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Article ; Online: Unravelling epistemic injustice in medical education: The case of the underperforming learner.

Luong, Victoria / Ajjawi, Rola / Burm, Sarah / Olson, Rebecca / MacLeod, Anna

2024

Abstract: Context: Epistemic injustice refers to a wrong done to someone in their capacity as a knower. While philosophers have detailed the pervasiveness of this issue within healthcare, it is only beginning to be discussed by medical educators. The purpose of ... ...

Abstract	Context: Epistemic injustice refers to a wrong done to someone in their capacity as a knower. While philosophers have detailed the pervasiveness of this issue within healthcare, it is only beginning to be discussed by medical educators. The purpose of this article is to expand the field's understanding of this concept and to demonstrate how it can be used to reframe complex problems in medical education. Methods: After outlining the basic features of epistemic injustice, we clarify its intended (and unintended) meaning and detail what is required for a perceived harm to be named an epistemic injustice. Using an example from our own work on introversion in undergraduate medical education, we illustrate what epistemic injustice might look like from the perspectives of both educators and students and show how the concept can reorient our perspective on academic underperformance. Results: Epistemic injustice results from two things: (1) social power dynamics that give some individuals control over others, and (2) identity prejudice that is associated with discriminatory stereotypes. This can lead to one, or both, forms of epistemic injustice: testimonial and hermeneutical. Our worked example demonstrates how medical educators can be unaware of when and how epistemic injustice is happening, yet the effects on students' well-being and sense of selves can be profound. Thinking about academic underperformance with epistemic injustice in mind can reveal an emphasis within current educational practices on diagnosing learning deficiencies, to the detriment of holistically representing its socially constructed and structural nature. Conclusions: This article builds upon recent calls to recognise epistemic injustice in medical education by clarifying its terminology and intended use and providing in-depth application and analysis to a particular case: underperformance and the introverted medical student. Equipped with a more sophisticated understanding of the term, medical educators may be able to re-conceptualise long-standing issues including, but also beyond, underperformance.
Language	English
Publishing date	2024-04-27
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	195274-2
ISSN	1365-2923 ; 0308-0110
ISSN (online)	1365-2923
ISSN	0308-0110
DOI	10.1111/medu.15410
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Article: Postmortem Genetic Testing Is an Increasingly Utilized Tool in Death Investigation.

Latimer, Rebecca / MacLeod, Heather / Dellefave-Castillo, Lisa / Macaya, Daniela / Hart, Tara R

Academic forensic pathology

2022 Volume 12, Issue 4, Page(s) 129–139

Abstract: Introduction: Postmortem genetic testing (PMGT) can provide valuable information about an individual's cause of death and potentially allow at-risk relatives to discern their risks for inherited cardiac disease. Postmortem genetic testing is most often ... ...

Abstract	Introduction: Postmortem genetic testing (PMGT) can provide valuable information about an individual's cause of death and potentially allow at-risk relatives to discern their risks for inherited cardiac disease. Postmortem genetic testing is most often successful with certain specimens. Methods: Investigators collected data on postmortem referrals to GeneDx, LLC for PMGT. Orders were reviewed and stratified based on provider, specimen type, and tests ordered. Discussion: This cohort included 601 deceased individuals referred for PMGT with a total of 673 genetic tests ordered from 247 different providers. The most common test categories ordered were arrhythmia (33.4%) and cardiomyopathy (29.3%). A likely pathogenic or pathogenic genetic variant was identified in approximately 15% of patients. Blood in EDTA was received for 21.6% of patients with a 95% success rate for completion of all test components. Blood samples in EDTA were most successful in completing PMGT, but sequencing was still successful in the majority of suboptimal specimens. Conclusion: The use of PMGT is increasing. Obtaining optimal samples (blood in EDTA) is important for successful completion of genetic testing. Obstacles may still exist for obtaining and storing ideal specimens. Continued efforts are needed for education and awareness around appropriate specimen types, storage and shipping of specimens, DNA banking, and overall availability of PMGT. In addition, access to resources such as supplies, proper storage conditions, DNA banking, and PMGT will allow for more opportunities to complete testing.
Language	English
Publishing date	2022-10-03
Publishing country	United States
Document type	Journal Article
ISSN	1925-3621
ISSN	1925-3621
DOI	10.1177/19253621221124800
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Article: Immunoglobulin utilization in Canada: a comparative analysis of provincial guidelines and a scoping review of the literature.

Harmon, Megan / Riazi, Kiarash / Callum, Jeannie / Arnold, Donald M / Barty, Rebecca / Sidhu, Davinder / Heddle, Nancy M / MacLeod, Laurie / Li, Na

Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology

2023 Volume 19, Issue 1, Page(s) 85

Abstract: Background: Canada has high immunoglobulin (IG) product utilization, raising concerns about appropriate utilization, cost and risk of shortages. Currently, there is no national set of standardized IG guidelines, and considerable variations exist among ... ...

Abstract	Background: Canada has high immunoglobulin (IG) product utilization, raising concerns about appropriate utilization, cost and risk of shortages. Currently, there is no national set of standardized IG guidelines, and considerable variations exist among the existing provincial guidelines. The aims of this study were: (1) to compare the existing Canadian provincial guidelines on the use of IG products to identify their consistencies and differences and (2) to examine the existing research in Canada on IG supply and utilization following the establishment of IG guidelines to understand the scope of research and pinpoint the gaps. Methods: A comparative analysis accounted for the differences across provincial IG guidelines. We highlighted similarities and differences in recommendations for medical conditions. A scoping review of citations from MEDLINE, PubMed, Scopus and Embase databases was conducted for studies published from January 01, 2014, to April 12, 2023. Results: While provincial guidelines represented a considerable overlap in the medical conditions delineated and relatively uniform dose calculations, numerous differences were observed, including in recommendation categories, provision of pediatric dosing, and divergent recommendations for identical conditions based on patient demographics. The scoping review identified 29 studies that focused on the use of IG in Canada. The themes of the studies included: IVIG utilization and audits, the switch from IVIG to SCIG, patient satisfaction with IVIG and/or SCIG, the economic impact of self-administered SCIG versus clinically administered IVIG therapy, and the efficacy and cost-effectiveness of alternative medications to IG treatment. Conclusion: The differences in guidelines across provinces and the factors influencing IVIG/SCIG use, patient satisfaction, and cost savings are highlighted. Future research may focus on clarifying costs and comparative effectiveness, exploring factors influencing guideline adherence, and evaluating the impact of updated guidelines on IG use and patient outcomes.
Language	English
Publishing date	2023-09-16
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2434973-2
ISSN	1710-1492 ; 1710-1484
ISSN (online)	1710-1492
ISSN	1710-1484
DOI	10.1186/s13223-023-00841-z
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Article ; Online: Advancing Health Equity, Inclusion, and Belonging in Integrative Oncology.

López, Ana María / Leibel, Leigh / Stein-Seroussi, Doreen / Salvador, Carolina / Leary Safon, Rebecca / Riggs, Tanya T J / Mann, Melvin D / MacLeod, Jodi / Walker, Eleanor M

Journal of integrative and complementary medicine

2023 Volume 29, Issue 8, Page(s) 462–467

MeSH term(s)	Humans ; Integrative Oncology ; Health Equity ; Medical Oncology ; Neoplasms/epidemiology ; Neoplasms/therapy
Language	English
Publishing date	2023-07-27
Publishing country	United States
Document type	Journal Article
ISSN	2768-3613
ISSN (online)	2768-3613
DOI	10.1089/jicm.2023.0316
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Article: Return on investment from service transformation for young people experiencing mental health problems: Approach to economic evaluations in ACCESS Open Minds (Esprits ouverts), a multi-site pan-Canadian youth mental health project.

Shah, Jai L / Moinfar, Zeinab / Anderson, Kelly K / Gould, Hayley / Hutt-Macleod, Daphne / Jacobs, Philip / Mitchell, Stephen / Nguyen, Thanh / Rodrigues, Rebecca / Reaume-Zimmer, Paula / Rudderham, Heather / Rudderham, Sharon / Smyth, Rebecca / Surood, Shireen / Urichuk, Liana / Malla, Ashok K / Iyer, Srividya N / Latimer, Eric

Frontiers in psychiatry

2023 Volume 14, Page(s) 1030407

Abstract: Introduction: Mental health problems are common globally, and typically have their onset in adolescence and early adulthood-making youth (aged 11-25) an optimal target for prevention and early intervention efforts. While increasing numbers of youth ... ...

Abstract	Introduction: Mental health problems are common globally, and typically have their onset in adolescence and early adulthood-making youth (aged 11-25) an optimal target for prevention and early intervention efforts. While increasing numbers of youth mental health (YMH) initiatives are now underway, thus far few have been subject to economic evaluations. Here we describe an approach to determining the return on investment of YMH service transformation Approach: As a complex intervention package, it is hoped that the AOM transformation will: (i) enable early intervention through accessible, community-based services; (ii) shift care away toward these primary/community settings and away from acute hospital and emergency services; and (iii) offset at least some of the increased costs of primary care/community-based mental health services with reductions in the volume of more resource-intensive acute, emergency, hospital or specialist services utilized. Co-designed with three diverse sites that represent different Canadian contexts, a return on investment analysis will (separately at each site) compare the costs generated by the intervention, including volumes and expenditures associated with the AOM service transformation and any contemporaneous changes in acute, emergency, hospital or service utilization (vs. historical or parallel comparators). Available data from health system partners are being mobilized to assess these hypotheses. Anticipated results: Across urban, semi-urban and Indigenous sites, the additional costs of the AOM transformation and its implementation in community settings are expected to be at least partially offset by a reduction in the need for acute, emergency, hospital or specialist care. Discussion: Complex interventions such as AOM aim to shift care "upstream": away from acute, emergency, hospital and specialist services and toward community-based programming which is more easily accessible, often more appropriate for early-stage presentations, and more resource-efficient. Carrying out economic evaluations of such interventions is challenging given the constraints of available data and health system organization. Nonetheless, such analyses can advance knowledge, strengthen stakeholder engagement, and further implementation of this public health priority.
Language	English
Publishing date	2023-02-21
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2564218-2
ISSN	1664-0640
ISSN	1664-0640
DOI	10.3389/fpsyt.2023.1030407
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Article ; Online: Immunisation against HPV in girls with intellectual disabilities.

MacLeod, Rebecca / Tuffrey, Catherine

Archives of disease in childhood

2014 Volume 99, Issue 12, Page(s) 1068–1070

MeSH term(s)	Female ; Humans ; Intellectual Disability/complications ; Papillomaviridae/immunology ; Papillomavirus Vaccines/administration & dosage ; Uterine Cervical Neoplasms/prevention & control
Chemical Substances	Papillomavirus Vaccines
Language	English
Publishing date	2014-12
Publishing country	England
Document type	Journal Article
ZDB-ID	524-1
ISSN	1468-2044 ; 0003-9888 ; 1359-2998
ISSN (online)	1468-2044
ISSN	0003-9888 ; 1359-2998
DOI	10.1136/archdischild-2013-305919
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Article ; Online: Moderating the stereotypical views of health and social care students: the role of interprofessional education.

Foster, Rebecca / Macleod Clark, Jill

Journal of interprofessional care

2015 Volume 29, Issue 1, Page(s) 34–40

Abstract: The potential of interprofessional education (IPE) to influence the perceptions and attitudes of health and social care professionals towards their colleagues in other disciplines is well recognized. However, empirical evidence for the positive impact of ...

Abstract	The potential of interprofessional education (IPE) to influence the perceptions and attitudes of health and social care professionals towards their colleagues in other disciplines is well recognized. However, empirical evidence for the positive impact of IPE on stereotypical beliefs has been limited. We report the findings of a pioneering, large scale study designed to assess the influence of IPE on these beliefs. A pre-test, post-test, quasi experimental design compared students' stereotypical views at the beginning and end of undergraduate studies. 580 students from 10 health and social care professional groups undertook assessed IPE modules over 3 years (the intervention group). Baseline and post-course stereotype ratings were compared with those of 672 students in a comparison group, not exposed to IPE modules. Baseline stereotype profiles showed clear variations in the way different professions were perceived, indicating stereotypical beliefs about the characteristics of each profession. Rating patterns were similar for intervention and comparison groups. At graduation, only minor changes were observed in the overall rating patterns for both groups. However, more ratings had decreased in the intervention group than the comparison group, suggesting that IPE may play a role in moderating more extreme stereotyping of colleagues in other professions.
MeSH term(s)	Adult ; Attitude of Health Personnel ; Clinical Competence ; Cohort Studies ; Cooperative Behavior ; Female ; Humans ; Interpersonal Relations ; Interprofessional Relations ; Leadership ; Learning ; Male ; Patient Care Team/organization & administration ; Self Efficacy ; Social Workers/education ; Social Workers/psychology ; Stereotyping ; Students, Health Occupations/psychology
Language	English
Publishing date	2015-01
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1099758-1
ISSN	1469-9567 ; 0884-3988 ; 1356-1820
ISSN (online)	1469-9567
ISSN	0884-3988 ; 1356-1820
DOI	10.3109/13561820.2014.936059
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Article: Ohnut Versus a Waitlist Control for the Self-management of Endometriosis-Associated Deep Dyspareunia: Protocol for a Pilot Randomized Controlled Trial.

Zhang, Sandy X J / MacLeod, Rebecca G K / Parmar, Gurkiran / Orr, Natasha L / Wahl, Kate J / Noga, Heather / Albert, Arianne / Flannigan, Ryan / Brotto, Lori A / Yong, Paul J

JMIR research protocols

2023 Volume 12, Page(s) e39834

Abstract: Background: Endometriosis-associated deep dyspareunia is associated with reduced sexual quality of life, lower self-esteem, and impaired sexual function.: Objective: The primary objective is to assess the acceptability of a phallus length reducer ( ... ...

Abstract	Background: Endometriosis-associated deep dyspareunia is associated with reduced sexual quality of life, lower self-esteem, and impaired sexual function. Objective: The primary objective is to assess the acceptability of a phallus length reducer (brand name: Ohnut [OhnutCo]), which is a buffer worn over the penis or a penetrating object to reduce endometriosis-associated deep dyspareunia, and the feasibility of a definitive randomized controlled trial (RCT). The secondary objective is to obtain estimates of the effectiveness of the buffer. An embedded substudy will explore the acceptability and the preliminary validity and reliability of a vaginal insert for the self-assessment of deep dyspareunia. Methods: Ours is an investigator-initiated, 2-arm RCT. We will recruit 40 patient participants with diagnosed endometriosis between the ages of 19 and 49 years, as well as their sexual partners. The participating couples will be randomized in a 1:1 ratio into the experimental arm or the waitlist control arm. The length of the study period will be 10 weeks, during which time all participants will record deep dyspareunia severity following each episode of sexual intercourse. In weeks 1 to 4, all patient participants will record deep dyspareunia severity at each sexual encounter. In weeks 5 to 10, participants in the experimental arm will use the buffer during vaginal penetration; participants in the waitlist control arm will continue engaging in vaginal penetration as usual. Participants will complete questionnaires for assessing measures of anxiety, depression, and sexual function at baseline, at 4 weeks, and at 10 weeks. In the substudy, patient participants will self-assess dyspareunia by using a vaginal insert on 2 occasions, at least 1 week apart. The primary outcomes-the acceptability and feasibility of the buffer-will be assessed with descriptive statistics, and the secondary outcome-phallus length reducer effectiveness-will be assessed by using an analysis of covariance-based approach. For the vaginal insert, we will assess acceptability, test-retest reliability, and convergent validity via correlation analyses comparing the use of the insert to clinical examination in terms of dyspareunia assessment outcomes. Results: Our pilot will provide initial data on the acceptability and effectiveness of the buffer and the feasibility of the study methodology. The results from our study are expected to be submitted for publication by the spring of 2023. As of September 2021, we have consented 31 couples into the study. Conclusions: Our study will provide preliminary evidence for the self-assessment and management of endometriosis-associated deep dyspareunia. The findings will inform the decision to proceed to a definitive RCT. Trial registration: ClinicalTrials.gov NCT04370444; https://clinicaltrials.gov/ct2/show/NCT04370444. International registered report identifier (irrid): DERR1-10.2196/39834.
Language	English
Publishing date	2023-03-27
Publishing country	Canada
Document type	Journal Article
ZDB-ID	2719222-2
ISSN	1929-0748
ISSN	1929-0748
DOI	10.2196/39834
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Article ; Online: Protocol for an evaluation of adherence monitoring and support interventions among people initiating antiretroviral therapy in Cape Town, South Africa-a multiphase optimization strategy (MOST) approach using a fractional factorial design.

Jennings, Lauren / West, Rebecca L / Halim, Nafisa / Kaiser, Jeanette L / Gwadz, Marya / MacLeod, William B / Gifford, Allen L / Haberer, Jessica E / Orrell, Catherine / Sabin, Lora L

Trials

2023 Volume 24, Issue 1, Page(s) 310

Abstract: Background: South Africa bears a large HIV burden with 7.8 million people with HIV (PWH). However, due to suboptimal antiretroviral therapy (ART) adherence and retention in care, only 66% of PWH in South Africa are virally suppressed. Standard care only ...

Abstract	Background: South Africa bears a large HIV burden with 7.8 million people with HIV (PWH). However, due to suboptimal antiretroviral therapy (ART) adherence and retention in care, only 66% of PWH in South Africa are virally suppressed. Standard care only allows for suboptimal adherence detection when routine testing indicates unsuppressed virus. Several adherence interventions are known to improve HIV outcomes, yet few are implemented in routinely due to the resources required. Therefore, determining scalable evidence-based adherence support interventions for resource-limited settings (RLS) is a priority. The multiphase optimization strategy (MOST) framework allows for simultaneous evaluation of multiple intervention components and their interactions. We propose to use MOST to identify the intervention combination with the highest levels of efficacy and cost-effectiveness that is feasible and acceptable in primary care clinics in Cape Town. Methods: We will employ a fractional factorial design to identify the most promising intervention components for inclusion in a multi-component intervention package to be tested in a future randomized controlled trial. We will recruit 512 participants initiating ART between March 2022 and February 2024 in three Cape Town clinics and evaluate acceptability, feasibility, and cost-effectiveness of intervention combinations. Participants will be randomized to one of 16 conditions with different combinations of three adherence monitoring components: rapid outreach following (1) unsuppressed virus, (2) missed pharmacy refill collection, and/or (3) missed doses as detected by an electronic adherence monitoring device; and two adherence support components: (1) weekly check-in texts and (2) enhanced peer support. We will assess viral suppression (<50 copies/mL) at 24 months as the primary outcome; acceptability, feasibility, fidelity, and other implementation outcomes; and cost-effectiveness. We will use logistic regression models to estimate intervention effects with an intention-to-treat approach, employ descriptive statistics to assess implementation outcomes, and determine an optimal intervention package. Discussion: To our knowledge, ours will be the first study to use the MOST framework to determine the most effective combination of HIV adherence monitoring and support intervention components for implementation in clinics in a RLS. Our findings will provide direction for pragmatic, ongoing adherence support that will be key to ending the HIV epidemic. Trial registration: ClinicalTrials.gov NCT05040841. Registered on 10 September 2021.
MeSH term(s)	Humans ; Anti-HIV Agents/therapeutic use ; South Africa/epidemiology ; Anti-Retroviral Agents/therapeutic use ; HIV Infections/diagnosis ; HIV Infections/drug therapy ; HIV Infections/epidemiology ; Medication Adherence ; Randomized Controlled Trials as Topic
Chemical Substances	Anti-HIV Agents ; Anti-Retroviral Agents
Language	English
Publishing date	2023-05-05
Publishing country	England
Document type	Clinical Trial Protocol ; Journal Article
ZDB-ID	2040523-6
ISSN	1745-6215 ; 1468-6694 ; 1745-6215
ISSN (online)	1745-6215
ISSN	1468-6694 ; 1745-6215
DOI	10.1186/s13063-023-07322-z
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Article ; Online: Acceptability, reliability, and validity of a vaginal insert for the self-assessment of endometriosis-associated deep dyspareunia: a cross-sectional study.

MacLeod, Rebecca G K / Parmar, Gurkiran / Zhang, Sandy / Noga, Heather / Allaire, Catherine / Albert, Arianne / Flannigan, Ryan / Brotto, Lori A / Orr, Natasha L / Wahl, Kate / Yong, Paul J

The journal of sexual medicine

2023 Volume 21, Issue 1, Page(s) 44–53

Abstract: Background: Approximately half of people with endometriosis experience deep dyspareunia; however, there is no means of objective self-testing of endometriosis-associated deep dyspareunia.: Aim: The aim of this study was to assess the acceptability, ... ...

Abstract	Background: Approximately half of people with endometriosis experience deep dyspareunia; however, there is no means of objective self-testing of endometriosis-associated deep dyspareunia. Aim: The aim of this study was to assess the acceptability, test-retest reliability, and validity of a vaginal insert for a self-assessment of endometriosis-associated deep dyspareunia. Methods: Participants were recruited from a tertiary endometriosis center. Inclusion criteria were: 19 to 49 years of age, self-reported deep dyspareunia of ≥4 of 10, and surgically confirmed endometriosis. Participants completed 2 self-assessments using the vaginal insert to self-assess tenderness at the right and left pelvic floor, bladder, cervix-uterus, and posterior cul-de-sac (vaginal fornix). The participants recorded tenderness at each pelvic site and completed a questionnaire regarding the acceptability of the vaginal insert to assess deep dyspareunia. Test-retest reliability was assessed by correlating the tenderness scores between the 2 assessment dates. Over a 4-week period, the participants also recorded deep dyspareunia severity at each penetrative vaginal sex encounter. Validity was assessed by correlating vaginal insert tenderness to deep dyspareunia severity, and also to tenderness reported on a prior gynecologic pelvic examination. Outcomes: The main outcome measures were the acceptability index score, tenderness (0-10) at each pelvic site, and prospective deep dyspareunia scores (0-10) over 4 weeks. Results: There were 19 participants (mean age 34 ± 7 years) who completed the study. The majority identified as female (94.7%), heterosexual (89.5%), and white (89.5%). The median acceptability index score was 0.72 (interquartile range, 0.66-0.81). For test-retest reliability, the intraclass correlation coefficients were 0.79 (P = .001) for the left pelvic floor, 0.82 (P < .001) for the right pelvic floor, 0.54 (P = .07) for the bladder, 0.89 (P < .001) for the cervix-uterus, and 0.77 (P = .003) for the cul-de-sac. The correlation between the highest self-assessed mean tenderness in each participant and self-reported deep dyspareunia over 4 weeks was r = 0.32, but correlations for each pelvic site varied significantly. Tenderness at each site on prior gynecologist pelvic exam was associated with higher self-assessed mean tenderness with the vaginal insert in each participant (effect sizes = 0.42-0.88). Clinical implications: The vaginal insert is acceptable and reliable for the objective self-assessment of endometriosis-associated deep dyspareunia, with initial evidence of validity. Strengths and limitations: A strength was the inclusion of participants who were avoiding sexual activity and a limitation was the small sample size. Conclusion: Future studies with larger sample sizes are required to further establish the validity of the vaginal insert for the self-assessment of endometriosis-associated deep dyspareunia.
MeSH term(s)	Female ; Humans ; Adult ; Endometriosis/complications ; Endometriosis/diagnosis ; Pelvic Pain/complications ; Cross-Sectional Studies ; Self-Assessment ; Prospective Studies ; Dyspareunia/etiology ; Dyspareunia/complications ; Reproducibility of Results
Language	English
Publishing date	2023-11-28
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2251959-2
ISSN	1743-6109 ; 1743-6095
ISSN (online)	1743-6109
ISSN	1743-6095
DOI	10.1093/jsxmed/qdad133
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