Committee Opinion Research Articles

Evaluation of salivary levels of beta amyloid in patients with Alzheimer’s disease

AbstractBackgroundSalivary analysis of amyloid beta protein levels in Alzheimer’s disease patients and research participants without Alzheimer’s disease.MethodThis is a case‐control study carried out in patients with a diagnosis of probable AD and cognitively healthy patients without AD. There were 3 groups, totaling 76 people: group 1 with AD; Group 2 without AD (under 59 years old) and group 3 without AD (over 60 years old). Ethics committee opinion n° 3,130,636. Salivary analysis of Ab‐40 and Ab‐42 performed by the ELISA method.ResultOur investigations for salivary AB42 showed slightly higher levels in male and female AD patients compared to healthy ones. The general AB42 group for AD was superior to the general group of healthy ones, demonstrating the feasibility of using saliva as a diagnostic element for AD.ConclusionAmyloid beta protein in fractions 40 and 42 amino acids (Ab1‐40 and Ab1‐42) were expressed in higher concentrations in AD patients and reduced in healthy ones, strengthening the hypothesis of the use of this fluid as an adjuvant in the diagnosis of Alzheimer’s Disease.

The promise and peril of using a large language model to obtain clinical information: ChatGPT performs strongly as a fertility counseling tool with limitations

To compare the responses of the large language model based "ChatGPT" to reputable sources when given fertility related clinical prompts DESIGN: ChatGPT "Feb 13" version by OpenAI was tested against established sources relating to patient oriented clinical information: 17 "Frequently Asked Questions" about infertility on the Centers for Disease Control (CDC) Website, 2 validated fertility knowledge surveys the Cardiff Fertility Knowledge Scale (CFKS) and the Fertility and Infertility Treatment Knowledge Score (FIT-KS), and the American Society for Reproductive Medicine (ASRM) Committee Opinion "Optimizing Natural Fertility." ChatGPT online chatbot INTERVENTION (FOR RCT) OR EXPOSURE (FOR OBSERVATIONAL STUDIES): FAQ's, survey questions and rephrased summary statements were entered as prompts in the chatbot over a 1-week period in February 2023. For FAQ's from CDC: words/response, sentiment analysis polarity and objectivity, total factual statements, rate of statements that were: incorrect, referenced source or noted value of consulting provider. For fertility knowledge surveys: percentile according to published population data. For Committee Opinion: whether response to conclusions rephrased as questions identified missing fact RESULTS: When administered the CDC's 17 Infertility FAQ's, ChatGPT produced responses of similar length (207.8 ChatGPT vs. 181.0 CDC words/response, p = NS), factual content (8.65 factual statements/response vs. 10.41, p =NS), sentiment polarity (mean 0.11 vs. 0.11 on a scale of -1 (negative) to 1 (positive), p = NS) and subjectivity (mean 0.42 vs. 0.35 on a scale of 0 (objective) to 1 (subjective), p = NS). 9 of the 147 (6.12%) ChatGPT factual statements were categorized as incorrect and only 1 statement (0.68%) cited a reference. ChatGPT would have been at the 87th percentile of Bunting's 2013 international cohort for the CFKS and at the 95th percentile based on Kudesia's 2017 cohort for the FIT-KS. ChatGPT reproduced the missing facts for all 7 summary statements from "Optimizing Natural Fertility." A February 2023 version of "ChatGPT" demonstrates the ability of generative Artificial Intelligence (AI) to produce relevant, meaningful responses to fertility related clinical queries comparable to established sources. While performance may improve with medical domain specific training, limitations such as the inability to reliably cite sources and the unpredictable possibility of fabricated information may limit its clinical utility.

Indications and management of preimplantation genetic testing for monogenic conditions: a committee opinion

This statement is offered to update and expand on the prior American Society for Reproductive Medicine preimplantation genetic testing (PGT) opinion, elucidate the current clinical and technical complexities specific to PGT for monogenic conditions, assist providers in supporting patient understanding of and access to this technology, and offer considerations for the development of future clinical and laboratory guidelines on PGT for monogenic conditions.

Informed consent in assisted reproduction: an Ethics Committee opinion

Informed consent is a process in which the patient is supported in developing an understanding of medical options (including risks, benefits, and alternatives) and coming to a voluntary and autonomous decision.

Defining embryo donation: an Ethics Committee opinion

Building families through the adoption of children has been supported by human society throughout history. The ethical appropriateness of patients donating embryos to other patients for family building, or for research, is well established and is affirmed by this Committee. The use of the term ''adoption'' for embryos is inaccurate and should be avoided. This document replaces the ASRM Ethics Committee statement by the same name, last published in2016.

Risk-Reducing Salpingectomy And Other Strategies For Prevention Of Ovarian And Tubal Carcinoma

Objective: To provide a review of most current evidence and data for risk-reducing strategies used in prevention of ovarian cancer. Methods of study selection: PubMed was used as a search tool for articles with key words focusing on current strategies on prevention of ovarian cancer such as “risk-reducing salpingectomy, “risk-reducing salpingo-oophorectomy, “salpingectomy with delayed oophorectomy”. General consensus and society guidelines from leading organizations such as Society of Gynecologic Oncology, American Cancer Society, and American College of Obstetricians and Gynecologists were reviewed and summarized in this review article with supporting evidence and research studies on most current riskreduction strategies for prevention of ovarian and tubal carcinoma. Result: There is growing evidence that high-grade serous ovarian carcinoma arises in the fallopian tube in the form of serous tubal intraepithelial carcinoma (STIC). Therefore, opportunistic salpingectomy has been increasingly offered at the time of routine benign gynecologic surgery. Risk-reducing bilateral salpingo-oophorectomy has been shown to reduce risk of ovarian cancer up to 90% and offered to women with high hereditary predisposition for ovarian cancer. Riskreducing salpingectomy with delayed oophorectomy (SDO) has been suggested in younger women to balance the effects of infertility and surgically induced menopause resulting from oophorectomy. Conclusion: Combined oral Contraceptive COCs confer long-term protection against ovarian cancer with reported 20% reduction for every 5 years of use, which have been cited as a confounding factor in most of the published studies. Women who used HRT (estrogen alone or combined estrogen and progesterone) carry 20% higher risk of ovarian cancer compared to never-users. The associated increased risk of cervical and breast cancer with COCs/HTR use, have recently let women prefer the RRSO over COCs for prevention of ovarian cancer. Bilateral risk reducing Salpingo-oophorectomy (RRSO) at the age of 40–45 in BRCA1 and 45–50 in BRCA2 mutation carriers is recommended to be the primary approach for risk reduction of ovarian cancer. There is well-supported evidence of lowering the risk of ovarian cancer in high-risk population by 90%. The American college of obstetrics and gynecology committee opinion, recommended opportunistic salpingectomy for the primary prevention of ovarian cancer in a woman already undergoing pelvic surgery for another indication. Bilateral salpingectomy at the time of cesarean delivery is recommended to replace the tubal ligation as the method of choice for sterilization performed with cesarean delivery. The novel alternative procedure of Risk-reducing Salpingectomy with delayed risk-reducing oophorectomy (RRSO-RRO) have growing attention as a better alternative to improve the menopause-related morbidity and quality of life.

Consideration of the gestational carrier: an Ethics Committee opinion

Intended parents engage with gestational carriers (GCs) to achieve their personal reproductive goals. All GCs have a right to be fully informed of the risks as well as the contractual and legal aspects of the gestational-carrier process. The GCs have autonomy in making their own decisions regarding medical care and should be free from undue influences by the stakeholders involved. They should have free access to and receive psychological evaluation and counseling before, during, and after participating. In addition, GCs require separate independent legal counsel regarding the contract and arrangement. This document replaces the document of the same name, lastpublished in 2018 (Fertil Steril 2018;110:1017-21).

Ethical Need for a Fertility Decision-Aid for Transgender Adults of Reproductive Age

Ethical Need for a Fertility Decision-Aid for Transgender Adults of Reproductive Age

The impact of the 2015 ACOG screening guidelines on the diagnosis of postpartum depression among privately insured women

BackgroundPostpartum depression (PPD), is underdiagnosed and undertreated. In 2015, the American College of Obstetricians and Gynecologists (ACOG) recommended that women be screened for PPD at least once during the perinatal period. The effect of the recommendation on PPD diagnosis is unknown. MethodsUsing the MerativeTM MarketScan® database, PPD prevalence was identified in privately insured women ages 13–45 with a live birth between 2013 and 2016. Postpartum depression was defined as an ICD diagnosis code for PPD or other depression, or a new pharmacy claim for an antidepressant medication during the first 12 months following delivery. Multivariable logistic regression was used to estimate the likelihood of PPD both before and after the ACOG PPD Committee Opinion. ResultsThe study included 244,624 women ages 13–45 who had a live birth in 2013 through 2016. PPD prevalence before and after the 2015 ACOG Committee Opinion was 15.1 % and 17.2 %, respectively. The likelihood of PPD was not statistically different following the 2015 Committee Opinion (adjusted OR, 1.00, 95 % CI, 0.97–1.03) when controlling for age, year, delivery complications, and geographic region. LimitationsSociodemographic variables are not included in the MarketScan database and therefore could not be analyzed as covariates. Re-defining a PPD diagnosis as above interfered with the ability to measure a prior history of mood disorders as a covariate. ConclusionImplementation of the ACOG recommendations was not associated with a significant increase in PPD diagnosis. This suggests that physician organization recommendations alone are not sufficient to increase detection of PPD.

Expanded carrier screening for reproductive risk assessment: An evidence-based practice guideline from the National Society of Genetic Counselors.

Expanded carrier screening (ECS) intends to broadly screen healthy individuals to determine their reproductive chance for autosomal recessive (AR) and X-linked (XL) conditions with infantile or early-childhood onset, which may impact reproductive management (Committee Opinion 690, Obstetrics and Gynecology, 2017, 129, e35). Compared to ethnicity-based screening, which requires accurate knowledge of ancestry for optimal test selection and appropriate risk assessment, ECS panels consist of tens to hundreds of AR and XL conditions that may be individually rare in various ancestries but offer a comprehensive approach to inherited disease screening. As such, the term "equitable carrier screening" may be preferable. This practice guideline provides evidence-based recommendations for ECS using the GRADE Evidence to Decision framework (Guyatt et al., BMJ, 2008, 336, 995; Guyatt et al., BMJ, 2008, 336, 924). We used evidence from a recent systematic evidence review (Ramdaney et al., Genetics in Medicine, 2022, 20, 374) and compiled data from peer-reviewed literature, scientific meetings, and clinical experience. We defined and prioritized the outcomes of informed consent, change in reproductive plans, yield in identification of at-risk carrier pairs/pregnancies, perceived barriers to ECS, amount of provider time spent, healthcare costs, frequency of severely/profoundly affected offspring, incidental findings, uncertain findings, patient satisfaction, and provider attitudes. Despite the recognized barriers to implementation and change in management strategies, this analysis supported implementation of ECS for these outcomes. Based upon the current level of evidence, we recommend ECS be made available for all individuals considering reproduction and all pregnant reproductive pairs, as ECS presents an ethnicity-based carrier screening alternative which does not rely on race-based medicine. The final decision to pursue carrier screening should be directed by shared decision-making, which takes into account specific features of patients as well as their preferences and values. As a periconceptional reproductive risk assessment tool, ECS is superior compared to ethnicity-based carrier screening in that it both identifies more carriers of AR and XL conditions as well as eliminates a single race-based medical practice. ECS should be offered to all who are currently pregnant, considering pregnancy, or might otherwise biologically contribute to pregnancy. Barriers to the broad implementation of and access to ECS should be identified and addressed so that test performance for carrier screening will not depend on social constructs such as race.

Management of Oligometastatic Breast Cancer: An Expert Committee's Opinion.

Patients with oligometastatic breast cancer (BC) are candidates of choice for metastasis-directed therapy (MDT). This paper summarizes the opinions of an expert committee about the management of oligometastatic BC. The experts could complete the questionnaire from 13 September 2021, to 10 October 2021, followed by a discussion. The experts were physicians working in the Province of Quebec (Canada) and specialized in BC care, including surgical oncologists, medical oncologists, and radiation oncologists. The experts provided their opinions about the context of the disease and therapeutic approach, local and systemic therapies, and the prognosis of oligometastatic BC. In addition to the expert panel's opinions about the management of oligometastatic disease per se, the experts stated that a prospective data registry should be implemented to collect data about oligometastatic BC to improve knowledge about oligometastatic BC and implement data-driven MDT. These data could also allow for the design of treatment algorithms. In conclusion, this paper presents the expert panel's opinions about the management of oligometastatic BC and highlights the needs to be met to improve the care of this condition.

Associação entre controle glicêmico em diferentes condições emocionais e adesão à contagem de carboidratos em pessoas com diabetes tipo 1 durante a pandemia de COVID-19 no Brasil

ABSTRACT Objective Evaluate the association between glycemic control in different emotional perceptions and the adherence to carbohydrate counting by adults with type 1 diabetes during the COVID-19 pandemic in Brazil. Methods This cross-sectional, descriptive, and analytical study was approved by the Research Ethics Committee (Opinion nº 4,147,663) and conducted in July 2020 using a Google Forms® form. Socioeconomic and demographic data were collected; glycemic monitoring according to the individuals’ emotions at the time of measurement (happy, motivated, or hopeful; stressed or anxious; sad, distressed, or with depressive symptoms); data on adherence to carbohydrate counting and social distancing. Pearson’s Chi-Square test was applied with adjusted residual analysis (p<0.05). Results Approximately 64.62% of the 472 participants, had hyperglycemia when stressed/anxious, and 52.97% when they felt sad/distressed/depressive (p<0.000). Associations were observed between having normoglycemia in any emotional situation and performing the carbohydrate counting (p<0.000); perceiving oneself as happy/motivated/hopeful and having hyperglycemia, and not measuring blood glucose was associated with not having the carbohydrate counting (p<0.000); being stressed or anxious was associated with not measuring blood glucose and not having the carbohydrate counting (p<0.000). Conclusion The need for multidisciplinary care to enhance mental health and adherence to treatment for people with type 1 diabetes is highlighted.

ACOG Committee Opinion No. 813, Gynecologic Considerations for Adolescents and Young Women With Cardiac Conditions: Correction

ACOG Committee Opinion No. 813, Gynecologic Considerations for Adolescents and Young Women With Cardiac Conditions: Correction

ACOG Committee Opinion No. 817, Options for Prevention and Management of Menstrual Bleeding in Adolescent Patients Undergoing Cancer Treatment: Correction.

ACOG Committee Opinion No. 817, Options for Prevention and Management of Menstrual Bleeding in Adolescent Patients Undergoing Cancer Treatment: Correction.

ACOG Committee Opinion No. 785, Screening and Management of Bleeding Disorders in Adolescents With Heavy Menstrual Bleeding: Correction

ACOG Committee Opinion No. 785, Screening and Management of Bleeding Disorders in Adolescents With Heavy Menstrual Bleeding: Correction

Implementation of and Barriers to Optimizing Postpartum Care by Resident and Attending Physicians.

Background: The American College of Obstetricians and Gynecologists released Committee Opinion No. 736: Optimizing Postpartum Care (CO No. 736) to address severe maternal morbidity and mortality in the United States by outlining recommendations for care in the critical time following birth. This study aimed to evaluate implementation of and barriers to the recommendations of CO No. 736 among obstetricians in south Louisiana. Methods: A survey to general obstetric providers assessed opinions on the CO No. 736 recommendations, implementation of these recommendations, and barriers to implementation. Fisher exact test was used to compare distributions between resident and attending groups. Qualitative, free-text responses about barriers to implementation were organized by common themes and categorized into systemic and patient factors. Results: Of 124 survey responses, 59.7% of respondents reported that they had read CO No. 736. Of the respondents who had read the document, 86.5% believed it was important to implement these recommendations, but only 50.0% had established the recommendations in their practices. Overall, fewer than half (46.8%) of respondents reported actively implementing the recommendation to make contact with postpartum patients at 3 weeks or sooner, but 86.3% reported having comprehensive clinic visits within 12 weeks of delivery. Commonly identified systemic barriers to implementation included the 3-week contact not being common practice, overbooked schedules, and unclear provider expectations. Commonly identified patient factor barriers to implementation included childcare or transportation and no-shows at postpartum appointments. Conclusion: Both resident and attending obstetricians in South Louisiana believe that the CO No. 736 recommendations are important but reported lacking the ability to implement them into clinical practice.

Sorting Out the Risks and Benefits of the #797 Recommended Intrapartum Vancomycin Dosing Approach.

ACOG Committee Opinion #797 proposed intrapartum vancomycin dosing guidelines in the absence of thorough evaluation of its risk versus benefit profile on the maternal and neonatal systems. The previously published serum and cord-blood concentration-time data of vancomycin given to mothers in the intrapartum period was analyzed in this work with a two-compartment pharmacokinetic (PK) model. Monte Carlo simulation was used to establish exposure for the studied population for doses of 1000 mg to 2000 mg every 8 h for gestational ages (GA) of 33 to 40 weeks and for birth times up to 4-h intervals. Probabilities of target attainment (PTA) were calculated for efficacy and toxicity indices unique to the peripartum maternal and neonatal population. Neonatal evaluations indicate uniformly high PTAs for the evaluated dosing regimens when the efficacy target is considered. On the other hand, the PTAs for potentially nephrotoxic exposure is expected to reach undesirable levels when three or more doses were to be administered. The risk is profoundly high in GA below 36 weeks and birth times beyond 20 h after the initiation of intrapartum prophylaxis and with doses greater than 1250 mg. Maternal vancomycin exposures seem reasonable up to two intrapartum doses given at 8 h intervals when the dose is kept to 1250 mg or less. Most mothers (up to 83%) who receive three or more doses of the commonly administered regimens are subjected to nephrotoxic exposures. Thus, it appears that the current recommendations by #797 for dosing of vancomycin pose considerable risk to mother and newborn alike, especially in cases with lengthy duration of preterm labor. Capping of doses at 1250 mg may be considered to minimize the need for therapeutic drug monitoring (TDM) interventions. Alternatively, and irrespective of the baseline maternal renal function, TDM for all cases requiring more than two doses of 1500 mg or higher must be assured.

Calculate modeling of the level of indoor air pollution during its cleaning with air purifiers

The article proposes a computational method for determining the concentrations of pollutants inside a ventilated or cleaned room, taking into account the initial conditions and parameters of the flow rate, incoming or purified air, the volume of the room, the initial concentrations of the pollutant in the atmospheric air and in the room air, the parameters of the efficiency of the air cleaner. The article proposes the solution of two mass transfer equations under known initial conditions for two methods of cleaning rooms. When solving the first equation, a direct mass transfer calculation was carried out, which makes it possible to determine the effect of natural or artificial ventilation used indoors with small linear dimensions on the change in the concentration of the selected air polluting substance in the form of a chemical compound or an aerosol containing biological or chemical pollutants. When solving the second equation, a direct mass transfer calculation was carried out, which makes it possible to determine the effect of the operation of an air purifier used indoors with small linear dimensions on the change in the concentration of the selected air polluting substance in the form of a chemical compound or an aerosol containing biological or chemical pollutants. Calculations allow us to determine the time during which a residential office or industrial space is saturated with pollutants or cleaned to the required air quality standards, taking into account the influence of factors such as pollution of the surface layers of atmospheric air, the appearance of pollutants inside the room, the performance and efficiency of ventilation or air purification systems. The proposed calculation methods can be used to determine changes in the quality of indoor air over time, including taking into account changes in oxygen concentrations and pollutants indoors, determining the effectiveness of ventilation and air purification systems of various capacities in residential, office, medical and industrial premises. Ethics. The study does not require the submission of a biomedical ethics committee opinion or other documents.

Hygienic problems of LED lighting

The work is devoted to the physiological and hygienic safety of the use of LED light sources, the analysis of domestic and foreign materials, the analysis of working conditions and training when using LED lamps. The literature was searched in the databases Scopus, Web of Science, etc. The study of the biological effect of light on humans remains an urgent problem of lighting hygiene. The authors of the article outlined their attitude to a number of scientific papers on this issue, choosing the most significant ones. The authors of the article studied over 23 works on the scientific study of the effect of LED lighting on the human body in comparison with fluorescent and incandescent paws. The studies carried out to assess the impact of LED lighting on the functional state and performance of railway workers using approved professional selection methods revealed negative changes. This was expressed in a slight decrease in the functional resistance to color discrimination of green and red signals, as well as in an increase in the response time of a complex visual-motor reaction and a significant decrease in the readiness for emergency action of the examined persons. Studies have shown that LED lighting affects not only the eyes, but also the human hormonal system, its psychophysiological state, performance and fatigue. Ethics. This study did not require an ethics committee opinion.

Variations in Postpartum Opioid Prescribing Practices among Obstetrician-Gynecologists.

There have been many efforts to combat the United States opioid crisis that has been occurring for the past two decades, specifically with postpartum patients that often were prescribed opioids. Prior studies described how accounting for usage of inpatient opioids on the day prior to discharge had an impact on how much discharge opioids were prescribed on the day of discharge. These studies provided a guideline to use the inpatient opioid amount from the day before discharge to determine discharge opioid quantity and minimize how much was being prescribed. In July 2018, the American College of Obstetrics and Gynecologists (ACOG) published Committee Opinion 742, guidelines for obstetricians-gynecologists about post-partum pain management. Prescription pain medications (including opioids, if necessary) require a shared decision-making approach between the physician and patient to determine the medication type and quantity. This study aimed to determine if there were differences in prescribing practices based on the specific post-operative day that opioid prescriptions were written, and if there were differences in the prescribing practices for cesarean deliveries following the publication of ACOG Committee Opinion 742. This retrospective chart review included patients who had a live cesarean birth at one rural Midwest facility anytime between July 1, 2017 and February 28, 2021. This study excluded those with chorioamnionitis and those discharged after more than four days. Opioid amounts were converted to oral morphine milligram equivalents (MME) for comparison, and total MME was calculated for each prescription. Patients were stratified into two groups based on the day that their discharge opioid medication prescriptions were written (i.e., a day prior to discharge or the day of discharge). Patients were also stratified based on date of delivery, before or after the publication of ACOG Committee Opinion 742. Of 411 cesarean patients, 93.9% (n = 386) had opioids prescribed at discharge, 86% (n = 330) of whom received a prescription written on the day of discharge. There was no difference in the quantity of MMEs, doses per day, or dosage from discharge prescriptions between those written on the day of discharge and those written on a prior day. Patients whose deliveries occurred after the publication of ACOG Committee Opinion 742 (63.9%, n = 263) received discharge prescriptions with fewer average MMEs (159.53 ± 61.64) than those whose deliveries occurred before the publication (36%, n = 148; 187.35 ± 53.42; χ2 (1, N = 411) = 17.71; p < 0.001), and they were prescribed fewer doses per day. After cesarean sections, the specific post-operative day did not seem to impact the prescribing trends as there were no differences in MMEs, doses per day, or dosage between prescriptions that were written on the day of discharge and before the day of discharge. Patients whose deliveries occurred after the publication of ACOG Committee Opinion 742 received discharge prescriptions with fewer MMEs, fewer doses per day, and the same dosage than those whose deliveries occurred before the publication, reflecting the overall national trend of decreasing prescription opioids over these years.