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Keywords = gynecology private practice

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9 pages, 342 KB  
Article
Impact of Physician Practice Racial Composition on Patient Demographics
by Gnankang Sarah Napoé, Hyagriv N. Simhan and Lara S. Lemon
Healthcare 2025, 13(18), 2255; https://doi.org/10.3390/healthcare13182255 - 9 Sep 2025
Viewed by 1214
Abstract
Background: Designing practices to better serve Black patients is necessary to decrease health disparities in America. Objective: To understand the impact of physician practice racial composition on patient demographics in a gynecology practice in the United States. We hypothesized that there will be [...] Read more.
Background: Designing practices to better serve Black patients is necessary to decrease health disparities in America. Objective: To understand the impact of physician practice racial composition on patient demographics in a gynecology practice in the United States. We hypothesized that there will be an increased proportion of Black patients seen by all physicians within a practice by adding Black physicians to that practice. Design: This is a retrospective study comparing patient demographics of three subspecialty gynecology practices: Practice A, with two Black physicians added to the staff during the study period, and Practice B and C, without any Black physicians. Methods: We compared patient demographics by practice over time, including race (Black and White), insurance status (public vs private), and area deprivation index (ADI) as a proxy for socioeconomic status. Results: During the study period, there was a statistically significant increase in Black patients in practice A (slope = 0.0029; p < 0.001), while the proportion trend of Black patients decreased or remained flat in Practice B (slope = −0.0020; p = 0.027) and C (slope = −0.0010; p = 0.23), respectively. While Black physicians saw more Black patients than nonBlack physicians in Practice A, the proportion of Black patients seen by nonBlack physicians, though modest, steadily increased during the study period. Practice A saw patients with higher ADI and more patients with public insurance. Black physicians in practice A saw more publicly insured patients than nonBlack physicians. There was no difference in patients’ ADI whether they were seen by Black or nonBlack physicians in Practice A. Conclusions: The addition of Black physicians to a practice is associated with increasing the proportion of Black patients seen by both Black and nonBlack physicians in that practice. Full article
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12 pages, 2828 KB  
Article
Findings and Challenges in Replacing Traditional Uterine Cervical Cancer Diagnosis with Molecular Tools in Private Gynecological Practice in Mexico
by José L. Castrillo-Diez, Carolina Rivera-Santiago, Silvia M. Ávila-Flores, Silvia A. Barrera-Barrera and Hugo A. Barrera-Saldaña
Viruses 2024, 16(6), 887; https://doi.org/10.3390/v16060887 - 31 May 2024
Cited by 3 | Viewed by 1940
Abstract
We have been encouraging practicing gynecologists to adopt molecular diagnostics tests, PCR, and cancer biomarkers, as alternatives enabled by these platforms, to traditional Papanicolaou and colposcopy tests, respectively. An aliquot of liquid-based cytology was used for the molecular test [high-risk HPV types, (HR [...] Read more.
We have been encouraging practicing gynecologists to adopt molecular diagnostics tests, PCR, and cancer biomarkers, as alternatives enabled by these platforms, to traditional Papanicolaou and colposcopy tests, respectively. An aliquot of liquid-based cytology was used for the molecular test [high-risk HPV types, (HR HPV)], another for the PAP test, and one more for p16/Ki67 dual-stain cytology. A total of 4499 laboratory samples were evaluated, and we found that 25.1% of low-grade samples and 47.9% of high-grade samples after PAP testing had a negative HR HPV-PCR result. In those cases, reported as Pap-negative, 22.1% had a positive HR HPV-PCR result. Dual staining with p16/Ki67 biomarkers in samples was positive for HR HPV, and 31.7% were also positive for these markers. Out of the PCR results that were positive for any of these HR HPV subtypes, n 68.3%, we did not find evidence for the presence of cancerous cells, highlighting the importance of performing dual staining with p16/Ki67 after PCR to avoid unnecessary colposcopies. The encountered challenges are a deep-rooted social reluctance in Mexico to abandon traditional Pap smears and the opinion of many specialists. Therefore, we still believe that colposcopy continues to be a preferred procedure over the dual-staining protocol. Full article
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11 pages, 1529 KB  
Article
Medical Professional Liability in Obstetrics and Gynecology: A Pilot Study of Criminal Proceedings in the Public Prosecutor’s Office at the Court of Rome
by Eva Bergamin, Annamaria Fiorillo, Vincenzo M. Grassi, Maria Lodise, Giuseppe Vetrugno and Fabio De-Giorgio
Healthcare 2023, 11(9), 1331; https://doi.org/10.3390/healthcare11091331 - 5 May 2023
Cited by 9 | Viewed by 3174
Abstract
Criminal trials and claims against physicians for malpractice-related damages have increased dramatically in recent years, and, with Obstetrics and Gynecology being one of the medical specialties that is at the highest risk, we carried out a retrospective analysis aimed at examining all Obstetrics- [...] Read more.
Criminal trials and claims against physicians for malpractice-related damages have increased dramatically in recent years, and, with Obstetrics and Gynecology being one of the medical specialties that is at the highest risk, we carried out a retrospective analysis aimed at examining all Obstetrics- and Gynecology-related medical professional liability prosecutions within the General Register of Criminal Records of the Rome Public Prosecutor’s Office between the years 2000 and 2014. The number of prosecutions increased steadily in the years 2000–2005, with varying trends in the following years. A total of 727 healthcare professionals were involved in criminal charges, and most prosecuted crimes were related to Articles 590 and 589 of the Italian Penal Code, followed by violations of Article 17 of Law 194/78. In most cases, filing was requested and granted without opposition. In 95 cases, an expert witness was appointed by the Court, and in 68 cases, the technical consultants of the State Prosecutor found culpable conduct. Public hospitals, private nursing homes and outpatient clinics, or private practices were mostly involved; in 45% of the cases, the physicians were hospital employees. In this setting, Italy is prepared to introduce new measures and regulations to address the issues posed by defensive medicine and charges of professional liability for healthcare providers. Full article
(This article belongs to the Special Issue Old Issues and New Challenges in Forensic and Legal Medicine)
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10 pages, 380 KB  
Article
Defensive Medicine in the Management of Cesarean Delivery: A Survey among Italian Physicians
by Vittorio Fineschi, Mauro Arcangeli, Nicola Di Fazio, Zoe Del Fante, Benedetta Fineschi, Paola Santoro, Paola Frati and Associazione Consulcesi Health and ONLUS Futura Ricerca
Healthcare 2021, 9(9), 1097; https://doi.org/10.3390/healthcare9091097 - 25 Aug 2021
Cited by 25 | Viewed by 4089
Abstract
Background and Objectives: This study aims to contribute to the definition of the defensive medicine phenomenon between obstetricians and gynecologists, as well as to possible effects on the frequency of deliveries performed by cesarean sections (CS). Materials and Methods: a digital questionnaire was [...] Read more.
Background and Objectives: This study aims to contribute to the definition of the defensive medicine phenomenon between obstetricians and gynecologists, as well as to possible effects on the frequency of deliveries performed by cesarean sections (CS). Materials and Methods: a digital questionnaire was administered through a mail-list including 600 gynecological specialists (of these 168 doctors completed the test), both in public and private settings. It was made of twenty multiple choice questions, concerning their awareness about the practice of defensive medicine and the planning and execution of CS. All doctors involved received clear and complete information about the purpose of this study and about the organizations that received their answers. Analyses of variance and regression were performed to describe differences between groups and to estimate the relationships between variables. The value of p < 0.5 was considered statistically relevant. Results: our analysis revealed that most respondents are confident with the defensive medicine definition and characteristics. This survey confirmed that gynecologists fear legal actions promoted by their patients and therefore modulate their choices by implementing professional behaviors of so-called “defensive medicine”. This relates to a greater number of medical liability judgements, which more often concern omission or delayed execution of cesarean section, rather than unskillful surgical procedures. Conclusions: there are few data to support a relation between the high rate of CS and defensive medicine. Numerous scientific studies associated this CS rate with the phenomenon of defensive medicine. This practice is constantly growing in all medical areas, especially in high-risk specialties such as obstetrics and gynecology. Our study highlights physicians’ awareness of adopting defensive medicine behaviors in their clinical practice, affecting the choice of the type of delivery to be performed. Full article
(This article belongs to the Special Issue New Trends in Forensic and Legal Medicine)
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