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.

Antibiotic prophylaxis compliance differences in surgery and gynecology/obstetrics services in Huánuco, Peru.

Introduction: Surgical site infections (SSIs) can increase mortality and morbidity in patients after surgery. Antibiotic prophylaxis is an effective measure to prevent SSIs, but inappropriate prescription is frequent. The objective of the study was to determine compliance with the clinical practice guideline for antibiotic prophylaxis in the general surgery and gynecology and obstetrics wards in the city of Huánuco, Peru. Methods: An analytical cross-sectional study was carried out on all surgical interventions in the general surgery and gynecology and obstetrics services during the year 2019. Compliance was determined based on the chosen antibiotic, dose, time of administration, and duration of prophylaxis. Related factors considered were age, presence of co-morbidities, surgery performed, duration of surgery, types of procedure, anesthesia, as well as years as a surgeon and anesthesiologist. Results: A total of 557 medical records of patients with a median age of 33 years undergoing surgery were collected,. Antibiotic prophylaxis was correctly followed in all aspects in 14.6% of cases in the general surgery service and only in 5.6% of cases in the gynecology and obstetrics service. The correct duration of prophylaxis was 11.6% and 19.7% in general surgery and gynecology and obstetrics, respectively. Conclusion: Low compliance with institutional clinical practice guidelines for antibiotic prophylaxis was identified in both services. However, surgical interventions in the general surgery service presented better compliance with antibiotic prophylaxis compared to gynecology and obstetrics procedures.

Conhecimento, atitude e prática dos médicos residentes de ginecologia e obstetrícia de Pernambuco sobre anticoncepção / Knowledge, attitude and practice of resident physicians in gynecology and obstetrics in Pernambuco about contraception

Resumo Introdução: Anticoncepção corresponde ao uso de métodos e técnicas com a finalidade de impedir que o relacionamento sexual resulte em gravidez. O médico residente em ginecologia e obstetrícia deve estar intimamente familiarizado com as múltiplas opções contraceptivas existentes, o modo de uso, os efeitos colaterais e suas contraindicações. Objetivo: Este estudo teve como objetivos identificar o nível de conhecimento, atitude e prática dos médicos residentes de ginecologia e obstetrícia do estado de Pernambuco sobre anticoncepção, determinar sua autopercepção em indicar e contraindicar os métodos contraceptivos, avaliar as melhores indicações clínicas, como prescrevê-los e orientar seu uso. Método: Foi realizado um estudo de inquérito, do tipo corte transversal, com componente analítico. Durante o período de maio a julho de 2022, aplicou-se um questionário à população-alvo, composta pelos médicos residentes de ginecologia e obstetrícia do estado de Pernambuco, e obteve-se um tamanho amostral de 157 respostas, que foram analisadas no programa estatístico Stata, versão 12.0. Resultado: Os métodos contraceptivos mais utilizados por eles foram o ACO, o DIU Mirena, a camisinha peniana e o DIU de cobre. Mais de 90% da amostra afirmou conhecer os critérios de elegibilidade e o índice de Pearl, e pouco mais da metade respondeu corretamente aos casos clínicos sobre contracepção; 52,9% relataram que não faziam uso da dupla proteção, e 40,1% da amostra mencionou que nunca usava camisinha. A maioria dos entrevistados atestou possuir uma boa prática com LARC e com esterilização cirúrgica; uma boa parcela dos residentes entrevistados considerou-se apta a orientar todos os métodos anticoncepcionais. Conclusão: O conhecimento das indicações e contraindicações pode ser considerado satisfatório, apesar de chamar a atenção a presença de uma disparidade entre a autopercepção do saber e os acertos das questões a respeito de casos clínicos específicos. Em relação à atitude, as respostas foram controversas. No âmbito da prática, obtiveram-se os melhores resultados de autopercepção de habilidade, com destaque para a prática com os LARC e a esterilização cirúrgica. As autoavaliações demonstraram que mais da metade da amostra considerou seus conhecimentos, suas atitudes e suas práticas muito satisfatórios e/ou adequados.

Abstract Introduction: Contraception corresponds to the use of methods and techniques with the purpose of preventing sexual intercourse from resulting in pregnancy. The resident physician in gynecology and obstetrics must be intimately familiar with the multiple existing contraceptive options, how to use them, their side effects and contraindications. Objectives: To identify the level of knowledge, attitude and practice among Gynecology and Obstetrics residents in the state of Pernambuco regarding contraception, determine their self-perception in indicating and contraindicating contraceptive methods, evaluating the best clinical indications, how to prescribe them and offer guidance for their use. Methods: A cross-sectional survey study with an analytical component. During the period from May to July 2022, a test was applied to the target population, composed by resident physicians of Gynecology and Obstetrics in the state of Pernambuco. A sample size of 157 responses was obtained, which were analyzed in the program STATA statistics, version 12.0. Results: The contraceptive methods most used by the resident physicians were the ACO, Mirena IUD, penile condom and copper IUD. More than 90% of the sample claimed to know the Eligibility Criteria and the Pearl Index, and just over half correctly answered the clinical cases on contraception; 52.9% reported not using double protection and 40.1% of the sample stated that they never used condoms. Most interviewees attested to having a good practice with LARC and with surgical sterilization; a good portion of the interviewed residents considered themselves able to guide all contraceptive methods. Conclusion: The knowledge of indications and contraindications can be considered satisfactory, despite a disparity between self-perceived knowledge and correct answers to questions regarding specific clinical cases; regarding attitude, the answers were controversial; within the scope of practice, the best results of self-perceived ability were obtained, with emphasis on the practice with LARC and surgical sterilization. Self-assessments showed that more than half of the sample considered their knowledge, attitudes and practices very satisfactory and/or adequate.

A Comprehensive Analysis of Postmarket Surveillance Study Orders: Device Characteristics, Study Statuses, Outcomes, and Potential Contributions.

BACKGROUND: The postmarket surveillance system plays a vital role in managing residual risks and identifying safety signals in real-world clinical practice. The Food and Drug Administration (FDA) can order postmarket surveillance studies when safety concerns are raised. We conducted a thorough investigation of device characteristics, study statuses, and the outcomes of US postmarket surveillance studies. METHODS: As of April 2017, we identified 338 orders, corresponding to 394 studies using the FDA database. Additional searches were conducted to identify safety issues or reasons for orders. RESULTS: Completed and active studies were limited. Fifteen of the 394 (3.8%) studies have been completed, and one study resulted in a recommendation of a labeling change. Forty-one (10.4%) studies were active. The majority of the studies (84.3%) were inactive. Three hundred fourteen (93%) orders were issued for implantable devices. The devices for use in women accounted for 144 (43%) orders. The mean from the first premarket approval or 510(k) clearance to 522 orders were 2968 days (n = 9) and 3320 days (n = 326), respectively, and the longest lag was 13,186 days. CONCLUSIONS: Our investigation highlighted that postmarket surveillance study orders resulted in the weeding out of many of the subject medical devices. There were little clinical data produced under the program. Timely and transparent feedback from the postmarket studies are critical for informed decisions by patients and medical practitioners and in expediting patient access to innovative or advanced medical devices.

Gynecology-obstetric resident surgery training: a national evaluation.

OBJECTIVES: The main objective of this study was to evaluate surgery training and evaluation of French gynecology-obstetrics residents. The second objective was to evaluate using simulation during residency. STUDY DESIGN: This national descriptive study, utilized a questionnaire to survey all interns in French gynecology and obstetrics. At the end of a study, 129 responses of residents were analyzed. RESULTS: The participation rate was 12%. The majority of residents were women (84%) and the highest response rate was from the Ile-de-France region (36%). The lowest rate was from the Southern region. The majority of residents were in the eighth semester (20%). Residents reported surgical and obstetric orientations in 53% (n = 68) and 44% (n = 57) of cases, respectively. Registration for cancer oncology was reported by 22% (n = 28) of respondents. Evaluation of oncologic surgery training was mostly considered "good" by the surgical group and "passable" by the obstetrics group. Access to simulators was usually restricted and most often utilized the pelvitrainer. Sessions were typically not mandatory and numbered between zero and five per semester. Three types of simulators were accessible in the Ile-de-France, North-West, West and Rhône-Alpes. The North-East did not have access to animal models, and the South-West did not have access to corpses. Surgical classes were more common in the Rhône-Alpes, North-East, Ile-de-France and North-West regions. To improve their training in oncological surgery, 64% (n = 18) of residents planned to do an inter-university exchange and 54% had completed additional specialized training. Measures that were most expected to improve training were increased training in surgery (96% of respondents, n = 27) and more intensive coaching (96%, n = 27). CONCLUSIONS: Companionship is a pillar of residents training, but its effectiveness is variable. One solution could be to implement better use of simulation methods.

[Impact of gender in academic career among obstetrics and gynecology's residents: A comparison between Lille and Paris]. / Impact du genre sur le choix de carrière parmi les internes de gynécologie-obstétrique : comparaison Lille/Paris.

OBJECTIVE: Compare the professional aspiration and obstacles in gynecology and obstetrics residents careers between Lille and Paris. METHODS: We conducted a cross-sectional survey, using questionnaires sent by e-mail to residents in obstetrics and gynecology in Lille. An analysis by genre was made, and those results were compared to results obtained in a same study with Parisian residents. RESULTS: Among the 73 residents in training in Lille, 63 responded (86.3%), of them 53 those were women and 10 were men. No woman answered wanting to start an academic career, however 50% of men did (P=0.001). The global analysis found obstacles to an academic career in defined areas such as: lack of mentors, lack of identification in a same sex role model or women doubting more than men in their abilities to achieve this career. The comparison between the two cities shown a greater gap between women and men in Lille: women in Lille were most reluctant to engage in academic careers and have not the prerequisites (diplomas, mobility or publications) that seem necessary for this type of career. CONCLUSIONS: Women were less expecting to have academic careers in Lille than in Paris. Many barriers have been identified as difficulties for them to follow this career path. It is important to develop strategies to encourage women in gynecology and obstetrics to find their place in research and teaching, since they are most present in this specialty.

La bioética en el desarrollo de la ginecobstetricia / Bioethics in the Development of Gynecology

El surgimiento de la bioética ha marcado un interés cada vez mayor para los hombres que se dedican a las ciencias, y sobre todo, a las ciencias médicas. Se realiza una reflexión con el objetivo de exponer la influencia de la bioética en el desarrollo de la obstetricia y ginecología actual, con ejemplos clásicos de su aplicación, polémica, dilemas y conflictos en nuestra labor cotidiana que garanticen una mejor calidad de la atención médica a nuestra población.

The emergence of bioethics has marked a growing interest for men who are dedicated to science, and above all, to medical science. Reflection is done with the goal of exposing the influence of bioethics in the development of modern gynecology- obstetrics, with classic examples of its application, controversy, dilemmas, and conflicts in our daily work to ensure our population a better quality of health care.

Construcción de la maternidad en el encuentro de la institución médico ginecológica con mujeres de clase media de la ciudad de Buenos Aires / Construção da maternidade no encontro da instituição médico-ginecológica com mulheres de classe média da cidade de Buenos Aires / Maternity construction in the meeting of the medical and gynecological institution with middle-class women of Buenos Aires

En este artículo se analiza cómo operan el discurso y la práctica de ginecólogos en la conformación de percepciones y prácticas de la maternidad en mujeres jóvenes de clase media porteña. A partir de un diseño descriptivo y exploratorio, se realizaron 50 entrevistas en profundidad a mujeres de clase media, de 25 a 35 años de edad, que se socializaron y viven actualmente en la Ciudad Autónoma de Buenos Aires, y 15 entrevistas a médicos ginecólogos que se desempeñan como tales en la misma ciudad. Se observa que tanto las mujeres como los médicos se ajustan a estereotipos tradicionales de género, no obstante lo cual existen intersticios normativos en sus prácticas y percepciones cuyo análisis se desarrollará aquí, con un abordaje metodológico cualitativo...

Neste artigo analisa-se como operam o discurso e a prática de ginecologistas na conformação de percepções e práticas da maternidade em mulheres jovens de classe média portenha. A partir de um desenho descritivo e exploratório, realizaram-se 50 entrevistas em profundidade com mulheres de classe média, de 25 a 35 anos de idade, que se socializaram e vivem atualmente na Cidade Autônoma de Buenos Aires, e 15 entrevistas com médicos ginecologistas que atuam como tais na mesma cidade. Observa-se que tanto as mulheres como os médicos enquadram-se em estereótipos tradicionais de gênero, não obstante o que existem interstícios normativos em suas práticas e percepções cuja análise se desenvolverá aqui, com uma abordagem metodológica qualitativa...

This article analyzes how gynecologists' discourse and practice organize perceptions and the experience of mothering among young middle class women in Buenos Aires. Using a descriptive, exploratory design, In-depth interviews were conducted with 50 middle class women, ages 25 to 35, raised and currently living in the City of Buenos Aires, and with 15 gynecologists who practice in town. Results indicate that both women and physicians adhere to traditional gender stereotypes, yet normative interstices are found in their practices and perceptions. The latter are analyzed using a qualitative approach...

Comparison of the Effect of Patient-Controlled Epidural Analgesia and Patient-Controlled Intravenous Analgesia on Postoperative Nausea and Vomit In Gynecologic and Obstetric Patients / 中国康复理论与实践

@#ObjectiveTo compare the effects of patient-controlled epidural analgesia (PCEA) and patient-controlled intravenous analgesia (PCIA) on postoperative nausea and vomit (PONV) in gynecologic and obstetric patients. Methods56 gynecologic or obstetric patients (ASA Ⅰ～Ⅱ) scheduled for lower abdominal surgeries were randomly allocated to receive either 1 mg/ml morphine plus 0.1 mg/ml droperidol intravenously (group PCIA) or 0.1 mg/ml morphine plus 0.125% bupivacaine (group PCEA-Ⅰ) or 0.1 mg/ml morphine plus 0.1 mg/ml droperidol plus 0.125% bupivacaine (group PCEA-Ⅱ) epidurally. 4, 24, and 48 h after operation, pain scores with visual analogus scale (VAS), sedation scores with Ramesay and the incidences of nausea, vomiting, pruritus, respiratory depression were assessed. ResultsVAS scores in the two PCEA groups were much lower than that of PCIA (P<0.01). The incidences of nausea and vomiting in PCEA-Ⅱ group were significantly lower than those in PCIA group (P<0.05), incidences of other side-effects such as pruritus, respiratory depression etc. were similar between the three groups (P>0.05). ConclusionThe regimen morphine/droperidol/bupivacaine by PCEA shows superiorities in relieving pain and reducing postoperative nausea and vomiting in gynecologic and obstetric patients.

Comparison of the Effect of Patient-Controlled Epidural Analgesia and Patient-Controlled Intravenous Analgesia on Postoperative Nausea and Vomit In Gynecologic and Obstetric Patients / 中国康复理论与实践

@#ObjectiveTo compare the effects of patient-controlled epidural analgesia (PCEA) and patient-controlled intravenous analgesia (PCIA) on postoperative nausea and vomit (PONV) in gynecologic and obstetric patients. Methods56 gynecologic or obstetric patients (ASA Ⅰ～Ⅱ) scheduled for lower abdominal surgeries were randomly allocated to receive either 1 mg/ml morphine plus 0.1 mg/ml droperidol intravenously (group PCIA) or 0.1 mg/ml morphine plus 0.125% bupivacaine (group PCEA-Ⅰ) or 0.1 mg/ml morphine plus 0.1 mg/ml droperidol plus 0.125% bupivacaine (group PCEA-Ⅱ) epidurally. 4, 24, and 48 h after operation, pain scores with visual analogus scale (VAS), sedation scores with Ramesay and the incidences of nausea, vomiting, pruritus, respiratory depression were assessed. ResultsVAS scores in the two PCEA groups were much lower than that of PCIA (P<0.01). The incidences of nausea and vomiting in PCEA-Ⅱ group were significantly lower than those in PCIA group (P<0.05), incidences of other side-effects such as pruritus, respiratory depression etc. were similar between the three groups (P>0.05). ConclusionThe regimen morphine/droperidol/bupivacaine by PCEA shows superiorities in relieving pain and reducing postoperative nausea and vomiting in gynecologic and obstetric patients.

Application of Method of Multimedia Network in Gynecology Obstetrics Teaching / 中华医学教育探索杂志

The article introduces the point of multimedia network teaching and application in gynecology and obstetrics teaching,pointing out the problems in multimedia network teaching that should be improved.