Tubo-ovarian abscess (TOA), a serious sequela of pelvic inflammatory disease, occurs usually in women of ages 20 to 40. Up to 59% of these women are nulliparous. Traditionally, pregnancy rates after TOA are estimated to be 15% or less. Current proposed management algorithms for TOA do not include a separate pathway for women of reproductive age who may desire future pregnancies. A MEDLINE search and extensive review of published literature was undertaken to study management options for patients with TOA, and to compare rates of responders, pregnancies and complications associated with each management option. If intra-abdominal rupture is suspected, and patients are treated with fertility-preserving, conservative surgery, reported pregnancy rate is 25%. If no rupture is suspected and patients are treated with medical management alone, reported pregnancy rates vary between 4% and 15%. If no rupture is suspected, and the treatment is medical management with immediate laparoscopic drainage within 24 hours, reported pregnancy rates vary between 32% and 63%. Laparoscopy should be considered to all patients with TOA who desire future conception. Overall, the advantages of immediate laparoscopy allow for an accurate diagnosis, effective treatment under magnification with minimal complications, possibly faster response rates with shorter hospitalization times and decreased infertility.

Charts were reviewed until November 26, 2008, for a minimum 17 months of follow-up. Completion was defined as receipt of 3 HPV vaccinations. Charts were reviewed for age, race/ethnicity, type of insurance (private vs Medicaid/Child Health Insurance Program [CHIP]), and distance from home to the clinic. Sexual history variables included sexual activity status prior to initiation of the series and history within 3 years of vaccine initiation of a gynecological exam and/or Papanicolaou (Pap) test, HPV DNA test, or sexually transmitted infection. The reason for each visit was classified as nonsick visit (well child, well woman, contraception), sick visit, or vaccine only. If the patient did not complete the series, the chart was reviewed to determine if the patient had any clinic visits after she was due for her next shot.Statistical analyses were performed using SPSS, version 12.0, with an α level of <.05 determining statistical significance. Missing data did not exceed 2% for any of the predictor variables with the exception of sexual activity status for which 27% were missing. Only Caucasian, African American, or Hispanic patients were included in analyses assessing race/ ethnicity, as these 3 groups comprised >98% of the sample. Bivariate relationships between patient characteristics and vaccine series completion were conducted. Variables that were significant were entered into a logistic regression analysis using backward stepwise elimination. ResultsA total of 352 charts met criteria for inclusion. A total of 193 (54.8%) patients received their vaccinations at an on-campus university-based pediatric T he Advisory Committee for Immunization Practices has recommended routine human papillomavirus (HPV) vaccination of 11 to 12-year-old girls and catch-up for females 13 to 26 years of age. 1 The 3 doses are administered at 0, 2 months (minimum 4 weeks), and 6 months (minimum 12 weeks after the second dose). 1 Low socioeconomic status, a primary language other than English, being an ethnic minority, not having health insurance, and not having consistent transportation were associated with poor hepatitis B virus vaccine completion in adolescents. [2][3][4] In contrast, completion rates increase when providers take advantage of opportunities for vaccination (eg, sick visits) and have reminder systems. 5 The purpose of this study was to describe the completion rates and timeliness of HPV vaccine receipt in university-associated practices. We also evaluated whether patient demographics and reasons for the clinic visit were associated with completion and if the reason for the visit was associated with timeliness. MethodsFollowing institutional review board approval, eligible medical charts were identified by using CPT code 90649. Criteria for inclusion in the study were female patient, age 21 years old or younger,

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Using an endometrial stripe cutoff of 5 mm in premenopausal women would miss significant intracavitary pathology. The sonographic evaluation of abnormal uterine bleeding in premenopausal women should include sonohysterography or equivalently accurate testing regardless of endometrial stripe thickness.

CONTEXT Many women undergoing cervical cancer screening lack appropriate understanding of the Pap test. It is important to evaluate knowledge and informational needs about Pap testing among groups who may have difficulty accessing care or a relatively low likelihood of obtaining follow‐up for an abnormal result, such as minority and low‐income women. METHODS A sample of 338 women undergoing cervical screening at two clinics in Texas completed a questionnaire measuring their knowledge of Pap testing and asking what specific information they would like to know about the test. Group comparisons and qualitative analyses were conducted. RESULTS Women correctly answered an average of 8.7 out of 20 questions; the range was 0‐17. Mean scores were higher among white women (10.2) than among blacks (8.4) and Hispanics (7.4), among women with more than a high school education than among their less educated counterparts (10.0 vs. 7.9) and among women with an annual household income of at least $10,000 than among those with a lower income (9.3 vs. 8.4). Knowledge scores did not differ according to Pap history. Open‐ended questioning identified a need for information on the purpose of the test, exam procedures, abnormal test results and prognosis. CONCLUSIONS Minority women and those of low socioeconomic status had poor understanding of Pap testing. Identifying misunderstandings in this vulnerable population and improving patient education on the most basic aspects of Pap testing may increase adherence to follow‐up when abnormalities are detected.

Objective To evaluate the effect of a theory-based, culturally-targeted intervention on adherence to follow-up among low-income and minority women who experience an abnormal Pap test. Methods 5,049 women were enrolled and underwent Pap testing. Of these, 378 had an abnormal result and 341 (90%) were randomized to 1 of 3 groups to receive their results: Intervention (I): culturally-targeted behavioral and normative beliefs + knowledge/skills + salience + environmental constraints/barriers counseling; Active Control (AC): non-targeted behavioral and normative beliefs + knowledge/skills + salience + environmental constraints/barriers counseling; or Standard Care Only (SCO). The primary outcome was attendance at the initial follow-up appointment. Secondary outcomes included delay in care, completion of care at 18 months, state anxiety (STAI Y-6), depressive symptoms (CES-D), and distress (CDDQ). Anxiety was assessed at enrollment, notification of results, and 7–14 days later with the CDDQ and CES-D. Results 299 women were included in intent-to-treat analyses. Adherence rates were 60% (I), 54% (AC), and 58% (SCO), p=0.73. Completion rates were 39% (I) and 35% in the AC and SCO groups, p=0.77. Delay in care (in days) was (M ±SD): 58 ±75 (I), 69 ±72 (AC), and 54 ±75 (SCO), p=0.75. Adherence was associated with higher anxiety at notification, p<0.01 while delay <90 days (vs. 90+) was associated with greater perceived personal responsibility, p<0.05. Women not completing their care (vs. those who did) had higher CES-D scores at enrollment, p<0.05. Conclusions A theory-based, culturally-targeted message was not more effective than a non-targeted message or standard care in improving behavior.

OBJECTIVE: To assess the effect of using of asynchronous video interviewing as a screening tool for obstetrics and gynecology residency selection. METHODS: This project was part of a quality-improvement effort to enhance the resident application process. Applications to a single obstetrics and gynecology residency program were scored using standardized criteria. In the 2018 Match, top-scored applicants were invited to in-person interviews, and second-tier applicants were asked to complete a three-question asynchronous video interview. Video interviews were scored and used to invite the remaining applicants for in-person interviews. In the 2019 Match, video interviewing was expanded to all applicants with top application scores, and the video score was used to determine in-person interview invitations. Applicants for 2019 were surveyed on their views regarding video interviewing. RESULTS: Half of the candidates interviewed in person in the 2018 season were screened by the video interview process compared with 82% in the 2019 season. The mean in-person interview score increased from 59.0 in 2017, before screening with asynchronous video interviews, to 62.2 in 2018 (effect size 0.50; 95% CI 0.09–0.90) In 2018, a nonsignificant correlation was seen between the video interview score and rank list percentile (r=0.22, P=.15, n=27) and in-person interview score (r=0.18, P=.12, n=46). United States Medical Licensing Examination step 1 and 2 scores were not correlated with video interview scores in either season. Most (58%) candidates indicated that the asynchronous video interview was an effective way to tell their story; however, only 42% were comfortable with the interview process. CONCLUSION: Video interviewing may have promise as a tool for program directors to use to select candidates from a competitive applicant pool by measuring important noncognitive skills. Acceptance by obstetrics and gynecology applicants was mixed.

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