Depot medroxyprogesterone acetate: a risk factor for cervical stenosis after loop electrosurgical excisional procedure management of cervical intraepithelial neoplasia?

OBJECTIVES: In our anecdotal experience and sporadically in the literature, gynecologists have observed a connection between patient's use of depot medroxyprogesterone acetate (DMPA) and increased occurrence of cervical stenosis during follow-up after loop electrosurgical excisional procedure (LEEP). We decided to formally examine this association in our clinic population. MATERIALS AND METHODS: We performed a chart review, enrolling 257 patients and tabulating data on demography, use of hormonal contraceptives, characteristics of the LEEP, and presence or absence of cervical stenosis at 1- and 6-month follow-up evaluations. Univariate tests of association between the independent variables and the dependent variable of cervical stenosis were examined via the chi and Student t tests for discrete and continuous variables, respectively. To characterize the relative importance of independent variables significantly associated with cervical stenosis, logistic regression was performed. RESULTS: Of the 257 charts reviewed, 127 patients (49.4%) completed 1 and 6 months after LEEP follow-up appointments, providing adequate data for analysis. In this population, we observed 25 cases of cervical stenosis, or an overall rate of 19.7%. Of patients using DMPA at the time of LEEP or during the follow-up period, 9 (41.0%) of 22 developed stenosis, whereas of those who did not use DMPA, 16 (15.2%) of 105 developed stenosis, indicating a significant difference (odds ratio = 3.85, 95% CI = 1.41-10.50). CONCLUSIONS: In our clinic population, use of DMPA was associated with higher rates of development of cervical stenosis, calling for larger studies of the association of DMPA in this LEEP complication.

The glass is half full: geriatric precepting encounters in family medicine.

Approximately 19% to 20% of all family medicine office visits involve care to patients older than age 65, yet limited research addresses family medicine geriatric education in the outpatient setting. This study explored how geriatric content is incorporated into resident/attending precepting encounters, using direct observation. An observer recorded the content of 259 sequential precepting interactions, including 33 encounters involving patients older than age 64. Eighty-five percent of these 33 encounters included discussion of a geriatric issue. Although precepting encounters for geriatric and nongeriatric patients were of similar length, more time was spent during geriatric encounters discussing functional issues. We conclude that resident continuity clinics are a source of geriatric education.

One-year outcomes of tension-free vaginal tape (TVT) mid-urethral slings in overweight and obese women.

INTRODUCTION: The purpose of this study was to assess the impact of body mass index (BMI) on tension-free vaginal tape (TVT) success rates, patient satisfaction, and complications 1 year following surgery. METHODS: Baseline and 1-year postsurgery outcomes were abstracted, including Urogenital Distress Inventory (UDI-6) scores, Incontinence Impact Questionnaire (IIQ-7) scores, and patient satisfaction ratings. Multivariable logistic and linear regression analyses were performed to examine relationships between outcomes and BMI. RESULTS: Subjects (N = 195) with a mean age of 59.3 +/- 12.6 were included. There was significant improvement within each group (all p values <0.01) in total UDI-6 and IIQ-7 scores from baseline to 1 year postsurgery; all groups had high patient satisfaction. No differences in improvement or complications rates were observed among the BMI cohorts (all p values >0.05). CONCLUSION: Differential counseling of overweight or obese women regarding outcomes of the TVT procedure is not supported by these results; longer follow-up is warranted.

Patient-centered treatment goals for pelvic floor disorders: association with quality-of-life and patient satisfaction.

OBJECTIVE: We sought to determine the relationship of patient-centered goal achievement in pelvic floor disorder (PFD) treatment to PFD-specific quality-of-life (QOL), depression, health status, and patient satisfaction. STUDY DESIGN: Ninety women with PFD identified up to 5 goals for treatment and reported their level of goal attainment (-2 to +2) at 1.5, 3, 6, and 12 months; completed the Incontinence Impact Questionnaire, Urogenital Distress Inventory, Incontinence Quality-of-Life Scale, Patient Health Questionnaire, and Short Form-12 Health Survey; and indicated their satisfaction with treatment. RESULTS: Twelve-month mean goal attainment was moderately correlated with PFD-specific measures of QOL (r range, -0.40 to 0.55; P < .05) but less strongly with depression and general health status (r range, -0.27 to 0.28). Twelve-month goal attainment differed significantly among those who were completely satisfied (1.6 +/- 0.5), very satisfied (1.2 +/- 0.6), satisfied (0.4-1.0), or not satisfied (-0.5 +/- 0.9; F = 24.2; P < .01). Earlier follow-up results were similar. CONCLUSION: PFD treatment goal attainment is associated with improved condition-specific QOL and patient satisfaction.