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Magdy P Milad

Publications and source records attributed to Magdy P Milad.

12 recordsLinked to original sources
PubMed2006

Burnout, depression, and career satisfaction: cross-sectional study of obstetrics and gynecology residents.

OBJECTIVE: This study was undertaken to measure career satisfaction among obstetrics and gynecology residents and assess its relationship to burnout, depression, and malpractice concerns. STUDY DESIGN: A 63-item, anonymous, self-administered survey was distributed to residents at 23 randomly selected obstetric and gynecologic residency programs in the United States. The outcome measures included the Maslach Burnout Inventory-Human Services Survey, the Center for Epidemiological Studies-Depression Scale, and perceptions of malpractice and career satisfaction. RESULTS: Eighty-three percent of the residents were either "very or somewhat satisfied" with their career choice. The majority (89.8%) showed evidence of moderate burnout and 34.2% were considered depressed. Ninety-six percent were concerned about malpractice with 35% pursuing fellowship solely because of malpractice concerns. Residents dissatisfied with their career choice were twice as likely to be depressed (30% vs 55%, P = .03). Both emotional exhaustion (P < .0001) and consideration of fellowship because of malpractice (P < .0001) were strongly predictive of diminishing career satisfaction. CONCLUSION: Resident career satisfaction was inversely correlated with burnout and depression, which were more prevalent than expected. Overall, residents were satisfied with their career choice, but also negatively influenced by malpractice concerns.

Attitude of Health Personnel↗
PubMed2005

In vitro fertilization (IVF) versus gonadotropins followed by IVF as treatment for primary infertility: a cost-based decision analysis.

OBJECTIVE: To compare the economic consequences of proceeding directly to IVF to those of proceeding with gonadotropins followed by IVF in patients <35 years of age with unexplained infertility. DESIGN: A decision-tree model. The model incorporated the cost and success of each infertility regimen as well as the pregnancy-associated costs of singleton or multiple gestations and the risk and cost of cerebral palsy. MAIN OUTCOME MEASURE(S): Cost per live birth. RESULT(S): Both treatment arms resulted in a >80% chance of birth. The gonadotropin arm was over four times more likely to result in a high-order multiple pregnancy (HOMP). Despite this, when the base case estimates were utilized, immediate IVF emerged as more costly per live birth. In sensitivity analysis, immediate IVF became less costly per live birth when IVF was more likely to achieve birth (55.1%) or cheaper (11,432 dollars) than our base case assumptions. CONCLUSION(S): After considering the risk and cost of HOMP, immediate IVF is more costly per live birth than a trial of gonadotropins prior to IVF.

Costs and Cost Analysis↗
PubMed2005

Does physician benchmarking improve performance of laparoscopically assisted vaginal hysterectomy?

BACKGROUND: Benchmarking techniques were implemented to optimize operating time and charges associated with laparoscopically assisted vaginal hysterectomy (LAVH). MATERIALS AND METHODS: The baseline LAVH profile over a period of 4 years (167 cases) was compared with 1-year data (47 cases) after a benchmarking educational program (disseminating data ranking performance by each surgeon plus suggestions for improvement). Preintervention and postintervention profiles were compared by means of Student t test and wilcoxon rank sum analysis. Hierarchical multiple regression was used to identify additional sources of variation for operative charges and time. RESULTS: Mean operating times after implementing benchmarking were lower, averaging 182 versus 197 minutes in the control subjects (P = 0.05). We found no significant difference in total or operative charges. After adjusting for potential confounders, benchmarking remained associated with decreased operating time in the multivariate model (P = 0.01). CONCLUSIONS: LAVH operating times decreased after a surgical benchmarking and education intervention, but operating charges did not.

Benchmarking↗
PubMed2004

Sexual functioning and patient expectations of sexual functioning after hysterectomy.

OBJECTIVE: The purpose of this study was to assess sexual functioning and patient expectations of sexual functioning after hysterectomy. STUDY DESIGN: Seventy-five patients who had undergone hysterectomy at an urban academic medical center were surveyed about sexual function at the time of hysterectomy and after hysterectomy. Chi-squared tests compared responses for discrete outcomes. RESULT: Most patients expected no change in sexual desire or orgasm quality. Hysterectomy had no effect on the frequency of sexual activity or on orgasmic response. Postoperatively, patients were less likely to report pain with intercourse (relative risk, 5.34; 95% CI, 2.2-12.95; P =.00002): 49.3% of patients had discussed sexual functioning after hysterectomy with their physicians, and 64.8% of patients recalled initiating the discussion. CONCLUSION: Most patients expected and experienced no change in sexual desire, orgasm frequency, or orgasm intensity. Hysterectomy appears to result in decreased pain with sexual relations.

Adult↗
PubMed2003

A randomized clinical trial of lorazepam for the reduction of postoperative urinary retention.

OBJECTIVE: To estimate whether lorazepam can decrease the incidence of postoperative urinary retention after ambulatory gynecologic surgeries. METHODS: A randomized clinical trial at an urban academic medical center was performed. Lorazepam (1 mg) or a placebo was administered intravenously 1 hour after ambulatory gynecologic procedures. Ninety patients were randomized to receive lorazepam (n = 47) or a placebo (n = 43). A computer-generated random number table was used for group assignment. Concealment was maintained by the hospital pharmacy, which prepared and dispensed the medication. Physicians, nurses, and patients were blinded to the group assignment. The time of the first spontaneous void and other information about the surgery and recovery were then recorded. RESULTS: There was no difference in the overall mean time to void between the lorazepam (3.1 +/- 1.2 hours) and placebo (2.8 +/- 2.0 hours) groups (P =.5). The time to void did not correlate with intravenous fluid use, length of procedure, type of procedure, narcotic use, body mass index, age, type of catheterization, or estimated blood loss. CONCLUSION: Medium half-life benzodiazepines do not significantly reduce the incidence of postoperative urinary retention.

Adult↗
PubMed2003

Risk factors for conversion to laparotomy during gynecologic laparoscopy.

STUDY OBJECTIVE: To identify risk factors and short-term outcomes associated with conversion from laparoscopic surgery to laparotomy. DESIGN: Case control study (Canadian Task Force classification II-2). SETTING: Large urban, academic medical center. SUBJECTS: All 2530 gynecologic laparoscopies, including those converted to laparotomy. INTERVENTION: Laparoscopic surgery. MEASUREMENTS AND MAIN RESULTS: Statistical analysis was performed to compare risk factors in converted versus non-converted cases. Multiple logistic regression analysis was performed using variables found to be significant on univariate analysis. Of 2530 laparoscopies identified, 159 (6.3%) were converted to laparotomy; 323 were selected by random number assignment from the remaining cases for the control group. The following factors were significantly associated with unintended laparotomy (OR; 95% CI): surgeon inexperience (2.43; 1.38, 4.17), level of laparoscopic complexity (3.19; 1.20, 5.10), body mass index greater than 30 kg/m(2) (2.45; 1.40, 4.41), suspicion of malignancy (17.45; 7.32, 43.57), history of laparotomy (1.34; 1.02, 1.78), presence of adhesions (2.30; 1.37, 3.76), and intraoperative technical difficulty (17.86; 7.32, 43.57). When stratified by level of complexity, experience in laparoscopy does not appear to confer protection during level 1 laparoscopic procedures (0.42; 0.12, 1.37) but does significantly reduce the frequency of conversion during level 2 procedures (0.39; 0.72, 0.93). Age, parity, bowel injury, vascular injury, and history of pelvic inflammatory disease and endometriosis did not increase the risk of conversion. Compared with controls, patients who were converted experienced significantly greater blood loss (p < 0.001), longer operating room time (p < 0.001), and longer hospital stay (p < 0.001). CONCLUSION: All women undergoing laparoscopy should be counseled that unintended laparotomy is a known risk and has additional morbidity over laparoscopy alone. Less-experienced surgeons attempting complicated procedures significantly increase the risk of conversion.

Academic Medical Centers↗
PubMed2003

Laparoscopic morcellator-related injuries.

STUDY OBJECTIVE: To identify and summarize all electric morcellator-related injuries published in the medical literature. DESIGN: Systematic review (Canadian Task Force classification II-2). SETTING: Databases. SUBJECTS: Articles on morcellator-related injuries published from 1992 through February 2002, plus additional sources of information. INTERVENTION: Search of MEDLINE and referencing of the FDA device report database. MEASUREMENTS AND MAIN RESULTS: We were unable to locate any references to morcellator-related visceral injuries in the medical literature. Of 17 cases identified from the FDA database, 3 were excluded based on the trivial nature of the event (e.g., instrument did not function). The remaining 14 visceral injuries were to small and large bowel (11), kidney (2), pancreas (1), and major vascular structures (3). Identification of the complication was immediate in 10 patients, but was not until 4 days postoperatively in 1 woman. Three patients died. No device manufacturer or surgical specialty was responsible for a preponderance of the injuries. CONCLUSION: These potentially fatal complications are unreported in the medical literature.

Databases, Factual↗
PubMed2002

The spinal needle test effectively measures abdominal wall thickness before cannula placement at laparoscopy.

STUDY OBJECTIVE: To demonstrate the usefulness of the spinal needle test at laparoscopy to correlate abdominal wall thickness at initial entry sites with body mass index (BMI). DESIGN: Prospective cohort study (Canadian Task Force classification). SETTING: University-affiliated hospital. PATIENTS: One hundred thirty-eight women. INTERVENTION: Diagnostic laparoscopy. MEASUREMENTS AND MAIN RESULTS: After CO(2) insufflation, the spinal needle test was performed by inserting a spinal needle attached to a partially filled syringe and advancing it perpendicular to the skin until the gas pocket was reached. To improve precision, the distance was measured 3 times at two sites, the umbilicus and Palmer's point (left upper quadrant). Patients' mean BMI was 25.8 kg/m(2) (range 17.2-60.0 kg/m(2)), with 24 (17%) considered clinically obese (BMI > or =30 kg/m(2)). A significant correlation was noted between BMI and abdominal wall thickness at the umbilicus (R = 0.69) and left upper quadrant (R = 0.81). Excellent correlation was also noted between body weight and thickness at the two points (R = 0.72 and R = 0.78, respectively). The mean thickness at the umbilicus differed significantly between obese (3.0 +/- 1.2 cm) and nonobese women (1.7 +/- 0.7 cm, p <0.001); as did mean thickness at the left upper quadrant (4.4 +/- 1.0 vs 2.0 +/- 0.7 cm, p <0.001). CONCLUSION: Thickness of the abdominal wall at umbilical and left upper quadrant entry sites correlates well with weight and BMI. Even among obese women, the distance to the pocket of gas after insufflation at either entry site is remarkably small.

Abdominal Wall↗
PubMed2002

The importance of physician gender in the selection of an obstetrician or a gynecologist.

OBJECTIVE: The purpose of this study was to determine the importance of gender in the selection of an obstetrician or a gynecologist. STUDY DESIGN: At a university-based hospital, 46 patients after delivery and 79 patients after gynecologic surgery who had selected their physician within the previous year were interviewed to determine the importance of physician gender in the selection of an obstetrician or gynecologist. Chi-square test, Fisher exact test, and the Student t test were used for statistical analysis. RESULTS: Of the 125 women who were surveyed, 52.8% of the women preferred a female physician, 9.6% of the women preferred a male physician, and 37.6% of the women stated no gender preference, with no significant difference between the obstetric and gynecologic groups. The groups were similar with respect to ranking the importance of gender; 24.8% of the women who were interviewed considered gender to be one of the 3 most important factors in the selection of a physician. When participants were asked to choose gender over physician experience, bedside manner, or competency, gender was selected by 12%, 10.4%, and 0.8%, respectively, with no significant differences between the groups. CONCLUSION: For most women, physician gender is not of primary importance in the selection of an obstetrician or gynecologist.

Adult↗
PubMedDate not supplied

Partial small bowel obstruction and ileus following gynecologic laparoscopy.

STUDY OBJECTIVE: To assess the incidence and management of partial small bowel obstruction (PSBO) and ileus after gynecologic endoscopy. DESIGN: Internet-based cross-sectional survey (Canadian Task Force classification II-3). MATERIAL AND METHODS: An online survey was distributed to gynecologic surgeons to collect information about frequency and management of ileus and PSBO after gynecologic laparoscopy. MEASUREMENTS AND MAIN RESULTS: Of the 58 physician respondents, 22 had managed at least 1 patient with PSBO or ileus after gynecologic laparoscopy. A total of 12 PSBOs and 14 patients experiencing ileus were identified for an overall incidence of 0.036%. Patients showed symptoms between 1 and 20 days postoperatively and had findings ranging from hypoactive (45%), to normal (30%), to hyperactive (25%) bowel sounds. Plain film radiographs (75%) were the most commonly used diagnostic modality followed by computed tomography (CT) scans of the abdomen. Most patients were initially managed with intestinal rest and nasogastric tube placement for 2 to 16 days. Fifty percent required a second procedure, with reported findings that included intestinal herniation (n = 7), bowel injury (n = 4), volvulus (n = 2), and urinoma (n = 1). CONCLUSION: Ileus and PSBO are rare findings after gynecologic laparoscopy. We identified 26 cases, most of which were initially managed conservatively. The majority of patients ultimately required a second operation. Surgeons should have a high index of suspicion when managing a patient with PSBO or ileus after gynecologic laparoscopy. Given the findings from the second procedures, CT scans would seem to be the diagnostic procedure of choice.

Adult↗
PubMedDate not supplied

Preemptive analgesia does not reduce pain or improve postoperative functioning.

OBJECTIVES: To examine the effectiveness of preemptive analgesia in gynecologic laparoscopy patients. METHODS: A double-blinded, randomized trial was performed from June 2000 to June 2001. Preoperatively, patients were randomly assigned to 0.25% bupivicaine or normal saline control. Following anesthetic induction, the study drug or a placebo was injected prior to the proposed incisions. RESULTS: Of the 164 patients enrolled, 85 were randomized to the study group and 79 to the control. Age, surgery indication, and estimated blood loss did not vary significantly between groups. Overall mean pain score (+/-standard error of the mean) for study and control groups did not differ at 4 hours (3.2+/-0.3 vs 3.2+/-0.3) or at 24 hours (4.2+/-0.3 vs 4.2+/-0.3). Incisional pain scores also did not differ at 4 hours (3.0+/-0.3 vs 2.7+/-0.3) or at 24 hours (3.6+/-0.3 vs 3.6+/-0.3). Both groups were similar in activity limitation at 24 hours and oral narcotic consumption within 24 hours postoperatively. After stratifying surgery type for level of complexity, no difference was noted between groups. Multiple logistic regression analysis also noted no difference in outcomes. CONCLUSION: Preemptive analgesia in patients undergoing gynecologic laparoscopy does not reduce postoperative pain or decrease the time to return of normal activities.

Adult↗