bluuebunny/crossref_metadata_2025 huggingface dataset:
A Unique Presentation of an Accessory Cavitated Uterine Mass: A Case Report [33G]
Authors: Wiltshire Ashley , Bright Frederick
Published: May 2017

INTRODUCTION:

An accessory cavitated uterine mass (ACUM) is defined as an isolated mass lined by functional endometrium and encapsulated by smooth muscle. The typical clinical presentation is age less than 30 years old, severe dysmenorrhea, and chronic pelvic pain. ACUM is considered to be a rare diagnosis. However, this pathology may be less rare and more commonly misdiagnosed than originally believed.

METHODS:

The clinical case was analyzed and followed with a literature review.

RESULTS:

The patient is a 28-year-old G2P1011 who presented with shortness of breath and abdominal distention. Imaging revealed a 15 cm x 13.9 cm x 14.7 cm complex pre-sacral mass, severe ascites, and pleural effusion. Her pre-operative diagnosis was Meigs syndrome. Final surgical pathology of the mass confirmed it to be an ACUM. Post-operatively, there was complete resolution of the ascites and pleural effusion.

CONCLUSION:

A high index of suspicion for ACUM followed by early surgical management is imperative for proper diagnosis and management. Pleural effusion and ascites may be clinical indications of ACUM and should lower one's threshold to consider ACUM on the differential diagnosis.
Utility of Measuring TSH Levels in Patients Presenting With Abnormal Uterine Bleeding [34G]
Authors: Summers Caroline , Johnson Isaiah
Published: May 2017

INTRODUCTION:

Abnormal uterine bleeding (AUB) affects 9 to 14% of reproductive aged women. Previous studies have demonstrated an increased prevalence of menstrual abnormalities in patients with thyroid disease. The American College of Obstetricians and Gynecologists recommends thyroid stimulating hormone (TSH) screening in patients with AUB. There, however, is no published data evaluating the prevalence of thyroid disease among women presenting with AUB. The purpose of this study is to determine the prevalence of thyroid disease in patients with AUB presenting to a gynecology clinic.

METHODS:

This is a retrospective case series of patients aged 18 to 50 years that presented with AUB to the gynecology clinic. Patients were identified through review of the electronic medical record (EMR) from January 2012 to June 2016. Two hundred and three patients meeting study criteria for inclusion were analyzed and the prevalence of abnormal TSH was calculated.

RESULTS:

Thirteen patients (6.4%) were identified with abnormal TSH values. These patients were diagnosed though subsequent testing with subclinical hyperthyroidism (3.4%), subclinical hypothyroidism (0.49%), clinical hypothyroidism (0.49%), and clinical hyperthyroidism (0.49%). The majority of these patients did not have an established diagnosis for AUB (AUB-N) in the EMR. Five patients (38.5%) were diagnosed with AUB-O (ovulatory dysfunction).

CONCLUSION:

In this patient population with AUB, the prevalence of thyroid disorders was not increased as compared to the expected prevalence of thyroid disease in general female population. Routine measurement of TSH identified few patients with clinical thyroid disease.
Genetic Carrier Screening (GCS) in Clinical Practice: A Current Survey of Physician Impressions and Attitudes [37G]
Authors: Briggs Allison , Nouri Parvaneh , Galloway Michael , Yaklic Jerome L. , Maxwell Rose , Lindheim Steven
Published: May 2017

INTRODUCTION:

GCS is an important component of preconception and prenatal care and allows for cost-effective and efficient screening. Given the complexity, we evaluated current physicians’ attitudes towards GCS and Expanded (E)-GCS to assess current practice.

METHODS:

The 32-question survey was distributed to Obstetricians, Gynecologist and Subspecialists through SurveyMonkey by Listserve database and our Premiere Health System.

RESULTS:

Overall 297 Obstetrician and Gynecologists responded. Compared to 5 years ago, providers were more likely to offer ethnic based GCS or E-GCS prior to conception (24%, vs 13%, P < .001) or post-conception (27%, vs 16%, P < .001). Currently, GCS based on family history (47%) was offered more than E-GCS (17%, P < .001). Ideally, physicians believed GCS should be offered during pre-conception counseling (57%) and during early pregnancy (33%), but limited by current office policy where it was more likely to be discussed during fertility (51%,) and post-miscarriage (43%) appointments, compared to contraceptive counseling (19%) and annual exams (14%, P < .001). GCS was addressed by physicians (67%) in most practices and 57% stated they were comfortable with counseling, however, only 32.0% were comfortable discussing a positive screening result, (P < .01). Fifty-five percent felt E-GCS should not be offered until clinical significance of each disease was fully understood compared to 26% who felt should be offered regardless.

CONCLUSION:

GCS is an underutilized resource which may be due to the level of comfort with counseling and beliefs surrounding E-GCS. Continued education and training programs are warranted to implement GCS and E-GCS in routine practice.
Disease Burden Among Canadian Women With Symptomatic Uterine Fibroids: Interim Results of CAPTURE [1H]
Authors: Laberge Philippe Y. , Singh Sukhbir S. , Lamontagne Alain , Vilos George
Published: May 2017

INTRODUCTION:

The CAnadian women wiTh Uterine fibroids (UF) REgistry (CAPTURE) was designed to document real-world data about disease burden, management, and outcomes of symptomatic UFs.

METHODS:

This up to 2-year, prospective, observational, practice-based study will include ∼1000 premenopausal adult women referred for treatment of symptomatic UF at ≥12 clinical practice sites across Canada.

RESULTS:

Among 461 women enrolled to date, 64.6% were White, with mean ± SD age of 43.3 ± 6.9 years and BMI of 26.4 ± 6.2 kg/m2. Comorbidities included anemia (43.4%), known/suspected endometriosis (7.2%), hypertension (6.3%), and diabetes (2.4%). Most frequently reported symptoms (>50%) included heavy menstrual bleeding (82.0%), pelvic discomfort (80.0%), dysmenorrhea (77.8%), urinary frequency (73.6%), pelvic pain (68.5%), low back pain (62.5%), bulk symptoms (60.2%), and urinary urgency (59.6%). Time since first symptoms was < 1 year for 14.2%, 1 to < 3 years for 25.1%, 3 to < 5 years for 16.4%, and ≥5 years for 44.3%. MRI or ultrasound indicated 36.2% had 1 UF, 34.1% had 2 to 4, and 29.6% had ≥5. At baseline, 88% reported bleeding in the past 3 months with mean ± SD Aberdeen menorrhagia severity scale score of 34.9 ± 20. As measured by the UF symptom and quality of life questionnaire (UFS-QoL), mean ± SD symptom severity was 48.7 ± 22.7 and QoL was 52.3 ± 25.1.

CONCLUSION:

CAPTURE is the first registry worldwide to examine real-world practice-based management of women with UF. The 461 patients enrolled to date, of the targeted 1000, demonstrate a high burden of disease and a poor QoL. Impact of interventions on QoL will be evaluated at follow-up visits.
Mode of Hysterectomy in the Veterans Administration: Associations With Race/Ethnicity and Clinical Factors [2H]
Authors: Pauk Sara J. , Callegari Lisa S. , Katon Jodie G. , Gray Kristen E. , Zephyrin Laurie C. , Gardella Carolyn M.
Published: May 2017

INTRODUCTION:

Evidence from the general population suggests that factors such as race/ethnicity and socioeconomic status, in addition to clinical factors, may influence hysterectomy route. We investigated factors associated with mode of hysterectomy in the Veterans Administration (VA).

METHODS:

We conducted a retrospective cohort study using VA data from 2008-2014 to identify women undergoing hysterectomy for benign indications. The outcome was hysterectomy mode [laparoscopic (total laparoscopic, laparoscopic-assisted vaginal, and robotic), vaginal, or abdominal], classified by ICD-9 codes. We used modified Poisson regression to estimate associations of demographic and clinic factors with hysterectomy mode including age, race/ethnicity, income, body mass index (BMI), indication (fibroids, endometriosis, prolapse), medical and mental health conditions, and where the procedure was performed (VA versus non-VA facility).

RESULTS:

Among 7844 identified hysterectomies, 58% were abdominal, 25% laparoscopic, and 17% vaginal. In adjusted models, compared to Whites, Blacks had 36% lower risk of having a laparoscopic versus abdominal hysterectomy (RR:0.64, 95%CI 0.16-0.51) and 44% lower risk of having vaginal versus abdominal hysterectomy (RR:0.56, 95%CI 0.28-0.56). Hispanics were equally likely to have laparoscopic versus abdominal hysterectomy compared to Whites, but had lower risk of vaginal versus abdominal hysterectomy (RR:0.62, 95%CI 0.10-0.58). Women with fibroids and BMI >30 were less likely to undergo laparoscopic or vaginal versus abdominal hysterectomy, whereas women with endometriosis were more likely to undergo laparoscopic versus abdominal hysterectomy.

CONCLUSION:

In addition to indication for surgery and BMI, race/ethnicity is independently associated with benign hysterectomy mode in VA. Further study is needed to explore the underlying causes of this apparent disparity.
Gastrointestinal Tolerability With Oliceridine, A Novel µ Receptor G Protein Pathway Selective (µ-GPS) Modulator [4H]
Authors: Steinberg Adam C. , Soergel David , Burt David , Skobieranda Franck
Published: May 2017

INTRODUCTION:

Conventional opioids bind to μ receptors and non-selectively activate two intracellular signaling pathways. One (G protein pathway) is associated with analgesia. The second (β-arrestin pathway) is associated with opioid-related adverse events and inhibition of G protein-mediated analgesia. Oliceridine (TRV130) is a novel µ receptor G protein Pathway Selective (µ-GPS) modulator that activates G protein while causing low β-arrestin recruitment to the μ receptor. This novel mechanism of action could lead to a differentiated therapeutic profile of rapid/effective analgesia with improved safety and gastrointestinal tolerability than conventional opioids.

METHODS:

Subjects in a Phase 2 randomized control clinical trial with moderate-to-severe acute pain following abdominoplasty were assigned into one of 4 IV PCA treatment groups. All treatment groups incorporated a 6-minute PCA lockout interval and were: volume-matched placebo, morphine regimen (4 mg loading; 1 mg demand), oliceridine regimen A (1.5 mg loading; 0.10 mg demand), oliceridine regimen B (1.5 mg loading; 0.35 mg demand).

RESULTS:

Of the 200 subjects, demographics and baseline characteristics were similar between treatment groups. At equianalgesic dose, both regimens of oliceridine were associated with a significantly lower percentage of patients who experienced both nausea and vomiting versus morphine (13% and 13% versus 39%; p less than 0.05). No serious adverse events (AEs) reported for the 4 groups.

CONCLUSION:

In this study, both regimens of oliceridine had a significantly lower prevalence of gastrointestinal AEs versus morphine. This suggests that oliceridine may widen the therapeutic window between rapid/effective analgesia and gastrointestinal dysfunction. These results may extrapolate to obstetric and gynecologic procedures but further investigation is warranted.
Practices and Complications of Pubic Hair Removal Among Saudi Women [5H]
Authors: Rouzi Abdulrahim , Turkistani Jemela , Alamoudi Rana , Alkafy Souzan , Mousa Ahmed , Alwazzan Ahmad
Published: May 2017

INTRODUCTION:

To determine pubic hair removal practices and the prevalence of its complications among Saudi women living in Jeddah, Saudi Arabia.

METHODS:

Between December 2015 and August 2016, a cross-sectional study was conducted at the outpatient gynecology clinics of King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Participants completed an anonymous, self-administered survey.

RESULTS:

Four hundred Saudi women completed the survey. The age was 26.3 ± 6.9; 16 - 58 years (mean ± SD; range). The majority 252 (63%) were classified as under/normal weight. The age of the start of pubic hair removal was 13.5 ± 1.9; 8 - 21 years. The frequency of removal was 20.8 ± 14.6; 3-90 days. Pubic hair removal was done by the women themselves in 308 (77%) women, and by professional personnel in medical clinics in 62 (15.5%) women, in beauty salons in 21 (5.3%) women, and at home in 9 (2.2%) women. The method was razor (33.5%), laser (8.7%), sugaring (6%), waxing (4.5%), trimming (2%), electric razor (2%), cream (1.5%), and combinations (41.8). Complications were skin cuts (7.7%), severe itching (7.5%), ingrown hair (6.8%), rash (3%), burn (2.5%), allergy (2%), abrasion (1.5%), bruise (1.5%), hyperpigmentation (1.5%) and combinations (41.5%). Only 13.6% required treatments. There were no associations between the age of starting of removal, BMI, removal by the women themselves or professional personnel in clinics, or in beauty salons, or at home, methods used for removal, and occurrence of complications.

CONCLUSION:

Pubic hair removal starts in adolescence years and is associated with infrequent complications that require treatments.
The Revolving Door? New York State Hospital Readmission Following Hysterectomy for Benign Conditions [6H]
Authors: Plair Andre , Griffin Todd , Henretta Melissa , Pearl Michael , Yang Jie , Park Jihye
Published: May 2017

INTRODUCTION:

As health care costs rise, hospital readmission remains a target for reform. Hysterectomy is the most common major gynecologic procedure performed in the U.S. Determining the readmission rate, cost, and factors related to readmission is critical to define the scope of the problem and identify areas for improvement.

METHODS:

The New York Statewide Planning and Research Cooperative System database collects patient encounter data across hospitals. Data were analyzed for hysterectomies performed for non-urogynecologic, benign indications from 2007-2014. Factors analyzed included: patient and procedure characteristics, hospital academic status, and annual surgical volume by hospital and surgeon. A multivariable logistic regression model was used to evaluate the independent predictors for 30-day readmission.

RESULTS:

Overall 132,943 unique hysterectomy encounters were analyzed with a total of 5,896 (4.43%) hospital readmissions. Black race, Medicare/Medicaid insurance, academic medical center status, total hysterectomy, minimally invasive procedures, comorbidities, postoperative complications, and longer length of stay were found to be significantly associated with increased risk of hospital readmission. Infectious Disease was the leading diagnosis (28.67%) for readmission. The mean hospital charge for readmission was $30,132, with a median of $18,072, and an 8-year total of $177,658,508.

CONCLUSION:

The significant prevalence and cost of hospital readmission following hysterectomy merit efforts for reduction. As postoperative infections were identified as a leading cause for readmission, attention should be paid to following American College of Obstetricians and Gynecologists and hospital-directed guidelines to minimize infectious risk. A more in-depth analysis of surgical case complexity may shed light on why academic medical center status was correlated with increased readmission risk.
Cesarean Scar Ectopic Incidence and Management in a Community Hospital Setting: Case Series [9H]
Authors: Dad Nimra , Vallejo Victoria , Chaudhuri Aparajita
Published: May 2017

INTRODUCTION:

The rate of Cesarean Deliveries has increased from 20.6% in 1996 to 32.9% in 2009. The incidence of scar ectopic pregnancies has increased reaching an estimated incidence of 1:2226. Objective is to identify the incidence and management of cesarean scar ectopic (CSE) pregnancies in a Community Hospital setting in NY State.

METHODS:

A retrospective chart review from January 2013 to December 2015 was performed. CSE diagnosed with transvaginal ultrasound. Methotrexate (MTX) single or multi-dose regimen was used. Serial serum human chorionic gonadotropin determinations (bhCG) were obtained until a negative result (< 5 mIU/ml). Descriptive data was analyzed using percentages, means and standard deviations.

RESULTS:

Five cases of CSE were diagnosed in a 3-year period. Women’s mean age was 34.2 ± 5.6 years. The average gestational age at diagnosis was 56 ± 12.9 days, and number of previous cesarean section was 2 ± 0.7. The mean bhCG at diagnosis was 22,540.2 ± 26,436.9 mIU/ml. Only 1 patient required hysterectomy after MTX due to unfavorable decline on bhCG. The mean duration to reach a negative pregnancy test was 36.7 ± 28.4 days.

CONCLUSION:

We estimate an incidence of 1 of 36 cases of all ectopic pregnancies diagnosed in the last 3 years and the main treatment used is MTX. Speculation is that this rise may be due to an increase in cesarean deliveries in the recent years and to the type of closure technique performed. Further investigation is encouraged to determine the underlying cause and safest management.
Risk of Occult Endometrial Cancer During Hysterectomy for Benign Indications [14H]
Authors: Palavalli Parsons Lavanya H. , Pedersen Rebecca , Richardson Debra L. , Kho Kimberly A.
Published: May 2017

INTRODUCTION:

Recent attention regarding the use of power morcellation highlighted concerns regarding occult uterine sarcomas. However, sarcomas comprise only 3% of uterine cancers. The vast majority of malignancies are endometrial in origin and are more reliably diagnosed preoperatively than sarcomas. We sought to estimate the frequency of occult endometrial cancer in women undergoing benign hysterectomies.

METHODS:

We performed a retrospective review of all patients undergoing hysterectomies for benign indications at our institution from 2006‒2014. A departmental database was used to identify all hysterectomies performed, and institutional tumor registry was used to identify cases of endometrial carcinoma. Occult carcinomas were defined as cases with no suspicion preoperatively and histopathologic diagnosis of endometrial cancer postoperatively.

RESULTS:

A total of 6,981 hysterectomies were performed. Thirteen patients (0.19%) were found to have occult endometrial cancer, with an overall rate of 1 in 537 patients (95% confidence interval 1:314‒1:1,008). Twelve patients had stage IA and one had stage IB disease. Median age of women with endometrial cancer was 50 years (range 35-72 years). The mean Body Mass Index was 32.6 ± 9.2 kg/m2. Most common indication for hysterectomy were abnormal bleeding (47%), then postmenopausal bleeding (15%). Cases included nine abdominal hysterectomies, two laparoscopic hysterectomies, and two vaginal hysterectomies. One specimen was manually morcellated during vaginal hysterectomy.

CONCLUSION:

This is one of the largest single institution cohorts to examine occult malignancy. Occult endometrial carcinomas are more common than occult uterine sarcomas, and were found to occur in 1:537 (0.19%) hysterectomies for benign indications in our population.
Challenges to National Human Papillomavirus Vaccine Program Implementation in Developing Countries [18H]
Authors: Shirazian Taraneh , Smith Courtney , Fisher Julia
Published: May 2017

INTRODUCTION:

In 2012, an estimated 527,624 women were diagnosed with cervical cancer globally, and an estimated 265,653 women died from the disease. Of deaths attributed to cervical cancer, 90% occur in low and middle-income countries (LMIC) due to lack of access to screening and treatment. Vaccines protecting against the strains of human papillomavirus (HPV) causing cervical cancer have been available since 2006, but little is known about their national implementation in LMIC.

METHODS:

Using the PubMed database, literature was reviewed for any LMIC with national or pilot HPV programs. 2014 World Bank definitions and data were used to identify LMIC. In addition to the literature search, websites of organizations with information regarding cervical cancer programs, including Cervical Cancer Action, ICO Information Centre on HPV and Cancer, and PATH, were reviewed.

RESULTS:

Thirty LMIC were identified with national HPV programs. Four of the thirty began their programs in 2015 or 2016 with little data available. Fifteen countries do not report coverage rates or programmatic features, suggesting limited scope of their HPV national programs. Of eleven countries reporting coverage rates, these rates vary dramatically, from 5% to 99%. Of countries with available data, all of them target girls aged 9-17 but use a variety of school and clinic-based delivery methods. Only three of the thirty countries receive GAVI support for vaccine purchasing.

CONCLUSION:

Given the disproportionate burden of cervical cancer-related mortality in LMIC and the availability of the HPV vaccine, further research on the effectiveness of national HPV vaccine programs is warranted.
Using Encounter Decision Aids to Share Decisions With Women Presenting With Heavy Menstrual Bleeding or Fibroids [20H]
Authors: Aarts Johanna W.M. , Thompson Rachel , Alam Shama , Dannenberg Michelle , Elwyn Glyn , Foster Tina C.
Published: May 2017

INTRODUCTION:

Heavy menstrual bleeding impacts women’s quality of life and can be treated in a variety of ways. Shared decision-making (SDM) requires providing tailored information to the patient about options and eliciting and integrating patient preferences as treatments are selected. decision aids used during the clinical encounter may facilitate SDM. We evaluated the impact of introducing decision aids for women presenting with heavy menstrual bleeding or fibroids on the level of SDM.

METHODS:

A before-after study was conducted in general OB-GYN practice in an academic medical center and two community practices between December 2014 and May 2015. Consultations were compared before (T1) and after (T2) introduction of two encounter decision aids on treatment options for heavy menstrual bleeding or uterine fibroids. Immediately after their appointments, patients filled out a brief validated survey (CollaboRATE) about the perceived level of SDM. Additionally, observers rated audio recordings of consultations for SDM using the OPTION5 instrument.

RESULTS:

Altogether, 16 providers participated, 25 patients were enrolled in T1, and 28 patients were enrolled in T2. The groups did not differ on demographic characteristics. The proportion of women reporting SDM increased significantly from T1 (50%) to T2 (75%; p < 0.05). The mean observer-rated level of SDM also increased significantly from T1 to T2 (mean difference = 12.50 on a scale of 0-100, where threshold for clinical relevance is 11.9).

CONCLUSION:

Implementation of encounter decision aids for women presenting with heavy menstrual bleeding or fibroids was associated with a higher level of SDM between women and gynecologists.
Elagolix Alone and With Add-Back Decreases Heavy Menstrual Bleeding in Women With Uterine Fibroids [21H]
Authors: Stewart Elizabeth , Owens Charlotte , Duan W. Rachel , Gao Jingjing , Chwalisz Kristof , Simon James A.
Published: May 2017

INTRODUCTION:

Elagolix, an oral gonadotropin-releasing hormone antagonist, with and without add-back therapy, was evaluated in premenopausal women with heavy menstrual bleeding (HMB; greater than 80 mL/month menstrual blood loss [MBL]) associated with uterine fibroids (UF).

METHODS:

This double-blind, randomized, placebo-controlled, parallel group study evaluated the efficacy and safety of 6 months of treatment in 2 cohorts, with four arms/cohort: elagolix alone as 300 mg twice daily in cohort 1 (C1) and 600 mg once daily in cohort 2, and in both cohorts, placebo, elagolix with add-back therapy of estradiol (E2)/norethindrone acetate (NETA), low dose 0.5 mg E2/0.1 mg NETA (LDA), or standard dose 1.0 mg E2/0.5 mg NETA (SDA). The primary endpoint was the percentage of women with less than 80 mL MBL assessed by the alkaline-hematin-method and at least 50% reduction in MBL from baseline to the last 28 days of treatment. Adverse events (AE), changes in bone mineral density (BMD) and quality of life (QoL) were assessed.

RESULTS:

In C1, 259 women were randomized and treated; 80% completed treatment. C1 responses for the primary endpoint were 92% in elagolix alone, 85% elagolix+LDA, 79% elagolix+SDA, and 27% placebo (all p < .001 vs. placebo). Add-back therapy attenuated hot flushes and lumbar spine BMD decreases in a dose-dependent manner; there were no statistically significant differences in BMD between elagolix+SDA and placebo at month 6. All elagolix treatments were associated with improved QoL. Results were similar in C2.

CONCLUSION:

Elagolix with or without add-back significantly reduced MBL in UF-associated HMB. Hot flushes and BMD decreases were reduced by add-back in a dose-dependent manner.
Patients’ Awareness and Attitudes Towards Genetic Carrier Screening [22H]
Authors: Briggs Allison , Nouri Parvaneh , Galloway Michael , Yaklic Jerome L. , Maxwell Rose , Lindheim Steven
Published: May 2017

INTRODUCTION:

Genetic Carrier Screening (GCS) is an important part of gynecological practice and preconception planning. We evaluated the awareness and attitudes among women regarding preconception GCS and factors that may influence decision-making in a family planning context.

METHODS:

A 32 question survey in an academic university practice was given to 521 women who were either currently pregnant (n=108); undergoing gynecologic care who were considering future fertility (n=308) and infertility patients (n=105). Data are reported descriptively.

RESULTS:

Forty-seven percent (n=245) of patients were aware of GCS. Though most reported feeling positive or neutral towards GCS, 51% (n=263) reported no desire for testing. Fifty-eight percent (n=303) felt it beneficial to know their carrier status, and 49% (n=257) said it was their responsibility to undergo testing. With respect to abnormal genetic findings, 48% (n=251) would never undergo an elective termination regardless of screening results, and 29% (n=151) would do nothing if they discovered they were a carrier for a genetic disease including pre-implantation genetic diagnosis or amniocentesis. Related to cost for GCS, 37% (n=191) would be willing to pay at least $50-100 for testing, while 28% (n=146) would not pay anything out of pocket.

CONCLUSION:

Despite patients’ beliefs that it would be beneficial and their responsibility to undergo carrier status testing, the majority reported no desire for GCS and many were unwilling to pay out of pocket. Further education is necessary to reconcile the gap between technology and patient decision-making.
Effect of Pregnancy Reasonably Excluded Guide on Pregnancy Testing in Outpatient Gynecologic Surgery [23H]
Authors: DeJong Stephanie , Holman Michelle A. , Ainsworth Alessandra , Adela Cope , Claire Flanagan , Long Margaret
Published: May 2017

INTRODUCTION:

The Pregnancy Reasonably Excluded Guide (PREG) questionnaire is based on traditional methods of excluding pregnancy including sterilization, menopause, and the World Health Organization criteria. The PREG has been validated and shows a 99-100% negative predictive value for pregnancy (Selected practice recommendations for contraceptive use, 2013: adapted from the world health organization selected practice recommendations for contraceptive use, 2nd edition. MMWR Recomm Rep 2013; 62:1‒60.). Pregnancy testing in our outpatient surgical settings varied by provider. This study compared utilization of pregnancy tests in the outpatient gynecologic surgery setting after implementation of universal PREG administration.

METHODS:

All women undergoing outpatient gynecologic surgery were prospectively evaluated between March and September 2016. Administration of the PREG to women 18-49, excluding those undergoing procedures related to pregnancy, was implemented in July and rates of pregnancy testing pre- and post-implementation were compared using Fisher’s exact test.

RESULTS:

369 patients underwent an outpatient gynecologic procedure during the study period (excluding a two week washout period after implementation). In the pre-implementation group, 136 met inclusion criteria with 45 pregnancy tests performed (33.1%). After implementation, 80 patients met inclusion criteria and 17 pregnancy tests were performed as indicated by PREG response (21.3%), demonstrating over one third reduction in pregnancy test administration (p = 0.086). No pregnancy tests were positive and no false negative evaluations were identified. Physician and nursing staff requested continued use of the PREG after the trial.

CONCLUSION:

PREG administration on admission for outpatient gynecologic surgery consistently and effectively identifies patients in whom pregnancy testing improves the value of care.
Effect of Flibanserin on Sexual Functioning: An Analysis of Female Sexual Function Index Domains [24H]
Authors: Krychman Michael L. , Yuan James , Barbour Krista , Kissling Rob , Derogatis Leonard R.
Published: May 2017

INTRODUCTION:

Flibanserin, a 5-HT1A agonist and 5-HT2A antagonist, is indicated for the treatment of acquired, generalized hypoactive sexual desire disorder (HSDD) in premenopausal women. The Female Sexual Function Index (FSFI) is a validated self-report questionnaire comprising 6 domains of sexual functioning: desire, arousal, lubrication, orgasm, satisfaction, and pain. This post hoc analysis evaluated the effect of flibanserin treatment across the 6 FSFI domains.

METHODS:

Patient-level data were pooled from three 24-week, double-blind, placebo-controlled studies of flibanserin 100 mg once daily (qhs) in premenopausal women with HSDD. Between group differences in change from baseline to week 24 (last observation carried forward [LOCF]) on FSFI domain and total scores were evaluated using analysis of covariance.

RESULTS:

This analysis included 2368 women (flibanserin, n=1165; placebo, n=1204) who had at least one on-treatment efficacy assessment. The least-squares mean differences (standard error of the mean) in change scores from baseline to week 24 (LOCF) for flibanserin versus placebo were 0.3 (0.1) for the FSFI desire domain, 0.4 (0.1) for the arousal domain, 0.3 (0.1) for the lubrication domain, 0.3 (0.1) for the orgasm domain, 0.3 (0.1) for the satisfaction domain, 0.2 (0.1) for the pain domain, and 1.9 (0.3) for the total score; all P less than 0.0001 except P less than 0.01 for pain.

CONCLUSION:

Treatment with flibanserin produced significant improvement not only in the FSFI desire domain (a key outcome in clinical trials of HSDD) but also across the other domains of sexual function assessed by the FSFI.
Treatment Decision-Making Processes in the Systemic Treatment of Ovarian Cancer: Review of the Scientific Evidence [26H]
Authors: Luketina Hrvoje
Published: May 2017

INTRODUCTION:

Background: The systemic treatment of epithelial ovarian cancer (OC) is one of the cornerstones in the multimodal management of advanced OC in both primary and recurrent stages of this disease. In most situations various treatment options are available but only few data exists about the treatment decision-making process. Therefore, we conducted a review of the current literature regarding the decision-making process concerning the systemic therapy in patients with advanced ovarian cancer.

METHODS:

The electronic database MEDLINE (PubMed) was systematically reviewed for studies that evaluate the treatment decision-making processes in patients with advanced OC.

RESULTS:

The PubMed database was searched in detail for all titles and abstracts of potentially relevant studies published between 1995 and 2011. An initial search identified 15 potentially relevant studies, but only seven met all inclusion criteria. Factors that influence treatment decisions in patients with OC include not only rational arguments and medical reasons, but also individual attitudes, fears, existential questions, various projections resulting from the physician patient relationship and the social environment. The physician’s personal experience with OC treatment seems to be an important factor, followed by previous personal experience with medical issues, and the fear of side-effects and future metastases. Family and self-support organizations also seem to play a significant role in the treatment decision-making process.

CONCLUSION:

This review underlines the need for more research activities to explore the treatment decision-making process to enable the best individual support for patients in treatment decision-making. It is a challenge for clinicians to determine the individual information needs of women with OC and to involve them during the decision-making process to the extent they wish.
Preoperative Factors and Surgical Routes for Outpatient Migration of Benign Hysterectomy [27H]
Authors: Moawad Gaby , Liu Emelline , Song Chao , Fu Alex
Published: May 2017

INTRODUCTION:

To assess the impact of patients, physicians, hospital factors and the choice of surgical routes on the likelihood of benign hysterectomy (BH) in outpatient (vs. inpatient) setting.

METHODS:

We reviewed the Premier Hospital Perspective Databases for women ≥18 years old who underwent BH from 2008-2014. Patient-, surgeon-, and hospital-level factors, and surgical routes, were included in the analysis .The impacts of preoperative factors and surgical routes were analyzed via a logistic regression model.

RESULTS:

A total of 527,964 patients who underwent BH were identified. Patient factors contributed 43.3% to the likelihood of outpatient BH, surgeon factors 22.7% and hospital factors 4.4%; surgical routes and surgeon experience of MIS in outpatient setting were the top 2 individual factors that contributed 38.0% and 20.4%, respectively. Subtotal hysterectomy (OR 1.25, 95%CI 1.23-1.28) was more likely in outpatient; older, non-white, higher CCI, obese, and insured by Medicare were less likely for outpatient BH. Surgeons with experience of outpatient minimally-invasive surgery (OR 2.90, 95%CI 2.85-2.96), obstetrics & gynecology surgeons (OR 1.71, 95%CI 1.62-1.80) and hospitals in the South region (OR 2.17, 95%CI 2.13-2.22) were more likely to perform outpatient BH. Compared to laparoscopic, robotic-assisted BH (OR 1.05, 95%C I 1.03-1.07) were more likely, whereas abdominal BH(OR 0.017, 95%CI 0.016-0.018) and vaginal BH(OR 0.45, 95%CI 0.44-0.46) were less likely to be performed in outpatient. (All P values < 0.05).

CONCLUSION:

Surgical routes and surgeon’s previous experience of MIS in outpatient setting were more impactful factors. Choice of robotic-assisted surgical route was associated with increased likelihood of outpatient BH.
Hysterectomy and Peri-operative Blood Transfusion: Identifying Modifiable Risk Factors [31H]
Authors: Zitsman Sarah , Yu Daohai , Bruce Shaina F. , Ramirez-Caban Laura , Diaz Juan
Published: May 2017

INTRODUCTION:

Blood loss and subsequent blood transfusion is a common complication in benign gynecologic surgery that has been understudied. The purpose of this study is to identify risk factors associated with peri-operative blood transfusion and highlight those that are modifiable for abdominal and vaginal hysterectomy.

METHODS:

Using a retrospective study design between 1/1/2008 and 4/30/2014, 562 of 667 hysterectomies were included. Hysterectomies performed peripartum or for cancer were excluded. Risk factors examined include race, pre-operative hemoglobin, body mass index (BMI), surgical route, and uterine size. Comparisons between subgroups were performed using Chi-square or Wilcoxon test. Blood transfusion rate, odds ratio (OR) of transfusion and its 95% confidence interval (CI) were reported. Multiple logistic regression was used to identify potential risk factors for peri-operative blood transfusion.

RESULTS:

The overall transfusion rate was 13.3% (75/562) and differed for abdominal versus vaginal hysterectomy (18.0% vs. 6.8% P < .001). Pre-operative hemoglobin less than 10.6 g/dL versus greater than or equal to 13.1 g/dL had five times the odds of transfusion (95% CI 2.4-13.5). Uterus size greater than 470 gm versus less than or equal to 108 gm had fourfold odds of transfusion (95% CI 1.5-14.3). African Americans had twice the odds of transfusion (95% CI 1.2-4.5), despite controlling for increased uterus size and lower hemoglobin. There was no statistically significant association between BMI and transfusion.

CONCLUSION:

This study identified lower pre-operative hemoglobin, larger uterus size, and African American race as three important risk factors. Prior to hysterectomy, hemoglobin should be optimized above 13.1 g/dL, especially for patients with large uteri and African Americans.
Impact of Extremely Advanced Maternal Age on Pregnancy Outcomes [35H]
Authors: Hollenbach Stefanie , Miller Lauren A. , Olson-Chen Courtney , Li Dongmei , Dye Timothy , Thornburg Loralei
Published: May 2017

INTRODUCTION:

The proportion of women giving birth after the age of 45 has increased significantly over the last several decades for a multitude of reasons. We set out to describe perinatal outcomes for women as pregnancy progresses from advanced (35 or older) to extremely advanced maternal age (45 or older).

METHODS:

The NYS Perinatal Data System in Upstate New York contains information on 724,802 pregnancies from 2005-2014. Pregnancy outcomes compared between women less than age 35 and those 35-39, 40-44, 45-49 and 50 and older at delivery. Chi-square testing utilized for categorical variable analysis (significance p-value less than 0.05); odds ratios (OR) calculated for significant comparisons. Significant results were controlled for the use of assistive reproductive technologies (ART) and pre-pregnancy risk factors.

RESULTS:

A total of 104,776 women were 35 or older at delivery with 1460 women 45 or older. Compared to women younger than age 35, women 45 or older had increased pre-pregnancy risks including increased pre-gestational diabetes and hypertension (HTN), as well as worse maternal and fetal pregnancy outcomes including preterm birth OR 2.45 (CI 2.15-2.78) and pregnancy-associated HTN OR 1.95 (CI 1.63-2.35). These results were ameliorated but persisted after controlling for multi-fetal gestations, with preterm birth OR 1.65 (CI 1.07-2.55) and pregnancy-associated HTN OR 2.03 (CI 1.25-3.31) remaining more prevalent.

CONCLUSION:

Maternal and fetal risks increase as maternal age progresses. Increased incidence of multi-fetal gestation contributes to—but does not appear to comprehensively explain—the difference in risk for these women. This has implications for preconception counseling, antepartum care, and delivery planning.
Medical Student Education in Abortion Care: A Survey of Exposure, Knowledge and Attitudes Among NYC Medical Students [9I]
Authors: Figueroa Melissa M. , Lunde Britt , Jacobs Adam , Chen Katherine , Dean Gillian
Published: May 2017

INTRODUCTION:

To assess the impact of Ryan Residency Programs on New York City (NYC) medical student exposure to, knowledge of, and attitudes towards abortion services following their clerkship in OBGYN.

METHODS:

An online survey of medical student exposure to, knowledge of, and attitudes towards abortion was created. The APGO educational objectives for abortion were used to develop knowledge questions. ACGME and Ryan Residency Program websites were used to identify medical schools and presence of Ryan programs at each clerkship site. Clerkships directors distributed the survey to students at the completion of their OBGYN clerkships. Data was evaluated using χ2 tests for categorical responses and multivariate analysis to control for confounding variables.

RESULTS:

5/6 medical schools with M.D. candidacy in NYC participated. 169 students completed the survey. 9/17 have Ryan programs. 43.2% reported routinely scheduled exposure to abortion services during the clerkship, with no difference between the Ryan and non-Ryan Program groups (p=0.10). Half (51.3%) of respondents failed the knowledge exam with no difference between the groups (p=1.0). Most students (94.8%) feel abortion should be available to women as a part of women's health care services, and that abortion is an important part of the medical school curriculum (87.8%).

CONCLUSION:

No significant difference in abortion-related knowledge, attitudes or exposure between NYC students completing clerkships at sites with and without a Ryan Residency Program. Overall, routine exposure to abortion was low, and knowledge was low. Despite this, most medical students favor including abortion education in the core medical school curriculum.
Knowledge and Perceptions of Zika Virus Among Reproductive-aged Women in Miami, Florida [11I]
Authors: Billero Victoria , Fein Lydia A. , Tse Colette , Hellerstein Leah , Messore Marisa , Curry Christine
Published: May 2017

INTRODUCTION:

To understand the knowledge and perceptions of Zika Virus among reproductive aged women living in Miami, Florida, the first area of the United States with local transmission.

METHODS:

Participants included reproductive-aged women attending a gynecology clinic visit in Miami-Dade County during the four weeks immediately following the announcement of local Zika virus transmission. The survey evaluated knowledge and perceptions of Zika Virus in three categories: pathogenesis and transmission, sequelae of infection, and epidemiology and public health information.

RESULTS:

Fifty-nine women (age range 18-45) completed the survey. Patients who desired or were unsure about desiring pregnancy in the next year (n=15) and those who did not desire pregnancy (n=44) received most of their information about Zika virus from the media rather than their doctors. All had a high level of knowledge in all three categories; there existed no statistically significant difference between the two groups regarding knowledge of Zika virus. Concern about spread of Zika virus in the community was greater in those desiring pregnancy (n=14, 93.3%) than those not desiring pregnancy (n=21, 79.5%, p=0.24). Personal concern about becoming infected with Zika virus was significantly higher in those considering pregnancy (n=13, 86.7% vs n=21, 47.7%, p=0.01).

CONCLUSION:

In the weeks following recognized local transmission of Zika virus, reproductive aged women had a high level of knowledge about Zika virus, but it was those considering pregnancy who had the greatest concern about personal risk of infection.
DEXA for Females Aged 65+ at an OBGYN Resident Clinic in Hawaii: A Chart Audit on Compliance for Osteoporosis Screening [13I]
Authors: Bullock Holly , Scogin K. Nicole , Gaspar-Oishi Maria
Published: May 2017

INTRODUCTION:

Osteoporosis is a skeletal disorder of aging, caused by loss of bone mass and deterioration in both bone quality and micro-architecture. The U.S. Preventive Services Task Force (USPSTF) recommends women ages 65 and older without previous known fractures or secondary causes of osteoporosis be screened using Dual-Energy X-ray Absorptiometry (DEXA).

METHODS:

This retrospective chart review assessed compliance with osteoporosis screening guidelines in a resident clinic. We reviewed all charts of female patients 65 years or older at the Women’s Health Firm of Queen Emma Clinic in Honolulu, Hawaii from July 1, 2014 through July 1, 2015. Age, ethnicity, insurance type, presence of DEXA results and ordering provider type were abstracted. Associations between patient characteristics and DEXA screening were evaluated.

RESULTS:

96 charts were reviewed with 87 meeting inclusion criteria, with mean age 69.6 (SD + 4.6) years. Of those, 92% (80/87) were offered DEXA screening with 87% (76/87) undergoing the test. Of the 11 untested, four were offered screening and refused; two refused outright and two declined while awaiting insurance coverage. Of the remaining 7 untested, four women presented for problem visits and three had no charted explanation precluding screening. There was no differences by race (P=.8) or insurance type (P=.5). OBGYNs and Primary Care Providers ordered equal numbers of scans (38/76 for both, P=1.0).

CONCLUSION:

DEXA scan is the gold-standard for diagnosing osteoporosis and recommended by USPSTF, yet screening referrals are not universal for eligible women in resident clinics. Tailored education for residents regarding this infrequently seen demographic group is needed.
Inpatient Consultation Communication: Hospital Culture and Perspectives [15I]
Authors: Heiselman Cassandra , Smelcer Philip , Shah Khooshali , Cottrell Connie , Lavin Justin
Published: May 2017

INTRODUCTION:

Obstetrical and Gynecological consultations are a significant component of the workflow within the healthcare system. Ineffective consult-related communication can lead to poor outcomes, costly medical errors, and suboptimal medical care.

METHODS:

This was a cross sectional mixed quantitative/qualitative survey design evaluating physicians’ perception regarding the inpatient consultation process. Physicians were asked to rank inpatient services with regards to quality of communication when requesting a consultation, to indicate the importance of specific behaviors during the consultation process, to assess the need for change, and to make suggestions for improvement.

RESULTS:

243 (32.4%) of 750 physicians completed the questionnaire. The OBGYN services ranked second for quality of communication as both the consultant and the consulter with only the Medical Subspecialties service ranking higher (p < 0.0001). Across specialties, the most important consultation elements identified were asking a clear question (91.2%) and answering the initial page in a timely fashion (84.3%). The distribution of consultation components considered essential differed across specialty groups (p < 0.0001). Direct communication by the consultant (p < 0.0001) and the consulter (p < 0.0001) were considered critical elements by OBGYN physicians. 89.5% of all physicians perceived a need for change within the consultation culture. The most frequent suggestion for improvement was direct physician-to-physician communication.

CONCLUSION:

Different specialties consider different consultation components essential, making it challenging for OBGYN physicians to effectively communicate with other services. Results suggest the need for well-designed hospital guidelines for consultations that include direct communication between providers and clear, specific clinical questions.
Patient Comprehension of Gestational Weight Gain Recommendations and Associated Pregnancy Outcomes [16I]
Authors: Niemasik Erin E. , Chasen Stephen , Taubel Debra
Published: May 2017

INTRODUCTION:

Gestational weight gain above the Institute of Medicine guidelines is associated with obstetric and fetal complications. American College of Obstetricians and Gynecologists recommends that weight management begin before conception and continue through the postpartum period. We assessed patients' knowledge of gestational weight gain recommendations and associated outcomes.

METHODS:

One-hundred-seventy-three women completed a survey at a prenatal visit after 20 weeks gestation. After delivery, a chart review obtained the patient’s starting and ending pregnancy weight and BMI. Pearson Chi-square testing and the Related Samples Wilcoxon Signed Rank test were used.

RESULTS:

Overall 44% of our studied population were overweight or obese. When assessing physician counseling of weight category, only 39% of women recalled being told their starting BMI (p=0.24). In addition, the majority (59%) reported receiving no counseling on pregnancy outcomes associated with starting BMI or excessive gestational weight gain (p=0.004). Less than one-third of overweight and obese women gained within guidelines (p=0.001), and most gained above guidelines (p=0.001).

CONCLUSION:

The majority of women gain in excess of guidelines. Excessive weight gain is associated with childhood and maternal health complications, including obesity. Our study shows that few women receive or retain information on weight recommendations and associated risks of excess gain. Not only are women unprepared for the immediate risks posed by excess gain, they are also more likely to retain weight which is a significant contributor to ill-health. Improved patient education could significantly reduce adverse outcomes in the United States related to excessive weight gain.