Opinions and Perceptions of Gynecologists and Midwives on the Use of the Intrauterine Device in Senegal

Objective: The purpose of this study was to analyze the opinions of gynecologists, midwives, and interns/Specialist students practicing in Senegal about the use of IUD, and to assess factors that stand as obstacles to IUD prescribing. Patients and methods: An online questionnaire was developed to assess providers’ IUD practices and attitudes. The questionnaire was based on the one used in a Swiss study on the same topic. The platform used was Google forms. The questionnaire was shared in associative platforms involving gynecologists, midwives and interns/Specialist students. Results and comments: We received 292 feedbacks. Gynecologists represented 13.7% of the sample, interns and specialist students 11.3% and midwives 76%. Parity is a determining factor in IUD selection. The care-providers were concerned about the followings, which might have prevented the use of IUD, even though it was indicated: infections (75.7%), pelvic pain (61.3%), expulsion (48.3%), increased risk of perforation (46.9%), women’s appreciation (45.2%), ectopic pregnancy (33.9%) and sexual behavior (28.4%). Conclusion: Our study reveals that providers’ apprehensions and concerns severely limit the availability of IUDs. These concerns are often unfounded, based on personal experiences and not on official recommendations. Parity is a major obstacle.

A study on the pattern of medication used by famous Chinese gynecologists in the treatment of dysmenorrhea based on the data mining method

Objective:To explore the pattern of medication used in the treatment of dysmenorrhea by famous Chinese gynecologists based on the data mining method.Method:The electronic search of the Chinese journal full-text database CNKI,WIP database,Wanfang database,and biomedical database was used to download the experience awareness of famous Chinese gynecologists on the literature of dysmenorrhea treatment,including the self-experience introduction of Chinese gynecologists and the experience summary of students.Conduct a manual search to extract relevant literature on dysmenorrhea treatment.An Excel sheet was used to create a statistical summary table from which all data collected were classified into dysmenorrhea,TCM diagnosis,Western medicine diagnosis,TCM evidence differentiation,and high-frequency pharmacological gender classification.Statistical methods were used to perform frequency statistics for all syndromes,formulations and herbal medicines and to apply association rules to mine potential connections between two diseases,syndromes,prescriptions and herbal medicines to summarize the pharmacological patterns of TCM gynecology treatment of dysmenorrhea.The method was used to provide evidence for differentiation and drug ideas and to improve the efficacy of the clinical treatment of dysmenorrhea.Results:Among the 50 gynecologists in The Experience of Famous Chinese Gynecologists,153 journal articles and 22 monographs that met the requirements were collected,and the total number of prescriptions finally collected was 715.A total of 294 medical cases were included,and the high-risk age group for the onset of dysmenorrhea was concentrated between 27–36 years old.The types of dysmenorrhea can be categorized into eight types,and the number of occurrences in descending order:Qi stagnation and blood stasis,cold clotting and blood stasis,kidney deficiency and blood stasis,heat burning and blood stasis,Qi and blood deficiency,damp-heat stasis,Qi deficiency and blood stasis,and liver and kidney deficiency.Famous TCM gynecologists used 296 kinds of herbs for treating dysmenorrhea,with a total drug frequency of 8020 times,of which the total frequency of the top 100 herbs was 7355 times,accounting for 91.71%of the total frequency.Conclusion:(1)Famous Chinese gynecologists treat dysmenorrhea with the guiding principle of"if it does not pass,it hurts;if it does not glory,it hurts".Blood stasis is the main type of dysmenorrhea,and the method of activating blood stasis is the main treatment for dysmenorrhea.(2)Dysmenorrhea is mainly caused by real evidence,among which primary dysmenorrhea can be caused by real evidence,deficiency evidence and mixed evidence of deficiency and real,and the prescriptions used are mainly sutra prescriptions;secondary dysmenorrhea is mainly caused by real evidence and mixed evidence of deficiency and real,and the prescriptions used are mainly empirical prescriptions and are often used together with drugs to disperse nodules.(3)Commonly used herbal medicines for treating dysmenorrhea include Danggui,Baishao,Chuanxiong,Xiangfu,Yanhusuo,Chishao,Gancao and Wulingzhi.Common classic formulas include Siwu Tang,Wenjing Tang,Shixiao San,Shaofuzhuyu Tang,Sini San,Jinlingzi San,and Xiaoyao San.Typical experienced formulas:Neiyi 1 Fang,Neiyi 2 Fang,Neiyi 3 Fang,Jiaweimojie Tang,Bailiansanjie Tang,Neiyizhitong Tang,Huoxuequyuhuazheng Tang,etc.

妇产科医生对复方短效口服避孕药的雌激素剂量和服药方案的认知调查研究

目的了解当前我国妇产科医生对不同种类复方短效口服避孕药(COC)服药方案及其雌激素剂量的认识和适应症应用情况,以期为临床个体化用药决策提供参考。方法2022年8月至12月在全国20个省、自治区、直辖市的155家医院邀请妇产科医生进行问卷调查,了解其对国内目前五种常用COC的雌激素剂量和服药方案的认知及适应症应用情况。采用卡方检验、Bonferroni法、Crame' s V系数、雷达图等方法对数据进行统计分析及归纳总结。结果向653名妇产科医生发放调查问卷,回收有效问卷650份,回收率99.54%。妇产科医生对国内目前五种常用COC的知晓率差别较大,其中以屈螺酮炔雌醇片(Ⅱ)(20μg/片,87.69%;24/4方案,84.77%)知晓率最高,去氧孕烯炔雌醇片(20μg/片,45.69%;21/7方案,83.54%)最低。对于治疗痤疮、经前焦虑障碍、易怒、抑郁、经前综合征、多毛症和多囊卵巢综合征,28.77%~31.69%的妇产科医生选择24/4方案,37.54%~47.85%的妇产科医生选择雌激素剂量20μg/片的COC;其中对改善易怒症状(χ^(2)=9.403,P=0.009)方面,硕士及以上妇产科医生选择选择24/4方案的比例高于本科及以下学历者,差异有统计学意义。在改善月经周期规律性、治疗月经过多、经期周期控制效果方面,49.38%~50.00%的妇产科医生选择两方案效果相似,44.46%~56.31%的妇产科医生选择两剂量效果相似;其中在改善月经周期规律性(χ^(2)=8.402,P=0.015)和治疗月经过多(χ^(2)=6.451,P=0.040)方面,选择两剂量相似的副主任医师及以上的比例高于主治医师及以下者,差异均有统计学意义。妇产科医生对不同雌激素剂量和服药方案的选择呈弱相关(0.2<Cramer's V<0.3,P<0.05)。结论国内妇产科医生对不同COC的知晓率参差不齐,普遍存在对COC的作用机制认知不足。鉴于COC应用的广泛性,建议对妇产科医生加强COC药物作用机制的相关培训,了解雌孕激素剂量、种类与服药方案的关系,准确掌握适应症,以期更好地提供个体化推荐用药。

Urinary tract injury during hysterectomy:Does surgeon specialty and surgical volume matter?

BACKGROUND Ureteral injury is a known complication of hysterectomies.Recent studies have attempted to correlate surgeon volume and experience with incidence of urinary tract injuries during hysterectomies.Some studies have reported that as surgeon volume increases,urinary tract injury rates decrease.To our knowledge,no studies have assessed the relationship between surgeon subspecialty and the rate of urinary tract injury rates during minimally invasive hysterectomy.AIM To determine the incidence of urinary tract injury between urogynecologists,gynecologic oncologists,and general gynecologists.METHODS The study took place from January 1,2016 to December 1,2021 at a large comm-unity hospital in Detroit,Michigan.We conducted a retrospective chart review of adult patients who underwent minimally invasive hysterectomy.After we identified eligible patients,the surgeon subspecialty was identified and the surgeon’s volume per year was calculated.Patient demographics,medical history,physician-dictated operative reports,and all hospital visits postoperatively were reviewed.RESULTS Urologic injury occurred in four patients(2%)in the general gynecologist group,in one patient(1%)in the gynecologic oncologist group,and in one patient(1%)in the urogynecologist group.When comparing high and low-volume surgeons,there was no statistically significant difference in urinary tract injury(1%vs 2%)or bowel injury(1%vs 0%).There were more complications in the low-volume group vs the high-volume group excluding urinary tract,bowel,or major vessel injury.High-volume surgeons had four(1%)patients with a complication and low-volume surgeons had 12(4%)patients with a complication(P=0.04).CONCLUSION Our study demonstrated that there was no difference in the urinary tract injury rate in general gynecologists vs subspecialists,however our study was underpowered.

2021-2022年妇产科医生复方短效口服避孕药处方知信行网络调查

目的:了解妇产科医生对复方短效口服避孕药(COC)的认知、态度和行为,为我国COC的应用和推广提供参考。方法:2021年6月-2022年4月,经全国计划生育工作网络招募调查对象,在全国21个省份招募自愿参加的妇产科医生为研究对象,用自制问卷进行线上调查。问卷内容主要包括调查对象基本信息和COC知信行情况。采用潜在类别分析、Cochran-Mantel-Haenszel检验、两水平二分类logistic回归分析等方法对数据进行统计分析。结果:共发出1600份调查问卷,回收有效问卷1450份,回收率90.63%。调查对象的COC总体认知得分集中趋势为[73.2(60.6,80.3),COC]优缺点、作用机制、禁忌证和非避孕应用的认知得分依次为[72.9(52.1,77.1)]、[80.0(80.0,100.0)]、[77.8(66.7,88.9)]、[88.9(77.8,100.0)]。针对COC应用的态度,阻碍因素中“老百姓对COC不了解”(85.2%)和“增加静脉血栓等心血管疾病风险”(75.5%)占比较高,促进因素中“对象有避孕需求且无禁忌证”(89.9%)、“对象有治疗需求且无禁忌证”(86.9%)和“对象不适合上环”(84.9%)占比较高。两水平二分类logistic回归分析显示,COC知识掌握较好(OR=1.74,95%CI 1.25~2.44)、高推荐意愿(OR=4.33,95%CI 2.77~6.76)的妇产科医生在临床实践中推荐COC用于避孕需求的频率较高。结论:我国妇产科医生对COC的认知、态度存在不足,并影响其对COC的临床实践行为。建议加强对妇产科医生避孕药具知识的培训,以为服务对象提供高质量的避孕咨询和指导服务。

妇产科医生医患沟通能力的培养对策分析

目的探讨妇产科医生医患沟通能力的培养对策。方法选取2020年2月—2022年4月期间山东颐养健康集团莱芜中心医院的15名妇产科医生作为研究对象;以投掷硬币法作为管理研究分组依据,展开所有妇产科医生不同组别划分;参照组7名施以常规管理;研究组8名施以强化医患沟通能力培养管理。对比两组妇产科医生的管理满意度评分、管理质量评分。结果研究组管理态度评分、管理流程评分、管理专业性评分、管理细节评分、管理效果评分高于参照组,差异有统计学意义(P<0.05);研究组医患沟通评分、技术水平评分、尊重患者评分、细节处理评分高于参照组,差异有统计学意义(P<0.05)。结论对于妇产科医生而言,合理采用强化医患沟通能力培养方法进行干预,可对医生尊重患者的态度给予端正,将其认可度显著提高,显著提高管理满意度以及管理质量。

北京市妇产科医务人员职业暴露防护情况调查

目的 了解北京地区妇产科医务人员职业暴露的现状及其防护管理情况,为制定相关管理规范提供依据.方法 采用自行设计的调查问卷,对120个提供计划生育技术服务医疗机构的300名妇产科医务人员进行了调查,收集数据进行分析.结果 北京市部分妇产科人员职业暴露的发生率为63.7%,暴露途径以经皮暴露为主占78.0,暴露时机以手术及手术配合时最多,发生职业暴露时帽子口罩使用率分别为58.5%和35.1%,防渗透隔离衣/围裙、护目镜和靴子的使用率很低,分别为16.0%、8.5%和4.8%.医院级别为二、三级的妇产科医务人员职业暴露发生率高于一级医院,经比较差异有统计学意义（χ^2=22.707,P〈0.01）.中高级以上职称及文化程度高的妇产科医生职业暴露发生率较高,属高危人群（χ^2分别为15.871、26.483,均P〈0.01）.结论 北京市妇产科医务人员职业暴露防护现状不容乐观,需完善相关制度,加强培训、管理及督导.

某院妇幼医师依法执业知识知晓率调查

目的 调查某三甲医院妇幼医师依法执业知识知晓情况,为有效开展培训提供依据.方法 对该院已获得执业医师资格证书并注册执业的164名妇产科与儿科医师进行依法执业知识调查.结果 依法执业知识平均得分为(23.13±2.24)分,总平均知晓率为82.62%.其中,医疗技术、病历书写规范、处方管理、会诊相关知识平均知晓率最高,为84.93%;医师执业基础知识平均知晓率为81.12%;计划生育与母婴保健依法执业知识平均知晓率最低,为80.77%.妇产科与儿科医师之间得分差异无统计学意义(P>0.05),不同年龄、不同职称之间得分差异具有统计学意义(P<0.01).结论 医院可通过设立“依法执业专员”搭建管理部门与临床科室间的沟通桥梁;通过关口前移、畅通咨询途径,为临床一线医师提供多种形式的依法执业知识培训和查询途径;营造医院依法执业文化氛围,进一步提升培训效果.

基层妇产科对宫颈癌知识认知现状和干预分析

目的了解江苏省基层医院妇产科医生对宫颈癌及人乳头瘤病毒相关知识的认知现状，为基层医院应对宫颈癌的防治及培训工作提供参考。方法采用自行设计的调查问卷对基层妇产科医生进行宫颈癌及人乳头瘤病毒相关知识的调查，采取相应的培训措施进行干预，并评估干预效果。结果干预后，调查对象对宫颈癌相关知识的知晓率显著上升，宫颈癌发病高危因素知晓率从66．3％上升到97．1％（Х^2=54．60，P〈0．01），宫颈病变诊断遵循程序的知晓率从83．7％上升到100．0％（r=30．50，P〈0．01），高危型人乳头瘤病毒感染的知晓率从59．9％上升到97．7％（Х^2=73．50，P〈0．01）。结论针对基层妇产科医生进行宫颈癌及人乳头瘤病毒相关知识的培训能够提高其认知水平，达到预期效果，对基层地区宫颈癌的防治工作具有重要意义。

妇科医师对更年期患者的接诊情况及诊疗行为调查

目的了解不同医疗机构、不同年资妇科医师接诊更年期患者的数量、把握度及诊疗行为,为建立更年期患者的分级诊疗及实现规范性诊疗提供参考。方法对104家医疗机构的131位妇科医师进行问卷调查,内容包括职称、更年期疾病患者接诊数量、更年期疾病治疗手段及治疗把握度等。结果 14位医师每周接诊更年期患者>15例,14位医师每周接诊更年期患者11~15例,其余接诊更年期患者≤10例/周。更年期疾病患者就诊主要选二级、三级医院,由副主任医师及主任医师接诊患者量较多。被调查妇科医师治疗更年期疾病总体把握度中位数为6分(满分为10分)。74.8%医师选择性激素治疗绝经相关症状,67.9%医师选择植物药治疗绝经相关症状,77.1%医师选择调整患者生活方式(包括饮食、运动)来治疗绝经相关症状。结论更年期疾病的分级诊疗并未良好实施。各级妇科医师对于更年期疾病治疗的规范性存在提升空间,有必要在医师群体中开展更年期疾病规范化诊疗的培训,造福更多患者。

安徽省县级妇产科业务骨干对普遍性防护原则的知-信-行调查

目的 了解县级妇产科业务骨干对普遍性防护原则的知识、态度和行为以及职业暴露和防护情况。方法 采用半结构式问卷方法 ,对参加安徽省降低孕产妇死亡专题县级师资培训班的学员进行自填式问卷调查。结果 有 1 5 %的人听说过普遍性防护原则 ,有 2 5 4%的人能正确地写出普遍性防护原则的内容 ;没有人能正确回答出污染针头刺伤传播艾滋病病毒的概率 ,3 3 6%的人知道针头刺伤传播乙型肝炎病毒的概率 ;1 68%的人在工作中遇到过感染了艾滋病病毒的患者 ,96 61 %人在工作中遇到过感染了乙型肝炎的患者 ;妇检、产检和全身检查时戴手套的频率分别是 95 76%、 1 1 0 2 %和 6 78% ,妇检比其他两类检查高 (P <0 0 1 ) ;妇检、产检和全身检查前后洗手的频率分别是 84 75 %、 77 3 9%和 73 0 4% ,妇检洗手率比其他两类检查高 (均P <0 0 5 ) ;其中妇检同全身检查的洗手率比较 (P <0 0 5 ) ,产检同全身检查的洗手率比较没有显著性差异。结论 安徽省县级妇产科工作人员对普遍性防护原则的了解程度有限、对职业暴露的危险性认识不足、存在明显的职业暴露现象 ,且县级医院和妇幼保健机构在妇产科职业防护方面措施不到位。

女妇产科医生295例对避孕及HRT的认知和态度

目的了解女妇产科医生对避孕方式的选择及性激素补充治疗(hormone replacement therapy,HRT)的认知。方法对参加2013年3月河北省妇科内分泌学习班的女妇产科医生,以问卷形式调查其自身对避孕方式的选择及口服避孕药、HRT的认知情况。结果 1共回收有效问卷295例(98.3%),平均年龄(37.6±9.6)岁,其中75.8%(222例)已生育。247.8%(141例)曾因意外妊娠而行人工流产,其中64.7%表示未采取任何避孕措施。3目前采取避孕措施的人群中52.6%选择宫内节育器,20.5%安全套+安全期,3.8%口服避孕药,1.3%曼月乐。4关于口服避孕药:76.8%认为可以治疗痛经和经前期紧张综合征,62.9%认为可改善皮脂分泌、治疗多囊卵巢综合征、减少月经量,而高达72.8%错误认为长期服用会导致闭经和卵巢早衰,52.6%表示低剂量口服避孕药需停药3-6个月后再妊娠。5认为HRT可以缓解和治疗更年期综合征症状,预防和治疗骨质疏松分别为93.9%,87.1%,高达60.9%的医生认为HRT增加乳腺癌风险。结论 1女妇产科医生中因意外妊娠而行人工流产的比率高。2女妇产科医生口服避孕药使用率低,且对口服避孕药的副作用存在误区。3女妇产科医生对HRT适应证认同性高,但对HRT的副作用过度担心。

基于关联规则的当代中医妇科名家治疗闭经用药规律的数据挖掘

目的:探讨当代中医妇科名家治疗闭经的用药规律。方法:收集当代中医妇科名家治疗闭经的医案,运用apriori算法进行数据挖掘,找出药物之间的关联规则,挖掘治疗闭经的核心药物组合以及新处方。结果:本研究共筛选出15位医家共235诊闭经医案,涉及250味中药。治疗闭经最常用的药物分别为牛膝、熟地黄、川芎、当归及白芍。最常用二联药物分别为赤芍-当归、鸡血藤-当归、白芍-当归、川芎-当归及熟地黄-当归;最常用三联药物分别为川芎-牛膝-当归、白芍-熟地黄-当归、川芎-熟地黄-当归、白芍-川芎-当归及白芍-牛膝-当归。最常用四联药物为白芍-川芎-熟地黄-当归及白芍-川芎-牛膝-当归。结论:当代妇科名家治疗闭经喜用养血活血药物,牛膝、熟地黄、川芎、当归及白芍则为核心药味。

Contribution of MRI in Extension Assessment of Cervical Cancer in Yaoundé(Cameroon)

Background: Cervical cancer is one of the most common cancers, requiring a precise complementary assessment. The aim of this study was to contribute to the improvement of the management of cervical cancer by describing the MRI aspects of cervical cancer according to the IFOG-MRI classification. Material and Methods: This was a cross-sectional study, conducted in patients who came for clinical suspicion, extension assessment of histologically confirmed cervical cancer, from October 2020 to March 2021, in Yaoundé (Cameroon). Results: 54 patients were selected, with an average age of 50.4 years. Genital hemorrhage was the most frequent symptom (92%). The mean tumor size was 52.9 mm. According to IFOG staging, stages Ia, Ib, IIa, IIb, IIIa, IIIb, and IV accounted for 9.10%, 10.20%, 12.50%, 29.50%, 5.70%, 12.50%, and 20% respectively. No patient had known metastasis at the time of examination. Conclusion: MRI allows non-invasive, satisfactory tumor staging examination by providing information on tumor size, parametrium invasion, adjacent organ involvement, and the presence of lymph node metastasis.

Medicalization of Abortion in Poland: How Medicine Affects the Lives of Women

The process of medicalization of abortion in Poland began when pregnancy termination procedures were legalized in 1956.The context in which that was possible is important:it happened under the communist rule as part of the Soviet bloc.The main goal of communism was to promote scientific approach to medicine and to eliminate popular folk medicine.The communist rule was also characterized by state feminism,which involved mass employment of women in industry and other occupations.The positive side to the changes was the fact that health care was free of charge.However,the system excluded the care of village healers and abortionists who were replaced by obstetricians-gynecologists,usually men.According to the official propaganda,an abortion that was not performed by a medical professional was dangerous for a woman’s health and could cause her death.Indeed,abortion-related mortality decreased,but the rate of abortion itself did not fall;it gradually increased.This is typical for countries with no free market,including communist ones,where access to contraceptive pills is very limited with abortion being the primary method of birth control.After the fall of communism in Poland,access to abortion was severely restricted;nevertheless,contraceptive pills and morning-after pills are available on prescription from pharmacies.The total fertility rate decreased in comparison to the period of communism and its broad access to abortion.Therefore,I maintain that the process of medicalization of abortion has not ended despite the partial disenfranchisement of women.

近代燕京妇科名家诊治不孕症的经验浅析

燕京中医流派源远流长,是著名的中医流派之一,其妇科名家在中医妇科诊疗方面具有较高的学术造诣及独到的学术见解。不孕症是影响人类生殖健康最主要的疾病,困扰众多渴求生育的妇女。通过收集燕京妇科名家治疗不孕症的理论资料及临床验案,浅析燕京妇科名家治疗不孕症的临床经验及用药特色,以飱同道。

妇科医师诊治妇科内分泌疾病的岗位胜任力调查

目的了解我国妇科医师对妇科内分泌相关疾病的诊治水平及岗位胜任力现状,为培养妇科内分泌专业医师及妇科内分泌相关疾病的规范化诊疗提供科学依据。方法于2013年1月至2017年7月,对来自94家医疗单位的115位妇科医师进行了问卷调查,内容涉及妇科内分泌相关疾病的诊断与治疗、中国临床医师岗位胜任力调查。结果妇科医师掌握妇科内分泌相关疾病知识的合格率为55.65%,其中性激素化验单解读(44.35%)、异常子宫出血的治疗-排卵功能障碍(22.09%)、异常子宫出血的治疗-内膜病变(17.39%)、黄体功能不全的治疗(23.48%)掌握较差,知晓率低,8类岗位胜任力自评分中的医学职业精神与素质(3.85±0.68)、团队合作能力(3.98±0.73)评分较高,信息与管理能力(3.31±0.68)、学术研究能力(3.13±0.67)得分较低。结论妇科医师对妇科内分泌相关疾病的诊疗掌握程度并不乐观,应该建立以胜任力为导向的妇科内分泌医生培训体系,提高妇科医师对妇科内分泌相关疾病的诊疗水平,规范治疗。

姚克敏对经断前后诸证的辨证思路及治疗

经断前后诸证常规多从肾论治。云南妇科名中医姚克敏则认为本病发病机理是源于脾，发于肝，根于肾。治疗从肝脾肾的调治入手，融健脾、疏肝、益肾于一炉，以濡养、调和为主。常采用滋阴养血，平肝清热法；疏肝解郁，养血健脾法；补血益气，养心安神法；育阴生津，宁心安神法及健脾益肾，温补气血法等，临床多获良效。

妇产科医师人文执业能力培养的思考

对医师人文执业能力的内涵进行分析,通过深入访谈了解当前妇产科医师人文执业能力现状,并据此提出培养妇产科医师人文执业能力的对策,主要包括夯实妇产科医师医学人文知识基础、开展妇产科医师人文技能培训、在医德医风工作中融入妇产科医师人文执业能力评价和将新医学人文观融入医院文化建设中。