Access to Urogynecologic Care in Federally Qualified Health Centers: A Mystery Caller Study.

IMPORTANCE: Federally Qualified Health Centers (FQHCs) play an important role in providing care to underserved populations. However, little is known about the availability of urogynecology services at FQHCs. OBJECTIVES: This study aimed to assess the availability of appointments for urogynecology care and to determine the prevalence of FQHCs offering urogynecologic services. STUDY DESIGN: A total of 362 FQHCs across the United States were randomly selected from the Health Resources and Services Administration website, based on specific inclusion criteria. Researchers called the FQHCs and requested the earliest available appointment for pelvic organ prolapse. The availability of urogynecologic services such as pessary fittings, pelvic floor physical therapy, and urodynamic studies was also inquired. RESULTS: A total of 362 FQHCs located in 46 states and the District of Columbia were called. On average, the 362 FQHCs had been established for 19.9 (SD ±15) years, were located in urban areas, and served a median county population of 24,573. Of the 220 FQHCs successfully contacted, 81% (180/220) reported that they could provide care for a patient with pelvic organ prolapse at an appointment 29.1 business days (SD ±30 days) from the date of the call, on average. However, only a small percentage of these FQHCs offered in-office pessary fittings (11%), complex multichannel urodynamics testing (8.6%), or pelvic floor physical therapy (5%). CONCLUSION: The availability of treatments for pelvic floor disorders at FQHCs is limited. These findings highlight a potential disparity in access to urogynecology services for individuals with public insurance.

Pregnancy and Outcomes After Prolapse Surgery: A Case Series.

IMPORTANCE: There are limited data on whether pelvic organ prolapse (POP) surgery is durable after subsequent delivery. OBJECTIVES: The aims of this study were to evaluate the safety and durability of POP surgery after delivery and to describe the medical decision-making and clinical outcomes of patients who gave birth after POP surgery. STUDY DESIGN: This study is a retrospective case series of patients who underwent surgery for symptomatic POP between 2007 and 2017, and subsequently had a live birth. RESULTS: Twenty patients were identified. Seventeen patients underwent posterior colporrhaphy, 10 anterior colporrhaphy, and 5 apical suspensions. The mean interval between POP surgery and the first delivery was 28.6 months. One patient endorsed recurrent POP symptoms before pregnancy, and none of the remaining 19 patients reported recurrent POP symptoms before or during pregnancy. There were no pregnancy complications related to the POP surgery. Nine patients underwent cesarean delivery (CD). Four patients were counseled to have a CD due to their prior POP surgery, 3 patients had an elective primary CD due to the POP surgery, 1 patient chose an elective repeat CD, and 1 patient had a CD due to obstructed labor. Urogynecologists were consulted for delivery recommendations for 6 patients and recommended CD for 3 of them. Eleven patients had spontaneous vaginal delivery. Three patients reported recurrent POP symptoms after delivery. CONCLUSIONS: Our findings corroborate previous case series demonstrating the safety and durability of POP surgery during and after pregnancy. More than 75% of patients gave birth by CD, which was due to physician or patient concerns regarding the prior POP surgery.

Medicare Patient Referral Networks to Pelvic Floor Physical Therapy Across the United States.

OBJECTIVE: The purpose of this study is to evaluate the distribution of referrals to pelvic floor physical therapy throughout the United States and to identify specialties with the highest and lowest referral rates. Referral networks to pelvic floor physical therapy were identified, and factors associated with referral connections were determined. METHODS: This retrospective network analysis of referrals examined U.S. Centers for Medicare and Medicaid Services data from 2009 to 2017. Pelvic floor physical therapists were identified, and their patient-sharing networks were modeled using social network analytics. RESULTS: There were 18,740 Medicare beneficiaries referred to pelvic floor physical therapists between 2009 and 2017. The mean number of referrals to each physical therapy provider or practice was 82 (SD ±46.3). Half of the referrals were made by a general acute care hospital. The remainder were referred by female pelvic medicine and reconstructive surgeons, nurse practitioners, colorectal surgeons, internal medicine, and obstetrician-gynecologists.The number of individual pelvic floor physical therapists, as well as the referrals, increased each year. The geographic representation of the patient referral networks is illustrated. The map reveals that pelvic floor physical therapists often work in groups and treat patients in their geographic vicinity. In this study, we demonstrate intensely fractured referral networks. CONCLUSION: Our network analysis of pelvic floor physical therapy referrals in Medicare patients across the United States shows fractured networks with dense geographic connections in some areas, whereas sparse in others. Multidisciplinary approaches and early referrals to pelvic floor physical therapy are recommended as some ways to amend these fractured networks.

Translation and linguistic validation of the Female Genitourinary Pain Index in Spanish.

INTRODUCTION AND HYPOTHESIS: We sought to develop a Spanish translation of the Female Genitourinary Pain Index (GUPI) and to validate this instrument in US Latina women. METHODS: Translation back-translation was performed to create the initial Spanish version. Bilingual women with pelvic and/or genitourinary pain were recruited from clinical sites and social media. Participants reported demographics and completed the Female GUPI in both English and Spanish. Agreement was assessed for each item, subscale and total score. Additionally, we performed cognitive debriefing interviews to further test face validity. A consensus group of bilingual physicians and healthcare personnel utilized comments from the interviews to create a final Spanish version. RESULTS: Thirty-four participants completed the questionnaire. Their average age was 33 years, 80% reported attending some college, and 20% reported an undergraduate degree or higher. Most were born in mainland USA (57%) or Mexico (27%). Agreement for the pain, urinary and quality of life subscales between the English and Spanish versions of the measure were excellent (0.91, 0.89 and 0.92, respectively) with 0.96 agreement for the measure as a whole. Despite favorable psychometrics, preferences for alternate wording were reported over 50 times. Based on that feedback, a consensus group was formed, which recommended changes to 13 of the 15 items, 3 of which required complete rewriting. CONCLUSIONS: The Spanish Female GUPI is strongly correlated with the English original; however, participants reported the language was overly complex. Translation and validation should include review of the measure and feedback by the target audience for optimal clarity and readability.

Disseminated Mycobacterium kansasii in an HIV-negative patient.

Disseminated Mycobacterium kansasii infection is a rare infection in non-HIV patients. This research has uncovered a very rare manifestation of disseminated M. kansasii infection in a non-HIV patient with lung and pericardial involvement.

Utility of Gastric Lavage for Diagnosis of Tuberculosis in Patients who are Unable to Expectorate Sputum.

BACKGROUND: There are number of patients who are unable to expectorate sputum specimens. In this study, we used gastric lavage (GL) test for diagnosis of tuberculosis (TB) in patients who were unable to produce sputum. MATERIALS AND METHODS: Patients who were unable to produce sputum specimens were included in the study to confirm TB disease. Gastric lavage sampling was performed and sent for acid fast bacillus smear and culture under special laboratory conditions and sterilized methods. Further bronchoscopy for broncho-alveolar lavage was done on patients with negative GL smear results. Drug susceptibility tests were performed on 48 GL culture positive cases. RESULTS: Eighty-five patients were included in the study; who were hospitalized at our referral center for suspected TB. GL smears were reported to be positive in 37 cases (66.07%) and culture in 85.7%. The total number of smear and culture-positive cases in this study was 48 (85.7%). Forty cases (87%) of drug-sensitive, 1 case (2.2%) of isoniazid and rifampin-resistant TB (multi-drug resistant; MDR), and 5 cases of resistant to one drug were detected. There have not been observed any complications after the GL method. CONCLUSION: It seems that regarding the high number of positive GL cultures (85.7%), GL can be effective for diagnosis of patients who have suspicious tuberculosis symptoms and are unable to produce sputum especially in resource limited areas.