Publications by authors named "Amanda P Stanton"

4 Publications

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Impact of Legislation on Opioid Prescribing following Hysterectomy and Hysteroscopy in Arizona and Florida.

Gynecol Obstet Invest 2021 Oct 12:1-9. Epub 2021 Oct 12.

Division of Gynecologic Surgery, Mayo Clinic, Jacksonville, Florida, USA.

Objectives: This study aimed to determine the oral morphine equivalents (OMEs) prescribed and refill rates following hysterectomy and hysteroscopy in the setting of opioid prescribing practice changes in 2 states.

Design: This is a retrospective cohort analysis consisting of 2,916 patients undergoing hysterectomy or hysteroscopy between July 2016 and September 2019 at 2 affiliated academic hospitals in states that underwent legislative changes in opioid prescribing in 2018.

Methods: Participants were identified using the Current Procedural Terminology procedure codes in Arizona and Florida. Hysterectomy was chosen as the most invasive gynecologic procedure, while hysteroscopy was chosen as the least invasive. Medical records were abstracted to find opioid prescriptions from 90 days before surgery to 30 days after discharge. Patients with opioid use between 90 and 7 days before surgery were excluded. Prescriptions were converted to OMEs and were calculated per quarter year. Statistical analysis included Wilcoxon rank sum t tests for OMEs and χ2 t tests for refill rates. Interrupted time-series analysis was used to determine significant change in OMEs before and after legislative change. Statistical analysis was performed using SAS version 9.4 (SAS Institute, Cary, NC, USA).

Results: In Arizona, 1,067 hysterectomies were performed; 459 (43%) vaginal, 561 (52.6%) laparoscopic/robotic, and 47 (4.4%) abdominal. There were 530 hysteroscopies. Overall median OMEs decreased from 225 prior to July 2018 to 75 after July 2018 (p < 0.0001). The opioid refill rate remained unchanged at 7.4% (p = 0.966). In Florida, there were 769 hysterectomies; 241 (31.3%) vaginal, 476 (61.9%) laparoscopic/robotic, and 52 (6.8%) abdominal. There were 549 hysteroscopies. Overall median OMEs decreased from 150 prior to July 2018 to 0 after July 2018 (p < 0.0001). The opioid refill rate was similar (7.8% before July 2018 and 7.3% after July 2018; p = 0.739).

Limitations: Limitations include involvement of a single hospital institution with a total of 10 fellowship-trained surgeons and biases inherent to retrospective study design.

Conclusions: Legislative and provider-led changes coincided with decreases in opioid prescribing after 2018 in both states without increasing rates of refills and showed actual data reflected in the medical record. Gynecologists must actively participate in safe prescribing practices to decrease opioid dependence and misuse.
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http://dx.doi.org/10.1159/000519517DOI Listing
October 2021

An enlarging vulvar mass.

Authors:
Amanda P Stanton

JAAPA 2021 Sep;34(9):56-57

Amanda P. Stanton practices in the Department of Medical and Surgical Gynecology at Mayo Clinic in Jacksonville, Fla., and is an instructor of obstetrics and gynecology at Mayo Clinic College of Medicine and Science. The author has disclosed no potential conflicts of interest, financial or otherwise.

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http://dx.doi.org/10.1097/01.JAA.0000769708.52059.e9DOI Listing
September 2021

New options for managing fecal incontinence in women.

JAAPA 2020 Aug;33(8):50-52

Amanda P. Stanton practices in the Department of Medical and Surgical Gynecology at Mayo Clinic in Jacksonville, Fla., and is an instructor of obstetrics and gynecology at Mayo Clinic College of Medicine and Science. Anita H. Chen is a consultant at Mayo Clinic in Florida and an assistant professor of obstetrics and gynecology at Mayo Clinic College of Medicine and Science. The authors have disclosed no potential conflicts of interest, financial or otherwise.

Fecal incontinence often is underreported and can be associated with both social embarrassment and isolation. As patients often do not proactively discuss their symptoms, healthcare providers should screen for this distressing condition. The cause of fecal incontinence often is multifactorial, so no single therapy can guarantee perfect, risk-free outcomes. This article reviews the limited therapies for managing fecal incontinence, including a minimally invasive vaginal control device that may offer hope for managing fecal incontinence in women.
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http://dx.doi.org/10.1097/01.JAA.0000684168.68881.61DOI Listing
August 2020

What is the role of dehydroepiandrosterone in gynecologic practice?

JAAPA 2019 Dec;32(12):11-12

Shilpa N. Gajarawala is a lead PA in the Department of Medical and Surgical Gynecology at the Mayo Clinic in Jacksonville, Fla., an instructor of obstetrics and gynecology in the Mayo Clinic College of Medicine and Science, and adjunct faculty for the Doctor of Medical Science program at Rocky Mountain University of Health Science in Provo, Utah. Tiffany A. Wood is a clinical assistant in the Department of Medical and Surgical Gynecology at the Mayo Clinic. Amanda P. Stanton practices in the Department of Medical and Surgical Gynecology at Mayo Clinic and is an instructor of obstetrics and gynecology at the Mayo Clinic College of Medicine and Science. The authors have disclosed no potential conflicts of interest, financial or otherwise.

In small clinical trials, dehydroepiandrosterone (DHEA) has been found to relieve symptoms associated with postmenopausal conditions and infertility in women. DHEA may provide a cost-effective alternative to typical hormone therapies. Because of a lack of long-term and large-scale studies, only intravaginal DHEA supplementation is approved and recommended for treatment. Further investigation of DHEA supplementation is needed and encouraged to determine its safety and effectiveness.
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http://dx.doi.org/10.1097/01.JAA.0000604888.50734.64DOI Listing
December 2019
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