ABSTRACT
STUDY OBJECTIVE: The purpose of this study was to better elucidate radiofrequency endometrial ablation (REA) durability by assessing the probability of failure as defined by need for postablation hysterectomy. Age at index REA, duration from REA until hysterectomy, and REA failure (REAF) risk factors were analyzed. DESIGN: A retrospective cohort study was conducted using patient data between April 1, 2002, and March 31, 2019. REAF cases were identified using operative procedure codes. Cox proportional hazard regression assessed the effect of age at index REA on time to postablation hysterectomy. Kaplan-Meier survival curve evaluated timing of postablation hysterectomy, stratified by age at index REA. SETTING: This study was conducted at Regina General Hospital in Regina, Saskatchewan, Canada. PATIENTS: Patient population included those who were 21 years of age or older, were premenopausal, and had a history of heavy menstrual bleeding at the time of REA. INTERVENTIONS: The intervention under investigation was REA. MEASUREMENTS AND MAIN RESULTS: The overall probability of postablation hysterectomy was 22.6%. The probabilities of postablation hysterectomy were 36.1% for women younger than 30 years (n = 128), 28% for women 30 to 34.9 years old (n = 528), 29.6% for women 35 to 39.9 years old (n = 1152), and 17.6% for women 40 years and older (n = 2221). Characteristics associated with REAF included tubal occlusion, cesarean section, dysmenorrhea, and chronic pelvic pain (p <.01) among women younger than 40 years. Leiomyomas accounted for higher failure rates in women 40 years and older (p <.01). CONCLUSION: Postablation hysterectomy is more likely to occur in women younger than 40 years. REA can be considered in women aged 30 to 39.9 years old, who have no known REAF risk factors. Women younger than 40 years with REAF risk factors will experience higher rates of hysterectomy. Thus, the decision to proceed with REA should be individualized with careful consideration for the underlying causes of abnormal uterine bleeding, while respecting patient autonomy.
Subject(s)
Endometrial Ablation Techniques , Menorrhagia , Pregnancy , Humans , Female , Young Adult , Adult , Endometrial Ablation Techniques/adverse effects , Endometrial Ablation Techniques/methods , Retrospective Studies , Cesarean Section , Canada , Menorrhagia/etiology , Menorrhagia/surgery , Menorrhagia/epidemiologySubject(s)
Internal Hernia/diagnosis , Intestinal Obstruction/diagnosis , Leiomyosarcoma/diagnosis , Uterine Neoplasms/diagnosis , Diagnosis, Differential , Female , Herniorrhaphy , Humans , Hysterectomy , Internal Hernia/complications , Internal Hernia/diagnostic imaging , Internal Hernia/surgery , Intestinal Obstruction/complications , Intestinal Obstruction/diagnostic imaging , Intestinal Obstruction/surgery , Leiomyosarcoma/complications , Leiomyosarcoma/diagnostic imaging , Leiomyosarcoma/surgery , Middle Aged , Uterine Hemorrhage/etiology , Uterine Neoplasms/complications , Uterine Neoplasms/diagnostic imaging , Uterine Neoplasms/surgerySubject(s)
Dyspareunia/etiology , Hysterectomy/adverse effects , Neuroma/diagnosis , Postoperative Complications/diagnosis , Vaginal Neoplasms/diagnosis , Adult , Female , Humans , Neuroma/complications , Neuroma/pathology , Neuroma/surgery , Postoperative Complications/etiology , Postoperative Complications/pathology , Postoperative Complications/surgery , Vagina , Vaginal Neoplasms/complications , Vaginal Neoplasms/pathology , Vaginal Neoplasms/surgeryABSTRACT
CONTEXT: Medical schools have tended to admit students with strong backgrounds in the biomedical sciences. Previous studies have shown that those with backgrounds in the social sciences can be as successful in medical school as those with science backgrounds. However, the experience of being a 'non-science' student over time has not been well described. METHODS: A mixed-methods study was developed and run with the aim of elucidating the personal experiences of science and non-science students at our institution. Data were generated from a student survey that focused on participants' self-identification as science or non-science students, and on their sense of preparedness and stress, and from a series of student focus groups exploring participants' experiences of science and non-science issues in all aspects of their training. Descriptive statistics were generated for structured survey data. Focus group data and unstructured survey data were analysed to identify common themes. End-of-module and end-of-year examination data for the four class cohorts in the programme were also analysed to compare science and non-science student performance over time. RESULTS: There were clear differences between the experiences and performance of science and non-science students. We found dichotomies in students' self-reported sense of preparedness and stress levels, and marked differences in their examination performance, which diminished over time to converge around the third year of their studies. Combining science and non-science students in the same class affected the students to different extents and in different ways. The potential disruption of mixing science and non-science students diminished as their levels of performance converged. CONCLUSIONS: The psychosocial stress experienced by non-science students and the challenges it posed, in both their academic and their personal lives, have implications for how such students should be supported, and how curricula can be configured to afford quality learning for all medical students.
