Objectives To explore the knowledge, attitudes, and beliefs related to pessary use in Spanish-speaking women along the US-Mexico border. Methods Spanish-speaking women with symptoms of vaginal bulge were recruited from the urogynecology/gynecology clinics at Texas Tech University Health Sciences Center El Paso to participate in moderated focus groups. Discussion topics included knowledge of prolapse/pessaries, pros/cons of pessaries, alternatives, and prolapse surgery. Audio-recorded group discussions were transcribed verbatim, and qualitative analysis completed by independent review using grounded theory methodology. Common themes were identified and then aggregated to form consensus concepts, agreed upon by the reviewers. Results Twenty-nine Spanish-speaking women participated in 6 focus group discussions. Approximately half of women reported little or no prior knowledge about pessaries. Three main themes were identified from analysis: knowledge/perceptions, misinformation/misconceptions, and surgery-related concerns. Concepts identified from common themes included limited knowledge of pessaries, confusing “pessary” with “mesh,” willingness to try pessaries in order to avoid surgery, desire to try pessary if it was recommended by physician, limited efficacy or complications of surgery, and mesh-related concerns. Interestingly, some women reported that pessaries appear to be a treatment more often offered in the United States rather than in Mexico. Conclusions Most participants showed a willingness to try a pessary for symptoms of pelvic organ prolapse in an effort to avoid surgery, despite expressing limited knowledge about this treatment. Physician recommendations and risks of pessary use influence their likelihood of trying a pessary. These concepts serve as focus points for effective pessary counseling to help improve education and informed decision making in this patient population.

Although the overall rate of transfusion was low, antenatal anemia was significantly associated with receiving a postpartum RBC transfusion.

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increases the risk of intubation, providers are wary to aggressively fluid-resuscitate septic patients who are at risk of fluid overload -namely, patients with congestive heart failure (CHF) or end-stage renal disease (ESRD). We sought to assess whether an initial fluid dose of 30 ml/kg in septic CHF or septic ESRD patients, compared to a fluidrestrictive strategy, leads to increased intubations. We also analyzed mortality rates and hospital length of stay (LOS).Methods: At our ED, data on septic patients > 17 years of age are prospectively tracked for quality metrics. Patients who trigger the sepsis flag are up-triaged for quicker provider evaluation to assess whether to implement a sepsis bundle, including whether or not to administer 30 ml/kg of fluids. All patients who are ultimately deemed to have had an infectious source that triggered the flag have multiple metrics logged and tracked. This prospectively collected set of data was retrospectively analyzed. Inclusion criteria were septic patients with past medical history of CHF or ESRD who were given fluids. Patients were excluded if they were under do-notresuscitate (DNR) or comfort-measures-only (CMO) status, as well as if amount of administered fluid was unknown. Primary outcome was intubation frequency. Secondary outcomes were hospital LOS and mortality. Student t-test and chi-square tests was used for analyses.Results: Table 1 demonstrates the outcomes in patients who were given at least 30 ml/kg compared to those who were not. In particular, there were no differences between groups in intubation rates. There were also no differences in hospital LOS or in mortality (although the sample was not sufficiently powered for mortality). Overall, 13.8% (95% CI 9.5%-19.2%) of septic patients with CHF and/or ESRD received 30 ml/kg of fluids in the ED whereas 21.0% (95% CI 18.7%-23.4%) of septic patients without either CHF or ESRD received 30 ml/kg of fluids in the ED (p<0.02).Conclusions: Our analysis suggests that patients with a history of CHF and/or ESRD who become septic and receive at least 30 ml/kg of fluids in the ED are not any more likely to be intubated than the patients who receive fluid-restrictive regimen of < 30 ml/kg. This analysis has limitations, including that there may be baseline differences between the patients who did receive 30 ml/kg of fluids in the ED vs. those who did not. However, our results are in line with some previously presented data. Therefore, an initial bolus of 30 ml/kg of fluids in septic CHF/ ESRD patients appears to be safe -possibly even beneficial -and can potentially be included in a triage bundle set for sepsis care in the ED. At our site, CHF/ESRD patients were significantly less likely to receive 30 ml/kg of fluids in the ED than non-CHF/ESRD patients, but adherence to the 30 ml/kg target was low for all patients. Implementing a 30 ml/kg fluid order from triage could enhance compliance with the Surviving Sepsis guidelines -and still leave providers the option of holding fluids when they clinically deem it appropriate.

[LAVH], and robotic-assisted total laparoscopic [RATLH] hysterectomy). Hysterectomy routes were identified using the International Classification of Disease, 9th Revision, Clinical Modification (ICD-9) procedure codes. The primary outcomes evaluated were readmission within 30 days of discharge and LOS. Annual trends in mode of hysterectomy were calculated across the study years. Univariate analyses employed the Student's t-test for continuous variables and the chi-squared test for categorical variables. Multivariable analyses utilized logistic regression for 30-day readmission and a generalized linear model for LOS. Statistical significance was set at p < 0.05. RESULTS: Approximately 4% of patients were readmitted within 30 days after any inpatient hysterectomy. Compared to TAH, all minimally invasive approaches except for RATLH resulted in significantly lower odds of readmission (OR ¼ 0.77-0.68, p 0.004). All minimally invasive techniques, including RATLH, significantly decreased LOS by 0.3-0.9 days (p < 0.0001 for all). Other factors that significantly increased readmission were black race (OR ¼ 1.52, p < 0.0001), public payer assistance (OR ¼ 1.49-1.59, p < 0.0001) and higher surgeon volumes (OR ¼ 1.34, p ¼ 0.005). Significantly longer LOS was associated with age 50 (p < 0.001), black race (p < 0.0001), public payer assistance (p < 0.0001), higher comorbidity burdens (p < 0.0001) and higher surgeon volumes (p < 0.0001). TAH was the dominant approach utilized between 2011 and 2014; minimally invasive approaches were only used 10-20% of the time within the inpatient setting [Figure 1]. CONCLUSION: Minimally invasive routes may reduce likelihood of 30day readmission and shorten LOS for women undergoing inpatient hysterectomy in Pennsylvania. Targeting at-risk populations (black race and public payer assistance) in quality improvement efforts is an opportunity to help decrease readmission rates and LOS where they tend to be highest.