bluuebunny/crossref_metadata_2025 huggingface dataset:
Late-onset Sepsis in Preterm Infants Can Be Detected Preclinically by Fecal Volatile Organic Compound Analysis: A Prospective, Multicenter Cohort Study
Authors: Berkhout Daniel J C , van Keulen Britt J , Niemarkt Hendrik J , Bessem Jet R , de Boode Willem P , Cossey Veerle , Hoogenes Neil , Hulzebos Christiaan V , Klaver Ellen , Andriessen Peter , van Kaam Anton H , Kramer Boris W , van Lingen Richard A , Schouten Aaron , van Goudoever Johannes B , Vijlbrief Daniel C , van Weissenbruch Mirjam M , Wicaksono Alfian N , Covington James A , Benninga Marc A , de Boer Nanne K H , de Meij Tim G J
Published: April 2018

Background

The intestinal microbiota has increasingly been considered to play a role in the etiology of late-onset sepsis (LOS). We hypothesize that early alterations in fecal volatile organic compounds (VOCs), reflecting intestinal microbiota composition and function, allow for discrimination between infants developing LOS and controls in a preclinical stage.

Methods

In 9 neonatal intensive care units in the Netherlands and Belgium, fecal samples of preterm infants born at a gestational age ≤30 weeks were collected daily, up to the postnatal age of 28 days. Fecal VOC were measured by high-field asymmetric waveform ion mobility spectrometry (FAIMS). VOC profiles of LOS infants, up to 3 days prior to clinical LOS onset, were compared with profiles from matched controls.

Results

In total, 843 preterm born infants (gestational age ≤30 weeks) were included. From 127 LOS cases and 127 matched controls, fecal samples were analyzed by means of FAIMS. Fecal VOCs allowed for preclinical discrimination between LOS and control infants. Focusing on individual pathogens, fecal VOCs differed significantly between LOS cases and controls at all predefined time points. Highest accuracy rates were obtained for sepsis caused by Escherichia coli, followed by sepsis caused by Staphylococcus aureus and Staphylococcus epidermidis.

Conclusions

Fecal VOC analysis allowed for preclinical discrimination between infants developing LOS and matched controls. Early detection of LOS may provide clinicians a window of opportunity for timely initiation of individualized therapeutic strategies aimed at prevention of sepsis, possibly improving LOS-related morbidity and mortality.
Examining Risk Perceptions Among Daily Smokers Naïve to Reduced Nicotine Content Cigarettes
Authors: Mercincavage Melissa , Lochbuehler Kirsten , Villanti Andrea C , Wileyto E Paul , Audrain-McGovern Janet , Strasser Andrew A
Published: April 2018

Introduction

The U.S. Food and Drug Administration (FDA) has stated its interest in reducing the addictiveness of combustible cigarettes by lowering their nicotine content. Delineating risk perceptions of reduced nicotine content (RNC) cigarettes prior to federal regulation may inform the content of future educational campaigns accompanying this policy.

Methods

Five hundred non–treatment-seeking, daily smokers naïve to RNC cigarettes (63.0% male, 51.6% nonWhite, mean [SD] cigarettes per day = 15.69 [7.58], age = 43.44 [11.46]) completed a 10-item RNC cigarette risk perception questionnaire at baseline in two, unrelated experimental studies. We used multinomial logistic regression models to identify demographic (eg, gender) and smoking-related (eg, nicotine dependence) correlates of RNC cigarette risk perceptions.

Results

Although the majority of participants did not misperceive RNC cigarettes as less harmful than regular or high nicotine cigarettes, a large portion of the sample held misperceptions about RNC cigarettes’ addictiveness (56.4%) and cessation aid potential (63.4%). More than 20% of the sample reported being unsure about RNC-related risks, especially tar content (51.8%). NonWhite smokers were 2.5 to 3 times more likely to be incorrect about multiple RNC cigarette risks (p = .002–.006).

Conclusions

If the FDA mandates a reduced nicotine content standard for cigarettes, educational campaigns will be needed to correct misperceptions about RNC cigarettes’ addictiveness and potential to aid cessation as well as inform consumers about their safety risks. Campaigns tailored toward nonWhite smokers may also be needed to correct misperceptions of RNC cigarette risks held by this subgroup.

Implications

The FDA has stated its interest in reducing cigarettes’ addictiveness by lowering their nicotine content, enabling smokers to quit. Our findings suggest that most smokers who have not used RNC cigarettes do not perceive these products as less addictive or as cessation tools, stressing a need for future educational campaigns to correct these misperceptions. Campaigns are also needed to educate uninformed smokers about RNC cigarettes and should consider targeting messages toward subgroups likely to hold misperceptions about the risks and benefits of using these products (eg, nonWhite smokers).
Using Patient Risk Factors to Identify Whether Carbapenem-Resistant Enterobacteriaceae Infections Are Caused by Carbapenemase-Producing Organisms
Authors: Simner Patricia J , Goodman Katherine E , Carroll Karen C , Harris Anthony D , Han Jennifer H , Tamma Pranita D
Published: April 2018

Evaluating all inpatient carbapenem-resistant Enterobacteriaceae (CRE) infections over a 1-year period, 47% were caused by carbapenemase-producing (CP) organisms. Compared with non-CP-CRE patients, patients with CP-CRE had an 18-fold greater odds of a recent stay in a foreign health care facility and a 3-fold greater odds of transfer from a post–acute care facility.
Incisional Hernia After Minimally Invasive Lateral Retroperitoneal Surgery: Case Series and Review of the Literature
Authors: Vivas Andrew C , Januszewski Jacob , Hajirawala Luv , Paluzzi Jason M , Gandhi Shashank V , Uribe Juan S
Published: April 2018

BACKGROUND

Minimally invasive lateral retroperitoneal (lateral-MIS) approaches to the spine involve traversing the lateral abdominal wall musculature and fascia. Incisional hernia is an uncommon approach-related complication.

OBJECTIVE

To review the incidence, treatment, and preventative measures of incisional hernia after lateral-MIS approaches.

METHODS

This is a retrospective review of cases performed by a single surgeon from 2011 to 2016. All patients who underwent lateral-MIS approaches at this institution were included. Patients with a postoperative diagnosis of lateral hernia on physical exam and corroborating advanced imaging findings were included in this study. Cases of flank bulge due to peripheral nerve injury were excluded.

RESULTS

Three-hundred three patients underwent lateral-MIS approaches to the spine. Three (1%) patients with incisional hernia were identified. Two patients presented with a clinically symptomatic incisional hernia, while 1 patient was diagnosed incidentally after a routine abdominal magnetic resonance imaging for an unrelated reason. No patients suffered bowel entrapment or strangulation.

CONCLUSION

Incisional hernia after lateral-MIS approaches is rare. Patients with incisional hernias may be susceptible to bowel incarceration and ischemia, though the incidence of this is probably low. Meticulous closure of the fascia is critical to avoiding this complication.
Alcohol Metabolism in the Progression of Human Nonalcoholic Steatohepatitis
Authors: Li Hui , Toth Erica , Cherrington Nathan J
Published: April 2018

Alcohol metabolism is a well-characterized biological process that is dominated by the alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) families. Nonalcoholic steatohepatitis (NASH) is the advanced inflammatory stage of nonalcoholic fatty liver disease (NAFLD) and is known to alter the metabolism and disposition of numerous drugs. The purpose of this study was to investigate the alterations in alcohol metabolism processes in response to human NASH progression. Expression and function of ADHs, ALDHs, and catalase were examined in normal, steatosis, NASH (fatty) and NASH (not fatty) human liver samples. ALDH4A1 mRNA was significantly decreased in both NASH groups, while no significant changes were observed in the mRNA levels of other alcohol-related enzymes. The protein levels of ADH1A, ADH1B, and ADH4 were each decreased in the NASH groups, which was consistent with a decreased overall ADH activity. The protein level of ALDH2 was significantly increased in both NASH groups, while ALDH1A1 and ALDH1B1 were only decreased in NASH (fatty) samples. ALDH activity represented by oxidation of acetaldehyde was decreased in the NASH (fatty) group. The protein level of catalase was decreased in both NASH groups, though activity was unchanged. Furthermore, the significant accumulation of 4-hydroxynonenal protein adduct in NASH indicated significant oxidative stress and a potential reduction in ALDH activity. Collectively, ADH and ALDH expression and function are profoundly altered in the progression of NASH, which may have a notable impact on ADH- and ALDH-associated cellular metabolism processes and lead to significant alterations in drug metabolism mediated by these enzymes.
Risk of Ovarian Malignancy in Patients Undergoing Surgery for an Adnexal Mass at a High-Volume Cancer Center [36A]
Authors: Byrne Maureen E. , Spross Jennifer , Zivanovic Oliver , Gardner Ginger , Chi Dennis , Roche Kara Long
Published: April 2018

INTRODUCTION:

To characterize a cohort of patients presenting to a high-volume cancer center with an adnexal mass (AM), reporting pathologic outcomes and risk of malignancy.

METHODS:

All new visits to the gynecology service were prospectively screened from July 1, 2015-5/31/2017. Patients with ovarian complaints were categorized prospectively and followed through treatment. AM was defined as a pelvic mass suspected to originate from the adnexa without apparent metastatic disease based on available clinical and radiographic studies. Clinicopathologic data were collected and analyzed.

RESULTS:

7690 new visits were screened and 2964 patients with an ovarian complaint were categorized: AM 35%, suspected advanced ovarian cancer (ovca) 28%, recurrent ovca 13%, hereditary ovca syndrome 14%, endocrine ablation 8%, other 2%. Of the 1046 with AM, 2% had evidence of metastatic disease on preoperative imaging, 40% were recommended observation, and 58% were managed surgically. For the 607 managed surgically, final pathology showed: benign 74%, non-ovarian malignancy 12%, ovca 8%, borderline tumor 5%, serous tubal intraepithelial carcinoma >1%, no pathology available >1%. Of the 51 patients diagnosed with ovca, median age was 57(27-79 years), median CA125 67 U/ml(9-353 U/ml), and median preoperative AM size was 9.8cm(2.6-21.4cm). Final histologic diagnosis was: epithelial ovca 40(78%), sex cord stromal tumor 5(9.8%), germ cell tumor 1(1.9%), other 5(9.8%). The most common epithelial histology was high grade serous 18(45%).

CONCLUSION:

In patients who underwent surgery for AM with no radiologic evidence of metastatic disease at a high-volume cancer center, risk of ovca was 8% with the majority of patients having benign disease.
Relationship between Sperm Vacuoles, Morphology, DNA Damage, Chromatin State, and Oxidative Stress [7B]
Authors: Tran Mai , Bilinski Melina , Lorenzi Daniela , Uriondo Heydy , Papier Sergio , Alvarez Sedó Cristian
Published: April 2018

INTRODUCTION:

Some studies found that the presence of sperm nuclear vacuoles is positively correlated with DNA fragmentation. Our objectives are: 1) Evaluate the quantity and size of vacuoles and their association with morphology, DNA damage, and chromatin compaction in semen from men who underwent assisted reproductive treatments; and 2) Investigate the effect of oxidative stress on DNA fragmentation.

METHODS:

Semen samples from 75 men were analyzed and the number and size of vacuoles, DNA fragmentation, and chromatin compaction state were determined via MSOME, TUNEL, and acridine orange (AO) respectively. Furthermore, the level of vitality, DNA fragmentation, and chromatin compaction were evaluated prior to and after 4 hours of oxidative stress (H202).

RESULTS:

In the Kruger ≥4% population, spermatozoa with one or more vacuoles that covered >20% of the nuclear surface had more DNA fragmentation compared to those that covered less. Also, spermatozoa with 1 large or several vacuoles had a chromatin compaction state that was more susceptible to acid-induced DNA denaturation compared to those with other vacuoles pattern. In the Kruger<4% population, there is no difference in DNA fragmentation between spermatozoa with or without vacuoles. After 4 hours, H2O2 did not affect the spermatozoa vitality but did increased the DNA fragmentation.

CONCLUSION:

In patients with Kruger ≥14%, selecting a spermatozoon without vacuoles for ICSI may result in one with less DNA fragmentation. In patients with Kruger<4%, vacuoles should not be a factor in spermatozoon selection; time spent examining vacuoles may increase exposure to oxidative stress resulting in greater DNA damage.
Abnormal Glucose Tolerance and Pregnancy Outcomes in Women Without Diagnosis of Gestational Diabetes Mellitus [23C]
Authors: Enakpene Christopher A. , Jones Tiffany , Mastrogiannis Dimitrios , Della Torre Micaela , Knazze Lauren , DiGiovanni Laura
Published: April 2018

INTRODUCTION:

Maternal hyperglycemia and untreated GDM lead to adverse perinatal outcomes. This study aims to determine whether abnormal 1-hour GCT alone or one elevated 3-hour GTT value are associated with adverse perinatal outcomes.

METHODS:

Retrospective cohort study of all pregnant women who had diabetic screening from January 2015 to December 2016 at the University of Illinois at Chicago (UIC. These singleton pregnancies were classified into 4 groups: normal 1-hour GCT, abnormal 1-hour GCT only, one elevated value on 3-hour GTT, and GDM. Baseline characteristics and pregnancy outcome of the four groups were compared. Chi square, one-way ANOVA and Student’s t-test were used.

RESULTS:

Of the 4658 deliveries during study the period, 497 women met inclusion criteria. There were 120 women with normal 1-hour GCT, 179 with abnormal 1-hour GCT only, 69 with one elevated value on 3-hour OGTT, and 129 diagnosed with GDM. The GDM patients were significantly older, heavier, gained more weight and delivered earlier (p-value: <0.001, 0.015, <0.001, and < 0.001 respectively). Mean birth weights were higher among patients with abnormal 1-hour GCT only and those with one abnormal value on 3-hours GTT but not statistically significant. A progressive trend was noted in primary cesarean delivery and NICU admission, and patients with GDM were most likely to have both, OR; 2.69 (95% CI: 1.21-5.96), and 2.0 (95% CI: 1.01-3.99) respectively.

CONCLUSION:

Our study shows that these screening results reflect a spectrum of glucose intolerance and these patients may require closer surveillance to improve pregnancy outcomes.
An Association Between Anemia and Postpartum Depression [35C]
Authors: Sutherland Shannon , O'Sullivan David , Mullins Jessica
Published: April 2018

INTRODUCTION:

Anemia in pregnancy has been associated with increased rates of low birth weight, preterm delivery, and perinatal mortality in several previous studies. Despite these complications, few have investigated the impact of anemia on postpartum women. This postpartum period can be extremely difficult for mothers as 19% of United States women experience postpartum depression (PPD). It is therefore imperative to investigate anemia as a possible physiologic risk factor for PPD.

METHODS:

This retrospective cohort study was conducted by collecting hematocrit and demographic data from medical records of patients meeting all criteria. Patients included were women ≥16 years old who received postpartum care at Women’s Ambulatory Health Services in Hartford, Connecticut from January 2014 to January 2017. Those excluded were patients <16 years old, those on psychiatric medications, those with disease disrupting iron metabolism, tobacco users, patients receiving blood transfusions, or those experiencing neonatal mortality. Records were categorized into anemic and non-anemic. Percentage of Edinburgh Postnatal Depression Scale (EPDS) ≥11 vs <11 were compared using Chi square test.

RESULTS:

922 women fulfilled study requirements and completed the EPDS questionnaire. 9.2% of study patients screened positively for PPD (EPDS ≥11). 75.2% were anemic antenatally or immediately postpartum. The difference in PPD incidence for those anemic (10.8%) vs non-anemic (4.8%) was statistically different (P=.007). Anemic patients had an increased risk of screening positive for PPD (RR 2.25, 95% CI 1.22-4.16).

CONCLUSION:

Anemia during pregnancy or peripartum is associated with an increased incidence of PPD and thus should be further investigated as a potential risk factor for PPD.
Myomectomy: Factors Influencing Patient Decision-Making and Satisfaction [10D]
Authors: van der Does Louise , Kazi Nilofar , Baxi Rupen , Haworth Leah , Washington Kellie
Published: April 2018

INTRODUCTION:

Myomectomy is a uterine-sparing treatment in women with symptomatic leiomyoma. We explored the decision-making process and overall postoperative satisfaction in patients who chose to undergo myomectomy.

METHODS:

Sequential mixed method design: retrospective chart review (n=1,380) of patients undergoing myomectomy at suburban hospital from 2011-2013, and postoperative mail survey of same population. Myomectomy routes: abdominal, laparoscopically-assisted abdominal (LAAM), conventional laparoscopic (CLM) & robotic-assisted (RAM). Myomectomy route was verified via corresponding survey identifiers. Survey response rate = 7.2%. Survey questions addressed preoperative education, patient decision-making process, complications, and patient satisfaction.

RESULTS:

Of 79 respondents: 18% abdominal, 48% LAAM, 16% CLM and 18% RAM. The top three reasons indicated for having a myomectomy was heavy periods (41.5%), fertility (26.8%) and painful periods (19.5%). 78.5% indicated the route of myomectomy mattered to them, yet 71.2% did not seek a second opinion. Primary reason for not seeking a second opinion was trust in their OBGYN (76.4%). 98% of respondents indicated they were satisfied with the “surgeon’s explanation of the surgical procedure,” yet 57.7% did not correctly identify their type of myomectomy. There was no significant difference in patient satisfaction with overall results of surgery across all myomectomy types. Postoperative care/follow-up was the only significant predictor of patient satisfaction (P <.05).

CONCLUSION:

Trust in the physician was the most significant factor in the patient decision-making process to undergo surgery, while postoperative follow-up care was most significant to overall patient satisfaction. This survey highlights the need for the OBGYN to recommend the most appropriate treatment option to their patients.
Prenatal Skills Pilot Study of Graduates from a Traditional Birth Attendant Training Program in Rural Guatemala [5M]
Authors: Hernandez Sasha , Oliveira Jessica , Cuc Juan Chumil , Shirazian Taraneh
Published: April 2018

INTRODUCTION:

In developing countries the importance of training traditional birth attendants (TBAs) has been recognized. There is limited data on direct effect on clinical skills and referring capacities from training programs. This pilot study tests the efficacy of a WHO-adapted skills checklist in capturing prenatal skills and referrals in real time in rural Guatemala.

METHODS:

There have been three graduating classes from Saving Mothers TBA training program from 2014-2016 with a total of forty-eight participants. Seventeen graduates were recruited and consented. Four Saving Mothers medical volunteers observed 84 prenatal home-visits in 6 weeks and measured clinical skills in real time.

RESULTS:

92% of prenatal visits by TBAs from the first graduating class, who have had three years of training, were complete. TBAs with four to six months of prenatal skills training performed complete prenatal visits 26% of the time. 30 women were referred to a government clinic and/or hospital; one revealed fetal demise. In 90% of prenatal home visits blood pressure and pulse were correctly taken. Review of at least one of four signs requiring immediate refer to a hospital occurred at 67% of visits. Hand washing only occurred on 35% of total visits.

CONCLUSION:

This pilot testing of a WHO adapted skills checklist appropriately captured clinical skill and referral capabilities in our cohort of TBAs. Continued in-field training improves prenatal clinical skills and referring capacities. This WHO-adapted checklist will be subsequently used in a large-scale study to measure direct skill improvement before and after our training program.
Driving Time as a Structural Barrier to Quality Prenatal Care [21M]
Authors: Maldonado Lauren Y. , Fryer Kimberly , Tucker Christine , Stuebe Alison M.
Published: April 2018

INTRODUCTION:

Timely prenatal care can significantly improve birth outcomes. To understand the impact of transportation on access to care, we investigated the effect of driving time on a patient’s likelihood of arriving late or no showing for prenatal appointments.

METHODS:

Retrospective cohort study of mothers receiving prenatal care and delivering at North Carolina Women's Hospital between 7/1/2014-6/30/2016. Demographic and outcome data were queried from the electronic medical record. Patients arriving more than 30 minutes late to appointments were classified as late arrivals. We used logistic regression to analyze the effect of driving time - calculated by ArcGIS software using geocoded addresses at time of delivery - on a patient’s arrival status while controlling for pregnancy (high vs. low risk, gravidity) and demographic (age, race/ethnicity, insurance status, partner status) characteristics. P values less than .05 were considered statistically significant.

RESULTS:

Among the 3,083 mothers included, most were publicly insured (62%) and partnered (50%), with an average gravidity of 3 (SD ±2). For every 10 additional minutes of drive time, women had a 1.05 (95% CI 1.02-1.08) adjusted odds of arriving late vs. on time to prenatal appointments. Mothers with higher gravidity, who are black (vs. white), and who are publicly (vs. privately) insured were significantly more likely to arrive late or no-show appointments. Partnered mothers (OR 0.75 95% CI 0.63-0.89) or high-risk pregnancies (OR 0.78 95% CI 0.67-0.90) are less likely to miss appointments.

CONCLUSION:

Longer driving time is one barrier that impedes timely prenatal care. Targeted approaches are needed to overcome these multi-faceted challenges.
Shirodkar Cerclage is More Effective than McDonald for the Prevention of Preterm Birth [36N]
Authors: Rodriguez Phillip Andres , Fylstra Donald , Newman Roger , Nino Julio Mateus
Published: April 2018

INTRODUCTION:

Data on the efficacy of the McDonald (MD) and Shirodkar (SK) cervical cerclage to reduce preterm birth (PTB) is inconclusive. We aimed to compare the efficacy of these two surgical techniques in pregnancies with history and ultrasound-indicated cervical cerclage.

METHODS:

A retrospective cohort study of patients who underwent history or ultrasound-indicated cerclage between 2007 and 2014. PTB rates were compared among pregnancies with either a MD or SK cerclage. Kaplan-Meier Survival Analysis was performed to determine the latency between cerclage placement and delivery. Selected neonatal outcomes were compared between the two groups. Chi-square test and One-Way ANOVA on Ranks were used to analyze the data.

RESULTS:

Of 306 MD and 43 SK cerclages, 185 (60.5%) and 34 (79.1%) were history-indicated, and 121 (39.5%) and 9 (20.9%) were ultrasound-indicated, respectively. PTB < 32 weeks occurred in 100 (32.7%) and in 7 (16.3%) of MD and SK (p =.045). PTB < 37 weeks was higher in the MD than in the SK group (58.2% and 41.8%; p =.046). Latency was also different between the groups, (Figure; p =.002) with median latency of 17.7 weeks (95% confidence interval (CI); 16.9, 18.5) for the MD group and 23.0 weeks (95% CI; 22.0, 23.9) for the SK group. Neonatal respiratory distress syndrome was more common in the MD than in the SK group (45.2% versus 13.9%, p =.032).

CONCLUSION:

Shirodkar cerclage is associated with improved pregnancy prolongation, lower PTB rates, and better neonatal outcomes compared with McDonald cerclage. A randomized clinical trial to confirm our findings is justified.
Social Media Use, Beliefs, and Training Among Residents and Medical Students in Ob/Gyn [11O]
Authors: Stalcup Alane M. , Pak Arlene , Dotters-Katz Sarah , Gray Beverly
Published: April 2018

INTRODUCTION:

To describe social media use, beliefs about appropriate use, and training from programs and institutions among residents in obstetrics and gynecology and students entering the profession.

METHODS:

A 28-question, anonymous, online survey was distributed throughout the country to current OB/GYN residents and 4th year Medical students who matched in the specialty.

RESULTS:

Most participants (96.5%) were between the ages of 25-34 and 86.8% were female. Social media usage included Facebook (90%), Instagram (55.2%), and Snapchat (32.4%). Only 5.5% report no use of social media. While the majority check their social media outlets at least once a day (66.9%), a majority post only 1-2 times per month (56.3%). Wide variation existed in beliefs about appropriate types of postings. 97% of respondents reported being tagged in a patient post. A majority of residents reported receiving social media training from their institutions (70%) or programs (56%), but most did not know whether a formal policy existed. Only 35% were aware of the ACOG Committee Opinion on social media, but only 8% had read it. Likewise, only 17% were aware of the relevant ACOG training video, and 5% had viewed it.

CONCLUSION:

Conclusion(s): Social media use and online patient contact is ubiquitous among residents and medical students, while awareness of formal policies is not common. A diversity of opinion around appropriateness of posts exists. Given potential issues with patient privacy protection and liability issues, training in social media use should become part of residency training.
Human Papillomavirus and Vaccine Knowledge Among Health Professional Students [19O]
Authors: Ruebsamen Rebecca , Savoni Jessica , Hosseini Parastou , Dong Fanglong , Nelson Anita L.
Published: April 2018

INTRODUCTION:

Human Papillomavirus (HPV) is known to be associated with cancer, therefore, it is important that all health care team members are well educated about HPV screening and prevention. This study seeks to explore knowledge gaps among students in different health professional programs.

METHODS:

A 45-question survey was available on Google Forms from July 5 - September 1, 2017 for students in osteopathic medicine, nursing, physician assistant (PA), and pharmacy schools at Western University of Health Sciences (WesternU). Seventeen questions (yes/no answers) were used to assess knowledge of HPV. This study was approved by the Institutional Review Board at WesternU on an exempt basis.

RESULTS:

This report is based on 265 completed surveys. Two-thirds (65.2%) of respondents were women; 60.4% were age 25-29; and 81.5% were osteopathic medical students. The correct answer percentage ranged from 32.8% (when dual testing begins) to 93.6% (if vaccinated women still require Pap smears). Half (50.6%) correctly reported the recommended age for vaccination. Women were more likely to know this fact (55.2% vs. 41.3%, P=.031) and that HPV infection is usually asymptomatic (69.8% vs. 57.6%, P=.0476). Osteopathic medical students were more likely than PA students to know the HPV subtypes associated with carcinoma (65.7% vs. 42.9%, P=.003).

CONCLUSION:

There is a diverse deficit in HPV knowledge among health professional students from various programs. While post-graduate experiences may provide opportunities to close those gaps, it is important to recognize that more education is needed across programs regarding HPV testing and prevention.
Routine Use of Tranexamic Acid in Postpartum Hemorrhage: A Cost-Effectiveness Analysis [34O]
Authors: Howard Dagnie , Skeith Ashley E. , Lai Jasmine , D'Souza Rohan , Caughey Aaron B.
Published: April 2018

INTRODUCTION:

Postpartum hemorrhage (PPH) is a leading cause of pregnancy-related morbidity and mortality worldwide. Recent data has demonstrated that tranexamic acid (TXA), an antifibrinolytic agent, reduces death due to bleeding when used as a treatment for PPH. Our objective was to determine whether the routine use of TXA in the setting of PPH is cost-effective.

METHODS:

A decision analytic model was designed using TreeAge software in order to compare the outcomes and costs of TXA use in the treatment of PPH.

RESULTS:

Administration of TXA to a theoretical cohort of 100,000 women receiving usual care for PPH would prevent 403 maternal deaths due to hemorrhage and 457 laparotomies to control bleeding. This improvement in outcomes would result in an increase in 11,000 QALYs and a cost savings of $596 million. Furthermore, if TXA were administered early (within 3 hours) to the same theoretical cohort, 568 maternal deaths due to hemorrhage and 635 laparotomies would be prevented. This amounts to an increase in 16,000 QALYs and a cost savings of $842 million. Sensitivity analysis showed that the administration of TXA was the dominant strategy (lower costs, better outcomes) at all probabilities of maternal death due to hemorrhage. When the cost of TXA was varied, TXA use remained dominant up to a cost of $6,000 per administration and was cost-effective up to $16,555 (assumed cost = $50.40 per administration).

CONCLUSION:

Early administration of TXA is a cost-effective strategy for reducing maternal morbidity and mortality due to PPH.
Placental Thickness on Ultrasound and Neonatal Birthweight [35P]
Authors: Hamidi Odessa P. , Hameroff Avi , Kunselman Allen , Sinha Risha , Curtin William M. , Ural Serdar
Published: April 2018

INTRODUCTION:

Our study aims to investigate the relationship between maximal placental thickness during routine anatomy scan and birthweight at delivery.

METHODS:

This retrospective descriptive study analyzed 200 term, singleton deliveries in 2016 at Penn State Hershey Medical Center. We measured maximal placental thickness in the sagittal plane from the ultrasound images of the placenta obtained at the 18-21 weeks fetal anatomy screen. The relationship between placental thickness and neonatal birthweight was assessed using Pearson's correlation coefficient (r) with 95% confidence interval (CI). Logistic regression was used to assess the association with secondary binary outcomes of NICU admission and poor APGAR scores. Two sample T-tests were used to assess for differences attributable to medical comorbidities (pre-gestational diabetes, gestational diabetes, chronic hypertension, gestational hypertension, preeclampsia and eclampsia).

RESULTS:

Placental thickness had a positive correlation with neonatal birthweight (r=0.18, 95% CI = (0.05, 0.32)). The mean placental thickness measured 34.2 ± 9.7mm. The strength of the correlation remained similar when adjusting for gestational age (r=0.20) or excluding medical comorbidities (r=0.19). Logistic regression analysis demonstrated no association between placental thickness and NICU admission, APGAR scores <7, or medical comorbidities.

CONCLUSION:

Our ongoing study demonstrated a positive correlation between sonographic placental thickness and birthweight. Future prospective studies are warranted in order to further investigate whether a clinically significant correlation exists while adjusting for more covariates. As an abnormally thick placenta may indicate implantation problems of placental disease, another area of future study is correlation with placental pathology and adverse pregnancy outcomes.
Routine HbA1c Testing in Women Undergoing Major Gynecologic Surgery to Detect Prevalence of Glucose Intolerance [20Q]
Authors: Valant Roseanna , Ahamed Tarnima , Musa Fernanda , Chan Kent , Jimenez Edward , Chalas Eva
Published: April 2018

INTRODUCTION:

Determine the prevalence of undiagnosed diabetes, prediabetes and overall incidence of glucose intolerance in women undergoing major surgical procedures on the gynecologic oncology service.

METHODS:

Retrospective review of preoperative HbA1c levels obtained at preadmission testing in women scheduled for major gynecologic surgery at NYU Winthrop Hospital by gynecologic oncologists between July 2014 and July 2016. Exclusion criteria were lack of HbA1c within 90 days of scheduled surgery and all women undergoing minor surgical procedures. Diabetes was defined either by established diagnosis or with HbA1c ≥6.5, and prediabetes if HbA1c ranged 5.7- 6.4. Value less than 5.7 was considered normal.

RESULTS:

343 women underwent major procedures and had HbA1c levels obtained. Fifty-eight (16.9%) had a known diagnosis of diabetes, and 285 (83.1%) were presumed non-diabetics. Majority (182, 63.9%) had normal HbA1c, 86 (30.2%) were prediabetic and 17 (6%) met criteria for diabetes, for a 36.2% prevalence of abnormal glucose tolerance in presumed non-diabetics. When all 343 women were considered, the diagnosis of glucose intolerance was present in 161 (46.9%), 64.0% of whom were previously undiagnosed.

CONCLUSION:

Nearly half of the women undergoing major gynecologic surgery procedures on the oncology service had impaired glucose tolerance. The diagnosis was previously not established in 64.0%. Pre-surgical assessment of HbA1c is warranted in this high risk population.
Reduction of Vaginal Cuff Dehiscence in Total Laparoscopic Hysterectomy with use of Un-barbed Monofilament Suture [5R]
Authors: Schultze Peter , Kronbach David , Brannen Laura , Mather Tara L. , Budny Tina
Published: April 2018

INTRODUCTION:

The incidence of vaginal cuff dehiscence is higher following total laparoscopic hysterectomy (TLH) compared to vaginal and abdominal hysterectomy. Theorized factors include energy, anatomy, stitch size, and other variables. Following a rise in our dehiscence rate to above 2%, several of our surgeons switched to PDS instead of barbed suture based on clinical observations. We present the results below.

METHODS:

Vaginal cuff handling at laparoscopic hysterectomy was reconsidered. Our group performs a significant volume of relatively homogeneous TLHs. Several physicians transitioned away from a two way barbed suture closure instead using two way running #1 polydioxanone monofilament suture (#1PDS). PDS closure was performed tensioning as in abdominal or vaginal hysterectomy cuff closure. During a 6 month period the two rates of vaginal cuff separation/dehiscence following TLH were compared using the Chi-squared test.

RESULTS:

334 TLHs were included in our 6-month study. No eviscerations were noted. Separations (managed surgically or expectantly) were observed in nine out of 175 cases (9/175, 5.1%) when barbed suture was used vs zero of 159 cases when PDS suture was used (0/159, 0%, p-value .0000028).

CONCLUSION:

Etiology of observed associations of dehiscence with TLH remains unclear. Postulated solutions include optimization of amputation and cuff closure. Our data show that, in a large multispecialty gynecologic group performing high volume TLHs, dehiscence rate is reduced using PDS monofilament. Techniques employed strive to mimic abdominal hysterectomy cuff closure tension and anatomic stitch bite sizes. This study is limited by cuff closure techniques being performed by different physicians.
The Prevalence of Postnatal Depression in Women with a History of Bariatric Surgery [33R]
Authors: Kok Susan N. , Kim Sharon J. , Grothe Karen , Moore Katherine M. , Long Margaret E. , Collazo-Clavell Maria L.
Published: April 2018

INTRODUCTION:

Obesity is associated with postnatal depression; however, the prevalence of postnatal depression in women after bariatric surgery has not been further evaluated.

METHODS:

For this observational investigation, women, ages 18-45 years, with pregnancy from 1989-2015 and bariatric surgery were identified using the Olmsted County Rochester Epidemiology Project and ICD-9 codes. Those with surgery after pregnancy and/or without permission to use their records were excluded. Charts were reviewed for maternal and infant characteristics and outcomes. Postnatal depression was identified from a positive screen, referral for mood disorder, antidepressant medication increase, suicidality, or provider diagnosis from delivery to 12 months postpartum.

RESULTS:

Ninety-one women with pregnancy >23 weeks after surgery and available data were reviewed. The average body mass index at time of surgery was 47±8.6 kg/m2 (N=88) and at time of pregnancy 32±6.6 kg/m2 (N=89). The average age at surgery was 29±4.1 years and at delivery 33±4.4 years. Roux-en-Y gastric bypass was the most common surgery (N=70, 77%). Pregnancy outcomes included: 14% preterm deliveries (<37 weeks, N=13), 67% vaginal deliveries (N=61), no stillbirths, and 97% singleton deliveries (N=88). Mean singleton birthweight was 3225 grams (±471, N=86). Postnatal depression was noted in 38% of women (N=35), which is significantly higher than that for obese women in general (13-18%) when a 1-sample proportion test is conducted for comparison (38%vs18%, p <0.0001).

CONCLUSION:

Postnatal depression may be increased in women with a history of bariatric surgery. Further investigation is needed, but particular care should be taken to screen and diagnose these high-risk women.
Patient Race/Ethnicity Are Predictors for Peripartum Hysterectomy [27J]
Authors: Ryan Isa , Martin Kimberly A. , Lawson Shari M. , Martin Kristin L. , Chou Betty
Published: April 2018

INTRODUCTION:

The rate of peripartum hysterectomy (PH) is rising in the United States. Patient characteristics such as race and ethnicity have been identified as a predictor of other adverse perinatal outcomes such as preterm delivery and stillbirth. In order to determine possible predictors and disparities, different clinical and socio-economic characteristics were examined.

METHODS:

We conducted a retrospective cohort study of 9,082,034 women (weighted to represent over 43 million women) aged 12–55, who were hospitalized for childbirth using data from the National Inpatient Sample (2004–2014). We tested the association between patient race/ethnicity and receiving PH during the hospitalization, before and after adjustment for advanced age, year of hospitalization, socioeconomic and hospital-level factors, as well as other known clinical correlates of PH.

RESULTS:

In adjusted analyses, race/ethnicity remained a significant predictor of in-hospital PH for Black (OR=1.11; P<.05) and Hispanic (OR=1.18; P<.01) women compared to their white counterparts. Compared to women who are insured with an HMO or private insurance, women who are covered by Medicaid (OR 1.13) or are self pay (OR 1.23) were at statistically increased risk. Conversely, economic level, using zip code quartile as an indicator, was not a statistically significant predictor.

CONCLUSION:

Race/ethnicity has been found to be an independent predictor of PH, even after adjustment for clinical, socioeconomic and hospital factors. Future research should further investigate the reasons why certain women are at increased risk for receiving this high risk procedure, in order to develop and test interventions to improve peripartum outcomes.
The Association Between Antenatal Depressive Symptomatology and Postpartum Visit Attendance [38K]
Authors: Shim Jessica , Stark Elisabeth , Ross Carolyn , Miller Emily Stinnett
Published: April 2018

INTRODUCTION:

A comprehensive postpartum visit within the first 6 weeks after birth is recommended, however attendance remains poor. We sought to evaluate whether antenatal depression was associated with postpartum visit non-attendance.

METHODS:

This retrospective cohort study included all women who received prenatal care at the academic outpatient offices associated with a single tertiary care center between January 1, 2008, and December 31, 2014. Women were screened for antenatal depression using the Patient Health Questionnaire-9, and a score of at least 10 was used to define antenatal depressive symptomatology. Attendance at the postpartum visit was compared between women with and without antenatal depressive symptomatology using bivariable and multivariable analyses.

RESULTS:

Of the 5,127 women who met inclusion criteria, 912 (18%) did not attend the postpartum visit. Women who did not attend a postpartum visit were younger and more likely to be a racial or ethnic minority, publicly insured, or multiparous; they were also more likely to have gestational diabetes, a higher body mass index, as well as a preterm delivery. In addition, women who did not attend their postpartum visit were more likely to have experienced antenatal depressive symptomatology (29% versus 19%, P<.001). This association persisted even after controlling for potential confounders.

CONCLUSION:

Antenatal depressive symptomatology is significantly associated with non-attendance at the postpartum visit. As women with antenatal depression are at high risk for ongoing postpartum depression, future research should be directed towards measures to improve postpartum visit attendance.
Integrating Screening, Brief Intervention and Referral to Treatment for Substance Abuse Into Prenatal Care [3L]
Authors: Hostage Jean Chavez , Brock Julia , Craig Wendy , Sepulveda Debra
Published: April 2018

INTRODUCTION:

Universal screening for substance abuse during pregnancy including brief intervention and referral to treatment (SBIRT) is recommended by ACOG. Here we present the implementation of SBIRT to facilitate clinical intervention and collect data about substance abuse during prenatal care.

METHODS:

A literature-based SBIRT instrument was developed and approved by regional clinicians. An EPIC team integrated the tool into the electronic health record (EHR) and built reports to display aggregate data. SBIRT is performed by a clinical social worker in a resident clinic and at nursing intake in a separate generalist and maternal fetal medicine (MFM) practice. Data reports included substance use by parents, partners, and patient (past and present use); a positive screen was defined as a “yes” response to any question from patients screened for the first time from June 2017 to September 2017.

RESULTS:

As of September 2017, 49% and 72% of all patients were screened in the MFM and generalist practice, respectively. Forty-six percent of new patients were screened in the resident clinic. In the resident clinic, MFM, and generalist practice from June 2017 to September 2017, 43% (n=34), 41% (n=35), and 32% (n=29) screened positive, respectively. Thirty-eight percent (n=30), 10% (n=9), and 10% (n=9) reported past or present substance abuse.

CONCLUSION:

Integrating universal SBIRT into prenatal care at disparate locations using EHR requires a multi-disciplinary approach. The SBIRT tool facilitates universal, reportable substance abuse screening. The tool has been expanded to quantify use and report interventions. Future reports will characterize substance abuse in our prenatal practices and inform intervention strategies in this population.
Teaching Optimism During Pregnancy: A Possible Protective Practice Against Postpartum Depression [15L]
Authors: Strunk Miguel A. , Bachmann Gloria A.
Published: April 2018

INTRODUCTION:

Transitioning into motherhood can render women more vulnerable to anxiety and depressive symptoms. Postpartum Depression (PPD) impacts between 10% and 26% of women worldwide. Pre-existing depression and anxiety, socioeconomic status, race, ethnicity, marital status, social relationships and support systems can be predisposing factors. Depressive outlooks also have adverse physical effects on infants that appear to increase the risk of preterm births or low birth weight, as well as negatively impact the mother's relationships. This review evaluated whether optimistic practices during pregnancy may decrease the risk of postpartum depression.

METHODS:

A literature review using standard search engines retrieved 16 scholarly articles and journals devoted to mental health and postpartum depression.

RESULTS:

Data suggest that women who exhibit optimism in the antepartum period appear to be at a decreased risk of postpartum depression. Since preliminary research suggests that optimism during pregnancy may act as coping and defense mechanisms, perhaps antepartum education should focus on teaching this practice, which may result in fewer pregnant women developing PPD. In fact, optimism educational practices may have even greater efficacy if the woman has a positive outlook before she becomes pregnant.

CONCLUSION:

Optimism, which can be enhanced through education, may play a role in contributing to an overall healthy pregnancy and the postpartum experience. Clinicians should consider teaching pregnant women, the benefits of optimism. This can have great benefits not only for women faced with the possibility of postpartum depression, but also for their babies, families, and relationships.
Current and future uses of probiotics
Authors: Tanner Georgia , Matthews Kacie , Roeder Hannah , Konopasek Maggie , Bussard Adrienne , Gregory Tanya
Published: April 2018

The relationship between host and gut microbiota has been the topic of research in recent decades, with particular emphasis on various species of bacteria and their distinct role in health promotion. Early promising research led to the new term probiotic, coined to describe these beneficial bacteria. This early research has laid the foundation for various proposed mechanisms of probiotic effects on health. This article describes current areas of established probiotic use and introduces areas of current investigation, including psychobiotics, which may help patients suffering from psychiatric illness.
Fighting Night-Shift Fatigue
Authors: Potera Carol
Published: April 2018

Short naps revive nurses.
Young Single Mothers Benefit from the Affordable Care Act
Authors: Sofer Dalia
Published: April 2018

But a study shows uneven results in birth outcomes.
New Radiopharmaceutical Approved to Treat Rare Digestive Tract Cancer
Authors: Aschenbrenner Diane S.
Published: April 2018

Lutathera (lutetium Lu 177 dotatate), a new iv radioactive drug, has been approved to treat gastroenteropancreatic neuroendocrine tumors.

Common adverse effects of Lutathera include lymphopenia; high levels of the enzymes gamma-glutamyltransferase, alanine transaminase, and aspartate transaminase (indicators of impaired liver function); vomiting; nausea; hyperglycemia; and hypokalemia.
Low-Molecular-Weight Heparin or Heparinoids vs. Unfractionated Heparin in Acute Ischemic Stroke
Authors: Newsom Cresilda T.
Published: April 2018

Editor's note: This is a summary of a nursing care–related systematic review from the Cochrane Library. For more information, see http://nursingcare.cochrane.org.
Nurses at the Top
Authors: Szulecki Diane
Published: April 2018

Regina Cunningham and Kevin Sowers head two of the nation's leading health care institutions.
Urine Reagent Strips Are Inaccurate for Assessing Hypohydration: A Brief Report
Authors: Adams J.D. , Capitan-Jiménez Catalina , Huggins Robert A. , Casa Douglas J. , Mauromoustakos Andy , Kavouras Stavros A.
Published: April 2018

Objective:

To assess the diagnostic ability of urine reagent strips to identify hypohydration based on urine specific gravity (USG).

Design:

This study examined the agreement of USG between strips and refractometry with Bland–Altman, whereas the diagnostic ability of the strips to assess hypohydration was performed by receiver operating characteristic analysis.

Setting:

Arkansas high school football preseason practice.

Participants:

Four hundred fourteen fresh urine samples were analyzed.

Main Outcome Measures:

Urine specific gravity was assessed by both reagent strips and refractometry. Cutoffs of >1.020 and >1.025 were used for identifying hypohydration.

Results:

Bland–Altman analysis showed agreement of the 2 methods. Overall diagnostic ability of the urine strip to identify hypohydration was fair (area under the curve 72%-78%). However, the sensitivity to correctly identify hypohydration was poor (63%-71%), and the specificity of correctly identifying euhydration was poor to fair (68%-83%).

Conclusion:

The urine strip method is not valid for assessing hypohydration.