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Although the mistreatment of medical students is a well-researched topic, the scope of mistreatment often leaves out neglect, a subtype for which there is no accepted definition based in the published literature. This review sought to summarize the existing data on the prevalence and descriptors of neglect, identify strategies seen in the literature designed to improve it, and offer a synthesized definition of this phenomenon to guide future research. Following PRISMA guidelines, a relevant systematic literature search from 2000 to April 2021 was performed to identify literature on neglect in clinical settings within American medical schools. Neglect, a poorly defined phenomenon in medical education related to the suboptimal learning environment, is often excluded from research on medical student mistreatment. Neglect is a barrier to a successful learning environment, yet a paucity of data and the heterogeneous nature of the present literature render it difficult to estimate its true prevalence. Studies that include neglect frequently assess it solely as the result of identity discrimination or stated career interests. Recent interventions include promoting longitudinal relationships between students and clinical faculty and establishing teaching expectations. Neglect is the mistreatment of medical students by the medical care team via a lack of meaningful inclusion in the clinical environment such that it has a notable negative impact on learning and student well-being, regardless of intentionality. An established definition that is grounded in the literature is required to create a common point of reference and understand its true prevalence, its associated variables, and the best mitigation strategies, as well as to guide future research, which should examine neglect independently and as a consequence of personal and professional identities.

Specific aim: The aim of this study is to systematically review the literature, including randomized clinical trials and observational comparative studies, and identify studies comparing preventive measurements for UTI after gynecologic surgery. We plan to conduct meta-analyses to compare interventions that can reduce UTI. Evidence profiles from the reviewed studies will be utilized to develop clinical practice guideline statements in relation to reduce postoperative UTI after gynecologic surgery. Searches: We searched MEDLINE, EMBASE and Cochrane Center Register for Controlled Trials from inception to January 1, 2015 and in this update we will update the search through June 30, 2020. Search terms included terms related to “gynecologic surgery” and those related to “urinary tract infection”. The search will be limited to comparative studies, cohort studies, and systematic reviews. The search will be further limited to human and English-language studies. Meeting abstracts were excluded. Systematic reviews were utilized to identify further studies from their reference list. Population: The population of interest is women undergoing gynecologic surgical intervention of interest. Interventions include specific gynecologic surgery procedures that are defined a priori including all aspects of gynecologic benign and cancer surgery and reconstructive pelvic surgery Intervention(s): Interventions were sub-grouped based on their type e.g. antibiotic use, bladder drainage type, and other interventions Comparator(s): Comparators include standard treatment or to other intervention will be included in the review Study Types : We will only include comparative studies including randomized clinical trials and cohort studies. Comparators to standard treatment or to other intervention were included in the review. Non-comparative studies were excluded. The population of interest is women undergoing gynecologic surgery, including all benign and cancer procedures, and reconstructive pelvic surgeries. Interventions for UTI prevention include sub-grouped based on type: antibiotic use, bladder drainage strategies, and other interventions. Comparators include standard practice of the time (including no intervention), placebo, and other active agents (e.g., alternative antibiotics). Outcomes: Outcomes of interest include the overall incidence of postoperative UTI and this including incidence of UTI per procedure group and in each subgroup with specific intervention to prevent or treat UTI. Measures of Effect: Odds ratios and risk differences are the main estimates. Number needed to treat will be utilized for interpretation of the results and communication of the conclusions Additional outcomes: Secondary outcomes include side effects of antibiotics and rates of urinary retention and other outcomes that help with determining the risk benefit balance for the final evidence based guidance Measures of Effect: Odds ratios and risk difference Data Extraction: This is a systematic review regarding prevention measures and treatment approaches for UTI after gynecologic surgery. It will be conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) will be utilized to assess the certainty of evidence and strength of guideline recommendations. The population of interest is women undergoing gynecologic surgery, including all benign and cancer procedures, and reconstructive pelvic surgeries. Interventions for UTI prevention will be sub-grouped based on type: antibiotic use, bladder drainage strategies, and other interventions. Comparators include standard practice of the time (including no intervention), placebo, and other active agents (e.g., alternative antibiotics). The outcome of interest was postoperative UTI. The review will be limited to comparative studies of different surgical procedures, whether randomized or not. Systematic Search Strategy: We will update the search of the MEDLINE, EMBASE and the Cochrane Center Register for Controlled Trials from inception through June 30, 2020. The searches will include terms related to “gynecologic surgery” and “urinary tract infection”. The search will be limited to human and English-language studies. Meeting abstracts will be excluded. Other systematic reviews will be utilized to identify further studies from their reference lists. Citations will be screened in duplicate after initial pilot rounds. Potentially relevant articles will be re-screened in full text, again in duplicate. During both phases, disagreements will be adjudicated by a third reviewer. Accepted studies will be extracted into a standardized form to capture data about study design, baseline participant characteristics, and outcomes of interest including rate of UTI in each study group (surgery) and in each reported subgroup. Data will be extracted by one reviewer and reviewed and confirmed by a second. Disagreements will be reconciled with a third reviewer. Risk of Bias: Quality analysis of the included studies were planned according to the type of the included study. Funnel plot of the OR of the primary endpoint in each study plotted against the standard error of log OR will be used for graphical evaluation of publication bias. Strategy for data synthesis: For binary outcomes, the number of events or the odds ratio (OR) will be recorded for each study. For binary outcomes, including the primary outcome, random effects meta-analyses will be performed using the DerSimonian and Laird method to estimate the pooled OR, and pooled risk difference and its 95% confidence interval (95% CI). A p value of 0.05 will be used as a cut point for rejection of the null hypothesis of study homogeneity to limit type II errors. All meta-analyses will be performed using the RevMan software (The Cochrane Collaboration, Oxford, UK). Analysis of subgroups or subsets: Subgroup analyses was planned a priori to identify potential explanations for heterogeneity across studies. We hypothesized that for a given binary outcome, the OR might vary depending on intervention, study design (RCTs vs. cohort studies), different outcomes, different sampling strategies, and potential confounding of the primary outcome. In these cases we will conduct a statistical test of interaction to evaluate the extent to which subgroup results differed. A P value of 0.05 is selected as cut off for interaction testing. Sensitivity analyses were to explore sources of heterogeneity.

Ovarian cancer is the most aggressive gynecologic cancer and is associated with lower survivor compared to other gynecologic malignancies. Hyperthermic Intraperitoneal Chemotherapy (HIPEC) has been offered as an added therapy which can in selected patients improve outcomes. Gap of the literature and specific aims: Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is part of the treatments offered to patients with pelvic primary or recurrent tumors here in Mayo Clinic Florida. There is contradictory evidence from few studies on the effectiveness of the treatment and the longer term follow-up. Currently there are many active trials both nationally and internationally that is designed to address those questions; however, the results will take years and we thought the clinical experience here at Mayo Clinic in Florida can provide reliable data which can add clinical management and help us deliver the best care to our patients. Our specific aims of this project are to: 1- Evaluate the overall and progression free survival in patients who had Hyperthermic Intraperitoneal Chemotherapy compared to those who did not. 2- To evaluate the efficacy of different combinations of HIPEC