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Dason ES, Koshkina O, Chan C, Sobel M. Diagnostic et prise en charge du syndrome des ovaires polykystiques. CMAJ 2024; 196:E449-E459. [PMID: 38589030 PMCID: PMC11001390 DOI: 10.1503/cmaj.231251-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024] Open
Affiliation(s)
- Ebernella Shirin Dason
- Département d'obstétrique et de gynécologie (Dason), Système de santé Sinaï; Division d'endocrinologie (Koshkina), Département de médecine, Hôpital Women's College et Département d'obstétrique et de gynécologie (Chan, Sobel), Université de Toronto, Toronto, Ont.
| | - Olexandra Koshkina
- Département d'obstétrique et de gynécologie (Dason), Système de santé Sinaï; Division d'endocrinologie (Koshkina), Département de médecine, Hôpital Women's College et Département d'obstétrique et de gynécologie (Chan, Sobel), Université de Toronto, Toronto, Ont
| | - Crystal Chan
- Département d'obstétrique et de gynécologie (Dason), Système de santé Sinaï; Division d'endocrinologie (Koshkina), Département de médecine, Hôpital Women's College et Département d'obstétrique et de gynécologie (Chan, Sobel), Université de Toronto, Toronto, Ont
| | - Mara Sobel
- Département d'obstétrique et de gynécologie (Dason), Système de santé Sinaï; Division d'endocrinologie (Koshkina), Département de médecine, Hôpital Women's College et Département d'obstétrique et de gynécologie (Chan, Sobel), Université de Toronto, Toronto, Ont
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Dason ES, Maxim M, Gesink D, Yee M, Chan C, Baxter NN, Shapiro H, Simpson AN. Medical Students' Perspectives on Family Planning and Impact on Specialty Choice. JAMA Surg 2024; 159:170-178. [PMID: 38090998 PMCID: PMC10719828 DOI: 10.1001/jamasurg.2023.6392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/31/2023] [Indexed: 12/17/2023]
Abstract
Importance Physicians are known to delay childbearing compared with nonphysicians and to experience higher rates of age-related pregnancy complications. Delay of childbearing is more pronounced in surgical specialties, and family planning and building goals may influence specialty choice. Objective To assess medical students' perspectives on the development of family planning goals and the timing of family building within a medical career to elucidate how these perceptions impact their choice of specialty. Design, Setting, and Participants This qualitative study included fourth-year medical students at the University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada, and was conducted between May and August 2021. Participants were purposively sampled to maximize diversity of gender and specialty choice. Interviews were conducted via videoconferencing software that were recorded, transcribed verbatim, and verified for accuracy. Thematic analysis was completed independently by 2 researchers and consensus on final themes was reached through discussion among study investigators. Data were analyzed between September and December 2021. Main Outcomes and Measures Participants were asked to share their perceptions of personal family planning goals, support currently in place, family planning education in medicine and factors contributing to their choice of specialty and program. Thematic analysis was completed. Results A total of 34 fourth-year medical students (median [range] age, 26 [24-33] years; 23 females [67.6%]) were interviewed. Four main themes were identified: (1) there is no ideal time to family build in a medical career, (2) family planning is a taboo topic, (3) surgical specialties offer less support for family building, and (4) residents who have children are perceived to place a burden on their colleagues. Medical students considered their family planning while deliberating among specialty choices and their experiences were highly influential in shaping their specialty selection. Conclusions and Relevance Results of this qualitative study suggest that medical students perceive that family building during training may have unfavorable implications for team dynamics and relationships with colleagues, and these perceptions may affect specialty choice and family planning goals. Integration of family planning discussions and support for family building into medical curricula is needed along with efforts to improve culture by supporting team dynamics and workload when students take parental leave.
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Affiliation(s)
- Ebernella Shirin Dason
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Madalina Maxim
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Obstetrics and Gynecology, McGill University, Montréal, Québec, Canada
| | - Dionne Gesink
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Michelle Yee
- Department of Emergency Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Crystal Chan
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Nancy N. Baxter
- Li Ka Shing Knowledge Institute, St Michael’s Hospital/Unity Health Toronto, Toronto, Ontario, Canada
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Heather Shapiro
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Andrea N. Simpson
- Li Ka Shing Knowledge Institute, St Michael’s Hospital/Unity Health Toronto, Toronto, Ontario, Canada
- Department of Obstetrics and Gynaecology, St Michael’s Hospital/Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
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Dason ES, Koshkina O, Chan C, Sobel M. Diagnosis and management of polycystic ovarian syndrome. CMAJ 2024; 196:E85-E94. [PMID: 38286488 PMCID: PMC10833093 DOI: 10.1503/cmaj.231251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024] Open
Affiliation(s)
- Ebernella Shirin Dason
- Department of Obstetrics and Gynaecology (Dason), Sinai Health System; Division of Endocrinology (Koshkina), Department of Medicine, Women's College Hospital, and Department of Obstetrics and Gynaecology (Chan, Sobel), University of Toronto, Toronto, Ont.
| | - Olexandra Koshkina
- Department of Obstetrics and Gynaecology (Dason), Sinai Health System; Division of Endocrinology (Koshkina), Department of Medicine, Women's College Hospital, and Department of Obstetrics and Gynaecology (Chan, Sobel), University of Toronto, Toronto, Ont
| | - Crystal Chan
- Department of Obstetrics and Gynaecology (Dason), Sinai Health System; Division of Endocrinology (Koshkina), Department of Medicine, Women's College Hospital, and Department of Obstetrics and Gynaecology (Chan, Sobel), University of Toronto, Toronto, Ont
| | - Mara Sobel
- Department of Obstetrics and Gynaecology (Dason), Sinai Health System; Division of Endocrinology (Koshkina), Department of Medicine, Women's College Hospital, and Department of Obstetrics and Gynaecology (Chan, Sobel), University of Toronto, Toronto, Ont
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Ardestani S, Dason ES, Sobel M. Saignement postcoïtal. CMAJ 2023; 195:E1735. [PMID: 38110214 PMCID: PMC10727791 DOI: 10.1503/cmaj.230143-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023] Open
Affiliation(s)
- Shakiba Ardestani
- Département d'obstétrique et de gynécologie, Faculté de médecine, Université de Toronto, Toronto, Ont
| | - Ebernella Shirin Dason
- Département d'obstétrique et de gynécologie, Faculté de médecine, Université de Toronto, Toronto, Ont
| | - Mara Sobel
- Département d'obstétrique et de gynécologie, Faculté de médecine, Université de Toronto, Toronto, Ont.
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Ardestani S, Dason ES, Sobel M. Postcoital bleeding. CMAJ 2023; 195:E1180. [PMID: 37696551 PMCID: PMC10495171 DOI: 10.1503/cmaj.230143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023] Open
Affiliation(s)
- Shakiba Ardestani
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Ebernella Shirin Dason
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Mara Sobel
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Toronto, Toronto, Ont.
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Dason ES, Maxim M, Hartman A, Li Q, Kanji S, Li T, Ng C, Huszti E, Sobel M, Chan C. Pregnancy outcomes with donor oocyte embryos in patients diagnosed with adenomyosis using the Morphological Uterus Sonographic Assessment criteria. Fertil Steril 2023; 119:484-489. [PMID: 36539054 DOI: 10.1016/j.fertnstert.2022.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 12/08/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To use the Morphological Uterus Sonographic Assessment (MUSA) criteria to evaluate the impact of adenomyosis on the live birth rate after donor egg embryo transfer. DESIGN Retrospective cohort study. SETTING Tertiary fertility care center. PATIENT(S) A total of 100 patients who received 223 donor embryo transfers from January 2014-2020. All patients underwent ultrasound before their first transfer. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Our study was powered (80%) to assess the primary outcome of live birth rate; the secondary outcomes included the clinical pregnancy, biochemical pregnancy, and miscarriage rates. RESULT(S) Only 22 of 100 patients were diagnosed with adenomyosis on the original ultrasound report. When the MUSA criteria were applied, 76 patients had at least 1 possible ultrasonographic feature of adenomyosis; all 76 patients had an interrupted junctional zone. The second most common feature of adenomyosis was a globular and/or enlarged uterus (89.4%). Adjusted modeling demonstrated that a single ultrasound feature, 2 or more features, specific features, or the location of features did not affect the live birth outcome. A per-centimeter increase in the diameter of focal lesions was significantly associated with a decrease in the odds of live birth by the factor of 0.91. CONCLUSION(S) To our knowledge, our study is the first to characterize adenomyosis using the MUSA criteria in the donor oocyte population. Overall, our data were reassuring in that the ultrasonographic features of adenomyosis may not impact reproductive outcomes. However, we identified that the location and size of focal lesions may be important and should be studied further.
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Affiliation(s)
- Ebernella Shirin Dason
- Department of Obstetrics and Gynaecology, University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada; Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Madalina Maxim
- University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada.
| | | | - Qixuan Li
- Biostatistics Research Unit, University Health Network, Toronto General Hospital, Ontario, Canada
| | - Salina Kanji
- Department of Obstetrics and Gynaecology, University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada; Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Tiantian Li
- The Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada
| | - Charis Ng
- Department of Obstetrics and Gynaecology, University of Western Ontario, London Health Sciences Centre - Victoria Hospital, London, Ontario, Canada
| | - Ella Huszti
- Biostatistics Research Unit, University Health Network, Toronto General Hospital, Ontario, Canada
| | - Mara Sobel
- Department of Obstetrics and Gynaecology, University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada; Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Crystal Chan
- Department of Obstetrics and Gynaecology, University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada; The Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada
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Maxim M, Dason ES, Chan C, Luketic L, Li Q, Huszti E, P. Sanders A, Sobel M. Current diagnosis and management of adenomyosis in Canada: A survey of Canadian gynaecologists. Journal of Endometriosis and Pelvic Pain Disorders 2022. [DOI: 10.1177/22840265221093263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: The purpose of this study was to understand how Canadian Obstetricians/Gynaecologists (OBGYNs) diagnose and manage adenomyosis. Methods: This cross-sectional study was performed via an online survey distributed to 262 OBGYNs at three Canadian universities (University of Toronto, University of Calgary, and McMaster University). Results: A total of 137 responses were obtained out of 262 OBGYNs (52.3%) with a completion rate of 98%. Adenomyosis was a diagnosis in 6%–10% of patients seen by OBGYNs. The most common clinical symptoms included heavy menstrual bleeding (HMB) (82.8%) and dysmenorrhea (91.0%). Most participants (83%) used transvaginal ultrasound (TVUS) as first-line imaging for diagnosis of adenomyosis. Many respondents (35.8%) indicated that adenomyosis was not associated with infertility or recurrent miscarriage. Treatment considerations for all patients with adenomyosis included levonorgestrel intra-uterine system (LNG-IUS) (91.8%), hysterectomy (88.8%), expectant management (85.1%), combined hormonal contraceptives (CHC) (83.6%), tranexamic acid (81.3%), gonadotropin releasing hormone (GnRH) agonists (64.2%), depo-provera (64.2%), dienogest (57.5%), and norethisterone acetate (NETA) (40.3%). Treatments for adenomyosis in patients wishing to conceive included expectant management (85.1%), tranexamic acid (79.1%), CHC (44.8%), LNG-IUS (32.8%), and GnRH agonists (35.8%). Excision of adenomyosis would only be offered by 24% of respondents. Uterine artery embolization (UAE) would not be used in the treatment of adenomyosis by 44% of respondents. Finally, 82.8% of respondents would use improvement of clinical symptoms to follow treatment success. Conclusion: Practice varies across Canada despite recent emerging evidence in the diagnosis and management of adenomyosis, highlighting the need for a clinical practice guideline on adenomyosis.
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Affiliation(s)
- Madalina Maxim
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ebernella Shirin Dason
- Department of Obstetrics and Gynaecology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Crystal Chan
- Department of Obstetrics and Gynaecology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Lea Luketic
- St. Joseph’s Healthcare Hamilton, McMaster University, Hamilton, ON, Canada
| | - Qixuan Li
- Biostatistics Research Unit, University Health Network, Toronto General Hospital, Toronto, ON, Canada
| | - Ella Huszti
- Biostatistics Research Unit, University Health Network, Toronto General Hospital, Toronto, ON, Canada
| | - Ari P. Sanders
- Peter Lougheed Centre, University of Calgary, Calgary, AB, Canada
| | - Mara Sobel
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, ON, Canada
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Dason ES, Chan C, Sobel M. Diagnostic et traitement de l’adénomyose. CMAJ 2021; 193:E663. [PMID: 33941529 PMCID: PMC8112635 DOI: 10.1503/cmaj.201607-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Ebernella Shirin Dason
- Département d'obstétrique et de gynécologie (Dason), Université de Toronto; Département d'obstétrique et de gynécologie (Sobel, Chan), Hôpital Mount Sinai, Toronto, Ont.
| | - Crystal Chan
- Département d'obstétrique et de gynécologie (Dason), Université de Toronto; Département d'obstétrique et de gynécologie (Sobel, Chan), Hôpital Mount Sinai, Toronto, Ont
| | - Mara Sobel
- Département d'obstétrique et de gynécologie (Dason), Université de Toronto; Département d'obstétrique et de gynécologie (Sobel, Chan), Hôpital Mount Sinai, Toronto, Ont
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Affiliation(s)
- Ebernella Shirin Dason
- Department of Obstetrics and Gynaecology (Dason), University of Toronto; Department of Obstetrics and Gynaecology (Sobel, Chan), Mount Sinai Hospital, Toronto, Ont.
| | - Crystal Chan
- Department of Obstetrics and Gynaecology (Dason), University of Toronto; Department of Obstetrics and Gynaecology (Sobel, Chan), Mount Sinai Hospital, Toronto, Ont
| | - Mara Sobel
- Department of Obstetrics and Gynaecology (Dason), University of Toronto; Department of Obstetrics and Gynaecology (Sobel, Chan), Mount Sinai Hospital, Toronto, Ont
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