Mount Auburn Hospital

INTRODUCTION: Urinary incontinence is a widely prevalent, yet undertreated condition. High-intensity focused electromagnetic (HIFEM) devices offer patients a non-invasive, non-pharmacologic alternative treatment for urinary incontinence. There is a paucity of non-industry-sponsored studies of the efficacy of HIFEM devices for the treatment of urinary incontinence. OBJECTIVE: The primary objective was to assess the efficacy of HIFEM for the treatment of overactive bladder and stress urinary incontinence. METHODS: Eligible patients with stress or urge-predominant urinary incontinence were enrolled in a double-blind, stratified block randomized sham-controlled trial and assigned in a 1:1 ratio. Participants received a total of six HIFEM sessions delivered at either therapeutic or sham (subtherapeutic) intensity. The primary outcome was treatment success defined as a response of “little better,” “much better,” or “very much better” on the PGI-I questionnaire. Secondary outcomes included changes in validated questionnaires: Pelvic Floor Disability Index (PFDI-20), Pelvic Floor Impact Questionnaire (PFIQ), Female Sexual Function Index (FSFI), and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ) scores, which were administered at baseline, two weeks, and three months after completion of treatment. Continuous variables were evaluated using Student t-test and categorical variables were assessed with chi-square or Fishers exact t-test, as needed. Variables with a p-value of less than 0.05 were considered to be significant. RESULTS: A total of 34 patients were enrolled and randomized: 19 to treatment and 15 to sham protocol. Baseline demographics including average age, BMI, and parity did not significantly differ between groups (Table 1). At the conclusion of the three-month follow-up, 12 patients completed the treatment protocol, and 12 patients completed the sham protocol. In the primary analysis at two weeks, more patients in the treatment protocol reported symptom improvement based on PGI-I compared to sham protocol (p=0.04). This improvement was sustained at three months, with PGI-I scores indicating improvement for those in the treatment protocol when compared to sham protocol (p=0.04). The secondary outcomes of PFDI-20, PFIQ-7, FSFI, or PISQ scores showed no difference between those in the treatment protocol and those in the sham protocol at either two weeks or three months (Table 2). After completing the study, a total of 12 patients, 2 (22%) from the sham protocol and 10 (83%) from the treatment protocol, opted for further treatment of their urinary symptoms. This included pelvic floor physical therapy (n=3), incontinence pessary (n=1), midurethral sling (n=3), beta-3-agonist (n=5), intradetrusor onabotulinumtoxina (n=2), or sacral neuromodulation device (n=1). CONCLUSIONS: Although underpowered, this randomized controlled trial demonstrated significantly improved patient-reported outcomes following HIFEM treatment for urinary incontinence. However, as most patients sought additional treatments, larger trials are needed to confirm these efficacy results.Table 1Table 2

To explore factors associated with burnout among childbearing practicing and trainee surgeons. Burnout among physicians is twice as prevalent as in the general population, with higher rates among childbearing surgeons. This negatively impacts surgeons' mental health and the quality of patient care while increasing healthcare costs, underscoring the urgent need to identify and address modifiable risk factors. Explanatory sequential mixed methods design using a survey distributed to members of the American College of Surgeons. Among 932 U.S. childbearing practicing and trainee surgeons, 55% reported burnout. In adjusted analysis, burnout was associated with lack of workplace support (LOWS, defined as childbearing-related stigma, pressure not to have children, and concerns about pregnancy-related workload or duty coverage) (OR 2.10, P<0.001), major pregnancy complications (OR 1.59, P=0.003), and prolonged standing (12 or more hours per week) during the third trimester of pregnancy (OR 1.52, P=0.007). Thematic network analysis of free-text comments revealed four global themes: 1) Work-family conflict contributes to burnout; 2) Insufficient accommodations for obstetric complications heighten burnout and career dissatisfaction; 3) LOWS adversely impacts well-being and personal relationships; and 4) The negative culture toward motherhood hinders career progression and undermines a sense of personal accomplishment. Female surgeons and surgical trainees face increased burnout from lack of workplace support, major pregnancy complications, and excess physical demands during pregnancy. These emphasize the need for systemic changes including policy reform, cultural shifts, and targeted interventions to support career satisfaction and equity.

Obstetric complications affect many surgeons and their childbearing partners, yet workplace dynamics surrounding pregnancy remain underexplored. To analyze the prevalence of obstetric complications among childbearing surgeons and childbearing partners of surgeons, identify the occupational risk factors associated with these complications, and explore the lived experiences related to obstetric complications. This survey study used convergent mixed-methods analysis of data from a 2024 survey of US surgeons administered to select members of the American College of Surgeons. The survey, which was available online from March to May 2024 and included free-text responses, asked about experiences related to family building, including obstetric complications and workplace support during pregnancy. Pregnancy or parenthood. Lack of workplace support (LOWS) was defined as feeling unsupported when reducing workloads during pregnancy, being discouraged from having children, being worried about childbearing-related stigma, and perceiving that childbearing conflicted with contractual obligations. Multivariable logistic regression models examined occupational factors associated with major pregnancy complications, comparing partners of nonchildbearing surgeons with childbearing surgeons and including and excluding exposures to LOWS. Qualitative thematic network analysis of free-text answers identified themes related to obstetric complications and perceptions of related workplace culture. Of 3125 respondents (9.5% response rate among 32 890 eligible surgeons), 1473 surgeon-parents were included; 949 (64.4%) were female, and 524 (35.6%) were male. Obstetric complications (eg, placental insufficiency, placenta previa, and intrauterine growth restriction) more often impacted female surgeons (295 [31.1%] female vs 120 [22.9%] males; P = .001) even after adjusting for demographics, multiple gestation, work hours, and time standing at work (odds ratio [OR], 1.34; 95% CI, 1.01-1.78). LOWS was more common among female than male surgeons (606 [64.4%] vs 167 [31.9%]; P < .001). Adjusting for LOWS eliminated the sex-based differences in obstetric complications (odds ratio, 1.19; 95% CI, 0.89-1.59). Qualitative analysis of 697 free-text responses revealed 3 major themes: (1) physical demands of surgical work negatively impact pregnancy outcomes, (2) cultural norms discourage workplace accommodations, and (3) limited parental leave policies exacerbate challenges after pregnancy complications. Pregnancy-related LOWS is a modifiable mediator of increased obstetric risk that disproportionately affects female surgeons. Addressing flexibility stigma, improving institutional support, and implementing policies that align with contemporary family needs are essential to foster gender equity in family building among surgeons.

Abstract Recognition of one’s positive qualities is fundamental to human dignity. Research in the cultural sociology of morality, worth, and evaluation has explored how individuals respond to stigmatization and moral devaluation, emphasizing the recognition claims that they formulate. However, less attention has been given to what happens when such claims are rejected. This study addresses this gap by examining elite philanthropy: a practice that forms part of claims by economic elites to moral worth, but which is also challenged by a critical public view. Analyzing how elite philanthropists account for such challenges, we identify a sequence of evaluations and devaluations whereby philanthropy is evaluated, the critical public view is devaluated, and the focus of the moral debate is shifted to other social issues. This sequence results in a recognition claim about the moral worth of philanthropy and in what we refer to as a negation claim, whereby social actors discredit the public view. Recognition and negation claims reflect two distinct, but not necessarily incompatible, ways in which social actors wrestle with moral devaluation. This distinction, we argue, is conceptually and analytically important for analyzing the responses of social actors to moral devaluation, and has implications for the study of dominance and symbolic inequality.

This national survey aimed to describe the work settings, characteristics, employment activities, scope, functions, and challenges of the pharmacist workforce responsible for infectious diseases (ID) and antimicrobial stewardship (AMS)-related tasks in the U.S. An internet-based Qualtrics XM survey was distributed to 22,749 unique individuals with potential ID or AMS job responsibilities via email listservs for three national pharmacy organizations, and was open from 9/25/2024 to 10/24/2024. A respondent was considered engaged in ID/AMS activities if they reported involvement in at least one of 14 activities directly related to ID/AMS. A total of 796 pharmacists with ID or AMS job responsibilities responded (3.5% response rate), with 607 working clinically or administratively in ID or AMS further categorized in four mutually exclusive groups based on formal and informal ID/AMS responsibilities. Respondents were predominantly female (66%), less than 40 years of age (59%) and white (82%). ID-specific training was completed by 41.8%, and 74% reported having student loan debt at graduation. Work-related activities were diverse and most frequently included: staffing or taking calls on weekends related to ID/AMS, AMS, educating learners or healthcare providers about ID-related topics, precepting learners, and conducting ID-related research and/or quality improvement projects. Respondents frequently indicated they lacked adequate job resources. The results highlight the extensive responsibilities placed on ID/AMS pharmacists to fulfill multiple roles. Pharmacists frequently lack ID-specific training or dedicated time for AMS responsibilities. The workforce is young, suggesting a need for both increased capacity for training programs and strategies for workforce retention.

PurposeDespite the need for advanced hemodynamic monitoring, the role of the pulmonary artery catheter (PAC) in cardiogenic shock (CS) remains controversial due to conflicting evidence from previous studies.Material and MethodsThis single-center retrospective study utilized the MIMIC-IV database to assess the impact of PAC use on 30-day in-hospital mortality and clinical outcomes in CS patients admitted between 2008 and 2019. Propensity score matching (PS) and inverse propensity treatment weighting (IPTW) were employed to adjust for baseline differences. The primary outcome was 30-day in-hospital mortality; secondary outcomes included hospital and ICU length of stay and complications. Cox proportional hazard ratio analyses were performed to evaluate the association between PAC use and mortality outcomes.ResultsThe final cohort consisted of 1940 adult CS patients, with 134 receiving PAC and 1806 not. PAC use significantly reduced 30-day in-hospital mortality (PS-matched HR 0.57, 95% CI: 0.39-0.83; IPTW HR 0.58, 95% CI: 0.35-0.96) but was associated with longer hospital stays (16.47 vs 12.37 days) and ICU stays (9.26 vs 7.52 days).ConclusionPAC use in CS patients was associated with improved short-term survival but also with longer hospitalization and potential complications, underscoring the need for careful patient selection and further research.

Strengthening midwifery education and the quality of midwifery care is one of the most impactful interventions to address maternal and newborn morbidity and mortality. In this perspective, we describe nine key components that make for an effective preceptor program that should be kept to ensure high fidelity and to support quality outcomes. A preceptor is an experienced healthcare provider who mentors students through structured experiences in the clinical setting to gain experience and apply their knowledge and skills in a supervised setting. For each of the nine key components, we delve into examples from a novel yearlong low-dose, high-frequency cohort preceptor program we developed to educate practicing midwives to become competent and confident preceptors of midwifery students in Sierra Leone. These nine key components include time, low cost, low-dose high frequency format, quality over quantity in cohorts, having a clinical component, partnership buy-in, ensuring an enabling learning environment and facilitators who can model ideal preceptor behavior, the ability to obtain accreditation for long-term sustainability, and leadership. Using these key components in other midwifery-led interventions may also prove beneficial. Finally, building in sustainability and having continuous measurement built into a program are also essential and should be considered when developing a new model of care or intervention. Ensuring midwives are equipped with quality education and prepared to provide quality care is essential to improving maternal health services for vulnerable populations globally.

Background: The role of diabetes mellitus (DM) in Type A aortic dissection (TAAD) mortality is controversial, with some studies suggesting protection and others equating DM to risk factors like hypertension (HTN), hyperlipidemia (HL), smoking, cocaine, and chronic kidney disease (CKD). Using the National Inpatient Sample (NIS) 2022, we assess DM’s impact on TAAD mortality, adjusting for confounders. Methods: From 32,891,849 hospitalizations, we identified 7,710 TAAD cases (ICD-10: I7100, I71010, I71011) via survey-weighted analyses. DM prevalence was 23.2% (95% CI: 21.0-25.4%); mortality was 12.3% (95% CI: 10.4-14.2%). Mean age was 66.1 years (95% CI: 65.3-66.9), with DM patients older (69.9 years, 95% CI: 68.5-71.2) than non-DM (64.9 years, 95% CI: 64.0-65.9). Females were 40.2% (95% CI: 37.3-43.1%) of non-DM and 44.5% (95% CI: 39.1-50.1%) of DM patients. Non-elective admissions were 6,860 (95% CI: 6,380-7,340); Univariate and multivariate logistic regressions assessed mortality, adjusting for age, HTN, HL, CKD, and a high-risk composite (smoking and cocaine). Results: Of 1,541 TAAD patients, 950 died (12.3%, 95% CI: 10.4-14.2%): 735 non-DM (12.7%, 95% CI: 10.6-14.9%) and 215 DM (12.0%, 95% CI: 8.4- 15.6%). Univariate analyses showed no DM-mortality link (OR: 0.966, 95% CI: 0.686-1.360, p=0.843), but age (OR: 1.029, 95% CI: 1.016-1.041, p&lt;0.001), HTN (OR: 0.472, 95% CI: 0.339-0.659, p&lt;0.001), and CKD (OR: 0.670, 95% CI: 0.469- 0.958, p=0.028) predicted mortality; high-risk composite was non-significant (OR: 0.193, p=0.107). Multivariate analysis, adjusting for age, HTN, HL, CKD, and high-risk composite, confirmed DM’s neutrality (OR: 1.108, 95% CI: 0.764-1.607, p=0.588). Age increased mortality (OR: 1.037, 95% CI: 1.024-1.050, p&lt;0.001); HTN (OR: 0.501, 95% CI: 0.355-0.708, p&lt;0.001), HL (OR: 0.482, 95% CI: 0.340- 0.681, p&lt;0.001), and CKD (OR: 0.659, 95% CI: 0.453-0.958, p=0.029) were linked to lower mortality; high-risk composite was non-significant (OR: 0.231, p=0.157). Conclusions: DM does not affect TAAD mortality, questioning its protective role. Age drives risk, while HTN, HL, and CKD’s lower mortality may reflect optimized management or selection bias, needing further study. Clinicians should focus on age-based risk and HTN/HL management

More than 80% of US maternal deaths are preventable yet maternity care in the United States (US) is becoming increasingly difficult to access. Recent years have seen the rise of maternity care deserts, defined as an area with no hospitals or birth centers offering obstetric care and without any obstetric providers. The number of counties without a birthing facility continues to grow, and 1/3 of US counties lack an obstetric clinician. The US has a maternal mortality rate that is 2-3 times greater than similar high-income countries, a steady rise in severe maternal morbidity, and markedly high infant mortality rates compared to similar countries. Traveling long distances to obtain obstetric care can impact whether a woman and infant survive an obstetric emergency such as hemorrhage. Nearly 2/3 of maternity care deserts are in rural areas, with the greatest need for maternity care located in the southern US. Maternity care deserts disproportionately impact rural, low-income, and Black women. The reasons for maternity closures are multifactorial, but are driven by hospital financial pressures and staff shortages. Government interventions are necessary to expand access to care and to keep critical obstetric units open. These interventions include increasing Medicaid reimbursements, expanding Medicaid access, expanding the perinatal workforce, setting standards for what constitutes safe distances between maternity units, and exploring mechanisms to leverage/reimagine existing programs to keep units open in critical areas. We call for urgent action given the serious public health threat to women and infants. We draw from diverse sources not commonly cited to comprehensively summarize the issues related to obstetric closures, outline the drawbacks of many previously proposed solutions, and propose some novel solutions.