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Ob/Gyn & Women’s Health PerspectivesAn Update for Physicians From Cleveland Clinic’s Ob/Gyn & Women’s Health Institute

Winter 2013

Cleveland Clinic Performs One of the First Cases of Robotic Total Pelvic Exenterationp 4

Medical Students Bring Healthcare

to Remote Areas of Peru

p 8

Patient Receives Special

Delivery from Cleveland Clinic

p 6

Emerging Research Fosters Innovation in

Breast Cancer Care

p 3

84283_CCFBCH_ACG.indd 1 2/7/13 11:30 PM

Medical Editor Marjan Attaran, MD

Marketing Melissa Raines

Managing Editor Kimberley Sirk

Art Director Anne Drago

Cover Photo Steve Travarca

Photographers Russell Lee, Al Fuchs, Steve Travarca

Ob/Gyn & Women’s Health Perspectives is written for physicians and should be relied on for medical education purposes only. It does not provide a complete overview of the topics covered and should not replace the independent judgment of a physician about the appropriateness or risks of a procedure for a given patient.

© 2013 The Cleveland Clinic Foundation

CONTENTS

3 Innovation in Breast Cancer Care

4 Cleveland Clinic Performs One of the First Cases of Robotic Total Pelvic Exenteration

6 Patient Receives Special Delivery from Cleveland Clinic

7 Another New NAFC Center of Excellence

8 Medical Students Bring Healthcare to Remote Areas of Peru

9 Roy Pitkin Award Bestowed for Vaginal Prolapse Repair Study

10 Selected Publications

Dear Colleagues and Friends:

Welcome to this issue of Ob/Gyn & Women's Health Perspectives.

On behalf of everyone at the Ob/Gyn & Women’s Health Institute,

I am pleased to share the information in the following pages.

This issue begins with a cover story about one of the world’s first

robotic total pelvic exenteration procedures, which was performed at

Cleveland Clinic. We also offer several articles about multidisciplinary

partnerships — one international and one very local — that show the

depth and the breadth of the work we do to advance the practice of

obstetrics and gynecology.

Cleveland Clinic continues to be dedicated to producing and reporting

our quality outcomes in our annual, transparent process. I encourage

you to review our Outcomes book for 2011, which is available at

clevelandclinic.org/outcomes.

I hope you find this edition helpful in your practice. As always, our team

welcomes your comments and feedback and continues to value our

ongoing collaborations with you.

Sincerely,

Tommaso Falcone, MD

Professor & Chairman,

Department of Obstetrics and Gynecology

Chairman, Ob/Gyn & Women’s Health Institute


3clevelandclinic.org /obgyn | 800.553.5056

Innovation in Breast Cancer CareEmerging Research Focuses on Nanotechnology, While Disease-Specific Metrics Drive Quality

“We are researching new ways to not only image cancers but

treat them, by combining imaging with treatment,” says Dr.

Grobmyer, who joined Cleveland Clinic in September 2012

as Section Head, Surgical Oncology, in the Department of

General Surgery and as Director of the Breast Center. “We are

researching new materials that are safe for administration but

that have unique properties. We also are working to integrate

new methods for staging cancer.”

He brings to his new role a research program in cancer

nanotechnology, an interdisciplinary field that is focused on

engineering materials on a very small scale and specifically

designing them to both diagnose and treat cancers at their

earliest stages. This research includes collaboration with

material scientists, imaging researchers and experts in

biomedical engineering.

Dr. Grobmyer and colleagues also are working on applying

new technologies to improve the ability of radiologists and

surgeons to identify cancers in the breast. “It is critical that

we continue to improve our ability to detect cancers at their

earliest stages, as this gives patients the greatest chance for

cure,” he says. “There is a great clinical need for us to continue

to translate these technologies to the clinic.”

An Interdisciplinary Approach to Research and Patient Care

Interdisciplinary collaboration forms the basis of progressive,

quality care at a center of excellence such as Cleveland Clinic.

Dr. Grobmyer says that the best treatments are evolving, and

the way in which surgery, radiation and medical therapy are

used together has a major effect on overall care and outcomes.

“We need to work with our colleagues to accurately triage and

stage and design treatments,” he says, “so that every patient is

treated at the right time and in the absolute right way.”

Disease-Specific Metrics in Real Time

Quality metrics for the care of breast cancer patients are

extremely important, because they enable care providers and

support staff to continuously refine and provide optimal care,

Dr. Grobmyer says. Technology plays a pivotal role in tracking

that information in real time.

In his previous position, Dr.

Grobmyer helped develop an

AndroidTM-based health applica-

tion, or “app,” that tracked the

department’s performance

against national metrics, from

diagnosis to follow-up.

Likewise, Cleveland Clinic is

looking at new ways to mea-

sure many quality parameters

through the Epic® electronic

medical records system as well

as some other high-tech means.

When it comes to quality

metrics, breast cancer is more

disease-specific than global,

and Cleveland Clinic’s technology-based tracking mecha-

nisms will be built with that in mind. “Metrics such as length

of stay in the hospital and readmission rates don’t really

apply to breast cancer,” Dr. Grobmyer says. “We need disease-

specific metrics: for example, the percentage of patients with

early-stage cancer who receive breast-conserving surgery and

the number of patients diagnosed with needle biopsy instead

of surgical biopsy, since less invasive is better.”

Groups and programs such as the American Society of Breast

Surgeons and the American College of Surgeons’ National

Accreditation Program for Breast Centers establish breast

cancer-specific quality metrics that can serve as a barometer

of a program’s care, and institutions also should develop their

own complementary metrics, he says.

“There’s lots of traction across departments and within the

institute at Cleveland Clinic to measure and track quality,”

Dr. Grobmyer says. “Metrics help us understand where we

stand currently so that we can further optimize processes.” ◆

To contact Dr. Grobmyer, call 216.445.3569 or email him at [email protected].

While many factors contribute to the successful treatment of breast cancer, Stephen R. Grobmyer, MD, says that

one of the most important is the ability to conduct meaningful research that can be widely applied.


4 CLEVELAND CLINIC OB/GyN & WOMEN’S HEALTH PERSPECTIVES | WINTER 2013

removed. The patient’s bladder, rectum

and vagina were removed completely

as one en bloc specimen through the

vaginal orifice.

A portion of the distal ileum was used to

create an ileal conduit, and the ureters

were reimplanted to the ileal conduit.

The final step in the procedure was

formation of an end colostomy.

The surgery lasted about seven hours.

“A pelvic exenteration using an open pro-

cedure in an 80-year-old patient would

have been very risky considering her

age and the potential complications of

surgery,” says Dr. Kebria. “The published

rate of major complications is as high as

25 percent, and there is a 5 percent risk

of mortality from this surgery. With a

laparotomy, the incision is large, the risk

of complications is higher and the recov-

ery would be protracted because

of her age.”

Pelvic Exenteration Offers Advantages

Patients with recurrent gynecologic

malignancies after primary treatment

with surgery and radiation or radiation

alone have a poor response to chemother-

apy. Limited resection is difficult when

high doses of radiation have been used

for treatment of the original malignancy.

Pelvic exenteration is a major operation

during which the entire pelvic con-

tents — the bladder, uterus, vagina and

rectum — are removed and a conduit is

reconstructed using a portion of small or

large bowel to replace the bladder. This

procedure is employed with the goal of

curing women with central pelvic cancer

recurrence or a gynecologic malignancy

that remains after failure of initial

definitive therapy.

Case: Recurrent Endometrial Cancer

An 80-year-old woman presented with

a central recurrence of an endometrial

cancer that had been surgically resected

and then treated with radiation.

The patient underwent robotic total

intracorporeal pelvic exenteration with

the creation of an ileal conduit and

end colostomy. The pelvic exentera-

tion was performed using the da Vinci®

Surgical System.

An advantage of the robotic platform is

that it allows the surgeon to precisely

dissect the tissues down to the pelvic

floor, often with minimal blood loss.

Because the location of the cancer

recurrence involved the bladder, and

since the field was previously heavily

radiated, the entire bladder had to be

Cleveland Clinic Performs One of the First Cases of Robotic Total Pelvic Exenteration

Evolving operative techniques and

better patient selection have resulted

in improved clinical outcomes with

total pelvic exenteration, but morbid-

ity, mortality and recovery time are still

significant. Using a minimally invasive

approach with robotically controlled

instrumentation holds the potential for

minimizing blood loss, reducing mor-

bidity and hastening recovery.

The robotic platform offers superior

visualization of the surgical site and

improved precision with the use of

much smaller articulating instruments,

and it enhances dissection of previously

radiated tissue, which is often fibrotic.

In addition, the procedure can resolve

other related pelvic issues. For example,

in the case presented above, the patient

also had significant radiation proctitis

with daily rectal bleeding, both of which

were cured through this procedure.

Speedy Recovery, Minimal Blood Loss

The minimally invasive approach to

total pelvic exenteration speeds up the

recovery phase and reduces the risk of

infection, says Dr. Kebria. “The woman

was ambulatory in two days, and she

was started on a regular diet and was

able to tolerate her diet by postoperative

COvER STORy

Robotic surgery represents a milestone in the management of gynecologic cancers. Cleveland Clinic has taken this

milestone one step further with the successful performance of a robotic total intracorporeal pelvic exenteration in a

patient with recurrent uterine cancer. It is one of the first documented cases of robotic-assisted total pelvic exenteration

in the world. The surgery was conducted by Mehdi Kebria, MD, an associate staff member in the Department of

Obstetrics and Gynecology.



day two. I saw her at her postoperative

visit at four weeks after surgery, and she

was doing quite well,” he says.

Blood loss was also much less than

with an open procedure. In this patient,

blood loss was less than 100 mL, com-

pared with the liters of blood loss that

is typical with open procedures.

“I would certainly use the robotic

approach for my next exenteration; there

are clearly many benefits to the patients

without any compromises,” he says.

“Robotic surgery allows me to perform

very complex operations in a minimally

invasive fashion. The instruments are

tiny and can fit and function in any

small cavity, which is an important

advantage in any pelvic surgery.”

Cleveland Clinic also recently became

the first center to perform robotic single-

site hysterectomy through a 2.5-cm

incision at the umbilicus. So far, more

than 25 such procedures have been

performed at Cleveland Clinic. ◆

Dr. Kebria can be reached at 216.445.7069 or [email protected].

Benefits of a Robotic-Assisted Approach to Total Pelvic Exenteration

• An open total pelvic exenteration is

associated with significant morbidity,

mortality and recovery time and would

be risky in an older patient with a recur-

rent uterine malignancy.

• A robotic-assisted approach to total

pelvic exenteration reduces morbidity

and speeds recovery.

• Blood loss is significantly less with

a robotic-assisted approach.

• The robotic platform offers the surgeon

better visualization of the surgical site,

improved surgical precision with the use

of much smaller articulating instruments

and enhanced dissection of previously

radiated tissue.


CLEVELAND CLINIC OB/GyN & WOMEN’S HEALTH PERSPECTIVES | WINTER 20136

Pregnancy can be both a wonderful and challenging time for an expectant mother. But for some patients, the normal

physiologic changes can become life-threatening, and underlying the excitement is constant fear.

That is exactly the way one Cleveland Clinic patient would

explain her experience. Twenty-eight-year-old Tabitha

McClendon was born with congenital bicuspid aortic valve

stenosis. Although she was aware of her condition from an

early age, she says she never experienced any symptoms,

and it never really occurred to her that her “heart murmur”

would become a problem during pregnancy.

After an echocardiogram indicated she had aortic steno-

sis, McClendon was referred to Cleveland Clinic’s Richard

Krasuski, MD, Director of Adult Congenital Heart Disease

Services, and Amy Merlino, MD, who specializes in high-risk

maternal-fetal medicine. Along with the potential risks,

the patient and her medical team discussed whether

McClendon wanted to terminate the pregnancy, repair

her heart and try again for a family from a healthier place.

“I was pretty scared. I was of course concerned for myself, but

I was more concerned for my baby at that point,” she says.

“I was already 16 weeks pregnant; I had already fallen in love.”

Hoping for the best but preparing for the worst, McClendon

began to meet regularly with the specialists who would

become her caregivers, confidants and supporters over

the next six months.

A New Class of Patients

About 1 in 125 babies born in the United States comes into

the world with congenital heart disease, says Dr. Krasuski.

It’s the most common congenital defect.

“As recently as 30 years ago, most children with congenital

heart disease did not survive into adulthood. If they did, they

certainly weren’t healthy enough to bear children. However,

as medical technology and strategies for managing these

patients have advanced, we’re seeing more women with this

disease who want to become pregnant, and the complexity

of what we’re seeing is increasing,” he says.

Patient Receives Special Delivery from Cleveland Clinic

“Probably at least a third of our patients in the Special Delivery

Unit are there because the mom has congenital heart dis-

ease and they need the combined services we offer,” says

Dr. Merlino. She says that is one of the primary reasons the

Special Delivery Unit was created. It’s a collaboration that

brings together a multidisciplinary team of maternal-fetal

medicine specialists, neonatologists, geneticists and pediatric

surgery specialists, as well as other specialists as required by

the mother’s or baby’s condition.

And the collaboration between obstetrics and the cardiolo-

gists who have brought these patients to childbearing age, and

who understand how their hearts react to the physiologic and

physical changes in pregnancy, is fundamental to their care.

Special Delivery

McClendon was monitored closely by her medical team.

Unfortunately, her heart disease did progress over the course

of her pregnancy. By her third trimester, she says normal

daily activities became more challenging. She became easily

winded and experienced some chest pain and tightening and

light-headedness. An echocardiogram showed that her valve

narrowing progressed during the course of her pregnancy,

and her heart muscle was beginning to show the effects.

McClendon would require a valve replacement, but with care-

ful observation, the team was confident that the procedure

could wait until after the birth of the baby.

McClendon was scheduled to deliver via a cesarean section

because of the impact natural labor has on blood flow and

the heart. She was able to carry to term, and under carefully

planned and monitored general anesthesia, McClendon

and her husband welcomed a healthy girl into the world

on May 2, 2012.

Baby Olivia was monitored in the Special Delivery Unit while

McClendon was monitored in the Cardiac Intensive Care Unit.

“The hardest part of the whole thing was not being able to hear

my baby’s first cries,” McClendon says.



Another New NAFC Center of Excellence

Five months after having her baby, McClendon was back at

Cleveland Clinic receiving a tissue valve replacement via open

heart surgery, with the hope that she may eventually be able

to have another child. She’s now on the road to recovery.

“I’m feeling stronger every day,” she says. “I can finally change

a diaper.”

The Road Ahead

According to Drs. Krasuski and Merlino, the departments are

working to formalize their collaborative approach by insti-

tuting a cardio-obstetrics clinic specifically for patients like

McClendon. The goal would be to arrange for the doctors to

be available jointly once a month to streamline appointments

for their patients.

“In the past I think people were scared away from this,”

Dr. Krasuski says. “A lot of doctors told the female patient

with heart disease who wanted to have a child that it was just

too high risk, but the reality is that there’s a growing body

of literature demonstrating that this can be done safely

under the right circumstances.” ◆

For more information about the Special Delivery Unit, contact Dr. Merlino at 440.366.9444.

In May 2012, Female Pelvic Medicine and

Reconstructive Surgery at Cleveland Clinic

was designated a Center of Excellence

(COE): Continence Care for Women by the

National Association for Continence (NAFC).

This designation takes into account training,

clinical experience, interdisciplinary resources

and patient satisfaction statistics. Female Pelvic

Medicine and Reconstructive Surgery is part of

Cleveland Clinic’s Ob/Gyn & Women’s Health

Institute and the Department of Colorectal

Surgery in the Digestive Disease Institute.

“This joint recognition reflecting the collaborative

expertise of two separate institutes underscores

our commitment to interdisciplinary care for

women with urinary and fecal incontinence,”

says Tracy Hull, MD, of the Digestive Disease

Institute. “We believe that each patient deserves

to be cared for by a team of clinicians who work

collaboratively to help the patient participate

fully in the best treatment pathway for her.” ◆

To refer your patient to one of our specialists, please call 855.REFER.123 (855.733.3712).

2012 - 2015


8 CLEVELAND CLINIC OB/GyN & WOMEN’S HEALTH PERSPECTIVES | WINTER 2013

This past June, I had the privilege of accompanying medical students from Cleveland Clinic Lerner College of Medicine

and Case Western Reserve University School of Medicine for one week to Peru.

It was the fourth consecutive year

that students participated in the Peru

Health Outreach Project (PHOP), a

grassroots effort to improve the health

of the indigenous population of Peru’s

Sacred Valley. Founded and run by

medical students, PHOP is directed

by Sangeeta Krishna, MD, a Cleveland

Clinic pediatrician.

The trip was organized through the non-

profit Peruvian Hearts, in collaboration

with local authorities and medical offi-

cers, and supported by Lerner College of

Medicine, MedWish, fundraising events

and private donations.

Evaluations, Medications,

Vision Screening and More

The students had prepared for the trip

for an entire year — collecting medical

supplies and medications, organiz-

ing committees, developing teaching

materials, raising funds and learning

Spanish.

In Peru, approximately 3,300 patients

received care from our 60 volunteers,

including 20 medical students as well

as nurses, physical therapists, residents,

fellows and other medical staff from

Cleveland Clinic, University Hospitals

of Cleveland and MetroHealth Medical

Center. Our medical team included

specialists in internal medicine, pediat-

rics, ob/gyn, ophthalmology, infectious

diseases and emergency medicine.

The group traveled to remote villages,

orphanages, schools and homes for the

disabled. They evaluated and treated

many acute problems; distributed basic

medications, such as antibiotics, anal-

gesics and vitamins; performed vision

screening; and supplied glasses and

children’s shoes. When more serious

conditions were suspected or diagnosed,

patients were referred to the urban

center of Cusco, Peru, for more special-

ized care.

Some of the more sustainable interven-

tions included educational programs

on parasite prevention, dental hygiene,

back-strengthening exercises and

child resuscitation.

Medical Students Bring Healthcare to Remote Areas of PeruBy Uma Perni, MD

This year, for the first time, PHOP col-

laborated with the Peruvian American

Medical Society (PAMS), serving an addi-

tional 800 patients at the PAMS clinic

in the Chincha region of Peru.

Volunteers Lead Symposium

for Local Healthcare Workers

The highlight of the last week was a

two-day symposium organized by our

partnering local physician, Dr. Morales.

Healthcare workers from mountain

villages and physicians, medical

students and physical therapists

all the way from Cusco attended.

We covered a variety of topics as

requested, including obstetrics and


clevelandclinic.org /obgyn | 800.553.5056

Marie Fidela Paraiso, MD, Section

Head of Urogynecology and Pelvic

Floor Disorders at Cleveland Clinic,

received the 2011 Roy M. Pitkin

Award from The American College

of Obstetricians and Gynecologists.

The award honors departments of

obstetrics and gynecology for excel-

lence in research.

Dr. Paraiso won the award for her

article "Laparoscopic Compared

with Robotic Sacrocolpopexy for

Vaginal Prolapse: a Randomized

Controlled Trial," published in

Obstetrics & Gynecology (2011

Nov;118(5):1005-13).

The trial compared the outcomes

of patients with stage 2-4 posthys-

terectomy vaginal prolapse who were

treated with laparoscopic sacrocolpo-

pexy and those treated with robotic

sacrocolpopexy. Results showed

that the conventional laparoscopic

approach took significantly less

operating time, caused significantly

less pain and cost considerably

less than the robotic approach. The

two approaches resulted in equally

significant improvement in vaginal

support and functional activity one

year after surgery.

In recognition of her award,

Dr. Paraiso received a certificate

from The American College of

Obstetricians and Gynecologists

plus a $5,000 check for Cleveland

Clinic’s Department of Obstetrics

and Gynecology. ◆

For more information, contact Dr. Paraiso at [email protected].

Roy Pitkin Award Bestowed for vaginal Prolapse Repair Study

pediatrics. I gave several lectures on

obstetric emergencies, such as post-

partum hemorrhage and preeclampsia.

They were well-received and gener-

ated much discussion. Timing of cord

clamping and routine use of oxytocin to

prevent postpartum hemorrhage were

topics of interest for local physicians.

In addition, healthcare workers were

invited to practice their CPR skills on

mannequins the students had brought.

Efforts to Reduce Maternal Mortality

I was most impressed with the region’s

dedication to reducing maternal mor-

tality and providing quality prenatal

care. Maternal mortality rates in the

Sacred Valley region have significantly

decreased thanks to efforts to prevent

home births.

Because many villages are located in

remote areas of mountainous regions,

women cannot quickly be transported

to the local hospital in case of complica-

tions during labor and delivery.

To ensure women do not deliver at

home, local healthcare providers track

all pregnant women in the region

and ensure they are going to prenatal

visits. When women reach term, they

are transported to small homes called

“mama wasis” (“wasi” means “house”

in the local Quechua language) closer

to the local hospital until labor

ensues. This ensures women deliver

in a supervised healthcare setting.

More Opportunities in 2013

Overall, the trip allowed us all to learn

about culturally sensitive and sustain-

able care in resource-limited areas.

It also provided unique networking,

administrative and leadership oppor-

tunities for the medical students.

The group’s future goals include

focusing on sustainable interventions,

expanding outreach and conduct-

ing more research projects. The next

trip is being planned. I would highly

recommend the experience to anyone

interested. ◆

Dr. Perni practices in the Department of Obstetrics and Gynecology at Cleveland Clinic. For more information about the Peru Health Outreach Project, contact Dr. Krishna at [email protected].

9


10 Cleveland CliniC Ob/Gyn & WOmen’s HealtH PersPeCtives | Winter 2013

Journal Articles

Barber MD, Weidner AC, Sokol AI, Amundsen CL, Jelovsek JE, Karram MM, Ellerkmann M, Rardin CR, Iglesia CB, Toglia M. Single-incision mini-sling compared with tension-free vaginal tape for the treatment of stress urinary incontinence: a randomized controlled trial. Obstet Gyne-col. 2012 Feb;119(2 Pt 1):328-337.

Beck TL, Singhal PK, Ehrenberg HM, Rose PG, Lele SB, Krivak TC, McBee WC, Jr. Endometrial stromal sarcoma: Analysis of recurrence fol-lowing adjuvant treatment. Gynecol Oncol. 2012 Apr;125(1):141-144.

Cheng V, Faiman C, Kennedy L, Khoury F, Hatipoglu B, Weil R, Hamrahian A. Pregnancy and acromegaly: a review. Pituitary. 2012 Mar;15(1):59-63.

Desai N, Goldberg J, Austin C, Sabanegh E, Falcone T. Cryopreservation of individually selected sperm: methodology and case report of a clinical pregnancy. J Assist Reprod Genet. 2012 May;29(5):375-379.

Escobar PF, Frumovitz M, Soliman PT, Frasure HE, Fader AN, Schmeler KM, Ramirez PT. Comparison of single-port laparoscopy, standard lapa-roscopy, and robotic surgery in patients with endometrial cancer. Ann Surg Oncol. 2012 May;19(5):1583-1588.

Esteves SC, Zini A, Aziz N, Alvarez JG, Sabanegh ES, Jr., Agarwal A. Critical appraisal of World Health Organization’s new reference values for human semen characteristics and effect on diagnosis and treatment of subfertile men. Urology. 2012 Jan;79(1):16-22.

Fader AN, Seamon LG, Escobar PF, Frasure HE, Havrilesky LA, Zanotti KM, Secord AA, Boggess JF, Cohn DE, Fowler JM, Skafianos G, Rossi E, Gehrig PA. Minimally invasive surgery versus laparotomy in women with high grade endometrial cancer: A multi-site study performed at high volume cancer centers. Gynecol Oncol. 2012 Aug;126(2):180-185.

Gibson KS, Muffly TM, Penick E, Barber MD. Factors used by program directors to select obstetrics and gynecology fellows. Obstet Gynecol. 2012 Jan;119(1):119-124.

Human Microbiome Project Consortium. A framework for human microbiome research. Nature. 2012 Jun 14;486(7402):215-221.

Human Microbiome Project Consortium. Structure, function and diversity of the healthy human microbiome. Nature. 2012 Jun 14;486(7402):207-214.

Jeppson PC, Paraiso MFR, Jelovsek JE, Barber MD. Accuracy of the digital anal examination in women with fecal incontinence. Int Urogyne-col J. 2012 Jun;23(6):765-768.

Selected Publications From Cleveland Clinic’s Ob/Gyn & Women’s Health Institute

Moslemi-Kebria M, El-Nashar SA, Aletti GD, Cliby WA. Intraoperative hypothermia during cytoreductive surgery for ovarian cancer and periop-erative morbidity. Obstet Gynecol. 2012 Mar;119(3):590-596.

Muffly TM, Paraiso MFR, Gill AS, Barber MD, Rainey MC, Walters MD. Interventional radiologic treatment of pelvic hemorrhage after place-ment of mesh for reconstructive pelvic surgery. Obstet Gynecol. 2012 Feb;119(2 Pt 2):459-462.

Nager CW, Brubaker L, Litman HJ, Zyczynski HM, Varner RE, Amundsen C, Sirls LT, Norton PA, Arisco AM, Chai TC, Zimmern P, Barber MD, Dandreo KJ, Menefee SA, Kenton K, Lowder J, Richter HE, Khandwala S, Nygaard I, Kraus SR, Johnson HW, Lemack GE, Mihova M, Albo ME, Mueller E, Sutkin G, Wilson TS, Hsu y, Rozanski TA, Rickey LM, Rahn D, Tennstedt S, Kusek JW, Gormley EA. A randomized trial of urody-namic testing before stress-incontinence surgery. N Engl J Med. 2012 May 24;366(21):1987-1997.

Ridgeway B, Barber MD. Midurethral slings for stress urinary incon-tinence: a urogynecology perspective. Urol Clin North Am. 2012 Aug;39(3):289-297.

Rose PG, Sill MW, McMeekin DS, Ahmed A, Salani R, yamada SD, Wolfson AH, Fusco N, Fracasso PM. A phase I study of concurrent weekly topotecan and cisplatin chemotherapy with whole pelvic radia-tion therapy in locally advanced cervical cancer: A gynecologic oncology group study. Gynecol Oncol. 2012 Apr;125(1):158-162.

Simoens S, Dunselman G, Dirksen C, Hummelshoj L, Bokor A, Brandes I, Brodszky V, Canis M, Colombo GL, Deleire T, Falcone T, Graham B, Halis G, Horne A, Kanj O, Kjer JJ, Kristensen J, Lebovic D, Mueller M, Vigano P, Wullschleger M, D’Hooghe T. The burden of endometriosis: costs and quality of life of women with endometriosis and treated in referral centres. Hum Reprod. 2012 May;27(5):1292-1299.

Smith JS, Lewkowitz AK, Qiao yL, Ji J, Hu S, Chen W, Zhang R, Liaw KL, Esser M, Taddeo FJ, Pretorius RG, Belinson JL. Population-based human papillomavirus 16, 18, 6 and 11 DNA positivity and seropositiv-ity in Chinese women. Int J Cancer. 2012 Sep 15;131(6):1388-1395.

Tunitsky E, Abbott S, Barber MD. Interrater reliability of the International Continence Society and International Urogynecological Association (ICS/IUGA) classification system for mesh-related complications. Am J Obstet Gynecol. 2012 May;206(5):442-446.

Wheeler TL, II, Murphy M, Rogers RG, Gala R, Washington B, Bradley L, Uhlig K. Clinical practice guideline for abnormal uterine bleeding: hysterectomy versus alternative therapy. J Minim Invasive Gynecol. 2012 Jan;19(1):81-88.


11

Resources for Physicians

Referring Physician Center and HotlineCleveland Clinic’s Referring Physician Center has established a 24/7 hotline — 855.REFER.123 (855.733.3712) — to streamline access to our array of medical services. Contact the Referring Physician Hotline for information on our clinical special-ties and services, to schedule and confirm patient appointments, for assistance in resolving service-related issues, and to connect with Cleveland Clinic specialists.

Physician DirectoryView all Cleveland Clinic staff online at clevelandclinic.org/staff.

Track Your Patient’s Care OnlineDrConnect is a secure online service providing real-time informa-tion about the treatment your patient receives at Cleveland Clinic. Establish a DrConnect account at clevelandclinic.org/drconnect.

Critical Care Transport WorldwideCleveland Clinic’s critical care transport teams and fleet of vehicles are available to serve patients across the globe.

• To arrange for a critical care transfer, call 216.448.7000 or 866.547.1467 (see clevelandclinic.org/criticalcaretransport).

• For STEMI (ST elevated myocardial infarction), acute stroke, ICH (intracerebral hemorrhage), SAH (subarachnoid hemor-rhage) or aortic syndrome transfers, call 877.379.CODE (2633).

Outcomes DataView clinical Outcomes books from all Cleveland Clinic institutes at clevelandclinic.org/outcomes.

Clinical TrialsWe offer thousands of clinical trials for qualifying patients. Visit clevelandclinic.org/clinicaltrials.

CME Opportunities: Live and OnlineThe Cleveland Clinic Center for Continuing Education’s website offers convenient, complimentary learning opportunities. Visit ccfcme.org to learn more, and use Cleveland Clinic’s my CME portal (available on the site) to manage your CME credits.

Executive EducationCleveland Clinic has two education programs for healthcare executive leaders — the Executive Visitors’ Program and the two-week Samson Global Leadership Academy immersion program. Visit clevelandclinic.org/executiveeducation.

Stay Connected to Cleveland Clinic

24/7 Referrals

Referring Physician Hotline

855.REFER.123 (855.733.3712)

Hospital Transfers

800.553.5056

On the Web at

clevelandclinic.org/refer123

Stay Connected to Cleveland Clinic

Same-Day AppointmentsCleveland Clinic offers same-day appointments to help your patients get the care they need, right away. Have your patients call our same-day appointment line, 216.444.CARE (2273) or 800.223.CARE (2273).

About Cleveland Clinic

Cleveland Clinic is an integrated healthcare delivery system with local, national and international reach. At Cleveland Clinic, more than 2,800 physicians represent 120 medical specialties and subspecialties. We are a main campus, 18 family health centers, eight community hospitals, Cleveland Clinic Florida, the Cleveland Clinic Lou Ruvo Center for Brain Health in Las Vegas, Cleveland Clinic Canada, Sheikh Khalifa Medical City, and Cleve-land Clinic Abu Dhabi.

In 2012, Cleveland Clinic was ranked one of America’s top 4 hospitals in U.S. News & World Report’s annual “America’s Best Hospitals” survey. The survey ranks Cleveland Clinic among the nation’s top 10 hospitals in 14 specialty areas, and the top hospital in three of those areas.


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CLEVELAND CLINIC OB/GyN & WOMEN’S HEALTH PERSPECTIVES | WINTER 2013 clevelandclinic.org /obgyn

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Cleveland Clinic's Ob/Gyn & Women's Health Institute is ranked as the No. 3 program in the country by U.S. News and World Report.

The 2012 “America's Best Hospitals” survey recognized Cleveland Clinic as one of the nation's best overall, rank-ing the hospital as No. 4 in the country. Cleveland Clinic ranked in all 16 specialties evaluated by the magazine.

For details, visit clevelandclinic.org.


ob/gyn & women’s health perspectives - cleveland clinic...welcome to this issue of ob/gyn...

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