Changes in Nutrition Focused Physical Examination Knowledge and Practices of Dietitians Who Completed an In-Person Workshop With 1-Year Online Follow-Up in Malaysia

Abstract Objectives Nutrition-focused physical examination (NFPE) is a component of nutrition assessment performed by dietitians. There is limited research globally on NFPE practices of dietitians. This study explored changes in NFPE knowledge and practices over 1-year among clinical dietitians in Malaysia who completed a hybrid NFPE training program. Methods This was a secondary analysis of data from a pilot study. Participants attended a 2-day in-person workshop in Malaysia with quarterly online follow-up over 1-year. A 50-item multiple-choice knowledge test was completed by participants before and immediately, 6- and 12-months post-training. They completed data collection forms with self-reported performance of 43 NFPE practice tasks conducted during patient assessments before and 6- and 12-months post-training. Descriptive statistics, one-way repeated-measures ANOVA for knowledge assessment scores and Chi-square tests for changes in frequencies of NFPE performance were used for analyses; statistical significance was P ≤ 0.05. Results Of the 16 clinical dietitian participants who enrolled, 81.3% (n = 13) completed the study. Participants had a mean of 9.3 ± 6.4 years ofclinical practice; 81.3% (n = 13) had no prior NFPE training. Mean NFPE knowledge scores increased significantly from before (33.8 ± 3.9) to immediately post-training (44.0 ± 3.2; P < 0.001); this increase was sustained to 12-months post-training (43.3 ± 2.9; P < 0.001). Performance of all 43 NFPE practice tasks increased significantly from before to 12-months post-training (P < 0.001). Conclusions Clinical dietitian participants in this study increased their knowledge and practice of NFPE from before to 12-months post-training. In-person NFPE training with 1-year online follow-up is feasible for training clinical dietitians in Malaysia. Future research should explore using a control group to examine the effectiveness of a hybrid NFPE training program in this population. Funding Sources Rutgers Global Grant.

Download Full-text

Small dose of ephedrine for prevention of hypotension following propofol and fentanyl administration during induction of general anesthesia

Annals of African Medical Research ◽

10.4081/aamr.2020.126 ◽

2021 ◽

Vol 3 (2) ◽

Author(s):

Gamal Ejaimi ◽

Abla Saab ◽

Sittelnissa Ahmed ◽

Areeg Ahmed ◽

Hussain Abujamilah ◽

...

Keyword(s):

General Anesthesia ◽

Small Dose ◽

Elective Surgery ◽

Statistical Significance ◽

Control Group ◽

P Value ◽

Chi Square ◽

Arterial Blood ◽

Chi Square Test ◽

Study Participants

Induction of general anesthesia with propofol and fentanyl could result in hypotension and bradycardia. Various methods are being used to prevent these adverse effects. The aim of our study was to assess the efficacy and safety of a small dose of ephedrine in prevention of hypotension following administration of propofol and fentanyl. This prospective, randomized, comparative study was conducted among a total of 50 patients, both genders, age 18 years up to 60 years with ASA grade Ι and ΙΙ and some of class ΙΙΙ, presented for elective surgery under general anesthesia. Patients were randomly allocated into one of two groups (25 patients in each): CG (the control group), which received propofol in a dose of 2 mg/kg, intravenously, over 20–30 s mixed with 2 mL normal saline: and EphG (Ephedrine group), while received propofol in a dose of 2 mg/kg, intravenously, over 20–30 s mixed with 2 mL of ephedrine (10 mg). The Mean Arterial Blood Pressure (MAP) and Heart Rate (HR) were recorded before induction and then every 1 min up to 6 min after induction. The categorical data are presented as a number and percentage and were subjected to Fisher’s exact or Chi-square test for analysis. The statistical significance was p≤0.05. The significant differences in HR were observed in the 3rd,4th, and 5th minutes with P-value, 0.018, 0.000, 0.000, respectively. However, no patient in the study participants had bradycardia. The significant differences in MAP were observed in the 2nd, 3rd,4th, and 5th minutes with P-value, 0.035, 0.000, 0.000, and 0.000, respectively. The percentage of patient in CG who developed hypotension in the 3rd and 4th is 44% and 32% compared to 8% and 0% in EphG, with significant differences (P-value 0.004 and 0.002, respectively). Administration of small dose of ephedrine with propofol could attenuate propofol/fentanyl hypotensive and bradycardic effects.

Download Full-text

Changes in Nutrition Focused Physical Exam Knowledge and Curriculum Integration of Dietetic Educators in Malaysia Who Have Completed an NFPE Hybrid Training Program

Current Developments in Nutrition ◽

10.1093/cdn/nzab051_025 ◽

2021 ◽

Vol 5 (Supplement_2) ◽

pp. 981-981

Author(s):

Lorren Lutz ◽

Rebecca Brody ◽

Joachim D Sackey ◽

Riva E Touger-Decker ◽

Seong-Ting Chen ◽

...

Keyword(s):

Physical Examination ◽

Training Program ◽

Repeated Measures ◽

Secondary Analysis ◽

Computer Assisted ◽

Knowledge Test ◽

Two Phase ◽

Funding Sources ◽

Assisted Instruction ◽

Nutrition And Dietetics

Abstract Objectives There is limited research on the integration of Nutrition Focused Physical Examination (NFPE) into dietetic educators’ curricula practices globally. The primary objectives of this study were to assess changes in dietetic educators’ NFPE knowledge and curricula practices over 12-months after completing a hybrid training program in NFPE. Methods This was a secondary analysis of data from the study A Two-phase International Approach to Teaching Nutrition Focused Physical Examination, a prospective cohort pilot study. Dietetic educators in Malaysia completed an NFPE hybrid training program consisting of in-person training and follow-up computer-assisted instruction over 12 months. Participants reported the extent to which they integrated 32 NFPE tasks into their curricula at 3 timepoints (baseline, 6- and 12-months post-training) and completed a 50-item multiple-choice knowledge test at 4 timepoints (baseline and immediately, 6- and 12-months post-training). Descriptive statistics were used for curricula data; one-way repeated measures ANOVA test was used to analyze the change in knowledge scores over time. Results Data were analyzed from those who completed knowledge tests (n = 14) and NFPE curricula data collection forms (n = 13) at all timepoints. Mean knowledge scores out of 50 possible points) increased significantly from baseline to immediately post-training and 6- and 12-months post-training (P < 0.001 for all) from 34.1 ± 5.4 at baseline to 43.7 ± 3.1 immediately post-training, 43.5 ± 2.9 at 6-months post-training, and 43.1 ± 3.0 at 12-months post-training. Changes in knowledge test scores were maintained from immediately post-training to 6- and 12-months post-training. At baseline, all of the participants reported that they “teach student NFPE tasks,” for three of the 32 NFPE tasks (examination of orbital fat pads, gastrocnemius muscle, and clavicle). At 12-months post-training,100% of the participants reported teaching all 32 NFPE tasks. Conclusions Dietetic educators in Malaysia who participated in the study significantly increased their NFPE knowledge and the integration of NFPE tasks in their nutrition and dietetics curricula from baseline to 12-months post-training. An NFPE hybrid training program is feasible to train dietetic educators in Malaysia. Funding Sources Rutgers Global Grant

Download Full-text

Destress 9-1-1—an online mindfulness-based intervention in reducing stress among emergency medical dispatchers: a randomised controlled trial

Occupational and Environmental Medicine ◽

10.1136/oemed-2018-105598 ◽

2019 ◽

Vol 76 (10) ◽

pp. 705-711 ◽

Cited By ~ 1

Author(s):

Michelle Lilly ◽

Rebecca Calhoun ◽

Ian Painter ◽

Randal Beaton ◽

Scott Stangenes ◽

...

Keyword(s):

Repeated Measures ◽

Controlled Trial ◽

Intervention Group ◽

Future Research ◽

Control Group ◽

Post Intervention ◽

Work Related ◽

Emergency Medical ◽

Emergency Medical Dispatchers

ObjectivesEmergency medical dispatchers (EMDs) experience significant stress in the workplace. Yet, interventions aimed at reducing work-related stress are difficult to implement due to the logistic challenges associated with the relatively unique EMD work environment. This investigation tested the efficacy of a 7-week online mindfulness-based intervention (MBI) tailored to the EMD workforce.MethodsActive-duty EMDs from the USA and Canada (n=323) were randomly assigned to an intervention or wait list control condition. Participants completed surveys of stress and mindfulness at baseline, post intervention, and 3 months follow-up. Repeated measures mixed effects models were used to assess changes in stress and mindfulness.ResultsDifferences between the intervention group and control group in pre–post changes in stress using the Calgary Symptoms of Stress Inventory were statistically significant, with a difference of −10.0 (95% CI: −14.9, −5.2, p<0.001) for change from baseline to post intervention, and a difference of −6.5 (95% CI: −11.9, −1.1, p=0.02) for change from baseline to 3 months follow-up. Change in mindfulness scores did not differ between groups. However, increases in mindfulness scores were correlated with greater reductions in stress for all participants, regardless of group (r=−0.53, p<0.001).ConclusionsDevelopment of tailored online MBIs for employees working in challenging work environments offer a promising direction for prevention and intervention. This study found that a short, weekly online MBI for EMDs resulted in reductions in reports of stress. Implications of online MBIs in other emergency responding populations and directions for future research are discussed.

Download Full-text

Effectiveness of Abdominal and Gluteus Medius Training in Lumbo-Pelvic Stability and Adductor Strength in Female Soccer Players. A Randomized Controlled Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18041528 ◽

2021 ◽

Vol 18 (4) ◽

pp. 1528

Author(s):

Héctor Guerrero-Tapia ◽

Rodrigo Martín-Baeza ◽

Rubén Cuesta-Barriuso

Keyword(s):

Repeated Measures ◽

Gluteus Medius ◽

Soccer Players ◽

Controlled Study ◽

Control Group ◽

Extrinsic Factors ◽

Randomized Controlled ◽

Limb Injuries ◽

Experimental Group

Background. Abdominal and lumbo-pelvic stability alterations may be the origin of lower limb injuries, such as adductor pathology in soccer players. Imbalance can be caused by both intrinsic and extrinsic factors. Methods: In this randomized controlled trial over 8 weeks, 25 female footballers were randomly allocated to an experimental group (isometric abdominal training and gluteus medius-specific training) or a control group (isometric abdominal training). Evaluations were performed at baseline, at the end of the intervention and after a 4-week follow-up period. The exercise protocol in common for both groups included three exercises: Plank, Lateral plank and Bird dog. Specific exercises for the gluteus medius were: Pelvic drop and Stabilization of the gluteus medius in knee valgus. Outcome measures were lumbar-pelvic stability and adductor strength. Results: After the intervention, there was an increase in lumbo-pelvic stability in both groups, being greater in the control group than in the experimental group (mean differences [MD]: 4.84 vs. MD: 9.58; p < 0.01) with differences in the analysis of repeated measures (p < 0.001), but not in group interaction (p = 0.26). Changes were found in adductor strength in the experimental group (MD: −2.48; p < 0.001 in the left adductor; MD: −1.48; p < 0.01 in right adductor) and control group (MD: −1.68; p < 0.001 in the left adductor; MD: −2.05; p < 0.001 in the right adductor) after the intervention, with differences in the analysis of repeated measures in left (p < 0.001) and right (p < 0.001) adductor strength. Conclusions: An abdominal and gluteal training protocol shows no advantage over a protocol of abdominal training alone for lumbo-pelvic stability and adductor strength, while improvements in both variables are maintained at four weeks follow-up.

Download Full-text

Effects of multi-domain cognitive training on working memory retrieval in older adults: behavioral and ERP evidence from a Chinese community study

Scientific Reports ◽

10.1038/s41598-020-79784-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Xiangfei Hong ◽

You Chen ◽

Jijun Wang ◽

Yuan Shen ◽

Qingwei Li ◽

...

Keyword(s):

Older Adults ◽

Working Memory ◽

Training Program ◽

Cognitive Training ◽

Local Community ◽

Training Group ◽

Event Related Potential ◽

Control Group ◽

Baseline Session

AbstractWorking memory (WM) is a fundamental cognitive function that typically declines with age. Previous studies have shown that targeted WM training has the potential to improve WM performance in older adults. In the present study, we investigated whether a multi-domain cognitive training program that was not designed to specifically target WM could improve the behavioral performance and affect the neural activity during WM retrieval in healthy older adults. We assigned healthy older participants (70–78 years old) from a local community into a training group who completed a 3-month multi-domain cognitive training and a control group who only attended health education lectures during the same period. Behavioral and electroencephalography (EEG) data were recorded from participants while performing an untrained delayed match or non-match to category task and a control task at a pre-training baseline session and a post-training follow-up session. Behaviorally, we found that participants in the training group showed a trend toward greater WM performance gains than participants in the control group. Event-related potential (ERP) results suggest that the task-related modulation of P3 during WM retrieval was significantly enhanced at the follow-up session compared with the baseline session, and importantly, this enhancement of P3 modulation was only significant in the training group. Furthermore, no training-related effects were observed for the P2 or N2 component during WM retrieval. These results suggest that the multi-domain cognitive training program that was not designed to specifically target WM is a promising approach to improve WM performance in older adults, and that training-related gains in performance are likely mediated by an enhanced modulation of P3 which might reflect the process of WM updating.

Download Full-text

Comparing Midterm Outcomes of High-Level Athletes Versus Nonathletes Undergoing Primary Hip Arthroscopy: A Propensity-Matched Comparison With Minimum 5-Year Follow-up

The American Journal of Sports Medicine ◽

10.1177/03635465211041763 ◽

2021 ◽

pp. 036354652110417

Author(s):

Andrew E. Jimenez ◽

Peter F. Monahan ◽

David R. Maldonado ◽

Benjamin R. Saks ◽

Hari K. Ankem ◽

...

Keyword(s):

Hip Arthroscopy ◽

Statistical Significance ◽

Arthroscopic Surgery ◽

Harris Hip Score ◽

Control Group ◽

Level Of Evidence ◽

Femoroacetabular Impingement Syndrome ◽

Patient Reported ◽

High Level

Background: High-level athletes (HLAs) have been shown to have better short-term outcomes than nonathletes (NAs) after hip arthroscopy. Purpose: (1) To report midterm outcomes of HLAs after primary hip arthroscopy and (2) to compare their results with a propensity-matched cohort of NA patients. Study Design: Cohort study; Level of evidence, 3. Methods: Data were prospectively collected and retrospectively reviewed between February 2008 and November 2015 for HLAs (professional, college, or high school) who underwent primary hip arthroscopy in the setting of femoroacetabular impingement syndrome (FAIS). HLAs were included if they had preoperative, minimum 2-year, and minimum 5-year follow-up data for the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), and Hip Outcome Score Sports-Specific Subscale (HOS-SSS). Radiographic and intraoperative findings, surgical procedures, patient-reported outcomes (PROs), patient acceptable symptomatic state (PASS), minimal clinically important difference (MCID), and return to sport were reported. The HLA study group was propensity-matched to a control group of NA patients for comparison. Results: A total 65 HLA patients (67 hips) were included in the final analysis with mean follow-up time of 74.6 ± 16.7 months. HLAs showed significant improvement in all PROs recorded, achieved high rates of MCID and PASS for mHHS (74.6% and 79.4%, respectively) and HOS-SSS (67.7% and 66.1%, respectively), and returned to sport at high rates (80.4%). When compared with the propensity-matched NA control group, HLAs reported higher baseline but comparable postoperative scores for the mHHS and NAHS. HLA patients achieved MCID and PASS for mHHS at similar rates as NA patients, but the HLA patients achieved PASS for HOS-SSS at higher rates that trended toward statistical significance (66.1% vs 48.4%; P = .07). NA patients underwent revision arthroscopic surgery at similar rates as HLA patients (14.9% vs 9.0%, respectively; P = .424). Conclusion: Primary hip arthroscopy results in favorable midterm outcomes in HLAs. When compared with a propensity-matched NA control group, HLAs demonstrated a tendency toward higher rates of achieving PASS for HOS-SSS but similar arthroscopic revision rates at minimum 5-year follow-up.

Download Full-text

Effectiveness of a Mobile Device–Based Resilience Training Program in Reducing Depressive Symptoms and Enhancing Resilience and Quality of Life in Parents of Children With Cancer: Randomized Controlled Trial (Preprint)

10.2196/preprints.27639 ◽

2021 ◽

Author(s):

Yuanhui Luo ◽

Wei Xia ◽

Ankie Tan Cheung ◽

Laurie Long Kwan Ho ◽

Jingping Zhang ◽

...

Keyword(s):

Depressive Symptoms ◽

Training Program ◽

Mobile Device ◽

Well Being ◽

Control Group ◽

Children With Cancer ◽

Resilience Training ◽

Experimental Group

BACKGROUND Caring for children with cancer can be a stressful experience for parents and may have negative effects on their physical and psychological well-being. Although evidence has shown that resilience is associated with positive psychological well-being, few interventions have been specifically designed to enhance the resilience of parents of children with cancer. OBJECTIVE The aim of this study is to examine the effectiveness of a mobile device–based resilience training program in reducing depressive symptoms and enhancing resilience and quality of life (QoL) in parents of children with cancer. METHODS Parents of children diagnosed with cancer were recruited from the pediatric oncology wards of 3 tertiary hospitals in China. The participants were randomly assigned to either the experimental group (52/103, 50.5%) to undergo an 8-week mobile device–based resilience training program or to the control group (51/103, 49.5%) to receive an 8-week program of placebo information. The study outcomes included resilience, depressive symptoms, and QoL, as measured by the Connor–Davidson Resilience Scale, the Self-Rating Depression Scale, and the Short Form of the 6-Dimension Health Survey, respectively. All data were collected at baseline and at 2 and 6 months of follow-up. The data analysis followed the intention-to-treat principle. A generalized estimating equation was used to examine the effects of the intervention. RESULTS The participants were mostly female (72/103, 69.9%), and their mean age was 33.6 (SD 5.2) years. The participants in the experimental group showed significantly higher levels of resilience (mean 67.96, SD 15.8 vs mean 58.27, SD 19.0; P<.001) and lower levels of depressive symptoms (mean 40.17, SD 9.9 vs mean 46.04, SD 10.9; P<.001) than those in the control group at 6 months of follow-up. The intervention showed statistically significant effects in improving resilience (β=6.082; P=.01) and decreasing depressive symptoms (β=−2.772; P=.04) relative to the control group. The QoL score in the experimental group was higher than that in the control group at 6 months of follow-up (mean 0.79, SD 0.2 vs mean 0.76, SD 0.3; P=.07); however, no statistically significant intervention effect was detected (β=.020; P=.38). CONCLUSIONS The mobile device–based resilience training program effectively enhanced resilience and alleviated depressive symptoms in parents of children with cancer. It is highly recommended that health care professionals incorporate this resilience training program when providing psychological care to parents of children with cancer. CLINICALTRIAL Clinical.Trials.gov NCT04038242; http://clinicaltrials.gov/ct2/show/NCT04038242

Download Full-text

Effectiveness of a Mobile Device–Based Resilience Training Program in Reducing Depressive Symptoms and Enhancing Resilience and Quality of Life in Parents of Children With Cancer: Randomized Controlled Trial

Journal of Medical Internet Research ◽

10.2196/27639 ◽

2021 ◽

Vol 23 (11) ◽

pp. e27639

Author(s):

Yuanhui Luo ◽

Wei Xia ◽

Ankie Tan Cheung ◽

Laurie Long Kwan Ho ◽

Jingping Zhang ◽

...

Keyword(s):

Depressive Symptoms ◽

Training Program ◽

Mobile Device ◽

Well Being ◽

Control Group ◽

Children With Cancer ◽

Resilience Training ◽

Experimental Group

Background Caring for children with cancer can be a stressful experience for parents and may have negative effects on their physical and psychological well-being. Although evidence has shown that resilience is associated with positive psychological well-being, few interventions have been specifically designed to enhance the resilience of parents of children with cancer. Objective The aim of this study is to examine the effectiveness of a mobile device–based resilience training program in reducing depressive symptoms and enhancing resilience and quality of life (QoL) in parents of children with cancer. Methods Parents of children diagnosed with cancer were recruited from the pediatric oncology wards of 3 tertiary hospitals in China. The participants were randomly assigned to either the experimental group (52/103, 50.5%) to undergo an 8-week mobile device–based resilience training program or to the control group (51/103, 49.5%) to receive an 8-week program of placebo information. The study outcomes included resilience, depressive symptoms, and QoL, as measured by the Connor–Davidson Resilience Scale, the Self-Rating Depression Scale, and the Short Form of the 6-Dimension Health Survey, respectively. All data were collected at baseline and at 2 and 6 months of follow-up. The data analysis followed the intention-to-treat principle. A generalized estimating equation was used to examine the effects of the intervention. Results The participants were mostly female (72/103, 69.9%), and their mean age was 33.6 (SD 5.2) years. The participants in the experimental group showed significantly higher levels of resilience (mean 67.96, SD 15.8 vs mean 58.27, SD 19.0; P<.001) and lower levels of depressive symptoms (mean 40.17, SD 9.9 vs mean 46.04, SD 10.9; P<.001) than those in the control group at 6 months of follow-up. The intervention showed statistically significant effects in improving resilience (β=6.082; P=.01) and decreasing depressive symptoms (β=−2.772; P=.04) relative to the control group. The QoL score in the experimental group was higher than that in the control group at 6 months of follow-up (mean 0.79, SD 0.2 vs mean 0.76, SD 0.3; P=.07); however, no statistically significant intervention effect was detected (β=.020; P=.38). Conclusions The mobile device–based resilience training program effectively enhanced resilience and alleviated depressive symptoms in parents of children with cancer. It is highly recommended that health care professionals incorporate this resilience training program when providing psychological care to parents of children with cancer. Trial Registration Clinical.Trials.gov NCT04038242; http://clinicaltrials.gov/ct2/show/NCT04038242

Download Full-text

More focus on atypical glandular cells in cervical screening: Risk of significant abnormalities and low histological follow-up rate

CytoJournal ◽

10.25259/cytojournal_77_2019 ◽

2020 ◽

Vol 17 ◽

pp. 22

Author(s):

Pingping Zhong ◽

Chenghong Yin ◽

Yulan Jin ◽

Tianbao Chen ◽

Yang Zhan ◽

...

Keyword(s):

Statistical Significance ◽

Cervical Screening ◽

Close Relation ◽

Prior History ◽

Pap Smears ◽

Chi Square ◽

Glandular Cells ◽

Atypical Glandular Cells ◽

Chi Square Test

Objectives: Atypical glandular cells (AGC) detected by Papanicolaou (Pap) smears are in close relation with adenocarcinoma and precursors detected by histopathology. Yet, sometimes the cytological diagnosis of AGC has been neglected. With increase of adenocarcinoma and precursors, we need more focus on glandular abnormalities. Material and Methods: Clinicopathological data of patients who had AGC on Pap smears between April 2015 and October 2018 and underwent histological follow-up were retrieved from the computerized database of Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Patients with a prior history of cancer were excluded from the study. Statistical analyses were performed using Pearson’s Chi-square test in SPSS software version 23. P < 0.05 (two sided) was considered as statistical significance. Results: Liquid-based cytological examination of the uterine cervix was carried out in 164,080 women. Five hundred and twenty-five women were diagnosed with AGC, 314 with not otherwise specified (AGC-NOS), and 211 with favor neoplastic (AGC-FN). Only 310 cases had histological follow-up, 168 women (168/314, 53.5%) originally with AGC-NOS on Pap smears, and 142 (142/211, 67.3%) with AGC-FN. The median age of histological significant abnormalities was 46.7 years, and 126 women (126/162, 77.8%) were postmenopausal. Sixty-six cases (66/168, 39.3%) of AGC-NOS had significant abnormalities (96/142, 67.6%, AGC-FN). One hundred and sixty-two cases of significant abnormalities included 40 high-grade squamous abnormalities and 122 glandular abnormalities. AGC-FN was more likely to be associated with a clinically significant abnormalities (P < 0.001) compared to AGC-NOS. Conclusions: Patients with AGC on Pap smears are in close relation with significant abnormalities, especially with significant glandular abnormalities on histopathology slices. AGC should be evaluated vigilantly with histological workup, especially if patients are diagnosed with AGC-FN and are aged 41–60 years. We need more focus on AGC.

Download Full-text

P–328 Dienogest significantly decreases the size of the cyst and alters Anti-Müllerian Hormone concentration in patients with endometrioma

Human Reproduction ◽

10.1093/humrep/deab130.327 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

E Karataş ◽

B E Temiz ◽

S Mumusoglu ◽

H Yarali ◽

G Bozdag

Keyword(s):

Primary Outcome ◽

Statistical Significance ◽

Mean Difference ◽

Secondary Outcome ◽

Control Group ◽

Significant Drop ◽

Mean Size ◽

The Mean ◽

Respective Figure

Abstract Study question Does utilization of dienogest make any impact on the size of cyst and Anti-Müllerian Hormone (AMH) concentration in patients with endometrioma throughout 12-months? Summary answer Although dienogest makes a gradual reduction in the size of endometrioma cyst throughout 12-months, a significant drop in AMH serum concentration was also noticed. What is known already According to recent studies, pre-operative serum AMH levels might be illusively increased with parallel to the size of endometrioma which will be a misleading factor while deciding to operate the patient via cystectomy. Although dienogest is one of the medical options that might be commenced in patients with endometrioma cyst, there is limited data about its effect on the size of the endometrioma and hence serum AMH concentration throughout 12 months of follow up. Study design, size, duration The current observational cohort study was conducted among patients with endometrioma those treated with dienogest from January 2017 to January 2020. The primary outcome was alteration in diameter of endometrioma cyst at 6th and 12th months of treatment. Secondary outcome was alteration in serum AMH concentration in the same period. Of 104 patients treated with dienogest, 44 patients were excluded due to being treated with any type of surgical intervention during follow up period. Participants/materials, setting, methods A total of 60 patients were recruited for the final analysis. Of them, primary symptom was dysmenorrhea, chronic pelvic pain and menstrual irregularity in 16 (26.7%), 25 (41.7%) and 8 (13.3%) patients, respectively. Eighteen patients (30%) were asymptomatic. As 21 patients had bi-lateral endometrioma, size of the leading cyst was considered to be analyzed for the primary outcome measure. Paired-t test was used for comparison of numerical values and p ≤ 0.05 was taken as statistical significance. Main results and the role of chance The mean age was 31.5±8.0 years. In the time point when dienogest was started, the mean size of the endometrioma was 46.3±17.4 mm. The mean serum AMH concentration was 3.6±2.4 ng/ml. After 6 months of treatment, the mean size of the endometrioma decreased to 38.6±14.0 mm which corresponds to a mean difference of 7.8 mm (95% CI: 3.0 to 12.6; p: 0.003). The respective figure for AMH was 3.3±2.7 ng/ml which corresponds to a mean difference of 0.3 ng/ml (95% CI: –0.2 to 0.8; p: 0.23) at 6 months. After 12 months of treatment, the mean size of the endometrioma was 37.5±15.7 mm which corresponds to a mean difference of 8.9 mm (95% CI: 2.9 to 14.9; p: 0.005) at the end of 12 months. The respective figure for AMH was 2.7±1.9 ng/ml which corresponds to a mean difference of 0.9 ng/ml (95% CI: 0.1 to 1.7; p: 0.045) at the end of 12 months. The mean diameter of endometrioma and AMH concentration did not differ throughout the time period between 6th and 12th months of the treatment. Limitations, reasons for caution Although herein we present the largest data that depicts the alteration of endometrioma cyst and AMH concentration with the application of dienogest, the lack of control group is a limitation that avoids to perform any comparison. Wider implications of the findings: A shrinkage after commencement of treatment suggest that dienogest might present improvement in patients with endometrioma with respect to radiological findings, but further studies are required whether a decline in AMH concentration after 12 months refers to a genuine decrease in ovarian reserve or resolution of misleading high pre-treatment levels. Trial registration number not available

Download Full-text