Use of Contraceptive Methods Among Women in the General Population and Female Gynecologists in Spain: the ELEGIAN Survey.

Background: The contraceptive preferences of obstetricians and gynecologists (OB/GYNs) are thought to influence the contraceptive counseling they provide. The purpose of this study was to assess contraceptive preferences of OB/GYNs and women in the general population (WGP) in the current Spanish contraceptive scenario. Materials and Methods: Anonymous online survey of 100 OB/GYNs and 1,217 WGP aged 23-49 years. Results: WGP were younger (35.3 ± 7.3 vs. 37.9 ± 6.2 years, respectively) and less likely to have stable partners (64.7% vs. 84.0%) and children (49.1% vs. 62.0%) (all p < 0.05 vs. OB/GYNs). Seventy-nine percent versus 82%, respectively, used contraceptive methods, with condoms used most frequently by WGP (37% vs. 22% by OB/GYNs; p < 0.05) and pills by OB/GYNs (26% vs. 21% by WGP; p > 0.05). Intrauterine devices (IUDs) were more frequently used by OB/GYNs (20% vs. 5%; p < 0.05), especially the levonorgestrel-releasing intrauterine devices (LNG-IUDs) (18% vs. 2.6%; p < 0.05). The highest-rated methods were condoms among WGP and LNG-IUDs among OB/GYNs. Effectiveness was the most valued attribute of contraceptive methods for both. Reasons related to convenience were the main reason for choosing IUDs. OB/GYNs prescribed the contraceptive method in 40% of cases. Conclusions: Our study reveals differences between female OB/GYNs and WGP in contraceptive methods use and rating. The use of LNG-IUDs was much higher among OB/GYNs.

Cycle control with an extended-regimen oral contraceptive combining levonorgestrel and ethinyl estradiol that includes continuous low-dose ethinyl estradiol instead of the traditional hormone-free interval.

PURPOSE: To evaluate scheduled and unscheduled bleeding and spotting over 1 year of treatment with 91-day extended-regimen combined oral contraception (COC) providing continuous low-dose ethinyl estradiol (EE) in place of the traditional 7-day hormone-free interval (HFI). PATIENTS AND METHODS: This post hoc analysis of a multicenter, open-label, 1-year, Phase 3 study of extended-regimen COC with 30 µg EE/150 µg levonorgestrel (LNG) for 84 days and EE 10 µg for 7 days included 799 sexually active, adult women who completed at least one 91-day cycle of therapy. Subjects recorded bleeding and spotting episodes daily using electronic diaries. Logistic regression analyses are reported as ORs with 95% CIs. RESULTS: There was a 10% increase (OR =1.102; 95% CI: 1.006-1.206) in the likelihood of reporting no scheduled bleeding for each additional 91-day cycle completed. From the third 91-day cycle, more than one fifth of women reported no scheduled bleeding (third cycle =23% [121/533]; fourth cycle =22% [97/446]). Among women who reported no scheduled bleeding at Cycle 1 (136/758 [18%]), ≥45% showed sustained lack of scheduled bleeding in later cycles. There were increases of 53% (OR =1.531; 95% CI: 1.393-1.683) and 31% (OR =1.307; 95% CI: 1.205-1.418) in the likelihood of reporting 0 to ≤6 days vs >6 days of unscheduled bleeding and spotting, respectively, for each additional 91-day cycle. By Cycle 2, more than 80% of women reported no unscheduled bleeding or ≤6 days of unscheduled bleeding during each 91-day cycle. CONCLUSION: Improved cycle control with decreased bleeding over time was shown during extended-regimen COC with 30 µg EE/150 µg LNG for 84 days and continuous low-dose EE instead of the traditional 7-day HFI. Women considering this regimen should be informed that those who complete at least one 91-day COC cycle will likely experience less bleeding/spotting in future cycles.

Development and conceptual validation of a questionnaire to help contraceptive choice: CHLOE (Contraception: HeLping for wOmen's choicE).

OBJECTIVE: The aim of this research was to develop a questionnaire to facilitate choice of the most appropriate contraceptive method for individual women. METHODS: A literature review was conducted to identify key aspects influencing contraceptive choice and inform development of a questionnaire for online completion. Questionnaire development was overseen by a steering committee consisting of eight gynaecologists from across Europe. The initial draft underwent conceptual validation through cognitive debriefing interviews with six native English-speaking women. A qualitative content analysis was conducted to accurately identify potential issues and areas for questionnaire improvement. A revised version of the questionnaire then underwent face-to-face and online evaluation by 115 international gynaecologists/obstetricians with expertise in contraception, prior to development of a final version. RESULTS: The final conceptually validated Contraception: HeLping for wOmen's choicE (CHLOE) questionnaire takes ≤10 min to complete and includes three sections to elicit general information about the individual, the health conditions that might influence contraceptive choice, and the woman's needs and preferences that might influence contraceptive choice. The questionnaire captures the core aspects of personalisation, efficacy and safety, identified as key attributes influencing contraceptive choice, and consists of 24 closed-ended questions for online completion prior to a health care provider (HCP) consultation. The HCP receives a summary of the responses. CONCLUSION: The CHLOE questionnaire has been developed to help women choose the contraception that best suits their needs and situation while optimising the HCP's time.

Differences in reporting Pearl Indices in the United States and Europe: Focus on a 91-day extended-regimen combined oral contraceptive with low-dose ethinyl estradiol supplementation.

BACKGROUND: Regulatory agencies in the United States (US) and Europe differ in requirements for defining pregnancies after the last dose of oral contraceptive, sometimes resulting in discrepant Pearl Indices (PIs) for the same product despite identical clinical data. This brief report highlights one such example, a 91-day extended-regimen combined oral contraceptive (COC). METHODS: The US- and European-based PI methodologies were compared for a 91-day extended-regimen COC consisting of 84 days of active levonorgestrel/EE 150 µg/30 µg tablets, followed by seven days of EE 10 µg tablets in place of placebo. CONCLUSIONS: At the times of approval of the 91-day extended-regimen COC in the US and Europe, the requirements for defining 'on-treatment' pregnancies differed (14-day vs. 2-day rule, respectively). This difference resulted in a higher PI in the US- vs. European-based calculation (1.34 and 0.76, respectively). The differences in the PI should not be interpreted as the extended-regimen COC being less effective in preventing pregnancy in the US compared with Europe.

Analysis of perception of training in graduates of the Faculty of Medicine at Universidad de Castilla-Mancha.

INTRODUCTION: Problem-based learning has been a key component of the teaching method employed at the Faculty of Medicine at the University of Castilla La Mancha (UCLM) in Albacete, Spain since its creation. The aim of this study was to evaluate perceptions of training among residents who graduated from the first three years of the UCLM Degree in Medicine. METHODS: Using the Jefferson Medical College postgraduate rating form, residents rated their performance in four areas of clinical competency (medical knowledge, data gathering skills, clinical judgment, and professional attitudes) at the beginning of residency training in comparison with colleagues from other faculties. The construct validity of responses was evaluated using Cronbach's alpha and exploratory factor analysis. RESULTS: Over half the respondents (57.8%) considered that they had received better training than peers from other medical schools, and 98.5% felt that their general performance in the four competencies analyzed was similar or superior to that of their colleagues. Factor analysis revealed two major factors: "the physician as scientist" and "the physician as manager and communicator". CONCLUSIONS: Our study shows that graduates from the UCLM Faculty of Medicine perceive their training, which is largely based on problem-based learning, as satisfactory.

Impacto económico de la histeroscopia quirúrgica en consulta. Modelo con escenarios progresivos / Economic analysis of outpatient versus day-case operative hysteroscopy. A progressive-scenario model

Objetivo. Analizar el coste de la histeroscopia en consulta frente al de la histeroscopia en régimen de cirugía mayor ambulatoria. Sujetos y métodos. Sobre la base de las 1.695 histeroscopias realizadas entre 2010 y 2012, se analiza el coste de los procedimientos en consulta y en quirófano de cirugía mayor ambulatoria. Se recrea un modelo con 10 escenarios progresivos según el número de procedimientos quirúrgicos realizados en consulta y se analizan el impacto económico y las horas de quirófano liberadas. Resultados. La realización en consulta de todos los procedimientos histeroscópicos posibles representó un ahorro de 177.971 Euros y se liberaron 85,16 jornadas de 7 h en quirófano. Conclusiones. La histeroscopia quirúrgica en consulta es una técnica segura, eficiente, con un importante impacto económico y altas tasas de satisfacción para las pacientes. Debe sustituir, en la medida de lo posible, a la histeroscopia quirúrgica en quirófano y ser difundida ampliamente en los centros asistenciales (AU)

Objective. To analyze the cost of outpatient versus day-case operative hysteroscopy. Subjects and methods. The average cost of outpatient and day-case procedures were analyzed, based on the 1695 hysteroscopies performed between 2010 and 2012. A model with 10 progressive scenarios was built according to the number of outpatient procedures performed. The economic saving and the number of operating room sessions avoided were analyzed. Results. Performing as many procedures as possible in the outpatient setting represented a saving of 177,971 Euros and avoided 85.16 seven-hour sessions in the operating room. Conclusions. Outpatient operative hysteroscopy represents a safe, efficient and cost saving procedure with a high degree of patient satisfaction. This procedure should replace day-case hysteroscopy and should be widespread in the health service (AU)

Use of and attitudes towards emergency contraception: a survey of women in five European countries.

OBJECTIVE: To identify knowledge of and attitudes towards emergency contraception (EC) in women from five European countries. METHODS: In an internet-based survey, sexually active women aged 16 to 46 years from France, Germany, Italy, Spain, and the UK were asked about their use of and opinions on EC. RESULTS: Overall, 7170 women completed the survey. Thirty percent reported having had unprotected sexual intercourse during the previous 12 months (population at risk). Twenty-four percent of the population at-risk reported using EC. The most common reasons given for not using EC were: not perceiving themselves to be at risk of pregnancy; and not thinking about EC as an option. A third of respondents indicated they did not know how EC works, with several misconceptions about EC noted e.g., leading to infertility, similar to abortion. Seventy-nine percent of women agreed that EC is a responsible choice to prevent unwanted pregnancy, but nearly a third of women who used EC felt uncomfortable or judged when obtaining it. CONCLUSIONS: EC is underutilised by three-quarters of the women surveyed. Women do not recognise they may be at risk of pregnancy when contraception fails. There are still several misbeliefs about EC indicating a need for better education of the public.

Evaluación por los tutores de la formación adquirida por los licenciados en medicina en la Universidad de Castilla-La Mancha / Evaluation by tutors from the training of postgraduates in medicine from the University of Castilla-La Mancha

Introducción: La comunidad universitaria debe cuestionarse si su producto final, el egresado, posee las competencias necesarias para enfrentarse al mercado laboral cuando abandona las aulas. Nuestro objetivo es analizar las valoraciones de las competencias profesionales de los posgraduados por la Universidad de Castilla-La Mancha (UCLM) realizadas por sus tutores de formación especializada. Sujetos y métodos: Hemos realizado un estudio observacional transversal de 67 tutores (sobre un total de 89, contestaron 73 y se excluyeron 6), que valoran a sus egresados procedentes de la Facultad de Medicina de la UCLM mediante 'formularios de evaluación', en los cuales se analizan cuatro áreas básicas de la competencia clínica del residente (conocimientos médicos, habilidades de recopilación de datos, juicio clínico profesional y actitudes profesionales). Los resultados se presentan en porcentajes. Para la asociación estadística se han realizado determinaciones no paramétricas. Resultados: El 53% de los tutores (35/63, 4 respuestas no válidas) consideran que la formación de nuestros egresados es superior a la de otros residentes procedentes de otras universidades. Más del 30% habla de un desempeño excepcional respecto a conocimientos, recogida de datos, diagnóstico y actitudes profesionales. Al analizar al residente como gestor de recursos sanitarios, un 6,3% de ellos administran peor los recursos que sus compañeros de residencia, formados en otras facultades. Conclusiones: Parece que la formación recibida por nuestros alumnos es adecuada según sus tutores, lo que les capacita para un correcto ejercicio profesional posterior. No obstante, se evidencian deficiencias respecto a la gestión de recursos sociosanitarios, problemática psicosocial y medicina preventiva (AU)

Introduction: The university community must question whether the end product, the graduate, has the skills necessary to face the labor market when they leave the classroom. Our objective is to examine the assessments of the professional skills of postgraduate students from the University of Castilla-La Mancha (UCLM) made by their specialized training supervisor. Subjects and methods: We conducted a cross-sectional study of 67 supervisor (a total of 89, 73 and excludes answer 6) of postgraduates of the Faculty of Medicine (UCLM), who helped answering the 'evaluation form', with 32 items about four basic areas of clinical competence (medical knowledge, data-gathering skills, clinical judgment and professional attitudes) The results are shown in percentages. Non-parametric measurements have been made for the statistical association. Results: 53% of the supervisor (35/63, 4 invalid responses) believe that the education of our graduates is higher than the others graduates coming from other universities. Over 30% talk about an exceptional performance in terms of knowledge, data collection, diagnosis and professional attitudes. Considering the resident as a manager of health resources, about 6.3% are below than the others graduates coming from other universities. Conclusions: According to their tutors, the training received by our students seems to be appropriated, which enables them to practice a correct professional task. However, deficiencies are evident on the management of healthcare resources, psychosocial problems and preventive medicine (AU)

Resultados de un programa de cirugía mayor ambulatoria en ginecología / Results of an ambulatory surgery program in gynecology

Objetivo: Evaluar los resultados de un programa de cirugía mayor ambulatoria (CMA) en ginecología. Material y métodos: Estudio retrospectivo del período 2002-2006. Las intervenciones incluidas fueron histeroscopias quirúrgicas y esterilizaciones tubáricas laparoscópicas. Se han analizado diversos indicadores de calidad (índice de sustitución, suspensión, ingresos, reingresos) y las complicaciones sistémicas y quirúrgicas que surgieron dentro de la primera semana tras la cirugía. Resultados: Mil doscientos catorce pacientes fueron intervenidos por el Servicio de Ginecología en el período indicado, con un índice de sustitución global del 90%. El índice de ingresos tras la cirugía fue 1,15%. Diez pacientes presentaron complicaciones graves, lo que representa un riesgo proporcional de 1:121. En 35 pacientes aparecieron complicaciones de menor gravedad que requirieron su ingreso hospitalario. Las complicaciones ginecológicas graves ocurrieron en 2 casos. Conclusiones: A pesar del cumplimiento de los requisitos óptimos, existe un porcentaje pequeño de complicaciones postoperatorias de gravedad variable (AU)

Objective: To evaluate the outcomes of an ambulatory surgery program in gynecological diseases. Material and methods: We performed a retrospective study of patients who underwent surgical hysteroscopy or laparoscopic tubal sterilization from January 2002 to December 2006. Several quality indicators (substitution, cancellation, admission and readmission rates) and the systemic and surgical complications appearing in the first week after surgery were analyzed. Results: During the study period, 1,214 patients underwent surgery in the gynecology service, with a global substitution rate of 90%. The admission rate after surgery was 1.15%. Severe complications occurred in 10 patients, representing a proportional risk of 1:121. Less severe complications requiring hospital admission occurred in 35 patients. Severe gynecological complications occurred in 2 patients. Conclusions: Despite compliance with optimal requirements, there was a low rate of postoperative complications of variable severity (AU)