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Halder GE, DeGraffenreid C, Bretschneider CE. Perioperative Morbidity Associated with Same-day Discharge in Elderly Patients. Int Urogynecol J 2024:10.1007/s00192-024-05758-8. [PMID: 38456895 DOI: 10.1007/s00192-024-05758-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 02/04/2024] [Indexed: 03/09/2024]
Abstract
INTRODUCTION AND HYPOTHESIS We compared postoperative complications in elderly patients discharged on POD#0 versus POD#1 after prolapse repair. METHODS Data were obtained from the National Surgical Quality Improvement database. A total of 20,984 women 65 years and older who underwent prolapse repair between 2014 and 2020 were analyzed. Patient demographics, comorbidities, readmission, reoperation, and 30-day postoperative complications were compared in patients discharged on POD#0 versus POD#1. A sensitivity analysis was completed to examine outcomes in patients who underwent an apical prolapse repair. Multivariate logistic regression was performed to evaluate for potential confounders. RESULTS Age, race, ethnicity, American Society of Anesthesiologists class, prolapse repair type, and operative time were significantly different in patients discharged on POD#0 vs POD#1 (all p < 0.01). Patients discharged on POD#0 had significantly fewer postoperative complications (2.63% vs 3.44%) and readmissions (1.56% vs 2.18%, all p < 0.01). On multivariate regression modeling, postoperative discharge day was independently associated with complications, but not with readmissions or reoperation after. Patients who underwent an apical prolapse repair and were discharged on POD#0 had significantly more postoperative complications (3.5% vs 2.5%, p = 0.02) and readmissions (2.42% vs 10.08%, p < 0.01) than those discharged on POD#1. In this group, multivariate regression modeling demonstrated that postoperative discharge day was independently associated with any postoperative complication. CONCLUSIONS For elderly women undergoing prolapse repair, the type of surgery should be considered when determining postoperative admission versus same-day discharge. Admission overnight does not seem to benefit women undergoing vaginal repairs but may decrease overall morbidity and risk of readmission in women undergoing an apical prolapse repair.
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Affiliation(s)
- Gabriela E Halder
- Division of Urogynecology, Department of Obstetrics and Gynecology, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77555-0587, USA.
| | - Corrie DeGraffenreid
- Division of Urogynecology, Department of Obstetrics and Gynecology, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77555-0587, USA
| | - C Emi Bretschneider
- Division of Urogynecology, Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL, USA
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Halder GE, Guo F, Harvie H, White AB, Caldwell L, Giles DL, Bilagi D, Rogers RG. Cost Effectiveness of Additional Preoperative Telephone Call to Increase Surgical Preparedness: Analysis of a Randomized Clinical Trial. Int Urogynecol J 2024; 35:527-536. [PMID: 38189853 DOI: 10.1007/s00192-023-05719-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/09/2023] [Indexed: 01/09/2024]
Abstract
INTRODUCTION AND HYPOTHESIS There is a need for cost effective interventions that increase surgical preparedness in urogynecology. METHODS We performed an ancillary prospective economic evaluation of the Telehealth Intervention to Increase Patient Preparedness for Surgery (TIPPS) Trial, a randomized multicenter trial that evaluated the impact of a preoperative telehealth call on surgical preparedness in women undergoing urogynecologic surgery. A within-trial analysis from the health care sector and societal perspective was performed. Cost-effectiveness was computed from health care sector and societal perspectives, with an 8-week time horizon. RESULTS A total of 126 women were included in our analysis. QALYs gained were similar between groups (telehealth 0.1414 + 0.0249; usual care 0.1409 + 0.0179). The cumulative mean per-person costs at 8 weeks from the healthcare sector perspective were telehealth call: $8696 +/- 3341; usual care: $8473 +/- 3118 (p = 0.693) and from the societal perspective were telehealth call: $11,195 + 5191; usual care: $11,213 +/- 4869 (p = 0.944). The preoperative telehealth call intervention was not cost effective from the health care sector perspective with an ICER of $460,091/QALY (95%CI -$7,382,608/QALY, $7,673,961) using the generally accepted maximum willingness to pay threshold of $150,000/QALY (Neumann et al. N Engl J Med. 371(9):796-7, 2014). From the societal perspective, because incremental costs per QALY gained were negative $-35,925/QALY (95%CI, -$382,978/QALY, $317,226), results suggest that preoperative telehealth call dominated usual care. CONCLUSIONS A preoperative telehealth call is cost effective from the society perspective. CLINICAL TRIAL REGISTRATION Registered with http://ClinicalTrials.gov . Date of registration: March 26, 2019 Date of initial participant enrollment: June 5, 2019 URL: https://clinicaltrials.gov/ct2/show/record/NCT03890471 Clinical trial identification number: NCT03890471.
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Affiliation(s)
- Gabriela E Halder
- Department of Women's Health, The University of Texas Austin Dell Medical School, Austin, TX, USA.
- Division of Urogynecology, Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, TX, USA.
| | - Fangjian Guo
- Division of Population and Preventive Health, Department of Obstetrics & Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
- Center for Interdisciplinary Research in Women's Health, School of Medicine, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Heidi Harvie
- Department of Obstetrics and Gynecology, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA
- The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Amanda B White
- Department of Women's Health, The University of Texas Austin Dell Medical School, Austin, TX, USA
| | - Lauren Caldwell
- Department of Women's Health, The University of Texas Austin Dell Medical School, Austin, TX, USA
| | - Dobie L Giles
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, The University of Wisconsin-Maddison, Maddison, WI, USA
| | - Daksha Bilagi
- Department of Women's Health, The University of Texas Austin Dell Medical School, Austin, TX, USA
| | - Rebecca G Rogers
- Department of Women's Health, The University of Texas Austin Dell Medical School, Austin, TX, USA
- Department of Obstetrics and Gynecology, Albany Medical Center, Albany, NY, USA
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Thompson JC, Halder GE, Jeppson PC, Alas A, Balgobin S, Dieter AA, Houlihan S, Miranne J, Sleemi A, Balk EM, Mama S, Meriwether KV, Antosh DD. Repair of Vesicovaginal Fistulae: A Systematic Review. Obstet Gynecol 2024; 143:229-241. [PMID: 38033311 DOI: 10.1097/aog.0000000000005468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/05/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVE To assess and compile the current level of evidence regarding successful surgical treatment of vesicovaginal fistulae and how these perioperative interventions affect anatomic, patient-centered, and adverse outcomes. DATA SOURCES PubMed and EMBASE were searched from inception through September 9, 2022. METHODS OF STUDY SELECTION This review included comparative studies (of any sample size) and single-group studies (1,000 or more participants) of primary or recurrent vesicovaginal fistula (ie, vesicovaginal fistula, urethrovaginal fistula, and bladder neck-vaginal fistula). We evaluated preintervention assessment or management, various techniques for intraoperative management, and postoperative management. Outcomes of interest included anatomic and objective outcomes (such as successful repair, fistula closure, urinary incontinence, recurrent fistula, perioperative complications) and subjective outcomes (such as voiding symptoms and quality of life). Abstracts and full-text articles were screened in duplicate, and study descriptions and findings were extracted into standardized extraction forms. Risk of bias was assessed independently by two investigators and adjudicated by a third. Study quality was summarized with standardized tools. We conducted random-effects model and restricted maximum-likelihood meta-analyses of relative risks when at least three studies compared similar interventions and reported similar outcome measures. TABULATION, INTEGRATION, AND RESULTS Forty-six studies met the inclusion criteria. Studies were categorized into 11 domains: 1) preoperative assessment, 2) preoperative and postoperative physical therapy, 3) route of surgery, 4) incorporation of a flap, 5) trimming, 6) layered closure, 7) intraoperative antibiotics, 8) fibrin glue, 9) fascial sling, 10) postoperative Foley catheter duration, and 11) quality of life. Although the strength of the data is insufficient, preoperative phenazopyridine, physical therapy, layered closure, and intraoperative antibiotics seemed to improve the rate of successful fistula repair. Route of surgery (vaginal vs abdominal laparotomy) was determined primarily by surgeon preference and showed no difference in successful fistula repair. In addition, use of interpositional flaps, trimming fistula edges, fibrin glue, and fascial sling did not show significant improvement in rates of fistula cure. Overall, quality-of-life scores improved postoperatively regardless of route of repair and use of interpositional flaps. CONCLUSION Our findings highlight the limited information available to guide evidence-based treatment of vesicovaginal fistula repair. Overall, high-quality evidence is lacking to provide guidelines; therefore, expert opinion remains the primary influence for fistula repair recommendations. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42021214948.
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Affiliation(s)
- Jennifer C Thompson
- Northwest Kaiser Permanente, Portland, Oregon; the University of Texas Medical Branch, Galveston, the University of Texas at San Antonio, San Antonio, UT Southwestern Medical Center, Dallas, and the Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, Texas; the Woman's Center for Advanced Pelvic Surgery, Phoenix, Arizona; MedStar Washington Hospital Center, Washington, DC; the Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada; Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; the International Medical Response Foundation, Brooklyn, New York; the Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, Rhode Island; Cooper Medical School of Rowan University, Cooper University Health Care, Camden, New Jersey; and the Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, New Mexico
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Fisher SR, Halder GE, Lee MJ, Allen L, Kilic GS. Cumulative Effects of Comorbid Burden and Overactive Bladder Symptoms on Fall Risk Among Older Women Seeking Treatment for Urogynecologic Conditions. Urogynecology (Phila) 2023; 29:763-769. [PMID: 36946883 DOI: 10.1097/spv.0000000000001343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
IMPORTANCE Overactive bladder (OAB) syndrome and urinary incontinence, age, and comorbid burden are strong risk factors for falls in women. Less is known about their cumulative effects on fall risk in a urogynecologic population. OBJECTIVE The purpose of this study was to investigate the effects of coexisting OAB, older age, and comorbidities on risk of falling among treatment seeking women with pelvic floor disorders. STUDY DESIGN We conducted a retrospective medical records review of 348 consecutive women presenting to a urogynecology clinic over 6 months. Fall risk was determined by the Centers for Disease Control and Prevention's, Stopping Elderly Accidents, Deaths, and Injuries screening tool. Clinical and sociodemographic measures were abstracted from the electronic medical record. Odds of screening positive for high fall risk based on different patient profiles were calculated. We then used a classification and regression tree analysis to determine the relative importance of the different variables on fall risk within the homogeneous subgroups. RESULTS Of the 348 women (mean age, 58.7 ± 15.8 years) who completed the fall risk screen, 124 (36%) screened positive for increased fall risk. Overactive bladder symptoms increased the likelihood of a positive fall risk screen across all combinations of age and comorbid burden. The patient profile of ≥3 OAB symptoms, ≥4 comorbid conditions, and age 65 years or older increased the odds of screening positive for high fall risk more than 6-fold (odds ratio, 6.4; 95% confidence interval, 3.1-12.9). In the following order of importance, the combination of high comorbid burden, OAB, and older age identified approximately 3 in 4 patients (73.3%) at high risk of falling. CONCLUSION The presence of 3 easily identifiable patient characteristics is strongly associated with a risk of falls in women seeking care for pelvic floor disorders.
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Affiliation(s)
- Steve R Fisher
- From the Department of Physical Therapy, School of Health Professions
| | - Gabriela E Halder
- Female Pelvic Medicine and Reconstructive Surgery, Urogynecology, Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, Galveston, TX
| | - Mi Jung Lee
- From the Department of Physical Therapy, School of Health Professions
| | - Lindsay Allen
- From the Department of Physical Therapy, School of Health Professions
| | - Gokhan S Kilic
- Female Pelvic Medicine and Reconstructive Surgery, Urogynecology, Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, Galveston, TX
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Dieter AA, Halder GE, Pennycuff JF, Singh R, El-Nashar SA, Lipetskaia L, Orejuela FJ, Jeppson PC, Sleemi A, Raman SV, Balk EM, Rogers RG, Antosh DD. Patient-Reported Outcome Measures for Use in Women With Pelvic Organ Prolapse: A Systematic Review. Obstet Gynecol 2023; 141:1098-1114. [PMID: 37073897 PMCID: PMC10524573 DOI: 10.1097/aog.0000000000005212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 03/23/2023] [Indexed: 04/20/2023]
Abstract
OBJECTIVE To describe the psychometric properties of existing patient-reported outcome measures for women with prolapse using the COSMIN (Consensus-Based Standards for the Selection of Health Measurement Instruments) framework. Additional objectives were to describe the patient-reported outcome scoring method or interpretation, methods of administration, and to compile a list of the non-English languages in which the patient-reported outcomes are reportedly validated. DATA SOURCES PubMed and EMBASE was searched through September 2021. Study characteristics, patient-reported outcome details, and psychometric testing data were extracted. Methodologic quality was assessed with COSMIN guidelines. METHODS OF STUDY SELECTION Studies reporting the validation of a patient-reported outcome in women with prolapse (or women with pelvic floor disorders that included a prolapse assessment) and reporting psychometric testing data on English-language patient-reported outcome for at least one measurement property per COSMIN and the U.S. Department of Health and Human Services definitions were included, as well as studies reporting the translation of an existing patient-reported outcome into another language, a new method of patient-reported outcome administration, or a scoring interpretation. Studies reporting only pretreatment and posttreatment scores, only content or face validity, or only findings for nonprolapse domains of the patient-reported outcome were excluded. TABULATION, INTEGRATION, AND RESULTS Fifty-four studies covering 32 patient-reported outcomes were included; 106 studies assessing translation into a non-English language were excluded from the formal review. The number of validation studies per patient-reported outcome (one version of one questionnaire) ranged from 1 to 11. Reliability was the most reported measurement property, and most measurement properties received an average rating of sufficient. The condition-specific patient-reported outcomes had on average more studies and reported data across more measurement properties compared with adapted and generic patient-reported outcomes. CONCLUSION Although measurement property data vary on patient-reported outcomes for women with prolapse, most data were of good quality. Overall, condition-specific patient-reported outcomes had more studies and reported data across more measurement properties. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42021278796.
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Hall EF, Biller DH, Buss JL, Ferzandi T, Halder GE, Muffly TM, Nickel KB, Nihira M, Olsen MA, Wallace SL, Lowder JL. Medium-Term Outcomes of Conservative and Surgical Treatments for Stress Urinary Incontinence: A Medicare Claims Analysis: Developed by the AUGS Payment Reform Committee. Urogynecology (Phila) 2023; 29:536-544. [PMID: 37235803 PMCID: PMC10468831 DOI: 10.1097/spv.0000000000001362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE This study aimed to evaluate the 3- to 5-year retreatment outcomes for conservatively and surgically treated urinary incontinence (UI) in a population of women 66 years and older. METHODS This retrospective cohort study used 5% Medicare data to evaluate UI retreatment outcomes of women undergoing physical therapy (PT), pessary treatment, or sling surgery. The data set used inpatient, outpatient, and carrier claims from 2008 to 2016 in women 66 years and older with fee-for-service coverage. Treatment failure was defined as receiving another UI treatment (pessary, PT, sling, Burch urethropexy, or urethral bulking) or repeat sling. A secondary analysis was performed where additional treatment courses of PT or pessary were also considered a treatment failure. Survival analysis was used to evaluate the time from treatment initiation to retreatment. RESULTS Between 2008 and 2013, 13,417 women were included with an index UI treatment, and follow-up continued through 2016. In this cohort, 41.4% received pessary treatment, 31.8% received PT, and 26.8% underwent sling surgery. In the primary analysis, pessaries had the lowest treatment failure rate compared with PT (P<0.001) and sling surgery (P<0.001; survival probability, 0.94 [pessary], 0.90 [PT], 0.88 [sling]). In the analysis where retreatment with PT or a pessary was considered a failure, sling surgery had the lowest retreatment rate (survival probability, 0.58 [pessary], 0.81 [PT], 0.88 [sling]; P<0.001 for all comparisons). CONCLUSIONS In this administrative database analysis, there was a small but statistically significant difference in treatment failure among women undergoing sling surgery, PT, or pessary treatment, but pessary use was commonly associated with the need for repeat pessary fittings.
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Affiliation(s)
- Evelyn F Hall
- From the Department of Obstetrics and Gynecology, Tufts University, Boston, MA
| | - Daniel H Biller
- Division of Urogynecology, Department of OBGYN, Vanderbilt University Medical College, Nashville, TN
| | - Joanna L Buss
- Institute for Informatics, Washington University School of Medicine, St Louis, MO
| | - Tanaz Ferzandi
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Keck School of Medicine at University of Southern California, Los Angeles, CA
| | - Gabriela E Halder
- Division of Urogynecology, Department of OBGYN, University of Texas Medical Branch, Galveston, TX
| | - Tyler M Muffly
- Department of Obstetrics and Gynecology, Denver Health and Hospital Authority, Denver, CO
| | - Katelin B Nickel
- Division of Infectious Diseases, Department of Internal Medicine, Washington University in St Louis, St Louis, MO
| | - Mikio Nihira
- KPC Healthcare, UC Riverside School of Medicine, Riverside, CA
| | - Margaret A Olsen
- Division of Infectious Diseases, Department of Internal Medicine, Washington University in St Louis, St Louis, MO
| | - Shannon L Wallace
- Division of Urogynecology, Subspecialty Care for Women's Health, Cleveland Clinic, Cleveland, OH
| | - Jerry L Lowder
- Department of Obstetrics and Gynecology, Washington University in St Louis, St Louis, MO
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Caldwell L, Halder GE, White AB, High RA, Wright ML, Rogers RG. The Impact of Language Discordance on Patients' Perception of a Clinical Encounter and Trust in Provider. Urogynecology (Phila) 2023; 29:443-451. [PMID: 36329559 DOI: 10.1097/spv.0000000000001283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
IMPORTANCE The impact of language discordance on care for Spanish-speaking patients with pelvic floor disorders is unknown. OBJECTIVE The aim of this study was to compare the impact of language concordance with the impact of language discordance on the patient experience and trust in their provider. METHODS This cross-sectional cohort study enrolled English- and Spanish-speaking patients during initial evaluation in a urogynecology clinic. English- and Spanish-speaking patients seen by native English- or Spanish-speaking providers were recruited to the language-concordant group. The language-discordant group included Spanish-speaking patients seen with a translator or by nonnative Spanish-speaking providers. Patients completed the Trust in Physician Scale and the Consumer Assessment of Healthcare Providers and Systems Clinician and Group Survey (CG-CAHPS). Patients and providers rated the provider's Spanish proficiency on a 10-point scale from 0 (low) to 10 (high). Symptom bother questionnaires were completed 4-6 months after enrollment. RESULTS Eighty women were recruited, with 40 in each group. Mean age was 55.4 ± 12.9 years. The majority identified as White (75%) and Hispanic (77.5%). Trust in Physician Scale scores were similar between groups (46.2 ± 8.5 vs 44.4 ± 7.5, P > 0.05). The provider communication, provider rating, and recommendation domains of the CG-CAHPS did not differ between groups (all P > 0.05). Provider self-rating of Spanish proficiency was lower than patient ratings (7.5 ± 1.8 vs 9.8 ± 0.5, P < 0.001). There was no difference between groups in symptom bother at 4-6 months (all P > 0.05). CONCLUSIONS Patient-provider language discordance does not affect patient trust in the provider or perception of the encounter as measured by the Trust in Physician Scale and CG-CAHPS questionnaires.
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Affiliation(s)
- Lauren Caldwell
- From the The University of Texas at Austin Dell Medical School, Austin, TX
| | | | - Amanda B White
- From the The University of Texas at Austin Dell Medical School, Austin, TX
| | - Rachel A High
- From the The University of Texas at Austin Dell Medical School, Austin, TX
| | - Michelle L Wright
- From the The University of Texas at Austin Dell Medical School, Austin, TX
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Halder GE, Rogers RG, Brown HW, Kenton KS, Carlsson E, White A, Caldwell L, High R, Constantine ML. Validation of the Surgical Preparedness Assessment in women with pelvic floor disorders. Int Urogynecol J 2022:10.1007/s00192-022-05418-9. [DOI: 10.1007/s00192-022-05418-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/24/2022] [Indexed: 12/13/2022]
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Cichowski S, Grzybowska ME, Halder GE, Jansen S, Gold D, Espuña M, Jha S, Al-Badr A, Abdelrahman A, Rogers RG. International Urogynecology Consultation: Patient Reported Outcome Measures (PROs) use in the evaluation of patients with pelvic organ prolapse. Int Urogynecol J 2022; 33:2603-2631. [PMID: 35980442 DOI: 10.1007/s00192-022-05315-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2022] [Indexed: 10/15/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Patient-reported outcome measure instruments include patient-reported outcomes (PROs) and patient-reported goals (PRGs), which allow practitioners to measure symptoms and determine outcomes of treatment that matter to patients. METHODS This is a structured review completed by the International Urogynecology Consultation (IUC), sponsored by the International Urogynecological Association (IUGA). The aim of this working group was to evaluate and synthesize the existing evidence for PROs and PRGs in the initial clinical work-up/evaluation and research arena for patients with pelvic organ prolapse (POP). RESULTS The initial search generated 3589 non-duplicated studies. After abstract review by 4 authors, 211 full texts were assessed for eligibility by 2 writing group members, and 199 studies were reviewed in detail. Any disagreements on abstract or full-text articles were resolved by a third reviewer or during video meetings as a group. The list of POP PROs and information on PRGs was developed from these articles. Tables were generated to describe the validation of each PRO and to provide currently available, validated translations. CONCLUSIONS All patients presenting for POP should be evaluated for vaginal, bladder, bowel and sexual symptoms including their goals for symptom treatment. This screening can be facilitated by a validated PRO; however, most PROs provide more information than needed to provide clinical care and were designed for research purposes.
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Affiliation(s)
| | - Magdalena Emilia Grzybowska
- Department of Gynecology, Gynecological Oncology and Gynecological Endocrinology Medical University of Gdansk, Gdansk, Poland
| | | | | | - Daniela Gold
- Department of Gynecology, Medical University Graz, Graz, Austria
| | | | - Swati Jha
- Sheffield Teaching Hospitals NHS trust, Sheffield, UK
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Caldwell L, Papermaster AE, Halder GE, White AB, Young A, Rogers RG. Evidence-based pelvic floor disorder care pathways optimize shared decision making between patients and surgeons. Int Urogynecol J 2022; 33:2841-2847. [PMID: 35001160 PMCID: PMC8743070 DOI: 10.1007/s00192-021-05021-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/18/2021] [Indexed: 11/30/2022]
Abstract
Introduction and hypothesis Evidence-based care pathways improve care standardization and patient outcomes. We created pelvic organ prolapse (POP) and stress urinary incontinence (SUI) care pathways as decision aids for our multidisciplinary team to use when counseling patients. Methods Using a modified Delphi process, an expert team reviewed existing guidelines and literature to reach consensus on pathway definitions and components. Results Entry to the care pathways occurs via an advanced practice provider visit. Symptom and quality-of-life questionnaires as well as open-ended patient goals are used to guide patient–provider shared decision making. All treatment choices, including surgical and nonsurgical management, are presented to patients by advanced practice providers. Patients electing nonsurgical management follow-up by telehealth (preferred) or in-person visits as determined by the care pathway. Surgeon consultations are scheduled for patients desiring surgery. Surgical patients undergo urodynamics, simple cystometrics or deferred bladder testing according to the urodynamics clinical pathway. Postoperative follow-up includes telehealth visits and minimizes in-person visits for women with uncomplicated postoperative courses. Patients with resolution of symptoms are graduated from clinic and return to their referring physician. The pathways are revised following publication of new compelling evidence. Conclusions We developed POP and SUI care pathways to standardize care across a diverse provider group. Advanced practice providers use care pathways with patients as shared decision-making tools for initial evaluation of patients with prolapse and incontinence. These pathways serve as components of value-based care and encourage team members to function independently while utilizing the full scope of their training.
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Affiliation(s)
- Lauren Caldwell
- University of Texas Dell Medical School, 1301 W. 38th Street, Suite 705, Austin, TX, 78705, USA.
| | - Amy E Papermaster
- University of Texas Dell Medical School, 1301 W. 38th Street, Suite 705, Austin, TX, 78705, USA
| | | | - Amanda B White
- University of Texas Dell Medical School, 1301 W. 38th Street, Suite 705, Austin, TX, 78705, USA
| | - Amy Young
- University of Texas Dell Medical School, 1301 W. 38th Street, Suite 705, Austin, TX, 78705, USA
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Halder GE, White AB, Brown HW, Caldwell L, Wright ML, Giles DL, Heisler CA, Bilagi D, Rogers RG. A telehealth intervention to increase patient preparedness for surgery: a randomized trial. Int Urogynecol J 2021; 33:85-93. [PMID: 34028575 PMCID: PMC8142611 DOI: 10.1007/s00192-021-04831-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 04/26/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Methods to increase surgical preparedness in urogynecology are lacking. Our objective was to evaluate the impact of a preoperative provider-initiated telehealth call on surgical preparedness. METHODS This was a multicenter randomized controlled trial. Women undergoing surgery for pelvic organ prolapse and/or stress urinary incontinence were randomized to either a telehealth call 3 (± 2) days before surgery plus usual preoperative counseling versus usual preoperative counseling alone. Our primary outcome was surgical preparedness, as measured by the Preoperative Prepardeness Questionnaire. The Modified Surgical Pain Scale, Pelvic Floor Distress Inventory-20, Patient Global Impressions of Improvement, Patient Global Impressions of Severity, Satisfaction with Decision Scale, Decision Regret Scale, and Clavien-Dindo scores were obtained at 4-8 weeks postoperatively and comparisons were made between groups. RESULTS Mean telehealth call time was 11.1 ± 4.11 min. Women who received a preoperative telehealth call (n = 63) were significantly more prepared for surgery than those who received usual preoperative counseling alone (n = 69); 82.5 vs 59.4%, p < 0.01). A preoperative telehealth call was associated with greater understanding of surgical alternatives (77.8 vs 59.4%, p = 0.03), complications (69.8 vs 47.8%, p = 0.01), hospital-based catheter care (54 vs 34.8%, p = 0.04) and patient perception that nurses and doctors had spent enough time preparing them for their upcoming surgery (84.1 vs 60.9%, p < 0.01). At 4-8 weeks, no differences in postoperative and patient reported outcomes were observed between groups (all p > 0.05). CONCLUSIONS A short preoperative telehealth call improves patient preparedness for urogynecological surgery.
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Affiliation(s)
- Gabriela E Halder
- Department of Women's Health, University of Texas Austin Dell Medical School, Medical Park Tower, 1301 W. 38th St., Suite 705, Austin, TX, 78705, USA.
| | - Amanda B White
- Department of Women's Health, University of Texas Austin Dell Medical School, Medical Park Tower, 1301 W. 38th St., Suite 705, Austin, TX, 78705, USA
| | - Heidi W Brown
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, University of Wisconsin-Maddison, Maddison, WI, USA
| | - Lauren Caldwell
- Department of Women's Health, University of Texas Austin Dell Medical School, Medical Park Tower, 1301 W. 38th St., Suite 705, Austin, TX, 78705, USA
| | - Michelle L Wright
- Department of Women's Health, University of Texas Austin Dell Medical School, Medical Park Tower, 1301 W. 38th St., Suite 705, Austin, TX, 78705, USA
| | - Dobie L Giles
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, University of Wisconsin-Maddison, Maddison, WI, USA
| | - Christine A Heisler
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, University of Wisconsin-Maddison, Maddison, WI, USA
| | - Daksha Bilagi
- Department of Women's Health, University of Texas Austin Dell Medical School, Medical Park Tower, 1301 W. 38th St., Suite 705, Austin, TX, 78705, USA
| | - Rebecca G Rogers
- Department of Women's Health, University of Texas Austin Dell Medical School, Medical Park Tower, 1301 W. 38th St., Suite 705, Austin, TX, 78705, USA
- Department of Obstetrics and Gynecology, Albany Medical Center, Albany, NY, USA
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Halder GE, Cardwell J, Gao H, Gardiner H, Nutt S, White A, Young A, Rogers RG. Creating a bundled care payment model for treatment of pelvic floor disorders: introducing value into urogynecology. Am J Obstet Gynecol 2020; 223:538-542.e1. [PMID: 32531215 PMCID: PMC7282790 DOI: 10.1016/j.ajog.2020.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/22/2020] [Accepted: 06/03/2020] [Indexed: 12/16/2022]
Abstract
Ineffective healthcare delivery and expenditures associated with the traditional fee for service in-person models have turned attention toward alternative payment models as a means of enhancing healthcare quality in the United States. Bundled care payment models are a form of alternate payment models that provide a single reimbursement for all services rendered for an episode of care and have been developed extensively in primary care settings with limited literature in urogynecology. We describe the process used to create a bundled care payment model for women seeking care in a subspecialty clinic for pelvic floor disorders in partnership with our safety net insurer. The process included estimation of prior average spend, the design of an integrated practice unit, creation of pelvic floor pathways, approximation of utilization rates, and estimation of reimbursement and expenses.
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High RA, Winkelman W, Panza J, Sanderson DJ, Yuen H, Halder GE, Shaver C, Bird ET, Rogers RG, Danford JM. Sacral neuromodulation for symptomatic chronic urinary retention in females: do age and comorbidities make a difference? Int Urogynecol J 2020; 32:2703-2715. [PMID: 32902761 DOI: 10.1007/s00192-020-04485-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/30/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To evaluate if age and medical comorbidities are associated with progression to implantation of sacral neuromodulation devices in women with symptomatic chronic urinary retention. METHODS This multisite retrospective cohort included women with symptomatic chronic urinary retention who had a trial phase of sacral neuromodulation. The primary outcome was progression to implantation. Post-implantation outcomes were assessed as stable response versus decreased efficacy. A sub-analysis of catheter-reliant (intermittent-self catheterization or indwelling) patients was performed. Age was analyzed by 10-year units (decades of age). Multivariate logistic regression determined odds ratios for outcomes of implantation and for post-implantation stable response. RESULTS Implantation occurred in 86% (243/284) women across six academic institutions. Most patients (160/243, 66%) were catheter reliant at the time of trial phase. Increased decade of age was associated with reduced implantation in all women [OR 0.54 (95% CI 0.42, 0.70)] and in the subgroup of catheter-reliant women [OR 0.52 (95% CI 0.37, 0.73)]. Post-implantation stable response occurred in 68% (193/243) of women at median follow-up of 2 years (range 0.3-15 years). Medical comorbidities present at the time of trials did not impact progression to implantation or post-implantation success. CONCLUSIONS Increasing decade of age is associated with reduced implantation in women with symptomatic chronic urinary retention. There is no age cutoff at which outcomes change. Post-implantation stable response was not associated with age or medical comorbidities.
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Affiliation(s)
- Rachel A High
- Department of Obstetrics and Gynecology, Baylor Scott & White Health, Temple, TX, USA.
| | - William Winkelman
- Department of Obstetrics and Gynecology, Mount Auburn Hospital, Cambridge, and the Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, and the Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA, USA
| | - Joseph Panza
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Derrick J Sanderson
- Department of Obstetrics & Gynecology, School of Medicine & Dentistry, University of Rochester, Rochester, NY, USA
| | - Hyde Yuen
- Department of Obstetrics and Gynecology, Christ Hospital, Cincinnati, OH, USA
| | | | - Courtney Shaver
- Office of Biostatistics Baylor Scott & White, Temple, TX, USA
| | - Erin T Bird
- Department of Urology Baylor Scott & White Health, Temple, TX, USA
| | | | - Jill M Danford
- Department of Urology Baylor Scott & White Health, Temple, TX, USA
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Grimes CL, Balk EM, Crisp CC, Antosh DD, Murphy M, Halder GE, Jeppson PC, Weber LeBrun EE, Raman S, Kim-Fine S, Iglesia C, Dieter AA, Yurteri-Kaplan L, Adam G, Meriwether KV. A guide for urogynecologic patient care utilizing telemedicine during the COVID-19 pandemic: review of existing evidence. Int Urogynecol J 2020; 31:1063-1089. [PMID: 32342112 PMCID: PMC7185267 DOI: 10.1007/s00192-020-04314-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 12/17/2022]
Abstract
Introduction and hypothesis The COVID-19 pandemic and the desire to “flatten the curve” of transmission have significantly affected the way providers care for patients. Female Pelvic Medicine and Reconstructive Surgeons (FPMRS) must provide high quality of care through remote access such as telemedicine. No clear guidelines exist on the use of telemedicine in FPMRS. Using expedited literature review methodology, we provide guidance regarding management of common outpatient urogynecology scenarios during the pandemic. Methods We grouped FPMRS conditions into those in which virtual management differs from direct in-person visits and conditions in which treatment would emphasize behavioral and conservative counseling but not deviate from current management paradigms. We conducted expedited literature review on four topics (telemedicine in FPMRS, pessary management, urinary tract infections, urinary retention) and addressed four other topics (urinary incontinence, prolapse, fecal incontinence, defecatory dysfunction) based on existing systematic reviews and guidelines. We further compiled expert consensus regarding management of FPMRS patients in the virtual setting, scenarios when in-person visits are necessary, symptoms that should alert providers, and specific considerations for FPMRS patients with suspected or confirmed COVID-19. Results Behavioral, medical, and conservative management will be valuable as first-line virtual treatments. Certain situations will require different treatments in the virtual setting while others will require an in-person visit despite the risks of COVID-19 transmission. Conclusions We have presented guidance for treating FPMRS conditions via telemedicine based on rapid literature review and expert consensus and presented it in a format that can be actively referenced.
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Affiliation(s)
- Cara L Grimes
- Departments of Obstetrics and Gynecology and Urology, New York Medical College, 19 Bradhurst Avenue, Suite 2700 South Hawthorne, Valhalla, NY, 10532, USA.
| | - Ethan M Balk
- Center for Evidence Synthesis in Health, Brown School of Public Health, Brown University, Providence, RI, USA
| | - Catrina C Crisp
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, TriHealth, Cincinnati, OH, USA
| | - Danielle D Antosh
- Department of Obstetrics and Gynecology, Division of Urogynecology, Houston Methodist Hospital, Houston, TX, USA
| | - Miles Murphy
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Gabriela E Halder
- Department of Women's Health, Dell Medical School, University of Texas Austin, Austin, TX, USA
| | - Peter C Jeppson
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM, USA
| | - Emily E Weber LeBrun
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Florida, Gainesville, FL, USA
| | - Sonali Raman
- Department of Women's Health, Female Pelvic Medicine and Reconstructive Surgery, St. Elizabeth Healthcare, Fort Thomas, KY, USA
| | - Shunaha Kim-Fine
- Section of Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada
| | - Cheryl Iglesia
- Department of Obstetrics and Gynecology, Georgetown University School of Medicine, Washington, DC, USA
| | - Alexis A Dieter
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ladin Yurteri-Kaplan
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, USA
| | - Gaelen Adam
- Center for Evidence Synthesis in Health, Brown School of Public Health, Brown University, Providence, RI, USA
| | - Kate V Meriwether
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM, USA
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15
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Halder GE, Scott L, Wyman A, Mora N, Miladinovic B, Bassaly R, Hoyte L. Botox combined with myofascial release physical therapy as a treatment for myofascial pelvic pain. Investig Clin Urol 2017; 58:134-139. [PMID: 28261683 PMCID: PMC5330376 DOI: 10.4111/icu.2017.58.2.134] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 01/06/2017] [Indexed: 11/18/2022] Open
Abstract
Purpose To report the effects of combined onabotulinumtoxinA (Botox) injections and myofascial release physical therapy on myofascial pelvic pain (MFPP) by comparing pre- and posttreatment average pelvic pain scores, trigger points, and patient self-reported pelvic pain. Secondary outcomes were to examine posttreatment complications and determine demographic differences between patients with/without an improvement in pain. Materials and Methods This was an Institutional Review Board approved retrospective case series on women over 18 years with MFPP who received Botox and physical therapy between July 2006 and November 2014. Presence of trigger points and pelvic pain scores were determined by digital palpation of the iliococcygeus, puborectalis, obturator internus, and rectus muscles. Average pelvic pain scores (0–10) reflected an average of the scores obtained from palpation of each muscle. Self-reported improvement in pain was recorded as yes/no. Results Fifty women met the inclusion/exclusion criteria. Posttreatment, patients had lower average pelvic pain scores (3.7±4.0 vs. 6.4±1.8, p=0.005), and fewer trigger points (44% vs. 100%, p<0.001). Fifty-eight percent of patients (95% confidence interval, 44–72) noted an improvement in self-reported pain. Patients most likely to report no improvement in pain had chronic bowel disorders, while those most likely to report an improvement in pain had a history of past incontinence sling (p=0.03). Posttreatment complications included: constipation (8%), worsening urinary retention (2%), and urinary tract infection (4%). Conclusions Botox combined with soft tissue myofascial release physical therapy under anesthesia can be effective in treating women with chronic pelvic pain secondary to MFPP.
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Affiliation(s)
- Gabriela E Halder
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL, USA
| | - Lauren Scott
- Department of Female Pelvic Floor Medicine and Reconstructive Surgery, University of South Florida, Tampa, FL, USA
| | - Allison Wyman
- Department of Female Pelvic Floor Medicine and Reconstructive Surgery, University of South Florida, Tampa, FL, USA
| | - Nelsi Mora
- Morsani School of Medicine, University of South Florida, Tampa, FL, USA
| | - Branko Miladinovic
- Center for Comparative Effectiveness Research and Evidence-based Medicine, University of South Florida, Tampa, FL, USA
| | - Renee Bassaly
- Department of Female Pelvic Floor Medicine and Reconstructive Surgery, University of South Florida, Tampa, FL, USA
| | - Lennox Hoyte
- Department of Female Pelvic Floor Medicine and Reconstructive Surgery, University of South Florida, Tampa, FL, USA
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Halder GE, Bearman G, Sanogo K, Stevens MP. Water deterioration in rural Honduras: an examination of three communities. Rural Remote Health 2014; 14:2970. [PMID: 25328023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Affiliation(s)
- Gabriela E Halder
- Department of Medical Education, Virginia Commonwealth University VCUHS Epidemiology and Infection Control, North Hospital, Richmond, Virginia, USA.
| | - Gonzalo Bearman
- Department of Internal Medicine, Division of Infectious Diseases, Virginia Commonwealth University VCUHS Epidemiology and Infection Control, North Hospital, Richmond, Virginia, USA.
| | - Kakotan Sanogo
- Department of Epidemiology and Infection Control, Virginia Commonwealth University Health System, Virginia Commonwealth University VCUHS Epidemiology and Infection Control, North Hospital, Richmond, Virginia, USA.
| | - Michael P Stevens
- Department of Internal Medicine, Division of Infectious Diseases, Virginia Commonwealth University School of Medicine, Virginia Commonwealth University VCUHS Epidemiology and Infection Control, North Hospital, Richmond, Virginia, USA.
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VanderWielen LM, Halder GE, Enurah AS, Pearson C, Stevens MP, Crossman SH. Short-term service trips and the interprofessional team: a perspective from Honduras. J Interprof Care 2014; 29:168-9. [DOI: 10.3109/13561820.2014.942775] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
This clinical case report represents an interesting manifestation of a neurovascular condition that can be easily overlooked by the practicing healthcare provider. In the United States, a Hispanic patient of non-Asian descent presented with atypical symptoms of intractable headache and nausea with no evidence of neurologic deficits. Further diagnostic work-up was performed as the patient was not responding to traditional analgesic medication administration. Ultimately, cerebral angiogram revealed vascular occlusion with collateral circulation consistent with moyamoya syndrome. Discussion of the challenges and available clinical guidance for healthcare professionals dealing with patients presenting with intractable headache are presented in this report.
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Affiliation(s)
- Ulisses J Diaz
- Department of Hospital Medicine, Baptist Hospital of Miami
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Halder GE, Bearman G, Sanogo K, Stevens MP. Water sanitation, access, use and self-reported diarrheal disease in rural Honduras. Rural Remote Health 2013; 13:2413. [PMID: 23683301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
INTRODUCTION Only 79% of individuals living in rural Honduras use improved water sources. Inadequate drinking water quality is related to diarrheal illness, which in Honduras contributes to 18.6 episodes of diarrhea per child year in children under five years of age. The purpose of this study was to examine and compare access to drinking water and sanitation, as well as self-reported diarrheal disease incidence among three proximal communities in the Department of Yoro area of Honduras. METHODS An 11-item language-specific, interviewer-administered, anonymous questionnaire was administered to 263 randomly selected adults attending a June 2011 medical brigade held in the communities of Coyoles, La Hicaca, and Lomitas. Chi-square with Fisher exact tests were utilized to compare water access, sanitation, and self-reported diarrheal incidence among these communities. RESULTS Coyoles and La Hicaca used private faucets as their primary water sources. Coyoles had the greatest use of bottled water. Lomitas used rivers as their primary water source, and did not use bottled water. Mostly, females were responsible for acquiring water. Usage of multiple water sanitation methods was most common in Coyoles, while no sanitation method was most common in Lomitas. In Lomitas and La Hicaca, water filters were mostly provided via donation by non-governmental organizations. Lomitas had the highest reported incidence of diarrhea among self and other household members. CONCLUSIONS Critical differences in water access, sanitation, and self-reported diarrheal incidence among three geographically distinct, yet proximal, communities highlights the need for targeted interventions even in geographically proximal rural areas.
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Affiliation(s)
- Gabriela E Halder
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA.
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Caban-Martinez AJ, Halder GE, Tellechea L, Fajardo M, Kaltman J, Anand J, Prendes S, Penyak V, Koganti D, Chavoustie S, Fleming LE. Health status and behaviors among adults residing in rural Dominican Republic. Rural Remote Health 2012; 12:1956. [PMID: 22591172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
INTRODUCTION The rapidly increasing burden of chronic diseases linked to adequacy of healthcare services and individual health behaviors is a key determinant of global public health. Given demographic aging and the accompanying health transition, chronic diseases in low and middle income communities of the Dominican Republic are likely to increase significantly. The objective of this article was to report on efforts in surveillance of health conditions and behaviors in underserved rural Dominican communities. METHODS A modified 30 item, language-sensitive health survey was randomly administered to 117 adult participants (18 years and older) during a health fair held at three rural villages from March to April 2009 in the rural San Cristobál region of the Dominican Republic. Descriptive analyses of select health conditions and behavior variables from all completed surveys were tabulated. RESULTS Adult participant ages ranged from 18 to 79 years (mean ± standard deviation; 34.0 ± 2.1), height from 1.4 to 2.0 m (1.7 ± 0.1), weight from 41.8 to 100.0 kg (66.2 ± 1.7) and BMI from 15.2 to 46.2 (24.2 ± 0.7). Overall, 69.2% of the sample self-reported their general health status to be fair to poor. The top three chronic diseases included: high blood pressure (35.8%), diabetes (15.0%), and asthma (14.2%). In all, 33.4% reported current smoker status and 61.7% were classified as heavy alcohol drinkers. CONCLUSION Considerable variation was found in the self-report of health conditions and behavioral characteristics among those individuals that attended the health fair. Documenting these important health indicators in the rural communities has the potential to inform the development of surveillance activities and prevention efforts for future health education interventions.
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