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INTRODUCTION: Frequently, postoperative pain lacks of systematic evaluation and follow-up. OBJECTIVES: 1. To determine the proportion of cases without appropriate pain relief in an Obstetrics and Gynecology hospital service. 2. To describe analgesics' use patterns and medication errors detected in a case series. METHODS: Our study was conducted in a private teaching hospital. To fulfill the first objective, an analogue numeric scale and a color scale were applied to 278 patients, in order to evaluate severity of pain. Measurements equal or higher to 30 mm were considered as inappropriate pain control. For the second objective, a retrospective random sample of 42 cases was selected to analyze analgesic use patterns and to detect medication errors. RESULTS: The 278 cases contributed with 3526 pain registries, average 12.7 +/- 5.46 measurements per patient, 348 data were > or = 30 mm, involving 136/278 patients. For the second objective we included patients with an average age 34.1 +/- 11 years-old, diagnoses were: cesareans n = 15, labor n = 4, myomectomy n = 4, hysterectomy n = 15 y 13 with diverse disease conditions, where an average of 2.47 +/- 1.48 analgesics were prescribed, 8 cases with simultaneous NSAIDs use, 24 cases had medication errors as overdose, therapeutic duplicity, transcription omission, none of them with consequences for patients. CONCLUSIONS: 1. Systematic pain evaluation and its scaled management, according to severity, are essential to improve postoperative health care quality. 2. Studies, as the one presented here, are desirable in any postoperative setting.

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Complaints related to uterine myomatosis treatments received by the National Commission of Medical Arbitration (Conamed) between 2001 and 2005 were analyzed. Complaints were from patients affiliated to social security institutions (51.7 %), private providers (34.5 %) and public health care services (13.8 %). A medical doctor suggested to fill in the complaint in 10.3 % of cases. Perception of inadequate treatment was the most frequent cause (69 %), incomplete medical charts were 60.3 % and only 24 % included the informed consent form. Medical information given to patients and relatives was inadequate (48.2 %). Hysterectomy was performed to 84.5 % of patients. The most frequent surgical complications were hemorrhage (25.7 %), urologic injuries (25.7 %) and surgical infections (12.7 %). 36.4 % of cases had no surgical complication. Main sequelae were: elapsed length of hospital stay (15 %) and loss of an organ (other than uterus) or function (not reproductive) (13.8 %). There was one death (1.7 %). Medical malpractice was found in 29.3 % of cases. Principal deviations: communication problems (29.6 %), unjustified delayed surgery (29.4 %) and delayed diagnosis of complications due to poor post-surgical care or premature hospital discharge (29.4 %).

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Objetivo. Evaluar la reproductibilidad de un cuestionario sobre aspectos clínicos y epidemiológicos del climaterio. Material y métodos. La población de estudio (n=100) fueron usuarias de servicios de ginecología y obstetricia que asistieron a consulta por motivos relacionados con el climaterio y que aceptaron participar voluntariamente. Cada paciente seleccionada respondió el mismo cuestionario en dos oportunidades con un intervalo de 15 a 30 días entre la primera y segunda entrevista. Se utilizó el estadístico de Kappa para evaluar la concordancia de las variables categóricas. Para variables continuas se estímo la media de las diferencias y se obtuvieron los intervalos de confianza respectivo. Resultados. La concordancia fue alta (Kappa de 0.81-1.0) para variables categóricas, como el tipo de ciclos menstruales, tipo de menopausia, lactancia al seno materno, uso de estrógenos en menopausia y uso de anticonceptivos hormonales; fue moderada (Kappa de 0.7-0.8) para síntomas relacionados con la menopausia, como bochornos, sudoración, dispareunia, resequedad vaginal y disminución de la libido. La media de las diferencias entre la primera y segunda medición fue muy cercana a cero para las variables continuas, como edad de la menarquia, edad de la menopausia, tiempo de uso de estrógenos y tiempo de lactancia al seno materno. De igual forma, los intervalos de confianza al 95 por ciento de las diferencias de las medias de estas variables incluyeron siempre el valor nulo. El cuestionario incluyó otras características de la población, como las socio-demográficas, consumo de tabaco y frecuencia de consumo de alimentos, las cuales mostraron de moderada a alta concordancia (Kappa 0.7-1.0). Conclusiones. Los resultados del estudio permiten afirmar que el instrumento utilizado es altamente reproducible y será de utilidad para los estudios relacionados con el climaterio en la población mexicana

Objective. This study evaluated the reproducibility of a questionnaire concerned with the clinical and epidemiological aspects of menopause. Material and methods. The study population consisted of a hundred perimenopausal Mexican women seeking care at gynecology and obstetric health care services. Their participation was voluntary and they answered the same questionnaire two times with a 15-30 day lag between each application. Results. The Kappa coefficient was high (0.81-1.0) for categorical variables such as: type of menstrual cycles, type of menopause, breast-feeding, use of estrogen during menopause and use of hormonal contraceptives. The Kappa coefficient was moderate (0.7-0.8) for symptoms related to menopause such as hot flashes, sweating, painful coitus, vaginal dryness and a decrease in libido. Mean differences were calculated for continuous variables such as age at menarche, age at menopause, time using estrogen and the duration of breast feeding, the majority had a value of zero and 95% confidence intervals for these mean differences included the null value. The questionnaire also included other characteristics such as tobacco consumption and a short food frequency questionnaire, which showed high concordance (Kappa 0.7-1.0). Conclusions. The results of this study show that this questionnaire has a high level of reproducibility and can be useful as a research tool to explore menopause in Mexican women.

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