Guideline No. 447: Diagnosis and Management of Endometrial Polyps.

Objective: The primary objective of this clinical practice guideline is to provide gynaecologists with an algorithm and evidence to guide the diagnosis and management of endometrial polyps.

Target Population: All patients with symptomatic or asymptomatic endometrial polyps.

Options: Options for management of endometrial polyps include expectant, medical, and surgical management.

Use and misuse of opioid after gynecologic surgery.

Postoperative opioid use following gynecologic surgery may be necessary for effective treatment of pain; however, it can result in significant side effects, adverse reactions, and negative health consequences, including prolonged problematic use. Surgeons and healthcare providers of patients recovering from gynecologic procedures should be aware of effective strategies that can decrease the need for opioid use, while providing high-quality pain management. These include adherence to Enhanced Recovery After Surgery Protocols, particularly the use of multimodal analgesia management.

Guideline No. 404: Initial Investigation and Management of Benign Ovarian Masses.

Objective: To provide recommendations for a systematic approach to the initial investigation and management of a benign ovarian mass and facilitate patient referral to a gynaecologic oncologist for management.

Intended Users: Obstetricians, gynaecologists, family physicians, internists, nurse practitioners, radiologists, general surgeons, medical students, medical residents, fellows, and other health care providers.

Target Population: Women ≥18 years of age presenting for evaluation of an ovarian mass (including simple and unilocular cystic masses, endometriomas, dermoids, fibromas, and hemorrhagic cysts) who are not acutely symptomatic and without known genetic predisposition to ovarian cancer.

Guideline No. 390-Classification and Management of Endometrial Hyperplasia.

Objective: The aim of this guideline is to aid primary care physicians and gynaecologists in the initial evaluation of women with suspected endometrial hyperplasia, to recommend the use of the 2014 World Health Organization classification for endometrial hyperplasia by all health care providers, and to guide the optimal treatment of women diagnosed with endometrial hyperplasia.

Intended Users: Physicians, including gynaecologists, obstetricians, family physicians, general surgeons, emergency medicine specialists; nurses, including registered nurses and nurse practitioners; medical trainees, including medical students, residents, and fellows; and all other health care providers.

Target Population: Adult women (18 years and older) presenting with suspected or confirmed endometrial hyperplasia.

Guideline No. 386-Gynaecologic Surgery in the Obese Patient.

Objective: To provide gynaecologic surgeons with a contemporary review on the pre-, intra-, and postoperative issues of the obese patient and to provide guidance for optimization and strategies for safer surgical care.

Intended Users: Physicians, including gynaecologists, family physicians, general surgeons; nurses, including registered nurses and nurse practitioners; medical trainees, including medical students, residents, and fellows; and all other health care providers.

Target Population: Adult women (18 years and older) meeting criteria for obesity (body mass index ≥30) and undergoing gynaecologic surgery.

Laparoscopic Single-port Subtotal Hysterectomy: Technique and Advantages.

Single-port laparoscopy aims to extend the benefits of minimally invasive surgery by reducing surgical trauma and enhancing patient recovery. Current evidence suggests that single-port hysterectomy is feasible, safe, and equally effective as compared with conventional laparoscopic hysterectomy, although global uptake of this approach has been geographically limited. To our knowledge, this is the first report of a single-port subtotal hysterectomy described in Canada.

N 377- Indications gynécologiques bénignes de l'hystérectomie.

Objectif: Aider les médecins qui pratiquent la chirurgie gynécologique dans leur processus décisionnel relatif aux indications bénignes de l'hystérectomie.

Public Cible: Médecins, y compris gynécologues, obstétriciens, médecins de famille, chirurgiens généralistes, urgentologues; infirmières, y compris les infirmières autorisées et les infirmières praticiennes; apprentis en médecine, y compris étudiants de médecine, résidents, stagiaires (fellows); et autres fournisseurs de soins de santé.

Population Cible: Femmes adultes (18 ans et plus) qui devront subir une hystérectomie pour une indication gynécologie bénigne.

No. 377-Hysterectomy for Benign Gynaecologic Indications.

Objective: To assist physicians performing gynaecologic surgery in decision making surrounding hysterectomy for benign indications.

Intended Users: Physicians, including gynaecologists, obstetricians, family physicians, general surgeons, emergency medicine specialists; nurses, including registered nurses and nurse practitioners; medical trainees, including medical students, residents, and fellows; and all other health care providers.

Target Population: Adult women (18 years and older) who will undergo hysterectomy for benign gynaecologic indications.

Ovarian Torsion in a Pediatric Patient: The Importance of Repeat Imaging.

A previously healthy 10-year-old girl presented to the emergency department with a 1-day history of abdominal pain. She was afebrile with an elevated white blood cell count and a negative pelvic ultrasound. The pain resolved while in hospital, and the patient was discharged home.

Disruption of protein kinase A localization using a trans-activator of transcription (TAT)-conjugated A-kinase-anchoring peptide reduces cardiac function.

Localization of protein kinase A (PKA) via A-kinase-anchoring proteins (AKAPs) is important for cAMP responsiveness in many cellular systems, and evidence suggests that AKAPs play an important role in cardiac signaling. To test the importance of AKAP-mediated targeting of PKA on cardiac function, we designed a cell-permeable peptide, which we termed trans-activator of transcription (TAT)-AKAD for TAT-conjugated A-kinase-anchoring disruptor, using the PKA binding region of AKAP10 and tested the effects of this peptide in isolated cardiac myocytes and in Langendorff-perfused mouse hearts. We initially validated TAT-AKAD as a PKA localization inhibitor in cardiac myocytes by the use of confocal microscopy and cellular fractionation to show that treatment with the peptide disrupts type I and type II PKA regulatory subunits.

Blood pressure measurement for hypertension in pregnancy.

Objective: Ambulatory BP monitoring (ABPM) has been proposed as a logical approach to overcoming many of the problems associated with clinical BP measurement. The extent of its use in diagnosing hypertension in pregnancy is unknown. The objective of this study was to identify the practices surrounding use of ABPM by practitioners to diagnose hypertension (HTN) and white coat hypertension (WCH) in pregnant women.