Office gynaecology

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BACKGROUND: Doctors are at high risk of burnout, which has far-reaching consequences on an individual and organisational level. Several studies have shown an association between burnout and depression. AIM: This study aimed to determine the rate of burnout and depressive symptoms among doctors, as well as factors associated with both conditions. SETTING: Charlotte Maxeke Johannesburg Academic Hospital. METHODS: Burnout was measured using the Maslach Burnout Inventory-Human Services Survey and defined as the total score of high emotional exhaustion (≥ 27 points) + high depersonalisation (≥ 13 points)...

BACKGROUND: The COVID-19 pandemic has had a significant effect on healthcare services, particularly affecting patients who suffer from chronic conditions. However, the pandemic's effect on endometriosis surgery is not yet known. OBJECTIVES: To determine the impact of the COVID-19 pandemic on surgery for severe endometriosis in the UK at a national, regional and centre-level. MATERIALS AND METHODS: The British Society for Gynaecological Endoscopy (BSGE) collects data nationally on all operations for severe endometriosis which involve dissection of the pararectal space...

AIM: This study aimed to investigate the relationship between the distance and travel time from each municipality to the nearest delivery facilities in the other municipalities and the frequency of out-of-facility deliveries in Hokkaido. METHODS: Vital statistics from 2016 to 2020 were used. For municipalities without delivery facilities, the distance and travel time from the town office of each municipality to the nearest delivery facility was measured using Google maps...

OBJECTIVE: To establish a prognostic model for endometrial cancer (EC) that individualizes a risk and management plan per patient and disease characteristics. METHODS: A multicenter retrospective study conducted in nine European gynecologic cancer centers. Women with confirmed EC between January 2008 to December 2015 were included. Demographics, disease characteristics, management, and follow-up information were collected. Cancer-specific survival (CSS) and disease-free survival (DFS) at 3 and 5 years comprise the primary outcomes of the study...

OBJECTIVE: We implemented and assessed a clinical practice quality improvement protocol aimed at decreasing postoperative urinary tract infections (UTIs) among patients with transurethral catheters. METHODS: This was a quality improvement study with pre- and post-intervention comparisons. Patients requiring postoperative transurethral catheters underwent 3 interventions: (1) shortening the time from surgery to repeat voiding trials to 3-5 days for pelvic reconstructive surgeries, and to 1-3 days for mid-urethral slings; (2) avoiding routine urine cultures at the time of voiding trials; (3) recommending 2L of water intake daily until 3 days after the voiding trial...

Background: Hysteroscopic transcervical resection of endometrial polyps is a widely used method and is increasingly performed in office or outpatient care. To ensure patient comfort is key, smaller instruments are preferred while also achieving a complete resection of the pathology. Objectives: To evaluate the effectiveness of the electrosurgical polyp snare (DPS) in comparison with a tissue removal device (TRD). Materials and Methods: This was a randomised controlled non-inferiority trial which included 66 women with symptomatic endometrial polyps who had been referred to the gynaecological outpatient clinic at the Máxima Medical Centre, Veldhoven, the Netherlands...

BACKGROUND: Menstrual problems with all manifestations ranging from life-threatening bleeding to amenorrhea are considered patterns of abnormal uterine bleeding (AUB), which is until now a popular reason for referral to the gynaecologic clinic and requires a special diagnostic tool. OBJECTIVE: To assess the accuracy of hysteroscopy in diagnosing endometrial pathologies and to compare it with sonographic and histopathologic reports. PATIENTS AND METHODS: A prospective study conducted in the Baghdad Teaching Hospital on 60 Iraqi females having varying complaints from abnormal uterine bleeding in pre- and post-menopausal women, infertility, and chronic pelvic pain with normal or abnormal ultrasound findings...

OBJECTIVE: Assessment of the practices and knowledge of general practitioners in the south of France regarding the diagnosis and management of endometriosis. METHOD: A descriptive cross-sectional study was conducted among general practitioners in the south of France from November 14, 2021 to February 14, 2022. A questionnaire was developed in consultation with and validated by two university endometriosis reference services of the APHM and was sent to general practitioners practicing in the south of France...

INTRODUCTION: A tertiary trauma survey (TTS) is a structured, comprehensive top-to-toe examination following major trauma [1]. Literature suggests that the ideal time frame for the initial TTS should be completed within 24-hours of a patient's admission and repeated at important moments [2-4]. Evidence suggests that formal TTS reduces the rate of missed injuries by up to 38% [2]. AIMS: To determine the rate of TTS being conducted in trauma patients in a tertiary hospital without an admitting trauma service...

Study Objective: To compare between oral diclofenac potassium alone versus a combination of it with hyoscine- N -butyl bromide (HBB) in reduction of pain in women undergoing office hysteroscopy. Design: Randomized, double-blind controlled trial. Setting: Kasralainy  hospital (a tertiary hospital). Intervention: Sixty-Four patients undergoing office hysteroscopy were randomly divided into 2 groups (study group and placebo group) in the ratio of 1:1...

A retrospective review over 12 months was conducted to assess the success rates for ultrasound-guided removal of an intrauterine device (IUD). Cases were broken up into two groups. There were 241 cases in which removal had been unsuccessful in the office setting. Where the strings were not visible the device was successfully removed in 97.7% of attempts. The second group had visible strings and 100% were successfully removed. The success rate for ultrasound-guided removal of IUDs when the strings are not visible supports the pilot study published in 2012...

INTRODUCTION: Kenya's maternal mortality ratio is relatively high at 342/100,000 live births. Confidential enquiry into maternal deaths showed that 90% of the maternal deaths received substandard care with health workforce related factors identified in 75% of 2015/2016 maternal deaths. Competent Skilled Health Personnel (SHP) providing emergency obstetric and newborn care (EmONC) in an enabling environment reduces the risk of adverse maternal and newborn outcomes. The study objective was to identify factors that determine the retention of SHP 1 - 5 years after EmONC training in Kenya...

BACKGROUND: Failure to obtain an office-based endometrial biopsy for abnormal uterine bleeding is not uncommon. Although operating room-based procedures are traditionally considered the gold standard assessment tool in these circumstances, outpatient hysteroscopy is a less invasive, more cost-effective, and safer alternative. However, there is no contemporary Canadian literature on the effectiveness of an outpatient approach for this specific population. OBJECTIVE: We aim to evaluate the effectiveness and outcomes of outpatient hysteroscopy for uterine cavity evaluation for patients who have failed an in-office endometrial biopsy attempt...

AIM: To compare the efficacy and safety of in-office hysteroscopy with a see-and-treat approach with that of operative hysteroscopy for the treatment of retained products of conception (RPOC). METHODS: We retrospectively identified all consecutive patients who underwent hysteroscopic treatment of RPOC between 2015 and 2019. We excluded patients with RPOC larger than 2 cm at preoperative transvaginal ultrasounds. Between 2015 and 2017, all hysteroscopic removals of RPOC were performed by operative hysteroscopy...

OBJECTIVE: Pregnancies complicated by fetal heart defects often undergo a planned delivery prior to term by either induction of labour or cesarean delivery to ensure optimal availability of neonatal care. We aimed to assess whether such planned deliveries achieve their goal of better perinatal care. METHODS: We conducted a retrospective case-control study of pregnancies complicated by isolated fetal cardiac defects, without other fetal comorbidities, managed at a single fetal medicine unit over a 10-year period...

BACKGROUND: Antibiotic resistance is a global problem. Irrational use of antibiotics is rampant. Guidelines recommend administration of single dose of antibiotic for surgical antimicrobial prophylaxis (SSAP) for elective obstetrical and gynaecological surgeries. However, it is not usually adhered to in practice. Majority of women undergoing elective major gynaecological surgeries and caesarean sections in the department of obstetrics and gynaecology of our tertiary level heavy case load public health facility were receiving therapeutic antibiotics (for 7-10 days) instead of recommended SSAP...

OBJECTIVE: To characterise the capacity of Kenya internship hospitals to understand whether they are suitable to provide internship training for medical doctors. DESIGN: A secondary data analysis of a cross-sectional health facility assessment (Kenya Harmonized Health Facility Assessment (KHFA) 2018). SETTING AND POPULATION: We analysed 61 out of all 74 Kenyan hospitals that provide internship training for medical doctors. OUTCOME MEASURES: Comparing against the minimum requirement outlined in the national guidelines for medical officer interns, we filtered and identified 166 indicators from the KHFA survey questionnaire and grouped them into 12 domains...

AIM: To evaluate the impact of warm distension medium versus room temperature distension medium on pain control among patients undergoing office hysteroscopy. METHODS: A systematic search was done in PubMed, Cochrane Library, Scopus, and ISI web of science from inception to October 2021. We selected randomized clinical trials (RCTs) compared warmed saline distension medium in the intervention group versus room temperature distension medium in the control group among women undergoing diagnostic and/or operative office hysteroscopy...

INTRODUCTION: Most efforts to assess maternal health indicator validity focus on measures of service coverage. Fewer measures focus on the upstream enabling environment, and such measures are typically not research validated. Thus, methods for validating system and policy-level indicators are not well described. This protocol describes original multicountry research to be conducted in Argentina, Ghana and India, to validate 10 indicators from the monitoring framework for the 'Strategies toward Ending Preventable Maternal Mortality' (EPMM)...