Browsing by Subject "gynecology"

Now showing 1 - 4 of 4
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    Gynecological cancers: an alternative approach to healing
    (Future Science, 2017-07-12) Saso, Srdjan; Jones, Benjamin P; Bracewell-Milnes, Timothy; Huseyin, Gulsen; Boyle, Deborah C; Del Priore, Giuseppe; Smith, James Richard; Obstetrics and Gynecology, School of Medicine
    Grief and hope are two conflicting emotions that a patient recently diagnosed with cancer has to master. The real challenge for gynecologic oncologists is how to reach out. Conventional wisdom states that offering patients focus and belief when combating cancer in their lives allows them to embrace hope with greater confidence, which minimizes their grief. Three pictorial models are presented: ‘4-cusp approach’ model used at the initial consultation; ‘tapestry of bereavement or landscape of grief’ model at the postsurgery consultation; and ‘Venn-diagram’ model at any time during patient management. We have applied these models in our practice and believe that they can act as a fulcrum for the patient, the family and healthcare team around which therapy should be centered., Grief and hope are two emotions that a patient faces if diagnosed with cancer. The real challenge for the doctor is how to reach out and help the patient through this process. A doctor's role may be to offer focus and belief to the patient which may allow her to embrace hope with greater confidence. This will hopefully lessen the grief. We present three models which we believe can play a crucial part: ‘4-cusp approach’ used at the initial consultation; ‘tapestry of bereavement or landscape of grief model’ at the postsurgery consultation; and ‘Venn-diagram model’ at any time during care.
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    MS4 Satisfaction with an Online Ultrasound Elective as an Alternative to Clinical Experience
    (2021-04-22) Shanks, Anthony L.; Baugh, Kyle; Darwish, Audrey; Sharifi, Mitra; Rouse, Caroline
    INTRODUCTION/BACKGROUND: A fourth year (MS4) elective in OBGYN US has traditionally been offered as a month-long rotation. MS4 students shadow Maternal-Fetal Medicine physicians and enhance knowledge with clinical exposure. Historically, the rotation provides adequate understanding of US in pregnancy. However, the COVID pandemic forced clinical experience to be replaced with virtual learning. To ensure MS4 students still had an opportunity to learn about US in pregnancy, a virtual, online curriculum was created. Using Kern’s six-step approach to curriculum, we developed a month-long OBGYN US virtual experience to replace clinical interaction. It is unclear if this transition was associated with high MS4 satisfaction. STUDY OBJECTIVE/HYPOTHESIS: To determine if converting a traditional hands-on ultrasound (US) elective to an online course for MS4 students was associated with course satisfaction. METHODS: Kern’s six-step approach to curriculum building was utilized to create a virtual course in US for MS4 students. This online course was created in Canvas based on US Milestones in the Residency Training Program Consensus Report (Abuhamad 2018). Self-directed modules and quizzes were created and administered weekly. Additionally, a weekly hour-long session using Nearpod technology – an interactive online website – was utilized to enhance instruction. Students completed an anonymous survey on Qualtrics at the completion of the elective. Satisfaction on a Likert scale of 1-7 was reported. Descriptive analysis and ANOVA were used when appropriate with SPSS 27. RESULTS: Nine MS4 students completed the course from May-July, 2020. Satisfaction was high for the course overall (mean 6.11, SD 1.96). Nearpod lecture (6.89, 0.31), Canvas modules (6.7, 0.47), and weekly quizzes (6.78, 0.42) were all rated highly with no statistically significant difference between the methods of instruction. Formative feedback from participants found the course material and Nearpod highly engaging. More students were able to complete the virtual class (9) compared to historical attendance of one student per month (3). DISCUSSION: An online US elective was associated with high satisfaction from participants. The course served as an adequate substitute for participants during COVID restrictions and allowed for greater enrollment. Future directions include integrating this online module with in-person clinical experience.
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    Opioid Prescription Usage after Benign Gynecologic Surgery: A Prospective Cohort Study
    (Elsevier, 2019) Patanwala, Insiyyah; Ouyang, Chensi; Fisk, Matthew; Lamvu, Georgine; Obstetrics and Gynecology, School of Medicine
    Study Objective To compare the amount of opioids (tablets and morphine milligram equivalents [MMEs]) prescribed by physicians and used by patients after benign gynecologic surgery. Design Prospective cohort study. Setting Tertiary center: main hospital operating room and outpatient surgery center. Patients Women undergoing benign gynecologic surgery. Interventions Major and minor gynecologic surgeries. Measurements and Main Results The surgery groups were minor laparoscopy (Minor), major minimally invasive (Major), and laparotomy (Laparotomy). Demographic, medical, and surgical data were abstracted from electronic medical records. On postoperative day (POD) 7, women completed a telephone survey describing pain levels, prescription use, and satisfaction with pain control. Patients who continued to use opioids for pain relief were surveyed on POD 14. If use continued, patients were surveyed again on POD 28. The primary outcome was amount of opioid prescribed compared with opioid used. Of 193 screened participants 172 were enrolled (89%), and data were analyzed for 154 (90%): 59 (38%) Major, 71 (56%) Minor, and 24 (16%) Laparotomy. The median number of tablets and MMEs prescribed was lowest for the Minor group (Minor, 24 tablets; Major, 30 tablets; Laparotomy, 30 tablets [p <.01]; Minor, 150 MMEs; Major, 225 MMEs; Laparotomy, 225 MMEs [p = .01]). We found no difference in the number of tablets (Minor, 8; Major, 8; Laparotomy, 9; p = .77) or MMEs used (Minor, 45 MMEs; Major, 45 MMEs; Laparotomy, 55 MME; p = .81) between the groups. On POD 7 there was no difference in median numerical rating scale pain scores (Minor, 3; Major, 2; Laparotomy, 2; p = .07) or satisfaction with analgesia on POD 7 (p = .44), 14 (p = .87), and 28 (p = .18). Patients with prior chronic pain used more total amounts of opioids (68 MME vs 30 MME, p <.01) and were more likely to require opioid refill (odds ratio, 10.4; 95% confidence interval, 1.3–83.6) compared with those without a similar history. Conclusion In this cohort, gynecologic surgeons prescribed nearly 3 times more opioid tablets and MMEs than was used by patients despite patients reporting similar levels of pain after minor and major surgeries.
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    Recommended standardized anatomic terminology of the posterior female pelvis and vulva based on a structured medical literature review
    (Elsevier, 2021) Hill, Audra Jolyn; Balgobin, Sunil; Mishra, Kavita; Jeppson, Peter C.; Wheeler, Thomas, II; Mazloomdoost, Donna; Anand, Mallika; Ninivaggio, Cara; Hamner, Jennifer; Bochenska, Katarzyna; Mama, Saifuddin T.; Balk, Ethan M.; Corton, Marlene M.; Delancey, John; Obstetrics and Gynecology, School of Medicine
    Background Anatomic terminology in both written and verbal forms has been shown to be inaccurate and imprecise. Objective Here, we aimed to (1) review published anatomic terminology as it relates to the posterior female pelvis, posterior vagina, and vulva; (2) compare these terms to “Terminologia Anatomica,” the internationally standardized terminology; and (3) compile standardized anatomic terms for improved communication and understanding. Study Design From inception of the study to April 6, 2018, MEDLINE database was used to search for 40 terms relevant to the posterior female pelvis and vulvar anatomy. Furthermore, 11 investigators reviewed identified abstracts and selected those reporting on posterior female pelvic and vulvar anatomy for full-text review. In addition, 11 textbook chapters were included in the study. Definitions of all pertinent anatomic terms were extracted for review. Results Overall, 486 anatomic terms were identified describing the vulva and posterior female pelvic anatomy, including the posterior vagina. “Terminologia Anatomica” has previously accepted 186 of these terms. Based on this literature review, we proposed the adoption of 11 new standardized anatomic terms, including 6 regional terms (anal sphincter complex, anorectum, genital-crural fold, interlabial sulcus, posterior vaginal compartment, and sacrospinous-coccygeus complex), 4 structural terms (greater vestibular duct, anal cushions, nerve to the levator ani, and labial fat pad), and 1 anatomic space (deep postanal space). In addition, the currently accepted term rectovaginal fascia or septum was identified as controversial and requires further research and definition before continued acceptance or rejection in medical communication. Conclusion This study highlighted the variability in the anatomic nomenclature used in describing the posterior female pelvis and vulva. Therefore, we recommended the use of standardized terminology to improve communication and education across medical and anatomic disciplines.