Intra-Hospital Delay in Emergency Care at the Obstetrics and Gynecology Department in the University Teaching Hospital of Ouagadougou(UTH-YO),Burkina Faso

Objective: To investigate the intra-hospital delay in the treatment of gynecological and obstetric emergencies in the obstetrics and gynecology department at the UTH-YO. Patients and methods: It has been a prospective and descriptive study over a period of four months from 1 May to 31 August 2015 in the obstetrics and gynecology department at the UTH-YO. All patients and their escorts were included in our study, admitted to gynecological or obstetric emergencies who have accepted to participate in the survey. Data were entered and analyzed using a PC equipped with the SPSS 16.0 software English version. Results: During the study period, we recorded 2627 admissions. Delays in the management involved 216 patients or a frequency of 8.2%. The average age of patients was 26.6 ± 6.2 years, ranging from 16 and 46 years. Patients had no income in 165 cases (that is to say 76.4%). The referred patients accounted for 165 admissions (85.7%). The intake patterns were dominated by obstetric acute fetal distress in 44 cases (20.4%), pre-failure syndrome in 27 cases (that is to say 12.8%) and in gynecology by the ectopic pregnancy in 171 cases (79.3%). The average waiting period between the arrival of a patient and the beginning of first aid was 2 hours and 23 minutes with extremes of 16 min and 546 min. The main reason for the delay was the unavailability of the operating room in 61.1% of cases. The opinion of escorts was dominated by improving communication with the creation of a post of information in 47% of cases. Maternal prognosis was marked by a maternal death in 0.1% of cases and maternal morbidity in 13.4% of cases. The fetal prognosis was dominated by death at birth in 13.8% of newborns. Conclusion: Despite the subsidy of the government in obstetric and neonatal emergencies, there remain intra-hospital delays in the management of emergencies. The opening of discussions between the various stakeholders responsible for the implementation of this grant is urgent to contribute more effectively to the fight against maternal mortality.

Retrospective Cohort Study on Acute Care in Obstetrics and Gynecology: Analogies and Differences When Compared to Emergency Medicine

Introduction: the demand for urgent obstetric and gynecology care has progressively increased: in the United States approximately 1.4 million gynecologic visits are made to the emergency department (ED) annually, while almost 75% of women make at least 1 unscheduled visit during pregnancy. Moreover, research has recently focused on setting standards in unscheduled care, and developing quality indicators to improve patients’ health. Therefore, we investigated the characteristics of women with acute gynecological or pregnancy complaints using quality indicators developed for emergency medicine, to better define the needs of this population and improve care. Methods: Retrospective cohort study on ED, and Obstetrics and Gynecology (ObGyn) triage visits, at a tertiary care hospital in Italy, during 2012. Data were analyzed with population-averaged logistic regression and Poisson regression. Results: When compared to the 33,557 ED visits, the 9245 ObGyntriage referrals were more frequently associated with pregnancy (≤12 weeks’ gestation, OR: 30.7, 95%CI;24.5 - 38.4;>12 weeks’ gestation, OR 81.2, 95%CI;64.8 - 101.4), vaginal bleeding (OR 156.6, 95%CI;82.7 - 294.4), diurnal (night access OR 0.87, 95% CI;0.78 - 0.96) and weekday access (holiday access OR 0.87, 95%CI;0.78 - 0.95), frequent users (recurrent ED visits IRR 0.87, 95%CI;0.83 - 0.9) and lower hospital admissions (ED admission OR 1.6, 95%CI;1.4 - 1.8). Conclusion: ObGyn triage patients differed from ED users, and were at higher risk of “crowding”. Such diversities should be considered to improve female healthcare services and allocate resources more efficiently.

Gynecological and Obstetrical Emergencies at the University Clinic of Gynecology-Obstetrics of the National Hospital Donka Guinea

Gynecological and obstetrical emergencies are found all over the world, especially in developing countries where women pay a heavy price for giving birth. They can occur at any time during pregnancy and outside of pregnancy often in a socio-economic context. The objectives of this study were to describe the sociodemographic characteristics and the maternal and fetal prognosis of gynecological and obstetric emergencies. Patients and Methods: This was a descriptive cross-sectional study with prospective data collection, conducted at the University Clinic of Gynecology and Obstetrics of the Donka National Hospital between June 1 and September 30, 2015. It involved all patients admitted to our department in emergency for a gynecological or obstetrical complaint. Results: We collected 361 cases of gynecological and obstetrical emergencies out of a total of 1779 consultations, i.e. a frequency of 20.29%. Obstetrical emergencies were predominant with 91.41% and gynecological emergencies represented 8.59%. The average age of patients was 29.5 with extremes of 14 and 47. Nulliparous women were the most numerous (34.35%). More than half of the patients did not attend school (52.08%) and 56.70% were evacuees. Abdominopelvic pain and hemorrhage were the main reasons for consultation (54.29% and 49.58%). Admission diagnoses were dominated by acute fetal distress and hemorrhage in the last quarter of pregnancy (52.3% and 36.01%). The caesarean section rate was high (82.12%). Maternal and perinatal lethality rates were high (5.2% and 30.3%). Conclusion: Gynecological and obstetrical emergencies are a public health issue because of the severity of the prognosis they impose on the mother and child. Maternal and perinatal mortality was very high. The prevention of these serious emergencies must be done through good quality prenatal consultations. Laparoscopy equipment and staff training are necessary for a minimal invasive surgery of gynecological emergencies.

Blood Transfusion Practices at the Gynecology-Obstetrics Department of the Sylvanus Olympio University Hospital in Lomé: A Study of 254 Cases

Objective:?To describe blood transfusion practices in obstetric at the Sylvanus Olympio University Hospital in Lomé. Patients and method: Prospective, cross-sectional and descriptive study, conducted from 1 June 2017 to 31 May 2018 at the gynecology-obstetrics department. The study focused on transfused pregnant, parturient and delivered women. Study parameters were sociodemographic, clinical, therapeutic and prognostic. Results: 252 patients, aged 16 to 49 with an average age of 30.4 years, referred in 74% of cases. Hemorrhage was observed in 238 cases (94.4%) and anemia in 14 cases (5.6%). Blood transfusion was urgently used in 89.7% of cases and hemorrhagic abortion was the main indication. Blood group O+ (34.5%) was the most used and blood products were obtained after two hours in 81% of cases. Conclusion: Blood transfusion is often performed urgently and for bleeding. But the Gynecology-Obstetrics department does not have any blood in reserve, whereas the Sylvanus Olympio University Hospital collection and distribution station covers less than 10% of the needs.

CBL联合纠错教学应用于妇产科规范化培训中的价值

目的分析以案例为基础的教学法(Case Based Learning,CBL)联合纠错教学应用于妇产科规范化培训中的价值。方法选取2022年1月—2023年12月在潍坊医学院附属医院妇产科轮转的40名规范化培训医师为研究对象,采用随机数表法将其分为两组,每组20名。对照组实施传统规范化培训,观察组实施CBL联合纠错教学规范化培训,对比两组医师专业理论知识考试成绩、临床技能操作考核成绩及满意度。结果观察组专业理论知识考试成绩高于对照组,差异有统计学意义(P<0.05);观察组病例问询、查体、病例分析、治疗计划分数及总分均高于对照组,差异有统计学意义(P均<0.05);观察组教学模式、学习兴趣、自学能力、表达沟通能力、团队协作能力评分均高于对照组,差异有统计学意义(P均<0.05)。结论在妇产科规范化培训中,采用CBL联合纠错教学方法具有显著的价值,能够提高住培医师的专业理论知识水平,增强他们在实践中的能力,并促进他们的自主学习和团队合作能力。

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。

妇产科门诊阴道分泌物检验结果的研究

目的评估妇产科门诊阴道分泌物检验结果。方法120例阴道分泌物检验者为研究对象,分析不同阴道清洁度下病原体(细菌、假丝酵母菌、滴虫)检出情况。结果120例阴道分泌物检验者中,清洁度Ⅰ度38例(31.67%)、清洁度Ⅱ度28例(23.33%)、清洁度Ⅲ度27例(22.50%)、清洁度Ⅳ度27例(22.50%)。120例阴道分泌物检验者中,20例(16.67%)检出细菌、13例(10.83%)检出假丝酵母菌、5例(4.17%)检出滴虫,且阴道清洁度越高,细菌、假丝酵母菌、滴虫的检出率越高。结论妇产科门诊阴道分泌物检验中,阴道病原体感染患者发病率高,需要加强防护措施,降低阴道感染的发生率。

FMEA联合RCA在剖宫产手术患者切口感染预防中的应用

目的探究失效模式与效应分析(FMEA)联合根因分析(RCA)在妇产科剖宫产手术患者切口感染预防中的应用。方法选取2022年3—12月医院行剖宫产手术的患者72例为研究对象,将2022年3—7月行剖宫产手术的36例患者为对照组,2022年8—12月行剖宫产手术的36例患者为观察组。对照组实施常规感染预防管理,观察组实施FMEA联合RCA模式的感染预防管理,计算实施前关键风险值(RPN)结果,分析实施前后RPN值,之后观察并记录FMEA与RCA前后RPN值和患者腹部手术切口感染发生的情况,再进行比较分析。结果实施前风险因素中RPN从大到小排序依次为不合理应用抗菌药物、未彻底清洗与消毒灭菌失效、未按无菌技术操作规范执行与手卫生不规范、未严格执行规定与手术室环境未达标、医护人员宣教不足与消毒效果不达标。抽样研究结果显示,实施FMEA与RCA后(观察组)RPN值较实施FMEA与RCA前(对照组)RPN值下降。且干预后观察组患者切口感染发生率低于对照组,差异有统计学意义(P<0.05)。结论FMEA联合RCA模式可有效降低关键RPN值,减少妇产科腹部手术患者切口感染率,从而达到预防感染的目的。

基于服务质量差距模型的管理模式对提升妇产科护理服务质量的影响研究

目的探讨基于服务质量差距(servicequality,SERVQUAL)模型的管理对提升妇产科护理服务质量的影响。方法以2022年1月到2023年1月医院妇产科收治的120名住院患者为研究对象,随机分为观察组与对照组,每组60例。对照组采取妇产科常规护理干预,观察组实施基于SERVQUAL模型的管理。采用SERVQUAL量表评价干预效果。结果观察组患者期望值与感知值之间的差值显著低于对照组。观察组满意度较对照组高(P<0.05)。结论采用基于SERVQUAL模型的管理方法有助于提升妇产科优质护理效果。通过密切关注患者所需随时发现缺陷所在并立即改正,能让患者降低在护理服务期待值与实际感知值之间的落差,从而提高他们的满意度。因此,在临床实践中广泛应用该方法是非常合适和可取的。

妇产科新兴专业不同教学方式的比较

目的针对妇产科学新兴学科教学探索一种新的教学方式。方法将2022年1—10月在内蒙古自治区人民医院妇产科实习的276名实习学生纳入研究,采用抽签法将其分为对照组和教改组,各138名。对照组由妇产科教学医生参照目前的教学大纲、教案带教,无跨学科专业教学的参与。教改组由生殖医学、产前诊断学、妇科内镜学组分别选出本专业组的教学骨干组成教师组,带教前共同参与编写教案、教学大纲,参与建立临床病案库、课后评价体系。比较2组学生基础理论和病例分析的得分;针对教学成果进行问卷调查,比较2组学生的学习兴趣提升率、新兴知识掌握率、临床思维培养率、学习能力提高率、教学效果满意率。结果教改组学生的基础理论、病例分析成绩[(92.86±2.41)分、(91.10±4.03)分]均高于对照组[(86.43±5.01)分、(83.90±6.05)分],差异有统计学意义(P<0.05)。教改组学习兴趣提升率、新兴知识掌握率、临床思维培养率、学习能力提高率、教学效果满意率(92.03%、94.21%、94.21%、97.82%、98.55%)高于对照组(65.22%、50.72%、63.04%、52.89%、68.12%),差异有统计学意义(P<0.05)。结论和传统妇产科学的带教方式对比,与交叉学科的联合教学方式更适合妇产科学新兴学科的教学,有助于基础理论掌握和临床思维养成,改善教学成果。

操作技能直接观察评量指导下的情景模拟教学结合行动学习法在妇产科临床教学中的应用效果

目的研究操作技能直接观察评量(DOPS)指导下的情景模拟教学结合行动学习法在妇产科临床教学中的应用效果。方法选取2022年1月至12月在湘南学院附属医院临床学院妇产科实习的60名临床医学生作为研究对象,按照随机数字表法分为对照组(n=30)和观察组(n=30)。对照组实施传统教学法,观察组实施操作技能DOPS指导下的情景模拟教学结合行动学习法。比较两组的出科考核成绩、批判性思维能力测评量表(CTDI-CV)评分、学生岗位胜任力测评量表评分。结果观察组的出科考核成绩、CTDI-CV评分、学生岗位胜任力测评量表评分均高于对照组,差异有统计学意义(P<0.05)。结论在妇产科临床教学中实施DOPS指导下的情景模拟教学结合行动学习法能够有效提升教学质量,促进临床医学生考核成绩、批判性思维能力以及岗位胜任力的提升。

PBL结合Seminar教学模式在妇产科见习中的应用方法研究

探讨了Seminar形态结合以问题为基础的课堂教学(PBL)教学法,以及在临床驻点班妇产科见习教育中的效果。在临床驻点班妇产科见习教育中,展开了Seminar形态的与临床应用个案探讨、床边教育等结合的PBL教学模式。Seminar紧密结合PBL课堂教学,充分调动了学生的学习积极性,培养了学生的语言交流技能,也训练了学生应用与反思的能力。Seminar紧密结合PBL课堂教学可以改善临床见习教学效果,但还应进行深入研究与应用。

“互联网+”背景下妇产科混合式教学模式的应用初探

随着国家对“互联网+”在教育领域应用的提出,为大力推进以“课程思政”为目标的教学改革,针对既往传统线下教学及疫情期间全程线上教学存在的问题,构建了基于“互联网+”背景下课程思政融入线上线下混合式教学模式在妇产科教学中的应用。通过将雨课堂及慕课平台作为载体,与线下课堂教学进行有机融合,以岗位胜任力为导向,同时在教学过程中适当融入课程思政教育,利用以问题为基础的学习(PBL)、以案例为基础的学习(CBL)、翻转课堂、同伴互助学习(PAL)、情景模拟等多种教学形式,既可以发挥教师在教学过程中的指导、监督作用,又能充分调动学生在学习过程中的积极性、创新性,实现知识传授、能力培养与价值引领的有效衔接及相互融合,以达到为社会培养德才兼备、全面发展的医学人才目的。

院前急救护理干预在妇产科急危重症患者急救护理中的应用价值体会

目的探析妇产科急危重症患者采取院前急救护理的效果及实践价值。方法选取60例妇产科急危重症患者,按照入院单双号分为对照组与观察组,每组30例。对照组予以常规急救护理,观察组予以院前急救护理,比较两组急救指标、抢救成功率、满意度及生活质量。结果观察组转运时间、病情评估时间、急救时间、住院时间均短于对照组,抢救成功率高于对照组(P<0.05)。观察组不良事件发生率3.33%较对照组的23.33%低(P<0.05)。观察组满意度、生活质量评分较对照组高(P<0.05)。结论妇产科急危重症患者采取院前急救护理效果显著,可缩短急救时间,提高抢救效率,规避不良事件,促进疾病转归,具有较高的运用价值。

临床操作示范视频在加强妇产科实习同质化中的探索

实习是通过医学理论和临床实践相结合,使医学生成长为临床医生的重要阶段。中山大学孙逸仙纪念医院妇产科教研室历来重视本科教学,为此制定了系列措施旨在确保教学质量。但在目前的妇产科实习过程中,存在教学内容、教学方式和教学效果差异较大的情况。妇产科实习涉及许多临床技能操作,为了让实习医生能更好地掌握妇产科临床操作技能,有必要加强实习质量的一致性。规范化操作示范视频有助于提高教学同质化,已在本科生见习、外科实习和住院医师规范化培训中得到证实和报道。前期的研究表明临床操作规范化示范视频可提高妇产科实习医生基本临床技能的掌握程度。文章立足于操作示范视频,探讨规范化视频录制和推广过程中的注意事项,以期有利于实习医生规范掌握妇产科临床操作,同时提高妇产科年轻医生临床带教能力,最终达到促进妇产科实习教学质量一致性的目的。

新医科背景下临床医学课程思政的探索与实践

以妇产科学课程为例,对临床医学课程思政与新医科交叉重合内容进行分析,介绍妇产科学课程思政教学设计,将新医科建设的健康意识、学科融合、医者仁心等思政元素,全过程、全方位地融入课程,提升临床医学课程的教学质量。

妇产科门诊医患共享决策与患者满意度关系研究

目的 探讨妇产科门诊医患共享决策(SDM)与患者满意度之间的关系,为提高患者满意度提供依据。方法 对实施SDM前后两组患者进行问卷调查(问卷内容包含患者医疗决策参与意愿、参与度及诊疗满意度),对影响患者满意度的因素进行相关性分析,并比较两组满意度差异。结果 (1)妇产科门诊患者参与医疗决策的意愿较强,评分为(4.53±0.52)分;(2)医疗决策参与度与总体满意度的相关性较强(r=0.706,P<0.05);(3)SDM模式实施前后参与度评分为(2.57±0.23)分和(4.12±0.68)分,差异具有统计学意义(P<0.05),患者总体满意度评分为(3.45±0.17)分和(4.33±0.51)分,差异具有统计学意义(P<0.05)。结论 妇产科门诊患者医疗共享决策诊疗模式有助于提高患者满意度。

PBL+情景模拟演练Debriefing教学法在妇产科急诊规培教学中的应用

目的:探究PBL+情景模拟演练Debriefing教学法应用于妇产科急诊规培教学中的价值。方法:选取2020年9月至2021年9月急诊60名第一年规培生随机分为对照组和试验组,分别采用PBL教学法和PBL+情境模拟演练Debriefing教学法进行规培教学及评价。结果:试验组教学满意度及教学质量均高于对照组(P<0.05)。结论:采用PBL+情景模拟演练Debriefing教学法可提高规培医生的理论知识转化能力、团队协作能力和突发事件应变能力,提升急诊规培教学质量。

PBL联合角色扮演法在妇产科学本科见习教学中的应用探索

目的探讨基于问题的教学方法(problem based learning,PBL)联合角色扮演法在妇产科学本科见习教学中的应用。方法选取2021年9—12月在川北医学院附属医院参加妇产科见习教学的2018级五年制临床专业的84名本科生为研究对象,根据教学模式的不同,分为实施PBL联合角色扮演教学方法的研究组(n=41)及仍采用传统见习模式的对照组(n=43)。课程结束后,完成课后测试题,并以问卷形式完成满意度评价。结果研究组的测试成绩高于对照组,差异有统计学意义(Z=5.430,P<0.001)。研究组总满意度明显高于对照组,差异有统计学意义(P<0.05)。结论应用PBL联合角色扮演教学方法,有利于提升妇产科本科见习教学的教学质量及满意度。