Faculty Bibliography

OBJECTIVE:To assess the effectiveness of an educational program in visual inspection with acetic acid (VIA) for cervical cancer screening among healthcare providers in 2 low-resource countries. METHODS:A cohort of multidisciplinary healthcare workers in Uganda and El Salvador were recruited to the study. A pretest was administered before the intervention of a 5-day educational program on VIA. A posttest was performed immediately after the educational program and again at a 6-month follow-up visit to assess retention of knowledge. RESULTS:In total, 42 (93%) of the healthcare workers who participated in the educational program completed the initial posttest evaluation, and 18 (40%) healthcare workers completed the 6-month follow-up evaluation. Mean test scores increased after participation in the training session (62% versus 81%; P<0.001). The self-reported comfort level for identifying cellular abnormalities also increased (2.1 versus 3.3; P<0.001). At 6-month follow-up, the mean test score remained higher than pretest scores (79% versus 57%; P<0.001). There was no significant difference in the initial and 6-month posttest scores (80% versus 79%; P=0.20). CONCLUSION/CONCLUSIONS:The educational program in VIA provided healthcare workers with the tools potentially to decrease the morbidity and mortality of cervical cancer in the 2 low-resource countries.

OBJECTIVE:To assess whether a novel educational curriculum using a simulation teaching laboratory improves resident knowledge, comfort with, and surgical performance of hysteroscopic sterilization. DESIGN/METHODS:An educational prospective, pretest/posttest study. SETTING/METHODS:The Montefiore Institute of Minimally Invasive Surgery Laboratory. PATIENT(S)/SUBJECT(S): Thirty-four OB/GYN residents in an academic medical center. INTERVENTION(S)/METHODS:Hysteroscopic sterilization simulation laboratory and a brief didactic lecture. MAIN OUTCOME MEASURE(S)/METHODS:Differences in scores on validated skill assessment tools: Task specific checklist, Global Rating Scale (GRS), pass fail assessment, and a multiple-choice examination to evaluate knowledge and attitude. RESULT(S)/RESULTS:In the entire cohort improvements were observed on all evaluation tools after the simulation laboratory, with 31% points (SD+/-11.5, 95% confidence interval [CI] 27.3-35.3) higher score on the written evaluation; 63% points (SD+/-15.7, 95% CI 57.8-68.8) higher score on the task specific checklist; and 54% points (SD+/-13.6, 95% CI 48.8-58.3) higher score on the GRS. Higher PGY status was correlated with better pretest performance, but was not statistically significant in posttest scores. Residents reported an improvement in comfort performing the procedure after the laboratory. CONCLUSION(S)/CONCLUSIONS:Simulation laboratory teaching significantly improved resident knowledge, comfort level, and technical skill performance of hysteroscopic sterilization.

INTRODUCTION AND HYPOTHESIS/OBJECTIVE:We aimed to identify factors contributing to successful pessary use for over 1 year. METHODS:A chart review was conducted composed of 150 women at Montefiore Medical Center, using a pessary for over 1 year. Characteristics of those who continued pessary usage were compared with those who discontinued use by using Chi-square, Fisher's exact test, logistic regression model, receiver-operator characteristic curve, and Kaplan-Meier survival curves. RESULTS:Thirty-five women (23%) discontinued using pessaries (DP) after a year, while 115 women (77%) continued (CP). There was no difference in multiple characteristics. The DP group had more patients with stress incontinence, p = 0.17. Older age at pessary insertion showed higher continued use (OR = 1.083, CI: 1.033-1.136). Patients with a history of prolapse repair surgery were more likely to discontinue pessary use. CONCLUSIONS:Age greater than 72 years was associated with continued pessary use and history of hysterectomy or prolapse surgery, and stress incontinence were associated with discontinuation.

Most healthy women have normal pregnancies; however, even healthy women may experience serious morbidity during pregnancy. Women with chronic medical problems face increased pregnancy-related risks compared with their healthy peers. Planning pregnancy improves maternal and fetal outcomes; medical conditions can be stabilized, teratogens can be avoided, and early antenatal intervention and surveillance can be instituted. The safest and most effective forms of contraception should be offered to women with medical conditions. Overestimatation of risk associated with the use of contraception among clinicians and women limits access to effective contraception. Contraception decision making should include consideration of the risks and benefits of a given method vs. the consequences of an unintended pregnancy. Published guidelines can inform contraceptive management of women with chronic medical conditions. Patient counseling should focus on helping women understand the need for contraception while optimizing their health for pregnancy.

OBJECTIVE:To compare 3-dimensional saline infusion sonohysterography (3DSIS) with 2-dimensional sonohysterography (2DSIS) using hysteroscopy and histologic diagnosis as the gold standard. METHOD/METHODS:A retrospective analysis of all SIS examination performed between July 1, 2005 and April 30, 2007 in our gynecological sonographic unit. 2DSIS or 3DSIS sonographic techniques were used randomly. Management decisions and operative procedures were done by the referring provider. Patients that had diagnostic hysteroscopy and complete histologic evaluation were included. Concordance between the various assessment methods as well as sensitivity and specificity were compared between 2DSIS and 3DSIS. Student's t test and chi-square test were used for statistical analysis. p < 0.05 was considered statistically significant. RESULT/RESULTS:Of 804 patients that had SIS, 125 patients met the inclusion criteria. Patient median age was 48 (range 19-82). Also, 77 patients were premenopausal, and 48 patients were postmenopausal. Furthermore, 43 patients had 2DSIS and 82 patients had 3DSIS. 3DSIS was found to correlate with hysteroscopic findings more often than 2DSIS (p < 0.05). A trend for higher specificity of 3DSIS with the different uterine pathologies was seen, but it did not reach statistical significance. No difference in sensitivity of 3DSIS compared with 2DSIS was found for all pathologic diagnoses. CONCLUSION/CONCLUSIONS:3DSIS correlated better with hysteroscopy than 2DSIS. Specificity for histologic diagnosis appears to be higher with 3DSIS compared with 2DSIS but larger-scale studies are needed to confirm this finding.

OBJECTIVE: The objective of this study is to gain insight into the nature of obstetric fistulae in Africa through patient perspectives. STUDY DESIGN: At l'Hopital Saint Jean de Dieu in Tanguieta, Benin, 37 fistula patients underwent structured interviews about fistula cause, obstacles to medical care, prevention, and reintegration by 2 physicians via interpreters. RESULTS: The majority of participants (43%) thought their fistulae were a result of trauma from the operative delivery. Lack of financial resources (49%) was the most commonly reported obstacle to care, and prenatal care (38%) was most frequently reported as an intervention that may prevent obstetric fistulae. The majority (49%) of the participants requested no further reintegration assistance aside from surgery. CONCLUSION: Accessible emergency obstetric care is necessary to decrease the burden of obstetric fistulae in Africa. This may be accomplished through increased and improved health care facilities and education of providers and patients.

OBJECTIVE:The purpose of this study was to assess whether a surgical skills simulator laboratory improves resident knowledge and operative performance of laparoscopic tubal ligation. STUDY DESIGN/METHODS:Twenty postgraduate year 1 residents were assigned randomly to either a surgical simulator laboratory on laparoscopic tubal ligation together with apprenticeship teaching in the operating room or to apprenticeship teaching alone. Tests that were given before and after the training assessed basic knowledge. Attending physicians who were blinded to resident randomization status evaluated postgraduate year 1 performance on a laparoscopic tubal ligation in the operating room with 3 validated tools: a task-specific checklist, global rating scale, and pass/fail grade. RESULTS:Postgraduate year 1 residents who were assigned randomly to the surgical simulator laboratory performed significantly better than control subjects on all 3 surgical assessment tools (the checklist, the global score, and the pass/fail analysis) and scored significantly better on the knowledge posttest (all P < .0005). CONCLUSION/CONCLUSIONS:Compared with apprenticeship teaching alone, a surgical simulator laboratory on laparoscopic tubal ligation improved resident knowledge and performance in the operating room.