journal

Clinical Obstetrics and Gynecology

journal
https://read.qxmd.com/read/31634158/to-robot-or-not-to-robot-the-use-of-robotics-in-benign-gynecologic-surgery
#1
Courtney S Lim, Kendall C Griffith, Jennifer Travieso, Sawsan As-Sanie
The use of robotic-assisted laparoscopic surgery has continued to grow since the Food and Drug Administration approval for robotic-assisted gynecologic surgery in 2005. However, despite this growth in utilization, the data supporting its use in benign gynecologic surgery has not strongly supported its advantages over conventional laparoscopy. Controversy exists between supporters of robotic-assisted laparoscopic surgery and conventional laparoscopy. This article discusses the current literature regarding the use of robotic-assisted surgery in benign gynecologic surgery...
October 18, 2019: Clinical Obstetrics and Gynecology
https://read.qxmd.com/read/31524660/updates-in-the-approach-to-chronic-pelvic-pain-what-the-treating-gynecologist-should-know
#2
Erin T Carey, Kristin Moore
Chronic pelvic is a multifaceted condition that often has both peripheral and central generators of pain. Despite its high prevalence, the evaluation and management of a pelvic pain patient often present many challenges to the practicing gynecologist. As with many other chronic pain conditions, pain severity does not always correlate with pelvic pathology and standard medical and surgical therapies are not always effective. An understanding of neurobiology and neuropsychology of chronic pelvic pain along with clinical pearls in the history and physical examination should guide management...
September 12, 2019: Clinical Obstetrics and Gynecology
https://read.qxmd.com/read/31524659/updates-and-controversies-of-robotic-assisted-surgery-in-gynecologic-surgery
#3
Aaron Varghese, Marisol Doglioli, Amanda N Fader
minimally invasive surgery (MIS) is the standard approach to performance of several gynecologic procedures, including hysterectomy, gynecologic cancer staging procedures, myomectomy, pelvic organ prolapse repair, and select adnexal procedures. Robotic-assisted surgery, a computer-based MIS approach, has been adopted widely in the United States and several other countries. Robotics may offer technological and ergonomic benefits that overcome limitations associated with conventional laparoscopy; however, it is not clear that reported claims of superiority translate into improved gynecologic patient outcomes compared with other MIS approaches...
September 12, 2019: Clinical Obstetrics and Gynecology
https://read.qxmd.com/read/31524658/foreword
#4
Barbara Levy
No abstract text is available yet for this article.
September 12, 2019: Clinical Obstetrics and Gynecology
https://read.qxmd.com/read/31498239/morcellation-for-gynecologic-surgery
#5
William Parker, Eliazabeth Pritts, David Olive
Morcellation is necessary for many women with fibroids who choose to undergo laparoscopic myomectomy or hysterectomy. After open and laparoscopic myomectomy, myometrial cells can be detected in the abdomen and pelvis. After morcellation, careful inspection for and removal of tissue fragments and copious irrigation and suctioning of fluid can remove residual tissue with or without the use of containment bags. Leiomyosarcoma has a poor prognosis because of early hematogenous metastasis and has a high propensity for recurrence despite the performance of total abdominal hysterectomy...
September 6, 2019: Clinical Obstetrics and Gynecology
https://read.qxmd.com/read/31490222/urinary-incontinence-evaluation-and-management
#6
Stephanie J Handler, Amy E Rosenman
Urinary incontinence is a major public health issue in the United States with physical, mental, social, and economic repercussions. History and in-office evaluation are paramount to diagnosis and formation of an appropriate treatment plan. Lifestyle modifications, which include pelvic floor muscle training and behavioral changes, are appropriate for initial management. Patients with overactive bladder syndrome whose symptoms are not adequately controlled with conservative treatment can be offered medical or procedural management...
September 4, 2019: Clinical Obstetrics and Gynecology
https://read.qxmd.com/read/31433311/prevention-of-obstetrical-infections
#7
Patrick Duff
No abstract text is available yet for this article.
August 19, 2019: Clinical Obstetrics and Gynecology
https://read.qxmd.com/read/31658098/antibiotics-for-the-treatment-of-staphylococcal-infections-in-the-obstetric-patient
#8
Tory A Finley, Patrick Duff
This review addresses current epidemiology and treatment of obstetric staphylococcal infections. It also examines current prophylaxis methods and the efficacy of universal screening.
December 2019: Clinical Obstetrics and Gynecology
https://read.qxmd.com/read/31644486/foreword-new-antibiotics-and-antibiotic-prophylaxis-in-obstetrics
#9
Patrick Duff
No abstract text is available yet for this article.
December 2019: Clinical Obstetrics and Gynecology
https://read.qxmd.com/read/31644485/contributors-new-antibiotics-and-antibiotic-prophylaxis-in-obstetrics
#10
(no author information available yet)
No abstract text is available yet for this article.
December 2019: Clinical Obstetrics and Gynecology
https://read.qxmd.com/read/31644484/foreword-clinical-dilemmas-and-unresolved-issues-in-gynecology
#11
Barbara Levy
No abstract text is available yet for this article.
December 2019: Clinical Obstetrics and Gynecology
https://read.qxmd.com/read/31644483/contributors-clinical-dilemmas-and-unresolved-issues-in-gynecology
#12
(no author information available yet)
No abstract text is available yet for this article.
December 2019: Clinical Obstetrics and Gynecology
https://read.qxmd.com/read/31503029/management-of-menopause-and-the-role-for-hormone-therapy
#13
Joann V Pinkerton, Edward A Conner, Andrew M Kaunitz
Hormone therapy remains the most effective treatment for menopausal symptoms but decisions are complex, requiring an assessment of benefits and risks and determination of best treatment type, dose, and duration. Benefits exceed risks for most women with bothersome menopausal symptoms or high risk for fracture if initiated under age 60 years or within 10 years since menopause. Long-term mortality and safety data from the Women's Health Initiative is reassuring, with no increase in deaths from cardiovascular disease or cancer compared with placebo after 18 years of follow-up and a trend towards less mortality in those who initiate hormone therapy ages 50 to 59 years...
December 2019: Clinical Obstetrics and Gynecology
https://read.qxmd.com/read/31433312/prevention-of-opportunistic-infections-in-women-with-hiv-infection
#14
Patrick Duff
Opportunistic infections are those that are either more frequent or more severe as a result of the patient's immunosuppressed condition. Opportunistic infections are, of course, the distinguishing feature of HIV infection, and they can be the cause of serious morbidity and even mortality. Some opportunistic infections can be prevented by vaccination, for example, pneumococcal infection, meningococcal infection, influenza, hepatitis A and B, and varicella. Other major opportunistic infections require prophylactic antibiotics or antiviral medications...
December 2019: Clinical Obstetrics and Gynecology
https://read.qxmd.com/read/31335347/lymphadenectomy-in-the-management-of-gynecologic-cancer
#15
Jamie N Bakkum-Gamez
Among nearly all gynecologic cancers, knowing whether the cancer has metastasized to lymph nodes impacts the ultimate management of the cancer. Lymph node status assists in cancer staging, prognostication, guidance of surgical intervention and adjuvant therapy, and removal of positive lymph nodes may be therapeutic in some cancers. Surgical staging through lymph node removal and pathologist assessment is standard of care for most gynecologic cancers. This section reviews the anatomic lymphatic drainage patterns of each gynecologic organ and the evolution and current practice of surgical lymph node assessment along the spectrum of gynecologic cancers...
December 2019: Clinical Obstetrics and Gynecology
https://read.qxmd.com/read/31305485/clinical-controversies-in-cervical-cancer-screening
#16
Ama Bus-Kwofie, Catherine Chan, Ryan Kahn, Kevin Holcomb
Through the implementation of systematic cervical cancer screening in the mid-20th century, the United States and other developed countries have seen death rates from cervical cancer decreased by ≥70%.The purpose of this article is to address several of the most controversial issues associated with cervical cancer screening recommendations in light of historical and evolving data. In this article, we will explore the controversies around the age at which to initiate and exit screening, human papilloma virus testing alone as a primary screening approach, and the impact of human papilloma virus vaccination on cervical cancer rates...
December 2019: Clinical Obstetrics and Gynecology
https://read.qxmd.com/read/31259841/breast-cancer-and-the-obstetrician-gynecologist-a-focus-on-screening-risk-assessment-and-treatment-of-survivors-with-genitourinary-syndrome-of-menopause
#17
Bharti Jasra, Laila Samiian, Andrew M Kaunitz
Because of conflicting guidelines, providing appropriate breast cancer screening recommendations to our patients has become challenging. Given the high prevalence of genitourinary syndrome of menopause (GSM) overall, and among breast cancer survivors, and the understandable reluctance of physicians to prescribe effective hormonal treatments to survivors with this condition, addressing the needs of breast cancer survivors with bothersome GSM is both a common and controversial issue. In this review, we detail current breast cancer screening recommendations, breast cancer risk assessment, and management of GSM in breast cancer survivors...
December 2019: Clinical Obstetrics and Gynecology
https://read.qxmd.com/read/31233423/enhanced-recovery-after-surgery-and-acute-postoperative-pain-management
#18
Eleftheria Kalogera, Sean C Dowdy
Enhanced recovery pathways were first developed in colorectal surgery and have since been adapted to other surgical subspecialties including gynecologic surgery. Mounting evidence has shown that the adoption of a standardized perioperative pathway based on evidence-based literature reduces length of hospital stay, reduces cost, reduces opioid requirements with stable to improved pain scores, and accelerates return to normal function as measured by validated patient reported outcomes measurements. The many elements of enhanced recovery may be distilled into 3 concepts: (1) optimizing nutrition before and after surgery, recognizing that nutritional status directly impacts healing; (2) opioid-sparing analgesia, considering the current American prescription opioid crisis and the importance of pain control to regaining functional recovery; and (3) maintenance of euvolemia before, during, and after surgery...
December 2019: Clinical Obstetrics and Gynecology
https://read.qxmd.com/read/31344004/organizational-strategies-to-create-a-burnout-resistant-environment
#19
Philip F Binkley, Edward Levine
Burnout afflicts a significant number of academic faculty and clinicians. There are many efforts the individual can undertake to prevent or lessen burnout. However, it not likely these will be successful without the institutional environment that promotes and atmosphere that assures self-efficacy, a sense of value and meaning and clear communication between leaders and members of the organization. This review discusses the factors that organizations and their leaders can leverage to create such an environment...
September 2019: Clinical Obstetrics and Gynecology
https://read.qxmd.com/read/31344003/moving-from-physician-burnout-to-resilience
#20
Wayne M Sotile, Rebecca S Fallon, Gary R Simonds
We contend that work ambivalence is a key building block in fostering physician burnout and its sequalae, while engagement in meaningful work and receiving family support for that work enhances resilience. No singular approach to curbing burnout in OBGYN physicians has received empirical support. Clinical experience suggests that curbing physician burnout requires a combination of workplace redesigns, positive leadership behaviors, and resilience training that teaches practical applications from the fields of resilience, emotional intelligence, positive psychology, and relationship systems...
September 2019: Clinical Obstetrics and Gynecology
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