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Biomedical subjects

F W Ling

Publications and source records attributed to F W Ling.

At least 37 records · Page 2Linked to original sources
PubMed1995

The in-training examination in obstetrics and gynecology: an attempt to establish a remediation indicator.

OBJECTIVE: With the use of a university- and community hospital-based faculty, we attempted to determine at what performance level remediation would be recommended. STUDY DESIGN: The Committee on In-Training Examinations for Residents in Obstetrics and Gynecology Task Force on Standard-Based Scoring sent the 1991 examination to 16 university- and 12 community hospital-based faculty members. Given a standardized definition of a "borderline third-year resident," each faculty scored each item on the examination on whether that hypothetic resident would or would not correctly answer the item. RESULTS: The mean expectation of correct responses on the 397-item test was 236 (59%). This was identical to the score obtained if 2 SDs were subtracted from the actual mean for all third-year residents taking the examination. University- and community hospital-based faculty members had generally similar expectations of this defined resident. CONCLUSION: Although poor examination results should not be recommended as the sole determinant for promotion, it appears that 2 SDs below the mean may be an appropriate score below which remediation could be recommended.

Educational Measurement↗
PubMed1995

Computer-assisted video evaluation of surgical skills.

Compact video cameras have allowed the review of operations in self-directed learning sessions. Controlling the video viewing process by computer allows the selection of specific videotape segments containing the desired psychomotor skills to be evaluated--in this study, the steps involving laparoscopic tubal banding. Six faculty members were able to evaluate 23 videotapes efficiently without knowledge of the resident operator's identity. Because the computer allowed selection of only those frames of the videotape containing the skills to be evaluated, the duration of videotape seen was reduced by an average of 34% from the actual surgical time, with an increase in time saved as experience with the system was gained. Faculty members evaluated these events using a self-made checklist. It was possible to calculate the performance scores of each resident for the individual psychomotor skill components of the reviewed procedure. Computer-assisted video evaluation of surgical skills is technically feasible, allowing time-efficient review by multiple evaluators. With the development of psychometrically valid checklists for use with this technology, computer-assisted video evaluation of surgical skills may provide a new, innovative means of assessing surgical skills and training.

Clinical Competence↗
PubMed1995

Chronic pelvic pain.

The basic approach to the patient with chronic pelvic pain as practiced at the University of Tennessee, Memphis, has been described here. Using this approach allows the practicing physician to evaluate and manage realistically or refer appropriately most patients with chronic pelvic pain. The key to management of patients who have chronic pelvic pain is to use any and all available diagnostic and therapeutic modalities to identify the source(s) and direct therapy. By having at least a working knowledge of the various diagnostic and therapeutic modalities available to the patient, the individual clinician can better aid the patient in her understanding of chronic pelvic pain, generally, and her own pelvic pain, specifically.

Chronic Disease↗
PubMed1995

Development of a program teaching laparoscopic sterilization using local anesthesia.

A program teaching laparoscopic sterilization using local anesthesia was developed and implemented in a large residency program in which sterilization using general anesthesia was already being taught in a traditional fashion. Important steps for the development of such a program included the designation of an individual with overall responsibility for the program, identification of potential obstacles along with feasible solutions, and training of residents and staff in the new techniques. The major obstacles to implementation included opposition from anesthesia personnel, the need for additional training in the new techniques for both residents and faculty, nursing staff resistance, and the uncertainty of patient acceptance. Solutions included involving anesthesia personnel in program planning as well as in the ultimate performance of the procedures, practicing local techniques during cases under general anesthesia, limiting initial cases to candidates anticipated to be uncomplicated, and using nondirective counseling of patients. Similar strategies can be useful both to other residency programs and individuals wishing to offer local anesthesia as an option for laparoscopic sterilization at their hospitals.

Anesthesia, Local↗
PubMed1994

Basic laparoscopic knowledge among gynecologic laparoscopists.

OBJECTIVE: Our purpose was to assess the basic knowledge of laparoscopy and laparoscopic sterilization among gynecologic laparoscopists. STUDY DESIGN: A four-part multiple-choice test designed for use in residency training, covering basic aspects of laparoscopy and laparoscopic sterilization, was distributed to 155 registrants at a gynecologic surgery postgraduate course. Test results were compared among subgroups, as well as with results for 23 residents who had taken the test before their rotation in laparoscopic sterilization. RESULTS: Residents scored higher than practitioners on all test segments. No practitioner achieved the 85% correct passing score required of residents. Practitioner scores did not increase as the number of laparoscopic sterilizations performed per year increased, but higher test scores were associated with more recent completion of residency. CONCLUSION: Basic knowledge of laparoscopic sterilization among practicing gynecologists, as measured by a test designed for residents, is less than that of the residents.

Education, Medical, Continuing↗
PubMed1994

Outpatient hysterectomy: determinants of discharge and rehospitalization in 133 patients.

OBJECTIVE: This study examines our continuing experience in performing vaginal hysterectomies and laparoscopy-assisted vaginal hysterectomies with an outpatient protocol. The purpose was to review factors associated with discharge and hospitalization. STUDY DESIGN: Surgical records from all women entering our previously reported outpatient hysterectomy protocol were reviewed. Demographics, surgical indications, intraoperative data, and postoperative data were studied, and their associations with patient discharge and hospitalization were determined. Specific attention was directed to complications. RESULTS: The study group consisted of 133 women. Twelve women (9.0%) were not discharged from the hospital and 5 (3.8%) required readmission. Surgical indications, the type of hysterectomy, and the requirement for pain medication revealed no association with hospitalization. The occurrence of an intraoperative complication (p < 0.000), the need for transfusion (p = 0.043), and postoperative antiemetics (p = 0.013) were statistically associated with hospitalization. In addition, low hematocrit values and elevated temperatures on the first and second postoperative days were associated with hospitalization. CONCLUSION: Long-term experience with outpatient hysterectomy reveals a hospitalization rate of 12.8%. Complications, blood loss, elevated temperatures, and postoperative nausea are the major determinants of patient discharge and hospitalization. Readmission rates continue to remain low.

Adolescent↗
PubMed1994

A randomized comparison of the Pipelle, Accurette, and Explora endometrial sampling devices.

OBJECTIVES: Our aim was to compare the Pipelle, Accurette, and Explora endometrial sampling devices. STUDY DESIGN: Patients (n = 248) undergoing endometrial biopsy were randomized to one of the three sampling instruments. Diagnostic accuracy, ability to obtain sufficient tissue for histologic diagnosis, and patient discomfort during sampling of the three devices were compared. When available, endometrial biopsy specimens were compared with subsequent pathologic findings at hysterectomy. Statistical analysis was performed with one-way variance of the means, chi 2, and Kruskal-Wallis statistic. RESULTS: In successful biopsies there was no statistical difference among groups in specimen adequacy and there was no discrepancy between endometrial biopsy and hysterectomy pathologic findings. However, 42% of Accurette biopsies either were failed attempts or obtained insufficient tissue (p < 0.01). Pain scores were similar among the groups. CONCLUSION: The results with the Pipelle and Explora endometrial samplers appear to be comparable. However, given a 42% unusable specimen rate, the Accurette cannot be recommended for routine endometrial sampling.

Adult↗
PubMed1994

Instruction in surgical anatomy for gynecology residents using prosected human cadavers.

Prosected human cadavers were used by a team of anatomists and gynecologic surgeons to teach surgical anatomy to gynecology residents. The course was offered at the start of each 8-week gynecologic surgery rotation. Hemisections and other similar prosections were used to demonstrate anatomic relationships and surgical procedures from vantage points unobtainable at the operating table. The initial response from the faculty and residents was encouraging. The residents believed the program to be beneficial and were satisfied with it. Both the anatomy faculty and the gynecology faculty found new insights into teaching issues during the interdisciplinary process of course preparation and teaching.

Anatomy↗
PubMed1994

Serum bupivacaine levels during laparoscopic sterilization using local anesthesia.

STUDY OBJECTIVE: To determine the serum levels of bupivacaine during laparoscopic sterilization when bupivacaine 0.5% without epinephrine is used as the sole local anesthetic agent. DESIGN: Case series. SETTING: Regional medical center and primary teaching hospital of Ob/Gyn Department of the University of Tennessee, Memphis. PATIENTS; Thirty women undergoing laparoscopic sterilization with bupivacaine for local anesthesia. INTERVENTIONS: Venous serum bupivacaine levels were measured, with samples drawn at 45, 60, 90, and 120 minutes after injection in 25 patients. Five additional patients had sampling at 15 and 30 minutes as well as at the above times. MEASUREMENTS AND MAIN RESULTS: The highest concentration of bupivacaine was detected at 15 minutes. The mean concentrations at 15, 30, 45, 60, and 120 minutes were 0.86, 0.74, 0.31, 0.27, 0.23, and 0.22 microg/ml, respectively. This is well below the level of serious toxicity. Only four patients received 2.5 mg/kg or greater of bupivacaine. In these patients, mean serum levels were 1.1, 1.0, 0.28, 0.43, 0.9, and 0.29 microg/ml, respectively. CONCLUSION: Serum bupivacaine levels during sterilization using bupivacaine 0.5% without epinephrine for local anesthesia are well below the threshold for serious toxicity.

Anesthesia, Local↗
PubMed1994

The effect of nitrous oxide and carbon dioxide pneumoperitoneum on operative and postoperative pain during laparoscopic sterilization under local anesthesia.

STUDY OBJECTIVE: To compare carbon dioxide and nitrous oxide pneumoperitoneum with respect to intraoperative and postoperative pain during laparoscopic sterilization under local anesthesia. DESIGN: Randomized, double-blind study of pain during surgery and at 15 minutes, 1 hour, and 24 hours postoperatively. SETTING: Regional Medical Center, Memphis, Tennessee. PATIENTS: Women scheduled for laparoscopic sterilization under local anesthesia. Interventions. Forty-nine patients were randomized to carbon dioxide and 56 to nitrous oxide pneumoperitoneum. MEASUREMENTS AND MAIN RESULTS: Pain was assessed using a modified McGill pain questionnaire. Intraoperative pain was measured by the amount of supplemental narcotic required. Analgesic use in the recovery room and during the first 24 hours postoperatively was compared. Demographics for both groups were similar. The groups had no statistical differences in pain during surgery or at any of the postoperative time periods. Recovery room analgesia requirement was similar, but the nitrous oxide group used fewer pain tables (0.98 vs 0.42 tablets) in the first 24 hours. CONCLUSIONS: There is no difference in intraoperative and postoperative pain between nitrous oxide and carbon dioxide pneumoperitoneum for laparoscopic sterilization when used in conjunction with a protocol such as ours.

Administration, Oral↗
PubMed1994

Premenstrual syndrome.

Premenstrual syndrome is a cyclical disorder involving behavioral, emotional, and physical symptoms during the premenstruum. Because of its unknown etiology, a variety of treatment options exist; yet no therapy has consistently reduced symptoms. Most recent advances have occurred in relaxation techniques and psychotropic therapies.

Contraceptives, Oral↗
PubMed1994

Efficacy of depot leuprolide in premenstrual syndrome: effect of symptom severity and type in a controlled trial.

OBJECTIVE: To determine whether depot leuprolide is effective in premenstrual syndrome (PMS) and whether symptom type or severity affects therapeutic or hormonal responses and the incidence of adverse events. METHODS: Twenty-five women who met strict diagnostic criteria for PMS completed a double-blind, placebo-controlled, 6-month crossover trial at a university medical center. Depot leuprolide (3.75 mg/month) or saline was administered intramuscularly for three consecutive treatment cycles. Efficacy, adverse events, and hormone concentrations were assessed at each visit. Repeated-measures analysis of variance was used to analyze continuous data, and ordinal and binary data were analyzed using nonparametric techniques. RESULTS: Depot leuprolide treatment was significantly more effective than placebo on all rating scales. Irritability, neurologic symptoms, breast tenderness, and fatigue were most responsive to treatment. Symptoms were reduced to follicular phase levels only in women without premenstrual depression. Those with moderate premenstrual depression improved but remained clinically symptomatic, whereas the group with severe premenstrual depression showed no improvement on any efficacy measure. Adverse events were lowest in those without premenstrual depression and highest in those with severe depression. Leuprolide suppressed estradiol and progesterone in most premenstrual depression groups but had varying effects on gonadotropins. CONCLUSIONS: Leuprolide treatment reduced both behavioral and physical symptoms and was well tolerated in the absence of severe premenstrual depression. Women should be evaluated for depression severity before receiving a GnRH agonist. The differential response to leuprolide suggests that it may possess diagnostic value in determining distinct subtypes of PMS.

Adolescent↗
PubMed1994

A model for resident surgical training in laparoscopic sterilization.

OBJECTIVE: To measure the effects of a specific instructional program designed to teach residents laparoscopic sterilization. METHODS: The teaching module consisted of a 40-minute videotape and monograph, which each resident studied 1-3 days before beginning a 4-5-week rotation on which he or she performed laparoscopic sterilization procedures. The change in knowledge was measured by comparing pre- and post-test assessments. Twenty-three PGY-2 gynecology residents were administered the peer-reviewed and validated pre-test, which consisted of 31 multiple-choice questions covering the following aspects of laparoscopic sterilization: 1) indications and complications, 2) general aspects of sterilization, 3) sterilization methods, and 4) technical aspects of occlusive device application. A post-test, which consisted of the identical 31 items with the question order changed, was administered after the teaching module was completed. RESULTS: The mean number of correct answers on the post-test (27.2 +/- 2.3, range 22-31) was significantly higher (P < .05) than the mean number of correct answers on the pre-test (17.9 +/- 3.4, range 13-24). There was no difference in residence scores if the module was completed early or late in the academic year or during the first or second year that the program was in effect. CONCLUSION: This study demonstrates that knowledge of a specific surgical technique can be measured and that structured learning packages can be effective. Efforts to teach residents a specific curriculum can have a significant effect on their fund of knowledge. Other specially designed programs may be applicable to procedures commonly performed by gynecologic residents.

Curriculum↗
PubMed1994

Chromopertubation at laparoscopic tubal occlusion.

OBJECTIVE: To evaluate the role of chromopertubation following laparoscopic sterilization in terms of occlusive device displacement, infectious complications, and sterilization failures. METHODS: Five hundred consecutive women scheduled for laparoscopic sterilization were randomized to rings, electrocoagulation, or clips for tubal occlusion. Subjects were further randomized to chromopertubation or no chromopertubation. At chromopertubation, any occlusive device displacement or dye spillage was noted. Patients were followed postoperatively for sterilization failure or infectious complications. Statistical analysis used the chi 2 test. RESULTS: At chromopertubation, no device dislodgment, change in position, or dye spillage from the occlusion site was noted. Dye spillage from the end of the fallopian tube occurred in five patients, and immediate repeat tubal occlusion was performed. Six true sterilization failures occurred during the follow-up period. Despite elimination of five apparent failures in the chromopertubation group, there was no significant difference between the no-chromopertubation and chromopertubation groups with regard to failure rate. There were also no significant differences in postoperative wound infections or development of pelvic inflammatory disease. CONCLUSION: Chromopertubation at sterilization is associated with minimal complications but has limited value in eliminating sterilization failures.

Fallopian Tube Patency Tests↗
PubMed1994

Gonadotropin-releasing hormone agonist use before hysterectomy.

OBJECTIVE: Our purpose was to compare the effects of leuprolide acetate in patients with symptomatic uterine leiomyoma before hysterectomy. STUDY DESIGN: Group I (n = 90) included patients with a pretreatment uterine size of 14 to 18 gestational weeks and group II (n = 60) included patients with uteri > 18 weeks' gestational size. Patients in both groups were randomized to either immediate hysterectomy or 2 months of preoperative gonadotropin-releasing hormone agonist. RESULTS: All patients in the two groups with a pretreatment hemoglobin < 11.0 gm/dl randomized to agonist had a significant (p < 0.05) increase (> or = 1.5 gm/dl) in hemoglobin level. Patients in group I who received preoperative agonist were more likely to undergo vaginal hysterectomy (80% vs 13%, p < 0.05) than were patients who did not receive preoperative agonist. Patients undergoing vaginal hysterectomy had a shorter hospital stay, decreased operative blood loss, and a shorter convalescence period than did those undergoing abdominal hysterectomy. In group II, in spite of a mean uterine volume reduction of 51.3%, intraoperative morbidity, operative blood loss, hospital stay, and postoperative convalescence period did not differ between treatment arms. CONCLUSION: The preoperative administration of gonadotropin-releasing hormone agonist in patients with a uterus of 14 to 18 weeks' size increases the use of vaginal hysterectomy, decreases intraoperative blood loss, and shortens hospital stay and convalescence. Preoperative gonadotropin-releasing hormone agonist for patients with a preoperative hemoglobin < 11.0 gm/dl reduces the risk of preoperative transfusion. Preoperative gonadotropin-releasing hormone use in the nonanemic patient with a uterine size > or = 18 weeks' gestational size doses not appear to lower operative morbidity.

Adult↗
PubMed1993

Single-dose methotrexate: an expanded clinical trial.

OBJECTIVE: Our purpose was to report an expanded clinical trial with a nonlaparoscopic approach to ectopic pregnancy diagnosis combined with single-dose intramuscular methotrexate treatment. STUDY DESIGN: A prospective cohort of 120 women with an ectopic pregnancy < or = 3.5 cm in greatest dimension was enrolled. RESULTS: Patients had a mean age of 26.1 +/- 6.2 years, a mean gravidity of 3.2 +/- 1.6, and a mean parity of 0.97 +/- 1.0. The mean human chorionic gonadotropin titer before treatment initiation was 3950 +/- 1193 mIU/ml. Transvaginal ultrasonography visualized cardiac activity in 14 (11.7%) patients, with an ectopic mass visualized in 113 (94.2%). The mean time to resolution in the 113 (94.2%) subjects successfully treated was 35.5 +/- 11.8 days. Four (3.3%) patients required a second methotrexate dose on day 7. No biochemical or clinical side effects occurred. Posttreatment hysterosalpingograms demonstrated tubal patency on the ipsilateral side in 51 of 62 (82.3%) patients. Of those attempting pregnancy, 79.6% were pregnant, 87.2% intrauterine and 12.8% ectopic. The mean time to achieve pregnancy was 3.2 +/- 1.1 months. CONCLUSIONS: This regimen requires minimal laboratory follow-up and eliminates leukovorin recovery, making it the regimen of choice for medical treatment of unruptured ectopic pregnancy.

Adolescent↗
PubMed1993

Relationship of pelvic infection and chronic pelvic pain.

The approach to the patient with CPP with a history of PID remains a diagnostic challenge even for the experienced clinician. From the initial diagnosis of presumed PID to managing the pain that may result, using an approach that looks at all factors, not just antecedent PID, allows the practicing physician to avoid becoming too narrowly focused in his or her approach. A clinical starting point would assume all possibilities for pelvic pain and evaluate for each. Given the history of one or more episodes of PID, especially if documented with a prior laparoscopy, earlier investigation for adhesions could be justified in selected patients. If the pelvic examination further suggests a pelvic source, a laparoscopy performed early rather than late in the work-up would seem appropriate. The key to management of the patients who have CPP following PID is to use any and all available diagnostic and therapeutic modalities to identify the source(s) before assuming that the patient suffers only from the known sequelae of PID.

Chronic Disease↗