Medical Specialties Commons^™

Family Presence During Trauma Resuscitation: Ready For Primetime?, Mae Pasquale, Michael Pasquale, Leslie Baga, Sherrine Eid, Jane Leske

Michael D Pasquale MD, FACS, FCCM

BACKGROUND: The concept of family presence during trauma resuscitation (FPTR) remains controversial. Healthcare providers have expressed concern that resuscitation of severely injured trauma patients is inappropriate for family members as they may have psychologic distress, disrupt resuscitative efforts, or misinterpret provider actions, which can ultimately impact satisfaction with care. The minimal evidence that exists is descriptive or anecdotal.

METHODS: Using a previously developed FPTR protocol, a prospective, comparative study assessing 50 adult family members, who were present (n = 25) or not present (n = 25) with their severely injured adult family member during resuscitation, was conducted. Family member anxiety …

In Vitro Fertilization Patients Support A Single Blastocyst Transfer Policy, S. Martini, Bradley Van Voorhis, B. Stegmann, Amy Sparks, T. Shochet, M. Zimmerman, Ginny Ryan

Amy E.T. Sparks

OBJECTIVE: To determine whether patients support a mandatory single blastocyst transfer (mSBT) policy in IVF. DESIGN: Prospective survey study. SETTING: Academic hospital-based infertility center. PATIENT(S): Two hundred sixty-two female patients presenting for fresh or cryopreserved/thawed ET after IVF. INTERVENTION(S): Internet-based in-clinic survey after ET. Follow-up at-home survey after pregnancy test results. MAIN OUTCOME MEASURE(S): Patient support for an mSBT policy and attitudes regarding patient input into IVF treatment. Logistic regression analyses tested associations among main outcome measures, patient characteristics, and treatment results. RESULT(S): Ninety-four percent of patients endorsed support for our mSBT policy; 95% and 87% felt they had the …

In Vitro Fertilization Patients Support A Single Blastocyst Transfer Policy, S. Martini, Bradley Van Voorhis, B. Stegmann, Amy Sparks, T. Shochet, M. Zimmerman, Ginny Ryan

Bradley J Van Voorhis

OBJECTIVE: To determine whether patients support a mandatory single blastocyst transfer (mSBT) policy in IVF. DESIGN: Prospective survey study. SETTING: Academic hospital-based infertility center. PATIENT(S): Two hundred sixty-two female patients presenting for fresh or cryopreserved/thawed ET after IVF. INTERVENTION(S): Internet-based in-clinic survey after ET. Follow-up at-home survey after pregnancy test results. MAIN OUTCOME MEASURE(S): Patient support for an mSBT policy and attitudes regarding patient input into IVF treatment. Logistic regression analyses tested associations among main outcome measures, patient characteristics, and treatment results. RESULT(S): Ninety-four percent of patients endorsed support for our mSBT policy; 95% and 87% felt they had the …

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, …

Ultrasound-Assisted Repair Of A Unique Case Of Distal Vaginal Agenesis, J. Kresowik, Ginny Ryan, J. Austin, Bradley Van Voorhis

Bradley J Van Voorhis

OBJECTIVE: To describe a unique vaginal outlet obstruction and its ultrasound-assisted surgical correction. DESIGN: Case report. SETTING: An academic medical center. PATIENT(S): A 12-year-old girl was seen with cyclic abdominal pain, nausea, and an abdominal mass. External genital examination revealed no vaginal opening or dimple. Transabdominal ultrasound revealed a large hematometrocolpos 5 cm proximal to the perineum, with an otherwise normal-appearing uterus and ovaries. INTERVENTION(S): Surgical treatment included perineal incision, creation of a 5-cm passage through connective tissue, drainage of the hematometrocolpos, and mobilization of the proximal vagina, allowing for pull-through vaginoplasty. Ultrasound guidance was used throughout the surgery and …

Prevalence Of Vulvar And Vaginal Symptoms During Pregnancy And The Puerperium, Colleen Kennedy, A. Turcea, Catherine Bradley

Colleen Kennedy Stockdale

OBJECTIVE: To identify the prevalence of vulvar and vaginal symptoms during pregnancy and at 3 months post partum. METHODS: A prospective, longitudinal, descriptive study of 103 pregnant women was undertaken in which a self-administered questionnaire was completed at each trimester and 3 months post partum. Retrospective data was collected from 122 women, queried using similar tools, who comprised a nonpregnant control group. Descriptive and comparative statistics were employed. RESULTS: The prevalence of vulvar burning, itching, pain, and vaginal discharge generally increased during pregnancy, and improved postpartum. Dyspareunia increased during pregnancy, but remained elevated post partum. Compared with the historical nonpregnant …

Ultrasound-Assisted Repair Of A Unique Case Of Distal Vaginal Agenesis, J. Kresowik, Ginny Ryan, J. Austin, Bradley Van Voorhis

Ginny L. Ryan

OBJECTIVE: To describe a unique vaginal outlet obstruction and its ultrasound-assisted surgical correction. DESIGN: Case report. SETTING: An academic medical center. PATIENT(S): A 12-year-old girl was seen with cyclic abdominal pain, nausea, and an abdominal mass. External genital examination revealed no vaginal opening or dimple. Transabdominal ultrasound revealed a large hematometrocolpos 5 cm proximal to the perineum, with an otherwise normal-appearing uterus and ovaries. INTERVENTION(S): Surgical treatment included perineal incision, creation of a 5-cm passage through connective tissue, drainage of the hematometrocolpos, and mobilization of the proximal vagina, allowing for pull-through vaginoplasty. Ultrasound guidance was used throughout the surgery and …

In Vitro Fertilization Patients Support A Single Blastocyst Transfer Policy, S. Martini, Bradley Van Voorhis, B. Stegmann, Amy Sparks, T. Shochet, M. Zimmerman, Ginny Ryan

Ginny L. Ryan

OBJECTIVE: To determine whether patients support a mandatory single blastocyst transfer (mSBT) policy in IVF. DESIGN: Prospective survey study. SETTING: Academic hospital-based infertility center. PATIENT(S): Two hundred sixty-two female patients presenting for fresh or cryopreserved/thawed ET after IVF. INTERVENTION(S): Internet-based in-clinic survey after ET. Follow-up at-home survey after pregnancy test results. MAIN OUTCOME MEASURE(S): Patient support for an mSBT policy and attitudes regarding patient input into IVF treatment. Logistic regression analyses tested associations among main outcome measures, patient characteristics, and treatment results. RESULT(S): Ninety-four percent of patients endorsed support for our mSBT policy; 95% and 87% felt they had the …

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 …

Obesity And Outcomes After Sacrocolpopexy, Catherine Bradley, K. Kenton, H. Richter, X. Gao, H. Zyczynski, A. Weber, I. Nygaard

Catherine S. Bradley

OBJECTIVE: The purpose of this study was to compare outcomes after sacrocolpopexy (SC) between obese and healthy-weight women. STUDY DESIGN: Baseline and postoperative data were analyzed from the Colpopexy And Urinary Reduction Efforts (CARE) randomized trial of SC with or without Burch colposuspension in stress continent women with stages II-IV prolapse. Outcomes and complications were compared between obese and healthy-weight women. RESULTS: CARE participants included 74 obese (body mass index >/=30 kg/m(2)), 122 overweight (25-29.9 kg/m(2)), and 125 healthy-weight (18.5-24.9 kg/m(2)) women, and 1 underweight (< 18.5 kg/m(2)) woman. Compared to healthy-weight women, obese women were younger (59.0 +/- 9.9 vs 62.1 +/- 10.3 yrs; P = .04), more likely to have stage II prolapse (25.7% vs 11.2%; P = .01), and had longer operative times (189 +/- 52 vs 169 +/- 58 min; P = .02). Two years after surgery, stress incontinence, prolapse, symptom resolution, and satisfaction did not differ between the obese and healthy-weight groups. CONCLUSION: Most outcomes and complication rates after SC are similar in obese and healthy-weight women.

Prevalence Of Vulvar And Vaginal Symptoms During Pregnancy And The Puerperium, Colleen Kennedy, A. Turcea, Catherine Bradley

Catherine S. Bradley

OBJECTIVE: To identify the prevalence of vulvar and vaginal symptoms during pregnancy and at 3 months post partum. METHODS: A prospective, longitudinal, descriptive study of 103 pregnant women was undertaken in which a self-administered questionnaire was completed at each trimester and 3 months post partum. Retrospective data was collected from 122 women, queried using similar tools, who comprised a nonpregnant control group. Descriptive and comparative statistics were employed. RESULTS: The prevalence of vulvar burning, itching, pain, and vaginal discharge generally increased during pregnancy, and improved postpartum. Dyspareunia increased during pregnancy, but remained elevated post partum. Compared with the historical nonpregnant …

Incontinence Surgery In The Older Woman, V. Sharp, Catherine Bradley, K. Kreder

Catherine S. Bradley

PURPOSE OF REVIEW: To review recently published studies on stress urinary incontinence surgery outcomes in older women. RECENT FINDINGS: Five prospective and two retrospective studies were identified that reported tension-free vaginal tape (n = 6), colposuspension (n = 1) and cadaveric fascia transvaginal sling (n = 1) procedure results. In each study, 21-175 older women were included, with mean ages ranging from 71 to 83 years; most studies included younger comparison groups. Mean follow-ups ranged from 3 to 30 months. Subjective stress urinary incontinence 'cure/improvement' rates after surgery were significantly lower in older women when compared with younger women in …

Continence Pessary Compared With Behavioral Therapy Or Combined Therapy For Stress Incontinence: A Randomized Controlled Trial, H. Richter, K. Burgio, L. Brubaker, I. Nygaard, W. Ye, A. Weidner, Catherine Bradley, V. Handa, D. Borello-France, P. Goode, H. Zyczynski, E. Lukacz, J. Schaffer, M. Barber, S. Meikle, C. Spino

Catherine S. Bradley

OBJECTIVE: To compare the effectiveness of a continence pessary to evidence-based behavioral therapy for stress incontinence and to assess whether combined pessary and behavioral therapy is superior to single-modality therapy. METHODS: This was a multisite, randomized clinical trial (Ambulatory Treatments for Leakage Associated with Stress Incontinence [ATLAS]) that randomly assigned 446 women with stress incontinence to pessary, behavioral therapy, or combined treatment. Primary outcome measures, at 3 months, were Patient Global Impression of Improvement and the stress incontinence subscale of the Pelvic Floor Distress Inventory. A priori, to be considered clinically superior, combination therapy had to be better than both …

Effect Of Tamoxifen On Endometrial Histology, Hormone Receptors, And Cervical Cytology: A Prospective Study With Follow-Up, Kimberly Leslie, S. Walter, K. Torkko, J. Stephens, C. Thompson, M. Singh

Kimberly K. Leslie

OBJECTIVES: Our major hypothesis for these studies was that tamoxifen's varied effects on the endometrium might be due in part to differences in effect on estrogen and progesterone receptors [ER, progesterone receptor isoform A (PRA), and progesterone receptor isoform B (PRB)]. We aimed to evaluate the changes in histology in serial endometrial biopsies (Em bx), Papanicolaou smears (Pap smears), and endometrial ultrasounds as well as changes in the expression of ER, PRA, and PRB in response to tamoxifen. We propose that understanding and correlating the dynamics of receptor expression with histologic and cytologic changes will help us better understand the …