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Why do we need psychosomatic care for menopausal patients?
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Abstracts / European Journal of Obstetrics & Gynecology and Reproductive Biology 206 (2016) 251–263
Methods: Review of impact of gynaecological surgery on female sexual function and demonstration of a model of sexological care after gynaecological surgery. Results: Surgical Treatment of benign and premalignant disorders refers to treatment of uterine fibromas, ovarian cysts, endometriosis and cervical and vaginal dysplasia as well as uterine prolaps and incontinence. Gynaeco-Oncological Surgery includes treatment of Vulvar, Vaginal, Cervical, Endometrial and Ovarian Cancer. Lege artis surgery of benign conditions does not result in physical consequences having a major impact on sexual function. There may however be a negative impact on body image and gender identity. The most negative longterm physical impact on sexual function after oncological surgical treatment is reported after vulvar surgery. Combined treatment regimens (radiotherapy and chemotherapy with and without surgery) have however a very important impact on sexual function. Conclusion: Patients should be asked about their sexual health after gyne surgery and a competent sexological diagnosis and treatment plan should be provided in good clinical practice. http://dx.doi.org/10.1016/j.ejogrb.2016.07.007 Communication skills in the context of medical error Johannes Bitzer University Hospital Basel, Switzerland Introduction: Medical error is a clinical reality which is frequently denied or ignored or overlooked. The reasons for this are various: It is considered to undermine trust of patients, it is burden on the patient-doctor relationship, it make doctor’s feel bad, it can ruin reputation, stop the career and last but not least lead to legal consequences. On the other hand we all know that medical error should be disclosed for ethical reasons: honesty, justice, patients want it, institutions want it and last but not least it seems to reduce liability cases and legal consequences. Methods: Analysis of the literature, extract of studies and clinical case discussions. Results: The criteria for error are negligence, confounding, wrong approach decision. The criteria for complication are unplanned negative outcome of an intervention for the patient. Only 30% of patients experiencing a medical error received full disclosure. 27% of patients who felt that they had suffered a damage got some apologies from the treatin physicians. 82% were satisfied with the completeness of information. 63% found that information giving was not empathic and cold. 44% reported that they did not have the opportunity to ask questions. 21% of practising and 24% of physicians in training have fully disclosed and error to patients of family members, 76% of doctors have not fully disclosed errors. Based on these studies a model for communicating medical errors will be presented. Conclusion: Communicating medical error should be part of specialist training. http://dx.doi.org/10.1016/j.ejogrb.2016.07.008
Why do we need psychosomatic care for menopausal patients? Johannes Bitzer University Hospital Basel, Switzerland Introduction: Postmenopausal women suffer from various and multidimensional problems. Physical symptoms, mental symptoms, psychosocial problems and stressors. These complaints have a multifactorial origin ranging from genetics, to hormonal changes, aging processes, psychosocial transitions and they are codetermined by behavioral patterns and sociocultural norms. Therefore these women need a biopsychosocial comprehensive concept of care. Methods: Case discussions in group supervision of physicians interested in menopausal medicine. Collaborative proposal for a comprehensive standard of care for menopausal women. Results: The menopausal consultation should be structured and contain the following elements: Eliciting the agenda of the patient (her symptoms, her needs and priorities). Assessing the biopsychosocial profile (risks and resources). Elaborating a shared understanding of the complaints and the health problems by eliciting the patient’s health beliefs and providing evidence based information and education. Inform and educate patients about all available treatment options including patient adapted risk counselling. Making a shared decision regarding solution to problems and treatment. Conclusions: Good clinical practice in the care of menopausal women needs a biopsychosocial perspective, up to date evidence based knowledge about screening, diagnostic procedures and therapeutic options and specialized communication skills including patient centred communication, risk counselling and shared decision making. http://dx.doi.org/10.1016/j.ejogrb.2016.07.009 Hormonal contraception in obese women Johannes Bitzer University Hospital Basel, Switzerland Introduction: Taking into account the high prevalence of obesity in many European Countries the Expert Group on Hormonal Contraception of the ESC has taken the task to answer two basic questions a) What it the efficacy of the available hormonal contraceptive methods in obese women? b) What are the risks in obese women? Methods: Review of the literature; expert opinion. Results: a) The majority of qualified observational and prospective studies do not indicate a decreased efficiency of COC in obese women. Data are limited for users of obesity class II and III. The transdermal patch (EVRA® ) is less efficient in women with body weight < 90 kg. No data are available on the efficiency of the contraceptive vaginal ring (Nuvaring® ) in obese women. Desogestrel: At present no data indicate a decreased efficiency of Desogestrel 75 mcg in obese women. Implanon: As etonogestrel plasma levels decrease over time, a premature exchange of the implant after 24 months instead of 36 months could be considered.
Abstracts / European Journal of Obstetrics & Gynecology and Reproductive Biology 206 (2016) 251–263
Methods: Review of impact of gynaecological surgery on female sexual function and demonstration of a model of sexological care after gynaecological surgery. Results: Surgical Treatment of benign and premalignant disorders refers to treatment of uterine fibromas, ovarian cysts, endometriosis and cervical and vaginal dysplasia as well as uterine prolaps and incontinence. Gynaeco-Oncological Surgery includes treatment of Vulvar, Vaginal, Cervical, Endometrial and Ovarian Cancer. Lege artis surgery of benign conditions does not result in physical consequences having a major impact on sexual function. There may however be a negative impact on body image and gender identity. The most negative longterm physical impact on sexual function after oncological surgical treatment is reported after vulvar surgery. Combined treatment regimens (radiotherapy and chemotherapy with and without surgery) have however a very important impact on sexual function. Conclusion: Patients should be asked about their sexual health after gyne surgery and a competent sexological diagnosis and treatment plan should be provided in good clinical practice. http://dx.doi.org/10.1016/j.ejogrb.2016.07.007 Communication skills in the context of medical error Johannes Bitzer University Hospital Basel, Switzerland Introduction: Medical error is a clinical reality which is frequently denied or ignored or overlooked. The reasons for this are various: It is considered to undermine trust of patients, it is burden on the patient-doctor relationship, it make doctor’s feel bad, it can ruin reputation, stop the career and last but not least lead to legal consequences. On the other hand we all know that medical error should be disclosed for ethical reasons: honesty, justice, patients want it, institutions want it and last but not least it seems to reduce liability cases and legal consequences. Methods: Analysis of the literature, extract of studies and clinical case discussions. Results: The criteria for error are negligence, confounding, wrong approach decision. The criteria for complication are unplanned negative outcome of an intervention for the patient. Only 30% of patients experiencing a medical error received full disclosure. 27% of patients who felt that they had suffered a damage got some apologies from the treatin physicians. 82% were satisfied with the completeness of information. 63% found that information giving was not empathic and cold. 44% reported that they did not have the opportunity to ask questions. 21% of practising and 24% of physicians in training have fully disclosed and error to patients of family members, 76% of doctors have not fully disclosed errors. Based on these studies a model for communicating medical errors will be presented. Conclusion: Communicating medical error should be part of specialist training. http://dx.doi.org/10.1016/j.ejogrb.2016.07.008
Why do we need psychosomatic care for menopausal patients? Johannes Bitzer University Hospital Basel, Switzerland Introduction: Postmenopausal women suffer from various and multidimensional problems. Physical symptoms, mental symptoms, psychosocial problems and stressors. These complaints have a multifactorial origin ranging from genetics, to hormonal changes, aging processes, psychosocial transitions and they are codetermined by behavioral patterns and sociocultural norms. Therefore these women need a biopsychosocial comprehensive concept of care. Methods: Case discussions in group supervision of physicians interested in menopausal medicine. Collaborative proposal for a comprehensive standard of care for menopausal women. Results: The menopausal consultation should be structured and contain the following elements: Eliciting the agenda of the patient (her symptoms, her needs and priorities). Assessing the biopsychosocial profile (risks and resources). Elaborating a shared understanding of the complaints and the health problems by eliciting the patient’s health beliefs and providing evidence based information and education. Inform and educate patients about all available treatment options including patient adapted risk counselling. Making a shared decision regarding solution to problems and treatment. Conclusions: Good clinical practice in the care of menopausal women needs a biopsychosocial perspective, up to date evidence based knowledge about screening, diagnostic procedures and therapeutic options and specialized communication skills including patient centred communication, risk counselling and shared decision making. http://dx.doi.org/10.1016/j.ejogrb.2016.07.009 Hormonal contraception in obese women Johannes Bitzer University Hospital Basel, Switzerland Introduction: Taking into account the high prevalence of obesity in many European Countries the Expert Group on Hormonal Contraception of the ESC has taken the task to answer two basic questions a) What it the efficacy of the available hormonal contraceptive methods in obese women? b) What are the risks in obese women? Methods: Review of the literature; expert opinion. Results: a) The majority of qualified observational and prospective studies do not indicate a decreased efficiency of COC in obese women. Data are limited for users of obesity class II and III. The transdermal patch (EVRA® ) is less efficient in women with body weight < 90 kg. No data are available on the efficiency of the contraceptive vaginal ring (Nuvaring® ) in obese women. Desogestrel: At present no data indicate a decreased efficiency of Desogestrel 75 mcg in obese women. Implanon: As etonogestrel plasma levels decrease over time, a premature exchange of the implant after 24 months instead of 36 months could be considered.