AI-Generated Draft Replies Integrated Into Health Records and Physicians' Electronic Communication.

Importance: Timely tests are warranted to assess the association between generative artificial intelligence (GenAI) use and physicians' work efforts. Objective: To investigate the association between GenAI-drafted replies for patient messages and physician time spent on answering messages and the length of replies. Design, Setting, and Participants: Randomized waiting list quality improvement (QI) study from June to August 2023 in an academic health system. Primary care physicians were randomized to an immediate activation group and a delayed activation group. Data were analyzed from August to November 2023. Exposure: Access to GenAI-drafted replies for patient messages. Main Outcomes and Measures: Time spent (1) reading messages, (2) replying to messages, (3) length of replies, and (4) physician likelihood to recommend GenAI drafts. The a priori hypothesis was that GenAI drafts would be associated with less physician time spent reading and replying to messages. A mixed-effects model was used. Results: Fifty-two physicians participated in this QI study, with 25 randomized to the immediate activation group and 27 randomized to the delayed activation group. A contemporary control group included 70 physicians. There were 18 female participants (72.0%) in the immediate group and 17 female participants (63.0%) in the delayed group; the median age range was 35-44 years in the immediate group and 45-54 years in the delayed group. The median (IQR) time spent reading messages in the immediate group was 26 (11-69) seconds at baseline, 31 (15-70) seconds 3 weeks after entry to the intervention, and 31 (14-70) seconds 6 weeks after entry. The delayed group's median (IQR) read time was 25 (10-67) seconds at baseline, 29 (11-77) seconds during the 3-week waiting period, and 32 (15-72) seconds 3 weeks after entry to the intervention. The contemporary control group's median (IQR) read times were 21 (9-54), 22 (9-63), and 23 (9-60) seconds in corresponding periods. The estimated association of GenAI was a 21.8% increase in read time (95% CI, 5.2% to 41.0%; P = .008), a -5.9% change in reply time (95% CI, -16.6% to 6.2%; P = .33), and a 17.9% increase in reply length (95% CI, 10.1% to 26.2%; P < .001). Participants recognized GenAI's value and suggested areas for improvement. Conclusions and Relevance: In this QI study, GenAI-drafted replies were associated with significantly increased read time, no change in reply time, significantly increased reply length, and some perceived benefits. Rigorous empirical tests are necessary to further examine GenAI's performance. Future studies should examine patient experience and compare multiple GenAIs, including those with medical training.

Women Physicians in Transition Learning to Navigate the Pipeline from Early to Mid-Career: Protocol for a Qualitative Study.

BACKGROUND: Women physicians face unique obstacles while progressing through their careers, navigating career advancement and seeking balance between professional and personal responsibilities. Systemic changes, along with individual and institutional changes, are needed to overcome obstacles perpetuating physician gender inequities. Developing a deeper understanding of women physicians' experiences during important transition points could reveal both barriers and opportunities for recruitment, retention, and promotion, and inform best practices developed based on these experiences. OBJECTIVE: The aim is to learn from the experiences and perspectives of women physicians as they transition from early to mid-career, then develop best practices that can serve to support women physicians as they advance through their careers. METHODS: Semistructured interviews were conducted with women physicians in the United States in 2020 and 2021. Eligibility criteria included self-identification as a woman who is in the process of transitioning or who recently transitioned from early to mid-career stage. Purposeful sampling facilitated identification of participants who represented diversity in career pathway, practice setting, specialty, and race/ethnicity. Each participant was offered compensation for their participation. Interviews were audio-recorded and professionally transcribed. Interview questions were open-ended, exploring participants' perceptions of this transition. Qualitative thematic analysis will be performed. We will use an open coding and grounded theory approach on interview transcripts. RESULTS: The Ethics Review Committee of the Faculty of Health, Medicine, and Life Sciences at Maastricht University approved the study; Stanford University expedited review approved the study; and the University of California, San Diego certified the study as exempt from review. Twelve in-depth interviews of 50-100 minutes in duration were completed. Preliminary analyses indicate one key theme is a tension resulting from finite time divided between demands from a physician career and demands from family needs. In turn, this results in constant boundary control between these life domains that are inextricable and seemingly competing against each other within a finite space; family needs impinge on planned career goals, if the boundary between them is not carefully managed. To remedy this, women sought resources to help them redistribute home responsibilities, freeing themselves to have more time, especially for children. Women similarly sought resources to help with career advancement, although not with regard to time directly, but to first address foundational knowledge gaps about career milestones and how to achieve them. CONCLUSIONS: Preliminary results provide initial insights about how women identify or activate a career shift and how they marshaled resources and support to navigate barriers they faced. Further analyses are continuing as of March 2022 and are expected to be completed by June 2022. The dissemination plan includes peer-reviewed open-access journal publication of the results and presentation at the annual meeting of the American Medical Association's Women Physicians Section.

Female Pelvic Conditions: Chronic Pelvic Pain.

Chronic pelvic pain (CPP) is defined as at least 6 months of pain originating from the lower abdomen or pelvis that is not associated with pregnancy. Symptoms include abdominal bloating, low back pain, and dyspareunia. CPP is considered a symptom and not a diagnosis. The etiology may involve a specific organ or condition (eg, endometriosis, adhesions). The most common associated conditions are endometriosis, interstitial cystitis, irritable bowel syndrome, and depression. The history and physical examination are essential in the evaluation. A comprehensive history that encompasses the gynecologic, obstetric, surgical, and psychosocial histories is key. The psychosocial history should include screening for depression, anxiety, posttraumatic stress disorder, and physical and sexual abuse because of their association with CPP. The physical examination should include musculoskeletal, abdominal, and gynecologic examinations. The choice of laboratory tests and imaging studies should be guided by the history and physical examination findings. Management is multimodal and involves management of associated conditions, pharmacotherapy, surgeries and procedures, physical therapy, and behavior and lifestyle therapies. The multidisciplinary care team typically consists of the primary care physician, subspecialty physicians (eg, gynecology, pain management, psychiatry, gastroenterology, urology), a physical therapist, and a behavioral health subspecialist.

Female Pelvic Conditions: Abnormal Uterine Bleeding.

Abnormal uterine bleeding (AUB) is the term used to describe uterine bleeding that varies from the normal parameters of menstruation. This term replaces several previously used terms with less clear or conflicting definitions, including dysfunctional uterine bleeding, irregular menstrual bleeding, and menorrhagia. PALM-COEIN is a classification system for the etiologies of AUB in nongravid menstruating women. PALM refers to discrete structural entities (ie, polyp, adenomyosis, leiomyoma, malignancy and hyperplasia); COEIN refers to nonstructural etiologies (ie, coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not yet classified). The prevalence of AUB is estimated to be 35% or higher. The history and physical examination are key in the evaluation of patients with AUB. Patients with symptomatic acute blood loss require urgent evaluation for potential hemodynamic instability. For women 45 years and younger with AUB, endometrial biopsy is indicated if specific risk factors for endometrial cancer are present. Endometrial biopsy is indicated for all patients with AUB who are older than 45 years or have postmenopausal bleeding. Management of AUB is determined by its etiology, and typically consists of medical therapy (ie, combination oral contraceptives, progestin-containing intrauterine devices, tranexamic acid, nonsteroidal anti-inflammatory drugs). Patients with structural lesions may require surgical procedures. Management should be individualized and patient desire for current or future fertility should be considered.

Female Pelvic Conditions: Polycystic Ovary Syndrome.

It is estimated that polycystic ovary syndrome (PCOS) affects about 10% of women of reproductive age in the United States. Principal risk factors include obesity and a family history of PCOS. A diagnosis of PCOS should be considered in women with irregular or absent menstrual cycles, issues related to hyperandrogenism, or infertility. The Rotterdam diagnostic criteria require two of the following three factors: oligo- or anovulation, clinical and/or biochemical signs of hyperandrogenism, and polycystic ovaries identified on ultrasonography. Laboratory tests are recommended to rule out other conditions and factors, including thyroid conditions, hyperprolactinemia, atypical congenital adrenal hyperplasia, and tumors. The mainstays of treatment are lifestyle changes to achieve weight loss and combination oral contraceptives (COCs). (PCOS is an off-label use of COCs.) A weight loss of 5% to 10% has been shown to decrease PCOS symptoms. Medical or surgical management of obesity may be indicated. COCs provide endometrial protection and help manage acne and hirsutism. (Hirsutism is an off-label use of COCs. Acne is an off-label use of some COCs.) Routine acne treatments also are used. Hirsutism may improve with topical cosmetic treatments, spironolactone, or finasteride. (Hirsutism is an off-label use of spironolactone and finasteride.) Infertility is a common issue in patients with PCOS. The aromatase inhibitor letrozole is the first-line treatment for PCOS-related anovulation. Gonadotropin-releasing hormone analogues also are used to induce ovulation. (This is an off-label use of letrozole and gonadotropin-releasing hormone analogues.).

Female Pelvic Conditions: Genitourinary Syndrome of Menopause.

Genitourinary syndrome of menopause (GSM) is a term that describes the genital, urinary, and sexual changes that occur in women because of a lack of estrogen. This most commonly is because of menopause, but can be because of a hypoestrogenic state caused by hyperprolactinemia, oophorectomy, premature ovarian failure, chemotherapy, or radiation. GSM describes a group of signs and symptoms that affect quality of life and progress over time, including vaginal dryness, dyspareunia, dysuria, urinary urgency, and frequent urinary tract infections. GSM is underdiagnosed. It affects 65% of women 1 year after the onset of menopause, and 84% of women 6 years after menopause. Physicians routinely should ask all perimenopausal and postmenopausal women about GSM symptoms. The diagnosis is made clinically, based on the history and physical examination. Use of nonhormonal lubricants and vaginal moisturizers should be recommended as first-line therapies. Vaginal estrogen is the most effective treatment. Other therapies include vaginal dehydroepiandrosterone (DHEA), ospemifene, systemic estrogen therapy, and pelvic floor physical therapy.

Attitudes of women participating in a clinical trial on point-of-care testing and home testing for STIs.

Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis infections are a public health concern and cost the United States' healthcare system 16 billion dollars annually. By minimizing barriers to testing, an increased number of infections can be detected and treated. A home-based point-of-care (POC) sexually transmitted infection (STI) test may reduce personal, structural, social and system-level barriers to STI testing. This study assesses patient preferences and acceptance of home-based POC STI testing. We performed a cross-sectional, single-visit study of women aged 18 years and older at a single site. Women completed an anonymous online survey evaluating interest in POC STI testing, comfort in self-collecting vaginal swabs and participant reaction to a positive STI result. 138 participants completed the anonymous online survey. The survey results indicate high acceptability with self-collection of samples and home POC STI testing. A majority of participants were interested or very interested in a home POC STI device-especially amongst women with a past history of a STI. If receiving a positive test result, participants indicated they would want to have someone to discuss their results with, most preferring to speak with their primary care provider. Women on lower incomes were less comfortable and less interested with home testing. Women are likely to be receptive to home POC STI testing. Adapting to home-based testing will require engagement of primary care providers for management and surveillance of STIs.