medRxiv - Obstetrics and Gynecology最新文献

{"title":"Customization and acceptability of the WHO Labor care guide to improve labor monitoring among health workers in Uganda. An Iterative Development Study","authors":"Godfrey R. Mugyenyi, Josaphat Byamugisha, Wilson Tumuhimbise, Esther C. Atukunda, Fajarldo Tones Yarine","doi":"10.1101/2024.01.07.24300952","DOIUrl":"https://doi.org/10.1101/2024.01.07.24300952","url":null,"abstract":"Background: Cognisant of the persistent maternal and perinatal mortality rates, the WHO has called for adoption and evaluation of new adaptable and context-specific health solutions to improve labor monitoring and health outcomes. We aimed at customizing and refining the new WHO labour care guide (LCG) to suite health care provider (HCP) needs in monitoring labour in Southwestern Uganda. Methods: We used an iterative approach to customize and refine the new WHO LCG. Between 1st July 2023 and 30th November 2023, we conducted; 1)30 stakeholder interviews to identify user needs and challenges, and inform the first LCG modifications; 2)10 HCP exit interviews to obtain feedback and modify LCG prototype one; 3)Two focus group discussions following use of prototype two to identify any further user needs; 4)Exit expert panel interviews involving HCPs to refine LCG components; 5)Pilot testing of final prototype among 40 HCPs; 6)Final panel reviews from two expert conferences, the National Safe Motherhood Conference, and Association of Obstetricians and Gynaecologists of Uganda to refine/consolidate modifications of final prototype for Uganda, ready for evaluation.\u0000Results: A total of 120 HCPs and MOH officials previously exposed to the new WHO LCG, with median age of 36 years (IQR;26-48) were interviewed. Over 53 modifications were made to tailor the WHO LCG into the modified LCG prototype for Uganda including; 1)Adjusting observation ordering to improve flow, clarity, and facilitate an easy user interface; 2)Inclusion of vital socio-demographic data compatible with existing programs in Uganda to prompt risk identification; 3)Modification of medications, baby-mother parameters/observations to suit local context; and 4)Inclusion of key cues to action, clinical notes and labour outcome data to facilitate auditing, accountability, reference, utilization and immediate postpartum care. All HCPs found the modified LCG useful, easy to use, appropriate, comprehensive, inclusive and would recommend it to others for use. Over 80% HCPs reported they took <2 minutes to plot/fill all observations on the LCG after assessment. Conclusions. Active involvement of targeted end-users in customizing the LCG was observed to improve inclusiveness, ownership, comprehensiveness, acceptability, engagement and uptake. The modified LCG prototype was found to be simple, appropriate and easy-to-use. Further research to evaluate this LCG prototype feasibility and effectiveness is needed.","PeriodicalId":501409,"journal":{"name":"medRxiv - Obstetrics and Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139411666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Probiotic effect of trichloroacetic acid on cervicovaginal microbiota in cervical intraepithelial neoplasia: A pilot study","authors":"Takeo Shibata, Ayumu Ohno, Isao Murakami, Masahiro Takakura, Toshiyuki Sasagawa, Tadashi Imanishi, Mikio Mikami","doi":"10.1101/2024.01.08.24301017","DOIUrl":"https://doi.org/10.1101/2024.01.08.24301017","url":null,"abstract":"Symbiosis of bacteria and human papillomavirus (HPV) in the cervicovaginal environment influences cervical intraepithelial neoplasia (CIN) progression or regression. In this case series, we enrolled all 10 patients who had resolved CIN after a cervical local treatment using trichloroacetic acid (TCA). Prominent changes in the cervicovaginal microbiota, such as an enrichment of the genus Bifidobacterium and genus Lactobacillus, were observed in seven of 10 patients. A decrease in cervicovaginal bacterial alpha diversity was observed in 4 patients with high-risk HPV clearance. Differential abundance analysis revealed that genus Bifidobacterium increased significantly after TCA. The dominance of a single bacteria can be characteristic of CIN cures after TCA. These results highlight the potential link of cervicovaginal bacteria such as genus Bifidobacterium and genus Lactobacillus in the clearance of CIN and high-risk HPV. This pilot study guides future research questions that specific cervicovaginal bacteria may be promising candidates for probiotic therapy to treat CIN and HPV infections.","PeriodicalId":501409,"journal":{"name":"medRxiv - Obstetrics and Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139412144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding diagnostic delay for endometriosis: a scoping review","authors":"Jodie Fryer, Amanda J. Mason-Jones, Amie Woodward","doi":"10.1101/2024.01.08.24300988","DOIUrl":"https://doi.org/10.1101/2024.01.08.24300988","url":null,"abstract":"Abstract\u0000Introduction\u0000Diagnostic delay for endometriosis is a well-established phenomenon. Despite this, little is known about where in the health care system these delays occur or why they occur. Our review is the first attempt to synthesise and analyse this evidence. Methods\u0000A systematic scoping review with a pre-specified protocol was used to incorporate the global mixed methods literature on diagnostic delay for endometriosis. Four databases (PubMed, MEDLINE, EMBASE, PsychINFO) were searched from inception to September 2023 with a search strategy designed specifically for each. Results\u0000The search yielded 367 studies, 22 of which met the inclusion criteria. A third of studies has been published since 2020 and 65% were from high income countries. Six were qualitative and 16 were quantitative studies. The average age of onset of endometriosis was 14 years for adolescents and 20 for adults. On average, the diagnostic delay reported for endometriosis across the included studies was 6.6 years (range 1.5 to 11.3 years) but this masked the very wide differences reported between countries such as a 0.5-year delay in Brazil to a 27-year delay in the UK. Discussion\u0000Health system barriers included access to private healthcare for those with limited finance, physical access for those using public health systems and a general lack of knowledge amongst patients and health care professionals. Women often reported feeling unheard by health professionals. Considering the impact on individuals and the health system, addressing diagnostic delay for endometriosis must remain a priority for researchers, health care providers and policy makers.","PeriodicalId":501409,"journal":{"name":"medRxiv - Obstetrics and Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139411646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Widely accessible prognostication using medical history for fetal growth restriction and small for gestational age in nationwide insured women","authors":"Herdiantri Sufriyana, Fariska Zata Amani, Aufar Zimamuz Zaman Al Hajiri, Yu-Wei Wu, Emily Chia-Yu Su","doi":"10.1101/2024.01.08.24300958","DOIUrl":"https://doi.org/10.1101/2024.01.08.24300958","url":null,"abstract":"Objectives: Prevention of fetal growth restriction/small for gestational age is adequate if screening is accurate. Ultrasound and biomarkers can achieve this goal; however, both are often inaccessible. This study aimed to develop, validate, and deploy a prognostic prediction model for screening fetal growth restriction/small for gestational age using only medical history. Methods: From a nationwide health insurance database (<em>n</em>=1,697,452), we retrospectively selected visits of 12-to-55-year-old females to 22,024 healthcare providers of primary, secondary, and tertiary care. This study used machine learning (including deep learning) to develop prediction models using 54 medical-history predictors. After evaluating model calibration, clinical utility, and explainability, we selected the best by discrimination ability. We also externally validated and compared the models with those from previous studies, which were rigorously selected by a systematic review of Pubmed, Scopus, and Web of Science. Results: We selected 169,746 subjects with 507,319 visits for predictive modeling. The best prediction model was a deep-insight visible neural network. It had an area under the receiver operating characteristics curve of 0.742 (95% confidence interval 0.734 to 0.750) and a sensitivity of 49.09% (95% confidence interval 47.60% to 50.58% using a threshold with 95% specificity). The model was competitive against the previous models in a systematic review of 30 eligible studies of 381 records, including those using either ultrasound or biomarker measurements. We deployed a web application to apply the model. Conclusions: Our model used only medical history to improve accessibility for fetal growth restriction/small for gestational age screening. However, future studies are warranted to evaluate if this model's usage impacts patient outcomes.","PeriodicalId":501409,"journal":{"name":"medRxiv - Obstetrics and Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139411827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors influencing referral to maternity models of care in Australian general practice","authors":"Jaime Thomas, Lesley Kuliukas, Jacqueline Frayne, Zoe Bradfield","doi":"10.1101/2023.12.16.23300085","DOIUrl":"https://doi.org/10.1101/2023.12.16.23300085","url":null,"abstract":"Background: In the Australian maternity system, general practitioners play a vital role in advising and directing prospective parents to maternity models of care. Optimising model of care discussions and the decision-making process avoids misaligning women with over or under specialised care, reduces the potential for disruptive care transitions and unnecessary healthcare costs, and is critical in ensuring consumer satisfaction. Current literature overwhelmingly focusses on women’s decision-making around model of care discussions and neglects the gatekeeping role of the General Practitioner (GP). This study aimed to explore and describe the factors influencing Australian GPs decision-making when referring pregnant women to maternity models of care.\u0000Methods: This study used a qualitative descriptive approach. General practitioners (N=12) with experience referring women to maternity models of care in Australia participated in a semi-structured interview. Interviews occurred between October and November 2021 by telephone or videoconference. Reflexive thematic analysis was facilitated by NVivo-12 data management software to codify and interpret themes from the data.\u0000Findings: Two broad themes were interpreted from the data. The first theme entitled ‘GP Factors’, incorporated three associated sub-themes including ‘GPs Previous Model of Care Experience’, ‘Gaps in GP Knowledge’ and ‘GP Perception of Models of Care’. The second theme, entitled ‘Woman’s Factors’, encapsulated two associated sub-themes including the ‘Woman’s Preferences’ and ‘Access to Models’.\u0000Conclusions: This study provides novel evidence regarding general practitioner perspectives of the factors influencing model of care decision-making and referral. The exploration and description of factors influencing model of care decisions provide unique insight into the ways that all stakeholders can experience access to a broader range of models of care including midwifery-led continuity of care models aligned with consumer-demand. In addition, the role of national primary health networks is outlined as a means to achieving this.","PeriodicalId":501409,"journal":{"name":"medRxiv - Obstetrics and Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138740994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transforming Healthcare Education: Harnessing Large Language Models for Frontline Health Worker Capacity Building using Retrieval-Augmented Generation","authors":"Yasmina Al Ghadban, Huiqi (Yvonne) Lu, Uday Adavi, Ankita Sharma, Sridevi Gara, Neelanjana Das, Bhaskar Kumar, Renu John, Praveen Devarsetty, Jane E. Hirst","doi":"10.1101/2023.12.15.23300009","DOIUrl":"https://doi.org/10.1101/2023.12.15.23300009","url":null,"abstract":"In recent years, large language models (LLMs) have emerged as a transformative force in several domains, including medical education and healthcare. This paper presents a case study on the practical application of using retrieval-augmented generation (RAG) based models for enhancing healthcare education in low- and middle-income countries. The model described in this paper, SMART<em>health</em> GPT, stems from the necessity for accessible and locally relevant medical information to aid community health workers in delivering high-quality maternal care. We describe the development process of the complete RAG pipeline, including the creation of a knowledge base of Indian pregnancy-related guidelines, knowledge embedding retrieval, parameter selection and optimization, and answer generation. This case study highlights the potential of LLMs in building frontline healthcare worker capacity and enhancing guideline-based health education; and offers insights for similar applications in resource-limited settings. It serves as a reference for machine learning scientists, educators, healthcare professionals, and policymakers aiming to harness the power of LLMs for substantial educational improvement.","PeriodicalId":501409,"journal":{"name":"medRxiv - Obstetrics and Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138823780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility of adjuvant self-administered intravaginal 5-fluorouracil cream following primary treatment of cervical intraepithelial neoplasia grade 2 or 3 among women living with HIV in Kenya: study protocol for a pilot trial","authors":"Chemtai Mungo, Elizabeth Bukusi, Grace E Kirkland, Cirillus Ogollah, Gershon Rota, Jackton Omoto, Lisa Rahangdale","doi":"10.1101/2023.12.13.23299916","DOIUrl":"https://doi.org/10.1101/2023.12.13.23299916","url":null,"abstract":"<strong>Background</strong> Women living with HIV (WLWH), the majority of whom live in low- and middle-income countries (LMICs), are at higher risk of cervical precancer, known as cervical intraepithelial neoplasia (CIN), and are up to six times more likely to get cervical cancer. Current CIN treatment methods, primarily ablation or excision, have high treatment failure rates among WLWH, up to 30% for CIN grade 2 or 3 (CIN2/3) at 24 months following ablation. Without strong follow-up many WLWH with treatment failure are at risk of developing invasive cervical cancer, highlighting the urgent need for improved CIN treatment methods. Prior studies in high-income countries (HICs) have demonstrated that 5-Fluorouracil (5-FU) cream, an antimetabolite drug that is easily accessible in LMICs, can be used intravaginally as adjuvant therapy following primary CIN2/3 treatment in WLWH to reduce CIN2/3 recurrence. While the safety, acceptability, and efficacy of self-administered 5-FU for cervical precancer treatment has been demonstrated in HICs, it has not been studied among WLWH in LMICs who bear the greatest burden of cervical cancer.","PeriodicalId":501409,"journal":{"name":"medRxiv - Obstetrics and Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138714433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expression of mechano-growth factor (MGF) in refractory overactive bladder","authors":"E Spiritosanto, B Lemmon, F Mohamedi-Yousufi, HA Munasinghe, A Mahmood, R Bray, R McNeice, FE Mackenzie, NJ Hill, E Cortes","doi":"10.1101/2023.12.08.23299594","DOIUrl":"https://doi.org/10.1101/2023.12.08.23299594","url":null,"abstract":"Overactive bladder (OAB) is a urological symptom complex defined by urinary urgency. It can have a devastating impact on an individual’s quality of life and leads to significant financial cost. Insulin-like growth factor 1 (IGF-1) is a protein hormone involved in a broad range of processes including cell proliferation and differentiation. IGF-1 is also regulated through alternative splicing. While the primary <em>IGF-1Ea</em> transcript is highly expressed in liver, the alternative <em>IGF-1Ec</em> transcript encodes the proteolytically-derived MGF peptide and has been primarily studied in skeletal muscle. MGF has been shown to stimulate satellite cell proliferation following tissue mechanical stretch or injury, but the role of MGF in smooth muscle, such as the detrusor muscle of the bladder, has been little explored. The aim of this study was to explore the expression of MGF in bladder biopsies from patients with OAB and age-matched controls.","PeriodicalId":501409,"journal":{"name":"medRxiv - Obstetrics and Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138572413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Exploration of the Mental Health impact among Menopausal Women: The MARIE Project Protocol (International Arm)","authors":"Gayathri Delanerolle, Heitor Cavalini, Julie Taylor, Sharron Hinchliff, Vikram Talaulikar, Zukiswa Zingela, Teck-Hock Toh, Xiu-Sing Wong, Kim-Yen Lee, Jeffrey Soon-Yit Lee, Sanghamitra Pati, Nirmala Rathnayake, Thamudi Sundarappeuma, Tharanga Mudalige, Lanka Dasanayake, Damayanthi Dasanayake, Vindya Pathiraja, Prasanna Herath, Om Kurmi, Ashish Shetty, Muhammed Irfan, Rabia Kareem, Helen Kemp, Subrata Kumar Palo, George Uchenna Eleje, Bellington Vwalika, Wenjing Zhao, Jian Qing Shi, Peter Phiri","doi":"10.1101/2023.11.26.23299012","DOIUrl":"https://doi.org/10.1101/2023.11.26.23299012","url":null,"abstract":"<strong>Introduction</strong> Menopause is characterised by the ending of the menstrual cycle as part of a natural process. However, menopause can also be caused by other health conditions, such as premature ovarian failure or cancers that may have led to an oophorectomy or a radical hysterectomy. The physiological and psychological mechanisms linked to menopause across all age groups, races and ethnicities are not well understood. The paucity of data could reduce the advancement of optimal clinical practice, leading to reduced quality of life for women. To better explore and assess menopause, we have designed the <strong>MenopAuse mental hEalth Rating (MARiE)</strong> tool.","PeriodicalId":501409,"journal":{"name":"medRxiv - Obstetrics and Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138521642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of High-grade Squamous Intraepithelial Lesion treatment failure","authors":"S. Botting-Provost, A. Koushik, H. Trottier, F. Coutlée, MH Mayrand","doi":"10.1101/2023.11.22.23298918","DOIUrl":"https://doi.org/10.1101/2023.11.22.23298918","url":null,"abstract":"<strong>Objective</strong> To estimate the association between several risk factors and high-grade squamous intraepithelial lesions (HSIL) treatment failure in order to identify predictors.","PeriodicalId":501409,"journal":{"name":"medRxiv - Obstetrics and Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138521643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}