Gynecologic Service Research Articles

Clinical Characteristics Related to Complications in Abdominal Gynecological Surgery

Background: Gynecological conditions account for a significant number of surgical procedures performed worldwide, with complication rates reported between 0.2-34%. In Mexico, complication rates range from 2.15% to 15.06%. Factors such as age, obesity, comorbidities (hypertension, diabetes), and prolonged surgical time are associated with a higher risk of complications, including postoperative infections. Objective: To determine the clinical characteristics related to complications in abdominal gynecological surgery. Materials and Methods: A retrospective, descriptive, cross-sectional, and analytical study was conducted on women undergoing scheduled surgery by the Gynecology service at the Hospital de Ginecoobstetricia UMAE-CMNO IMSS during the period from January 2023 to December 2023. The study aimed to determine the frequency of postoperative complications and their relationship with clinical characteristics. The sample size calculation used the proportion formula and finite population, requiring a minimum sample of 156 patients. However, all gynecological surgeries performed during the study period were included. After obtaining approval from the Local Research Committee in Health 1310, data was collected from the hospital’s surgical productivity registry platform. Surgical data was obtained from both electronic and physical clinical records to identify postoperative complications. The data collection tool was entered into a Microsoft Excel database, and statistical analysis was performed using IBM SPSS (version 30.0). Results: A total of 392 patients were included in the study. Among them, 78 patients (19.9%) experienced complications. The most common complication was hemorrhage (9.2%), followed by wound dehiscence (3.6%), bladder injury (3.1%), surgical wound infection (2.6%), fever (1.5%), vaginal dome hematoma (1.0%), intestinal injury, and urinary tract infection (both at 0.8%), paralytic ileus (0.3%), along with other complications such as vascular injury and death (0.3%). When analyzing the groups, it was found that patients in the complication group had a higher Body Mass Index (BMI) compared to those without complications. Additionally, the surgical time, estimated bleeding, and hospital stay days were significantly higher in the complication group. Both groups showed similar characteristics in terms of age, parity, prior abdominal surgeries, comorbid conditions, smoking, ASA risk classification, and preoperative hemoglobin levels. Conclusions: The frequency of postoperative complications in this study aligns with findings reported in most international studies, with hemorrhage being the most common complication. BMI was significantly associated with a higher risk of complications, including bleeding, need for transfusions, and prolonged surgical times.

Management of Factors Associated with Job Satisfaction of Healthcare Workers in Obstetrics and Gynecology Services at Private Hospitals: A Cross-Sectional Study

Purpose: The job satisfaction of employees is a critical factor in determining the level of health care quality. This study aimed to find out the factors affecting the job satisfaction level of healthcare workers working in obstetrics and gynecology services. Further, to evaluate the job satisfaction level of these healthcare workers on the basis of various dimensions of job satisfaction by using different statistical analysis tools.Design, methodology, and approach: Healthcare workers in obstetrics and gynecology services were measured on the basis of their job satisfaction level by using cross-sectional and descriptive research methods. Survey responses of 220 health care workers were collected from private hospitals in Delhi and NCR India. The collected data was coded and incorporated into SPSS version 20.0 for further evaluation. Descriptive statistical analysis and multi-level logistic regression were employed to summarize the data, and frequency tables and percentages were used to present the results. Findings: A self-administered survey was conducted with a sample of 220 health workers. Overall, 65 (29.54%) of health workers reported satisfaction with their job, and 155 (70.45%) were not satisfied, with neutral responses being assumed. The study also concluded that pharmacists were less satisfied with their jobs, while laboratory professionals, junior resident doctors, and senior resident doctors were more satisfied with their jobs than nurses. Additionally, criteria for performance evaluation and appraisal were found to be the most influential factors in job satisfaction. Practical implications: The findings of this article are useful for hospital management, government, the healthcare sector, and policymakers. All these stakeholders can perform better and work for the betterment of healthcare workers and society by implementing appropriate service policies. Originality/value: The findings of this study reinforce current knowledge on the causes and consequences of dissatisfaction among healthcare workers.

Nursing Care for a Postoperative Patient with Uterine Myomatosis in the Gynecology Department of a National Hospital in Lima, 2022

The present study was applied to an immediate post-operative patient for uterine myomatosis hospitalized in the obstetrics and gynecological service. Uterine fibroids or leiomyomas are tumors formed by smooth muscles that grow on the wall of the uterus. They are non-malignant tumors common in women of reproductive age. The objective was to manage nursing care in a postoperative patient for uterine myomatosis. The study had a qualitative, single-case approach; The methodology applied was the nursing care process (PAE), which included a 41-year-old patient, in which each of its stages was applied, the assessment was carried out through the assessment guide with the eleven patterns Marjory Gordon's functional models, three altered patterns were prioritized: cognition and perception, coping and tolerance to stress, and sleep and rest; The diagnostic stage was developed based on taxonomy II of NANDA I, seven nursing diagnoses were identified, prioritizing 3 of them: (00132) Acute pain, (00146) Anxiety and (00198) Altered sleep pattern, according to the format SSPFR (signs and symptoms, problem and related factor/risk factor/associated); In planning, the individualized care plan was developed based on the NOC Taxonomy, NIC with expected results and selection of interventions; In the execution stage, nursing care was administered and the care plan was updated; and the evaluation was given by the difference in final and baseline scores respectively; In the evaluation, favorable results were obtained with change scores of + 2, +2 and + 1. In conclusion, the PAE was carried out on the patient, which made it possible to provide humanized care with warmth and quality to the patient

The role of the nurse in the care of a post-operative cesarean patient with HELLP syndrome in the gynecology and obstetrics service of a National Hospital, 2022

Pregnancy with hellp syndrome is life-threatening, it appears in 5-9 out of every 1000 pregnancies and in 10-20% of cases with severe preeclampsia, it causes the breakdown of red blood cells, causing liver problems , bleeding and blood pressure. The objective of this study is to manage nursing care for a patient with síndrome of hellp and hemoperitoneum with pelvic hematoma in the obstetrics-gynecology service. The present study is a research with a qualitative approach, clinical case type, study subject female, 21 years old. The nursing care process was used as a method, the assessment guide of Marjorie Gordon's 11 functional patterns was applied, by which altered patterns were found, formulating the nursing diagnoses: Decreased cardiac output, Acute Pain and CP: Shock hypovolemic. The activities were executed in a timely manner, the evaluation was through the difference in baseline and final scores of the indicators. We can conclude that hellp syndrome is a hypertensive disorder of pregnancy, however, the complication of this post-cesarean patient is hemoperitoneum with pelvic hematoma, timely nursing care against this was the main axis in the patient's restoration. It is concluded that, according to the problems identified in the patient, the nursing care process was managed in its five stages, improving the patient's health status, but the survival and success of the treatment provided depends on the timely identification of the problems and appropriate choice of treatment

Estimating Future Obstetrics and Gynecology Workforce Needs in Japan.

Introduction The Ministry of Health, Labour, and Welfare of Japan (MHLW) introduced a regulation on physician overtime work in 2024, limitingovertime hours to a maximum of 960 annually. This regulation has raised concerns that the quality of medical care may decline. On the other hand, the shifting demographics of Japan, characterized by an aging population and declining birth rates, suggest a potential decrease in demand for obstetrics and gynecology (OBGYN) services in the future. In Japan, there is no feasible study regarding how many OBGYN doctors are currently lacking and how many of them will be necessary. Herein, we conduct simulations using Japanese insurance claims data to estimate the required number of OBGYN doctors. Methods This is a simulation study. We projectfuture demand based on the current demand, working hours, and demographic changes. Using health insurance claims data, we estimate how many OBGYN doctors will be necessary in the future within the overtime work limit. Results The required number of doctors shows a declining trend that mirrors the declining population. Presently, there is a shortage of 1,500 doctors to comply with the 960-hour limit, and it is anticipated to be until 2040 or later before all doctors adhere to this limit. Several sensitivity analyses consistently support this trend. Conclusions Despite the existing shortage of obstetricians and gynecologists, future demands are expected to decrease. Inter-hospital and regional communication should be promoted for systemic innovations.

Nursing Care for a Patient with Severe Preeclampsia in the Gynecology and Obstetrics Service of a National Hospital in Chimbote, 2022

Preeclampsia is a complication of the third trimester of pregnancy that affects the maternal-fetal dyad, which is the reason for the patient's admission to the service. The objective was to describe the nursing care of a pregnant woman with preeclampsia with severity criteria in a hospital in Chimbote, 2022. The study had a qualitative approach, single case type, the methodology was the nursing care process, which included the patient of 25 years of age, in which all the stages of the Nursing Care process were followed: the assessment stage was carried out through the assessment framework of Maryori Gordon's 11 functional patterns. Nine altered patterns were found, prioritizing four: Nutritional/metabolic, perceptive/cognitive, sexuality, reproduction and activity/exercise, the diagnostic stage was formulated using the NANDA I classification, eight nursing diagnoses were identified, one of them being prioritized through the reasoning network; Likewise, the planning stage was carried out taking into account the NOC NIC Taxonomy, in the execution stage the care was administered and the evaluation was given by the difference in start and end scores respectively. In conclusion, the nursing care process made it possible to provide humanized, individual and quality care to the patient in a systematic, logical, orderly manner, with favorable results

Clinical and Ultrasound Features of Normocyclic Non-Hyperandrogenic Adolescents in Early Gynecological Life

Objective: This study aimed to determine the prevalence of polycystic ovarian morphology (PCOM) in healthy postmenarcheal girls and assess whether it represents a crucial physiological phase in gynecological development. Additionally, it evaluated if an elevated stromal-to-surface area (S/A) ratio could identify individuals at risk of developing polycystic ovarian syndrome (PCOS). Design: This is an observational cross-sectional study. Participants: A total of 302 healthy postmenarcheal girls aged 14–18 were included in the study. Setting: The study was conducted at the Pediatric and Adolescent Gynecology Service of the University Hospital Duilio Casula, Monserrato, University of Cagliari, from 2020 to 2023. Methods: Participants were divided into three groups: normal ovarian morphology (NOM), PCOM with normal S/A ratio (PCOM-NS), and PCOM with increased S/A ratio (PCOM-IS). Anthropometric, clinical, hormonal, and ultrasound (US) characteristics were analyzed. Results: The overall prevalence of PCOM was 43% (95% CI: 0.37–0.49). Among 302 subjects, 171 (57%) exhibited NOM, 90 (30%) showed PCOM-NS, and 41 (13%) had PCOM-IS. The age and years of postmenarcheal life were significantly lower in the PCOM-NS group than in the NOM group. PCOM-NS exhibited a higher waist-to-hip ratio, hirsutism prevalence, and follicle count per ovarian section. PCOM-IS was associated with elevated androgen levels. A significant reduction in the PCOM pattern was observed after the third postmenarcheal year, while the NOM pattern increased significantly beyond 5 years postmenarche. Limitations: The study is limited by its cross-sectional design, which precludes establishing causality. Additionally, the exclusion of certain participants due to technical limitations in US evaluation may introduce selection bias. Conclusions: PCOM may represent a normal physiological phase in ovarian development during early adolescence, predominantly observed in the first 1–3 years postmenarche. An increased S/A ratio could help identify adolescents who may benefit from monitoring for potential PCOS development.

Examination of the Relationship Between the Comfort Levels and the Mother to Infant Bonding Levels of Women in the Postpartum Period

Aim: The research was conducted to establish the relationship between the comfort levels of mothers in the postpartum period and mother-infant bonding. Material and Method: The research is of descriptive type. The sample of the study consisted of 257 women who had just given birth in the Gynecology and Obstetrics service of a public hospital in Türkiye and voluntarily participated in the research between February and April 2023. Personal information questionnaire, postpartum comfort scale, and mother to infant bonding scale were used to collect the data of the study. Results: The average total score women received from the postpartum comfort scale in the postpartum period was 97.45±15.22. A statistically significant difference was found between the postpartum comfort scale total score average according to the women's working status, number of postpartum days, postpartum care requirement and number of patients in the room (p

The Effect of Genital Aesthetic Surgery on Body Image Cathexis and Sexual Function in Women.

The emotions that women generally feel about the appearance of their bodies cause them to turn to aesthetics surgery. This study was conducted to determine the effect of genital aesthetic surgery on body image cathexis and sexual function in women. This descriptive-prospective study was conducted between November 1, 2022, and July 30, 2023, with 50 women who applied to the gynecology service in a training and research hospital. Sociodemographic and descriptive characteristics questionnaire, body image cathexis scale, and female sexual function index were filled out before surgery. The patients whose contact information was obtained were called by phone 2 months after surgery and the body image cathexis scale and the female sexual function index were administered again. Frequency analysis, t-test, and one-way analysis of variance were used to evaluate the data. Significance was accepted as p<0.05. The average age of the women was 39.26±10.28 (22-68) and the mean body mass was 25.39±4.55 (17.6-39.8). The majority of women (44%) underwent perineoplasty. It was observed that the level of body cathexis after genital aesthetics surgery was significantly higher than the preoperative body cathexis, and the general level of sexual function, desire, arousal, orgasm, and satisfaction level increased significantly after surgery. Female genital aesthetics surgery was found to improve body cathexis and increase sexual function in women. In order to reduce unnecessary female genital aesthetic surgery, education should be planned on this subject and public awareness about genital appearance should be increased. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Relationship Between Population Density, Availability of Gynecological Services, and Cervical Cancer Incidence and Mortality Across Administrative Units in Serbia and Bosnia and Herzegovina During 2016-2020.

Background and Objectives: Burden of cervical cancer in Central and Eastern Europe is higher than in other parts of Europe. We analyzed cervical cancer epidemiology in Serbia and Bosnia and Herzegovina (the Federation of Bosnia and Herzegovina and the Republic of Srpska) from January 2016 to December 2020, exploring the role of available sociodemographic factors and healthcare service parameters on incidence and mortality rates, using an ecological approach based on aggregated data. Materials and Methods: Incidence and mortality rates are standardized using the method of direct standardization with the World-ASR-W. Administrative units are grouped by tertiles of incidence and mortality to explore sociodemographic factors and healthcare parameters across these groups. Results: Average age-standardized incidence rates of cervical cancer per 100,000 females were 19.28 in Serbia, 12.48 in the Federation of Bosnia and Herzegovina, and 22.44 in the Republic of Srpska. Mortality rates per 100,000 females were 6.67, 5.22, and 4.56 in Serbia, the Federation of Bosnia and Herzegovina, and the Republic of Srpska, respectively. Several parameters of sociodemographics and health service usage differed significantly across units grouped by tertiles based on incidence level, i.e., female population ≥ 15 years old (p = 0.028), population density (p = 0.046), percent of gynecologists in the primary healthcare (p = 0.041), number of gynecologists per 10,000 females ≥ 15 years (p = 0.007), and the area-to-gynecologist ratio (p = 0.010). A moderate negative correlation was found between incidence and population density (rho = -0.465, p = 0.017), and a moderate positive correlation between incidence and area-to-gynecologist ratio (rho = 0.534, p = 0.005). Conclusions: Cervical cancer remains a leading cause of cancer among women in developing countries. Implementing tailored activities, such as educational programs, preventive services, and investments in healthcare infrastructure, particularly at the administrative units' level, can help in reducing health disparities and improving health outcomes.

The Effects of Baby Calming Training Provided to Primiparous Mothers on Maternal Role Perception, Maternal Attachment, and Breastfeeding Self-Efficacy: A Randomized Controlled Trial.

Background: Mothers of crying babies have difficulty adapting to their roles and problems with breastfeeding and attachment. Objective: This study aimed to assess the impact of the baby calming training provided to primiparous mothers on maternal role perception, maternal attachment, and breastfeeding self-efficacy. Methods: The study was conducted in a randomized controlled experimental design between March 2023 and March 2024 in the gynecology and obstetrics services of a public hospital in northeastern Turkey (Clinical Trial Number: NCT05594836). The research was conducted with a total of 84 primiparous mothers, including 41 intervention and 43 control groups, who met the inclusion criteria. The Baby Calming Training was administered face-to-face in the intervention group, utilizing a baby swaddling blanket, a sleep companion emitting white noise, and a training booklet. The control group received routine care. Data were collected through the Mother and Baby Introductory Information Form, Semantic Difference Scale-Me as a Mother, Maternal Attachment Inventory, Breastfeeding Self-Efficacy Scale-Short Form, and Infant Sleep Activity Record. The data were analyzed using descriptive statistics, Pearson's chi-square test, independent samples t-test, Mann-Whitney U test, Wilcoxon test, mixed design ANOVA analysis, Cohen's d, and 95% confidence interval (CI). This study adhered to CONSORT research guidelines. Results: Mothers in the intervention group exhibited higher mean scores on the perception of maternal role (mean ± SD: 70.37 ± 5.92, t: 8.590, 95% confidence interval [CI]: [1.347-2.375], d: 1.865, p < 0.001), maternal attachment (mean ± SD: 100.42 ± 1.52, U: 151.500, 95% CI: [0.732-0.892], d: 0.828, p < 0.001), and breastfeeding self-efficacy (mean ± SD: 64.00 ± 5.98, t: 8.109, 95% CI: [1.248-2.258], d: 1.757, p < 0.001) than the control group. It was determined that the total sleep time of the babies in the intervention group was higher, and the total crying duration was lower (p < 0.001). Conclusion: The study revealed that infant soothing training for primiparous mothers enhanced maternal role perception, maternal attachment, breastfeeding self-efficacy, and extended infants' sleep duration. Furthermore, infants exhibited reduced crying.

A Survey on Awareness Regarding Pediatric and Adolescent Gynecology (PAG) Services in Malaysia—Are We Lacking?

A Survey on Awareness Regarding Pediatric and Adolescent Gynecology (PAG) Services in Malaysia—Are We Lacking?

Effects of White Noise and Therapeutic Touch on Pain and Comfort in Newborns during Heel Lance: A Randomized Controlled Study.

Nonpharmacological methods such as white noise and therapeutic touch can be used in pain management in neonates. This randomized controlled study evaluated the effects of white noise and therapeutic touch during heel lance procedures on pain, comfort levels, and physiological parameters in healthy neonates. This parallel, randomized controlled study was conducted in the Obstetrics and Gynecology Service of a regional hospital. The sample comprised 160 neonates with gestational ages of >35weeks randomly assigned to 4 groups (white noise [WN], therapeutic touch [TT], white noise+therapeutic touch [WT], and control [CG] group). Pain and comfort levels were evaluated according to the Neonatal Infant Pain Scale, and the COMFORTneo Scale. The primary outcomes were pain and comfort levels, and the secondary outcomes were heart rate and SpO2 levels. The Kruskal-Wallis test was used to compare the scale scores among groups. There were significant differences among groups in terms of Neonatal Infant Pain Scale and COMFORTneo scores (P <.05). The pain scores for the white noise, therapeutic touch, and white noise+therapeutic touch groups were 4.2±2.0, 5.2±1.6, and 3.3±1.7, respectively. There was a significant difference in average heart rate during the heel lance procedure among the groups (P <.05). Pain scores of the intervention groups were lower compared to the control group. The combination of white noise and therapeutic touch was more effective in reducing pain and increasing comfort levels. Nurses could reduce procedural pain by applying these pain relief methods.

OCCURRENCE OF HUMAN PAPILLOMAVIRUS (HPV) IN WOMEN OF LGBTQIA+ COMMUNITY TREATED IN MANAUS, AMAZONAS

Human papillomavirus (HPV) is a significant etiological factor for several types of cancer, including cervical carcinoma, with 80% of cases of cervical cancer occurring in Latin America. In Brazil, cervical carcinoma is the third most prevalent cancer among women, and the northern region and the state of Amazonas have the highest incidence in the country. However, not all women benefit from cervical cancer screening measures. Most women in the LGBTQIA+ community do not seek gynecological health services since they often face barriers related to female homosexuality when accesing sexual health services. Using PCR, this study perfomed the molecular detection and genotyping of HPV in thirty-six patients (20 homosexual and 16 bisexual women) from Manaus, Amazonas, Brazil. Samples of the cervical epithelium were taken during the preventive examination and genotyping was perfomed to detect HPV 16, 18, 31 and 58. Of the thirty-six patients analyzed in this study, 88% of bisexual women (n=14) and 60% of homosexual women (n=12) tested positive for HPV. The HPV 18 genotype was the most frequent among the findings. The results indicate that homosexual and bisexual women are more vulnerable to HPV infections due to the lack of more specific gynecological care directed to this group, which includes the lack of training of professionals to deal with the particularities of this population group. Therefore, more HPV screening studies for LGBTQIA+ women and improved training for specialized health professionals are needed.

Gynecological health care services utilization and violence among female sex workers in Togo in 2021

BackgroundFemale Sex Workers (FSW) in Sub Saharan Africa face multiple challenges increasing their vulnerability to poor health, particularly poor sexual and reproductive (SRH) health outcomes and violence. The aim of this study was to assess the use of gynecology health care services and factors associated with its use as well as experiences of violence among FSW in Togo.MethodA cross-sectional study was carried out in 2021 among FSW in two cities of Togo. A snowball sampling method was used and initial seeds were identified in each site in collaboration with FSW non-governmental organizations. A logistic regression was performed to identify factors associated with the use of a SRH service and violence.ResultsA total of 447 FSW with a median age of 30 [IQR: (24–38)] participated in this study and 43.4% of them had reached at least secondary school. Among them, 29.1% reported having been to a gynecological consultation over the previous year. Factors associated with a gynecological consultation included: living in the Lomé capital city (aOR = 0.35, 95%CI 0.22–0.54), and an experience of condom breakage or slippage (aOR = 2.00; 95%CI 1.19–2.64). The majority reported at least one lifetime pregnancy (87.9%), 39.8% reported ever having an unintended pregnancy and 67.6% of them ever had an abortion. Finally, 61.1% indicated being victims of physical, sexual, or emotional violence in the previous six months. Sex workers living in Lomé (aOR = 1.78; 95%CI 1.16–2.73); a history of abortion (aOR = 1.53; 95%CI 1.03–2.31) and having more than 15 clients per week (aOR = 4.87; 95% CI 1.99–11.94), were more likely to experience violence.ConclusionThere is an under-utilization of health care services among FSW in Togo in addition to overall poor sexual and reproductive health outcomes with a high prevalence of gender-based violence. Those results highlight the importance of continued advocacy for the integration of SRH care with HIV prevention services geared toward FSW as well as a holistic approach to SRH care with innovative ways to prevent violence.

Rare bleeding disorders in girls and adolescent females with bleeding symptoms

Background Females with rare bleeding disorders who suffer from mild bleeding symptoms and extra bleeding symptoms related to menstruation are usually delayed in their diagnosis, necessitating early evaluation for an underlying bleeding diathesis based on clinical suspicion. Objectives We aimed to assess the frequency of rare bleeding disorders among female children and adolescents presenting with bleeding symptoms and to evaluate their health-related quality of life. Patients and methods Sixty females with bleeding symptoms younger than 18 years old were recruited and were subjected to detailed medical assessment and evaluation of different bleeding symptoms using the ISTH-BAT, the menstrual pictogram for assessing menstrual blood loss in pubertal females, and the Arabic version of the pediatric quality of life multidimensional fatigue scale. Laboratory investigations are tailored according to the institutional guidelines. Results The median age of the studied population was 8.25 years and 48.3% had a positive family history of bleeding. The mean age of presentation/diagnosis of Von Willebrand disease and Glanzmann disease were 6.1/8.2 and 5.3/7.6 years, respectively. Forty-five females had inherited bleeding disorders, and 15 had acquired ones. The most common diagnosis was Von Willebrand disease (30%), followed by Glanzmann disease (18.3%). The most common acquired disorder was aplastic anemia (13.3%). There was a higher ISTH-BAT total score in those with inherited disorders than in those with acquired disorders (P=0.006). Conclusion Adolescent females who present to a tertiary pediatric or gynecology service with bleeding manifestations should be screened for underlying bleeding disorders.

Implementing a financial toxicity screening program.

275 Background: Financial toxicity (FT) is a well-documented negative side effect of cancer treatment. Routine screening can mitigate FT by proactively connecting at-risk patients to resources and counseling. Herein, we describe implementation of a FT screening quality improvement (QI) program. Methods: At a comprehensive cancer center, an interdisciplinary team explored options for implementation, with consideration for screening content, mechanism for delivery, and clinical workflow. Through consensus, the team agreed to use the 12-item COmprehensive Score for Financial Toxicity (COST) tool, a health-related social risk checklist, patient-self report of cost-related medication non-adherence, and a visual analog quality of life scale. Surveys were sent via portal every four months to patients on active treatment. The QI project was implemented on the breast, gastrointestinal, gynecologic, and thoracic services. COST scores ≤20 or any endorsed social risk (e.g., food, transportation) yielded a positive screen, and nurses placed a financial counseling referral, with counseling dispositions tracked. In March 2023, due to an influx of “unproductive” counseling dispositions (e.g., patient could not be contacted, patient no longer wanted help), machine learning models suggested reducing the screening threshold to COST scores ≤16 and limiting the social risk checklist to four items (food, transportation, medication, and housing insecurity). Results: From 06/2022-12/2023, 196,675 financial toxicity surveys were assigned to 78,289 unique patients: 38% (n=75,526) were completed by 45,003 patients. Of these, 56% have completed one survey, 26% have completed two surveys, and 18% have completed three or more. Since implementation, 9612 financial counseling referrals have been placed, yielding assistance with insurance selection and applications for assistance with co-payments, non-medical expenses, and out-of-pocket costs. During the QI project, several real-time workflow changes were made. On day 1, 519/1811 patients screened positive, yielding an overflow of counseling referrals: an additional question to allow patients to opt into referral, rather than generating an automatic referral, was then added: the following week, 136 referrals were generated. In September 2022, this opt-in was modified to allow patients to directly identify the areas in which they were seeking assistance (e.g., insurance counseling, out-of-pocket expenses). In 2024, the screening was reduced to two COST questions that had a 0.92 correlation with the full-tool. Conclusions: Routine FT screening is feasible during active treatment, although attention is needed to clinical workflows to ensure patients have access to the screening, nurses and other clinical staff are involved in the implementation, and referrals to resources are available for patients who screen positive. Future work will address cadence of delivery and outcomes of interventions.

The Effect of Mother's Voice and Father's Voice Listened by Newborns During Heel Blood Collection on Pain Level and Physiological Parameters: A Randomized Controlled Study.

The newborn can learn the voices of its mother and father during intrauterine life, and the reencounter with these familiar voices after birth has a relaxing and calming effect on the baby. The purpose of this study was to determine the effect of mother's voice and father's voice that newborns listened to during the heel blood collection procedure on pain level and physiological parameters. The study was a randomized controlled trial. The study consisted of a total of 90 newborns as participants (mother voice group=30, father voice group=30, and control group=30) at the Düzce Atatürk State Hospital Gynecology Service, Türkiye. Newborns randomly assigned to the intervention groups were made to listen to the mother's voice/father's voice during the heel prick procedure. The newborn in the control group received standard heel blood collection procedures. When the pain level of newborns was examined, it was determined that the lowest Newborn Infant Pain Scale score was in the mother's voice group (P <.05). When the physiological parameter results were evaluated, it was determined that the highest oxygen saturation value and the lowest heart rate were found in the mother's voice group (P <.05). It was determined that the mother's voice was the most effective method in relieving the pain that occurred during the heel prick procedure and in the positive course of physiological parameters in newborns. According to the results of the study, it is recommended to use the mother's voice in order to reduce the pain caused by the heel prick attempt in newborns and to regulate their physiological parameters.

Effect of kangaroo mother care and white noise on physiological-stress parameters in heel lancing: randomized controlled study

BackgroundNewborns are exposed to varying degrees of stressful interventions due to procedures such as heel lancing used in routine metabolic screenings. It is an examination of the effects of white noise and kangaroo care on some physiological parameters and stress markers (cortisol and glucose-regulated protein 78-GRP78) in heel lancing in newborns.MethodsRandomized controlled study was conducted at a gynecology service of a hospital between January and September 2023. 90 babies were divided into three groups: 30 babies in the Kangaroo Care Group (KCG), 30 babies in the White Music Group (WMG), and 30 babies in the Control Group (CG). All babies were randomly divided into groups. Stress parameters were measured by saliva collection method and physiological parameters by saturation device.ResultsA statistically significant difference was determined between the total crying time, pulse and saturation values ​​according to the groups (p < 0.001; p = 0.001). A statistically significant difference was determined between the mean values ​​of cortisol and GRP78 measurements according to group and time interaction (p < 0.001). KCG was more effective in reducing total crying time and stabilizing pulse, saturation, salivary cortisol, GRP-78 values compared to WNG and CG.ConclusionIt was concluded that white noise and kangaroo care help reduce newborns’ stress in the case of heel lancing.Practical implicationsThe practice of kangaroo care and the use of white noise methods may assist healthcare professionals as supportive methods in stress management during invasive procedures.Trial RegistrationNCT06278441, registered on 19/02/2024.

Организационные аспекты мониторинга беременных в Тульской области.

In recent decades, there has been an increasing use of modern technologies and information systems in order to increase the accessibility, effectiveness and quality of medical care. The issue of organizing medical care using digital technologies in the Tula region is relevant. The purpose of the study is to determine the main organizational aspects of the work of the situational center of the Tula Regional Perinatal Center named after V. S. Gumilyovskaya for monitoring pregnant women. Materials and methods. The structure and mechanisms of operation of the situational center of the GUZ «TOPTS named after V. S. Gumilyovskaya» are analyzed. Research methods: empirical, analytical, descriptive. Results. The situation center inside the perinatal center represents a new direction, where the collection, visualization and processing of data from various services play a crucial role in optimizing and improving the level of medical care for pregnant women registered in the regional women’s clinics. One of the main pillars is such a division of the perinatal center as the obstetric remote consultation center. In addition to the ADCC, the situation center receives data on the state of the service from the regional information subsystem for monitoring maternity care in the Tula region (RISAR) and reports from the BARS-Web-Vaults information and analytical system. The main visualization tool obtained from all data sources used by the situation center is a component of the information and analytical system of the Situation Center of the Governor of the Tula Region interactive analytical panels with a graphical interface – dashboards. Conclusion. Creation of a situation center in the State Institution «TOPC named after. V. S. Gumilevskaya» is designed to increase the efficiency of the obstetrics and gynecology service in the region through the prism of modern technologies. The combination of modern technologies and medical knowledge in the situation center makes it a relevant tool for improving medical care for pregnant women and newborns, providing medical institutions with solutions based on advanced information technologies and data analytics. The introduction of a situation center made it possible to reduce the number of errors in routing pregnant women at the regional level.