Search

Objective: The aims of this retrospective cohort study were to determine the proportion of women on medical therapy to correct anemia, defined as hemoglobin

Does a decrease in endometrial thickness (compaction ≥10%) before embryo transfer prognosticate the risk for preterm birth and placenta-mediated pregnancy complications among IVF pregnancies?Retrospective cohort study at a large private fertility practice. Patients with a singleton live birth after a fresh or frozen embryo transfer between 2016 and 2019 were included. The primary outcome was preterm birth (delivery before 37 weeks gestational age). Secondary outcomes included gestational hypertension, pre-eclampsia, intrauterine growth restriction and placental abruption.Of the 252 patients that met the study criteria, 122 (48%) demonstrated endometrial compaction (≥10%) and 130 (52%) did not. Age, body mass index (BMI), parity, history of preterm birth or history of pre-existing maternal conditions between the compaction and no-compaction groups were not significantly different. The overall prevalence of placenta-mediated complications across all participants was 25% (n = 62). The number of preterm births between the compaction and no-compaction groups (13% and 6%, respectively, P = 0.09) as well as the prevalence of placenta-mediated complications (29.5% and 20%, respectively, P = 0.08) were not significantly different. Findings for the primary outcome (preterm birth) persisted even after adjustment for potential confounding variables, including maternal age, parity, BMI, embryo score and type of embryo transfer (fresh versus frozen) (adjusted OR 1.86, 95% CI 0.64 to 5.38).Endometrial compaction (or decrease in endometrial thickness) before embryo transfer is not associated with preterm birth or placenta-mediated pregnancy complications.

The primary objective was to introduce an intraoperative blood conservation bundle (BCB) checklist into clinical practice and assess its impact on perioperative blood transfusion rates during myomectomy.Prospective cohort study with retrospective control group.A Canadian tertiary-care teaching hospital.One hundred and eighty-six women who underwent myomectomy.The BCB is a physical checklist attached to the patient chart and consists of evidence-based medical and surgical interventions to reduce intraoperative blood loss. It was introduced in October 2018, and data were collected prospectively during a 12-month period for all open, robotic, and laparoscopic myomectomies at our institution. The primary outcome was the perioperative transfusion rate, and the secondary outcomes included estimated intraoperative blood loss, perioperative complications, readmissions, and BCB usage rates. Data were compared with those of a historic control group for a 24-month period before the BCB introduction.In the pre-BCB period, 134 myomectomies (90 open, 31 robotic, and 13 laparoscopic) were performed, and during our study period, 52 myomectomies (33 open, 10 robotic, and 9 laparoscopic) were performed. There was a decrease in transfusion rate from 15.7% (21/134) to 7.7% (4/52) after introduction of the BCB; however, this was not significant (p = .152). The mean estimated blood loss was lower postintervention (491 mL ± 440 mL vs 350 mL ± 255 mL; p.05) as was the mean delta hemoglobin (-28 g/L ± 13.0 g/L vs -23 g/L ± 11.4g/L; p.05]. The checklist was used in 92.3% of cases (48/52). There were no differences in intraoperative or postoperative complications or readmission rates.Best practice care bundles can improve knowledge translation of guidelines into care delivery. The introduction of the BCB was successful in reducing intraoperative blood loss during myomectomy at our institution. The BCB is a simple, effective tool that can be easily adopted by gynecologic surgeons to guide intraoperative decision-making during myomectomy.

Immigrant taxi drivers in metropolitan cities are exposed to experiences of discrimination and occupation-based health risks. Given the structural differences in health care systems in the United States and Canada, we investigated the differences in reports of discrimination, health conditions and concern about health conditions between taxi drivers in New York City and Toronto, Ontario. Participants were recruited for a taxi driver Needs Assessment Survey as part of a Taxi Network needs assessment project using a street side convenience sampling technique in New York City and Toronto. The matched sample contained 33 drivers from Toronto and 33 drivers from NYC. All Toronto drivers in our sample reported having health insurance while over a quarter of NYC drivers did not have health insurance. Toronto drivers reported greater everyday and workplace discrimination. Drivers in both cities experienced higher rates than average, and reported concern about, major health conditions. We also found preliminary evidence suggesting a relationship between experiencing discrimination and reporting chronic pain. Our findings suggest the need for future research to more closely examine the associations between discrimination and health among the taxi driver population.

Objectives Myomectomy is a common gynecologic procedure associated with high rates of blood loss and subsequent blood transfusion in reproductive-aged women. An intraoperative Blood Conservation Bundle (BCB) was developed as a standardized approach to decreasing blood loss during myomectomy. This study aimed to introduce the care bundle into clinical practice and assess its impact on various surgical outcomes. Methods We conducted a prospective cohort study assessing perioperative transfusion rates and intraoperative blood loss following open, robotic and laparoscopic myomectomy over a 12-month period following introduction of the BCB. Data were compared to a retrospective control group from a 24-month period prior to bundle introduction. The BCB is a physical checklist attached to the patient chart consisting of evidence-based medical and surgical interventions aimed at decreasing intraoperative blood loss. Results In the 24 months prior to introduction of the BCB, 134 myomectomies were performed and during the study period, 52 were performed. Perioperative transfusion rate was 15.7% pre- and 7.7% post-introduction of the BCB. Mean estimated blood loss was significantly lower post-intervention (491 ± 440 mL vs. 350 ± 255 mL, p Conclusions Best practice care bundles can improve knowledge translation of guidelines into care delivery. The introduction of a Blood Conservation Bundle was associated with a reduction in intraoperative blood loss and transfusion rates during myomectomy at our institution.

Objective The authors sought to study whether there is differential access to fertility services for immigrant women in a single-payer system. Methods A cross-sectional quantitative survey was administered to 265 patients over 3 months. All participants were female patients in heterosexual relationships at a university-affiliated hospital-based fertility clinic in a large metropolitan city. Data on sociodemographic characteristics, reproductive history, and experience accessing fertility services were collected. Statistical analysis, including chi-square and ANOVA regression, was completed using JMP software. Results The response rate of the survey was 86.6%. A total of 265 women participated, 124 (47%) immigrants and 141(53%) non-immigrants. Immigrants more commonly left questions unanswered. Long-term immigrants had a significantly longer average duration of infertility than non-immigrant women (47 months vs. 34 months; P = 0.04). There was a trend towards a delay in seeing a health care provider among long-term immigrants. The most commonly reported reasons for delaying fertility care were “not knowing there was a problem” and “treatments being too expensive.” Although participants across all groups relied on their primary care provider to supply information on fertility services, a greater percentage (17%) of recent immigrants than non-immigrant participants (7%) used the Internet to obtain information. Conclusion Immigrant women addressed their fertility needs even when they had fewer resources and less social stability than did non-immigrant women. However, they experienced a delay in receiving specialized care for infertility. Immigrant women also appeared less comfortable disclosing personal information in a health care setting.

Study Objective Myomectomy is a common gynecologic procedure that is associated with high rates of intraoperative blood loss and subsequent blood transfusion. An intraoperative Blood Conservation Bundle (BCB) was developed as a standardized approach to decreasing blood loss during myomectomy. This study aimed to introduce the care bundle into clinical practice and assess its impact on transfusion rates and other perioperative parameters. Design Prospective cohort study with retrospective control group. Setting Canadian tertiary care academic hospital. Patients or Participants Women who underwent myomectomy between November 2018-April 2019 were included in the prospective portion of the study. Women who underwent myomectomy between January 2015-December 2016 were included as a retrospective control group. Interventions We assessed perioperative transfusion rates (primary outcome), intraoperative blood loss and complication rates over a 6-month period following introduction of the BCB. This data was compared to baseline data collected retrospectively over a 24-month period prior to bundle introduction. The BCB is a physical checklist attached to the patient chart and consists of evidence-based medical and surgical interventions. Measurements and Main Results In the 24-month period prior to the introduction of the BCB, 137 myomectomies were performed (90 open, 31 robotic, 16 laparoscopic). Overall transfusion rate during that time period was 16% (18/90 open, 4/31 robotic, 0/16 laparoscopic) and mean intraoperative blood loss was 484 mL. During the study period, 27 myomectomies were performed (15 open, 7 robotic, 5 laparoscopic). Overall transfusion rate was 3.7% (0/15 open, 1/7 robotic, 0/5 laparoscopic), four-fold lower than prior to bundle introduction, and average intraoperative blood loss was 340 mL. There was no increase in intraoperative/postoperative complications. Conclusion Best practice care bundles can improve knowledge translation of guidelines into care delivery. The introduction of a Blood Conservation Bundle was associated with a reduction in blood loss and transfusion rates during myomectomy at our institution.

Study Objective Myomectomy is associated with significant blood loss and pre-operative medical optimization can improve surgical outcomes including minimizing transfusions rates and associated complications. The purpose of this study was to determine the proportion of women who are medically optimized prior to undergoing myomectomy with interventions to correct anemia and reduce fibroid volume. Design Retrospective cohort study. Setting Large academic, university-affiliated hospital in Canada. Patients or Participants All patients undergoing myomectomy (open, laparoscopic and robot-assisted) between February 2015 and June 2018 were included. Interventions N/A Measurements and Main Results 225 myomectomies were completed between February 2015 and June 2018. 158 (70%), 25 (11%) and 42 (19%) of myomectomies were completed using open, laparoscopic and robot assisted approaches, respectively. Across all approaches, 68 (30%) of patients had a hemoglobin Conclusion At the time of myomectomy, a third of women in our study were anemic yet only two-thirds were medically optimized within 3 months of surgery. 17% of open myomectomy patients required a perioperative transfusion. More efforts should be directed at optimizing patients prior to myomectomy in the hope of decreasing rates of peri-operative transfusions, particularly when an open procedure is planned.

Objectives The purpose of this study was to determine the proportion of women who were medically optimized prior to undergoing myomectomy with interventions to correct anemia and reduce fibroid volume. Myomectomy has been associated with significant blood loss. Pre-operative medical optimization can improve surgical outcomes including minimizing transfusions rates and associated complications. Methods For this retrospective chart review, all patients undergoing myomectomy (open, laparoscopic and robot-assisted) between February 2015 and June 2018 at a large academic, university-affiliated hospital in Toronto were included. Results 225 myomectomy surgeries were completed between February 2015 and June 2018. 158 (70%), 25 (11%) and 42 (19%) of myomectomies were completed using open, laparoscopic and robot assisted approaches, respectively. Across all approaches, 68 (30%) of patients had a hemoglobin 32 (20%) of patients who had an open myomectomy required a peri-operative transfusion. None of laparoscopic myomectomy patients required a transfusion. Five (12%) robotic-assisted patients had a post-operative transfusion. Conclusions At the time of myomectomy, a third of women in our study were anemic yet only half were medically optimized within 3 months of surgery. 20% of open myomectomy patients required a perioperative transfusion. More efforts should be directed at optimizing patients prior to myomectomy in the hope of decreasing rates of perioperative transfusions, particularly when an open procedure is planned.

Background Low- and middle-income countries (LMICs) are developing novel approaches to healthcare that may be relevant to high-income countries (HICs). These include products, services, organizational processes, or policies that improve access, cost, or efficiency of healthcare. However, given the challenge of replication, it is difficult to identify innovations that could be successfully adapted to high-income settings. We present a set of criteria for evaluating the potential impact of LMIC innovations in HIC settings. Methods An initial framework was drafted based on a literature review, and revised iteratively by applying it to LMIC examples from the Center for Health Market Innovations (CHMI) program database. The resulting criteria were then reviewed using a modified Delphi process by the Reverse Innovation Working Group, consisting of 31 experts in medicine, engineering, management and political science, as well as representatives from industry and government, all with an expressed interest in reverse innovation. Results The resulting 8 criteria are divided into two steps with a simple scoring system. First, innovations are assessed according to their success within the LMIC context according to metrics of improving accessibility, cost-effectiveness, scalability, and overall effectiveness. Next, they are scored for their potential for spread to HICs, according to their ability to address an HIC healthcare challenge, compatibility with infrastructure and regulatory requirements, degree of novelty, and degree of current collaboration with HICs. We use examples to illustrate where programs which appear initially promising may be unlikely to succeed in a HIC setting due to feasibility concerns. Conclusions This study presents a framework for identifying reverse innovations that may be useful to policymakers and funding agencies interested in identifying novel approaches to addressing cost and access to care in HICs. We solicited expert feedback and consensus on an empirically-derived set of criteria to create a practical tool for funders that can be used directly and tested prospectively using current databases of LMIC programs.

South Asian (SA) taxi drivers potentially possess a double epidemiologic risk for cardiovascular disease (CVD) due to their ethnicity and occupation. This study investigates SA taxi drivers' knowledge, attitudes, beliefs about general health, CVD and approaches to reduce CVD risk. Five focus groups were conducted with 31 SA taxi drivers in the participants' primary language (Bengali, Hindi, Urdu or Punjabi). Audio-recordings of the sessions were transcribed, translated and entered into ATLAS.ti 6.2 for coding and analysis. SA drivers in an urban setting perceive themselves to be at high risk for CVD because of high work-related stress, physical inactivity, poor diet and poor health care access. Participants attributed their occupation to increasing risk for heart disease; none believed that being SA increased their risk. Interventions to lower CVD risk among SA taxi drivers should be multi-level and involve the individual drivers and the taxi industry.

Introduction . South Asians have a high prevalence and early age of onset of diabetes, metabolic syndrome, and cardiovascular disease (CVD). We assess the potential of a culturally responsive intervention, health camps, to identify and inform U.S. South Asian community members at risk for CVD. Methods . We held four culturally and linguistically tailored health camps between October 2009 and November 2010 to educate participants about and screen for CVD risk factors, including diabetes, hypertension, and hypercholesterolemia. Data analysis was conducted in December 2010. Results . Nearly 300 (289) South Asians registered at the health camps: 20% reported a previous diagnosis of diabetes, 34% elevated blood pressure, and 22% hypercholesterolemia. Most (240) participants had their blood glucose measured; 13% had values 200 mg/dl. Most (265) had their blood pressure measured; 32% had elevated values. Over half (57%) of LDLs were Discussion . Health camps are a potentially important component in addressing increased CVD risk in this vulnerable population.

Objectives. We describe the impact of the Step On It! intervention to link taxi drivers, particularly South Asians, to health insurance enrollment and navigate them into care when necessary. Methods. Step On It! was a worksite initiative held for 5 consecutive days from September 28 to October 2, 2011, at John F. Kennedy International Airport in New York City. Data collected included sociodemographics, employment, health care access and use, height, weight, blood pressure, and random plasma glucose. Participants were given their results, counseled by a medical professional, and invited to participate in free workshops provided by partner organizations. Results. Of the 466 drivers participated, 52% were uninsured, and 49% did not have a primary care provider. Of 384 drivers who had blood pressure, glucose, or both measured, 242 (63%) required urgent or regular follow-up. Of the 77 (32%) requiring urgent follow-up, 50 (65%) sought medical care at least once, of whom 13 (26%) received a new diagnosis. Of the 165 (68%) requiring regular follow-up, 68 (41%) sought medical care at least once, of whom 5 (7%) received a new diagnosis. Conclusions. This study provides encouraging results about the potential impact of an easy-to-deliver, easily scalable workplace intervention with a large, vulnerable population.

There is considerable evidence demonstrating the positive impact of pedometers and walking programs for increasing physical activity and reducing risk for cardiovascular disease among diverse populations. However, no interventions have been targeted towards South Asian taxi drivers, a population that may be at high risk for developing cardiovascular disease. Supporting South Asian Taxi Drivers to Exercise through Pedometers (SSTEP) was a 12-week pilot study among South Asian taxi drivers to increase their daily step counts. SSTEP assessed the feasibility, acceptability, and potential impact of an exercise intervention employing pedometers, a step diary, written materials, and telephone follow-up to initiate or increase physical activity in this at-risk occupational group. Seventy-four drivers were recruited to participate at sites frequented by South Asian taxi drivers. Participant inclusion criteria were: (1) age 18 or over; (2) birthplace in India, Pakistan, or Bangladesh; (3) fluent in English, Hindi, Urdu, Punjabi, or Bengali; and (4) intention to remain in New York City for the 3-month study period. Comprehensive intake and exit questionnaires were administered to participants in their preferred languages. Intake and exit health screenings, including blood pressure, cholesterol, and glucose were completed. Daily step counts were obtained 4 days after recruitment, and at the 4-, 8-, and 12-week mark via phone calls. To measure the impact of the intervention, step counts, blood pressure, cholesterol, and body mass index were compared at intake and exit. Participants in SSTEP were sedentary at baseline. The SSTEP intervention resulted in a small increase in step counts among participants overall, and in a significant increase (>2,000 steps) among a subset (“Bigsteppers”). Drivers with higher baseline glucose values had significantly greater improvements in their step counts. Focused lifestyle interventions for drivers at high risk for cardiovascular disease may be particularly impactful.