There was no difference in quality of life measures between Icon™ underwear and disposable pad users; however, Icon™ underwear was preferred on product performance.
The FPMRS fellowship was established in 2008, providing a natural experiment in which to examine potential impact of the fellowship on resident training. Materials and methods: While the number of residents remained approximately constant during this time period, faculty in the department of OB/GYN and the division of Urogynecology doubled in size. Cases were identified by CPT codes and route of hysterectomy (vaginal, abdominal, or laparoscopic; with or without robotic assistance), resident and fellow involvement, division of attending surgeon (general obstetrics and gynecology generalist, gynecology generalist, gynecology oncology, urogynecology, minimally invasive) were recorded from the electronic medical record. Resident American College of Graduate Medical Education (ACGME) case log data was used to estimate the number of hysterectomies where residents reported themselves as the primary surgeon. These logs are deidentified with respect to cases, so these data could not be combined with case record data. Results: During the 8-year period of this study, 3317 hysterectomies were performed at our institution, 41% (1371) in the 4 years before and 59% (1946) in the 4 years after fellowship. Prior to fellowship, 27% (393) were vaginal, 56% (766) were abdominal, and 15% (212) were laparoscopic/robotic. After addition of fellowship, 23% (449) were vaginal, 31% (597) were abdominal, and 46% (900) were laparoscopic/robotic. Of the TVHs, there was resident involvement in 98.0% (385) of the cases before fellowship and 98.2% (441) of the cases after fellowship. From the ACGME case log data, the resident identified himself/herself as the primary surgeon in 388 cases before and 393 cases after fellowship. The higher number of vaginal hysterectomies from ACGME case log data than recorded in medical records suggests some misclassification in either case log or CPT obtained data logs. During this time period, medical records indicate a fellow was involved in 42% (189) of TVHs, with resident involvement in all but 5 of these procedures. Of the vaginal hysterectomies with resident involvement, 58.7% (226) were performed by surgeons in the division of urogynecology before initiation of a fellowship. After the fellowship, 70.7% (312) of vaginal hysterectomies were performed by this group of surgeons. Conclusion: Nationally, there has been a decline in TVHs, prompting concern regarding resident training. At our institution, the decline in TVHs performed by non-urogynecology faculty was offset by an increase in TVHs by urogynecology. Frequency of resident involvement in TVH cases, either as primary surgeon or team member, remained constant after the addition of the FPMRS fellowship. Thus, prospective residents need not be concerned about a fellowship diminishing their surgical experience.
Femoral head donation at the time of hip replacement surgery provides a much needed resource of bone allograft to orthopaedic surgeons. Prior to 2005, potential femoral head donors were identified and consented in the hospital setting on the day of surgery. This resulted in over 40 % of donations failing post operatively suggesting that more effort could be given to pre-operative screening resulting in substantial savings in the cost associated with collection and testing of donors who were subsequently failed. The Donor Liaison role was implemented in 2005 to coordinate a Femoral Head Donation program maximising the number of successful donations through pre-operative screening. This study reviews the effectiveness of pre-operative screening of potential femoral head donors at PlusLife from 2002-2012. A retrospective audit of the database was undertaken 2002-2012 and medical/social reasons for pre-operative and postoperative failures were collated into 4 main categories to enable comparison: malignancy, autoimmune conditions, variant Creutzfeldt Jakob disease risk and general medical/social reasons. The number of femoral heads failed post operatively has decreased significantly from 26 % in 2003 to 6 % in 2012. A cost of $121,000 was expended on femoral heads failed post operatively in 2004, as compared to $20,350 in 2012. Donors excluded due to the 4 main categories (medical/social history) were identified pre-operatively in over 80 % of all cases. Preoperative screening of femoral head donors through a coordinated Femoral Head Donation Program is a safe and cost effective method.
INTRODUCTION: Hysterectomies for benign indications have become increasingly performed by fellowship-trained Subspecialists, possibly due to the lack of mentorship among surgeons. We sought to evaluate the change in confidence level of Specialist Attendings (Sas) with the enactment of an Attending Mentorship Program (AMP) for laparoscopic hysterectomies (LHs) and vaginal hysterectomies (VHs). METHODS: Sas were invited to participate in this IRB-approved study. Baseline and 6-month post-AMP confidence levels were obtained using a Visual Analog Scale (VAS). LH mentors were members of the MIGS Division. VH mentors were members of the FPMRS Division. Secondary outcomes of operative time, estimated blood loss (EBL), length of admission (LOA), and postoperative complication rates were recorded. RESULTS: Thirteen Sas met inclusion criteria for this study and agreed to participate. From July 1st, 2017 to December 31st, 2017, 12 of these surgeons participated in the AMP performing a total of 35 hysterectomies. Ten Sas performed 27 LHs; seven Sas performed eight VHs. VAS scores increased 1.05 cm (p = 0.002) for LHs and increased 0.34 cm (p = 0.33) for VHs. The differences in operative time and EBL were not statistically significant in the AMP groups compared to the non-AMP groups. LOA and postoperative complication rates were similar between all groups. CONCLUSION: Confidence levels of Sas in performing LHs increased when the AMP was implemented. Though an increase in VAS confidence scores for VH was seen, this was not statistically significant. Mentoring can be an important factor in SA hysterectomy confidence.
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