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  • Tschann, Mary  (16)
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  • 1
    In: Obstetrics & Gynecology, 2018, Vol.131 Suppl 1, pp.87S-88S
    Description: INTRODUCTION:: Pathologists routinely use fetal foot length (FFL) to estimate the gestational ages (GA) of aborted fetuses. However, there is no standard formula. We aimed to develop an updated FFL-to-GA reference range from patient reported last menstrual period (LMP), ultrasound estimate, and best estimate for GA based on American College of Obstetricians and Gynecologists’ criteria in our patient population. After determining a reference range, we compared our measurements to those of previously published, commonly referenced FFL tables, which may not represent the ethnic diversity, or increasing BMI of current patient populations. METHODS:: Retrospective chart review of 628 dilation and evacuation (D&E) clinical records and procedure pathology reports from October 2012 to December 2014 in Honolulu, HI. RESULTS:: A linear relationship exists between FFL and GA in our population. Linear regression analysis of three pregnancy dating methods demonstrated that ultrasound derived dating provided the best-fit regression formula: FFL (mm) =496*(GA in days)-34.53 with an R2 value of .916. Patient race/ethnicity and BMI did not affect these equations in regression analysis. Our mean FFL differed from historically referenced ranges by .36-3.92mm, dependent on GA. Our FFL by GA was similar to ranges more recently endorsed by the National Abortion Federation despite differences in population racial and ethnic backgrounds. CONCLUSION:: If post-abortion FFL measurement is utilized for GA estimation, then updated, modern ranges should be referenced to better reflect the diversity of abortion patients nationwide.
    ISSN: 0029-7844
    Source: Copyright © 2013 Lippincott Williams & Wilkins. All rights reserved.〈img src=http://exlibris-pub.s3.amazonaws.com/LWW%20logo.png style="vertical-align:middle;margin-left:7px"〉
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  • 2
    In: Obstetrics & Gynecology, 2018, Vol.132(3), pp.612-618
    Description: OBJECTIVE:: To evaluate whether prophylactic pregabalin reduces pain experienced with medication abortion. METHODS:: We conducted a randomized, double-blind, placebo-controlled trial of women initiating medication abortion with mifepristone and buccal misoprostol up to 70 days of gestation. Participants were randomized to 300 mg oral pregabalin or a placebo immediately before misoprostol. The primary outcome was maximum pain on an 11-point numerical rating scale, reported using real-time electronic surveys over 72 hours. Secondary outcomes included pain at each time point, ibuprofen and narcotic use, side effects, and satisfaction. We estimated that 110 women would be required to have 80% power to detect a difference in pain of 1.3 points. RESULTS:: Between June 2015 and October 2016, 241 women were screened and 110 were randomized (56 pregabalin, 54 placebo). Three were lost to follow-up. The primary outcome of mean maximum pain in the pregabalin group was 5.0±2.6 vs 5.5±2.2 in the placebo group (P=.32). Excluding medication taken before the study capsule, ibuprofen was used by 64% (35/55) of the pregabalin group vs 87% (45/52) placebo (P〈.01). Narcotics were used by 29% (16/55) of the pregabalin group vs 50% (26/52) placebo (P〈.03). More dizziness (P〈.001), sleepiness (P〈.04), and blurred vision (P〈.05) occurred in the pregabalin group. Satisfaction scores for the analgesic regimen were higher in the pregabalin group (very satisfied: 47% vs 22%; P=.006). CONCLUSION:: Compared with placebo, 300 mg pregabalin coadministered with misoprostol during medication abortion did not significantly decrease maximum pain scores. Women who received pregabalin were less likely to require any ibuprofen or narcotic and were more likely to report higher satisfaction with analgesia, despite an increase in dizziness, sleepiness, and blurred vision. CLINICAL TRIAL REGISTRATION:: ClinicalTrials.gov, NCT02782169.
    Keywords: Abortion, Induced -- Adverse Effects ; Analgesics -- Therapeutic Use ; Pain -- Prevention & Control ; Pregabalin -- Therapeutic Use;
    ISSN: 0029-7844
    E-ISSN: 1873233X
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  • 3
    In: Obstetrics & Gynecology, 2017, Vol.130(2), pp.387-392
    Description: OBJECTIVE:: To evaluate the efficacy of a paracervical block to decrease pain during osmotic dilator insertion before second-trimester abortion. METHODS:: In this double-blind, randomized trial, 41 women undergoing Laminaria insertion before a second-trimester abortion received either a paracervical block with 18 mL 1% lidocaine and 2 mL sodium bicarbonate or a sham block. Women were between 14 and 23 6/7 weeks of gestation. The primary outcome was pain immediately after insertion of Laminaria. Women assessed their pain on a 100-mm visual analog scale. Secondary outcomes included assessment of pain at other times during the insertion procedure and overall satisfaction with pain control. To detect a 25-mm difference in pain immediately after Laminaria insertion, at an α of 0.05 and 80% power, we aimed to enroll 20 patients in each arm. RESULTS:: From May 2015 to December 2015, 20 women received a paracervical block and 21 received a sham block. Groups were similar in demographics, including parity, history of surgical abortion, and number of Laminaria placed. The paracervical block reduced pain after Laminaria insertion (median scores 13 mm [interquartile range 2–39] compared with 54 mm [interquartile range 27–61], P=.01, 95% CI −47.0 to −4.0). Women who received a paracervical block also reported higher satisfaction with overall pain control throughout the entire Laminaria insertion procedure (median scores 95 mm [interquartile range 78–100] compared with 70 mm [interquartile range 44–90], P=.05, 95% CI 0.0–37.0). CONCLUSION:: Paracervical block is effective at reducing the pain of Laminaria insertion. Additionally, a paracervical block increases overall patient satisfaction with pain control during Laminaria placement. CLINICAL TRIAL REGISTRATION:: ClinicalTrials.gov, NCT02454296.
    Keywords: Abortion, Induced–Methods ; Adult–Methods ; Anesthesia, Obstetrical–Administration & Dosage ; Double-Blind Method–Administration & Dosage ; Female–Administration & Dosage ; Gestational Age–Administration & Dosage ; Hawaii–Administration & Dosage ; Humans–Administration & Dosage ; Laminaria–Administration & Dosage ; Lidocaine–Administration & Dosage ; Pain Measurement–Administration & Dosage ; Patient Satisfaction–Administration & Dosage ; Pregnancy–Administration & Dosage ; Pregnancy Trimester, Second–Administration & Dosage ; Sodium Bicarbonate–Administration & Dosage ; Abridged ; Sodium Bicarbonate ; Lidocaine;
    ISSN: 0029-7844
    E-ISSN: 1873233X
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  • 4
    Language: English
    In: Hawai'i journal of medicine & public health : a journal of Asia Pacific Medicine & Public Health, July 2017, Vol.76(7), pp.178-182
    Description: Emergency contraceptive pills (ECPs) are medications used after unprotected intercourse, underprotected intercourse, or sexual assault to decrease the risk of pregnancy. Availability of ECPs in Hawai'i's retail pharmacies was last assessed in 2007, following over-the-counter access to levonorgestrel ECPs (LNG-ECP) for women age 18 years or older and prior to U.S. Food and Drug Administration (FDA) approval of prescription-only ulipristal acetate (UPA). We conducted a county-by-county subanalysis from a larger observational population-based study on statewide availability of ECPs in Hawai'i's pharmacies. In the original study, researchers called all 198 unique retail pharmacies in Hawai'i between December 2013 and June 2014. Only 3% of pharmacies had UPA immediately available on-site in the state, with UPA available on Kaua'i and O'ahu only. At least one form of LNG-ECPs was available in 82% of pharmacies in 2013-2014, roughly the same as 2007 (81%) (P=0.9) when Lana'i and Moloka'i lacked access. Currently, only Moloka'i lacks retail pharmacy access to ECPs. When controlling for general inflation, the 2013-2014 mean price for name brand LNG-ECP fell within the reported range of 2007 prices. Generic LNG-ECPs were substantially lower in price than name brand LNG-ECPs in 2007 and 2013-2014. Availability of UPA is limited and significantly lower compared to LNG-ECPs. Availability of LNG-ECPs statewide has remained stable and the arrival of generics has decreased prices.
    Keywords: Availability ; Emergency Contraception ; Hawai‘i ; Pharmacies ; Ulipristal Acetate ; United States ; Contraceptives, Postcoital -- Therapeutic Use ; Health Services Accessibility -- Standards ; Pharmacy -- Statistics & Numerical Data
    E-ISSN: 2165-8242
    Source: MEDLINE/PubMed (U.S. National Library of Medicine)
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  • 5
    Language: English
    In: Journal of Pediatric and Adolescent Gynecology, February 2017, Vol.30(1), pp.29-34
    Description: To assess the values and beliefs regarding sexual behavior, sexual decision-making, and reproductive health learning preferences among teens in Hawaii. Survey regarding teens' knowledge, attitudes, and beliefs about sexual behaviors and preferences for learning about reproductive health. University of Hawaii Department of Obstetrics and Gynecology clinics in Honolulu, Hawaii. Female patients and their male or female companions ages 14-19 years. A 30-question anonymous survey. The main outcome was to describe the norms, attitudes, beliefs, and preferences of teens in this setting with regard to sexual health and sexual health education. For this, we provide a description of response frequencies and a comparison of mean scores across demographic characteristics. We analyzed a total of 100 surveys. Teens endorsed more values and norms protective against sexually transmitted infection than those protective against pregnancy. Younger teens expressed more protective values as a result of the influence of perceived parental values, whereas older teens expressed less protective values on the basis of the influence of peers. Respondents expressed comfort talking with their clinician about sexual health, and also expressed a slight preference that their clinicians initiate these conversations. The influence of parental values and peer norms on sexual behavior must be taken into consideration when designing interventions to address adolescent sexual health. Additionally, teens' greater concern about the consequences of sexually transmitted infection could be leveraged by clinicians to initiate broader conversations about sexual health, and a variety of modalities, including online resources and in-person conversations, should be used to meet the diversity of preferences expressed by teens across demographic groups.
    Keywords: Adolescents ; Pregnancy ; Sexually Transmitted Infections ; Surveys ; Norms ; Attitudes ; Behaviors ; Prevention ; Medicine
    ISSN: 1083-3188
    E-ISSN: 1873-4332
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  • 6
    Language: English
    In: Contraception, September 2018, Vol.98(3), pp.205-209
    Description: To determine if offering patients a choice of adjunctive nonpharmacologic pain management during first-trimester aspiration abortion results in lower pain scores when compared with standard care. We enrolled women receiving first-trimester aspiration abortion at the University of Hawaii. We randomized patients to standard care (control) or standard care plus a choice of nonpharmacologic pain management options (intervention). Standard care was ibuprofen 800 mg orally at least 30 min preprocedure, lidocaine paracervical block and anticipatory guidance from the provider. We measured pain on a 100-mm visual analog scale immediately postprocedure with adequate sample size to detect a 20-mm difference in pain scores. Seventy-four women participated in the trial and reported an overall mean pain score of 61.9±27.0. Participants in the control and intervention groups reported similar overall mean pain scores (control 60.6±28.8, intervention 63.3±28.5). We found procedure time, complications, provider-perceived case difficulty and patient satisfaction with pain management to be similar between groups. Providers underestimated participant pain compared to participants' own scores (mean physician estimate of participant pain: 46.3±18.5, mean participant pain score: 61.9±27.0, p〈.01). Intervention group participants most frequently selected ambient music (59%) as the nonpharmacologic intervention. Forty-one percent (15/37) of participants in the intervention group chose more than one nonpharmacologic intervention. Participants in the control group reported similar pain scores to participants in the intervention group. Procedure time and difficulty were similar between the two groups. Incorporating patient choice into a nonpharmacologic pain management model did not result in lower pain scores. This approach did increase the patient's visit time. Abortion providers frequently use nonpharmacologic pain management in the United States, and these techniques did not negatively impact patient pain scores in our study.
    Keywords: Abortion ; First-Trimester ; Nonpharmacologic ; Pain Management ; Medicine
    ISSN: 0010-7824
    E-ISSN: 1879-0518
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  • 7
    Language: English
    In: Contraception, May 2016, Vol.93(5), pp.452-454
    Description: To determine pharmacy availability of ulipristal acetate (UPA) and compare to availability of levonorgestrel-containing emergency contraceptive pills (LNG-ECPs). We conducted an observational population-based study utilizing a telephone-based secret shopper methodology. Researchers called all 198 unique retail pharmacies in Hawaii on December 2013–June 2014, representing themselves as patients and physicians. Only 2.6% of pharmacies had UPA immediately available, though 22.8% reported ability to order UPA. In contrast, 82.4% reported immediate availability of LNG-ECPs. No significant difference in availability was reported to patients and physicians. Availability of UPA is limited and significantly lower compared to LNG-ECPs. The study period did overlap with a change in distributor for UPA, likely capturing some disruption of the supply chain. Systems-based interventions are needed to address barriers to obtaining UPA.
    Keywords: Ulipristal Acetate ; Emergency Contraception ; Pharmacies ; Availability ; United States ; Hawaii ; Medicine
    ISSN: 0010-7824
    E-ISSN: 1879-0518
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  • 8
    Language: English
    In: Hawai'i journal of medicine & public health : a journal of Asia Pacific Medicine & Public Health, January 2018, Vol.77(1), pp.7-13
    Description: The literature suggests that women of different races are more or less likely to use certain contraceptive methods and patient race can influence which contraceptive recommendations a provider makes. To explore whether health care providers treat individuals of different races differently, we conducted a preliminary investigation on whether medical students recommended different contraceptive methods for hypothetical patients presenting with the same clinical features who only varied by race. Third- and fourth-year medical students (n=103) at the University of Hawai'i completed an online survey. Students read case studies about a 23-year-old and 36-year-old patient and then made contraceptive recommendations. All students reviewed the same scenarios, with the exception of the patient's name which was randomly assigned to represent one of five racial/ethnic groups (White, Chinese, Filipina, Native Hawaiian, and Micronesian). Recommendations were analyzed using χ tests and bivariate logistic regressions. For the younger patient, students were most likely to recommend intrauterine devices (IUDs), followed by the contraceptive pill and Etonogestrel implant; recommendations did not differ by race/ethnicity (P = .91). For the older patient, students were most likely to recommend IUDs or sterilization, and Micronesian women were more likely to receive sterilization recommendations compared to White women (60% versus 27%, P = .04). In summary, contraceptive recommendations, specifically the frequency of recommending sterilization varied by race. Our findings add to the literature exploring the role of a patient's race/ethnicity on recommendations for contraception and highlights the need for more studies exploring the etiology of health care disparities.
    Keywords: Contraception ; Disparities ; Medical Students ; Race/Ethnicity ; Sterilization ; Age Factors ; Continental Population Groups -- Statistics & Numerical Data ; Contraception Behavior -- Ethnology ; Racism -- Psychology ; Students, Medical -- Psychology
    E-ISSN: 2165-8242
    Source: MEDLINE/PubMed (U.S. National Library of Medicine)
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  • 9
    Language: English
    In: Hawai'i journal of medicine & public health : a journal of Asia Pacific Medicine & Public Health, June 2017, Vol.76(6), pp.143-146
    Description: Studies have shown that healthcare professionals often demonstrate obesity biases, which in turn reduce the quality of care obese patients receive. The purpose of the current study was to describe third and fourth year University of Hawai'i, John A. Burns School of Medicine medical students' attitudes towards obese patients. Data were collected using previously validated questions from a pilot study assessing how healthcare providers react and recommend medical care to patients with varying characteristics. The responses of 114 medical students were analyzed. Overall, the majority of students' responses reflected the belief that obesity may be a behavioral issue. There were no statistically significant differences between the third and fourth year students' responses. Important areas of future research include assessing students' awareness of the social determinants of health and ability to self-identify possible biases in caring for obese patients.
    Keywords: Attitude ; Bias ; Medical Students ; Obese Patients ; Obesity ; Attitude of Health Personnel ; Obesity -- Psychology ; Students, Medical -- Psychology
    E-ISSN: 2165-8242
    Source: MEDLINE/PubMed (U.S. National Library of Medicine)
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  • 10
    Language: English
    In: Contraception, June 2018, Vol.97(6), pp.500-503
    Description: Our objective was to document current practices of abortion providers on the use of medications to decrease bleeding during surgical abortion. We emailed surveys to 336 abortion providers through a professional listserv to elicit information on their use of medications to prevent and treat bleeding during first- and second-trimester surgical abortion. One hundred sixty-eight (50%) providers responded to our survey. The majority were obstetrician-gynecologists (83%) working in an academic practice (66%). Most completed a fellowship in family planning (87%) and currently perform abortions up to 22 or 24 weeks of gestation (63%). Seventy-two percent routinely used prophylactic medications for bleeding. Providers who routinely used medications to prevent bleeding most commonly chose vasopressin (83%). Providers preferred methylergonovine as a treatment for excessive bleeding in the second trimester, followed by misoprostol. We found that most providers routinely use medications to prevent bleeding and use several different regimens to treat bleeding during abortion. We found that surgical abortion providers use a range of medications to prevent and treat hemorrhage at the time of surgical abortion. Scant evidence is available to guide abortion providers on the use of medications to decrease hemorrhage during surgical abortion. To provide evidence-based recommendations for the prevention and treatment of clinically significant bleeding, researchers should target the most commonly used interventions.
    Keywords: Abortion ; Survey ; Uterotonic ; Misoprostol ; Methylergonovine ; Vasopressin ; Medicine
    ISSN: 0010-7824
    E-ISSN: 1879-0518
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