News for Your Practice

Oral ospemifene (Osphena) received FDA approval in February 2013 to treat moderate to severe dyspareunia that results from vulval and vaginal atrophy. This drug, a tissue-selective estrogen agonist/antagonist, is the first oral alternative to estrogen therapy, said Steven R. Goldstein, MD, who presented data on 12- and 52-week safety of ospemifene in Phase 2/3 placebo-controlled clinical trials at NAMS 2013.

Click on the audio player below to listen to Dr. Goldstein explain the available options for vulvar and vaginal atrophy and how oral ospemifene expands these options. In addition, he describes the tolerability and side effects of ospemifene that clinicians should be aware of.

Oral ospemifene (Osphena) received FDA approval in February 2013 to treat moderate to severe dyspareunia that results from vulval and vaginal atrophy. This drug, a tissue-selective estrogen agonist/antagonist, is the first oral alternative to estrogen therapy, said Steven R. Goldstein, MD, who presented data on 12- and 52-week safety of ospemifene in Phase 2/3 placebo-controlled clinical trials at NAMS 2013.

Click on the audio player below to listen to Dr. Goldstein explain the available options for vulvar and vaginal atrophy and how oral ospemifene expands these options. In addition, he describes the tolerability and side effects of ospemifene that clinicians should be aware of.

Oral ospemifene (Osphena) received FDA approval in February 2013 to treat moderate to severe dyspareunia that results from vulval and vaginal atrophy. This drug, a tissue-selective estrogen agonist/antagonist, is the first oral alternative to estrogen therapy, said Steven R. Goldstein, MD, who presented data on 12- and 52-week safety of ospemifene in Phase 2/3 placebo-controlled clinical trials at NAMS 2013.

Click on the audio player below to listen to Dr. Goldstein explain the available options for vulvar and vaginal atrophy and how oral ospemifene expands these options. In addition, he describes the tolerability and side effects of ospemifene that clinicians should be aware of.

In an appeal for increased vaccination against influenza, the Centers for Disease Control and Prevention (CDC) announced that, although vaccination coverage has increased for some groups of the population, the nation needs to do better. Recommendations from the Advisory Committee on Immunization Practices reported seasonal influenza vaccination data in the CDC’s Morbidity and Mortality Weekly Report (MMWR) on September 20, 2013.¹

More children aged 6 months through 17 years received the influenza vaccine during the 2012–2013 season (56.6%), up 5.1% from the 2011–2012 season. Smaller increases were reported for adults aged 18 years and older at 41.5%, up 2.7% from 2011–2012. Overall, 45% of the entire US population aged 6 months and older was vaccinated in 2012–2013. However, this falls short of public health goals.²

Howard K. Koh, MD, Assistant Secretary for Health at the US Department of Health and Human Services, pointed out that, although the increases in number of those who received the influenza vaccine last year is significant, there is more work to do. “Despite substantial progress, we can do even more to make our country healthier through prevention. Flu vaccination should represent a simple investment we make year in and year out to maximize the gift of health.”²

What vaccines will be available for the 2013-2014 season?
The 2013-2014 influenza vaccine is detailed in MMWR¹:

Risk of complications from influenza
Mothers. Vaccination to prevent influenza is particularly important for those who are at increased risk for severe complications from influenza. Pregnant and postpartum women are at higher risk for severe illness and complications from influenza than women who are not pregnant because of changes in the immune system, heart, and lungs during pregnancy.¹

Increased severity of influenza among pregnant women was reported during pandemics in 1918–1919, 1957–1958, and 2009–2010. Severe infections were also observed among postpartum (within 2 weeks after delivery) women during the 2009–2010 pandemic.¹ 

One study by Cox et al indicated an increase in delivery complications, including fetal distress, preterm labor, and cesarean delivery, for pregnant women with respiratory hospitalizations during the flu season.¹

Vaccination coverage has increased in pregnant women in the last few years, but, unlike other groups where rates continue to increase, coverage in pregnant women appears to have stalled at around 50%.²

Pregnant women who were treated with antivirals more than 4 days after symptoms arose were more likely to be admitted to an ICU (57% vs 9%; 95% confidence interval [CI] 3.5–10.6] than those treated within 2 days on symptom onset.¹

Infants. Pregnant women have protective levels of anti-influenza antibodies after vaccination that are passively transferred to their children. In a randomized controlled trial of vaccinated pregnant women who later breastfed their children, infants of vaccinated women had a 63% reduction in laboratory-confirmed influenza during the first 6 months of life. In addition, authors Zaman et al reported a 29% reduction in respiratory illness with fever among the infants and a 36% reduction in respiratory illness with fever among their mothers during the first 6 months after birth.¹

Another study by Eick et al found that infants aged less than 6 months who were born to women who were given influenza vaccination during pregnancy had significantly reduced risk for influenza virus infection (relative risk [RR]: 0.59; 95% CI = 0.37–0.93) and hospitalization for influenza-like illness (ILI) (RR: 0.61; 95% CI = 0.45–0.84).¹

Infants born to women with laboratory-confirmed flu during pregnancy did not have higher rates of low birthweight, congenital abnormalities, or lower Apgar scores compared with infants born to uninfected women.¹

ACOG recommendations for pregnant and postpartum women

Because of the increased risk for serious illness and complications from influenza, the American College of Obstetricians and Gynecologists (ACOG) recommends that all women who are pregnant or who might be pregnant in the upcoming influenza season receive the IIV vaccine. This vaccination can be administered at any time during pregnancy, before and during the influenza season.³

LAIV is not recommended for pregnant women. Postpartum women can receive either LAIV or IIV. Pregnant and postpartum women do not need to avoid contact with persons recently vaccinated with LAIV.¹

Recommendations for nonpregnant women
The CDC continues to recommend annual influenza vaccination for all persons ages 6 months or older. Among healthy younger adults, seasonal influenza is typically less acute and results less often in hospitalization, as compared with children aged <5 years, adults aged ≥65 years, pregnant women, or persons with chronic medical conditions. The flu is a significant reason for outpatient medical visits and worker absenteeism among healthy adults aged 19 through 49 years.¹

For specific guidelines, visit the CDC’s “Influenza Vaccination: A Summary for Clinicians” at http://www.cdc.gov/flu/professionals/vaccination/vax-summary.htm.

What can you, as a physician, do?
Health-care professionals are critical to the vaccination program and need to lead by example. “If you are around people at high risk for flu complications, you need to get vaccinated,” said Anne Schuchat, MD, Assistant Surgeon General, US Publish Health Service, and Director of the National Center for Immunization and Respiratory Diseases at the CDC.²

The CDC reported that 72% of health-care personal received a vaccination in 2012–2013. Physicians had the highest coverage at 92.3%.²

“Patients also look to you,” said Dr. Schuchat. “Data show that a personal recommendation makes a big difference to patients.”²

For example, pregnant women whose physicians recommend flu vaccination are five times more likely to get vaccinated. Dr. Schuchat also reminded healthcare professionals that they should begin vaccinating patients as soon as vaccine is available in their area.

In an appeal for increased vaccination against influenza, the Centers for Disease Control and Prevention (CDC) announced that, although vaccination coverage has increased for some groups of the population, the nation needs to do better. Recommendations from the Advisory Committee on Immunization Practices reported seasonal influenza vaccination data in the CDC’s Morbidity and Mortality Weekly Report (MMWR) on September 20, 2013.¹

More children aged 6 months through 17 years received the influenza vaccine during the 2012–2013 season (56.6%), up 5.1% from the 2011–2012 season. Smaller increases were reported for adults aged 18 years and older at 41.5%, up 2.7% from 2011–2012. Overall, 45% of the entire US population aged 6 months and older was vaccinated in 2012–2013. However, this falls short of public health goals.²

Howard K. Koh, MD, Assistant Secretary for Health at the US Department of Health and Human Services, pointed out that, although the increases in number of those who received the influenza vaccine last year is significant, there is more work to do. “Despite substantial progress, we can do even more to make our country healthier through prevention. Flu vaccination should represent a simple investment we make year in and year out to maximize the gift of health.”²

What vaccines will be available for the 2013-2014 season?
The 2013-2014 influenza vaccine is detailed in MMWR¹:

Risk of complications from influenza
Mothers. Vaccination to prevent influenza is particularly important for those who are at increased risk for severe complications from influenza. Pregnant and postpartum women are at higher risk for severe illness and complications from influenza than women who are not pregnant because of changes in the immune system, heart, and lungs during pregnancy.¹

Increased severity of influenza among pregnant women was reported during pandemics in 1918–1919, 1957–1958, and 2009–2010. Severe infections were also observed among postpartum (within 2 weeks after delivery) women during the 2009–2010 pandemic.¹ 

One study by Cox et al indicated an increase in delivery complications, including fetal distress, preterm labor, and cesarean delivery, for pregnant women with respiratory hospitalizations during the flu season.¹

Vaccination coverage has increased in pregnant women in the last few years, but, unlike other groups where rates continue to increase, coverage in pregnant women appears to have stalled at around 50%.²

Pregnant women who were treated with antivirals more than 4 days after symptoms arose were more likely to be admitted to an ICU (57% vs 9%; 95% confidence interval [CI] 3.5–10.6] than those treated within 2 days on symptom onset.¹

Infants. Pregnant women have protective levels of anti-influenza antibodies after vaccination that are passively transferred to their children. In a randomized controlled trial of vaccinated pregnant women who later breastfed their children, infants of vaccinated women had a 63% reduction in laboratory-confirmed influenza during the first 6 months of life. In addition, authors Zaman et al reported a 29% reduction in respiratory illness with fever among the infants and a 36% reduction in respiratory illness with fever among their mothers during the first 6 months after birth.¹

Another study by Eick et al found that infants aged less than 6 months who were born to women who were given influenza vaccination during pregnancy had significantly reduced risk for influenza virus infection (relative risk [RR]: 0.59; 95% CI = 0.37–0.93) and hospitalization for influenza-like illness (ILI) (RR: 0.61; 95% CI = 0.45–0.84).¹

Infants born to women with laboratory-confirmed flu during pregnancy did not have higher rates of low birthweight, congenital abnormalities, or lower Apgar scores compared with infants born to uninfected women.¹

ACOG recommendations for pregnant and postpartum women

Because of the increased risk for serious illness and complications from influenza, the American College of Obstetricians and Gynecologists (ACOG) recommends that all women who are pregnant or who might be pregnant in the upcoming influenza season receive the IIV vaccine. This vaccination can be administered at any time during pregnancy, before and during the influenza season.³

LAIV is not recommended for pregnant women. Postpartum women can receive either LAIV or IIV. Pregnant and postpartum women do not need to avoid contact with persons recently vaccinated with LAIV.¹

Recommendations for nonpregnant women
The CDC continues to recommend annual influenza vaccination for all persons ages 6 months or older. Among healthy younger adults, seasonal influenza is typically less acute and results less often in hospitalization, as compared with children aged <5 years, adults aged ≥65 years, pregnant women, or persons with chronic medical conditions. The flu is a significant reason for outpatient medical visits and worker absenteeism among healthy adults aged 19 through 49 years.¹

For specific guidelines, visit the CDC’s “Influenza Vaccination: A Summary for Clinicians” at http://www.cdc.gov/flu/professionals/vaccination/vax-summary.htm.

What can you, as a physician, do?
Health-care professionals are critical to the vaccination program and need to lead by example. “If you are around people at high risk for flu complications, you need to get vaccinated,” said Anne Schuchat, MD, Assistant Surgeon General, US Publish Health Service, and Director of the National Center for Immunization and Respiratory Diseases at the CDC.²

The CDC reported that 72% of health-care personal received a vaccination in 2012–2013. Physicians had the highest coverage at 92.3%.²

“Patients also look to you,” said Dr. Schuchat. “Data show that a personal recommendation makes a big difference to patients.”²

For example, pregnant women whose physicians recommend flu vaccination are five times more likely to get vaccinated. Dr. Schuchat also reminded healthcare professionals that they should begin vaccinating patients as soon as vaccine is available in their area.

In an appeal for increased vaccination against influenza, the Centers for Disease Control and Prevention (CDC) announced that, although vaccination coverage has increased for some groups of the population, the nation needs to do better. Recommendations from the Advisory Committee on Immunization Practices reported seasonal influenza vaccination data in the CDC’s Morbidity and Mortality Weekly Report (MMWR) on September 20, 2013.¹

More children aged 6 months through 17 years received the influenza vaccine during the 2012–2013 season (56.6%), up 5.1% from the 2011–2012 season. Smaller increases were reported for adults aged 18 years and older at 41.5%, up 2.7% from 2011–2012. Overall, 45% of the entire US population aged 6 months and older was vaccinated in 2012–2013. However, this falls short of public health goals.²

Howard K. Koh, MD, Assistant Secretary for Health at the US Department of Health and Human Services, pointed out that, although the increases in number of those who received the influenza vaccine last year is significant, there is more work to do. “Despite substantial progress, we can do even more to make our country healthier through prevention. Flu vaccination should represent a simple investment we make year in and year out to maximize the gift of health.”²

What vaccines will be available for the 2013-2014 season?
The 2013-2014 influenza vaccine is detailed in MMWR¹:

Risk of complications from influenza
Mothers. Vaccination to prevent influenza is particularly important for those who are at increased risk for severe complications from influenza. Pregnant and postpartum women are at higher risk for severe illness and complications from influenza than women who are not pregnant because of changes in the immune system, heart, and lungs during pregnancy.¹

Increased severity of influenza among pregnant women was reported during pandemics in 1918–1919, 1957–1958, and 2009–2010. Severe infections were also observed among postpartum (within 2 weeks after delivery) women during the 2009–2010 pandemic.¹ 

One study by Cox et al indicated an increase in delivery complications, including fetal distress, preterm labor, and cesarean delivery, for pregnant women with respiratory hospitalizations during the flu season.¹

Vaccination coverage has increased in pregnant women in the last few years, but, unlike other groups where rates continue to increase, coverage in pregnant women appears to have stalled at around 50%.²

Pregnant women who were treated with antivirals more than 4 days after symptoms arose were more likely to be admitted to an ICU (57% vs 9%; 95% confidence interval [CI] 3.5–10.6] than those treated within 2 days on symptom onset.¹

Infants. Pregnant women have protective levels of anti-influenza antibodies after vaccination that are passively transferred to their children. In a randomized controlled trial of vaccinated pregnant women who later breastfed their children, infants of vaccinated women had a 63% reduction in laboratory-confirmed influenza during the first 6 months of life. In addition, authors Zaman et al reported a 29% reduction in respiratory illness with fever among the infants and a 36% reduction in respiratory illness with fever among their mothers during the first 6 months after birth.¹

Another study by Eick et al found that infants aged less than 6 months who were born to women who were given influenza vaccination during pregnancy had significantly reduced risk for influenza virus infection (relative risk [RR]: 0.59; 95% CI = 0.37–0.93) and hospitalization for influenza-like illness (ILI) (RR: 0.61; 95% CI = 0.45–0.84).¹

Infants born to women with laboratory-confirmed flu during pregnancy did not have higher rates of low birthweight, congenital abnormalities, or lower Apgar scores compared with infants born to uninfected women.¹

ACOG recommendations for pregnant and postpartum women

Because of the increased risk for serious illness and complications from influenza, the American College of Obstetricians and Gynecologists (ACOG) recommends that all women who are pregnant or who might be pregnant in the upcoming influenza season receive the IIV vaccine. This vaccination can be administered at any time during pregnancy, before and during the influenza season.³

LAIV is not recommended for pregnant women. Postpartum women can receive either LAIV or IIV. Pregnant and postpartum women do not need to avoid contact with persons recently vaccinated with LAIV.¹

Recommendations for nonpregnant women
The CDC continues to recommend annual influenza vaccination for all persons ages 6 months or older. Among healthy younger adults, seasonal influenza is typically less acute and results less often in hospitalization, as compared with children aged <5 years, adults aged ≥65 years, pregnant women, or persons with chronic medical conditions. The flu is a significant reason for outpatient medical visits and worker absenteeism among healthy adults aged 19 through 49 years.¹

For specific guidelines, visit the CDC’s “Influenza Vaccination: A Summary for Clinicians” at http://www.cdc.gov/flu/professionals/vaccination/vax-summary.htm.

What can you, as a physician, do?
Health-care professionals are critical to the vaccination program and need to lead by example. “If you are around people at high risk for flu complications, you need to get vaccinated,” said Anne Schuchat, MD, Assistant Surgeon General, US Publish Health Service, and Director of the National Center for Immunization and Respiratory Diseases at the CDC.²

The CDC reported that 72% of health-care personal received a vaccination in 2012–2013. Physicians had the highest coverage at 92.3%.²

“Patients also look to you,” said Dr. Schuchat. “Data show that a personal recommendation makes a big difference to patients.”²

For example, pregnant women whose physicians recommend flu vaccination are five times more likely to get vaccinated. Dr. Schuchat also reminded healthcare professionals that they should begin vaccinating patients as soon as vaccine is available in their area.

Although US hospitals have been quick to embrace surgical robot technology over the past decade, a “slapdash” system of reporting complications paints an unclear picture of its safety, according to Johns Hopkins researchers.

The Johns Hopkins team, led by Martin A. Makary, MD, MPH, found that, among the 1 million or so robotic surgeries performed since 2000, only 245 complications—including 71 deaths—were reported to the US Food and Drug Administration (FDA).¹ When an adverse event or device malfunction occurs, hospitals are required to report these incidents to the manufacturer, which in turn is required to report them to the FDA—but this reporting doesn’t always happen.

“The number reported is very low for any complex technology used over a million times,” says Dr. Makary, associate professor of surgery at the Johns Hopkins University School of Medicine. “Doctors and patients can’t properly evaluate safety when we have a haphazard system of collecting data that is not independent and not transparent. There may be some complications specific to the use of this device, but we can only learn about them if we accurately track outcomes.”

The use of the robot in surgery has skyrocketed. Between 2007 and 2011, for example, the number of procedures involving the robot increased by more than 400% in the United States and more than 300% internationally. At the end of 2011, there were 1,400 surgical robots installed in US hospitals, up from 800 just 4 years earlier.

Some incidents went unreported until the news media highlighted them
Dr. Makary and colleagues found several incidents reported in the national news media that were not reported to the FDA until after the stories appeared in the press, even though the incidents took place long before the media exposure. Dr. Makary says it’s likely that many other incidents go unreported, never to be captured by research like his or by the FDA.

“We need innovation in medicine and, in this country, we are tremendously good at introducing new technologies,” he says. “But we have to evaluate new technology properly so we don’t over-adopt—or under-adopt—important advances that could benefit patients.”

How the study was conducted
Makary and colleagues reviewed the FDA adverse events database from January 1, 2000, to August 1, 2012. They also searched legal judgments and adverse events using LexisNexis to scan news media, and PACER to scan court records. The cases then were cross-referenced to see if they matched. The investigators found that eight cases were not appropriately reported to the FDA, five of which were never reported and two of which were reported only after a story about them appeared in the press.

Complication rate was highest for hysterectomy
When investigators reviewed complications that were reported, the procedures most commonly associated with death were:

• gynecologic (22 of the 71 deaths)
• urologic (15 deaths)
• cardiothoracic (12 deaths).

The cause of death was most often excessive bleeding. In cases where patients survived, hysterectomy by far had the most complications (43% of injuries).

A call for standardized reporting
Dr. Makary contends that standardized reporting is needed for all adverse events related to robotic devices. One rare complication that occurs, he says, is that a surgeon can accidentally cut the aorta because the surgeon cannot feel its firmness. For reporting purposes, however, it’s unclear whether such an event is surgeon error or device-related error.  The FDA currently collects only device-related errors.

Dr. Makary argues that errors such as inadvertent cutting of the aorta, although preventable with proper technique, should be tracked as device-related errors because they are more common with robotic surgery than with conventional surgery. Without better reporting standards, he says, these complications are less likely to be reported to the FDA at all. And if they go unreported, they cannot contribute to the understanding or identification of safety problems.

He suggests one solution: use of a database like the one maintained by the American College of Surgeons, in which independent nurses identify and track adverse events and complications of traditional operations.

Good information on robotic surgery is needed not only for research, but also to ensure that patients are fully informed about potential risks. Right now, Dr. Makary says, it’s too easy for a surgeon to claim that there are no additional risks related to robotic surgery because the evidence is nowhere to be found.

“Decisions should not be made based on the information in the FDA database,” he says. “We need to be able to give patients answers to their questions about safety and how much risk is associated with the robot. We have all suspected the answer has not been zero. We still don’t really know what the true answer is.”

We want to hear from you! Tell us what you think.

Although US hospitals have been quick to embrace surgical robot technology over the past decade, a “slapdash” system of reporting complications paints an unclear picture of its safety, according to Johns Hopkins researchers.

The Johns Hopkins team, led by Martin A. Makary, MD, MPH, found that, among the 1 million or so robotic surgeries performed since 2000, only 245 complications—including 71 deaths—were reported to the US Food and Drug Administration (FDA).¹ When an adverse event or device malfunction occurs, hospitals are required to report these incidents to the manufacturer, which in turn is required to report them to the FDA—but this reporting doesn’t always happen.

“The number reported is very low for any complex technology used over a million times,” says Dr. Makary, associate professor of surgery at the Johns Hopkins University School of Medicine. “Doctors and patients can’t properly evaluate safety when we have a haphazard system of collecting data that is not independent and not transparent. There may be some complications specific to the use of this device, but we can only learn about them if we accurately track outcomes.”

The use of the robot in surgery has skyrocketed. Between 2007 and 2011, for example, the number of procedures involving the robot increased by more than 400% in the United States and more than 300% internationally. At the end of 2011, there were 1,400 surgical robots installed in US hospitals, up from 800 just 4 years earlier.

Some incidents went unreported until the news media highlighted them
Dr. Makary and colleagues found several incidents reported in the national news media that were not reported to the FDA until after the stories appeared in the press, even though the incidents took place long before the media exposure. Dr. Makary says it’s likely that many other incidents go unreported, never to be captured by research like his or by the FDA.

“We need innovation in medicine and, in this country, we are tremendously good at introducing new technologies,” he says. “But we have to evaluate new technology properly so we don’t over-adopt—or under-adopt—important advances that could benefit patients.”

How the study was conducted
Makary and colleagues reviewed the FDA adverse events database from January 1, 2000, to August 1, 2012. They also searched legal judgments and adverse events using LexisNexis to scan news media, and PACER to scan court records. The cases then were cross-referenced to see if they matched. The investigators found that eight cases were not appropriately reported to the FDA, five of which were never reported and two of which were reported only after a story about them appeared in the press.

Complication rate was highest for hysterectomy
When investigators reviewed complications that were reported, the procedures most commonly associated with death were:

• gynecologic (22 of the 71 deaths)
• urologic (15 deaths)
• cardiothoracic (12 deaths).

The cause of death was most often excessive bleeding. In cases where patients survived, hysterectomy by far had the most complications (43% of injuries).

A call for standardized reporting
Dr. Makary contends that standardized reporting is needed for all adverse events related to robotic devices. One rare complication that occurs, he says, is that a surgeon can accidentally cut the aorta because the surgeon cannot feel its firmness. For reporting purposes, however, it’s unclear whether such an event is surgeon error or device-related error.  The FDA currently collects only device-related errors.

Dr. Makary argues that errors such as inadvertent cutting of the aorta, although preventable with proper technique, should be tracked as device-related errors because they are more common with robotic surgery than with conventional surgery. Without better reporting standards, he says, these complications are less likely to be reported to the FDA at all. And if they go unreported, they cannot contribute to the understanding or identification of safety problems.

He suggests one solution: use of a database like the one maintained by the American College of Surgeons, in which independent nurses identify and track adverse events and complications of traditional operations.

Good information on robotic surgery is needed not only for research, but also to ensure that patients are fully informed about potential risks. Right now, Dr. Makary says, it’s too easy for a surgeon to claim that there are no additional risks related to robotic surgery because the evidence is nowhere to be found.

“Decisions should not be made based on the information in the FDA database,” he says. “We need to be able to give patients answers to their questions about safety and how much risk is associated with the robot. We have all suspected the answer has not been zero. We still don’t really know what the true answer is.”

We want to hear from you! Tell us what you think.

Although US hospitals have been quick to embrace surgical robot technology over the past decade, a “slapdash” system of reporting complications paints an unclear picture of its safety, according to Johns Hopkins researchers.

The Johns Hopkins team, led by Martin A. Makary, MD, MPH, found that, among the 1 million or so robotic surgeries performed since 2000, only 245 complications—including 71 deaths—were reported to the US Food and Drug Administration (FDA).¹ When an adverse event or device malfunction occurs, hospitals are required to report these incidents to the manufacturer, which in turn is required to report them to the FDA—but this reporting doesn’t always happen.

“The number reported is very low for any complex technology used over a million times,” says Dr. Makary, associate professor of surgery at the Johns Hopkins University School of Medicine. “Doctors and patients can’t properly evaluate safety when we have a haphazard system of collecting data that is not independent and not transparent. There may be some complications specific to the use of this device, but we can only learn about them if we accurately track outcomes.”

The use of the robot in surgery has skyrocketed. Between 2007 and 2011, for example, the number of procedures involving the robot increased by more than 400% in the United States and more than 300% internationally. At the end of 2011, there were 1,400 surgical robots installed in US hospitals, up from 800 just 4 years earlier.

Some incidents went unreported until the news media highlighted them
Dr. Makary and colleagues found several incidents reported in the national news media that were not reported to the FDA until after the stories appeared in the press, even though the incidents took place long before the media exposure. Dr. Makary says it’s likely that many other incidents go unreported, never to be captured by research like his or by the FDA.

“We need innovation in medicine and, in this country, we are tremendously good at introducing new technologies,” he says. “But we have to evaluate new technology properly so we don’t over-adopt—or under-adopt—important advances that could benefit patients.”

How the study was conducted
Makary and colleagues reviewed the FDA adverse events database from January 1, 2000, to August 1, 2012. They also searched legal judgments and adverse events using LexisNexis to scan news media, and PACER to scan court records. The cases then were cross-referenced to see if they matched. The investigators found that eight cases were not appropriately reported to the FDA, five of which were never reported and two of which were reported only after a story about them appeared in the press.

Complication rate was highest for hysterectomy
When investigators reviewed complications that were reported, the procedures most commonly associated with death were:

• gynecologic (22 of the 71 deaths)
• urologic (15 deaths)
• cardiothoracic (12 deaths).

The cause of death was most often excessive bleeding. In cases where patients survived, hysterectomy by far had the most complications (43% of injuries).

A call for standardized reporting
Dr. Makary contends that standardized reporting is needed for all adverse events related to robotic devices. One rare complication that occurs, he says, is that a surgeon can accidentally cut the aorta because the surgeon cannot feel its firmness. For reporting purposes, however, it’s unclear whether such an event is surgeon error or device-related error.  The FDA currently collects only device-related errors.

Dr. Makary argues that errors such as inadvertent cutting of the aorta, although preventable with proper technique, should be tracked as device-related errors because they are more common with robotic surgery than with conventional surgery. Without better reporting standards, he says, these complications are less likely to be reported to the FDA at all. And if they go unreported, they cannot contribute to the understanding or identification of safety problems.

He suggests one solution: use of a database like the one maintained by the American College of Surgeons, in which independent nurses identify and track adverse events and complications of traditional operations.

Good information on robotic surgery is needed not only for research, but also to ensure that patients are fully informed about potential risks. Right now, Dr. Makary says, it’s too easy for a surgeon to claim that there are no additional risks related to robotic surgery because the evidence is nowhere to be found.

“Decisions should not be made based on the information in the FDA database,” he says. “We need to be able to give patients answers to their questions about safety and how much risk is associated with the robot. We have all suspected the answer has not been zero. We still don’t really know what the true answer is.”

We want to hear from you! Tell us what you think.

There may one day be another compelling reason for women to undergo the Pap test on a regular basis: It may be used to screen for endometrial and ovarian cancers.

That’s the conclusion of researchers who sought to determine whether the Pap test can be used to detect mutations present in rare tumor cells that are shed from endometrial and ovarian cancers and end up on the cervix.¹ They found that DNA from most endometrial and some ovarian cancers can be found in a standard liquid-based Pap specimen obtained during a routine pelvic exam.

Kinde and colleagues performed their study in four parts:

1. They established the somatic mutations that often are present in endometrial and ovarian cancers
2. They identified one or more mutations in each tumor from 46 women with these cancers
3. They determined whether these mutations could also be detected in Pap specimens from the same patients
4. They developed a technology—which they called the “PapGene test”—that could directly evaluate cells from Pap specimens to determine whether these mutations were present.

Using massively parallel sequencing, they identified these mutations in the DNA from liquid Pap specimens in 100% of women with endometrial cancers (24 of 24 cases) and 41% of women with ovarian cancers (9 of 22 cases).¹

Kinde and colleagues concluded that “PapGene testing has the capacity to increase the use of conventional cytology screening through the unambiguous detection of DNA from endometrial and ovarian carcinomas, and lays the foundation for a new generation of screening tests.”¹

In a summary accompanying the study, the editors of Science Translational Medicine noted that PapGene testing “is not yet ready for clinical use and will not serve as a foolproof method of diagnosing genital tract tumors, particularly ovarian cancer … Importantly, though, the new test has not misclassified any healthy woman as harboring a cancer, raising the possibility of its eventual use as a screening test for cancer. Even if this approach cannot identify every ovarian tumor, it may be able to detect more of them earlier and more accurately than is possible with existing methods.”¹

We want to hear from you. Tell us what you think.

There may one day be another compelling reason for women to undergo the Pap test on a regular basis: It may be used to screen for endometrial and ovarian cancers.

That’s the conclusion of researchers who sought to determine whether the Pap test can be used to detect mutations present in rare tumor cells that are shed from endometrial and ovarian cancers and end up on the cervix.¹ They found that DNA from most endometrial and some ovarian cancers can be found in a standard liquid-based Pap specimen obtained during a routine pelvic exam.

Kinde and colleagues performed their study in four parts:

1. They established the somatic mutations that often are present in endometrial and ovarian cancers
2. They identified one or more mutations in each tumor from 46 women with these cancers
3. They determined whether these mutations could also be detected in Pap specimens from the same patients
4. They developed a technology—which they called the “PapGene test”—that could directly evaluate cells from Pap specimens to determine whether these mutations were present.

Using massively parallel sequencing, they identified these mutations in the DNA from liquid Pap specimens in 100% of women with endometrial cancers (24 of 24 cases) and 41% of women with ovarian cancers (9 of 22 cases).¹

Kinde and colleagues concluded that “PapGene testing has the capacity to increase the use of conventional cytology screening through the unambiguous detection of DNA from endometrial and ovarian carcinomas, and lays the foundation for a new generation of screening tests.”¹

In a summary accompanying the study, the editors of Science Translational Medicine noted that PapGene testing “is not yet ready for clinical use and will not serve as a foolproof method of diagnosing genital tract tumors, particularly ovarian cancer … Importantly, though, the new test has not misclassified any healthy woman as harboring a cancer, raising the possibility of its eventual use as a screening test for cancer. Even if this approach cannot identify every ovarian tumor, it may be able to detect more of them earlier and more accurately than is possible with existing methods.”¹

We want to hear from you. Tell us what you think.

There may one day be another compelling reason for women to undergo the Pap test on a regular basis: It may be used to screen for endometrial and ovarian cancers.

That’s the conclusion of researchers who sought to determine whether the Pap test can be used to detect mutations present in rare tumor cells that are shed from endometrial and ovarian cancers and end up on the cervix.¹ They found that DNA from most endometrial and some ovarian cancers can be found in a standard liquid-based Pap specimen obtained during a routine pelvic exam.

Kinde and colleagues performed their study in four parts:

1. They established the somatic mutations that often are present in endometrial and ovarian cancers
2. They identified one or more mutations in each tumor from 46 women with these cancers
3. They determined whether these mutations could also be detected in Pap specimens from the same patients
4. They developed a technology—which they called the “PapGene test”—that could directly evaluate cells from Pap specimens to determine whether these mutations were present.

Using massively parallel sequencing, they identified these mutations in the DNA from liquid Pap specimens in 100% of women with endometrial cancers (24 of 24 cases) and 41% of women with ovarian cancers (9 of 22 cases).¹

Kinde and colleagues concluded that “PapGene testing has the capacity to increase the use of conventional cytology screening through the unambiguous detection of DNA from endometrial and ovarian carcinomas, and lays the foundation for a new generation of screening tests.”¹

In a summary accompanying the study, the editors of Science Translational Medicine noted that PapGene testing “is not yet ready for clinical use and will not serve as a foolproof method of diagnosing genital tract tumors, particularly ovarian cancer … Importantly, though, the new test has not misclassified any healthy woman as harboring a cancer, raising the possibility of its eventual use as a screening test for cancer. Even if this approach cannot identify every ovarian tumor, it may be able to detect more of them earlier and more accurately than is possible with existing methods.”¹

We want to hear from you. Tell us what you think.

ObGyns’ mean income was $242,000 in 2012, up from a mean of $220,000 in 2011, although almost half (45%) of ObGyns reported similar incomes in 2011 and 2012. In 2012, 25% of ObGyns reported earnings of $300,000 or more, and 10% said they earned less than $100,000.¹ The newest salary data are based on Medscape’s 2013 Compensation Report, a survey of 21,878 US physicians across 25 specialties.

Forty-three percent of ObGyns were satisfied with their 2012 compensation levels; 48% of all physicians were satisfied.^1,2

Other findings
Men still make more than women. In 2012, male ObGyns reported earning 14% more than female ObGyns. This pay gap is smaller for ObGyns than for all physicians; overall, male physicians earn 30% more than females. One contributing factor to the closer pay gap for ObGyns is that there are fewer women in the higher-paying specialties, such as orthopedics (9% of orthopedic respondents were female). Response rates also matter: of those who responded to the full Medscape poll, 31% were female; of ObGyn respondents, 43% were female.^1,2

ObGyn compensation varies by region. Highest earnings were found in the South Central region (mean: $250,000 in 2012); lowest earnings were found in the Northeast (mean: $213,000).¹

Work setting counts. When ranked by job setting, in 2012, ObGyns employed by health-care organizations were the top earners (mean income: $272,000). This figure rose considerably from the 2011 mean of $239,000. Additional mean earnings of ObGyns ranked by work setting in 2012 were¹:

• single-specialty (office-based) group practices: $264,000
• multispecialty (office-based) group practices: $252,000
• hospitals: $216,000
• academic: $212,000
• solo practices (office-based): $208,000
• outpatient clinics: $206,000.

When ranked by work situation, partners beat all other settings at $268,000 (mean). Employed ObGyns earned more than owners of solo practices (mean: $241,000 vs $204,000, respectively). Independent contractors came in the lowest at $198,000 (mean).¹

Satisfaction with career choice and practice setting showed a slight dip from 2011. When all physicians were asked if they would choose medicine again, 53% would do so in 2012, versus 55% in 2011. Among the ObGyns who said they would choose medicine again, 37% said they would choose the same specialty (the same as in 2011). In 2012, 18% of ObGyns said they would choose the same practice setting, compared with 23% in 2011.^1,2

What’s most rewarding? In 2012, 42% of ObGyns ranked their relationships with patients as the most satisfying part of their job, compared with 31% of all physicians. While 34% of all physicians said that being good at the practice of medicine was their primary reward, 28% of ObGyns listed that first.^1,2

Money issues
Where does your income come from? In the 2011 report, only 4% of ObGyns either participated in or planned to join an accountable care organization. In 2012, that jumped to 25%. Only 1% of ObGyns opted for concierge medical practices in 2012 and 2011, and only 3% chose cash-only practices in 2012 and 2011.^1,2

What about Medicare and Medicaid? More physicians were concerned with potentially reduced Medicare payments in 2012 than in 2011. The new report indicated that 15% of ObGyns plan to stop taking new Medicare or Medicaid patients, 3% plan to stop seeing current Medicare or Medicaid patients, and 28% are undecided. However, 53% of ObGyns will continue to see current patients and take on new Medicare and Medicaid patients. In 2012, 59% of all physicians planned to treat new Medicare and Medicaid patients.^1,2

What about insurance company payments? Practice management experts often recommend that physicians review annual payments from insurers and drop those who pay the least or create the most trouble. In 2012, 26% of ObGyns reported that they already follow this practice or are planning to take that advice. However, 29% will keep all insurers; they feel that even poor payers still represent income. About 15% felt that dropping insurers was inappropriate behavior.¹

Do you provide ancillary services? When asked if they would offer additional medical services to increase income, 21% of ObGyns said yes; 19% of all physicians said yes.^1,2

Do you discuss cost with your patients? In larger practices and hospital settings, treatment costs are often discussed by a staff member responsible for billing and payment, rather than by the physician. As physicians move toward these larger organizations, the trend is becoming more apparent¹:

• In 2011, 41% of ObGyns regularly discussed the cost of services with their patients; 48% occasionally discussed cost if the patient brought it up (89% total).
• In 2012, 35% of ObGyns regularly discussed cost with their patients; 41% occasionally discussed cost (76% total).

In 2011, 84% of all physicians either regularly or occasionally discussed the cost of treatment with patients. In 2012, 68% of all physicians regularly discussed cost of treatment (30%) or did so if the patient asked (38%), and 6% reported that it was inappropriate to discuss cost with patients.^1,2 

How you spend your time
How many hours do you work? The number of hours in a workweek remained about the same. In 2012, 11% of ObGyns worked 41 to 45 hours; 13% worked 46 to 50 hours; 4% worked 51 to 55 hours; 9% worked 56 to 60 hours; and 20% reported working less than 30 hours.¹

Time spent with patients? In 2012, most ObGyns spent less than 16 minutes with a patient: 30% reported spending 13 to 16 minutes; another 30% spent less than 13 minutes; and 17% saw patients for 21 minutes or longer.¹

Demographics of the survey
Respondents to the Medscape survey totaled 21,878 US physicians and ranged in age from 28 years to older than 70; 66% were aged 40 to 64 years; 31% were female; 69% were male; and 89% were board certified.

Of the overall survey respondents, 5% (n = 1,094) were ObGyns. Of these respondents, 71% were aged 40 to 64; 43% were female; 57% were male; and 92% were board certified.^1,2

ObGyns’ mean income was $242,000 in 2012, up from a mean of $220,000 in 2011, although almost half (45%) of ObGyns reported similar incomes in 2011 and 2012. In 2012, 25% of ObGyns reported earnings of $300,000 or more, and 10% said they earned less than $100,000.¹ The newest salary data are based on Medscape’s 2013 Compensation Report, a survey of 21,878 US physicians across 25 specialties.

Forty-three percent of ObGyns were satisfied with their 2012 compensation levels; 48% of all physicians were satisfied.^1,2

Other findings
Men still make more than women. In 2012, male ObGyns reported earning 14% more than female ObGyns. This pay gap is smaller for ObGyns than for all physicians; overall, male physicians earn 30% more than females. One contributing factor to the closer pay gap for ObGyns is that there are fewer women in the higher-paying specialties, such as orthopedics (9% of orthopedic respondents were female). Response rates also matter: of those who responded to the full Medscape poll, 31% were female; of ObGyn respondents, 43% were female.^1,2

ObGyn compensation varies by region. Highest earnings were found in the South Central region (mean: $250,000 in 2012); lowest earnings were found in the Northeast (mean: $213,000).¹

Work setting counts. When ranked by job setting, in 2012, ObGyns employed by health-care organizations were the top earners (mean income: $272,000). This figure rose considerably from the 2011 mean of $239,000. Additional mean earnings of ObGyns ranked by work setting in 2012 were¹:

• single-specialty (office-based) group practices: $264,000
• multispecialty (office-based) group practices: $252,000
• hospitals: $216,000
• academic: $212,000
• solo practices (office-based): $208,000
• outpatient clinics: $206,000.

When ranked by work situation, partners beat all other settings at $268,000 (mean). Employed ObGyns earned more than owners of solo practices (mean: $241,000 vs $204,000, respectively). Independent contractors came in the lowest at $198,000 (mean).¹

Satisfaction with career choice and practice setting showed a slight dip from 2011. When all physicians were asked if they would choose medicine again, 53% would do so in 2012, versus 55% in 2011. Among the ObGyns who said they would choose medicine again, 37% said they would choose the same specialty (the same as in 2011). In 2012, 18% of ObGyns said they would choose the same practice setting, compared with 23% in 2011.^1,2

What’s most rewarding? In 2012, 42% of ObGyns ranked their relationships with patients as the most satisfying part of their job, compared with 31% of all physicians. While 34% of all physicians said that being good at the practice of medicine was their primary reward, 28% of ObGyns listed that first.^1,2

Money issues
Where does your income come from? In the 2011 report, only 4% of ObGyns either participated in or planned to join an accountable care organization. In 2012, that jumped to 25%. Only 1% of ObGyns opted for concierge medical practices in 2012 and 2011, and only 3% chose cash-only practices in 2012 and 2011.^1,2

What about Medicare and Medicaid? More physicians were concerned with potentially reduced Medicare payments in 2012 than in 2011. The new report indicated that 15% of ObGyns plan to stop taking new Medicare or Medicaid patients, 3% plan to stop seeing current Medicare or Medicaid patients, and 28% are undecided. However, 53% of ObGyns will continue to see current patients and take on new Medicare and Medicaid patients. In 2012, 59% of all physicians planned to treat new Medicare and Medicaid patients.^1,2

What about insurance company payments? Practice management experts often recommend that physicians review annual payments from insurers and drop those who pay the least or create the most trouble. In 2012, 26% of ObGyns reported that they already follow this practice or are planning to take that advice. However, 29% will keep all insurers; they feel that even poor payers still represent income. About 15% felt that dropping insurers was inappropriate behavior.¹

Do you provide ancillary services? When asked if they would offer additional medical services to increase income, 21% of ObGyns said yes; 19% of all physicians said yes.^1,2

Do you discuss cost with your patients? In larger practices and hospital settings, treatment costs are often discussed by a staff member responsible for billing and payment, rather than by the physician. As physicians move toward these larger organizations, the trend is becoming more apparent¹:

• In 2011, 41% of ObGyns regularly discussed the cost of services with their patients; 48% occasionally discussed cost if the patient brought it up (89% total).
• In 2012, 35% of ObGyns regularly discussed cost with their patients; 41% occasionally discussed cost (76% total).

In 2011, 84% of all physicians either regularly or occasionally discussed the cost of treatment with patients. In 2012, 68% of all physicians regularly discussed cost of treatment (30%) or did so if the patient asked (38%), and 6% reported that it was inappropriate to discuss cost with patients.^1,2 

How you spend your time
How many hours do you work? The number of hours in a workweek remained about the same. In 2012, 11% of ObGyns worked 41 to 45 hours; 13% worked 46 to 50 hours; 4% worked 51 to 55 hours; 9% worked 56 to 60 hours; and 20% reported working less than 30 hours.¹

Time spent with patients? In 2012, most ObGyns spent less than 16 minutes with a patient: 30% reported spending 13 to 16 minutes; another 30% spent less than 13 minutes; and 17% saw patients for 21 minutes or longer.¹

Demographics of the survey
Respondents to the Medscape survey totaled 21,878 US physicians and ranged in age from 28 years to older than 70; 66% were aged 40 to 64 years; 31% were female; 69% were male; and 89% were board certified.

Of the overall survey respondents, 5% (n = 1,094) were ObGyns. Of these respondents, 71% were aged 40 to 64; 43% were female; 57% were male; and 92% were board certified.^1,2

ObGyns’ mean income was $242,000 in 2012, up from a mean of $220,000 in 2011, although almost half (45%) of ObGyns reported similar incomes in 2011 and 2012. In 2012, 25% of ObGyns reported earnings of $300,000 or more, and 10% said they earned less than $100,000.¹ The newest salary data are based on Medscape’s 2013 Compensation Report, a survey of 21,878 US physicians across 25 specialties.

Forty-three percent of ObGyns were satisfied with their 2012 compensation levels; 48% of all physicians were satisfied.^1,2

Other findings
Men still make more than women. In 2012, male ObGyns reported earning 14% more than female ObGyns. This pay gap is smaller for ObGyns than for all physicians; overall, male physicians earn 30% more than females. One contributing factor to the closer pay gap for ObGyns is that there are fewer women in the higher-paying specialties, such as orthopedics (9% of orthopedic respondents were female). Response rates also matter: of those who responded to the full Medscape poll, 31% were female; of ObGyn respondents, 43% were female.^1,2

ObGyn compensation varies by region. Highest earnings were found in the South Central region (mean: $250,000 in 2012); lowest earnings were found in the Northeast (mean: $213,000).¹

Work setting counts. When ranked by job setting, in 2012, ObGyns employed by health-care organizations were the top earners (mean income: $272,000). This figure rose considerably from the 2011 mean of $239,000. Additional mean earnings of ObGyns ranked by work setting in 2012 were¹:

• single-specialty (office-based) group practices: $264,000
• multispecialty (office-based) group practices: $252,000
• hospitals: $216,000
• academic: $212,000
• solo practices (office-based): $208,000
• outpatient clinics: $206,000.

When ranked by work situation, partners beat all other settings at $268,000 (mean). Employed ObGyns earned more than owners of solo practices (mean: $241,000 vs $204,000, respectively). Independent contractors came in the lowest at $198,000 (mean).¹

Satisfaction with career choice and practice setting showed a slight dip from 2011. When all physicians were asked if they would choose medicine again, 53% would do so in 2012, versus 55% in 2011. Among the ObGyns who said they would choose medicine again, 37% said they would choose the same specialty (the same as in 2011). In 2012, 18% of ObGyns said they would choose the same practice setting, compared with 23% in 2011.^1,2

What’s most rewarding? In 2012, 42% of ObGyns ranked their relationships with patients as the most satisfying part of their job, compared with 31% of all physicians. While 34% of all physicians said that being good at the practice of medicine was their primary reward, 28% of ObGyns listed that first.^1,2

Money issues
Where does your income come from? In the 2011 report, only 4% of ObGyns either participated in or planned to join an accountable care organization. In 2012, that jumped to 25%. Only 1% of ObGyns opted for concierge medical practices in 2012 and 2011, and only 3% chose cash-only practices in 2012 and 2011.^1,2

What about Medicare and Medicaid? More physicians were concerned with potentially reduced Medicare payments in 2012 than in 2011. The new report indicated that 15% of ObGyns plan to stop taking new Medicare or Medicaid patients, 3% plan to stop seeing current Medicare or Medicaid patients, and 28% are undecided. However, 53% of ObGyns will continue to see current patients and take on new Medicare and Medicaid patients. In 2012, 59% of all physicians planned to treat new Medicare and Medicaid patients.^1,2

What about insurance company payments? Practice management experts often recommend that physicians review annual payments from insurers and drop those who pay the least or create the most trouble. In 2012, 26% of ObGyns reported that they already follow this practice or are planning to take that advice. However, 29% will keep all insurers; they feel that even poor payers still represent income. About 15% felt that dropping insurers was inappropriate behavior.¹

Do you provide ancillary services? When asked if they would offer additional medical services to increase income, 21% of ObGyns said yes; 19% of all physicians said yes.^1,2

Do you discuss cost with your patients? In larger practices and hospital settings, treatment costs are often discussed by a staff member responsible for billing and payment, rather than by the physician. As physicians move toward these larger organizations, the trend is becoming more apparent¹:

• In 2011, 41% of ObGyns regularly discussed the cost of services with their patients; 48% occasionally discussed cost if the patient brought it up (89% total).
• In 2012, 35% of ObGyns regularly discussed cost with their patients; 41% occasionally discussed cost (76% total).

In 2011, 84% of all physicians either regularly or occasionally discussed the cost of treatment with patients. In 2012, 68% of all physicians regularly discussed cost of treatment (30%) or did so if the patient asked (38%), and 6% reported that it was inappropriate to discuss cost with patients.^1,2 

How you spend your time
How many hours do you work? The number of hours in a workweek remained about the same. In 2012, 11% of ObGyns worked 41 to 45 hours; 13% worked 46 to 50 hours; 4% worked 51 to 55 hours; 9% worked 56 to 60 hours; and 20% reported working less than 30 hours.¹

Time spent with patients? In 2012, most ObGyns spent less than 16 minutes with a patient: 30% reported spending 13 to 16 minutes; another 30% spent less than 13 minutes; and 17% saw patients for 21 minutes or longer.¹

Demographics of the survey
Respondents to the Medscape survey totaled 21,878 US physicians and ranged in age from 28 years to older than 70; 66% were aged 40 to 64 years; 31% were female; 69% were male; and 89% were board certified.

Of the overall survey respondents, 5% (n = 1,094) were ObGyns. Of these respondents, 71% were aged 40 to 64; 43% were female; 57% were male; and 92% were board certified.^1,2

Concerned by state and federal laws that force physicians to give or withhold specific information when counseling patients, as well as laws that mandate specific treatments, tests, and procedures, the American College of Obstetricians and Gynecologists (the College) and the American Congress of Obstetricians and Gynecologists (ACOG) issued a Statement of Policy opposing such interference.

The policy statement, issued in May 2013, opposes government interference with the patient-physician relationship without a substantial public health justification. The statement reads, in part:

Efforts to legislate elements of patient care and counseling can drive a wedge between a patient and her health-care provider, be that a physician, certified nurse-midwife, certified midwife, nurse practitioner, or physician assistant. Laws should not interfere with the ability of physicians to determine appropriate treatment options and have open, honest and confidential communications with their patients. Nor should laws interfere with the patient’s right to be counseled by a physician according to the best currently available medical evidence and the physician’s professional medical judgment. The College and ACOG strongly oppose any governmental interference that threatens communication between patients and their physicians or causes a physician to compromise his or her medical judgment about what information or treatment is in the best interest of the patient.¹

ACOG highlighted several examples of ill-advised laws that either interfere with physicians counseling their patients or that force patients to have unnecessary tests and procedures:

• laws that prohibit physicians from speaking to their patients about firearms and gun safety
• statutes that dictate a script about what must be communicated to women about breast density and cancer risk
• laws that require women to undergo unnecessary ultrasound imaging before an abortion.

“Given the relentless legislative assault on the patient-physician relationship that we’ve seen in the past few years—and unfortunately continue to see—we were compelled to issue a formal Statement of Policy,” said ACOG President Jeanne A. Conry, MD, PhD. “A disproportionate number of these types of laws are aimed at women’s reproductive rights and the physicians that provide women’s health-care services.”

We want to hear from you! Tell us what you think.

Concerned by state and federal laws that force physicians to give or withhold specific information when counseling patients, as well as laws that mandate specific treatments, tests, and procedures, the American College of Obstetricians and Gynecologists (the College) and the American Congress of Obstetricians and Gynecologists (ACOG) issued a Statement of Policy opposing such interference.

The policy statement, issued in May 2013, opposes government interference with the patient-physician relationship without a substantial public health justification. The statement reads, in part:

Efforts to legislate elements of patient care and counseling can drive a wedge between a patient and her health-care provider, be that a physician, certified nurse-midwife, certified midwife, nurse practitioner, or physician assistant. Laws should not interfere with the ability of physicians to determine appropriate treatment options and have open, honest and confidential communications with their patients. Nor should laws interfere with the patient’s right to be counseled by a physician according to the best currently available medical evidence and the physician’s professional medical judgment. The College and ACOG strongly oppose any governmental interference that threatens communication between patients and their physicians or causes a physician to compromise his or her medical judgment about what information or treatment is in the best interest of the patient.¹

ACOG highlighted several examples of ill-advised laws that either interfere with physicians counseling their patients or that force patients to have unnecessary tests and procedures:

• laws that prohibit physicians from speaking to their patients about firearms and gun safety
• statutes that dictate a script about what must be communicated to women about breast density and cancer risk
• laws that require women to undergo unnecessary ultrasound imaging before an abortion.

“Given the relentless legislative assault on the patient-physician relationship that we’ve seen in the past few years—and unfortunately continue to see—we were compelled to issue a formal Statement of Policy,” said ACOG President Jeanne A. Conry, MD, PhD. “A disproportionate number of these types of laws are aimed at women’s reproductive rights and the physicians that provide women’s health-care services.”

We want to hear from you! Tell us what you think.

Concerned by state and federal laws that force physicians to give or withhold specific information when counseling patients, as well as laws that mandate specific treatments, tests, and procedures, the American College of Obstetricians and Gynecologists (the College) and the American Congress of Obstetricians and Gynecologists (ACOG) issued a Statement of Policy opposing such interference.

The policy statement, issued in May 2013, opposes government interference with the patient-physician relationship without a substantial public health justification. The statement reads, in part:

Efforts to legislate elements of patient care and counseling can drive a wedge between a patient and her health-care provider, be that a physician, certified nurse-midwife, certified midwife, nurse practitioner, or physician assistant. Laws should not interfere with the ability of physicians to determine appropriate treatment options and have open, honest and confidential communications with their patients. Nor should laws interfere with the patient’s right to be counseled by a physician according to the best currently available medical evidence and the physician’s professional medical judgment. The College and ACOG strongly oppose any governmental interference that threatens communication between patients and their physicians or causes a physician to compromise his or her medical judgment about what information or treatment is in the best interest of the patient.¹

ACOG highlighted several examples of ill-advised laws that either interfere with physicians counseling their patients or that force patients to have unnecessary tests and procedures:

• laws that prohibit physicians from speaking to their patients about firearms and gun safety
• statutes that dictate a script about what must be communicated to women about breast density and cancer risk
• laws that require women to undergo unnecessary ultrasound imaging before an abortion.

“Given the relentless legislative assault on the patient-physician relationship that we’ve seen in the past few years—and unfortunately continue to see—we were compelled to issue a formal Statement of Policy,” said ACOG President Jeanne A. Conry, MD, PhD. “A disproportionate number of these types of laws are aimed at women’s reproductive rights and the physicians that provide women’s health-care services.”

We want to hear from you! Tell us what you think.

ObGyns’ 2012 mean income was $242,000, up from a mean of $220,000 in 2011, although almost half (45%) of ObGyns reported their 2012 income to be the same as their 2011 income. In 2012, about 25% of ObGyns reported earnings of $300,000 or more, and 10% said they earn less than $100,000.¹ The newest salary data are based on Medscape’s 2013 Compensation Report, a survey of 21,878 US physicians across 25 specialties.

Forty-three percent of ObGyns were satisfied with their 2012 compensation levels; 48% of all physicians were satisfied.^1,2

Other Findings

Men still make more than women. In 2012, male ObGyns reported earning 14% more than female ObGyns. This pay gap is smaller for ObGyns than for all physicians, however; overall, male physicians earn 30% more than females. One contributing factor to the closer pay gap for ObGyns is that there are fewer women in the higher-paying specialties, such as orthopedics (only 9% of orthopedic respondents were female). Response rates also matter: of those who responded to the overall Medscape poll, 31% were female; of the ObGyn respondents, 43% were female.^1,2

ObGyn compensation varies by region. Highest earnings were found in the South Central region (mean: $250,000 in 2012); lowest earnings were found in the Northeast (mean: $213,000).¹

Work setting counts. When ranked by job setting, in 2012, ObGyns employed by health-care organizations were the top earners (mean income: $272,000). This figure rose considerably from the 2011 mean of $239,000. Additional mean earnings of ObGyns ranked by work setting in 2012 were¹:

• single-specialty (office-based) group practices: $264,000

• multispecialty (office-based) group practices: $252,000

• hospitals: $216,000

• academic: $212,000

• solo practices (office-based): $208,000

• outpatient clinics: $206,000.

When ranked by work situation, partners beat all other situations at $268,000 (mean). Employed ObGyns earned more than owners of solo practices (mean: $241,000 vs $204,000, respectively). Independent contractors came in the lowest at $198,000 (mean).¹

Satisfaction with career choice and practice setting showed a slight dip from 2011. When all physicians were asked if they would choose medicine again, 53% would do so in 2012, versus 55% in 2011. Among the ObGyns who said they would choose medicine again, 37% said they would choose the same specialty (the same as in 2011). In 2012, 18% of ObGyns said they would choose the same practice setting, compared with 23% in 2011.^1,2

What’s most rewarding? In 2012, 42% of ObGyns ranked their relationships with patients as the most satisfying part of their job, compared with 31% of all physicians. While 34% of all physicians said that being good at the practice of medicine was their primary reward, 28% of ObGyns listed that first.^1,2

FINDINGS ON HOW YOU MAKE AND DISCUSS MONEY

Where does your income come from? In the 2011 report, only 4% of ObGyns either participated in or planned to join an accountable care organization (ACO). In 2012, that figure jumped to 25%. Only 1% of ObGyns opted for concierge medical practices in 2012 and 2011, and only 3% chose cash-only practices in 2012 and 2011.^1,2

What about Medicare and Medicaid? More physicians were concerned with the potential for reduced Medicare reimbursement in 2012 than in 2011. The current report indicated that 15% of ObGyns plan to stop taking new Medicare or Medicaid patients, 3% plan to stop seeing current Medicare or Medicaid patients, and 28% are undecided. However, 53% of ObGyns are not conflicted and will continue to see current patients and take on new Medicare and Medicaid patients. In 2012, 59% of all physicians planned to treat new Medicare and Medicaid patients.^1,2

What about insurance company payments? Practice management experts often recommend that physicians review their annual payments from insurers and drop those who pay the worst or create the most trouble. In 2012, 26% of ObGyns reported that they already do that or are planning to take that advice. However, 29% will keep all insurers because they feel that even poor payers still represent income. About 15% felt that dropping insurers was inappropriate behavior.¹

Do you provide ancillary services? When asked if they would offer additional medical services to increase income, 21% of ObGyns said yes. Nineteen percent of all physicians said they had begun to do that.^1,2

Do you discuss cost with your patients? In larger practices and hospital settings, treatment costs are often discussed by a staff member responsible for billing and payment, rather than by the physician. As physicians move toward these larger organizations, the trend is becoming more apparent¹:

• In 2011, 41% of ObGyns reported that they regularly discuss the cost of services with their patients; 48% said they occasionally discuss cost if the patient brings it up (89% total).

• In 2012, 35% of ObGyns said they regularly discuss cost with their patients; 41% said they occasionally discuss cost (76% total).

In 2011, 84% of all physicians either regularly or occasionally discussed the cost of treatment with patients. In 2012, 68% of all physicians regularly discussed cost of treatment (30%) or did so if the patient asked (38%), and 6% reported that it was inappropriate to discuss cost with patients.^1,2

Findings on how you spend your time

How many hours do you work? The number of hours in a workweek remained approximately the same for the last 2 years: in 2012, 11% of ObGyns worked 41–45 h/w; 13% worked 46–50 h/w; 4% worked 51–55 h/w; and 9% worked 56–60 h/w. Approximately 20% of ObGyns reported working less than 30 h/w.¹

How much time do you spend with patients? In 2012, most ObGyns spent 16 minutes or less per patient visit. Thirty percent of ObGyns spent 13–16 minutes with a patient, and another 30% spent less than 13 minutes. Some indicated longer patient visits—17% saw patients for 21 minutes or more.¹

Demographics of the survey

Respondents to the Medscape survey totaled 21,878 US physicians and ranged in age from 28 years to older than 70; 66% were aged 40 to 64 years; 31% were female; 69% were male; and 89% were board certified.

Of the overall survey respondents, 5% (n = 1094) were ObGyns. Of these respondents, 71% were aged 40 to 64; 43% were female; 57% were male; and 92% were board certified.^1,2

ObGyns’ 2012 mean income was $242,000, up from a mean of $220,000 in 2011, although almost half (45%) of ObGyns reported their 2012 income to be the same as their 2011 income. In 2012, about 25% of ObGyns reported earnings of $300,000 or more, and 10% said they earn less than $100,000.¹ The newest salary data are based on Medscape’s 2013 Compensation Report, a survey of 21,878 US physicians across 25 specialties.

Forty-three percent of ObGyns were satisfied with their 2012 compensation levels; 48% of all physicians were satisfied.^1,2

Other Findings

Men still make more than women. In 2012, male ObGyns reported earning 14% more than female ObGyns. This pay gap is smaller for ObGyns than for all physicians, however; overall, male physicians earn 30% more than females. One contributing factor to the closer pay gap for ObGyns is that there are fewer women in the higher-paying specialties, such as orthopedics (only 9% of orthopedic respondents were female). Response rates also matter: of those who responded to the overall Medscape poll, 31% were female; of the ObGyn respondents, 43% were female.^1,2

ObGyn compensation varies by region. Highest earnings were found in the South Central region (mean: $250,000 in 2012); lowest earnings were found in the Northeast (mean: $213,000).¹

Work setting counts. When ranked by job setting, in 2012, ObGyns employed by health-care organizations were the top earners (mean income: $272,000). This figure rose considerably from the 2011 mean of $239,000. Additional mean earnings of ObGyns ranked by work setting in 2012 were¹:

• single-specialty (office-based) group practices: $264,000

• multispecialty (office-based) group practices: $252,000

• hospitals: $216,000

• academic: $212,000

• solo practices (office-based): $208,000

• outpatient clinics: $206,000.

When ranked by work situation, partners beat all other situations at $268,000 (mean). Employed ObGyns earned more than owners of solo practices (mean: $241,000 vs $204,000, respectively). Independent contractors came in the lowest at $198,000 (mean).¹

Satisfaction with career choice and practice setting showed a slight dip from 2011. When all physicians were asked if they would choose medicine again, 53% would do so in 2012, versus 55% in 2011. Among the ObGyns who said they would choose medicine again, 37% said they would choose the same specialty (the same as in 2011). In 2012, 18% of ObGyns said they would choose the same practice setting, compared with 23% in 2011.^1,2

What’s most rewarding? In 2012, 42% of ObGyns ranked their relationships with patients as the most satisfying part of their job, compared with 31% of all physicians. While 34% of all physicians said that being good at the practice of medicine was their primary reward, 28% of ObGyns listed that first.^1,2

FINDINGS ON HOW YOU MAKE AND DISCUSS MONEY

Where does your income come from? In the 2011 report, only 4% of ObGyns either participated in or planned to join an accountable care organization (ACO). In 2012, that figure jumped to 25%. Only 1% of ObGyns opted for concierge medical practices in 2012 and 2011, and only 3% chose cash-only practices in 2012 and 2011.^1,2

What about Medicare and Medicaid? More physicians were concerned with the potential for reduced Medicare reimbursement in 2012 than in 2011. The current report indicated that 15% of ObGyns plan to stop taking new Medicare or Medicaid patients, 3% plan to stop seeing current Medicare or Medicaid patients, and 28% are undecided. However, 53% of ObGyns are not conflicted and will continue to see current patients and take on new Medicare and Medicaid patients. In 2012, 59% of all physicians planned to treat new Medicare and Medicaid patients.^1,2

What about insurance company payments? Practice management experts often recommend that physicians review their annual payments from insurers and drop those who pay the worst or create the most trouble. In 2012, 26% of ObGyns reported that they already do that or are planning to take that advice. However, 29% will keep all insurers because they feel that even poor payers still represent income. About 15% felt that dropping insurers was inappropriate behavior.¹

Do you provide ancillary services? When asked if they would offer additional medical services to increase income, 21% of ObGyns said yes. Nineteen percent of all physicians said they had begun to do that.^1,2

Do you discuss cost with your patients? In larger practices and hospital settings, treatment costs are often discussed by a staff member responsible for billing and payment, rather than by the physician. As physicians move toward these larger organizations, the trend is becoming more apparent¹:

• In 2011, 41% of ObGyns reported that they regularly discuss the cost of services with their patients; 48% said they occasionally discuss cost if the patient brings it up (89% total).

• In 2012, 35% of ObGyns said they regularly discuss cost with their patients; 41% said they occasionally discuss cost (76% total).

In 2011, 84% of all physicians either regularly or occasionally discussed the cost of treatment with patients. In 2012, 68% of all physicians regularly discussed cost of treatment (30%) or did so if the patient asked (38%), and 6% reported that it was inappropriate to discuss cost with patients.^1,2

Findings on how you spend your time

How many hours do you work? The number of hours in a workweek remained approximately the same for the last 2 years: in 2012, 11% of ObGyns worked 41–45 h/w; 13% worked 46–50 h/w; 4% worked 51–55 h/w; and 9% worked 56–60 h/w. Approximately 20% of ObGyns reported working less than 30 h/w.¹

How much time do you spend with patients? In 2012, most ObGyns spent 16 minutes or less per patient visit. Thirty percent of ObGyns spent 13–16 minutes with a patient, and another 30% spent less than 13 minutes. Some indicated longer patient visits—17% saw patients for 21 minutes or more.¹

Demographics of the survey

Respondents to the Medscape survey totaled 21,878 US physicians and ranged in age from 28 years to older than 70; 66% were aged 40 to 64 years; 31% were female; 69% were male; and 89% were board certified.

Of the overall survey respondents, 5% (n = 1094) were ObGyns. Of these respondents, 71% were aged 40 to 64; 43% were female; 57% were male; and 92% were board certified.^1,2

ObGyns’ 2012 mean income was $242,000, up from a mean of $220,000 in 2011, although almost half (45%) of ObGyns reported their 2012 income to be the same as their 2011 income. In 2012, about 25% of ObGyns reported earnings of $300,000 or more, and 10% said they earn less than $100,000.¹ The newest salary data are based on Medscape’s 2013 Compensation Report, a survey of 21,878 US physicians across 25 specialties.

Forty-three percent of ObGyns were satisfied with their 2012 compensation levels; 48% of all physicians were satisfied.^1,2

Other Findings

Men still make more than women. In 2012, male ObGyns reported earning 14% more than female ObGyns. This pay gap is smaller for ObGyns than for all physicians, however; overall, male physicians earn 30% more than females. One contributing factor to the closer pay gap for ObGyns is that there are fewer women in the higher-paying specialties, such as orthopedics (only 9% of orthopedic respondents were female). Response rates also matter: of those who responded to the overall Medscape poll, 31% were female; of the ObGyn respondents, 43% were female.^1,2

ObGyn compensation varies by region. Highest earnings were found in the South Central region (mean: $250,000 in 2012); lowest earnings were found in the Northeast (mean: $213,000).¹

Work setting counts. When ranked by job setting, in 2012, ObGyns employed by health-care organizations were the top earners (mean income: $272,000). This figure rose considerably from the 2011 mean of $239,000. Additional mean earnings of ObGyns ranked by work setting in 2012 were¹:

• single-specialty (office-based) group practices: $264,000

• multispecialty (office-based) group practices: $252,000

• hospitals: $216,000

• academic: $212,000

• solo practices (office-based): $208,000

• outpatient clinics: $206,000.

When ranked by work situation, partners beat all other situations at $268,000 (mean). Employed ObGyns earned more than owners of solo practices (mean: $241,000 vs $204,000, respectively). Independent contractors came in the lowest at $198,000 (mean).¹

Satisfaction with career choice and practice setting showed a slight dip from 2011. When all physicians were asked if they would choose medicine again, 53% would do so in 2012, versus 55% in 2011. Among the ObGyns who said they would choose medicine again, 37% said they would choose the same specialty (the same as in 2011). In 2012, 18% of ObGyns said they would choose the same practice setting, compared with 23% in 2011.^1,2

What’s most rewarding? In 2012, 42% of ObGyns ranked their relationships with patients as the most satisfying part of their job, compared with 31% of all physicians. While 34% of all physicians said that being good at the practice of medicine was their primary reward, 28% of ObGyns listed that first.^1,2

FINDINGS ON HOW YOU MAKE AND DISCUSS MONEY

Where does your income come from? In the 2011 report, only 4% of ObGyns either participated in or planned to join an accountable care organization (ACO). In 2012, that figure jumped to 25%. Only 1% of ObGyns opted for concierge medical practices in 2012 and 2011, and only 3% chose cash-only practices in 2012 and 2011.^1,2

What about Medicare and Medicaid? More physicians were concerned with the potential for reduced Medicare reimbursement in 2012 than in 2011. The current report indicated that 15% of ObGyns plan to stop taking new Medicare or Medicaid patients, 3% plan to stop seeing current Medicare or Medicaid patients, and 28% are undecided. However, 53% of ObGyns are not conflicted and will continue to see current patients and take on new Medicare and Medicaid patients. In 2012, 59% of all physicians planned to treat new Medicare and Medicaid patients.^1,2

What about insurance company payments? Practice management experts often recommend that physicians review their annual payments from insurers and drop those who pay the worst or create the most trouble. In 2012, 26% of ObGyns reported that they already do that or are planning to take that advice. However, 29% will keep all insurers because they feel that even poor payers still represent income. About 15% felt that dropping insurers was inappropriate behavior.¹

Do you provide ancillary services? When asked if they would offer additional medical services to increase income, 21% of ObGyns said yes. Nineteen percent of all physicians said they had begun to do that.^1,2

Do you discuss cost with your patients? In larger practices and hospital settings, treatment costs are often discussed by a staff member responsible for billing and payment, rather than by the physician. As physicians move toward these larger organizations, the trend is becoming more apparent¹:

• In 2011, 41% of ObGyns reported that they regularly discuss the cost of services with their patients; 48% said they occasionally discuss cost if the patient brings it up (89% total).

• In 2012, 35% of ObGyns said they regularly discuss cost with their patients; 41% said they occasionally discuss cost (76% total).

In 2011, 84% of all physicians either regularly or occasionally discussed the cost of treatment with patients. In 2012, 68% of all physicians regularly discussed cost of treatment (30%) or did so if the patient asked (38%), and 6% reported that it was inappropriate to discuss cost with patients.^1,2

Findings on how you spend your time

How many hours do you work? The number of hours in a workweek remained approximately the same for the last 2 years: in 2012, 11% of ObGyns worked 41–45 h/w; 13% worked 46–50 h/w; 4% worked 51–55 h/w; and 9% worked 56–60 h/w. Approximately 20% of ObGyns reported working less than 30 h/w.¹

How much time do you spend with patients? In 2012, most ObGyns spent 16 minutes or less per patient visit. Thirty percent of ObGyns spent 13–16 minutes with a patient, and another 30% spent less than 13 minutes. Some indicated longer patient visits—17% saw patients for 21 minutes or more.¹

Demographics of the survey

Respondents to the Medscape survey totaled 21,878 US physicians and ranged in age from 28 years to older than 70; 66% were aged 40 to 64 years; 31% were female; 69% were male; and 89% were board certified.

Of the overall survey respondents, 5% (n = 1094) were ObGyns. Of these respondents, 71% were aged 40 to 64; 43% were female; 57% were male; and 92% were board certified.^1,2

Earlier research revealed an increased risk of several cancers, including ovarian cancer, in women with endometriosis. Some found a protective effect against ovarian cancer with surgical intervention, such as hysterectomy or tubal ligation.

“Patients with endometriosis typically are treated with hormones or, in more severe cases, with surgery,” said lead author Dr. Anna-Sofia Melin from the Karolinska Institute and Karolinska University Hospital in Stockholm, Sweden. “We wanted to expand understanding of ovarian cancer risk in women with endometriosis who had some type of surgery or hormone therapy.”

Using the National Swedish Patient Register, the team identified women given a diagnosis of endometriosis between 1969 and 2007. They then used the National Swedish Cancer Register to link women who were given a diagnosis of epithelial ovarian cancer at least 1 year after a diagnosis of endometriosis. Information on hormonal and surgical treatments was taken from the medical records of 220 women who had both endometriosis and ovarian cancer and 416 who had only endometriosis.

Among women who underwent oophorectomy, the risk of ovarian cancer declined significantly (crude odds ratio [OR], 0.42; 95% confidence interval [CI], 0.28–0.62). Women who underwent radical surgical extirpation of all visible endometriosis also had a lower risk of ovarian cancer (OR, 0.37; 95% CI, 0.25–0.55).

“Our study suggests that surgical removal of an ovary and removal of visible endometriosis protects women from developing ovarian cancer at a later point,” said Dr. Melin. “For women with endometriosis, the role of hormonal treatment and future ovarian cancer risk remains unclear.”

We want to hear from you! Tell us what you think.

Earlier research revealed an increased risk of several cancers, including ovarian cancer, in women with endometriosis. Some found a protective effect against ovarian cancer with surgical intervention, such as hysterectomy or tubal ligation.

“Patients with endometriosis typically are treated with hormones or, in more severe cases, with surgery,” said lead author Dr. Anna-Sofia Melin from the Karolinska Institute and Karolinska University Hospital in Stockholm, Sweden. “We wanted to expand understanding of ovarian cancer risk in women with endometriosis who had some type of surgery or hormone therapy.”

Using the National Swedish Patient Register, the team identified women given a diagnosis of endometriosis between 1969 and 2007. They then used the National Swedish Cancer Register to link women who were given a diagnosis of epithelial ovarian cancer at least 1 year after a diagnosis of endometriosis. Information on hormonal and surgical treatments was taken from the medical records of 220 women who had both endometriosis and ovarian cancer and 416 who had only endometriosis.

Among women who underwent oophorectomy, the risk of ovarian cancer declined significantly (crude odds ratio [OR], 0.42; 95% confidence interval [CI], 0.28–0.62). Women who underwent radical surgical extirpation of all visible endometriosis also had a lower risk of ovarian cancer (OR, 0.37; 95% CI, 0.25–0.55).

“Our study suggests that surgical removal of an ovary and removal of visible endometriosis protects women from developing ovarian cancer at a later point,” said Dr. Melin. “For women with endometriosis, the role of hormonal treatment and future ovarian cancer risk remains unclear.”

We want to hear from you! Tell us what you think.

Earlier research revealed an increased risk of several cancers, including ovarian cancer, in women with endometriosis. Some found a protective effect against ovarian cancer with surgical intervention, such as hysterectomy or tubal ligation.

“Patients with endometriosis typically are treated with hormones or, in more severe cases, with surgery,” said lead author Dr. Anna-Sofia Melin from the Karolinska Institute and Karolinska University Hospital in Stockholm, Sweden. “We wanted to expand understanding of ovarian cancer risk in women with endometriosis who had some type of surgery or hormone therapy.”

Using the National Swedish Patient Register, the team identified women given a diagnosis of endometriosis between 1969 and 2007. They then used the National Swedish Cancer Register to link women who were given a diagnosis of epithelial ovarian cancer at least 1 year after a diagnosis of endometriosis. Information on hormonal and surgical treatments was taken from the medical records of 220 women who had both endometriosis and ovarian cancer and 416 who had only endometriosis.

Among women who underwent oophorectomy, the risk of ovarian cancer declined significantly (crude odds ratio [OR], 0.42; 95% confidence interval [CI], 0.28–0.62). Women who underwent radical surgical extirpation of all visible endometriosis also had a lower risk of ovarian cancer (OR, 0.37; 95% CI, 0.25–0.55).

“Our study suggests that surgical removal of an ovary and removal of visible endometriosis protects women from developing ovarian cancer at a later point,” said Dr. Melin. “For women with endometriosis, the role of hormonal treatment and future ovarian cancer risk remains unclear.”

We want to hear from you! Tell us what you think.

For healthy full-term infants, development at age 12 months is associated with gestational age, with scores increasing for each additional week of gestation, according to a study published online in Pediatrics.

Olga Rose, MD, from Massachusetts General Hospital in Boston, and colleagues investigated the correlation between gestational age and mental and psychomotor development scores in a cohort of 1,562 healthy full-term infants born between 37 and 41 weeks. The Bayley Scales of Infant Development were used to assess development at 12 months.

The researchers found that, after controlling for birth weight percentile, gender, socioeconomic status, and home environment, the Mental Development Index increased by 0.8 points, and the Psychomotor Development Index increased by 1.4 points for every additional week of gestation.

“There is increasing evidence that birth at 39 to 41 weeks provides developmental advantages compared with birth at 37 to 38 weeks,” the authors write. “Because cesarean deliveries and early-term inductions have increased to 40% of all births, consideration of ongoing brain development during the full-term period is an important medical and policy issue.”

To access the abstract of the article published in Pediatrics, click here.

For healthy full-term infants, development at age 12 months is associated with gestational age, with scores increasing for each additional week of gestation, according to a study published online in Pediatrics.

Olga Rose, MD, from Massachusetts General Hospital in Boston, and colleagues investigated the correlation between gestational age and mental and psychomotor development scores in a cohort of 1,562 healthy full-term infants born between 37 and 41 weeks. The Bayley Scales of Infant Development were used to assess development at 12 months.

The researchers found that, after controlling for birth weight percentile, gender, socioeconomic status, and home environment, the Mental Development Index increased by 0.8 points, and the Psychomotor Development Index increased by 1.4 points for every additional week of gestation.

“There is increasing evidence that birth at 39 to 41 weeks provides developmental advantages compared with birth at 37 to 38 weeks,” the authors write. “Because cesarean deliveries and early-term inductions have increased to 40% of all births, consideration of ongoing brain development during the full-term period is an important medical and policy issue.”

To access the abstract of the article published in Pediatrics, click here.

For healthy full-term infants, development at age 12 months is associated with gestational age, with scores increasing for each additional week of gestation, according to a study published online in Pediatrics.

Olga Rose, MD, from Massachusetts General Hospital in Boston, and colleagues investigated the correlation between gestational age and mental and psychomotor development scores in a cohort of 1,562 healthy full-term infants born between 37 and 41 weeks. The Bayley Scales of Infant Development were used to assess development at 12 months.

The researchers found that, after controlling for birth weight percentile, gender, socioeconomic status, and home environment, the Mental Development Index increased by 0.8 points, and the Psychomotor Development Index increased by 1.4 points for every additional week of gestation.

“There is increasing evidence that birth at 39 to 41 weeks provides developmental advantages compared with birth at 37 to 38 weeks,” the authors write. “Because cesarean deliveries and early-term inductions have increased to 40% of all births, consideration of ongoing brain development during the full-term period is an important medical and policy issue.”

To access the abstract of the article published in Pediatrics, click here.