The Experts below are selected from a list of 66072 Experts worldwide ranked by ideXlab platform
Jay Schulkin - One of the best experts on this subject based on the ideXlab platform.
-
Obstetrician gynecologists screening and management of depression during perimenopause
Menopause, 2020Co-Authors: Greta B Raglan, Jay Schulkin, Laura M Juliano, Elizabeth MicksAbstract:Objective Depression in women is more common during perimenopause (the time period around and during menopause) than pre and postmenopause. Obstetrician-gynecologists (ob-gyns) play a vital role in the detection and management of depression symptoms in women because for many women ob-gyns are the first and most frequent point of medical contact. This study assessed ob-gyns' screening practices and management of depression in perimenopause. Methods A survey regarding depression during perimenopause was sent to 500 practicing ob-gyns who were fellows of the American College of Obstetricians and Gynecologists and members of the Collaborative Ambulatory Research Network. Results The survey response rate was 41.8% (209 of 500 surveys returned). Over a third of respondents (34.1%) reported that they did not regularly screen perimenopausal patients for depression. Higher-quality education about depression, respondent sex, and personal experience with depression were associated with higher rates of screening. While 85.7% of respondents believed that they could recognize depression in perimenopausal women, only about half (55.8%) were confident in their ability to treat these patients. Conclusion Increased education of ob-gyn physicians related to depression during perimenopause may increase the screening and treatment of women during this phase of life.
-
Obstetrician gynecologists practices and attitudes on substance use screening during pregnancy
Journal of Perinatology, 2020Co-Authors: Van T Tong, Carrie Snead, Sarah C Haight, Mishka Terplan, Lauren Stark, Jay SchulkinAbstract:To describe Obstetrician–gynecologists’ practices and attitudes related to substance use screening in pregnant patients. A 2017 cross-sectional survey assessed US Obstetrician–gynecologists’ (n = 462; response rate = 34%) practices (substance use screening frequency and methods) and attitudes (practice priority of screening, confidence in treating, and responsibility statements). Chi-squared tests and adjusted modified Poisson regression were used to estimate associations between practices and attitudes. Of 353 respondents with screening information, 79% frequently screen for substance use and 11% used a validated instrument. Confidence was the highest for treating pregnant patients using tobacco (81%). Respondents whose practices make it a high priority to screen for all substances were 1.2 times as likely to frequently screen as their counterparts (95% CI: 1.1–1.3). Four out of five Obstetricians–gynecologists reported a high frequency of substance use screening in pregnant patients. Findings highlight the importance of increasing priority of substance use screening by Obstetrician–gynecologists.
-
implementing best practices for the provision of long acting reversible contraception a survey of Obstetrician gynecologists
Contraception, 2019Co-Authors: Neko Castleberry, Jay Schulkin, Lauren Stark, Daniel GrossmanAbstract:Abstract Objective To examine Obstetrician-gynecologists' practices regarding provision of long-acting reversible contraceptive (LARC) methods same-day, immediately postpartum, or to women under age 21. Study design Between August 2016 and March 2017, the American College of Obstetricians and Gynecologists (ACOG) sent 2500 of their members an electronic survey questionnaire regarding the provision of LARC methods. ACOG mailed nonresponders paper surveys. Results After exclusions, the final sample was 1280 respondents (52.2% response rate). Although 91% of Obstetrician-gynecologists reported providing IUDs, only 29% (95% CI, 26–32%) offered same-day placement. Ninety-two percent (95% CI, 90–94%) offered IUDs to eligible patients under age 21. Nineteen percent (95% CI, 16.1–21.3%) offered immediate postpartum IUD placement and 21% (95% CI, 18–23%) offered immediate postpartum implant placement. Obstetrician-gynecologists practicing in states where Medicaid reimbursed for immediate postpartum LARC devices within the global fee for delivery (versus separate reimbursement) had lower odds of offering them. Conclusion While most ob-gyns are offering IUDs to women under age 21, many are still not offering them same-day. A minority of ob-gyns offer either IUDs or implants immediately postpartum, and there are important geographic and practice setting disparities in this practice. Implications Efforts to align LARC practices with published evidence and improve access to LARC methods for women desiring them will require a multipronged effort including continuing education of physicians, patient education and outreach, as well as advocacy to improve insurance coverage and reimbursement.
-
practice variation in antenatal steroid administration for anticipated late preterm birth a physician survey
American Journal of Perinatology, 2019Co-Authors: Ashley N Battarbee, Mark A Clapp, Carrie Snead, Anjali J Kaimal, Kim A Boggess, Jay Schulkin, Sofia AliagaAbstract:Objective The objective of this study was to measure knowledge and practice variation in late preterm steroid use. Study Design Electronic survey of American College of Obstetricians and Gynecologists (ACOG) members about data supporting the ACOG/Society for Maternal-Fetal Medicine (SMFM) recommendations and practice when caring for women with anticipated late preterm birth (PTB), 340/7 to 366/7 weeks. Results Of 352 administered surveys, we obtained 193 completed responses (55%); 82.5% were generalist Obstetrician-gynecologists (OB/GYNs), and 42% cared for women with anticipated late PTB at least weekly. Most believed that late preterm steroids provided benefit by reducing respiratory distress syndrome (93%), transient tachypnea of the newborn (83%), and neonatal intensive care unit admission (82%). More than half administered late preterm steroids to women with multiple gestations (73%), and pregestational diabetes (55–80%) depending on glycemic control. OB/GYNs administered steroids to insulin-dependent and poorly controlled diabetics more often than MFMs (75 vs. 46% and 59 vs. 37% respectively, p Conclusion Most providers are administering late preterm steroids to all women, even those populations who have been excluded from previous trials. Despite widespread use, providers believe more research is needed to optimize management.
-
Screening for History of Childhood Abuse: Beliefs, Practice Patterns, and Barriers Among Obstetrician-Gynecologists
Womens Health Issues, 2018Co-Authors: Victoria A Farrow, Jeane Bosch, Jennifer N. Crawford, Carrie Snead, Jay SchulkinAbstract:Abstract Background A history of childhood abuse is strongly linked to adult health problems. Obstetrician–gynecologists will undoubtedly treat abuse survivors during their careers, and a number of patient presenting problems may be related to a history of childhood abuse (e.g., chronic pelvic pain, sexual dysfunction, mental health disorders, obesity, and chronic diseases). Knowledge of abuse history may assist with treatment planning and the delivery of trauma-informed care. The current study sought to explore Obstetrician–gynecologists' training, knowledge, beliefs, practice patterns, and barriers around screening for history of childhood abuse in their adult patients. Methods Eight hundred Fellows and Junior Fellows of the American College of Obstetricians and Gynecologists were sent an electronic survey; 332 viewed recruitment emails. Data were analyzed with SPSS 24.0, including descriptive statistics, χ2, and t tests. Results One-hundred forty-five physicians completed the survey. The majority of responding providers believe that assessment of abuse history is important and relevant to patient care, yet few reported screening regularly. Most did not have formal training in screening for childhood abuse or its effects, although those who completed their training more recently were more likely to report training in these areas, as well as more likely to screen regularly. The majority of respondents noted they were not confident to screen. Barriers to screening were identified. Conclusions Greater education and training about screening for childhood abuse history and the effects of childhood abuse are needed. The integration of mental health providers into practice is one method that may increase screening rates.
Britta L Anderson - One of the best experts on this subject based on the ideXlab platform.
-
Obstetrician gynecologists and contraception long acting reversible contraception practices and education
Contraception, 2014Co-Authors: Alicia T Luchowski, Britta L Anderson, Jay Schulkin, Michael L Power, Greta B Raglan, Eve EspeyAbstract:Abstract Objectives Long-acting reversible contraception (LARC) — the copper and levonorgestrel intrauterine devices (IUDs) and the single-rod implant — are safe and effective but account for a small proportion of contraceptive use by US women. This study examined Obstetrician–gynecologists' knowledge, training, practice and beliefs regarding LARC methods. Design A survey questionnaire was mailed to 3000 Fellows of the American College of Obstetricians and Gynecologists. After exclusions, 1221 eligible questionnaires were analyzed (45.8% response rate, accounting for exclusions). Results Almost all Obstetrician–gynecologists reported providing IUDs (95.8%). Most Obstetrician–gynecologists reported requiring two or more visits for IUD insertion (86.9%). Respondents that reported IUD insertion in a single visit reported inserting a greater number of IUDs in the last year. About half reported offering the single-rod implant (51.3%). A total of 92.0% reported residency training on IUDs, and 50.8% reported residency training on implants. Residency training and physician age correlated with the number of IUDs inserted in the past year. A total of 59.6% indicated receiving continuing education on at least one LARC method in the past 2 years. Recent continuing education was most strongly associated with implant insertion, and 31.7% of respondents cited lack of insertion training as a barrier. Conclusions Barriers to LARC provision could be reduced if more Obstetrician–gynecologists received implant training and provided same-day IUD insertion. Continuing education will likely increase implant provision. Implications This study shows that Obstetrician–gynecologists generally offer IUDs, but fewer offer the single-rod contraceptive implant. Recent continuing education strongly predicted whether Obstetrician–gynecologists inserted implants and was also associated with other practices that encourage LARC use.
-
Obstetrician gynecologists and contraception practice and opinions about the use of iuds in nulliparous women adolescents and other patient populations
Contraception, 2014Co-Authors: Alicia T Luchowski, Britta L Anderson, Jay Schulkin, Michael L Power, Greta B Raglan, Eve EspeyAbstract:Abstract Objectives Use of intrauterine devices (IUDs) by US women is low despite their suitability for most women of reproductive age and in a variety of clinical contexts. This study examined Obstetrician–gynecologists' practices and opinions about the use of IUDs in adolescents, nulliparous women and other patient groups, as well as for emergency contraception. Design A survey questionnaire was sent to a computer-generated sample of 3000 fellows who were reflective of the American College of Obstetricians and Gynecologists (College) membership. Results After exclusions from the 1552 returned surveys (51.7% response rate), 1150 eligible questionnaires were analyzed. Almost all Obstetrician–gynecologists (95.8%) reported providing IUDs, but only 66.8% considered nulliparous women, and 43.0% considered adolescents appropriate candidates. Even among Obstetrician–gynecologists who recalled reading a College publication about IUDs, only 78.0% and 45.0% considered nulliparous women and adolescents appropriate candidates, respectively. Few respondents (16.1%) had recommended the copper IUD as emergency contraception, and only 73.9% agreed that the copper IUD could be used as emergency contraception. A total of 67.3% of respondents agreed that an IUD can be inserted immediately after an abortion or miscarriage. Fewer (43.5%) agreed that an IUD can be inserted immediately postpartum, and very few provide these services (11.4% and 7.2%, respectively). Staying informed about practice recommendations for long-acting reversible contraception was associated with broader provision of IUDs. Conclusions Although most Obstetrician–gynecologists offer IUDs, many exclude appropriate candidates for IUD use, both for emergency contraception and for long-term use, despite evidence-based recommendations. Implications This study shows that Obstetrician–gynecologists still do not offer IUDs to appropriate candidates, such as nulliparous women and adolescents, and rarely provide the copper IUD as emergency contraception.
-
challenges in cervical cancer prevention a survey of u s Obstetrician gynecologists
American Journal of Preventive Medicine, 2013Co-Authors: Rebecca B Perkins, Britta L Anderson, Sherri Sheinfeld Gorin, Jay SchulkinAbstract:Background Current cervical cancer prevention recommendations include human papillomavirus (HPV) vaccination, Pap and HPV co-testing, and Pap testing at 3- to 5-year intervals. Purpose To examine attitudes, practice patterns, and barriers related to HPV vaccination and cervical cancer screening guidelines among U.S. Obstetrician-gynecologists. Methods In 2011–2012, a national sample of members of the American Congress of Obstetricians and Gynecologists responded to a 15-item (some with multiple parts) questionnaire assessing sociodemographic characteristics, clinical practices, and perceived barriers to HPV vaccination and cervical cancer screening. Multivariate logistic regression was used to identify factors associated with guideline adherence. Analyses were conducted in 2012. Results A total of 366 Obstetrician-gynecologists participated. Ninety-two percent of respondents offered HPV vaccination to patients, but only 27% estimated that most eligible patients received vaccination. Parent and patient refusals were commonly cited barriers to HPV vaccination. Approximately half of respondents followed guidelines to begin cervical cancer screening at age 21 years, discontinue screening at age 70 years or after hysterectomy, and appropriately utilize Pap and HPV co-testing. Most physicians continued to recommend annual Paps (74% aged 21–29 years, 53% aged ≥30 years). Physicians felt that patients were uncomfortable with extended screening intervals and were concerned that patients would not come for annual exams without concurrent Paps. Solo practitioners were less likely to follow both vaccination and screening guidelines than those in group practices. Conclusions This survey of Obstetrician-gynecologists indicates persistent barriers to the adoption of HPV vaccination and cervical cancer screening guidelines. Interventions to promote guideline adherence may help improve the quality of cervical cancer prevention.
-
Evaluation of bleeding disorders in women with menorrhagia: a survey of Obstetrician-gynecologists
American Journal of Obstetrics and Gynecology, 2012Co-Authors: Vanessa R. Byams, Hani K. Atrash, Britta L Anderson, Althea M. Grant, Jay SchulkinAbstract:Objective To better understand the current evaluation of unexplained menorrhagia by Obstetrician-gynecologists and the extent to which a bleeding disorder diagnosis is being considered in this population. Study Design A total of 1200 Fellows and Junior Fellows of the American College of Obstetricians and Gynecologists were invited to participate in a survey on blood disorders. Respondents completed a questionnaire regarding their patient population and their evaluation of patients with unexplained menorrhagia. Results The overall response rate was 42.4%. Eighty-two percent of respondents reported having seen patients with menorrhagia caused by a bleeding disorder. Seventy-seven percent of physicians reported they would be likely or very likely to consider a bleeding disorder as causing menorrhagia in adolescent patients; however, only 38.8% would consider bleeding disorders in reproductive age women. Conclusion The current data demonstrate that Obstetrician-gynecologists seem to have a relatively high awareness of bleeding disorders as a potential underlying cause of menorrhagia.
-
Obstetrician gynecologists practices and perceived knowledge regarding immunization
American Journal of Preventive Medicine, 2009Co-Authors: Michael L Power, Britta L Anderson, Meaghan A Leddy, Stanley A Gall, Bernard Gonik, Jay SchulkinAbstract:Background Obstetrician–gynecologists can play a key role in providing appropriate vaccinations to women of childbearing age. Purpose This study investigated immunization knowledge and practices, and opinions concerning potential barriers to immunization, among Obstetrician-gynecologists. Methods In 2007, surveys were sent to Collaborative Ambulatory Research Network members, a representative sample of practicing Fellows of the American College of Obstetricians and Gynecologists; 394 responded (51.2%). Data analysis was completed in 2008. Results Most responding Obstetrician–gynecologists disagreed that “routine screening for vaccine-preventable diseases falls outside of the routine practice of an ob/gyn.” A majority (78.7%) stock and administer at least some vaccines. Among those who stock vaccines, 91.0% stock the human papillomavirus vaccine, and 66.8% stock the influenza vaccine. All other vaccines were stocked by Conclusions Immunization is an important part of women's health care and has been, at least partially, incorporated into Obstetrician–gynecologist practice. Financial burdens and knowledge regarding vaccine recommendations remain barriers to vaccine administration. Additional training and professional information may benefit obstetric–gynecologic practice.
Albert L Strunk - One of the best experts on this subject based on the ideXlab platform.
-
special requirements of electronic medical record systems in obstetrics and gynecology
Obstetrics & Gynecology, 2010Co-Authors: Michael J Mccoy, Anne M Diamond, Albert L StrunkAbstract:There is growing recognition of the importance and potential benefit of information technology and electronic medical records in providing quality care for women. Incorporation of Obstetrician-gynecologist-specific requirements by electronic medical record vendors is essential to achieve appropriate electronic medical record functionality for Obstetrician-gynecologists. Obstetricians and gynecologists record and document patient care in ways that are unique to medicine. Current electronic medical record systems are often limited in their usefulness for the practice of obstetrics and gynecology because of the absence of Obstetrician-gynecologist specialty-specific requirements and functions. The Certification Commission on Health Information Technology is currently the only federally recognized body for certification of electronic medical record systems. As Certification Commission on Health Information Technology expands the certification criteria for electronic medical records, the special requirements identified in this report will be used as a framework for developing Obstetrician-gynecologist specialty-specific criteria to be incorporated into the Certification Commission on Health Information Technology endorsement for electronic medical records used by Obstetrician-gynecologists.
-
special requirements of electronic medical record systems in obstetrics and gynecology
Obstetrics & Gynecology, 2010Co-Authors: Michael J Mccoy, Anne M Diamond, Albert L StrunkAbstract:There is growing recognition of the importance and potential benefit of information technology and electronic medical records in providing quality care for women. Incorporation of Obstetrician–gynecologist-specific requirements by electronic medical record vendors is essential to achieve appropriate electronic medical record functionality for Obstetrician-gynecologists. Obstetricians and gynecologists record and document patient care in ways that are unique to medicine. Current electronic medical record systems are often limited in their usefulness for the practice of obstetrics and gynecology because of the absence of Obstetrician– gynecologist specialty-specific requirements and functions. The Certification Commission on Health Information Technology is currently the only federally recognized body for certification of electronic medical record systems. As Certification Commission on Health Information Technology expands the certification criteria for electronic medical records, the special requirements identified in this report will be used as a framework for developing Obstetrician– gynecologist specialty-specific criteria to be incorporated into the Certification Commission on Health Information Technology endorsement for electronic medical records used by Obstetrician–gynecologists. (Obstet Gynecol 2010;116:140–3)
-
professional liability and other career pressures impact on Obstetrician gynecologists career satisfaction
Obstetrics & Gynecology, 2004Co-Authors: Barbara Bettes, Albert L Strunk, Victoria H Coleman, Jay SchulkinAbstract:OBJECTIVE: To investigate the impact of career pressures on career satisfaction and satisfaction with job-specific activities among Obstetrician- gynecologists. METHODS: A questionnaire was sent to 1,500 member-Fellows of The American College of Obstetricians and Gynecologists in June 2001. The analyses were designed to examine the relationship between career pressures in 3 domains on clinicians' professional satisfaction. RESULTS: Overall career satisfaction and satisfaction with job-specific activities were both inversely related to the perceived impact of career pressures. The major impact reported was that liability insurance costs would shorten the duration of the members' careers. Managed care had less impact than liability, with moderate concern surrounding the limitation of diagnostic and treatment options. Obstetrician-gynecologists were less satisfied with their careers and job-specific activities if they believed the cost or time of obtaining continuing medical education requirements to be a burden. CONCLUSION: Career pressures produced by liability insurance costs have more negative impact on clinicians' satisfaction with their professional lives and job-specific activities than managed care and requirements for continuing medical education.
Michael L Power - One of the best experts on this subject based on the ideXlab platform.
-
metabolic screening in patients with polycystic ovary syndrome is largely underutilized among Obstetrician gynecologists
American Journal of Obstetrics and Gynecology, 2016Co-Authors: Amy S Dhesi, Jay Schulkin, Michael L Power, Katie L Murtough, Jonathan K Lim, Peter G Mcgovern, Sara S MorelliAbstract:Women with polycystic ovary syndrome have substantially higher rates of insulin resistance, impaired glucose tolerance, type 2 diabetes, dyslipidemia, and metabolic syndrome when compared with women without the disease. Given the high prevalence of these comorbidities, guidelines issued by the American College of Obstetricians and Gynecologists and the Endocrine Society recommend that all women with polycystic ovary syndrome undergo screening for impaired glucose tolerance and dyslipidemia with a 2 hour 75 g oral glucose tolerance test and fasting lipid profile upon diagnosis and also undergo repeat screening every 2-5 years and every 2 years, respectively. Although a hemoglobin A1C and/or fasting glucose are widely used screening tests for diabetes, both the American College of Obstetricians and Gynecologists and the Endocrine Society preferentially recommend the 2 hour oral glucose tolerance test in women with polycystic ovary syndrome as a superior indicator of impaired glucose tolerance/diabetes mellitus. However, we found that gynecologists underutilize current recommendations for metabolic screening in women with polycystic ovary syndrome. In an online survey study targeting American College of Obstetricians and Gynecologists fellows and junior fellows, 22.3% of respondents would not order any screening test at the initial visit for at least 50% of their patients with polycystic ovary syndrome. The most common tests used to screen for impaired glucose tolerance in women with polycystic ovary syndrome were hemoglobin A1C (51.0%) and fasting glucose (42.7%). Whereas 54.1% would order a fasting lipid profile in at least 50% of their polycystic ovary syndrome patients, only 7% of respondents order a 2 hour oral glucose tolerance test. We therefore call for increased efforts to encourage Obstetrician-gynecologists to address metabolic abnormalities in their patients with polycystic ovary syndrome. Such efforts should include education of physicians early in their careers, at the medical student and resident level. Efforts should also include implementation of continuing medical education activities, both locally and at the national level, to improve understanding of the metabolic implications of polycystic ovary syndrome. Electronic medical record systems should be utilized to generate prompts for appropriate screening tests in patients with a diagnosis of polycystic ovary syndrome. Because Obstetrician-gynecologists may be the only physicians seen by many polycystic ovary syndrome patients, particularly those in their young reproductive years, such interventions could effectively promote optimal preventative health care and early diagnosis of metabolic comorbidities in these at-risk women.
-
Obstetrician gynecologists and contraception practice and opinions about the use of iuds in nulliparous women adolescents and other patient populations
Contraception, 2014Co-Authors: Alicia T Luchowski, Britta L Anderson, Jay Schulkin, Michael L Power, Greta B Raglan, Eve EspeyAbstract:Abstract Objectives Use of intrauterine devices (IUDs) by US women is low despite their suitability for most women of reproductive age and in a variety of clinical contexts. This study examined Obstetrician–gynecologists' practices and opinions about the use of IUDs in adolescents, nulliparous women and other patient groups, as well as for emergency contraception. Design A survey questionnaire was sent to a computer-generated sample of 3000 fellows who were reflective of the American College of Obstetricians and Gynecologists (College) membership. Results After exclusions from the 1552 returned surveys (51.7% response rate), 1150 eligible questionnaires were analyzed. Almost all Obstetrician–gynecologists (95.8%) reported providing IUDs, but only 66.8% considered nulliparous women, and 43.0% considered adolescents appropriate candidates. Even among Obstetrician–gynecologists who recalled reading a College publication about IUDs, only 78.0% and 45.0% considered nulliparous women and adolescents appropriate candidates, respectively. Few respondents (16.1%) had recommended the copper IUD as emergency contraception, and only 73.9% agreed that the copper IUD could be used as emergency contraception. A total of 67.3% of respondents agreed that an IUD can be inserted immediately after an abortion or miscarriage. Fewer (43.5%) agreed that an IUD can be inserted immediately postpartum, and very few provide these services (11.4% and 7.2%, respectively). Staying informed about practice recommendations for long-acting reversible contraception was associated with broader provision of IUDs. Conclusions Although most Obstetrician–gynecologists offer IUDs, many exclude appropriate candidates for IUD use, both for emergency contraception and for long-term use, despite evidence-based recommendations. Implications This study shows that Obstetrician–gynecologists still do not offer IUDs to appropriate candidates, such as nulliparous women and adolescents, and rarely provide the copper IUD as emergency contraception.
-
Obstetrician gynecologists and contraception long acting reversible contraception practices and education
Contraception, 2014Co-Authors: Alicia T Luchowski, Britta L Anderson, Jay Schulkin, Michael L Power, Greta B Raglan, Eve EspeyAbstract:Abstract Objectives Long-acting reversible contraception (LARC) — the copper and levonorgestrel intrauterine devices (IUDs) and the single-rod implant — are safe and effective but account for a small proportion of contraceptive use by US women. This study examined Obstetrician–gynecologists' knowledge, training, practice and beliefs regarding LARC methods. Design A survey questionnaire was mailed to 3000 Fellows of the American College of Obstetricians and Gynecologists. After exclusions, 1221 eligible questionnaires were analyzed (45.8% response rate, accounting for exclusions). Results Almost all Obstetrician–gynecologists reported providing IUDs (95.8%). Most Obstetrician–gynecologists reported requiring two or more visits for IUD insertion (86.9%). Respondents that reported IUD insertion in a single visit reported inserting a greater number of IUDs in the last year. About half reported offering the single-rod implant (51.3%). A total of 92.0% reported residency training on IUDs, and 50.8% reported residency training on implants. Residency training and physician age correlated with the number of IUDs inserted in the past year. A total of 59.6% indicated receiving continuing education on at least one LARC method in the past 2 years. Recent continuing education was most strongly associated with implant insertion, and 31.7% of respondents cited lack of insertion training as a barrier. Conclusions Barriers to LARC provision could be reduced if more Obstetrician–gynecologists received implant training and provided same-day IUD insertion. Continuing education will likely increase implant provision. Implications This study shows that Obstetrician–gynecologists generally offer IUDs, but fewer offer the single-rod contraceptive implant. Recent continuing education strongly predicted whether Obstetrician–gynecologists inserted implants and was also associated with other practices that encourage LARC use.
-
Obstetrician gynecologists practices and perceived knowledge regarding immunization
American Journal of Preventive Medicine, 2009Co-Authors: Michael L Power, Britta L Anderson, Meaghan A Leddy, Stanley A Gall, Bernard Gonik, Jay SchulkinAbstract:Background Obstetrician–gynecologists can play a key role in providing appropriate vaccinations to women of childbearing age. Purpose This study investigated immunization knowledge and practices, and opinions concerning potential barriers to immunization, among Obstetrician-gynecologists. Methods In 2007, surveys were sent to Collaborative Ambulatory Research Network members, a representative sample of practicing Fellows of the American College of Obstetricians and Gynecologists; 394 responded (51.2%). Data analysis was completed in 2008. Results Most responding Obstetrician–gynecologists disagreed that “routine screening for vaccine-preventable diseases falls outside of the routine practice of an ob/gyn.” A majority (78.7%) stock and administer at least some vaccines. Among those who stock vaccines, 91.0% stock the human papillomavirus vaccine, and 66.8% stock the influenza vaccine. All other vaccines were stocked by Conclusions Immunization is an important part of women's health care and has been, at least partially, incorporated into Obstetrician–gynecologist practice. Financial burdens and knowledge regarding vaccine recommendations remain barriers to vaccine administration. Additional training and professional information may benefit obstetric–gynecologic practice.
-
obesity prevention and treatment practices of u s Obstetrician gynecologists
Obstetrics & Gynecology, 2006Co-Authors: Michael L Power, Mary E Cogswell, Jay SchulkinAbstract:OBJECTIVE To describe obesity prevention and treatment practices of U.S. Obstetrician-gynecologists. METHODS A cross-sectional survey was mailed to 1,806 practicing members of the American College of Obstetricians and Gynecologists (ACOG) in February-April 2005. RESULTS Of the 900 respondents who returned questionnaires, 82% reported using body mass index (BMI) to assess obesity; 80% reported counseling patients about weight control and 84% about physical activity "most of the time" or "often." Most reported counseling patients about diet; the most frequently recommended dietary strategies were changing eating patterns, limiting intake of specific foods, and controlling portion size. About 27% reported referring their patients for behavioral therapy "most of the time" or "often," and 35% reported ever prescribing weight loss medications to obese patients. More than 85% counseled patients about pregnancy weight gain, and 64% used the patients' prepregnancy BMI to modify their recommendations "most of the time" or "often." Respondents who completed their residency after 1996 were more likely to use patients' BMI to screen for obesity than those who finished earlier. Respondents who believed that they could help their patients lose weight (44%) were more likely to counsel their patients to do so (P < .001). CONCLUSION A majority of Obstetrician-gynecologists appear to use BMI to screen for obesity and to counsel their patients about weight control, diet, and physical activity. Many, however, do not prescribe weight loss medications or refer patients to behavioral weight loss therapy. Obstetrician-gynecologists who believe they can help patients lose weight are more likely to follow recommendations for the treatment of obesity. LEVEL OF EVIDENCE III.
Philippe H. Ravaud - One of the best experts on this subject based on the ideXlab platform.
-
Variation in severe postpartum hemorrhage management: A national vignette-based study
PLoS ONE, 2018Co-Authors: Anne Rousseau, Patrick Rozenberg, Élodie Perrodeau, Philippe H. RavaudAbstract:Objectives To assess variations in management of severe postpartum hemorrhage: 1) between Obstetricians in the same situation 2) by the same Obstetrician in different situations. Study design A link to a vignette-based survey was emailed to Obstetricians of 215 maternity units; the questionnaire asked them to report how they would manage the PPH described in 2 previously validated case-vignettes of different scenarios of severe PPH. Vignette 1 described a typical immediate, severe PPH, and vignette 2 a less typical case of severe but gradual PPH. They were constructed in 3 successive steps and included multiple-choice questions proposing several types of clinical practice options at each step. Variations in PPH were assessed in a descriptive analysis; agreement about management and its timing between vignette 1 and vignette 2 was assessed with the Kappa coefficient. Results Analysis of complete responses from 119 (43.4%) Obstetricians from 53 (24.6%) maternity units showed delayed or inadequate management in both vignettes. While 82.3% and 83.2% of Obstetricians (in vignettes 1 and 2, respectively) would administer oxytocin 15 minutes after PPH diagnosis, only 52.9% and 29.4% would alert other team members. Management by Obstetricians of the two vignette situations was inconsistent in terms of choice of treatment and timing of almost all treatments. Conclusion Case vignettes demonstrated inadequate management as well as variations in management between Obstetricians and in different PPH situations. Protocols or procedures are necessary in all maternity units to reduce the variations in practices that May explain a part of the delay in management that leads to PPH-related maternal mortality and morbidity.
-
Assessing complex emergency management with clinical case-vignettes: A validation study
PLoS ONE, 2015Co-Authors: Anne Rousseau, Patrick Rozenberg, Philippe H. RavaudAbstract:Objective: To evaluate whether responses to dynamic case-vignettes accurately reflect actual practices in complex emergency situations. We hypothesized that when Obstetricians were faced with vignette of emergency situation identical to one they previously managed, they would report the management strategy they actually used. On the other hand, there is no reason to suppose that their response to a vignette based on a source case managed by another Obstetrician would be the same as the actual management. Methods: A multicenter vignette-based study was used in 7 French maternity units.We chose the example of severe postpartum hemorrhage (PPH) to study the use of case-vignettes for assessing the management of complex situations. We developed dynamic case-vignettes describing incidents of PPH in several steps, using documentation in patient files. Vignettes described the postpartum course and included multiple-choice questions detailing proposed clinical care. Each participating Obstetrician was asked to evaluate 4 case-vignettes: 2 directly derived from cases they previously managed and 2 derived from other Obstetricians' cases. We compared the final treatment decision in vignette responses to those documented in the source-case by the overall agreement and the Kappa coefficient, both for the cases the Obstetricians previously managed and the cases of others. Results: Thirty Obstetricians participated. Overall agreement between final treatment decisions in case-vignettes and documented care for cases Obstetricians previously managed was 82% (Kappa coefficient: 0.75, 95% CI [0.62-0.88]). Overall agreement between final treatment decisions in case-vignettes and documented care in vignettes derived from other Obstetricians' cases was only 48% (Kappa coefficient: 0.30, 95% CI [0.12-0.48]). Final agreement with documented care was significantly better for cases based on their own previous cases than for others (p
