bluuebunny/crossref_metadata_2025_split huggingface dataset:
Feasibility of Vaginal Hysterectomy for Female-to-Male Transgender Men
Authors: Obedin-Maliver Juno , Light Alexis , de Haan Gene , Jackson Rebecca A. 
Published: February 2017

OBJECTIVE:
To describe the hysterectomy data among a cohort of transgender men and nontransgender (ie, cisgender) women with a particular goal to evaluate the feasibility of vaginal hysterectomy among transgender men.

METHODS:
This cohort study includes all hysterectomies performed for benign indications on transgender men and cisgender women at a single academic county hospital from 2000 to 2012. Hysterectomy cases and patient gender were identified by billing records and confirmed by review of medical records. Primary study outcome was the hysterectomy route among transgender men compared with cisgender women. We also examined risk factors and operative outcomes. Student two-sided t tests, χ2 analysis, and descriptive statistics are presented; sensitivity analyses using regression techniques were performed.

RESULTS:
Hysterectomies for benign gynecologic procedures were performed in 883 people: 33 on transgender men and 850 on cisgender women. Transgender men were younger, had fewer pregnancies and deliveries, and smaller uteri. The leading indication for hysterectomy differed significantly: pain (85%) was most common among transgender men (compared with 22% in cisgender women; P<.001), whereas leiomyomas (64%) was most common for cisgender women (compared with 21% in transgender men; P<.001). Vaginal hysterectomies were performed in 24% transgender men and 42% of cisgender women. Estimated blood loss was less among transgender men (P=.002), but when uterine size and route of hysterectomy were considered, the difference between gender groups was no longer significant. There was no difference in patients experiencing complications between the groups.

CONCLUSION:
Transgender men and cisgender women have different preoperative characteristics and surgical indications. Vaginal hysterectomies have been successfully completed among transgender men. Because vaginal hysterectomy is a viable procedure for this population, it should be considered in surgical planning for transgender men.
Urinary Microbiome and Cytokine Levels in Women With Interstitial Cystitis
Authors: Abernethy Melinda G. , Rosenfeld Amy , White James R. , Mueller Margaret G. , Lewicky-Gaupp Christina , Kenton Kimberly 
Published: February 2017

OBJECTIVE:
To investigate differences in the urinary microbiome and cytokine levels between women with and without interstitial cystitis and to correlate differences with scores on standardized symptom severity scales and depression and anxiety screening tools.

METHODS:
Our cross-sectional study compared women presenting to a pelvic floor clinic and diagnosed with interstitial cystitis over a 6-month period with age-matched women in a control group from the same institution. Participants provided a catheterized urine sample and completed symptom severity, quality-of-life, depression, and anxiety screening questionnaires. Urinary microbiomes generated through bacterial ribosomal RNA sequencing and cytokine levels were analyzed using a standard immunoassay. Nonparametric analyses were used for all comparisons.

RESULTS:
Participants with interstitial cystitis reported more disability, bothersome urinary symptoms, genitourinary pain, and sexual dysfunction and scored higher on depression and anxiety screens compared with women in the control group. The urine of participants with interstitial cystitis contained fewer distinct operational taxonomic units (2 [median range 2–7, interquartile range 1] compared with 3.5 [median, range 2–22, interquartile range 5.25], P=.015) and was less likely to contain Lactobacillus acidophilus (1/14 [7%] compared with 7/18 [39%], P=.05) compared with women in the control group. L acidophilus was associated with less severe scores on the Interstitial Cystitis Symptoms Index (1 [median, range 0–17, interquartile range 5] compared with 10 [median, range 0–14, interquartile range 11], P=.005) and the Genitourinary Pain Index (0 [median, range 0–42, interquartile range 22] compared with 22.5 [median, range 0–40, interquartile range 28], P=.03). Participants with interstitial cystitis demonstrated higher levels of macrophage-derived chemokine (13.32 [median, range 8.93–17.05, interquartile range 15.86] compared with 0 [median, range 8.93–22.67, interquartile range 10.35], P=.037) and interleukin-4 (1.95 [median, range 1.31–997, interquartile range 11.84] compared with 1.17 [median, range 0.44–3.26, interquartile range 1.51], P=.029). There was a positive correlation between interleukin-4 and more severe scores on the Interstitial Cystitis Symptoms Index (r=0.406, P=.013). No associations between the presence of lactobacillus species and cytokine levels were observed.

CONCLUSION:
The urinary microbiome of participants with interstitial cystitis was less diverse, less likely to contain Lactobacillus species, and associated with higher levels of proinflammatory cytokines. It is unknown whether this represents causality and whether the effect of alterations to the urinary microbiome is mediated through an inflammatory response.
Relocation of Obstetrician–Gynecologists in the United States, 2005–2015
Authors: Xierali Imam M. , Nivet Marc A. , Rayburn William F. 
Published: February 2017

OBJECTIVE:
To examine recent trends in the relocation of obstetrician–gynecologists (ob-gyns) in the United States.

METHODS:
This longitudinal descriptive study analyzed relocation patterns of ob-gyns between the earliest reference point (2005) and most recently (2015). A physician's county location in a year was compared with his or her location during the previous year. Physician background and county characteristics came from three data resources (Association of American Medical Colleges databases, American Medical Association Physician Masterfile, American Community Survey). A multilevel logistic regression model was used to model factors associated with relocation for the entire period.

RESULTS:
An average of 2,446 (6.5%) of the 37,385 ob-gyns in practice moved per year. Approximately one third (32.1%) relocated (usually once or twice) during the 10 years with more than half (58.2%) remaining within their state. The odds of relocating were higher if the ob-gyns was young, male, black, or an international medical graduate. Relocations were predominantly to counties that were either urban or with a lower percentage of the population in poverty (less than 21.2%). Although the number of ob-gyns and women 18 years or older increased in most states, the population to ob-gyn ratio increased from 3,155 in 2006 to 3,293 in 2015. Net gains from relocations were most apparent in Florida, California, and Washington, whereas net losses were especially apparent in Michigan, Pennsylvania, Ohio, Illinois, and New York.

CONCLUSION:
Approximately one in every three ob-gyns in the United States moved at least once in the past 10 years to counties that were predominantly urban or with less poverty. Observing this trend might contribute to a better understanding about the uneven national distribution of ob-gyns.
Clinical Updates in Women’s Health Care Summary: Structural Heart Disease
Authors: Frisoli Tiberio , Voeltz Michele Doughty 
Published: February 2017

Abstract:
Reproductive-aged women with structural heart disease who become pregnant as well as postreproductive-aged women with this condition represent a significant proportion of patients seen by obstetrician– gynecologists. Usually, their conditions are complex, and a basic knowledge of the anatomy and physiology of the heart is required. Additionally, understanding the effect of pregnancy on women with structural heart disease is critically important to optimizing maternal and fetal outcomes. This monograph addresses the pathophysiology, signs and symptoms, screening and diagnosis, basic management, and suggested counseling for an obstetric–gynecologic patient with structural heart disease.
Combined adductor canal and sciatic nerve block compared with local intraarticular infiltration analgesia for total knee arthroplasty: a prospective blinded randomized controlled study
Authors: Rizk Haitham , Hosni Yaser , Abdeldayem Sherif 
Published: February 2017

Background:
A combined adductor canal block and sciatic nerve block is an efficient way to obtain postoperative analgesia after total knee replacement that spares the motor power of the femoral nerve. This is a prospective controlled randomized study comparing the efficacy of local infiltrative analgesia (LIA) to a combined adductor canal block and sciatic nerve block (CNB).

Methods:
Seventy-five patients were included and randomized to two groups. The first (34 patients) received ultrasound guided CNB and the second group (41 patients) received LIA.

Results:
There was no significant difference in pain control after 4, 6, or 12 hr postoperatively, and there was no significant difference in pain before or after physiotherapy. Both groups achieved knee flexion to 90 degrees at comparable times. Operative time and length of hospital stay were significantly less in the LIA group. Opiate use was similar in both groups. One patient in the LIA group had transient popliteal artery spasm postoperatively.

Conclusions:
LIA may be comparable in efficacy to combined adductor canal and sciatic nerve block, moreover it is easier and faster to perform.
Population Pharmacokinetics of Topiramate in Japanese Pediatric and Adult Patients With Epilepsy Using Routinely Monitored Data
Authors: Takeuchi Masato , Yano Ikuko , Ito Satoko , Sugimoto Mitsuhiro , Yamamoto Shota , Yonezawa Atsushi , Ikeda Akio , Matsubara Kazuo 
Published: February 2017

Background:
Topiramate is a second-generation antiepileptic drug used as monotherapy and adjunctive therapy in adults and children with partial seizures. A population pharmacokinetic (PPK) analysis was performed to improve the topiramate dosage adjustment for individualized treatment.

Methods:
Patients whose steady-state serum concentration of topiramate was routinely monitored at Kyoto University Hospital from April 2012 to March 2013 were included in the model-building data. A nonlinear mixed effects modeling program was used to evaluate the influence of covariates on topiramate pharmacokinetics. The obtained PPK model was evaluated by internal model validations, including goodness-of-fit plots and prediction-corrected visual predictive checks, and was externally confirmed using the validation data from January 2015 to December 2015.

Results:
A total of 177 steady-state serum concentrations from 93 patients were used for the model-building analysis. The patients' age ranged from 2 to 68 years, and body weight ranged from 8.6 to 105 kg. The median serum concentration of topiramate was 1.7 mcg/mL, and half of the patients received carbamazepine coadministration. Based on a one-compartment model with first order absorption and elimination, the apparent volume of distribution was 105 L/70 kg, and the apparent clearance was allometrically related to the body weight as 2.25 L·h−1·70 kg−1 without carbamazepine or phenytoin. Combination treatment with carbamazepine or phenytoin increased the apparent clearance to 3.51 L·h−1·70 kg−1. Goodness-of-fit plots, prediction-corrected visual predictive check, and external validation using the validation data from 43 patients confirmed an appropriateness of the final model. Simulations based on the final model showed that dosage adjustments allometrically scaling to body weight can equalize the serum concentrations in children of various ages and adults.

Conclusions:
The PPK model, using the power scaling of body weight, effectively elucidated the topiramate serum concentration profile ranging from pediatric to adult patients. Dosage adjustments based on body weight and concomitant antiepileptic drug help obtain the dosage of topiramate necessary to reach an effective concentration in each individual.
Avoiding Facial Incisions with Midface Free Tissue Transfer
Authors: Stalder Mark W. , Sosin Michael , Urbinelli Leo J. , Mayo James L. , Dorafshar Amir H. , Hilaire Hugo St. , Borsuk Daniel E. , Rodriguez Eduardo D. 
Published: February 2017

Background:
We have adopted an intraoral microsurgical anastomosis to the facial vessels to eliminate the need for any visible facial incisions.

Methods:
Cadaveric dissection was used to demonstrate accessibility of the facial artery and vein through an intraoral approach. Additionally, 5 patients underwent free tissue transfer for reconstruction of major defects of the midface through an intraoral, transmucosal approach, obviating the need for visible skin incisions.

Results:
The pathology included palatal defects due to mucoepidermoid carcinoma and ischemic necrosis from cocaine abuse, maxillary defects secondary to fibrous dysplasia and avascular necrosis from traumatic blast injury, and a residual posttraumatic bony deformity of the zygoma. Reconstructions were performed with a free ulnar forearm flap, a free vastus lateralis muscle flap, a deep circumflex iliac artery myoosseous flap, a free fibula flap, and a deep circumflex iliac artery osseous flap, respectively. The facial artery and vein were used as recipient vessels for microvascular anastomosis for all cases. Mean follow-up was 12.2 months. All free tissue transfers were successful, and each patient had a satisfactory aesthetic outcome with no associated facial scars.

Conclusion:
This technique can be employed during reconstruction of an array of bony or soft-tissue midface deficits with minimal morbidity. This small series effectively demonstrates the varied pathologies and tissue deficiencies that can be successfully reconstructed with free tissue transfer using an entirely intraoral approach to the recipient facial vessels, resulting in no visible scars on the face and an improvement in the overall aesthetic outcome.
First Presentation Acute Rheumatic Fever is Preventable in a Community Setting
Authors: Lennon Diana , Anderson Philippa , Kerdemilidis Melissa , Farrell Elizabeth , Crengle Mahi Suzanne , Percival Teuila , Jansen David , Stewart Joanna 
Published: February 2017

Background:
Robust evidence is lacking for community initiatives to prevent first presentation acute rheumatic fever (ARF) by group A streptococcal (GAS) pharyngitis treatment.

Methods:
We measured the effect of introducing a sore throat clinic program on first presentation ARF into 61-year 1–8 schools with students 5–13 years of age (population ≈25,000) in Auckland, New Zealand. The study period was 2010–2016. A generalized linear mixed model investigated ARF rate changes before and after the staggered introduction of school clinics. Nurses and lay workers treated culture-proven GAS sore throats (including siblings) with 10 days of amoxicillin. ARF cases were identified from a population-based secondary prophylaxis register. Annual pharyngeal GAS prevalence was assessed in a subset.

Results:
ARF rates in 5–13 year olds dropped from 88 [95% confidence interval (CI): 79–111] per 100,000 preclinics to 37 (95% CI: 15–83) per 100,000 after 2 years of clinic availability, a 58% reduction. No change in rate was demonstrated before the introduction of clinics [P = 0.88; incidence risk ratio for a 1-year change: 0.98 (95% CI: 0.63–1.52)], but there was a significant decrease of first presentation ARF rates with time after the introduction of the sore throat program [P = 0.008; incidence risk ratio: 0.61 (95% CI: 0.43–0.88)]. Pharyngeal GAS cross-sectional prevalence fell from 22.4% (16.5–30.5) preintervention to 11.9% (8.6–16.5) and 11.4% (8.2–15.7) 1 or 2 years later (P = 0.005).

Conclusions:
ARF declined significantly after school-based GAS pharyngitis management using oral amoxicillin paralleled by a decline in pharyngeal GAS prevalence.
Implementation of an Early Mobility Pathway in Neurointensive Care Unit Patients With External Ventricular Devices
Authors: Moyer Megan , Young Bethany , Wilensky Eileen Maloney , Borst Joseph , Pino William , Hart Marisa , LoBreglio Jesse , Zaleski Derek , Leonor Isaira , Kung David , Smith Michelle , Zager Eric , Grady M. Sean , Kumar Monisha 
Published: February 2017

ABSTRACT

Background: Patients with an external ventricular drain (EVD) may not be readily mobilized because of concerns of catheter dislodgment and/or inappropriate cerebrospinal fluid drainage. Delayed mobilization may result in longer hospital stays and an increased risk for complications related to immobility. We aimed to determine the safety, feasibility, and outcome of an EVD mobilization protocol in patients with subarachnoid hemorrhage (SAH). Methods: A multidisciplinary group developed a formal algorithm for the mobilization of patients with SAH with EVDs. Outcome measures included intensive care unit (ICU) length of stay (LOS), day to first mobilization, and discharge disposition. Patients were prospectively enrolled during a 12-month period and compared with a historical control group of patients with SAH for the preceding 12-month period. Results: Thirty-nine of 45 (86.7%) patients were women. Mean age did not differ significantly between the preintervention (n = 19) and postintervention (n = 26) groups (59.6 vs 55.7). Number of EVD device days did not differ significantly between groups (16.3 vs 15, P = .422]. Of 101 attempted postintervention mobilization sessions, six were aborted for increased lethargy (1), pain (1), elevated intracranial pressure (1), drain malfunction (1), and hypotension (2). Twenty-four sessions were attempted but never initiated because of worsening neurologic examination (10), pulmonary instability (2), hemodynamic instability (2), medical instability (3), and provider request (1). No patient experienced catheter dislodgment. Mean ICU LOS was not different between groups (20.7 vs 18.2, P = .262). The day of first mobilization was significantly earlier in the postintervention group (18.7 vs 6.5, P < .0001). The percentage of patients discharged home or to acute rehabilitation was higher in the postintervention group (63.2% vs 88.5%, P = .018], when accounting for Hunt and Hess grade. Conclusions: The mobilization of patients with EVDs is safe and feasible; it may be associated with earlier mobilization, reduced ICU LOS, and better discharge disposition. No major complications were attributable to early mobilization.
Hospital Outpatient Visits Associated With Medication-Related Problems in Thailand: A Multicenter Prospective Observational Study
Authors: Dechanont Supinya , Jedsadayanmata Arom , Butthum Bodin , Kongkaew Chuenjid 
Published: February 2017

Objectives
The aims of the study were to investigate the prevalence of hospital visits associated with medication-related problems (MRPs, i.e., adverse drug events [ADEs], adverse drug reactions [ADRs], nonadherence [NA] to medication, and medication error) and to identify the medications involved in hospital visits associated with MRPs in outpatient departments (OPDs).

Methods
A prospective observational study was carried out in OPD of 11 hospitals in the lower northern region of Thailand. Patients visiting OPDs were screened for suspected MRPs by clinical pharmacists using medical record review supplemented by patient interview. Three experts evaluated suspected MRPs using the following 3 criteria: causality, severity, and preventability.

Results
Of the 3069 patients who visited the OPDs during the study period, 113 (3.7%) were deemed to have causal MRPs. Nearly half of the causal MRPs (n = 49, 43.4%) were preventable. The following 4 types of causal MRPs were identified: ADEs (n = 112, 3.7%), ADRs (n = 65, 2.1%), NA to medications (n = 48, 1.6%), and medication errors (n = 1, 0.03%). In nonelective patients (n = 764), 35 patients (4.6%) were judged to have causal MRPs. Of the nonelective patients who experienced causal MRPs, 25 (71.4%) were preventable. The medications commonly associated with ADEs and NA to medication were those targeting the cardiovascular system (especially enalapril, amlodipine, and hydrochlorothiazide), whereas the medications involving ADRs involved the cardiovascular and endocrine systems (especially, enalapril, amlodipine, and metformin).

Conclusions
Outpatient department visits associated with MRPs, particularly in nonelective patients, were preventable. Effective strategies are needed for reducing visits to hospital OPD associated with preventable MRPs.
The Effect of Preoperative Phenazopyridine on Urinary Retention Following Midurethral Sling
Authors: Dueñas-Garcia Omar Felipe , Sierra Tania , Nicasio Erica , Leung Katherine , Hall Cynthia D. , Flynn Michael K. 
Published: February 2017

Objective
The aim of this study was to determine the effect of preoperative oral phenazopyridine on short-term voiding dysfunction in patients undergoing a retropubic midurethral sling.

Methods
We conducted a retrospective cohort study in subjects undergoing a retropubic midurethral sling comparing those who received preoperative oral phenazopyridine with those who did not. We included all women who underwent a retropubic midurethral sling without concomitant procedures under general anesthesia at our institution. Slings were placed by either suprapubic or transvaginal approach, per surgeon’s preference. Demographics and intraoperative data on preoperative dose of phenazopyridine and medications linked to voiding dysfunction were captured.

Results
One hundred seventy-four subjects were identified. Twenty-five subjects failed to meet inclusion and exclusion criteria and were excluded, and 149 subjects comprised the final groups. Eighty-two subjects (55.03%) received phenazopyridine, and 67 (44.97%) did not. Most subjects received a 200-mg dose (97.6%). Except for surgical approach, both groups receiving and not receiving phenazopyridine had similar demographic characteristics. Eighty-eight percent of the subjects who received phenazopyridine passed the voiding trial versus 73.1% (odds ratio, 2.98; 95% confidence interval, 1.23–7.17). After adjusting for medications, estimated blood loss, number of trocar passages, or bladder perforation, the patients receiving phenazopyridine were still more likely to pass the postoperative voiding trials compared with those who did not (odds ratio, 2.97; 95% confidence interval, 1.10–7.98).

Conclusions
Our findings suggest that the preoperative administration of phenazopyridine may improve postoperative voiding function after a retropubic midurethral sling. Additional prospective trials are needed to confirm this finding.