Pelvic Floor Therapy and Initial Interventions for Pelvic Floor Dysfunction in Gynecologic Malignancies.

PURPOSE OF REVIEW: This review provides evidence-based updates for the first-line management approaches for pelvic floor disorders in patients with gynecologic malignancies, as well as important provider considerations when referring for pelvic floor physical therapy. RECENT FINDINGS: Currently, there is strong evidence to recommend pelvic floor muscle training as initial treatment for urinary incontinence and for pelvic organ prolapse; some evidence to recommend a more targeted pelvic floor muscle training program for fecal incontinence; and mostly expertise-based evidence to recommend vaginal gels or estrogen to aid with dyspareunia causing sexual dysfunction. More research is greatly needed to understand the role of overactive pelvic floor muscles in survivors with chronic pelvic pain and the treatment of post-radiation pelvic complications such as vaginal stenosis and cystitis. While pelvic floor disorders are common concerns in gynecologic cancer survivors, there are evidence-based initial noninvasive treatment approaches that can provide relief for many individuals.

Physical medicine & rehabilitation residents' perspectives on women's musculoskeletal health.

INTRODUCTION: Women are either disproportionately or uniquely affected by certain musculoskeletal conditions but have limited access to providers of sex-specific musculoskeletal care. Few physical medicine & rehabilitation (PM&R) residencies offer women's musculoskeletal health training, and it is unknown whether PM&R residents feel prepared to care for women's musculoskeletal health concerns. OBJECTIVE: To examine PM&R residents' perspectives and experiences in women's musculoskeletal health. DESIGN: Cross-sectional survey developed through clinical expertise and consistent with sports medicine guidelines. SETTING: Electronic survey sent to all accredited PM&R residency programs within the United States, distributed through program coordinators and resident representatives. PARTICIPANTS: PM&R residents. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The primary outcome was residents' perspective of comfort with women's musculoskeletal health. Secondary outcomes were exposure to formal education on women's musculoskeletal health topics, exposure to various learning formats for these topics; and residents' perspectives on desire for further education, access to field-specific mentors, and interest in incorporating women's musculoskeletal health into future practice. RESULTS: Two hundred eighty-eight responses were included for analysis (20% response rate, 55% female sex residents). Only 19% of residents self-reported feeling comfortable providing care for women's musculoskeletal health conditions. Comfort did not significantly differ by postgraduate year, program region, or sex. However, with regression modeling, the number of topics learned formally in their curriculum had an increased odds of residents self-reporting comfort (odds ratio [OR] 1.18, confidence interval [CI] 1.08-1.30, adjusted p value .01). The majority of residents viewed learning women's musculoskeletal health as important (94%) and requested more exposure to the field (89%). CONCLUSIONS: Many PM&R residents do not feel comfortable in caring for women's musculoskeletal health conditions despite their interest in the field. To improve health care access for patients seeking care for these sex-predominant or sex-specific conditions, residency programs may want to consider increasing exposure to women's musculoskeletal health for residents.

Reflecting on an Academic Career: Associations Between Past Mentoring Investments and Career Benefits.

Receiving mentoring is positive associated with lasting career benefits for academic protégés; however, less is known about the connection to long-term career gains for mentors. In this study national sample of retired academics were surveyed to examine the associations between past mentoring behaviors and current evaluations of their careers. Participants (N=277) were on average 73.6 (SD=6.2) years old with 34.9 (SD=8.0) years of occupational tenure and 7.7 (SD=5.8) years post-retirement. Structural equation modeling results demonstrated that having more protégés (ß=.19, p=.024) and engaging in more mentoring behaviors (ß=.18, p=.027) were associated with objective career achievements. However, mentoring behaviors, and not the number of protégés, were linked to subjective career achievements (ß=.33, p<.001). Interestingly, previous mentoring experiences were not related to career satisfaction. While prior research demonstrates that mentors experience short-term benefits from mentoring, the present study's findings suggest that mentors may also experience long-term objective and subjective career benefits.

Office Evaluation of Pelvic Pain.

The history and physical examination are important keys to diagnosis and treatment of patients with chronic pelvic pain. The comprehensive history should include questioning regarding patient's pain complaint and a thorough history and review of any body system that may be involved, including neuromusculoskeletal, obstetric, gynecologic, gastrointestinal, urologic, dermatologic, infectious, oncologic, and psychiatric. The physical examination should also follow a focused systems-based approach and includes examination of gastrointestinal, dermatologic, neurologic, and musculoskeletal (including lumbosacral spine, sacroiliac joints, pelvis, and hips) systems, and the pelvic floor (internal and external examination, including neuromuscular anatomy).

Advances in the Treatment of Chronic Pelvic Pain: A Multidisciplinary Approach to Treatment.

The treatment of chronic pelvic pain can often be difficult, as many times after visits to multiple providers, patients can carry multiple diagnoses. Even with appropriate treatments, patients often have continued pain that can result in frustrations for both patients and their providers. Utilizing a multidisciplinary and multimodal approach to chronic pelvic pain is beneficial, especially when including evaluation for musculoskeletal dysfunction or other contributors to chronic pelvic pain.

An Argonaute 2 switch regulates circulating miR-210 to coordinate hypoxic adaptation across cells.

Complex organisms may coordinate molecular responses to hypoxia by specialized avenues of communication across multiple tissues, but these mechanisms are poorly understood. Plasma-based, extracellular microRNAs have been described, yet their regulation and biological functions in hypoxia remain enigmatic. We found a unique pattern of release of the hypoxia-inducible microRNA-210 (miR-210) from hypoxic and reoxygenated cells. This microRNA is also elevated in human plasma in physiologic and pathologic conditions of altered oxygen demand and delivery. Released miR-210 can be delivered to recipient cells, and the suppression of its direct target ISCU and mitochondrial metabolism is primarily evident in hypoxia. To regulate these hypoxia-specific actions, prolyl-hydroxylation of Argonaute 2 acts as a molecular switch that reciprocally modulates miR-210 release and intracellular activity in source cells as well as regulates intracellular activity in recipient cells after miR-210 delivery. Therefore, Argonaute 2-dependent control of released miR-210 represents a unique communication system that integrates the hypoxic response across anatomically distinct cells, preventing unnecessary activity of delivered miR-210 in normoxia while still preparing recipient tissues for incipient hypoxic stress and accelerating adaptation.

Outcomes of acute inpatient rehabilitation of patients with left ventricular assist devices.

OBJECTIVE: To investigate the benefits of comprehensive inpatient rehabilitation for patients after left ventricular assist device (LVAD) implantation. DESIGN: A retrospective cohort study. SETTING: An urban academic inpatient rehabilitation hospital. PATIENTS: This study included 58 patients admitted to inpatient rehabilitation after LVAD implantation between 2009 and 2012. METHODS: Chart review of demographic, clinical, and functional data for patients admitted to inpatient rehabilitation after LVAD implantation was performed. MAIN OUTCOME MEASUREMENTS: Length of stay, admission and discharge Functional Independence Measure (FIM), and FIM efficiency. RESULTS: The study included 47 male and 11 female patients ages 21.8-84.1 years (mean [standard deviation {SD}], 64.2 ± 11.2 years). The mean (SD) length of time between LVAD implantation and admission to rehabilitation was 27.0 ± 15.3 days. Twenty-one patients (36%) required transfer to an acute care hospital. Ten patients returned after transfer and completed inpatient rehabilitation. For the 47 total patients who completed inpatient rehabilitation, the mean (SD) length of stay was 20.3 ± 10.8 days (range, 7-50 days). Mean (SD) admission and discharge FIM scores were 68.4 ± 13.6 and 91.7 ± 11.8, respectively, with a mean (SD) difference between admission and discharge FIM scores of 23.4 ± 11.2. The mean (SD) FIM efficiency was 1.33 ± 0.65. Complications during rehabilitation included anemia that required transfusion, respiratory distress, epistaxis, gout flare, automated implantable cardioverter defibrillator firing, and gastrointestinal bleeding. CONCLUSIONS: Patients with LVADs demonstrate functional gains in inpatient rehabilitation. However, there is a high incidence of complications in this population, which often requires transfer to an acute care setting.