Phaedra Thomas
Boston Children's Hospital
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Featured researches published by Phaedra Thomas.
Journal of Pediatric and Adolescent Gynecology | 2008
Peter M. Wayne; Catherine E. Kerr; Rosa N. Schnyer; Anna T. R. Legedza; Jacqueline Savetsky-German; Monica Shields; Julie E. Buring; Roger B. Davis; Lisa Conboy; Ellen Silver Highfield; Barbara Parton; Phaedra Thomas; Marc R. Laufer
STUDY OBJECTIVE To assess feasibility, and collect preliminary data for a subsequent randomized, sham-controlled trial to evaluate Japanese-style acupuncture for reducing chronic pelvic pain and improving health-related quality of life (HRQOL) in adolescents with endometriosis. DESIGN Randomized, sham-controlled trial. SETTINGS Tertiary-referral hospital. PARTICIPANTS Eighteen young women (13-22y) with laparoscopically-diagnosed endometriosis-related chronic pelvic pain. INTERVENTIONS A Japanese style of acupuncture and a sham acupuncture control. Sixteen treatments were administered over 8 weeks. MAIN OUTCOME MEASURES Protocol feasibility, recruitment numbers, pain not associated with menses or intercourse, and multiple HRQOL instruments including Endometriosis Health Profile, Pediatric Quality of Life, Perceived Stress, and Activity Limitation. RESULTS Fourteen participants (out of 18 randomized) completed the study per protocol. Participants in the active acupuncture group (n = 9) experienced an average 4.8 (SD = 2.4) point reduction on a 11 point scale (62%) in pain after 4 weeks, which differed significantly from the control groups (n = 5) average reduction of 1.4 (SD = 2.1) points (P = 0.004). Reduction in pain in the active group persisted through a 6-month assessment; however, after 4 weeks, differences between the active and control group decreased and were not statistically significant. All HRQOL measures indicated greater improvements in the active acupuncture group compared to the control; however, the majority of these trends were not statistically significant. No serious adverse events were reported. CONCLUSION Preliminary estimates indicate that Japanese-style acupuncture may be an effective, safe, and well-tolerated adjunct therapy for endometriosis-related pelvic pain in adolescents. A more definitive trial evaluating Japanese-style acupuncture in this population is both feasible and warranted.
The Journal of Urology | 2009
Patricio C. Gargollo; Glenn M. Cannon; David A. Diamond; Phaedra Thomas; Vicki Burke; Marc R. Laufer
PURPOSE In women with vaginal agenesis progressive perineal dilation provides a minimally invasive method to create a functional vagina without the attendant risks or complications of traditional surgical options. We report our 12-year experience with this technique. MATERIALS AND METHODS Patients with vaginal agenesis treated at our institution were analyzed retrospectively and followed prospectively using case report forms and semistructured interviews. Patients diagnosed with vaginal agenesis were counseled on vaginal reconstruction options. Those electing progressive perineal dilation were instructed on the proper use of vaginal dilators by one of us (MRL) and advised to dilate 2 or 3 times daily for 20 minutes. All patients received physician, nursing and social work education and counseling. Parameters reviewed included primary diagnosis, start and end of vaginal dilation, dilation frequency, dilator size, sexual activity and whether the patient experienced pain or bleeding with dilation or sexual activity. Functional success was defined as the ability to achieve sexual intercourse, vaginal acceptance of the largest dilator without discomfort or a vaginal length of 7 cm. Univariate and multivariate analysis was performed to identify factors associated with successful neovaginal creation. RESULTS From 1996 to 2008 we enrolled 69 females with vaginal agenesis in a progressive perineal dilation program. The primary diagnosis was Mayer-Rokitansky-Küster-Hauser syndrome in 64 patients. Mean age at the start of vaginal dilation was 17.5 years (range 14 to 35) Mean followup was 19 months (range 0 to 100). Four patients (5.7%) were lost to followup. In 7 of the remaining 65 patients (12%) treatment failed due to noncompliance and 50 (88%) achieved functional success at a median of 18.7 months. Patients who dilated frequently (once daily or greater) achieved a functional neovagina at a mean +/- SD of 4.3 +/- 2.4 months. Functional success correlated positively with frequent (once daily or greater) dilation and the initiation of sexual activity. Complications were minor. Three patients reported infrequent pain and 2 reported a single episode of bleeding with dilation. A total of 18 sexually active patients reported satisfactory intercourse without dyspareunia. CONCLUSIONS Progressive perineal dilation for neovaginal creation is a valuable, minimally invasive therapy to create a functional vagina with a high success rate and a much lower complication rate than that in published surgical series. Given these findings, progressive perineal dilation should be offered as first line therapy in adolescents with a congenitally absent vagina.
Obstetrics & Gynecology | 1995
Andrew J. Friedman; Phaedra Thomas
Objective To assess whether low-dose oral contraceptive (OC) use affects uterine size or menstrual flow in women with leiomyomas. Methods Eighty-seven premenopausal women with leiomyomas were enrolled in a 1-year study. Fifty-five women took low-dose monophasic OCs, and 32 took no OCs or other hormonally active medications. Uterine size was assessed by bimanual and sonographic examinations before and after the study. Duration of menstrual flow and hematocrit were also assessed. Results Fifty (91%) of 55 women completed 1 year of OC use. There was no significant difference in mean uterine size determined by bimanual examination or in uterine volume measured by sonography after 12 months of OC use. Likewise, there were no significant changes in these indices among the 32 women who did not take OCs. The mean duration of menstrual flow decreased significantly, from 5.8 to 4.4 days ( P P =.014), in this group. In contrast, the women who did not take OCs had no significant changes in these indices. Conclusion In most women with leiomyomas, low-dose OC use provides the noncontraceptive benefit of a reduction in the duration of menstrual flow, with resultant improvement in hematocrit, without increasing uterine size.
Fertility and Sterility | 1992
Mark D. Hornstein; Phaedra Thomas; Ray E. Gleason; Robert L. Barbieri
OBJECTIVE To examine the serum levels of CA-125 in the menstrual, follicular, and luteal phases of the menstrual cycle in women with endometriosis and to determine if serum CA-125 levels drawn during menses improve the clinical utility of the test in diagnosing endometriosis. DESIGN Serum CA-125 was measured in the menstrual, follicular, and luteal phases of the cycle preceding surgery. CA-125 levels for each phase were categorized by postoperative diagnosis and endometriosis stage. SETTING The reproductive endocrine unit of a tertiary care university-affiliated hospital. PATIENTS A total of 65 patients were recruited from the Fertility and Endocrine Unit and the Gynecology Service of Brigham and Womens Hospital. MAIN OUTCOME MEASURE Serum CA-125 levels were measured by an immunoradiometric assay and were stratified by menstrual cycle phase, diagnosis, and stage of endometriosis. The menstrual cycle phase was confirmed by serum estradiol and progesterone measurements. RESULTS Serum CA-125 levels in patients with stages II to IV endometriosis were significantly elevated in the menstrual phase compared with levels drawn in the nonmenstrual follicular and luteal phases. The sensitivity and specificity of CA-125 for the diagnosis of endometriosis were not significantly better in the menstrual than in the follicular or luteal phases. CONCLUSIONS Despite menstrual cyclicity of CA-125, measurement of serum CA-125 during menses does not improve the clinical utility of the test in the diagnosis of endometriosis.
Human Reproduction | 1996
Mitchell S. Rein; Katharine V. Jackson; David Sable; Phaedra Thomas; Mark D. Hornstein
The purpose of the present study was to determine whether adrenal androgen suppression with dexamethasone (DEX) during ovulation induction improves the outcome of in-vitro fertilization (IVF) cycles. A total of 25 patients with serum dehydroepiandrosterone sulphate (DHEAS) concentrations > 2.5 micrograms/ml were randomized to receive either 0.5 mg DEX daily or placebo during ovulation induction with leuprolide acetate down-regulation plus human menopausal gonadotrophins (HMG). Nine patients undergoing a subsequent IVF cycle were crossed over to the other treatment group. Ovarian responsiveness and IVF outcome variables analysed included number of follicles > 12 mm in diameter, serum oestradiol concentrations on the day of human chorionic gonadotrophin (HCG) administration, number of ampoules of HMG administered, number of oocytes retrieved, percentage of oocytes fertilized, number of embryos transferred, implantation rate and numbers of clinical pregnancies and live birth pregnancies. The 31 randomized IVF cycles revealed a trend towards a higher implantation rate for the placebo-treated group compared to the DEX-treated group (24 versus 10%; P = 0.07). The remainder of the IVF cycle variables revealed no statistically significant differences. In conclusion, the suppression of adrenal androgens with DEX in women with DHEAS concentrations > 2.5 micrograms/ml appears to have no beneficial effects on ovarian responsiveness or clinical or live birth pregnancy rates.
Fertility and Sterility | 1992
Mark D. Hornstein; Jane N. Cohen; Phaedra Thomas; Ray E. Gleason; Andrew J. Friedman; George L. Mutter
This study demonstrates a statistically significant decrease in semen volume, sperm concentration, and sperm motility in samples obtained on the 2nd day of consecutive day inseminations in an IUI program. This diminution in semen characteristics persists despite sperm washing. The effects of a second ejaculation on semen parameters in oligospermic and asthenospermic men were mixed. Thus, in general, sperm-washing procedures cannot overcome the natural reduction in semen quality produced by frequent ejaculations. Clinicians may wish to use this information in timing IUI cycle inseminations.
Gynecologic and Obstetric Investigation | 1996
Mark D. Hornstein; Howard M. Goodman; Phaedra Thomas; Robert C. Knapp; Bernard L. Harlow
OBJECTIVE To determine the correlation between the widely used CA125 assay and a second-generation assay, CA125 II, in a large population of women to determine the utility of measuring CA125 levels in the diagnosis of benign gynecologic disease. METHODS A total of 822 patients who presented to a gynecology clinic completed a medical questionnaire and underwent a physical examination. Blood samples were obtained to determine serum CA125 levels. Hospital charts were reviewed, and diagnoses were correlated with serum CA125 levels as measured by the CA125 and CA125 II assays. RESULTS CA125 and CA125 II assay values were highly correlated within four subject categories: age, ethnicity, smoking history, and menstrual category. Mean values decreased with increasing age but were unchanged across ethnic groups and cigarette-smoking status. When means were compared for results of the second-generation and current assays, little difference was found in the age, ethnicity, and smoking categories. Mean serum CA125 values on the CA125 II assay exceeded those on the CA125 assay when obtained during the menstrual and follicular/luteal phases of the menstrual cycle, but they did not differ in anovulatory, pregnant, and menopausal women or in those patients taking hormonal medications. CA125 levels were elevated on both assays in women with fibroids and were higher on the CA125 II assay than on the CA125 assay in women with benign ovarian cysts. CONCLUSIONS Serum CA125 levels obtained using the CA125 II assay are closely correlated with those obtained using the more familiar CA125 assay. In the diagnosis of benign gynecologic disease, the usefulness of a single serum level measured with the newer CA125 II assay was the same as that of a single CA125 assay level.
The Patient: Patient-Centered Outcomes Research | 2018
Traci M. Kazmerski; Elizabeth Miller; Gregory S. Sawicki; Phaedra Thomas; Olga Prushinskaya; Eliza Nelson; Kelsey Hill; Anna Miller; S. Jean Emans
PurposeStakeholder engagement, specifically integration of patient and family perspectives about what matters, is increasingly recognized as a critical component of patient-centered healthcare delivery. This study describes a structured approach to and evaluation of stakeholder engagement in the development of novel sexual and reproductive health (SRH) educational resources for adolescent and young adult (AYA) women with cystic fibrosis (CF).MethodsKey stakeholders participated in a systematic series of steps to iteratively develop and adapt patient educational resources. Process measures (stakeholder recruitment, composition, co-learning, and transparency) and proximal outcomes of stakeholder involvement (impact on the development process and satisfaction) were measured via recorded stakeholder recommendations and a stakeholder survey.ResultsSeventeen stakeholders participated in seven group and two patient-only conference calls. The majority of stakeholders understood their roles, had their expectations met or exceeded, and were satisfied with the frequency and quality of engagement in the project. All stakeholders in attendance provided multiple concrete recommen-dations during the development process. Stakeholders explored the motivations of AYA women with CF related to SRH and agreed that the ideal resource should be online. After reviewing the design of existing resources, stakeholders decided by consensus to partner with a pre-existing young women’s health website and created 11 CF-specific SRH guides.ConclusionsThis study illuminates a path for a formal process of stakeholder engagement and evaluation in educational resource development centered on the SRH care needs of AYA women with CF. Similar systematic, planned processes could be extended to other populations and aspects of healthcare.
Journal of Pediatric and Adolescent Gynecology | 2012
Phaedra Thomas; Amanda Kohn; Francie Mandel; Vicki Burke; Shaunna King; Marc R. Laufer
There was no clitoromegaly and the remaining genital structures were normal. Translabial ultrasound identified an anechoic labial cyst with thin septations measuring 8.7 X 3.5 X 4.8cm. MRI confirmed these sonographic findings. Percutaneous drainage was performed with a 4 French centesis needle using ultrasound guidance (see figure 2). Following a fluoroscopic contrast study and aspiration of the contrast, doxycycline sclerotherapy was performed using 30cc of concentrated doxycycline (20 mg/cc). The sclerosant was aspirated after 20 minutes of dwell time. Subsequent delayed labioplasty was performed with excellent cosmetic results (see figure 3,4). Comment: Doxycycline functions as an inhibitor of angiogenesis by interfering with cell proliferation and migration via inhibition of matrix metalloproteinase and suppression of vascular endothelial growth factor induced angiogensis and lymphangiogenisis. It causes a fibrocytic cellular reaction with deposition of fibrin and collagen resulting in cystic regression. While surgical treatment remains the standard of care, sclerotherapy may provide a less invasive approach to treatment of large lymphatic malformations of the labia. This case suggests that doxycycline percutaneous sclerotherapy is a safe and effective treatment for labial lymphatic malformations.
Journal of Pediatric and Adolescent Gynecology | 1996
Phaedra Thomas; Paula H. Higgins; Donna H. Wolfe; Marc R. Laufer
Background Endometriosis is a chronic disease that can cause severe pelvic pain in adolescents. We sought to develop a support network to educate adolescents, their families, schools, and peers. In addition, we aimed to develop a network to assist adolescents coping with this chronic disease, that could then be adapted for use by other local and national chapters of the Endometriosis Association (EA). Methods Patients were informally surveyed by their health care provider to inquire if they thought that they would benefit from an “Endometriosis Teen Support Group”; if they answered affirmatively they were asked if they would like to be contacted by the Boston Chapter of the EA. The EA was contacted with the names of those patients who were interested. A support group for adolescents was established with in the EA which provided information to patients, parents, health care providers, and schools by supplying periodic newsletters, literature, and book lists. In addition members of the EA contacted the adolescents by telephone to periodically offer advice for coping with specific endometriosis problems that arose, and for effective communication with doctors, teachers, or parents. Monthly Sunday afternoon meetings were established addressing subjects of interest to the adolescent with endometriosis and her parents. After one year of existence the EA contacted the adolescent members by telephone to assess their perspective of the support group in order to improve services. Results 30 adolescents with endometriosis were identified who desired contact by the EA. The mean age at the time of referral was 17 years (range: 14–21). The mean number of months of association with the EA was 7 (range: 1–12). The adolescents selected “TEEN: Teen Endometriosis Education Network” as the name for the support group. They reported that the “best” day for meetings was Sunday, and preferred that the meeting be held at a hospital (70%) as compared to a school (30%). They preferred that the meetings occur monthly as opposed to bi-monthly. 100% wanted to receive a newsletter. 900% wanted to be contacted by other adolescents by phone at the time of their diagnosis. 900% wanted to be a contact person for newly diagnosed individuals with endometriosis. 60% wanted to have a designated “big sister” with endometriosis. 60% of the young women wanted information about endometriosis distributed to schools: 90% of those in high school, 20% of those in college. 100% stated that they found the TEEN to be helpful. Conclusions Adolescents with endometriosis feel that they benefit from an age specific support system. We present “TEEN - Teen Endometriosis Education Network” as a model for other chapters of the EA to establish proven support and education for adolescents, their families, and schools.