Gynaecology Diagram
Madeleine Harrier
With Competence-By-Design (CBD) implementation around the corner, we would like to introduce the concept of Entrustable Professional Activities (EPAs). These are key tasks that an individual resident can be trusted to perform without direct supervision, once sufficient competence has been demonstrated.
It might help to visualize an EPA as a basket or a bundle. For each EPA there are various skills, also known as milestones, that are needed to perform that task. As an individual works towards entrustment, they will need to develop each of those milestones (see diagram below).
One of the key motivations for CBD has been encouraging greater agency and promoting lifelong learning. With EPAs, residents have the opportunity to better monitor their progress and solicit feedback from supervisors on areas where they may feel less confident.
EPAs are formative, low stakes assessments. Residents are encouraged to make the most of their time on rotation by asking supervisors for feedback whenever possible and not just when they feel they are entrustable in a given EPA. The program will be looking for multiple observations with progress over time (not perfection from the beginning).
EPA progress will be tracked with a digital tool that is easy to use and permits supervisors to make rapid decisions about whether they can entrust a resident to perform a task independently. There will be more about entrustment scales and the digital tool at the CBD Development Day on April 12th and in the May ObGyn Newsletter.
The introduction of an Electronic Health Record (EHR) the Maternal and Newborn Clinical Management System (MN-CMS) for all women and babies receiving maternity services in Cork University Maternity Hospital (CUMH), University Hospital Kerry (UHK), the Rotunda, and the National Maternity Hospital (NMH) has transformed the way in which care is delivered and recorded. This clinical management system has enhanced care as it allows electronically recorded clinical information to be shared easily with relevant providers of care, as and when required through the use of a technology enabled solution.
As a result of the review of the Phase 1 sites implementation, the requirement to extend this functionality to enhance the Gynaecology service was identified. Consequently, the Gynaecology project was commenced in 2018 with a plan to roll out to the 4 aforementioned live sites, prior to the roll-out of MN-CMS to the remaining 15 maternity sites in Ireland.
Clinical Director, Professor John Higgins in CUMH with the local implementation team (LIT), in conjunction with the MN-CMS national project team and back office, the Office of the Chief Information Officer (OoCIO) and Cerner, are delighted to announce that CUMH has become the first fully digital hospital in Ireland from the 28th July 2019. All women interacting with CUMH for gynaecology services from that date will have a complete electronic health record, enabling the rapid sharing of clinical information to those providing care for the over 18,000 patients who attend each year.
CUMH is the first site in Ireland to extend the use of MN-CMS to include gynaecology care. The other sites using MN-CMS, The Rotunda Hospital, National Maternity Hospital & University Hospital Kerry, will also adopt the change in the coming months.
Who are the LIT? The LIT includes dedicated representatives from clinical, administrative, bio-med and ICT staff and is led by the local MN-CMS Project Manager. In addition, the LIT is supported by the HSE National Project Team (NPT), National Back Office (NBO) and the Cerner team. Both the HSE and Cerner teams have leads across key areas such as change management, migration, testing, training and reporting.
This document contains flow charts and diagrams summarizing the diagnosis and management of various gynecological conditions. It includes flow charts for abnormal uterine bleeding, infertility workup, sexual dysfunction, abnormal sexual development, chronic pelvic pain, cervical cancer screening and interpretation, endometrial cancer management, and ovarian cancer treatment. The charts provide an overview of the evaluation and treatment pathways for different gynecological issues.Read less
Many women with vaginal prolapse also have difficulty with complete bowel evacuation. This may manifest as sensation of incomplete bowel evacuation were the faeces may become trapped in the rectocoele (bowel prolapse into the vagina) as seen in the diagram.
Approximately 4% of women who have given birth experience faecal incontinence. About 10% of women with vaginal prolapse experience faecal incontinence and generally the bowel leakage is not related to the vaginal prolapse. Causes of faecal incontinence include
While defects of the external sphincter maybe detected on rectal examination investigations including endoanal ultrasound, nerve studies and or imaging will help differentiate between the various causes. We would work with a colorectal surgeon when required to correct these problems.
Chronic constipation is infrequent bowel movements or difficult passage of stools that persists for several weeks or longer and is defined as having fewer than three bowel movements a week. Other symptoms may include:
Constipation is related to prolonged and slow transit of the faeces through the bowel and is not caused by vaginal prolapse. Constipation and associated straining to evacuate causes vaginal prolapse. Women undergoing prolapse surgery should understand the importance of correcting and managing the constipation to decrease the risk of recurrence of the vaginal prolapse.
In 2017 the International Collaboration on Incontinence (ICI 2017) committee on the surgical management of prolapse produced this guideline statement that summarises a planned approach to the management of bowel symptoms.
2. Women with obstructed defecation (incomplete evacuation or those using digital pressure to assist in evacuation of their bowel) with a rectocele should be managed as per the POP surgical guideline.
3. Those with obstructed defecation without rectocele should be investigated to exclude rectal prolapse (rectum extruding from the anus). If rectal and vaginal prolapse present combined gynaecological and colorectal surgery could be considered.
4. Women with faecal incontinence require colorectal diagnostics as discussed above and those with rectal prolapse as a cause may require combined gynaecology and colorectal surgery. Other causes of fecal incontinence such as anal sphincter injury or nerve damage will require separate colorectal interventions in addition to the gynaecology intervention.
A set of rather uncanny diagrams from Die Heilgymnastik in der Gynaekologie: und die mechanische Behandlung von Erkrankungen des Uterus und seiner Adnexe nach Thure Brandt (1895), translated from German as "The physiotherapy in gynecology and the mechanical treatment of diseases of the uterus and its appendages by Thure Brandt". As the title implies the gynecological exercises are based on those invented by the Swedish obstetrician and gynecologist, Thure Brandt (1819-1895). Brandt began treating women in 1861, combining massage, stretching, and general exercise as a form of treating gynecological conditions. After his methods were examined in Jena by German gynecologists in 1886, they became widely used in Europe. The images in this particular text are eye-catching today less for the gynecological technique they depict but more the bizarre similarity between the rakishly thin figures employed in demonstrating the exercises (no doubt an attempt to de-sexualise the images) and the figure of the so-called "Grey Alien" - thin body, huge head, large eyes - which wouldn't hit popular consciousness for another 65 years.
The Public Domain Review is registered in the UK as a Community Interest Company (#11386184), a category of company which exists primarily to benefit a community or with a view to pursuing a social purpose, with all profits having to be used for this purpose.
It is normal to have an ovarian cyst each month before menstruation.This functinal ovarian cyst is called the Corpus Luteal Cyst. It will go away after menstruation. Click here for menstruation cyst diagram.
"Water Cyst" or Functional ovarian cysts are the most common cyst in the reproductive age. They contain only fluid or blood and usually resolve in a month or two. They are usually less than 5cm although rarely they may be as large as 8cm."Blood Cyst" or Endometriomas (or chocolate cysts) are formed by Endometriosis where the womb lining is found outside the uterus leading to monthly bleeding in the pelvis. This sometimes forms blood cysts within the ovary and leads to painful menstruation or pelvic pain."Tissue Cyst" or Dermoid cyst (or benign mature cystic teratomas) usually contains oil and hair. Dermoid Cyst form because the ovary has cells with the potential to develop into any type of tissue. Hence, these cysts can also contain skin, fat, bone and cartilage. Dermoid cyst can happen in both ovaries in 10% of the time.
In selected cases, Single Incision Laparoscopy can be done with the cyst removed with Just One Cut.Single Incision Laparoscopic Ovarian Cystectomy results in fewer abdominal cuts, fast recovery and almost scarless results.
As the Ob/Gyn Infectious /Diseases program is modeled on training available in centres of excellence in the US and involves a role as a primary infectious diseases resident in most cases. The typical content and sequence of infectious diseases training is indicated in the following schematic diagram, for information. Modification to enhance Ob/Gyn specific exposure done on a case by case basis.
This leaflet answers common questions about seeing a gynaecology specialist on the faster diagnosis pathway. If you would like further information, or have any worries, please do not hesitate to ask your nurse or doctor.
Most women referred on this pathway do not have cancer and will receive reassuring results. However, it is important that you come for any tests or appointments offered so that, if you do have a cancer, it can be diagnosed, and you can start treatment as soon as possible.
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