Understanding pre-residency abortion training pathways and career choices in the United States: a qualitative study.

BACKGROUND: Many factors contribute to the decision to provide abortion in the United States. We aim to describe pre-residency experiences and decisions that contribute to choosing a career as an abortion provider in the United States. METHODS: We conducted 60-min semi-structured telephone interviews with 34 current abortion care providers about their career trajectories, decision-making and planning. Interviews were transcribed and coded by three members of the research team using thematic analysis. RESULTS: A majority of the participants considered (73.5%, n=25) and firmly committed (62.8%, n=22) to providing abortion care prior to entering residency. They described important professional experiences with women's health and reproductive rights, as well as personal experiences with abortion care, all of which inspired them to seek out abortion training during medical school and residency. Participants also described a dearth of mentors or role models until late in training, especially for family physicians. CONCLUSIONS: Our study suggests that the decision to provide abortion care is often made prior to residency training, before or during medical school, so additional support may be needed to promote exposure to abortion care during undergraduate medical education or even before. Further, there is a need for improved mentorship and role modelling during these periods, especially for family physicians. This may be especially critical after the overturn of Roe v Wade, as medical schools in restrictive states may not be able to provide abortions to patients, depriving students of role models who are abortion providers.

Impact of oral carbohydrate consumption prior to cesarean delivery on preoperative well-being: a randomized interventional study.

PURPOSE: Oral carbohydrate consumption before surgery improves insulin sensitivity, cardiac output and well-being, and shortens hospital stays without adverse effects. No work has compared higher-dose carbohydrate beverages made for preoperative consumption to common, commercial oral rehydration solutions with lower carbohydrate concentrations. METHODS: We recruited low-risk women undergoing scheduled cesarean deliveries with planned spinal anesthesia. Participants were randomized to one of three groups: those who consumed Clearfast® beverage, those who consumed Gatorade Thirst Quencher® beverage, or fasting control. Participants in the two beverage groups received 710 mL of the appropriate beverage the night before surgery and 355 mL 2 h before surgery. Participants in the control group fasted after midnight the night before surgery. Two hours before surgery, we recorded baseline patient well-being using visual analogue scales, followed by beverage consumption for subjects in the beverage groups. One hour later, we repeated the same assessment. Additional recorded measures included cord blood glucose level, intraoperative variables, breastfeeding success, and a quality of recovery assessment administered 1 day after surgery. RESULTS: Forty-seven patients were recruited: 15 received Clearfast®, 17 received Gatorade Thirst Quencher®, and 15 patients fasted after midnight. Group differences in change in patient well-being using visual analog scales were analyzed using linear regression. Both beverage-consuming groups showed significant improvements in patient well-being using visual analog scales while fasted patients showed no change. CONCLUSION: Either a common oral rehydration beverage or a higher-dose carbohydrate beverage consumed preoperatively resulted in superior well-being compared to fasting. No differences in other outcomes were noted. TRIAL REGISTRATION: This study was registered on ClinicalTrials.gov with clinical trial registration number: NCT02684513.

Laser Therapy for Genitourinary Syndrome of Menopause.

PURPOSE OF REVIEW: The purpose of this article is to review the available data regarding the application and therapeutic outcomes of laser therapy for the treatment of genitourinary syndrome of menopause (GSM). RECENT FINDINGS: There have been several studies regarding the use of laser therapy for the treatment of GSM. Most of these studies show a trend toward safe and effective treatment in the short term (less than or equal to 12 weeks). However, these studies are lacking in randomization, blinding, placebo, and comparison groups. Although laser therapy for the treatment of the symptoms of GSM appears promising, there is currently a lack of high-level and long-term evidence regarding its safety and efficacy. There is also a lack of professional guidelines in the USA regarding this modality of treatment, specifically for GSM. Opportunities exist for future research in this area, specifically to determine safety and long-term outcomes of therapy.

The utility of endocervical curettage: does routine ECC at the time of colposcopy for low-grade cytologic abnormalities improve diagnosis of high-grade disease?

OBJECTIVE: To determine the use of endocervical curettage at the time of colposcopy for low-grade cytologic abnormalities. STUDY DESIGN: We conducted a retrospective chart review of women with low-grade Papanicolaou smears who had undergone satisfactory colposcopic examinations with identifiable lesions. We evaluated results during a 2-year period thereafter to determine whether endocervical curettage increased the diagnosis of high-grade dysplasia. RESULTS: The study group consisted of 374 patients. Of these patients, 16 had endocervical curettages suggestive of high-grade dysplasia. Of these 16 patients, 4 did not have concomitant high-grade dysplasia identified on ectocervical biopsy. Therefore, 93 to 94 endocervical curettages needed to be performed to detect 1 case of high-grade dysplasia that would not have been identified otherwise. CONCLUSION: Routine endocervical curettage at the time of satisfactory colposcopy for low-grade cytologic abnormalities with a visible lesion does not significantly improve the diagnosis of high-grade dysplasia.

Role of robotic surgery in urogynecologic surgery.

PURPOSE OF REVIEW: Robotic surgery with its numerous advantages over conventional laparoscopy has assumed an ever-expanding role in pelvic and pelvic floor reconstructive surgery. Our goal is to review the literature regarding robotic use in urogynecologic surgery. RECENT FINDINGS: The current literature demonstrates the feasibility and safety of performing robotic urogynecologic procedures in a wide variety of cases. Robotic sacrocolpopexy and hysterectomy are most commonly described, but the use of robotics in the repair of complex pelvic fistulae has also been examined. The available studies mainly consist of case series with short-term follow-up, but early outcomes appear to be comparable to open surgery with decreased patient morbidity. SUMMARY: The role of robotics in urogynecologic surgery will continue to grow, as there is an increasing access to the robotic platform, and its use is being incorporated into residency training. More robust studies will be needed to validate the continued use of the robot, as there are concerns regarding cost, training, and credentialing.

Vaginal hysterectomy for the enlarged uterus.

OBJECTIVE: To evaluate the effect of uterine weight on the perioperative outcomes of vaginal hysterectomy for benign gynecological conditions. MATERIALS AND METHODS: The medical records of 312 consecutive women who underwent vaginal hysterectomies for benign gynecological conditions without major pelvic reconstruction at Temple University Hospital between March 1994 and August 1999 were reviewed. 88 women with uterine weights > or =250 g were compared with 224 women with uterine weights <250 g. The risk of perioperative complications, operative time, perioperative hemoglobin change, length of postoperative hospital stay, and readmission were evaluated between the groups. RESULTS: Groups were similar with respect to age, parity, history of previous pelvic surgery and concurrent adnexal removal. Operative time was significantly increased for women with uteri weighing > or =250 g. Women with uterine weight > or =250 g had a higher risk for postoperative febrile morbidity. The risks of all other major complications, perioperative change in hemoglobin concentration, length of stay, and readmission risk were not statistically different between the groups (p < 0.05). CONCLUSIONS: Despite the increased postoperative febrile morbidity and prolonged operative time, women with uteri weighing > or =250 g who underwent vaginal hysterectomy were discharged from the hospital without any increase in other complications when compared to women with a smaller uterus.

Ovarian preservation in stage I low-grade endometrial stromal sarcomas.

OBJECTIVE: To examine the impact of ovarian preservation in a case-control study of women with stage I low-grade endometrial stromal sarcomas. METHODS: Patients with low-grade endometrial stromal sarcomas were identified at 5 institutions from 1976 to 2002. Cases were defined as patients who retained ovarian function; each case was matched to 2 control patients who underwent bilateral salpingo-oophorectomy (BSO). Immunostaining for estrogen and progesterone receptors was performed. Data were examined with Student t, chi(2), Cox regression, and Kaplan-Meier analyses. RESULTS: Twelve premenopausal patients with low-grade endometrial stromal sarcomas who did not undergo BSO were matched to 24 controls. Of the 36 patients in the entire cohort, disease recurred in 14 (39%). Recurrences were identified in the pelvis, abdomen, lung, or lymphatics in both cases and controls. Disease recurred in 4/12 (33%) case patients, compared with 10/24 (42%) control patients (P = .63). When case patients were compared with controls, no differences in progression-free (91.3 months versus 68.6 months, P = .44) or overall survival (median survival not yet reached versus 406 months, P = .82) were identified. This study had 13% power to detect the observed difference in median disease-free survival. After controlling for use of adjuvant therapy and BSO, older age remained the only independent poor prognostic factor for progression-free survival (P = .008). Twenty-two available tumors demonstrated positivity for both estrogen and progesterone receptors. CONCLUSION: Bilateral salpingo-oophorectomy did not appear to affect time to recurrence or overall survival. Retention of ovarian function may be an option for premenopausal women with low-grade endometrial stromal sarcomas.