Magee Womens Hospital

Pittsburgh, PA, United States

Magee Womens Hospital

Pittsburgh, PA, United States
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Rafferty E.A.,Massachusetts General Hospital | Park J.M.,University of Iowa | Philpotts L.E.,Yale University | Poplack S.P.,Dartmouth Hitchcock Medical Center | And 3 more authors.
Radiology | Year: 2013

Purpose: To compare radiologists' diagnostic accuracy and recall rates for breast tomosynthesis combined with digital mammography versus digital mammography alone. Materials and Methods: Institutional review board approval was obtained at each accruing institution. Participating women gave written informed consent. Mediolateral oblique and craniocaudal digital mammographic and tomosynthesis images of both breasts were obtained from 1192 subjects. Two enriched reader studies were performed to compare digital mammography with tomosynthesis against digital mammography alone. Study 1 comprised 312 cases (48 cancer cases) with images read by 12 radiologists; study 2, 312 cases (51 cancer cases) with 15 radiologists. Study 1 readers recorded only that an abnormality requiring recall was present; study 2 readers had additional training and recorded both lesion type and location. Diagnostic accuracy was compared with receiver operating characteristic analysis. Recall rates of noncancer cases, sensitivity, specificity, and positive and negative predictive values determined by analyzing Breast Imaging Reporting and Data System scores were compared for the two methods. Results: Diagnostic accuracy for combined tomosynthesis and digital mammography was superior to that of digital mammography alone. Average difference in area under the curve in study 1 was 7.2% (95% confidence interval [CI]: 3.7%, 10.8%; P < .001) and in study 2 was 6.8% (95% CI: 4.1%, 9.5%; P < .001). All 27 radiologists increased diagnostic accuracy with addition of tomosynthesis. Recall rates for noncancer cases for all readers significantly decreased with addition of tomosynthesis (range, 6%-67%; P < .001 for 25 readers, P < .03 for all readers). Increased sensitivity was largest for invasive cancers: 15% and 22% in studies 1 and 2 versus 3% for in situ cancers in both studies. Conclusion: Addition of tomosynthesis to digital mammography offers the dual benefit of significantly increased diagnostic accuracy and significantly reduced recall rates for noncancer cases. © RSNA, 2012.

Gernand A.D.,University of Pittsburgh | Simhan H.N.,Magee Womens Hospital | Simhan H.N.,University of Pittsburgh | Klebanoff M.A.,Ohio State University | Bodnar L.M.,University of Pittsburgh
Journal of Clinical Endocrinology and Metabolism | Year: 2013

Context: Inconsistent associations between maternal vitamin D status and fetal size have been published in small studies. Objective: Our objective was to examine the association between maternal 25-hydroxyvitamin D [25(OH)D] levels and measures of newborn and placental weight. Design and Setting: We measured maternal 25(OH)D in mothers from the Collaborative Perinatal Project, an observational cohort conducted in 12 U.S. medical centers from 1959 to 1965. Participants: Women delivering singleton, term, live births with 25(OH)D measured at a gestation of 26 wk or less (n = 2146). Main Outcome Measures: Birth weight, ponderal index, placental weight, the placental to fetal weight ratio, and small for gestational age were measured. Hypotheses were formulated after data collection. Results: After confounder adjustment, mothers with 25(OH)D of 37.5 nmol/liter or greater gave birth to newborns with 46 g [95% confidence interval (CI), 9-82 g] higher birth weights and 0.13 cm (0.01-0.25 cm) larger head circumferences compared with mothers with less than 37.5 nmol/liter. Birth weight and head circumference rose with increasing 25(OH)D up to 37.5 nmol/liter and then leveled off (P < 0.05). No association was observed between 25(OH)D and ponderal index, placental weight, or the placental to fetal weight ratio. Maternal 25(OH)D of 37.5 nmol/liter or greater vs. less than 37.5 nmol/liter in the first trimester was associated with half the risk of small for gestational age (adjusted odds ratio 0.5; 95% CI 0.3- 0.9), but no second-trimester association was observed. Conclusions: Maternal vitamin D status is independently associated with markers of physiological and pathological growth in term infants. Adequately powered randomized controlled trials are needed to test whether maternal vitamin D supplementation may improve fetal growth. Copyright © 2013 by The Endocrine Society.

Akers A.Y.,Magee Womens Hospital | Holland C.L.,Magee Womens Hospital | Bost J.,University of Pittsburgh
Pediatrics | Year: 2011

CONTEXT: The relative effectiveness of interventions to improve parental communication with adolescents about sex is not known. OBJECTIVE: To compare the effectiveness and methodologic quality of interventions for improving parental communication with adolescents about sex. METHODS: We searched 6 databases: OVID/Medline, PsychInfo, ERIC, Cochrane Review, Communication and Mass Media, and the Cumulative Index to Nursing and Allied Health Literature. We included studies published between 1980 and July 2010 in peer-reviewed English-language journals that targeted US parents of adolescents aged 11 to 18 years, used an experimental or quasi-experimental design, included a control group, and had a pretest/posttest design. We abstracted data on multiple communication outcomes defined by the integrative conceptual model (communication frequency, content, skills, intentions, self-efficacy, perceived environmental barriers/ facilitators, perceived social norms, attitudes, outcome expectations, knowledge, and beliefs). Methodologic quality was assessed using the 11-item methodologic quality score. RESULTS: Twelve studies met inclusion criteria. Compared with controls, parents who participated in these interventions experienced improvements in multiple communication domains including the frequency, quality, intentions, comfort, and self-efficacy for communicating. We noted no effects on parental attitudes toward communicating or the outcomes they expected to occur as a result of communicating. Four studies were of high quality, 7 were of medium quality, and 1 was of lower quality. CONCLUSIONS: Our review was limited by the lack of standardized measures for assessing parental communication. Still, interventions for improving parent-adolescent sex communication are well designed and have some targeted effects. Wider dissemination could augment efforts by schools, clinicians, and health educators. Copyright © 2011 by the American Academy of Pediatrics.

Milne M.E.,University of Pittsburgh | Yazer M.H.,University of Pittsburgh | Waters J.H.,Magee Womens Hospital
Obstetrics and Gynecology | Year: 2015

Objective: To describe which obstetric patients lose enough blood during postpartum hemorrhage to receive a reinfusion of intraoperative blood salvage. Methods: Eight years of intraoperative blood salvage data from a regional tertiary care maternity hospital were analyzed. The volume of blood returned through intraoperative blood salvage was standardized to the volume of red blood cells in an allogeneic red blood cell unit from the blood bank. Results: There were 884 obstetric hemorrhage cases in which intraoperative blood salvage was utilized. Sufficient blood was collected by intraoperative blood salvage to permit reinfusion in 189 of 884 (21%) patients. For patients in whom intraoperative blood salvage blood was reinfused, the mean±standard deviation number of reinfused shed blood units was 1.2±1.1 units. Although intraoperative blood salvage was most commonly performed on patients who underwent routine cesarean delivery (748/884 patients), only 13% of these patients received an intraoperative blood salvage reinfusion; 73% of the patients undergoing cesarean hysterectomy, 69% of those who had bleeding after cesarean delivery, and 53% of the patients who bled after vaginal delivery received an intraoperative blood salvage reinfusion (P<.001). Conclusion: Although intraoperative blood salvage was attempted on many patients, on only 21% of the women was a sufficient amount of intraoperative shed blood collected to proceed with reinfusion. Patients who experienced bleeding or who underwent a cesarean hysterectomy were the most likely to receive a reinfusion of intraoperative blood salvage-processed blood. © 2015 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.

Krajewski C.,Magee Womens Hospital | Sucato G.,University of Pittsburgh
Best Practice and Research: Clinical Obstetrics and Gynaecology | Year: 2014

Contraception, cervical cancer screening, human papillomavirus (HPV) vaccination, sexually transmitted infection (STI) screening, and menstrual disorders are issues that need to be addressed in all reproductive-aged women, including those with a history of solid organ transplantation. There are specific considerations that may alter routine care in this population. Due to teratogenic immunosuppressive medications, highly effective contraception is important to planning or appropriately timing pregnancy. Estrogen-containing methods (pill, patch, and ring) may be contraindicated. Immunosuppression is also a consideration when screening for and treating STIs including precancerous conditions of the cervix. This chapter will provide a framework to address the specific gynecologic needs of women with a history of solid organ transplantation. © 2014 Elsevier Ltd. All rights reserved.

Kos Z.,University of Ottawa | Dabbs D.J.,Magee Womens Hospital
Histopathology | Year: 2016

Current treatment of breast cancer incorporates clinical, pathological and molecular data. Oestrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) define prognosis and identify tumours for targeted therapy, and remain the sole established single-molecule biomarkers defining the minimum breast cancer pathology data set. Ki67 remains one of the most promising yet controversial biomarkers in breast cancer, implemented routinely in some, but not all, pathology departments. Beyond the single-molecule biomarkers, a host of multigene expression tests have been developed to interrogate the driver pathways and biology of individual breast cancers to predict clinical outcome more accurately. A minority of these assays have entered into clinical practice. This review focuses on the established biomarkers of ER, PR and HER2, the controversial but clinically implemented biomarker Ki67 and the currently marketed gene expression signatures. © 2016 John Wiley & Sons Ltd.

Objective: To estimate whether 6-month use of the levonorgestrel-releasing intrauterine device (IUD) would be higher when insertion occurred within 10 minutes of placental delivery compared with 6-8 weeks postpartum. Methods: We enrolled pregnant women planning vaginal deliveries and desiring a postpartum levonorgestrel-releasing IUD. Patients were randomly assigned when admitted in labor to postplacental or delayed IUD insertion. The women followed up in person at 6-8 weeks and 6 months and were contacted by telephone at 3 months. Women were ineligible for a study IUD postenrollment for intrapartum events including infection, hemorrhage, and cesarean delivery; these women were contacted by phone at 3 and 6 months. Expelled IUDs were replaced per patient preference. Results: Successful IUD placement occurred in 50 of 51 participants (98.0%) and 46 of 51 participants (90.2%) in the postplacental and delayed groups, respectively (P=.2). Expulsion within 6 months occurred in 12 of 50 (24.0%; 95% confidence interval [CI], 13.1-38.2) and two of 46 (4.4%; 95% CI 0.5-14.8) participants, respectively (P=.008). Intrauterine device use at 6 months was 43 of 51 (84.3%; 95% CI 71.4-93.0) and 39 of 51 (76.5%; 95% CI 62.5-87.2), respectively (P=.32). For ineligible patients, only 11 of 41 (26.8%) women were using IUDs at 6 months and two (4.9%) had become pregnant. Conclusion: Intrauterine device use 6 months after delivery is similar in women who have postpartum or scheduled delayed IUD placement through a study after replacement of expelled IUDs. Expulsions are significantly higher with postplacental compared with delayed IUD placement. Women asked to follow up with their own health care providers for delayed insertion are significantly less likely to receive an IUD. © 2010 by The American College of Obstetricians and Gynecologists.

Kalan A.M.,Magee Womens Hospital | Simhan H.N.,Magee Womens Hospital
American Journal of Obstetrics and Gynecology | Year: 2010

Objective: The purpose of this study was to explore the relation between the relative balance of pro- and antiinflammatory cytokines in cervical fluid and mid-trimester cervical length. Study Design: In this prospective longitudinal cohort of women with a previous spontaneous preterm birth, mid-trimester cervical length ultrasound scans and cervical fluid levels were obtained serially. Multiple pro- and antiinflammatory cytokines were selected. We summed the multiples of the median for proinflammatory cytokines to generate the proinflammatory and the antiinflammatory scores. The relation between cervical length and pro-/antiinflammatory ratio was assessed by generalized estimating equations. Results: The pro-/antiinflammatory ratio had a negative linear association with cervical length (β = -0.09; P < .001). Sixty percent of visits demonstrated greater concentrations of proinflammatory cytokines relative to antiinflammatory cytokines. This relationship did not change between first and last visits. Conclusion: Among women with a previous preterm birth, shorter mid-trimester cervical length is associated with a more proinflammatory balance of cytokines in the cervical inflammatory milieu. © 2010 Mosby, Inc.

Hamlin B.R.,Magee Womens Hospital
Orthopedic Clinics of North America | Year: 2011

The purpose of this article is to present the challenges of dealing with the morbidly obese patient suffering from degenerative knee arthrosis. Surgery should only be undertaken when conservative management has failed and comorbidities optimized. Owing to risks related to comorbidities, diligence is necessary before proceeding with surgery to lessen the chance of complications-especially infection. Evaluation, conservative treatments, preoperative optimization, and surgical options are discussed. © 2011 Elsevier Inc.

Wikiel K.J.,Magee Womens Hospital | McCloskey C.A.,Magee Womens Hospital | Ramanathan R.C.,Magee Womens Hospital
Surgery for Obesity and Related Diseases | Year: 2014

Background Obesity and obesity-related co-morbidities, including advanced heart failure, are epidemic. Some of these patients will progress to require cardiac allografts as the only means of long-term survival. Unfortunately, without adequate weight loss, they may never be deemed acceptable transplant candidates. Often surgical weight loss may be the only effective and durable option for these complex patients. The objective of this study was to assess whether bariatric surgery is feasible and safe in patients with severe heart failure, which in turn, after adequate weight loss, would allow these patients to be listed for a heart transplant. Methods Four patients who underwent bariatric procedures, such as laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (SG), for the purpose of attaining adequate weight loss with the goal to improve their eligibility for orthotopic heart transplants are presented. Results All patients did well around the time of surgery, and 3 of the 4 progressed to receiving a heart transplant. The fourth patient will be listed pending attaining adequate weight loss. Conclusion Bariatric surgery may be an important bridge to transplantation for morbidly obese patients with severe heart failure. With the appropriate infrastructure, bariatric surgery is a feasible and effective weight loss method in this population. © 2014 American Society for Bariatric Surgery.

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