Articles related to Obstetrics & Gynecology

The article explores social interactions and institutional structures impacting the consistent practice of 24-hour rooming-in for new mothers and newborns in hospitals. Researchers employed an institutional ethnographic design, gathering data through semistructured interviews and unit observations from February 2020 to June 2021. Seven mother-baby nurses participated in interviews. Additionally, three on-unit observations lasting 2 hours each took place. From the collected data, the researchers unearthed a shared sentiment: “Baby-Friendly” practices don’t always equate to being “mother-friendly.” Three primary social interaction themes surfaced from the data analysis: viewing the mother as a patient, managing expectations, and inconsistent practices. The nurses’ perspectives revealed the complexity of managing maternal care while juggling newborn demands. Discrepancies in methods highlighted the need for standardized practices to maintain consistency across care provision. The analysis also identified three significant institutional factors that affect 24-hour rooming-in: rates of labor induction and cesarean births, nurse staffing, and nursery use monitoring. Labor induction and cesarean births often disrupt the smooth transition to rooming-in. Limited nurse staffing presents challenges in managing both mother and baby needs, while nursery use monitoring practices influence rooming-in implementation. The article’s findings provide critical insights into the daily organization and experience of 24-hour rooming-in from a […]

Dive into the essence of AANA’s updated guidelines for obstetric anesthesia and analgesia as we spotlight its focus on health equity and safety in maternal care. Commencing with the unveiling of the revised practice guidelines for obstetric anesthesia and analgesia, the American Association of Nurse Anesthesiology (AANA) has emphasized enhancing patient care and safety. Interestingly, these updates also strive to tackle the critical issue of enduring health disparities in the United States. The AANA firmly believes in the power of certified registered nurse anesthetists (CRNAs) to help curb maternal mortality rates. The primary strategy focuses on mitigating racial and ethnic imbalances in pregnancy-related deaths. Beth Ann Clayton, DNP, CRNA, FAANA, FAAN, the key subject matter expert behind the revisions, underscores these inequalities as significant barriers to optimal maternal care. Using an evidence-based process, the AANA revised the guidelines, paying careful attention to current research. They’ve prioritized enhancing the readability of the content, updating the quality of references, and broadening their scope to encompass the most recent recommendations on obstetric analgesia and anesthesia care. The notable alterations include the broadening of analgesia and anesthesia considerations for labor and delivery. This expansion encompasses inhalation analgesia, neuraxial analgesia, general anesthesia, and an updated […]

Permissive cardiotoxicity strategy could enhance trastuzumab treatment outcomes in HER2-positive breast cancer patients, despite requiring more research into its long-term safety. A study conducted at McMaster University and published in The Oncologist explored the feasibility of a permissive cardiotoxicity strategy in patients with HER2-positive breast cancer undergoing trastuzumab treatment. Although trastuzumab significantly improves outcomes in these patients, up to 4% of them may experience cardiac dose-limiting toxicity (cDLT), resulting in therapy discontinuation, which can negatively impact patient outcomes. The researchers employed a retrospective cohort study of 51 patients who had been referred to the cardio-oncology service between January 2016 and May 2021 for left ventricular dysfunction after trastuzumab administration. Notably, a permissive cardiotoxicity strategy was applied, which allows the continuation of trastuzumab therapy while closely monitoring mild to moderate cardiotoxicity. The primary outcomes for this study were left ventricular (LV) function and completion of an entire course of trastuzumab. Astonishingly, 92% of patients (47 out of 51) were able to complete their full course of HER2-targeted therapy without experiencing cDLT. However, 6% developed cDLT during trastuzumab treatment, and even after discontinuation, they were more likely to experience persistent cardiotoxicity. Interestingly, despite most patients regaining their LV function post-treatment, 14% persisted […]

Northwestern University Feinberg School of Medicine has once again been recognized as one of the top medical schools in the nation, ranking 13th among research-oriented institutions, according to the latest US News & World Report rankings. This marks the 16th consecutive year that Feinberg has placed in the top 20. The rankings underwent changes in methodology, incorporating factors such as federal research awards, surveys completed by deans and senior faculty at peer institutions, and entering class data. Feinberg’s commitment to patient-centered care, breakthrough discoveries, innovation, and exceptional medical education remains unwavering. Feinberg’s specialty programs also received recognition, with seven programs ranking among the best in the nation, including obstetrics and gynecology, surgery, pediatrics, anesthesiology, radiology, psychiatry, and internal medicine. The physician assistant program saw a notable improvement in its ranking, moving from 26th to 8th. Additionally, Feinberg’s school of public health ranked 28th. With its rich history, cutting-edge scientific initiatives, and outstanding faculty, Feinberg continues to be a leading institution within Northwestern Medicine, dedicated to advancing healthcare and improving patient outcomes.

Recent draft guidelines from the United States Preventive Services Task Force (USPSTF) propose a change in routine screening mammography recommendations. The new guidelines suggest that women should begin undergoing regular mammograms 10 years earlier than previously advised, starting at the age of 40. This recommendation applies to all individuals assigned female at birth. Simultaneously, FDA has made updates to federal mammography regulations, with a particular focus on reporting requirements related to breast density. These regulatory changes are motivated by studies indicating that approximately half of women over the age of 40 have dense breast tissue in concordance with the high prevalence of breast cancer in the population.

Dr. Jyoti Mayadev, a professor of Radiation Medicine at University of California San Diego, discussed the treatment of patients with 1B3 cervical cancer at the Society of Gynecological Oncology’s Annual Meeting on Women’s Cancer. The discussion centered around whether to treat patients with primary chemoradiation and brachytherapy or radical surgery. Dr. Mayadev recommends a multidisciplinary approach, but notes that level 1 evidence data from Landoni et al. in 1997 showed no difference in progression-free survivals or overall survivals between radiation therapy and radical hysterectomy in patients with bulky disease, 1B3, and no lymph node disease. Dr. Mayadev discusses the benefits of chemoradiation, including potential toxicity reduction if a patient needs adjuvant therapy after surgery. She also notes that with technologically advanced radiation and brachytherapy, long-term toxicities can be minimized, including genitourinary toxicities at 6-8%, vaginal toxicities at 5%, and fistula at less than 2%. Dr. Mayadev believes that adaptive radiation therapy may further decrease toxicities and increase cure rates for patients with 1B3 cervical cancer. There are ongoing trials for novel therapeutics and adaptive radiation therapy, such as the ARTIA Cervical Trial, which aims to decrease toxicities and collect patient reported outcomes.