Care Of Female Patients Research Articles

Abstract PO4-10-08: Building a standard methodology: Early Gynecologic Consultation and Bone Mass Density Examination in Breast Cancer Patients Receiving Endocrine Therapy

Abstract Purpose Hormone receptor-positive type of breast cancer is typically treated with hormone therapy (HT), including tamoxifen and aromatase inhibitors (AI). However, long-term use of HT may increase the risks of endometrial cancer, vaginal dryness, and osteoporosis. To minimize the risks, breast surgeons should schedule regular follow-up with gynecologists and arrange bone mass density (BMD) examination. Using the Plan-Do-Study-Act (PDSA) methodology, we aimed to increase cross-team care with gynecology department and to promote BMD examination for breast cancer patients receiving HT. Methods We formed a multidisciplinary team including breast surgery department and gynecologic department in our hospital that care for female patients with breast cancer and related side effects. We arranged a lecture for all collaborative doctors, introducing our aims, interventions, and measurement strategies to test in multiple PDSA cycles. The interventions with standardized criteria include: (1) a gynecologic consultation, triggered if a patient initially receive tamoxifen and (2) a BMD examination, triggered if a patient initially receive AI. The triggering mechanism is embedded in the ambulatory alarming system. Both the intervention rates were tracked during PDSA cycle 1 in 2023 and compared with baseline rates in 2020-2022. Adherence to the plan was maintained and measured using data analytic reports and chart audits. Results The gynecologic consultation rate during PDSA cycle 1 is significantly higher than the baseline, which is 40.4% and 22.4% (p = 0.006), respectively. In patients who received tamoxifen, 6-month-consultation rate during PDSA cycle 1 is also significantly higher than the baseline group, which is 77.77% and 42.9% (p = 0.005), respectively. The median time from HT therapy to first gynecologic consultation decreased from 51 days to 28 days. Furthermore, the baseline BMD testing rate before our intervention was 30.6%. This increased to 48.3% during PDSA cycle 1. Conclusion Standardized gynecologic consultation criteria led to earlier gynecologic consultation in breast cancer patients receiving tamoxifen and higher BMD test rates in patients receiving AI. Future PDSA cycles will focus on assessing the frequency of subsequent gynecologic encounters in patients who received a triggered gynecologic consult. Citation Format: Chiu Ching-Wen, Tam Ka-Wai, Su Chih-Ming, Wu Hsueh-Chi. Building a standard methodology: Early Gynecologic Consultation and Bone Mass Density Examination in Breast Cancer Patients Receiving Endocrine Therapy [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-10-08.

EE323 Implications for Utilizing a Female External Catheter (FEC) in End-of-Life Patients – Model of the Potential Impact upon Informal, Unpaid Caregiver (IUC) Burden in the Community Setting

1.72 million Medicare beneficiaries were enrolled in hospice care in 2020. Hospice care enrollment yields savings for payers for many categories of patient. Additionally, disenrollment in hospice has been found to result in higher Medicare expenditures. The majority of Medicare days associated with hospice care take place in the home – a challenge for IUCs as these patients typically present with numerous co-morbidities including urinary incontinence which affects 84% of hospice patients. A major reason for hospice patients’ return to the hospital setting is caregiver burden. This analysis seeks to determine the hours that IUCs provide to end-of-life patients in the community. Further, this analysis estimates the percentage of time that could be saved with a novel FEC that has been found to reduce time expended in the care of female patients with urinary incontinence.

Digital photography in the evaluation and management of female patients with congenital adrenal hyperplasia: A standardized protocol for quality improvement

Digital photography can be securely stored in the medical record and enhance documentation of physical exam findings and monitor wound healing. A standardized protocol that respects the dignity of the patient and maintains the fidelity of objective documentation is needed for patients with differences in sexual development (DSD) and congenital adrenal hyperplasia (CAH). The purpose of this study was to evaluate the feasibility, acceptability, and applications of a HIPAA-compliant digital photography protocol in the care of female patients with CAH. A protocol for standardized digital imaging including consent, permission, data capture, and storage in the electronic medical record (EMR) was implemented. Patients undergoing physical examination during multidisciplinary CAH clinic visits, preoperative evaluation, and postoperative follow-up from October 2020 through May 2021 were included. Male patients with CAH, patients with clitoromegaly or urogenital sinus not from CAH, and patients seen through telehealth were excluded. Consent was obtained from caregivers and permission from patients. Images of the exam were taken during clinic visits or at the time of surgery with no identifying features included. Images were directly uploaded into the patient's chart in the HIPAA-protected EMR separate from other clinical documentation and not stored on personal devices. There were 17 patients with CAH seen with median age 6 years (range 2 weeks-18 years). There was a median of 3 photos per patient during the study period with cooperation from both the patient and their caregiver. Amongst the patients seen, 6 patients underwent reconstruction with a median of 10 photos per patient. Images were available and used for preoperative planning and counseling. Patients with previous images did not require repeat examinations and were subjected to fewer genital examinations. Fewer providers were present during exams. Images taken by providers and caregivers during the postoperative period were used to monitor wound healing and surgical outcomes. Protocol implementation improved patient care by reducing the number of exams and number of providers present, enhancing clinical documentation, and providing a means of tracking the physical exam over time. This was in concordance with guidelines for limiting exams for patients with DSD and CAH. Implementation of best practices for medical photography was important in respecting patient dignity and confidentiality. Implementation of standardized digital photography was feasible and acceptable to patients and caregivers. Digital images reduced the need for repeat physical examination and provided a visual means of enhancing clinical documentation.

Association of Gender With Outcomes in Hospitalized Patients With 2019-nCoV Infection in Wuhan.

Aim: The aim of this study was to analyze the association of gender with psychological status and clinical outcomes among patients with 2019-nCoV infection to provide new directions for the prevention and control of the pandemic.Methods: One hundred and thirty-eight patients with confirmed 2019-nCoV infection at Wuhan Union Hospital, between February 8 and March 31, 2020, were included in the study analysis. General information and data on clinical characteristics were collected from patients' medical records. Participants' responses to self-report measures of psychological status were also collected.Results: Anxiety levels, depression levels, and recovery rates were significantly higher among women compared to men. Conversely, chronic disease history and smoking rates, dry cough incidence, C-reactive protein levels, and disease severity were significantly higher among men than women (p < 0.05).Conclusion: Female patients experienced more severe psychological issues, due to higher levels of anxiety and stress, than male patients; indicating that more attention should be paid to the psychological care of female patients. In contrast, the general condition of male patients was more severe, particularly among elderly male patients with a history of chronic disease and smoking, suggesting that, to prevent and control 2019-nCoV infection, male patients should be encouraged to quit smoking as soon as possible to reduce the risk of severe pneumonia.

The challenges of male nurses in the care of female patients in Iran.

Nurses professional duty mean that nurses must care for patients without gender discrimination. Meanwhile, the intrinsic differences between men and women and the need for personal contact with the patients during care procedures can create challenges for male nurses in the process of caring for a female patient. The present study aims to understand the challenges of male nurses in the care of female patients in Iran. A descriptivequalitative study was conducted with20 male nurses selected by purposive sampling. Data were collected through unstructured and semi-structured interviews as well as observations and were analysedusing conventional content analysis,based on the Graneheim and Lundman model. The findings revealed two main themes, including 'religious-cultural restrictions' and 'inappropriate organizational context'. Male nurses are faced with a combination of religious-cultural and organizational challenges in providing patient care without discrimination in clinical settings. In addition to negatively affecting the quality of nursing care and satisfaction for female patients, these problems also create a stressful work environment for male nurses. These problems can be alleviated in clinical settings by trying to ensure same-gender nurses and patients, especially when performing personal care. In addition to the efforts made by nurses to present a positive and real image of themselves in caring for female patients, health policy-makers should also attempt to improve society's attitude towards male nurses caring for female patients through the media.

Haseki Women’s Hospital and the female destitute of nineteenth-century Istanbul

This article is on one of the longest-lived medical institutions of the Ottoman Empire, the Haseki Hospital. I will try to glimpse to the daily workings of the Haseki Hospital and the transformations it underwent in terms of the services it offered, its patients, its social functions, and its relevance for the urban lives of the destitute women of the empire for the period between the 1830s and 1893. During that period, the Haseki Women's Hospital was an institution hosting poor and destitute women as well as pregnant, ill, feeble-minded, convicted women, widows, prostitutes, and orphans. Although it has been called a hospital, it has been used as a women's hospital, lying-in clinic, madness asylum, widow's house, orphanage, and a women's prison. I submit that the Haseki Women's Hospital fulfilled a dual purpose by combining social relief services with medical care for female patients. Besides being a locus of medicine, the hospital was also a site where women in the margins were confined and isolated, but also received care otherwise denied to them. Along these lines, this article searches the vulnerability of the destitute women of nineteenth century Istanbul.

The Analysis of Actual Approaches in Evaluating Efficiency of Medical Care of Female Patients with Habitual Miscarriage

The prevalence of habitual miscarriage varies depending on territories of the Russian Federation and other countries. The rate of premature delivery in the Moscow Zelenograd administrative okrug in 2013-2015 in average made up to 4.5%-4.7%. The percentage of habitual miscarriage made up to 3.6% that is a rather low indicator as compared with other Moscow okrugs and national average indices. The article considers three-level model of evaluation of medical, economic and social efficiency of obstetric gynecologic care support of population at the out-patient stage.

A Community-Oriented Approach to Breast Cancer in a Low-Resource Setting: Improving Awareness, Early Detection and Treatment of Breast Cancer in Tajikistan.

Breast cancer is one of the most common cancers and causes of death in females in Tajikistan; yet less than half of the adult women in Tajikistan have heard of breast cancer. Limited access to health care contributes to late stage presentation. We developed a public-private partnership to implement a breast cancer awareness intervention in a low-resource community in Khorog, Tajikistan. We trained local health professionals in clinical breast care and conducted a breast cancer screening and treatment program. The partnership involved visiting USA-based health professionals working alongside local health care providers (HCP) in the continuum of breast care-from education to the diagnostic evaluation and management of detected breast abnormalities. Patient data were collected using a web-based program (VirtualDoc). Twenty-four HCP received didactic and clinical breast examination training. 441 women underwent clinical breast evaluation. 74 (17%) had abnormal exams and underwent additional diagnostic procedures. We identified six (1.4%) cases of breast cancer (all locally advanced) and two women had benign fibroadenomas. All women with cancer underwent modified radical mastectomy, while the fibroadenomas were treated by cosmetically appropriate lumpectomy. Five of six subjects with cancer were previously aware of their breast lump and three had recently seen a family medicine (FM) doctor. Health systems assessment revealed availability of diagnostic equipment but lack of well-trained operators and clinician interpreters. We were successful in integrating clinical breast exams into the routine care of female patients by local FM doctors and in the process, achieved a better understanding of existing risk factors and barriers to breast cancer care. This public-private partnership, leveraging the technical expertise of visiting health professionals, demonstrates how a focused onsite training and awareness program can provide sustained improvements in breast care in a low-resource environment.

A historic and scientific review of breast cancer: The next global healthcare challenge.

Breast cancer is fast becoming the leading cause of oncologic morbidity and mortality among women worldwide. Demographic changes in Asia, Southeast Asia, and South America will further accelerate this trend. Different specialties are involved in the treatment of breast cancer patients: gynecology, surgery, pathology, hematology/oncology, radiology, radiation oncology, and nuclear medicine. Optimal results are seen in countries providing standardized breast cancer care in certified breast centers. The present article provides an overview of current state-of-the-art treatment strategies and explains the contributions of different specialties to optimal and individualized care for breast cancer patients. Breast cancer will be one of the most important health issues facing physicians involved with women's health and a basic understanding of current treatment objectives will be essential medical knowledge for everyone taking care of female patients.

Role strain of undergraduate male nurse students during learning experience in nursing education program

Aim: Role strain is one of the concerning issues for male nurse students which indicates increasing evidence for more gender based than their female peers, especially when caring for female patients. The purpose of the current research was to study the role strain of undergraduate male nurse students during their learning experience in nursing education program. Method: A cross sectional descriptive quantitative design was used in this study. A sample size of 124 and 274 of undergraduates male nurse students were from nursing Faculties of Ain Shams and Tanta Universities respectively. Role strain of male nurse students' questionnaire comprising four subscales; the Community Role Strain (12 items), the Colleague Role Strain (12 items), the Patient Role Strain (7 items), and the Instructors' Role Strain (10 items) was used to assess the role strain of male nurse students during their learning experience in nursing education program. Results: The findings indicated that half of male nurse students had medium level of total role strain. However, the level of total role strain among male nurses' students was higher at Tanta Nursing Faculty than did male students at Ain Shams Nursing Faculty. Conclusion: There is still much can and should do towards nursing profession to increase the satisfaction of men in nursing. This study provides awareness that important barriers persist for male nursing students in traditional learning environments which is female-oriented.

Two male nurses’ experiences of caring for female patients after intimate partner violence: a South African perspective

Background: South Africa is perceived to be one of the countries with the worst reputation regarding the occurrence of intimate partner violence. The women who suffer from serious physical injuries are admitted to emergency care units and their first contact with health care is through the nurses in these units. Emergency care nurses become secondary victims of violence due to their exposure to the pain of assaulted patients. Female nurses tend to identify with these patients as some nurses are in similar relationships. Not much research has been done on the challenges that male nurses face when they are confronted with abuse of women inflicted by males.Methodology: In this case study with a phenomenological research methodology two African male emergency care nurses were interviewed.Findings: The participants experienced a dichotomy of being-in-nursing and being-in-society and had been confronted with the conflicting roles of being men (the same sex as the perpetrators) and being nurses (the carer of the victim). They tried to manage the situation by using the ‘self’ to care for the patient and to be a problem solver for the patient and her partner or husband.Conclusion: The authors conclude that society expects men not to be in a caring profession and nursing is still a female-dominated caring profession that finds it difficult to move away from its engendered and caring image. The participants experienced role conflict when they took care of female patients who have suffered intimate partner violence.

Primary Biliary Cirrhosis and Primary Sclerosing Cholangitis: a Review Featuring a Women's Health Perspective.

Primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC) are two major types of chronic cholestatic liver disease. Each disorder has distinguishing features and variable progression, but both may ultimately result in cirrhosis and hepatic failure. The following offers a review of PBC and PSC, beginning with a general overview of disease etiology, pathogenesis, diagnosis, clinical features, natural course, and treatment. In addition to commonly associated manifestations of fatigue, pruritus, and fat-soluble vitamin deficiency, select disease-related topics pertaining to women's health are discussed including metabolic bone disease, hyperlipidemia and cardiovascular risk, and pregnancy-related issues influencing maternal disease course and birth outcomes. This comprehensive review of PBC and PSC highlights some unique clinical considerations in the care of female patients with cholestatic liver disease.

A Clinical Analysis of Two Cases of Refractory Status Epilepticus of Generalized Convulsive Seizures

A clinical analysis of two cases of refractory status epilepticus of generalized convulsive seizures is presented. The reasons behind the ineffec- tiveness of the pre-hospital emergency services are discussed. The features of clinical care of female patients according to the modern treat- ment standards and the possibilities for using intravenous forms of antiepileptic drugs in combination with general anesthetic drugs are ana- lyzed. The tactics of further treatment are discussed.

Exploration of staff attitudes and experiences towards mixed- and single-sex wards in the National Secure Forensic Service for Young People

Mixed-sex wards in adult forensic secure services have been abolished and replaced by single-sex services. The National Secure Forensic Service for Young People (NSFSYP) continues to use a mixture of single-sex male and mixed-sex wards. This study aimed to explore staff experiences and attitudes towards placing young people in mixed- or single-sex wards in the NSFSYP. Mixed methodology was adopted in the form of focus groups (qualitative) and questionnaires (semi-quantitative). Content analyses of the qualitative data revealed five themes: care of female patients, normalization, safety, commissioning and social representation of women. The questionnaire was developed from the qualitative findings and comprised 22 statements measuring attitudes towards mixed- and single-sex wards. One hundred and forty-five questionnaires were returned: a 44% total response rate. Overall, the responses to the questionnaire confirmed the focus group data. There were statistically significant differences in responses between staff working on mixed- and single-sex wards. Staff working on mixed-sex wards felt that mixing genders on wards is a crucial part of adolescent forensic inpatient treatment. For them, mixed wards provide a more developmentally appropriate environment for young people. The needs of female patients broaden the debate beyond segregating and mixing gender.

Sa1231 Awareness Among Practitioners Regarding Efficacy of Oral Contraceptives With Concomitant use of Antibiotics in Inflammatory Bowel Disease (IBD) Patients

Background: Antibiotics such as metronidazole and ciprofloxacin are often prescribed to IBD patients. Common misperception is that use of antibiotics can decrease efficacy of oral contraceptives (OCPs) and result in contraception failure, refuted in a recently published guideline from the American College of Obstetrics and Gynecology. The purpose of this study was to assess the knowledge among practitioners regarding the lack of evidence to support decreased contraceptive efficacy with concomitant use of OCPs and antibiotics. Methods: We conducted a survey of 215 practitioners (GI-General n=36, IBD specialists n= 11, GI-Fellows n=39, Internal Medicine n=44, Family Medicine n=29, OB/Gyn n=19 and Pharmacists n=37). Practitioners were quizzed on two scenarios in which a 28-year-old female patient with fistulizing Crohn's disease on an OCP was recently prescribed ciprofloxacin or metronidazole. The practitioners were asked whether they would: 1) ask the patient to use an alternativemethod of contraception, 2) ask the patient to use twomethods of contraception, or 3) inform the patient that there is no evidence to support decreased contraceptive efficacy with the concomitant use of OCPs and antibiotics. The percentage of practitioners among the different groups was compared using either χ2 or Fisher's exact test as appropriate. Multiple, pair-wise comparisons were then performed if the overall χ2 test or Fisher's exact test was statistically significant. The p-value was adjusted for multiple comparisons. Results: Compared to all other specialties combined, IBD specialists and OB/Gyns were more likely to accurately believe that there is no evidence to support a lack of contraceptive efficacy with concomitant use of ciprofloxacin (91% vs. 20% p <0.0005 and 90% vs.17% p <0.0005 respectively) and metronidazole (100% vs. 26% and 95% vs. 23% p <0.0005 respectively) (Figure 1). Knowledge among gastroenterologists (except for IBD specialists) for both questions was not statistically any different than internists (18% vs. 4%p=0.245), family physicians (18% vs. 0% p=0.11) or pharmacists (18% vs. 18% p=1.00). Ninety-eight percent of the practitioners who thought there was an interaction between antibiotics and OCPs answered that the information learned from this survey will change their practice. Conclusion: Excluding IBD specialists and OB/Gyns, most practitioners involved in the care of female patients with IBD believe there to be interaction between antibiotics and OCPs and would prescribe an alternative method of contraception or two different methods to such patients. It is thus important to appropriately educate those without the appropriate knowledge in order that patients are not falsely counseled to increase means of birth control.

Gender‐specific aspects in the clinical presentation of cardiovascular disease

More than a quarter of a million women die each year in the industrialized countries from cardiovascular diseases (CVD), and current projections indicate that this number will continue to rise with our ageing population. Important sex-related differences in the prevalence, presentation, management and outcomes of different CVD have discovered in the last two decades of cardiovascular research. Nevertheless, much evidence supporting contemporary recommendations for testing, prevention and treatment of CVD in women is still extrapolated from studies conducted predominantly in men. The compendium of CVD indicates that current research and strategy development must focus on gender-specific issues to address the societal burden and costs related to these incremental shifts in female gender involvement. Indeed, this significant burden of CVD in women places unique diagnostic, treatment and financial encumbrances on our society that are only further intensified by a lack of public awareness about the disease on the part of patients and clinicians alike. This societal burden of the disease is, in part, related to our poor understanding of gender-specific pathophysiologic differences in the presentation and prognosis of CVD and the paucity of diagnostic and treatment guidelines tailored to phenotypic differences in women. In this, scenario is of outmost importance to know these differences to provide the best care for female patients, because under-recognition of CVD in women may contribute to a worse clinical outcome. This review will provide a synopsis of available evidence on gender-based differences in the initial presentation, pathophysiology and clinical outcomes of women affected by CVD.

Menopausal transition, mood, and cognition

Epidemiological and clinic data support the notion that some women may be at higher risk for developing mood and anxiety symptoms and cognitive complaints during certain periods in life that are marked by intense hormone variations and psychosocial stressors. The complexity of the so-called windows of vulnerability poses a particular challenge to professionals involved in the care of female patients. Menopausal transition is perhaps a paramount example; the process itself is marked by progressive, dynamic changes in hormone levels and reproductive function that interact with the aging process, changes in metabolism, sexuality, lifestyle behaviors, and overall health.The putative compounded burden of health challenges associated with this transition has become a main focus of attention of physicians and researchers who aim to identify preventive and/or early intervention strategies to promote healthy aging in midlife women. Recent studies have provided further evidence that the menopausal transition may be not only a window of vulnerability for depression and cognitive impairment but also a critical "window of opportunity" for the success of hormone-based treatments.The need for further investigation and better understanding of common underlying mechanisms seems intuitive. An ultimate goal could include preventive strategies for women presenting with various risk factors for cardiovascular, cognitive, and mood disorders as well as treatments that could be tailored to multiple symptom domains during the menopausal transition.

“Inflammatory” changes in breast: how to provide a better care to our patients

"Inflammatory" changes of the breast can be seen in many different entities ranging from benign self-limited processes, for example puerperal mastitis, to highly aggressive malignant tumors, such as inflammatory carcinoma. While clinically many of these "inflammatory" processes may look alike, there are some characteristics that allow an accurate differential diagnosis and accordingly a correct treatment. A worldwide effort is made everyday to promote breast health awareness, to facilitate prevention, early detection, and effective treatment. Nevertheless, breast cancer still remains as the number one female cancer and as the second cause of death for cancer in women. Physicians involved in the care of female patients are the first line of defense in the battle against cancer. Therefore, it is important to keep in mind a broad differential diagnosis in patients that seek medical attention complaining of a breast problem. Herein is a summary of the most common causes of inflammatory and inflammatory-like changes in breast with special emphasis on clinical presentation and differential diagnosis.

Genderspezifische Aspekte der Gesundheitsversorgung und Rehabilitation nach Herzinfarkt

Coronary heart diseases (CHD) and the acute myocardial infarction (AMI) as a possible manifestation of CHD are seen as one the most important chronic conditions until now. Female patients account for approximately one third of all cases of AMI in Germany. Despite the high incidence and prevalence, women after myocardial infarction remained seriously neglected for decades in epidemiological and clinical studies. In this review gender-specific aspects of health care delivery and cardiac rehabilitation after an AMI are summarized. Gender-specific targets and recommendations in current guidelines and different needs for medical and psychosocial interventions as well as the current practice of health care delivery will be discussed. Empirical data suggest that health care for female patients after AMI does not follow existing guidelines as strictly as the health care for male patients; the reasons are widely unknown. There is a tremendous need for further research on gender-specific differences in health care needs and in the effectiveness of health care interventions in male and female cardiac patients. Systematic knowledge is an essential precondition for the development of gender specific guidelines for the health care and rehabilitation of patients after AMI.

Caring for female patients: the experiences of male nurses

This article presents the results of two small qualitative studies, which examined the experiences of six male registered psychiatric nurses (RPN) and five male registered general nurses (RGN) when caring for patients of the opposite sex. Semi-structured interviews were used to collect the data. The focus of the interviews was an attempt to describe the male nurses' experiences of caring for women with a particular emphasis on interventions that involved physical touch. Themes were generated from both studies and the common themes are presented here. Male nurses in this study were often apprehensive about using physical touch and they used coping strategies in response to their fears of being accused of using touch inappropriately. Several factors also influenced the male nurses when using physical touch as an intervention. These findings suggest that learning about caring for female patients needs to be included in the undergraduate curriculum and that further research on the experience of men as nurses is required.