O-057 The impact of diagnosis endometriosis as part of the fertility workup

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
J A Garcia-Velasco
Keyword(s):  
Fertility Preservation ◽  
Ovarian Reserve ◽  
Time To Pregnancy ◽  
Her Family ◽  
Potential Damage ◽  
Changes Over Time ◽  
The Impact ◽  
Late Stages ◽  
Ovarian Surgery

Abstract Abstract text The impact of diagnosis endometriosis as part of the Fertility workup Endometriosis is a multifaceted disease that may go from completely asymptomatic to a debilitating condition with severe pelvic pain complicated infertility. In the last few years, how we approach fertility in women with endometriosis has clearly changed, postponing definitive/radical surgery till the patient has completed her family. As a clear association exists with endometriosis and infertility, during the fertility workup it is one of the diseases to investigate, as it may have been missed in previous annual gynecologic checkups. Here we may face two problems: a) the stigma of diagnosis a young women with the label “endometriosis”, as she may be under the pressure of a progressive disease that may or may not affect her quality of life, and b) if the diagnosis of endometriosis is positive, how this may affect the decision making process during the fertility journey. In this lecture we will discuss the difficulties of early diagnosis of endometriosis, why most of the previous test have failed, and the new opportunity that miRNAs seem to offer. Once endometriosis is diagnosed –early or late stages- how this may affect spontaneous chances of pregnancy, ovarian reserve, oocyte and embryo quality, endometrial receptivity, and last but not least, time to pregnancy. Obviously, the prognosis changes over time, and women’s age will be conditioning most of our decisions. We will try to identify whom to treat, to increase the absolute pregnancy rate, and when to treat, to reduce the time to pregnancy. Finally, we will discuss the opportunity of fertility preservation in this particular subgroup of women. Being aware of the potential damage that endometriosis by itself, or the associated ovarian surgery, may inflict on ovarian reserve make these women more proactive for fertility preservation.

Dementia 7. When dementia is diagnosed, supporting the person and family caregivers

2020 ◽  
Vol 14 (4) ◽  
pp. 178-184
Author(s):  
Linda Nazarko
Keyword(s):  
End Of Life Care ◽  
Progressive Disease ◽  
World Health ◽  
Her Family ◽  
Learning Capacity ◽  
The Family ◽  
Health Organization ◽  
Person With Dementia ◽  
The Impact

The impact of a dementia diagnosis can be devastating to the person with dementia and his or her family. The person and their loved ones have been informed that the person has a progressive disease that affects memory, thinking, orientation, comprehension, calculation, learning capacity, language, and judgement ( World Health Organization (WHO), 2017 ). It is often thought of as a diagnosis of despair; however, if managed well, the diagnosis is an opportunity to enable the person to experience the best possible quality of life and to inform the family of his or her wishes in relation to end-of-life care.

scholarly journals Quality of reporting for randomised clinical trials published in Latin American and Spanish journals: A protocol for a systematic survey of three clinical specialities

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e036148
Author(s):  
Vivienne C Bachelet ◽  
Víctor A Carrasco ◽  
Fabiana Bravo-Córdova ◽  
Ruben A Díaz ◽  
Francisca J Lizana ◽  
...  
Keyword(s):  
Latin American ◽  
Reporting Quality ◽  
Quality Of Reporting ◽  
Systematic Survey ◽  
Secondary Analyses ◽  
Randomised Controlled ◽  
Changes Over Time ◽  
The Impact ◽  
Internal And External Validity

IntroductionQuality of reporting refers to how published articles communicate how the research was done and what was found. Gaps and imprecisions of reporting hamper the assessment of the methodological quality and internal and external validity. The CONsolidated Standards of Reporting Trials (CONSORT) are a set of evidence-based recommendations of the minimum elements to be included in the reporting of randomised controlled trials (RCTs) to ensure a complete and transparent account of what was done, how it was done and what was found. Few studies have been conducted on the impact of CONSORT on RCTs published in Latin American and Spanish journals. We aim to assess the reporting quality of RCTs of three clinical specialities published in Spanish and Latin American journals, as well as to assess changes over time and associations of quality with journal and country indicators.Methods and analysisWe will conduct a systematic survey of all RCTs published in Spanish-language journals in three clinical fields (dentistry, neurology and geriatrics) from 1990 to 2018. We will include RCTs from previous work that has identified all RCTs on these medical fields published in Spain and Latin America. We will update this work via handsearching of relevant journals. Assessment of quality of reporting will be conducted independently and in duplicate using the CONSORT 2010 Statement. We will also extract journal and country indicators. We will conduct descriptive statistics and secondary analyses considering the year, country, and journal of publication, among others.Ethics and disseminationThe Universidad de Santiago de Chile’s ethics committee approved the protocol. We will disseminate the results of this work in peer-reviewed scientific journals and conference proceedings. We expect to raise awareness among researchers, journal editors and funders on the importance of training in reporting guidelines and using them from the inception of RCT protocols.

Using the International Classification of Functioning to Conceptualize Quality of Life Among Rehabilitation Services Recipients

2014 ◽  
Vol 28 (1) ◽  
pp. 2-23 ◽  
Author(s):  
Allison R. Fleming ◽  
Michael J. Leahy
Keyword(s):  
Quality Of Life ◽  
Social Impact ◽  
Health Condition ◽  
International Classification ◽  
International Classification Of Functioning ◽  
Her Family ◽  
Relational Support ◽  
The Impact

Researchers and policy makers have proposed that quality of life (QOL) is an important and useful way to measure the impact of services, although practical application of QOL in rehabilitation has been limited. In this study, a comprehensive framework (the International Classification of Functioning [ICF]) is used to compare the relationship between QOL and function in key life areas in a sample of adults with disabilities receiving vocational services (n = 224). Results of a multiple regression analysis indicated that level of education, duration of disability, difficulty with social relationships and inclusion, the impact of the disability or health condition on the person or his or her family, and relational support and attitudes of family, friends, and acquaintances showed significant relationships with QOL. This study highlights the role of the social impact of disability on QOL and provides support for the use of the ICF for conceptualizing disability and its impact in a way that is inclusive of personal and environmental factors.

scholarly journals A Warning Call for Fertility Preservation Methods for Women Undergoing Gonadotoxic Cancer Treatment

Medicina ◽  
2021 ◽  
Vol 57 (12) ◽  
pp. 1340
Author(s):  
Claudia Mehedintu ◽  
Francesca Frincu ◽  
Andreea Carp-Veliscu ◽  
Ramona Barac ◽  
Dumitru-Cristinel Badiu ◽  
...  
Keyword(s):  
Cancer Treatment ◽  
Fertility Preservation ◽  
Ovarian Reserve ◽  
Negative Impact ◽  
Future Fertility ◽  
Negative Effect ◽  
The One

Malignant hematological conditions have recognized an increased incidence and require aggressive treatments. Targeted chemotherapy, accompanied or not by radiotherapy, raises the chance of defeating the disease, yet cancer protocols often associate long-term gonadal consequences, for instance, diminished or damaged ovarian reserve. The negative effect is directly proportional to the types, doses, time of administration of chemotherapy, and irradiation. Additionally, follicle damage depends on characteristics of the disease and patient, such as age, concomitant diseases, previous gynecological conditions, and ovarian reserve. Patients should be adequately informed when proceeding to gonadotoxic therapies; hence, fertility preservation should be eventually regarded as a first-intention procedure. This procedure is most beneficial when performed before the onset of cancer treatment, with the recommendation for embryos or oocytes’ cryopreservation. If not feasible or acceptable, several options can be available during or after the cancer treatment. Although not approved by medical practice, promising results after in vitro studies increase the chances of future patients to protect their fertility. This review aims to emphasize the mechanism of action and impact of chemotherapy, especially the one proven to be gonadotoxic, upon ovarian reserve and future fertility. Reduced fertility or infertility, as long-term consequences of chemotherapy and, particularly, following bone marrow transplantation, is often associated with a negative impact of recovery, social and personal life, as well as highly decreased quality of life.

scholarly journals The impact of previous ovarian surgery on ovarian reserve in patients with endometriosis

2015 ◽  
Vol 15 (1) ◽  
Author(s):  
Hsin-Ju Chiang ◽  
Pin-Yao Lin ◽  
Fu-Jen Huang ◽  
Fu-Tsai Kung ◽  
Yu-Ju Lin ◽  
...  
Keyword(s):  
Ovarian Reserve ◽  
The Impact ◽  
Ovarian Surgery

scholarly journals Impact of disease activity and treatments on ovarian reserve in patients with rheumatoid arthritis in the ESPOIR cohort

Rheumatology ◽  
2020 ◽  
Author(s):  
Camille Valdeyron ◽  
Martin Soubrier ◽  
Bruno Pereira ◽  
Arnaud Constantin ◽  
Jacques Morel ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Fertility Preservation ◽  
Ovarian Reserve ◽  
Inverse Correlation ◽  
Analysis Data ◽  
Serum Analysis ◽  
National Cohort ◽  
The Impact ◽  
Over Time

Abstract Objectives Patients with RA have a higher prevalence of infertility than the general population. This study sought to examine the impact of RA disease activity and treatments on ovarian reserve measured by serum anti-Müllerian hormone (AMH) levels in the ESPOIR cohort. We sought to better define the indications for fertility preservation. Methods Patients and serum analysis data were derived from the French national cohort ESPOIR. Enrolled patients (n = 102; 18–37-year-olds) fulfilled ACR/EULAR 2010 criteria for RA. Serum AMH levels were measured at T0, T6, T12, T24 and T36 months post-diagnosis. The impacts of RA activity (DAS28 and CRP level) and treatments (MTX only or with other medications) were evaluated at each study visit. Results A gradual decrease in patients’ serum AMH levels was observed over time, in line with the descending curve described for healthy women. Serum AMH levels of RA patients in comparison with the values considered normal for age did not reveal any significant differences (P > 0.05). We did not observe any impact of RA treatments. We demonstrated an inverse correlation between AMH variation and disease activity (DAS28: r = –0.27, P = 0.003; CRP: r = –0.16, P = 0.06). Conclusion This is the first study to determine serum AMH levels of a large cohort of RA patients over 36 months. Rapid disease activity control appears to be required to limit changes in the ovarian reserve. Fertility preservation is not likely to be necessary if inflammation is promptly controlled. ClinicalTrials.gov Identifier: NCT03666091.

The impact of tuberous sclerosis complex – a parent’s perspective

2016 ◽  
Vol 2 (2) ◽  
pp. 70-75
Author(s):  
Helen Willacy
Keyword(s):  
Tuberous Sclerosis ◽  
Tuberous Sclerosis Complex ◽  
Professional Service ◽  
Content Type ◽  
Her Family ◽  
Accessible Information ◽  
Wide Range ◽  
The Impact

Purpose – The purpose of this paper is to describe the impact of having a child with tuberous sclerosis complex (TSC). Design/methodology/approach – The author explains the process her family has been through on their TSC journey. Findings – Several themes emerge from the author’s story: a lack of awareness about relatively common conditions such as epilepsy; a dearth of accessible information provided to families; delays in identification/assessment and a lack of follow up on parents’ concerns; the wide range in the quality of advice provided from one professional/service to another; the extent to which parents have to advocate for their children and the importance of social support. Originality/value – Few journal articles explore the impact of complex health conditions on families from their perspective and in their own words. This thought provoking viewpoint piece provides a powerful insight into the reality of having a child with TSC.

scholarly journals When to Cryopreserve Ovarian Tissue: Effects of Chemotherapy on the Ovarian Reserve by Studying Follicular Density, Tissue Damage and Follicular Apoptosis

2021 ◽  
Author(s):  
Elsa Labrune ◽  
Serge Bianchetti ◽  
Odile Lepinasse ◽  
Gaelle Soignon ◽  
Bruno Salle ◽  
...  
Keyword(s):  
Fertility Preservation ◽  
Ovarian Reserve ◽  
Tissue Damage ◽  
Ovarian Tissue ◽  
Alkylating Agents ◽  
Group A ◽  
Ovarian Conservation ◽  
Group B ◽  
The Impact ◽  
Follicular Density

Abstract BackgroundPatients scheduled to receive chemotherapy should be counseled on fertility preservation. Known gonadotoxic chemotherapies such as alkylating agents have a high risk of altering ovarian reserve. In some cases, the urgency of treatment requires the use of chemotherapy before fertility preservation, which will be carried out at a later stage. Most often the ovarian tissue is cryopreserved. The aim of our study is to investigate the impact of chemotherapies on follicular density, tissue damage and apoptosis of reserve follicles.ResultsWe included 140 patients: 63 patients, mean age 18.8 years, were included in the group no chemotherapy (group A) and 77 patients, mean age 17.1 years, in the group presence of chemotherapy before ovarian conservation (group B). None of the patients had had pelvic radiotherapy prior to ovarian cryopreservation. The histological parameters studied were: follicular density, the presence of cortical fibrosis and the presence of vessel abnormalities. We selected 12 patients from group A and 15 patients from group B, comparable in age and pathology, for whom we evaluated follicle apoptosis by immunostaining cleaved caspase 3. We demonstrated an inverse relationship between follicular density and age (p<0.0001), as well as a lack of effect of chemotherapy on follicular density (p=0.87). There was no difference in other histological parameters. On the other hand, we showed an impact of chemotherapies, especially alkylating agents, on the apoptosis of ovarian follicles (p<0.0001).ConclusionOur study is the largest cohort reported to date. This work underlines that conservation of ovarian tissue after chemotherapy remains possible.

scholarly journals TTP: long-term outcomes following recovery

Hematology ◽  
2018 ◽  
Vol 2018 (1) ◽  
pp. 548-552 ◽  
Author(s):  
James N. George
Keyword(s):  
Cognitive Impairment ◽  
Black Women ◽  
Lupus Erythematosus ◽  
Health Issues ◽  
Her Family ◽  
Treatment Of Depression ◽  
Young Black Women ◽  
The Impact

Abstract Although risk for relapse may be the greatest concern following recovery from acquired, autoimmune thrombotic thrombocytopenic purpura (TTP), there are multiple other major health issues that must be recognized and appropriately addressed. Depression may be the most common disorder following recovery from TTP and may be the most important issue for the patient’s quality of life. Severe or moderate depression has occurred in 44% of Oklahoma Registry patients. Recognition of depression by routine screening evaluations is essential; treatment of depression is effective. Minor cognitive impairment is also common. The recognition that cognitive impairment is related to the preceding TTP can provide substantial emotional support for both the patient and her family. Because TTP commonly occurs in young black women, the frequency of systemic lupus erythematosus, as well as other autoimmune disorders, is increased. Because there is a recognized association of TTP with pregnancy, there is always concern for subsequent pregnancies. In the Oklahoma Registry experience, relapse has occurred in only 2 of 22 pregnancies (2 of 13 women). The frequency of new-onset hypertension is increased. The most striking evidence for the impact of morbidities following recovery from TTP is decreased survival. Among the 77 patients who survived their initial episode of TTP (1995-2017), 16 (21%) have subsequently died, all before their expected age of death (median difference, 22 years; range 4-55 years). The conclusion from these observations is clear. Following recovery from TTP, multiple health problems occur and survival is shortened. Therefore, careful continuing follow-up is essential.

Research Issues in Palliative Care

1985 ◽  
Vol 1 (1) ◽  
pp. 24-31 ◽  
Author(s):  
Carolyn Cook Gotay
Keyword(s):  
Palliative Care ◽  
Hospice Care ◽  
Research Focus ◽  
Research Issues ◽  
Related Research ◽  
Populations At Risk ◽  
Changes Over Time ◽  
The Impact ◽  
Over Time

Despite the recent proliferation of hospice programs and related research, a number of basic issues remain. Firstly the populations “at risk” for hospice care have not been precisely delineated. Secondly, the impact of the structure of a given hospice program on outcome has been given insufficient attention. Thirdly, assessing the impact of hospice care on quality of life has presented challenges in both definition and measurement. Finally, data relating to the costs of hospice care are difficult to evaluate. It is recommended that palliative care research focus on these areas. In addition, hospice programs and research need to be sensitive to changes over time and to dissemination of principles of hospice care.

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