Background During the COVID pandemic, residency program’s social media presence increased to aid in residency recruitment by attempting to increase engagement and readily available information for applicants across specialties. However, little information exists on what characteristics and content on obstetrics and gynecology (OBGYN) residency program accounts attract more followers or engagement. Objectives To identify social media trends in OBGYN residencies and determine which aspects of programs influence the number of followers and interaction with content posted. Methods We performed a retrospective review of ACGME accredited OBGYN programs and determined their presence on Instagram and X in the fall of 2021. Content from the thirty programs with the most followers was analyzed independently by two authors. Multivariate analysis and a linear mixed model were used to characterize and evaluate content on Instagram and X. Results Most programs utilized Instagram (88.5%, N = 262/296) and were managed solely by residents (84.4%, N = 108/128). Number of followers on Instagram positively correlated with features such as program size, Instagram profile duration, and Doximity rankings (p < 0.0x01). Programs on X had more followers if their profile had a longer duration, followed more individuals, or were ranked higher on Doximity. The most posted Instagram content was biographical and social in nature. Instagram posts with the highest engagement were awards and/or the Match. Conclusions Understanding what social media content attracts more followers and increases engagement is crucial as it likely impacts OBGYN resident recruitment. Professional groups should establish guidelines for social media use in recruitment for the protection of both residents and applicants.

INTRODUCTION: Adverse childhood experiences (ACEs) are instances of abuse or household dysfunction that occur prior to 18 years of age. Numerous studies have demonstrated an increased risk of morbidity and mortality with increasing ACE scores. An association between ACEs and chronic pelvic pain has also been described; however, data for acute pain are lacking. This study evaluates the relationship between ACEs and acute postoperative pain after benign minimally invasive hysterectomies. METHODS: Institutional review board approval was obtained at a large academic health center. Consenting participants completed the ACEs survey prior to hysterectomy. Patient data were collected by retrospective chart review, including postoperative care unit pain scores. Descriptive statistics, Kruskal-Wallis tests, and Spearman’s correlation coefficients were utilized for analysis. Enrollment is ongoing with a recruitment goal of 112 participants. RESULTS: Preliminary analysis included 47 participants. Average patient age was 39.2±11.4 years. The average ACE score was 3.5±2.9 and 46.8% of participants had high ACE scores, defined as 4 or more. Although not statistically significant, patients with high ACE scores trended towards higher pain scores and morphine milligram equivalents (MME) usage. Maximum pain scores and required MME were 5.86 and 16.50 MME in the high-ACE group versus 4.88 and 7.50 MME in the low-ACE group, respectively (P=.41, P=.40). CONCLUSION: High ACE scores are greater than threefold more prevalent in our surgical study population compared to previously reported general population rates. Although preliminary data suggest ACE scores and postoperative pain are not associated, further data are needed.

STUDY OBJECTIVE:To evaluate the 30-day complication rate among different hysterectomy routes and operative times. DESIGN:A retrospective cohort study. SETTING:American College of Surgeons National Surgical Quality Improvement Program database from 2011 to 2019. PATIENTS:A total of 216 621 total cases including total abdominal hysterectomies (TAHs), total vaginal hysterectomies, total laparoscopic-assisted vaginal hysterectomies, and total laparoscopic hysterectomies. INTERVENTIONS:Eligible cases included benign hysterectomies with operative times between 20 minutes and 500 minutes. We excluded cases involving disseminated cancer, emergency surgery, supracervical approaches, or concomitant procedures. MEASUREMENTS AND MAIN RESULTS:Multivariable logistic regression was used to evaluate the relationship between postoperative complications and operative time for each operative route. Multivariable logistic regression with a linear spline term was used to analyze differences in the association between postoperative complications and operative time below and above threshold operative times. Multivariable logistic regression demonstrated a significant association between operative time and overall complication rates for all hysterectomy routes. Spline logistic regression demonstrated a significant increase in adjusted odds of a complication occurring at or above the thresholds of 100 minutes for TAH. CONCLUSION:Patients undergoing a TAH for benign indications had a significantly increased odds of developing a complication within 30 days when operative time exceeded 100 minutes. Operative time may play a larger role in preoperative, intraoperative, and postoperative management than previously recognized for TAH in contrast to other hysterectomy routes.

Objectives The aims of the study were to identify whether obese women are less appropriately screened for cervical cancer before diagnosis and to explore related cancer outcomes. Methods We retrospectively reviewed all cervical cancer patients at a single institution between 1986 and 2016 and collected demographic information including age, cancer stage, body mass index (BMI), screening information, and cancer outcomes. Morbid obesity was defined as BMI of 40 kg/m 2 or greater, obesity as BMI of 30 to less than 40 kg/m 2 , and nonobese as BMI of less than 30 kg/m 2 . χ 2 , Fisher exact, and Wilcoxon rank sum tests were used to compare variables between BMI categories. Cox regression models were used to evaluate recurrence-free survival and overall survival (OS). Results A total of 1,080 patients were reviewed, of whom 311 (29.4%) were obese and 107 (10.1%) morbidly obese. A significant association between BMI and cytology screening was evidenced with morbidly obese women having the highest incorrect rate (64.4%), followed by obese (51.5%) and nonobese women (46.0%, p < .01). There was no significant difference in presence of symptoms at presentation ( p = .12) or stage ( p = .06) between BMI categories. In multivariable analysis of cancer outcomes, higher BMI was associated with worse OS ( p < .01) with a hazard ratio of 1.25 (95% CI = 0.92–1.69) for obese women and hazard ratio 2.27 (95% CI = 1.56–3.31) for morbidly obese women relative to normal weight but recurrence-free survival did not differ between BMI groups ( p = .07). Conclusions Our study strengthens evidence that obese and morbidly obese women have disproportionate inappropriate screening before cervical cancer diagnosis, and morbidly obese women have worse OS than their counterparts.

OBJECTIVES: In recent years, hysterectomy rates have been significantly decreasing due to novel, non-surgical ways managing benign gynecologic indications for hysterectomy. As a result, as modern women age, they are more likely to have a uterus and cervix in situ. Cervical cancer guidelines currently discontinue screening at the age of 65, if appropriate negative screening has been documented, based on historical data. Our aim was to determine if the age of diagnosis in cervical cancer is increasing in order to inform whether consideration should be given to extending cervical cancer screening beyond age 65.

Despite dramatic improvements in outcomes arising from the introduction of targeted therapies and immunotherapies, metastatic melanoma is a highly resistant form of cancer with 5 year survival rates of <35%. Drug resistance is frequently reported to be associated with changes in oxidative metabolism that lead to malignancy that is non-responsive to current treatments. The current report demonstrates that triphenylphosphonium(TPP)-based lipophilic cations can be utilized to induce cytotoxicity in pre-clinical models of malignant melanoma by disrupting mitochondrial metabolism. In vitro experiments demonstrated that TPP-derivatives modified with aliphatic side chains accumulated in melanoma cell mitochondria; disrupted mitochondrial metabolism; led to increases in steady-state levels of reactive oxygen species; decreased total glutathione; increased the fraction of glutathione disulfide; and caused cell killing by a thiol-dependent process that could be rescued by N-acetylcysteine. Furthermore, TPP-derivative-induced melanoma toxicity was enhanced by glutathione depletion (using buthionine sulfoximine) as well as inhibition of thioredoxin reductase (using auranofin). In addition, there was a structure-activity relationship between the aliphatic side-chain length of TPP-derivatives (5-16 carbons), where longer carbon chains increased melanoma cell metabolic disruption and cell killing. In vivo bio-distribution experiments showed that intratumoral administration of a C14-TPP-derivative (12-carbon aliphatic chain), using a slow-release thermosensitive hydrogel as a delivery vehicle, localized the drug at the melanoma tumor site. There, it was observed to persist and decrease the growth rate of melanoma tumors. These results demonstrate that TPP-derivatives selectively induce thiol-dependent metabolic oxidative stress and cell killing in malignant melanoma and support the hypothesis that a hydrogel-based TPP-derivative delivery system could represent a therapeutic drug-delivery strategy for melanoma.

Partial rotation of the uterus up to 45 degrees is a common physiological finding during pregnancy whereas uterine torsion is pathologic and defined as rotation greater than 45 degrees. Torsion of up to 720 degrees has been reported; with most cases occurring between 90 degrees and 180 degrees. While uterine torsion in pregnancy requires emergent intervention, the incidence is unknown. Most cases of uterine torsion are diagnosed intra-operatively at emergent cesarean section following non-specific clinical presentation, such as fetal heart rate decelerations or bradycardia, severe abdominal pain, hypotension, or vaginal bleeding. In this case series, we report on two cases of one woman with gravid uterine levorotation of 180 degrees and another with gravid uterine dextrorotation of 180 degrees.

Objectives: The objective of this study was to determine if there has been an increase in the age of diagnosis of cervical cancer over time, specifically in the proportion of patients over 65 years old, given decreasing rates of hysterectomy. Materials and methods: A retrospective review of a single institution was conducted including cervical cancer patients seen between 1986 and 2016. Data included demographic variables including age of diagnosis, last cervical cancer screening, and cancer information. Cochran-Armitage test was used to assess temporal trends in the proportion of patients diagnosed over 65. Results: A total of 1,019 patients with cervical cancer were reviewed, of whom 116 were over the age of 65. The age of diagnosis increased by 0.2 years per calendar year, with an average age of diagnosis of 43.7 years old in 1986 versus 49.5 years old in 2016 (p < 0.01). The proportion of patients diagnosed with cervical cancer over the age of 65 did not significantly differ over time (17.2 % in 1986 vs. 14.8 % in 2016, p = 0.39). 19.0 % of women diagnosed with cervical cancer over the age of 65 developed cancer despite exiting screening appropriately. Conclusions: In our cohort, the age of diagnosis of cervical cancer increased over time, however, there was no significant difference in the percentage of women diagnosed over the age of 65. Published by Elsevier Masson SAS.

A diagnosis of recurrent epithelial ovarian cancer carries with it a very poor prognosis despite aggressive chemotherapy with or without secondary surgical cytoreduction. Recently, maintenance treatment after second-line chemotherapy has gained momentum given promising results of antiangiogenics and PARP inhibitors used in this setting. When used appropriately, these agents may provide a meaningful survival benefit with minimal effects on quality of life. This paper reveals the current literature evaluating the use of maintenance therapy in the recurrent setting for the epithelial ovarian, fallopian tube, or primary peritoneal cancers.

Local Mentor: Colleen K. Stockdale, MD, MS APGO Advisor: Hope Ricciotti, MD OBJECTIVE: Evaluate the effect of differing sexual history communication curricula as assessed by a standardized performance examination administered at the end of the Obstetrics and Gynecology clerkship. Differences in specific types of communication skills were considered based on varied training in sexual history-taking as experienced by medical students. METHODS: This retrospective cohort study examined “naturally occurring” comparison groups of medical students resulting from curricular changes in sexual history communication training over time. The curricular changes were hypothesized to positively affect practice based assessment (PBA) scores. Other variables considered were medical student sex and year. Outcome measures included items regarding clinical history, physical exam, communication skills and final diagnosis related to sexual history communication curriculum experienced. Group means and paired t-tests were performed for individual variables as well as several composite variables. RESULTS: Nine hundred and nine (n = 909) PBA scores were analyzed. Post-hoc power analysis defined minimum group size to be 45, which was exceeded. There was no relationship, positive or negative, between sexual history communication curricula with any outcome measure. Females performed significantly better on the PBA overall ( P <.0001) and on several individual communication measures on the PBA checklist (range P 0.0003–0.02). Students who received “double” sexual history communication training compared to those who received “single” or no training showed no difference on any outcome measure ( P 0.06). CONCLUSION: There appears to be minimal correlation of differing sexual history communication curricula with individual or composite communication skill scores as evaluated with a standardized performance examination administered at the end of the Obstetrics and Gynecology clerkship.

Objective: Anastomotic leak after bowel resection is often accompanied by significant morbidity and prolonged postoperative recovery. Risk factors associated with AL in gynecologic oncology are often abstracted from the colorectal literature. The objective of this study is to determine morbidity and 90-day mortality associated with bowel surgery during gynecologic oncologic procedures. We also aimed to identify perioperative factors and operative techniques associated with anastomotic leak.

Exstrophy-epispadias sequence is an uncommon diagnosis in which surgical reconstruction has increased quality of life for these patients. As they are entering the reproductive phase of their life, consideration must be made for management of their pregnancies in the context of their genitourinary reconstruction. There have been few case reports of patients with cloacal exstrophy conceiving; therefore, information to guide management of their pregnancies is limited. Here we describe a patient with Omphalocele-Exstrophy-Imperforate Anus-Spinal defects (OEIS) and a patient with a history of bladder exstrophy both with spontaneous pregnancy managed by a multidisciplinary approach and primary cesarean delivery.

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality Improvement & Patient Safety II1 Apr 2017MP92-02 BPA ALERT EFFECT ON CAUTIS HOSPITAL-WIDE AT UIHC Colette Gnade, Douglas Storm, and Patrick Ten Eyck Colette GnadeColette Gnade More articles by this author , Douglas StormDouglas Storm More articles by this author , and Patrick Ten EyckPatrick Ten Eyck More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2863AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Catheter associated urinary tract infections (CAUTIs), the most common hospital-acquired infection, increase hospital cost, length of stay, morbidity/mortality and time/wages lost for patients. In an effort to reduce the CAUTI rate, our hospital instituted a Best Practice Alert (BPA) reminder within our inpatient electronic medical record system in 2013. To determine the effect of this BPA, we compared the CAUTI rate and number of urinary catheter days before and after 2013, hypothesizing that this BPA reduced both variables. METHODS A retrospective review was performed utilizing our institution′s inpatient database from 2011-2016. All CAUTIs were defined using the 2013 CDC guidelines. Generalized linear mixed modeling was used to estimate the effects of variables of interest on catheter utilization (CU) and CAUTI rates. CU and CAUTI rates were measured using a binomial distribution with a logit link and were also compared between ICU, general adult and general pediatric wards. RESULTS Data from 1,102,803 patient days accounting for 227,256 catheter days was evaluated. Between 2011 and 2013, there was a 1.9% decrease per month (p value < 0.0001) in CU rates. Comparing the years of 2013 to 2016, there was less significant decrease at 1.3% per month (p value < 0.0001) in CU rates. Between 2012 and 2016, there was not a significant decrease in CAUTIs despite a decrease in CU rates (0.01% per month, p value 0.846). We also found a lower relative rate in overall CU rate in pediatrics (-3.14, p value < 0.001) as compared to adult units and a higher rate in overall CU rates in the ICU setting (2.04, p value 0.003) as compared to the non-ICU setting. CONCLUSIONS Our study shows that there is a decrease in CU rates, but no effect on CAUTI rates with the BPA alert. This suggests that factors resulting in CAUTIs are multifactorial and not just limited to length of catheter use. These additional factors may be difficult to control, and perhaps are intrinsic to the patient and their disease process, making some CAUTIs difficult to prevent, despite limiting catheter use. This may result in a plauteau in a hospital′s overall CAUTI rate, despite following recommended best practices. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1226 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Colette Gnade More articles by this author Douglas Storm More articles by this author Patrick Ten Eyck More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Objectives: We aimed to determine the factors which influence BRCA1/BRCA2 positive patients to opt for surveillance versus risk reducing surgery. Additionally, we sought to identify demographic and clinical attributes specific to BRCA1/BRCA2 positive women who underwent risk reducing surgery and compare them to women who decided on surveillance.

Anti-N-methyl-D-aspartate receptor encephalitis in young healthy women while rare may be the result of an ovarian teratoma that produces anti-NMDA receptor antibodies. Symptoms from this encephalitis can be severe enough to result in hypoventilation, autonomic instability, and coma. Although treatable with tumor removal via oophorectomy and immunosuppression, median time to diagnosis is 8 weeks, which may lead to the onset of severe symptoms. The case presented highlights the severity of symptoms including rhabdomyolysis and respiratory distress in a female who had a previous history of functional somatic syndromes, which possibly resulted in a delayed diagnosis. This case demonstrates the importance of a thorough evaluation for causes of new onset neurological symptoms when the patient’s clinical status continues to deteriorate. This includes an evaluation for anti-N-methyl-D-aspartate receptor encephalitis. Following salpingo-oophorectomy, IVIG/methylprednisolone, and rituximab/cyclophosphamide treatment, this patient demonstrated improvement although she continues to require rehabilitation therapy, maintenance Keppra and low-dose Prednisone.