The utilization of the Papanicolaou (Pap) test and the human papillomavirus (HPV) vaccine has significantly decreased rates of cervical cancer and related mortality. Disparities in receiving these ...preventive screenings are scarcely studied in Muslim females. Our study explores primary care providers’ (PCP) approaches to cervical cancer screening in Muslim females. We created a cross-sectional Qualtrics survey using convenience sampling of PCPs who perform Pap tests in central Ohio. Recruitment emails were disseminated via departmental email listservs. We had 200 analyzable responses and 78% of respondents reported having Muslim patients. Bivariate analysis was used to identify predictors of providers’ approaches. Providers younger than 35 years obtained a sexual history from Muslim females less frequently, family medicine providers were more likely to obtain a sexual history from Muslim females, and gynecologists were more likely to offer the HPV vaccine to Muslim females. Providers who counseled patients about Pap tests (P<0.001) and HPV modes of transmission (P<0.004) were more likely to offer cervical cancer screening for Muslim females. Our findings suggested that providers’ age and specialty may be predictors of proactive cervical cancer screening and prevention in Muslim females and that there is a gap between current guidelines and preventive clinical practices regarding the HPV vaccine and transmission counseling.
•HPV vaccination is not consistently offered (31.3%) to patients being treated for high-grade cervical or vulvar dysplasia.•Patients undergoing surgery for HPV-related dysplasia are likely to accept ...HPV vaccination (65.6%).•The rate at which adjuvant HPV vaccination is offered may improve over time.
Eligibility for the human papillomavirus (HPV) vaccine now includes adults 27 through 45 years. It has not been reported how providers are addressing HPV vaccination in patients with existing preinvasive disease. Our objectives were to determine the rates at which vaccination is offered to and received by patients undergoing surgery for high-grade cervical or vulvar dysplasia.
This was a single-institution retrospective cohort study including patients ages 18 through 45 years undergoing surgery for high-grade cervical or vulvar dysplasia from 10/2018 to 2/2020. Our primary outcome was the rate at which HPV vaccination was discussed at the pre- and/or post-operative visits. The secondary outcome was the rate of vaccine uptake in these individuals. Characteristics of those offered HPV vaccination were compared to those not offered vaccination.
Of the 115 patients included, 36 (31.3%) had HPV vaccination addressed in the perioperative setting. Thirty-two of these patients had never been vaccinated, and 21 of these (65.6%) went on to receive partial or complete HPV vaccination. Those in whom HPV vaccination was addressed were more likely to be under 27 years (RR 3.2; 95% CI 2.1–4.8) and less likely to be smokers (RR 0.5; 95% CI 0.2–0.9) or have prior excisional procedures (RR 0.3; 95% CI 0.1–0.9). The absolute rate of discussing HPV vaccination with patients improved from 26.0% within six months of vaccine age eligibility expansion, to 35.4% after six months (P = 0.32).
Providers did not consistently address HPV vaccination among patients being treated for high-grade cervical or vulvar dysplasia despite the potential benefits. However, a high proportion of these patients are amenable to vaccination. Quality improvement initiatives are warranted to increase the rate of HPV vaccine counseling in this context.
•Advanced age alone should not serve as contraindication to same-day discharge following minimally invasive hysterectomy.•Elderly patients who undergo same-day discharge are not at increased risk of ...30-day hospital readmission.•Elderly, frail patients encompass a higher-risk group where prehab and heightened peri-operative monitoring are warranted.
To determine the safety and feasibility of same-day discharge (SDD) following minimally invasive hysterectomy (MIH) for elderly patients and to evaluate associations between age, frailty, and postoperative outcomes.
Retrospective review was conducted of patients aged ≥ 70 who underwent MIH within a single gynecologic oncology institution from 2018 to 2020. Demographics, peri-operative factors, postoperative complications, and 30-day readmission rates were collected. Frailty was determined by an 11-point modified frailty index ≥ 2. Outcomes were compared between SDD and observation groups using Fisher’s exact and Wilcoxon rank-sum tests.
Of 169 patients included in the analysis, 8.9% (n = 15) underwent SDD, and 91.1% (n = 154) were admitted for OBS following MIH. Demographics, peri-operative factors, and frailty rates (33% SDD vs 43.5% observation; p = 0.59) were similar between groups. 86.7% (n = 13) of SDD cases were completed before 12PM, and none were completed after 6PM. No SDD patients had early post-operative complications or hospital readmissions. Early postoperative complications were diagnosed in 9 (5.8%) patients admitted for OBS, and the 30-day hospital readmission rate for patients who underwent OBS was 8.4% (n = 13). While elderly patients who met objective frailty criteria (n = 72) did not have a higher likelihood of early post-operative complications (44.4% vs 55.6%; p = 0.909), they did have a higher likelihood of ED visit within 30 days of discharge (15.3 vs 3.1%; p = 0.009), and a trend was noted toward a higher rate of 30-day hospital readmission (12.5% vs 4.1%; p = 0.080).
Elderly patients undergoing SDD following MIH did not have increased morbidity or mortality. Elderly patients who meet objective criteria for frailty, however, represent a more vulnerable population.
In 2021, the Centers for Disease Control (CDC) revised the treatment recommendation for Trichomonas vaginalis from a single dose to a 7-day course of metronidazole. Given the high risk of Trichomonas ...infection in adolescents and young adults (AYA), this study evaluated reinfection rates before and after the change in CDC treatment guidelines.
This is a retrospective cohort study of AYA patients who presented to an academic children's hospital who were diagnosed with Trichomonas vaginalis genital infection in 2020 or 2022. Patients were identified by ICD codes. Data were collected on demographics, location of visit, provider specialty, lab results, prescriptions, and use of expedited partner therapy (EPT). The study population was split into two cohorts by year of visit. The primary outcome was the rate of reinfection for Trichomonas in the two cohorts. Descriptive statistics, Fisher's exact test, and chi-square test data are reported. This study was IRB approved.
110 patients met inclusion criteria and were included in the study, including 62 and 48 patients in the 2020 and 2022 cohorts, respectively. In both cohorts, the majority of patients (66% in 2020 and 75% in 2022) were prescribed the treatment option in line with CDC recommendations at that time (p=0.245). Location of visit did not affect rates of prescribing recommended treatment in either cohort (p=0.285 and 0.635, respectively). Adolescent medicine was more likely to follow CDC guidelines compared to other specialties (p=0.041 in 2020 and p=0.166 in 2022). In 2020, EPT was offered to 39% (accepted by 54%), similar to 35% (accepted by 41%) in 2022 (p=0.723 and 0.412, respectively). There was a difference in use of EPT based on visit location with only 1/34 emergency department/urgent care (ED/UC) visits offering EPT compared to 40/74 outpatient visits (p< 0.001). In 2020, 65% were retested between >4 weeks and < 12 months, similar to 67% in 2022 (p=0.814). Of those who were retested within this time frame, 33% in 2020 and 22% in 2022 were again positive for trichomonas (p=0.317).
The majority of providers in all locations and specialties followed CDC recommendations for treatment of Trichomonas. There was a trend towards lower rates of reinfection with the change in treatment guidelines, though this was not statistically significant and rates of reinfection remain high. Patients seen in outpatient clinics were more likely to be given EPT compared to ED/UC. Given the high rates of recurrence, further research is needed to identify barriers to treatment and prevention of sexually transmitted infections.
•Repeated ketamine treatment induced opposite behavioral effects in the two sexes.•Repeated ketamine treatment induced antidepressant-like effects in male mice.•Repeated ketamine treatment induced ...anxiogenic and depressogenic effects in females.•Ketamine enhanced hippocampal synapsin levels and serotonin turnover in males.
One of the most striking discoveries in the treatment of major depression was the finding that infusion of a single sub-anesthetic dose of ketamine induces rapid and sustained antidepressant effects in treatment-resistant depressed patients. However, ketamine’s antidepressant-like actions are transient and can only be sustained by repeated drug treatment. Despite the fact that women experience major depression at roughly twice the rate of men, research regarding the neurobiological antidepressant-relevant effects of ketamine has focused almost exclusively on the male sex. Importantly, knowledge regarding the sex-differentiated effects, the frequency and the dose on which repeated ketamine administration stops being beneficial, is limited. In the current study, we investigated the behavioral, neurochemical and synaptic molecular effects of repeated ketamine treatment (10mg/kg; 21days) in male and female C57BL/6J mice. We report that ketamine induced beneficial antidepressant-like effects in male mice, but induced both anxiety-like (i.e., decreased time spent in the center of the open field arena) and depressive-like effects (i.e., enhanced immobility duration in the forced swim test; FST) in their female counterparts. Moreover, repeated ketamine treatment induced sustained sex-differentiated neurochemical and molecular effects, as it enhanced hippocampal synapsin protein levels and serotonin turnover in males, but attenuated glutamate and aspartate levels in female mice. Taken together, our findings indicate that repeated ketamine treatment induces opposite behavioral effects in male and female mice, and thus, present data have far-reaching implications for the sex-oriented use of ketamine in both experimental and clinical research settings.
Objective
To examine the association between initial COVID‐19 vaccine hesitancy and subsequent vaccination among pregnant and postpartum individuals.
Design
Prospective cohort.
Setting
A Midwestern ...tertiary‐care academic medical center. Individuals completed a baseline vaccine hesitancy assessment from 22 March 2021 to 2 April 2021, with subsequent ascertainment of vaccination status at 3–6 months follow‐up.
Methods
We used multivariable Poisson regression to estimate the relative risk of vaccination by baseline vaccine hesitancy status, and then characteristics associated with vaccination.
Main outcome measures
Self‐report of COVID‐19 vaccination, and secondarily, consideration of COVID‐19 vaccination among those not vaccinated.
Results
Of 456 individuals (93% pregnant, 7% postpartum) initially surveyed, 290 individuals (64%; 23% pregnant, 77% postpartum) provided subsequent vaccination status (median = 17 weeks). Of these 290 individuals, 40% (116/290) reported COVID‐19 vaccine hesitancy upon enrolment, of whom 52% reported subsequent vaccination at follow‐up. Few individuals transitioned during the study period from vaccine hesitant to vaccinated (10%); in comparison, 80% of those who were not vaccine hesitant were vaccinated at follow‐up (aRR 0.19, 95% CI 0.11–0.33). Among those who remained unvaccinated at follow‐up, 38% who were vaccine hesitant at baseline were considering vaccination, compared with 71% who were not vaccine hesitant (aRR 0.48, 95% CI 0.33–0.67). Individuals who were older, parous, employed and of higher educational attainment were more likely to be vaccinated, and those who identified as non‐Hispanic black, were Medicaid beneficiaries, and were still pregnant at follow‐up were less likely to be vaccinated.
Conclusions
COVID‐19 vaccine hesitancy persisted over time in the peripartum period, and few individuals who reported hesitancy at baseline were later vaccinated. Interventions that address vaccine hesitancy in pregnancy are needed.
Tweetable
COVID‐19 vaccination hesitancy among pregnant and postpartum individuals persists over time, and few of the individuals who reported hesitancy were later vaccinated.
To determine whether morbid obesity should serve as an independent factor in the decision for same day discharge following minimally invasive hysterectomy.
Retrospective review was performed of ...patients with BMI ≥ 40 who underwent minimally invasive hysterectomy within a single comprehensive cancer center between January 2018 – August 2020. Demographics, perioperative factors, post-operative monitoring, complications, and readmissions were compared between patients who underwent same day discharge and overnight observation using Fisher's exact tests and Wilcoxon rank-sum tests.
374 patients with BMI ≥ 40 were included. Eighty-three (22.2%) patients underwent same day discharge, and 291 (77.8%) patients underwent overnight observation. Factors associated with increased likelihood of same day discharge included younger age (median age 53 vs 58; p = 0.001), lower BMI (median BMI 45 vs 47; p = 0.005), and fewer medical co-morbidities (Charlson Co-Morbidity Index 2 vs 3; p < 0.001). On multivariate regression analysis, frailty (OR 2.16 1.14–4.11, p = 0.019) and surgical completion time after 12 PM (OR 3.67 2.16–6.24, p < 0.001) were associated with increased risk of overnight observation. Few patients admitted for routine overnight observation required medical intervention (n = 14, 4.8%); most of these patients were frail (64.3%). The overall hospital readmission rate within 30 days of discharge was 3.2% (n = 12), with no patients discharged on the day of surgery being readmitted.
Morbid obesity alone should not serve as a contraindication to same day discharge following minimally invasive hysterectomy. Admission for observation was associated with low rates of clinically meaningful intervention, and patients who underwent same day discharge were not at increased risk of adverse outcome.
•Same day discharge following minimally invasive hysterectomy is generally safe and feasible for morbidly obese patients.•Age, BMI, medical co-morbidities, surgery time and frailty were associated with likelihood of undergoing same day discharge.•Routine overnight observation after minimally invasive hysterectomy led to little clinically meaningful intervention.•Hospital readmission rates are not higher for patients who undergo same day discharge.•A trend toward worse post-operative outcomes was seen in morbidly obese patients who met objective criteria for frailty.
External demand on biological, social and psychological equilibrium of individuals, called as stress, has adverse impact on health, performance and wellbeing of an individual. One of the principal ...sectors of life, job and organization, leads to workplace stress. In both developed and developing nations job stress poses significant health risk to employees leading to anxiety, burnout, cardiovascular disease, depression, and insomnia. Declared as worldwide epidemic by WHO, stress, not only results in large emotional cost to worker's performance and financial burden on organization but also accounts for accidents at workplace. In the context of this study, the factor of psychological well-being is a state of mind which includes an individual's desire to live life joyfully, and attain equilibrium between activities at work and efforts to build psychological resilience where resilience is the ability to bounce back or rebound from difficulty or misfortune or even increased responsibility. This analysis which establishes quantitative relationship among organization role stress, psychological well-being and resilience at work can be used by organizations and academia in order to gain insights into organizations role stress, psychological well-being and resilience at workplace.
The process of neurosurgery is delicate and time consuming, often resulting in lower patient outcomes and survival rates. Therefore, we are implementing computer algorithms for the classification and ...segmentation of brain tumors. This aims to improve the accuracy of identifying tumor and segmentation of the brain. The automatic segmentation of the brain is based on CT (Computed tomography) data using the Desktop Image Processing System (DISOS). The DISOS system integrates modules such as preoperative planning and user guidance. Automated segmentation algorithms, including fuzzy c means clustering method, intensity thresholding, region growing, level set methods, and machine learning approaches, are employed to segment the brain structures. This system demonstrates improved accuracy, robustness, and efficiency, although a final check by a medical expert is still necessary. Additionally, our paper highlights the use of advanced algorithms and machine learning techniques to differentiate between cancerous and non-cancerous tumors using various medical imaging data. The incorporation of genetic, molecular, and clinical data further enhances the accuracy of tumor classification models. Challenges in real time robot path planning and navigation for neurosurgery are addressed, including the use of A-mode ultrasound and augmented reality systems to provide enhanced guidance during procedures. This study concludes by emphasizing the collaboration between medical professionals and computer scientists in advancing the field of computer-assisted brain tumor diagnosis and robot-assisted surgery. Our goal is not to replace humans with robots, but the collaboration between them for incredible outcomes.
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