Opportunity For Counseling Research Articles

Patient experiences with prenatal cell-free DNA screening in a safety net setting.

Thirty-five states, including Florida, now cover cell-free DNA (cfDNA) screening of fetuses for all pregnant patients enrolled in state public insurance programs. We interviewed Black and Hispanic obstetric patients at a safety net clinic in Florida shortly after the state rolled out cfDNA as a first-tier screening method for publicly insured patients. Black and Hispanic patients receiving prenatal care from a prenatal or maternal fetal medicine clinic at a federally qualified health center in Jacksonville, FL were invited to participate in a qualitative interview in English or Spanish to explore experiences and perceptions of prenatal cfDNA screening. Participants were recruited following their first prenatal visit when cfDNA is typically introduced. Interview transcripts were qualitatively analyzed for iterative themes based on principles of grounded theory. One hundred Black and Hispanic patients (n=51 non-Hispanic Black, n=43 Hispanic, n=3 Hispanic Black, n=3 Not Reported/Other) completed an interview. Participants described minimal opportunity for pre-screening counseling and limited health literacy about cfDNA or its uses. Some believed that cfDNA could positively impact pregnancy health. Many were unsure if they had received cfDNA even though they were aware of the information provided by it. Most participants expressed an interest in cfDNA as a means for early detection of fetal sex and as an additional indication of general fetal health. Patient experiences indicate limited informed consent and decision-making for cfDNA, discordant with professional guidelines on pre-screen counseling. Our findings suggest that there should be additional investment in implementing cfDNA in safety net settings to ensure that patients and providers receive the support necessary for effective patient counseling and follow-on care for the ethical implementation of cfDNA.

Risk perception and surveillance uptake in individuals at increased risk for pancreatic ductal adenocarcinoma

BackgroundSurveillance for pancreatic ductal adenocarcinoma (PDAC) is recommended for high-risk individuals with genetic variants in PDAC-associated genes and/or family history. Surveillance uptake and adherence may depend on the perception of...

(376) High Capability of ChatGPT to Answer Common Patient Questions on Vasectomy Reviewed by Sexual Medicine Specialists

Abstract Introduction Novel technologies utilizing artificial intelligence (AI) have shown their potential to reduce provider workload and improve task efficiency in certain clinical settings. ChatGPT is an AI-powered chatbot which utilizes natural language processing (NLP) technology to provide human-like responses to open-ended questions posed by users. Recent studies have shown ChatGPT’s ability to provide diabetes counseling in lieu of trained educators, and effectively communicate technical research papers in layman’s terms to patients. Vasectomy is a common urologic clinic procedure that can be a source of anxiety for patients, many of whom desire the opportunity for further pre-operative counseling. Objective The objective of this preliminary study was to evaluate the ability of ChatGPT to respond to common patient questions on vasectomy encountered by sexual medicine specialists. Methods We composed a list of 20 questions commonly asked by patients pertaining to vasectomy. The questions were submitted to ChatGPT Plus with the prompt: “Answer the following questions in 50 words or less”. 3 fellowship-trained sexual medicine specialists then rated the accuracy of ChatGPT’s responses on a scale from 1-5 (1 representing a completely inaccurate response and 5 representing a response in line with what they would recommend to patients). Scores were tabulated and summarized (Table 1). Descriptive statistics were performed. Weighted Cohen’s kappa was calculated to assess for interrater reliability. Results Median score across all 20 responses from 3 raters was 4.1 (IQR 1.3). The most common rating was 5, indicating a high level of agreement between ChatGPT’s responses and those of sexual medicine specialists. The lowest score assigned was 2 (indicating poor accuracy), and was received by 6 responses. Weighted Cohen’s kappa was 0.49, implying moderate agreement amongst raters. Overall, ChatGPT was able to provide relatively accurate and concise responses to these common questions. Conclusions Our results demonstrate the capability of using ChatGPT as a potentially reliable source of information for patients desiring vasectomy counseling. Given the high clinical volume faced by many vasectomy providers, ChatGPT could possibly improve patient satisfaction and reduce provider burden. Further collection of real-world data is needed to better assess the accuracy and reliability of ChatGPT’s responses. Sexual medicine specialists should be aware of the strengths and limitations of emerging AI technologies as a medium for providing accurate health information to patients. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Fellow, Posterity Health, Coloplast, Hims, Genentech.

Right message, right medium, right time: powering counseling to improve maternal, infant, and young child nutrition in South Asia.

Quality counseling can positively impact maternal, infant and young child nutrition (MIYCN) behaviors linked to poor nutrition outcomes. Global guidance includes 93 recommendations on MIYCN counseling. A desk review and key informant interviews sought to assess compliance to the recommendations, reach and quality, systemic gaps and opportunities for MIYCN counseling in seven South Asian countries. Ninety-three (93) policies and guidelines, 180 counseling materials and over 50 documents were reviewed; 115 key informant interviews were conducted. Information synthesis captured eight domains. Data from national surveys were analyzed to determine MIYCN counseling reach, quality and association with nutrition behaviors. Results showed that national guidelines were inconsistent with global recommendations for seven thematic areas. Coverage of contacts points like antenatal and postnatal care (ANC, PNC) with potential to deliver MIYCN counseling was highly variable. Having at least four ANC contacts was significantly associated with consumption of 100+ iron folic acid tablets in all countries. Rates of early initiation of breastfeeding (18% Pakistan to 90% Sri Lanka) were lower than institutional delivery rates, except for Bangladesh and Sri Lanka. PNC contact within 48 h of birth was positively correlated with exclusive breastfeeding in India, Pakistan and Sri Lanka (OR 1.4, 3.1, 3.2). Health worker contacts and wealth status equally influenced child's dietary diversity in India. MIYCN services were add-on roles for community-based workers, except in India. Supervision mechanisms exist but were not focused on quality of MIYCN services. Counseling resources were predominantly paper based (>70%), had rural-focused messaging on diets and mainly targeted women. Platforms to engage men were largely missing. Health management information systems included indicators on maternal contact points in all countries but not for children. Assessing funding for MIYCN counseling was challenging as costs were subsumed across several budget line-items. The research findings can be used to (1) align country guidance with global recommendations, (2) review workforce responsibilities and capacity building with supervision, (3) assess the need for new counseling materials based on coverage of content, service providers and audience, (4) integrate MIYCN counseling indicators in information systems and (5) include MIYCN counseling services with activities and budget in country plans.

Firearm Safety Screening in the Pediatric Hospital Setting: A Quality Improvement Initiative.

Firearm injuries are a leading cause of morbidity and mortality for US youth. Secure storage is protective against firearm injuries in children. Despite this evidence and national recommendations, rates of firearm safety screening among pediatric providers are low, particularly in the inpatient setting. Therefore, we aimed to increase the frequency of firearm safety screening among patients admitted to the Pediatric Hospital Medicine service. This project occurred in a tertiary pediatric hospital with a medium-sized pediatric residency program. The initial intervention was a firearm safety screening tool embedded into the electronic health record history and physical note template. Subsequent interventions included nursing education, monthly reminder emails, and gun violence discussions during intern orientation. Patients who screened positive were provided with educational materials and a free gun lock. Data collection occurred by chart review to determine the frequency of screening documentation in the H&P. A survey was also conducted among pediatric residents to identify persistent barriers to screening. The percentage of inpatient firearm safety screening increased from 0.01% to 39% over 25 months, with a centerline shift noted after 2 months. Residents cited a lack of time with the patient and a belief that it was not the appropriate time to screen as persistent barriers to screening. This study identified an effective approach to improving firearm safety screening in an academic pediatric hospital. Hospitalization represents a unique opportunity for firearm safety screening and counseling, and inpatient providers should feel empowered to intervene in this setting.

Attitudes Toward Injection Practices Among People Who Inject Drugs Utilizing Medical Services: Opportunities for Harm Reduction Counseling in Health Care Settings.

Hospitals are an important setting to provide harm reduction services to people who inject drugs (PWID). This study aimed to characterize PWID's injection practices, the perceived risk and benefits of those practices, and the immediate IDU risk environment among individuals seeking medical care. Surveys were administered to 120 PWID seeking medical services at an urban hospital. Poisson regression was used to examine the effect of perceived risk or importance of injection practices on the rate of engaging in those practices. The mean participant reported "often" reusing syringes and "occasionally" cleaning their hands or skin prior to injection. 78% of participants reported that syringes were extremely risky to share, which was associated with lower likelihood of sharing them (ARR: 0.59; 95% CI: 0.36-0.95). 38% of participants reported it was extremely important to use a new syringe for each injection, and these participants were more likely to report never reusing syringes >5 times (ARR: 1.62, 95% CI: 1.11-2.35). Other factors that may influence injection practices-including fear of arrest, withdrawal, lack of access to supplies, and injecting outdoors-were common among participants. In conclusion, practices that place PWID at risk of injury and infection are common, and risk-benefit perception is associated with some, but not all, injection practices. Injecting in challenging environments and conditions is common. Therefore, harm reduction counseling in medical settings must be accompanied by other strategies to reduce risk, including facilitating access to supplies. Ultimately, structural interventions, such as affordable housing, are needed to address the risk environment.

Surgical outcomes and prediction of complications following high complexity buried penis reconstruction.

With uniform modern approaches to adult acquired buried penis reconstruction, this study provides updated results on surgical outcomes for complex cases while evaluating the relative influence of medical, surgical, and socioeconomic factors on these results. Retrospective review was conducted of all patients undergoing initial buried penis reconstruction including escutcheonectomy and penile skin grafting at one tertiary center from 2015 through 2022. Summary scores for frailty and socioeconomic status were calculated with the modified frailty index (mFI-5) and area deprivation index (ADI), respectively. The cohort included 103 patients. Median age was 51 years (IQR 44-65), and median body mass index was 43 (IQR 38-49). Frail patients (>/= 2 mFI-5 risk factors) accounted for 27% of the population while socioeconomic disadvantage (>/= 85th percentile on ADI) affected 33% of patients. 28% of repairs included a panniculectomy. Rate of revision for a poor outcome was 3.9% with median follow up of 11 months. Complications were frequent (50%) with most being Clavien I or II (41%) and related to wound dehiscence (31%) or infection (30%). Frail patients had a higher rate of complication (71 v. 41%, p = 0.01) and were six times more likely to experience a complication on multivariable logistic regression (OR 6.41, 95% CI: 1.77-23.22, p = 0.005). The modern approach to complex buried penis reconstruction results in a low revision rate, however, low-grade complications are frequent. Patient frailty identifies those at highest risk for complication offering an opportunity for counseling and pre-operative preparation.

Retaining hospitality talent during COVID-19: the joint impacts of employee resilience, work social support and proactive personality on career change intentions

PurposeDue to the COVID-19 pandemic, many people have experienced career shocks, especially employees in the hotel industry. To address how to retain talent in the industry, this study aims to examine the joint impacts of employee resilience, work social support and proactive personality on hotel employees’ career change intentions.Design/methodology/approachA survey questionnaire was developed to test the proposed framework. Data from 339 current hotel employees in the USA was analyzed using the PROCESS model.FindingsResults show a significant three-way interaction, indicating that for less proactive employees, resilience is negatively associated with career change intentions. However, for highly proactive employees, an additional situation cue in the form of strong work social support is required to activate the expression of resilience. Highly proactive and resilient employees who receive strong supervisor or coworker support during the pandemic have lower career change intentions. However, highly proactive employees who receive weak supervisor or coworker support exhibit similar levels of career change intentions, regardless of resilience level.Practical implicationsHotel managers should consider helping employees enhance their resilience and overcome career shocks by providing training and resources and establishing a learning culture. More importantly, it is essential to offer strong supervisor and coworker support to promote resilience among proactive employees. Hotel managers should actively promote strong work social support, and offer training and counseling opportunities to promote employee retention during the pandemic.Originality/valueTo the best of the authors’ knowledge, this study is the first to examine employee resilience in the hospitality field. This study contributes to the employee resilience literature as well as trait activation theory by examining situational cues that can activate employee resilience and by providing empirical evidence to reveal the boundary conditions of how employee resilience impacts career change intentions.

A Focus on Contraception in the Wake of Dobbs.

A Focus on Contraception in the Wake of Dobbs.

Empowering Rehabilitation: An Exploration of Legal Counselling's Role in Female Inmate Assimilation at Indonesian Penitentiaries

This study aims to examine the implementation of community service activities as part of the Tri Dharma Perguruan Tinggi (Three Pillars of Higher Education) by lecturers, focusing on legal counseling on Islamic law for female inmates at Class II A Tembilahan Penitentiary. The research employs a direct field approach, offering lectures related to Islamic law and providing counseling opportunities. It spans over a period from January 2023 to March 2023. The findings indicate a noticeable increase in legal awareness and a potential for assimilation among female convicts, contributing to their mental development and promoting repentance. These measures are anticipated to result in a deterrent effect, preventing the recurrence of past transgressions. The implications of this research underline the crucial role of academic involvement in penitentiaries, specifically highlighting the impact of integrating the teaching of Islamic law into the rehabilitation of female convicts.
 Highlights:
 
 Implementation of legal counseling by academic lecturers contributes significantly to the increase of legal awareness among female inmates at Class II A Tembilahan Penitentiary.
 Lectures on Islamic law over a three-month period contributed to noticeable mental development and a sense of repentance among the inmates.
 The integration of academic community services in penitentiaries presents a potential deterrent effect and reduces the chances of inmates repeating past transgressions.
 
 Keywords: Legal Counseling, Islamic Law, Female Inmates, Rehabilitation, Assimilation
 
 

Empowering Rehabilitation: An Exploration of Legal Counselling's Role in Female Inmate Assimilation at Indonesian Penitentiaries

This study aims to examine the implementation of community service activities as part of the Tri Dharma Perguruan Tinggi (Three Pillars of Higher Education) by lecturers, focusing on legal counseling on Islamic law for female inmates at Class II A Tembilahan Penitentiary. The research employs a direct field approach, offering lectures related to Islamic law and providing counseling opportunities. It spans over a period from January 2023 to March 2023. The findings indicate a noticeable increase in legal awareness and a potential for assimilation among female convicts, contributing to their mental development and promoting repentance. These measures are anticipated to result in a deterrent effect, preventing the recurrence of past transgressions. The implications of this research underline the crucial role of academic involvement in penitentiaries, specifically highlighting the impact of integrating the teaching of Islamic law into the rehabilitation of female convicts.
 Highlights:
 
 Implementation of legal counseling by academic lecturers contributes significantly to the increase of legal awareness among female inmates at Class II A Tembilahan Penitentiary.
 Lectures on Islamic law over a three-month period contributed to noticeable mental development and a sense of repentance among the inmates.
 The integration of academic community services in penitentiaries presents a potential deterrent effect and reduces the chances of inmates repeating past transgressions.
 
 Keywords: Legal Counseling, Islamic Law, Female Inmates, Rehabilitation, Assimilation
 
 

Bridging the gap in knowledge and use of antibiotics among pediatric caregivers: comparing two educational interventions

BackgroundThe inappropriate use of antibiotics in pediatrics contributes to antimicrobial resistance. Behavior change intervention involving education to improve the use of antibiotics is a strategy included in antimicrobial stewardship. This study aims to evaluate and compare the impact of two educational interventions on knowledge of antibiotic and its use among pediatric home caregivers.MethodsThis was a cross-sectional study conducted in the pediatric out-patient department of a healthcare facility. A structured questionnaire was administered to sixty pediatric caregivers. Pediatric caregivers were grouped in two of 30. Caregivers in a group filled the questionnaire, and refilled the same questionnaire after a one-on-one education. The second arm refilled the questionnaire after a group education. Ethical clearance was obtained and participants gave consent. Data analysis was done using SPSS version 22 and Graph pad Instat, p values < 0.05 were considered significant.ResultsFouty-nine (81.7%) participants believe that antibiotics can treat malaria infection [8(13.3%) after education)], 43(71.7%) of respondents agreed that antibiotics can be used to treat all kinds of diarrhea, while 45(65%) of them thought that antibiotics in powder form can be reconstituted with hot or warm water before use [7(11.7%) after education]. Mean score among the sixty participants before and after education on knowledge and use of antibiotics were 36.1 ± 6.467 versus 46.7 ± 4.027 (p≤0.0001) and 29.82 ± 4.949 versus 36.92 ± 3.997 (p≤ 0.0001), respectively. Mean score on knowledge and use of antibiotics for one-on-one versus group education were 46.7 ± 4.027 versus 43.3 ± 6.249 (p = 0.022) and 37.9 ± 3.044 versus 35.93 ± 4.608 (p = 0.039), respectively.ConclusionsMany pediatric caregivers had poor knowledge on antibiotics and use which improved significantly after education. One-on-one education has more impact than group education. Pharmacists and other healthcare professionals can use counseling opportunity to inform caregivers on appropriate knowledge and use of antibiotics consistently to change behavior.

Severe impact on family planning programme due to COVID-19 pandemic in urban population

Background: Contraception and sexual health are a fundamental human right and an integral part of women’s health services. Postpartum period is the unique opportunity for counseling and availing contraception. COVID-19 pandemic hindered routine and special services like postpartum clinics has negative impact on family planning services. Aims and Objectives: The objective of study was to compare the change in contraceptive services due to COVID-19 in two consecutive financial years (2019–2020 and 2020–2021) at Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India. Materials and Methods: An institution-based, retrospective, and cohort study was carried out in Nil Ratan Sircar Medical College and Hospital among the users of contraceptive services at the department of family planning for the financial year 2019–2020 and 2020–2021. During the period, 226,700 beneficiaries attended department of family planning for the financial year 2019–2020 and 98,584 beneficiaries attended department of family planning for the financial year 2020–2021. Template was generated in MS excel sheet and analysis was done on SPSS software. Results: During the year 2019–2020, 94.73% availed combined oral contraceptives while in the year 2020–2021, 93.97% availed combined oral contraceptives. Lap ligation was decreased by 96.42%, post-abortion ligation was decreased by 85%, Interval IUCD was decreased by 79.62% and PAIUCD was decreased by 76%. During the year 2019–2020, OCP was used by the maximum beneficiaries, that is, 219,654 while in the year 2020–2021 OCP was used by 97,353 beneficiaries. Conclusion: During COVID-19 pandemic, family planning services suffer a huge setback as it is does not came under emergency services. With the ongoing COVID-19 crisis and continuous need for contraception, there is a need to refocus and motivate eligible couples for long-acting reversible contraceptive methods with significantly lower failure rates.

(437) Post-Vasectomy Semen Analysis (PVSA) Compliance Rates and Associations

Abstract Introduction Vasectomy is a highly effective, permanent method of contraception. Poor compliance rates have been observed for patients in obtaining their post-vasectomy semen analyses (PVSA). Few studies have looked at associations with low compliance. Objective The objective of our study was to identify compliance rates of post-vasectomy semen analysis and to identify associations that may increase or decrease the rates of compliance. Methods We studied 111 patients between November 2018 and April 2022 who underwent vasectomy at a single institution. Only patients who underwent vasectomy for fertility-related reasons were included in our final analysis. We excluded any patients who had undergone previous vasectomy or vasectomy reversal. Variables analyzed included age, relationship status, presence of primary care provider, anxiety diagnosis, and race. Variables were obtained via chart review which included but was not limited to reviewing notes, summary diagnostic pages, problem lists, and medication lists. All analyses were performed using R version 4.1.2 (R Foundation for Statistical Computing, Vienna, Austria). Categorical data were described with the number and percentage of patients. Continuous data were described with the median, minimum, and maximum. Associations of race and anxiety diagnosis with PVSA were explored using Fisher’s exact test. All p-values were two-sided at the 5% significance level without adjustment for multiple testing. Results Our cohort included 111 men who underwent vasectomy with exclusion of 1 patient who underwent vasectomy for non-fertility reasons. The median age of vasectomy was 38 years (range 26-59 years). Of 110 patients, 83 (75%) returned for PVSA. There were 103 (94%) married patients. Additional cohort characteristics can be seen in Table 1. As shown in Table 2, African American patients were less likely to return for PVSA than either white patients (14% vs. 79%, p&amp;lt;0.001) or Hispanic patients (14% vs. 100%, p=0.015). we did not find evidence of difference between white and Hispanic patients (p=0.58). Patients with an anxiety diagnosis were more likely to undergo PVSA compared to patients without an anxiety diagnosis (p&amp;lt;0.001). Conclusions Patients in our cohort of African American race were significantly less likely to undergo PVSA compared to white and Hispanic patients. This suggests an opportunity for improved counseling in the African American population. We do recognize a disparity in the number of white patients studied (n=95) versus African American (n=7) and Hispanic (n=5) patients. Additionally, patients with an anxiety disorder were more likely to undergo PVSA compared to patients without an anxiety disorder. The prevalence of anxiety disorder in our cohort is somewhat high relative to the overall population in the United States. This could be due to questionnaires used at our institution and the timeliness of those questionnaires. Personality traits could also lead to confounding in anxiety diagnoses. Overall, a 75% rate of PVSA speaks to an opportunity for better counseling regarding PVSA, especially in particular populations such as the African American population. Disclosure No

Adolescents’ self-reported health status, behaviours and health issues addressed during routine school doctor consultations in Switzerland: an observational study

We aimed to investigate the self-reported health status and behaviours of 7th-grade adolescents, associations with gender and educational track, as well as health issues addressed during routine school doctor consultations in Switzerland. Data on health status and behaviours, specifically general well-being, stimulant and addictive substance use, bullying/violence, exercise, nutrition and health protection, and puberty/sexuality, were drawn from routinely collected self-assessment questionnaires from 1076 (of a total of 1126) students from 14 schools in the Swiss canton of Zug in 2020. Data on health issues addressed in school doctor consultations were collected by nine school doctors (for 595 individual consultations). Multilevel logistic regression analyses were used to investigate the association of gender and educational track with unfavourable health status or behaviours. Although 92% (n = 989) of the students reported being happy or satisfied overall, 21% (n = 215) often or almost always felt sad, and 5-10% had repeatedly been seriously physically hurt (n = 67), sexually harassed with words (n = 88) or experienced uncomfortable physical contact (n = 60). Female gender and a lower educational track were associated with unfavourable health status. In 90% (n = 533) of the school doctor consultations, at least one topic of disease prevention or health promotion was addressed, whereby the topics addressed depended strongly on the individual school doctors. Our findings revealed that unfavourable health status and behaviours were prevalent among adolescents but the health topics addressed in school doctor consultations were not tailored to students' self-reported health issues. A school-based approach that strengthens adolescents' health literacy and provides opportunities for patient-centred counselling has the potential to improve the current and future health of adolescents and, ultimately, adults. To realise this potential, it is essential for school doctors to be sensitised and trained to address students' health concerns. Emphasis should be placed on the importance of patient-centred counselling, the high prevalence of bullying, and gender and educational differences.

Psychosocial distress and quality of life in patients after radical cystectomy – one year follow-up in 842 German patients

PurposeThis study aims to report on psychosocial distress and QoL in bladder cancer patients after radical cystectomy (RC) and urinary diversion to obtain a better basis for patient counseling and postoperative care.MethodsThe study relied on prospectively collected data for 842 patients, who underwent three weeks of inpatient rehabilitation after RC and creation of an ileal conduit (IC) or ileal neobladder (INB). Data on QoL and psychosocial distress were collected by validated questionnaires. Multivariate logistic regression was performed to identify predictors for high psychosocial distress.ResultsFour-hundred and forty-seven patients (326 male, 121 female) received an IC, while 395 patients (357 male, 38 female) received an INB. Health-related QoL improved steadily in the whole cohort during follow-up. Patients with an INB reported better physical function but suffered more from diarrhea and financial worries. Patients with an IC reported reduced satisfaction with their body image, increased worries about the future, and suffered more from constipation. Psychosocial distress increased significantly during follow-up. One year after surgery, 43.1% of patients suffered from high psychosocial distress. Multivariate regression analysis identified age ≤ 59 years (OR 1.731; CI 1.056–2.838; p = 0.030) and lymph node metastases (OR 2.073; CI 1.133–3.793; p = 0.018) as independent predictors for high psychosocial distress.ConclusionQoL improves significantly in all patients one year after RC. However, psychosocial distress remains high in a substantial number of patients.Implications for Cancer SurvivorsTo prevent chronic psychological disorders, easily accessible opportunities for psycho-oncological counseling are needed for patients following RC.

Comprehensive Genomic Profiling Detects Hereditary Cancers and Confers Survival Advantage in Patients With Gynaecological Cancers.

The clinical benefits of comprehensive genomic profiling (CGP) of tumours in patients with gynaecological cancers remain unknown. We investigated the utility of CGP in assessing patient survival and its efficacy in detecting hereditary cancers in gynaecological patients. We retrospectively analysed the medical records of 104 gynaecological patients who underwent CGP between August 2018 and December 2022. The detection of actionable and accessible genomic alterations and administration of targeted therapy, as recommended by the molecular tumour board (MTB), were assessed. The overall survival (after second-line treatment in cervical and endometrial carcinomas and after platinum-resistant recurrence in ovarian carcinoma) was compared between patients with or without administration of MTB-recommended genotype-matched therapy. Germline findings were assessed using a variant allele frequency-tumour content graph. Among 104 patients, actionable and accessible genomic alterations were observed in 53 patients. Matched therapy was applied in 21 patients, comprising administration of repurposing itraconazole (n=7), immune checkpoint inhibitors (n=7), poly (ADP-ribose) polymerase inhibitors (n=5), and others (n=2). The median overall survival of patients receiving and not receiving matched therapy were 19.3 months and 11.2 months, respectively (p=0.036, hazard ratio=0.48). Among 12 patients with hereditary cancers, 11 patients were previously undiagnosed. Seven patients had hereditary breast and ovarian cancer, and five had other cancer. The implementation of CGP testing prolonged overall survival in gynaecological cancer as well as provided an opportunity for genetic counselling for newly-diagnosed patients with hereditary cancers and their families.

Clinical risk management of breast, ovarian, pancreatic, and prostatic cancers for BRCA1/2 variant carriers in Japan.

Opportunities for genetic counseling and germline BRCA1/2 (BRCA) testing are increasing in Japan owing to cancer genomic profiling testing and companion diagnostics being covered by national health insurance for patients with BRCA-related cancers. These tests are useful not only to judge whether platinum agents and PARP inhibitors are indicated but also to reveal an autosomal-dominant inherited cancer syndrome: hereditary breast and ovarian cancer. In individuals with germline BRCA variants, risk of cancers of the breast, ovary, pancreas, and prostate is significantly increased at various ages of onset, but the stomach, uterus, biliary tract, and skin might also be at risk. For women with pathogenic BRCA variants, breast awareness and image analyses should be initiated in their 20s, and risk-reducing procedures such as mastectomy are recommended starting in their 30s, with salpingo-oophorectomy in their late 30s. For male BRCA pathogenic variant carriers, prostatic surveillance should be applied using serum prostate-specific antigen starting in their 40s. For both sexes, image examinations ideally using endoscopic ultrasound and magnetic resonance cholangiopancreatography and blood testing should begin in their 50s for pancreatic surveillance. Homologous recombination pathway-associated genes are also causative candidates. Variant pathogenicity needs to be evaluated every 6-12 months when results are uncertain for clinical significance. Genetic counseling needs to be offered to the blood relatives of the pathogenic variant carriers with suitable timing. We review the recommended cross-organ BRCA risk management in Japan.

The Postpartum Period: An Opportunity for Alcohol Screening and Counseling to Reduce Adverse Health Impacts.

The postpartum period presents an opportunity to engage in discussions about alcohol consumption and related health harms. This study examined the prevalence of alcohol consumption among a sample of postpartum persons with a recent live birth and screening and brief intervention (alcohol SBI) or counseling by their providers. We analyzed 2019 data from a telephone survey conducted 9 to 10 months postpartum among individuals who responded to the standard Pregnancy Risk Assessment Monitoring System survey in 6 states. Weighted prevalence estimates were calculated for alcohol consumption and alcohol SBI after birth through up to 10 months postpartum. Among 1790 respondents, 53.1% reported consuming alcohol postpartum. Among those who drank postpartum, 70.8% reported being asked about alcohol use by a healthcare provider. Slightly more than half of respondents who drank postpartum and were trying to get pregnant (52.4%) or were not using birth control at the time of the survey (59.8%) reported being asked about alcohol use. Approximately 25% of respondents who drank alcohol postpartum were advised about risky alcohol levels by a healthcare provider. Small proportions of individuals who drank alcohol postpartum and were pregnant or trying to get pregnant at the time of the survey were advised to reduce or stop drinking alcohol (10.6% and 2.3%, respectively). These findings suggest missed opportunities to promote health and prevent adverse alcohol-related health outcomes during the postpartum period through evidence-based tools such as alcohol SBI.

Continuation Rates of the Etonogestrel Implant and Factors Associated With Early Discontinuation.

The etonogestrel implant is generally consideredaneffective, three-year, long-acting reversible contraceptive device. Previous research, such as the landmark CHOICE study, has reported a one-year continuation rate of 72% to 84%, however, in a real-world setting these rates may be significantly lower. To study etonogestrel implant continuation rates and factors associated with early discontinuation in a specific clinical setting. Single-center, retrospective cohort study of patients who received the etonogestrel implant between January 1, 2015, and December 31, 2017, at several practices at an academic community hospital network. Records were reviewed up to three years after implant insertion to determine continuation rates (oneto threeyears), early discontinuation rates (≤12 months), and reasons for early discontinuation. A sample size calculation was performed to guide a subanalysis of side effects. A total of 774 patients underwent etonogestrel insertion during the study period.The one-year continuation rate was lower than that of the CHOICE study (62% vs. 83%, P <0.001). A subanalysis (n=216) revealed that a majority (82%, n=177) of patients reported side effects. Side effects were more common in patients with early discontinuation compared with patients who continued use longer than one year (93% vs. 71%, P <0.001). The most common side effect, abnormal uterine bleeding, was not significantly associated with early discontinuation. A significant association (P=0.02) was found between early discontinuation and neurologic/psychiatric complaints. The one-year continuation rate of the etonogestrel implant inourpopulation is significantly lower than the value reported by CHOICE. Implant side effects are common and significantly affect rates of discontinuation. Our data suggest there is an opportunity for education and counseling for individuals opting for this method of long-acting contraception.