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  • March 30, 2017 8:59 AM | Deleted user

    TUESDAY, March 28, 2017 (HealthDay News) -- For women with stage I endometrial cancer, total laparoscopic hysterectomy (TLH) is equivalent to total abdominal hysterectomy (TAH) for disease-free survival at 4.5 years, according to a study published in the March 28 issue of the Journal of the American Medical Association.

    Monika Janda, Ph.D., from the Queensland University of Technology in Brisbane, Australia, and colleagues randomized 760 women with stage I endometrioid endometrial cancer to TAH (353 women) or TLH (407 women). Patients were followed for a median of 4.5 years; 89 percent of patients completed the trial.

    The researchers found that disease-free survival was 81.3 and 81.6 percent in the TAH and TLH groups, respectively, at 4.5 years of follow-up, with a disease-free survival difference of 0.3 percent favoring TLH (95 percent confidence interval, −5.5 to 6.1 percent; P = 0.007), meeting the criteria for equivalence. There was no statistically significant difference between the groups in the recurrence of endometrial cancer (7.9 versus 8.1 percent; risk difference, 0.2 percent; 95 percent confidence interval, −3.7 to 4.0 percent; P = 0.93) or in overall survival (6.8 versus 7.4 percent; risk difference, 0.6 percent; 95 percent confidence interval, −3.0 to 4.2 percent; P = 0.76).

    "These findings support the use of laparoscopic hysterectomy for women with stage I endometrial cancer," the authors write.

    Several authors disclosed financial ties to the medical device industry.

    Abstract/Full Text (subscription or payment may be required)
    Editorial (subscription or payment may be required)



    Copyright © 2017 HealthDay. All rights reserved.


  • March 28, 2017 7:42 AM | Deleted user

    APAOG Events at AAPA

    AAPA Conference 2017

    Wednesday, May 17, 2017, 9-10 am
    SPARK Student Session - PAs in OBGYN

    Thursday, May 18, 2017, 5-6 pm
    APAOG Meet and Greet ~ no RSVP required

    Thursday, May 18, 2017 6-8 pm
    APAOG Banquet and Annual Meeting - RSVP today!

    APAOG Banquet and Annual Meeting Sponsored by:

    AAPA Conference Sessions Related to Women's Health

    • Female Pelvic and Vulvar Pain (Aleece Fosnight, APAOG President)
    • Basic Obstetrics Review (Melinda Blazar, APAOG Director at Large)
    • Preconception Counseling (Heather Adams, APAOG Publications Committee Chair)
    • Genital Ulcer STIs
    • Female Urology Update
    • Zika and Pregnancy
    • Women's Health Issues
    • Breast Cancer Patient Options
    • HPV Vaccination
    • Contraception Update
    • Menopause Management
    • Drug and Alcohol and Sexual Assault


  • March 27, 2017 9:54 AM | Deleted user

    According to new data, almost three-quarters of PAs (72 percent) who responded to a survey express support for the full practice authority and responsibility (FPAR) proposal drafted by the Joint Task Force on the Future of PA Practice Authority.

    Issued in December 2016, the proposal includes four components for the profession on which the Joint Task Force was seeking comment: Team-Based Practice; Elimination of Supervisory Agreement Requirements in Law/Regulation; Creation of Autonomous State PA Boards; and PA Eligibility for Direct Reimbursement.

    Read the full report here


  • March 27, 2017 9:37 AM | Deleted user

    Dorothy L. Tengler      

    Removing ovaries during hysterectomy may increase risk of heart disease

    Hysterectomy is one of the most commonly performed surgeries in women. Approximately 600,000 hysterectomies are performed each year in the United States, second only to cesarean sections.

    According to the Centers for Disease Control and Prevention (CDC), 11.7 percent of women between the ages of 40-44 had a hysterectomy from 2006-2010. By the age of 60, more than one-third of all women have had a hysterectomy.

    Although surgeons may suggest removing the ovaries to prevent possible ovarian cancer, this is not always medically necessary and may contribute to increased risk of cardiovascular disease, other cancers and higher overall mortality, according to recent research. A study in the British Medical Journal compared cases in which both ovaries were removed with those in which some ovarian tissue was conserved.

    The study, led by Richard Lilford, professor of obstetrics and gynecology and chair in public health at the University of Warwick's Warwick Medical School, examined a national database of hospital admissions and linked them to the national register of deaths. Unlike the previous, smaller Nurses' Health Study, the study was conducted on a countrywide basis rather than in a sample and examined associations between operation type and subsequent hospital admissions, as well as mortality.

    More than 113,679 hysterectomy cases were studied; the ovaries were removed in a third of these. The women were between the age of 35 and 45 (mean age, 41 years), the upper limit ensuring that the great majority of cases would be premenopausal. Women with a history of reproductive cancer, including breast cancer, were excluded. Outcomes included mortality, mortality resulting from ischemic heart disease and hospital admission for ischemic heart disease, cancer (all cancers, ovarian cancer, breast cancer), and suicide.

    Patients in the ovarian conservation group were less likely to be admitted for ischemic heart disease after hysterectomy than were those in the bilateral removal group. They were also less likely to have a cancer related post-hysterectomy admission.

    Fewer women who retained one or both ovaries compared to those who had both removed died within the study period (0.6 percent compared to 1.01 percent). Mortality was lower when ovarian tissue was conserved than when all ovarian tissue was removed, with a statistically significant difference of 0.41 percentage points. This amounts to one death in about 240 operations over 10 years, which is clinically significant.

    Researchers also found that there was a slow decline in the number of hysterectomies performed. Nearly 9,000 women had a hysterectomy for a benign condition in the target age range in 2014 compared to almost 13,000 in the 2004-05 group.

    Many premenopausal women with no specific risk factors have both ovaries removed during hysterectomy to protect them from the possible development of ovarian cancer. However, removing the ovaries may have long-term harmful effects that should be weighed against the potential benefit. A decrease in endogenous estrogen may increase the risk of cardiovascular disease or all cause mortality, but little empirical evidence for this exists.     

    About the Author

    Dorothy L. Tengler

    Dorothy L. Tengler, MA, is a freelance medical writer/communication specialist with nearly 20 years of experience in the pharmaceutical and medical communication industries. She has developed educational and medical marketing materials, including monographs, slide kits, health articles, prima


  • March 17, 2017 10:14 AM | Deleted user

    AstraZeneca’s Lynparza honed its edge in ovarian cancer on Tuesday, and just in time to help preserve its lead in the marketplace.

    In detailed results from a test of the drug in patients who’d relapsed after platinum chemo, the first-in-class PARP inhibitor held off cancer recurrence by more than two years, compared with placebo, and delivered a statistically significant improvement in the risk of tumor progression or death.

    Those numbers compare favorably with Tesaro’s much-ballyhooed competitor niraparib, which delivered a 15.5-month survival advantage in its own maintenance-therapy trial presented last fall. Tesaro's shares were down Tuesday afternoon by more than 11% on the news.

    AstraZeneca’s Solo-2 trial tested Lynparza (olaparib) against placebo in 295 patients who tested positive for the BRCA gene. It showed the drug delivering a median 30 months before patients’ tumors grew again, compared with just 5.5 months for patients in the placebo arm—a progression-free survival advantage of 24.5 months.

    With Clovis Oncology’s rival drug Rubraca now approved, and niraparib due for an FDA decision in June, the strong showing is good news for AstraZeneca, competitively speaking. And beyond the niraparib-beating numbers that could help Lynparza keep a leg up on its future rival, the new study might persuade regulators to broaden the drug’s approval.

    A new maintenance-therapy indication in the U.S. would not only give a new group of women access to Lynparza, but would also allow patients to stay on treatment for longer periods of time, leading to higher sales. Lynparza already has a maintenance approval in Europe, and its capsule formulation has put up positive data in the same setting, but right now it’s approved for stateside ovarian cancer patients only after treatment with three or more other agents.

    AstraZeneca Chief Medical Officer Sean Bohen, M.D., Ph.D., said in a statement that the company is “extremely pleased with the results” from Solo-2, which were unveiled Tuesday at the Society of Gynecologic Oncology meeting in Maryland.

    The data “support the potential benefit of Lynparza tablets as a maintenance therapy for patients with relapsed ovarian cancer,” Bohen said, adding that the tablets used in the study—as opposed to the currently approved capsule formulation—may cut the number of pills patients need to take daily.

    “We will work with regulatory authorities to make Lynparza tablets available to patients as quickly as possible,” he said.

    AstraZeneca is also testing Lynparza in other cancers, including breast cancer, where it put up solid data last month. Phase 3 results showed that Lynparza could top standard-of-care chemo at increasing progression-free survival in patients with HER2-negative breast cancer and BRCA1 or BRCA2 mutations. Bohen pointed out at the time that the numbers were the first positive phase 3 data for any PARP med outside the ovarian cancer arena.


  • March 17, 2017 10:11 AM | Deleted user

    Nearly five years ago, the nation's leading group of obstetricians and gynecologists issued a policy statement saying the time had come for oral contraception to be available without a prescription.

    We wrote about it and everything.

    In the intervening years, some states have changed their laws. California authorized pharmacists to distribute most types of hormonal birth control. Oregon passed a similar law covering both pills and patches.

    But neither law changed the status of birth control pills from prescription to over-the-counter. Only the Food and Drug Administration can do that. And in Oregon's case, the law does not apply to people of all ages. People under 18 are still required to get their first contraceptive prescription from a doctor.

    But researchers say there is no evidence that adolescents are at greater risk from birth control pills than adult women.

    review of oral contraceptive research presents the most comprehensive evidence yet that, as the authors state, "There is no scientific rationale for limiting access to a future over-the-counter oral contraceptive product by age."

    "There is a growing body of evidence that the safety risks are low and benefits are large," says Krishna Upadhya, an assistant professor of pediatrics at the Johns Hopkins University School of Medicine and the lead author of the review, which was published this week in the Journal of Adolescent Health.

    In fact, she says, some of the potential negative side effects of oral contraception are less likely in younger people. For example, birth control pills that contain both estrogen and progestin come with an increased risk of a type of blood clot called a venous thromboembolism, but that risk is lower in teenagers than in older women.

    As a result, the pill is "potentially safer the younger you are," says Upadhya.

    The review also found no evidence that increased access to birth control would lead teenagers to have more sex or engage in riskier sex, a concern voiced by some critics of oral contraception access.

    Teen pregnancy rates are way down in the U.S., and teenagers are using contraceptives more often. Between 2007 and 2013, the number of 15 to 19-year-olds giving birth dropped 36 percent. The abortion rate has also fallen.

    "These pills are safe and effective and we should reduce barriers to using them. And teens should benefit just as adult women do," Upadhya says.

    One reason more girls and women are using birth control is that the Affordable Care Act requires insurers to fully cover prescribed contraception. That includes the pill, implanted hormonal birth control and intrauterine devices.

    So what would happen if oral contraception no longer required a prescription? The Affordable Care Act does not require insurance companies to cover over-the-counter birth control like condoms, sponges and spermicide. If hormonal birth control was available over the counter, it too would fall outside the law's coverage mandate.

    The current Republican proposal to repeal part of the ACA would not affect mandatory coverage for prescription contraceptives, as we have reported.Sen. Patty Murray, D-Wash., introduced a bill in 2015 that would automatically amend the language of the ACA to require insurance companies to pay for any contraceptive approved for over-the-counter sale by the FDA. Sen. Kelly Ayotte, R-N.H., introduced a separate bill that proposed giving priority to any request from a birth control manufacturer asking the FDA to consider over-the-counter status for its drug, as long as it only applied to women over 18. Neither bill has made it out of committee.

    The American College of Obstetricians and Gynecologists has issued multiple statements in the past year stressing that, while the group still supports making oral contraception available without a prescription to teens as well as adults, such a change is not enough on its own for making birth control available to everyone who needs it.

    "Over-the-counter contraception is not an acceptable substitute for the ACA contraceptive coverage mandate," the group wrote in a statement issued in February.

    Of course, there is currently no version of the pill has been approved by the FDA for use without a prescription.

    An FDA spokesperson said the agency "generally cannot confirm or deny the existence of a pending product application," so it is difficult to know whether any birth control manufacturers have requested that that their products be considered for over-the-counter status.

    If a manufacturer did apply, the FDA would consider many of the same things Upadhya and her team looked at, including safety and efficacy data and potential age restrictions.

    Original Article: http://www.npr.org/sections/health-shots/2017/03/16/520268440/over-the-counter-birth-control-pills-would-be-safe-for-teens-researchers-say

  • March 09, 2017 4:12 PM | Deleted user

    APAOG is currently accepting career video blogs to enhance their offerings to pre-PA and PA student membership. 

    Are you passionate women's health professional? Do you have career advice for future PAs? Are you interested in contributing to the future workforce?

    Consider submitting a video blog to the APAOG career center!

    Videos should be under 5 minutes will feature a number of topics including but not limited to:

    • How did you get interested in Women's Health?
    • What was your first job as a PA? (and subsequent jobs)
    • How did you find your Women's Health job? Was it difficult? Any advice on how to find these jobs?
    • Do you suggest doing a primary care job first before going into Women's Health? 
    • What is your role in your current job? Specifically: procedures, OR, ultrasound, etc
    • What do you like about your job in Women's Health?
    • Do you feel like you are utilized to the top of your ability? 
    • What was your biggest challenge starting out as a PA/ Women's Health PA?
    • What is your relationship like with your supervising physician? Any advice for dealing with supervising physicians?

    Interested individuals should contact Ashley at ashley@badgerbay.co with interest.


  • March 08, 2017 8:47 AM | Deleted user

    The U.S. Preventive Services Task Force released today a final recommendation statement on screening for gynecologic conditions with pelvic examination. The Task Force concludes that more research is needed to recommend for or against performing pelvic examinations in adult women without any signs or symptoms. To view the recommendation and the evidence on which it is based, please go to this link. The final recommendation statement can also be found in the March 7 online issue of JAMA. 


  • March 03, 2017 10:10 AM | Deleted user

    A large national study suggests that treating pregnant women for mildly low thyroid function does not improve the IQs of their babies or reduce preterm births or other negative outcomes.

    The 10-year study, conducted at UT Southwestern Medical Center and 14 other universities and medical centers in the National Institutes of Health's (NIH) Maternal Fetal Medicine Units Network, found no benefit in treating the women during their pregnancies. The results are published today in The New England Journal of Medicine (NEJM).

    Full-blown hypothyroidism during pregnancy, especially when untreated, has long been associated with lower mental functioning in offspring, as well as low birth weight, stillbirth, and preterm labor. It is commonly treated by giving expectant mothers a synthetic substitute to boost their low thyroid hormone, thyroxine.

    In 1999, another NEJM study raised concerns that the same problems might occur in women with even mild, or subclinical, hormone abnormalities. As a result, several physician groups called for routine testing of all pregnant women in the U.S.—about 4 million women a year—and treatment for these marginal hormone problems.

    The American College of Obstetricians and Gynecologists has recommended against universal screening for thyroid disease in pregnant women.

    "Our study found that treatment did not benefit children born to these women," said Dr. Brian Casey, Professor of Obstetrics and Gynecology at UT Southwestern Medical Center and first author of the new study. "There's no evidence that treatment improves either pregnancy outcomes or the children's neurodevelopmental or behavioral outcomes through 5 years of age."

    Dr. Casey is Division Director of Maternal-Fetal Medicine at UT Southwestern and holds the Gillette Professorship of Obstetrics and Gynecology. He is also Chief of Obstetrics at Parkland Health & Hospital System.

    The NIH study grew out of research begun in 2000 at UT Southwestern, when Dr. Casey and his colleagues performed a study on thyroid disease during pregnancy in over 25,000 women at Parkland Memorial Hospital. That study culminated in his proposal of a multicenter treatment study to the NIH in 2005. Dr. Casey now is principal investigator of the NIH study and chair of the protocol subcommittee.

    Starting in October 2006, researchers screened more than 97,000 pregnant women for the study and enrolled 1,203 who had either subclinical hypothyroidism or isolated hypothyroxinemia. Subclinical hypothyroidism is characterized by high levels of a pituitary gland hormone, TSH, which stimulates the thyroid to produce thyroxine. In isolated hypothyroxinemia, the pituitary hormone level is normal, but thyroxine, or free T4, is abnormally low.

    Half the study participants were given levothyroxine, a synthetic substitute for their thyroid hormone; the other half received a placebo. Researchers then analyzed pregnancy outcomes of both groups and followed the neurocognitive development of the women's babies for five years.

    IQ levels and other test scores were not significantly different between the children of women given levothyroxine and children whose mothers received a placebo, Dr. Casey said.

    Children of the women treated for subclinical hypothyroidism scored an average of 97 on the IQ test, compared with 94 for those born to women in the placebo group. In the hypothyroxinemia part of the study, the children of those treated averaged 94, while offspring of those given placebos averaged 91. These scores are considered normal and the three-point differences are not viewed as significant, Dr. Casey said.

    The results suggest there is no benefit to widespread testing and treatment for subclinical thyroid problems during pregnancy, he said. "If treatment doesn't improve outcomes, then it calls into question whether we should be screening every pregnant woman for this mild degree of thyroid deficiency."

    A 2012 study published in The Journal of Clinical Endocrinology & Metabolism estimated a cost of $25 (in 2009 dollars) for the TSH test and $13 to test the free T4 thyroid hormone level, in addition to the cost of the physician visits and consultation. Pregnant women diagnosed with a thyroid problem would then need continued testing, as well as potential treatment with levothyroxine at an estimated cost of $170 (again, in 2009 dollars) for a year's supply.

    The current study's findings followed those of a large British study, published in NEJM in 2012, which screened more than 20,000 pregnant women. That study concluded treatment for reduced thyroid function in pregnant women did not improve cognitive function in their children at age 3.

     Explore further: Does treatment of subclinical hypothyroidism in pregnant women impact IQ in offspring?

    More information: Brian M. Casey et al. Treatment of Subclinical Hypothyroidism or Hypothyroxinemia in Pregnancy, New England Journal of Medicine (2017). DOI: 10.1056/NEJMoa1606205 

    Journal reference: New England Journal of Medicine  

    Provided by: UT Southwestern Medical Center


  • March 02, 2017 11:26 AM | Deleted user

    Now Open – Apply Below

    Over the years, the PA Foundation has awarded more than $2.25 million in scholarships to PA students, benefitting more than 1,400 future PAs. Scholarships are awarded based on the availability of funds provided through contributions from AAPA members, other individuals, and corporate partners.

    Eligibility Requirements

    Scholarship applicants must meet all of the following criteria:

    • Be a student member of AAPA
    • Attend an ARC-PA-accredited PA program
    • Have successfully completed at least one term of PA studies (semester or quarter) and be in good academic standing
    • Be enrolled in PA school at the time the application period closes (May 31, 2017)

    2017 PA Student Scholarship Cycle

    The 2017 scholarship cycle is now open! The following scholarships will be awarded for the 2017 cycle (click on the link under each to apply):

    PLEASE NOTE: You must click on the application link under the name/description of each scholarship in order to apply for that award. You will be prompted to create an account when you begin your first application, and will sign into that same account when completing the others; however, you still must click on each individual link on this page to apply for each award.

    View the applicant instructional guide here.

    Questions? Contact Caroline Pierce at cpierce@aapa.org or 571-319-4510.

    Additional Financial Aid Resources

    Information about additional financial aid resources for PA students is available in the Student Academy section of the AAPA website.

    2016 PA Foundation Scholarship Recipients

    Congratulations to the 16 PA students who were awarded scholarships during the 2016 application cycle.


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