A sonographic classification of adenomyosis: interobserver reproducibility in the evaluation of type and degree of the myometrial involvement.

OBJECTIVE: To study the interobserver reproducibility of our new ultrasonographic mapping system to define the type and extension of uterine adenomyosis. DESIGN: Interobserver study involving two observers with different medical backgrounds and gynecological ultrasound experience. SETTING: University hospital. PATIENTS: Seventy consecutive women who underwent transvaginal ultrasound for suspected endometriosis, pelvic pain, heavy menstrual bleeding, and infertility. INTERVENTION: Two operators (observers A and B), who were blinded, independently reviewed the ultrasound videos offline, assessing the type of adenomyosis and the severity of the disease. Diagnosis of adenomyosis was made when typical ultrasonographic features of the disease were observed at the examination. Adenomyosis was defined as diffuse, focal, and adenomyoma according to the ultrasonographic characteristics. The severity of adenomyosis was described using a new schematic scoring system that describes the extension of the disease considering all possible ultrasound adenomyosis features. MAIN OUTCOME MEASURES: Reproducibility of the new mapping system for adenomyosis and rate agreement between two operators. RESULTS: Multiple rate agreements to classify the different features and the score of adenomyosis (diffuse, focal adenomyoma, and focal or diffuse alteration of junctional zone) ranged from substantial to almost perfect (Cohen κ = 0.658 - 1) except for adenomyoma score 4 (one or more adenomyomas with the largest diameter >40 mm) in which interobserver agreement was moderate (κ = 0.479). CONCLUSION: Our new scoring system for uterine adenomyosis is reproducible and could be useful in clinical practice. The standardization of the transvaginal approach and of the sonographer training represent a crucial point for a correct diagnosis of myometrial disease.

Medical Devices; Obstetrical and Gynecological Devices; Classification of the Gynecologic Laparoscopic Power Morcellation Containment System. Final order.

The Food and Drug Administration (FDA) is classifying the gynecologic laparoscopic power morcellation containment system into class II (special controls). The special controls that will apply to the device are identified in this order and will be part of the codified language for the gynecologic laparoscopic power morcellation containment system's classification. The Agency is classifying the device into class II (special controls) in order to provide a reasonable assurance of safety and effectiveness of the device.

Impacto económico y social de la cirugía mayor ambulatoria en ginecología por método de corta estadía / Economic and Social Impact of Ambulatory Surgery in Gynecology by Short Stay Methods

La introducción de la cirugía mayor ambulatoria ginecológica ha supuesto un cambio en la labor asistencial; sin embargo, su impacto social y económico en Pinar del Río no ha sido evaluado. El objetivo fue evaluar el impacto económico y social de la cirugía mayor ambulatoria en ginecología por método de corta estadía. Se realizó una investigación observacional, descriptiva, retrospectiva y transversal en el Hospital General Docente Abel Santamaría Cuadrado, Pinar del Río, en los años 2010-2011. El universo, la totalidad de operadas durante la etapa analizada (N=4887); la muestra, intencional (n=264 pacientes) en las que se aplicó el método de corta estadía (grupo de estudio). Se recogieron: tipo de cirugía, diagnóstico principal, operación quirúrgica realizada, promedio de estadía, y costos, así como tiempo quirúrgico y nivel de satisfacción de las pacientes. Se resumieron las variables mediante frecuencias absolutas y relativas porcentuales, la media, desviación estándar e intervalo de confianza para la media al 95 por ciento. Se compararon los costos con los de la cirugía Gineco-obstétrica de pacientes hospitalizadas. Se utilizó la cirugía mayor de corta estadía en el 37,3 por ciento de las pacientes. El fibroma uterino fue la causa quirúrgica principal, y la histerectomía total abdominal la intervención más frecuentemente realizada. Hubo un ahorro por concepto de estadía de $204441,60; por otra parte, el tiempo quirúrgico medio fue de 47,1 ± 13,5 min y el 95,8 por ciento de las pacientes refirió una satisfacción buena. Se comprueba que la cirugía mayor de corta estadía es costo-eficiente y representa un impacto social satisfactorio(AU)

The introduction of ambulatory gynecological surgery has meant a change in health care services, but its social and economic impact in Pinar del Rio has not been evaluated. The objective was to assess the economic and social impact of ambulatory surgery in gynecology by short stay method. An observational, descriptive, retrospective and cross-sectional research was conducted in Abel Santamaria Cuadrado General Teaching Hospital, in Pinar del Rio, in the years 2010 and 2011. The universe was the sheer number of women operated during the period analyzed (N=4887); in the intentional sample (n=264 patients), we applied the short stay method (study group). We gathered: surgery type, main diagnosis, surgical operation performed, average stay, and costs, as well as operating time and level of patient satisfaction. Variables were summarized by absolute and relative percentage frequencies, mean, standard deviation and confidence interval, for the average at 95 per cent. Costs were compared with those of hospitalized patients of obstetric surgery. Most short stay surgeries were used in 37.3 per cent of patients. Uterine fibroid surgery was the main cause, and total abdominal hysterectomy surgery was the most commonly performed. In concept of stay, there were savings of $204,441.60, on the other hand, the mean operating time was 47.1±13.5 minutes and 95.8 per cent of the patients reported good satisfaction.Conclusions: we found that most short-stay surgery is cost- efficient and represents a satisfactory social impact.

[Quality monitoring based on data from the Danish National Patient Registry]. / Kvalitetsmonitorering ud fra data i Landspatientregisteret.

The Danish National Patient Registry (DNRP) was established in Denmark in 1976, and since then in accordance with current law, it has been collecting discharge diagnoses, surgical codes and recently also different diagnostic and treatment codes from all Danish hospitals. Besides being an administrative tool and a tool for epidemiological research through recent years, the DNPR has also supported national clinical quality databases. We report the experiences from a national quality control in Danish reproductive gynaecology based on data from the DNPR. We conclude that the NRP is a suitable tool for continuous clinical quality control, and discuss ways of improving the validity of DNPR data.

Are entering obstetrics/gynecology residents more similar to the entering primary care or surgery resident workforce?

OBJECTIVE: We compared demographic characteristics of first-year residents entering obstetrics/gynecology with those entering primary care and surgery. STUDY DESIGN: We analyzed first-year residents from the 1997-2004 National Graduate Medical Education Census. Multivariable logistic regression models identified independent associations between obstetrics/gynecology residency (compared with primary care and surgery) and demographic predictor variables. RESULTS: More than 90% of studied programs completed the National Graduate Medical Education Census for 146,174 first-year residents. Graduates of US allopathic medical schools, women, African Americans, and entering residents in 2003 and 2004 were more likely to enter obstetrics/gynecology than primary care; Asians were less likely to enter obstetrics/gynecology than primary care. Women, African Americans, and Hispanics were more likely to enter obstetrics/gynecology than surgery; trainees who were Asian, "other" race/ethnicity, and entered residency from 1999-2004 were less likely to enter obstetrics/gynecology than surgery. CONCLUSION: Demographic characteristics of incoming obstetrics/gynecology-residents differed significantly from both primary care and surgery residents. Obstetrics/gynecology should be a unique category in physician workforce studies.

Should obstetrics and gynaecology be separate specialities? A survey of Yorkshire trainees.

A questionnaire was given to trainees attending the Yorkshire Modular training programme to determine their views on separating obstetrics and gynaecology. A total of 73 questionnaires were collected; 34% of participants were junior grade (SHO), 65% were middle grade (SpR, LAT, SSHO) and 30% of participants were male. A total of 42% of participants wanted to work in gynaecology only; 28% of participants wanted to work in obstetrics only; and only 23% wanted a combined practice. The primary reasons to prefer gynaecology was more job satisfaction than in obstetrics and better social hours of work (100%). All of the 28% of participants who wanted to work in obstetrics only, thought it is more rewarding and 100% enjoyed the challenge. In conclusion, perhaps separating obstetrics and gynaecology will make both specialties more attractive, as individuals would not be compelled to practice both. There is a possibility that this might result in better recruitment and retention in both specialities.

Iatrogenia contra la mujer: la violencia que se admite / Iatrogenesis against the woman: violence that is admitted

El documento dedica un especial análisis a la problemática sexual relacionado con la salud, a través del Naturismo Médico Hipocrático

Rural Indian women's care-seeking behavior and choice of provider for gynecological symptoms.

This study uses data from the India National Family and Health Survey-2 conducted in 1998-99 to investigate the level and correlates of care-seeking and choice of provider for gynecological symptoms among currently married women in rural India. Of the symptomatic women surveyed, 31 percent sought care, overwhelmingly from private providers (70 percent). Only 8 percent of women consulted frontline paramedical health workers. Care-seeking behavior and type of providers consulted varied significantly across different Indian states. Significant differentials in care-seeking by age, caste, religion, education, household wealth, and women's autonomy suggest the existence of multiple cultural, economic, and demand-side barriers to care-seeking. Although socially disadvantaged women were less likely than better-off women to consult private providers, the majority of even the poorest, uneducated, and lower-caste women consulted private providers. Geographical access to public health facilities had no significant association with choice of provider, whereas access to private providers had only a moderately significant association with that choice. The predominance of use of private services for self-perceived gynecological morbidity warrants the inclusion of private providers in the national reproductive health strategy to enhance its effectiveness.

Obstetric and gynecology devices; effective date of requirement for premarket approval for glans sheath devices. Final rule.

The Food and Drug Administration (FDA) is issuing a final rule to require the filing of a premarket approval application (PMA) or a notice of completion of product development protocol (PDP) for glans sheath medical devices. The agency has previously published its findings regarding the degree of risk of illness or injury designed to be eliminated or reduced by requiring the devices to meet the statute's approval requirements and the benefits to the public from the use of the devices.

Chequeo ginecológico en estudiantes de enfermería del segundo, tercer y cuato cursos del Instituto "Dr. Andrés Barbero" del año 2001

Estudio descriptivo explicativo de la situación de las estudiantes de enfermería en términos de conocimiento acerca del chequeo ginecológico. Define los exámenes ginecológicos a los cuales se pueden acceder y los requisitos para realizarlos. Cita factores socioeconómicos culturales que influyen en la consulta ginecológica. Explica sugerencias oportunas para la situación analizada

Prevalecencia de lesiones premalignas de cuello uterino en el Hospital Regional Honorio Delgado del 1º de mayo de 1994 al 30 de abril de 1995

El cáncer de cuello uterino es en el Perú la primera causa de muerte por cáncer en la mujer, esta patología va presedida de una serie de lesiones premalignas (lesiones intraepitaliales escamosas) que son no invasivas y que evolucionan lenta y gradualmente. El diagnóstico correcto de las lesiones premalignas y de patología del tracto genital inferior, se basa en el trípode "Citología-Colposcopia-Biopsia Dirigida", esta metodología se viene empleando en el Hospital Regional Honorio Delgado desde los primeros meses de 1994. Con el objetivo de saber la prevalecencia real de las lesiones premalignas en nuestro medio así como los factores epidemiológicos más importantes y la metodología diagnóstica más acertada. Se evalua a 263 pacientes entre el 1ero. de mayo de 1994 al 30 de abril de 1995 mediante Papanicolau y Colposcopía y a 49 de ellas con biopsia dirigida. Los resultados fueron una prevalecencia de lesiones intraepiteliales escamosas de 14.07 por ciento. La edad de mayor frecuencia de presentación es entre los 25 y 29 años y se encontró como factor de riesgo; el inicio de precoz de relaciones sexuales, promiscuidad y el nivel socio-económico bajo. No se encontró como factor de riego en nuestra muestra al tabaquismo, a la multiparidad, el antecedente de enfermedad de transmisión sexual ni el uso de anticonceptivos orales. El porcentaje de falsos negativos hallados con citología, fue de 51.35 por ciento; y se encontró una sensibilidad para la citología de 63.64 por ciento y para la colposcopía, de 97.67 por ciento con relación a la Histología

Informe Anual Gestion 1992: Centro de Capacitación Hospital San Gabriel / sss

El presente documento trata de los servicios de salud integral a la mujer en edad fértil se lleva a cabo en 9 consultorios, atendidos por ginecólogos-obstetras; en horarios de la mañana, tarde y vespertino. En el Distrito III se realiza también atención a la mujer en 7 consultorios, de los cuales solamente 3 médicos fueron capacitados en el ramo teórico-práctico de salud reproductiva el año 1991, los cuales están llevando a cabo la toma de citología cervical; detección de E.T.S. y anticoncepción (inser D.I.U), Consejería, etc.. Los 4 médicos que no realizaron el curso de salud reproductiva solamente realizan consejería; opción métodos de barrera y anticoncepción hormonal, detección de E.T.S. y atención primaria de salud