1022例妇产科腹腔镜手术病人的围术期护理

[目的]总结妇产科腹腔镜手术病人的围术期护理。[方法]对1 022例妇产科腹腔镜手术病人加强围术期护理,强调术前加强心理护理、皮肤护理、胃肠道和阴道准备、留置导尿管,术中加强护理配合、监测生命体征的变化,术后加强一般护理、尿管及引流管护理、疼痛护理等。[结果]本组病人手术成功1 019例,中转开腹手术3例。[结论]加强妇产科腹腔镜手术病人的围术期护理是手术成功的保证。     

Aromatherapy for outpatients with menopausal symptoms in obstetrics and gynecology

OBJECTIVE: To introduce Complementary and Alternative Medicine (CAM) into a hospital department of obstetrics and gynecology with the goal of achieving integrative medicine, the authors investigated the effectiveness of aromatherapy for outpatients with menopausal symptoms. LOCATION: The department of obstetrics and gynecology, St. Marianna University Hospital, Kawasaki, Japan. DESIGN: Participants in the aromatherapy trial received a 30 minute aromatherapy session performed by an aromatherapist that included a consultation, massage, and home care guidance. After they carried out approximately 1 month of home care, they received a second aromatherapy session. The patients' physical and mental health status was measured at the start and endpoint of the trial by use of the Kupperman index (KI), the self-rating depression scale, and consultation. SUBJECTS: Fifteen (15) outpatients (mean age, 54.3 +/- 7.4 years) with menopausal symptoms in the department of obstetrics and gynecology of St. Marianna University Hospital. RESULTS: The mean value of the KI score was significantly lowered after the aromatherapy trial from 31.4 +/- 6.8 to 22.9 +/- 6.1 (p = 0.001). CONCLUSION: This investigation shows that aromatherapy could be effective as a CAM method for menopausal symptoms in the setting of a hospital obstetrics and gynecology department.     

妇产科医院新入职护士母乳喂养知识态度现况调查

目的:了解新入职护士母乳喂养知识与态度情况及对母乳喂养的临床教学需求,为后期构建母乳喂养临床教学方案提供依据.方法:2020年8月至10月,采用方便抽样法选取上海市3所妇产科医院新入职护士作为研究对象,采用母乳喂养知识与态度问卷及培训需求问卷对其进行调查.结果:101名新入职护士对母乳喂养知识和态度总分分别为(13.8...     

Nontargeted Hepatitis C Screening in an Urban Emergency Department in New York City

BackgroundPreviously the Centers for Disease Control and Prevention (CDC) recommended targeted hepatitis C virus (HCV) screening for adults born between 1945 and 1965 and individuals with HCV risk factors. In April 2020, the CDC updated their recommendations to now include all individuals 18 years of age and older in settings with HCV prevalence > 0.1%. Few emergency departments (EDs) currently employ this nontargeted screening approach.ObjectivesWe examined how a shift from targeted to nontargeted screening might affect HCV case identification. We hypothesized that nontargeted screening could improve HCV case identification in our ED.MethodsRetrospective review of prospectively collected nontargeted screening data from June 6, 2018 to June 5, 2019 in a large urban academic ED. Patients 18 years of age and older, triaged to the adult or pediatric ED and able to provide consent for HCV testing, were eligible for study inclusion.ResultsThere were 83,864 ED visits and 40,282 unique patients deemed eligible for HCV testing. Testing occurred in 10,630 (26.4%) patients, of which 638 (6%) had positive HCV antibody (Ab+) tests and 214 (2%) had a positive viral load (VL+). Birth cohort-targeted screening would have identified 48% of the patients with Ab+ tests and 47% of those who were VL+. Risk-based targeted screening would increase the number of Ab+ patients to 67% and VL+ to 72%.ConclusionsNontargeted ED-based HCV screening can identify a large number of patients with HCV infection. A shift from targeted to nontargeted screening may result in fewer missed infections but requires further study.     

Identifying ED patients with previous abnormal HIV or hepatitis C test results who may require additional services

ObjectivesRoutine emergency department (ED) HIV or HCV screening may inadvertently capture patients already diagnosed but does not specifically prioritize identification of this group. Our objective was to preliminarily estimate the volume of this distinct group in our ED population through a pilot electronic health record (EHR) build that identified all patients with indications of HIV or HCV in their EHR at time of ED presentation.MethodsCross-sectional study of an urban, academic ED's HIV/HCV program for previously diagnosed patients August 2017–July 2018. Prevention program staff, alerted by the EHR, reviewed records and interviewed patients to determine if confirmatory testing or linkage to care was needed. Primary outcome was total proportion of ED patients for whom the EHR generated an alert. Secondary outcome was the proportion of patients assessed by program staff who required confirmatory testing or linkage to HIV/HCV medical care.ResultsThere were 65,374 ED encounters with 5238 (8.0%, 95% CI: 7.8%–8.2%) EHR alerts. Of these, 3741 were assessed by program staff, with 798 (21%, 95% CI: 20%–23%) requiring HIV/HCV confirmatory testing or linkage to care services, 163 (20%) for HIV, 551 (69%) for HCV, and 84 (11%) for both HIV and HCV services.ConclusionsPatients with existing indication of HIV or HCV infection in need of confirmatory testing or linkage to care were common in this ED. EDs should prioritize identifying this population, outside of routine screening, and intervene similarly regardless of whether the patient is newly or previously diagnosed.     

Implementing a Cardiovascular Screening Tool for High-Risk Pregnant Women in a Hospital Setting

ObjectiveTo implement a cardiovascular screening tool in a hospital unit for high-risk pregnant women to determine if additional testing and specialty consultation were indicated.DesignQuality improvement project.SettingHigh-risk obstetrics unit of a U.S. Midwest 127-bed specialty hospital.ParticipantsWomen ages 19 years and older who were admitted to the high-risk obstetric care unit during February and March of 2020; staff registered nurses assigned to the women completed the screening tool upon women’s admission to the unit.InterventionNursing implementation of a cardiovascular screening tool in women hospitalized on a high-risk unit. The Iowa Model of Evidence-Based Care was used for implementation to recruit staff, guide the intervention of the screening tool, and collect and analyze the data.ResultsIn a 2-month period of time, the cardiovascular screening tool was completed for 31 women. Four of the 31 women screened positive, indicating the need for clinicians to consider further testing and/or specialty consultation. The intervention identified pregnant women requiring additional interventions including testing and/or specialty consultation, which may not have occurred without the screening triggering such need.ConclusionFurther research is needed to validate if routine screening of pregnant women using a cardiovascular screening tool will improve long-term outcomes for pregnant women.     

Relationship Between Specialty Choice and Medical Student Temperament and Character Assessed With Cloninger Inventory

Background: Multiple variables affect medical specialty choice, including temperament, sociodemographic factors, and personal experiences. Many studies address specific variables for specific specialties, but few assess the relative impact of each factor.

Purpose: To identify the relative influence of temperament in choosing a specialty.

Methods: A sociodemographic and personal experiences questionnaire and a 240-question temperament and character inventory was distributed to 682 medical students. Their scores for 6 medical specialties were examined using analyses of variance, multivariate analyses of variance, and discriminant analysis.

Results: Students choosing surgery, emergency medicine, and obstetrics and gynecology were higher on novelty seeking than other students. Future surgeons were lower in harm avoidance and reward dependence (RD) than the others. Students choosing primary care specialties, emergency medicine, and obstetrics and gynecology were all high on RD; with pediatrics being highest. Students differed from college students, the women differed from the men, and the Asian Americans differed from the other groups.

Conclusion: The implications of these findings are discussed for career counseling and future research.     

What if It Were Me? A Qualitative Exploratory Study of Emergency Nurses’ Clinical Decision Making Related to Obstetrical Emergencies in the Context of a Post-Roe Environment

IntroductionPrevious research describes a significant knowledge deficit in obstetrical care in emergency settings. In a post-Roe environment, additional medicolegal challenges are documented across the obstetrics and gynecology landscape, but an understudied care setting is the emergency department, where patients may present to a practice environment where there is limited or no obstetrical care available. It is unknown how emergency nurses make decisions around these types of presentations. The purpose of this study was to explore the clinical decision-making processes of emergency nurses in the care of patients with obstetrical emergencies in the context of limited or absent access to abortion care and the impact of those processes on patient care.MethodsQualitative exploratory approach using interview data (n = 13) and situational analysis was used.ResultsSituational mapping uncovered human elements comprised nurses, providers, pregnant people, and families; nonhuman elements comprised legislation, education, and legal understanding. Social worlds mapping included challenges of inexperience, conflict about clinical responsibility, uncertainty about the meaning of legislation, and passivity around implications for patient care. Positional mapping yielded both the overlapping discourses around the phenomenon of interest and the area of silence around abortion-limiting legislation.DiscussionWe found that emergency nurses in states with abortion care-limiting laws had significant self-reported deficits in both education and training around the management of obstetrical emergencies. In this sample, there was a surprising lack of awareness of care-limiting legislation and the clinical, ethical, and legal implications for both emergency care staff and for patients.     

生物可降解材料在妇产科临床治疗与护理中的应用

背景：目前生物相容性好、无不良反应的生物可降解材料在妇产科临床治疗和护理中应用越来越广泛,近几年在国内外发展十分迅速。目的：综述生物可降解材料在妇产科治疗中的应用。方法：由第一作者根据丰富的临床实践经验并检索PubMed、CNKI数据库,重点总结生物可降解材料在妇产科手术治疗及护理方面的应用,检索词为“degraded materials,可降解生物材料,妇科护理,手术治疗”。根据临床实际应用中出现的问题进一步展望生物可降解材料在妇产科治疗护理中的发展目标。结果与结论：生物可降解材料在生物医学材料中占有重要地位,其具有良好的生物相容性和生物安全性,聚合物和降解产物对机体不良反应小,生物力学性质、物理化学性能良好可调控,并有良好的可加工性,在妇产科治疗护理中应用广泛,如可吸收缝合线、止血材料等,取得了良好的临床效果。虽然生物材料研究取得了很大的发展,但目前应用到临床中应有很大的局限性和安全性问题。相信随着生物材料领域的进一步发展,在临床治疗和护理方面的应用前景也会越来越广阔。     

外科及妇产科医疗不良事件22例分析

目的分析外科及妇产科医疗不良事件的危险因素,保障医疗安全。方法收集笔者所在3家医院1981—2011年发生的22例外科及妇产科医疗不良事件,回顾性分析临床资料。结果本组22例,误诊6例,漏诊、误治及沟通缺陷各3例,并发症7例;发生在外科(含麻醉科)17例、妇产科5例。死亡9例,生存13例,其中5例遗留后遗症。17例发生医疗争议,其中诉至法院3例,经医患双方或第三方协调解决14例。结论因临床思维缺陷造成诊疗决策失误是外科和妇产科医疗不良事件的最常见因素,医院管理者要重视核心制度环节管理,切实提高患者医疗安全性。     

Strategies for the improvement of HCV testing and diagnosis

Introduction: The improvement of number of people diagnosed with hepatitis C virus (HCV) infection is crucial to reach the WHO objectives for eliminating viral hepatitis by 2030. Alternatives to classical HCV virological tests using serum or plasma taken from venous puncture including point-of-care (POC) tests and dried blood spot (DBS) are being considered for HCV screening, diagnosis, and monitoring. Reflex nucleic acid testing and HCV core antigen test have the potential to simplify diagnostic algorithm, increase diagnosis and facilitate linkage to care.

Areas covered: This review examines strategies for the improvement of HCV testing and diagnosis including alternatives to classical HCV virological tests and approaches for simplified diagnostic algorithms.

Expert opinion: Serological and molecular POC tests are now available for HCV antibody and HCV RNA detections in less than 20 and 60, respectively. DBS offers the main advantage to store desiccated blood that can be easily transported to reference centers where state-of-the-art molecular and serological diagnostic tests are used. Simplifications of diagnostic algorithms are urgently needed to enhance HCV testing, linkage to care and treatment.     

咀嚼口香糖对妇产科微创手术后病人胃肠功能的影响

[目的]探讨妇产科微创手术后咀嚼口香糖对促进病人胃肠功能恢复的临床价值。[方法]收集我院收治的行妇产科微创手术病人160例,随机分为两组,对照组采用常规护理并结合早期功能锻炼,实验组在对照组基础上术后予口香糖咀嚼,观察两组病人术后排气时间、首次排便时间以及术后腹胀和口腔溃疡的发生情况;检测术后第2天血中胃动素水平。[结果]实验组病人术后肛门排气时间明显缩短,与对照组比较,差异有统计学意义（P〈0.05）;术后排便时间实验组较对照组有所缩短,但差异无统计学意义;实验组病人出现腹胀及口腔溃疡等不适感的病例数明显少于对照组（P〈0.01）;胃动素水平实验组高于对照组,但差异无统计学意义。[结论]妇产科微创手术后咀嚼口香糖可促进胃肠功能恢复。     

Crashing eclamptic patient and a resulting peri-mortem C-section

BackgroundCardiac arrest in pregnancy is high acuity, low occurrence event. It involves the coordination of multiple teams to take care of ultimately two patients. This is further compounded by physiology that is frequently unfamiliar to the providers taking care of the patient.Case reportThis case report will detail sudden onset eclampsia in a patient whose condition deteriorated rapidly into cardiac arrest. It will delve into the complexities of managing this complex disease process and how the multi-disciplinary team quickly integrated to manage both the mother and the baby.Why should the emergency physician be aware of this?: Cardiac arrest in pregnancy is an incredibly difficult situation due to both the physiological differences in the pregnant woman and the emotional factors on the treating providers (1). Due to its rarity, the pregnant cardiac arrest situation should be frequently reviewed to ensure appropriate care when the time arrives.The per-mortem c-section for a woman in cardiac arrest is a critical resuscitation technique that must be understood by providers who take care of critically ill patients ranging from emergency medicine to obstetrics and gynecology (Ob/Gyn) clinicians.     

Proceedings: Beyond Ultrasound First Forum on Improving the Quality of Ultrasound Imaging in Obstetrics and Gynecology

The Beyond Ultrasound First Forum was conceived to increase awareness that the quality of obstetric and gynecologic ultrasound can be improved, and is inconsistent throughout the country, likely due to multiple factors, including the lack of a standardized curriculum and competency assessment in ultrasound teaching. The forum brought together representatives from many professional associations; the imaging community including radiology, obstetrics and gynecology, and emergency medicine among others; in addition to government agencies, insurers, industry, and others with common interest in obstetric and gynecologic ultrasound. This group worked together in focus sessions aimed at developing solutions on how to standardize and improve ultrasound training at the resident level and beyond. A new curriculum and competency assessment program for teaching residents (obstetrics and gynecology, radiology, and any other specialty doing obstetrics and gynecology ultrasound) was presented, and performance measures of ultrasound quality in clinical practice were discussed. The aim of this forum was to increase and unify the quality of ultrasound examinations in obstetrics and gynecology with the ultimate goal of improving patient safety and quality of clinical care. This report describes the proceedings of this conference including possible approaches to resident teaching and means to improve the inconsistent quality of ultrasound examinations performed today.     

Operationalizing Depression Screening in Ambulatory Palliative Care: A Quality Improvement Project

BackgroundDepression is common in the palliative care setting and impacts outcomes. Operationalized screening is unusual in palliative care.Local ProblemLack of operationalized depression screening at two ambulatory palliative care sites.MethodsA fellow-driven quality improvement initiative to implement operationalized depression screening using the patient health questionnaire-2 (PHQ-2). The primary measure was rate of EMR-documented depression screening. Secondary measures were clinician perspectives on the feasibility and acceptability of implementing the PHQ-2.InterventionThe intervention is a clinic-wide implementation of PHQ-2 screening supported by note templates, brief clinician training, referral resources for clinicians, and opportunities for indirect psychiatric consultation.ResultsOperationalized depression screening rates increased from 2% to 38%. All clinicians felt incorporation of depression screening was useful and feasible.ConclusionsOperationalized depression screening is feasible in ambulatory palliative care workflow, though optimization through having screening be completed prior to clinician visit might improve uptake.     

超声医学科住院医师规范化培训:妇产超声培训中国指南(2024版)

为进一步提升妇产超声亚专业规范化培训质量,中国医师协会超声医师分会组织国内相关专家,参考《住院医师规范化培训基地标准（2022年版）》及《住院医师规范化培训内容与标准（2022年版）》,结合自身经验,经过充分讨论形成本指南,旨在指导实施妇产超声教学工作。     

Learning in a High-Stress Clinical Environment: Stressors Associated with Medical Students’ Clerkship Training on Labor and Delivery

Abstract

Phenomenon: Obstetrics and gynecology can be a high-stress clinical environment for medical students due to the specialty’s fast-paced and unpredictable nature. Little is known about learning stressors for medical students on the obstetrics and gynecology clerkship to inform stress-reducing interventions and improve learning experience. This study investigated (a) which aspects of the learning environment are most stressful for obstetrics and gynecology clerkship students, (b) how perceived learning stressors in this environment differ for medical students and teachers (residents, fellows, and faculty), and (c) what interventions students propose to address these stressors. Approach: From May 2015 to April 2016, we conducted semistructured individual interviews with 3rd-year medical students from obstetrics and gynecology clerkship cohorts (n?=?52) as well as clerkship teachers (n?=?10) at an academic medical center. Two investigators used a qualitative Framework Method approach to analyze the interview data and agree upon final themes. Findings: We identified labor and delivery as the most stressful learning environment and four labor and delivery–related themes of students’ learning stressors: context (pace, logistics, nature of childbirth, and nonroutine schedule), learning tasks (student role and assignments and the amount of new knowledge and skills), communication (terminology used in conversation and interacting with the labor and delivery team), and clinical scenario (crisis, emergency, and patient refusal of student involvement). Whereas students identified context as causing most of the stress, teachers concentrated on stressors related to learning tasks. Insights: Learning stressors associated with students’ educational experience in the clinical context of labor and delivery are challenging for medical students. In addition to the specific content of these challenges, the recognition that teachers’ assumptions about sources of stressors are different from those of students is an important finding and has implications for changing the learning environment. Clerkship programs are encouraged to provide practical guidelines and embed an introduction of the clinical learning environment into the Obstetrics and Gynecology clerkship orientation curriculum.     

妇产科护理人员职业性肌肉骨骼疾患现状及社会心理因素调查分析

目的调查分析妇产科护理人员职业性肌肉骨骼疾患(WRMDs)现状及社会心理因素。方法通过整群抽样法随机抽取我市8家三甲综合医院的355名妇产科护理人员为研究对象,调查其WRMDs患病情况,通过多因素logistic回归分析社会心理因素。结果妇产科护理人员1年内WRMDs患病率由高到低依次为腰、肩、颈、背、手腕、脚踝、膝盖、臀部/大腿和肘部。多因素logistic回归分析显示,妇产科WRMDs患病与护理人员自觉身体健康差、繁重的工作、工作疲劳感和消极工作情绪密切相关(P<0.05)。结论社会心理因素对妇产科护理人员发生WRMDs密切相关,因此应给予充分重视。