Applicability of information and communication technologies in a secondary hospital pelvic floor service.

Information and Communication Technologies increase healthcare education. Since the COVID-19 pandemic outbreak, they have been gaining importance. Our aim was to assess the effects of a web-based questionnaire used in a pelvic floor consultation. We performed a prospective intervention study analysing the use of a web-based questionnaire prior to a first appointment. Fifty-two women used the questionnaire and 52 did not. All patients filled in a paper-based survey relating to satisfaction and pelvic floor knowledge after the appointment. Women in the intervention group showed better knowledge. They had 11% more correct answers for organ prolapse definition [CI 95% (-0.30 to 0.07)], 25% more correct answers for incontinence definition [CI 95% (-0.41 to -0.08)] and 23% better incontinence classification [CI 95% (-0.34 to 0.09]. More patients in the web-questionnaire group started primary therapy in the first consultation (38% versus 16%). Measurements of the total mean time in the consultation room revealed no statistically significant differences [19.36 (SD 4.96) and 21.19 (SD 4.62) minutes, respectively; p = .05] and satisfaction levels were similar.After using our web-based questionnaire, the time for medical histories reduced and patient knowledge increased without changing satisfaction levels. Impact statementWeb-based questionnaires (WBQ) and information web links may help to reduce time of history taking while time for physical examination, counselling and treatment discussion increases. Also, patient knowledge improves.What is already known on this subject? There are reviews showing how Information and Communication Technologies (ICT) can improve health quality and sanitary education. Since the Covid-19 pandemic started, ICT use has been accelerated and traineeship and learning has been enforced. However, there is not extensive research on its use in gynaecological consultations.What do the results of this study add? We have proved that the use of a WBQ and information web links before face-to-face first visit in a pelvic floor service improves patient knowledge. We have also worked to provide scientific evidence to an ICT tool.What are the implications of these findings for clinical practice and/or further research? The most important implications for clinical practice are the improvement of patient-provider communication, the time reduction for history taking in contrast to time increase for physical examination, counselling and treatment discussion.Apart from that, WBQ may help to measure qualitative information, because it is registered and can be used as patient reported outcomes (PRO) to increase quality of care. Further research should focus on other benefits of WBQ such as achieving better patient satisfaction.

Inadequate visits to the emergency department by pregnant women.

Inadequate emergency visits, which could be resolved in primary care, are an unnecessary expense for the healthcare service. We did a review of all gynaecology and obstetrics emergency visits by pregnant or postpartum women during 2010 and 2011 in order to describe the adequacy of the visits by pregnant women to the emergency service. We defined three levels of adequacy: adequate, moderately adequate, and inadequate. One thousand seven hundred and forty-three visits to the emergency room of gynaecology and obstetrics were studied. These consultation motivations were adequate in 38.9%, moderately adequate in 46.7% and inadequate in 14.4%. This shows that the amount of inadequate and moderately adequate visits to the emergency department could be reduced by 61% by implementing different interventions, and also reducing health spending for emergencies. Impact statement What is already known on this subject: Visits to the emergency room constitute a basic pillar in the hospital structure, and it generates great health expense. Other authors have reported high rates of inadequacy of these visits to the emergency services. They find inadequate visits are associated with young age and female gender among other factors. What the results of this study add: Knowing the adequacy of the visits generated by pregnant young women is a starting point for implementing health policies that could reduce these inadequate visits and consequently health expenditure could be reduced. What the implications are of these findings for clinical practice and/or further research: These health policies could consequently reduce health expenditure.

Office Hysteroscopic Laser Enucleation of Submucous Myomas without Mass Extraction: A Case Series Study.

Background and Objectives. A new two-step hysteroscopic myomectomy carried out in the office setting and without anesthesia was feasible for the excision of submucous myomas. The objective of this study was to assess whether removal of submucous myomas from the uterine cavity after hysteroscopic laser enucleation is necessary. Methods. Between June 2009 and April 2013, all outpatients with symptomatic myomatosis (bleeding, pelvic pain, and infertility) assessed ultrasonographically were eligible to participate in a prospective study. All patients underwent office hysteroscopic enucleation of submucous myomas. Enucleated myomas were left in the uterine cavity. Neither anesthesia nor antibiotic prophylaxis was used. Results. Sixty-one women (mean age: 47.3 years) were included. Regardless of hysteroscopic localization and grading, all myomas were enucleated. The mean (standard deviation, SD) diameter of the myoma as measured by the ultrasound scan was 22.6 (8.5) mm. In 29 cases (47.5%), the diameter of the resected myoma was >20 mm and in 10 cases (16.4%) >30 mm. After a mean follow-up of 68.2 (16.5) days, none of the patients showed a residual myoma inside the uterine cavity. Conclusions. The present results indicate that leaving laser-enucleated submucous myoma in the uterine cavity is a feasible and safe therapeutic option.

Outpatient Hysteroscopic Polypectomy: Bipolar Energy System (Versapoint®) versus Mechanical Energy System (TRUCLEAR System®) - Preliminary Results.

HYPOTHESIS: The new hysteroscopic system with mechanical energy is an effective outpatient technique for diagnosis and treatment that has certain advantages over conventional hysteroscopy in the management of endometrial polyps. OBJECTIVES: Our primary objective was to assess the total duration of hysteroscopy and polypectomy performed in an outpatient setting comparing the new mechanical energy hysteroscopy to the bipolar energy system. Our secondary objective was to compare the level of safety of both hysteroscopic techniques using the procedure success rate, the need for subsequent referral to surgery, existing complications, and comfort experienced by the patient during the procedure. PATIENTS AND METHODS: This randomized controlled trial included the first 90 patients with an ultrasound diagnosis of endometrial polyp (>1 cm) who underwent an outpatient diagnostic and operative hysteroscopy at the Igualada Hospital (Barcelona) and agreed to be included in the study by signing an informed consent. RESULTS: We obtained a 91% success rate with the TRUCLEAR System® compared to a 69% success rate with the Versapoint® system. Total operating time was 6.36 min in the TRUCLEAR System group versus 10.82 min in the Versapoint system group (p < 0.05), with a polypectomy time of 3.06 and 7.91 min, respectively (p < 0.05). There were no significant differences between the two techniques when analyzing pain using the visual analogue scale. No complications were recorded for either technique. CONCLUSION: The mechanical energy system presents a significant decrease in the total duration of polypectomy and hysteroscopy when performed both by experienced staff and by staff in training, resulting in higher success rates without complications with respect to conventional hysteroscopy with bipolar energy.

Preliminary results: ethanol sclerotherapy after ultrasound-guided fine needle aspiration without anesthesia in the management of simple ovarian cysts.

STUDY OBJECTIVE: To investigate the feasibility of ultrasound-guided, fine-needle aspiration and ethanol sclerotherapy of simple ovarian cysts in an office setting without anesthesia. We also describe the rate of cyst recurrence in patients treated with this technique and explore the associated risk factors. DESIGN: Prospective follow-up of patients after ethanol sclerotherapy of simple adnexal cysts in a single center trial (Canadian Task Force classification II-1). SETTING: The study was conducted at Bellvitge Teaching Hospital in Barcelona, Spain. PATIENTS: Ethanol sclerotherapy was performed on 60 simple adnexal cysts between 2009 and 2012. INTERVENTIONS: Ultrasound-guided fine-needle aspiration and ethanol sclerotherapy. MEASUREMENTS AND MAIN RESULTS: Patient demographics and cyst characteristics were collected for all patients. Potential risk factors for recurrence were analyzed by univariate and multivariate analyses. All the procedures, except 1, were performed without anesthesia. The only major complication was a case of self-limiting hem peritoneum that was managed expectantly. Moderate abdominal pain occurred in 26.7% of patients during the procedure. Fifty-five patients completed at least 6 months of follow-up and were included in the statistical recurrence analyses. Cyst recurrence was recorded in 9.1% of the patients and was managed in the usual manner in all the cases. Univariate analyses indicated that a larger cyst diameter and a higher estimated cyst volume were significantly associated with recurrence. In the multivariate analysis, recurrence was only significantly associated with estimated cyst volume. CONCLUSION: Ethanol sclerotherapy of simple ovarian cysts in an office setting without anesthesia is a feasible technique associated with a low rate of complications and recurrence, although larger randomized studies are necessary to assess the predictive factors for cyst recurrence.

Use of mobile phones as a tool for weight loss: a systematic review.

We conducted a systematic review of the literature on the use of mobile phones for weight loss. A total of 43 studies were identified on obese or overweight adults, aged 18 years or over. After review, ten articles met the inclusion criteria. There were 19-534 participants per study. Participants were from European, Asian and North American regions. The mean body mass index (BMI) of the subjects varied from 22 to 36 kg/m(2). Two studies used text messaging or multimedia messaging. All the other studies used mobile-phone apps or web-based programmes that could be accessed from mobile phones as a part of a weight-loss intervention or for evaluating their potential for use and their acceptance. Most studies lasted 2-4 months and the maximum duration was 1 year. All but two studies showed reductions in the participants' bodyweight, BMI, waist circumference and body fat in the various interventions. There appeared to be a proportional relationship between weight loss and programme use. The programmes most benefited those who took a pro-active approach to everyday problems. Frequent self-recording of weight seemed to be important, as was the personalisation of the intervention (counselling and individualized feedback). Finally, a social support system acted as a motivational tool.

¿Qué hubiera pasado si hubiésemos aplicado el Z0011 en nuestro medio? Revisión de los ganglios centinela realizados en los últimos 2 años en nuestro centro / What would happen if we applied the Z0011 study criteria? A review of the sentinel node dissections performed in our centre over the last 2 years

Objetivo: Revisar la casuística de nuestro centro para determinar en cuantas pacientes hubiéramos dejado enfermedad residual en la axila si hubiéramos aplicado los criterios del estudio Z0011. Material y métodos: Estudio retrospectivo de los ganglios centinelas (GC) realizados en carcinomas infiltrantes de nuestra Unidad de Patología Mamaria entre junio de 2008 y diciembre de 2010. Se revisaron todos los GC y las linfadenectomías axilares realizadas si 2 o menos GC eran positivos. Resultados: De 194 GC realizados, 33 resultaron positivos en 2 o menos ganglios centinelas (12,3%). La linfadenectomía axilar fue positiva en 13 casos (39,3%). Esto se produjo de forma más frecuente en las pacientes con ≤ 50 años (el 53,84 frente al 30%); en los tumores T2 en comparación con los T1 (el 53,84 frente al 30%); en los que tenían un grado histológico III comparados con los que mostraban grado I y II (el 38,46 frente al 33,33%); en aquéllos con receptores hormonales positivos en comparación con los que tenían receptores hormonales negativos (el 41,9 frente al 0%), y cuando el Ki67 era ≤ 20% en comparación con un Ki67 > a 20% (el 50 frente al 18,18%). Ninguna de estas diferencias fue estadísticamente significativa. Conclusión: Si hubiéramos aplicado los criterios del Z0011, un 39,3% de pacientes hubiera tenido enfermedad residual. Esto parece producirse con más frecuencia en pacientes de 50 o menos años, con tumoraciones de más de 2 cm, alto grado histológico, receptores hormonales positivos y Ki67 bajo. Sin embargo, el número bajo de casos de nuestra casuística no nos permite establecer unas conclusiones definitivas (AU)

Objective: To review the series of our centre in order to determine how many patients would have had residual disease in the axilla if we had applied the criteria of the Z0011 study. Material and methods: Retrospective study of sentinel lymph nodes performed in T1 and T2 breast infiltrating carcinomas in our Breast Pathology Unit between June 2008 and December 2010. We reviewed all the sentinel nodes (SN) and axillary lymph node dissections (ALND) performed when 2 or less SN were positive. Results: Of 194 sentinel nodes reviewed, 33 were positive in two nodes or less (12.3%). ALND was positive in 13 cases of 33 (39.3%). Positive ALND occurred more frequently in patients ≤ 50 years old than in > 50 years old patients (53.84% vs. 30%), in T2 compared toT1 tumours (30% vs. 53.84%), in grade III versus grade I and II tumours (38.46 vs. 33.33%), in hormone receptor-positive than in receptor-negative tumours (41.9 vs. 0%) and in Ki67 ≤ 20% compared to Ki67 > 20% tumours (50% vs. 18.18%). None of these differences were statistically significant. Conclusion: If we had applied the criteria of the Z0011 study, 39.3% of patients would have had residual disease. This seems to occur more frequently in patients 50 years or younger, with tumours larger than 2 cm, with high histological grade tumours, with positive hormone receptor and low Ki67. However, the low number of cases in our series does not allow definitive conclusions to be made (AU)

The Value of Hysterosalpingography following Medical Treatment with Methotrexate for Ectopic Pregnancy.

After an ectopic pregnancy (EP) fertility decreases, mostly due to tubal factor. Hysterosalpingography (HSG) is the most cost-effective tool for tubal patency assessment. Objective. To evaluate the usefulness of a HSG after a medical treatment for an EP, in order to counsel women on the most appropriate way to conceive future pregnancies. Methods. Between 1998 and 2008, 144 patients were submitted to medical treatment for an EP and performed HSG 3 months after the event. Results. 72.2% of normal HSG, 18.8% with unilateral obstruction, 6.3% tubal patency with defect, and 2.8% bilateral obstruction. Conclusion. Routine HSG following medical treatment for an EP does not seem necessary, as it does not change the initial management in 97.2% of the cases, but might be considered in selected risk cases, permitting timely referral of patients to in vitro fertilization.

Consumo de drogas durante la gestación y su repercusión neonatal. Análisis de los períodos 1982-1988 y 2002-2008 / Use of illicit drugs over gestation and their neonatal impact. Comparison between periods 1982-1988 and 2002-2008

Fundamento y objetivo: El consumo de drogas durante la gestación es una situación de riesgo. Nuestro objetivo es conocer la prevalencia actual, las características del embarazo, parto y recién nacidos (RN) de madres consumidoras de drogas. Pacientes y método: Estudio retrospectivo de los hijos de madres consumidoras de drogas entre los años 2002-2008 y comparación con los años 1982-1988, atendidos en nuestro hospital. Resultados: Actualmente hay un menor consumo de heroína y siempre asociada a otras drogas, siendo mayoritariamente inhalada o fumada. Se observa mayor edad materna (28,4 años), mejor control gestacional (60,5%) y más RN que van a centros de acogida (13,1%). Los programas de metadona proporcionan mejores resultados globales. Hay reducción de infecciones por virus de la inmunodeficiencia humana (VIH) (25%) y de la hepatitis B (VHB) (2,5%). El desprendimiento de placenta en el consumo de cocaína es muy elevado (11%). En el comparativo de los dos períodos se observan diferencias estadísticamente significativas en edad materna, control del embarazo, tipo de parto, tratamiento del síndrome de abstinencia a drogas (SAD) y destino de los RN.Conclusiones: Se observa un predominio de drogadicción en gestantes autóctonas, y disminución del consumo de heroína, con predominio del policonsumo. Actualmente se observa mejor control gestacional, menor infección por VIH y VHB. Asimismo, más niños van a centros de acogida. La edad gestacional y parámetros somatométricos se han mantenido a lo largo de los años. Los programas de metadona mejoran los aspectos nocivos del consumo de opiáceos. El desprendimiento prematuro de placenta en la gestante y las alteraciones neuroconductuales (ANC) en el RN son frecuentes en el consumo de cocaína (AU)

Background and objective: The use of illicit drugs during pregnancy becomes a high risk situation. Ourobjective is to determine the currently prevalence, pregnancy, delivery and newborn’s characteristics of mothers who use illicit drugs. Patients and methods: Retrospective study of children exposed prenatally to illicit drugs in the Neonatology’s Unit of the Hospital del Mar during 2002-2008 and comparison with 1982-1988 data. Results: Heroin use is lower currently and it is always associated with other drugs, mainly inhaled or smoked. There is an increase of the maternal age (28.4 years), an improved gestational control (60.5%) and more newborns are attended in shelters (13.1%). Methadone programs provide better overall results. Human immunodeficiency virus (HIV) (25%) and hepatitis B (BHV) (2.5%) infections have decreased.Placental abruption rate in cocaine users is very high (11%). By comparing both periods, there were statistically significant differences in maternal age, gestational control, delivery way, neonatalwithdrawal syndrome treatment and newborn destination. Conclusions: Drug abuse remains prevalent in native pregnants. Heroin use has decreased. At present, there is a better gestational control and less HIV and HBV infections. The gestational age andsomatometric parameters have not changed over the years. Methadone programs improve thedeleterious aspects of opioid use. Placental abruption in pregnancy and neurobehavioral disorders innewborn are common in cocaine users (AU)

[Use of illicit drugs over gestation and their neonatal impact. Comparison between periods 1982-1988 and 2002-2008]. / Consumo de drogas durante la gestación y su repercusión neonatal. Análisis de los períodos 1982-1988 y 2002-2008.

BACKGROUND AND OBJECTIVE: The use of illicit drugs during pregnancy becomes a high risk situation. Our objective is to determine the currently prevalence, pregnancy, delivery and newborn's characteristics of mothers who use illicit drugs. PATIENTS AND METHODS: Retrospective study of children exposed prenatally to illicit drugs in the Neonatology's Unit of the Hospital del Mar during 2002-2008 and comparison with 1982-1988 data. RESULTS: Heroin use is lower currently and it is always associated with other drugs, mainly inhaled or smoked. There is an increase of the maternal age (28.4 years), an improved gestational control (60.5%) and more newborns are attended in shelters (13.1%). Methadone programs provide better overall results. Human immunodeficiency virus (HIV) (25%) and hepatitis B (BHV) (2.5%) infections have decreased. Placental abruption rate in cocaine users is very high (11%). By comparing both periods, there were statistically significant differences in maternal age, gestational control, delivery way, neonatal withdrawal syndrome treatment and newborn destination. CONCLUSIONS: Drug abuse remains prevalent in native pregnants. Heroin use has decreased. At present, there is a better gestational control and less HIV and HBV infections. The gestational age and somatometric parameters have not changed over the years. Methadone programs improve the deleterious aspects of opioid use. Placental abruption in pregnancy and neurobehavioral disorders in newborn are common in cocaine users.

Aplicación de la lectura automatizada de citología ginecológica. El punto de vista de los citotécnicos / The use of automated readings in gynaecological cytology. The cytotechnician's viewpoint

La automatización de la citología ginecológica es ya un hecho en progresivo aumento en los servicios de anatomía patológica. Entre otros cambios, permite focalizar la atención del citotécnico y del citopatólogo en algunos datos de la extensión a analizar lo que permite mejorar la interpretación y por tanto, el diagnóstico. Hemos realizado un estudio comparativo de un total de 53.311 muestras correspondientes a otras tantas mujeres de distintos distritos de Barcelona, comparando el rendimiento de la citología convencional, de la citología liquida (ThinPrep Pap Test®, TPPT, Hologic, Malborough, Massachussets) con lectura manual y de la citología liquida (ThinPrep Pap Test®) con lectura automatizada (Imager®, Hologic, Malborough Massachussets), en 2 aspectos, uno el rendimiento global comparativo y 2 el rendimiento en relación al seguimiento de las pacientes. Concluimos que la lectura automatizada aumenta en nuestra serie el diagnóstico de ASCUS y LSIL, manteniendo en términos comparativos el diagnóstico de HSIL. Sin embargo, en el seguimiento de las pacientes observamos que se detectan más casos de HSIL en diagnósticos previos de ASCUS y LSIL con lectura automatizada y que los casos diagnosticados de HSIL muestran una correlación con la biopsia significativamente superior. Concluimos que la lectura automatizada de citología ginecológica incrementa la sensibilidad para diagnóstico de ASCUS y LSIL e incrementa la especificidad para el diagnóstico de HSIL(AU)

The use of automated technologies in gynaecological cytology is increasing in many departments of pathology. Amongst other things, it allows the cytotechnician and the cytologist to focus on specific areas of the slide which enhances identification and therefore improves diagnosis. We have carried out a comparative study of 53.311 samples taken from the same number of women resident in Barcelona. We compared the efficiency of conventional cytology, liquid cytology (ThinPrep Pap Test®, TPPT, Hologic, Malborough, Massachussets) with manual reading and liquid cytology (ThinPrep Pap Test) with automated reading (Imager®, Hologic, Malborough Massachussets). Two aspects were evaluated: comparative global performance and performance in relation to patient follow-up. We found that automated readings increased the diagnosis of ASCUS and LSIL whilst the frequency of HSIL diagnosis remained similar. However, in patient follow-ups, we observed that more cases of HSIL were detected in women with previous diagnoses of ASCUS and LSIL when automated reading was used and that there was a significantly greater correlation between the cytological diagnosis and the findings on biopsy. We concluded that there is greater sensitivity for the diagnosis of ASCUS and LSIL as well as an increased specificity for the diagnosis of HSIL when automated readings of gynaecological cytology are used(AU)

Periurethral granuloma following injection with dextranomer/hyaluronic acid copolymer for stress urinary incontinence.

Periurethral injection of bulk-enhancing agents provides a simpler and cost-effective therapeutic approach for stress incontinence in women. We report a case of periurethral granuloma secondary to dextranomer/hyaluronic acid (Dx/HA) copolymer injection. A 73-year-old woman with history of radiotherapy for cervical carcinoma at the age of 55 presented with stress urinary incontinence. She underwent periurethral injection of Dx/HA copolymer, and incontinence was resolved. At 4 months postoperatively, a 3-4 cm noninflammatory painless mass in the external genitalia was noted. Cystic images compatible with urethral diverticula were seen in the magnetic resonance imaging scan, but voiding cystourethrography was unrevealing. Transvaginal tumor puncture yielded abundant creamy material, the culture of which was negative. Microscopic examination revealed refractile foreign material surrounded by foreign body giant cells. Surgical debridement of the granuloma using a cold scalpel was performed. Stress urinary incontinence recurred but resolved spontaneously within 1 month. One year later, the patient continues to be asymptomatic.