Seminars in reproductive medicine
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Uterine adenomyosis can be diagnosed on ultrasonography (US) and magnetic resonance imaging (MRI) with a high degree of accuracy. Adenomyosis is a myometrial process that can appear as diffuse or focal on imaging. Diffuse adenomyosis typically causes uterine enlargement, while focal adenomyosis can mimic other myometrial lesions, such as leiomyomas. ⋯ Despite these characteristic imaging appearances, there are several gynecologic pathologies which can mimic adenomyosis and it is important to be vigilant of these when interpreting cross-sectional imaging exams. The decision to evaluate patients with US or MRI is contingent on multiple factors, including availability of the necessary technology and expertise for the latter. However, MRI appears to offer greater specificity and positive predictive value for the diagnosis of adenomyosis.
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Chronic pelvic pain is a condition defined by pelvic pain for more than six months which is severe enough to cause functional disability or require treatment. When pain becomes a chronic condition, it is more challenging to evaluate and treat. Chronic pelvic pain patients often have multiple factors contributing to their pain. ⋯ It is important to establish a trusting patient-physician relationship. When evaluating a female patient with chronic pelvic pain, an in-depth history and targeted physical exam can localize contributors to pain. While limited, corresponding imaging and laboratory work should also be considered.
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Semin. Reprod. Med. · Jan 2018
Application of Monash Centre for Health Research and Implementation Framework to the Development of Polycycstic Ovary Syndrome Guideline: A Case Study on Implementation.
Implementation of healthcare guidelines, a set of recommendations aiming to optimize patient care, can be a complex process which is at risk of poor translation into practice. Failure to adopt new evidence-based healthcare findings can contribute to a large variation in care, potentially affecting outcomes for service users. Designed to avoid this issue, the Monash Centre for Health Research and Implementation (MCHRI) knowledge translation framework was created to support the development and future implementation of clinical practice guidelines. ⋯ Specifically, this article discusses stakeholder engagement; development and codesign of evidence-based recommendations; implementation and knowledge generation; dissemination, translation, and scale up; and refinement/learning from evaluation. This case study demonstrates how hybrid frameworks, models, and theories for implementation, such as the MCHRI implementation framework, have their place in healthcare. The underlying principle that informs the framework is stakeholder engagement, including codesign, empowerment, and partnership.