Owen Montgomery

Essential Components of Successful Collaborative Maternity Care Models. The ACOG-ACNM Project

The American College of Obstetricians and Gynecologists (ACOG) and the American College of Nurse-Midwives (ACNM) asked ACNM member midwives and ACOG Fellows with successful and sustainable collaborative practices between obstetricians and midwives to describe their care models in jointly written articles. This review analyzes 12 of the 60 articles submitted. Five main themes were identified: impetus for new collaboration, basic foundations of collaborative care, commitment to successful partnership, care integration, and health professions education in an interprofessional practice environment. The analysis provides evidence of the extent to which committed clinicians are working together to provide excellent, women-centered maternity care.

Human Papillomavirus and Cervical Cancer Knowledge, Health Beliefs, and Preventative Practices in Older Women

OBJECTIVE To explore knowledge of Human Papillomavirus (HPV) and cervical cancer, health beliefs, and preventative practices in women 40 to 70 years. DESIGN Cross-sectional descriptive. SETTING Three urban ambulatory Obstetrics and Gynecology offices connected with a teaching hospitals Department of Obstetrics and Gynecology in the Mid-Atlantic section of the United States. PARTICIPANTS A convenience sample of 149 women age 40 to 70. METHODS To assess HPV and cervical cancer knowledge, health beliefs, and preventative practices a self-administered survey, the Awareness of HPV and Cervical Cancer Questionnaire was distributed to women as they waited for their well-woman gynecologic exam. RESULTS The mean knowledge score was 7.39 (SD=3.42) out of 15. One third of the questions about the relationship of HPV and risks for cervical cancer were answered incorrectly by more than 75% of these women. Although most appreciate the seriousness of cervical cancer, they believed themselves not particularly susceptible. CONCLUSION There is a need for HPV and cervical cancer awareness and education for women older than age 40. Womens health care professionals are well positioned to act as a catalyst to improve HPV and cervical cancer knowledge, health beliefs, and preventative practice to ensure optimum health promotion for all women.

Transdisciplinary Teamwork Simulation in Obstetrics–Gynecology Health Care Education

This program evaluation was designed to assess whether a transdisciplinary teamwork simulation experience improves collaborative attitudes among womens health students toward the goals of reducing medical errors and improving patient outcomes. This program evaluation used a pretest-posttest comparative design to measure changes in collaborative attitudes among 35 multidisciplinary womens health students before and after a transdisciplinary simulation experience. Collaborative attitudes were measured by the Team Attitudes Questionnaire. Data analysis consisted of descriptive analysis, paired t tests, and post hoc item analysis. Findings suggest significant increases in collaborative attitudes for mutual support and communication but no significant increases in attitudes for structure, situation monitoring, or leadership from pretest to posttest. Trans-disciplinary simulation experiences among womens health students may enhance mutual support and communication and promote better patient outcomes. Future research should focus on mechanisms to facilitate improvements in structure, situation monitoring, and leadership.

Body enhancement through female genital cosmetic surgery creates ethical and rights dilemmas

Female genital cosmetic surgery is surgery performed on a woman within a normal range of variation of human anatomy. The issues are heightened by a lack of long‐term and substantive evidence‐based literature, conflict of interest from personal financial gain through performing these procedures, and confusion around macroethical and microethical domains. It is a source of conflict and controversy globally because the benefit and harm of offering these procedures raise concerns about harmful cultural views, education, and social vulnerability of women with regard to both ethics and human rights. The rights issues of who is defining normal female anatomy and function, as well as the economic vulnerability of women globally, bequeath the profession a greater responsibility to ensure that there is adequate health and general education—not just among patients but broadly in society—that there is neither limitation nor interference in the decision being made, and that there are no psychological disorders that could be influencing such choices.

Sacral nerve stimulation during pregnancy: case report and review of the literature.

Background The use of sacral nerve stimulation during pregnancy is not recommended because of the unknown effects on the offspring. There is a paucity of literature on the subject. Case A 25-year-old woman who had a sacral nerve stimulator for severe interstitial cystitis/bladder pain syndrome had 2 successful pregnancies. Against medical advice, she kept the stimulator activated for symptom control during the pregnancies. The first child was later diagnosed with chronic motor tic disorder, and the second had a pilonidal sinus at birth. Whether this outcome is related to the neurostimulator is unknown. The efficacy of sacral nerve stimulation decreased after each pregnancy. Conclusion The safety of sacral nerve stimulation in pregnancy has not been well established. Until further research is done, we recommend that women of reproductive age with a sacral nerve stimulator be advised about contraception and that the device should be deactivated before or as soon as pregnancy is confirmed.

The State of Sexual Health Education in U.S. Medicine.

Although studies have shown that patients want to receive sexual health services from their physicians, doctors often lack the knowledge and skills to discuss sexual health with their patients. There is little consistency among medical schools and residency programs in the United States regarding comprehensiveness of education on sexual health. Sexuality education in U.S. medical schools and residency programs is reviewed, highlighting schools that go beyond the national requirements for sexuality education. Increasing the amount of sexuality instruction provided for medical education and training, standardizing sexuality education requirements in medical school and residency programs, incorporating different learning models, establishing means of consistently assessing and evaluating sexuality knowledge and skills, and creating national certification standards for the practice of sexual medicine are recommended.

A Multi-Disciplinary Framework for Continuous Biomedical Monitoring Using Low-Power Passive RFID-Based Wireless Wearable Sensors

We have applied passive Radio Frequency Identification (RFID), typically used for inventory management, to implement a novel knit fabric strain gauge assembly using conductive thread. As the fabric antenna is stretched, the strength of the received signal varies, yielding potential for wearable, wireless, powerless smart-garment devices based on small and inexpensive passive RFID technology. Knit fabric sensors and other RFID biosensors can enable comfortable, continuous monitoring of biofeedback, but requires an integrated framework consisting of antenna modeling and fabrication, signal processing and machine learning on the noisy wireless signal, secure HIPAA- compliant data storage, visualization and human factors, and integration with existing medical devices and electronic health records (EHR) systems. We present a multidisciplinary, end-to-end framework to study, model, develop, and deploy RFID-based biosensors.

Outcomes of effective transmission of electronic prenatal records from the office to the hospital

OBJECTIVE: To investigate the outcomes associated with improved transmission of prenatal test results between the outpatient and inpatient obstetric setting after implementation of an electronic prenatal record system. METHODS: Admission paper charts of patients admitted to our labor and delivery unit were reviewed before and after implementation of an electronic prenatal record system. The availability of maternal hepatitis B and human immunodeficiency virus (HIV) serology on admission, the occurrence of repeat hepatitis B surface antigen and rapid HIV blood testing, and the occurrence of hepatitis B immunoglobulin administration to the newborns of mothers without available hepatitis B serology was recorded. Fishers exact tests were performed to determine differences in availability of prenatal test results, the occurrence of repeat blood testing, and the occurrence of immunoglobulin administration before and after implementation. RESULTS: A total of 460 admission charts were reviewed, 229 preimplementation and 231 postimplementation. Of the preimplementation charts, 78.2% contained maternal hepatitis B and HIV serology results, whereas all postimplementation charts contained such results (P<.001). Although repeat hepatitis B surface antigen testing was performed in 3.1% of patients preimplementation, no patients required repeat testing postimplementation (P=.007). Similarly, rapid HIV blood testing was performed in 3.5% of patients preimplementation, but no patients required repeat testing postimplementation (P=.003). Increased availability of testing results prevented unnecessary administration of hepatitis B immunoglobulin postimplementation. CONCLUSION: Implementation of an electronic perinatal record system was associated with improved transmission of prenatal test results between the outpatient and inpatient obstetric setting and a decreased rate of unnecessary maternal testing and newborn interventions. LEVEL OF EVIDENCE: III

Transdisciplinary Simulation Learning and Practicing Together

The Institute of Medicine, partnering with national private foundations, has challenged existing approaches to health care delivery and patient safety by suggesting a sweeping redesign of the entire U.S. health care system. This article explores the historical and philosophic imperative to change health care education to a seamless transdisciplinary model to foster interprofessional communication and collaboration during the formative training years. To improve patient safety and quality of care and reduce medical error, students in health care disciplines will need to be educated together to practice together effectively.

Self-disclosure of sexually transmitted diseases: an integrative review.

In the United States, there are currently more than 65 million individuals living with a sexually transmitted disease (STD), and approximately 19 million new infections will continue to occur each year. To decrease the transmission of potentially dangerous and life-altering STDs, self-disclosure of sexual and drug history and sexual orientation is paramount. This integrative review examines the concept of self-disclosure of STDs, suggests areas of additional research, and proposes a comprehensive public health campaign, with a specific focus on the recent human papillomavirus epidemic to improve the physical and psychological health of all individuals.