Recommendations for a standardised educational program in robot assisted gynaecological surgery: Consensus from the Society of European Robotic Gynaecological Surgery (SERGS).

BACKGROUND: The Society of European Robotic Gynaecological Surgery (SERGS) aims at developing a European consensus on core components of a curriculum for training and assessment in robot assisted gynaecological surgery. METHODS: A Delphi process was initiated among a panel of 12 experts in robot assisted surgery invited through the SERGS. An online questionnaire survey was based on a literature search for standards in education in gynaecological robot assisted surgery. The survey was performed in three consecutive rounds to reach optimal consensus. The results of this survey were discussed by the panel and led to consensus recommendations on 39 issues, adhering to general principles of medical education. RESULTS: On review there appeared to be no accredited training programs in Europe, and few in the USA. Recommendations for requirements of training centres, educational tools and assessment of proficiency varied widely. Stepwise and structured training together with validated assessment based on competencies rather than on volume emerged as prerequisites for adequate and safe learning. An appropriate educational environment and tools for training were defined. Although certification should be competence based, the panel recommended additional volume based criteria for both accreditation of training centres and certification of individual surgeons. CONCLUSIONS: Consensus was reached on minimum criteria for training in robot assisted gynaecological surgery. To transfer results into clinical practice, experts recommended a curriculum and guidelines that have now been endorsed by SERGS to be used to establish training programmes for robot assisted surgery.

Resilience and related factors in urban, mid-aged Spanish women.

OBJECTIVE: To assess resilience and related factors among urban, mid-aged Spanish women. METHODS: This was a cross-sectional study performed in 227 women aged 40-65 years who filled out the 14-item Wagnild and Young Resilience Scale (WYRS-14), the Menopause Rating Scale (MRS) and a questionnaire containing personal sociodemographic data. RESULTS: For the whole sample, median (interquartile range) age and total WYRS-14 score were 52.4 (8.7) years and 79 (20.0) points, respectively. Resilience score was inversely related to non-working status, non-university studies, depressed mood, perimenopausal status, and higher MRS total scores (≥ 17). Using the 25th percentile of the obtained total WYRS-14 score as a cut-off value to define lower resilience (< 68.0 points), logistic regression analysis determined that low resilience was related to being unemployed, having depressed mood and being perimenopausal. Drinking less than 3 units/day of alcohol was significantly related to higher resilience. CONCLUSION: In this sample of urban, mid-aged Spanish women, low resilience (lower WYRS-14 scores) was related to unemployment status, depressed mood and severe menopausal symptoms.

Determinaciones analíticas de la mujer anciana en ginecología / Biological-analitical determinations in the older woman

En esta revisión se hace un análisis de los cambios anatómicos, suelo pélvico, etc. en el envejecimiento femenino, de lo déficits hormonales y marcadores tumorales, ya que los procesos oncológicos tan frecuentes en la mujer postolmatérica y anciana (AU)

P53 overexpression predicts endometrial carcinoma recurrence better than HER-2/neu overexpression.

OBJECTIVE: to investigate the prognostic value of p53 and HER-2/neu overexpression in endometrial cancer. STUDY DESIGN: p53 and HER-2/neu immunostaining was performed in 114 paraffin-embedded specimens of endometrial cancer diagnosed and treated between 1990 and 1997. Nuclear p53 and membrane HER-2/neu immunostaining were used. RESULTS: p53 and HER-2/neu overexpression was observed in 17 cases (14.9%) and in 19 cases (16.7%), respectively. In univariate analysis p53 (P<0.001) and HER-2/neu (P=0.018) overexpression had a positive correlation with a high risk of recurrence. In multivariate analysis, age (P<0.001), FIGO stage (P<0.001), differentiation (P=0.013), non-endometrioid subtypes (P<0.001) and p53 overexpression (P<0.001), but not HER-2/neu overexpression, were independent prognostic indicators of recurrence. Simultaneous p53 and HER-2/neu overexpression made worse the prognostic (P<0.001). CONCLUSIONS: p53 overexpression was an independent predictor of recurrent disease in endometrial cancer. HER-2/neu overexpression had a more limited effect but enhance the effect of p53.

A comparison of epithelial membrane antigen overexpression in benign and malignant endometrium.

OBJECTIVE: The aim of this study was to analyze the value of epithelial membrane antigen (EMA) overexpression in benign and malignant endometrium and its prognostic significance. METHODS: EMA immunostaining was performed in 178 paraffin-embedded specimens including 105 endometrial cancers, 40 endometrial hyperplasias, and 33 benign endometriums. EMA immunostaining was correlated with traditional prognostic factors and progression-free survival in endometrial cancer specimens. RESULTS: EMA overexpression was observed more frequently in adenocarcinomas (60%) than in hyperplasias (15%) or benign endometrium (9.1%). EMA overexpression was observed in two patients with endometrial hyperplasia who progressed to carcinoma. In adenocarcinomas, EMA overexpression had a positive correlation with nonendometrioid subtypes (P = 0.012). In multivariate analysis, FIGO stage (P = 0.025) and EMA overexpression (P = 0.017) were independent prognostic factors for progression-free survival. CONCLUSIONS: EMA overexpression appears to be a marker of malignant transformation in the endometrium and it is an independent predictor of recurrent disease in endometrial cancer.