bluuebunny/crossref_metadata_2025 huggingface dataset:
Operationalizing the Hyde Amendment at Federally Funded Health Care Centers [A40]
Authors: Glaser Katherine , Karlin Jennifer , Schwarz Eleanor Bimla
Published: June 2022

INTRODUCTION:

The Hyde Amendment restricts federal funding for abortion in the US. Currently, federal funding for abortion is only allowed in cases of rape, incest, or a threat to the woman’s life.

METHODS:

To understand how clinicians in federally funded settings care for patients who qualify for abortion permitted by the Hyde Amendment, we conducted semi-structured interviews with 17 clinicians [obstetrician-gynecologists (n=12), family physicians (n=2), and certified nurse midwives (n=3)] practicing in four states, including some that provide state funding for abortion (n=3).

RESULTS:

Most respondents stated there was no way they knew of to operationalize federally funded abortion care in their clinical setting in cases of rape, incest, or a threat to the woman’s life. Most clinicians described having referred patients to freestanding abortion clinics with the expectation that the patient would pay out of pocket or receive state-funded abortion care, despite the theoretical commitment to federal funding for such services; as one clinician stated, “…[we’re] kind of compounding trauma, you know, when you’re saying, ‘Okay, you have to go really far to receive the abortion…’.” Only one clinician described working at a federally funded health center that had a policy in place that allowed prompt delivery of permitted abortion care when needed.

CONCLUSION:

Even in cases of rape, incest, or a threat to the woman’s life, few patients are able to access federal funding for abortion services in settings without state funding for abortion. Efforts are needed to ensure equitable access to compassionate and timely care for these vulnerable patients.
The Impact of X-Waiver Training Within Obstetrics and Gynecology Residency Programs on Improving Access to Medication-Assisted Treatment in Pregnancy [A51]
Authors: Frazier La-Tisha , Fields Reagen , Tuller Molly , Eskridge Jessica , Miller Edward E.
Published: June 2022

INTRODUCTION:

The opioid epidemic is a crisis within the country, with 136 Americans dying daily from opioid overdose. One of the hardest hit areas is the Appalachian region. Despite medication-assisted treatment (MAT) with methadone or buprenorphine being considered standard of care, studies find that pregnant women in this region face significant barriers to receiving this lifesaving treatment from both insurers and providers. While the number of providers in the country with X-waivers has increased dramatically, the availability of providers willing to prescribe in pregnancy is disproportionate to the severity of the epidemic.

METHODS:

We surveyed 91 obstetrics and gynecology residency programs within Appalachian states to assess if X-waiver training was a part of their residency training. We then collected the geographic locations of program graduates from 2016 to 2021 to assess the impact that this training could have provided to the region.

RESULTS:

Despite working in regions disproportionately impacted by the opioid epidemic, the majority of obstetrics and gynecology residency programs do not provide X-waiver training to their residents. Many residents who train in residency programs located in the Appalachian regions work/have worked in the region after graduation. Our results will be displayed graphically along with mapping illustrations.

CONCLUSION:

Residents of the Appalachian region face barriers accessing adequate health care. This disparity is more prevalent among pregnant women. Coordinated efforts by obstetrics and gynecology residency programs to allow access to X-waiver licensure among residents in training could make a significant impact by improving access to MAT among pregnant women and lead to improved maternal and fetal outcomes.
An Implementation Project to Expand Access to Teledoulas for Abortion Patients [A52]
Authors: Shapiro Marit Pearlman , Termulo Kara , McAllaster Sara , Raidoo Shandhini
Published: June 2022

INTRODUCTION:

The purpose of this study was to describe the implementation and results of a patient outreach project to offer teledoula services to patients choosing medication abortion in Hawai’i during the COVID-19 pandemic.

METHODS:

We trained medical student volunteers at John A. Burns School of Medicine (JABSOM) as abortion teledoulas to remotely provide emotional support, education, pain management, and self-advocacy. We offered teledoula services to pregnant patients presenting for medication abortion either in person or via telemedicine appointment at a university-based, outpatient family planning clinic. The teledoulas were notified by the abortion provider when a patient was interested in the service and the assigned teledoula contacted the patient by phone or text message. We conducted initial training and outreach in February 2021 and recorded completed pairings of teledoulas and patients through July 2021. Institutional review board (IRB) committee approval was waived for the study.

RESULTS:

Of the 15 medical students who attended the teledoula training, 12 (80%) were interested in participating. Of the interested medical students, 100% successfully paired with patients for support. Of the 194 patients who had a medication abortion in the 5 months that this service was offered, 37 (19.1%) were interested in participating in the program and all were contacted by a teledoula via text message. Thirty-three (89%) patients responded to the text message and successfully connected with a teledoula for support during their medication abortion.

CONCLUSION:

A teledoula service staffed by medical student volunteers can be successfully implemented and provide remote support for patients choosing medication abortion during the COVID-19 pandemic.
Experiences of Inappropriate, Disrespectful, or Coercive Health Care: A Study of University Women [A71]
Authors: Hess Andrea , Loder Charisse , Kalpakjian Claire , Munro-Kramer Michelle L. , Ernst Susan
Published: June 2022

INTRODUCTION:

A number of prominent cases involving sexual misconduct among university-affiliated physicians reveal the need to assess inappropriate, disrespectful, or coercive (IDC) health care experienced by university students.

METHODS:

We surveyed students at one public university to gather information about their positive and negative experiences while receiving health care. Survey items included questions about respect for the participant’s identity (race, gender, sexual identity) and whether IDC occurred during health care provision. Items queried about experiences with sensitive exams or exams involving the breast, genitals, or rectum.

RESULTS:

Survey respondents (n=2495) had a mean age of 23 years, identified as female or trans-male, and had experienced at least five relevant health care interactions (76%). Most respondents reported that their needs were accommodated (99%) and their provider made sure they understood their care (98%). However, respondents felt judged about sexual behavior (52%), experienced sexist comments (42%), reported unwanted attention (29%) or advances (23%), and experienced personal calls (1%) from their provider. During sensitive exams, respondents reported that they waited too long while undressed (26%) and were not provided a gown or drape (5%). Alarmingly, respondents reported that sensitive exams were performed without gloves (2%) and experienced inappropriate touch (1%). Finally, 62% stated that they did not know how to report a concern about a provider.

CONCLUSION:

University students are vulnerable to IDC health care experiences and lack comfort with reporting concerns. These negative experiences reveal the need to improve health professional education, including robust training in cultural safety, professionalism, and trauma-informed care, and to create transparent reporting mechanisms.
Trends in Surgeon Subspecialty and Surgical Indications for Vaginal Hysterectomy [A75]
Authors: Hong Christopher X. , Kim Edward K. , White Joseph , Harvie Heidi
Published: June 2022

INTRODUCTION:

Although the American College of Obstetricians and Gynecologists recommends vaginal hysterectomy (VH) as the preferred approach for benign hysterectomy whenever feasible, the number of VH performed is declining in the US. Our objective was to describe trends in gynecologic surgeon subspecialty and surgical indications for patients who underwent vaginal hysterectomy between 2015-2019.

METHODS:

Institutional review board approval was waived for this study of patients who underwent VH for benign indications between 2015-2019 in the American College of Surgeons’ National Surgical Quality Improvement Program database. Patients were identified using current procedural terminology (CPT) codes. To analyze trends over time, two cohorts were compared: VH surgeries between 2015-2017 versus 2018-2019.

RESULTS:

Of 122,457 benign hysterectomies captured, 18,262 (14.9%) were VH. The proportion of VH decreased from 15.8% during 2015-2017 to 14.0% during 2018-2019 (P 05 for all).

CONCLUSION:

Trends in surgeon subspecialty and surgical indications for vaginal hysterectomy are important to consider in addressing the shift away from VH, as they may have implications for patient outcomes and surgical education.
Management of Cesarean Scar Ectopic Pregnancies at an Academic Referral Center [A82]
Authors: Wu Brenda T. , Feld Zoe M. , Creinin Mitchell D.
Published: June 2022

INTRODUCTION:

Cesarean scar ectopic pregnancies (CS-EP) represent less than 1% of ectopic pregnancies and are associated with significant morbidity when undiagnosed. Currently, no standard of care exists for optimal management.

METHODS:

We reviewed our de-identified family planning clinical database for patients seen by our subspecialty service for CS-EP from 7/2017-6/2021 as a quality assurance project. We extracted referral date, final diagnosis, management, and outcome information.

RESULTS:

Of 47 patients referred for suspected CS-EPs, 16 (34%) had a confirmed diagnosis with eight less than and eight greater than 50 days gestation (range 39-58 days). Most (n=40[85%]) referrals occurred in the last 2 years of the 4-year study period. We treated all eight patients less than 50 days primarily with suction aspiration under ultrasound guidance with no complications and estimated blood loss (EBL) of 17±11mL. The eight patients greater than 50 days included six managed with primary aspiration, of which four were uncomplicated, one required intrauterine Foley balloon (EBL 200 mL), and one had uterine perforation and exploratory laparotomy (EBL 250 mL). Two patients primarily received systemic methotrexate with aspiration after significant hCG decline, one uncomplicated and one requiring intrauterine Foley balloon (EBL 250mL). One patient (57 days) had attempted intrauterine double-catheter balloon for primary treatment with immediate hemorrhage requiring uterine artery embolization followed by an uncomplicated suction aspiration.

CONCLUSION:

Patients with confirmed CS-EPs at less than 50 days gestation can be primarily treated with suction aspiration with low risk for significant adverse outcomes. CS-EPs of greater than 50 days gestation are more likely to have complicated outcomes.
Effect of Age on Gynecologic Patients’ Use of Social Media for Women’s Health Information [A84]
Authors: Avis Emily , Sundaram Padmaja , Flink-Bochacki Rachel , Bringley Johanna
Published: June 2022

INTRODUCTION:

Over the last decade, social media platforms have become a major source of health information. We aimed to determine prevalence of social media usage for women’s health information, timing of usage, and perceived benefit among general gynecologic patients.

METHODS:

We performed a cross-sectional study of patients presenting to one US academic gynecology clinic, distributing an anonymous 15-question survey over a 3-week period in spring 2021. The Albany Medical Center Institutional Review Board determined this study to be exempt. We calculated descriptive statistics and used chi-square testing to compare patients of reproductive age (< 50 years) and non-reproductive age (≥50 years).

RESULTS:

Of 377 who completed the survey (91.3% response rate), 259 (68.7%) were reproductive aged and 333 (88.3%) used social media. Most respondents use social media to learn about women’s health (57.0%), believe women’s health information should be available on social media (92.4%), and find social media helpful in making health decisions (58.5%), without differences by age group. Older patients are more likely than their reproductive-aged counterparts to actively search for women’s health information rather than passively finding it on a feed (52.2% vs. 36.8%, P=.024), to use social media for health information specifically around doctor’s visits (52.8% vs. 28.6%, P<.001), and to only trust health information from medical professionals rather than non-medical individuals (85.5% vs. 71.6%, P=.015).

CONCLUSION:

Social media is ubiquitous, with different usage patterns by patient age. Understanding how different groups find and determine trustworthiness of health information on social media can facilitate creation of accessible, medically accurate, and patient-friendly content.
Influence of Prior Vertical Uterine Incision on Subsequent Cesarean Delivery Characteristics and Outcomes [A85]
Authors: Youssefzadeh Ariane , Sangara Rauvynne , Mandelbaum Rachel , Matsuzaki Shinya , Ouzounian Joseph , Matsuo Koji
Published: June 2022

INTRODUCTION:

There is a scarcity of national-level data examining the effect of prior vertical hysterotomy on subsequent cesarean delivery characteristics. The objective of this study is to examine outcomes of cesarean delivery in women with a history of vertical hysterotomy.

METHODS:

Comparative study that retrospectively queried the National Inpatient Sample, a population-based inpatient database in the United States. Subjects were women who underwent cesarean delivery with known uterine incision type from 10/2016-12/2018 (N=1,091,524). Exposure allocation was uterine hysterotomy type in prior delivery, vertical versus low-transverse. Main outcome measures were (i) patient demographics assessed by multivariable generalized estimating equation model and (ii) perioperative outcomes assessed by propensity score inverse provability of treatment weighting.

RESULTS:

A total of 18,575 women with prior vertical uterine incision were compared to 1,072,949 women with prior low-transverse incision. In a multivariable analysis, (i) patient factors older age, decreasing incidence in recent years, low median household income, obesity, (ii) hospital factors—large bed capacity, and (iii) pregnancy characteristics—early gestational age at delivery, placenta previa, placenta accreta spectrum, and uterine rupture remained independent characteristics associated with prior vertical hysterotomy (all, P<.05). In a propensity score weighted model, prior vertical hysterotomy was associated with increased surgical morbidity in the current cesarean delivery compared to prior low-transverse hysterotomy (10.6% versus 4.8%, OR 2.02, 95%CI 1.81-2.26), including hemorrhage (OR 1.99, 95%CI 1.74-2.27) and hysterectomy (OR 3.67, 95%CI 2.97-4.53).

CONCLUSION:

Prior vertical hysterotomy was associated with increased risk of placenta accreta spectrum (particularly percreta), uterine rupture (particularly pre-labor), and other adverse outcomes in the subsequent cesarean delivery.
Screening for High Risk Human Papillomavirus Using Passively Self-Collected Menstrual Blood [A91]
Authors: Naseri Sara , Cruz Giovanna I. , Young Stephen , Blumenthal Paul D.
Published: June 2022

INTRODUCTION:

Globally, cervical cancer is the fourth most common women’s cancer, and the second highest cause of cancer-related mortality. High risk human papillomavirus (HR-HPV) testing is a potential primary test but is conventionally clinic-performed. HR-HPV detection via self-collected samples could increase screening access, reducing opportunity costs and uncomfortable visits. A modified menstrual pad (Q-Pad, www.qvin.com/en), offers passive HR-HPV sample collection and is a potential screening approach alternative. It has a removable collection strip, with specimen-processing as dried blood spots. Objectives: 1) to assess Q-Pad vs. clinician-collected HR-HPV concordance 2) assess Q-Pad acceptability.

METHODS:

Women presenting for either cervical cancer screening or with an HPV-positive history were eligible. Three samples were requested from participants: 1) clinician-collected cervical specimens (CCS) 2) self-collected swabs (SCS), and 3) a Q-Pad which was taken home for use during the next menstruation (QPS). All conventional samples were processed using the Roche Molecular Systems’ Cobas HPV Test. Q-Pad dried blood spots were eluted, then similarly processed.

RESULTS:

A total of 153 women participated and 107 provided QPS and CCS. Among HR-HPV positive samples where the CCS to QPS interval (Q-Pad use) was CIN2, Q-Pad and CCS agreement was 100%. Thirty percent expressed discomfort with self-swabbing and refused SCS collection. Ninety-four percent recommended Q-Pad over clinician-collected sampling. Twelve percent of patients were Q-pad HPV-positive but CCS negative.

CONCLUSION:

Among HPV-positive women, the Q-Pad showed highly concordant results (95-100%) compared to clinician-collected sampling. This collection approach shows promise for integration into cervical cancer prevention programs.
Transvaginal Myomectomy of a Large Obstructive Fibroid Performed at 10 Weeks Gestation [A95]
Authors: Alley Addison W. , Norton Taylor , Steck-Bayat Kayvahn P. , Mourad Jamal
Published: June 2022

INTRODUCTION:

Vaginal natural orifice transluminal endoscopic surgery (vNOTES) is a minimally invasive approach for gynecologic surgery with increasing applications. We present the case of a patient at 10weeks of gestation with a desired pregnancy who developed urinary retention related to uterine fibroids leading to recurrent urinary infections and requiring indwelling catheter. Due to this, she sought termination, however this was unsuccessful due to anatomic distortion. The patient expressed her desire to continue the pregnancy if myomectomy could be performed. Magnetic resonance imaging revealed a 10.4 cm posterior lower uterine fibroid and large left fundal fibroid. The size and position of the fibroids made access via laparoscopy or laparotomy difficult. With shared decision making, we performed a diagnostic vNOTES procedure and subsequent transvaginal myomectomy.

METHODS:

We performed diagnostic laparoscopy and diagnostic vNOTES procedure through a posterior colpotomy to identify pelvic anatomy and obstructing fibroid. Vasopressin was injected and fibroid excised and morcellated vaginally. A second vNOTES and cystoscopy were performed to confirm hemostasis, restoration of normal anatomy and urine outflow. Informed consent was obtained to present the case.

RESULTS:

The patient tolerated the procedure well, was able to void spontaneously, and discharged home on post-operative day one. Final pathology confirmed leiomyoma with degenerative features. The patient carried her pregnancy to term without further urinary obstruction and delivered a healthy infant.

CONCLUSION:

Vaginal surgical approaches, such as vNOTES, can provide surgical access and visualization that may not be accessible by traditional laparoscopy or laparotomy. In certain patient scenarios, this may be considered for gynecologic surgery in pregnancy.
A Curriculum for Opioid Prescribing: What is the Effect on Postoperative Prescribing Patterns? [A97]
Authors: Harris Chelsey A. , Jin Emmy , McDaniel Katherine E. , Dancz Christina E. , Ciotti Mary C.
Published: June 2022

INTRODUCTION:

Many patients receive an excess of opioids to treat their postoperative pain. We sought to assess the impact of a provider-based curricular intervention on postoperative prescribing patterns following benign obstetric and gynecologic procedures.

METHODS:

A provider-based opioid curriculum was developed and implemented. Cases for each of six different categories of procedure were identified (abdominal, laparoscopic, vaginal, hysteroscopic, vaginal delivery, and cesarean delivery). Morphine milligram equivalents (MMEs) prescribed were recorded before and after the curriculum. Initial analysis was to describe MMEs prescribed with a precision of 10 MMEs– requiring 72 subjects per group (80% power alpha=0.05). For the post curricular comparison, 26 subjects were required in each of the six surgical groups to detect a reduction of 10 MMEs (2:1, 80% power alpha=0.05).

RESULTS:

A total of 588 charts were reviewed. The overall median opioids prescribed decreased from 75 to 35 MMEs (P post curriculum were: abdominal (150->60, n=98, P=43.7, n=99, P 50, n=96, P=.01); hysteroscopic (0->0, n=98, P=.87); vaginal delivery (0->0, n=99, P=.22); and cesarean delivery (100->60, n=98, P<.01). The number of people who were prescribed no opioids increased from 145 of 429 (33.6%) to 65of 156 (41.7%), though this was not statistically significant (P=.08). The variation of types of opioid medications prescribed decreased from 7 to 4 (P=.027).

CONCLUSION:

A provider-based curriculum was successful at decreasing the total number of opioids prescribed to gynecologic and cesarean delivery patients in addition to increasing consistency among prescribers.
Incidence of Alopecia in Treatment of Women With Uterine Fibroids: Results of Two Phase 3 Trials of Linzagolix [A104]
Authors: Al-Hendy Ayman , Taylor Hugh S. , Catherino William , Stewart Elizabeth A. , Bestel Elke , Garner Elizabeth
Published: June 2022

INTRODUCTION:

Although hair loss (alopecia) is a benign disorder, it can negatively affect patient's self-esteem, self-image, and overall quality of life. Linzagolix is an oral GnRH antagonist being developed at full and partial suppression doses with and without hormonal add-back therapy (ABT) for treatment of uterine fibroid-related symptoms. Alopecia was previously reported with other GnRH antagonists.

METHODS:

PRIMROSE 1 and 2 are two randomized, double-blind, placebo-controlled phase 3 trials investigating the efficacy and safety of linzagolix 100 mg and 200 mg once daily, +/- ABT in the treatment of uterine fibroids for 52 weeks.

RESULTS:

Up to week 24, alopecia was reported in total of five subjects (0.5%) in the pooled safety analysis set (N=1037). There was a similar incidence in the placebo (two subjects; 1.0%), 100 mg (one subject; 0.5%), and 200 mg+ABT groups (two subjects; 1.0%), and no reports in the 100 mg+ABT or 200 mg groups. Four of the cases resolved. For one subject (200 mg+ABT group) mild alopecia had not resolved. For this subject, the study drug was continued, and no concomitant therapy was administered for the alopecia. Up to week 52, one (0.1%) subject in the 200 mg+ABT group reported alopecia, which resolved. None of the cases led to treatment discontinuation. No subjects reported alopecia during the post-treatment follow-up.

CONCLUSION:

Hair loss (alopecia) was rarely observed in the PRIMROSE trials of linzagolix in the treatment of uterine fibroids.
Incidence of Mood Disorders in Women Treated With Linzagolix: 52-week Results From Two Phase 3 Trials [A106]
Authors: Marsh Erica E. , Catherino William , Al-Hendy Ayman , Donnez Jacques , Bestel Elke , Garner Elizabeth
Published: June 2022

INTRODUCTION:

Safety data from two Phase 3 trials of linzagolix, a GnRH receptor antagonist, for the treatment of women with uterine fibroids (UFs) for 52 weeks were reviewed for treatment emergent adverse events (TEAEs) of depression and other mood disorders. We note that the incidence of TEAEs of depression and other mood disorders, previously reported up to 24 weeks, was low and revealed no consistent drug-related pattern.

METHODS:

PRIMROSE 1 and 2 are randomized, double-blind, placebo-controlled Phase 3 trials investigating the efficacy and safety of linzagolix 100 mg and 200 mg once daily, with and without hormonal add-back therapy (ABT) in women with UFs. After 24 weeks, the placebo group in PRIMROSE2 was switched to 200 mg+ABT. The incidence of depression and other mood disorder TEAEs from week 24 to week 52 was assessed using the Standardized MedDRA Query for Depression and suicide/self-injury and adding TEAEs of anxiety.

RESULTS:

Safety data from 336 and 421 patients, in PRIMROSE1 and PRIMROSE2, respectively, were collected from week 24 to week 52. Mood swings were reported for one (1.1%) subject in PRIMROSE2, and anxiety was reported in one (1.1%) subject in PRIMROSE1, both in the placebo/200 mg+ABT group. Depression was reported in one (1.1%) subject in PRIMROSE2 in the 200 mg/200 mg+ABT group. There were no reports of suicidal ideation, affect lability, or altered mood.

CONCLUSION:

The low incidence of depression and other mood disorder TEAEs was maintained up to 52 weeks of treatment with linzagolix. Linzagolix appears to be well tolerated in women with symptomatic UFs.
Quality of Life Improvements in Women with Uterine Fibroids: Results of Two Phase 3 Trials with Linzagolix [A107]
Authors: Al-Hendy Ayman , Bradley Linda D. , Taylor Hugh S. , Catherino William , Humberstone Andrew , Garner Elizabeth
Published: June 2022

INTRODUCTION:

Uterine fibroids (UFs) are a frequent cause of long-term impairment in health-related quality of life (HRQL), including self-image, interpersonal relationships, and sexual function. Linzagolix is an oral GnRH antagonist being developed for treatment of fibroid-related symptoms at doses that result in full or partial estradiol suppression, both with and without add-back therapy (ABT).

METHODS:

PRIMROSE 1 and 2 are randomized, double-blind, placebo-controlled Phase 3 trials investigating the efficacy and safety of linzagolix 100 mg and 200 mg once daily, +/- ABT in the treatment of UFs for 52 weeks. Health-related qualify of life was assessed using the 3-month recall version of the Uterine Fibroid Symptom Health-Related Quality of Life (UFS QOL) questionnaire (score range: 0-100, a higher score indicating a better HRQL).

RESULTS:

After 24 weeks, in the pooled population (n=1012), the HRQL total score estimated mean (95% CI) change from baseline was 21.8 (25.6; 18.1), 28.2 (31.8; 24.5), 32.1 (35.6; 28.5), 31.5 (35.2; 27.8) and 12.7 (16.2; 9.1) in the 100 mg, 100 mg+ABT, 200 mg, 200 mg+ABT and placebo groups, respectively. All differences from placebo were significant (P<.001). The positive changes in HRQL were maintained at 52 weeks. At week 64, 12 weeks after the end of treatment, the improvements decreased in all treatment groups but did not return to baseline, ranging from a mean (SD) of 12.83 (SD 23.64) to 19.45 (SD 23.83) in the linzagolix arms.

CONCLUSION:

Linzagolix treatment had substantial beneficial effects on HRQL in women with UFs. The benefits persisted, with improvements not fully returning to baseline 12 weeks after treatment termination.
Predictors of Intraoperative Conversion to Open Hysterectomy During Minimally Invasive Approaches [A109]
Authors: Pfeuti Courtney K. , Krewson Briana
Published: June 2022

INTRODUCTION:

Conversion from a minimally invasive approach to hysterectomy (MIH) to an open approach represents a significant complication. We therefore sought to determine risk factors for conversion.

METHODS:

We performed an institutional review board (IRB)-approved retrospective cohort study of women who underwent MIH in an academic hospital system from 2014-2021 via current procedural terminology (CPT) codes for MIH: vaginal (VH), laparoscopic-assisted vaginal (LA-VH), and laparoscopic or robotic (Lsc-H). Gynecologic cancer cases were excluded. MIH cases converted to open hysterectomies were compared to successful MIH to determine factors associated with the primary outcome: intraoperative conversion. Univariable and multivariable regression were used to determine predictors of conversion using STATA v15.0 (College Station, TX).

RESULTS:

A total of 2,231 patients were identified; conversion occurred in 23 of 228 LA-VH (10%), 48 of 1618 Lsc-H (9%), and 8 of 468 VH (2%). Age (46.3±0.95 vs. 50.9±0.25, P<.001), tobacco use (19% vs. 13%, P=.01), and preoperative hemoglobin (11.7±0.21 vs. 12.7±0.04, P<.001) were lower in converted cases. Black women underwent conversion more frequently (6%) than White women (2%), P<.001. Conversion frequency between gynecologic subspecialties significantly differed: generalists (6%), minimally invasive gynecologic surgeons (4%), urogynecologists (0.3%), and oncologists (1%), P<.001. Converted cases had larger uterine weights (459.2g±43.8 vs. 167.7g±3.5, P<.001). Adhesiolysis and postoperative transfusion frequency were higher in converted cases (27% vs. 8%, P<.001) and (14% vs. 1%, P<.001), respectively. In multivariable modeling, predictors of conversion included uterine weight (OR 1.003; 95% CI 1.002–1.004) and adhesiolysis (OR 4.11; 95% CI 2.35–7.21), P< .001.

CONCLUSION:

Uterine weight and adhesiolysis are predictors of intraoperative conversion during MIH and should be considered, along with age, race, tobacco use, and subspecialty, during preoperative risk stratification.
Cost Efficacy of Phenazopyridine Versus Sodium Fluorescein for Use During Cystoscopy After Hysterectomy [A114]
Authors: Ryan Kelly L. , Heisler Elise , Stumpf Luciana A. , Pham Thythy
Published: June 2022

INTRODUCTION:

Recently, sodium fluorescein and phenazopyridine have both been used to visualize ureteral efflux during cystoscopy after hysterectomy. We compared the hysterectomies at our institution that utilized these marker dyes with those that did not and the cost-utility of using sodium fluorescein versus phenazopyridine.

METHODS:

We performed a retrospective chart review of all hysterectomies from June 2018 to March 2020. The primary outcome was the proportion of hysterectomies that used marker dye. Data were analyzed, with SPSS v26, using chi-square tests and Student’s t-tests.

RESULTS:

A total of 625 mostly laparoscopic/robotic (80%), hysterectomies were performed during the study period; two-thirds by Oncology and the rest by Benign Gynecology or Female Pelvic Medicine and Reconstructive Surgery (FPMRS). In 89% of the cases, a cystoscopy was performed. Marker dyes were used in one-third (190/553) of cases; 75% used sodium fluorescein, 20% phenazopyridine, and 3% both. There were no differences in patient or surgery characteristics between the cases that used dyes and those that did not. Eight-eight percent of the FPMRS cases used marker dye compared to 60% Benign and 13% Oncology cases (P=<.001). Dye was used in two-thirds of vaginal, half of laparoscopic, 33% of open, and 19% of robotic cases (P=<.001). Complication rates were low (12%), with no urinary tract injuries. At our institution, the cost of sodium fluorescein is 97 times greater than phenazopyridine. If all cases that utilized sodium fluorescein were to instead use phenazopyridine, the total cost incurred would be almost 1/100th of the cost calculated during this period.

CONCLUSION:

Switching to phenazopyridine in place of sodium fluorescein would result in significant cost savings.
Effect of Endometriosis on Postoperative Outcomes After Hysterectomy Performed for Benign Gynecologic Disease [A115]
Authors: Wang Emily , Bossa Deina R. , Rosero Eric B. , Kho Kimberly A.
Published: June 2022

INTRODUCTION:

Endometriosis affects 10% of reproductive-aged women. Its impact on complications after gynecologic surgery is, however, not well known. This study aimed to investigate the effect of endometriosis on perioperative outcomes of patients undergoing hysterectomy for benign disease.

METHODS:

Institutional Review Board (IRB) approval was obtained. The 2014-2019 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) databases were used to select patients undergoing elective hysterectomy performed for benign indications. Propensity scores derived from logistic regression and inverse probability treatment weighting analysis were used to assemble weighted samples of patients with and without endometriosis. Primary outcomes included 30-day mortality, postoperative complications, and reoperations. Binary logistic regression was used to compare differences in the primary outcomes between patients with and without endometriosis.

RESULTS:

A total of 127,556 hysterectomy cases were identified. Of those, 19,618 (15.4%) had a diagnosis of endometriosis. Patients with endometriosis were younger, had higher incidence of pelvic inflammatory disease and prior abdominal operations but lower prevalence of chronic comorbidities. The incidence of postoperative complications was higher in patients with endometriosis (9.3% vs. 8.4%; OR[95% CI], 1.12 [1.05-1.20]; P=.001). However, the incidence of 30-day mortality (0.04% vs. 0.03%; OR [95% CI],1.16 [0.38-3.52]; P=.789) and reoperations (1.50% vs. 1.36%; OR [95% CI, 1.11 [0.92-1.33]; P=.287) were not different in patients with and without endometriosis.

CONCLUSION:

The rate of postoperative complications was higher in hysterectomies involving endometriosis compared to hysterectomies without endometriosis. Likely this is due to the anatomic distortion incurring increased surgical complexity. Patients and surgeons should be aware of this increased risk when planning surgery for suspected endometriosis.
A Structured Skin Care Protocol for Preventing and Treating Incontinence-associated Dermatitis in Critically Ill Patients
Authors: Zhang Xiaoxue , Wang Xinran , Zhao Xiaowei , Zhang Yu
Published: June 2022

OBJECTIVE

To examine the effectiveness of a structured skin care protocol for preventing and treating incontinence-associated dermatitis (IAD) in critically ill patients.

METHODS

Participants were drawn from the ICUs of three teaching hospitals between January 2016 and December 2017. Patients were eligible if they were ≥18 years old, had idiopathic fecal incontinence, had diarrhea but were unable to sense it, and were expected to stay in the ICU for at least 72 hours after developing incontinence. A total of 143 patients were enrolled: 79 in the experimental group and 64 in the control group. In the first phase of the study, routine skin care measures were used; in the second phase, three ICU caregivers were trained to provide a structured skin care protocol. Trained research team members conducted the data collection and analysis. The TREND (Transparent Reporting of Evaluations with Nonrandomized Designs) Statement Checklist was followed in reporting the study results.

RESULTS

Application of the structured skin care protocol reduced the incidence of IAD from 35.9% in the control phase to 17.7% in the intervention phase (χ
2 = 6.117, P < .05) and also decreased the severity of IAD (z = −2.023, P < .05). Further, IAD developed later (z = −2.116, P < .05) in the intervention group than in the control group. In addition, the nursing times to prevent or manage IAD did not differ significantly between the groups (t = −0.258, P > .05; t = −1.190, P > .05).

CONCLUSIONS

Use of the developed structured skin care protocol for IAD in critically ill patients lowered the incidence and severity of IAD and delayed IAD development.
Beyond Checking Boxes: Exploring Tensions With Use of a Workplace-Based Assessment Tool for Formative Assessment in Clerkships
Authors: Phinney Lauren B. , Fluet Angelina , O’Brien Bridget C. , Seligman Lee , Hauer Karen E.
Published: June 2022

Purpose

To understand the role of a workplace-based assessment (WBA) tool in facilitating feedback for medical students, this study explored changes and tensions in a clerkship feedback activity system through the lens of cultural historical activity theory (CHAT) over 2 years of tool implementation.

Method

This qualitative study uses CHAT to explore WBA use in core clerkships by identifying feedback activity system elements (e.g., community, tools, rules, objects) and tensions among these elements. University of California, San Francisco core clerkship students were invited to participate in semistructured interviews eliciting experience with a WBA tool intended to enhance direct observation and feedback in year 1 (2019) and year 2 (2020) of implementation. In year 1, the WBA tool required supervisor completion in the school’s evaluation system on a computer. In year 2, both students and supervisors had WBA completion abilities and could access the form via a smartphone separate from the school’s evaluation system.

Results

Thirty-five students participated in interviews. The authors identified tensions that shifted with time and tool iterations. Year 1 students described tensions related to cumbersome tool design, fear of burdening supervisors, confusion over WBA purpose, WBA as checking boxes, and WBA usefulness depending on clerkship context and culture. Students perceived dissatisfaction with the year 1 tool version among peers and supervisors. The year 2 mobile-based tool and student completion capabilities helped to reduce many of the tensions noted in year 1. Students expressed wider WBA acceptance among peers and supervisors in year 2 and reported understanding WBA to be for low-stakes feedback, thereby supporting formative assessment for learning.

Conclusions

Using CHAT to explore changes in a feedback activity system with WBA tool iterations revealed elements important to WBA implementation, including designing technology for tool efficiency and affording students autonomy to document feedback with WBAs.
Participation in a Resident-as-Teacher Rotation: Motivations of and Impacts on Faculty Coaches
Authors: Marcus Carolyn H. , Michelson Catherine D. , Luff Donna , Newman Lori R.
Published: June 2022

Purpose

Coaching in medical education is increasingly used for trainee development for a variety of skills, including improving trainee teaching skills through resident-as-teacher programs. Faculty who serve as coaches commit significant effort to the coaching role, often without protected time or support. Little is known about faculty motivations to participate in coaching programs or how the coaching experience affects the faculty. This study explored faculty coaches’ motivations to participate as coaches in a resident-as-teacher rotation and the impacts they experienced as a result of their participation.

Method

In this qualitative study, authors conducted 14 semistructured interviews in 2019 with faculty coaches from a single resident-as-teacher program in Boston, Massachusetts. Authors analyzed the transcripts using thematic analysis to develop a conceptual framework.

Results

Faculty coaches’ motivations for initial participation included a sense of honor; a sense of duty; perception of competence; interest in promoting medical education; and desire for increased connectedness. These motivations all related to a larger theme of educator identity. Coaches identified 3 main impacts from participation: improvement in their own teaching, personal satisfaction from helping others and seeing improvement in their learners, and increased connectedness. These impacts affirmed the coaches’ educator identity and led to ongoing motivation to participate. They also contributed to the coaches’ well-being at work.

Conclusions

Faculty were initially motivated to participate as coaches in a resident-as-teacher rotation based on their identity as educators. The benefits achieved—improvement in own teaching, personal satisfaction, and increased connectedness—affirmed their educator identity and led to ongoing participation and increased well-being at work. These motivations and impacts are important to consider as future programs are developed and coaches are recruited for programs across undergraduate, graduate, and continuing medical education settings.
Phenotypes and Genotypes in Postherpetic Neuralgia Drug Therapy
Authors: Anosike Udochukwu G. , Ouko Innocent , Mwaura Anita W. , Ongidi Ibsen , Mbonu Chijioke C.
Published: June 2022

Neuropathic pain is a debilitating symptom reported by patients presenting with postherpetic neuralgia (PHN). Efforts to alleviate this pain have been projected to lie in individualization of pharmacological treatment through pain phenotyping and subsequent investigations into the genetic basis of PHN therapy. Understanding the various mechanisms related to these phenotypes can aid in improvement of available treatment options and discovery of new ones. Knowledge and application of genetic variations in PHN, structural proteins, and genes can aid in ascertaining risk, susceptibility to, severity of, and protection from PHN. This review summarizes the most recent information that has been published on phenotypes and genotypes with possible clinical applications and directions for future research.
How to support parenting in patients with cancer and co-parents? From research to practice
Authors: Liénard Aurore , Lamal Salomé , Merckaert Isabelle
Published: June 2022

Purpose of review

When a parent is diagnosed with cancer, the entire family is impacted. Patients with cancer and co-parents may no longer feel able to fulfill their parenting roles. The aims of this article are to describe interventions designed to support parenting in the oncological context and to make suggestions for the development and assessment of such interventions.

Recent findings

Ten parenting support interventions published in the last 10 years in oncology were identified, among which four randomized controlled trials (RCTs). The therapeutic aims, techniques, and modalities of these interventions were heterogeneous. Five main therapeutic aims were addressed to: increase parents’ knowledge, promote parents’ emotion regulation, enhance parents’ self-efficacy related to parenting, promote parents’ support of their children's reactions and coping strategies, and promote open and appropriate parent–child communication. Few studies have combined informational resources with experiential techniques.

Very few studies examining the efficacy of parenting support interventions have been published. There is still a need to develop, test, and compare interventions that meet the many needs of parents and their children. Suggestions are made about the contents and formats of parenting support interventions in oncology.
Brain metabolic changes in patients with disseminated malignant melanoma under immunotherapy
Authors: Sizova Marina , Camacho Valle , Sampedro Frederic , Sabaté-Llobera Aida , Abouzian Safae , Stefaneli Patricia , Duch Joan , Fernández-León Alejandro , López-Mora Diego Alfonso , Estorch Montserrat , Carrió Ignasi , Flotats Albert
Published: June 2022

Although there is evidence that chemotherapy can have side effects on metabolism and brain function, there are few studies on the occurrence of these side effects with immunotherapy. The present study was conducted to assess whether brain metabolic changes occur in patients with malignant melanoma under immunotherapy. Thirty-nine patients after surgical intervention and with a diagnosis of malignant melanoma were retrospectively included and were divided into two groups: one group under the first-line therapy with anti-programmed cell death-1 ± anti-cytotoxic T lymphocyte antigen-4 monoclonal antibodies and the other group without any treatment after surgery, which served as a control. Basal and follow-up whole body and brain 2-[18F]fluoro-2-deoxy-D-glucose (18F]FDG) PET/computed tomography (CT) studies were performed. Changes in brain glucose metabolism after treatment initiation of the immunotherapy group were compared with the findings in the control group. In addition, longitudinal regression analysis to investigate whether the time under immunotherapy influenced the changes of brain metabolism was performed. None of the patients presented cognitive impairment or other neurological alterations between basal and follow-up brain [18F]FDG PET/CT examinations. The statistical analysis revealed a significant relative SUV (SUVr)-loss in the left frontal region in patients of the immunotherapy group compared with the control group, with r
adjusted = −0.62 and P = 0.008. Severity of SUVr-loss was correlated with duration of treatment. Patients with disseminated malignant melanoma receiving immunotherapy may present a decrease of brain metabolism in the left frontal region, which is related with time-under-treatment, without any clinical evidence of neurological disorder.
Lupus Erythematosus Tumidus: Clinical and Pathological Features in a Series of 20 Patients
Authors: Magaña Mario , Castellanos Guillermo , Meurehg Charles C. , Magaña-Mainero Mario-Ramón
Published: June 2022

Objective:

We sought to assess the clinicopathologic/immunophenotypical features in patients with lupus erythematosus tumidus (LET).

Methods:

All skin biopsies diagnosed as LET in 16 years were retrieved from our pathology laboratory. Clinical charts were reviewed and immunohistochemical markers were performed. Subpopulations of cells in the infiltrates were studied, as well as the number/distribution of plasmacytoid dendritic cells (PDC), which were compared with two control groups: normal skin and discoid lupus erythematosus. Direct immunofluorescence was performed when available.

Results:

We found 20 patients (11 men and 9 women; mean age 43.5 years); the mean evolution previous to diagnosis was 20.3 months. They all had erythematous, nonscarring urticarial-like plaques: 8 in the head region only, 8 in trunk/limbs only; both segments were affected in 2 patients; topography was unknown in 2. Except for 1 patient, no one developed systemic lupus erythematosus. A dense perivascular/periadnexal superficial-to-deep lymphocytic infiltrate and stromal mucin deposition were characterized histopathologically; interphase changes were absent. Immunophenotype supported an inflammatory profile. The differential count of CD123 + PDC in 10/20 cases of LET (n = 1180) was notably higher than 5 cases of discoid lupus erythematosus (n = 419) and 5 cases of normal skin (n = 38). No immune deposits were found in 2 cases.

Conclusion:

LET is a rare, peculiar form of cutaneous lupus erythematosus that only exceptionally evolves to systemic lupus erythematosus . Its clinical–pathologic/immunophenotypical features are very characteristic. The amount of CD123 + PDC is a very helpful feature among the criteria for its diagnosis and seems to be relevant in its pathogenesis.
Severe Vitamin D Deficiency in Youth with Autism Spectrum Disorder During the COVID-19 Pandemic
Authors: Ganta Avani , Pillai Sabitha S. , Fredette Meghan E. , Topor Lisa Swartz
Published: June 2022

Background:

Decrease in sunlight exposure during periods of social distancing during the COVID-19 pandemic increased the risk of severe manifestations of vitamin D deficiency (VDD) in a particular “high-risk” population. Our objective was to highlight the importance of vitamin D screening in youth with autism spectrum disorder (ASD) and restrictive eating.

Case Presentation:

We describe 3 adolescent male patients with ASD who developed severe manifestations of VDD and hypocalcemia in late 2020 during the COVID-19 pandemic. All spent less time outdoors than in prior years because of isolation at home during the pandemic. Presenting symptoms included seizures and atraumatic fractures. All 3 were found to have hypocalcemia and severe VDD. Limited sun exposure because of isolation indoors during the COVID-19 pandemic was a likely contributing factor to the severity of VDD. All 3 were treated with intravenous calcium acutely, followed by oral calcium and vitamin D. Laboratory tests performed post-treatment showed biochemical resolution of hypocalcemia and VDD.

Conclusion:

These cases highlight the importance of screening “at-risk” youth for VDD. Clinicians should be cognizant that children and adolescents with ASD and restricted eating can have severe manifestations of hypocalcemia and VDD. Decreased sun exposure because of isolating indoors during the COVID-19 pandemic increased their risk for this.