Impact of an educational intervention on patient safety culture among gynecology-obstetrics' healthcare professionals.

BACKGROUND: In recent years, patient safety has begun to receive particular attention and has become a priority all over the world. Patient Safety Culture (PSC) is widely recognized as a key tenet that must be improved in order to enhance patient safety and prevent adverse events. However, in gynecology and obstetrics, despite the criticality of the environment, few studies have focused on improving PSC in these units. This study aimed at assessing the effectiveness of an educational program to improve PSC among health professionals working in the obstetric unit of a Tunisian university hospital. METHODS: We conducted a quasi-experimental study in the obstetric unit of a university hospital in Sousse (Tunisia). All the obstetric unit's professionals were invited to take part in the study (n = 95). The intervention consisted of an educational intervention with workshops and self-learning documents on patient safety and quality of care. The study instrument was the French validated version of the Hospital Survey on Patient Safety Culture. Normality of the data was checked using Kolmogorov-Smirnov test. The comparison of dimensions' scores before and after the intervention was carried out by the chi2 test. The significance level was set at 0.05. RESULTS: In total, 73 participants gave survey feedback in pre-test and 68 in post-test (response rates of 76.8% and 71.6, respectively). Eight dimensions improved significantly between pre- and post-tests. These dimensions were D2 "Frequency of adverse events reported" (from 30.1 to 65.6%, p < 0.001), D3 "Supervisor/Manager expectations and actions promoting patient safety" (from 38.0 to 76.8%, p < 0.001), D4 "Continuous improvement and organizational learning" (from 37.5 to 41.0%, p < 0.01), D5 "Teamwork within units" (from 58.2 to 79.7%, p < 0.01), D6 "Communication openness" (from 40.6 to 70.6%, p < 0.001), and D7 "Non-punitive response to error" (from 21.1 to 42.7%, p < 0.01), D9 "Management support for patient safety" (from 26.4 to 72.8%, p < 0.001), and D10 "Teamwork across units" (from 31.4 to 76.2%, p < 0.001). CONCLUSIONS: Educational intervention, including workshops and self-learning as pedagogical tools can improve PSC. The sustainability of the improvements made depends on the collaboration of all personnel to create and promote a culture of safety. Staff commitment at all levels remains the cornerstone of any continuous improvement in the area of patient safety.

Actions for mitigating the negative effects of patient participation in patient safety: a qualitative study.

BACKGROUND: Recent research within the context of Obstetrics shows the added value of patient participation in in-hospital patient safety. Notwithstanding these benefits, recent research within an Obstetrics department shows that four different negative effects of patient participation in patient safety have emerged. However, the approach to addressing these negative effects within the perspective of patient participation in patient safety is currently lacking. For this reason, the aim of this study is to generate an overview of actions that could be taken to mitigate the negative effects of patient participation in patient safety within an Obstetrics department. METHODS: This study was conducted in the Obstetrics Department of a tertiary academic center. An explorative qualitative interview study included sixteen interviews with professionals (N = 8) and patients (N = 8). The actions to mitigate the negative effects of patient participation in patient safety, were analyzed and classified using a deductive approach. RESULTS: Eighteen actions were identified that mitigated the negative effects of patient participation in patient safety within an Obstetrics department. These actions were categorized into five themes: 'structure', 'culture', 'education', 'emotional', and 'physical and technology'. These five categories reflect the current approach to improving patient safety which is primarily viewed from the perspective of professionals rather than of patients. CONCLUSIONS: Most of the identified actions are linked to changing the culture to generate more patient-centered care and change the current reality, which looks predominantly from the perspective of the professionals and too little from that of the patients. Furthermore, none of the suggested actions fit within a sixth anticipated category, namely, 'politics'. Future research should explore ways to implement a patient-centered care approach based on these actions. By doing so, space, money and time have to be created to elaborate on these actions and integrate them into the organizations' structure, culture and practices.

Exploring disaster preparedness in an obstetric unit in a district hospital in the Western Cape Province.

BACKGROUND: Research on disaster preparedness in public hospitals is limited, and specialised units such as obstetric departments need to be even more prepared when rendering health care to vulnerable populations. Disasters can be natural, such as floods due to human interventions, sinkholes due to mining, or pandemic occurrences, such as the recent COVID-19 pandemic. Research on disaster preparedness is limited, and even more so in specialised units such as obstetrics and evacuating a ward of maternal and neonatal patients present unique challenges. Being prepared for any disaster is the only assurance of effective patient healthcare during a disaster. This study explored and described nurses' knowledge and attitudes regarding preparedness for a disaster in an obstetric unit in a public institution. The study aimed to make recommendations to improve disaster preparedness in an obstetric ward based on the nurses' knowledge and attitudes. METHODS: This study utilised an exploratory, descriptive qualitative design within a contextual approach. The data were acquired through individual interviews that were done using a semi-structured interview schedule. An observational walkabout was performed with the unit manager to validate interviewee responses. The study employed purposive sampling with a sample size of 17 nurses (N = 32, n = 17) and a response rate of 53%. The interviews were transcribed verbatim, and later, the data underwent analysis using theme analysis and a co-coder. RESULTS: The results indicate that the participants demonstrate an awareness of disaster terminology but need more assertiveness in executing the institutional disaster policy. The results illustrate that more frequent training, disaster rehearsals, and simulations should be implemented to improve disaster readiness. Strategies are recommended to enhance preparedness for a disaster in the obstetric unit. CONCLUSION: The study findings recommend more education and training opportunities that should be regularly instilled as a practice within the obstetric ward. More disaster drills and simulation exercises should be performed to ensure confidence in disaster preparedness. Obstetric staff of all levels should be involved with policymaking and disaster plan development.

Impacto de la implementación de un método de traspaso de información estandarizada interdisciplinar en sala de partos y unidad de cuidados obstétricos intermedios / Impact of the implementation of a standardised interdisciplinary information transfer method in the Delivery room and Intermediate Obstetric Care Unit

Objetivo Este estudio tiene como objetivo describir la implementación de la metodología estandarizada en la transferencia de información en sala de partos y unidad de cuidados obstétricos intermedios en un hospital de tercer nivel de Barcelona e identificar el impacto de esta implementación en los factores que actúan como facilitadores y barreras en el procedimiento. Método Estudio cuasiexperimental tipo pretest-postest sin grupo control en la unidad de cuidados obstétricos intermedios y sala de partos del servicio de Medicina Maternofetal de un hospital de tercer nivel de Barcelona. El personal sanitario autocumplimentó un cuestionario ad hoc antes y después de implementar la metodología estandarizada IDEAS en el servicio durante 2019 y 2020. Se evaluó la autopercepción personal en el procedimiento de transferencia de información. El test de Wilcoxon por pares se utilizó para la comparación antes y después. Resultados El uso de una metodología estandarizada ha mostrado un impacto en la mejora de la transmisión de la información. Se detectaron diferencias significativas antes y después de la intervención en las siguientes dimensiones: ubicación, personas implicadas, periodo de tiempo del procedimiento, estructurada ordenada y clara y tiempo suficiente para preguntas (p<0,001); mientras que no se observaron diferencias en transmisión al profesional referente, actuaciones bien definidas y realización de un resumen. Conclusiones Existen factores, como aspectos estructurales, organizativos y falta de tiempo, que dificultan la comunicación efectiva, por tanto, actúan como barreras en la transferencia de información. La implementación de una metodología con las personas implicadas, el tiempo y el espacio adecuado permite mejorar aspectos en la comunicación en el equipo multiprofesional y, por tanto, la seguridad del paciente. (AU)

Aim This study aims to describe the implementation of the standard methodology for information transfer in the labour ward and Intermediate Obstetric Care Unit and to identify the impact of this implementation on the factors that act as facilitators and barriers in the procedure. Method Quasi-experimental pretest-posttest study without a control group in an Intermediate Obstetric Care Unit and delivery room of the Maternal-Fetal Medicine Service of a tertiary hospital in Barcelona. Healthcare staff self-completed an ad hoc questionnaire before and after implementing the standardised IDEAS methodology in the service during 2019 and 2020. Personal self-perception in the information transfer procedure was assessed. The Wilcoxon pairwise test was used for comparison before and after. Results The use of a standardised methodology has shown an impact on improving the transmission of information. Significant differences were detected before and after the intervention in the following dimensions: location, people involved, time period of the procedure, structured, orderly and clear, and sufficient time for questions (p<0.001); while no differences were observed in: transmission to the referring professional, well-defined actions, and completion of a summary. Conclusions There are factors such as structural and organisational aspects and lack of time that hinder effective communication and therefore act as barriers to the transfer of information. The implementation of a methodology with the health professionals involved, the time and the appropriate space allows for the improvement of communication aspects in the multiprofessional team and, therefore, patient safety. (AU)

Evaluation of the incorporation of an IOTA-ADNEX model in the discrimination of adnexal masses in our third-level hospital centre, taking into account the menopausal status of patients. Five years of experience / Evaluación de la incorporación del IOTA-ADNEX model en la discriminación de las masas anexiales en nuestro centro hospitalario de tercer nivel teniendo en cuenta el estado menopáusico en la predicción de malignidad. Cinco años de experiencia

Objective: The objectives were to estimate the performance of the IOTA-ADNEX model test after its incorporation into the ultrasound tests of our third-grade hospital gynecology service, as well as to assess whether its capacity of accuracy is modified when taking into account the patient's menopausal status. Methods: A cross-sectional study was conducted to clinically evaluate the diagnostic performance of the IOTA-ADNEX model test, which was performed between January 2016 and December 2021. The study included 573 women with an adnexal injury who underwent surgical excision within 180 days after ultrasound diagnosis and histological confirmation (gold standard). After the ultrasound exam, the injuries were classified using the ADNEX model. The study estimated the area under the receiver-operating-characteristics curve (AUC) of the ADNEX model for classifying between benign and malignant adnexal masses and compared the performance by menopausal state. Sensitivity and specificity were determined for different cut-off points. Results: Out of the 573 women, 183 (31.9%) had a malignant tumor. The AUC of the ADNEX model for differentiating between benign and malignant adnexal masses at the time of ultrasound examination was 0.92 and the best malignancy threshold, detected by Youden index, was 22.5%. At this cut-off, the sensitivity of the ADNEX model was 91.8% and the specificity was 76.4%. However, it varies according to menopausal status: in the group of pre-menopausal patient, sensitivity was 86.1% (95% CI, 85.4%–86.8%) and specificity was 81.3% (95% CI, 85.4%–86.8%). In the postmenopausal group, sensitivity was 96.1% (95% CI, 95.6%–96.7%) and specificity was 68.5% (95% CI, 68.1%–68.8%)...(AU)

Objetivo: Los objetivos eran estimar el rendimiento del test IOTA ADNEX model después de su incorporación en el estudio ecográfico en nuestro servicio de ginecología, en un hospital de tercer nivel, así como evaluar si su capacidad de precisión se modifica al tener en cuenta el estado menopáusico de la paciente. Método: Se llevó a cabo un estudio transversal para evaluar clínicamente el rendimiento diagnóstico del test IOTA ADNEX model, el cual se realizó entre enero de 2016 y diciembre de 2021. El estudio incluyó a 573 mujeres con una lesión anexial que se sometieron a tratamiento quirúrgico en un plazo de 180 días después del diagnóstico por ecografía y confirmación histológica (gold standard). Después de realizar la ecografía, las lesiones fueron clasificadas utilizando el modelo ADNEX. El estudio estimó el área bajo la curva (AUC) del modelo ADNEX para diferenciar entre masas anexiales benignas y malignas, y se comparó el rendimiento según el estado menopáusico. Se determinó la sensibilidad y la especificidad para diferentes puntos de corte. Resultados: De las 573 mujeres, 183 (31,9%) tenían un tumor maligno. El AUC del modelo ADNEX para diferenciar entre masas anexiales benignas y malignas en el momento del examen ecográfico fue de 0,92 y el umbral de malignidad óptimo, detectado por el índice de Youden, fue del 22,5%. Con este punto de corte, la sensibilidad (SE) del modelo ADNEX fue del 91,8% y la especificidad (SP) fue del 76,4%. Sin embargo, esto varía según el estado menopáusico: en el grupo de pacientes premenopáusicas, la sensibilidad fue del 86,1% (IC del 95%: 85,4-86,8%) y la especificidad fue del 813% (IC del 95%: 85,4-86,8%). En el grupo de pacientes posmenopáusicas, la sensibilidad fue del 96,1% (IC del 95%: 95,6-96,7%) y la especificidad fue del 68,5% (IC del 95%: 68,1-68,8%)...(AU)

Secuencia anemia-policitemia en la gestación monocorial. Manejo prenatal y resultados perinatales / Twin anaemia polycythemia polycythemia sequence in monochorionic gestation. Prenatal management and perinatal outcomes

Introducción: El objetivo de este trabajo consiste en describir y analizar los resultados perinatales de una serie de casos de anemia-policitemia (TAPS) seguidos y tratados en un centro de referencia en Medicina Fetal, en términos del tipo TAPS y la conducta prenatal aplicada. Métodos: Análisis estadístico descriptivo e inferencial con el programa IBM SPSS Statistics. Resultados: Se diagnosticaron 13 casos de TAPS en un total de 510 gestaciones monocoriales. La mayoría de TAPS espontáneos se diagnosticaron en estadios precoces (5 casos), mientras que, en TAPS posláser, 3/6 casos se diagnosticaron en estadios avanzados. Cuatro fetos (4/26; 15,4%) presentaron alteraciones en la neurosonografía, 3 (3/14; 21,4%) en TAPS espontáneos y uno (1/12, 8,3%) en TAPS posláser (p = 0,308). Se detectó hipertrofia miocárdica en 7 fetos, 5 (71,4%) de los cuales correspondían a TAPS en estadios avanzados. Cuatro eran TAPS espontáneos (4/14; 28,6%) y 3 TAPS posláser (3/12; 25%) (p = 0,797). Ocho casos (8/13; 62,5%) precisaron algún procedimiento de terapia fetal. Se produjeron 3 muertes fetales anteparto y una pareja decidió interrupción legal del embarazo (19,23%). Las 5 pérdidas se produjeron en estadio IV (p=0,008).La supervivencia global fue del 80,8% (21/26 recién nacidos vivos). No hubo diferencias significativas en función del tipo TAPS (p = 0,159) y la conducta prenatal adoptada (p = 0,746). Conclusiones: El TAPS espontáneo es, por tanto, una entidad clínica con un impacto en los resultados perinatales similar al posláser. Parece que la conducta expectante y el láser consiguen mayor edad gestacional al nacimiento.(AU)

Introduction: The aim of this paper is to describe and analyze the perinatal outcomes of a series of TAPS cases followed and treated in a Fetal Medicine referral center, in terms of the type of TAPS and the prenatal behavior applied. Methods: Descriptive and inferential statistical analysis with IBM SPSS Statistics software. Results: Thirteen cases of TAPS were diagnosed in a total of 510 monocorial gestations. Most of the spontaneous TAPS were diagnosed at early stages (5 cases), whereas, in post-laser TAPS, 3/6 cases were diagnosed at advanced stages. Four fetuses (4/26; 15.4%) presented alterations in neurosonography, 3 (3/14; 21.4%) in spontaneous TAPS and one (1/12, 8.3%) in post-laser TAPS (P=0.308). Myocardial hypertrophy was detected in 7 fetuses, 5 (71.4%) of which corresponded to advanced stage TAPS. Four were spontaneous TAPS (4/14; 28.6%) and 3 were post-laser TAPS (3/12; 25%) (P=0.797). Eight cases (8/13; 62.5%) required some fetal therapy procedure. There were 3 antepartum fetal deaths and one couple decided to legally terminate the pregnancy (19.23%). All 5 losses were stage IV (P=0.008). Overall survival was 80.8% (21/26 live newborns). There were no significant differences according to the type of TAPS (P= 0.159) and the prenatal behavior adopted (P=0.746).Conclusions: Spontaneous TAPS is therefore a clinical entity with an impact on perinatal outcomes similar to post-laser. It seems that expectant management and laser achieve higher gestational age at birth.(AU)

Impacto de la implementación de un método de traspaso de información estandarizada interdisciplinar en sala de partos y unidad de cuidados obstétricos intermedios / Impact of the implementation of a standardised interdisciplinary information transfer method in the Delivery room and Intermediate Obstetric Care Unit

Objetivo Este estudio tiene como objetivo describir la implementación de la metodología estandarizada en la transferencia de información en sala de partos y unidad de cuidados obstétricos intermedios en un hospital de tercer nivel de Barcelona e identificar el impacto de esta implementación en los factores que actúan como facilitadores y barreras en el procedimiento. Método Estudio cuasiexperimental tipo pretest-postest sin grupo control en la unidad de cuidados obstétricos intermedios y sala de partos del servicio de Medicina Maternofetal de un hospital de tercer nivel de Barcelona. El personal sanitario autocumplimentó un cuestionario ad hoc antes y después de implementar la metodología estandarizada IDEAS en el servicio durante 2019 y 2020. Se evaluó la autopercepción personal en el procedimiento de transferencia de información. El test de Wilcoxon por pares se utilizó para la comparación antes y después. Resultados El uso de una metodología estandarizada ha mostrado un impacto en la mejora de la transmisión de la información. Se detectaron diferencias significativas antes y después de la intervención en las siguientes dimensiones: ubicación, personas implicadas, periodo de tiempo del procedimiento, estructurada ordenada y clara y tiempo suficiente para preguntas (p<0,001); mientras que no se observaron diferencias en transmisión al profesional referente, actuaciones bien definidas y realización de un resumen. Conclusiones Existen factores, como aspectos estructurales, organizativos y falta de tiempo, que dificultan la comunicación efectiva, por tanto, actúan como barreras en la transferencia de información. La implementación de una metodología con las personas implicadas, el tiempo y el espacio adecuado permite mejorar aspectos en la comunicación en el equipo multiprofesional y, por tanto, la seguridad del paciente. (AU)

Aim This study aims to describe the implementation of the standard methodology for information transfer in the labour ward and Intermediate Obstetric Care Unit and to identify the impact of this implementation on the factors that act as facilitators and barriers in the procedure. Method Quasi-experimental pretest-posttest study without a control group in an Intermediate Obstetric Care Unit and delivery room of the Maternal-Fetal Medicine Service of a tertiary hospital in Barcelona. Healthcare staff self-completed an ad hoc questionnaire before and after implementing the standardised IDEAS methodology in the service during 2019 and 2020. Personal self-perception in the information transfer procedure was assessed. The Wilcoxon pairwise test was used for comparison before and after. Results The use of a standardised methodology has shown an impact on improving the transmission of information. Significant differences were detected before and after the intervention in the following dimensions: location, people involved, time period of the procedure, structured, orderly and clear, and sufficient time for questions (p<0.001); while no differences were observed in: transmission to the referring professional, well-defined actions, and completion of a summary. Conclusions There are factors such as structural and organisational aspects and lack of time that hinder effective communication and therefore act as barriers to the transfer of information. The implementation of a methodology with the health professionals involved, the time and the appropriate space allows for the improvement of communication aspects in the multiprofessional team and, therefore, patient safety. (AU)

More Than Half of US Rural Hospitals No Longer Offer Birthing Services-Here's Why.

This Medical News article discusses a new report on labor and delivery department closures in the rural US as well as potential financial and workforce solutions.

The obstetrical emergency department: need, rationale, and guide to implementation.

The past 2 decades have seen dramatic growth in the number of obstetrics and gynecology hospitalists, and many hospitals have created obstetrical-specific emergency departments. The goals of an obstetrics emergency department are to provide safe and efficient care to the pregnant dyad and postpartum patient, while generating revenue for emergency services provided. In an obstetrics emergency department, all patients must be evaluated in person by a licensed practitioner, whereas historically they may have been evaluated in person by nursing staff or a trainee. We make the argument that formation of an obstetrics emergency department has the potential to improve the safety and quality of patient care. In addition, the financial benefits to institutions are substantial and can subsidize the cost of maintaining obstetrician presence all the time in the hospital. There are various regulatory requirements to become certified, accredited, and licensed as an emergency department. In addition, there are many operational and systems issues that institutions should consider before implementation. We provide a guide for healthcare systems considering creating an obstetrics emergency department.

Prevalence and dietary management of polycystic ovary syndrome among Libyan women attending Tripoli Infertility Center

Polycystic ovarian syndrome (PCOS) is the most common heterogenic endocrine illness in women of reproductive age, caused mostly by an excess of androgen and ovarian dysfunction. The present study was carried out to estimate the prevalence of PCOS among Libyan women who attended infertility center Tripoli, Libya, from 2020-2022, evaluate hormonal profile, Body Mass Index, weight and west circumferential before and after treatment and diet management. A longitudinal cross-sectional study conducted in the Tripoli Fertility Center in Tripoli, Libya, the study population targeting output Libyan female patients who presented to the gynecology and obstetrics (OPD) department and therapeutic nutrition department. Data Retrospectively collected from 2020 until 2022 and diagnosed using Rotterdam's criteria. A total of 603 patients visited the gynecology and obstetrics department and the therapeutic nutrition department between January 2020 and December 2022. Out of which 174 women in the PCOS group and 429 in the non-PCOS group. The prevalence of PCOS was 29.56% in 2020, 37.5% in 2021, and 20.27% in 2022. The mean age of PCOS was 34.90 ± 5.5 SD, and all of the PCOS group were married. Worth to mention that all of PCOS cases was insulin resistance type. In terms of weight in the PCOS group, 19.54% were obese BMI >29, 68.96% were morbid obese with BMI >35, and approximately 68.39% of waist circumference measurements were more than 88cm. Hirsutism and oligomenorrhea were the major clinical features, morbid obese seems to be more prevalent in Libyan PCOS patients, low carbohydrate diet and physical activities may play an important role in PCOS management

A multi-centre, open-label, prospective, observational study to assess the safety of a nifedipine oral solution in the treatment of preterm labor / Estudio multicéntrico, de diseño abierto, prospectivo y observacional para evaluar la seguridad de una solución oral de nifedipino en el tratamiento del parto prematuro

Objective: To analyze the safety profile of a nifedipine oral solution in the treatment of preterm labor (PTL). Methods: A multi-center, open-label, prospective, single-arm, observational study was conducted in 500 women with PTL to whom a nifedipine oral solution was prescribed according to its Summary of Product Characteristics. Safety profile and tolerability of oral administration of nifedipine solution during routine clinical practice was assessed as the primary objective of the study and treatment efficacy as secondary objective. Results: No severe adverse events were reported among these women, including severe hypotension. Eight patients (2.3%) reported adverse reactions of moderate intensity, and in 0.9% of the patients (3 cases), these adverse reactions caused the discontinuation of the treatment. Conclusions: The results of this study show that nifedipine oral solution exhibits an excellent safety profile used as a tocolytic treatment in women with PTL.(AU)

Objetivo: Analizar el perfil de seguridad de una solución oral de nifedipino en el tratamiento del parto prematuro (PP). Métodos: Se llevó a cabo un estudio observacional, prospectivo, de diseño abierto, de rama única y multicéntrico en 500 mujeres que presentaban un PP, a las que se les administró una solución oral de nifedipino según la ficha técnica del producto. El perfil de seguridad y la tolerancia de la solución oral de nifedipino, en el contexto de la práctica clínica rutinaria, fueron evaluados como objetivo primario del estudio, y la eficacia del tratamiento, como objetivo secundario. Resultados: No se notificaron efectos adversos graves, incluyendo hipotensión severa. Ocho pacientes (2,3%) presentaron reacciones adversas de intensidad moderada, y en el 0,9% de las pacientes (3 casos) estos efectos adversos provocaron la discontinuación del tratamiento. Conclusiones: Los resultados de este estudio muestran que la solución oral de nifedipino dispone de un excelente perfil de seguridad para su uso como tocolítico en el tratamiento de mujeres con PP.(AU)

Cost and regression analysis of preeclampsia from the perspective of the reimbursement agency / Análisis de costes y regresión de la preeclampsia desde la perspectiva de la agencia de reembolso

Objective: The aim of this study is to determine the financial burden of preeclampsia (PE) from a single institution's perspective and then determine the cost of the illness from the reimbursement institution perspective and finally draw a regression model that predicts the annual cost of a patient. Materials and methods: The research is a descriptive and cross-sectional type of research and a retrospective cost analysis. Patients diagnosed with PE in 2021 were included in the study. For the regression analysis of the study, a dataset with 29 parameters belonging to 65 patients was created. Regression models were built on top of it. Results: In our study, per-patient expenses of PE patients from the perspective of the reimbursement institution were calculated and presented as average costs; severe PE patient with cesarean section 7598.5 Ł ($769.8), severe PE patient with normal vaginal delivery 8487.48 Ł (1050.43 $), mild PE patient with cesarean section 5331.67 Ł ($659.86) and mild PE patient with normal vaginal delivery was calculated as 6220.65 Ł (769.88 $). In the study, different regression formulas were created for the two groups of PE. The created regression model had an R2 score of 91.85%. Conclusion: The actors involved in the management of the disease should determine the cost-effectiveness of the disease by using the financial data of the patients and choose the right approach. Health costs in Turkey differ from the parameters in the European Union economy. Therefore, there are lower health costs. The financial findings of the disease are a guide for health policy makers, health managers and researchers.(AU)

Objetivo: El objetivo de este estudio es determinar la carga financiera de la preeclampsia (PE) desde la perspectiva de una única institución, para luego determinar los costes de la enfermedad desde la perspectiva de la institución de reembolso, y así elaborar un modelo de regresión que prediga el coste anual de un paciente. Materiales y métodos: Se trata de una investigación de tipo descriptivo, transversal y de un análisis retrospectivo de costes. Se incluyeron en el estudio los pacientes diagnosticados de PE en 2021. Para el análisis de regresión del estudio se creó un conjunto de datos con 29 parámetros que pertenecían a 65 pacientes diferentes. Los modelos de regresión se construyeron en base a este. Resultados: En nuestro estudio, los gastos por paciente de las pacientes con PE desde la perspectiva de la institución de reembolso se calcularon y presentaron como costos promedio; paciente con PE grave con cesárea 7598.5 (769.8 $), paciente con PE grave con parto vaginal normal 8487.48 (1050.43 $), paciente con PE leve con cesárea 5331.67 (659.86 $) y paciente con PE leve con parto vaginal normal se calculó como 6220.65 (769.88 $). En el estudio se crearon diferentes fórmulas de regresión para los dos grupos de PE. El modelo de regresión creado tuvo una puntuación R2 de 91,85%. Conclusión: Los agentes implicados en la gestión de la enfermedad tendrán que determinar su rentabilidad utilizando los datos económicos de los pacientes y elegir el enfoque adecuado. Los costes sanitarios en Turquía difieren de los parámetros de la economía de la Unión Europea. Por tanto, los costes sanitarios se reducen. Los hallazgos financieros de la enfermedad servirán de guía para los responsables de las políticas de salud, los gerentes de salud y los investigadores.(AU)

Concept of opportunistic bilateral salpingectomy in a sample of Mexican gynecologists. What should residents be trained on? / Concepto de salpingectomía bilateral oportunista en una muestra de ginecólogos mexicanos. ¿En qué se debe capacitar a los residentes?

Background: Ovarian cancer is the fifth deadliest cancer among women. There is no effective screening method. It has been suggested that ovarian cancer originates from precursor lesions in the fimbriae of the fallopian tubes. Objective: The aim of this study was to determine the level of knowledge of opportunistic bilateral salpingectomy by gynecologists. Methods: A cross-sectional study was carried out and a survey was sent electronically to gynecologists and gynecology residents. Demographic characteristics as well as questions of interest related to clinical practice and indication for surgery were included. Results: 52 subjects were included, 21 women and 31 men, with a mean age of 40.7 years. Thirty-five board certified gynecologists, as well as 17 gynecology residents, were included as part of the total survey group. Thirty-six individuals (69.2%) reported performing elective salpingectomy. The motivation they had to perform salpingectomy as a method of sterilization was: “reduction in the risk of ovarian cancer in the future” (55.6%). The indication for elective salpingectomy while performing other procedures was: “to prevent ovarian cancer” (61.1%). Certified gynecologists (42.9%) as well as residents (41.1%) considered “transvaginal ultrasound screening” as the best primary prevention method for ovarian cancer in low-risk women. Conclusions: Opportunistic bilateral salpingectomy is safe and cost-effective. However, when gynecologists are interviewed to find out their level of knowledge, there is poor acceptance of opportunistic bilateral salpingectomy in Mexico. A training strategy should be designed in the gynecology residency in order to motivate ovarian cancer prevention.(AU)

Antecedentes: El cáncer de ovario es el quinto cáncer más mortal entre las mujeres. No existe un método de detección eficaz. Se ha sugerido que el cáncer de ovario se origina a partir de lesiones precursoras en las fimbrias de las trompas de Falopio. Objetivo: Determinar el nivel de conocimiento de los ginecólogos sobre la salpingectomía bilateral oportunista. Métodos: Se envió una encuesta por vía electrónica a médicos ginecólogos y residentes de Ginecología. Se incluyeron características demográficas, así como preguntas de interés relacionadas con la práctica clínica y la indicación de cirugía. Resultados: Se incluyeron 52 sujetos, 21 mujeres y 31 hombres, con una edad media de 40,7 años. Treinta y cinco ginecólogos certificados, así como 17 residentes de ginecología, se incluyeron como parte del grupo total. Treinta y seis individuos (69,2%) informaron haber realizado salpingectomía electiva. La motivación que tuvieron para realizar la salpingectomía como método de esterilización fue: «reducción del riesgo de cáncer de ovario en el futuro» (55,6%). La indicación de salpingectomía electiva mientras se realizaban otros procedimientos fue: «para prevenir el cáncer de ovario» (61,1%). Los ginecólogos certificados (42,9%) y los residentes (41,1%) consideraron la «detección con ultrasonido transvaginal» como el mejor método de prevención primaria para el cáncer de ovario en mujeres de bajo riesgo. Conclusiones: Cuando entrevistamos a los ginecólogos detectamos poca aceptación de la salpingectomía bilateral oportunista en México. Se debe diseñar una estrategia de formación en la residencia de Ginecología para motivar la prevención del cáncer de ovario.(AU)

Prevalencia e impacto del sangrado menstrual abundante en España: resultados de una encuesta nacional / Prevalence and impact of heavy menstrual bleeding in Spain: Results of a national survey

Antecedentes: El sangrado menstrual abundante (SMA) es un problema ginecológico frecuente. Los datos sobre su prevalencia en España y su impacto son limitados. Material y métodos: Encuesta realizada en España en mujeres de 23-49 años incluidas en un panel en línea voluntario. La encuesta abordó varios aspectos, incluidos las características y el impacto de la menstruación. La información se recogió mediante un cuestionario semiestructurado enviado por correo electrónico. Los resultados se ponderaron por edad y distribución geográfica. Resultados: Se obtuvieron datos de 1.206 mujeres de las 4.478 invitadas (26,9%), de las que 1.169 (96,9%) tenían la menstruación. El 32,7% (n=373) expresó tener «sangrado menstrual excesivo» (SME), lo que se asoció con una mayor frecuencia e intensidad de síntomas menstruales. También con un porcentaje superior de mujeres a las que la menstruación limita «bastante o mucho» (29,1% frente a 15,7% con sangrado normal/leve). Las relaciones sexuales fueron el ámbito más afectado (al 59% les limitaba «bastante o mucho»). El porcentaje de mujeres con afectación de los ámbitos analizados fue significativamente superior entre aquellas con SME, excepto para la vida familiar. El 67,5% de las mujeres con SME había acudido al médico por este motivo; el 19,8% seguía algún tratamiento específico. Conclusiones: En nuestra muestra de 1.206 mujeres de edad fértil, el 6,2% presentaba SMA (SME+limitación «bastante o mucho» de la vida diaria). El SME tiene un impacto importante en la vida diaria de la mujer. Dos de cada 3consultan al médico por este motivo.(AU)

Background: Heavy menstrual bleeding (HMB) is a common gynecological complaint. Data on its prevalence and impact in Spain are limited. Material and methods: A voluntary web-based survey was conducted in Spain among women aged 23–49. The survey covered several aspects of menstruation, including the characteristics and impact. The information was gathered using a semi-structured questionnaire sent by email. Results were weighted by age and geographic distribution. Results: Of the 4478 women invited to participate, 1206 (26.9%) responded, of whom 1169 (96.9%) were menstruating. 32.7% (n=373) said they experienced “excessive menstrual bleeding” (EMB), which was associated with increased frequency and intensity of menstrual symptoms as well as a higher percentage of women whose menstruation limited them “a lot or quite a lot” (29.1% vs. 15.7% with normal/light bleeding). Sexual intercourse was the domain most affected (59% were limited “a lot or quite a lot”). Except for family life, the impact on the domains analyzed was significantly higher among women with EMB. 67.5% of women with EMB had seen a doctor for this reason; 19.8% were receiving some type of treatment. Conclusions: In our sample of 1206 women of childbearing age, 6.2% had HMB (EMB+“a lot or quite a lot” of limitations of daily activities). Excessive menstrual bleeding has a major impact on the daily lives of women. Two out of 3see a doctor for this reason.(AU)

Divisions of health equity in departments of obstetrics and gynecology.

Disparities in maternal morbidity and mortality remain vivid reminders of the role of racism in obstetrics and gynecology. If a serious attempt is to be made to purge medicine of its ongoing role in unequal care, then departments must commit the same intellectual and material resources as they would to the other health challenges in their remit. A division that understands the unique needs and complexities of the specialty, including translating theory into practice, is uniquely positioned to keep health equity as a focus of clinical care, education, research, and community engagement. To achieve reproductive justice, an approach addressing the intersectionality of race, ethnicity and gender identity is critical. In this article, we detailed the ways in which divisions of health equity within departments of obstetrics and gynecology can dismantle impediments to progress and can move our discipline closer to optimal and equitable care for all. We described the unique educational, clinical, research, and innovative community-based activities of these divisions.

Clinical Simulation in the Training of Obstetrics and Gynecology Resident from the Perspective of Medical Residency Programs / A Simulação Clínica na Formação do Residente em Obstetrícia e Ginecologia na Perspectiva do Programa de Residência Médica

Abstract Objective This study analyzes the role of clinical simulation in internal medical residency programs (IMRP) in Obstetrics and Gynecology (OB/GYN), attributed by the supervisors, in the training of residents in the city of São Paulo (SP). Methods Cross-sectional descriptive, qualitative, and exploratory approach. Semi-structured interviews were performed with ten supervisors of Medical Residency programs in Obstetrics and Gynecology. Interviews were analyzed by means of content analysis under the thematic modality, starting with the core the role of clinical simulation in Obstetrics and Gynecology Medical Residency Programs. Results Supervisors view Clinical simulation as: a complementary tool for the teaching and learning process, a possibility of a safe teaching and learning environment, an opportunity to learn from mistakes, a support for professional practice committed to patient safety, a learning scenario for teamwork, a scenario for reflection on the work process in Obstetrics and Gynecology, a scenario for evaluative processes in the medical residency. Still according to supervisors, Clinical Simulation favors decision-making and encourages the resident participation in activities. Conclusion Supervisors recognize Clinical Simulation as a powerful pedagogical tool in the learning process of resident doctors in Obstetrics and Gynecology Residency Programs.

Resumo Objetivo O presente estudo analisa o papel da Simulação Clínica em programas de Residência Médica (PRM) de Obstetrícia e Ginecologia, atribuído pelos supervisores, na formação do residente no município de São Paulo (SP). Métodos Abordagem qualitativa, transversal, de natureza exploratória e descritiva. Foram realizadas entrevistas semiestruturadas com dez supervisores de programas de Residência Médica de Obstetrícia e Ginecologia. Para análise das entrevistas foi realizada análise de conteúdo na modalidade temática partindo do seguinte núcleo: o papel da simulação clínica nos Programas de Residência Médica de Obstetrícia e Ginecologia. Resultados A Simulação Clínica, na visão dos supervisores, emerge como: ferramenta complementar para o processo de ensino e aprendizagem; possibilidade de um ambiente de ensino e aprendizagem seguro; possibilidade de aprendizagem a partir do erro; suporte para prática profissional comprometida com a segurança do paciente; cenário de aprendizagem para o trabalho de equipe; cenário de reflexão sobre o processo de trabalho em Obstetrícia e Ginecologia; favorecimento na tomada de decisão; cenários de processos avaliativos na residência; e, por fim, estímulo à participação dos residentes nas atividades. Conclusão Os supervisores reconhecem a Simulação Clínica como uma ferramenta pedagógica potente no aprendizado dos médicos residentes em Obstetrícia e Ginecologia.

Factors associated with the closure of obstetric units in German hospitals and its effects on accessibility.

BACKGROUND: An increase in regionalization of obstetric services is being observed worldwide. This study investigated factors associated with the closure of obstetric units in hospitals in Germany and aimed to examine the effect of obstetric unit closure on accessibility of obstetric care. METHODS: Secondary data of all German hospital sites with an obstetrics department were analyzed for 2014 and 2019. Backward stepwise regression was performed to identify factors associated with obstetrics department closure. Subsequently, the driving times to a hospital site with an obstetrics department were mapped, and different scenarios resulting from further regionalization were modelled. RESULTS: Of 747 hospital sites with an obstetrics department in 2014, 85 obstetrics departments closed down by 2019. The annual number of live births in a hospital site (OR = 0.995; 95% CI = 0.993-0.996), the minimal travel time between two hospital sites with an obstetrics department (OR = 0.95; 95% CI = 0.915-0.985), the availability of a pediatrics department (OR = 0.357; 95% CI = 0.126-0.863), and population density (low vs. medium OR = 0.24; 95% CI = 0.09-0.648, low vs. high OR = 0.251; 95% CI = 0.077-0.822) were observed to be factors significantly associated with the closure of obstetrics departments. Areas in which driving times to the next hospital site with an obstetrics department exceeded the 30 and 40 min threshold slightly increased from 2014 to 2019. Scenarios in which only hospital sites with a pediatrics department or hospital sites with an annual birth volume of ≥ 600 were considered resulted in large areas in which the driving times would exceed the 30 and 40 min threshold. CONCLUSION: Close distances between hospital sites and the absence of a pediatrics department at the hospital site associate with the closure of obstetrics departments. Despite the closures, good accessibility is maintained for most areas in Germany. Although regionalization may ensure high-quality care and efficiency, further regionalization in obstetrics will have an impact on accessibility.

Atuação da psicologia em unidade neonatal no contexto da pandemia da covid-19 / The work of psychology in a neonatal unit in the covid-19 pandemic / Actuación de la psicología en una unidad neonatal en el contexto de la pandemia de la covid-19

A pandemia de covid-19 provocou intensas mudanças no contexto do cuidado neonatal, exigindo dos profissionais de saúde a reformulação de práticas e o desenvolvimento de novas estratégias para a manutenção da atenção integral e humanizada ao recém-nascido. O objetivo deste artigo é relatar a atuação da Psicologia nas Unidades Neonatais de um hospital público de Fortaleza (CE), Brasil, durante o período de distanciamento físico da pandemia de covid-19. Trata-se de estudo descritivo, do tipo relato de experiência, que ocorreu no período de março a agosto de 2020. No contexto pandêmico, o serviço de Psicologia desenvolveu novas condutas assistenciais para atender às demandas emergentes do momento, como: atendimento remoto; registro e envio on-line de imagens do recém-nascido a seus familiares; visitas virtuais; e reprodução de mensagens de áudio da família para o neonato. Apesar dos desafios encontrados, as ações contribuíram para a manutenção do cuidado centrado no recém-nascido e sua família, o que demonstra a potencialidade do fazer psicológico.(AU)

The COVID-19 pandemic brought intense changes to neonatal care and required health professionals to reformulate practices and develop new strategies to ensure comprehensive and humanized care for newborn. This study aims to report the experience of the Psychology Service in the Neonatal Units of a public hospital in Fortaleza, in the state of Ceará, Brazil, during the social distancing period of the COVID-19 pandemic. This descriptive experience report study was conducted from March to August 2020. During the pandemic, the Psychology Service developed new care practices to meet the emerging demands of that moment, such as remote care, recordings and online submission of newborns' pictures and video images for their family, virtual tours, and reproduction of family audio messages for the newborns. Despite the challenges, the actions contributed to the maintenance of a care that is centered on the newborns and their families, which shows the potential of psychological practices.(AU)

La pandemia de la COVID-19 ha traído cambios intensos en el contexto de la atención neonatal, que requieren de los profesionales de la salud una reformulación de sus prácticas y el desarrollo de nuevas estrategias para asegurar una atención integral y humanizada al recién nacido. El objetivo de este artículo es reportar la experiencia del Servicio de Psicología en las Unidades Neonatales de un hospital público de Fortaleza, en Ceará, Brasil, durante el periodo de distanciamiento físico en la pandemia de la COVID-19. Se trata de un estudio descriptivo, un reporte de experiencia, que se llevó a cabo de marzo a agosto de 2020. En el contexto pandémico, el servicio de Psicología desarrolló nuevas conductas asistenciales para atender a las demandas emergentes del momento, tales como: atención remota; grabación y envío em línea de imágenes del recién nacido; visitas virtuales; y reproducción de mensajes de audio de la familia para el recién nacido. A pesar de los desafíos encontrados, las acciones contribuyeron al mantenimiento de la atención centrada en el recién nacido y su familia, lo que demuestra el potencial de la práctica psicológica.(AU)