What Do Patients Attending an Antenatal Clinic Know About the Role of Resident Physicians?

ObjectiveTo assess antenatal patients’ working knowledge of resident physicians involved with their care.MethodsA prospective short-answer survey was distributed to a convenience sample of 120 consecutive patients of a busy obstetrical practice in a teaching hospital in 2006. Patients were asked about resident physicians’ roles and responsibilities, level of education, hours of work, and relationship to the attending physician.ResultsThe majority of patients had attended the teaching hospital within the preceding year and had also previously delivered a baby at the hospital. Only 7% of patient participants correctly identified a resident as actively involved in their care and only 18% correctly identified the attending physician as the residents’ supervisor and/or educator. Most patients correctly identified the resident’s highest level of education as university (90%) and knew that the resident was under the supervision of the attending physician (70%). Except the 5% of participants who answered “don’t know,” all respondents greatly underestimated residents’ average weekly hours of work.ConclusionsPatient knowledge of the role of the resident physician in the health care team is lacking. Increasingly, patients wish to be educated and engaged in their health care management. Given the significant role of residents in patient care in Canada’s teaching centres, further attention should be paid to finding out what patients wish to know about their care providers and providing them with that knowledge.     

Assessment of resident competency in the performance of sonohysterography: does the level of training impact the accuracy?

OBJECTIVE: The objective of this study was to examine the true-positive rates by level of training of the operator and to determine whether the accuracy of the procedure differed by the level of education after formalized training. STUDY DESIGN: This was a retrospective analysis. The records of patients who underwent surgery for the indication of an abnormal saline sonohysterography were reviewed from January 2001 to April 2003 (n=73 patients). The nature of the saline sonohysterography abnormality, the intraoperative findings, and the level of training of the provider were recorded. Findings at saline sonohysterography were compared with findings at hysteroscopy or surgery. Statistical significance was determined by chi(2) test. RESULTS: The overall true-positive rate was 86.3% (63/73 patients). The true-positive rates for nurse practitioners, second- and fourth-year residents, and fellows were 84%, 80%, 90%, and 89%, respectively. There was no significant difference among providers (P=.96). CONCLUSION: The true-positive rates for saline hysterography were comparable among different provider levels.     

What is the role of assisted reproduction technology in the management of age-related infertility?

Although in the UK the upper age limit for National Health Service (NHS) provision of in?vitro fertilisation (IVF) is 39 years of age there has been an increase in number of women having fertility treatment in their 40s. However, the success rates of IVF and intra-uterine insemination (IUI) in this group remain low. Human Fertilisation and Embryology Authority (HFEA) data from 2006 showed that the live-birth rate from IVF in the UK was 11% in the age group 40-42, 4.6% in the age group 43-44 and less than 4% in women over 44. We performed a literature search for studies using terms and combinations of terms in online databases and published meta-analyses reporting the outcome of interventions in older women. This review showed that assisted reproduction technologies (ARTs) continue to have low live-birth rates in women over 40. Trials showed that assisted hatching may increase the chance of pregnancy in women with poor history. Blastocyst transfer is associated with better outcome, whereas application of pre-implantation genetic screening (PGS) in older women has not increased the success rates. It appears that, with the exception of egg-donation, ART has no answer yet to age-related decline of female fertility.     

Canadian Physicians’ Role in Contraception from the 19th Century to Now

Birth control techniques were widely available in 19th-century Canada, despite the fact that they were illegal. Most physicians remained silent about contraception, with a small minority vocally opposed to the practice of birth control. Canadian physicians were influenced by the social, economic, legal, and political values of their time, and their support of birth control initially lagged far behind public interest and need. At later points in Canadian medical history, physicians actively supported increased access to contraceptive services, and played a significant role in the legalization of contraception in this country. The Canadian birth control movement made tremendous strides in the 1930s with the dissemination of contraceptive information to the public and the opening of the first public birth control clinic. The Canadian Medical Association supported contraceptive practice as part of preventive medicine in the 1930s, and the legalization of contraception in the early and mid 1960s. Contraception was formally legalized in Canada in 1969 and has become a significant aspect of medical practice. In Canada, current medical controversies in contraception include issues of public education, advertising, contraceptive research, and the integration of contraception with other aspects of reproductive and sexual health in medical practice.     

Surgical treatment of ovarian tumors in girls in the materials of the 2nd Department and Gynecological Clinic of the Medical Academy in Wroc?aw]

Between 1987 and 1998 44 young women (average age 17.4) were operated for ovarian tumours at the 2nd Clinic and Department of Academy of Medicine in Wroc?aw. Bilateral changes were observed in 6 patients. In one case a malignant tumour was diagnosed. The most frequent benign tumours were teratoma adultum (30%) and cystis paraovarialis (22%) the type of surgical intervention depended on the size of the tumour and on the degree of destruction of the ovarian tissue. Since 1995 the clinic carries out surgical laparoscopy particularly prefened modality in case of young women. During that time, 16 of 21 patients aged up to 21, had their ovarian tumours enucleated by means of the laparoscopic method.