Board Certification: American Board of Obstetrics and Gynecology, Obstetrics and Gynecology (2021)
Residency: Stanford University Obstetrics and Gynecology Residency (2019) CA
Medical Education: University of California at San Francisco School of Medicine (2015) CA
MD, University of California, San Francisco (2015)
MBA, Duke University - Fuqua School of Business (2014)
BA, University of California, Berkeley, Political Economy of Industrial Societies & Public Health (2007)
Measurement of Marginal Placental Cord Insertion by Prenatal Ultrasound Was Found Not to Be Predictive of Adverse Perinatal Outcomes
View details for DOI 10.1002/jum.15586
INCIDENCE OF PELVIC FLOOR DISORDERS IN US ARMY FEMALE SOLDIERS.
To determine the incidence of pelvic floor disorders (PFD) among active-duty US Army female soldiers.We studied 102,015 women for incident PFD using the Stanford Military Data Repository, which comprises medical, demographic and service-related information on all soldiers on active duty in the US Army during 2011-14. Cox proportional hazards estimated adjusted associations with PFD diagnoses. In the adjusted models, military-specific characteristics and fitness were evaluated alongside known PFD predictors.Among 102,015 subjects at risk there was a cumulative incidence of 6.4% over a mean of 27 months (median 29, range 1-42). In adjusted models, obese soldiers were more likely to have a PFD compared to those of normal weight (HR 1.23, CI 1.14-1.34, p<0.001) and those with recent weight gain were more likely to have a PFD compared to those without (HR 1.32, CI 1.24-1.40, p<0.05). Women with the lowest physical fitness scores were more likely to have a PFD (HR 1.14, CI 1.04-1.25) compared to those with the highest scores.Over a median follow-up time of 29 months, 1 in 15 women in this active-duty cohort was diagnosed with a PFD. Optimizing risk factors including BMI and physical fitness may benefit the pelvic health of female soldiers, independent of age, children, and years of service.
View details for DOI 10.1016/j.urology.2020.05.085
View details for PubMedID 32650018
Outcomes of Sacral Nerve Stimulation for Treatment of Refractory Overactive Bladder Among Octogenarians.
Neuromodulation : journal of the International Neuromodulation Society
OBJECTIVE: Sacral nerve stimulation (SNS) is an effective treatment for refractory overactive bladder (OAB). However, advanced age is often cited as a reason to avoid SNS in the elderly. This study evaluates the safety and efficacy of SNS for refractory OAB among our octogenarian population.METHODS: A retrospective review from a single institution was performed on all SNS lead placements from December 1998 to June 2017 for refractory OAB. Octogenarians were characterized as 80years of age or older at the time of Stage I. Efficacy and safety were determined by the rate of progression to Stage II, subsequent need for multimodal therapy, and rate of surgical revision and explantation. All patients were followed for a minimum of 12months.RESULTS: Of 374 patients in this study, 37 (9.9%) were octogenarians. There was no difference in gender, race, smoking history, or prior OAB treatment regimens between cohorts. The rate of progression to Stage II was 56.8% for octogenarians compared to 60.5% for nonoctogenarians (p = 0.66). The rate of surgical revision, explantation, and need for multimodal therapy did not differ between groups. Subgroup analysis of octogenarians did not reveal any significant differences between successful and nonsuccessful Stage I patients.CONCLUSIONS: The safety and efficacy of SNS was similar between cohorts. This result suggests that SNS is a safe and effective therapy that should be considered among the treatment options for refractory OAB in octogenarian patients. Further studies are needed to determine predictive factors of Stage I success in elderly patients.
View details for DOI 10.1111/ner.12981
View details for PubMedID 31215713
Peroxisome proliferator-activated receptor gamma agonist as a novel treatment for interstitial cystitis: A rat model.
Investigative and clinical urology
2018; 59 (4): 257–62
Purpose: To understand the therapeutic potential of pioglitazone, a peroxisome proliferator-activated receptor gamma (PPAR-gamma) agonist with a propensity to cause bladder mucosal proliferation, on interstitial cystitis (IC) in a rat model.Materials and Methods: Using a previously described animal model for IC, Sprague-Dawley rats were treated with biweekly cyclophosphamide injections (35 mg/kg) to induce cystitis. Animals were divided into 4 groups (n=6 for each group): IC plus daily sham saline gavage (IC+Pio-), IC plus daily pioglitazone gavage (15 mg/kg) (IC+Pio+), normal rats with daily pioglitazone (IC-Pio+), and normal rats with neither IC nor pioglitazone (IC-Pio- or Control). At the end of four weeks, urinary frequency and bladder capacity were measured. Histologic examination of urothelial integrity was also performed.Results: Average voids per hour were significantly lower in IC+Pio+ (4.0±1.9) vs. IC+Pio- (10.0±2.4) rats (p<0.01) and were similar to IC-Pio+ (6.0±1.4) and IC-Pio- (6.0±1.5) controls. Cystometric capacity was significantly higher in IC+Pio+ (0.945±0.122 mL) vs. IC+Pio- rats (0.588±0.165 mL, p=0.01) and was comparable to IC-Pio- capacity (0.817±0.196 mL) and IC-Pio+ capacity (0.941±0.188 mL). Urothelial structural integrity was improved in IC+Pio+ rats versus IC+Pio- rats upon histologic observation.Conclusions: Pioglitazone, a PPAR-gamma agonist, improved bladder function in cyclophosphamide-induced cystitis by both observed urinary frequency and measured cystometric capacity. Urothelial structural integrity was also improved. Pioglitazone, due to a propensity to cause bladder mucosal proliferation, may prove useful for treating IC, and deserves further investigation.
View details for PubMedID 29984341
- Peroxisome proliferator-activated receptor gamma agonist as a novel treatment for interstitial cystitis: A rat model INVESTIGATIVE AND CLINICAL UROLOGY 2018; 59 (4): 257–62
THE PREVALENCE OF PELVIC FLOOR DISORDERS IN ACTIVE DUTY FEMALE SOLDIERS: DATA FROM THE STANFORD MILITARY DATA REPOSITORY
WILEY. 2018: S567–S568
View details for Web of Science ID 000427016100082
Fetal intolerance to labor in pregnancies complicated by marginal and eccentric cord insertion
MOSBY-ELSEVIER. 2018: S285
View details for Web of Science ID 000422946900475
The economic impact of surgical care for morbidly obese endometrial cancer patients: a nationwide study.
American journal of obstetrics and gynecology
2016; 214 (4): 498 e1-6
Obesity significantly impacts the cost of cancer treatment, yet the impact of morbid obesity on inpatient hospital charges related to endometrial cancer treatment is not well-defined.The purpose of this study was to determine the charges that are associated with inpatient surgery, hospitalization, and postoperative care of morbidly obese patients with endometrial cancer.Data were obtained from the National Inpatient Sample from 2010. Chi-square test, t-test, and linear regression were used for statistical analyses.Six thousand five hundred sixty patients who underwent hysterectomy for endometrial cancer were identified. Mean age was 62 years (range, 22-99 years). The majority were white (78%), and the remainder were black (10%), Hispanic, (8%), Asian (3%), and Native American (1%). Insurance types were private (45%), Medicare (45%), Medicaid (5%), and uninsured (7%). One thousand eighty-eight of these patients (17%) were coded as morbidly obese. The mean postoperative stay for the morbidly obese was 4.0 days (range, 0-46 days) compared with 3.5 days (range, 0-81 days) for the non-morbidly obese patients (P < .01). Morbidly obese patients required more intensive care with mechanical ventilation (5.5% vs 1.6%; P < .01). The median hospital charges were higher for morbidly obese patients compared with their counterparts ($46,654 vs $41,164; P < .01). After adjustment for charges that were associated with insurance type, hospital type, and the surgery that was performed, the incremental increase in hospital charges that were associated with treating the morbidly obese patient was $5096 per patient (95% confidence interval, $2593-$7598; P < .01).In this economic analysis, the health care charges that were associated with inpatient endometrial cancer treatment in the morbidly obese patient was significantly higher compared the non-morbidly obese patient. Resources are needed to support the needs of this population, and programs to encourage weight loss and optimize general health should be encouraged.
View details for DOI 10.1016/j.ajog.2015.10.015
View details for PubMedID 26478102
- The Economic Impact of Surgical Care for Morbidly Obese Endometrial Cancer Patients: A Nationwide Study EDITORIAL COMMENT OBSTETRICAL & GYNECOLOGICAL SURVEY 2016; 71 (2): 78–79
- TYPE I UTERINE CANCER IN US-BORN ASIANS VERSUS IMMIGRANT ASIANS ELSEVIER SCI LTD. 2014: E66
Applications for Oncologic Drugs: A Descriptive Analysis of the Oncologic Drugs Advisory Committee Reviews
2014; 19 (3): 299-304
Despite advances in cancer research, the majority of drug applications submitted to the U.S. Food and Drug Administration (FDA) are not approved. It is important to identify the concerns of the Oncologic Drugs Advisory Committee (ODAC) from rejected applications.All applications referred to the ODAC from 2001 to 2012 were reviewed.Of 46 applications, 31 (67%) were for full and 15 (33%) were for supplemental approval, 34 (74%) were for solid and 12 (26%) were for hematologic tumors. In all, 22 (48%) were not approved. ODAC comments addressed missing or inadequate data (65%), excessive toxicity (55%), inappropriate study endpoints (45%), poor study design (40%), and insufficient sample size (30%). To define efficacy, 19 applications used response rates (RR) (median = 38%), and 19 applications used hazard ratios (HR) (median = 0.67). For all organ systems combined, the median cumulative grade 3 or 4 toxicity was 64%. Drugs with higher RR, lower HR, and lower toxicity were more likely to be approved versus other drugs (89% vs. 45%; p = .02). Over time (2001-2004, 2005-2008, 2009-2012), there was an increase in the following: number of applications submitted for review (from 11 to 12 to 23, respectively), number of approvals (from 6 to 6 to 12, respectively), and proportion of trials using progression-free survival as a primary endpoint (from 0% to 50% to 70%, respectively; p = .01).Of all applications, common ODAC concerns included inadequate data, excessive toxicity, and inappropriate study endpoints. Over time, there was an approximate doubling of FDA application submissions and approved oncology drugs.
View details for DOI 10.1634/theoncologist.2013-0276
View details for PubMedID 24599479
- Applications for oncologic drugs - Lessons from the oncologic drug advisory committee ACADEMIC PRESS INC ELSEVIER SCIENCE. 2012: S13
- Trends and progress of oncology drug development - An analysis of the FDA oncologic drug advisory committee reviews ACADEMIC PRESS INC ELSEVIER SCIENCE. 2012: S11–S12
- Predictive model for cancer drug approval - An analysis of FDA drug submissions over the last decade ACADEMIC PRESS INC ELSEVIER SCIENCE. 2012: S13–S14
PROGRESS AND TRENDS FOR CANCER DRUG APPROVAL - AN ANALYSIS OF FDA ADVISORY COMMITTEE
37th Congress of the European-Society-for-Medical-Oncology (ESMO)
OXFORD UNIV PRESS. 2012: 460–460
View details for Web of Science ID 000309409002348
An economic analysis of robotic versus laparoscopic surgery for endometrial cancer: Costs, charges and reimbursements to hospitals and professionals
2012; 125 (1): 237-240
To determine the actual costs, charges, and reimbursements associated with robotic vs. laparoscopic surgery for endometrial cancer.Data were collected from hospital billing records, MD professional group billing records, tumor registry, and medical records on operations performed by a single surgeon from one institution between 2008 and 2010. For comparison, surgical groups were matched based on age, histology, and stage of disease over the same time period.Of 54 patients, 27 underwent robotic surgery (RS) and 27 had laparoscopic surgery (LS). The median age was 57 years. There were no statistically significant differences between the groups based on age, stage, and histology. The hospital charges for RS were higher at $64,266 vs. $55,130 for LS (p=0.036). However, the reimbursement to the hospital was not statistically different at $13,003 for RS and $10,245 for LS (p=0.29). Operating suite, room and board, anesthesia, post anesthesia care unit, and pathology accounted for over 90% of hospital charges. The surgeon charges for RS and LS were $6824 and $6327, respectively (p=0.033) and the anesthesiologist charges were $4049 and $2985, respectively (p=0.001). However, there were no differences in reimbursement to the surgeon (p=0.74) and anesthesiologist (p=0.84) between the two operative approaches.Our data showed that the direct costs and charges associated with robotic surgery were higher compared to laparoscopic surgery. However, actual reimbursements to the hospital, surgeon, and anesthesiologist were not significantly different between the two surgical approaches.
View details for DOI 10.1016/j.ygyno.2011.11.036
View details for Web of Science ID 000301879600042
View details for PubMedID 22120176