Objective: To review tuboplasty techniques for alleviating fallopian tube blockage. Design: A step-by-step explanation of the techniques that comprise tuboplasty-fimbrioplasty, salpingo-ovariolysis, and salpingostomy-with surgical video footage. Setting: Academic medical center. Patient: A 28-year-old G0 female patient with primary infertility and bilateral fallopian tube occlusion wanting to avoid in vitro fertilization. Intervention(s): Tuboplasty and its component techniques of fimbrioplasty, salpingo-ovariolysis, and salpingostomy are demonstrated in a stepwise fashion for a case of mild tubal disease. Fimbrioplasty includes identifying the agglutinated or phimosed fimbrial end and gently opening it with fine forceps and blunt microdissection. Salpingo-ovariolysis is demonstrated with video and comprises: 1) surveying the anatomy; 2) applying traction to delineate the adhesions; and 3) transecting the adhesions with microsurgical scissors or electrosurgery. Finally, the steps of a salpingostomy are demonstrated, including: 1) identifying the length of the fallopian tube; 2) performing chromotubation to delineate tubal obstruction; 3) creating a salpingostomy at the terminal end; and 4) suturing open the salpingostomy site circumferentially to evert the edges. Main Outcome Measure(s): Successful restoration of normal tubal anatomy and identification of the location of tubal occlusion to guide salpingostomy site placement. Result(s): The fallopian tubes were assessed bilaterally and noted to have mild tubal disease and therefore were appropriate for tuboplasty. Normal tubal anatomy was restored bilaterally through salpingo-ovariolysis. Subsequent identification of the area of tubal occlusion bilaterally and salpingostomy were performed to create a patent fallopian tube able to pick up an oocyte from the ovary and facilitate fertilization. Conclusion(s):Tubal reconstructive surgery remains an important option to offer patients who want to avoid in vitro fertilization and who have mild tubal disease. (Fertil Steril Ò 2020;113:1330-2. Ó2020 by American Society for Reproductive Medicine.) El resumen está disponible en Español al final del artículo.
Background:The COVID-19 pandemic has exacerbated pre-existing challenges with respect to access to elective surgery across Canada, and a single-entry model (SEM) approach has been proposed as an equitable and efficient method to help manage the backlog. With Ontario's recent investment in centralized surgical wait-list management, we sought to understand the views of health system leaders on the role of SEMs in managing the elective surgery backlog.Methods: We used the qualitative method of interpretive description to explore participant perspectives and identify practical strategies for policy-makers, administrators and clinical leaders. We conducted semistructured interviews with health system leaders from across Ontario on Zoom between March and June 2021. We used snowball and purposive sampling. Inclusion criteria included Ontario health care leaders, fluent in English or French, in positions relevant to managing the elective surgery backlog. Exclusion criteria were individuals who work outside Ontario, or do not hold relevant roles.Results: Our interviews with 10 health system leaders -including hospital chief executive officers, surgeons, administrators and policy experts -resulted in 5 emergent domains: perceptions of the backlog, operationalizing and financing SEMs, barriers, facilitators, and equity and patient factors. All participants emphasized the need for clinical leaders to champion SEMs and the utility of SEMs in managing wait-lists for high-volume, low-acuity, low-complexity and low-variation surgeries.Interpretation: Although SEMs are no panacea, the participants in our study stated that they believe SEMs can improve quality and reduce variability in wait times when SEMs are designed to address local needs and are implemented with buy-in from champions. Health care leaders should consider SEMs for improving surgical backlog management in their local jurisdictions.
Background: The contributions of arts and humanities to medical education are known in the medical education community, but medical schools’ offerings vary. The Companion Curriculum (CC) is a student-curated set of optional humanities content for medical students at the University of Toronto. This study evaluates integration of the CC to identify key enabling conditions for medical humanities engagement. Methods: A mixed-methods evaluation gauged usage and perceptions of integration of the CC among medical students using an online survey and focus groups. Narrative data underwent thematic analysis, supported by summary statistics of quantitative data. Results: Half of survey respondents were aware of the CC (n = 67/130; 52%), and, once prompted with a description, 14% had discussed it in their tutorial groups. Of students using the CC, 80% reported learning something new regarding their roles as communicators and health advocates. Themes were the perceived value of the humanities, internal student barriers, institutional neglect of the humanities, and student critiques and recommendations. Conclusion: Despite participants’ interest in medical humanities, our CC remains underused. To improve humanities’ visibility in the MD curriculum, our results indicate that greater institutional support, including faculty development and early curricular integration, is required. Further study should explore reasons for gaps between interest and participation.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.