ginecología y Obstetricia en la Facultad de Ciencias Médicas "Finlay-Albarrán" para identificar los problemas y las potencialidades que permitan programar actividades para su mejoramiento. Métodos: Se realizó análisis documental e histórico-lógico. Se efectuó revisión documental. Se hicieron entrevistas, encuestas y la observación del desempeño del profesor durante el proceso docente educativo; parametrización y triangulación metodológica. Resultados: Se identificaron problemas en las tres dimensiones estudiadas entre los que se destacan: deficiente nivel de comprobación de los conocimientos de las ciencias básicas, limitada utilización del idioma inglés en la práctica profesional, insuficiente conocimiento entorno a la evaluación del desempeño y la insuficiente participación del profesor en actividades de superación profesional relacionadas con el proceso de evaluación. Se identificó una potencialidad. Conclusiones: La caracterización del proceso de evaluación del desempeño del residente de Ginecología y Obstetricia en la Facultad de Ciencias Médicas "Finlay-Albarrán" permitió la identificación de problemas y una potencialidad. Los resultados de esta investigación conducen al diseño y desarrollo de actividades que propicien el mejoramiento del sistema de evaluación con enfoque en el desempeño(AU)

Introduction: The process of evaluation in medical specialties is mainly a qualitative one, based on the verification of performance evidences that guarantee an adequate professional training. The specialty program for Gynecology and Obstetrics in Cuba has been enriched with new contents since its implementation, but the resident's evaluation system has undergone few modifications. Objective: To characterize the process of evaluation for the Gynecology and Obstetrics resident's performance in "Finlay-Albarrán" Medical School, in order to identify the problems and potentialities that allow to program activities for its improvement. Methods: Literature and historical-logical analyses were carried out. A documentary review was made. Interviews, surveys and the observation of the teacher's performance during the educational process; parametrization and methodological triangulation. Results: Problems were identified in the three dimensions studied; for example, a poor level of knowledge verification in basic sciences, limited use of the English language in the professional practice, insufficient knowledge about performance evaluation, and insufficient participation of the teacher in professional improvement activities related with the evaluation process. A potentiality was identified.Conclusions: The characterization of the process of performance evaluation for the Gynecology and Obstetrics resident in Finlay-Albarrán Medical School allowed the identification of problems and a potentiality. The results of this research lead to the design and development of activities that encourage the improvement of the evaluation system, with a focus on performance(AU)

Cultura de segurança do paciente em serviços de atenção obstétrica / Culture of patient safety in obstetric care services

A Cultura de Segurança do Paciente é considerada um importante componente estrutural dos serviços de saúde, que favorece a implantação de práticas seguras para a diminuição de eventos adversos. Conhecer a cultura de segurança por meio de questionários validados, possibilita uma análise das dimensões envolvidas no cuidado assistencial das organizações de saúde e identifica oportunidades de melhoria na segurança do paciente. Objetivo geral: analisar a cultura de segurança do paciente em serviços de atenção obstétrica, na perspectiva da equipe multiprofissional. Método: trata-se de estudo descritivo, transversal com abordagem quantitativa. Utilizou-se como instrumento de coleta de dados o questionário "Hospital Survey on Patient Safety Culture". A amostra foi constituída por 301 profissionais de saúde da equipe multidisciplinar de três serviços de atenção obstétrica do município de Belo Horizonte. Os dados foram analisados segundo os testes de Mann-Whitney e Kruskal-Wallis. Também foi utilizada a correlação de Spearman para verificar a associação entre as dimensões e as varáveis caracterizadoras. Resultados: a maioria dos profissionais era da obstetrícia 70%, o tempo de trabalho na área e no hospital que predominou foi de um a cinco anos; 40% dos profissionais trabalham de 40 a 59 horas por semana, 27% são enfermeiros; 96% prestam assistência direta ao paciente. Não foram identificadas dimensões fortes na cultura de segurança do paciente nos serviços pesquisados, já que todas obtiveram percentuais abaixo de 75%. Apenas as dimensões "Aprendizado organizacional e melhoria continua"; "Expectativas e ações do supervisor\chefe para a segurança do paciente" e; "Trabalho em equipe dentro da unidade" obtiveram percentuais igual ou acima de 50% que representam dimensões com potencial de melhoria. Por outro lado, "Percepção geral da segurança do paciente", "Frequência de eventos comunicados" e "Resposta não punitiva ao erro" foram as dimensões com menor índice de respostas positivas. Conclusão: Das 12 dimensões do instrumento, apenas 03 comportarem-se como potencial para melhoria, e as outras 09 apresentaram-se frágeis para a cultura de segurança do paciente nos três serviços de atenção obstétrica. Evidencia-se a manutenção de uma cultura de culpa e hierárquica que não privilegia a qualidade do cuidado entre a equipe multiprofissional. Estratégias precisam ser desenvolvidas para que os profissionais da área da saúde identifiquem as atitudes e comportamentos seguros na assistência obstétrica e fortaleçam a cultura de segurança do paciente nessa área.(AU)

Resumo em língua estrangeira The Culture of Patient Safety is considered an important structural component of health services, which favors the implementation of safe practices for the reduction of adverse events. Knowingthesafetyculturethroughvalidatedquestionnairesallowsananalysisofthedimensions involvedinthecareofhealthorganizationsandidentifiesopportunitiesforimprovementinsafety. Overall objective: to analyze the safety culture of the patient in obstetric care services, from the perspective of the multiprofessional team. Method: This is a descriptive, cross-sectional study with a quantitative approach. The questionnaire "Hospital Survey on Patient Safety Culture" was used as instrument of data collection. The sample consisted of 301 health professionals from the multidisciplinary team of three obstetric care services in the city of Belo Horizonte. Data were analyzed according to the Mann-Whitney and Kruskal-Wallis tests. Spearman's correlation was also used to verify the association between the dimensions and the characterizing variables. Results: the majority of the professionals were from obstetrics 70%, the working time in the area and in the hospital that predominated was one to five years; 40% of professionals work from 40 to 59 hours, 27% are nurses; 96% provide direct patient care. It was identified that all the dimensions obtained percentages below 75%. Only the dimensions "Organizational learning and continuous improvement"; "Expectations and actions of the supervisor \ boss for patient safety" and; "Teamwork within the unit" obtained percentages equal to or above 50%. On the other hand, "General perception of patient safety", "Frequency of reported events" and "Non-punitive response to error" were the dimensions with the lowest index of positive responses. Conclusion: no strength areas were identified in the dimensions evaluated by the Survey on Patient Safety Culture questionnaire, in the three obstetric care services. Strategies for patient safety culture need to be developed for health professionals to identify safe attitudes and behaviors in obstetric care.(AU)

Contribución de la Sociedad Peruana de Obstetricia y Ginecología a la especialidad del país a sus 70 años de creación, valuada a través de las páginas de la Revista Peruana de Ginecología y Obstetricia / Contribution of the Peruvian Society of Obstetrics and Gynecology to the specialty during 70 years from its creation, valued through the pages of The Peruvian Journal of Gynecology and Obstetrics

La Sociedad Peruana de Obstetricia y Ginecología (SPOG) fue fundada hace 70 años, en el año 1947, con la misión de contribuir al desarrollo de la ciencia, en beneficio de la mujer peruana. En 1955 apareció el primer número de la Revista Peruana de Ginecología y Obstetricia (RPGO), órgano oficial de la Sociedad, con el nombre Ginecología y Obstetricia [Ginecol Obstet, o Ginecol Obstet (Perú)], que lo conservó hasta el año 2006, desde cuando se denominó Revista Peruana de Ginecología y Obstetricia (Rev Peru Ginecol Obstet -RPGO). Un recuento de las actividades societarias puede establecerse a través de los editoriales y artículos escritos desde los primeros números de la RPGO, en los que se observa el anhelo de los directivos de SPOG de tener un medio de comunicación científica en donde los mejores profesionales de la especialidad publicaran sus experiencias y resultados, como información que sirviera de derrotero a los elementos más jóvenes. Las investigaciones de sus miembros y otros investigadores han aportado a nuestra realidad en medicina reproductiva, diagnóstico temprano del cáncer ginecológico, atención adecuada del parto, disminución de la mortalidad materna y perinatal, hemorragia obstétrica, preeclampsia, gestación y recién nacido en la altura, anticoncepción, menopausia, prolapso genital e incontinencia urinaria, patología de la mama, genética, ecografía, cirugía endoscópica, y muchos otros temas relacionados. Y miembros de la SPOG han creado capítulos institucionales como las Sociedades Peruana de Fertilidad, Perinatología, Climaterio y Menopausia, Ultrasonido, Cirugía Laparoscópica, Contracepción, Medicina Fetal, entre otras. Los diferentes Comités y Consejos Directivos han apoyado la existencia y permanencia de la Revista, habiendo seis de sus Presidentes tomado el reto de dirigir la Revista para fortalecer su calidad, permanencia, puntualidad y visibilidad. Así, todos los artículos de la RPGO pueden actualmente ser visitados y descargados en su página web, desde el primer número publicado en 1955. Se publica artículos en inglés, y la Revista es de libre acceso al mundo, hallándose indizada en importantes bases de datos. Allí se puede leer la historia multiplicadora de la SPOG.

The Peruvian Society of Obstetrics and Gynecology (SPOG) was founded 70 years ago, in 1947, with the mission of contributing to the scientific progress in benefit of the Peruvian women. In 1955, the first number of The Peruvian Journal of Gynecology and Obstetrics (RPGO), the official journal of SPOG, was published with the name Ginecología y Obstetricia [Ginecol Obstet, o Ginecol Obstet (Perú)] until 2006, when the name changed to Revista Peruana de Ginecología y Obstetricia (Rev Peru Ginecol Obstet). An account of the Society's activities may be retrieved through the editorials and papers written from the beginning of RPGO, as we observe the desire of the SPOG directors to have an organ of scientific communication where the leading obstetricians and gynecologists would publish their medical experiences and outcomes, as a source of information for the younger physicians. Research has contributed to the advancement in reproductive medicine, early diagnosis of gynecologic cancer, adequate delivery care, decrease in maternal and perinatal mortality, obstetrical hemorrhage, preeclampsia, pregnancy and newborn at high altitude, contraception, menopause, genital prolapse and urinary stress incontinence, breast pathology, genetics, ultrasound, endoscopic surgery, and many related themes. Members of SPOG have created institutional chapters such as the Fertility, Perinatology, Climacteric and Menopause, Ultrasound, Laparoscopic Surgery, Contraception, Fetal Medicine and others. The various SPOG Executive Committees have supported the RPGO permanence, and six Presidents of the Society took the challenge of managing the Journal in order to endorse its quality, punctuality and visibility. All the articles published since 1955 can be currently visited in its OJS web, where pdf files may be downloaded. Articles are also published in English. The RPGO is an open access journal and is indexed in important databases. There you can read about the burgeoning medical actions of the SPOG.

La Sociedad Peruana de Obstetricia y Ginecología y la salud pública / The Peruvian Society of Obstetrics and Gynecology and public health

En estos 70 años de vida institucional, la Sociedad Peruana de Obstetricia y Ginecología ha contribuido a través de sus Congresos, Simposios, Mesas Redondas, Sesiones Científicas, Cursos Pre Congreso, Cursos para residentes y su Revista institucional, no solo con el desarrollo del conocimiento de la especialidad sino también con la Salud Pública del país. Solo en la Revista se han publicado 48 artículos que han sido catalogados, por su contenido, en relación con la Salud Pública. Pero son algunos temas que por su importancia han tenido una mayor difusión. En este artículo revisaremos los mismos.

During its 70 years of institutional life, the Peruvian Society of Obstetrics and Gynecology has contributed not only to the development of the specialty, but also of the country’s Public Health, through its Congresses, Symposia, round tables, courses, and The Peruvian Journal of Gynecology and Obstetrics. There were 48 articles related with public health aspects published in the institutional journal only. However, certain topics have been more exposed than others due to their relevance. We will review them in this article.