Patient and provider perspectives on LEEP/LLETZ treatment and outcomes: an interview study.

BACKGROUND: The loop electrosurgical excision procedure (LEEP) and large loop excision of the transformation zone (LLETZ) effectively treat cervical dysplasia, though some women have reported negative outcomes postoperatively (e.g., sexual dysfunction, psychosexual sequalae). There is insufficient understanding of patient experiences with these symptoms and perspectives from the providers who perform LEEP/LLETZ. AIM: To characterize the perceptions and experiences of LEEP/LLETZ treatment from providers and patients, including whether there is a characteristic symptom profile of women who report negative outcomes. METHODS: Patients who had LEEP/LLETZ treatment and reported negative outcomes and providers who perform LEEP/LLETZ completed semistructured interviews about their perceptions and experiences, which were coded through thematic analysis (NVivo 12; QSR International). Patients also completed an online survey assessing demographics, medical history, and sexual function. OUTCOMES: Outcomes included perspectives generated from patient and provider interviews regarding LEEP/LLETZ procedural outcomes, including symptoms and experiences related to sexual functioning. RESULTS: Perspectives and experiences gathered from patient and provider interviews revealed misaligned narratives surrounding LEEP/LLETZ outcomes and treatment. We identified 4 overarching themes encapsulating provider and patient responses: Expectations for Preoperative Consultation; Procedure Experiences; Attitudes; and Resources. Patients reported a unique symptom profile and negative outcome experiences, namely surrounding domains of sexual functioning: decreased physical sensations, orgasm response, and vaginal discharge, as well as loss of arousal, interest, and desire. Patients described changes to overall quality of life, with impacts to interpersonal relationships. Patients discussed preferring open-ended and directed questions to comprehensively elucidate negative outcomes. Provider narratives outlined the current process of care, emphasizing limited experiences with adverse outcomes (e.g., sexual issues) and the use of open-ended questions during counseling. Providers described an evolving intention to create comfortable clinical spaces. Regarding pre- and postoperative resources, patients described seeking support from online patient groups, and providers disclosed limitations to providing resources. CLINICAL IMPLICATIONS: Evidence of discordance between patient and provider perspectives of LEEP/LLETZ reveals a need to reassess clinical practices surrounding this procedure at the level of discussions regarding informed consent, sexual function, and available resources. STRENGTHS AND LIMITATIONS: This study is the first to examine patient and provider perspectives on LEEP/LLETZ treatment. Only patients who self-report negative outcomes were recruited, to elicit narratives from this specific subpopulation. CONCLUSION: Results indicate a characteristic symptom profile of women who undergo LEEP/LLETZ and report negative outcomes and that the perceptions of patients and providers differ regarding several aspects of the treatment experience, supporting the need for directed open conversation and comprehensive pre- and postoperative sexual counseling.

Iatrogenic Barotrauma in COVID-19-Positive Patients: Is It Related to the Pneumonia Severity? Prevalence and Trends of This Complication Over Time.

COVID-19 has attracted worldwide attention ever since the first case was identified in Wuhan (China) in December 2019 and was classified, at a later time, as a public health emergency of international concern in January 2020 and as a pandemic in March 2020. The interstitial pneumonia caused by COVID-19 often requires mechanical ventilation, which can lead to pulmonary barotrauma. We assessed the relationship between pneumonia severity and the development of barotrauma in COVID-19-positive patients mechanically ventilated in an intensive care unit; we therefore analyzed the prevalence of iatrogenic barotrauma and its trends over time during the pandemic in COVID-19-positive patients undergoing mechanical ventilation compared to COVID-19-negative patients, making a distinction between different types of ventilation (invasive mechanical ventilation vs. noninvasive mechanical ventilation). We compared CT findings of pneumomediastinum and pneumothorax in 104 COVID-19-positive patients hospitalized in an intensive care unit and 101 COVID-19-negative patients undergoing mechanical ventilation in the period between October 2020 and December 2021. The severity of pneumonia was not directly correlated with the development of barotrauma. Furthermore, a higher prevalence of complications due to barotrauma was observed in the group of mechanically ventilated COVID-19-postive patients vs. COVID-19-negative patients. A higher rate of barotrauma was observed in subgroups of COVID-19-positive patients undergoing mechanical ventilation compared to those treated with invasive mechanical ventilation. The prevalence of barotrauma in COVID 19-positive patients showed a decreasing trend over the period under review. CT remains an essential tool in the early detection, diagnosis, and monitoring of the clinical course of SARS-CoV2 pneumonia; in evaluating the disease severity; and in the assessment of iatrogenic complications such as barotrauma pathology.

Disclosure of Loop Electrosurgical Excision Procedure Complications: Qualitative Analysis of Hospital- Affiliated Online Resources in Canada.

OBJECTIVE: Determine the current level of knowledge translation presented in hospital-affiliated online resources (HAOR) related to Loop Electrosurgical Excision Procedure (LEEP) and critically evaluate how these resources convey information to patients using validated measures of health literacy. METHODS: Qualitative analysis was conducted to assess HAOR content. Reading level was calculated using the Flesch-Kincaid Grade Level (FKGL), Gunning Fog Index (GFI), and Simple Measure of Gobbledygook (SMOG). Actionability and understandability were measured using the Patient Education Material Assessment Tool for Print (PEMAT-P). RESULTS: Twenty-four HAORs relating to LEEP were identified on Canadian health care institution websites (n = 167). Bleeding (n=15), discharge (n=14), pain/discomfort (n=14), infections (n=9), and cervical stenosis (n=7) were disclosed as short-term complications. Less frequently disclosed were long-term risks relating to pregnancy (n=5) and fertility (n=1). Complications related to sexual health and well-being were absent. Discrepancies were observed in the disclosure of when updates were performed (n=21) and sourcing details (n=2). The mean readability scores were above the recommended grade-level 5/6 for patient education materials (FKGL: x̄ = 6.64, σ = 1.07; GFI: x̄ = 8.58, σ = 1.50; SMOG: x̄ = 9.92, σ = 0.92). All HAORs scored above the PEMAT-P threshold (≥70%) for good actionability. Few HAORs (n=7) exceeded the threshold (≥70%) for good understandability (x̄ = 68.7%, σ = 11.0). CONCLUSIONS: Inconsistent disclosure of LEEP risks and complications suggests critical elements of knowledge translation are inadequately applied to the curation process of HAORs. Measures of readability, understandability, and actionability indicate poor resource accessibility.