Pharmacy Benefit Managers in the Eye of the Storm: Growing Multipartite Scrutiny.

The high cost of prescription drugs in the U.S. remains an ongoing national challenge.

Factors affecting live birth rates in donor oocytes from commercial egg banks vs. program egg donors: an analysis of 40,485 cycles from the Society for Assisted Reproductive Technology registry in 2016-2018.

Objective: To examine the differences in live birth rates (LBRs), with single embryo transfer (SET), using oocytes from program generated egg donors vs. commercial egg bank donors and other factors affecting LBRs using donor oocytes.

Design: Retrospective cohort study.

Governance of Academic Health Centers and Systems: A Conceptual Framework for Analysis.

Health care has evolved from a cottage industry to a very complex one constituting nearly one-fifth of the U.S. economy.

Governance of Academic Medical Centers Is Indeed a Complex and Unique Operation.

As academic medical centers (AMCs) have extended their operations into their communities, partnered with new organizations, and developed new modes of operation to achieve their missions, new governance approaches are required. Chari and colleagues, in this issue of Academic Medicine, describe the development and application of criteria to evaluate governance options for the University of California (UC), which has a number of public AMCs, almost all of which are components of individual UC universities. Although many of these criteria may also be applicable to smaller AMCs, a more individual approach to governance is required-that is, one must step back and first ask about the organization, structure, and goals of the entities to be governed.

Predictors of pregnancy and live birth after insemination in couples with unexplained or male-factor infertility.

Objective: To identify risk factors for pregnancy outcomes in couples treated with intracervical or intrauterine insemination, with or without superovulation for unexplained or male-factor infertility.

Design: Secondary analysis of data from a randomized superovulation and intrauterine insemination trial.

Setting: Academic medical centers.

Randomized trial of leuprolide versus continuous oral contraceptives in the treatment of endometriosis-associated pelvic pain.

Objective: To compare the efficacy of leuprolide and continuous oral contraceptives in the treatment of endometriosis-associated pain.

Design: Prospective, randomized, double-blind controlled trial.

Setting: Academic medical centers in Rochester, New York, and Boston, Massachusetts.

Development of an audit method to assess the prevalence of the ACGME's general competencies in an undergraduate medical education curriculum.

Background: Despite the use of competency-based frameworks to evaluate physicians, the role of competency-based objectives in undergraduate medical education remains uncertain.

Purpose: By use of an audit methodology, we sought to determine how the six Accreditation Council for Graduate Medical Education (ACGME) competencies, conceptualized as educational domains, would map onto an undergraduate medical curriculum.

Methods: Standardized audit forms listing required activities were provided to course directors, who were then asked to indicate which of the domains were represented in each activity.

Improvement in quality-of-life questionnaire measures in obese adolescent females with polycystic ovary syndrome treated with lifestyle changes and oral contraceptives, with or without metformin.

We studied the effect of metformin or placebo in a lifestyle modification program combined with oral contraceptives (OC) on quality-of-life parameters measured by the polycystic ovary syndrome (PCOS) questionnaire in obese adolescent women with validated PCOS. The quality-of-life indicators were measured at baseline and conclusion for five domains on the PCOS questionnaire, with equal improvement in scores in both placebo and metformin groups, suggesting that the addition of metformin does not add improvement to quality-of-life measures above those observed with lifestyle modification and OC treatment.

Is a history of gestational diabetes related to risk factors for coronary heart disease?

Coronary heart disease (CHD) risk in 20 non-diabetic women with and 20 without a distant history of gestational diabetes (hGDM), matched on age, body mass index, and time since GDM-affected pregnancy, was compared in a case control study. Women with an hGDM had lower high-density lipoprotein cholesterol (HDL-c), p = .02, and higher triglycerides, p < or = .

Semen quality in fertile men in relation to psychosocial stress.

Objective: To examine the association between stressful life events and semen parameters.

Design: Cross-sectional analysis in a pregnancy cohort study.

Setting: Prenatal clinics in five U.

The economics of new faculty hires in basic science.

Purpose: To compare the streams of expenses and revenues associated with investment in a cohort of basic science investigators at the University of Rochester School of Medicine & Dentistry for seven years.

Method: The authors evaluated a medical school's financial investment in 25 basic science faculty who were hired between 1999 and 2004 to expand basic science research. The authors compared direct and indirect costs with the extramural grant support generated by these investigators through 2006.

Prevalence of metabolic syndrome and related characteristics in obese adolescents with and without polycystic ovary syndrome.

Context: Adults with polycystic ovary syndrome (PCOS) may be at increased risk for metabolic syndrome (MBS) and related cardiovascular disease. It is not clear whether PCOS diagnosed in adolescence increases the risk of MBS in this age group.

Objective: The aim was to compare the prevalence and related characteristics of MBS in obese adolescents with and without PCOS.

The impact of metformin, oral contraceptives, and lifestyle modification on polycystic ovary syndrome in obese adolescent women in two randomized, placebo-controlled clinical trials.

Context: Polycystic ovary syndrome (PCOS) presents in adolescence, and obesity is a common finding. The benefits and risks of alternate approaches to the management of PCOS in obese adolescent women are not clear.

Objective: We investigated the effects of metformin, oral contraceptives (OCs), and/or lifestyle modification in obese adolescent women with PCOS.

Ovulation induction management of PCOS.

Ovulation induction is the principal infertility treatment for women with polycystic ovarian syndrome (PCOS). Among PCOS patients who are overweight or obese, weight loss is the most physiologic method of inducing ovulation. For women in whom weight loss is not possible, or for lean women with PCOS, clomiphene citrate is an effective first-line method of ovulation induction.

Pelvic organ prolapse in nulliparous women and their parous sisters.

Objective: To investigate the role of vaginal delivery and familial factors in the development of pelvic organ prolapse by comparing the prevalence of this condition in nulliparous women and their parous sisters.

Methods: Pairs of nulliparous and parous postmenopausal sisters were recruited for assessment of pelvic organ prolapse. One hundred one sister pairs underwent clinical evaluation.

Effect of mifepristone for symptomatic leiomyomata on quality of life and uterine size: a randomized controlled trial.

Objective: To assess the effect of low-dose mifepristone on quality of life, pain, bleeding, and uterine size among women with symptomatic leiomyomata.

Methods: Forty-two women with symptomatic uterine leiomyomata and uterine volume of 160 mL or more were randomized to mifepristone, 5 mg daily, or placebo for 26 weeks. Quality of life (Uterine Fibroid Symptoms Quality of Life Questionnaire and Medical Outcomes Study 36-Item Short Form survey) and uterine and leiomyoma size (ultrasonography) were assessed at baseline, and at 1 month, 3 months, and 6 months of treatment.