Eric J Bieber’s research while affiliated with Geisinger Health System and other places

Background: New methods to enhance colorectal cancer (CRC) screening rates are needed. The web offers novel possibilities to educate patients and to improve health behaviors, such as cancer screening. Evidence supports the efficacy of health communications that are targeted and tailored to improve the uptake of recommendations. Methods: We identified unscreened women at average risk for CRC from the scheduling databases of obstetrics and gynecology practices in 2 large health care systems. Participants consented to a randomized controlled trial that compared CRC screening uptake after receipt of CRC screening information delivered via the web or in print form. Participants could also be assigned to a control (usual care) group. Women in the interventional arms received tailored information in a high- or low-monitoring Cognitive Social Information Processing model-defined attentional style. The primary outcome was CRC screening participation at 4 months. Results: A total of 904 women were randomized to the interventional or control group. At 4 months, CRC screening uptake was not significantly different in the web (12.2%), print (12.0%), or control (12.9%) group. Attentional style had no effect on screening uptake for any group. Some baseline participant factors were associated with greater screening, including higher income (P = .03), stage of change (P < .001), and physician recommendation to screen (P < .001). Conclusions: A web-based educational intervention was no more effective than a print-based one or control (no educational intervention) in increasing CRC screening rates in women at average risk of CRC. Risk messages tailored to attentional style had no effect on screening uptake. In average-risk populations, use of the Internet for health communication without additional enhancement is unlikely to improve screening participation. Trial registration: clinicaltrials.gov Identifier: NCT00459030.

Given the extensive use of the Internet for health information, Web-based health promotion interventions are widely perceived as an effective communication channel. The authors conducted this study to determine use of a Web-based intervention intended to improve colorectal cancer screening in a population of women who are at average risk and noncompliant to current screening recommendations. The study was a randomized controlled trial designed to compare the effectiveness of colorectal cancer screening educational materials delivered using the Internet versus a printed format. In 3 years, 391 women seen for routine obstetrics/gynecology follow-up at 2 academic centers provided relevant survey information. Of these, 130 were randomized to the Web intervention. Participants received voluntary access to a password-protected, study-specific Web site that provided information about colorectal cancer and colorectal cancer screening options. The main outcome measures were self-reported and actual Web site use. Only 24.6% of women logged onto the Web site. Age was the only variable that differentiated users from nonusers (p = .03). In contrast, 16% of participants self-reported Web use. There was significant discordance between the veracity of actual and self-reported use (p = .004). Among true users, most (81%) logged on once only. These findings raise questions about how to increase use of important health communication interventions.

Although sexuality remains an important component of emotional and physical intimacy that most men and women desire to experience throughout their lives, sexual dysfunction in women is a problem that is not well studied. The prevalence of sexual dysfunction among all women is estimated to be between 25% and 63%; the prevalence in postmenopausal women is even higher, with rates between 68% and 86.5%. Increasing recognition of this common problem and future research in this field may alter perceptions about sexuality, dismiss taboo and incorrect thoughts on sexual dysfunction, and spark better management for patients, allowing them to live more enjoyable lives.

Background: Endometriosis, defined as endometrial glands and stroma outside the endometrial cavity, affects up to 10% of reproductive age women. Implants outside of the pelvis, extrapelvic endometriosis, may occur in up to 15% of endometriosis patients. A patient with two rare manifestations of extrapelvic endometriosis; umbilical and thoracic including catamenial pneumothorax is presented. Case: A 43-year-old white woman had a history of intermittent umbilical bleeding beginning at age 23. She was diagnosed at age 42 with a right spontaneous pneumothorax occurring perimenstrually. Six months later, the patient had an umbilical 8-mm purple-bluish endometriotic papule excised. She has since experienced two additional menstrually related pneumothoraces. Conclusions: Histopathology of the umbilical lesion revealed endometriosis. Thoracoscopy at the time of the third pneumothorax showed multiple endometriotic lesions on the diaphragm, similar in appearance to pelvic lesions. Mechanical pleurodesis and partial apical pleurectomy were performed. The patient was started on gonadotropin-releasing hormone agonist, with a plan of hysterectomy and oophorectomy. A case is reported of a patient presenting with two rare manifestations of extrapelvic endometriosis: umbilical and thoracic. It allows a multispecialty review of endometriosis, the theories regarding the etiology, and treatments (including minimally invasive surgery) available for patients with extrapelvic endometriosis.

To present a case of secondary amenorrhea after occlusion of microperforate transverse vaginal septum. Case report. Academic teaching hospital. A 19-year-old woman with new onset of irregular menses and pelvic pain, with history of menarche at age 14. Surgical evaluation and treatment, including laparoscopy, hysteroscopy, and excision of septum, followed by repeat surgery with lysis of adhesions due to agglutination of the area previously excised. Awareness of the possibility of secondary amenorrhea occurring due to septal scarring of a perforate transverse vaginal septum. Imaging revealed a hematometra and hematocolpos. Examination revealed a transverse vaginal septum. Ultrasound scans and magnetic resonance imaging revealed an enlarged uterus and an endometrial cavity and cervix distended with fluid and debris. Examination under anesthesia revealed a septum approximately 5 mm thick, which was revealed to be benign fibromuscular tissue with chronic nonspecific inflammation. This case demonstrates the evolution from a microperforate transverse vaginal septum with regular menses for over 4 years to an occluded septum. Although transverse vaginal septa causing amenorrhea are usually diagnosed at menarche, perforate septa have been shown to lead to hypomenorrhea, dysmenorrhea, dyspareunia, infertility, and issues with vaginal childbirth. We present a case in which a perforate transverse vaginal septum led to secondary amenorrhea.

Background: Ectopic pregnancy, in which the gestational sac is outside the uterus, is the most common life-threatening emergency in early pregnancy. It affects approximately 2% of all pregnancies. Case Report: This article presents a case of ectopic pregnancy, treated with methotrexate, which failed medical management, and was noted to have trophoblastic tissue extruding from the midampullary portion of the fallopian tube, without associated hemorrhage. Conclusions: This underscores the 15%-20% failure rate with methotrexate and its potential risks, including tubal rupture. (J GYNECOL SURG 25:157)

Nonovarian endometriomas typically present as a slow-growing, painful abdominal mass in or around the site of a previous surgery. There can be considerable variation, however, because some masses grow rapidly and are not associated with pain whereas others cause patients significant discomfort and associated symptoms. The case of a 31-year-old woman, gravida 3 para 2, who had development of a uterine scar endometrioma after perforation during a dilation and evacuation, is examined. This is an unusual case considering the rate of uterine perforation at the time of gynecologic procedures and the lack of data related to the creation of nonovarian endometriomas.

Agenesis of the inferior vena cava (IVC) is an uncommon congenital vascular malformation. We report a case in a teenage female recently started on oral contraception. Because of menorrhagia, the patient had begun an oral contraceptive pill (OCP) 1(1/2) months prior to presentation. She initially presented with pelvic and lower back pain, and imaging showed a pelvic deep venous thrombosis (DVT) and an interrupted IVC. Anticoagulation was started, the OCP was discontinued, and a discussion occurred regarding the treatment options for her menorrhagia following her recent diagnosis. The case presented shows the rare occurrence of the congenital absence of an IVC with pelvic thrombosis in a young female with a history of menorrhagia and new onset of pelvic pain. The evaluation of this case report leads to a comprehensive review in the treatment choice for menorrhagia with the preceding history of a thrombotic event.