在妇科门诊进行精神障碍筛查的初步研究

目的探讨在妇科门诊进行精神障碍筛查的必要性。方法连续对妇科门诊1702名就诊者进行问卷调查,筛查工具采用《问题导向的患者报告》。包括重性抑郁发作、心境恶劣、广泛焦虑、强迫障碍和精神病性障碍5个分量表及Sheehan功能障碍尺。结果有效问卷为1626份,脱落率为4.5%。1626例中431例患者筛查阳性,占26.51%。在1626例中重性抑郁发作49例,占3.01%;亚临床重性抑郁发作130例,占8.00%;心境恶劣230例,占14.15%;广泛焦虑155例,占9.53%。常见的精神症状包括记忆力减退(36.5%)、乏力(28.2%)、注意力不集中(24.4%)等。结论妇科门诊患者中精神卫生问题突出,在妇科门诊进行精神障碍的筛查是十分必要的。     

腹腔镜手术治疗妇科疾病85例的体会

目的 探讨腹腔镜在妇科手术方面的临床应用价值.方法 回顾分析2006年6月～2007年6月腹腔镜诊治妇科疾病85例的临床资料.结果 85例腹腔镜妇科手术均顺利完成,无严重术中及术后并发症.结论 妇科腹腔镜手术具有恢复快、住院时间短、创伤小等优点,掌握好适应证,腹腔镜手术能完全有效地应用于大部分妇科疾病.     

Bleeding Disorders in Adolescents with Heavy Menstrual Bleeding: The Queensland Statewide Paediatric and Adolescent Gynaecology Service

Study Objective

Heavy menstrual bleeding (HMB) is a common gynecological complaint among young women with up to 40% having experienced HMB. Bleeding disorders are increasingly being recognized in adolescents and young adults with HMB. The aim of this study was to determine the prevalence of bleeding disorders in adolescents with HMB, among patients who presented to the Queensland Statewide Paediatric and Adolescent Gynaecology Service between July 2007 and July 2017.

Hormonal changes in premenstrual syndrome

The etiology of premenstrual syndrome (PMS) is unknown. Presently there is little or no data to show that cyclic hormonal changes cause PMS or that patients with PMS have different hormonal patterns from those without. Routine measurements of peripheral luteal phase levels of prolactin, thyroxine (T₄), thyroid-stimulating hormone (TSH), and dehydroepiandrosterone sulfate (DHEAS) in patients with PMS are presented. These tests proved not useful in diagnosis. Routine use of costly peripheral hormonal measurements in patients with premenstrual complaints is not indicated at the present time.     

The obstetrics and gynecology clerkship: building a better model from past experience

OBJECTIVE: The study was undertaken to identify factors contributing to the poor student perception of the obstetrics and gynecology clerkship. STUDY DESIGN: Third-year medical students at the University of Michigan complete an annual questionnaire about the overall quality of their clinical experiences. In addition, at the end of each rotation, the students complete an evaluation form assessing various aspects of their learning experience. We reviewed data collected from 2000 to 2002. We calculated effect sizes using mean scores and SDs to compare individual aspects of the learning environment across the clerkships. RESULTS: Twenty-six percent of the third-year medical students at the University of Michigan rated the strength of their obstetrics and gynecology experience as very or exceptionally strong. Compared with the other 6 clerkships, the rotation had one of the lowest ratings for overall quality. Aspects of the clerkship experience we identified as potentially explaining this overall poor rating include the clarity of the clerkship goals and objectives, clarity of expectations for student performance, accessibility of faculty, experiences in learning history-taking skills, experiences in learning physical examination skills, and student perception that they were treated in a respectful/professional manner. CONCLUSION: Aspects of the clerkship experience identified by this study as potentially explaining the low ratings of the obstetrics and gynecology rotation should be studied in greater detail. Addressing these factors will be critical for improving the overall student perception of the obstetrics and gynecology clerkship.     

Use of complementary and alternative medicine among women with gynecologic cancers

OBJECTIVE: The aim of this study was to determine the prevalence and types of complementary and alternative medicine (CAM) usage by women with gynecologic cancer in an outpatient midwestern university practice. METHODS: Any patient with a gynecologic cancer seen in the outpatient clinic of the gynecologic oncology division at Washington University over a 3-month period was eligible, excluding those patients with a new cancer diagnosis. Subjects completed a questionnaire anonymously. Two by two comparisons were made using the Fisher exact test and P was considered significant at P < 0.05. RESULTS: Nearly half (49.6%) of 113 respondents had used CAM since being diagnosed with cancer. Characteristics significantly associated with CAM use include annual income greater than $30,000, cancer site of origin other than the cervix, and use of CAM prior to cancer diagnosis. Users with annual incomes greater than $30,000 were significantly more likely to use CAM in the "other" category that included acupuncture, reflexology, and electromagnetic therapy. Fewer than 25% of CAM users received information regarding CAM from a physician, nurse, or practitioner of CAM. Women used CAM in hopes of achieving a wide range of potential benefits including both improved well-being and anti-cancer effects. The most common actual benefit these women perceived was an improvement in psychosocial well-being, including increased hope or optimism. CONCLUSIONS: American patients with gynecologic cancer frequently use CAM in addition to standard medical therapy. Oncologists caring for women with gynecologic cancer should initiate a dialogue about usage of CAM, discussing the potential adverse effects of CAM and the patient's therapeutic goals.     

Collaboration and practice patterns among urologists and gynecologists in the treatment of urinary incontinence and pelvic floor prolapse: a survey of the International Continence Society members

Both urologists and gynecologists are involved in the care of women with urinary incontinence (UI) and pelvic floor prolapse (PFP). This study was designed to examine the differences among urologists and gynecologists who treat UI and PFP, and to characterize the collaboration between them. A 14-question survey was mailed to the International Continence Society (ICS) members who are urologists or gynecologists. Questions dealt with professional training, type of practice, volume of UI and PFP procedures, preferred procedures for various types of UI and PFP, and the type and extent of collaboration. Of the 666 urologists and gynecologists to whom the questionnaire was sent, 229 responded (34.4% response rate). Among them, 63.7% were urologists and 36.2% were gynecologists. Collaboration in the operating room was reported by 140 responders (50.7%) and was significantly correlated with the specialty, and with the country of practice, with P values of 0.004, and 0.004, respectively. Collaboration in the operating room was reported mainly in procedures for the correction of vaginal vault prolapse or enterocele, and hysterectomy. It was not statistically correlated with the time dedicated to UI and PFP, the volume of surgeries performed, UI and PFP fellowship training, university hospital affiliation, and years in practice. Reasons for not collaborating in the operating room included familiarity with all or most of the anti-incontinence and pelvic floor reconstruction procedures (44.5%), unavailability of the other professional (6.1%), and reimbursement problems (3.1%). While urologists and gynecologists do collaborate extensively in clinical research and diagnosis of challenging cases, surgical collaboration is limited to procedures traditionally performed by gynecologists. Future training programs exposing trainees to both fields of expertise may enable better ground for collaboration and improved care for women with UI and PFP.     

妇产科全英语教学的探讨

通过分析妇产科临床教学部分章节采用全英语授课（授课对象是医学系七年制学生）存在的问题，探讨在妇产科全英语教学中提高教学质量的方法。学生需要强化医学专业英语，做好课前预习，教师需要提高英语水平，课前需要充分的准备，才能确保妇产科全英语教学取得良好的教学效果。     

异丙酚复合不同镇痛药用于老年患者妇科门诊手术麻醉的观察

目的研究异丙酚复合不同镇痛药用于老年患者妇科门诊手术的麻醉作用。方法年龄55岁以上ASA分级Ⅰ～Ⅲ患者80例，随机分4组（n=20），Ⅰ组先缓慢静脉注射芬太尼1μg／kg1min后静脉注射异丙酚2mg／kg。Ⅱ组先静脉注射曲马多1mg／kg1min后静脉注射异丙酚2mg／kg。Ⅲ组先静脉注射氯诺昔康0．15mg／kg5min后静脉注射异丙酚2mg／kg，Ⅳ组静脉注射异丙酚2mg／kg。四组异丙酚静注速率均为100mg／min。观察各组诱导及苏醒时间，用药总量，记录术中呼吸、循环参数改变和术中、术后不良反应。术后由手术医生评定麻醉效果。结果手术全程异丙酚给药量及术毕至唤醒时间对照组高于其他各组。Ⅰ组术中最低SpO2值在85％-90％之间或小于85％的病例数均多于其他组（P〈0．05），Ⅰ、Ⅱ组术中舌根后坠、术后恶心、呕吐发生率高于Ⅲ和Ⅳ组，Ⅳ组苏醒期兴奋躁动的发生率高于其他各组。麻醉效果达优者以Ⅳ组最少。术后下腹痛VAS评分0～2分者Ⅲ组优于其他组。结论异丙酚复合氯诺昔康用于老年患者妇科门诊短小手术的麻醉中不但可获得较为满意的麻醉效果，而且药物不良反应少，对术后下腹痛也表现出更好的镇痛效果，是一种更为有效的配伍方法。