BMI and uterine size: is there any relationship?

To evaluate the influence of BMI on the prevalence of fibroids and uterine weight. Uterine pathology specimens of all the women who underwent hysterectomy for benign indications from 1995 to 2002 were studied. Patient characteristics such as age, race, body mass index (BMI), and parity were collected by chart review. The data were statistically analyzed using a 1-way analysis of variance and regression analysis. Uterine weight and fibroids were the dependent variables and BMI, age, and parity were the independent variables. The correlation between BMI and the presence/number of fibroids and their size was also studied. Among the 873 patients who underwent hysterectomy for benign indications, 47.1% were obese and these women had the highest mean uterine weight of 349.53 g. Overall, BMI had a significant correlation with the uterine size (P<0.0001). For every 1-point increase in BMI, uterine weight increased by 7.56 g. BMI positively correlated with uterine size both in the women with fibroids (P=0.038) and in those without fibroids (P=0.016). After controlling for fibroids, every 1-point increase in BMI resulted in an increase of 4.56 g in uterine weight (P<0.0001). In addition, there was a significant correlation between BMI and the presence of fibroids (P<0.0001), but not with the size of fibroids (P=0.11). A significant correlation was found between BMI and uterine weight in all the women, independent of age and parity. For every 1-point increase in BMI, there was a 7.56 g increase in uterine weight. This association needs to be further assessed in healthy women without uterine pathology.

The effect of obesity on total abdominal hysterectomy.

OBJECTIVE: To compare perioperative outcomes of total abdominal hysterectomy (TAH) between obese and nonobese women. METHODS: The medical charts of all women who underwent TAH for benign gynecological conditions at Temple University Hospital between 1997 and 2002 were reviewed. We excluded those who had concomitant surgery except for adnexal removal. The rates of perioperative indices were compared between obese (body mass index [BMI] ≥ 30 kg/m²) and nonobese women; p < 0.05 was considered significant. RESULTS: Of 357 women, 172 (48.2%) were obese, and 185 (51.8%) were not. Among the baseline characteristics, only race was statistically different between the groups. There were more African American women among the obese women (82.5% vs. 70%, p < 0.05). Postoperative complications, including urinary tract injury, were not significantly increased in the obese group. On the contrary, nonobese women had a significantly higher incidence of ileus (13.5% vs. 6.4%, p < 0.05). Although operative time was significantly prolonged for obese women, obesity did not increase the length of hospitalization, transfusion rate, and perioperative hemoglobin change. All these results remained the same even after controlling for race. CONCLUSIONS: Contrary to the general opinion, obesity does not significantly affect the perioperative outcomes for TAH performed for benign gynecological causes.

Objective structured clinical examination and advanced practice nursing students.

Educators, challenged to measure clinical competency impartially in Advanced Health Assessment courses, have used Objective Structured Clinical Examination (OSCE) and standardized patients (SP). Faculty-trained laypersons act as patients (SP) for students in a clinical laboratory setting using a standardized, scripted scenario. Students typically are evaluated during the examination and receive instant feedback from the SP. There has been little evidence that supports this as the best way to measure student's clinical competency. This study's purpose was to compare outcomes of graduate nursing students completing a traditional methods Health Assessment course to those students using OSCE and SPs. Problem-based Learning Theory guided the quasi-experimental study that included 37 students divided into research and control groups. There were statistically significant differences between the two groups for the final practical examination grades, clinical preceptor evaluations, satisfaction scores, and self-evaluations of skills at the course's end. Research group's course scores were higher than the control group. There was no difference between group's self-evaluation for their current assessment skills. This intervention had a positive impact on students' outcomes. Educators should incorporate SPs and OSCE to improve clinical competency scores, course satisfaction, and preceptor evaluations. Future studies should include a longitudinal design and qualitative student feedback.

Prevalence of urinary symptoms in morbidly obese women and changes after bariatric surgery.

OBJECTIVE: To evaluate the impact of rapid weight loss following bariatric surgery on urinary symptom frequency and overall quality of life. STUDY DESIGN: Validated questionnaires (Urinary Distress Inventory [UDI-6] and Incontinence Impact Questionnaire [IIQ-7]), were mailed to all women who underwent bariatric surgery at Temple University Hospital between January 2004 and March 2006. McNemar test of paired proportions was used for analysis. RESULTS: Mean body mass index prior to surgery was 47.5 and after surgery was 31.0, with an average weight loss of 49.2 kg. About half the subjects had stress incontinence, 32% had frequency and 24.8% had urgency at baseline. Twenty-six percent of the subjects were frustrated and emotionally distressed by the urinary symptoms at baseline, while one fifth reported interference with performing household chores, travel and other activities. There was a significant improvement in stress incontinence (p < 0.001), frequency and leakage of any degree and overall quality of life subsequent to surgery. CONCLUSION: Body mass index has a significant effect on urinary symptoms as an independent factor. We report a marked improvement in stress incontinence symptom frequency and symptom bother with rapid weight loss subsequent to bariatric surgery in morbidly obese women.