Short-term costs and cost-efficiency of HPV triage strategies in a high HIV-prevalence setting: Evidence from Botswana.

Cervical cancer remains the leading cause of cancer death among women in sub-Saharan Africa and is more severe in high HIV-burdened countries due to persistent high-risk human papillomavirus (hrHPV). In 2021, the World Health Organization recommended primary hrHPV testing for cervical cancer screening; however, optimal triage strategies following positive hrHPV tests remain unclear. We conducted a prospective cost analysis of triage methods for positive hrHPV results among women living with and without HIV in Gaborone, Botswana.

Adverse Maternal Outcomes Among People With Human Immunodeficiency Virus (HIV) Using Antiretroviral Therapy in Botswana.

Objective: This study aimed to evaluate maternal outcomes in a large cohort with high prevalence of human immunodeficiency virus (HIV) infection in Botswana after implementation of a treat-all policy.

Methods: In this retrospective cohort study, data were collected from the medical record at the time of discharge from November 2021 to December 2023. Outcomes were recorded in the Tsepamo Birth Outcomes Surveillance and Safe Birth studies at Princess Marina Hospital in Botswana.

Engaging Patients in Organ Transplant Listing Meetings: A Survey Study.

Organ transplant listing decisions are made by multidisciplinary selection committees using structured, deliberative processes to evaluate candidate eligibility. Engaging patients in these meetings has been proposed as a strategy to enhance transparency, trust, and patient-centered care. This study assessed patient and professional perspectives via an online survey of 1,349 American Society of Transplantation (AST) and National Kidney Foundation (NKF) members (907 patients, caregivers, family; 442 transplant team members).

Communicating uncertainty with perinatal counseling: a randomized controlled trial of a multimodal curriculum for obstetrical trainees.

Background: Effective communication of uncertain prognoses is a critical skill in obstetrics. Yet few curricula exist to prepare graduate medical education trainees for these high-stakes conversations.

Objective: To design and evaluate a multimodal curriculum for improving obstetric trainees' communication skills when conveying uncertain prognoses.

Association between ABO blood groups and pancreatic cancer outcomes: A systematic review and meta-analysis.

Background/objectives: Although some studies report an increased overall survival for patients with pancreatic cancer and blood type O, others show no significant association. Therefore, we sought to perform a systematic review and meta-analysis to evaluate the association between ABO blood groups and the outcomes of patients with pancreatic cancer.

Methods: A systematic review of the literature was conducted using the PubMed/Medline, Cochrane Library, and Embase databases in April 2024.

Postpartum Hemorrhage in Patients With a Low-Lying Placenta: A Systematic Review and Meta-analysis.

Objective: We hypothesized that a second- or third-trimester diagnosis of low-lying placenta imparts underappreciated risk for postpartum hemorrhage (PPH) and placenta accreta spectrum (PAS). To quantify this risk and to assess whether it varies by the specific distance of the placenta from the cervical os and low-lying placenta resolution status, we conducted a systematic review and meta-analysis.

Data Sources: Systematic searches were conducted in PubMed, ClinicalTrials.

Non-English Language Preference and Breast Cancer Outcomes.

Importance: Non-English language preference (NELP) poses a challenge in health care delivery and may contribute to disparate outcomes. Understanding the impact of NELP can provide insight for health care professionals, policymakers, and advocates aiming to enhance care quality for diverse populations.

Objective: To investigate the association of NELP with breast cancer-related outcomes.

Improved cervical screening using HPV type restriction and cycle threshold limit setting with the AmpFire assay: A prospective screening cohort of women with and without HIV in Botswana.

Objective: The aim of this study was to evaluate the performance of HPV type restriction and cycle threshold (Ct)-limit setting to optimize detection of cervical intraepithelial neoplasia (CIN) with primary HPV testing.

Methods: Baseline cervical screening at time of entry into a prospective longitudinal cohort of women with and without HIV was conducted from February 2021 to July 2022 in Botswana. All women underwent HPV testing of 15 individual types using the AmpFire assay; all HPV-positive and a random subset of HPV negative had histopathology collected.

Cervical dysplasia in women with HIV in the modern treat-all era: elevated risk remains despite long-term ART and normal CD4 + cell count.

Objective: To evaluate the impact of antiretroviral therapy (ART) duration and CD4 + cell count on risk for high grade cervical dysplasia in women with HIV (WWH) compared to women without HIV in the treat-all era with integrase strand inhibitors (INSTIs).

Design: A prospective longitudinal cohort study in Botswana.

Methods: From February 2021 to July 2022, baseline HPV self-sampling was offered to women with and without HIV.

A novel approach for inferring effects on pregnancy loss.

Identifying the determinants of pregnancy loss is a critical public health concern. However, pregnancy loss is often not noticed, and even when it is, it is inconsistently recorded. Thus, past studies have been limited to medically-identified losses or small, highly selected cohorts, which can lead to biased or non-generalizable results.

Machine Perfusion Technology Drives a Major Growth Surge in Liver Transplantation.

Introduction: Machine perfusion (MP) opens the possibility to overcome the existing disbalance between supply and demand in liver transplantation. However, it has not been widely adopted across the country. We explored trends of MP adoption in the United States and their effect on center volume (CV).

Using Parametric g-Computation for Time-to-Event Data and Distributed Lag Models to Identify Critical Exposure Windows for Preterm Birth: An Illustrative Example Using in a Retrospective Birth Cohort Based in Eastern Massachusetts (2011-2016).

Background: Parametric g-computation is an attractive analytic framework to study the health effects of air pollution. Yet, the ability to explore biologically relevant exposure windows within this framework is underdeveloped.

Objectives: We outline a novel framework for how to incorporate complex lag-responses using distributed lag models (DLMs) into parametric g-computation analyses for survival data.

A Randomized Controlled Trial of Consent for Patients Undergoing Transobturator Slings.

Importance: Improving patients' recall and understanding of their planned surgery is essential for fully informed consent.

Objective: The objective of this study was to assess if the addition of an information handout to the standard preoperative consent process for the transobturator midurethral sling procedure improved patient understanding, recall, and satisfaction.

Study Design: This is a randomized controlled trial of adult women undergoing a transobturator midurethral sling procedure for the treatment of stress urinary incontinence.

Cerclage Plus Adjuvant Vaginal Progesterone for Preterm Birth Prevention in Patients with a Short or Dilated Cervix without Prior Preterm Birth.

Objective:  The primary objective was to determine if vaginal progesterone following cerclage for cervical length <10 mm or cervical dilation in patients without a history of spontaneous preterm birth (sPTB) decreased the risk of preterm birth at <34 weeks' gestation compared with cerclage alone. Secondary objectives were to determine if vaginal progesterone following cerclage (1) decreased the risk of preterm birth at <24, <28, and <37 weeks' gestation and (2) increased the latency period from cerclage placement to delivery compared with treatment with cerclage alone.

Study Design:  Multicenter retrospective cohort study from 2015 to 2020 of singleton pregnancies, without prior sPTB, who had cerclage placement <24 weeks' gestation for cervical length <10 mm or cervical dilation.

Hiding in Plain Sight: Resident Remediation in Obstetrics and Gynecology.

Objective: Residents who are in need of remediation are prevalent across residency programs and often tend to be deficient in multiple competencies that the American Council for Graduate Medical Education (ACGME) has established. The purpose of this study was to determine the prevalence of residents requiring remediation, understand the scope of the challenges in resident remediation, and assess what resources were used to aid in remediation in obstetrics and gynecology programs.

Design: An anonymous survey was emailed to obstetrics and gynecology program directors.

Liver machine perfusion technology: Expanding the donor pool to improve access to liver transplantation.

The imbalance between organ supply and demand continues to limit the broader benefits of organ transplantation. Machine perfusion (MP) may increase the supply of donor livers by expanding the use of extended-criteria donors. Using the United Network for Organ Sharing/Organ Procurement and Transplantation Network and the Standard Transplant Analysis and Research dataset, we reviewed the effect of MP implementation on the behavior of transplant centers.

Risk Profiling In Vitro Fertilization Pregnancies that Develop Placenta Accreta Spectrum.

Objective:  The objective of this study is to assess whether, among a cohort of placenta accreta spectrum (PAS) patients, antenatal suspicion of PAS was less likely in in vitro fertilization (IVF) compared with non-IVF patients. In addition, we aimed to assess whether IVF patients exhibited similar risk factors for PAS compared with non-IVF patients.

Study Design:  This is an international multicenter retrospective study of patients with pathologically confirmed PAS (accreta, increta, percreta) between 1998 and 2021.

Association between gestational exposure to solar activity and pregnancy loss using live births from a Massachusetts-based medical center.

Background: Solar activity has been linked to biological mechanisms important to pregnancy, including folate and melatonin levels and inflammatory markers. Thus, we aimed to investigate the association between gestational solar activity and pregnancy loss.

Methods: Our study included 71,963 singleton births conceived in 2002-2016 and delivered at an academic medical center in Eastern Massachusetts.

Novel interactive text-messaging curriculum for endocrinology board review.

Background: The ABIM certification exam is one of the measures to ensure that physicians have the clinical skills for good care delivery. The 5-year average pass rate for ABIM Endocrinology exam is 82%. The pass rate significantly decreased to a nadir of 74% in 2021 and 2022, lowest of all medicine subspecialties.

Basal Plate Myofibers and the Risk of Placenta Accreta Spectrum in the Subsequent Pregnancy: A Large Single-Center Cohort.

Objective: We aimed to evaluate whether there is a significant association between a placental pathology diagnosis basal plate myofibers (BPMF) in an index pregnancy with placenta accreta spectrum (PAS) in the subsequent pregnancy.

Study Design: We conducted a retrospective nested cohort study of all cases with a histopathological finding of BPMF between August 2012 and March 2020 at a single tertiary referral center. Data were collected for all subjects (cases and controls) with at least two consecutive pregnancies (the initial index pregnancy and at least one subsequent pregnancy) accompanied by a concomitant record of histopathological study of the placenta at our center.