Availability of the HPV Vaccine in Regional Pharmacies and Provider Perceptions Regarding HPV Vaccination in the Pharmacy Setting.

There is increasing support for HPV vaccination in the pharmacy setting, but the availability of the HPV vaccine is not well known. Additionally, little is known about perceptions of medical providers regarding referring patients to community pharmacies for HPV vaccination. The purpose of this study was to determine HPV vaccine availability in community pharmacies and to understand, among family medicine and obstetrics-gynecology providers, the willingness of and perceived barriers to referring patients for HPV vaccination in a pharmacy setting. HPV vaccine availability data were collected from pharmacies in a southern region of the United States. Family medicine and obstetrics-gynecology providers were surveyed regarding vaccine referral practices and perceived barriers to HPV vaccination in a community pharmacy. Results indicated the HPV vaccine was available in most pharmacies. Providers were willing to refer patients to a community pharmacy for HPV vaccination, despite this not being a common practice, likely due to numerous barriers reported. Pharmacist-administered HPV vaccination continues to be a commonly reported strategy for increasing HPV vaccination coverage. However, coordinated efforts to increase collaboration among vaccinators in different settings and to overcome systematic and legislative barriers to increasing HPV vaccination rates are still needed.

Pharmacists' Perceived Barriers to Human Papillomavirus (HPV) Vaccination: A Systematic Literature Review.

About 45:000 cancers are linked to HPV each year in the United States alone. The HPV vaccine prevents cancer and is highly effective, yet vaccination coverage remains low. Pharmacies can play a meaningful role in increasing HPV vaccination access due to their availability and convenience. However, little is known about pharmacists' perceived barriers to HPV vaccination. The objective of this systematic review was to summarize existing literature on perceived barriers to administering HPV vaccination reported by pharmacists. Barriers identified from selected studies were synthesized and further grouped into patient, parental, (pharmacist's) personal, and system/organization barrier groups. Six studies were included in this review. The cost of the HPV vaccine, insurance coverage and reimbursement were commonly reported perceived barriers. Adolescent HPV vaccination barriers related to parental concerns, beliefs, and inadequate knowledge about the HPV vaccine. Perceived (pharmacist's) personal barriers were related to lack of information and knowledge about HPV vaccine and recommendations. At the system/organization level, barriers reported included lack of time/staff/space; difficulty in series completion; tracking and recall of patient; perceived competition with providers; and other responsibilities/vaccines taking precedence. Future strategies involving pharmacy settings in HPV-related cancer prevention efforts should consider research on multilevel pharmacy-driven interventions addressing barriers.

Optimizing contraceptive access for women undergoing bariatric surgery.

With the dramatic increase in the prevalence of obesity, there is a corresponding increase in surgical procedures to treat obesity. Reproductive aged women (18-45 years old) undergo half of the bariatric surgical procedures performed in the United States each year. These women experience profound physiologic changes in response to bariatric surgery, including dramatic changes in reproductive function. Current guidelines recommend delaying attempts at conception for 12-24 months after bariatric surgery during the time of most profound weight loss. Despite these recommendations, many women report unprotected intercourse during this time, and many use less efficacious contraceptive options. Herein, we address contraceptive considerations in women of reproductive age who undergo bariatric surgery and opportunities to maximize a multidisciplinary surgical approach to optimize their overall health.

Women's preferences for permanent contraception method and willingness to be randomized for a hypothetical trial.

OBJECTIVE: To understand women's preferences for permanent contraception by salpingectomy or tubal occlusion following standardized counseling and evaluate the practicality of a future randomized trial. STUDY DESIGN: We invited pregnant and non-pregnant women planning permanent contraception at the University of California, Davis (UCD) and University of Tennessee (UT) Obstetrics and Gynecology clinics to participate. We enrolled women when they received routine counseling and signed procedure consent. Participants received standardized information sheets reviewing permanent contraception options based on pregnancy status then completed an anonymous survey with questions about demographics, method preference, and willingness to participate in a hypothetical randomized trial comparing salpingectomy and tubal occlusion. We evaluated predictors for salpingectomy preference using multivariable analysis. RESULTS: From July 2015 to October 2016, we enrolled 75 women at UCD and 63 women at UT. Overall, respondents preferred salpingectomy (63.0%); among the 47 women not currently pregnant at both sites, 40 (85.1%) preferred salpingectomy, most commonly because of higher efficacy. Although population characteristics differed significantly between the sites, only UCD site (aOR 4.2; 95% CI 1.9, 9.4) and non-pregnancy status (aOR 4.2; 95% CI 1.6, 10.8) predicted preference for salpingectomy in the multivariable model. Most participants (n=84, 60.9%) would not be willing to be randomized to a theoretical trial comparing salpingectomy and tubal occlusion procedures. CONCLUSION: Among a diverse group of women from two different areas in the U.S. given a choice of permanent contraception methods, salpingectomy is preferred over tubal occlusion. Most women planning a permanent contraceptive procedure would not agree to a randomized comparison of these methods. IMPLICATIONS STATEMENT: Salpingectomy, which offers theoretically higher efficacy and potentially greater ovarian cancer protection compared to tubal occlusion, is preferred by the majority of patients and should be offered to all women seeking permanent contraception. Differences in method choices less likely reflect the patient population and more likely the counseling provided.

Predictive value of current imaging modalities for the detection of urolithiasis during pregnancy: a multicenter, longitudinal study.

PURPOSE: We determined the optimal imaging study by which to diagnose and treat pregnant patients with suspected urolithiasis. MATERIALS AND METHODS: A retrospective, multicenter study was performed to determine the comparative accuracy of imaging modalities used before the surgical management of suspected urolithiasis in pregnant patients. Patients with a clinical suspicion of urolithiasis were evaluated with directed imaging including renal ultrasound alone, renal ultrasound and low dose computerized tomography, or renal ultrasound and magnetic resonance urography. When indicated, patients underwent therapeutic ureteroscopy. The rate of negative ureteroscopy was determined and the positive predictive values of the imaging modalities were calculated. RESULTS: A total of 51 pregnant patients underwent ureteroscopy. The mean age of the cohort was 27 years. Mean gestational age was 24.4 weeks. Of the women 24 (47%) underwent renal ultrasound and low dose computerized tomography, 22 (43%) underwent ultrasound alone, and 5 (10%) underwent renal ultrasound and magnetic resonance urography. Negative ureteroscopy occurred in 7 of the 51 patients (14%). The rate of negative ureteroscopy among patients who underwent renal ultrasound alone, renal ultrasound and low dose computerized tomography, and renal ultrasound and magnetic resonance urography was 23%, 4.2% and 20%, respectively. The positive predictive value of computerized tomography, magnetic resonance and ultrasound was 95.8%, 80% and 77%, respectively. CONCLUSIONS: The rate of negative ureteroscopy was 14% among pregnant women undergoing intervention in our series. Of the group treated surgically after imaging with ultrasound alone, 23% had no ureteral stone, resulting in the lowest positive predictive value of the modalities used. Alternative imaging techniques, particularly low dose computerized tomography, offer improved diagnostic information that can optimize management and obviate unnecessary intervention.

In my own words: misunderstanding of Pap smears and colposcopy among Appalachian women.

OBJECTIVE: To evaluate knowledge of Pap smear screening and colposcopy among Appalachian women. MATERIALS AND METHODS: English-speaking women (18 years or older) referred for colposcopy after abnormal Pap testing at a teaching hospital in the southeastern United States were studied. Structured interviews were conducted to assess demographic characteristics, health literacy skills using the Rapid Estimate of Adult Literacy in Medicine, understanding of the Pap smear and colposcopy, state anxiety, and cervical intraepithelial neoplasia distress. RESULTS: The mean age of women was 29.6 +/- 10.94, 93.2% white, 50.2% high school graduates or had an equivalency diploma, and 55.3% current cigarette use. Approximately one fifth (n = 22) of women had limited health literacy skills. Overall, womens' understanding of the Pap test, meaning of abnormal Pap test results, identification of risk factors contributing to abnormal Pap test results, and understanding of colposcopy was limited. Health literacy skills was the lone characteristic to significantly predict overall understanding of the Pap smear and colposcopy (unstandardized beta coefficient [SE] = 0.68 [0.02], p < .05). CONCLUSIONS: These findings demonstrate that Pap smear and colposcopy knowledge is associated with health literacy skills. Health care providers should be aware that many women lack sufficient knowledge of the Pap smear and colposcopy and tailor counseling during the clinical encounter accordingly.

Molar cornual ectopic pregnancy.

BACKGROUND: Few cases of ectopic molar pregnancies have been reported. We present one such case of a molar cornual pregnancy. CASE: A woman at 12 weeks' gestation by last menstrual period presented with ultrasound evidence of a molar pregnancy and a surgical abdomen. Diagnostic laparoscopy revealed a large amount of free intraperitoneal blood. Laparotomy revealed villous-appearing tissue with numerous fluid-filled cysts erupting from the posterior aspect of the right uterine cornu. A cornual resection was performed, followed by a suction dilation and curettage (D&C). The pathologic findings from the cornual resection were consistent with a partial molar pregnancy, while the material from the suction D&C demonstrated no villi or trophoblastic tissue. CONCLUSION: A molar cornual ectopic pregnancy is presented.