Implementation of a Standardized Protocol for Postpartum Anemia: A Prospective Cohort Study.

Objective:  Implementation of standardized protocols for antepartum anemia increases intravenous iron (IVFe) use and improves predelivery hemoglobin (Hb). However, this condition is often overlooked and inadequately treated in postpartum care settings. We aimed to determine if implementation of a standardized protocol for postpartum anemia increases postpartum IVFe use and affects clinical outcomes.

Integrating Family Caregivers Into Cancer Care: Implementation of Evidence-Based Caregiver Protocols Into Gynecologic Oncology Practice.

Purpose: Family caregivers (CGs) of individuals with cancer are increasingly relied upon to provide long-term, sometimes intense care, although their integration into clinical cancer care remains minimal. The Caregiver Advocacy, Research, and Education (CARE) Center is a novel nurse-led academic-clinical partnership to support family CGs of individuals with gynecologic cancer. This study aims to describe the implementation of the Center protocols and report metrics of CG needs and Center support.

Remote blood pressure management for postpartum hypertension: a cost-effectiveness analysis.

Background: Recognizing the importance of close follow-up after hypertensive disorders of pregnancy, many centers have initiated programs to support postpartum remote blood pressure management.

Objective: This study aimed to evaluate the cost-effectiveness of remote blood pressure management to determine the scalability of these programmatic interventions.

Study Design: This was a cost-effectiveness analysis of using remote blood pressure management vs usual care to manage postpartum hypertension.

Decision-making and Treatment Preferences Surrounding Bacteriuria in Nonpregnant Women: A Qualitative Investigation.

Introduction And Hypothesis: Best practices suggest nontreatment for asymptomatic bacteriuria in a nonpregnant population, yet there is little literature on patient preference or understanding of asymptomatic bacteriuria treatment. We hypothesize that there might be core factors that affect antibiotic preferences and care-seeking decisions for urinary tract infection and asymptomatic bacteriuria in a postmenopausal population.

Methods: We performed semi-structured interviews with postmenopausal individuals who had been previously treated for at least one patient-reported urinary tract infection.

Large Solitary Lung Metastasis of a Matrix-Producing Metaplastic Breast Carcinoma: A Diagnostic Challenge.

Metaplastic breast carcinoma represents a diverse category of invasive breast cancers distinguished by the transformation of neoplastic epithelial cells into squamous cells or cells with mesenchymal appearance. Matrix-producing breast carcinoma is a variant of metaplastic breast carcinoma, an exceedingly uncommon malignancy accounting for less than 1% of all breast tumors. The precise origin of this tumor remains elusive; some molecular research points to a potential derivation from myoepithelial cells, while other studies emphasize the possibility of neoplastic transformation originating from multipotent stem cells.

Maternal outcomes following postpartum autotransfusion of blood lost during vaginal obstetric hemorrhage.

Background: Autotransfusion following vaginal delivery has not been as widely adopted and existing data on this topic are limited to small case series.

Methods: This is a single-center retrospective matched cohort study. Deliveries exposed to autotransfusion during obstetric hemorrhage were matched to unexposed controls with obstetric hemorrhage who did not receive autotransfusion.

Patient-Reported Outcomes of Omission of Breast Surgery Following Neoadjuvant Systemic Therapy: A Nonrandomized Clinical Trial.

Importance: Patients should have an active role in decisions about pursuing or forgoing specific therapies in treatment de-escalation trials.

Objective: To evaluate longitudinal patient-reported outcomes (PROs) encompassing decisional comfort and health-related quality of life (HRQOL) among patients who elected to enroll in a clinical trial evaluating radiotherapy alone, without breast surgery, for invasive breast cancers with exceptional response to neoadjuvant systemic therapy (NST).

Design, Setting, And Participants: Prospective, single-group, phase 2 clinical trial at 7 US medical centers.

The feasibility, acceptability, and preliminary efficacy of a self-advocacy serious game for women with advanced breast or gynecologic cancer.

Background: Cancer clinicians and systems aim to provide patient-centered care, but not all patients have the self-advocacy skills necessary to ensure their care reflects their needs and priorities. This study examines the feasibility, acceptability, and preliminary efficacy of a self-advocacy serious game (an educational video game) intervention in women with advanced breast or gynecologic cancer.

Methods: Women with recently diagnosed (<3 months) metastatic breast or advanced gynecologic cancer were randomized 2:1 to receive a tablet-based serious game (Strong Together) (n = 52) or enhanced care as usual (n = 26).

Weight gain patterns among pregnancies with obesity and small- and large-for-gestational-age births.

Objective: This case-cohort study estimated associations between gestational weight gain (GWG) and small-for-gestational-age (SGA) and large-for-gestational-age (LGA) births stratified by obesity class (I: 30-34.9 kg/m ; II: 35-39.9 kg/m ; III: ≥40 kg/m ) (Magee-Womens Hospital, Pittsburgh, Pennsylvania, 1998-2011).

Learning Curves of OBGYN Residents Preparing for the FLS Manual Skills Exam.

Objective: To describe obstetrics and gynecology (OBGYN) resident practice patterns and learning curves as they prepare for the Fundamentals for Laparoscopic Surgery (FLS) manual skills exam and to assess the importance of meeting proficiency, based on published standards, for passing the FLS manual skills exam.

Methods: This is a prospective observational study of OBGYN resident physicians from July 2018 to January 2022. Residents recorded details about their FLS practice sessions and proficiency metrics for each task repetition.

Cost-effectiveness of overactive bladder treatments from a US commercial and payer perspective.

The cost-effectiveness of treatment options (anticholinergics, β3-adrenoceptor agonists, onabotulinumtoxinA, sacral nerve stimulation and percutaneous tibial stimulation [the latter two including new rechargeable neurostimulators]) for the management of overactive bladder (OAB) were compared with best supportive care (BSC) using a previously published Markov model. Cost-effectiveness was evaluated over a 15-year time horizon, and sensitivity analyses were performed using 2- and 5-year horizons. Discontinuation rates, resource utilization, and costs were derived from published sources.

"I was never one of those people who just jumped right in for me": patient perspectives on self-advocacy training for women with advanced cancer.

Purpose: Patients with advanced cancer experience many complicated situations that can make self-advocacy (defined as the ability speak up for yourself in the face of a challenge) difficult. Few self-advocacy interventions exist, and most are atheoretical with minimal patient engagement. The purpose of this study is to describe participant perspectives of a novel, self-advocacy serious game intervention called Strong Together.

Polypharmacy and Multimorbidity in the Urogynecology Population and Their Effect on Pelvic Floor Symptoms.

Importance: Polypharmacy and multimorbidity are common in older adults but has not been well studied in the urogynecologic patient population.

Objectives: The objective of this study was to determine the prevalence of polypharmacy and multimorbidity in a diverse outpatient urogynecologic population and to examine whether polypharmacy and/or multimorbidity were associated with lower urinary tract symptoms, pelvic organ prolapse, defecatory distress, and/or female sexual dysfunction.

Study Design: This is a secondary analysis of a dual-center cross-sectional study of new patients presenting for evaluation of pelvic floor disorders at 2 urban academic outpatient urogynecology clinics.

Postpartum Depression-Identifying Risk and Access to Intervention.

Purpose Of Review: As maternal mortality climbs in the USA with mental health conditions driving these preventable deaths, the field of reproductive psychiatry must shift towards identification of women and other birthing individuals at risk and facilitating access. This review brings together recent studies regarding risk of perinatal depression and highlights important comorbidities that place individuals at higher vulnerability to poor perinatal outcomes.

Recent Findings: Recent research suggests that identifying risk for perinatal depression including historical diagnoses of depression, anxiety, trauma, and comorbid substance use and intimate partner violence may move the field to focus on preventive care in peripartum populations.

Testing the effects of the Strong Together self-advocacy serious game among women with advanced cancer: Protocol for the STRONG randomized clinical trial.

Background: Women with advanced cancer experience significant barriers to achieving high-quality care and maximizing their physical and emotional health. Our novel serious game, Strong Together, aims to teach women with advanced cancer self-advocacy skills needed to improve their symptom burden, quality of life, and patient-centered care.

Methods: This is a single-center, multi-site randomized clinical trial of the Strong Together intervention among 336 women within three months of an advanced breast or gynecologic cancer diagnosis.

Eliminating breast surgery for invasive breast cancer in exceptional responders to neoadjuvant systemic therapy: a multicentre, single-arm, phase 2 trial.

Background: Neoadjuvant systemic therapy (NST) for triple-negative breast cancer and HER2-positive breast cancer yields a pathological complete response in approximately 60% of patients. A pathological complete response to NST predicts an excellent prognosis and can be accurately determined by percutaneous image-guided vacuum-assisted core biopsy (VACB). We evaluated radiotherapy alone, without breast surgery, in patients with early-stage triple-negative breast cancer or HER2-positive breast cancer treated with NST who had an image-guided VACB-determined pathological complete response.

Association of Availability of State Medicaid Coverage for Abortion With Abortion Access in the United States.

Objective: To evaluate the association between state Medicaid coverage for abortion and abortion access measures among U.S. patients.

Traditional uterine tamponade and vacuum-induced uterine tamponade devices in obstetrical hemorrhage management.

Obstetrical hemorrhage is the leading cause of maternal morbidity and mortality worldwide, and the rates of severe hemorrhage are increasing. There is a crucial need to expand treatment options for hemorrhage to address this global crisis. Over the last decade, the evolution of hemorrhage control devices has contributed to advancements in obstetrical hemorrhage management.

Postpartum urinary retention: an expert review.

Postpartum urinary retention is a relatively common condition that can have a marked impact on women in the immediate days following childbirth. If left untreated, postpartum urinary retention can lead to repetitive overdistention injury that may damage the detrusor muscle and the parasympathetic nerve fibers within the bladder wall. In rare circumstances, postpartum urinary retention may even lead to bladder rupture, which is a potentially life-threatening yet entirely preventable complication.

Self-advocacy Behaviors and Needs in Women with Advanced Cancer: Assessment and Differences by Patient Characteristics.

Background: Self-advocacy skills allow individuals with cancer to overcome challenges related to their health, care, and well-being. Understanding the self-advocacy behaviors and needs of individuals with cancer is critical to addressing the lack of evidence-based self-advocacy interventions. The aims of this study are to describe (1) self-advocacy behaviors and needs of women with advanced cancer and (2) associations between self-advocacy and sociodemographic, cancer, and patient-reported outcomes.

Evaluation and Analysis of Fellow Learning and Education Curriculum in a Regional Anesthesiology and Acute Pain Medicine Fellowship: A Prospective, Observational Pilot Study.

Background: Since 2017, several regional anesthesiology and acute pain medicine fellowship programs throughout the country have developed various educational didactic curriculums to address the core medical knowledge requirements as set by the Accreditation Council for Graduate Medical Education. Given the paucity of existing literature regarding the medical knowledge acquisition of regional anesthesiology and acute pain medicine fellows, this study aimed to determine how quickly these fellows learn during their fellowship year, with a secondary aim of analyzing a new educational didactic curriculum in its goal of delivering the required medical knowledge.

Methods: An 89-question, multiple-choice examination was administered to the 2020-2021 regional anesthesiology and acute pain medicine fellows at the University of Pittsburgh Medical Center during orientation and again at 4 months and 8 months into the fellowship.

Knowledge Retention and Clinical Skills Acquisition in Sexual and Gender Minority Health Curricula: A Systematic Review.

Purpose: To identify exemplary medical education curricula, operationalized as curricula evaluating knowledge retention and/or clinical skills acquisition, for health care for sexual and gender minoritized (SGM) individuals and individuals born with a difference in sex development (DSD).

Method: The authors conducted a systematic review of the literature using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Searches were performed in PubMed/MEDLINE, The Cochrane Library, Web of Science, ERIC, Embase, PsycINFO, and the gray literature to identify studies that (1) pertained to undergraduate and/or graduate medical education, (2) addressed education on health care of SGM/DSD individuals, and (3) assessed knowledge retention and/or clinical skills acquisition in medical trainees.

Accuracy of estimated fetal weight in extremely preterm infants and the impact of prepregnancy body mass index.

Background: Antenatally, we rely on ultrasound estimated fetal weight as a proxy for birthweight to inform discussions regarding perinatal morbidity and mortality. Maternal obesity may negatively impact the quality of ultrasound imaging, and thus, understanding the associations between obesity and estimated fetal weight in the preterm period is important.

Objective: Given the rising obesity rates and association with preterm birth, we sought to determine the accuracy of ultrasound-derived estimated fetal weight in predicting birthweight in preterm infants by prepregnancy body mass index and to evaluate the accuracy of estimated fetal weight in predicting birthweight between small-for-gestational-age and appropriate-for-gestational-age infants.