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At least 649 records · Page 36Linked to original sources
PubMed1997

A medical approach to management of spontaneous abortion using misoprostol. Extending misoprostol treatment to a maximum of 48 hours can further improve evacuation of retained products of conception in spontaneous abortion.

BACKGROUND: To compare a 48 hour non surgical policy in the management of spontaneous abortion with a policy of routine, universal uterine curettage. METHODS: A prospective, observational study on 354 women admitted to hospital with spontaneous abortion. Of these, 225 who had retained products of conception were treated with misoprostol for up to 48 hours after 101 were excluded because they had an empty uterus on transvaginal scan (TVS) and another 28 women because they were unsuitable for conservative management. Follow-up was conducted over a 3 week period to assess morbidity. A reference group of 137 women, all of whom had an evacuation of retained products of conception (ERPC) as a routine after they had a TVS documenting retained products of conception (POCs), was used for comparison. RESULTS: Evacuation of the uterus occurred within 24 hours in 107 women and in 148 at 48 hours after misoprostol treatment was started. There were three uterine curettages up to 14 days after discharge from hospital for persistent bleeding and two cases of pelvic infection. An ectopic pregnancy was diagnosed at follow-up in one woman. In the reference group, there were nine women who had complications, four requiring another ERPC and five had infection, an overall complication rate of 6.6% in the reference group and 1.7% in the protocol treatment group. CONCLUSION: A 48 hour regimen using transvaginal ultrasound and misoprostol for the management of spontaneous abortion was successful in avoiding surgery in 249 out of a possible 354 (70.6%) women with spontaneous abortion, with a low rate of subsequent morbidity.

Abortifacient Agents, Nonsteroidal↗
PubMed1996

The problem of post-partum fistulas in developing countries.

Postpartum fistulas are frequent in the tropical environment. They are mostly found in very young women who live in remote areas. Without treatment women with fistulas will be condemned to the disconsolate life of social outcasts. Good operative treatment is crucial. The different operative methods are discussed. The operation through vaginal approach can be performed in any hospital. It does not need special surgical skill. More important than surgery is prevention of postpartum fistulas through a well-organised primary health care program which reaches out into the villages and which includes adequate prenatal controls and competent midwifery.

Adolescent↗
PubMed2003

Medical education as a science: the quality of evidence for computer-assisted instruction.

OBJECTIVE: A marked increase in the number of computer programs for computer-assisted instruction in the medical sciences has occurred over the past 10 years. The quality of both the programs and the literature that describe these programs has varied considerably. The purposes of this study were to evaluate the published literature that described computer-assisted instruction in medical education and to assess the quality of evidence for its implementation, with particular emphasis on obstetrics and gynecology. STUDY DESIGN: Reports published between 1988 and 2000 on computer-assisted instruction in medical education were identified through a search of MEDLINE and Educational Resource Identification Center and a review of the bibliographies of the articles that were identified. Studies were selected if they included a description of computer-assisted instruction in medical education, regardless of the type of computer program. Data were extracted with a content analysis of 210 reports. The reports were categorized according to study design (comparative, prospective, descriptive, review, or editorial), type of computer-assisted instruction, medical specialty, and measures of effectiveness. RESULTS: Computer-assisted instruction programs included online technologies, CD-ROMs, video laser disks, multimedia work stations, virtual reality, and simulation testing. Studies were identified in all medical specialties, with a preponderance in internal medicine, general surgery, radiology, obstetrics and gynecology, pediatrics, and pathology. Ninety-six percent of the articles described a favorable impact of computer-assisted instruction in medical education, regardless of the quality of the evidence. Of the 210 reports that were identified, 60% were noncomparative, descriptive reports of new techniques in computer-assisted instruction, and 15% and 14% were reviews and editorials, respectively, of existing technology. Eleven percent of studies were comparative and included some form of assessment of the effectiveness of the computer program. These assessments included pre- and posttesting and questionnaires to score program quality, perceptions of the medical students and/or residents regarding the program, and impact on learning. In one half of these comparative studies, computer-assisted instruction was compared with traditional modes of teaching, such as text and lectures. Six studies compared performance before and after the computer-assisted instruction. Improvements were shown in 5 of the studies. In the remainder of the studies, computer-assisted instruction appeared to result in similar test performance. Despite study design or outcome, most articles described enthusiastic endorsement of the programs by the participants, including medical students, residents, and practicing physicians. Only 1 study included cost analysis. Thirteen of the articles were in obstetrics and gynecology. CONCLUSION: Computer-assisted instruction has assumed to have an increasing role in medical education. In spite of enthusiastic endorsement and continued improvements in software, few studies of good design clearly demonstrate improvement in medical education over traditional modalities. There are no comparative studies in obstetrics and gynecology that demonstrate a clear-cut advantage. Future studies of computer-assisted instruction that include comparisons and cost assessments to gauge their effectiveness over traditional methods may better define their precise role.

Computer-Assisted Instruction↗
PubMed2001

[Prevalence and management of pain in a hospital: a cross-sectional study].

OBJECTIVES: Improved management of pain, particularly in inpatients, is a public health priority. We conducted this study to ascertain current practices and identify indications useful for measuring their impact. PATIENTS AND METHODS: A "given day" cross-sectional study was conducted in 18 units (11 medicine units and 7 surgery and obstetrics units) at the Cochin Hospital, Paris. All patients hospitalized over 24 hours were included in the study. A short one-page questionnaire was administered by an investigator (nurse or physician) after the patient agreed to participate in the study. All pertinent information concerning pain at admission and/or during the 24 hours of hospitalization (quantified on a simple verbal scale), percent pain relief compared with the initial level, and any circumstances leading to an increase in the pain level during hospitalization were recorded. Data were also collected on antalgesia prescription administered the day of the survey. Social and demographic data as well as discharge diagnosis(es) were also recorded. RESULTS: Nearly 60% of the patients stated they had experienced pain at the time of admission or during the 24-h preceding the survey. In medicine units, 29% of the inpatients with pain were not given any anti-pain treatment (this percentage was 12% in surgery) and 35% stated their pain had been relieved by less than 50% (13% of the patients in surgery). Hospitalization in a medicine unit was associated with fewer and less effective prescriptions in patients experiencing pain. CONCLUSION: Regular and simple indications, specifically the number of patients complaining of pain who have not been given an antalgesic, would provide the health care team with a measurement of pain management useful for assessing its impact and improving patient care.

Acetaminophen↗
PubMedDate not supplied

[Type of surgical articles. Comparative study of 3 Italian and 3 foreign periodicals].

BACKGROUND: Medical progress in the world is divulged to peers and colleagues through books and scientific journals. It is thus linked not only to the quality of articles, but also to their type. MATERIAL AND METHODS: The type of articles published in three Italian periodicals (Annali Italiani di Chirurgia; Chirurgia; Minerva chirurgica) and three foreign periodicals published in English (Annals of Surgery; British Journal of Surgery; Surgery, Gynecology & Obstetrics) was compared. The articles were classified according to their potential contribution to medical progress, being divided into two main groups: research papers and simple case series or case reports. Other types of articles (reviews, description of surgical techniques, editorials etc.) were excluded from the study. RESULTS: Both the total number and the percentage of research papers were markedly superior in the three foreign journals with respect to the three Italian periodicals. All the differences were highly significant. CONCLUSIONS: The number of research papers published in Italian periodicals should be increased. Greater attention should be paid to quality, at the expense of quantity, since serious research inevitably takes longer to perform.

General Surgery↗
PubMed1984

Tubal conservation with ectopic gestations. A reappraisal.

Ectopic pregnancies have shown an increasing trend during the past decade. Factors that appear to be responsible are the intrauterine device (IUD), fallopian tube surgery (ligation reversals, reconstructive tuboplasty), and more effective antibiotics against pelvic inflammatory disease (precluding radical pelvic surgery). Our ability to diagnose an ectopic pregnancy at an earlier gestation (prior to rupture) through the use of highly sensitive pregnancy tests (Beta-HCG), ultrasonography, and diagnostic laparoscopy, has significantly altered our approach in treatment. Because these ectopic gestations are seen in a younger population, older nulliparous patients, and patients who desire future fertility, earlier diagnosis precludes an emergency approach to a now-elective procedure. In this paper, we will explore the pros and cons of conservative management for ectopic pregnancies, emphasizing present day evaluation and microsurgical approaches for repair.

Castration↗
PubMed1996

Management of incomplete abortion with manual vacuum aspiration in comparison to sharp metallic curette in an Ethiopian setting.

This institution based case control study emanated from the fact that manual vacuum aspiration (MVA) has been recently introduced in Ethiopia and Gandhi Memorial hospital is currently serving as the pioneering centre. Abortion is an important everyday medicolegal, social, political and public health issue. The objectives of the study were to focus on abortion issues, to show that MVA is alternative instrument applicable in our setting and to highlight some of the determinants that can influence the choice of instruments in the management of incomplete abortions of less than 12 weeks of gestation. A total of 1896 patients who fulfilled the inclusion criteria underwent evacuation and curettage with MVA and SMC during the study period. The main considered variables included socio-demographic characteristics, service-providers, complications in relation to operators and method of surgery, duration of the surgery, patient pain evaluation and uterine factors. MVA is found to be equally safe, effective, simple and fast set of instruments which can be employed in the management of incomplete abortions. Integration of MVA in the medical training is recommended as it is a measure which can greatly contribute towards the reduction of maternal morbidity and mortality especially in a developing country like ours where resources are scare and alternatives are quite limited.

Abortion, Incomplete↗
PubMedDate not supplied

[Cesarean sections in Senegal: coverage of needs and quality of services].

A prospective longitudinal study was carried out of all women undergoing Cesarean section in the surgical maternity hospitals of Senegal between January 1 and December 31 1996. The epidemiology and quality of Cesarean sections were investigated. For each case, the following data were recorded: marital status, prenatal monitoring, conditions of hospitalization, indications for and outcome of surgery, maternal and neonatal follow-up one month after the operation. 2,436 Cesarean sections were performed. Of these, 2,269 cases were indexed and filed and 1,612 received a postnatal checkup one month after the operation. The mean age of the women involved was 26 years. The referral system is not effective, with 58% of patients being rushed to a surgical maternity unit in medically unsuitable forms of transport. Cesarean section is not widely available either geographically or economically. The mean national rate of Cesarean section was 0.6% of expected births but there were differences between regions. The main indications for Cesarean section were the fetus being too large to pass through the pelvic girdle (30%) and fetal suffering (18%). The maternal mortality rate was 3% and one third of the women who died did so immediately after the operation. Maternal morbidity occurred in 10% of cases, mainly due to postoperative infection. The rate of perinatal stress was 25%, most deaths being caused by neonatal distress (33%) or infection (18%). Thus, overall, both the availability and quality of Cesarean section in Senegal are poor.

Adult↗
PubMed1997

Surgical operations in the United States. Then (1983) and now (1994).

OBJECTIVE: To study the hypothesis that numbers of surgical operations in the United States have increased from 1983 and 1994. DESIGN: Analysis of data from the National Center for Health Statics. SETTING: Short-stay general and specialty noninstitutional hospitals, and freestanding ambulatory surgical facilities, exclusive of federal, military, and Veterans Affairs hospitals. PATIENTS: Five-percent national sample. MAIN OUTCOME MEASURE: Ten most frequent surgical operations or classes of surgical procedures within neurosurgery, ophthalmology, otorhinolaryngology, cardiothoracic surgery, general surgery, urology, obstetrics and gynecology, and orthopedics. RESULTS: In 1994, the 10 most frequently performed surgical operations in the United States totaled 7,929,000 cases. This contrasted with 5,731,000 top 10 procedures in 1983, or an increase of 38%. The most common surgical operation in 1994 was cataract extraction, totaling 2,049,000 cases. Groin herniorrhaphy (689,000 procedures) remained the most common operation performed by a general surgeon. Cesarean section was the most frequently completed obstetrical-gynecological operation (858,000 procedures) and the country's second most common surgical procedure in 1994. Arthroscopy of the knee (632,000 procedures) demonstrated enormous growth (153%) and was the country's seventh most frequent operation in 1994. Transurethral prostatectomy (229,000 procedures) underwent the most precipitous decline (29%) of any No. 1-ranked specialty procedure. CONCLUSIONS: Numbers of top 10 surgical operations have increased in every surgical specialty except obstetrics-gynecology. Explanations may be the presence of new technologies, willingness of a preexisting reservoir of patients to undergo now less anxiety-provoking procedures, or less stringent indications.

Female↗
PubMed1996

Arthrogryposis associated with unsuccessful attempts at termination of pregnancy.

We report three cases of failed termination of pregnancy in which the children were subsequently born with arthrogryposis (AMC) (multiple congenital contractures). Arthrogryposis is a sign with many causes. We suggest that the multiple congenital contractures seen in these children are due to vascular compromise during the attempted termination with secondary loss of functional neurons leading to fetal akinesia and subsequent contractures. Two of the children have additional evidence of intrauterine vascular compromise. Limitation of movement secondary to the rupture of the fetal membranes and continuous leakage of amniotic fluid after the attempted termination may have compounded the contractures in two of the children.

Abortion, Incomplete↗
PubMed1984

Sexual function during the puerperium.

Of 328 women interviewed at a postnatal clinic, 166 (50.6%) had resumed sexual intercourse, the average interval after delivery being 5 weeks postpartum. Of the various social and clinical factors examined, resumption of coitus was related only to marital status, vaginal laceration, and continuing vaginal bleeding. Of the sexually active group, 89% were practicing effective contraception.

Adult↗
PubMed1990

Maternal mortality audit in a Zimbabwean province.

A maternal mortality audit was introduced in the Midlands Province (Zimbabwe) in order to identify which avoidable factors were involved most frequently. During the two-year study period, the maternal mortality rate was 137 per 100,000 total births. The main causes of death were uterine rupture, eclampsia, haemorrhage and caesarean section related accidents. An avoidable factor was identified among 87% of these deaths involving the health system in 57% of the cases and the patient in 33%. Access to the health facilities and transport problems only played a minor role.

Cesarean Section↗
PubMed1991

First-trimester legally induced abortions. The amount of aspirated tissue in relation to gestational age.

A possible method for reducing complications after legally induced first-trimester abortions was sought. One hundred-seventeen patients participated in the study and had the gestational age determined by ultrasound before evacuation. The aspirated amount of tissue was measured and a definite correlation was made to the seventh to twelfth week of gestation respectively. It is concluded that at least 15 ml tissue should be evacuated in the seventh to eight week, 25 ml in the ninth to tenth week, and 35 ml in the eleventh to twelfth respectively.

Abortion, Induced↗
PubMedDate not supplied

Increase of plasma tissue-plasminogen activator antigen levels after induced abortion.

We previously reported that plasma thrombotic activity is transiently increased immediately after induced abortion. However, changes in the fibrinolytic system have not yet been studied. Plasma tissue-plasminogen activator (t-PA) antigen levels were studied before and after abortion induced during the first trimester of pregnancy. Compared with the preoperative level (1.68 +/- 0.15 ng/ml), t-PA level was significantly increased (2.78 +/- 0.55 ng/ml, p less than 0.01) 15 min after the induced abortion, while it almost returned to the preoperative values (2.09 +/- 0.40 ng/ml) 2h later. This finding suggests that fibrinolytic activity is transiently increased immediately after the induced abortion, acting as a defense mechanism against thrombosis.

Abortion, Induced↗
PubMed2007

The U.S. Thrombosis and Hemostasis Centers pilot sites program.

Venous thromboembolism (VTE) is a common disorder associated with significant morbidity and mortality. Despite important advances in understanding the etiology of VTE, delivery of care to patients with thrombosis and thrombophilia is frequently incomplete and highly variable. A comprehensive model of health care has been used successfully to treat and prevent complications for people with hemophilia and other chronic disorders. The effectiveness of an integrated healthcare model for patients with all coagulation disorders has yet to be evaluated. The Division of Hereditary Blood Disorders of the Centers for Disease Control and Prevention (CDC) is collaborating with eight Thrombosis and Hemostasis Centers (pilot sites) to provide health-related services and conduct research directed toward the reduction or prevention of complications of thrombosis and thrombophilia. The initial objectives of the collaboration are to (1) determine the efficacy of integrated multidisciplinary care and prevention services for people with hemostatic disorders, (2) assess unmet needs for service delivery and identify outreach strategies to improve access to care, (3) develop effective messages aimed at disease management and prevention, and (4) foster the development of training programs to enhance provider skills for the delivery of patient care. To address these objectives, the investigators and CDC have developed and implemented a web-based patient registry to follow prospectively service allocation and patient outcomes. Funding for the program began in October 2001. All eight funded centers are affiliated with U.S. medical schools. Principal investigators at the centers are hematologists (five adult, two pediatric) or cardiologists. Faculty in obstetrics-gynecology, surgery, and multiple other specialties are integral to the model of care at the centers. Other critical components at the centers are clinical laboratory services, training programs, research networks, and education and outreach programs. From August 2003 to March 2006, over 2,600 patients were enrolled in the registry, accounting for a total of more than 5,000 visits to the centers. Immediate goals of the data collection at the centers are to characterize patients receiving care at centers and document the state of health services provided. Long-term goals are to evaluate prospectively clinical outcomes for patients receiving multidisciplinary care and prevention services at centers. The network of data collection across centers will facilitate future collaborative clinical and epidemiologic investigations and enhance collective expertise in hemostasis and coagulation disorders.

Academic Medical Centers↗