Sanaa Suharwardy, MD

View details for Web of Science ID 000737459400241

View details for Web of Science ID 000737459401514

View details for Web of Science ID 000737459400099

Abstract

Prospective longitudinal cohorts assessing women's health and gynecologic conditions have been historically limited.The Apple Women's Health Study was designed to gain a deeper understanding of the relationship between menstrual cycles, health, and behaviors. This paper describes the design and methods of the ongoing Apple Women's Health Study and provides demographic characteristics of the first 10,000 participants.Mobile-application based longitudinal cohort study with survey and sensor-based data. We collected data from 10,000 participants who responded to the demographics survey upon enrollment between November 14, 2019 and May 20, 2020. Participants were asked to complete a monthly follow-up through November 2020. Eligibility criteria include having ever menstruated, installing the Apple Research app on iPhone with iOS version 13.2 or later, living in USA, age of 18 years or older in most states (19 years old in Alabama and Nebraska, 21 years old in Puerto Rico), proficiency in written and spoken English, sole user of an iCloud account or iPhone, and providing informed consent to participate in the study.Mean age at enrollment was 33.6 years old (+/- standard deviation 10.3). Race/ethnicity was representative of the US population [69% White/Non-Hispanic (6,910/10,000)], while 51% (5,089/10,000) had a college education or above. Participant geographic distribution included all U.S. states and Puerto Rico. Seventy-two percent (7,223/10,000) reported use of an Apple Watch, and 24.4% (2,438/10,000) consented to sensor-based data collection. For this cohort, 38% (3,490/9,238) did not respond to the Monthly Survey: Menstrual Update after enrollment. At the six-month follow-up there was a 35% (3,099/8,972) response rate to the Monthly Survey: Menstrual Update. 82.7% (8,266/10,000) of the initial cohort and 95.1% (2,948/3,099) of participants who responded to month 6 of the Monthly Survey: Menstrual Update, tracked at least one menstrual cycle via HealthKit. Participants tracked menstrual bleeding days an average of 4.44 (25-75% range: 3 - 6) calendar months during the study period. Non-White participants were slightly more likely to drop out than White participants; those remaining at 6 months were otherwise similar in demographic characteristics to the original enrollment group.The first 10,000 participants of the Apple Women's Health Study were recruited via the Research app and were diverse in race/ethnicity, educational attainment, and economic status, despite all using an Apple iPhone. Future studies within this cohort incorporating this high-dimensional data may facilitate discovery in women's health in exposure outcome relationships and population-level trends among iPhone users. Retention efforts centered around education, communication, and engagement will be utilized to improve survey response rates, such as the study update feature.

View details for Web of Science ID 000675441000663

View details for PubMedID 34610322

View details for DOI 10.1016/j.ajogmf.2020.100256

Abstract

Patients who present with brain tumors during pregnancy require unique imaging and neurosurgical, obstetrical, and anesthetic considerations. Here, we review the literature and discuss the management of patients who present with brain tumors during pregnancy. Between 2009 and 2019, 9 patients were diagnosed at our institution with brain tumors during pregnancy. Clinical information was extracted from the electronic medical records. The median age at presentation was 29 years (range, 25-38 years). The most common symptoms at presentation included headache (n=5), visual changes (n=4), hemiparesis (n=3), and seizures (n=3). The median gestational age at presentation was 20.5 weeks (range, 11-37 weeks). Of note, 8 patients (89%) delivered healthy newborns, and 1 patient terminated her pregnancy. In addition, 5 patients (56%) required neurosurgical procedures during pregnancy (gestational ages, 14-37 weeks) because of disease progression (n=2) or neurologic instability (n=3). There was 1 episode of postneurosurgery morbidity (pulmonary embolism [PE]) and no surgical maternal mortality. The median length of follow-up was 15 months (range, 6-45 months). In cases demonstrating unstable or progressive neurosurgical status past the point of fetal viability, neurosurgical intervention should be considered. The physiological and pharmacodynamic changes of pregnancy substantially affect anesthetic management. Pregnancy termination should be discussed and offered to the patient when aggressive disease necessitates immediate treatment and the fetal gestational age remains previable, although neurologically stable patients may be able to continue the pregnancy to term. Ultimately, pregnant patients with brain tumors require an individualized approach to their care under the guidance of a multidisciplinary team.

View details for DOI 10.1016/j.ajogmf.2020.100256

View details for PubMedID 33451609

View details for Web of Science ID 000525432601113

Abstract

PURPOSE OF REVIEW: The aim of this article is to describe enhanced recovery after surgery (ERAS) and its application to cesarean delivery.RECENT FINDINGS: ERAS is a standardized, multidisciplinary approach to improving the care of surgical patients, from the preoperative planning through the surgery and postoperative period. ERAS is associated with many benefits, including improved patient outcomes and satisfaction as well as reduced length-of-stay and cost. Obstetric implementation of ERAS protocols has lagged compared to other surgical subspecialties. Given the volume of cesarean deliveries worldwide, improving the quality and cost of care through broad application of ERAS could have significant benefits.SUMMARY: ERAS pathways specific to cesarean delivery should be implemented and can improve the quality of care provided.

View details for DOI 10.1097/GCO.0000000000000616

View details for PubMedID 32068543

View details for DOI 10.1016/j.ajog.2019.11.090

View details for Web of Science ID 000504997300075

View details for DOI 10.1016/j.ajog.2019.11.879

View details for Web of Science ID 000504997301190

View details for DOI 10.1016/j.ajog.2019.11.773

View details for Web of Science ID 000504997301086

View details for DOI 10.1016/j.ajog.2019.11.132

View details for Web of Science ID 000504997300116

View details for Web of Science ID 000454249401299

View details for DOI 10.1016/j.ajog.2018.11.530

View details for Web of Science ID 000454249401294

View details for DOI 10.1097/01.AOG.0000514324.24913.bb

View details for Web of Science ID 000402705800129

View details for DOI 10.1097/LGT.0000000000000196

View details for Web of Science ID 000372850200005

View details for DOI 10.1016/j.ajog.2015.10.682

View details for Web of Science ID 000367092800630

Abstract

Human immunodeficiency virus (HIV)-infected women are at increased risk of invasive cervical cancer; however, screening rates remain low. The objectives of this study were to analyze a quality improvement intervention to increase cervical cancer screening rates in an urban academic HIV clinic and to identify factors associated with inadequate screening. Barriers to screening were identified by a multidisciplinary quality improvement committee at the Washington University Infectious Diseases clinic. Several strategies were developed to address these barriers. The years pre- and post-implementation were analyzed to examine the clinical impact of the intervention. A total of 422 women were seen in both the pre-implementation and post-implementation periods. In the pre-implementation period, 222 women (53%) underwent cervical cancer screening in the form of Papanicolaou (Pap) testing. In the post-implementation period, 318 women (75.3%) underwent cervical cancer screening (p < 0.01). Factors associated with lack of screening included fewer visits attended (pre: 4.2 1.5; post: 3.4 1.4; p < 0.01). A multidisciplinary quality improvement intervention was successful in overcoming barriers and increasing cervical cancer screening rates in an urban academic HIV clinic.

View details for DOI 10.1080/09540121.2014.894610

View details for PubMedID 24625234

View details for PubMedCentralID PMC4065211