Marguerite Duane - Academia.edu (original) (raw)

Papers by Marguerite Duane

PubMed, Jul 1, 2007

... Ohio State University College of Medicine, Columbus, Ohio. RICH SISSON. Georgetown University... more ... Ohio State University College of Medicine, Columbus, Ohio. RICH SISSON. Georgetown University School of Medicine, Washington, DC. ... Author disclosure: Nothing to disclose. REFERENCES. 1. McGaha AL, Garrett E, Jobe AC, Nalin P, Newton WP, Pugno PA, et al. ...

Frontiers in Medicine, May 24, 2022

Background: Fertility awareness-based methods (FABMs) educate about reproductive health and enabl... more Background: Fertility awareness-based methods (FABMs) educate about reproductive health and enable tracking and interpretation of physical signs, such as cervical fluid secretions and basal body temperature, which reflect the hormonal changes women experience on a cyclical basis during the years of ovarian activity. Some methods measure relevant hormone levels directly. Most FABMs allow women to identify ovulation and track this "vital sign" of the menstrual or female reproductive cycle, through daily observations recorded on cycle charts (paper or electronic). Applications: Physicians can use the information from FABM charts to guide the diagnosis and management of medical conditions and to support or restore healthy function of the reproductive and endocrine systems, using a restorative reproductive medical (RRM) approach. FABMs can also be used by couples to achieve or avoid pregnancy and may be most effective when taught by a trained instructor. Challenges: Information about individual FABMs is rarely provided in medical education. Outdated information is widespread both in training programs and in the public sphere. Obtaining accurate information about FABMs is further complicated by the numerous period tracking or fertility apps available, because very few of these apps have evidence to support their effectiveness for identifying the fertile window, for achieving or preventing pregnancy. Conclusions: This article provides an overview of different types of FABMs with a published evidence base, apps and resources for learning and using FABMs, the role FABMs can play in medical evaluation and management, and the effectiveness of FABMs for family planning, both to achieve or to avoid pregnancy.

Journal of the American Board of Family Medicine, 2014

The Future of Family Medicine (FFM) project has helped shape and direct the evolution of primary ... more The Future of Family Medicine (FFM) project has helped shape and direct the evolution of primary care medicine over the past decade. Pisacano Scholars, a group of leaders in family medicine supported by the American Board of Family Medicine, gathered for a 2-day symposium in April 2013 to explore the history of the FFM project and outline a vision for the next phase of this work-FFM version 2.0 (v2.0). After learning about the original FFM project (FFM v1.0), the group held interactive discussions using the World Café approach to conversational leadership. This commentary summarizes the discussions and highlights major themes relevant to FFM v2.0 identified by the group. The group endorsed the FFM v1.0 recommendations as still relevant and marveled at the progress made toward achieving many of those goals. Most elements of FFM v1.0 have moved forward, and some have been incorporated into policy blueprints for reform. Now is the time to refocus attention on facets of FFM v1.0 not yet realized and to identify key aspects missing from FFM v1.0. The Pisacano Scholars are committed to moving the FFM goals forward and hope that this expression of the group's vision will help to do so. (J Am Board Fam Med 2014;27:142-150.

PubMed, Jun 1, 2002

Background: Family practice residency programs are based largely on a model implemented more than... more Background: Family practice residency programs are based largely on a model implemented more than 30 years ago. Substantial changes in medical practice, technology, and knowledge necessitate reassessment of how family physicians are prepared for practice. Methods: We simultaneously surveyed samples of family practice residency directors, first-year residents, and family physicians due for their first board recertification examination to determine, using both quantitative and qualitative methods, their opinions about the length and content of family practice residencies in the United States. Results: Twenty-seven percent of residency directors, 32% of residents, and 28% of family physicians favored extending family practice residency to 4 years; very few favored 2- or 5-year programs. There was dispersion of opinions about possible changes within each group and among the three groups. Most in all three groups would be willing to extend residency for more training in office-based procedures and sports medicine, but many were unwilling to extend residency for more training in surgery or hospital-based care. Residents expressed more willingness than program directors or family physicians to change training. Barriers to change included disagreement about the need to change; program financing and opportunity costs, such as loss of income and delay in debt repayment; and potential negative impact on student recruitment. Conclusion: Most respondents support the current 3-year model of training. There is considerable interest in changing both the length and content of family practice training. Lack of consensus suggests that a period of elective experimentation might be needed to assure family physicians are prepared to meet the needs and expectations of their patients.

Clinical Pediatrics, Nov 1, 2000

An 8-year-old male with a history of asthma presented to our Emergency Department (ED) with an el... more An 8-year-old male with a history of asthma presented to our Emergency Department (ED) with an elevated heart rate, tremors, and diaphoresis following home treatment with nebulized albuterol. The patient had been receiving nebulized albuterol treatments at home every 4 hours for the previous 3 days for exacerbation of asthma. On the day of presentation, after his morning albuterol treatment, the patient started shaking uncontrollably and had rapid pulsations in his neck. At his pediatrician's office, his temperature was 102.70F and his heart rate 255 beats per minute. Vagal maneuvers failed to convert his tachycardia to normal sinus rhythm. The patient was then sent to the ED, where a 12lead EKG (Figure IA) demon-

AMA journal of ethics, Jun 1, 2005

Family medicine training is still largely based on a model developed more than 35 years ago, with... more Family medicine training is still largely based on a model developed more than 35 years ago, with 3 years of required rotations in multiple areas of medicine, combined with a longitudinal clinic experience in model family practice centers [1, 2]. The physician trained in this model has been prepared to practice in a range of settings and with diverse scopes of practice. The outcome is a physician workforce that is distributed across urban and rural America with important positive effects for the health of communities [3, 4]. The durability and beneficial outcomes of this training model suggest that it should continue, but there are several reasons to consider innovative changes in its character if not its duration:

PEC Innovation, Dec 1, 2023

PubMed, 2022

Background and objectives: Knowledge and competency in the topics of reproductive health and fami... more Background and objectives: Knowledge and competency in the topics of reproductive health and family planning are important for primary care physicians. Given the high rates of unintended pregnancy, increasing rates of infertility and other gynecologic conditions, it is important for medical students, many of whom will become primary care physicians, to receive good foundational knowledge of reproductive health topics. The objective of this research project was to investigate the current curricula at US medical schools to determine the breadth and extent of education that medical students receive in reproductive health. Methods: Medical students and faculty at 20 US medical schools shared all relevant materials from their required reproductive health curriculum used between 2016-2019, including syllabi, PowerPoint lectures, and official class handouts that were available to all students. From these, the number of mentions of 69 reproductive health-related terms were counted, including those related to family planning methods, abortion, ectopic pregnancy, reproductive counseling, and infertility. Results: Of the over 9000 mentions of reproductive health terms, approximately half of mentions were related to family planning, with 10% related to abortion, 10% to infertility, and 6% to reproductive counseling. Family planning strategies emphasized oral contraceptives and long-acting reversible contraceptives with limited mentions of natural or fertility awareness-based methods. Conclusions: This data demonstrates opportunities for broadening reproductive health education in medical school so that future primary care physicians are prepared to discuss the full range of reproductive options for their patients.

Contraception, Nov 1, 2022

Objective: The Natural Cycles app employs daily basal body temperature to define the fertile wind... more Objective: The Natural Cycles app employs daily basal body temperature to define the fertile window via
a proprietary algorithm and is clinically established effective in preventing pregnancy. We sought to (1)
compare the app-defined fertile window of Natural Cycles to that of CycleProGo, an app that uses BBT
and cervical mucus to define the fertile window and (2) compare the app-defined fertile windows to the
estimated physiologic fertile window.
Study Design: Daily BBT were entered into Natural Cycles from 20 randomly selected regularly cy-
cling women with at least 12 complete cycles from the CycleProGo database. The proportion of cycles
with equivalent (±1 cycle day) fertile-window starts and fertile-window ends was determined. The app-
defined fertile windows were then compared to the estimated physiologic fertile window using Peak
mucus to estimate ovulation.
Results: Fifty seven percent of cycles (136/238) had equivalent fertile-window starts and 36% (72/181)
had equivalent fertile-window end days. The mean overall fertile-window length from Natural Cycles was
12.8 days compared to 15.1 days for CycleProGo (p < 0.001). The Natural Cycles algorithm declared 12%
to 30% of cycles with a fertile-window start and 13% to 38% of cycles with a fertile-window end within
the estimated physiologic fertile window. The CycleProGo algorithm declared 4% to 14% of cycles with
a fertile-window start and no cycles with a fertile-window end within the estimated physiologic fertile
window.
Conclusions: Natural Cycles designated a higher proportion of cycles days as infertile within the estimated
physiologic fertile window than CycleProGo.
Implications: Use of cervical mucus in addition to BBT may improve the accuracy of identifying the fertile
window. Additional studies with other markers of ovulation and the fertile windo

Journal of the American Board of Family Medicine, Mar 1, 2010

The Linacre Quarterly, Nov 1, 2018

Background: Hormonal contraception (HC) is widely used throughout the world and has been associat... more Background: Hormonal contraception (HC) is widely used throughout the world and has been associated with venous thrombosis (VT) such as deep vein thrombosis, pulmonary emboli, and cerebral VT. Objectives: To provide a current comprehensive overview of the risk of objectively confirmed VT with HC in healthy women compared to nonusers. Search methods: PubMed was searched from inception to April 2018 for eligible studies in the English language, with hand searching from past systematic reviews. Selection criteria: We selected original research evaluating risk of objectively confirmed VT in healthy women taking oral or nonoral HC compared with nonusers. Data collection: The primary outcome of interest was a fatal or nonfatal VT in users of HC compared to nonusers or past users. Studies with at least twenty events were eligible. Adjusted relative risks with 95 percent confidence intervals were reported. Three independent reviewers extracted data from selected studies. Results: 1,962 publications were retrieved through the search strategy, with 15 publications included. Users of oral contraception with levonorgesterol had increased risk of VT by a range of 2.79-4.07, while other oral hormonal preparations increased risk by 4.0-48.6. Levonorgestrel intrauterine devices did not increase risk. Etonogestrel/ethinyl estradiol vaginal rings increased the risk of VT by 6.5. Norelgestromin/ethinyl estradiol patches increased risk of VT by 7.9. Etonogestrel subcutaneous implants by 1.4 and depot-medroxyprogesterone by 3.6. The risk of fatal VT was increased in women aged fifteen to twenty-four by 18.8-fold. Conclusion: Users of HC have a significant increased risk of VT compared to nonusers. Current risks would project at least 300-400 healthy young women dying yearly in the United States due to HC. Women should be informed of these risks and offered education in fertility-awareness-based methods with comparable efficacy for family planning. Summary: HC is widely used throughout the world and has been associated with blood clots in the legs and lungs. We searched the literature and found the risks of currently used forms of birth control increased between three-and ninefold for blood clots for healthy women. The risks found would project 300-400 women dying from using HC each year in the United States.

BMC Pregnancy and Childbirth, Dec 9, 2022

Background: Miscarriage is defined as spontaneous loss of pregnancy prior to 20 weeks gestation. ... more Background: Miscarriage is defined as spontaneous loss of pregnancy prior to 20 weeks gestation. With an estimated risk of 15% of clinically confirmed pregnancies ending in miscarriage, it is the most common adverse event in pregnancy. Woman's age is the primary risk factor for miscarriage, while medical conditions, including hormonal abnormalities, are also associated. Progesterone is essential for maintaining pregnancy. A short luteal phase may reflect inadequate levels of progesterone production, but it is unclear whether a short luteal phase correlates with an increase in the risk of miscarriage. Methods: Using a cohort study design, we conducted a secondary data analysis from four cohorts of couples who used a standardized protocol to track biomarkers of the female cycles. A short luteal phase was defined as less than 10 days, with < 11, < 9, and < 8 days as alternate definitions in sensitivity analyses. We included women who experienced a pregnancy with a known outcome, identified the length of the luteal phase in up to 3 cycles prior to conception and assessed the relationship with miscarriage using a modified Poisson regression analysis, adjusting for demographic characteristics, smoking, alcohol use and previous pregnancy history. Results: In our sample of 252 women; the overall miscarriage rate was 18.7%. The adjusted incident risk ratio of miscarriage in women who had at least one short luteal phase < 10 days, compared to those who had none, was 1.01 (95% CI: 0.57, 1.80) Similar null risk was found when assessing alternative lengths of short luteal phase. Women who had short luteal phases < 10 days in all 3 cycles prior to the conception cycle had an incident risk ratio of 2.14 (95% CI: 0.7, 6.55). Conclusions: Our study found that a short luteal phase in the three cycles prior to conception was not associated with higher rates of miscarriage in an international cohort of women tracking their cycles, but our sample size was limited. Further research to determine if short luteal phases or luteal phase deficiency is associated with early pregnancy losses among preconception cohorts with daily tracking of cycle parameters, in addition to progesterone and human chorionic gonadotropin levels, is warranted. Additionally, future studies should include women with recurrent short luteal phases as a more likely risk factor than isolated short luteal phases.

American Family Physician, Aug 1, 2007

Issues in Law & Medicine, 2022