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Johannesson L, Humphries LA, Porrett PM, Testa G, Anderson S, Walter JR, Rush M, Ferrando CA, O'Neill K, Richards EG. Classification and treatment of vaginal strictures at the donor-recipient anastomosis after uterus transplant. Fertil Steril 2024:S0015-0282(24)00247-4. [PMID: 38636770 DOI: 10.1016/j.fertnstert.2024.04.019] [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: 02/20/2024] [Revised: 04/08/2024] [Accepted: 04/09/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVE To describe the incidence and management of vaginal stricture after uterus transplantation (UTx) in the US, to propose a grading system to classify stricture severity, and to identify risk factors for stricture formation. DESIGN Prospective cohort study. SETTING University Hospital. PATIENTS Recipients undergoing UTx from 2016-2023 at Baylor University Medical Center in Dallas, Cleveland Clinic, the University of Pennsylvania, and the University of Alabama at Birmingham were monitored postoperatively with regular pelvic examinations. Stricture was defined as vaginal narrowing of <3 cm in patients with graft survival of at least 7 days. INTERVENTION Demographic and surgery characteristics. MAIN OUTCOME MEASURES Stricture development and severity (grade 1 for diameter 2-<3 cm, grade 2 for 1-<2 cm, or grade 3 for <1 cm). RESULTS Of the 45 UTx from 2016-2023 (16 deceased donors and 29 living donors), 3 were excluded from the analysis because of graft loss within 7 days. Of the 42 remaining recipients, 39 (92.9%) had Mayer-Rokitansky-Küster-Hauser syndrome and 3 (7.1%) had a prior hysterectomy. Twenty-eight (66.7%) UTx recipients developed postoperative vaginal strictures with a median time to stricture of 33 days (interquartile range 19-53 days). Most strictures were of moderate severity, with 4 (14.3%) strictures categorized as grade 1, 19 (67.9%) as grade 2, and 5 (17.9%) as grade 3. History of Mayer-Rokitansky-Küster-Hauser syndrome and preoperative recipient vaginal length were significant risk factors for stricture, after adjustment for donor and recipient age and body mass index, anastomosis technique, total ischemia time, center, and year. Patients with longer preoperative vaginal length had a lower risk of stricture (hazard ratio 0.45, 0.29-0.70). The severity grading of the stricture was associated with the effectiveness of a nonoperative treatment approach (grade 1 vs. grade 3). No patients with grade 3 strictures improved with self-dilation alone; all required surgical repair and/or dilation under anesthesia. Conversely, for grade 1 or 2 strictures, self-dilation alone was successful in 47.8% (11/23), and no grade 1 strictures required surgical repair. CONCLUSIONS Vaginal stricture is a common postoperative complication after UTx, affecting >65% of recipients. Short preoperative vaginal length and history of müllerian agenesis in the recipient are significant risk factors. Vaginal self-dilation was effective for some mild to moderate strictures, although dilation under anesthesia or surgical repair was required in most cases. CLINICAL TRIAL REGISTRATION NUMBERS Dallas UtErus Transplant Study (DUETS) at Baylor University Medical Center (NCT02656550), Uterine transplantation for the treatment of uterine factor infertility at the Cleveland Clinic (NCT02573415), The University of Pennsylvania Uterus Transplant for Uterine Factor Infertility Trial (UNTIL) (NCT03307356).
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Affiliation(s)
- Liza Johannesson
- Department of Obstetrics and Gynecology, Baylor University Medical Center, Dallas, Texas; Department of Surgery, Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas.
| | - Leigh A Humphries
- Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Paige M Porrett
- Department of Surgery, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama
| | - Giuliano Testa
- Department of Surgery, Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas
| | | | - Jessica R Walter
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
| | - Margaret Rush
- Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cecile A Ferrando
- Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, Ohio
| | - Kathleen O'Neill
- Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Elliott G Richards
- Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, Ohio
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Walter JR, Johannesson L, Falcone T, Putnam JM, Testa G, Richards EG, O'Neill KE. In Vitro Fertilization Practice in Patients with Absolute Uterine Factor Undergoing Uterus Transplant in the United States. Fertil Steril 2024:S0015-0282(24)00245-0. [PMID: 38631504 DOI: 10.1016/j.fertnstert.2024.04.017] [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: 01/26/2024] [Revised: 04/06/2024] [Accepted: 04/09/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVE Report detailed, pooled multicenter experiences and outcomes after IVF among patients undergoing uterus transplantation in the United States. DESIGN Cohort study SUBJECTS: Patients undergoing uterus transplant from the three longest running uterus transplant clinical trials in the United States. INTERVENTION In vitro fertilization among uterus transplant patients MAIN OUTCOME MEASURES: Reproductive outcomes pre- and post-transplant ovarian stimulation RESULTS: 31 uterus transplant recipients were included in this cohort (mean age at transplant was 31 years, standard deviation 4.7). Prior to transplant, recipients completed a mean of 2 oocyte retrievals (range 1-4), banking a mean of 8 untested embryos (range 3-24) or 6 euploid embryos (range 2-10). Post-transplant retrieval cycles were required in 19% of recipients (n=6/31): a total of 16 cycles (range 2-4 cycles per recipient). All post-transplant retrievals were performed vaginally without complication. Preimplantation genetic testing was used by 74% of subjects (n=23/31). 72 autologous single embryo transfers occurred in 23 patients who completed at least one embryo transfer. Two embryo transfers followed a fresh IVF cycle and the remainder were frozen embryo transfers (n=70). Endometrial preparation during was more commonly performed with programmed protocols (n=61) (exogenous administration of estrogen/progesterone) compared to natural cycle protocols (n=9). The overall live birth rate for this cohort was 35% (n=25/72) per embryo transfer. Among those patients who had an embryo transfer leading to a live birth (n=21), a mean of 2.2 embryo transfers was performed. The overall live birth rate after the first embryo transfer was 57% (n=13/23) and rose to 74% after a second embryo transfer (n=17/23). There was no difference in rate of preeclampsia, live birth, neonatal birth, or placental weights among programmed versus natural cycle frozen embryo transfers. There were no differences in the live birth rate between living or deceased donor uteri (37% versus 32%, p=0.6). CONCLUSIONS Post-transplant ovarian stimulation was required in 26% (n=6/23) of recipients undergoing at least one embryo transfer despite high rates of preimplantation genetic testing and pre-transplant embryo cryopreservation. Post-transplant retrievals were performed transvaginally, without complication. Future reporting of IVF experience will be essential to optimize reproductive outcomes after uterus transplant.
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Affiliation(s)
- Jessica R Walter
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL
| | - Liza Johannesson
- Baylor Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX
| | - Tommaso Falcone
- Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, OH
| | - J Michael Putnam
- Fertility Center of Dallas, Baylor University Medical Center, Dallas, TX
| | - Giuliano Testa
- Baylor Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX
| | - Elliott G Richards
- Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, OH
| | - Kathleen E O'Neill
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA. kathleen.o'
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Walter JR, Lee JY, Yu L, Kim B, Martell K, Opdycke A, Scheffel J, Felsl I, Patel S, Rangel S, Serao A, Edel C, Bharat A, Xu S. Use of artificial intelligence to develop predictive algorithms of cough and PCR-confirmed COVID-19 infections based on inputs from clinical-grade wearable sensors. Sci Rep 2024; 14:8072. [PMID: 38580712 PMCID: PMC10997665 DOI: 10.1038/s41598-024-57830-4] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 03/21/2024] [Indexed: 04/07/2024] Open
Abstract
There have been over 769 million cases of COVID-19, and up to 50% of infected individuals are asymptomatic. The purpose of this study aimed to assess the use of a clinical-grade physiological wearable monitoring system, ANNE One, to develop an artificial intelligence algorithm for (1) cough detection and (2) early detection of COVID-19, through the retrospective analysis of prospectively collected physiological data from longitudinal wear of ANNE sensors in a multicenter single arm study of subjects at high risk for COVID-19 due to occupational or home exposures. The study employed a two-fold approach: cough detection algorithm development and COVID-19 detection algorithm development. For cough detection, healthy individuals wore an ANNE One chest sensor during scripted activity. The final performance of the algorithm achieved an F-1 score of 83.3% in twenty-seven healthy subjects during biomarker validation. In the COVID-19 detection algorithm, individuals at high-risk for developing COVID-19 because of recent exposures received ANNE One sensors and completed daily symptom surveys. An algorithm analyzing vital parameters (heart rate, respiratory rate, cough count, etc.) for early COVID-19 detection was developed. The COVID-19 detection algorithm exhibited a sensitivity of 0.47 and specificity of 0.72 for detecting COVID-19 in 325 individuals with recent exposures. Participants demonstrated high adherence (≥ 4 days of wear per week). ANNE One shows promise for detection of COVID-19. Inclusion of respiratory biomarkers (e.g., cough count) enhanced the algorithm's predictive ability. These findings highlight the potential value of wearable devices in early disease detection and monitoring.
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Affiliation(s)
- Jessica R Walter
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL, USA
| | - Jong Yoon Lee
- Sibel Health, Chicago, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, USA
| | - Lian Yu
- Sibel Health, Chicago, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, USA
| | - Brandon Kim
- Sibel Health, Chicago, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, USA
| | - Knute Martell
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | | | | | | | - Soham Patel
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Stephanie Rangel
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Alexa Serao
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Claire Edel
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Ankit Bharat
- Department of Surgery, Northwestern University, Chicago, IL, USA
| | - Shuai Xu
- Sibel Health, Chicago, USA.
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, USA.
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, USA.
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Walter JR, Barnhart KT, Koelper NC, Santoro NF, Zhang H, Thomas TR, Huang H, Harvie HS. Cost-effectiveness analysis of expectant vs active management for treatment of persistent pregnancies of unknown location. Am J Obstet Gynecol 2024:S0002-9378(24)00471-X. [PMID: 38552817 DOI: 10.1016/j.ajog.2024.03.035] [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: 12/11/2023] [Revised: 03/08/2024] [Accepted: 03/24/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Persistent pregnancies of unknown location are defined by abnormally trending serum human chorionic gonadotropin with nondiagnostic ultrasound. There is no consensus on optimal management. OBJECTIVE This study aimed to assess the cost-effectiveness of 3 primary management strategies for persistent pregnancies of unknown location: (1) expectant management, (2) empirical 2-dose methotrexate, and (3) uterine evacuation followed by methotrexate, if indicated. STUDY DESIGN This was a prospective economic evaluation performed concurrently with the Expectant versus Active Management for Treatment of Persistent Pregnancies of Unknown Location multicenter randomized trial that was conducted from July 2014 to June 2019. Participants were randomized 1:1:1 to expectant management, 2-dose methotrexate, or uterine evacuation. The analysis was from the healthcare sector perspective with a 6-week time horizon after randomization. Costs were expressed in 2018 US dollars. Effectiveness was measured in quality-adjusted life years and the rate of salpingectomy. Incremental cost-effectiveness ratios and cost-effectiveness acceptability curves were generated. Sensitivity analyses were performed to assess the robustness of the analysis. RESULTS Methotrexate had the lowest mean cost ($875), followed by expectant management ($1085) and uterine evacuation ($1902) (P=.001). Expectant management had the highest mean quality-adjusted life years (0.1043), followed by methotrexate (0.1031) and uterine evacuation (0.0992) (P=.0001). The salpingectomy rate was higher for expectant management than for methotrexate (9.4% vs 1.2%, respectively; P=.02) and for expectant management than for uterine evacuation (9.4% vs 8.1%, respectively; P=.04). Uterine evacuation, with the highest costs and the lowest quality-adjusted life years, was dominated by both expectant management and methotrexate. In the base case analysis, expectant management was not cost-effective compared with methotrexate at a willingness to pay of $150,000 per quality-adjusted life year given an incremental cost-effectiveness ratio of $175,083 per quality-adjusted life year gained (95% confidence interval, -$1,666,825 to $2,676,375). Threshold analysis demonstrated that methotrexate administration would have to cost $214 (an increase of $16 or 8%) to favor expectant management. Moreover, expectant management would be favorable in lower-risk patient populations with rates of laparoscopic surgical management for ectopic pregnancy not exceeding 4% of pregnancies of unknown location. Based on the cost-effectiveness acceptability curves, the probability of expectant management being cost-effective compared with methotrexate at a willingness to pay of $150,000 per quality-adjusted life year gained was 50%. The results were dependent on the cost of surgical intervention and the expected rate of methotrexate failure. CONCLUSION The management of pregnancies of unknown location with a 2-dose methotrexate protocol may be cost-effective compared with expectant management and uterine evacuation. Although uterine evacuation was dominated, expectant management vs methotrexate results were sensitive to modest changes in treatment costs of both methotrexate and surgical management.
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Affiliation(s)
- Jessica R Walter
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL.
| | - Kurt T Barnhart
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA
| | - Nathanael C Koelper
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA
| | - Nanette F Santoro
- Divisions of Reproductive Endocrinology and Infertility and Reproductive Sciences, Department of Obstetrics and Gynecology, University of Colorado, Aurora, CO
| | - Heping Zhang
- Department of Biostatistics, Yale University School of Public Health, New Haven, CT
| | - Tracey R Thomas
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA
| | - Hao Huang
- Department of Biostatistics, Yale University School of Public Health, New Haven, CT
| | - Heidi S Harvie
- Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
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Walter JR, Xu S, Rogers JA. From lab to life: how wearable devices can improve health equity. Nat Commun 2024; 15:123. [PMID: 38167483 PMCID: PMC10761710 DOI: 10.1038/s41467-023-44634-9] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024] Open
Abstract
Wearable devices can provide personalised medicine at the point of need, potentially increasing access to health services and therefore improving health equity. Here the authors discuss their experiences developing wearable devices for vulnerable patient populations, including neonates and pregnant individuals.
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Affiliation(s)
- Jessica R Walter
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL, 60611, USA
| | - Shuai Xu
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, 60611, USA
- Sibel Health, Chicago, IL, 60614, USA
| | - John A Rogers
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, 60611, USA.
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, 60208, USA.
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL, 60208, USA.
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
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Nadgauda A, Ganti T, Walter JR. Cost-effectiveness analyses of preimplantation genetic testing. Fertil Steril 2023:S0015-0282(23)02089-7. [PMID: 38123052 DOI: 10.1016/j.fertnstert.2023.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Ashni Nadgauda
- Department of Obstetrics and Gynecology, Reading Hospital-Tower Health, Reading, Pennsylvania
| | - Tej Ganti
- Department of Obstetrics and Gynecology, Reading Hospital-Tower Health, Reading, Pennsylvania
| | - Jessica R Walter
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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Pelayo RA, Xu S, Walter JR. Embryo transfers performed during daylight savings time led to reduced live birth rates in older patients. J Assist Reprod Genet 2023; 40:2639-2647. [PMID: 37667016 PMCID: PMC10643731 DOI: 10.1007/s10815-023-02920-x] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/18/2023] [Indexed: 09/06/2023] Open
Abstract
PURPOSE To study the impact of undergoing an embryo transfer during the week of daylight savings time transition on live birth rates. METHODS We performed a retrospective observational cohort study of patients undergoing embryo transfer at an academic infertility practice during the week of spring or fall daylight savings time transition (cases), or the 2 weeks preceding and following the daylight savings transition (controls) between 2015 and 2021. The primary exposure was completion of an embryo transfer during the week of daylight savings time transition. The primary outcome was a comparison of live birth rate per embryo transfer among individuals undergoing an embryo transfer during the week of daylight savings time (DST) transition and those who did not. RESULTS A total of 309 embryo transfers occurred during the week of daylight savings transition and 1242 embryo transfers occurred in the control group outside of the daylight savings transition week. The live birth rate after embryo transfer during DST transition weeks was 39.2% (121/309) compared to 40.8% (507/1242) (p = 0.59). When restricting the analysis to individuals (age > 37 years), the live birth rate after embryo transfer during DST transition week was 23.5% (24/102) compared to 34.8% (149/429) (p = 0.03). This difference persisted in the mixed-effects regression model demonstrating that after adjusting for relevant covariates, embryo transfer during DST transition weeks resulted in a 45% decrease in the odds of achieving a live birth. CONCLUSION Daylight savings time transition may be associated with less favorable outcomes after embryo transfer among an older infertile patient population. Future work is needed to prospectively examine the influence of circadian rhythm disruption on reproductive outcomes.
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Affiliation(s)
- Ramon A Pelayo
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Jessica R Walter
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 259 E Erie St Suite 2400, Chicago, IL, 60611, USA.
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Chen H, Soetikno A, Xu S, Suresh S, Walter JR. Advanced wireless monitoring for children in the cardiac perioperative setting. Paediatr Anaesth 2023; 33:670-672. [PMID: 37102400 PMCID: PMC10330310 DOI: 10.1111/pan.14684] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 02/16/2023] [Accepted: 04/13/2023] [Indexed: 04/28/2023]
Abstract
INTRODUCTION More than 40,000 children undergo surgical interventions annually for the treatment of congenital heart defects. Intraoperative and postoperative vital sign monitoring is a cornerstone of pediatric care. METHODS A single-arm prospective observational study was performed. Pediatric patients undergoing a procedure with a planned admission to the Cardiac Intensive Care Unit at Lurie Children's Hospital (Chicago, IL) were eligible for enrollment. Participant vital signs were monitored using standard equipment and an FDA-cleared experimental device (ANNE® ) consisting of a wireless patch positioned at the suprasternal notch and index finger or foot. The primary goal of the study was to assess real-world feasibility of wireless sensors in pediatric patients with congenital cardiac defects. RESULTS A total of 13 patients were enrolled, ranging in age from 4 months to 16 years with a median age of 4 years. Overall, 54% (n = 7) were female and the most common anomaly in the cohort was an atrial septal defect (n = 6). The mean admission length was 3 days (range 2-6), resulting in more than 1000 h of vital sign monitoring (⟩60,000 data points). Bland-Altman plots were generated for heart rate and respiratory rate to assess beat-to-beast differences between the standard equipment and the experimental sensors. CONCLUSIONS Novel, wireless, flexible sensors demonstrated comparable performance to standard monitoring equipment in a cohort of pediatric patients with congenital cardiac heart defects undergoing surgery.
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Affiliation(s)
- Hope Chen
- Feinberg School of Medicine
- Querrey Simpson Institute for Bioelectronics, Chicago, IL, USA
| | - Alan Soetikno
- Feinberg School of Medicine
- Querrey Simpson Institute for Bioelectronics, Chicago, IL, USA
| | - Shuai Xu
- Sibel Health, Inc, Chicago IL, USA
- Department of Biomedical Engineering, Northwestern University McCormick School of Engineering, Chicago, IL, USA
| | - Santhanam Suresh
- Department of Pediatric Anesthesiology, Northwestern University, Chicago IL, USA
| | - Jessica R. Walter
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL, USA
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Wong JN, Walter JR, Conrad EC, Seshadri DR, Lee JY, Gonzalez H, Reuther W, Hong SJ, Pini N, Marsillio L, Moskalyk K, Vicenteno M, Padilla E, Gann O, Chung HU, Ryu D, du Plessis C, Odendaal HJ, Fifer WP, Wu JY, Xu S. A comprehensive wireless neurological and cardiopulmonary monitoring platform for pediatrics. PLOS Digit Health 2023; 2:e0000291. [PMID: 37410727 PMCID: PMC10325120 DOI: 10.1371/journal.pdig.0000291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 06/01/2023] [Indexed: 07/08/2023]
Abstract
Neurodevelopment in the first 10 years of life is a critical time window during which milestones that define an individual's functional potential are achieved. Comprehensive multimodal neurodevelopmental monitoring is particularly crucial for socioeconomically disadvantaged, marginalized, historically underserved and underrepresented communities as well as medically underserved areas. Solutions designed for use outside the traditional clinical environment represent an opportunity for addressing such health inequalities. In this work, we present an experimental platform, ANNE EEG, which adds 16-channel cerebral activity monitoring to the existing, USA FDA-cleared ANNE wireless monitoring platform which provides continuous electrocardiography, respiratory rate, pulse oximetry, motion, and temperature measurements. The system features low-cost consumables, real-time control and streaming with widely available mobile devices, and fully wearable operation to allow a child to remain in their naturalistic environment. This multi-center pilot study successfully collected ANNE EEG recordings from 91 neonatal and pediatric patients at academic quaternary pediatric care centers and in LMIC settings. We demonstrate the practicality and feasibility to conduct electroencephalography studies with high levels of accuracy, validated via both quantitative and qualitative metrics, compared against gold standard systems. An overwhelming majority of parents surveyed during studies indicated not only an overall preference for the wireless system, but also that its use would improve their children's physical and emotional health. Our findings demonstrate the potential for the ANNE system to perform multimodal monitoring to screen for a variety of neurologic diseases that have the potential to negatively impact neurodevelopment.
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Affiliation(s)
- Jeremy N. Wong
- Epilepsy Center, Division of Pediatric Neurology, Lurie Children’s Hospital of Chicago, Chicago, Illinois, United States of America
- Department of Pediatrics, Division of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Jessica R. Walter
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Erin C. Conrad
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | | | - Jong Yoon Lee
- Sibel Inc., Niles, Illinois, United States of America
| | | | | | - Sue J. Hong
- Department of Pediatrics, Division of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
- Division of Critical Care, Lurie Children’s Hospital of Chicago, Chicago, Illinois, United States of America
- Department of Pediatrics, Division of Critical Care, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Nicolò Pini
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, United States of America
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, New York, United States of America
| | - Lauren Marsillio
- Division of Critical Care, Lurie Children’s Hospital of Chicago, Chicago, Illinois, United States of America
- Department of Pediatrics, Division of Critical Care, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Khrystyna Moskalyk
- Epilepsy Center, Division of Pediatric Neurology, Lurie Children’s Hospital of Chicago, Chicago, Illinois, United States of America
| | - Mariana Vicenteno
- Epilepsy Center, Division of Pediatric Neurology, Lurie Children’s Hospital of Chicago, Chicago, Illinois, United States of America
| | - Erik Padilla
- Epilepsy Center, Division of Pediatric Neurology, Lurie Children’s Hospital of Chicago, Chicago, Illinois, United States of America
| | - Olivia Gann
- Sibel Inc., Niles, Illinois, United States of America
| | - Ha Uk Chung
- Sibel Inc., Niles, Illinois, United States of America
| | - Dennis Ryu
- Sibel Inc., Niles, Illinois, United States of America
| | - Carlie du Plessis
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Hein J. Odendaal
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - William P. Fifer
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, United States of America
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, New York, United States of America
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Joyce Y. Wu
- Epilepsy Center, Division of Pediatric Neurology, Lurie Children’s Hospital of Chicago, Chicago, Illinois, United States of America
- Department of Pediatrics, Division of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Shuai Xu
- Sibel Inc., Niles, Illinois, United States of America
- Simpson Querrey Institute, Northwestern University, Chicago, Illinois, United States of America
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, United States of America
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
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Johannesson L, Testa G, Beshara MM, da Graca B, Walter JR, Quintini C, Latif N, Hashimoto K, Richards EG, O’Neill K. Awareness and Interest in Uterus Transplantation over Time: Analysis of Those Seeking Surgical Correction for Uterine-Factor Infertility in the US. J Clin Med 2023; 12:4201. [PMID: 37445236 PMCID: PMC10342774 DOI: 10.3390/jcm12134201] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/07/2023] [Accepted: 06/15/2023] [Indexed: 07/15/2023] Open
Abstract
This study describes the characteristics of women who contacted an active program performing uterus transplantation (UTx) in the US, expressing interest in becoming a uterus transplant recipient or a living donor. Basic demographic and self-reported clinical information was collected from women who contacted any of the three US UTx programs from 2015 to July 2022. The three centers received 5194 inquiries about becoming a UTx recipient during the study timeframe. Among those reporting a cause of infertility, almost all of the reports (4066/4331, 94%) were absence of a uterus, either congenitally (794/4066, 20%) or secondary to hysterectomy (3272/4066, 80%). The mean age was 34 years, and 49% (2545/5194) had at least one child at the time of application. The two centers using living donors received 2217 inquiries about becoming living donors. The mean age was 34 years, and 60% (1330/2217) had given birth to ≥1 child. While most of the UTx clinical trial evidence has focused on young women with congenital absence of the uterus, these results show interest from a much broader patient population in terms of age, cause of infertility, and parity. These results raise questions about whether and to what extent the indications and eligibility criteria for UTx should be expanded as the procedure transitions from the experimental phase to being offered as a clinical treatment.
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Affiliation(s)
- Liza Johannesson
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX 75246, USA
- Department of Obstetrics and Gynecology, Baylor University Medical Center, Dallas, TX 75246, USA
| | - Giuliano Testa
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX 75246, USA
| | - Menas M. Beshara
- TX A&M College of Medicine, Texas A&M University, Dallas, TX 75231, USA
| | - Briget da Graca
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX 75246, USA
| | - Jessica R. Walter
- Department of Obstetrics & Gynecology, Northwestern University, Chicago, IL 60611, USA
| | - Cristiano Quintini
- Department of General Surgery, Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Nawar Latif
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA 19107, USA
| | - Koji Hashimoto
- Department of General Surgery, Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH 44103, USA
| | - Elliott G. Richards
- Obstetrics and Gynecology and Women’s Health Institute, Cleveland Clinic, Cleveland, OH 44103, USA
| | - Kathleen O’Neill
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA 19107, USA
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11
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Komorowski AS, Walter JR, Martin CE, Bedrick BS, Riley JK, Jungheim ES. Neighborhood disadvantage is associated with decreased ovarian reserve in women with overweight and obesity. Fertil Steril 2023; 119:653-660. [PMID: 36565977 PMCID: PMC10079614 DOI: 10.1016/j.fertnstert.2022.12.026] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 11/16/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE(S) To evaluate the association between neighborhood disadvantage and ovarian reserve stratified by body mass index (BMI). DESIGN Cross-sectional cohort study. SETTING Single academic medical center. PATIENT(S) A total of 193 healthy reproductive-age women with regular menstrual cycles in the St. Louis, Missouri metropolitan area. INTERVENTION(S) Residence in a disadvantaged neighborhood. MAIN OUTCOME MEASURE(S) Ovarian reserve as assessed by ovarian antral follicle count (AFC) and serum anti-Müllerian hormone (AMH) concentration. RESULT(S) Women (n = 193) ranged from 20 to 44 years. The majority had overweight or obesity (59%, n = 117) with mean BMI of 28±7 kg/m2. Forty-eight women lived in the most disadvantaged neighborhood quartile, of which 75% had overweight or obesity, compared with 54% of the 145 women living in the 3 less disadvantaged neighborhood quartiles. When controlling for age, race, and smoking status, women with overweight or obesity living in the most disadvantaged neighborhoods had significantly lower AMH compared with those living in the less disadvantaged neighborhoods. Antral follicle count did not differ among women with overweight or obesity by neighborhood of residence. Neighborhood disadvantage was not associated with ovarian reserve by AFC or AMH in women with normal weight or underweight status. CONCLUSION(S) Living in a socioeconomically deprived area is associated with lower markers of ovarian reserve among women with an elevated BMI.
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Affiliation(s)
- Allison S Komorowski
- Department of Obstetrics & Gynecology, Washington University School of Medicine, St. Louis, Missouri.
| | - Jessica R Walter
- Department of Obstetrics & Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - Caitlin E Martin
- Department of Obstetrics & Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - Bronwyn S Bedrick
- Department of Obstetrics & Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - Joan K Riley
- Department of Obstetrics & Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - Emily S Jungheim
- Department of Obstetrics & Gynecology, Washington University School of Medicine, St. Louis, Missouri
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12
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Yang AF, Chun KS, Yu L, Walter JR, Kim D, Lee JY, Jeong H, Keller MC, Seshadri DR, Olagbenro MO, Bae JW, Reuther W, Wu E, Okamoto K, Ikoma A, Lio PA, Fishbein AB, Paller AS, Xu S. Validation of a hand-mounted wearable sensor for scratching movements in adults with atopic dermatitis. J Am Acad Dermatol 2023; 88:726-729. [PMID: 36156307 DOI: 10.1016/j.jaad.2022.09.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 09/18/2022] [Accepted: 09/19/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Albert F Yang
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; University of Illinois at Chicago College of Medicine, Chicago, Illinois
| | | | - Lian Yu
- Sibel Health, Niles, Illinois
| | - Jessica R Walter
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | - Hyoyoung Jeong
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, Illinois
| | | | | | - Matthew O Olagbenro
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | - Ellen Wu
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | - Peter A Lio
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Medical Dermatology Associates of Chicago, Chicago, Illinois
| | - Anna B Fishbein
- Department of Pediatrics/Allergy, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Amy S Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, Illinois; Department of Pediatrics/Allergy, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Shuai Xu
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Sibel Health, Niles, Illinois; Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, Illinois; Department of Biomedical Engineering, Northwestern University, Evanston, Illinois.
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13
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Olagbenro M, Ravi S, Myers D, Lin D, Woodburn W, Walter JR, Xu S. Assessment of Blue Light Phototherapy for Grover Disease: A Nonrandomized Controlled Trial. JAMA Dermatol 2023; 159:102-104. [PMID: 36449285 PMCID: PMC9713673 DOI: 10.1001/jamadermatol.2022.4491] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/24/2022] [Indexed: 12/05/2022]
Abstract
This nonrandomized clinical trial assesses treatment of patients diagnosed with Grover disease with blue light phytotherapy for several weeks.
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Affiliation(s)
- Matthew Olagbenro
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sowmya Ravi
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Daniel Myers
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Derrick Lin
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - William Woodburn
- McCormick School of Engineering, Northwestern University, Evanston, Illinois
- Tcellerate LLC, Greenwich, Connecticut
| | - Jessica R. Walter
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Shuai Xu
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Biomedical Engineering, Northwestern University, Chicago, Illinois
- Querry Simpson Institute for Bioelectronics, Northwestern University, Chicago, Illinois
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14
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Walter JR, Lee JY, Snoll B, Park JB, Kim DH, Xu S, Barnhart K. Pregnancy outcomes in infertility patients diagnosed with sleep disordered breathing with wireless wearable sensors. Sleep Med 2022; 100:511-517. [PMID: 36306629 DOI: 10.1016/j.sleep.2022.09.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 09/14/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To study the feasibility of home-based assessment of sleep disordered breathing (SDB) on early pregnancy success after in vitro fertilization with novel wearable sensors. DESIGN Prospective observational study. SETTING Patients 18 to 45 years old undergoing autologous IVF at an academic infertility center. PATIENTS 30 women (24-44 years old) INTERVENTION: Participants provided medical history, completed sleep surveys, and a single night of home sleep monitoring prior to IVF with a novel, FDA-cleared wireless sensor system (ANNE® Sleep, Sibel Health), to collect continuous measurements of heart rate, respiratory rate, pulse oxygenation, respiratory effort/snoring, peripheral arterial tonometry, pulse arrival time, and pulse transit time, an accepted surrogate of continuous blood pressure generated by pulse arrival time and pulse transit time. Sleep nights were reviewed to derive the apnea hypopnea index (AHI), defined as the average number of apnea or hypopnea events per hour. An AHI of greater than or equal to 5 events/hour was considered abnormal. MAIN OUTCOME MEASURE Rate of clinical pregnancy (defined as intrauterine gestational sac with a yolk sac) after IVF. Logistic regression models were used to estimate the unadjusted and adjusted odds ratio. RESULTS The overall rate of sleep disordered breathing of any severity was 57%. Participants with SDB had a mean AHI of 13.4 compared to 2.7 events/hr (p<0.01), were younger, and more likely to have polycystic ovary syndrome. Of the 29 patients undergoing an embryo transfer, clinical pregnancy and livebirth occurred in 35% of women with SDB compared to 58% without SDB (p = 0.22). After adjusting for age, SDB reduced pregnancy rates but was not statistically significant (aOR 0.23, 95% CI: 0.04-1.5, p = 0.12). Though polycystic ovary syndrome was associated with higher rates of SDB it was not independently associated with lower pregnancy rates. CONCLUSION Screening for sleep disordered breathing using home-based wireless, wearable sensors was well accepted and easily performed by infertile patients in this cohort. Sleep disordered breathing of any severity was associated with an 77% (95% CI: 0.08-1.8) lower likelihood of clinical pregnancy and live birth independent of underlying diagnosis. Future larger studies will be needed to understand the role of sleep disordered breathing and IVF outcomes.
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Affiliation(s)
- Jessica R Walter
- University of Pennsylvania, Division of Reproductive Endocrinology and Infertility, Philadelphia, PA, USA.
| | | | | | | | | | - Shuai Xu
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Chicago, IL, USA; Northwestern University, Department of Dermatology, Chicago, IL, USA
| | - Kurt Barnhart
- University of Pennsylvania, Division of Reproductive Endocrinology and Infertility, Philadelphia, PA, USA
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15
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Abstract
A confluence of advances in biosensor technologies, enhancements in health care delivery mechanisms, and improvements in machine learning, together with an increased awareness of remote patient monitoring, has accelerated the impact of digital health across nearly every medical discipline. Medical grade wearables-noninvasive, on-body sensors operating with clinical accuracy-will play an increasingly central role in medicine by providing continuous, cost-effective measurement and interpretation of physiological data relevant to patient status and disease trajectory, both inside and outside of established health care settings. Here, we review current digital health technologies and highlight critical gaps to clinical translation and adoption.
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Affiliation(s)
- Shuai Xu
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60611, USA.,Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA.,Sibel Health, Niles, IL 60714, USA
| | - Joohee Kim
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60611, USA
| | - Jessica R Walter
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60611, USA.,Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Roozbeh Ghaffari
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60611, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA.,Epicore Biosystems Inc., Cambridge, MA 02139, USA
| | - John A Rogers
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60611, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA.,Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA.,Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
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16
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Walter JR, Xu S, Stringer JS, Rogers JA. The Future of Remote Monitoring for Pregnancy. Bridge (Wash D C) 2022; 52:16-24. [PMID: 38111590 PMCID: PMC10727511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Affiliation(s)
- Jessica R Walter
- Department of Obstetrics and Gynecology, Northwestern University
| | - Shuai Xu
- Querrey Simpson Institute for Bioelectronics and Departments of Dermatology, Biomedical Engineering, and Pediatrics at Northwestern University
| | - Jeffrey S Stringer
- Department of Obstetrics and Gynecology at the University of North Carolina at Chapel Hill
- Global Women's Health Division
| | - John A Rogers
- Querrey Simpson Institute for Bioelectronics and the Departments of Biomedical Engineering, Materials Science, Computer Science, and Neurological Surgery at Northwestern University
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17
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Abstract
Uterus transplantation (UTx) provides a new pathway to parenthood for patients with absolute uterine factor infertility. The application of reproductive technologies, such as in vitro fertilization, embryo cryopreservation, and frozen embryo transfers, for this unique population, is particularly nuanced and continually evolving. There are important pretransplant and posttransplant reproductive considerations for physicians and patients anticipating UTx. As with any rapidly evolving medical innovation, efforts to consolidate experiences and knowledge by centers offering UTx is paramount.
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Affiliation(s)
- Jessica R Walter
- Northwestern Medicine Feinberg School of Medicine, Chicago, Illinois
| | - Kathleen E O'Neill
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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18
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Walter JR, Kim D, Myers D, Hill M, Snoll B, Lee JY, Kulikova E, Fagan K, Cauinian R, Nguyen L, Shapiro M, Heitor F, O'Brien KT, Xu S. Pilot and Feasibility Deployment of an Advanced Remote Monitoring Platform for
COVID
‐19 in
Long‐Term
Care Facilities. J Am Geriatr Soc 2022; 70:968-971. [PMID: 35099063 PMCID: PMC9109640 DOI: 10.1111/jgs.17673] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 01/12/2022] [Accepted: 01/16/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Jessica R. Walter
- Department of Obstetrics and Gynecology Northwestern University Chicago IL USA
| | | | - Daniel Myers
- Department of Dermatology Northwestern University Chicago Illinois USA
| | - Marc Hill
- Sibel Health, Inc Chicago Illinois USA
| | - Brooke Snoll
- Sibel Health, Inc Chicago Illinois USA
- University of Leeds Leeds UK
| | | | | | | | | | | | | | - Fernanda Heitor
- Department of General Internal Medicine and Geriatrics Chicago Illinois USA
| | | | - Shuai Xu
- Department of Dermatology Northwestern University Chicago Illinois USA
- Department of Biomedical Engineering Northwestern University McCormick School of Engineering Chicago Illinois USA
- Querrey Simpson Institute for Bioelectronics Chicago Illinois USA
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19
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Heyward Q, Walter JR, Alur-Gupta S, Lal A, Berger DS, Koelper N, Butts SF, Gracia CR. Racial disparities in frozen embryo transfer success. J Assist Reprod Genet 2021; 38:3069-3075. [PMID: 34739643 DOI: 10.1007/s10815-021-02348-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/25/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To compare pregnancy and birth outcomes after frozen embryo transfers (FETs) among White, Black, and Asian women and evaluate the effect of patient, protocol, and cycle characteristics on success. METHODS A retrospective chart review identified women who underwent an autologous FET at an academic fertility center between January 2013 and March 2020. RESULTS White, Black, and Asian women completed 1,181 (71.7%), 230 (14.0%), and 235 (14.3%) cycles, respectively. Black women were significantly less likely to achieve a positive hCG level (AOR 0.66, 95% CI 0.49-0.90), clinical pregnancy (AOR 0.71, 95% CI 0.53-0.97), and live birth (AOR 0.65, 95% CI 0.47-0.89) compared to White women after adjusting for possible confounders. There were no differences in the aforementioned outcomes when looking at cycles completed by Asian versus White women. When comparing outcomes by endometrial preparation protocol, significant differences were seen amongst the three groups for live birth rates following natural cycle FETs (52.36%, 25.81%, and 44.19% for White, Black, and Asian women, respectively, p = 0.02), a difference not appreciated after programmed FETs. CONCLUSION Black race is associated with significantly worse pregnancy and live birth rates following FET when compared to White race. Additionally, significant differences in live birth rates among White, Black, and Asian women exist following natural cycle FET versus programmed FET. These disparities in success are not only important for patient counseling, but also when determining management strategies to improve fertility rates among minority women.
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Affiliation(s)
- Quetrell Heyward
- Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, 3400 Spruce Street, 1 West Gates, Philadelphia, PA, 19104, USA.
| | - Jessica R Walter
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, PA, Philadelphia, USA
| | | | - Arnav Lal
- University of Pennsylvania, Philadelphia, PA, USA
| | - Dara S Berger
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, PA, Philadelphia, USA
| | - Nathanael Koelper
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, PA, Philadelphia, USA
| | - Samantha F Butts
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Pennsylvania State Hershey Medical Center, Hershey, PA, USA
| | - Clarisa R Gracia
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, PA, Philadelphia, USA
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20
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Grant GM, Walter JR, Berger D. INFERTILITY DIAGNOSIS AND MOSAICISM RATE. Fertil Steril 2021. [DOI: 10.1016/j.fertnstert.2021.07.1026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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21
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Walter JR, Xu S, Barnhart KT. EARLY PREGNANCY OUTCOMES AFTER IVF AND SLEEP DISORDERED BREATHING. Fertil Steril 2021. [DOI: 10.1016/j.fertnstert.2021.07.620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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22
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Walter JR, Barnhart KT, Koelper NC, Santoro NF, Zhang H, Thomas TR, Huang H, Harvie H. COST-EFFECTIVENESS ANALYSIS OF THE ACTIVE TREATMENT OR NO TREATMENT (ACT OR NOT) RANDOMIZED CONTROLLED TRIAL OF THE OPTIMAL MANAGEMENT OF PERSISTENT PREGNANCIES OF UNKNOWN LOCATION. Fertil Steril 2021. [DOI: 10.1016/j.fertnstert.2021.07.216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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23
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Walter JR, Koelbel J, Berger D. DAY 7 EMBRYO MORPHOLOGY IS NOT PREDICTIVE OF BIOPSY Results. Fertil Steril 2021. [DOI: 10.1016/j.fertnstert.2021.07.1055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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24
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Walter JR. Ketorolac use after oocyte retrieval: doing our part to combat the opioid crisis. F S Rep 2021; 2:142-143. [PMID: 34278342 PMCID: PMC8267400 DOI: 10.1016/j.xfre.2021.03.001] [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: 11/17/2022] Open
Affiliation(s)
- Jessica R Walter
- Division of Reproductive Endocrinology and Infertility, University of Pennsylvania, Philadelphia, Pennsylvania
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25
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Heyward QD, Walter JR, Alur-Gupta S, Lal A, Berger DS, Butts S, Gracia C. RACIAL DISPARITIES IN FROZEN EMBRYO TRANSFER SUCCESS. Fertil Steril 2020. [DOI: 10.1016/j.fertnstert.2020.08.674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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26
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Grant GM, Walter JR, Russell HI, Berger DS. PREDICTORS OF EMBRYO ANEUPLOIDY AND MOSAICISM: INSEMINATION METHOD, SPERM AND PATIENT CHARACTERISTICS. Fertil Steril 2020. [DOI: 10.1016/j.fertnstert.2020.08.844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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27
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Weiss MS, Walter JR, Koelper NC, Kalliora C, Brooks RB, Stentz NC, Barnhart KT, Epperson CN, Senapati S. Stress and success: data from a prospective cohort investigating the impact of early life stress on IVF outcomes. Fertil Steril 2019. [DOI: 10.1016/j.fertnstert.2019.07.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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28
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Ghobadi CW, Janetos TM, Tsai S, Welty L, Walter JR, Xu S. Approval-adjusted recall rates of high-risk medical devices from 2002-2016 across food and drug administration device categories. Issues Law Med 2019; 34:77-92. [PMID: 31179672] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Between 2002 and 2016, 806 million medical devices were recalled. When approving a device, the FDA employs advisory boards organized by medical specialty (e.g. cardiovascular) to make approval recommendations. Previous work has demonstrated high numbers of recalled orthopedic and cardiovascular devices; however, no prior studies have controlled for the number of approvals by advisory board. The purpose of this study is to identify device fields at higher risk for safety problems. This study compares specialty-specific, approval-adjusted recall rates of high-risk medical devices from 2002 to 2016 by utilizing publicly available FDA data on recalls and approvals. Devices approved under general hospital (113), anesthesiology (98), and cardiovascular (98) advisory boards constituted 71% of all class I recalls. For devices approved via the more rigorous pre-market approval pathway, those under the purview of the general hospital (0.25 recalls/approval, 95% CI 0.15 - 0.41) advisory board had a significantly higher rate than average (p<0.05). For 510(k) cleared devices, microbiology (6.0 recalls/clearance, 95% CI 3.4 - 10.6), anesthesiology (0.04 recalls/clearance, 95% CI 0.03 - 0.04), general hospital (0.02 recalls/clearance, 95% CI 0.02 - 0.02), and cardiovascular (0.010 recalls/ clearance, 0.009 to 0.015) advisory boards had significantly higher recall rates than average (p<0.05). Future regulatory resources should be directed towards device areas and approval pathways that pose a higher risk for safety problems.
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Affiliation(s)
| | - Timothy M Janetos
- Department of Ophthalmology, Feinberg School of Medicine of Northwestern University, Chicago, IL
| | - Shelun Tsai
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Leah Welty
- Biostatistics Collaboration Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jessica R Walter
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Shuai Xu
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL
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Janetos TM, Xu RS, Walter JR, Xu S. Reducing FDA regulations for medical devices: cutting red tape or putting patients' lives at risk? Expert Rev Med Devices 2018; 15:859-861. [PMID: 30345824 DOI: 10.1080/17434440.2018.1539666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Timothy M Janetos
- a Department of Ophthalmology , Northwestern University Feinberg School of Medicine , Chicago , IL , USA
| | - Rebecca S Xu
- b Feinberg School of Medicine , Northwestern University , Chicago , IL , USA
| | - Jessica R Walter
- c Department of Obstetrics and Gynecology , Northwestern University Feinberg School of Medicine , Chicago , IL , USA
| | - Shuai Xu
- d Department of Dermatology , Northwestern University Feinberg School of Medicine , Chicago , IL , USA.,e Center for Bio-Integrated Electronics , Northwestern University , Chicago , IL , USA
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Walter JR, Jacob SL, Xu S. Better Reporting Needed for Cosmetics and Women's Health. Am J Obstet Gynecol 2018; 218:265-266. [PMID: 29138032 DOI: 10.1016/j.ajog.2017.11.558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 11/06/2017] [Indexed: 11/24/2022]
Affiliation(s)
- Jessica R Walter
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Saya L Jacob
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Shuai Xu
- Department of Dermatology - Northwestern University Feinberg School of Medicine, Chicago, IL.
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Walter JR, Xu S, Woodruff TK. A Call for Fertility Preservation Coverage for Breast Cancer Patients: The Cost of Consistency. J Natl Cancer Inst 2017; 109:3074378. [PMID: 28376233 DOI: 10.1093/jnci/djx006] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 01/09/2017] [Indexed: 12/19/2022] Open
Abstract
In 1998, the passage of the Women's Health and Cancer Rights Act required insurance health plans nationwide covering breast cancer treatments to also reimburse for subsequent breast reconstructive surgery and prostheses. In response to low utilization of breast reconstructive services, particularly among racial minorities, plastic surgery interest groups successfully advocated for the passage of the Breast Cancer Patient Education Act, which provides a timely opportunity to reconsider patient accessibility to other equally important quality of life issues for cancer survivors. Currently, the potential threat of infertility as a consequence of cancer therapy does not meet preexisting definitions of infertility, making preemptive fertility preservation elective. Ultimately, cost remains the largest barrier to the pursuit of fertility preservation. In this Commentary, we estimate the potential additive cost of providing fertility preservation coverage for approximately 19 000 eligible women of reproductive age diagnosed with breast cancer based on previously published prevalence and cost data. We determine an upper limit of yearly cost of $126.6 million US dollars assuming 100% participation. Legislation providing mandatory insurance coverage of breast reconstruction surgeries in all 50 states following cancer treatment represents a powerful policy commitment to address existing health disparities in reproductive health services and ensures comprehensive cancer survivorship care. Extending coverage for fertility preservation in the setting of fertility-threatening treatment offers a consistent stance for insurance coverage of iatrogenic sequelae of cancer therapy at a fraction of the cost of breast reconstruction.
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Affiliation(s)
- Jessica R Walter
- Department of Obstetrics and Gynecology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Shuai Xu
- Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Teresa K Woodruff
- Women's Health Research Institute, Northwestern University, Chicago, IL, USA
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Janetos TM, Ghobadi CW, Xu S, Walter JR. Overview of high-risk medical device recalls in obstetrics and gynecology from 2002 through 2016: implications for device safety. Am J Obstet Gynecol 2017; 217:42-46.e1. [PMID: 28500861 DOI: 10.1016/j.ajog.2017.03.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 03/04/2017] [Accepted: 03/23/2017] [Indexed: 11/19/2022]
Abstract
The field of women's health has endured numerous recent controversies involving medical devices such as pelvic meshes, laparoscopic morcellators, and a hysteroscopic sterilization device. With the recent passage of the 21st Century Cures Act, new legislation will change how the Food and Drug Administration regulates medical devices. Given these controversies and new changes, we investigated high-risk, class I recalls in women's health from 2002 through 2016. Class I recalls for medical devices are defined by the Food and Drug Administration as the most serious recall events and are designated for situations when there is a reasonable probability of serious adverse health consequences or death. We defined a recall event as a group of unique Food and Drug Administration recalls that share a similar reason for recall and occurred within a 1-month time frame. In total, 7 class I recall events were identified encompassing 83 unique recalls affecting >88,000 medical devices in distribution. Recalls involved a broad range of devices used in women's health including diagnostic assays for chlamydia and gonorrhea, a laparoscopic tissue morcellator, and obstetrical/gynecological surgical kits. Four of 7 (57%) recall events were due to postmarketing problems such as improper packaging and labeling while the remaining 3 (43%) recalls were due to premarketing problems (eg, software issues). Additionally, 3 of 7 (43%) recall events were cleared via the 510(k) pathway, while the remaining were essentially exempt from any form of premarket approval. Two recall events involved sterility concerns of 71 surgical kits used in obstetrics and gynecological surgeries representing the majority of affected devices (78,423) in distribution. Class I medical device recalls are rare but serious events. Most recalled devices in women's health had minimal preapproval regulation and were recalled due to both premarketing and postmarketing reasons. Future regulatory efforts to improve postmarketing surveillance may mitigate the potential impact and frequency of class I recalls, but do not replace the need for a higher burden of proof for both safety and efficacy prior to medical device approval.
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Affiliation(s)
- Timothy M Janetos
- Northwestern University's Feinberg School of Medicine, Chicago, and Kellogg School of Management, Evanston, IL
| | - Comeron W Ghobadi
- Department of Radiology, University of Chicago Medical Center, Chicago, IL
| | - Shuai Xu
- Department of Dermatology, McGaw Medical Center of Northwestern University, Chicago, IL
| | - Jessica R Walter
- Department of Obstetrics and Gynecology, McGaw Medical Center of Northwestern University, Chicago, IL.
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Walter JR, Xu S, Paller AS, Choi JN, Woodruff TK. Oncofertility considerations in adolescents and young adults given a diagnosis of melanoma: Fertility risk of Food and Drug Administration-approved systemic therapies. J Am Acad Dermatol 2017; 75:528-534. [PMID: 27543212 DOI: 10.1016/j.jaad.2016.04.031] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [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: 12/10/2015] [Revised: 04/06/2016] [Accepted: 04/09/2016] [Indexed: 01/23/2023]
Abstract
BACKGROUND Melanoma is the most common cancer diagnosed for patients ages 25 to 29 years, the group with the highest birth rates in the United States. Oncofertility is a new field addressing the reproductive needs of patients with cancer facing fertility-threatening treatments. OBJECTIVE We sought to assess gender-specific fertility risk for Food and Drug Administration (FDA)-approved melanoma therapies with a new risk category system. METHODS We conducted a retrospective review of FDA, European Union, and Health Canada regulatory filings, along with previously published reports to grade fertility risk of systemic melanoma therapies. The proposed fertility risk category system is analogous to the FDA's A/B/C/D/X/N pregnancy-risk categories. RESULTS For female patients, 58% of treatments represent a fertility risk (Category C and D), 33% have unknown risk (Category N), and 1 therapy (vemurafenib) did not show animal ovarian toxicity (Category B). For male patients, 33% represented a fertility risk (Category C and D), 50% of treatments had unknown risk (Category N), and 17% did not show animal testicular toxicity (Category B). LIMITATIONS Data on fertility risk for melanoma therapies approved after 2009 are limited to preclinical animal studies. CONCLUSION Dermatologists have an opportunity to discuss fertility preservation, make appropriate referrals, and steward registries on reproductive outcomes for patients with melanoma.
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Affiliation(s)
- Jessica R Walter
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Shuai Xu
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Amy S Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jennifer N Choi
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Teresa K Woodruff
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Women's Health Research Institute, Northwestern University, Chicago, Illinois
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Ghobadi CW, Gevorgyan O, Bednarski CE, Hayman EL, Walter JR, Xu S. Medical malpractice web advertising: a qualitative, cross-sectional analysis of plaintiff medical malpractice firms in Suffolk County, Massachusetts. Issues Law Med 2017; 32:205-214. [PMID: 29108143] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Medical malpractice plaintiff firms play a central role in the prosecution of malpractice claims. There have been limited studies on the online advertising practices of plaintiff medical malpractice firms. The Martindale-Hubbell directory was used to identify all plaintiff medical malpractice firms in Suffolk County, Massachusetts. Each firm's website was individually mined for relevant data. Thirty-one unique medical malpractice law firms were identified. Seventy-seven percent of law firms advertised awards with the Martindale-Hubbell AV rating, AVVO, and Super Lawyer being the three most common. The second most common method of advertising was accomplished through descriptions of successful verdicts and settlements (61%). A total of 408 verdicts, settlements, and arbitrations collectively representing $1.4 billion dollars were advertised by all law firms. Median awarded values for verdicts was advertised as $4.5 million, while the median awarded values for settlements was $1.25 million. Defendants most commonly practiced obstetrics (18%), followed by primary care (14%). Law firms report treatment and diagnosis delay as the most common successful claim (50%), followed much further by misdiagnosis (8%), and communication error (4%). Our sample correlates with larger claims-based studies surrounding the most commonly sued specialties, however, median reported settlement and verdict values were significantly higher in our cohort. Considerations should be made to provide advertising guidelines for medical malpractice plaintiff firms.
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Affiliation(s)
| | - Ofelya Gevorgyan
- Department of Medicine, Presence Saint Joseph Hospital in affiliation with the University of Illinois College of Medicine, Chicago, IL
| | | | - Emily L Hayman
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jessica R Walter
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Shuai Xu
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL
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Walter JR, Lohman ME, Kundu SD, Xu S. A new fertility risk rating system for surgical, radiotherapy, and chemotherapy interventions used in testicular cancer. Transl Cancer Res 2016. [DOI: 10.21037/tcr.2016.10.90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Walter JR, Xu S. Therapeutic transdermal drug innovation from 2000 to 2014: current status and outlook. Drug Discov Today 2015; 20:1293-9. [DOI: 10.1016/j.drudis.2015.06.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 05/17/2015] [Accepted: 06/11/2015] [Indexed: 11/29/2022]
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Affiliation(s)
- Jessica R. Walter
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Shuai Xu
- Department of Internal Medicine, Presence Saint Joseph Hospital, Chicago, Illinois3Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Walter JR, Perng W, Kleinman KP, Rifas-Shiman SL, Rich-Edwards JW, Oken E. Associations of trimester-specific gestational weight gain with maternal adiposity and systolic blood pressure at 3 and 7 years postpartum. Am J Obstet Gynecol 2015; 212:499.e1-12. [PMID: 25446696 DOI: 10.1016/j.ajog.2014.11.012] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 09/24/2014] [Accepted: 11/06/2014] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Our objective was to examine the associations of total and trimester-specific gestational weight gain (GWG) rate with postpartum maternal weight and cardiometabolic risk. We hypothesized that first-trimester GWG would be most strongly associated with long-term maternal health. STUDY DESIGN We studied 801 women enrolled during the first trimester of pregnancy in the Boston-area Project Viva cohort 1999 through 2002. At 3 years postpartum we measured maternal weight, waist circumference (WC), and systolic blood pressure (SBP) and collected fasting blood from a subset. At 7 years postpartum we again measured weight and WC. We used multivariable linear regression to evaluate relations of total and trimester-specific GWG rate with weight change (vs self-reported prepregnancy weight) and WC at each time point, stratified by prepregnancy weight, as well as associations with SBP and insulin resistance at 3 years. RESULTS Median age at enrollment was 34.0 years (range, 16.4-44.9); 65% were white. Mean (SD) total GWG rate was 0.38 (0.14) kg/wk. Women gained weight faster during the second (0.47 [0.19] kg/wk) and third (0.44 [0.22] kg/wk) trimesters than the first (0.22 [0.22] kg/wk). Total and first-trimester GWG rate were most strongly associated with postpartum weight change. Among normal-weight women, each 1-SD increase in total and first-trimester GWG rate corresponded with 0.85 (95% confidence interval [CI], 0.07-1.63) kg and 2.08 (1.32-2.84) kg greater weight change at 3 and 7 years postpartum, respectively, but there was not strong evidence of association for either second- (-0.30 kg; 95% CI, -1.08 to 0.48) or third- (-0.26 kg; 95% CI, -1.08 to 0.55) trimester GWG. First-trimester GWG rate also related to 3-year postpartum weight change in overweight (2.28 kg; 95% CI, 0.95-3.61) and obese (2.47 kg; 95% CI, 0.98-3.97) women. Greater total and first-trimester GWG rate were associated with larger WC and higher SBP but not insulin resistance. CONCLUSION In this observational cohort, first-trimester weight gain was more strongly associated with maternal weight retention as well as higher WC and blood pressure than second- or third-trimester gain. Interventions targeting GWG beginning very early in pregnancy may benefit long-term maternal health.
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Affiliation(s)
| | - Wei Perng
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Ken P Kleinman
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Sheryl L Rifas-Shiman
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Janet W Rich-Edwards
- Channing Laboratory and Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, MA
| | - Emily Oken
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA.
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Walter JR, Hubenet KS. The emergency and after-hours care system at Group Health Cooperative. HMO Pract 1991; 5:80-3. [PMID: 10111916] [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] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
The Group Health Cooperative (GHC) emergency and after-hours care system has defined several roles that are unique in our community. The consulting nurse service provides a valued tie between patients and the many services available at GHC. The consulting nurses also encourage self care and autonomy. The GHC-operated emergency departments function to maximize the efficiency of primary care physicians and specialists while providing high quality care and a professionally rewarding emergency medicine practice.
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Affiliation(s)
- J R Walter
- Group Health Cooperative of Puget Sound, Seattle, WA 98122
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Abstract
The mini-dose Bier block, a technique of intravenous (IV) regional anesthesia that uses low-dose lidocaine and provides safe and effective anesthesia for outpatient closed reductions of upper extremity fractures and dislocations, is presented. This procedure was evaluated in two hospital emergency departments in 105 patients (ages 2 to 86). Ninety-five percent achieved adequate anesthesia (minimal or no pain on closed reduction). No significant complications were noted. Full neurologic function returned in ten minutes in all cases. Both patient and physician satisfaction with the procedure were high. The mini-dose Bier block creates the potential for significant cost savings in cases previously treated in the operating room by providing a safe, effective technique of IV regional anesthesia for outpatient use.
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Abstract
The mini-dose Bier block, a technique of intravenous (IV) regional anesthesia that uses low-dose lidocaine and provides safe and effective anesthesia for outpatient closed reductions of upper extremity fractures and dislocations, is presented. This procedure was evaluated in two hospital emergency departments in 105 patients (ages 2 to 86). Ninety-five percent achieved adequate anesthesia (minimal or no pain on closed reduction). No significant complications were noted. Full neurologic function returned in ten minutes in all cases. Both patient and physician satisfaction with the procedure were high. The mini-dose Bier block creates the potential for significant cost savings in cases previously treated in the operating room by providing a safe, effective technique of IV regional anesthesia for outpatient use.
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Wilson R, Wolfson W, Centner S, Walter JR. Systems analysis in health sciences educational planning. Can Med Assoc J 1969; 100:715-23. [PMID: 5778957 PMCID: PMC1945863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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