American journal of obstetrics and gynecology
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Am. J. Obstet. Gynecol. · Dec 2018
ReviewSurgical technical evidence review for gynecologic surgery conducted for the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery.
The Agency for Healthcare Research and Quality, in partnership with the American College of Surgeons and the Armstrong Institute at Johns Hopkins, developed the Safety Program for Improving Surgical Care and Recovery, which integrates principles of implementation science into adoption of enhanced recovery pathways and promotes evidence-based perioperative care. ⋯ Evidence and existing guidelines support 29 protocol elements for the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery in gynecologic surgery.
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Am. J. Obstet. Gynecol. · Dec 2018
Medicaid savings from the Contraceptive CHOICE Project: a cost-savings analysis.
Forty-five percent of births in the United States are unintended, and the costs of unintended pregnancy and birth are substantial. Clinical and policy interventions that increase access to the most effective reversible contraceptive methods (intrauterine devices and contraceptive implants) have potential to generate significant cost savings. Evidence of cost savings for these interventions is needed. ⋯ A program providing counseling and no-cost contraception yields substantial cost savings because of the increased uptake of highly effective contraception and consequent averted unintended pregnancy and birth.
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Am. J. Obstet. Gynecol. · Dec 2018
Preventing incremental drift away from professionalism in graduate medical education.
Professionalism is a core competency of graduate medical education programs, stipulated by the Accreditation Council for Graduate Medical Education. We identify an underappreciated challenge to professionalism in residency training, the risk of incremental drift from professionalism, and a preventive ethics response, which can occur in residency programs in countries with oversight similar to that of the Accreditation Council for Graduate Medical Education. Two major, welcome changes in graduate medical education-required duty hours and increased attending supervision-create incentives for drift from professionalism. ⋯ This concept calls for physicians to make 3 commitments: to scientific and clinical competence; to the protection and promotion of the patient's health-related interests; and to keeping individual and group self-interest systematically secondary. Some responses of programs and residents to these incentives can undermine professionalism, creating a subtle and therefore hard-to-detect drift away from professionalism that in its worst form results in infantilization of residents. Program directors and educators should prevent this drift from professionalism by implementing practices that promote professionally responsible responses to the incentives created by required duty hours and increased attending supervision.
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Am. J. Obstet. Gynecol. · Dec 2018
Guild interests: an insidious threat to professionalism in obstetrics and gynecology.
Powerful incentives now exist that could subordinate professionalism to guild self-interest. How obstetrician-gynecologists respond to these insidious incentives will determine whether guild self-interests will define our specialty. We provide ethically justified, practical guidance to obstetrician-gynecologists to prevent this ethically unacceptable outcome. ⋯ Obstetrician-gynecologists should identify guild interests affecting their group practices, set ethically justified limits on self-sacrifice, and prevent incremental drift toward dominance of guild self-interests over professionalism. Guild self-interests could succeed in undermining professionalism, but only if obstetrician-gynecologists allow this to happen. When guild self-interest becomes the deciding factor in patient care, professionalism withers and insidious incentives flourish.