Background: Vaginal estrogen is a common therapy for many gynecologic conditions. Medication cost... more Background: Vaginal estrogen is a common therapy for many gynecologic conditions. Medication cost poses a barrier to medication compliance. The purpose of our study is to report patient cost savings by utilizing compounding pharmacies in the preparation of topical vaginal estrogen. Methods: A survey of 10 topical vaginal estrogen compounding pharmacies was performed and prescription cost data was obtained. The University of Oklahoma Outpatient Pharmacy and the 2008 Wolters Kluwer Health Pharmaceutical Audit Suite were cost comparisons for compounded estrogen. All data was processed using statistical software yielding descriptive statistics. Results: The average cost of compounded estrogen was $42.22. At the University of Oklahoma Outpatient Pharmacy, average cost for branded vaginal estrogen preparation was $137.70. The national cost average for branded vaginal estrogen preparations was $82.42. Cost savings of $94.98 (69%) locally and $40.20 (51%) nationally was identified. Conclusions: Compounded estrogen is a cost conscious alternative than branded preparations.
Objective: To evaluate medical students in the United States at several medical schools regarding... more Objective: To evaluate medical students in the United States at several medical schools regarding their knowledge of the global health burden of obstetric fistulas. Study design: A cross-sectional survey was conducted in 8 schools across the United States over a period of 6 months. The survey was composed of 18 questions on epidemiology, pathology, and treatment of fistulas. It was a web-based module accessed through an emailed link. It was sent to 5,103 medical students' email addresses at the 8 institutions once a week for 4 weeks. SPSS paired student t tests was used for statistical analysis. Results: Of the 1,089 students from 8 medical schools that initially began the survey, 965 completed this voluntary and anonymous survey, with a 21% response rate and 19% completion rate. Overall the students averaged 11/18 (60.7%) correct on this survey. The knowledge of obstetric fistula improved, but not significantly, with increasing level of medical school education, with first-year medical students achieving 10/18 (55%) correct and senior medical students achieving 12/18 (67%) correct (p = 0.1). Conclusion: U.S. medical students' knowledge of obstetric fistulas in developing countries does not increase significantly over 4 years of medical school education. While this condition presents largely in the developing world, given rapid globalization as well as increased international health experiences for U.S.-trained health professionals,further effort should be placed in improving medical student knowledge of this devastating condition.
Female pelvic medicine & reconstructive surgery, Mar 1, 2014
This study aimed to pilot a cystoscopy training program for community gynecologists that is valid... more This study aimed to pilot a cystoscopy training program for community gynecologists that is validated by posttraining examination. Twenty-eight gynecologists were trained to perform cystoscopy using a competency-based training approach. Baseline information included years in practice and number of incontinence procedures and/or cystoscopies performed per month. Three 5-hour workshops were administered that included applied practice. After learners individually trained until they felt comfortable with their skills on a model, they were individually tested on a cadaver. Performance was evaluated with 2 instruments, namely, a task-specific checklist and a global rating scale based on the objective structured assessment of technical skill model. Failure was defined as inability to independently complete elements of the task-specific checklist for cystoscopic examination. Likert-type self-report scales were used during pretesting and posttesting, assessing confidence to perform component tasks for diagnostic cystoscopy. Twenty-four of 28 trainees successfully performed a systematic cadaveric bladder examination during the primary posttest. After debriefing, the 4 trainees who initially failed successfully performed cystoscopy during a second trial. Median age was 51 years and median time in practice was 19.5 years. All participants reported high confidence in identifying ureteral injury at the course's conclusion. A task-specific training program can successfully improve the confidence and skill of community gynecologists to perform intraoperative diagnostic cystoscopy. Professionals may not be able to define when they have received enough instruction in terms of hands-on training with models, before acquisition of technical skills. Formal evaluation of technical skills is recommended after training to ensure competence.
Female Pelvic Medicine & Reconstructive Surgery, 2019
Objectives The objective of this study was to identify differences in pain perception and satisfa... more Objectives The objective of this study was to identify differences in pain perception and satisfaction with pain control in women receiving nonsteroidal anti-inflammatory drugs postoperatively. Methods This was a prospective, randomized controlled trial including urogynecology surgical patients. After surgery, all patients were randomized to receive either intravenous (IV) ketorolac or ibuprofen. The patients completed 3 visual analog scales (VAS) assessing pain at rest, pain with ambulation, and satisfaction with pain control. Postoperative opioid use was also measured. Results A total of 224 patients (112 in each arm) were included. Pain scores (SD) at rest in all patients who received ketorolac versus those who received ibuprofen was 2.30 (2.1) versus 2.68 (2.34) (P = 0.20). Pain scores (SD) with ambulation was 3.94 (2.57) versus 4.16 (2.73) (P = 0.57) in patients who received ketorolac and ibuprofen, respectively. Patients who received ketorolac rated their satisfaction with the...
Background: Vaginal estrogen is a common therapy for many gynecologic conditions. Medication cost... more Background: Vaginal estrogen is a common therapy for many gynecologic conditions. Medication cost poses a barrier to medication compliance. The purpose of our study is to report patient cost savings by utilizing compounding pharmacies in the preparation of topical vaginal estrogen. Methods: A survey of 10 topical vaginal estrogen compounding pharmacies was performed and prescription cost data was obtained. The University of Oklahoma Outpatient Pharmacy and the 2008 Wolters Kluwer Health Pharmaceutical Audit Suite were cost comparisons for compounded estrogen. All data was processed using statistical software yielding descriptive statistics. Results: The average cost of compounded estrogen was $42.22. At the University of Oklahoma Outpatient Pharmacy, average cost for branded vaginal estrogen preparation was $137.70. The national cost average for branded vaginal estrogen preparations was $82.42. Cost savings of $94.98 (69%) locally and $40.20 (51%) nationally was identified. Conclusions: Compounded estrogen is a cost conscious alternative than branded preparations.
Objective: To evaluate medical students in the United States at several medical schools regarding... more Objective: To evaluate medical students in the United States at several medical schools regarding their knowledge of the global health burden of obstetric fistulas. Study design: A cross-sectional survey was conducted in 8 schools across the United States over a period of 6 months. The survey was composed of 18 questions on epidemiology, pathology, and treatment of fistulas. It was a web-based module accessed through an emailed link. It was sent to 5,103 medical students' email addresses at the 8 institutions once a week for 4 weeks. SPSS paired student t tests was used for statistical analysis. Results: Of the 1,089 students from 8 medical schools that initially began the survey, 965 completed this voluntary and anonymous survey, with a 21% response rate and 19% completion rate. Overall the students averaged 11/18 (60.7%) correct on this survey. The knowledge of obstetric fistula improved, but not significantly, with increasing level of medical school education, with first-year medical students achieving 10/18 (55%) correct and senior medical students achieving 12/18 (67%) correct (p = 0.1). Conclusion: U.S. medical students' knowledge of obstetric fistulas in developing countries does not increase significantly over 4 years of medical school education. While this condition presents largely in the developing world, given rapid globalization as well as increased international health experiences for U.S.-trained health professionals,further effort should be placed in improving medical student knowledge of this devastating condition.
Female pelvic medicine & reconstructive surgery, Mar 1, 2014
This study aimed to pilot a cystoscopy training program for community gynecologists that is valid... more This study aimed to pilot a cystoscopy training program for community gynecologists that is validated by posttraining examination. Twenty-eight gynecologists were trained to perform cystoscopy using a competency-based training approach. Baseline information included years in practice and number of incontinence procedures and/or cystoscopies performed per month. Three 5-hour workshops were administered that included applied practice. After learners individually trained until they felt comfortable with their skills on a model, they were individually tested on a cadaver. Performance was evaluated with 2 instruments, namely, a task-specific checklist and a global rating scale based on the objective structured assessment of technical skill model. Failure was defined as inability to independently complete elements of the task-specific checklist for cystoscopic examination. Likert-type self-report scales were used during pretesting and posttesting, assessing confidence to perform component tasks for diagnostic cystoscopy. Twenty-four of 28 trainees successfully performed a systematic cadaveric bladder examination during the primary posttest. After debriefing, the 4 trainees who initially failed successfully performed cystoscopy during a second trial. Median age was 51 years and median time in practice was 19.5 years. All participants reported high confidence in identifying ureteral injury at the course's conclusion. A task-specific training program can successfully improve the confidence and skill of community gynecologists to perform intraoperative diagnostic cystoscopy. Professionals may not be able to define when they have received enough instruction in terms of hands-on training with models, before acquisition of technical skills. Formal evaluation of technical skills is recommended after training to ensure competence.
Female Pelvic Medicine & Reconstructive Surgery, 2019
Objectives The objective of this study was to identify differences in pain perception and satisfa... more Objectives The objective of this study was to identify differences in pain perception and satisfaction with pain control in women receiving nonsteroidal anti-inflammatory drugs postoperatively. Methods This was a prospective, randomized controlled trial including urogynecology surgical patients. After surgery, all patients were randomized to receive either intravenous (IV) ketorolac or ibuprofen. The patients completed 3 visual analog scales (VAS) assessing pain at rest, pain with ambulation, and satisfaction with pain control. Postoperative opioid use was also measured. Results A total of 224 patients (112 in each arm) were included. Pain scores (SD) at rest in all patients who received ketorolac versus those who received ibuprofen was 2.30 (2.1) versus 2.68 (2.34) (P = 0.20). Pain scores (SD) with ambulation was 3.94 (2.57) versus 4.16 (2.73) (P = 0.57) in patients who received ketorolac and ibuprofen, respectively. Patients who received ketorolac rated their satisfaction with the...
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Papers by Mikio Nihira