bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.