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ABSTRACT: AIMS: To develop a comprehensive conceptual framework representing the most important outcomes for women seeking treatment for pelvic organ prolapse (POP). METHODS: Twenty-five women with POP were recruited and participated in four semi-structured focus groups to refine and assess the content validity of a conceptual framework representing patient-important outcomes for POP. Specifically, the focus groups addressed the following three aims: (1) to evaluate the content and appropriateness of domains in our framework; (2) to identify gaps in the framework; and (3) to determine the relative importance of our framework domains from the patient perspective. Sessions were transcribed, coded, and qualitatively and quantitatively analyzed using analytic induction and deductive analysis to identify themes and domains relevant to women with POP. RESULTS: Our focus groups confirmed the importance of vaginal bulge symptoms (discomfort, bother, and adaptation), and the overarching domains and subdomains of physical (physical function and participation), social (social function, relationships, and sexual function), and mental health (emotional distress, preoccupation, and body image). Patients ranked outcomes in the following order of importance: (1) the resolution of vaginal bulge symptoms, (2) improvement in physical function; (3) improvement in sexual function; (4) improvement in body image perception; and (5) improvement in social function. CONCLUSIONS: We developed a conceptual framework for patient important outcomes of women seeking treatment for POP. This framework can improve the transparency and interpretation of POP study findings from the patient perspective. Vaginal bulge and its associated discomfort are most important for the definition of POP treatment success from the patient perspective. Neurourol. Urodynam. 9999:XX-XX, 2013. © 2013 Wiley Periodicals, Inc.
Neurourology and Urodynamics 03/2013; · 2.96 Impact Factor
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ABSTRACT: INTRODUCTION AND HYPOTHESIS: This study evaluates the effect of baseline pelvic organ prolapse (POP) severity on improvement in overactive bladder (OAB) symptoms after pelvic reconstructive surgery. METHODS: We performed a retrospective cohort study of women with POP and OAB who underwent surgical correction of symptomatic apical and/or anterior POP. OAB was defined as an affirmative response to item #15 (urinary frequency) and/or item #16 (urge incontinence) of the Pelvic Floor Distress Inventory (PFDI). POP severity was dichotomized as Pelvic Organ Prolapse Quantification (POP-Q) stage 1-2 versus stage 3-4. Our primary outcome was complete resolution or improvement of urinary frequency or urge incontinence on the PFDI 12 months postoperatively. RESULTS: At 12 months postoperative, 41 (89%) women with stage 1-2 POP versus 47 (85 %) with stage 3-4 POP reported improvement in urinary frequency (p = 0.58). Thirty five (90 %) with stage 1-2 and 34 (85 %) with stage 3-4 POP reported improvement in urge incontinence (p = 0.74). On multiple logistic regression, women with stage 3-4 POP had a decreased odds of improvement in frequency or urge incontinence compared with women with stage 1-2 POP (adjusted odds ration [AOR] = 0.06 [95 % CI 0.01-0.67]), after adjusting for confounders. CONCLUSIONS: Women with coexisting POP and OAB who undergo surgical correction of POP experience improvement in OAB symptoms after surgery, although women with more severe POP may be at a higher risk of persistent frequency or urge incontinence.
International Urogynecology Journal 12/2012; · 1.83 Impact Factor
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Michelle Y Morrill,
Megan O Schimpf,
Husam Abed,
Cassandra Carberry,
Rebecca U Margulies,
Amanda B White,
Lior Lowenstein,
Renée M Ward,
Ethan M Balk,
Katrin Uhlig, Vivian W Sung
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ABSTRACT: BACKGROUND: Antibiotic prophylaxis for surgery is commonly used and is recommended by multiple organizations. OBJECTIVE: To critically review gynecology-specific data regarding surgical antibiotic prophylaxis in selected benign gynecologic surgeries. SEARCH STRATEGY: MEDLINE and Cochrane databases were searched from inception to July 2010. SELECTION CRITERIA: Randomized controlled trials of benign vaginal, cervical, transcervical, abdominal, or laparoscopic procedures other than hysterectomy comparing prophylactic antibiotic use with placebo or with another antibiotic. Outcomes of interest were postoperative infections, additional treatments, and adverse events. DATA COLLECTION AND ANALYSIS: In total, 19 trials met the inclusion criteria. Studies were individually assessed for methodologic quality, then grouped by procedure and evaluated for evidence quality. MAIN RESULTS: There was no difference in infectious outcome for loop electrosurgical excision, hysteroscopic ablation, or laparoscopy, although evidence quality was poor. Fair evidence supports antibiotic prophylaxis for suction curettage or laparotomy. There were insufficient data regarding vaginal surgery prophylaxis. CONCLUSION: Antibiotic prophylaxis may be beneficial in first-trimester suction curettage and laparotomy. No advantage was found for loop electrosurgical excision, hysteroscopy, or laparoscopic gynecologic surgery. Newer procedures and vaginal surgery lack research and merit study.
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 10/2012; · 1.41 Impact Factor
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ABSTRACT: The primary objective was to estimate the effect of the midurethral sling on improving leisure physical activity levels and physical functioning in women with stress urinary incontinence (SUI). Our secondary objective was to identify possible risk factors for postoperative insufficient physical activity.
We conducted a prospective, observational study of women undergoing outpatient midurethral sling for SUI. Women completed validated questionnaires for incontinence, leisure physical activity, and physical functioning at baseline and 6 months postoperatively. The primary outcome was leisure physical activity level. We used multiple logistic and linear regression to estimate the effect of improvements in urinary symptoms and life effect on physical activity levels and physical functioning scores.
Ninety women underwent surgery and 85 returned for follow-up. At baseline, 38% had sedentary, 18% had moderate, and 44% had sufficient leisure physical activity levels. Postoperatively, this modestly improved to 26% sedentary, 20% moderate, and 54% sufficient levels. The median leisure physical activity energy expenditure increased from 396 to 693 metabolic equivalent-minutes per week (P=.04). Physical functioning scores also significantly improved (mean score 44 compared with 55 points, P<.001). On multiple logistic regression, improvements in incontinence life effect were associated with increased odds of leisure physical activity improvement (adjusted odds ratio 1.66; 95% confidence interval 1.08-2.54). On multiple linear regression, improvements in both urinary incontinence severity and effect were associated with improvements in physical functioning scores (P<.01 for both). Factors associated with insufficient postoperative physical activity included low baseline physical activity levels and smaller improvements in urinary effect scores.
Midurethral sling and subsequent improvements in urinary incontinence are associated with improved leisure physical activity levels and physical functioning.
Obstetrics and Gynecology 09/2012; 120(3):573-80. · 4.73 Impact Factor
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ABSTRACT: To assess surgeon practice patterns for antibiotic prophylaxis in gynecologic surgery.
A survey was distributed at the 2011 annual scientific meeting of the Society of Gynecologic Surgeons regarding antibiotic prophylaxis practices.
The response rate was 51%. Most surgeons did not use antibiotic prophylaxis for dilation and curettage without products of conception, hysteroscopy, and loop electrocautery excision procedure/cone biopsy. For laparoscopy without graft placement, 45.9% did not use prophylaxis. Prophylaxis was common for hysterectomy. For midurethral slings, 8.2% did not use prophylaxis. When graft material was used in prolapse surgery, at least 93% of surgeons administered some form of antibiotic prophylaxis. Only 70% of respondents prescribe antibiotic prophylaxis for hysterectomy consistent with recommendations from the American College of Obstetricians and Gynecologists, whereas 78% are consistent with specifications from the Joint Commission.
Wide variability exists in antibiotic prophylaxis in gynecologic surgery. Surgeon preference or local hospital policies affect choice of prophylaxis less than 14.9% of the time.
Journal of Pelvic Medicine and Surgery 09/2012; 18(5):281-5.
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ABSTRACT: OBJECTIVE: We sought to evaluate changes in bowel symptoms after rectocele repair and identify risk factors for persistent symptoms. STUDY DESIGN: We conducted ancillary analysis of a randomized surgical trial for rectocele repair. Subjects underwent examinations and completed questionnaires for bowel symptoms at baseline and 12 months postoperatively. Outcomes included resolution, persistence, or de novo bowel symptoms. We used multiple logistic regression to identify risk factors for bowel symptom persistence. RESULTS: A total of 160 women enrolled: 139 had baseline bowel symptoms and 85% had 12-month data. The prevalence of bowel symptoms decreased after rectocele repair (56% vs 23% splinting, 74% vs 37% straining, 85% vs 19% incomplete evacuation, 66% vs 14% obstructive defecation; P < .001 for all). On multiple logistic regression, a longer history of splinting was a risk factor for persistent postoperative splinting (adjusted odds ratio, 2.25; 95% confidence interval, 1.02-4.93). CONCLUSION: Bowel symptoms may improve after rectocele repair but almost half of women will have persistent symptoms.
American journal of obstetrics and gynecology 06/2012; · 3.28 Impact Factor
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ABSTRACT: To estimate the effect of porcine subintestinal submucosal graft augmentation on improving anatomic and subjective rectocele repair outcomes compared with native tissue repair.
We conducted a randomized controlled trial at two sites, including women with at least stage 2 symptomatic rectocele. Anatomic and subjective outcomes (vaginal bulge and defecatory) were collected 12 months postoperatively, including blinded Pelvic Organ Prolapse Quantification (POP-Q) examinations. Anatomic failure was defined as points Ap or Bp -1 or greater on POP-Q. Subjective failure was defined as no improvement or worsening of symptoms. We estimated number needed to treat and adjusted odds ratios (ORs). Assuming graft use is associated with 93% anatomic success, 63 women per group would be needed to detect a 20% difference at α=.05 and β=.20.
One hundred sixty women were randomized; 137 had 12-month anatomic data (67 graft; 70 control). There was no difference in anatomic failure (12% compared with 9%, P=.5), vaginal bulge symptom failure (3% compared with 7%, P=.4, number needed to treat=26) or defecatory symptom failure (44% compared with 45%, P=.9, number needed to treat=91) for graft compared with control, respectively. Both groups reported improvement in vaginal bulge and defecatory symptoms (P<.05 for all). On multiple logistic regression, graft use was not associated with a decreased odds of anatomic failure (adjusted OR 1.36, 95% confidence interval [CI] 0.44-4.25), vaginal bulge symptoms (adjusted OR 0.46, 95% CI 0.08-2.68), or defecatory symptoms (adjusted OR 0.98, 95% CI 0.48-2.03).
Although rectocele repair by either approach is associated with improved symptoms, subintestinal submucosal graft augmentation was not superior to native tissue for anatomic or subjective outcomes at 12 months.
ClinicalTrials.gov, www.clinicaltrials.gov, NCT00321867.
Obstetrics and Gynecology 01/2012; 119(1):125-33. · 4.73 Impact Factor
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ABSTRACT: We describe techniques and objective and subjective outcomes for women who underwent midurethral sling (MUS) shortening for persistent stress urinary incontinence (SUI). This is a case series of women who underwent MUS shortening for SUI within 8 weeks of initial MUS placement. Objective and subjective findings including Urinary Distress Inventory (UDI)-6 and Urinary Impact Questionnaire (UIQ)-7 scores are reported, and shortening techniques are described. Between June 2007 and June 2010, three women underwent MUS shortening for persistent SUI within 8 weeks of initial MUS placement. Shortening was performed with either midline plication or mesh excision and reapproximation. Five months postoperative to shortening, one woman reported subjective improvement in SUI symptoms, and two had subjective and objective resolution of SUI. All showed improvement from baseline in UDI-6 and UIQ-7 scores. There were no erosions. MUS shortening may offer a safe and effective option for management of persistent SUI.
International Urogynecology Journal 12/2011; 23(6):805-7. · 1.83 Impact Factor
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ABSTRACT: To compare hysterectomy with less-invasive alternatives for abnormal uterine bleeding (AUB) in 7 clinically important domains.
Systematic review.
Randomized clinical trials comparing bleeding, quality of life, pain, sexual health, satisfaction, need for subsequent surgery, and adverse events between hysterectomy and less-invasive treatment options.
Women with AUB, predominantly from ovulatory disorders and endometrial causes.
Systematic review of the literature (from inception to January 2011) comparing hysterectomy with alternatives for AUB treatment. Eligible trials were extracted into standardized forms. Trials were graded with a predefined 3-level rating, and the strengths of evidence for each outcome were evaluated with the Grades for Recommendation, Assessment, Development and Evaluation system.
Nine randomized clinical trials (18 articles) were eligible. Endometrial ablation, levonorgestrel intrauterine system, and medications were associated with lower risk of adverse events but higher risk of additional treatments than hysterectomy. Compared to ablation, hysterectomy had superior long-term pain and bleeding control. Compared with the levonorgestrel intrauterine system, hysterectomy had superior control of bleeding. No other differences between treatments were found.
Less-invasive treatment options for AUB result in improvement in quality of life but carry significant risk of retreatment caused by unsatisfactory results. Although hysterectomy is the most effective treatment for AUB, it carries the highest risk for adverse events.
Journal of Minimally Invasive Gynecology 11/2011; 19(1):13-28. · 1.74 Impact Factor
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David D Rahn,
Mamta M Mamik,
Tatiana V D Sanses,
Kristen A Matteson,
Sarit O Aschkenazi,
Blair B Washington,
Adam C Steinberg,
Heidi S Harvie,
James C Lukban,
Katrin Uhlig,
Ethan M Balk, Vivian W Sung
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ABSTRACT: To comprehensively review and critically assess the available gynecologic surgery venous thromboembolism prophylaxis literature and provide clinical practice guidelines.
MEDLINE and Cochrane databases from inception to July 2010. We included randomized controlled trials in gynecologic surgery populations. Interventions and comparators included graduated compression stockings, intermittent pneumatic compression, unfractionated heparin, and low molecular weight heparin; placebo and routine postoperative care were allowed as comparators.
One thousand two hundred sixty-six articles were screened, and 14 randomized controlled trials (five benign gynecologic, nine gynecologic oncology) met eligibility criteria. In addition, nine prospective or retrospective studies with at least 150 women were identified and provided data on venous thromboembolism risk stratification, gynecologic laparoscopy, and urogynecologic populations.
Two reviewers independently screened articles with discrepancies adjudicated by a third. Eligible randomized controlled trials were extracted for these characteristics: study, participant, surgery, intervention, comparator, and outcomes data, including venous thromboembolism incidence and bleeding complications. Studies were individually and collectively assessed for methodologic quality and strength of evidence. Overall incidence of clinical venous thromboembolism was 0-2% in the benign gynecologic population. With use of intermittent pneumatic compression for benign major procedures, venous thromboembolism incidence was less than 1%. No venous thromboembolisms were identified in prospective studies of benign laparoscopic procedures. Overall quality of evidence in the benign gynecologic literature was poor. Gynecologic-oncology randomized controlled trials reported venous thromboembolism incidence (including "silent" venous thromboembolisms) of 0-14.8% with prophylaxis and up to 34.6% without prophylaxis. Fair quality of evidence supports that unfractionated heparin and intermittent pneumatic compression are both superior to placebo or no intervention but insufficient to determine whether heparins are superior to intermittent pneumatic compression for venous thromboembolism prevention. Combining two of three risks (aged 60 years or older, cancer, or personal venous thromboembolism history) substantially elevated the risk of venous thromboembolism.
Intermittent pneumatic compression provides sufficient prophylaxis for the majority of gynecology patients undergoing benign surgery. Additional risk factors warrant the use of combined mechanical and pharmacologic prophylaxis.
Obstetrics and Gynecology 11/2011; 118(5):1111-25. · 4.73 Impact Factor
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ABSTRACT: Vaginal cuff dehiscence and evisceration are rare but serious complications of pelvic surgery, specifically hysterectomy. The data on risks of vaginal cuff dehiscence are variable, and there is no consensus on how to manage this complication. In our review, we present a summary of the risk factors, with symptoms, precipitating events, and treatment options for patients with vaginal cuff dehiscence after pelvic surgery. In addition, we provide a review of the current literature on this important surgical outcome and suggestions for future research on the incidence and prevention of vaginal cuff dehiscence.
American journal of obstetrics and gynecology 08/2011; 206(4):284-8. · 3.28 Impact Factor
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Vivian W Sung
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ABSTRACT: The aim of most pelvic floor disorders (PFD) research is to obtain an unbiased effect estimate and to make causal inferences. New developments in epidemiologic research, including the use of causal directed acyclic graphs (DAGs), have shown that traditional analytical strategies for research can be inadequate, leading to unintended consequences such as introducing additional bias. Although DAGs have been proven to be useful in other medical fields, their use has been limited in PFD research. The aim of this paper is to introduce DAGs and then demonstrate their application in PFD research. This paper will also illustrate how relying purely on statistical techniques can lead to pitfalls in reducing bias in research studies.
DAGs are a graphical epidemiologic tool that provide a method to select for potential confounders and minimize bias in the design and analysis of research studies. We start by providing an introduction to DAGs. We then describe six scenarios in PFD research in which DAGs can be helpful: (1) identifying appropriate confounding variables for adjustment; (2) identifying potential over-adjustment when conditioning on a mediator; (3) identifying unintended confounding due to inappropriate adjustment; (4) identifying unintended selection bias due to inappropriate adjustment; (5) planning analyses in cross-sectional studies; and (6) using DAGs as a framework to help plan data collection and analyses in PFD research.
We demonstrate how the application of DAGs as an aid to PFD research can help to decrease bias and discuss the insights and implications for study design and analytical approaches.
Neurourology and Urodynamics 08/2011; 31(1):115-20. · 2.96 Impact Factor
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ABSTRACT: We sought to estimate the number of women who will undergo inpatient and outpatient surgery for stress urinary incontinence (SUI) or pelvic organ prolapse (POP) in the United States from 2010 through 2050.
Using the 2007 Nationwide Inpatient Sample and the 2006 National Survey of Ambulatory Surgery, we calculated the rates for inpatient and outpatient SUI and POP surgery. We applied the surgery rates to the US Census Bureau population projections from 2010 through 2050.
The total number of women who will undergo SUI surgery will increase 47.2% from 210,700 in 2010 to 310,050 in 2050. Similarly, the total number of women who will have surgery for prolapse will increase from 166,000 in 2010 to 245,970 in 2050.
If the surgery rates for pelvic floor disorders remain unchanged, the number of surgeries for urinary incontinence and POP will increase substantially over the next 40 years.
American journal of obstetrics and gynecology 04/2011; 205(3):230.e1-5. · 3.28 Impact Factor
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ABSTRACT: The purpose of this study was to estimate the effect of insurance status on pelvic floor physical therapy (PFPT) nonparticipation for the treatment of urinary incontinence.
A cross-sectional study of women referred to PFPT for urinary incontinence between January 2009 and June 2010 was conducted. A telephone questionnaire was administered. Multiple logistic regression was used to identify risk factors for nonparticipation.
Thirty-three percent of women with private insurance and 17% with other insurance were PFPT nonparticipants. On multiple logistic regression, women with Medicare were more likely to participate in PFPT (odds ratio [OR], 0.12; 95% confidence interval [CI], 0.01-0.72). Risk factors for nonparticipation included insurance noncoverage (OR, 103.85; 95% CI, 6.21-infinity) and a negative perception regarding the benefit of PFPT (OR, 5.07; 95% CI, 2.16-12.49).
Among women who were referred to PFPT for urinary incontinence, insurance noncoverage and negative patient perception of efficacy were risk factors for nonparticipation, although having Medicare was protective. Improving patient education and insurance coverage for PFPT may increase usage.
American journal of obstetrics and gynecology 03/2011; 205(2):152.e1-9. · 3.28 Impact Factor
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David D Rahn,
Husam Abed, Vivian W Sung,
Kristen A Matteson,
Rebecca G Rogers,
Michelle Y Morrill,
Matthew D Barber,
Joseph I Schaffer,
Thomas L Wheeler,
Ethan M Balk,
Katrin Uhlig
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ABSTRACT: (1) To systematically collect and organize into clinical categories all outcomes reported in trials for abnormal uterine bleeding (AUB); (2) to rank the importance of outcomes for patient decision making; and (3) to improve future comparisons of effects in trials of AUB interventions.
Systematic review of English-language randomized controlled trials of AUB treatments in MEDLINE from 1950 to June 2008. All outcomes and definitions were extracted and organized into major outcome categories by an expert group. Each outcome was ranked "critically important," "important," or "not important" for informing patients' choices.
One hundred thirteen articles from 79 trials met the criteria. One hundred fourteen different outcomes were identified, only 15 (13%) of which were ranked as critically important and 29 (25%) as important. Outcomes were grouped into eight categories: (1) bleeding; (2) quality of life; (3) pain; (4) sexual health; (5) patient satisfaction; (6) bulk-related complaints; (7) need for subsequent surgical treatment; and (8) adverse events.
To improve the quality, consistency, and utility of future AUB trials, we recommend assessing a limited number of clinical outcomes for bleeding, disease-specific quality of life, pain, sexual health, and bulk-related symptoms both before and after treatment and reporting satisfaction and adverse events. Further development of validated patient-based outcome measures and the standardization of outcome reporting are needed.
Journal of clinical epidemiology 03/2011; 64(3):293-300. · 2.96 Impact Factor
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ABSTRACT: To assess whether the existing National Institutes of Health (NIH) Patient Reported Outcomes Measurement Information System (PROMIS) conceptual framework and item banks sufficiently capture the concerns of women with urinary incontinence (UI).
Thirty-five women with UI were recruited between February-April 2009 for 4 structured focus groups to develop and assess the content validity of a conceptual framework for the impact of UI. This framework included domains from the NIH PROMIS framework and item banks including broad domains of physical and social function and mental health. All sessions were transcribed, coded, and qualitatively and quantitatively analyzed using analytic induction and deductive analysis to identify new themes and domains relevant to women with UI.
The focus groups provided information that confirmed the relevance of existing PROMIS domains and identified new outcome domains that are important to this patient population. The groups confirmed the relevance of the physical and social functioning, and mental health domains. Additional themes that emerged included the distinction between ability versus participation and satisfaction, role functioning, external mediators, re-calibration/coping, cognitive function and new possibilities. Participants also felt strongly that not all domains and items apply to all women with UI and an option to tailor questionnaires and skip non-relevant items was important.
The PROMIS framework domains are relevant to women with UI, but additional patient-important themes are identified that may improve the comprehensiveness of this assessment framework for measuring outcomes important to women with UI. These results will inform future item content development for UI.
Neurourology and Urodynamics 03/2011; 30(4):503-9. · 2.96 Impact Factor
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ABSTRACT: The aim of this study was to estimate the number of women undergoing ambulatory surgical procedures for female pelvic floor disorders (PFDs) in the United States and to compare age-adjusted ambulatory surgical case rates between 1996 and 2006.
We analyzed data from the 1996 and 2006 National Survey of Ambulatory Surgery, a federal public access de-identified database. Procedures for PFDs were identified using International Classification of Diseases-9th revision Clinical Modification procedure codes for urinary incontinence, fecal incontinence, and pelvic organ prolapse.
The number of women undergoing ambulatory surgical procedures for urinary incontinence increased from 34,968 (95% confidence interval, 25,583-44,353) in 1996 to 105,656 (95% confidence interval, 79,033-132,279) in 2006. The age-adjusted ambulatory surgical case rates for all PFDs increased from 7.91 per 10,000 in 1996 to 12.10 per 10,000 in 2006 (P = .0006).
Ambulatory procedures for urinary incontinence increased between 1996 and 2006, as well as the age-adjusted ambulatory case rate for all PFDs.
American journal of obstetrics and gynecology 11/2010; 203(5):497.e1-5. · 3.28 Impact Factor
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ABSTRACT: : The objective of this study was to determine the association between obesity, sexual activity and sexual function in women with pelvic floor disorders (PFDs).
: A retrospective study of women seeking care for PFDs was conducted between May 2008 and May 2009. Obesity was defined as body mass index ≥ 30 kg/m. Outcomes included sexual activity and sexual function measured using the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 (PISQ-12). Multivariable regression was used to estimate the association between obesity and sexual inactivity and function.
: There were 161 (45.5%) non-obese and 193 (54.5%) obese women, with a subset of 214 sexually active women. Obesity was not associated with sexual inactivity, but was associated with worse PISQ-12 scores compared with non-obese women (mean score 36.9 ± 38 versus 74.8 ± 34, P < 0.001). On multivariable linear regression, obese women had a mean score of 30 points lower (95% confidence interval -40.6 to -20.2, P < 0.001) on the PISQ-12 compared with non-obese women.
: Obesity is associated with worse sexual function in women with PFDs.
Journal of Pelvic Medicine and Surgery 11/2010; 16(6):331-5.
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ABSTRACT: The Autonomy Preference Index (API) and Control Preferences Scale (CPS) measure information-seeking and decision-making preferences. Our objective was to validate these scales in women with pelvic floor disorders (PFDs) and identify variables associated with decision-making preferences.
Women seeking care for PFDs completed the API and the CPS. Psychometric properties were determined. Multivariable analyses were used to identify correlates of information-seeking and decision-making preferences.
One hundred ten women were recruited. Both scales demonstrated good psychometric properties (intraclass correlation coefficient = 0.5 to 0.7; Cronbach's alpha = 0.8 for the API, and r = -0.3 between the API and CPS). Based on scores, women had strong preferences to be well informed, but were more neutral in their decision-making preferences. In multivariable analyses, higher education levels were associated with a stronger desire for seeking medical information.
Women seeking care for PFDs vary in their preferences for participating in treatment decisions.
International Urogynecology Journal 09/2010; 21(9):1071-8. · 1.83 Impact Factor
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ABSTRACT: : To estimate the effect of a computer trainer on improving knowledge and attitudes of Obstetrics and Gynecology residents regarding female pelvic anatomy (PA) and pelvic floor dysfunction (PFD) compared to usual teaching.
: A randomized trial was conducted between April and June 2008. Obstetrics and Gynecology residents randomized by year of training participated in a 1-hour session with a computer trainer for individual-based learning of female PA and PFD or usual teaching. Questionnaires assessing (1) knowledge of and (2) attitude regarding, or comfort with, female PA and PFD were completed at baseline and 1 month following recruitment. Residents randomized to the trainer answered trainer-specific questions on the post-intervention questionnaire. Higher scores indicated higher knowledge and comfort level. Between-group differences in pre-intervention and post-intervention questionnaire knowledge and attitude scores were analyzed. Eleven residents randomized to each group would provide a power of 0.8 at α = 0.05.
: Twenty-two residents completed the study. There were no significant differences between residents randomized to trainer versus usual teaching in knowledge or attitude scores on the pre-intervention questionnaire (p > 0.50). There was no significant difference in median post-intervention knowledge (14 [range 13-17] vs 13 [range 10-18], P = 0.10) or attitude scores (30 [range 14-41] vs 22 [range 11-42], P = 0.49) for the residents randomized to the trainer compared to the controls.
: In this single-center study, the trainer was not associated with significant improvements in resident knowledge or attitude scores regarding female PA and PFD.
Journal of Pelvic Medicine and Surgery 07/2010; 16(4):224-8.
