Ovarian cysts
Adnexal cyst; Adnexal mass; Cyst of ovary; Cystic ovary; Extrauterine pelvic mass; Obstetrics and gynecology; Ovarian cyst; Ovarian mass; Ovary cyst; Primary care
A fluid-filled sac in the ovarian tissue. The cyst may be unilocular or multilocular. The causes may be physiologic, infectious, benign neoplastic, malignant neoplastic, or metastatic. The most important step in management is assessing the risk of malignancy. Oral contraceptives do not hasten or influence regression of benign ovarian cysts. Asymptomatic postmenopausal women with simple unilocular ovarian cysts Ultrasonography can provide a morphology index score that is useful in determining likelihood of malignancy. Guidelines by the American College of Obstetricians provide validated criteria for referral to gynecologic oncology.
Michael P Hopkins MD MEd
2019
1905-7
Journal Article
n/a
Ovarian torsion
Adnexal torsion; Fallopian tube torsion; Tubal torsion
A twisting of the ovary and/or fallopian tube on its vascular and ligamentous supports, blocking adequate blood flow to the ovary. Rapid diagnosis and intervention are necessary to preserve ovarian function. Most often seen in women of reproductive age between 20 and 40 years, but can occur during pregnancy, as well as in infants, children, adolescents, and postmenopausal women. Commonly presents with abdominal pain, nausea, vomiting, and an abdominal mass. High clinical suspicion is necessary. Clinical presentation is nonspecific, with no absolute clinical profile. Transvaginal ultrasound with Doppler flow studies may show an enlarged ovary with absence of blood flow. Definitive diagnosis is surgical. Laparoscopic surgery with detorsion is the preferred treatment to preserve normal ovarian function and fertility.
Michael P Hopkins MD MEd; Jay R Patibandla MD
2019
1905-07
Journal Article
n/a
Telepresent mechanical ventilation training versus traditional instruction: a simulation-based pilot study
critical care; education; telepresence; simulation; Health Care Sciences & Services; telementoring; mechanical ventilation; society; critical-care medicine; DASH
Background Mechanical ventilation is a complex topic that requires an in-depth understanding of the cardiopulmonary system, its associated pathophysiology and comprehensive knowledge of equipment capabilities. Introduction The use of telepresent faculty to train providers in the use of mechanical ventilation using medical simulation as a teaching methodology is not well established. The aim of this study was to compare the efficacy of telepresent faculty versus traditional in-person instruction to teach mechanical ventilation to medical students. Materials and methods Medical students for this small cohort pilot study were instructed using either in-person instruction or telementoring. Initiation and management of mechanical ventilation were reviewed. Effectiveness was evaluated by pre- and post-multiple choice tests, confidence surveys and summative simulation scenarios. Students evaluated faculty debriefing using the Debriefing Assessment for Simulation in Healthcare Student Version (DASH-SV). Results A 3-day pilot curriculum demonstrated significant improvement in the confidence (in person P<0.001; telementoring P=0.001), knowledge (in person P<0.001; telementoring P=0.022) and performance (in person P<0.001; telementoring P<0.002) of medical students in their ability to manage a critically ill patient on mechanical ventilation. Participants favoured the in-person curriculum over telepresent education, however, resultant mean DASH-SV scores rated both approaches as consistently to extremely effective. Discussion While in-person learners demonstrated larger confidence and knowledge gains than telementored learners, improvement was seen in both cases. Learners rated both methods to be effective. Technological issues may have contributed to students providing a more favourable rating of the in-person curriculum. Conclusions Telementoring is a viable option to provide medical education to medical students on the fundamentals of ventilator management at institutions that may not have content experts readily available.
Ciullo A; Yee J; Frey J A; Gothard M D; Benner A; Hammond J; Ballas D; Ahmed R A
Bmj Simulation & Technology Enhanced Learning
2019
2019-01
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1136/bmjstel-2017-000254" target="_blank" rel="noreferrer noopener">10.1136/bmjstel-2017-000254</a>
Simulation-based Training in Ectopic Pregnancy and Salpingostomy
ectopic; education; General & Internal Medicine; medical; obstetrics and gynecology; Pregnancy; salpingectomy; salpingostomy; simulation
Objective Ectopic pregnancy leads to approximately 3% of deaths in pregnancy. Surgical management is indicated when patients are hemodynamically unstable or have signs of a ruptured ectopic pregnancy. Salpingectomy is more commonly performed, but salpingostomy is preferred in a patient with prior salpingectomy with a desire for future pregnancy. Due to the lack of exposure, salpingostomy is not frequently performed and most residents do not feel adequately trained. Our goal was to provide a hands-on simulation about ectopic pregnancy and salpingostomy in hopes that the simulation will improve the resident's confidence and knowledge in recognizing an ectopic pregnancy, identifying an appropriate candidate for surgical management, and performing a salpingostomy. Methods The educational initiative was aimed towards postgraduate year (PGY) 1-4 OB/GYN residents (n=11). Knowledge and confidence questionnaires were given to participants prior to and post-simulation. A gynecologic mannequin was modified by taking the existing pelvic organs and creating a tubal pregnancy. In the first part of the simulation, a hemodynamically unstable patient presented with lab and imaging findings consistent with an ectopic pregnancy. Once recognized and the decision made for surgical intervention, participants were transferred to a simulated operating room where they performed salpingostomy or salpingectomy on the mannequin. The simulation was followed by a debriefing session to discuss the actions and thought processes of participants, provide reflection, and incorporate improvement opportunities for future cases. Finally, participants engaged in a didactic lecture where they were educated about the incidence, presentation, and management of tubal ectopic pregnancy. Results Analysis of the knowledge questionnaires showed the median score pre- and post-intervention was 9 and 12, respectively, with a median change of 3 (p=0.001). The median confidence value pre- and post-intervention were 28 and 42, respectively, with a median value change of 12 (p<0.001). Conclusion Our intervention improved residents' confidence and knowledge in recognizing an ectopic pregnancy, identifying an appropriate candidate for surgical management, and performing a salpingostomy.
Sabatina I A; Shah J V; Gothard D; Ballas D A
Cureus
2019
2019-07
<a href="http://doi.org/10.7759/cureus.5116" target="_blank" rel="noreferrer noopener">10.7759/cureus.5116</a>
Acute Eclampsia
Eclampsia is a uniquely pregnancy-related disorder that manifests as new onset of generalized tonic colonic seizures. It typically occurs after 20 weeks of concluded gestation, although it may occur sooner with plural gestations or molar pregnancies, and may additionally occur in the 6-week postpartum window. It represents the severe end of the preeclampsia spectrum. Preeclampsia spectrum includes symptoms of the central nervous system (CNS), for example, severe headaches or vision changes, and may involve hepatic abnormalities (such as elevated liver transaminases with right upper quadrant/epigastric discomfort), elevated blood pressures, and also may include thrombocytopenia, renal abnormalities, and pulmonary edema. In developed countries, resultant maternal mortality may be as high as 1.8%, and in the developing countries, it may be as high as 14%.[1]
Gill Prabhcharan; Tamirisa Anita P; Van Hook MD James W
StatPearls
2019
1905-07
<a href="https://www.ncbi.nlm.nih.gov/books/NBK459193/">https://www.ncbi.nlm.nih.gov/books/NBK459193/</a>
Uterine Atony
Uterine atony refers to the corpus uteri myometrial cells inadequate contraction in response to endogenous oxytocin that is released in the course of delivery. It leads to postpartum hemorrhage as delivery of the placenta leaves disrupted spiral arteries which are uniquely void of musculature and dependent on contractions to mechanically squeeze them into a hemostatic state. Uterine atony is a principal cause of postpartum hemorrhage, an obstetric emergency. Globally, this is one of the top 5 causes of maternal mortality.[1]
Gill Prabhcharan; Van Hook MD James W
StatPearls
2019
2019-01
<a href="https://www.ncbi.nlm.nih.gov/books/NBK493238/">https://www.ncbi.nlm.nih.gov/books/NBK493238/</a>
Twin Births
Twin births account for approximately 3% of live births and 97% of multiple bouts in the United States. In the absence of assisted reproductive technology, dizygotic twins are far more common than monozygotic twins and account for 70% of all twin gestations. Whereas the instance of dizygotic twins is variable in different populations, the prevalence of monozygotic twinning is globally constant at 3 to 5 per a thousand births. Except for post-term pregnancy and fetal macrosomia, pregnancy-related risks are exaggerated. Preterm birth is a prominent risk associated with twin gestations with others at risk for fetal growth restriction, congenital anomalies, and abnormal placentation. Other obstetric risks that increase include the risk of preeclampsia and gestational diabetes. Twin gestation in itself is not an adequate obstetric diagnosis. Definition of the placental chronicity is essential, as monochorionic twin gestations have unique risks associated with them that deserves surveillance.[1]
Gill Prabhcharan; Van Hook MD James W
StatPearls
2019
2019-01
Abnormal Labor
Normal labor is characterized by regular and painful uterine contractions that conclude in progressive in labor. A discussion on abnormal labor patterns is reviewed as abnormalities of the first stage (cervical dilation to complete cervical dilation) and the second stage (descent of the presenting part leading to delivery of the baby). The third stage of labor describes expulsion of the placenta. An overview of labor abnormalities encompasses all the stages of labor. First and second-stage abnormalities are described either as protraction disorders (which means that delivery is progressing but is lower than normal) or as arrest disorders (complete cessation in progress). Abnormal third-stage labor meriting intervention is placenta retention beyond 30 minutes, as most third stages are concluded within the first 10 to 20 minutes of delivery.[1]
Gill Prabhcharan; Van Hook MD James W
StatPearls
2019
2019-01
<a href="https://www.ncbi.nlm.nih.gov/books/NBK493238/" target="_blank" rel="noreferrer noopener">https://www.ncbi.nlm.nih.gov/books/NBK493238/</a>
Induction of Labor
This article reviews of methodologies for the induction of uterine contractions so that labor may occur. Physicians induce labor to promote vaginal delivery and to prevent complications of obstetric intervention. These complications are diverse and lead to cesarean section. Labor induction rates levels rose from 9.5% in 1992 to as high as 23.8% in 2010. The rates have been fairly stable since then.[1]
Gill Prabhcharan; Van Hook MD James W
StatPearls
2019
2019-01
Impact of Interventions to Change CBC and Differential Ordering Patterns in the Emergency Department.
Objectives: A CBC with leukocyte differential (CBC-DIFF) is a frequently ordered emergency department (ED) test. The DIFF component often does not add to clinical decision making. Our objective was to evaluate the impact of a performance improvement project on CBC ordering. Methods: ED orders for CBC-DIFF were identified through the laboratory information system. Two interventions were evaluated: an educational intervention regarding CBC-DIFF uses and a reprioritization of ED CBC-DIFF and CBC in the electronic medical record (EMR) orders. Pearson chi2 tests were used to assess for differences in the proportions. Results: There was no difference in the proportion of CBC tests performed after the education intervention (175/6,192, 2.8% [95% CI, 2.39%-3.21%] vs 219/6,270, 3.5% [95% CI, 3.05%-3.95%]). There was a significant increase in CBC samples ordered following the EMR intervention (604/6,044, 9.1% [95% CI, 8.37%-9.83%]; P \textless .01). Conclusions: Reprioritizing EMR laboratory orders can reduce overutilization of CBC-DIFF testing.
Phelan Michael P; Nakashima Megan O; Good Daniel M; Hustey Fredric M; Procop Gary W
American journal of clinical pathology
2019
2019-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1093/ajcp/aqy128" target="_blank" rel="noreferrer noopener">10.1093/ajcp/aqy128</a>