Multi-institutional Validation of a Vaginal Hysterectomy Simulation Model for Resident Training.

STUDY OBJECTIVE: The purpose of the research was to both develop a vaginal hysterectomy model with surgically pertinent anatomic landmarks and assess its validity for simulation training. DESIGN: A low-cost, reproducible vaginal hysterectomy model with relevant anatomic landmarks for key surgical steps. SETTING: Nine academic and community-based obstetrics and gynecology residency programs. PARTICIPANTS: One hundred sixty-nine obstetrics and gynecology residents. INTERVENTIONS: A vaginal hysterectomy model with surgically pertinent anatomic landmarks was developed and tested for construct validity. MEASUREMENTS AND MAIN RESULTS: Of the 184 available residents, 169 (91%) participated in this study and performed a vaginal hysterectomy procedure on the described model. The validated objective 7-item global rating scale (GRS) and the 13-item task-specific checklist (TSC) were used as tools to assess performance. The median TSC and GRS scores correlated with year of training, prior experience, and trainee confidence. In addition, the TSC scores also correlated with the GRS scores (p <.001) with regard to performance and resident year of training. Receiver Operator Curves for identification of the residents meeting national residency accreditation minimum numbers for vaginal hysterectomy using the GRS and TSC scores had an area under the curve of 0.89 and 0.83, respectively. CONCLUSION: This reduced-cost vaginal hysterectomy model offers high construct validity and pertinence for simulation.

Does co-location of medication assisted treatment and prenatal care for women with opioid use disorder increase pregnancy planning, length of interpregnancy interval, and postpartum contraceptive uptake?

INTRODUCTION: Women with opioid use disorder have higher rates of unplanned pregnancies, shorter interpregnancy intervals and lower rates of contraceptive use compared to women without substance use disorders. This contributes to worse perinatal and reproductive health outcomes for this population. It has been suggested that co-location of medication assisted treatment (MAT) and reproductive health services could allow for improved outcomes among women with substance use disorders. The aim of this study was to determine if location where women received MAT influenced their pregnancy planning, interpregnancy interval or uptake of postpartum contraception between subsequent pregnancies. METHODS: We conducted a retrospective chart review at the University of Vermont Medical Center (UVMMC). Women were eligible for the study if they had two consecutive deliveries at UVMMC between 2009 and 2015 and if they received MAT during one or both pregnancies. Women in this community can receive MAT through a public MAT opioid treatment program (methadone or buprenorphine), a community MAT program (buprenorphine), or through an obstetric provider with co-location of prenatal care and MAT (buprenorphine). Demographics and maternal and neonatal outcomes were collected and descriptive statistics were performed. RESULTS: A total of 98 women were included in the study. Of the women with documented pregnancy intention status, 84% were unplanned, for both pregnancies. Over half of women had a short interpregnancy interval (56.1%), defined as <18 months between consecutive pregnancies. Half of women (50%) did not receive any contraceptive method in the postpartum period. Furthermore, many patients (42.2%) desired long acting reversible contraception (LARC), but only 9.3% received it. Outcomes were not statistically different among the models of care. DISCUSSION: Colocation of MAT with antenatal care did not improve pregnancy planning, interpregnancy interval, or uptake of postpartum contraception. Decisions regarding family planning and continued engagement with the health care system following pregnancy remain challenges in this group of women.

RNAi-mediated gene silencing in tick synganglia: a proof of concept study.

BACKGROUND: Progress in generating comprehensive EST libraries and genome sequencing is setting the stage for reverse genetic approaches to gene function studies in the blacklegged tick (Ixodes scapularis). However, proving that RNAi can work in nervous tissue has been problematic. Developing an ability to manipulate gene expression in the tick synganglia likely would accelerate understanding of tick neurobiology. Here, we assess gene silencing by RNA interference in the adult female black-legged tick synganglia. RESULTS: Tick beta-Actin and Na+-K+-ATPase were chosen as targets because both genes express in all tick tissues including synganglia. This allowed us to deliver dsRNA in the unfed adult female ticks and follow a) uptake of dsRNA and b) gene disruption in synganglia. In vitro assays demonstrated total disruption of both tick beta-Actin and Na+-K+-ATPase in the synganglia, salivary glands and midguts. When dsRNA was microinjected in unfed adult female ticks, nearly all exhibited target gene disruption in the synganglia once ticks were partially blood fed. CONCLUSION: Abdominal injection of dsRNA into unfed adult female ticks appears to silence target gene expression even in the tick synganglia. The ability of dsRNA to cross the blood-brain barrier in ticks suggests that RNAi should prove to be a useful method for dissecting function of synganglia genes expressing specific neuropeptides in order to better assess their role in tick biology.