Shoulder Injuries in Individuals Who Participate in CrossFit Training.

Background: CrossFit, a sport and fitness program, has become increasingly popular both nationally and internationally. Researchers have recently identified significant improvements in health and wellness due to CrossFit. However, some individuals assert that CrossFit poses an inherent risk of injury, specifically to the shoulder, due to the intensity of training.

Sexual functioning after total compared with supracervical hysterectomy: a randomized trial.

Objective: To compare sexual functioning and health-related quality-of-life outcomes of total abdominal hysterectomy (TAH) and supracervical hysterectomy (SCH) among women with symptomatic uterine leiomyomata or abnormal uterine bleeding refractory to hormonal management.

Methods: We randomly assigned 135 women scheduled to undergo abdominal hysterectomy in 4 U.S.

Resource use for total and supracervical hysterectomies: results of a randomized trial.

Objective: Hysterectomy is the most common major surgical procedure performed in the United States for nonobstetric reasons. Although most hysterectomies include removal of the cervix, the rate of supracervical procedures has increased in recent years. To provide evidence about the outcomes of both types of hysterectomy, we conducted a randomized clinical trial of total (TAH) or supracervical (SCH) hysterectomy (the "TOSH" trial).

Hysterectomy versus expanded medical treatment for abnormal uterine bleeding: clinical outcomes in the medicine or surgery trial.

Objective: To compare clinical outcomes after randomization to hysterectomy versus medical treatment in patients with chronic abnormal uterine bleeding refractory to medroxyprogesterone acetate.

Methods: We randomly assigned 63 premenopausal women with abnormal uterine bleeding refractory to cyclic medroxyprogesterone acetate treatment to receive either a hysterectomy or expanded medical treatment. Within each randomized group, the specific treatment approach was determined by patient and provider preference.

Effect of hysterectomy vs medical treatment on health-related quality of life and sexual functioning: the medicine or surgery (Ms) randomized trial.

Context: Although a quarter of US women undergo elective hysterectomy before menopause, controlled trials that evaluate the benefits and harms are lacking.

Objective: To compare the effect of hysterectomy vs expanded medical treatment on health-related quality of life.

Design, Setting, And Participants: A multicenter, randomized controlled trial (August 1997-December 2000) of 63 premenopausal women, aged 30 to 50 years, with abnormal uterine bleeding for a median of 4 years who were dissatisfied with medical treatments, including medroxyprogesterone acetate.

Medicine or Surgery (Ms): a randomized clinical trial comparing hysterectomy and medical treatment in premenopausal women with abnormal uterine bleeding.

Hysterectomy may be overused as treatment for abnormal uterine bleeding due to benign causes in reproductive women. Medical therapies are an alternative, and there is a need for randomized trials comparing the outcomes of these approaches. Women of reproductive age who continued to have bothersome abnormal uterine bleeding after cyclic hormonal treatment with medroxyprogesterone acetate (MPA; 10-20 mg for 10-14 days/month) for 3-5 months were invited to participate in a randomized trial of hysterectomy versus other medical therapies.

Is a resident's score on a videotaped objective structured assessment of technical skills affected by revealing the resident's identity?

Objective: The purpose of this study was to determine whether knowledge of resident's identity affects the evaluation of surgical skills.

Study Design: During an objective structured assessment of technical skills, 33 residents in obstetrics and gynecology who performed 10 surgical skills were videotaped with two digital cameras simultaneously. One camera videotaped "hands only," concealing resident identity; the other camera videotaped from the "waist up," revealing identity.

A randomized comparison of total or supracervical hysterectomy: surgical complications and clinical outcomes.

Objective: To compare surgical complications and clinical outcomes after total versus supracervical abdominal hysterectomy for control of abnormal uterine bleeding, symptomatic uterine leiomyomata, or both.

Methods: We conducted a randomized intervention trial in four US clinical centers among 135 patients who had abdominal hysterectomy for symptomatic uterine leiomyomata, abnormal uterine bleeding refractory to hormonal treatment, or both. Patients were randomly assigned to receive a total or supracervical hysterectomy performed using the surgeon's customary technique.

Medroxyprogesterone acetate treatment of abnormal uterine bleeding: factors predicting satisfaction.

Objective: This study was undertaken to identify the determinants of patient satisfaction with a cyclic regimen of medroxyprogesterone acetate (MPA) for abnormal uterine bleeding.

Study Design: A prospective cohort study of 413 premenopausal women were treated for 3 to 5 months with oral MPA 10 to 20 mg per day for 10 to 14 days per month. We assessed satisfaction with and willingness to continue MPA.

Practice management in obstetrics and gynecology residency curriculum.

Objective: To establish the current level of instruction in practice management in obstetrics and gynecology residency programs; review recommendations of medical school practice management executives and current and former residents on design of practice management instruction programs; and develop recommendations for future management instruction by residency programs in obstetrics and gynecology.

Methods: A questionnaire was sent to 101 practice plan executives of obstetrics and gynecology departments at medical schools in the United States and Canada. A modified version was sent to 44 current obstetrics and gynecology residents and 72 former residents from the University of Tennessee, Memphis.

A multicenter randomized comparison of laparoscopically assisted vaginal hysterectomy and abdominal hysterectomy in abdominal hysterectomy candidates.

Objective: To compare intraoperative and postoperative outcomes between laparoscopically assisted vaginal hysterectomy and abdominal hysterectomy among patients who are not eligible for vaginal hysterectomy.

Methods: Study subjects were randomly assigned to undergo laparoscopically assisted vaginal hysterectomy or standard abdominal hysterectomy. Intraoperative and postoperative management was similar for each group.

Addressing a state's physician workforce priorities through the funding of graduate medical education: the TennCare model.

TennCare is Tennessee's innovative program that replaces the state's Medicaid program with a health care system based on managed care and designed to cover the vast majority of the state's poor and uninsured. The program provides health care benefits not only to those eligible for Medicaid, but also to the uninsured poor who do not qualify for Medicaid and those who are uninsurable because of existing medical conditions. This article describes the allocation of TennCare graduate medical education funding, which is designed to address the state's physician workforce priorities regarding specialty mix and practice location.

Peritoneal closure at vaginal hysterectomy: a reassessment.

Objective: To evaluate the clinical outcome of patients who underwent vaginal hysterectomy with or without peritoneal closure.

Methods: This study was a randomized trial. Using computer-generated numbers, all patients undergoing vaginal hysterectomy without oophorectomy were randomized to either no peritoneal closure (n = 57) or routine peritoneal closure (n = 49).

Outpatient vaginal hysterectomy as a new trend in gynecology.

A large number of vaginal hysterectomies are performed on an outpatient basis through ambulatory surgery units (ASU). Recognizing this trend, we researched the possibility of performing vaginal hysterectomies in our ASU and developed an outpatient vaginal hysterectomy protocol. The preoperative and postoperative education we provide to patients is the key to our protocol's success.

GnRH agonist and iron versus placebo and iron in the anemic patient before surgery for leiomyomas: a randomized controlled trial. Leuprolide Acetate Study Group.

Objective: To determine the effectiveness of leuprolide acetate depot plus iron compared with iron alone in the preoperative treatment of anemia due to prolonged or excessive bleeding associated with uterine leiomyomas.

Methods: This was a phase III, stratified, randomized, double-blind, placebo-controlled, parallel-group, 12-week multicenter study. Enrolled patients had hemoglobin levels of 10.

Incisional bowel herniations after operative laparoscopy: a series of nineteen cases and review of the literature.

Objectives: The objectives of this report were (1) to identify all cases of incisional bowel herniations noted after operative laparoscopy in 11 participating institutions and (2) to report the clinical details of such patients.

Study Design: A retrospective case review was performed.

Results: Nineteen cases of incisional bowel herniation were identified.

Synthetic hygroscopic cervical dilator use in patients with unsatisfactory colposcopy.

Objective: To assess the ability of a synthetic hygroscopic cervical dilator to make an unsatisfactory colposcopic examination satisfactory, thereby avoiding cervical conization.

Materials: From April 1991 to March 1993, 30 women with unsatisfactory colposcopic examinations underwent repeat colposcopy after a synthetic hygroscopic cervical dilator had been placed in the endocervical canal for approximately 2 hours.

Results: The reasons for initial unsatisfactory colposcopy in the 30 patients were squamocolumnar junction not seen in its entirety (18 patients, 60%), lesion not seen in its entirety (ten, 33%), and neither transformation zone nor lesion seen in their entirety (two, 7%).

Outpatient hysterectomy: determinants of discharge and rehospitalization in 133 patients.

Objective: This study examines our continuing experience in performing vaginal hysterectomies and laparoscopy-assisted vaginal hysterectomies with an outpatient protocol. The purpose was to review factors associated with discharge and hospitalization.

Study Design: Surgical records from all women entering our previously reported outpatient hysterectomy protocol were reviewed.

The effect of nitrous oxide and carbon dioxide pneumoperitoneum on operative and postoperative pain during laparoscopic sterilization under local anesthesia.

Study Objective: To compare carbon dioxide and nitrous oxide pneumoperitoneum with respect to intraoperative and postoperative pain during laparoscopic sterilization under local anesthesia.

Design: Randomized, double-blind study of pain during surgery and at 15 minutes, 1 hour, and 24 hours postoperatively.

Setting: Regional Medical Center, Memphis, Tennessee.

Serum bupivacaine levels during laparoscopic sterilization using local anesthesia.

Study Objective: To determine the serum levels of bupivacaine during laparoscopic sterilization when bupivacaine 0.5% without epinephrine is used as the sole local anesthetic agent.

Design: Case series.

Prospective comparison of indwelling bladder catheter drainage versus no catheter after vaginal hysterectomy.

Objective: This study compares the postoperative outcomes of patients in whom indwelling bladder catheterization or no catheter was used after vaginal hysterectomy.

Study Design: One hundred women undergoing inpatient vaginal hysterectomy were randomly assigned to have an indwelling Foley catheter for 24 hours or no catheter after the procedure. Data regarding postoperative morbidity were recorded, and a clean voided urine specimen for urinalysis and culture was obtained 48 hours and 2 weeks after surgery.