DeStephano, Christopher C.

AbstractIntroductionSmoking commercial tobacco products is highly prevalent in American Indian and Alaska Native (Indigenous) pregnancies. This disparity directly contributes to maternal and fetal mortality. Our objective was to describe cigarette smoking prevalence, cessation intervention uptake, and cessation behaviors of pregnant Indigenous people compared to sex and age-matched regional cohort.Aims and MethodsPregnancies from an Indigenous cohort in Olmsted County, Minnesota, identified in the Rochester Epidemiology Project, were compared to pregnancies identified in a sex and age-matched non-Indigenous cohort from 2006 to 2019. Smoking status was defined as current, former, or never. All pregnancies were reviewed to identify cessation interventions and cessation events. The primary outcome was smoking prevalence during pregnancy, with secondary outcomes measuring uptake of smoking cessation interventions and cessation.ResultsThe Indigenous cohort included 57 people with 81 pregnancies, compared to 226 non-Indigenous people with 358 pregnancies. Smoking was identified during 45.7% of Indigenous pregnancies versus 11.2% of non-Indigenous pregnancies (RR: 3.25, 95% CI = 1.98–5.31, p ≤ .0001). Although there was no difference in uptake of cessation interventions between cohorts, smoking cessation was significantly less likely during Indigenous pregnancies compared to non-Indigenous pregnancies (OR: 0.23, 95% CI = 0.07–0.72, p = .012).ConclusionsIndigenous pregnant people in Olmsted County, Minnesota were more than three times as likely to smoke cigarettes during pregnancy compared to the non-indigenous cohort. Despite equivalent uptake of cessation interventions, Indigenous people were less likely to quit than non-Indigenous people. Understanding why conventional smoking cessation interventions were ineffective at promoting cessation during pregnancy among Indigenous women warrants further study.ImplicationsIndigenous pregnant people in Olmsted County, Minnesota, were greater than three times more likely to smoke during pregnancy compared to a regional age matched non-Indigenous cohort. Although Indigenous and non-Indigenous pregnant people had equivalent uptake of cessation interventions offered during pregnancy, Indigenous people were significantly less likely to quit smoking before fetal delivery. This disparity in the effectiveness of standard of care interventions highlights the need for further study to understand barriers to cessation in pregnant Indigenous people.

Abstract Polycystic ovarian syndrome (PCOS) is a complex health condition associated with metabolic disturbances and infertility. Recent data suggest that the prevalence of PCOS is increasing among women globally, although the etiology of these trends is undefined. Consequently, preclinical models that better reflect the biology of PCOS are urgently needed to facilitate research that can lead to the discovery of prevention strategies or improved management. The existing animal models have several limitations as they do not reflect all the PCOS features metabolically and/or phenotypically. Therefore, there is no clear consensus on the use of appropriate animal model and selection of the most appropriate PCOS-inducing agent. To that end, we have established a Swiss albino mouse model of PCOS based on 3 weeks of daily treatment with letrozole (50 μg/day; intraperitoneal) and dehydroepiandrosterone (DHEA, 6 mg/100 g body weight; subcutaneous) in 5-week-old female mice fed on normal or high-fat diet (HFD). Mice were regularly assessed for body weight, blood glucose, and estrous cycle. Three weeks after drug administration, mice were sacrificed and assessed for blood-based metabolic parameters as well as ovarian function. Our results indicate that DHEA combined with HFD produces changes mimicking those of clinical PCOS, including elevated serum testosterone and luteinizing hormone, dyslipidemia, poor ovarian microenvironment, and development of multiple ovarian cysts, recapitulating cardinal features of PCOS. In comparison, normal diet and/or letrozole produced fewer features of PCOS. The data from the experimental models presented here can improve our understanding of PCOS, a growing concern in women’s health.

INTRODUCTION: Chronic pelvic pain (CPP) affects up to 15% of women in the United States. The endocannabinoid system can be a pharmacological target for endometriosis-related pelvic pain, as cannabis receptors are highly expressed in the uterus and other non-reproductive tissues. We hypothesize that many patients with CPP use cannabis and report improvement in symptoms. METHODS: An anonymous, confidential, electronic survey was performed from March through August 2019. Patients aged 18 through 89 were included if they had a diagnosis of pelvic/perineal pain, dyspareunia, or endometriosis. Subjects were approached during outpatient appointments. Study approval was obtained from the Institutional Review Board. RESULTS: A total of 122 of 240 (50.8%) patients responded. Of these, 113 self-reported a diagnosis of CPP (92.6%). Twenty-six patients reported cannabis use (23%). Six (24%) used Cannabidiol (CBD), 3 (12%) used tetrahydrocannabinol (THC), and 15 (60%) used a combination of CBD and THC. Frequency of use varied, with the majority using at least once per week (n=18, 69.2%). Only 5 (19.2%) utilized a State Medical Cannabis Program to obtain a certification. Of users, 24 (92.3%) reported improvement in symptoms, including pain, cramping, muscle spasms, anxiety, depression, sleep disturbances, libido, and irritability. However, 21 (80.7%) reported side effects; the most common were dry mouth, sleepiness, and feeling “high.” CONCLUSION: Up to 23% of patients with CPP report use of cannabis as an adjunct to their prescribed therapy, and they use a variety of formulations and doses. Most report daily or weekly use. Although side effects are common, most users report improvement in symptoms.

INTRODUCTION: Study Objective: To determine the payments made to Obstetricians and Gynecologists (OBGYNs) compared to other surgical specialties by the makers of the Da Vinci robot-Intuitive Surgical, Inc. in 2014. METHODS: Design: Retrospective cross-sectional study (Canadian Task force classification- II-3). Setting: Payments to OBGYNs in the United States compared to the total Intuitive Surgical payment amount in each state as analyzed from Centers for Medicare & Medicaid Services (CMS)’ Open Payments website. Subjects: General OBGYNs, OBGYN subspecialists (Gynecologic Oncology, Reproductive Endocrinology, Female Pelvic Medicine and Reconstructive Surgery, Gynecology), and providers in other specialties nationwide. Interventions: Compare Intuitive Surgical Inc. payments to OBGYNs versus other surgical specialties as analyzed from publicly available CMS Open Payments database. RESULTS: A total of 50 states received money from Intuitive Surgical Inc. in 2014. Payments to general OBGYNs totaled $5,061,439, OBGYN subspecialties received $1,591,556, and other surgical specialties that use the Da Vinci platform received $33,011,657. Total payments per state can be represented in a map diagram. The state of Texas got the highest amount. Payments to OBGYNs divided by total payments in each state can be depicted in a similar fashion, Wyoming state had the highest value. CONCLUSION: OBGYNs received a significant proportion of funding from Intuitive Surgical Inc. as compared to other surgical specialties in 2014. We recommend that OBGYNs update or declare any conflicts when required.

BACKGROUND: OB/GYN residencies use myTIPreport to improve resident feedback. Validation is viewed as a process with construct validity established from different levels of evidence. In Kane's validity framework, extrapolation focuses on links between assessment outcomes and other measures of performance. METHODS: Single-institution, prospective cohort study of OB/GYN residents (n=24). Using the ACGME case log system and myTIPreport application, associations of PGY level, number of previous hysteroscopies (HSC), total vaginal hysterectomies (TVH), and total abdominal hysterectomies (TAH) with myTIPreport ratings of each procedure when performed in the operating room were assessed using Spearman's test correlation. A pilot study of inexpensive, low technology simulation models was initiated to assess extrapolation evidence for myTIPreport in the simulation setting (n=8). RESULTS: Associations (P<.01) existed between PGY level and myTIPreport scores in the OR (r=0.612 for HSC, r=0.763 for TAH, r=0.864 for TVH). Associations (P<.01) existed between number of procedures performed and myTIPreport scores in the OR (r=0.587 for HSC, r=0.681 for TAH, r=0.869 for TVH). An association (r=0.852, P=.031) existed between number of TVHs performed in the OR and myTIPreport scores during simulation, but not for TAH (P=.199) nor HSC (P=.154) due to the small sample size. DISCUSSION: The association between myTIPreport TVH performance with PGY level and number of TVHs was the strongest, supporting extrapolation evidence. The associations were weaker for TAH and HSC in both the OR and simulation settings secondary to higher ratings for lower PGY levels and fewer cases.

Although studies on simulation of rare complications have become more common in the trauma and obstetric literature, there is a paucity of studies on simulation of rare laparoscopic emergencies. High-fidelity models, virtual reality systems, and porcine labs are available; however, their cost limits wider use and repetition of skills. A low-cost, laparoscopic entry and emergency model was created using on-hand base parts. A convenience sample of obstetrics/gynecology and general surgery residents and attending surgeons completed a laparoscopic entry and emergency scenario using an innovative model in the multidisciplinary simulation center. A total of 29 gynecology, urology, and general surgery residents, fellows, and attending surgeons participated in the laparoscopic emergency simulation drill. Of the 29 participants of the laparoscopic emergency simulation drill using the model, 27 (93.1%) agreed or strongly agreed that the simulated drill approximates the stress of a vascular injury during laparoscopy and 27 (93.1%) agreed or strongly agreed that the model set up appears appropriate for approximating a retroperitoneal hematoma. The reusable, laparoscopic simulation model and emergency drill were rated favorably by participants. The model and drill have the potential to be used for multidisciplinary drills that include anesthesiologists, surgical nurses, surgical technologists, and surgeons.