Pennsylvania Hospital is a private, non-profit, 515-bed teaching hospital located in Center City Philadelphia and is part of the University of Pennsylvania Health System. Founded on May 11, 1751, by Benjamin Franklin and Dr. Thomas Bond, Pennsylvania Hospital is one of the earliest established public hospitals in the United States.[a] It is also home to America's first surgical amphitheatre and its first medical library. The hospital's main building, dating to 1756, is a National Historic Landmark.
Urinary tract infections (UTIs) are among the most common reasons for antibiotic prescriptions in women in the United States (US); however, 40
Medicaid-insured individuals and those dually eligible for Medicare and Medicaid face high rates of adverse post-hospital outcomes, driven in part by fragmented care transitions and unmet social needs. Despite evidence supporting the use of home health services post-hospitalization, fewer than 20 https://clinicaltrials.gov/ct2/show/NCT05714605
Importance:The management of patent ductus arteriosus (PDA) in preterm infants is controversial. Objective:To determine whether expectant management compared with active treatment of a protocol-defined PDA in preterm infants decreases the incidence of death or bronchopulmonary dysplasia (BPD). Design, Setting, and Participants:A randomized clinical trial including infants born at 22 to 28 weeks' gestation and diagnosed with a protocol-defined PDA between the age of 48 hours and 21 days at screening. The trial was conducted from December 2018 to December 2024 at 33 hospitals within the National Institute of Child Health and Human Development Neonatal Research Network. The final date of follow-up was June 2025. Interventions:Infants with PDA were randomized to expectant management (n = 242) or active treatment (n = 240; acetaminophen, ibuprofen, or indomethacin) to close the PDA. Main Outcomes and Measures:The primary outcome was death or BPD at 36 weeks' postmenstrual age. The secondary outcomes included the components of the primary outcome and other morbidities of prematurity. Results:A total of 482 infants were randomized (median gestational age, 25 weeks [IQR, 24 to 27 weeks]; median birth weight, 760 g [IQR, 620 to 935 g]). The trial was stopped for futility and safety after the 50% interim analysis for the primary outcome due to higher survival in the expectant management group. The incidence of death or BPD was 80.9% (195/241) of infants in the expectant management group vs 79.6% (191/240) of infants in the active treatment group (adjusted risk difference, 1.2% [95% CI, -5.7% to 8.1%]; P = .73). The incidence of death before 36 weeks' postmenstrual age was 4.1% (10/241) of infants in the expectant management group vs 9.6% (23/240) of infants in the active treatment group (adjusted risk difference, -5.6% [95% CI, -10.1% to -1.2%]; P = .01). Infections resulting in death occurred in 0.8% (2/241) of infants in the expectant management group vs 3.8% (9/240) of infants in the active treatment group. Conclusions and Relevance:In extremely preterm infants with a protocol-defined PDA, death or BPD did not differ between the expectant management group and the active treatment group. Survival was substantially higher with expectant management. Trial Registration:ClinicalTrials.gov Identifier: NCT03456336.
IMPORTANCE:Fecal incontinence (FI) is common, underdiagnosed, and often undertreated. Understanding gaps in training, comfort, and confidence in managing FI among urogynecology fellows and attending physicians (attendings) may improve patient access to high-quality care. OBJECTIVE:The objective of this study was to assess clinical exposure, didactic training, and self-reported comfort with FI management among urogynecology fellows and fellowship-trained attendings in the United States. STUDY DESIGN:A cross-sectional, anonymous electronic survey was distributed to physician members of the American Urogynecologic Society (AUGS) in 2025. The survey evaluated demographic characteristics, exposure to FI during fellowship and current practice, availability of diagnostic and procedural tools, didactic education, and comfort with medical and procedural management. Responses were summarized using descriptive statistics, and 1-way analyses of variance (ANOVA) were used to assess associations between level of training and overall comfort. RESULTS:A total of 202 respondents completed the survey (35 fellows, 167 attendings; response rate 14.3%). More than half of fellows (54.3%) and two thirds of attendings (66.5%) completed a colorectal surgery rotation, while gastroenterology rotations were less common. Most respondents evaluated patients with FI weekly (60.0% of fellows; 51.5% of attendings). Fewer than half felt comfortable performing or interpreting anorectal manometry or endoanal ultrasound. Only 8.6% of fellows and 31.1% of attendings reported feeling very comfortable with FI management. Overall comfort increased with advancing training stage and years in practice (P<0.001) but was not associated with colorectal or gastroenterology rotations. Most respondents (80.0% of fellows; 63.5% of attendings) believed that improving clinician comfort would enhance patient outcomes and access to care. CONCLUSIONS:Clinical and didactic exposure to FI varies widely across urogynecology training and practice. Despite frequent encounters, limited procedural experience contributes to persistent discomfort with FI management. Standardizing fellowship education and expanding interdisciplinary, longitudinal training may improve clinician confidence and patient care.
