P–308 Fertility preservation in endometriosis: Appraising the factors affecting the ovarian response

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
S Goaz ◽  
Y Fouks ◽  
F Azem
Keyword(s):  
Fertility Preservation ◽  
Medical Center ◽  
Oocyte Retrieval ◽  
Ovarian Response ◽  
Deep Infiltrating Endometriosis ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Surgical Interventions ◽  
Factors Affecting ◽  
The Impact

Abstract Study question To estimate the factors affecting the ovarian response in women with endometriosis who seek fertility preservation. Summary answer AMH was the most important predictor of ovarian response. What is known already Endometriosis is a chronic disease characterised by the presence of endometrial tissue outside the uterine mucosa. This condition affects up to 10% of reproductive-aged women and up to 50% of women with infertility. Infertility in patients affected with endometriosis has been thought to stem mainly from the inherent effect of implants on the ovarian reserve or by the distortion of the female upper reproductive tract organs in the late stages of the disease. Women diagnosed with endometriosis should be counselled about family planning however, the data available to guide these patients regarding fertility preservation or oocyte freezing is scarce. Study design, size, duration A Retrospective cross-sectional study was conducted from July 2017 to May 2020 at a university-affiliated medical center. Patients who had been treated in the endometriosis clinic and underwent controlled ovarian stimulation and oocyte retrieval for fertility preservation, filled an online questionnaire crossed reference with electronic chart analysis related to patient data and fertility preservation cycles. Participants/materials, setting, methods Eighty-one patients were included and categorized into two groups according to the number of oocytes retrieved: 0–5 (Group A, n = 26) low ovarian response and 6 or more oocytes (Group B, n = 55). Main results and the role of chance The severity and duration of the disease so as the symptoms indicative of deep infiltrating endometriosis, were not associated with reduced numbers of vitrified oocytes. The presence of deep infiltrating implants was not associated with numbers of vitrified oocytes (44.4% vs 70.6%, p = 0.08). More Patients who underwent surgical interventions, had significantly lower ovarian responses compared to women who had no intervention (95.2% vs 61.5%, respectively, p = 0.005). A multivariate logistic regression adjusted for the number of oocyte vitrified revealed that anti-Müllerian hormone (AMH) level below 0.8 ng/ml was the only factor significantly associated with low ovarian response, with an adjusted odds ratio of 13.40 (2.02–157.27, p = 0.015). Limitations, reasons for caution: The size of our cohort is relatively small for the number of covariates, reducing the impact of our results when put on an international scope and the lack of information regarding the return rate of patients who had their oocytes vitrified in the attempt of achieving a pregnancy. Wider implications of the findings: We believe that since the practice of FP for endometriosis is relatively new and there is a substantial lack of data, this cohort represents an important contribution to existing literature by extracting data from medical files and cross-referencing them with existing data for fertility specialists, patient encounters, and hospital registries. Trial registration number Not applicable

scholarly journals Impact of COronaVirus Disease -2019 (COVID-19) pandemic on Haemodialysis care delivery pattern in Karnataka, India- a cross-sectional, questionnaire based survey.

2020 ◽  
Author(s):  
Anupama Y J ◽  
Arvind Conjeevaram ◽  
Ravindra Prabhu A ◽  
Manjunath Doshetty ◽  
Sanjay Srinivasa ◽  
...  
Keyword(s):  
Care Delivery ◽  
National Policy ◽  
Well Being ◽  
Care Providers ◽  
Movement Restriction ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Factors Affecting ◽  
Dialysis Facilities ◽  
The Impact

The COVID-19 pandemic has disrupted health care delivery globally. Patients on in-centre haemodialysis(HD) are particularly affected due to their multiple hospital visits and the need for uninterrupted care for their well-being and survival. We studied the impact of the pandemic and the national policy for pandemic control on the HD care delivery in Karnataka state in India in April 2020, when the first and second national lockdown were in place. An online, questionnaire based survey of dialysis facilities was conducted and the responses analysed. The questions were pertaining to the key areas such as changes in number of dialysis treatments, frequency, duration, expenses, transportation to and from dialysis units, impact on availability of consumables, effect on dialysis personnel and on machine maintenance. 62 centres participated. Median of dialysis treatments for the months of March and April 2020 were 695.5 and 650 respectively. Reduction in dialysis treatments was noted in 29(46.8%) facilities , decreased frequency reported by 60 centres. In at least 35(56.5%) centres, dialysis patients had to bear increased expenses. Cost and availability of dialysis consumables were affected in 40(64.5%) and 55(88.7%) centres respectively. Problems with transportation and movement restriction were the two key factors affecting both patients and dialysis facilities.This survey documents the collateral impact of COVID -19 on the vulnerable group of patients on HD, even when not affected by COVID. It identifies the key areas of challenges faced by the patients and the facilities and implores the care-providers for finding newer avenues for mitigation of the problems. Key words: COVID-19, India, Haemodialysis , dialysis care delivery, questionnaire-based survey

Factors Affecting Dilation Interval in Patients With Granulomatosis With Polyangiitis-Associated Subglottic and Glottic Stenosis

2021 ◽  
pp. 019459982110042
Author(s):  
Lena W. Chen ◽  
Ioan Lina ◽  
Kevin Motz ◽  
Alexandra J. Berges ◽  
Rafael Ospino ◽  
...  
Keyword(s):  
Granulomatosis With Polyangiitis ◽  
Medical Center ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Interquartile Range ◽  
Surgical Interventions ◽  
Factors Affecting ◽  
Academic Medical ◽  
Preliminary Study ◽  
The Impact

Objective Subglottic stenosis (SGS) is a known complication of granulomatosis with polyangiitis (GPA). We investigated the impact of medical and surgical interventions on the surgical dilation interval and characterized patients with glottic involvement. Study Design A retrospective chart review of patients with GPA-associated SGS was performed from 2010 to 2019. Setting Tertiary academic medical center. Methods The impact of medical and surgical interventions on dilation interval was assessed. The prevalence of glottic involvement was assessed, and clinical characteristics and outcomes were compared with patients without glottic involvement. Results A total of 39 patients with GPA-associated SGS were analyzed. Dilation intervals in patients receiving leflunomide (n = 4; median, 484 days; 95% CI, 405-1099) were greater than in those not receiving leflunomide (median, 155 days; 95% CI, 48-305; P = .033). The surgical technique used did not affect dilation interval. Patients with glottic involvement (n = 13) had a greater incidence of dysphonia (13/13 vs 15/26 [58%], P = .007) and a shorter dilation interval with involvement (median, 91 days; interquartile range, 70-277) versus without involvement (median, 377 days; interquartile range, 175-1148; hazard ratio, 3.38; 95% CI, 2.26-5.05; P < .001). Of 13 patients, 8 (62%) did not have glottic involvement on first presentation. Conclusion Although GPA is classically thought to affect the subglottis, it also involves the glottis in a subset of patients. These patients have greater complaints of dysphonia and require more frequent surgery. Systemic therapy may increase dilation intervals. In this preliminary study, patients taking leflunomide demonstrated an improvement, highlighting the need for further study of immunosuppression regimens in the treatment of GPA-associated SGS.

scholarly journals COVID-19 Psychological Impact on Health Care Workers in Saudi Arabia

2021 ◽  
Vol 18 (11) ◽  
pp. 6076
Author(s):  
Hasan S. Alamri ◽  
Wesam F. Mousa ◽  
Abdullah Algarni ◽  
Shehata F. Megahid ◽  
Ali Al Bshabshe ◽  
...  
Keyword(s):  
Health Care ◽  
Saudi Arabia ◽  
Health Care Workers ◽  
Psychological Impact ◽  
Psychological Outcomes ◽  
Cross Sectional Survey ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Care Workers ◽  
The Impact

Objective: Little is known about the impact of Coronavirus (COVID-19) among the health care workers in Saudi Arabia. Therefore, the present study aimed to assess the psychological impact of COVID-19 among the health care workers. Methods: A cross-sectional survey was conducted from May till mid-July among 389 health care workers from government and private hospitals in Saudi Arabia. Data was collected using a pre-structured online questionnaire that measured adverse psychological outcomes, including the Patient Health Questionnaire-9 (PHQ-9) scale and the Generalized Anxiety Disorder 7-item (GAD-7) scale. The Pearson chi-square test was used to assess the distribution of depression and anxiety among health care workers. Results: A high level of anxiety was recorded among the health care workers, and 69.3% of health care workers below the age of 40 were found to have depression. There was a significant increase in depression among staff with chronic health problems (72.1% vs. 61.9%; p = 0.048). High anxiety levels were detected among young staff compared to others (68.7% vs. 43.8%; p = 0.001). Moreover, 82.1% of the female staff were anxious, as compared to 55.6% of the males (p = 0.001). Conclusions: We found increased prevalence of adverse psychological outcomes among the health care workers in Saudi Arabia during the outbreak of COVID-19. Therefore, there is a need for proper screening and development of corresponding preventive measures to decrease the adverse psychological outcomes.

scholarly journals Stress Perceived by University Health Sciences Students, 1 Year after COVID-19 Pandemic

2021 ◽  
Vol 18 (10) ◽  
pp. 5233
Author(s):  
Yolanda Marcén-Román ◽  
Angel Gasch-Gallen ◽  
Irene Isabel Vela Martín de la Mota ◽  
Estela Calatayud ◽  
Isabel Gómez-Soria ◽  
...  
Keyword(s):  
Nursing Students ◽  
University Students ◽  
Perceived Stress ◽  
Psychological Health ◽  
Health Sciences ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Occupational Therapy Students ◽  
Health Sciences Students ◽  
The Impact

Today’s COVID-19 situation can affect university Health Sciences students’ psychological health. This study aimed to analyze the stress caused by the impact of the COVID-19 pandemic on Health Sciences students from the University of Zaragoza (Spain) almost 1 year after the pandemic began. This cross-sectional descriptive study was conducted with a sample of 252 university students who completed a self-administered online questionnaire. It evaluated the impact of perceived stress with a modified scale (PSS-10-C), and assessed anxiety and depression on the Goldberg scale. Students presented stress (13.1%), anxiety (71.4%) and depression (81%). Females (81.7%) and the third-year Occupational Therapy students (p = 0.010) reported perceived stress. Nursing students perceived less stress (OR: 0.148; 95% CI: 0.026 to 0.842). University students developed stress and anxiety due to COVID-19 almost 1 year after the pandemic began. Psychological support measures for these groups should be prioritized.

scholarly journals Ex vivo Retrieval of Mature Oocytes for Fertility Preservation in a Patient with Bilateral Borderline Ovarian Tumor

2021 ◽  
Author(s):  
Bruno Ramalho de Carvalho ◽  
Geórgia Fontes Cintra ◽  
Taise Moura Franceschi ◽  
Íris de Oliveira Cabral ◽  
Leandro Santos de Araújo Resende ◽  
...  
Keyword(s):  
Fertility Preservation ◽  
Ovarian Stimulation ◽  
Ovarian Tumor ◽  
Ex Vivo ◽  
Oocyte Retrieval ◽  
Ovarian Response ◽  
Malignant Cell ◽  
Borderline Ovarian Tumor ◽  
Increased Risk

AbstractWe report a case of ultrasound-guided ex vivo oocyte retrieval for fertility preservation in a woman with bilateral borderline ovarian tumor, for whom conventional transvaginal oocyte retrieval was deemed unsafe because of the increased risk of malignant cell spillage. Ovarian stimulation with gonadotropins was performed. Surgery was scheduled according to the ovarian response to exogenous gonadotropic stimulation; oophorectomized specimens were obtained by laparoscopy, and oocyte retrieval was performed ∼ 37 hours after the ovulatory trigger. The sum of 20 ovarian follicles were aspirated, and 16 oocytes were obtained. We performed vitrification of 12 metaphase II oocytes and 3 oocytes matured in vitro. Our result emphasizes the viability of ex vivo mature oocyte retrieval after controlled ovarian stimulation for those with high risk of malignant dissemination by conventional approach.

scholarly journals Prevalence of biologic, behavioral and psychosocial determinant of tuberculosis in tuberculosis patients of Semnan city; a five-year cross-sectional study

2020 ◽  
Vol 5 (2) ◽  
pp. e24-e24
Author(s):  
Naim Sadat Kia ◽  
Mohammad Nassaji Zavareh ◽  
Elnaz Sarkheil ◽  
Elaheh Ghods
Keyword(s):  
Demographic Data ◽  
Cross Sectional Study ◽  
Alcoholic Beverages ◽  
Cross Sectional ◽  
Factors Affecting ◽  
Incidence And Mortality ◽  
The Social ◽  
Household Crowding ◽  
Clinical Records ◽  
The Impact

Introduction: Tuberculosis (TB) is one of the most common and lethal infectious diseases. Objectives: Due to the impact of biological, behavioral, socio-economic factors on the incidence of TB and the risks of the disease, we aimed to investigate the factors affecting TB in TB patients in Semnan. Patients and Methods: All patients with confirmed TB, who were referred to primary healthcare centers in Semnan for receiving medication, enrolled in the study (2012 to 2016). Data collected from clinical records and in-person interviews. The questionnaire consisted of two parts; the first part was demographic data and the other was related to the risk factors for TB. Results: The household crowding index was 1.86 ± 0.88. Most of patients (48.1%) were elderly (≥60 years old), female (59.7%), housewife (48.1%), had a pre-diploma education (63.6%), low-monthly income (62.3%) and married (63.6%). Around13.0% had diabetes. 20.8% drug abuser, 16.9% cigarettes and tobacco smokers, and 1.3% consumed alcoholic beverages. Besides, 40.3% were Afghans and 1.3% had the Pakistani nation. Conclusion: Identifying and controlling the social, geographical and biological factors affecting the incidence and mortality of TB in different regions can help to formulate appropriate strategies for achieving global goals. These factors differ among native and non-native population.

scholarly journals Variability of Antibiotic Prescribing in a Large Healthcare Network Despite Adjusting for Patient-Mix: Reconsidering Targets for Improved Prescribing

2019 ◽  
Vol 6 (2) ◽  
Author(s):  
Sophia Jung ◽  
Mary Elizabeth Sexton ◽  
Sallie Owens ◽  
Nathan Spell ◽  
Scott Fridkin
Keyword(s):  
Antibiotic Prescription ◽  
Medical Center ◽  
Academic Medical Center ◽  
Primary Care Clinic ◽  
Multivariable Logistic Regression Analysis ◽  
Comorbid Condition ◽  
Antibiotic Prescribing ◽  
Cross Sectional ◽  
Care Clinic ◽  
The Impact

Abstract Background In the outpatient setting, the majority of antibiotic prescriptions are for acute respiratory infections (ARIs), but most of these infections are viral and antibiotics are unnecessary. We analyzed provider-specific antibiotic prescribing in a group of outpatient clinics affiliated with an academic medical center to inform future interventions to minimize unnecessary antibiotic use. Methods We conducted a cross-sectional study of patients who presented with an ARI to any of 15 The Emory Clinic (TEC) primary care clinic sites between October 2015 and September 2017. We performed multivariable logistic regression analysis to examine the impact of patient, provider, and clinic characteristics on antibiotic prescribing. We also compared provider-specific prescribing rates within and between clinic sites. Results A total of 53.4% of the 9600 patient encounters with a diagnosis of ARI resulted in an antibiotic prescription. The odds of an encounter resulting in an antibiotic prescription were independently associated with patient characteristics of white race (adjusted odds ratio [aOR] = 1.59; 95% confidence interval [CI], 1.47–1.73), older age (aOR = 1.32, 95% CI = 1.20–1.46 for patients 51 to 64 years; aOR = 1.32, 95% CI = 1.20–1.46 for patients ≥65 years), and comorbid condition presence (aOR = 1.19; 95% CI, 1.09–1.30). Of the 109 providers, 13 (12%) had a rate significantly higher than predicted by modeling. Conclusions Antibiotic prescribing for ARIs within TEC outpatient settings is higher than expected based on prescribing guidelines, with substantial variation in prescribing rates by site and provider. These data lay the foundation for quality improvement interventions to reduce unnecessary antibiotic prescribing.

scholarly journals Newly qualified doctors’ perceived effects of assistantship alignment with first post: a longitudinal questionnaire study

BMJ Open ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. e023992 ◽  
Author(s):  
Stephanie E Wells ◽  
Alison Bullock ◽  
Lynn V Monrouxe
Keyword(s):  
Questionnaire Study ◽  
Limited Evidence ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Confidence Levels ◽  
Preparedness For Practice ◽  
Experience Effects ◽  
Perceived Effects ◽  
The Impact

PurposeGrowing evidence supports the role of student assistantships in enhancing graduates’ preparedness for practice. However, there is limited evidence concerning the impact of aligning assistantships with graduates’ first doctor post. The aims of our study were to determine newly-qualified doctors’ views on the value their assistantship experience, effects on anxiety levels, confidence and preparedness for increased responsibilities, exploring change over time and whether effects differ according to assistantship alignment.DesignWe conducted a longitudinal cross-sectional online questionnaire study examining experiences of aligned and non-aligned assistantships across the transition from medical student to newly-qualified doctor. The questionnaire was distributed to final year medical students within Wales, UK (n=351) and those commencing their first post in Wales, UK (n=150) in June 2015 at Time 1 (T1), and repeated in September 2015 (1 month following transition, T2) and January 2016 (T3).ResultsResponse rates at T1 were 50% (n=251, aligned=139, non-aligned=112), T2 36% (n=179, aligned=83, non-aligned=96) and T3 28% (n=141, aligned=69, non-aligned=72): 15% (n=73, aligned=36, non-aligned=37) completed all questionnaires. Paired longitudinal analysis was undertaken where possible. Significant differences were observed between participants on aligned and non-aligned assistantships in terms of the value they place on their assistantship experiences, their anxiety, confidence levels and preparedness for responsibility.ConclusionAlthough not sustained, aligned assistantships seem to provide graduates with additional benefits during the August transition. Further work is required to establish what it is about the aligned assistantship programme that works and why.

Diversity and Equality Management System and Perceived Organisational Performance: A Mediating Role of Organisational Citizenship Behaviour

2020 ◽  
pp. 227853372096351
Author(s):  
Bignya Patnaik ◽  
Mahendra Kumar Shukla
Keyword(s):  
Management System ◽  
Human Resource Managers ◽  
Organisational Performance ◽  
Online Questionnaire ◽  
It Industry ◽  
Cross Sectional ◽  
Mediating Role ◽  
Resource Managers ◽  
The Impact

A structured diversity and equality management system (DEMS) contributes to the smooth and peaceful functioning of organisations. The review of literature shows that the impact of DEMS on organisational performance and growth is found to be positive in Western countries. However, there appears to be a lack of research on the role of DEMS in Indian organisations, especially in the IT industry. This study makes an attempt to assess the impact of DEMS on perceived organisational performance and organisational citizenship behaviour (OCB) and empirically validate the mediating role of OCB in Indian IT firms. This study used descriptive research design, and the nature of research questions mandated the primary cross-sectional data collection method. The online questionnaire was e-mailed to human resource managers as well as executives of IT firms in India. Responses of 220 respondents were analysed to test the hypotheses of the research using CB-SEM. The results confirm a mediating role of OCB on the linkage between DEMS and perceived organisational performance. Findings suggest that organisations should promote OCB as it contributes significantly in establishing a positive, committed and conflict-free work environment.

Prescribers' perceptions on the impact of hydrocodone rescheduling on geriatric pain management: A qualitative study

2018 ◽  
Vol 14 (5) ◽  
pp. 317-326
Author(s):  
Julianna Fernandez, PharmD, BCPS, CGP ◽  
James Douglas Thornton, PhD, PharmD, BCPS ◽  
Sanika Rege, MS ◽  
Benjamin Lewing, MS ◽  
Shweta Bapat, BPharm ◽  
...  
Keyword(s):  
Pain Management ◽  
Focus Groups ◽  
Geriatric Patients ◽  
Medical Center ◽  
Academic Medical Center ◽  
Monitoring Program ◽  
Prescribing Patterns ◽  
Cross Sectional ◽  
Term Care ◽  
The Impact

Objective: To qualitatively assess prescribers’ perceptions regarding the consequences associated with hydrocodone rescheduling among geriatric patients being discharged from inpatient settings.Design: This was a cross-sectional study.Setting: Two focus groups were conducted by a trained facilitator in a metropolitan academic medical center in January 2016.Participants: Prescribers who manage noncancer pain for geriatric patients were recruited. Focus groups were recorded, transcribed, and then analyzed using ATLAS.ti Qualitative Data Analysis software. Codes were derived from six primary research questions and results were summarized into key themes regarding the impact of rescheduling.Main outcome measures: Prescribers’ perceptions regarding hydrocodone rescheduling.Results: Prescribers mentioned that they review the prescription monitoring program (PMP) more often before prescribing opioids after rescheduling. They expressed concern regarding the required special serialized prescription forms needed to issue schedule II prescriptions. This led to substituting hydrocodone with potentially less effective pain medications, the inability to issue refills on hydrocodone prescriptions, and an ethical concern over prescribing hydrocodone to patients not under their direct care. Additionally, rescheduling has affected the coordination of care upon discharge, as patients moving to long-term care or skilled nursing facilities may not have adequate pain management when transferred.Conclusions: The majority of physicians felt rescheduling negatively impacted both practical and ethical aspects of patient care related to pain management after discharge. Rescheduling has changed physicians’ hydrocodone prescribing patterns, leading to more caution when prescribing hydrocodone and greater use of the PMP. Future studies should assess geriatric patients’ satisfaction and quality of life regarding pain management since hydrocodone was rescheduled.

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