Easy and effective – web-based information systems designed and maintained by physicians: experience with two gynecological projects

It is well established that medical information sources develop continuously from printed media to digital online sources. To demonstrate effectiveness and feasibility of decentralized performed web-based information sources for health professionals, two projects are described. The information platform of the German Working Group for Information Technologies in Gynecology and Obstetrics (AIG) and the information source concerning the German Registry for in vitro fertilization (DIR) were implemented using ordinary software and standard computer equipment. Only minimal resources and training were necessary to perform safe and reliable web-based information sources with a high correlation of effectiveness in costs and time exposure.     

Comparability of Reasons for Cesarean Sections in Patient Records and Mothers' Interviews

ABSTRACT: Reasons for cesarean sections from three different data sources were compared. One hundred mothers were interviewed, their patient records were read, and the discharge diagnoses were noted. In about 70% of cases at least two of the data sources gave similar reasons for cesarean section, but when all three sources were compared, in only one-third was information similar. These figures cast doubt on the utility of recorded indications in studying reasons for cesarean sections.     

Cold light sources. Are they really cold?

Two light sources used in laparoscopy, both in the photo mode, proved capable of burning a hole in a standard paper surgical drape in less than five seconds. The relationship between power (in watts) and dial settings is not linear. Both of these sources have a maximum power density of 5.6 w/cm2, which far exceeds the 1.8 w/cm2 power density of the other light sources tested. Today, with the demand for increased illumination for photodocumentation , the physician must be cognizant of its potential hazards. Light sources will vary according to the type of source--tungsten, halogen or mercury arc. Each increase in wattage output will transmit a greater cable power density. Equipment should be checked for its potential to produce burns in routine use and, if defective, should be replaced.     

Influence of Sources of Information and Parental Attitudes on Human Papillomavirus Vaccine Uptake among Adolescents

Study ObjectiveThe purpose of this study was to: 1) describe parental sources of information about human papillomavirus (HPV) vaccination for adolescents, 2) understand how parental sources of information about HPV vaccine are associated with adolescent HPV vaccine uptake, and 3) understand if the relationship between a greater number of HPV-related information sources and HPV vaccine uptake among adolescents is mediated by parental attitudes.Design, Setting, Participants, and InterventionsWe conducted a 3-arm randomized controlled trial in middle and high schools in eastern Georgia from 2011 to 2013. As part of the trial, we surveyed parents during the final year to understand their sources of information about HPV vaccine for their adolescent. Data were collected from 360 parents via phone and online surveys.Main Outcome MeasuresParents responded to a survey that asked them to identify demographic information, parental HPV attitudes, sources of information about HPV vaccination, and HPV vaccine uptake.ResultsMost of the sample was African American (74%; n = 267) and 53% of parents (n = 192) reported that their adolescent received at least 1 HPV vaccine dose. The top sources of information about HPV vaccine reported by parents were a doctor or medical professional (80%; n = 287) and television (64%; n = 232). A mediation analysis showed sources of information about HPV vaccine are associated with parental attitudes, and parental attitudes about HPV vaccine are associated with vaccine uptake among adolescents.ConclusionThese findings highlight the importance of HPV sources of information on parental attitudes.     

Energy substrates,mitochondrial membrane potential and human preimplantation embryo division

Carbohydrate additives to modern embryo culture media are based on three basic energy sources, glucose, pyruvate and lactate. Although the use of these substrates is almost universal, debate continues as to the roles of the individual components in the human. This is mainly due to the lack of human embryos for research and the reliance on animal model systems. In the present work, the human embryo was used to study the role of the above simple substrates in the maintenance of the mitochondrial membrane potential and cell division. The mitochondrial membrane potential was measured with fluorescence techniques. Cell division was scored as the number of blastomeres on day 3. Both the mitochondrial membrane potential and cell division were dramatically lost in the absence of energy sources. The mitochondrial membrane potential and cell division were normal in media containing all three energy sources, or in pyruvate-containing media. Both glucose and lactate individually proved poor energy sources for the maintenance of the mitochondrial membrane potential. However, cell division continued in the presence of glucose, suggesting that some energy production can continue. These data suggest that pyruvate is an absolute requirement for mitochondrial respiration and cell cleavage during human preimplantation development. The role of lactate is as yet unclear.     

Reproductive health education and sexual risk among high-risk female adolescents and young adults

STUDY OBJECTIVE: The objective of this study was to explore the associations of sources, content, and timing of reproductive health education with cognitive and behavioral sexual risk in a sample of high-risk female adolescents and young adults. DESIGN: Female adolescents and young adults (n=113, median age 17 years) receiving treatment for a sexually transmitted disease (STD) reported sources of reproductive health education, topics covered, and when first formal education occurred. Dependent variables included sexual risk knowledge; condom attitudes, negotiation skills, and use (consistent and at last sex); and number of sexual partners. RESULTS: Most participants reported receiving reproductive health education from both parental (80%) and formal sources (92%). Parents discussed the menstrual cycle (94%) more frequently than other sex education topics, while formal sources focused most on teaching about STDs (91%). Although median age of first formal instruction was 12 years, 26% of girls received their first formal education during or after the year they initiated coitus. Girls with a parental source of education and those receiving formal instruction on pregnancy reported greater ability to negotiate condom use. Girls who received education later in relation to the onset of sexual activity and those with a parental source of education reported more sexual partners. CONCLUSIONS: Early reproductive health education and education from both parental and formal sources is associated with reduced sexual risk among high-risk adolescent girls. Interestingly, receiving parental education is also associated with more sexual partners, suggesting that parental educational efforts may be reactive to their daughters' increasing sexual risk behavior. Future research should examine multiple sources of reproductive health education and the timing of education from these sources to enhance understanding the dynamic interactions between reproductive health education and adolescent sexual risk.     

Occupational fatigue and preterm premature rupture of membranes. National Institute of Child Health and Human Development Maternal-Fetal Medicine, Units Network

OBJECTIVE: The aim of this study was to prospectively determine the relationship between occupational fatigue and spontaneous preterm delivery segregated into the etiologically distinct categories of spontaneous preterm labor, preterm premature rupture of membranes, and indicated preterm delivery. STUDY DESIGN: A total of 2929 women with singleton pregnancies at 22 to 24 weeks' gestation were enrolled in a multicenter (10 sites) Preterm Prediction Study. Patients reported the number of hours worked per week and answered specific questions designed to determine the following 5 sources of occupational fatigue described by Mamelle et al: posture, work with industrial machines, physical exertion, mental stress, and environmental stress. Fatigue was quantified (0-5 index) according to the number of these sources positively reported. Simple and Mantel-Haenszel chi2 tests were used to test the univariate association and hypothesis of a linear trend between sources of occupational fatigue and spontaneous preterm delivery. Covariables were considered by multivariate logistic regression analysis. Women who did not work outside the home were considered separately from those who worked but did not report any sources of occupational fatigue. RESULTS: Each source of occupational fatigue was independently associated with a significantly increased risk of preterm premature rupture of membranes among nulliparous women but not among multiparous women. The risk of preterm premature rupture of membranes increased (P = .002) with an increasing number of sources of occupational fatigue-not working outside the home, 2.1%; working but not reporting fatigue, 3.7%; working with 1 source of fatigue, 3.2%; working with 2 sources of fatigue, 5.2%; working with 3 sources of fatigue, 5.1%; and working with 4 or 5 sources of fatigue, 7.4%. There was also a significant relationship (P = .01) between preterm premature rupture of membranes and an increasing number of hours worked per week among nulliparous women. Neither spontaneous preterm labor nor indicated preterm delivery was significantly associated with occupational fatigue among either nulliparous or multiparous women. CONCLUSION: The occupational fatigue index of Mamelle et al discriminated a group of nulliparous women at increased risk for preterm premature rupture of membranes. The relationship between preterm premature rupture of membranes and occupational fatigue or hours worked may provide guidelines according to which nulliparous women and their employers can be advised.     

Photolaparoscopy (author's transl)

Photocelioscopy, or laparoscopic photography, has improved enormously due to the development of photographic technology. The availability of new laparoscopes, new sources of light, especially intracorporal sources, new and more sensitive films, now enable teachers to use laparoscopic photography as a didactic tool in medical schools. The Polaroid method can be used for immediate documentation; with this method the quality of film development is of primary importance. Video cassette recording of laproscopic procedures can also be made.     

Comparative Studies of Energy Sources in Gynecologic Laparoscopy

Energy sources incorporating “vessel sealing” capabilities are being increasingly used in gynecologic laparoscopic surgery although conventional monopolar and bipolar electrosurgery remain popular. The preference for one device over another is based on a combination of factors, including the surgeon’s subjective experience, availability, and cost. Although comparative clinical studies and meta-analyses of laparoscopic energy sources have reported small but statistically significant differences in volumes of blood loss, the clinical significance of such small volumes is questionable. The overall usefulness of the various energy sources available will depend on a number of factors including vessel burst pressure and seal time, lateral thermal spread, and smoke production. Animal studies and laboratory-based trials are useful in providing a controlled environment to investigate such parameters. At present, there is insufficient evidence to support the use of one energy source over another.     

Prevention of maternal and congenital cytomegalovirus infection

Congenital cytomegalovirus (CMV) infection is an important cause of hearing impairment, mental retardation, and cerebral palsy. Principal sources of infection during pregnancy are young children and intimate contacts. Prevention of maternal and congenital CMV infection depends on counseling women regarding the sources of infection and hygienic measures that might prevent infection. There is currently insufficient evidence to support use of antiviral treatment or passive immunization for postexposure prophylaxis of pregnant women or as a maternal treatment aimed at preventing fetal infection. Vaccines for CMV are under development but it will be a number of years before one is licensed.     

Latino teens talk about help seeking and help giving in relation to dating violence

The authors examine attitudes about help seeking and help giving related to dating violence among Latino ninth graders, including survey and focus group data. Latino teens are more likely to seek help for a dating violence situation from informal sources of support (e.g., friends) than from formal sources (e.g., health professionals). Students are most likely to turn to other teens for help and do not confide or trust the adults in their social network. Teens are reluctant to intervene in dating violence situations. The quality of help offered by teens related to dating violence is perceived as being limited.     

Prostaglandins in reproductive physiology

This review of prostaglandins (PGs) in reproductive physiology discusses nomenclature, biosynthesis, separation, and analysis, and then focuses on studies with PGs from various sources, including human semen. The structural formulas of human seminal PGs are reproduced in the text. The relationship between PGs and uterine function, fallopian tube function (and possible sperm transport), and ovarian function is reviewed. Recent studies which suggest possible roles for PGs in luteolysis, ovum transport, and implantation suggest that PGs have potential as antifertility agents. An addendum is included which summarizes PG pharmacological data from various sources.     

Frequency and perceived effectiveness of strategies to survive abuse employed by battered Mexican-origin women

This study documented the frequency and perceived effectiveness of battered Mexican-origin women's usage of formal and informal help and personal strategies to survive abuse. Semistructured interviews were conducted with 75 battered Mexican-origin women. Consistent with survivor theory, results indicated that participants sought help multiple times from several formal and informal help sources; some (i.e., shelter, family) were perceived more effective than others (i.e., lawyer, in-laws). Participants engaged in various personal strategies to survive abuse; some (i.e., using faith/religion) were rated more effective than others (i.e., placating the batterer). Responses to open-ended questions suggest why specific help sources and strategies were/were not effective and provide socioculturally specific suggestions for improving services. This study illuminates battered Mexican-origin women's strengths and barriers that impede their survival efforts. Contributions include focusing on a subset of battered Latinas and documenting the frequency and perceived effectiveness of a wide array of help sources and strategies.     

Wharton's Jelly stem cells: future clinical applications

This review focuses on the therapeutic potential of stem cells harvested from the Wharton's Jelly of the human umbilical cord. Recently, investigators have found that a potent stem cell population exists within the Wharton's Jelly. In this review, the authors define a new subset of stem cells, termed perinatal stem cells, and compare them to other sources of stem cells. Furthermore, cryopreservation of Wharton's Jelly stem cells is described for potential use in future cell based therapies and/or regenerative medicine applications. Current evidence of the application of mesenchymal stem cells from various sources in both pre-clinical and clinical trials is reviewed in the context of potential indications of use for Wharton's Jelly derived mesenchymal stem cells.     

Community Awareness of Postpartum Depression

Objective: To explore awareness of postpartum depression and its symptoms and available community resources for women with postpartum depression.
Design: Cross-sectional surveillance research, using population-based data.
Setting: Eight communities in southern and eastern Ontario, Canada.
Participants: A random selection of adults 18 years of age and older with telephones.
Method: Logistic regression and chi-square test were used to analyze awareness of postpartum depression and its symptoms, the baby blues, and sources of assistance for women with postpartum depression.
Results: The vast majority of respondents were aware of postpartum depression (90.1%± 0.6% confidence interval) ( n= 8,750) as compared with the baby blues (62.5%± 1.1%). Awareness of postpartum depression, its symptoms, the baby blues, and sources of assistance varied according to the demographic profiles of the respondents (family structure, education, and language spoken at home).
Conclusion: Awareness of the term postpartum depression does not necessarily imply awareness of its symptoms or sources of assistance. Public education is needed to address this fact in order to provide social support and encourage treatment for symptomatic women and their families. Education should target individuals with lower levels of education and non-English–speaking groups.     

History of Power Sources in Endoscopic Surgery

The history of energy sources used in surgery is inextricably linked to the history of electricity. Milestones include identification of safe electrical waveforms that can be used in the human body, patient isolation to prevent alternate-site burns, bipolar energy sources to negate capacitance injuries, laser energy, and the combination vessel sealing devices commonly used today. Engineering efforts to eliminate many of the hazards of electrosurgery are critical to how we practice modern gynecologic surgery. The introduction of bipolar instruments, increasing the safety of monopolar electrosurgery by not using hybrid trocars, and introduction of active shielding of the instruments from stray radiofrequency energy using intelligent secondary conductors have led to the re-emergence of electrosurgery as the universal surgical energy source. The low ongoing costs and the presence of electrosurgical generators in all hospitals readily enables electrosurgery to be the mainstay. Expensive lasers are confined to specialized centers, where they continue to be used, but for a long while filled a gap created by complications of electrosurgery. Sophisticated power sources continue to be introduced and include the ultrasonic scalpel, plasma surgery, and various devices for sealing vessels, all of which have advantages and disadvantages that are recognized as they begin to be subjected to scientific validation in randomized trials.