Family medicine physician identification of obstetric lacerations: a US national survey.

INTRODUCTION AND HYPOTHESIS: We evaluated family medicine obstetric providers' identification and categorization of vaginal delivery lacerations in the USA. We hypothesized that there would be inaccuracy in family medicine physicians' identification of vaginal delivery injuries, similar to our previous studies of midwives and obstetricians (OBs). METHODS: We included clinically active physicians who attended deliveries within 2 years and evaluated their identification and categorization of delivery lacerations using descriptive text and visual images. We asked about their education on this topic and how they document lacerations in the labor and delivery record. RESULTS: We analyzed 250 completed responses (70% of opened surveys). Fifty-five percent of respondents characterized their obstetric laceration training as "good" or "excellent" and half previously had education on obstetric lacerations. The median accuracy overall for the classification and identification of perineal lacerations was 78% (IQR 56-91%). Respondents frequently mischaracterized nonperineal lacerations. Few respondents (36%) reported using the third-degree injury subclassification system. In adjusted analysis, the highest scoring respondents were board certified in family medicine, with fewer years in practice, and a higher obstetric volume. CONCLUSIONS: Obstetric laceration diagnoses may be inaccurate, which could influence perinatal quality and patient outcomes. We found gaps in knowledge similar to previous reports on midwives and obstetricians in the USA. These data suggest a need for increased education and training on obstetric injuries, perhaps especially for physicians with less obstetric activity. Improved categorization and identification of vaginal delivery trauma can impact management and improve women's postpartum care and long-term pelvic floor outcomes.

Put down the electronics after a concussion?

Yes, patients should do just that. In a randomized clinical trial, symptom duration was reduced when teens and young adults observed a certain screen-time hiatus.

One Step Forward, One Step Back: Changes in News Coverage of Medical Interventions.

During 2005-2013, the award-winning website HealthNewsReview.org offered reviews of major media outlets' news stories related to health interventions, including tests, treatments, dietary changes, and prescription drugs. The reviews offered a measure by which the public and journalists themselves could assess the completeness and usefulness of health coverage across 10 criteria for quality reporting. This study produced an analysis of those reviews from 2005 to 2013, indicating significant changes in key areas. Analysis of 1,889 health news story reviews published by HealthNewsReview.org (HNR) between 2005 and 2013 showed that, on average, the stories reviewed during 2005-2010 successfully met just less than half of the criteria, but by 2010-2013, that average had improved to almost 70%. There were significant improvements over time in news organizations' success in meeting six of HNR's 10 criteria for a successful health news story related to drugs, devices, surgery and other medical procedures, and diet; however, when data for television stories were excluded, only the improvement in avoiding disease-mongering remained significant. In addition, there was a statistically significant decline in the percentage of stories rated satisfactory on establishing the true novelty of the intervention discussed in the story. There was no improvement in quantification of possible harms from medical interventions. Changes over time in meeting the criteria were related to outlet type and story topic.