改良式以问题为基础学习教学方法在妇产科学临床实习中的应用

以问题为基础学习(problem-based learning,PBL)教学方法是以问题为基础、以学生为中心的教学模式。改良式PBL教学方法在PBL的基础上增加了教师的指导和参与,结合CBL和TBL的优点,更适合中国医学生的特点和思维方法。北京大学人民医院妇产科在临床实习教学中,实施了改良式PBL教学方法,实习结束后对医学生进行了考核,并结合问卷调查对改良式PBL教学效果进行了评估。考核及问卷调查结果均显示,改良式PBL教学方法可以提高医学生的学习积极性、主动性和学习效果,培养医学生的临床工作综合能力。实践证明,改良式PBL教学模式在妇产科学临床实习教学中,具有一定的推广价值。     

留学生妇产科学教学的初步探讨

本文对巴基斯坦留学生的妇产科学教学进行了总结。教学态度端正,认真备课;定期进行“业务学习”;生动进行课堂教学,切忌照本宣科;积极主动与学生交流,努力成为学生的朋友：做到这四点是教学取得成功的关键。同时,还总结了临床见习带教的经验：积极进行见习前的准备;开展病例讨论式教学;组织好现场参观和参与式教学。     

康复新液在妇产科疾病中应用的研究进展

查阅近年有关康复新液的国内文献,综述其在宫颈糜烂、阴道炎、宫颈上皮内瘤变、宫颈癌放化疗性疾病等妇产科疾病中的应用研究进展,供临床医师参考。     

Impact of gynecologic hospitalist on patient waiting time at the emergency department in Korea: A retrospective pre-post cohort study

ObjectiveThis study aimed to identify the impact of care and change in the consultation process given by a gynecologic hospitalist on patient waiting time in the emergency department (ED).Materials and methodsThis is a pre-post study that compared patients’ length of stay at the ED ten months before and after intervention by the gynecologic hospitalist in 2018. The consultation process changed from ED staff contacting the gynecologic resident (pre-intervention group) to directly contacting the gynecologic hospitalist (post-intervention group). Times elapsed from gynecologic consultation to final disposition, from gynecologic consultation to discharge, and from arrival at ED to discharge were compared between the two groups.ResultsAmong 945 referrals at the ED during the study period, the number of daytime weekday gynecologic consultations were 68 and 187 cases in the pre-intervention and post-intervention groups, respectively. The time elapsed from gynecologic consultation to the final disposition, the time elapsed from gynecologic consultation to discharge and the time elapsed from arrival at ED to discharge were shorter in the post-intervention group than in the pre-intervention group (median values, 98 vs. 167.5 min, 205 vs. 311.5 min, and 419 vs. 497 min; P < 0.05), and extended length of stay more than 12 h at the ED was less common in the post-intervention group than in the pre-intervention group (9.6 vs. 19.1%; P < 0.01).ConclusionThe waiting time of gynecologic patients upon admission and prolonged length of stay at ED significantly decreased after the establishment of the gynecologic hospitalist system.     

Evaluation of the incorporation of an IOTA-ADNEX model in the discrimination of adnexal masses in our third-level hospital centre,taking into account the menopausal status of patients. Five years of experience

ObjectiveThe objectives were to estimate the performance of the IOTA-ADNEX model test after its incorporation into the ultrasound tests of our third-grade hospital gynecology service, as well as to assess whether its capacity of accuracy is modified when taking into account the patient's menopausal status.MethodsA cross-sectional study was conducted to clinically evaluate the diagnostic performance of the IOTA-ADNEX model test, which was performed between January 2016 and December 2021. The study included 573 women with an adnexal injury who underwent surgical excision within 180 days after ultrasound diagnosis and histological confirmation (gold standard). After the ultrasound exam, the injuries were classified using the ADNEX model. The study estimated the area under the receiver-operating-characteristics curve (AUC) of the ADNEX model for classifying between benign and malignant adnexal masses and compared the performance by menopausal state. Sensitivity and specificity were determined for different cut-off points.ResultsOut of the 573 women, 183 (31.9%) had a malignant tumor. The AUC of the ADNEX model for differentiating between benign and malignant adnexal masses at the time of ultrasound examination was 0.92 and the best malignancy threshold, detected by Youden index, was 22.5%. At this cut-off, the sensitivity of the ADNEX model was 91.8% and the specificity was 76.4%. However, it varies according to menopausal status: in the group of pre-menopausal patient, sensitivity was 86.1% (95% CI, 85.4%–86.8%) and specificity was 81.3% (95% CI, 85.4%–86.8%). In the postmenopausal group, sensitivity was 96.1% (95% CI, 95.6%–96.7%) and specificity was 68.5% (95% CI, 68.1%–68.8%).ConclusionsThe IOTA-ADNEX model is a reliable diagnostic tool to discard ovarian cancer. However, the accuracy of the test, at the same cut-off point, varies according to the menopausal state of the patient so it may be important to take it into account when taking decisions in clinical practice.     

CircRNA在妇科肿瘤中的研究进展

CircRNA是非编码RNA中最为稳定的RNA分子,其稳定存在于各种生物体中并参与生物体的代谢功能调节。近年来,大量研究从基因组学及信号通路方向深入研究,发现CircRNA可与miRNA通过复杂调控参与机体各种疾病的发生及发展,其中CircRNA在肿瘤细胞的增殖、凋亡及转移中的作用备受瞩目。妇科肿瘤是妇科疾病中危害最大的疾病。本文主要从CircRNA的特征功能认知、在肿瘤发生及发展中途径、以及其在妇科肿瘤中的致病机理和未来诊断方向上,综合国内外相关研究进展进行整理,总结CircRNA在妇科肿瘤中的临床应用。     

Physician experience is associated with greater underestimation of patient pain

ObjectiveProcedural pain is unique in that physicians simultaneously cause and assess it. Experienced male physicians are known to underestimate their female patients’ pain more than other physicians. However, it is unknown whether this also occurs in obstetrics/gynecology, where all patients are females. This study addresses the gap in literature on procedural pain assessment accuracy.MethodsThe present research compares paired pain evaluations from 20 obstetricians/gynecologists and their 92 female patients.ResultsOur data demonstrate that patients’ reported pain levels (M = 5.53, SD = 2.7) were significantly higher than their physicians’ pain estimates (M = 4.89, SD = 2.19), t = 2.64, p < 0.005. The gap between patients’ and physicians’ pain estimates was greatest among physicians with the greatest procedural experience (M = 1.49, SD = 2.24), f = 5.72, p < 0.005. Male physicians underestimated their patients’ pain significantly more than female physicians do, t = 2.27, p < 0.05.ConclusionOur results shed light on systematic underestimation of procedural pain and highlight the significance of experience and sex differences in pain evaluation.Practice implicationsPhysicians’ experience influences their perception of patient pain while performing procedures. Experienced male physicians, even those who exclusively treat female patients, need to be aware of this ubiquitous bias in assessing their female patients’ procedural pain.     

Is pelvic floor muscle strength and thickness associated with pelvic organ prolapse in Nepali women? – A cross-sectional study

BackgroundPelvic floor muscle function has been shown to be inversely associated with pelvic organ prolapse in Western women, however differences have been documented between ethnic groups.ObjectiveTo determine if pelvic floor muscle strength and thickness and hiatal area are associated with pelvic organ prolapse in Nepali women.MethodsThis cross-sectional study included non-pregnant Nepali women ≥18 years attending an outpatient gynecology clinic in Kathmandu, Nepal. A clinical examination included the pelvic organ prolapse quantification (POP-Q)- system examination and Modified Oxford Scale. Puborectalis muscle thickness and hiatal area were assessed using 3D/4D translabial ultrasound. Statistical analysis included Pearson's correlation and multiple regression (p < 0.05).ResultsOf the 123 women; 14 (11%) had POP-Q stage 0 prolapse, 29 (24%) stage I, 69 (56%) stage II, 8 (7%) stage III, and 3 (2%) stage IV. Mean ± SD Modified Oxford Scale was 3.37 ± 0.48 and muscle thickness was 1.14 ± 0.21 cm, hiatal area at rest was 14.67 ± 3.11 cm² and on contraction was 11.29 ± 2.51 cm². No associations were found between pelvic floor muscle strength or thickness and POP-Q stages 0–IV. There was a positive correlation found between hiatal area at rest and pelvic organ prolapse stage (r = 0.34, p < 0.001)and hiatal area on contraction and prolapse stage (r = 0.30, p < 0.001) and a negative correlation between pelvic floor muscle strength and hiatal area on contraction (r = ?0.36, p < 0.001).ConclusionIn contrast to previous findings, pelvic floor muscle strength and thickness are not associated with pelvic organ prolapse in this sample of Nepali women. It is important to consider these findings when developing pelvic organ prolapse treatment and management strategies in this population.     

4项凝血指标联合CA125检测对良恶性卵巢肿瘤辅助诊断的价值分析

目的探讨4项凝血指标凝血酶时间(TT)、纤维蛋白原(FIB)、D-二聚体(D-D)、血小板计数(PLT)联合糖类抗原(CA)125检测对良恶性卵巢肿瘤辅助诊断的价值。方法比较62例卵巢癌患者(卵巢癌组)与62例良性肿瘤患者(良性肿瘤组),以及不同国际妇产科协会(FIGO)分期卵巢癌患者,不同病理类型卵巢癌患者中CA125、4项凝血指标水平;采用受试者工作特征(ROC)曲线分析联合检测对良恶性卵巢肿瘤辅助诊断的价值。结果卵巢癌组CA125、TT、FIB、D-D、PLT水平均明显高于良性肿瘤组,差异有统计学意义(P<0.05);卵巢癌早期(FIGO分期Ⅰ~Ⅱ期)患者CA125、FIB水平低于卵巢癌晚期(FIGO分期Ⅲ~Ⅳ期)患者,差异有统计学意义(P<0.05),而TT、D-D、PLT水平比较,差异无统计学意义(P>0.05)。不同病理类型患者之间CA125、D-D水平比较,差异有统计学意义(P<0.05);CA125、TT、FIB、D-D、PLT单项指标对于良恶性卵巢肿瘤具有辅助诊断价值,5项指标联合检测对卵巢癌诊断的ROC曲线下面积为0.982,特异度为100.00%,诊断价值更高。结论CA125及4项凝血指标联合检测比单项指标检测对良恶性卵巢肿瘤具有更高的辅助诊断价值。