55 results on '"Barbara S. Levy"'
Search Results
2. Uterine Fibroids in Black Women: A Race-Stratified Subgroup Analysis of Treatment Outcomes After Laparoscopic Radiofrequency Ablation
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Linda D. Bradley, Barbara S. Levy, Jay M. Berman, and Soyini M. Hawkins
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medicine.medical_specialty ,Uterine fibroids ,Radiofrequency ablation ,Subgroup analysis ,Disease ,law.invention ,Race (biology) ,Quality of life ,law ,medicine ,Humans ,Black women ,Radiofrequency Ablation ,Uterine leiomyoma ,Leiomyoma ,Obstetrics ,business.industry ,General Medicine ,medicine.disease ,female genital diseases and pregnancy complications ,Treatment Outcome ,Uterine Neoplasms ,Quality of Life ,Female ,Laparoscopy ,business - Abstract
Background: The disease and treatment burden of uterine fibroids (UF) in Black women is substantially greater compared with other racial groups, with higher rates of complications and poorer outcom...
- Published
- 2021
3. Evolving the Preconception Health Framework: A Call for Reproductive and Sexual Health Equity
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Monica Simpson, Aletha Y. Akers, Sonya Borrero, Kiko Malin, Michael C. Lu, Miriam Kuppermann, Jamie Hart, Joia Crear-Perry, Lisa S. Callegari, Miriam Yeung, Sarah Verbiest, Anu Manchikanti Gomez, Laura Jimenez, Christine Dehlendorf, Barbara S. Levy, and Denicia Cadena
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medicine.medical_specialty ,Reproductive health and childbirth ,Basic Behavioral and Social Science ,Paediatrics and Reproductive Medicine ,03 medical and health sciences ,0302 clinical medicine ,Social Justice ,Health care ,Behavioral and Social Science ,medicine ,Humans ,030212 general & internal medicine ,Social determinants of health ,Obstetrics & Reproductive Medicine ,Reproductive health ,Peace ,030219 obstetrics & reproductive medicine ,Health Equity ,business.industry ,Public health ,Contraception/Reproduction ,Equity (finance) ,Obstetrics and Gynecology ,Social environment ,Public relations ,Reproductive justice ,Justice and Strong Institutions ,Call to action ,Reproductive Health ,Good Health and Well Being ,Personal Autonomy ,Preconception Care ,Sexual Health ,business - Abstract
Over the past decade, increasing attention has been paid to intervening in individuals' health in the "preconception" period as an approach to optimizing pregnancy outcomes. Increasing attention to the structural and social determinants of health and to the need to prioritize reproductive autonomy has underscored the need to evolve the preconception health framework to center race equity and to engage with the historical and social context in which reproduction and reproductive health care occur. In this commentary, we describe the results of a meeting with a multidisciplinary group of maternal and child health experts, reproductive health researchers and practitioners, and Reproductive Justice leaders to define a new approach for clinical and public health systems to engage with the health of nonpregnant people. We describe a novel "Reproductive and Sexual Health Equity" framework, defined as an approach to comprehensively meet people's reproductive and sexual health needs, with explicit attention to structural influences on health and health care and grounded in a desire to achieve the highest level of health for all people and address inequities in health outcomes. Principles of the framework include centering the needs of and redistributing power to communities, having clinical and public health systems acknowledge historical and ongoing harms related to reproductive and sexual health, and addressing root causes of inequities. We conclude with a call to action for a multisectoral effort centered in equity to advance reproductive and sexual health across the reproductive life course.
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- 2021
4. Vaginal Hysterectomy: Historical Footnote or Viable Route?
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William H. Parker and Barbara S. Levy
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medicine.medical_specialty ,business.industry ,General surgery ,Hysterectomy vaginal ,Uterus ,Hysterectomy, Vaginal ,Obstetrics and Gynecology ,Medicine ,Humans ,Female ,business ,Hysterectomy ,Article - Published
- 2020
5. Path to leadership in medicine: Advocacy and evidence-based medicine
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Barbara S. Levy
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Evidence-Based Medicine ,business.industry ,Energy (esotericism) ,media_common.quotation_subject ,Obstetrics and Gynecology ,Public policy ,Passion ,Evidence-based medicine ,Public relations ,Leadership ,Reproductive Medicine ,Work (electrical) ,Order (exchange) ,Medicine ,Revenue ,business ,Autonomy ,media_common - Abstract
Physicians are experiencing overwhelming demands to generate revenue and complete ever-increasing administrative tasks. Whether employed by large health systems, academic centers or still struggling in small private practices, the autonomy so valued by medical professionals, and our ability to influence policies impacting our patients and the public, has diminished. In order to regain the joy in practicing medicine and overcome the sense of "burn-out" and frustration so many of us experience, it is essential to dedicate ourselves to becoming leaders in our communities, in our institutions and in our medical schools. We must apply the triad of evidence-based medicine - the data derived from randomized clinical trials, our learned experience, and our patients' values - to become leaders in the path towards reasoned public policy and institutional procedures that improve the care for individual patients and the community. Through advocacy and leadership, we can re-engage with the passion that drove us to our profession and renew our commitment to the patients we serve. The energy and time required for these activities will be more than repaid with joy and passion in our daily work and a sense of purpose in our lives.
- Published
- 2019
6. Drivers of maternity care in high-income countries: can health systems support woman-centred care?
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Jeanne Marie Guise, Neel Shah, Dorothy Shaw, Susannah Woodd, Elliott K. Main, K.S. Joseph, Kristina Gemzell-Danielsson, Barbara S. Levy, and Fontayne Wong
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Program evaluation ,Maternal-Child Health Services ,Population ,Psychological intervention ,Midwifery ,Care provision ,03 medical and health sciences ,0302 clinical medicine ,Nursing ,Pregnancy ,Patient-Centered Care ,Infant Mortality ,Humans ,Childbirth ,Medicine ,030212 general & internal medicine ,education ,Quality of Health Care ,education.field_of_study ,030219 obstetrics & reproductive medicine ,business.industry ,Developed Countries ,Infant ,General Medicine ,Place of birth ,Delivery, Obstetric ,Infant mortality ,Birth attendant ,Female ,Health Facilities ,business ,Delivery of Health Care - Abstract
Summary In high-income countries, medical interventions to address the known risks associated with pregnancy and birth have been largely successful and have resulted in very low levels of maternal and neonatal mortality. In this Series paper, we present the main care delivery models, with case studies of the USA and Sweden, and examine the main drivers of these models. Although nearly all births are attended by a skilled birth attendant and are in an institution, practice, cadre, facility size, and place of birth vary widely; for example, births occur in homes, birth centres, midwifery-led birthing units in hospitals, and in high intervention hospital birthing facilities. Not all care is evidenced-based, and some care provision may be harmful. Fear prevails among subsets of women and providers. In some settings, medical liability costs are enormous, human resource shortages are common, and costs of providing care can be very high. New challenges linked to alteration of epidemiology, such as obesity and older age during pregnancy, are also present. Data are often not readily available to inform policy and practice in a timely way and surveillance requires greater attention and investment. Outcomes are not equitable, and disadvantaged segments of the population face access issues and substantially elevated risks. At the same time, examples of excellence and progress exist, from clinical interventions to models of care and practice. Labourists (who provide care for all the facility's women for labour and delivery) are discussed as a potential solution. Quality and safety factors are informed by women's experiences, as well as medical evidence. Progress requires the ability to normalise birth for most women, with integrated services available if complications develop. We also discuss mechanisms to improve quality of care and highlight areas where research can address knowledge gaps with potential for impact. Evaluation of models that provide woman-centred care and the best outcomes without high costs is required to provide an impetus for change.
- Published
- 2016
7. In Reply
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Barbara S. Levy, Debra L. Ness, and Steven E. Weinberger
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Consensus ,Outpatients ,Obstetrics and Gynecology ,Humans - Published
- 2019
8. In Reply
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Barbara S. Levy
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Obstetrics ,Gynecology ,Physicians ,Obstetrics and Gynecology ,Humans - Published
- 2018
9. National Partnership for Maternal Safety
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Barbara S. Levy, Jed B. Gorlin, David C. Lagrew, Debra Bingham, Dena Goffman, Barbara M. Scavone, Lisa Kane Low, Elliott K. Main, and Patricia L. Fontaine
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Health Knowledge, Attitudes, Practice ,Safety Management ,medicine.medical_specialty ,Inservice Training ,Consensus ,Standardization ,Best practice ,MEDLINE ,Critical Care Nursing ,Pediatrics ,Risk Assessment ,Patient safety ,Risk Factors ,Pregnancy ,Early Medical Intervention ,Maternity and Midwifery ,Health care ,medicine ,Humans ,Blood Transfusion ,Maternal Health Services ,Cooperative Behavior ,Quality Indicators, Health Care ,Patient Care Team ,Evidence-Based Medicine ,business.industry ,Postpartum Hemorrhage ,Benchmarking ,medicine.disease ,Quality Improvement ,United States ,Surgery ,Maternal Mortality ,Treatment Outcome ,Outcome and Process Assessment, Health Care ,Anesthesiology and Pain Medicine ,General partnership ,Practice Guidelines as Topic ,Interdisciplinary Communication ,Female ,Patient Safety ,Medical emergency ,Emergency Service, Hospital ,Working group ,Risk assessment ,business ,Delivery of Health Care ,Patient Care Bundles - Abstract
Hemorrhage is the most frequent cause of severe maternal morbidity and preventable maternal mortality and therefore is an ideal topic for the initial national maternity patient safety bundle. These safety bundles outline critical clinical practices that should be implemented in every maternity unit. They are developed by multidisciplinary work groups of the National Partnership for Maternal Safety under the guidance of the Council on Patient Safety in Women's Health Care. The safety bundle is organized into four domains: Readiness, Recognition and Prevention, Response, and Reporting and System Learning. Although the bundle components may be adapted to meet the resources available in individual facilities, standardization within an institution is strongly encouraged. References contain sample resources and "Potential Best Practices" to assist with implementation.
- Published
- 2015
10. National Partnership for Maternal Safety Consensus Bundle on Obstetric Hemorrhage
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Jed B. Gorlin, Patricia L. Fontaine, Dena Goffman, Debra Bingham, Elliott K. Main, Barbara S. Levy, Barbara M. Scavone, David C. Lagrew, and Lisa Kane Low
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Standardization ,business.industry ,Best practice ,Obstetrics and Gynecology ,medicine.disease ,Patient safety ,Nursing ,Multidisciplinary approach ,General partnership ,Maternity and Midwifery ,Health care ,Medicine ,Medical emergency ,business ,Working group ,Risk assessment - Abstract
Hemorrhage is the most frequent cause of severe maternal morbidity and preventable maternal mortality and therefore is an ideal topic for the initial national maternity patient safety bundle. These safety bundles outline critical clinical practices that should be implemented in every maternity unit. They are developed by multidisciplinary work groups of the National Partnership for Maternal Safety under the guidance of the Council on Patient Safety in Women's Health Care. The safety bundle is organized into 4 domains: Readiness, Recognition and Prevention, Response, and Reporting and Systems Learning. Although the bundle components may be adapted to meet the resources available in individual facilities, standardization within an institution is strongly encouraged. References contain sample resources and "Potential Best Practices" to assist with implementation.
- Published
- 2015
11. In Response
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Paloma Toledo, Joseph E. Pellegrini, David E. Soper, William C. Bradford, Deborah A. Cruz, Lauren A. Lemieux, and Barbara S. Levy
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Anesthesiology and Pain Medicine - Published
- 2017
12. How Can We Increase the Percentage and Quality of Minimally Invasive Hysterectomy for Benign Disease Among Low/Intermediate-Volume Gynecologic Surgeons? A Perspective Piece From an Expert Panel Session at the 2017 Society of Gynecologic Surgeons Annual Meeting
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Barbara S. Levy, Daniel M. Morgan, Suketu Mansuria, Andrew J. Walter, Robert E. Gutman, and Rosanne M. Kho
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medicine.medical_specialty ,030219 obstetrics & reproductive medicine ,Hysterectomy ,Benign disease ,business.industry ,medicine.medical_treatment ,Obstetrics and Gynecology ,Panel session ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,medicine ,030212 general & internal medicine ,business - Published
- 2017
13. The Maternal Quality Improvement Program: A Clinical Data-Driven National Registry for Maternity Care
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Sean M. Currigan, Timberly Butler, Barbara S. Levy, and Steve Hasley
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Quality management ,media_common.quotation_subject ,MEDLINE ,Midwifery ,03 medical and health sciences ,0302 clinical medicine ,Nursing ,Pregnancy ,Health care ,Medicine ,Humans ,Performance measurement ,Quality (business) ,Maternal Health Services ,030212 general & internal medicine ,Registries ,Obstetrics and Gynecology Department, Hospital ,media_common ,030219 obstetrics & reproductive medicine ,business.industry ,Pregnancy Outcome ,Obstetrics and Gynecology ,Prenatal Care ,Benchmarking ,Quality Improvement ,United States ,Identification (information) ,Data quality ,Female ,business - Abstract
Advancing the quality and safety of maternity care should be data-driven. Defining a standard set of clinical data elements, across electronic health record platforms and facilities, could accelerate performance measurement, benchmarking, and identification of better practices. In 2014, the American College of Obstetricians and Gynecologists and the American Society of Anesthesiologists launched the Maternal Quality Improvement Program, a data-driven national clinical registry for maternity care. Having an agreed-on set of discrete data elements related to labor and delivery will set the stage for analysis of this care. Through the use of clinical performance measures and data quality metrics, the Maternal Quality Improvement Program will provide an opportunity for health care providers to better understand the overall quality and safety of the maternity care provided within their institution.
- Published
- 2017
14. The National Partnership for Maternal Safety
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Barbara S. Levy, Elliott K. Main, M. Kathryn Menard, and Mary E. D'Alton
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Nursing ,business.industry ,General partnership ,medicine ,Obstetrics and Gynecology ,Maternal death ,medicine.disease ,business - Abstract
Recognition of the need to reduce maternal mortality and morbidity in the United States has led to the creation of the National Partnership for Maternal Safety. This collaborative, broad-based initiative will begin with three priority bundles for the most common preventable causes of maternal death
- Published
- 2014
15. Health Reform in Action
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Rebekah E. Gee, Carolina Reyes, and Barbara S. Levy
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medicine.medical_specialty ,Action (philosophy) ,Family medicine ,medicine ,Health insurance ,Obstetrics and Gynecology ,Public administration ,Psychology ,Health reform - Published
- 2014
16. Consensus Bundle on Prevention of Surgical Site Infections After Major Gynecologic Surgery
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Joseph E Pellegrini, David E. Soper, William C. Bradford, Deborah A. Cruz, Barbara S. Levy, Paloma Toledo, and Lauren A. Lemieux
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Health Knowledge, Attitudes, Practice ,medicine.medical_treatment ,Critical Care Nursing ,Pediatrics ,0302 clinical medicine ,Gynecologic Surgical Procedures ,Risk Factors ,Health care ,Medicine ,Infection control ,030212 general & internal medicine ,Antibiotic prophylaxis ,Cooperative Behavior ,media_common ,Teamwork ,030219 obstetrics & reproductive medicine ,Obstetrics and Gynecology ,Anti-Bacterial Agents ,Treatment Outcome ,Female ,Patient Safety ,Clinical Competence ,Patient Care Bundles ,medicine.medical_specialty ,Consensus ,Attitude of Health Personnel ,media_common.quotation_subject ,MEDLINE ,Preoperative care ,Risk Assessment ,03 medical and health sciences ,Patient safety ,Preoperative Care ,Maternity and Midwifery ,Surgical site ,Humans ,Surgical Wound Infection ,Patient Care Team ,Surgical team ,Infection Control ,Hysterectomy ,business.industry ,Postpartum Hemorrhage ,Antibiotic Prophylaxis ,United States ,Surgery ,Anesthesiology and Pain Medicine ,Bundle ,Interdisciplinary Communication ,business - Abstract
Surgical site infections are the most common complications of surgery in the United States. Of surgeries in women of reproductive age, hysterectomy is one of the most frequently performed, second only to cesarean birth. Therefore, prevention of surgical site infections in women undergoing gynecologic surgery is an ideal topic for a patient safety bundle. The primary purpose of this safety bundle is to provide recommendations that can be implemented into any surgical environment in an effort to reduce the incidence of surgical site infection. This bundle was developed by a multidisciplinary team convened by the Council on Patient Safety in Women's Health Care. The bundle is organized into four domains: Readiness, Recognition and Prevention, Response, and Reporting and Systems Learning. In addition to recommendations for practice, each of the domains stresses communication and teamwork between all members of the surgical team. Although the bundle components are designed to be adaptable to work in a variety of clinical settings, standardization within institutions is encouraged.
- Published
- 2016
17. National Partnership for Maternal Safety: Consensus Bundle on Venous Thromboembolism
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Robyn D'Oria, Douglas M. Montgomery, Michael J. Paidas, Richard M. Smiley, Mary E. D'Alton, Deborah Karsnitz, Alexander M. Friedman, Jennifer L. Frost, Barbara S. Levy, Afshan B. Hameed, and Steven L. Clark
- Subjects
medicine.medical_specialty ,Consensus ,MEDLINE ,Critical Care Nursing ,Pediatrics ,03 medical and health sciences ,Patient safety ,0302 clinical medicine ,Multidisciplinary approach ,Pregnancy ,Risk Factors ,Maternity and Midwifery ,Health care ,medicine ,Humans ,030212 general & internal medicine ,Intensive care medicine ,030219 obstetrics & reproductive medicine ,business.industry ,Postpartum Hemorrhage ,Obstetrics and Gynecology ,Venous Thromboembolism ,medicine.disease ,Delivery, Obstetric ,United States ,Pregnancy Complications ,Anesthesiology and Pain Medicine ,Maternal Mortality ,Bundle ,General partnership ,Practice Guidelines as Topic ,Maternal Death ,Observational study ,Maternal death ,Female ,Medical emergency ,Patient Safety ,business ,Risk assessment - Abstract
Obstetric venous thromboembolism is a leading cause of severe maternal morbidity and mortality. Maternal death from thromboembolism is amenable to prevention, and thromboprophylaxis is the most readily implementable means of systematically reducing the maternal death rate. Observational data support the benefit of risk-factor-based prophylaxis in reducing obstetric thromboembolism. This bundle, developed by a multidisciplinary working group and published by the National Partnership for Maternal Safety under the guidance of the Council on Patient Safety in Women's Health Care, supports routine thromboembolism risk assessment for obstetric patients, with appropriate use of pharmacologic and mechanical thromboprophylaxis. Safety bundles outline critical clinical practices that should be implemented in every maternity unit. The safety bundle is organized into four domains: Readiness, Recognition, Response, and Reporting and Systems Learning. Although the bundle components may be adapted to meet the resources available in individual facilities, standardization within an institution is strongly encouraged.
- Published
- 2016
18. Building a Better Safety Net
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Joseph Sclafani, Joanna M. Cain, Hal Lawrence, Barbara S. Levy, and Mindy Saraco
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Teamwork ,Scope (project management) ,business.industry ,Safety net ,media_common.quotation_subject ,education ,Effective safety training ,Obstetrics and Gynecology ,Certification ,Occupational safety and health ,Obstetrics ,Nursing ,Gynecology ,Excellence ,Environmental health ,Health care ,Ambulatory Care ,Humans ,Women's Health ,Medicine ,Female ,Patient Safety ,business ,media_common - Abstract
The recent focus on health care safety is a response to the central ethical tenet of medicine--to do no harm. The delivery of safe hospital care has led to demonstrable reductions in medical errors, adverse events, and patient injuries. These improvements have led to a commensurate reduction of legal risk and the emotional toll on caregivers as well as families. It also has reinvigorated the reason many physicians went into medicine--to make a difference for women's health. The new, voluntary Safety Certification in Outpatient Practice Excellence (SCOPE) for Women's Health program of the American Congress of Obstetricians and Gynecologists is a means to both evaluate and recognize work in a critical but often neglected arena--the outpatient setting. It builds on infrastructure created for safety programs in hospital settings. Strong physician leadership, the development of an office culture committed to safety, communication and teamwork skills, safety programs for office-based surgery, medication safety, and tracking systems are all important for safe treatment of our patients in the office setting. The SCOPE Program defines the necessary safety goals for ambulatory women's health care and provides an educational pathway to reach those goals. SCOPE certification is an achievement recognizing the commitment of physicians and their staff to the health and safety of their patients.
- Published
- 2012
19. Ultrasound: An effective method for localization of the echogenic Essure sterilization micro-insert: Correlation with radiologic evaluations
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Barbara S. Levy and John F. Kerin
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medicine.medical_specialty ,Time Factors ,Sterilization, Tubal ,Hysteroscopy ,Humans ,Medicine ,Prospective Studies ,Prospective cohort study ,Ultrasonography ,medicine.diagnostic_test ,business.industry ,Ultrasound ,Obstetrics and Gynecology ,Echogenicity ,Soft tissue ,Ambulatory Surgical Procedure ,Surgery ,Ambulatory Surgical Procedures ,Essure ,Sterilization (medicine) ,Vagina ,Female ,Radiology ,business ,Intrauterine Devices - Abstract
Study objective To examine the reliability and practicality of performing office-based transvaginal ultrasound for determining the ease of locating the Essure hysteroscopic sterilization micro-insert and compare its usefulness against established radiologic evaluations. Design Prospective single-center, single-arm, clinical study (Canadian Task Force classification xx). Setting Hospital-based clinical research center. Patients One hundred forty-five women of reproductive age and proven fertility. Intervention Thirty-seven women who underwent the Essure hysteroscopic method of sterilization had routine radiologic and transvaginal ultrasound assessments for determining the retention of these micro-inserts from 3 months to 2 years after placement. An additional 108 women had ultrasound assessment as the only means of micro-insert localization 3 months after placement. Measurements and main results The 145 women (100%) who underwent an ultrasound assessment at a 3-month, posthysteroscopic-sterilization office visit had their micro-inserts readily identified and localized to the uterotubal area due to the micro-inserts’ dense echogenic properties. For the 37 women who had both assessments, the ultrasound findings correlated with pelvic radiograph and hysterosalpingogram assessments of micro-insert location in all instances. In addition, the ultrasound evaluations provided additional information about the micro-inserts relative position to the surrounding, less-echogenic soft tissue structures of the upper uterotubal area. In the 37 women who had serial ultrasound and radiologic evaluations performed for up to 2 years after micro-insert placement, ultrasound was found to be equally effective in identifying the location of the micro-inserts and indicted that their position remained identifiable and stable over time. Conclusion A single transvaginal ultrasound in-office examination, performed 3 months after hysteroscopic micro-insert placement, was found to be a simple, reliable, and convenient method of assessing micro-insert location, when compared with radiologic assessments.
- Published
- 2005
20. Randomized trial of suture versus electrosurgical bipolar vessel sealing in vaginal hysterectomy
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Barbara S. Levy and Laura L. Emery
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Adult ,medicine.medical_specialty ,medicine.medical_treatment ,Population ,Blood Loss, Surgical ,Risk Assessment ,Sensitivity and Specificity ,Statistics, Nonparametric ,Electrocoagulation ,law.invention ,Suture (anatomy) ,Randomized controlled trial ,law ,Hysterectomy, Vaginal ,Humans ,Medicine ,education ,Probability ,Uterine Diseases ,education.field_of_study ,Hysterectomy ,business.industry ,Suture Techniques ,Obstetrics and Gynecology ,Vessel sealing ,Middle Aged ,Hemostasis, Surgical ,Surgery ,Hemostasis ,Hysterectomy vaginal ,Female ,business ,Follow-Up Studies - Abstract
OBJECTIVE: To compare blood loss and procedure time of vaginal hysterectomy using an electrosurgical bipolar vessel sealer versus using sutures. METHODS: Sixty patients scheduled for vaginal hysterectomy in a single surgical practice were randomized to either electrosurgical bipolar vessel sealer or sutures as the hemostasis technique. Procedure time was defined as time from initial mucosal injection to closure of the vaginal cuff with satisfactory hemostasis. Blood loss was estimated by the anesthesia service. Statistical methodology included the Student t and Wilcoxon rank-sum tests, and all comparisons were two tailed, with P
- Published
- 2003
21. 1997 AAGL membership survey: Practice profiles
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William H. Parker, Jaroslav F. Hulka, Jordan M. Phillips, Anthony A. Luciano, and Barbara S. Levy
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Adult ,Male ,Medical education ,business.industry ,Data Collection ,Obstetrics and Gynecology ,Hysteroscopy ,Middle Aged ,United States ,Humans ,Medicine ,Female ,Laparoscopy ,Practice Patterns, Physicians' ,Medical prescription ,business ,Genital Diseases, Female ,Societies, Medical ,Reimbursement - Abstract
In 1997 the Board of the AAGL decided to use its surveying capacity to learn more about its membership with respect to current practices, including office procedures, types of patients, drug prescriptions, and fees and reimbursement. A list of such questions was sent to 6058 members in July 1997, and responses were analyzed from October to February 1998. The purpose was to provide information about who and what our membership currently is and how we practice, as well as to inform potential vendors as to the nature of the AAGL membership for their marketing considerations. Information of primary interest to fiscal and commercial purposes will be used by the AAGL for the benefit of its members. Information relevant to dayto-day practice is presented here.
- Published
- 1998
22. Nonsurgical management of chronic pelvic pain
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Barbara S. Levy
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Analgesics ,medicine.medical_specialty ,business.industry ,media_common.quotation_subject ,Pelvic pain ,MEDLINE ,Obstetrics and Gynecology ,Pelvic Pain ,Prognosis ,Combined Modality Therapy ,Antidepressive Agents ,Chronic disease ,Continuing medical education ,Behavior Therapy ,Reading (process) ,Family medicine ,Chronic Disease ,Humans ,Medicine ,Female ,medicine.symptom ,business ,media_common - Abstract
The following article will give you the opportunity to assess your understanding and knowledge of the material and earn continuing medical education (CME) credit. Review articles will be published in many issues of the Journal of the American Association of Gynecologic Laparoscopists. They will be designated as course reading and offer physicians a chance to earn up to 1 CME credit hour per article.
- Published
- 1997
23. Hysteroscopic sterilization: 10-year retrospective analysis of worldwide pregnancy reports
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Barbara S. Levy, John E. Nichols, S. Veersema, Malcolm G. Munro, and M.P.H. Vleugels
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Adult ,medicine.medical_specialty ,Databases, Factual ,Pregnancy Rate ,Sterilization, Tubal ,Hysteroscopy ,Global Health ,Pregnancy ,Interim ,Outcome Assessment, Health Care ,medicine ,Humans ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Obstetrics ,Sterilization, Reproductive ,Obstetrics and Gynecology ,Retrospective cohort study ,medicine.disease ,Pregnancy rate ,Essure ,Family planning ,Patient Compliance ,Women's Health ,Female ,business ,Medical literature - Abstract
Study Objective To identify factors that might contribute to pregnancies reported after hysteroscopic sterilization worldwide. Design Retrospective review of commercial data compiled from the MAUDE database, medical literature, and manufacturer reports received during commercial distribution of hysteroscopic sterilization micro-inserts from 2001 through 2010 (Canadian Taskforce classification III descriptive study). Measurements and Main Results From 2001 through 2010, 497 305 hysteroscopic sterilization kits were distributed worldwide, and 748 pregnancies were reported, i.e., 0.15% of the estimated user population based on the number of distributed kits. The data were sufficient to enable analysis of 508 pregnancies for potential contributing factors and showed most to be associated with patient or physician noncompliance (n = 264) or misinterpreted confirmation tests (n = 212). Conceptions deemed to have occurred within 2 weeks of the procedure and therefore too early for detection were identified in 32 cases. Conclusion Although there are limitations to the dataset and the study design is retrospective, it represents the largest body of cumulative hysteroscopic sterilization data available to date. Of the 748 pregnancies reported, it is apparent that some might have been prevented with greater patient and clinician attention to interim contraceptive use and counseling and with more rigorous evaluation and informed interpretation of the procedure confirmation tests. Although the estimated pregnancy rate based on such a dataset is likely an underestimation, it does suggest that the evaluable field performance of hysteroscopic sterilization micro-inserts is consistent with the labeled age-adjusted effectiveness of 99.74% at 5 years.
- Published
- 2013
24. The quality of our journey
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Barbara S. Levy
- Subjects
medicine.medical_specialty ,Enthusiasm ,Surgical instrumentation ,business.industry ,media_common.quotation_subject ,Cystoscope ,Obstetrics and Gynecology ,Endoscopic excision ,Health care ,medicine ,Medical physics ,Quality (business) ,business ,Function (engineering) ,media_common ,Pace - Abstract
As we embark on our twenty-fifth year let's take a few moments to evaluate our course. Can we measure our progress in real improvement in health care for women, or are we looking at shadows on the sand? Medicine has changed dramatically since the AAGL was founded in 1971. Laparoscopy has been transformed from a diagnostic tool into an approach for even the most complex of operative procedures. Reflections, however, give us pause to evaluate the direction of our journey. What roads have we traveled and where are we headed? Have we defined our goals and do we know which way to go? Is all this progress benefiting our patients? How do we measure the success of our journey? Over the past century medicine evolved from Sir William Osler's study of the diagnosis and prognosis of disease to the science of treating and curing disease using technologies and pharmacology beyond comprehension only a few decades--and sometimes only a few years--ago. The extraordinary pace of development has left little time for us to contemplate or evaluate our achievements. Without question we have successfully accomplished remarkable technologic feats. Surgical practice, the art, the craft, and more recently the science, has always been defined by its tools. Let us remember, however, that the quality of our journey will not be measured by new inventions. Ultimately it will be measured by our ability to affect the health and well-being of our patients and to improve the quality of their lives. We risk falling in love with technology, but will this compromise the care we provide? As technology swiftly develops we must understand the difference between seeing and vision. Only vision will enable us to incorporate these advances appropriately as instruments for healing. Endoscopy began as a relatively crude and invasive diagnostic procedure. The ability to harness and amplify light triggered provided an impetus for advances in the firle. We have come a great distance from Max Nitze's electrically lighted cystoscope in 1879 to the fiberoptic microendoscope in 1995. Surgery, which began as a magical art, changed and grew into a science with the integration of physiology, pathology, and technology. Endoscopic surgery was initiated by Nitze's adaptation of electric light for the cystoscope. He performed endoscopic excision of bladder tumors in situ in the 1890s, but his tools were crude by our standards. Progress in surgical instrumentation and surgical techniques went hand in hand. 1 Yet many surgeons continue to function as technicians, incorporating new procedures without first subjecting them to the rigors of scientific study. Science and technology enable us to perform intricate surgical procedures successfully. We have demonstrated that many things can be done endoscopically, but should they be? We now have smaller, clearer, cheaper instruments with which to view and manipulate the organs of the human body. Have they improved the health of patients? Are they safe, useful, or cost effective? Is our ability to look directly at the abdomen, pelvis, and uterus an advantage? We can easily be seduced by more refined technology, computerized tomographic scans, magnetic resonance imaging, and endoscopy. However, our enthusiasm for everything new must be justified with
- Published
- 1996
25. Tribute to Jay M. Cooper, M.D
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Barbara S. Levy, William H. Parker, Andrew I. Brill, RJ Gimpelson, Linda D. Bradley, Franklin D. Loffer, and Stephen L. Corson
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Gerontology ,business.industry ,media_common.quotation_subject ,Obstetrics and Gynecology ,Tribute ,Passion ,Management ,law.invention ,Equilibrioception ,law ,Excellence ,Private practice ,Health care ,CLARITY ,Medicine ,Surgical education ,business ,media_common - Abstract
Our AAGL family lost a treasured friend and colleague on February 4th. Jay Cooper, our 26th president, was the quintessential academic clinician. Early on, and throughout his career, Jay not only sustained a successful private practice but also actively participated in clinical research. He left an unsurpassed legacy in minimally invasive gynecologic surgery. His intelligence, innovations, and integrity will continue to be benchmarks for all of us. Jay had clarity of vision and a unique gift for communication. His passion for excellence in women's healthcare in research and in surgical education was unwavering over the 30 years of his career. Above all, however, Jay's dedication to the important values in life—his dedication to family and friends; his sense of balance; and his teaching, guidance, wisdom, and support—has left a lasting legacy among those of us privileged to know him. We dedicate this issue of the Journal of the AAGL to Jay.
- Published
- 2004
26. Outpatient vaginal hysterectomy: optimizing perioperative management for same-day discharge
- Author
-
M.A. Zakaria and Barbara S. Levy
- Subjects
Adult ,medicine.medical_specialty ,medicine.medical_treatment ,Population ,Operative Time ,Blood Loss, Surgical ,Patient Readmission ,Perioperative Care ,Ambulatory care ,Ambulatory Care ,Hysterectomy, Vaginal ,Medicine ,Humans ,education ,Aged ,Aged, 80 and over ,education.field_of_study ,Hysterectomy ,business.industry ,Obstetrics ,Uterus ,Obstetrics and Gynecology ,Perioperative ,Consecutive case series ,Organ Size ,Middle Aged ,Confidence interval ,Community hospital ,Patient Discharge ,Surgery ,Treatment Outcome ,Private practice ,Female ,business - Abstract
Objective To present tactics for optimizing outpatient vaginal hysterectomy and describe perioperative outcomes in a large consecutive case series. Methods This is a descriptive study and review of clinical outcomes in 1,071 patients selected to undergo vaginal hysterectomy for benign indications from 2000 to 2010. The setting is a single-surgeon private practice in a community hospital. Outcome measures include length of hospital stay, estimated blood loss, operative time, uterine weight, and perioperative complications, including hospital readmissions and emergency room visits. Results One thousand seventy-one of 1,162 cases (92%, 95% confidence interval [CI] 90.5-93.7) were total vaginal hysterectomies, of which 1,029 (96%, 95% CI 94.9-97.3) were discharged the same day after surgery. The median operative time was 34 minutes (range 17-210 minutes), and estimated blood loss was 45 mL (range 5-800 mL). The median patient age was 46 years (range 27-86 years), and median uterine weight was 160 g (range 25-1,380 g). One hundred ninety-three patients (18%, 95% CI 15.8-20.5) were nulliparous and 218 (20%, 95% CI 18-22.9) had prior pelvic surgery. Five patients (0.5%, 95% CI 0.2-1.1) required readmission or emergency room evaluation within the first 30 days. Conclusion Vaginal hysterectomy can be successfully adopted as a same-day discharge procedure. In this population, regardless of previous pelvic surgery or nulliparity, good perioperative outcomes have been achieved.
- Published
- 2012
27. National Partnership for Maternal Safety: Consensus Bundle on Obstetric Hemorrhage
- Author
-
Elliott K. Main, David C. Lagrew, Jed B. Gorlin, Barbara S. Levy, Debra Bingham, Patricia Fontaine, L.K. Kane, and B.M. Goffman
- Subjects
03 medical and health sciences ,030219 obstetrics & reproductive medicine ,0302 clinical medicine ,030202 anesthesiology ,business.industry ,General partnership ,Bundle ,Medicine ,Medical emergency ,business ,medicine.disease - Published
- 2016
28. How to Be Paid for What You Do: Know the Process
- Author
-
George A. Hill, Edward Stanford, and Barbara S. Levy
- Subjects
Insurance Claim Reporting ,Medical education ,business.industry ,Process (engineering) ,Obstetrics and Gynecology ,Relative Value Scales ,United States ,Obstetrics ,Nursing ,Gynecology ,Practice Management, Medical ,Humans ,Medicine ,Current Procedural Terminology ,Forms and Records Control ,Medical diagnosis ,business ,American Medical Association ,Diagnosis-Related Groups - Abstract
Study Objective Current Procedural Terminology and ICD-9-CM codes are tools used in clinical medicine to define work done and diagnoses or conditions for which the work was performed. It is important that all physicians become knowledgeable about these schemes to describe services provided correctly and accurately.
- Published
- 2001
29. Tribute to Jordan M. Phillips, M.D
- Author
-
Louis G. Keith, Robert B. Hunt, Anthony A. Luciano, Franklin D. Loffer, Philip G. Brooks, Barbara S. Levy, and William H. Parker
- Subjects
business.industry ,Obstetrics and Gynecology ,Medicine ,Tribute ,business ,Humanities - Published
- 2001
30. Endometriosis and chronic pain: a multispecialty roundtable discussion
- Author
-
Barbara S, Levy, Barbara S, Apgar, Eric S, Surrey, and Susan, Wysocki
- Subjects
Reoperation ,Clinical Trials as Topic ,Danazol ,Anti-Inflammatory Agents, Non-Steroidal ,Endometriosis ,Estrogen Antagonists ,Medroxyprogesterone Acetate ,Pelvic Pain ,Severity of Illness Index ,Diagnosis, Differential ,Gonadotropin-Releasing Hormone ,Administration, Intravaginal ,C-Reactive Protein ,Treatment Outcome ,Chronic Disease ,Practice Guidelines as Topic ,Catheter Ablation ,Contraceptive Agents, Female ,Humans ,Drug Therapy, Combination ,Female ,Laparoscopy ,Infertility, Female ,Biomarkers - Published
- 2008
31. The complex nature of chronic pelvic pain
- Author
-
Barbara S, Levy
- Subjects
Adult ,Complementary Therapies ,Cyclohexanecarboxylic Acids ,Mental Disorders ,Anti-Inflammatory Agents, Non-Steroidal ,Endometriosis ,Tissue Adhesions ,Antidepressive Agents, Tricyclic ,Hysterectomy ,Pelvic Pain ,Irritable Bowel Syndrome ,Psychotherapy ,Treatment Outcome ,Anti-Anxiety Agents ,Patient Education as Topic ,Chronic Disease ,Humans ,Drug Therapy, Combination ,Female ,Amines ,Gabapentin ,Selective Serotonin Reuptake Inhibitors ,gamma-Aminobutyric Acid ,Contraceptives, Oral - Published
- 2008
32. Modern management of uterine fibroids
- Author
-
Barbara S. Levy
- Subjects
Infertility ,medicine.medical_specialty ,Abdominal pain ,Uterine fibroids ,medicine.medical_treatment ,Ultrasonic Therapy ,Antineoplastic Agents ,Hysterectomy ,Uterine artery embolization ,medicine.artery ,Medicine ,Humans ,Embolization ,Uterine artery ,Uterine leiomyoma ,Leiomyoma ,business.industry ,Obstetrics ,Obstetrics and Gynecology ,General Medicine ,medicine.disease ,Embolization, Therapeutic ,female genital diseases and pregnancy complications ,Surgery ,Uterine Neoplasms ,Reproductive Control Agents ,Female ,medicine.symptom ,business - Abstract
Uterine fibroids are the most common tumor of the reproductive tract in women of reproductive age. Although they are benign tumors that are often asymptomatic, uterine fibroids may cause debilitating symptoms in many women, such as abnormal uterine bleeding, abdominal pain, increased abdominal girth, urinary frequency, constipation, pregnancy loss, dyspareunia, and in some cases infertility. Several approaches are available for the treatment of uterine fibroids. These include pharmacologic options, such as hormonal therapies and gonadotropin-releasing hormone agonists; surgical approaches, such as hysterectomy, myomectomy, myolysis, laparoscopic uterine artery occlusion, magnetic resonance imaging-guided focused ultrasound surgery, and uterine artery embolization. The choice of approach may be dictated by factors such as the patient's desire to become pregnant in the future, the importance of uterine preservation, symptom severity, and tumor characteristics. New treatment options for uterine fibroids would be minimally invasive, have long-term data demonstrating efficacy and safety, have minimal or no incidence of fibroid recurrence, be easy to perform, preserve fertility, and be cost effective. New treatment approaches are under investigation, with the goals of being effective, safe, and less invasive.
- Published
- 2008
33. A guide to manuscript review for the Journal of Minimally Invasive Gynecology
- Author
-
Barbara S. Levy, Krisztina Bajzak, and Malcolm G. Munro
- Subjects
medicine.medical_specialty ,business.industry ,Gynecology ,Obstetrics and Gynecology ,Medicine ,Humans ,Medical physics ,Periodicals as Topic ,business - Published
- 2008
34. A summary of reported pregnancies after hysteroscopic sterilization
- Author
-
Barbara S. Levy, Meredith E. Childers, and M. Levie
- Subjects
Pregnancy ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Obstetrics ,Sterilization, Tubal ,Sterilization, Reproductive ,Obstetrics and Gynecology ,Pregnancy, Unplanned ,Hysteroscopy ,medicine.disease ,Hysterosalpingography ,Essure ,Sterilization (medicine) ,Instructions for use ,medicine ,Humans ,In patient ,Female ,business ,Hysteroscopic sterilization - Abstract
The purpose of this article is to describe 64 unintended pregnancies reported by patients who had undergone hysteroscopic sterilization and to provide recommendations for avoiding post-procedure pregnancies. Sixty-four pregnancies out of an estimated 50,000 procedures were reported to the device manufacturer from 1997 through December 2005. Most occurred in patients without appropriate follow-up. Other causes included misread hysterosalpingograms, undetected preprocedure pregnancies, and failure to follow product-labeling guidelines. The risk of pregnancy with hysteroscopic sterilization may be reduced by educating patients about the necessity of follow-up, ensuring that patients use effective contraception before and after placement, following the instructions for use, and adhering to the hysterosalpingography protocol.
- Published
- 2006
35. Outpatient vaginal hysterectomy is safe for patients and reduces institutional cost
- Author
-
Laura L. Emery, Barbara S. Levy, and Danielle E. Luciano
- Subjects
Adult ,medicine.medical_specialty ,Cost effectiveness ,Nausea ,medicine.medical_treatment ,Postoperative Complications ,Clinical Protocols ,medicine ,Hysterectomy, Vaginal ,Humans ,Prospective Studies ,Hospital Costs ,Prospective cohort study ,Aged ,Retrospective Studies ,Hysterectomy ,business.industry ,Urinary retention ,Obstetrics and Gynecology ,Retrospective cohort study ,Length of Stay ,Middle Aged ,Community hospital ,Surgery ,Hospitalization ,Ambulatory Surgical Procedures ,Cohort ,Costs and Cost Analysis ,Female ,medicine.symptom ,business - Abstract
Objective To evaluate a management protocol based on scientific evidence in the care of patients undergoing vaginal hysterectomy. Study design (Canadian Task Force classification II-2). Setting 110-bed community hospital. Patients Women with vaginal hysterectomy between 2000 and 2003. Intervention Data were collected on all vaginal hysterectomies performed by a single surgeon over a 4-year period. Demographics, surgical indications, procedural parameters, length of stay, and postoperative complications were evaluated. Hospital costs for all vaginal hysterectomies performed over a 2-year period at the same hospital also were examined. An analysis of the literature was performed to develop a protocol for optimizing patients’ surgical experience. All patients were managed using the protocol. These patients were compared with a cohort at the same institution. Measurements and main results Four hundred twelve vaginal hysterectomies were performed by the lead author during the 4-year time period. Three hundred eighty-four patients (93%) were discharged within 12 hours of admission. There were no readmissions for bleeding, pain management, urinary retention, or nausea and vomiting. Four hundred nineteen vaginal hysterectomies were performed by 10 surgeons from 2002 through 2003 at the same institution, including 219 by the lead author. The average direct cost for outpatient vaginal hysterectomy was 21.3% lower than for inpatient vaginal hysterectomy. Conclusion Incorporating a protocol based on scientific evidence into the management of surgical patients facilitated safe outpatient vaginal hysterectomy in a majority of patients. This optimized management may save up to 25% of the cost for these procedures.
- Published
- 2005
36. Laparoscopic-assisted vaginal hysterectomy: American Association of Gynecologic Laparoscopists' 2000 membership survey
- Author
-
Sari L. Kives, Barbara S. Levy, and Ronald L. Levine
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Obstetrics ,General surgery ,Obstetrics and Gynecology ,Laparoscopic-assisted vaginal hysterectomy ,Risk Assessment ,United States ,Postoperative Complications ,Sterilization (medicine) ,Gynecology ,Health Care Surveys ,Hysterectomy vaginal ,Hysterectomy, Vaginal ,Medicine ,Humans ,Female ,Laparoscopy ,business ,Genital Diseases, Female ,Societies, Medical - Abstract
roscopists (AAGL) has been conducting membership surveys since 1976. Originally, surveys were designed to evaluate only sterilization techniques. As increasingly complicated operative laparoscopic operations became more widely accepted, it was apparent that laparoscopic-assisted vaginal hysterectomy (LAVH) was the most significant surgical procedure performed by most of the membership. Since 1989 the AAGL has actively attempted to document various aspects of LAVH through surveys of its members. The first survey in 1995 attempted to gain information as to current performance of the procedure and to assess relative frequencies and complications. Dr. Barbara S. Levy, who designed the 1995 survey with Drs. Jaroslav F. Hulka and William H. Parker, wrote this instrument, which was developed with few modifications from the earlier one to allow comparisons to be made between time periods. A total of 4437 surveys were mailed to AAGL members and contained 50 questions on laparoscopy, particularly LAVH, performed from January 1, 2000, to December 31, 2000. As in all AAGL surveys, the replies were strictly anonymous and confidential so that reporting of complications might be as frank as possible.
- Published
- 2003
37. Reported Pregnancies after Essure® Hysteroscopic Sterilization: A Retrospective Analysis of Pregnancy Reports Worldwide: 2001-2010
- Author
-
Malcolm G. Munro, S. Veersema, Barbara S. Levy, and M.P.H. Vleugels
- Subjects
Gynecology ,medicine.medical_specialty ,Pregnancy ,Essure ,business.industry ,Obstetrics ,Retrospective analysis ,Obstetrics and Gynecology ,Medicine ,business ,medicine.disease ,Hysteroscopic sterilization - Published
- 2011
38. FOREWORD
- Author
-
Barbara S. Levy
- Subjects
medicine.medical_specialty ,business.industry ,medicine ,Obstetrics and Gynecology ,Medical physics ,Current (fluid) ,business - Published
- 2007
39. Laparoscopic-assisted vaginal hysterectomy: American Association of Gynecologic Laparoscopists' 1995 membership survey
- Author
-
Barbara S. Levy, William H. Parker, Jaroslav F. Hulka, and Jordan M. Phillips
- Subjects
medicine.medical_specialty ,business.industry ,General surgery ,Incidence ,Obstetrics and Gynecology ,Laparoscopic-assisted vaginal hysterectomy ,Length of Stay ,Patient Readmission ,United States ,Postoperative Complications ,Gynecology ,Surveys and Questionnaires ,Hysterectomy vaginal ,medicine ,Hysterectomy, Vaginal ,Humans ,Female ,Laparoscopy ,Complication ,business ,Genital Diseases, Female ,Abdominal hysterectomy ,Societies, Medical ,Retrospective Studies - Abstract
A questionnaire was mailed to all members of the AAGL to determine the current performance of laparoscopic-assisted vaginal hysterectomy (LAVH), and to assess the relative frequencies of techniques and complications. Answers of the 1092 members who responded were entered into a database computer program and analyzed. The analysis revealed 14,911 LAVHs performed by 767 members. Complication rates appeared to be in the same range as those reported for vaginal hysterectomy and total abdominal hysterectomy. Inferior epigastric injury was the most common complication. Physicians showed a shift in their practices away from abdominal hysterectomy after they learned LAVH.
- Published
- 1997
40. Complications
- Author
-
Barbara S. Levy
- Published
- 1996
41. Perioperative pain management
- Author
-
Barbara S. Levy and Randall Carpenter
- Subjects
medicine.medical_specialty ,Postoperative ileus ,Sedation ,Postoperative pain ,Pain ,Anesthesia, General ,Patient care ,Postoperative Complications ,medicine ,Humans ,Prospective Studies ,Prospective cohort study ,Intensive care medicine ,Intraoperative Complications ,Randomized Controlled Trials as Topic ,Analgesics ,Pain, Postoperative ,business.industry ,Managed Care Programs ,Obstetrics and Gynecology ,Nociceptors ,Perioperative ,Genitalia, Female ,Pain management ,Awareness ,Length of Stay ,Self Care ,Physical therapy ,Managed care ,Female ,medicine.symptom ,business ,Intestinal Obstruction ,Locomotion ,Anesthesia, Local - Abstract
The clinical anesthesia, general surgery, and gynecology literature addressing the pathophysiology and management strategies for perioperative pain were reviewed. There are few prospective, randomized studies from which to draw meaningful conclusions. Nevertheless, a theoretical construct has been developed which may help the gynecologic surgeon optimizing pain management. The era of managed care and shorter hospital stays has focused physicians and, in particular, surgeons on elements of patient care that can be addressed and improved. Reducing or eliminating postoperative pain without excessive sedation promotes rapid mobilization and return to self-care. Strategies for pain management can be adopted that reduce postoperative ileus and other adverse reactions to analgesics.
- Published
- 1995
42. Ligasure versus sutures in vaginal hysterectomy
- Author
-
Barbara S. Levy
- Subjects
medicine.medical_specialty ,business.industry ,Hysterectomy vaginal ,Obstetrics and Gynecology ,Medicine ,business ,Surgery - Published
- 2002
43. Tissue damage variables: energy source and operator
- Author
-
Anthony A. Luciano, Malcolm G. Munro, Barbara S. Levy, and Andrew I. Brill
- Subjects
Physics ,Reproductive Medicine ,Tissue damage ,Obstetrics and Gynecology ,Biological system ,Energy source - Published
- 2001
44. Litigation and Laparoscopy
- Author
-
Barbara S. Levy
- Subjects
Warrant ,medicine.medical_specialty ,Plaintiff ,medicine.diagnostic_test ,Adverse outcomes ,business.industry ,Obstetrics and Gynecology ,Intervention (law) ,Invasive surgery ,medicine ,Etiology ,Intensive care medicine ,business ,Laparoscopy ,Surgical patients - Abstract
cal complications comes from studying the accumulated experiences of others. In gynecology, rates for major complications are low, on the order of 1% to 2%. Most of us are statistically unlikely to see many devastating injuries, therefore it is critical for us to understand the etiology, characteristics, and treatment of these complications if we are to recognize and manage them appropriately when they do occur. And they will occur. I have reviewed gynecologic surgery cases for plaintiff and defense attorneys as well as hospitals and insurance companies since 1984. This experience has been enlightening and highly educational. I now evaluate potential surgical patients with a more careful assessment of the risk: benefit ratio and intervention, and I am a more cautious surgeon when I enter the operating room. Having vicariously witnessed the severe consequences of surgical injuries, I am consciously meticulous both technically and in decision making in the surgical suite as well as in postoperative management of patients. In reality, medical litigation cases are about adverse outcomes and resulting patient injury, not about negligent medical care. In gynecology, most particularly with minimally invasive surgery, patient and surgeon expectations for rapid recovery and excellent outcomes are high. Unfortunately, no surgery is without complications, and substantial patient injuries occur despite our best effort to avoid them. In this issue of the journal Corson and colleagues accumulated a series of litigation cases involving laparoscopic entry injuries. We should consider litigation as a proxy for significant adverse outcomes in these procedures, since the cost of discovery and deposition of legal cases is prohibitive enough to prevent most cases that result in insignificant damage from reaching court. This series likely represents the tip of the iceberg; that is, complications that were related to patient injuries important enough to warrant the time and expense of litigation. We know from published reports that a minimum of 25% of practicing
- Published
- 2001
45. Pelvic Pain: Diagnosis and Management
- Author
-
Barbara S. Levy
- Subjects
medicine.medical_specialty ,business.industry ,Pelvic pain ,medicine ,Physical therapy ,Obstetrics and Gynecology ,medicine.symptom ,business - Published
- 2001
46. [Untitled]
- Author
-
Barbara S. Levy
- Subjects
medicine.medical_specialty ,business.industry ,Family medicine ,Health care ,Obstetrics and Gynecology ,Medicine ,business ,Biomedical sciences - Published
- 2000
47. Air embolism during gynecologic endoscopic surgery
- Author
-
Barbara S. Levy
- Subjects
medicine.medical_specialty ,business.industry ,medicine ,Obstetrics and Gynecology ,Endoscopic surgery ,medicine.disease ,business ,Air embolism ,Surgery - Published
- 1997
48. Radiology Illustrated: Gynecological Imaging
- Author
-
Barbara S. Levy
- Subjects
medicine.medical_specialty ,business.industry ,Obstetrics and Gynecology ,Medicine ,Medical physics ,business - Published
- 2005
49. Tribute to Robert B. Hunt, M.D
- Author
-
Barbara S. Levy
- Subjects
business.industry ,Obstetrics and Gynecology ,Tribute ,Medicine ,business ,Humanities - Published
- 2005
50. Response
- Author
-
Barbara S. Levy
- Subjects
Obstetrics and Gynecology - Published
- 1996
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