Gynecology Medical News

A paper published online by the journal Circulation concluded that, while men and women have a similar in-hospital death rate following acute myocardial infarction, women with STEMI had an adjusted mortality rate almost twice as high as men (10.2% versus 5.5%). These differences were associated with a lower likelihood of reperfusion therapy in women. The paper was widely reported in the press, with suggestions of disparity in care and outcome after AMI.

This study is one of many undertaken in the past 20 years on gender differences in the management of acute coronary events. Many, like this latest study, have found that women are treated less intensively in the acute phase. However, after adjustment for age, co-morbidity and severity of disease, some of these disparities have been found to disappear. Similarly, many studies have found gender differences in short-term survival rates after AMI, but such differences have not always persisted in the long term.

In Europe results from a Swedish cohort study of 53,781 subjects (of whom 37 per cent were women) also showed that overall women were less intensively treated than men, but, in cases of non-STEMI, had a better long-term prognosis than men.

Commenting for the ESC on the STEMI results in the Circulation paper, Professor Eva Swahn (University Hospital, Link?¶ping, Sweden), who has conducted gender studies in acute coronary syndrome patients, said: “We are not surprised. We found similar results in our Swedish cohort study.”

Although the incidence of AMI is low in both sexes, especially in premenopausal women, the view persists – mistakenly – that women don’t have the same coronary symptoms as men. “This is a myth,” says Professor Swahn. “The classical symptoms of AMI are the same for women as for men.” However, this mistaken belief may explain why reperfusion therapy is not started as quickly in women as in men – because women interpret their symptoms differently from men and may not summon help soon enough.

While there are some recurring patterns in the studies – less intensive treatment in women, lower survival rates in female STEMI patients – much of the explanation for the disparities remains unknown. Definite answers about medication, invasive or non-invasive treatment, and survival will only be derived from studies powered to draw significant conclusions in both men and women in the same prospective cohort. And the optimal treatment recommendations for men and women respectively will only be resolved by inclusion of sufficient numbers of both women and men in future clinical trials.

Source: ESC Press Office

European Society of Cardiology Continue reading →

Attorneys for Kansas abortion provider George Tiller on Friday in Sedgwick County District Court entered a not guilty plea to 19 misdemeanor charges filed by Attorney General Paul Morrison (D) alleging Tiller violated a Kansas law that requires an independent, consulting physician to approve some late-term abortions, the AP/Forbes reports (Hegeman, AP/Forbes, 8/3). Lee Thompson, one of Tiller’s attorneys, in a statement said, “The law permits first appearance in misdemeanor cases to be made by counsel, and that has been done,” adding, “A plea of not guilty has been entered” (Kansas City Star, 8/3).

Former state Attorney General Phill Kline (R) in 2004 subpoenaed the records of 90 women and girls who in 2003 underwent late-term abortions at Comprehensive Health in Overland Park, Kan., and Women’s Health Care Services in Wichita, Kan., which is owned by Tiller. Kline charged Tiller with 30 misdemeanors for allegedly performing 15 illegal late-term abortions in 2003 on women and girls ages 10 to 22 without properly reporting the details to the state. Kline hired attorney Don McKinney as special prosecutor in the case. Morrison — who defeated Kline in the November 2006 election — fired McKinney in January, and Morrison spokesperson Ashley Anstaett earlier this year said that 15 of the 30 charges Kline filed against Tiller were based on incomplete and substandard information.

However, Morrison in June filed charges alleging that before performing 19 late-term abortions in 2003, Tiller received a second opinion from physician Ann Kristin Neuhaus, who Morrison said had financial ties with Tiller. A 1998 Kansas law says that before an abortion of a fetus of 21 weeks’ gestation or more, two physicians must determine if continuation of a pregnancy will lead to death or “substantial and irreversible” harm to a “major bodily function.” The consulting physician agreeing on the necessity of a late-term abortion cannot have legal or financial ties to the abortion provider.

Tillers’ attorneys filed a motion last month to dismiss the charges. In the motion, his attorneys argued that the provision of the law requiring two or more doctors to sign off on late-term abortions is unconstitutional. The motion filed by Tiller’s attorneys stated that the requirement is unconstitutional because it is vague, it violates a woman’s right to obtain an abortion as outlined in previous court decisions and it places an undue burden on a physician’s right to practice medicine. “There is absolutely no guidance in the state as to what activities constitute legal or financial affiliation — or how a physician might avoid some prosecutor making such a filing,” the attorneys wrote. The attorneys also argued a provision in the law requiring the second opinion to come from a doctor licensed in Kansas increases possible dangerous delays and could illegally infringe on a woman’s right to travel between states for medical treatment (Kaiser Daily Women’s Health Policy Report, 7/3).

Tiller on Friday turned himself in to the Sedgwick County Sheriff’s Office for processing on misdemeanor charges and was released on his own recognizance, the Star reports. Tiller’s first court appearance was scheduled for Tuesday, but the unannounced move permitted his attorneys to enter a not guilty plea on all counts on Tiller’s behalf, the Star reports. Thompson said the next hearing, which is scheduled for August 10, will examine Tiller’s motion to dismiss the charges. Tiller’s clinic closed this week. His attorneys Dan Monnat and Thompson said the closure is because of “increased protests and acts of vandalism” (Kansas City Star, 8/3). If convicted, Tiller could face up to one year in jail and a $2,500 fine for each charge. The Kansas State Board of Healing Arts also could consider revoking Tiller’s license to practice if he is convicted (Kaiser Daily Women’s Health Policy Report, 7/3).

Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation. © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved. Continue reading →

The fifth annual international conference of the African Science Academy Development Initiative (ASADI) will be held Nov. 9-11 in Accra, Ghana, in conjunction with the 50th anniversary of the Ghana Academy of Arts and Sciences. The theme of this year’s conference will be improving maternal, newborn, and child health in Africa, which will be discussed by top experts from around the world. ASADI V will kick off with the release of Science in Action: Saving the Lives of Africa’s Mothers, Newborns, and Children, a new report by several African science academies, assessing the effectiveness of interventions aimed at reducing maternal and childhood mortality — the focus of U.N. Millennium Development Goals Four and Five — in sub-Saharan Africa. The report will include estimates of lives that could be saved if proven scientific methods reached more parts of Africa.

Details:


The conference will be held in the Adae Kese Conference Room of the La Palm Royal Beach Hotel, Accra, Ghana. The opening ceremony takes place on Monday, Nov. 9, at 6 p.m. It will be preceded that afternoon by a press conference to release the Science in Action report (time to be determined). On Tuesday, Nov. 10, the conference runs from 8 a.m. to 6 p.m., and on Wednesday, Nov. 11, from 9 a.m. to 4:15 p.m. More information, including a draft agenda, is available at national-academies/asadi. ASADI is a collaboration among several African science academies and the U.S. National Academies to strengthen the capacity of the African academies to inform policy and public discourse through independent, evidence-based advice.

Source:
William Kearney

National Academy of Sciences Continue reading →

In an effort to curb the rising rates of HIV and sexually transmitted infections (STIs) along the Mexico-US border, a binational team of researchers led by the University of California, San Diego School of Medicine have shown that brief but personalized behavioral counseling significantly reduced rates and improved condom use among female sex workers in Tijuana and Ciudad Juarez, Mexico.

The researchers observed a 40 percent decline in the combined rate of new STIs (including HIV, syphilis, gonorrhea and Chlamydia) in the group of female sex workers who received the 30-minute one-on-one counseling intervention, compared to an encounter that was based on educational information only. The study, headed by Thomas L. Patterson, Ph.D., professor of psychiatry at UC San Diego School of Medicine, in collaboration with researchers from across Mexico, at UC Davis and Northeastern University, will be published on line September 17 in advance of the November edition of the American Journal of Public Health.

“An advantage to the counseling approach is that – instead of simply listening to a lecture – women are taught and can practice skills that are tailored to their personal situations,” Patterson said. “By working with the counselor, women identify for themselves the barriers to safer sex and discuss potential solutions as part of their goal setting.”

The study looked at 924 female sex workers aged 18 years or older, without known HIV infection, living in Tijuana and Ciudad Juarez – approximately equal numbers in both cities – who had recently had unprotected sex with clients. Half of the women took part in the Mujer Segura (Healthy Woman) counseling session with specially trained, local health care staff. The others participated in a face-to-face informational session, with prevention materials drawn from the U.S. Centers for Disease Control and Prevention guidelines for HIV counseling, testing and referral and from Mexico’s National Center for AIDS Studies.

“The major difference in the two approaches is that the Mujer Segura sessions focused on the participants assessing their personal risk factors, such as having unprotected sex with clients, and developing strategies for reducing that risk,” said Patterson.

Counselors helped the participants identify and understand behaviors and circumstances that put them at risk for contracting HIV or other STIs. They also provided positive reinforcement, helping the women to set small and achievable goals and providing motivational techniques and role-playing to reinforce ways of practicing safe sex.

Individuals in the intervention group reported significant improvements in their risk behaviors. In particular, not a single incidence of HIV infection occurred in the intervention group.

“In the absence of an effective HIV vaccine in the near future, the urgent need continues for effective, culturally appropriate interventions that can be used as stand-alone programs, or to support existing approaches,” Patterson said. “Our brief intervention, which counselors can be easily trained to deliver in a variety of settings, is an inexpensive and effect approach to reducing the risk of HIV and other STIs.”

Studies show that current rates of HIV infection (at six percent of FSWs in Tijuana and Ciudad Juarez) and active cases of STIs (at 25 percent, with one out of four women having at least one of the following: gonorrhea, chlamydia, syphilis or HIV) are increasing at a rate of two percent per year.

“These are diseases that recognize no borders, and it is critical that we work alongside health providers in Mexico to stem this disturbing trend,” Patterson said.

Additional contributors include Brent Mausbach, Shirley J. Semple, Prisci Orozovich, Daniela Abramovitz, and Steffanie A. Strathdee, UC San Diego; Remedios Lozada, Patronato Pro-COMUSIDA, Tijuana, Mexico; Hugo Staines-Orozco, Autonomous University of Ciudad Juarez, Mexico; Miguel Fraga-Vallejo, Autonomous University of Baja California, Tijuana, Mexico; Adela de la Torre, UC Davis; Hortensia Amaro, Institute on Urban Health Research and the Bouv?© College of Health Sciences, Northeastern University, Boston;. Gustavo Martinez, Medical Units of Health and Community Development of Ciudad Juarez, Mexico; and Carlos Magis-Rodriguez, National Center for the Prevention and Control of HIV and AIDS, Mexico City, Mexico.

The study was funded by the National Institute of Mental Health.

Source: Debra Kain

University of California – San Diego Continue reading →

Health Canada is advising women who are taking antidepressants known as Selective Serotonin Re-uptake Inhibitors (SSRI) and who are pregnant or intend to become pregnant to discuss the situation with their doctor due to potential risks to the baby.

Health Canada stresses that patients should not stop taking SSRI medication without first consulting their doctors, as they could experience serious side effects.

Generally, SSRI treatment should only be continued if the benefits to the individual patient are thought to outweigh the risks to the unborn child, while also considering the benefits and risks of switching to another treatment option or stopping treatment altogether. These precautions and the possibility of adverse health effects in newborns are mentioned in the current Canadian prescribing information and consumer information for SSRIs.

SSRIs and other newer antidepressants prescribed for the treatment of depression include the following drugs: Wellbutrin (bupropion), Celexa (citalopram), Cipralex (escitalopram), Prozac (fluoxetine), Luvox (fluvoxamine), Remeron (mirtazapine), Paxil (paroxetine), Zoloft (sertraline) and Effexor (venlafaxine), and Zyban (bupropion) for smoking cessation.

A study published recently in the New England Journal of Medicine suggests that use of SSRIs during the second half of pregnancy may be associated with a condition called persistent pulmonary hypertension of the newborn. Newborns with this rare but life-threatening condition do not receive enough oxygen in the blood and require intensive-care treatment to survive. According to the study, babies born with this condition were six times more likely than healthy babies to have been exposed to SSRIs. This information is considered to be preliminary at this time.

Numerous reports in Canada and abroad have already indicated that some children exposed to SSRIs and other newer antidepressants during pregnancy may develop serious complications at birth. An increase in the overall risk of major birth defects has also been associated with SSRI use.

The safety of these drugs is vigilantly monitored and Canadians will continue to be informed if new concerns arise. Health Canada advisories on other SSRI-related complications in newborns are available on the Health Canada website (see August 9, 2004, October 6, 2005 and December 22, 2005).

Managing the adverse reactions of marketed health products depends on the active participation of both healthcare professionals and consumers in reporting these reactions. The spontaneous reporting of adverse reactions generally underestimates the risks associated with the use of marketed health products.

To report a suspected adverse reaction to SSRIs or other newer antidepressants, please contact the Canadian Adverse Drug Reaction Monitoring Program (CADRMP) of Health Canada by one of the following methods:

Telephone: (Canada) 866-234-2345
Facsimile: (Canada) 866-678-6789

CADRMP
Marketed Health Products Directorate
Health Protection Building, Tunney’s Pasture, AL 0701C, Canada

HEALTH CANADA

View drug information on Celexa; Effexor; LUVOX. Continue reading →

The American Medical Association (AMA), the nation’s largest physician group, voted at its Annual Meeting to adopt the following new policy.

According to the National Cancer Institute, minority women have a significantly higher cancer mortality rate than Caucasian women. In an effort to combat this troubling fact, the AMA adopted new policy urging more research and funding to address the racial and ethnic disparities in cancer screening, diagnosis, and treatment among minority women.

“There continues to be great disparities in the detection and treatment of cancer among minority women,” said AMA Board Member Samantha Rosman, M.D. “Physicians must work to promote cancer education to their minority patients in a way that is understandable and culturally sensitive.”

American Medical Association
ama-assn Continue reading →

Two research
studies published today in The New England Journal of Medicine found taking
SSRIs (selective serotonin reuptake inhibitors), anti-depression drugs,
during pregnancy did not significantly increase the overall risk for most
birth defects. However, each study found that taking SSRIs during pregnancy
was associated with a small increase in the risk of certain rare birth
defects — but they were different birth defects.

Dr. Michael Katz, acting Medical Director of the March of Dimes, said
the studies show how important post-market surveillance is in assessing the
safety of medications in pregnancy. During pre-approval, drugs are tested
on relatively few subjects and only side effects with a large frequency are
detected. Once approved, many people take the medication and even very rare
side effects surface.

“Most prescription drugs are not tested on pregnant women,” said Dr.
Katz. “So we must start monitoring the effects of these medications as soon
as they reach consumers, and keep monitoring for as long as it takes to get
good data on risks to mothers and babies.”

The March of Dimes recommends women discuss the potential risks and
benefits of taking SSRIs during pregnancy with their doctors. Women who are
taking an antidepressant should not stop taking their medications if they
discover they are pregnant, but should immediately contact their health
care provider. It may be dangerous to stop taking an antidepressant
suddenly.

About 10 percent of pregnant women in the United States suffer from
depression, some of it undiagnosed.

Previous studies have found that some SSRIs may increase the risk for
other problems for babies, including:

— Withdrawal symptoms in newborns;

— Pulmonary hypertension of the newborn (PPHN), a rare, but serious heart
and lung disorder;

— Low birthweight or preterm delivery.

One study was led by researchers at the University of British Columbia
and the National Center on Birth Defects and Developmental Disabilities and
the other by researchers at Boston University’s Slone Epidemiology Center.

The March of Dimes works to improve the health of babies by preventing
birth defects, premature birth and infant mortality.

March of Dimes
marchofdimes Continue reading →

Cases of cervical cancer will be reduced by up to 70 per cent with
the introduction of a new vaccine into the national immunisation
programme.

The Department of Health has agreed, in principle, to accept JCVI
advice that HPV vaccines should be introduced routinely for girls
aged around 12-13 years, subject to independent peer review of the
cost benefit analysis.
Funding for this will be considered in the context of the
Comprehensive Spending Review.

Human Papilloma Viruses cause 99 per cent of invasive cervical
cancer. The vaccine protects against the viruses responsible for
about 70% of cases.

Routine vaccination of girls could start as early as autumn 2008.
Details of the programme will be finalised over the next few months,
following further advice from JCVI and discussions with the NHS on
the implementation of the programme.

Public Health Minister Caroline Flint said:

“Cervical cancer is the second most common cancer of women worldwide.
In the UK alone, the lifetime risk of developing cervical cancer is
one in 116.

“It is great news that vaccines have been developed that protect
women against this form of cancer and I am delighted to announce that
we intend, in principle, to introduce an HPV vaccine into the
national immunisation programme.

“The benefits of introducing this vaccine will be felt by women and
their families for generations to come. In England, 2221 new cases of
invasive cervical cancer were diagnosed in 2004 alone. In addition
around 200,000 women in England are identified through the cervical
screening programme (smear tests) as having a pre-cancerous change.

“This vaccine will prevent many women from catching the HPV virus in
the first place, potentially saving hundreds of lives.

“A significant amount of planning is required before we can introduce
the immunisation into our programme. We are still working on the
details and logistics, and will work closely with the NHS to ensure
the vaccination can be delivered effectively. However, we are hoping
that girls will start being vaccinated from as early as 2008.”

The highly successful and comprehensive cervical screening programme
(smear tests) will continue after an HPV vaccine has been introduced.
This is because of the gap between the age of vaccination and age of
first screening. Also, screening will be required as the vaccine
does not protect against all HPV types that may cause cervical
cancer.

1. The Joint Committee for Vaccination and Immunisation (JCVI) has
advised that HPV vaccines are clearly beneficial. It has commissioned
a cost-effectiveness analysis which will be the subject of an
external peer review. The JCVI is expected to make their formal
recommendation to the Government at their next meeting on 17 October
2007.

2. The JCVI provides the Department of Health with independent
expert advice on all vaccine issues.

3. Human papilloma virus is a sexually transmitted virus that causes
99 per cent of invasive cervical cancer.

4. To ensure maximum benefit and protection from this vaccine, it
would be necessary to administer it before the onset of sexual
activity.

Department of Health, UK Continue reading →

The Salem Women’s Clinic in Salem, Ore., earlier this month filed a federal antitrust lawsuit in U.S. District Court in Eugene, Ore., against Salem Hospital alleging that the hospital is using its monopoly in the local health care system to drive the clinic out of business, the Salem Statesman Journal reports. In the suit, the clinic claims that hospital officials are restricting the clinics midwives from practicing by removing access to backup physicians, who are required to be present in case a medical emergency occurs during labor, according to the Statesman Journal.

The suit seeks an emergency injunction to reinstate hospital privileges for Elizebeth Harmon, director of the clinic, until an appeals hearing takes place. The hospital on Jan. 25 sent a letter to Harmon that said her privileges were suspended because she had violated hospital requirements for reappointment to the medical staff. The letter also cited “concerns regarding quality of patient care, behavioral issues and interpersonal relationships with members of the health care team” as reasons for the suspension. Harmon has requested an appeal hearing with the hospital to have her privileges reinstated, but a hearing has not been granted, according to the Statesman Journal.

According to the Statesman Journal, the clinic’s midwives have continued to practice because physicians from the hospital’s in-house obstetric group have provided backup. However, the obstetricians on April 23 told hospital officials that after the end of May they will no longer provide backup to clinic midwives because the additional patient load is placing too much strain on their practice. Sherryll Johnson Hoar, a spokesperson for the hospital, said the hospital will bring in temporary physicians to provide backup.

Harmon in the lawsuit also alleges that the hospital has refused to grant privileges to three new physicians hired by the clinic to take on some of her patients and alleviate the burden on Kimberly Eltzroth, the clinic’s other physician with privileges. Eltzroth has said she will resign on June 24 because of the additional patient load resulting from Harmon’s suspension.

The clinic, which is the only provider of midwife services at the hospital, delivers about 70 infants annually, according to the Statesman Journal. According to the suit, the clinic could close late next month if the midwives are not given access to backup physicians. Johnson Hoar said the hospital is “surprised” by the lawsuit, adding that it will take steps to ensure backup physicians are provided (Thompson, Salem Statesman Journal, 5/18).

Antiabortion Groups Concerned That Language in Bill Would Allow Midwives, Nurses To Perform Abortions
In related news, some antiabortion groups, including Missouri Right to Life and the Missouri Catholic Conference, have expressed concern over language in a bill (HB 818) passed last week by the state House that they say could be interpreted as allowing any certified health professional, including nurses and midwives, to perform abortions, the AP/Columbian Missourian reports (Lieb, AP/Columbian Missourian, 5/17). A provision of the bill would allow any person holding “ministerial or tocological certification” to provide pregnancy-related services (Wagar, Kansas City Star, 5/17).

According to the AP/Missourian, lawmakers did not realize that state Sen. John Loudon (R), who opposes abortion rights, had added the language to the bill until after it had passed, and they are now trying to pass a second bill that omits the language before the end of the legislative session. Loudon said that he does not think his amendment would allow people who are not physicians to perform abortions but added that he would support an amendment to clarify the language (AP/Columbian Missourian, 5/17). According to the Star, the House has added a provision to the other bill that states that only a physician can perform an abortion, even if another law states that other health care providers, such as nurses or midwives, can provide pregnancy-related care (Kansas City Star, 5/17).

“Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved. Continue reading →

Interlace Medical, Inc., announced that it has received 510K clearance from the U. S. Food and Drug Administration (FDA) to market the MyoSure Hysteroscopic Tissue Removal System for the removal of submucosal fibroids and polyps.

The MyoSure System enables physicians to quickly remove fibroids in a single step, avoid risks associated with energy-based devices, and will provide women with an incision-less treatment alternative that preserves uterine form and function. The easy-to-use device provides gynecologists with confidence, control and a minimally invasive care option for their patients.

“An increasing number of gynecologists and their patients are choosing less invasive treatment options which preserve uterine form and function and fewer life interruptions. With the MyoSure System, a 3cm fibroid (about the size of a walnut) can be removed in less than 10 minutes,” said Bill Gruber, President and CEO of Interlace medical. “In addition, the MyoSure device’s small outer diameter minimizes the need for cervical dilation often associated with other hysteroscopic procedures thereby reducing the risk of cervical perforation and trauma.”

“The availability of the MyoSure System allows me to offer a clinically effective front line solution vs. traditional drug therapy which has proven to be ineffective in the treatment of my symptomatic patients”, said Kelly Roy, M.D. of Phoenix Gynecology Consultants, Phoenix, AZ .

About Fibroids

Nearly 80% of all women will develop fibroids in their lifetime. The economic impact of fibroids is considerable. With an estimated 200,000 hospital admissions, costing more than $2 billion per year, fibroids clearly have a significant public health impact. These estimates do not include medical costs incurred in outpatient settings, or nonmedical costs such as time lost from work, according to data reported by the Agency for Healthcare Research and Quality. The need for better solutions that reduce the economic burden associated with treating and managing fibroids continues to increase. Hysteroscopic Myomectomy is recognized by the American Academy of Obstetricians and Gynecologists (ACOG), as a safe and effective treatment of Abnormal Uterine Bleed (AUB) caused by fibroids and polyps and is clinically proven to relieve AUB symptoms by greater than 90% with a less than 20% chance of recurrence at five years.

By developing cost effective, technologically advanced devices that improve patient care, reduce cost and provide procedural convenience to physicians, Interlace Medical addresses an ongoing need for safer, less invasive gynecology procedures.

Source
Interlace Medical, Inc. Continue reading →