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Deng M, Yang R, Sun Q, Zhang J, Miao J. Small-molecule inhibitor HI-TOPK-032 improves NK-92MI cell infiltration into ovarian tumours. Basic Clin Pharmacol Toxicol 2024; 134:629-642. [PMID: 38501576 DOI: 10.1111/bcpt.14002] [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: 12/17/2023] [Revised: 02/24/2024] [Accepted: 02/26/2024] [Indexed: 03/20/2024]
Abstract
The effectiveness of natural killer (NK) cells transferred adoptively in combating solid tumours is limited by challenges such as their difficulty in penetrating tumours from the bloodstream and maintaining viability without the support of interleukin-2 (IL-2). Genetically modified NK-92MI cells, which can release IL-2 to sustain their viability, have been identified as a promising alternative. This adaptation addresses the negative consequences of systemic IL-2 administration. The role of PSD-95/discs large/ZO-1 (PDZ)-binding kinase (PBK) in cancer development is recognized, but its effects on immunity are not fully understood. This study explores how PBK expression influences the ability of NK-92MI cells to infiltrate ovarian tumours. Elevated levels of PBK expression have been found in various cancers, including ovarian cancer (OV), with analyses showing higher PBK mRNA levels in tumour tissues compared to normal ones. Immunohistochemistry has confirmed increased PBK expression in OV tissues. Investigations into PBK's role in immune regulation reveal its association with immune cell infiltration, indicating a potentially compromised immune environment in OV with high PBK expression. The small-molecule inhibitor HI-TOPK-032, which inhibits PBK, enhances the cytotoxicity of NK-92MI cells toward OV cells. It increases the production of interferon-γ and tumour necrosis factor-α, reduces apoptosis and encourages cell proliferation. Mechanistic studies showed that contact with OV cells treated with HI-TOPK-032 upregulates CD107a on NK-92 cells. In vivo studies demonstrated that HI-TOPK-032 improves the antitumour effects of NK-92MI cells in OVCAR3Luc xenografts, extending survival without significant side effects. Safety assessments in mice confirm HI-TOPK-032's favourable safety profile, highlighting its potential as a viable antitumour therapy. These results suggest that combining NK-92MI cells with HI-TOPK-032 enhances antitumour effectiveness against OV, indicating a promising, safe and effective treatment strategy that warrants further clinical investigation.
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Affiliation(s)
- Mengqi Deng
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Ruiye Yang
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Qi Sun
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Jiamin Zhang
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Jinwei Miao
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
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2
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Kirshteyn G, Golan R, Chaet M. Performance of ChatGPT vs. HuggingChat on OB-GYN Topics. Cureus 2024; 16:e56187. [PMID: 38618446 PMCID: PMC11015885 DOI: 10.7759/cureus.56187] [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: 02/26/2024] [Accepted: 03/14/2024] [Indexed: 04/16/2024] Open
Abstract
Background While large language models show potential as beneficial tools in medicine, their reliability, especially in the realm of obstetrics and gynecology (OB-GYN), is not fully comprehended. This study seeks to measure and contrast the performance of ChatGPT and HuggingChat in addressing OB-GYN-related medical examination questions, offering insights into their effectiveness in this specialized field. Methods ChatGPT and HuggingChat were subjected to two standardized multiple-choice question banks: Test 1, developed by the National Board of Medical Examiners (NBME), and Test 2, gathered from the Association of Professors of Gynecology & Obstetrics (APGO) Web-Based Interactive Self-Evaluation (uWISE). Responses were analyzed and compared for correctness. Results The two-proportion z-test revealed no statistically significant difference in performance between ChatGPT and HuggingChat on both medical examinations. For Test 1, ChatGPT scored 90%, while HuggingChat scored 85% (p = 0.6). For Test 2, ChatGPT correctly answered 70% of questions, while HuggingChat correctly answered 62% of questions (p = 0.4). Conclusion Awareness of the strengths and weaknesses of artificial intelligence allows for the proper and effective use of its knowledge. Our findings indicate that there is no statistically significant difference in performance between ChatGPT and HuggingChat in addressing medical inquiries. Nonetheless, both platforms demonstrate considerable promise for applications within the medical domain.
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Affiliation(s)
- Gabrielle Kirshteyn
- Obstetrics and Gynecology, Florida State University College of Medicine, Tallahassee, USA
| | - Roei Golan
- Urology, Florida State University College of Medicine, Tallahassee, USA
| | - Mark Chaet
- Pediatric Surgery, Florida State University College of Medicine, Orlando, USA
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3
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Salvi P, Gaikwad V, Bhadoriya A, Ponde S. Medical Management of Cesarean Scar Ectopic Pregnancy: A Unique Approach. Cureus 2024; 16:e55481. [PMID: 38571849 PMCID: PMC10989398 DOI: 10.7759/cureus.55481] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 04/05/2024] Open
Abstract
One of the rarest types of ectopic pregnancy, with an incidence of 1:1,800, is cesarean scar ectopic pregnancy. Here, we report the case of a 28-year-old woman who had undergone two previous cesarean sections. She arrived at our labor room with per vaginal spotting and abdominal pain with an ultrasound that revealed a cesarean scar ectopic pregnancy. The initial beta-human chorionic gonadotropin (β-hCG) value upon admission was 27,133 mIU/mL. Her ultrasound findings were confirmed with magnetic resonance imaging. Opting for combined medical management, we successfully treated her using systemic methotrexate and mifepristone, avoiding surgical intervention despite high β-hCG values. There is currently no established standardized treatment for cesarean scar ectopic pregnancies, and we feel that treatment must be tailored to every patient's individual needs. Our experience suggests that combining mifepristone and systemic methotrexate can be an effective approach with better curative effects, emphasizing the need for further research.
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Affiliation(s)
- Pankaj Salvi
- Department of Obstetrics and Gynaecology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, IND
| | - Vidya Gaikwad
- Department of Obstetrics and Gynaecology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, IND
| | - Ayushi Bhadoriya
- Department of Obstetrics and Gynaecology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, IND
| | - Sanjay Ponde
- Department of Obstetrics and Gynaecology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, IND
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Plöger R, Abramian A, Egger EK, Mustea A, Sänger N, Plöger H, Weber E, Gembruch U, Walter A, Strizek B, Recker F. Evaluation of an OSCE's implementation and a two-step approach for a theoretical and practical training program in Obstetrics and Gynecology. Front Med (Lausanne) 2023; 10:1263862. [PMID: 38179276 PMCID: PMC10765409 DOI: 10.3389/fmed.2023.1263862] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/13/2023] [Indexed: 01/06/2024] Open
Abstract
Objective structured clinical examination (OSCE) is a well-known assessment method to evaluate clinical skills and competence in healthcare. Following the recently reformed National Competence-Based Catalog of Learning Objectives in Medicine, the implementation of this assessment method in the training program for medical students is now obligatory in Germany. This major change requires a reorganization not only of the training programs but also of the students themselves and the way they learn. We performed a poll evaluating the students' opinions regarding these major changes and the implementation of the OSCE with a new training program. To implement this assessment method and to evaluate the OSCE, Kern's six-step approach comprising (1) problem identification and general needs assessment, (2) needs assessment of the targeted learners, (3) goals and objectives, (4) educational strategies, (5) implementation, and (6) evaluation and feedback was applied. To evaluate and gather feedback, a poll was used to analyze the student's opinions regarding OSCE in gynecology and obstetrics and OSCE in general, in addition to the regular analysis of the students' results. To reform the educational strategy, a two-step approach was developed: First, the students completed the regular training program and a written examination, and second, they participated in a 1-week clerkship, in small group teaching, and in the OSCE. The OSCE stations were developed primarily based on the National Competence-Based Catalog and the German Catalog of Learning Objectives in Medicine, as well as on the feedback of experts reflecting their expectations for physicians beginning their careers. The students performed well in the OSCE and gave positive feedback regarding this examination method. Furthermore, they welcomed the upcoming changes by considering OSCE a valuable assessment tool, and they showed appreciation for the two-step approach by supporting the combination of an OSCE and a written examination. Thus, this article presents the implementation of an OSCE and a strategy for the adaptation of the curriculum to fulfill the new OSCE requirements and-to our knowledge-reveals students' primary opinions regarding the changes in their medical training program for the first time.
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Affiliation(s)
- Ruben Plöger
- Department of Obstetrics and Gynecology, University Hospital Bonn, Bonn, Germany
| | - Alina Abramian
- Department of Senology, University Hospital Bonn, Bonn, Germany
| | - Eva Katharina Egger
- Department of Gynecology and Gynecological Oncology, University Hospital Bonn, Bonn, Germany
| | - Alexander Mustea
- Department of Gynecology and Gynecological Oncology, University Hospital Bonn, Bonn, Germany
| | - Nicole Sänger
- Department of Gynecological Endocrinology and Reproductive Medicine, University Hospital Bonn, Bonn, Germany
| | - Hannah Plöger
- Department of Neonatology and Pediatric Intensive Care, University Hospital Bonn, Bonn, Germany
| | - Eva Weber
- Division of Prenatal Medicine, Gynecological Ultrasound and Fetal Surgery, Department of Obstetrics and Gynecology, University of Cologne, Cologne, Germany
| | - Ulrich Gembruch
- Department of Obstetrics and Perinatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Adeline Walter
- Department of Obstetrics and Perinatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Brigitte Strizek
- Department of Obstetrics and Perinatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Florian Recker
- Department of Obstetrics and Perinatal Medicine, University Hospital Bonn, Bonn, Germany
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Riascos N, Loaiza-Osorio S, Monroy A, Barona JS, Carvajal J, Echavarria MP, Nasner D, Escobar MF. Effect of the postpartum hemorrhage intervention package implementation in a fourth-level hospital in Latin America. Int J Gynaecol Obstet 2023; 163:291-301. [PMID: 37269178 DOI: 10.1002/ijgo.14886] [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: 01/17/2023] [Revised: 04/12/2023] [Accepted: 05/09/2023] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of the implementation of intervention packages for postpartum hemorrhage (PPH) management in pregnant women hospitalized in a High Obstetric Complexity Unit in a Latin American country. METHODS Retrospective cohort study including pregnant women with PPH attended between January 2011 to December 2019. Three periods of time were defined according to management strategies We performed univariate and multivariate robust Poisson regression logistic models for each of the outcomes derived from each period. RESULTS We included 602 patients. There was a reduction in period 3 of the incidence of massive PPH (16% versus 12% P < 0.001, relative risk [RR] 0.61, 95% confidence interval [CI] 0.44-0.85; P = 0.003), major surgery (24%, 13%, 11%, P = 0.002, RR 0.54, 95% CI 0.33-0.883; P = 0.014), and admission to the intensive care unit (ICU) (14%, 7%, 6.1%, P = 0.0, RR 0.40, 95% CI 0.17-0.96 P = 0.00). CONCLUSION The implementation of PPH intervention packages in a hospital in a middle-income country from Latin America, led to a significant decrease in the incidence of massive bleeding, the rate of major surgery, and the ICU stay of pregnant women affected by this condition.
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Affiliation(s)
- Natalia Riascos
- Department of Obstetrics and Gynecology, Fundación Valle del Lili, Cali, Colombia
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
| | - Sara Loaiza-Osorio
- Department of Obstetrics and Gynecology, Fundación Valle del Lili, Cali, Colombia
| | - Angelica Monroy
- Department of Obstetrics and Gynecology, Fundación Valle del Lili, Cali, Colombia
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
| | - Juan Sebastián Barona
- Department of Obstetrics and Gynecology, Fundación Valle del Lili, Cali, Colombia
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
| | - Javier Carvajal
- Department of Obstetrics and Gynecology, Fundación Valle del Lili, Cali, Colombia
| | | | - Daniela Nasner
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia
| | - María Fernanda Escobar
- Department of Obstetrics and Gynecology, Fundación Valle del Lili, Cali, Colombia
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
- Department of Telemedicine, Fundación Valle del Lili, Cali, Colombia
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Rizvi Z, Sharma KC, Kunder V, Abreu A. Barriers of Care to Ovarian Cancer: A Scoping Review. Cureus 2023; 15:e40309. [PMID: 37448421 PMCID: PMC10337512 DOI: 10.7759/cureus.40309] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/11/2023] [Indexed: 07/15/2023] Open
Abstract
Ovarian cancer is a leading cause of female cancer-related deaths, but patients continue to be diagnosed late. This subjects them to disease progression and possible death due to lack of early detection, despite earlier stage detection improving survival rates by significant percentages. Early detection and access to care are closely related. However, many barriers to high-quality care exist for patients and the majority of patients do not receive recommended care according to ovarian cancer treatment guidelines. In order to improve care for ovarian cancer patients and decrease healthcare disparities in accessing equitable care, it is important to acknowledge the current gaps in patient knowledge, healthcare availability, and physician practice. This scoping review explores the available evidence on ovarian cancer to identify these barriers to care in the effective treatment of ovarian cancer. Using both inclusion and exclusion criteria, results from the initial literature search were screened by the authors. After quality assessment and screening for relevance, 10 articles were included in the final review. The following themes emerged as barriers to care: hospital and physician-patient volumes, geographic distance from care facilities, patient and physician education, and demographic factors. Many patients were found to not receive guideline adherent care due to various barriers to care, whereas guideline adherent care was independently associated with factors such as patient proximity to a high-volume hospital, White race, and higher socioeconomic status. Several areas were identified as potential for increased patient and physician education, including treatment complications and patient resources. The evidence found that certain socioeconomic groups and racial minorities are often at higher risk for guideline non-adherent care. Additionally, the evidence showed a further need for physicians and healthcare providers to be provided with resources for post-cancer treatment, follow-up, and patient education. The findings of this review will provide health experts and patients with better insight into what barriers may exist so that guideline-adherent care can be better advocated for and met.
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Affiliation(s)
- Zehra Rizvi
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Kiran C Sharma
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Viktor Kunder
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Adrian Abreu
- Obstetrics and Gynecology, Broward Health Medical Center, Fort Lauderdale, USA
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7
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Yang HJ, Zhang DY, Hao YY, Xu HL, Li YZ, Zhang S, Li XY, Gong TT, Wu QJ. GRADE Use in Evidence Syntheses Published in High-Impact-Factor Gynecology and Obstetrics Journals: A Methodological Survey. J Clin Med 2023; 12. [PMID: 36675377 DOI: 10.3390/jcm12020446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/24/2022] [Accepted: 12/27/2022] [Indexed: 01/09/2023] Open
Abstract
Objective: To identify and describe the certainty of evidence of gynecology and obstetrics systematic reviews (SRs) using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Method: Database searches of SRs using GRADE, published between 1 January 2016 to 31 December 2020, in the 10 "gynecology and obstetrics" journals with the highest impact factor, according to the Journal Citation Report 2019. Selected studies included those SRs using the GRADE approach, used to determine the certainty of evidence. Results: Out of 952 SRs, ninety-six SRs of randomized control trials (RCTs) and/or nonrandomized studies (NRSs) used GRADE. Sixty-seven SRs (7.04%) rated the certainty of evidence for specific outcomes. In total, we identified 946 certainty of evidence outcome ratings (n = 614 RCT ratings), ranging from very-low (42.28%) to low (28.44%), moderate (17.65%), and high (11.63%). High and very low certainty of evidence ratings accounted for 2.16% and 71.60% in the SRs of NRSs, respectively, compared with 16.78% and 26.55% in the SRs of RCTs. In the SRs of RCTs and NRSs, certainty of evidence was mainly downgraded due to imprecision and bias risks. Conclusions: More attention needs to be paid to strengthening GRADE acceptance and building knowledge of GRADE methods in gynecology and obstetrics evidence synthesis.
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8
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Bernardo D, Carvalho C, Leirós-Rodríguez R, Mota J, Santos PC. Comparison of the Portuguese Version of the Pregnancy Physical Activity Questionnaire (PPAQ) with Accelerometry for Classifying Physical Activity among Pregnant Women with Obesity. Int J Environ Res Public Health 2023; 20:929. [PMID: 36673683 PMCID: PMC9859283 DOI: 10.3390/ijerph20020929] [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] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/29/2022] [Accepted: 12/30/2022] [Indexed: 06/17/2023]
Abstract
In recent years, the number of pregnant women with obesity has increased exponentially; thus, it is important to evaluate and characterize the physical activity levels of this specific group. The aim of this study is to evaluate the reliability and validity of the Portuguese version of the Physical Activity and Pregnancy Questionnaire and Pregnancy Questionnaire in pregnant women with obesity and to classify physical activity using the Physical Activity and Pregnancy Questionnaire and accelerometry. An analytical observational study was carried out between May and August of 2019 at the University Hospital Center of São João, with a sample of 31 pregnant women with obesity (30.9 ± 4.6 years 36.5 ± 4.6 kg/m2 of BMI and 21.5 ± 9 gestational weeks). The physical activity of participants was evaluated using an accelerometer and Physical Activity and Pregnancy Questionnaire at two time points (the first visit at the moment of consultation and the second seven days after, with accelerometer retest), the interclass correlation coefficient was used to test reliability between the Physical Activity and Pregnancy Questionnaire filled out at visit1 and the Physical Activity and Pregnancy Questionnaire filled out at visit2, and Pearson's correlation was used to determine validity between the Physical Activity and Pregnancy Questionnaire and accelerometry. The interclass correlation coefficient values for total activity were 0.95, 0.97 for moderate and 0.58 for vigorous intensities. It ranged from 0.74 for sports/exercise to 0.96 for domestic activities. The Pearson's correlations showed that the Physical Activity and Pregnancy Questionnaire is moderately valid for moderate intensity (r = 0.435). A total of 67.7% of the pregnant women complied with international physical activity recommendations.
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Affiliation(s)
- Diana Bernardo
- KinesioLab Research Unit in Human Movement, Department of Physiotherapy, Piaget Institute, School of Health, 4405-678 Vila Nova de Gaia, Portugal
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto (FADEUP), 4200-450 Porto, Portugal
| | - Carlos Carvalho
- Sword Health Technologies, Department of Physiotherapy, 4100-467 Porto, Portugal
| | - Raquel Leirós-Rodríguez
- SALBIS Research Group, Nursing and Physical Therapy Department, University of Leon, 24004 León, Spain
| | - Jorge Mota
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto (FADEUP), 4200-450 Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Faculty of Sport, University of Porto (FADEUP), 4200-450 Porto, Portugal
| | - Paula Clara Santos
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto (FADEUP), 4200-450 Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Faculty of Sport, University of Porto (FADEUP), 4200-450 Porto, Portugal
- Department of Physiotherapy, School of Health, Polytechnic of Porto (ESS), 4200-072 Porto, Portugal
- Center for Rehabilitation Research (CIR), School of Health, Polytechnic of Porto, 4200-072 Porto, Portugal
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Longo de Oliveira ALM, de Oliveira Pereira RF, Agati LB, Ribeiro CM, Kawamura Suguiura GY, Cioni CH, Bermudez M, Pirani MB, Caffaro RA, Castelli V, Resende Aguiar VC, Volpiani GG, Paschoa A, Scarlatelli Macedo AV, de Barros e Silva PGM, de Campos Guerra JC, Fareed J, Lopes RD, Ramacciotti E. Rivaroxaban Versus Enoxaparin for Thromboprophylaxis After major Gynecological Cancer Surgery: The VALERIA Trial : Venous thromboembolism prophyl Axis after gyneco Logical p Elvic cancer surgery with RIvaroxaban versus enox Aparin (VALERIA trial). Clin Appl Thromb Hemost 2022; 28:10760296221132556. [PMID: 36474344 PMCID: PMC9732794 DOI: 10.1177/10760296221132556] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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] [Indexed: 12/13/2022] Open
Abstract
Direct oral anticoagulants (DOACs) for venous thromboembolism (VTE) prevention after major gynecological cancer surgery might be an alternative to parenteral low-molecular-weight heparin (LMWH). Patients undergoing major gynecological cancer surgery were randomized at hospital discharge to receive rivaroxaban 10 mg once daily or enoxaparin 40 mg once daily for 30 days. The primary efficacy outcome was a combination of symptomatic VTE and VTE-related death or asymptomatic VTE at day 30. The primary safety outcome was the incidence of major or clinically relevant nonmajor bleeding. Two hundred and twenty-eight patients were enrolled and randomly assigned to receive rivaroxaban (n = 114)or enoxaparin (n = 114). The trial was stopped due to a lower-than-expected event rate. The primary efficacy outcome occurred in 3.51% of patients assigned to rivaroxaban and in 4.39% of patients assigned to enoxaparin (relative risk 0.80, 95% CI 0.22 to 2.90; p = 0.7344). Patients assigned to rivaroxaban had no primary bleeding event, and 3 patients (2.63%) in the enoxaparin group had a major or CRNM bleeding event (hazard ratio, 0.14; 95% CI, 0.007 to 2.73; P = 0.1963). In patients undergoing major gynecological cancer surgery, thromboprophylaxis with rivaroxaban 10 mg daily for 30 days had similar rates of thrombotic and bleeding events compared to parenteral enoxaparin 40 mg daily. While the power is limited due to not reaching the intended sample size, our results support the hypothesis that DOACs might be an attractive alternative strategy to LMWH to prevent VTE in this high-risk population.
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Affiliation(s)
| | | | | | | | | | | | - Marilsa Bermudez
- São Paulo State Public Women's Health Reference Center, São Paulo,
Brazil
| | | | | | - Valter Castelli
- Santa Casa de São Paulo School of Medical Sciences, São Paulo,
Brazil
| | | | - Giuliano Giova Volpiani
- Santa Casa de São Paulo School of Medical Sciences, São Paulo,
Brazil,Hospital e Maternidade Christóvão da Gama, Grupo DASA, Santo André,
SP, Brazil
| | | | | | | | | | - Jawed Fareed
- Hemostasis & Thrombosis Research Laboratories at Loyola
University Medical Center, Maywood, IL, USA
| | - Renato Delascio Lopes
- Duke Clinical Research Institute, Duke University School of
Medicine, Durham, NC, USA
| | - Eduardo Ramacciotti
- Science
Valley Research Institute, Santo André, São
Paulo, Brazil,Hospital e Maternidade Christóvão da Gama, Grupo DASA, Santo André,
SP, Brazil,Hemostasis & Thrombosis Research Laboratories at Loyola
University Medical Center, Maywood, IL, USA,Eduardo Ramacciotti, Science Valley
Research Institute, Santo André, São Paulo, Brazil.
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10
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Küng SA, Ochoa B, Ortiz Avendano GA, Martínez López C, Zaragoza M, Padilla Zuniga K. Factors affecting the persistent use of sharp curettage for abortion in public hospitals in Mexico. ACTA ACUST UNITED AC 2021; 17:17455065211029763. [PMID: 34263683 PMCID: PMC8287640 DOI: 10.1177/17455065211029763] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Objectives: Dilation and curettage is an outdated abortion procedure no longer recommended by the World Health Organization. However, use of dilation and curettage remains high in some countries, including Mexico. We aim to understand the factors that contribute to persistent use of dilation and curettage in Mexico. Methods: We conducted a mixed-methods study in two phases: (1) secondary quantitative data analysis from 40 Ipas-supported public hospitals in Mexico and (2) 28 in-depth interviews in 9 Ipas-affiliated hospitals with doctors, nurses, and hospital administrators. Results: Among our sample, 41% of abortions less than 13 weeks performed in 2019 were treated with dilation and curettage, while this increased to 67% of abortions at or above 13 weeks. Only 18% of induced abortions were performed with dilation and curettage compared to 44% of post-abortion care procedures. The main factor identified as determining use of dilation and curettage in in-depth interviews was availability of abortion supplies, both in terms of cleaning, storage, and maintenance of supplies and in the budgeting and procurement of supplies. Other factors included confidence in the efficacy of other methods, attitudes toward different methods, skill and training, and perceived benefits to patients. Conclusion: Ensuring supplies for recommended abortion methods are available is a key lever for any intervention aimed at reducing dilation and curettage use. However, as the doctor performing the abortion decides which method to use, individual factors such as lack of skill and mistrust in other procedures can become a particularly obstinate barrier to recommended method use. Localizing decision-making power in the hands of doctors is problematic in that it places the doctor’s preference above that of the person receiving the abortion. It is important to look deeply at the power structures that contribute to doctor-oriented models of abortion care.
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Affiliation(s)
| | - Beatriz Ochoa
- Ipas Central America and Mexico, Mexico City, Mexico
| | | | | | - Mara Zaragoza
- Ipas Central America and Mexico, Mexico City, Mexico
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Bi S, Liu R, Li J, Gu J. The effectiveness of problem-based learning in gynecology and obstetrics education in China: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2021; 100:e24660. [PMID: 33655930 PMCID: PMC7939176 DOI: 10.1097/md.0000000000024660] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 10/08/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND A meta-analysis was conducted to assess the effectiveness of problem-based learning (PBL) in gynecology and obstetrics education in China. METHODS English and Chinese databases were systematically searched for eligible studies that compared the effects of PBL and traditional teaching methods measuring theoretical knowledge, student satisfaction, clinical operations, and clinical practice scores in gynecology and obstetrics education in China. The authors restricted included studies to randomized controlled trials and performed a meta-analysis. Standardized mean difference (SMD) and risk ratio with 95% confidence interval (CI) were estimated. RESULTS A total of 38 randomized controlled trials with 3005 participants were included. Compared with traditional teaching group, the PBL group significantly increased theoretical knowledge scores (SMD: 3.17, 95% CI: 2.28, 4.07), student satisfaction (risk ratio: 1.29, 95% CI: 1.16, 1.43), clinical operations (SMD: 1.15, 95% CI: 0.93, 1.37) and clinical practice (SMD: 2.17, 95% CI: 3.63, 2.71). CONCLUSION The current research shows that PBL in gynecology and obstetrics education in China is more effective than the traditional teaching in enhancing theoretical knowledge, student satisfaction, clinical operations, and clinical practice scores. However, more delicate-designed studies on this topic are needed in the future to validate these results.
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Affiliation(s)
- Siwei Bi
- Department of Burn and Plastic Surgery, West China Hospital
| | - Ruiqi Liu
- Department of Burn and Plastic Surgery, West China Hospital
| | | | - Jun Gu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
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12
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Siddiqui DES. Minimizing Medication Errors by Triangle Check of Look-Alike Sound-Alike Medications from Crash Cart of Gynecology and Obstetrics in Emergency. Innov Pharm 2020; 11:10.24926/iip.v11i4.3480. [PMID: 34007659 PMCID: PMC8127121 DOI: 10.24926/iip.v11i4.3480] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND According to the Joint Commission, crash cart-related patient safety issues are mixed-up medications, medication errors, damaged or expired medicines, improper checking of crash cart and non-competent staff. The availability of crash cart with all the needed emergency items, appropriate clinical protocols and rapid response team are regarded as important tools for the management of clinical emergencies in obstetrics and gynecology. The aim of this study was to design and implement a strategy to prevent the medication errors of look-alike sound-alike medications in emergency situations from the crash cart of gynecology and obstetrics. METHOD A nurse was assigned to record all the medications-related events in emergency situations along with receiving the medication order from healthcare professionals and dispensing medications from crash cart of gynecology and obstetrics. Triangle check of look-alike sound-alike medications was regarded necessary. RESULTS A significant reduction in number of look-alike sound-alike medication errors and near misses was recorded (p<0.05). DISCUSSION This strategy can be implemented not only to the gynecology and obstetrics but also to other areas of healthcare where look-alike sound-alike medications are stored, dispensed, administered or supplied and will be of great help in emergency situations. CONCLUSION A healthcare professional should be assigned at crash cart to record all the medications-related events and triangle check of dispensed look-alike sound-alike medications must be compulsory in emergency conditions.
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13
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Lu W, Evans RD, Zhang T, Ni Z, Tao H. Evaluation of resource utilization efficiency in obstetrics and gynecology units in China: A three-stage data envelopment analysis of the Shanxi province. Int J Health Plann Manage 2019; 35:309-317. [PMID: 31637764 DOI: 10.1002/hpm.2908] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 07/29/2019] [Revised: 08/21/2019] [Accepted: 09/10/2019] [Indexed: 11/06/2022] Open
Abstract
In China, health care resources for expectant mothers and children are still not utilized to full efficiency, with health requirements still not being met. The purpose of this study is to critically examine the efficiency of gynecology and obstetrics hospital (OB/GYN) units in Shanxi province of China, with the overarching objective of exploring methods for improving their efficiency. We employ the three-stage data envelopment analysis (DEA) model to measure the efficiency of 134 OB/GYN units in Shanxi. The results show that the technical efficiency and scale efficiency scores of the sample units were low (0.48 and 0.54, respectively). The efficiency of the OB/GYN units varies by region, city, and county and by type of unit. We conclude that the main reason for the low efficiency of OB/GYN units in Shanxi province lies in the unreasonable scale. The government should, therefore, allocate health resources more reasonably, improving the efficiency of different regions, cities, and counties, as well as different types of OB/GYN units.
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Affiliation(s)
- Wei Lu
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Richard David Evans
- College of Engineering, Design and Physical Sciences, Brunel University London, London, UK
| | - Tao Zhang
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Ziling Ni
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Hongbing Tao
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
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14
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Moorehead PC, Chan AKC, Lemyre B, Winikoff R, Scott H, Hawes SA, Shroff M, Thomas A, Price VE. A Practical Guide to the Management of the Fetus and Newborn With Hemophilia. Clin Appl Thromb Hemost 2018; 24:29S-41S. [PMID: 30373387 PMCID: PMC6714852 DOI: 10.1177/1076029618807583] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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] [Indexed: 12/22/2022] Open
Abstract
Newborns with hemophilia are at risk of intracranial hemorrhage, extracranial hemorrhage,
and other bleeding complications. The safe delivery of a healthy newborn with hemophilia
is a complex process that can begin even before conception, and continues throughout
pregnancy, birth, and the newborn period. This process involves the expectant parents and
a wide variety of health-care professionals: genetic counselors, obstetricians,
neonatologists, pediatricians, radiologists, adult and pediatric hematologists, and nurses
with expertise in hemophilia. Because of this multidisciplinary complexity, the relative
rarity of births of newborns with hemophilia, and the lack of high-quality evidence to
inform decisions, there is considerable variation in practice in this area. We present a
comprehensive multidisciplinary approach, from preconception counseling to discharge
planning after birth, and describe available options for management decisions. We
highlight a number of areas of important uncertainty and controversy, including the
preferred mode of delivery, the appropriate use and timing of neuroimaging tests, and the
appropriate use of clotting factor concentrates in the newborn period. While the approach
presented here will aid clinicians in planning and providing care, further research is
required to optimize the care of newborns with hemophilia.
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Affiliation(s)
- Paul C Moorehead
- Section of Pediatric Hematology/Oncology, Janeway Children's Health and Rehabilitation Centre, St. John's, Canada.,Discipline of Pediatrics, Faculty of Medicine, Memorial University, St. John's, Canada
| | - Anthony K C Chan
- McMaster Children's Hospital, McMaster University, Hamilton, Canada
| | - Brigitte Lemyre
- Department of Pediatrics, Division of Neonatology, University of Ottawa, Ottawa, Canada
| | - Rochelle Winikoff
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Ste-Justine University Health Center, University of Montreal, Montreal, Canada
| | - Heather Scott
- Department of Obstetrics and Gynecology, Dalhousie University, Halifax, Canada
| | - Sue Ann Hawes
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, Canada
| | - Manohar Shroff
- Department of Radiology, Hospital for Sick Children, Toronto, Canada.,Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Aidan Thomas
- Maritime Medical Genetics Service, IWK Health Centre, Halifax, Canada
| | - Victoria E Price
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, Canada
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Abstract
Estrogen-containing medication, prescribed either for contraception in women of reproductive age or for prevention of cardiovascular events and osteoporosis as well as for alleviation of symptoms related to menopause, is associated with changes in the hemostatic balance and contributes to increased risk of development of venous thromboembolic complications. This risk is dose and medication dependent, increases with age, congenital and/or acquired predisposition to thrombosis, and mode of administration. This review attempts to summarize the current knowledge regarding the pathophysiology of oral contraceptive (OC) and hormone replacement therapy (HRT) -induced prothrombotic state in women, the risk of thrombosis associated with administration of various commercially available OCs and HRT, the additional risk in women with hereditary or acquired thrombophilia, and the currently available recommendations regarding massive screening of women for thrombophilia prior to initial prescription or continuation of treatment with OCs and HRT preparations.
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Affiliation(s)
- Argyri Gialeraki
- 1 Hematology Laboratory - Blood Bank, ATTIKON Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Serena Valsami
- 2 Hematology Laboratory - Blood Bank, ARETAIEION Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodoros Pittaras
- 2 Hematology Laboratory - Blood Bank, ARETAIEION Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Marianna Politou
- 2 Hematology Laboratory - Blood Bank, ARETAIEION Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Guasch E, Gilsanz F. Treatment of Postpartum Hemorrhage With Blood Products in a Tertiary Hospital: Outcomes and Predictive Factors Associated With Severe Hemorrhage. Clin Appl Thromb Hemost 2015; 22:685-92. [PMID: 25712981 PMCID: PMC5006099 DOI: 10.1177/1076029615573303] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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] [Indexed: 02/03/2023] Open
Abstract
Postpartum hemorrhage (PPH) remains a leading cause of maternal mortality and morbidity worldwide. This retrospective observational study describes patient characteristics and hemostatic therapies administered to 352 parturients experiencing PPH and analyzes risk factors for developing severe PPH. During the study period, bleeding was controlled in all cases and 99.4% survived. The majority (98%) of patients received packed red blood cells. The most frequent hemostatic therapies administered were fibrinogen concentrate (56%), fresh frozen plasma (49%), and platelets (30%). A total of 124 (35%) women experienced severe PPH. Significant independent predictors for evolution to severe PPH were age, obstetric comorbidity, and plasma fibrinogen concentration. The latter was based on records from 267 (76%) patients. Plasma fibrinogen concentration before labor was the only modifiable prepartum risk factor independently associated with severe PPH, indicating that fibrinogen monitoring is warranted in these patients.
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Affiliation(s)
- Emilia Guasch
- Anesthesia and Intensive Care Department, Hospital Universitario La Paz, Madrid, Spain
| | - Fernando Gilsanz
- Anesthesia and Intensive Care Department, Hospital Universitario La Paz, Madrid, Spain
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Abstract
This study was undertaken to evaluate the impact of progestins as part of low-estrogen (ethinyl estradiol [EE2] ≤35 μg) combined oral contraceptives (COCs) on hemostatic variables. One hundred ninety-five healthy women took oral contraceptives with following formulations: 35 EE2/norgestimate (NGM), 35 EE2/cyproterone acetate, 35 EE2/norethisterone, 30 EE2/levonorgestrel, 30 EE2/drospirenone (DRSP), 20 EE2/gestodene, and 20 EE2/DRSP, for 6 months. Hemostatic assays (prothrombin time, activated partial thromboplastin time, fibrinogen, resistance to activated protein C ratio, protein C, protein S, factor VIII [FVIII], antithrombin, plasminogen, α2-antiplasmin, inhibitor of plasminogen activator type 1 [PAI-1] and d-dimers) were performed in 3 time points: at baseline, after 3, and 6 cycles. For each formulation, results were compared according to baseline values, intergroup analysis, and the amount of estrogen or progestin component. Most of the variables were changed except FVIII. Significant difference between oral contraceptives was found in antithrombin, protein C, protein S activities, and PAI-1 values, but changes were mostly within reference range.
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Affiliation(s)
- Sandra Oslakovic
- 1Department of Transfusion Medicine, Cakovec County Hospital, Cakovec, Croatia
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