Maya Kavita Ramachandran

All Publications

• Addressing cancer survivorship needs in geriatric survivors: Feasibility of a primary care-based survivorship clinic. Ramachandran, M., Steele, N., Kim, J., Schapira, L., Yurkiewicz, I. LIPPINCOTT WILLIAMS & WILKINS. 2024

  View details for Web of Science ID 001275557403539

• Feasibility and impact of a mental health chatbot on postpartum mental health: a randomized controlled trial. AJOG global reports Suharwardy, S., Ramachandran, M., Leonard, S. A., Gunaseelan, A., Lyell, D. J., Darcy, A., Robinson, A., Judy, A. 2023; 3 (3): 100165

  Abstract

  BACKGROUND: Perinatal mood disorders are common yet underdiagnosed and un- or undertreated. Barriers exist to accessing perinatal mental health services, including limited availability, time, and cost. Automated conversational agents (chatbots) can deliver evidence-based cognitive behavioral therapy content through text message-based conversations and reduce depression and anxiety symptoms in select populations. Such digital mental health technologies are poised to overcome barriers to mental health care access but need to be evaluated for efficacy, as well as for preliminary feasibility and acceptability among perinatal populations.OBJECTIVE: To evaluate the acceptability and preliminary efficacy of a mental health chatbot for mood management in a general postpartum population.STUDY DESIGN: An unblinded randomized controlled trial was conducted at a tertiary academic center. English-speaking postpartum women aged 18 years or above with a live birth and access to a smartphone were eligible for enrollment prior to discharge from delivery hospitalization. Baseline surveys were administered to all participants prior to randomization to a mental health chatbot intervention or to usual care only. The intervention group downloaded the mental health chatbot smartphone application with perinatal-specific content, in addition to continuing usual care. Usual care consisted of routine postpartum follow up and mental health care as dictated by the patient's obstetric provider. Surveys were administered during delivery hospitalization (baseline) and at 2-, 4-, and 6-weeks postpartum to assess depression and anxiety symptoms. The primary outcome was a change in depression symptoms at 6-weeks as measured using two depression screening tools: Patient Health Questionnaire-9 and Edinburgh Postnatal Depression Scale. Secondary outcomes included anxiety symptoms measured using Generalized Anxiety Disorder-7, and satisfaction and acceptability using validated scales. Based on a prior study, we estimated a sample size of 130 would have sufficient (80%) power to detect a moderate effect size (d=.4) in between group difference on the Patient Health Questionnaire-9.RESULTS: A total of 192 women were randomized equally 1:1 to the chatbot or usual care; of these, 152 women completed the 6-week survey (n=68 chatbot, n=84 usual care) and were included in the final analysis. Mean baseline mental health assessment scores were below positive screening thresholds. At 6-weeks, there was a greater decrease in Patient Health Questionnaire-9 scores among the chatbot group compared to the usual care group (mean decrease=1.32, standard deviation=3.4 vs mean decrease=0.13, standard deviation=3.01, respectively). 6-week mean Edinburgh Postnatal Depression Scale and Generalized Anxiety Disorder-7 scores did not differ between groups and were similar to baseline. 91% (n=62) of the chatbot users were satisfied or highly satisfied with the chatbot, and 74% (n=50) of the intervention group reported use of the chatbot at least once in 2 weeks prior to the 6-week survey. 80% of study participants reported being comfortable with the use of a mobile smartphone application for mood management.CONCLUSION: Use of a chatbot was acceptable to women in the early postpartum period. The sample did not screen positive for depression at baseline and thus the potential of the chatbot to reduce depressive symptoms in this population was limited. This study was conducted in a general obstetric population. Future studies of longer duration in high-risk postpartum populations who screen positive for depression are needed to further understand the utility and efficacy of such digital therapeutics for that population.

  View details for DOI 10.1016/j.xagr.2023.100165

  View details for PubMedID 37560011

• Inequity in care delivery in cardio-oncology: dissecting disparities in underrepresented populations. Frontiers in oncology Patel, S. R., Suero-Abreu, G. A., Ai, A., Ramachandran, M. K., Meza, K., Florez, N. 2023; 13: 1124447

  Abstract

  It is well known that patients with cancer have a significantly higher cardiovascular mortality risk than the general population. Cardio-oncology has emerged to focus on these issues including risk reduction, detection, monitoring, and treatment of cardiovascular disease or complications in patients with cancer. The rapid advances in early detection and drug development in oncology, along with socioeconomic differences, racial inequities, lack of support, and barriers to accessing quality medical care, have created disparities in various marginalized populations. In this review, we will discuss the factors contributing to disparities in cardio-oncologic care in distinct populations, including Hispanic/Latinx, Black, Asian and Pacific Islander, indigenous populations, sex and gender minorities, and immigrants. Some factors that contribute to differences in outcomes in cardio-oncology include the prevalence of cancer screening rates, genetic cardiac/oncologic risk factors, cultural stressors, tobacco exposure rates, and physical inactivity. We will also discuss the barriers to cardio-oncologic care in these communities from the racial and socioeconomic context. Appropriate and timely cardiovascular and cancer care in minority groups is a critical component in addressing these disparities, and there need to be urgent efforts to address this widening gap.

  View details for DOI 10.3389/fonc.2023.1124447

  View details for PubMedID 37361603

• The impact of estradiol on pregnancy outcomes in letrozole-stimulated frozen embryo transfer cycles. F&S reports Zhang, W. Y., Gardner, R. M., Kapphahn, K. I., Ramachandran, M. K., Murugappan, G., Aghajanova, L., Lathi, R. B. 2021; 2 (3): 320-326

  Abstract

  Objective: To assess the impact of low estradiol (E2) levels in letrozole-stimulated frozen embryo transfer (FET) cycles on pregnancy and neonatal outcomes.Design: Retrospective cohort.Setting: University-affiliated fertility center.Patients: All patients who underwent letrozole-stimulated FET cycles from January 2017 to April 2020 (n = 217). The "Low E2" group was defined as those with E2 serum levels on the day of trigger <10th percentile level (E2 <91.16 pg/mL, n = 22) and the "Normal E2" group was defined as those with E2 serum levels ≥10th percentile level (E2 ≥91.16 pg/mL, n = 195).Interventions: None.Main Outcome Measures: Pregnancy outcomes including rates of clinical pregnancy, clinical miscarriage, and live birth. Neonatal outcomes including gestational age at delivery, birth weight, and Apgar score.Results: The mean ± SD estradiol level was 66.8 ± 14.8 pg/mL for the "Low E2" group compared with 366.3 ± 322.1 pg/mL for the "Normal E2" group. There were otherwise no substantial differences in cycle characteristics such as endometrial thickness on the day of ovulation trigger and progesterone levels in early pregnancy. The "Low E2" group had a significantly higher clinical miscarriage rate (36.4% vs. 8.8%, adjusted odds ratio 8.06) and lower live birth rate (31.8% vs. 57.9%, adjusted odds ratio 0.28). Neonatal outcomes such as gestational age at delivery, mean birth weight, Apgar scores, and incidence of newborn complications were not clinically different between the groups.Conclusion: Low E2 levels were associated with a significantly higher miscarriage rate and lower live birth rate, suggesting that E2 levels in the follicular phase may have an effect on cycle outcomes. Given the rise in use of FET, further studies are needed to confirm our findings and understand the mechanisms.

  View details for DOI 10.1016/j.xfre.2021.05.007

  View details for PubMedID 34553158

• ASSOCIATION BETWEEN ESTRADIOL LEVELS AND OBSTETRIC OUTCOMES IN LETROZOLE-STIMULATED FROZEN EMBRYO TRANSFER CYCLES. Zhang, W. Y., Ramachandran, M. K., Murugappan, G., Aghajanova, L., Lathi, R. ELSEVIER SCIENCE INC. 2020: E304

  View details for Web of Science ID 000579355301012

• Acceptability of postnatal mood management through a smartphone-based automated conversational agent Ramachandran, M., Suharwardy, S., Leonard, S. A., Gunaseelan, A., Robinson, A., Darcy, A., Lyell, D. J., Judy, A. MOSBY-ELSEVIER. 2020: S62

  View details for DOI 10.1016/j.ajog.2019.11.090

  View details for Web of Science ID 000504997300075

• Effect of an automated conversational agent on postpartum mental health: A randomized, controlled trial Suharwardy, S., Ramachandran, M., Leonard, S. A., Gunaseelan, A., Robinson, A., Darcy, A., Lyell, D. J., Judy, A. MOSBY-ELSEVIER. 2020: S91

  View details for DOI 10.1016/j.ajog.2019.11.132

  View details for Web of Science ID 000504997300116