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Sung VW, Menefee S, Richter HE, Moalli PA, Andy U, Weidner A, Rahn DD, Paraiso MF, Jeney SE, Mazloomdoost D, Gilbert J, Whitworth R, Thomas S. Patient perspectives in adverse event reporting after vaginal apical prolapse surgery. Am J Obstet Gynecol 2024:S0002-9378(24)00569-6. [PMID: 38710268 DOI: 10.1016/j.ajog.2024.04.043] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/10/2024] [Accepted: 04/30/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND Many clinical trials use systematic methodology to monitor adverse events (AE) and determine grade (severity), expectedness, and relatedness to treatments as determined by clinicians. However, patient perspective in the process remains lacking. OBJECTIVES To compare clinician versus patient grading of AE severity in a urogynecologic surgical trial. Secondary objectives were to estimate the association between patient grading of AEs with decision-making and quality of life outcomes and to determine if patient perspective changes over time. STUDY DESIGN This was a planned supplementary study, "Patient-Perspectives in Adverse Event Reporting" (PPAR), to a randomized trial comparing 3 surgical approaches to vaginal apical prolapse. In the parent trial, AEs experienced by patients were collected per a standardized protocol every 6 months where clinicians graded AE severity (mild, moderate, severe/life threatening). In this sub-study, we obtained additional longitudinal patient perspectives for 19 predetermined "PPAR AEs". Patients provided their own severity grading (mild, moderate, severe/very severe/ life threatening) at initial assessment and at 12 and 36 months postoperatively. Clinicians and patients were masked to each other's reporting. The primary outcome was the interrater agreement (kappa statistic, κ) for AE severity between the initial clinician and patient assessment, combining patient grades of mild and moderate. Association between AE severity and the Decision-Regret Scale (DRS), Satisfaction with Decision Scale (SDS), the Short-Form Health Survey-12 (SF-12), and Patient-Global Impression of Improvement (PGI-I) scores were assessed utilizing Spearman's correlation coefficient (ρ) for continuous scales, Mantel-Haenszel chi-squared test for PGI-I, and T-tests or chi-squared tests comparing assessments of severe vs other grades. To describe patient perspective changes over time, the intra-observer agreement was estimated for AE severity grade over time using weighted kappa-coefficients. RESULTS Of 360 patients randomized, 219 (61%) experienced a total of 527 PPAR AEs (91% moderate and 9% severe/life threatening by clinician grading). Mean patient age was 67 years, 87% were White, and 12% Hispanic. Of patients reporting any PPAR event, the most common were urinary tract infection (61%), de novo urgency urinary incontinence (35%), stress urinary incontinence (22%), and fecal incontinence (13%). Overall agreement between clinician and participant grading of severity was poor (κ=0.24 (95%CI 0.14, 0.34). Of 414 AEs clinicians graded as moderate, patients graded 120 (29%) mild, and 80 (19%) severe. Of 39 AEs graded severe by clinicians, patients graded 15 (38%) mild or moderate. Initial patient grading of the most severe reported AE was mildly correlated with worse DRS (ρ=0.2, p=0.01), SF-12 (ρ=-0.24, p<0.01) and PGI-I (p<0.01). There was no association between AE severity and SDS. Patients with an initial grading of "severe" had more regret, lower quality of life, and poorer global impressions of health than those whose worst severity grade was mild (p<0.05). Agreement between the patients' initial severity and later timepoints was fair at 12 months (κ=0.48 (95% CI 0.39, 0.58)) and 36 months (κ=0.45 (95% CI 0.37, 0.53)). CONCLUSIONS Clinician and patient perceptions of AE severity are discordant. Worse severity from the patient perspective was associated with patient-centered outcomes. Including the patient perspective provides additional information for evaluating surgical procedures.
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Affiliation(s)
- Vivian W Sung
- Department of Obstetrics & Gynecology, Division of Urogynecology, Alpert Medical School of Brown University, Providence, RI, United States.
| | - Shawn Menefee
- Division of Female Pelvic Medicine & Reconstructive Surgery, Department of Obstetrics and Gynecology, Kaiser Permanente San Diego, San Diego, CA
| | - Holly E Richter
- Department of Obstetrics and Gynecology, Division of Urogynecology and Reconstructive Pelvic Surgery, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Pamela A Moalli
- Department of Obstetrics & Gynecology, Division of Urogynecology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Uduak Andy
- Division of Urogynecology, Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Alison Weidner
- Department of Obstetrics & Gynecology, Division of Urogynecology & Reconstructive Pelvic Surgery, Duke University, Durham, NC, United States
| | - David D Rahn
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Marie F Paraiso
- Center for Urogynecology & Pelvic Reconstructive Surgery, Women's Health Institute, Cleveland Clinic, Cleveland, OH
| | - Sarah E Jeney
- Department of Obstetrics & Gynecology, Division of Urogynecology, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Donna Mazloomdoost
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
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Kravitz E, Thompson JJ, Christiansen T, Arya L, Andy U, Kim EK. Dual Incontinence and Risk of Fall: A Retrospective Cohort Study. Urogynecology (Phila) 2024; 30:280-285. [PMID: 38484243 DOI: 10.1097/spv.0000000000001467] [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: 03/19/2024]
Abstract
IMPORTANCE Although there is a known association between urinary incontinence (UI) and fall risk, it is unclear if having both UI and fecal incontinence, or dual incontinence (DI), increases this risk. OBJECTIVE The objective of our study was to elucidate a relationship between DI and falls. STUDY DESIGN This was a retrospective cohort study at a tertiary academic health system of female patients 65 years and older presenting for a new patient visit to a urogynecology health care professional for UI from 2019 to 2021. Demographic data and responses to intake questionnaires on fall and markers of frailty were extracted. Multivariable logistic regression was performed to identify factors associated with fall adjusting for covariates identified upon univariate comparison. RESULTS A total of 2,814 women were included in the analysis; 2,661 patients reported UI alone, and 153 reported DI. A greater proportion of women with DI reported a fall in the past year compared with those with UI alone (22.9% vs 12.2%, P < 0.001). Univariable comparison showed that these 2 groups differed regarding age, body mass index, and estimated median household income. On multivariable logistic regression, DI was significantly associated with falls (adjusted odds ratio 2.56; 95% confidence interval, 1.02-5.46). Other factors independently associated with falls in older women with UI include (adjusted odds ratio, 95% confidence interval): lower income groups (2.35, 1.50-3.67 for $20,000-$40,000, compared with $100,000 and higher-income group), difficulty with activities of daily living (1.60, 1.25-2.13), and unintentional weight loss (1.68, 1.05-2.68). CONCLUSION Patients with DI have a 2-fold higher risk of fall compared with patients with UI alone.
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Affiliation(s)
- Elizabeth Kravitz
- From the Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Jacqueline J Thompson
- From the Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | | | - Lily Arya
- From the Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Uduak Andy
- From the Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, PA
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Andy U, Muñoz J, Koelper N, Borodyanskaya Y, Compher C, Ejike N, Markland A, Arya L. A diet modification intervention for older women with fecal incontinence. J Am Geriatr Soc 2023; 71:3316-3318. [PMID: 37235480 PMCID: PMC10783857 DOI: 10.1111/jgs.18424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 05/08/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023]
Affiliation(s)
- Uduak Andy
- Division of Urogynecology, Department of OBGYN, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jaclyn Muñoz
- Division of Urogynecology, Department of OBGYN, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nathanael Koelper
- Division of Urogynecology, Department of OBGYN, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yelizaveta Borodyanskaya
- Division of Urogynecology, Department of OBGYN, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Charlene Compher
- Department of Biobehavioral Health Science, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Nancy Ejike
- Division of Urogynecology, Department of OBGYN, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alayne Markland
- Birmingham/Atlanta VA GRECC, Birmingham VA Health Care System, Birmingham, Alabama, USA
- Division of Gerontology, Geriatrics and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Lily Arya
- Division of Urogynecology, Department of OBGYN, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Luchristt D, Carper B, Balgobin S, Meyer I, Myers D, Mazloomdoost D, Gantz M, Andy U, Zyczynski HM, Lukacz ES. Characteristics associated with subjective and objective measures of treatment success in women undergoing percutaneous tibial nerve stimulation vs sham for accidental bowel leakage. Int Urogynecol J 2023; 34:1715-1723. [PMID: 36705728 PMCID: PMC10372194 DOI: 10.1007/s00192-022-05431-y] [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: 09/07/2022] [Accepted: 11/25/2022] [Indexed: 01/28/2023]
Abstract
INTRODUCTION AND HYPOTHESIS In randomized trials both percutaneous tibial nerve stimulation (PTNS) and sham result in clinically significant improvements in accidental bowel leakage (ABL). We aimed to identify subgroups who may preferentially benefit from PTNS in women enrolled in a multicenter randomized trial. METHODS This planned secondary analysis explored factors associated with success for PTNS vs sham using various definitions: treatment responder using three cutoff points for St. Mark's score (≥3-, ≥4-, and ≥5-point reduction); Patient Global Impression of Improvement (PGI-I) of ≥ much better; and ≥50% reduction in fecal incontinence episodes (FIEs). Backward logistic regression models were generated using elements with significance of p<0.2 for each definition and interaction terms assessed differential effects of PTNS vs sham. RESULTS Of 166 women randomized, 160 provided data for at least one success definition. Overall, success rates were 65% (102 out of 158), 57% (90 out of 158), and 46% (73 out of 158) for ≥3-, ≥4-, and ≥5-point St Mark's reduction respectively; 43% (68 out of 157) for PGI-I; and 48% (70 out of 145) for ≥50% FIEs. Of those providing data for all definitions of success, 77% (109 out of 142) met one success criterion, 43% (61 out of 142) two, and 29% (41 out of 142) all three success criteria. No reliable or consistent factors were associated with improved outcomes with PTNS over sham regardless of definition. CONCLUSIONS Despite exploring diverse success outcomes, no subgroups of women with ABL differentially responded to PTNS over sham. Success results varied widely across subjective and objective definitions. Further investigation of ABL treatment success definitions that consistently and accurately capture patient symptom burden and improvement are needed.
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Affiliation(s)
| | | | | | - Isuzu Meyer
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Deborah Myers
- Brown University, Women's & Infants Hospital, Providence, RI, USA
| | - Donna Mazloomdoost
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Marie Gantz
- RTI International, Research, Triangle Park, NC, USA
| | - Uduak Andy
- University of Pennsylvania, Philadelphia, PA, USA
| | - Halina M Zyczynski
- Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, PA, USA
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Familusi OO, Amutah C, Levin P, Andy U, James A. U.S.-Based Obstetrician/Gynecologists' Experiences with Delivering Care to Women with Female Genital Cutting. J Womens Health (Larchmt) 2023; 32:486-493. [PMID: 36857710 DOI: 10.1089/jwh.2022.0294] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
Background: There has been an increase of women living in the United States who have experienced female genital cutting (FGC). However, limited research exists evaluating the experiences of obstetrician/gynecologists delivering care to this patient population. This study aimed to assess the overall experiences, including barriers and facilitators, of U.S.-based obstetrician/gynecologists (OBGYNs) with delivering care to patients with female genital cutting at a single academic health center in the United States. Materials and Methods: This is a qualitative study of OBGYNs at a large, U.S., urban, academic health center. OBGYNs participated in a one-on-one semistructured interview. Thematic analysis using a grounded theory approach was conducted to identify predominating themes regarding the overall experiences, barriers, and facilitators to delivering care to patients with FGC. Results: Analysis of 15 study interviews revealed 4 main themes impacting the ability of OBGYNs to deliver care to patients with FGC: (1) limited educational training on FGC, (2) challenges with identifying that a patient had FGC and with using the World Health Organization classification system, (3) questions regarding "normative" anatomy and reinfibulation after vaginal procedures, and (4) navigating affective responses of patient and self when FGC is encountered. Conclusion: The above findings have practical implications, showing that the limited educational experience and lack of a clear policy on how to manage the care of women with FGC lead to variation and even limitations in how care is delivered to these women. We encourage OBGYN professional societies to consider creating education and policy to aid clinicians in caring for patients with FGC.
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Affiliation(s)
- Olivia O Familusi
- Department of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christina Amutah
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Pamela Levin
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania. USA
| | - Uduak Andy
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania. USA
| | - Abike James
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania. USA
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Mueller MG, Das P, Andy U, Brennaman L, Dieter AA, Dwarica D, Kirby AC, Shepherd JP, Gregory WT, Amundsen CL. Longitudinal urinary microbiome characteristics in women with urgency urinary incontinence undergoing sacral neuromodulation. Int Urogynecol J 2023; 34:517-525. [PMID: 35608624 DOI: 10.1007/s00192-022-05219-0] [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] [Received: 01/11/2022] [Accepted: 04/19/2022] [Indexed: 01/26/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to evaluate the stability of the urinary microbiome communities in women undergoing sacral neuromodulation (SNM) for urgency urinary incontinence (UUI). We hypothesized that clinical response to SNM therapy would be associated with changes in the urinary microbiome. METHODS Women completed the Overactive Bladder Questionnaire Short-Form, the International Consultation on Incontinence Questionnaire Short Form, and the Female Sexual Function Index at baseline and 3 months post-SNM implantation. Transurethral urinary specimens were obtained for microbiome analysis at baseline and 3 months postoperatively. The V4 region of the 16S rRNA gene (515F-806R) was amplified with region-specific primers, and Amplicon Sequence Variants (ASVs) were identified with a closed-reference approach of taxonomic classification. Alpha-diversity was calculated using the phylogenetic (i.e., Faith's phylogenetic diversity) and nonphylogenetic metrics (i.e., Shannon diversity, and Pielou's evenness) using the QIIME2 plugin. Longitudinal paired volatility analysis was performed using the DEICODE and Gemelli plugin to account for host specificity across both time and space. RESULTS Nineteen women who underwent SNM and provided both baseline and 3-month urine samples were included in this analysis. Women reported improvement in objective (number of UUI episodes) and subjective (symptom severity and health-related quality of life) measures. Ninety percent of the bacteria were classified as Bacteroidetes, Firmicutes, Proteobacteria, and Actinobacteria. No significant differences were observed in each subject's beta-diversity at 3 months compared with their baseline microbiome. CONCLUSIONS Our descriptive pilot study of a cohort of women who had achieved objective and subjective improvements in UUI following SNM therapy demonstrates that the urinary microbiome remains relatively stable, despite variability amongst the cohort.
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Affiliation(s)
- Margaret G Mueller
- Northwestern University, 250 E. Superior St, Suite 05-2113, Chicago, IL, 60611, USA.
| | - Promi Das
- University of California, San Diego, CA, USA
| | - Uduak Andy
- University of Pennsylvania, Philadelphia, PA, USA
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Mueller MG, Das P, Andy U, Dieter AA, Dwarica D, Kirby AC, Shepherd JP, Gregory WT, Amundsen CL, Kenton K. Characterization of the GU microbiome in women with self-perceived bladder health over the life course. Neurourol Urodyn 2023; 42:133-145. [PMID: 36259770 PMCID: PMC10091982 DOI: 10.1002/nau.25058] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 09/20/2022] [Accepted: 09/22/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND A variety of factors influence bladder health, including environmental factors, life experiences, biologic foundations, and coexistent medical conditions. A biologically diverse microbial community exists in the urine that is likely influenced by the microbial inhabitants of the vagina. The relationship between the genitourinary (GU) microbiome and self-perceived bladder health is unknown. OBJECTIVE To longitudinally define the GU microbiome in women with self-percieved bladder health sampled across multiple time points over a year. STUDY DESIGN Women with no reported lower urinary tract dysfunction or symptoms (LUTS) were recruited from six clinical sites and assessed every 6 weeks for 1 year. Voided urine and vaginal samples were longitudinally collected. Self-perceived bladder health was assessed with select items from the LURN comprehensive assessment of self-reported urinary symptoms (CASUS) tool. We defined four life phases as follows: young (18-34 years, nulliparous), midlife (35-45 years, menstruating), transitional (46-60 years, perimenopausal), mature (>60 years, not using vaginal and/or systemic hormone replacement therapy). DNA was extracted from samples, and the V4 region of the 16S rRNA gene was amplified with region-specific primers. The 16S rRNA sequencing on an Illumina NovaSeq. Microbial beta-diversity was calculated using DEICODE to identify microbial taxa that cluster in the samples. Longitudinal volatility analysis was performed using the gemelli plugin. Log-abundance ratios of microbial features were explored and visualized in Qurro. RESULTS Fifty-four (N = 16 young, N = 16 midlife, N = 15 transitional, N = 7 mature) women were enrolled and provided baseline data. Most women in each life phase (93%-98%) continued to report self-perceived bladder health throughout the 1-year follow-up as assessed by CASUS items. Temporal-based microbial diversity of urinary and vaginal microbiome remained relatively stable over 1 year in all subjects. The GU microbiomes of mature women were distinct and microbially diverse from that of young, midlife, and transitional women, with genera of Gardnerella, Cupriavidus, and Dialister contributory to the microbial features of the mature microbiome. The mature GU microbiome was statistically different (p < 0.0001) from the midlife, transitional, and young microbiome for the log ratio of Gardnerella and Cupriavidus (in the numerator) and Lactobacillus (in the denominator) for voided samples and Gardnerella and Dialister (in the numerator) and Lactobacillus (in the denominator) for vaginal samples. Differences in the GU microbiome were also demonstrated via longitudinal beta-diversity between women developing urinary frequency as reported by CASUS responses or objectively on bladder diary compared to women without urinary frequency. CONCLUSION In women with a self-perceived healthy bladder, the GU microbiome remained stable in all age groups over a 1 year period. Differences were seen with respect to life phase, where mature women were distinct from all other groups, and with respect to self-reported LUTS.
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Affiliation(s)
- Margaret G Mueller
- Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University, Evanston, Illinois, USA
| | - Promi Das
- Department of Pediatrics, University of California, San Diego, San Diego, California, USA
| | - Uduak Andy
- Division of Female Pelvic Medicine and Reconstructive Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alexis A Dieter
- Medstar Washington Hospital Center, Washington, District of Columbia, USA
| | - Denicia Dwarica
- Division of Female Pelvic Medicine and Reconstructive Surgery, University of Missouri, Columbia, Missouri, USA
| | - Anna C Kirby
- Division of Female Pelvic Medicine and Reconstructive Surgery, University of Washington, Seattle, Washington, USA
| | | | - W Thomas Gregory
- Division of Female Pelvic Medicine and Reconstructive Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Cindy L Amundsen
- Division of Female Pelvic Medicine and Reconstructive Surgery, Duke University, Durham, North Carolina, USA
| | - Kimberly Kenton
- Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University, Evanston, Illinois, USA
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Hassani D, Koelper N, Borodyanskaya Y, Arya NG, Rao H, Andy U. Cognitive function following surgery for pelvic organ prolapse. Neurourol Urodyn 2022; 41:1853-1861. [PMID: 36047412 PMCID: PMC9633552 DOI: 10.1002/nau.25035] [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: 05/25/2022] [Revised: 07/29/2022] [Accepted: 08/16/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Older women are at higher risk for cognitive dysfunction following surgery. We hypothesized that for women undergoing pelvic organ prolapse (POP) surgery, memory function would not be significantly different at delayed postoperative assessment compared to baseline. OBJECTIVE We sought to compare performance on tests of various neurocognitive domains before and after surgery for POP. METHODS A prospective cohort study was conducted with women, aged 60 years and older who were undergoing surgery for POP. A battery of highly sensitive neurocognitive tests was administered preoperatively (baseline), on postoperative day 1 (postoperative visit 1, POV1), and at the first postoperative clinic visit 4-6 weeks after surgery (postoperative visit 2, POV2). The test battery included the scene-encoding memory task, the n-back task, the Iowa gambling task, the balloon analogue risk task, and the psychomotor vigilance task. These tests assessed the neurocognitive subdomains of episodic memory, working memory, decision-making, risk-taking, and sustained attention. Two score comparisons were made: between baseline and POV1, and between baseline and POV2. RESULTS In 29 women, performance on the scene-encoding memory task was worse at POV1 than at baseline (2.22 ± 0.4 vs. 2.45 ± 0.6, p < 0.05) but was better than baseline at POV2 (2.7 ± 0.7 vs. 2.45 ± 0.6, p < 0.05). Similarly, performance on the psychomotor vigilance test was worse at POV1 than at baseline (p < 0.01) but there was no difference at POV2. There was no difference in performance on the Iowa gambling test, n-back test, and balloon analogue risk tasks between baseline and any postoperative visit. CONCLUSION Cognitive test scores did not worsen significantly between baseline and delayed postoperative assessments in older women undergoing surgery for POP.
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Affiliation(s)
- Daisy Hassani
- University of Pennsylvania Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery
| | - Nathanael Koelper
- Department of Obstetrics and Gynecology, Center for Research on Reproduction and Women's Health (N.K.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Yelizaveta Borodyanskaya
- University of Pennsylvania Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery
| | | | - Hengyi Rao
- University of Pennsylvania Perelman School of Medicine, Department of Neurology
| | - Uduak Andy
- University of Pennsylvania Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery
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Andy A, Andy U. Understanding Communication in an Online Cancer Forum: Content Analysis Study. JMIR Cancer 2021; 7:e29555. [PMID: 34491209 PMCID: PMC8456325 DOI: 10.2196/29555] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 04/12/2021] [Revised: 07/20/2021] [Accepted: 08/10/2021] [Indexed: 01/30/2023] Open
Abstract
Background Cancer affects individuals, their family members, and friends, and increasingly, some of these individuals are turning to online cancer forums to express their thoughts/feelings and seek support such as asking cancer-related questions. The thoughts/feelings expressed and the support needed from these online forums may differ depending on if (1) an individual has or had cancer or (2) an individual is a family member or friend of an individual who has or had cancer; the language used in posts in these forums may reflect these differences. Objective Using natural language processing methods, we aim to determine the differences in the support needs and concerns expressed in posts published on an online cancer forum by (1) users who self-declare to have or had cancer compared with (2) users who self-declare to be family members or friends of individuals with or that had cancer. Methods Using latent Dirichlet allocation (LDA), which is a natural language processing algorithm and Linguistic Inquiry and Word Count (LIWC), a psycholinguistic dictionary, we analyzed posts published on an online cancer forum with the aim to delineate the language features associated with users in these different groups. Results Users who self-declare to have or had cancer were more likely to post about LDA topics related to hospital visits (Cohen d=0.671) and use words associated with LIWC categories related to health (Cohen d=0.635) and anxiety (Cohen d=0.126). By contrast, users who declared to be family members or friends tend to post about LDA topics related to losing a family member (Cohen d=0.702) and LIWC categories focusing on the past (Cohen d=0.465) and death (Cohen d=0.181) were more associated with these users. Conclusions Using LDA and LIWC, we show that there are differences in the support needs and concerns expressed in posts published on an online cancer forum by users with cancer compared with family members or friends of those with cancer. Hence, responders to online cancer forums need to be cognizant of these differences in support needs and concerns and tailor their responses based on these findings.
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Affiliation(s)
- Anietie Andy
- Penn Medicine Center for Digital Health, University of Pennsylvania, Philadelphia, PA, United States
| | - Uduak Andy
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
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Allen A, DeAgostino-Kelly M, Andy U. 102 Is advanced preoperative imaging associated with lower perioperative adverse outcomes in women undergoing laparoscopic hysterectomy? Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2021.04.127] [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] [Indexed: 10/21/2022]
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Abstract
Purpose of review The purpose of this article is to review the various forms of incontinence, highlight their impact on older women, and to explore current literature regarding the link between physical activity, physical function, and incontinence. Recent findings Both urinary and fecal incontinence become more prevalent with age, and are associated with significant morbidity. In parallel, there is a well-established decline in physical function that occurs with age. Furthermore, incontinence has a bidirectional relationship with physical function decline. Given the known link between increasing physical activity and preserved physical function, there is an emerging body of literature seeking to determine whether increases in physical activity may also improve incontinence outcomes. We review some recent data on this topic. Summary Continence and physical function are two closely linked entities. Further research is needed to determine whether interventions that increase physical activity might result in improved continence outcomes.
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Affiliation(s)
- Daisy Hassani
- Department of Obstetrics and Gynecology Hospital of the University of Pennsylvania 3400 Spruce Street Philadelphia, PA 19104
| | - Lily Arya
- Department of Obstetrics and Gynecology Hospital of the University of Pennsylvania 3400 Spruce Street Philadelphia, PA 19104
| | - Uduak Andy
- Department of Obstetrics and Gynecology Hospital of the University of Pennsylvania 3400 Spruce Street Philadelphia, PA 19104
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Richter HE, Dunivan G, Brown HW, Andy U, Dyer KY, Rardin C, Muir T, McNevin S, Paquette I, Gutman RE, Quiroz L, Wu J. A 12-Month Clinical Durability of Effectiveness and Safety Evaluation of a Vaginal Bowel Control System for the Nonsurgical Treatment of Fecal Incontinence. Female Pelvic Med Reconstr Surg 2019; 25:113-119. [PMID: 30807411 DOI: 10.1097/spv.0000000000000681] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The aim of this study was to characterize clinical success, impact on quality of life, and durability up to 1 year in women with fecal incontinence (FI) responsive to an initial test period with a trial vaginal bowel control system. METHODS This was a prospective open-label study in subjects with FI and successfully fit who underwent an initial 2-week trial period. Those achieving 50% or greater reduction in FI episodes were provided the long-term system. Primary outcome was success at 3 months defined as 50% or greater reduction in baseline FI episodes, also assessed at 6 and 12 months. Secondary outcomes included symptom impact measured with Fecal Incontinence Quality of Life scale, symptom severity by the St Mark's (Vaizey) questionnaire, Patient Global Impression of Improvement, and satisfaction. Adverse events were collected. Primary analysis was intention to treat (ITT). RESULTS Seventy-three subjects with baseline mean of 14.1 ± 12.15 FI episodes over 2 weeks entered the treatment period. Success rate at 3 months was 72.6% (53/73, P < 0.0001); per-protocol, 84.1% (53/63, P < 0.0001). Significant improvement in all Fecal Incontinence Quality of Life subscales and St Mark's questionnaire meeting minimally important differences was noted. Satisfaction was 91.7%, 89.7%, and 94.4% at 3, 6, and 12 months, respectively; 77.4%, 77.6%, and 79.6% were very much/much better on the Patient Global Impression of Improvement at 3, 6, and 12 months, respectively. Most common adverse event was vaginal wall injury, with most adverse events (90/134, 67%) occurring during fitting period. CONCLUSIONS In women with successful fitting and initial treatment response, durable efficacy was seen at 3, 6, and 12 months by objective and subjective measures, with favorable safety.
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Affiliation(s)
| | | | - Heidi W Brown
- University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI
| | - Uduak Andy
- University of Pennsylvania, Philadelphia, PA
| | | | | | | | | | | | - Robert E Gutman
- MedStar Washington Hospital Center/Georgetown University, Washington, DC
| | | | - Jennifer Wu
- University of North Carolina, Chapel Hill, NC
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13
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Chu* C, Schmitz K, Khanijow K, Stambakio H, Newman D, Andy U, Arya L. PD06-12 FEASIBILITY AND OUTCOMES IN A PILOT RANDOMIZED CONTROLLED TRIAL OF A HOME-BASED INTEGRATED PHYSICAL EXERCISE AND BLADDER TRAINING PROGRAM VERSUS USUAL CARE FOR COMMUNITY-DWELLING OLDER WOMEN WITH URINARY INCONTINENCE. J Urol 2019. [DOI: 10.1097/01.ju.0000555233.29108.0b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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Kadam-Halani P, Sansone S, Arya L, Harvie H, Andy U. 15: Dietary patterns and defecatory symptoms in women undergoing surgery for pelvic organ prolapse. Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2019.01.025] [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] [Indexed: 11/17/2022]
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15
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Buckingham L, Haggerty A, Graul A, Morgan M, Burger R, Ko E, Andy U, Giuntoli R. Sexual function following hysterectomy for endometrial cancer: A five-year follow up investigation. Gynecol Oncol 2018; 152:139-144. [PMID: 30420200 DOI: 10.1016/j.ygyno.2018.10.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 10/12/2018] [Accepted: 10/20/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVES We sought to determine a baseline and five-year follow up sexual function score in women undergoing hysterectomy for endometrial cancer. METHODS A cross-section of endometrial cancer patients receiving care from 2006 to 2010 was identified. Patients were surveyed during academic year 2011 using the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ). Respondents were re-surveyed in 2016. The PISQ was also administered at a single time point to a control group of urogynecology patients. Statistical analyses were conducted using STATA software, version 13.1. RESULTS 129 endometrial cancer and 63 matched urogynecology patients responded to an initial survey and sufficiently answered the PISQ. There was no statistical difference in BMI, race, diabetes, or smoking history between groups. In 2011, 62.5% of endometrial cancer patients versus 72.6% of urogynecology patients reported sexual activity (p = 0.166). Median PISQ score for these groups was 33 [IQR 29-38] and 32 [IQR 28-37] respectively (p = 0.472). Twenty-nine (22%) endometrial cancer patients sufficiently answered the initial and 5-year follow up PISQ to be included in follow up analysis. Median PISQ score at five years was not significantly different from baseline: 31 [IQR 27-39] versus 33 [IQR 31-38] (p = 0.299). With multivariable modeling, no demographic or clinical characteristics of endometrial cancer patients were independently associated with sexual function (p = NS). CONCLUSIONS Sexual function for endometrial cancer patients was not significantly different from women treated for benign disease. Sexual function also remained stable for endometrial cancer patients regardless of time from initial treatment. Further prospective studies are needed to better characterize sexual function in endometrial cancer survivors.
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Affiliation(s)
- Lindsey Buckingham
- University of Pennsylvania Health System, 3400 Civic Center Blvd, Third Floor, West Pavilion, Philadelphia 19104, PA, USA.
| | - Ashley Haggerty
- University of Pennsylvania Health System, 3400 Civic Center Blvd, Third Floor, West Pavilion, Philadelphia 19104, PA, USA
| | - Ashley Graul
- University of Pennsylvania Health System, 3400 Civic Center Blvd, Third Floor, West Pavilion, Philadelphia 19104, PA, USA
| | - Mark Morgan
- University of Pennsylvania Health System, 3400 Civic Center Blvd, Third Floor, West Pavilion, Philadelphia 19104, PA, USA
| | - Robert Burger
- University of Pennsylvania Health System, 3400 Civic Center Blvd, Third Floor, West Pavilion, Philadelphia 19104, PA, USA
| | - Emily Ko
- University of Pennsylvania Health System, 3400 Civic Center Blvd, Third Floor, West Pavilion, Philadelphia 19104, PA, USA
| | - Uduak Andy
- University of Pennsylvania Health System, 3400 Civic Center Blvd, Third Floor, West Pavilion, Philadelphia 19104, PA, USA
| | - Robert Giuntoli
- University of Pennsylvania Health System, 3400 Civic Center Blvd, Third Floor, West Pavilion, Philadelphia 19104, PA, USA
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Traylor J, Koelper N, Kim S, Sammel M, Andy U. Impact of Delay to Hysterectomy for Benign Gynecologic Disease. J Minim Invasive Gynecol 2018. [DOI: 10.1016/j.jmig.2018.09.326] [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] [Indexed: 11/29/2022]
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18
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Lee D, Arya L, Harvie H, Andy U. Factors Associated with Catastrophizing in Women with Urinary Urgency. J Minim Invasive Gynecol 2015. [DOI: 10.1016/j.jmig.2014.12.059] [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] [Indexed: 10/24/2022]
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