Low vs Standard Pressures in Gynecologic Laparoscopy: a Systematic Review

Background:

The optimal intraperitoneal pressure during laparoscopy is not known. Recent literature found benefits of using lower pressures, but the safety of doing abdominal surgery with low peritoneal pressures needs to be assessed. This systematic review compares low with standard pneumoperitoneum during gynecologic laparoscopy.

Database:

We searched Medline, Embase, and the Cochrane Library for randomized controlled trials comparing intraperitoneal pressures during gynecologic laparoscopy. Two authors reviewed references and extracted data from included trials. Risk ratios, mean differences, and standard mean differences were calculated and pooled using RevMan5. Of 2251 studies identified, three were included in the systematic review, for a total of 238 patients. We found a statistically significant but modest diminution in postoperative pain of 0.38 standardized unit based on an original 10-point scale (95% confidence interval [CI], –0.67 to –0.08) during the immediate postoperative period when using low intraperitoneal pressure of 8 mm Hg compared with ≥12 mm Hg and of 0.50 (95% CI, –0.80 to –0.21) 24 hours after the surgery. Lower pressures were associated with worse visualization of the surgical field (risk ratio, 10.31; 95% CI, 1.29–82.38). We found no difference between groups over blood loss, duration of surgery, hospital length of stay, or the need for increased pressure.

Conclusion:

Low intraperitoneal pressures during gynecologic laparoscopy cannot be recommended on the behalf of this review because improvement in pain scores is minimal and visualization of the surgical field is affected. The safety of this intervention as well as cost-effectiveness considerations need to be further studied.     

Well-woman Care Barriers and Facilitators of Low-income Women Obtaining Induced Abortion after the Affordable Care Act

Objectives

This study uses the abortion visit as an opportunity to identify women lacking well-woman care (WWC) and explores factors influencing their ability to obtain WWC after implementation of the Affordable Care Act.

The Impact of Sexual Satisfaction,Functioning, and Perceived Contraceptive Effects on Sex Life on IUD and Implant Continuation at 1 Year

Introduction

Contraceptives improve women's lives and public health, but many women discontinue their contraceptive method owing to dissatisfaction. An underexamined aspect of contraceptive discontinuation is sexual acceptability, or how contraception affects sexual experiences. Investigators' aims were two-fold: 1) to document changes in multiple domains of women's sexual experiences with their intrauterine device (IUD) or contraceptive implant over time and 2) to examine whether these sexuality factors were associated with method continuation at 12 months.

基于布鲁姆教育理论的反思型教学在妇科住院医师规培中的实践研究

目的　探讨基于布鲁姆教育理论的反思型教学在妇科住院医师规培中的实践作用。方法　将2019年7月至2020年1月在本院妇科参加住院医师规范化培训的31名医师归为对照组,将2020年3月至2020年9月参加住院医师规范化培训的33名医师归为观察组。对照组实施常规教学,观察组实施基于布鲁姆教育理论的反思型教学。对比两组规培前后的理论考试成绩、技能操作测试成绩,比较两组规培医师临床能力及教学满意度。应用SPSS 25.0进行t检验和卡方检验。结果　规培后,观察组理论考试成绩[（88.78±5.69）vs.（84.56±5.23）]、技能操作测试成绩[（89.37±5.75）vs. （85.22±5.34）]均高于对照组,差异有统计学意义;规培后,观察组团队协作能力、诊疗技术操作能力、分析及解决问题能力、临床思维能力及医患交流能力均高于对照组,差异有统计学意义;规培后,观察组对教学模式在激发学习兴趣、提高自学能力、提高诊疗思维能力、提高问题分析解决能力等方面的满意度均高于对照组,差异有统计学意义。结论　基于布鲁姆教育理论的反思型教学能够提高妇科住院医师的专业理论知识水平、临床操作水平、临床能力及规培满意度,有助于医师更快地适应临床工作。     

老年妇科恶性肿瘤合并糖尿病患者的围手术期护理研究

目的对老年妇科恶性肿瘤合并糖尿病患者的围手术期护理进行研究和分析。方法选取2018年10月—2019年9月该院收诊的80例老年妇科恶性肿瘤合并糖尿病患者作为临床研究对象,将其分为两组,分别给予其围手术期常规护理和综合护理,对临床护理效果进行研究与分析。结果在手术时间和术中出血量方面,两组比较,差异无统计学意义(P>0.05)。而在住院时间和拆线时间的比较上,实验组要优于对照组,差异有统计学意义(P<0.05)。从空腹血糖及餐后2 h血糖水平来看,实验组分别为(5.35±1.88)、(7.22±1.59)mmol/L,而对照组分别为(8.93±1.86)、(11.55±2.93)mmol/L。组间数据比较,差异有统计学意义(t=5.496、7.492,P<0.05)。实验组不良反应发生率为10.00%,明显低于对照组(27.50%),差异有统计学意义(χ²=4.021,P<0.05)。结论针对老年妇科恶性肿瘤合并糖尿病患者进行围手术期综合护理,有利于患者血糖的稳定,并促进患者的康复。     

体现实践成果，引领未来方向:国际妇产科联盟2018年宫颈癌分期解读

一直以来,国际妇产科联盟(International Federation of Gynecology and Obstetrics,FIGO)的宫颈癌分期都是临床分期。但随着诊断技术的发展、手术方式的进步以及对宫颈癌预后的了解加深,过去的FIGO分期已不能很好地推测宫颈癌预后及指导临床治疗选择。因此,FIGO在2009年宫颈癌分期的基础上,引入了近10年来宫颈癌诊治的新进展,形成了2018年宫颈癌分期。新的分期主要体现在肿瘤大小的分层更加细化,且纳入了淋巴结转移情况。本文对FIGO的2018年宫颈癌分期变化及其临床意义进行解读。     

自我效能感理论在妇产科护理学技能教学中的应用

目的:探讨妇产科护理实践技能教学改革的运用效果。方法:将2008级护理专业四个班学生206人分为实验组和对照组,实验组在妇产科护理学技能教学中教师采取创造条件使学生成功、提供积极地反馈与评价、充分发挥榜样的作用、帮助学生建立积极乐观的情绪等措施。对照组采用"教师示教-学生练习、教师指导-学生回示-教师总结"的方法。结果:实验组学生操作成绩优于对照组。结论:教师可协助学生建立高自我效能感,提高技能教学的效果。