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Clinical evaluation of patients treated with open gynecologic laparoscopy versus conventional laparoscopic surgery
Three patients with documented noncompliance were exeluded from analysis. Results: Nineteen of the 21 patients treated with nonoxynol-9 were available for follow-up (six by phone interview); 11 of 13 patients (84.6%) examined had a positive wet prep. Nineteen of the 22 patients treated with metronidazole were available for follow-up (four by phone interview); only one of 15 patients (6.7%) examined had a positive wet prep. All nonoxynol-9 failures evaluated after treatment with 2 g of metronidazole had a negative wet prep. Therapy with nonoxynol-9 suppositories resulted in a 15.4% cure rate compared to a 93.3% cure rate with a single dose of oral metronidazole (P = 0.007). Conclusion: This study suggests that intravaginal nonoxynol-9 at this dose is not an effective cure for vaginal trichomoniasis.
A COMPREHENSIVE ENDOSCOPIC CREDENTIALLING PROGRAM Magdy P. Milad, MD, and Susan Larsh, MD Northwestern University Medical School,Chicago,IL
Objectives: The purpose of this study is to describe a comprehensive gynecologic endoscopic credentialling program at an urban teaching hospital and to evaluate its effect on complication rates before and after the credentialling process. Methods: In 1996, a gynecologic endoscopy credentialling program was instituted. Initially, experienced surgeons were invited to apply for advanced privileges based on case lists. Afterwards, new applications were credentialled by proctorship. Since 1995, charts have been reviewed by the quality management committee using the following indicators: operating time greater than 4 hours, estimated blood loss greater than 500 mL, any visceral injury, hospitalization greater than 24 hours, readmission within 15 days, unrecognized diagnosis of cancer, reexploration, admission for hysteroscopic fluid overload, and conversion to laparotomy. The cases were separated into three 12-month periods representing time before, during, and after the establishment of the credentialling program. Results: Of the 3,891 gynecologic endoscopic procedures that were performed during the review period, 2,702 medical records were reviewed. One or more of the nine indicators were identified in lo-15% of cases per year. The incidence of visceral injury remained low (l-2%). Conclusions: The establishment of a comprehensive gynecologic endoscopic credentialling program does not reduce an already low complication rate but does ensure delivery of standardized, quality care by competent surgeons.
VOL.
93, NO.
4 (SUPPLEMENT),
APRIL
1999
CLINICAL EVALUATION OF PATIENTS TREATED WITH OPEN GYNECOLOGIC LAPAROSCOPY VERSUS CONVENTIONAL LAPAROSCOPIC SURGERY JestisBarr&z-Vallejo, MD, Luz Elena Aburto-Mdrquez, MD, Rafael Pereyra-Quiiiones, MD, and Albert0 Kably-Ambe, MD The American British Cowdray Hospital, Mt%ico, Mexico
Objective: The purpose was to compare the clinical evolution and rates of complications for open and conventional gynecologic laparoscopy. Methods: We studied the cases of 253 patients divided in two groups: group 1 (n = 106) patients treated with open laparoscopy, and group 2 (n = 147) patients managed with conventional surgery. The major indication for performing laparoscopy was infertility management. Results: There were no early or late complications of trocar insertion or operative laparoscopy in group 1. However, there were four complications in group 2 (P <0.05), two related to needle or trocar insertion. Concllrsion: In the studied group, open laparoscopy can eliminate the risks of blind insufflation and trocar insertion observed in the classical technique; it is a safe and efficacious method to treat several gynecologic pathologies.
PERCEPTIONS REGARDING ORAL CONTRACEPTIVE USE IN HISPANIC ADOLESCENTS JosefinaRomaguera,MD, MPH,” Susan L. Rosenthal, PhD, Margaret M. Polaneczky, MD, Paula Hillard, MD, and Margaret E. Weber,MD *University of Puerto Rico Medical School,Rio Piedras, PR
Oral contraceptives (OCS) are an important option for sexually active adolescents. Hispanic (H) women are less likely to use 00 than non-Hispanic (NH) women. From 1988 to 1995, the proportion of H women using OCs dropped from 33% to 23%. Misperceptions of CK side effects (SEs) may influence contraceptive choice and compliance for many females. Objectives: To investigate H adolescent girls’ (ages 14-19) attitudes and expectations of OC use, as well as SEs, compared with NH girls. Introduction:
Tuesday Posters 59s
A COMPREHENSIVE ENDOSCOPIC CREDENTIALLING PROGRAM Magdy P. Milad, MD, and Susan Larsh, MD Northwestern University Medical School,Chicago,IL
Objectives: The purpose of this study is to describe a comprehensive gynecologic endoscopic credentialling program at an urban teaching hospital and to evaluate its effect on complication rates before and after the credentialling process. Methods: In 1996, a gynecologic endoscopy credentialling program was instituted. Initially, experienced surgeons were invited to apply for advanced privileges based on case lists. Afterwards, new applications were credentialled by proctorship. Since 1995, charts have been reviewed by the quality management committee using the following indicators: operating time greater than 4 hours, estimated blood loss greater than 500 mL, any visceral injury, hospitalization greater than 24 hours, readmission within 15 days, unrecognized diagnosis of cancer, reexploration, admission for hysteroscopic fluid overload, and conversion to laparotomy. The cases were separated into three 12-month periods representing time before, during, and after the establishment of the credentialling program. Results: Of the 3,891 gynecologic endoscopic procedures that were performed during the review period, 2,702 medical records were reviewed. One or more of the nine indicators were identified in lo-15% of cases per year. The incidence of visceral injury remained low (l-2%). Conclusions: The establishment of a comprehensive gynecologic endoscopic credentialling program does not reduce an already low complication rate but does ensure delivery of standardized, quality care by competent surgeons.
VOL.
93, NO.
4 (SUPPLEMENT),
APRIL
1999
CLINICAL EVALUATION OF PATIENTS TREATED WITH OPEN GYNECOLOGIC LAPAROSCOPY VERSUS CONVENTIONAL LAPAROSCOPIC SURGERY JestisBarr&z-Vallejo, MD, Luz Elena Aburto-Mdrquez, MD, Rafael Pereyra-Quiiiones, MD, and Albert0 Kably-Ambe, MD The American British Cowdray Hospital, Mt%ico, Mexico
Objective: The purpose was to compare the clinical evolution and rates of complications for open and conventional gynecologic laparoscopy. Methods: We studied the cases of 253 patients divided in two groups: group 1 (n = 106) patients treated with open laparoscopy, and group 2 (n = 147) patients managed with conventional surgery. The major indication for performing laparoscopy was infertility management. Results: There were no early or late complications of trocar insertion or operative laparoscopy in group 1. However, there were four complications in group 2 (P <0.05), two related to needle or trocar insertion. Concllrsion: In the studied group, open laparoscopy can eliminate the risks of blind insufflation and trocar insertion observed in the classical technique; it is a safe and efficacious method to treat several gynecologic pathologies.
PERCEPTIONS REGARDING ORAL CONTRACEPTIVE USE IN HISPANIC ADOLESCENTS JosefinaRomaguera,MD, MPH,” Susan L. Rosenthal, PhD, Margaret M. Polaneczky, MD, Paula Hillard, MD, and Margaret E. Weber,MD *University of Puerto Rico Medical School,Rio Piedras, PR
Oral contraceptives (OCS) are an important option for sexually active adolescents. Hispanic (H) women are less likely to use 00 than non-Hispanic (NH) women. From 1988 to 1995, the proportion of H women using OCs dropped from 33% to 23%. Misperceptions of CK side effects (SEs) may influence contraceptive choice and compliance for many females. Objectives: To investigate H adolescent girls’ (ages 14-19) attitudes and expectations of OC use, as well as SEs, compared with NH girls. Introduction:
Tuesday Posters 59s