Abstract：
OBJECTIVE:To evaluate the effects of shared decision making using a simple decision aid for opioid prescribing after hysterectomy. METHODS:We conducted a prospective quality initiative study including all patients undergoing hysterectomy for benign, nonobstetric indications between March 1, 2018, and July 31, 2018, at our academic institution. Using a visual decision aid, patients received uniform education regarding postoperative pain management. They were then educated on the department's guidelines regarding the maximum number of tablets recommended per prescription and the mean number of opioid tablets used by a similar cohort of patients in a previously published study at our institution. Patients were then asked to choose their desired number of tablets to receive on discharge. Structured telephone interviews were conducted 14 days after surgery. The primary outcome was total opioids prescribed before compared with after implementation of the decision aid. Secondary outcomes included opioid consumption, patient satisfaction, and refill requests after intervention implementation. RESULTS:Of 170 eligible patients, 159 (93.5%) used the decision aid (one patient who used the decision aid was subsequently excluded from the analysis owing to significant perioperative complications), including 110 (69.6%) laparoscopic, 40 (25.3%) vaginal, and eight (5.3%) abdominal hysterectomies. Telephone surveys were completed for 89.2% (n=141) of participants. Student's t-test showed that patients who participated in the decision aid (post-decision aid cohort) were discharged with significantly fewer oral morphine equivalents than patients who underwent hysterectomy before implementation of the decision aid (pre-decision aid cohort) (92±35 vs 160±81, P<.01), with no significant change in the number of requested refills (9.5% [n=15] vs 5.7% [n=14], P=.15). In the post-decision aid cohort, 76.6% of patients (n=121) chose fewer tablets than the guideline-allotted maximum. Approximately 76% of patients (n=102) reported having leftover tablets. CONCLUSION:This quality improvement initiative illustrates that a simple decision aid can result in a significant decrease in opioid prescribing without compromising patient satisfaction or postoperative pain management.
journal_name
Obstet Gynecoljournal_title
Obstetrics and gynecologyauthors
Vilkins AL,Sahara M,Till SR,Ceci C,Howard R,Griffith KC,Waljee JF,Lim CS,Skinner BD,Clauw DJ,Brummett CM,As-Sanie Sdoi
10.1097/AOG.0000000000003468subject
Has Abstractpub_date
2019-10-01 00:00:00pages
823-833issue
4eissn
0029-7844issn
1873-233Xjournal_volume
134pub_type
杂志文章abstract：:Seventy-seven patients, presenting with radiation small bowel injuries at the University of Texas M. D. Anderson Hospital and Tumor Institute at Houston between 1962 and 1978, were analyzed retrospectively. The patients were divided into two categories: bowel bypass without resection, and resection of irradiated bowel...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：
更新日期：1985-04-01 00:00:00
abstract：OBJECTIVE:To evaluate a new sonographic method to measure depth and width of proximal urethral dilation during coughing and Valsalva maneuver and to report its use in a group of stress-incontinent and continent women. METHODS:Fifty-eight women were evaluated, 30 with and 28 without stress incontinence proven urodynami...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/s0029-7844(98)00420-7
更新日期：1999-03-01 00:00:00
abstract：BACKGROUND:Placental abscess formation is rarely recognized prenatally. We present a case detected ultrasonographically that developed from a central line infection and caused recurrent maternal bacteremia. CASE:A young woman with a 21-week twin gestation presented with recurrent fevers. She had received treatment for...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：10.1097/01.AOG.0000165268.09352.ed
更新日期：2006-02-01 00:00:00
abstract：:A case of meconium peritonitis that was diagnosed ultrasonographically in the early third trimester in a patient with acute polyhydramnios is presented. The pathophysiologic progression of this condition is demonstrated by serial ultrasound examinations. Neonatal radiologic confirmation of the diagnosis is also presen...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：
更新日期：1984-12-01 00:00:00
abstract：:A preterm birth prevention program consisting of risk scoring, intensive weekly observation including cervical examinations, and detailed education about preterm labor signs and symptoms was tested in a predominantly black, indigent population. One thousand high-risk women were randomized to treatment or control group...
journal_title：Obstetrics and gynecology
pub_type： 临床试验,杂志文章,随机对照试验
doi：
更新日期：1990-06-01 00:00:00
abstract：:Management of the post-term pregnancy depends on the certainty of dating, likelihood of successful induction, and risks of expectant management. To estimate the risk of fetal death in an expectantly managed post-term population, we reviewed 8038 consecutive post-term gestations followed expectantly with a twice-weekly...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章,评审
doi：
更新日期：1992-06-01 00:00:00
abstract：OBJECTIVE:To evaluate the pregnancy characteristics, methods of delivery, and neonatal outcomes of fetuses affected by osteogenesis imperfecta. METHODS:We reviewed medical records of 1016 individuals whose cells were sent to the University of Washington Collagen Diagnostic Laboratory between 1987 and 1994 for confirma...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/s0029-7844(00)01100-5
更新日期：2001-01-01 00:00:00
abstract：:Inherited thrombophilias are associated with an increased risk of venous thromboembolism and also have been linked to adverse outcomes in pregnancy. However, there is limited evidence to guide screening for and management of these conditions in pregnancy. The purpose of this document is to review common thrombophilias...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：10.1097/AOG.0b013e3181d9d82d
更新日期：2010-04-01 00:00:00
abstract：:Ten gravidas with bacteriuria in the immediate antepartum period subsequently delivered vaginally and did not receive antibiotic therapy. Four of these women developed postpartum endometritis and in three of them, the same Enterobacteriaceae recovered from the urine was present in the endometrial cultures. Of the 1233...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：
更新日期：1991-08-01 00:00:00
abstract：:The value of the contraction stress test (CST), although well documented in late pregnancy, has been questioned earlier in gestation. We have evaluated the reliability of the CST in 102 patients tested before 33 weeks' gestation. Eighteen patients with a positive CST had a significantly higher incidence of abnormal ur...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：
更新日期：1978-12-01 00:00:00
abstract：:For direct laparoscopic entry using a sharp and dull trocar technique, the sharp trocar is inserted with a twisting motion under constant pressure, then replaced with a dull trocar when a slight loss of resistance is felt. A slow, gradual entry into the peritoneal cavity is accomplished by twisting the dull trocar und...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/0029-7844(96)00215-3
更新日期：1996-10-01 00:00:00
abstract：OBJECTIVE:To identify independent risk factors for endometrial neoplasia in women with abnormal perimenopausal or postmenopausal bleeding and to use those factors to develop and test a predictive model. METHODS:We conducted a case-control study of women with abnormal perimenopausal or postmenopausal bleeding who had e...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/s0029-7844(98)00469-4
更新日期：1999-04-01 00:00:00
abstract：:Preterm birth is the leading cause of neonatal mortality and the most common reason for antenatal hospitalization (1-4). In the United States, approximately 12% of all live births occur before term, and preterm labor preceded approximately 50% of these preterm births (5, 6). Although the causes of preterm labor are no...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：10.1097/AOG.0000000000001260
更新日期：2016-01-01 00:00:00
abstract：:Two hundred ten rats were randomized into one of five study groups to compare standard absorbable sutures with a new synthetic absorbable suture. We evaluated Maxon (polyglyconate), Vicryl (polyglactin), chromic catgut (catgut), and PDS (polydioxanone) with respect to tissue inflammatory reaction, knot security, sutur...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：
更新日期：1988-03-01 00:00:00
abstract：:Although it is generally believed that patients with previous cervical cerclage have abnormal labor patterns, there is little evidence to support this belief. We analyzed the pattern of cervical dilatation during labor in 114 women with cervical cerclage by the McDonald procedure who delivered vaginally at term and co...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：
更新日期：1990-08-01 00:00:00
abstract：:The safety and efficacy of laminaria tents as an adjunct to labor induction near term were examined in a prospective, controlled, and randomized study involving insertion of laminaria into the cervical canal the evening prior to planned induction. Six of 35 subjects in whom laminaria were used entered labor spontaneou...
journal_title：Obstetrics and gynecology
pub_type： 临床试验,杂志文章,随机对照试验
doi：10.1097/00006250-197805000-00021
更新日期：1978-05-01 00:00:00
abstract：:The diagnostic effectiveness of the lecithin:sphingomyelin (L:S) ratio was compared with that of the quantitative amniotic fluid foam stability index (FSI) test in the prenatal evaluation of pregnancies associated with fetuses appropriately grown for gestational age (AGA) and with intrauterine growth retardation (IUGR...
journal_title：Obstetrics and gynecology
pub_type： 临床试验,杂志文章
doi：
更新日期：1981-09-01 00:00:00
abstract：:A case of nonfatal air embolism from orogenital sex in the 30th week of pregnancy is described. Because of a delay in the diagnosis, the patient did not receive hyperbaric oxygen therapy until 39 hours after the incident. Severe neurologic dysfunction persisted despite hyperbaric therapy. The world literature on oroge...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：
更新日期：1983-05-01 00:00:00
abstract：:The outcome of delivery of infants weighing more than 4000 g born during two time periods 15 years apart was studied retrospectively. The increased use of cesarean section and other obstetric advances did not reduce the risk of fetal asphyxia and trauma associated with large fetal size. Maternal factors were identifie...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：
更新日期：1983-06-01 00:00:00
abstract：:Continuous-wave and pulsed Doppler ultrasound measurements of blood flow velocity waveforms of both uterine and umbilical arteries were performed on 85 patients to assess the correlation between these two measurements techniques. Peak systolic to end-diastolic (S/D) ratios measured by continuous-wave devices were not ...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：
更新日期：1988-10-01 00:00:00
abstract：OBJECTIVE:The experience of physical and sexual violence (victimization) is common among U.S. women and is associated with adverse health consequences. The study objectives were to estimate the prevalence of victimization in women with cancer and to examine associations with demographics, cancer screening, and cancer s...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：10.1097/01.AOG.0000217694.18062.91
更新日期：2006-06-01 00:00:00
abstract：OBJECTIVE:To estimate the diagnostic accuracy of electronic fetal heart rate abnormalities in the identification of neonates with encephalopathy treated with whole-body hypothermia. METHODS:Between January 1, 2007, and July 1, 2013, there were 39 neonates born at two hospitals within our system treated with whole-body...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：10.1097/AOG.0000000000000424
更新日期：2014-09-01 00:00:00
abstract：OBJECTIVE:To assess the effect of maternal involvement in motor vehicle crashes on the likelihood of adverse pregnancy outcomes and to estimate the effect of seatbelt use in reducing the occurrence of those outcomes. METHODS:Statewide motor vehicle crash, birth, and fetal death records from 1992 to 1999 were probabili...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/s0029-7844(03)00518-0
更新日期：2003-08-01 00:00:00
abstract：:Cervical smears taken by the wooden Ayre spatula (widely used in the United Kingdom) and by a plastic spatula (Armovical) were compared for their ability to detect dysplastic cervical epithelium and endocervical cells. At the same time, the value of taking duplicate smears was assessed. Paired cervical smears were obt...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：
更新日期：1982-07-01 00:00:00
abstract：:An analysis was performed of malignant and host cells found in peritoneal fluids obtained during intraperitoneal chemotherapy and immunotherapy in patients with ovarian cancer. The concentration of malignant cells and the surgically documented response to the intraperitoneal treatment were correlated. Twenty-three pat...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：
更新日期：1988-11-01 00:00:00
abstract：:Sixty-five infertile patients with moderate or severe endometriosis were treated with conservative surgery. Acosta's classification was used to demonstrate the extent of disease. In 48 women whose partners were normally fertile, 65% conceived, and in 17 whose partners were deficient, 35% achieved pregnancy. The extent...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：
更新日期：1977-05-01 00:00:00
abstract：OBJECTIVE:To assess the potential role of childhood and adulthood physical and sexual abuse and complaints of chronic pain in accounting for psychiatric symptomatology in adult women. METHODS:We assessed sexual abuse, physical abuse, depression, anxiety, and somatization in 64 women with chronic pelvic pain, 42 women ...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：
更新日期：1994-08-01 00:00:00
abstract：OBJECTIVE:To compare adverse childhood experiences (ACEs) in women with chronic pelvic pain with a control group, and describe occurrence of specific ACEs in women with chronic pelvic pain. METHODS:This case-control study examined the relationship between history of ACEs, traumatic events occurring during childhood as...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：10.1097/AOG.0000000000003533
更新日期：2019-11-01 00:00:00
abstract：:Caffeine citrate in doses of 6.96 mg/kg (equivalent to 3.50 mg/kg of caffeine) of combined maternal and fetal weight and 69.6 mg/kg (35.0 mg/kg of caffeine) was administered in 1-dl solutions intravenously over ten minutes to chronically prepared pregnant sheep. The ewes and their fetuses were monitored for cardiovasc...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：
更新日期：1983-04-01 00:00:00
abstract：:Maternal serum levels of placental protein 5 (PP5) were measured during the third trimester in women with normal and abnormal pregnancies. PP5 levels were significantly elevated in patients with preeclampsia, diabetes, intrauterine growth retardation associated with preeclampsia, and twin pregnancy. ...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：
更新日期：1982-04-01 00:00:00
