As a resident, you are required to demonstrate at least one scholarly product during your training. To help support your research endeavors, the Ob/Gyn & Women’s Health Institute has six full-time and two part-time research staff including five RN research nurse coordinators, three non-RN research coordinators and an RN nurse manager. The clinical research team is responsible for all patient-related aspects of your research project with respect to regulatory compliance.
Research in the section of gynecologic oncology has covered the gamut of gynecologic malignancies. We presently have phase 3 trials in ovarian, cervical and endometrial cancers, involving both national cooperative groups from the Gynecologic Oncology Group (GOG) as well as industry trials to assess the standard of care for these diseases. We are participating in phase 1 clinical trials nationally to evaluate cutting edge therapies for cervical and ovarian cancers, including antiangiogenic agents. Our clinical trials cover both primary therapy as well as recurrent disease, with the hope of expanding our knowledge as well as offering our patients unique treatments not offered elsewhere. Finally, our department is also investigating novel MUC1 vaccine agents in the attempt to prevent recurrence of ovarian cancer with some promising results. .
Center for Urogynecology and Reconstructive Pelvic Surgery
The Center for Urogynecology and Reconstructive Pelvic Surgery at Cleveland Clinic includes nationally and internationally recognized scientists and clinician-investigators performing basic, translational and clinical research dedicated to improving the understanding and treatment of pelvic floor disorders such as urinary incontinence, pelvic organ prolapse and fecal incontinence. Highlights of current research activities include: .
- Clinical trials evaluating the surgical management of stress urinary incontinence and pelvic organ prolapse.
- Clinical studies evaluating minimally invasive treatments for pelvic floor disorders including laparoscopic and robotic surgery.
- Studies to improve the classification and treatment of complications of transvaginal mesh procedures.
- Cleveland Clinic is recruiting patients and serving as the data coordinating center for a national multi-center study evaluating two minimally invasive procedures that allow a women undergoing surgery for utervaginal prolapse to avoid a hysterectomy.
- Clinical studies evaluating methods to decrease urinary tract infections and decrease catheter use after surgery for urinary incontinence.
- Studies evaluating ways to measure and improve surgical competency and judgment among pelvic surgeons in training.
- Basic and translational research in pelvic floor disorders. Learn more.
Reproductive Endocrinology & Infertility
The Section of Reproductive Endocrinology and Infertility has an active and varied basic science and clinical research program. Residents at all levels of training are encouraged to participate in ongoing projects. We will also support studies on other topics that they may want to investigate. The following is a list of the areas of research our labs are currently pursuing. .
- Use of time-lapse imaging and morphokinetics in the IVF lab to improve clinical outcomes
- Development of methodology for single sperm cryopreservation
- Artificial blastocyst collapse to improve human embryo survival after cryopreservation
- Non-invasive techniques for assessing embryo vitality
- Preimplantation genetic diagnosis to understand association between embryonic multinucleation and euploidy
- Development of 3-D culture models for prolonged in vitro cultivation and maturation of human preantral ovarian follicles
- Study of extracellular matrix components and their role in folliculogenesis
- Derivation and feeder –free culture of embryonic stem cell lines
- Co-culture models and identification of embryotrophic secretions
- Growth factor modulation of embryonic growth, blastocyst differentiation and apoptosis
- Characterization of endometrial secretions during the window of implantation
- Optimizing ovarian tissue cryopreservation and transplantation
- Role of microRNAs in endometriosis
- ADAMTS and myoma extracellular matrix
- Development of an anti-adhesion product for laparoscopic surgery
- For more information on IVF Research please visit the Cleveland Clinic Beachwood Fertility Center.
Research activity in the section of maternal-fetal medicine primarily deals with the pathogenesis of preeclampsia. This includes the putative effects of progesterone on activation of vascular endothelial cells by TNFα, sFlt-1 and sEng, and the role of heme oxygenases and carbon monoxide system. Also, we are studying the potential impact of new insights into the natriuretic peptide system on hypertensive disease in pregnancy. On the clinical side, we continue to participate in the PCOR study (Pregnancy and Cardiovascular Outcomes Registry), which looks at the relationship between certain complications during pregnancy and the development of cardiovascular disease later in life. Finally, we continue to assess the impact of new protocols for aneuploidy screening and patient preferences. .
Specialized Women’s Health
The Center for Specialized Women’s Health encompasses holistic care of women, often with complex medical conditions, and provides cutting edge evidence based therapies. The research program emphasizes an interdisciplinary approach to the study of women’s health concerns. Collaboration between the multidisciplinary staff at the Center with a diverse group of clinicians from across Cleveland Clinic and Case Western University allows for novel approaches and the dissemination of the latest breakthroughs in women’s health research. Our staff have worked along with the Case Western School of Dentistry to examine periodontal issues in women taking bisphosphonate therapy and with Cleveland Clinic's Department of Radiology to assess compliance with osteoporosis screening. Ongoing areas of study include treatment of osteoporosis, gynecologic concerns after bone marrow transplant, resident education, cervical cancer screening, sexual dysfunction, pelvic organ prolapse and stress incontinence. .
General Gynecology/Pelvic Pain
The Chronic Pelvic Pain Program at the Cleveland Clinic is dedicated to clinical and translational research to improve the lives of our patients. Our research program emphasizes an interdisciplinary approach to the study of pelvic pain. Our clinician investigators collaborate with medical and surgical specialists from across the country, and within the Cleveland Clinic, to increase our understanding and to optimize treatments for female pelvic pain disorders. Ongoing areas of study and interest include: .
- A clinical trial that investigates the efficacy of an experimental electrical device for the treatment of chronic pelvic pain.
- A prospective clinical study evaluating the impact of novel surgical instruments for patients suffering from chronic pelvic pain
- A study evaluating the use of patient reported outcome questionnaires in assessing chronic pelvic pain improvement
- Pelvic sensory discrimination mapping
- Mucosal sensitivity in Vulvar Vestibulitis Syndrome
Global Women’s Health
Women’s Health Institute Global Health Research activities focus on cervical cancer prevention and treatment in multiple countries throughout the world. This is a collaborative relationship between Cleveland Clinic’s Women’s Health Institute, Basic Health International www.basichealth.org (BHI) and Preventive Oncology International, Inc. www.poiinc.org (POI), two non-profit medical research organizations founded by Cleveland Clinic physicians. .
BHI was founded in 2005 by Dr. Miriam Cremer with a mission to eradicate cervical cancer globally. POI was founded by Dr. Jerome Belinson, former Chairman of Cleveland Clinic Department of Ob/Gyn, and has a mission to conduct research and provide education while working toward the prevention and early detection of gynecologic cancers. Dr. Cremer welcomes medical student, resident and fellow involvement in all projects. The best contact information is via email firstname.lastname@example.org.
Dr. Cremer’s current activities with Basic Health International include:
- The Cervical Cancer Prevention in El Salvador (CAPE) is a joint effort between the Salvadoran Ministry of Health (MOH) and BHI to implement a 3-phase screening program of 30,000 women in the Paracentral region of El Salvador. This is the first time that HPV DNA screening has ever been used in a national implementation program.
- Self-sampling study. Women who did not come for provider-based screening in Phase 3 of CAPE will be approached in their homes and offered self-collection of a vaginal sample, which is an appealing alternative for many women. The aims of this project are multi-fold: to identify barriers to screening and attitudes about self-sampling, to determine if women who do not attend a clinic-based cervical cancer screening program will accept self-sampling at home, and to determine the rate of pre-cancer and cancer in this population.
- Dr. Cremer is a recipient of a $4M grant (over 5 years) from The National Institutes of Health (NIH). Dr. Cremer, along with several collaborators, is developing a CryoPen® Cryosurgical System adapted for low-and middle-income countries (LMIC) for the treatment of cervical pre-cancer. This innovative new device, which does not require cryogen gas, is part of the NIH initiative to support the development of cancer-related technologies suitable for use in these areas.
- A supplement to the NIH grant has been submitted to further study the question of what duration of cryotherapy most effectively causes the tissue necrosis necessary to prevent cervical pre-cancer from progressing to invasive cancer.
- Dr. Cremer is working on a R01 grant application to the NIH to fund a project tentatively titled: Development of an LMIC-adapted Thermocoagulation Prototype for the Treatment of Cervical Pre-cancer. This study proposes the rapid development and deployment of a novel point-of-care technology for the treatment of cervical pre-cancer. The proposed device uses thermocoagulation, also referred to as cold coagulation which uses a probe heated to 100-120º Celsius. No scientific evidence to date has investigated its efficacy and there are no standardized methods of timing or temperature for treatment. Since this rapid and inexpensive technology has the potential to address the need for more accessible treatment options, an academic industrial partnership has been formed to develop and test a thermocoagulation prototype.
- A team from BHI will be helping to do a cryotherapy training course in Rwanda November 2-6. We would be happy to take a resident or fellow but the interested party would be responsible for costs associated with travel.
- Other travel opportunities arise throughout the year mainly to work on projects in Latin America. I am happy to include residents and fellows particularly those who speak Spanish. There may be limited funds available for travel.
Dr. Belinson’s current activities with Preventive Oncology International, Inc. include:
- The Chinese Multi-Center Screening Trial (CHIMUST): The Prevention of Cervical Cancer Using Self-collection as the Primary Screen. 10,000 patient trial covering 5 sites from Inner Mongolia to Guangdong Province. The study will explore self-collection, three distinct assays, all integrated with the individual communities and local healthcare systems. – Planned initiation October-November.
- Ongoing development and phase I evaluation of a new Thermal Coagulator for outpatient management of pre-invasive cervical cancer. In Progress.
- Development of a new solid media transport card for specimen transport with a special focus on self-collected specimens. Two studies completed (Oncology fellow project). Two papers submitted. Current work is now focusing on optimizing the card protocol for RNA detection
- Proposal completed and funding being explored for “Implementation of Community Based Cervical Cancer Screening Program in Northern Samar, Philippines”. This project hopefully can serve as a community based screening demonstration project for the Philippines. We plan to screen all the women ages 30-50 years in Northern Samar (est. 55-60,000). The plan is to screen and complete evaluation and management of the positives over a period of 2-3 months.
- Development and evaluation of a methylated version of SEQHPV (HR-HPV assay based on next gen sequencing). This project in collaboration with BGI Shenzhen is in its second year with more developmental work still ahead.
Over the past several years multiple students have done research with POI and traveled to the Dominican Republic, Mexico, Peru and China for those projects.
Each year in May, the Obstetrics, Gynecology & Women’s Health Institute holds the Annual Research Day. This is a new tradition for the Institute with the first annual Research Day being held in 2016. There were over 100 attendees which included residents, fellows, staff, and past and present Chairs of the Institute.
PGY2 residents are required to present poster presentations of their research project. PGY3 residents will present their oral presentations. This is a requirement of the program and is led by Matthew Barber, MD, MHS, Vice Chair of Research in the Obstetrics, Gynecology and Women’s Health Institute. At the 2016 Research Day, 13 residents and fellows did oral presentations of their research and 5 PGY2 residents presented their research in the poster session.
Each Research Day will have a Visiting Professor for our Key Note Address and a lunchtime lecture entitled “Innovations in Ob/Gyn” that will highlight fascinating research and clinical expertise within the last academic year.
- Past Key Note Speaker - 5/25/2016
Daniel Clarke-Pearson, MD
Distinguished Professor and Chair, Department of Obstetrics and Gynecology
University of North Carolina-Chapel Hill
“Preventing Venous Thromboembolism in Gynecologic Surgery”
- Past Innovations in Ob/Gyn - 5/25/16
Rebecca Flyckt, MD & Ruth Farrell, MD
Obstetrics, Gynecology and Women’s Health Institute – Cleveland Clinic