Postpartum Use of Long-Acting Reversible Contraception in Primiparous Women: Ramathibodi Hospital’s Experiences

Objective: To determine desire and initiation of long-acting reversible contraception (LARC) of primiparous women in the postpartum period. Material and Method:A prospective cohort study was conducted at Faculty of Medicine Ramathibodi Hospital, Bangkok, from July 2012 to December 2012. Postpartum women, who were primiparous, aged greater than or equal to 20 years and willing to participate were recruited into this study. Prior to discharge, a structured interview questionnaire was used to determine initial postpartum contraception desires. After discharge, data was collected at 8–12 weeks postpartum using telephone calls to determine postpartum contraception utilization and reasons.Results:Five hundred and two out of 547 women had a documented postpartum visit at 8-12 weeks, giving an overall response rate of 91.8%. Amongst the 197 women (36.0%), who desired LARC prior to discharge, 161 (32.1%) utilized LARC within 8-12 weeks postpartum and the most common reason was no effect on breast-feeding. Injectable was the most common method of LARC used (55.9%). Simultaneous factor associated with desire for LARC prior to discharge and LARC utilization at 8-12 weeks postpartum was occupation. Compared to government officers, employees and housewives, business owners were more likely to desire and utilize LARC.Conclusions: LARC is highly desired and utilized at 8-12 weeks postpartum in primiparous women. Occupation was a predictor of LARC desire and utilization. The most common reason of LARC utilization at 8-12 weeks was no effect on breast-feeding

Efficacy of Topical Ethyl Chloride Spray versus Subcutaneous 1% Lidocaine Injection in Reducing Pain from One Rod System Implant Insertion

Objectives: To compare the efficacy of topical ethyl chloride spray and subcutaneous 1% lidocaine injection in reducing pain from one rod system implant insertion.Materials and Methods: Eighty-four women undergoing one rod implant insertion during February 2014 to December 2015 were enrolled and randomly allocated to ethyl chloride spray and 1% lidocaine injection groups. After skin was sterilized, the assigned anesthetic method was administered before insertion of one rod implant according to the standard pro-cedure. Pain during anesthetic administration, implant insertion, 20 min after insertion, and overall pain were evaluated, using a 100-mm visual analogue scale (VAS). Patient and doctor satisfaction were measured using a five-point Likert scale.Results: All basis clinical characteristics between two groups did not differ. There was no significant difference in VAS during and 20 min after implant insertion between 2 anesthetic groups (p > 0.05). Median VAS during anesthetic administration and overall pain in ethyl chloride spray group (1.50 and 1.60) were significant lower than lidocaine injection group (3.75 and 2.75) (p < 0.01). Patient and doctor satisfaction scores were significant higher in ethyl chloride spray group (p < 0.05).Conclusion: Ethyl chloride spray can be used as anesthetic option for one rod system implant insertion. It provides comparable analgesic effect to lidocaine injection but with less pain from anesthetic administration

Mobile Application Based Pelvic Floor Muscle Training for Treatment of Stress Urinary Incontinence: An Assessor-Blind, Randomized, Controlled Trial

A first-line treatment for stress urinary incontinence (SUI) is pelvic floor muscle training (PFMT) for at least three months. The key problem is that patients do not understand the importance of these exercises and their effectiveness. Mobile health apps offer new possibilities to increase treatment adherence. This study compared a reduction in SUI, exercise adherence, and quality of life in PFMT with animation vs. standard instruction. A prospective, single-blind, randomized control trial was collected. SUI patients were randomized into the application or control groups confirmed using a one-hour pad test. In the intervention group, the PFMT application was applied via mobile phone (PFMT with animations, recording system, and reminder system). The standard exercise protocol was similar in both groups. Additional follow-up was conducted at 4, 8, and 12 weeks. A total of 51 participants were randomized to the application (n = 26) and control groups (n = 25), respectively. At the 12-week follow-up, there was no significant difference between the two groups in terms of SUI cure rate, SUI severity by pad test, and daily SUI episodes from the bladder diary (p-value of 0.695, 0.472, and 0.338, respectively). The mean PFME adherence in the application group was higher than the control group at 8 weeks (66.3 ± 13.6 vs. 52.7 ± 16.6, p = 0.002) and 12 weeks (59.1 ± 13.9 vs. 37.8 ± 11.0, p = 0.001). The application group reported no difference from the conventional PFMT group in terms of improvements in SUI cure rate, symptom severity, and quality of life effects at 12-week follow-up. However, the improvement evaluated by the mean difference in SUI episodes and quality of life effects (ICIQ-UI SF) reported a better outcome in the mobile app group. The PFMT application has been proven to be an effective tool that improves PFMT adherence

The effect of online video-assisted teaching program on medical students learning procedure of fractional curettage

Abstract Objectives Since 2020, with the entire world in crisis over the coronavirus pandemic (COVID-19), medical students have adapted to hybrid and distance learning. This study aims to compare the learning outcomes of students learning the procedure of fractional curettage in an online video-assisted teaching program to those of students learning the procedure in a traditional class. Methods A quasi-experimental study was conducted among fourth-year medical students who rotated to Obstetrics and Gynecology courses between April 2021 and October 2021. Participants in the first two rotations were enrolled in traditional classes, and the online video-assisted teaching program was introduced in the subsequent two rotations. Both study groups took OSCEs (objective structured clinical examinations), a pre-test and post-test with MCQs (multiple choice questions), and a confidence and satisfaction level questionnaire. Results A total of 106 fourth-year medical students, 54 in the traditional group and 52 in the online video-assisted teaching program, were recruited. The online video-assisted group showed a statistically better mean OSCE score (85.67 ± 11.29 vs. 73.87 ± 13.01, p < 0.001) and mean post-test MCQ score than the traditional group (4.21 ± 0.87 vs. 3.80 ± 0.98, p = 0.0232). Moreover, the mean difference between the two groups' pre and post-test MCQ scores was significantly different (0.96 ± 1.37 vs. 1.79 ± 1.50 in traditional and online video-assisted teaching program groups, respectively, P = 0.0038). The participants in the experimental group reported significantly greater confidence (P < 0.001) in performing the fractional curettage procedure. However, the mean satisfaction score was significantly higher in the control group (p = 0.0053). Conclusion The online video-assisted teaching program on the fractional curettage procedure, a necessary and skill-demanding procedure, is an effective and advantageous education tool that improves skills, knowledge, and confidence in fourth-year medical students. We recommend that the video-assisted teaching program is another effectively procedural teaching method for medical students