The activity advantage: Objective measurement of preoperative activity is associated with postoperative recovery and outcomes in patients undergoing surgery with gynecologic oncologists.

OBJECTIVE: To examine the association between objectively-measured preoperative physical activity with postoperative outcomes and recovery milestones in patients undergoing gynecologic oncology surgeries. METHODS: Prospective cohort study of patients undergoing surgery with gynecologic oncologists who wore wearable actigraphy rings before and after surgery from 03/2021-11/2023. Exposures encompassed preoperative activity intensity (moderate- and vigorous-intensity metabolic equivalent of task-minutes [MAVI MET-mins] over seven days) and level (average daily steps over seven days). Intensity was categorized as <500, 500-1000, and >1000 MAVI MET-mins; level categorized as <8000 and ≥8000 steps/day. Primary outcome was 30-day complications. Secondary outcomes included reaching postoperative goal (≥70% of recommended preoperative intensity and level thresholds) and return to baseline (≥70% of individual preoperative intensity and level). RESULTS: Among 96 enrolled, 87 met inclusion criteria, which constituted 39% (n = 34) with <500 MET-mins and 56.3% (n = 49) with <8000 steps preoperatively. Those with <500 MET-mins and <8000 steps had higher ECOG scores (p = 0.042 & 0.037) and BMI (p = 0.049 & 0.002) vs those with higher activity; all other perioperative characteristics were similar between groups. Overall, 29.9% experienced a 30-day complication, 29.9% reached postoperative goal, and 64.4% returned to baseline. On multivariable models, higher activity was associated with lower odds of complications: 500-1000 MET-mins (OR = 0.26,95%CI = 0.07-0.92) and >1000 MET-mins (OR = 0.25,95%CI = 0.07-0.94) vs <500 MET-mins; ≥8000 steps (OR = 0.25,95%CI = 0.08-0.73) vs <8000 steps. Higher preoperative activity was associated fewer days to reach postoperative goal. CONCLUSION: Patients with high preoperative activity are associated with fewer postoperative complications and faster attainment of recovery milestones. Physical activity may be considered a modifiable risk factor for adverse postoperative outcomes.

Use of topic modeling to assess research trends in the journal Gynecologic Oncology.

STUDY OBJECTIVE: There is scant research identifying thematic trends within medical research. This work may provide insight into how a given field values certain topics. We assessed the feasibility of using a machine learning approach to determine the most common research themes published in Gynecologic Oncology over a thirty-year period and to subsequently evaluate how interest in these topics changed over time. METHODS: We retrieved the abstracts of all original research published in Gynecologic Oncology from 1990 to 2020 using PubMed. Abstract text was processed through a natural language processing algorithm and clustered into topical themes using latent Dirichlet allocation (LDA) prior to manual labeling. Topics were investigated for temporal trends. RESULTS: We retrieved 12,586 original research articles, of which 11,217 were evaluable for subsequent analysis. Twenty-three research topics were selected at the completion of topic modeling. The topics of basic science genetics, epidemiologic methods, and chemotherapy experienced the greatest increase over the time period, while postoperative outcomes, reproductive age cancer management, and cervical dysplasia experienced the greatest decline. Interest in basic science research remained relatively constant. Topics were additionally reviewed for words indicative of either surgical or medical therapy. Both surgical and medical topics saw increasing interest, with surgical topics experiencing a greater increase and representing a higher proportion of published topics. CONCLUSIONS: Topic modeling, a type of unsupervised machine learning, was successfully used to identify trends in research themes. The application of this technique provided insight into how the field of gynecologic oncology values the components of its scope of practice and therefore how it may choose to allocate grant funding, disseminate research, and participate in the public discourse.

Sleep and gynecological cancer outcomes: opportunities to improve quality of life and survival.

Sleep is important for immune function, metabolic function and physical repair. Sleep is more commonly disrupted in women compared with men and is disrupted by surgery, chemotherapy, and cancer itself, making gynecological oncology patients at higher risk of insomnia and sleep disruption. Insomnia and sleep disruption are linked to increased pain, poorer quality of life, depression, and anxiety which can all negatively affect patient outcomes. A number of environmental, behavioral, and pharmacological interventions have been investigated to improve patient sleep and aid in the recovery process. It is vital to understand and address patient sleep quality in order to give patients the highest quality care and improve outcomes.

Attitudes of Lay Stakeholders and Transplant Professionals About Disclosure to Living Kidney Donors in Exchanges and Chains.

BACKGROUND: Current policies require very limited informational disclosure between living kidney donors and recipients regardless of the relationship type. No specific policies exist to suggest that exchange/chain donors and their recipients should be treated differently. We surveyed transplant professionals (surgeons and nephrologists) and members of the National Kidney Foundation (NKF) to determine their support for disclosing to donors the health, health behavior, and social information of their exchange/chain donors and exchange/chain recipients. METHODS: Twenty questions regarding disclosing to donors information about both their exchange/chain donors and exchange/chain recipients were included in 2 larger surveys on disclosure about kidney transplantation. Survey A was sent electronically to NKF list-servs, and survey B was sent to transplant professionals both electronically and by postal mail. RESULTS: Survey A yielded 236 valid surveys from NKF donors and recipients (lay stakeholders). Survey B yielded 111 valid surveys from transplant professionals. Both sets of stakeholders support disclosing to donors some health and health behavior information of their exchange/chain donor and exchange/chain recipient, and mostly oppose disclosure of social information. Lay stakeholders favored disclosing significantly more information than transplant professionals. Among lay stakeholders, donor respondents were more supportive than recipient respondents in disclosing to donors health information about the exchange/chain recipient. Among transplant professionals, surgeons were more supportive than nephrologists in disclosing to donors information about the exchange/chain recipient that may impact graft survival. CONCLUSIONS: There is broad stakeholder support for disclosing some health and health behavior information to donors about their exchange/chain donors and recipients.