ABSTRACT
PURPOSE: To evaluate the opinions of gynecologists and interventional radiologists regarding uterine fibroid embolization (UFE). METHODS: We mailed surveys to all gynecologists and interventional radiologists practising in Toronto, Ontario. Study criteria excluded those physicians who did not assess or treat patients with uterine fibroids. We evaluated whether they educated patients regarding UFE, together with their opinion of current and future effectiveness of UFE, self-rated knowledge of fibroid treatment options, and recommendations for treatment in several clinical scenarios. RESULTS: A total of 102 gynecologists (46.4% response rate) and 28 interventional radiologists (51.9% response rate) completed the survey. After applying the exclusion criteria, the final study population was 82 gynecologists and 17 interventional radiologists. Both groups reported high rates of patient education regarding UFE (gynecologists 100% and interventional radiologist 88.2%, P > 0.05). Interventional radiologists had higher self-rated knowledge of UFE (P = 0.05), and gynecologists had higher self-rated knowledge of all other treatment options (P = 0.00). Interventional radiologists had a more favourable opinion of the current effectiveness (P < 0.05) and future use (P > 0.05) of UFE. In 5 of the 7 clinical scenarios, interventional radiologists chose UFE, whereas gynecologists chose other treatment options (P < 0.05). CONCLUSIONS: Although most gynecologists and intterventional radiologists educate their patients regarding UFE as a treatment option for uterine fibroids, interventional radiologists have greater self-rated knowledge and a higher opinion of current effectiveness and future use and recommend UFE more often for uterine fibroid scenarios.
Subject(s)
Attitude of Health Personnel , Embolization, Therapeutic/methods , Gynecology , Leiomyoma/therapy , Radiology, Interventional , Uterine Neoplasms/therapy , Adult , Data Collection , Female , Humans , Male , Middle Aged , Ontario , Patient Education as Topic , Practice Patterns, Physicians' , Surveys and QuestionnairesABSTRACT
The surface features, morphology, and tensile properties of fibers obtained from pristine, reprocessed, and reused Fresenius Polysulfone High-Flux (Hemoflow F80A) hemodialyzers have been studied. Scanning electron microscopy of the dialyzer fibers revealed a dense skin layer on the inner surface of the membrane and a relatively thick porous layer on the outer surface. Transmission electron microscopy and atomic force microscopy showed an alteration in membrane morphology due to reprocessing and reuse, or to a deposition of blood-borne material on the membrane that is not removed with reprocessing. Fluorescent microscopy images also showed that a fluorescent material not removed by heat/citric acid reprocessing builds up with continued use of the dialyzers. The tensile properties of the dialyzer fibers were not affected by the heat/citric acid reprocessing procedure. The protein layers formed on pristine and reused hemodialyzer membranes during clinical use were also studied using sodium dodecyl sulfate polyacrylamide gel electrophoresis and immunoblotting. A considerable amount of protein was found on the blood side of single and multiple use dialyzers. Proteins adsorbed on the dialysate side of the membrane were predominantly in the molecular weight region below 30 kDa. Little protein was detected on the membranes of reprocessed hemodialyzers.
