NASPAG 28th Annual Clinical Research Meeting, Issues and Answers in
Pediatric and Adolescent Gynecology, April 24-26, 2014, Philadelphia, PA
Oral Abstracts
1. Why Didnt You Text me a Reminder? Post-Study Trends From the
Depotext Trial
Cara Buchanan BA, Kathy Tomaszewski RN, BSN, Shang-en Chung MS,
Maria Trent MD, MPH*
Johns Hopkins School of Medicine, Baltimore, Maryland
Background: Implementing and maintaining new technology into clinical
practice is an ongoing challenge in the era of Meaningful Use guidance by the
federal government. Preliminary data from the DepoText Intervention sug-
gests that adherence to family planning appointments is improved by the
connection created through text messaging support. Little data quanties the
impact of shortterm pilot interventions on longer-term outcomes. The
objective of this study is to evaluate longitudinal post-intervention outcomes
of the DepoText intervention to better understand how short-term techno-
logical interventions may inuence patient care.
Methods: One hundred female adolescents aged 13-21 years were
enrolled starting in January 2011 from an urban academic clinical practice
for this IRB approved randomized feasibility and acceptability trial. All
participants completed a web-based survey. Adolescents in the interven-
tion arm received text messaging reminders and support using the
Compliance for Life (CFL)TM texting platform. Eighty-seven of original
participants completed all 3-injection cycles of the original DepoText Trial.
The CFL intervention was sold towards the end of the pilot period resulting
in discontinuation of texting services for clinic patients. For this analysis,
additional data was collected on the sixty-eight patients who were still
using Depo-Provera during cycle 4 to determine their contraceptive
practices from the end of the study to present (October 2013). Published
failure rates for typical use of contraceptive methods were used to
categorize ongoing methods. Data were evaluated using multivariate
regression analyses.
Results: The majority of participants was African American and had a
form a of health insurance coverage. Over time, positive effects for on-
schedule injections gained by cycle 2 were attenuated. In the post-study
longitudinal follow-up, 73.1% of participants were still on Depo-Provera or
a method more efcacious (lower failure rate) compared with only 55.6%
of control participants. Despite this trend in improved contraceptive
practice, this did not meet statistical signicance in multivariate regression
analyses due to sample size.
Conclusions: While longitudinal follow-up of DepoText demonstrates a
trend towards improved contraceptive choice, gains in adherence to
scheduled appointments were attenuated overtime. Additional research
using larger samples to assess the impact of integrating texting into
Meaningful Use clinical activities is warranted.
2. The Utility of Ultrasonography in the Diagnosis of Polycystic
Ovarian Syndrome (PCOS) in Adolescents
Michal Youngster MD, Valerie L. Ward MD, MPH, Emily A. Blood PhD,
Carol E. Barnewolt MD, S. Jean Emans MD*, Amy D. Divasta MD, MMSc
Division of Adolescent/Young Adult Medicine, Department of Medicine,
Division of Gynecology, and Department of Radiology, Boston Childrens
Hospital, Departments of Pediatrics and Radiology, Harvard Medical
School, Boston, Massachusetts
Background: Diagnosing PCOS during adolescence can be challenging.
Although included in the Rotterdam criteria (RC), the utility of ovarian
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http://dx.doi.org/10.1016/j.jpag.2014.01.009
morphology for the diagnosis of PCOS has been questioned due to the
difculties associated with Trans-abdominal ultrasonography (TAUS) in
this generally obese population. Furthermore, current literature suggests
that polycystic ovaries (PCO) are found in up to 40% of the general
adolescent population. It has thus been suggested that US should not be a
diagnostic criteria in adolescents or, alternatively, that all three RC should
be fullled to diagnose PCOS. The purpose of our study was to determine
the prevalence of PCO in the general non-PCOS population compared to
adolescents with known PCOS, and to evaluate the diagnostic utility of US
in adolescents.
Methods: A random sample of adolescents with PCOS (n68; age 152y) as
determined by the 1990 NIH criteria (ovulatory dysfunction plus clinical/
biochemical evidence of hyperandrogenism) who were evaluated at a large
childrens hospital between 2006-2008 was selected for review of initial
TAUS. A control group (n158; age 142y) included patients who presented
to the emergency department between 2005-2012 with abdominal/pelvic
pain, underwent TAUS, and were diagnosed with appendicitis during surgical
procedure. Potential control subjects were excluded if they were pre-
menarchal or had previously known ovarian pathology, hormonal or meta-
bolic disturbances, irregular menses, and/or use of medications affecting
ovarian morphology. TAUS images of both groups were reviewed indepen-
dently by a pediatric radiologist and a gynecologist. US images were assessed
using the RC for PCO (ovarian volume >10cc or >11 follicles 2-9 mm). The
study was approved by the local IRB.
Results: Thirteen patients with PCOS were excluded from analyses due to
nondiagnostic quality imaging (n3), follicle size >10mm (n9), or both
(n1). Of the 55 remaining cases, 34 met the RC for PCO (62%); among these,
12 (35%) diagnosed by number of follicles, 7 (21%) by volume and 15 (44%)
by both. Ten controls were similarly excluded for nondiagnostic quality
imaging, 46 for follicle size > 10mm, and 4 for both. Of the remaining 98
controls, 7 met criteria for PCO (7%); 3 by volume criteria alone and 4 by
volume and number of follicles. Patients in the PCOS group were much more
likely to meet the RC for PCO than controls (p< 0.0001). Mean weight in the
PCOS group (79 19.8 kg) was higher than in the controls (56.6  11.7 kg,
p<0.001). 91% and 94% of images in the case and control group respectively
were of adequate quality (p0.45). There were no signicant associations
between PCO and age or weight in either group.
Conclusions: The prevalence of ovarian morphology meeting RC on TAUS
in girls with PCOS by NIH criteria was 62%, markedly higher than in ado-
lescents serving as controls (7%). Thus, the prevalence of PCO may be lower
in a non-gynecologic adolescent population than previously reported. Our
results suggest that TAUS is an effective tool to evaluate ovarian
morphology in the adolescent population, and provides evidence for the
utility of US in the evaluation of PCOS.
3. Assessing the Reliability and Factor Structure of the Menorrhagia
Assessment Tool: A First Step Toward Clinical Use
Ian Kudel PhD, Serena Chan MD, Masatoshi Ashiki MS, Anjali Basu MS,
Leslie Ayensu-Coker MD, Lesley Breech MD
Cincinnati Childrens Hospital Medical Center, Cincinnati, OH
Background: Menorrhagia is difcult to diagnose because the provider
only has one tool - the clinical interview. In this study, we sought to
determine whether the Menorrhagia Assessment Tool (MAT), a question-
naire composed of symptom-specic items consistent with the condition,
could be used to facilitate this process. Specically, we sought to determine
the factor structure (for scoring) and reliability.