Search

Context The knowledge of normal variation of reproductive hormones, internal genitalia imaging, and the prevalence of gynecological disorders in adolescent girls is limited. Objective The study aimed to describe reproductive parameters in postmenarchal girls from the general population including the frequency of oligomenorrhea, polycystic ovary syndrome, and use of hormonal contraception. Design The Copenhagen Mother-Child Cohort is a population-based longitudinal birth cohort of 1210 girls born between 1997 and 2002. Setting University hospital. Participants A total of 317 girls were included, with a median age of 16.1 years and time since menarche of 2.9 years. Main Outcome Measure(s) Tanner stage, height, weight, age at menarche, menstrual cycle length and regularity, ovarian/uterine volume, and number of follicles were recorded. Serum concentrations of FSH, LH, anti-Müllerian hormone (AMH), inhibin B, estradiol, testosterone, SHBG, androstenedione, dehydroepiandrosterone sulfate, 17-OH-progesterone, and IGF-1 were measured. Results Twenty girls (6.3%) had oligomenorrhea and differed significantly in serum androgens and AMH, age at and time since menarche from girls with regular cycles. Twenty-seven girls were classified with PCOS (8.5%) and had significantly higher 17-OH-progesterone, estradiol, AMH, LH, and age at menarche than the reference group. Girls on oral contraception had significantly higher serum SHBG concentrations and lower serum concentrations of all hormones except AMH and IGF-1. Ovarian follicles 2 to 29.9 mm correlated positively with serum AMH (P < 0.0001). Conclusions Most 16-year-old girls had regular menstrual cycles, normal reproductive hormones, and uterine and ovarian ultrasound. Serum AMH reflected ovarian follicle count and may be a useful biomarker of ovarian reserve.

Objective To provide a model for conducting cost‐effectiveness analyses in medical education. The model was based on a randomised trial examining the effects of training midwives to perform cervical length measurement (CLM) as compared with obstetricians on patients' waiting times. (CLM), as compared with obstetricians. Methods The model included four steps: (i) gathering data on training outcomes, (ii) assessing total costs and effects, (iii) calculating the incremental cost‐effectiveness ratio (ICER) and (iv) estimating cost‐effectiveness probability for different willingness to pay (WTP) values. To provide a model example, we conducted a randomised cost‐effectiveness trial. Midwives were randomised to CLM training (midwife‐performed CLMs) or no training (initial management by midwife, and CLM performed by obstetrician). Intervention‐group participants underwent simulation‐based and clinical training until they were proficient. During the following 6 months, waiting times from arrival to admission or discharge were recorded for women who presented with symptoms of pre‐term labour. Outcomes for women managed by intervention and control‐group participants were compared. These data were then used for the remaining steps of the cost‐effectiveness model. Results Intervention‐group participants needed a mean 268.2 (95% confidence interval [CI], 140.2‒392.2) minutes of simulator training and a mean 7.3 (95% CI, 4.4‒10.3) supervised scans to attain proficiency. Women who were scanned by intervention‐group participants had significantly reduced waiting time compared with those managed by the control group (n = 65; mean difference, 36.6 [95% CI 7.3‒65.8] minutes; p = 0.008), which corresponded to an ICER of 0.45 EUR minute−1. For WTP values less than EUR 0.26 minute−1, obstetrician‐performed CLM was the most cost‐effective strategy, whereas midwife‐performed CLM was cost‐effective for WTP values above EUR 0.73 minute−1. Conclusion Cost‐effectiveness models can be used to link quality of care to training costs. The example used in the present study demonstrated that different training strategies could be recommended as the most cost‐effective depending on administrators' willingness to pay per unit of the outcome variable., Discuss ideas arising from the article at http://www.mededuc.com discuss.

INTRODUCTION: There is no international consensus on the orientation of transvaginal ultrasound images and no evidence exists to support the superiority of one image orientation over the other. The aim of this study was to compare learning curves and skills transfer in a group of novices randomized to top-down or bottom-up image orientation, and to determine whether individual preferences for image orientation affect learning and skills transfer.MATERIAL AND METHODS: 60 senior medical students, with no prior ultrasound experience, were randomized to orient the image top-down or bottom-up during training on an ultrasound simulator until attaining expert levels of performance. Participants then completed a transfer test involving a systematic ultrasound examination on a physical mannequin using real ultrasound equipment. Performance was assessed during the transfer test by two independent raters using the objective structured assessment of ultrasound skills (OSAUS) score and a global rating score.RESULTS: The bottom-up group reached the expert level with significantly fewer attempts than did the top-down group [median ± interquartile range: 4 ± 2 vs 5 ± 3] (U = 285.5, P = 0.014). The bottom-up group used less time to achieve the expert level (median ± interquartile range: 3 h 2 m ± 1 h 14 m vs 3 h 28 m ± 2 h 21 m) (U = 301.5, P = 0.029). The two groups performed similarly during the transfer test with respect to their OSAUS scores (top-down 56.7% vs bottom-up 53.2%, P = 0.13). The global rating scores were higher in the top-down group (top-down 57.1% vs bottom-up 50.0%, P = 0.02).CONCLUSIONS: Orientation of the images bottom-up rather than top-down, led to a steeper learning curve, but had little or no impact on the subsequent transfer of skills.