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Although multiple professional organizations encourage minimally invasive surgical approaches whenever feasible, nationally, fewer than half of myomectomies are performed via minimally invasive routes. Black women are less likely than their non-Black counterparts to have minimally invasive surgery.This study aimed to assess the trends in surgical approach among women who underwent minimally invasive myomectomies for uterine leiomyomas within a large integrated healthcare system as initiatives were implemented to encourage minimally invasive surgery, particularly evaluating differences in the proportion of minimally invasive surgery performed in Black vs non-Black women.We conducted a retrospective cohort study of women, aged ≥18 years, who underwent a myomectomy for a uterine leiomyoma within Kaiser Permanente Northern California between 2009 and 2019. Generalized estimating equations and Cochran-Armitage testing were used to assess myomectomy incidence and linear trend in the proportions of myomectomy by surgical route-abdominal myomectomy and minimally invasive myomectomy. Multivariable logistic regression analyses were used to assess the associations between surgical route and (1) race and ethnicity and (2) complications, controlling for patient demographic, clinical, and surgical characteristics.A total of 4033 adult women underwent a myomectomy during the study period. Myomectomy incidence doubled from 0.12 (95% confidence interval, 0.12-0.13) per 1000 women in 2009 to 0.25 (95% confidence interval, 0.24-0.25) per 1000 women in 2019 (P.001). During the 11-year study period, the proportion of minimally invasive myomectomy increased from 6.0% to 89.5% (a 15-fold increase). The proportion of minimally invasive myomectomy in Black women remained lower than in non-Black women (54.5% vs 64.7%; P.001). Black women undergoing myomectomy were younger (36.4±5.6 vs 37.4±5.8 years; P.001), had a higher mean fibroid weight (436.0±505.0 vs 324.7±346.1 g; P.001), and had a higher mean body mass index (30.8±7.3 vs 26.6±5.9 kg/mWithin an integrated healthcare delivery system, although initiatives to encourage minimally invasive surgery were associated with a marked increase in the proportion of minimally invasive myomectomy, Black women continued to be less likely to undergo minimally invasive myomectomy than their non-Black counterparts. Race and fibroid weight alone did not explain the disparities in minimally invasive myomectomy.

Background/Purpose Approximately 0.7% of US adolescents identify as transgender or gender diverse (TGD). In recent years, TGD children have been presenting for treatment at increasing rates. While this population is at increased risk for mental health comorbidities, studies have demonstrated that TGD children supported in their gender identity have decreased risk. To date, few studies have described how many TGD patients are ultimately treated or the time-to-treatment (TTT) in this population. The aim of this study was to understand medication practices, TTT, and how they vary by different demographic and clinical factors. Methods Patients were identified using TGD-related …

Purpose/Objective To determine clinically helpful dose-volume and clinical metrics correlating with symptomatic radiation pneumonitis (RP) in malignant pleural mesothelioma (MPM) patients with two lungs treated with hemithoracic intensity modulated pleural radiation therapy (IMPRINT). Methods and Materials Treatment plans and resulting normal organ dose-volume histograms of 103 consecutive MPM patients treated with IMPRINT (2/2005- 1/2015) to the highest dose ≤50.4 Gy satisfying departmental normal tissue constraints were uniformly recalculated. Patient records provided maximum RP grade (CTCAE v4.0), clinical and demographic information. Correlations analyzed with the Cox model were: ≥ Grade 2 RP (RP2+) and ≥ Grade 3 RP (RP3+) with clinical variables, with volumes of PTV and PTV-Lung overlap and with mean dose, percent volume receiving dose D, (V D ), highest dose encompassing % volume V, (D V ), and heart, total, ipsilateral, and contralateral lungs volumes. Results Twenty-seven patients had RP2+ (14 with RP3+). Median prescription dose was 46.8 Gy (39.6 to 50.4 Gy, 1.8Gy/fraction). Median age was 67.6 years (42 to 83 years). There were 79 males, 40 never-smokers, 44 with left-sided MPM. There were no significant (p≤0.05) correlations with clinical variables, prescription dose, total lung dose-volume metrics and PTV-Lung overlap volume. Dose-volume correlations for heart were RP2+ with V D (35≤D≤47 Gy, V 43 strongest at p=0.003), RP3+ with V D (31 ≤D≤ 45 Gy), RP2+ with D V (5 ≤V≤ 30%), RP3+ with D V (15 ≤V≤ 35%) and mean dose. Significant for ipsilateral lung were RP2+ with V D (38 ≤D≤44 Gy), RP3+ with V 41 , RP2+ and RP3+ with minimum dose; for contralateral lung, RP2+ with maximum dose. Correlation of PTV with RP2+ was strong (p Conclusions Heart dose correlates strongly with symptomatic RP in this large cohort of MPM patients with two lungs treated with IMPRINT. Planning constraints to reduce future heart doses are suggested.

A pregnant African-American woman presents to labor and delivery with concerns of leg swelling. During her time at the hospital, the patient encounters biased and inappropriate comments from the attending physician.

A female African-American medical student is instructed by her neurology resident to start admitting history and physical of a Caucasian male who comes to the emergency room with his wife after a seizure. The patient’s wife refuses to allow the student to see the patient.

This cross-sectional study examines racial disparities in the route of hysterectomy for benign indications within an integrated health care system in the United States.