Associations between gynecologic clinician type and routine female sexual dysfunction screening.

BACKGROUND: Female sexual dysfunction (FSD) is a common problem in the United States; however, only 14% to 40% of women are screened by their health care clinicians. There are few data on how differences in clinician type affects screening rates. AIM: This study aimed to assess differences in FSD screening rates among gynecology clinician types, identify factors associated with screening, and compare screening rates of FSD against conditions with established screening recommendations. METHODS: Data were collected by retrospective chart review of annual visits at an urban tertiary care center. Screening rates for FSD, depression, cervical cancer, and breast cancer were calculated and compared. Multivariable logistic regression modeling was utilized to assess the correlation between various patient characteristics and FSD screening rates. OUTCOMES: Study outcome measures included percentages of women who were screened for FSD, depression, cervical cancer, and breast cancer. RESULTS: FSD screening rate was significantly higher among resident-level clinicians vs nonresident clinicians (59% vs 31%; P < .001). When the nonresident clinicians were subanalyzed, certified nursing midwives were the second most likely to screen for FSD (odds ratio [OR], 0.41), followed by nurse practitioners (OR, 0.29) and attending physicians (OR, 0.22). According to multivariable logistic regression techniques, 5 factors were associated with an increased likelihood of a patient being screened for FSD at an annual examination: patient seen by a resident physician rather than an attending physician, patient history of FSD, patient age ≥40 years, patient report of being sexually active at the time of visit, and patient history of cervical procedures. CLINICAL IMPLICATIONS: There is an opportunity to improve FSD screening rates by clinicians. Future research may assess what factors, such as increased sexual function education or greater incentives to document FSD screening, may result in higher screening rates. From this, targeted and effective interventions might be crafted to improve future screening rates. STRENGTHS AND LIMITATIONS: This study is one of the first to compare FSD screening rates among clinician types in the same specialty. Study limitations include the inherent limitations of a retrospective design, including selection biases. CONCLUSION: Residents were more likely to screen for FSD at annual well-woman visits than attending clinicians, nurse practitioners, and certified nurse midwives. Understanding the reasons for varied FSD screening rates among clinician types may aid in the development of strategies to improve screening for this important aspect of women's health.

Quantitative and Visual Assessments toward Potential Sub-mSv or Ultrafast FDG PET Using High-Sensitivity TOF PET in PET/MRI.

PURPOSE: Newer high-performance time-of-flight (TOF) positron emission tomography (PET) systems have the capability to preserve diagnostic image quality with low count density, while maintaining a high raw photon detection sensitivity that would allow for a reduction in injected dose or rapid data acquisition. To assess this, we performed quantitative and visual assessments of the PET images acquired using a highly sensitive (23.3 cps/kBq) large field of view (25-cm axial) silicon photomultiplier (SiPM)-based TOF PET (400-ps timing resolution) integrated with 3 T-MRI in comparison to PET images acquired on non-TOF PET/x-ray computed tomography (CT) systems. PROCEDURES: Whole-body 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) PET/CT was acquired for 15 patients followed by whole body PET/magnetic resonance imaging (MRI) with an average injected dose of 325 ± 84 MBq. The PET list mode data from PET/MRI were reconstructed using full datasets (4 min/bed) and reduced datasets (2, 1, 0.5, and 0.25 min/bed). Qualitative assessment between PET/CT and PET/MR images were made. A Likert-type scale between 1 and 5, 1 for non-diagnostic, 3 equivalent to PET/CT, and 5 superior quality, was used. Maximum and mean standardized uptake values (SUVmax and SUVmean) of normal tissues and lesions detected were measured and compared. RESULTS: Mean visual assessment scores were 3.54 ± 0.32, 3.62 ± 0.38, and 3.69 ± 0.35 for the brain and 3.05 ± 0.49, 3.71 ± 0.45, and 4.14 ± 0.44 for the whole-body maximum intensity projections (MIPs) for 1, 2, and 4 min/bed PET/MR images, respectively. The SUVmean values for normal tissues were lower and statistically significant for images acquired at 4, 2, 1, 0.5, and 0.25 min/bed on the PET/MR, with values of - 18 ± 28 % (p < 0.001), - 16 ± 29 % (p = 0.001), - 16 ± 31 % (p = 0.002), - 14 ± 35 % (p < 0.001), and - 13 ± 34 % (p = 0.002), respectively. SUVmax and SUVpeak values of all lesions were higher and statistically significant (p < 0.05) for 4, 2, 1, 0.50, and 0.25 min/bed PET/MR datasets. CONCLUSION: High-sensitivity TOF PET showed comparable but still better visual image quality even at a much reduced activity in comparison to lower-sensitivity non-TOF PET. Our data translates to a seven times reduction in either injection dose for the same time or total scan time for the same injected dose. This "ultra-sensitivity" PET system provides a path to clinically acceptable extremely low-dose FDG PET studies (e.g., sub 1 mCi injection or sub-mSv effective dose) or PET studies as short as 1 min/bed (e.g., 6 min of total scan time) to cover whole body without compromising diagnostic performance.