Medicine and Health Sciences Commons^™

Creating A Gold Medal Olympic And Paralympics Health Care Team: A Satisfaction Survey Of The Mobile Medical Unit/Polyclinic Team Training For The Vancouver 2010 Winter Games, D Ross Brown, Behrouz Heidary, Nathaniel Bell, Leanne Appleton, Richard K. Simons, David C. Evans, S Morad Hameed, Jack Taunton, Kosar Khwaja, Michael O'Connor, Naisan Garraway, Peter Hennecke, Donna Kuipers, Tracey Taulu, Lori Quinn

Faculty Publications

BACKGROUND:

The mobile medical unit/polyclinic (MMU/PC) was an essential part of the medical services to support ill or injured Olympic or Paralympics family during the 2010 Olympic and Paralympics winter games. The objective of this study was to survey the satisfaction of the clinical staff that completed the training programs prior to deployment to the MMU.

METHODS:

Medical personnel who participated in at least one of the four training programs, including (1) week-end sessions; (2) web-based modules; (3) just-in-time training; and (4) daily simulation exercises were invited to participate in a web-based survey and comment on their level of satisfaction …

Determination Of Cutpoints For Low And High Number Of Symptoms In Patients With Advanced Cancer, Stephanie Gilbertson-White, B. Aouizerat, T. Jahan, S. Paul, C. West, K. Schumacher, M. Dodd, M. Rabow, A. Abu Raddaha, C. Miaskowski

Stephanie Gilbertson-White

While patients with advanced cancer experience a wide range of symptoms, no work has been done to determine an optimal cutpoint for a low versus a high number of symptoms. Analytic approaches that established clinically meaningful cutpoints for the severity of cancer pain and fatigue provided the foundation for this study. The purpose of this study was to determine the optimal cutpoint for low and high numbers of symptoms using a range of potential cutpoints and to determine if those cutpoints distinguished between the two symptom groups on demographic and clinical characteristics and depression, anxiety, and quality of life (QOL). …

Support For A Smoke-Free Bylaw In Parks And On Beaches, Chizimuzo T.C. Okoli, Ann Pederson, Wendy Rice

Nursing Faculty Publications

BACKGROUND: In September 2010, Vancouver, Canada enacted a smoke-free bylaw in parks and on beaches.

OBJECTIVE: To examine demographic and attitudinal factors associated with the public opinion on Vancouver's outdoor smoke-free bylaw.

METHODS: From 496 randomly selected Vancouver residents, information on demographics, smoking status, and opinions and support for or opposition to the smoke-free bylaw were obtained by telephone surveys.

RESULTS: Approximately 84.2% of the sample endorsed the legislation; a greater proportion of non-smokers supported the bylaw than smokers (88.6% vs. 52.0%). In multivariate analysis, demographic variables significantly associated with supporting the smoke-free bylaw were being female, having completed community …

Serum Inhibin-B In Fertile Men Is Strongly Correlated With Low But Not High Sperm Counts: A Coordinated Study Of 1,797 European And Us Men, N. Jorgensen, F. Liu, A. Andersson, M. Vierula, D. Irvine, J. Auger, C. Brazil, E. Drobnis, T. Jensen, P. Jouannet, J. Overstreet, J. Redmon, Amy Sparks, J. Toppari, C. Wang, N. Skakkebaek, S. Swan

Amy E.T. Sparks

OBJECTIVE: To describe associations between serum inhibin-b and sperm counts, adjusted for effect of time of blood sampling, in larger cohorts than have been previously reported. DESIGN: Cross-sectional studies of spermatogenesis markers. SETTING: Four European and four US centers. PATIENT(S): Fertile men (1,797) were included and examined from October 1996-February 2005. INTERVENTION(S): The study was observational and therefore without any intervention. MAIN OUTCOME MEASURE(S): Associations between inhibin-b and semen variables controlled for time of blood sampling and other covariates. RESULT(S): Inhibin-b decreased about 2.00% per hour from 8 am-12 pm and then about 3.25% per hour from 12 pm-4 pm. …

Psychological Empowerment And Job Satisfaction Between Baby Boomer And Generation X Nurses, Amy Sparks

Amy E.T. Sparks

AIM: This paper is a report of a study of differences in nurses' generational psychological empowerment and job satisfaction. BACKGROUND: Generations differ in work styles such as autonomy, work ethics, involvement, views on leadership, and primary views on what constitutes innovation, quality, and service. METHOD: A secondary analysis was conducted from two data sets resulting in a sample of 451 registered nurses employed at five hospitals in West Virginia. One data set was gathered from a convenience sample and one from a randomly selected sample. Data were collected from 2000 to 2004. RESULTS: Baby Boomer nurses reported higher mean total …

Characterization Of Human Sperm Antigens Reacting With Anti-Sperm Antibodies From An Infertile Female Patient's Serum, H. Feng, Y. Han, Amy Sparks, J. Sandlow

Amy E.T. Sparks

Identification of sperm antigens that elicit immunoglobulin (Ig) production and knowledge of their roles in sperm transport and fertilization may enhance diagnosis and treatment of immunologic infertility. Sperm antigens recognized by a female patient's serum anti-sperm antibodies were characterized using an indirect immunobead-binding test, immunoblot analysis, and immunochemical labeling. The anti-sperm antibodies' effect on sperm function was evaluated by acrosome induction by calcium ionophore. Immunobeads specific for IgG were bound to the head of 79% of motile donor sperm. Immunochemical labeling of antibody-binding sites was restricted to the plasma membrane over the acrosomal crescent. No labeling was observed on the …

Social Cognition, Empathy And Functional Outcome In Schizophrenia, Amy Sparks, S. Mcdonald, B. Lino, M. O'Donnell, M. Green

Amy E.T. Sparks

Social and occupational functioning difficulties are a characteristic feature of schizophrenia, and a growing body of evidence suggests that deficits in social cognition contribute significantly to these functional impairments. The present study sought to investigate whether the association between social cognition and social functioning in schizophrenia would be mediated by self-reported levels of empathy. Thirty outpatients with a diagnosis of schizophrenia or schizoaffective disorder, and twenty-five healthy controls completed a well-validated facial affect processing task (Ekman 60-faces facial task from the Facial Expressions of Emotion - Stimuli and Tests; FEEST), The Awareness of Social Inference Test (TASIT; to assess emotion …

Are Environmental Levels Of Bisphenol A Associated With Reproductive Function In Fertile Men?, J. Mendiola, N. Jorgensen, A. Andersson, A. Calafat, X. Ye, J. Redmon, E. Drobnis, C. Wang, Amy Sparks, S. Thurston, F. Liu, S. Swan

Amy E.T. Sparks

BACKGROUND: Rodent and in vitro studies have demonstrated the estrogenicity of bisphenol A (BPA). However, few studies have examined the relationship between human exposure to BPA and male reproductive function. OBJECTIVES: We investigated the relationships between environmental BPA exposure and reproductive parameters, including semen quality and male reproductive hormones, in prospectively recruited fertile men. METHODS: Participants (n = 375) were partners of pregnant women who participated in the Study for Future Families in four U.S. cities, and all of the men provided blood, semen, and urine samples. BPA was measured in urine. Serum samples were analyzed for reproductive hormones, including …

Impact Of Male Age On The Outcome Of Assisted Reproductive Technology Cycles Using Donor Oocytes, Eyup Duran, D. Dowling-Lacey, S. Bocca, L. Stadtmauer, S. Oehninger

Eyup Hakan Duran

This study assessed the influence of the age of the male partner on the outcome of oocyte donation cycles. A total of 408 couples participating in 519 consecutive anonymous oocyte donation cycles were examined. Main outcome measures were fertilization rate, embryo quality, clinical pregnancy, implantation, miscarriage and live birth rates, as well as the total reproductive potential, which estimates the outcome from fresh and cryopreserved-thawed embryo transfers. A total of 241 cycles resulted in clinical pregnancy (48.5% of transfers). The mean embryo score for transferred embryos (ESTE) was higher in cycles resulting in pregnancy (P=0.003). Semen volume (P<0.001), sperm …

Sperm Dna Quality Predicts Intrauterine Insemination Outcome: A Prospective Cohort Study, Eyup Duran, M. Morshedi, S. Taylor, S. Oehninger

Eyup Hakan Duran

BACKGROUND: We aimed to investigate whether sperm DNA quality may predict intrauterine insemination (IUI) outcome. METHODS: The study was designed in a prospective cohort fashion, at a tertiary centre for reproductive medicine. A total of 119 patients underwent 154 cycles of IUI. Parameters related to demography, cycle management and semen sample used for IUI were evaluated. Conventional semen parameters, morphology (strict criteria), sperm DNA fragmentation and stability [evaluated by terminal deoxynucleotidyl transferase-mediated dUDP nick-end labelling (TUNEL) and acridine orange staining under both acid and acid + heat denaturing conditions respectively] were measured. The main outcome measure was clinical pregnancy, defined …

The Effect Of Age On The Expression Of Apoptosis Biomarkers In Human Spermatozoa, A. Colin, G. Barroso, N. Gomez-Lopez, Eyup Duran, S. Oehninger

Eyup Hakan Duran

OBJECTIVE: To evaluate the impact of age on the expression of apoptotic biomarkers in human spermatozoa. DESIGN: Cross sectional, prospective study. SETTING: Academic centers. PATIENT(S): Healthy volunteers with proven fertility, stratified by age (n = 25, range: 20-68 years). INTERVENTION(S): Examination of serum hormone levels and basic semen parameters, and assessment of early (plasma membrane translocation of phosphatidylserine) and late (DNA fragmentation) sperm apoptotic markers by flow cytometry (using Annexin-V binding and terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling). MAIN OUTCOME MEASURE(S): Apoptosis markers. RESULT(S): Advancing male age was significantly and positively correlated with Annexin-V binding results. Although not significant, …

Endometrial Response To Unopposed Estrogens Remains Unaltered In Patients With Chronic Renal Failure Receiving Hemodialysis, M. Ergeneli, Eyup Duran, H. Zeyneloglu, B. Demirhan, M. Erdogan

Eyup Hakan Duran

Most patients with chronic renal failure who are on maintenance hemodialysis are anovulatory and have menstrual abnormalities. This study was designed to determine the prevalence of organic causes of abnormal uterine bleeding in this group of patients exposed to unopposed estrogens. Eighteen patients with chronic renal failure and abnormal uterine bleeding underwent vacuum curettage. The histopathologic findings were compared with a group of 154 premenopausal women who had abnormal uterine bleeding without detectable organic causes. Excluding patients with secretory and atrophic endometrium, only 2 of 8 patients (25%) with chronic renal failure had endometrial lesions while 44 of 131 patients …

Outcomes From Assisted Reproductive Technology, Bradley Van Voorhis

Bradley J Van Voorhis

The use of assisted reproductive technology (ART) for treating the infertile couple is increasing in the United States. The purpose of this paper is to review the short-term outcomes after ART. Pregnancy rates after ART have shown nearly continuous improvement in the years since its inception. A number of factors affect the pregnancy rate, with the most important being a woman's age. Certain clinical diagnoses are associated with a poorer outcome from ART, including the presence of hydrosalpinges, uterine leiomyomata that distort the endometrial cavity, and decreased ovarian reserve. Multiple gestations are the major complication after ART. New laboratory techniques, …

Immunohistochemical Localization Of Prostaglandin H Synthase In The Female Reproductive Tract And Endometriosis, Bradley Van Voorhis, P. Huettner, M. Clark, J. Hill

Bradley J Van Voorhis

Prostaglandin H synthase, also known as cyclooxygenase, is an essential enzyme in prostaglandin synthesis. Using a monoclonal antibody and immunohistochemical techniques, we studied the localization of this enzyme in the female reproductive tract and in endometriosis. In the uterus, prostaglandin H synthase was primarily localized to endometrial epithelium with surface epithelium containing more immunoreactive prostaglandin H synthase than glandular epithelium. Fallopian tube secretory epithelial cells also contained prostaglandin H synthase while ciliated epithelial cells did not. Cervical epithelium and myometrial cells did not contain prostaglandin H synthase. A higher percentage of glands in endometriosis and adenomyosis, as compared with eutopic …

Pelvic Floor Symptoms And Lifestyle Factors In Older Women, Catherine Bradley, Colleen Kennedy, I. Nygaard

Colleen Kennedy Stockdale

OBJECTIVES: To measure the prevalence of pelvic floor symptoms in noncare-seeking older women and the association between symptoms and lifestyle factors. METHODS: Women enrolled at one site of the Women's Health Initiative Hormone Therapy clinical trial completed a questionnaire, modified from the Pelvic Floor Distress Inventory, on bladder, bowel, and prolapse symptoms. Individual symptoms and symptom groups were examined in a cross-sectional analysis. RESULTS: In the 297 women who participated, mean age was 68.2 years, mean body mass index (BMI) was 30.2 kg/m(2), and median vaginal parity was 3. The median number of symptoms endorsed was 3 (range 0-18). The …

Urinary Incontinence, Depression And Posttraumatic Stress Disorder In Women Veterans, Catherine Bradley, I. Nygaard, M. Mengeling, J. Torner, Colleen Stockdale, B. Booth, A. Sadler

Colleen Kennedy Stockdale

OBJECTIVE: To study associations between urinary incontinence (UI) symptoms, depression, and posttraumatic stress disorder in women veterans. STUDY DESIGN: This cross-sectional study enrolled women 20 to 52 years of age registered at 2 midwestern US Veterans Affairs Medical Centers or outlying clinics within 5 years preceding study interview. Participants completed a computer-assisted telephone interview assessing urogynecologic, medical, and mental health. Multivariable analyses studied independent associations between stress and urgency UI and depression and posttraumatic stress disorder. RESULTS: Nine hundred sixty-eight women mean aged 38.7 +/- 8.7 years were included. Of these, 191 (19.7%) reported urgency/mixed UI and 183 (18.9%) stress …

Bladder And Bowel Symptoms Among Women With Vulvar Disease: Are They Universal?, Colleen Kennedy, I. Nygaard, Catherine Bradley, R. Galask

Colleen Kennedy Stockdale

OBJECTIVE: To compare the prevalence of painful bladder syndrome, recurrent urinary tract infections, urinary leakage and irritable bowel syndrome between women with specific vulvar disorders and controls. STUDY DESIGN: Women with a primary diagnosis of vulvar intraepithelial neoplasia (dysplasia), vulvar vestibulitis (vestibulitis), contact vulvitis, atrophic vulvovaginitis, lichen simplex, lichen sclerosus and lichen planus, were compared to women presenting for annual examinations. RESULTS: As compared to controls, painful bladder syndrome was more prevalent among subjects with dysplasia, vestibulitis and contact vulvitis; a history of recurrent urinary tract infection was more prevalent among subjects with contact vulvitis; and urinary incontinence was less …

Risk Factors For Painful Bladder Syndrome In Women Seeking Gynecologic Care, Colleen Kennedy, Catherine Bradley, R. Galask, I. Nygaard

Colleen Kennedy Stockdale

The aim of this cross-sectional study was to report risk factors for painful bladder syndrome in women. We surveyed 645 women presenting for care to general gynecology clinics and a vulvar specialty clinic using a standardized questionnaire and validated outcome measures. We used two definitions for painful bladder syndrome, based on the O'Leary-Sant interstitial cystitis symptom and problem indices. Of those women surveyed, 29.5% met broader criteria and 8.5% met more restrictive criteria for painful bladder syndrome. After adjusting for confounders, bladder pain was significantly associated with current smoking, irritable bowel syndrome, and a generalized pain disorder. Tobacco use, the …

Vulvar Carcinoma With Hypercalcemia, Jennifer Niebyl, Rene Genadry, E. Friedrich, E. Wilkinson, J. Woodruff

Jennifer R Niebyl

Hypercalcemia associated with nonmetastatic malignancy has been reported most frequently with lung or kidney tumors, while among gynecologic malignancies, the ovary has been the most common primary site. The pertinent clinicopathologic features of 2 cases of nonmetastatic vulvar carcinoma producing hypercalcemia are described in the present report. Including 3 previously reported cases, the vulva is seen to be the second most common site in the female genital tract for production of this paraendocrine syndrome. The clinician should be aware of the association of hypercalcemia and mental confusion with bulky vulvar tumors, so that surgery will not needlessly be delayed in …

Cyclic Changes In Glycemia Assessed By Continuous Glucose Monitoring System During Multiple Complete Menstrual Cycles In Women With Type 1 Diabetes, W. Goldner, V. Kraus, W. Sivitz, Stephen Hunter, J. Dillon

Stephen K. Hunter

Many women with diabetes notice changes in glucose control perimenstrually. To describe the pattern of changes in glucose control throughout the complete menstrual cycle, and the reproducibility of these changes, we performed a pilot study evaluating glycemic profiles continuously for three cycles in four women with type 1 diabetes. All participants had hemoglobin A1c <7.5% and regular menstrual periods off oral contraceptives. They used Medtronic MiniMed (Northridge, CA) Continuous Glucose Monitoring System (CGMS) devices continuously for three complete menstrual cycles, checked capillary glucose measurements six times daily, changed their own sensors every 3 days, and were seen seven times per …

Endometrial Cancer, Kimberly Leslie, K. W. Thiel, Michael Goodheart, Koen De Geest, Y. Jia, S. Yang

Koen De Geest

Despite the questions and barriers, the incorporation of molecular therapy into treatment regimens in endometrial cancer is an exciting area of investigation with the potential to improve outcomes. Outside of the development of a reliable screening test for endometrial cancer, converting the disease to a chronic state and improving progression-free survival is our best hope to reverse the concerning trend of decreasing 5-year survival for this disease.

Postoperative Irradiation In Malignant Tumors Of Submandibular Gland, Donghai Dai

Donghai Dai

A retrospective review of 18 patients with treated primary malignant tumors of submandibular gland is presented. The data revealed that initial control of malignancies was inversely related to the presence of disease and surgical margins. Postoperative radiation therapy was used in cases with positive surgical margins. Of the patients with inadequate surgical margins, 71% achieved local relapse when they had surgery alone, compared with 27% of the group that received postoperative irradiation. This study suggests that adjuvant radiation therapy may improve the local control and survival. Such therapy can serve as the salvage method for those who have inadequate surgical …

A New Questionnaire For Urinary Incontinence Diagnosis In Women: Development And Testing, Catherine Bradley, E. Rovner, M. Morgan, M. Berlin, J. Novi, J. Shea, L. Arya

Catherine S. Bradley

OBJECTIVE: The purpose of this study was to develop a questionnaire for urinary incontinence diagnosis in women and to test its reliability and validity, with incontinence specialists' clinical evaluations as the gold standard. STUDY DESIGN: One hundred seventeen urogynecology outpatients with urinary incontinence symptoms completed the Questionnaire for Urinary Incontinence Diagnosis at enrollment and 1 week and 9 months later. Baseline clinical diagnoses were compared with Questionnaire for Urinary Incontinence Diagnosis diagnoses (criterion validity). Nine-month Questionnaire for Urinary Incontinence Diagnosis change scores were compared across treatment groups (responsiveness). RESULTS: Clinical diagnoses included stress (n = 15), urge (n = 26), …

The Sensitivity And Specificity Of A Simple Test To Distinguish Between Urge And Stress Urinary Incontinence, J. S. Brown, Catherine Bradley, L. L. Subak, H. E. Richter, S. R. Kraus, L. Brubaker, F. Lin, E. Vittinghoff, D. Grady

Catherine S. Bradley

BACKGROUND: Urinary incontinence is common in women. Because treatments differ, urge incontinence should be distinguished from stress incontinence. To make this distinction, current guidelines recommend an extensive evaluation that is too time-consuming for primary care practice. OBJECTIVE: To test the accuracy of a simple questionnaire to categorize type of urinary incontinence in women. DESIGN: Multicenter, prospective study of the accuracy of the 3 Incontinence Questions (3IQ) compared with an extended evaluation to distinguish between urge incontinence and stress incontinence. SETTING: 5 academic medical centers in the United States. PARTICIPANTS: 301 women enrolled from April to December 2004 who were older …

Vaginal Wall Descensus And Pelvic Floor Symptoms In Older Women, Catherine Bradley, I. Nygaard

Catherine S. Bradley

OBJECTIVE: To understand the clinical significance of early pelvic organ prolapse in older women, we studied associations between vaginal descensus and pelvic floor symptoms. METHODS: In this cross-sectional study, 270 women enrolled at one site of the Women's Health Initiative clinical trial completed a questionnaire modified from the Pelvic Floor Distress Inventory on pelvic floor symptoms and underwent a Pelvic Organ Prolapse Quantification (POP-Q) examination. We tested associations between symptoms (individual and grouped) with anterior, posterior, uterine, and maximum vaginal descensus. RESULTS: Mean age was 68 years. Ninety-six percent had POP-Q stages I or II. Only obstructive urinary symptoms and …

The Questionnaire For Urinary Incontinence Diagnosis (Quid): Validity And Responsiveness To Change In Women Undergoing Non-Surgical Therapies For Treatment Of Stress Predominant Urinary Incontinence, Catherine Bradley, D. Rahn, I. Nygaard, M. Barber, C. Nager, K. Kenton, N. Siddiqui, R. Abel, C. Spino, H. Richter

Catherine S. Bradley

AIMS: The Questionnaire for Urinary Incontinence Diagnosis (QUID), a 6-item urinary incontinence (UI) symptom questionnaire, was developed and validated to distinguish stress and urge UI. This study's objective was to evaluate QUID validity and responsiveness when used as a clinical trial outcome measure. METHODS: Participants enrolled in a multi-center trial of non-surgical therapy (continence pessary, pelvic floor muscle training or combined) for stress-predominant UI and completed baseline and 3-month diaries, the Urinary Distress Inventory (UDI) and QUID. Data from all treatment groups were pooled. QUID internal consistency (Cronbach's alpha) and convergent/discriminant validity (Pearson correlations) were evaluated. Responsiveness to change was …

Urinary Incontinence Self-Report Questions: Reproducibility And Agreement With Bladder Diary, Catherine Bradley, J. Brown, S. Van Den Eeden, M. Schembri, A. Ragins, D. Thom

Catherine S. Bradley

INTRODUCTION AND HYPOTHESIS: This study aims to measure self-report urinary incontinence questions' reproducibility and agreement with bladder diary. METHODS: Data were analyzed from the Reproductive Risk of Incontinence Study at Kaiser. Participating women reporting at least weekly incontinence completed self-report incontinence questions and a 7-day bladder diary. Self-report question reproducibility was assessed and agreement between self-reported and diary-recorded voiding and incontinence frequency was measured. Test characteristics and area under the curve were calculated for self-reported incontinence types using diary as the gold standard. RESULTS: Five hundred ninety-one women were included and 425 completed a diary. The self-report questions had moderate …

Vaginal Erosion After Pubovaginal Sling Procedures Using Dermal Allografts, Catherine Bradley, M. Morgan, L. Arya, E. Rovner

Catherine S. Bradley

No abstract provided.

Urodynamically Defined Stress Urinary Incontinence And Bladder Outlet Obstruction Coexist In Women, Catherine Bradley, E. Rovner

Catherine S. Bradley

PURPOSE: The definition and significance of female bladder outlet obstruction (BOO) are poorly understood. We identified patients with urodynamic evidence of BOO in a cohort of women with stress urinary incontinence (SUI). MATERIALS AND METHODS: Women with SUI were identified from a videourodynamic data base and pressure flow studies were reexamined. Subjects were excluded if detrusor pressures could not be measured. BOO was diagnosed if the maximum flow rate was less than 12 ml per second and detrusor pressure at maximum flow was greater than 20 cm water or maximum detrusor pressure was greater than 20 cm water in those …

Pharmacologic Treatment For Urgency-Predominant Urinary Incontinence In Women Diagnosed Using A Simplified Algorithm: A Randomized Trial, A. Huang, R. Hess, L. Arya, H. Richter, L. Subak, Catherine Bradley, R. Rogers, D. Myers, K. Johnson, W. Gregory, S. Kraus, M. Schembri, J. Brown

Catherine S. Bradley

OBJECTIVE: The purpose of this study was to evaluate clinical outcomes associated with the initiation of treatment for urgency-predominant incontinence in women diagnosed by a simple 3-item questionnaire. STUDY DESIGN: We conducted a multicenter, double-blinded, 12-week randomized trial of pharmacologic therapy for urgency-predominant incontinence in ambulatory women diagnosed by the simple 3-item questionnaire. Participants (N = 645) were assigned randomly to fesoterodine therapy (4-8 mg daily) or placebo. Urinary incontinence was assessed with the use of voiding diaries; postvoid residual volume was measured after treatment. RESULTS: After 12 weeks, women who had been assigned randomly to fesoterodine therapy reported 0.9 …