James L Whiteside | East Carolina University (original) (raw)
Papers by James L Whiteside
Female Pelvic Medicine & Reconstructive Surgery, 2021
OBJECTIVE The aim of this study was to determine if injection of bupivacaine into levator muscles... more OBJECTIVE The aim of this study was to determine if injection of bupivacaine into levator muscles after posterior colporrhaphy reduces postoperative pain. METHODS This study was a multicenter, double-blinded, placebo-controlled, randomized clinical trial of 130 participants, comparing bilateral infiltration of puborectalis and iliococcygeus muscles with 0.5% bupivacaine without epinephrine or normal saline after vaginal prolapse repair that included a posterior colporrhaphy. Primary outcome was the 24-hour cumulative Visual Analog Scale (VAS) pain score (measured as a sum of VAS pain scores at postoperative hours 0, 4, 8, 16, and 24) across intervention allocations. Secondary outcomes include the individual VAS pain scores per postoperative times 0, 4, 8, 16, and 24 hours and at 1 and 2 weeks, morphine equivalent use, postoperative void trial success, and time to first bowel movement. RESULTS Sixty-eight participants received bupivacaine, and 62 participants received normal saline. No significant differences were identified in the 24-hour postoperative cumulative VAS pain scores for the bupivacaine and normal saline arms, 19 and 18 (P = 0.71); individual pain scores per each postoperative assessment time; opiate use (24-hour use was 42 vs 48, P = 0.39; 48-hour use was 75 vs 37, P = 0.09); length of hospital stay (26 hours vs 22 hours, P = 0.069); hours to passing void trial (10 hours vs 12 hours, P = 0.17); or hours to first postoperative bowel movement (18 hours vs 12 hours, P = 0.78). CONCLUSIONS Use of bupivacaine for muscle block after posterior colporrhaphy does not reduce postoperative pain, opiate use, and time to first bowel movement, or increase void trial success.
Clinicas Obstetricas Y Ginecologicas, 2003
Uroginecología y cirugía reconstructiva de la pelvis, 2008
Journal of Midwifery & Women's Health
INTRODUCTION Influenza can be a significant health threat for any affected individual. Pregnant w... more INTRODUCTION Influenza can be a significant health threat for any affected individual. Pregnant women are a high-risk population because of the likelihood of developing severe disease. Although the influenza vaccine has been recommended for use by pregnant women since 2004, current vaccination rates among pregnant women are lower than the general population and other high-risk groups. PROCESS A quality improvement project was undertaken during the 2019-to-2020 influenza season to increase the uptake of the influenza vaccine by women who were pregnant. The primary objective of the project was to increase the influenza vaccination rate compared with the rate in the previous season. The project had a secondary objective of standardizing documentation of the patient's vaccination status in the health record to capture data for performance measures. Interventions directed at patients, health care providers, and the health care system were simultaneously implemented as recommended by the Community Preventive Services Task Force. OUTCOMES Data were collected from 2967 records with 1480 from the 2018-to-2019 season and 1487 from the 2019-to-2020 season. Compared with records from the 2018-to-2019 season, the rate of those associated with a documented influenza vaccine was higher in the 2019-to-2020 season (63% vs 59%; P = .01). The rate of records without vaccination status codes was significantly less in the 2019-to-2020 season compared with the 2018-to-2019 season (14% vs 23%; P < .001). DISCUSSION Although interventions were effective in improving influenza vaccination uptake among pregnant women, vaccination rates still remain below the 80% goal set by the US Department of Health and Human Services. Bundled interventions have proven to be more effective than individual interventions, although which interventions are most effective remains unclear.
Journal of Gynecologic Surgery
Objective: The goal of this research was to examine how hospital type influences emergency depart... more Objective: The goal of this research was to examine how hospital type influences emergency department (ED) utilization within 30 days after benign gynecologic surgery. Materials and Methods: This was a pilot retrospective cohort study. Across 2 hospital settings-an academic medical center and a community-teaching hospital-adult women undergoing benign gynecologic surgery were placed randomly into 80 subject cohorts based on their 30-day postoperative ED utilization. The cohorts were defined as: (1) no ED visit; (2) low-yield ED visit (an ED visit with same-day discharge); and (3) high-yield ED visit (an ED visit with hospital admission). An analysis of risk factors for ED use according to hospital setting was performed. Results: Risk factors for ED use varied by hospital type. In the academic setting, Caucasian patients had fewer postoperative ED visits than patients of minority race/ethnicities, and insured patients had fewer postoperative ED visits than patients insured by Medicaid. In the academic setting, proximity to the hospital, performance of adhesiolysis, and prescription for an opiate were factors in frequency and types of ED visits. The need for catheterization was a factor in the type of ED visit only in the community-teaching setting, Conclusions: Hospital type influences use of emergency services following benign gynecologic surgery.
OBJECTIVE To determine if pelvic organ prolapse reduction decreases cystometric leak point pressu... more OBJECTIVE To determine if pelvic organ prolapse reduction decreases cystometric leak point pressure. STUDY DESIGN A retrospective review was performed of women with pelvic organ prolapse points Aa, Ba or C > or = -1 cm that leaked with and without vaginal support (barrier testing) during multichannel urodynamic investigation (N=44). An analysis of the mean and difference between leak point pressure (LPP) (vesicle pressure) with and without prolapse reduction was used to determine significance. RESULTS Among 460 possible study subjects, 15% (71/460) leaked only with and 4% (17/460) only without prolapse reduction. Among the 44 women who leaked both with and without prolapse reduction, prolapse reduction was associated with a mean decrease in LPP of 16.1 cm H2O (95% CI 7.4-24.7, p = 0.0005). CONCLUSION Reduction of pelvic organ prolapse is associated with a mean decrease in LPP of 16.1 cm H2O.
Urology Practice
AbstractIntroduction:We determined the rate of cystoscopy with hydrodistention (CH) before and af... more AbstractIntroduction:We determined the rate of cystoscopy with hydrodistention (CH) before and after the 2011 American Urological Association (AUA) amended clinical guideline, “Diagnosis and Treatm...
Obstetrics & Gynecology
Since a variety of procoagulant products, collectively called hemostatic agents, became available... more Since a variety of procoagulant products, collectively called hemostatic agents, became available to surgeons in the mid-20th century, their use has increased across multiple specialties, including gynecology. Congruent with past research on the causes of regional variation in the practice of medicine, available evidence suggests that a central predictor for use of these products is physician preference rather than documented clinical necessity. Use of these products adds risks and avoidable cost. This article seeks to highlight specific gynecologic circumstances in which evidence and surgical judgment supports hemostatic agent use and other settings in which use should be reconsidered.
Obstetrics & Gynecology
A 29-year-old multiparous patient is referred for chronic lower abdominal pain radiating into her... more A 29-year-old multiparous patient is referred for chronic lower abdominal pain radiating into her groin since undergoing cesarean delivery 2-years previously. Laboratory and radiographic evaluation results are negative. She asks you, "Please tell me, why am I having this pain?"
Clinical Obstetrics and Gynecology
Obstetrics & Gynecology
This month, we focus on current research in hysterectomy. Dr. Whiteside discusses four recent pub... more This month, we focus on current research in hysterectomy. Dr. Whiteside discusses four recent publications, and each is concluded with a "bottom line" that is the take-home message. The complete reference for each can be found in on this page, along with direct links to the abstracts.
American Journal of Obstetrics and Gynecology, 2016
Urogynecology and Reconstructive Pelvic Surgery, 2007
Seminars in Thrombosis and Hemostasis, 2010
Aprotinin has been used clinically to enhance hemostasis for decades and was approved in the Unit... more Aprotinin has been used clinically to enhance hemostasis for decades and was approved in the United States by the Food and Drug Administration in 1993 to reduce the transfusion requirement during coronary artery bypass surgery. Marketing of aprotinin ceased recently when observational studies and a randomized clinical trial reported increased cardiovascular toxicity in patients receiving this drug. The importance of prohemostatic therapy is reviewed in light of new information on long-term deleterious effects of blood transfusion, including increased risk of cardiovascular disease, malignancy, and infection possibly attributable to delivery of a load of red cell-derived redox-active iron. Weaknesses in design of clinical trials that failed to control adequately for such alternative mechanisms of toxicity complicate interpretation of risks versus benefits in clinical trials of aprotinin given to reduce transfusion requirement in the acute surgical setting. Properties and applications of aprotinin that may not have received sufficient attention in the decision to remove this drug from the therapeutic armamentarium are reviewed. Potential application of prohemostatic drugs, including aprotinin to special populations at risk for operative blood loss requiring transfusion, is illustrated by the description of nine patients with coagulopathies whose operative bleeding was managed effectively with aprotinin. This drug may remain safe and effective in patients at risk of bleeding with surgery. Beneficial effects of aprotinin seemingly unrelated to its prohemostatic properties, especially its apparent striking antineoplastic effects, warrant further study.
International Journal of Gynecology & Obstetrics, 2008
American Journal of Obstetrics and Gynecology
Journal of Pelvic Medicine and Surgery
Journal of Pelvic Medicine and Surgery
ABSTRACT Objective: The purpose of this study was to determine the incidence of and risk factors ... more ABSTRACT Objective: The purpose of this study was to determine the incidence of and risk factors for perioperative complications in elderly women who undergo urogynecologic surgery. Study design: A retrospective chart review of patients >= 75 years old who underwent urogynecologic surgery between January 1999 and December 2003 was performed. Demographics, comorbidities, and significant perioperative complications were recorded. The Charlson Comorbidity Index and American Society of Anesthesiologists classification were calculated to summarize the patients' overall perioperative risk. Logistic regression was used to identify independent risk factors for perioperative complications. Results: Two hundred sixty-seven patients who were >= 75 years old met the inclusion criteria; 25.8% of the patients had a significant perioperative complication. The most common perioperative complication was blood transfusion or significant blood loss, pulmonary edema, and postoperative congestive heart failure. Independent risk factors that were predictive of a patient having a perioperative complication were the length of surgery, coronary artery disease, and peripheral vascular disease. The Charlson Comorbidity Index and American Society of Anesthesiologists classification did not predict perioperative complications in this population. Conclusion: Pre-existing cardiovascular disease increases the risk of a significant perioperative complication in elderly women who undergo urogynecologic surgery. However, the overall perioperative morbidity rate in elderly women who undergo urogynecologic surgery is low. (c) 2005 Elsevier Inc. All rights reserved.
Female Pelvic Medicine & Reconstructive Surgery, 2021
OBJECTIVE The aim of this study was to determine if injection of bupivacaine into levator muscles... more OBJECTIVE The aim of this study was to determine if injection of bupivacaine into levator muscles after posterior colporrhaphy reduces postoperative pain. METHODS This study was a multicenter, double-blinded, placebo-controlled, randomized clinical trial of 130 participants, comparing bilateral infiltration of puborectalis and iliococcygeus muscles with 0.5% bupivacaine without epinephrine or normal saline after vaginal prolapse repair that included a posterior colporrhaphy. Primary outcome was the 24-hour cumulative Visual Analog Scale (VAS) pain score (measured as a sum of VAS pain scores at postoperative hours 0, 4, 8, 16, and 24) across intervention allocations. Secondary outcomes include the individual VAS pain scores per postoperative times 0, 4, 8, 16, and 24 hours and at 1 and 2 weeks, morphine equivalent use, postoperative void trial success, and time to first bowel movement. RESULTS Sixty-eight participants received bupivacaine, and 62 participants received normal saline. No significant differences were identified in the 24-hour postoperative cumulative VAS pain scores for the bupivacaine and normal saline arms, 19 and 18 (P = 0.71); individual pain scores per each postoperative assessment time; opiate use (24-hour use was 42 vs 48, P = 0.39; 48-hour use was 75 vs 37, P = 0.09); length of hospital stay (26 hours vs 22 hours, P = 0.069); hours to passing void trial (10 hours vs 12 hours, P = 0.17); or hours to first postoperative bowel movement (18 hours vs 12 hours, P = 0.78). CONCLUSIONS Use of bupivacaine for muscle block after posterior colporrhaphy does not reduce postoperative pain, opiate use, and time to first bowel movement, or increase void trial success.
Clinicas Obstetricas Y Ginecologicas, 2003
Uroginecología y cirugía reconstructiva de la pelvis, 2008
Journal of Midwifery & Women's Health
INTRODUCTION Influenza can be a significant health threat for any affected individual. Pregnant w... more INTRODUCTION Influenza can be a significant health threat for any affected individual. Pregnant women are a high-risk population because of the likelihood of developing severe disease. Although the influenza vaccine has been recommended for use by pregnant women since 2004, current vaccination rates among pregnant women are lower than the general population and other high-risk groups. PROCESS A quality improvement project was undertaken during the 2019-to-2020 influenza season to increase the uptake of the influenza vaccine by women who were pregnant. The primary objective of the project was to increase the influenza vaccination rate compared with the rate in the previous season. The project had a secondary objective of standardizing documentation of the patient's vaccination status in the health record to capture data for performance measures. Interventions directed at patients, health care providers, and the health care system were simultaneously implemented as recommended by the Community Preventive Services Task Force. OUTCOMES Data were collected from 2967 records with 1480 from the 2018-to-2019 season and 1487 from the 2019-to-2020 season. Compared with records from the 2018-to-2019 season, the rate of those associated with a documented influenza vaccine was higher in the 2019-to-2020 season (63% vs 59%; P = .01). The rate of records without vaccination status codes was significantly less in the 2019-to-2020 season compared with the 2018-to-2019 season (14% vs 23%; P < .001). DISCUSSION Although interventions were effective in improving influenza vaccination uptake among pregnant women, vaccination rates still remain below the 80% goal set by the US Department of Health and Human Services. Bundled interventions have proven to be more effective than individual interventions, although which interventions are most effective remains unclear.
Journal of Gynecologic Surgery
Objective: The goal of this research was to examine how hospital type influences emergency depart... more Objective: The goal of this research was to examine how hospital type influences emergency department (ED) utilization within 30 days after benign gynecologic surgery. Materials and Methods: This was a pilot retrospective cohort study. Across 2 hospital settings-an academic medical center and a community-teaching hospital-adult women undergoing benign gynecologic surgery were placed randomly into 80 subject cohorts based on their 30-day postoperative ED utilization. The cohorts were defined as: (1) no ED visit; (2) low-yield ED visit (an ED visit with same-day discharge); and (3) high-yield ED visit (an ED visit with hospital admission). An analysis of risk factors for ED use according to hospital setting was performed. Results: Risk factors for ED use varied by hospital type. In the academic setting, Caucasian patients had fewer postoperative ED visits than patients of minority race/ethnicities, and insured patients had fewer postoperative ED visits than patients insured by Medicaid. In the academic setting, proximity to the hospital, performance of adhesiolysis, and prescription for an opiate were factors in frequency and types of ED visits. The need for catheterization was a factor in the type of ED visit only in the community-teaching setting, Conclusions: Hospital type influences use of emergency services following benign gynecologic surgery.
OBJECTIVE To determine if pelvic organ prolapse reduction decreases cystometric leak point pressu... more OBJECTIVE To determine if pelvic organ prolapse reduction decreases cystometric leak point pressure. STUDY DESIGN A retrospective review was performed of women with pelvic organ prolapse points Aa, Ba or C > or = -1 cm that leaked with and without vaginal support (barrier testing) during multichannel urodynamic investigation (N=44). An analysis of the mean and difference between leak point pressure (LPP) (vesicle pressure) with and without prolapse reduction was used to determine significance. RESULTS Among 460 possible study subjects, 15% (71/460) leaked only with and 4% (17/460) only without prolapse reduction. Among the 44 women who leaked both with and without prolapse reduction, prolapse reduction was associated with a mean decrease in LPP of 16.1 cm H2O (95% CI 7.4-24.7, p = 0.0005). CONCLUSION Reduction of pelvic organ prolapse is associated with a mean decrease in LPP of 16.1 cm H2O.
Urology Practice
AbstractIntroduction:We determined the rate of cystoscopy with hydrodistention (CH) before and af... more AbstractIntroduction:We determined the rate of cystoscopy with hydrodistention (CH) before and after the 2011 American Urological Association (AUA) amended clinical guideline, “Diagnosis and Treatm...
Obstetrics & Gynecology
Since a variety of procoagulant products, collectively called hemostatic agents, became available... more Since a variety of procoagulant products, collectively called hemostatic agents, became available to surgeons in the mid-20th century, their use has increased across multiple specialties, including gynecology. Congruent with past research on the causes of regional variation in the practice of medicine, available evidence suggests that a central predictor for use of these products is physician preference rather than documented clinical necessity. Use of these products adds risks and avoidable cost. This article seeks to highlight specific gynecologic circumstances in which evidence and surgical judgment supports hemostatic agent use and other settings in which use should be reconsidered.
Obstetrics & Gynecology
A 29-year-old multiparous patient is referred for chronic lower abdominal pain radiating into her... more A 29-year-old multiparous patient is referred for chronic lower abdominal pain radiating into her groin since undergoing cesarean delivery 2-years previously. Laboratory and radiographic evaluation results are negative. She asks you, "Please tell me, why am I having this pain?"
Clinical Obstetrics and Gynecology
Obstetrics & Gynecology
This month, we focus on current research in hysterectomy. Dr. Whiteside discusses four recent pub... more This month, we focus on current research in hysterectomy. Dr. Whiteside discusses four recent publications, and each is concluded with a "bottom line" that is the take-home message. The complete reference for each can be found in on this page, along with direct links to the abstracts.
American Journal of Obstetrics and Gynecology, 2016
Urogynecology and Reconstructive Pelvic Surgery, 2007
Seminars in Thrombosis and Hemostasis, 2010
Aprotinin has been used clinically to enhance hemostasis for decades and was approved in the Unit... more Aprotinin has been used clinically to enhance hemostasis for decades and was approved in the United States by the Food and Drug Administration in 1993 to reduce the transfusion requirement during coronary artery bypass surgery. Marketing of aprotinin ceased recently when observational studies and a randomized clinical trial reported increased cardiovascular toxicity in patients receiving this drug. The importance of prohemostatic therapy is reviewed in light of new information on long-term deleterious effects of blood transfusion, including increased risk of cardiovascular disease, malignancy, and infection possibly attributable to delivery of a load of red cell-derived redox-active iron. Weaknesses in design of clinical trials that failed to control adequately for such alternative mechanisms of toxicity complicate interpretation of risks versus benefits in clinical trials of aprotinin given to reduce transfusion requirement in the acute surgical setting. Properties and applications of aprotinin that may not have received sufficient attention in the decision to remove this drug from the therapeutic armamentarium are reviewed. Potential application of prohemostatic drugs, including aprotinin to special populations at risk for operative blood loss requiring transfusion, is illustrated by the description of nine patients with coagulopathies whose operative bleeding was managed effectively with aprotinin. This drug may remain safe and effective in patients at risk of bleeding with surgery. Beneficial effects of aprotinin seemingly unrelated to its prohemostatic properties, especially its apparent striking antineoplastic effects, warrant further study.
International Journal of Gynecology & Obstetrics, 2008
American Journal of Obstetrics and Gynecology
Journal of Pelvic Medicine and Surgery
Journal of Pelvic Medicine and Surgery
ABSTRACT Objective: The purpose of this study was to determine the incidence of and risk factors ... more ABSTRACT Objective: The purpose of this study was to determine the incidence of and risk factors for perioperative complications in elderly women who undergo urogynecologic surgery. Study design: A retrospective chart review of patients >= 75 years old who underwent urogynecologic surgery between January 1999 and December 2003 was performed. Demographics, comorbidities, and significant perioperative complications were recorded. The Charlson Comorbidity Index and American Society of Anesthesiologists classification were calculated to summarize the patients' overall perioperative risk. Logistic regression was used to identify independent risk factors for perioperative complications. Results: Two hundred sixty-seven patients who were >= 75 years old met the inclusion criteria; 25.8% of the patients had a significant perioperative complication. The most common perioperative complication was blood transfusion or significant blood loss, pulmonary edema, and postoperative congestive heart failure. Independent risk factors that were predictive of a patient having a perioperative complication were the length of surgery, coronary artery disease, and peripheral vascular disease. The Charlson Comorbidity Index and American Society of Anesthesiologists classification did not predict perioperative complications in this population. Conclusion: Pre-existing cardiovascular disease increases the risk of a significant perioperative complication in elderly women who undergo urogynecologic surgery. However, the overall perioperative morbidity rate in elderly women who undergo urogynecologic surgery is low. (c) 2005 Elsevier Inc. All rights reserved.